Alzheimer's Disease THErapy With NEuroaid (ATHENE): A Randomized Double-Blind Delayed-Start Trial

ObjectivesPreclinical and clinical studies indicate a role for MLC901 (NeuroAiD II) in Alzheimer's disease (AD). The primary aim was to investigate its safety as add-on therapy to standard treatment and the secondary aims its effect on cognition and slowing disease progression.DesignRandomized double-blind placebo-controlled delayed-start study.Setting and ParticipantPatients with mild to moderate probable AD by NINCDS-ADRDA criteria, stable on acetylcholinesterase inhibitors or memantine (n = 125), were randomized to receive MLC901 (early starters) or placebo (delayed starters) for 6 months, followed by a further 6 months when all patients received MLC901, in a delayed-start design (clinical trial registration: ClinicalTrials.gov, NCT03038035).MethodsThe primary outcome measure was occurrence of serious adverse events (SAEs) at 6 months. Secondary outcomes included the Alzheimer's Disease Assessment Scale–Cognitive subscale (ADAS-Cog) and other assessment scales.ResultsThere was no significant difference in the risk of SAEs between early and delayed starters at month (M) 6 (22.6% vs 27.0%, risk difference ?4.4%, 90% CI –16.9% to 8.3%). Similarly, there was no significant difference in the risk of adverse events and the occurrence of stroke or vascular events between early and delayed starters throughout the 12-month study period. Early starters did not differ significantly on ADAS-Cog from delayed starters at M6 [mean difference (MD) ?1.0, 95% CI –3.3 to 1.3] and M12 (MD –2.35, 95% CI –5.45 to 0.74) on intention-to-treat analysis. Other cognitive assessment scales did not show significant differences.Conclusions and ImplicationsThis study of 125 persons with dementia found no evidence of a significant increase in adverse events between MLC901 and placebo, thus providing support for further studies on both efficacy and safety. Analyses suggest the potential of MLC901 in slowing down AD progression, but this requires further confirmation in larger and longer studies using biomarkers for AD.     

The Risk of Alzheimer's Disease After Acute Appendicitis With or Without Appendectomy

ObjectivePrevious epidemiologic studies have suggested an association between appendectomy and Parkinson's disease. The aim of the current study was to examine the risk of Alzheimer's disease (AD) and other types of dementia following appendicitis or appendectomy for appendicitis.DesignPopulation-based cohort study.Setting and participantsWe used claims data from the Taiwan National Health Insurance Research Database. Participants aged ≥45 years with acute appendicitis or who received appendectomy for appendicitis were enrolled and followed up for more than 15 years. Cases and controls underwent 1:1 matching by age, sex, index date, and dementia-related comorbidities.MethodsThe primary outcome was AD, and secondary outcomes included other dementia types. Adjusted hazard ratios (aHRs) were calculated, and a competing risk regression model was created. The E value for causality of evidence was calculated.ResultsPatients developing appendicitis (0.6% vs 0.1%, P = .005) and those receiving appendectomy for appendicitis (0.4% vs 0.1%, P = .003) had higher incidences of AD than the controls during the follow-up period. A Cox regression analysis with adjustment for potential confounders showed that patients with appendicitis [aHR 6.68, 95% confidence interval (CI) 1.84-24.48] and those receiving appendectomy for appendicitis (aHR 5.01, 95% CI 1.33-18.85) were more likely to develop AD than the controls. These 2 groups also had higher risks for unspecified dementia and all types of dementia but not for vascular dementia than the controls. The age at dementia diagnosis was 88.51 years in the controls; however, among people who developed dementia following appendicitis, the mean age at diagnosis was 70.18 years, and dementia occurred 5.84 years after appendicitis. The competing risk regression models and the E values support the study findings.Conclusions and implicationsAfter recovery from appendicitis, these patients should be followed up for signs of AD.     

A cross-sectional study on coronary artery disease diagnosis in patients with peripheral artery disease

PurposeCompared with healthy individuals, patients with peripheral artery disease (PAD) generally have a very high risk of subclinical Coronary artery disease (CAD) and cardiovascular events. To determine the correlation between CAD in PAD patients, thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD.MethodsThis clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016. In this research, PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination. In addition, this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test.ResultsWith the statistical results, the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography. Further, 30.93% of asymptomatic CAD prevalence was observed in PAD patients. The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD, particularly in patients with diabetes and dyslipidemia.ConclusionThere exists a strong correlation between PAD and CAD. Hence, precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.     

A Lifestyle Intervention Program to Improve Knowledge and Health Behaviors in Women

ObjectiveTo improve health knowledge, facilitate healthy behaviors, and provide social support for a high-risk population of women by implementing a culturally tailored, gender-specific lifestyle intervention program.DesignEvidence-based practice project.Setting/Local ProblemA Chicago neighborhood in Cook County, Illinois, where there are increased rates of diabetes, heart disease, cancer, stroke, hypertension, obesity, preterm birth, and violent crime.ParticipantsFemale residents of the community, ages 19 to 45 years; 12 participants registered for the program, and 11 participants completed the entire 2-month program.Interventions/MeasurementsThe BE WISE Lifestyle Intervention, a culturally tailored, gender-specific behavior change curriculum, was used for this project. An interprofessional team was used to enhance participant experience, and neighborhood collaborations were established to create sustainability of efforts. Pre- and postintervention measures of diet, physical activity, social support, and knowledge acquisition were used to evaluate outcomes.ResultsImprovement was noted for knowledge in most of the content areas, as well as for dietary and physical activity behaviors. All participants rated the program highly and responded positively to the social support experienced in the group.ConclusionCulturally tailored lifestyle interventions can be effective in improving knowledge and encouraging behavior change, especially when delivered in group settings to enhance social support. Community-level collaborations enhance interventions by providing local support and resources for participants. Because behavior change takes time, follow-up at the 6-month and 1-year intervals is recommended to determine longer-term outcomes.     

1例富血小板血浆治疗外阴Paget′s病术后创面感染的护理体会

总结1例外阴Paget’s病术后创面感染的护理体会,利用伤口评估三角工具对患者创面进行评估,通过使用液体伤口敷料联合银离子敷料控制感染,富血小板血浆技术促进伤口愈合,个体化健康教育提高患者治疗依从性的整体干预方案对伤口进行有效管理,结果显示伤口愈合效果良好。     

Perceived neighborhood social cohesion and the 10-year risk of cardiovascular disease in low- and middle-income countries: The World Health Organization Study on Global Aging and Adult Health

Low- and middle-income countries (LMICs) bear the greatest burden of cardiovascular disease (CVD) worldwide. Emerging evidence, mostly from industrialized countries, suggest that neighborhood characteristics influence cardiovascular health. This study presents results from 27,797 participants living in six LMICs on the association of perceived neighborhood social cohesion, the degree of connectedness among neighbors, with 10-year risk of CVD. We observed that greater perceived neighborhood social cohesion was associated with lower odds of high (>20%) 10-year CVD risk (OR = 0.67, 95%CI: 0.53–0.86). These novel findings, suggest that interventions to enhance social cohesion may have beneficial effects on cardiovascular health in LMICs.