Skeletal Muscle and Prognosis of Liver Cancer

Sarcopenia is gaining attention as a poor prognostic factor for various types of malignancies. This study evaluated the prevalence and prognostic significance of sarcopenia and its association with survival in hepatocellular carcinoma (HCC) patients who underwent radiotherapy (RT) to the primary site (1). The results showed that Pre-RT sarcopenia occurred in 99 (63.5%) patients and was significantly associated with higher levels of protein induced by vitamin K absence or antagonist-II (PIVKA-II), lower percentage of overweight/obesity (body-mass index), higher percentage of previous systemic chemotherapy, and lower total RT dose. At a median follow-up of 9.3 months, median overall survival (OS) was significantly lower in patients with pre-RT sarcopenia than in those without. In multivariate analysis albumin-bilirubin score, total dose and pre-RT sarcopenia were independent OS prognostic factors. Among patients without pre-RT sarcopenia, 20 newly developed sarcopenia after RT and showed significantly lower OS compared to those without sarcopenia after RT. Multivariate logistic regression analysis demonstrated older age, Child-Pugh classification B or C, higher alpha-fetoprotein), higher PIVKA-II, and larger planning target volume as significant factors for newly developed post-RT sarcopenia. The authors conclude that developed sarcopenia after RT, as well as pre-RT sarcopenia, were associated with poor survival for HCC patients who underwent RT to the liver. This result suggests the possibility that early intervention such as nutritional support and exercise therapies before and during RT could prevent muscle wasting and may be effective in improving the prognosis of HCC patients.

Vitamin D and Diabetic Retinopathy

Contrasting data about the association between proliferative diabetic retinopathy (PDR) and vitamin D status remain unknown, and was discussed by this study (1). First, a hospital-based cross-sectional study consisting of 889 diabetic retinopathy (DR) and non-DR (NDR) patients was admitted. Further the accumulated evidence was performed to explore the association and dose-response relationship. The study indicated that the odd ratio for PDR in vitamin D deficiency (VDD) individuals was significantly increased compared with NDR in vitamin D sufficiency individuals, adjusted by age, sex, diabetic duration, and HbA1c. Four studies plus the study with data on vitamin D levels in 4970 patients with PDR and NDR subjects were compared. Results showed that association between vitamin D deficiency and risk of PDR exists. The authors conclude that vitamin D deficiency is significantly associated with risk of proliferative diabetic retinopathy.

The treatment of ankylosing spondylitis (AS) patients requires a combination of non-pharmacological (education, exercise and physical therapy), as well as pharmacological treatment modalities. The optimal management of AS still remains unresolved. The aim of this study was to measure and compare the effects of whole-body cryotherapy (WBC) at -110∘C and at -60∘C and exercise therapy alone on disease activity and the functional parameters of patients with ankylosing spondylitis (AS) (1). Ninety-two patients were allocated to three groups: with WBC at -110∘C or at -60∘C (each concurrent with exercise therapy), or exercise therapy alone. Disease activity and the functional parameters of the patients were measured at study entry and at the end of the 8-day treatment. The results showed that therapy, irrespective of the program, led to a significant reduction in disease activity (Bath Ankylosing Spondylitis Disease Activity Index: BASDAI, Ankylosing Spondylitis Disease Activity Score: ASDAS-CRP), disease-related back pain, fatigue, duration and intensity of morning stiffness and a significant improvement in the patient's functional capacity (Bath Ankylosing Spondylitis Functional Index: BASFI), spine mobility (Bath Ankylosing Spondylitis Metrology Index: BASMI) and chest expandability, with no changes in the levels of CRP. It has been demonstrated that following therapy, the group that underwent cryotherapy at -110∘C manifested significantly reduced disease activity (BASDAI) compared with exercise therapy only.

