Exercised blood plasma promotes hippocampal neurogenesis in the Alzheimer's disease rat brain

Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors.Here we used an in vitro model of AD to investigate effects of blood plasma from exercise-trained donors on neuronal viability,and an in vivo rat model of AD to test whether such plasma impacts cognitive function,amyloid pathology,and neurogenesis.Methods:Mouse hippocampal neuronal cells were exposed to AD-like stress using amyloid-βand treated with plasma collected from human male donors 3 h after a single bout of high-intensity exercise.For in vivo studies,blood was collected from exercise-trained young male Wistar rats(high-intensity intervals 5 days/week for 6 weeks).Transgenic AD rats(McGill-R-Thyl-APP)were inj ected 5 times/fortnight for 6 weeks at2 months or 5 months of age with either(a)plasma from the exercise-trained rats,(b)plasma from sedentary rats,or(c)saline.Cognitive function,amyloid plaque pathology,and neurogenesis were assessed.The plasma used for the treatment was analyzed for 23 cytokines.Results:Plasma from exercised donors enhanced cell viability by 44.1%(p=0.032)and reduced atrophy by 50.0%(p<0.001)in amyloid-β-treated cells.In vivo exercised plasma treatment did not alter cognitive function or amyloid plaque pathology but did increase hippocampal neurogenesis by~3 fold,regardless of pathological stage,when compared to saline-treated rats.Concentrations of 7 cytokines were significantly reduced in exercised plasma compared to sedentary plasma.Conclusion:Our proof-of-concept study demonstrates that plasma from exercise-trained donors can protect neuronal cells in culture and promote adult hippocampal neurogenesis in the AD rat brain.This effect may be partly due to reduced pro-inflammatory signaling molecules in exercised plasma.

Diagnostic and clinical significance of antigen-specific pancreatic antibodies in inflammatory bowel diseases: A meta-analysis

BACKGROUND Non-invasive criteria are needed for Crohn’s disease(CD)diagnosis,with several biomarkers being tested.Results of individual diagnostic test accuracy studies assessing the diagnostic value of pancreatic autoantibodies-to-glycoprotein-2(anti-GP2)tests for the diagnosis of CD appear promising.AIM To systematically review and meta-analyze evidence on the diagnostic accuracy of anti-GP2 tests in patients with suspected/confirmed CD.METHODS An electronic search was conducted on PubMed,Cochrane-CENTRAL and grey literature(CRD42019125947).The structured research question in PICPTR format was“Population”including patients with symptoms akin to CD,the“Index test”being anti-GP2 testing,the“Comparator”involved standard CD diagnosis,the“Purpose of test”being diagnostic,“Target disorder”was CD,and the“Reference standard”included standard clinical,radiological,endoscopical,and histological CD diagnostic criteria.Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and hierarchical models were employed to synthesize the data.RESULTS Out of 722 studies retrieved,15 were meta-analyzed.Thirteen studies had industry-related conflicts-of-interest,and most included healthy donors as controls(spectrum bias).For the combination of IgA and/or IgG anti-GP2 test,the summary sensitivity was 20%(95%confidence interval:10%-29%)at a median specificity of 97%.If the test was applied in 10000 suspected patients,9669 would be true negatives and in 26,the diagnosis would be missed.In this hypothetical cohort,the anti-GP2 would fail to produce a diagnosis for 81.3%of the positive cases.Low summary points of sensitivity and high specificity were estimated for the IgG or IgA anti-GP2 test.Analogous results were observed when the analyses were restricted using specific cut-offs,or when ulcerative colitis patients were used as comparators.CONCLUSION Anti-GP2 tests demonstrate low sensitivity and high specificity.These results indicate that caution is required before relying on its diagnostic value.Additionally,the need for improving the methodology of diagnostic test accuracy studies is evident.

Peripheral nerve regeneration through nerve conduits evokes differential expression of growth-associated protein-43 in the spinal cord

