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Neuroprotective effects of chaperone-mediated autophagy in neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1291-1298页

作者： Qi Jia Jin Li Xiaofeng Guo Yi Li You Wu Yuliang Peng Zongping Fang Xijing Zhang Department of anesthesiology and Perioperative Medicine and Department of Intensive care Unit Xijing Hospital The Fourth Military Medical University Department of critical care Medicine Translational Research Institute of Brain and Brain-Like Intelligence Shanghai Fourth People's Hospital School of Medicine Tongji University

Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins. Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis, while providing nutrients and support for cell survival. Chaperone-mediated autophagy activity can be detected in almost all cells, including neurons. Owing to the extreme sensitivity of neurons to their environmental changes, maintaining neuronal homeostasis is critical for neuronal growth and survival. Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases. It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction. Under certain conditions, regulation of chaperone-mediated autophagy activity attenuates neurotoxicity. In this paper, we review the changes in chaperone-mediated autophagy in neurodegenerative diseases, brain injury, glioma, and autoimmune diseases. We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.

关键词： chaperone-mediated autophagy neurodegenerative disease neuronal homeostasis neuroprotection

Clinical practice of sepsis-induced immunosuppression:Current immunotherapy and future options

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Chinese Journal of Traumatology 2024年第2期27卷 63-70页

作者： Fei Pei Bin Gu Shu-Min Miao Xiang-Dong Guan Jian-Feng Wu Department of critical care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhou510080China Guangdong Clinical Research Center for critical care Medicine Guangzhou510080China

Sepsis is a potentially fatal condition characterized by the failure of one or more organs due to a disordered host response to infection.The development of sepsis is closely linked to immune dysfunction.As a result,immunotherapy has gained traction as a promising approach to sepsis treatment,as it holds the potential to reverse immunosuppression and restore immune balance,thereby improving the prognosis of septic patients.However,due to the highly heterogeneous nature of sepsis,it is crucial to carefully select the appropriate patient population for immunotherapy.This review summarizes the current and evolved treatments for sepsis-induced immunosuppression to enhance clinicians'understanding and practical application of immunotherapy in the management of sepsis.

关键词： Sepsis Sepsis-induced immunosuppression Immunotherapy Enrichment Classifier

Artificial intelligence:Applications in critical care gastroenterology

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Artificial Intelligence in Gastrointestinal Endoscopy 2024年第1期5卷 1-10页

作者： Deven Juneja Department of critical care Medicine Max Super Speciality HospitalNew Delhi 110017India

Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.

关键词： Artificial intelligence critical care Gastroenterology Hepatology Intensive care unit Machine learning

Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 364-371页

作者： Ji-Chun Tang Jia-Wei Ma Jin-Jin Jian Jie Shen Liang-Liang Cao Department of anesthesiology The Affiliated Hospital of Jiangnan UniversityWuxi 214122Jiangsu ProvinceChina Department of anesthesiology People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture 843599Xinjiang Uygur Autonomous RegionChina Department of critical care Medicine Jiangnan University Medical CenterWuxi 214122Jiangsu ProvinceChina Department of critical care Medicine People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture843599Xinjiang Uygur Autonomous RegionChina

BACKGROUND According to clinical data,a significant percentage of patients experience pain after surgery,highlighting the importance of alleviating postoperative pain.The current approach involves intravenous self-control analgesia,often utilizing opioid analgesics such as morphine,sufentanil,and fentanyl.Surgery for colo-rectal cancer typically involves general anesthesia.Therefore,optimizing anes-thetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative recovery.The study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients'postoperative pain.AIM To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal cancer.METHODS Following the inclusion criteria and exclusion criteria,a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included,of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group,and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research group.After data collection,the effects of postoperative analgesia,sedation,and recovery were compared.RESULTS Compared to the control group,the research group had shorter recovery times for orientation,extubation,eye-opening,and spontaneous respiration(P<0.05).The research group also showed lower Visual analog scale scores at 24 h and 48 h,higher Ramany scores at 6 h and 12 h,and improved cognitive function at 24 h,48 h,and 72 h(P<0.05).Additionally,interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group(P<0.05).Levels of CD3+,CD4+,and CD4+/CD8+were also lower in the research group at multiple time points(P<0.05).CONCLUSION For patients with colorectal cancer,general anesthesia coupled with epidural anesthes

