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The neurological complications following cardiovascular surgery can significantly affect the prognosis of patients. As a convenient and non⁃invasive intraoperative neurological monitoring method, transcranial Doppler ultrasonography (TCD) can provide real⁃time assessment of cerebral hemodynamics and microemboli signals, guide the development of neuroprotective strategies, and reduce the brain injury events. This review systematically summarizes the basic methods and technical performance of TCD monitoring, its clinical application in cardiovascular surgery, as well as the main limitations and future trends of this technology, in order to improve perioperative safety.

Brain and heart comorbidity is one of the major public health problems in China, which seriously threatens national health. After many years of exploration, the concept of "synchronous treatment for brain and heart" has become more and more accepted. This article summarizes the pathophysiological mechanism of brain ⁃ heart interaction, the clinical and research practice of the theory of "synchronous treatment for brain and heart", and its future development direction, and jointly help the diagnosis and treatment of brain and heart comorbidity.

Objective To explore a potential relationship of Timed Up and Go (TUG) test to cognitive functions among elders. Methods The participants were from Rugao Longevity and Ageing Study conducted in Jiangsu province, China. TUG test was completed, recording gaits stability, test time and the overall scale. Cognitive function was evaluated using Chinese version of revised Hasegawa's Dementia Scale (HDS-R). Results A total of 1 655 participants (aged 75-84 years old) completed the TUG test and cognitive evaluation were included in this study. Among them, 872(52.7%) in cognitive impairment group and 783(47.3%) in non-cognitive impairment group, the gait stability, time and scale of TUG test were inverse associated with HDS-R and its subcomponents, respectively(P＜0.001). Logistic regression analysis showed that unsteady gait(OR=1.11, 95% CI:1.08-1.14, P＜0.001), longer time (OR=2.50, 95% CI:1.76-3.55, P＜0.001) and deteriorated scale (OR=1.62, 95% CI:1.39-1.89, P＜0.001) in TUG test were independently associated with increased risk of cognitive impairment. Conclusions Worse motor function performance on TUG test is significantly associated with cognitive impairment. The application of TUG test is potential method in early risk screening of cognitive impairment in community and has certain feasibility.

Objective To investigate whether depression is a potential risk factor for falls in the elderly in China. Methods Data were collected from the Subcohort of Rugao Longevity and Aging Study. Depression in the elderly was assessed by the GDS-15(Geriatric Depression Scale), and the occurrence of falls in the subjects at baseline in 2014 and the second follow-up in 2017 were collected and recorded. According to the depression status, subjects were divided into depression group and normal group, and the general information and occurrence of falls were compared between the two groups. Logistic regression was used to analyze whether depression increased the risk of falls in older adults. Results In the cross-sectional study of 1 548 subjects, the incidence of falls was 8.3%. The proportion of subjects in the “fall” group was higher in older age, lower education level and cognitive impairment. Compared with the normal group, the depressed group had a higher proportion of women, farmers, less education, unmarried, non-smokers, non-drinkers and cognitively disabled people. After adjusting for confounders, depression was associated with an increased risk of falls at baseline and 3 years later in older adults (P＜ 0.05). Conclusions Depression is a potential risk factor for falls among the elderly in the Chinese community.

Objective To investigate whether serum cystatin C (Cys C) is a potential risk factor for motoric cognitive risk syndrome (MCR) in Chinese elderly. Methods A total of 1592 elderly people were included in the subcohort from Rugao Longevity and Aging Study (RuLAS) at the third follow⁃up in 2019. The presence of subjective memory complaints was assessed by Geriatric Depression Scale (GDS⁃15) and the presence of slow walking speed was assessed by the 5⁃Meter Walking Speed Test. The presence of both symptoms was determined as MCR (n = 132). According to the serum Cys C level, the patients with serum Cys C level < 1.06 mg/L were classified as low level group (n = 794), and the patients with serum Cys C level ≥ 1.06 mg/L were classified as middle and high level group (n = 798). Univariate and multivariate stepwise Logistic regression were used to analyze whether elevated serum Cys C levels increased the risk of MCR. Results Compared with non⁃MCR group, MCR group had higher age (P = 0.041), female proportion (P = 0.027), farmer occupation (P = 0.044), married status (P = 0.034), cerebral vascular disease (P = 0.015), higher Cys C level (P = 0.023). Compared with the Cys C low level group, the Cys C middle and high level group had higher age (P = 0.000), male (P = 0.000), hypertension (P = 0.006), MCR (P = 0.049), and lower farmer proportion (P = 0.001); there was significant difference in smoking status (P = 0.041). Logistic regression analysis showed that increased Cys C level was a risk factor for the occurrence of MCR (OR = 1.419, 95%CI: 1.027-1.962; P = 0.034). Conclusions The incidence of MCR is higher in older people, female, farmers and the elderly with the history of cerebral vascular disease, and increased Cys C level is a potential risk factor for MCR.

