Monthly Archives: August 2024

High-tridymite, Cristobalite, and Londsdaleite in a Minette Lamprophyre from E-Thuringia/Germany

Leave a reply

DOI: 10.31038/GEMS.2024653

Abstract

The minette from Cunsdorf near Elsterberg in E-Thuringia has an astonishingly high number of tridymite and remnants of other quard polymorphs. More exceptional is the high content of lonsdaleite whiskers and, in part, his degradation products in the form of diamonds and graphite in quard and K-feldspar of this rock. The presence of lonsdaleite demands ultra-high-pressure conditions for the formation of the minette lamprophyre magma. The high number of lonsdaleite whiskers in a magmatic rock is unexpected.

Keywords

Lonsdalite, Genesis of lamprophyres, Raman spectroscopy

Introduction

During the study of a minette sample from E-Turinga [1], we found in quartz schlieren, besides quartz, lonsdaleite, also hints of high- tridymite and cristobalite. Cristobalite is rare, however. Such schlieres we interpret as remnants of supercritical fluids or melts, inserted into the minette rock by multi-interaction of both phases (supercritical fluid and lamprophyre magma) coming from the earth’s mantle. The equilibrium temperature of both SiO2 phases is, according to Frondel [2], 1470°C at low pressure. The inversion of cristobalite to tridymite is sluggish, and cristobalite can persist as a metastable form at room temperature. However, the coexistence of cristobalite and tridymite is an essential mark in quartz, together with diamond and lonsdaleite, for the origin and the emplacement of the minette lamprophyre.

Sample and Methods

The minette sample 2210 is from a 50 cm thick vein in a small quarry at Highway B 92, about 1 km northwards from Cunsdorf near Elsterberg, E-Thuringia. A more detailed description and references to it are provided by Thomas and Recknagel [1]. A more detailed description of the rock is in Beuge and Kramer [3] as well as in Kramer [4]. We use Raman spectroscopy here to characterize the cristobalite and high-tridymite in quartz schlieres in the minette. For measurements, the Raman spectrometer EnSpectr R532 combined with the Olympus BX43 microscope, both for transmitted and reflected light and equipped with a rotating stage and polarizers (for parallel and perpendicular positions), is used. Generally, we used an Olympus long-distance 100x objective lens for the studies. As references, we applied a water-clear diamond crystal from Brazil (1331.63 ± 0.60 cm-1 and a semiconductor-grade silicon single-crystal (520.70 ± 0.15 cm-1). For this study, we generally used laser energies of 12 mW on the sample. To identify the minerals of the minette sample, we used the RRUFF database [5].

Result and Discussion

The Raman study of a mixture of SiO2 polymorphs, developed on the long way from the mantle to the upper crust, is a challenge [6]. The monocline modification of tridymite dominates the Raman spectrum (Figure 1). The bands at 66.3, 83.0 (not shown), 142.6, 194.7, 334.5, and 430.0 cm-1 correspond, according to Kanzaki [6], well to the monocline tridymite of the Steinbach iron meteorite (IVA-an). The Steinbach meteorite (which fell near Meissen/Germany in 1540- 1550) forms, according to Grady et al. [7], almost equal amounts of Fe-Ni metal and, tridymite and other silicates. In our minette sample, remnants of the MX-1 modification [6] are present too. This modification is formed by quenching high-temperature tridymite modifications. Typical bands are 456.9 (band quite right in Figure 1), and 789.3 cm-1.

fig 1

Figure 1: Raman spectrum of quartz, tridymite, and cristobalite in the low-frequency region (η=50-450 cm-1). The shoulder at 420 cm-1 is a hidden band of cristobalite.

Besides quartz, cristobalite, and high-tridymite modifications, there are in Figure 1 also indications of coesite present: 116.6, 175.3, 269.8, and 430 cm-1 [8]. However, the unambiguous proof is difficult because of the presence of fine-distributed microcrystals of orthoclase in the bulk quartz and also many lonsdaleite whiskers (Figure 2). Some whiskers are up to 100 µm long. The number of lonsdaleite whiskers > 20 µm is about 5.5 · 106/cm3. These whiskers appear not only in quartz and feldspar but also in other darker minerals, which demonstrate that the whole rock has seen a high-pressure history. Micro-diamonds in the larger black lath-shaped graphite crystals will also support that [1].

fig 2

Figure 2: Raman spectrum of lonsdaleite whisker in quartz of the E-Thuringia minette.

The lonsdaleite whisker in quartz proves that the SiO2 polymorphs are at least clearly related to the coesite field. According to Frondel [2], the 1470°C corresponds to a pressure of about 5.25 GPa and a depth of about 165 km (however, that is a minimum), as we will see later (Figure 3).

fig 3

Figure 3: Black lath-shaped anatase crystal in orthoclase of the minette from E-Thuringia. In this needle, there are micro-diamonds and/or lonsdaleite whiskers.

Most lonsdaleite whiskers are in quartz polymorphs and transparent K-feldspars. After 20 measurements, lonsdaleite shows a strong Raman band at 1322.6 ± 2.7 cm-1 (mode η = E1g ) and a FWHM = 68.6 ± 12.3 cm-1 (see also Thomas and Recknagel 2024) [1]. FWHM means Full Width at Half Maximum. The weaker bands at 1266.9 ± 31.5 and 1528 cm-1 (modes η = E2g and A1g, respectively, are also present) – see Yang et al. [9].

Interpretation

The presence of tridymite and other remnants of SiO2 polymorphs show that during the ascent of the minette lamprophyre at high temperatures, these polymorphs with the lonsdaleite whiskers were subject to steady changes. According to Gigl and Dachille [10] and Hemley et al. [11], the stability of, for example, stishovite is strongly limited at high temperatures and low pressures. The survival of lonsdaleite and diamond under such conditions is a surprise. That means at least that lonsdaleite is more stable than the quartz polymorphs. The formation of lonsdaleite in the earth’s mantle is up to now unclear. Greshnyakov et al. [12] wrote that the formation of lonsdaleite from hexagonal graphite takes place at 56 GPa, corresponding to a depth of about 1400 km and a temperature of about 1730°C. The involvement of supercritical fluids or melts during the lamprophyre ascent can reduce the origin depth of lonsdaleite and can also accelerate the lamprophyre ascent.

Acknowledgment

The studied minette sample 2210 from Cunsdorf near Elsterberg/ E-Thuringa is from Kramer. Wolfgang Kramer wrote: The Minette from Cunsdorf bei Elsterberg is a very fascinating rock.

References

  1. Thomas R, Recknagel U (2024) Lonsdaleite, Diamond, and Graphite in a Lamprophyre: Minette from East-Thuringia/Germany. GEMS.
  2. Frondel C (1962) The System of Mineralogy, III Silica Wiley and Sons. Pg: 334.
  3. Beuge P, Kramer W (1977) Lamprphyre Ostthüringens und ihre anomalen Quecksilbergehalte im Ergebnis endogener uns exogener Anreicherungsprozesse. Schriftenreihe Geol Wiss 8: 79-99.
  4. Kramer W (1988) Magmengenetische Aspecte der Lithosphärenentwicklung. Akademie-Verlag Berlin. Pg: 136.
  5. Lafuente B, Downs RT, Yang H, Stone N (2015) The power of database: RRUFF In: Armbruster T, Danisi RM (eds.). Highlights in mineralogical crystallography. Berlin Pg: 1-30.
  6. Kanzaki M (2019) Raman spectra of tridymite modifications: MC, MX-1, and PO-Journal of Mineralogical and Petrological Sciences. 114: 214-218.
  7. Grady M, Pratesi G, Cecchi VM (2014) Atlas of Cambridge. Pg 1181.
  8. Boyer H, Schmidt DC, Chopin C, Lasnier B (1985) Raman microprobe (RMP) determinations of natural and synthetic coesite. Phys Chem Minerals 12: 45-48.
  9. Yang L, Lau CK, Zeng Z, Zhang D, Tang H, et (2021) Lonsdaleite: The diamond with optimized bond lengths and enhanced hardness. Condensed Matter, Material: 1-19 Science.
  10. Gigl PD, Dachille F (1968) Effect of pressure and temperature on the reversal transitions of stishovite. Meteoritics 4: 123-136.
  11. Hemley RJ, Prewitt CT, Kingma KJ (1994) High-pressure behavior of silica. Reviews in Mineralogy. 29: 41-81.
  12. Greshnyakov VA, Belenkov EA (2017) Investigation on the formation of lonsdaleite from graphite J Exp Theor Phys 124: 265-274.

Lifestyle Education for Hypertension Management: Insights from a College Student Cohort

Leave a reply

DOI: 10.31038/IJNM.2024534

Abstract

Hypertension, a pervasive global health issue, poses significant risks to cardiovascular health and financial burdens on individuals and healthcare systems. We observed the impact of a lifestyle intervention, the Complete Health Improvement Program (CHIP), on blood pressure reduction among Hypertension, a pervasive global health issue, poses significant risks to cardiovascular health and financial burdens on individuals and healthcare individuals with seemingly normal levels. The pillars of a healthy lifestyle—physical activity, whole food plant-based nutrition, avoidance of harmful substances, stress management, passion, sleep, and connectedness—are examined as potential contributors to hypertension management. This study involved ten freshmen and two staff members. While statistically significant reductions in systolic and diastolic blood pressures were observed after 12 weeks of the CHIP program, no significant changes were evident at six weeks. Importantly, no substantial alterations were found in weight, BMI, total cholesterol, triglycerides, or fasting glucose levels. The results suggest that lifestyle education, exemplified by CHIP, can effectively assist individuals in lowering blood pressure. However, further research is crucial to elucidate the mechanisms through which lifestyle modifications influence blood pressure regulation. Understanding these underlying factors will contribute to tailoring interventions and addressing the rising prevalence of hypertension, enhancing overall health and well-being.

Keywords

Complete health improvement program, Hypertension, Lifestyle education

Introduction

Hypertension, commonly known as high blood pressure, is a chronic medical condition that affects millions of people worldwide. It occurs when the force of blood against the walls of the arteries is consistently too high, putting strain on the cardiovascular system. Hypertension is a major risk factor for heart disease, stroke, and other serious health complications. Moreover, it poses significant financial burdens on individuals, families, and healthcare systems. However, adopting a lifestyle that encompasses the pillars of a healthy lifestyle—physical activity, whole food plant-based nutrition, avoidance of harmful substances, stress management, passion, sleep, and connectedness—has shown promising results in managing hypertension effectively and reducing healthcare costs.

The health impacts of hypertension are far-reaching and can be severe. Prolonged high blood pressure can lead to damage of the arteries, heart, kidneys, and other vital organs. It increases the risk of heart attacks, strokes, heart failure, kidney disease, and vision problems. Furthermore, hypertension often goes undetected and uncontrolled, causing a silent deterioration of health. This silent killer can significantly reduce the quality of life and even be life-threatening if left untreated [1-4]. In addition to the health consequences, hypertension also imposes substantial financial burdens on individuals and healthcare systems [5]. The costs associated with managing hypertension include doctor visits, medications, diagnostic tests, hospitalizations, and the treatment of complications that arise from uncontrolled blood pressure. These expenses can quickly accumulate and strain personal finances, while also burdening healthcare systems with high expenditure and resource allocation.