Growth-associated protein 43 plays a key role in neurite outgrowth through cytoskeleton remodeling.We have previously demonstrated that structural damage of peripheral nerves induces growth-associated protein 43 upregulation to promote growth cone formation.Conversely,the limited regenerative capacity of the central nervous system due to an inhibitory environment prevents major changes in neurite outgrowth and should be presumably associated with low levels of growth-associated protein 43 expression.However,central alterations due to peripheral nerve damage have never been assessed using the growthassociated protein 43 marker.In this study,we used the tubulization technique to repair 1 cm-long nerve gaps in the rat nerve injury/repair model and detected growth-associated protein 43 expression in the peripheral and central nervous systems.First,histological analysis of the regeneration process confirmed an active regeneration process of the nerve gaps through the conduit from 10 days onwards.The growth-associated protein 43 expression profile varied across regions and follow-up times,from a localized expression to an abundant and consistent expression throughout the regeneration tissue,confirming the presence of an active nerve regeneration process.Second,spinal cord changes were also histologically assessed,and no apparent changes in the structural and cellular organization were observed using routine staining methods.Surprisingly,remarkable differences and local changes appeared in growth-associated protein 43 expression at the spinal cord level,in particular at 20 days post-repair and beyond.Growth-associated protein 43 protein was first localized in the gracile fasciculus and was homogeneously distributed in the left posterior cord.These findings differed from the growth-associated protein 43 pattern observed in the healthy control,which did not express growth-associated protein 43 at these levels.Our results revealed a differential expression in growth-associated protein 43 protein not only in the regenerating nerve tissue but also in the spinal cord after peripheral nerve transection.These findings open the possibility of using this marker to monitor changes in the central nervous system after peripheral nerve injury.

Reversibility of visual field defects through induction of brain plasticity: vision restoration, recovery and rehabilitation using alternating current stimulation

For decades visual field defects were considered irreversible because it was thought that in the visual system the regeneration potential of the neuronal tissues is low.Nevertheless,there is always some potential for partial recovery of the visual field defect that can be achieved through induction of neuroplasticity.Neuroplasticity refers to the ability of the brain to change its own functional architecture by modulating synaptic efficacy.It is maintained throughout life and just as neurological rehabilitation can improve motor coordination,visual field defects in glaucoma,diabetic retinopathy or optic neuropathy can be improved by inducing neuroplasticity.In ophthalmology many new treatment paradigms have been tested that can induce neuroplastic changes,including non-invasive alternating current stimulation.Treatment with alternating current stimulation(e.g.,30 minutes,daily for 10 days using transorbital electrodes and^10 Hz)activates the entire retina and parts of the brain.Electroencephalography and functional magnetic resonance imaging studies revealed local activation of the visual cortex,global reorganization of functional brain networks,and enhanced blood flow,which together activate neurons and their networks.The future of low vision is optimistic because vision loss is indeed,partially reversible.

Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

An Efficient Method for Epileptic Seizure Detection in Long-Term EEG Recordings

Epilepsy is one of the most prevalent neurological disorders with no age, racial, social class, and neither national nor geographic boundaries. There are 50 million sufferers in the world today with 2.4 million new cases occur each year. Electroencephalogram (EEG) has become a traditional procedure to investigate abnormal functioning of brain activity. Epileptic EEG is usually characterized by short transients and sharp waves as spikes. Identification of such event splays a crucial role in epilepsy diagnosis and treatment. The present study proposes a method to detect three epileptic spike types in EEG recordings based mainly on Template Matching Algorithm including multiple signal-processing approaches. The method was applied to real clinical EEG data of epileptic patients and evaluated according to sensitivity, specificity, selectivity and average detection rate. The promising results illuminate that hybrid processing approaches in temporal, frequency and spatial domains can be a real solution to identify fast EEG transients.

Graph-based network analysis in schizophrenia

Over the last few years, many studies have been published using modern network analysis of the brain. Researchers and practical doctors alike should understand this method and its results on the brain evaluation at rest, during activation and in brain disease. The studies are noninvasive and usually performed with elecroencephalographic, magnetoencephalographic, magnetic resonance imaging and diffusion tensor imaging brain recordings. Different tools for analysis have been developed, although the methods are in their early stages. The results of these analyses are of special value. Studies of these tools in schizophrenia are important because widespread and local network disturbances can be evaluated by assessing integration, segregation and several structural and functional properties. With the help of network analyses, the main findings in schizophrenia are lower optimum network organization, less efficiently wired networks, less local clustering, less hierarchical organization and signs of disconnection. There are only about twenty five relevant papers on the subject today. Only a few years of study of these methods have produced interesting results and it appears promising that the development of these methods will present important knowledge for both the preclinical signs of schizophrenia and the methods' therapeutic effects.

