ABSTRACT
Cognitive dysfunction is one of the common central nervous systems (CNS) complications of diabetes mellitus, which seriously affects the quality of life of patients and results in a huge economic burden. The glymphatic system dysfunction mediated by aquaporin-4 (AQP4) loss or redistribution in perivascular astrocyte endfeet plays a crucial role in diabetes-induced cognitive impairment (DCI). However, the mechanism of AQP4 loss or redistribution in the diabetic states remains unclear. Accumulating evidence suggests that peripheral insulin resistance target tissues and CNS communication affect brain homeostasis and that exosomal miRNAs are key mediators. Glucose and lipid metabolism disorder is an important pathological feature of diabetes mellitus, and skeletal muscle, liver and adipose tissue are the key target insulin resistance organs. In this review, the changes in exosomal miRNAs induced by peripheral metabolism disorders in diabetes mellitus were systematically reviewed. We focused on exosomal miRNAs that could induce low AQP4 expression and redistribution in perivascular astrocyte endfeet, which could provide an interorgan communication pathway to illustrate the pathogenesis of DCI. Furthermore, the mechanisms of exosome secretion from peripheral insulin resistance target tissue and absorption to the CNS were summarized, which will be beneficial for proposing novel and feasible strategies to optimize DCI prevention and/or treatment in diabetic patients.
ABSTRACT
Objective:To investigate the effect of liaison nurse-led relocation program on the relocation stress in family members of neurosurgery patients after ICU transfer.Methods:A total of 90 neurosurgery patients and family members were randomly divided into study group (45 cases) and control group (45 cases) . Participants in the control group received routine nursing, while the study group carried out liaison nurse-led relocation program. Family relocation stress scale and family caregiver task inventory-Chinses version was used to assessed relocation stress, care ability of the families before and after intervention.Results:After intervention, the scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were 15.20±2.42, 7.14±1.63, 7.68±2.12, 7.10±1.73, 8.25±1.94 and 49.69±6.96 in the study group, those scores were 16.93±4.19, 9.42±2.31, 10.53±2.64, 8.06±2.12, 10.39±1.62 and 42.56±4.68 in the control group. The scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were lower in the study group compared to the control group ( t value was 2.400-5.678, P<0.05). After intervention, the scores of FCTI such as care role, strain and provide assistance, handle personal emotions, assess family and community resources and adjust life to meet care needs and total scores were 4.16±0.66, 5.28±0.73, 3.51±0.65, 3.99±0.83, 4.52±1.07 and 21.46±1.73 in the study group, those scores were 7.63±1.30, 6.82±1.08, 4.94±0.94, 5.08±1.09, 7.17±1.51 and 31.65±3.09 in the control group. The scores of care role, strain and provide assistance, handle personal emotions, assess family and community resources and total FCTI scores significantly decreased in the study group compared to the control group ( t value was 5.343-19.268, P<0.05). Conclusion:The liaison nurse-led relocation program can effectively prevent the level of relocation stress and improve the care ability of family members of neurosurgery patients after ICU transfer.
ABSTRACT
Objective To sum up clinical experiences of intractable temporal lobe epilepsy by microsurgery. Methods A retrospective review was conducted in 50 cases with epilepsy,and temporal lobe was resected by microsurgery from June 1996 to Oct. 2003. Results Follow-up patients from six months to five years.The follow up showed healing outcome in 25 cases,good results in 13 cases,unsatisfactory outcome in 9 cases,no improvement in 3 cases.Slight paresis 6 cases,divagation 8 cases,psychosis 5 cases and no death case. Conclusions Application of microsurgery can obvously improve the clinical result of patients with temporal lobe epilepsy and decrease the complication after operation.