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Τρίτη 23 Αυγούστου 2022

Is lithium neuroprotective? An updated mechanistic illustrated review

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Abstract

Background

Neurodegeneration is a pathological process characterized by progressive neuronal impairment, dysfunction, and loss due to mitochondrial dysfunction, oxidative stress, inflammation, and apoptosis. Many studies have shown that lithium protects against neurodegeneration. Herein, we summarize recent clinical and laboratory studies on the neuroprotective effects of lithium against neurodegeneration and its potential to modulate mitochondrial dysfunction, oxidative stress, inflammation, and apoptosis. Recent findings indicate that lithium regulates critical intracellular pathways such as phosphatidylinositol-3 (PI3)/protein kinase B (Akt)/glycogen synthase kinase-3 (GSK3β) and PI3/Akt/response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF).

Methods

We queried PubMed, Web of Science, Scopus, Elsevier, and other related databases using search terms related to lithium and its neuroprotective effect in various neurodegenerative diseases and events from January 2000 to May 2022. We reviewed the major findings and mechanisms proposed for the effects of lithium.

Results: Lithium's neuroprotective potential against neural cell degeneration is mediated by inducing anti-inflammatory factors, antioxidant enzymes, and free radical scavengers to prevent mitochondrial dysfunction. Lithium effects are regulated by two essential pathways: PI3/Akt/GSK3β and PI3/Akt/CREB/BDNF.

Conclusion

Lithium acts as a neuroprotective agent against neurodegeneration by preventing inflammation, oxidative stress, apoptosis, and mitochondrial dysfunction using PI3/Akt/GSK3β and PI3/Akt/CREB/BDNF signaling pathways.

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Serum vitamin D and cardiometabolic risk factors

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Abstract

Low serum 25-hydroxyvitamin D (25(OH)D) concentrations have been associated with greater adiposity and an adverse cardiometabolic risk profile, yet findings are inconsistent and the role of vitamin D status in cardiovascular disease (CVD) remains uncertain. We aimed to examine the associations between serum 25(OH)D and CVD risk factors in the British population. We analysed data on 2842 subjects aged ≥40 years enrolled in the National Diet and Nutrition Survey (NDNS 2008–2018). Based on serum 25(OH)D concentrations, study subjects were grouped in three categories: vitamin D deficiency (<25 nmol/L), vitamin D insufficiency (25-49 nmol/L) and vitamin D sufficiency status (≥50 nmol/mL). Differences in CVD risk factors between vitamin D deficiency or insufficiency and vitamin D sufficiency status were expressed in standard deviation scores (SDSs) and estimated through weighted multiple linear regression models. We found that vitamin D deficiency was directly associated with B MI, waist circumference, triglycerides and inversely associated with high-density lipoprotein cholesterol (HDL) values. The strongest associations were found between vitamin D deficiency and triglycerides (0.50 SDS, 95% CI: 0.24, 0.77) among men, and vitamin D deficiency and waist circumference (0.70 SDS, 95% CI: 0.56, 0.94), BMI (0.63 SDS, 95% CI: 0.39, 0.88) and triglycerides (0.54 SDS, 95% CI: 0.30, 0.77) among women. When adjusting for BMI the association with triglyceride attenuated (from 0.50 SDS to 0.39 SDS among men and from 0.54 SDS to 0.30 SDS among women). Our data indicates a relationship between inadequate vitamin D status and an adverse CVD risk profile. However, interventional studies are needed to establish possible benefits of vitamin D supplementation on cardiovascular risk.

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The Duration and Magnitude of Postdischarge Venous Thromboembolism Following Colectomy

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imageObjective: To assess the impact of current guidelines by reporting weekly postoperative postdischarge venous thromboembolism (VTE) rates. Summary Background Data: Disparity exists between the postoperative thromboprophylaxis duration colectomy patients receive based on surgical indication, where malignant resections routinely receive 28 days extended thromboprophylaxis into the postdischarge period and benign resections do not. Methods: English national cohort study of colectomy patients between 2010 and 2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type and surgical indication, absolute incidence rates (IRs) per 1000 person-years and adjusted incidence rate ratios (aIRRs) for postdischarge VTE were calculated for the first 4 weeks following resection and postdischarge VTE IRs for each postoperative week to 12 weeks postoperative. Results: Of 104,744 patients, 663 (0.63%) developed postdischarge VTE within 12 weeks after colectomy. Postdischarge VTE IRs per 1000 person-years for the first 4 weeks postoperative were low following elective resections [benign: 20.66, 95% confidence interval (CI): 13.73–31.08; malignant: 28.95, 95% CI: 23.09–36.31] and higher following emergency resections (benign: 47.31, 95% CI: 34.43–65.02; malignant: 107.18, 95% CI: 78.62–146.12). Compared with elective malignant resections, there was no difference in postdischarge VTE risk within 4 weeks following elective benign colectomy (aIRR=0.92, 95% CI: 0.56–1.50). However, postdischarge VTE risks within 4 weeks following emergency resections were significantly greater for benign (aIRR=1.89, 95% CI: 1.22–2.94) and malignant (aIRR=3.13, 95% CI: 2.06–4.76) indications compared with elective malignant colectomy. Conclusions: Postdischarge VTE risk within 4 weeks of colectomy is ∼2-fold greater following emergency benign compared with elective malignant resections, suggesting emergency benign colectomy patients may benefit from extended VTE prophylaxis.
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