Research and development of Cordyceps in Taiwan

Cordyceps is treasured entomopathogenic fungi that have been used as antitumor,immunomodulating,antioxidant,and pro-sexual agent.Cordyceps,also called DongChongXiaCao in Chinese,Yartsa Gunbu(Tibetan),means winter worm-summer grass.Natural Cordyceps sinensis with parasitic hosts is difficult to be collected and the recent findings on its potential pharmacological functions,resulted in skyrocketing prices.Therefore,finding a mass-production method or an alternative for C.sinensis products is a top-priority task.In this review,we describe current status of Cordyceps research and its recent developments in Taiwan.The content and pharmacological activities of four major industrial species of Cordyceps(C.sinensis,Cordyceps militaris,Cordyceps cicadae and Cordyceps sobolifera)used in Taiwan,were reviewed.Moreover,we highlighted the effect of using different methods of fermentation and production on the morphology and chemical content of Cordyceps sp.Finally,we summarized the bottle-necks and challenges facing Cordyceps research as well as we proposed future road map for Cordyceps industry in Taiwan.

The Antioxidant and Free Radical Scavenging Activities of Chlorophylls and Pheophytins

Chlorophylls are important antioxidants found in foods. We explored the mechanisms through which the a and b forms of chlorophyll and of pheophytin (the Mg-chelated form of chlorophyll) reduce oxidation: we used comet assay to measure prevention of H2O2 DNA damage;we tested for quenching of 1,1-diphenyl-2-picrylhydrazyl (DPPH);we measured the ability to chelate Fe(II);and, we tested their ability to prevent formation of thiobarbituric acid reactive substances (TBARS) during Cu-mediated peroxidation of low density lipoprotein (LDL) in a chemical assay. All chlorophylls and pheophytins showed significant dose-dependent activity in the assays, with the pheophytins being the strongest antioxidants. Thus, these chemicals can prevent oxidative DNA damage and lipid peroxidation both by reducing reactive oxygen species, such as DPPH, and by chelation of metal ions, such as Fe(II), which can form reactive oxygen species.

Effects of a Care Workshop on Caring Behaviors as Measured by Patients and Patient Satisfaction

Caring is a central focus of nursing, and patient satisfaction is a critical indicator of nursing care quality. The aim of this study was to determine the effects that a care workshop exerted on nurse caring behaviors as perceived by patients and reflected by patient satisfaction. A quasi-experimental, pretest-posttest design without a control group was applied. The intervention consisted of several facets: 1) formal educational sessions twice a week for six weeks, 2) an angel-master mentorship activity, and 3) posts of exemplary caring behavior and stories. A demographic questionnaire, the Modified Nurse Caring Behaviors Inventory, and the Hartford Hospital Satisfaction Survey were used in this study. Descriptive statistics were analyzed to evaluate participant demographic characteristics. Paired t tests were used to determine the effects of a care workshop on nurse caring behaviors as perceived by patients and reflected by patient satisfaction. Of the 236 patients enrolled, 49.6% were women and 57.2% were admitted to medical-surgical units. Female patients rated nurse caring behaviors higher and reported greater patient satisfaction than did male patients on the pretest (p p p p p p = 0.000). Caring educational programs for nurses are commonly regarded to be an essential strategy for promoting care knowledge and practice and improving patient satisfaction. According to the favorable results of this study, care workshops must be provides to nurses in other units or hospitals in future studies.

Tumor progression-dependent angiogenesis in gastric cancer and its potential application

