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Cocoa tree (Theobroma cacao L.) is a recently planted crop in Taiwan, a country located in East Asia. Taiwanese cocoa beans are appreciated globally because of their distinctive flavor and aroma. The effects of the water extracts of unfermented Taiwan cocoa beans (WUFCB) and fermented and roasted Taiwan cocoa beans (WFRCB) on the anti-oxidation, vascular protection, and variation in phytochemical components were investigated. Variations in the catechins components of WUFCB and WFRCB were examined by high performance liquid chromatography. The values of catechin compounds in WUFCB (epicatechin [EC]: 52.32 ± 0.56 mg/g, and catechin (C): 15.14 ± 0.26 mg/g) were approximately two times higher than those found in WFRCB (EC: 26.22 ± 0.48 mg/g, and C: 4.56 ± 0.10 mg/g), indicating that the fermentation and roasting steps caused decline in catechins compounds of WFRCB. In the range of 50–300 µg mL-1, both WUFCB and WFRCB depict noncytotoxicity in endothelial cells; they protect cells from H2O2-induced cytotoxicity as established by MTT assay. Meanwhile, nitric oxide (NO) levels in endothelial cells were elevated by WUFCB. In addition, WUFCB displayed radical scavenging in the acellular model and inhibited increase in reactive oxygen species (ROS) noted in endothelial cell induced by H2O2. Overall, the significant vascular protection of WUFCB is associated with increased NO formation. The decreased ROS generation against oxidative damage was attributed to abundant catechin compounds. This study establishes Taiwan cocoa polyphenol as an effective and complementary tool for preventing endothelial dysfunction and cardiovascular disease.

Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis.We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events.This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies.The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries.

Taiwan cocoa beans were fermented in a wooden box by natural occurring microorganisms for seven days. Six types of chocolate were manufactured from the fermented cocoa beans under different roasting degree. The fermentation parameters including the count of microorganisms, fermenting mass temperature, pH value of the pulp and cotyledons of cocoa bean along with the fermentation time were determined. Furthermore, the flavan-3-ols monomer and oligomer (FMO) of chocolates were determined by normal phase HPLC and the volatile aroma compounds of the six types of chocolate were analyzed by electronic nose to identify the important flavors and odors. Primary component analysis (PCA) was performed to distinguish the flavor profiles among the chocolates. The sensory assessment was conducted to evaluate the organoleptic properties of the six types of chocolate and their overall acceptability. The results showed that the total amount of FMO and proanthocyanidins in the chocolate both decrease with the intensity of the roasting degree of cocoa beans. Twenty-three important volatile aroma compounds were identified by electronic nose analysis. Differences in the amount of each compound were determined in the investigated chocolate and these are expected to cause sensory differences among the six types of chocolate. As a result, chocolates produced from beans under medium roasting condition (130°C and 25min) rated the highest score of overall acceptability among the chocolates. It was significantly higher than those of chocolate produced from light roasting beans. On the other hand, chocolate produced from cocoa bean under light roasting degree was retained more content of the bioactive compounds and could be a potent candidate of health functional food. PCA was successful to discriminate the flavor profiles of the six types of chocolate produced from beans under different roasting degree and could be used as a tool to recognize the origin of chocolate product. These results of this study could provide an important approach for producing chocolate products with desired flavor properties and bioactive compounds that have positive benefits for human health.

Background Early childhood is a critical stage for the prevention of dental caries. The prevalence of caries in preschool children is still high in Taiwan, where National Health Insurance covers 99% of the population. The effort to improve the oral health of preschool children should be based on conceptual model that encompasses more than individual-level factors. This study input nationwide survey data in a conceptual model to evaluate the effects of comprehensive factors related to the high prevalence of caries in preschool children. Methods This observation study examined factors related to the oral health of preschool children by employing a comprehensive multilevel model to analyse nationally representative data from the Taiwan Oral Health Survey of Preschool Children (TOHPC) 2017–2018. Individual-level, family-level and community-level contextual effects were evaluated through multilevel analysis in this study. The proportional change in variance (PCV) was used to compare the multilevel model with the null model and individual-level, family-level, and community-level context effects. Results The estimated deft index for preschool children was 1.34 (1.22–1.47) at age 3, 2.20 (2.08–2.32) at age 4, and 3.05 (2.93–3.18) at age 5. The overall prevalence of caries in preschool children in Taiwan was 34.27% (30.76%, 37.78%) at age 3, 51.67% (48.99%, 54.35%) at age 4, and 62.05% (59.66%, 64.44%) at age 5. The model that included the individual-, family-, and community-context levels exhibited the highest reduction of variance (PCV = 53.98%). The PCV was further reduced to 35.61% when only the level of accessibility to dental services for individuals, families, and the community was considered. For the model in which no community-context cofactors were considered and the model considering only the individual level, the PCVs were 20.37% and 5.52%, respectively. Conclusions The most notable finding of this study is that to improve the oral health of preschool children, community-level factors should be targeted. Such community-based programs would effectively improve the oral health knowledge and behaviours of the parents and caregivers of preschool children. We suggest training more professional oral health educators to provide more community-based oral health promotion campaigns.

