Effect of Muscle Energy Technique on Hamstring Flexibility: Systematic Review and Meta-Analysis.

Since 2005, there have been no systematic reviews on the effects of multiple manual therapies, including muscle energy technique (MET), on the hamstrings. Therefore, this systematic review aimed to provide clinical evidence for the effectiveness of the MET on hamstring flexibility. We queried 10 electronic databases (PubMed, EMBASE, The Cochrane Library, KISS, NDSL, KMBASE, KISTI, RISS, Dbpia, and OASIS) up to the end of March 2022. This study only included randomized controlled trials (RCTs) investigating the use of MET for the hamstring. The literature was organized using Endnote. Literature screening and data extraction were conducted by two researchers independently. The methodological quality of the included RCTs was evaluated using the Cochrane risk-of-bias tool 1.0, and the meta-analysis was performed using RevMan 5.4. In total, 949 patients from 19 RCTs were selected according to the inclusion criteria. During active knee extension tests, the efficacy between MET and other manipulations did not significantly differ. For sit and reach tests, MET groups had higher flexibility compared to stretching (MD = 1.69, 95% CI: 0.66 to 2.73, p = 0.001) and no treatment (MD = 2.02, 95% CI: 0.70 to 3.33, p = 0.003) groups. No significant differences were observed in the occurrence of adverse reactions. Overall, we found that MET is more efficacious for improving hamstring flexibility compared to stretching and having no treatment during sit and reach tests because it combines isometric contraction with stretching. Owing to clinical heterogeneity, uncertain risk of bias, and the small number of included studies, further high-quality studies should assess the effectiveness of MET.

Improving the quality of life in a breast cancer patient and caregiver: Protocol for the application of the integrative medical service model.

BACKGROUND: Patients with chronic diseases require ongoing treatment, and caregivers face financial burdens as well as psychological and physical difficulties. However, the current healthcare system does not provide adequate systems or services to address the difficulties that patients and caregivers face. PURPOSE: The purpose of this study was to conduct an observational case study in order to evaluate and improve the application of an integrative healthcare service model developed for distress management and improved quality of life in breast cancer (BC) patients and caregivers. METHOD: The integrative healthcare service model was intensively applied to a patient-caregiver pair in this observational study. This was followed by gathering feedback from participants and experts, as well as reflecting on the content of the feedback in order to improve the model further. RESULTS: This study will then modify and improve the program with feedback and provide integrative medical services to a BC patient and caregiver. CONCLUSION: This study used the BC patients' pain management and quality of life enhancement model, aiming to provide basic data for the establishment of a healthcare service system for patients suffering from chronic pain due to diseases such as BC by systematically integrating previously applied interventions into the current healthcare system and soliciting feedback from patients and caregivers.

The efficacy, effectiveness, and safety of Kyung-ok-ko: A narrative review.

Kyung-ok-ko (KOK), a traditional medicinal formula in East Asia, has been recently studied across various fields. However, comprehensive reviews of clinical applications of KOK targeting clinical and experimental studies are lacking. Therefore, the application of KOK is being limited to the range of tonic medicines. To overcome this limitation, we aim to investigate the effectiveness, mechanism, and safety of KOK to obtain evidence regarding its effects in clinical applications. We searched for clinical and experimental articles in 11 databases (PubMed, Cochrane Library, Excerpta Medica dataBASE, China National Knowledge Infrastructure, Google Scholar, Research Information Sharing Service, Oriental Medicine Advanced Searching Integrated System, Koreanstudies Information Service System, Korean Medical Database, DBpia, and ScienceON). We selected 54 studies based on the inclusion criteria. Three clinical studies used KOK for a consumptive disease and health promotion. Fifty-one experimental studies reported the antioxidant activity, neuroprotective activity, anticancer effect, anti-inflammatory activity, immunological activity, growth promotion, impacts on cardiovascular system diseases, gastrointestinal system diseases, respiratory system diseases, and metabolic bone disease, hepatoprotective function, and antifatigue function of KOK, which were considered effective and safe in consumptive, chronic, metabolic, inflammatory, and immune diseases. We identified the effectiveness of KOK in the treatment of a wide range of diseases. However, further clinical studies are warranted in the future.