Despite improvements in the early diagnosis,prognosis and therapeutic strategies for gastric cancer(GC),human GC remains one of the most frequently diagnosed malignant tumors in the world,and the survival rate of GC patients remains very poor.Thus,a suitable therapeutic strategy for GC is important for prolonging survival.Both tumor cells themselves and the tumor microenvironment play an important role in tumorigenesis,including angiogenesis,inflammation,immunosuppression and metastasis.Importantly,these cells contribute to gastric carcinogenesis by altering the angiogenic phenotype switch.The development,relapse and spreading of tumors depend on new vessels that provide the nutrition,growth factors and oxygen required for continuous tumor growth.Therefore,a state of tumor dormancy could be induced by blocking tumor-associated angiogenesis.Recently,several antiangiogenic agents have been identified,and their potential for the clinical management of GC has been tested.Here,we provide an up-to-date summary of angiogenesis and the angiogenic factors associated with tumor progression in GC.We also review antiangiogenic agents with a focus on the anti-vascular endothelial growth factor receptor(VEGFR)-mediated pathway for endothelial cell growth and their angiogenesis ability in GC.However,most antiangiogenic agents have reported no benefit to overall survival(OS)compared to chemotherapy alone in local or advanced GC.In phase III clinical trials,only ramucirumab(anti-VEGFR blocker)and apatinib(VEGFR-TKI blocker)have reported an improved median overall response rate and prolonged OS and progression-free survival outcomes as a 2 nd-line agent combined with chemotherapy treatment in advanced GC.By providing insights into the molecular mechanisms of angiogenesis associated with tumor progression in GC,this review will hopefully aid the optimization of antiangiogenesis strategies for GC therapy in combination with chemotherapy and adjuvant treatment.

The Relationship between Myopia and Ocular Alignment among Rural Adolescents

Purpose: The prevalence of myopia in school-age children and rural area in Taiwan has increased dramatically. The aim of this study was to explore the associated factors of myopia in rural ado-lescents. Methods: A cross sectional design with a rural junior high student was invited to partici-pate in this study. The relationship between refraction error (RE), spectacle fitting condition, and ocular alignment was determined by stereoacuity. The RE was determined using autorefractor. The ocular alignment was evaluated by cover-uncover test. Stereoacuity was measured by Titmus test. The examination about spectacle fitting included the lens power, lens transparency, pupil distance, frame size, and distortion of the frame. Multiple linear regression was used to determine the effect of the spectacle suitability and ocular alignment on the RE and stereoacuity. Results: The prevalence of myopia was 78% in a total of 338 adolescents, and the incidence of high myopia (≤-6 Diopter, D) accounted for 10.2%. Participant worn poor-fitting spectacles were found with more myopia (-3.95D vs -3.42D, p = 0.02). The exophoria or exotropia significantly increased RE (p < 0.01). The eye position was significantly associated with decreased steroacuity function (p = 0.03). Head position demonstrated to have a significant relationship with stereoacuity (p = 0.03). Conclusions: Good-fitting spectacles provided a good visual function and were associated with less RE condition. Exotrope showed a significant correlation with myopia and stereoacuity. The health care providers should be aware of the ocular alignment in myopic suffers.

Molecular mechanism of therapeutic approaches for human gastric cancer stem cells

Gastric cancer(GC)is a primary cause of cancer-related mortality worldwide,and even after therapeutic gastrectomy,survival rates remain poor.The presence of gastric cancer stem cells(GCSCs)is thought to be the major reason for resistance to anticancer treatment(chemotherapy or radiotherapy),and for the development of tumor recurrence,epithelial–mesenchymal transition,and metastases.Additionally,GCSCs have the capacity for self-renewal,differentiation,and tumor initiation.They also synthesize antiapoptotic factors,demonstrate higher performance of drug efflux pumps,and display cell plasticity abilities.Moreover,the tumor microenvironment(TME;tumor niche)that surrounds GCSCs contains secreted growth factors and supports angiogenesis and is thus responsible for the maintenance of the growing tumor.However,the genesis of GCSCs is unclear and exploration of the source of GCSCs is essential.In this review,we provide up-todate information about GCSC-surface/intracellular markers and GCSC-mediated pathways and their role in tumor development.This information will support improved diagnosis,novel therapeutic approaches,and better prognosis using GCSC-targeting agents as a potentially effective treatment choice following surgical resection or in combination with chemotherapy and radiotherapy.To date,most anti-GCSC blockers when used alone have been reported as unsatisfactory anticancer agents.However,when used in combination with adjuvant therapy,treatment can improve.By providing insights into the molecular mechanisms of GCSCs associated with tumors in GC,the aim is to optimize anti-GCSCs molecular approaches for GC therapy in combination with chemotherapy,radiotherapy,or other adjuvant treatment.

