Background:Over the past few decades,a threefold increase in obesity and type 2 diabetes(T2D)has placed a heavy burden on the health-care system and society.Previous studies have shown correlations between obesity,T2D...Background:Over the past few decades,a threefold increase in obesity and type 2 diabetes(T2D)has placed a heavy burden on the health-care system and society.Previous studies have shown correlations between obesity,T2D,and neurodegenera-tive diseases,including dementia.It is imperative to further understand the relation-ship between obesity,T2D,and cognitive deficits.Methods:This investigation tested and evaluated the cognitive impact of obesity and T2D induced by high-fat diet(HFD)and the effect of the host genetic background on the severity of cognitive decline caused by obesity and T2D in collaborative cross(CC)mice.The CC mice are a genetically diverse panel derived from eight inbred strains.Results:Our findings demonstrated significant variations in the recorded phenotypes across different CC lines compared to the reference mouse line,C57BL/6J.CC037 line exhibited a substantial increase in body weight on HFD,whereas line CC005 ex-hibited differing responses based on sex.Glucose tolerance tests revealed significant variations,with some lines like CC005 showing a marked increase in area under the curve(AUC)values on HFD.Organ weights,including brain,spleen,liver,and kidney,varied significantly among the lines and sexes in response to HFD.Behavioral tests using the Morris water maze indicated that cognitive performance was differentially affected by diet and genetic background.Conclusions:Our study establishes a foundation for future quantitative trait loci map-ping using CC lines and identifying genes underlying the comorbidity of Alzheimer's disease(AD),caused by obesity and T2D.The genetic components may offer new tools for early prediction and prevention.展开更多
BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(H...BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(HbA1c)reflects persistent hyperglycemia and serves as a key indicator of long-term glycemic control in T2DM.Although both factors have been individually linked to neurobehavioral deficits,it remains uncertain whether HbA1c contributes to APOE4-related cognitive and olfactory impairment in individuals with T2DM.AIM To investigate the role of HbA1c in APOE4-associated cognitive and olfactory dysfunction in patients with T2DM.METHODS Of 636 T2DM patients were recruited from five medical centers in Wuhan,Hubei Province,China.APOE genotyping was evaluated by polymerase chain reaction using Gerard’s method.Cognitive and olfactory functions were assessed by mini-mental state examination and Connecticut chemosensory clinical research center test,respectively.Regression analysis was employed to assess the independent and interactive effects of HbA1c on APOE4-associated cognitive and olfactory function.RESULTS APOE4 was associated with increased risks of cognitive impairment[odds ratios(OR)=1.815,P=0.021]and olfactory dysfunction(OR=2.588,P<0.001).Higher HbA1c levels were also related to worse cognitive(OR=1.189,P<0.001)and olfactory performance(OR=1.149,P=0.011).HbA1c exerted a moderating effect,yet not a mediating effect,between APOE4 and its impacts on cognition and olfaction.Specifically,a higher level of HbA1c exacerbated the damaging effect of APOE4,as shown by significant interaction effects on both cognitive impairment(OR=2.687,P<0.001)and olfactory dysfunction(OR=1.440,P=0.027).CONCLUSION Elevated HbA1c levels are associated with increased risks of cognitive and olfactory impairments in patients with T2DM and may exacerbate the detrimental effects of APOE4.These findings underscore the need for early preventive strategies targeting individuals with both poor glycemic control and APOE4 carriage to mitigate neurodegenerative risk.展开更多
Identifying a potential dietary non-pharmacological treatment to prevent cerebrovascular damage in Alzheimer's disease is crucial for alleviating cognitive decline in older adults and enhancing quality of life.Thi...Identifying a potential dietary non-pharmacological treatment to prevent cerebrovascular damage in Alzheimer's disease is crucial for alleviating cognitive decline in older adults and enhancing quality of life.This study featured the combined supplementation of soy lecithin(SL)and soy isoflavones(SIF),using in vivo animal models,in vitro vascular ring preparation,and cell studies to investigate the potential advantages and mechanisms of SL combined with SIF on cognitive function and cerebrovascular health from multiple perspectives.The results show that Aβcan significantly induce learning and memory impairment in rats,as well as pathological changes in brain blood vessels,exacerbating damage to cerebral vasodilation function and subsequently reducing cerebral blood flow in the brain.The above-mentioned phenomena induced by Aβcan be significantly improved by the combined intervention of SL and SIF.Further research has revealed that the combined intervention of SL and SIF can reverse the downregulation of the PI3K/PIP3/PDK-1/Akt/eNOS signaling pathway and phosphorylated protein expression induced by Aβin rat brain vascular tissues and bEND.3 cells.Silencing PDK-1 expression in bEND.3 cells showed that the upregulation effect of SL and SIF on Akt and eNOS disappeared.Here we find that prophylactically supplementation with SL in conjunction with SIF appears to effectively activate the PI3K/PIP3/PDK-1/Akt/e NOS pathway within cerebral vascular.This activation improves cerebrovascular vasodilation,offering potential protective effects for both cerebral vascular health and cognitive function.展开更多
The massive connectivity and limited energy pose significant challenges to deploy the enormous devices in energy-efficient and environmentally friendly in the Internet of Things(IoT).Motivated by these challenges,this...The massive connectivity and limited energy pose significant challenges to deploy the enormous devices in energy-efficient and environmentally friendly in the Internet of Things(IoT).Motivated by these challenges,this paper investigates the energy efficiency(EE)maximization problem for downlink cooperative non-orthogonal multiple access(C-NOMA)systems with hardware impairments(HIs).The base station(BS)communicates with several users via a half-duplex(HD)amplified-and-forward(AF)relay.First,we formulate the EE maximization problem of the system under HIs by jointly optimizing transmit power and power allocated coefficient(PAC)at BS,and transmit power at the relay.The original EE maximization problem is a non-convex problem,which is challenging to give the optimal solution directly.First,we use fractional programming to convert the EE maximization problem as a series of subtraction form subproblems.Then,variable substitution and block coordinate descent(BCD)method are used to handle the sub-problems.Next,a resource allocation algorithm is proposed to maximize the EE of the systems.Finally,simulation results show that the proposed algorithm outperforms the downlink cooperative orthogonal multiple access(C-OMA)scheme.展开更多
