Jugular Venous Oxygen Saturation During Mild Hypothermic Versus Normothermic Cardiopulmonary Bypass in Elderly Patients

Purpose. Age is known to be a major risk factor for adverse postoperative cognitive dysfunction after cardiac surgery. We conducted this study to determine if jugular venous oxygen saturation (SjvO₂) differed during mild hypothermic (32°C) and normothermic cardiopulmonary bypass (CPB) in elderly patients.Methods. Sixty patients aged over 70 years who underwent elective coronary artery bypass grafting were randomly divided into two groups. Group 1 (n = 30) underwent normothermic CPB (>35°C) and group 2 (n = 30) underwent mild hypothermic CPB (32°C). For the continuous monitoring of SjvO₂, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb after the induction of anesthesia. Hemodynamic parameters, and arterial and jugular venous blood gases were measured at seven time points.Results. The SjvO₂ in the normothermic group was lower at the onset of CPB and 20min after the onset, than from the time of induction of anesthesia until the start of surgery (period 1), the respective SjvO₂ values being 50.3% ± 1.0%, 50.1% ± 1.6%, and 59.5% ± 1.9% (P < 0.05). However, in the mild hypothermic group there were no changes in the SjvO₂ value throughout the study. The cerebral desaturation time (when the SjvO₂ value was <50%) and the ratio of the cerebral desaturation time to the total CPB time in the normothermic group differed significantly from those in the hypothermic group, being 19 ± 11min and 17% ± 10%, and 9 ± 3min and 8% ± 4%, respectively (P < 0.05).Conclusions. The SjvO₂ value was better during mild hypothermic CPB than during normothermic CPB in elderly patients.     

The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty

The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n = 106), social anxiety disorder (n = 88), or generalized anxiety disorder (n = 62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and ‘trans-therapy’ process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders.     

Cognitive profile of young well-trained athletes with intellectual disabilities

BackgroundPrevious research has shown that cognitive and motor skills are related. The precise impact of cognitive impairment on sport proficiency, however, is unknown.AimsThis study investigated group and individual differences in cognitive profiles in a large cohort of track and field athletes, basketball players, swimmers and table tennis players with (N = 468) and without (N = 162) intellectual disabilities (ID).Methods and proceduresBased on the Cattell-Horn-Carroll Theory of Cognitive abilities, eight subtests were selected for inclusion in a generic cognitive test (GCT) to assess executive functions and cognitive abilities relevant to sport, i.e., fluid reasoning, visual processing, reaction and decision speed, short-term memory and processing speed.Outcomes and resultsReliability coefficients for the subtests ranged between 0.25 and 0.88 respectively. Factor analysis revealed two clusters of subtests, i.e., a speed-based factor (simple and complex reaction time and simple and complex visual search) and a performance-based factor (Corsi Memory, Tower of London, WASI Block Design and Matrix Reasoning).After controlling for psychomotor speed, the group of ID-athletes scored significantly lower than athletes without ID on all the GCT subtests, except the complex visual search test. When cognitive profiles of individual ID- athletes were examined, some obtained higher scores than the average norm values in the reference population.Conclusions and implicationsThe GCT is currently administered as part of the classification process for athletes with ID who compete in the Paralympic Games. The results of this study indicate that the complex visual search and Tower of London test in the GCT should be reconsidered.     

Interactions of visual hallucinations,rapid eye movement sleep behavior disorder and cognitive impairment in Parkinson's disease: A review

Patients with Parkinson's disease may develop various non-motor symptoms during the course of the illness. Visual hallucinations (VH) and cognitive impairment (CI) are two common non-motor symptoms of Parkinson's disease. Studies have reported association of both VH and CI with presence of rapid eye movement sleep behavior disorder (RBD). Presence of visual hallucinations and cognitive impairment has been described as risk factors for emergence of each other. There is marked overlap in the risk factors for development of RBD, VH and CI in patients with PD. Results of clinical and epidemiological studies as well as studies based on neuroimaging, electrophysiology especially transcranial magnetic stimulation and neuropsycholgical evaluations in PD patients have suggested presence of certain common neurobiological process leading to emergence of RBD, VH and CI. Structural neuroimaging studies using voxel-based morphometry have often reported grey matter atrophy of hippocampus and parahippocampal cortices in PD patients with RBD, VH and CI. Cholinergic dysfunction is common in PD patients with RBD, VH and CI. This review explores the complex interactions of RBD, VH and CI in patients with PD and their potential implications.     

老年精神分裂症与痴呆

精神分裂症存在广泛的认知缺陷与脑结构异常。随着年龄增长,精神分裂症患者认知缺陷及脑结构与健康老年人、AD 不一样,部分患者后期会发展为痴呆,且这种痴呆可能为一种非特定痴呆。精神分裂症后期发展为痴呆危险因素较多,部分因素具有可控性。现就老年精神分裂症与痴呆之间的关系进行综述,以降低精神分裂症后期痴呆的发生。     

