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Wan C, Zong RY, Chen XS. The new mechanism of cognitive decline induced by hypertension: High homocysteine-mediated aberrant DNA methylation. Front Cardiovasc Med 2022; 9:928701. [PMID: 36352848 PMCID: PMC9637555 DOI: 10.3389/fcvm.2022.928701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
The prevalence and severity of hypertension-induced cognitive impairment increase with the prolonging of hypertension. The mechanisms of cognitive impairment induced by hypertension primarily include cerebral blood flow perfusion imbalance, white and gray matter injury with blood–brain barrier disruption, neuroinflammation and amyloid-beta deposition, genetic polymorphisms and variants, and instability of blood pressure. High homocysteine (HHcy) is an independent risk factor for hypertension that also increases the risk of developing early cognitive impairment. Homocysteine (Hcy) levels increase in patients with cognitive impairment induced by hypertension. This review summarizes a new mechanism whereby HHcy-mediated aberrant DNA methylation and exacerbate hypertension. It involves changes in Hcy-dependent DNA methylation products, such as methionine adenosyltransferase, DNA methyltransferases, S-adenosylmethionine, S-adenosylhomocysteine, and methylenetetrahydrofolate reductase (MTHFR). The mechanism also involves DNA methylation changes in the genes of hypertension patients, such as brain-derived neurotrophic factor, apolipoprotein E4, and estrogen receptor alpha, which contribute to learning, memory, and attention deficits. Studies have shown that methionine (Met) induces hypertension in mice. Moreover, DNA hypermethylation leads to cognitive behavioral changes alongside oligodendroglial and/or myelin deficits in Met-induced mice. Taken together, these studies demonstrate that DNA methylation regulates cognitive dysfunction in patients with hypertension. A better understanding of the function and mechanism underlying the effect of Hcy-dependent DNA methylation on hypertension-induced cognitive impairment will be valuable for early diagnosis, interventions, and prevention of further cognitive defects induced by hypertension.
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Affiliation(s)
- Chong Wan
- Department of Military Medical Geography, Army Medical Training Base, Army Medical University (Third Military Medical University), Chongqing, China
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Rui-Yi Zong
- Department of Military Medical Geography, Army Medical Training Base, Army Medical University (Third Military Medical University), Chongqing, China
- NCO School, Army Medical University, Shijiazhuang, China
| | - Xing-Shu Chen
- Department of Military Medical Geography, Army Medical Training Base, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Xing-Shu Chen,
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Lauretta MP, Melotti RM, Sangermano C, George AM, Badenes R, Bilotta F. Homocysteine Plasmatic Concentration in Brain-Injured Neurocritical Care Patients: Systematic Review of Clinical Evidence. J Clin Med 2022; 11:jcm11020394. [PMID: 35054087 PMCID: PMC8780007 DOI: 10.3390/jcm11020394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Hyperhomocysteinemia (HHcy) is considered as an independent risk factor for several diseases, such as cardiovascular, neurological and autoimmune conditions. Atherothrombotic events, as a result of endothelial dysfunction and increased inflammation, are the main mechanisms involved in vascular damage. This review article reports clinical evidence on the relationship between the concentration of plasmatic homocysteine (Hcy) and acute brain injury (ABI) in neurocritical care patients. Materials and methods: a systematic search of articles in the PubMed and EMBASE databases was conducted, of which only complete studies, published in English in peer-reviewed journals, were included. Results: A total of 33 articles, which can be divided into the following 3 subchapters, are present: homocysteine and acute ischemic stroke (AIS); homocysteine and traumatic brain injury (TBI); homocysteine and intracranial hemorrhage (ICH)/subarachnoid hemorrhage (SAH). This confirms that HHcy is an independent risk factor for ABI and a marker of poor prognosis in the case of stroke, ICH, SAH and TBI. Conclusions: Several studies elucidate that Hcy levels influence the patient’s prognosis in ABI and, in some cases, the risk of recurrence. Hcy appears as biochemical marker that can be used by neuro-intensivists as an indicator for risk stratification. Moreover, a nutraceutical approach, including folic acid, the vitamins B6 and B12, reduces the risk of thrombosis, cardiovascular and neurological dysfunction in patients with severe HHcy that were admitted for neurocritical care.
