Improved nutritional support with immune-modulating formula in patients with head and neck and esophageal cancer undergoing radiochemotherapy: A retrospective clinical study.

BACKGROUND AND OBJECTIVES: Malnutrition is frequent in patients with head and neck (HN) and esophageal cancer, aggravated by radiochemotherapy (RCT), and increases morbidity and mortality and treatment toxicity. Recent studies suggest that the immune, nutritional, or inflammatory status can be modulated by the use of pharmaconutrients in RCT-treated patients. In this study, the effect of immunonutrition, including arginine, ω-3 fatty acid, and nucleotide enriched diet, on nutritional status in patients with HN or esophageal cancer undergoing RCT was investigated. METHODS AND STUDY DESIGN: A retrospective review of 88 patients undergoing RCT was conducted. Either an immune-modulating enteral nutrition (IEN) (Impact formula) or a standard enteral nutrition (SEN) (isonitrogenous and isoenergetic formula) was administered. Anthropometric parameters, nutritional risk index (NRI), serum albumin, and functional capacity were recorded at the beginning and end of the RCT. RESULTS: Approximately 45% of patients were moderate to severely malnourished (NRI <97.5) at the beginning of the RCT in the SEN (n=19) and IEN (n=21) groups alike. Significant improvement was observed in the NRI of malnourished patients of the IEN group (97.3±11.9 vs 98.0±12.0, p=0.021). Additionally, a significant difference in the body weight (BW) between the two groups was observed, and BW increased (65.4±14.8 kg vs 66.3±14.3 kg, p=0.03) in the IEM group but decreased (62.3±12.3 kg vs 61.7±12.0 kg, p=0.023) in the SEM group. CONCLUSIONS: Pharmaconutrient- enriched IEN had a more potent effect than SEN in preventing deterioration of nutritional status during RCT.

Pinworm infections associated with risk of psychiatric disorders-A nationwide cohort study in Taiwan: Pinworm infections and psychiatric disorders.

AIM: This study aimed to investigate the association between males with pinworm infections and the risk of developing psychiatric disorders. METHOD: A total of 2044 enrolled patients, with 511 pinworm subjects and 1533 unexposed subjects (1:3) matched for sex, age and index year, from Taiwan's Longitudinal Health Insurance Database (LHID) from 2000 to 2015, selected from the National Health Insurance Research Database (NHIRD). After adjusting for confounding factors, the Cox regression model was used to compare the risk of developing psychiatric disorders during the 15 years of follow-up. RESULTS: Of all the enrollees, 24 in the pinworm cohort and 18 in the unexposed cohort (343.10 vs 84.96 per 100,000 person-year) developed psychiatric disorders. The Cox regression model revealed that, after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 4.581 (95% CI: 2.214-9.480, p < .001, p < .001). Pinworm infections were associated with the increased risk in anxiety disorders, depressive disorders, and sleep disorders, respectively. CONCLUSION: Patients who suffered from pinworm infections have a higher risk of developing psychiatric disorders, and this finding should be considered as a timely reminder for the clinicians to provide much more attention for these patients because of their mental health issues.

Speech comprehension in noisy environments: Evidence from the predictability effects on the N400 and LPC.

Introduction: Speech comprehension involves context-based lexical predictions for efficient semantic integration. This study investigated how noise affects the predictability effect on event-related potentials (ERPs) such as the N400 and late positive component (LPC) in speech comprehension. Methods: Twenty-seven listeners were asked to comprehend sentences in clear and noisy conditions (hereinafter referred to as "clear speech" and "noisy speech," respectively) that ended with a high-or low-predictability word during electroencephalogram (EEG) recordings. Results: The study results regarding clear speech showed the predictability effect on the N400, wherein low-predictability words elicited a larger N400 amplitude than did high-predictability words in the centroparietal and frontocentral regions. Noisy speech showed a reduced and delayed predictability effect on the N400 in the centroparietal regions. Additionally, noisy speech showed a predictability effect on the LPC in the centroparietal regions. Discussion: These findings suggest that listeners achieve comprehension outcomes through different neural mechanisms according to listening conditions. Noisy speech may be comprehended with a second-pass process that possibly functions to recover the phonological form of degraded speech through phonetic reanalysis or repair, thus compensating for decreased predictive efficiency.

