Effect of Antioxidant Supplementation on Macular Pigment Optical Density and Visual Functions: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Antioxidants are bioactive molecules that function to scavenge free radicals and balance oxidative stress. Although all antioxidants can act as reactive oxygen species scavengers, their efficacy on eye health may vary. Moreover, the comparative effectiveness and potential additive effect between groups of antioxidants, hitherto, have not been systematically studied. A systematic review and network meta-analysis were conducted to investigate the comparative or additive effect of dietary antioxidant supplements on eye health. Four databases (PubMed, Embase, CINAHL, and Cochrane) were searched, and relevant randomized controlled trials were identified. Out of 60 articles selected for systematic review, 38 were included in the network meta-analysis, categorized into 8 distinct antioxidant-supplemented groups and placebo. All groups significantly increased macular pigment optical density and contrast sensitivity at low spatial frequency, whereas only the antioxidant mixture + lutein (L) + fatty acid combination exhibited significant improvements in visual acuity (hazard ratio = -0.15; 95% confidence interval: -0.28, -0.02) and L + zeaxanthin combination for photostress recovery time (hazard ratio = -5.75; 95% confidence interval: -8.80, -1.70). Especially, the L + zeaxanthin + fatty acid combination was ranked best for macular pigment optical density (surface under the cumulative ranking: 99.3%) and second best for contrast sensitivity at low spatial frequency (67.7%). However, these findings should be interpreted with caution due to low quality of evidence, primarily influenced by indirectness and potential publication bias. Overall, antioxidant supplementation was estimated to improve eye health parameters on average, whereas different combinations of antioxidants may also have varying effects on improving visual health from multiple perspectives. This study was registered at PROSPERO as CRD42022369250.

Factors Associated With Achieving Complete Skin Clearance Compared to Almost Complete Skin Clearance in Patients With Moderate to Severe Psoriasis Treated With Biologics: A Retrospective Chart Review

BACKGROUND

Biologics have demonstrated high efficacy in achieving 'almost complete' skin clearance in patients with moderate to severe psoriasis. Nonetheless, achieving 'complete' skin clearance remains a treatment goal for some highly biologics-resistant patients, as residual lesions impact their quality of life.

OBJECTIVE

The risk factors for failure to achieve a Psoriasis Area and Severity Index (PASI) 100 response in patients with good response to biologics remain unknown.

METHODS

This retrospective study evaluated the risk factors by comparing patients who achieved complete skin clearance (PASI100) with those who achieved almost complete skin clearance (PASI90). A database of 131 psoriasis patients treated with biologics, who achieved a PASI90 or PASI100 response, was reviewed from a tertiary referral hospital in South Korea. The patients were classified into PASI90 and PASI100 groups according to their PASI response.

RESULTS

The PASI100 group had a lower prevalence of smoking history (adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.85; p=0.021) and psoriasis on the anterior lower legs at baseline (adjusted OR, 0.18; 95% CI, 0.03-0.99; p=0.049) than patients in the PASI90 group.

CONCLUSION

This study suggested that smoking history and psoriatic skin lesions on the anterior lower legs are considered as the risk factors for the failure to achieve a PASI100 response in psoriasis patients treated with biologics.

Facial Dermatoses Associated With Mask-Wearing in the COVID-19 Era: A Nationwide, Cross-Sectional, Multicenter, Questionnaire-based Study

BACKGROUND

Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses.

OBJECTIVE

This study investigated the impact of mask-wearing habits on facial dermatoses.

METHODS

A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea.

RESULTS

Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing.

CONCLUSION

Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

Risk of Developing Hypertension in Atopic Dermatitis Patients Receiving Long-term and Low-dose Cyclosporine: A Nationwide Population-based Cohort Study

BACKGROUND

Cyclosporine (CS) is a first-line immunosuppressive agent used to manage moderate to severe atopic dermatitis (AD). To date, the risk of developing hypertension associated with the long-term use of low-dose CS in AD patients is understudied.

OBJECTIVE

To determine the cumulative dose-dependent effect of CS on the risk of developing hypertension in patients with AD.

METHODS

A nationwide population-based retrospective cohort with 1,844,009 AD patients was built from the Korean National Health Insurance System database from 2005 to 2009. A Cox proportional-hazard regression analysis was performed according to patients' CS treatment history adjusted for potential confounders.

RESULTS

Current use of CS was associated with an increased risk of developing hypertension (adjusted hazard ratio, 4.442; 95% confidence interval, 3.761-5.247). Among the current CS users, a higher cumulative dose of CS (≥39,725 mg) or longer cumulative use of CS (≥182 days), was significantly associated with an increased risk of developing hypertension.

CONCLUSION

The incidence of CS-associated hypertension is very low when using low-dose treatment regimens for AD. However, the current use or a high cumulative dose of CS for treating patients with AD increases the risk of developing hypertension. Precaution is needed when prescribing CS for long-term treatment of AD.

The impact of 5-hydroxytryptophan supplementation on sleep quality and gut microbiota composition in older adults: A randomized controlled trial

BACKGROUND & AIMS

Sleep quality is a pivotal part of health and there is growing evidence on the association between gut microbiota composition and sleep quality. 5-Hydroxytryptophan (5-HTP) is known as a precursor of the sleep regulating neurotransmitter and hormone. However, efficacy of 5-HTP supplementation for improving sleep quality in older adults is unclear. Hence, the aim of this study is to assess the impact of 5-HTP supplementation on sleep quality and gut microbiota composition in older adults.

METHODS

This is a single-blinded, 12-week parallel randomized controlled trial. Thirty older adults (66 ± 3 years) in Singapore were randomly assigned to either consume or not consume 100 mg 5-HTP daily. Every 4 weeks, sleep quality was assessed via both subjective (Pittsburg Sleep Quality Index) and objective (actigraphy watch) measures. A global sleep score (GSS) was obtained from the PSQI, where a GSS>5 defines as poor sleeper while a GSS≤5 defines as good sleeper. Blood serotonin level, urine melatonin concentration, gut microbiota composition and stool short chain fatty acids (SCFA) content were assessed at week 0 and 12. This study was registered in clinicaltrials.gov as NCT04078724 (https://clinicaltrials.gov/ct2/show/NCT04078724).

RESULTS

5-HTP supplementation showed an overall favorable effect on certain sleep quality components and an increase in serum serotonin concentration. In particular, at week 12, not good sleepers but poor sleepers with 5-HTP supplementation were able to significantly improve subjective GSS (ΔSL5-HTP: -2.80 ± 1.10 min, p-value = 0.005). In addition, they showed an increase in microbiota diversity (Simpson5-HTP vs. SimpsonControl: 0.037 ± 0.032 a.u. vs. -0.007 ± 0.022 a.u.; pinteraction: 0.013) and relative abundance of SCFA producing bacteria in the gut.

CONCLUSIONS

5-HTP supplementation can improve certain sleep quality components in older adults and this benefit was more prominently observed in poor sleepers. 5-HTP was also able to improve the gut microbiota composition in poor sleepers.

Effects of wolfberry (Lycium barbarum) consumption on the human plasma lipidome and its association with cardiovascular disease risk factors: a randomized controlled trial of middle-aged and older adults

Background

Long-term wolfberry intake as part of a healthy dietary pattern was recognized to have beneficial vascular outcomes. Characterization of the plasma lipidome may further provide comprehensive insights into pathways underlying these cardiovascular protective effects.

Objective

We analyzed the plasma lipidome of subjects who adhered to a healthy dietary pattern either with or without wolfberry and investigated the associations between the plasma lipidomic profile and cardiovascular health-related indicators.

Methods

In this 16-week, parallel design, randomized controlled trial, middle-aged and older adults (n = 41) were provided dietary counseling and assigned to either consume or not consume 15 g of wolfberry daily. At baseline and post-intervention, plasma lipidomics was assayed, and its relationships with classical CVD risk factors, vascular health, oxidant burden, carotenoids status, body composition, and anthropometry were examined.

Results

From the plasma lipidome, 427 lipid species from 26 sub-classes were quantified. In the wolfberry and control groups, significant changes were prominent for 27 and 42 lipid species, respectively (P < 0.05 with > 0.2-fold change). Fold changes for seven lipid species were also markedly different between the two groups. Examining the relationships between the plasma lipidome and CVD-related risk factors, total cholesterol revealed a marked positive correlation with 13 ceramide species, while HDL-cholesterol which was notably increased with wolfberry consumption showed a positive correlation with 10 phosphatidylcholine species. Oxidant burden, as represented by plasma 8-isoprostanes, was also inversely associated with lipidomic triglycerides and ether-triglycerides (41 species) and directly associated with hexosylceramides (eight species) and sphingomyelins (six species). There were no differential associations with CVD risk detected between groups.

