Chronic cerebral hypoperfusion can cause progressive demyelination as well as ischemic vascular dementia,however no effective treatments are available.Here,based on magnetic resonance imaging studies of patients with ...Chronic cerebral hypoperfusion can cause progressive demyelination as well as ischemic vascular dementia,however no effective treatments are available.Here,based on magnetic resonance imaging studies of patients with white matter damage,we found that this damage is associated with disorganized cortical structure.In a mouse model,optogenetic activation of glutamatergic neurons in the somatosensory cortex significantly promoted oligodendrocyte progenitor cell(OPC)proliferation,remyelination in the corpus callosum,and recovery of cognitive ability after cerebral hypoperfusion.The therapeutic effect of such stimulation was restricted to the upper layers of the cortex,but also spanned a wide time window after ischemia.Mechanistically,enhancement of glutamatergic neuron-OPC functional synaptic connections is required to achieve the protection effect of activating cortical glutamatergic neurons.Additionally,skin stroking,an easier method to translate into clinical practice,activated the somatosensory cortex,thereby promoting OPC proliferation,remyelination and cognitive recovery following cerebral hypoperfusion.In summary,we demonstrated that activating glutamatergic neurons in the somatosensory cortex promotes the proliferation of OPCs and remyelination to recover cognitive function after chronic cerebral hypoperfusion.It should be noted that this activation may provide new approaches for treating ischemic vascular dementia via the precise regulation of glutamatergic neuron-OPC circuits.展开更多
Through clinical practice over the last decade, , I have been using Baihui （GV 20） and Sishencong （Ex-HN 1） for treating various diseases or symptoms. It is now reported as follows.
The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic hear...The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.展开更多
The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with ...The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.展开更多
BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common public health issue that has been linked to cognitive dysfunction.AIM To investigate the relationship between COPD and a risk of mild cognitive impairm...BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common public health issue that has been linked to cognitive dysfunction.AIM To investigate the relationship between COPD and a risk of mild cognitive impairment(MCI)and dementia.METHODS A comprehensive literature search of the PubMed,Embase,Google Scholar,and Cochrane Library electronic databases was conducted.Pooled odds ratios(OR)and mean differences(MD)with 95%confidence intervals(CIs)were calculated using a random or fixed effects model.Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.RESULTS Twenty-seven studies met all the inclusion criteria.Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence(OR=2.11,95%CI:1.32-3.38).It also revealed a borderline trend for an increased dementia risk in COPD patients(OR=1.16,95%CI:0.98-1.37).Pooled hazard ratios(HR)using adjusted confounders also showed a higher incidence of MCI(HR=1.22,95%CI:-1.18 to-1.27)and dementia(HR=1.32,95%CI:-1.22 to-1.43)in COPD patients.A significant lower mini-mental state examination score in COPD patients was noted(MD=-1.68,95%CI:-2.66 to-0.71).CONCLUSION Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients.Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.展开更多
The purpose of this study is to develop a nursing protocol aiming at early recovery of hospitalized patients with reduced cognitive functions in the process of recovery from acute exacerbation of chronic heart failure...The purpose of this study is to develop a nursing protocol aiming at early recovery of hospitalized patients with reduced cognitive functions in the process of recovery from acute exacerbation of chronic heart failure. At the first stage of the research, a draft nursing protocol was prepared based on a basic survey. At the second stage of research, a semi-structured interview was conducted for 4 nurses certified for chronic heart failure nursing and 11 nurses certified for dementia nursing so as to ensure content validity of the draft nursing protocol. At the third stage of the study, the possibility of clinical application of the nursing protocol revision plan proposed at the second stage of the study was examined. The nursing protocol revision plan was effective for 118 nurses (90.1%) who carried out the protocol for the target patient on assessment items, essential points of nursing care and specific nursing care. There were no items or contents for which confirmation of usefulness was less than 60%. Since 90.1% of the usefulness was confirmed by nurses working in the actual clinical setting, the authors believe that this nursing protocol was secured to a certain level. The nursing protocol developed in this study has been requested by nurses at clinical sites in the past. It is very meaningful in improving nursing for the early recovery of hospitalized patients with reduced cognitive function in the process of recovery from acute exacerbation of chronic heart failure.展开更多