Albumin–bilirubin (ALBI) grade is an objective and reproducible model for evaluating overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the original ALBI grade was established for patients with Child–Pugh classes A–C. HCC patients with Child–Pugh class C or poor performance status (Barcelona Clinic Liver Cancer (BCLC) stage D) usually receive hospice care. Thus, optimized cutoffs for the ALBI grade for stratifying OS in HCC patients receiving anticancer therapy are pertinent for accurate prognostication. This study retrospectively enrolled 2116 patients with BCLC stages A–C HCC after the exclusion of those ineligible for receiving anticancer therapy. The modified ALBI (mALBI) grades were: an ALBI score ≤−3.02 for mALBI grade 1, an ALBI score >−3.02 to ≤−2.08 for mALBI grade 2, and an ALBI score >−2.08 for mALBI grade 3. The original ALBI and mALBI grades were independent predictors of OS in all the enrolled patients and those receiving transarterial chemoembolization. In patients receiving curative therapy (radiofrequency ablation and surgical resection), the mALBI grade (grade 2 vs. 1 and grade 3 vs. 2) was an independent predictor of OS. Original ALBI grade 2 vs. 1 was an independent predictor of OS but not ALBI grade 3 vs. 2. The mALBI model can differentiate between patients with early, intermediate, or advanced HCC who received anticancer therapy into three prognostic groups. External validation of the proposed mALBI grade is warranted.

INTRODUCTION Transforaminal epidural steroid injection (TFESI) is one of the nonoperative interventions for lower back pain. In this study, we presented an alternative approach for TFESI, far lateral lateral recess TFESI (FLLR TFESI), which is targeted on lateral recess and anterior epidural space in patients with degenerative lumbar spondylosis-related radiculopathy. TECHNIQUE Under fluoroscopy, needle entry site and pathway are drawn according to the spinal anatomy. The needle is advanced toward the lateral recess and the needle tip is placed medially to the medial border of the pedicle under anteroposterior view and posteriorly to the posterior border of the upper endplate under lateral view. After checking optimal contrast spread, steroids and local anesthetics are injected. CASE ILLUSTRATION An 86-year-old woman who suffered from lower back pain with radiculopathy received interventional treatment. Comparing the "traditional" supraneural approach with the FLLR approach, the difference in contrast enhancement to lateral recess is clearly shown. DISCUSSION Compared to the pre-existing approaches, the FLLR approach may provide better ventral epidural and lateral recess enhancement. Furthermore, with the advanced needle tip, the injectate may enhance not only the at-level nerve root but also the nerve root of adjacent level during their existence in a single injection. With blunt needle usage, no nerve root injury or dura puncture was noted so far. CONCLUSION FLLR TFESI is a modified fluoroscopic technique targeted on lateral recess and anterior epidural space. However, subsequent trials are needed to confirm its efficacy in pain reduction and the rate of complications.

Tooth loss is a common problem among older adults that affects masticatory function (MF) and food selection. Financial burden is a reason that some older adults in Taiwan with this condition forgo dental restoration. To identify the number of posterior occlusal support areas (POSAs) associated with MF. Large-scale cross-sectional study included 1100 community-dwelling participants of Taiwan aged ≥65 years. Participants completed dental examination and questionnaires through personal interviews. Masticatory performance was evaluated using a colour-changeable chewing gum. Masticatory ability was evaluated on the basis of how many of 14 common foods the participants were able to eat. Participants were grouped into 10 categories (A1-A3, B1-B4 and C1-C3) according to the Eichner index (EI) of posterior occlusal contacts. Multivariable regression models were used to analyse the association between the EI groups and MF. More than 80% of the participants with two or more POSAs (those in groups A1-B2) could easily eat various foods. Compared with those in groups A1-B2, those in groups in B3, B4, C1, C2 and C3 exhibited a significantly different masticatory performance (all P