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Affiliation(s)
- Maria Paola Lauretta
- Department of Anaesthesia and Pain Management, IRCCS Policlinico S. Orsola-Malpighi of Bologna, University of Bologna, 40138 Bologna, Italy;
| | - Rita Maria Melotti
- Department of Anaesthesia and Pain Management, IRCCS Policlinico S. Orsola-Malpighi of Bologna, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Corinne Sangermano
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
| | - Anneliya Maria George
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
| | - Rafael Badenes
- Department of Anesthesiology and Surgical Trauma Intensive Care, Hospital Clínic Universitar de Valencia, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Federico Bilotta
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
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Prognostic Significance of Homocysteine Level on Neurological Outcome in Brain Arteriovenous Malformations. DISEASE MARKERS 2020; 2020:6661475. [PMID: 33312268 PMCID: PMC7721487 DOI: 10.1155/2020/6661475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022]
Abstract
Objective We aimed to investigate the serum homocysteine (Hcy) level in patients with brain arteriovenous malformation (bAVM) and their impact on neurological outcome during hospitalization. Method We retrospectively reviewed patients diagnosed with bAVMs in Beijing Tiantan Hospital from January 2019 to August 2020. Patients were divided into two groups according to the mRS (modified Rankin Scale) score at discharge. Clinical and laboratory characteristics were compared. Logistic regression analyses were performed to identify the potential risk factors for short-term neurological outcome. Results A total of 175 bAVM patients were enrolled in the study, including 139 patients with favorable outcome (mRS ≤ 2) and 36 patients with unfavorable outcome (mRS > 2). Hyperhomocysteinemia was identified in 32.6% of cases (n = 57). Serum Hcy level was related to seizure manifestation (P = 0.034) and short-term neurological outcome (P = 0.027). Logistic regression analysis showed that serum glucose (OR 1.897, 95% CI 1.115-3.229; P = 0.018) and Hcy level (OR 0.838, 95% CI 0.720-0.976; P = 0.023) were significantly associated with short-term disability. Conclusion Our results indicated that the lower serum Hcy level is strongly associated with in-hospital unfavorable outcome. Further prospective studies of Hcy natural history and managements in bAVMs are required, which would be valuable for evaluating the disease-modifying efficacy of oral nutritional supplements in bAVM patients.
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Early Tranexamic Acid Administration After Traumatic Brain Injury Is Associated With Reduced Syndecan-1 and Angiopoietin-2 in Patients With Traumatic Intracranial Hemorrhage. J Head Trauma Rehabil 2020; 35:317-323. [PMID: 32881765 DOI: 10.1097/htr.0000000000000619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the effect of early tranexamic acid (TXA) administration on circulating markers of endotheliopathy. SETTING Twenty trauma centers in the United States and Canada. PARTICIPANTS Patients with moderate-to-severe traumatic brain injury (TBI) (MS-TBI) and intracranial hemorrhage who were not in shock (systolic blood pressure ≥90 mm Hg). DESIGN TXA (2 g) or placebo administered prior to hospital arrival, less than 2 hours postinjury. Blood samples and head computed tomographic scan collected upon arrival. Plasma markers measured using Luminex analyte platform. Differences in median marker levels evaluated using t tests performed on log-transformed variables. Comparison groups were TXA versus placebo and less than 45 minutes versus 45 minutes or more from time of injury to treatment administration. MAIN MEASURES Plasma levels of angiopoietin-1, angiopoietin-2, syndecan-1, thrombomodulin, thrombospondin-2, intercellular adhesion molecule 1, vascular adhesion molecule 1. RESULTS Demographics and Injury Severity Score were similar between the placebo (n = 129) and TXA (n = 158) groups. Levels of syndecan-1 were lower in the TXA group (median [interquartile range or IQR] = 254.6 pg/mL [200.7-322.0] vs 272.4 pg/mL [219.7-373.1], P = .05. Patients who received TXA less than 45 minutes postinjury had significantly lower levels of angiopoietin-2 (median [IQR] = 144.3 pg/mL [94.0-174.3] vs 154.6 pg/mL [110.4-209.8], P = .05). No differences were observed in remaining markers. CONCLUSIONS TXA may inhibit early upregulation of syndecan-1 and angiopoietin-2 in patients with MS-TBI, suggesting attenuation of protease-mediated vascular glycocalyx breakdown. The findings of this exploratory analysis should be considered preliminary and require confirmation in future studies.
