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Frontiers in Physiology 2023Studies have shown that exercise increases angiogenesis and perfusion in the hippocampus, activates neurogenesis in the dentate gyrus and increases synaptic plasticity,...
Studies have shown that exercise increases angiogenesis and perfusion in the hippocampus, activates neurogenesis in the dentate gyrus and increases synaptic plasticity, as well as increases the complexity and number of dendritic spines, all of which promote memory function and protect against cognitive decline. Flavonoids are gaining attention as antioxidants in health promotion due to their rich phenolic content, particularly for their modulating role in the treatment of neurodegenerative diseases. Despite this, there has been no comprehensive review of cognitive improvement supplemented with flavonoid and prescribed with exercise or a combination of the two interventions has been conducted. The purpose of this review is to determine whether a combined intervention produces better results when given together than when given separately. Relevant articles assessing the effect of physical exercise, flavonoid or in combination on cognitive related biomarkers and neurobehavioral assessments within the timeline of January 2011 until June 2023 were searched using three databases; PubMed, PROQUEST and SCOPUS. A total of 705 articles were retrieved and screened, resulting in 108 studies which are in line with the objective of the current study were included in the analysis. The selected studies have shown significant desired effect on the chosen biomarkers and neurobehavioral assessments. identifier: [CRD42021271001].
PubMed: 37664425
DOI: 10.3389/fphys.2023.1216948 -
Journal of Alzheimer's Disease Reports 2023Cognitive impairment (CI) is an important extrapulmonary complication in patients with chronic obstructive pulmonary disease (COPD). Multimodal Neuroimaging Examination...
BACKGROUND
Cognitive impairment (CI) is an important extrapulmonary complication in patients with chronic obstructive pulmonary disease (COPD). Multimodal Neuroimaging Examination can display changes in brain structure and functions in patients with COPD.
OBJECTIVE
The purpose of this systematic review is to provide an overview of the variations in brain imaging in patients with COPD and their potential relationship with CI. Furthermore, we aim to provide new ideas and directions for future research.
METHODS
Literature searches were performed using the electronic databases PubMed, Scopus, and ScienceDirect. All articles published between January 2000 and November 2021 that met the eligibility criteria were included.
RESULTS
Twenty of the 23 studies focused on changes in brain structure and function. Alterations in the brain's macrostructure are manifested in the bilateral frontal lobe, hippocampus, right temporal lobe, motor cortex, and supplementary motor area. The white matter microstructural changes initially appear in the bilateral frontal subcortical region. Regarding brain function, patients with COPD exhibited reduced frontal cerebral perfusion and abnormal alterations in intrinsic brain activity in the bilateral posterior cingulate cortex, precuneus, right lingual gyrus, and left anterior central gyrus. Currently, there is limited research related to brain networks.
CONCLUSION
CI in patients with COPD may present as a type of dementia different from Alzheimer's disease, which tends to manifest as frontal cognitive decline early in the disease. Further studies are required to clarify the neurobiological pathways of CI in patients with COPD from the perspective of brain connectomics based on the whole-brain system in the future.
PubMed: 37662615
DOI: 10.3233/ADR-220083 -
Journal of Cardiothoracic and Vascular... Nov 2023Strategies for red blood cell (RBC) transfusion in patients undergoing cardiac surgery have been traditionally anchored to hemoglobin (Hb) targets. A more physiologic...
Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.
OBJECTIVE
Strategies for red blood cell (RBC) transfusion in patients undergoing cardiac surgery have been traditionally anchored to hemoglobin (Hb) targets. A more physiologic approach would consider markers of organ hypoperfusion.
DESIGN
The authors conducted a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials (RCTs).
SETTING
Cardiac surgery.
PARTICIPANTS
Adult patients.
INTERVENTION
RBC transfusion targeting only Hb levels compared with strategies combining Hb values with markers of organ hypoperfusion.
MEASUREMENTS AND MAIN RESULTS
Primary outcomes were the number of RBC units transfused, the number of patients transfused at least once, and the average number of transfusions. Secondary outcomes were postoperative complications, intensive care (ICU) and hospital lengths of stay, and mortality. Only 2 RCTs were included (n = 257 patients), and both used central venous oxygen saturation (ScvO) as a marker of organ hypoperfusion (cut-off: <70% or ≤65%). A transfusion protocol combining Hb and ScvO reduced the overall number of RBC units transfused (risk ratio [RR]: 1.57 [1.33-1.85]; p < 0.0001, I = 0%), and the number of patients transfused at least once (RR: 1.33 [1.16-1.53]; p < 0.0001, I = 41%), but not the average number of transfusions (mean difference [MD]: 0.18 [-0.11 to 0.47]; p = 0.24, I = 66%), with moderate certainty of evidence. Mortality (RR: 1.29, [0.29-5.77]; p = 0.73, I = 0%), ICU length-of-stay (MD: -0.06 [-0.58 to 0.46]; p = 0.81, I = 0%), hospital length-of-stay (MD: -0.05 [-1.49 to 1.39];p = 0.95, I = 0%), and all postoperative complications were not affected.
