Risk of cognitive decline progression is associated to increased blood-brain-barrier permeability: A longitudinal study in a memory unit clinical cohort.

INTRODUCTION: This study examined the relationship between blood-brain-barrier permeability (BBBp), measured by cerebrospinal fluid/serum albumin ratio (QAlb), and cognitive decline progression in a clinical cohort. METHODS: This prospective observational study included 334 participants from the BIODEGMAR cohort. Cognitive decline progression was defined as an increase in Global Deterioration Scale and/or Clinical Dementia Rating scores. Associations between BBBp, demographics, and clinical factors were explored. RESULTS: Male sex, diabetes mellitus, and cerebrovascular burden were associated with increased log-QAlb. Vascular cognitive impairment patients had the highest log-QAlb levels. Among the 273 participants with valid follow-up data, 154 (56.4%) showed cognitive decline progression. An 8% increase in the hazard of clinical worsening was observed for each 10% increase in log-QAlb. DISCUSSION: These results suggest that increased BBBp in individuals with cognitive decline may contribute to clinical worsening, pointing to potential targeted therapies. QAlb could be a useful biomarker for identifying patients with a worse prognosis.

Efficacy of conditioned autologous serum therapy (Orthokine®) on the dorsal root ganglion in patients with chronic radiculalgia: study protocol for a prospective randomized placebo-controlled double-blind clinical trial (RADISAC trial).

BACKGROUND: Pulsed radiofrequency (PRF) treatment on the dorsal root ganglion (DRG) has been proposed as a good option for the treatment of persistent radicular pain based on its effect of neuromodulation on neuropathic pain. Autologous conditioned serum (ACS) therapy is a conservative treatment based on the patient's own blood. The aim of this manuscript is to develop a study protocol using ACS on the DRG as a target for its molecular modulation. METHODS: We plan to conduct a randomized controlled study to compare the efficacy of PRF therapy plus ACS versus PRF therapy plus physiological saline 0.9% (PhS) on the DRG to reduce neuropathic pain in patients with persistent lower limb radiculalgia (LLR) and to contribute to the functional improvement and quality of life of these patients. Study participants will include patients who meet study the inclusion/exclusion criteria. Eligible patients will be randomized in a 1:1 ratio to one of treatment with PRF plus ACS (experimental group) or PRF plus PhS (placebo group). The study group will consist of 70 patients (35 per group) who have experienced radicular pain symptoms for ≥ 6 months' duration who have failed to respond to any therapy. Both groups will receive PRF on the DRG treatment before the injection of the sample (control or placebo). Patient assessments will occur at baseline, 1 month, 3 months, 6 months, and 12 months after therapy. The primary efficacy outcome measure is Numeric Pain Rating Scale (NPRS) responders from baseline to 12 months of follow-up using validated minimal important change (MIC) thresholds. A reduction of ≥ 2 points in NPRS is considered a clinically significant pain relief. The secondary efficacy outcome measure is the proportion of Oswestry Low Back Pain Disability Scale (ODS) responders from baseline to 12 months of follow-up in the experimental group (PRF plus ACS) versus the placebo group (PRF plus PhS). ODS responders are defined as those patients achieving the validated MIC of ≥ 10-point improvement in ODS from baseline to 12 months of follow-up as a clinically significant efficacy threshold. DISCUSSION: This prospective, double-blind, randomized placebo-controlled study will provide level I evidence of the safety and effectiveness of ACS on neuropathic symptoms in LLR patients. TRIAL REGISTRATION {2A}{2B}: EUDRACT number: 2021-005124-38. Validation date: 13 November 2021. Protocol version {3}: This manuscript presents the 2nd protocol version.

Changes in Salivary Immunoglobulin A, Stress, and Burnout in a Workplace Mindfulness Intervention: A Pilot Study.

The purpose of this pilot study was to examine the effectiveness of a 6-week workplace mindfulness- and self-compassion-based intervention (MSCBI) on perceived stress, burnout, immune functioning (assessed with the biomarker Immunoglobulin A), self-compassion, and experiential avoidance compared to a Workplace Stress Management Intervention. Both interventions were contextual, i.e., they were carried out in the workplace setting and during working hours. We followed a randomised controlled trial study design. The total sample was composed of 24 employees of an automotive company. One-way analyses of covariance between groups revealed significant differences in post-intervention levels of perceived stress, salivary Immunoglobulin A (sIgA), emotional exhaustion, self-compassion, and experiential avoidance, after adjusting for pre-test scores. The results of this study have several implications. Firstly, it confirms that MSCBIs might be more effective than regular psychoeducational interventions for work-related stress and burnout treatment. Secondly, sIgA can be used to assess immune function state changes when MSCBIs are carried out. Furthermore, these results indicate that it is feasible to carry out MSCBIs within companies and during working hours, and that these interventions can help effectively manage stress and burnout associated with the work environment.

Differential Effects of Mindfulness-Based Intervention Programs at Work on Psychological Wellbeing and Work Engagement.

