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Krzyzaniak K, Krion R, Szymczyk A, Stepniewska E, Sieminski M. Exploring Neuroprotective Agents for Sepsis-Associated Encephalopathy: A Comprehensive Review. Int J Mol Sci 2023; 24:10780. [PMID: 37445958 DOI: 10.3390/ijms241310780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Sepsis is a life-threatening condition resulting from an inflammatory overreaction that is induced by an infectious factor, which leads to multi-organ failure. Sepsis-associated encephalopathy (SAE) is a common complication of sepsis that can lead to acute cognitive and consciousness disorders, and no strict diagnostic criteria have been created for the complication thus far. The etiopathology of SAE is not fully understood, but plausible mechanisms include neuroinflammation, blood-brain barrier disruption, altered cerebral microcirculation, alterations in neurotransmission, changes in calcium homeostasis, and oxidative stress. SAE may also lead to long-term consequences such as dementia and post-traumatic stress disorder. This review aims to provide a comprehensive summary of substances with neuroprotective properties that have the potential to offer neuroprotection in the treatment of SAE. An extensive literature search was conducted, extracting 71 articles that cover a range of substances, including plant-derived drugs, peptides, monoclonal antibodies, and other commonly used drugs. This review may provide valuable insights for clinicians and researchers working in the field of sepsis and SAE and contribute to the development of new treatment options for this challenging condition.
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Affiliation(s)
- Klaudia Krzyzaniak
- Department of Emergency Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Robert Krion
- Department of Emergency Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Aleksandra Szymczyk
- Department of Emergency Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Ewelina Stepniewska
- Department of Emergency Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Huang CA, Casey C, Ismael H. A Rare Case of Postoperative Encephalopathy in Twin. Cureus 2023; 15:e37610. [PMID: 37197100 PMCID: PMC10184516 DOI: 10.7759/cureus.37610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
The clinical picture of encephalopathy invites a broad differential with multiple etiologies. It is with judicious history, hospital course, lab testing, and imaging that the ultimate cause is identified. We present a unique case of identical twins who share a similar clinical presentation of postoperative encephalopathy. The striking similarities in both twins suggest a genetic component requiring further research to identify patients who are genetically predisposed.
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Affiliation(s)
- Chenan A Huang
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Caroline Casey
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Hussam Ismael
- General Surgery, Orlando Veterans Affairs Medical Center, Orlando, USA
- Surgery, University of Central Florida College of Medicine, Orlando, USA
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Zhao L, Song Y, Zhang Y, Liu H, Shen Y, Fan Y, Li Y, Xie K. HIF-1α/BNIP3L induced cognitive deficits in a mouse model of sepsis-associated encephalopathy. Front Immunol 2022; 13:1095427. [PMID: 36569834 PMCID: PMC9768421 DOI: 10.3389/fimmu.2022.1095427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Sepsis Associated Encephalopathy (SAE) is a common complication in critically ill patients and perioperative period, but its pathogenesis is still unclear. This study aimed to explore the effect of the HIF-1α (hypoxia-inducible factor-1α)/BNIP3L (Bcl-2/adenovirus E1B 19-kDa interaction protein) signaling pathway on SAE. Methods C57BL/6J male mice were divided into four groups, using a random number table method: control group, sham group, sepsis group, sepsis+HIF-1α activity inhibitor (echinomycin) group. Sepsis was induced by cecal ligation and puncture (CLP). At 24 h after surgery, brain tissue was sampled. HE was staining to observe changes in the hippocampus structure. Fluoroscopy observes changes in mitochondrial structure. Western blot, QT-PCR, and immunofluorescence were used to assess the amount of expression of HIF-1α and BNIP3L in the hippocampus and mitochondrion of hippocampus neurons. Observation of neuronal apoptosis by TUNEL staining. Seven days after surgery, mice were tested in a Morris water maze test to assess cognitive function after CLP. Results Our results show that CLP-induced hippocampus-dependent cognitive deficits were accompanied with increased HIF 1a and decreased BNIP3L, increased protein levels of TNF-α, IL-6, and IL-β, and damage to mitochondrial structures and neuronal apoptosis in the hippocampus. In addition, administration of echinomycin rescues cognitive deficits, ameliorates HIF-1α and BNIP3L-mediated neuronal pyroptosis and damaged mitochondrial structures, and decreases the expression of TNF-α and IL-6 in the hippocampus. Conclusions HIF-1α and the BNIP3L promote mitochondrial damage, and neuronal apoptosis and the expression of inflammatory factors may be the mechanism of SAE in critically ill patients and perioperative period.
