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Chiang-Wen Lee,1– 4,* Thi Thuy Tien Vo,5,* Yinshen Wee,6 Yao-Chang Chiang,1,2 Miao-Ching Chi,7– 9 Min-Li Chen,10,11 Lee-Fen Hsu,9,12 Mei-Ling Fang,13,14 Kuan-Han Lee,15 Su-Er Guo,11 Hsin-Chung Cheng,5,16 I-Ta Lee5 1Department of Nursing, Division of Basic Medical Sciences, Chronic Diseases and Health Promotion Research Center and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan; 2Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Chiayi County, Taiwan; 3Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan; 4College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 5School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; 6Department of Pathology, University of Utah, Salt Lake City, UT, USA; 7Chronic Disease and Health Promotion Research Center, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan; 8Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City, Chiayi County, Taiwan; 9Department of Respiratory Care, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan; 10Department of Nursing, Chang Gung Memorial Hospital, Puzi City, Chiayi County, Taiwan; 11Graduate Institute of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan; 12Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Puzi City, Chiayi County, Taiwan; 13Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, Taiwan; 14Super Micro Research and Technology Center, Cheng Shiu University, Kaohsiung, Taiwan; 15Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; 16Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: I-Ta LeeSchool of Dentistry, College of Oral Medicine, Taipei Medical University, 250 Wuxing St, Taipei, 11031, TaiwanTel +886-2-27361661 ext. 5162Fax +886-2-27362295Email itlee0128@tmu.edu.twAbstract: Incense burning is a very popular activity in daily life among many parts all over the world. A growing body of both epidemiological and experimental evidences has reported the negative effects of incense use on human well-being, posing a potential threat at public significance. This work is a comprehensive review that covers the latest findings regarding the adverse impact of incense smoke on our health, providing a panoramic visualization ranging from mechanisms to implications. The toxicities of incense smoke come directly from its harmful constituents and deposition capacity in the body. Besides, reactive oxygen species-driven oxidative stress and associated inflammation seem to be plausible underlying mechanisms, eliciting various unfavorable responses. Although our current knowledge remains many gaps, this issue still has some important implications.Keywords: incense burning, oxidative stress, inflammation, cancer, toxicants

Meng-Meng Han,1,* Wen-Shu Zhao,2,* Xin Wang,2,* Shan He,3 Xiao-Rong Xu,2 Cai-Jing Dang,2 Juan Zhang,2 Jia-Mei Liu,2 Mu-Lei Chen,2 Lin Xu,2 Hua Wang2 1Intensive Care Units, Beijing Longfu Hospital, Beijing, 100010, People’s Republic of China; 2Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 3Heart Center, Beijing Chaoyang Hospital Jingxi Branch, Capital Medical University, Beijing, 100020, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lin Xu; Hua WangHeart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of ChinaTel +86-10-85231445; +86-10-85231556Email lxdrqw09_dr@163.com; huwsmndr66@yandex.comObjective: This study aimed to find echocardiographic parameters that can predict short- and long-term adverse cardiovascular events in patients with AMI.Methods: A total of 126 patients with AMI admitted to our hospital from July to December 2012 were enrolled in this study. All patients underwent echocardiographic examination within 12 hours after admission and received regular follow-ups until December 2018. The primary endpoint was a composite of the major adverse cardiovascular events (MACEs).Results: In the first year of this study, a primary endpoint occurred in 35 patients and the predictor derived from the echocardiography of 1-year primary endpoint was LVEF< 40% (OR: 9.000, 95% CI 3.242-24.987, p< 0.0001) and the area under the curve (AUC) for the predictor was 0.676 (95% CI 0.561-0.790, p=0.002). For the total 5 years, 57 patients underwent primary endpoint. The results of the 5-year primary endpoint were: E/E’> 15 (OR: 4.094, 95% CI 1.726– 9.710, P=0.001), the wall motion score index was (WMSI)> 1.5 (OR: 12.791, 95% CI 1.511– 108.312, P=0.019), and the AUC was 0.691 (95% CI 0.595– 0.787 P< 0.0001).Conclusion: LVEF is correlated with a short-term outcome (1-year), and WMSI and E/E’ can predict a long-term outcome (5-year) in patients with acute myocardial infarction.Keywords: echocardiography, cardiovascular events, predictors, acute myocardial infarction, wall motion score index

