Longitudinal Changes in Clock Drawing Test (CDT) Performance before and after Cognitive Decline

Background

Many scoring systems exist for clock drawing task variants. However, none of them are reliable in evaluating longitudinal changes of cognitive function. The purpose of this study is to create a simple yet optimal scoring procedure to evaluate cognitive decline using a clinic-based sample.

Methods

Clock-drawings from 121 participants (76 individuals with no dementia and later did not develop dementia after a mean 41.2-month follow-up, 45 individuals with no dementia became demented after a mean 42.3-month follow-up) were analyzed using t-test to determine a new and simplified CDT scoring system. The new scoring method was then compared with other commonly used systems.

Results

In the converters, there were only 7 items that are significantly different between the initial visits and the second visits. We propose a new scoring system that includes the seven critical items: numbers are equally spaced (12–3–6–9) (p = 0.031), the other eight numbers are marked (p = 0.022), numbers are clockwise (p = 0.002), all numbers are correct (p = 0.030), distance between numbers is constant (p = 0.016), clock has two hands (p = 0.000), arrows are drawn (p = 0.003). Compared with other traditionally used scoring methods, this based change clock drawing test (BCCDT) has one of the most balanced sensitivities/specificities with a clinic-based sample.

Conclusions

The new CDT scoring system provides further evidence in support of a simple and reliable clock-drawing scoring system in follow-up studies to evaluate cognitive decline, which can be used in assessing the efficacy of medicine.     

The Location Learning Test as a measure of spatial memory: applicability of a modified administration procedure and normative data

The Location Learning Test is a neuropsychological test that can be used to assess memory for object locations. The test has originally been developed for the assessment of visuo-spatial memory impairment in patients with dementia. However, ceiling effects may be present in other patient groups. This study has examined the applicability of a modified administration procedure with a shorter presentation duration and longer delay. The test was administered in a group of stroke patients (n = 105), a group of patients with diabetes (n = 93), as well as a group of healthy volunteers (n = 97). The results indicate that the Location Learning Test can be used to discriminate the diabetes and stroke patients from the control group. Furthermore, differences between patients with a left and a right-hemisphere stroke were found. The test has a high correlation with another memory test. The performance of the group healthy volunteers was used to calculate normative data for use in clinical practice.     

置管溶栓与药物机械溶栓对急性下肢深静脉血栓的临床疗效对比

摘要 目的：对比分析置管溶栓（CDT）与药物机械溶栓（PMT）对急性下肢深静脉血栓（DVT）的安全性与有效性。方法：回顾性分析2018年1月至2021年12月在重庆医科大学附属巴南医院的98例单侧DVT患者临床资料,依据不同的治疗方式分为药物机械溶栓组（PMT组）48例和置管溶栓组（CDT组）50例,对比分析两组患者的围手术期指标、治疗后患侧大腿消肿率和小腿消肿率、血栓溶解率、并发症发生率及术后1年的PTS发生率。结果：PMT组患者的尿激酶使用量及住院时间较CDT组显著缩短,差异具有统计学意义（P<0.05）,但术中出血较CDT组显著增加,差异具有统计学意义（P<0.05）,PMT组患者的患肢消肿率和血栓溶解率显著高于CDT组,差异具有统计学意义（P<0.05）,两组患者的并发症发生率及术后1年的深静脉血栓形成后遗症发生（PTS）率无显著统计学差异（P>0.05）。结论：PMT比CDT具有更好的患肢消肿率及血栓溶解率,且PMT治疗能显著缩短住院时间及减少尿激酶用量,但两者的围手术期并发症发生率及术后1年PTS发生率无显著差异。     

Derivative-free neural network for optimizing the scoring functions associated with dynamic programming of pairwise-profile alignment

Background

A profile-comparison method with position-specific scoring matrix (PSSM) is among the most accurate alignment methods. Currently, cosine similarity and correlation coefficients are used as scoring functions of dynamic programming to calculate similarity between PSSMs. However, it is unclear whether these functions are optimal for profile alignment methods. By definition, these functions cannot capture nonlinear relationships between profiles. Therefore, we attempted to discover a novel scoring function, which was more suitable for the profile-comparison method than existing functions, using neural networks.