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Affiliation(s)
- Lina Zhao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Song
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Haiying Liu
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuehao Shen
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Fan
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yun Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China,*Correspondence: Yun Li, ; Keliang Xie,
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China,Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Research Institute of Anesthesiology, Tianjin, China,*Correspondence: Yun Li, ; Keliang Xie,
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Zhao L, Li Y, Wang Y, Gao Q, Ge Z, Sun X, Li Y. Corrigendum: Development and Validation of a Nomogram for the Prediction of Hospital Mortality of Patients With Encephalopathy Caused by Microbial Infection: A Retrospective Cohort Study. Front Microbiol 2021; 12:773499. [PMID: 34803994 PMCID: PMC8600948 DOI: 10.3389/fmicb.2021.773499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fmicb.2021.737066.].
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Affiliation(s)
- Lina Zhao
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Yun Li
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Yunying Wang
- Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Qian Gao
- Department of Neurology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengzheng Ge
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xibo Sun
- Department of Neurology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Zhao L, Li Y, Wang Y, Gao Q, Ge Z, Sun X, Li Y. Development and Validation of a Nomogram for the Prediction of Hospital Mortality of Patients With Encephalopathy Caused by Microbial Infection: A Retrospective Cohort Study. Front Microbiol 2021; 12:737066. [PMID: 34489922 PMCID: PMC8417384 DOI: 10.3389/fmicb.2021.737066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hospital mortality is high for patients with encephalopathy caused by microbial infection. Microbial infections often induce sepsis. The damage to the central nervous system (CNS) is defined as sepsis-associated encephalopathy (SAE). However, the relationship between pathogenic microorganisms and the prognosis of SAE patients is still unclear, especially gut microbiota, and there is no clinical tool to predict hospital mortality for SAE patients. The study aimed to explore the relationship between pathogenic microorganisms and the hospital mortality of SAE patients and develop a nomogram for the prediction of hospital mortality in SAE patients. Methods The study is a retrospective cohort study. The lasso regression model was used for data dimension reduction and feature selection. Model of hospital mortality of SAE patients was developed by multivariable Cox regression analysis. Calibration and discrimination were used to assess the performance of the nomogram. Decision curve analysis (DCA) to evaluate the clinical utility of the model. Results Unfortunately, the results of our study did not find intestinal infection and microorganisms of the gastrointestinal (such as: Escherichia coli) that are related to the prognosis of SAE. Lasso regression and multivariate Cox regression indicated that factors including respiratory failure, lactate, international normalized ratio (INR), albumin, SpO2, temperature, and renal replacement therapy were significantly correlated with hospital mortality. The AUC of 0.812 under the nomogram was more than that of the Simplified Acute Physiology Score (0.745), indicating excellent discrimination. DCA demonstrated that using the nomogram or including the prognostic signature score status was better than without the nomogram or using the SAPS II at predicting hospital mortality. Conclusion The prognosis of SAE patients has nothing to do with intestinal and microbial infections. We developed a nomogram that predicts hospital mortality in patients with SAE according to clinical data. The nomogram exhibited excellent discrimination and calibration capacity, favoring its clinical utility.
