Monday, December 5, 2022




In the US, influenza (flu) causes 9 to 45 million illnesses, leading to 12,000 to 61,000 deaths annually (10.1001/jama.2020.14772). The World Health Organization estimates that annually there are about one billion infections, 3-5 million severe illnesses, and 300,000-500,000 deaths worldwide (10.1038/s41572-018- 0002-y). Influenza is caused primarily by influenza A and influenza B viruses [1]. Influenza A is the cause of pandemics. A schematic diagram of the influenza A virus is presented in Figure 1. Influenza will continue to be prevalent because current vaccines are safe but only 30-60% efficacious. In contradistinction, COVID-19 vaccines have an efficacy of about 90%. Additionally, unlike coronavirus, new zoonotic influenza strains intermittently migrate to humans. Influenza is a major part of “The New Normal.”


Figure 1: A schematic diagram of influenza A virus.


Overlapping spread of COVID-19 and influenza could be a major strain on the health care system [2]. Their coinfection is not common but may cause more severe disease. Influenza vaccination and therapy are important in addition to COVID-19 vaccination and therapy, especially in persons at increased risk.


Influenza’s median incubation period is 2 days. Patients are infectious for a day before and 5 to 7 days after symptoms. COVID-19 has an incubation period of 4-12 days, a median of about 5 days [3]. Patients are most infectious from 2 days before symptom onset. Influenza symptoms peak in 3-7 days. COVID-19 symptoms peak in second or third week. The spread of both viruses is facilitated by transmission by asymptomatic patients.


About one-half of influenza A cases are due to aerosol transmission (10.1038/s41598-019-38825-y). Adequate ventilation can reduce it. Used appropriately, surgical masks reduce the concentration of aerosolized influenza virus by about ten-fold and are adequate for prophylaxis against influenza (10.1016/j.jhin.2013.02.007; 10.7326/M20-3213). Transmission by respiratory droplets can also be reduced by masking [4-9]. Transmission by direct contact can be reduced by hand and general hygiene. COVID-19 is transmitted in a similar manner. Social distancing reduces transmission by all the mechanisms. According to the Centers for Disease Control and Prevention (CDC), the precautions utilized for COVID-19 reduced the positivity rate for influenza tests from 16.8% in 2019-20 to 0.15% in 2020-21. Influenza is less contagious and causes less severe disease than COVID-19. Quarantine recommended for COVID-19 patients is not necessary for those with influenza. As children play an important role in transmitting influenza, opening of schools is likely to increase transmission. Healthcare providers should take precautions to avoid infecting themselves and others.

Influenza-Like Illness (ILI)

CDC defines ILI as fever 100°F (38°C) or greater and cough or sore throat that is not due to another known cause such as streptococcal pharyngitis (strep throat). ILI’s causes can be benign such as common cold, i.e., nasopharyngitis caused by rhinovirus or other viruses. ILI’s severe causes include sepsis, meningitis, COVID-19, and SARS. Often there is an abrupt onset. SARS leads to severe disease in most of the infected persons. Influenza and COVID-19 cause mild disease in most of the infected persons (10.1016/S1473-3099(20)30484-9). SARS is currently not prevalent [10]. Severe disease due to COVID-19 and SARS occurs primarily in the elderly. Influenza is more evenly distributed across the age groups. ILI can cause immunosuppression, leading to bacterial pneumonia, necessitating antibiotic treatment (10.1097/ QCO.0000000000000347). After general anesthesia, children with influenza have a longer hospital length of stay and increased risk of requiring intensive care (10.1186/1471-2253-11-16). Routine surgery should be postponed for about four weeks in a patient with ILI. Unvaccinated patients should be offered influenza vaccination after the acute phase of ILI has passed and before the surgery. Before performing urgent surgery, severe causes of ILI should be excluded [11].

Upper Respiratory Tract Infection (URI) Excluding ILI

In cold weather URI is common, especially in children. Often it is due to a common cold, or noninfectious allergic or vasomotor rhinitis. Less commonly, it can be an early presentation of more serious illness including ILI, COVID-19, strep throat, and herpes simplex. Early in infection it is difficult to distinguish between different etiologies of URI. URI may cause sneezing, coughing, headache, malaise, rhinorrhea, sore throat, sinusitis, and bronchitis. Subsequently, bronchi may be hyperreactive for about six weeks. Pulmonary complications associated with surgery in a patient with URI are bronchospasm, laryngospasm, coughing, breath holding, postintubation croup, episodes of desaturation, atelectasis, and pneumonia. Anticholinergics and bronchodilators may not be beneficial. If ILI and other serious illnesses are unlikely, routine surgery can be performed with caution. Perioperatively, adequate hydration and humidification should be maintained. There are no pediatric or adult anesthesia closed claims that implicate URIs including influenza with serious adverse events.

Cardiac Effects

There is a very small incidence of viral myocarditis in patients with URI including ILI. It may lead to serious arrhythmias and refractory heart failure (10.1016/j.jcrc.2018.06.001; 10.1038/ s41569-020-00435-x). Cardiac abnormality should be excluded before performing non-emergent surgery.

Diagnostics Tests

These include nucleic acid amplification via polymerase chain reaction (PCR) and antigen-based immunological assays [12]. A PCR test can be performed even at the point-of-care with results available within an hour (10.1016/S2213-2600(20)30469-0). This can facilitate infection control and utilization of antiviral thrapeutics. It is especially useful for patients who have severe symptoms or are hospitalized. Test for COVID-19 may also be performed if indicated.

Influenza Vaccine

It is the best preventive measure. Despite moderate efficacy, it substantially reduces morbidity and mortality because of the high prevalence of influenza. It is recommended for anyone over 6 months of age. It is especially beneficial in the presence of age <2 years or >65 years, pregnancy, and pre-existing conditions (10.1001/jama.2020.14772). Lack of vaccination in pregnancy not only increases the risk to the mother but also increases risk of preterm birth, fetal death, infant respiratory infections, and hospital admission [13]. The T cell response vaccines elicit is substantially weaker than the antibody response. Children may need two doses of the vaccine, at least four weeks apart. The vaccine should be administered at least one week before surgery. It takes two weeks to develop full effect. As the protection wanes over time, mid- September to mid-October is preferred for vaccination. Influenza and COVID-19 vaccines may be administered together. The vaccine may be administered to surgical inpatients (10.7326/M15-1667).