3.0T MRI与高分辨力超声对颈动脉内-中膜厚度和可扩张性测量的比较

评价3．0TMRI检查对于评估32例健康志愿者及20例重度颈内动脉狭窄病人的颈总动脉（CCA）形态及功能的价值。颈总动脉管壁厚度通过多层2D T2快速自旋回波黑血技术获得,并与超声测量的中-内膜厚度（IMT）相比较。颈总动脉可扩张系数（DC）通过血压和心电门控的3D T1电影MRI及M型超声检查测得一个心动周期颈总动脉的直径变化而获得量化指标。除了MRI测量值普遍较高外．两种方法对于志愿者及病人的管壁厚度和顺应性评估均具有较高一致性。

Dynamic mechanical allodynia following finger amputation:Unexpected skin hyperinnervation

The development of chronic pain after amputations is not an uncommon event. In some cases the most disabling problem is represented by the symptom called dynamic mechanical allodynia, characterized by the painful sensation evoked by gently stroking the skin. Despite the growing interest in understanding pain mechanisms, little is known about the mechanism sustaining this peculiar type of pain. We present here the case of a 53-year-old female patient who complained of severe tactile allodynia in the hand after amputation of her left second finger, resistant to several medical and surgical treatments. In order to gain information about the pain mechanism, two neurodiagnostic skin biopsies were obtained from the area of tactile allodynia and from the contralateral, normal skin area. Skin biopsies showed an unexpected increased innervation of the allodynic skin compared to the contralateral, normal skin area(+ 80.1%). Hyperinnervation has been proposed as a mechanism of pain following nerve lesions, but the increased innervation described here could be also attributed to neuronal plasticity occurring in chronic inflammatory conditions. Independently from the uncertain cause of the epidermal hyperinnervation, in this patient we tried to reduce the elevated number of epidermal nerve fibres by treating the skin with topical capsaicin(0.075%) three times a day, and obtained a persistent pain relief. In conclusion, neurodiagnostic skin biopsy might represent an useful tool for detecting derangements of epidermal innervation in patients with dynamic mechanical allodynia and can help to select an individually tailored therapeutic strategy in such difficult clinical conditions. Further studies are needed to clarify this issue and try to gain better understanding of chronic pain mechanisms in patients who underwent finger amputation.

Paradoxical brain embolism followed by percutaneous atrial septal closure： Stroke in a patient＇s thirties highlighting some issues surrounding brain stroke in an emergency setting

Brain stroke in patients younger than 40 deprivessociety of its work force. Paradoxical brain embolism（PBE） is sometimes responsible. PBE should never beoverlooked in emergency settings because its recurrencemay be preventable.

Laser evoked potential: Analysis of the methodology in post herpetic neuralgia

Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.

A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects

Background and Aim: Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology background and their interactions in Egyptian patients with IBS. Patients and Methods: Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. Results: All IBS patients were young, with significant female predominance (P = 0.007), particularly in IBS-C group (20/20;100%, P = 0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroids were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. Conclusions: IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.

异常H反射对周期性腿动症的病理生理学理解的影响

Objective: To get more insight in the pathophysiological basis of periodic lim b movement disorder (PLMD) with or without restless legs syndrome (RLS), we inve stigated whether these patients have spontaneous changes in H-reflexes or show altered reflex patterns after (external) inhibition or excitation of the relevan t spinal segment. Methods: The ratio of the peak-to-peak values of the maximal soleus H-reflex and the maximal direct muscle potential (H/M ratio), H-reflex recruitment curves, vibratory inhibition and recovery curves of the soleus H-r eflexin double stimulus experiments were measured in 9 PLMD patients and 11 cont rols. Results: In comparison to controls the vibratory inhibition, predominantly reflecting pre-synaptic inhibitory action, was depressed in PLMD patients. The soleus H-reflex recovery curves showed increased late facilitation and depress ed late inhibition, both reflecting diminished inhibition due to post-synaptic central activity. Conclusions: Our data indicate diminished inhibition at spinal level in PLMD patients. This is probably due to altered function of the descend ing spinal tracts, peripheral influence or changes at the inter-neural circuitr y at spinal level itself, or combinations of these 3 possibil ities. Significance: The results of this study give further insight in the pat hophysiology of PLMD and RLS by stressing the importance of diminished central i nhibition.

