BACKGROUND：Amyotrophic lateral sclerosis （ALS） is the most common of all the motor neuron diseases and the absence of a biologic marker has made both diagnosis and tracking evolution of the disease difficult, Elect...BACKGROUND：Amyotrophic lateral sclerosis （ALS） is the most common of all the motor neuron diseases and the absence of a biologic marker has made both diagnosis and tracking evolution of the disease difficult, Electrodiagnostic tests play a fundamental role in quantifying pathological changes in the motor unit pool.OBJECTIVE：We assessed distal-proximal Motor Unit （MU） loss and changes using the method of motor unit number estimation （MUNE）.DESIGN, TIME AND SETTING：A case-control study was performed at the Department of Neuroscience, Pisa University Medical School, Italy from December 1999 to November 2009. PARTICIPANTS：A total of 50 ALS patients were recruited, 30 males：mean age （59.6 ± 13.3） years; 20 females：mean age （63.9 ± 11.7） years; range （30-82） years; all patients had probable or definite ALS. Thirty healthy volunteers were recruited from department staffs, including 20 males and 10 females; mean age （57.7 ± 13.8） years served as controls.METHODS：MUNE was performed for both the biceps brachii and abductor digiti minimi muscles of the same side. The technique used relayed substantially on manual incremental stimulation of the motor nerve, known as the McComas technique （50 ms sweep duration, a gain of 2 mV/Div for M wave, 0.5 mV/Div for each step; filters 10-20 kHz）.MAIN OUTCOME MEASURES：MUNE results were measured.RESULTS：Functioning MU numbers, measured by MUNE, decreased in the biceps brachii and abductor digiti minimi muscles over the entire one-year follow-up period （one assessment every three months） compared with baseline determination, the rate of MU decrease was similar in both muscles, but steeper distally.CONCLUSION：MUNE is a feasible method for ALS patients both proximally and distally to track changes over time in muscle MUs during the disease＇s evolution.展开更多
Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual p...Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.展开更多
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.展开更多
The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut micr...The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut microbiota and sexual health,mediated by its impact on systemic inflammation,hormonal regulation,and immune function.A balanced gut microbiota supports optimal levels of sex hormones,such as estrogen and testosterone,which are critical for sexual function and reproductive health.Additionally,gut-derived metabolites such as short-chain fatty acids contribute to maintaining mucosal barrier integrity and regulating immune responses,which are essential for protecting against infections that may impair sexual health.Conversely,dysbiosis,an imbalance in gut microbial composition,has been linked to conditions such as erectile dysfunction,polycystic ovary syndrome,and reduced libido,emphasizing its role in sexual dysfunction.Lifestyle factors,including diet,stress,and antibiotic use,can modulate the gut microbiota and,consequently,sexual health outcomes.Recent therapeutic approaches,such as probiotics,prebiotics,and fecal microbiota transplantation,offer potential for restoring gut balance and improving sexual health.This review highlights the central role of the gut microbiota in sexual health,emphasizing its importance as a target for therapeutic interventions to enhance overall well-being.展开更多
Dear Editor,In recent years,there has been an increasing focus on the non-motor functions of the cerebellum[1,2].Clinical observations have demonstrated that individuals with cerebellar damage exhibit affective insens...Dear Editor,In recent years,there has been an increasing focus on the non-motor functions of the cerebellum[1,2].Clinical observations have demonstrated that individuals with cerebellar damage exhibit affective insensitivity,executive dysfunction,spatial cognitive impairment,personality changes,and speech difficulties,collectively known as cerebellar cognitive affective syndrome[3].Furthermore,cerebellar dysfunction has been implicated in various neurological disorders such as autism spectrum disorder,obsessive-compulsive disorder,and attention-deficit/hyperactivity disorder[4].展开更多
