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Objective The purpose of this study was to assess the associations between the self-reported oral health-related quality of life (OHRQoL) of older Chinese people and their socio-economic status and oral health using data collected in the 4th National Oral Health Survey. Methods After multistage stratified cluster sampling, 4332 adults aged 65-74 years participated in the study. After a clinical examination, the participants completed a structured questionnaire. A Mandarin version of the General Oral Health Assessment Index (GOHAI) was included in the questionnaire. Clinical examinations were carried out using the criteria recommended by the World Health Organization. Multivariate analysis was used to evaluate the associations of the clinical and socio-demographic variables with the GOHAI scores of the participants. Results The weighted mean (SE) GOHAI score was 51.6 (0.0). Female sex and having more than 10 missing teeth, unrestored tooth spaces, more than 10 decayed teeth and a periodontal pocket ≥6 mm were negatively associated with the GOHAI score, while having a higher education level and living in the Eastern region of China were positively associated with the GOHAI score. Conclusion After adjustment for confounders, the OHRQoL of older Chinese individuals was mainly affected by untreated dental caries and the loss of teeth. Older Chinese individuals who were male, had a higher education level, were from the Eastern region, had no unrestored tooth spaces or deep periodontal pockets and had fewer decayed or missing teeth had higher GOHAI scores, indicating better OHRQoL.

Background The glycocalyx plays an important physiological role and may be damaged during cardiopulmonary bypass. Sevoflurane can protect the glycocalyx; however, its relevance in a clinical setting is unknown. Objective Glycocalyx degradation during cardiopulmonary bypass in patients was investigated. On the basis of the available experimental data, we hypothesised that sevoflurane-based anaesthesia would confer additional protection against cardiopulmonary bypass-induced glycocalyx damage. Design Randomised controlled study. Setting Clinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019. Patients Fifty-one patients. Interventions After intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery. Main outcome measures Glycocalyx markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for the degradation of the endothelial glycocalyx (such as matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine ratio and levels of lactic acid and myocardial enzymes were all measured. Postoperative mechanical ventilation time and length of stay in the cardiac care unit and hospital were also measured. Morbidity and mortality after 30 days and 1 year were evaluated. Results The vascular endothelial glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx damage in the sevoflurane group was less extensive than that in the propofol group. The urine albumin-to-creatinine ratio increased in both groups but was lower in the sevoflurane group. Enzymes including matrix metalloproteinase-9 and cathepsin-B were positively correlated with glycocalyx marker concentrations. After operation, the sevoflurane group showed lower levels of lactic acid and myocardial enzyme, as well as shorter duration of postoperative mechanical ventilation than the propofol group. Conclusion Sevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass. Trial registration Chinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.

Objective To evaluate the diagnostic yield of the multiplex polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) for the diagnosis of purulent meningitis (PM) in children. Methods PM was diagnosed according to the European Society for Clinical Microbiology and Infectious Diseases guideline (2016). Patients with PM between May 2015 and October 2018 were included. The multiplex PCR method was used to detect eight common identified bacteria in PM. Its sensitivity and specificity were compared with bacteria culture. Results A total of 106 cases were enrolled. Pathogenic bacteria were identified in 27 (25.5%) cases by culture and in 37 (34.9%) cases by multiplex PCR assay. The top three bacteria were Streptococcus pneumoniae, Escherichia coli K1, and Streptococcus agalactiae. When using culture as the gold standard, the multiplex PCR assay showed a sensitivity of 100, 88.9, and 75.0% for S. agalactiae, S. pneumoniae, and E. coli K1, respectively, and a specificity of more than 91.3% for all three bacteria. For detectable bacteria, the positive rate of the multiplex PCR assay (36.6%, 37/101) was significantly higher than that of the bacteria culture (21.8%, 22/101). When combining the two methods, etiology was identified in 42.5% (45/106) of the patients. Conclusion Streptococcus pneumoniae, E. coli K1, and S. agalactiae were the predominant pathogens causing pediatric PM. As a rapid method with high sensitivity and specificity, the multiplex PCR assay in CSF could be used as an adjunctive approach with bacteria culture for the pathogen identification of PM.

The prevalence of malnutrition is high among oncology patients in Northern China. Malnutrition is related to the longer hospital stay, and it can be used to predict the prognostic outcome of patients. This work focused on investigating the relationship of nutritional condition with the length of hospital stay (LOS) in Northern Chinese patients with lung adenocarcinoma (LUAD). The Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS 2002) score, recent weight loss and BMI were assessed in a probabilistic sample of 389 LUAD patients without epidermal growth factor receptor (EGFR) mutations. This study collected the demographic and clinical features of patients in a prospective manner. Then, we examined the association of nutritional status with LOS among the population developing LUAD. According to the PG-SGA, 63 (16·3 %), 174 (44·7 %) and 78 (20·1 %) patients were at risk for undernutrition, moderate undernutrition and severe undernutrition, respectively. Nutritional risk was found in 141 (36·2 %) patients based on the NRS 2002. The average LOS for tumour patients in Northern China was 12·5 d. At admission, a risk of undernutrition or undernutrition according to the PG-SGA (P < 0·001), NRS 2002 (P < 0·001) and latest weight loss (P < 0·001) predicted the longer LOS. LOS was related to nutritional status and hospitalisation expenses (P < 0·001). LUAD patients who stayed in the ICU had a poorer nutritional status and a longer LOS (P < 0·001). In Northern Chinese patients with LUAD, a risk for undernutrition evaluated by the PG-SGA, the NRS 2002 and recent weight loss, but not BMI, could predict a longer LOS.

