Dear Editor,Cases of succinylcholine poisoning are rarely seen in clinic,and severe brain damage due to ingestion of succinylcholine is even rarer.Here,we report on a patient who poisoned herself via oral ingestion of...Dear Editor,Cases of succinylcholine poisoning are rarely seen in clinic,and severe brain damage due to ingestion of succinylcholine is even rarer.Here,we report on a patient who poisoned herself via oral ingestion of succinylcholine,discuss the clinical characteristics,pathogenesis,and treatment of the succinylcholine-related ischemic-hypoxic encephalopathy that this patient suffered,and review the relevant literature.This study aimed to improve clinicians'understanding of ischemic-hypoxic encephalopathy due to succinylcholine chloride toxicity.展开更多
GNAO1-associated disorder is a rare disease and an example of developmental and epileptic encephalopathies.Caused by ca.150 different dominant missense mutations in the gene encoding the major neuronal G protein Gao,i...GNAO1-associated disorder is a rare disease and an example of developmental and epileptic encephalopathies.Caused by ca.150 different dominant missense mutations in the gene encoding the major neuronal G protein Gao,it spans a wide range of neurological clinical manifestations,that may include epileptic seizures,motor dysfunctions,developmental and intellectual delay,and other symptoms(Sáez González et al.,2023).展开更多
An ischemic-hypoxic animal model was established using right common carotid artery occlusions and inhalation of low concentrations of oxygen in mice. At 10 days after the ischemic-hypoxic injuries, saline-treated mice...An ischemic-hypoxic animal model was established using right common carotid artery occlusions and inhalation of low concentrations of oxygen in mice. At 10 days after the ischemic-hypoxic injuries, saline-treated mice exhibited significantly prolonged escape latencies in water-maze tests and significantly shorter memory latencies and more mistakes in step-down tests. In contrast, mice treated with 5 mg/kg minocycline exhibited significant reversals of each of these effects compared with the saline-treated control mice. Moreover, we found that minocycline can relieve brain water content and morphological changes in mice following ischemic-hypoxic cerebral injuries. Accordingly, our findings indicate that minocycline provides some protections against the deleterious effects of these injuries in mice.展开更多
BACKGROUND：Previous studies have demonstrated that acupuncture treatment could ameliorate impaired motor function,and these positive effects might be due to neural plasticity.OBJECTIVE：Myelin basic protein（MBP）,mi...BACKGROUND：Previous studies have demonstrated that acupuncture treatment could ameliorate impaired motor function,and these positive effects might be due to neural plasticity.OBJECTIVE：Myelin basic protein（MBP）,microtubule-associated protein 2（MAP2）,growth-associated protein-43（GAP-43）,and synaptophysin（SYN） were selected as markers of neural remodeling,and expression of these markers was evaluated with regard to altered motor function following brain injury and acupuncture treatment.DESIGN,TIME AND SETTING：A completely randomized experiment was performed at the Central Laboratory of Peking University First Hospital from November 2006 to May 2007.MATERIALS：Twenty-four Sprague Dawley rat pups,aged 7 days,were selected for the present experiment.The left common carotid artery was ligated to establish a rat model of ischemic-hypoxic brain injury.METHODS：All animals were randomly divided into three groups：sham operation,model,and electro-acupuncture treatment,with 8 rats in each group.Rats in the model and electro-acupuncture treatment group underwent establishment of ischemic-hypoxic brain injury.Upon model established,rats underwent hypobaric oxygen intervention for 24 hours.Only the left common carotid artery was exposed in rats of the sham operation group,without model establishment or oxygen intervention.The rats in the electro-acupuncture treatment group were treated with electro-acupuncture.One acupuncture needle electrode was inserted into the subcutaneous layer at the Baihui and Dazhui acupoint.The stimulation condition of the electro-acupuncture simulator was set to an amplitude-modulated wave of 0-100% and alternative frequency of 100 cycles/second,as well as frequency-modulated wave of 2-100 Hz and an alternative frequency of 3 cycles/second.Maximal current through the two electrodes was limited to 3-5 mA.The stimulation lasted for 30 minutes per day for 2 weeks.Rats in the sham operation and model groups were not treated with electro-acupuncture,but only fixed to the table for the same time period.MAIN OUTCOME MEASURES：After 2 weeks stimulation,expression of MBP,MAP2,GAP-43,and SYN were detected in the brain by immunohistochemistry.Motor function was evaluated in the three groups.RESULTS：In the sham operation group,MBP was abundant in the myelinated nerve fibers.In the electro-acupuncture treatment group,however,the corpus callosum exhibited more MBP staining than the model group.MAP2 expression was increased in the model group,and increased further in the electro-acupuncture treatment group compared with the sham operation group.GAP-43 expression in the cerebral cortex was less in model group than in sham operation,but present in abundance in the electro-acupuncture treatment group.SYN expression in the cerebral cortex was less in the model and electro-acupuncture treatment group compared with the sham operation group.There was no significant difference in SYN expression and distribution between the model and electro-acupuncture treatment groups.Motor function of rats in the electro-acupuncture treatment group was significantly better than the model group（P 〈 0.05）,although function remained lower than the sham operation group（P 〈 0.05）.CONCLUSION：Two weeks of electro-acupuncture treatment improved motor function in rats,and protein markers related to neural plasticity also changed,which may be a mechanism for improved motor function in rats with ischemic-hypoxic brain injury.展开更多
Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela ...Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.展开更多
