INTRODUCTION: Timely detection of dementia enables early access to dementia-specific care services and interventions. Various stakeholders brought together to refine Singapore's dementia care strategy identified a lack of a standardised cognitive screening tool and the absence of a comparative review of existing tools. We hence conducted a rapid review to evaluate the diagnostic performance of brief cognitive screening tools in identifying possible dementia among community-dwelling older adults in Singapore. METHOD: Brief cognitive screening tools were defined as interviews or tests administered in ≤5 minutes. Studies performed in Singapore on older adults ≥60 years, which used locally-validated comparators and reported outcomes of clinician-diagnosed dementia were included. Rapid review methodology was used in study screening and selection. Quality Assessment of Diagnostic Accuracy Studies version 2 tool was used for risk-of-bias assessment. A negative likelihood ratio (LR-) of ≤0.2 was defined a priori as having a moderate effect in shifting post-test probability. RESULTS: Fourteen studies were included in qualitative synthesis: 3 studies evaluated self-/informant-based tools only, 4 evaluated performance-based measures only and 7 evaluated combination approaches. Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) was the most studied self-/ informant-based tool. One study found informant AD8 (iAD8) superior to self-rated AD8. Another study found iAD8 superior to Mini-Mental State Examination. Among performance-based measures, Abbreviated Mental Test, Visual Cognitive Assessment Test-Short form version 1 (VCAT-S1), VCAT-S2 and Mini-Cog had LR- <0.2. Minimal improvement of combination approaches compared to iAD8 alone was demonstrated. CONCLUSION Our review suggests the limited utility of dementia screening in communities with low dementia prevalence and supports a case-finding approach instead. With a reliable informant, iAD8 alone has sufficient discriminant ability. Further research is needed to specifically assess the diagnostic ability of performance-based tools in community settings.
Humans ; Singapore ; Dementia/diagnosis* ; Aged ; Independent Living ; Mass Screening/methods* ; Middle Aged ; Aged, 80 and over

Biological clock proteins are involved in the regulation of many important physiological processes, including blood pressure. The deletion or mutation of core circadian clock genes may cause elevated blood pressure levels and disrupted blood pressure rhythms, exacerbating vascular function damage, and ultimately leading to the occurrence, development and poor outcome of ischemic stroke. This article reviews the molecular mechanism of biological clock rhythm, the relationship between biological clock gene and blood pressure regulation mechanism, the mechanism of circadian rhythm disorder in the occurrence and development of hypertension, and the relationship between blood pressure rhythm disorder and stroke.

Objective    To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer, which may guide its reasonable application. Methods    We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital. There were 57 patients with thoracoscopic pulmonary wedge resection, and harmonic scalpel was used in 34 patients (8 males, 26 females at age of 59.68±10.91 years), and was not used in 23 patients (13 males and 10 females at age of 59.13±11.21 years). There were 88 patients receiving thoracoscopic pulmonary lobectomy, among whom harmonic scalpel was used in 80 patients (36 males and 44 females at age of 59.68±10.91 years), and was not used in 8 patients (5 males, 3 females at age of 61.63±5.60 years). We recorded the perioperative outcomes of all patients. Results    In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe, the operation time was 90.09±43.52 min, the blood loss was 21.32±12.75 ml, the number of lymph nodes resected was 5.12±4.26, duration of drainage was 3.15±1.16 d, volume of drainage was 535.00±291.69 ml, the length of postoperative hospital stay was 4.56±1.40 d, and no postoperative complication was observed. In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel, operation time was 131.88±41.82 min, blood loss was 42.79±31.62 ml, the number of lymph nodes resected was 13.54±8.75, duration of thoracic drainage was 4.47±2.30 d, drainage volume was 872.09±585.24 ml, the length of postoperative hospital stay was 5.81±2.26 d, and 20 patients had postoperative complications. No complication occurred in the 8 patients without harmonic scalpel. Conclusion    Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.

Programmed death 1 (PD-1) and programmed death 1 ligand (PD-L1) pathway is a key mechanism of immune regulation, and its abnormal activation in tumor tissues suggests that PD-1/PD-L1 pathway may participate in the regulation of tumor immune escape. Driver gene mutation which is known as a key factor in the tumorigenesis of non-small cell lung cancer (NSCLC), was also reported to play a important role in the process of tumor immune escape. It indicates that there is an interaction between driver gene and PD-1/PD-L1 pathway. The purpose of this paper is to review the relationship be-tween PD-1/PD-L1 pathway and lung cancer driver gene, such as epidermal growth factor receptor (EGFR), Kirsten rate sarcoma viral oncogene homolog (KRAS) and echinoderm microtubuleassociated protein-like 4 - anaplastic lymphoma kinase (EML4-ALK) and to summarize the role of lung cancer driver gene and PD-1/PD-L1 pathway interaction in the tumorigenesis and progres-sion of NSCLC.

Objective To evaluate the clinical efficacy of Qingrehuashi herbal formula combined with high intensity focused ul-trasound(HIFU ) in the treatment of advanced pancreatic cancer .Methods 86 patients with pancreatic cancer (22 case of III stage and 64 case of IV stage) were included in this study .18 cases were performed the HIFU therapy for 2-3 times .Other 68 cases re-ceived once HIFU therapy ,among 53 cases of liver metastasis ,8 cases were simultaneously conducted HIFU ablation therapy on liv-er metastasis .The patients were given Chinese medicines dominated by Qingrehuashi before and after HIFU therapy and during fol-low up period .Results The single evaluation on HIFU irradiation cases after 1 month:complete remision(CR) in 0 case ,partial re-mission(PR) in 8 cases(9 .3% ) ,stable disease(SD in 64 cases(74 .4% ) and progress disease(PD) in 14 cases(16 .3% ) .The median survival rate of 1 year and half a year was 52 .0% and 11 .4% .Among 73 cases of increased CA199 before treatment ,CA199 after treatment was decreased in 12 cases .Among 36 cases of increased CA242 before treatment ,CA242 after treatment was decreased in 15 cases .The effective rate of analgesic relief in all the cases was 70 .9% (62/86) .Conclusion The integrated therapy of Qingre-huashi herbal formula and HIFU is an effective method for treating advanced pancreatic cancer .

To establish an analytical method for tongue image acquisition under natural daylight based on L*a*b* error correction, and to observe the classification rules of tongue color using color error correction.

Background and purpose:Advanced pancreatic cancer is characteristic of poor treatment eff icacy and short survival time. Gemcitabine is considered as front-line therapy for advanced pancreatic cancer. Gemcitabine combinations have shown a favorable impact on survival. We compared gemcitabine-based combination cheme therapy and gemcitabine(GEM) alone in patients with advanced pancreatic cancer through Meta analysis in phase Ⅲ clinical trials. Methods:MEDLINE and EMBASE searches were supplemented by information from trial registers of phase Ⅲ randomized controlled trials(RCTs) for GEM-based combination therapy and GEM alone for advanced pancreatic cancer. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The Meta-analysis involved 6-months and 1-year survival rate and objective remission rate(ORR) . Results:The Meta-analysis included 20 RCTs. The result of our Meta-analysis showed that there was signifi cant improvement in the GEM combination group with regard to the 1-year survival rate(RR:0.87,95%:(0.78,0.96) ,P=0.008) . The other result of our meta-analysis showed no signifi cant difference between two groups. Conclusion:GEM-based combination therapy may be effective with regard to the survival rate compared with GEM alone.