However, there is a ray of hope in managing hypertension through the adoption of a healthy lifestyle that focuses on the pillars: physical activity, whole food plant-based nutrition, avoidance of harmful substances, stress management, passion, sleep, and connectedness. These pillars are interconnected and work synergistically to promote overall well-being and effectively manage hypertension [6-12]. Regular physical activity, such as aerobic exercises, has been proven to lower blood pressure and improve cardiovascular health. Engaging in activities like walking, swimming, or cycling for at least 30 minutes a day can have a significant impact on reducing hypertension and improving overall fitness. A whole food plant-based diet, rich in fruits, vegetables, whole grains, and legumes, has been associated with lower blood pressure levels. This dietary approach emphasizes the consumption of nutrient-dense foods while minimizing processed foods, saturated fats, and sodium, which contribute to hypertension. Some substances have been shown to elevate blood pressure. Alcohol consumption is shown to produce an acute biphasic effect on blood pressure [13]. Daily consumption of alcoholic beverages is associated with a higher instance of hypertension [13-18]. Cigarette smoking is also linked to hypertension [19-22]. Even passive smoking is associated with elevated blood pressure [23-27]. Additionally, alcohol consumption heightens the effects of smoking on hypertension [28-32]. Stress management techniques, such as meditation, deep breathing exercises, and yoga, help reduce the negative effects of stress on blood pressure. Chronic stress can contribute to the development and exacerbation of hypertension, so adopting stress management practices is crucial for managing blood pressure effectively [33,34]. Finding and pursuing one’s passion in life can provide a sense of purpose and fulfillment, which positively influences overall health. Engaging in activities that bring joy and satisfaction can reduce stress levels and indirectly impact hypertension management. It is particularly beneficial in managing occupational stress. Adequate sleep is essential for maintaining optimal health and managing hypertension. Poor sleep quality or insufficient sleep has been linked to higher blood pressure levels. Establishing a consistent sleep routine and creating a sleep-conducive environment are vital for individuals with hypertension. Finally, fostering social connections and maintaining a strong support network can contribute to better hypertension management. Positive social interactions and emotional support have been shown to reduce stress levels and promote overall well-being. By embracing the basic pillars of a healthy lifestyle, individuals can effectively manage hypertension and potentially reduce the need for costly medical interventions. Moreover, adopting these lifestyle practices can have a preventive effect, reducing the risk of developing hypertension in the first place. The long-term health benefits and potential cost savings associated with a healthy lifestyle make it a compelling strategy for individuals, families, and healthcare systems to combat the impacts of hypertension.

The Complete Health Improvement Program (CHIP) developed by Hans Diehl is a comprehensive lifestyle intervention designed to promote optimal health and well-being [35-47]. This program encompasses a holistic approach that focuses on making sustainable changes in diet, physical activity, stress management, and social support. With its evidence-based principles and practical strategies, CHIP has emerged as a highly effective program for improving health outcomes and reducing the burden of chronic diseases. The CHIP program has been proven to have significant positive effects on various health parameters. Participants often experience improvements in weight management, blood pressure control, cholesterol levels, blood sugar regulation, and overall cardiovascular health. By adopting healthier eating habits, engaging in regular physical activity, and effectively managing stress, individuals can achieve a range of health benefits and reduce the risk of chronic diseases such as diabetes, heart disease, and stroke.

Materials and Methods

Complete Health Improvement Program (CHIP). The program consisted of 18 sessions that were delivered by certified facilitators. The participants met twice a week for six weeks and then once a week for six weeks. Each session included a video presentation, facilitated discussions, and food samples. The food was prepared by a local café, following whole food, plant-based recipes provided by the facilitators. Subjects. Ten freshmen and two staff from the University of Minnesota Rochester (UMR) participated. Ten were females. One was Hispanic, three Caucasian, and eight African American. Biometrics and Questionnaires. Biometrics including height, weight, BMI, systolic and diastolic pressures, fasting glucose, triglycerides, and total cholesterol were measured at weeks 1, 6, and 12. The Perceived Stress Scale (PSS) questionnaire was filled out at weeks 1 and 12.Statistical Analysis. For biometrics, a one-way ANOVA with repeated measures was conducted to compare the three time periods for each of the physical measurements. This was performed with a protected F-test (p-value < 0.05) being the threshold for further statistical analysis. Tukey’s HSD method was used for post hoc multiple comparisons whenever the treatment effect was significant. For PSS, a paired t-test was conducted to compare the pre and post scores.

Results

Statistical analyses of biometrics were shown in Table 1. Both systolic and diastolic blood pressures were significantly reduced after 12 weeks but not six weeks. There was no statistical difference between before and after the program.

Discussion

The statistical analyses of biometrics are presented in Table 1, providing a comprehensive overview of the data. The focus of the study was on the systolic and diastolic blood pressures, and the results revealed interesting findings. After a duration of 12 weeks, both systolic and diastolic blood pressures demonstrated a significant reduction. However, it is worth noting that this notable improvement was not observed at the six-week mark. Furthermore, the statistical analysis conducted to compare the measurements before and after the program indicated that there was no significant difference between these two time points. This suggests that the program did not have a discernible impact on the biometric measurements being examined. The absence of statistical significance between the pre- and post- program measurements implies that any changes observed in the biometric data were likely due to other factors or natural fluctuations. It is important to interpret these findings with caution, considering the limitations of the study and the potential influence of confounding variables that were not accounted for in the analysis. These results shed light on the potential benefits of stress management programs in a college setting, particularly in terms of promoting healthier coping mechanisms. Although the study did not yield the expected changes in biometric markers, the students’ self-reported ability to handle stress suggests that the program had a positive impact on their overall well- being and stress management skills.

Table 1: Statistical Analysis of Biometrics

Measurement

 Time N Mean ± std error

p-value
Weight

1

 12 153 ± 10.7 0.597
  2 9 153 ± 10.8

 

3

 6 154 ± 10.8  

BMI

 1 12 25.1 ± 1.5

0.468
 

2

 9 25.2 ± 1.5  
  3 6

25.5 ± 1.5

  
Systolic Blood Pressure

1

 12 119 ± 2.4A <0.0001*
  2 9 119 ± 2.6 A

 

3

 6 97 ± 2.8 B  

Diastolic Blood Pressure

 1 12 71.3 ± 2.3 A

0.014*
 

2

 9 73.8 ± 2.6 A  
  3 6

62.2 ± 3.1 B

  
Glucose Level

1

 12 90.4 ± 10.6 0.157
  2 8

94.8 ± 10.7

  

Data expressed as least squares mean ± standard error. Different superscript letters indicate significance for time within each physical measurement. *Statistical significance.

Conclusion

The findings from this study indicate that lifestyle education, as demonstrated through the Comprehensive Health Improvement Program (CHIP), can effectively assist individuals with hypertension in lowering their blood pressure. The results suggest that equipping individuals with knowledge and strategies related to lifestyle modifications can lead to positive changes in their blood pressure levels. However, it is important to acknowledge that further research is necessary to delve deeper into the mechanisms through which lifestyle education contributes to blood pressure reduction. The study did not reveal significant differences in other biometric variables, such as weight, total cholesterol, triglycerides, or fasting glucose, nor did it show substantial changes in stress levels following the education program. Therefore, additional investigations are required to elucidate the precise pathways by which lifestyle education influences blood pressure. By conducting more comprehensive studies, researchers can explore potential mediators and confounding factors that may be associated with the observed blood pressure reduction. These investigations could involve examining variables such as dietary patterns, physical activity levels, sleep quality, and other lifestyle factors that might be influenced by the education program. Understanding these underlying factors would enhance our knowledge of how lifestyle interventions impact blood pressure regulation and provide insights into the most effective strategies for hypertension management. In conclusion, while the current study highlights the potential efficacy of lifestyle education in lowering blood pressure among individuals with seemingly normal levels, further research is warranted to unravel the intricate mechanisms involved. Such studies will aid in refining the design and implementation of lifestyle education programs, allowing for more tailored and targeted interventions for individuals with hypertension. Ultimately, this research will contribute to the development of evidence-based practices that can effectively address the rising prevalence of hypertension and improve the overall health and well-being of individuals.

Acknowledgement

The authors wish to extend their gratitude to Silas Bergen, PhD, and his team at Winona State University for conducting the statistical analyses. Funding was supported by the Lotus Health Foundation and the George Family Foundation.