Two different mindfulness-based interventions were deployed in a sample of white-collar workers to explore the differential effects on different facets of mindfulness, dimensions of psychological wellbeing, work engagement, performance, and stress of a participant. A total of 28 participants completed one of the different programs, and their results were compared between groups and against 27 participants randomly allocated to a waiting list control group. Results suggest both mindfulness intervention programs were successful at increasing the levels of psychological wellbeing, work engagement, and performance of the participants, as well as decreasing their levels of stress. Significant differences were found between the two programs in all outcome variables. Results suggest that brief and customized mindfulness interventions at work are as successful as lengthier programs.

Characterization of microMOSFET detectors for in vivo dosimetry in high-dose-rate brachytherapy with 192 Ir.

PURPOSE: The objective of this study was to characterize the Best Medical Canada microMOSFET detectors for their application in in vivo dosimetry for high-dose-rate brachytherapy (HDRBT) with 192 Ir. We also developed a mathematical model to correct dependencies under the measurement conditions of these detectors. METHODS: We analyzed the linearity, reproducibility, and interdetector variability and studied the microMOSFET response dependence on temperature, source-detector distance, and angular orientation of the receptor with respect to the source. The correction model was applied to 19 measurements corresponding to five simulated treatments in a custom phantom specifically designed for this purpose. RESULTS: The detectors (high bias applied in all measurements) showed excellent linearity up to 160 Gy. The response dependence on source-detector distance varied by (8.65 ± 0.06)% (k = 1) for distances between 1 and 7 cm, and the variation with temperature was (2.24 ± 0.05)% (k = 1) between 294 and 310 K. The response difference due to angular dependence can reach (10.3 ± 1.3)% (k = 1). For the set of measurements analyzed, regarding angular dependences, the mean difference between administered and measured doses was -4.17% (standard deviation of 3.4%); after application of the proposed correction model, the mean difference was -0.1% (standard deviation of 2.2%). For the treatments analyzed, the average difference between calculations and measures was 4.7% when only the calibration coefficient was used, but it is reduced to 0.9% when the correction model is applied. CONCLUSION: Important response dependencies of microMOSFET detectors used for in vivo dosimetry in HDRBT treatments, especially the angular dependence, can be adequately characterized by a correction model that increases the accuracy of this system in clinical applications.

Identification of research priorities in infertility and assisted reproduction: an international, multicentre study.

RESEARCH QUESTION: What are the main research interests among patients of assisted reproductive technologies (ART)? DESIGN: Cross-sectional study consisting of an anonymous online survey sent to 2112 patients from eight centres in four countries in 2018. Patients were asked to identify research questions relevant to them in the field of infertility and ART. Answers were categorized into topics and ranked by frequency. A long list of the top 30 research topics was extracted from the aggregate results, from which a short list of the top 10 research topics was created. Ten research questions were finally formulated. RESULTS: A total of 945 responses were analysed. Main interests were side-effects, success rates, infertility prevention and emotional support. The 10 research questions were: 1. What are the side-effects of drugs used in ART treatments? (51.6%). 2. What are the most effective methods to cope with infertility from the psychological point of view? (35.7%). 3. What effects could diet have on fertility? (25.9%). 4. What are ART success rates per clinical profile? (24.8%). 5. Are there some habits and lifestyle factors that could prevent infertility? (20.0%). 6. What are the long-term risks associated with ART in mother and child? (18.5%). 7. Are alternative therapies such as acupuncture, yoga and meditation effective to treat/prevent infertility? (18.5%). 8. What is the impact of exercise on fertility? (15.4%). 9. How does oocyte quantity and quality affect fertility? (9.5%). 10. What are the genetic patterns or hereditary conditions causing/related to infertility? (9.5%). CONCLUSIONS: Researchers and clinicians should keep in mind that, in addition to success rates and safety, patients greatly value research into causes, prevention and emotional aspects of infertility.

Underdiagnosis of Unilateral Spatial Neglect in stroke unit.

OBJECTIVES: Unilateral spatial neglect (USN) is the incapacity to respond to stimuli presented opposite to a dysfunctional cerebral hemisphere. It is usually caused by non-dominant hemisphere lesions, leads to poorer prognosis and might be underdiagnosed. The objectives of the study were to ascertain the presence of USN in acute stroke patients and analyze the possible degree of underdiagnosis in a Stroke Unit. MATERIALS AND METHODS: Prospective study of consecutive non-dominant hemisphere stroke patients within a period of 21 months. "Line Bisection" and "Triangles Cancellation" tests were used for USN screening and "Circle Gap Detection Task" to confirm the USN. The results were compared with routine Stroke Unit assessment using the NIHSS to determine the possible degree of underdiagnosis. RESULTS: A total of 62 subjects, 38 women (61.29%), mean age of 74.05 (SD 10.5) years, were included. USN was diagnosed in 25 cases (40.3%) but 56% of them were not detected in routine evaluation using the NIHSS. CONCLUSIONS: Unilateral spatial neglect, a common cognitive deficit after acute stroke, is greatly underdiagnosed in routine Stroke Unit assessment. The use of simple USN-specific screening tools would improve diagnosis and therefore the possibility of implementing appropriate rehabilitation strategies.

