Integrative Therapeutic Approach Research Articles

Immediate effect of sunlight exposure through blue glass on blood pressure in hypertensive patients: a randomized controlled trial.

Hypertension affects approximately 1.28 billion adults worldwide, driving the search for integrative therapeutic approaches alongside conventional treatments. While chromotherapy, particularly blue light exposure, has historical roots in traditional medicine and its specific impact on blood pressure regulation remains understudied. So, the present study aims to investigate the immediate impact of exposure to blue glass through sunlight on blood pressure in hypertensive individuals. This randomized controlled trial was carried out with a sample of 60 hypertensive patients, who were divided into two groups: a study group that received blue glass exposure for 20 min and a control group that received exposure to colourless glass. The primary outcome measures were systolic and diastolic blood pressure, pulse rate, and oxygen saturation levels. The results of the study revealed statistically significant differences in systolic blood pressure (p=0.006) and pulse rate (p=0.005) after the intervention in the study group and no such changes were noted in the control group. The findings of this study suggest that blue glass exposure has a significant impact on reducing blood pressure and pulse rate in hypertensive patients, indicating its potential use as a integrative treatment in the management of hypertension.

Efficacy and safety of immune checkpoint inhibitors combined with chemotherapy or tyrosine kinase inhibitors in advanced endometrial cancer: A systematic review and meta-analysis.

The objective of this meta-analysis was to conduct a comprehensive assessment of the therapeutic effectiveness and safety profile of the combination of immune checkpoint inhibitors (ICIs) with either chemotherapy or tyrosine kinase inhibitors (TKIs) in the treatment of advanced-stage endometrial cancer (EC). This meta-analysis conducted a thorough literature search across PubMed, Cochrane Library, Embase, and Web of Science databases from their earliest records up to November 18th, 2023, identifying qualified randomized controlled trials (RCTs), cohort studies, and single-arm trials for inclusion in the analysis. The meta-analysis were performed to quantify and analyzed the evidence from the existing literature, focusing on outcomes including the objective response rate (ORR), disease control rate (DCR), duration of response (DOR), overall survival (OS), progression-free survival (PFS), and adverse events (AE). A total of 13 studies were included. In terms of ICI combined with chemotherapy, the single-arm trials showed that ICI combined with chemotherapy was effective in improving the ORR, but the overall rate of AE was higher. The results based on RCT suggested that ICI combined with chemotherapy resulted in a longer PFS of 12-24 months and OS of 18-month compared to the control group in advanced EC. In terms of ICI combined with TKI, the pooled ORR was 39.0%, the pooled DCR was 79.9%, the pooled OS rate was 50.4%, and the pooled overall AE rate was 95.8%, the pooled grade ≥3 AE rate was 73.8%, the pooled median progression-free survival (mPFS) was 6.126 months, and pooled OS was 15.099 months in advanced EC. The integrative therapeutic approach combining (ICIs) with chemotherapy or (TKIs demonstrates notable clinical efficacy in advanced EC, which can prolong the survival and help to disease control. Nevertheless, it is imperative for clinicians to be vigilant regarding the potential for adverse reactions to emerge. In addition, more RCTs are needed to solidify this study's efficacy and safety further.

Clinical efficacy and mechanism of the combination of autologous platelet-rich gel and recombinant human acidic fibroblast growth factor in the management of refractory diabetic foot.

This study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment. Ninety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment. Following treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P< 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P< 0.05). The integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF.

The Impact of Intermittent Hypoxia-Hyperoxia Therapy on Metabolism and Respiratory System in Obese Patients as Part of Comprehensive Medical Rehabilitation.

