Correction to: Occurrence of mental illness following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study.

Following publication of the original article [1], the author reported that, because of a programming error, incorrect sentences and incorrect Table 3 has been published. The correct sentences and Table 3 are shown below.

The spectrum of disease in chronic traumatic encephalopathy.

Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages I-IV. Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white matter at all stages of chronic traumatic encephalopathy. TAR DNA-binding protein 43 immunoreactive inclusions and neurites were also found in 85% of cases, ranging from focal pathology in stages I-III to widespread inclusions and neurites in stage IV. Symptoms in stage I chronic traumatic encephalopathy included headache and loss of attention and concentration. Additional symptoms in stage II included depression, explosivity and short-term memory loss. In stage III, executive dysfunction and cognitive impairment were found, and in stage IV, dementia, word-finding difficulty and aggression were characteristic. Data on athletic exposure were available for 34 American football players; the stage of chronic traumatic encephalopathy correlated with increased duration of football play, survival after football and age at death. Chronic traumatic encephalopathy was the sole diagnosis in 43 cases (63%); eight were also diagnosed with motor neuron disease (12%), seven with Alzheimer's disease (11%), 11 with Lewy body disease (16%) and four with frontotemporal lobar degeneration (6%). There is an ordered and predictable progression of hyperphosphorylated tau abnormalities through the nervous system in chronic traumatic encephalopathy that occurs in conjunction with widespread axonal disruption and loss. The frequent association of chronic traumatic encephalopathy with other neurodegenerative disorders suggests that repetitive brain trauma and hyperphosphorylated tau protein deposition promote the accumulation of other abnormally aggregated proteins including TAR DNA-binding protein 43, amyloid beta protein and alpha-synuclein.

Management of a Patient With Premenstrual Syndrome Using Acupuncture, Supplements, and Meditation: A Case Report.

Objective: The purpose of this case report was to describe a multimodal approach for the treatment of premenstrual syndrome (PMS). Clinical Features: A 36-year-old nulliparous woman presented to a free clinic for veterans and their spouses. She received a PMS diagnosis at age 18. She was previously prescribed hormonal birth control and nonsteroidal anti-inflammatory drugs, which minimally affected her condition. She stopped using conventional medicine therapies at age 27. Laboratory results showed that her progesterone was below 0.5 ng/mL. Her symptom score was 50 out of 60 on the Treatment Strategies for PMS assessment tool. During her menses, she experienced low back pain and stiffness, bloating, swelling, weight gain, breast tenderness, swelling, and pain, and she felt overwhelmed and stressed. Intervention and Outcome: Traditional Chinese medicine acupuncture was administered in conjunction with 100 mg of coenzyme Q10 (ubiquinol) and a B-100 complex once a day and 400 mg of magnesium citrate, 1000 mg of flaxseed oil (Linum usitatissimum), and 1000 mg of turmeric (Curcuma longa) twice a day. Five days before the onset of her menstrual period, she was to ingest a B-100 complex twice a day and 400 mg of magnesium citrate, 1000 mg of flaxseed oil, and 1000 mg of turmeric 3 times a day. Mindfulness meditation was encouraged twice a day for 10 minutes to reduce stress. After 12 treatments over 3 months, her symptom score decreased to 18 out of 60 and remained below 20 for an additional 32 weeks. Conclusion: This patient with PMS symptoms positively responded to a multimodal approach using traditional Chinese medicine-style acupuncture, dietary supplements, and mindfulness meditation.

Inclusion of Acupuncture as an Adjunct Therapy in the Management of a Patient With Schizophrenia and Dissociative Identity Disorder: A Case Report.

Objective: The purpose of this case report is to describe the inclusion of acupuncture in the management of a patient with schizophrenia and dissociative identity disorder (DID). Clinical Features: A 68-year-old man presented with schizophrenia and DID, which had been diagnosed at age 25. The patient was currently under psychiatric care and prescribed antipsychotic medications and psychiatric counseling. His predominant symptoms were anxiety, paranoia, and irritability. In addition, 2 to 5 personas manifested over the years that he referred to as the "Others." A Brief Psychiatric Rating Scale was 81 out of 126 on his first visit. Intervention and Outcome: Traditional Chinese medicine-style acupuncture was administered. Over the year, the severity of the patient's symptoms was reduced according to the Brief Psychiatric Rating Scale to 56 and was maintained between 55 and 61 for 6 months. Conclusion: Acupuncture included as an adjunct therapy to antipsychotic medication and psychiatric counseling may have reduced the severity of symptoms associated with schizophrenia and DID for this patient.

