Dynamic electrical synapses rewire brain networks for persistent oscillations and epileptogenesis.

One of the very fundamental attributes for telencephalic neural computation in mammals involves network activities oscillating beyond the initial trigger. The continuing and automated processing of transient inputs shall constitute the basis of cognition and intelligence but may lead to neuropsychiatric disorders such as epileptic seizures if carried so far as to engross part of or the whole telencephalic system. From a conventional view of the basic design of the telencephalic local circuitry, the GABAergic interneurons (INs) and glutamatergic pyramidal neurons (PNs) make negative feedback loops which would regulate the neural activities back to the original state. The drive for the most intriguing self-perpetuating telencephalic activities, then, has not been posed and characterized. We found activity-dependent deployment and delineated functional consequences of the electrical synapses directly linking INs and PNs in the amygdala, a prototypical telencephalic circuitry. These electrical synapses endow INs dual (a faster excitatory and a slower inhibitory) actions on PNs, providing a network-intrinsic excitatory drive that fuels the IN-PN interconnected circuitries and enables persistent oscillations with preservation of GABAergic negative feedback. Moreover, the entities of electrical synapses between INs and PNs are engaged in and disengaged from functioning in a highly dynamic way according to neural activities, which then determine the spatiotemporal scale of recruited oscillating networks. This study uncovers a special wide-range and context-dependent plasticity for wiring/rewiring of brain networks. Epileptogenesis or a wide spectrum of clinical disorders may ensue, however, from different scales of pathological extension of this unique form of telencephalic plasticity.

The impact of blood pressure variability on the development of parenchymal hematoma in acute cerebral infarction with atrial fibrillation.

Although blood pressure variability (BPV) and reperfusion are associated with parenchymal hematoma (PH) after stroke, the relationship between BPV and PH in atrial fibrillation (AF) patients who are at risk of reperfusion injury with frequent spontaneous recanalization is unknown. This study aimed to investigate whether BPV within the first 48 h is associated with PH within 72 h in patients with AF and stroke in terms of major vessel occlusion status. A total of 131 patients with AF that were admitted within 24 h after stroke onset were enrolled. PH was defined as a confluent hemorrhage with mass effect. The maximum (max), minimum (min), and average blood pressure (BP) during the first 48 h after admission were calculated. BPV was analyzed by using range between maximum and minimum (max-min), successive variation (SV), standard deviation (SD), and coefficient of variation (CV). All parameters were applied for systemic (SBP), diastolic (DBP), and pulse pressure (PP). After adjusting for confounding variables, various BPV parameters were associated with PH, including SBPmax (p = 0.0426), SBPSV (p = 0.0006), DBPmax-min (p = 0.0437), DBPSV (p = 0.0358), DBPSD (p = 0.0393), PPmax-min (p = 0.0478), PPSV (p < 0.0001), PPSD (p = 0.0034), and PPCV (p = 0.0120). The relationship remained significant in patients with a patent major vessel responsible for infarction but not in patients with an occluded major vessel. In conclusion, this study revealed that high BPV was associated with PH in patients with AF and acute stroke, particularly for those with a patent major vessel. The control of BP and BPV after stroke may be considered in patients with AF.

Predicting Adverse Recanalization Therapy Outcomes in Acute Ischemic Stroke Patients Using Characteristic Gut Microbiota.

Recanalization therapy is the most effective treatment for eligible patients with acute ischemic stroke (AIS). Gut microbiota are involved in the pathological mechanisms and outcomes of AIS. However, the association of gut microbiota features with adverse recanalization therapy outcomes remains unclear. Herein, we investigated gut microbiota features associated with neurological deficits in patients with AIS after recanalization therapy and whether they predict the patients' functional outcomes. We collected fecal samples from 51 patients with AIS who received recanalization therapy and performed 16S rRNA gene sequencing (V3-V4). We compared the gut microbiota diversity and community composition between mild to moderate and severe disability groups. Next, the characteristic gut microbiota was compared between groups, and we noted that the characteristic gut microbiota in patients with mild to moderate disability included Bilophila, Butyricimonas, Oscillospiraceae_UCG-003, and Megamonas. Moreover, the relative abundance of Bacteroides fragilis, Fusobacterium sp., and Parabacteroides gordonii was high in patients with severe disability. The characteristic gut microbiota was correlated with neurological deficits, and areas under the receiver operating characteristic curves confirmed that the characteristic microbiota predicted adverse recanalization therapy outcomes. In conclusion, gut microbiota characteristics are correlated with recanalization therapy outcomes in patients with AIS. Gut microbiota may thus be a promising biomarker associated with early neurological deficits and predict recanalization therapy outcomes.