Introduction Obesity is a complex condition characterized by excessive accumulation of body fat, which can have multiple causes, including genetic factors, inadequate diet, lack of physical exercise, and socioeconomic factors. Obesity can cause significant respiratory changes, so obese patients present pulmonary complications more frequently than individuals with normal weight. Improving respiratory function is an important aspect of obesity management, as it can reduce the risk of pulmonary complications and improve patients' quality of life. Material and method We conducted a randomized controlled, single-center study that included 70 obese patients, aiming to evaluate the effectiveness of intermittent hypoxia-hyperoxia therapy (IHHT) on metabolic and respiratory effects. Patients were randomly allocated into two equivalent groups: an intervention group, consisting of 35 patients who received IHHT, and a control group, consisting of 35 patients who did not receive this therapy. Results Patients in the intervention group showed a significant increase in exercise tolerance (p < 0.001), improvement in renal function parameters (p = 0.047 for uric acid; p = 0.006 for creatinine), and liver function (p = 0.001 AST; p = 0.030 ALT), compared to the control group. An improvement in the Tiffeneau index was also observed in the intervention group (p < 0.001), indicating an improvement in respiratory function and lung capacity. Conclusions The approach to obesity requires a holistic perspective that takes into account the physical, psychological, and social aspects of this condition. IHHT represents an integrative therapeutic approach that addresses both the metabolic and respiratory aspects of obesity and metabolic syndrome, offering promising prospects for improving patients' health and quality of life. The study results suggest that IHHT may be effective in improving physical performance, renal and hepatic function, as well as respiratory function, with the potential to provide significant benefits in the management and treatment of obese and/or metabolic syndrome patients.

Nongenetic Precise Neuromodulation and Spatiotemporal Neuroprotection for Epilepsy Therapy via Rationally Designed Multifunctional Nanotransducer.

The precise modulation of electrical activity in specific neuronal populations is paramount for rectifying abnormal neurological functions and is a critical element in the therapeutic arsenal for neurological disorders. However, achieving a balance between minimal invasiveness and robust neuroprotection poses a considerable challenge. Herein, we present a nanoneuromodulation strategy integrating neuroprotective features to effectively address epilepsy with minimal invasiveness and enable wireless functionality. Strategically engineered nanotransducer, adorned with platinum (Pt) decoration with titanium disulfide (TiS2) (TiS2/Pt), enables precise modulation of neuronal electrical activity in vitro and in vivo, ensuring exceptional temporal fidelity under millisecond-precision near-infrared (NIR) light pulses irradiation. Concurrently, TiS2/Pt showcase a pronounced enhancement in enzyme-mimicking activity, offering a robust defense against oxidative neurological injury in vitro. Nanotransducer-enabled wireless neuromodulation with biocatalytic neuroprotective capacity is highly effective in alleviating epileptic high-frequency neural activity and diminishing oxidative stress levels, thereby restoring redox equilibrium. This integrated therapeutic approach reduces the severity of epilepsy, demonstrating minimal invasiveness and obviating the requirements for genetic manipulation and optical fiber implantation, while providing an alternative avenue for neurological disorder treatment.

Effect of Deep Breathing Relaxation and Progressive Muscle Relaxation on Blood Pressure

Hypertension, characterized by diastolic pressure exceeding 90 mmHg and systolic pressure surpassing 140 mmHg, poses a significant health challenge often addressed through pharmacological antihypertensive therapy. This research endeavors to evaluate the impact of complementary interventions, specifically deep breathing relaxation and progressive muscle relaxation, on reducing blood pressure among hypertensive patients within the operational domain of the Kertasemaya Community Health Center in the Indramayu Regency in 2023. Adopting a Quasi-Experimental Design with a Pretest-Posttest and Control Group paradigm, the study engaged a cohort of 70 respondents stratified into intervention and control groups. The intervention group underwent a combined therapy of deep breathing relaxation and progressive muscle relaxation, followed by a meticulous post-test for final observations. Meanwhile, the control group underwent an initial blood pressure measurement (pre-test), a relaxation period of 15-30 minutes, and concluded with a post-test for final measurements. The study revealed a statistically significant influence (p=0.013) on average blood pressure within the intervention group compared to the control group. This disparity was observed both before and after the implementation of deep breathing relaxation and progressive muscle relaxation techniques among hypertensive respondents. These findings underscore the potential efficacy of non-pharmacological interventions in mitigating hypertension and enhancing patient well-being. The combination of deep breathing relaxation and progressive muscle relaxation emerges as a highly effective strategy in reducing blood pressure among hypertensive individuals. This integrative therapeutic approach showcases promising potential for promoting cardiovascular well-being, offering a valuable non-pharmacological avenue for hypertension management

Integrative Interventions for Improving Outcomes in Depression: A Narrative Review

Antidepressants are among the most used medications in the US, with significant deleterious effects on people’s well-being. At any given time, depression impacts approximately 1 in 10 Americans, causing wide and broad societal costs. Interest is developing for non-pharmacological treatments and preventative measures. We summarize the literature on non-invasive dietary and lifestyle approaches for treating depression. This review aims to inform future research and treatment programs for depression by providing an evidentiary summary of integrative therapeutic approaches for depression.