Conclusion

Characteristic alterations to the plasma lipidome were observed with healthy dietary pattern adherence and wolfberry consumption. An examination of these fluctuations suggests potential biochemical mechanisms that may mediate the antioxidant and cardiovascular protective effects of healthy dietary pattern adherence and wolfberry intake. This study was registered at clinicaltrials.gov as NCT0353584.

Utilization of Orem's Self-Care Deficit Nursing Theory in Self-Care Among Older Korean Immigrants With Diabetes in the United States

Background: Diabetes is a chronic illness and increasing among older populations. Self-care is a critical element in managing diabetes. Orem's Self-Care Deficit Nursing Theory (SCDNT) has been used and applied in nursing to explain significant self-care concepts. Although older Korean immigrants are marginalized in maintaining optimal health status and accessing adequate health services, related studies are still lacking. Utilization of Orem's SCDNT allows nurses to better understand associated factors in self-care among older Korean immigrants with diabetes. Purpose: The first aim is to explain the significant concepts of SCDNT. The second aim is to examine basic conditioning factors on self-care among older Korean immigrants with diabetes based on Orem's SCDNT. Methods: Each concept and structure of Orem's SCDNT was described with a table and figure. The 10 basic conditioning factors in self-care among older Korean immigrants with diabetes were investigated based on the previous literature and discussed in terms of Orem's SCDNT. Results: By exploring the 10 basic conditioning factors among older Korean immigrants, nurses can identify related factors in the self-care of this minority immigrant group and initiate the development of culturally tailored and age-specific nursing interventions. Implications for Nursing Practice: This study provides an understanding of related self-care factors among older Korean immigrants with diabetes. Additionally, the findings will help nurses to develop customized effective interventions and implement appropriate diabetes care for this minority group.

Consensus Report on Truncal Acne: The Korean Acne and Rosacea Society Experts Panel

BACKGROUND

More than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient.

OBJECTIVE

To establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne.

METHODS

We conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires.

RESULTS

A total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders).

CONCLUSION

Our study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.

Effect of xanthophyll-rich food and supplement intake on visual outcomes in healthy adults and those with eye disease: a systematic review, meta-analysis, and meta-regression of randomized controlled trials

CONTEXT

Xanthophyll intake is known to improve eye health; however, its benefits on visual outcomes have not been systematically studied, particularly in a population with eye diseases.

OBJECTIVE

A systematic review, meta-analysis, and meta-regression were conducted to investigate the effect of xanthophyll intake on visual outcomes, and further subgroup analysis was performed on the basis of eye disease status.

DATA SOURCES

The PubMed, Scopus, Embase, CINAHL, Cochrane, and Web of Science databases were searched, and relevant randomized controlled trials were identified.

DATA EXTRACTION

For systematic review, meta-analysis, and meta-regression, 43, 25, and 21 articles were selected, respectively.

DATA ANALYSIS

Xanthophyll intake enhanced macular pigment optical density (MPOD) for both heterochromatic flicker photometry (weighted mean difference [WMD], 0.05; 95% confidence interval [CI], 0.03-0.07) and autofluorescence imaging (WMD, 0.08; 95%CI, 0.05-0.11) measurements and decreased photostress recovery time (WMD, -2.35; 95%CI, -4.49 to -0.20). While enhancement in visual acuity logarithm of the minimum angle of resolution was observed in response to the xanthophyll-rich food and supplement intake only for patients with eye disease (WMD, -0.04; 95%CI, -0.07 to -0.01). Meta-regression showed a positive correlation between change in MPOD (heterochromatic flicker photometry) and the corresponding change in serum lutein levels (regression coefficient = 0.068; P = 0.00).

CONCLUSION

Intake of xanthophyll-rich food or supplements can improve eye health. Additional improvement in visual acuity was observed in patients with eye disease. A positive association between MPOD and serum lutein level, while absent with dietary xanthophyll intake, suggests the importance of bioavailability when examining the effect of xanthophyll on eye health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021295337.

Factors Affecting COVID-19 Incidences and Deaths of Geriatric Hospital Patients in Korea

The current retrospective study aimed to investigate the association between organizational factors and nursing staff in geriatric hospitals and coronavirus disease 2019 (COVID-19) incidences and deaths using secondary data from governments nationwide in Korea. We used data on the number of COVID-19-confirmed cases and deaths among older adults in geriatric hospitals and nursing staff levels in those hospitals. We found that when the RN level was higher than the sample mean, the number of COVID-19-confirmed cases by geriatric hospital was significantly lower (4.3%; p = 0.05) and the number of deaths by geriatric hospital was marginally significantly lower (1.4%; p = 0.05). This study presented the national description of geriatric hospitals during the COVID-19 pandemic in terms of organizational and nursing staff factors. Findings highlight the impact of nursing staff skill mix and number of geriatric hospitals during the COVID-19 pandemic in Korea. It is necessary to allocate a realistic designation of infection control staff and establish a clear standard so infection control activities in geriatric hospitals can proceed systematically. [Research in Gerontological Nursing, 16(6), 302-311.].

Reply to Finsterer et al

This letter acknowledges Finsterer and colleagues' insightful comments on pesticide use in fruits and vegetables and impact on eye health. Pesticides can harm eyes through various exposures. Adverse effects occur due to direct entry into ocular tissues, with absorption through eye components. While the potential of organic diets to reduce pesticide exposure is acknowledged, the original paper's cited studies lack clarity on whether organic diet interventions were used. Future systematic reviews comparing organic and nonorganic diets could provide further insights.

Differentiation between Chondrosarcoma and Synovial Chondromatosis of the Temporomandibular Joint Using CT and MR Imaging

BACKGROUND AND PURPOSE

Chondrosarcoma and synovial chondromatosis of the temporomandibular joint share overlapping clinical and histopathologic features. We aimed to identify CT and MR imaging features to differentiate chondrosarcoma from synovial chondromatosis of the temporomandibular joint.

MATERIALS AND METHODS

The CT and MR images of 12 and 35 patients with histopathologically confirmed chondrosarcoma and synovial chondromatosis of the temporomandibular joint, respectively, were retrospectively reviewed. Imaging features including lesion size, center, enhancement, destruction/sclerosis of surrounding bone, infiltration into the tendon of the lateral pterygoid muscle, calcification, periosteal reaction, and osteophyte formation were assessed. A comparison between chondrosarcoma and synovial chondromatosis was performed with a Student t test for quantitative variables and the Fisher exact test or linear-by-linear association test for qualitative variables. Receiver operating characteristic analysis was performed to determine the diagnostic performance for differentiation of chondrosarcoma and synovial chondromatosis based on a composite score obtained by assigning 1 point for each of 9 imaging features.

RESULTS

High-risk imaging features for chondrosarcoma were the following: lesion centered on the mandibular condyle, destruction of the mandibular condyle, no destruction/sclerosis of the articular eminence/glenoid fossa, infiltration into the tendon of the lateral pterygoid muscle, absent or stippled calcification, periosteal reaction, internal enhancement, and size of ≥30.5 mm. The best cutoff value to discriminate chondrosarcoma from synovial chondromatosis was the presence of any 4 of these high-risk imaging features, with an area under the curve of 0.986 and an accuracy of 95.8%.

CONCLUSIONS

CT and MR imaging features can distinguish chondrosarcoma from synovial chondromatosis of the temporomandibular joint with improved diagnostic performance when a subcombination of 9 imaging features is used.

Impacts of regular consumption of grapes on macular pigment accumulation in Singapore older adults: a randomized controlled trial

Background: Oxidative stress is a key risk factor for visual impairment and consuming dietary antioxidant-rich foods may help in managing visual impairments. However, a limited number of studies have investigated the effect of dietary antioxidant-rich food including grapes on eye health in older adults. Objectives: To assess the effects on macular pigment accumulation of regular consumption of grapes in Singapore older adults. Methods: This was a 16 week, double-blind, randomized, placebo-controlled trial. Thirty-four Singapore older adults were randomized into regularly consuming either 46 g day-1 of freeze-dried table grape powder (the intervention group) or the same amount of placebo powder (the control group). Macular pigment optical density (MPOD), skin carotenoid status, advanced glycation end product (AGEs) status and dietary lutein intake were assessed every 4 weeks, and plasma lutein concentration, total antioxidant capacity and total phenolic content were measured every 8 weeks. Results: A significant time effect (p = 0.007) was observed for MPOD, and this is largely attributed to the improvement in the MPOD for the intervention group, as a significant increase was observed only in this group (week 0: 0.56 ± 0.04 D.U.; week 16: 0.61 ± 0.04 D.U., p < 0.01). Additionally, a significant increase in plasma total antioxidant capacity (week 0: 0.26 ± 0.13 mM TEAC; week 16: 0.36 ± 0.20 mM TEAC, p < 0.01) and total phenolic content (week 0: 10.50 ± 0.44 mg L-1 GAE; week 16: 12.58 ± 0.55 mg L-1 GAE, p < 0.001) was observed for the intervention group only. In contrast, a significant increase in skin AGE status was observed in the control group (week 0: 2.47 ± 0.24; week 16: 2.99 ± 0.12, p < 0.05) while this was mitigated in the intervention group. There were no differences in dietary lutein intake, plasma lutein concentration and skin carotenoid status between groups throughout the study. Conclusions: Regular intake of grapes may improve eye health in Singapore older adults, specifically in augmenting MPOD, which can be explained by an increase in plasma total antioxidant capacity and phenolic content, and the downregulation of AGEs. This study was registered at clinicatrials.gov as NCT05064865.