CONCLUSIONS
In adult patients undergoing cardiac surgery, a restrictive protocol integrating Hb values with a marker of organ hypoperfusion (ScvO) reduces the number of RBC units transfused and the number of patients transfused at least once without apparent signals of harm. These findings were preliminary and warrant further multicentric research.
PubMed: 37652848
DOI: 10.1053/j.jvca.2023.08.001 -
PloS One 2023The function of coronary microcirculation is an important factor in predicting the prognosis of patients with acute coronary syndrome (ACS) who receive percutaneous... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The function of coronary microcirculation is an important factor in predicting the prognosis of patients with acute coronary syndrome (ACS) who receive percutaneous coronary intervention (PCI) therapy. Ticagrelor, a type of oral P2Y12 inhibitor, is widely prescribed to ACS patients and can improve prognosis compared to clopidogrel. However, the efficacy of ticagrelor on coronary microcirculation, compared to clopidogrel, remains unclear. The objective of this meta-analysis was to determine the efficacy of ticagrelor on coronary microcirculation.
METHODS
The PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were comprehensively searched to identify studies until November 2022. Data was pooled using the fixed effects model or random effects model based on the level of heterogeneity. Sensitivity analyses were performed to measure the effects of potential confounders.
RESULTS
After screening, 16 trials with a total of 3676 participants were ultimately included in the analysis. The meta-analysis revealed that compared to clopidogrel, patients receiving ticagrelor exhibited a more significant reduction in the IMR (WMD: -6.23, 95% CI: -8.41 to -4.04), a reduction in the cTFC (WMD: -1.88; 95% CI: -3.32 to -0.45), and greater increases in CFR (WMD: 0.38; 95% CI: 0.18 to 0.57), MBG (RR 1.29, 95% CI 1.12 to 1.48), and TIMI (RR 1.03, 95% CI 1.00 to 1.06).
CONCLUSION
Our findings suggest that, compared to clopidogrel, ticagrelor has a significant effect in reducing coronary microcirculatory resistance, enhancing coronary blood flow reserve, and improving myocardial perfusion.
Topics: Humans; Acute Coronary Syndrome; Clopidogrel; Ticagrelor; Microcirculation; Percutaneous Coronary Intervention
PubMed: 37643179
DOI: 10.1371/journal.pone.0289243 -
Current Cardiology Reports Oct 2023Heart failure is a serious global health problem, and coronary artery disease is one of the main causes. At present, the treatment options for ischemic heart failure... (Review)
Review
PURPOSE OF REVIEW
Heart failure is a serious global health problem, and coronary artery disease is one of the main causes. At present, the treatment options for ischemic heart failure (IHF) are limited. This article mainly aims to explore the evidence of enhanced external counterpulsation (EECP) as a non-invasive cardiac rehabilitation method in patients with IHF and to make a preliminary exploration of its mechanisms.
RECENT FINDINGS
According to the existing evidence, the standard course of EECP is safe in patients with IHF and can significantly improve the quality of life of these patients. The effect of EECP on systolic function is still unclear, while EECP has a significant improvement effect on cardiac diastolic function. At the same time, this treatment can reduce the re-hospitalization rate and emergency visit rate of patients within 6 months. In terms of mechanisms, in addition to the immediate hemodynamic effect, existing evidence mostly suggests that its improvement of cardiac function may come from its upregulation of shear stress to improve myocardial perfusion. EECP is safe to use in patients with stable ischemic heart failure, and it can improve the performance status of patients and may be beneficial to cardiac function and reduce the short-term re-hospitalization rate.
