Factors Affecting the Compliance of Curative-Intent Treatment in Patients With Head and Neck Cancer.

Objectives: This study aims to investigate the factors that lead to poor compliance in initiating the treatment in patients with newly diagnosed head and neck cancers. Methods: A total of 193 patients from the head and neck cancer database dated from January 1, 2018 to September 30, 2020, were analyzed. Variables analyzed included age, gender, primary cancer site, T stage, N stage, M stage, overall stage (I-IV), patient's residential distance, and the impact of COVID-19. Univariate and multivariate analyses were used to assess the significance of these variables in relation to the time to receiving on-time treatment as recommended by specialists. Results: Upon multivariate analysis, the advanced stage and residential distance were significantly associated with initial compliance (P < .09). The impact of nasopharyngeal carcinoma (NPC) and COVID-19 shows a borderline significance (P = .224 and P = .184). Conclusions: The overall stage and patient living distance to the healthcare facility, patient with NPC, and the impact of COVID-19 might affect the compliance of initiating a curative-intent treatment in patients with newly diagnosed head and neck cancers.

Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis.

BACKGROUND: Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD. METHODS: A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model. RESULTS: Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration. CONCLUSION: Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.

Simple Advanced Preparation Method for Improving the Thickness Stability of Powder Thickening Agents in Dysphagia Management.

Texture modification of foods by using thickening agents is a routine practice for assessing and treating dysphagic patients. However, a powder-thickened fluid's viscosity might change over time, and little has been proposed to overcome this inconsistency. This study aimed to evaluate variations in the thickness of a fluid thickened with a common xanthan gum-based powder and to explore the feasibility of a simple advanced preparation method for thickened liquids to improve thickness stability. Thickened fluids with concentrations of 1.0 g/100 mL, 0.7 g/100 mL, and 0.5 g/100 mL were prepared from both freshly opened and previously opened thickening powders. Fluid thickness was measured every 10 min in a series of International Dysphagia Diet Standardization Initiative flow tests. A significant time-dependent decline in thickness was observed for all three concentrations in both groups, namely those prepared with freshly opened and previously opened thickening powders, and the shortest periods to achieve a stable viscosity after liquid preparation for the two groups were 80 and 70 min, respectively. On diluting the thickened liquids from the base liquid, which was prepared at a concentration of 1.0 g/100 mL and stored at room temperature for 90 min, no significant time-dependent thickness changes were observed over the following 60 min. The simple protocol of preparing the thickest "base" liquid in advance and then diluting it to the desired thickness resulted in a consistent liquid thickness, with the prepared liquids ready to be clinically applied and consumed, with high stability within 60 min.

Dose-response analysis of toxic effect from palm oil mill effluent (POME) by-products on biohydrogen producing bacteria - A preliminary study on microbial density and determination of EC50.

The stimulant and toxicity effects of reported organic (acetic acid, propionic acid, butyric acid, formic acid, oil & grease) and inorganic (copper) by-products presented in palm oil mill effluent on anaerobic bacterial population were examined in this paper. The toxicity test had shown that acetic, propionic and butyric acids tend to stimulate the bacterial density level (survival rate more than 50%), while formic acid, copper, oil and grease were shown to have suppressed the density level (survival rate less than 50%). The highest biomass recorded was 1.66 mg/L for the concentration of acetic acid at 216 mg/L and lowest biomass concentration, 0.90 mg/L for copper at 1.40 mg/L. Biohydrogen-producing bacteria have a favourable growth rate around pH 5.5. The comparison of half maximal effective concentration (EC50) values between two test duration on the effects of organic and inorganic by-products postulate that bacteria had a higher tolerance towards volatile fatty acids. While acetic, butyric and propionic acids had exhibited higher tolerance EC50 values for bacteria, but the opposite trend was observed for formic acid, copper and oil & grease.

Safety Assessment of the Auto Manipulation Device for Acupuncture in Sprague-Dawley Rats: Preclinical Evaluation of the Prototype.

BACKGROUND: The Auto Manipulation Device for Acupuncture (AMDA) is designed for providing stable, quantified effects and higher frequency when doing lifting and thrusting manipulation. The purpose of this study is to investigate the safety of manipulation by AMDA in different frequency and duration in healthy rats. METHODS: The study was divided into two parts: single intervention and once a day for a week. 12 rats and 15 rats were randomly allocated to different groups: Control (needle insertion only), AMDA (2Hz/10Mins), AMDA (2Hz/20Mins), AMDA (20Hz/10Mins), and AMDA (20Hz/20Mins) for single and repeated interventions. Real-time physiological functions, laboratory data, and the bilateral muscle tissue of acupoint (ST 36) were obtained after the intervention. RESULTS: We found neither real-time physiological functions nor laboratory data differences between control group and AMDA groups in both parts. In the muscle tissue samples, the slight damage had been observed in the AMDA group with a frequency of 2 Hz for 20 minutes after once intervention, and the repeated session groups noted more obvious tissue damage with fibrotic change. Although the period was shorter, higher frequency manipulation caused more damage that fibroblast nuclei became more slender and obvious. However, no significant adverse effect was noted such as crippled and molting in the whole process. CONCLUSION: Our study suggested that the safety issue of AMDA operation in rats is feasible because there was no difference between control group and AMDA groups among real-time physiological functions and laboratory data. However, manipulation with higher frequency should be more preserved.

