Chinese herbal medicine might be associated with a lower rate of joint replacement in patients with osteoarthritis: A 12-year population-based matched cohort analysis.

ETHNOPHARMACOLOGICAL RELEVANCE: To determine whether adjuvant Chinese herbal medicine (CHM) treatment is associated with the risk of joint replacement in osteoarthritis (OA) patients. MATERIALS AND METHODS: This retrospective study used a population-based national health insurance (NHI) database from 2000 to 2012 in Taiwan. A total of 125,023 newly diagnosed OA patients were selected from one million beneficiaries of longitudinal health insurance database. Based on applying ten selected frequently used CHM formulas for OA, patients were divided into CHM user and non-CHM user. One-CHM to four-non-CHM user were propensity score matched with age, gender, monthly income, urbanization, comorbidities, Nonsteroidal anti-inflammatory drugs (NSAIDs) and index year were adjusted to reduce selection bias and confounding. Cox regression model was used for comparing the hazard ratios (HR) for the risk of joint replacement and Kaplan-Meier curve for the proportion of joint replacement. RESULTS: OA patients who were female, younger (20-60 years), higher income and lived in urbanization location were found to preferred using CHM. Younger CHM users had a lower adjusted HR (0.63) of the risk of joint replacement (95% confidence interval (CI) = 0.42-0.94). Compared to non-CHM user, HR among CHM users (≥225 days annually) is 0.48 (95% CI = 0.31-0.76). The proportion of joint replacement in younger non-CHM user began to rise notably with time (log-rank test, p = 0.026). However, this benefit by CHM did not apply to older (over 60 years) OA patients. CONCLUSION: This study suggested that adjuvant CHM might be associated with a lower rate of joint replacement in OA patients. CHM therapy might be considered in OA patients to reduce the need of joint replacement.

Effects of Chinese Mind-Body Exercises on Executive Function in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis.

Chinese mind-body exercises (CMBEs) are positively associated with executive function (EF), but their effects on EF, from synthesized evidence using systematic and meta-analytic reviews, have not been conducted. Therefore, the present systematic review with meta-analysis attempted to determine whether CMBEs affect EF and its sub-domains, as well as how exercise, sample, and study characteristics moderate the causal relationship between CMBEs and EF in middle-aged and older adults. Seven electronic databases were searched for relevant studies published from the inception of each database through June 2020 (PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Wanfang, China National Knowledge Infrastructure, and Weipu). Randomized controlled trials with at least one outcome measure of CMBEs on EF in adults of mean age ≥ 50 years with intact cognition or mild cognitive impairment (MCI) and with or without chronic diseases were included. A total of 29 studies (N = 2,934) ultimately were included in this study. The results indicated that CMBEs improved overall EF (Standardized Mean Differences = 0.28, 95% CI 0.12, 0.44), as well as its sub-domains of working memory and shifting. The beneficial effects of CMBEs on EF occurred regardless of type (Tai Chi, Qigong), frequency of group classes (≤2 time, 3-4 time, ≥5 times), session time (≤45 min, 46-60 min), total training time (≥150 to ≤300 min, >300 min), and length of the CMBEs (4-12 week, 13-26 week, and >26 week), in addition to that more frequent participation in both group classes and home practice sessions (≥5 times per week) resulted in more beneficial effects. The positive effects of CMBEs on EF were also demonstrated, regardless of participants mean age (50-65 years old, >65 years old), sex (only female, both), and cognitive statuses (normal, MCI, not mentioned), health status (with chronic disease, without chronic disease), as well as training mode (group class, group class plus home practice) and study language (English, Chinese). This review thus suggests that CMBEs can be used as an effective method with small to moderate and positive effects in enhancing EF, and that more frequent group classes and home practice sessions may increase these effects. However, certain limitations, including strictly design studies, limited ES (effect size) samples for specific variables, and possible biased publications, required paying particular attention to, for further exploring the effects of CMBEs on EF.

Mindfulness Training Enhances Endurance Performance and Executive Functions in Athletes: An Event-Related Potential Study.

