Effectiveness of Montessori-based activities on agitation among Asian patients with dementia: A systematic review and meta-analysis

Objectives:Montessori based activity are supposed to be an effective nonpharmacological intervention in the treatment of agitation in western countries. However, most studies conducted to evaluate the effectiveness of Montessori based activities on agitation in Asian patients were small sample size, as well as inconsistent outcomes, which may limit the reliability of the conclusions. The present pooled analysis, hence, was conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.Design:Prospective randomized clinical studies were included, of which available data was extracted. Outcomes of physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors were pooled for the analysis by weighted mean differences.Data sources:Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang, and China Science and Technology Journal Database (VIP)Eligibility criteria:Prospective, randomized, controlled clinical studies, conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.Data extraction and synthesis:Available data including baseline characteristics and interested outcomes from the included literature were extracted independently by 2 investigators. Measuring scales including CMAI and NOSIE were adopted for the efficacy comparison between Montessori based activity and standard activity. Weighted mean difference was used for the pooled analysis.Results:A total of 460 participants were included in the present meta-analysis. The pooled mean difference agitation for Montessori based activity was –3.86 (95% CI: –7.38 to –0.34, P = 0.03) comparing to standard activity. The pooled mean differences for physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors in Montessori based activity group were –0.82 (95% CI: –1.10 to –0.55; P < 0.00001), –0.81 (95% CI: –1.68 to 0.55; P = 0.07), and 0.38 (95% CI: –0.92 to 1.68; P = 0.57).Conclusions:Montessori based activities may reduce the frequency of agitation, especially in physical aggressive behaviors comparing to standard activities in Asian patients with dementia. However, the effectiveness of Montessori based activities on reduction of subcategorized agitated behaviors including physical nonaggressive behaviors, and verbal aggressive behaviors may not be reliable as physical aggressive behaviors.     

Exploring the mechanism of Buyang Huanwu decoction in the treatment of lumbar disc herniation based on network pharmacology and molecular docking

Buyang Huanwu decoction (BYHWD), as one of the traditional Chinese medicine formulas, is widely used in the clinical treatment of lumbar disc herniation (LDH) with curative effect. It has the characteristics of multi-component, multi-target, and mutual synergy, but the mechanism of action is often unclear. It needs some research to explore the molecular mechanism of BYHWD in the treatment of LDH based on network pharmacology and molecular docking. Screen the active compounds of BYHWD and predict drug-related gene/protein targets, which could determine the specific target of BYHWD in the treatment of LDH. Construct the “Drugs-Compounds-Targets” network and search for the core targets. Use Gene Ontology functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and molecular docking verification to explore the possible molecular mechanism. Eighty-two effective compounds and 666 targets of BYHWD, 187 targets for LDH treatment, and 20 core candidate targets were excavated. A total of 3414 entries were identified by Gene Ontology enrichment analysis, 173 related signal pathways were identified by Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and 5 core compounds were identified by molecular docking, which had a good affinity with core genes STAT3, JUN, AKT1, MAPK1, RELA, and PIK3CA. BYHWD may play the role of analgesic and improving function by synergistic anti-inflammatory and analgesic compounds, regulating cell metabolic differentiation, regulating immunity, and anticoagulation. BYHWD in the treatment of LDH may play a role in analgesia and improve function through multiple signaling pathways, including PI3K-Akt, mitogen-activated protein kinase, tumor necrosis factor, and interleukin-17. The PI3K-Akt signaling may be one of the key mechanisms.     

Heterogeneous iodine-organic chemistry fast-tracks marine new particle formation

The gas-phase formation of new particles less than 1 nm in size and their subsequent growth significantly alters the availability of cloud condensation nuclei (CCN, >30–50 nm), leading to impacts on cloud reflectance and the global radiative budget. However, this growth cannot be accounted for by condensation of typical species driving the initial nucleation. Here, we present evidence that nucleated iodine oxide clusters provide unique sites for the accelerated growth of organic vapors to overcome the coagulation sink. Heterogeneous reactions form low-volatility organic acids and alkylaminium salts in the particle phase, while further oligomerization of small α-dicarbonyls (e.g., glyoxal) drives the particle growth. This identified heterogeneous mechanism explains the occurrence of particle production events at organic vapor concentrations almost an order of magnitude lower than those required for growth via condensation alone. A notable fraction of iodine associated with these growing particles is recycled back into the gas phase, suggesting an effective transport mechanism for iodine to remote regions, acting as a “catalyst” for nucleation and subsequent new particle production in marine air.