Synthesis of Titanium Dioxide by Microwave Plasma Torch.

In this study, TiO2 nanoparticles were synthesized from titanium tetraisopropanol (TTIP) using a microwave plasma torch (MPT) and characterized by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD) and thermogravimetry analysis (TGA). The visible light photocatalysis was studied by the decomposition of methylene blue. MB present in the aqueous solution could be almost completely (> 70%) decomposed within about 720 min of reaction time under visible light irradiation. This is due to the carbon-compounds on the surface of TiO2 (TiOC) corresponding to the results of FTIR. Furthermore, a decrease in recombination between the electron and hole was induced by the existence of TiOC.

The neural generators of the mismatch responses to Mandarin lexical tones: an MEG study.

The present magnetoencephalography study used the cortically constrained minimum-norm estimates of human brain activity to elucidate functional roles of neural generators for detecting different magnitudes of lexical tones changes. A multiple-deviant oddball paradigm was used in which the syllable "yi" with a low-dipping tone (T3) was the common standard sound and the same syllable with a high-level tone (T1) or a high-rising tone (T2) were the large and small deviant sounds, respectively. The data revealed a larger magnetic mismatch field (MMNm) for large deviant in the left hemisphere. The source analysis also confirmed that the MMNm to lexical tone changes was generated in bilateral superior temporal gyri and only the large deviant revealed left lateralization. A set of frontal generators was activated at a later time and revealed differential sensitivities to the degree of deviance. The left anterior insula, the right anterior cingulate cortex, and the right ventral orbital frontal cortex were activated when detecting a large deviant, whereas the right frontal-opercular region was sensitive to the small deviant. These frontal generators were thought to be associated with various top-down mechanisms for attentional modulation. The time frequency (TF) analysis showed that large deviants yielded large theta band (5-7Hz) activity over the left anterior scalp and the left central scalp, while small deviants yielded large alpha band activity (9-11Hz) over the posterior scalp. The results of TF analyses implied that mechanisms of working memory and functional inhibition involved in the processes of acoustic change detection.

Development of Automatic Manipulation Device for Acupuncture (AMDA).

Needle lifting and thrusting manipulation is one of common skills in acupuncture. However, there exists artificial error in frequency and amplitude due to individual difference when performing lifting and thrusting during acupuncture. For providing stable and quantified effects and higher frequency when doing lifting and thrusting manipulation, a well controlled device is needed. The aim of this article is to report the preliminary results of the development of Auto Manipulation Device for Acupuncture (AMDA) and characterization of its functional parameters. A tissue-simulating Agar gel phantom with 4.8%, 5.2%, and 5.4% concentrations was prepared and used for characterization of the AMDA. Tests of the linearity, reliability and safety of the AMDA were implemented with conditions of different drive voltages, frequencies, and simulated tissues. Our preliminary results have demonstrated the developed AMDA its plausibility in the clinical application of acupuncture.

Responses to booster hepatitis B vaccination are significantly correlated with genotypes of human leukocyte antigen (HLA)-DPB1 in neonatally vaccinated adolescents.

Genome-wide association studies have identified single nucleotide polymorphisms (SNPs) near the human leukocyte antigen (HLA)-DP loci that were significantly correlated with outcomes of hepatitis B virus (HBV) infection. We performed a case-control study nested in a well-characterized cohort of booster recipients to assess whether genetic variants of HLA-DPB1 are also associated with response to hepatitis B (HB) vaccination. The cases and controls were 171 and 510 booster recipients whose post-booster titers of antibodies against HBV surface antigen (anti-HBs) were undetectable and detectable, respectively. The HLA-DPB1 genotype was determined using sequence-based techniques. The frequencies of HLA-DPB1 alleles were significantly different between cases and controls (p = 1.7 × 10(-8)). The HLA-DPB1 05:01 and 09:01 alleles were significantly more frequent in the cases, and 02:01:02, 02:02, 03:01:01, 04:01:01, and 14:01, were significantly more frequent in the controls. The adjusted odds ratio (OR) of undetectable post-booster anti-HBs titers was significantly correlated with the number of risk alleles (p for trend = 3.8 × 10(-5)). For the number of protective alleles, the trend was significantly inversed (p for trend = 1.3 × 10(-5)). As compared with subjects with two risk alleles, adjusted OR were 0.34 (95 % confidence interval [CI] 0.21-0.55) and 0.20 (95 % CI 0.08-0.48) for subjects with 1 and 2 protective alleles, respectively. The HLA-DPB1 02:02, 04:01:01, 05:01 and 09:01 alleles were also significantly correlated with the likelihoods of undetectable pre-booster anti-HBs titers. Our results indicated that HLA-DPB1 is significantly correlated with response to booster HB vaccination in adolescent who had received postnatal active HB vaccination. HLA-DBP1 may also determine the long-term persistence of response to HB vaccination.

