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Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.

Purpose Long non-coding RNAs (lncRNAs) may act as oncogenes in several cancers, including endometrial carcinoma (EC). The purpose of the current study is to investigate the regulatory mechanism of exosomal-lncRNA deleted in lymphocytic leukemia1 (DLEU1) on EC. Methods The expression levels of lncRNA DLEU1, microRNA-381-3p and E2F Transcription Factor 3 (E2F3) in EC tissues or cells were detected using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). We then analysed the proliferation, migration, and invasion of EC cells by performing the MTT assay, wound healing assay, and transwell invasion assay, respectively. Identification of exosomes was detected using Western blot assay. The uptake of exosomes was detected by a confocal microscope. The effects of exosomes on EC cells were investigated by construction of cell co-culture system. The interactions among DLEU1, miR-381-3p and E2F3 were confirmed using the dual-luciferase reporter (DLR) assay. Results LncRNA DLEU1 expression was highly up-regulated in EC tissues and cells. Knockdown of DLEU1 inhibited the proliferation, migration, and invasion of EC cells. Exosomes could be uptaken by the ambient EC cells. MiR-381-3p was a target of DLEU1 and was negatively modulated by DLEU1. Overexpression of miR-381-3p suppressed the proliferation, migration, and invasion of EC cells. Additionally, E2F3 was the target gene of miR-381-3p and was negatively modulated by miR-381-3p. Upregulation of miR-381-3p and down-regulation of E2F3 reversed the promoting effect of exosomal DLEU1 on EC cells. Conclusion Exosomal DLEU1 accelerates the development of EC by regulating the miR-381-3p/E2F3 axis, thus DLEU1 may act as a possible therapeutic target for treating EC.

Background and purpose Significant clinical recovery has commonly been observed in ischaemic stroke patients with irreversible brain structural damage. However, brain mechanisms that help to maintain clinical function remain unclear. Methods Sixty-two patients with acute ischaemic stroke underwent longitudinal clinical assessments and magnetic resonance scanning. The clinical recovery trajectory was evaluated using a hierarchical linear model and intrinsic connectivity was analysed with a seed-based approach to examine its changing pattern based on the regional volume changes calculated using voxel-wise analysis. Results It was observed that clinical outcome measures improved mainly in the short-term period (baseline versus 3 weeks) and then remained stable. Grey matter volume was reduced significantly in the bilateral caudate over the entire 3-year long-term period. Significant intrinsic connectivity increases were observed in the caudate-middle cingulum over the short-term period and in the caudate-precuneus and caudate-calcarine over the long-term period. Finally, it was found that increased caudate-calcarine connectivity was associated with reduced right caudate volume, and a positive correlation was found between increased caudate-middle cingulum connectivity and the amount of modified Rankin score changes. Conclusions The increased intrinsic connectivity found in this study tends to be a compensatory mechanism for post-stroke structural damage, associated with clinical recovery. The study helps in understanding the significance of enhanced intrinsic connectivity in post-stroke long-term assessment and rehabilitation.

Background New therapies are urgently needed for Alzheimer’s disease (AD). Sodium oligomannate (GV-971) is a marine-derived oligosaccharide with a novel proposed mechanism of action. The first phase 3 clinical trial of GV-971 has been completed in China. Methods We conducted a phase 3, double-blind, placebo-controlled trial in participants with mild-to-moderate AD to assess GV-971 efficacy and safety. Participants were randomized to placebo or GV-971 (900 mg) for 36 weeks. The primary outcome was the drug-placebo difference in change from baseline on the 12-item cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-cog12). Secondary endpoints were drug-placebo differences on the Clinician’s Interview-Based Impression of Change with caregiver input (CIBIC+), Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale, and Neuropsychiatric Inventory (NPI). Safety and tolerability were monitored. Results A total of 818 participants were randomized: 408 to GV-971 and 410 to placebo. A significant drug-placebo difference on the ADAS-Cog12 favoring GV-971 was present at each measurement time point, measurable at the week 4 visit and continuing throughout the trial. The difference between the groups in change from baseline was − 2.15 points (95% confidence interval, − 3.07 to − 1.23; p Conclusions GV-971 demonstrated significant efficacy in improving cognition with sustained improvement across all observation periods of a 36-week trial. GV-971 was safe and well-tolerated. Trial registration ClinicalTrials.gov, NCT02293915. Registered on November 19, 2014

