我国老年人轻度认知障碍与全因死亡关联的Meta分析

目的 对老年人轻度认知障碍与全因死亡的关联进行定量评估。方法 检索PubMed、EMBASE、万方数据知识服务平台、中国知网数据库中关于老年人轻度认知障碍与全因死亡关系的相关文献,时限自建库至2021年8月1日,采用R 4.02软件对纳入文献进行Meta分析。结果 最终纳入9篇队列研究文献,共计48 709例患者。纳入文献均为高质量水平。Meta分析结果显示,轻度认知障碍与全因死亡风险增加之间的关联有统计学意义,与认知正常人群相比,患有轻度认知障碍的老年人死亡风险增加39%（HR=1.39,95％CI：1.18~1.63）。结论 当前研究证据表明,轻度认知障碍是中国老年人全因死亡风险增加的独立预测指标,应加强老年人轻度认知功能障碍的早发现、早诊断和早治疗。     

HIV感染者神经认知功能及可调控危险因素的现况研究

  目的  了解可调控危险因素对人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者神经认知功能的影响。  方法  利用“HIV与衰老相关疾病前瞻性队列研究”队列2018-2019年基线调查数据,选取40岁及以上的中老年HIV感染者。采用广义线性模型(general liner model, GLM)分析包括心血管疾病危险因素和不良生活行为的可调控危险因素对感染者神经认知表现的影响。  结果  研究共纳入625例HIV感染者。心血管疾病危险因素及不良生活行为在中老年HIV感染者中报告比例较高。在不同年龄阶段,感染者各神经认知功能有不同程度的下降,整体上以60岁以后认知功能下降较明显。多因素回归分析模型分析显示,高血压是感染者定向力、记忆力、延迟回忆、语言功能和运动能力的危险因素,其他可调控危险因素如吸烟、饮酒、糖尿病和腹部肥胖等尚未发现统计学关联。此外,血压临床分级分析后发现,高血压前期和语言功能(β=-0.327, P=0.020)、定向力(β=-0.216, P=0.028)下降有关,即使未发展至高血压状态,高值血压仍会对神经认知功能产生负面影响。  结论  高血压和中老年HIV感染者神经认知功能下降相关,定向力及语言能力在高血压前期即可能受到不良影响。在日后HIV随访管理中要加大对高血压的防控力度,对高血压及早发现并进行规范化临床管理。     

HIV感染者神经认知障碍相关血液生物标志物研究

生物标志物辅助识别HIV感染者中神经认知障碍,尤其是血液中的生物标志物,凭借其操作简单、成本低、易于接受等特点,已成为更有前景的研究方向。本文系统检索了PubMed、中国知网、万方和维普数据库2008－2017年有关HIV感染者神经认知障碍的血液生物标志物研究文献,结合手工引文追溯检索到与纳入排除标准相符合的文献2篇,共纳入43篇相关文献进行系统综述,以期为深入研究和临床应用提供科学参考。     

中国HIV感染者和艾滋病患者抗逆转录病毒治疗后耐药情况的Meta分析

目的：了解中国HIV感染者和艾滋病患者抗逆转录病毒治疗后的耐药情况。方法检索中国知网、万方数据库和Pubmed数据库,将中国HIV感染者/AIDS患者抗病毒治疗后耐药性的文献纳入研究。应用R软件进行Meta分析。结果最终纳入15篇文献,经Meta分析结果显示,中国HIV感染者和艾滋病患者抗逆转录病毒治疗后总耐药率为4%;中等发达地区耐药率为4%,欠发达地区耐药率为5%;疫情较重地区的耐药率为5%,疫情居中地区为4%。结论中国HIV感染者/AIDS 患者经抗逆转录病毒治疗后总耐药率不高。     

HIV感染者巨细胞病毒血症现患率Meta分析

目的:运用Meta分析了解HIV感染者巨细胞病毒（CMV）血症的流行情况及相关因素。方法:系统检索2011-2020年PubMed、中国知网、万方数据知识服务平台、维普数据库中关于HIV感染者CMV血症现患率的文献,文献筛选和数据提取后进行Meta分析。结果:共纳入15篇文献,总样本量为5 076例。Meta随机效应模...     