To investigate the relationship between 25-hydroxyvitamin D (25-OHD) deficiency and hepatic encephalopathy (HE) in patients with chronic liver disease (CLD). METHODSA retrospective analysis of the results of 392 adult...To investigate the relationship between 25-hydroxyvitamin D (25-OHD) deficiency and hepatic encephalopathy (HE) in patients with chronic liver disease (CLD). METHODSA retrospective analysis of the results of 392 adult patients with chronic liver disease who were assessed for liver transplantation between 2006 and 2010 was undertaken. HE, severity of CLD, nutritional status and 25-OHD were analysed in patients assessed for liver transplantation between 2006 and 2010. Patients who presented with acute, fulminant or subacute disease, with a primary diagnosis of liver cancer, were assessed for re-transplantation or who did not have a 25-OHD measurement were excluded from the analysis. RESULTSOne hundred and sixty-five patients were included in this analysis. The mean age of all patients was 53 ± 8 years. Moderate to severe 25-OHD deficiency was identified in 49 patients of whom 36 had grade 2-3 HE compared with 13 patients who were not encephalopathic (P ≤ 0.0001). Mild 25-OHD deficiency was not associated with HE. There was a significant correlation between the severity of 25-OHD deficiency and the severity of liver disease (r = 0.39, P ≤ 0.0001) and disease severity and the presence of HE (P ≤ 0.0001). Importantly, individuals with 25-OHD deficiency were more likely to have a diagnosis of overt HE (OHE) at a significantly lower model for end stage liver disease (MELD) score than individuals without OHE (P ≤ 0.0001). This significant difference was observed with MELD scores from 10 to 38. CONCLUSION25-OHD deficiency was observed in the majority of patients with CLD and for the first time was found to be significantly worse in patients with OHE.展开更多
基金We would like to thank the Core Facilities,Zhejiang University School of Medicine for technical support.This work was supported by the National Natural Science Foundation of China(81973302,81903580)the National Key R&D Program of China(2020YFA0803900)the Zhejiang Provincial Natural Science Foundation of China(LR17H310001,LYY22H310003).
文摘Chronic cerebral hypoperfusion can cause progressive demyelination as well as ischemic vascular dementia,however no effective treatments are available.Here,based on magnetic resonance imaging studies of patients with white matter damage,we found that this damage is associated with disorganized cortical structure.In a mouse model,optogenetic activation of glutamatergic neurons in the somatosensory cortex significantly promoted oligodendrocyte progenitor cell(OPC)proliferation,remyelination in the corpus callosum,and recovery of cognitive ability after cerebral hypoperfusion.The therapeutic effect of such stimulation was restricted to the upper layers of the cortex,but also spanned a wide time window after ischemia.Mechanistically,enhancement of glutamatergic neuron-OPC functional synaptic connections is required to achieve the protection effect of activating cortical glutamatergic neurons.Additionally,skin stroking,an easier method to translate into clinical practice,activated the somatosensory cortex,thereby promoting OPC proliferation,remyelination and cognitive recovery following cerebral hypoperfusion.In summary,we demonstrated that activating glutamatergic neurons in the somatosensory cortex promotes the proliferation of OPCs and remyelination to recover cognitive function after chronic cerebral hypoperfusion.It should be noted that this activation may provide new approaches for treating ischemic vascular dementia via the precise regulation of glutamatergic neuron-OPC circuits.
文摘Through clinical practice over the last decade, , I have been using Baihui （GV 20） and Sishencong （Ex-HN 1） for treating various diseases or symptoms. It is now reported as follows.
文摘The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.
文摘The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.
文摘BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common public health issue that has been linked to cognitive dysfunction.AIM To investigate the relationship between COPD and a risk of mild cognitive impairment(MCI)and dementia.METHODS A comprehensive literature search of the PubMed,Embase,Google Scholar,and Cochrane Library electronic databases was conducted.Pooled odds ratios(OR)and mean differences(MD)with 95%confidence intervals(CIs)were calculated using a random or fixed effects model.Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.RESULTS Twenty-seven studies met all the inclusion criteria.Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence(OR=2.11,95%CI:1.32-3.38).It also revealed a borderline trend for an increased dementia risk in COPD patients(OR=1.16,95%CI:0.98-1.37).Pooled hazard ratios(HR)using adjusted confounders also showed a higher incidence of MCI(HR=1.22,95%CI:-1.18 to-1.27)and dementia(HR=1.32,95%CI:-1.22 to-1.43)in COPD patients.A significant lower mini-mental state examination score in COPD patients was noted(MD=-1.68,95%CI:-2.66 to-0.71).CONCLUSION Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients.Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.