References

  1. Correia ETO, Mechanick JI, Jorge AJL, Leticia MDB, Maria LGR, et (2023) The hypertension-based chronic disease model in a primary care setting. Int J Cardiol Cardiovasc Risk Prev. 18. [crossref]
  2. Katsimardou A, Imprialos K, Stavropoulos K, Sachinidis A, Doumas M, et (2020) Treatment strategies for hypertension in patients with type 1 diabetes. Expert Opin Pharmacother.21: 1241-1252.
  3. Mente A, Dehghan M, Rangarajan S, Martin O’D, Weihong H, et al. (2023) Diet, cardiovascular disease, and mortality in 80 Eur Heart J. Jul 21; 44: 2560- 2579. [crossref]
  4. Islam SMS, Daryabeygi-Khotbehsara R, Ghaffari MP, Riaz U, Lan G, et al. (2023) Burden of Hypertensive Heart Disease and High Systolic Blood Pressure in Australia from 1990 to 2019: Results From the Global Burden of Diseases Heart Lung Circ. [crossref]
  5. Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, et al. (2018) The economic burden of cardiovascular disease and hypertension in low- and middle- income countries: a systematic BMC Public Health. 18 . [crossref]
  6. Debela DB, Dhaba B, Shumi G, Abdulnasir A, Gemechu G, et (2021) Effect of an Educational Intervention on Lifestyle Modification of Patients With Hypertension at Bishoftu General Hospital, Ethiopia. Prev Chronic Dis. [crossref]
  7. Hanssen H (2023) Lifestyle recommendations as treatment for arterial hypertension: a time to Eur J Prev Cardiol. 30: 95-97. [crossref]
  8. Hoshide S, Mogi M, Kario K (2023) The importance of lifestyle modification for hypertension in Asia. Hypertens Res. 46: 815-816. [crossref]
  9. Karatzi K, Manios Y (2021) The Role of Lifestyle, Eating Habits and Social Environment in the Prevention and Treatment of Type 2 Diabetes and Nutrients.13. [crossref]
  10. Kodela P, Okeke M, Guntuku S, Lingamsetty SSP, Slonovschi E (2023) Management of Hypertension With Non-pharmacological Interventions: A Narrative Review. Cureus. 15. [crossref]
  11. Krishnamoorthy Y, Nagarajan R, Murali S (2023) Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis. J Public Health (Oxf). 45: e319-e331. [crossref]
  12. Valenzuela PL, Carrera-Bastos P, Galvez BG, Gema RH, José MO et al. (2021) Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol. 18: 251-275. [crossref]
  13. Fuchs FD, Fuchs SC (2021) The Effect of Alcohol on Blood Pressure and Curr Hypertens Rep. 23. [crossref]
  14. Asowata OJ, Okekunle AP, Adedokun B, Akpa OM (2023) Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data. Public Health. 225: 327-335. [crossref]
  15. Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G (2001) Alcohol consumption and the incidence of hypertension: The Atherosclerosis Risk in Communities Hypertension. 37: 1242-1250. [crossref]
  16. Harris E (2023) Even Without Hypertension, Daily Alcohol May Increase Blood JAMA. 330.
  17. Steffens AA, Moreira LB, Fuchs SC, Wiehe M, Gus M, et al. (2006) Incidence of hypertension by alcohol consumption: is it modified by race? J 24: 1489- 1492. [crossref]
  18. Vacca A, Bulfone L, Cicco S, Gabriele B, Andrea DP, et ( 2023) Alcohol Intake and Arterial Hypertension: Retelling of a Multifaceted Story. Nutrients.15. [crossref]
  19. Reinikainen J, Harkanen T, Tolonen H (2023) Projections for obesity, smoking and hypertension based on multiple imputation. Scand J Public Health. 51: 829-834. [crossref]
  20. Song S, Lee HA, Kim Y, Jeon BK, Moon CM, et al. (2023) Dynamic changing smoking habits and cardiovascular events in patients newly diagnosed with hypertension, diabetes, or dyslipidemia: a national cohort study. Front Cardiovasc Med. 10. [crossref]
  21. Wagai GA, Jeelani U, Beg MA, Romshoo GJ (2023) Relationship between hypertension and smoking: A preliminary study in South Kashmiri population of J&K. J Family Med Prim 12(5): 958-961. [crossref]
  22. Zhang DY, Huang JF, Kang YY, Yu Dou, Yan Lun S et (2020) The prevalence of masked hypertension in relation to cigarette smoking in a Chinese male population. J Hypertens. 38: 1056-1063. [crossref]
  23. Wu L, Yang S, He Y, Miao Liu, Yiyan Wang, et al. (2017) Association between passive smoking and hypertension in Chinese non-smoking elderly Hypertens Res. 40: 399-404. [crossref]
  24. Tamura T, Kadomatsu Y, Tsukamoto M, Rieko O, Tae S, et (2018) Association of exposure level to passive smoking with hypertension among lifetime nonsmokers in Japan: a cross-sectional study. Medicine (Baltimore). 97. [crossref]
  25. Makris TK, Thomopoulos C, Papadopoulos DP, Athanassios B, Ourania P, et al. (2009) Association of passive smoking with masked hypertension in clinically normotensive nonsmokers. Am J Hypertens. 22: 853-859. [crossref]
  26. Pierdomenico SD (2009) Passive smoking and masked Am J Hypertens. 22.
  27. Akpa OM, Okekunle AP, Asowata JO, Adedokun B (2021) Passive smoking exposure and the risk of hypertension among non-smoking adults: the 2015-2016 NHANES Clin Hypertens. 1. [crossref]
  28. Palatini P, Mos L, Saladini F, Olga V, Claudio F, et al. (2023) Both Moderate and Heavy Alcohol Use Amplify the Adverse Cardiovascular Effects of Smoking in Young Patients with Hypertension. J Clin Med.12. [crossref]
  29. Nagao T, Nogawa K, Sakata K, Hideki M, Kotaro M, et (2021) Effects of Alcohol Consumption and Smoking on the Onset of Hypertension in a Long-Term Longitudinal Study in a Male Workers’ Cohort. Int J Environ Res Public Health. 18. [crossref]
  30. Singh PK, Dubey R, Singh L, Nishikant S, Chandan K, et al. (2022) Mixed Effect of Alcohol, Smoking, and Smokeless Tobacco Use on Hypertension among Adult Population in India: A Nationally Representative Cross-Sectional Study. Int J Environ Res Public Health. 19. [crossref]
  31. Gupta R, Sharma S, Gupta VP, Gupta KD (1995) Smoking and alcohol intake in a rural Indian population and correlation with hypertension and coronary heart disease J Assoc Physicians India. 43: 253-258. [crossref]
  32. Wong DR, Willett WC, Rimm EB (2007) Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. Am J Epidemiol. 165: 838-845. [crossref]
  33. Pickering TG (2001) Effects of stress and behavioral interventions in hypertension–the effects of smoking and nicotine replacement therapy on blood pressure. J Clin Hypertens (Greenwich). 3: 319-21.
  34. Gu Z, Qu Y, Wu H (2022) The Interaction between Occupational Stress and Smoking, Alcohol Drinking and BMI on Hypertension in Chinese Petrochemical Workers. Int J Environ Res Public Health. 19. [crossref]
  35. Davis JL (2021) Evaluating the Influence of the Complete Health Improvement Program (CHIP) on Blood Glucose, Blood Pressure, and J Lifestyle Med.11: 33-37. [crossref]
  36. Kent L, Morton D, Hurlow T, Rankin P, Hanna A, Diehl H (2013) Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study. BMJ Open. 3.
  37. Kent L, Morton D, Rankin P, et (2013) The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status – a cohort study. Nutr Metab (Lond). 10. [crossref]
  38. Kent LM, Grant RS, Watts G, Morton DP, Rankin PM, et (2018) HDL subfraction changes with a low-fat, plant-based Complete Health Improvement Program (CHIP). Asia Pac J Clin Nutr.27: 1002-1009. [crossref]
  39. Kent LM, Morton DP, Rankin PM, Gobble JE, Diehl HA (2015) Gender differences in effectiveness of the Complete Health Improvement Program (CHIP). J Nutr Educ Behav. 47: 44-52.
  40. Kent LM, Morton DP, Rankin PM, Mitchell BG, Chang E, et (2014) Gender differences in effectiveness of the Complete Health Improvement Program (CHIP) lifestyle intervention: an Australasian study. Health Promot J Austr.25: 222-229. [crossref]
  41. Kent LM, Morton DP, Ward EJ, Rankin PM, Ferret RB, et (2016) The Influence of Religious Affiliation on Participant Responsiveness to the Complete Health Improvement Program (CHIP) Lifestyle Intervention. J Relig Health. Oct;55(5): 1561-73. [crossref]
  42. Kotekal D, Worley M, Patel H, Jensen L, Dogbey GY, Drozek D (2019) Effect of Participation with Accompanying Household Member in the Complete Health Improvement Program in Appalachia. Adv Prev Med. [crossref]
  43. Leibold C, Shubrook JH, Nakazawa M, Drozek D (2016) Effectiveness of the Complete Health Improvement Program in Reducing Risk Factors for Cardiovascular Disease in an Appalachian J Am Osteopath Assoc. 116: 84-91. [crossref]
  44. Morton D, Rankin P, Kent L, Dysinger W (2016) The Complete Health Improvement Program (CHIP): History, Evaluation, and Am J Lifestyle Med. 10: 64-73. [crossref]
  45. Morton D, Rankin P, Kent L, Rex S, Wayne D, et al. (2014) The Complete Health Improvement Program (CHIP) and reduction of chronic disease risk factors in Canada. Can J Diet Pract Res. 75: 72-77. [crossref]
  46. Morton DP, Rankin P, Morey P, Lillian K, Trevor H, et al. et al. (2013) The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility N Z Med J.126: 43-54. [crossref]
  47. Remy C, Shubrook JH, Nakazawa M, Drozek D (2017) Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes. J Am Osteopath Assoc.117: 293-300. [crossref]

Unexpected Infections in Wound Management – Case Studies

Leave a reply

DOI: 10.31038/IJNM.2024533

Introduction

Chronic wounds pose a significant challenge in the United States, affecting approximately 2.5% of the general population. These persistent wounds not only have a detrimental impact on the quality of life for patients but also exert a considerable financial burden on the healthcare system. Given the intricate nature of the wound healing process, healthcare professionals often approach the management of wounds based on their underlying causes. In cases where a wound fails to heal, clinicians commonly resort to the utilization of wound dressings and various technologies [1,2]. However, a crucial aspect that is frequently overlooked is the reassessment of the wound’s etiology, particularly when the wounds appear superficially normal. Incorporating a comprehensive understanding of the underlying cause of a chronic wound is paramount in formulating an effective treatment plan.

One essential tool in the assessment of chronic wounds is wound culture. By conducting a wound culture, clinicians can identify the presence of specific pathogens and gain insights into the appropriate course of treatment. Conventional wound culture techniques involving plating, though commonly employed, may not always capture the causative pathogens accurately. This limitation can potentially mislead treatment decisions and inadvertently prolong the healing process. To illustrate this point, two non-typical cases are presented as examples, shedding light on the importance of accurate wound culture techniques and the subsequent implications on healing outcomes.

Case #1

A 27-year-old male presented with multiple plantar warts on toes and feet. Two months later, a lesion appeared on the left thumb. The lesion was presumed to be a wart transmitted from the feet. Debridement with topical antiviral cream, containing 5% Cimetidine, 5% 5-Fluoracil and 10% Salicylic acid, did not resolve the lesion. More lesions developed on the fingers. Patient was referred to a dermatologist who performed Candida injections without success. HIV test was negative. Patient was referred back to continue the treatment of debridement and topical antiviral cream. However, the etiology of the wounds is now being questioned. The lesions appeared on fingers on the left hand only and on four fingers except the middle one (Figure 1).

fig 1

Figure 1: Suspected verrucae on the fingers

The lesions did not appear to follow the contact transmission logics. A wound culture by PCR (HealthTrackRx, Denton, TX) was performed. High volume of Peptostreptococcus anaerobius and Cutibacterium acnes were detected. Patient admitted to a habit of nail biting. All lesions on the fingers were resolved after seven days of Azithromycin and two weeks of topical antibiotic ointment (Figure 2).

fig 2

Figure 2: Fingers after the proper antibiotic treatment

Case #2

A 47-year-old female presented with an ingrown toenail and an incidental complaint of athlete’s foot. Patient indicated that the lesions were located in the left fourth interspace and had been resistant to over-the-counter antifungal for a few weeks. The webspace was erythematous with open skin and vesicles (Figure 3).

fig 3

Figure 3: Suspected tinea pedis

Suspicion was immediately raised since she was a double-transplant recipient due to a rare desmin-related myopathy. A wound culture by PCR (HealthTrackRx, Denton, TX) was performed. High volume of Enterococcus faecalis, E. faecium, Klebsiella pneumoniae, K. Oxytoca, P. anaerobius, C. acnes, Staphylococcus spp, and Trichophyton mentagraphophytes were detected. Patient admitted to having issues with her gastric pouch. Patient immediately contacted her transplant team. Open wounds were resolved with seven days of Levofloxacin (Figures 4 and 5). Patient continued to apply topical antifungal for tinea pedis.

