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OBJECTIVE@#To investigate the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and deterioration of global and specific domains of cognitive function in peritoneal dialysis (PD) patients.@*METHODS@#This was a multi-center prospective cohort study. The PD patients who met the inclusion criteria were examined with general and specific cognitive function between March 2013 and November 2013. The patients were divided into MIA0, MIA1 and MIA2 groups, according to items of "Yes" for whether or not having cardiovascular disease, serum albumin≤35 g/L or high-sensitive C-reactive protein (hs-CRP) ≥3 mg/L. After 2 years, the patients maintained on PD would be repeatedly measured with cognitive function. The Chi-square test, One-way ANOVA, Kruskal-wallis H rank sum test were used to compare the differences of clinical characteristics, biochemical data, and global and specific cognitive function parameters among the three groups at baseline, and two years later, respectively. The Bonferroni method was applied to adjust the significance level for further comparison between each two different groups. The change of score in each cognitive parameter of global and specific domains was used as dependent variable. Age, gender, education level, depression index, body-mass index, diabetes mellitus, serum sodium levels and MIA (MIA0 was control, MIA1 and MIA2 as dummy variables) were all included in the multivariable linear regression models to analyze the risk factors of the deterioration of cognitive function. The analysis for each cognitive domain was adjusted for the baseline score of the corresponding cognitive parameter. All the analyses were performed using SPSS for Windows, software version 25.0 (SPSS Inc., Chicago, IL).@*RESULTS@#Over two-year follow up, the prevalence of cognitive impairment increased from 20.0% to 24.7%, absolute decrease of 3MS scores were more significantly decreased in MIA2 (-3.9±12.0 vs. 1.1±6.7, P<0.01) and MIA1 group (-2.3±11.8 vs. 1.1±6.7, P<0.05) than those in MIA0 group respectively. Specific cognitive functions, included executive function (trail-making tests A and B, P=0.401, P=0.176), immediate memory (P=0.437), delayed memory (P=0.104), visuospatial skill (P=0.496), and language ability (P=0.171) remained unchanged. Advanced age, lower education, diabetes mellitus and depression were all correlated with the deterioration of one or more cognitive domains, and the patients having one item of MIA syndrome were prone to develop the deterioration of 3MS (P=0.022). Furthermore, the patients having two or more items of MIA syndrome were more likely to develop the deterioration of not only 3MS (P <0.001), but also delayed memory, visuospatial skill, and language ability (P=0.002, P=0.007, P=0.004, respectively).@*CONCLUSION@#Patients with one item or above of MIA syndrome were at high-risk for the deterioration of global cognitive function. The more MIA syndrome items there were, the more specific cognitive domains deteriorated.
Subject(s)
Humans , C-Reactive Protein , Cardiovascular Diseases/etiology , Cognition , Cognitive Dysfunction/complications , Cross-Sectional Studies , Inflammation/etiology , Malnutrition/etiology , Peritoneal Dialysis , Prospective StudiesABSTRACT
Objective To investigate the prevalence of children dental fluorosis in drinking-water-borne endemic fluorosis areas in Liaoning province and to evaluate the disease prevention effects of water improvement measures.Methods Haicheng city,Linghai city,Faku county,Fumeng county,Liaoyang county and Jianping county six endemic fluorosis diseased counties (cities) of Liaoning province were included in the study in September 2011.In each county,3 water improvement villages were selected as survey points.In each surveyed village,children aged 8-12 were generally surveyed the prevalence of dental fluorosis.One tap water sample was collected in each surveyed village for determination of water fluorine.level.Results A total of 786 children aged 8-12 were examined; 110 of them were found with dental fluorosis; detection rate of dental fluorosis was 14.0％ ; no defect case of dental fluorosis was found,and dental fluorosis index was 0.27.Among the cases,very mild were 76 cases,and the detection rate was 9.7％; mild 33 cases,the detection rate was 4.2％; moderate 1 case,the detection rate was 0.1％; and no severe case.Four cases were in the eight-year-old group,accounting for 3.6％ of the total number of cases; 20 in the 9-year-old group,accounting for 18.2％ ; 26 in the 10-year-old group,accounting for 23.6％; 32 in the 11-year-old group,accounting for 29.1％; and 28 in the 12-year-old group,accounting for 25.5％.The differences of detection rates of dental fluorosis of children in each age groups were statistically significant (x2 =13.57,P ＜ 0.05).Water fluoride of the 18 water samples ranged from 0.34 to 2.03 mg/L; 77.8％ (14/18) of the water improvement areas reached the control standard for endemic fluorosis areas.Conclusion The prevalence of dental fluorosis in the areas with high fluoride in drinking water remains high,the measures of water improvement should be strengthened.