Occurrence of mental illness following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study.

BACKGROUND: While many studies of adults with solvent exposure have shown increased risks of anxiety and depressive disorders, there is little information on the impact of prenatal and early childhood exposure on the subsequent risk of mental illness. This retrospective cohort study examined whether early life exposure to tetrachloroethylene (PCE)-contaminated drinking water influenced the occurrence of depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia among adults from Cape Cod, Massachusetts. METHODS: A total of 1,512 subjects born between 1969 and 1983 were studied, including 831 subjects with both prenatal and early childhood PCE exposure and 547 unexposed subjects. Participants completed questionnaires to gather information on mental illnesses, demographic and medical characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure originating from the vinyl-liner of water distribution pipes was assessed using water distribution system modeling software that incorporated a leaching and transport algorithm. RESULTS: No meaningful increases in risk ratios (RR) for depression were observed among subjects with prenatal and early childhood exposure (RR: 1.1, 95% CI: 0.9-1.4). However, subjects with prenatal and early childhood exposure had a 1.8-fold increased risk of bipolar disorder (N = 36 exposed cases, 95% CI: 0.9-1.4), a 1.5-fold increased risk post-traumatic stress disorder (N = 47 exposed cases, 95% CI: 0.9-2.5), and a 2.1-fold increased risk of schizophrenia (N = 3 exposed cases, 95% CI: 0.2-20.0). Further increases in the risk ratio were observed for bipolar disorder (N = 18 exposed cases, RR; 2.7, 95% CI: 1.3-5.6) and post-traumatic stress disorder (N = 18 exposed cases, RR: 1.7, 95% CI: 0.9-3.2) among subjects with the highest exposure levels. CONCLUSIONS: The results of this study provide evidence against an impact of early life exposure to PCE on the risk of depression. In contrast, the results provide support for an impact of early life exposure on the risk of bipolar disorder and post-traumatic stress disorder. The number of schizophrenia cases was too small to draw reliable conclusions. These findings should be confirmed in investigations of other similarly exposed populations.

Affinity for risky behaviors following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study.

BACKGROUND: Many studies of adults with acute and chronic solvent exposure have shown adverse effects on cognition, behavior and mood. No prior study has investigated the long-term impact of prenatal and early childhood exposure to the solvent tetrachloroethylene (PCE) on the affinity for risky behaviors, defined as smoking, drinking or drug use as a teen or adult. OBJECTIVES: This retrospective cohort study examined whether early life exposure to PCE-contaminated drinking water influenced the occurrence of cigarette smoking, alcohol consumption, and drug use among adults from Cape Cod, Massachusetts. METHODS: Eight hundred and thirty-one subjects with prenatal and early childhood PCE exposure and 547 unexposed subjects were studied. Participants completed questionnaires to gather information on risky behaviors as a teenager and young adult, demographic characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure was estimated using the U.S. EPA's water distribution system modeling software (EPANET) that was modified to incorporate a leaching and transport model to estimate PCE exposures from pipe linings. RESULTS: Individuals who were highly exposed to PCE-contaminated drinking water during gestation and early childhood experienced 50-60% increases in the risk of using two or more major illicit drugs as a teenager or as an adult (Relative Risk (RR) for teen use = 1.6, 95% CI: 1.2-2.2; and RR for adult use = 1.5, 95% CI: 1.2-1.9). Specific drugs for which increased risks were observed included crack/cocaine, psychedelics/hallucinogens, club/designer drugs, Ritalin without a prescription, and heroin (RRs:1.4-2.1). Thirty to 60% increases in the risk of certain smoking and drinking behaviors were also seen among highly exposed subjects. CONCLUSIONS: The results of this study suggest that risky behaviors, particularly drug use, are more frequent among adults with high PCE exposure levels during gestation and early childhood. These findings should be confirmed in follow-up investigations of other exposed populations.

