The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy

OBJECTIVE: The possible association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life has been studied in high-risk breast cancer survivors 5 years following standard adjuvant (n=23) versus high-dose chemotherapy (n=24) and in early-stage breast cancer patients (n=29) (comparison group) following radiation therapy. METHODS: A neuropsychological assessment covering attention, memory and executive functions was used together with the questionnaire for self-perceived deficits in attention (FEDA), the multidimensional fatigue inventory (MFI-20) and the EORTC-QLQ-C30. RESULTS: Findings have shown that neuropsychological impairment is not directly associated with self-perceived cognitive deficits, fatigue and HRQOL. However, 46% of patients reported self-perceived cognitive deficits and 82% of the patients complained about cancer related fatigue. Except for reduced activity we did not find significant group differences, even though patients who received standard-dose chemotherapy had consistently higher levels of self-perceived cognitive deficits and fatigue, and the lowest HRQOL. CONCLUSION: Results emphasize the need for psychosocial counseling and support during treatment phase and follow up care as well. Sensitive cancer-specific measures for the assessment of self-perceived cognitive deficits in different cognitive domains according to neuropsychological measurements are required. PRACTICE IMPLICATIONS: The role of self-perceived cognitive deficits and fatigue should be considered in educational interventions and counseling. Specific rehabilitation measures should be developed, implemented and evaluated in order to meet the needs of these patients and to decrease the frequency of cognitive deficits following cancer treatment.     

Quercetin attenuates domoic acid-induced cognitive deficits in mice

Domoic acid (DA) is one of the best known marine toxins, causative of important neurotoxic alterations. DA effects are documented both in wildlife and experimental assays, showing that this toxin causes severe injuries principally in the hippocampal area. Accumulating evidence indicates that mitochondrial dysfunction and oxidative stress are involved in DA-induced cognitive functional impairment. Therefore, therapeutics targeted to improve mitochondrial function and increase oxidative stress defence could be bene?cial. Quercetin, a bio?avanoid, has been reported to have potent neuroprotective effects and anti-oxidative ability, but its preventive effects on DA-induced mitochondrial dysfunction and cognitive impairment have not been well characterised. In this study, we evaluated the effects of quercetin on DA-induced cognitive deficits in mice and explored its potential mechanism. Our results showed that the oral administration of quercetin to DA-treated mice significantly improved their behavioural performance in a novel objective recognition task and a Morris water maze task. These improvements were mediated, at least in part, by a stimulation of PPARγ coactivator 1α-mediated mitochondrial biogenesis signalling and an amelioration of mitochondrial dysfunction. Moreover, quercetin activated nuclear factorerythroid-2-related factor-2 (Nrf2)-mediated phase II enzymes and decreased reactive oxygen species and protein carbonylation. Furthermore, the AMP-activated protein kinase (AMPK) activity significantly increased in the quercetin-treated group. Taken together, these findings suggest that a reduction in mitochondrial dysfunction through the increase of AMPK activity, coupled with an increase in Nrf2 pathway mediated oxidative defence, may be one of the mechanisms by which quercetin improves cognitive impairment induced by DA in mice.     

Evaluation of a tape removal test to assess neurological deficit after cardiac arrest in rats

BACKGROUND: In animal models of cardiocirculatory arrest (CA) it is of major interest to establish tests that can assess neurological damage after global cerebral ischaemia following CA. We evaluated a tape removal test with regard to detection of sensorimotor deficit, comparing it to the Neurological Deficit Score (NDS) in an established model of global cerebral ischaemia after CA in rats. METHODS: Rats were subjected to either 6 min of CA followed by cardiopulmonary resuscitation (CPR) or a sham operation. At 1, 3 and 7 days from the intervention, two different neurological tests were applied to all animals: in the tape removal test, the time was measured from attachment of adhesive tapes to the front paws until the animals removed them using their teeth and compared to latencies in the sham group. The NDS assessed two parameters ("travel beam" and "stop at the edge of a table"). Receiver operating characteristic (ROC) analysis was used to compare tests. RESULTS: In the tape removal test, all animals of the CPR group showed a clear neurological deficit throughout the observation period with a marked recovery until day 7 (pre-CA: 4s, 1 day: 180 s, 3 days: 165 s, 7 days: 44 s; data are median values). Latencies differed significantly from those of sham-operated animals (1 day: P<0.001, 3 days: P=0.003, 7 days: P=0.006). ROC analysis showed that the tape removal test but not the NDS was appropriate for detecting neurological damage 3 and 7 days after restoration of spontaneous circulation (ROSC). Histological examination confirmed neuronal damage to the hippocampus, cortex, thalamus and striatum. CONCLUSION: In the present study, a clinically relevant sensorimotor deficit after global cerebral ischaemia following cardiac arrest in rats has been quantified for the first time by using a tape removal test. The tape removal test is a sensitive method that can be easily applied to test large numbers of animals in future studies.     