Development and psychometric evaluation of the radiographers’ competence scale

Assessing the competence of registered radiographers’ clinical work is of great importance because of the recent change in nursing focus and rapid technological development. Self-assessment assists radiographers to validate and improve clinical practice by identifying their strengths as well as areas that may need to be developed. The aim of the study was to develop and psychometrically test a specially designed instrument, the Radiographers Competence Scale (RCS). A cross sectional survey was conducted comprising 406 randomly selected radiographers all over Sweden. The study consisted of two phases;the development of the instrument and evaluation of its psychometric properties. The first phase included three steps: 1) construction of the RCS;2) pilot testing of face and content validity;and 3) creation of a web-based 54-item questionnaire for testing the instrument. The second phase comprised psychometric evaluation of construct validity, internal consistency reliability and item reduction. The analysis reduced the initial 54 items of the RCS to 28 items. A logical two-factor solution was identified explaining 53.8% of the total variance. The first factor labelled “Nurse initiated care” explained 31.7% of the total variance. Factor 2 labelled “Technical and radiographic processes” explained 22.1% of the total variance. The scale had good internal consistency reliability, with a Cronbach’s alpha of 0.87. The RCS is a short, easy to administer scale for capturing radiographers’ competence levels and the frequency of using their competence. The scale was found to be valid and reliable. The self-assessment RCS can be used in management, patient safety and quality improvement to enhance the radiographic process.

Transcriptional inhibition in Schwann cell development and nerve regeneration

Schwann cells, the myelinating glial cells of the peripheral nervous system are remarkably plastic after nerve trauma. Their transdifferentiation into specialized repair cells after injury shares some features with their development from the neural crest. Both processes are governed by a tightly regulated balance between activators and inhibitors to ensure timely lineage progression and allow re-maturation after nerve injury. Functional recovery after injury is very successful in rodents, however, in humans, lack of regeneration after nerve trauma and loss of function as the result of peripheral neuropathies represents a significant problem. Our understanding of the basic molecular machinery underlying Schwann cell maturation and plasticity has made significant progress in recent years and novel players have been discovered. While the transcriptional activators of Schwann cell development and nerve repair have been well defined, the mechanisms counteracting negative regulation of（re-）myelination are less well understood. Recently, transcriptional inhibition has emerged as a new regulatory mechanism in Schwann cell development and nerve repair. This mini-review summarizes some of the regulatory mechanisms controlling both processes and the novel concept of ＂inhibiting the inhibitors＂ in the context of Schwann cell plasticity.

Unilateral peripheral neuropathic pain: The role of neurodiagnostic skin biopsy

According to the current definition of neuropathic pain("pain arising as a direct consequence of a lesion or disease affecting the somatosensory system"), the demonstration of a lesion or disease involving the somatosensory system is mandatory for the diagnosis of definite neuropathic pain. Although several methods are currently available for this aim, none is suitable for every type of disease(or lesion). Neurodiagnostic skin biopsy(NSB) is a relatively new technique for the diagnosis of peripheral nerve lesions. It is an objective method, completely independent from the patient's complaining, based on immunohistochemical staining techniques that allow measurement of the density of the epidermal nerve fibers, currently considered the free nerve endings of small diameter(A-delta and C) afferent fibers. NSB has the important property of being used to investigate the skin, allowing obtaining a diagnosis of small fiber axonal neuropathy of peripheral nerves supplying every body part covered by skin. This feature appears to be very important, particularly in cases of unilateral nerve lesions, because it allows going beyond the possibilities of neurophysiological tests which are available only for a limited number of peripheral nerves. All these characteristics make NSB a precious instrument for the diagnosis of peripheral unilateral neuropathic pain.

Where is hidden the ghost in phantom sensations?

The term phantom sensations(PS) refers to sensations in a missing body part. They are almost universal in amputees and can be both painful and not painful. Although PS have been frequently described in limb amputees, they can also occur in other clinical conditions and several pathophysiological interpretations have been proposed, with a predominance of theories based on a central origin. Actually, different mechanisms are able to create a phantom sensation. After an amputation, PS are frequently generated by the genesis of ectopic action potentials in the interrupted nerve fibers but the PS generator can also be more proximal. Sometimes PS are not created by the stimulation of somatosensory fibers with a missing territory, but they can be the result of central sensitization or neuroplastic changes that allow for the convergence of impulses coming from different body parts(referred sensations), one of which is missing. In conclusion, PS can be generated by both neuropathic and non-neuropathic mechanisms developed in the amputated body part or in other parts of the nervous system. Since these mechanisms are not pathognomonic of amputation there are no hidden ghosts to look for in phantom sensations. The only interpretative rule is just to follow the pathophysiological principles.