Objective To explore whether cognitive frailty increases the risk of falls 5 years later in elderly Chinese population. Methods The data were collected from the Rugao Aging Cohort. Fried frailty phenotype was used to evaluate frailty. Those who met ≥3 of the five criteria were defined as frailty, those who met 1-2 criteria were defined as pre-frailty, and those who did not meet any criteria were considered to be robust. The revised Hasegawa Dementia Scale(HDS-R) was used to evaluate cognitive function. Excluding severe cognitive impairment (HDS-R≤10), the lowest quartile of scores was cognitive impairment. Those with both frailty and cognitive impairment were defined as cognitive frailty. Binary logistic regression was used to analyze frailty and falls risk at 5-year follow-up, and explore the effect of cognitive frailty (frailty plus cognitive function assessment) on falls risk. Results This study included 962 subjects with a mean age of 74.7±3.7 years at baseline, including 526 females. After 5 years of follow-up, 134 people experienced falls in the last year of following up . The incidence of falls was higher in female, illiterate and unmarried subgroups. Logistic regression analysis showed that the frail subjects at baseline were more likely to fall(OR=4.360,95% CI=1.955-9.722), and those with cognitive frailty had a higher risk of fall than those robust without cognitive impairment (OR=6.000,95% CI=1.935-18.603). After adjusting for covariates, the higher five-year falls risk for cognitive frailty remained statistically significant (OR=6.736,95% CI=1.897-23.922, P＜0.05). Conclusions Cognitive frailty is significantly correlated with a higher risk of falls after 5 years. The assessment of cognitive frailty is important for assessing the risk of falls in older adults.

Objective To explore the epidemiological characteristics of motoric cognitive risk syndrome (MCR) in Chinese elderly and its relationship with hospitalization. Methods Data were collected from a subcohort of the rugao longevity and aging study. Subjective memory complaints were assessed by the geriatric depression scale (GDS-15), and slow gait was assessed by the time up and go test (TUGT). MCR was determined by the presence of both. The incidence of hospitalization was recorded from the baseline survey in 2014 to the second 3-year follow-up in 2017, and the incidence of MCR in the hospitalized and non-hospitalized groups was compared to analyze the association between MCR and hospitalization. Results In this study, 1 076 subjects were enrolled, with an average age of 75.0±3.8 years old; The prevalence of MCR was 3.3%. During the 3-year follow-up period, 61.1% of the MCR group had records of hospitalization, while only 41.9% of the non-MCR group had the record of hospitalization (P＜0.05). The hospitalized group had a higher average age, and a higher proportion of men, non-illiterates, and those with hypertension, diabetes, and cerebrovascular disease. Hospital combination and the proportion of MCR is 4.8%, the hospital group was 2.3% (P＜0.05). After adjusting for age, sex, occupation, level of education, marital status, smoking status, BMI, blood pressure, diabetes and coronary heart disease, cerebrovascular disease, and other confounding factors, MCR is associated with increased risk of hospitalization in the elderly (P＜0.05). Conclusions The incidence of hospitalization was higher in the population of male especiall those with hypertension, diabetes and cerebrovascular history, MCR is significantly associated with hospitalization.

Cognitive frailty, which increases the risk of dementia, is a geriatric syndrome characterized by both physical frailty and cognitive impairment. It is associated with adverse health events such as functional disability, hospitalization, falls, all-cause mortality and the incidence of dementia, vascular dementia, neurocognitive disorders, with potential reversibility. A clear and unified operational definition of cognitive frailty in the future is of great significance for early recognition and intervention of cognitive frailty and secondary prevention of early or asymptomatic dementia.

Frailty is a geriatric syndrome caused by a decrease in multi ⁃ system physiological reserve and function, which reduces the elderly's ability to stress the internal and external environment and maintain homeostasis, and increases the risk of adverse health events. The incidence of frailty and pre ⁃ frailty in stroke patients is the highest and significantly higher than that in non ⁃ stroke patients, while the prevalence of cerebrovascular disease in frailty patients is also significantly increased and the prognosis is worse. This paper intends to review the potential association between frailty and cerebrovascular disease.