Objectives Recently, the Gram-negative bacterium Klebsiella oxytoca has been identified as an emerging pathogen. Here we report the draft genome of a 2,3-butanediol-producing strain, K. oxytoca CCTCC M207023, isolated from soil in Nanjing, China. The tetracycline-resistant phenotype and the high yield of 2,3-butanediol was demonstrated. Methods The draft genome of K. oxytoca CCTCC M207023 was determined using an Illumina NovaSeq™ 6000 next-generation DNA sequencing platform. Clean sequencing data were subsequently assembled using SOAPdenovo. Results The draft genome of K. oxytoca CCTCC M207023, comprising 5 658 144 bp and with a GC content of 56.50%, was assembled into 5262 open-reading frames (ORFs). Antimicrobial resistance genes were also annotated. Conclusions The draft genome sequence of K. oxytoca CCTCC M207023 reported here will be a reference for comparative analysis with the antimicrobial resistance mechanisms for the safety of 2,3-butanediol industrial production.

Terpenoids are a large class of natural compounds based on the C5 isoprene unit, with many biological effects such activity against cancer and allergies, while some also have an agreeable aroma. Consequently, they have received extensive attention in the food, pharmaceutical and cosmetic fields. With the identification and analysis of the underlying natural product synthesis pathways, current microbial-based metabolic engineering approaches have yielded new strategies for the production of highly valuable terpenoids. Yarrowia lipolytica is a non-conventional oleaginous yeast that is rapidly emerging as a valuable host for the production of terpenoids due to its own endogenous mevalonate pathway and high oil production capacity. This review aims to summarize the status and strategies of metabolic engineering for the heterologous synthesis of terpenoids in Y. lipolytica in recent years and proposes new methods aiming towards further improvement of terpenoid production.

adolescents aged 12 to 15 years based on the 4th National Oral Health Survey and to explore its associated factors.Students aged 12 to 15 years were recruited using to a multistage stratified random sampling method. All the subjects received oral examination and completed a questionnaire. Information relating to OHRQoL was collected through a Mandarin version of the child oral impacts on daily performances (Child-OIDP) questionnaire. The relationship between the Child-OIDP scores and independent variables was assessed using a Mann-Whitney U-test, Kruskal-Wallis test and a multivariate Poisson regression.A total of 89,582 subjects were included in the analysis, of whom 76.6% reported oral impacts in the last 6 months. Eating was the most affected daily performance. The results of the regression analysis showed that factors associated with adolescents' OHRQoL included sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, self-perception of general/oral health, dental appointments in the past 12 months, oral health knowledge status, age, decayed, missing and filled teeth (DMFT) index and number of teeth with gingival bleeding.Oral impacts were common among Chinese adolescents, although most were not so severe. Eating was the most commonly affected performance. Sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, selfperception of general/oral health status, dental appointments in the previous 12 months, oral health knowledge status, age, DMFT index and number of teeth with gingival bleeding were found to be associated with OHRQoL.

Background The relationship between dental caries and periodontal disease is still controversial. The objective of this study was to explore the relationship between different types of caries and periodontal disease severity in middle-aged and elderly people in China. Methods The study population consisted of 4407 middle-aged and 4117 elderly subjects. Caries were divided into the following three types: type A, crown caries; type B, lesions involving both the crown and root, representing mixed-type caries; and type C, root caries. These three types together represent the overall caries situation, which we call type ABC. Caries were quantitated by decayed and filled teeth (DFT index). Periodontitis was evaluated by clinical attachment loss. Results Middle-aged people with periodontitis had a significant association with DFT type B (OR: 1.21, 95% CI 1.17–1.25) and type C (OR: 1.40, 95% CI 1.24–1.56). Elderly people with periodontitis had a significant association with DFT type C (OR: 1.28, 95% CI 1.21–1.35). Conclusions In China, caries types B/C were positively correlated with periodontitis in the middle-aged group, and only caries type C was positively correlated with periodontitis in the elderly group.

This article studies the influence of physical interphase on magneto-electro-elastic (MEE) composites under far-field loading. The analytical solutions for the coupled transverse magnetoelectric field and axial displacement are given for fibrous composites with generalized plane strain assumption. The effect of interphase between fiber and matrix is considered through implementing the fiber-interphase and interphase-matrix continuities. Numerical results are used to verify that the axial stress, transverse electric and magnetic displacement distributions of composite materials with good agreement. The effect of interfacial thickness on the internal fields of fibrous composites is also investigated.

To observe the prevention effect of transcutaneous electrical acupoint stimulation (TEAS) for chemotherapy-related myelosuppression in non-small cell lung cancer.A total of 102 patients with non-small cell lung cancer who received initial chemotherapy were randomly divided into a conventional group, a medication group and a TEAS group, 34 cases in each one. The conventional group was treated with chemotherapy of gemcitabine combined with cisplatin and given routine care. On the basis of conventional group's treatment, the medication group was givenCompared with before chemotherapy, the leukocyte counts of three groups were decreased at various time points after chemotherapy (Transcutaneous electrical acupoint stimulation can prevent chemotherapy-induced myelosuppression (leukocyte, platelets) in patients with non-small cell lung cancer and improve patient comfort situation.

