Objective To discuss the distance training for medical staff of children's rehabilitation. Methods 15 lessions were carried out using computer software from April, 2013 to November, 2014 in our centre. 7 cooperative hospitals participated the trainings. The implemen-tation effect was surveyed after training. Results 2693 person-times attended the trainings, including 2109 person-times with living distance training and 584 person-times with video distance training. In the following sampling survey, 92.8%staff thought that the distance training was helpful to their work. 98.6%staff thought that the living distance training was better than the video distance training and 88.6%staff thought their rehabilitation level improved after the distance training. Conclusion The distance training of children's rehabilitation has the advantages of economy, convenience and celerity. It has a wide developmental prospect.

Objective:To detect the abnormalities within the functional connectivity (FC) of the prefrontal cortex (PFC) in patients with overactive bladder (OAB) and to explore its central pathogenesis.Methods:Seven OAB patients (OAB group, 6 females, mean age 47.6±16.0 years) and 13 healthy controls [HC] (HC group, 10 females, mean age 49.9±9.2 years) were prospectively enrolled from August to December 2020. All subjects underwent rs-fNIRS scanning synchronized with urodynamic monitoring, and two rs-fNIRS scans were performed when the bladder was empty and when the desire to void was strong/urodynamic monitoring indicated detrusor hyperactivity (DO). The Pearson's correlation coefficients (r value, i. e., FC value) between time series of the 22 channels were calculated, and a 22×22 FC matrix for each subject was obtained. A paired-sample t-test ( P<0.05, FDR corrected) was used to compare the difference in FC values between the HC group and the OAB group when the bladder was empty and the desire to void was strong. A two-sample t-test ( P<0.05, FDR corrected) was used to compare the group differences in FC values between OAB and HC groups. Results:In this study, 7 patients were included in the OAB group, including 1 male and 6 female. The mean age was (47.6±16.0) years old. In HC group, 13 healthy subjects were included, including 3 males and 10 females. The mean age was (49.9±9.2) years. There was no significant difference in baseline data between the two groups, including age, sex composition, years of education, handedness and urgency score at the second scan ( P>0.05). Residual urine volume in both groups was less than 10 ml. The OABSS score, 3-day urine diary parameters (frequency of urination/24 h, frequency of urinary incontinence/24 h, frequency of urgency/24 h) and maximum detrusor pressure during urine storage in OAB group were significantly higher than those in HC group, with statistical significance ( P<0.01). The average urination volume/time, bladder capacity at first sensation and maximum bladder capacity in OAB group were significantly lower than those in HC group, and the differences were statistically significant ( P<0.01). In the process of bladder filling to strong desire to void, the detrusor pressure in HC group was stable without DO, and 6 cases in OAB group had DO. Compared to empty bladder state, healthy subjects with strong desire to void showed significantly increased FC within PFC in 5 Brodmann area (BA9, BA10, BA44, BA45, BA46)and 13 edges, such as the BA9(left dorsolateral prefrontal cortex [DLPFC]: ch 4, 5, 7 and right DLPFC: ch 3), BA10(left frontopolar area: ch 12, 21 and right frontopolar area: ch 10, 18), BA44(left pars opercularis Broca's area: ch 15), BA45(left pars triangularis: ch 22), BA46(left DLPFC: ch 6, 14); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 2 edges, such as the BA9(left DLPFC: ch 7), BA10(left frontopolar area: ch21 and right frontopolar area: ch 17), BA46(right DLPFC: ch 9). There was no significant difference in FC within PFC between OAB and HC groups with empty bladder. However, during the strong desire to void state, the FC within PFC in OAB patients was significantly abnormal when compared with HC. OAB patients showed significantly increased FC within PFC in 4 brain regions (BA9, BA10, BA45 and BA46) and 4 edges, such as the BA9(right DLPFC: ch 1 and left DLPFC: ch 7), BA10(right frontopolar area: ch 17), BA45(left pars triangularis: ch 22), BA46(right DLPFC: ch 9, 16); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 4 edges, such as the BA9 (right DLPFC: ch 3 and left DLPFC: ch 4), BA10(left frontopolar area: ch 12, 21), BA46(left DLPFC: ch 14) Conclusion:Compared with HC group, the PFC in OAB group showed significant abnormalities, which may lead to "dyssynergia" of PFC internal functions, result in frontal lobe dysfunction, involving sensory integration, motivation drive, emotional control and decision whether to urinate or not, etc., leading to urinary control dysfunction, which manifested as typical clinical symptoms of OAB. Our findings contribute to the understanding of the central pathogenesis of OAB and may provide a theoretical basis for the emergence of targeted brain therapy in the future.

