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Objective: to develop an integrative learning program for people with dementia. Method: a methodological study was conducted using Delphi technique to develop the learning program, followed by a feasibility test. An expert panel was invited to develop the integrative learning program based on the neuroplasticity and learning framework. A feasibility test was conducted to evaluate the implementation of the program in two centers after the training of personnel who run the program. Verbatim transcripts of case conferences were coded, analyzed, and collapsed into themes and sub-themes by consensus. Results: there was no indication for content modification during the period of program implementation. Qualitatively, the participating older adults showed improvement in communications, emotions, connectedness with self and others, and well-being. Conclusion: the integrative learning program was uneventfully implemented with promising results. The program is ready for full-scale research on its efficacy in multiple centers to obtain more robust evidence.
Objetivo: desarrollar un programa de aprendizaje integrador para personas con demencia. Método: se realizó un estudio metodológico empleando la técnica Delphi para desarrollar el programa de aprendizaje, seguida de una prueba de viabilidad. Se invitó a un panel de expertos a que desarrollara el programa de aprendizaje integrador sobre la base del marco de la neuroplasticidad y el aprendizaje. Se realizó una prueba de viabilidad para evaluar la implementación del programa en dos centros después de haber capacitado al personal que dirige el programa. Las transcripciones literales de los debates de casos se codificaron, analizaron y resumieron en temas y subtemas por medio de consenso. Resultados: no hubo ninguna indicación para modificar el contenido durante el período de implementación del programa. En forma cualitativa, los adultos mayores que participaron del programa evidenciaron mejoras en la comunicación, las emociones, la capacidad de conexión con ellos mismos y con los demás y el bienestar. Conclusión: el programa de aprendizaje integrador se implementó sin inconvenientes con resultados prometedores. El programa es apto para ser sometido a una investigación a gran escala con respecto a su eficacia en varios centros para obtener evidencia más sólida.
Objetivo: desenvolver um programa de aprendizagem integrativa para pessoas com demência. Método: foi realizado um estudo metodológico com a técnica Delphi para desenvolver o programa de aprendizagem, seguido de um teste de viabilidade. Um grupo de especialistas foi convidado para desenvolver o programa de aprendizagem integrativa com base no framework da neuroplasticidade e da aprendizagem. Um teste de viabilidade foi realizado para avaliar a implementação do programa em dois centros após treinamento do pessoal que dirige o programa. Transcrições literais de conferências de casos foram codificadas, analisadas e agrupadas em temas e subtemas por consenso. Resultados: não houve indicação de modificação de conteúdo durante o período de implementação do programa. Qualitativamente, os idosos participantes apresentaram melhora nas comunicações, emoções, conexão consigo e com os outros e bem-estar. Conclusão: o programa de aprendizagem integrativa foi implementado sem intercorrências com resultados promissores. O programa está adequado para ser submetido a pesquisas em grande escala relacionadas com sua eficácia em vários centros a fim de obter evidências mais robustas.
Subject(s)
Psychiatric Nursing , Nursing Methodology Research , Delphi Technique , Communication , Community Health Services , Dementia , Learning , Neuronal PlasticityABSTRACT
Objective:To investigate the role of miRNA-181 targeting phosphatase and tensin homologue deleted on chromosome ten (PTEN) in regulating phosphatidylinositol-3-kinase/Akt signaling pathway (PI3K/Akt) signaling pathway in renal injury of hyperuricemia rats.Methods:Forty male Wistar rats were randomly divided into control group, model group, negative control group and miRNA-181 inhibition group. Their serum uric acid, creatinine and urea nitrogen were tested. HE staining was used to observe the renal histopathological changes in each group. The expression of miRNA-181, PTEN, PI3K and Akt mRNA in renal tissue of rats in each group was detected by quantitative real time-polymerase chain reaction (qRT-PCR). Western blotting analysis of PTEN, PI3K, Akt and p-Akt protein expression in renal tissue of rats in each group. The targeting relationship between miRNA-181 and PTEN was confirmed by double luciferase reporter gene experiment. One-way analysis of variance (ANOVA) was used for the comparison between multiple groups, with the same