Association Between Antibiotic Treatment of Leptospirosis Infections and Reduced Risk of Dementia: A Nationwide, Cohort Study in Taiwan.

Background: To explore the association between leptospirosis, the risk of dementia, and the potential protective role of antibiotic treatment. Methods: We conducted a retrospective cohort nationwide, population-based study, from Taiwan's National Health Insurance Research Database (NHIRD). We enrolled 1,428 subjects aged 50 years or above, in the index year of 2000, which included those retrieved from the NHIRD record. Dementia diagnosis and incidence over 16 years follow-up was retrieved from the NHIRD records. The Fine and Gray survival analysis was used to determine the risk of dementia, and the results were presented as a sub-distribution hazard ratio (SHR) with a 95% confidence interval. Results: In the study period, 43 of the 357 leptospirosis patients developed dementia, as compared to 103 of the control group (930.90 vs. 732.49 per 105 person-years). By the Fine and Gray survival analysis, the leptospirosis was associated with the risk of dementia, and the adjusted SHR was 1.357 (95% confidence interval [CI]: 1.213-1.519, P < 0.001), across 16-year of the follow-up period. To exclude the protopathic bias, the sensitivity analysis was conducted. This analysis revealed that the leptospirosis was associated with the increased risk of dementia, even after excluding the dementia diagnosis within the first year (adjusted SHR = 1.246, 95%CI: 1.114-1.395, P < 0.001) or within the first 5 years (adjusted SHR = 1.079, 95%CI: 1.023-1.152, P = 0.028), antibiotic treatment for leptospirosis was associated with the reduced risk of dementia (P = 0.001). Conclusion: Leptospirosis was associated with an increased risk for dementia, and antibiotic treatment was associated with a reduced risk. Further research will be necessary to explore the underlying mechanisms of this association.

In vivo cytokine modulatory effects of cinnamaldehyde, the major constituent of leaf essential oil from Cinnamomum osmophloeum Kaneh.

The purpose of this study was to analyse the major compound in the leaf essential oil of Cinnamomum osmophloeum Kaneh. and to examine its in vivo toxicity and cytokine-modulatory effects. The HS-GC/MS and quantitative HPLC analyses showed the concentrations of the major compounds, cinnamaldehyde, benzaldehyde and 3-phenylpropionaldehyde, in the leaf essential oil of Cinnamomum osmophloeum to be 16.88, 1.28 and 1.70 mg/mL, respectively. Acute and sub-acute toxicity tests identified no significant changes in body weight, liver and kidney function indices, and pathology for the mice treated with up to 1 mL/kg body weight of Cinnamomum osmophloeum leaf essential oil or up to 4 mg/kg body weight of cinnamaldehyde. A murine model was established using ovalbumin (OVA)-primed Balb/C mice treated with various concentrations of Cinnamomum osmophloeum leaf essential oil or cinnamaldehyde daily for 4 weeks. The results of tests with commercial ELISA kits indicated no significant cytokine-modulatory effects in mice treated with Cinnamomum osmophloeum leaf essential oil; however, the serum concentrations of IL-2, IL-4 and IL-10, but not IFN-γ, significantly increased in animals treated with 1 mg/kg body weight of cinnamaldehyde during the 4-week period. The possibility that the other constituents act as antagonists of cinnamaldehyde cannot be excluded.

In vivo Th1 and Th2 cytokine modulation effects of Rhodiola rosea standardised solution and its major constituent, salidroside.