Objective:Evaluate the influence of different pressure transmission media of urodynamic water filled catheter(WFC) and air charged catheter(ACC) on the pressure measurement results to determine whether they can be used interchangeably.Methods:The results of 2 147 patients who underwent urodynamic examination in our hospital from January 2014 to December 2020 were retrospectively analyzed. A total of 2 538 times of bladder manometry data were obtained, including 1 299 times in WFC group, 856 times in male and 443 times in female, aged 37(24, 50)years, course of disease 1.2(0.4, 5.0) years, 1 130 times in neurogenic bladder(NB)and 169 times in non-neurogenic bladder(N-NB); In ACC group, there were 1 239 times, 773 times for male and 466 times for female, with age of 37(24, 55)years, course of disease of 1.5(0.5, 6.0)years, 1 040 times for Nb and 199 times for N-NB. There was no significant difference in baseline data of general clinical data between the two groups. The intravesical pressure(Pves), intra-abdominal pressure(Pabd)and detrusor pressure(Pdet) of WFC and ACC patients during filling and urination were analyzed. For traumatic spinal cord injury(SCI) and idiopathic patients, the two sets of pressure measurement data were analyzed separately. Nonparametric test and Chi-square test were used to compare the Pves, Pabd, and Pdet recorded by the two manometry catheters before, at the end and after urination, the maximum detrusor pressure at DO(Pdet.max-DO), and the maximum detrusor pressure during spontaneous urination (Pdet. max) and the detrusor pressure (Pdet.Qmax) corresponding to the maximum urine flow rate, the maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) during resting urethral pressure profile, and the initial cough Pdet signal pattern (typeⅠ, typeⅡand typeⅢ).Results:Regardless of the cause, the Pabd values measured by ACC were significantly higher than WFC before filling, end filling and after voiding[18(10, 26)cmH 2O vs.15(11, 21)cmH 2O; 23(16, 31)cmH 2O vs. 20(14, 26)cmH 2O; 23(15, 31)cmH 2O vs.18(12, 24)cmH 2O], and Pdet were significantly lower than WFC[0(0, 0) cmH 2O vs. 0(0, 1)cmH 2O; 5(1, 13)cmH 2O vs. 9(4, 17)cmH 2O; 6(1, 12)cmH 2O vs. 7(3, 14)cmH 2O]. In the initial cough state, Pves and Pabd increase value were also significantly lower than that of WFC [22(12, 36)cmH 2O vs. 23(14, 38)cmH 2O; 20(10, 33)cmH 2O vs. 21(12, 36)cmH 2O]. The Pves measured by ACC was also significantly higher than WFC before filling and after voiding[18(10, 27)cmH 2O vs. 16(11, 21)cmH 2O; 30(22, 39)cmH 2O vs. 26(20, 36)cmH 2O]. Maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) measured by ACC were significantly higher than WFC [91(69, 118)cmH 2O vs.81(64, 106)cmH 2O; 77(55, 103)cmH 2O vs. 68(48, 91)cmH 2O], and there were no significant differences in Pdet.max-DO、Pdet.max和Pdet.Qmax. For patients with traumatic SCI, the Pves measured by ACC was significantly higher than WFC before filling[15(10, 24)cmH 2O vs. 14(10, 20)cmH 2O], and only MUP was significantly higher than WFC in the measurement of urethral pressure[95(71, 119)cmH 2O vs. 85(65, 112)cmH 2O], and there were no significant differences in Pdet.max-DO, Pdet.max, Pdet.Qmax and MUCP. For idiopathic patients, Pves measured by ACC before filling and after urination were significantly higher than WFC[25(20, 29)cmH 2O vs. 18(11, 23)cmH 2O; 35(29, 44)cmH 2O vs. 28(20, 38)cmH 2O], while Pdet.max-DO, Pdet.max, Pdet.Q max, MUP and MUCP were not significantly different in different pressure measurement systems. For the comparison of the initial cough Pdet signal pattern, ACC is easier to detect type Ⅰ, and WFC is easier to detect type Ⅱ and type Ⅲ. Conclusions:Compared with WFC, ACC measured higher Pves and Pabd and lower Pdet in resting state, and lower Pves and Pabd in initial cough state. The pressure values and signal pattern measured by WFC and ACC are not completely consistent, so they cannot be used interchangeably.

