Effects of APOE ɛ4 on brain amyloid,lacunar infarcts,and white matter lesions: a study among patients with subcortical vascular cognitive impairment

The relationship between the apolipoprotein E ?4 allele (APOE4) and factors associated with vascular cognitive impairment (VCI) is unclear. We aimed to examine the effects of APOE4 on brain amyloid beta using Pittsburg compound B (PiB) and subcortical cerebrovascular disease, as assessed by lacunes and white matter hyperintensities (WMH) in subcortical VCI (SVCI) patients. We recruited 230 subjects with normal cognition, 111 subjects with cognitive impairment due to clinically defined Alzheimer’s disease (ADCI), and 134 subjects with clinically defined SVCI. A PiB retention ratio greater than 1.5 was considered to be PiB positive. Logistic regression analysis was performed to investigate whether APOE4 increased the risk for each cognitive impairment group. Multiple linear regression analysis was performed to investigate whether APOE4 was associated with brain amyloid beta, lacunes, and WMH. APOE4 did not increase the risk of PiB(−) SVCI (odds ratio [OR], 1.50; 95% confidence interval [CI], 0.79–2.84), whereas APOE4 increased the risk of PiB(+) SVCI (OR, 4.52; 95% CI, 1.70–11.97) and PiB(+) ADCI (odds ratio, 4.84; 95% CI, 2.54–7.91). In SVCI patients, APOE4 was positively associated with PiB retention ratio, whereas APOE4 was not associated with the number of lacunes or with WMH volume. Our results suggest that amyloid beta burden can occur in patients with and without subcortical cerebrovascular disease, and that it is associated with APOE4. However APOE4 might be independent of subcortical cerebrovascular disease.     

Current Trends in Research into the Waterborne Parasite Giardia

The waterborne flagellated parasite Giardia intestinalis continues to be the most frequent protozoan agent of intestinal disease world-wide, causing an estimated 2.8 x 108 cases per annum. Severe symptoms of diarrhea and sickness can be persistent and even life threatening in the immunocompromised, in infants, and in the aged, although self-limiting in the majority of patients. Despite a growing awareness and intensified research many uncertainties remain, especially with respect to the risk of potential zoonotic transmission. Water supplies can be monitored for cysts using automated cytofluorimetric immunoassays, but this does not measure infectivity. Filtration provides the best protection, because cysts are highly resistant to chlorine and ozone. Other incompletely elucidated aspects include mechanisms of pathogenicity, host reaction to infection, immunity and parasite control using vaccines or antigiardial compounds; the 5-nitroimidazole metronidazole is the most effective of these. Molecular typing of various isolates indicates that most animal parasites are not infective to humans, but those that are can be genotypically classified as assemblage A or B. The phylogeny of the organism remains uncertain, but there is a growing opinion that Giardia is not an ancient primitive eukaryote, but that it is derived from a more complex mitochondria-containing protozoon.     

乳腺癌术后上肢淋巴水肿病人自我感受负担与自我护理能力的相关性研究

目的:了解乳腺癌术后上肢淋巴水肿病人的自我感受负担、自我护理能力,并探讨二者的相关性。方法:采用方便抽样方法选取在中山大学肿瘤防治中心就诊的187例乳腺癌术后上肢淋巴水肿病人进行问卷调查。结果:乳腺癌术后上肢淋巴水肿病人自我感受负担总分为(30.40±7.65)分,自我护理能力总分为(109.36±18.57)分。自我感受负担与自我护理能力呈负相关(P<0.05)。结论:多数乳腺癌术后上肢淋巴水肿病人存在中重度自我感受负担,且自我护理能力有待提高。护理人员应关注病人的心理问题,及时进行心理疏导,同时提高病人的自我护理能力,减轻其心理负担。     

肝癌患者主要照顾者负性自动思维在压力与抑郁关系中的中介作用

目的：探讨肝癌患者主要照顾者的负性自动思维在压力和抑郁关系中的中介作用。方法：采用便利抽样,选取2018年6月至2019年6月在复旦大学附属金山医院住院的肝癌患者患者的主要照顾者98人为研究对象,应用一般资料调查表、照顾者反应评估量表、负性自动思维问卷、抑郁自评量表调查。结果：肝癌患者主要照顾者反应评分(74.23±8.21)分,负性自动思维得分(50.33±8.45)分,抑郁自评量表得分(42.43±6.31)分,其中抑郁症状者占42.86%。相关性分析：负性自动思维评分与照顾者反应评分、抑郁得分呈正相关(P < 0.05);多元线性回归分析,负性自动思维得分在压力和抑郁关系中呈中介效应,其效应值占总效应的49.37%。结论：改善肝癌患者主要照顾者的负性思维,积极应对有利于消除抑郁情绪。     

个体化综合干预对肺部肿瘤患者陪护者的心理负担影响分析

目的:探究个体化综合干预对肺部肿瘤患者陪护者心理负担的影响。方法:将前来某院陪护就医的肺部肿瘤患者家属74例为对象开展研究,随机将陪护者分为研究组与对照组各37例,研究组采取个体化综合干预,对照组采取常规入院宣教,观察干预效果。结果:研究组各项ZBI评分均明显低于护理前,且低于对照组(P<0.05);研究组自我效能高例数明显高于对照组(40.54%>13.51%),自我效能较低例数低于对照组(5.41%<35.14%),比较存在显著差异(P<0.05)。结论:应用个体化综合干预可减轻陪护者负担,提升陪护者自我效能,缓解其心理压力。     

癌症患者家庭照顾者负担量表的研究进展

为探讨癌症患者家庭照顾者负担测评工具的研究现状,本文阐述并分析了2000年以来在癌症患者家庭照顾者负担测量方面应用较为广泛的几种照顾者负担测量工具:照顾者负担量表(ZBI),照顾者压力指标量表(CSI),照顾者反应评估量表(CRA),照顾者负担问卷(CBI)。并在此基础上提出应采用质性研究与量性研究相结合的方法,发展适合我国文化的癌症患者照顾者负担量表。     

Hypoglycaemia in Type 2 diabetes

The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication—in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self‐reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes—both direct hospital costs and indirect costs—are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around £1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.