Facing considerable challenges associated with aging and dementia, China urgently needs an evidence-based health-care system for prevention and management of dementia. The Beijing Aging Brain Rejuvenation Initiative (BABRI) is a community-based cohort study initiated in 2008 that focuses on asymptomatic stages of dementia, aims to develop community-based prevention strategies for cognitive impairment, and provides a platform for scientific research and clinical trials. Thus far, BABRI has recruited 10,255 participants (aged 50 and over, 60.3% female), 2021 of whom have been followed up at least once at a 2- or 3-year interval. This article presents aims and study design of BABRI; summarizes preliminary behavioral and neuroimaging findings on mild cognitive impairment (MCI) and results of clinical trials on MCI; and discusses issues concerning early prevention in community, MCI diagnosis methods, and applications of database of aging and dementia. BABRI is proposed to build a systematic framework on brain health in old age.

Background Approximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis. Method The clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student’s t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher’s exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities. Result A total of 714 adolescent scoliosis patients with a mean age of 13.5 (10–18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P Conclusion Risk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.

Anti-Sry-like high mobility group box (SOX) 1 antibodies (abs) are partly characterized onconeural autoantibodies (autoabs) due to their correlation with neoplastic diseases. Anti-SOX1 abs are associated with various clinical manifestations, including Lambert-Eaton myasthenic syndrome (LEMS) and paraneoplastic cerebellar degeneration (PCD). However, the clinical characteristics of patients with anti-SOX1 abs have not been described in detail. This review systematically explores the reported patients with anti-SOX1 abs and analyzes these cases for demographic characteristics, clinical features, coexisting neuronal autoabs, neuroimaging findings, treatment, and clinical outcomes. In addition, considering that PCD is the most common paraneoplastic neurological syndrome and that the association between PCD and anti-SOX1 abs remains unclear, we focus on the presence of autoabs in relation to PCD and associated tumors. PCD-associated autoabs include various intracellular autoabs (e.g., anti-Hu, anti-Yo, anti-Ri, and anti-SOX1) and cell-surface autoabs (anti-P/Q-type voltage-gated calcium channel). Commonly involved tumors in PCD are small-cell lung cancer (SCLC), gynecological, and breast tumors. LEMS is the most common clinical symptom in patients with anti-SOX1 abs, followed by PCD, and multiple neuronal autoabs coexist in 47.1% of these patients. SCLC is still the predominant tumor in patients with anti-SOX1 abs, while non-SCLC is uncommon. No consistent imaging feature is found in patients with anti-SOX1 abs, and there is no consensus on either the therapy choice or therapeutic efficacy. In conclusion, the presence of anti-SOX1 abs alone is a potential predictor of an uncommon paraneoplastic neurological disorder, usually occurring in the setting of LEMS, PCD, and SCLC. The detection of anti-SOX1 abs contributes to an early diagnosis of underlying tumors, given the diversity of clinical symptoms and the absence of characteristic neuroimaging features.

White matter hyperintensity (WMH) is a common finding in aging population and considered to be a contributor to cognitive decline. Our study aimed to characterize the spatial patterns of WMH in different severities and explore its impact on cognition and brain microstructure in non-demented elderly. Lesions were both qualitatively (Fazekas scale) and quantitatively assessed among 321 community-dwelled individuals with MRI scanning. Voxel- and atlas-based analyses of the whole-brain white matter microstructure were performed. The WMH of the same severities was found to occur uniformly with a specific pattern of lesions. The severity of WMH had a significant negative association with the performance of working and episodic memory, beginning to appear in Fazekas 3 and 4. The white matter tracts presented significant impairments in Fazekas 3, which showed brain-wide changes above Fazekas 4. Lower FA in the superior cerebellar peduncle and left posterior thalamic radiation was mainly associated with episodic memory, and the middle cerebellar peduncle was significantly associated with working memory. These results support that memory is the primary domain to be affected by WMH, and the effect may potentially be influenced by tract-specific WM abnormalities. Fazekas scale 3 might be the critical stage predicting a future decline in cognition.

