Recurrent chronic subdural hemorrhage due to cervical spinal CSF leak in a young adult: Report of a case

SummaryNontraumatic intracranial subdural hemorrhage may result from disorders at remote anatomic sites. Here, we report a young adult who suffered from bilateral subdural hematoma without antecedent head injury. The subdural hematoma did not resolve after surgical drainage. The symptom of postural headache prompted a contrast-enhanced magnetic resonance imaging (MRI) examination of the brain, which revealed signs indicative of intracranial hypotension. Subsequently, MRI of the spine demonstrated leakage of cerebrospinal fluid (CSF) in the upper cervical spine region. The patient recovered after conservative treatment. A review of the patient’s medical history revealed that the patient had chiropractic therapy on his neck 2 months prior to admission. Intracranial hypotension due to spinal CSF leak is a rare cause of subdural hemorrhage, yet it should be considered in the absence of head trauma

Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era

In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses

Evaluation of the Effect of Laser Acupuncture and Cupping with Ryodoraku and Visual Analog Scale on Low Back Pain

The purpose of this study was to evaluate the effect of laser acupuncture (LA) and soft cupping on low back pain. In this study, the subjects were randomly assigned to two groups: active group (real LA and soft cupping) and placebo group (sham laser and soft cupping). Visual analog scale (VAS) and Ryodoraku were used to evaluate the effect of treatment on low back pain in this trial. Laser, 40 mW, wavelength 808 nm, pulse rate 20 Hz, was used to irradiate Weizhong (BL40) and Ashi acupoints for 10 minutes. And the Ryodoraku values were measured 2 times, that is, before and 15 minutes after treatment. The results show that there were significant difference between the first day baseline and the fifth day treatment in VAS in the two groups. Therefore, LA combined with soft cupping or only soft cupping was effective on low back pain. However, the Ryodoraku values of Bladder Meridian of the placebo group have been decreased apparently, and didn’t come back to their original values. It means that “cupping” plays the role of “leak or purge” in traditional Chinese medicine (TCM). On the other hand, the Ryodoraku values of Bladder Meridian of the active group have been turned back to almost their original values; “mend or reinforcing” effect is attributed to the laser radiation

The role of head-up cardiopulmonary resuscitation in sudden cardiac arrest: a systematic review and meta-analysis

BACKGROUND: Head-up cardiopulmonary resuscitation (HU-CPR) is an experimental treatment for sudden cardiac arrest (SCA), where cardiopulmonary resuscitation (CPR) is performed in a ramped position. We evaluated whether HU-CPR improved survival and surrogate outcomes as compared to standard CPR (S-CPR). METHODS: Studies reporting on HU-CPR in SCA were searched for in PubMed, Embase and Cochrane Library from inception to May 1st 2021. Outcomes included neurologically-intact survival, 24-hour-survival, intracranial pressure (ICP), cerebral perfusion pressure (CerPP) and brain blood flow (BBF). Risk of bias was assessed using the GRADE assessment tool and Newcastle Ottawa Scale. Fixed- and random-effects models were used to estimate the pooled effects of HU-CPR at 30 degrees. RESULTS: Thirteen articles met the criteria for inclusion (11 animal-only studies, one before-and-after human-only study, one study that utilized human- and animal-cadavers). Among animal studies, the most common implementation of HU-CPR was a 30-degree upward tilt of the head and thorax (n=7), while four studies investigated controlled sequential elevation (CSE). Two animal studies reported improved cerebral performance category (CPC) scores at 24-hour. The pooled effect on 24-hour survival was not statistically significant (P=0.37). The lone human study reported doubled return of spontaneous circulation (ROSC) (17.9% versus 34.2%, P<0.0001). The pooled effect on ROSC in three porcine studies was OR =3.63 (95% CI: 0.72–18.39). Pooled effects for surrogate physiological outcomes of intracranial cranial pressure (MD −14.08, 95% CI: −23.21 to −4.95, P=0.003), CerPP (MD 14.39, 95% CI: 3.07–25.72, P=0.01) and BBF (MD 0.14, 95% CI: 0.02–0.27, P=0.03), showed statistically significant benefit. DISCUSSION: Overall, HU-CPR improved neurologically-intact survival at 24-hour, ROSC and physiological surrogate outcomes in animal models. Despite promising preclinical data, and one human observational study, clinical equipoise remains surrounding the role of HU-CPR in SCA, necessitating clarification with future randomized human trials

Clinical Effects of Laser Acupuncture plus Chinese Cupping on the Pain and Plasma Cortisol Levels in Patients with Chronic Nonspecific Lower Back Pain: A Randomized Controlled Trial