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Affiliation(s)
- Lina Zhao
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Yun Li
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Yunying Wang
- Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Qian Gao
- Department of Neurology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengzheng Ge
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xibo Sun
- Department of Neurology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Cui YH, Zhou SF, Liu Y, Wang S, Li F, Dai RP, Hu ZL, Li CQ. Injection of Anti-proBDNF Attenuates Hippocampal-Dependent Learning and Memory Dysfunction in Mice With Sepsis-Associated Encephalopathy. Front Neurosci 2021; 15:665757. [PMID: 34354558 PMCID: PMC8329425 DOI: 10.3389/fnins.2021.665757] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) is a risk factor for cognitive and memory dysfunction; however, the mechanism remains unclear. Brain-derived neurotrophic factor (BDNF) was reported to have a positive effect on cognition and emotion regulation, but the study of its precursor, proBDNF, has been limited. This study aimed to elucidate the effects and associated mechanisms of hippocampal proBDNF in a lipopolysaccharide (LPS)-induced SAE mouse model. In this study, we found that the mice exhibited cognitive dysfunction on day 7 after LPS injection. The expression of proBDNF and its receptor, p75NTR, was also increased in the hippocampus, while the levels of BDNF and its receptor, TrkB, were decreased. A co-localization study showed that proBDNF and p75NTR were mainly co-localized with neurons. Furthermore, LPS treatment reduced the expression of NeuN, Nissl bodies, GluR4, NR1, NR2A, and NR2B in the hippocampus of SAE mice. Furthermore, an intrahippocampal or intraperitoneal injection of anti-proBDNF antibody was able to ameliorate LPS-induced cognitive dysfunction and restore the expression of NeuN, Nissl bodies, GluR4, NR1, NR2A, NR2B, and PSD95. These results indicated that treatment with brain delivery by an intrahippocampal and systemic injection of mAb-proBDNF may represent a potential therapeutic strategy for treating patients with SAE.
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Affiliation(s)
- Yan-Hui Cui
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China.,Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Fen Zhou
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Yu Liu
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China.,Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Wang
- Department of Medical Research Center and Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Li
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Ru-Ping Dai
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Lan Hu
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang-Qi Li
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
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Heming N, Mazeraud A, Azabou E, Moine P, Annane D. Vasopressor Therapy and the Brain: Dark Side of the Moon. Front Med (Lausanne) 2020; 6:317. [PMID: 31998736 PMCID: PMC6966606 DOI: 10.3389/fmed.2019.00317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022] Open
Abstract
Sepsis, a leading cause of morbidity and mortality, is caused by a deregulated host response to pathogens, and subsequent life-threatening organ dysfunctions. All major systems, including the cardiovascular, respiratory, renal, hepatic, hematological, and the neurological system may be affected by sepsis. Sepsis associated neurological dysfunction is triggered by multiple factors including neuro-inflammation, excitotoxicity, and ischemia. Ischemia results from reduced cerebral blood flow, caused by extreme variations of blood pressure, occlusion of cerebral vessels, or more subtle defects of the microcirculation. International guidelines comprehensively describe the initial hemodynamic management of sepsis, revolving around the normalization of systemic hemodynamics and of arterial lactate. By contrast, the management of sepsis patients suffering from brain dysfunction is poorly detailed, the only salient point being mentioned is that sedation and analgesia should be optimized. However, sepsis and the hemodynamic consequences thereof as well as vasopressors may have severe untoward neurological consequences. The current review describes the general neurological complications, as well as the consequences of vasopressor therapy on the brain and its circulation and addresses methods for cerebral monitoring during sepsis.