Topics: Humans; Quality of Life; Heart Failure; Coronary Artery Disease; Hemodynamics; Counterpulsation
PubMed: 37642929
DOI: 10.1007/s11886-023-01943-1 -
Frontiers in Cardiovascular Medicine 2023The mortality rate of patients with heart failure (HF) remains high, and when heart failure occurs, blood urea nitrogen (BUN) is involved in the perfusion of renal blood... (Review)
Review
BACKGROUND
The mortality rate of patients with heart failure (HF) remains high, and when heart failure occurs, blood urea nitrogen (BUN) is involved in the perfusion of renal blood flow. Some studies have shown an association between heart failure prognosis and blood urea nitrogen, but the results of some other studies were inconsistent. Therefore, we conducted a comprehensive meta-analysis to investigate the value of BUN on the prognosis of patients with heart failure.
METHODS
A computerized systematic search of all English literature was performed in four databases, PubMed, Cochrane, Embase and Web of Science, from their inception to May 2022. The data of BUN were classified into continuous and categorical variables after passing the inclusion and exclusion criteria. The BUN data of both types were extracted separately into stata15.0 for statistical analysis.
RESULTS
A total of 19 cohort studies involving 56,003 patients were included. When BUN was used as a categorical variable, the risk of death in heart failure was 2.29 times higher for high levels of BUN than for low levels of BUN ( = 2.29, 95% CI:1.42-3.70, < 0.001). The results showed statistical significance in multifactorial and univariate groups, the prospective cohort, and European and Asian groups. When BUN was used as a continuous variable, the risk of death in heart failure was 1.02 times higher for each unit increase in BUN ( = 1.02, 95% CI:1.01-1.03, < 0.001). Subgroup analysis showed statistical significance in retrospective cohort, American and Asian.
CONCLUSION
High BUN is an independent predictor of all-cause mortality in heart failure. Lower BUN was associated with better prognosis in patients with heart failure.
PubMed: 37583584
DOI: 10.3389/fcvm.2023.1189884 -
International Journal of Surgery... Nov 2023The increasing use of extended criteria donors (ECD) sets higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The increasing use of extended criteria donors (ECD) sets higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes, but its effects on different donor types remains unclear. The authors' aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types.
MATERIALS AND METHODS
A literature search comparing the efficacy of MP versus SCS in PubMed, Cochrane, and EMBASE database was conducted. A meta-analysis was performed to obtain pooled effects of MP on ECD, donation after circulatory death (DCD), and donor after brainstem death.
RESULTS
Thirty nine studies were included (nine randomized controlled trials and 30 cohort studies). Compared with SCS, HMP significantly reduced the risk of non-anastomotic biliary stricture (NAS) [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.26-0.72], major complications (OR 0.55, 95% CI 0.39-0.78), and early allograft dysfunction (EAD) (OR 0.46, 95% CI 0.32-0.65) and improved 1-year graft survival (OR 2.36, 95% CI 1.55-3.62) in ECD-OLT. HMP also reduced primary non-function (PNF) (OR 0.40, 95% CI 0.18-0.92) and acute rejection (OR 0.62, 95% CI 0.40-0.97). NMP only reduced major complications in ECD-OLT (OR 0.56, 95% CI 0.34-0.94), without favorable effects on other complications and survival. NRP lowered the overall risk of NAS (OR 0.27, 95% CI 0.11-0.68), PNF (OR 0.43, 95% CI 0.22-0.85), and EAD (OR 0.58, 95% CI 0.42-0.80) and meanwhile improved 1-year graft survival (OR 2.40, 95% CI 1.65-3.49) in control DCD-OLT.
CONCLUSIONS
HMP might currently be considered for marginal livers as it comprehensively improves ECD-OLT outcomes. NMP assists some outcomes in ECD-OLT, but more evidence regarding NMP-ECD is warranted. NRP significantly improves DCD-OLT outcomes and is recommended where longer non-touch periods exist.
Topics: Humans; Liver Transplantation; Tissue Donors; Liver; Graft Survival; Perfusion; Organ Preservation
PubMed: 37578436
DOI: 10.1097/JS9.0000000000000661 -
Diagnostics (Basel, Switzerland) Aug 2023This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean... (Review)
Review
Predictive Efficacy of the Perfusion Index for Hypotension following Spinal Anesthesia in Parturient Undergoing Elective Cesarean Section: A Systematic Review and Meta-Analysis.
