Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta-analysis.

It remains unclear whether melatonin and its analogues prevent postoperative delirium (POD). Therefore, we conducted a systematic review and meta-analysis to evaluate the effect of melatonin and its analogues on POD prevention. PubMed, Cochrane Library, Web of Science, Embase and CINAHL databases were searched. Primary outcome was the incidence of POD. Six randomized controlled trials, 2 cohort studies and 1 case-control study were included in this meta-analysis. Results showed that melatonin and its analogue ramelteon decreased the incidence of POD in the entire adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval [CI] 0.24-0.84, P = .01). When administered at a higher dose (5 mg), melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI 0.20-0.52, P < .00001). Melatonin administered less than 5 elimination half-lives before the surgery significantly reduced the POD incidence (OR = 0.31, 95% CI 0.19-0.49, P < .00001). Current literature supports the effectiveness of melatonin and its analogue ramelteon in POD prevention. However, the present study was limited by the significant heterogeneity of the included studies. More studies are needed to ascertain the preventive effect of melatonin and its analogues on the incidence of delirium after cardiac and noncardiac surgeries.

[Exploration of demonstration and promotion experiment of fluorine fixation technology during coal burning].

OBJECTIVE: To demonstrate and promote the fluorine-fixing technology of the coal burning on a calcium-based compound as the additive for briquettes made in the coal-burning fluorosis area, in order to evaluate the effects of fluorine-fixing and indoor air pollutants condition. METHODS: The briquettes added calcium-based fluorine sorbent were used for heating and cooking. In the meantime, the figures on various components in briquettes and fluorine content in coal slag as well as concentrations of indoor air fluorides, sulfur dioxide and PM10 were calculated. RESULTS: On the basis of the coal burning fluorine-fixing pilot experiment, 100 households in Longli County, Guizhou Province were selected as the experimental group for coal burning fluorine-fixing demonstration and promotion. When the burning calcium-based fluorine-fixing bitumites were made into coalballs, the average fluorine-fixing ratios in demonstration and promotion were 77.26%. The average reduction ratios of indoor air pollutants, fluorides were 53.3% -73.8%, sulfur dioxide were 62.8% -91.1% and PM10 were 9.5% -41.4%. There were 10% increases in the cost of briquettes due to the addition of calcium-based fluorine sorbent in demonstration and promotion. CONCLUSION: The preparation process of calcium-based fluorine-fixing briquettes was simple and highly flammable and it was applicable to regions abundant in bitumite.

Comparison of efficacy and safety of urate-lowering therapies for hyperuricemic patients with gout: a meta-analysis of randomized, controlled trials.

OBJECTIVES: To assess the efficacy and safety of the commonly used urate-lowering therapies (ULTs): febuxostat, allopurinol, and lesinurad in hyperuricemic patients with gout. METHODS: We included all randomized controlled trials (RCTs) that compared ULTs with placebo or head to head. The primary efficacy endpoint was the proportion of subjects achieving the target serum urate (SU) level at month 6. Safety outcomes included total adverse events (AEs), serious AEs, withdrawals due to AEs, and AEs per organ system. A Bayesian network model was used to compare all ULTs with placebo and among themselves. RESULTS: Fifteen RCTs were included for the analysis, in which 7968 patients were randomly assigned to take either placebo or one of 11 ULTs: allopurinol, febuxostat 40/80/120/240 mg/day, lesinurad 400 mg/day, lesinurad 200/400/600 mg/day plus allopurinol, and lesinurad 200/400 mg/day plus febuxostat. All ULTs were effective in achieving the target SU level at month 6 compared with placebo (ORs between 26.81 and 1928). Febuxostat 80/120/240 mg/day was superior to allopurinol and well tolerated for urate reduction. And as febuxostat dosage increased, more patients achieved the target SU level. Furthermore, the lesinurad combination with xanthine oxidase inhibitor (XOI) groups had a higher proportion of patients achieving the target SU level than the febuxostat 40 mg/day group (ORs between 2.89 and 9.17), the allopurinol group (ORs between 3.56 and 11.27), or the lesinurad 400 mg/day monotherapy group (ORs between 12.30 and 39.17) but might have a high risk of AEs. CONCLUSIONS: All ULTs are effective in achieving the target SU level compared with placebo in hyperuricemic patients with gout. Lesinurad in combination with febuxostat or allopurinol is effective in urate lowering, especially for patients with inadequate response to XOI monotherapy. Key Points • All urate-lowering therapies (ULTs) were effective in achieving the target serum urate (SU) level at month 6 compared with placebo in hyperuricemic patients with gout. • Febuxostat 80/120/240 mg/day was superior to allopurinol and well tolerated for urate reduction. And as febuxostat dosage increased, more patients achieved the target SU level. • Lesinurad in combination with febuxostat or allopurinol was effective in urate lowering, especially for patients with inadequate response to xanthine oxidase inhibitor monotherapy, but might have a high risk of AEs.

