Safety of home-based exercise for people with intermittent claudication: A systematic review

Intermittent claudication (IC) is a classic symptom of peripheral artery disease, with first line treatment being supervised exercise therapy (SET). Despite this, SET is frequently underutilised, and adherence is often poor. An alternative option are home-based exercise programmes (HBEP). Although HBEPs are well tolerated, to the authors’ knowledge, no research has assessed their safety. The aim of this review was to assess the safety of HBEPs in people living with IC. We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library databases. The main parameter of interest was complication rate, calculated as the number of related adverse events per patient-hours. Subanalysis was undertaken to determine differences in safety for studies that did and did not include pre-exercise cardiac screening, and for studies with exercise at low, moderate, and high levels of claudication pain. Our search strategy identified 8693 results, of which 27 studies were included for full review. Studies included 1642 participants completing 147,810 patient-hours of home-based exercise. Four related adverse events were reported, three of which were cardiac in origin, giving an all-cause complication rate of one event per 36,953 patient-hours. Three of these events occurred following exercise to high levels of claudication pain, and one occurred with pain-free exercise. All four events occurred in studies without cardiac screening. Based on the low number of related adverse events, HBEPs appear to be a safe method of exercise prescription for people with IC. Our results strengthen the rationale for providing alternative exercise options for this population. PROSPERO Registration No.: CRD42021254581

Comparative Physiological and Transcriptomic Analyses Reveal Ascorbate and Glutathione Coregulation of Cadmium Toxicity Resistance in Wheat Genotypes

Background: Understanding the cadmium (Cd) resistance mechanism is crucial for combating the phytotoxicity of Cd and meeting the increasing food demand daily. A classic symptom of Cd toxicity is root growth inhibition. Results: Using two wheat genotypes (Cd tolerant genotype T207 and Cd sensitive genotype S276) with differing root growths in response to Cd, we conducted comparative physiological and transcriptomic analyses and exogenous application tests to interpret Cd detoxification mechanisms. S276 accumulated more H2O2, O2-, and malonaldehyde than T207. Catalase activity and levels of ascorbic acid (AsA) and glutathione (GSH) were higher, whereas superoxide dismutase and peroxidase activities were lower in T207 than in S276. Transcriptome analysis showed that the expression of RBOHA, RBOHC, and RBOHE significantly increased, whereas that of RBOHB markedly decreased by Cd treatment. The transcriptional levels of 22 genes encoding RBOH were higher, and that of 11 genes were lower in T207 than in S276. The transcription of genes involved in the AsA-GSH cycle was profoundly reshaped by Cd treatment; 124 genes were higher and 43 genes were lower in T207 than in S276. Exogenous combined application of AsA and GSH alleviated Cd toxicity by scavenging excess ROS and coordinately modulating root length and branching, especially in S276.Conclusions: These results indicate that the AsA-GSH cycle fundamentally and vigorously influences plant defense against Cd toxicity, which provides valuable information for further clarification of the mechanisms underlying Cd detoxification.

Electrophysiological Effect of Acupuncture in the Carpal Tunnel Syndrome Case

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and occurs as a result of compression of the median nerve in the carpal tunnel at the wrist. The classic symptom in patients with CTS is paresthesia (numbness, burning, tingling) and pain in the median nerve distribution area of the hand, especially at night. A 24-year-old female patient presented to GETAT polk with the diagnosis of mild carpal tunnel syndrome after examination and EMG after the complaint of numb tingling in the hand in the neurology outpatient clinic. The patient was using Parkyn (pramipexole dihydrochloride monohydrate) 25mg. Acupuncture was applied to the patient for 10 sessions. Disposable sterile acupuncture needles were applied to the PC-6, H-7, LU-9, H-7, SI-3 points (0.22x13mm, 0.22x1.5mm Hua Long). The sessions lasted 20 minutes. The sessions were done first twice a week, then once a week. The patient was prescribed Vitamin B1 + B6 supplements. After 10 sessions of acupuncture, the EMG was repeated. The EMG result of the patient was normal. Parkyn was cut by neurology, Lyrica (pregabalin) was switched to 150mg. The patient's need for medication was also reduced.

Presentation of Bilateral Facial Paralysis in Melkersson–Rosenthal Syndrome

Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.

Vanek’s tumor causing ileoileal intussusception in a middle-aged man

Intestinal obstruction is a common surgical emergency requiring urgent intervention. Small bowel obstruction secondary to intussusception is rarely encountered especially when inflammatory fibroid polyp (IFP) is the lead point. A 41-year-old gentleman with intestinal intussusception secondary to IFP presented to us with a classic symptom of intestinal obstruction. Computed tomography revealed a target or sausage-shaped soft tissue mass with a layering effect, which was confirmed by intraoperative findings. Histopathology was consistent with IFP and supported by immunoreactivity of CD34 and negative immunostaining for CD117. He recovered without any surgical complication or recurrence. Even intussusception can be managed via non-surgical technique in children; surgery is the mainstay of treatment in adults.

