A summary of the evidence and evaluation of the effectiveness of nonpharmacological interventions for mild cognitive impairment

Objective: To summarize and evaluate the evidence of guidelines and systematic reviews(SRs) of nonpharmacological interventions for mild cognitive impairment(MCI) to support the development of future guidelines and clinical decisions for MCI patients.Methods: Scottish Intercollegiate Guideline Network(SIGN), National Institute for Health and Clinical Excellence(NICE), American Academy of Neurology(AAN), Registered Nurses Association of Ontario(RNAO), Web of Science, PubMed, Cochrane Library, CNAHL, VIP, China National Knowledge Infrastructure(CNKI), and Wanfang Database were searched for relevant publications, including guidelines and SRs, from January 2014 to March 2019. Two authors independently screened articles, extracted data, and assessed the publications for adherence to the inclusion criteria. Appraisal of Guidelines for Research and Evaluation(AGREE II) was used to assess the quality of the guidelines, and Assessment of Multiple Systematic Reviews(AMSTAR 2) was used to assess the quality of SRs. In addition, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) approach was used to evaluate the quality of outcomes.Results: Thirty-two articles were retrieved, including 1 guideline and 31 SRs. Fourteen SRs of physical exercise for MCI, six articles describing cognitive interventions, four articles describing acupuncture, and seven articles assessing dietary interventions(including four articles employing a Mediterranean diet, one article using vitamin B supplementation, and two articles assessing the effects of tea, coffee, and caffeine) were included. The quality of the articles was very low for 4(13%), low for 10(32%), and moderate for 17(55%).Conclusions: Based on the evidence available to date, nonpharmacological interventions may improve the current cognitive function of persons with MCI. In particular, physical exercise, cognitive interventions, and acupuncture exerted promising effects. However, due to the limited number and quality of the included publications, additional high-quality reviews are needed to further confirm.

Prognostic value of modified Lauren classification in gastric cancer

BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.METHODS Patients were identified from the Surveillance,Epidemiology,and End Results program.Univariate and multivariate analyses were performed to identify the independent prognostic factors.Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria.Decision curve analysis was performed to assess clinical usefulness.The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.RESULTS A total of 2718 eligible GC patients were identified.The modified Lauren classification was identified as one of the independent prognostic factors for OS.It showed superior model discriminative ability and model-fitting performance over the other pathological classifications,and similar results were obtained in various patient settings.In addition,it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3-and 5-year OS.A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability,model-fitting performance,and net benefits over the American Joint Committee on Cancer 8th edition tumor-nodemetastasis classification.CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS.A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability,model-fitting performance,and net benefits.

Three-dimensional CT angiography study on the relations between the vertebral artery and atlantoaxial joint

Background The vertebral artery （VA） and atlantoaxial joint （AAJ）, with complicated structures, are located in the depths of the head-neck boundary area, the regional anatomy of which cannot be shown globally and directly. This study aims to evaluate three-dimensional CT angiography （3DCTA） in displaying the AAJ, atlantoaxial segment of the vertebral artery （ASVA） and the identification of their interrelations. Methods Sixty-eight subjects without pathology of the ASVA and AAJ were selected from head-neck CTA examination. All the 3D images were formed with volume rendering （VR） together with techniques of separating, fusing, opacifying and false-coloring （SFOF）. On the 3D images, the ASVA and AAJ were observed, and their interrelations were measured. Results All the 3DCTA images were of high quality and up to our requirements. They could clearly and directly show the ASVA, ascending along the AAJ. There were 5 curves in the course of the ASVA, of which 2 curves were away from the atlantoaxial joint, one in the 2rid curve of 0.0 mm-5.4 mm, the other in the 4th of 2.6 mm-9.2 mm. There was no significant difference in the measurements between left and right （P 〉0.05）. The curved parts of the ASVA slightly expanded, with the biggest diameter of 5.6 mm in the 4th curve. Statistical comparison shows that the left ASVA is larger than the right （P 〈0.05）. Variations of the ASVA were found in 8 cases and of the AAJ in 12. Conclusions 3DCTA can globally and directly demonstrate the structures of the AAJ, ASVA and their interrelations. The 3D imaging data make up and enrich the research contents of regional anatomy and lay the foundation for related study and applications.

In Vitro and In Vivo Evaluation of Antitumor Activity ofLigustrum robustum, A Chinese Herbal Tea

Objective: To examine the effect of the aqueous extract of Ligustrum robustum on tumor growth in vitro and in vivo and explore the possible molecular mechanisms. Methods: In in vitro study, cell viabilities of human cervical carcinoma cells(HeLa), human breast cancer cells(MCF-7), human prostate cancer cells(PC-3),human hepatoma cells(7721) and human colon carcinoma cells(SW480) were evaluated with cell counting kit-8.For L. robustum-treated Hela cells, early or late apoptosis were evaluated by annexin V/PI staining. Mitochondrial membrane potential was measured by staining cells with JC-1. Apoptosis was monitored by nuclear morphology based on chromatin condensation and fragmentation by 4’,6-diamidino-2-phenylinole(DAPI) staining. Caspase-3 and-8 activity levels were measured by a colorimetric assay. In vivo, to evaluate the possible mechanism of L. robustum-mediated antitumor effect, nude mouse xenograft study was also conducted. Results: In in vitro study, L. robustum was found to be toxic to HeLa, MCF-7, PC-3, 7721, SW480, with an half maximal inhibitory concentration value of 2–5 mg/mL(P<0.05). Moreover, externalization of phosphatidylserine, loss of mitochondrial membrane potential, DNA fragmentation and activation of caspase-3 and-8 were detected in L. robustumtreated Hela cells. Using a nude mouse model bearing Hela xenografts, we found that L. robustum reduced tumor volume and tumor weight(P<0.05), but had no effect on body weight and histological damage of important organs. Intraperitoneal injection of L. robustum caused a signi?cant reduction in serum aspartate transaminase and alanine transaminase levels(P<0.05). Furthermore, cleaved caspase-3-positive and terminal nucleotidyl transferase-mediated nick end labeling(TUNEL)-positive cells were observed in L. robustum-treated tumor tissues.Conclusions: L. robustum inhibits tumor cell growth both in vitro and in vivo by inducing apoptosis in a caspasedependent way without apparent hepatic toxicity and histological damage, which may offer partial scienti?c support for the ethnopharmacological claims of L. robustum as a herbal tea for its antitumor activity.

Association between Diabetes Mellitus and Hypertension in Benign Prostatic Hyperplasia Patients

To the Editor：Hypertension is a global problem characterized by high morbidity;the prevalence rate of hypertension reaches 29.6％ in China.[1] Diabetes mellitus （DM） is known to be associated with an increased risk of hypertension[2] and greater severity of benign prostatic hyperplasia （BPH）.[3] In addition,some researches also suggest that hypertension is implicated in BPH etiology.[4] With the existed evidences,it is hypothesized that BPH may influence the relationship between DM and hypertension.Hence,this study was carried out to investigate the association between DM and hypertension in BPH patients using a case-control design.