Surface Functional Groups Affect Iron (Hydr)oxide Heterogeneous Nucleation: Implications for Membrane Scaling.

Because of its favorable thermodynamics and fast kinetics, heterogeneous solid nucleation on membranes triggers early-stage mineral scaling. Iron (hydr)oxide, a typical membrane scale, initially forms as nanoparticles that interact with surface functional groups on membranes, but these nanoscale phenomena are difficult to observe in real time. In this study, we utilized in situ grazing incidence small angle X-ray scattering and ex situ atomic force microscopy to examine the heterogeneous nucleation of iron (hydr)oxide on surface functional groups commonly used in membranes, including hydroxyl (OH), carboxyl (COOH), and fluoro (F) groups. We found that, compared to nucleation on hydrophilic OH- and COOH-surfaces, the high hydrophobicity of an F-modified surface significantly reduced the extents of both heterogeneously and homogeneously formed iron (hydr)oxide nucleation. Moreover, on the OH-surface, the high functional group density of 0.76 nmol/cm2 caused faster heterogeneous nucleation than that on a COOH-surface, with a density of 0.28 ± 0.04 nmol/cm2. The F-surface also had the highest heterogeneous nucleation energy barrier (26 ± 0.6 kJ/mol), followed by COOH- (23 ± 0.8 kJ/mol) and OH- (20 ± 0.9 kJ/mol) surfaces. The kinetic and thermodynamic information provided here will help us better predict the rates and extents of early-stage scaling of iron (hydr)oxide nanoparticles in membrane processes.

Dynamic Resource Allocation for Network Slicing with Multi-Tenants in 5G Two-Tier Networks.

Virtualization is a core 5G network technology which helps telecom companies significantly reduce capital expenditure and operating expenses by deploying multiple services on the same hardware infrastructure. However, providing QoS-guaranteed services for multi-tenants poses a significant challenge due to multi-tenant service diversity. Network slicing has been proposed as a means of addressing this problem by isolating computing and communication resources for the different tenants of different services. However, optimizing the allocation of the network and computation resources across multiple network slices is a critical but extremely difficult problem. Accordingly, this study proposes two heuristic algorithms, namely Minimum Cost Resource Allocation (MCRA) and Fast Latency Decrease Resource Allocation (FLDRA), to perform dynamic path routing and resource allocation for multi-tenant network slices in a two-tier architecture. The simulation results show that both algorithms significantly outperform the Upper-tier First with Latency-bounded Overprovisioning Prevention (UFLOP) algorithm proposed in previous work. Furthermore, the MCRA algorithm achieves a higher resource utilization than the FLDRA algorithm.

The Prognostic Biomarkers of Plasma Trimethylamine N-Oxide and Short-Chain Fatty Acids for Recanalization Therapy in Acute Ischemic Stroke.

Bidirectional communication of the microbiota-gut-brain axis is crucial in stroke. Recanalization therapy, namely intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), are recommended for eligible patients with acute ischemic stroke (AIS). It remains unclear whether gut microbiota metabolites, namely trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), can predict the prognosis after recanalization therapy. This prospective study recruited patients with AIS receiving IVT, EVT, or both. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were used to assess the severity and functional outcomes of AIS, respectively. A functional outcome of mild-to-moderate disability was defined as a mRS score of 0-3 at discharge. Plasma TMAO and SCFA levels were measured through liquid chromatography with triple-quadrupole mass spectrometry. Fifty-six adults undergoing recanalization therapy for AIS were enrolled. Results showed that TMAO levels were not associated with stroke severity and functional outcomes, while isovalerate levels (one of the SCFAs) were negatively correlated with NIHSS scores at admission and discharge. In addition, high isovalerate levels were independently associated with a decreased likelihood of severe disability. The study concluded that an elevated plasma isovalerate level was correlated with mild stroke severity and disability after recanalization therapy for AIS.