Available Vaccines

The influenza virus mutates frequently. Quadrivalent vaccines protect against four of the currently most prevalent strains of influenza. The vaccines are altered every year for the predicted prevalent strains. Nine vaccines from four manufacturers are available in the US. Inactivated influenza vaccine is most commonly used. It is approved for persons above 6 months of age. As older individuals have a reduced response, vaccines that have a higher dose or are adjuvanted are recommended for persons above 65 years of age [14]. The vaccine is usually administered intramuscular, but a lower dose intradermal vaccine may be non-inferior (13-10.1001/ jamanetworkopen.2020.35693). Live-attenuated influenza vaccine is administered via nasal spray. It is approved for ages 2-49 years. It may be preferable in some situations such as vaccinating many persons in a community. It should be avoided if the patient or someone nearby has a suppressed immune system. Hence, it is not suitable for inpatients. Recombinant vaccine and cell culture vaccine do not contain egg products. They are especially suitable for persons who need to avoid eggs because of allergy or dietary preferences.

Future Vaccines

Universal vaccines that provide durable response against all influenza strains are in human trials (10.1038/s41591-020- 1118-7). These vaccines generate antibodies against the viral hemagglutinin protein stem (stalk) domain (HA2). Current vaccines generate antibodies against the immunodominant globular head domain (HA1), which is variable and mutates much more frequently [15]. Vaccines utilizing mRNA are also in human trials. They are likely to have greater efficacy but more side effects than current vaccines. A major advantage of the mRNA vaccines is that they can be readily modified to match mutations in the virus.

Benefits of Vaccination for Adults

Influenza vaccine reduces the risk of respiratory and cardiovascular adverse outcomes and mortality among adults, especially in the presence of pre-existing conditions and advanced age. This was confirmed in a meta-analysis of studies on all adults (10.1016/j.arr.2020.101124). Another meta-analysis found that vaccination reduced the risk of adverse cardiac outcomes, especially in patients with more severe cardiac disease (10.1001/ jama.2013.279206). Preoperative vaccination is beneficial. A large study of elderly patients who had major surgery found preoperative vaccination reduced by about one-half the risk of pneumonia, intensive care admission, and death (10.1093/infdis/jix616). Patients also had shorter hospital stays and reduced resource utilization.

Influenza Therapeutics

These include neuraminidase inhibitors oseltamivir, zanamivir, peramivir, and laninamivir; cap-dependent endonuclease inhibitor baloxavir; and matrix protein M2 ion channel blockers (10.1001/ jamanetworkopen.2021.19151). They attenuate viral replication. They provide postexposure prophylaxis. When started within 2 days of symptom onset, they reduce duration and severity of the disease, and complications. They also reduce transmission of influenza virus. However, their efficacy is limited, especially in patients with serious illness [16]. They are expensive and not widely utilized. Although influenza and COVID-19 have similar initial symptoms, their therapeutics are different. Thus, dexamethasone reduces mortality for hospitalized COVID-19 patients on respiratory support but may increase mortality for hospitalized influenza patients (10.1001/ jama.2020.15260).

Influenza Pandemics

They are usually caused by zoonotic influenza A virus strains migrating to humans. The 1918 “Spanish flu” pandemic caused by influenza A H1N1 virus led to more than 40 million deaths worldwide. H1 denotes haemagglutinin subtype 1 and N1 denotes neuraminidase subtype 1. The pandemics of 1957, 1968 and 2009 were caused by influenza A H2N2, H3N2, and H1N1 viruses, respectively [17,18]. The 2009 “swine flu” influenza A H1N1 virus that originated from pigs was antigenically different from previously dominant influenza A H1N1 viruses. It caused 150,000- 600,000 deaths worldwide. Avian influenza “bird flu” caused by H5N1 and H7N9 is not prevalent. Overlapping occurrence of influenza pandemic and COVID-19 could be devastating. Vigilance and prompt action are essential to prevent zoonotic influenza A virus strains from migrating to humans.


Influenza is a prevalent respiratory disease that will continue to affect anesthesia practice in the foreseeable future. Vaccination reduces risk. With appropriate management, the risk of adverse outcomes is low.

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Friday, December 2, 2022

The Alarming Toxicity of Ruta Graveolens


The Alarming Toxicity of Ruta Graveolens


Worldwide use of Ruta Graveolens as an herb and as alternative medicine has increased dramatically in the past decades without any increased effort to compensate for the toxicity and the unsafe human consumption. While pharmacological studies on drugs that cause cardiac, hepatic, and nephrotoxicity have resulted in drug termination, the same type of studies on herbal medicine are ignored and actions have not been taken to protect the youth from this herb in their productive stages of life. The endemic production of Ruta Graveolens is in India [1], Ethiopia [2], and South Africa [3] where there is a dramatic growth in population that masks the toxic and infertility effect on the younger population. The purpose of this study is to bring awareness that Ruta Graveolens is a toxic plant and should be handled with caution.

Scholarly articles have reported their findings on the abortifacient properties of herbs resulting in miscarriages followed by a likely chance of organ failure, especially kidney failure in pregnant mothers. In herbal medicine, Ruta is an emmenagogues herb that is taken by women to induce and increase menstrual flows and to cleanse the body. It is reported that Ruta has been used as an abortifacient in Europe, Asia, Africa, and South America and is found to be endemic in the Mediterranean countries. Studies over the past twenty-one years on both female and male mammals have shown abortive effects, specifically implantation, premature infant losses, and paralyzing sperm activities. The chemical composition analysis of Ruta Graveolens listed 50-120 different compounds among which Kuzovkina in his 2004 publication found coumarins and xanthotoxins as the toxic infertility drugs known to man. The most active component of Ruta Graveolens extract is chalepensin, widely known as an anti-fertility drug in mammals. In cultural medicine, Ruta Graveolens is still used as an anti-inflammation, anticancer, antioxidant, antidiabetic, antibacterial, and antifungal medicine. Figure 1 shows a picture of Ruta Graveolens grown in our laboratory.


Figure 1: Ruta Graveolens.



Figure 2: Treated Onion bulbs with Rue.

In this study, Ruta was extracted by diethyl ether, hydrochloric acid, and sodium hydroxide solutions and was used on the commercially purchased organic onions and the growth rate of onion roots was observed. Rationally, we used onion roots to avoid animal sacrifice. The three extracts were administered in the solution where the onions were grown in the amount of 1, 2, 5, 10, 15, 25 milliliters and the growth rate were measured. Pure water was used in the control sample. A review of literature lists several methods of extraction of phytochemical compounds like coumarins and xanthotoxins which is effectively done with a hot water extract and or a variety of pure and mixed organic solvents of ethanol, hexane, chloroform, acetone, and a combination of these solvents. Separation of the essential oil and other chemicals from the stem, leaves, roots, and seeds of Ruta was done by several planned extraction steps and the results were successful. Figure 2 is the setup of the onion bulbs hanging on sticks and the roots were submerged in water. The submersion water was replenished every day and onions were exposed to open air sunlight. At the end of 15 days, the roots and stems were shaved, dried, and weighed along with the control group.