Six weeks later, patient returned with abscess and cellulitis in the same location. Wound culture by PCR was performed. The results showed a high amount of C. acnes and moderate amount of Trichophyton but no enterobacteria.

fig 4

Figure 4: Gastrostomy tube

fig 5

Figure 5: Resolved cellulitis

Conclusion

Verrucae and tinea pedis are prevalent skin conditions encountered frequently in podiatry and primary care practices [3-7]. As clinicians diagnose these conditions, they typically adhere to established treatment protocols. However, when wound healing fails to progress as expected, healthcare professionals often find themselves compelled to modify the course of action by altering wound dressings or incorporating additional therapeutic modalities. In such instances, it becomes imperative to consider the significance of conducting a proper wound culture to gain a comprehensive understanding of the microbial load. This timely and detailed assessment not only confirms the initial diagnosis but also plays a pivotal role in formulating an accurate and tailored treatment plan to promote optimal wound healing. By performing a wound culture, clinicians can identify the specific microorganisms present in the affected area. This information offers valuable insights into the nature of the infection, including its type, severity, and potential resistance patterns. Armed with this knowledge, healthcare professionals can make informed decisions regarding appropriate antimicrobial therapies, taking into account the specific pathogens involved. The implementation of targeted and effective treatments based on the wound culture results enhances the chances of successful wound healing.

In summary, when faced with persistent or non-progressing wounds, clinicians should recognize the significance of a wound culture. This diagnostic approach ensures a thorough assessment of the microbial load, enabling accurate diagnosis confirmation and the formulation of an individualized treatment plan. By leveraging the insights gained from a detailed wound culture, healthcare professionals can optimize their interventions and enhance the prospects of successful wound healing for their patients.

Acknowledgement

None

Funding

None

Conflict of Interest

None

References

  1. Childs DR, Murthy AS (2017) Overview of Wound Healing and Management. Surg Clin North Am 97: 189-207. [crossref]
  2. Korting HC, Schollmann C, White RJ (2011) Management of minor acute cutaneous wounds: importance of wound healing in a moist environment. J Eur Acad Dermatol Venereol 25: 130-137.
  3. Aldana-Caballero A, Marcos-Tejedor F, Mayordomo R (2021) Diagnostic techniques in HPV infections and the need to implement them in plantar lesions: A systematic review. Expert Rev Mol Diagn 21: 1341-1348. [crossref]
  4. Clebak KT, Malone MA (2018) Skin Infections. Prim Care 45: 433-454.
  5. Etcheverria E (2020) Recognizing and treating five common dermatologic conditions seen in primary care. JAAPA 33: 33-37. [crossref]
  6. Kaushik N, Pujalte GG, Reese ST (2015) Superficial Fungal Infections. Prim Care 42: 501-516. [crossref]
  7. Lai JY, Doyle RJ, Bluhm JM, Johnson JC (2006) Multiplexed PCR genotyping of HPVs from plantaris verrucae. J Clin Virol 35: 435-441. [crossref]

Optimal Deep Belief Network with Opposition Based Pity Beetle Algorithm for Lung Cancer Classification: A DBNOPBA Approach – Short Review

Leave a reply

DOI: 10.31038/CST.2024933

Overview

Deep Belief Networks (DBN):

  • DBNs are a class of deep learning models that consist of multiple layers of stochastic, latent variables. They are particularly effective for unsupervised learning and have been widely used in feature extraction and classification tasks.

Opposition-Based Pity Beetle Algorithm (OBPBA)

  • The Pity Beetle Algorithm is a nature-inspired optimization algorithm based on the foraging behavior of pity beetles.
  • The Opposition-Based Learning (OBL) strategy enhances the algorithm by considering opposite solutions simultaneously, which helps in exploring the search space more effectively and avoiding local optima.

Approach

DBNOPBA Framework

  • The study integrates a DBN with the OBPBA to optimize the network’s weights and structure, aiming to improve the classification accuracy for lung cancer.
  • The opposition-based mechanism helps in maintaining diversity in the solution space, which enhances the optimization process.

Lung Cancer Classification

  • The model is trained and tested on lung cancer datasets to evaluate its performance in classifying cancerous and non-cancerous cases.
  • The authors claim that the DBNOPBA approach achieves superior accuracy and robustness compared to traditional methods and other deep learning models.

Strengths

  1. Improved Accuracy: The combination of DBN and OBPBA leads to improved classification performance due to the optimized network parameters.
  2. Exploration and Exploitation Balance: The opposition-based strategy allows for a better balance between exploration and exploitation, enhancing the algorithm’s ability to find optimal solutions.
  3. Scalability: The approach can be potentially applied to other medical classification problems, making it a versatile tool in healthcare diagnostics.

Limitations

  • Complexity: The integration of DBN with a metaheuristic algorithm increases the computational complexity, which might be a challenge for real-time applications.
  • Generalization: While the model shows promising results on the tested datasets, its generalization capability to diverse and unseen datasets needs further validation

Conclusion

The DBNOPBA approach offers an innovative solution for lung cancer classification by leveraging the strengths of deep learning and metaheuristic optimization. Its ability to achieve high accuracy makes it a promising tool in medical diagnostics. However, further research and testing are needed to fully understand its potential and limitations in real-world applications.

Beyond the Lesions: Unraveling the Multifactorial Nature of Endometriosis and Chronic Overlapping Pain

Leave a reply

DOI: 10.31038/AWHC.2024741

Commentary

Endometriosis has a long and complex history in the field of medicine, with its etiology and treatment being sources of debate for many years. This estrogen-dependent neuro inflammatory disease is marked by the presence of endometrial-like tissue outside the uterus, affecting approximately 10% of women of reproductive age. The disease’s symptoms are varied, with pain being a defining characteristic, including dysmenorrhea, painful intercourse, chronic pelvic pain, and bowel and bladder pain. These symptoms can be profoundly debilitating, adversely impacting quality of life and psychological health [1].

Compounding these challenges is the staggering reality that diagnosis can take 10 years or more, prolonging the suffering of those affected and underscoring the urgent need for greater awareness and more efficient diagnostic methods for the disease. Adding to its existing burden, endometriosis remains incurable, with treatments based on the suspected etiology of the pelvic pain and primarily focused on symptom relief. While such treatments can benefit those whose pain is driven by peripheral mechanisms, therapies that primarily target the periphery are often only effective for individuals experiencing anatomically localized pain. In fact, nearly 50% of medical and surgical treatments are unsuccessful, leaving patients with ongoing pain even after the suppression or surgical removal of endometriosis lesions. Moreover, there is little correlation between the extent of the disease and the severity of pain experienced, suggesting that factors beyond the lesions themselves may play a significant role in the pain associated with endometriosis. Over the past two decades, a growing body of evidence has supported this notion, indicating that endometriosis is not merely a disease defined by the presence of endometrial lesions but one that is also mediated by central nervous system factors, including altered sensory processing as well as structural and functional changes in the brain [2-7].

In recent years, endometriosis has increasingly been recognized as a heterogeneous condition that often coexists with other organic pain disorders. Collectively referred to as chronic overlapping pain conditions (COPCs), these disorders frequently occur together and include endometriosis, vulvodynia, irritable bowel syndrome, temporomandibular disorder, chronic fatigue syndrome, interstitial cystitis/painful bladder syndrome, fibromyalgia, tension-type and migraine headaches, and chronic low back pain. COPCs predominantly affect females and exhibit a high degree of co-prevalence. Although the underlying causes of these conditions remain poorly understood, they are generally believed to share common pathophysiological mechanisms, with alterations in central nervous system processing likely contributing to the pain experienced. Substantial evidence suggests that a higher prevalence of these conditions is associated with more frequent and prolonged pelvic pain episodes, increased pain severity, impairments in daily activities, reduced treatment efficacy, and declines in psychological functioning and quality of life [8-10].

It is estimated that over 95% of patients with endometriosis report having at least one overlapping pain condition. Unfortunately, these comorbidities are often resistant to singular treatments and may even exacerbate pelvic pain severity and reduce therapeutic effectiveness. Despite this understanding, endometriosis has traditionally been classified and treated as a peripheral disease, focusing on the removal or suppression of endometrial lesions—an approach that has yielded suboptimal outcomes [11].

Why do these treatments often fall short? Given the heterogeneity of endometriosis and its common overlap with other pain conditions, one possibility is that our treatment efforts are not appropriately targeted, failing to address centrally mediated factors that impact endometriosis pain, including the multimorbidity of the disease. Recognizing this gap, our team recently conducted a study examining the prevalence of COPCs in a sample of 525 women with chronic pelvic-abdominal pain (CPP), 25% of whom also reported endometriosis. Not surprisingly, compared to women with just CPP, those with endometriosis reported more adverse pain outcomes including greater pelvic pain severity and interference, as well as a higher degree of burden associated with their pelvic pain. They also reported a higher prevalence of COPCs, including fibromyalgia, chronic fatigue syndrome, and temporomandibular disorder. Even more striking, approximately 25% of women with endometriosis reported three or more COPCs, compared to only 12% of women with just CPP. Interestingly, a higher prevalence of COPCs was linked to more adverse pain outcomes, regardless of an endometriosis diagnosis. These findings align with previous data showing that as the number of pain diagnoses increases, symptoms become significantly more severe. More importantly, our results underscore the substantial burden that multimorbidity places on patient functioning [12,13].

Given the impact of co-occurring pain, screening and treatment of COPCs in endometriosis could be crucial steps toward improving clinical care. However, achieving effective treatments for these comorbidities is often complex, as providers frequently encounter challenges stemming from limited resources and inadequate education about endometriosis and chronic pelvic pain, making it difficult to systematically assess and manage multiple pain conditions. Additionally, patients with endometriosis often endure long, fragmented care across multiple medical specialties, with many providers lacking extensive training in pain management and focusing on treatment from their own medical lens. Unfortunately, this approach often overlooks the multidimensional nature of the disease, potentially neglecting the central mechanisms driving endometriosis pain [14].

Patients with comorbidities often face an array of challenges that can significantly hinder treatment. To make meaningful strides in disease management, it is crucial that we prioritize endometriosis care and expand the focus of treatment beyond the lesions. The presence of COPCs should be a key consideration in patient management, as those with multiple pain comorbidities likely require a broader and more comprehensive spectrum of therapeutic targets to effectively manage their symptoms. Alongside pharmacological management, this could include supportive counseling or psychotherapy to address maladaptive beliefs and emotional distress that often accompany pain, integrative and complementary therapies (e.g., yoga, mindfulness), self-management strategies (e.g., physical activity, stress management), and physical therapy to treat myofascial pain and dysfunction.

Given the decades of research demonstrating that endometriosis is not merely a disease of lesions, it is time we consider other contributing biological, psychological, and social factors that affect patient functioning and well-being. We desperately need a paradigm shift in both the management of endometriosis and the way patients are informed about the disease and their treatment options. This transformation could enhance patient care and provide a more holistic approach to pain management. Not only could this offer a vital opportunity to alleviate the profound burden of endometriosis, but it may also dramatically improve the overall quality of life for those affected.

Funding

Research reported in this publication was supported by the National Institutes of Health (1R21HD104957).