variance. LSD- t test was used for further comparison between the two groups. If the variance was not the same, Tamhane's T2 test was used for further comparison between the two groups. Independent sample t-test was used to compare between the two groups. Results:Compared with the control group (135±21) mmol/L; (27.8±2.1) μmol/L; (6.8±0.5) μmol/L, the contents of uric acid [(213±28) mmol/L, (214±23) mmol/L, creatinine (49.2±2.3) μmol/L, (48.6±2.2) μmol/L and urea nitrogen (11.5±2.7) μmol/L; (11.7±2.5) μmol/L] in the model group and the negative control group were significantly increased ( Furic acid=26.739, Fcreatinine=259.055, Furea nitrogen=12.921, all P<0.05); compared with the nega-tive control group, the contents of uric acid (169±21) mmol/L, creatinine (33.7±1.8) μmol/L and urea nitrogen (9.1±1.7) μmol/L in the miRNA-181 inhibition group were decreased (LSD- turic acid=4.356, LSD- tcreatinine=15.773, LSD- turea nitrogen=2.858, all P<0.05). The expression level of miRNA-181 in renal tissue of the model group and the negative control group (1.88±0.16, 1.84±0.18) was significantly higher than that of the control group (0.53±0.08) ( F=193.554, P<0.05), while the expression level of PTEN protein (0.18±0.02, 0.16±0.02) and mRNA (0.48±0.08, 0.44±0.07) were lower than that of the control group (1.27±0.06, 1.27±0.16) ( Fprotein=515.116, FmRNA=141.470, all P<0.05) ); after inhibiting miRNA-181, the expression level of miRNA-181 (1.35±0.58) in renal tissue increased significantly (LSD- t=10.341, P<0.05), and the expression level of PTEN protein (0.84±0.05) and mRNA (0.90±0.08) increased on average (LSD- tprotein=20.471, Tamhane's T2 mRNA=13.881, all P<0.05). The results of double luciferase reporter gene analysis showed that PTEN was the target gene of miRNA-181. Compared with the control group (0.18±0.02, 0.09±0.01, 0.05±0.02, 1.06±0.07, 0.96±0.06), the expression level of PI3K (1.01±0.06, 1.00±0.06), Akt (0.90±0.05, 0.95±0.04), p-Akt protein (0.99±0.07, 0.97±0.05) and the expression level of PI3K (3.63±0.18, 3.68±0.22), Akt mRNA (2.38±0.05, 2.34±0.12) in the renal tissue of the model group and the negative control group were significantly increased ( FPI3K protein=169.979, FAkt protein=393.411, Fp-Akt protein=164.201, FPI3K mRNA=563.944, FAkt mRNA=141.470, all P<0.05); after inhibiting the expression of miRNA-181, the expression level of PI3K (0.69±0.06), Akt (0.42±0.03), p-Akt protein (0.50±0.05) and the expression level of PI3K (2.40±0.09), Akt mRNA (1.40±0.12) in the renal tissue of the rats were decreased (LSD- tPI3K protein=7.432, LSD- tAkt protein=18.291, LSD- tp-Akt protein=9.595, Tamhane's T2 PI3K mRNA=17.070, Tamhane's T2 Akt mRNA=17.357, all P<0.05). Conclusion:Inhibition of miRNA-181 expression can target PTEN to inhibit PI3K / Akt signaling pathway to protect renal injury in hyperuricemia rats.
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Objective@#To investigate the effects of micronutrient supplementation for the elderly on plasma homocysteine level and cognitive function in institutional older adults.@*Methods@#A total of 98 older adults with the score≤11 by mini nutritional assessment short-form aged 65-100 years were enrolled and assigned to either intervention group or control group (n=49 each), with either a package of micronutrient pack or placebo daily, for three months. Fasting blood samples were collected both at baseline and the end of study to detect serum vitamin B12, folate and plasma homocysteine (Hcy) concentrations. Global cognitive function was assessed using the mini-mental state examination (MMSE). The paired t test was used to compare the continuous variables between the two groups after intervention. The relationship between changes in MMSE score and changes in plasma Hcy concentrations was examined by least-squares linear regression.@*Results@#Eighty-two patients completed the study, and 17 patients withdrew from the study due to diarrhea and hospital discharge with the drop rate of 17.3%. Compared to the control group, concentrations of serum vitamin B12 (128.8±34.8 vs 13.3±16.0 pmol/L, P=0.003) and folate (21.1±1.6 vs 0.6±0.5 nmol/L, P<0.01) significantly increased in the intervention group over 3-month supplementation, while plasma Hcy levels were remarkably reduced (-5.3±0.7 vs 1.7±0.3 μmol/L, P<0.01). The incidences of deficiency of folate, deficiency of serum vitamin B12and high Hcy all decreased in intervention group. Although individual item scores in MMSE were not changed markedly, change of total MMSE score in intervention group were higher than that in the control group (1.2±3.0 vs -0.2±2.5, P<0.05).@*Conclusions@#The supplementation of the micronutrient pack in long-term care facilities can reduce the incidence of hyperhomocysteinemia, and improve the total MMSE score.
