Effects of exergaming in older individuals with mild cognitive impairment and dementia: A systematic review and meta-analysis.

BACKGROUND: Non-pharmaceutical interventions have been implemented for people with dementia or mild cognitive impairment (MCI). Researchers have used exergaming in dementia to alleviate cognitive decline in patients with dementia. AIMS: We assessed the effects of exergaming interventions on MCI and dementia. METHODS: We conducted a systematic review and meta-analysis (PROSPERO [CRD42022347399]). PubMed, Cochrane Library, Web of Science, CINAHL, and Embase electronic databases were searched for randomized controlled trials (RCTs). The impact of exergaming on cognitive function, physical performance, and quality of life in patients with MCI and dementia was investigated. RESULTS: Ten RCTs met the eligibility criteria and were included in our systematic review. The results of the meta-analysis demonstrated a statistically significant difference in the Mini-mental State Examination, Montreal Cognitive Assessment, Trail Making Test, Chinese version of the Verbal Learning Test, Berg Balance Scale, Short Physical Performance Battery, and Physical Activity Scale for the Elderly in people with dementia and MCI who participated in exergaming. However, there were no significant improvements in the Activities of Daily Living, Instrumental Activity of Daily Living or Quality of Life. CONCLUSION: Although there were significant differences in cognitive and physical functions, these results should be interpreted with caution because of heterogeneity. The additional benefits of exergaming remain to be confirmed in future studies.

Thyroid function of twin-pregnant women in early pregnancy.

BACKGROUND: Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimulating hormone (TSH) levels, the reference ranges of thyroid-related indicators may differ between singleton and twin pregnancies in the first trimester. This study aimed to establish reference ranges for thyroid-related indicators in early twin pregnancies and to compare them with singleton pregnancies. METHODS: Data of 820 twin-pregnant women were extracted from the established database of all pregnant women who delivered at Peking University First Hospital from October 2013 to May 2018; 160 who met National Academy of Clinical Biochemistry criteria were included to establish TSH and FT4 reference ranges. We screened 480 (3:1 paired) women with singleton pregnancies from the same database as controls. The Mann-Whitney test for TSH and FT4 levels was applied for comparisons between singleton and twin pregnancies. RESULTS: First-trimester reference ranges (4-12 gestational weeks) for twin pregnancies were: TSH 0.69 (0.01-3.35) mIU/L and FT4 16.38 (12.45-23.34) pmol/L. Median TSH was significantly lower at 7 to 12 gestational weeks than that at 4 to 6 gestational weeks (0.62 vs. 0.96 mIU/L, Z = -1.964, P = 0.049); FT4 was not significantly different between the two groups. Compared to singleton pregnancies, median TSH was significantly lower (0.69 vs. 1.27 mIU/L, Z = -6.538, P = 0.000), and FT4 was significantly higher (16.38 vs. 14.85 pmol/L, Z = -7.399, P = 0.000) in twin pregnancies in the first trimester. CONCLUSIONS: Specific reference ranges for thyroid-related indicators for twin pregnancies are needed to avoid a misdiagnosis of thyroid dysfunction. Moreover, establishment of separate reference ranges for 4 to 6 and 7 to 12 gestational weeks in twin pregnancies may be considered.

The psychometric properties of the Chinese version of the Conditions of Work Effectiveness Questionnaire-II.

AIMS: The present study was conducted to evaluate the psychometric properties of a newly adapted Chinese version of an instrument designed to measure structural empowerment among staff nurses. BACKGROUND: Structural empowerment has been shown to be important to nurses in Western cultures, but its importance in China is unknown. METHODS: A convenience sample of 650 staff nurses was selected from six hospitals in Harbin, China. After linguistic adaptation using the forward-backward translation method, the 19-item Conditions of Work Effectiveness Questionnaire-II (CWEQ-II-CV) was answered by participants. Content validity, Cronbach's alpha, item-to-total correlation and exploratory factor analysis were used to assess the reliability and validity of the translated instrument. RESULTS: In the factor analysis, a six-factor solution was found to be reasonable with the sub-dimensions of structural empowerment that included support (three items), resources (three items), information (three items), opportunity (three items), formal power (three items) and informal power (four items). Cronbach's alpha coefficient for the total instrument was 0.92 and ranged from 0.68 to 0.86 in the six subscales. The item-to-total correlation coefficients ranged from 0.48 to 0.80. The findings also gave support for content validity. CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ-II-CV scale that measures the quality of the work environment for nurses from a structural empowerment perspective. IMPLICATIONS FOR NURSING MANAGEMENT: The translated version of CWEQ-II-CV can provide an effective evaluation tool for structural empowerment in the Chinese nursing workplace.