References

  1. Shafrir AL, Farland LV, Shah DK, Harris HR, et al. (2018) Risk for and consequences of endometriosis: A critical epidemiologic review. Best Practice & Research Clinical Obstetrics & Gynaecology 51: 1-15. [crossref]
  2. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, et al. (2009) The effect of surgery for symptomatic endometriosis: The other side of the story. Hum Reprod Update 15(2). [crossref]
  3. Guo SW (2009) Recurrence of endometriosis and its control. Hum Reprod Update 15(4). [crossref]
  4. Vercellini P, Fedele L, Aimi G, Pietropaolo G, et al. (2006) Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: A multivariate analysis of over 1000 patients. Human Reproduction 22(1). [crossref]
  5. As-Sanie S, Kim J, Schmidt-Wilcke T, Sundgren PC, et al. (2016) Functional connectivity is associated with altered brain chemistry in women with endometriosis-associated chronic pelvic pain. J Pain 17(1). [crossref]
  6. As-Sanie S, Harris RE, Harte SE, Tu FF, et al. (2013) Increased pressure pain sensitivity in women with chronic pelvic pain. Obstetrics and Gynecology 122(5). [crossref]
  7. Bajaj P, Bajaj P, Madsen H, Arendt-Nielsen L (2003) Endometriosis is associated with central sensitization: A psychophysical controlled study. J Pain 4(7). [crossref]
  8. Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD (2016) Overlapping chronic pain conditions: Implications for diagnosis and classification. J Pain 17(supp9). [crossref]
  9. Till SR, Nakamura R, Schrepf A, As-Sanie S (2022) Approach to diagnosis and management of chronic pelvic pain in women: Incorporating chronic overlapping pain conditions in assessment and management. Obstet Gynecol Clin North Am 49(2). [crossref]
  10. Leuenberger J, Kohl Schwartz AS, Geraedts K, Haeberlin F, et al. (2022) Living with endometriosis: Comorbid pain disorders, characteristics of pain and relevance for daily life. Eur J Pain 26(5). [crossref]
  11. Hernández Cardona MI, Ajewole C, Lewis H, Carrillo JF, et al. (2023) Time to move beyond surgical classification systems for endometriosis. Int J Gynaecol Obstet 163(1). [crossref]
  12. Bartley EJ, Alappattu MJ, Manko K, Lewis H, et al. (2024) Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey. Womens Health V(20). [crossref]
  13. Ohrbach R, Sharma S, Fillingim RB, Greenspan JD, et al. (2020) Clinical characteristics of pain among five chronic overlapping pain conditions. J Oral Facial Pain Headache 34(s29-s42). [crossref]
  14. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N (2009) Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility 91(1). [crossref]

How US Insurance Companies Limit and Deny Payments for Mental Health Services

Leave a reply

DOI: 10.31038/JNNC.2024712

Abstract

In the United States, insurance companies make it very difficult, and sometimes impossible, to provide mental health services. The author describes the insurance tactics and strategies he encountered while running an outpatient psychotherapy program for survivors of severe childhood trauma. After four years, the author had to close the program despite having 30-40 patients enrolled per day in the months prior to closure. This was due to low reimbursement rates and a set of denial strategies described herein.

Keywords

Insurance companies, Mental health, Denial of service

Despite an epidemic of deaths due to opiate overdoses, gun violence, drunk drivers, and suicide in the United States, insurance companies and the federal government make it difficult, and sometimes impossible to provide mental health services. This is due to low reimbursement rates for services and an array of denial strategies. The author owned and ran an outpatient psychotherapy program for survivors of severe childhood trauma for four years but it had to close effective August 16, 2024. During those four years, the author, who was the Medical Director, received no salary and the Chief Operating Officer (COO) worked extremely long hours resulting in severe burnout and strain on her physical and mental health. Despite her unflagging dedication to the program and the patients, she tendered her resignation in June, 2024. Citing overwhelming burnout, the Clinical Directors for the two Trauma Recovery Institute (TRI) program sites also tendered their resignations in the same month. It was not financially possible to hire sufficient support staff to reduce the stress level for the Clinical Directors.

TRI provided a Partial Hospitalization Program (PHP) and an Intensive Outpatient Program (IOP) both in person and by telehealth. The PHP provided 4 hours of group therapy per day Monday to Friday plus one hour of individual therapy per week. The IOP provided the same content but for 9-12 hours per week, and no individual therapy. TRI groups were highly structured and patients were provided with 91 pages of spiral-bound lesson plans that matched the different groups. Treatment included educational, cognitive-behavioral, systems and experiential approaches with a lot of focus on self-regulation skills and work with dissociated self-states. Patient acuity levels were high and meaningful treatment could not have been provided by skeleton staff. The average length of stay in the Program was 48.4 days (SD=38.0). Almost all patients admitted to TRI met criteria for Complex PTSD and/or a dissociative disorder as well as major depressive disorder, generalized anxiety disorder and multiple other comorbidities. Treatment was based on a well-defined treatment model that has been the basis of a series of prospective treatment outcome studies and is evidence-based at Level 2 of the US Public Health Service criteria, which require multiple prospective cohort studies but not randomization or a control group. All these studies were conducted with no external or grant funding [1-11].

Denial by Medicare

Even though Medicare pays more poorly than commercial insurance, the author wanted to provide services to individuals on Medicare because he had done so through hospital-based Trauma Programs for 31 years. Those programs were closed in 2020-22 by the hospitals with which he was an independent contractor despite their maintaining a stable census. The three hospitals – one in Texas, one in Michigan and one in California – decided that they could fill the beds without paying the management fee for the author so they closed the Trauma Programs. Most patients met criteria for PTSD and dissociative identity disorder or other specified dissociative disorder. In July, 2020 TRI applied to be enrolled as a Medicare provider. The application was processed and accepted and in August, 2021 TRI was told by mail that that the application had been forwarded to the state of Texas for final approval. During that year the COO had made dozens of phone calls and sent dozens of emails to Medicare with no responses. The phone number provided to reach out to the state with questions was no longer in service according to the message played when it was called. Then in July, 2022 TRI received a letter saying that Medicare had received a letter from TRI asking for is application to be withdrawn – no such letter was ever sent. Numerous phone calls did not yield any information as to how or where to reapply. Then in November, 2022 TRI received a letter from Medicare saying that its enrollment with Medicare was being cancelled because it had not treated any patients.

Insurance Denial and Cost-Escalation Strategies

Insurance company strategies for denial of payments and escalating administrative costs for providers include:

  1. If they issue a physical check that doesn’t arrive, they won’t issue a replacement check for 60 days. They require the provider to say which patient the check was for, but they don’t say in any of their payments which patient a check is for; in addition, they tell the provider that they can’t tell them which patient a check is for.
  2. They state that decisions about the need for treatment are made by the doctor, not by the insurance company, but then they deny payment on the grounds that there is no medical necessity.
  3. When a provider gets in network with an insurance company, the provider is not told that there are some policies for which the provider is not in network. The insurance company does not require prior authorization for that provider but when the provider submits a claim, the insurance company says that the provider is not in network with that particular sub-policy. The insurance company does not inform the provider in advance that the provider’s in network status with that company does not apply to all policies.
  4. The insurance company denies payment for treatment provided because no prior authorization was obtained, even though it says in insurance company paperwork that no prior authorization is required.
  5. Insurance policies often have deductibles of $5,000.00-$10,000.00 which start anew every January 1 – as a result patients have to stop treatment until their deductible is met because they can’t afford it. They pay for insulin, cardiac medications or other expenses till their deductibles are met.
  6. The insurance company gives only a few days notice that they aren’t going to pay for anymore treatment, even though the patient clearly meets criteria for ongoing treatment.
  7. When the provider calls the insurance company about a claim, the wait time for someone to answer can be an hour.
  8. When a human being does answer, the information provided is often different from that provided on previous calls and on subsequent calls.
  9. Escalating a denied claim to a supervisor is often difficult or impossible.
  10. Not processing claims at all or not for long periods.
  11. Not sending information about which payment is for which patient, which requires inordinate time on the provider’s end to sort out and reconcile everything and maintain an accurate accounts receivable.
  12. Freezing reimbursement rates without a cost of living adjustment while provider costs inflate substantially.
  13. Denying treatment altogether even for patients who are actively suicidal.
  14. Employing reviewers who are actively hostile and belittling on the telephone – of both provider and patient.
  15. Paying huge sums for new chemotherapy drugs that extend life by only a few months, and ICU stays at the end of life while nickel and diming mental health.
  16. Routinely taking 6 weeks to pay for services after a billing is submitted.
  17. Saying that the insurance company won’t pay for anymore treatment because the patient isn’t improving, is “at baseline” or has a chronic condition, while paying for renal dialysis, insulin, COPD treatment and numerous other maintenance treatments for chronic medical conditions, most of them more expensive than psychotherapy.
  18. Using the diagnosis of borderline personality disorder to deny treatment.
  19. Requiring inordinate amounts of utilization review by telephone, often resulting in denial of payment for treatment already provided.
  20. Requesting medical records in order to pay for a claim when the records were provided at the beginning of treatment.
  21. Approving a status for TRI such that pre-authorizations were no longer required but then denying payment because no pre-authorization was obtained. Insurance company personnel answering the phone had never heard of the no pre-authorization required program and didn’t know who we could talk to about it. This was a Texas program but is now being offered nationally by that insurance company.
  22. The insurance company reviewer asks only set questions from a script about symptoms, diagnoses and medications and refuses to listen to or consider recent psychosocial stresses.
  23. Multiple TRI clients ended up requiring inpatient treatment after the insurance company denied additional IOP treatment. This was not in the financial best interests of the insurance companies, which seem to have no procedure for monitoring such outcomes.
  24. For multiple TRI clients, additional treatment was denied starting the day of the denial, resulting in TRI providing additional free care for adequate discharge planning, which is required by the insurance companies.
  25. Paying only 90% of the contracted rate for PHP or IOP. However, if TRI billed above the contracted rate, the insurance company would pay 100% of the contracted rate. We found this out after a long period of providing treatment.

All the above tactics result in huge amounts of provider personnel time being expended, plus endless stress and hassle. All of these barriers to staying in business were compounded in early 2024 due to a global security breach that impacted insurance payment systems, resulting in a 75% drop in revenue for 6 weeks. The likelihood of future such calamities was another strain and source of exasperation and stress.

Discussion

In the case of TRI, the treatment involved complex sub-specialty intensive psychotherapy. This required a lot of training and supervision by TRI supervisory staff. With the low insurance reimbursement rates, TRI could not afford to pay therapists an hourly amount that could compete with private practice, therefore TRI had to employ and train interns or pay more seasoned staff more than it could afford. Four years of not knowing whether we would be able to make the next payroll took their toll. If I had sold TRI to an investor, they would have destroyed it in short order by cutting costs, meaning cutting staff and putting so many people in each group that the quality of treatment was gone. There just isn’t any political will to provide intensive, high-level psychotherapy to childhood trauma survivors in the United States – governments, insurance companies, politicians and medical schools talk the talk but none of them walk the walk. All the above problems were compounded by the fact that many TRI patients met criteria for dissociative identity disorder (DID) or other specified dissociative disorder: bias and prejudice against DID are endemic in the mental health field including at medical schools and in academic departments of psychology.