The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neosubstances that react abnormally), mainly by cytochromes P-4...The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neosubstances that react abnormally), mainly by cytochromes P-450 (CYP), with further pathways, such as mitochondrial dysfunction and apoptosis, also playing a role. Risk factors for drug-induced liver injury include concomitant hepatic diseases, age and genetic polymorphisms of CYP. However, some susceptibility can today be predicted before drug administration, working on the common substrate, by phenotyping and genotyping studies and by taking in consideration patients' health status. Physicians should always think of this adverse effect in the absence of other clear hepatic disease. Ethical and legal problems towards operators in the health care system are always matters to consider.展开更多
The versatility of glutamate as the brain’s foremost excitatory neurotransmitter and modulator of neurotransmission and function is considered common knowledge.Years of research have continued to uncover glutamate’s...The versatility of glutamate as the brain’s foremost excitatory neurotransmitter and modulator of neurotransmission and function is considered common knowledge.Years of research have continued to uncover glutamate’s effects and roles in several neurological and neuropsychiatric disorders,including depression.It had been considered that a deeper understanding of the roles of glutamate in depression might open a new door to understanding the pathological basis of the disorder,improve the approach to patient management,and lead to the development of newer drugs that may benefit more patients.This review examines our current understanding of the roles of endogenous and exogenous sources of glutamate and the glutamatergic system in the aetiology,progression and management of depression.It also examines the relationships that link the gut-brain axis,glutamate and depression;as it emphasizes how the gut-brain axis could impact depression pathogenesis and management via changes in glutamate homeostasis.Finally,we consider what the likely future of glutamate-based therapies and glutamate-based therapeutic manipulations in depression are,and if with them,we are now on the final chapter of understanding the neurochemical milieu of depressive disorders.展开更多
The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescen...The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescent boy who developed a cerebral sinus venous thrombosis during a relapse of his ulcerative colitis and who, while on treatment with heparin, developed heparin-induced thrombocytopenia (HIT). The treatment was then switched to fondaparinux, a synthetic and selective inhibitor of activated factor .展开更多
Due to their immunomodulatory potential and release of trophic factors that promote healing,mesenchymal stromal cells(MSCs)are considered important players in tissue homeostasis and regeneration.MSCs have been widely ...Due to their immunomodulatory potential and release of trophic factors that promote healing,mesenchymal stromal cells(MSCs)are considered important players in tissue homeostasis and regeneration.MSCs have been widely used in clinical trials to treat multiple conditions associated with inflammation and tissue damage.Recent evidence suggests that most of the MSC therapeutic effects are derived from their secretome,including the extracellular vesicles,representing a promising approach in regenerative medicine application to treat organ failure as a result of inflammation/fibrosis.The recent outbreak of respiratory syndrome coronavirus,caused by the newly identified agent severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has forced scientists worldwide to use all available instruments to fight the infection,including the inflammatory cascade caused by this pandemic disease.The use of MSCs is a valid approach to combat organ inflammation in different compartments.In addition to the lungs,which are considered the main inflammatory target for this virus,other organs are compromised by the infection.In particular,the liver is involved in the inflammatory response to SARS-CoV-2 infection,which causes organ failure,leading to death in coronavirus disease 2019(COVID-19)patients.We herein summarize the current implications derived from the use of MSCs and their soluble derivatives in COVID-19 treatment,and emphasize the potential of MSCbased therapy in this clinical setting.展开更多
