Patients with anxiety disorders exhibit complex and diverse clinical manifestations, with symptoms showing significant overlap with somatic diseases. In clinical practice, relying solely on psychiatric symptoms and prioritizing anxiety disorders as the diagnostic pathway, while neglecting systematic evaluation of somatic symptoms and comprehensive analysis of auxiliary examinations could lead to missed or incorrect diagnoses, which may delay the appropriate treatment. This diagnostic dilemma is particularly evident in patients who have visited multiple general hospitals without identifying a clear somatic etiology before ultimately presenting to psychiatric services. This paper reports a case of a middle-aged patient who remained undiagnosed after multiple general hospital visits. The patient developed symptoms including anxiety, sleep disorders, nausea, and dysphagia due to working in a locked-down area. After failing to obtain a clear diagnosis, the patient was admitted to psychiatry department. While anti-anxiety therapy alleviated some symptoms, the patient subsequently developed progressive anemia, which was unresponsive to blood supplementation. Multidisciplinary Team consultation and bone marrow aspiration excluded anemia related to psychiatric medications and confirmed a diagnosis of acute myeloid leukemia. The patient achieved a favorable prognosis following bone marrow transplantation. This case highlights the importance of systematically differentiating between somatic and psychiatric symptoms in clinical practice.

Objective:To observe the effects of shallow needling at Baihui(GV20)on neurological function and cerebral hemodynamics in patients with poststroke depression(PSD).Methods:A total of 90 PSD patients were divided into a Western medication group and a shallow needling group using the random number table,with 45 cases in each group.The Western medication group was treated with oral paroxetine tablets.The shallow needling group was treated with shallow needling at Baihui(GV20).The treatment course for both groups was 4 weeks.After treatment,the clinical efficacy was compared between the two groups.The scores of Hamilton depression scale-24(HAMD-24)and National Institutes of Health stroke scale(NIHSS),the cerebral hemodynamic changes,and the adverse reactions were observed.Results:After treatment,the total effective rate was 88.9%in the Western medication group and 84.4%in the shallow needling group;the difference between the two groups was not statistically significant(P>0.05).After treatment,the scores of HAMD-24 and NIHSS in both groups decreased(P<0.05).The difference in the HAMD-24 score between the two groups was not statistically significant(P>0.05).The NIHSS score in the shallow needling group was lower than that in the Western medication group,and the difference between the two groups was statistically significant(P<0.05).After treatment,there were no significant differences in the blood flow resistance index of the left middle cerebral artery(LMCA),right middle cerebral artery(RMCA),and basilar artery(BA)in the Western medication group compared to those before treatment.The blood flow resistance index of LMCA,RMCA,and BA in the shallow needling group was lower than that before treatment(P<0.05),and was significantly lower compared to the Western medication group(P<0.05).The incidence of adverse reactions in the shallow needling group was significantly lower than that in the Western medication group(P<0.05).Conclusion:The curative effect of shallow needling at Baihui(GV20)in the treatment of PSD is equivalent to that of oral paroxetine tablets.However,shallow needling at Baihui(GV20)is more effective in improving neurological function and cerebral perfusion,and the incidence of adverse reactions is lower.

Objective:To observe the effects of shallow needling at Baihui(GV20)on neurological function and cerebral hemodynamics in patients with poststroke depression(PSD).Methods:A total of 90 PSD patients were divided into a Western medication group and a shallow needling group using the random number table,with 45 cases in each group.The Western medication group was treated with oral paroxetine tablets.The shallow needling group was treated with shallow needling at Baihui(GV20).The treatment course for both groups was 4 weeks.After treatment,the clinical efficacy was compared between the two groups.The scores of Hamilton depression scale-24(HAMD-24)and National Institutes of Health stroke scale(NIHSS),the cerebral hemodynamic changes,and the adverse reactions were observed.Results:After treatment,the total effective rate was 88.9%in the Western medication group and 84.4%in the shallow needling group;the difference between the two groups was not statistically significant(P>0.05).After treatment,the scores of HAMD-24 and NIHSS in both groups decreased(P<0.05).The difference in the HAMD-24 score between the two groups was not statistically significant(P>0.05).The NIHSS score in the shallow needling group was lower than that in the Western medication group,and the difference between the two groups was statistically significant(P<0.05).After treatment,there were no significant differences in the blood flow resistance index of the left middle cerebral artery(LMCA),right middle cerebral artery(RMCA),and basilar artery(BA)in the Western medication group compared to those before treatment.The blood flow resistance index of LMCA,RMCA,and BA in the shallow needling group was lower than that before treatment(P<0.05),and was significantly lower compared to the Western medication group(P<0.05).The incidence of adverse reactions in the shallow needling group was significantly lower than that in the Western medication group(P<0.05).Conclusion:The curative effect of shallow needling at Baihui(GV20)in the treatment of PSD is equivalent to that of oral paroxetine tablets.However,shallow needling at Baihui(GV20)is more effective in improving neurological function and cerebral perfusion,and the incidence of adverse reactions is lower.