Social skills and psychopathology are associated with autonomic function in children:a cross-sectional observational study

In recent years,the increase of psychopathological disorders in the population has become a health emergency,leading to a great effort to understand psychological vulnerability mechanisms.In this scenario,the role of the autonomic nervous system(ANS)has become increasingly important.This study investigated the association between ANS,social skills,and psychopathological functioning in children.As an ANS status proxy,we measured heart rate variability(HRV).Infants admitted to the neonatal intensive care unit of the University Hospital of Padova because of preterm birth or neonatal hypoxic-ischemic encephalopathy were sequentially recruited from January 2011 to June 2013 and followed long-term up to school age in this cross-sectional observational study.We recorded 5 minutes of HRV immediately before measuring performance in social abilities tasks(affect recognition and theory of mind,NEPSY-II)in 50 children(mean age 7.4±1.4 years)with and without risk factors for developing neuropsychiatric disorders due to pre-/perinatal insults without major sequelae.Children also completed extensive cognitive,neuropsychological,and psychosocial assessment.Parents were assessed with psychopathological interviews and a questionnaire(CBCL 6-18).Analysis in a robust Bayesian framework was used to unearth dependencies between HRV,social skills,and psychopathological functioning.Social task scores were associated with HRV components,with high frequency the most consistent.HRV bands were also associated with the psychopathological questionnaire.Only normalized HRV high frequency was able to distinguish impaired children in the affect recognition task.Our data suggest that ANS may be implicated in social cognition both in typical and atypical developmental conditions and that HRV has cross-disease sensitivity.We suggest that HRV parameters may reflect a neurobiological vulnerability to psychopathology.The study was approved by the Ethics Committee of the University Hospital of Padova(Comitato Etico per la Sperimentazione,Azienda Opedaliera di Padova,approval No.1693 P).

Insomnia is associated to depressive symptoms in patients with chronic heart failure

Introduction: Insomnia and depressive symptoms are common among patients with chronic heart failure (HF). Aim: The aim was to describe the prevalence of insomnia and depressive symptoms, as well as to examine the association between insomnia and depressive symptoms in patients with HF. Method: A crosssectional descriptive study including 212 patients with HF. All patients responded to questionnaires regarding sleeping difficulties (Uppsala Sleep Inventory-Chronic Heart Failure), daytime sleepiness (Epworth Sleepiness Scale) and depressive symptoms (The Mental Health Scale). Results: Patients with depressive symptoms (34%) had, compared to those without, significantly more major complaints of insomnia as indicated by the sub-types;non-restorative sleep (66% vs. 32%, p < 0.0001), difficulty in maintaining sleep (35% vs. 16%, p = 0.003), difficulty in initiating sleep (29% vs. 14%, p = 0.009) and early morning awakenings (25% vs. 10%, p = 0.004). The odds ratio (OR) to suffer from depressive symptoms;were for;non-restorative sleep 5.2 (CI 95%, 2.2 - 12.3), difficulties maintaining sleep 2.5 (CI 95%, 1.2 - 4.9), difficulties in initiating sleep 2.2 (CI 95%, 1.1 - 4.4) and early morning awakenings 2.4 (CI 95%, 1.1 - 5.4). When categorising insomnia into three severity groups, 1) non insomnia, 2) mild insomnia, and 3) severe insomnia, the OR for depressive symptoms for the mild insomnia and severe insomnia group were 2.2 (CI 95%, 1.1 - 4.2) and 7.4 (CI 95%, 2.4 - 22.8) respectively, compared to the non insomnia group. Conclusion: Insomnia is independently associated to depressive symptoms. Assessment of depressive symptoms and insomnia in patients with HF is important since treatment could be targeted to depressive symptoms only and/or to the sleep disturbance.

Impact of COVID-19 pandemic on the neuropsychiatric status of Wilson’s disease

We have read with interest the Letter to the Editor by Drs.Zhuang and Zhong,who presented the clinical data of 68 patients with Wilson’s disease(WD)who were admitted to the hospital before and during the coronavirus disease 2019(COVID-19)pandemic,and appreciated their findings on hepatic and some extrahepatic manifestations.Nevertheless,given the strong impact of the pandemic on patients with neurological and psychiatric disorders,we would have expected a worsening of the psychiatric and/or neurological impairments in these patients.In contrast,according to the authors,these manifestations remained,somewhat unexpectedly,unchanged.This finding is in contrast with most of the current literature that highlights not only an increased incidence of mental health disorders in the general population but also an exacerbation of neurological and psychiatric symptoms in patients with chronic diseases,especially in those with pre-existing neuropsychiatric disorders,such as WD.Although the study was mainly focused on the hepatic features of WD patients taking anti-copper treatment,a generic and cumulative definition of neurological and psychiatric manifestations,as in this study,does not allow for further considerations.Future studies during and after the pandemic are necessary to clarify the real impact,either direct or indirect,of the COVID-19 pandemic on the neurological and psychiatric symptoms of WD patients.