The following research approach is reviewed below to show that the extraction of Ruta Graveolens by different solvents and different testing methodology compliments the method we chose in this study. Kong et al [4]. performed solvent extraction of 10.4 Kg of powdered whole plant of Ruta Graveolens with petroleum ether and chloroform that percolated overnight. The extracts from the root, stem, and leaves were separated into its components using benzene and methanol. They succeeded in isolating chalepensin, a toxic compound among furanocoumarin which is a pharmacologically active compound in Ruta Graveolens. They purified chalepensin and the yield was 9 grams of the crystal that was tested and confirmed with proton NMR and mass spectroscopy. The effects of infertility due to Ruta Graveolens were tested on 10 Sprague Dawley rats that were randomly selected from a large selection of genetically identical 8 weeks old females. The pregnant rats were kept in an environmentally controlled room, with minimized infections, and a supply of nutrition. Solvent enhanced chalepensin extract was administered to the experimental group and the control group.

Hale et al [5]. studied Ruta Graveolens leaves, seeds, flowers, and stems obtained from credible sources and separated for extraction. The sample was blended, the extraction was conducted by several volatile liquids, and the isolated crystals were separated into fractions and tested using TLC and proton and carbon 13 NMR, and UV-VIS spectroscopic methods. Fresh leaf extraction was purified and isolated using several steps in the extraction process. All the extracts from their experiment inhibited cell division in the root tip of duckweed. Gonçalves de Freitas [6]. studied Ruta Graveolens grown in Brazil. These were air-dried, grounded, and extracted using 70% ethanol with a 25% yield. The selected CF1 mice were supervised in a controlled environment with nutritional supplies and an environmentally controlled laboratory. They administered 1000 mg/kg of extract per body weight to the experimental group and only the vehicle was administered to the control group. The extract was administered to the 10 mice per group at different stages of pregnancy. The mice were sacrificed and checked for the condition of the fetus in their ovaries.

Indian [1] grown Ruta Graveolens was collected, and aerial parts and the roots were separately, dried, and powdered, and made as a paste with water. The plant gave a 20% slurry extract, and the paste was administered to rats and hamsters. The ingestion dose was 8g/kg, and it was administered to rats and hamsters within two weeks of pregnancy. Then healthy female rats and hamsters were used in a controlled environment and experimental and controlled groups were used. At the end of the experimental comparison of body weight, before and after the trial was used, the effect of the toxicity of the Ruta Graveolens on the inner body organs was investigated. Statistical significance using (P,0.05) chi-square analysis was obtained. The results showed increased toxicity and a high rate of fetus mortality. The chloroform extract chalepnisin was found in all parts of the plant, and its toxicity was reported in the pregnant rodents. The results showed a significant increase in infertility effect in the pregnant rats, and the experiment revealed chalepnisin, as the specific compound that has a significant effect on fertility. Finally, Ruta Graveolens leaves grown in Peru [7] were stove dried, pulverized into powder, and produced the collected extract using water as a solvent. The extracted liquid was evaporated and administered as 10 mL injection per mouse. Most of these methods that are published in the literature used rodents and animals’ specimen for their study investigation, and our experimental study of the toxicity of Ruta on plants is a good complement to the collection.

Results and Discussion

This study showed significant effect in the retardation of onion root cell growth in our laboratory. Onion root growth that was treated with different concentrations of ether extracts were graphed in Figure 3. The ruta extract showed its growth inhibitory effect in all three extracts. All the variables like the pH (6.0 + 0.5), temperature (23 + 1oC), and atmospheric pressure were the same for the control group and the experiment. The experiment was stopped after 15 days, the roots and stem were shaved from the onion bulb, and the dried sample was weighed for the 1-10 mL ether extract solution of Ruta Graveolens. The onion bulbs died when any significant Ruta Graveolens extract was added to the water where the plant was partially immersed. In other studies, the toxicity of the Ruta extract has also prohibited other researchers from coming to a firm conclusion Y. C. Kong et al. [4] did not come to a clear conclusion in the Ruta’s anti-infertility and abortion effect, and their results didn’t produce any clear-cut conclusion. The amount of Ruta Graveolens they used in rats was far too toxic to the specimen and organ failure resulted before the infertility rate was observed. The chlorophyll-water extract they used was less toxic, but the cumrain and specifically chalepensin’s anti-implantation and infertility has not been proven.


Figure 3: Root Growth of onion bulb after addition of different volumes of Rue extract by ether.

Anderson Gonçalves de Freitas et al. [6] also found that Ruta Graveolens did not result in infertility and anti-implantation in pregnant mouse. However, their results showed good evidence of fetotoxicity after the seventh DOP pregnant mouse that received the herbal extract. The use of Ruta Graveolens resulted in organ failure, and they concluded that the herb should not be used in humans as a medicinal herb or as a contraceptive. Manoj Gandhi et al. studied the effect of Ruta Graveolens in rats and hamsters for infertility activities. They used methanol and petroleum ether extracts and found that the herb caused acute toxicity in both the rats and hamsters used. In their study, the toxicity effect interfered with the result. Gutiérrez-Pajares et al. [7] exposed pregnant mice to Ruta Graveolens during the first four days of pregnancy. The super ovulated pregnant mice different amounts of the aqueous extract. The administration of Ruta Graveolens to goats was found to attack the kidneys and higher doses were toxic resulting in death. The oil extract from the leaves has the potential toxicity that will result in uterine hemorrhaging. They were cautious to advise that their finding in animals cannot be transferred to humans. Their studies showed that ingested Ruta Graveolens is toxic enough to create an unfavorable environment for embryo implantation and will also retard fetal growth at any stage of fetus development. They isolated the alkaloid components of the herb like flavonoids, acridones, and furanocoumarins that are known growth inhibitors, and they concluded that the herb reduces implantation and growth development in mice. In our experiment, the toxicity level that will kill the onion was determined to be 5 mL of ether extract of Ruta, and we used 1-4 mL of volumes to gather our conclusions. Figure 3 showed 99.4% retardation of onion root growth while 1- and 2-mL extract resulted in 72.4% and 80.8% respective retardation [8,9].