Mindfulness interventions have been linked to improved sport performance and executive functions; however, few studies have explored the effects of mindfulness on sport performance and executive functions simultaneously. This study sought to examine whether a mindfulness training program would affect both the endurance performance and executive functions of athletes. In addition, event-related potentials (ERPs) associated with the Stroop task were assessed to investigate the potential electrophysiological activation associated with the mindfulness training. Applying a quasiexperimental design, forty-six university athletes were recruited and assigned into a five-week mindfulness training program or a waiting list control group. For each participant, the mindfulness level, endurance performance assessed by a graded exercise test, executive functions assessed via Stroop task, and N2 component of ERPs were measured prior to and following the 5-week intervention. After adjusting for the preintervention scores as a covariate, it was found that the postintervention mindfulness level, exhaustion time, and Stroop task accuracy scores, regardless of task condition, of the mindfulness group were higher than those of the control group. The mindfulness group also exhibited a smaller N2 amplitude than the control group. These results suggest that the five-week mindfulness program can enhance the mindfulness level, endurance performance, and multiple cognitive functions, including executive functions, of university athletes. Mindfulness training may also reduce conflict monitoring in neural processes.

Botulinum Toxin Injection to Treat Masticatory Movement Disorder Corrected Mandibular Asymmetry in a Growing Patient.

An 8-year-old girl with masticatory movement disorder received botulinum toxin-A (BTX-A) injection and orthodontic treatment. She showed facial asymmetry with right masseter muscle hyperplasia. After BTX-A injection combined with orthodontic treatment, the transverse discrepancy between right and left maxillary dentition completely corrected. Cone-beam computed tomography images revealed that the height of the left mandibular ramus had increased by 2.3 mm, considerably more than on the right side, the discrepancy in mandibular ramus height between the left and the right decreased dramatically. In a short period, BTX-A injection combined with orthodontic treatment corrected a mandibular movement disorder with asymmetric mandibular growth in a growing patient.

Chronic intermittent hypoxia stimulates testosterone production in rat Leydig cells.

AIMS: The hypoxia-stimulated response of the endocrine system depends on the kind and duration of hypoxia. Hypoxia has been reported to stimulate testosterone (T) production in rats, but the mechanisms remain to be investigated. MATERIALS AND METHODS: Male rats were divided into two groups. The rats exposed to chronic intermittent hypoxia (CIH) at 8 h/day were housed in a hypoxic chamber (12% O2) for 14 days. Normoxic rats were used as control animals. T was measured after challenging the rat Leydig cells (LCs) with different stimulators, including hCG (0.01 IU/ml), forskolin (10-5 M), 8-bromo-cAMP (10-4 M), A23187 (10-5 M), cyclopiazonic acid (10-4 M), and androstenedione (10-8 M). Meanwhile, the LCs were incubated with trilostane (10-5 M) and/or 25-OH-hydroxycholesterol (10-5 M); thereafter the media were collected for pregnenolone assay. KEY FINDINGS: In the CIH group, plasma T levels were increased, but the serum luteinizing hormone (LH) was decreased. Furthermore, at several time intervals after hCG injection, plasma T levels were higher in the CIH group. The evoked-release of T and pregnenolone were significantly increased in the CIH group. Compared with the normoxic group, the CIH group had higher mRNA and protein expression levels of the LH receptor and CYP11A1 but not StAR. The plasma and testicular microvasculature VEGF levels were increased in the CIH group. The testicular vessel distribution was more obvious in CIH rats. SIGNIFICANCE: CIH-induced T secretion might be partially mediated by mechanisms involving the induction of LH receptor expression, testicular angiogenesis, CYP11A1 activity, 17ß-HSD activity, and calcium-related pathway.

The effects of negative air ions on cognitive function: an event-related potential (ERP) study.