The filamentous fungus Fusarium fujikuroi is well-known for its production of natural plant growth hormones: a series of gibberellic acids (GAs). Some GAs, including GA1, GA3, GA4, and GA7, are biologically active and have been widely applied in agriculture. However, the low efficiency of traditional genetic tools limits the further research toward making this fungus more efficient and able to produce tailor-made GAs. Here, we established an efficient CRISPR/Cas9-based genome editing tool for F. fujikuroi. First, we compared three different nuclear localization signals (NLS) and selected an efficient NLS from histone H2B (HTB

The accumulation of reactive oxygen species (ROS) can induce oxidative damage which can be detrimental to microbial biomass and product yields. In this study, we used intermittent hypoxic stress (IHS) to eliminate the main source of ROS during the production of arachidonic acid (ARA)-rich lipids by Mortierella alpina. Biomass, lipid- and ARA concentration simultaneously reached their peak values, and the ARA yield increased by about 20% along with a lower level of ROS concentration. Under these conditions, more NADPH, substrate and energy may be available for lipid biosynthesis. The efficacy of this strategy was also confirmed in a bioreactor, with similar results. Interestingly, the total power required for stirring fell by about 4%, which may be of practical value for energy savings. This work offers new insights into the control of ROS generation in M. alpina and might be applicable to other microbial PUFAs producers.

OBJECTIVES The purpose of this study was to investigate the correlation between flow-mediated dilatation of the brachial artery and serum endothelial biomarkers and to discuss the feasibility of sonographic evaluation of acute endothelial injury during cardiopulmonary bypass (CPB) surgery. METHODS Sonography was applied to determine the percentage of change in the brachial artery size during flow-mediated dilatation. Meanwhile, the plasma concentrations of endothelial-derived biomarkers, such as endothelin 1, nitric oxide, and von Willebrand factor, were measured to monitor the changes in endothelial function. We analyzed the correlation between flow-mediated dilatation and biomarkers during the perioperative period of CPB in 27 patients. RESULTS All of the biomarkers changed dramatically, especially during the CPB period. There was a negative correlation between flow-mediated dilatation and von Willebrand factor (P = .001; R = -0.31). CONCLUSIONS A CPB event has a substantial impact on endothelial function, and sonographic assessment of the percentage of change in the brachial artery size during flow-mediated dilatation allows early detection of acute endothelial function injury in cardiac surgery.

Background The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults. Methods A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants. Results The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was − 0.1391 and for the decayed tooth (DT), it was − 0.2252. For out-of-pocket payment, the Kakwani index was − 0.3154 and for health insurance payment it was − 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure. Conclusion Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.

Cement-fly ash mixture has been commonly used for the foundation treatment projects in the fly ash stratum, as it is effective in improving foundation bearing capacity and reducing settlement of stratum. In order to figure out the effect of dynamic and static load on the mechanical properties exhibited by the cement-fly ash and the reaction mechanism of cement-fly ash, a combination of the unconfined compressive test, impact test, scanning electron microscopy (SEM), and X-ray diffraction (XRD) method was adopted in this study to investigate the cement-fly ash test samples. As demonstrated by the results, the observed growth rate of 0–60 days (d) is higher than that in the later stages and the typical stress-strain curve can be divided into six sections under the unconfined compressive test. At the gas pressure of 0.2 MPa, the cement-fly ash samples exhibited obvious plastic properties in early curing time (0–60 d), and brittle failure was observed in the final stage (90 d). It is obvious that the value of dynamic compressive strength (DCS) is higher than that of unconfined compressive strength (UCS). The analysis of XRD has revealed that the hydration products are primarily derived from the hydration reaction of cement in the early stage and the pozzolanic reaction in the late stage. The pores of cement-fly ash are found to be filled with the hydration products, despite the presence of a mass of pores in the interior.

In recent years, eukaryotic microorganisms have been widely applied to offer many solutions for everyday life and have come to play important roles in agriculture, food, health care, and the fine-chemicals industry. However, the complex genetic background and low homologous recombination efficiency have hampered the implementation of large-scale and high-throughput gene editing in many eukaryotic microorganisms. The low efficiency of homologous recombination (HR) not only makes the modification process labor-intensive but also completely precludes the application of many otherwise very useful genome editing techniques. Thus, increasing the efficiency of HR is clearly an enabling technology for basic research and gene editing in eukaryotic microorganisms. In this review, we summarize the current strategies for enhancing the efficiency of HR in eukaryotic microorganisms (particularly yeasts and filamentous fungi), list some small molecules and candidate genes associated with homologous and non-homologous recombination, and briefly discuss the further development prospects of these strategies.

