Ovarian steroids and cognitive function

The ovarian steroids, estrogen and progesterone, not only govern reproductive events in mammalian females but also influence an array of other processes. Of particular clinical interest is the potential of ovarian steroids to facilitate storage of new memories and to protect neurons from various threats. Research during the past decade confirms that estrogen and progesterone influence the biochemical, electrical, and structural properties of neurons in brain regions that subserve learning and memory. These mechanisms form the biological foundations for the complex effects of ovarian steroids on cognitive functions in various species, including humans. Despite significant progress in our understanding of the roles of hormonal factors in cognitive function and neuronal survival, the value of hormone replacement as a treatment and deterrent for cognitive impairments associated with age, disease, and injury remains uncertain as we enter the new century.     

Estrogen and Neural Plasticity

Converging clinical evidence suggests that postmenopausal estrogen therapy in women is associated with improved cognition and a reduced incidence of Alzheimer's disease. In experimental work, investigators have found estrogen to promote changes in synaptic plasticity within the nervous system. In this article, we review both the clinical and the experimental literature, and consider mechanisms of action of estrogen on neurons and synaptic plasticity, and how they might protect against the cognitive impairments of old age.     

激素替代治疗对绝经妇女心脏保护效应的重新认识

激素替代疗法（HRT）已有数十年历史,但是否具有心脏保护效应一直存在争议。早期研究提示HRT可维持血管正常功能,但大样本随机对照研究却发现服用雌激素和孕激素妇女的心血管疾病较安慰剂组增加22％,这导致了HRT应用的急剧减少。而2007年妇女健康启动计划——冠状动脉钙化研究（WHI—CACS）却证实HRT能显著降低冠状动脉钙化,再次提起了人们对HRT心脏保护效应的关注。     

性激素替代治疗在冠心病防治中的作用

冠心病的发病率有着明显的性别差异,大量研究表明内源性雌激素和雄激素与冠心病的发生发展有着密切关系,它对于女性和男性分别有抗动脉粥样硬化作用,这提示人们可以通过恢复机体激素水平达到防治冠心病的作用。因此性激素替代治疗成为了对冠心病的防治研究的热点,本文主要综述性激素替代治疗在冠心病防治中的研究进展。     

The Effects of Estrogen Replacement Therapy on Neuropsychological Functioning in Postmenopausal Women With and Without Dementia: A Critical and Theoretical Review

We review 42 studies examining the effects of estrogen replacement therapy (ERT) on memory and cognition in nondemented postmenopausal women. Although there are an appreciable number of nonsignificant findings, the number of significant findings favoring ERT users considerably outnumbers the rare findings of better performance in controls. Experimental studies demonstrate a consistent beneficial effect on verbal memory, but these are short-term studies of the more acute effects of ERT. The observational studies suggest that there may be a long-lasting effect of continued ERT on cognitive functioning, but these studies need to be interpreted with caution because of the lack of random assignment and a possible healthy user bias. We also summarize findings from studies on the effects of ERT on Alzheimer's disease (AD). ERT is associated with a decreased risk for dementia, but there is little evidence for a positive effect on cognition in women with AD. Definitive answers to questions about the long-term effects of ERT on cognitive aging and risk of developing AD should be provided by 3 ongoing clinical trials.     

The Burden of Dementia: A Medical and Research Perspective

Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase the likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging.     

Recognition and Social Justice: A Roman Catholic View of Christian Bioethics of Long-Term Care and Community Service

Contemporary Christian ethics encounters the challenge to communicategenuinely Christian normative orientations within the scientificdebate in such a way as to render these orientations comprehensible,and to maintain or enhance their plausibility even for non-Christians.This essay, therefore, proceeds from a biblical motif, takesup certain themes from the Christian tradition (in particularthe idea of social justice), and connects both with a compellingcontemporary approach to ethics by secular moral philosophy,i.e. with Axel Honneth's reception of Hegel, as based on Hegel'stheory of recognition. As a first step, elements of an ethicsof recognition are developed on the basis of an anthropologicalrecourse to the conditions of intersubjective encounters. Theseconditions are then brought to bear on the idea of social justice,as developed in the social-Catholic tradition, and as systematicallyexplored in the Pastoral Letter of the United States Conferenceof Catholic Bishops, Economic Justice For All (1986). Proceedingfrom this basis, aspects of a Christian ethics of communityservice with regard to long-term care can be defined.     

Some Hindu Insights on a Global Ethic in the Context of Diseases and Epidemics

As we develop a global ethic in the context of diseases, we need to reconsider the wisdom of the religious traditions, for there is more to ailments than their material causes. In the Hindu framework, aside from the Ayurvedic system, which is based on herbal medicines and a philosophical framework, there is the insight that much of what we experience is a direct consequence of our karma (consequential actions). Therefore, here one emphasizes self–restraint and self–discipline in contexts that are conducive to self–hurting behavior.     

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.     

The tasks of self-managing hepatitis C: The significance of disclosure

The narratives of those with hepatitis C were viewed through the lens of Corbin and Strauss’ [Corbin, J., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. The Jossey-Bass health series and The Jossey-Bass social and behavioral science series. San Francisco, CA: Jossey-Bass.] self-management model for chronic illness, using qualitative methodology. Fifteen Australian hepatitis C positive interviewees described the challenges and turning points in adjusting to their diagnosis. The data were analysed using open- and closed-coding methods. Support was found for a self-management model encompassing medical, emotional and life role facets for those adjusting to life with hepatitis C. Unique challenges emerged beyond those described by Corbin and Strauss (1988 Corbin, J and Strauss, A. 1988. Unending work and care: Managing chronic illness at home, The Jossey-Bass health series and The Jossey-Bass social and behavioral science series San Francisco, CA: Jossey-Bass.  [Google Scholar]), namely that disclosure impacted both positively and negatively on the tasks of self-management. It was concluded that self-management may be compromised by disclosure, particularly distress derived from hepatitis C-related stigma. The self-management tasks described contribute to broadening clinicians’ understanding of the challenges faced by those living with hepatitis C.     

Central Nervous System Complications of Sickle Cell Disease in Children: An Overview

Complications involving the central nervous system are among the most devastating manifestations of sickle cell disease. Although overt stroke occurs in 1 in 10 children with Hemoglobin SS, “silent cerebral infarcts” are even more frequent. Both are associated with significant neuropsychological deficits. The end result of these effects on the CNS often is diminished school performance. The use of transcranial Doppler ultrasonography screening allows the identification of patients at high risk for clinical stroke as well as stroke prevention by chronic transfusion. However, definitive prophylaxis and treatment for most CNS complications of sickle cell disease have yet to be determined.