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Loneliness is thean experience that is intertwined inwith being human, but since it is so painful and troubling, all of us try to avoid it. It has short- and long-term negative consequences, including its influence on our life satisfaction, health, and mortality. Various causal factors were explored regarding loneliness, which is essentially a subjective experience. This commentary aims to highlight the contribution of culture, be it collectivistic or individualistic, to the development of loneliness. Since loneliness is correlated with the expectation of being with others and part of a community, research found that people in collectivistic cultures are lonelier than those in individualistic ones. Ethnicity also contributes to the development, and was thus reviewed. While it beingis an essential part of being human, loneliness can, indeed, be attenuated and its pain lessened, and culture may predict ways of doing so.

Tardive Dyskinesia (TD) is an iatrogenic complication caused by antipsychotic agents and rarely by other anti-depressive/antiepileptic or anti-nausea medication. It is mostly a benign condition with implications regarding esthetic issues but it can also impact social and emotional well-being. We are reporting a case in which severe TD ensued in an elderly lady with newly diagnosed dementia, who presented to the psychiatric ER with a Capgras syndrome and paranoia accompanied by behavioral disturbances. She was treated with 4 consecutive antipsychotic agents (haloperidol, brexiprazole, risperidone, and olanzapine) due to unresponsive psychosis in conjunction with biperiden and developed a severe case of TD, which was complicated by two successive episodes of jaw subluxation. In spite of the good outcome following the reduction of the subluxation, we emphasize the danger of this rare painful, and bothersome side-effect and recommend how to pharmacologically deal with the TD setting in which it occurred.

Most underwater explosions show characteristics of a bubble pulse and reverberation effects. To specifically identify the cause of an underwater explosion, it is most important to find a bubble pulse and reverberation effects using spectral and cepstral analyses. For a very shallow underwater explosion, spectral analysis is preferable to cepstral analysis. Time-domain analyses show bubble pulses as well as positive polarities of the first P-wave arrivals on the vertical component, and frequency-domain spectral analyses also clearly reveal the bubble pulse and reverberation effects. This study includes comparative studies including a Russian underwater nuclear explosion and US Navy shock trials. The ROKS Cheonan sinking was a shallow underwater explosion that occurred near the surface showing a bubble jet characteristic resulting in splitting the ship into two pieces including a bubble pulse and reverberation effects. The findings of a bubble jet and a toroidal bubble deformation including a bubble pulse are highlighted for a shallow underwater explosion in this study. The ROKS Cheonan sinking took place off the Baengnyeong Island in the Yellow Sea of the Korean Peninsula at a depth of about 8 m in the sea depth of 44 m on March 26, 2010. The explosive charge weight was estimated at 136 kg TNT which is equivalent to one of the abandoned land control mines (LCM) that were deployed near the Northern Limited Lines (NLL) in the Yellow Sea in the late 1970s.

Background: Clinical practice guidelines recommend monitoring the depth of anesthesia during endoscopic examination of the gastrointestinal tract using sedation scales, despite their subjective nature, while the use of the bispectral index, an objective measure, during sedation, remains controversial. The main objective of this study was to assess the ability of bispectral index monitoring to characterize the depth of anesthesia during endoscopy.Methods: We conducted a cross-sectional study to assess the performance of the bispectral index using data from a multicentre clinical trial with 180 patients undergoing scheduled colonoscopies. Sedation was monitored using the bispectral index and Ramsay Sedation Scale. Data on sedation were recorded at five-time points (t1 to t5) during the colonoscopy.Results: Bispectral values were significantly associated with Ramsay scores (rho, -0.73; p < 0.0001). In regression analysis, each unit increase in bispectral value was associated with a reduction in the risk of a high Ramsay score (> 3) at all points (OR 0.922; 95% CI: 0.865–0.979; p < 0.0001 at t1). Receiver operating characteristic curve analysis found areas under the curve of 0.8272 for a bispectral index cut-off for deep sedation of 69.76 (sensitivity, 95.35%; negative predictive value, 97.53%) when reaching the colic flexure (t2) and 0.8399 for a cut-off of 69.29 (sensitivity, 96.15%; negative predictive value, 98.81%) at the end of the colonoscopy (t5).Conclusion: Bispectral index monitoring enables objective real-time reliable assessment of sedation. It enables easy continuous monitoring with a very good performance for detecting deep sedation and correlates with a clinical scale routinely used in endoscopic procedures.