Microglial pyroptosis and neuroinflammation have been implicated in the pathogenesis of sepsis-associated encephalopathy(SAE).OGT-mediated O-GlcNAcylation is involved in neurodevelopment and injury.However,its regulat...Microglial pyroptosis and neuroinflammation have been implicated in the pathogenesis of sepsis-associated encephalopathy(SAE).OGT-mediated O-GlcNAcylation is involved in neurodevelopment and injury.However,its regulatory function in microglial pyroptosis and involvement in SAE remains unclear.In this study,we demonstrated that OGT deficiency augmented microglial pyroptosis and exacerbated secondary neuronal injury.Furthermore,OGT inhibition impaired cognitive function in healthy mice and accelerated the progression in SAE mice.Mechanistically,OGT-mediated O-GlcNAcylation of ATF2 at Ser44 inhibited its phosphorylation and nuclear translocation,thereby amplifying NLRP3 inflammasome activation and promoting inflammatory cytokine production in microglia in response to LPS/Nigericin stimulation.In conclusion,this study uncovers the critical role of OGT-mediated O-GlcNAcylation in modulating microglial activity through the regulation of ATF2 and thus protects against SAE progression.展开更多
Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental disability.Detailed asse...Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental disability.Detailed assessment is important to help identify highrisk infants,to help families,and to support appropriate interventions.A wide range of monitoring tools is available to assess changes over time,including urine and blood biomarkers,neurological examination,and electroencephalography.At present,magnetic resonance imaging is unique as although it is expensive and not suited to monitoring the early evolution of hypoxic-ischemic encephalopathy by a week of life it can provide direct insight into the anatomical changes in the brain after hypoxic-ischemic encephalopathy and so offers strong prognostic information on the long-term outcome after hypoxic-ischemic encephalopathy.This review investigated the temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries,with a particular emphasis on exploring the correlation between the prognostic implications of magnetic resonance imaging scans in the first week of life and their relationship to long-term outcome prediction,particularly for infants treated with therapeutic hypothermia.A comprehensive literature search,from 2016 to 2024,identified 20 pertinent articles.This review highlights that while the optimal timing of magnetic resonance imaging scans is not clear,overall,it suggests that magnetic resonance imaging within the first week of life provides strong prognostic accuracy.Many challenges limit the timing consistency,particularly the need for intensive care and clinical monitoring.Conversely,although most reports examined the prognostic value of scans taken between 4 and 10 days after birth,there is evidence from small numbers of cases that,at times,brain injury may continue to evolve for weeks after birth.This suggests that in the future it will be important to explore a wider range of times after hypoxic-ischemic encephalopathy to fully understand the optimal timing for predicting long-term outcomes.展开更多
Objective:The neurotoxicity of carbon monoxide(CO)to the central nervous system is a key pathogenesis of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Our previous study found that retinoic acid...Objective:The neurotoxicity of carbon monoxide(CO)to the central nervous system is a key pathogenesis of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Our previous study found that retinoic acid(RA)can suppress the neurotoxic effects of CO.This study further explores,in vivo and in vitro,the molecular mechanisms by which RA alleviates CO-induced central nervous system damage.Methods:A cytotoxic model was established using the mouse hippocampal neuronal cell line HT22 and primary oligodendrocytes exposed to CO,and a DEACMP animal model was established in adult Kunming mice.Cell viability and apoptosis of hippocampal neurons and oligodendrocytes were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay and Annexin V/propidium iodide(PI)double staining.The transcriptional and protein expression of each gene was detected using real time fluorescence quantitative PCR(RT-qPCR)and Western blotting.Long noncoding RNA(lncRNA)SNHG15 and LINGO-1 were knocked down or overexpressed to observe changes in neurons and oligodendrocytes.In DEACMP mice,SNHG15 or LINGO-1 were knocked down to assess changes in central nervous tissue and downstream protein expression.Results:RA at 10 and 20μmol/L significantly reversed CO-induced apoptosis of hippocampal neurons and oligodendrocytes,downregulation of SNHG15 and LINGO-1,and upregulation of brain-derived neurotrophic factor(BDNF)and tyrosine kinase receptor B(TrkB)(all P<0.05).Overexpression of SNHG15 or LINGO-1 weakened the protective effect of RA against CO-induced cytotoxicity(all P<0.05).Knockdown of SNHG15 or LINGO-1 alleviated CO-induced apoptosis of hippocampal neurons and oligodendrocytes and upregulated BDNF and TrkB expression levels(all P<0.05).Experiments in DEACMP model mice showed that knockdown of SNHG15 or LINGO-1 mitigated central nervous system injury in DEACMP(all P<0.05).Conclusion:RA alleviates CO-induced apoptosis of hippocampal neurons and oligodendrocytes,thereby reducing central nervous system injury and exerting neuroprotective effects.LncRNA SNHG15 and LINGO-1 are key molecules mediating RA induced inhibition of neuronal apoptosis and are associated with the BDNF/TrkB pathway.These findings provide a theoretical framework for optimizing the clinical treatment of DEACMP and lay an experimental foundation for elucidating its molecular mechanisms.展开更多
Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and revers...Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.展开更多
BACKGROUND:Sepsis-associated encephalopathy(SAE)is a diff use dysfunction of the nervous system resulting from sepsis originating outside the central nervous system.Elderly individuals(≥65 years of age)constitute a p...BACKGROUND:Sepsis-associated encephalopathy(SAE)is a diff use dysfunction of the nervous system resulting from sepsis originating outside the central nervous system.Elderly individuals(≥65 years of age)constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications,which frequently leads to underdiagnosis or misdiagnosis.These patients are at increased risk of long-term or permanent central nervous system impairment,making rapid and accurate diagnosis and treatment especially critical.The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients,ultimately achieving more standardized and effi cient SAE management.METHODS:We performed a literature search in four databases-PubMed,Embase,China National Knowledge Infrastructure(CNKI),and Wanfang-from inception to April 2025 using bilinguals(Chinese and English).RESULTS:The diagnostic criteria for SAE in elderly individuals include the following:(1)sepsis;(2)new-onset neurological dysfunction;and(3)exclusion of other causes of neurological dysfunction.Physicians should develop tailored empiric anti-infective plans for elderly SAE patients,considering comorbidities,organ function,infection site,local bacterial spectrum,and resistance.The treatment protocol can be adjusted once the pathogen is identifi ed.Stabilizing hemodynamics and ensuring cerebral perfusion are two fl uid resuscitation strategies used in elderly SAE patients.An individualized approach to fl uid resuscitation using restrictive fl uid volumes should be employed.Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation,controlling blood glucose levels,and correcting internal imbalances.Early rehabilitation,nutritional support,cognitive training,and family-based emotional support are important components of comprehensive care.CONCLUSION:The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.展开更多
Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter le...Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.展开更多
Hyperglycemia in individuals with diabetes causes cognitive impairment,called diabetic encephalopathy(DE).The pathogenesis of DE is closely related to angiopathy,and effective treatment is highly desirable.The botanic...Hyperglycemia in individuals with diabetes causes cognitive impairment,called diabetic encephalopathy(DE).The pathogenesis of DE is closely related to angiopathy,and effective treatment is highly desirable.The botanical agent berberine(BBR)effectively lowers blood glucose in diabetic patients.Here,we show for the first time that BBR significantly improved cognitive function in type 2 diabetic encephalopathy KK-Ay(2DEK)mice.High-resolution imaging via fluorescence micro-optical sectioning tomography(fMOST)revealed that the integrity of brain vessels was improved by BBR treatment.The improvements in average vessel diameter,vessel length,and total vessel volume were significant in the parietal association cortex(PtA),as well as in the CA1 and CA3 regions.A mechanistic study revealed that oral BBR inhibited δ-valerobetaine(δ-VB,a metabolite of the gut microbiota)production in the intestine.As intestinal δ-VB can enter the circulation and activate the Toll-like receptor-4(TLR-4)/myeloid differentiation factor 88(MyD88)/nuclear factor kappa B(NF-jB)inflammatory pathway in the epithelial cells of blood vessels through interacting with TLR-4,BBR might reduce the intestinal level of δ-VB to protect the cerebral blood vessels of DE mice and improve their brain function.Fecal microbiota transplantation(FMT)using the gut microbiota from BBR-treated mice confirmed the vital role of the gut microbiota.BBR showed a wide range of effects on the gut flora,also increasing short-chain fatty acid(SCFA)production and decreasing lipopolysaccharide(LPS)levels in the intestine by adjusting the abundance of SCFA-or LPS-producing bacteria.The observed therapeutic efficacy in vivo revealed a synergistic effect of BBR on the gut microbiota.Conclusively,we found an association between the gut microbiota and blood vessels,of which intestinal δ-VB might be a chemical link.Mainly through downregulating δ-VB in the intestine,BBR protected cerebral vessels and alleviated DE.展开更多
The present study employed network pharmacology to elucidate the molecular mechanism underlying the therapeutic effects of kuwanon G in diabetic encephalopathy.Utilizing the Pharmmapper databases,we identified potenti...The present study employed network pharmacology to elucidate the molecular mechanism underlying the therapeutic effects of kuwanon G in diabetic encephalopathy.Utilizing the Pharmmapper databases,we identified potential targets associated with kuwanon G.Simultaneously,targets related to diabetic encephalopathy were screened.The VENNY software facilitated the identification of 34 common target genes,forming the basis for constructing a protein-protein interaction network map via the STRING database.GO enrichment and KEGG pathway analyses were conducted using the David database,with Cytoscape software employed to pinpoint key target genes.Results revealed 101 potential targets for kuwanon G and 1058 for diabetic encephalopathy,with an overlap of 34 target genes.Notably,GSK3B,CASP3,MAKP14,ESR1,and PPARG emerged as pivotal genes in the therapeutic action of kuwanon G against diabetic encephalopathy.Pathway analysis of these key genes indicated that kuwanon G exerted its therapeutic effects through modulating pathways associated with lipid and atherosclerosis,fluid shear stress and atherosclerosis,IL-17 signaling,and the AGE-RAGE signaling pathway.This study offered valuable insights into the potential molecular mechanisms of kuwanon G in treating diabetic encephalopathy,presenting a novel framework for future research in this domain.展开更多
BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study...BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incide...BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.展开更多
Neonatal hypoxic-ischemic encephalopathy(HIE)refers to neonatal brain damage caused by various factors during the perinatal period that lead to hypoxia and reduced cerebral blood flow[1].Globally,0.2%to 2.26%of newbor...Neonatal hypoxic-ischemic encephalopathy(HIE)refers to neonatal brain damage caused by various factors during the perinatal period that lead to hypoxia and reduced cerebral blood flow[1].Globally,0.2%to 2.26%of newborns develop HIE,with approximately 20%resulting in neonatal death and about 25%of survivors suffering from neurological impairment[2].Currently,there is a lack of highly sensitive and specific diagnostic tools for HIE,posing significant challenges to reducing HIE mortality and neurological abnormalities[3].The development of high-throughput proteomics technology based on mass spectrometry(MS)has significantly enhanced the potential to discover biomarkers in biological fluids such as plasma,cerebrospinal fluid,saliva,and urine[4].Proteomics technology has become an engine for exploring novel markers of HIE[5].This article systematically reviews the progress of proteomics technology in the study of biomarkers for the early diagnosis of HIE,elucidating its potential application value.展开更多
