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Background Strokes significantly impair quality of life and incur high economic and societal burdens. The triglyceride and glucose (TyG) index is a biochemical marker of insulin resistance (IR) and may have important value in the prediction of strokes, especially ischemic stroke (IS). Our study aims to investigate the relationship between TyG index and IS and ascertain whether TyG index is independently associated with IS adverse outcomes. Methods The Cochrane, Embase, Medline, Web of Science, PubMed, and other relevant English databases and related websites were systematically searched for articles on ‘‘TyG index’’ and \"stroke\" published from inception to April 4, 2022. We reviewed the available literature on the TyG index and its relation to predicting IS occurrence in the general population and adverse clinical outcomes. We calculated odds ratios (OR) of TyG index and its predictability of IS occurrence and adverse outcomes. Statistical analyses were performed using the Meta Package in STATA, version 12.0. Results A total of 18 studies and 592,635 patients were included in our analysis. The pooled effect values of all stroke types showed that higher TyG index was associated with increased the risk of IS in the general population (OR 1.37; 95% CI 1.22–1.54) in a total sample of 554,334 cases with a high level of heterogeneity (P = 0.000, I 2  = 74.10%). In addition, compared to IS patients with a lower TyG index, IS patients with a higher TyG index was associated with higher risk of stroke recurrence (OR: 1.50; 95% CI 1.19–1.89) and increased risk of mortality (OR 1.40 95% CI 1.14–1.71). No correlation was found in the effect value combinations of poor functional outcomes (OR 1.12; 95% CI 0.88–1.43) and neurological worsening (OR: 1.76; 95% CI 0.79–3.95) in a total sample of 38,301 cases with a high level of heterogeneity (P = 0.000; I 2  = 77.20%). Conclusions TyG index has potential value in optimizing risk stratification for IS in the general population. Furthermore, there is a significant association between high TyG index and many adverse outcomes of stroke, especially stroke recurrence and high mortality. Future studies should focus on multi-center and multi-regional designs in order to further explore the relationship between IS and TyG index.

Objective: Currently, the prevalence of CF (Cognitive Frailty) is not very clear, and the relationship between CF and its associated risk factors has not been accurately evaluated. Therefore, it is necessary to conduct a systematic review and meta-analysis further to understand CF's prevalence and associated factors. Method: Embase, PubMed, Web of Science, Ovid, and Cochrane were systematically searched for articles exploring the prevalence of CF published from January 1341 to March 2021. For the prevalence of CF, the events of CF and the total number of patients in every included study were extracted to estimate the prevalence of CF. For associated factors of CF, OR (Odds Ratio) and its 95% CI (Confidence Interval) were used for estimations. Result: Firstly, the estimated prevalence of CF I (Cognitive Frailty in the model I) was 16%, 95% CI (0.13-0.19), and the estimated prevalence of CF II (Cognitive Frailty in model II) was 6%, 95% CI (0.05-0.07). Secondly, both lower engagement in activities and age were calculated to be independent risk factors of CF, and the OR (95% CI) was 3.31(2.28-4.81) and 1.10 (1.04-1.16), respectively. Finally, depression was also a prominent risk factor of CF, with the overall OR (95% CI) as 1.57(1.32-1.87). Conclusion: CF was a high prevalence in community older. The various assessment scales and the different cutoff values of diagnostic criteria would affect the prevalence of CF. Lower engagement in activities, age, and depression was the risky factor of CF.

Sarcopenia is a progressive skeletal muscle disorder involving the loss of muscle mass and function, associated with an increased risk of disability and frailty. Though its prevalence in dementia has been studied, its occurrence in mild cognitive impairment (MCI) has not been well established. As MCI is often a prelude to dementia, our study aims to investigate the prevalence of MCI among individuals with sarcopenia and to also ascertain whether sarcopenia is independently associated with MCI. The Cochrane Library, PubMed, Ovid, Embase and Web of Science were systematically searched for articles on MCI and/or sarcopenia published from inception to 1 February 2022. We reviewed the available literature on the number of individuals with MCI and/or sarcopenia and calculated odds ratios (ORs) of sarcopenia in MCI and MCI in sarcopenia, respectively. Statistical analyses were performed using the meta package in Stata, Version 12.0. A total of 13 studies and 27 428 patients were included in our analysis. The pooled prevalence of MCI in participants with sarcopenia was 20.5% (95% confidence interval [CI]: 0.140–0.269) in a total sample of 2923 cases with a high level of heterogeneity (P < 0.001; I2 = 95.4%). The overall prevalence of sarcopenia with MCI was 9.1% (95% CI: 0.047–0.134, P < 0.001; I2 = 93.0%). For overall ORs, there were 23 364 subjects with a mean age of 73 years; the overall adjusted OR between MCI and sarcopenia was 1.46 (95% CI: 1.31–1.62). Slight heterogeneity in both adjusted ORs (P = 0.46; I2 = 0%) was noted across the studies. The prevalence of MCI is relatively high in patients with sarcopenia, and sarcopenia may be a risk factor for MCI.