Yu Liu,1 Le-Feng Wang,1 Li-Hong Liu,1 Xin-Chun Yang,1 Zheng-Hong Ren,2 Kui-Bao Li,1 Mu-Lei Chen,1 Hong-Shi Wang,1 Jiu-Chang Zhong,1 Li Xu,1 Zhu-Hua Ni,1 Wei-Ming Li,1 Kun Xia,1 Da-Peng Zhang,1 Hao Sun,1 Zong-Sheng Guo,1 Yong-Hui Chi,1 Ji-Fang He,1 Zhi-Yong Zhang,1 Feng Jiang1 1Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of ChinaCorrespondence: Le-Feng WangHeart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 of Gongtinan Road, Chaoyang District, Beijing, People’s Republic of ChinaTel/Fax +86 10 85231173Email wanglefeng_dr66@163.comObjective: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding.Methods: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors.Results: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86– 9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07– 7.04), indicated by multivariate logistic regression analysis.Conclusion: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.Keywords: gastrointestinal bleeding, digestive system disease, acute myocardial infarction, peptic ulcer, gastroenterological tract tumor

Hui-Qin Lin,1* Jing-Ying Wu,2* Mei-Li Chen,3 Feng-Qiang Chen,4 Yan-Jun Liao,5 Yu-Ting Wu,1 Zhi-Jun Guo11Departments of Geriatric, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China; 2Department of Cardiology, The Second Hospital Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China; 3Physical Examination Center, Medical College of Quanzhou, Quanzhou, People’s Republic of China; 4Luoshan Community Health Center of Jinjiang, Quanzhou, People’s Republic of China; 5Departments of Intensive Care Unit, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China*These authors contributed equally to this work Objective: This study aims to analyze the prevalence of dyslipidemia and identify the cardiovascular disease (CVD) risk stratification among older adults living in Quanzhou, China’s southeast coastal region, where the ancient Maritime Silk Road starts.Methods: A population-based cross-sectional survey of 2,018 adults was conducted in 60–98-year-old residents in Quanzhou from September 2016 to March 2018 using multistage stratified cluster random sampling. The 10-year CVD risk was also estimated by applying the Chinese model recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases.Results: The overall prevalence of dyslipidemia among older adults was 56.8%. The prevalence of high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) were 8.4%, 13.9%, 23.1% and 11.4%, respectively. The mean levels of TC, LDL-C, HDL-C and TG were 5.12±1.18, 3.37±0.81, 1.03±0.27 and 1.65±0.76 mmol/L, respectively. Older adults had low risk, moderate risk and high risk for CVD, which were 49.7%, 36.8% and 13.5%, respectively. Age, body mass index and abdominal obesity were significantly associated with the risk of increasing LDL-C levels and were positively correlated to CVD risk.Conclusion: The prevalence of high TC, high LDL-C, low HDL-C and high TG was relatively low among older adults in Quanzhou, but their lipid levels were high. Approximately half of the elderly adults had moderate or high CVD risk. The personalized primary prevention and control of CVD are recommended for elderly people to identify high-risk individuals.Keywords: prevalence, prediction, dyslipidemia, CVD risk, older adults