The use of Ruta Graveolens, an unclassified drug, reported in this paper shows that the dosage level used for experimentation can very easily reach the toxic level before recognizing its anti-cell growth characteristics. We were successful to show the growth retardation of Ruta Graveolens in onion bulbs by plant-based research and applying the toxicity of a plant against another plant. The growth rate inhibition may be the root cause of the herb’s damage to unborn babies. In the studies reviewed, the toxicity of the chalepension which is extracted from the herb, led to organ failure and death in rats before any meaningful infertility result was achieved. It will be interesting to see further studies to implement Ruta Graveolens as an organically grown safe and herbal alternative to currently available hormone contraception. Ruta Graveolens is shown here as a plant-growth inhibitor, and this property of the herb may open the door for the development of future organic herbicide development. Furthermore, Ruta’s cell growth inhibition has been studied in anticancer melanoma, and it will be beneficial to see further research in implementing Ruta for other medicinal purposes. In conclusion, the toxicity of Ruta Graveolens is alarming, and this study showed that onion cell growth inhibition was demonstrated.

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Thursday, December 1, 2022

A Tensional Network in the Knee


A Tensional Network in the Knee

The Medium of Haptic Perception

In contrast to the widespread assumption that the neural system generates impulses to the motor units in the skeletal muscle fibers, Turvey [1] place high importance on the fibrous collagenous connective tissues in the body; these are seen as providing a tensional network throughout the whole body, the biomechanical properties of which provide the framework for muscular force transmission as well as for the haptic sensory system. To identify the haptic system’s medium, Turvey focused on connective tissue and the conjunction of muscular, connective tissue net, and skeletal as the body’s proper characterization Turvey [1]. Myers has also posed the medium as a body-wide responsive physiological network—the myofascial meridian Myers [2]. Taking on ‘geometry’ first, cell biologist Donald Ingber placed one final piece of the puzzle: to view the body’s architecture in the light of ‘tensegrity’ geometry Ingber [3]. ‘Tensegrity’ was coined from the phrase’ tension integrity’ by the designer R. Buckminster Fuller (working from original structures developed by artist Kenneth Snelson Skelton [4]. As Snelson describes it Snelson [5], “The sculpture could be put into orbit in outer space, and it would maintain its form. Its forces are internally locked. These mechanical forces, compression, and tension or push and pull are invisible—just pure energy—in the same way that magnetic or electric fields are invisible.”
The tensegrity principle describes precisely the relationship between the connective tissues, the muscles, and the skeleton. For example, weight applied to shank/thigh bones would cause it to slide off its knee joint if it were not for the tensional balances that hold it in place and control its pivoting Swanson [6]. The invariant feature of tensegrity structures encompasses those that stabilize themselves through a phenomenon known as pre-stressing. Architects call this type of pre-stressed structural network, composed of opposing tension and compression elements that self-stabilize its shape by establishing a mechanical force balance, a tensegrity structure. Bio tensegrity is a term introduced by Dr. Stephen Levin and denotes the application of tensegrity’s principles to biological structures Hutson [7]. Tensional forces naturally transmit over the shortest distance between two points, so the elastic members of tensegrity structures are precisely positioned to withstand applied stress. For this reason, tensegrity structures offer a maximum amount of strength for any given amount of material Myers [2]. Furthermore, the invariant feature of a knee tensegrity system (specified by a given set of external forces such as the ground reaction force (GRF)) is a stable equilibrium if the structure returns to the initially given configuration after the application of arbitrarily small perturbations with respect to the functional knee axis (FKA) anywhere within the configuration Ingber [3].
Kim [8] showed how the knee tensegrity system manages the balance between tension and compression during locomotion by utilizing a unique combination of the FKA and GRF stimuli Kim [8]. When deformed by the shank to the ground via GRF, the strain is distributed over the whole structure, not locked into the joint itself by virtue of the assembly Phillips [9]. Thus, a reaction torque is zero on the knee joint if the GRF line of action intersects the joint axis. The configuration can exert a significant force on the ground without overloading the knee joint. This study aims to introduce the conception of the tensional network in muscles, i.e., the action lines that satisfy the given condition as the tensegrity’s structure is characterized by transmitting forces across the bones Kim [10]. Thus, we hypothesized that tensional forces in muscles are derivable from a scalar function, the work function.

N-lines as the Medium of Haptic Perception

Neurophysiologist Nikolai Bernstein (1967) defined coordination as mastering the many degrees of freedom (DOF) of a particular movement by reducing the number of variables to be controlled Turvey [11]. Recently, a contemporary perspective on Bernstein’s concept of synergies has been proposed Profeta [12]. The muscle synergy is equivalent to the complexity of lines, a manifold approximated by individual fibers Kim, et al. [13]. Muscles are not functional units, even though this is a common misconception. Instead, most muscular movements are generated by many individual motor units distributed over some portions of one muscle, plus portions of other muscles. The tensional forces of these motor units are then transmitted to a complex network of fascia sheets, bags, and strings, which convert them into the final joint/body movement Myers [14]. We define an n-line in a body as a member of the tensional network by virtue of some constraint upon the body Phillips [9]. This will mean that, whereas all n-lines in a body will immediately become a tensional network as soon as the body begins to move, not all members in a tensional network in a moving body will have been n-lines before they began to move. The whole regulus of n-lines is a tensional network for the three constraints at the instant (Figure 1a). This single infinity of n-lines are the generators of the regulars of lines, a linear ruled surface, upon the hyperboloid. Given any three lines in a body (protectively independent) which are bespoken by virtue of some existing constraints to be n-lines in the body, the whole regulus of lines to which the three bespoken lines belong are also n-lines in the body.
In (Figure 1), if any four forces along the n-lines are in equilibrium, their lines of action will reside in space as the lines of some regulus. What makes this remarkable is that, while any three of the lines of action are enough to define the hyperboloidal surface, the fourth line of action will be found, not to miss or to intersect that surface, but to lie automatically and exactly upon it. The object of the illustrated apparatus in (Figure 1) is to set up body 2 with 3 DOF with respect to body 1 in such a way that, within it, three n-lines do exist. The 3 DOF speaks about a body’s ICRM, its instantaneous capacity for relative motion with respect to some other body. It should next be clear that, given this infinity of n-lines in (Figure 1a), there is a corresponding infinity of hinges, which are the generators of the other regulus upon the same hyperboloid. The articulation between bones in (Figure 1b) is ball-and-socket type, which can take up the single infinity of hinges as the ICRM, which seem to be continuously registered by the joints; the changes of the angles seem to be episodically registered by their input to the nervous system Gibson [15]. The question to be answered is this: How does a perceiver feel what he is touching instead of the cutaneous impression and the bone posture as such Gibson [15]? Now to answer the question. In brief, The ICRM of the body (with its 3DOF) can be exactly reproduced by the substitution of (6DOF-3) direct points of contact between the body and its frame.