Cognitive Decline: Current Intervention Strategies and Integrative Therapeutic Approaches for Alzheimer's Disease.

Alzheimer's disease (AD) represents a pressing global health challenge, with an anticipated surge in diagnoses over the next two decades. This progressive neurodegenerative disorder unfolds gradually, with observable symptoms emerging after two decades of imperceptible brain changes. While traditional therapeutic approaches, such as medication and cognitive therapy, remain standard in AD management, their limitations prompt exploration into novel integrative therapeutic approaches. Recent advancements in AD research focus on entraining gamma waves through innovative methods, such as light flickering and electromagnetic fields (EMF) stimulation. Flickering light stimulation (FLS) at 40 Hz has demonstrated significant reductions in AD pathologies in both mice and humans, providing improved cognitive functioning. Additionally, recent experiments have demonstrated that APOE mutations in mouse models substantially reduce tau pathologies, with microglial modulation playing a crucial role. EMFs have also been demonstrated to modulate microglia. The exploration of EMFs as a therapeutic approach is gaining significance, as many recent studies have showcased their potential to influence microglial responses. Th article concludes by speculating on the future directions of AD research, emphasizing the importance of ongoing efforts in understanding the complexities of AD pathogenesis through a holistic approach and developing interventions that hold promise for improved patient outcomes.

Moving-sensing-feeling bodies clamouring for contact in on-line therapy groups

ABSTRACT The author examines working with groups on-line from a Gestalt therapy perspective, an integrated therapeutic approach. The growing occurrence of the therapeutic group online setting brings the need to reconsider clinical tools to use bodily processes in the therapeutic relationship. This article provides a detailed and nuanced consideration of embodied process on-line and offers a practical and useful framework for clinicians, from a phenomenological, aesthetic and field oriented epistemological ground. In the on-line therapeutic group consideration needs to be given to the way embodied vitality can be engendered as supports for contact between members. Vitality is supported through a renewing of attention to the lived body as a support for spontaneous interactions, yet care is required in the on-line domain as there is a tendency towards disinhibition. The author explores how the relational grail of on-line therapy is an inter-embodied experience. This can be supported by the therapist cultivating an embodied presence, accompanied by an intentional disposition to wander with wonder as a way of surrendering to the unknowing of the virtual between. Such an orientation includes the therapist adopting an embodied hermeneutic phenomenological approach in group work that supports the co-creating of meaning between members in this trans-subjective situation.

Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population

ObjectivesTo examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up.Methodsn = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control.ResultsThe presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up.ConclusionsThis study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short–medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Integrating Cognitive Behavioral Therapy and Relational–Cultural Theory in the Treatment of Female College Athletes

Female college athletes struggle with mental health issues at rates similar to their nonathlete peers. Relationships with coaches and teammates can significantly impact mental health. An integrative therapeutic approach that combines cognitive behavioral therapy with relational–cultural theory can provide clinicians with a framework for addressing underlying relational and systemic issues to better meet the needs of female college athletes. A case illustration featuring a Division I female soccer player struggling with negative mental self-talk will demonstrate how to effectively integrate relational–cultural theory and cognitive behavioral therapy when working with female student athletes. This article will discuss the implications for coaches, athletes, parents, mental health providers, and sport psychology practitioners about the integration of relational–cultural theory and cognitive behavioral therapy to enhance relationships with female college athletes to improve their mental health.

Synergistic inhibition of glioblastoma multiforme through an in-silico analysis of luteolin and ferulic acid derived from Angelica sinensis and Cannabis sativa: Advancements in computational therapeutics.

The primary objective of this study is to uncover novel therapeutic agents for the treatment of Glioblastoma Multiforme (GBM), a highly aggressive form of brain cancer, and Alzheimer's Disease (AD). Given the complexity and resistance associated with both conditions, the study underscores the imperative need for therapeutic alternatives that can traverse the biological intricacies inherent in both neuro-oncological and neurodegenerative disorders. To achieve this, a meticulous, target-based virtual screening was employed on an ensemble of 50 flavonoids and polyphenol derivatives primarily derived from plant sources. The screening focused predominantly on molecular targets pertinent to GBM but also evaluated the potential overlap with neural pathways involved in AD. The study utilized molecular docking and Molecular Dynamic (MD) simulation techniques to analyze the interaction of these compounds with a key biological target, protein tyrosine phosphatase receptor-type Z (PTPRZ). Out of the 50 compounds examined, 10 met our stringent criteria for binding affinity and specificity. Subsequently, the highest value of binding energy was observed for the synergistic binding of luteolin and ferulic acid with the value of -10.5 kcal/mol. Both compounds exhibited inherent neuroprotective properties and demonstrated significant potential as pathway inhibitors in GBM as well as molecular modulators in AD. Drawing upon advanced in-silico cytotoxicity predictions and sophisticated molecular modeling techniques, this study casts a spotlight on the therapeutic capabilities of polyphenols against GBM. Furthermore, our findings suggest that leveraging these compounds could catalyze a much-needed paradigm shift towards more integrative therapeutic approaches that span the breadth of both neuro-oncology and neurodegenerative diseases. The identification of cross-therapeutic potential in flavonoids and polyphenols could drastically broaden the scope of treatment modalities against both fatal diseases.