Objectives. Chronic nonspecific lower back pain (LBP) is a common disease. Insufficient data is currently available to conclusively confirm the analgesic effects of laser acupuncture on LBP. This study evaluated the effectiveness of laser acupuncture plus Chinese cupping in LBP treatment. Methods. Patients with chronic nonspecific LBP were enrolled for a randomized controlled trial and assigned to the laser acupuncture group (laser acupuncture plus Chinese cupping) and control group (sham laser plus Chinese cupping). Laser acupuncture (808 nm; 40 mW; 20 Hz; 15 J/cm2) and Chinese cupping were applied on the Weizhong (BL40) and Ashi acupoints for 5 consecutive days. Plasma cortisol levels were assessed before and after the 5-day treatment session. The visual analog scale (VAS) scores were recorded at baseline and throughout the 5-day treatment session. Results. After the treatment session, the plasma cortisol levels and VAS scores decreased significantly in both groups. In the laser acupuncture group, the VAS scores decreased significantly on days 4 and 5, and an enhanced reduction in VAS scores was observed. Conclusion. Laser acupuncture plus Chinese cupping at the Weizhong (BL40) and Ashi acupoints effectively reduced pain and inflammation in chronic nonspecific LBP. This therapy could be a suitable option for LBP treatment in clinical settings

ATOMS : ALMA Three-millimeter Observations of Massive Star-forming regions - VIII. A search for hot cores by using C2H5CN, CH3OCHO, and CH3OH lines

Hot cores characterized by rich lines of complex organic molecules are considered as ideal sites for investigating the physical and chemical environments of massive star formation. We present a search for hot cores by using typical nitrogen- and oxygen-bearing complex organic molecules (C2H5CN, CH3OCHO, and CH3OH), based on ALMA Three-millimeter Observations of Massive Star-forming regions (ATOMS). The angular resolutions and line sensitivities of the ALMA observations are better than 2 arcsec and 10 mJy beam(-1), respectively. A total of 60 hot cores are identified with 45 being newly detected, in which the complex organic molecules have high gas temperatures (> 100 K) and hot cores have small source sizes (< 0.1 pc). So far, this is the largest sample of hot cores observed with similar angular resolution and spectral coverage. The observations have also shown nitrogen and oxygen differentiation in both line emission and gas distribution in 29 hot cores. Column densities of CH3OH and CH3OCHO increase as rotation temperatures rise. The column density of CH3OCHO correlates tightly with that of CH3OH. The pathways for production of different species are discussed. Based on the spatial position difference between hot cores and ultracompact H ii (UC H ii) regions, we conclude that 24 hot cores are externally heated, while the other hot cores are internally heated. The observations presented here will potentially help establish a hot core template for studying massive star formation and astrochemistry.Peer reviewe

Patterns of Oncogene Coexpression at Single-Cell Resolution Influence Survival in Lymphoma

Cancers often overexpress multiple clinically relevant oncogenes, but it is not known if combinations of oncogenes in cellular subpopulations within a cancer influence clinical outcomes. Using quantitative multispectral imaging of the prognostically relevant oncogenes MYC, BCL2, and BCL6 in diffuse large B-cell lymphoma (DLBCL), we show that the percentage of cells with a unique combination MYC+BCL2+BCL6- (M+2+6-) consistently predicts survival across four independent cohorts (n = 449), an effect not observed with other combinations including M+2+6+. We show that the M+2+6- percentage can be mathematically derived from quantitative measurements of the individual oncogenes and correlates with survival in IHC (n = 316) and gene expression (n = 2,521) datasets. Comparative bulk/single-cell transcriptomic analyses of DLBCL samples and MYC/BCL2/BCL6-transformed primary B cells identify molecular features, including cyclin D2 and PI3K/AKT as candidate regulators of M+2+6- unfavorable biology. Similar analyses evaluating oncogenic combinations at single-cell resolution in other cancers may facilitate an understanding of cancer evolution and therapy resistance

Concise Review: Dissecting a Discrepancy in the Literature: Do Mesenchymal Stem Cells Support or Suppress Tumor Growth?

The discovery that mesenchymal stem cells (MSCs) are recruited into tumors has led to a great deal of interest over the past decade in the function of MSCs in tumors. To address this, investigators have used a variety of tumor models in which MSCs are added exogenously to determine their impact on tumor development. Interestingly, many studies have reported contradicting results, with some investigators finding that MSCs promote tumor growth and others reporting that MSCs inhibit tumor growth. Many mechanisms have been reported to account for these observations, such as chemokine signaling, modulation of apoptosis, vascular support, and immune modulation. In this review, we analyzed the differences in the methodology of the studies reported and found that the timing of MSC introduction into tumors may be a critical element. Understanding the conditions in which MSCs enhance tumor growth and metastasis is crucial, both to safely develop MSCs as a therapeutic tool and to advance our understanding of the role of tumor stroma in carcinogenesis. Stem Cells 2011;29:11–1