Marine aerosol formation contributes significantly to the global radiative budget given the high susceptibility of marine stratiform cloud radiative properties to changes in cloud condensation nuclei (CCN) availability. Atmospheric new-particle-formation is thought to involve nucleation of sulfuric acid with water, ammonia, or amines followed by condensation/growth in the presence of organic vapors (1, 2). Unique in the marine boundary layer (MBL), new particle formation involves sequential addition of HIO₃ or clustering of iodine oxides (I_xO_y) (3, 4). In specific source regions such as coastal zones, seaweed beds, or snowpack/pack-ice, iodine oxide nucleation can be a driving force for nucleation (5–7). Over Arctic waters, nonetheless, one study finds insufficient iodic acid vapors to grow nucleated particles to CCN sizes (8), whereas another study finds that both nucleation and growth are almost exclusively driven by iodic acid (9). Over the open ocean, the supply of iodine oxides has been thought to be limited; however, recent measurements suggest that significant reactive iodine chemistry can occur in these regions (10). Moreover, observational evidence exists for open ocean particle formation and growth, especially when oceanic productivity is high (11, 12). An increase in atmospheric iodine levels in the North Atlantic since the mid-20th century has been shown to be driven by growth of anthropogenic ozone and enhanced subice phytoplankton production (13). While the reported IO concentration (0.4–3.1 ppt) in the remote MBL (10, 14, 15) is likely sufficient for formation of prenucleation clusters (∼1 nm), growth of these initial clusters requires the presence of other condensable vapors (16). Since preexisting aerosol particles act as a strong sink for the nucleated clusters, thus inhibiting atmospheric aerosol and CCN formation (17, 18), this early growth phase is essential for their survival. Whereas sulfuric acid vapor is also involved in nucleation, its level in remote open ocean is generally too low (10⁵ molecules cm⁻³) to support subsequent particle growth, leaving organic vapors as the most plausible alternative for particle growth.In the marine atmosphere, condensing organics must originate from the oxidation of marine volatile organic compounds (VOCs), which predominantly comprise C₁–C₅ VOCs (e.g., isoprene) released from phytoplankton. Principal high volatility oxidation products consist of intermediate oxidized organics (IOOs), such as polyhydric alcohols (e.g., tetrols) or polyfunctional carbonyls (e.g., glyoxal) (19–22). Nonetheless, growth of available prenucleation clusters/nanometer particles requires condensing organic molecules of low effective volatilities (i.e., saturation mass concentration, C* < ∼10⁻³ μg m⁻³); otherwise, preferential condensation of the organic mass to larger-diameter particles would occur (23, 24). Formation of such extremely low-volatility organic compounds (ELVOCs) from gas-phase reaction is well established for monoterpene oxidation products (25, 26).A potential pathway for formation of low-volatility organics could also result from particle-phase chemical reactions induced by iodine oxides in the early stages of marine particle formation. When the underlying chemistry is sufficiently fast, kinetic condensation occurs, resulting in particles with diameters smaller than about 50 nm growing at the same rate (e.g., nm h⁻¹) (24). If, however, particle-phase chemistry is preferentially favored in the smallest particles (i.e., stemming from the higher relative concentration of iodine oxides in freshly formed marine particles), growth of the nucleated particles could proceed more rapidly, as compared to that in which gas-phase chemistry is the source of the low-volatility compounds (23).In this paper, we present experimental results from field measurements as well as laboratory studies of nanometer particle growth and derive a plausible chemical mechanism from the results that can explain the observations of ultrafine particle growth in the marine atmosphere. The results suggest that both iodine and condensed organics contribute to particle growth from a nascent nucleation mode into an ultrafine particle mode. Moreover, laboratory studies of the growth of seed iodine oxide particles (IOP) via heterogeneous reactions with organic vapors suggest a hitherto unrecognized mechanism that fast-tracks the growth of nucleation mode clusters into survivable aerosol particles. In this process, a notable fraction of the iodine associated with these growing particles is recycled back to the gas phase, suggesting a transport mechanism for iodine to remote regions.     

儿童肾癌的临床及CT和病理特点分析

目的 探讨儿童肾癌的临床、CT及病理特点,积累其临床诊治经验.方法 回顾性分析2014年至2016年单中心收治的7例儿童肾癌患儿的临床、CT、病理资料,并随访其生存情况.就诊时年龄5～12岁,女4例,男3例,左侧5例,右侧2例.临床表现多为血尿(4/7)、腹部包块(3/7)、腰痛(1/7).CT平扫肿瘤呈低密度,多位于上下极,可见钙化(6/7)及坏死区,增强特点多为“快进快出”(4/7),部分为“快进慢出”(2/7).结果 7例患儿全部获得随访,随访时间8～35个月.1例肿瘤位于左腹膜后,确诊时已发生腹膜后及颈部淋巴结转移,行肿瘤部分切除活检,术后5个月死亡.1例为复发性肾癌,行肾窝肿瘤切除加腹膜后淋巴结清扫,术后5个月出现淋巴结转移,予放化疗后带瘤生存.余5例患儿均行根治性肾切除加淋巴结清扫,术后均无瘤生存.病理多为肾透明细胞(5/7)及乳头状肾细胞癌(2/7),癌细胞呈巢团状、乳头状、腺管样结构分布,可见砂粒体(6/7),核级多为3～4级.4例患儿淋巴结转移,共清扫出60枚淋巴结,淋巴结阳性率为16.7％.5例加做免疫组化,TFE3 (4/5)、CD10 (5/5)、Kb67 (4/5)、E-cardherin (4/5)、Vinentin (3/5)、CK(3/5)阳性率较高,4例确诊为MiT家族异位性肾癌.结论 儿童肾癌多发生于年长患儿,有其特有的临床、CT及病理特点,MiT家族异位性肾癌常见,病理及免疫组化是确诊和分型的主要手段.     