Application of the Objective Structure Clinical Evaluation in Evaluating Clinical Competence for a BSN Program

Given the complex clinical situations and the dynamic nature of nursing, the greatest challenge for nursing educators is performing objective evaluation of students’ clinical competence. The Objective Structured Clinical Evaluation (OSCE) is designed to address this challenge and it has been widely used in nursing education. However, its implementation in nursing education in Taiwan has been limited. Accordingly, a quasi-experimental design was utilized to examine students’ clinical performance and stress levels using a 12-station OSCE assessment. Further, we investigated the inter-rater reliability and internal consistency of the OSCE. After controlling for scores of clinical performance, overall differences in pre- and post-practicum stress in the OSCE group were significantly higher than in the control group (F (1, 89) = 4.89, p = 0.03). There was no group effect on practicum performance after controlling for grade point average (F (1, 89) = 2.69, p = 0.14). Cronbach’s alpha for 12 OSCE stations ranged from 0.22 to 0.80 and inter-rater reliability for all 12 stations showed Pearson’s r ranging between 0.76 and 1.00. Cohen’s kappa ranged from 0.70 to 1.00

Effect of Buerger’s Exercises on Improving Peripheral Circulation: A Systematic Review

The aim of this study was to systematically review the evidence for the effectiveness of Buerger’s exercise on the peripheral circulation or diabetic foot ulceration. A systematic search and 18 electronic databases were conducted. The intervention was predominantly focused on Buerger’s exercise as an outcome. Due to high heterogeneity, data were synthesized in a narrative format rather than by statistical methods. Nine studies that covered 592 participants were selected in the analysis, of which 8 of the 9 found an effect of Buerger’s exercise on peripheral circulation. The positive effects were indicative of improving blood flow, walking ability, reducing necrosis, reducing venous embolism, pain, swelling, cyanosis and the bed-rest times. However, the study design and quality appraisal were limited to Jadad score 2 and the sample size was small. Findings provide some evidence of the beneficial effects of Buerger’s exercises. It was seen as a low cost and low risk physical activity that most diabetic patients could undertake at home. This review highlighted a need for further investigation of standardized procedures of Buerger’s exercises. More high quality studies on the prevention of diabetic foot are required regarding Buerger’s exercises.

Biofunctionality Studies of <i>Cudrania cochinchinensis</i>Extracts

Cudrania cochinchinensis has been found to show remarkable medicinal values. The total phenolic and flavonoid contents of C. cochinchinensis extracts were analyzed, and the antioxidant activity and reducing ability of C. cochinchinensis extracts were also evaluated. Tetrahydroxyflavanonol (THF) was isolated from the xylem and pith portions of C. cochinchinensis stem;however, the bark portion of C. cochinchinensis stem was found to contain no THF. Consequently, solutions extracted from the xylem and pith portions of C. cochinchinensis showed good antioxidant activity. The IC50 values of pith, xylem, and bark extracts were 0.779, 3.020, and 3.507 mg/mL, respectively. As the pith portion of C. cochinchinensis stem contained more THF and had a higher flavonoid content, it exhibited better antioxidant activity and reducing ability. In addition, C. cochinchinensis pith extracts reduced tyrosinase activity in a dose-dependent manner with IC50 = 16.1 μg/mL. The inhibitory activity was determined to be noncompetitive with Km = 0.23 mM.

