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Clinical Gastroenterology and... Mar 2018A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment...
BACKGROUND & AIMS
A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies, and facilitates shared decision-making. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up.
METHODS
Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n = 15,316 UC patients).
RESULTS
Left-sided colitis is the most frequent location, and disease extension is observed in 10%-30% of patients. Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity; about 10%-15% of patients experience an aggressive course, and the cumulative risk of relapse is 70%-80% at 10 years. Almost 50% of patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ∼50%. The 5-year and 10-year cumulative risk of colectomy is 10%-15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators (20%) and anti-tumor necrosis factor (5%-10%). Although UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn's disease.
CONCLUSIONS
UC is a disabling condition over time. Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach with immunomodulators and biologics. Long-term studies from low-incidence areas are also needed.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Colectomy; Colitis, Ulcerative; Disease Progression; Female; Hospitalization; Humans; Incidence; Male; Middle Aged; Prognosis; Recurrence; Young Adult
PubMed: 28625817
DOI: 10.1016/j.cgh.2017.06.016 -
Psychoneuroendocrinology Nov 2022Allostatic load (AL) refers to prolonged dysregulation related to chronic stress that affects brain regions such as the hippocampus, amygdala, and prefrontal cortex...
Allostatic load (AL) refers to prolonged dysregulation related to chronic stress that affects brain regions such as the hippocampus, amygdala, and prefrontal cortex (PFC). Higher levels of AL have been associated with poor health outcomes, including psychiatric disorders, cognitive decline, and chronic somatic conditions. However, still little is known about the relationship between AL and the brain, and the mechanisms explaining the damaging effects of stress-related biological dysregulations. Therefore, we aimed to perform a systematic review of studies investigating the association of the AL index with brain structure and functioning in adult populations. PubMed/MEDLINE, CINAHL, Academic Search Complete and Web of Science were searched from their inception until August, 9th 2021. A total of 13 studies were included in the qualitative synthesis. There was a high between-study heterogeneity with respect to the methods used to calculate the AL index and brain parameters. All studies confirmed the associations between a higher AL index and alterations in various brain areas, especially: 1) the hippocampus, white matter volume, gray matter volume, and density in the older adults; 2) the cortex, fornix, hippocampus and choroid plexus in patients with schizophrenia spectrum disorders; and 3) whole-brain white matter tracts, cortical gray matter volume, and cortical thickness in overweight subjects. Overall, the findings of this systematic review imply that an elevated AL index might be associated with various neurostructural and neurofunctional alterations. Some of these associations may appear regardless of clinical or non-clinical populations being investigated (e.g., white matter tracts), whereas others may appear in specific populations (e.g., cortical thinning in overweight/obesity and schizophrenia spectrum disorders). However, additional studies utilizing a consistent approach to calculating the AL index are needed to extend these findings and indicate populations that are most vulnerable to the damaging effects of AL.
Topics: Aged; Allostasis; Brain; Gray Matter; Humans; Overweight; White Matter
PubMed: 36113380
DOI: 10.1016/j.psyneuen.2022.105917 -
Current Alzheimer Research 2017To systematically review the relationship between the cerebral microinfarcts and dementia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the relationship between the cerebral microinfarcts and dementia.
METHODS
We conducted a systematic review and meta-analyses using the MEDLINE, EMBASE,the Cochrane library, and BIOSIS preview for studies published in the period from January 1st, 1997 to April 1st, 2014. We also searched the reference lists of relevant studies and review articles. Studies had to be controlled, with participants divided into a dementia group and a control group. Experimental participants included must be demented individuals with dementia syndromes (dementia overall, AD, and vascular dementia (VaD)). Outcome measures should include the presence of microinfarcts lesions. The effect size was estimated as odds ratio (OR) with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran's Q-test and I2-statistic.
RESULTS
We pooled data from 12 studies, including 2181 people. Cerebral microinfarcts were significantly associated with dementia in random effects model [the odds ratios (OR) 2.15, 95% confidence interval (95% CI) 1.46-3.15, P=0.0008]. There was no evidence of an association between the microinfarcts and Alzheimer's disease (AD) in random effects model (OR 2.81, 95% CI 0.94-8.42, P=0.06).
CONCLUSION
These results suggest that cerebral microinfarcts are significantly associated with dementia. Whether cerebral microinfarcts are associated with AD needs to be further investigated.
