Effects of income and residential area on survival of patients with head and neck cancers following radiotherapy: working age individuals in Taiwan

Objectives The five-year survival rate of head and neck cancer (HNC) after radiotherapy (RT) varies widely from 35% to 89%. Many studies have addressed the effect of socioeconomic status and urban dwelling on the survival of HNC, but a limited number of studies have focused on the survival rate of HNC patients after RT. Materials and methods During the period of 2000–2013, 40,985 working age individuals (20  medium income group > low income group and northern > central > southern > eastern Taiwan. Patients with moderate income levels had a 36.9% higher risk of mortality as compared with patients with high income levels (hazard ratio (HR) = 1.369; p < 0.001). Patients with low income levels had a 51.4% greater risk of mortality than patients with high income levels (HR = 1.514, p < 0.001). Conclusion In Taiwan, income and residential area significantly affected the survival rate of HNC patients receiving RT. The highest income level group had the best survival rate, regardless of the geographic area. The difference in survival between the low and high income groups was still pronounced in more deprived areas

[[alternative]]The Association Between the Use of Complementary and Alternative Medicine and Glycemic Control in Patients with Diabetes

[[abstract]]　　研究目的：探討糖尿病患者為了治療糖尿病而使用輔助及另類醫學(以下簡稱另類醫學)的人口社會學，罹病情況和盛行率及其使用另類醫學的關聯性，以及影響使用另類醫學的因素與使用另類醫學是否影響血糖的控制。　　　　研究方法：採立意取樣和結構性問卷，面對面方式訪談，以南部某區域教學醫院新陳代謝科門診之糖尿病患者為樣本。　　　　研究結果：在收集的221份問卷中，47.5%的受訪者曾使用另類醫學，從未使用的人，占52.5%。過去一年內有使用的人，有24.4%，過去一年內沒有使用的人，75.6 %。使用多元羅吉斯逐步反向迴歸分析，結果為(1)得糖尿病開始至受訪為止，是否使用另類醫學的情形下：罹病期(>10，≦15年,odds ratio=2.56, 95%CI=1.17-5.57)；罹病期(>15，≦20年,odds　ratio=2.98, 95%CI=1.18-7.53)；罹病期(>20年,odds ratio=3.12, 95%CI=1.26-7.69)比罹病期(>1，≦5年)傾向使用另類醫學。(2)過去一年內是否使用另類醫學的情形下：同時使用飲食控制、運動和藥物的治療方式(odds ratio=2.01, CI= 1.05-3.87)比缺少其中1至2種治療方式，傾向使用另類醫學。(3)過去一年內是否使用另類醫學情形下(曾經使用另類醫學，過去一年內是否仍繼續使用和過去一年內是否才開始使用另類醫學)：沒有完整接受過護理衛教師、營養師和醫師三種人的衛教(odds ratio=7.58, 95%CI= 1.88-30.67)比完整接受過三種人的衛教，傾向使用另類醫學。(4)在人口社會學、糖尿病類型、併發症數目、是否加入醫療改善方案，與是否使用另類醫學的研究結果，皆無統計上的顯著差異。使用卡方檢定和 t-檢定的結果為：不論將糖化血色素分成2組、3組、5組和平均值來分析，顯示出糖化血色素(HbA1c)的改變，與使用另類醫學都沒有統計上的顯著差異。　　　　結論：糖尿病患者，為了糖尿病而使用另類醫學的比例，比國外的研究報告高(24.4% )。是否使用另類醫學，不影響血糖控制。罹病期>10年，傾向使用另類醫學。同時使用飲食控制、運動和藥物的治療方式，較傾向使用另類醫學。沒有完整接受過護理衛教師、營養師和醫師三種人的衛教，較傾向使用另類醫學。[[abstract]]　　Objective:This study aimed to investigate the use of complementary and alternative medicine (CAM) for glycemic control in patients with diabetes. Demography, conditions and duration of morbidity, prevalence and factors associated with the use of CAM, and glycemic control were studied.　　　　Methods: Convenient sampling method was used to recruit participants from outpatients with diabetes in the department of endocrinology and metabolism in a regional teaching hospital in south Taiwan. Structured questionnaires were administered to the participants using face-to-face interview.　　 　　Results: Of the 221 participants, 47.5% had used CAM and 52.5% had never used it. For use of CAM over the past year, 24.4% of the participants used CAM over the past year and 75.6% of them did not use it over the past year. Results from backward stepwise multiple logistic regression indicated that (1) duration of diabetes was directly associated with the use of CAM (duration >10 & ≤ 15 years, odds ratio=2.56,95%CI=1.17-5.57; duration> 15 & ≤ 20 years, odds ratio=2.98, 95%CI=1.18-7.53; and duration >20 years, odds ratio=3.12, 95%CI=1.26-7.69; compared to duration >1 & ≤ 5 years); (2) using all three diet control, exercise, and medications treatment modalities was directly associated with the use of CAM in participants who used CAM in the past year (odds ratio=2.01, 95%CI= 1.05-3.87) compared to those who used only one or two of the three modalities; (3) receiving diabetes education from only one or two of the three information sources of diabetes educators (nurses , dieticians, and physicians) was directly associated with the use of CAM in participants who had ever used CAM and still used CAM in the past year and those who first used CAM in the past year (odds ratio=7.58, 95%CI=1.88-30.67) compared to those who received diabetes education from all three sources. (4) none of the other factors including demography, type of diabetes, the number of complications, participation in the medical improvement project were significantly associated with the use of CAM. Results from chi-square test and t-test indicated that change in HbA1c was not associated with the use of CAM regardless whether HbA1c was categorized into two, three, five groups, and mean values.　　　　Conclusion: The prevalence of CAM use for diabetes management was high (24.4%) in this study compared with those reported in international studies. The use of CAM was not associated with glycemic control in patients with diabetes. The use of CAM was significantly associated with the duration of diabetes over 10 years, using all three modalities of treatment for diabetes (diet control, exercise, and medications), and not receiving all three information sources of diabetes educators (nurses, dieticians, and physicians)

Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan.

OBJECTIVES:Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer. METHODS:A total of 14,240 working-age patients (20 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074-1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107-1.277, p = 0.001, respectively). CONCLUSIONS:In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers' attention

Intravascular laser irradiation of blood as novel migraine treatment: an observational study

Abstract Background Migraine is one of four major chronic diseases that cause disability. Decreases in regional cerebral blood flow (rCBF) occur during migraine attacks. Laser therapy is extensively employed in treating other vascular diseases; nevertheless, its effectiveness in migraine management remains largely unknown. Therefore, we evaluated the effect of low-level intravascular laser irradiation of blood (ILIB) therapy in patients with migraine. Methods We performed an observational case–control study in 24 patients suffering from migraine. Patients were divided into an ILIB treatment group and a traditional rehabilitation group. This study performed clinical assessments and single-photon emission computed tomography (SPECT) prior to and after the treatment and 1 month later. Changes in rCBF-SPECT between groups and between timepoints were compared to clinical outcomes. Results Nine patients undergoing rehabilitation and fifteen patients undergoing ILIB were studied from baseline to 1 month follow-up. The ILIB group, visual analog scale for pain (P = 0.001), Montreal Cognitive Assessment (P = 0.003), and Athens Insomnia Scale (P < 0.001) symptom scores significantly improved after treatment. SPECT imaging showed a 1.27 ± 0.27 fold increase in rCBF after ILIB treatment, and no significant differences in the rehabilitation group. Conclusions Low-level ILIB therapy is associated with better clinical and vascular outcomes, and may be a feasible treatment option for migraine. Although our sample size was small, our data provide a starting point for migraine laser therapy research

High pre-operative serum aminotransferase levels predict local recurrence after curative resection of hepatocellular carcinoma