Refractory edema is characterized by persistent swelling which does not react to diuretic use and sodium restriction. This case report shows a traditional herbal medicine, Gwack Rhyung Tang and Chunggan extract effectively treated refractory lower limb edema caused by cirrhosis and improved liver function (1). A 64-year-old male patient with a history of hypertension, diabetes mellitus, hepatic encephalopathy, and cellulitis presented lower limb edema which did not react to diuretics for more than 7 months. The patient was treated for 25 days using Gwack Rhyung Tang and Chunggan extract. The results showed a loss of body weight, decrease in circumferences of both lower limb and improvement of liver function biochemistry results are checked. There was no recurrence or aggravation of the condition up to 3 weeks of follow-up periods. The authors conclude that traditional herbal medicine can be an effective alternative for refractory edema due to cirrhosis with improving liver function.

The objective of this study was to assess the efficacy and safety of acupuncture plus routine treatment (RT) for acute pancreatitis (AP) (1). Literature searches were performed in 8 databases up to October 31, 2018. Randomized controlled trials comparing acupuncture plus RT with RT alone for AP were included. The results showed that twelve eligible studies were included finally. The meta-analysis showed that acupuncture plus RT compared with RT alone could significantly improve the total effective rate and gastrointestinal function and reduce the Acute Physiology, Age, Chronic Health Evaluation II score, tumor necrosis factor α count, the time of resuming to diets, and the length of hospital stay. Only 3 of the studies reported adverse events or reactions. The authors conclude that this study suggested that acupuncture combined with RT may be effective for AP. However, more rigorously designed randomized controlled trials are warranted to confirm the current findings.

Chronic kidney disease (CKD) patients have a high incidence of cardiovascular diseases (CVD) which increases their morbidity and mortality. A sedentary lifestyle in CKD is directly linked to the onset of CVD. Physical activity can bring beneficial effects to CKD patients. The aim of this study was assess the impact of aerobic training on nontraditional cardiovascular risk factors in CKD patients on hemodialysis (1). This was a prospective, controlled, and randomized clinical trial with analysis of intention to treat. Thirty patients underwent an exercise treadmill test, an arterial stiffness evaluation, echocardiography and analysis of endothelial reactivity, and carotid ultrasound and laboratorial tests, including analysis of serum aldosterone. The intervention group (IG) (n =15) underwent aerobic exercise during hemodialysis 3 times a week for 4 months. The control group (CG) (n =15) had no intervention. All of the patients were reassessed after 4 months. Results showed that there was a statistically significant improvement in flow-mediated vasodilation and a reduction in left ventricular hypertrophy and serum aldosterone. There was an increase in C-reactive protein in the CG. The authors conclude that this aerobic training protocol was able to improve endothelial function with enhanced FMV and reduce left ventricular hypertrophy and serum aldosterone, which could have a positive impact on the reduction of nontraditional cardiovascular risk factors in CKD patients on hemodialysis.

This study was a randomized controlled trial aimed to test whether vitamin D (VD) supplementation affects measures of physical performance in VD-insufficient mildly trained children (1). Thirty-six recreationally soccer player boys were randomly assigned to single dose (200,000 IU) of VD3 or placebo. Plasma 25-hydroxyvitamin D (25-OHD) was assessed and measures of physical performance (i.e. vertical and standing broad jumps, triple hop, 10-m and 30-m sprints, shuttle run) were performed before and 12 weeks after the loading dose. Baseline 25-OHD and physical variables were equivalent in the two groups. The results showed that twelve weeks after VD loading, plasma 25-OHD increased and physical variables improved in VD group, only. There was a significant interaction effects for group by time for vertical jump, triple hop jump, 10-m and 30-m sprints, and shuttle run. The authors conclude that a single bolus of VD3 resulted in significant improvements in jumping ability, agility, and running speed in VD-insufficient mildly trained children. The findings suggest that correcting VD deficit might be beneficial for physical performance.