The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates. [ABSTRACT FROM AUTHOR]

The Guanzhong Plain of Shaanxi Province is a severely afflicted hemorrhagic fever with renal syndrome (HFRS) epidemic area, while HFRS prevalence has decreased in most epidemic areas in China. Little information is available regarding the leading fine-scale influencing factors in this highly HFRS-concentrated area and the roles of natural environmental and socioeconomic factors. To investigate this, two regions in the Guanzhong Plain, that is, the Chang'an District and Hu County, with similar geographical environments, different levels of economic development, and high epidemic prevalence, were chosen as representative areas of the HFRS epidemic. Maximum entropy models were constructed based on HFRS cases and fine-scale influencing factors, including meteorological, natural environmental, and socioeconomic factors, from 2014 to 2016. More than 95% of the HFRS cases in the study area were located in the northern plains, which has an altitude of less than 800 m, with topography contributed 84.1% of the impact on the spatial differentiation of the HFRS epidemic. In the northern plains, precipitation and population density jointly affected the spatial differentiation of the HFRS epidemic, with contribution rates of 60.7% and 28.0%, respectively. By comparing the influencing factors of the northern plains of Chang'an District and Hu County, we found that precipitation and the normalized difference vegetation index (NDVI) dominated the HFRS epidemic in the relatively developed Chang'an District, while land-use type, temperature, precipitation and population density dominated the HFRS epidemic in the relatively undeveloped Hu County. Topography was the primary key factor for HFRS prevalence in the Chang'an District and Hu County, and the spatial differentiation of HFRS was dominated by precipitation and population density in the northern plains. Compared with the influencing factors of the relatively developed Chang'an District, the developing Hu County was more affected by socioeconomic factors. When formulating targeted HFRS epidemic prevention and control strategies in the targeted areas, it is crucial to consider the local economic development state and combine natural environmental factors, including the meteorological environment and vegetation coverage. [ABSTRACT FROM AUTHOR]

In an attempt to improve therapeutic efficacy of dexamethasone (DXM)-loaded solid lipid nanoparticles (NPs) for renal ischemia-reperfusion injury (IRI)-induced acute renal injury (AKI), sialic acid (SA) is used as a ligand to target the inflamed vascular endothelium. DXM-loaded SA-conjugated polyethylene glycol (PEG)ylated NPs (SA-NPs) are prepared via solvent diffusion method and show the good colloidal stability. SA-NPs reduce apoptotic human umbilical vein endothelial cells (HUVECs) via downregulating oxidative stress-induced Bax, upregulating Bcl-xL, and inhibiting Caspase-3 and Caspase-9 activation. Cellular uptake results suggest SA-NPs can be specifically internalized by the inflamed vascular endothelial cells (H2O2-pretreated HUVECs), and the mechanism is associated with the specific binding between SA and E-selectin receptor expressed on the inflamed vascular endothelial cells. Bio-distribution results further demonstrated the enhanced renal accumulation of DXM is achieved in AKI mice treated with SA-NPs, and its content is 2.70- and 5.88-fold higher than those treated with DXM and NPs at 6 h after intravenous administration, respectively. Pharmacodynamic studies demonstrate SA-NPs effectively ameliorate renal functions in AKI mice, as reflected by improved blood biochemical indexes, histopathological changes, oxidative stress levels and pro-inflammatory cytokines. Moreover, SA-NPs cause little negative effects on lymphocyte count and bone mineral density while DXM leads to severe osteoporosis. It is concluded that SA-NPs provide an efficient and targeted delivery of DXM for ischemia-reperfusion-induced injury-induced AKI, with improved therapeutic outcomes and reduced adverse effects. [ABSTRACT FROM AUTHOR]

The male patient, one day old, was admitted to the hospital due to hypoglycemia accompanied by apnea appearing six hours after birth. The patient had transient hypoglycemia early after birth, and acute heart failure suddenly occurred on the eighth day after birth. Laboratory tests showed significantly reduced levels of adrenocorticotropic hormone and cortisol, and pituitary magnetic resonance imaging was normal. Genetic testing results showed that the patient had probably pathogenic compound heterozygous mutations of the TBX19 gene (c.917-2A>G+c.608C>T), inherited respectively from the parents. The patient was conclusively diagnosed with congenital isolated adrenocorticotropic hormone deficiency caused by mutation of the TBX19 gene. Upon initiating hydrocortisone replacement therapy, cardiac function rapidly returned to normal. After being discharged, the patient continued with the hydrocortisone replacement therapy. By the 18-month follow-up, the patient was growing and developing well. In neonates, unexplained acute heart failure requires caution for possible endocrine hereditary metabolic diseases, and timely cortisol testing and genetic testing should be conducted.