This study investigated the effects of negative air ions (NAIs) on cognitive function in young male adults, specifically examined whether NAIs could influence the behavioral and neuroelectrical indices of inhibition. Thirty-nine young adults participated in the NAI and the control sessions in a counterbalanced order. A computerized Stroop color-word test was administrated, and N2 of the event-related potential was recorded and then analyzed. The results revealed that participants in the NAI session demonstrated shorter reaction times and higher accuracy for both Stroop congruent and incongruent trials. Larger N2 amplitudes were also observed in the NAI session than in the control session, whereas no alterations in the latencies were found. These findings suggest that NAIs resulted in a general improvement in both basic information processing and inhibition. This facilitation may be related to an enhanced neuronal processing or alertness status reflected by larger amplitudes of the N2 component.

Dose-Response Relationship between Exercise Duration and Executive Function in Older Adults.

This study aimed to determine the dose-response relationship between exercise duration and task switching in older adults. Acute moderate intensity aerobic exercise for 20 min resulted in shorter response times than control and 10-min sessions in the heterogeneous, non-switch, and switch conditions, but not in the homogeneous condition. Additionally, linear and cubic trends between exercise duration and global switching performance as well as local switching performance were revealed with faster times being predicted by longer duration exercise; however, the cubic relationship resulted in performance following the 45-min session being not significantly different from the other three sessions. Acute aerobic moderate intensity exercise for 20 min is an effective duration to improve task switching. Although a longer duration of exercise is not optimal for benefiting task switching, it does not harm task switching in older adults and hence may be of value for other health-related reasons.

Utilization of traditional Chinese medicine in patients treated for depression: a population-based study in Taiwan.

OBJECTIVES: Traditional Chinese medicine (TCM) has been used to treat depression-like symptoms in Taiwan. We aim to examine factors associated with utilization of TCM in patients with depression and to test whether the use of TCM would impact the use of psychiatric services with a subsequent impact on healthcare costs. METHODS: Adult patients (n = 216,557) who received antidepressant treatment for depression in 2003 was identified in the National Health Insurance Research Database in Taiwan. A Two-Part model was conducted. A multivariate logistic regression was employed to explore factors associated with the use of TCM, with a particular focus on baseline comorbidities, painful physical symptoms (PPS), and frequency of psychiatric service contacts over the ensuing 12-month study period. Multivariate generalized linear modeling was then applied to examine factors associated with healthcare costs for TCM users. RESULTS: More than 40% of individuals prescribed with antidepressant treatments for depression used TCM services. Younger age, female gender, the presence of certain comorbid mental/physical illnesses or PPS, as well as having fewer psychiatric service contacts were found to be associated with the use of TCM services. These factors also affected TCM costs for users; the TCM costs equaled to 30% of costs of psychiatric out-patient services for TCM users. CONCLUSIONS: The current study suggested a set of significant factors which could influence use and cost of TCM services for patients with depression. Utilization of TCM services could have a substantial impact on use of psychiatric services and healthcare costs for patients with depression.

Aging effects on exercise-induced alternations in plasma acylated ghrelin and leptin in male rats.

Ghrelin and exercise have been known to stimulate the release of growth hormone which is related to the glucose metabolism. However, the age effects of exercise on ghrelin in energy consumption remain unclear. Young (3 month old) and middle-aged (12 month old) Sprague-Dawley male rats were overnight fasted, and then randomly partitioned into exercise and control groups. Exercise groups swam for 20 min in 25°C water. Rats immersed in 25°C water for 20 min were used as control animals. All blood samples were collected before and 10, 20, 30, and 60 min after initiation of exercise via the right jugular vein. Our results indicated that the swimming regimen decreased the secretion of acylated ghrelin and insulin, but increased the secretion of leptin, lactate, and glucose. In addition, exercise significantly amplified the inverse correlation between leptin and acylated ghrelin (r < -0.6) in middle-age group. Both the above findings were not emphasized in related articles before. Moreover, the time courses of these changes were slightly different in young and middle-aged rats. In basal metabolic characteristics, body weight and the plasma lactate, glucose, insulin, and leptin are higher in middle-age group than that in young group. In conclusion, compared with young rats, middle-aged rats have higher basal body weight, plasma glucose, insulin, and leptin, but age had no effect on the level of plasma acylated ghrelin. A 20-min exercise regimen decreased acylated ghrelin and increased leptin with inverse correlation between them which was strengthened during exercise, but were not influenced by age.