The Internet of Vehicles(IoV)will carry a large amount of security and privacy-related data,which makes the secure communication between the IoV terminals increasingly critical.This paper studies the joint beamforming...The Internet of Vehicles(IoV)will carry a large amount of security and privacy-related data,which makes the secure communication between the IoV terminals increasingly critical.This paper studies the joint beamforming for physical-layer security transmission in the coexistence of Vehicle-to-Infrastructure(V2I)and Vehicle-toVehicle(V2V)communication with Reconfigurable Intelligent Surface(RIS)assistance,taking into account hardware impairments.A communication model for physical-layer security transmission is established when the eavesdropping user is present and the base station antenna has hardware impairments assisted by RIS.Based on this model,we propose to maximize the V2I physical-layer security transmission rate.To solve the coupled non-convex optimization problem,an alternating optimization algorithm based on second-order cone programming and semidefinite relaxation is proposed to obtain the optimal V2I base station transmit precoding and RIS reflect phase shift matrix.Finally,simulation results are presented to verify the convergence and superiority of our proposed algorithm while analyzing the impact of system parameters on the V2I physical-layer security transmission rate.The simulation results further demonstrate that the proposed robust beamforming algorithm considering hardware impairments will achieve an average performance improvement of 0.7 dB over a non-robustly designed algorithm.Furthermore,increasing the number of RIS reflective units from 10 to 50 results in an almost 2 dB enhancement in secure transmission rate.展开更多
Alzheimer's disease(AD)is a progressive neurodegenerative disease characterized by the deposition of amyloid-β(Aβ),neurofibrillary tangles,neuroinflammation,and neurodegeneration in the brain.In recent years,con...Alzheimer's disease(AD)is a progressive neurodegenerative disease characterized by the deposition of amyloid-β(Aβ),neurofibrillary tangles,neuroinflammation,and neurodegeneration in the brain.In recent years,considering the unsatisfied benefits of pharmacological therapies,non-pharmacological therapy has become a research hotspot for AD intervention.Terahertz(THz)waves with a range between microwave and infrared regions in the electromagnetic spectrum and high permeability to a wide range of materials have great potential in the bioengineering field.However,its biological impacts on the central nervous system,under either physiological or pathological conditions,are poorly investigated.In this study,we first measured the 0.14 THz waves penetration across the skull of a C57BL/6 mouse and found the percentage of THz penetration to be~70%,guaranteeing that THz waves can reach the relevant brain regions.We then exposed the APPSWE/PS1DE9 mouse model of AD to repeated low-frequency THz waves on the head.We demonstrated that THz waves treatment significantly improved the cognitive impairment and alleviated AD neuropathology including Aβdeposition and tau hyperphosphorylation in the AD mice.Moreover,THz waves treatment effectively attenuated mitochondrial impairment,neuroinflammation,and neuronal loss in the AD mouse brain.Our findings reveal previously unappreciated beneficial effects of THz waves treatment in AD and suggest that THz waves may have the potential to be used as a novel therapeutic intervention for this devastating disease.展开更多
BACKGROUND Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder(MDD).Understanding their relationships is crucial for developing targeted interventio...BACKGROUND Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder(MDD).Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients.We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments.We also hypothesize that anxiety symptoms,especially psychic anxiety,is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors.AIM To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode.METHODS A comprehensive neurocognitive test battery assessed executive function,attention,processing speed,and memory in 162 medication-free MDD patients and 142 matched healthy controls.The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms,and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms.Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms,as well as their interactions,on cognitive impairments.RESULTS Among the depressive symptoms,sleep disturbances were associated with poorer executive function(P=0.004),lower processing speed(P=0.047),and memory impairments(P<0.001),and psychomotor retardation(PR)was associated with lower processing speed in patients with MDD(P=0.019).Notably,PR was found to mediate the impact of sleep disturbances on the processing speed.Regarding anxiety symptoms,psychic anxiety,rather than somatic anxiety,was associated with cognitive impairments in all aspects.Sleep disturbances mediated the effect of psychic anxiety on executive function[β=-0.013,BC CI(-0.027,-0.001)]and memory[β=-0.149,BC CI(-0.237,-0.063)],while PR mediated its effect on processing speed(β=-0.023,BC CI(-0.045,-0.004)].CONCLUSION Sleep disturbances may be a key predictor of poorer executive function,lower processing speed,and memory loss,while PR is crucial for lower processing speed during a depressive episode.Psychic anxiety contributes to all aspects of cognitive impairments,mediated by sleep disturbances and PR.展开更多
Cognitive impairment is the main clinical manifestation of Alzheimer's disease(AD),and amyloid-β(AB)deposition and senile plaques are the characteristic neuropathological hallmarks in AD brains.This study aimed t...Cognitive impairment is the main clinical manifestation of Alzheimer's disease(AD),and amyloid-β(AB)deposition and senile plaques are the characteristic neuropathological hallmarks in AD brains.This study aimed to explore the effect and mechanism of tetrahydroxy stilbene glucoside(TSG)on cognitive function in APP/PS 1 mice during long-term administration.Here,we treated APP/PS1 model mice of AD with different doses of TSG(50 mg/kg and 100 mg/kg)for 5 to 17 months by gavage,and we further observed whether TSG could ameliorate the cognitive decline in APP/PS1 mice using behavioral tests,and investigated the possible mechanisms by immunohistochemistry and Western blotting.Our results showed that TSG treatment rescued the spatial and non-spatial learning and memory impairments of APP/PS1 mice at Morris water maze test and novel object recognition test.Furthermore,Aβ40/42 deposition in the cortex and hippocampus of APP/PS1 mice treated with TSG was significantly reduced compared to the wild type mice using the immunohistochemical technique.Finally,Western blotting showed that TSG primarily decreased the APP expression to avoid the Aβplaque deposition in the cortex and hippocampus of mice.These results reveal the beneficial effects of TSG in APP/PSI-AD mice,which may be associated with the reduction of Aβdeposits in the brain.展开更多
In this paper,the spectral efficiency(SE)of an uplink hardware-constrained cell-free massive multi-input multi-output(MIMO)system with maximal ratio combining(MRC)receiver filters in the context of superimposed pilots...In this paper,the spectral efficiency(SE)of an uplink hardware-constrained cell-free massive multi-input multi-output(MIMO)system with maximal ratio combining(MRC)receiver filters in the context of superimposed pilots(SPs)is investigated.Tractable closed-form SE expressions for the considered system are derived,which share us with opportunities to explore the impacts of the hardware quality coefficient,the length of coherence interval,and the power balance factor between pilot and data signals.Numerical results indicate that the achievable SE deteriorates as the hardware quality decreases and is more susceptible to the hardware impairments at the user equipments(UEs).Besides,we observe that SPs outperform regular pilots(RPs)in terms of SE and this performance gain is heavily dependent on the values of power balance factor and coherence interval.However,the superiorities of SPs over RPs have vanished when severe hardware imperfections are considered.展开更多