Multimodal Care for Headaches, Lumbopelvic Pain, and Dysmenorrhea in a Woman With Endometriosis: A Case Report.

Objective: The purpose of this case report is to describe the conservative management of a patient with headaches, lumbopelvic pain, and dysmenorrhea. Clinical Features: A 36-year-old woman presented with intense pelvic and daily lumbar pain. She had difficulty sleeping and focusing and had 3 to 4 headaches per week. Before, during, or after her menses, she would have migraine headaches. During her menses, she experienced severe lumbopelvic pain and dysmenorrhea with moderate bloating, constipation, nausea, and diarrhea. When she was 32 years old, her gynecologist diagnosed endometriosis and prescribed nonsteroidal anti-inflammatory drugs and hormonal oral contraceptives, which failed to alleviate her symptoms. She sought an alternative approach to help control her symptoms. Intervention and Outcome: A multimodal approach was selected for this patient, which consisted of acupuncture combined with supplements of magnesium citrate, B-100 complex and botanicals turmeric (Curcuma longa/root extract), bromelain (Ananas comosus [pineapple stem]) and black cohosh (Cimicifuga racemosa). After an initial trial of care, her daily lumbopelvic pain was reduced, and she was sleeping better and feeling more focused and less fatigued. She rarely had tension headaches during the week or migraine headaches or dysmenorrhea before, during, or after menses. Her lumbopelvic pain and gastrointestinal symptoms were reduced. Conclusion: A patient who was experiencing headaches, lumbopelvic pain, and dysmenorrhea responded favorably to a course of care that included a combination of botanicals, supplements, and acupuncture.

An Exploratory Review of Potential Adjunct Therapies for the Treatment of Coronavirus Infections.

OBJECTIVE: The purpose of this exploratory review was to examine vitamin D, zinc, vitamin A, elderberry (Sambucus nigra), garlic (Allium sativum), licorice (Glycyrrhiza glabra), stinging nettle (Urtica dioica), N-acetylcysteine, quercetin, and selenium as potential adjunct therapies for the treatment of coronavirus infections. METHODS: A search of PubMed was performed for articles published from 2005 to 2021. Keywords searched were "zinc," "vitamin A," "vitamin D," "Sambucus nigra," "Allium sativum," "Glycyrrhiza glabra," "Urtica dioica," "N-acetylcysteine," "quercetin," "selenium," and "coronavirus." RESULTS: There were 47 articles selected for this review. Findings included that vitamin D, zinc, vitamin A, S. nigra, A. sativum, G. glabra, U. dioica, N-acetylcysteine, quercetin, and selenium have been shown to produce antiinflammatory, immunostimulatory, or antiviral effects that may enhance the actions of standard therapeutics for the treatment of coronavirus infections. Specific to effects against COVID-19, we found research articles related to the effects of only vitamin D, zinc, G. glabra, quercetin, and selenium. CONCLUSION: We identified nonpharmaceutical supplements (vitamin D, zinc, vitamin A, S. nigra, A. sativum, G. glabra, and U. dioica) which may have potential to provide support for those with coronavirus infections. However, rigorous clinical studies need to be performed before any clinical recommendations can be made.

Treatment of Psoriatic Arthritis With Acupuncture, Turmeric (Curcuma longa), Sarsaparilla (Smilax officinalis) and Vitamin D: A Case Report.

