Frailty of Prostate Cancer Patients Receiving Androgen Deprivation Therapy: A Scoping Review.

PURPOSE: This study aimed to explore the existing literature on frailty experienced by patients with prostate cancer (PC) receiving androgen deprivation therapy (ADT). MATERIALS AND METHODS: Database and manual searches were conducted to identify relevant studies published in English, with no limitation on the year of publication, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Four databases-PubMed, Cochrane Library, EMBASE, and CINAHL-were used for database searches and reference lists, related journals, and Google Scholar were used for manual searches. RESULTS: A total of 12 studies were analyzed for this scoping review. Of these, only 2 were intervention studies, and 1 was a randomized controlled trial. Among the two intervention studies, the multidisciplinary intervention program, including psychological counseling, nutritional coaching, and supervised group physical exercise did not show significant improvement in frailty. In contrast, high-dose vitamin D supplementation significantly decreased frailty. The conceptual and operational definitions of frailty used in each study varied, and the most used one was mainly focused on physical functions. As a result of analyzing the other health-related variables associated with frailty in patients with PC receiving ADT, age, metastases, comorbidities, and incident falls were related to a high frailty level. As for the physiological index, high levels of C-reactive protein, and interleukin-6, and fibrinogen, low levels of total testosterone, lymphocyte count, and creatinine were associated with a high level of frailty. A few studies explored the relationship between psychological and cognitive variables and frailty. CONCLUSIONS: Further research related to frailty in patients with PC receiving ADT should be conducted, and effective interventions to manage frailty should be developed. Additionally, research that considers not only the physical domain of frailty but also the psychological, cognitive, and social domains needs to be conducted.

Long Term Effects of a Social Capital-Based Exercise Adherence Intervention for Breast Cancer Survivors With Moderate Fatigue: A Randomized Controlled Trial.

OBJECTIVES: This study reports on the long-term effects of the Better Life After Cancer: Energy, Strength, and Support (BLESS) program, a 12-week social capital-based exercise adherence program for breast cancer survivors (BCS), implemented using a randomized controlled trial design. The study investigated outcomes related to cancer-related fatigue (CRF), quality of life (QOL), physical activity, depression, anxiety, sleep quality, and social capital. METHODS: Participants who had moderate or greater CRF were randomly assigned to the intervention (n = 24), consisting of supervised and home-based exercise, or the control (n = 26), who received exercise leaflets. Generalized estimating equations models were fitted for the outcome variables. The assessment points were baseline (M1), immediately after completing the intervention at 12 weeks (M2), 1 month (M3), and 6 months post-intervention (M4). RESULTS: A significant reduction in the total CRF score was found for both groups. We observed a significant time by group effect at M2, indicating a reduction of behavioral/severity CRF scores and a higher increase of physical activity. Also, there was an increase in the QOL score of both groups at M2, M3, and M4, compared to M1. Both groups had reduced anxiety at M3 and M4 compared to M1. The time by group effect for depression, sleep quality and social capital was not statistically significant. CONCLUSION: This 12-week exercise adherence program improved behavioral/severity CRF and physical activity post-intervention. Both the experimental group and control group showed significant improvements in CRF, QOL, and anxiety domains compared to the baseline, which extended to 6 months post-intervention. TRIAL REGISTRATION: Korean Clinical Research Information Service (KCT0005763).

A Study on 'Insul (An Art of Benevolence)': Formation of Korean Medical Ethics in Modern Korea.