Acute effect of exercise-hypoxia challenge on GLUT4 protein expression in rat cardiac muscle.

Altitude training is a frequently used method for enhancing endurance performance in athletes. But its acute effect on carbohydrate metabolism in cardiac muscle is unknown. In this study, we determined the acute effect of an exercise-hypoxia challenge on glycogen storage and GLUT4 protein expression in heart muscle. Sixteen male Sprague-Dawley rats were assigned to one of two groups: control (CTRL) and exercise-hypoxia (EX+HY). The exercise protocol consisted of swimming for 180 min twice, with a 45-min rest interval. Five hours after the exercise, the EX+HY rats were exposed to a 14% O(2) systemic hypoxia under normobaric condition for 12 h. After this hypoxia exposure, the EX+HY and control rats were given glucose orally (1 g/kg body weight) with stomach tube and recovered under normal condition for 16 h. Ventricular portion of the heart was used to determine the levels of glycogen, GLUT4 mRNA, and GLUT4 protein after recovery. We found that myocardial glycogen level was lowered by the exercise-hypoxia challenge (51% below control, p < 0.05), while GLUT4 mRNA was dramatically elevated (approximately 400% of the control level, p < 0.05). The acute exercise-hypoxia treatment did not affect GLUT1 protein level in the same tissue. The novel finding of the study was that the exercise-hypoxia treatment significantly induced GLUT4 gene expression in the cardiac muscle. This acute response appears to be associated with a sustained glycogen depletion of the muscle.

Interactive effect of an acute bout of resistance exercise and dehydroepiandrosterone administration on glucose tolerance and serum lipids in middle-aged women.

The present study determined the interactive effect of an acute bout of resistance exercise and dehydroepiandrosterone (DHEA) administration on glucose tolerance and serum lipids. Twenty middle-aged female subjects performed an acute bout of resistance exercise and were subsequently divided into two groups: placebo (age 40.7 +/- 2.0) and DHEA administered (age 39.0 +/- 2.7). Ten subjects who received DHEA (age 41.5 +/- 4.6) participated in a non-exercise control. DHEA (25 mg twice daily) or placebo was orally supplemented for 48 hours. Before exercise and 48 hours after the last exercise bout (14 hours after the last DHEA intake), an oral glucose tolerance test and an insulin concentration were determined. Levels of fasting serum cholesterol and triglyceride, tumor necrosis factor-alpha (TNF-alpha), creatine kinase (CK) were also measured. The DHEA administration significantly elevated the fasting dehydroepiandrosterone sulfate (DHEA-S) level by approximately 3-fold. Both acute resistance exercise and DHEA administration improved glucose tolerance, but no addictive effect was found. Furthermore, exercise and DHEA administration did not affect serum triglyceride and cholesterol levels, but both lipids were significantly lowered when DHEA was given following exercise. Resistance exercise induced elevations in serum CK and TNFalpha levels, but these increases were attenuated by the DHEA administration. The new finding of this study was that post-exercise DHEA administration decreased serum triglycerides and cholesterol. This effect appeared to be associated with its TNF-alpha lowering action.

Characteristics of glycemic control in elite power and endurance athletes.

