Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo

Introduction and objectivesThis study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias.Material and methodsWe performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini–Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC).ResultsThe study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people.ConclusionThe most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.     

白及多糖超声提取工艺及其抗氧化活性研究

目的：优化白及多糖的超声提取工艺，比较不同产地白及多糖含量差异，考察白及多糖稳定性和抗氧化活性。方法：以多糖得率为考察指标，料液比、超声温度、超声时间为考察因素设计L9（34）正交试验优化白及多糖超声波提取工艺；以苯酚-硫酸法测定白及多糖含量，考察陕西汉中、云南普洱、湖南洪江及四川绵阳白及多糖含量产地差异；以化学方法考察白及多糖稳定性，并比较白及多糖对1,1-二苯基-2-苦肼基自由基（DPPH·）和羟基自由基（·OH）的清除率以评价其体外抗氧化活性。结果：最佳超声提取工艺条件为：料液比1:25（g/mL）、超声温度80 ℃、超声时间10 min；四川绵阳白及多糖含量最高，达到60.81%，湖南洪江次之，云南普洱最低；白及多糖在柠檬酸及中性溶液中的稳定性较好，在苯甲酸钠、过酸性或过碱性溶液中的稳定性较差；白及多糖能有效地清除DPPH和羟基自由基，具有潜在的体外抗氧化活性。结论：白及多糖超声波提取工艺的优化及其抗氧化活性研究，可为白及多糖提取及综合利用提供借鉴。     

Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Prevention–sponsored Summit

Uptake of colorectal cancer screening remains suboptimal. Mailed fecal immunochemical testing (FIT) offers promise for increasing screening rates, but optimal strategies for implementation have not been well synthesized. In June 2019, the Centers for Disease Control and Prevention convened a meeting of subject matter experts and stakeholders to answer key questions regarding mailed FIT implementation in the United States. Points of agreement included: 1) primers, such as texts, telephone calls, and printed mailings before mailed FIT, appear to contribute to effectiveness; 2) invitation letters should be brief and easy to read, and the signatory should be tailored based on setting; 3) instructions for FIT completion should be simple and address challenges that may lead to failed laboratory processing, such as notation of collection date; 4) reminders delivered to initial noncompleters should be used to increase the FIT return rate; 5) data infrastructure should identify eligible patients and track each step in the outreach process, from primer delivery through abnormal FIT follow-up; 6) protocols and procedures such as navigation should be in place to promote colonoscopy after abnormal FIT; 7) a high-quality, 1-sample FIT should be used; 8) sustainability requires a program champion and organizational support for the work, including sufficient funding and external policies (such as quality reporting requirements) to drive commitment to program investment; and 9) the cost effectiveness of mailed FIT has been established. Participants concluded that mailed FIT is an effective and efficient strategy with great potential for increasing colorectal cancer screening in diverse health care settings if more widely implemented.     

香连胃漂浮片的制备及体外释放研究

目的制备香连胃漂浮片并考察其体外释放性能。方法以羟丙基甲基纤维素K4M(hydroxypropyl methylcellulose K4M,HPMC-K4M)、十六醇、碳酸氢钠(NaHCO3)、乳糖、聚维酮K30(povidone K30,PVP-K30)、硬脂酸镁为辅料,采用粉末压片法制备香连胃漂浮片;以盐酸小檗碱的累积释放度为指标考察制剂的体外释药性能;采用正交试验对HPMC-K4M、十六醇、NaHCO3用量进行优选。通过数据拟合方程探讨制剂中盐酸小檗碱、木香烃内酯的释药机制。结果最优处方为香连复方提取物60.0 g、HPMC-K4M30.0 g、十六醇8.0 g、NaHCO38.0 g、乳糖8.0 g、PVP-K304.8 g、硬脂酸镁1.2 g(200片量)。指标成分盐酸小檗碱和木香烃内酯的体外释药特性均符合Riger Peppas模型,为扩散与骨架溶蚀协同作用。结论成功制得香连胃漂浮片,漂浮滞后时间短,持续漂浮时间长,且具有缓释特性。     

The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening

The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information-system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut-off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut-off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non-participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut-off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut-off were detected in the subsequent round.