Background: Hepatocellular carcinoma is a common cancer with an increasing incidence worldwide because of the dissemination of hepatitis B and hepatitis C virus infection. Surgical resection is the most important therapeutic option with a curative intent. Early tumor detection through screening and improvements in surgical techniques have significantly improved the outcome of patients with hepatocellular carcinoma. However, local recurrence after curative hepatic resection is common and is the most frequent cause of death in these patients. Patients and Methods: In an attempt to identify the risk factors that predict tumor recurrence, we conducted this retrospective study in a single institution for a 6-year period. Of the 100 consecutive patients who underwent curative tumor resection, we analyzed age, sex, viral etiology (hepatitis B virus vs. hepatitis C virus), preoperative levels of aspartate aminotransferase and alanine aminotransferase, the α-fetoprotein level, underlying liver disease status (chronic hepatitis vs. cirrhosis), number and size of tumors, type of resection, and presence of microvascular invasion. Results: In the median follow-up period of 36 months (range, 12–85 months), the 1-year, 3-year, and 5-year overall survival rates were 90%, 84%, and 73%, respectively; tumor recurrence occurred in 38 (38%) patients and was the leading cause of death among the patients who died (15 of 17 patients; 88%). On univariate analysis, the only factor significantly associated with a higher incidence of tumor recurrence was preoperative levels of aspartate aminotransferase greater than twice the upper normal value (p < 0.01) and this factor remained significant with multivariate analysis. Subgroup analysis of the risk factor of early tumor recurrence (≤2 years) and late tumor recurrence (>2 years) was conducted and a preoperative aspartate aminotransferase level greater than twice the upper normal value was still significant in both groups (p = 0.02 and p = 0.044, respectively). Conclusion: Although this is a small-scale study, our findings could be easily applied clinically and used as readily available indicators to help the follow-up algorithm. We also suggest antiviral management as soon as possible for patients with hepatocellular carcinoma undergoing curative resection, especially those with a high preoperative aspartate aminotransferase level

High pre-operative serum aminotransferase levels predict local recurrence after curative resection of hepatocellular carcinoma

Hepatocellular carcinoma is a common cancer with an increasing incidence worldwide because of the dissemination of hepatitis B and hepatitis C virus infection. Surgical resection is the most important therapeutic option with a curative intent. Early tumor detection through screening and improvements in surgical techniques have significantly improved the outcome of patients with hepatocellular carcinoma. However, local recurrence after curative hepatic resection is common and is the most frequent cause of death in these patients. In an attempt to identify the risk factors that predict tumor recurrence, we conducted this retrospective study in a single institution for a 6-year period. Of the 100 consecutive patients who underwent curative tumor resection, we analyzed age, sex, viral etiology (hepatitis B virus vs. hepatitis C virus), preoperative levels of aspartate aminotransferase and alanine aminotransferase, the α-fetoprotein level, underlying liver disease status (chronic hepatitis vs. cirrhosis), number and size of tumors, type of resection, and presence of microvascular invasion. In the median follow-up period of 36 months (range, 12–85 months), the 1-year, 3-year, and 5-year overall survival rates were 90%, 84%, and 73%, respectively, tumor recurrence occurred in 38 (38%) patients and was the leading cause of death among the patients who died (15 of 17 patients, 88%). On univariate analysis, the only factor significantly associated with a higher incidence of tumor recurrence was preoperative levels of aspartate aminotransferase greater than twice the upper normal value (p 2 years) was conducted and a preoperative aspartate aminotransferase level greater than twice the upper normal value was still significant in both groups (p = 0.02 and p = 0.044, respectively). Although this is a small-scale study, our findings could be easily applied clinically and used as readily available indicators to help the follow-up algorithm. We also suggest antiviral management as soon as possible for patients with hepatocellular carcinoma undergoing curative resection, especially those with a high preoperative aspartate aminotransferase level

Ferroptosis-Regulated Natural Products and miRNAs and Their Potential Targeting to Ferroptosis and Exosome Biogenesis

Ferroptosis, which comprises iron-dependent cell death, is crucial in cancer and non-cancer treatments. Exosomes, the extracellular vesicles, may deliver biomolecules to regulate disease progression. The interplay between ferroptosis and exosomes may modulate cancer development but is rarely investigated in natural product treatments and their modulating miRNAs. This review focuses on the ferroptosis-modulating effects of natural products and miRNAs concerning their participation in ferroptosis and exosome biogenesis (secretion and assembly)-related targets in cancer and non-cancer cells. Natural products and miRNAs with ferroptosis-modulating effects were retrieved and organized. Next, a literature search established the connection of a panel of ferroptosis-modulating genes to these ferroptosis-associated natural products. Moreover, ferroptosis-associated miRNAs were inputted into the miRNA database (miRDB) to bioinformatically search the potential targets for the modulation of ferroptosis and exosome biogenesis. Finally, the literature search provided a connection between ferroptosis-modulating miRNAs and natural products. Consequently, the connections from ferroptosis–miRNA–exosome biogenesis to natural product-based anticancer treatments are well-organized. This review sheds light on the research directions for integrating miRNAs and exosome biogenesis into the ferroptosis-modulating therapeutic effects of natural products on cancer and non-cancer diseases