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Alzheimer's disease (AD), the most common type of dementia, is becoming a major challenge for global health and social care. However, the current understanding of AD pathogenesis is limited, and no early diagnosis and disease-modifying therapy are currently available. During the past year, significant progress has been made in clinical research on the diagnosis, prevention, and treatment of AD. In this review, we summarize the latest achievements, including diagnostic biomarkers, polygenic hazard score, amyloid and tau PET imaging, clinical trials targeting amyloid-beta (Aβ), tau, and neurotransmitters, early intervention, and primary prevention and systemic intervention approaches, and provide novel perspectives for further efforts to understand and cure the disease.
Assuntos
Animais , Humanos , Doença de Alzheimer , Diagnóstico , Terapêutica , Biomarcadores , Sangue , Pesquisa Biomédica , Métodos , Progressão da Doença , Imageamento por Ressonância MagnéticaRESUMO
Objective To investigate the differences of thromboelastography (TEG) and routine coagulation test in evaluating the coagulation function of patients with acute cerebral infarction before antithrombotic therapy, and to evaluate the short-term prognosis of these two methods and their application values in guiding clinical intervention treatment. Methods The clinical data of 99 patients with acute cerebral infarction, admitted to our hospital from October 2016 to March 2018, were retrospectively analyzed. At admission, patients were assessed by TEG and routine coagulation test. All patients were assessed by National Institutes of Health Stroke Scale (NIHSS) at admission and 7 d after antithrombotic therapy and modified Rankin scale (mRS) at discharge. According to NIHSS scores, the patients were divided into neurological function poor prognosis group (NIHSS scores being decreased by less than 18％ or being increased, n=49) and neurological function good prognosis group (NIHSS scores being decreased more than 18％, n=50). According to mRS scores, the patients were divided into living ability good prognosis group (mRS scores being less than/ equal to 2, n=68) and living ability poor prognosis group (mRS scores being more than 3, n=27). When grouping patients with the above two scoring scales, the differences of coagulation functions between TEG and routine coagulation test were compared. The risk factors and protective factors affecting the neurological function and living ability of patients were analyzed using binary Logistic regression analysis, and receiver-operator characteristic (ROC) curve of the subjects was plotted. Results (1) In TEG indexes, response time of coagulation (R), α angle, maximum amplitude (MA), and composite index (CI) were significantly different between the neurological function poor prognosis group and neurological function good prognosis group (P<0.05), while in conventional coagulation test, only thrombin time (TT) and fibrinogen (Fib) level were significantly different between the neurological function poor prognosis group and neurological function good prognosis group (P<0.05). In TEG indexes, coagulation time (K), α angle, MA, and CI were significantly different between the living ability poor prognosis group and living ability good prognosis group (P<0.05), while in conventional coagulation test, only antithrombase III (AT III) and Fib level were significantly different between the living ability poor prognosis group and living ability good prognosis group (P<0.05). (2) Binary Logistic regression analysis showed that Fib was an independent risk factor for living ability poor prognosis in patients with cerebral infarction (OR=0.080, 95％ CI: 0.009-0.693, P=0.022); AT III was a protective factor for living ability good prognosis (OR= 1.174, 95％ CI: 1.010-1.366, P=0.037); however, all parameters of routine coagulation test showed no signficant difference in Logistic regression analysis of prognosis of neurological function (P>0.05), and all parameters of TEG had no statistical significance in Logistic regression analysis of prognosis of neurological function and prognosis of life ability (P>0.05). (3)ROC curve analysis showed that TT=17.3 s was the best diagnostic threshold for good prognosis of neurological function and poor prognosis of neurological function (area under curve [ACU]=0.738, sensitivity=94.7％, specificity=52.4％) and AT III=72.1％ was the best diagnostic threshold for good prognosis of living ability and poor prognosis of living ability (ACU=0.740, sensitivity=95.8％, specificity= 61.5％); in ROC curve analysis of prognoses of neurological function and living ability, ACU of TEG indexes were all smaller than those of TT and AT III. Conclusion TEG is more sensitive and comprehensive than routine coagulation test in evaluating early changes of coagulation function and predicting short-term prognosis after antithrombotic therapy in patients with acute cerebral infarction, while routine coagulation test has higher application value in guiding clinical intervention treatment.