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Objective To investigate the effects of micronutrient supplementation for the elderly on plasma homocysteine level and cognitive function in institutional older adults. Methods A total of 98 older adults with the score≤11 by mini nutritional assessment short-form aged 65-100 years were enrolled and assigned to either intervention group or control group (n =49 each), with either a package of micronutrient pack or placebo daily, for three months. Fasting blood samples were collected both at baseline and the end of study to detect serum vitamin B12, folate and plasma homocysteine (Hcy) concentrations. Global cognitive function was assessed using the mini-mental state examination (MMSE). The paired t test was used to compare the continuous variables between the two groups after intervention. The relationship between changes in MMSE score and changes in plasma Hcy concentrations was examined by least-squares linear regression. Results Eighty-two patients completed the study, and 17 patients withdrew from the study due to diarrhea and hospital discharge with the drop rate of 17. 3％. Compared to the control group, concentrations of serum vitamin B12 (128. 8±34. 8 vs 13. 3±16. 0 pmol/ L, P =0. 003) and folate (21. 1±1. 6 vs 0. 6±0. 5 nmol/ L, P<0. 01) significantly increased (-5. 3±0. 7 vs 1. 7±0. 3 μmol/ L, P<0. 01). The incidences of deficiency of folate, deficiency of serum vitamin B12and high Hcy all decreased in intervention group. Although individual item scores in MMSE were not changed markedly, change of total MMSE score in intervention group were higher than that in the control group (1. 2±3. 0 vs -0. 2±2. 5, P<0. 05). Conclusions The supplementation of the micronutrient pack in longterm care facilities can reduce the incidence of hyperhomocysteinemia, and improve the total MMSE score.
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Objective To investigate the relationship between lipid fluctuations of daily diet and insulin resistance in patients with type 2 diabetes mellitus(T2DM) with normal fasting lipid profile. Methods One hundred and ninety?eight cases patients with T2DM who were treated in the Endocrinology Department of the General Hospital of Benxi Iron and Steel Group Corporation from October 2012 to September 2014 were selected. Patients were divided into three groups according to fasting and postprandial 4 h triglyceride( TG4 h) level,the group with normal fasting TG and normal TG4 h with 38 cases,the group with normal fasting TG and rising TG4 h with 78 cases,the group with rising fasting TG and rising TG4 h with 82 cases. The control group was composed of healthy volunteers with 20 cases. The patients followed daily diet habits to eat,blood glucose, insulin and lipid level of fasting and 2 h,4 h after lunch were monitored. Homeostasis model insulin resistance index( HOMA?IR) was used as an index to evaluate insulin resistance,and the correlation analysis was carried out with fasting and dietary intake of postprandial lipid metabolism. Results (1)HbA1c,FPG,HOMA?IR,TG and insulin level in the patients of the group with normal fasting TG and normal TG4 h,the group with normal fasting TG and rising TG4 h,the group with rising fasting TG and rising TG4 h were higher than the control group (HbA1c:(8. 4±1. 9)%,(8. 2±2. 4)%,(7. 8±1. 8)% vs. (4. 3±0. 6)%);FPG:(8. 98±1. 93) mmol/L, (8. 62±1. 33) mmol/L,(8. 28±1. 26) mmol/L vs. (4. 82±0. 63) mmol/L;,HOMA?IR:11. 07±0. 11,6. 98 ±0. 08,3. 83±0. 09 vs. 1. 24±0. 16;TG:0 h TG:(2. 35±1. 85) mmol/L,(1. 60±0. 41) mmol/L,(1. 58±0. 46) mmol/L vs. (0. 82±0. 25) mmol/L;2 h TG:(3. 97±2. 96) mmol/L,(2. 98±1. 49) mmol/L,(1. 83±0. 62) mmol/L vs. (1. 22±0. 31) mmol/L;4 h TG:(4. 24±1. 57) mmol/L,(3. 15±1. 63) mmol/L,(1. 92±0. 53) mmol/L vs. (1. 16±0. 24) mmol/L;insulin(0 h insulin:(26. 51±3. 65) mU/L,(18. 18±6. 24) mU/L,(10. 31 ±2. 38) mU/L vs. (5. 87±1. 62) mU/L;2 h insulin:(59. 