This paper investigates the system outage performance of a simultaneous wireless information and power transfer(SWIPT)based two-way decodeand-forward(DF)relay network,where potential hardware impairments(HIs)in all tr...This paper investigates the system outage performance of a simultaneous wireless information and power transfer(SWIPT)based two-way decodeand-forward(DF)relay network,where potential hardware impairments(HIs)in all transceivers are considered.After harvesting energy and decoding messages simultaneously via a power splitting scheme,the energy-limited relay node forwards the decoded information to both terminals.Each terminal combines the signals from the direct and relaying links via selection combining.We derive the system outage probability under independent but non-identically distributed Nakagami-m fading channels.It reveals an overall system ceiling(OSC)effect,i.e.,the system falls in outage if the target rate exceeds an OSC threshold that is determined by the levels of HIs.Furthermore,we derive the diversity gain of the considered network.The result reveals that when the transmission rate is below the OSC threshold,the achieved diversity gain equals the sum of the shape parameter of the direct link and the smaller shape parameter of the terminalto-relay links;otherwise,the diversity gain is zero.This is different from the amplify-and-forward(AF)strategy,under which the relaying links have no contribution to the diversity gain.Simulation results validate the analytical results and reveal that compared with the AF strategy,the SWIPT based two-way relaying links under the DF strategy are more robust to HIs and achieve a lower system outage probability.展开更多
Aim To investigate whether tluoxetine, a selective serotonin reuptake inhibitor（ SSRI） , could amelio- rate cognitive impairments induced by chronic cerebral hypopeffusion in rats and to clarify the underlying mecha...Aim To investigate whether tluoxetine, a selective serotonin reuptake inhibitor（ SSRI） , could amelio- rate cognitive impairments induced by chronic cerebral hypopeffusion in rats and to clarify the underlying mecha- nisms of its efficacy. Methods Rats were subjected to permanent bilateral occlusion of the common carotid arteries （two-vessel occlusion, 2VO）. Two weeks later, rats were treated with 30 mg · kg^-1 fluoxetine （intragastric injec- tion, i. g. ） for 6 weeks. Cognitive function was evaluated by Morris water maze （MWM） and novel objects recog- nition （NOR） test. Long-term potentiation （LTP） was used to address the underlying synaptic mechanisms. West- ern blot was used to quantify the protein levels. Results Fluoxetine treatment significantly improved the cognitive 2VO impairments caused by 2VO, accompanied with a reversion of 2VO-induced inhibitory of LTP. Furthermore, caused an up-regulation of hyperpolarization-activated cyclic nueleotide-gated channel 2 （HCN2） surface expres- sions in the hippocampal CA1 area and fluoxetine also effectively recovered the up-regulation of HCN2 surface ex- pressions. Conclusion Fluoxetine can ameliorate cognitive impairments induced by chronic cerebral hypopeffusion and a possible mechanism may via down-regulating HCN2 surface expression in the Hippocampal CA1 area.展开更多
Hardware impairments(HI)are always present in low-cost wireless devices.This paper investigates the outage behaviors of intelligent reflecting surface(IRS)assisted non-orthogonal multiple access(NOMA)networks by takin...Hardware impairments(HI)are always present in low-cost wireless devices.This paper investigates the outage behaviors of intelligent reflecting surface(IRS)assisted non-orthogonal multiple access(NOMA)networks by taking into account the impact of HI.Specifically,we derive the approximate and asymptotic expressions of the outage probability for the IRS-NOMA-HI networks.Based on the asymptotic results,the diversity orders under perfect self-interference cancellation and imperfect self-interference cancellation scenarios are obtained to evaluate the performance of the considered network.In addition,the system throughput of IRS-NOMA-HI is discussed in delay-limited mode.The obtained results are provided to verify the accuracy of the theoretical analyses and reveal that:1)The outage performance and system throughput for IRS-NOMA-HI outperforms that of the IRS-assisted orthogonal multiple access-HI(IRS-OMA-HI)networks;2)The number of IRS elements,the pass loss factors,the Rician factors,and the value of HI are pivotal to enhancing the performance of IRS-NOMAHI networks;and 3)It is recommended that effective methods of reducing HI should be used to ensure system performance,in addition to self-interference cancellation techniques.展开更多
In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy...In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy outage probability is obtained.Moreover,to get more information on the secrecy outage probability in a high signalto-noise regime,the asymptotic analysis along with the secrecy diversity order and secrecy coding gain for the secrecy outage probability are also further obtained,which presents a fast method to evaluate the impact of system parameters and hardware impairments on the considered network.Finally,Monte Carlo simulation results are provided to show the efficiency of the theoretical analysis.展开更多
The purpose of this study was to investigate the dimensions and conditions caused by shifts in nurses who worked in constant shifts in non-governmental selective hospitals in Tehran in 2014. In this cross-sectional an...The purpose of this study was to investigate the dimensions and conditions caused by shifts in nurses who worked in constant shifts in non-governmental selective hospitals in Tehran in 2014. In this cross-sectional and applied research, the shifts standard questionnaire was used. After confirming the validity and reliability (Cronbach’s alpha 0.73), the questionnaires were distributed among 305 nurses of 6 non-governmental selective hospitals in Tehran, based on stratified random sampling. In the research, the data analysis was conducted in two levels of descriptive and inferential statistics. The response rate was 0.91. 74.4% of the participant nurses were female and 25.6% were male. The results showed that there was a significant relationship between age and physical health (P = 0.008), gender and physical health (P = 0.015), education and health (P = 0.014), gender and physical-cognitive anxiety (P = 0.006), age and social-familial status (P = 0.001), Marital status and social-familial status (P = 0.001), having a second job and social-familial status (P = 0.001), education and sleep-fatigue (P = 0.002). Planning with respect to standards of nurses’ working hours and avoiding overtime, especially nurses who have more experience, can prevent severe complications of shifts and improve health level and ultimately the quality of care.展开更多
