Marie-Ève Bergeron

Cognitive Intervention Programs for Individuals With Mild Cognitive Impairment: Systematic Review of the Literature

This systematic literature review addressed the efficacy of 15 cognitive intervention programs that have been tested in individuals presenting with mild cognitive impairment of the amnestic type (MCI-A) possibly at risk to progress toward dementia. MEDLINE, PsycINFO, and Current Content databases were searched using the following key terms: cognitive training, cognitive stimulation, cognitive rehabilitation, neuropsychological intervention, memory training, memory stimulation, and Mild Cognitive Impairment. The data showed statistically significant improvements at the end of training on 44% of objective measures of memory, when compared with 12% of objective measures of cognition other than memory. Statistically significant improvements after treatment were obtained on 49% of subjective measures of memory, quality of life, or mood. Samples sizes ranged from 1 to 193 patients with MCI-A but were usually < or =30. Five studies were randomized controlled trials, eight were quasiexperimental designs, and two were single-case investigations. Some programs focused only on memory, whereas other programs used multifaceted approaches targeting two or more cognitive functions. Eight were offered in groups, and seven took place on an individual basis. Recommendations to improve cognitive interventions in MCI-A are proposed, such as using large samples and a robust experimental design, as well as the implementation of a standardized cognitive training manual. Well standardized and validated direct and indirect measures of efficacy and noncognitive outcomes are also a crucial issue. A consensus meeting among all the experts working on cognitive training in this population should occur to provide guidelines to improve this treatment option.

Efficacy of a cognitive training programme for mild cognitive impairment: Results of a randomised controlled study

This study aimed to determine the efficacy of cognitive training in a 10-week randomised controlled study involving 22 individuals presenting with mild cognitive impairment of the amnestic type (MCI-A). Participants in the experimental group (n = 11) learned face–name associations using a paradigm combining errorless (EL) learning and spaced retrieval (SR) whereas participants in the control group (n = 11) were trained using an errorful (EF) learning paradigm. Psycho-educational sessions on memory were also provided to all participants. After neuropsychological screening and baseline evaluations, the cognitive training took place in 6 sessions over a 3-week period. The post-training and follow-up evaluations, at one and four weeks respectively, were performed by research assistants blind to the participants study group. The results showed that regardless of the training condition, all participants improved their capacity to learn face–name associations. A significant amelioration was also observed in participant satisfaction regarding their memory functioning and in the frequency with which the participants used strategies to support memory functions in daily life. The absence of difference between groups on all variables might be partly explained by the high variability of scores within the experimental group. Other studies are needed in order to verify the efficacy of EL learning and SR over EF in MCI-A.

Discoidin domain receptor 1 expression in activated T cells is regulated by the ERK MAP kinase signaling pathway

The expression and function of discoidin domain receptor 1 (DDR1) in T cells are still poorly explored. We have recently shown that activation of primary human T cells via their T cell receptor leads to increased expression of DDR1, which promoted their migration in three‐dimensional collagen. In the present study, we provide evidence that activated T cells bind collagen through DDR1. We found that the DDR1:Fc blocking molecule significantly reduced the ability of activated T cells to bind soluble biotinylated collagen. However, DDR1:Fc had no impact on the adhesion of activated T cells to collagen and overexpression of DDR1 in Jurkat T cells did not enhance their adhesion. Together, our results indicate that DDR1 can promote T cell migration without enhancing adhesion to collagen, suggesting that it can contribute to the previously described amoeboid movement of activated T cells in collagen matrices. Our results also show that CD28, in contrast to IL‐2 expression, did not costimulate the expression of DDR1 in primary human T cells. Using specific inhibitors, we demonstrated that TCR‐induced expression of DDR1 in T cells is regulated by the Ras/Raf/ERK MAP Kinase and PKC pathways but not by calcium/calcineurin signaling pathway or the JNK and P38 MAP Kinases. Thus, our study provides additional insights into the physiology of DDR1 in T cells and may therefore further our understanding of the regulatory mechanisms of T cell migration. J. Cell. Biochem. 112: 3666–3674, 2011.