This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean section (CS). Electronic databases, including Google Scholar, EMBASE, Cochrane Library, and MEDLINE, were searched from inception to June 2023. The primary outcome was the diagnostic accuracy of the perfusion index in predicting the probability of perioperative hypotension following SA. The review included 12 studies involving 2009 patients, published between 2017 and 2023. The pooled sensitivity and specificity were 0.81 (95% confidence interval (CI) = 0.72-0.87) and 0.75 (95% CI = 0.67-0.82), respectively. Additionally, the pooled area under the curve (AUC) was calculated as 0.84 (95% CI = 0.81-0.87), suggesting a moderate to good accuracy of the diagnostic test. Using Fagan's nomogram plot, the positive likelihood ratio (LR) and negative LR were found to be 3 and 0.26, respectively. The results demonstrated that the perfusion index exhibited an acceptable level of accuracy in predicting perioperative hypotension after spinal anesthesia in parturients undergoing elective CS. These findings highlight the potential value of incorporating a perfusion index as a useful tool for clinicians to integrate into routine clinical practice, which necessitates further large-scale studies for verification.
PubMed: 37568947
DOI: 10.3390/diagnostics13152584 -
Physics and Imaging in Radiation... Jul 2023Improving the accuracy of brain tumour radiotherapy (RT) treatment planning is important to optimise patient outcomes. This systematic review investigates primary... (Review)
Review
BACKGROUND AND PURPOSE
Improving the accuracy of brain tumour radiotherapy (RT) treatment planning is important to optimise patient outcomes. This systematic review investigates primary studies providing clinical evidence for the integration of quantitative magnetic resonance imaging (qMRI) biomarkers and MRI radiomics to optimise brain tumour RT planning.
MATERIALS AND METHODS
PubMed, Scopus, Embase and Web of Science databases were searched for all years until June 21, 2022. The search identified original articles demonstrating clinical evidence for the use of qMRI biomarkers and MRI radiomics for the optimization of brain cancer RT planning. Relevant information was extracted and tabulated, including qMRI metrics and techniques, impact on RT plan optimization and changes in target and normal tissue contouring and dose distribution.
RESULTS
Nineteen articles met the inclusion criteria. Studies were grouped according to the qMRI biomarkers into: 1) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI; five studies); 2) diffusion tensor imaging (DTI; seven studies); and 3) MR spectroscopic imaging (MRSI; seven studies). No relevant MRI-based radiomics studies were identified. Integration of DTI maps offers the potential for improved organs at risk (OAR) sparing. MRSI metabolic maps are a promising technique for improving delineation accuracy in terms of heterogeneity and infiltration, with OAR sparing. No firm conclusions could be drawn regarding the integration of DWI metrics and PWI maps.
CONCLUSIONS
Integration of qMRI metrics into RT planning offers the potential to improve delineation and OAR sparing. Clinical trials and consensus guidelines are required to demonstrate the clinical benefits of such approaches.
PubMed: 37565088
DOI: 10.1016/j.phro.2023.100476 -
Journal of Medical Radiation Sciences Mar 2024Despite improvements in imaging and treatment approaches, brain metastases (BMs) continue to be the primary cause of mortality and morbidity in about 20% of adult cancer...
Despite improvements in imaging and treatment approaches, brain metastases (BMs) continue to be the primary cause of mortality and morbidity in about 20% of adult cancer patients. This research aimed to review the magnetic resonance imaging (MRI) and clinical characteristics of BMs resulting from breast cancer (BC). A systematic review of original research articles published from January 2000 to June 2023. We selected studies that reported MRI findings of BMs in BC patients. We excluded reviews, case reports, books/book chapters, animal studies and irrelevant records. We identified 24 studies that included 1580 BC patients with BMs. T1-weighted (T1-w) (pre- and postcontrast), T2-weighted (T2-w), fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*-w) was used to measure the lesion size, shape and area. In other studies, advanced structural techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were used to more precisely and sensitively evaluate the pathological area. Furthermore, functional and metabolic techniques like functional MRI (fMRI), magnetic resonance spectroscopy (MRS) and perfusion-weighted imaging (PWI) have also been utilised. The MRI findings of BMs varied depending on the MRI technique, the BC subtype, the lesion size and shape, the presence of haemorrhage or necrosis and the comparison with other brain tumours. Some MRI findings were associated with prognosis, recurrence or cognitive impairment in BC patients with BMs. MRI detects, characterises and monitors BMs from BC. Findings vary by MRI technique, BC subtype, lesion characteristics and comparison with other brain tumours. More research should validate emerging MRI techniques, determine the clinical implications of findings and explore the underlying mechanisms and biology of BMs from BC. MRI is a valuable tool for diagnosis, targeted therapy and studying BC metastasis.
Topics: Adult; Female; Humans; Brain Neoplasms; Breast Neoplasms; Diffusion Tensor Imaging; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy
PubMed: 37563948
DOI: 10.1002/jmrs.715