Oral health in patients with dementia: A meta-analysis of comparative and observational studies.

OBJECTIVE: Poor oral health is common in dementia, but findings of epidemiological studies have been inconsistent. This meta-analysis examined oral health in patients with dementia diagnosed according to standardized diagnostic criteria. METHODS: Six international databases (PubMed, EMBASE, PsycINFO, Medline, Cochrane Library, and Web of Science) were searched from their commencement date until 8 November 2018. Oral health was measured by the Remaining Teeth (RT) and Decayed, Missing, and Filled Teeth (DMFT) Index. The mean differences (MD) and 95% confidence intervals (CI) of DMFT Index total and component scores were calculated using a random-effect model. RESULTS: Twenty-four studies were included for analyses. The pooled DMFT Index was 23.48 (95% CI: 22.34, 24.62), while the pooled score for each component was 2.38 (95% CI: 1.56, 3.20) in decayed teeth (DT), 18.39 (95% CI: 15.92, 20.87) in missing teeth (MT), 2.29 (95% CI: 0.62, 3.95) in filled teeth (FT), and 11.59 (95% CI: 9.14, 14.05) in RT. Compared to controls, people with dementia had significantly a higher DMFT Index total score (MD = 3.80, 95% CI: 2.21, 5.39, p < 0.00,001), and significantly lower number of RT (MD = -3.15, 95% CI: -4.23, -2.06, p < 0.00,001). Subgroup analyses revealed that higher DMFT Index score was significantly associated with year of survey (>2010), study design (case-control study), percentage of females (≤54.3), and the Mini Mental State Examination score (≤18.2). Higher MT score was significantly associated with study design (cross-sectional study), and lower FT score was significantly associated with year of survey (>2010). CONCLUSIONS: Oral health was significantly poorer in people with dementia compared with controls. Regular screening and effective treatment should be implemented for this population.

Prevalence of suicide-related behaviors among physicians: A systematic review and meta-analysis.

OBJECTIVE: Suicide is a major cause of premature death among physicians, but the prevalence of suicide-related behaviors (including suicidal ideation, SI and suicide attempt, SA) is inconsistent across studies. This meta-analysis aimed to estimate the prevalence of suicide-related behaviors among physicians and its associated factors. METHODS: PubMed, EMBASE, PsycINFO, and Cochrane library databases were systematically searched from commencement date to August 14, 2018. Eligible studies on the prevalence of suicide-related behaviors among physicians were included. RESULTS: Thirty-five eligible studies with 70,368 physicians were included. The lifetime prevalence of SI was 17.4% (95% CI: 13.8%-21.8%), while the 1-year prevalence was 8.6% (95% CI: 7.1%-10.3%), 6-month prevalence was 11.9% (95% CI: 2.7%-39.2%), and 1-month prevalence was 8.6% (95% CI: 5.6%-13.0%). The lifetime prevalence of SA was 1.8% (95% CI: 0.9%-3.7%), while the 1-year prevalence was 0.3% (95% CI: 0.1%-0.8%). Subgroup analyses revealed that geographic region was significantly associated with lifetime and 1-year prevalence of SI, while sample size was significantly associated with 1-month prevalence of SI. CONCLUSIONS: This meta-analysis found a relatively high prevalence of suicide-related behaviors, particularly lifetime SI, among physicians. Appropriate preventive and treatment measures should be implemented to reduce the risk of suicide-related behaviors in this population.

Clozapine prescription pattern in patients with schizophrenia in Asia: The REAP survey (2016).

Clozapine is an effective antipsychotic medication for treatment resistant schizophrenia and is widely used in Asian countries. This study investigated clozapine prescription patterns and their associated factors in Asian countries and territories based on the database of the Research on Asian Psychotropic prescription study (REAP) conducted in 2016. Demographic and clinical information of 3744 schizophrenia patients in 15 Asian countries and territories was collected with a standardized data collection form. In total, 18.4% of the sample received clozapine, ranging from 2.6% in Japan to 32.3% in Hong Kong. Binary logistic regression analysis revealed that higher antipsychotic dose (OR = 1.002, P < 0.001), less frequent first admission in the sample (OR = 0.6, P < 0.001), more severe negative symptoms (OR = 1.4, P = 0.001) and less first generation antipsychotics (FGAs) (OR = 0.2, P < 0.001) were independently and significantly associated with clozapine prescription. Clozapine is frequently and increasingly prescribed for schizophrenia in Asia, with large variation across countries and territories. Given the diverse prescription patterns of clozapine found in Asian countries/territories, the clinical rationale of clozapine prescription needs careful consideration in Asia with more local input.

Super-formable pure magnesium at room temperature.