HLA and response to booster hepatitis B vaccination in anti-HBs-seronegative adolescents who had received primary infantile vaccination.

To explore contemporarily genetic and non-genetic determinants of long-term immunological memory to hepatitis B (HB) vaccination, we conducted a case-control study nested in an adolescent cohort of booster recipients who had received primary infantile HB vaccination but with residual anti-HBs titers <10 mIU/mL at 15-18 years of age. High-resolution phenotypes of human leukocyte antigen (HLA)-A, -B, and -DRB1 loci were determined by sequence-specific oligonucleotide probe hybridization. After controlling for pre-booster anti-HBs levels, the absences of HLA-A*02 and -DRB1*08, simply expressed as A*02(-) and -DRB1*08(-), and the presence of B*15 were significantly associated with elevated risks of non-response (post-booster anti-HBs titers<10 mIU/mL) to booster vaccination. The adjusted odds ratios (ORs) were 3.85 (CI, 1.82-8.33), 4.55 (CI, 1.23-16.67), 3.59 (CI, 1.40-9.17), respectively. There was multiplicative synergism between A*02 and B*15 on the risk of non-response to booster vaccination. The multivariate-adjusted ORs for A*02(-)/B*15, A*02(-)/B*15(-), A*02/B*15, and A*02/B*15(-) haplotypes were 20.39 (p=0.0003), 3.29 (p=0.007), 1.32 (p>0.05), and 1.0, respectively. Recent cigarette smoking and/or betel-quid chewing was associated with a 12-fold risk of non-response to booster vaccination. Further comparisons between responders and adolescents who had undetectable post-booster anti-HBs titers (<0.1 mIU/mL) demonstrated similar results. Our results indicated that response to booster HB vaccination as well as long-term immunological responses to HB vaccination are closely related with host genetic factors, and probably modified by recent substance use.

Limited feasibility of routinely analyzing fetal cells from maternal blood by using magnetic activated cell sorting and polymerase chain reaction for prenatal diagnosis.

BACKGROUND: To assess the feasibility of analyzing fetal cells from maternal circulation by using magnetic activated cell sorting (MACS) and polymerase chain reaction (PCR) for prenatal diagnosis. METHODS: Thirty-one high-risk (either advanced maternal age or abnormal serum Down screening) pregnant women (14-22 weeks) were enrolled. Twenty ml of venous blood from each woman after amniocentesis were pretreated with density gradient centrifugation and sorted by MACS with monoclonal antibodies: anti-CD71 (n = 26) or anti-GPA (n = 5). Nested PCR with Y-specific probes--Y1.5-Y1.8 (n = 10) and Amelogenin (n = 21) were then applied to the sorted nucleated red blood cells (NRBCs) for fetal sex determination. These results were compared with cytogenetic data. To assess the sensitivity of PCR, different proportions of known male and female cultured amniocytes were mixed and amplified for gender identification. RESULTS: Karyotypes were normal in all fetuses (18 females and 13 males). The proportions of NRBCs (in total cells) sorted by MACS--anti-GPA or anti-CD71 were 50% (2000 +/- 1500) and 85% (350 +/- 280), respectively. Accuracies of sex determination by PCR-Amelogenin or Y1.5-Y1.8 were 76.2% (16/21) and 50% (5/10), respectively. Three cases resulted in PCR failure. Assay of nested PCR inferred that after cell sorting, existence of at least 20% of male fetal cells mixed in maternal blood circulation was required for prenatal diagnosis under current methodology. CONCLUSIONS: We confirmed the existence of fetal NRBCs in maternal blood during pregnancy. The low accuracy of sex determination (76.2%) may be attributed to contamination of either maternal NRBCs or non-NRBCs. No conclusive data, however, so far demonstrates the ideal marker to identify the origin of NRBCs. Without specific fetal cell marker and more sophisticated fetal cell analysis methodologies, in our experience, the feasibility of routinely analyzing fetal cells from maternal blood for prenatal diagnosis is limited.