Incidence of brain injuries in premature infants with gestational age ≤34 weeks in ten urban hospitals in China

Background

There is a large number (1.5 million per year) of premature births in China. It is necessary to obtain the authentic incidences of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), the common brain injuries, in Chinese premature infants. The present multicenter study aimed to investigate the incidence of brain injuries in premature infants in ten urban hospitals in China.

Methods

The research proposal was designed by the Subspecialty Group of Neonatology of Pediatric Society of the Chinese Medical Association. Ten large-scale urban hospitals voluntarily joined the multicenter investigation. All premature infants with a gestational age ≤34 weeks in the ten hospitals were subjected to routine cranial ultrasound within three days after birth, and then to repeated ultrasound every 3–7 days till their discharge from the hospital from January 2005 to August 2006. A uniform data collection sheet was designed to record cases of brain injuries.

Results

The incidences of overall IVH and severe IVH were 19.7% (305/1551) and 4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) for grade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in nine hospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and 0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) for grade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statistically significant risk factors that might aggravate the severity of IVH were vaginal delivery (OR=1.883, 95% CI: 1.099–3.228, P=0.020) and mechanical ventilation (OR=4.150, 95% CI: 2.384–7.223, P=0.000). The risk factors that might result in the development of cystic PVL was vaginal delivery (OR=21.094, 95% CI: 2.650–167.895, P=0.000).

Conclusions

The investigative report can basically reflect the incidence of brain injuries in premature infants in major big cities of China. Since more than 60% of the Chinese population live in the rural areas of China, it is expected to undertake a further multicenter investigation covering the rural areas in the future.     

非穿透性小梁手术超声生物显微镜检查

目的：应用超声生物显微镜（ＵＢＭ）检查技术,探讨非穿透性小梁手术联合透明质酸钠生物胶植入手术区域解剖特点和房水引汉机制。方法：对１４例１６只眼行非穿透性小梁手术联合透明质酸钠生物胶植入的患者,在术后１～３个月内进行手术区域ＵＢＭ检查。检查的指标（项目）包括：巩膜瓣下形成液间腔的大小（宽和高）、透明质酸钠生物胶吸收的情况、剩余角膜小梁膜的厚度以及滤过泡的形态,并对结果进行分析。结果：１６只眼术前平均     

糖尿病患者后房型人工晶状体体植入术眼前段并发症探讨

目的：观察糖尿病患者中行后房型人工晶状体植入术后眼前段并发症及预后。方法：对31例（40只眼）糖尿病组后房型人工晶状体植入与28例（35只眼）对照组老年白内障患者手术效果及并发症进行对比观察。结果：糖尿病组白内障前段手术并发症发生率高于对照组，其术前准备、术中及术后处理均有其特殊性。但总体预后两组并无显著差异。结论：糖尿病患者人工晶状体植入安全可靠、手术预后良好。     

增殖性糖尿病视网膜病变多次手术临床分析

目的：探讨增殖性糖尿病视网膜病变玻璃体切割术后多次手术的原因及处理。方法：回顾性分析3a来因增殖性糖尿病视网膜病变行玻璃体切割术后需要再次手术的患者。结果：患者189眼术后需要再次进行手术的为24例26眼（占总观察眼数13.8%）。分别是：玻璃体再积血3眼,前房积血1眼,视网膜脱离11眼（占总观察眼数5.8%,占再手术眼42.3%,其中3眼合并新生血管性青光眼）,白内障6眼（占总观察眼数3.2%）,单纯硅油取出5眼。189眼中有6眼发生了新生血管性青光眼（3.2%）,6眼均为玻璃体晶状体联合手术或玻璃体切割术后又摘除白内障病例。2次手术19眼,3次或以上手术7眼（其中5眼合并视网膜脱离）。结论：发生视网膜脱离是糖尿病视网膜病变玻璃体切割术后需要多次手术的主要原因;也占据需要3次或以上手术的主要部分。新生血管性青光眼的发生值得重视,出现视网膜脱离时要提高警惕,需要摘除晶状体时必须慎重。