The role of the gut microbiota in the pathogenesis and treatment of hepatic encephalopathy (HE) has garnered increasing attention due to significant advancements in understanding the gut microbiota over recent years. ...The role of the gut microbiota in the pathogenesis and treatment of hepatic encephalopathy (HE) has garnered increasing attention due to significant advancements in understanding the gut microbiota over recent years. A growing body of evidence from laboratory and clinical studies highlights a substantial relationship between gut microbiota and HE. Identifying the role of gut microbiota in maintaining normal cognitive function, including its influence on the gut barrier and immune cells, is essential to elucidate the mechanisms underlying the development of HE. This understanding offers novel perspectives for its prevention and treatment. This paper provides a comprehensive review of the research progress concerning the gut microbiota, HE, and their interrelationship, along with current treatment methods for HE. Furthermore, it outlines the limitations and challenges associated with microbiota-based therapeutic research.展开更多
Inflammation plays a crucial role in the initiation and progression of sepsis and induces alterations in brain neurotransmission, thereby contributing to the development of sepsis-associated encephalopathy(SAE).Parval...Inflammation plays a crucial role in the initiation and progression of sepsis and induces alterations in brain neurotransmission, thereby contributing to the development of sepsis-associated encephalopathy(SAE).Parvalbumin(PV) interneurons are pivotal contributors to cognitive processes and have been implicated in various central nervous system dysfunctions, including SAE. Oxytocin, known for its ability to augment the firing rate of gamma-aminobutyric acid(GABA)-ergic interneurons and directly stimulate inhibitory interneurons to enhance the tonic inhibition of pyramidal neurons, has prompted an investigation into its potential therapeutic effects on cognitive dysfunction in SAE. In the current study, we administered intranasal oxytocin to SAE mice induced by lipopolysaccharide. Behavioral assessments, including open field, Y-maze, and fear conditioning, were used to evaluate cognitive performance. Golgi staining revealed hippocampal synaptic deterioration, local field potential recordings showed weakened gamma oscillations, and immunofluorescence staining demonstrated decreased PV expression in the cornu ammonis 1(CA1) region of the hippocampus following lipopolysaccharide treatment, all of which were alleviated by oxytocin administration. Furthermore, immunofluorescence staining of PV co-localization with vesicular glutamate transporter 1 or vesicular GABA transporter indicated a balanced excitation/inhibition effect of neurotransmitters on PV interneurons after oxytocin administration in the SAE mice, leading to an improved cognitive function. In conclusion, oxytocin treatment improved cognitive function by increasing the number of PV^(+) neurons in the hippocampal CA1 region, restoring the balance of excitatory/inhibitory synaptic transmission on PV interneurons, and enhancing hippocampal CA1 local field potential gamma oscillations. These findings suggest a potential mechanism underlying the beneficial effects of oxytocin in SAE.展开更多
In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)i...In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.展开更多
BACKGROUND Sepsis-associated encephalopathy(SAE)is a common complication of sepsis,characterized by cognitive impairment,altered consciousness,and psychiatric symptoms,including anxiety and depression.These psychiatri...BACKGROUND Sepsis-associated encephalopathy(SAE)is a common complication of sepsis,characterized by cognitive impairment,altered consciousness,and psychiatric symptoms,including anxiety and depression.These psychiatric symptoms often exacerbate the overall prognosis and quality of life of affected patients.However,the underlying metabolic and proteomic features associated with SAE-induced psychiatric symptoms remain poorly understood.AIM To investigate the clinical manifestations of anxiety and depression in patients with sepsis and SAE and to explore their associated metabolic and proteomic characteristics.METHODS A total of 88 patients were enrolled,comprising 30 healthy controls,29 patients with sepsis,and 29 with SAE.Anxiety and depression symptoms were evaluated using the Hamilton anxiety rating scale(HAM-A)and Hamilton depression rating scale(HAM-D)in sepsis and SAE.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA),and quality of life was measured using the 36-Item Short Form Health Survey.Plasma samples were analyzed for metabolomic and proteomic profiling.Metabolic alterations were identified through liquid chromatography-mass spectrometry,while protein expression was assessed using Olink targeted proteomics.RESULTS Compared to the sepsis group,patients with SAE exhibited significantly higher levels of anxiety(HAM-A:15.2±4.0 vs 10.4±3.0,P=0.012)and depression(HAM-D:16.0±3.5 vs 9.1±2.3,P=0.003).Cognitive function,as measured by MoCA,was notably impaired in the SAE group(MoCA:18.5±4.0 vs 24.5±3.2,P=0.007).Quality of life scores,particularly in physical functioning,emotional well-being,and mental health,were significantly lower in patients with SAE.Metabolomic and proteomic analyses revealed substantial alterations in oxidative stress and nicotinamide adenine dinucleotide(NAD+)metabolism pathways,with cluster of differentiation(CD)38 emerging as a potential biomarker associated with psychiatric symptoms in SAE.Further validation in an independent cohort confirmed the diagnostic relevance of CD38.CONCLUSION This study highlights the significant psychological burden of SAE,manifested as anxiety and depression.Multiomics analysis identified distinct metabolic alterations,particularly in NAD+metabolism,that may contribute to psychiatric symptom development and progression.Furthermore,CD38 was identified as a promising biomarker for the early detection of SAE,providing potential avenues for early intervention and therapeutic targeting.展开更多
基金This study was supported by grants from the Ministry of Science and Technology of the People’s Republic of China(2019YFC0118203)Science Technology Department of Zhejiang Province(WKJ-ZJ-2024)。
文摘Dear Editor,Cases of succinylcholine poisoning are rarely seen in clinic,and severe brain damage due to ingestion of succinylcholine is even rarer.Here,we report on a patient who poisoned herself via oral ingestion of succinylcholine,discuss the clinical characteristics,pathogenesis,and treatment of the succinylcholine-related ischemic-hypoxic encephalopathy that this patient suffered,and review the relevant literature.This study aimed to improve clinicians'understanding of ischemic-hypoxic encephalopathy due to succinylcholine chloride toxicity.