The devil is in the detail: Prevention of diabetic foot ulceration in rural area is possible

Background: Foot self-care capability is an important factor in diabetic foot ulceration, especially in disadvantaged rural areas. Aim: To explore the causes of foot ulceration and practice foot self-care behaviors before and after diabetic foot ulceration. Method: A descriptive, retrospective design was conducted in a rural hospital in southern Taiwan. Results: A total of 49 participants with diabetic foot ulcers participated in this study. More than half were male (63.3%), still working in farming or fishing (61.2%). All participants were suffering from peripheral neuropathy (100%) and 71.5% showed claudication. Nearly two thirds reported not having received diabetic foot care education and 82% not having received regular vasculopathy assessment before the wound appeared. The common reasons for foot ulcers were unnoticed trauma, neglect of foot self-care. Conclusions: Most diabetic foot ulcers are preventable, since they result from a high prevalence of peripheral neuropathy, inadequate provision of vasculopathy assessment and inappropriate management of foot self-care. Community health nurses can focus care toward screen regularly for early diabetic foot problems.

Evidence of Specific Healthy Behaviors Positively Associated with General Life Satisfaction among Rural Adults

Background: Chronic diseases are the leading causes of death worldwide. Evidence suggests that infrequent adopting healthy behaviors correlated with many chronic diseases. Healthy behaviors can lead to a marked reduction of morbidity and mortality. Life satisfaction is an important parameter of well-being. Few studies have focused on the association between healthy behaviors and life satisfaction among adults in rural areas. Aim: To establish the determinant and modifiable lifestyle factors associated with life satisfaction among rural adults. Methods: We analyzed our previous health promotion program in a rural area in 2013 obtained from 27 villages (n = 8024) in Yunlin County, Taiwan. The assessment comprised one question assessing self-reported life satisfaction on a 5-point scale (dichotomous: low satisfaction/high satisfaction) and four domain-specific items of health-related behaviors (smoking, oral hygiene, exercise, healthy diet). Logistic regression was used to examine the association between health-related behaviors and life satisfaction adjusted for age, sex, and education. Findings: The mean age was 47.6 years (SD = 16.2), and 56.7% (n = 4551) of the participants were female. Participants with lower life satisfaction reported frequently perceived dissatisfaction with sleep quality (p < 0.001) and health status (p < 0.001). After adjusting for potential confounding variables, the associated risk factors for lower life satisfaction were smoking (OR = 1.20, p = 0.006), less frequently adopted healthy behaviors including dental check (OR = 1.23, p < 0.001), infrequent teeth brushing (OR = 1.12, p = 0.022), infrequent use of dental floss (OR = 1.12, p = 0.028), infrequent consumption of a balanced diet (OR = 1.64, p < 0.001), insufficient vegetable intake (OR = 1.19, p = 0.001), insufficient water intake (OR = 1.14, p = 0.009), and infrequent regular exercise (OR = 1.26, p < 0.001). Conclusions: The findings showed that many adults did not adopt healthy habits in their life. This study identified significant unhealthy behaviors associated with lower life satisfaction, including cigarette smoking, unhealthy diet, poor oral hygiene, and physical inactivity. The enhancement of health promotion programs to improve life satisfaction through decreasing unhealthy habits is necessary for rural adults.

Short term acupressure therapy on weight-reduction in adolescence: A randomized controlled trial

Aim: Common treatment options for obesity include a reduced-calorie diet, increased physical activity, behavioral modification, pharmacotherapy, and surgery. Ear acupressure may also be an effective adjunct therapy. Methods: This study used a randomized controlled design to test the effectiveness of auricular acupressure for weight reduction in young, Taiwan Residents adults with a BMI ≥ 23 kg/m2. Sixty-eight participants aged 18 to 20 years were recruited from Taiwan Residents universities at the beginning of the study. After four weeks of auricular therapy, the total sample included 57 young adults. All participants met one time per week for ten minutes. The treatment group received ear acupressure treatment with Semen Vaccariae sticks on auricular acupoints while the control group had adhesive tape placed on ear acupoints, change in BMI from baseline to trial completion. Results: BMI in controls increased significantly by +0.0133 kg/m2 (P = 0.000) while the intervention group BMI decreased significantly by ?0.8022 kg/m2 (P ≤ 0.0001). Conclusions: Just four weeks of auricular acupressure by Semen Vaccariae, sticks may significantly help to decrease BMI among young adults.