Deep brain stimulation is a therapy for Alzheimer's disease (AD) that has previously been used for mainly mild to moderate cases. This study provides the first evidence of early alterations in performance induced by stimulation targeted at the fornix in severe AD patients. The performance of the five cases enrolled in this study was scored with specialized assessments including the Mini-Mental State Examination and Clinical Dementia Rating, both before and at an early stage after deep brain stimulation. The burden of caregivers was also evaluated using the Zarit Caregiver Burden Interview. As a whole, the cognitive performance of patients remained stable or improved to varying degrees, and caregiver burden was decreased. Individually, an improved mental state or social performance was observed in three patients, and one of these three patients showed remarkable improvement in long-term memory. The conditions of another patient deteriorated because of inappropriate antipsychotic medications that were administered by his caregivers. Taken together, deep brain stimulation was capable of improving some cognitive aspects in patients with severe AD, and of ameliorating their emotional and social performance, at least at an early stage. However, long-term effects induced by deep brain stimulation in patients with severe AD need to be further validated. More research should focus on clarifying the mechanism of deep brain stimulation. This study was registered with ClinicalTrials.gov (NCT03115814) on April 14, 2017.

How to quickly and safely identify blood species has always been an urgent problem for scientists. Smear test method has the risk of blood contamination, and the blood itself may carry some unknown viruses or pathogens, which will bring health risks to the testing personnel. Therefore, in order to meet the urgent needs of rapid and safe detection of blood, a technology which can detect dynamic confocal Raman spectroscopy of flowing blood in bionic blood vessel was proposed. The blood, which was sealed in the bionic blood vessel, flowed through the focus gaze area of laser by the microfluidic pump, to detect the dynamic blood Raman spectrum. Human blood and cattle blood were selected as experimental objects, and the experiments were carried out under the same parameters. Combined with PCA-LDA (principal component analysis and linear discriminate analysis) classification model, the predictive classification of the two species without error recognition was realized. The hidden weak Raman signals were mined by derivative spectra, and the fundamental differences of Raman spectra of two species were compared. Then the biochemical information that caused the differences was also analyzed. The results show the method can meet the detection requirements of sealed blood, and the Raman spectra of flowing blood is more representative than those of static blood.

Supplemental material, JCB893600 Supplemental Material for Severity of white matter hyperintensities: Lesion patterns, cognition, and microstructural changes by Weiyi Zeng, Yaojing Chen, Zhibao Zhu, Shudan Gao, Jianan Xia, Xiaochun Chen, Jianjun Jia and Zhanjun Zhang in Journal of Cerebral Blood Flow & Metabolism

One of the most common psychological consequences of stroke is post-stroke depression (PSD). While more than 30 percent of stroke patients eventually develop PSD, the neurobiological mechanisms underlying such a phenomenon have not been well investigated. Given the critical involvement of hypothalamic-pituitary-adrenal axis and endocannabinoid system in response to stressful stimuli, we evaluated the hypothesis that cannabinoid receptors in the hypothalamus are critical for modulation of post-stroke depression-like behaviors in rats. To this end, rats were treated with middle cerebral artery occlusion (MCAO) followed by chronic unpredictable mild stress (CUMS) treatment procedure. We then assessed the expression of CB1 and CB2 receptors in the hypothalamus, and evaluated the effects of pharmacological stimulations of CB1 or CB2 receptors on the expression and development of depression-like behaviors in PSD rats. We found that PSD rats exhibited decreased the expression of CB1 receptor, but not CB2 receptor, in the ventral medial hypothalamus (VMH). Such an effect was not observed in the dorsally adjacent brain regions. Furthermore, intra-VMH injections of CB2 receptor agonist, but not CB1 receptor agonist, attenuated the expression of depression-like behaviors in PSD rats. Finally, repeated intraperitoneal injections of CB1 or CB2 receptor agonists during CUMS treatment inhibited the development of depression-like behaviors in PSD rats. Taken together, these results suggest that decreased CB1 receptor expression is likely associated with the development of post-stroke depression, and CB2 receptor may be a potential therapeutic target for the treatment post-stroke depressive disorders.