Hyperbaric Oxygen Therapy Alleviates Paclitaxel-Induced Peripheral Neuropathy Involving Suppressing TLR4-MyD88-NF-κB Signaling Pathway.

Paclitaxel (PAC) results in long-term chemotherapy-induced peripheral neuropathy (CIPN). The coexpression of transient receptor potential vanilloid 1 (TRPV1) and Toll-like receptor 4 (TLR4) in the nervous system plays an essential role in mediating CIPN. In this study, we used a TLR4 agonist (lipopolysaccharide, LPS) and a TLR4 antagonist (TAK-242) in the CIPN rat model to investigate the role of TLR4-MyD88 signaling in the antinociceptive effects of hyper-baric oxygen therapy (HBOT). All rats, except a control group, received PAC to induce CIPN. Aside from the PAC group, four residual groups were treated with either LPS or TAK-242, and two of them received an additional one-week HBOT (PAC/LPS/HBOT and PAC/TAK-242/HBOT group). Mechanical allodynia and thermal hyperalgesia were then assessed. The expressions of TRPV1, TLR4 and its downstream signaling molecule, MyD88, were investigated. The mechanical and thermal tests revealed that HBOT and TAK-242 alleviated behavioral signs of CIPN. Immunofluorescence in the spinal cord dorsal horn and dorsal root ganglion revealed that TLR4 overexpression in PAC- and PAC/LPS-treated rats was significantly downregulated after HBOT and TAK-242. Additionally, Western blots showed a significant reduction in TLR4, TRPV1, MyD88 and NF-κB. Therefore, we suggest that HBOT may alleviate CIPN by modulating the TLR4-MyD88-NF-κB pathway.

Autologous Fat Grafting in Female Genital Area Improves Sexual Function by Increasing Collagenesis, Angiogenesis, and Estrogen Receptors.

BACKGROUND: Vulvovaginal laxity, atrophic vaginitis, and orgasmic dysfunction are not only aesthetic but also sexual problems. Autologous fat grafting (AFG) facilitates tissue rejuvenation through the effects of adipose-derived stem cells; the fat grafts serve as soft-tissue filler. However, few studies have reported the clinical outcomes of patients undergoing vulvovaginal AFG. OBJECTIVES: The aim of this study was to describe a new technique, micro-autologous fat transplantation (MAFT), for AFG in the vulvovaginal area. Posttreatment histologic changes in the vaginal canal that imply improved sexual function were assessed. METHODS: This retrospective study enrolled females who underwent vulvovaginal AFG performed through MAFT between June 2017 and 2020. Assessments were based on the Female Sexual Function Index (FSFI) questionnaire and on histologic and immunohistochemical staining. RESULTS: In total, 20 female patients (mean age, 38.1 years) were included. On average, 21.9 mL of fat was injected into the vagina and 20.8 mL in the vulva and mons pubis area. Six months afterwards, the patients' mean total FSFI score (68.6) was significantly higher than that at baseline (43.8; P < .001). Histologic and immunohistochemical staining of vaginal tissues revealed substantially increased levels of neocollagenesis, neoangiogenesis, and estrogen receptors. By contrast, the level of protein gene product 9.5, which is associated with neuropathic pain, was considerably lower after AFG. CONCLUSIONS: AFG performed through MAFT in the vulvovaginal area may help manage sexual function-related problems in females. In addition, this technique improves aesthetics, restores tissue volume, alleviates dyspareunia with lubrication, and reduces scar tissue pain.

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis.