The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates.

Long non-coding RNAs (lncRNAs) play important roles in the pathogenesis of various diseases, including diabetic nephropathy (DN). However, the detailed mechanism is still largely unknown. High-glucose treated SV40-MES13 cells was used to mimic diabetic nephropathy in vitro. qRT-PCR was introduced to measure Hottip, collagen type I (Col. I), collagen type IV (Col. IV), fibronectin (FN), PAI-1, miR-455-3p and Wnt2B, IL-6, TNF-α mRNA level. Ellisa was used to examine the expression level of IL-6, TNF-α in the cell culture medium. Western blotting was employed to detect the protein level of Col. I, Col. IV, FN, PAI-1, Wnt2B, β-catenin and cyclin D1. Cell viability was examined by MTT assay, luciferase reporter assay were used to determine the relationship between Hottip, miR-455-3p and Wnt2B. In the results, Hottip and Wnt2B was upregulated in db/db DN mice and high-glucose treated mouse mesangial cells (MMCs) while miR-455-3p was downregulated. High glucose treatment could enhance cell proliferation, and inflammation, increase fibrosis-related protein expression and active Wnt2B/β-catenin/cyclin D1 pathway, while Hottip silencing reversed all the effects caused by high-glucose treatment. miR-455-3p was a sponge target of Hottip while Wnt2B was a downstream target of miR-445-3p. miR-445-3p inhibitor could suppress the effect of Hottip knockdown in cell proliferation, inflammation and fibrosis-related protein expression. Our data supported lncRNA Hottip/miR-455-3p/Wnt2B axis plays an important role in cell proliferation, inflammation, and extracellular matrix (ECM) accumulation in diabetic nephropathy., Competing Interests: None., (IJCEP Copyright © 2019.)

Sustained release of thermal-instable and water-soluble drugs with low molecule weight is a challenge. In this study, sodium bicarbonate was encapsulated in ethyl cellulose microspheres by a novel solid-in-oil-in-oil (S/O/O) emulsification method using acetonitrile/soybean oil as new solvent pairs. Properties of the microspheres such as size, recovery rate, morphology, drug content, and drug release behavior were evaluated to investigate the suitable preparation techniques. In the case of that the ratio of the internal and external oil phase was 1: 9, Tween 80 as a stabilizer resulted in the highest drug content (2.68%) and a good spherical shape of microspheres. After the ratio increased to 1: 4, the microspheres using Tween 80 as the stabilizer also had high drug content (1.96%) and exhibited a sustained release behavior, with 70% of drug released within 12 h and a sustained release of more than 40 h. Otherwise, different emulsification temperatures at which acetonitrile was evaporated could influence the drug release behaviour of microspheres obtained. This novel method is a potential and effective method to achieve the encapsulation and the sustained release of thermal-instable and water-soluble drugs with low molecule weight.