The treatment of industrial wastewater containing complex foulants demands high efficiency yet cost-effective separation process. The composite hollow fiber nanofiltration membranes suffer from tedious fabrication procedures, impeding the large volume fabrication and application. Herein, we reveal a very simplified designing strategy by polyelectrolyte modification of the co-extruded polyimide/polyethersulphone dual-layer hollow fibers with hierarchical structure and chemistry. The active layer's thickness of the dual-layer hollow fiber substrate is only 800 nm, the thinnest in literature. Compared to integral active single layer hollow fiber, the ultrathin active layer not only leads to over 4 times increase in mechanical flexibility and tenfold reduction in material cost but also enables fully chemical transition from imide to cross-linked polyamide, minimizing the intrinsic hydrolysis tendency of active material. The optimized membranes with a well-defined pore radius of 0.23 nm have 93–95% rejection to Mg2+ and Ca2+ and PWP of 9.1 LMH/bar. Moreover, the composite membranes exhibit backwash ability and stability in the heated feed solutions, which meets the demand for direct treatment of industrial effluents. This work paves the way for the large volume fabrication and application of hollow fiber nanofiltration membranes for treating municipal water, industrial wastewater, and other applications.

The hollow fiber organic solvent nanofiltration (OSN) membranes have drawn increasing interest for the refining of high value-added products such as nutraceuticals, pharmaceuticals and fine chemicals. The hollow fiber OSN membranes with defined pore size, reliable stability and durability in various harsh solvents are in urgent demand. Herein, for the first time, braid reinforced hollow fiber (BRHF) OSN membranes with defined pore size, robust mechanical strength, and excellent solvent stability were fabricated and used for the recovery of pharmaceuticals. The BRHF nanofiltration membranes can endure an operation pressure over 3 times larger than that of the cross-linked polyimide hollow fiber OSN membranes in aprotic solvents with a DMF flux of 37.9 LMH and a methanol flux of 70.3 LMH at 15 ​bar. The membranes show over 98.8% rejection to the Tetracycline, Chlortetracycline hydrochloride and Vitamin B12. After immersion in DMF for 360 ​h, the membranes maintain over 98% rejection to Chlortetracycline hydrochloride. Moreover, the BRHFs eliminate the risk of module leakage caused by breakage of hollow fibers and surmount the swelling tendency of polymeric OSN membranes in harsh solvents which enables the scaling-up of high-performance hollow fiber OSN membrane modules. The BRHF OSN membranes with robust stability and durability exhibit very promising application prospects in the pharmaceutical and fine chemical industry.

Fly ash and lime have been frequently employed to reduce the swelling potential of expansive soils. Laboratory experiments, scanning electron microscopy (SEM), and X-ray diffraction (XRD) were used in this study to investigate the stabilizing effect of fly ash and lime on expansive soils in the Jianghuai undulating plain area. The comparison was drawn between the variation laws of physical parameters, mechanical properties, microstructure, and mineral composition of expansive soil before and after being stabilized. Experimental results suggest that, after 5% lime is added based on fly ash, the plasticity index of the expansive soil decreases by 64.9%, the free swelling ratio is reduced to about 10%, the unloading swelling ratio is reduced to nearly 4%, and the stabilized soil no longer exhibits the expansive property. The unconfined compressive and tensile strengths of the stabilized soil increase first and then decrease with the rising in fly ash content. After the addition of 5% lime, both the unconfined compressive and tensile strengths increase significantly. The optimum modifier mixture ratio is obtained as 10% fly ash + 5% lime. The SEM images reveal that the microstructures of the stabilized expansive soil vary from an irregular flake-like and flocculent structures to blocky structures, and the soil samples compactness is enhanced. XRD results indicate that quartz is the main component of the stabilized soil. These are the underlying causes of the rise in the strength. The conclusions of this study can be referenced for the engineering design and construction of expansive soil in Jianghuai undulating plain area.

Polyunsaturated fatty acids (PUFAs), especially the omega-3 and -6 types, play an important role in human health and have consequently received extensive attention as nutritional ingredients. Oleaginous microorganisms, as an alternative source of PUFAs, can accumulate cellular PUFA-rich lipids. However, these microbial cells have evolved robust metabolic networks with hard-wired, tightly regulated lines of communication between molecular pathways, which poses a challenge to our metabolic pathway reconstruction efforts for increased PUFA production. Nowadays, the development of systems and synthetic biotechnology provides powerful new tools for us to better understand and remodel microbial metabolic networks. In this chapter, we will focus on these two technologies to summarize the strategies for microbial production of PUFAs and provide guidance for future study.

To probe into the dynamic mechanical properties of expansive soil stabilized by fly ash and lime under impact load, the split-Hopkinson pressure bar (SHPB) test was carried out in this study. An analysis was made on the dynamic mechanical property and final fracture morphology of stabilized soil, and the failure mechanism was also explored from the perspective of energy dissipation. According to the test results, under the impact pressure of 0.2 MPa, plain soil and pure fly ash-stabilized soil exhibit strong plasticity. After the addition of lime, the stabilized soil shows obvious brittle failure. The dynamic compressive strength and absorbed energy of stabilized soil first increase and then decrease with the change of mix proportions. Both the dynamic compressive strength and the absorbed energy reach the peak value at the content of 20% fly ash and 5% lime (20% F + 5% L). In the process of the test, most of the incident energy is reflected back to the incident bar. The absorbed energy of stabilized soil increases linearly with the rise of dynamic compressive strength, while the absorbed energy is negatively correlated with the fractal dimension. The fractal dimension of pore morphology of the plain soil is lower than that of the fly ash-lime combined stabilized soil when it comes to the two different magnification ratios. The test results indicate that the modifier content of 20% F + 5% L can significantly improve the dynamic mechanical properties of the expansive soil.