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Asken BM. Author response: Concussion Biomarkers Assessed in Collegiate Student-Athletes (BASICS) I: Normative study. Neurology 2019; 93:565. [DOI: 10.1212/wnl.0000000000008144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Karimi P, Sayehmiri K, Azami M, Tardeh Z. The association between iron deficiency anemia and febrile seizure. Int J Adolesc Med Health 2019; 34:ijamh-2019-0083. [PMID: 31301671 DOI: 10.1515/ijamh-2019-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 11/15/2022]
Abstract
Objective Different studies have reported contradictory results regarding the relationship between iron deficiency anemia (IDA) and febrile seizure (FS). The present study was conducted to determine the effect of IDA on FS in children. Patients and methods This case-control study was conducted among 52 children with FS (the case group) and 18 children with afebrile seizures and 51 children with fever without seizures in the age range of 6 months to 5 years admitted to the pediatric ward of Imam Khomeini Hospital in Ilam from March 2016 to January 2017. Patients were selected using the convenience sampling method. Red blood cell (RBC) count as well as measurement of hemoglobin (Hb), hematocrit (Hct), ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) levels were performed in all patients. The collected data were analyzed using SPSS16 software. Results A total of 34.6% in the FS group, 66.7% in the afebrile seizure group and 41.2% in the fever without seizure group suffered from IDA, which was not statistically significant between the three groups. Hb, Hct and RBC levels were higher in the case group and MCV, MCH, MCHC levels in the case group were lower than those in the control group. The odds ratio (OR) for FS compared to the febrile group was 0.756 [95% confidence interval (CI) = 0.34-1.68; p = 0.493] and that for FS compared to seizure was 0.265 (95% CI = 0.085-0.823; p = 0.022). Conclusions This study showed that IDA may have protective effects on the onset of FS, and based on the results, IDA is more common in children with afebrile seizures. Further and more comprehensive studies are recommended.
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Affiliation(s)
- Parviz Karimi
- Department of Pediatric Diseases, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Koroush Sayehmiri
- Department of Biostatistics, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Azami
- Student Research Committee, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Zeinab Tardeh
- Student Research Committee, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran, Phone: +9337416255
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Pouy S, Etebarian Khorasgani A, Azizi-Qadikolaee A, Yaghobi Y. Effect of acupressure on post tonsillectomy pain in adolescents: a randomized, single-blind, placebo-controlled trial study. Int J Adolesc Med Health 2019; 34:ijamh-2019-0065. [PMID: 31287797 DOI: 10.1515/ijamh-2019-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/11/2019] [Indexed: 12/26/2022]
Abstract
Introduction Tonsillectomy is one of the most common pediatric surgeries in the world and pain control following tonsillectomy is very important. Objective The aim of this study is to investigate the effect of acupressure on the amount of pain following tonsillectomy in children. Method One hundred and forty-four children aged 5-12 years old were assigned into one of three groups: interventions, control and placebo. In the intervention group, acupressure was applied at three acupoints and in the placebo group, sham acupressure was applied. In the control group routine care only was applied. Results There was a significant difference between an average of changes in pain score before and after the intervention during the 3 time periods after the tonsillectomy operation in the acupressure group (p = 0.002). Conclusion The results showed that acupressure had a positive effect on pain reduction after tonsillectomy in children in the intervention group.