Results

Although neural networks required derivative-of-cost functions, the problem being addressed in this study lacked them. Therefore, we implemented a novel derivative-free neural network by combining a conventional neural network with an evolutionary strategy optimization method used as a solver. Using this novel neural network system, we optimized the scoring function to align remote sequence pairs. Our results showed that the pairwise-profile aligner using the novel scoring function significantly improved both alignment sensitivity and precision relative to aligners using existing functions.

Conclusions

We developed and implemented a novel derivative-free neural network and aligner (Nepal) for optimizing sequence alignments. Nepal improved alignment quality by adapting to remote sequence alignments and increasing the expressiveness of similarity scores. Additionally, this novel scoring function can be realized using a simple matrix operation and easily incorporated into other aligners. Moreover our scoring function could potentially improve the performance of homology detection and/or multiple-sequence alignment of remote homologous sequences. The goal of the study was to provide a novel scoring function for profile alignment method and develop a novel learning system capable of addressing derivative-free problems. Our system is capable of optimizing the performance of other sophisticated methods and solving problems without derivative-of-cost functions, which do not always exist in practical problems. Our results demonstrated the usefulness of this optimization method for derivative-free problems.

     

Evolution of funnel-revolver flowers and ornithophily in nasa (loasaceae)

Floral morphology, distribution, and flower visitors for 60 taxa of Nasa are investigated and compared to molecular trees inferred both from a combined marker analysis (ITS1 and trnL (UAA)) and from a single marker (ITS1). Flowers conform to two different floral types: Firstly, "tilt-revolver flowers", with spreading to reflexed, white to yellow petals and small, brightly coloured floral scales contrasting with the petals and firmly enclosing the nectar (Saccatae and Carunculatae); secondly, "funnel-revolver flowers", with half-erect to erect, orange to red petals and floral scales not contrasting with the petals, or enclosed in the corolla, and nectar freely accessible by funnel-shaped floral scales ( Alatae, Grandiflorae, and N. venezuelensis species group). Phylogenetic analysis shows that "tilt-revolver flowers" represent the plesiomorphic condition by outgroup comparison. The two groups with tilt-revolver flowers in Nasa are not monophyletic ( Saccatae are paraphyletic, Carunculatae are polyphyletic). Most Saccatae fall into two monophyletic assemblages, the N. poissoniana species group and the N. triphylla species group. The remainder of Saccatae group either with Grandiflorae ( N. insignis species group) or with Alatae ( N. laxa species group). The clades retrieved in the molecular analysis contradict the traditional classification, but are congruent with vegetative morphology, details of the flower morphology, and biogeography. "Funnel-revolver flowers" represent the derived condition, but molecular data suggest a convergent development (at least twice independently), since the corresponding species do not constitute a monophyletic group. "Tilt-revolver flowers" are visited and pollinated by bees (especially Colletidae), whereas "funnel-revolver flowers" are mostly visited by hummingbirds. The transition from melittophily to ornithophily may have been the license for the colonization of, and the diversification in, both cloud forest and high Andean habitats.     