"Medicine is an art of benevolence [Kr. 인술 Insul, Ch. Renshu]." This slogan is widely accepted in East Asia, and at least in South Korea, it is generally regarded as an innate medical ethic. However, the original meaning of 'In' (Ch. Ren), which means 'benevolence,' 'humanity,' or simply 'love for one another,' is a Confucian virtue emphasized by Mencius. It is unclear when this Confucian term became the representative medical ethic in South Korea. The term "medical ethic" was not coined until the 19th century in the West (Robert Baker and Laurence B. McCullough, eds. 2009). We often use the terms 'Insul,' 'affection,' 'Hippocratic Oath,' and other related concepts interchangeably, but these words come from different times and have different ideological implications (Shin 2000). This paper examines how 'Insul' has been recreated under the tensions between Western and Eastern Medicine in modern Korea. The arrival of Western medicine caused an existential crisis in traditional Korean medicine. The status of TKM doctors was demoted by the 'Uisaeng Regulation' in 1913 by the JGGK, which aimed to establish a unicameral medical system based on Western medicine. In response, the scientification of Eastern medicine became an inevitable task, and Eastern medicine had to maintain its identity while also modernizing itself to avoid being absorbed into Western medicine. Until the late Joseon period, 'Insul' was rarely used in medicine but rather for political practices. Medical practice was a peripheral way of conducting Ren, the Confucian benevolence. However, TKM rediscovered the concept during the modern era. With the Convention of Korean Uisaeng in October 1915, the TKM community actively used 'Insul' as their identity. At this convention, Governor General Terauchi Mastake used the term to mean traditional medicine and implied that without scientification, 'Insul' would be disused. This address was immediately and widely quoted in TKM journals. TKM doctors and adherents interpreted his address to mean that if they could achieve scientification of TKM, their medical ideal (Insul) would be used in the future. Soon, a number of articles on 'Insul' as a medical ethic were published in newspapers and journals. From the mid-1920s, regardless of whether the doctors practiced East or West medicine, people started to claim that only those who pursued 'Insul' were true medical personnel, and they used this as a criterion for evaluating medical doctors. The people's demand for 'Insul' influenced medicine in general, and Western doctors also linked their medical practices to 'Insul.' This is an interesting example of the localization of Western medicine in Korea. Through the rivalry relationship or interaction between East and West medicine that took place in modern Korea, 'Insul' gradually became a representative term of Korean medical ethics since the mid-1920s. The process took place gradually over a decade, and it has now become firmly established throughout medicine in Korea.

Cardiopulmonary Exercise Test With Comorbidity Index Before Allogeneic Hematopoietic Stem Cell Transplantation.

PURPOSE: To evaluate the role of the cardiopulmonary exercise test (CPET) with comorbidity index as a predictor of overall survival (OS) and non-relapse mortality (NRM) in patients with hematological malignancies who undergo allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: We retrospectively analyzed consecutive adult patients with hematological malignancies who underwent HLA-matched donor-HSCT at Chungnam National University Hospital (Daejeon, South Korea) between January 2014 and December 2020. Maximal oxygen consumption (VO2max) was classified using the recommendations of the Mayo Clinic database. RESULTS: Of 72 patients, 38 (52.8%) had VO2max values lower than the 25th percentile (VO2max ≤ 25th) of an age- and sex-matched normal population. Patients with VO2max ≤ 25th had no significant differences both OS and NRM (30 month OS 29.8% vs 41%, P = .328; and 30 month NRM 16% vs 3.3%, P = .222), compared with other patients. VO2max ≤ 25th was assigned a weight of 1 when added to the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to form a composite comorbidity/CPET index (HCT-CI/CPET). Patients with HCT-CI/CPET scores of 0 to 1 demonstrated significantly better OS and NRM than did patients with HCT-CI/CPET scores ≥2 [median OS not reached vs 6 months, P < .001 and 30 month NRM 7.4% vs 33.3%, P = .006]. An HCT-CI/CPET score ≥2 was the only adverse risk factor for NRM on multivariate analysis [hazard ratio (HR) of NRM 10.36 (95% CI 1.486-2.25, P = .018)]. CONCLUSION: The composite HCT-CI/CPET score can predict the survival and mortality of patients with hematological malignancies who undergo allogeneic HSCT.

Effects of a multimodal approach to food art therapy on people with mild cognitive impairment and mild dementia.

BACKGROUND: Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM-FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self-esteem, self-efficacy, self-expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. METHODS: The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM-FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM-FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi-structured interviews (n = 9) were conducted to evaluate the overall experience of the MM-FAT program and its outcomes. RESULTS: The findings reveal that MM-FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM-FAT program. Self-expression and self-efficacy were significantly higher in the MM-FAT group than in the control group. The semi-structured interviews revealed improvements in participants' behaviour, communication, and interaction. CONCLUSION: This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID-19 pandemic, the study was able to enrich the effects of MM-FAT on cognitive, emotional, and social functioning through qualitative findings.

What is the optimal antibiotic treatment strategy for carbapenem-resistant Acinetobacter baumannii (CRAB)? A multicentre study in Korea.