Endothelial progenitor cells as an emerging cardiovascular risk factor in the field of food and nutrition research: advances and challenges

Dietary modifications can help prevent many cardiovascular disease (CVD) events. Endothelial progenitor cells (EPCs) actively contribute to cardiovascular system maintenance and could function as surrogate markers for evaluating improvement in cardiovascular health resulting from nutritional interventions. This review summarizes the latest research progress on the impact of food and nutrients on EPCs, drawing on evidence from human, animal, and in vitro studies. Additionally, current trends and challenges faced in the field are highlighted. Findings from studies examining cells as EPCs are generally consistent, demonstrating that a healthy diet, such as the Mediterranean diet or a supervised diet for overweight people, specific foods like olive oil, fruit, vegetables, red wine, tea, chia, and nutraceuticals, and certain nutrients such as polyphenols, unsaturated fats, inorganic nitrate, and vitamins, generally promote higher EPC numbers and enhanced EPC function. Conversely, an unhealthy diet, such as one high in sugar substitutes, salt, or fructose, impairs EPC function. Research on outgrowth EPCs has revealed that various pathways are involved in the modulation effects of food and nutrients. The potential of EPCs as a biomarker for assessing the effectiveness of nutritional interventions in preventing CVDs is immense, while further clarification on definition and characterization of EPCs is required.

The effect of shortening the quarantine period and lifting the indoor mask mandate on the spread of COVID-19: a mathematical modeling approach

In this paper, we present a mathematical model to assess the impact of reducing the quarantine period and lifting the indoor mask mandate on the spread of Coronavirus Disease 2019 (COVID-19) in Korea. The model incorporates important epidemiological parameters, such as transmission rates and mortality rates, to simulate the transmission of the virus under different scenarios. Our findings reveal that the impact of mask wearing fades in the long term, which highlights the crucial role of quarantine in controlling the spread of the disease. In addition, balancing the confirmed cases and costs, the lifting of mandatory indoor mask wearing is cost-effective; however, maintaining the quarantine period remains essential. A relationship between the disease transmission rate and vaccine efficiency was also apparent, with higher transmission rates leading to a greater impact of the vaccine efficiency. Moreover, our findings indicate that a higher disease transmission rate exacerbates the consequences of early quarantine release.

Effects of different fats on postprandial appetite responses: a randomised crossover trial

Overconsumption of fat is considered a major driver of the prevalence of obesity globally. While fat type and emulsification have been suggested to play roles in appetite control, very limited data exist. This study aimed to investigate the impacts of type and emulsification of fat on postprandial appetite responses. Sixteen healthy subjects participated in a 4-arm, randomised, crossover study. The net iAUC of hunger visual analogue scales (VAS) (mean ± SE) was observed higher with emulsified fat (-512 ± 137 cm × 300 min) than with non-emulsified fat (-785 ± 133 cm × 300 min) (p < 0.05), but the difference became insignificant over time. Compared to olive oil, coconut oil resulted in higher fullness VAS iAUC (olive oil: 1369 ± 306 cm × 600 min; coconut oil: 1786 ± 311 cm × 600 mi, p < 0.05). Findings from this study support the potential effects of fat in appetite regulation.

Safety and efficacy of trastuzumab biosimilar plus irinotecan or gemcitabine in patients with previously treated HER2 (ERBB2)-positive non-breast/non-gastric solid tumors: a phase II basket trial with circulating tumor DNA analysis

BACKGROUND

Human epidermal growth factor receptor 2 (HER2) (ERBB2)-directed agents are standard treatments for patients with HER2-positive breast and gastric cancer. Herein, we report the results of an open-label, single-center, phase II basket trial to investigate the efficacy and safety of trastuzumab biosimilar (Samfenet®) plus treatment of physician's choice for patients with previously treated HER2-positive advanced solid tumors, along with biomarker analysis employing circulating tumor DNA (ctDNA) sequencing.

METHODS

Patients with HER2-positive unresectable or metastatic non-breast, non-gastric solid tumors who failed at least one prior treatment were included in this study conducted at Asan Medical Center, Seoul, Korea. Patients received trastuzumab combined with irinotecan or gemcitabine at the treating physicians' discretion. The primary endpoint was the objective response rate as per RECIST version 1.1. Plasma samples were collected at baseline and at the time of disease progression for ctDNA analysis.

RESULTS

Twenty-three patients were screened from 31 December 2019 to 17 September 2021, and 20 were enrolled in this study. Their median age was 64 years (30-84 years), and 13 patients (65.0%) were male. The most common primary tumor was hepatobiliary cancer (seven patients, 35.0%), followed by colorectal cancer (six patients, 30.0%). Among 18 patients with an available response evaluation, the objective response rate was 11.1% (95% confidence interval 3.1% to 32.8%). ERBB2 amplification was detected from ctDNA analysis of baseline plasma samples in 85% of patients (n = 17), and the ERBB2 copy number from ctDNA analysis showed a significant correlation with the results from tissue sequencing. Among 16 patients with post-progression ctDNA analysis, 7 (43.8%) developed new alterations. None of the patients discontinued the study due to adverse events.

CONCLUSIONS

Trastuzumab plus irinotecan or gemcitabine was safe and feasible for patients with previously treated HER2-positive advanced solid tumors with modest efficacy outcomes, and ctDNA analysis was useful for detecting HER2 amplification.

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment

BACKGROUND

Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact.

OBJECTIVE

To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea.

METHODS

We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus.

RESULTS

Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used.

CONCLUSION

The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part II Systemic Treatment

BACKGROUND

Alopecia areata (AA) is a chronic disease with an unpredictable course and can have a severe psychological impact on an individual.

OBJECTIVE

To provide evidence and consensus-based statements regarding the treatment of patients with AA in Korea.

METHODS

We searched for relevant studies from inception to May 2021 regarding the systemic treatment of AA. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statement, and an agreement of 75% or greater was considered as having reached consensus.

RESULTS

Current evidence supports the efficacy of systemic corticosteroids, oral cyclosporine monotherapy or combination with systemic corticosteroids, and oral Janus kinase inhibitors in severe AA patients. Systemic steroids may be considered for pediatric patients with severe AA. A consensus was achieved in three out of nine (33.3%), and one out of three (33.3%) statements pertaining to systemic treatment in adult and pediatric AA, respectively.

CONCLUSION

The present study produced up-to-date, evidence-based treatment guidelines for AA associated with the consensus obtained by experts based on the Korean healthcare system.

Psychometric Properties of General Self-Efficacy (GSE) Scale Korean Version for Older Korean Immigrants with Diabetes: A Cross-Sectional Study in the United States

Patients with diabetes must have self-efficacy to perform necessary self-care tasks. Self-efficacy has been considered as one of the primary motivators on diabetes self-care; therefore, it is essential for health care professionals to assess the self-efficacy of patients with diabetes to provide optimal care. Despite older Korean immigrants having greater difficulty in diabetes management, research on self-efficacy for them is lacking. This study aims to examine the psychometric property of the General Self-Efficacy scale Korean version for older Korean immigrants with diabetes in the United States. In this cross-sectional, methodological study, data were collected using convenience sampling. Cronbach's alpha, exploratory factor analysis, and confirmatory factor analysis were employed to examine the psychometric properties. Cronbach's alpha for the entire GSE scale Korean version is 0.81. The initial Eigenvalues show two factors, coping and confidence; however, the confirmatory factor analysis showed reasonable goodness of fit to the data (χ²(35) = 86.24, p < 0.01), χ²/df ratio = 2.46, AGFI = 0.87, GFI = 0.91, IFI = 0.90, ECVI = 0.74, CFI = 0.89, and RMSEA = 0.093 in the one-factor model. The General Self-Efficacy scale Korean version demonstrated acceptable reliability and validity. It can be used to investigate self-efficacy and to devise culturally tailored diabetes interventions.