15±8. 34) mU/L,(43. 75±9. 83) mU/L,(34. 27 ±1. 61) mU/L vs. (25. 24±1. 98) mU/L;4 h insulin:(51. 22±6. 79) mU/L,(40. 06±7. 51) mU/L,(31. 06 ±1.77) mU/L vs. (13.36±1.37) mU/L;P<0.05). (2)WHR(0.90±0.08 vs.0.72±0.06),HOMA?IR, insulin level of fasting and 2 h,4 h after lunch,TG of 2 h,4 h after lunch in the group with normal fasting TG and rising TG4 h were higher than the group with normal fasting TG and normal TG4 h ( P<0. 05 ) . ( 3 ) BMI ((27. 3±3. 3) kg/m2 vs. (23. 1±1. 5) kg/m2),WHR(0. 96±0. 10 vs. 0. 72±0. 06),HOMA?IR,TG and insulin level of fasting and 2 h,4 h after lunch in the group with rising fasting TG and rising TG4 h were higher than the group with normal fasting TG and normal TG4 h( P<0. 05) . HOMA?IR,TG and insulin level of fasting and 2 h, 4 h after lunch in the group with rising fasting TG and rising TG4 h were higher than the group with normal fasting TG and rising TG4 h( P<0. 05) . ( 4) HOMA?IR was positively correlated with BMI,WHR,and fasting TG levels in the groups with diabetes(r=0. 297,0. 376,0. 326,P<0. 05). HOMA?IR was significantly positively correlated with TG of 2 h,4 h after lunch in the groups with diabetes( r=0. 529,0. 693,P<0. 05) . HOMA?IR was significantly positively correlated with BMI and WHR in the control group(r=0. 617,0. 728,P <0. 05). HOMA?IR was not significantly correlated with fasting and postprandial TG in the control group. Conclusion Postprandial lipid metabolism disorder after daily diet is in some of patients with T2DM with normal fasting lipid profile. Postprandial lipid metabolism disorder after daily diet is significantly positively correlated with insulin resistance in patients with T2DM. Insulin resistance may be one of the pathogenesis of postprandial dyslipidemia in patients with type 2 diabetes.
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Objective To investigate the effect of hyperuricemia on early renal damage in patients with type 2 diabetic,and to explore the improvement of albumin-to-creatinine ratio (ACR) after lifestyle intervention to control the level of serum uric acid.Methods One hundred and sixty patients with type 2 diabetic mellitus from our hospital from January 2012 to December 2012 were recruited and divided into the high uric acid group (HUA,60 cases),and the normal uric acid group (NUA,100 cases).Fasting blood glucose (FBG),insulin (FINS),glycosylated hemoglobin (HbA1c),serum lipid levels,morning urine albumin-to-creatinine ratio (ACR) were detected in each group,and body mass index (BMI),insulin resistance index (HOMA-IR) were calculated.The HUA group was intervened by lifestyle for at least 6 months,and related indexes were measured again.Results The FINS,HOMA-IR,ACR and triglyceride(TG) of the patients in the HUA group were higher than that in the NUA group((110.33 ±38.73) pmol/L vs.(72.64 ±21.94) pmol/L,t =2.876; (7.0 ±2.3)vs.(4.6±1.3),t =2.364;13.6(5.1,53.2) mg/mmol vs.6.4(2.9,16.8) mg/mmol,H=3.390;(2.53± 1.45) mmol/L vs.(1.71 ± 1.32) mmol/L,t =2.626 ; P ＜ 0.05).By the Spearman correlation analysis,the level of serum uric acid was positively correlated with FINS,HOMA-IR,ACR,and BMI (r =0.304,0.225,0.248,0.271 respectively; P ＜ 0.05).After adjusting the factor of age,duration,obesity,blood glucose and insulin resistance,the level of serum uric acid was still positively correlated with ACR (r =0.312,P ＜ 0.01).The FINS,UA,HOMA-IR and ACR in group HUA were lower than those before lifestyle intervention ((463.7± 18.6) μmol/L vs.(380.3 ± 9.5) μmol/L,t =3.065 ; (110.33 ± 38.73) pmol/L vs.(83.30 ± 28.21)pmol/L,t =2.532; (7.0 ±2.3) vs.(5.0 ±0.9),t =2.165;13.6(5.1,53.2) mg/mmol vs.8.1(4.9,20.4)mg/mmol,H =2.912 ; P ＜ 0.05).Conclusion The patients with type 2 diabetes complicating hyperuricemia were likely to having abnormal ACR.Controlling the level of serum uric acid by lifestyle intervention may be benefit for delaying the development of early diabetic nephropathy in patients with type 2 diabetes.