BACKGROUND: Depressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms. METHODS: A cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis. RESULTS: A total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%. CONCLUSION: Health care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

The Association between Electronegative Low-Density Lipoprotein Cholesterol L5 and Cognitive Functions in Patients with Mild Cognitive Impairment.

L5, the most electronegative subfraction of low-density lipoprotein cholesterol (LDL-C), may play a role in the pathogenesis of cerebrovascular dysfunction and neurodegeneration. We hypothesized that serum L5 is associated with cognitive impairment and investigated the association between serum L5 levels and cognitive performance in patients with mild cognitive impairment (MCI). This cross-sectional study conducted in Taiwan included 22 patients with MCI and 40 older people with normal cognition (healthy controls). All participants were assessed with the Cognitive Abilities Screening Instrument (CASI) and a CASI-estimated Mini-Mental State Examination (MMSE-CE). We compared the serum total cholesterol (TC), LDL-C, and L5 levels between the MCI and control groups and examined the association between lipid profiles and cognitive performance in these groups. The serum L5 concentration and total CASI scores were significantly negatively correlated in the MCI group. Serum L5% was negatively correlated with MMSE-CE and total CASI scores, particularly in the orientation and language subdomains. No significant correlation between the serum L5 level and cognitive performance was noted in the control group. Conclusions: Serum L5, instead of TC or total LDL-C, could be associated with cognitive impairment through a disease stage-dependent mode that occurs during neurodegeneration.

Ameliorated chest drain wound closure in patients undergoing uniportal thoracoscopic pulmonary resection.

Background: Although uniportal video-assisted thoracoscopic surgery (VATS) has been performed for a wide array of thoracic diseases, unsightliness and poor wound healing often occur, particularly when a chest drain is placed postoperatively. Different chest drain wound closure (CWC) methods have been introduced with the benefits of cosmesis and patient satisfaction. We aimed to describe our improved CWC technique in this setting and assess its efficacy. Methods: A total of consecutive 334 patients undergoing uniportal VATS pulmonary resection with single chest drain placement were investigated from 2016 to 2021. The techniques for CWC were classified into the conventional method (35 patients, group A), continuous suture with removal-free stitches (122 patients, group B), and continuous suture with removal-free barbed suture plus topical skin adhesives (177 patients, group C). Perioperative data and complications related to CWC were analyzed. Results: Group C had a significantly shorter operative time, postoperative hospital stay, and chest tube days than groups A and B (all p < 0.01). In terms of chest tube-related complications, there were no statistically significant differences in post-removal pneumothorax, subcutaneous emphysema, incisional effusion leakage, wound dehiscence, or infection. Overall, significant differences in scar scale scores were observed between the groups, where the ameliorated group C was superior to the conventional group A (p < 0.01). Conclusion: The improved CWC technique using continuous sutures with removal-free barbed sutures and topical skin adhesives is simple, safe, and effective. This may be a favorable CWC strategy when performing uniportal VATS, with enhanced patient satisfaction.

Oxidative Roles of Polystyrene-Based Nanoplastics in Inducing Manganese Oxide Formation under Light Illumination.

Every year, large quantities of plastics are produced and used for diverse applications, growing concerns about the waste management of plastics and their release into the environment. Plastic debris can break down into millions of pieces that adversely affect natural organisms. In particular, the photolysis of micro/nanoplastics can generate reactive oxygen species (ROS). However, their oxidative roles in initiating redox chemical reactions with heavy and transition metals have received little attention. In this study, we investigated whether the photolysis of polystyrene (PS) nanoplastics can induce the oxidation of Mn2+(aq) to Mn oxide solids. We found that PS nanoplastics not only produced peroxyl radicals (ROO•) and superoxide radicals (O2•-) by photolysis, which both play a role in unexpected Mn oxidation, but also served as a substrate for facilitating the heterogeneous nucleation and growth of Mn oxide solids and controlling the formation rate and crystalline phases of Mn oxide solids. These findings help us to elucidate the oxidative roles of nanoplastics in the oxidation of redox-active metal ions. The production of ROS from nanoplastics in the presence of light can endanger marine life and human health, and affect the mobility of the nanoplastics in the environment via redox reactions, which in turn may negatively impact their environmental remediation.