Topics: Animals; Cerebral Cortex; Cerebral Infarction; Dementia; Humans
PubMed: 27915996
DOI: 10.2174/1567205013666161201200429 -
The World Journal of Biological... Mar 2024Corticosteroids are widely prescribed for a variety of medical conditions. Accumulating evidence suggests that their use may be associated with adverse psychiatric... (Review)
Review
OBJECTIVES
Corticosteroids are widely prescribed for a variety of medical conditions. Accumulating evidence suggests that their use may be associated with adverse psychiatric effects, including mania. In this systematic review, we aim to critically evaluate the existing literature on the association between corticosteroid use and the emergence of mania.
METHODS
We conducted a comprehensive search of major electronic databases (PubMed, Embase, Cochrane Library) for relevant studies published up to the date of the search (12th January 2023). Inclusion criteria involve studies that investigate the association between corticosteroid use and the emergence of mania in adult patients. The primary outcome is the prevalence of (hypo)mania following corticosteroid administration. Secondary outcomes include potential risk factors, dose-response relationships, and differences among various corticosteroid formulations.
RESULTS
The identified studies were subjected to a systematic selection process and data extraction by an independent reviewer. A total of 47 articles met the inclusion criteria for our systematic review.
CONCLUSION
Our findings suggest that mania is a common side-effect of corticosteroid use, particularly in prednisone equivalent doses above 40 mg. These findings hold practical significance for clinicians and provide insights into potential interventions, including careful monitoring, dose adjustments, and consideration of psychotropic medications when managing corticosteroid-induced mania.
Topics: Adult; Humans; Mania; Adrenal Cortex Hormones; Prednisone
PubMed: 38363330
DOI: 10.1080/15622975.2024.2312572 -
Survey of Ophthalmology 2018Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both... (Review)
Review
Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.
Topics: Adrenal Cortex Hormones; Aging; Anti-Inflammatory Agents; Conjunctival Diseases; Dry Eye Syndromes; Humans; Lubricant Eye Drops; Ophthalmologic Surgical Procedures; Risk Factors; Tears
PubMed: 29128574
DOI: 10.1016/j.survophthal.2017.10.010 -
The Journal of Arthroplasty Oct 2022Corticosteroids are commonly used intraoperatively to treat pain and reduce opioid consumption and nausea associated with primary total joint arthroplasty (TJA). The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Corticosteroids are commonly used intraoperatively to treat pain and reduce opioid consumption and nausea associated with primary total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of corticosteroids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management.
METHODS
The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published before February 2020 on corticosteroids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of corticosteroids.
RESULTS
Critical appraisal of 1,581 publications revealed 23 studies regarded as the best available evidence for analysis. Intraoperative dexamethasone reduces postoperative pain, opioid consumption, and nausea and vomiting. Multiple doses lead to further reduction in pain, opioid consumption, nausea and vomiting. There is insufficient evidence on the risk of adverse events with perioperative dexamethasone in TJA.
CONCLUSION
Strong evidence supports the use of a single dose or multiple doses of intravenous dexamethasone to reduce postoperative pain, opioid consumption, nausea and vomiting after primary TJA. There is insufficient evidence on perioperative dexamethasone in primary TJA to determine the optimal dose, number of doses, or risk of postoperative adverse events.
Topics: Adrenal Cortex Hormones; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Dexamethasone; Humans; Nausea; Pain, Postoperative; Vomiting
PubMed: 36162922
DOI: 10.1016/j.arth.2022.03.084 -
Neuroscience and Biobehavioral Reviews Apr 2021Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a... (Review)
Review
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
Topics: Biomarkers; Frontal Lobe; Hippocampus; Humans; Mental Disorders; Neuroimaging
PubMed: 33271160
DOI: 10.1016/j.neubiorev.2020.11.019 -
JCPP Advances Jun 2022Peer adversity and aggression are common experiences in childhood and adolescence which lead to poor mental health outcomes. To date, there has been no review conducted...
BACKGROUND
Peer adversity and aggression are common experiences in childhood and adolescence which lead to poor mental health outcomes. To date, there has been no review conducted on the neurobiological changes associated with relational peer-victimisation, bullying and cyberbullying.
METHODS
This systematic review assessed structural and functional brain changes associated with peer-victimisation, bullying, and cyberbullying from 1 January 2000 to April 2021. A systematic search of Psychoinfo, Pubmed, and Scopus was performed independently by two reviewers using predefined criteria. Twenty-six studies met the selection criteria and were considered for review.