Shefang Ye,1 Min Chen,1 Yuanqin Jiang,1,2 Mingliang Chen,3 Tong Zhou,1 Yange Wang,1 Zhenqing Hou,1 Lei Ren11Department of Biomaterials, Research Center of Biomedical Engineering, College of Materials, Xiamen University, Xiamen, People's Republic of China; 2First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China; 3Key Laboratory of Marine Biogenetic Resources, Third Institute of Oceanography, State Oceanic Administration, Xiamen, People's Republic of ChinaAbstract: Polyhydroxylated derivatives of fullerene C60, named fullerenols (C60[OH]n), have stimulated great interest because of their potent antioxidant properties in various chemical and biological systems, which enable them to be used as a new promising pharmaceutical for the future treatment of oxidative stress-related diseases, but the details remain unknown. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a principal transcription factor that regulates expression of several antioxidant genes via binding to the antioxidant response element and plays a crucial role in cellular defence against oxidative stress. In this study we investigated whether activation of the Nrf2/antioxidant response element pathway contributes to the cytoprotective effects of C60(OH)24. Our results showed that C60(OH)24 enhanced nuclear translocation of Nrf2 and upregulated expression of phase II antioxidant enzymes, including heme oxygenase-1 (HO-1), NAD(P)H: quinine oxidoreductase 1, and γ-glutamate cysteine ligase in A549 cells. Treatment with C60(OH)24 resulted in phosphorylation of p38 mitogen-activated protein kinases (p38 MAPK), extracellular signal-regulated kinases, and c-Jun-N-terminal kinases. By using inhibitors of cellular kinases, we showed that pretreatment of A549 cells with SB203580, a specific inhibitor of p38 MAPK, abolished nuclear translocation of Nrf2 and induction of HO-1 protein induced by C60(OH)24, indicating an involvement of p38 MAPK in Nrf2/HO-1 activation by C60(OH)24. Furthermore, pretreatment with C60(OH)24 attenuated hydrogen peroxide-induced apoptotic cell death in A549 cells, and knockdown of Nrf2 by small interfering ribonucleic acid diminished C60(OH)24-mediated cytoprotection. Taken together, these findings demonstrate that C60(OH)24 may attenuate oxidative stress-induced apoptosis via augmentation of Nrf2-regulated cellular antioxidant capacity, thus providing insights into the mechanisms of the antioxidant properties of C60(OH)24.Keywords: fullerenol, Nrf2, oxidative stress, cytoprotection, A549 cells

Jun Chen,1,* Guo-jun Yan,1,* Rong-rong Hu,1 Qian-wen Gu,1 Ming-lei Chen,1 Wei Gu,1 Zhi-peng Chen,1 Bao-chang Cai1,2 1College of Pharmacy, 2Engineering Center of State Ministry of Education for Standardization of Chinese Medicine Processing, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China *These authors contributed equally to this projectObjective: Brucine was encapsulated into stealth liposomes using the ammonium sulfate gradient method to improve therapeutic index.Materials and methods: Four brucine stealth liposomal formulations were prepared, which were made from different phosphatidylcholines (PCs) with different phase transition temperatures (Tm). The PCs used were soy phosphatidylcholine (SPC), dipalmitoyl phosphatidylcholine (DPPC), hydrogenated soy phosphatidylcholine (HSPC), and distearoyl phosphatidylcholine (DSPC). The stabilities, pharmacokinetics, and toxicities of these liposomal formulations were evaluated and compared.Results: Size, zeta potential, and entrapment efficiency of brucine-loaded stealth liposomes (BSL) were not influenced by PC composition. In vitro release studies revealed that drug release rate increased with decreased Tm of PCs, especially with the presence of rat plasma. After intravenous administration, the area under the curve (AUC) values of BSL-SPC, BSL-DPPC, BSL-HSPC, and BSL-DSPC in plasma were 7.71, 9.24, 53.83, and 56.83-fold as large as that of free brucine, respectively. The LD50 values of brucine solution, BSL-SPC, BSL-DPPC, BSL-HSPC, and BSL-DSPC following intravenous injection were 13.17, 37.30, 37.69, 51.18, and 52.86 mg/kg, respectively. It was found in calcein retention experiments that the order of calcein retention in rat plasma was SPC < DPPC << HSPC < DSPC stealth liposomes.Conclusion: PC composition could exert significant influence on the stabilities, pharmacokinetics, and toxicities of brucine-loaded stealth liposomes. DSPC or HSPC with Tm above 50°C should be used to prepare the stealth liposomal formulation for the intravenous delivery of brucine. However, it was found in the present paper that the pharmacokinetics and toxicity of BSL were not influenced by the PC composition when the Tm of the PC was in the range of –20°C to 41°C.Keywords: brucine, stealth liposomes, phosphatidylcholine, pharmacokinetics, toxicity