伴神经症状的骨质疏松性重度椎体压缩骨折的研究进展

骨质疏松性重度椎体压缩骨折（osteoporotic severe vertebral compression fractures,OSVCF）伴神经症状（neurological symptoms,NS）是骨质疏松椎体压缩性骨折一种严重的亚型。由于需要考虑各种因素,包括患者自身状况、神经损伤情况、脊柱畸形、骨质量及合并其他疾病,手术策略要复杂得多。对于伴有神经症状的骨质疏松性重度椎体压缩骨折更加需要整体把握,全面分析,制定适宜的手术策略。随着对伴有神经症状的OSVCF治疗研究的不断进展,采用综合治疗的方式以及个体化治疗理念深入人心。笔者就伴NS的OSVCF治疗的最新技术和研究进展作一综述。     

三酰甘油-葡萄糖指数与急性缺血性卒中神经功能缺损的相关性分析

目的 探讨三酰甘油-葡萄糖（triglyceride-glucose,TyG）指数与急性缺血性卒中（acute ischemic stroke,AIS）患者神经功能缺损的相关性。      

麝香四黄汤联合重组组织型纤溶酶原激活剂治疗急性缺血性脑血管病临床研究

目的:观察麝香四黄汤联合重组组织型纤溶酶原激活剂(rt-PA)治疗急性缺血性脑血管病(AICD)的临床疗效。方法:选取90例AICD患者,随机分为参照组及试验组各45例。参照组采用rt-PA静脉溶栓治疗,试验组在参照组基础上联合麝香四黄汤治疗。比较2组临床疗效、实验室指标及不良反应发生率。结果:试验组总有效率为93.33%,明显高于参照组的66.67%(P<0.05)。治疗后,2组血清神经元特异性烯醇化酶(NSE)、内皮素-1 (ET-1)水平均较治疗前降低(P<0.05),血清超氧化物歧化酶(SOD)、一氧化氮(NO)水平均较治疗前升高(P<0.05);试验组血清NSE、ET-1水平均低于参照组(P<0.05),血清SOD、NO水平均高于参照组(P<0.05)。试验组不良反应发生率为6.67%,参照组为4.44%,2组比较,差异无统计学意义(P>0.05)。结论:麝香四黄汤联合rt-PA治疗AICD,可有效减轻患者的神经功能受损情况,改善其血管功能,且不良反应发生率低。     

针灸联合注射用鼠神经生长因子对脑卒中患者认知水平及神经功能的影响

目的:探究针灸联合注射用鼠神经生长因子对脑卒中患者认知水平及神经功能的影响。方法:选取脑卒中患者132例为研究对象,随机分为对照组(n=66)和观察组(n=66),对照组给予常规治疗联合注射用鼠神经生长因子,观察组在对照组的基础上给予针灸,比较两组临床疗效、认知水平[简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)]、中医症候积分、神经功能[美国国立卫生研究院卒中量表(NIHSS)]、生活质量[36条目简明健康量表(SF-36)]及不良反应。结果:观察组总有效率明显高于对照组(89.39% 与 75.76%,P<0.05); 与对照组比较,观察组治疗后MMSE评分和MoCA评分明显较高(P<0.05),中医症候积分和NIHSS评分明显较低(P<0.05),SF-36各维度评分明显较高(P<0.05); 观察组和对照组不良反应总发生率比较无统计学差异(7.58% 与 4.55%,P>0.05)。结论:针对脑卒中患者,在常规治疗基础上给予针灸联合注射用鼠神经生长因子具有较好的临床疗效,可减少中医症候积分,改善患者认知水平和神经功能,提升患者生活质量,安全性较好。     

外伤性颅骨缺损修补时机选择对患者的影响分析

目的分析创伤性颅骨缺损修补时机对患者的影响。方法选择2009年9月－2013年2月颅骨缺损修补手术患者90例为研究对象,根据修补时间分为3组,分别为早期修补组、中期修补组及晚期修补组,每组30例,对比观察3组患者的神经功能改善率。结果早期修补组患者神经功能改善率高于晚期修补组,差异具有统计学意义（P〈0.05）;早期修补组与中期修补组比较,差异无统计学意义（P〉0.05）。结论外伤性颅骨缺损患者早期颅骨缺损修补可以更好地改善患者的神经功能。     

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

Purpose

To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery.

Methods

A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10–48 years). There were 52 adolescent patients (with an age <18 years) and 24 adult patients (with an age ≥18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis.

Results

No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P < 0.05): location of apex at main curve (X ₃), Cobb angle at the main curve at the coronal plane (X ₄), scoliosis associated with thoracic hyperkyphosis (X ₅), level of vertebral column resected (X ₆), number of segmental vessels ligated (X ₇), preexisting neurologic dysfunction (X ₈), and associated with intraspinal and brain stem anomalies (X ₉). The multi-factor unconditional logistic regression analysis revealed that X ₈ (OR = 49.322), X ₉ (OR = 18.423), X ₅ (OR = 11.883), and X ₆ (OR = 8.769) were independent and positively correlated with the neurologic deficit.

Conclusions

Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.     

后方韧带复合体完整性在胸腰椎骨折中的临床意义

目的 探讨胸腰椎骨折中后方韧带复合体（PLC）完整性的临床意义。方法 回顾性分析自2008-07-2012-12收治的93例胸腰椎骨折,根据临床查体结合影像资料将其分为PLC完整组41例与PLC损伤组52例。结果 与PLC完整组相比,PLC损伤组的Denis分型与AO分型分布有明显区别。PLC损伤组中LCS评分、LSC〉7分比例、TLICS评分、TLICS〉5分比例、除外PLC项目的 TLICS评分、Cobb角度与PLC完整组相比差异有统计学意义（P〈0.05）;2组的年龄、性别及椎管占位率之间对比差异无统计学意义（P〉0.05）。PLC损伤组神经功能ASIA分级较PLC完整组更重。结论 PLC的完整性是评估胸腰椎骨折损伤程度的重要指标,其与骨折的分型、损伤评分、后凸畸形及神经功能损伤等方面密切相关。