Treatments via the minor papilla is effective where the deep cannulation via the major papilla is impossible in such cases as [1] the Wirsung’s duct is inflammatory narrowed, bent or obstructed by impacted stones [2] pancreatic duct divisum (complete or incomplete) [3], maljunction of pancreatico-biliary union with stones [4], pancreatic stones in the Santorini’s duct. In [1,2] cases, the pancreatic juice flow via the major papilla decreases, while that of the minor papilla increases. Then the size of minor papilla and its orifice shows corresponding enlargement. This substitutional mechanism is an advantage when undertaking our new method. Since the pancreatic juice flow is maintained via the minor papilla in these cases, accurate and careful endoscopic skills are necessary to prevent pancreatitis due to the occlusion of the Santorini’s duct after this procedure. We have experienced 135 cases treated via minor papilla in these 27 years, so we would like to report about its safety and efficacy.

A 21-y-old recreationally active male lacking the last 30° of elbow extension from a fractured and dislocated elbow sustained while wakeboarding came to our clinic November of 2015. A regimen was applied of 20-minutes of pulsed shortwave diathermy (PSWD) treatments delivered at 100 watts to heat the affected tissue prior to approximately 40°C followed by 10 minutes of joint mobilizations. This was followed by application of an ice pack to the area for 30 minutes. Measurements and treatments were given on Nov 3,5 and 10. The changes in AROM extension were as follows: Nov 3, from 30° to 20°; Nov 5, from 24° to 10°; Nov 10, from 10° to 0°. Over the course of the treatment the PSWD/ joint mobilizations improved extension AROM of the elbow 30° (full AROM) in just 3 treatments. There was also no post-treatment pain.

Introduction: Post-dilution online hemodiafiltration is the most efficient extracorporeal depurative treatment of CKD. Recently a new type of membrane has been developed, with a higher cut-off point also called a medium cut-off point, which has the capacity to eliminate higher molecular weight molecules in hemodialysis. The hemodialysis performed with these membranes has been called “Expanded Hemodialysis”.Objective: Compare the purifying efficacy of medium and high molecular weight molecules in patients dialyzed with high-flux hemodialysis, VitaPES 210HF, and with patients treated with expanded hemodialysis with the medium cut-off dialyzer, Elisio-HX.We also assessed the effect that the increased removal of inflammatory mediators by MCO hemodialysis had on fecal Calprotectin levels.Patients and methods: This is a prospective observational cross-over study in which 8 prevalent hemodialysis patients were followed for two months. Blood levels of IL-6, C-reactive protein (CRP), β2-microglobulin, Kappa and Lambda immunoglobulin light chains, and serum albumin were determined before and after each hemodialysis session.Results: The percentage of reduction of medium and higher molecular weight molecules: β2microglobulin, IL-6, Kappa and Lambda chains and CRP were higher with the Elisio-21HX dialyzer compared to the VitaPES 210HF dialyzer. There was no difference in albumin clearance between the two dialyzers.Fecal calprotectin levels were lower in patients dialyzed with Elisio-21HX.Conclusion: The medium cutoff dialyzer, Elisio-HX, is more efficient in the elimination of medium/high molecular weight molecules than the VitaPES HF high-flux dialyzer, with the same albumin elimination.Improving inflammation at the local intestinal level with lower levels of fecal Calprotectin.

Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature. Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications. Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available. Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms

The ability to live things to transfer their genetic heritage to future generations in a healthy way forms the basis of the science of reproduction. In this sense, understanding the structure and functions of the sperm cell, which is one of the sexual cells, is one of the important issues that should be emphasized. Methods such as omics, genomics, proteomics, and metabolomics, which have been found in research in recent years, are also used to evaluate the functions of the sperm cell.

With increasing awareness of the mental health issues among the clergy and seminary students, it is important to explore possible interventions to help address their mental health concerns. This pilot study examined the impact of Christian meditation and biofeedback on levels of stress, anxiety, and depression of seminary students. Participants of this study included 20 theology students from two seminary campuses. Participants were of various ethnic backgrounds and had an average age of 31. At the beginning of the study, participants were randomly assigned to practice either Christian meditation or biofeedback for 4 weeks, three times per day, and to keep a log of their practice times. The results from the paired samples t-tests indicated that both Christian meditation and biofeedback significantly reduced the levels of stress, anxiety, and depression experienced by the participants. ANCOVA indicated that neither intervention was more effective than the other. Seminaries, churches, and pastoral care groups should look into these interventions as a good source to help their clergy cope with stress, anxiety and depression.