Consumer theory’s narcissism epidemic: Towards a theoretical framework that differentiates the self and other

This article critically engages with Russell Belk’s ‘extended self’ theory and Susan Fournier’s ‘human relationship model’. When a human development model is applied to the ‘extended self’ theory, Belk appears to equate the psychology of infants with consumerism in general – an inability to differentiate between the self and other. Fournier concludes that when consumers think about brands as if they were human, endowing inanimate brand objects with personality qualities, the object becomes animated, facilitating a ‘relationship dyad’. However, she confuses ‘dyad’ with the projection of the self onto objects, what psychoanalytic theory suggests is a classic symptom of narcissism. Devoid of any (psychological) understanding of narcissism, these theorists do not make connections between narcissism and its behavioural patterns exhibited in contemporary consumer culture. While the culture of consumption facilitates associations and projections of the self onto objects through a steady flow of fantasy, encouraging consumers to blur self-other distinctions, it does not necessarily follow that all consumers are unable to differentiate between the self and other. Through examining the complex symbolism and powerful repositories of meaning that consumers project onto objects, our understanding of how consumers interact with products will be deepened; by (re-)inserting the unconscious into consumer theory, the self-other divide emerges.

Cornea verticillata in Fabry disease

Cornea verticillata is the typical sign of ocular involvement in Fabry disease and manifests by the whorl-like, linear opacities in the inferior part of the cornea. Aim. To study the frequency of cornea verticillata in patients with Fabry disease and it’s relation to the severity of the disease and the types of mutation in the GLA gene. Materials and methods. We studied 69 adult (over 18 years) patients with a classic form of Fabry disease that was confirmed by enzymatic and molecular genetic studies. There were 39 males and 30 females. The median age was 39 years [30.0; 50.0]. The severity of Fabry disease was assessed using the Mainz Severity Score Index (MSSI) with a maximum value of 76 points. Depending on the MSSI score, patients were classified into mild (40) clinical categories. Results and discussion. At least one classic symptom of Fabry disease was present in 88.4% of patients. The majority of patients had the missense mutations of the GLA gene. Cornea verticillata was found in 65.2% of patients and occurred with a similar frequency in males (56.4%) and females (76.7%; p=0.07). Cornea verticillata was the single classic symptom of Fabry disease in only 4.9% of cases, while the rest of the patients presented with angiokeratoma, neuropathic pain and/or hypohidrosis. The frequency of classic symptoms of Fabry disease, as well as renal disease (with the exception of terminal chronic renal failure), brain and heart damage was similar in patients with and without cornea verticillata. Median MSSI scores were also similar in patienths with and without cornea verticillata (20.0 and 18.5 points, respectively; p=0.92). Similar results were obtained in males (26.5 and 30.0 points, p=0.97) and females (16.0 and 16.0 points, p=0.45). The frequency of cornea verticillata did not differ in patients with different types of mutations in the GLA gene. Conclusion. Cornea verticillata occured in 65% of adult patients with Fabry disease, was usually accompanied by the other classic symptoms of the disease, and was not associated with the severity of the disease.

Dangerous Diplomacy

This book assesses the role of the UN Secretariat in the Rwandan genocide. With the help of new sources, including the personal diaries and private papers of the late Sir Marrack Goulding, it situates the Rwanda operation within the context of bureaucratic friction existing at Headquarters in the early 1990s between the Department of Political Affairs (DPA) and the Department of Peacekeeping Operations (DPKO). The book argues that these units clashed not only over resources (a classic symptom of bureaucratic pathology) but also over the scope of peacekeeping and the role of the Secretary-General (SG) within it. This rivalry also reflected a split between a strong-willed SG determined to leave his mark on international affairs and to use his ‘political’ department independently of states, and Washington and the politico-military apparatus of the Pentagon, which in Somalia, Rwanda, Bosnia, and Haiti found itself increasingly at odds with Boutros-Ghali. Although the book looks at how this bureaucratic and power-political confrontation impacted on the Rwanda mission, it identifies the conceptual reasons for the DPA–DPKO split in the grey area that separates peacebuilding and peacekeeping. The difficulty of distinguishing these two key UN functions, coupled with the creative tension between SGs and states, explains why six decades after the birth of the UN, it has still not been possible to demarcate the exact roles of DPA and DPKO. Far from being dull and irrelevant, the book concludes that the UN bureaucracy is an intriguing barometer of the role of the Secretary-General in world politics.

The Versatile Brainstem

The role of the brainstem in life is detailed from both medical and legal points of view. This chapter describes how the brainstem divides up the fundamental processes of human life, with the most automatic and basic ones supported most caudally and progressively more expressive functions depending on more rostral brainstem regions. The text then steps through the internal anatomy of the brainstem with a focus on cranial nerve nuclei. The location of the three long tracts is followed for the length of the brainstem, and the course of the corticobulbar tract is presented. A primer on the anatomy of the cerebellum is capped by introducing ataxia, the classic symptom stemming from ipsilateral cerebellar damage.