AIM： To shed some light on the relationship between anti-apoptotic serum Bcl-2 concentrations and metabolic status, anthropometric parameters, inflammation indi- ces, and non-alcoholic fatty liver disease severity we...AIM： To shed some light on the relationship between anti-apoptotic serum Bcl-2 concentrations and metabolic status, anthropometric parameters, inflammation indi- ces, and non-alcoholic fatty liver disease severity were investigated in 43 young individuals with fatty liver （FL） and 41 with nonalcoholic steatohepatitis （NASH）. METHODS： Circulating levels of Bcl-2 were detected in 84 patients with ultrasonographic findings of ＂bright liver＂ and/or hyper-transaminasemia of unknown origin and/or increase in T-glutamyl-transpeptidase （T-GT） strictly in the absence of other acute or chronic liver disease, whose age was not advanced, who gave consent to liver biopsy and were then divided on the basis of the histological results into two groups （43 with FL and 41 with NASH）. Twenty lean subjects, apparently healthy and young, were chosen as controls.RESULTS： Serum Bcl-2 concentrations were significantly higher in the FL group than in the NASH group. Insulin resistance and γ-GT activity were significantly higher in NASH subjects. Apoptotic hepatocytes were significantly more numerous in NASH patients. NASH patients presented with larger spleens and augmented C-reactive protein （CRP） concentrations than healthy subjects. Steatosis grade at histology was similar in both NASH and FL populations. The number of apoptotic cells was significantly related to anti-apoptotic Bcl-2 protein values in FL patients. Bcl-2 serum levels positively correlated to body mass index （BMI） values （P ~ 0.0001） but not to age of the population. Triglycerides/HDL ratio correlated well to waist circumference in males （P = 0.0008）. γ-GT activity was associated with homeostatic metabolic assessment （HOMA） （P = 0.0003） and with serum ferritin （P = 0.02）. Bcl-2 concentrations were not related to either spleen size or CRP values. NASH patients pre- sented a weak negative correlation between Iobular inflammation and Bcl-2 levels. A prediction by low values of serum Bcl-2 towards a greater presence of metabolically unhealthy overweight/obese patients （MUOs） was evidenced. HOMA, BMI and uric acid, in that sequence, best predicted serum Bcl-2 concentrations. CONCLUSION： IvlUOs could be detected by Bcl-2 levels. By favoring the life span of hepatocytes, and enhancing triglyceride formation, the anti-apoptotic process inhibits free fatty acids toxicity in FL.展开更多
The development of secondary health complications following spinal cord injury has been increasingly recognized by healthcare professionals as a major concern. These problems most specifically affect complete or near-...The development of secondary health complications following spinal cord injury has been increasingly recognized by healthcare professionals as a major concern. These problems most specifically affect complete or near-complete spinal cord injury patients （e.g., those with minimal mobility）, who are not typically rehabilitated with treadmill training approaches, because motor control and leg movements are largely impaired. However, recent pharmaceutical advances in central pattern generator activation may provide new therapeutic hopes for these spinal cord injury patients. This article provides a comprehensive overview, for the non-specialist, of the most recent advances in this field.展开更多
AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBAS...AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.展开更多
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provi...Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.展开更多
Objective： The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods： Searches of Pub Med and Web of Science were undert...Objective： The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods： Searches of Pub Med and Web of Science were undertaken to identify studies evaluating the association between antiepileptic drugs and bone mineral density and bone metabolism. Results： A total of 22 studies with 1492 subjects were included in our research. We identified：（1） a reduction in bone mineral density at lumbar spine（standardized mean difference（SMD）=-0.30, 95% confidence interval（CI） [-0.61,-0.05]）, trochanter（mean difference（MD）=-0.07, 95% CI [-0.10,-0.05]）, femoral neck（MD=-0.05, 95% CI [-0.09,-0.02]）, and total body bone mineral density（MD=-0.33, 95% CI [-0.51,-0.15]）;（2） a reduction in 25-hydroxyvitamin D（MD=-3.37, 95% CI [-5.94,-0.80]） and an increase in serum alkaline phosphatase（SMD=0.71, 95% CI [0.38, 1.05]）;（3） no significant changes in serum parathyroid hormone, calcium, or phosphorus. Conclusions： Our meta-analysis suggests that treatment with antiepileptic drugs may be associated with decreased bone mineral density in epileptic children.展开更多