Repetitive transcranial magnetic stimulation (rTMS) is an effective and safe treatment for depression; however, its potential has likely been hindered due to non-optimized targeting, unclear ideal stimulation parameters, and lack of information regarding how the brain is physiologically responding during and after stimulation. While neuroimaging is ideal for obtaining such critical information, existing modalities have been limited due to poor resolutions, along with significant noise interference from the electromagnetic spectrum. In this study, we used a novel diffuse optical tomography (DOT) device in order to advance our understanding of the neurophysiological effects of rTMS in depression. Healthy and depressed subjects aged 18–70 were recruited. Treatment parameters were standardized with targeting of the left dorsolateral prefrontal cortex with a magnetic field intensity of 100% of motor threshold, pulse frequency of 10 per second, a 4 s stimulation time and a 26 s rest time. DOT imaging was simultaneously acquired from the contralateral dorsolateral prefrontal cortex. Six healthy and seven depressed subjects were included for final analysis. Hemoglobin changes and volumetric three-dimensional activation patterns were successfully captured. Depressed subjects were observed to have a delayed and less robust response to rTMS with a decreased volume of activation compared to healthy subjects. In this first-in-human study, we demonstrated the ability of DOT to safely and reliably capture and compare cortical response patterns to rTMS in depressed and healthy subjects. We introduced this emerging optical functional imaging modality as a novel approach to investigating targeting, new treatment parameters, and physiological effects of rTMS in depression.

This case report describes the successful use of oral guanfacine, a centrally acting alpha-2 agonist, for treating panic-induced vasovagal syncope in a 68-year-old intensive care unit (ICU) patient recovering from lung transplant and cardiac complications. The patient experienced recurrent episodes of severe anxiety and syncope triggered by physical therapy, unresponsive to standard anxiolytics. Guanfacine was chosen given its less pronounced cardiovascular effects and modulation of norepinephrine, and titrated over 10 days, leading to complete resolution of symptoms without adverse effects or recurrence. The patient resumed rehabilitation and guanfacine was successfully tapered prior to discharge. This case highlights guanfacine as a potentially useful anxiolytic option for ICU patients even with cardiovascular vulnerability as it exhibits less pronounced cardiovascular effects and may therefore be considered safer than other alpha-2 agonists.

Transcranial magnetic stimulation (TMS) has been established as an important and effective treatment for various psychiatric disorders. However, its effectiveness has likely been limited due to the dearth of neuronavigational tools for targeting purposes, unclear ideal stimulation parameters, and a lack of knowledge regarding the physiological response of the brain to TMS in each psychiatric condition. Modern optical imaging modalities, such as functional near-infrared spectroscopy and diffuse optical tomography, are promising tools for the study of TMS optimization and functional targeting in psychiatric disorders. They possess a unique combination of high spatial and temporal resolutions, portability, real-time capability, and relatively low costs. In this mini-review, we discuss the advent of optical imaging techniques and their innovative use in several psychiatric conditions including depression, panic disorder, phobias, and eating disorders. With further investment and research in the development of these optical imaging approaches, their potential will be paramount for the advancement of TMS treatment protocols in psychiatry.

