Peripherally induced movement disorders are a rare in clinical practice.This study presents a case of scar-related chorea in a patient who developed abnormal movements under a surgical scar within one year following spinal surgery.The symptoms worsened with emotional excitement and partially improved when lying flat or sleeping,with no significant impact from voluntary movements or distraction.Examination revealed involuntary movements of the muscles beneath the scar.Brain magnetic resonance imaging demonstrated no remarkable structural abnormalities.The patient exhibited limited response to oral pharmacotherapy but achieved marked symptomatic improvement following botulinum toxin type A injection.Therapeutic effects persisted for approximately three months without adverse events.The underlying pathophysiology may involve abnormal activation of mechanically sensitive ion channel Piezo1 within the scar region.Botulinum toxin type A primarily alleviates symptoms by inhibiting muscle contraction and may also act indirectly by reducing mechanical stress-induced activation of Piezo1 channels.

AIM:To investigate the ameliorative effect of interleukin 17A(IL-17A)gene knockout on airway remodeling in asthmatic mice and the specific mechanism involved.METHODS:In vivo,wild-type and IL-17A knockout(IL-17A-/-)mice were divided into 4 groups:control,IL-17A-/-,ovalbumin(OVA)and OVA+IL-17A-/-,with 6 mice in each group.Airway hyperresponsiveness was measured,pathological changes in the lungs were observed by staining tissue sections,the expression of the proteins related to airway remodeling,such as α-smooth muscle actin(α-SMA),matrix me-talloproteinase-9(MMP-9)and collagen type Ⅲ(Col Ⅲ),was detected by immunohistochemistry,and the level of p-p38 mitogen-activated protein kinase was detected by Western blot.In vitro,the regulatory effects of IL-17A on transforming growth factor β1(TGF-β1)-induced proliferation and migration of human airway smooth muscle(HASM)cells were as-sessed.Additionally,the level of p38 phosphorylation was detected,and the effect of a p38 inhibitor on airway remodel-ing-related protein expression was evaluated.RESULTS:Knockout of IL-17A significantly attenuated airway hyperrespon-siveness,airway inflammation and downregulated α-SMA(P<0.01),MMP-9(P<0.01)and Col Ⅲ(P<0.01)in asth-matic mice.In HASM cells,the proliferation and migration of these cells were inhibited following IL-17A intervention.Furthermore,a significant reduction in p38 phosphorylation was observed in both mouse lung tissue(P<0.01)and HASM cells(P<0.01).In addition,the gene expression of α-SMA(P<0.05),MMP-9(P<0.01)and Col Ⅲ(P<0.05)was re-duced upon further inhibition of p38 phosphorylation.CONCLUSION:Knockout of IL-17A attenuates airway remodeling in asthmatic mice by inhibiting the phosphorylation of p38 in airway smooth muscle.

Objective:To construct the symptom network of patients after hepatectomy, analyze the core symptoms and bridge symptoms in the network, and provide evidence for symptom management of patients after hepatectomy.Methods:A cross-sectional study was conducted to select the patients after hepatectomy in the Second Affiliated Hospital of Zhejiang University from January to July 2024 by convenient sampling method. M.D. Anderson Sympotom Inventory and the Symptom Module Specific to Primary Liver Cancer were used to investigate the composition of symptoms. Symptom clusters were extracted by exploratory factor analysis, and simultaneous network layout was constructed by R language to describe the relationship between symptoms and analyze the central indicators.Results:A total of 228 questionnaires were distributed and 220 valid questionnaires were collected. There were 174 males and 46 females, aged (60.31 ± 10.69) years old. The four symptom groups were neuroaffective symptom group, gastrointestinal symptom group, fatigue-related symptom group and pain-related symptom group, and the cumulative variance contribution rate was 54.592%.In the concurrent symptom network analysis, distress was the core symptom of node centrality index, and the top 3 bridge symptoms were pain (r bs=2.40), decreased appetite (r bs=2.10) and nausea (r bs=2.00), the correlation stability coefficients of network strength centrality, compact centrality and expected influence values were 0.595, 0.595 and 0.673, the symptom group network was stable. Conclusions:Distress is the core symptom of patients after hepatectomy, and pain, decreased appetite and nausea are bridge symptoms. It is recommended that medical staff construct intervention programs based on core symptoms and bridge symptoms, implement precise symptom management, and improve the outcome of symptom management of patients.