Glycosylation of recombinant human thyroid peroxidase ectodomain of insect cell origin has little effect on recognition by serum thyroid peroxidase antibody.

BACKGROUND: Thyroid peroxidase (TPO) is an important autoantigen in Hashimoto's thyroiditis (HT), and almost all epitopes are located in TPO ectodomain. The glycosylation of TPO might contribute to breaking self-tolerance, therefore, purified glycosylated recombinant TPO ectodomain is prerequisite of elucidating its role in the pathogenesis of HT. The aim of our study was to investigate whether the glycosylation has influence on the antigenic determinants of recombinant TPO. METHODS: Bac-to-Bac baculovirus expression system was used to generate recombinant human TPO ectodomain. The antigenicity was analyzed by antigen specific enzyme-linked immunosorbant assays (ELISAs). The glycosylation of recombinant human TPO ectodomain of High Five insect cell origin was detected by lectin-ELISAs. RESULTS: TPO ectodomain was recovered from the culture media as a soluble protein, and it was fused with a hexahistidine tag which allowed purification by nickel-affinity chromatography. The recombinant TPO ectodomain could be recognized by all the 54 HT patients and three TPO monoclonal antibodies. Fucose, sialic acid and galactose were all detected on the recombinant TPO ectodomain. Sera TPOAb binding decreased slightly after non-specific deglycosylation of TPO by periodic acid. CONCLUSIONS: High Five insect cells derived recombinant human TPO ectodomain had N-glycosylation sites, which might have little effect on recognition by serum TPOAb.

The psychometric properties of the Chinese version of the Problem Areas in Psychological Empowerment Scale (PES): scale development.

AIMS: This study was conducted to adapt the Problem Areas in Psychological Empowerment Scale for use among staff nurses and to evaluate the psychometric properties. BACKGROUND: Considering the importance of psychological aspects in the administration of nursing, there is a need for validated measurements in this area. Such tools make it possible to understand staff nurses as well as they serve as reliable measures when evaluating medical, psychological and educational interventions. DESIGN: Instrument development. METHODS: A convenience sample of 750 staff nurses was systematically selected from six hospitals in Harbin, China. Following the linguistic adaptation using the forward-backward translation method, the 12-item Psychological Empowerment Scale was answered by the selected staff nurses. Statistics covered exploratory factor analysis, content validity, Cronbach's alpha and item-to-total correlation. RESULTS: In the factor analysis, a four-factor solution was found to be reasonable with the subdimensions psychological empowerment-related meaning problems (three items), competence problems (three items), self-determination (three items) and impact problems (three items). Cronbach's alpha coefficient for the total score was 0.85 and varied between 0.82-0.89 in the four subscales. The item-to-total correlation coefficient was 0.40, and items were excluded with item-to-total correlation coefficient of lower than 0.40. The findings also gave support for the content validity. CONCLUSIONS: The Chinese version of the Problem Areas in Psychological Empowerment Scale seems to be reliable and valid outcome for measuring empowerment-related psychological response in staff nurses. RELEVANCE TO CLINICAL PRACTICE: The Psychological Empowerment Scale can be used to evaluate staff nurses' empowerment-related psychological response in clinical.

[A clinical pathological study of thyroid nodules detected by physical examinations].

OBJECTIVE: To investigate the relation among the results of thyroid fine needle aspiration cytology (FNAC), thyroid ultrasonography (US) and histopathologic diagnosis about the thyroid nodules detected by physical examination, meanwhile to analyze the etiopathogenesis of the nodules and to evaluate the risk of thyroid cancer and the clinical diagnostic value of FNAC. METHODS: The data of thyroid FNAC results of the thyroid nodules detected by physical examination in 271 cases were analyzed and compared with thyroid US and histopathologic diagnosis. RESULT: (1) The FNAC results showed that the incidences of malignant and suspected malignant lesions were 1.48% and 5.90% respectively. The rate of benign lesions was 78.60% and that of goiter was 29.15%, Hashimoto's thyroiditis 26.57% and thyroid adenoma 15.13%. Benign lesions were more common than malignant ones. (2) Comparison of the FNAC and US results of the thyroid nodules showed that of 96 cases with single nodule the rates of malignancy and suspected malignancy were 3.12% and 7.29%, but of 137 cases with multiple nodules the rates of the two lesions were 0.73% and 6.57%. In 108 cases with smaller nodules (< or = 1.5 cm) the rate of malignancy and suspected malignancy found with FNAC were 0.93% and 7.41%, while in 125 cases with greater nodules (> 1.5 cm) the rate of the two lesions were 2.40% and 6.42%. In 99 solid nodules the rates of malignancy and suspected malignancy were 2.02% and 12.12%, while in 85 cystic or mixed nodules the rates of the two lesions were 2.35% and 2.35%. In the above-mentioned three groups, only the suspected malignancy rate in solid nodules was higher than these in cystic or mixed ones with significant difference (P = 0.013). (3) As compared with the cytological and histological diagnoses in 24 cases, the diagnostic accuracy of FNAC was 75.00% and the rates of false positive and false negative were 25.00% and 0, respectively. CONCLUSIONS: The common causes of the thyroid nodules detected in physical examination are goiter, Hashimoto's thyroiditis and thyroid adenoma. FNAC is a reliable method to define the benign or malignant nature of thyroid nodules with a high diagnostic accuracy. US features of the nodule alone, no matter it is single, solid or of greater size do not sufficiently increase the incidence of thyroid carcinoma.