Comparison of efficacy between palonosetron-midazolam combination and palonosetron alone for prevention of postoperative nausea and vomiting in patients undergoing breast surgery and patient controlled analgesia: A prospective, randomized, double-blind study: A CONSORT-compliant study.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complaint in patients following general anesthesia. Various antiemetics, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, are effective but still have limited efficacy. Therefore, combination therapy is preferable to using a single drug alone in high-risk patients. We performed a comparative study on the antiemetic effect of palonosetron, a 5-HT3 receptor antagonist, monotherapy vs palonosetron-midazolam combination therapy for the prevention of PONV. METHODS: A total of 104 female patients scheduled for breast cancer surgery were enrolled. They were randomly divided into 2 groups, a palonosetron monotherapy group (group P) and palonosetron-midazolam combination therapy group (group PM). Both groups received 0.075 mg palonosetron intravenously after induction of anesthesia. Patient-controlled analgesia (PCA) was applied according to the allocated group. Intravenous (IV)-PCA in group P consisted of fentanyl 20 µg/kg plus normal saline (total volume: 100 ml); IV-PCA in group PM consisted of fentanyl 20 µg/kg plus midazolam 4 mg plus normal saline (total volume: 100 ml). Efficacy parameters were collected during 0 to 1, 1 to 6, 6 to 24, and 24 to 48 hours postoperative time intervals. These measures included complete response (defined as no PONV and no rescue anti-emetic use) rate, incidence of PONV, sedation score, rescue antiemetic use, rescue analgesic use, and numerical rating scale (NRS) for pain. The complete response rate during the 0 to 24 hours interval was analyzed as the primary outcome. RESULTS: Although the complete response rate between 0 and 24 hours was higher in group PM (42.3% and 48.1% in group P and PM, respectively), there was no statistically significant difference (P = .55). The complete response rates in other time intervals were not different between the 2 groups as well. The sedation score and NRS score also showed no differences between the 2 groups. CONCLUSIONS: The combination therapy of palonosetron with midazolam did not lead to a greater reduction in the incidence of PONV than monotherapy in patients undergoing breast surgery and receiving IV-PCA containing fentanyl.

Novel GFP expression using a short N-terminal polypeptide through the defined twin-arginine translocation (Tat) pathway.

Escherichia coli is frequently used as a convenient host organism for soluble recombinant protein expression. However, additional strategies are needed for proteins with complex folding characteristics. Here, we suggested that the acidic, neutral, and alkaline isoelectric point (pI) range curves correspond to the channels of the E. coli type-II cytoplasmic membrane translocation (periplasmic translocation) pathways of twin-arginine translocation (Tat), Yid, and general secretory pathway (Sec), respectively, for unfolded and folded target proteins by examining the characteristic pI values of the N-termini of the signal sequences or the leader sequences, matching with the known diameter of the translocation channels, and analyzing the N-terminal pI value of the signal sequences of the Tat substrates. To confirm these proposed translocation pathways, we investigated the soluble expression of the folded green fluorescent protein (GFP) with short N-terminal polypeptides exhibiting pI and hydrophilicity separately or collectively. This, in turn, revealed the existence of an anchor function with a specific directionality based on the N-terminal pI value (termed as N-terminal pI-specific directionality) and distinguished the presence of the E. coli type-II cytoplasmic membrane translocation pathways of Tat, Yid, and Sec for the unfolded and folded target proteins. We concluded that the pI value and hydrophilicity of the short N-terminal polypeptide, and the total translational efficiency of the target proteins based on the ΔGRNA value of the N-terminal coding regions are important factors for promoting more efficient translocation (secretion) through the largest diameter of the Tat channel. These results show that the short N-terminal polypeptide could substitute for the Tat signal sequence with improved efficiency.

PoCRIP1, Paralichthys olivaceus cysteine-rich intestinal protein 1: molecular characterization, expression analysis upon Edwardsiella tarda challenge and a possible role in the immune regulation.

Cysteine-rich intestinal protein (CRIP) is a LIM domain protein containing a zinc-finger motif and plays a role in the regulation of the inflammatory immune response. In the present study, we isolated a CRIP1 cDNA, designated PoCRIP1, from an olive flounder Paralichthys olivaceus intestine cDNA library by EST analysis. The PoCRIP cDNA consists of 421 bp with a polyadenylation signal sequence, AATAAA, and a poly(A) tail; it encodes a polypeptide of 76 amino acids containing a double zinc-finger motif (Cys(2)HisCys and Cys(4) sequences). The deduced amino acid sequence of PoCRIP1 showed 75.3-94.7% homology with CRIP1s of other species, including mammals. The PoCRIP1 transcript was highly expressed in the intestine and pyloric ceca and moderately expressed in the gill, heart, kidney, liver, muscle, spleen, skin, and stomach of normal conditioned flounder. Inducible expression of the PoCRIP1 transcript was observed in flounder challenged with Edwardsiella tarda, an economically important pathogen for aquaculture of flounder. Over-expression of PoCRIP1 augmented p65-driven flounder IL-6 promoter activity in HINAE cells. These results suggest that PoCRIP1 may function in the immune response of the flounder through the regulation of cytokine expression.

Phase II study of erlotinib for chemotherapy-naïve patients with advanced or metastatic non-small cell lung cancer who are ineligible for platinum doublets.