Patients with anxiety disorders exhibit complex and diverse clinical manifestations, with symptoms showing significant overlap with somatic diseases. In clinical practice, relying solely on psychiatric symptoms and prioritizing anxiety disorders as the diagnostic pathway, while neglecting systematic evaluation of somatic symptoms and comprehensive analysis of auxiliary examinations could lead to missed or incorrect diagnoses, which may delay the appropriate treatment. This diagnostic dilemma is particularly evident in patients who have visited multiple general hospitals without identifying a clear somatic etiology before ultimately presenting to psychiatric services. This paper reports a case of a middle-aged patient who remained undiagnosed after multiple general hospital visits. The patient developed symptoms including anxiety, sleep disorders, nausea, and dysphagia due to working in a locked-down area. After failing to obtain a clear diagnosis, the patient was admitted to psychiatry department. While anti-anxiety therapy alleviated some symptoms, the patient subsequently developed progressive anemia, which was unresponsive to blood supplementation. Multidisciplinary Team consultation and bone marrow aspiration excluded anemia related to psychiatric medications and confirmed a diagnosis of acute myeloid leukemia. The patient achieved a favorable prognosis following bone marrow transplantation. This case highlights the importance of systematically differentiating between somatic and psychiatric symptoms in clinical practice.

Objective:To investigate the effects of preoperative mammalian target of rapamycin(mTOR )inhibitor on partial nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex (TSC-RAML).Methods:A retrospective analysis was conducted on clinical data from 13 patients who were diagnosed with TSC-RAML and treated at Peking Union Medical College Hospital between August 2019 and July 2022. This cohort included 4 males and 9 females, with ages ranging from 22 to 66 years. All patients underwent partial nephrectomy, with 2 patients requiring two-stage surgeries due to bilateral RAMLs, resulting in a total of 15 surgeries being performed. Preoperative mTOR inhibitors, specifically everolimus (10 mg/d) or sirolimus (2 mg/d), were administered orally for at least 3 months prior to 7 of the surgeries. The effects of mTOR inhibitors on tumor size, tumor computed tomography attenuation value (CT value), and tumor CT enhancement were evaluated. The comparison of surgery-related clinical parameters was conducted between patients who received preoperative mTOR inhibitors and those who did not to assess the influences of mTOR inhibitors on surgery.Results:Compared to the baseline tumor, there was a significant reduction in tumor diameter after mTOR treatment [(6.4±3.1) cm vs. (8.7±3.9)cm], as well as in the CT value in both the unenhanced phase[(-18.63±48.73)HU vs. (-2.13±51.58)HU] and corticomedullary phase[(13.25±64.01)HU vs. (47.25±66.99)HU]. Additionally, tumor CT enhancement also decreased as compared with that before treatment [(31.88±18.20)HU vs. (49.38±20.63)HU]. Patients who received preoperative mTOR inhibitor showed a trend towards shorter operative time for removing per milliliter of tumor compared to those without preoperative mTOR inhibitor [1.06(0.18, 2.40) min/ml vs. 1.98(0.39, 5.03) min/ml] and so was the renal artery clamping time [0.17(0.03, 0.79) min/ml vs. 0.34(0.10, 1.71) min/ml]. Additionally, the amount of intraoperative bleeding for removing per milliliter of tumor was lower in patients with preoperative mTOR inhibitors compared to those without [0.72(0.19, 0.88) ml/ml vs. 1.69(0.59, 4.54) ml/ml].Conclusions:The administration of mTOR inhibitors before partial nephrectomy in patients with TSC-RAM have the potential to reduce tumor size and blood supply, as well as operative time, renal artery clamping time and intraoperative bleeding, which might contribute to surgery safety and preservation of renal function.

Objective To explore the effect of low molecular weight heparin calcium on coagulation function and platelet(PLT)in patients before and after anterolateral thigh flap transplantation.Methods Fifty patients with skin and soft tissue defects of hands and feet treated in Wuxi Ninth Hospital and Jiujiang No.1 People's Hospital from January to December 2022 were selected as the study objects.They were divided into observation group(26 cases)and control group(24 cases)according to random number table method.Patients in observation group received low molecular weight heparin calcium 12h before surgery,and continued to receive routine treatment once a day after surgery.Patients in control group began to use low molecular weight heparin calcium routinely 4h after surgery,once a day.The coagulation function and PLT before and after surgery were compared between two groups.Results There were no significant differences in incidences of vascular crisis and skin flap necrosis between two groups(P>0.05).Five patients in observation group received intraoperative or postoperative blood transfusion,which was excluded in further analysis.On first day and third day after surgery,fibrinogen(FIB)and PLT in two groups were significantly higher than those before surgery,and thrombin time(TT)was significantly shorter than that before surgery(P<0.05).On third day after surgery,activated partial thromboplastin time(APTT)and prothrombin time(PT)in observation group were significantly longer than those before surgery(P<0.05).Before surgery,first day and third day after surgery,there were no significant differences in FIB,APTT,PT and TT between two groups(P>0.05).On third day after surgery,PLT of observation group was significantly higher than that of control group(P<0.05).Conclusion Both FIB and PLT were higher after surgery regardless of the use of low molecular weight heparin calcium before and after surgery,and FIB and PLT were more significantly higher in patients treated 12h before surgery.