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Affiliation(s)
- Nicholas Heming
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
| | - Aurélien Mazeraud
- Department of Neuro-Anesthesiology and Intensive Care Medicine, Sainte-Anne Teaching Hospital, Paris-Descartes University, Paris, France
| | - Eric Azabou
- U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France.,Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, Garches, France
| | - Pierre Moine
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
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Abstract
Sepsis is a leading cause of death in medical and surgical intensive care units (ICUs). Disturbance of consciousness of varying severity is an early warning sign of developing sepsis in the majority of cases. Sepsis-associated encephalopathy (SAE) is the most frequent type of encephalopathy in the ICU and is defined as a state of diffuse cerebral dysfunction caused by the inflammatory response of the body to various infections, where the inflammatory process does not affect the central nervous system (CNS) directly and the primary symptom is a disturbed level of consciousness. The aim of this comprehensive review was to collect the latest scientific knowledge regarding the epidemiology, clinical aspects, pathogenesis, diagnosis, and possible prevention strategies related to SAE.
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Affiliation(s)
- Levente Molnár
- Department of Anesthesiology and Intensive Care, Institute of Surgery, University of Debrecen, Hungary
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Care, Institute of Surgery, University of Debrecen, Hungary
| | - Norbert Németh
- Department of Operative Techniques and Surgical Research, Institute of Surgery, University of Debrecen, Hungary
| | - Csilla Molnár
- Department of Anesthesiology and Intensive Care, Institute of Surgery, University of Debrecen, Hungary
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Wen M, Lian Z, Huang L, Zhu S, Hu B, Han Y, Deng Y, Zeng H. Magnetic resonance spectroscopy for assessment of brain injury in the rat model of sepsis. Exp Ther Med 2017; 14:4118-4124. [PMID: 29067103 PMCID: PMC5647722 DOI: 10.3892/etm.2017.5034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/10/2017] [Indexed: 12/17/2022] Open
Abstract
The diagnostic value of magnetic resonance spectroscopy (MRS), T2-weighted imaging (T2WI) and serum markers of brain injury in a rat model of sepsis were investigated. Rats were randomly divided into the control group and 6, 12 and 24 h after lipopolysaccharide-injection groups. Brain morphology and metabolism were assessed with T2WI magnetic resonance imaging (MRI) and MRS. Serum and brain tissue samples were then collected to examine the concentrations of neuron-specific enolase (NSE) and S100-β protein. Brain T2WI showed no differences between the groups. N-acetylaspartate/choline (NAA/Cr) ratio measured by MRS showed different degrees of decrease in the sepsis groups, and serum NSE and S100-β concentrations were increased compared with the control group. Apoptosis rates were measured in the right hippocampal area, and there were statistically significant differences between the indicated groups and the control group (p<0.05). The correlation between apoptosis rate and NAA/Cr ratio was closer than that between apoptosis rate and NSE or S100-β (−0.925 vs. 0.434 vs. 0.517, respectively). In conclusion, MRS is a sensitive, non-invasive method to investigate complications of brain injury in septic rats, which may be utilized for the early diagnosis of brain injury caused by sepsis.
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Affiliation(s)
- Miaoyun Wen
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Zhesi Lian
- Tufts University School of Medicine, Boston, MA 02111, USA
| | - Linqiang Huang
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Senzhi Zhu
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Bei Hu
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Yongli Han
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Yiyu Deng
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Hongke Zeng
- Department of Acute Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
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Eckenhoff RG, Laudansky KF. Anesthesia, surgery, illness and Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:162-6. [PMID: 22729032 DOI: 10.1016/j.pnpbp.2012.06.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/12/2012] [Accepted: 06/17/2012] [Indexed: 11/24/2022]
Abstract
Patients and their families have, for many decades, detected subtle changes in cognition subsequent to surgery, and only recently has this been subjected to scientific scrutiny. Through a combination of retrospective human studies, small prospective biomarker studies, and experiments in animals, it is now clear that durable consequences of both anesthesia and surgery occur, and that these intersect with the normal processes of aging, and the abnormal processes of chronic neurodegeneration. It is highly likely that inflammatory cascades are at the heart of this intersection, and if confirmed, this suggests a therapeutic strategy to mitigate enhanced neuropathology in vulnerable surgical patients.
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