Predictors of Depression Level among Community-Dwelling Elderly Persons.

Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.

Thoracoscopic Repair of Adult-Onset Congenital Tracheoesophageal Fistula Using a Polyglycolic Acid Sheet-Buttressed Stapler.

Congenital tracheoesophageal fistula (TEF) without esophageal atresia is usually diagnosed and treated in the neonatal period. It is uncommon to occur in adulthood. Conventional treatment of adult-onset TEF involves repair by either cervicotomy or thoracotomy. We reported the case of a 31-year-old male patient with clinical and radiographic evidence of congenital H-type TEF. Although this fistula was located at the level of the second thoracic vertebra, the repair of the anomaly was performed successfully using a thoracoscopic approach with the novel use of a polyglycolic acid sheet reinforcement.

Shanghai expert consensus on clinical protocol for traditional Chinese medicine treatment of COVID-19 among the elderly population (second edition).

This document is the revised edition of the previously issued Shanghai Expert Consensus on Clinical Protocol for Traditional Chinese Medicine Treatment of COVID-19 among the Elderly Population. Based on the clinical experience and the Protocol for Diagnosis and Treatment of COVID-19 (Trial 9th Edition), this revised edition provides treatment approaches and recommendations to proactively cope with Omicron variant and increase the therapeutic efficacy for coronavirus disease 2019 among the elderly population in Shanghai, China.

Investigation of the Relationship between Cardiovascular Biomarkers and Brachial-Ankle Pulse Wave Velocity in Hemodialysis Patients.

Brachial−ankle pulse wave velocity (baPWV) and cardiovascular (CV) biomarkers are correlated with clinical cardiovascular diseases (CVDs) in patients with kidney disease. However, limited studies evaluated the relationship between baPWV and CV biomarkers in hemodialysis patients. This study investigated the relationship between circulating CV biomarkers and baPWV in patients on hemodialysis. Hemodialysis patients were enrolled between August 2016 and January 2017 for the measurement of baPWV, traditional CV biomarkers, including high-sensitivity troponin-T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and novel CV biomarkers, including Galectin-3, Cathepsin D, placental growth factor, Endocan-1, and Fetuin-A. The independent association was assessed by multivariate-adjusted linear regression analysis to control for potential confounders. The final analysis included 176 patients (95 men and 81 women) with a mean age of 60 ± 11 y old. After adjusting for age and sex, hsTnT (p < 0.01), NT-proBNP (p = 0.01), Galectin-3 (p = 0.03), and Cathepsin D (p < 0.01) were significantly directly correlated with baPWV. The direct correlation with baPWV existed in multivariable linear regression models with a ß of 0.1 for hsTnT and 0.1 for Cathepsin D. The direct relationship between baPWV and CV biomarkers, particularly with hsTnT and Cathepsin D, may be helpful for risk stratification of hemodialysis patients.

Perceived Stress and Coping Behavior of Nurses Caring for Critical Patients with COVID-19 Outbreak in Taiwan: A Mixed-Methods Study.

Severe pneumonia with novel pathogens, also called COVID-19, caused a pandemic in Taiwan as well as in the rest of the world in May 2021. Nurses are under great stress when caring for critically ill patients with COVID-19. This study aimed to explore the perceived stress and coping behaviors of nurses caring for critically ill patients with COVID-19 using a mixed-methods approach. We recruited 85 nurses from a special intensive care unit (ICU) of a medical center in Taiwan between May and June 2021. To gather data, we used a questionnaire on basic characteristics, the perceived stress scale (PSS-14), and the brief coping orientation to problems experienced inventory (B-COPE), then conducted a qualitative interview. The results showed that the average perceived stress level among nurses was 25.4 points, and most of them perceived moderate stress. The top three coping behaviors practiced by the nurses were active coping, planning, and acceptance. Nurses who received less perceived support from their friends or families and who had shorter working experience in nursing had significantly higher stress levels. The qualitative results revealed that the nurses' perceived stress came from fear, worry, and the increased burden caused by caring for critical patients with COVID-19. Coping behaviors included rest, seeking support, and affirmative fighting. Based on these findings, it is suggested that the support nurses receive from their families is an important predictor of perceived stress. Therefore, it is suggested that nurses be provided with more support in dealing with stress caused by caring for critical patients with COVID-19 in special ICUs.