OBJECTIVES: The optimal treatment option for carbapenem-resistant Acinetobacter baumannii (CRAB) is still limited. This study investigated the efficacy of three or more antibiotic types and regimens for treatment of CRAB infection in high CRAB endemic areas. METHODS: A multicentre retrospective study was conducted to evaluate the efficacy of treatment types and regimens of CRAB infections in 10 tertiary hospitals in the Republic of Korea. The outcomes comprised 7-day and 28-day mortality, and clinical and microbiological responses at 7 days, 28 days, and the end of treatment. Nephrotoxicity and hepatotoxicity were evaluated as drug adverse reactions. RESULTS: A total of 282 patients were included in the study. Among the CRAB strains, the two most susceptible antibiotics were colistin (99.6%) and minocycline (80.4%). A combination of colistin and carbapenem significantly reduced 7-day mortality, and a sulbactam-containing regimen significantly reduced 28-day mortality. Colistin monotherapy was significantly associated with increased 7-day and 28-day mortality. A minocycline-containing regimen showed the best microbiological responses at 7 days, 28 days, and the end of treatment. Colistin and tigecycline were associated with increased nephrotoxicity and hepatotoxicity, respectively. Subgroup analysis of patients with pneumonia showed similar results to the overall CRAB infection. CONCLUSIONS: A combination of colistin and carbapenem and sulbactam-containing regimen may contribute improved mortality in CRAB infections. Colistin monotherapy should be considered cautiously in severe CRAB infections or CRAB pneumonia. A minocycline-containing regimen showed the best microbiological responses, and further studies may be needed to evaluate improved mortality.

Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: a retrospective study and in vitro activities of antimicrobial combinations.

BACKGROUND: Stenotrophomonas maltophilia causes serious infections in immunocompromised hosts. Here, we analyzed the clinical characteristics of S. maltophilia bloodstream infection (BSI) in patients with hematologic malignancies and evaluated in vitro synergistic effects of antimicrobial combinations. METHODS: We retrospectively reviewed all consecutive episodes of S. maltophilia BSIs in adult hematologic patients from June 2009 to May 2014, with in vitro susceptibility and synergy tests using high-throughput bioluminescence assay performed for available clinical isolates. RESULTS: Among 11,004 admissions during 5-year period, 31 cases were identified as S. maltophilia BSIs. The incidence rate of S. maltophilia BSI was 0.134 cases/1,000 patient-days. Overall and attributable mortality of S. maltophilia BSI was 64.5% and 38.7%, respectively. Severe neutropenia (adjusted hazard ratio [HR] 5.24, p =0.013), shock at the onset of BSI (adjusted HR 6.05, p <0.001), and pneumonia (adjusted HR 3.15, p =0.017) were independent risk factors for mortality. In vitro susceptibilities to ceftazidime, levofloxacin, ticarcillin-clavulanic acid (TIM) and trimethoprim-sulfamethoxazole (SXT) were 11.1%, 44.0%, 40.7%, and 88.9%, respectively. MIC50/MIC90 for moxifloxacin and tigecycline were 1/4 mg/L and 4/8 mg/L. The 50% and 90% fractional inhibitory concentrations (FIC(50)/FIC(90)) of clinical isolates against a combination of SXT and TIM were 0.500/0.750. For SXT plus levofloxacin or moxifloxacin, FIC(50)/FIC(90) were 0.625/1.000 and 0.625/0.625, respectively. CONCLUSION: S. maltophilia BSIs show high mortality, which is related to severe neutropenia, shock, and S. maltophilia pneumonia. Based upon drug susceptibility testing, the primary treatment of choice for S. maltophilia BSIs should be SXT in hematologic patients, rather than quinolones, with combination therapies including SXT serving as a feasible treatment option.

Impact of extended-spectrum ß-lactamase production on treatment outcomes of acute pyelonephritis caused by escherichia coli in patients without health care-associated risk factors.

Extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused by E. coli at a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3; P = 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38; P = 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65; P = 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused by E. coli showed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30; P = 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12; P = 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associated E. coli APN.

Streptomyces panaciradicis sp. nov., a ß-glucosidase-producing bacterium isolated from ginseng rhizoplane.