OBJECTIVE: To examine the factors correlating with repetitive use of complementary and alternative medicine (CAM). RESEARCH DESIGN: In 2006, a community-based epidemiological survey was conducted in Taiwan. A total of 2457 participants (1237 men and 1220 women) aged 18 and over participated in the study. RESULTS: From the application of regression tree analysis and the Health Belief Model, we have noticed the following findings. First, demand motive was the most dominant discriminator factor for the repetitive use of CAM. Second-layer discriminators were evaluated on the basis of action benefits and barriers, as well as sources of action information. Another predominant factor is the heterogeneity of individual background. When participants used CAM for treatment of illness, their household income was >=1000 US dollars per month, they had past experience of western medicine seeking without effects and aged between 30 and 60 years, the predicted mean values for all types of CAM use is 5.62 (the highest). By contrast, when participants used CAM for maintenance of health, their household income was <2000 US dollars per month, they are male, with moderate or good self-rated health who had less than 9 education years, the predicted mean values for all types of CAM use is 1.36 (the lowest). CONCLUSION: Upon the above components, it assists us to understand the multiple interactive reasons on people's repetitive use of CAM. It also provides essential information for specific CAM issues. Furthermore, from the different perspectives; it stimulates the thoughts for the future medical care projects. [ABSTRACT FROM AUTHOR]

Purpose: Depressive symptoms are commonly experienced by cancer patients, especially those with advanced disease. The link between depression and survival outcome in cancer patients has received increasing attention. The purpose of this study was to determine, after adjusting the known covariates, whether the depressive symptoms during the first cycle of chemotherapy can predict the mortality of patients with advanced non-small cell lung cancer (NSCLC).Methods: Patients with stage III or IV NSCLC were recruited from a large teaching hospital located in northern Taiwan. Depressive symptoms were assessed during the first cycle of chemotherapy using the Hospital Anxiety and Depression Scale-Depression subscale. A cut-off of 7/8 was used to categorize patients into depressed and non-depressed groups. All patients were followed up until the end of the study. The follow-up time ranged from 10 to 30 months.Results: The study sample consisted of 90 NSCLC patients. Twenty patients (22.2%) were categorized as depressed. The median survival time in the depressed group was significantly shorter than that of the non-depressed group (11.83 vs. 24.47 months, P = 0.017). After controlling for demographic and clinical factors, depressive symptoms remained significantly (p = 0.023) associated with a shorter survival time. Compared to the non-depressed group, the depressed group had twice the risk of death (HR = 2.18, 95% CI = 1.11 to 4.28).Conclusion: The finding supports that depressive symptoms at the early phase of treatment can predict shorter survival in patients with advanced NSCLC. [ABSTRACT FROM AUTHOR]