Incidence and Mortality of Vertebral Compression Fracture Among All Age Groups: A Nationwide, Population-based Study in the Republic of Korea

BACKGROUND

Although several studies have examined the epidemiological features of vertebral compression fractures (VCF) among elderly patients, few studies have reported the epidemiology of VCF among younger individuals.

OBJECTIVE

To examine trends in the incidence and mortality of VCF in both the old (>= 65 years) and young (< 65 years) age groups. This study aimed to investigate the incidence and mortality of VCF among all age groups in Korea.

STUDY DESIGN

Population-based cohort study.

SETTING

A nationwide, population-based setting.

METHODS

Using the Korean National Health Insurance database, which has complete population coverage, we identified patients diagnosed with VCF between 2005 to 2018. Differences in incidence, survival and mortality were compared across groups using Kaplan-Meier analysis and Cox regression for all age groups and both genders.

RESULTS

We identified a total of 742,993 VCF patients and the annual incidence was 140.09/100,000 individuals. Although the incidence of VCF was significantly higher in the older age compared to younger age group (556.38/100,000 vs. 44.09/100,000 individuals), the mortality rate ratio for VCF patients was higher among younger compared to older individuals (old: 1.59 vs. young: 2.87). In our multivariable-adjusted analysis, the hazard ratio for multiple fractures, traumatic injury and osteoporosis were higher in patients aged < 65 years compared to patients aged >= 65 years, suggesting that the impact of these clinical variables on mortality is more significant in the younger age group.

LIMITATION

A limitation of this study was its lack of information on clinical features, such as disease severity and laboratory data. The precise cause of death of VCF patients could not be confirmed from the study database.

CONCLUSIONS

The mortality rate ratio and hazard ratio were significantly higher among younger patients with VCF, indicating the need for further research on VCF in younger age groups.

Regular Consumption of Biovalorized Okara-Containing Biscuit Improves Circulating Short-Chain Fatty Acids and Fecal Bile Acids Concentrations by Modulating the Gut Microbiome: A Randomized Controlled Crossover Trial

SCOPE

Okara is a fiber-rich food by-product whereby biovalorization with Rhizopus oligosporus can improve its nutritional quality, generating fermentable substrates for improved gut health maintenance. This study evaluates the impact of okara- and biovalorized okara-containing biscuits consumption on gut health in Singapore adults.

METHODS AND RESULTS

Participants consumed control (C), 20% flour-substituted okara- (AOK) and biovalorized okara- (RO) biscuits for 3 weeks, with assessment of gut metabolites, microbiome, and dietary intake. Fecal valeric acid was significantly higher with RO compared to AOK (P = 0.005). RO and AOK had significantly higher total serum short-chain fatty acids (P = 0.002&0.018 respectively) and acetic acid (P = 0.007&0.030 respectively) compared to C. Higher serum propionic acid (P = 0.004) and lower fecal lithocholic acid (P = 0.009) were observed with RO. Although serum zonulin showed no significant difference, AOK reduced Clostridiales while RO increased Bifidobacterium.

CONCLUSION

Okara consumption improved serum SCFA regardless of fermentation while biovalorised okara further enhanced gut metabolites by modulating gut microbiome. This article is protected by copyright. All rights reserved.

Abstract 5322: High throughput chemotherapeutic drug screening system for gastric cancer: cure-GA

To discover clinically applicable anticancer drugs and predict therapeutic response for advanced gastric cancer, we developed a high-throughput drug (HTD) screening system that could rapidly evaluate drug reactivity using 3D cultured primary cells derived from gastric cancer (GC) patients. Primary cancer cells were isolated from fresh surgical specimens that resected from 143 GC patients using Gentle Max tissue dissociation system. Primary cells were mixed with Matrigel, and placed on a micropillar for three-dimensional (3D) culture. After the primary cells were stabilized in the complete culture medium (CCM) than added various chemotherapeutic drugs containing 5-FU, Oxaliplatin, and Paclitaxel in CCM and incubated for 7 days. Cell viability was determined through calcein staining and quantified scanned images. The IC50 for each drug was calculated by a sigmoidal dose-response curve, using the GraphPad Prism 9 program. The average weight of gastric cancer tissue used in the experiment was 300 mg (75 mg ~ 1930 mg), and the average number of dissociated viable cells for each tissue was 3.9 × 10^6 cells/case. About 2.4 × 10^5 live cell was required per drug, we were able to obtain an average of 6.4 (Min.2, Max 14) drug reactivity data per tissue using the HTD screening system. GC tissues obtained from the operating room were dissociated within 16 hours and then loaded into the HTS system within 3 hours. Cells were stabilized for 1 day in 3D culture plate and exposed to the drug for 7 days, and then data reports were made within 3 days. As a result, it was possible to obtain within 14 days from fresh surgical GC tissue to drug response data. Additionally, we confirmed that 3D cultured primary cells derived from GC tissues consistently preserved primary characters using IHC. Similar to their parental cancer tissue, GC 3D cultured primary cells derived from adenocarcinoma large glandular patterns and retain the expression of some marker proteins. In this study, we evaluated the drug response data for 101 cases (success rate 71%; 101/143) to 5-FU, Oxaliplatin, and Palitaxel, etc. using the HTD screening system and it was confirmed that individual patient had a difference response to each drug. Here we established the HTD screening system using 3D cultured GC patient derived primary cells. The advantages of this system were that it is the first model system that directly used patient-derived primary cells for drug screening, and it can rapidly evaluate drug reactivity to various anticancer drugs within 10 days. The HTD screening system based on patient-derived primary cells can provide that information to predict drug response and allow for finding more appropriate therapy for each patient.

Citation Format: Jieun Lee, Jung Eun Kim, Sanjun Lee, Tae-Kyeong Lee, In Hee Kim, So Hee Yoon, Mira Yoo, Eunju Lee, Doo-Young Hwang, So Hyun Kang, Bo Sung Ku, Dong Woo Lee, Young Suk Park, Ji-Won K, Jin Won Kim, Sang-Hoon Ahn, Keun-Wook Lee, Hyung-Ho Kim, Hyun Jung Oh, Yun-Suhk Suh. High throughput chemotherapeutic drug screening system for gastric cancer: cure-GA. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5322.

Measures of carbohydrate quality and their association with diet quality and cardiometabolic health outcomes in Singapore middle-aged and older adults

BACKGROUND AND AIMS

Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health.

METHODS AND RESULTS

This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20-36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021).

CONCLUSION

An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ CLINICAL TRIAL REGISTRATION: NCT03554954, 13 Sept. 2018.

High-throughput organo-on-pillar (high-TOP) array system for three-dimensional ex vivo drug testing

The development of organoid culture technologies has triggered industrial interest in ex vivo drug test-guided clinical response prediction for precision cancer therapy. The three-dimensional culture encapsulated with basement membrane (BM) components is extremely important in establishing ex vivo organoids and drug sensitivity tests because the BM components confer essential structures resembling tumor histopathology. Although numerous studies have demonstrated three-dimensional culture-based drug screening methods, establishing a large-scale drug-screening platform with matrix-encapsulated tumor cells is challenging because the arrangement of microspots of a matrix-cell droplet onto each well of a microwell plate is inconsistent and difficult to standardize. In addition, relatively low scales and lack of reproducibility discourage the application of three-dimensional organoid-based drug screening data for precision treatment or drug discovery. To overcome these limitations, we manufactured an automated organospotter-integrated high-throughput organo-on-pillar (high-TOP) drug-screening platform. Our system is compatible with various extracellular matrices, including BM extract, Matrigel, collagen, and hydrogel. In addition, it can be readily utilized for high-content analyses by simply exchanging the bottom plates without disrupting the domes. Our system demonstrated considerable robustness, consistency, reproducibility, and biological relevancy in three-dimensional drug sensitivity analyses using Matrigel-encapsulated ovarian cancer cell lines. We also demonstrated proof-of-concept cases representing the clinical feasibility of high-TOP-assisted ex vivo drug tests linked to clinical chemo-response in ovarian cancer patients. In conclusion, our platform provides an automated and standardized method for ex vivo drug-sensitivity-guided clinical response prediction, suggesting effective chemotherapy regimens for patients with cancer.

Needle Depth and Angle for Lumbar Interlaminar Epidural Injection Using Magnetic Resonance Imaging and C-Arm Measurements

BACKGROUND

Interlaminar epidural injection (ILEI) is used to relieve low back pain, with or without radiating pain. The distance from the skin to the epidural space determines the needle depth and may be influenced by the patient's body measurements.

OBJECTIVES

The objective of this study was to investigate the correlation between needle depth for ILEI and patients' body profiles, including weight, height, and body mass index (BMI), using magnetic resonance imaging (MRI) and also to compare the needle depth and angle between MRI and C-arm fluoroscopic images of ILEI.

STUDY DESIGN

This was a retrospective study.