文摘GNAO1-associated disorder is a rare disease and an example of developmental and epileptic encephalopathies.Caused by ca.150 different dominant missense mutations in the gene encoding the major neuronal G protein Gao,it spans a wide range of neurological clinical manifestations,that may include epileptic seizures,motor dysfunctions,developmental and intellectual delay,and other symptoms(Sáez González et al.,2023).
基金supported by the National Natural Science Foundation of China, No. 81160157Key Program of the Science and Technology Department of Guizhou Province, No. SY20093075
文摘An ischemic-hypoxic animal model was established using right common carotid artery occlusions and inhalation of low concentrations of oxygen in mice. At 10 days after the ischemic-hypoxic injuries, saline-treated mice exhibited significantly prolonged escape latencies in water-maze tests and significantly shorter memory latencies and more mistakes in step-down tests. In contrast, mice treated with 5 mg/kg minocycline exhibited significant reversals of each of these effects compared with the saline-treated control mice. Moreover, we found that minocycline can relieve brain water content and morphological changes in mice following ischemic-hypoxic cerebral injuries. Accordingly, our findings indicate that minocycline provides some protections against the deleterious effects of these injuries in mice.
基金International Science and Technology Cooperation Fundation of the Ministry of Science and Technology of China, No.2008DFA31850
文摘BACKGROUND：Previous studies have demonstrated that acupuncture treatment could ameliorate impaired motor function,and these positive effects might be due to neural plasticity.OBJECTIVE：Myelin basic protein（MBP）,microtubule-associated protein 2（MAP2）,growth-associated protein-43（GAP-43）,and synaptophysin（SYN） were selected as markers of neural remodeling,and expression of these markers was evaluated with regard to altered motor function following brain injury and acupuncture treatment.DESIGN,TIME AND SETTING：A completely randomized experiment was performed at the Central Laboratory of Peking University First Hospital from November 2006 to May 2007.MATERIALS：Twenty-four Sprague Dawley rat pups,aged 7 days,were selected for the present experiment.The left common carotid artery was ligated to establish a rat model of ischemic-hypoxic brain injury.METHODS：All animals were randomly divided into three groups：sham operation,model,and electro-acupuncture treatment,with 8 rats in each group.Rats in the model and electro-acupuncture treatment group underwent establishment of ischemic-hypoxic brain injury.Upon model established,rats underwent hypobaric oxygen intervention for 24 hours.Only the left common carotid artery was exposed in rats of the sham operation group,without model establishment or oxygen intervention.The rats in the electro-acupuncture treatment group were treated with electro-acupuncture.One acupuncture needle electrode was inserted into the subcutaneous layer at the Baihui and Dazhui acupoint.The stimulation condition of the electro-acupuncture simulator was set to an amplitude-modulated wave of 0-100% and alternative frequency of 100 cycles/second,as well as frequency-modulated wave of 2-100 Hz and an alternative frequency of 3 cycles/second.Maximal current through the two electrodes was limited to 3-5 mA.The stimulation lasted for 30 minutes per day for 2 weeks.Rats in the sham operation and model groups were not treated with electro-acupuncture,but only fixed to the table for the same time period.MAIN OUTCOME MEASURES：After 2 weeks stimulation,expression of MBP,MAP2,GAP-43,and SYN were detected in the brain by immunohistochemistry.Motor function was evaluated in the three groups.RESULTS：In the sham operation group,MBP was abundant in the myelinated nerve fibers.In the electro-acupuncture treatment group,however,the corpus callosum exhibited more MBP staining than the model group.MAP2 expression was increased in the model group,and increased further in the electro-acupuncture treatment group compared with the sham operation group.GAP-43 expression in the cerebral cortex was less in model group than in sham operation,but present in abundance in the electro-acupuncture treatment group.SYN expression in the cerebral cortex was less in the model and electro-acupuncture treatment group compared with the sham operation group.There was no significant difference in SYN expression and distribution between the model and electro-acupuncture treatment groups.Motor function of rats in the electro-acupuncture treatment group was significantly better than the model group（P 〈 0.05）,although function remained lower than the sham operation group（P 〈 0.05）.CONCLUSION：Two weeks of electro-acupuncture treatment improved motor function in rats,and protein markers related to neural plasticity also changed,which may be a mechanism for improved motor function in rats with ischemic-hypoxic brain injury.
文摘Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.
基金supported by the Jiangsu Provincial Medical Key Discipline(Laboratory)Cultivation Unit(JSDW202249)the Natural Science Foundation of Jiangsu Province(BK20211108)+4 种基金a Scientific Research Project of the Health Commission of Nantong(MS2023035)Nantong Natural Science Foundation(JC2023114)the Scientific Research Innovation Team of Kangda College of Nanjing Medical University(KD2022KYCXTD005)Nantong University Clinical Medicine Special Project(2022JY005)the Postgraduate Research&Practice Innovation Program of Jiangsu province(KYCX23_3416).