丙戊酸钠联合喹硫平治疗双相情感障碍躁狂发作的疗效

目的探讨喹硫平联合丙戊酸钠治疗双相情感障碍躁狂发作的疗效及对认知功能的影响。方法选取2013-2014年我院收治的双相情感障碍躁狂发作患者80例,随机平均分为观察组与对照组,分别行丙戊酸钠联合喹硫平与利培酮治疗,均早晚2次服用,持续6周。于治疗前和治疗6周后采用杨氏躁狂量表(YRMS)评定临床疗效,采用威斯康星卡片分类测验(WCST)、持续操作测验(CPT)和霍普金斯词语学习测验修订版(HVLT-R)评定认知功能。结果观察组临床治愈率、显效率、总有效率与对照组相比均无显著性差异(P0.05)。治疗后2组完成分类数、错误应答数、持续应答数均明显改善,持续注意水平明显改善,观察组错误应答数与持续应答数改善更为明显(P0.05)。结论喹硫平联合丙戊酸钠能够有效治疗双相情感障碍躁狂发作,改善患者的部分认知功能。     

Factors associated with texting and walking performance in children with ADHD: The role of age,environment, and symptom severity

BackgroundChildren with ADHD show deficits in executive function, as well as motor symptoms such as difficulties in gross and fine motor skills and gait stability. Texting while walking is becoming increasingly common and is a significant health risk among people of all ages.Research questionThe objective of this work was to compare texting and walking performance between children with ADHD and controls and between two environments (indoors and outdoors), and evaluate the role of age and symptom severity in dual-task performance.MethodsNineteen children with ADHD and 30 healthy children walked across an indoors corridor and an outdoors street, with and without texting on a mobile phone. Walking and texting performance were measured using inertial measurement units and a custom-made mobile app.ResultsNo between-group differences were found in texting or walking performance. Walking and texting were similar across environments. In both groups, older children had smaller dual-task performance deficits for both gait and texting speed. Children with ADHD who had more severe symptoms of hyperactivity had larger dual task costs for gait speed outdoors (r = 0.69, p = 0.002), and those with more motor symptoms typed faster under dual-task conditions indoors (r = 0.6, p = 0.007) but were less accurate (r = − 0.60, p = 0.009).SignificanceChildren with ADHD do not demonstrate deficits in dual-task performance of a texting and walking task indoors or outdoors. The relationship of age, hyperactivity and motor symptoms with texting and walking performance supports a more personalized approach for examination of dual-task performance in children with ADHD.     

术后认知功能障碍老龄大鼠海马神经元缝隙连接蛋白36表达的变化

目的 评价术后认知功能障碍老龄大鼠海马神经元缝隙连接蛋白36(Cx36)表达的变化.方法 健康雄性SD大鼠90只,20月龄,体重500～600 g,按随机数字表法,将其随机分为3组(n=30):正常对照组(C组)、假手术组(S组)和术后认知功能障碍组(POCD组).采用脾脏切除术制备老龄大鼠术后认知功能障碍模型,分别于脾脏切除术后1、3、7 d(T1-3)时每组各取10只大鼠,经旷场分析和Y型迷宫实验测试大鼠认知功能,随后处死大鼠取海马,采用免疫组化法检测海马神经元Cx36的表达.结果 与C组比较,S组各项认知功能指标和海马神经元Cx36表达水平差异无统计学意义(P＞0.05),POCD组中央格停留时间延长,跨格次数、站立次数和正确反应次数减少,全天总反应时间增加,海马神经元Cx36表达水平降低(P＜0.05);与S组比较,POCD组大鼠T1时中央格停留时间延长,跨格次数、站立次数和正确反应次数减少,全天总反应时间增加,海马神经元Cx36表达水平降低(P＜0.05),T2,3时各项认知功能指标及海马神经元Cx36表达水平差异无统计学意义(P＞0.05).结论 术后认知功能障碍可能与老龄大鼠海马神经元Cx36表达下调有关.     

Accuracy and content of medical student midclerkship self-evaluations

Background

Midclerkship self-evaluations (MCSEs) require students to reflect on their knowledge, skills, and behaviors. We hypothesized that MCSEs would be consistent with supervisor midpoint evaluations during a surgical clerkship.

Methods

MCSEs of 153 students who completed our surgery clerkship in 2 academic years were compared with supervisor midclerkship evaluations. The quantitative domains of the MCSE and supervisor evaluation were compared for accuracy. Identified areas of strengths and weakness were evaluated for thematic consistency.

Results

Student MCSE scoring was accurate across evaluated domains most of the time; when students were inaccurate, they tended to underrate themselves. Students and supervisors most often identified cognitive skills as areas for improvement and noncognitive skills predominated as student strengths.

Conclusions

Medical students can accurately identify their strengths and weaknesses in the context of an MCSE. Based on these findings, knowledge acquisition and application by medical students in the clinical setting should be emphasized in undergraduate medical education.     

Promoting functioning and well-being in older CKD patients: review of recent evidence

Osteoporosis, falls, sleep difficulty, cognitive impairment, and depressed mood are major clinical concerns in the geriatric population that are physiologically and psychologically based and are often interrelated. All of these issues have implications for patients’ daily functioning and quality of life (QOL). This review synthesizes recent evidence about these prominent issues in geriatric care and related implications for care of older patients with chronic kidney disease (CKD). Recent evidence about pre-dialysis and dialysis treatment strategies that may help to optimize management of older patients is also considered. Although elderly patients often report better psychosocial adjustment to dialysis than do younger patients, physical functioning and cognitive functioning losses challenge the QOL of many elderly persons. Early management of CKD and attention to anemia, consideration of the benefits of peritoneal dialysis compared with hemodialysis, and inclusion of some form of exercise or regular physical activity in routine care provide key opportunities to enhance the functioning and well-being of older patients.