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Four previously undescribed heterodimeric diketopiperazine alkaloids, expansines A-D, were identified from the solid rice medium fermented by Penicillium expansum MA147, along with one new resorcylic acid derivative and five known compounds. Their structures and relative/absolute configurations were elucidated by interpretation of their spectroscopic data, quantum chemical calculations, and chemical conversion. Some obtained compounds were evaluated for the cytotoxicity against a triple-negative breast cancer cell line MDA-MB-231, and expansine C showed an IC 50 value of 3.23 μM. In further mechanistic studies, we found that it might act by increasing the expression of ATP-binding cassette transporter A1 and reducing cellular cholesterol levels, suggesting its potential as a novel anti-cancer agent.

Background: Cigarette smoking and particulate matter (PM) with aerodynamic diameter < 2.5 μm (PM 2.5 ) are major preventable cardiovascular mortality and morbidity promoters. Their joint role in metabolic syndrome (MS) pathogenesis is unknown. We determined the risk of MS based on PM 2.5 and cigarette smoking in Taiwanese adults., Methods: The study included 126,366 Taiwanese between 30 and 70 years old with no personal history of cancer. The Taiwan Biobank (TWB) contained information on MS, cigarette smoking, and covariates, while the Environmental Protection Administration (EPA), Taiwan, contained the PM 2.5 information. Individuals were categorized as current, former, and nonsmokers. PM 2.5 levels were categorized into quartiles: PM 2.5  ≤ Q1, Q1 < PM 2.5  ≤ Q2, Q2 < PM 2.5  ≤ Q3, and PM 2.5  > Q3, corresponding to PM 2.5 ≤ 27.137, 27.137 < PM 2.5  ≤ 32.589, 32.589 < PM 2.5 ≤ 38.205, and PM 2.5  > 38.205 μg/m 3 ., Results: The prevalence of MS was significantly different according to PM 2.5 exposure ( p -value = 0.0280) and cigarette smoking ( p -value < 0.0001). Higher PM 2.5 levels were significantly associated with a higher risk of MS: odds ratio (OR); 95% confidence interval (CI) = 1.058; 1.014-1.104, 1.185; 1.134-1.238, and 1.149; 1.101-1.200 for 27.137 < PM 2.5  ≤ 32.589, 32.589 < PM 2.5 ≤ 38.205, and PM 2.5  > 38.205 μg/m 3 , respectively. The risk of MS was significantly higher among former and current smokers with OR; 95% CI = 1.062; 1.008-1.118 and 1.531; 1.450-1.616, respectively, and a dose-dependent p -value < 0.0001. The interaction between both exposures regarding MS was significant ( p -value = 0.0157). Stratification by cigarette smoking revealed a significant risk of MS due to PM 2.5 exposure among nonsmokers: OR (95% CI) = 1.074 (1.022-1.128), 1.226 (1.166-1.290), and 1.187 (1.129-1.247) for 27.137 < PM 2.5  ≤ 32.589, 32.589 < PM 2.5 ≤ 38.205, and PM 2.5  > 38.205 μg/m 3 , respectively. According to PM 2.5 quartiles, current smokers had a higher risk of MS, regardless of PM 2.5 levels (OR); 95% CI = 1.605; 1.444-1.785, 1.561; 1.409-1.728, 1.359; 1.211-1.524, and 1.585; 1.418-1.772 for PM 2.5 ≤ 27.137, 27.137 < PM 2.5  ≤ 32.589, 32.589 < PM 2.5 ≤ 38.205, and PM 2.5  > 38.205 μg/m 3 , respectively. After combining both exposures, the group, current smokers; PM 2.5  > 38.205 μg/m 3 had the highest odds (1.801; 95% CI =1.625-1.995)., Conclusion: PM 2.5 and cigarette smoking were independently and jointly associated with a higher risk of MS. Stratified analyses revealed that cigarette smoking might have a much higher effect on MS than PM 2.5 . Nonetheless, exposure to both PM 2.5 and cigarette smoking could compound the risk of MS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tsai, Tantoh, Lu, Chen and Liaw.)

Background: Varicose veins (VVs), a common vascular disease is associated with a huge medical burden. The prevalence in women surpasses that in men. The role of vegetarian diets in the pathogenesis of the disease remains inconclusive. In this study, we examined the risk of VVs in vegetarian and non-vegetarian men and women., Methods: The study involved 9905 adults whose data were obtained from Taiwan Biobank between 2008 and 2020. Information on VVs, sex, and vegetarian diets was obtained from participants' self-responses to the Taiwan Biobank questionnaires., Results: The study subjects consisted of 4,142 men and 5,763 women. About 12% of men and 35% of women had VVs. Study participants were predominantly non-vegetarians (91.84% were men and 88.24% were women). Women had a higher risk of VVs than men. The odds ratio (OR); 95% confidence interval (CI) was 3.414; 2.995-3.891. There was a significant interaction between sex and vegetarian diets ( p  = 0.0034). Women were at higher risk of VVs than men both in the vegetarian (OR = 1.877, 95% CI = 1.270-2.774) and non-vegetarian (OR = 3.674, 95% CI = 3.197-4.223) groups. Based on vegetarian diets, only vegetarian men had a higher risk of VVs (OR = 1.453, 95% CI = 1.069 to 1.976). Based on the sex-stratified model, the risk of VVs was significantly higher in vegetarian men (OR = 1.457, 95% CI = 1.072-1.979), and in vegetarian and non-vegetarian women with corresponding ORs (95% CI) of 3.101 (2.528-3.803) and 3.599 (3.140-4.124), respectively., Conclusion: Women were more susceptible to varicose veins compared to men, regardless of diet. However, in terms of diet, only men who followed a vegetarian diet were at greater risk for developing VVs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tsai, Nfor, Tantoh, Lu and Liaw.)

Objective: To observe the effect of electroacupuncture (EA) combined with caudal epidural injection on subjective pain, walking capability, lumbar flexibility and muscle strength in patients with lumbar disc hernia (LDH)., Methods: Sixty LDH patients were randomly allocated to the control group and the research group. The patients of the control group received ultrasound guided caudal epidural injection, and those of the research group received EA combined with ultrasound guided caudal epidural injection. Bilateral Jiaji (EX-B2) and adjunct points Guanyuanshu (BL26), Shenshu (BL23), Chengfu (BL36), Huantiao (GB30), Zhibian (BL54), etc. on the affected side were stimulated with EA (2 Hz/16 Hz, 5-8 mA) for 30 min each time, once every other day for 4 weeks, with 2 days' rest between every two weeks. The patients' pain was evaluated by using visual analogue scale (VAS), walking capability assessed by timed-up and go (TUG) test (time of walking back and forth in 3 m distance), lumbar flexibility (range of motion, ROM) detected by using an inclinometer and the strength of the lumbar flexor and extensor determined by using a push-pull dynamometer., Results: After the treatment, self-comparison showed that the VAS score and TUG-measured time in both groups were significantly decreased ( P <0.01, P <0.05), and the post-bucking ROM and extension ROM in the research group, and the lumbar flexor and extensor muscle strength in both groups were obviously increased compared with their own pre-treatment ( P <0.05). Comparison between two groups showed that the VAS score and TUG-measured time of the research group were significantly lower than those of the control group ( P <0.01), while the lumbar flexor's ROM as well as the extensor's strength were significantly higher in the research group than in the control group ( P <0.05)., Conclusion: For patients with LDH, EA combined with caudal epidural injection can alleviate pain, improve the walking capability, lumbar flexibility and strength of the lumbar extensor, and the therapeutic effect of the combined treatment is significantly better than that of simple caudal epidural injection.