Globally, the population is living longer and by 2050, it is predicted to reach 2.1 billion people. Sensory and cognitive impairments are common long-term conditions among older Europeans and have considerable functio...Globally, the population is living longer and by 2050, it is predicted to reach 2.1 billion people. Sensory and cognitive impairments are common long-term conditions among older Europeans and have considerable functional, social, emotional and economic impacts on the individual and those caring for them. Nurses have frequent encounters with patients with these impairments and are expected to prioritise people, assess their needs and accommodate practice to meet these needs. In order to develop the requisite knowledge and understanding to support people living with these impairments, student nurses require an immersive and experiential approach to learning as opposed to just information transfer. This study reports on a cross-sectional analysis of a low fidelity simulation on sensory impairments as part of a wider dementia curriculum in semester one of the undergraduate nursing programme at the University of Highlands and Islands. Findings from an online questionnaire-based survey and content analysis of free text responses revealed that students found the simulation activities critical for gaining subject knowledge, understanding and insight. This study concluded that low-fidelity simulation of sensory/cognitive impairments, within the context of a broader curriculum of supportive activities, can be effective at developing relevant knowledge, understanding and gaining insights in this subject area among undergraduate nursing students.展开更多
As all-optical networks grow with ever increasing ultra-high speed,the communication quality suffers seriously from physical layer impairments( PLIs). The same problem still exists in software defined optical network(...As all-optical networks grow with ever increasing ultra-high speed,the communication quality suffers seriously from physical layer impairments( PLIs). The same problem still exists in software defined optical network( SDON) controlled by OpenFlow. Aimed to solve this problem,a PLIs tolerance based lightpath provision scheme is proposed for OpenFlow controlled optical networks. This proposed approach not only takes the OSNR model to represent those linear PLIs factors,but also introduces those nonlinear factors into the OSNR model. Thus,the proposed scheme is able to cover most PLIs factors of each optical link and conduct optical lightpath provison with better communication quality. Moreover,PLIs tolerance model is also set up and considered in this work with some necessary extension to OpenFlow protocols to achieve better compatibility between physical layer impairments factors and various services connections. Simulation results show that the proposed scheme is able to get better performance in terms of packet loss rate and connection setup time.展开更多
Male infertility is a complex reproductive disorder that impedes a huge number of couples from having children naturally in the world(Agarwal et al.,2021).As an important pathogenic factor of male infertility,spermato...Male infertility is a complex reproductive disorder that impedes a huge number of couples from having children naturally in the world(Agarwal et al.,2021).As an important pathogenic factor of male infertility,spermatogenic impairments are mainly characterized by impaired male gamete production,reduced sperm quality,or function(Tournaye et al.,2017).Spermatogenesis is a delicate and complex biological process that requires the collaboration of a large number of proteins performing different biological functions(Liu et al.,2021).展开更多
Is physical fatigue one of the major causes of motor vehicle accidents？ Our study results challenged this traditional belief, and indicated that motor vehicle induced whole body vibration （WBV） is the actual cause....Is physical fatigue one of the major causes of motor vehicle accidents？ Our study results challenged this traditional belief, and indicated that motor vehicle induced whole body vibration （WBV） is the actual cause. In this study, rats were subjected to simulated WBV. After 2 weeks all rats were evaluated by multiple physiological tests. Results indicated that WBV for short periods impaired the animal＇s mental judgment capabilities as well as sensory and motor functions. The primary reason for this is that WBV caused vasoconstriction, which decreased the cerebral blood flow as shown by Doppler imaging. This reduction in blood flow impaired the animal＇s ability to run a maze. Nerve functions were affected as well. This was shown by a reduction in nerve conduction velocity （NCV）. An increase in tail flick and Von Frey withdrawal times showed sensory deficits. Grip strength was also reduced. 4F （human apolipoprotein A-I molecule mimetic） conditioning has shown preventive effects against WBV injury as indicated by the above functional tests. This animal model simulated the most common motor vehicle travel vibration and validated the biological cause and mechanism of physiological impairment from WBV, which can be translated into a practical application for motor vehicle accident prevention.展开更多
Background: The use of anticholinergics has been on the rise. With the increase in population longevity, more medication-related cognitive impairments (ACIs) have been reported. These impairments result in significant...Background: The use of anticholinergics has been on the rise. With the increase in population longevity, more medication-related cognitive impairments (ACIs) have been reported. These impairments result in significant morbidities. We present a case that stresses on the importance of being vigilant when prescribing anticholinergic medications, especially in the elderlies. Case Report: A case of ACIs related to the use of tiotropium bromide/olodaterol (Stiolto Respimat) is being reported in a 71-year-old white man with COPD. Treatment with budesonide 180 mcg/actuation, and tiotropium bromide/olodaterol (Stiolto Respimat) inhalers was initiated. Two days after initiating treatment, the patient developed ACIs which manifested by gait imbalance, short-term memory dysfunction, inability to remember his family members, or to take his medications. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued. After three days, a full recovery of ACIs was reported. A month later, due to worsening dyspnea, the patient self-resumed the medicine. Similar ACIs were reported within two days of resuming treatment. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued indefinitely. Full recovery of ACIs was reported. Conclusion: ACIs should be noted as a significant side effect of tiotropium bromide/olodaterol. Clinicians should be vigilant, when prescribing anticholinergic medications to elderlies.展开更多
文摘Background:Over the past few decades,a threefold increase in obesity and type 2 diabetes(T2D)has placed a heavy burden on the health-care system and society.Previous studies have shown correlations between obesity,T2D,and neurodegenera-tive diseases,including dementia.It is imperative to further understand the relation-ship between obesity,T2D,and cognitive deficits.Methods:This investigation tested and evaluated the cognitive impact of obesity and T2D induced by high-fat diet(HFD)and the effect of the host genetic background on the severity of cognitive decline caused by obesity and T2D in collaborative cross(CC)mice.The CC mice are a genetically diverse panel derived from eight inbred strains.Results:Our findings demonstrated significant variations in the recorded phenotypes across different CC lines compared to the reference mouse line,C57BL/6J.CC037 line exhibited a substantial increase in body weight on HFD,whereas line CC005 ex-hibited differing responses based on sex.Glucose tolerance tests revealed significant variations,with some lines like CC005 showing a marked increase in area under the curve(AUC)values on HFD.Organ weights,including brain,spleen,liver,and kidney,varied significantly among the lines and sexes in response to HFD.Behavioral tests using the Morris water maze indicated that cognitive performance was differentially affected by diet and genetic background.Conclusions:Our study establishes a foundation for future quantitative trait loci map-ping using CC lines and identifying genes underlying the comorbidity of Alzheimer's disease(AD),caused by obesity and T2D.The genetic components may offer new tools for early prediction and prevention.