文摘Microglial pyroptosis and neuroinflammation have been implicated in the pathogenesis of sepsis-associated encephalopathy(SAE).OGT-mediated O-GlcNAcylation is involved in neurodevelopment and injury.However,its regulatory function in microglial pyroptosis and involvement in SAE remains unclear.In this study,we demonstrated that OGT deficiency augmented microglial pyroptosis and exacerbated secondary neuronal injury.Furthermore,OGT inhibition impaired cognitive function in healthy mice and accelerated the progression in SAE mice.Mechanistically,OGT-mediated O-GlcNAcylation of ATF2 at Ser44 inhibited its phosphorylation and nuclear translocation,thereby amplifying NLRP3 inflammasome activation and promoting inflammatory cytokine production in microglia in response to LPS/Nigericin stimulation.In conclusion,this study uncovers the critical role of OGT-mediated O-GlcNAcylation in modulating microglial activity through the regulation of ATF2 and thus protects against SAE progression.
基金supported by a grant from the Health Research New Zealand(HRC)22/559(to AJG and LB)。
文摘Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental disability.Detailed assessment is important to help identify highrisk infants,to help families,and to support appropriate interventions.A wide range of monitoring tools is available to assess changes over time,including urine and blood biomarkers,neurological examination,and electroencephalography.At present,magnetic resonance imaging is unique as although it is expensive and not suited to monitoring the early evolution of hypoxic-ischemic encephalopathy by a week of life it can provide direct insight into the anatomical changes in the brain after hypoxic-ischemic encephalopathy and so offers strong prognostic information on the long-term outcome after hypoxic-ischemic encephalopathy.This review investigated the temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries,with a particular emphasis on exploring the correlation between the prognostic implications of magnetic resonance imaging scans in the first week of life and their relationship to long-term outcome prediction,particularly for infants treated with therapeutic hypothermia.A comprehensive literature search,from 2016 to 2024,identified 20 pertinent articles.This review highlights that while the optimal timing of magnetic resonance imaging scans is not clear,overall,it suggests that magnetic resonance imaging within the first week of life provides strong prognostic accuracy.Many challenges limit the timing consistency,particularly the need for intensive care and clinical monitoring.Conversely,although most reports examined the prognostic value of scans taken between 4 and 10 days after birth,there is evidence from small numbers of cases that,at times,brain injury may continue to evolve for weeks after birth.This suggests that in the future it will be important to explore a wider range of times after hypoxic-ischemic encephalopathy to fully understand the optimal timing for predicting long-term outcomes.
基金supported by the Natural Science Foundation of Hunan Province(2021JJ31089)the Scientific Research Project of Health Commission of Hunan Province(202203104548),China。
文摘Objective:The neurotoxicity of carbon monoxide(CO)to the central nervous system is a key pathogenesis of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Our previous study found that retinoic acid(RA)can suppress the neurotoxic effects of CO.This study further explores,in vivo and in vitro,the molecular mechanisms by which RA alleviates CO-induced central nervous system damage.Methods:A cytotoxic model was established using the mouse hippocampal neuronal cell line HT22 and primary oligodendrocytes exposed to CO,and a DEACMP animal model was established in adult Kunming mice.Cell viability and apoptosis of hippocampal neurons and oligodendrocytes were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay and Annexin V/propidium iodide(PI)double staining.The transcriptional and protein expression of each gene was detected using real time fluorescence quantitative PCR(RT-qPCR)and Western blotting.Long noncoding RNA(lncRNA)SNHG15 and LINGO-1 were knocked down or overexpressed to observe changes in neurons and oligodendrocytes.In DEACMP mice,SNHG15 or LINGO-1 were knocked down to assess changes in central nervous tissue and downstream protein expression.Results:RA at 10 and 20μmol/L significantly reversed CO-induced apoptosis of hippocampal neurons and oligodendrocytes,downregulation of SNHG15 and LINGO-1,and upregulation of brain-derived neurotrophic factor(BDNF)and tyrosine kinase receptor B(TrkB)(all P<0.05).Overexpression of SNHG15 or LINGO-1 weakened the protective effect of RA against CO-induced cytotoxicity(all P<0.05).Knockdown of SNHG15 or LINGO-1 alleviated CO-induced apoptosis of hippocampal neurons and oligodendrocytes and upregulated BDNF and TrkB expression levels(all P<0.05).Experiments in DEACMP model mice showed that knockdown of SNHG15 or LINGO-1 mitigated central nervous system injury in DEACMP(all P<0.05).Conclusion:RA alleviates CO-induced apoptosis of hippocampal neurons and oligodendrocytes,thereby reducing central nervous system injury and exerting neuroprotective effects.LncRNA SNHG15 and LINGO-1 are key molecules mediating RA induced inhibition of neuronal apoptosis and are associated with the BDNF/TrkB pathway.These findings provide a theoretical framework for optimizing the clinical treatment of DEACMP and lay an experimental foundation for elucidating its molecular mechanisms.
文摘Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.
基金supported by the Beijing Clinical Key Specialty Project(2023).