Four designed cocoa fermentations were conducted in separated wooden boxes with different strains inoculum. One was spontaneous fermentation with natural occurring microorganisms, another was inoculated with Saccharomyces cerevisiae, another was inoculated with Lactobacillus plantarum, and the other was inoculated with Acetobacter aceti. The experimental parameters, including the fermenting cocoa mass temperature, the pH value, the total acidity of the pulp and cotyledons of cocoa beans, along with the fermentation time were determined. Furthermore, the phenolic compounds (flavanols and procyanidins DP1-10) of chocolates were determined by normal phase HPLC. In addition, the rheological, textural properties, and color parameters of the chocolates were measured. Meanwhile, the electronic nose was used to analyze the aroma compounds of the investigated chocolates and the principal components analysis (PCA) was conducted to distinguish the flavor profiles among the chocolates. The consumer sensorial assessment was carried out to evaluate the organoleptic properties of chocolates and their overall acceptability. The quality of chocolates produced by the defined inoculum varied with each other with the exception of the FP and PAC content. Different inoculated fermentation methods affected the rheological, textural properties, and color parameters of the end product chocolates. Furthermore, they influenced the types and numbers of aroma compounds generated during fermentation. However, the impact is mainly on their levels of aroma compounds. From sensory point of view, chocolates produced from inoculated Acetobacter aceti BCRC12324 during fermentation had the highest score point of overall acceptability among the investigated chocolates. The high levels of 2-methylbutanal content occurred in this chocolate could be an adequate reply of this finding. The quality of chocolate from fermentation with Lactobacillus plantarum B0091 inoculum was similar to the others, but some properties such as rheological, textural, and flavor profiles were inferior and less pronounced, leading to a slightly poorer response by the sensory panel. PCA successfully discriminates the aroma profiles into four groups, providing a better visualization of the variation among the chocolates produced by the different strains. This attempt to manipulate the strains during cocoa fermentation is a new approach in Taiwan chocolate industry. By controlling the starter culture of fermentation properly, we could improve the quality and flavor profiles of chocolate with a consistent and more reliable production.

Background: To our knowledge, there have been no systematic reviews of health economic evaluations of proton therapy specific to lung cancer. Methods: We conducted this systematic review according to the predefined protocol [PROSPERO CRD42022365869]. We summarized the results of the included studies via structured narrative synthesis. Results: We identified four studies (all used passively scattered proton therapy) from 787 searches. Two cost analyses reported that proton therapy was more costly than photon therapy for early- or locally advanced-stage non-small cell lung cancer, one cost-utility analysis reported that proton therapy was dominated by nonproton therapy in early-stage non-small cell lung cancer, and one cost-utility analysis reported that proton therapy was not cost-effective (vs. photon) in locally advanced non-small cell lung cancer. Conclusions: Passively scattered proton therapy was more costly and not cost-effective than photon therapy for early- and locally advanced-stage non-small cell lung cancer. Further health economic evaluations regarding modern proton therapy (such as scanning beam) for common radiotherapy indications of lung cancer are eagerly awaited.

Flavanol in cocoa is beneficial to cardiovascular health. This study investigated the effect of roasting conditions, temperature ranging from 110 to 150°C and time duration 15-35 min, on the level of flavanol and procyanidin (FP), total proanthocyanidin (PAC) and antioxidant activity of fermented cocoa beans in Southern Taiwan. The content of FP in unroasted and roasted cocoa bean was determined by the normal phase HPLC method and the antioxidant activity was assayed by DPPH and ABTS methods. High roasting temperature for long time decreased the content of FP and PAC in cocoa beans, where ranged from 55.30±1.95 mg (-)-epicatechin equivalents /g and 103.56±8.33mg procyanidin B1/g (at 110°C for 15 min) to 19.12±0.66 mg (-)-epicatechin equivalents /g and 51.58±0.86 mg procyanidin B1/g (at 150°C for 35 min), respectively. Meanwhile, as the roasting temperature rose, the DPPH and ABTS free radical scavenging ability of roasted cocoa bean extracts decreased gradually, varying from the maximum (IC50 = 104±2 µg/ml and 50.4±1.1mg TE/g) for unroasted bean to the minimum (IC50 = 144±4 µg/ml and 27.7±2.4 mg TE/g), and then slightly increased to IC50=134±4 µg/ml and 31.5±0.7 mg TE/g, respectively at most severe roasting treatment, showing the formation of melanoidins and polyphenols caused the synergistic effect, leading to the rise of the antioxidant activity. The first order kinetic reaction and the Arrhenius equation were applied to forecast the change of FP concentration during roasting. The activation energy of FP degradation is 11.2 kcal/mol. The obtained kinetic equation could be useful to predict the remaining amount of FP in cocoa beans under the designed experiment. The cocoa products with higher flavanol content and antioxidant activity could be possible by setting appropriate roasting conditions.