SETTING

This study was conducted at a single Department of Anesthesiology and Pain Medicine of Konkuk University Medical Center.

METHODS

This retrospective study reviewed patients who underwent MRI and ILEI. The needle depth and caudal angle were measured on the sagittal view of MRI and C-arm images for L3-L4, L4-L5, and L5-S1 ILEI.

RESULTS

Overall, 386 patients were reviewed. For MRI, the mean value of the needle angle given caudally was 14.70, 12.06, and 11.33 for L3-4, L4-5, and L5-S1 ILEIs, respectively. Mean values of needle depth were 52.17, 52.09, and 47.91 mm for L3-4, L4-5, and L5-S1 ESIs, respectively. Height combined with weight and BMI had a higher correlation with needle depth than weight and height. In the comparison between MRI and fluoroscopy, needle depth at L5-S1 and caudal angle at L3-4 and L4-5 were significantly correlated.

LIMITATIONS

This study was a retrospective study conducted at a single center.

CONCLUSION

Height combined with weight and BMI can help estimate the optimal needle depth from the skin to the epidural space. Needle depth in L5-S1 and caudal angle in L3-4 and L4-5 of MRI were correlated with those of fluoroscopy of ILEI.

Preoperative Chemoradiotherapy With Capecitabine With or Without Temozolomide in Patients With Locally Advanced Rectal Cancer: A Prospective, Randomised Phase II Study Stratified by O6-Methylguanine DNA Methyltransferase Status: KCSG-CO17-02

AIMS

To evaluate the clinical efficacy of adding temozolomide (TMZ) to preoperative capecitabine (CAP)-based chemoradiotherapy in patients with locally advanced rectal cancer (LARC) and validate O⁶-methylguanine DNA methyltransferase (MGMT) methylation status as a predictive marker for TMZ combined regimens.

MATERIALS AND METHODS

LARC patients with clinical stage II (cT3-4N0) or III (cT_anyN+) disease were enrolled. They were stratified into unmethylated MGMT (uMGMT) and methylated MGMT (mMGMT) groups by methylation-specific polymerase chain reaction before randomisation and were then randomly assigned (1:1) to one of four treatment arms: uMGMT/CAP (arm A), uMGMT/TMZ + CAP (arm B), mMGMT/CAP (arm C) and mMGMT/TMZ + CAP (arm D). The primary end point was the pathological complete response (pCR) rate.

RESULTS

Between November 2017 and July 2020, 64 patients were randomised. Slow accrual caused early study termination. After excluding four ineligible patients, 60 were included in the full analysis set. The pCR rate was 15.0% (9/60), 0%, 14.3%, 18.8% and 26.7% for the entire cohort, arms A, B, C and D, respectively (P = 0.0498 between arms A and D). The pCR rate was 9.7% in the CAP group (arms A + C), 20.7% in the TMZ + CAP group (arms B + D), 6.9% in the uMGMT group (arms A + B) and 22.6% in the mMGMT group (arms C + D). Grade 1-2 nausea or vomiting was significantly more frequent in the TMZ + CAP treatment groups (arms B + D) than in the CAP treatment groups (arms A + C, P < 0.001) with no difference in grade 3 adverse events. There were no grade 4 or 5 adverse events.

CONCLUSION

The addition of TMZ to CAP-based chemoradiotherapy tended to improve pCR rates, particularly in those with mMGMT LARC. MGMT status may warrant further investigation as a predictive biomarker for chemotherapeutic agents and radiotherapy.

Sleep-promoting activity of lotus (Nelumbo nucifera) rhizome water extract via GABAA receptors

CONTEXT

The sleep-promoting activity of Nelumbo nucifera Gaertn. (Nymphaeaceae) alkaloids in leaves or seeds are well known. However, the sleep-promoting activity of the lotus rhizome (LE), which is used mainly as food, has not yet been evaluated.

OBJECTIVE

We investigated the sleep-promoting activity of LE water extract.

MATERIALS AND METHODS

Institute of Cancer Research (ICR) mice (n = 8) were subject to a pentobarbital-induced sleep test to assess changes in sleep latency and duration following the administration of LE (80-150 mg/kg). In addition, electroencephalography analysis was performed to determine the sleep quality after LE treatment as well as the sleep recovery effect of LE using a caffeine-induced insomnia SD rat model. Real-time PCR and western blot analysis were performed to investigate the expression of neurotransmitter receptors, and the GABA_A receptor antagonists were used for receptor binding analysis.

RESULTS

An oral administration of 150 mg/kg LE significantly increased sleep duration by 24% compared to the control. Furthermore, LE increased nonrapid eye movement (NREM) sleep by increasing theta and delta powers. In the insomnia model, LE increased sleep time by increasing NREM sleep. Moreover, treatment with picrotoxin and flumazenil decreased the sleep time by 33% and 23%, respectively, indicating an involvement of the GABA_A receptor in the sleep-enhancing activity of LE. The expression of GABA_A receptors and the concentration of GABA in the brain were increased by LE.

DISCUSSION AND CONCLUSIONS

The results suggest that the sleep-promoting activity of LE was via the GABA_A receptor. Collectively, these data show that LE may promote sleep.

Evaluation of harvesting urban water resources for sustainable water management: Case study in Filton Airfield, UK

Filton Airfield in the UK is a new community under development aiming to become self-sufficient in its water supply toward a circular economy. Urban water management strategies, water demand minimization, urban resource reuse, and wastewater discharge minimization, can improve the urban circular economy. Understanding the practical impacts of those strategies is crucial for a new development area like Filton. As a site investigation, the physiochemical and microbial characteristics of raw rainwater showed acceptable for irrigation and drinking water, indicating no significant risk of using rainwater collected within Filton, but still requiring a treatment process depending on chosen applications. This study further conducted stochastic water demand profiles and urban water cycle simulations at a block scale, taking possible rainwater harvesting (RWH) and greywater recycling (GWR) options for non-potable purposes to quantitatively assess the impact of urban water management strategies on urban harvesting potential indicators (0-100%). When the RWH was implemented, the water demand minimization potential varied from 62% to 71%. Meanwhile, the combined use of RWH and GWR yielded even better results in terms of water demand minimization, peaking at 78% due to the additional supply from GWR. The combination also reduced wastewater production potential from 100% to 54% and consequently improves self-sustainability potential from 0 with no recycling, to 44% with only GWR, and to 100% with the combined use of RWH and GWR. The sensitivity analysis revealed that wastewater discharge is the most sensitive to variations in rainfall patterns (wet and dry conditions) and urban density (water demand patterns), indicating that both need to be balanced for better implementation of urban water harvesting strategies. This study can provide insights into the applicability of urban water resource harvesting and its assessment approaches in existing and new development areas.

Actual situation and prescribing patterns of opioids by pain physicians in South Korea

Background

Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients’ quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians’ experiences with opioid use in South Korea.

Methods

Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions.

Results

A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%).

Conclusions

The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

The economic impact of COVID-19 interventions: A mathematical modeling approach

Prior to vaccination or drug treatment, non-pharmaceutical interventions were almost the only way to control the coronavirus disease 2019 (COVID-19) epidemic. After vaccines were developed, effective vaccination strategies became important. The prolonged COVID-19 pandemic has caused enormous economic losses worldwide. As such, it is necessary to estimate the economic effects of control policies, including non-pharmaceutical interventions and vaccination strategies. We estimated the costs associated with COVID-19 according to different vaccination rollout speeds and social distancing levels and investigated effective control strategies for cost minimization. Age-structured mathematical models were developed and used to study disease transmission epidemiology. Using these models, we estimated the actual costs due to COVID-19, considering costs associated with medical care, lost wages, death, vaccination, and gross domestic product (GDP) losses due to social distancing. The lower the social distancing (SD) level, the more important the vaccination rollout speed. SD level 1 was cost-effective under fast rollout speeds, but SD level 2 was more effective for slow rollout speeds. If the vaccine rollout rate is fast enough, even implementing SD level 1 will be cost effective and can control the number of critically ill patients and deaths. If social distancing is maintained at level 2 at the beginning and then relaxed when sufficient vaccinations have been administered, economic costs can be reduced while maintaining the number of patients with severe symptoms below the intensive care unit (ICU) capacity. Korea has wellequipped medical facilities and infrastructure for rapid vaccination, and the public's desire for vaccination is high. In this case, the speed of vaccine supply is an important factor in controlling the COVID-19 epidemic. If the speed of vaccination is fast, it is possible to maintain a low level of social distancing without a significant increase in the number of deaths and hospitalized patients with severe symptoms, and the corresponding costs can be reduced.

