Toward a revision of criteria for the dementias

This article critically considers current diagnostic criteria for dementia and reports recommendations approved by at least 80% of experts attending the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3). There was consensus that many of the features proposed as essential to a diagnosis of dementia in the 1980s no longer are relevant (for example, the requirements for memory impairment, electroencephalogram and cerebrospinal fluid studies, age-specific exclusions). In addition, other syndromes such as frontotemporal dementia have been recognized and need to inform new dementia criteria. It is also recognized that a diagnosis of depression need not exclude a dementia diagnosis. Other proposals, such as neuropathology should be considered as additional evidence and not as a gold standard or that some people with dementia have prolonged plateaus so that progressive decline need not be a criterion for Alzheimer’s disease (AD), were more controversial and did not receive similar support. Given the evidence of the last three decades, there is merit in reconsidering the criteria by which dementia and AD are diagnosed.     

阻塞性睡眠呼吸暂停低通气综合征对患者外周血淋巴细胞免疫表型及C反应蛋白的影响

目的:通过分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者外周血淋巴细胞免疫表型及C反应蛋白(CRP),探讨OSAHS对机体免疫功能及炎症反应的影响。方法:根据多导睡眠图检测结果,将60例OSAHS患者分为轻度OSAHS组20例,中度OSAHS组22例,重度OSAHS组18例,选取排除OSAHS诊断的健康体检者40名作为对照组。比较受试者的年龄、睡眠状况及睡眠中末梢血氧,抽取空腹血两份,分别采用流式细胞仪行淋巴细胞免疫表型分析,检查血CRP值。结果:OSAHS组最低血氧、平均血氧均较对照组明显下降,且在OSAHS严重程度间差异均有统计学意义(P<0.01)。OSAHS组患者外周血CD3+、CD4+/CD3+及CD4+/CD8+比值均较对照组下降(P<0.05~P<0.01),在OSAHS严重程度间差异均有统计学意义(P<0.01);OSAHS组CD8+/CD3+较对照组升高(P<0.05~P<0.01);OSAHS组CD16+CD56+较对照组升高(P<0.05);CD19+与对照组差异无统计学意义(P>0.05);重度OSAHS组外周血CRP均较对照组和轻度OSAHS组升高(P<0.01和P<0.05)。结论:OSAHS导致机体免疫功能下降,同时伴有炎症反应增强,并且与OSAHS严重程度有一定关系。     

基于国际居民长期照护评估工具的养老机构不同能力等级老年人照护需求研究

背景　我国各地各机构分级护理划分的标准和依据不统一,加之老年人经济水平及其他因素,影响了分级护理内容的完整性和客观性,导致实际的分级护理可能与老年人需求、能力等级不匹配。目的　了解养老机构不同能力等级老年人对长期照护服务的需求,为针对性地采取适宜的老年照护服务提供依据。方法　于2018年4-7月采用方便抽样的方法,选取南京市和常州市2家养老机构的老年人（≥60岁,n=575）进行问卷调查。问卷包括老年人能力评估问卷、国际居民长期照护评估工具（interRAI-LTCF）,分别用以评价老年人的能力等级、照护问题和需求。采用interRAI-LTCF中的临床评估报告（CAPs）分析每例老年人的综合评估资料,记录发现的照护问题;采用对应分析对不同能力等级的老年人与CAPs所发现的问题进行分析。结果　共回收有效问卷532份,有效回收率92.5%。其中,能力等级评价为能力完好55例（10.3%）,轻度失能264例（49.6%）,中度失能71例（13.4%）,重度失能142例（26.7%）。采用CAPs可将养老机构老年人存在的照护问题分为4类21个方面,老年人存在的中位照护问题数为4（3）个。对应分析结果显示：能力完好老年人的主要照护问题为不良的生活习惯,需要进行健康教育;轻度失能老年人的主要照护问题为心理社会和躯体活动不足问题,是精神慰藉和健康促进服务的高需人群;中度和重度失能老年人的主要照护问题是日常生活活动能力受限和临床健康问题,是日常生活照料和医疗护理的高需人群。结论　运用对应分析对不同能力等级老年人的健康问题及照护需求进行比较,发现能力等级不同的老年人之间照护服务需求存在差异,这可以为养老机构有针对性地开展适宜的老年健康服务项目提供依据,从而更好地提高老年人的生活质量。     

