Elevated Hemidiaphragm and Shortness of Breath: Challenges in Clinicoradiologic Integration

Unilateral diaphragmatic paralysis is often suspected when a hemidiaphragm is found abnormally elevated on chest radiography. Chest radiography has a high sensitivity for diaphragmatic palsy. A 67-year-old male presented to the hospital with a history of 4 months of exertional breathlessness that improved after taking a rest. The patient had normal cardiac and respiratory physical function. He also had a normal electrocardiogram and good systolic function on echocardiography. A treadmill test revealed ST-segment changes during peak exercise and recovery phases. On chest X-ray, his right hemidiaphragm was shown to be significantly elevated. Further investigation was conducted to rule out diaphragmatic paralysis, and the findings took a surprising turn to an entirely different diagnosis.

Impact of Internet Addiction on Mental Health: An Integrative Therapy Is Needed

In the past few years internet addiction (IA) and internet gaming disorder (IGD) have become very frequent, leading to many personality and psychiatric disorders including low self-esteem, impulsivity, poor sleep quality, mood disorder, and suicide. IA has been included in Appendix III of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as IGD. In addition, IA leads to many neuroanatomical and neurochemical alterations including cortical thinning of various components of the brain and altered dopaminergic reward circuitry. Due to widespread neuropsychiatric and neurobiological implications of IA, multiple therapeutic approaches are needed. Integrative therapy in the form of yoga and mindfulness has proven to be effective in many addiction disorders including IA.

Strengthening the Ability of General Hospital Neurology Departments to Treat Neuropsychiatric Diseases and Mental Disorders

Due to the “stigma” of neuropsychological and psychogenic disorders in China, patients with psychological and affective disorders mostly prefer to go to general hospitals or integrative medicine hospitals, while the majority of patients with mental disorders in the department of internal medicine are treated in the department of neurology. At present, there are few physicians with the ability to diagnose and treat neuropsychiatric diseases properly in the neurological department of general hospitals in China, and the diagnosis and treatment experience of mental diseases is insufficient. At the same time, the diagnosis and treatment of comorbid patients with internal diseases and mental disorders are more complicated. The psychology departments in general hospitals or mental health centers also have a limited ability to diagnose and treat comorbid diseases relating to internal medicine and mental disorders together. Therefore, this article reviews the current status of diagnosis and treatment of neuropsychiatric and mental disorders in general hospitals or integrative medicine hospitals.

Assessment of Acupuncture and Moxibustion Effects on the Electrophysiological Properties of the Ulnar Nerve: A Nerve Conduction Study

Background/Aims: Acupuncture and moxibustion, when used together, have act mechanically and thermally on treated reflexological areas. The main goal of this work was to evaluate the effects of acupuncture and moxibustion on the electrophysiological properties of the ulnar nerve. Methods: Electrical stimulation was applied to the ulnar nerve above the epi­condyle of 28 volunteers. A 20-V potential was applied, and after each 10 impulses it was increased by 10 V, up to a maximum of 80 V. At 20 and 80 V, the participants were asked to rate the discomfort from 0 to 10 on a Numeric Rating Scale for pain. After the first stimulation and data collection, the control group rested for 6 min, while the intervention group was submitted to acupuncture and moxibustion on Lingdao (HT 4). Following this period of time, a second electrical stimulation was performed on both groups. Results: The discomfort was greater in the intervention group during the second stimulation. The stimulus required to achieve the maximum amplitude decreased, but the changes were only statistically significant in the intervention group (p = 0.006). An increase in latency and a decrease in reaction velocity were noticed between the first and the second stimulation for both groups; however, only the control group presented statistically significant differences (p = 0.018 and p = 0.022, respectively). Conclusions: Acupuncture and moxibustion on HT 4 increased the electrical sensitivity, decreased the stimulus intensity to achieve the maximum amplitude, and avoided a significant increase in latency and decrease in reaction velocity in two consecutive electrical stimulations.

