Objective:To explore the changes of cerebral blood flow in patients with chemotherapy-related cognitive impairment using magnetic resonance pseudo-continuous arterial spin labeling (PCASL).Methods:Twenty-seven patients with invasive ductal carcinoma of the breast who were treated at Nuclear Industry 215 Hospital of Shaanxi Province from June 2019 to October 2021 were selected as the patient group. All of them received modified radical mastectomy for the affected breast cancer and were treated with EC-T chemotherapy after the operation. During the same period, 26 healthy volunteers with matched age and years of education were included as the control group. The time point before the first chemotherapy after surgery for breast cancer patients is defined as point T0, and the time point after the end of the entire chemotherapy cycle is defined as point T1. At point T0, neuropsychological scale assessment and magnetic resonance data collection were conducted for the patient group, while the control group completed the data collection of the above two indicators from June 2019 to May 2020. Subsequently, the neuropsychological scale scores and cerebral blood flow (CBF) graphs of the two groups of samples were compared. At point T1, the neuropsychological scale assessment and magnetic resonance scanning were conducted again for the patient group. The neuropsychological scale scores and CBF plots of the patient group at points T0 and T1 were longitudinally compared. Finally, based on linear regression analysis, the relationship between the differences in CBF before and after chemotherapy for breast cancer and the neuropsychological score was explored.Results:At point T0, there was no statistically significant difference in the CBF and neuropsychological scale scores between the patient group and the control group (all P>0.05). Compared with point T0, in the patient group, the scores of multiple sub-items of the Auditory Verbal Learning Test-HuaShan Version (AVLT-H) at point T1 [including immediate recall (AVLT_1), short-term delayed recall (AVLT_2), and long-term delayed recall (AVLT_3)] were significantly decreased (all P<0.05); The score of the backward digit span (BDS) also significantly decreased ( P<0.05); The time spent on the Color Trails Test (CTT) [including CTT-1 and CTT-2] significantly increased (all P<0.05); In addition, compared with point T0, in the patient group, CBF decreased in the left middle frontal gyrus, superior frontal gyrus and inferior parietal lobule at point T1 (all P<0.05, GRF corrected), and the CBF of the right superior radiative crown, anterior radiative crown, anterior limb of the internal capsule, anterior part of the corpus callosum and pusin increased (all P<0.05, corrected by GRF). The results of regression analysis indicated that ΔCTT-1 was negatively correlated with Δ left inferior parietal lobular CBF ( t=-5.741, P<0.001). Conclusions:Chemotherapy can cause changes in cerebral blood flow in patients with breast cancer, accompanied by multiple reductions in cognitive domain functions. The decreased cerebral blood flow in the left inferior parietal lobule is closely related to the decline of attention function and executive function in patients.

Objective:To explore the changes of cerebral blood flow in patients with chemotherapy-related cognitive impairment using magnetic resonance pseudo-continuous arterial spin labeling (PCASL).Methods:Twenty-seven patients with invasive ductal carcinoma of the breast who were treated at Nuclear Industry 215 Hospital of Shaanxi Province from June 2019 to October 2021 were selected as the patient group. All of them received modified radical mastectomy for the affected breast cancer and were treated with EC-T chemotherapy after the operation. During the same period, 26 healthy volunteers with matched age and years of education were included as the control group. The time point before the first chemotherapy after surgery for breast cancer patients is defined as point T0, and the time point after the end of the entire chemotherapy cycle is defined as point T1. At point T0, neuropsychological scale assessment and magnetic resonance data collection were conducted for the patient group, while the control group completed the data collection of the above two indicators from June 2019 to May 2020. Subsequently, the neuropsychological scale scores and cerebral blood flow (CBF) graphs of the two groups of samples were compared. At point T1, the neuropsychological scale assessment and magnetic resonance scanning were conducted again for the patient group. The neuropsychological scale scores and CBF plots of the patient group at points T0 and T1 were longitudinally compared. Finally, based on linear regression analysis, the relationship between the differences in CBF before and after chemotherapy for breast cancer and the neuropsychological score was explored.Results:At point T0, there was no statistically significant difference in the CBF and neuropsychological scale scores between the patient group and the control group (all P>0.05). Compared with point T0, in the patient group, the scores of multiple sub-items of the Auditory Verbal Learning Test-HuaShan Version (AVLT-H) at point T1 [including immediate recall (AVLT_1), short-term delayed recall (AVLT_2), and long-term delayed recall (AVLT_3)] were significantly decreased (all P<0.05); The score of the backward digit span (BDS) also significantly decreased ( P<0.05); The time spent on the Color Trails Test (CTT) [including CTT-1 and CTT-2] significantly increased (all P<0.05); In addition, compared with point T0, in the patient group, CBF decreased in the left middle frontal gyrus, superior frontal gyrus and inferior parietal lobule at point T1 (all P<0.05, GRF corrected), and the CBF of the right superior radiative crown, anterior radiative crown, anterior limb of the internal capsule, anterior part of the corpus callosum and pusin increased (all P<0.05, corrected by GRF). The results of regression analysis indicated that ΔCTT-1 was negatively correlated with Δ left inferior parietal lobular CBF ( t=-5.741, P<0.001). Conclusions:Chemotherapy can cause changes in cerebral blood flow in patients with breast cancer, accompanied by multiple reductions in cognitive domain functions. The decreased cerebral blood flow in the left inferior parietal lobule is closely related to the decline of attention function and executive function in patients.

With the rapid acceleration of aging in China, there is a huge need for elderly patients to have improved quality of life in the terminal stage.Palliative sedation is an integral part of palliative care and can alleviate painful refractory symptoms, and its use in patients in various terminal illnesses is being explored across the world.Attention is focused on its indications and implementation.In China, palliative sedation in clinical practice is in an early exploratory stage and relevant criteria and guidelines have yet to be established.A review of the current practice and research progress concerning palliative sedation for patients' end-of-life care in China and the rest of the world will offer insight and strategic considerations in the initial pursuit and accelerated acceptance in the future in China.

Pain is a prevalent symptom in both cancer and non-cancer end-stage diseases, often being the most feared by patients and significantly impacting their quality of life.Hospice care aims to address physical, psychological, spiritual, and other needs of patients and their families during this stage, with a focus on alleviating pain and discomfort.Effective pain management is a crucial component of hospice care, particularly given the increasing prevalence of cancer and chronic diseases in China and the growing elderly population.To provide analgesic management for hospice patients, a thorough assessment of pain is essential to identify its type and characteristics.Treatment approaches may include etiological interventions, pharmacotherapy, interventional therapy, physiotherapy, psychotherapy, and comfort care, all aimed at achieving comprehensive pain management.The use of opioid should be carefully guided by scientific principles to minimize adverse effects and optimize pain relief, ultimately enhancing patients' end-of-life quality of life.