Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

ObjectivesTo systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia.DesignSystematic review and random effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019.Setting and participantsRandomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up.MeasuresAll cause dementia and/or Alzheimer's disease.ResultsFifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR=0.84, 95% CI 0.74-0.95), beta blockers (HR=0.83, 95% CI 0.73-0.95) and diuretics (HR=0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR=0.88, 95% CI 0.81-0.97), beta blockers (HR=0.87, 95% CI 0.77-0.99), and diuretics (HR=0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone.Conclusions and ImplicationsRecommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.     

Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes

ObjectiveAfter diagnosis of Alzheimer's disease and related syndromes (ADRS), personalized care adapted to each patient's needs is recommended to provide a care plan and start symptomatic treatments according to guidelines. Over the past decade, dedicated structures and care have been implemented in various settings. Equal access to ADRS care, health care providers and services is crucial to ensure potential health benefits for everyone. However, the extent of use of recommended services and favorable health care utilization trajectories (HUT) may vary according to individual and contextual characteristics. The aim of this article was to (1) describe HUT patterns after multidimensional clustering of similar trajectories, (2) assess the proportion of individuals presenting favorable HUTs, and (3) identify factors associated with favorable HUTs.DesignCohort study.Setting and participantsA cohort of 103,317 people newly diagnosed with ADRS identified in the French health reimbursement system (SNDS) was followed for 5 years with their monthly utilization on 11 health care dimensions.MethodsFor 3 age groups (65–74, 75–84, ≥85 years), 15 clusters of patients were identified using partitioning around medoids applied to Levenshtein distances. They were qualitatively assessed by pluridisciplinary experts. Individual and contextual determinants of clusters denoting favorable trajectories were identified using mixed random effects multivariable logistic regression models.ResultsClusters with favorable HUTs denoting slow, progressive trajectories centered on at-home care, represented approximatively 25% of the patients. Determinants of favorable HUTs were mostly individual (age, female gender, absence of certain comorbidities, circumstances of ADRS identification, lower deprivation). Contextual determinants were also identified, in particular accessibility to nurses and nursing homes. Inter-territories variance was small but significant in all age groups (from 0.9% to 1.8%).Conclusion and implicationsFavorable HUTs remain the minority and many efforts can still be made to improve HUTs. Qualitative studies could help understanding underlying barriers to favorable HUTs.     

医务人员手术鞋血液及微生物污染情况调查

 目的 对医务人员手术鞋的血液及微生物污染情况进行调查,为手术鞋的清洗消毒提供理论依据。方法 2020年4—5月,连续3周从某院手术室内随机挑选清洗消毒后的手术鞋共80双,按照鞋子所属工作人员的类别（手术医生、护士、麻醉师和保洁人员）分为4类,采用肉眼观察与隐血测试两种方法调查鞋面血渍污染情况,以及采用接触印迹法对鞋底采样进行细菌和真菌培养。结果 隐血测试结果显示50.00%（40/80）的手术鞋被血液污染,其中手术医生的鞋面被血液污染的比率最高,达63.33%。细菌菌落计数显示保洁人员的手术鞋微生物污染严重,细菌和真菌计数均位于首位,分别为93、58 CFU/cm²。评估隐血测试与肉眼观察两种方法,结果显示胶体金免疫层析隐血测试方法的灵敏度为85.00%,特异度为70.00%。有6只鞋为假阴性,12只鞋为假阳性。肉眼观察的阳性率为57.50%,隐血试验的阳性率为50.00%,两种方法的阳性率比较,差异无统计学意义（P>0.05）。结论 医务人员手术鞋血液和微生物污染严重,需加强清洁与消毒,重视手术鞋作为病原微生物隐匿宿主传播的风险。     

微核试验制片方法的改进

目的简化、优化微核试验方法。方法对微核试验的制片过程进行简化、优化,改进后在细胞培养结束后直接吸弃上清液,然后加入氯化钾溶液进行低渗处理,随后预固定、离心。离心完成后,细胞再固定一次即可滴片。结果改进法玻片背景清晰,细胞染色稍深,但不影响细胞和微核观察。双核细胞数量不少,能够满足计数要求。油镜和高倍镜下,图像更清楚、背景更干净。改进法胞浆完整率、细胞着色率和平均每高倍视野细胞个数与传统方法比较有统计学意义,概率P值分别为0.0051(χ²=7.8375)、0.0140(χ²=6.0437)和0.0025(t=3.0951)。微核细胞率和细胞成团指数与传统方法比较无统计学意义,概率P值分别为0.7749(χ²=0.0817)和0.5152(U=0.0000)。结论改进法制片方法简单易行、结果可靠,试验质量更容易控制,还节省了时间,节省了人力、物力。     

上下肢康复机器人检验常见问题的讨论

随着我国医疗器械技术的发展,上下肢康复机器人作为一种新型的医疗器械出现在大众面前,很大程度上替代了传统的康复训练,提高了康复训练的效率。但是上下肢康复机器人的出现也伴随着一些问题,文章结合上下肢康复机器人的一些标准及广东省医疗器械质量监督检验所近年来对上下肢康复机器人的检测情况进行探讨,并提出一些问题和建议,以期能够规范上下肢康复机器人的市场和提高上下肢康复机器人的产品质量。     

婴儿运动表现测试在昆明地区小婴儿中的应用研究

目的 通过使用婴儿运动表现测试(TIMP)对昆明地区168名婴儿进行测试,并与美国常模数据进行比较,分析影响得分的相关因素及临床应用价值,为TIMP的本土化提供一定的参考依据。 方法 对昆明地区168例足月儿及矫正胎龄 34~57⁺⁶ 周早产儿进行TIMP测试,并记录原始得分及婴儿一般情况。 结果 1)随着婴儿胎龄的增加,TIMP测试得分逐渐升高,且各组测试得分均明显低于同周龄组美国常模标准,差异有统计学意义(t＝-3.763、-4.181、-3.554、-3.423、-2.489、-3.463、-4.579、-2.612、-2.359、-3.249、-3.038、-4.248,P<0.05);2)足月儿的TIMP得分高于早产儿(t=2.615,P<0.05);出生体重≥2 500 g婴儿的TIMP得分高于出生体重在1 500~<2 500 g之间的婴儿(t=-2.593,P<0.05);测试时矫正年龄在<40周、40~44周、45~48周、49~52周、≥53周的各组婴儿间TIMP得分比较,差异有统计学意义(F=168.226,P<0.001)。3)出生时胎龄(足月或早产儿),以及进行TIMP测试时的矫正胎龄分组是TIMP得分的影响因素(β=0.164、0.743,P<0.05)。 结论 TIMP评估得分能反映不同矫正胎龄婴儿的运动表现能力,各组测试得分均明显低于同周龄组美国常模标准,因此需要建立中国常模提供本土化数据参考;并对早产儿及低出生体重儿给予早期评估和干预。