Although Rhodiola rosea (L.) is used widely and disseminated in Oriental medicine, its in vivo effects on cytokine modulation remain unclear. Among the biologically active components of Rhodiola rosea, salidroside was suggested to be the most active compound. The objectives of this study were to assess the toxicity and cytokine modulation effects of Rhodiola rosea standardised solution (RRSS) and salidroside. Quantitative high pressure liquid chromatography (HPLC) analysis determined the content of salidroside in RRSS to be 4.39% (w/v). Groups of Balb/c mice were fed daily with different doses of RRSS or salidroside, with CAPE or distilled water used as positive and negative controls, respectively. The acute and subacute toxicity tests did not reveal weight differences, pathological changes, or abnormalities in liver or kidney function indices among the treated groups. Ovalbumin-primed mouse cytokine assays demonstrated that both T helper (Th1) (IL-2 and IFN-γ) and Th2 (IL-4 and IL-10) cytokines were significantly increased by feeding with RRSS in a dose- and time-dependent manner (p < 0.05). Moreover, the cytokine modulation effects of salidroside were less prominent than that of RRSS treatment and not dose-dependent. These findings suggest that increased secretion of both Th1- and Th2-pattern cytokines can be achieved with RRSS and salidroside treatment.

Neural correlates of phonology-to-orthography mapping consistency effects on Chinese spoken word recognition.

Previous studies have shown that reading experience reshapes speech processing. The orthography can be implemented in the brain by restructuring the phonological representations or being co-activated during spoken word recognition. This study utilized event-related functional magnetic resonance imaging and functional connectivity analysis to examine the neural mechanism underlying two types of orthographic effects in the Chinese auditory semantic category task, namely phonology-to-orthography consistency (POC) and homophone density (HD). We found that the POC effects originated from the speech network, suggesting that sublexical orthographic information could change the organization of preexisting phonological representations when learning to read. Meanwhile, the HD effects were localized to the left fusiform and lingual gyrus, suggesting that lexical orthographic knowledge may be activated online during spoken word recognition. These results demonstrated the different natures and neural mechanisms for the POC and HD effects on Chinese spoken word recognition.

Investigation of toxic heavy metals content and estimation of potential health risks in Chinese herbal medicine.

The content of toxic heavy metals (THMs), including lead (Pb), arsenic (As), cadmium (Cd), and mercury (Hg), was determined in a total of 10,245 samples for 279 types of Chinese herbal medicine (CHM) using a validated inductively coupled plasma mass spectrometry method. The exceeding rate (ER) for the four THMs were calculated based on diverse permissible limits (PLs) established by different organizations and national pharmacopeias. Cluster analysis was used to classify the degree risk of THMs contamination according to the calculated ER. Results revealed that Cibotii rhizome, Selaginellae herba, Morindae officinalis radix, Asprellae ilicis radix, and Toxicodendri resina exhibited high-degree risk of Pb contamination. Eckloniae/Laminariae thallus, Spirodelae herba, and Naturalis indigo possessed high-degree risk of As contamination. Tetrapanacis medulla, Centipedae herba, Cyathulae radix, Linderae radix, Meretricis/Cyclinae concha, and Tabanus displayed high-degree risk of Cd contamination. Toxicodendri resina has high-degree risk of Hg contamination. In addition, six types of CHM, including Asprellae ilicis radix, Toxicodendri resina, Eckloniae/Laminariae thallus, Fossilia Ossis Mastodi, Haematitum, and Hedyotidis diffusae herba, may have non-carcinogenic health risk after consumption of raw materials because the calculated hazard quotient and hazard index were over 1.0. In summary, these data provide useful information about THMs contamination in CHM.

Association of dietary AGEs with circulating AGEs, glycated LDL, IL-1α and MCP-1 levels in type 2 diabetic patients.