基金Supported by the China Postdoctoral Science Foundation General Program,No.2024M762504the Intramural Research Program of Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,No.2023 LYYYGZRP0004.
文摘BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(HbA1c)reflects persistent hyperglycemia and serves as a key indicator of long-term glycemic control in T2DM.Although both factors have been individually linked to neurobehavioral deficits,it remains uncertain whether HbA1c contributes to APOE4-related cognitive and olfactory impairment in individuals with T2DM.AIM To investigate the role of HbA1c in APOE4-associated cognitive and olfactory dysfunction in patients with T2DM.METHODS Of 636 T2DM patients were recruited from five medical centers in Wuhan,Hubei Province,China.APOE genotyping was evaluated by polymerase chain reaction using Gerard’s method.Cognitive and olfactory functions were assessed by mini-mental state examination and Connecticut chemosensory clinical research center test,respectively.Regression analysis was employed to assess the independent and interactive effects of HbA1c on APOE4-associated cognitive and olfactory function.RESULTS APOE4 was associated with increased risks of cognitive impairment[odds ratios(OR)=1.815,P=0.021]and olfactory dysfunction(OR=2.588,P<0.001).Higher HbA1c levels were also related to worse cognitive(OR=1.189,P<0.001)and olfactory performance(OR=1.149,P=0.011).HbA1c exerted a moderating effect,yet not a mediating effect,between APOE4 and its impacts on cognition and olfaction.Specifically,a higher level of HbA1c exacerbated the damaging effect of APOE4,as shown by significant interaction effects on both cognitive impairment(OR=2.687,P<0.001)and olfactory dysfunction(OR=1.440,P=0.027).CONCLUSION Elevated HbA1c levels are associated with increased risks of cognitive and olfactory impairments in patients with T2DM and may exacerbate the detrimental effects of APOE4.These findings underscore the need for early preventive strategies targeting individuals with both poor glycemic control and APOE4 carriage to mitigate neurodegenerative risk.
基金supported by the National Natural Science Foundation of China(82273620,81302427)。
文摘Identifying a potential dietary non-pharmacological treatment to prevent cerebrovascular damage in Alzheimer's disease is crucial for alleviating cognitive decline in older adults and enhancing quality of life.This study featured the combined supplementation of soy lecithin(SL)and soy isoflavones(SIF),using in vivo animal models,in vitro vascular ring preparation,and cell studies to investigate the potential advantages and mechanisms of SL combined with SIF on cognitive function and cerebrovascular health from multiple perspectives.The results show that Aβcan significantly induce learning and memory impairment in rats,as well as pathological changes in brain blood vessels,exacerbating damage to cerebral vasodilation function and subsequently reducing cerebral blood flow in the brain.The above-mentioned phenomena induced by Aβcan be significantly improved by the combined intervention of SL and SIF.Further research has revealed that the combined intervention of SL and SIF can reverse the downregulation of the PI3K/PIP3/PDK-1/Akt/eNOS signaling pathway and phosphorylated protein expression induced by Aβin rat brain vascular tissues and bEND.3 cells.Silencing PDK-1 expression in bEND.3 cells showed that the upregulation effect of SL and SIF on Akt and eNOS disappeared.Here we find that prophylactically supplementation with SL in conjunction with SIF appears to effectively activate the PI3K/PIP3/PDK-1/Akt/e NOS pathway within cerebral vascular.This activation improves cerebrovascular vasodilation,offering potential protective effects for both cerebral vascular health and cognitive function.
基金partially supported by the National Natural Science Foundation of China under Grant 61701064Chongqing Natural Science Foundation under Grant cstc2019jcyj-msxmX0264Sichuan Science and Technology Program under Grant 2022YFQ0017。
文摘The massive connectivity and limited energy pose significant challenges to deploy the enormous devices in energy-efficient and environmentally friendly in the Internet of Things(IoT).Motivated by these challenges,this paper investigates the energy efficiency(EE)maximization problem for downlink cooperative non-orthogonal multiple access(C-NOMA)systems with hardware impairments(HIs).The base station(BS)communicates with several users via a half-duplex(HD)amplified-and-forward(AF)relay.First,we formulate the EE maximization problem of the system under HIs by jointly optimizing transmit power and power allocated coefficient(PAC)at BS,and transmit power at the relay.The original EE maximization problem is a non-convex problem,which is challenging to give the optimal solution directly.First,we use fractional programming to convert the EE maximization problem as a series of subtraction form subproblems.Then,variable substitution and block coordinate descent(BCD)method are used to handle the sub-problems.Next,a resource allocation algorithm is proposed to maximize the EE of the systems.Finally,simulation results show that the proposed algorithm outperforms the downlink cooperative orthogonal multiple access(C-OMA)scheme.