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Objective To evaluate the effect of precision anesthesia strategy on postoperative cognitive function in elderly patients undergoing hip replacement.Methods Seventy elderly patients of both sexes,aged 65-85 yr,weighing 50-75 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective unilateral hip replacement under general anesthesia,with years of education＞6 yr,were divided into 2 groups (n =35 each) using a random number table:precision anesthesia group (group P) and routine anesthesia group (group R).Anesthetic protocol and perioperative management were optimized using precision anesthesia strategy in group P.Routine anesthetic protocol and perioperative management were performed in group R.Peripheral venous blood samples were collected at 1 day before operation (T0) and 1,6,12 and 24 h after operation (T1-4) for determination of serum S100β protein,neuronspecific enolase (NSE),interleukin-1beta (IL-1β),IL-6,tumor necrosis factor-alpha (TNF-α) and Creactive protein (CRP) concentrations by enzyme-linked immunosorbent assay.The patient's cognitive function was assessed using Mini-Mental State Examination (MMSE) at T0 and 3 and 7 days after operation (T5,6).Results Compared with the baseline at T0,the serum S100β protein and NSE concentrations were significantly increased at T1-3,the serum IL-1β,IL-6 and TNF-α concentrations were increased at T1-4,the CRP concentrations were increased at T2,3,MMSE scores were decreased at T5 in group R,and the serum S100β protein,IL-1β and IL-6 concentrations were significantly increased at T1-3,the serum NSE and CRP concentrations were increased at T2,the serum TNF-α concentrations were increased at T1-4,and MMSE cores were decreased at T5 in group P (P＜0.05).Compared with group R,the serum S100β protein and IL-1β concentrations were significantly decreased at T1,2,the serum NSE and TNF-α concentrations were decreased at T1-3,the serum IL-6 concentrations were decreased at T2,3,and MMSE scores were increased at T5 in group P (P＜ 0.05).Conclusion Precision anesthesia strategy can improve postoperative cognitive function in elderly patients undergoing hip replacement,which is related to inhibiting inflammatory responses.
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Objective To investigate the angiographic manifestations of renal artery injury caused by percutaneous nephrolithotomy, and to evaluate the therapeutic effect of super-selective renal arterial embolization in treating renal artery injury. Methods A total of 22 patients with persistent or intermittent gross hematuria that occurred after percutaneous nephrolithotomy, who were encountered at authors’ hospital during the period from Jan. 2010 to June 2014, were included in this study. The diagnosis was confirmed by renal angiography in all patients, and super-selective renal arterial embolization with steel micro-coils was carried out in all patients. The patients were followed up for three months. The results were analyzed. Results Of the 22 patients, DSA examination showed that renal artery pseudoaneurysm (RAP) was found in 14 (63.6%), renal arteriovenous fistula (RAVF) in 5 (22.7%) and RAP associated with RAVF in 3 (13.6%). Renal angiography performed after super-selective renal arterial embolization showed that complete obstruction of the bleeding arteries was achieved in all patients, and the active bleeding stopped. Both the technical success rate and the hemostasis rate were 100%. During the follow-up period lasting for three months, no recurrence of hematuria or severe complications occurred. In 20 patients, different degree of embolism syndrome was observed after the treatment. Conclusion Renal artery pseudoaneurysm and renal arteriovenous fistula are the main types of renal artery injury after percutaneous nephrolithotomy. Super-selective renal arterial embolization with micro-coils can be used as the treatment of choice for patients who has failed to respond to conservative therapy.