Vascular dementia (VaD), a severe neurologic condition related to aging of the cerebrovascular structure, has been treated with herbal medications and products. In this overview of systematic reviews (SRs) on the effects of herbal medications, the authors aimed to summarize the current clinical evidence on the benefits of herbal drugs and to propose an evidence map outlining their effects on VaD (1). The results showed that ten SRs (4 on individual herbal medications, 6 on various herbal drugs) were included. The overall evidence on herbal medicines suggests that they are effective in improving cognitive function and performance. Individual herbal medications including FuFangHaiShe, NaoXinTong, YinDanXingNaoTong, NaoMaiTai, ShenFuTang, and TongXinLuo showed favourable effects when assessed via a minimal mental state examination score but have limited evidence supporting their effectiveness due to the scarcity of randomized controlled trials. Concerning safety, most SRs did not outline the estimated risk ratio of adverse events. The authors conclude that herbal medications might have benefits for VaD patients but they need to be evaluated further.

In this study, the authors identified the frequency and assessed the validity of marketing claims made by American chiropractors, naturopaths, homeopaths, acupuncturists, and integrative medicine practitioners relating to the diagnosis and treatment of celiac disease and nonceliac gluten sensitivity (NCGS), both of which have increased in prevalence in recent years (1). The results showed that of 500 clinics identified, 178 (35.6%) made a claim regarding celiac disease, NCGS, or a gluten-free diet. Naturopath clinic websites have the highest rates of advertising at least one of diagnosis, treatment, or efficacy for celiac disease (40%), followed by integrative medicine clinics (36%), homeopaths (20%), acupuncturists (14%), and chiropractors (12%). Integrative medicine clinics have the highest rates of advertising at least one of diagnosis, treatment, or efficacy for NCGS (45%), followed by naturopaths (37%), homeopaths (14%), chiropractors (14%), and acupuncturists (10%). A geographic analysis yielded no significant variation in marketing rates among clinics from different cities. Of 232 marketing claims made by these complementary and alternative medicine (CAM) clinic websites, 138 (59.5%) were either false or unproven. The authors conclude that a significant number of CAM clinics advertise diagnostic techniques or treatments for celiac disease or NCGS. Many claims are either false or unproven, thus warranting a need for increased regulation of CAM advertising to protect the public.

Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea, infertility and hirsutism. Conventional treatment of PCOS includes a range of oral pharmacological agents, lifestyle changes and surgical modalities. Beta-endorphin is present in the follicular fluid of both normal and polycystic ovaries. It was demonstrated that the beta-endorphin levels in ovarian follicular fluid of otherwise healthy women who were undergoing ovulation were much higher than the levels measured in plasma. Given that acupuncture impacts on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion, it is postulated that acupuncture may have a role in ovulation induction via increased beta-endorphin production affecting GnRH secretion. This is an update of a review from 2016 (1). The goal was to assess the effectiveness and safety of acupuncture treatment for oligo/anovulatory women with polycystic ovarian syndrome (PCOS) for both fertility and symptom control. The authors conclude that for true acupuncture versus sham acupuncture they cannot exclude clinically relevant differences in live birth rate, multiple pregnancy rate, ovulation rate, clinical pregnancy rate or miscarriage. Number of intermenstrual days may improve in participants receiving true acupuncture compared to sham acupuncture. True acupuncture probably worsens adverse events compared to sham acupuncture. No studies reported data on live birth rate and multiple pregnancy rate for the other comparisons: physical exercise or no intervention, relaxation and clomiphene. Evidence was very low quality with very wide CIs and very low event rates.There are only a limited number of RCTs in this area, limiting their ability to determine effectiveness of acupuncture for PCOS.

The purpose of this study was to evaluate the results of patients, with a chief complaint of recurrent aphthous stomatitis (RAS), who were found to have zinc deficiency as the predisposing factor and received appropriate replacement therapy (1). A retrospective study was conducted using data from the medical records of patients with a chief complaint of RAS. Patients with potential ulcer-causing conditions were excluded. All patients were intraorally examined to rule out trauma-associated aetiologies. Blood tests were ordered to measure total blood count, serum transferrin, ferritin, zinc, folic acid and vitamin B12 levels. The results showed that a total of 48 patients, 34 with zinc deficiency and 14 with both zinc and iron deficiencies, were included in this study. Patients received an initial three-monthly replacement treatment and blood tests for the certain deficiencies were repeated at the end of this time interval. Two patients with zinc deficiency reported no relief due to incorrect intake of tablets with milk. Following correct instructions, all patients reached normal serum mineral levels and reported no recurrences. All patients remained asymptomatic and their mineral levels were monitored in every 3 months to detect any abnormalities. Overall mean follow-up for this study was 12.06 months (range: 8-28 months, SD: ± 5.7). The authors conclude that zinc deficiency should be considered and investigated as part of the diagnostic process of RAS. A simple blood test may aid in correct diagnosis and complete resolution of this recurring condition rather than constant prescription of certain medicines to suppress the symptoms.