Quercetin exerts anti-inflammatory effects via inhibiting tumor necrosis factor-α-induced matrix metalloproteinase-9 expression in normal human gastric epithelial cells

BACKGROUND Gastric injury is the most common digestive system disease worldwide and involves inflammation,which can lead to gastric ulcer or gastric cancer(GC).Matrix metallopeptidase-9[MMP-9(gelatinase-B)]plays an important role in inflammation and GC progression.Quercetin and quercetin-rich diets represent potential food supplements and a source of medications for treating gastric injury given their anti-inflammatory activities.However,the effects and mechanisms of action of quercetin on human chronic gastritis and whether quercetin can relieve symptoms remain unclear.AIM To assess whether tumor necrosis factor-α(TNF-α)-induced MMP-9 expression mediates the anti-inflammatory effects of quercetin in normal human gastric mucosal epithelial cells.METHODS The normal human gastric mucosa epithelial cell line GES-1 was used to establish a normal human gastric epithelial cell model of TNF-α-induced MMP-9 protein overexpression to evaluate the antiinflammatory effects of quercetin.The cell counting Kit-8 assay was used to evaluate the effects of varying quercetin doses on cell viability in the normal GES-1 cell line.Cell migration was measured using Transwell assay.The expression of proto-oncogene tyrosine-protein kinase Src(cSrc),phospho(p)-c-Src,extracellular-signal-regulated kinase 2(ERK2),p-ERK1/2,c-Fos,p-c-Fos,nuclear factor kappa B(NF-κB/p65),and p-p65 and the effects of their inhibitors were examined using Western blot analysis and measurement of luciferase activity.p65 expression was detected by immunofluorescence.MMP-9 m RNA and protein levels were measured by quantitative reverse transcription polymerase chain reaction(q RT–PCR)and gelatin zymography,respectively.RESULTS q RT-PCR and gelatin zymography showed that TNF-αinduced MMP-9 m RNA and protein expression in a dose-and time-dependent manner.These effects were reduced by the pretreatment of GES-1 cells with quercetin or a TNF-αantagonist(TNFR inhibitor)in a dose-and timedependent manner.Quercetin and TNF-αantagonists decreased the TNF-α-induced phosphorylation of c-Src,ERK1/2,c-Fos,and p65 in a dose-and time-dependent manner.Quercetin,TNF-αantagonist,PP1,U0126,and tanshinone IIA(TSIIA)reduced TNF-α-induced c-Fos phosphorylation and AP-1–Luciferase(Luc)activity in a dose-and time-dependent manner.Pretreatment with quercetin,TNF-αantagonist,PP1,U0126,or Bay 11-7082 reduced TNF-α-induced p65 phosphorylation and translocation and p65–Luc activity in a dose-and timedependent manner.TNF-αsignificantly increased GES-1 cell migration,and these results were reduced by pretreatment with quercetin or a TNF-αantagonist.CONCLUSION Quercetin significantly downregulates TNF-α-induced MMP-9 expression in GES-1 cells via the TNFR-c-Src–ERK1/2 and c-Fos or NF-κB pathways.

Health-promoting behavior is positively associated with diabetic control among type 2 diabetes patients

Background: The increasing prevalence of type 2 diabetes mellitus (T2DM) poses a major public health challenge throughout the world. It is a major healthcare issue among the elderly. This study was to identify the association between the health promoting behaviors and the diabetic control of type 2 diabetes mellitus (T2DM) patients. Methods: Cross sectional and descriptive research designs were used in this study. Participants were enrolled from three medical centers in northern, central and southern Taiwan during August, 2010 and June, 2011. The instruments encompassed biochemical indicators, and the preliminary developed scale of diabetes mellitus and health promotion (DMHP). Results: A total of 323 participants with T2DM were included in this study. The results showed 1) a high percentage of the participants used cigarette smoking, alcohol drinking and betel nut chewing, which were not conducive to adopting health promoting behaviors;2) a high percentage of patients showed abnormal blood glucose, dyslipidemia, and elevated blood pressure;3) few of the participants practiced ideally health promoting behaviors;and 4) practicing health-promoting behavior was positively associated with fasting blood glucose (FBG) and HbA1c levels. Conclusions: Patients with higher health promotion scores had better diabetic control. Less physical activity was found among those addicted to cigarette, alcohol and betel nut consumption. The findings suggest that health care providers should assess health promoting behaviors first for each diabetic patient.