The oral health of individuals with dementia in nursing homes

Objective: To determine if moderate to severe dementia has an effect on the oral health of individuals resident in nursing homes. Background: A significant proportion of the elderly population lives in nursing homes and suffers from varying degrees of dementia. Dementia might affect an individual's ability to implement oral care. Previous work in this area has focused on individuals with mild dementia living in the community setting. Material and methods: Two matched cohorts of subjects resident in four nursing homes in Cheshire were recruited (n = 135). One cohort's subjects were deemed to have no or mild dementia, whereas the other cohort's subjects were deemed to have moderate to severe dementia. Oral parameters were scored, including Decayed, Missing, Filled Teeth (DMFT) scoring, dental deposit scoring, denture assessment and the noting of any other pathology. Results: There was a statistically significant difference in the relative level of dementia of the subjects between the two cohorts (p < 0.01, Student's t‐test). The DMFT scores were similar for both groups. The mean number (±SD) of decayed and missing teeth for the no/mild dementia group was 1.11 (±3.42) and 28.22 (±6.64), whilst that of the moderate/severe dementia cohort was 0.80 (±1.87) and 27.28 (±7.73), respectively. Eleven per cent of the moderate/severe dementia cohort wore an upper denture alone as compared with 16% in the no/mild dementia group. Conclusion: For individuals resident in nursing homes, moderate to severe dementia might have a deleterious effect on oral health. Further work in this area is required.     

Ontwikkeling van de Gedragsobservatieschaal Psychomotorische therapie voor demente ouderen (GPMT-dem).

PDevelopment of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem).Reliability and concurrent validity This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale’s correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen’s kappa) varied between 0.27 and 1.00, the internal consistency of the subscales (Cronbach’s alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach’s alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia. Tijdschr Gerontol Geriatr 2007; 38: 88-99     

REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis

BackgroundJoint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care.MethodsThis multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person''s home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both.ResultsThe intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions—only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group.ConclusionsThis trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions.

Trial Registration

ISRCTN Registry ISRCTN42430123     

Development of the behaviour observation scale for psychomotor therapy for elderly people with dementia (BPMT-dem). Reliability and concurrent validity

This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale's correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen's kappa) varied between 0.27 and 1.00 the internal consistency of the subscales (Cronbach's alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach's alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia.     

Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial

Background

Dementia is among the leading causes of functional loss and disability in older adults. Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living, strength, balance and mental well being by physical exercise. The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous. Thus, the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia. The secondary objective was to examine the effect of this exercise on muscle strength, mobility, activities of daily living, quality of life and neuropsychiatric symptoms.

Design and Methods

This single blinded randomized controlled trial was conducted among 170 persons with dementia living in nursing homes. Mean age was 86.7 years (SD = 7.4) and 74% were women. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities.

Results

The intervention group improved the score on Bergs Balance Scale by 2.9 points, which was significantly more than the control group who improved by 1.2 points (p = 0.02). Having exercised 12 times or more was significantly associated with improved strength after intervention (p<0.05). The level of apathy was lower in the exercise group after the intervention, compared to the control group (p = 0.048).

Conclusion

The results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia.

Trial Registration

ClinicalTrials.gov NCT02262104     

Proteome-wide characterization of seed aging in Arabidopsis: a comparison between artificial and natural aging protocols

A variety of mechanisms have been proposed to account for the extension of life span in seeds (seed longevity). In this work, we used Arabidopsis (Arabidopsis thaliana) seeds as a model and carried out differential proteomics to investigate this trait, which is of both ecological and agricultural importance. In our system based on a controlled deterioration treatment (CDT), we compared seed samples treated for different periods of time up to 7 d. Germination tests showed a progressive decrease of germination vigor depending on the duration of CDT. Proteomic analyses revealed that this loss in seed vigor can be accounted for by protein changes in the dry seeds and by an inability of the low-vigor seeds to display a normal proteome during germination. Furthermore, CDT strongly increased the extent of protein oxidation (carbonylation), which might induce a loss of functional properties of seed proteins and enzymes and/or enhance their susceptibility toward proteolysis. These results revealed essential mechanisms for seed vigor, such as translational capacity, mobilization of seed storage reserves, and detoxification efficiency. Finally, this work shows that similar molecular events accompany artificial and natural seed aging.     

