A benchmark dose study of prenatal exposure to di(2-ethylhexyl) phthalate and behavioral problems in children

IntroductionPrenatal exposure to di(2-ethylhexyl) phthalate (DEHP) has been reported to be associated with adverse effects on neurodevelopment that yield behavior syndromes in young children with an estimated median exposure lower than the currently recommended tolerable daily intake (TDI) and reference dose (RfD).ObjectivesOur aim was to derive the benchmark dose for prenatal exposure to DEHP for the neurodevelopmental health in children.MethodsA total of 122 mother-child pairs from the Taiwan Maternal and Infant Cohort Study were analyzed for the dose-response relationship between maternal exposure to DEHP and children's behavioral syndromes evaluated at 8 years (n = 122, 2009), 11 years (n = 96, 2012), and 14 years (n = 78, 2015) of age. We employed a multivariate regression model to assess the statistical associations between the estimated maternal average daily intake of DEHP and child's individual CBCL scores for boys and girls at each separate age, followed by a mixed model for all the children across three ages accounting for individual variations. We then employed structural equation models by combining the children's specific behavioral problem scores at different ages and obtained a simulated overall latent score in relation to maternal exposure. Based on the established dose-response relationship, we derived the benchmark dose (BMD) and the lower limit (BMDL).ResultsAssociations of maternal DEHP exposure (median 4.54$\mu g/kg\_bw/day$) with the Child Behavior Checklist (CBCL) scores were all significant, except for somatic complaints, adjusting for child's age, gender, IQ, and family income. The BMDL, given a benchmark response of 0.10 (0.05) and a background response of 0.05, was 6.01 (2.16) $\mu g/kg\_bw/day$for an integrated CBCL score.ConclusionsThe current TDI (RfD) of 50 (20) $\mu g/kg\_bw/day$ for DEHP might not protect pregnant women for their children from behavioral problems. There remains the lack of comparable toxicological data. Further investigations are needed.     

Oral mixing ability and cognition in elderly persons with dementia: A cross‐sectional study

Masticatory performance has been positively associated with cognitive ability in both animals and healthy humans. We hypothesised that there would also be a positive correlation between masticatory performance and cognition in older persons suffering from dementia. Older persons suffering from dementia (n = 114) and receiving institutionalised care were studied in a cross‐sectional design. The assessments included masticatory performance, which was measured objectively with a two‐colour gum mixing ability test, and cognition, which was assessed with a multidomain neuropsychological test battery. Significant relationships were observed between masticatory performance and general cognition and between masticatory performance and verbal fluency. Hierarchical regression analysis revealed that the correlation with general cognition was influenced by the scores for dependency in activities of daily living. The association between verbal fluency and masticatory performance was not significantly affected by secondary variables. An unexpected limitation of this study was the high dropout rate for the mixing ability test. The clinical implications of these findings are profound; care professionals should endeavour to maintain and stimulate mastication in older persons with dementia in an attempt to preserve cognition.     

康复护理干预在改善脑梗死后患者日常生活能力和认知功能中的应用效果

目的 探讨康复护理对脑梗死后认知功能障碍及日常生活能力的影响及意义。方法 将90 例脑梗死后发生认知功能障碍的患者依随机数字表法分为观察组(45例)与对照组(45例)。对照组和观察组均 实施常规的护理治疗措施,此外,对观察组实施早期的康复护理措施。 疗程为1个月,比较两组患者的认知功能障碍及日常生活能力的情况。结果 试验1个月后,观察组有效率为78%,对照组有效率为31%,两组的临床疗效差异有统计学意义(χ²=19.929,P＜0.001)。观察组的简易智能精神状态检查量表(MMSE)、韦氏成人记忆量表(WMS)和日常生活功能量表(ADL)评分明显增高,两组MMSE(t=3.226,P=0.002)、WMS(t=3.394,P=0.001)、ADL(t=7.221,P<0.001)得分均差异有统计学意义。结论 早期康复护理干预对脑梗死患者具有良好的临床疗效,可以显著改善患者认知功能及日常生活能力。     

Impact of Frailty on Outcomes After Primary and Revision Total Hip Arthroplasty

Background

Frailty and disability from arthritis are closely intertwined and little is known about the impact of frailty on total hip arthroplasty (THA) outcomes. We hypothesized that higher preoperative frailty is associated with more adverse events following THA.

2018年某院辅助用药重点监控品种使用情况分析

目的 对西安医学院附属宝鸡医院排名前10位的辅助用药重点监控品种的使用情况进行分析，为加强辅助用药的监管和促进临床合理用药提供参考。方法 通过医院信息系统将2018年重点监控药品的科室分布、销售金额、用药频度（DDDs）、日均费用（DDC）和药品排序比（B/A）进行统计分析，并对其使用合理性进行医嘱点评分析。结果 重点监控品种使用科室大多与其科室疾病谱相符。销售金额排序前3位依次为小牛血清去蛋白注射液、丹参川芎嗪注射液和醒脑静注射液；按DDDs排序前3位依次为丹参川芎嗪注射液、小牛血清去蛋白注射液、腺苷钴胺注射液；按DDC排序前3位依次为醒脑静注射液、小牛血清去蛋白注射液、转化糖电解质注射液；鹿瓜多肽注射液、注射用硫辛酸、舒血宁注射液和注射用血栓通的B/A接近1。不合理应用集中表现在适应症不适宜、给药剂量不规范，构成比分别为59.41%、16.01%。结论 西安医学院附属宝鸡医院重点监控药品管理工作初见成效，但仍需采取积极有效的监管措施进一步促进重点监控药品的合理使用。     

Occupational performance and strategies for managing daily life among the elderly with heart failure

Abstract

Aim: The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF). Methods: Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis. Results: The first theme, “Redefining an active life, aware of one’s impaired body”, was based on four sub-themes: realizing one’s limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, “Planning activities and balancing the degree of effort”, was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today’s ability; and using technology and adapting the environment. Conclusions: Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.     

Suppression of serum lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism by intensive insulin therapy in the first year of type 1 diabetes mellitus: Prospective InLipoDiab1 study

Background and aimsCholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are crucial proteins in reverse cholesterol transport. There are insufficient data on regulating these proteins by insulin therapy in type 1 diabetes mellitus (T1DM). We aimed to assess prospectively the impact of insulin therapy initiation on transfer proteins serum levels in adults with newly diagnosed T1DM.Methods and results57 adults with newly diagnosed T1DM were enrolled in the InLipoDiab1 Study. All participants were treated with subcutaneous insulin in the model of intensive insulin therapy since the diagnosis of diabetes. Serum PLTP and CETP concentrations were measured at diagnosis, after three weeks, six months, and after one year of insulin treatment, using the immunoenzymatic method ELISA.A significant decrease in PLTP and CETP concentrations were demonstrated during twelve months of insulin therapy in newly diagnosed T1DM. The dynamics of changes in the level of these proteins varied depending on the occurrence of remission after a year of the disease. In the group without remission, a significant decrease in PLTP and CETP levels appeared after six months of follow-up. The remission group was characterized by a decrease in proteins concentration only after one year of treatment. In the non-remission group, significant negative correlations were found between the daily dose of insulin and levels of PLTP and CETP.ConclusionExogenous insulin is an inhibitor of lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism in the first year of treatment.