To evaluate the effects of an at-home artificial intelligence (AI)-assisted dental monitoring application on treatment outcomes in patients with periodontitis.Participants with periodontitis were recruited and randomly assigned to an AI (n = 16), AI and human counselling (AIHC; n = 17), or control (CG; n = 20) group. All participants received non-surgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intra-oral scanning and assessment. Patients in the AI and AIHC groups received additional (a) DM or (b) DM, respectively, with real-person counselling over 3 months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analysed the follow-up effects over time.The AI and AIHC groups, respectively, exhibited greater improvement in probing pocket depth (PPD) (mean diff = -0.9 ± 0.4 and -1.4 ± 0.3, effect size [ES] = 0.76 and 1.98), clinical attachment level (mean diff = -0.8 ± 0.3 and -1.4 ± 0.3, ES = 0.84 and 1.77), and plaque index (mean diff = -0.5 ± 0.2 and - 0.7 ± 0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in PPD (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group.Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients who received AI-assisted health counselling exhibited better treatment outcomes than did patients who received AI monitoring alone.

The need for dental emergency (DE) services has increased in recent years. This study therefore investigated the characteristics of patients presenting with DEs in a medical center in southern Taiwan.This was a retrospective study of 1964 adult patients who presented with a DE at the Kaohsiung Medical University Hospital in 2018. Medical records providing age, sex, time, day, past visit history, chief complaint, diagnosis, and treatment were collected and analyzed.The results revealed that men constituted 52.4% of the patients with DEs, the average age was 45.6 years, and the age distribution peak was 20-29 years (26.5%). The peak period for the DE visit was between 17:00 and 24:00 (42.1%), and the peak day of the week was Sunday (27.4%), followed by Saturday (18.0%). The most common chief complaint was pain (49.8%), and the diagnoses were as follows: pulp-related problems (36.7%), periodontal-related problems (22.9%), trauma (22.2%), odontogenic infection (15.3%), postoperative complications (9.2%), and temporomandibular disorders (3.7%). Dental treatment and medication were prescribed for 51.9% of the patients with DE. The rate of patients recommended for further dental treatment was 86.8%, and the actual return rate was 40.1%.This study revealed that the top three reasons for adult DE visits were pulp-related problems, periodontal-related problems, and trauma. These results may be used as a reference for dentists who provide DE services.

Roasting is an important step in cocoa processing that affects the functional and organoleptic properties of chocolate products. The effect of roasting treatment on antioxidation, antityrosinase activity, and physicochemical properties of 12 manufactured chocolates from Southern Taiwan fermented cocoa beans was investigated. The cocoa beans were roasted at different fixed temperatures ranging from 90 to 150°C for different time duration 15-35 min. The results showed that more severe thermal treatment decreased the contents of total phenolic compounds and proanthocyanidins, from the highest 20.57± 0.86mg GAE /g defatted chocolate and 9.20±0.49 mg CyE /g defatted chocolate to the lowest 11.48±0.23 mg GAE /g defatted chocolate and 4.14±0.41 mg CyE /g defatted chocolate, respectively. Meanwhile, roasting treatment also reduced DPPH and ABTS radical scavenging activities in temperature and time-dependent manners. In addition, the low-roasting chocolate revealed the potent inhibitory action on mushroom tyrosinase activity at 2.5 mg/g defatted chocolate. However, chocolate produced from beans roasted at 130°C for 25 min was ranked the highest consumer acceptability in the sensory evaluation. Taken together, the optimization of cocoa bean roasting conditions can improve the health benefits of chocolate, while the low-roasting chocolate acts as a potent candidate for tyrosinase inhibitors.

