Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial.

BACKGROUND: Painful oral mucositis or trismus, caused by cancer therapy, reduces patients' willingness to maintain basic oral hygiene and eventually results in a poor oral health status. Using mouth rinses and cleaning the tongue are popular ways to improve the oral health status. OBJECTIVES: To evaluate the effectiveness of green tea mouthwash for improving the oral health status in oral cancer patients undergoing cancer treatment. DESIGN: This was a prospective, single-blind, randomized, controlled trial. SETTINGS: Patients were recruited from a major regional teaching hospital that provides specialist cancer care services in Chia-Yi, Taiwan, from July 2018 to June 2020. PARTICIPANTS: A total of 63 patients met the following criteria: > 20 years old; newly diagnosed with oral cancer by a physician; treated with oral surgery within one month prior; and completion of follow-up, with or without chemotherapy or radiation therapy. The exclusion criteria were mental illness; an acute and severe illness; complete edentulism; and inability to open the mouth more than 1 cm. METHODS: Patients were randomly assigned to 2 groups: the mouthwash with green tea (intervention) group or the tap water (control) group. After each teeth-brushing procedure, those in the intervention group rinsed the mouth with 100 ml of a green tea solution for 60 seconds, and those in the control group rinsed the mouth with 100 ml of tap water for 60 seconds. The primary outcome was the oral health status, which was evaluated according to the Oral Assessment Guide and measured at baseline and at every monthly outpatient follow-up until six months by the same nurse. RESULTS: There were 31 subjects in the intervention group and 30 subjects in the control group in the final analysis. The results of t-test showed that compared with baseline, the improvement in the oral health status in the intervention group was significantly better than that in the control group at 4 months after the intervention began. At 4 to 6 months after the intervention began, the oral health status score in the intervention group significantly decreased, by 1.71, 2.97 and 2.93 points, respectively, compared with that in the control group. CONCLUSIONS: The oral health status can be improved and maintained for a long time with the continuous use of green tea mouthwash. Green tea mouthwash is a simple, natural, effective and safe intervention that should be recognized as a nonpharmacological treatment option for protecting the oral mucosa. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT04615780.

Prevalence and associated factors of myopia among rural school students in Chia-Yi, Taiwan.

BACKGROUND: The prevalence of myopia has increased rapidly worldwide over the past few decades. The aim of this study was to evaluate the prevalence and associated risk factors for myopia in elementary and junior high school students in Chia-Yi, Taiwan. METHODS: We included 5417 students in total from Grade 1-6 (n = 4763) and Grade 7-9 (n = 654) from Chia Yi County in this population-based study. The students underwent noncycloplegic autorefractometry and an interview with a structured questionnaire. RESULTS: For this study population, the prevalence of myopia and high myopia was 42.0 and 2.0%, respectively, revealing a statistically significant increase with increasing age (p < 0.05). Junior high school students (aged 13-15) showed a greater prevalence of myopia than elementary school students (aged 7-12) (55.8% vs. 40.1%, respectively, p < 0.001). Multiple logistic regression analysis showed that associated factors of myopia were body height (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.05-1.06), body mass index (OR: 0.98, 95% CI: 0.96-1.00), and ocular alignment (horizontal heterophoria vs. orthophoria, OR: 2.37, 95% CI: 2.08-2.70; tropia vs. orthophoria, OR: 1.94, 95% CI: 1.50-2.52) for elementary school students, whereas in junior high school students, they included body height (OR: 1.02, 95% CI: 1.01-1.04) and ocular alignment (heterophoria vs. orthophoria, OR: 2.20, 95% CI: 1.56-3.10). CONCLUSIONS: This study provided epidemiological data on myopia in rural school students in Chia-Yi, Taiwan, and demonstrated the association between heterophoria and myopia. Correction of refractive errors in the students remained a challenge.

Investigation of the variants at the binding site of inflammatory transcription factor NF-κB in patients with end-stage renal disease.

BACKGROUND: A chronic inflammatory state is a prominent feature in patients with end-stage renal disease (ESRD). Nuclear factor-kappa B (NF-κB) is a transcription factor that regulates the expression of genes involved in inflammation. Some genetic studies have demonstrated that the NF-κB genetic mutation could cause kidney injury and kidney disease progression. However, the association of a gene polymorphism in the transcription factor binding site of NF-κB with kidney disease is not clear. METHODS: We used the Taiwan Biobank database, the University of California, Santa Cruz, reference genome, and a chromatin immunoprecipitation sequencing database to find single nucleotide polymorphisms (SNPs) at potential binding sites of NF-κB. In addition, we performed a case-control study and genotyped 847 patients with ESRD and 846 healthy controls at Tri-Service General Hospital from 2015 to 2016. Furthermore, we used the ChIP assay to identify the binding activity of different genotypes and used Luciferase reporter assay to examine the function of the rs9395890 polymorphism. RESULT: The results of biometric screening in the databases revealed 15 SNPs with the potential binding site of NF-κB. Genotype distributions of rs9395890 were significantly different in ESRD cases and healthy controls (P = 0.049). The ChIP assay revealed an approximately 1.49-fold enrichment of NF-κB of the variant type TT when compared to that of the wild-type GG in rs9395890 (P = 0.027; TT = 3.20 ± 0.16, GT = 2.81 ± 0.20, GG = 1.71 ± 0.18). The luciferase reporter assay showed that the NF-κB binding site activity in T allele was slightly higher than that in G allele, though it is not significant. CONCLUSIONS: Our findings indicate that rs9395890 is associated with susceptibility to ESRD in Taiwan population.