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Affiliation(s)
- Somaye Pouy
- School of Nursing and Midwifery,Guilan University of Medical Sciences(GUMS), Rasht, Iran
| | - Abolfazl Etebarian Khorasgani
- Student Research Committee, Mazandaran University Of Medical Sciences, sari, iran.,Faculty of Nursing and Midwifery of Amol, Mazanaran University of Medical Sciences, Sari, Iran
| | - Ali Azizi-Qadikolaee
- School of Nursing and Midwifery,Guilan University of Medical Sciences(GUMS), Rasht, Iran
| | - Yasaman Yaghobi
- School of Nursing and Midwifery,Guilan University of Medical Sciences(GUMS), Rasht, Iran
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Borji M, Pouy S, Yaghobi Y, Nabi BN. Effectiveness of acupressure on anxiety of children undergoing anesthesia. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0177/ijamh-2018-0177.xml. [PMID: 31050652 DOI: 10.1515/ijamh-2018-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Tonsillectomy is one of the most commonly used pediatric surgeries with high stress levels for children and their parents. The present study was designed and implemented regarding the fact that limited studies have ever been carried out about the effects of complementary therapies such as acupressure on the preoperative anxiety levels in children throughout the world. MATERIALS AND METHODS Present study was a randomized clinical trial that was done in three groups with 144 children aged 5-12 years undergoing tonsillectomy. In present study, the children were allocated in three groups: intervention, control and sham. In the intervention group, the acupressure was applied on the Yintang point and in the sham group, was applied at a sham acupoint. No intervention was performed in the control group. Before and after intervention, the pediatric anxiety levels were measured using instruments. The results were analyzed using descriptive and inferential statistics such as the Kruskal-Wallis and Wilcoxon tests, chi-square (χ2) and analysis of variance (ANOVA) test. The significance level was considered p < 0.05. RESULTS The total anxiety score in children was (70.39 ± 20.93) in the control group, (67.83 ± 16.78) in the intervention group and (71.40 ± 21.82) in the sham group, not significant difference (p > 0.05). The different in the overall anxiety score among children before intervention compare to after intervention was as following: Control group (-3 ± 17.46), intervention group (8.42 ± 32.98) and sham group (-4.32 ± 24.47). CONCLUSION Like other surgical procedures, the tonsillectomy has serious stress for children. Our study demonstrates that the acupressure has a significant effect on the level of preoperative anxiety in children undergoing surgery. Therefore, nurses can use this technique to reduce the pediatric anxiety.
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Affiliation(s)
- Milad Borji
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Somaye Pouy
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Yasaman Yaghobi
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
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Wang XJ, Tian DC, Wang FW, Zhang MH, Fan CD, Chen W, Wang MH, Fu XY, Ma JK. Astaxanthin inhibits homocysteine‑induced endothelial cell dysfunction via the regulation of the reactive oxygen species‑dependent VEGF‑VEGFR2‑FAK signaling pathway. Mol Med Rep 2019; 19:4753-4760. [PMID: 31059085 PMCID: PMC6522805 DOI: 10.3892/mmr.2019.10162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/10/2019] [Indexed: 12/11/2022] Open
Abstract
Increased plasma levels of homocysteine (Hcy) can cause severe damage to vascular endothelial cells. Hcy‑induced endothelial cell dysfunction contributes to the occurrence and development of human cerebrovascular diseases (CVDs). Our previous studies have revealed that astaxanthin (ATX) exhibits novel cardioprotective activity against Hcy‑induced cardiotoxicity in vitro and in vivo. However, the protective effect and mechanism of ATX against Hcy‑induced endothelial cell dysfunction requires further investigation. In the present study, treatment of human umbilical vascular endothelial cells (HUVECs) with Hcy inhibited the migration, invasive and tube formation potentials of these cells in a dose‑dependent manner. Hcy treatment further induced a time‑dependent increase in the production of reactive oxygen species (ROS), and downregulated the expression of vascular endothelial growth factor (VEGF), phosphorylated (p)‑Tyr‑VEGF receptor 2 (VEGFR2) and p‑Tyr397‑focal adhesion kinase (FAK). On the contrary, ATX pre‑treatment significantly inhibited Hcy‑induced cytotoxicity and increased HUVEC migration, invasion and tube formation following Hcy treatment. The mechanism of action may involve the effective inhibition of Hcy‑induced ROS generation and the recovery of FAK phosphorylation. Collectively, our findings suggested that ATX could inhibit Hcy‑induced endothelial dysfunction by suppressing Hcy‑induced activation of the VEGF‑VEGFR2‑FAK signaling axis, which indicates the novel therapeutic potential of ATX in treating Hcy‑mediated CVD.