Peripherally induced movement disorders are a rare in clinical practice.This study presents a case of scar-related chorea in a patient who developed abnormal movements under a surgical scar within one year following spinal surgery.The symptoms worsened with emotional excitement and partially improved when lying flat or sleeping,with no significant impact from voluntary movements or distraction.Examination revealed involuntary movements of the muscles beneath the scar.Brain magnetic resonance imaging demonstrated no remarkable structural abnormalities.The patient exhibited limited response to oral pharmacotherapy but achieved marked symptomatic improvement following botulinum toxin type A injection.Therapeutic effects persisted for approximately three months without adverse events.The underlying pathophysiology may involve abnormal activation of mechanically sensitive ion channel Piezo1 within the scar region.Botulinum toxin type A primarily alleviates symptoms by inhibiting muscle contraction and may also act indirectly by reducing mechanical stress-induced activation of Piezo1 channels.

AIM:To investigate the ameliorative effect of interleukin 17A(IL-17A)gene knockout on airway remodeling in asthmatic mice and the specific mechanism involved.METHODS:In vivo,wild-type and IL-17A knockout(IL-17A-/-)mice were divided into 4 groups:control,IL-17A-/-,ovalbumin(OVA)and OVA+IL-17A-/-,with 6 mice in each group.Airway hyperresponsiveness was measured,pathological changes in the lungs were observed by staining tissue sections,the expression of the proteins related to airway remodeling,such as α-smooth muscle actin(α-SMA),matrix me-talloproteinase-9(MMP-9)and collagen type Ⅲ(Col Ⅲ),was detected by immunohistochemistry,and the level of p-p38 mitogen-activated protein kinase was detected by Western blot.In vitro,the regulatory effects of IL-17A on transforming growth factor β1(TGF-β1)-induced proliferation and migration of human airway smooth muscle(HASM)cells were as-sessed.Additionally,the level of p38 phosphorylation was detected,and the effect of a p38 inhibitor on airway remodel-ing-related protein expression was evaluated.RESULTS:Knockout of IL-17A significantly attenuated airway hyperrespon-siveness,airway inflammation and downregulated α-SMA(P<0.01),MMP-9(P<0.01)and Col Ⅲ(P<0.01)in asth-matic mice.In HASM cells,the proliferation and migration of these cells were inhibited following IL-17A intervention.Furthermore,a significant reduction in p38 phosphorylation was observed in both mouse lung tissue(P<0.01)and HASM cells(P<0.01).In addition,the gene expression of α-SMA(P<0.05),MMP-9(P<0.01)and Col Ⅲ(P<0.05)was re-duced upon further inhibition of p38 phosphorylation.CONCLUSION:Knockout of IL-17A attenuates airway remodeling in asthmatic mice by inhibiting the phosphorylation of p38 in airway smooth muscle.

Objective:To construct the symptom network of patients after hepatectomy, analyze the core symptoms and bridge symptoms in the network, and provide evidence for symptom management of patients after hepatectomy.Methods:A cross-sectional study was conducted to select the patients after hepatectomy in the Second Affiliated Hospital of Zhejiang University from January to July 2024 by convenient sampling method. M.D. Anderson Sympotom Inventory and the Symptom Module Specific to Primary Liver Cancer were used to investigate the composition of symptoms. Symptom clusters were extracted by exploratory factor analysis, and simultaneous network layout was constructed by R language to describe the relationship between symptoms and analyze the central indicators.Results:A total of 228 questionnaires were distributed and 220 valid questionnaires were collected. There were 174 males and 46 females, aged (60.31 ± 10.69) years old. The four symptom groups were neuroaffective symptom group, gastrointestinal symptom group, fatigue-related symptom group and pain-related symptom group, and the cumulative variance contribution rate was 54.592%.In the concurrent symptom network analysis, distress was the core symptom of node centrality index, and the top 3 bridge symptoms were pain (r bs=2.40), decreased appetite (r bs=2.10) and nausea (r bs=2.00), the correlation stability coefficients of network strength centrality, compact centrality and expected influence values were 0.595, 0.595 and 0.673, the symptom group network was stable. Conclusions:Distress is the core symptom of patients after hepatectomy, and pain, decreased appetite and nausea are bridge symptoms. It is recommended that medical staff construct intervention programs based on core symptoms and bridge symptoms, implement precise symptom management, and improve the outcome of symptom management of patients.