Lepidoptera evolved tympanic ears in response to echolocating bats. Comparative studies have shown that moth ears evolved many times independently from chordotonal organs. With only 1 to 4 receptor cells, they are one...Lepidoptera evolved tympanic ears in response to echolocating bats. Comparative studies have shown that moth ears evolved many times independently from chordotonal organs. With only 1 to 4 receptor cells, they are one of the simplest hearing organs. The small number of receptors does not imply simplicity, neither in behavior nor in the neural circuit. Behaviorally, the response to ultrasound is far from being a simple reflex. Moths＇ escape behavior is modulated by a variety of cues, especially pheromones, which can alter the auditory response. Neurally the receptor cell（s） diverges onto many interneurons, enabling pa- rallel processing and feature extraction. Ascending interneurons and sound-sensitive brain neurons innervate a neuropil in the ventrolateral protocerebrum. Further, recent electrophysiological data provides the first glimpses into how the acoustic response is modulated as well as how ultrasound influences the other senses. So far, the auditory pathway has been studied in noctuids. The findings agree well with common computational principles found in other insects. However, moth ears also show unique mechanical and neural adaptation. Here, we first describe the variety of moths＇ auditory behavior, especially the co-option of ul- trasonic signals for intraspecific communication. Second, we describe the current knowledge of the neural pathway gained from noctuid moths. Finally, we argue that Galleriinae which show negative and positive phonotaxis, are an interesting model species for future electrophysiological studies of the auditory pathway and multimodal sensory integration, and so are ideally suited for the study of the evolution of behavioral mechanisms given a few receptors.展开更多
The spleen could be considered a neglected organ.To date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attenti...The spleen could be considered a neglected organ.To date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attention in infectious diseases for some time.Now,it is thought to be central in regulating the immune system,a metabolic asset and involved in endocrine function with regard to nonalcoholic fatty liver disease.The main mechanisms involved in this complex network will be critically discussed in this article.展开更多
Group 1 metabotropic glutamate receptors(Gp1 mGluRs),comprising mGluR1 and mGluR5,are predominantly located at postsynaptic terminals.Gp1 mGluRs induce the activation of phospholipase C-γ.
Background:Convulsive status epilepticus is the mostcommon childhood medical neurological emergency,and is associated with significant morbidity and mortality. Mostdata for this disorder are from mainly adult populati...Background:Convulsive status epilepticus is the mostcommon childhood medical neurological emergency,and is associated with significant morbidity and mortality. Mostdata for this disorder are from mainly adult populations and might not be relevant to childhood. Thus we undertook the North London Status Epilepticus in Childhood Surveillance Study (NLSTEPSS):a prospective,population-based study of convulsive status epilepticus in childhood,to obtain a uniquely paediatric perspective.Methods:Clinical and demographic data for episodes of childhood convulsive status epilepticus that took place in north London were obtained through a clinical network that covered the target population. We obtained these data from anonymised copies of a standardised admission proforma; accident and emergency,nursing,ambulance,and intensive-care unit notes; and interviews with parents,medical,nursing,and paramedic staff. We investigated ascertainment using capture-recapture modelling.Findings:Of 226 children enrolled,176 had a first ever episode of convulsive status epilepticus. We estimated that ascertainment was between 62%and 84%.The ascertainment-adjusted incidence was between 17 and 23 episodes per 100 000 per year. 98 (56%,95%CI 48-63) children were neurologically healthy before their first ever episode and 56 (57%,47-66) of those children had a prolonged febrile seizure. 11 (12%,6-18) of children with first ever febrile convulsive status epilepticus had acute bacterial meningitis. Conservative estimation of 1-year recurrence of convulsive status epilepticus was 16%(10-24%). Case fatality was 3%(2-7%). Interpretation:Convulsive status epilepticus in childhood is more common,has a different range of causes,and a lower risk of death than that in adults. These paediatric data will help inform management of convulsive status epilepticus and appropriate allocation of resources to reduce the effects of this disorder in childhood.展开更多
基金Supported by the Italian MIUR PRIN Grant year 2006,# 2006062332_002