References

  1. Ross CA, Norova S, Ross AW (2024) Concurrent validity of the Dissociative Disorders Interview Schedule for diagnosing major depressive disorder in a highly dissociative outpatient sample. Journal of Neurology and Neurocritical Care 7(1).
  2. Ross CA, Halpern N (2009) Trauma model therapy: A treatment approach for trauma, dissociation and complex comorbidity. Richardson, TX: Manitou Communications.
  3. Ellason JW, Ross CA (1996) Millon Clinical Multiaxial Inventory – II follow-up of patients with dissociative identity disorder. Psychological Reports 78(V). [crossref]
  4. Ellason JW, Ross CA (1997) Two-year follow-up of inpatients with dissociative identity disorder. American Journal of Psychiatry 154(6). [crossref]
  5. Ross CA, Ellason JW (2001) Acute stabilization in a Trauma Program. Journal of Trauma and Dissociation 2(2)
  6. Ellason JW, Ross CA (2004) SCL-90-R norms for dissociative identity disorder. Journal of Trauma and Dissociation 5(3),
  7. Ross CA, Haley C (2004) Acute stabilization and three month follow-up in a Trauma Program. Journal of Trauma and Dissociation 5(1)
  8. Ross CA, Burns S (2007) Acute stabilization in a Trauma Program: A pilot study. Journal of Psychological Trauma 6(1).
  9. Ross CA, Goode C, Schroeder E (2018) Treatment outcomes across ten months of combined inpatient and outpatient treatment in a traumatized and dissociative inpatient group. Frontiers in the Psychotherapy of Trauma and Dissociation 2(1).
  10. Ross CA, Engle M, Baker B (2018) Reductions in symptomatology at a residential treatment center for substance use disorders. Journal of Aggression, Maltreatment & Trauma 28(10).
  11. Ross CA, Engle M, Edmonson J, Garcia A (2020) Reductions in symptomatology from admission to discharge at a residential treatment center for substance abuse disorders: A replication study. Psychological Disorders and Research.

Commentary on Radiation Induced Skin Fibrosis (RISF): Opportunity for Angiotensin II-Dependent Intervention

Leave a reply

DOI: 10.31038/PSYJ.2024642

 

The publication “Radiation Induced Skin Fibrosis (RISF): Opportunity for Angiotensin II-Dependent Intervention” presents a compelling examination of an emerging therapeutic target for mitigating the adverse effects of radiation therapy. Radiation-induced skin fibrosis is a debilitating condition that manifests as thickened and scarred skin following radiation treatment, often significantly complicating the quality of life for cancer patients status post radiation. We propose a novel dual intervention strategy involving the simultaneous modulation of angiotensin II (Ang II) and reactive oxygen species (ROS) pathways, offering a fresh perspective on how to address this challenging side effect. The study meticulously reviews the pathophysiology of RISF, highlighting how radiation triggers a cascade of fibrotic responses. We elucidate the role of Ang II and ROS activation, for their involvement in various fibrotic processes, in exacerbating skin fibrosis. We argue that the dual role of Ang II and elevated ROS in promoting fibrosis makes it a promising target for therapeutic intervention. This insight is significant, given the current lack of effective treatments for RISF that directly address its underlying mechanisms. We believe that one of the strengths of the publication is its integration of detailed mechanisms pathways with preclinical data and clinical observations. In this manner, we effectively link experimental findings with clinical outcomes, underscoring how Ang II antagonists and ROS inhibition could potentially alter the course of RISF. By referencing both animal models and human studies, the paper builds a robust case for the proposed intervention. This comprehensive approach with detailed figures and a supplemental summary table not only supports the feasibility of targeting both Ang II and ROS but also provides a foundation for potential future clinical trials.

Although the concept of dual targeting Ang II and ROS is innovative, we believe that further publications addressing additional potential limitations and considerations would be valuable. For example, dose range finding studies and the safety of long-term Ang II inhibition in the context of RISF have yet to be fully established. Additionally, we think that further research into personalized approaches, considering the variability in individual responses to radiation and drug interventions, would be beneficial. “Moreover, future considerations into the broader implications of the proposed dual treatment approach would provide additional guidance. Integrating Ang II inhibitors and targeted antioxidant therapy into standard care protocols for patients undergoing radiation therapy could have significant impacts on treatment strategies and patient management. Additional commentary could explore how these approaches might be incorporated into existing treatment regimens and what additional research would be necessary to facilitate such integration.

In conclusion, “Radiation Induced Skin Fibrosis (RISF): Opportunity for Angiotensin II-Dependent Intervention” represents a significant step forward in the quest to improve the management of RISF. By focusing on a dual approach to targeting Ang II and ROS pathways, we offer a promising new avenue for therapeutic development. Future research might address the highlighted potential limitations and further validate the proposed intervention’s clinical benefits. Overall, we believe this publication is a valuable contribution to the field and could pave the way for more effective treatments for patients suffering from radiation-induced fibrosis in general.

Berberine and Type II Diabetes: A Mini Review

Leave a reply

DOI: 10.31038/EDMJ.2024831

Abstract

Berberine is a bioactive compound with a broad spectrum of pharmacological activities. Berberine has gained significant attention for its ability to manage Type 2 Diabetes Mellitus. It significantly reduces fasting blood glucose levels, glycated hemoglobin HbA1c, and postprandial blood glucose levels in patients with T2DM, with efficacy comparable to that of metformin. It exerts its antidiabetic effects via activation of AMP-activated protein kinase, improvement of Insulin Sensitivity, reduction of Intestinal Glucose Absorption and modulation of gut microbia, anti-inflammatory and antioxidant effects.

Keywords

Berberine, Type 2 Diabetes Mellitus, Glucose, Anti-inflammatory effects, Antioxidant effects

Introduction

Berberine is a bioactive compound found in several plants, including Berberis species (e.g., Berberis vulgaris or barberry) (Figure 1). It is traditionally used in Chinese and Ayurvedic medicine for its antimicrobial, anti-inflammatory, and antidiabetic properties. Recent research has concentrated as a therapeutic agent for Type II Diabetes Mellitus (T2DM) due to its ability to modulate glucose and lipid metabolism [1-6].

fig 1

Figure 1: Berberine molecule

Berberine is renowned for its broad spectrum of pharmacological activities, including:

Antimicrobial activity: Berberine is effective against microorganisms, bacteria, viruses, fungi and protozoa. It can fight bacterial infections, especially those caused by Staphylococcus aureus and Escherichia coli [7-10].

Anti-inflammatory effects: Berberine works by lowering the induced oxidative stress by inhibiting the production of pro- inflammatory cytokines (TNF-α, IL-6). Oxidative stress represents a disturbance in the balance between the production of reactive oxygen species (Reactive Oxygen Species) and the ability of a biological system to inactivate these toxic molecules and fix the injury they cause. Reactive oxygen species harm all cell elements, as well as proteins, lipids, and DNA. The main antioxidant shields accessible to the cell are: Superoxide dismutase (SOD), Catalase and Glutathione peroxidase. Arthritis and inflammatory bowel disease are two examples of diseases that benefit from berberine administration. Modification of gut microbiota composition appears to be involved in gastrointestinal health [2,14].

Cardiovascular beneflts: Berberine acts by lessening blood pressure, cholesterol levels and at the same time improving endothelial function.

Anticancer potential: Research has shown that berberine possesses anticancer properties. It can initialize apoptosis (programmed cell death) in cancer cells, arrest cell proliferation, and subdue tumor growth in different types of cancer [4,13,17]. Some of the mechanisms with which Berberine inhibits cancer metastasis are shown in Figure 2.

fig 2

Figure 2: Some of the mechanisms with which Berberine inhibits cancer metastasis.

Effects of Berberine on Diabetes

Berberine BBR has gained significant attention for its ability to manage Type 2 Diabetes Mellitus (T2DM). Clinical studies have shown that berberine significantly reduces fasting blood glucose levels, glycated hemoglobin HbA1c, and postprandial blood glucose levels in patients with T2DM, with efficacy comparable to that of metformin. Berberine not only lowers glucose levels but also improves lipid profiles by reducing triglycerides TG, LDL-cholesterol, and total cholesterol, making it a valuable treatment option for patients with both T2DM and dyslipidemia. In a study including thirty-six adults with T2DM, who took berberine or metformin 0.5 g, 3 times a day) in a 3-month trial, there was the same significant decrease in glucose, HbA1c, TG both with berberine and metformin [14]. Ninety-seven T2DM patients with T2DM were treated orally with BBR, 1 g/d for 2 months and it was found increased insulin sensitivity and decrease in glucose, HbA1c, TG [15].

In a double-blind randomized controlled placebo trial, eighty-four patients with T2DM were divided in 2 groups (42 each) and each group received Berberine capsules 500 mg or placebo twice daily for 4 weeks. In the BBR group, a statistically significant decrease in glucose levels was observed before and after the meal, while the decrease in LDL, TG, VLDL was not statistically significant [9,18]. Administration of BBR with plant polyphenols to T2DM patients for 90 days significantly reduced glycated hemoglobin, insulin, homeostatic model assessment of insulin resistance, total and low-density lipoprotein cholesterol, and triglycerides [3]. In a double-blind study including patients with Non-alcoholic steatohepatitis (a liver problem frequently associates with diabetes), BBR administration 1000 mg twice a day, caused a significant decrease in liver fat content and a significant decrease in glycemic and lipid indices in the group of patients with T2DM [5].

Mechanisms of Action

Berberine exerts its antidiabetic effects through several mechanisms:

  1. Activation of AMPK Pathway: One of the most critical mechanisms of berberine is the activation of AMP-activated protein kinase (AMPK), a crucial enzyme that regulates energy homeostasis in cells. Activation of AMPK leads to increased glucose uptake in peripheral tissues, enhanced fatty acid oxidation, and decreased lipid synthesis (Figure 3). This results in improved insulin sensitivity and reduced blood glucose levels. AMPK activation by berberine also inhibits hepatic gluconeogenesis (the production of glucose by the liver) and promotes glycolysis (the breakdown of glucose for energy), contributing to its antidiabetic effects [15,19].
  2. Improvement of Insulin Sensitivity: Berberine improves insulin sensitivity by reducing insulin resistance, a hallmark of T2DM. It does this by modulating key insulin signaling pathways, which helps in lowering fasting blood glucose levels and glycated hemoglobin (HbA1c) (Figure 4) (Yin et al,2008).
  3. Reduction of Intestinal Glucose Absorption: Berberine is an inhibitor of α-glucosidase, an enzyme responsible for the breakdown of glycogen in lysosomes. Binding to M6P receptors on the cell surface has been shown to occur via carbohydrate groups on the enzyme molecule, after which it is internalized and transported to lysosomes, where it undergoes proteolytic cleavage leading to increased enzyme activity for glycogen degradation [7]. It also inhibits acetyl- CoA carboxylase ACC and fatty acid synthase FAS inducing the activity of enzymes that promote lipolysis (Figure 5). This regulation results in lower levels of triglycerides, low-density lipoprotein (LDL) cholesterol, and total cholesterol, making berberine effective in managing dyslipidemia [1].
  4. Modulation of Gut Microbiota: The action of berberine includes its effect on the composition of the intestinal microflora (Figure 6). Increases bacteria such as Bifidobacterium, Akkermansia involved in glucose and lipid metabolism. It also reduces the population of bacteria involved in metabolic disorders and inflammatory reactions [16]. The changes in the intestinal microflora contribute to the antidiabetic and anti- obesity effect of the molecule.
  5. Anti-inflammatory and Antioxidant Effects: Chronic low- grade inflammation and oxidative stress are implicated in the pathogenesis of T2DM [8,11,12]. Berberine exhibits anti-inflammatory and antioxidant properties, which contribute to its protective effects against T2DM and its complications [2].

fig 3

Figure 3: Berberine activates AMPK and effects on cellular metabolism. At the center, depict AMPK as a large protein complex with labels, showing it being activated by Berberine molecules attaching to it. Berberine molecules can be represented as small, yellow compounds binding to the AMPK complex.

fig 4

Figure 4: Berberine regulates glucose and lipid metabolism by inhibiting enzymes involved in lipid synthesis and enhancing those promoting lipid catabolism.

fig 5

Figure 5: How Berberine promotes lipolysis

fig 6

Figure 6: Modulation of gut microbiota by berberine

Safety of Berberine

While metformin is a prescription medication, used as a standard treatment for type 2 diabetes, Berberine is available as a dietary supplement and is often used by individuals seeking natural alternatives or adjuncts to conventional treatments. It is generally well-tolerated, with gastrointestinal discomfort being the most commonly reported side effect. Its safety profile compares favorably with standard antidiabetic drugs, making it a promising alternative or complementary therapy.