A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot.

Buerger exercise can improve the peripheral circulation of lower extremities. However, the evidence and a quantitative assessment of skin perfusion immediately after this exercise in patients with diabetes feet are still rare.We recruited 30 patients with unilateral or bilateral diabetic ulcerated feet in Chang Gung Memorial Hospital, Chia-Yi Branch, from October 2012 to December 2013. Real-time dorsal foot skin perfusion pressures (SPPs) before and after Buerger exercise were measured and analyzed. In addition, the severity of ischemia and the presence of ulcers before exercise were also stratified.A total of 30 patients with a mean age of 63.4 ± 13.7 years old were enrolled in this study. Their mean duration of diabetes was 13.6 ± 8.2 years. Among them, 26 patients had unilateral and 4 patients had bilateral diabetes foot ulcers. Of the 34 wounded feet, 23 (68%) and 9 (27%) feet were classified as Wagner class II and III, respectively. The real-time SPP measurement indicated that Buerger exercise significantly increased the level of SPP by more than 10 mm Hg (n = 46, 58.3 vs 70.0 mm Hg, P < 0.001). In terms of pre-exercise dorsal foot circulation condition, the results showed that Buerger exercise increased the level of SPP in severe ischemia (n = 5, 22.1 vs 37.3 mm Hg, P = 0.043), moderate ischemia (n = 14, 42.2 vs 64.4 mm Hg, P = 0.001), and borderline-normal (n = 7, 52.9 vs 65.4 mm Hg, P = 0.028) groups, respectively. However, the 20 feet with SPP levels more than 60 mm Hg were not improved significantly after exercise (n = 20, 58.3 vs 71.5 mm Hg, P = 0.239). As to the presence of ulcers, Buerger exercise increased the level of SPP in either unwounded feet (n = 12, 58.5 vs 66.0 mm Hg, P = 0.012) or wounded feet (n = 34, 58.3 vs 71.5 mm Hg, P < 0.001). The majority of the ulcers was either completely healed (9/34 = 27%) or still improving (14/34 = 41%).This study quantitatively demonstrates the evidence of dorsal foot peripheral circulation improvement after Buerger exercise in patients with diabetes.

Organization of wound healing services: The impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement.

Diabetes foot ulceration (DFU) has a negative impact on the quality of life and leads to disabling morbidity, such as lower extremity amputation (LEA). This study aimed to evaluate the LEA trend before and after the establishment of the diabetes foot team, an on-time debridement, on-site screening, and multidisciplinary integration with standardizing care, in Chang Gung Memorial Hospital, Chia Yi, Taiwan, starting in 2010. The study retrospectively investigated the non-traumatic LEA rate in diabetes foot (identified by using ICD-9-Clinical Modification (CM) codes, 250.70-250.83) and whole patients with diabetes (ICD-9 250.XX) yearly from 2004 to 2013. Patients were enrolled from hospitalization, emergency room (ER), or outpatient departments, respectively. Despite the overall incidence of diabetes foot in patients with diabetes remaining constant, from 3.47% in 2004 to 3.58% in 2013, the incidence of hospitalized diabetes foot from diabetes reduced, from 2.83% in 2004 to 1.51% in 2013. Introduction of integrated wound care also led to a reduction of the average LEA rate in hospitalized patients, from 15.27% (2004-2009) to 6.08% (2010-2013) (P<0.001). A similar decline of the LEA rate was observed for patients from hospitalization, ER and outpatient departments together with an average LEA rate from 7.99% (2004-2009) down to 3.02% (2010-2013) (P<0.001). In trend analysis, the curve estimation revealed a quadratic trend in the relationship between LEA rate and time (R-square=0.869, P=0.001) for hospitalized patients as well as a linear (R-square=0.819, P<0.001) and quadratic (R-square=0.845, P=0.001) trend in the relationship between LEA rate and time for hospitalization, ER, and outpatient departments together. The LEA rate for DM patients declined from 372.72/100,000 in 2004 to 61.74/100,000 in 2013. With establishment of an organizing, standardized wound care protocol and integrated multidisciplinary team, we demonstrated a significant decline in the LEA rate both in diabetes foot patients and all patients with diabetes. These improvements can be attributed to introducing an efficient pathway with on-time debridement and early intervention of diabetes foot ulcers.

Alcohol consumption is inversely associated with stage 3 chronic kidney disease in middle-aged Taiwanese men.