基于联合模型的老年人轻度认知功能障碍发病风险预测研究

目的构建并比较基于6种不同认知功能测量量表的老年人轻度认知功能障碍(MCI)发病风险动态预测模型。方法基于2005-2020年阿尔茨海默病神经影像学倡议的纵向数据, 以简易精神状态量表(MMSE)、社会功能活动调查表(FAQ)、阿尔茨海默病评定量表认知分量表(ADAS-Cog11、ADAS-Cog13)、阿尔茨海默病评定量表延迟词语回忆(ADASQ4)和Rey听觉词语学习即刻测验(RAVLT_immediate)作为纵向认知功能评估指标评估认知功能的纵向变化, 利用联合模型分析纵向认知功能评估指标变化轨迹与生存结局MCI之间的关系, 构建老年人MCI发病风险预测模型, 以线性混合模型对纵向评估指标的变化轨迹建模, 以比例风险模型对生存过程建模, 通过关联参数(α)将两个子模型联系起来。采用受试者工作特征曲线下面积(AUC)评价模型在(t, t+Δt)随访时间段的预测效能, 其中t选取第30、42、54个月, Δt选取15和21个月。基于预测模型, 选取1名研究对象示例进行MCI发病风险个体动态预测。结果最终纳入544名基线认知状态正常的老年人(≥60岁), 其中11...     

抗病毒治疗HIV感染者神经认知损伤与认知表现特征研究

目的 联合应用两种神经认知评价量表,探讨接受抗病毒治疗（ART）的HIV感染者神经认知损伤患病率、影响因素及其神经认知表现特征。方法 纳入浙江省台州市开展的HIV与衰老相关疾病前瞻性队列研究中2 250例接受ART的HIV感染者。使用中国版简易智能精神状态检查量表（MMSE）和国际HIV相关性痴呆量表（IHDS）评价其神经认知损伤情况,并对2个量表中的7个神经认知域进行聚类分析。结果 在接受ART的HIV感染者2 250例中,年龄集中在45~89岁（48.0%,1 080/2 250）,男性占79.2%（1 782/2 250）,小学及以下文化程度者占37.8%（852/2 250）。MMSE和IHDS判断的神经认知损伤的患病率分别为14.3%（321/2 250）和31.8%（716/2 250）。多因素logistic回归分析结果显示,HIV感染者MMSE判断的神经认知损伤危险因素包括60~89岁（aOR=2.63,95%CI：1.52~4.56）、抑郁症状（aOR=5.58,95%CI：4.20~7.40）和使用依非韦伦（EFV）治疗（aOR=2.86,95%CI：1.89~4.34）;男性（aOR=0.71,95%CI：0.51~1.00）、偏胖（aOR=0.63,95%CI：0.44~0.89）和文化程度较高（aOR=0.11,95%CI：0.05~0.25）为保护因素。IHDS判断的神经认知损伤危险因素包括60~89岁（aOR=3.10,95%CI：2.09~4.59）、抑郁症状（aOR=1.78,95%CI：1.44~2.20）和使用EFV治疗（aOR=1.79,95%CI：1.41~2.29）;男性（aOR=0.75,95%CI：0.58~0.97）、偏瘦（aOR=0.67,95%CI：0.47~0.96）、基线CD4⁺T淋巴细胞（CD4）计数≥350个/μl（aOR=0.69,95%CI：0.53~0.91）和文化程度较高（aOR=0.23,95%CI：0.14~0.39）是保护因素。HIV感染者的神经认知表现分为4种主要类型,在年龄、性别、文化程度、饮酒、抑郁症状、腰臀比、高血压病史、糖尿病病史、基线CD4计数和使用EFV治疗的差异有统计学意义（均P < 0.05）。结论 接受ART的HIV感染者神经认知表现分为4种类型,神经认知损伤患病率较高,需对不同类型者采取针对性的监测、预防与控制措施。     

维生素A营养状况与AIDS发生发展的系统综述

目的综述维生素A在获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)发生发展过程中的作用。方法检索万方、中国知网、维普等数据库获得1997年至2019年国内公开发表的相关研究中文文献,检索Cochrane library,Pubmed,EMbase等数据库获得2002年至2019年公开发表的相关研究英文文献,包括系统综述和随机对照实验。结果从检索的到的985篇文献中筛选获得18篇英文文献,其中维生素A与HIV感染/AIDS患者死亡及患病风险关系的文献共纳入5篇,维生素A与HIV传播风险关系的文献共纳入了5篇,维生素A与HIV疾病进展关系的文献共纳入4篇,维生素A对HIV感染/AIDS患者健康状况影响的文献共纳入4篇。(1)HIV暴露儿童补充维生素A,可能会降低HIV暴露儿童的死亡风险。(2)HIV感染的孕妇补充维生素A可能会增加HIV垂直传播的风险。(3)维生素A的补充不会影响HIV的疾病进展。(4)维生素A的补充可能会为HIV感染/AIDS患者及HIV暴露人群带来健康收益。结论根据文献搜索结果分析,为HIV暴露儿童补充维生素A会降低其死亡风险,在AIDS的发生发展过程中为患者补充维生素A有利于其健康。[营养学报,2020,42(3):296-300]     