Update on the roles of macrophages in the degeneration and repair process of intervertebral discs

Intervertebral disc (IVD) degeneration is the common cause of lumbar degenerative diseases, causing severe social and economic burden. The process of IVD degeneration involves a complex of pathologic changes on both extracellular matrix degradation and resident cell apoptosis. In recent years, there is increasing evidence that macrophages play vital roles during the damage and repair process of IVD degeneration. Nevertheless, the interactions between macrophages and IVD are not well understood, even if the IVD has long been regarded as the immune privileged site. Therefore, this review mainly focuses on the progress and obstacles of studies investigating the blood supply, immune response and especially macrophages during the IVD degeneration process.     

老年人内脏脂肪面积与血脂水平及冠心病的相关性研究

目的 探讨内脏脂肪面积与血脂水平及冠心病的相关性。 方法 选取2018年4月安徽广德农村地区参与体检的老年人(年龄≥60岁)共139例,结合当地基层医疗档案仔细询问冠心病病史,将于当地医院确诊为冠心病者57例分为冠心病组(CHD),其余体检者共82例为非冠心病组(NC)。清晨空腹抽取静脉血测定血总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平。嘱受检者免冠、脱鞋、空腹,仅着单衣测量身高体重。随后使用韩国Inbody S10人体成分分析仪,应用生物电阻抗原理测量肥胖相关指标:内脏脂肪面积、体脂率、体脂含量、体质量指数。分析内脏脂肪面积与血脂水平及冠心病的相关性。 结果 CHD组的内脏脂肪面积[(92.57±39.29)cm2]及其他肥胖相关指标和血低密度脂蛋白[(3.96±0.86)mmol/L]水平均高于NC组。回归分析显示内脏脂肪面积增高者及高低密度脂蛋白血症者发生冠心病的风险增加,分别为NC组的4.052倍及2.348倍。相关性分析显示,内脏脂肪面积与血甘油三酯水平呈正相关。 结论 内脏脂肪面积和低密度脂蛋白与冠心病密切相关,老年冠心病个体中内脏脂肪面积及其他肥胖指标显著高于非冠心病个体,当内脏脂肪面积增加或高低密度脂蛋白血症时,老年人冠心病发病风险明显增高。随着内脏脂肪面积增加,血甘油三酯水平增高。故可利用生物电阻抗法分析老年人肥胖相关指标,结合血脂水平对冠心病的预防及预后进行动态监测。      

Occlusal force predicted cognitive decline among 70- and 80-year-old Japanese: A 3-year prospective cohort study

PurposeDementia is a growing health problem for countries with aging populations, but few effective dementia treatments are available. However, there is increasing interest in oral health as a modifiable risk factor in interventions to prevent cognitive decline. This study aimed to investigate the impact of oral health on the decline of cognitive function over 3 years among Japanese people aged 70 and 80 years.MethodsParticipants (n = 860) were community-dwelling older adults who participated in baseline and follow-up surveys (at baseline: 69–71 years n = 423; 79–81 years, n = 437). Registered dentists examined the number of teeth, number of functional teeth, number of periodontal teeth, and occlusal force. The Japanese version of the Montreal Cognitive Assessment was used to evaluate cognitive function. We also evaluated socioeconomic factors, medical history, drinking and smoking habits, physical performance, genetic factors, and C-reactive protein concentration in blood. A generalized estimating equation (GEE) was used to examine how oral health at baseline influenced cognitive decline over 3 years.ResultsThe GEE showed that the number of teeth (non-standardized coefficient: B = 0.031, p = 0.022) and occlusal force (B = 0.103, p = 0.004) at baseline were associated with cognitive function at follow-up, even after adjusting for other risk factors. Furthermore, maintaining more teeth (B = 0.009, p = 0.004) and a stronger occlusal force (B = 0.020, p = 0.040) buffered cognitive decline.ConclusionsNumber of teeth and occlusal force predict cognitive decline over 3 subsequent years in Japanese older adults aged 70 and 80 years.     