文摘BACKGROUND：Amyotrophic lateral sclerosis （ALS） is the most common of all the motor neuron diseases and the absence of a biologic marker has made both diagnosis and tracking evolution of the disease difficult, Electrodiagnostic tests play a fundamental role in quantifying pathological changes in the motor unit pool.OBJECTIVE：We assessed distal-proximal Motor Unit （MU） loss and changes using the method of motor unit number estimation （MUNE）.DESIGN, TIME AND SETTING：A case-control study was performed at the Department of Neuroscience, Pisa University Medical School, Italy from December 1999 to November 2009. PARTICIPANTS：A total of 50 ALS patients were recruited, 30 males：mean age （59.6 ± 13.3） years; 20 females：mean age （63.9 ± 11.7） years; range （30-82） years; all patients had probable or definite ALS. Thirty healthy volunteers were recruited from department staffs, including 20 males and 10 females; mean age （57.7 ± 13.8） years served as controls.METHODS：MUNE was performed for both the biceps brachii and abductor digiti minimi muscles of the same side. The technique used relayed substantially on manual incremental stimulation of the motor nerve, known as the McComas technique （50 ms sweep duration, a gain of 2 mV/Div for M wave, 0.5 mV/Div for each step; filters 10-20 kHz）.MAIN OUTCOME MEASURES：MUNE results were measured.RESULTS：Functioning MU numbers, measured by MUNE, decreased in the biceps brachii and abductor digiti minimi muscles over the entire one-year follow-up period （one assessment every three months） compared with baseline determination, the rate of MU decrease was similar in both muscles, but steeper distally.CONCLUSION：MUNE is a feasible method for ALS patients both proximally and distally to track changes over time in muscle MUs during the disease＇s evolution.
文摘Premenstrual and menstrual exacerbation of psychiatric disorders is a significant area of concern in female mental health.Many females experience a worsening of psychiatric symptoms in the premenstrual and menstrual phases of their menstrual cycle,including heightened anxiety,depression,irritability,and mood swings.These exacerbations are most commonly associated with premenstrual syndrome and premenstrual dysphoric disorder that are characterized by severe emotional and physical symptoms that interfere with daily functioning.The hormonal fluctuations during the menstrual cycle,particularly changes in estrogen and progesterone levels,are believed to play a pivotal role in these exacerbations.Psychiatric disorders such as depression,anxiety,bipolar disorder,and schizophrenia may be influenced by these hormonal changes,with many females reporting an increase in symptom severity during specific phases of the cycle.The mechanisms behind this phenomenon remain complex,with both biological and psychosocial factors contributing to the heightened vulnerability.Clinical management includes careful monitoring of symptom patterns in relation to the menstrual cycle,with treatment options ranging from lifestyle modifications and psychotherapy to pharmacological interventions such as antidepressants and hormonal therapies.Understanding the link between menstruation and psychiatric disorders is essential for improving diagnosis and tailoring effective treatment strategies for affected individuals.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
文摘The gut microbiota plays a pivotal role in human health,influencing diverse physiological processes,including those related to sexual health.Emerging evidence suggests a bidirectional relationship between the gut microbiota and sexual health,mediated by its impact on systemic inflammation,hormonal regulation,and immune function.A balanced gut microbiota supports optimal levels of sex hormones,such as estrogen and testosterone,which are critical for sexual function and reproductive health.Additionally,gut-derived metabolites such as short-chain fatty acids contribute to maintaining mucosal barrier integrity and regulating immune responses,which are essential for protecting against infections that may impair sexual health.Conversely,dysbiosis,an imbalance in gut microbial composition,has been linked to conditions such as erectile dysfunction,polycystic ovary syndrome,and reduced libido,emphasizing its role in sexual dysfunction.Lifestyle factors,including diet,stress,and antibiotic use,can modulate the gut microbiota and,consequently,sexual health outcomes.Recent therapeutic approaches,such as probiotics,prebiotics,and fecal microbiota transplantation,offer potential for restoring gut balance and improving sexual health.This review highlights the central role of the gut microbiota in sexual health,emphasizing its importance as a target for therapeutic interventions to enhance overall well-being.