Object-location memory is particularly fragile and specifically impaired in Alzheimer's disease (AD) patients. Electroencephalogram (EEG) was utilized to objectively measure memory impairment for memory formation correlates of EEG oscillatory activities. We aimed to construct an object-location memory paradigm and explore EEG signs of it. Two groups of 20 probable mild AD patients and 19 healthy older adults were included in a cross-sectional analysis. All subjects took an object-location memory task. EEG recordings performed during object-location memory tasks were compared between the two groups in the two EEG parameters (spectral parameters and phase synchronization). The memory performance of AD patients was worse than that of healthy elderly adults The power of object-location memory of the AD group was significantly higher than the NC group(healthy elderly adults) in the alpha band in the encoding session, and alpha and theta bands in the retrieval session. The channels-pairs the phase lag index (PLI) value of object-location memory in the AD group was clearly higher than the NC group in the delta, theta, and alpha bands in encoding sessions and delta and theta bands in retrieval sessions. The results provide support for the hypothesis that the AD patients may use compensation mechanisms to remember the items and episode.

Background and Purpose. It is well known that there is a wide range of different pathological stages related to Alzheimer’s disease (AD) among patients with amnestic mild cognitive impairment (aMCI). Further refinement of the stages based on neuropsychological and neuroimaging methods is important for earlier disease detection, as well as for the development and evaluation of disease-modifying interventions. Materials and Methods. In this cross-sectional study, 125 aMCI patients were classified into declined progressively three stages of mild, moderate and severe, utilizing the extreme groups approach (EGA) based on their memory function. Fifty- two patients, in addition to 24 cognitively normal subjects, were included in further structural MRI analyses. Characteristics of cognitive functions and brain structures across these newly defined stages were explored through general linear models. Results. Almost all of the non-memory cognitive functions showed progressive decline as memory function deteriorated. In addition, medial structures including the right hippocampus, right lingual and left fusiform gyrus, presented with greater grey matter (GM) atrophy during the later stages of aMCI (corrected p < 0.05). Correlations were found between GM volume of the lingual gyrus and processing speed (r = 0.419, p = 0.003) and between the fusiform gyrus and general cognitive function (r = 0.281, p = 0.046). Moreover, both cognitive function and GM volume presented non-linear trajectories over stages of aMCI. Conclusion. Our study characterized the cognitive profiles along with the degree of episodic memory impairment, and these three stages of aMCI showed non-linear progressive decline in cognitive functions and GM volumes.

In order to evaluate the role of positron emission tomography (PET) with N-methyl-[(11)C]-2-(4'-methylaminophenyl)-6-hydroxybenzothiazole, also known as Pittsburgh compound B (PIB), in the early diagnosis of Alzheimer's disease (AD). Clinical data were collected, and PIB PET cerebral imaging was performed in patients with AD (n = 6), mild cognitive impairment (MCI) (n = 7), and elderly, mentally normal controls (NCs) (n = 7). PET images of the subjects were then analyzed. Visual analysis showed that the radioactivity clearance rate in AD patients was significantly different from that found in the NC group. Furthermore, the radioactivity clearance rate 45 min after PIB injection was significantly lower than the NC group. Images from the MCI group presented heterogeneous results, overlapping with those from both the AD and NC groups. Statistical analysis showed that the radioactivity clearance rate during 5-45 min post-injection was significantly lower in the AD group (41-77%) than the control group (75-81%) (P > 0.05) and the MCI group (59-77%). The radioactivity clearance rate in the bilateral parietal lobes, frontal, temporal, and right occipital lobes, and the bilateral corpora striata in MCI group were lower than that in control group (P < 0.05). PIB PET brain imaging can differentiate early AD patients from NCs and may have certain value in identifying patients progressing to MCI.