To determine the efficacy and safety, in terms of maternal and neonatal outcomes, of adding intrathecal midazolam to spinal anesthesia for cesarean delivery in healthy pregnant women.A meta-analysis of randomized controlled trials was conducted. PubMed, Cochrane Library, Embase, and Web of Science were searched manually, and citation screening was completed on May 20, 2021.Most of the included data were collected in the operating room and postoperative recovery area.A total of 1382 healthy parturients undergoing cesarean delivery with single-shot spinal anesthesia were recruited in 19 eligible randomized controlled trials.Single intrathecal midazolam adjuvant was compared to a control, with the local anesthetic dose in spinal anesthesia identical between the intervention and control groups.The primary outcomes were time to first analgesic use, maternal adverse effects, and neonatal Apgar scores at 1 and 5 min. The secondary outcomes were the onset and duration of the sensory and motor blocks.Adjuvant intrathecal midazolam prolonged the time to the first analgesic (mean difference [MD]: 59.96 min, 95% confidence interval [CI]: [23.12, 96.79]) and decreased perioperative maternal nausea and/or vomiting (odds ratio [OR], 0.28; 95% CI: [0.17, 0.45]). However, more sedation events were observed with midazolam (OR, 3.93; 95% CI: [1.12, 13.78]). There was no significant difference in the neonatal Apgar scores at 1 or 5 min (MD: -0.29, 95% CI: [-0.61, 0.03]; MD: -0.00, 95% CI: [-0.11, 0.1], respectively). Intrathecal midazolam also shortened sensory and motor block onset by less than 1 min and prolonged sensory block duration but had no significant effect on motor block duration.Current evidence indicates that intrathecal midazolam, as an adjuvant to spinal anesthesia, provides modest analgesic and significant antiemetic effects at the cost of more sedation events in cesarean delivery patients. The neonatal Apgar score was not affected by intrathecal midazolam administration. However, more objective, sensitive, and long-term measurements of neonatal safety and maternal neurological effects should be performed in the future.

Objective: To date, little research has been done to answer whether people with acute leukemia (AL) experience stigma. No previous studies investigated stigma and its relationship with most common negative emotion and coping styles in patients newly diagnosed as AL. Therefore, the study was designed to find out stigma and its possible contributing factors among the patients with initial diagnosis of AL. Methods: A total of 167 patients newly diagnosed as AL were recruited and investigated by Social Impact Scale (SIS), Medical Coping Modes Questionnaire, Hospital Anxiety and Depression Scale. The data was analyzed by multivariate linear regression to identify influencing factors of stigma. Results: The mean score of SIS was 60.61 ± 9.45, with 13.17% of patients at high level. Almost individuals experienced anxiety or depression during first chemotherapy after diagnosis. The main coping strategy was acceptance-resignation. Patients with following characteristics tend to experienced stronger stigma: male, childless, lower family income, higher degree of dependence, having chronic diseases, more severe depression, and tendency to adopt acceptance-resignation. Conclusions: Patients newly diagnosed as AL were in moderate level of stigma. Effective measures were suggested to alleviate stigma the patients undergoing when struggling for complete remission, especially for those exposed to risk factors of stigma.

The purpose of this study is to examine the prospective therapeutic effects of photobiomodulation on the healing of bone defects in diabetic mellitus (DM) using rat models to provide basic knowledge of photobiomodulation therapy (PBMT) during bone defect repair. For in vitro study, an Alizzarin red stain assay was used to evaluate the effect of PBMT on osteogenic differentiation. For in vivo study, micro-computed tomography (microCT) scan, H&amp, E and IHC stain analysis were used to investigate the effect of PBMT on the healing of the experimental calvarial defect (3 mm in diameter) of a diabetic rat model. For in vitro study, the high glucose groups showed lower osteogenic differentiation in both irradiated and non-irradiated with PBMT when compared to the control groups. With the PBMT, all groups (control, osmotic control and high glucose) showed higher osteogenic differentiation when compared to the non-irradiated groups. For in vivo study, the hyperglycemic group showed significantly lower bone regeneration when compared to the control group. With the PBMT, the volume of bone regeneration was increasing and back to the similar level of the control group. The treatment of PBMT in 660 nm could improve the bone defect healing on a diabetic rat calvarial defect model.