Conclusions and Perspectives

Berberine exerts its pharmacological effects through multiple mechanisms, including AMPK activation, modulation of glucose and lipid metabolism, inhibition of glucose absorption, alteration of gut microbiota, and anti-inflammatory actions. These diverse mechanisms make berberine a promising therapeutic agent for managing Type 2 Diabetes Mellitus, cardiovascular diseases, and other metabolic disorders. Additionally, more methods or techniques should be developed to improve the bioavailability and antidiabetic activity of berberine. More clinical trials should be carried out to confirm effects of berberine on Diabetes and metabolic disorders.

Funding Statement

This research was not funded

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Brusq JM, Ancellin N, Grondin P, Guillard R, Martin S, Saintillan Y, Issandou M, et al. (2006) Inhibition of lipid synthesis through activation of AMP kinase: an additional mechanism for the hypolipidemic effects of berberine. Journal of Lipid Research 47(6): 1281-1288. [crossref]
  2. Chang W, Chen L, Hatch GM, Zhang Y (2015) Berberine as a therapy for type 2 diabetes and its complications: From mechanism of action to clinical studies. Biochemical Pharmacology 87(1): 42-52. [crossref]
  3. Di Pierro F, Villanova N, Agostini F, Marzocchi R, Soverini V, Marchesini G (2012) Pilot study on the additive effects of berberine and oral type 2 diabetes agents for patients with suboptimal glycemic control. Diabetes Metab Syndr Obes 5: 213-217 [crossref]
  4. Fu T, Coulter S, Yoshihara E, Oh TG, Fang S, Cayabyab F, Zhu QY, Zhang T, Leblanc M, Liu SH (2019) FXR regulates intestinal cancer stem cell proliferation. Cell. [crossref]
  5. Harrison SA, Gunn N, Neff GW, Kohli A, Liu L, Flyer A, Goldkind L, Di Bisceglie AM (2021) A phase 2 proof of concept, randomised controlled trial of berberine ursodeoxycholate in patients with presumed non-alcoholic steatohepatitis and type 2 Nat Commun 12,5503. [crossref]
  6. Imenshahidi M, Hosseinzadeh H (2019) Berberine and barberry (Berberis vulgaris): A clinical Phytother Res 33: 504-523. [crossref]
  7. Lee YS, Kim WS, Kim KH, Yoon MJ, Cho HJ, Shen Y, Kim J B (2006) Berberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant Diabetes 55(8): 2256-2264. [crossref]
  8. Lourenço A, Freitas C, Timóteo M, Soares M, Figueiredo J, Osório N, Valado A, Trapali M, Pereira T, Caseiro A (2024) Laboratory Assessment of the Effects of AGA@4life Multidisciplinary Intervention on the Inflammatory Profile, MMPs, and TIMPs in a Geriatric Population. Healthcare 12(5): 509. [crossref]
  9. Rashidi H, Namjoyan F, Mehraban Z, Zakerkish M, Ghaderian SB, Latifi S (2018) The Effects of Active Ingredients of Barberry Root (Berberine) on Glycemic Control and Insulin Resistance in Type 2 Diabetic Patients. Jundishapur J Nat Pharm Prod 13: e64180.
  10. Tan J, Wang J, Yang C, Zhu C, Guo G, Tang J, Shen H (2019) Antimicrobial characteristics of berberine against prosthetic joint infection-related Staphylococcus aureus of different multi-locus sequence types. BMC Complement Altern Med 19,218. [crossref]
  11. Trapali M (2021) Oxidic degradation of lipids in patients with type II Diabetes. Review Clinical Pharmacology and Pharmacokinetics. 35(2): 75-77.
  12. Trapali M (2022) Antioxidant Activity in Patients with Type II Diabetes. Review Clinical Pharmacology and Pharmacokinetics. 36(1): 6.
  13. Wang Y, Liu Y, Du X, Ma H, Yao J (2020) The anti-cancer mechanisms of berberine: A Cancer Manag Res. 12,695-702. [crossref]
  14. Yin J, Xing H, Ye J (2008) Efficacy of berberine in patients with type 2 diabetes Metabolism 57(5): 712-717. [crossref]
  15. Zhang H, Wei J, Xue R, Wu JD, Zhao W, Wang Z Zeng Q (2010) Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor Metabolism 59(2): 285-292. [crossref]
  16. Zhang X, Zhao Y, Xu J, Feng Q, Chen W, Wei H, Zhang Y (2012) Modulation of gut microbiota by berberine and metformin during the treatment of high-fat diet- induced obesity in rats. Scientific Reports 5: 14405. [crossref]
  17. Zhang C, Sheng J, Li G, Zhao L, Wang Y, Yang W, Yao X, Sun L, Zhang Z, Cui R (2019) Effects of berberine and its derivatives on cancer: A systems pharmacology Front Pharmacol 10,1461. [crossref]
  18. Zhang Y, Gu Y, Ren H, Wang S, Zhong H, Zhao X, Ma J, Gu X, Xue Y, Huang S (2020) Gut microbiome-related effects of berberine and probiotics on type 2 diabetes (the PREMOTE study) Nat Commun. 11: 5015. [crossref]
  19. Zhou L, Wang X (2014) Berberine has beneficial effects on glucose-lipid metabolism and associated diseases by activating AMP-activated protein kinase. Clinical and Experimental Pharmacology and Physiology 41(6): 398-405.

Lonsdaleite, Diamond, and Graphite in a Lamprophyre: Minette from East-Thuringia/Germany

Leave a reply

DOI: 10.31038/GEMS.2024652

Abstract

We present a microscopical and Raman spectroscopical study of a minette sample from East-Thuringia/Germany. This sample contains needle-like graphite with micro-diamond crystals and his changed carbon products. Besides diamonds in larger graphite needles, there are also whisker-like needles of lonsdaleite and diamonds in quard and orthoclase, which are later inserted into the minette rock by supercritical fluids or melts. That means we have a two-stage process at the formation of the minette.

Keywords

Minette, Raman spectroscopy, Lonsdaleite, Diamond, Graphite, Depth of origin, Supercritical fluid

Introduction

Vein-like lamprophyres are here decimeter-to-meter thick intrusions, which can be assigned as deep-reaching faults that permeate the earth’s mantle and the crust. The origin of the lamprophyric magma is still discussed because all information about it is based on geochemical studies [1]. In this short contribution, we will show that careful mineralogical studies can contribute to this question. We forswear to a thorough description of this magmatic rock because of its extensive literature, for example, Beuge and Kramer (1977) [2-6].

Sample Material

The minette sample 2210 is from a 50 cm thick vein in a small quarry at Highway F 92, about 1 km northwards from Cunsdorf. A petrographic characteristic of the orbicular minette rock is in Beuge and Kramer (1977) [2] Figure 1 inside – together with a mineralogical description and chemical composition. The reddish brown ocelli are composed predominantly of alkali feldspar, quartz, actinolite, and chlorite. The black interstice is composed of femic phenocrysts of biotite, amphibole, and pyroxene. During the study of a lamprophyre sample (sample 2210; see Kramer 1988) [1], a thick section of minette from E-Thuringia (Cunsdorf, Meltheuer Mulde in the immediate vicinity of the Bergaer Sattel, near Elsterberg), we found, as a surprise, many crystals of diamond-graphite intergrowths. Figure 1 shows the studied sample. Further minerals found with Raman spectroscopy, often containing carbon, are anatase, calcite, orthoclase, and quartz. Apatite is present in two different generations: an early magmatic type as phenocrysts and a late apatite in the form of larger lamellas. The chemical composition (main and trace elements) of the studied minette sample (sample No. 2210) is in Kramer (1988) [1] and Beuge and Kramer (1977) [2] here represented by samples 3 and 4. Beuge and Kramer (1977) [2] found in the orbicular minette rock from Cunsdorf near Elsterberg 5600 ppb Hg. Kramer and Just (1995) [7] also present REE and other trace elements (Ba, F, Bi, Hg, Cr, Ni, Th, U).

fig 1

Figure 1: Petrologic thick section (about 500 µm thick) of the orbicular minette sample from Cunsdorf near Elsterberg.

Methodology: Microscopy and Raman Spectroscopy

We use Raman spectroscopy here to characterize the diamond crystals in the minette, which show high-pressure and high- temperature origin. For the study of the minette sample, we use the Raman spectrometer EnSpectr R532 combined with the Olympus BX43 microscope both for transmitted and reflected light and equipped with a rotating stage and polarizers (for parallel and perpendicular positions). Note here that the incident laser light is always polarized – in our case, N – S [8]. Generally, we used an Olympus long-distance 100x objective lens for the studies. As references, we applied a water-clear diamond crystal from Brazil (1331.63 ± 0.60 cm-1 and a semiconductor-grade silicon single-crystal (520.70 ± 0.15 cm-1). For this study, we generally used laser energies of ≤ 30 mW on the sample to minimize the heating by the laser light for the studies.

Results

Diamonds – lonsdaleite – Graphite

The minette sample contains many black needles. Some are whisker-like. They are mainly composed of carbon with remnants of diamond, according to Raman spectroscopy (Figure 2).

fig 2

Figure 2: Needels of carbon in the quartz matrix. The quartz matrix contains many remnsants of cristobalite, often also shaped as light needles.

Figure 3 shows such a Raman spectrum of diamonds in graphite- like needles in the minette quartz. This quartz also contains remnants of cristobalite.

fig 3

Figure 3: Raman spectrum of diamond in a thick graphite needle (see Figurs 2) in the orbicular minette sample from Cunsdorf near Elsterberg.

