Objective To explore the clinical features, diagnosis and treatment of Wunderlich syndrome (WS).Methods Fifteen patients with WS were included from September 2008 to February 2014, and their clinical features, diagnosis and treatment were retrospectively reviewed.The most common clinical manifestations were flank or abdominal pain (15/15), hypovolemic shock (5/15), gross hematuria (4/15) and percussion pain on kidney region ( 15/15 ) .Laboratory tests showed anemia ( 9/15 ) and coagulation abnormalities (5/15).Five of 15 cases were critical patients with moderate to severe shock ( systolic blood pressure≤90 mmHg, 1 mmHg =0.133 kPa ) accompanied with severe anemia ( Hb <60 g/L ) and coagulation abnormalities.Results In the acute stage, the diagnostic ratios of ultrasonography and contrast enhanced CT for WS were 11/15 and 15/15, and cause determination ratios were 4/15 and 10/15, respectively.The latter was significantly higher than the former ( P <0.05 ) .Contrast enhanced MRI was performed in 5 cases, and the results were identical to those of CT.According to the causes made by emergent imaging, critical patients underwent emergent operations or renal arteriography plus selective arterial embolization, and the other patients underwent conservative management, emergency operations, or renal arteriography plus selective arterial embolization, respectively.The causes of WS included angiomyolipoma (8 cases), renal cell carcinoma (3 cases), metastatic tumor of lung cancer (1 case) and renal cyst (3 cases) in this study.The mean follow-up period was 34 months.One critical patient died, and all the other patients were cured or relieved.Conclusions WS has no specific clinical features.Contrast enhanced CT or MRI is the main approach for diagnosis and cause determination, which is superior to ultrasonography.Treatments for WS vary according to severity classification and imaging diagnosis.

Based on the hospital information systems and the hospital network,a software for patients with peripherally inserted central catheter (PICC) was developed and applied in clinical practice,which achieved the share of PICC information within the hospital,saved nursing time effectively,made the clinical data more standardized,systematical and objective.

ObjectiveTo explore the impact of different types of virtual reality environments balance exercise on human balance and posture control. MethodsFrom March to April, 2022, 30 male students from Dalian University of Technology were recruited to accept VR balance training of dynamic background (dynamic VR training) and static background (static VR training), respectively, with an interval of one week. They were measured the average moving speed of the center of pressure of human body under eight conditions before and after training, namely open-eye floor standing, close-eye floor standing, static VR background floor standing, dynamic VR background floor standing, open-eye sponge pad standing, close-eye sponge pad standing, static VR background sponge pad standing, and dynamic VR background sponge pad standing. Meanwhile, the weight of human body sensation was calculated. ResultsBefore training, the average movement speed of center of pressure was higher under the static VR than under open-eye (|t| > 2.811, P < 0.01), and lower than under close-eye (t > 3.279, P < 0.01) on both planes; while it was higher under dynamic VR than under close-eye (|t| > 4.830, P < 0.001). After dynamic VR training, the average movement speed of center of pressure increased under open-eye stable floor standing (t = 2.305, P < 0.05), decreased under close-eye on both planes (t > 3.405, P < 0.01), and decreased under static and dynamic VR on both planes (|t| > 3.285, P < 0.01). After static VR training, the average movement speed of center of pressure increased under open-eye floor standing (t = 2.224, P < 0.05), decreased under close-eye sponge pad standing (t = 2.223, P < 0.05), and decreased under dynamic VR on both planes (|t| > 2.380, P < 0.05). The weight of vision decreased after training (t > 4.132, P < 0.001), and the visual weight under normal proprioception was less after dynamic VR training than after static VR training (t = 3.611, P < 0.01). ConclusionUnder static VR background, the balance stability is poorer than under open-eye, but stronger than under close-eye. Under dynamic VR background, the balance stability is poorer under close-eye. VR balance training may decrease the stability without interference, but improve the stability under interference, which may result from reducing the dependence on visual sensation and strengthening the use of vestibular sensation, especially after VR training with dynamic background.

