The role of serotonin in hot flushes

Hot flushes are experienced in those periods of the female life when estrogen levels are low. Hormone replacement therapy is thus the first choice for treatment of hot flushes. However this treatment is not always accepted or contraindicated for a variety of reasons. Estrogen (and progestogen) strongly interact with a number of neurotransmitters and this has led to a range of non-hormonal treatments including compounds that act via the noradrenergic or dopaminergic systems as well as herbal remedies. These treatments (which are shortly reviewed) are not always successful. Surprisingly, apart from treatment with some selective serotonin (5-HT) reuptake inhibitors (SSRI's), up till now, little attention is given to the strong interaction of estrogens with the serotonergic system. These interactions are shortly reviewed. Based on these interactions, a hypothesis on the genesis of hot flushes is postulated. Especially the 5-HT_2A receptor subtype may play a key role in the occurrence of hot flushes. A number of arguments that support this hypothesis are discussed.     

Talking to Youth About Drugs: What Do Late Adolescents Say About Parental Strategies?

Abstract: This research, comprised of 2 studies, extends current knowledge of parent‐child communication about drugs. The first study developed a typology of parental strategies used to deter children’s substance use. The second study examined relationships among the parental strategies identified in the first study, which included family communication environments and self‐reported substance use. Results revealed that parental communication strategies to deter substance use may be employed in different ways by laissez‐faire, pluralistic, consensual, and protective families. Of the 7 identified types of strategies, very few actually impacted substance use in the previous 30 days. The only strategy to have a significant effect on the use of all drug types was a “no tolerance rule.” Prevention efforts and programs may target parents so as to enhance parental communication competence and offer parents an array of strategies to choose from that might best fit with their family communication environment.     

The Hot Flash Related Daily Interference Scale: A Tool for Assessing the Impact of Hot Flashes on Quality of Life Following Breast Cancer

To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.     

护士对出入量的认知与记录准确性的相关性分析

记录液体出入量（简称出入量）是指将患者24h内的摄人量与排泄量详细地记录在护理记录单上，为临床了解病情，协助诊断，决定治疗方案提供重要依据。因而准确记录出入量是一项十分重要的基础护理工作。由于出入量所包含项目的多样性，在实践中记录出入量容易产生误差，存在着漏记、记量不准确等现象。为进一步分析出入量记录存在误差的原因，     

Levetiracetam for the treatment of hot flashes: a phase II study

Goals of work The objectives of this pilot trial were to assess the potential efficacy and safety of levetiracetam for the treatment of hot flashes, a major cause of morbidity among breast cancer survivors. Patients and methods Women, aged 18 years or more, with a history of breast cancer or those who wished to avoid estrogen because of a perceived increased risk of breast cancer, who were experiencing bothersome hot flashes (more than or equal to 14 times per week, for more than or equal to 1 month before study entry), were included. During the baseline week, general demographic characteristics, hot flash information, and quality of life data were obtained. At the beginning of week 2, patients were started on levetiracetam for a total of 4 weeks. Information about hot flashes, quality of life, and toxicity were collected during these 4 weeks and compared with the baseline week. Main results After treatment with levetiracetam for 4 weeks (N = 19), mean hot flash scores (frequency times mean severity) were reduced by 57%, and mean hot flash frequencies were reduced by 53%, compared to the baseline week; both these reductions were greater than what would be expected with a placebo (20–25% reduction). There were significant improvements in abnormal sweating (p = 0.004), hot flash distress (p = 0.0002), and satisfaction of hot flash control (p = 0.0001), when comparing data from the fourth week of treatment to the baseline week. Twenty-nine percent of the subjects did not complete the study because of treatment-related adverse events, with the most frequently reported side effects being somnolence, fatigue, and dizziness, usually with mild to moderate intensity. Conclusion The results of this pilot trial suggest that levetiracetam might be an effective therapy for the treatment of hot flashes. Further data are needed to test this hypothesis, evaluating the efficacy and toxicity of this agent. Financial Disclosure: None     

