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Spinal cord injury-induced cognitive impairment: a narrative review

Neural Regeneration Research 2022年第12期17卷 2649-2654页

作者： Oscar V.Alcántar-Garibay Diego Incontri-Abraham Antonio Ibarra Centro de Investigación en Ciencias de la Salud(CICSA) Facultad de Ciencias de la SaludUniversidad Anáhuac México Campus NorteHuixquilucanEstado de MéxicoMéxico

Spinal cord injury is a serious damage to the spinal cord that can lead to life-long *** on its etiology,spinal cord injury can be classified as traumatic or non-traumatic spinal cord ***,the pathology of spinal cord injury can be divided into two phases,a primary injury phase,and a secondary injury *** primary spinal cord injury phase involves the initial mechanical injury in which the physical force of impact is directly imparted to the spinal cord,disrupting blood vessels,axons,and neural cell *** the primary injury,a cascade of secondary events begins,expanding the zone of neural tissue damage,and exacerbating neurological *** injury is a progressive condition characterized by pro-inflammatory cytokines,reactive oxygen species,oxidative damage,excitatory amino acids such as glutamate,loss of ionic homeostasis,mitochondrial dysfunction,and cell *** secondary phase lasts for several weeks or months and can be further subdivided into acute,subacute,and *** of the most frequent and devastating complications developed among the spinal cord injury population is cognitive *** risk of cognitive decline after spinal cord injury has been reported to be 13 times higher than in healthy *** exact etiology of this neurological complication remains unclear,however,many factors have been proposed as potential contributors to the development of this disorder,such as concomitant traumatic brain injury,hypoxia,anoxia,autonomic dysfunction,sleep disorders such as obstructive sleep apnea,body temperature dysregulation,alcohol abuse,and certain *** review focuses on a deep understanding of the pathophysiology of spinal cord injury and its relationship to cognitive *** highlight the main mechanisms that lead to the development of this neurological complication in patients with spinal cord injury.

关键词： autonomic dysfunction cognitive impairment spinal cord injury traumatic brain injury

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Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

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World Journal of Gastroenterology 2014年第10期20卷 2555-2563页

作者： Massimo Bolognesi Marco Di Pascoli Alberto Verardo Angelo Gatta Department of Internal Medicine-DIMED University of Padua Azienda Ospedaliera Università di Padova 35128 Padova Italy

Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

关键词： Portal hypertension Splanchnic flow Splenic circulation Nitric oxide autonomic dysfunction Cirrhosis Hyperdynamic circulatory syndrome

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Nonalcoholic fatty liver disease and aging: Epidemiology to management

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World Journal of Gastroenterology 2014年第39期20卷 14185-14204页

作者： Marco Bertolotti Amedeo Lonardo Chiara Mussi Enrica Baldelli Elisa Pellegrini Stefano Ballestri Dante Romagnoli Paola Loria Department of Biomedical Metabolic and Neural Sciences Nuovo Ospedale Civile di Modena University of Modena and Reggio Emilia and Azienda USL of Modena Baggiovara 41126 Modena Italy Division of Internal Medicine Pavullo Hospital 41026 Pavullo (MO) Italy

Nonalcoholic fatty liver disease(NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic(nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications(cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment(diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.

关键词： Adipose tissue Atherosclerosis Aortic valve sclerosis autonomic dysfunction Arrhythmia Cirrhosis Dementia Falls Frailty Hepatocellular carcinoma Microbiota Nuclear receptors Pathogenesis Sarcopenia Treatment

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Abnormal Systemic and Ocular Responses to the Valsalva Manoeuvre in Primary Open-Angle Glaucoma:A Case for autonomic Failure?

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Current Medical Science 2023年第2期43卷 376-383页

作者： Bin-bin LIU Bo-wen ZHAO Fei-peng WU Tian HU Yin ZHAO Hong ZHANG Department of Ophthalmology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

Objective This study aimed to examine the association of primary open-angle glaucoma(POAG)with autonomic dysfunction by assessing the differences in systemic and ocular responses to an autonomic provocation test,the Valsalva manoeuvre(VM),between POAG patients and normal *** Forty POAG and forty control subjects were subjected to the *** and ocular parameters were measured at baseline,phase 2,and phase 4 of the VM(VM2 and VM4),where VM2 and VM4 are sympathetic and parasympathetic nervous activation states,*** rate variability was used to assess the autonomic nervous activity,among which the high-frequency component(HF)and the low-frequency(LF)/HF ratio were used as indices of parasympathetic and sympathetic activation,*** POAG patients demonstrated higher sympathetic activation(LF/HF ratio median:2.17 vs.1.53,P=0.000)than controls at baseline and exhibited attenuated sympathetic and parasympathetic responses(a smaller change in LF/HF and HF values)during the VM than *** VM,the intraocular pressure(IOP),mean blood pressure(MAP),mean ocular perfusion pressure(MOPP),and the Schlemm’s canal area(SCAR)increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups(all Pautonomic dysfunction in POAG.