Myopia prevention in Taiwan

Complications of myopia have become an important public health issue with serious socio-economic burdens.Prevention and treatment are both important.The Taiwan Student Vision Care Program(TSVCP)promoted by Ministry of Education(MOE)has been carried out for 3 decades in Taiwan.The myopia prevalence has increased rapidly to a high level and therefore myopia prevention has continued to be the most important item in the program.Therefore,TSVCP aims to decrease the prevalence of myopia,in order to decrease the high myopia related blindness in the future.Recently,outdoor activity has been found to be an important protective factor for myopia and was implemented in TSVCP since 2010.Afterwards,the nationwide vision impairment rate(uncorrected vision 20/25 or less)of elementary school students declined unprecedentedly and continuously in recent years.Evidence-based protective and risk factors for myopia are now clearer.Widespread acknowledgement of myopic disease,preventing the onset of myopia,prompt diagnosis,and early treatment to control progression are all important.

Dust mite allergen-specific immunotherapy increases IL4 DNA methylation and induces Der p-specific T cell tolerance in children with allergic asthma

Allergen-specific immunotherapy(allergen-SIT)is a highly effective treatment for children with allergic asthma(AA),an immune-mediated chronic disease leading to bronchial muscle hypertrophy and airway obstruction in response to specific allergens.T helper cells and secreted cytokines play important roles in the pathogenesis of asthma,and epigenetic modulation controls genes important for T cell development and cytokine expression.This study evaluated T helper cell-secreted cytokines and DNA methylation patterns in children treated with Dermatophagoides pteronyssinus(Der p)allergen-SIT.Our results showed that after Der p challenge,peripheral blood mononuclear cells(PBMCs)from the SIT group,compared with the non-SIT AA group,produced lower levels of IL-4,IL-5 and IL-2.The SIT group,compared with the AA group,exhibited decreased sensitivity to the Der p allergen,concurrent with IL-4 down-modulation due to increased promoter DNA methylation,as estimated in PBMCs.Our results showed that SIT decreased IL-4 and IL-5,and inhibited T cell proliferation,by inhibiting IL-2 production after the specific allergen challenge.These results suggest that decreased IL-2 production and increased IL-4 cytokine promoter methylation is a potential mechanism of Der p-specific allergen desensitization immunotherapy.

Role of gut microbiota in identification of novel TCM-derived active metabolites

Traditional Chinese Medicine(TCM)has been extensively used to ameliorate diseases in Asia for over thousands of years.However,owing to a lack of formal scientific validation,the absence of information regarding the mechanisms underlying TCMs restricts their application.After oral administration,TCM herbal ingredients frequently are not directly absorbed by the host,but rather enter the intestine to be transformed by gut microbiota.The gut microbiota is a microbial community living in animal intestines,and functions to maintain host homeostasis and health.Increasing evidences indicate that TCM herbs closely affect gut microbiota composition,which is associated with the conversion of herbal components into active metabolites.These may significantly affect the therapeutic activity of TCMs.Microbiota analyses,in conjunction with modern multiomics platforms,can together identify novel functional metabolites and form the basis of future TCM research.

Plurigenera of compact connected strongly pseudoconvex CR manifolds In memory of Salah Baouendi

Strongly pseudoconvex CR manifolds are boundaries of Stein varieties with isolated normal singularities.We introduce a series of new invariant plurigeneraδm,m∈Z+for a strongly pseudoconvex CR manifold.The main purpose of this paper is to present the following result:Let X1and X2be two compact strongly pseudoconvex embeddable CR manifolds of dimension 2n-1 3.If there is a non-constant CR morphism from X1to X2,thenδm(X2)δm(X1)whereδm(Xi)is the plurigeneus of Xi(see Definition 2.4).