Objective:To investigate the clinical characteristics of patients with keratoconus, and to explore the factors influencing keratoconus severity.Methods:A cross-sectional study was performed.A total of 908 patients (1 476 eyes) with primary keratoconus were enrolled in Henan Eye Hospital from January 2019 to December 2021.The medical history data of patients were collected by face-to-face questionnaire survey.Refractive parameters were measured by subjective optometry.Intraocular pressure (IOP) was measured by a non-contact tonometer, and corrected IOP was calculated by Dresden formula.Corneal topography parameters was obtained using Pentacam HR.The subgroup analysis of clinical characteristics of all patients was performed by age (<21 years, 21~<31 years, ≥31 years) and gender.Disease severity was graded based on steep keratometry (Ks), namely mild (Ks<48 D), moderate (48 D≤Ks<55 D) and severe (Ks≥55 D). The influencing factors of disease severity in keratoconus were analyzed by ordered Logistic regression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[5]). All subjects or guardians were informed of the purpose and significance of the study and written informed consent was obtained.Results:Of the 908 patients, 622 were with bilateral keratoconus and 286 were with unilateral keratoconus.The median age of onset was 20(17, 26) years, and the median age of diagnosis was 21(18, 27) years.The ratio of males to females was 3.05∶1.There were 9.80%(89/908) of the patients having a history of allergy, 25.55%(232/908) having a history of other systemic diseases, and 1.98%(18/908) having a family history of keratoconus.Of the 1 476 affected eyes, 27.57%(407/1 476) were diagnosed as severe keratoconus, and 61.94%(568/917) had a history of eye rubbing.The medians of sphericity, cylindricity, IOP, corrected IOP, Ks, thinnest corneal thickness (TCT), anterior corneal surface elevation (AE) and posterior corneal surface elevation (PE) were -4.00(-7.00, -1.75)D, -3.50(-6.00, -1.50)D, 12.00(10.30, 13.80)mmHg, 15.40(13.60, 17.00)mmHg, 49.85(46.40, 54.90)D, 460.00(425.00, 490.00)μm, 21.00(13.00, 34.75)μm, 51.00(33.00, 75.00)μm, respectively.The spherical refraction, IOP and corrected IOP were lower and the cylindrical refraction was higher in patients at age <21 years than in patients at age 21~<31 years, and the TCT of patients at age <21 years was higher than that at age ≥31 years, and the differences were statistically significant (all at P<0.05). Compared with female patients, male patients had younger onset age, lower spherical refraction, IOP and corrected IOP, as well as higher cylindrical refraction, AE and PE, showing statistically significant differences (all at P<0.05). The spherical refraction and IOP of male patients were lower than those of female patients at age <21 years, and the cylindrical refraction was higher in males than in females among the patients at age 21~<31 years, and the differences were statistically significant (both at P<0.05). Among the patients with onset age <21 years and diagnosis age <21 years, the ratio of males to females in patients with severe keratoconus was higher than those with mild and moderate disease, and the difference was statistically significant (both at P<0.05). Older age of onset was a protective factor for disease severity in keratoconus (odds ratio=0.981, 95% confidence interval: 0.963~0.999). Conclusions:The younger the onset age of keratoconus patients, the more severe the disease.Among the patients with severe keratoconus, there were more male patients, and males have a younger onset age and severer conditions.It is suggested that early screening of keratoconus in children and adolescents should be strengthened in clinical work, and more active prevention and treatment measures should be taken for younger patients, especially males.