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Objective To establish information management systems of drinking water defluoridation project in water-related endemic fluorosis areas and investigate the status of drinking water defluoridation project in Liaoning, provide the basis for the development of control measures. Methods Global positioning systems (GPS)and geographic information systems(GIS) were used in the study in August 2006 - July 2008. Water defluoridation projects of 1234 in 48 counties(cities, districts) in drinking water type of fluorosis areas were positioned. Latitude and longitude, water samples, water fluoride content were collected or tested. GIS was used to establish information management system of water defluoridation projects. Results We have established information management system for the facilities of decreasing water fluorine in drinking water type of endemic fluorosis regions in Liaoning. One thousand two hundred and thirty four defluoridation facilities distributed in east longitude between 39.39° - 43.37°,north latitude between 119.25° - 125.50°, and altitude between - 6.60 and 801.14 meter in 48 endemic fluorosis counties in 13 cities. Nine hundred and twenty seven facilities for decreasing fluorine were able to supply water regularly, accounting for 75.1% of investigated projects;29 facilities was .not yet completely rebuilt, accounting for 2.4%;278 facilities(supply water for 344 villages) were out of order or discarded for 22.5% of investigated projects.Water fluorine contents of 63 facilities were greater than 1.2 mg/L, accounting for 6.8% of investigation project.Facilities working regularly and water fluorine was in accord with hygienic standard for drinking water facilities were 70.0%. Conclusions The establishment of Liaoning province defluoridation project information management system in the whole province of drinking water type of fluorosis areas provides scientific basis for accurate decision-making on prevention and control of the disease.
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Objective To investigate the status of control of endemic fluorosis in Liaoning Province.Methods To investigate the prevalence rate of endemic fluorosis and water fluoride content in regions with different extent of endemic fluorosis,dental fluomsis among 8-12 years old children and clinical fluorosis at adult above 16 years old were extensively surveyed,urinary fluoride among 8-12 years old children was detected.Results We surveyed 842 undefluorided drinking water in endemic fluorosis villages and 1234 projects of improving drinking water in 1829 endemic fluorosis viflages.Water fluoride content was 0.01-7.10 mg/L in unimproved drinking water in endemic fluorosis resions,averaging(0.96±0.64)mg/L;29.2%(246/842)of the endemic fluorosis regions had a fluoride content more than 1.2 mg/L In 1234 projects of improving drinking water.drinking water fluoride content was between 0.06-7.67 mg/L.The project normally operated and having a fluoride content≤1.2 mg/L accounted for 68.31%(843/1234),while 31.69%(391/1234)of the projects did not function well.The prevalence of dental fluomsis in 8-12 years old child ren in endemic fluorosis regions was 24.4%(2960/12 127),the prevalence of clinical fluorosis among adults was 2.22%(1900/85 636).The prevalente of dental fluorosis in slight,moderate and serious fluorosis regions had remarkable statistics differences(X2＝19.25,P＜0.01).The prevalence of dental fluorosis of children in serious fluorosis regions was the highest,reaching 100%,while the prevalence of skeletal fluorosis wns 18.03%(97/538).The median of urinary fluoride was 2.01.2.00mg/L in serious and slight fluomsis regions,respectively.Conclusions Endemic fluorosis is still serious.so we need urgently to improve water in serious fluorosis regions without defluoridaton of drinking water.Endemic fluomsis resions where worn-out and closed defluoriding projects exist need defluoriding management.