基金the Key Research and Development Plan of Jiangsu Province,grant number BE2020084-2the National Key Research and Development Program of China,grant number 2020YFB1600104.
文摘The Internet of Vehicles(IoV)will carry a large amount of security and privacy-related data,which makes the secure communication between the IoV terminals increasingly critical.This paper studies the joint beamforming for physical-layer security transmission in the coexistence of Vehicle-to-Infrastructure(V2I)and Vehicle-toVehicle(V2V)communication with Reconfigurable Intelligent Surface(RIS)assistance,taking into account hardware impairments.A communication model for physical-layer security transmission is established when the eavesdropping user is present and the base station antenna has hardware impairments assisted by RIS.Based on this model,we propose to maximize the V2I physical-layer security transmission rate.To solve the coupled non-convex optimization problem,an alternating optimization algorithm based on second-order cone programming and semidefinite relaxation is proposed to obtain the optimal V2I base station transmit precoding and RIS reflect phase shift matrix.Finally,simulation results are presented to verify the convergence and superiority of our proposed algorithm while analyzing the impact of system parameters on the V2I physical-layer security transmission rate.The simulation results further demonstrate that the proposed robust beamforming algorithm considering hardware impairments will achieve an average performance improvement of 0.7 dB over a non-robustly designed algorithm.Furthermore,increasing the number of RIS reflective units from 10 to 50 results in an almost 2 dB enhancement in secure transmission rate.
基金supported by the National Natural Science Foundation of China(32220103006 and 82271524).
文摘Alzheimer's disease(AD)is a progressive neurodegenerative disease characterized by the deposition of amyloid-β(Aβ),neurofibrillary tangles,neuroinflammation,and neurodegeneration in the brain.In recent years,considering the unsatisfied benefits of pharmacological therapies,non-pharmacological therapy has become a research hotspot for AD intervention.Terahertz(THz)waves with a range between microwave and infrared regions in the electromagnetic spectrum and high permeability to a wide range of materials have great potential in the bioengineering field.However,its biological impacts on the central nervous system,under either physiological or pathological conditions,are poorly investigated.In this study,we first measured the 0.14 THz waves penetration across the skull of a C57BL/6 mouse and found the percentage of THz penetration to be~70%,guaranteeing that THz waves can reach the relevant brain regions.We then exposed the APPSWE/PS1DE9 mouse model of AD to repeated low-frequency THz waves on the head.We demonstrated that THz waves treatment significantly improved the cognitive impairment and alleviated AD neuropathology including Aβdeposition and tau hyperphosphorylation in the AD mice.Moreover,THz waves treatment effectively attenuated mitochondrial impairment,neuroinflammation,and neuronal loss in the AD mouse brain.Our findings reveal previously unappreciated beneficial effects of THz waves treatment in AD and suggest that THz waves may have the potential to be used as a novel therapeutic intervention for this devastating disease.
基金Supported by National Key Research and Development Program of China,No.2019YFA0706200National Natural Science Foundation of China,No.82301738Natural Science Foundation of Hunan Province,No.2022JJ40701 and No.2022JJ40697.
文摘BACKGROUND Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder(MDD).Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients.We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments.We also hypothesize that anxiety symptoms,especially psychic anxiety,is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors.AIM To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode.METHODS A comprehensive neurocognitive test battery assessed executive function,attention,processing speed,and memory in 162 medication-free MDD patients and 142 matched healthy controls.The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms,and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms.Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms,as well as their interactions,on cognitive impairments.RESULTS Among the depressive symptoms,sleep disturbances were associated with poorer executive function(P=0.004),lower processing speed(P=0.047),and memory impairments(P<0.001),and psychomotor retardation(PR)was associated with lower processing speed in patients with MDD(P=0.019).Notably,PR was found to mediate the impact of sleep disturbances on the processing speed.Regarding anxiety symptoms,psychic anxiety,rather than somatic anxiety,was associated with cognitive impairments in all aspects.Sleep disturbances mediated the effect of psychic anxiety on executive function[β=-0.013,BC CI(-0.027,-0.001)]and memory[β=-0.149,BC CI(-0.237,-0.063)],while PR mediated its effect on processing speed(β=-0.023,BC CI(-0.045,-0.004)].CONCLUSION Sleep disturbances may be a key predictor of poorer executive function,lower processing speed,and memory loss,while PR is crucial for lower processing speed during a depressive episode.Psychic anxiety contributes to all aspects of cognitive impairments,mediated by sleep disturbances and PR.
基金supported by grants from the National Natural Science Foundation of China(No.81803537)the"Major New Drug Creation"of Major Science and Technology Project(No.2015ZX09101-016)+1 种基金Capital Science and Technology Leading Talent Training Project(No.Z191100006119017)Beijing Hospitals Authority Ascent Plan(No.DFL20190803)。
文摘Cognitive impairment is the main clinical manifestation of Alzheimer's disease(AD),and amyloid-β(AB)deposition and senile plaques are the characteristic neuropathological hallmarks in AD brains.This study aimed to explore the effect and mechanism of tetrahydroxy stilbene glucoside(TSG)on cognitive function in APP/PS 1 mice during long-term administration.Here,we treated APP/PS1 model mice of AD with different doses of TSG(50 mg/kg and 100 mg/kg)for 5 to 17 months by gavage,and we further observed whether TSG could ameliorate the cognitive decline in APP/PS1 mice using behavioral tests,and investigated the possible mechanisms by immunohistochemistry and Western blotting.Our results showed that TSG treatment rescued the spatial and non-spatial learning and memory impairments of APP/PS1 mice at Morris water maze test and novel object recognition test.Furthermore,Aβ40/42 deposition in the cortex and hippocampus of APP/PS1 mice treated with TSG was significantly reduced compared to the wild type mice using the immunohistochemical technique.Finally,Western blotting showed that TSG primarily decreased the APP expression to avoid the Aβplaque deposition in the cortex and hippocampus of mice.These results reveal the beneficial effects of TSG in APP/PSI-AD mice,which may be associated with the reduction of Aβdeposits in the brain.