Body positions and movement patterns in female patients with congenital adrenal hyperplasia

Female patients with congenital adrenal hyperplasia (CAH; N = 33; 11-41 years), simple-virilizing (SV) patients (N = 19), salt-wasting (SW) patients (N = 13), and sister controls (N = 14) were compared with regard to their body positions and movement patterns. Data collection comprised both self assessments and mothers' assessments using 20 sex-dimorphic items with corresponding "more masculine" and "more feminine" versions for each variable, represented in photographs (forced-choice approach). Primarily based on mothers' assessments, single-item results suggested slightly more masculine positions and patterns for female CAH patients compared to sisters, for SW patients more distinct than for SV patients. Results from an 11-item scale ("motor behavior", alpha = 0.59) revealed differences between SW (more masculine) and SV patients for self assessments (P, one-tailed, < 0.09); sisters were in an intermediate position closer to the SV patients. According to mothers' assessments, the CAH patient group as a whole differed (more masculine) from sisters (P < 0.06); this finding was mainly accounted for by the SW group (P < 0.04). Complex analyses on the relationship of motor behavior and intervening variables (e.g., postnatal androgenization, onset of puberty, menarche, height, weight, sexual orientation) revealed very few significant results. Findings rather suggested organizational hormonal effects on body positions and movements prenatally; they are in line with main results from the interview section of the Hamburg CAH study (e.g., "Gender-related behavior"). An approach of this kind seems to be justified for investigating motor behavior in future psychoendocrine studies.     

Defrosting the frozen approximation: PROSPECTOR--a new approach to threading

PROSPECTOR (PROtein Structure Predictor Employing Combined Threading to Optimize Results) is a new threading approach that uses sequence profiles to generate an initial probe-template alignment and then uses this "partly thawed" alignment in the evaluation of pair interactions. Two types of sequence profiles are used: the close set, composed of sequences in which sequence identity lies between 35% and 90%; and the distant set, composed of sequences with a FASTA E-score less than 10. Thus, a total of four scoring functions are used in a hierarchical method: the close (distant) sequence profiles screen a structural database to provide an initial alignment of the probe sequence in each of the templates. The same database is then screened with a scoring function composed of sequence plus secondary structure plus pair interaction profiles. This combined hierarchical threading method is called PROSPECTOR1. For the original Fischer database, 59 of 68 pairs are correctly identified in the top position. Next, the set of the top 20 scoring sequences (four scoring functions times the top five structures) is used to construct a protein-specific pair potential based on consensus side-chain contacts occurring in 25% of the structures. In subsequent threading iterations, this protein-specific pair potential, when combined in a composite manner, is found to be more sensitive in identifying the correct pairs than when the original statistical potential is used, and it increases the number of recognized structures for the combined scoring functions, termed PROSPECTOR2, to a total of 61 Fischer pairs identified in the top position. Application to a second, smaller Fischer database of 27 probe-template pairs places 18 (17) structures in the top position for PROSPECTOR1 (PROSPECTOR2). Overall, these studies show that the use of pair interactions as assessed by the improved Z-score enhances the specificity of probe-template matches. Thus, when the hierarchy of scoring functions is combined, the ability to identify correct probe-template pairs is significantly enhanced. Finally, a web server has been established for use by the academic community (http://bioinformatics.danforthcenter.org/services/threading.html).     

盐酸多奈哌齐联合综合康复训练对老年痴呆患者认知功能、事件相关电位及血清BDNF、IGF-1的影响

目的:探讨盐酸多奈哌齐联合综合康复训练对老年痴呆患者认知功能、事件相关电位及血清脑源性神经营养因子(BDNF)、胰岛素样生长因子1(IGF-1)的影响。方法:选取2017年3月~2020年3月期间来我院接受治疗的120例老年痴呆患者,根据随机数字表法分为对照组(n=60,盐酸多奈哌齐治疗)和联合组(n=60,盐酸多奈哌齐联合综合康复训练治疗)。对比两组疗效,治疗前、治疗3个月后的认知功能评分、事件相关电位、血清BDNF和IGF-1水平变化,以及治疗期间不良反应发生情况。结果:联合组的临床总有效率为91.67%,高于对照组的70.00%(P<0.05)。两组治疗3个月后日常生活能力评估量表(ADL)、临床痴呆量表(CDR)评分降低,且联合组低于对照组(P<0.05);简易精神状态量表(MMSE)评分升高,且联合组高于对照组(P<0.05)。两组治疗3个月后N1潜伏期、P2潜伏期均缩短,P3波幅均升高,且联合组治疗3个月后P2潜伏期短于对照组,P3波幅高于对照组(P<0.05);两组治疗3个月后N1潜伏期比较未见统计学差异(P>0.05)。联合组治疗3个月后BDNF水平高于对照组(P<0.05);两组治疗3个月后IGF-1水平比较未见统计学差异(P>0.05)。对照组与联合组不良反应发生率对比无统计学差异(P>0.05)。结论:老年痴呆患者在盐酸多奈哌齐基础上联合综合康复训练,认知功能可得到明显改善,同时还可调节患者事件相关电位及血清BDNF、IGF-1水平。     