Invitro and in vivo anthelmintic efficacy of peppermint (Mentha x piperita L.) essential oil against gastrointestinal nematodes of sheep.

Nowadays, the exclusive use of commercial anthelmintics for the treatment of gastrointestinal nematode infections in ruminants is less sustainable due to anthelmintic resistance, as well as the problem of drug residues in animal products and the environment. Therefore, an integrated therapeutic approach is needed, including the search for alternatives to synthetic anthelmintic drugs. The aim of this study was to evaluate the possibility of using the essential oil of peppermint (Mentha x piperita L.) in the control of gastrointestinal nematodes in sheep. For this purpose, the in vitro and in vivo anthelmintic efficacy of this oil and the toxic effects on the hosts were examined. In the in vitro egg hatch test, ovicidal activity varied from 21.0-90.3% depending on the concentration of essential oil used (0.0125, 0.025, 0.049, 0.195, 0.781, 3.125, 12.5, and 50 mg/mL). To some extent, anthelmintic efficacy was confirmed in the in vivo fecal egg count reduction test at a mean dose of 150 mg/kg, with an average reduction of nematode eggs of 26.9 and 46.0% at Days 7 and 14 after treatment, respectively. Furthermore, no toxic effects of applied oil were observed on sheep behavior, kidney, or liver function. The main compounds identified by gas chromatography-mass spectrometry analyzes were menthol (32.6%), menthone (22.0%), menthyl-acetate (10.0%), and isomenthone (9.39%). Due to their complex chemical compositions, numerous bioactive ingredients, and natural origin, herbal formulations represent a potentially valuable alternative for the control of gastrointestinal nematodes in sheep. In this context, the results of the present study showed that peppermint essential oil is one of the promising candidates. Further studies should be performed to collect more data on the safety profile of M. piperita EO in treated animals to find the most appropriate formulation for use in field conditions and to test it against resistant gastrointestinal nematode populations.

O-135 Integrative therapeutic approach in sheep lymphoma model

O-135 Integrative therapeutic approach in sheep lymphoma model

Implementation of an evidence-based management algorithm for patients with chronic pancreatitis (COMBO trial): study protocol for a stepped-wedge cluster-randomized controlled trial

BackgroundChronic pancreatitis (CP) is an inflammatory disease that may be complicated by abdominal pain, pancreatic dysfunction, nutritional deficiencies, and diminished bone density. Importantly, it is also associated with a substantially impaired quality of life and reduced life expectancy. This may partly be explained by suboptimal treatment, in particular the long-term management of this chronic condition, despite several national and international guidelines. Standardization of care through a structured implementation of guideline recommendations may improve the level of care and lower the complication rate of these patients. Therefore, the aim of the present study is to evaluate to what extent patient education and standardization of care, through the implementation of an evidence-based integrated management algorithm, improve quality of life and reduce pain severity in patients with CP.MethodsThe COMBO trial is a nationwide stepped-wedge cluster-randomized controlled trial. In a stepwise manner, 26 centers, clustered in 6 health regions, cross-over from current practice to care according to an evidence-based integrated management algorithm. During the current practice phase, study participants are recruited and followed longitudinally through questionnaires. Individual patients contribute data to both study periods. Co-primary study endpoints consist of quality of life (assessed by the PANQOLI score) and level of pain (assessed by the Izbicki questionnaire). Secondary outcomes include process measure outcomes, clinical outcomes (e.g., pancreatic function, nutritional status, bone health, interventions, medication use), utilization of healthcare resources, (in) direct costs, and the level of social participation. Standard follow-up is 35 months from the start of the trial.DiscussionThis is the first stepped-wedge cluster-randomized controlled trial to investigate whether an evidence-based integrated therapeutic approach improves quality of life and pain severity in patients with CP as compared with current practice.Trial registrationISRCTN, ISRCTN13042622. Registered on 5 September 2020.