PURPOSE: This phase II study evaluated efficacy of single-agent erlotinib for chemotherapy-naïve patients with advanced/metastatic NSCLC who were ineligible for platinum doublets. METHODS: Chemotherapy-naive patients but ineligible for platinum doublets (aged 18-75 with an ECOG performance status [PS] 2-3; or aged 76 or older with an ECOG PS 1-3) were enrolled and treated with erlotinib 100 mg once daily till disease progression, unacceptable toxicity or patient's refusal. RESULTS: Out of 24 patients enrolled, 5 reached a PR, giving an overall response rate of 21%, but all responders were never-smokers with adenocarcinoma. According to EGFR mutation status, PR was observed in two of three patients having mutant EGFR (67%) but in one of nine having wild-type EGFR (11%). With a median follow-up of 22.6 months, the median progression-free and overall survival was 1.5 months and 3.2 months, respectively. All responders to post-erlotinib chemotherapy had responded to prior erlotinib. CONCLUSIONS: For unselected chemotherapy-naïve Asian patients with NSCLC but ineligible for platinum doublets, empirical use of upfront erlotinib could not be recommended because of poor survival outcome. However, this can be given to selected subsets based on molecular or clinical predictors.

N-terminal pI determines the solubility of a recombinant protein lacking an internal transmembrane-like domain in E. coli.

We examined whether the isoelectric point (pI) of the Nterminal region of the recombinant protein 7xMefp1 acts as a universal index for expression of the protein in soluble form in E. coli. Expression analysis of 7xMefp1 fused to various N-terminal sequences with pI values ranging from 2.73 to 13.35 yielded three pI range-specific curves (acidic, neutral, and alkaline curves at pI 2.73-3.25, 4.61-9.58, and 9.90-13.35, respectively) for soluble expression (by facilitated diffusion) as a proportion of total protein. For neutral N-termini (pI 4.61-9.58), the total amount of rMefp1 expressed was minimally affected by DeltaG(RNA) for unfolding the mRNA secondary structure. The highly hydrophilic nature of longer N-terminal sequences with strongly acidic and alkaline pI values reduced the translation of rMefp1-encoding transcripts, thereby reducing the amount of soluble rMefp1 produced. After characterizing both feedback and non-feedback regulation in the acidic, alkaline, and neutral pI ranges, we suggest that three different pI range-specific soluble expression curves exist for the recombinant protein, each defined by specific ranges of the leader sequence pI values.

Soluble expression of recombinant olive flounder hepcidin I using a novel secretion enhancer.

Expression of olive flounder hepcidin I (HepI) fused with truncated OmpA signal peptides (OmpASP(tr)) as directional signals does not produce soluble fusion proteins. However, by inserting amino acid segments (xxx) varying in pI and hydrophobicity/hydrophilicity into a leader sequence containing a truncated OmpASP (OmpASP(tr)) and a factor Xa cleavage site (Xa) [OmpASP(tr)|(xxx)|Xa], we were able in some cases to express soluble recombinant HepI. Soluble expression of the recombinant protein strongly correlated with (xxx) insertions of high pI and hydrophilicity. Therefore, we modified the OmpASP(tr)|(xxx)|Xa sequence by inserting Arg and Lys into (xxx) to increase the hydrophilicity of the signal peptide region. These modifications enhanced the expression of soluble recombinant HepI. Hydropathic profile analysis of the OmpASP(tr)|(xxx)|Xa| HepI fusion proteins revealed that the transmembrane-like domains derived from the OmpASP(tr)|(xxx)|Xa sequence were larger than the internal positively charged domain native to HepI. It should therefore be possible to overcome the obstacle of internal positively charged domains to obtain soluble expression of recombinant proteins by monitoring the hydrophilicity and hydropathic profile of the signal peptide region using a computer program.

A novel expression system for recombinant marine mussel adhesive protein Mefp1 using a truncated OmpA signal peptide.

To express an increased level of recombinant Mefp1 (marine mussel adhesive protein) in soluble form, we constructed expression vectors encoding truncated OmpA signal peptide-Mefp1 fusion proteins. OmpA signal peptide (OmpASP) is the 21 residue peptide fragment of the 23 residue OmpA signal sequence cleavable by signal peptidase I. We successfully produced increased levels of soluble recombinant Mefp1 (rMefp1) with various deletions of OmpASP, and found that the increased expression was caused by the increased pI of the N-terminus of the fusion proteins (> or = 10.55). All the OmpA signal peptide segments of 3-21 amino acids in length had the same pI value (10.55). Our results suggest that the pI value of the truncated OmpASP (OmpASP(tr)) play an important role in directional signaling for the fusion protein, but we found no evidence for the presence of a secretion enhancer in OmpASP. For practical applications, we increased the expression of soluble rMefp1 with OmpASP(tr) peptides as directional signals, and obtained rMefp1 with the native amino terminus (nN-rMefp1) using an OmpASP(tr)| Xa leader sequence that contains the recognition site for Xa protease.