Asia is the most populous region in the world and its rapidly growing societies are the sources of global development. However, aging of its population with increasing occurrence of diseases, of which dementia is the most prominent, is a major challenge to healthcare system. For example, there are 177 million people aged 65 and older living with dementia in China, expressing 20% of dementia patients worldwide. It has been estimated that the Chinese proportion of the elderly will reach 30.4% in 2050, which will include 100 million elderly people over 80 years of age [1]. Dementia prevalence in Asia, however, has previously been found to be lower than in Western populations [2]. Cultural differences could contribute to this. Dementia research in Chinese population has been primarily focused on Alzheimer's disease and vascular dementia [2]. Most of our knowledge about dementia, however, comes from studies in Caucasian population. Early and accurate diagnosis of dementia is crucial in order to start with the treatment as early as possible. Intervention and treatment of dementia (AD-dementia) can be cost-effective, but the majority of patients are not diagnosed in a timely manner. Technology is now available that can enable earlier detection of cognitive loss associated with incipient dementia, offering the potential for earlier intervention and health care systems and resulting in a less financial burden to an individual and a society. In this special issue on screening of dementia, we focused on screening tests for the detection of very mild dementia. We have invited a few papers that address those topics accordingly. One paper of this special issue gives a view on dementia screening in an outpatient department of a regional hospital in Taiwan by means of AD8 (ascertainment of dementia 8), a brief informal interview to screen dementia [3]. Screening people at the risk of dementia is a first and a major issue in screening of dementia. Another paper explores depression as a crucial public health issue in Taiwan. By means of brief tool, Epidemiological Studies Depression Scale (CES-D), to screen depression, a ratio of 16.4% of suspected depression patients compared to 13.3% aged patients out of all recruited patients was shown. This result may provide important information for a public health issue. In another paper, by means of AD8 consistent problems with thinking and/or memory were found in 56.8% participants, difficulty in remembering appointments was found in 47% participants, forgetting correct month or year was found in 40.9% of recruited participants in Taiwan, accordingly. Another paper presents the utility of informant AD8 for case finding of cognitive impairment in primary healthcare setting in Singapore. On a sample of 205 patients and their informants, AD8 was shown to be useful for case finding of cognitive impairment in the primary healthcare in one-third of adult patients. Another paper shows efficacy of the Takeda Three Colors Combination (TTCC) test, a screening tool for detection of very mild AD-dementia in Japan. Despite a lower sensitivity, a TTCC test was accomplished within 2 minutes in all subjects, thus being a great potential for the use as an AD screening tool by general practitioners in communities worldwide. Another paper assesses the influence of education on the performance of Chinese version of the Montreal Cognitive Assessment (C-MoCA) compared to Mini-Mental State Examination (MMSE) in detecting amnestic mild cognitive impairment (aMCI) among rural population in Beijing community. C-MoCA showed modest accuracy and was no better than MMSE in detecting aMCI, most likely due to overwhelming effect of education relative to aMCI diagnosis on variations in C-MoCA performance. Finally, all presented cognitive tests show great potential for the use as screening tools for early and very mild dementia worldwide, being easy to apply and at a low cost in communities worldwide. Rajka M. Liscic Gorsev G. Yener Huali Wang Jong-Ling Fuh Jianjun Jia Yuan-Han Yang

White matter lesions (WMLs) are of considerable research interest because of their high prevalence and serious consequences, such as stroke and dementia. Most existing studies of WMLs have focused on severe WMLs, but mild WMLs, which are clinically and fundamentally significant, have been largely neglected. The present study is a comprehensive investigation on the injury pattern and on the anatomical, functional, and cognitive changes related to mild WMLs. These results may provide better understanding mild WMLs. Fifty-one human subjects with mild WMLs and 49 control participants completed serial neuropsychological tests and underwent a 3-T magnetic resonance imaging (MRI) scan that included diffusion tensor imaging, a resting-state functional MRI, and a structural MRI. We found declines in cognitive functions such as global function, executive function, and episodic memory in mild WMLs subjects. The white matter injuries in the mild WMLs subjects were mainly in the fibers that projected to frontal areas, while gray matter structures were relatively intact. The overall resting state function of the frontal area was significantly increased. The integrity of the neural fibers in the inferior fronto-occipital fasciculus and the inferior longitudinal fasciculus was significantly correlated with the cognitive scores in executive function and episodic memory in both the control and the mild WMLs group. These findings demonstrate that mild WMLs subjects exhibit abnormalities in both white matter structure and functional intrinsic brain activity and that such changes are related to several types of cognitive dysfunction.