Vitamin D supplementation is important in military research because of its role in musculoskeletal health. This systematic review examined the effects of vitamin D supplementation on serum 25-hydroxyvitamin D (25(OH)D) concentrations and musculoskeletal health outcomes in military personnel (1). Reviewers independently screened titles, abstracts, and full texts of the articles using predefined criteria. The results showed that four RCTs were included in the qualitative analyses. The 25(OH)D concentrations was improved with 2000 IU/d supplementation (mean difference = 3.90 ng/mL; 95% CI, 0.22-7.58). A trial on female Navy recruits showed a significant decrease in stress fractures (risk ratio, 0.77; 95% CI, 0.62-0.95), particularly tibial fractures, from daily supplementations of 800 IU vitamin D and 2000 mg calcium. The authors conclude that there was a positive trend in 25(OH)D concentrations from higher doses of supplementary vitamin D in military submariners and a possible benefit to bone health when vitamin D was combined with calcium.

Potential health benefits are attributed to the antioxidant properties of green tea polyphenolic compounds. The main aim of the study was to evaluate the effects of a six-week green tea extract (GTE) supplementation combined with CrossFit workout on blood antioxidant status and serum brain-derived neurotrophic factor (BDNF) in men (1). Sixteen young males involved in CrossFit training were randomized into two groups supplemented with GTE or placebo for six weeks. Each participant performed an exercise test for the evaluation of maximum oxygen uptake (VO2max) twice, i.e., before starting (1st trial) and after completing the supplementation combined with CrosFit workout (2nd trial). The results showed that except for a significantly higher SOD activity and FRAP level recorded at rest and post-exercise in the 2nd trial compared to the corresponding values in the 1st trial, no significant differences were recorded among other assayed measures such as CAT, GPx, GR, GSH and BDNF. The authors conclude that a six weeks' consumption of GTE had marginal effect on aerobic capacity and serum BDNF level in CrossFit-trained men, but it caused a marked increase in the blood antioxidant capacity and a moderate attenuation of the training-induced lipid peroxidation.

Urinary tract infection (UTI) is one of the most severe public health problem affecting both genders but females are more susceptible due to the differences in urogenital and reproductive anatomy, physiology and lifestyle. This review article was aimed to describe the natural therapeutic strategies to manage and cure the UTI (1). For this purpose, different databases including Google Scholar, Cochrane database, and PubMed etc. were explored. Inclusion criteria was to include any research article investigating the current therapy of UTI. It was found that microbial infections including Escherichia coli, Enterococcus faecalis and Klebsiella species are the major causes of UTI with a different signs and symptoms including painful urination or dysuria, hematuria, urinary urgency, burning micturition, frequent urination, nausea, and vomiting. Antibiotics like Trimethoprim, Sulfamethoxazole, quinolone etc. as the first choice of the drug are used worldwide. However, due to microbial resistance, several life-threatening side effects, repeated high doses, high cost and low efficacy of these antibiotics motivated the researchers to explore natural remedies for the treatment of UTI. Herbal medicines are effective to combat bacterial resistance with high efficacy, and easy availability with minimal or no side effects, that's why it attained the attention to explore the herbal treatment of UTI. The authors conclude that Vaccinium macrocarpon, Tribulus terrestris, Trachyspermum copticum, Cinnamomum verum and Hybanthusenn easpermus are some common medicinal plants reported to have therapeutic potential for the management and cure of the UTI. Although herbal medicines have more potential over conventional medicine but more discoveries are required to explore the phytoconstituents and their mechanism of action.