To evaluate the use of oral health services, the economic burden of oral diseases and related influential factors in China.Using the multistage, stratified, equal proportion, random sampling method in the 4th National Oral Health Survey of China conducted in 2015 to 2016, residents aged 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years respectively were recruited, clinically examined and answered a questionnaire. Utilisation of oral health services were assessed in all the age groups and the economic burden of oral diseases in the past 12 months were assessed in the 3 to 5 years and 35 to 74 year-old groups. Chi-squared tests, t tests, correlation analysis and a one-way ANOVA were used to determine the relationships of different factors with utilisation of oral health services and the economic burden of oral diseases.In the subject groups - 3 to 5 years, 12 to 15 years and 35 to 74 years - the prevalence of the utilisation of oral health services in the past 12 months was 14.6% (5,876/40,353), 23.6% (27,936/118,592), and 20.1% (2,708/13,461), respectively. In all three groups, receiving dental treatment was the most common reason for subjects' recent dental visit. The average dental cost in the past 12 months was 403.43 CNY (median = 100) for 3 to 5-year-old children and 850.83 CNY (median = 300) for adults aged 35 to 74 years old. Area, education and annual household income per person were the socio-economic influential factors. Oral health status, oral hygiene and attitudes to and knowledge of oral health affected the utilisation of oral health services and the economic burden of oral diseases.The percentage of dental service utilisation was relatively low, and the economic burden was high. The related factors for both utilisation of oral health services and the economic burden of oral diseases included living in area, educational attainment, household income, perceived oral health status, and oral hygiene.

To investigate the current status and distribution of resources for oral health in China, by means of analysing national data from the National Investigation of Resources for Oral Health.The National Investigation of Resources for Oral Health in China was performed in 2015, in parallel with the 4th National Oral Health Survey of China (2015 to 2016). A structured questionnaire on resources for oral health was used to collect the data of professional institutions and stomatological/dental workforce in each province. For each province, the local Investigation Group was responsible to summarise the status and distribution of institutions with stomatological/dental departments and stomatological/dental workforce. Descriptive analysis of resources for oral health was performed to learn about the number and percentage of each category both for each province and nationally. The ratio of number of stomatological/dental workforce to population was also calculated and compared with the criteria of the World Health Organisation (WHO).There were totally 75,399 stomatological/dental departments nationally in all professional institutions in the mainland of China, most of which were set in institutions of primary health care services. Institutions of private sectors accounted for a higher proportion (69.8%) which was over two-fold compared to that of public ones (30.2%). General hospitals were the major part of hospitals with stomatological/dental departments compared with stomatological/dental specialised hospitals. Stomatological/dental clinics were the majority of institutions of primary health care services, compared to community health care service centres/stations and township health care services. Amongst all professional institutions of public health with stomatological/dental departments, 35.0% were maternal and child health care services and 11.2% were institutions for prevention and control of oral diseases. The total number of stomatological/dental workforce in the country was 314,347, among whom 171,587 (54.6%) were stomatologists/dentists. The ratio of number of stomatologists/dentists to population was 1:7,768 nationally, which was lower than the WHO standard of 1:5,000.The National Investigation of Resources for Oral Health in China exhibited the current status and distribution of resources for oral health over the country, whereas insufficiencies of stomatological/dental workforce and institutions and inequalities of their distribution were found nationally. This could provide some policy suggestions for the health authorities in China to promote oral health in the Chinese population in the future.

To investigate the oral health status and related factors of 12-year-olds from regions with and without coverage of the National Oral Health Comprehensive Intervention Program in China by means of analysing national data from the 4th National Oral Health Survey.Data of 12-year-olds participating in the 4th National Oral Health Survey of China were used for statistical analysis. Children who were recruited in the survey completed a dental examination and filled in a questionnaire. Oral health status, pit-and-fissure sealant history, oral hygiene behaviours, sugar consumption habits, status of dental service utilisation, and oral health knowledge were compared between children from regions with and without coverage of the national programme. For the number of decayed, missing and filled permanent teeth (DMFT) and its components, as well as the number of teeth with pit-and-fissure sealants, mean values were statistically tested to see if significance existed between regions covered by the national programme and uncovered regions, whereas caries prevalence and percentage of pit-and-fissure sealants presented were also compared.Data from 27,821 12-year-old children were analysed, among whom 7,726 were from regions covered by the national programme and 20,095 were from uncovered regions. Statistical significance was found in caries experience and activity, pit-and-fissure sealant history, sugar consumption habits, utilisation of dental services and oral health knowledge when compared between the covered and uncovered regions. Prevalence of dental caries and indices for caries experience and activity was lower in regions covered by the national programme than those not covered, while the percentage of pit-and-fissure sealants presented and the number of teeth with pit-and-fissure sealants exhibited higher in the covered regions. This remained the same even if we focused only on the first molars instead of the full dentition.The National Oral Health Comprehensive Intervention Program for Children in China potentially contributed to better oral health status, behaviour and knowledge in 12-year-old children. The expansion and extension of coverage of the national programme was expected to be beneficial for improving oral health status in children, as well as constructing teams of oral and dental workforce and working mechanisms in some underdeveloped regions.