Predictors of dementia, the construction of classification trees

In order to identify persons who are at risk for dementia in an early phase, two classification trees were developed. Data were used from the Longitudinal Aging Study Amsterdam (LASA). The prevalence of dementia in the whole sample was 4.0%. In the first tree age seemed to be the strongest predictor, with an increased risk for persons older than 75. In this group the positive predictive value reached a maximum of 33.3% when the persons had memory complaints and a score on the Mini Mental State Examination (MMSE) <24. In a second classification tree, age was excluded as a predictor because of high association with the other potential predictors. In this tree functional limitations seemed the strongest predictor. In the group of persons with at least one functional limitations, the positive predictive value reached a maximum of 28.8% when the persons had memory complaints and a score <24 on the MMSE. In persons without memory complaints, persons with cardiovascular diseases or diabetes were at increased risk of dementia. Further research is necessary before these classification trees can be implemented in general health care.     

Effects of pulsed electromagnetic fields on learning and memory abilities of STZ-induced dementia rats

Introduction: Recent studies have shown that pulsed electromagnetic field (EMF) has therapeutic potential for dementia, but the associated neurobiological effects are unclear. This study aimed to determine the effects of pulsed EMF on Streptozotocin (STZ)-induced dementia rats.Methods: Forty Sprague-Dawley rats were randomly allocated to one of the four groups: (i) control, (ii) normal saline injection (sham group), (iii) STZ injection (STZ group) and (iv) STZ injection with pulsed EMF exposure (PEMF, 10 mT at 20 Hz) (STZ + MF group). Morris water maze was used to assess the learning and memory abilities. Insulin growth factors 1 and 2 (IGF-1 and IGF-2) gene expression were determined by quantitative PCR. Results: The results showed that the mean escape latency in STZ-induced dementia rats was reduced by 66% under the exposure of pulsed EMF. Compared with the STZ group, the swimming distance and the time for first crossing the platform decreased by 55 and 41.6% in STZ + MF group, respectively. Furthermore, the IGF-2 gene expression significantly increased compared to that of the STZ group. Conclusions: Our findings indicate that the pulsed EMF exposure can improve the ability of learning and memory in STZ-induced dementia rats and this effect may be related to the process of IGF signal transduction, suggesting a potential role for the pulsed EMF for the amelioration of cognition impairment.     

Levels of immunoglobulins of isotype IgG and IgG2 in subjects lacking formation of IgG antibodies against lipopolysaccharide of Chlamydia