[A experimental study on the effect of fluorine capture of calcium based coal briquette].

OBJECTIVE: To study on the fluorine capture effect of calcium based coal briquette with fluorine capture additive in coal-burning fluorosis area. METHODS: Add proper proportions of calcium based fluorine capture additive in high fluorine coal for making coal briquette were added, and were added the fluorine in coal cinder in order to reduce its emission. Meanwhile, to determine the composes of coal briquette were added, the percentage of fluorine in coal cinder and the concentration of fluoride, sulfur dioxide and PM10 were determinated, to evaluate the effect of fluorine capture and the level of door air pollution. RESULT: After pilot-scale studying on the effect of fluorine capture in 30 households at coal-burning fluorosis area in Guiding of Guizhou Province. The average fluorine capture rate were 71.8%, and the average concentration of fluoride were 0.0052 mg/m3, which reduces by 27.8% in comparison with control group and were lower than environmental air quality standard (0.007 mg/m3); and the average concentration of SO2 were 0.67 mg/m3, which reduces 52.8% in comparison with control group and slightly higher than those of indoor air quality standard (0.5 mg/m3). CONCLUSION: The application of the coal briquette made by calcium based fluorine capture additive could reduce the pollution caused by high fluorine coal, could improve the quality of indoor air.

Fluorine-fixing efficiency on calcium-based briquette: pilot experiment, demonstration and promotion.

BACKGROUND: The fluorosis derived from coal burning is a very serious problem in China. By using fluorine-fixing technology during coal burning we are able to reduce the release of fluorides in coal at the source in order to reduce pollution to the surrounding environment by coal burning pollutants as well as decrease the intake and accumulating amounts of fluorine in the human body. The aim of this study was to conduct a pilot experiment on calcium-based fluorine-fixing material efficiency during coal burning to demonstrate and promote the technology based on laboratory research. METHODS: A proper amount of calcium-based fluorine sorbent was added into high-fluorine coal to form briquettes so that the fluorine in high-fluorine coal can be fixed in coal slag and its release into atmosphere reduced. We determined figures on various components in briquettes and fluorine in coal slag as well as the concentrations of indoor air pollutants, including fluoride, sulfur dioxide and respirable particulate matter (RPM), and evaluated the fluorine-fixing efficiency of calcium-based fluorine sorbents and the levels of indoor air pollutants. RESULTS: Pilot experiments on fluorine-fixing efficiency during coal burning as well as its demonstration and promotion were carried out separately in Guiding and Longli Counties of Guizhou Province, two areas with coal burning fluorosis problems. If the calcium-based fluorine sorbent mixed coal was made into honeycomb briquettes the average fluorine-fixing ratio in the pilot experiment was 71.8%. If the burning calcium-based fluorine-fixing bitumite was made into a coalball, the average of fluorine-fixing ratio was 77.3%. The concentration of fluoride, sulfur dioxide and PM10 of indoor air were decreased significantly. There was a 10% increase in the cost of briquettes due to the addition of calcium-based fluorine sorbent. CONCLUSIONS: The preparation process of calcium-based fluorine-fixing briquette is simple yet highly flammable and it is applicable to regions with abundant bitumite coal. As a small scale application, villagers may make fluorine-fixing coalballs or briquettes by themselves, achieving the optimum fluorine-fixing efficiency and reducing indoor air pollutants providing environmental and social benefits.