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Affiliation(s)
- Xian-Jun Wang
- Department of Neurology, People's Hospital of Linyi Affiliated to Qingdao University, Linyi, Shandong 276000, P.R. China
| | - Da-Chen Tian
- Department of Neurology, People's Hospital of Linyi Affiliated to Qingdao University, Linyi, Shandong 276000, P.R. China
| | - Feng-Wen Wang
- Department of Biochemistry, Basic Medical School, Taishan Medical University, Taian, Shandong 271000, P.R. China
| | - Meng-Hao Zhang
- Department of Biochemistry, Basic Medical School, Taishan Medical University, Taian, Shandong 271000, P.R. China
| | - Cun-Dong Fan
- Department of Biochemistry, Basic Medical School, Taishan Medical University, Taian, Shandong 271000, P.R. China
| | - Wang Chen
- Department of Neurology, People's Hospital of Linyi Affiliated to Qingdao University, Linyi, Shandong 276000, P.R. China
| | - Mei-Hong Wang
- Department of Neurology, People's Hospital of Linyi Affiliated to Qingdao University, Linyi, Shandong 276000, P.R. China
| | - Xiao-Yan Fu
- Department of Biochemistry, Basic Medical School, Taishan Medical University, Taian, Shandong 271000, P.R. China
| | - Jin-Kui Ma
- Department of Food Science and Technology, School of Food and Pharmaceutical Engineering, Zhaoqing University, Zhaoqing, Guangdong 526061, P.R. China
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Pouy S, Etebarian A, Azizi-Qadikolaee A, Saeidi S. The effect of acupuncture on postoperative pain, nausea and vomiting after pediatric tonsillectomy: a systematic review. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0285/ijamh-2018-0285.xml. [PMID: 30954971 DOI: 10.1515/ijamh-2018-0285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/01/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Tonsillectomy is one of the most commonly performed surgical procedures among children around the world and management of post tonsillectomy complications are very important. OBJECTIVES The aim of this study was to evaluate the effects of acupuncture on the amount of pain, nausea and vomiting after tonsillectomy in children. METHODS In this study, two researchers searched individually for qualified articles on the effects of acupuncture on post-tonsillectomy pain, nausea and vomiting using PubMed, Cochrane Library, Embase, Google scholar and Ovid databases by September 2018. RESULTS After critically appraising the searched studies, 12 studies were selected and entered into a systematic review. Among the studies, various acupuncture methods were used. CONCLUSION This systematic review shows that acupuncture as a complementary method can prevent and reduce the severity of complications surrounding tonsillectomy.
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Affiliation(s)
- Somaye Pouy
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Abolfazl Etebarian
- Master of Nursing, Amol Faculity of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Azizi-Qadikolaee
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Solmaz Saeidi
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Satyarthee GD. Biomarker-Based Targeted Therapy of Traumatic Brain Injury: From Prehospital Care to In-Hospital Care to Rehabilitation. World Neurosurg 2017; 103:939-941. [PMID: 28672716 DOI: 10.1016/j.wneu.2017.02.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Guru Dutta Satyarthee
- Department of Neurosurgery, Neurosciences Center, AIIMS New Delhi, New Delhi, India.
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12
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Dhandapani S, Bajaj A, Gendle C, Saini I, Kaur I, Chaudhary I, Jasandeep, Kaur J, Kalyan G, Dhandapani M, Gupta SK. Independent impact of plasma homocysteine levels on neurological outcome following head injury. Neurosurg Rev 2017; 41:513-517. [PMID: 28741220 DOI: 10.1007/s10143-017-0880-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/05/2017] [Indexed: 12/13/2022]
Abstract
Homocysteine (tHcy) has been hardly studied among patients with head injury. This study was to evaluate whether there is any independent impact of tHcy levels on neurological outcome following head injury in a multivariate model. Patients admitted within 24 h of injury were included in the study, along with 20 age- and gender-matched controls. Plasma levels of tHcy were measured at admission using direct immunoassay. All the variables were analyzed with respect to tHcy levels and outcome according to Glasgow Outcome Score (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21. There were a total of 72 patients in the study. tHcy levels were significantly higher after head injury (mean 24.03[SD ± 16.0] μmol/L), compared to matched controls (mean 16.62 [SD ± 10.4] μmol/L) (p = 0.05). Patients with severe head injury, acute SDH, or diffuse higher radiological grades had greater levels of tHcy compared to others. There was a significant relationship between tHcy level and neurological outcome. tHcy levels were significantly higher in patients who had unfavorable GOS (mean 36.22[±25.3] μmol/L), compared to those with favorable GOS (mean 22.71[±14.3] μmol/L) (P = 0.03). In multivariate analysis, tHcy level (adj. odds ratio [OR] 1.17, P = 0.05) and Glasgow Coma Scale (adj. OR 5.17, P = 0.01) had significant association with neurological outcome at 3 months independent of age, dietary habit, radiological grading and of each other. tHcy level has significant independent impact on neurological outcome and may be useful as a prognostic marker following head injury.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India.
| | - Ankur Bajaj
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Chandrasekar Gendle
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Inderjeet Saini
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Irwanjeet Kaur
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Isha Chaudhary
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Jasandeep
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Jaspinder Kaur
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Geetanjali Kalyan
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Manju Dhandapani
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
| | - Sunil K Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India
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