BACKGROUND: Chronic kidney disease (CKD) is a major global public health burden, but there is limited understanding of the relationship of alcohol consumption with CKD. METHODS: In this cross-sectional multivariable study, all participants of a health check-up program in Ditmanson Medical Foundation Chia-Yi Christian Hospital in Taiwan from 2003 to 2009 (15,353 women and 11,900 men) were included for analysis. Estimated glomerular filtration rate was used to define CKD stage and history of alcohol consumption was obtained by self-reporting. Multivariable logistic regression analyses of gender-specific association of alcohol drinking with stage 3 CKD were conducted. A trend tests was conducted to check the dose-response relationship of alcohol consumption with renal disease. A sensitivity test was conducted to rule out the likelihood of reverse causality. RESULTS: The prevalence of stage 3 CKD was lower in drinkers than non-drinkers (p < 0.001) and the percentage of drinkers with stage 3 CKD was less than that of non-drinkers. Multivariable analysis indicated that alcohol consumption was negatively associated with the presence of stage 3 CKD in men (adjusted odds ratio [aOR] for occasional drinking: 0.68, 95% CI: 0.59 ~ 0.78, p < 0.001; aOR for frequent drinking: 0.47, 95% CI: 0.35 ~ 0.63, p < 0.001). Advanced age, hypertension, anemia, BMI of at least 24, hyperuricemia, and proteinuria were also associated with stage 3 CKD in men. Trend tests indicated lower odds of having stage 3 CKD with increased alcohol consumption in both genders. Subgroup analyses and sensitivity tests also indicated the reverse association between alcohol consumption and stage 3 CKD in men regardless of age, diabetes status, and other risky behaviors. CONCLUSIONS: Alcohol consumption was inversely associated with stage 3 CKD in Taiwanese men. However, considering the potential of other health damage with alcohol consumption, the current results should be interpreted cautiously.

The effect of t'ai chi exercise on autonomic nervous function of patients with coronary artery disease.

OBJECTIVE: The objective of this study was to evaluate the effect of t'ai chi (TC) on heart rate variability (HRV) from baseline to 9 months in patients with coronary artery disease (CAD). DESIGN: A comparative trial was undertaken comparing the acute and long-term effect of TC on HRV in patients with CAD. PARTICIPANTS: Sixty-one (61) subjects with CAD undergoing percutaneous intervention or coronary bypass grafting for a period of more than 1 month were recruited from the clinics of cardiology and cardiovascular surgery at Chia-Yi Christian Hospital, Taiwan. INTERVENTIONS: The experimental group (n = 22) practiced weekly 90-minute Yang's style TC for 9 months and the control group (n = 39) continued their normal daily physical activity. MAIN OUTCOME MEASURES: HRV was recorded at baseline, 3 months, 6 months, and 9 months in the control group. Resting HRV was recorded before TC exercise and recovery HRV was recorded 30 minutes post TC at the same four time points in the experimental group. RESULTS: The change in the normalized low-frequency power, normalized high-frequency power, and the low-/high-frequency power ratio between resting and post-TC was significantly different at 9 months when compared with those at baseline, 3, and 6 months. The mean difference in normalized low-frequency power and the low/high-frequency power ratio changed from positive values at baseline, 3, and 6 months to negative values at 9 months. However, there were no significant differences in resting HRV between the patients in TC and control groups in either time domain or frequency domain HRV indices. CONCLUSIONS: The change in heart rate and HRV between resting and post-TC suggested that TC exercise could enhance vagal modulation. The potential beneficial effect of long-term regular TC exercise in patients with CAD merits further investigation.

Modified vastus lateralis flap in treating a difficult hip infection.

BACKGROUND: Difficult-to-treat hip infections are typically a reconstructive challenge to orthopedic surgeons. Treatment regimens must be tailored to each patient on the basis of an overall evaluation of systemic host factors and local wound factors. To treat a medically ill patient with compromised local wounds in the hip area, a modified vastus lateralis flap transposition was developed. This flap transposition is of a simple design and effective as both a soft-tissue coverage and a dead space filler. METHODS: From January 2002 to June 2003, 10 patients (5 male patients and 5 female patients) suffering difficult hip infections were referred to Chang Gung Memorial Hospital at Chia-Yi for further treatment. Before visiting the clinic, each patient had undergone repeated failed operations, including debridement, introduction of antibiotic-loaded cement spacers, and fasciocutaneous flap transposition. After being diagnosed with difficult hip infections, these patients were treated with the modified vastus lateralis flap transposition immediately after radical debridement. The average follow-up period was 17.4 months (range, 9-27 months). RESULTS: The hip infections in all 10 patients were controlled and the wounds healed uneventfully. The need for another soft-tissue procedure was not indicated. The C-reactive protein returned to a near-normal and stable level within 1 month. The only complication occurred when case 1 developed a contralateral iliopsoas abscess and secondary septic hip 9 months after the procedure. There was no morbidity or mortality related to the technique. CONCLUSION: For medically ill patients with compromised local wounds, the modified vastus lateralis muscle flap transposition after radical debridement is a simple and effective way of resolving refractory and limb-threatening hip infections.