Effect of Antenatal Pelvic Floor Muscle Exercise on Mode of Delivery: A Randomized Controlled Trial

Background: Vaginal delivery is the best end of the pregnancy for the mother and the newborn. Aim: To evaluate the impacts of short-term antenatal pelvic floor muscle (PFM) exercises on a woman’s mode of delivery. Methods: This is a randomized controlled trial that recruited 20 healthy pregnant women aged between 20 and 25 years and able to contract the PFMs. The participants were included in the study at 20 weeks of gestation (WG) and were randomly allocated to one of two groups: the intervention group (n = 10) or the control group (n = 10). PFM strength was measured by vaginal squeeze pressure at 20 and 36 WG, and delivery outcomes were evaluated by a blinded searcher from the birth registry after labor. Results: There were no statistically significant changes between both groups at baseline regarding gestational age, type of labor, previous pregnancy complications, and PFM strength (p > 0.05). There was a significant change between both groups in mean PFM strength at 36 WG (p < 0.05). A significant correlation was observed between PFM strength at 36 WG and mode of delivery (vaginal delivery: r = 0.58, p < 0.05; caesarean delivery: r = –0.49, p < 0.05). Conclusions: PFM exercise is recommended for healthy pregnant women as a safe and inexpensive strategy for increasing the vaginal delivery rate.

Effect of a Residential Integrated Yoga Program on Blood Glucose Levels, Physiological Variables, and Anti-Diabetic Medication Score of Patients with Type 2 Diabetes Mellitus: A Retrospective Study

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease characterized by chronic hyperglycemia. Yoga is a form of mind-body intervention shown to have a positive impact on several health conditions in both healthy and diseased patients. The present study is intended to assess the effects of the Residential Integrated Yoga Program (RIYP) on blood glucose levels in patients with T2DM. Material and Methods: Data of 598 (186 females) T2DM patients from a holistic health center in Bengaluru, India, who attended a 15-day RIYP between January 2013 and December 2015 was obtained retrospectively. Average age of the participants was 56.45 ± 11.02 years. All subjects underwent a 15-day RIYP which involved yoga-based lifestyle changes with components of regulated sleep, balanced diet, asanas, pranayama, relaxation techniques, meditations, yogic cleaning procedures, and tuning to the nature. Fasting and post-prandial blood sugar, medication score, symptom score, systolic and diastolic blood pressure, pulse rate, and respiratory rate were assessed before and after intervention. Result: There was a significant decrease in fasting (p < 0.001) and post-prandial blood sugar levels (p < 0.001) along with a significant reduction in medication and symptom scores after 15 days of RIYP compared to baseline. Conclusion: The present study indicates that 2 weeks of a yoga-based residential program improves blood glucose levels, blood pressure, and medication score in patients with T2DM. However, further randomized controlled studies need to be performed in order to confirm the present findings.

The State of Intracellular Molecular Regulators during the Reconvalescence of Community-Acquired Pneumonia under the Influence of Microwaves at 1 GHz

We evaluated the levels of protein p53, retinoblastoma protein (RB), β-catenin, SMAD2, protein kinases AKT and focal adhesion kinase (FAK), and transcription factor CREB using ELISA in mononuclear leukocytes of patients with community-acquired pneumonia on days 15–17 of the disease. The research results showed that the subclinical immune-inflammatory process was characterized by a higher content of β-catenin by 19.8%, CREB by 23.3%, RB protein by 14.7%, increased phosphorylation level of protein kinase FAK by 19.8%, АKТ1 at serine-473 by 65.6%, and RB by 13.7%. In the cells, there was a decrease in p53 of 15.7%, SMAD2 of 16.9%, and protein kinase АKТ1 of 31.2%. Three hours after 1-GHz microwave irradiation, MNCs displayed a statistically significant increase in their content of the p53 protein of 20.0‰, RB of 9.35‰, β-catenin of 10.9‰, protein kinase FAK of 10.0‰, and CREB of 8.55‰. A day after a single irradiation of the cultures of whole blood cells, in irradiated cells compared to nonirradiated control, we observed a statistically significant increase in the content of p53 of 24.2‰, β-catenin of 15.1‰, SMAD2 of 20.4‰, RB of 9.8‰, as well as a reduction of the initially elevated levels of protein kinase AKT1 of 25.1‰, its phosphorylated form at serine-473 of 16.5‰, and a decrease in the phosphorylated form of the transcription factor CREB at serine-133 of 4.1‰. The research results indicate that a low-intensity microwave frequency of 1 GHz can be considered as a factor in molecular immune rehabilitation in conditions of community-acquired pneumonia.