One-stage pulmonary nodule detection using 3-D DCNN with feature fusion and attention mechanism in CT image.

BACKGROUND AND OBJECTIVE: Lung cancer is the most common cause of cancer-related death in the world. Low-dose computed tomography (LDCT) is a widely used modality in lung cancer detection. The nodule is an abnormal tissue and may evolve into lung cancer. Hence, it is crucial to detect nodules in the early detection stage. However, reviewing the LDCT scans to observe suspicious nodules is a time-consuming task. Recently, designing a computer-aided detection (CADe) system with convolutional neural network (CNN) architecture has been proven that it is helpful for radiologists. Hence, in this study, a 3-D YOLO-based CADe system, 3-D OSAF-YOLOv3, is proposed for nodule detection in LDCT images. METHODS: The proposed CADe system consists of data preprocessing, nodule detection, and non-maximum suppression algorithm (NMS). At first, the data preprocessing including the background elimination, the spacing normalization, and the volume of interest (VOI) extraction, are conducted to remove the non-lung region, normalize the image spacing, and divide LDCT image into numerous VOIs. Then, the VOIs are fed into the 3-D OSAF-YOLOv3 model, to detect the suspicious nodules. The proposed model is constructed by integrating the 3-D YOLOv3 with the one-shot aggregation module (OSA), the receptive field block (RFB), and the feature fusion scheme (FFS). Finally, the NMS algorithm is performed to eliminate the duplicated detection generated by the model. RESULTS: In this study, the LUNA-16 dataset composed 1186 nodules from 888 LDCT scans and the competition performance metric (CPM) are used to evaluate our CADe system. In the experiment results, the proposed system can achieve a sensitivities rate of 0.962 with the false positive rate of 8 and complete a CPM value of 0.905. Moreover, according to the ablation study results, the employment of OSA module, RFB, and FFS could improve the detection performance actually. Furthermore, compared to other start-of-the-art (SOTA) models, our detection system could also achieve the higher performance. CONCLUSIONS: In this study, a YOLO-based CADe system for nodule detection in CT image system integrating additional modules and scheme is proposed for nodule detection in LDCT. The result indicates that the proposed the modification can significantly improve detection performance.

Effects of Dabigatran on Dementia Pathogenesis and Neuropsychological Function: A Review.

BACKGROUND: Patients with atrial fibrillation (AF) carry higher risks of cognitive consequences and psychological burden. An optimal anticoagulant therapy would be expected to better preserve neuropsychological function in addition to effective prevention of stroke and systemic thromboembolism. OBJECTIVE: The aim of this review is to explore the effects of the non-vitamin K antagonist oral anticoagulant (NOAC) dabigatran, a direct thrombin inhibitor, on cognitive and psychological function as well as dementia pathogenesis. METHODS: We performed a comprehensive search of PubMed/Medline for all types of relevant articles using a combination of dabigatran and associated keywords updated to August 31, 2021. All titles and abstracts were screened for eligibility, and potentially relevant papers were collected for inclusion. RESULTS: The pooled results demonstrated neutral to positive impacts of dabigatran on cognitive and psychological outcomes, including laboratory results in animal models of Alzheimer's disease, and reduced incidences of anxiety/depression and dementia for AF patients. Dabigatran also exhibited better therapeutic profiles than warfarin in preclinical and observational research. CONCLUSION: Given limited strength of evidence from heterogeneous studies, our review proposed modest beneficial effects of dabigatran on neuropsychological function. Further clinical trials are warranted to affirm the pleiotropic protective effects of NOACs on dementia treatment.