Aspirin Cessation Before Interventional Procedures: Not Blindly Following Guidelines but Making Test-based Decisions

BACKGROUND

Deciding whether to continue or discontinue aspirin prior to interventional procedures is a major concern for pain physicians. Many guidelines have been published on the discontinuation of aspirin before invasive procedures; however, the recommendations are inconsistent and do not consider individual platelet function. Furthermore, many studies have shown a high prevalence of aspirin resistance  in patients taking this medication.

OBJECTIVES

To determine the necessity of discontinuing aspirin prior to interventional pain procedures in relation to individual platelet function.

STUDY DESIGN

Multicenter, cross-sectional study.

SETTING

University-affiliated hospitals.

METHODS

We examined platelet function among patients scheduled for an interventional pain procedure by measuring their closure time using collagen/epinephrine cartridges in a commercial platelet-function analyzer. The patients were categorized into either an aspirin-taking or nonaspirin-taking group (Group A or Group N, respectively). The proportion of patients who showed normal/abnormal platelet function was calculated and compared between the groups.

RESULTS

A total of 1,111 patients were included in this study. In Group A, 56.4% (102/181) showed normal platelet function, whereas 43.6% (79/181) showed abnormal platelet function. In Group N, 85.8% (798/930) and 14.2% (132/930) showed normal and abnormal platelet function, respectively.

LIMITATION

The proportion of laboratory, not clinical aspirin resistance was evaluated. Factors affecting platelet function were not investigated exhaustively.

CONCLUSION

The high prevalence of normal platelet function in patients taking aspirin suggests no necessity of discontinuation before procedures in such patients. Abnormal platelet function can occur even in patients who are not taking aspirin. Therefore, platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors.

Postprandial glycemic and circulating SCFA concentrations following okara- and biovalorized okara-containing biscuit consumption in middle-aged and older adults: a crossover randomized controlled trial

Okara is a high-fiber food by-product that can be biotransformed with Rhizopus oligosporus to improve its nutritional value and palatability. This research aims to assess postprandial changes in glycemic-related and lipid-related outcomes in middle-aged and older Singaporeans following okara- and biovalorized okara-containing biscuit consumption. Fifteen participants (58 ± 6 years old, mean ± SD) completed the randomized crossover study. Participants were provided control (C), okara (AOK)-, and biovalorized okara (RO)-containing biscuits in separate 4 h mixed meal tolerance tests. Serum glucose and insulin, insulin indices, serum short-chain fatty acids (SCFA) and lipid-lipoprotein panels, and sensory analysis were assessed. Glucose-stimulated insulin secretion was significantly lower for RO than for C (p: 0.035) while log insulin incremental area under the curve (AUC) was significantly lower for AOK compared to that for C (p: 0.023). The estimated insulin sensitivity index and estimated metabolic clearance rate were significantly higher for AOK compared to that for C (p: 0.025 and 0.016 respectively). Normalized AUC for total SCFA was significantly higher for RO compared to that for C (p: 0.038). Normalized AUC for LDL-cholesterol was significantly higher for AOK than for C (p: 0.010). No significant difference was noted for glucose, total cholesterol, HDL-cholesterol, and triglyceride concentrations. RO had greater flavor and overall liking than AOK (p: 0.007 and 0.017 respectively). Biscuits incorporated with okara or biovalorized okara can attenuate postprandial insulin responses. RO offered a greater SCFA response than C, indicating improved SCFA concentrations upon consumption of okara improved with fermentation. The trial was registered under https://www.clinicaltrials.gov (NCT03978104, 25 May 2019).

Keratinocytes cut corners on the cell cycle for the sake of skin barrier integrity

Epidermis can grow its surface by activating mitotic division in basal stem cells. In a recent issue of Nature,Chan et al. (2022) show that under high demand for new skin, differentiated epidermal cells in zebrafish divide without DNA synthesis, forming cells in the new surface with reduced and abnormal genomes.

The Effects of Wolfberry Consumption on the Human Plasma Lipidome and Its Potential Role in Cardiovascular Disease Risk Modulation: A Randomized Controlled Trial

Objectives

The adverse effects of dyslipidemia on cardiovascular health are well-documented. Conventionally assayed by blood lipids/lipoproteins, these classical indicators alone yield an oversimplified view of the human plasma lipidome. We previously observed an attenuation of cardiovascular disease (CVD) risk after regular wolfberry consumption for 16 weeks, with a prominent reduction in oxidative stress. To complement these findings, the objective of this study was to characterize the alterations to the plasma lipidome and explore its potential correlations to CVD risk.

Methods

In this parallel randomized controlled trial, middle-aged and older adults (55 ± 4 y) from Singapore were counselled to follow a healthy dietary pattern, either with or without consuming 15 g cooked whole wolfberry daily (WB; n = 21, CON; n = 17). Following lipid extraction of weeks 0 and 16 plasma samples, the lipidome was assayed by high-performance liquid chromatography-tandem mass spectrometry and quantified with internal standards (427 lipid species). Pearson's correlations between the fold changes (FCs) of lipid species from baseline, with corresponding changes to CVD risk-related outcomes including blood lipids/lipoproteins, blood pressure as well as vascular health and oxidative stress-related indicators were further evaluated.

Results

A comparison between the groups identified 7 distinct lipid species between WB and CON (FC > 1.2; P < 0.05). Notably, sphingomyelin 38:1, which had a markedly higher FC in WB compared to CON (FC_WB: 1.2, FC_CON: 1.0), was also significantly raised compared to baseline. Phosphatidylcholine (PC) 35:2, which increased by 1.8-fold in WB only (P < 0.05), additionally depicted an inverse linear correlation with the FC of plasma 8-isoprostanes (Pearson's correlation coefficient: −0.45, P < 0.05). Across both groups, FCs from baseline were also significant for species of triglycerides (TG; 42 species), PC (4 species), ether-TG, ether-PC, plasmalogen-PC and cholesteryl ester (1 species each) albeit independent of wolfberry intake and with no clear associations to the other CVD risk-related outcomes.

Conclusions

Characteristic alterations to the plasma lipidome observed with wolfberry consumption may potentially modulate its underlying antioxidant effect.

Funding Sources

Ministry of Education, Singapore

Impact of 5-Hydroxytryptophan Supplementation on Gut Microbiota Composition of Older Adults With Different Sleep Status in Singapore: A Randomized Controlled Trial

Objectives

The gut and brain communicate bidirectionally through the gut brain axis. Lower microbial diversity has been observed in populations with sleep disturbances. 5-Hydroxytryptophan (5-HTP) is known as a potential modulator of sleep quality, while its impact on the gut remains unclear. The aim of this study was to assess the impact of 5-HTP on gut microbiota in older Singaporeans with different sleep status.

Methods

This study is a single-blinded, 12-week parallel randomized controlled trial. Thirty older adults (66 ± 3 years, mean ± SD) were randomly assigned to either consume or not consume 100 mg 5-HTP daily. Their baseline sleep status was evaluated using global sleep score (GSS): GSS ≤ 5 (good sleepers, n:17); GSS > 5 (poor sleepers: n:13). Characterization of the bacterial population from the stool samples collected at week 0 and 12 was analyzed through 16S metagenomic sequencing. Microbiota composition between GSS ≤ 5 and GSS > 5 was compared via MetaStat analysis. The main effect and interaction of 5-HTP on gut microbiota composition was evaluated by mixed analysis of variance (ANOVA).

Results

At baseline, poor sleepers have a significantly lower relative abundance of Firmicutes than good sleepers (GSS > 5: 3.78 × 10⁻¹ ± 5.43 × 10⁻²; GSS ≤ 5: 4.33 × 10⁻¹ ± 9.32 × 10⁻²; p-value: 0.048). After a 12-week consumption of 5-HTP, subjects with GSS > 5 showed an increase in α-diversity (Simpson_5-HTP vs. Simpson_Control: 0.037 ± 0.032 vs. −0.007 ± 0.022; p_interaction: 0.013). 5-HTP supplementation also showed interaction effects on the relative abundance of Bacteroidota (Bacteroidota_5-HTP vs. Bacteroidota_Control: −1.03 × 10⁻¹ ± 4.99 × 10⁻² vs. −3.06 × 10⁻² ± 4.39 × 10⁻²; p_interaction: 0.019) and Firmicutes (Firmicutes_5-HTP vs. Firmicutes_Control: 1.10 × 10⁻¹ ± 2.40 × 10⁻² vs. 2.02 × 10⁻² ± 7.82 × 10⁻²; p_interaction: 0.031). No significant changes were observed for GSS ≤ 5 group.

Conclusions

In older adults, 5-HTP consumption modulated gut microbiota composition in poor sleepers (GSS > 5). However, no influence to the gut microbiota was observed in good sleepers (GSS ≤ 5).

Funding Sources

NUS iHealthtech Microbiome in Health, Disease and Ageing.