中国HIV/AIDS患者焦虑检出情况的Meta分析

目的 系统评价中国HIV/AIDS患者的焦虑检出情况。方法 检索建库至2022年3月有关中国HIV/AIDS患者焦虑检出率的横断面研究,完成文献筛选及质量评价后,采用R 4.4.1软件进行Meta分析。结果 共纳入文献65篇,研究对象31 303例,合并后中国HIV/AIDS患者焦虑检出率为33.04%(95%CI:29.73%～36.36%);亚组分析结果显示,中国不同地区、不同评价量表、不同感染途径、不同研究人群HIV/AIDS患者焦虑检出率的差异均有统计学意义(均P<0.05);对不同研究特征进行分组比较,获得社会/家人/朋友支持(OR=0.739 4, 95%CI:0.683 9～0.799 5,P<0.01)是HIV/AIDS患者焦虑症状的保护因素。结论 中国HIV/AIDS患者焦虑检出率较高,建议加强对HIV/AIDS患者心理健康状态的早期评估与干预,改善HIV/AIDS患者的焦虑状态。     

我国HIV感染者合并感染HBV现况

目的:通过文献回顾,了解我国HIV感染者中HBV感染的流行特征。方法:通过对2010-2019年文献检索、文献筛选、质量评价等过程,收集我国有关HIV感染者合并感染HBV的研究文献,对符合纳入标准的文献提取相关数据后进行Meta分析。结果:共纳入27项研究,合并样本量为69 816例;我国HIV感染者的HBV合并感染率...     

The Role of Depressive Symptoms and Physical Activity Levels in Mediating the Association Between HIV Status and Neurocognitive Functions Among Individuals Aged at Least 50 Years in China: Cross-sectional Study

BackgroundNeurocognitive impairments are prevalent among older people in China. It is more problematic among older people living with HIV.ObjectiveThis study aims to compare neurocognitive performance between older people living with HIV and HIV-negative controls, and to explore whether the association between HIV status and neurocognitive performance was mediated by depressive symptoms and level of physical activity.MethodsA cross-sectional study was conducted in Yongzhou, China. All people living with HIV aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls from the general population according to the distribution of age, sex, and years of formal education of older people living with HIV. A total of 315 older people living with HIV and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function, and motor skills).ResultsAs compared to HIV-negative controls, older people living with HIV performed worse in global score and all seven domains (P<.05). HIV infection was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and level of physical activity mediated the association between HIV status and global z-score and four domain z-scores of neurocognitive performance (learning, memory, verbal fluency, and processing speed).ConclusionsChange in mental health and physical activity after HIV infection may partially explain why older people living with HIV are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older people living with HIV.     

The effect of EPA and DHA on metabolic syndrome patients: a systematic review of randomised controlled trials

Metabolic syndrome (MS) is characterised by accumulation of CVD risk factors. The use of very long chain n-3 polyunsaturated fatty acids (VLC n3 PUFA) could potentially benefit MS by reducing risk factors. To better understand the possible VLC n3 PUFA benefits, the literature was systematically reviewed for randomised controlled trials (RCT) that published effects of VLC n3 PUFA on MS patients. 17 RCT fulfilled the inclusion criteria and were analysed for relevance to the research question. The available RCT convincingly show that the administration of VLC n3 PUFA doses > 1 g for at least 3 months produces a significant reduction of triglycerides ranging from 7 % to 25 %. These results confirm the hypotriglyceridemic effect of VLC n3 PUFA in MS patients. The triglyceride lowering may produce further benefits by reducing the % of pro-atherogenic small dense LDL particles (sdLDL) and also perhaps by ameliorating the inflammatory process associated with MS. High doses of VLC n3 PUFA ( ≥ 3 g/day) may produce further TAG reductions but could raise other risk factors such as LDL-C. No clear effects were found on other MS markers. The combination of VLC n3 PUFA plus a statin may be useful to prevent the occurrence of coronary events. More studies are needed using different amounts of VLC n3 PUFA, time lengths, dietary backgrounds and different profiles of MS patients before clear recommendations can be made.     

Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms

BACKGROUND: This meta-analysis compares the prevalence of fatigue, musculoskeletal pain, and neurocognitive difficulties in patients who have had Lyme borreliosis (LB) and control subjects without LB. METHODS: Titles and abstracts in PubMed were reviewed for studies with data on the symptoms listed above that compared patients who had had LB with controls from the general population. Five studies with 504 patients and 530 controls were included in the meta-analysis. RESULTS: The prevalence of symptoms was significantly higher in the LB patients, with P-values between <0.00001 and 0.007 for 8 of the 10 symptoms in the three categories listed above. The higher prevalence of certain neurocognitive symptoms but not others, in the same pattern as reported in the literature, is further confirmation of this syndrome. The pattern of symptoms appears to be different from that seen in fibromyalgia, depression, and chronic fatigue syndrome. CONCLUSIONS: This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.     