To explore the clinical and socio-demographic factors influencing oral health-related quality of life (OHRQoL) of Chinese adults in the 4th National Oral Health Survey.Multistage stratified cluster sampling and PPS method were used in sampling and 4720 adults aged 35 to 44 years were recruited. The study subjects completed a structured questionnaire in an interview and underwent a clinical examination. The questionnaire was a Putonghua version of the General Oral Health Assessment Index (GOHAI) and was completed by the interviewer on the site of the 4th National Oral Health Survey. Clinical examination was performed using the criteria recommended by the World Health Organization (WHO).The mean GOHAI score of the subjects was 54.42 (SD 6.01). Result of Poisson regression showed that subjects with a higher household income per capita, had lower DMFT, fewer missing teeth, had no unrepaired missing teeth, or not wearing a partial denture had higher GOHAI scores indicating better OHRQoL.The OHRQoL of the adults in China was fair and was mainly influenced by dental caries, integrity of dentition and restoration of lost teeth. With limited resources and dental manpower in China, higher priority should be given to the prevention and treatment of the main cause leading to losing teeth.

To investigate the status of tooth loss and denture restoration in Chinese adults, analyse the changing trend and provide fundamental data for oral health policy.According to the protocol of the 4th National Oral Health Survey, a multistage stratified random cluster-sampling method was used to enrol adult subjects aged 35 to 44, 55 to 64 and 65 to 74 years in all 31 provinces, municipalities and autonomous regions of the mainland of China. The status of tooth loss and denture restoration was investigated. SPSS20.0 software was used for statistics analysis.Among the 13,464 subjects investigated, 13.8% had complete dentition, 84.4% had dentition defects, and 1.8% was edentulous. Urban subjects showed a significantly higher proportion of complete dentition than those in rural (P = 0.02), and males showed the statistically higher proportion of complete dentition than females (P = 0.01). The mean of remaining teeth was 26.1 ± 6.90, which in urban areas was significantly higher than in rural areas (P0.01). The means of remaining teeth were 29.6 ± 2.3, 26.3 ± 6.1, and 22.5 ± 8.7 in the 35 to 44, 55 to 64 and 65 to 74 age groups, respectively. The detection rate of fixed partial dentures (FPD) was statistically higher in urban than in rural areas and in males than that in females (P0.01). The detection rate of removable partial dentures (RPD) was statistically higher in urban areas than in rural locations (P0.01). However, the detection rates of irregular denture and unrepair of tooth loss were both significantly lower in urban than in rural areas (P0.01). The rate of restoration of tooth loss was 41.6% in Chinese adults.Although the tooth loss and denture restoration status recorded in the survey was improved compared with the results of 10 years ago, more efforts need to be made on strengthening oral health promotion, particularly for elderly people and those living in rural areas.

To understand the oral health knowledge, attitude, behaviour and oral health status of Chinese diabetic patients so as to facilitate the development of oral health education programmes for diabetic patients in China.A face-to-face questionnaire was conducted for 1,024 diabetic patients and 8,030 non-diabetic people aged 55 to 74 years old in order to understand their oral health knowledge, attitudes, and behaviour. Oral health examination was implemented including caries, gingival bleeding, dental calculus, periodontal attachment loss, etc. according to the Oral Health Surveys Basic Methods 5th Edition.Compared with non-diabetic patients, those with diabetes had more oral health knowledge and more positive attitudes. The proportion of people who formed toothbrushing habits was higher in diabetic patients, but that of regular scaling and flossing is as low as that in non-diabetic people. The detection rate of deep periodontal pockets in diabetic patients was higher than that in non-patients, while the caries situation was better than that in non-patients.This study has shown that the oral health knowledge, attitude, behaviour and oral health status of the 55 to 64-year-old diabetic population are not optimistic. There is a great need for a systematic oral health education programme in China. The contradiction between a large number of diabetes patients and limited health resources requires us to give priority to the improvement of oral health behaviours, such as educating patients to develop toothbrushing and flossing habits.

To explore the prevalence and associated risk indicators of dental fluorosis in the mainland of China.Data for this study was obtained from the 4th National Oral Health Survey in China, conducted from 2015 to 2016. The sample population was 12-year-old school students. Study participants were selected using a multi-stage, stratified random sample selection procedure using a sampling frame compiled from geographical distribution of China. The level of dental fluorosis was determined using the Dean index recommended by the World Health Organization (WHO). A structured questionnaire was distributed to all the subjects in schools. Participants completed a questionnaire with assistance from staff. A bivariate analysis was performed using the chi-square test. Logistic regression was performed to evaluate the association between dental fluorosis and the independent variables.A total of 27,495 students were evaluated, of which 13,650 (49.6%) were male. Overall, dental fluorosis was found in 13.4% of participants; 6.3% had very mild fluorosis, 4.3% had mild fluorosis, 2.3% had moderate fluorosis, and 0.5% had severe fluorosis. The community fluorosis index was 0.28. In the final logistic regression model students from rural areas (RR:1.582, 95%CI 1.473-1.700), students whose fathers had low education (RR:1.429, 95%CI 1.230-1.6611.184, 95%CI 1.026-1.365), and those students with sibling (RR:1.537, 95%CI 1.414-1.671) were more significantly associated with dental fluorosis.As a whole, China has a low dental fluorosis prevalence. Rural areas were the key places for the prevention of dental fluorosis. More prevention measures should be conducted on the children whose fathers were of lower education and who were not an only child.