OBJECTIVE: The purpose of this case report is to analyze the treatment of a patient with psoriatic arthritis (PsA) using natural medicine. CLINICAL FEATURES: A 73-year-old woman complained of PsA in her second and third digits with gradual onset over a 6-month period. PsA was manifesting as dactylitis with moderate to severe stiffness and edema in her proximal and distal interphalangeal joints and the surrounding soft tissue. A radiographic image revealed narrowing of the proximal and distal interphalangeal joints, mild erosion, and periosteal thickening. INTERVENTION AND OUTCOME: Traditional Chinese Medicine-style acupuncture was combined with 500 mg of turmeric curcumin (Curcuma longa root extract) with 3 mg of black pepper extract (Piper nigrum) that was standardized to contain 95% curcuminoids, 425 mg of sarsaparilla root (Smilax officinalis) powdered capsules that were not standardized and 10,000 IU vitamin D3 as cholecalciferol oil capsules once a day. She received 2 acupuncture treatments in combination with the supplements. She experienced an increased range of motion and a reduction in edema and stiffness. She continued to experience a reduction in symptomatology while supplementing with turmeric curcumin, sarsaparilla root, and vitamin D3, which might have helped to control her symptoms. Supplementation with these agents may have helped to maintain the swelling and stiffness at a tolerable level for the past year. CONCLUSION: The natural modalities administered to the patient might have been able to reduce her symptoms of PsA and maintain them at a tolerable level. Acupuncture, turmeric, sarsaparilla root, and vitamin D3 could be viable natural alternatives for the treatment of PsA.

Complementary Medicine Therapies That May Assist With Weight Loss: A Narrative Review.

OBJECTIVE: The purpose of this study was to review the potential effects of traditional Chinese medicine-which includes acupuncture; electroacupuncture; plum blossom needle hammer; auricular acupuncture; herbs that balance hormones, regulate neurotransmitters, induce sedative effects, and increase thermogenesis; and functional foods that can suppress the appetite-as an adjunct therapy for weight loss. METHODS: A narrative review of the current literature was performed using searches of MEDLINE and 4 scholarly texts. The inclusion criteria for the review consisted of studies that were performed from 2005 to 2016. RESULTS: In general, some traditional Chinese medicine modalities claim to promote weight loss. Acupuncture, electroacupuncture, and herbs aim to reduce stress-related food cravings. These therapeutic approaches aim to downregulate dopamine and leptin levels, suppressing the appetite. Other attributes of these therapies are increasing uncoupling protein-1 activity promoting thermogenesis, which contributes to weight loss. In addition, acupuncture, electroacupuncture, and Cimicifuga racemosa may regulate estrogen, which could attenuate the appetite, assisting in weight-loss programs. CONCLUSION: The literature reviewed includes information that describes how traditional Chinese medicine, herbal medicine, or functional foods as adjunct therapies may be beneficial for weight-loss programs.

Treatment of a Woman With Glycyrrhiza glabra for Acute Sinusitis: A Case Report.

OBJECTIVE: The purpose of this case report is to describe the treatment of a patient with acute sinusitis using Glycyrrhiza glabra. CLINICAL FEATURES: A 26-year-old woman presented with acute sinusitis of 10-day duration. Her symptoms included facial pressure and soreness around the frontal and maxillary sinuses, a headache, pharyngitis, a fever, rhinorrhea, nasal congestion with postnasal drip, a productive cough, myalgias, and fatigue. INTERVENTION AND OUTCOME: After administration of 12 to 15 drops of a 2 000-mg tincture of G glabra twice a day, improvements were noted. Resolution of her symptoms occurred after 3 days of treatment. CONCLUSION: For the treatment of acute sinusitis, G glabra may be a natural therapeutic remedy.

Multimodal Care in the Management of a Patient With Chronic Tendinopathy of the Biceps Femoris: A Case Report.

OBJECTIVE: The purpose of this case report was to describe the use of dry needling in conjunction with auricular acupuncture, core exercises, and light aerobic activity for treating chronic tendinopathy of the biceps femoris. CLINICAL FEATURES: A 30-year-old white female presented with chronic biceps femoris tendinopathy. The injury had occurred 18 months prior while training for a triathlon. Active stretching of her right biceps femoris while standing with her feet 6 inches apart aggravated the pain at the origin in the right tendon of the biceps femoris at 0 degrees of movement. INTERVENTION/OUTCOME: The combination of dry needling and auricular acupuncture with core rehabilitation exercises and light activity was employed. Alleviation of pain with full range of motion was achieved during hip extension, knee flexion, and standing biceps femoris stretch at the 11th, 16th, and 18th treatments. In addition, the patient also reported improvement in her symptoms, including night sweats, insomnia, anxiety, tension, and constipation. CONCLUSIONS: This patient's symptoms and function improved after 18 treatments of multimodal care. Dry needling employed simultaneously with auricular acupuncture, core exercises, and light activity could be considered a possible strategy for treating chronic tendinopathy.