基金This work was supported in part by the National Natural Science Foundation of China under Grants 62071246,61771252,61861039,and 61427801in part by the National Key Research and Development Program of China under Grants 2020YFB1806608 and 2018YFC1314903+2 种基金in part by the Jiangsu Province Special Fund Project for Transformation of Scientific and Technological Achievements under Grant BA2019058in part by the Major Natural Science Research Project of Jiangsu Higher Education Institutions under Grant 18KJA510005in part by the Postgraduate Research&Practice Innovation Program of Jiangsu Province under Grants SJKY190740 and KYCX200709.
文摘In this paper,the spectral efficiency(SE)of an uplink hardware-constrained cell-free massive multi-input multi-output(MIMO)system with maximal ratio combining(MRC)receiver filters in the context of superimposed pilots(SPs)is investigated.Tractable closed-form SE expressions for the considered system are derived,which share us with opportunities to explore the impacts of the hardware quality coefficient,the length of coherence interval,and the power balance factor between pilot and data signals.Numerical results indicate that the achievable SE deteriorates as the hardware quality decreases and is more susceptible to the hardware impairments at the user equipments(UEs).Besides,we observe that SPs outperform regular pilots(RPs)in terms of SE and this performance gain is heavily dependent on the values of power balance factor and coherence interval.However,the superiorities of SPs over RPs have vanished when severe hardware imperfections are considered.
基金supported in part by the National Natural Science Foundation of China under Grant 62201451in part by the Young Talent fund of University Association for Science and Technology in Shaanxi under Grant 20210121+1 种基金in part by the Shaanxi provincial special fund for Technological innovation guidance(2022CGBX-29)in part by BUPT Excellent Ph.D.Students Foundation under Grant CX2022106.
文摘This paper investigates the system outage performance of a simultaneous wireless information and power transfer(SWIPT)based two-way decodeand-forward(DF)relay network,where potential hardware impairments(HIs)in all transceivers are considered.After harvesting energy and decoding messages simultaneously via a power splitting scheme,the energy-limited relay node forwards the decoded information to both terminals.Each terminal combines the signals from the direct and relaying links via selection combining.We derive the system outage probability under independent but non-identically distributed Nakagami-m fading channels.It reveals an overall system ceiling(OSC)effect,i.e.,the system falls in outage if the target rate exceeds an OSC threshold that is determined by the levels of HIs.Furthermore,we derive the diversity gain of the considered network.The result reveals that when the transmission rate is below the OSC threshold,the achieved diversity gain equals the sum of the shape parameter of the direct link and the smaller shape parameter of the terminalto-relay links;otherwise,the diversity gain is zero.This is different from the amplify-and-forward(AF)strategy,under which the relaying links have no contribution to the diversity gain.Simulation results validate the analytical results and reveal that compared with the AF strategy,the SWIPT based two-way relaying links under the DF strategy are more robust to HIs and achieve a lower system outage probability.
文摘Aim To investigate whether tluoxetine, a selective serotonin reuptake inhibitor（ SSRI） , could amelio- rate cognitive impairments induced by chronic cerebral hypopeffusion in rats and to clarify the underlying mecha- nisms of its efficacy. Methods Rats were subjected to permanent bilateral occlusion of the common carotid arteries （two-vessel occlusion, 2VO）. Two weeks later, rats were treated with 30 mg · kg^-1 fluoxetine （intragastric injec- tion, i. g. ） for 6 weeks. Cognitive function was evaluated by Morris water maze （MWM） and novel objects recog- nition （NOR） test. Long-term potentiation （LTP） was used to address the underlying synaptic mechanisms. West- ern blot was used to quantify the protein levels. Results Fluoxetine treatment significantly improved the cognitive 2VO impairments caused by 2VO, accompanied with a reversion of 2VO-induced inhibitory of LTP. Furthermore, caused an up-regulation of hyperpolarization-activated cyclic nueleotide-gated channel 2 （HCN2） surface expres- sions in the hippocampal CA1 area and fluoxetine also effectively recovered the up-regulation of HCN2 surface ex- pressions. Conclusion Fluoxetine can ameliorate cognitive impairments induced by chronic cerebral hypopeffusion and a possible mechanism may via down-regulating HCN2 surface expression in the Hippocampal CA1 area.
基金supported by the National Natural Science Foundation of China under Grants 62071052,61901043the R&D Program of Beijing Municipal Education Commission under Grant KM202011232003+1 种基金supported by Talent Engineering Training Funds of Hebei Province under Grant A202101106Science and Technology Project of Hebei Education Department under Grant QN2020508.
文摘Hardware impairments(HI)are always present in low-cost wireless devices.This paper investigates the outage behaviors of intelligent reflecting surface(IRS)assisted non-orthogonal multiple access(NOMA)networks by taking into account the impact of HI.Specifically,we derive the approximate and asymptotic expressions of the outage probability for the IRS-NOMA-HI networks.Based on the asymptotic results,the diversity orders under perfect self-interference cancellation and imperfect self-interference cancellation scenarios are obtained to evaluate the performance of the considered network.In addition,the system throughput of IRS-NOMA-HI is discussed in delay-limited mode.The obtained results are provided to verify the accuracy of the theoretical analyses and reveal that:1)The outage performance and system throughput for IRS-NOMA-HI outperforms that of the IRS-assisted orthogonal multiple access-HI(IRS-OMA-HI)networks;2)The number of IRS elements,the pass loss factors,the Rician factors,and the value of HI are pivotal to enhancing the performance of IRS-NOMAHI networks;and 3)It is recommended that effective methods of reducing HI should be used to ensure system performance,in addition to self-interference cancellation techniques.
基金supported by the Natural Science Foundation of China under Grant No.62001517.
文摘In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy outage probability is obtained.Moreover,to get more information on the secrecy outage probability in a high signalto-noise regime,the asymptotic analysis along with the secrecy diversity order and secrecy coding gain for the secrecy outage probability are also further obtained,which presents a fast method to evaluate the impact of system parameters and hardware impairments on the considered network.Finally,Monte Carlo simulation results are provided to show the efficiency of the theoretical analysis.