Gut microbiota composition in COVID-19 hospitalized patients with mild or severe symptoms.

Background and aimCOVID-19, the infectious disease caused by SARS-CoV-2 virus that has been causing a severe pandemic worldwide for more than 2 years, is characterized by a high heterogeneity of clinical presentations and evolution and, particularly, by a varying severity of respiratory involvement. This study aimed to analyze the diversity and taxonomic composition of the gut microbiota at hospital admission, in order to evaluate its association with COVID-19 outcome. In particular, the association between gut microbiota and a combination of several clinical covariates was analyzed in order to characterize the bacterial signature associate to mild or severe symptoms during the SARS-CoV-2 infection.Materials and methodsV3–V4 hypervariable region of 16S rRNA gene sequencing of 97 rectal swabs from a retrospective cohort of COVID-19 hospitalized patients was employed to study the gut microbiota composition. Patients were divided in two groups according to their outcome considering the respiratory supports they needed during hospital stay: (i) group “mild,” including 47 patients with a good prognosis and (ii) group “severe,” including 50 patients who experienced a more severe disease due to severe respiratory distress that required non-invasive or invasive ventilation. Identification of the clusters of bacterial population between patients with mild or severe outcome was assessed by PEnalized LOgistic Regression Analysis (PELORA).ResultsAlthough no changes for Chao1 and Shannon index were observed between the two groups a significant greater proportion of Campylobacterota and Actinobacteriota at phylum level was found in patients affected by SARS-CoV-2 infection who developed a more severe disease characterized by respiratory distress requiring invasive or non-invasive ventilation. Clusters have been identified with a useful early potential prognostic marker of the disease evolution.DiscussionMicroorganisms residing within the gut of the patients at hospital admission, were able to significantly discriminate the clinical evolution of COVID-19 patients, in particular who will develop mild or severe respiratory involvement. Our data show that patients affected by SARS-CoV-2 with mild or severe symptoms display different gut microbiota profiles which can be exploited as potential prognostic biomarkers paving also the way to new integrative therapeutic approaches.

Tangential role of therapeutics in COVID-19 induced Mucormycosis: A Review

Due to restricted treatment alternatives that were excessively expensive, people resorted to an integrated strategy with other relevant professions to reduce the burden on a single therapy. Objective: To estimate our ability to live with the limited disease load while reviewing the likely influence of holistic science on sustaining health dimensions. Method: PubMed, Google Scholar, and other embedded websites chose 205 Mucormycosis papers for examination, and 69 publications were chosen from diverse sources for the study. The study concentrated on clinical symptoms, risk factors for mortality, and future integrative therapeutic options, with a particular emphasis on Indian demographic data. Data were extracted from the study about India and Indian peoples based on descriptions and facts. Conclusion: Integrative preventive strategies and therapeutic approaches can reduce the burden on one drug and can prove cost-effective with better.

POS0583 RHEUMATOID ARTHRITIS BENEFITS FROM FASTING AND PLANT-BASED DIET: AN EXPLORATORY RANDOMIZED CONTROLLED TRIAL (NUTRIFAST)