RESULTS
The data collected shows altered brain activation of regions implicated in processing reward, social pain, and affect; and heightened sensitivity and more widespread activation of brain regions during acute social exclusion, most notably in the amygdala, left parahippocampal gyrus, and fusiform gyrus, associated with victimisation exposure. In addition, victimised youths also demonstrated greater risk-taking behaviours following acute social exclusion showing greater ventral striatum-inferior frontal gyrus coupling, activation in the bilateral amygdala, orbital frontal cortex (OFC), medial prefrontal cortex (MPFC), temporoparietal junction (TPJ), medial posterior parietal cortex (MPPC) and dorsomedial prefrontal cortex (dmPFC), suggesting greater social monitoring, seeking of inclusion, and more effortful cognitive control. The studies included participants from a very broad developmental age range, mostly using cross-sectional measure of peer-victimisation exposure, at varying developmental stages.
CONCLUSIONS
This review highlights the need for more neuroimaging studies in cyberbullying, as well as longitudinal studies across more diverse samples for investigating gender, age, and developmental interactions with peer-victimising. This also brings to attention the importance of addressing bullying victimisation particularly in adolescence, given the evidence for social stress in heightening developmentally sensitive processes which are associated with depression, anxiety, and externalising symptoms.
PubMed: 37431463
DOI: 10.1002/jcv2.12081 -
Bipolar Disorders Dec 2023Glutamatergic transmission and N-methyl-D-aspartate receptors (NMDARs) have been implicated in the pathophysiology schizophrenic spectrum and major depressive disorders.... (Review)
Review
OBJECTIVES
Glutamatergic transmission and N-methyl-D-aspartate receptors (NMDARs) have been implicated in the pathophysiology schizophrenic spectrum and major depressive disorders. Less is known about the role of NMDARs in bipolar disorder (BD). The present systematic review aimed to investigate the role of NMDARs in BD, along with its possible neurobiological and clinical implications.
METHODS
We performed a computerized literature research on PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using the following string: (("Bipolar Disorder"[Mesh]) OR (manic-depressive disorder[Mesh]) OR ("BD") OR ("MDD")) AND ((NMDA [Mesh]) OR (N-methyl-D-aspartate) OR (NMDAR[Mesh]) OR (N-methyl-D-aspartate receptor)).
RESULTS
Genetic studies yield conflicting results, and the most studied candidate for an association with BD is the GRIN2B gene. Postmortem expression studies (in situ hybridization and autoradiographic and immunological studies) are also contradictory but suggest a reduced activity of NMDARs in the prefrontal, superior temporal cortex, anterior cingulate cortex, and hippocampus.
CONCLUSIONS
Glutamatergic transmission and NMDARs do not appear to be primarily involved in the pathophysiology of BD, but they might be linked to the severity and chronicity of the disorder. Disease progression could be associated with a long phase of enhanced glutamatergic transmission, with ensuing excitotoxicity and neuronal damage, resulting into a reduced density of functional NMDARs.
Topics: Humans; Receptors, N-Methyl-D-Aspartate; Bipolar Disorder; Depressive Disorder, Major; Neurons; Gyrus Cinguli
PubMed: 37208966
DOI: 10.1111/bdi.13335 -
Neuroscience and Biobehavioral Reviews Dec 2016Serotonergic hallucinogens produce alterations of perceptions, mood, and cognition, and have anxiolytic, antidepressant, and antiaddictive properties. These drugs act as... (Review)
Review
Serotonergic hallucinogens produce alterations of perceptions, mood, and cognition, and have anxiolytic, antidepressant, and antiaddictive properties. These drugs act as agonists of frontocortical 5-HT receptors, but the neural basis of their effects are not well understood. Thus, we conducted a systematic review of neuroimaging studies analyzing the effects of serotonergic hallucinogens in man. Studies published in the PubMed, Lilacs, and SciELO databases until 12 April 2016 were included using the following keywords: "ayahuasca", "DMT", "psilocybin", "LSD", "mescaline" crossed one by one with the terms "mri", "fmri", "pet", "spect", "imaging" and "neuroimaging". Of 279 studies identified, 25 were included. Acute effects included excitation of frontolateral/frontomedial cortex, medial temporal lobe, and occipital cortex, and inhibition of the default mode network. Long-term use was associated with thinning of the posterior cingulate cortex, thickening of the anterior cingulate cortex, and decreased neocortical 5-HT receptor binding. Despite the high methodological heterogeneity and the small sample sizes, the results suggest that hallucinogens increase introspection and positive mood by modulating brain activity in the fronto-temporo-parieto-occipital cortex.
Topics: Cerebral Cortex; Hallucinogens; Humans; Male; Neuroimaging; Psilocybin; Receptor, Serotonin, 5-HT2A
PubMed: 27810345
DOI: 10.1016/j.neubiorev.2016.10.026