The National Taiwan University Hospital (NTUH) adopted international guidelines for surveillance and control of healthcare-associated infection (HCAI) in 1981. This report describes the secular trends in HCAI at the NTUH over the past 27 years according to site of infection, aetiological agents and control measures. Clinical and microbiological data were collected by infection prevention and control nurses using a standardised case-record form. Specific control programmes were implemented and/or intensified as needed. Poisson or negative binomial regression analysis was used to quantify time trends of the incidence of HCAI. The annual number of discharges increased from 25 074 to 91 234 with a parallel increase in the Charlson comorbidity index. Active HCAI surveillance and periodic feedback were associated with a marked decrease in surgical site infections from 1981 to 2007 (2.5 vs 0.5 episodes per 100 procedures, P<0.0001). On the other hand, there was a 4.8-fold increase in bloodstream infections (BSIs) (0.39 vs 1.88 episodes per 100 discharges, P<0.0001). The average annual increase of pathogen-specific HCAI incidence during 1981-2007 was 11.4% for meticillin-resistant Staphylococcus aureus (MRSA), 75.4% for extensively drug-resistant A. baumannii (XDRAB), and 7.5% for Candida albicans (P<0.0001, respectively). The infection prevention and control programme was upgraded in 2004 by implementing annual, intensive, project-based control programmes, and decreases in rates of HCAI, BSI, MRSA and XDRAB were observed. This long term study demonstrates the need to couple surveillance of HCAI with focused control programmes. Hospitals must invest in adequate manpower to accomplish these goals. [ABSTRACT FROM AUTHOR]

Arsenic is an environmental hazard and the reduction of drinking water arsenic levels is under consideration. People are exposed to arsenic not only through drinking water but also through arsenic-contaminated air and food. Here we report the health effects of arsenic exposure from burning high arsenic-containing coal in Guizhou, China. Coal in this region has undergone mineralization and thus produces high concentrations of arsenic. Coal is burned inside the home in open pits for daily cooking and crop drying, producing a high concentration of arsenic in indoor air. Arsenic in the air coats and permeates food being dried producing high concentrations in food; however, arsenic concentrations in the drinking water are in the normal range. The estimated sources of total arsenic exposure in this area are from arsenic-contaminated food (50-80%), air (10-20%), water (1-5%), and direct contact in coal-mining workers (1%). At least 3,000 patients with arsenic poisoning were found in the Southwest Prefecture of Guizhou, and approximately 200,000 people are at risk for such overexposures. Skin lesions are common, including keratosis of the hands and feet, pigmentation on the trunk, skin ulceration, and skin cancers. Toxicities to internal organs, including lung dysfunction, neuropathy, and nephrotoxicity, are clinically evident. The prevalence of hepatomegaly was 20%, and cirrhosis, ascites, and liver cancer are the most serious outcomes of arsenic poisoning. The Chinese government and international organizations are attempting to improve the house conditions and the coal source, and thereby protect human health in this area. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a complex neurodegenerative disorder contributed by both environmental and genetic factors. The inconsistent findings in genetic association studies may be due to unrecognized interactions with other genetic or environmental factors. Therefore, we assessed the combined effects of genetic variants of three candidate genes of familial PD and environmental exposure on risk of PD in Taiwanese population. A total of 744 study subjects, 453 PD cases and 291 ethnicity-matched controls, were included. The genetic variants on the PINK1, BDNF, and LRRK2 genes were sequenced accordingly. We used a regression approach based on a generalized linear model to evaluate single-locus genotype effects and detection of gene-environment interaction by incorporating interaction terms in the model. We found a significant difference of LRRK2 G2385R and R1628P between PD patients and controls, which confirmed our previous findings. A logistic regression model which included gene-environment interactions was applied. Notably, we identified the variant of LRRK2 T4939A (S1647T) (TT, OR = -0.36, p = 0.03) is associated with increased PD risk, after considering the interaction effects with environmental factors in the model. Additionally, two novel interactions were detected: pesticide exposure with BDNF (OR = -0.85, p = 0.01) and to a lesser extent, with PINK1 (OR = 1.99, p = 0.07). Our findings reinforced the importance that PD risk is modulated by both genetic and environmental exposures. LRRK2 S1647T may be another risk factor for PD development in our ethnicity while considering the joint interaction effects with environmental factors. [ABSTRACT FROM AUTHOR]