To investigate the periodontal health status and associated factors of adolescents aged 12 to 15 years old in China.A cross-sectional national oral health survey was conducted in 2015-2016. The multi-stage stratified cluster sampling was used to select participants in all 31 provinces, autonomous regions and municipalities in the mainland of China. Each participant received a clinical assessment including periodontal bleeding and calculus, and 15-year-old adolescents received additional examinations including for periodontal pocket depth and attachment loss, using the latest criteria from the Oral Health Survey Basic Methods, as recommended by the World Health Organization (WHO). A self-answered structured questionnaire was designed to collect the data of background information and associated risk factors.A total of 118,514 adolescents (14.0 ± 1.09 years old) completed all the oral examinations and the questionnaire. The prevalence of periodontal bleeding and calculus was 61.0% and 67.3% respectively. In the group of 15 year olds, 6.5% adolescents had periodontal pocket and 0.5% had attachment loss. Molars were often involved and, furthermore, calculus also occurred on lower incisors. The periodontal status of adolescents became worse as they grew up. The condition of girls was significantly better than boys.This survey illustrated a brief picture of periodontal status of adolescents in China showing that gingival bleeding and calculus were very common and frequent. Further actions on oral health education were necessary, especially for those in lower socio-economic classes.

To investigate the dental caries status and related factors in Chinese elderly people, using data from the 4th National Oral Health Survey of China.In this cross-sectional study, a multistage, cluster strategy was used to recruit 4,431participants (2,222 male and 2,209 female) aged 65 to 74 years from all 31 provinces, autonomous regions and municipalities of the mainland of China. The survey was performed according to the diagnostic standard proposed by the World Health Organization (WHO). Socio-demographic information was collected with a closed questionnaire.The caries prevalence in 65 to 74-year-olds was rather high; the report shows it was 98.0% (DMFT ≥ 1) among elderly people in China. The mean DMFT, DT, MT and FT was 13.33 ± 9.32, 3.33 ± 4.17, 9.50 ± 8.66 and 0.49 ± 1.41, respectively. The filling rate was very low, assessed as 12.8%. The number of DMFT related to gender, residential district type, educational level, level of annual household income, toothbrushing frequency, consumption frequency of desserts, attitudes to oral health and oral health-related knowledge.The prevalence of dental caries in Chinese elderly people is rather high and a lot of decayed teeth still need to be filled and suitable prevention and treatment for this group is urgently needed.

To investigate the differences in distribution of root caries and related factors between middle-aged and elderly people in China.In this cross-sectional study, a multistage, cluster strategy was used to recruit 4,410 participants (2,197 males and 2,213 females) aged 35 to 44 years and 4,431 participants (2,222 males and 2,209 females) aged 65 to 74 years from all 31 provinces, autonomous regions and municipalities of the mainland of China. The survey was conducted according to the basic methods proposed by the World Health Organization (WHO). Sociodemographic information, oral health behaviour, attitude and knowledge, history of dental prophylaxis and general health condition were collected with a closed questionnaire.A great increase in the occurrence of root caries in Chinese adults from 35 to 44-year-old to 65 to 74-year-olds, with the prevalence (DFR ≥ 1) from 25.4% to 61.9% and with the mean DFR score from 0.54 ± 1.34 to 2.63 ± 3.75. Filling rates were also very low, only 1.8% and 3.0%, respectively. Females and residents of rural areas were more likely to suffer from root caries. In both the middle-aged group and the elderly group, root caries related to gender, education level, sweet food/drinks consumption, oral health knowledge and status of root surface explosion. In 35 to 44 year olds, toothbrushing is a significant protection factor (OR = 0.88, 95%CI 0.81 ~ 0.96), while using toothpicks is a risk factor (OR = 1.06, 95%CI 1.02 ~ 1.10). In 65 to 74 year olds, not having dental had scaling in the past 12 months is a risk factor (OR = 1.66, 95%CI 1.09 ~ 2.53).Root caries among middle-aged people and elderly people in China have different risk factors and need more attention in future research to develop proper prevention.