Background Sarcopenia, a significant geriatric syndrome, faces challenges in accurate diagnosis due to limitations of current imaging techniques. This study explores the novel application of multispectral optoacoustic tomography (MSOT) in evaluating sarcopenia, focusing on quantifying oxygen dynamics and collagen distribution in skeletal muscles. Methods We conducted MSOT imaging on the lower limbs of senescence‐accelerated mouse prone 8 (SAMP8; n = 14) and senescence‐accelerated mouse resistant 1 (SAMR1; n = 8) models, using light wavelengths of 760, 840 and 930 nm. CT, histopathology and immunofluorescence were used for cross‐validation. Results Label‐free MSOT imaging directly visualized muscle structure and metabolism with high spatiotemporal resolution. Compared to SAMR1 controls, sarcopenic SAMP8 mice demonstrated 23.8% lower HbO2 levels (SAMP8: 0.0016 ± 0.0003 a.u. vs. SAMR1: 0.0021 ± 0.0005 a.u.; p = 0.018) and reduced metabolic activity in skeletal muscles. SAMP8 mice also revealed 43.2% higher collagen content (SAMP8: 3.451 ± 1.159 a.u. vs. SAMR1: 2.409 ± 0.635 a.u.; p = 0.030) alongside more disordered muscle structure, suggesting increased fibrosis. An inverse correlation was observed between computed tomography (CT) values and MSOT‐derived collagen signals (r = −0.789, p < 0.001), whereas no such correlation existed with HbO2, indicating that MSOT provides unique metabolic insights beyond traditional imaging techniques. Conclusions This first application of MSOT in sarcopenia research highlights its potential as a noninvasive, real‐time tool for early diagnosis, therapeutic evaluation and mechanistic understanding. Its ability to detect metabolic changes not captured by CT underscores its complementary role in comprehensive muscle assessment. Future research should focus on longitudinal studies and clinical translation.

Herba Epimedii, commonly known as yin yang huo, inyokaku, and horny goat weed, is a traditional Chinese herbal medicine utilized for treating osteoporosis and enhancing libido. Studies conducted in vitro have demonstrated that Herba Epimedii interacts with the enzyme cytochrome P450 3A4 (CYP3A4). This interaction poses a potential risk for drug-drug interactions, particularly with medications metabolized by CYP3A4, such as buprenorphine. This paper presents a case of a patient experiencing exacerbated opioid cravings following the initiation of Herba Epimedii. This is the first reported case supporting this interaction, emphasizing the necessity of screening for alternative medicines in patients undergoing medication-assisted treatments for opioid use disorder.

Sepsis is a life-threatening syndrome consisting of physiological, pathological, and biochemical abnormalities induced by infection which continues to be a major public health burden. It remains one of the most common reasons for intensive care unit (ICU) admission. Delirium precipitated by sepsis in the intensive care setting is one of its most common neuropsychiatric complications that leads to prolonged hospitalization, increased mortality, and an increased risk of incident dementia. Understanding the pathophysiology and neurobiological mechanisms of sepsis-associated delirium is difficult; neuroimaging biomarkers are lacking due to difficulties with imaging critically ill patients. Optical imaging techniques, including near-infrared spectroscopy and diffuse optical tomography are potentially promising approaches for investigating this pathophysiology due to their portability and high spatiotemporal resolution. In this review, we examine the emergence of optical neuroimaging techniques for the study of sepsis-associated delirium in the ICU and how they can further advance our knowledge and lead to the development of improved preventative, predictive, and therapeutic strategies.

Functional neuroimaging studies of neuropsychiatric disorders and cognitive impairment are commonly conducted in the clinic setting but less so in the acutely medically ill while hospitalized. This is largely due to technical and logistical limitations, given the lack of portable devices with high spatial and temporal resolutions. This exploratory study reports on the development and implementation of a novel diffuse optical tomography (DOT) system that can be employed for bedside three-dimensional functional neuroimaging. To test this portable DOT system, our protocol included a task-based sequence involving the Months Backwards Test with imaging centered on the bilateral prefrontal cortex. Fifteen subjects were recruited from intensive care units and the general wards of a single tertiary academic hospital and included in our final analysis. Volumetric hemoglobin analyses of the dorsolateral prefrontal cortex (DLPFC) and dorsomedial prefrontal cortex (DMPFC) were reliably captured in all our subjects. The peak value was calculated to be 3.36 µM and 0.74 µM for oxygenated-hemoglobin (HbO) and total-hemoglobin (HbT) (p < 0.042, [HbT]), respectively. The standard error was calculated to be 4.58 uM and 3.68 uM for (HbO) and (HbT). We additionally developed a seed-based correlation analysis to demonstrate the capability of DOT in studying functional connectivity. The right DLPFC was found to be moderately associated with the left DLPFC in all our subjects (r = 0.656). The DMPFC was observed to be associated with the left DLPFC but less so (r = 0.273) at the group level. Overall, the contribution of left-to-right DLPFC connectivity was significantly higher than left DLPFC to DMPFC in our group (p = 0.012). Future studies should investigate the potential of such a DOT system in the research of neuropsychiatric and neurocognitive disorders within the hospital to study different types of mechanisms, pathophysiology, and interventions that occur acutely and can advance our knowledge of these disorders.