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Objective To investigate the clinical effect and safety of alpha lipoic acid injection combined mecobalamin and prostaglandin E on type 2 diabetic patients complicated with diabetic peripheral neuropathy(DPN).Methods One hundred and sixty type 2 diabetic patients complicated with DPN in the General Hospital of Benxi Iron and Steel Group Corporation from Jan.2011 to Dec.2012 were randomly divided into the treatment group(n =80) and the control group (n =80).Three cases of the treatment group and 5 cases of the control group discharged early from the study because of their own reasons.There were 77 cases in the treatment group and 75 cases in the control group.On the basis of controlling blood glucose,patients in the two groups were given 500 μg mecobalamin combined with intramuscular injection once two days,as well as prostaglandinE 10 μg injection once a day.Patients in treatment group were added with 600 mg alpha lipoic acid for intravenous injection once a day for 10-14 days.Total symptom score (TSS),nerve conduction velocity,satisfaction and adverse reactions were evaluated before and after treatment.Results TSS score,tingling score,burning sensation score and hypoesthesia score,numb score in treatment group were (3.5 ± 2.5),(1.1 ± 0.4),(0.9 ± 0.7),(1.3 ± 0.4),(1.3 ± 0.9),significantly lower than those in control group (4.3 ± 2.1,t =2.11,P ＜0.05;1.5 ±0.5,t =1.86,P＜0.05;1.3 ±0.5,t =1.83,P ＜0.05;1.7 ±0.5,t =1.87,P ＜0.05; 1.9 ± 0.4,t =1.91,P ＜ 0.05).The median nerve conduction velocity,peroneal nerve motor conduction velocity,median nerve sensory conduction velocity,common peroneal nerve sensory conduction velocity of patients in treatment group were (53.6 ± 1.4) m/s,(49.6 ± 1.1) m/s,(47.3 ± 1.1) m/s,(48.2 ± 1.9) m/s,lower than those in control group((48.5 ±2.7) m/s,t =-4.94,P ＜0.05;(43.9 ±2.1) m/s,t =-5.36,P ＜0.05; (41.6 ± 1.8) m/s,t =-5.09,P ＜0.05;(43.2 ±2.5) m/s,t =-4.27,P ＜ 0.05,P ＜0.05).In the treatment group,97.4％ (75/77) physicians and 92.2％ (71/77) patients were satisfied with treatment effect,while in the control group,84.0％ (63/75) physicians and 78.7％ (59/75) patients were satisfied with treatment effect.During the study periods,there were 3 cases with facial flushing and 1 cases of dizziness in the treatment group,and 2 cases of facial flushing and 1 cases of dizziness in the control group.All adverse reactions were spontaneous remission without any special treatment.Conclusion Alpha lipoic acid intravenous drip is effective in term of treating type 2 diabetic peripheral neuropathy,and with high safety.
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Objective To observe biological effect of cardiotrophin-1(Adv-CT1)gene transfection mediated by adnovims on traumatic brain iniuries(TBI)in-vivo and discuss the role and mechanism of Adv-CT1 on TBI. Metheds A rat TBI model was established bv Allen method.After Adv-CT1 was transfefred into the iniured brain by adnovims,the effect of CT-1 on apoptosis and survival of neurons after TBI was determined by means of Nissl staining,TUNEL and flow cytometry apoptosis assay. Resuits Apoptotic cells were increased but the survived cells decreased in the injured cortical brain and hippocampus from 12 hours to 14 days after TBI in the control group.As compared with control group,Adv-CT1 treatment reversed this situation to some degrees. Conclusion CT-1 has neuropmtective effect on neurons after TBI by reducing apoptosis of neurons.