Figure 1:

(a) A regulus of n-lines represents the tensional network. It physically connects bodies 1 and 2. The whole regulus of hinges is an equivalent mechanical substitution for the three n-lines at the instant
(b) The articulation of bones is the ball-and-socket type.

Tensional Network

Skelton [16] defined a tensegrity configuration of rigid bodies as follows Skelton [16]. In the absence of external forces, let a set of rigid bodies in a specific configuration have torque less connections (e.g. via frictionless ball-joints). Then this configuration forms a tensegrity configuration if the given configuration can be stabilized by some set of internal tensile members, i.e. connected between the rigid bodies. The configuration is not a tensegrity configuration if no tensile members are required and/or no set of tensile members exist to stabilize the configuration. (p. 1) which are conjointly reciprocal to the ICRM as indicated by their intersections (at the ⊗ ’ s). A balance of forces happens when the virtual coefficient vanishes, being it the necessary and sufficient condition for knee equilibrium. The original anatomic schematics and lines of action were published previously Kim, et al. [17-19] and are used with the permission of Professor Michele Conconi. The video is available:
h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 8 _ Y t s z z T 3 _ IvNIken5uxObj4jmSd0Zs_/view?usp=sharing
Attached to body member 1, in (Figure 2a), by mean of five taut strings, there are five n-lines, exhibiting a body with 1 DOF. It follows that body 2 suffers constrained motion as the tensegrity system moves that the paths in body 1 of all pints in body 2 are predetermined. (Figure 2a) is a stable embodiment of the same tensegrity configuration, hence a tensegrity system, exhibiting a torque less connection between body 1 and body 2. The line n-E-n in (Figure 2a) is an n-line by this definition, for it is a tensional network by virtue of a constraint. A member in the tensional network in a moving body is any straight line that joins two points in the body whose linear velocities are perpendicular to the line. The instantaneous velocity at point E,, is not yet known without analysis. Still, we know that it will occur in one or another of the directions indicated by the planar pencil of possible directions vectors drawn upon the flat surface perpendicular to the n-line at the point there, E (Figure 2a). The intra-articular structures of the tensegrity system of the knee include the muscles, the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and articular contact in the medial (P1) and lateral (P2) compartments (Figure 2b) Kim [18]. We have shown that six n-lines or constraints are members of the “tensional network” and are spatially oriented in such ways that by imposing an internal tension or “pre-stress” to reduce the play in the system; this ensures immediate mechanical responsiveness (all others feel, i.e., that movement of one element) and reduces impact fatigue at the joint.

Please refer to the authors ‘ previous works towards a visualization of the linear complex set Kim [13]. Let us look at the case next of six forces in equilibrium. When six forces are in equilibrium, their lines of action in the n-lines in the tensional network will be members of the same linear complex. Line manifold contraction is a linear line complex Jessop [20] defined by screws ICRM (Figure 2b). Using the superposition principle of infinitesimal quantities of DOF Kim [21], we can apply these two types of displacement as a body twist around a screw called Instantaneous Screw Ball [22]. The lines remain within the complex in any screw motion along a line axis, forming a linear complex. Additional cognitive processes or internal representations are not needed to explain these phenomena, as perception and action are coupled. Perceptual systems are active sets of organs designed to reach equilibrium through synergies Smart [23]. Our previous research Kim, et al. [24] introduced the concept of measurable invariance of the knee perceptual organ. In such invariant, six constraints ($) are collectively reciprocal to the instantaneous knee screw (ICRM) indicated by ⊗ (Figure 2b). These metrics predicted the knee synergy model based on synergies Turvey [25]. Moreover, this perspective defines torque-free pure forces based on the tensegrity structure Kim, et al. [26,27,21,24].
It is important to note that this configuration is a tensegrity configuration, as the system is pre-stress able in the absence of external forces, such as ground reaction forces during actual locomotion Skelton [16]. It was shown the knee tensional network (KTN) has six constraints and that it can balance the forces between tension and compression in the joint such that no work results Huang [28]. The KTN can be pre-stressed to obtain the same configuration as if external loads were applied. The selected pre-stress may yield the same configuration in the swing phase (external forces are absent) as in the stance phase (external forces are present) Skelton [9]. Notably, preparedness is not only a reactive aspect of the movement apparatus, but it also relates to anticipatory adjustments that predispose a system to behave in a particular way Profeta [12].


Figure 2:

(a) A set of rigid bodies in a specific tensegrity configuration have torque less connections.
(b) The knee joint synergy is represented by six constraints ($' , 1,..,6 i i = ).

Ensembles of a Geometric Pattern

It has been shown that a special kind of line in a body, which is determined by the constraints, namely n-line, is a regularly occurring and probably useful kind of line in bio tensegrity. Moreover, an important theorem about the overall layout or tensional network of n-lines in a body has been presented: the beginnings of a geometric pattern that emerged; it has been found in some special cases only, that associated 1 DOF and 3 DOF of a body in tensegrity, there are ensembles of n-lines existing which are, respectively, linear complex and regulus. This study has shown that the appearance or otherwise of n-lines in a body is a mystery. Still, it can be said that throughout the knee tensional network run two forces in the two types of n-lines: the one is mechanically operated by direct contact between bodies Lanczos [29]; the other is the living force exerted by the neuromuscular mechanism. Sylvester has shown that when six n-lines in (Figure 2) are so situated that forces acting along them equilibrate when applied to a free rigid body, a certain determinant vanishes, and he speaks of the six lines so related as being in involution Ball [22]. We shall see in a later investigation that these ensembles of lines figure largely and continuously in the theory of freedom and constraint of the tensegrity.

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Wednesday, November 30, 2022

An Acute Necrotising Pancreatitis - A Medical Emergency

An Acute Necrotising Pancreatitis - A Medical Emergency


Acute Necrotizing Pancreatitis results in approximately 300,000 hospital admissions in the United States every year, at a cost of $2.2 billion approximately [1]. It is defined as necrosis of the pancreatic parenchyma with or without necrosis of the peripancreatic tissues. Acute Necrotizing Pancreatitis occurs as a complication in most of the patients with acute pancreatitis and results in high morbidity (34%–95%) and high mortality (2%–39%) rates [2]. Gallstones and Alcohol are the most common causes of Acute Pancreatitis (AP). Diagnosis of Acute necrotizing pancreatitis is on the basis of three of the following criteria:
(1) Upper abdominal pain radiating in a belt-shaped fashion;
(2) Amylase or lipase values three times above normal levels; and
(3) Radiological findings [3].
Mortality occurring within the first 2 weeks of onset is most likely due to exaggerated systemic Inflammatory response, associated with decrease in immunity and systemic multiorgan failure [4].