[Distribution and significance of IgG subclasses of serum antithyroglobulin antibody in Hashimoto thyroiditis].

OBJECTIVE: To evaluate the distribution and significance of IgG subclasses of antithyroglobulin antibody in sera from patients with Hashimoto thyroiditis. METHODS: Sera from 112 patients with Hashimoto thyroiditis were collected and patients were divided into 3 groups, i. e. hypothyroidism, subclinical hypothyroidism and euthyroidism. Antigen specific ELISA was used to detect the distribution of IgG subclasses of antithyroglobulin antibody. RESULTS: The positive rates of IgG subclasses of TgAb were IgG1 90.2%, IgG2 58.0%, IgG3 19.6% and IgG4 87.5% respectively. The mean geometric titers of IgG1 in sera from patients with hypothyroidism and subclinical hypothyroidism were 1: 450.8 and 1: 245.5 respectively, both being significantly higher than that with euthyroidism (1:8.7, P < 0.01). The mean geometric titers of IgG2 in sera from patients with hypothyroidism and subclinical hypothyroidism were 1: 37.3 and 1: 3.2 respectively, both being also significantly higher than that with euthyroidism (1: 0.2, P < 0.01 and P < 0.05 respectively) and that with hypothyroidism was significantly higher than that with subclinical hypothyroidism (P < 0.05). CONCLUSION: The distribution of IgG subclasses of antithyroglobulin antibody in sera from patients with Hashimoto thyroiditis was predominantly IgG1, IgG2 and IgG4. High titers of IgG1 and IgG2 implicated the possibility of development from subclinical hypothyroidism to overt hypothyroidism.

[Post-hoc analyses of type 2 diabetes patients switch from premixed insulin regimen to basal insulin plus oral hypoglycemic agents regimen].

OBJECTIVE: To compare characteristics of better responders to new regimen therapy with non-responders. METHODS: In a 12-week, two-center, open, parallel group clinical trial, 80 type 2 diabetic patients treated with twice-daily premixed 30 R insulin with or without OAD (s) [fasting blood glucose (FBG) 7.8 - 16.7 mmol/L, HbA1c 7% - 10%] were randomized to once-daily morning insulin glargine plus glimepiride 3 mg or premixed 30 R insulin (70/30) twice-daily plus glimepiride 3 mg. Insulin dosage was titrated to target FBG 8.0% vs 8.9%-->7.8%, P > 0.05). However, hypoglycemic episodes were significantly higher in premixed-insulin-treated subjects than in glargine-treated subjects [total: 123 vs 57; proved hypoglycemic episodes 94 (76%) vs 21 (47%), chi(2) = 23.692, P < 0.01], The frequency of hypoglycemia before lunch was especially greater in premixed-insulin-treated subjects 64 (52%) vs 17 (30%), chi(2) = 7.762, P = 0.005. Several subjects from the premixed arm experienced too frequent hypoglycemic episodes to be recorded during 10AM-11AM almost every day. Subgroup analysis for patients treated with glargine: 28.2% (11 cases) of the patients in this group attained HbA1c 8.5% at 12 weeks, mean daily dosage for glargine were (0.66 +/- 0.30) U.kg(-1).d(-1). There were significant differences of baseline HbA1c, diabetes duration and baseline postprandial C-peptide between the two subgroups in glargine arm (HbA1c: 8.1% +/- 0.8% vs 9.6% +/- 1.2%; duration: 10 (6 - 14.5) years vs 13 (8 - 19.5) years; postprandial c peptide: 2.5 nmol/L (1.4 - 3.3) vs 1.4 (1.2 - 2.6) nmol/L, all P < 0.05). CONCLUSION: Type 2 diabetic patients treated with twice-daily injection of premixed 30 R insulin with or without OAD (s) can be effectively and safely switched to basal insulin plus OAD. Pretreatment HbA1c, diabetes duration and postprandial C peptide are the key factors that closely related to efficacy of this new regimen.