关键词： Multimodal analgesia Anesthesia Colorectal cancer Postoperative pain

The action mechanism by which C1q/tumor necrosis factor-related protein-6 alleviates cerebral ischemia/reperfusion injury in diabetic mice

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Neural Regeneration Research 2024年第9期19卷 2019-2026页

作者： Bo Zhao Mei Li Bingyu Li Yanan Li Qianni Shen Jiabao Hou Yang Wu Lijuan Gu Wenwei Gao Department of anesthesiology Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina Central Laboratory Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina Department of critical care Medicine Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina

Studies have shown that C1q/tumor necrosis factor-related protein-6 (CTRP6) can alleviate renal ischemia/reperfusion injury in mice. However, its role in the brain remains poorly understood. To investigate the role of CTRP6 in cerebral ischemia/reperfusion injury associated with diabetes mellitus, a diabetes mellitus mouse model of cerebral ischemia/reperfusion injury was established by occlusion of the middle cerebral artery. To overexpress CTRP6 in the brain, an adeno-associated virus carrying CTRP6 was injected into the lateral ventricle. The result was that oxygen injury and inflammation in brain tissue were clearly attenuated, and the number of neurons was greatly reduced. In vitro experiments showed that CTRP6 knockout exacerbated oxidative damage, inflammatory reaction, and apoptosis in cerebral cortical neurons in high glucose hypoxia-simulated diabetic cerebral ischemia/reperfusion injury. CTRP6 overexpression enhanced the sirtuin-1 signaling pathway in diabetic brains after ischemia/reperfusion injury. To investigate the mechanism underlying these effects, we examined mice with depletion of brain tissue-specific sirtuin-1. CTRP6-like protection was achieved by activating the sirtuin-1 signaling pathway. Taken together, these results indicate that CTRP6 likely attenuates cerebral ischemia/reperfusion injury through activation of the sirtuin-1 signaling pathway.

关键词： brain C1q/tumor necrosis factor-related protein-6 cerebral apoptosis diabetes inflammation ischemia/reperfusion injury neuron neuroprotection oxidative damage Sirt1

Aspirin interruption before neurosurgical interventions:A controversial problem

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World Journal of Cardiology 2024年第4期16卷 191-198页

作者： Alexander Kulikov Anton Konovalov Pier Paolo Pugnaloni Federico Bilotta Department of anesthesiology Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia Department of Vascular Neurosurgery Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia Department of anesthesiology Critical Care and Pain MedicineUniversity of Rome“Sapienza”Rome 00161Italy

Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.

关键词： Aspirin Neurosurgery Postoperative complications Bleeding risk Brain tumor surgery Cerebrovascular surgery Spinal surgery

A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

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Open Journal of anesthesiology 2024年第4期14卷 118-125页

作者： Kunal Tewari Om Bahadur Thapa Deepak Mishra Manjot Multani Jyotsna Sharma Akash Ray Mohapatra Sandhya Khwaunju Department of anesthesiology and critical care Armed Forces Medical College Pune India Department of anesthesiology and critical care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

Nasogastric tube syndrome:A Meta-summary of case reports

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World Journal of Clinical Cases 2024年第1期12卷 119-129页

作者： Deven Juneja Prashant Nasa Gunjan Chanchalani Ravi Jain Department of critical care Medicine Max Super Speciality HospitalNew Delhi 110017India Department of critical care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of critical care Medicine Karamshibhai Jethabhai Somaiya Hospital and Research CentreMumbai 400022India Department of critical care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://***/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.

关键词： Nasogastric tube Nasogastric tube syndrome Ryle’s tube Sofferman syndrome Vocal cord paralysis

Prediabetes in children and adolescents:A ticking bomb!

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World Journal of Clinical Pediatrics 2024年第2期13卷 11-15页

作者： Anju Gupta Nitin Choudhary Nishkarsh Gupta Department of anesthesiology Pain Medicine and Critical CareAll India Institute of Medical ScienceNew Delhi 110076India Department of Onco-anesthesiology and Palliative Medicine All India Institute of Medical ScienceNew Delhi 110029India

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade.It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus.The incidence of prediabetes in adolescents ranges from 4%-23%which is alarmingly high and requires active intervention from the system.We have discussed early identification of high-risk patients,prompt screening and active intervention to manage this growing problem.

关键词： Prediabetes Children Adolescents Glucose metabolism Complications