Case Report

A 26-year-old male presented to Emergency department with Jaundice, generalized severe abdominal pain, nausea, vomiting and absolute constipation with on and off fever from last 2 to 3 weeks. On examination, there was generalized abdominal tenderness. Computed tomography of the abdomen and pelvis I/V contrast (CT Abdomen+ pelvis) showed complete necrosis of pancreatic body, tail and part of the pancreatic head. About 60%-70% of pancreatic head was spared. There was evidence of thrombosis in superior mesenteric vein and proximal part of portal vein, bowel loops had edematous walls and Lung bases showed bilateral atelectasis. There was moderate ascites with debris. In lab investigations, serum amylase and serum lipase values were surprisingly normal. Patient underwent laparotomy, lesser sac was approached, there was extensive necrosis of pancreas, abscess in lesser sac and saponification of omentum which was densely adherent to gut.
Abscess was drained out and then a drain was placed in lesser sac, right subhepatic region and pelvis and reverse closure was done with retention sutures. Samples of fluids, blood, urine, wound (pus) swab and cvp tip for culture and sensitivity were collected and sent to Akhtar Saeed Medical and Dental College Histopathology department. According to reports, there was E. coli growth in the Pus sample and CVP tip for C/S showed no bacterial growth even after 24 hour of incubation at 37 ˚C. Post-Operative patient was NPO/TFO, stable and I/v antibiotics continued but after few days of surgery, he again developed pain and high-grade fever. On CT abdomen there was phelgmon present with multiple pancreatic pockets of collection in the peri pancreatic abdominal and pelvic spaces and consolidation at right lower lung as well. In Lab investigations, urine C/S showed heavy growth of klebsiella and candida species for which multiple gram-negative spectrum coverage antibiotics were given but it could not settle down.
As the patient was young, another laparotomy was done through previous incision, peritoneum was approached, findings were noted and partial adhesiolysis done with drainage of abscess cavities and removal of necrotic slough. The drain was placed in left and right paracolic gutters, lesser sac, pelvis and reverse closure was done with retention sutures. After 2nd surgery, patient was shifted to ICU. On Lab investigations, high billirubin levels were noted upto13 mg/dl which settled down gradually after few days, it was later justified as a post-operative inflammatory response of pancreatic head. After a week of operation, patient again developed high grade fever and abdominal pain. On CT abdomen, there was a large abscess of about 10×8 cm in right side of abdomen near the pancreatic head. In Urine C/S, klebsiella showed heavy growth and there was Pseudomonas Aeruginosa present in pus swab. Patient complained of fecal matter coming out of abdominal drain because of colon erosion due to barium enema which was inserted for CT scan with I/V contrast Abdomen + pelvis per rectum. Then again, the patient had to undergo 3rd surgery in which adhesiolysis was done with drainage of right para colic and right retroperitoneal abscess.
The necrotic slough removed from lesser sac, left paracolic gutter and pelvis. Copious peritoneal lavage was done, and hemostasis maintained. Drains were placed in lesser sac, left and right paracolic region. Terminal ileum brought out as loop ileostomy in left iliac fossa. The distal part of colon was ligated and reverse closure was done with retention sutures. After few days of last surgery, patient was stable and discharged on oral medications. Patient continues to gain weight and now is perfectly normal.He is due to undergo reversal of his loop Ileostomy almost 16 months from his surgery. He is on Lifelong Pancreatic enzyme Replacement for Pancreatic Insufficiency however fortunately has not developed Diabetes.


The guidelines of the International Association of Pancreatology (2012) recommends endoscopic or percutaneous drainage as the first line treatment of NP, followed by surgical necrosectomy only if required. However, the best mode of drainage is not stated [5]. Recent reported studies involve various patient populations, definitions and techniques of infected necrosis but results are not commensurable. Prophylaxis refers to the administration of antibiotics in patients with no clinical infection in order to prevent pancreatic infection. The third generation cephalosporins have an intermediate penetration into pancreatic tissues and are effective against gram-negative microorganisms and can sheath the minimal inhibitory concentration (MIC) for most gram-negative organisms present in pancreatic infections [6]. Amid these antibiotics, only piperacillin/tazobactam is effective against gram-positive bacteria and anaerobes. Quinolones (ciprofloxacin and moxifloxacin) and carbapenems both have good tissue penetration into the pancreas and have good anaerobic coverage [7] even aminoglycoside antibiotics (e.g., gentamicin and tobramycin) in intravenous dosages failed to invade pancreatic tissue sufficient enough to conceal the minimal inhibitory concentration (MIC) of the bacteria that are most commonly present in secondary pancreatic infections.
However, in our case, our patient was had organisms resistant to quinolones, Cephlosporins, Piperacillin/Tazobactam and beta-lactamase drugs. He was only sensitive to Carbapenems, aminoglycosides except Tobramycin, Fosfomycin and Chloramphenicol. whereas early trials indicated that administration of antibiotics possibly prevent infectious complications in patients with sterile necrosis. Recent studies have shown that prophylactic antibiotics in patients with acute pancreatitis do not have remarkable decrease in mortality or morbidity [8]. Hence, routine prophylactic antibiotics for all patients with acute pancreatitis are no longer suggested. Conventionally, the most commonly used method to treat infected necrosis has been open surgical necrosectomy, but in the last 1-2 decades the treatment of NP has evolved from open surgery to minimally invasive techniques (PCD, per-oral endoscopy, laparoscopy, and rigid retroperitoneal videoscopy) and for that therapeutic equipments, hospital preferences and availability of expertise of these techniques are compulsory. Imageguided percutaneous catheter drainage (PCD) may be used both as primary and as supplementary approach to other techniques.
This approach can be transperitoneal or retroperitoneal. Probably, the latter one is preferred as it avoids peritoneal contamination and enteric leaks. But sometimes the results are beyond expectations and enteric leaks still occur [8]. However, in current scenario, a different method was taken into account by draining abscesses from lesser sac, retroperitoneal sac, left and right paracolic gutter as the patient had thrombosis in portal vein and saponification of omentum. Other revelation was that fecal matter started coming out of abdominal drain. For that, loop ileostomy was done successfully.