PURPOSE: The association of dietary advanced glycation endproducts (AGEs) intake with the oxidative and inflammatory status in type 2 diabetic patients was examined. METHODS: Seventy-four healthy controls, 50 low AGEs intake and 68 high AGEs intake type 2 diabetic patients were requested to complete a 7-day dietary record. Blood levels of several oxidative and inflammatory biomarkers were determined. RESULTS: Diabetic patients with high AGEs intake had significantly elevated plasma levels of AGEs, HbA1c, low-density lipoprotein (LDL), LDL-cholesterol and glycated LDL than low AGEs intake patients and controls (P < 0.05). These high AGEs intake patients also had significantly increased plasma levels of 8-isoprostane, interleukin (IL)-1α, tumor necrosis factor-α, monocyte chemoattractant protein (MCP)-1 and lower superoxide dismutase (SOD) activity than low AGEs intake patients (P < 0.05). Correlation coefficients of dietary AGEs versus plasma AGEs, HbA1c, 8-isoprostane, IL-1α and MCP-1 were >0.6; but the correlation coefficient of dietary AGEs versus plasma SOD activity was <-0.6. CONCLUSION: Increasing dietary AGEs intake might enrich circulating AGE level and contribute to oxidative and inflammatory progression under diabetic condition. The circulating 8-isoprostane, IL-1α and MCP-1 levels and SOD activity might be appropriate biomarkers used to evaluate dietary AGEs-associated oxidative and inflammatory stress.

Development of a titanium dioxide-assisted preconcentration/on-site vapor-generation chip hyphenated with inductively coupled plasma-mass spectrometry for online determination of mercuric ions in urine samples.

In this study, a novel automatic analytical methodology using a titanium dioxide (TiO2)-assisted preconcentration/on-site vapor-generation (VG) chip hyphenated with inductively coupled plasma-mass spectrometry (ICP-MS) for online determination of mercuric ions (Hg2+) was developed. Interestingly, the TiO2 nanoparticle (nano-TiO2) coating on the channel surface acted not only as a sorbent for preconcentration but also as a catalyst for photocatalyst-assisted VG. Under optimum operation conditions, the developed method was validated by analyzing the certified reference material (CRM) Seronorm™ Trace Elements Urine L-2 (freeze-dried human urine). Based on the obtained results, the dramatic reduction of "hands-on" manipulation and the elimination of hazardous materials (e.g., sodium borohydride (NaBH4) and stannous chloride (SnCl2)) from the process enabled a simple and ultraclean procedure with an extremely low detection limit of 0.75 ng L-1 for Hg2+ in urine samples. To the best of our knowledge, this is the first study to report the direct exploitation of a nano-TiO2-coated microfluidic device for online sample preconcentration and on-site VG prior to ICP-MS measurement.

Hypomania Induced by Bifrontal Transcranial Direct Current Stimulation in a Patient with Bipolar Depression.

Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has been increasingly used to treat bipolar depression. Researchers recently noticed the risk of tDCS-emergent mania/hypomania in depressed patients and started to evaluate this risk by launching a meta-analysis. Here we present a female with bipolar II depression who rapidly developed hypomanic switching during bifrontal tDCS.

Electroconvulsive Therapy and Risk of Dementia-A Nationwide Cohort Study in Taiwan.

Background: Electroconvulsive therapy (ECT) is an effective treatment for schizophrenia, bipolar disorder, and major depressive disorder, and a temporary memory loss may occur after ECT. However, the association between ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, and the risk of dementia is yet to be examined. Objective: This study aimed to clarify as to whether ECT is associated with the risk of dementia after ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, using Taiwan's National Health Insurance Research Database (NHIRD). Methods: A total of 3,796 enrolled participants (schizophrenia, 46.68%; bipolar disorder, 11.77%; and major depressive disorder, 41.55%) with 994 patients who had received ECT and 2,982 controls matched for sex and age, between January 1, and December 31, 2000, were selected from the NHIRD. After adjusting for confounding factors, Fine and Gray's survival analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Results: Of the study patients, 45 (4.53%) of them developed dementia when compared to 149 (5.0%) in the control group. Fine and Gray's survival analysis revealed that the study patients were not associated with an increased risk of dementia [hazard ratio (HR) = 0.612, 95% confidence interval (CI) = 0.438-1.854, P = 0.325]. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 0.633 (95% CI = 0.448 - 1.895, P = 0.304). Conclusion: This study supports that ECT was not associated with the increased risk of dementia in patients with schizophrenia, bipolar disorder, and major depressive disorder, using the NHIRD.