Collaborative intervention to improve airway assessment and safety in management for anaesthesia: the Qualitat & Via Aèria (QUAVA) study.

BACKGROUND: Airway assessment and management are cornerstones of anaesthesia, yet airway complications remain an important source of morbidity. OBJECTIVE: We performed a before-and-after evaluation of a collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. DESIGN: A prospective, multicentre before-and-after evaluation of a collaborative intervention. SETTING: Collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. Data were collected on 21 consecutive days before and after the intervention. PARTICIPANTS: Anaesthetists with staff or residency positions at 22 hospitals. Patients aged 18 years or older undergoing nonemergency surgery were recruited. INTERVENTION: Establishing a learning network that included local leaders, meetings to share experiences and knowledge, interactive sessions and provision of printed materials on airway assessment and management. Clinical airway management for general anaesthesia was provided by the anaesthetists participating in the study. MAIN OUTCOME MEASURES: Outcomes were the completion of airway assessment at the preanaesthetic visit, rates of unanticipated difficult airway, algorithm adherence and related airway complications. RESULTS: The study included 3753 patients (1947 preintervention and 1806 postintervention). The percentage of patients with a complete airway assessment increased from 25.1% preintervention to 48.4% postintervention (P <0.001). The incidences of unanticipated difficult airway were 4.1% before the intervention and 3% after it (P = 0.433). Rates of adherence to the algorithms for anticipated and unanticipated difficult airway management were similar in the two periods. The incidences of related adverse events were also similar. CONCLUSION: The collaborative intervention was effective in improving airway assessment but not in changing difficult airway management practices.

Neuropsychology of Alzheimer's disease.

The expression of neurodegenerative diseases can be categorized into three main symptomatic domains: neurological, cognitive and, neuropsychiatric. This review focuses on the cognitive profile and neuropsychological assessment of Alzheimer's disease (AD). The topography and progression of brain neuropathology determines the cognitive expression of the disease. Thus, in accordance with the initial involvement of the medial temporal lobe, cognitive changes in AD start with specific difficulties in encoding and storage of new information. This particular memory deficit can be optimally detected with memory tests that enhance mnemonic retrieval by means of encoding specificity technique such as the Free and Cued Selective Reminding Test (FCSRT). Along the course of the disease, the neuropathology spreads to association cortices, and other neuropsychological deficits can be detected. A comprehensive neuropsychological examination encompassing several cognitive domains can provide a pattern of altered and preserved functions that is helpful to early detection, differential diagnosis and even prognosis of progression in predementia stages. The use of adapted and standardized instruments is necessary to properly estimate cognitive and functional performance in AD.

Intra- and intersession repeatability of a double-pass instrument.

PURPOSE: To evaluate the intra- and intersession repeatability of the optical quality parameters provided by the Optical Quality Analysis System (OQAS), which is based on the double-pass technique. METHODS: We performed optical quality measurements using the OQAS on 20 eyes of 10 healthy subjects who had best spectacle-corrected visual acuity of 20/20 or better. Measurements were performed by the same examiner in three different sessions that were separated by 10-min intervals. The subject's eye was realigned at the beginning of each session. During each session, three consecutive measurements were taken without realignment. The following optical quality parameters were analyzed: the modulation transfer function cutoff frequency (MTFcutoff), the Strehl ratio, the OQAS values (OV) at contrasts of 100%, 20%, and 9%, and the objective scatter index (OSI). RESULTS: The mean coefficients of repeatability obtained for the first session were 4.51 (MTFcutoff), 0.049 (Strehl ratio), 0.15 (OV 100%), 0.21 (OV 20%), 0.28 (OV 9%), and 0.11 (OSI), which were similar to those found in the second and third sessions. The confidence limits in the Bland and Altman charts when the intrasession repeatability was assessed (in a comparison of the first and second measurements of the first session) ranged from -3.16 to 3.94 (MTFcutoff), -0.060 to 0.069 (Strehl ratio), -0.12 to 0.18 (OV 100%), -0.20 to 0.23 (OV 20%), -0.29 to 0.27 (OV 9%), and -0.12 to 0.13 (OSI). The same limits when the intersession repeatability was assessed (in a comparison of the first and second sessions) ranged from -5.30 to 5.49 (MTFcutoff), -0.054 to 0.050 (Strehl ratio), -0.17 to 0.17 (OV 100%), -0.22 to 0.19 (OV 20%), -0.26 to 0.29 (OV 9%), and -0.12 to 0.13 (OSI). CONCLUSIONS: Our findings showed that OQAS is a clinical instrument with a good intra- and intersession repeatability and that the realignment of the eye does not introduce any additional variability in the measurements.