The interventions should be chosen in the manner of a triad of optimal intensive care, operative, and medical management. To assess the disease severity and proper selection of treatment strategy, the role of laboratory diagnosis and imaging techniques cannot be ignored. Therefore, further studies should be conducted to highlight this aspect.

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Tuesday, November 29, 2022

The Effectiveness of Conservative Management for Parapharyngeal Abscess and Cranial Bones Osteomyelitis

The Effectiveness of Conservative Management for Parapharyngeal Abscess and Cranial Bones Osteomyelitis


A parapharyngeal abscess is a deep neck abscess [1]. The parapharyngeal space is lateral to the superior pharyngeal constrictor and medial to the pterygoid muscle, it is divided into anterior and posterior compartments and contains many important structures [2]: carotid artery, IJV, CN V, IX, XI and XII. Abscesses in this area can present as fever, sore throat, difficulty in swallowing and neck swelling and rarely trismus. The diagnosis is based on history and clinical suspicion with evidence of a generalized neck infection. Confirmation is made with a CT scan head and neck with contrast. Management includes broad spectrum antibiotics [3] that have good blood brain barrier penetration and surgical intervention in complex cases. Major complications include airway compromise, severe sepsis, seizures, neurological deficit, carotid artery rupture, IJV thrombosis with septicaemia [4].

Case Report

85 years old male presented to Emergency Department (ED). He had a past medical history of epilepsy, chronic otitis media, ischaemic heart disease and hypertension. He was usually mobile and independent at home. He was found on the floor by his son with evidence of a head injury and bleeding. In the ED his CT head was reported as no acute intracranial abnormality. Blood tests showed inflammatory markers were raised; CRP 300, WBC 16, ESR 95 and he treated with broad spectrum antibiotics and superficial laceration was sutured. No obvious source of infection localised on the CT scan of his thorax, abdomen and pelvis. After 1 day stay on the acute medical unit he was transferred to the Care of Elderly ward where he had 2 episodes of seizures, self-terminated with good recovery [5]. His GCS remained 15 during course of admission and no acute neurological deficit on clinical examination. Later on noted to have a right ear yellow discharge, urgent ENT referral made and was seen by the ENT team. After initial assessment by the ENT team CT scan head and neck with IV contrast which showed a complex right parapharyngeal abscess with soft tissue inflammation in the right carotid space with, petrous and squamous bone destruction and right IJV thrombosis extending to the dural venous sinuses. He underwent series of CT head and neck scans and was listed for potential emergency surgical intervention by the ENT team. He was started on ceftriaxone and metronidazole for the abscess and LMWH for right IJV thrombus. Daily bloods showed improvement in CRP and ESR. Detailed discussions with ENT and microbiology teams and agreed for long term antibiotics through PICC Line. Repeat CT scan showed a reduction in the size of the abscess with no further bone destruction and stable IJV thrombus.


Parapharyngeal abscesses are deep neck abscesses in the parapharyngeal space.


Can develop in any age group, more common in children.

Potential Causes (5)

a) Acute and chronic tonsillitis
b) Chronic otitis media
c) Peritonsillar abscess
d) Dental infections
e) Extension of existing deep neck abscesses like retropharyngeal
or submandibular
f) Traumatic
g) Iatrogenic post-operative or local anesthetics

Clinical Presentation

a) Fever
b) Sore throat
c) Dysphonia
d) Pain
e) Neck swelling,
f) Dysphagia
g) Dyspnoea
h) Stridor

Examination Findings

a) Tender neck
b) Erythema
c) CN findings
d) High grade fever
e) Malodourous


Based on clinical suspicion arrange for CT scan – ideally CT scan H&N with contrast.


Don’t delay treatment
a) Broad spectrum antibiotics
b) Blood cultures / swabs
c) Early call to specialist team
d) Low threshold for l surgical intervention


a) Airway compromise b) Extension to neighbouring structures (IJV thrombosis)
c) Meningitis
d) Seizures
e) Extension into carotid artery with subsequent mycotic aneurysm
f) Spread to mediastinum
g) Local bleeding
h) CN involvement.

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Monday, November 28, 2022

Ba Duan Jin and the Treatment of Illness in General, and Cognitive Impairment in Particular

Ba Duan Jin and the Treatment of Illness in General, and Cognitive Impairment in Particular


Qigong (pronounced chee gong) is a tool in the toolbox of traditional Chinese medicine (TCM). It is used to treat and even cure a wide range of diseases [1-54]. Ba Duan Jin (baduanjin) is the most popular set of qigong exercises. Zhang, et al. [55] examined the results of 886 clinical studies in 14 countries and discovered that Ba Duan Jin was used in 492 (55.5%) of them. Some of the diseases and ailments that have been treated with qigong exercises include:
i. Ankylosing Spondylitis [56]
ii. Anxiety [38,57-58]
iii. Arthritis [39,59-61]
iv. Attention Deficit [62]
v. Autism [63]
vi. Back Pain [64]
vii. Blood Pressure [40,65-66]
viii. Cancer [36,47,67-84]
ix. Chronic Fatigue Syndrome, Cognitive Impairment and COPD [85-101]
x. Covid-19 [46,102-104]
xi. Depression [38,105-114]
xii. Fibromyalgia [115]
xiii. Frailty [116-118]
xiv. Heart Disease [119]
xv. Hypertension [40,65-66]
xvi. Immune System [120]
xvii. Parkinson’s Disease [121-126]
xviii. Quality of Life [127-131]
xix. Rheumatism [132]
xx. Schizophrenia [133]
xxi. Stress [134]
xxii. Stroke [135-138]
xxiii. Substance Abuse [139]
xxiv. Unilateral Vocal Fold Paralysis [140]
Ba Duan Jin consists of a series of 8 qigong exercises. The version promoted by the International Health Qigong Federation [9] takes about 12 minutes to perform. Qigong is similar to yoga, in that it involves physical movement, breathing and moving meditation, but it is not yoga. Qigong is actually gentler than yoga. It is a close cousin of kung fu and other martial arts, but it is not quite a martial art. It involves unblocking the flow of energy in the body, like acupuncture and acupressure, but it is not acupuncture or acupressure. It is an internal component of tai chi, which is a martial art. When one does tai chi properly, one is also doing qigong, perhaps unknowingly. It is a form of meditation as well as exercise, and can be performed from a standing or seated position.