Cognitive enhancers associated with decreased risk of injury in patients with dementia: a nationwide cohort study in Taiwan.

This study aimed to investigate the associations among dementia, psychotropic medications and the risk of overall injuries. In this nationwide matched cohort study, a total of 144 008 enrolled patients ≥age of 50, with 36 002 study subjects who suffered from dementia and 108 006 controls matched for sex and age, from the Inpatient Dataset, for the period 2000-2010 in Taiwan were selected from the National Health Insurance Research Database, according to International Classification of Diseases, 9th Revision, Clinical Modification. When adjusting for the confounding factors, a Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 10 years of follow-up. Of the study subjects, 6701 (18.61%) suffered injury when compared with 20 919 (19.37%) in the control group. The Cox regression analysis revealed that the study subjects were more likely to develop an injury (HR: 2.294, 95% CI=2.229 to 2.361, P<0.001) after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications in the subjects with dementia were associated with the risk of injury (adjusted HR=0.217, 95% CI: 0.206 to 0.228, P<0.001). Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, were associated with the risk of injury in the study subjects after being adjusted for all comorbidities and medications (adjusted HR=0.712(95% CI=0.512 to 0.925, P<0.01)). In conclusion, patients who suffered dementia had a higher risk of developing injury, and the cognitive enhancers were associated with the decreased risk of injury.

Parenteral nutrition combined with enteral feeding improves the outcome of cancer patients.

BACKGROUND AND OBJECTIVES: This study investigated whether total parenteral nutrition combined with enteral nutrition is associated with improved biochemical and clinical outcomes in cancer patients with gastrointestinal dysfunction. METHODS AND STUDY DESIGN: From January to December 2014, the clinical data of 68 patients in a cancer ward were retrospectively collected, and these patients were classified into two groups according to nutrition delivery, through parenteral nutrition, combined with enteral nutrition more (group A) or less (group B) than 250 kcal/day. The following variables were analyzed: the route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, diagnosis at admission, complications of intestinal failure, modified Glasgow Prognostic Score, co-morbidities, duration of total parenteral nutrition support, performance status scale, and plasma nutritional markers. RESULTS: A significant difference was observed between the two groups in functional capacity, including the Karnofsky index, World Health Organization/Eastern Cooperative Oncology Group score, body-weight loss, and serum albumin levels. However, no significant difference was observed in the modified Glasgow Prognostic Score. CONCLUSIONS: Cancer patients receiving total parenteral nutrition who were fed enterally more than 250 kcal/d exhibited more favorable clinical outcomes than those who were fed enterally less than 250 kcal/d. Enteral nutrition should be considered for these severely ill patients.

Asiatic acid attenuated apoptotic and inflammatory stress in the striatum of MPTP-treated mice.

The effects of post-treatments with asiatic acid (AA) at 20, 40 or 80 mg per kg BW per day against apoptotic, oxidative and inflammatory injury in the striatum of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice were examined. The results showed that AA supplements at 40 and 80 mg per kg BW per day increased AA deposit in the striatum, increased glutathione content and decreased reactive oxygen species production in the striatum. AA supplements at 20-80 mg per kg BW per day dose-dependently lowered striatal levels of nitric oxide, 3-nitrotyrosine, interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha and prostaglandin E2. AA supplements at 40 and 80 mg per kg BW per day down-regulated striatal p47(phox) and gp91(phox) expression; but, at three test doses suppressed striatal expression of inducible nitric oxide synthase and cyclooxygenase-2. AA post-treatments at 40 and 80 mg per kg BW per day enhanced Bcl-2 expression, and lowered Bax, apoptosis-inducing factor and caspase-3 expression in the striatum. AA at 20-80 mg per kg BW per day up-regulated striatal tyrosine hydroxylase expression, and suppressed Toll-like receptors (TLR)2 and nuclear factor kappa B p65 expression. AA treatments at 40 and 80 mg per kg BW per day decreased striatal expression of α-synuclein and TLR4, increased striatal levels of dopamine, brain-derived nerve growth factor and glial cell line-derived neurotrophic factor. These novel findings suggest that asiatic acid is a potent nutraceutical agent against the progression of Parkinson's disease.