A Gram-staining-positive actinobacterium, designated strain 1MR-8(T), was isolated from the rhizoplane of ginseng and its taxonomic status was determined using a polyphasic approach. The isolate formed long chains of spores that were straight, cylindrical and smooth-surfaced. Strain 1MR-8(T) grew at 10-37 °C (optimum 28 °C), whilst no growth was observed at 45 °C. The pH range for growth was 4.0-11.0 (optimum pH 6.0-8.0) and the NaCl range for growth was 0-7% (w/v) with optimum growth at 1% (w/v). Strain 1MR-8(T) had cell-wall peptidoglycans based on ll-diaminopimelic acid. Glucose, mannose and ribose were the whole-cell sugars. The predominant isoprenoid quinones were MK-9 (H4), MK-9 (H6) and MK-9 (H8) and the major fatty acids were anteiso-C(15:0), iso-C(15:0), anteiso-C(17:0) and iso-C(16:0). 16S rRNA gene sequencing studies showed that the novel strain was closely related to the type strains of Streptomyces caeruleatus GIMN4(T), Streptomyces curacoi NRRL B-2901(T), Streptomyces capoamus JCM 4734(T) and Streptomyces coeruleorubidus NBRC 12761(T) with similarities of 98.8%. However, DNA-DNA relatedness, as well as physiological and biochemical analyses, showed that strain 1MR-8(T) could be differentiated from its closest phylogenetic relatives. It is proposed that this strain should be classified as a representative of a novel species of the genus Streptomyces, with the suggested name Streptomyces panaciradicis sp. nov. The type strain is 1MR-8(T) ( = KACC 17632(T) = NBRC 109811(T)).

The efficacy of non-carbapenem antibiotics for the treatment of community-onset acute pyelonephritis due to extended-spectrum ß-lactamase-producing Escherichia coli.

OBJECTIVE: Extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli has become an important cause of community-onset urinary tract infections. We aimed to evaluate the efficacy of non-carbapenem antibiotics for acute pyelonephritis (APN) due to ESBL-producing E. coli. METHODS: We conducted a retrospective cohort study of patients with community-onset APN due to ESBL-producing E. coli at a single centre in Korea from 2007 to 2013. Outcomes included both microbiological and clinical failure. To adjust for non-random assignment of antibiotics, the propensity score method of inverse probability of treatment weighting and a multivariable analysis using Cox proportional hazards modelling were employed to estimate the efficacy of non-carbapenem antibiotics as compared with carbapenems. RESULTS: Of 152 eligible patients, 85 (55.9%) received carbapenems and 67 (44.1%) received non-carbapenems. Non-carbapenem antibiotics used in this cohort included aminoglycosides (n = 30), ß-lactam/ß-lactamase inhibitors (n = 13), fluoroquinolones (n = 12) and trimethoprim/sulfamethoxazole (n = 5). Microbiological failure was observed in 16 patients receiving carbapenems (16/83, 19.3%) versus 4 patients receiving non-carbapenem (4/67, 6.0%). After weighting, the risk of microbiological failure was similar between the two groups [weighted hazard ratio (HR) 0.99; 95% CI 0.31-3.19]. In a multivariable regression analysis combined with weights, the estimate did not change (weighted adjusted HR 0.96; 95% CI 0.41-2.27). The clinical failure rate was also similar in the two groups (weighted HR 1.05; 95% CI 0.24-4.62). CONCLUSIONS: These results suggest that non-carbapenem antibiotics were as effective as carbapenems as definitive therapy for treating community-onset APN caused by ESBL-producing E. coli if they are active in vitro.

Moringa fruit inhibits LPS-induced NO/iNOS expression through suppressing the NF-κ B activation in RAW264.7 cells.

In this study, we evaluated the anti-inflammatory effects of moringa (Moringa oleifera Lam.), a natural biologically active substance, by determining its inhibitory effects on pro-inflammatory mediators in lipopolysaccharide (LPS)-stimulated macrophage RAW264.7 cells. Extracts from different parts of moringa (root, leaf, and fruit) reduced LPS-induced nitric oxide (NO) release in a dose-dependent manner. The moringa fruit extract most effectively inhibited LPS-induced NO production and levels of inducible nitric oxide synthase (iNOS). The moringa fruit extract also was shown to suppress the production of inflammatory cytokines including IL-1ß, TNF-α, and IL-6. Furthermore, moringa fruit extract inhibited the cytoplasmic degradation of I κ B -α and the nuclear translocation of p65 proteins, resulting in lower levels of NF -κ B transactivation. Collectively, the results of this study demonstrate that moringa fruit extract reduces the levels of pro-inflammatory mediators including NO , IL-1ß, TNF-α, and IL-6 via the inhibition of NF -κ B activation in RAW264.7 cells. These findings reveal, in part, the molecular basis underlying the anti-inflammatory properties of moringa fruit extract.