ABSTRACT Background Cognitive impairment is a prevalent and debilitating feature in multiple sclerosis (MS), yet its pathophysiology remains incompletely understood. Dysfunction of the neurovascular unit (NVU) and impaired neurovascular coupling (NVC) may be related to cognitive performance in MS, but this pathway remains insufficiently studied. This study investigated whether NVC abnormalities are associated with cognitive performance in MS. Methods Ninety‐seven MS patients and 83 healthy controls (HCs) underwent resting‐state functional magnetic resonance imaging (rs‐fMRI) and arterial spin labeling (ASL) perfusion MRI acquisition. The amplitude of low‐frequency fluctuations (ALFF) was used as an index of regional spontaneous neuronal activity, and cerebral blood flow (CBF) was quantified. NVC was quantified globally (CBF‐ALFF correlation) and regionally (CBF/ALFF ratio). We analyzed the correlations between regional NVC metrics and cognitive performance and Expanded Disability Status Scale (EDSS) scores. Sensitivity analyses tested robustness across alternative functional metrics, gray matter volume (GMV), T2 lesion volume, disability severity, treatment status, and the relapsing‐remitting multiple sclerosis (RRMS) subgroup. Results Compared with HCs, MS patients demonstrated (1) reduced CBF‐ALFF coupling in the ALFF‐based analysis, and (2) increased CBF/ALFF ratios in the bilateral medial prefrontal cortex (mPFC). The regional mPFC finding, particularly on the left, remained robust across sensitivity analyses and was associated with worse cognitive performance and higher EDSS scores. Conclusion These findings suggest altered NVC in MS, with regional prefrontal abnormalities representing the most robust and clinically relevant finding. Regional prefrontal NVC abnormalities may provide a potential imaging correlate of cognitive performance in MS.
BACKGROUND
Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial.
AIM
To compare the benefits and risks of intensive versus liberal glucose control in ICU patients.
STUDY DESIGN
A Meta analysis of randomized controlled trials.
METHODS
Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome.
RESULTS
Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion.
CONCLUSIONS
Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia.
RELEVANCE TO CLINICAL PRACTICE
These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.
Yuanjie Duan, Juan Liu, Shiyu Lin et al.· Nursing Critical Care· 0 citations
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