Effects of orthographic consistency and homophone density on Chinese spoken word recognition.

Studies of alphabetic language have shown that orthographic knowledge influences phonological processing during spoken word recognition. This study utilized the Event-Related Potentials (ERPs) to differentiate two types of phonology-to-orthography (P-to-O) mapping consistencies in Chinese, namely homophone density and orthographic consistency. The ERP data revealed an orthographic consistency effect in the frontal-centrally distributed N400, and a homophone density effect in central-posteriorly distributed late positive component (LPC). Further source analyses using the standardized low-resolution electromagnetic tomography (sLORETA) demonstrated that the orthographic effect was not only localized in the frontal and temporal-parietal regions for phonological processing, but also in the posterior visual cortex for orthographic processing, while the homophone density effect was found in middle temporal gyrus for lexical-semantic selection, and in the temporal-occipital junction for orthographic processing. These results suggest that orthographic information not only shapes the nature of phonological representations, but may also be activated during on-line spoken word recognition.

Anti-apoptotic and anti-glycative effects of asiatic acid in the brain of D-galactose treated mice.

Protection of asiatic acid (AA) in mice brain against D-galactose (DG) induced aging was examined. AA at 5, 10 or 20 mg kg(-1) per day was supplied to DG treated mice for 8 weeks. AA intake at 10 or 20 mg kg(-1) per day increased its deposit in brain. DG treatment increased Bax, cleaved caspase-3 protein expression and decreased Bcl-2 expression. AA intake at 10 and 20 mg kg(-1) per day declined Bax, cleaved caspase-3 expression, and retained Bcl-2 expression. DG treatment decreased brain glutathione content and glutathione peroxidase activity; increased brain reactive oxygen species and protein carbonyl levels, and enhanced NAPDH oxidase expression. AA intake at test doses reversed these changes. DG treatment up-regulated the expression of advanced glycation end product (AGE), carboxymethyllysine, receptor of AGE (RAGE), mitogen-activated protein kinases and CD11b as well as increasing the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha release in the brain. AA intake at 5, 10 and 20 mg kg(-1) per day lowered AGE and carboxymethyllysine expression, and at 10 and 20 mg kg(-1) per day reduced RAGE production. AA intake dose-dependently suppressed p-p38 expression and lowered IL-6 and TNF-alpha levels, and at 10 and 20 mg kg(-1) per day down-regulated p-JNK and CD11b expression. DG treatment declined brain-derived neurotropic factor (BDNF) expression and raised glial fibrillary acidic protein (GFAP) expression. AA intake at 20 mg kg(-1) per day retained BDNF expression and at 10 and 20 mg kg(-1) per day reduced GFAP expression. These findings indicated that the supplement of asiatic acid might be beneficial to the prevention or alleviation of brain aging.

The Malnutrition Universal Screening Tool (MUST) and a nutrition education program for high risk cancer patients: strategies to improve dietary intake in cancer patients.

Four hundred and forty-four high-risk oncology patients with malnutrition participated in this study aimed at assessing the effectiveness of nutrition education on improving an oncology patient's dietary intake. We used a nutritional risk screening to select oncology patients in need of nutritional care. Team Nutrition provides technical assistance for foodservice, nutrition education for patients and their caregivers, and support for healthy eating and physical activity to improve their diets and their lives. The average contribution of protein and total energy of each patient increased after imparting the nutritional education to them. Thus, nutritional education is an effective measure to bring about a favorable and significant change in oncology patients' nutrient intake.