BackgroundFasting has been shown to be beneficial in many diseases, including rheumatoid arthritis (RA). Among other effects, fasting stimulates ketogenic metabolism, induces autophagy, and harbors immunomodulatory functions. Recent studies have highlighted the role of the intestinal microbiota in the still unclear etiology of RA1. This could be a potential target for additional dietary therapy in RA.ObjectivesTo investigate the effect of therapeutic fasting followed by a plant-based diet compared to standard dietary recommendations in patients with RA.MethodsIn this pilot study2 patients with RA were randomized to either a 7-day fast (≤250kcal/d) followed by 11 weeks of plant-based diet or to conventional nutritional counselling according to the recommendations of the German Society for Nutrition (Deutsche Gesellschaft für Ernährung, DGE) for 12 weeks. Disease activity and treatment response in RA (including Health Assessment Questionnaire, HAQ; EULAR Response Criteria, ACR Response Criteria) were measured at baseline (T0), day 7 (T1), 6 weeks (T2) and 12 weeks (T3).ResultsA total of 50 from 53 enrolled participants were included into the per-protocol analysis. The mean age was 51.98 ± 9.4 years with symptoms duration of 6.8 ± 8.1 years; 92% were females and 78% were ACPA and/or RF IgM positive. At baseline, participants presented HAQ 0.8 ± 0.5, DAS28CRP 4.0 ± 1.3, CRP 3.1 ± 3.8 mg/L, and a BMI of 25.0 ± 3.7 kg/m2.The primary endpoint did not become significant. However, post-hoc analyses revealed clinically relevant improvements in the HAQ after 12 weeks in both the fasting and the DGE group (Δ-0.29; 95% CI, -0.45 to -0.13; p = 0.001; and Δ-0.23; 95% CI, -0.45 to -0.22; p = 0.032; respectively). Furthermore, the effect already set on by day 7 in the fasting group compared to week 6 in the DGE group (Figure 1). This effect was independent of antibody status, delivery mode of the intervention or previous dietary forms. CV risk factors including weight and total cholesterol levels improved stronger in the fasting group compared to the DGE group (Δ-3.9 kg vs. -0.7kg; 95% CI, 1.4 to 5.0; p = 0.001 and Δ-18.60 mg/dl vs Δ6.44 mg/dl; 95% CI, 7.3 to 42.8, p=0.007).Figure 1.EULAR and ACR Response until week 12 and HAQ up to 6 months. ACR, American College of Rheumatology; CI, confidence interval; HAQ, health assessment questionnaire.ConclusionFasting followed by a plant-based diet positively impacts disease activity and CV risk factors in RA, comparable to and no lesser than those of an anti-inflammatory diet according to the DGE. These results may open new perspectives by dietary interventions in an integrative therapeutic approach. Further confirmatory clinical studies with larger patient numbers are needed to confirm these exploratory findings.

Aspirin Colorectal Cancer Prevention in Lynch Syndrome: Recommendations in the Era of Precision Medicine.

Cancer prevention in the era of precision medicine has to consider integrated therapeutic approaches. Therapeutic cancer prevention should be offered to selected cohorts with increased cancer risk. Undoubtedly, carriers of hereditary cancer syndromes have a well-defined high cancer risk. Lynch Syndrome is one of the most frequent hereditary syndromes; it is mainly associated with colorectal cancer (CRC). Nonsteroidal anti-inflammatory drugs and, in particular, aspirin use, has been associated with reduced CRC risk in several studies, initially with contradictory results; however, longer follow-up confirmed a reduced CRC incidence and mortality. The CAPP2 study recruited 861 Lynch syndrome participants randomly assigned to 600 mg of aspirin versus placebo. Like sporadic CRCs, a significant CRC risk reduction was seen after an extended follow-up, with a median treatment time that was relatively short (2 years). The ongoing CAPP3 will address whether lower doses are equally effective. Based on pharmacology and clinical data on sporadic CRCs, the preventive effect should also be obtained with low-dose aspirin. The leading international guidelines suggest discussing with Lynch syndrome carriers the possibility of using low-dose aspirin for CRC prevention. We aim systematically promote this intervention with all Lynch syndrome carriers.

Potential Adjuvant Therapeutic Effect of Lactobacillus plantarum Probio-88 Postbiotics against SARS-COV-2.

In response to the ongoing COVID-19 pandemic, the global effort to develop high efficacy countermeasures to control the infection are being conducted at full swing. While the efficacy of vaccines and coronavirus drugs are being tested, the microbiome approach represents an alternative pathophysiology-based approach to prevent the severity of the infection. In the current study, we evaluated the action of a novel probiotic Lactobacillus plantarum Probio-88 against SARS-COV-2 replication and immune regulation using an in vitro and in silico study. The results showed that extract from this strain (P88-CFS) significantly inhibited the replication of SARS-COV-2 and the production of reactive oxygen species (ROS) levels. Furthermore, compared with infected cells, P88-CFS treated cells showed a significant reduction in inflammatory markers such as IFN-α, IFN-β, and IL-6. Using an in silico molecular docking approach, it was postulated that the antiviral activity of L. plantarum Probio-88 was derived from plantaricin E (PlnE) and F (PlnF). The high binding affinity and formation of hydrogen bonding indicated that the association of PlnE and PlnF on SARS-COV-2 helicase might serve as a blocker by preventing the binding of ss-RNA during the replication of the virus. In conclusion, our study substantiated that P88-CFS could be used as an integrative therapeutic approach along with vaccine to contain the spread of the highly infectious pathogen and possibly its variants.