Effects of enteral nutrition support combined with enhanced recovery after surgery on the nutritional status,immune function,and prognosis of patients with esophageal cancer after Ivor-Lewis operation

BackgroundEsophageal cancer (EC) with a high incidence of malnutrition is a highly malignant digestive tract tumor. We investigated the effect of enteral nutrition (EN) support combined with enhanced recovery after surgery (ERAS) on the nutritional status, immune function, and prognosis of patients with EC after Ivor-Lewis operation.MethodsOne hundred patients were randomly divided into the observation group (n=42) and the control group (n=58). The patients in observation group were treated with EN combined with ERAS intervention after Ivor-Lewis operation, and the patients in control group were treated with conventional postoperative EN intervention. The situation of operation, nutritional status, immune function recovery and prognosis between the two groups were compared.ResultsThere was no statistically significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The chest tube removal time and oral feeding time of the observation group after operation were shorter than those of the control group (P<0.05). After intervention, serum albumin (ALB), transferrin (TF), pre-albumin (PA) and hemoglobin (Hb) levels in both groups were significantly decreased. These indexes were significantly higher in the observation group than in the control group (P<0.05). There were no significant changes in the levels of immunoglobulin (Ig) A, IgG, and IgM, or the numbers of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ T cells in the observation group before and after intervention (P>0.05); however those indexes were significantly decreased in the control group after the intervention (P<0.05). Interestingly, the levels of IgA, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells and CD4⁺/CD8⁺ T cells in the observation group were significantly higher than those in the control group after intervention (P<0.05). The incidence of pulmonary infection in the observation group was significantly lower than that in the control group. The postoperative exhaust time, postoperative defecation time and postoperative hospital stay were shorter in the observation group than in the control group (P<0.05). There was no significant difference in hospitalization cost between the two groups (P>0.05).ConclusionsEN combined with ERAS was more beneficial to the improvement of nutritional status and immune function recovery of patients with EC after Ivor-Lewis operation. It also shortened the length of hospital stay.     

Vitamin D Receptor Genetic Polymorphism Is Significantly Associated With Decreased Risk of Hypertension in a Chinese Han Population

The aim of this study was to investigate the association of vitamin D receptor (VDR) gene polymorphism and hypertension in a Chinese Han population. The authors genotyped 3 tagSNPs (rs11574129, rs2228570, and rs739837) of the VDR gene using TaqMan assays in a case‐control study including 2409 patients with hypertension and 3063 controls. The results showed that rs2228570 presented statistical correlations with decreased risk of male hypertension after adjustment for confounding factors, odds ratios (ORs) and 95% confidence intervals (CIs) of additive, dominant, and recessive models were 0.828 (0.74–0.927), 0.75 (0.631–0.89), and 0.816 (0.67–0.995), and P values were .001, .001, and .044, respectively. Significant associations were found in the smoking population and ORs (95% CIs) of additive and dominant models were 0.81 (0.69–0.952) and 0.71 (0.552–0.913) (P values .011 and .008), respectively, after adjustment for covariates. Quantitative trait analysis indicated that the untreated cases with TT genotype of rs2228570 showed higher systolic blood pressure compared with the TC/CC genotype (P=.015). Our findings suggest that VDR genetic polymorphism rs2228570 is significantly associated with the decreased risk of hypertension in Chinese men and smokers.