文摘BACKGROUND:Sepsis-associated encephalopathy(SAE)is a diff use dysfunction of the nervous system resulting from sepsis originating outside the central nervous system.Elderly individuals(≥65 years of age)constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications,which frequently leads to underdiagnosis or misdiagnosis.These patients are at increased risk of long-term or permanent central nervous system impairment,making rapid and accurate diagnosis and treatment especially critical.The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients,ultimately achieving more standardized and effi cient SAE management.METHODS:We performed a literature search in four databases-PubMed,Embase,China National Knowledge Infrastructure(CNKI),and Wanfang-from inception to April 2025 using bilinguals(Chinese and English).RESULTS:The diagnostic criteria for SAE in elderly individuals include the following:(1)sepsis;(2)new-onset neurological dysfunction;and(3)exclusion of other causes of neurological dysfunction.Physicians should develop tailored empiric anti-infective plans for elderly SAE patients,considering comorbidities,organ function,infection site,local bacterial spectrum,and resistance.The treatment protocol can be adjusted once the pathogen is identifi ed.Stabilizing hemodynamics and ensuring cerebral perfusion are two fl uid resuscitation strategies used in elderly SAE patients.An individualized approach to fl uid resuscitation using restrictive fl uid volumes should be employed.Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation,controlling blood glucose levels,and correcting internal imbalances.Early rehabilitation,nutritional support,cognitive training,and family-based emotional support are important components of comprehensive care.CONCLUSION:The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.
文摘Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.
基金funded by the National Key Research and Devel-opment Program of China(2022YFA0806400)the CAMS Innova-tion Fund for Medical Sciences(CIFMS)(2023-I2M-2-006,2021-1-I2M-027,and 2021-1-I2M-028)+1 种基金the National Natural Science Foundation of China(82173888 and 81973290)the Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study(Z141102004414062).
文摘Hyperglycemia in individuals with diabetes causes cognitive impairment,called diabetic encephalopathy(DE).The pathogenesis of DE is closely related to angiopathy,and effective treatment is highly desirable.The botanical agent berberine(BBR)effectively lowers blood glucose in diabetic patients.Here,we show for the first time that BBR significantly improved cognitive function in type 2 diabetic encephalopathy KK-Ay(2DEK)mice.High-resolution imaging via fluorescence micro-optical sectioning tomography(fMOST)revealed that the integrity of brain vessels was improved by BBR treatment.The improvements in average vessel diameter,vessel length,and total vessel volume were significant in the parietal association cortex(PtA),as well as in the CA1 and CA3 regions.A mechanistic study revealed that oral BBR inhibited δ-valerobetaine(δ-VB,a metabolite of the gut microbiota)production in the intestine.As intestinal δ-VB can enter the circulation and activate the Toll-like receptor-4(TLR-4)/myeloid differentiation factor 88(MyD88)/nuclear factor kappa B(NF-jB)inflammatory pathway in the epithelial cells of blood vessels through interacting with TLR-4,BBR might reduce the intestinal level of δ-VB to protect the cerebral blood vessels of DE mice and improve their brain function.Fecal microbiota transplantation(FMT)using the gut microbiota from BBR-treated mice confirmed the vital role of the gut microbiota.BBR showed a wide range of effects on the gut flora,also increasing short-chain fatty acid(SCFA)production and decreasing lipopolysaccharide(LPS)levels in the intestine by adjusting the abundance of SCFA-or LPS-producing bacteria.The observed therapeutic efficacy in vivo revealed a synergistic effect of BBR on the gut microbiota.Conclusively,we found an association between the gut microbiota and blood vessels,of which intestinal δ-VB might be a chemical link.Mainly through downregulating δ-VB in the intestine,BBR protected cerebral vessels and alleviated DE.
基金financially supported by the Hebei Administration of Traditional Chinese Medicine(Grant No.2024040)。
文摘The present study employed network pharmacology to elucidate the molecular mechanism underlying the therapeutic effects of kuwanon G in diabetic encephalopathy.Utilizing the Pharmmapper databases,we identified potential targets associated with kuwanon G.Simultaneously,targets related to diabetic encephalopathy were screened.The VENNY software facilitated the identification of 34 common target genes,forming the basis for constructing a protein-protein interaction network map via the STRING database.GO enrichment and KEGG pathway analyses were conducted using the David database,with Cytoscape software employed to pinpoint key target genes.Results revealed 101 potential targets for kuwanon G and 1058 for diabetic encephalopathy,with an overlap of 34 target genes.Notably,GSK3B,CASP3,MAKP14,ESR1,and PPARG emerged as pivotal genes in the therapeutic action of kuwanon G against diabetic encephalopathy.Pathway analysis of these key genes indicated that kuwanon G exerted its therapeutic effects through modulating pathways associated with lipid and atherosclerosis,fluid shear stress and atherosclerosis,IL-17 signaling,and the AGE-RAGE signaling pathway.This study offered valuable insights into the potential molecular mechanisms of kuwanon G in treating diabetic encephalopathy,presenting a novel framework for future research in this domain.
文摘BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.
文摘BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.
文摘Neonatal hypoxic-ischemic encephalopathy(HIE)refers to neonatal brain damage caused by various factors during the perinatal period that lead to hypoxia and reduced cerebral blood flow[1].Globally,0.2%to 2.26%of newborns develop HIE,with approximately 20%resulting in neonatal death and about 25%of survivors suffering from neurological impairment[2].Currently,there is a lack of highly sensitive and specific diagnostic tools for HIE,posing significant challenges to reducing HIE mortality and neurological abnormalities[3].The development of high-throughput proteomics technology based on mass spectrometry(MS)has significantly enhanced the potential to discover biomarkers in biological fluids such as plasma,cerebrospinal fluid,saliva,and urine[4].Proteomics technology has become an engine for exploring novel markers of HIE[5].This article systematically reviews the progress of proteomics technology in the study of biomarkers for the early diagnosis of HIE,elucidating its potential application value.
基金supported by the Health Commission of Sichuan Province(Popularization of Application Project,Grant No.21PJ182).