Biovalorized Okara Consumption Improves Gut Metabolites by Modulating Gut Microbiome: A Randomized Controlled Crossover Trial

Objectives

Okara is a major food by-product of soymilk or tofu production, particularly rich in dietary fiber. Biovalorization with Rhizopus oligosporus can improve its nutritional quality with greater soluble fiber, bioavailable isoflavones, and antioxidants. These nutrients are fermented by the gut microbiota to generate gut metabolites involved in gut health maintenance. This study evaluates the impact of okara and biovalorized okara- containing biscuits consumption on gut health in middle-aged and older Singaporeans.

Methods

Healthy participants (n = 15) of the crossover trial were randomly allocated to 3-week interventions of 100 g of control (C), 20% flour substituted autoclaved okara- (AOK), and 20% four substituted R. oligosporus biovalorized okara- (RO) containing biscuits, with 3-week washout periods. Pre- and post- intervention serum short-chain fatty acids (SCFA), fecal SCFA, fecal bile acids, serum zonulin, gastrointestinal symptoms, and dietary intakes were assessed. Pre- and post- intervention fecal 16S ribosomal RNA V3-V4 sequencing was also investigated for gut microbiome analysis. Results are presented as change value mean (95% confidence interval).

Results

Amongst fecal SCFA, only valeric acid (µmol/g) observed a significant difference, higher with RO compared to AOK (0.16 (0.01, 0.30) vs −0.20 (−0.34, −0.05), P = 0.005). RO and AOK had significantly higher total serum SCFA (P = 0.002 & 0.018 respectively) and serum acetic acid (P = 0.007 & 0.030 respectively) compared to C. RO had significant improvements with higher serum propionic acid (µmol/L) (RO: 3.04 (0.80, 5.27) vs C: −2.65 (−4.97, −0.33), P = 0.004) and lower fecal lithocholic acid (mg/g) (a secondary bile acid) (RO: −0.11 (−0.20, −0.02) vs C: 0.10 (0.01, 0.19), P = 0.009) contrasted to C. Although serum zonulin showed no significant difference, AOK induced a reduction in Clostridiales while RO increased Bifidobacterium. Okara consumption increased dietary fiber intake, with greater soluble fiber intake from RO compared to AOK and C (P = 0.018 & 0.019 respectively), aligning with the greater flatulence felt by participants on RO.

Conclusions

Okara consumption improved serum SCFA rather than fecal SCFA, regardless of fermentation. Biovalorized okara consumption further improved SCFA and bile acid profiles by modulating gut microbiome.

Funding Sources

Singapore Ministry of Education.

Impact of Dietary Counselling on Mental Health and Diet Quality in Singapore Older Adults: A Randomized Controlled Trial

Objectives

As the proportion of population ages in Singapore, some of the challenges associated with mental health conditions such as depression and anxiety become common. A good nutrition has been found to be beneficial for good mental health and the provision of dietary counselling is one of the effective dietary strategies to improve their nutritional status and mental health. However, this effect has not been assessed in Singapore older adults. Therefore, this study aimed to determine the impact of dietary counselling on the mental health and diet quality of older Singaporean adults.

Methods

This was a 24-week, parallel design, randomized controlled trial where 39 older women (aged above 60 y) in Singapore were randomized in which the intervention group received dietary counselling to follow a healthy dietary pattern and the control group did not receive dietary counselling. The dietary counselling was given for 12 weeks for the intervention group and the remaining 12 weeks were for follow up. The counselling topic covered various topics on food proportioning, food label reading and several age-related diseases. Mental health questionnaire, quality of life questionnaire and sleep quality questionnaire were administered at baseline, week 12 and week 24. Participants were required to complete a 3-day food record and the diet quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). All results were presented as least square mean ± SE.

Results

The intervention group observed a significant decrease in Geriatric Depression Scale over time from week 0 to week 12 and week 24 (week 0: 2.0 ± 0.5; week 12: 1.1 ± 0.5; week 24: 0.8 ± 0.3, P &lt; 0.05) while Geriatric Anxiety Inventory and Quality of Life scores were not changed. The intervention group also showed an increase in dietary quality based on the AHEI-2010 score at week 12 (55 ± 2 to 60 ± 2) and week 24 (55 ± 2 to 61 ± 2, P &lt; 0.05) as compared to week 0 (55 ± 2), however only week 24 was statistically significantly. The control group saw a decrease in score over time though not statistically significant (baseline: 59 ± 2; week 12: 58 ± 2; week 24: 56 ± 2).

Conclusions

The provision of dietary counselling over a period of 24 weeks may be a viable nutritional strategy to improve dietary quality and may confer benefits in the mental health outcome.

Funding Sources

Mind Science Centre, National University of Singapore (NUS)

Effects of the Type and Emulsification of Oil on Postprandial Appetite Responses in Healthy Young Adults

Objectives

Previous studies revealed that consuming different types of oil or the same type of oil but whether being emulsified could result in a different subsequent food intake. While these results suggest that different types of oils or emulsification could affect appetite control, very limited data exist. Therefore, this study aimed to investigate the impact of type and emulsification of oil on postprandial appetite responses.

Methods

This is a randomized, controlled, double-blinded crossover study and 16 healthy males and females aged between 21 and 29 participated in the study. All participants consumed a high-fat isocaloric breakfast meal containing 29 g of one of the following four oil: i) olive oil-water non-emulsified; ii) olive oil-water emulsified; (iv) coconut oil-water non-emulsified, v) coconut oil-water emulsified. Five hours after the test breakfast meal, subjects received a standard low-fat lunch. Six appetites components including hunger, desire to eat, prospective consumption, fullness, nausea and bloating were evaluated over a 10-hour postprandial duration by using visual analogue scales (VAS). The net incremental area under the curve (iAUC) of appetite VAS was calculated by the trapezoidal method.

Results

The iAUC value (mean ± SE) of hunger VAS was higher with the oil emulsified group (-512.2 ± 137.4) than the oil non-emulsified group (-785.4 ± 132.9) over a 5-hour postprandial period (P < 0.05), but the difference became insignificant over a 10-hour postprandial period. On the other hand, the coconut oil group resulted in higher fullness VAS than the olive oil group (P < 0.05), for both iAUC_{0-5 hour} (coconut oil: 813.3 ± 146.0; olive oil: 575.4 ± 139.8) and iAUC_{0-10 hour} values (coconut oil: 1,785.9 ± 311.3; olive oil: 1,368.5 ± 306.3). There is no interaction effect of the emulsification and the type of oil on all the six subjective appetites VAS during the postprandial state.

Conclusions

The type and emulsification of oil in a high-fat meal could cause differential appetite responses over a certain postprandial duration. Physiological measures, such as appetite-regulating hormones, energy expenditure and substrate oxidation rates, are necessary to elucidate the differences in subjective appetite responses in future studies.

Funding Sources

National University of Singapore and Agency for Science, Technology and Research, Industry Alignment.

Effect of Okara and Biovalorized Okara Biscuits Consumption on Postprandial Circulating Amino Acid Concentrations: A Crossover Randomized Controlled Trial

Objectives

Soymilk or tofu production results in considerable okara (soybean pulp) generation. Although okara has a high protein content and contains all essential amino acids, its low water solubility and anti-nutrient presence reduces its protein digestibility. Okara fermented with Rhizopus oligosporus can increase its digestibility by lowering anti-nutrient content and liberating free amino acids. However, neither okara nor biovalorized okara has been evaluated for its effect on postprandial blood amino acids. This study hence explored this gap in knowledge with okara- and biovalorized okara- containing biscuits consumption.

Methods

The randomized controlled crossover trial involved 15 middle-aged and older Singaporean adults. Each participant undertook 3 separate 2-hour meal tolerance test with 100 g of control biscuits (C), biovalorized okara biscuits (RO), and autoclaved okara biscuits (AOK). RO and AOK were developed with the same recipe as C, utilizing a 20% wheat flour substitution with R. oligosporus fermented okara or autoclaved okara respectively. Biscuit total and free amino acids contents were analyzed by cation-exchange chromatography. Circulating free amino acids concentrations were assessed at timepoints 0, 15, 30, 45, 60, 90, and 120 min. Incremental area under curve (iAUC) and peak concentration were assessed, with results presented as mean (95% confidence interval).

Results

Biscuit total amino acid content (mean ± standard deviation, g/100 g) was significantly greater for RO (7.51 ± 0.22) and AOK (6.78 ± 0.39) compared to C (5.93 ± 0.33), with RO having notably greater alanine, cysteine, and proline content over AOK. Free amino acid content in biscuit (nmol/g) in ascending order was C (485 ± 11), AOK (698 ± 13), and RO (3414 ± 97). Amino acid iAUC had no significant difference, as demonstrated with total amino acids iAUC (μmol/L·min) (P = 0.568, C: 23 649 (13 738, 33 560), RO: 23 284 (13 374, 33 195) & AOK: 17 257 (7 346, 27 168)). Peak iAUC concentration also showed no significant difference across all amino acids, with total amino acids peak iAUC concentration (μmol/L) as P = 0.560, C: 387 (233,540), RO: 456 (303,610) & AOK: 343 (189,497).