Ten different crystals of micro-diamonds give a mean of 1332.9 ± 10.2 cm-1 and a Full Width at Half Maximum (FWHM) of 71.6 ± 28.8 cm-1. A typical Raman spectrum is shown in Figure 4. However, a large proportion of the thick needles give diamond un-typical Raman spectra: 1355 ± 5.7 cm-1 with FWHM = 67.2 ± 9.8 cm-1 (17 different crystals). According to Zaitsev (2001) [9], this carbon is disordered or nanocrystalline defective graphite or amorphous diamond-like carbon. According to our ideas, diamonds are the precursor of this carbon.

fig 4

Figure 4: Raman spectrum of a small black needle in quartz and orthoclase in the orbicular minette sample from Cunsdorf near Elsterberg. In the quartz are many anatase inclusions.

Besides the thick needles (Figure 2), here, mostly with diamond microcrystals, there are also significant thinner, whisker-like needles (Figure 5), mainly in quartz and orthoclase, which give distinct lower values of the Raman band. Besides the needles, there are also more or less isometric and statistic-distributed graphite grains (with about ~10 to 20 µm diameter). The Raman spectra of these grains show nondiamond carbon phases (see further above).

fig 5

Figure 5: Whisker-like lonsdaleite crystals in quartz-cristobalite-high tridymite of the minette sample from Cunsdorf near Elsterberg.

From the Raman measurement, we obtained for the whisker-like needles of lonsdaleite in quartz and orthoclase of the minette a mean for 15 different needles of 1323.5 ± 2.4 cm-1 an FWHM = 75.6 ± 10.9. Only a tiny number have diamond-like band positions: 1333.2 ± 3.1 cm-1 (n = 7). The astonishing is that the needles do not bend. Figure 6 shows a typical Raman spectrum of a lonsdaleite-like diamond from the minette sample. The carbon G-band is always present at around 1562 cm-1. In the case of the diamond, this G-band has significantly shifted to higher values than the lonsdaleite-like diamond: 1577 – 1586 cm-1.

fig 6

Figure 6: Raman spectrum of lonsdaleite-like diamond in orthoclase and quartz of the minette sample from Cunsdorf/E-Thuringa, Germany.

The minette sample contains relatively large amounts of quartz. Besides lonsdaleite-diamond-graphite needles, some such quartz grains include slight spheric inclusions of anatase [TiO2] (Figure 7). The formation of such small globules in quartz is considered a mystery alone. According to our studies, starting with Thomas et al. (2022) [10], spherical minerals, like the anatase here, are a solid hint to their speedy transport via supercritical fluids or melts.

fig 7

Figure 7: Many globules of anatase in minette quartz from Cunsdorf/E-Thuringa, Germany.

Anatase

Anatase is widespread as perfect crystals in the minette rock. An exception is the anatase globules (Figure 7) in irregular, tubular quartz aggregates. Obviously, there are two different age generations. The spheric anatase crystals, included in quartz, are introduced into the rock via supercritical phases. The interstitial quartz between the lonsdaleite whisker is partially composed of high-tridymite (extreme high 150 cm-1 Raman band) and cristobalite, which indicates a high temperature of about 1470°C [11,12].

Interpretation and Discussion

As a rule, lamprophyres seldom contain melt inclusions for the estimation of formation temperatures. Only for a kersantite in the Kirchberger granite (sample 296/85), Thomas (1989) [13] has determined a temperature of 1175°C from homogenization measurement on melt inclusion in apatite using a microscope heating stage. After the correlation of the bulk composition and the temperature (Thomas 1990) [14], the formation temperature of the lamprophyres should be1170 ± 37°C and corresponds very well with the measured data. If we take a temperature of 1200°C, it results in a minimum pressure of about 4.5 GPa (diamond-graphite equilibrium), which corresponds to a depth of about 150 km or more. Most diamonds in the typical minette rock show a transformation of diamond into carbon. Only the diamonds in orthoclase and quartz are well preserved. Therefore, we assume that the quartz and orthoclase are later added into the minette rock (see the globules of anatase), maybe by contamination of supercritical fluids/melts. So, the formation of the minette rock is at least a two-step process. Supercritical fluids use partially the same ascent ways. Up to now, the highest pressure determined is 12-15 GPa (Thomas 2024) [15,16], corresponding to a depth of about 560 km. We think that the same depth is conceivable for the origin of lamprophyres. Maybe supercritical fluids or melts use the same paths as lamprophyres, which are obviously their predecessors. Conceivable is also an interaction of both mantle related magmatic phases (supercritical fluid/melt and lamprophyre magma).

Acknowledgment

The studied minette sample 2210 from Cunsdorf near Elsterberg/ E-Thuringa is from Kramer. We dedicate this short contribution to Dr. Wolfgang Kramer for his 85 birthday in August 2024.

References

  1. Kramer W (1988) Magmengenetische Aspecte der Lithosphärenentwicklung. Akademie-Verlag Berlin. Pg: 136.
  2. Beuge P, Kramer W (1977) Lamprphyre Ostthüringens und ihre anomalen Quecksilbergehalte im Ergebnis endogener uns exogener Anreicherungsprozesse. Schriftenreihe geol Wiss. 8: 79-99.
  3. Pfeifer L, Kurze M, Mathe G (1981) Einführung in die Petrologie. Akademieverlag Berlin. Pg: 632.
  4. Reinisch, R (1904) Petrographisches Praktikum. Gebrüder Borntraeger, Berlin Part II, Pg: 180.
  5. Wahlstrom EE (1955) Petrographic John Wiley & Sons. Pg: 408.
  6. Von Wolff F (1951) Gesteinskunde – die Eruptivgesteine. RA Lang Verlag Pössneck. Pg:265.
  7. Kramer W, Just G (1995) Seltene Elemente in the spätvariszischen mafischen Ganggesteinen und Effusiva im Bereich der Uranlagerstätten des Westerzgebirges und Ostthüringens. Z geol Wiss. 23: 561-572.
  8. Tuschel D (2012) Raman crystallography, in theory and and Spectroscopy. 27: 2-6.
  9. Zaitsev AM (2001) Optical Properties of diamond – A Data Handbook. Springer. Pg:502.
  10. Thomas R, Davidson P, Rericha A, Recknagel U (2022) Water-rich coesite in prismatine-granulite from Waldheim/Saxony. Veröffentlichungen Museum für Naturkunde Chemnitz. 45: 5-44.
  11. Frondel C (1962) The System of Mineralogy, III Silica Wiley and Sons. Pg: 334.
  12. Kanzaki M (2019) Raman spectra of tridymite modifications: MC, MX-1, and PO-Journal of Mineralogical and Petrological Sciences. 114: 214-218.
  13. Thomas R (1989) Investigations of melt inclusion and their application to the solution of various problems of deposit geology and Dissertation B, Mining Academy Freiberg. Pg: 131.
  14. Thomas R (1990) Abschätzung der Bildungstemperatur magmatischer Z geol Wiss Berlin. 18: 5-15.
  15. Thomas R (2024) Rhomboedric cassiterite as inclusions in tetragonal cassiterite from Slavkovský les – North Geol Earth Mar Sci 6: 1-6.
  16. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultrahigh-pressure mineral inclusions in a crustal granite: Evidence for a novel transcrustal transport mechanism. Geosciences 13: 1-13.

Psychological Impact of Breast Cancer Diagnosis and Treatment

Leave a reply

DOI: 10.31038/AWHC.2024734

 

Breast cancer diagnosis and treatments are often associated with significant psychological distress impacting psychosocial adjustment to the disease process and health outcomes. This distress has been linked to poorer physical and mental health during treatment. The diagnosis of breast cancer can be profoundly distressing, creating enormous stress for patients who must navigate treatment choices, undergo testing, understand prognoses, manage treatments and side effects, and face uncertain futures. This process can also lead to or exacerbate existing psychological symptoms, such as anxiety and depression, and significantly impact psychological health and well-being, including quality of life and treatment compliance. Common psychological symptoms in breast cancer patients include anxiety, depression, impaired cognitive function, pain, sleep disturbances, sexual dysfunction, and fatigue. These symptoms can trigger fear of death or recurrence, altered body image, and diminished well-being. Psychological distress is particularly high at transition points in treatment, such as diagnosis, awaiting treatment, during and post-treatment, at follow-up visits, recurrence, and treatment failure [1,2].

Patients diagnosed with breast cancer often face multiple modalities of treatment, and the type of cancer treatment impacts psychological symptoms. Surgical procedures, radiotherapy, and chemotherapy are associated with significant psychological dysfunction. Anxiety, depression, and other psychological symptoms are prevalent and can persist long after treatment completion of these treatments.

The link between psychological and physical health in breast cancer patients is well-documented. Anxiety and depression can manifest as physical symptoms, impacting overall health outcomes. Addressing psychological symptoms can improve treatment adherence and quality of life, as well as reduce mortality rates in patients with depressive symptoms. Thus, screening for psychological distress and symptoms is crucial to comprehensive care for breast cancer patients. Screening and assessing psychological stressors are crucial for planning appropriate treatment approaches. Tools like the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale (HADS), and other standardized psychological assessments help identify and address psychological symptoms. The Institute of Medicine and the National Comprehensive Cancer Network emphasize the importance of distress screening as part of standard oncology care [3-5].

Research shows variability in psychological symptoms among breast cancer patients, influenced by factors like socioeconomic status, social support, and cultural background. Adjustment disorders, anxiety, depression, cognitive impairment, sleep disturbances, body image disturbances, sexual dysfunction, and post-traumatic stress are common psychological issues in this population.

Effective psychotherapeutic interventions for breast cancer patients include psycho-education, cognitive-behavioral therapy (CBT), mindfulness-based therapy, supportive-expressive therapy, meaning-centered psychotherapy, and acceptance and commitment therapy (ACT). These interventions address various psychological symptoms and improve coping skills, quality of life, and overall well-being. Research on psychosocial interventions in diverse populations is limited. Tailored, culturally informed assessments and treatments are necessary to address unique stressors faced by underrepresented groups, such as Black women, who experience higher mortality rates and distinct psychosocial challenges. Psychotropic medications play a crucial role in treating psychiatric symptoms in breast cancer patients. Medications must be carefully selected to avoid drug interactions with cancer treatments, such as tamoxifen.

Breast cancer diagnosis and treatment are associated with significant psychological distress, impacting overall health outcomes and quality of life. Routine assessment and targeted psychotherapeutic interventions are essential for managing psychological symptoms in breast cancer patients. Tailored treatments, including psychotropic medications and culturally informed approaches, can improve patient well-being, quality of life, and treatment adherence.

References

  1. Dinapoli L, Colloca G, Di Capua B, Valentini V (2021) Psychological aspects to consider in breast cancer diagnosis and treatment. Current Oncology Reports 23(3). [crossref]
  2. Chiriac VF, Baban A, Dumitrascu DL (2018) Psychological stress and breast cancer incidence: a systematic review. Clujul Med 91(1). [crossref]
  3. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6). [crossref]
  4. National Comprehensive Cancer Network (2012) Clinical Practice Guidelines in Oncology (NCCN Guidelines) Distress Management.
  5. Institute of Medicine (2008) Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.