A third generation of synchrotron radiation facilities is coming on line worldwide, whose brilliance exceeds previous ultraviolet and x-ray light sources by four orders of magnitude. The capabilities at second and third generation light sources are discussed, using examples in surface and interface chemistry and magnetic nanostructures. The authors' experience at the IBM-Tennessee-Tulane-LLNL-LBL undulator beam line will serve as a hands-on guide for work at one of the new facilities.

The stability of nitric acid oxidized carbon nanotubes (CNTs) and the precipitation of oxidized CNTs in water by salts were investigated. Stability investigation shows that during an aging time of 30 days, oxidized CNTs dispersion shows characteristic UV-vis absorbance peak of individual CNTs at 252 nm and CNTs concentration in the dispersion after 30d aging is 85% of the initial concentration. The precipitation value of salts were measured and the precipitation value follows the order of NaCl>KCl>1/2(MgCl(2))>1/2(CaCl(2))>1/3(FeCl(3))>1/3(AlCl(3)). The nature of anions investigated has little effect on precipitation values of salts.

In this study, a Lagrangian particle tracking model driven by hydrodynamic fields was used to investigate the changes of flushing properties in Xiaohai Lagoon resulting from natural evolution and influences of human activities. Comparisons of residence times between 1936 and 2001 indicate that the flushing efficiency of the lagoon has deteriorated greatly during the past seven decades. Over this period, the average residence time of the lagoon has increased from 45 to 71 days, an increase of 59%. The Lagrangian residual velocity has decreased from 1936 to 2001 in the large portions of the lagoon, and the spatial distribution pattern of the residual current has changed significantly. The well-developed horizontal circulations in 1936 disappeared. Instead, the horizontal Lagrangian residual velocity showed uniformly seaward motion with reduced velocity in 2001. Human activities have incurred great impacts on the deterioration of flushing efficiency. The reduction of river inflow imposed the most significant impact, causing an increase of average residence time by 33%. The land reclamation in the lagoon came as the second most significant factor, causing an increase of 15%. Closure of the North Opening had posed minor impact. The model results suggest that restoring the river inflow, as well as the dredging of the tidal channel and the inner lagoon, should be the top proprieties for future water quality management.

This article illustrates the use of synchrotron radiation for illuminating the electronic structure of surfaces. After a brief introduction into the most common spectroscopies, their capabilities are exposed by a set of examples from the authors’ area of expertise. It comprises the surface and interface chemistry of semiconductors and magnetic materials, but leaves out a large body of work on surface chemistry of heterogeneous catalysis.

Background Healthcare resource utilisation for Alzheimer’s disease (AD) in China is not well understood. This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used. Methods A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews. In the first round, 9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients. In the second round, 2 hospital administrators were asked about the cost of AD management and care. Results from the interviews were discussed by the experts in a Delphi panel meeting, where consensus was reached on quantitative aspects of AD management, including the rate of healthcare resource utilisation, the respective unit costs and caregiving time. Results Interviewees reported that mild AD is under-recognised in China; most patients are diagnosed with moderate to severe AD. Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden. It was estimated that 70 % moderate AD patients are independent/non-aggressive at the time of diagnosis, 15 % are independent/aggressive, 10 % are dependent/non-aggressive, and 5 % are dependent/aggressive. Dependent/aggressive AD patients are more likely to be hospitalised (70–90 %) than accepted in a nursing home (0–20 %), while the opposite is true for dependent/non-aggressive patients (5–35 % for hospitalisation vs. 80 % for nursing home). Independent AD patients require 1–3 hours/day of caregiver time, while dependent patients can require up to 12–15 hours/day. Experts agreed that AD complicates the management of age-related comorbidities, found in 70–80 % of all AD patients, increasing the frequency and cost of hospitalisation. Conclusions The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China. The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning, as well as to perform economic evaluations of AD therapies.