Ba Duan Jin Studies

Wang, et al. (2021) [141]

Wang, et al. [141] systematically evaluated the effects of Baduanjin on global cognitive function and specific cognitive domains of middle-aged and elderly individuals. They searched multiple data bases, looking for randomized control trials (RCTs) that utilized Baduanjin exercises. They found that Baduanjin exercises resulted in significant benefit for global cognitive function and parts of specific domains of cognition, including immediate and delayed memory, executive function, and processing speed. However, no significant difference was found in attention function, visual-spatial ability or long-term memory. None of the studies reported any adverse effects. They concluded that Baduanjin is safe and effective in enhancing global cognitive function and memory, and might be beneficial for other cognitive domains, such as executive function and processing speed.
Eleven of the RCTs compared Baduanjin to non-exercise control; 3 compared Baduanjin and other no-exercise treatments to the same no-exercise treatment. Duration of the studies varied between 1.5 and 12 months. Frequency of the sessions varied between 3-7 per week. Sessions lasted 30-60 minutes. In most studies, participants were older than 60. In four studies, participants were between 45- 55. Global cognitive function was tested in 13 studies that included 938 participants. Cognitive function was measured by the MMSE, MoCA and LOTCA scales. The results from 6 pooled studies of 444 participants found that Baduanjin significantly improved the MMSE scores without heterogeneity (p < 0.001). In 9 other studies involving a total of 628 participants, it was found that Baduanjin improved MoCA scores, although heterogeneity was present among the studies (p < 0.001). A smaller study involving 60 participants measured global cognition using the LOTCA scale. That study found significant improvement (p < 0.001).
Specific cognitive domain was also examined. Significant improvement was found in general memory function in two studies involving 157 participants (p < 0.001). Four studies examining immediate memory showed significant improvement (p < 0.001) in the Baduanjin group compared to the control group. Several studies of delayed memory found that MD values increased significantly in the Baduanjin group. Two studies involving 109 participants found that the Baduanjin group’s executive function using the TMT improved significantly (p = 0.05) over that of the control group. However, Baduanjin had no significant effect on the Go/No Go reaction-time test and the correct-number test. Two studies on processing speed found that Baduanjin significantly improved DSC scores (p = 0.0008). One study on the effects of Baduanjin on visualspatial ability found no significant difference between the Badjanjin and control groups. No serious adverse events were reported by any of the studies during the Baduanjin training. The findings suggest that Baduanjin is safe and effective for enhancing global cognitive function and memory in middle-aged and older adults, and may benefit other cognitive functions.

Yu, et al. (2020) [142]

Yu, et al. [142] reviewed 16 randomized control trials (RCTs) involving 1054 participants on the effect of Baduanjin on patients having mild cognitive impairment. They found that Baduanjin combined with conventional therapy produced significantly better results than conventional therapy alone after six months of treatment in terms of the Montreal Cognitive Assessment and Mini-Mental State Examination scores (p < 0.00001). There was also significant improvement in some dimensional scores on the Wechsler Memory Scale and the auditory verbal learning test scores after six months (p < 0.05).

Zheng, et al. (2020) [143]

Zheng, et al. [143] conducted a randomized control trial (RCT) on the effects of Baduanjin on cognitive function in patients with post-stroke cognitive impairment. It was a randomized, two-arm parallel controlled trial with allocation concealment and assessors blinding, and was conducted in the community center of Fuzhou city, China. Forty-one participants completed the study (22 Baduanjin and 19 control group), which consisted of 24 weeks of Baduanjin training, 3 days a week, 40 minutes per day. The control group maintained their original medication and rehabilitation regimen. Mean scores were significantly different between the two groups for global cognitive function, execution, memory (immediate recall), short-term and long-term delayed recognition, attention response time, and activities of daily living. The study concluded that regular Baduanjin training is associated with less loss of cognitive function in patients after a stroke.

Li, et al. (2021) [144]

Li et al. [144] studied the effects of four kinds of traditional Chinese exercise (TCE) on patients with cognitive impairment. They found that Baduanjin may be the most effective of the four exercises for significantly improving cognitive function, followed by tai chi, Liuzijue and qigong. They examined 27 randomized control trials (RCTs) involving 2414 patients with sample sizes ranging from 10-194. The groups consisted of 1133 in the TCE groups and 1281 in the control groups. The breakdown of the 4 TCE groups was as follows:
i. Tai chi 644
ii. Baduanjin 386
iii. Liuzijue 75
iv. Qigong 28
Participants had the following diagnoses:
i. Dementia 4
ii. Mild cognitive impairment 17
iii. Cognitive impairment (CI) 6
The RCTs were conducted in the following countries:
i. China 22
ii. Thailand 1
iii. USA 1
iv. England 1
v. France 1
vi. Not disclosed 1
The intervention lengths varied from 7 weeks to 25 months, between 1 and 6 times per week, from 30 to 90 minutes per day. The scales used for cognitive assessment were the Mini-Mental State examination (MMSE), the Chinese version (CMMSE), and the Montreal Cognitive Assessment (MoCA). Pairwise comparisons of the four types of TCE found that all four had significant improvements in global cognition, as measured by the MMSE or MoCA. The p-values for the four TCEs were:
i. Baduanjin p< 0.00001
ii. Tai Chi p < 0.00001
iii. Liuzijue p = 0.003
iv. Qigong p = 0.02
Li, et al. [144] ranked the probability of the efficacy of the different interventions. Baduanjin was most likely to rank first (53%); tai chi was most likely to rank second (40%), etc. The full rankings, taken from the study, are given below. Li, et al. [144] cited several other studies that reached similar conclusions regarding the use of Baduanjin and tai chi to improve cognitive function [145- 147] (Table 1).


Table 1: Rank Probability of the Efficacy of Different Interventions.

Concluding Comments

It is clear that Baduanjin and other traditional Chinese exercises can aid in the treatment of cognitive decline. Many studies have found that TCE can be beneficial in the treatment of many other ailments as well. Several studies are now in process that are examining the effects of Baduanjin on other ailments. The results of those studies are not yet available as of this writing. Chen, et al. [148] searched several data bases to find controlled trials that evaluated the effects of Baduanjin on postoperative rehabilitation of breast cancer patients. The goal of their study will be to offer a guideline for clinical workers. The results have not been published as of this writing. Dai, et al. [149] are searching several databases to determine the effectiveness of baduanjin on the treatment of cervical spondylotic radiculopathy (CSR). Li, et al. [150] plan to conduct a systematic review and meta-analysis to determine whether Baduanjin is an effective intervention in post percutaneous coronary intervention (PCI) patients. Zou, et al. [151] are conducting a study, the aim of which is to evaluate the safety and effectiveness of Baduanjin for patients having cervical spondylosis (CS).

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