基金supported by grants from the STI2030-Major Projects(2021ZD0204000)the Key Strategic Science and Technology Cooperation Project(2023YFE0206800)+1 种基金the Ministry of Science and Technology of China,the National Natural Science Foundation of China(31820103005,32170976,32100791,and 81971874),Zhejiang Province Natural Science Foundation of China(LZ24C090003 and LY21C090003)the Peak Discipline Cultivation Program of Zhejiang University School of Basic Medicine.
文摘Dear Editor,In recent years,there has been an increasing focus on the non-motor functions of the cerebellum[1,2].Clinical observations have demonstrated that individuals with cerebellar damage exhibit affective insensitivity,executive dysfunction,spatial cognitive impairment,personality changes,and speech difficulties,collectively known as cerebellar cognitive affective syndrome[3].Furthermore,cerebellar dysfunction has been implicated in various neurological disorders such as autism spectrum disorder,obsessive-compulsive disorder,and attention-deficit/hyperactivity disorder[4].
文摘The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neosubstances that react abnormally), mainly by cytochromes P-450 (CYP), with further pathways, such as mitochondrial dysfunction and apoptosis, also playing a role. Risk factors for drug-induced liver injury include concomitant hepatic diseases, age and genetic polymorphisms of CYP. However, some susceptibility can today be predicted before drug administration, working on the common substrate, by phenotyping and genotyping studies and by taking in consideration patients' health status. Physicians should always think of this adverse effect in the absence of other clear hepatic disease. Ethical and legal problems towards operators in the health care system are always matters to consider.
文摘The versatility of glutamate as the brain’s foremost excitatory neurotransmitter and modulator of neurotransmission and function is considered common knowledge.Years of research have continued to uncover glutamate’s effects and roles in several neurological and neuropsychiatric disorders,including depression.It had been considered that a deeper understanding of the roles of glutamate in depression might open a new door to understanding the pathological basis of the disorder,improve the approach to patient management,and lead to the development of newer drugs that may benefit more patients.This review examines our current understanding of the roles of endogenous and exogenous sources of glutamate and the glutamatergic system in the aetiology,progression and management of depression.It also examines the relationships that link the gut-brain axis,glutamate and depression;as it emphasizes how the gut-brain axis could impact depression pathogenesis and management via changes in glutamate homeostasis.Finally,we consider what the likely future of glutamate-based therapies and glutamate-based therapeutic manipulations in depression are,and if with them,we are now on the final chapter of understanding the neurochemical milieu of depressive disorders.
文摘The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescent boy who developed a cerebral sinus venous thrombosis during a relapse of his ulcerative colitis and who, while on treatment with heparin, developed heparin-induced thrombocytopenia (HIT). The treatment was then switched to fondaparinux, a synthetic and selective inhibitor of activated factor .
基金UPMC International,Pittsburg,United States,No.I0000026Italian Ministry of Education,University and Research,Rome,Italy,No.CTN01_00177_888744PO FESR Sicilia 2014/2020 Azione 1.1.5 Project(Prometeo),No.08PA8610200270.
文摘Due to their immunomodulatory potential and release of trophic factors that promote healing,mesenchymal stromal cells(MSCs)are considered important players in tissue homeostasis and regeneration.MSCs have been widely used in clinical trials to treat multiple conditions associated with inflammation and tissue damage.Recent evidence suggests that most of the MSC therapeutic effects are derived from their secretome,including the extracellular vesicles,representing a promising approach in regenerative medicine application to treat organ failure as a result of inflammation/fibrosis.The recent outbreak of respiratory syndrome coronavirus,caused by the newly identified agent severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has forced scientists worldwide to use all available instruments to fight the infection,including the inflammatory cascade caused by this pandemic disease.The use of MSCs is a valid approach to combat organ inflammation in different compartments.In addition to the lungs,which are considered the main inflammatory target for this virus,other organs are compromised by the infection.In particular,the liver is involved in the inflammatory response to SARS-CoV-2 infection,which causes organ failure,leading to death in coronavirus disease 2019(COVID-19)patients.We herein summarize the current implications derived from the use of MSCs and their soluble derivatives in COVID-19 treatment,and emphasize the potential of MSCbased therapy in this clinical setting.