Objective:To explore the feasibility of deep learning technology for renal artery recognition in retroperitoneal laparoscopic renal surgery videos.Methods:From January 2020 to July 2021, the video data of 87 cases of laparoscopic retroperitoneal nephrectomy, including radical nephrectomy, partial nephrectomy, and hemiurorectomy, were retrospectively analyzed. Two urological surgeons screened video clips containing renal arteries. After frame extraction, annotation, review, and proofreading, the labeled targets were divided into training set and test set by the random number table in a ratio of 4∶1. The training set was used to train the neural network model. The test set was used to test the ability of the neural network to identify the renal artery in scenes with different difficulties, which was uniformly transmitted to the YOLOv3 convolutional neural network model for training. According to the opinion of two senior doctors, the test set was divided into high, medium, and low discrimination of renal artery and surrounding tissue. High identification means a clean renal artery and a large exposed area. For middle recognition degree, the renal artery had a certain degree of blood immersion, and the exposed area was medium. Low identification means that the exposed area of the renal artery was small, often located at the edge of the lens, and the blood immersion was severe, which may lead to lens blurring. In the surgical video, the annotator annotated the renal artery truth box frame by frame. After normalization and preprocessing, all images were input into the neural network model for training. The neural network output the renal artery prediction box, and if the overlap ratio (IOU) with the true value box was higher than the set threshold, it was judged that the prediction was correct. The neural network test results of the test set were recorded, and the sensitivity and accuracy were calculated according to IOU.Results:In the training set, 1 149 targets of 13 videos had high recognition degree, 1 891 targets of 17 videos had medium recognition degree, and 349 targets of 18 videos had low recognition degree. In the test set, 267 targets in 9 videos had high recognition degree, 519 targets in 11 videos had medium recognition degree, and 349 targets in 18 videos had low recognition degree. When the IOU threshold was 0.1, the sensitivity and accuracy were 52.78% and 82.50%, respectively. When the IOU threshold was 0.5, the sensitivity and accuracy were 37.80% and 59.10%, respectively. When the IOU threshold was 0.1, the sensitivity and accuracy of high, medium and low recognition groups were 89.14% and 87.82%, 45.86% and 78.03%, 32.95%, and 76.67%, respectively. The frame rate of the YOLOv3 algorithm in real-time surgery video was ≥15 frames/second. The false detection rate and missed detection rate of neural network for renal artery identification in laparoscopic renal surgery video were 47.22% and 17.49%, respectively (IOU=0.1). The leading causes of false detection were similar tissue and reflective light. The main reasons for missed detection were image blurring, blood dipping, dark light, fascia interference, or instrument occlusion, etc.Conclusions:Deep learning-based renal artery recognition technology is feasible. It may assist the surgeon in quickly identifying and protecting the renal artery during the operation and improving the safety of surgery.

BACKGROUNDOveractive bladder (OAB) is a series of symptoms with high prevalence in elderly people. This study was conducted using the overactive bladder symptom score (OABSS) to evaluate the efficacy of solifenacin succinate for the treatment of OAB.

METHODSThis was a prospective, multicenter, single-arm, 12-week study that enrolled 241 OAB patients. The patients received 5-10 mg/day solifenacin. Changes in OABSS, symptoms from voiding diary, perception of bladder condition (PPBC) score, international prostate symptom score (IPSS) and quality of life (QOL) were evaluated at weeks 0, 4, and 12. The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.

RESULTSAt baseline, the mean OABSS for all patients was 9.41 ± 2.40, and was reduced significantly at week 12 (-3.76 points; 61.21%, P < 0.0001). The OABSS subscore, PPBC score, IPSS, and QOL were also significantly reduced during the study (P < 0.0001). The overall incidence of adverse events was 19.91% (44 cases). The gastrointestinal system was the most commonly affected (11.31%). Around 5.88% of the cases had adverse events related to the genitourinary system. There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.

CONCLUSIONSWe showed that solifenacin was clinically effective for relieving OAB symptoms, considering the balance between efficacy, patients' well-being, and tolerability. OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Muscarinic Antagonists ; therapeutic use ; Prospective Studies ; Quality of Life ; Quinuclidines ; therapeutic use ; Solifenacin Succinate ; Tetrahydroisoquinolines ; therapeutic use ; Treatment Outcome ; Urinary Bladder, Overactive ; drug therapy