Promotion of angiogenesis and proliferation cytokines patterns in peritoneal fluid from women with endometriosis

Studies have long sought specific cytokines that could characterize endometriosis. Either due to variations between study designs regarding the assessment criteria for the cytokine or to low power resulting from small sample size, no factor proved to be sufficiently specific to endometriosis. In other clinical fields, a combination of several markers proved to be more powerful than a single-molecule approach. As well, in the context of endometriosis, simultaneous assessment of several cytokines present in the peritoneal fluid might help in unveiling patho-physiological processes, thus contributing to a better understanding of the condition. Therefore, the objective of this study was to investigate peritoneal fluid cytokines-derived of endometriotic women. For this retrospective case-control study, peritoneal fluid samples were obtained at laparoscopy and assessed by multiplex. Our data showed distinct patterns of peritoneal fluid cytokine concentrations in endometriotic women most notably a marked increase in EGF, FGF-2, IL-1α, MIP-1β, TGFα, PDGF-AA, PDGF-BB, MCP-3, sCD40L, Gro Pan, IL-17α, MDC and Rantes. The overall effect of fertility status revealed a significant difference for only one cytokine, namely MDC. Furthermore, FLT-3L and IP-10 levels were decreased in endometriosis patients, the former in both menstrual cycle phases and the latter in the secretory phase. A significant inverse Pearson correlation (p<0.05) was noted between pro-angiogenic cytokines EGF and FGF and the anti-angiogenic cytokine IP-10 in endometriosis patients at stages III-IV and in the secretory phase. These changes may exacerbate the local peritoneal angiogenic and proliferative reaction observed in women with endometriosis, and contributes to its pathophysiology.

Towards a cognitive stimulation program using an errorless learning paradigm in amnestic mild cognitive impairment

Considering the high risk for amnestic mild cognitive impairment (A-MCI) individuals to progress towards dementia, it is crucial to study the efficacy of innovative treatment strategies such as cognitive stimulation techniques. The present study is a case report of two individuals presenting with A-MCI who were enrolled in a memory training program. After a broad neuropsychological assessment, the two participants were trained with an errorless (EL) learning paradigm on an individual basis, twice a week, over three weeks. Two follow-up sessions took place one and five weeks after the end of the training. Results showed that the program was well tolerated and feasible, and enhanced daily memory abilities. For the second participant only, a re-evaluation of her cognitive profile was completed 23 months after her first assessment and training. In addition, EL was directly compared with a control condition using an errorful (EF) learning paradigm to teach her new names over two sessions (one session for each condition). Her improvement on the trained material supported the preliminary efficacy of EL compared with EF for learning episodic material. These results are compatible with previous work that has preliminarily demonstrated the efficacy of an EL paradigm in patients with dementia.

Glycine absorption in operative hysteroscopy: the impact of anesthesia

OBJECTIVE This study aimed to evaluate the impact of anesthesia on the absorption of glycine in operative hysteroscopy. STUDY DESIGN A retrospective cohort study was performed over 2 years. The absorption of glycine was compared among general anesthesia, local anesthesia with intravenous sedation, and spinal anesthesia. Multiple logistic regression analyses were performed. RESULTS In all, 282 operative hysteroscopies were reviewed. The median absorption was 145 mL (10th-90th centile: 0-963 mL) for general anesthesia, 35 mL (10th-90th centile: 0-389 mL) for local anesthesia, and 100 mL (10th-90th centile: 0-500 mL) for spinal anesthesia (P = .002). In comparison with general anesthesia, local anesthesia was associated with lower rate of absorption of 500-1000 mL (4.2% vs 13.4%) and of 1000-1500 mL (3.6% vs 9.8; P = .002). Laparoscopic tubal ligation performed during the procedure was also associated with higher glycine absorption (odds ratio, 3.63; 95% confidence interval, 1.12-11.84). CONCLUSIONS Local anesthesia with sedation is associated with significantly decreased glycine absorption and lower rate of absorption > 500 mL when compared with general anesthesia.

Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review protocol

BackgroundHysterosalpingosonography has been suggested as a less invasive alternative to hysterosalpingography for detecting tubal occlusion among subfertile women. We aim to determine the diagnostic accuracy of hysterosalpingosonography and to compare it to hysterosalpingography.Methods/designWe will conduct a systematic review of diagnostic test accuracy. We will search Medline, Embase, Cochrane Library, Web of Science and Biosis, as well as reference lists of included studies and previous related review articles. Diagnostic studies that compared hysterosalpingosonography ± hysterosalpingography to laparoscopy with chromotubation in women suffering from subfertility will be eligible. Two authors will independently screen for inclusion, data extraction, and quality assessment. Methodological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Study 2 tool (QUADAS-2). We will use SAS 9.3 (SAS Institute Inc., Cary, NC, USA, 2011) to program bivariate random-effects models, estimate pooled sensitivity and specificity with 95% confidence intervals and to generate summary receiver operating characteristics curves. We will perform sensitivity analyses to examine the effect of differences in techniques used for hysterosalpingosonography and in methodological quality of studies.DiscussionThis systematic review will help to determine if hysterosalpingosonography is an adequate alternative screening test for diagnosing tubal occlusion. Accuracy of specific sono-HSG techniques may also be identified.Systematic review registrationThis review has been registered at PROSPERO. The registration number is CRD42013003829

Preovulatory uterine flushing with saline as a treatment for unexplained infertility: a randomised controlled trial protocol.

Introduction In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. Preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF. Our objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility. Methods and analysis We will perform a randomised controlled trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants will be randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally. We will assess relative risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. We will report the side effects, complications and acceptability of the intervention. Ethics and dissemination This project was approved by the Ethics committee of the Centre Hospitatlier Universitaire de Quebec (no 2015–1146). Uterine flushing is usually well tolerated by women and would constitute a simple, affordable and minimally invasive treatment for unexplained infertility. We plan to communicate the results of the review by presenting research abstracts at conferences and by publishing the results in a peer-reviewed journal. Trial registration number NCT02539290; Pre-results.

Quintuplets: a rare event following clomiphene citrate therapy.

While the effectiveness of clomiphene citrate in the treatment of oligo-ovulatory women has been demonstrated, its use in unexplained infertility remains controversial. In fact, expectant management, controlled ovarian stimulation plus intrauterine insemination and in vitro fertilization are among the possible treatments options for unexplained infertility. According to the most recent Cochrane review, clomiphene citrate was found to be no more effective than no treatment or placebo for clinical pregnancy or live birth, independent of the use of intrauterine insemination or human chorionic gonadotropin. 2 Clomiphene citrate increases the number of follicles produced per cycle and, therefore, increases the number of potential oocytes to be fertilized. Hence, ovulation induction with clomiphene citrate in unexplained infertility, which by definition includes women with ovulatory cycles, must be done very carefully because it can easily lead to multiple ovulations and multiple pregnancies. Moreover, with no clear positive impact on the live birth rate, clomiphene citrate can definitely be considered as risky, as shown in this Image of the Month. 1 Furthermore, we would like to emphasize the need for close ultrasound monitoring of the follicular response when clomiphene citrate is used in conjunction with gonadotropins. In the case mentioned, human chorionic gonadotropin was used to trigger ovulation, which most probably led to the fertilization of five oocytes. Most high order pregnancies could be averted with ultrasound monitoring which could, if needed, prompt cancellation of the cycle or conversion to rescue IVF. 3

P2-437: Efficacy of a memory training program using errorless or errorful learning in amnestic mild cognitive impairment: Preliminary results

[89.3/65.3], men 71,1 [81.6/62.6]).Co-existing dementia prior to ECT was diagnosed in 10 (23.8%) patients, mild cognitive imparment (MCI) in 7 (16.7%). Advanced vascular or neurodegenerative disease was found in 50% of patients. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. All patients achieved complete or partial remission of affective symptoms in HAMD 24. During ECT-treatment, patients with dementia or MCI showed more distinctive cognitive deficits than geriatric participiants without preexisting cognitive deficits in rating MMSE. In patients with cerebrovascular lesions, neurodegeneration or both in cranial MRI transient cognitive impairments were induced faster than in patients without cerebral changes. About 75% of these patients had not achieved baseline levels in cognitive functioning 8 weeks after finishing treatment. In 1/3 MCI or dementia were diagnosed in follow-up. Geriatric patients without cognitive impairment before treatment and no or only mild neuroimaging findings achieved full cognitive functioning during follow-up. Conclusions: Our results show that ECT is effective in refractory geriatric depression. Severe cognitive side-effects occur mainly in patients with pre-diagnosed cognitive impairment or MRI signs of neurodegenerative or vascular disease.