Objective:To determine the effects of menopausal stage, age and other associated risk factors on symptoms of anxiety and depression among women in a community in Beijing.Methods:This study was a community-based prospective cohort. Participants who had transitioned through natural menopause, completed two or more depressive and anxiety symptoms evaluations, aged 35 to 64 years, and did not use hormone therapy were selected from the Peking Union Medical College Hospital aging longitudinal cohort of women in midlife to this analysis. The primary outcome variables were depressive and anxiety symptoms, assessed by hospital anxiety and depression scale (HADS). The generalized estimation equation was used in the statistical analysis.Results:Followed up from 2006 to 2014, 430 women and 2 533 HADS assessments were retained in the cohort. Depressive symptoms were more common than anxiety symptoms during all menopausal stages. The incidences of depressive and anxiety symptoms were 14.5% (19/191) and 3.1% (4/191) in the premenopausal -3 stage, respectively. The incidence increased in both menopausal transition and postmenopausal stage, with the highest incidence in the +1c stage [20.6% (155/751) and 8.8% (66/751), respectively]. However, these differences were not statistically significant (all P>0.05). Depressive symptoms were highest in the ≥60-<65 age group [20.8% (74/355)], and anxiety symptoms were highest in the ≥50-<55 age group [8.2% (62/754)]; but there were no statistical significances between different age groups and depressive and anxiety symptoms (all P>0.05). Multivariable analysis showed that high body mass index, low education status, and poor health status were independently associated with depressive symptoms (all P<0.05), and that poor health status, trouble falling asleep, and early awakening were independently associated with anxiety symptoms (all P<0.01). Conclusions:Depressive and anxiety symptoms are more common during menopausal transition and postmenopausal stage compared with reproductive stage. Depressive symptoms are more common than anxiety symptoms. To screen and assess depressive and anxiety symptoms in perimenopausal women is essential, especially for women with high risk factors.

Objective: To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC). Methods: Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups. Results: The rate of jugular vein malposition in the first try of catheterization was 19.1%(130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ²=3.917, P=0.047 8). Conclusion Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.

Objective To establish macrosomia risk prediction models based on a cohort study, and to analyze and compare the results. Methods The research subjects were the pregnant women of the Chinese Pregnant Women Cohort Study. The general demographic information and clinical data of pregnant women were collected through the questionnaire and physical examination, and the related outcomes of newborns were obtained by follow-up. The dataset was divided into training set and test set by a 3:1 ratio. Multivariate logistic regression analysis (LR) and random forest algorithm (RF) were used to construct macrosomia risk prediction models in the training set, and the models were verified in the test set. The prediction efficiency of the models was evaluated by Kappa and the area under the receiver operating characteristic curve (ROC). Results Among 5544 pregnant women, 397 women delivered macrosomia, and the incidence of macrosomia was 7.16%. Among the pregnant women who delivered macrosomia, 10.08% (40/397) were over 35 years old, 27.46% (109/397) were overweight or obese, and 60.96% (242/397) were excessive gestational weight gain (GWG). LR was used to establish a macrosomia risk prediction model to predict the test set, with the accuracy of 0.716, the sensitivity of 0.719, the specificity of 0.715, the Kappa value of 0.428, the Yoden index of 0.393, and the AUC of 0.796 (95% CI: 0.777-0.815). RF was used to construct a risk prediction model to predict the test set, with the accuracy of 0.819, the sensitivity of 0.782, the specificity of 0.846, the Kappa value of 0.629, the Yoden index of 0.439, and the AUC of 0.897 (95% CI: 0.883-0.910). Conclusion The prediction effect of the two models is satisfactory. The random forest algorithm has a higher predictive effect on the risk of macrosomia in this cohort, but the multivariate logistic regression analysis can directly explain the influencing factors of the macrosomia. It is suggested to integrate the advantages of the two models in the future, so that they can play a more important role in macrosomia risk prediction.

Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.
Humans ; Intraocular Pressure ; Glaucoma, Open-Angle/surgery* ; Incidence ; Treatment Outcome ; Risk Factors

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.