To investigate the dental caries status of teenagers in China by means of analysing national data from the 4th National Oral Health Survey of China.Data for 12- to 15-year-olds participated in the 4th National Oral Health Survey of China were used for statistical analysis. Children who were recruited in the survey completed a dental examination and filled in a questionnaire. Social demographic factors, oral hygiene behaviours, sugar consumption habits, status of dental service utilisation, and pit-and-fissure sealant history were compared between adolescents with caries experiences and those without. For decayed, missing and filled permanent teeth (DMFT) and each of its components, mean values were statistically tested to see if significance existed between or among different categories of all involved variables.In total, data from 27,821, 30,961, 30,691 and 29,128 Chinese 12-, 13-, 14-, and 15-year-olds respectively, were analysed. Social demographic factors, sugar consumption and dental service utilisation showed statistical significance when compared between those with and without dental caries experience in the 12- and 15-year-old groups. Certain categories of these factors above also had important influence on the mean value of the number of decayed teeth (DT), filled teeth (FT) and DMFT, and they might be potential determinants of dental caries experience of permanent teeth for teenagers.Dental caries in 12- and 15-year-old Chinese adolescents was impacted by certain social demographic and dental behavioural factors, which could provide some implications for policy makers and dental public health professionals when attempting to enhance oral health status for those teenagers in the early stages of permanent dentition.

Oral disease patterns change over time and it is important to conduct epidemiological surveillance population surveys regularly to monitor the situation. The overall objectives of the present survey were: (1) to describe the oral health status of Chinese children and adults in the 2015-2016 4th National Oral Health Survey; (2) to investigate the oral health knowledge, attitudes, and behaviours among children and adults; (3) to explore the association among sociodemographic characteristics, oral health behaviours, and the oral health status of Chinese children and adults. A national oral health survey was conducted among a representative sample of Chinese children and adults. Local residents from the five age groups - 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years - were selected. A multi-stage cluster sampling method was adopted for the identification of participants. All 31 provinces, autonomous regions and municipalities of the mainland of China were included. All participants were clinically examined and information on their oral health status, including oral mucosal lesions, dental caries experience, periodontal health status, dental fluorosis, and dental prosthesis status, was collected according to the procedures and criteria recommended by the World Health Organization (WHO). A calibration training programme and quality control procedures were conducted to ensure the reliability of the findings. Information on sociodemographic background, oral health behaviours, knowledge and attitude was also collected from all five age groups through a questionnaire survey.

To investigate the prevalence and severity of dental caries among pre-school children in China as part of the 4th National Oral Health Survey.The sampling process was conducted with a multistage stratified cluster method. A total of 40,360 children aged between 3 and 5 years were recruited for this study. Each participant was clinically assessed according to the 5th edition of the oral health survey's basic methods recommended by the World Health Organization (WHO) and their parents or grandparents completed a questionnaire at a face-to-face interview. The status of dental caries was shown in the form of the mean dmft and the prevalence of dental caries. The logistic regression analysis was performed to study the relationships between the prevalence of dental caries and the selected variables.The prevalence of dental caries was 50.8%, 63.6% and 71.9% for 3-, 4- and 5-year-olds, respectively. The mean dmft was 2.28, 3.40 and 4.24, respectively. Logistic regression analysis showed that children who were mixed-fed had a higher chance of staying free of dental caries; children who had dessert before going to bed were associated with a higher probability of caries.The status of dental caries among preschool children in China is on the increase. The preschoolers' dental caries status related to their breastfeeding conditions within the first 6 months of life and their snacking habits.

This study aims at introducing a method for individual agreement evaluation to identify the discordant raters from the experts’ group. We exclude those experts and decide the best experts selection method, so as to improve the reliability of the constructed tongue image database based on experts’ opinions. Fifty experienced experts from the TCM diagnostic field all over China were invited to give ratings for 300 randomly selected tongue images. Gwet’s AC1 (first-order agreement coefficient) was used to calculate the interrater and intrarater agreement. The optimization of the interrater agreement and the disagreement score were put forward to evaluate the external consistency for individual expert. The proposed method could successfully optimize the interrater agreement. By comparing three experts’ selection methods, the interrater agreement was, respectively, increased from 0.53 [0.32-0.75] for original one to 0.64 [0.39-0.80] using method A (inclusion of experts whose intrarater agreement>0.6), 0.69 [0.63-0.81] using method B (inclusion of experts whose disagreement score=“0”), and 0.76 [0.67-0.83] using method C (inclusion of experts whose intrarater agreement>0.6& disagreement score=“0”). In this study, we provide an estimate of external consistency for individual expert, and the comprehensive consideration of both the internal consistency and the external consistency for each expert would be superior to either one in the tongue image construction based on expert opinions.

Introduction Although several techniques have been described to access the parapharyngeal space, tumour surgery in this area remains a challenge. This study investigated a simple and safe technique to access parapharyngeal space tumours. Material and methods Eight primary parapharyngeal space tumours were treated with osteotomy of the vertical ramus outside the mandibular foramen. The primary tumours were pleomorphic adenoma, schwannoma, Warthin's tumour, lipoma, chordoma, and adenoid cystic carcinoma. Tumour size ranged from 4 × 4 cm to 6 × 7 cm. Patients with malignant tumours who underwent surgical resection also received adjuvant dose-fractionated stereotactic radiotherapy. Results All tumours were removed completely without rupture. No patient exhibited any permanent postoperative complication, malocclusion, or other dental complications from this surgical approach. One patient had slight transient postoperative facial paresis, which resolved spontaneously within 4 weeks. The patients were followed for 7–26 months, during which no recurrence was encountered. Conclusions Osteotomy of the vertical ramus outside the mandibular foramen achieved good exposure and satisfactory aesthetic and functional results. This simple and safe technique facilitates the removal of infratemporal fossa tumours while preserving the inferior alveolar nerve.