Magnesium, the lightest structural metal, is difficult to form at room temperature due to an insufficient number of deformation modes imposed by its hexagonal structure and a strong texture developed during thermomechanical processes. Although appropriate alloying additions can weaken the texture, formability improvement is limited because alloying additions do not fundamentally alter deformation modes. Here we show that magnesium can become super-formable at room temperature without alloying. Despite possessing a strong texture, magnesium can be cold rolled to a strain at least eight times that possible in conventional processing. The resultant cold-rolled sheet can be further formed without cracking due to grain size reduction to the order of one micron and inter-granular mechanisms becoming dominant, rather than the usual slip and twinning. These findings provide a pathway for developing highly formable products from magnesium and other hexagonal metals that are traditionally difficult to form at room temperature.Replacing steel or aluminium vehicle parts with magnesium would result in reduced emissions, but shaping magnesium without cracking remains challenging. Here, the authors successfully extrude and roll textured magnesium into ductile foil at low temperatures by activating intra-granular mechanisms.

[One-stop hybrid cardiac surgery for adults with complex heart disease].

OBJECTIVE: To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of adult patients with complex heart disease. METHODS: From November 2011 to March 2012, a total of 5 patients [4 male, mean age: (58.8 ± 14.7) years] underwent one-stop hybrid approach in the hybrid operating room. Two patients suffered from multi-coronary lesions, 2 patients were diagnosed with both valvular heart disease and coronary disease, and another 1 patient had valve disease and congenital heart disease (patent ductus arteriosus). Minimally invasive cardiac surgery (coronary artery bypass grafting for the left anterior descending or valvular surgery) and percutaneous intervention were performed in an enhanced operative unit. The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure. RESULTS: The one-stop hybrid procedure was successful in all patients. Left internal mammary artery grafts were unobstructed. A total of 6 non-left anterior descending coronary lesions were treated by percutaneous coronary intervention and 6 drug-eluting stents were implanted. There was no death, perioperative myocardial infarction, heart failure, prosthetic valve dysfunction, respiratory failure, stroke or repeat surgery during the procedure period. All patients remained free from angina, prosthetic valve dysfunction and patent ductus arteriosus recanalisation during the 3.2 months (rang 1 to 5 months) follow-up period. CONCLUSION: One-stop hybrid cardiac surgery provides a reasonable, feasible and safe alternative for treating adult patients with complex heart disease.

Structure and dynamics of nitrifier populations in a full-scale submerged membrane bioreactor during start-up.

Changes of microbial characteristics in a full-scale submerged membrane bioreactor system (capacity, 60,000 m(3) day(-1)) treating sewage were monitored over the start-up period (96 days). Fluorescence in situ hybridization analysis showed that the percentages of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (nitrobacter-related population) in total bacteria counted with DAPI staining increased significantly from 1.9% and 0.9% to 4.5% and 2.8%, corresponding to an increase of the specific ammonium oxidizing rate (from 0.06 to 0.12 kg N kg(-1) mixed liquor suspended solids (MLSS) per day) and the specific nitrate forming rate (from 0.05 to 0.10 kg N kg(-1) MLSS day(-1)). Both the denaturing gradient gel electrophoresis of polymerase chain reaction and clone library results showed that the AOB was dominated by the genus Nitrosomonas, the diversity of which increased markedly with operational time. Most of the day 2 clones were closely related with the uncultured Nitrosomonas sp. clone Ninesprings-49S amoA gene (AY356450.1) originated from activated sludge, while the day 96 clone library showed a more diverse distribution characterized by the appearance of the oligotrophic nitrifiers like the Nitrosomonas oligotropha- and Nitrosomonas ureae-like bacteria, perhaps due to the interception by membrane and the low food-to-microorganisms ratio environment. The above results show that the membrane bioreactor system was characterized by the increased diversity and percentage of nitrifiers, which made it possible to achieve a stable and high efficient nitrification. Ammonia-oxidizing archaea with the changing population structures were also detected, but their roles for ammonia oxidation in the system need further studies.

[Effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma].

OBJECTIVE: To investigate the effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma. METHODS: Eighty severely injured patients were divided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2-4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6-8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-alpha, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. RESULTS: High fever appeared in 9 patients in IT group, and WBC exceeded 10.0 x 10(9) for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 patients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5%). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-alpha and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3-7 ( P < 0.05 or P < 0.01), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group (P < 0.05 or P < 0.01). Plasma levels of TNF-alpha (1.3 +/- 0.6 microg/L) and CRP (55 +/- 16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0 +/- 0.8 microg/L, 89 +/- 20 mg/L, respectively, P < 0.01). CONCLUSIONS: Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.

Simultaneous nitrification and denitrification in step feeding biological nitrogen removal process.

The simultaneous nitrification and denitrification in step-feeding biological nitrogen removal process were investigated under different influent substrate concentrations and aeration flow rates. Biological occurrence of simultaneous nitrification and denitrification was verified in the aspect of nitrogen mass balance and alkalinity. The experimental results also showed that there was a distinct linear relationship between simultaneous nitrification and denitrification and DO concentration under the conditions of low and high aeration flow rate. In each experimental run the floc sizes of activated sludge were also measured and the results showed that simultaneous nitrification and denitrification could occur with very small size of floc.