文摘AIM： To shed some light on the relationship between anti-apoptotic serum Bcl-2 concentrations and metabolic status, anthropometric parameters, inflammation indi- ces, and non-alcoholic fatty liver disease severity were investigated in 43 young individuals with fatty liver （FL） and 41 with nonalcoholic steatohepatitis （NASH）. METHODS： Circulating levels of Bcl-2 were detected in 84 patients with ultrasonographic findings of ＂bright liver＂ and/or hyper-transaminasemia of unknown origin and/or increase in T-glutamyl-transpeptidase （T-GT） strictly in the absence of other acute or chronic liver disease, whose age was not advanced, who gave consent to liver biopsy and were then divided on the basis of the histological results into two groups （43 with FL and 41 with NASH）. Twenty lean subjects, apparently healthy and young, were chosen as controls.RESULTS： Serum Bcl-2 concentrations were significantly higher in the FL group than in the NASH group. Insulin resistance and γ-GT activity were significantly higher in NASH subjects. Apoptotic hepatocytes were significantly more numerous in NASH patients. NASH patients presented with larger spleens and augmented C-reactive protein （CRP） concentrations than healthy subjects. Steatosis grade at histology was similar in both NASH and FL populations. The number of apoptotic cells was significantly related to anti-apoptotic Bcl-2 protein values in FL patients. Bcl-2 serum levels positively correlated to body mass index （BMI） values （P ~ 0.0001） but not to age of the population. Triglycerides/HDL ratio correlated well to waist circumference in males （P = 0.0008）. γ-GT activity was associated with homeostatic metabolic assessment （HOMA） （P = 0.0003） and with serum ferritin （P = 0.02）. Bcl-2 concentrations were not related to either spleen size or CRP values. NASH patients pre- sented a weak negative correlation between Iobular inflammation and Bcl-2 levels. A prediction by low values of serum Bcl-2 towards a greater presence of metabolically unhealthy overweight/obese patients （MUOs） was evidenced. HOMA, BMI and uric acid, in that sequence, best predicted serum Bcl-2 concentrations. CONCLUSION： IvlUOs could be detected by Bcl-2 levels. By favoring the life span of hepatocytes, and enhancing triglyceride formation, the anti-apoptotic process inhibits free fatty acids toxicity in FL.
文摘The development of secondary health complications following spinal cord injury has been increasingly recognized by healthcare professionals as a major concern. These problems most specifically affect complete or near-complete spinal cord injury patients （e.g., those with minimal mobility）, who are not typically rehabilitated with treadmill training approaches, because motor control and leg movements are largely impaired. However, recent pharmaceutical advances in central pattern generator activation may provide new therapeutic hopes for these spinal cord injury patients. This article provides a comprehensive overview, for the non-specialist, of the most recent advances in this field.
文摘AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
文摘Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
基金Project supported by the National High-Tech R&D Program(863)of China(No.2012AA020408)the Medical and Health General Research Plan of Zhejiang Province(No.2014KYA103),China
文摘Objective： The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods： Searches of Pub Med and Web of Science were undertaken to identify studies evaluating the association between antiepileptic drugs and bone mineral density and bone metabolism. Results： A total of 22 studies with 1492 subjects were included in our research. We identified：（1） a reduction in bone mineral density at lumbar spine（standardized mean difference（SMD）=-0.30, 95% confidence interval（CI） [-0.61,-0.05]）, trochanter（mean difference（MD）=-0.07, 95% CI [-0.10,-0.05]）, femoral neck（MD=-0.05, 95% CI [-0.09,-0.02]）, and total body bone mineral density（MD=-0.33, 95% CI [-0.51,-0.15]）;（2） a reduction in 25-hydroxyvitamin D（MD=-3.37, 95% CI [-5.94,-0.80]） and an increase in serum alkaline phosphatase（SMD=0.71, 95% CI [0.38, 1.05]）;（3） no significant changes in serum parathyroid hormone, calcium, or phosphorus. Conclusions： Our meta-analysis suggests that treatment with antiepileptic drugs may be associated with decreased bone mineral density in epileptic children.