文摘The role of the gut microbiota in the pathogenesis and treatment of hepatic encephalopathy (HE) has garnered increasing attention due to significant advancements in understanding the gut microbiota over recent years. A growing body of evidence from laboratory and clinical studies highlights a substantial relationship between gut microbiota and HE. Identifying the role of gut microbiota in maintaining normal cognitive function, including its influence on the gut barrier and immune cells, is essential to elucidate the mechanisms underlying the development of HE. This understanding offers novel perspectives for its prevention and treatment. This paper provides a comprehensive review of the research progress concerning the gut microbiota, HE, and their interrelationship, along with current treatment methods for HE. Furthermore, it outlines the limitations and challenges associated with microbiota-based therapeutic research.
基金supported by grants from the general project of Nanjing Medical University Science and Technology Development Foundation (Grant No.NMUB20210112)。
文摘Inflammation plays a crucial role in the initiation and progression of sepsis and induces alterations in brain neurotransmission, thereby contributing to the development of sepsis-associated encephalopathy(SAE).Parvalbumin(PV) interneurons are pivotal contributors to cognitive processes and have been implicated in various central nervous system dysfunctions, including SAE. Oxytocin, known for its ability to augment the firing rate of gamma-aminobutyric acid(GABA)-ergic interneurons and directly stimulate inhibitory interneurons to enhance the tonic inhibition of pyramidal neurons, has prompted an investigation into its potential therapeutic effects on cognitive dysfunction in SAE. In the current study, we administered intranasal oxytocin to SAE mice induced by lipopolysaccharide. Behavioral assessments, including open field, Y-maze, and fear conditioning, were used to evaluate cognitive performance. Golgi staining revealed hippocampal synaptic deterioration, local field potential recordings showed weakened gamma oscillations, and immunofluorescence staining demonstrated decreased PV expression in the cornu ammonis 1(CA1) region of the hippocampus following lipopolysaccharide treatment, all of which were alleviated by oxytocin administration. Furthermore, immunofluorescence staining of PV co-localization with vesicular glutamate transporter 1 or vesicular GABA transporter indicated a balanced excitation/inhibition effect of neurotransmitters on PV interneurons after oxytocin administration in the SAE mice, leading to an improved cognitive function. In conclusion, oxytocin treatment improved cognitive function by increasing the number of PV^(+) neurons in the hippocampal CA1 region, restoring the balance of excitatory/inhibitory synaptic transmission on PV interneurons, and enhancing hippocampal CA1 local field potential gamma oscillations. These findings suggest a potential mechanism underlying the beneficial effects of oxytocin in SAE.
基金Supported by The Basic and Clinical Integration Project of Xi'an Jiaotong University,No.YXJLRH2022067.
文摘In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.
基金the Shanghai Municipal Health Commission Medical New Technology Research and Translation Seed Program,No.2024ZZ2052Scientific Research Project funded by Shanghai Fifth People’s Hospital,Fudan University,No.2023WYRH03 and No.2025GZRFY05+2 种基金Shanghai Putuo District Health System Clinical Medicine Discipline Construction Project,No.2024tszk01Shanghai Health System Key Discipline,No.2024ZDXK0005Shanghai Minhang District Health and Family Planning Commission,No.2024MWDXK01.
文摘BACKGROUND Sepsis-associated encephalopathy(SAE)is a common complication of sepsis,characterized by cognitive impairment,altered consciousness,and psychiatric symptoms,including anxiety and depression.These psychiatric symptoms often exacerbate the overall prognosis and quality of life of affected patients.However,the underlying metabolic and proteomic features associated with SAE-induced psychiatric symptoms remain poorly understood.AIM To investigate the clinical manifestations of anxiety and depression in patients with sepsis and SAE and to explore their associated metabolic and proteomic characteristics.METHODS A total of 88 patients were enrolled,comprising 30 healthy controls,29 patients with sepsis,and 29 with SAE.Anxiety and depression symptoms were evaluated using the Hamilton anxiety rating scale(HAM-A)and Hamilton depression rating scale(HAM-D)in sepsis and SAE.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA),and quality of life was measured using the 36-Item Short Form Health Survey.Plasma samples were analyzed for metabolomic and proteomic profiling.Metabolic alterations were identified through liquid chromatography-mass spectrometry,while protein expression was assessed using Olink targeted proteomics.RESULTS Compared to the sepsis group,patients with SAE exhibited significantly higher levels of anxiety(HAM-A:15.2±4.0 vs 10.4±3.0,P=0.012)and depression(HAM-D:16.0±3.5 vs 9.1±2.3,P=0.003).Cognitive function,as measured by MoCA,was notably impaired in the SAE group(MoCA:18.5±4.0 vs 24.5±3.2,P=0.007).Quality of life scores,particularly in physical functioning,emotional well-being,and mental health,were significantly lower in patients with SAE.Metabolomic and proteomic analyses revealed substantial alterations in oxidative stress and nicotinamide adenine dinucleotide(NAD+)metabolism pathways,with cluster of differentiation(CD)38 emerging as a potential biomarker associated with psychiatric symptoms in SAE.Further validation in an independent cohort confirmed the diagnostic relevance of CD38.CONCLUSION This study highlights the significant psychological burden of SAE,manifested as anxiety and depression.Multiomics analysis identified distinct metabolic alterations,particularly in NAD+metabolism,that may contribute to psychiatric symptom development and progression.Furthermore,CD38 was identified as a promising biomarker for the early detection of SAE,providing potential avenues for early intervention and therapeutic targeting.