Conclusions

Consumption of okara- or biovalorized okara- containing biscuits does not alter postprandial amino acid responses in middle-aged and older Singaporeans.

Funding Sources

Singapore Ministry of Education.

Booster Vaccination Strategies for “Living With COVID-19”

Although the primary and secondary vaccination rates in Korea account for over 75% of the total population, confirmed cases of COVID-19 are dramatically increasing due to immune waning and the Omicron variant. Therefore, it is urgent to evaluate the effectiveness of booster vaccination strategies for living with COVID-19. In this work, we have developed an age-specific mathematical model with eight age groups and included age-specific comorbidities to evaluate the effectiveness of age-specific vaccination prioritization strategies to minimize morbidity and mortality. Furthermore, we have investigated the impacts of age-specific vaccination strategies for different vaccine supplies and non-pharmaceutical intervention levels during two periods: (1) when vaccine supply was insufficient and (2) after the emergence of the omicron variant. During the first period, the best option was to vaccinate the 30–49 year age group and the group with comorbidities to minimize morbidity and mortality, respectively. However, a booster vaccination should prioritize the 30–49 year age group to promote both minimal morbidity and mortality. Critical factors, such as vaccination speed, vaccine efficacy, and non-pharmaceutical interventions (NPIs), should be considered for effective vaccination prioritization as well. Primary, secondary vaccinations, and a booster shot vaccinations require different age prioritization strategies under different vaccination rates, vaccine efficacies, and NPI levels.

High-precision measurement of the W boson mass with the CDF II detector

The mass of the W boson, a mediator of the weak force between elementary particles, is tightly constrained by the symmetries of the standard model of particle physics. The Higgs boson was the last missing component of the model. After observation of the Higgs boson, a measurement of the W boson mass provides a stringent test of the model. We measure the W boson mass, M_W, using data corresponding to 8.8 inverse femtobarns of integrated luminosity collected in proton-antiproton collisions at a 1.96 tera-electron volt center-of-mass energy with the CDF II detector at the Fermilab Tevatron collider. A sample of approximately 4 million W boson candidates is used to obtain [Formula: see text], the precision of which exceeds that of all previous measurements combined (stat, statistical uncertainty; syst, systematic uncertainty; MeV, mega-electron volts; c, speed of light in a vacuum). This measurement is in significant tension with the standard model expectation.

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

Background

The coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain.

Methods

Patients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors.

Results

A total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients’ decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain.

Conclusions

COVID-19 has caused several changes in patients with chronic pain. During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients’ increasing pain.

Impact of fiber-fortified food consumption on anthropometric measurements and cardiometabolic outcomes: A systematic review, meta-analyses, and meta-regressions of randomized controlled trials

The consumption of processed and refined food lacking in fiber has led to global prevalence of obesity and cardiometabolic diseases. Fiber-fortification into these foods can yield potential health improvements to reduce disease risk. This meta-analyses aimed to evaluate how fiber-fortified food consumption changes body composition, blood pressure, blood lipid-lipoprotein panel, and glycemic-related markers. Searches were performed from 5 databases, with 31 randomized controlled trial eventually analyzed. Hedges' g values (95% confidence interval [CI]) attained from outcome change values were calculated using random-effects model. Fiber-fortified food significantly reduced body weight (-0.31 [-0.59, -0.03]), fat mass (-0.49 [-0.72, -0.26]), total cholesterol (-0.54 [-0.71, -0.36]), low-density lipoprotein cholesterol (-0.49 [-0.65, -0.33]), triglycerides (-0.24 [-0.36, -0.12]), fasting glucose (-0.30 [-0.49, -0.12]), and HbA1c (-0.44 [-0.74, -0.13]). Subgroup analysis differentiated soluble fiber as significantly reducing triglycerides and insulin while insoluble fiber significantly reduced body weight, BMI, and HbA1c. Greater outcome improvements were observed with solid/semi-solid food state than liquid state. Additionally, fiber fortification of <15 g/day induced more health outcome benefits compared to ≥15 g/day, although meta-regression found a dose-dependent improvement to waist circumference (p-value = 0.036). Findings from this study suggest that consuming food fortified with dietary fiber can improve anthropometric and cardiometabolic outcomes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2053658.

Association Between Dietary Protein Intake and Sleep Quality in Middle-Aged and Older Adults in Singapore

Poor sleep has been associated with the increased risk of developing detrimental health conditions. Diet and certain nutrients, such as dietary protein (PRO) may improve sleep. This cross-sectional study aimed to investigate the relationship between PRO intake, their amino acid components, and sources with sleep quality in middle-aged and older adults residing in Singapore. A dataset of 104 healthy subjects between the age of 50 and 75 years old were used. Collected data included 3-day food record and sleep quality [sleep duration, global sleep score (GSS), sleep latency (SL), and sleep efficiency (SE)]. The collected 3-day food records were extracted for PRO, tryptophan (Trp), and large neutral amino acid (LNAA) intake. PRO intake was further categorized into plant and animal PRO. A multivariate multiple linear regression (MLR) was performed to assess the association between PRO intake and sleep quality. Dietary Trp:LNAA ratio was positively associated with sleep duration (β_total: 108.234 h; p: 0.005) after multiple covariates adjustment. Similarly, plant Trp (β_plant: 2.653 h/g; p: 0.020) and plant Trp:LNAA (β_plant: 54.006 h; p: 0.008) was positively associated with sleep duration. No significant associations were observed for both SL and SE. Sleep duration in middle-aged and older Singaporean adults was positively associated with dietary Trp and Trp:LNAA, especially when obtained from plant sources.

A Phase 3, Randomized, Multi-center Clinical Trial to Evaluate the Efficacy and Safety of Neu-BoNT/A in Treatment of Primary Axillary Hyperhidrosis

BACKGROUND

Botulinum toxin type A is widely used to treat primary axillary hyperhidrosis and has proven to be an effective and safe approach. Onabotulinumtoxin A was approved by the FDA as a treatment for primary axillary hyperhidrosis. This study aimed to evaluate the efficacy and safety of Neu-BoNT/A in subjects diagnosed with primary axillary hyperhidrosis.

METHODS

The Hyperhidrosis Disease Severity Scale, gravimetric measurement of sweat, and Global Assessment Scale were analyzed at weeks 4, 8, 12, and 16 to determine the effect of treatment. Adverse events, physical examination, and vital signs were monitored.

RESULTS

Subjects treated with Neu-BoNT/A showed statistically significant improvement by all 3 methods at weeks 4, 8, 12, and 16 (P value = 0.00). There were no severe adverse events or significant changes in vital signs, physical examination, or laboratory tests.

CONCLUSION

Neu-BoNT/A can be effectively and safely used for primary axillary hyperhidrosis.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Impact of following a healthy dietary pattern with co-consuming wolfberry on number and function of blood outgrowth endothelial cells from middle-aged and older adults

Blood outgrowth endothelial cells (BOECs) have received growing attention in relation to cardiovascular disease (CVD). However, the effect of diet intervention, a primary strategy for CVD prevention, on BOECs is not reported. This study aims to investigate the effect of following a healthy dietary pattern (HDP) with or without wolfberry consumption, healthy food with potential cardiovascular benefits, on the number and function of BOECs in middle-aged and older adults. Twenty-four subjects consumed either an HDP only (n = 9) or an HDP supplemented with 15 g day^-1 wolfberries (n = 15) for 16 weeks. At pre- and post-intervention, vascular health biomarkers and composite CVD risk indicators were assessed. BOECs were derived from peripheral blood mononuclear cells and their angiogenic and migration activities were measured. Isolated BOECs have typical endothelial cobblestone morphology, express von Willebrand factor and KDR. Consuming an HDP improved the BOEC colony's growth rate, which was demonstrated by significant time effects in the colony's culture time between passages 1 and 2 (P = 0.038). Both interventions increased BOECs' tube formation capacity. Moreover, HDP intervention contributed to a time effect on BOEC migration activity (P = 0.040 for t_1/2gap). Correlation analysis revealed that BOEC colony number was positively associated with blood pressure, atherogenic index, vascular age, and Framingham risk score. In conclusion, adherence to an HDP improved BOECs' function in middle-aged and older populations, while additional wolfberry consumption did not provide an enhanced effect. Our results provide mechanistic dissection on the beneficial effects on BOECs of dietary pattern modification.