文摘Lepidoptera evolved tympanic ears in response to echolocating bats. Comparative studies have shown that moth ears evolved many times independently from chordotonal organs. With only 1 to 4 receptor cells, they are one of the simplest hearing organs. The small number of receptors does not imply simplicity, neither in behavior nor in the neural circuit. Behaviorally, the response to ultrasound is far from being a simple reflex. Moths＇ escape behavior is modulated by a variety of cues, especially pheromones, which can alter the auditory response. Neurally the receptor cell（s） diverges onto many interneurons, enabling pa- rallel processing and feature extraction. Ascending interneurons and sound-sensitive brain neurons innervate a neuropil in the ventrolateral protocerebrum. Further, recent electrophysiological data provides the first glimpses into how the acoustic response is modulated as well as how ultrasound influences the other senses. So far, the auditory pathway has been studied in noctuids. The findings agree well with common computational principles found in other insects. However, moth ears also show unique mechanical and neural adaptation. Here, we first describe the variety of moths＇ auditory behavior, especially the co-option of ul- trasonic signals for intraspecific communication. Second, we describe the current knowledge of the neural pathway gained from noctuid moths. Finally, we argue that Galleriinae which show negative and positive phonotaxis, are an interesting model species for future electrophysiological studies of the auditory pathway and multimodal sensory integration, and so are ideally suited for the study of the evolution of behavioral mechanisms given a few receptors.
文摘The spleen could be considered a neglected organ.To date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attention in infectious diseases for some time.Now,it is thought to be central in regulating the immune system,a metabolic asset and involved in endocrine function with regard to nonalcoholic fatty liver disease.The main mechanisms involved in this complex network will be critically discussed in this article.
文摘Group 1 metabotropic glutamate receptors(Gp1 mGluRs),comprising mGluR1 and mGluR5,are predominantly located at postsynaptic terminals.Gp1 mGluRs induce the activation of phospholipase C-γ.
文摘Background:Convulsive status epilepticus is the mostcommon childhood medical neurological emergency,and is associated with significant morbidity and mortality. Mostdata for this disorder are from mainly adult populations and might not be relevant to childhood. Thus we undertook the North London Status Epilepticus in Childhood Surveillance Study (NLSTEPSS):a prospective,population-based study of convulsive status epilepticus in childhood,to obtain a uniquely paediatric perspective.Methods:Clinical and demographic data for episodes of childhood convulsive status epilepticus that took place in north London were obtained through a clinical network that covered the target population. We obtained these data from anonymised copies of a standardised admission proforma; accident and emergency,nursing,ambulance,and intensive-care unit notes; and interviews with parents,medical,nursing,and paramedic staff. We investigated ascertainment using capture-recapture modelling.Findings:Of 226 children enrolled,176 had a first ever episode of convulsive status epilepticus. We estimated that ascertainment was between 62%and 84%.The ascertainment-adjusted incidence was between 17 and 23 episodes per 100 000 per year. 98 (56%,95%CI 48-63) children were neurologically healthy before their first ever episode and 56 (57%,47-66) of those children had a prolonged febrile seizure. 11 (12%,6-18) of children with first ever febrile convulsive status epilepticus had acute bacterial meningitis. Conservative estimation of 1-year recurrence of convulsive status epilepticus was 16%(10-24%). Case fatality was 3%(2-7%). Interpretation:Convulsive status epilepticus in childhood is more common,has a different range of causes,and a lower risk of death than that in adults. These paediatric data will help inform management of convulsive status epilepticus and appropriate allocation of resources to reduce the effects of this disorder in childhood.