关键词： primary open-angle glaucoma Valsalva manoeuvre autonomic dysfunction intraocular pressure Schlemm’s canal

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Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes?

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World Journal of Clinical Pediatrics 2024年第1期13卷 150-154页

作者： Annemarie Cecilie Grauslund Emilie Bundgaard Lindkvist Steffen Ullitz Thorsen Søren Ballegaard Jens Faber Jannet Svensson Anna Korsgaard Berg Department of Pediatrics Herlev and Gentofte HospitalHerlev 2730Denmark Copenhagen University Hospital Steno Diabetes Center CopenhagenHerlev 2730Denmark Department of Clinical Immunology RigshospitaletUniversity of CopenhagenCopenhagen 2100Denmark Department of Endocrinology Herlev and Gentofte HospitalHerlev 2730Denmark Department of Clinical Medicine Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen 2200Denmark

Type 1 diabetes(T1D)is associated with general-and diabetes-specific stress which has multiple adverse *** measuring stress is of great *** algometer measuring pressure pain sensitivity(PPS)has been shown to correlate to certain stress measures in ***,it has never been investigated in children and *** aim of our study was to examine associations between PPS and glycated hemoglobin(HbA1c),salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with ***-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study *** cortisol,PPS and questionnaires were collected,measured,and answered on ***1c was collected from medical *** found correlations between PPS and HbA1c(rho=0.35,P=0.046),cortisol(rho=-0.25,P=0.02)and Perceived Stress Scale(rho=-0.44,P=0.02)in different subgroups based on *** scored higher in PPS than females(P<0.001).We found PPS to be correlated to HbA1c but otherwise inconsistent in *** PPS values indicated either measurement difficulties or hypersensibility towards pain.

关键词： Stress Children and adolescents Type 1 diabetes autonomic dysfunction

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Cardiopulmonary,complications in chronic liver disease

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World Journal of Gastroenterology 2006年第4期12卷 526-538页

作者： SφrenMφller JensHHenriksen Department of Clinical Physiology 239Hvidovre HospitalUniversity of CopenhagenCopenhagenDenmark

Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular and pulmonary hemodynamic changes. A vasodilatatory state and a hyperdynamic circulation affecting the cardiac and pulmonary functions dominate the circulation. The recently defined cirrhotic cardiomyopathy may affect systolic and diastolic functions, and imply electromechanical abnormalities. In addition, the baroreceptor function and regulation of the circulatory homoeostasis is impaired. Pulmonary dysfunction involves diffusing abnormalities with the development of the hepatopulmonary syndrome and portopulmonary hypertension in some patients. Recent research has focused on the assertion that the hemodynamic and neurohumoral dysregulation are of major importance for the development of the cardiovascular and pulmonary complications in cirrhosis. This aspect is important to take into account in the management of these patients.

关键词： Cirrhosis Portal hypertension Cardiomyopathy Hemodynamics Vasoactive substances Baroreceptors Hepatopulmonary syndrome Portopulmonary hypertension autonomic dysfunction

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Cardiac implications in myasthenia gravis

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World Journal of Clinical Cases 2024年第26期12卷 5863-5867页

作者： Praveen Reddy Elmati Gowthami Sai Kogilathota Jagirdhar Salim Surani Department of Anesthesiology Saint Clair HospitalDoverNJ 07801United States Department of Medicine Saint Michaels Medical CenterNewarkNJ 07107United States Department of Medicine and Pharmacology Texas A&M UniversityCollege StationTX 77843United States

This editorial aimed to consolidate the current evidence in literature on the association between myasthenia gravis(MG)and cardiac involvement,focusing on the impact of thymoma,antistriational antibodies,and late-onset ***,the study aimed to explore the influence of genetic differences among populations on the association with cardiac *** conducted a review of existing literature in PubMed and Google Scholar to find relevant studies on cardiac involvement in *** created search criteria using a combination of free text words,including MG,antistriational antibodies,thymectomy,cardiomyopathy,myocarditis,arrhythmias,autonomic *** articles published in English language were analyzed and *** findings indicate a strong association between thymoma,myasthenic crisis,antistriational antibodies,and late-onset MG with cardiac *** study also revealed that genetic differences among populations influence the risk of cardiac disease and electrocardiography(ECG)abnormalities in MG *** dysfunctions altered cardiac autonomic response and increased susceptibility to arrhythmias and sudden cardiac death in MG *** study supports the significance of thymoma,antistriational antibodies,and late-onset MG as key factors associated with cardiac involvement in MG *** emphasizes the importance of ECG as the initial test in managing MG patients,particularly in the perioperative period,to identify and genetic testing if needed to address their cardiac risk effectively.

关键词： Myasthenia gravis Antistriational antibodies Thymectomy Cardiomyopathy Myocarditis Arrhythmias autonomic dysfunction

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