文摘The purpose of this study was to investigate the dimensions and conditions caused by shifts in nurses who worked in constant shifts in non-governmental selective hospitals in Tehran in 2014. In this cross-sectional and applied research, the shifts standard questionnaire was used. After confirming the validity and reliability (Cronbach’s alpha 0.73), the questionnaires were distributed among 305 nurses of 6 non-governmental selective hospitals in Tehran, based on stratified random sampling. In the research, the data analysis was conducted in two levels of descriptive and inferential statistics. The response rate was 0.91. 74.4% of the participant nurses were female and 25.6% were male. The results showed that there was a significant relationship between age and physical health (P = 0.008), gender and physical health (P = 0.015), education and health (P = 0.014), gender and physical-cognitive anxiety (P = 0.006), age and social-familial status (P = 0.001), Marital status and social-familial status (P = 0.001), having a second job and social-familial status (P = 0.001), education and sleep-fatigue (P = 0.002). Planning with respect to standards of nurses’ working hours and avoiding overtime, especially nurses who have more experience, can prevent severe complications of shifts and improve health level and ultimately the quality of care.
文摘Globally, the population is living longer and by 2050, it is predicted to reach 2.1 billion people. Sensory and cognitive impairments are common long-term conditions among older Europeans and have considerable functional, social, emotional and economic impacts on the individual and those caring for them. Nurses have frequent encounters with patients with these impairments and are expected to prioritise people, assess their needs and accommodate practice to meet these needs. In order to develop the requisite knowledge and understanding to support people living with these impairments, student nurses require an immersive and experiential approach to learning as opposed to just information transfer. This study reports on a cross-sectional analysis of a low fidelity simulation on sensory impairments as part of a wider dementia curriculum in semester one of the undergraduate nursing programme at the University of Highlands and Islands. Findings from an online questionnaire-based survey and content analysis of free text responses revealed that students found the simulation activities critical for gaining subject knowledge, understanding and insight. This study concluded that low-fidelity simulation of sensory/cognitive impairments, within the context of a broader curriculum of supportive activities, can be effective at developing relevant knowledge, understanding and gaining insights in this subject area among undergraduate nursing students.
基金Supported by the National High Technology Research and Development Programme of China(No.2012AA050804)
文摘As all-optical networks grow with ever increasing ultra-high speed,the communication quality suffers seriously from physical layer impairments( PLIs). The same problem still exists in software defined optical network( SDON) controlled by OpenFlow. Aimed to solve this problem,a PLIs tolerance based lightpath provision scheme is proposed for OpenFlow controlled optical networks. This proposed approach not only takes the OSNR model to represent those linear PLIs factors,but also introduces those nonlinear factors into the OSNR model. Thus,the proposed scheme is able to cover most PLIs factors of each optical link and conduct optical lightpath provison with better communication quality. Moreover,PLIs tolerance model is also set up and considered in this work with some necessary extension to OpenFlow protocols to achieve better compatibility between physical layer impairments factors and various services connections. Simulation results show that the proposed scheme is able to get better performance in terms of packet loss rate and connection setup time.
基金supported by the National Key Research and Development Program of China(2021YFC2701400 and 2021YFC2700901)the National Natural Science Foundation of China(32100480,82171607,and 81971441)+4 种基金the Shanghai Municipal Science and Technology Major Project(2017SHZDZX01)the Scientific Research(TP202002)from Anhui Medical Universitythe China Postdoctoral Science Foundation(2020TQ0072)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2019PT310002)supported by Shanghai Municipal Commission for Science and Technology Grants(19411951800)。
文摘Male infertility is a complex reproductive disorder that impedes a huge number of couples from having children naturally in the world(Agarwal et al.,2021).As an important pathogenic factor of male infertility,spermatogenic impairments are mainly characterized by impaired male gamete production,reduced sperm quality,or function(Tournaye et al.,2017).Spermatogenesis is a delicate and complex biological process that requires the collaboration of a large number of proteins performing different biological functions(Liu et al.,2021).
文摘Is physical fatigue one of the major causes of motor vehicle accidents？ Our study results challenged this traditional belief, and indicated that motor vehicle induced whole body vibration （WBV） is the actual cause. In this study, rats were subjected to simulated WBV. After 2 weeks all rats were evaluated by multiple physiological tests. Results indicated that WBV for short periods impaired the animal＇s mental judgment capabilities as well as sensory and motor functions. The primary reason for this is that WBV caused vasoconstriction, which decreased the cerebral blood flow as shown by Doppler imaging. This reduction in blood flow impaired the animal＇s ability to run a maze. Nerve functions were affected as well. This was shown by a reduction in nerve conduction velocity （NCV）. An increase in tail flick and Von Frey withdrawal times showed sensory deficits. Grip strength was also reduced. 4F （human apolipoprotein A-I molecule mimetic） conditioning has shown preventive effects against WBV injury as indicated by the above functional tests. This animal model simulated the most common motor vehicle travel vibration and validated the biological cause and mechanism of physiological impairment from WBV, which can be translated into a practical application for motor vehicle accident prevention.
文摘Background: The use of anticholinergics has been on the rise. With the increase in population longevity, more medication-related cognitive impairments (ACIs) have been reported. These impairments result in significant morbidities. We present a case that stresses on the importance of being vigilant when prescribing anticholinergic medications, especially in the elderlies. Case Report: A case of ACIs related to the use of tiotropium bromide/olodaterol (Stiolto Respimat) is being reported in a 71-year-old white man with COPD. Treatment with budesonide 180 mcg/actuation, and tiotropium bromide/olodaterol (Stiolto Respimat) inhalers was initiated. Two days after initiating treatment, the patient developed ACIs which manifested by gait imbalance, short-term memory dysfunction, inability to remember his family members, or to take his medications. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued. After three days, a full recovery of ACIs was reported. A month later, due to worsening dyspnea, the patient self-resumed the medicine. Similar ACIs were reported within two days of resuming treatment. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued indefinitely. Full recovery of ACIs was reported. Conclusion: ACIs should be noted as a significant side effect of tiotropium bromide/olodaterol. Clinicians should be vigilant, when prescribing anticholinergic medications to elderlies.