土豆片联合热敷对预防肌注后硬结的疗效观察

目的比较单用热敷法与热水袋＋土豆片湿热敷法预防肌注后硬结发生的疗效,寻找预防长期肌注后硬结的最有效方法。方法选择120例肌注黄体酮的患者,采用自身对照,在每例患者的两侧臂大肌首次注射后,分别用热敷法（热敷组）和热水袋＋土豆片湿热敷（联用组）,观察患者注射局部硬结的发生率,疼痛程度。结果联用组较热敷组局部硬结的形成及疼痛发生率低,两者比较差异有统计学意义（P〈0．001）。结论联用法预防肌注后硬结的发生,减轻患者疼痛效果优于单用热敷法。     

Cardiovascular autonomic responsiveness in postmenopausal women with and without hot flushes

Objectives

During menopausal transition autonomic balance is known to shift towards sympathetic dominance, but the role of vasomotor hot flushes in this phenomenon is not understood. We compared cardiovascular autonomic responsiveness between women with and without hot flushes.

Study design and main outcome measures

One hundred fifty recently postmenopausal healthy women with varying degree of hot flushes (none, mild, moderate, severe) underwent comprehensive cardiovascular autonomic nervous testing (controlled and deep breathing, active orthostatic test, Valsalva manoeuvre and handgrip test) assessing both sympathetic and parasympathetic activity. The responses of heart rate, heart rate variability and blood pressure in these tests were evaluated.

Results

Responses in heart rate showed differences between the study groups only in the Valsalva manoeuvre where the tachycardia ratio in all symptomatic women was lower (p = 0.041) than in women without hot flushes. Neither change in the heart rate variability analyses nor the blood pressure responses were affected by hot flush status. However, there was a non-significantly higher maximum systolic (140 (112–182) mmHg vs. 135 (102–208) mmHg) and diastolic blood pressure (94 (72–112) mmHg vs. 90 (66–122) mmHg) following the handgrip test in women without hot flushes vs. all the symptomatic women.

Conclusions

Menopausal hot flushes seem to be associated with a possibly increased sympathetic preponderance without an effect on parasympathetic activity in cardiovascular autonomic responses. This may imply a potentially negative impact on cardiovascular health in women experiencing hot flushes.     

Management of menopausal symptoms in breast cancer patients

In breast cancer patients, menopausal symptoms such as hot flashes, urogenital problems, musculoskeletal symptoms and cognitive dysfunction are common, regardless of age at diagnosis. They affect quality of life and systemic therapy will worsen this. Endocrine and/or chemotherapy may induce temporary or permanent ovarian failure and can exacerbate these symptoms. Hormone therapy (HT) has been studied in breast cancer survivors, but safety has been questioned. The HABITS trial investigating estrogen-based HT, as well as the LIBERATE trial investigating tibolone, found a reduction in disease-free survival for those treated. Alternative strategies are needed, as menopause symptoms may reduce compliance with breast cancer treatments. This article reviews recently published strategies to tackle menopausal problems in breast cancer patients. Antidepressants may help with hot flashes. Acupuncture and hypnosis can also be used but the evidence is conflicting. For urogenital problems vaginal moisturizers or topical estrogens can be employed. A musculoskeletal syndrome induced by aromatase inhibitors (AIs) is frequently encountered and currently there are no effective treatment strategies. Bisphosphonates reduce AI-induced bone resorption and can also increase disease-free and overall survival. Standard-dose endocrine and chemotherapy are associated with a decline in cognitive function.     

A critical view of the effects of phytoestrogens on hot flashes and breast cancer risk

The increased risk of breast cancer recently observed with some specific estro-progestin associations has raised concerns about the harmful effects of menopausal hormone replacement therapy (HRT). It has been proposed that phytoestrogens (PEs), which have a similar chemical structure to estrogens, could be used as HRT. The main selling points of these preparations concern the management of hot flashes and their potential beneficial effects on breast tissue. In this review, we will address the effects of PE on hot flashes and breast cancer risk as well as the questions raised on a chemical point of view. We conclude that the efficacy of a PE rich diet or nutritional supplements is not clearly established. The use of PE as an alternative for HRT cannot be advocated for now, due to insufficient and conflicting data on efficacy and safety. Moreover, due to the hormone dependence of breast cancer, PE use must be contraindicated in breast cancer survivors.