Dietary and Lifestyle Changes in the Treatment of a 23-Year-Old Female Patient With Migraine.

OBJECTIVE: The purpose of this case report is to describe the chiropractic management of a patient with atypical migraine headache. CLINICAL FEATURES: A 23-year-old woman experienced migraines for 3 months. She had no previous history of migraines and was unresponsive to pharmaceutical and musculoskeletal therapies. The migraine headaches could not be classified according to the common categories associated with migraines. She had a change in diet due to severe gastroesophageal reflux causing her to reduce or avoid consuming foods. She also had a history of smoking and alcohol consumption. INTERVENTION AND OUTCOME: Dietary and lifestyle changes were recommended in conjunction with the administration of a multivitamin, magnesium oxide, and Ulmus rubra. Her migraine headaches improved with the resolution of her gastroesophageal reflux symptoms. CONCLUSION: This patient with atypical migraines and a history of poor dietary and lifestyle choices improved using nutritional changes and supplementing with a multivitamin and magnesium oxide.

Assessing clinicopathological correlation in chronic traumatic encephalopathy: rationale and methods for the UNITE study.

INTRODUCTION: Chronic traumatic encephalopathy (CTE) is a progressive neurodegeneration associated with repetitive head impacts. Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) is a U01 project recently funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering. The goal of the UNITE project is to examine the neuropathology and clinical presentation of brain donors designated as "at risk" for the development of CTE based on prior athletic or military exposure. Here, we present the rationale and methodology for UNITE. METHODS: Over the course of 4 years, we will analyze the brains and spinal cords of 300 deceased subjects who had a history of repetitive head impacts sustained during participation in contact sports at the professional or collegiate level or during military service. Clinical data are collected through medical record review and retrospective structured and unstructured family interviews conducted by a behavioral neurologist or neuropsychologist. Blinded to the clinical data, a neuropathologist conducts a comprehensive assessment for neurodegenerative disease, including CTE, using published criteria. At a clinicopathological conference, a panel of physicians and neuropsychologists, blinded to the neuropathological data, reaches a clinical consensus diagnosis using published criteria, including proposed clinical research criteria for CTE. RESULTS: We will investigate the validity of these clinical criteria and sources of error by using recently validated neuropathological criteria as a gold standard for CTE diagnosis. We also will use statistical modeling to identify diagnostic features that best predict CTE pathology. CONCLUSIONS: The UNITE study is a novel and methodologically rigorous means of assessing clinicopathological correlation in CTE. Our findings will be critical for developing future iterations of CTE clinical diagnostic criteria.

Prenatal and early childhood exposure to tetrachloroethylene and adult vision.

BACKGROUND: Tetrachloroethylene (PCE; or perchloroethylene) has been implicated in visual impairments among adults with occupational and environmental exposures as well as children born to women with occupational exposure during pregnancy. OBJECTIVES: Using a population-based retrospective cohort study, we examined the association between prenatal and early childhood exposure to PCE-contaminated drinking water on Cape Cod, Massachusetts, and deficits in adult color vision and contrast sensitivity. METHODS: We estimated the amount of PCE that was delivered to the family residence from participants' gestation through 5 years of age. We administered to this now adult study population vision tests to assess acuity, contrast sensitivity, and color discrimination. RESULTS: Participants exposed to higher PCE levels exhibited lower contrast sensitivity at intermediate and high spatial frequencies compared with unexposed participants, although the differences were generally not statistically significant. Exposed participants also exhibited poorer color discrimination than unexposed participants. The difference in mean color confusion indices (CCI) was statistically significant for the Farnsworth test but not Lanthony's D-15d test [Farnsworth CCI mean difference = 0.05, 95% confidence interval (CI): 0.003, 0.10; Lanthony CCI mean difference = 0.07, 95% CI: -0.02, 0.15]. CONCLUSIONS: Prenatal and early childhood exposure to PCE-contaminated drinking water may be associated with long-term subclinical visual dysfunction in adulthood, particularly with respect to color discrimination. Further investigation of this association in similarly exposed populations is necessary.