Cell Death and Induced p53 Expression in Oral Cancer, HeLa, and Bone Marrow Mesenchyme Cells under the Exposure to Noncontact Electric Fields

Background: p53 acts as a transcription factor to regulate the expression of genes that modulate various cellular activities. The proliferation of cancer cells has been inhibited under the exposure to low-intensity (18 peak-to-peak voltage) and intermediate-frequency (100 KHz) electric fields generated between 2 capacitive electrodes. Therefore, the aims of this study were to observe the molecular mechanism of cell death caused by noncontact electric field exposure and to determine whether p53 protein can serve as a biomarker for this exposure or not. Methods: Oral squamous cell carcinoma, HeLa, and bone marrow mesenchyme cells were exposed to noncontact electric fields of Electro-Capacitive Cancer Therapy (ECCT) for 24 h. To observe the mechanism of cell death caused by ECCT, immunocytochemistry of p53 was performed, and the p53 expression was evaluated using immunoreactive score (IRS) calculation. Results: Electric field exposure by ECCT increased the percentage of dead cells in oral cancer cells (18.39%), HeLa cells (6.60%), and bone marrow mesenchyme cells (34.05%) with statistical significance using the independent t test compared to each control group. The IRS of p53 in oral cancer, HeLa, and bone marrow mesenchyme cultures were 10.50, 11.25, and 4.94, respectively. Conclusion: The high IRS shown in the treated oral cancer and HeLa culture cells may suggest that p53 expression in these culture cells is associated with the cell death mechanism induced by the exposure to noncontact electric fields, and the increased cell death in these culture cells may correlate with the IRS.

Whitening Efficacy of Tranexamic Acid Cataplasm on Melasma in Chinese Women

Background/Aims: Oral tranexamic acid (TXA) has been reported to be effective for treating melasma. However, the effect of topical TXA on melasma remains controversial. The aim of this study was to assess the effects of topical TXA cataplasm on melasma. Methods: Eighty-four patients with melasma were randomly assigned to a treatment group or a separate control group. They were instructed to apply 2 pieces of cataplasm with or without TXA. The melasma area severity index (MASI), skin color tone scale (SCTS), and area score were evaluated by dermatologists blinded to the treatment. Results: A significant decrease in the MASI and SCTS was observed on either or both sides of the face by the end of 8 weeks compared to the control group (p < 0.05). The area score was also significantly reduced on both tested sides compared to the control group (p < 0.05). Conclusion: Based on these results, we believe that localized cataplasm of TXA may be used as a potentially new, effective, and safe therapeutic modality for treating melasma.

Postural Orthostatic Tachycardia Syndrome (POTS): Assess, Diagnose, and Evaluate for POTS Treatment (ADEPT)

Background/Aims: Postural orthostatic tachycardia syndrome (POTS) is often identified as being clinically underdiagnosed and undertreated, resulting in unnecessary costs and poorer patient outcomes. Method: Through a literature search, the information has been synthesized, supporting the creation of a POTS diagnostic screening tool that can be implemented within the psychiatric outpatient clinic. Results: POTS patients are often referred to psychiatry for the treatment of chronic fatigue and anxiety disorders. Psychiatric professionals are in a position to prescreen for POTS in patients with orthostatic intolerance. Conclusion: A diagnostic prescreening tool helps to identify patients with POTS so they can be referred for proper treatment, improving their functionality and quality of life, and decreasing the healthcare burden.