Aims: This study sought to explore right (RV) and left ventricular (LV) mechanics and ventricular-ventricular interaction in adolescents and young adults late after percutaneous balloon pulmonary valvoplasty (PBPV) for valvar pulmonary stenosis (PS)., Methods and Results: Potential late effects of PS despite PBPV on cardiac mechanics have not been well defined. Thirty-one patients aged 20.2 ± 7.6 years were studied at 18 ± 6 years after PBPV. Ventricular myocardial deformation was determined using speckle tracking echocardiography, while RV and LV volumes and ejection fraction as well as LV systolic dyssynchrony index were assessed by three-dimensional echocardiography. The results were compared with those of 30 controls. Pulmonary regurgitation, mostly trivial to mild, was present in 90% (28/31) of patients. Compared with controls, patients had significantly greater RV end-diastolic (P < 0.001), RV end-systolic (P < 0.001), and LV end-systolic (P = 0.04) volumes as well as lower LV ejection fraction (P < 0.001). For deformation, patients had significantly reduced RV longitudinal systolic strain (P = 0.004), decreased LV circumferential systolic strain (P < 0.001), and strain rate (P = 0.001) as well as greater LV mechanical dyssynchrony (P < 0.001). In patients, RV end-diastolic and end-systolic volumes correlated with LV circumferential strain (r = -0.47, P = 0.008 and r = -0.36, P = 0.049, respectively) and dyssynchrony (r = 0.53, P = 0.002 and r = 0.49, P = 0.005, respectively). Patients who had PBPV at age ≤1 year had ventricular deformation indices similar to those who had interventions beyond 1 year., Conclusion: Impaired RV and LV mechanics and adverse ventricular-ventricular interaction occur in adolescents and young adults late after balloon valvoplasty for isolated valvar PS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Objective: To explore the characteristics of cognitive impairment in patients with leukoaraiosis (LA)., Methods: Forty-six LA patients and 38 age and gender-matched healthy subjects were recruited from the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between September 2010 and March 2011. All participants underwent the neuropsychological tests recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards (NINDS/CSN). The were divided into 3 different groups (mild, moderate and severe) according to the Fazekas scale. The differences of neuropsychological performances were compared among 3 groups., Results: The LA patients were associated with comprehensive cognitive function deficits, including MMSE (24.4 ± 3.2 vs 28.3 ± 1.2), MoCA (20.4 ± 3.0 vs 26.2 ± 0.8), digital span forward (5.7 ± 0.9 vs 6.8 ± 1.0), digital span backward (3.5 ± 0.7 vs 4.1 ± 0.7), Stroop-B (69 ± 13 vs 43 ± 5), Stroop-C (141 ± 42 vs 65 ± 10), trail making test-A (73 ± 15 vs 31 ± 7), trail making test-B (126 ± 18 vs 82 ± 6) and digit symbol test (25 ± 6 vs 37 ± 5, P < 0.05). However, there was no difference in the performance of verbal fluency (12.7 ± 2.5 vs 13.4 ± 2.5, P > 0.05). Correlation analysis showed that the severity of LA had a negative correlation with the performance of MoCA (r = -0.601, P = 0.002)., Conclusions: The LA patients are closely correlated with cognitive impairments of attention, memory, executive function and information processing speed. It may be attributed to the frontal-subcortical circuitry dysfunction.

In the title compound, (C(11)H(15)N(2))(2)[HgBr(4)], the tetra-coordinated Hg(II) center of the complex anion adopts a distorted tetra-hedral geometry [Hg-Br = 2.5755 (8)-2.623 (11) Å and Br-Hg-Br = 103.78 (19)-116.4 (3)°]. One of the Br atoms is disordered over two sites [site-occupancy factors = 0.51 (6) and 0.49 (6)]. The N-C-N angles in the cations are 110.7 (6) and 111.4 (7)°. In the crystal packing, a supra-molecular chain is formed via both weak inter-molecular C-H⋯Br hydrogen bonds and π-π aromatic ring stacking inter-actions [centroid-centroid separation = 3.803 (1) Å].

Objective: To investigate effects of peroxisome proliferator-activated receptor gamma (PPARgamma) and its ligands on cytotrophoblast invasion and its influence on matrix metalloproteinase (MMP)-2 and MMP-9 activities on cytotrophoblast cells., Methods: Samples of fresh placental trophoblast tissue were obtained from the pregnant women in first trimester. Cytotrophoblasts were isolated, cultured, and added with PPARgamma. Immunocytochemistry and inverted microscopy were used to examine the protein expression of PPARgamma in the cytotrophoblasts. Isolated cytotrophoblasts were inoculated in the Transwell chamber The natural stimulatory ligand of PPARgamma15-deoxy-delta (12, 14)-prostaglandin J2 (15d-PGJ2) and synthesized stimulatory ligand of PPARgamma troglitazone (TGZ) of the concentrations of 0, 1, and 10 micromol/L respectively were added respectively to examine the invasion ability of the cytotrophoblasts. Immunofluorochemistry and confocal technique and RT-PCR were used to examine the expression of MMP-2 and MMP-9., Results: PPARgamma protein expression was detectable in the cytotrophoblasts, mainly in the nuclei. The invasion indexes of the cytotrophoblasts stimulated by 15d-PGJ2 and TGZ of different concentrations were significant lowered in a concentration-dependent manner, the effect of 15d-PGJ2 being stronger than that of TGZ (P < 0.05). After stimulated by 15d-PGJ2 and TGZ of different concentrations the mRNA expression and protein expression of MMP-9 and MMP-2 in the cytotrophoblasts were all inhibited significantly (all P < 0.05)., Conclusion: PPARgamma plays an important role in the modulation of trophoblast invasion, and PPARgamma ligands can inhibit the trophoblast invasion through downregulating MMP-2 and MMP-9 expressions.