艾滋病儿童神经认知障碍相关因素研究进展

目的 总结艾滋病儿童神经认知障碍影响因素。方法 在PubMed、Web of Science、CNKI、万方和维普数据库，以“艾滋病”、“儿童”、“神经认知障碍”、“脑病”、“影响因素”为主题词或关键词，同时辅以手工检索和文献追溯检索近年相关文献。着重整理影响艾滋病儿童神经认知障碍的因素。对资料进行汇总并撰写综述。结果 检索并阅读相关文献100余篇。艾滋病病毒相关因素（HIV损害中枢神经系统、HIV逃逸及病毒储存库、HIV亚型）、宿主因素（启动抗病毒治疗时机、遗传因素、营养状况及合并其他疾病）、抗病毒治疗药物、社会心理因素等均可影响艾滋病感染儿童神经认知。结论 为了尽可能避免或降低艾滋病儿童神经认知障碍，应当尽早诊断、尽早给予高效的抗逆转录病毒治疗；随访中应重视神经认知发育的观察和筛查，及早识别神经认知障碍，积极寻找多方面的原因并进行有效干预。     

People with multiple sclerosis report significantly worse symptoms and health related quality of life than the US general population as measured by PROMIS and NeuroQoL outcome measures

Background

Individuals with multiple sclerosis (MS) report fatigue, pain, depression, cognitive difficulties, and other symptoms. It is often difficult to compare symptoms across studies and populations because scales used to measure individual symptoms or quality of life indicators (QOLI) use different metrics and often do not provide norms. PROMIS and Neuro-QOL measures, developed with modern psychometric methods, use a common metric and provide population norms.

Factors associated with dropout in medical education: a literature review

Medical Education 2011: 45 : 440–454 Context Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised. Objectives This review aimed to systematically and critically review studies dealing with factors found to be associated with dropping out of medical school. Methods A systematic critical literature review of the international peer‐reviewed research literature on medical education was performed. A primary search was conducted and subsequently supplemented with ancestry and descendancy searches. The population of interest was medical students and the outcome was dropout. Abstract/title screening and quality assessment were performed by two independent researchers. Studies were assessed on six domains of quality: study participation; study attrition; predictor measurement; measurement of and accounting for confounders; outcome measurement, and analysis. Only studies that accounted for confounding were included in the final analysis. Results Of 625 studies found, 48 were quality‐assessed and 13 of these were eventually included based on their fulfilment of our quality‐related criteria. A range of entry qualifications seemed to be associated with greater chances of a student dropping out (odds ratio [OR] = 1.65–4.00). Struggling academically in medical school may be strongly associated with dropout. By contrast, no specific pattern of demographic variables was particularly important in relation to dropout. The effects of socio‐economic, psychological and educational variables on dropout were not well investigated. Conclusions More research into causal models and theory testing, which considers the effects of education, organisation and institution, is necessary if we are to learn more about how we can actively prevent medical student withdrawal.     

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33–18.99) and 3.22 (95% CI, 1.15–9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions.     

Reevaluating the Diagnostic Criteria for Metabolic Syndrome in the Taiwanese Population

Objective: Metabolic syndrome (MS) represents a constellation of conditions, which, taken together, increase an individual's risk for the development of type 2 diabetes and cardiovascular disease. Numerous guidelines have been suggested; however, increasing evidence has suggested that universal recommendations are not applicable across different ethnic groups. To date, no specific screening recommendations exist for the Taiwanese population.

Materials and Methods: A total of 8913 Taiwanese (>18 years) were enrolled and evaluated for MS based on the International Diabetes Federation (IDF) criteria established for the Asian population, in an attempt to reevaluate the appropriate guidelines for diagnosing MS in the Taiwanese population.

Results: Among the risk factors assessed, hypertension (24.72%), hyperglycemia (6.86%), and elevated triglycerides (18.50%) were significantly more prevalent among men (p < 0.01). Low high-density lipoprotein was not significantly different between genders. The prevalence of MS was 24.83% (1171/4716) for men and 15.48% (650/4197) for women. When modified cutoff points for waist circumference (WC) were analyzed (≥86.0 cm for men, ≥76.0 cm for women), the prevalence of MS increased to 40.88% (1928/4716) for men and 27.88% (1170/4197) for women. Not unexpectedly, the odds ratio for developing MS increased with an increasing WC, as well as with an increasing number of risk factors for MS.

Conclusions: The suggested IDF guidelines for defining MS in the Asian population, including WC, seem appropriate for use in the Taiwanese population but need modification. Further studies are warranted to identify other anthropometric measures specific to the population that would enhance the ability to diagnose MS.