文摘目的 :观察慢性低灌注3个月大鼠空间学习、记忆能力的变化及17β-雌二醇(E2)的长期保护作用,揭示血管性痴呆进行性病变的分子机制。方法:永久性结扎成年雄性SD大鼠双侧颈总动脉,诱导慢性低灌注模型,并随机分为假手术(sham)组、安慰剂(placebo,Pla)组及E2处理组;采用免疫荧光染色或Western blot技术检测海马CA1区神经元及突触相关蛋白的变化,采用Morris水迷宫检测大鼠空间记忆能力。结果:1Morris水迷宫结果显示,Pla组大鼠发现水下平台所用时间与sham组大鼠相比无显著差异,而探索试验中在平台原所在象限探索的时间较sham组大鼠显著降低;2与sham组相比,Pla组大鼠海马CA1区Neu N阳性染色细胞数及微管相关蛋白(microtubule-associated protein,MAP)-2的蛋白表达水平无显著差异,而髓鞘碱性蛋白(myelin basic protein,MBP)-2的蛋白表达水平显著降低;3Pla组大鼠海马CA1区突出后致密蛋白95(post-synaptic density protein 95,PSD95)及突触小泡蛋白的蛋白表达水平较sham组显著降低;4长期给予E2可显著治疗双侧颈总动脉结扎造成的以上变化。结论:双侧颈总动脉结扎3个月可导致大鼠空间记忆能力降低,长期给予E2可能通过上调海马CA1区神经元MBP2、PSD95、突触小泡蛋白的蛋白表达,从而阻断血管性痴呆的进行性病变。
文摘The purpose of this study is to develop a nursing protocol aiming at early recovery of hospitalized patients with reduced cognitive functions in the process of recovery from acute exacerbation of chronic heart failure. At the first stage of the research, a draft nursing protocol was prepared based on a basic survey. At the second stage of research, a semi-structured interview was conducted for 4 nurses certified for chronic heart failure nursing and 11 nurses certified for dementia nursing so as to ensure content validity of the draft nursing protocol. At the third stage of the study, the possibility of clinical application of the nursing protocol revision plan proposed at the second stage of the study was examined. The nursing protocol revision plan was effective for 118 nurses (90.1%) who carried out the protocol for the target patient on assessment items, essential points of nursing care and specific nursing care. There were no items or contents for which confirmation of usefulness was less than 60%. Since 90.1% of the usefulness was confirmed by nurses working in the actual clinical setting, the authors believe that this nursing protocol was secured to a certain level. The nursing protocol developed in this study has been requested by nurses at clinical sites in the past. It is very meaningful in improving nursing for the early recovery of hospitalized patients with reduced cognitive function in the process of recovery from acute exacerbation of chronic heart failure.
文摘To investigate the relationship between 25-hydroxyvitamin D (25-OHD) deficiency and hepatic encephalopathy (HE) in patients with chronic liver disease (CLD). METHODSA retrospective analysis of the results of 392 adult patients with chronic liver disease who were assessed for liver transplantation between 2006 and 2010 was undertaken. HE, severity of CLD, nutritional status and 25-OHD were analysed in patients assessed for liver transplantation between 2006 and 2010. Patients who presented with acute, fulminant or subacute disease, with a primary diagnosis of liver cancer, were assessed for re-transplantation or who did not have a 25-OHD measurement were excluded from the analysis. RESULTSOne hundred and sixty-five patients were included in this analysis. The mean age of all patients was 53 ± 8 years. Moderate to severe 25-OHD deficiency was identified in 49 patients of whom 36 had grade 2-3 HE compared with 13 patients who were not encephalopathic (P ≤ 0.0001). Mild 25-OHD deficiency was not associated with HE. There was a significant correlation between the severity of 25-OHD deficiency and the severity of liver disease (r = 0.39, P ≤ 0.0001) and disease severity and the presence of HE (P ≤ 0.0001). Importantly, individuals with 25-OHD deficiency were more likely to have a diagnosis of overt HE (OHE) at a significantly lower model for end stage liver disease (MELD) score than individuals without OHE (P ≤ 0.0001). This significant difference was observed with MELD scores from 10 to 38. CONCLUSION25-OHD deficiency was observed in the majority of patients with CLD and for the first time was found to be significantly worse in patients with OHE.