A previous study has shown that former elite power athletes exhibited significantly greater relative risk in diabetes than that of former elite endurance athletes. It is unknown whether insulin sensitivity in elite young healthy power athletes is lower than that in elite young endurance athletes. This study includes two parts, part I and part II. In the part I of this study, an oral glucose tolerance test was performed in all of the elite juvenile track athlete subjects, specializing either in short-distance racing (jSD, N = 13, aged 12.5 +/- 0.37 years) or in long-distance racing (jLD, N = 13, aged 12.6 +/- 0.42 years). In the part II of this study, we recruited elite adult swimmers and divided them into two groups according to their specialty in swimming race distance: long-distance (aLD, N = 10, age 20.3 +/- 1.32) and short-distance groups (aSD, N = 10, age 20.2 +/- 1.31). Insulin sensitivity was significantly lower in the jSD group than that in the jLD group, as indicated by the area under the curves of insulin and glucose following a 75-g oral glucose load. Fasting plasma LDL-C and total cholesterol levels in the jSD group were significantly greater than those in the jLD group. The result of the part II of this study, similar to the result of the part I, shows that insulin sensitivity in aSD swimmers was significantly lower than that in aLD swimmers. LDL-C, total cholesterol, and triglyceride levels were also found higher in aSD swimmers than in those of aLD swimmers. These new findings implicate that the genetic makeup associated with exceptional power or endurance performance of elite athletes could also reflect on their metabolic characteristics; elite power athletes appear to be more insulin resistant than elite endurance athletes.

Effect of prolonged intermittent hypoxia and exercise training on glucose tolerance and muscle GLUT4 protein expression in rats.

We compared the chronic effect of intermittent hypoxia and endurance training on the glucose tolerance and GLUT4 protein expression in rat skeletal muscle. Thirty-two Sprague-Dawley rats were matched for weight and assigned to one of the following four groups: control, endurance training, hypoxia, or hypoxia followed by endurance training. Hypoxic treatment consisted of breathing 14% O2 for 12 h/day under normobaric conditions, and the training protocol consisted of making animals swim 2 times for 3 h/day. At the end of the 3rd week, an oral glucose tolerance test (OGTT) was performed 16 h after treatments. At the end of the 4th week, GLUT4 protein, mRNA, and glycogen storage in skeletal muscle were determined. Endurance training significantly improved OGTT results. Glycogen content and GLUT4 protein expression in the plantaris and red gastrocnemius, but not in the soleus or white gastrocnemius muscles, were also elevated. Chronic intermittent hypoxia also improved OGTT results, but did not alter GLUT4 protein expression. Additionally, hypoxia followed by exercise training produced significant increases in GLUT4 protein and mRNA in a greater number of muscles compared to endurance training alone. Both exercise training and hypoxia significantly reduced body mass, and an additive effect of both treatments was found. In conclusion, chronic intermittent hypoxia improved glucose tolerance in the absence of increased GLUT4 protein expression. This treatment facilitated the exercise training effect on muscle GLUT4 expression and glycogen storage. These new findings open the possibility of utilizing intermittent hypoxia, with or without exercise training, for the prevention and clinical treatment of type 2 diabetes or insulin resistance.

Effect of systemic hypoxia on GLUT4 protein expression in exercised rat heart.

Altitude training is a common method used to enhance endurance performance in athletes. We have examined the interactive effect of exercise training and chronic hypoxic on glycogen storage and GLUT4 protein expression in cardiac muscles. Thirty-two male Sprague-Dawley rats were weight balanced and assigned to one of the following four groups: control, exercise, hypoxia, and hypoxia-exercise. Rats with hypoxic treatment (breathing 14% O(2) for 12 hr/d) were exposed under normobaric conditions. The training protocol consisted of swimming for two 3-hr periods per day for 4 weeks. Glycogen content, GLUT4 protein, and mRNA of all rats were determined 16 hr after treatments. Four-week exercise training without hypoxia significantly elevated myocardial glycogen level by 45%. The chronic hypoxic-exercise training elevated the myocardial glycogen level by 67% above control level, significantly greater than the exercise group. Chronic hypoxia, exercise training, and hypoxia-exercise training significantly elevated GLUT4 protein by 40-70% in cardiac muscles. Chronic hypoxia significantly elevates the GLUT1 protein level independent of exercise training. The new finding in this study was that GLUT4 gene expression in cardiac muscle can be stimulated by exercise training with hypoxia treatments. This molecular adaptation appears to be associated with the observed increase in glycogen storage of the muscle.