In some patients with antibodies against LPS antigen of Chlamydia, specific immunoglobulins G are not present. The findings of isolated anti-LPS IgA/IgM antibodies are to be considered as possibly non-specifically or "false" positive. The aim of this study was to investigate if there is any difference in the level of total immunoglobulins of isotypes IgG and IgG2 in probands with isolated positivity anti-LPS IgA (i.e. without simultaneous presence of specific IgG; n = 34) as compared with a control group of subjects presenting positive anti-LPS IgA and IgG antibodies (n = 44). Antibodies against LPS antigen of Chlamydia were determined by ELISA method ("Chlamydien--rELISA", medac, Germany). Total immunoglobulin levels were determined by nephelometry using the following kits: "Immunoglobulin G Reagent, ARRAY Systems", Beckman Coulter, USA and "Human IgG2 Subclass Beckman ARRAY Kits", The Binding Site, UK. The measured values were related to the age-dependent laboratory standard values and the differences between the tested groups were statistically evaluated (chi(2) test). Decreased total IgG have been demonstrated in 4 (11.8 %) probands and in 5 (11.4 %) subjects of the control group; increased total IgG were found in 2 (5.9 %) probands and in 1 (2.3 %) subject of the control group. Decreased levels of total IgG2 were not determined in any proband and were found in 1 (2.3 %) subject of the control group. Increased levels of IgG2 were registered in 12 (35.3 %) probands and in 15 (34.1 %) control subjects. No statistically significant differences were found between the two groups. It can be concluded that no relationship was proved between the levels of total IgG and IgG2 and the absence of formation of specific anti-Chlamydia-LPS IgG. Further research will be necessary for the elucidation of this phenomenon (e.g. the presence of specific anti-LPS IgG in immunocomplexes).     

基于标准病例的案例教学法在普外科见习教学中的应用探讨

目的:探讨基于标准病例(SP)的案例教学法(CBL)在普外科见习教学中的应用效果。方法:选取2014年6月至2015年6月我院见习的五年制临床本科医学生共112人,利用随机数字表的方法将其分为对照组和研究组,两组人数各56人。对研究组采取基于SP的CBL教学法,而对照组则使用传统临床带教方法,1个月后对理论、技能进行评价,并对学生和教师的满意进行问卷调查。结果:在技能考核和病例分析方面,研究组学生的得分显著高于对照组(P0.05),理论成绩无明显差异(P0.05)。对学生满意度的调查中,在"课堂气氛活跃"、"对学习兴趣的激发"、"利于理论与实践结合"以及"有利于形成正确临床思维"四个方面,研究组的满意度显著高于对照组(P0.05)。在对教师满意度调查中,认为试验组教学法的效率要高于对照组教学法(P0.05),而在"易实施性"满意度低于对照组教学法(P0.05),在"可操作性"方面差异无统计学意义(P0.05)。结论:与传统教学模式比较,基于SP的CBL教学法具有显著的优势,能更直观的展示某种疾病的特征,使学生通过实践巩固对基础知识的记忆,值得进一步探索并推广。     

Statins Reduces the Risk of Dementia in Patients with Late-Onset Depression: A Retrospective Cohort Study

Objective

Patients with late-onset depression (LOD) have been reported to run a higher risk of subsequent dementia. The present study was conducted to assess whether statins can reduce the risk of dementia in these patients.

Methods

We used the data from National Health Insurance of Taiwan during 1996–2009. Standardized Incidence Ratios (SIRs) were calculated for LOD and subsequent dementia. The criteria for LOD diagnoses included age ≥65 years, diagnosis of depression after 65 years of age, at least three service claims, and treatment with antidepressants. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients for validation studies. Kaplan-Meier curve estimate was used to measure the group of patients with dementia living after diagnosis of LOD.

Results

Totally 45,973 patients aged ≥65 years were enrolled. The prevalence of LOD was 12.9% (5,952/45,973). Patients with LOD showed to have a higher incidence of subsequent dementia compared with those without LOD (Odds Ratio: 2.785; 95% CI 2.619–2.958). Among patients with LOD, lipid lowering agent (LLA) users (for at least 3 months) had lower incidence of subsequent dementia than non-users (Hazard Ratio = 0.781, 95% CI 0.685–0.891). Nevertheless, only statins users showed to have reduced risk of dementia (Hazard Ratio = 0.674, 95% CI 0.547–0.832) while other LLAs did not, which was further validated by Kaplan-Meier estimates after we used the propensity scores with the one-to-one nearest-neighbor matching model to control the confounding factors.

Conclusions

Statins may reduce the risk of subsequent dementia in patients with LOD.