Objective:To explore the methods of fertility preservation in prepubertal patients with thalassemia major (TM), and to provide further data support for the fertility preservation in prepubertal patients with hematologic diseases.Methods:A case of a prepubertal patient with TM who required urgent hematopoietic stem cell transplantation (HSCT) receiving ovarian tissue cryopreservation (OTC) and in vitro maturation (IVM) to preserve fertility was reported, and the timing, the indications and strategies of fertility preservation in prepubertal girls with thalassemia were discussed in combination with related literature. Results:After ovarian tissue extraction, a total of 24 cumulus-oocyte complexes (COCs) and 11 ovarian cortex pieces were obtained through puncture and aspiration. After IVM for 48 h, a total of 9 M Ⅱ oocytes were frozen by vitrification. Conclusion:For the prepubertal girls facing HSCT urgently, cryopreserving ovarian tissue in combination with retrieving immature oocytes followed by IVM can preserve the fertility of patients to the greatest extent in a short period of time, as well as improve the therapeutic effect of fertility preservation in patients.

Objective:To explore the methods of fertility preservation in prepubertal patients with thalassemia major (TM), and to provide further data support for the fertility preservation in prepubertal patients with hematologic diseases.Methods:A case of a prepubertal patient with TM who required urgent hematopoietic stem cell transplantation (HSCT) receiving ovarian tissue cryopreservation (OTC) and in vitro maturation (IVM) to preserve fertility was reported, and the timing, the indications and strategies of fertility preservation in prepubertal girls with thalassemia were discussed in combination with related literature. Results:After ovarian tissue extraction, a total of 24 cumulus-oocyte complexes (COCs) and 11 ovarian cortex pieces were obtained through puncture and aspiration. After IVM for 48 h, a total of 9 M Ⅱ oocytes were frozen by vitrification. Conclusion:For the prepubertal girls facing HSCT urgently, cryopreserving ovarian tissue in combination with retrieving immature oocytes followed by IVM can preserve the fertility of patients to the greatest extent in a short period of time, as well as improve the therapeutic effect of fertility preservation in patients.

Objective To investigate the precipitating factors,clinical manifestations,magnetic resonance imaging (MRI) features and prognoses of children with posterior reversible encephalopathy syndrome (PRES) during the treatment of hematological diseases,and to improve the understanding of the diseases.Methods A total of 9 children with PRES,admitted to our hospital from January 2012 to December 2016,were chosen.The clinical data,including precipitating factors,clinical manifestations,MRI features and prognoses,were retrospectively analyzed.Results (1) Precipitating factors:6 patients with acute lymphoblastic leukemia occurred PRES during remission induction therapy (6/9,66.7％) and 3 occurred PRES during oral cyclosporine A after hematopoietic stem cell transplantation or autoimmune diseases (3/9,33.3％).(2) Clinical manifestations:all of them were acute onset,and the main symptoms were seizures (8/9,88.9％) and hypertension (7/9,77.8％);some patients suffered from headache,vomiting,visual disturbances,disturbance of consciousness and poor mental symptoms.(3) Features of head MR imaging:the lesions were mainly located in the parietal-occipital lobe,showing patchy long T1 and long T2 signals,and bilateral imperfect symmetry;FLAIR imaging showed high signal distinctly,and other parts of brain could also been involved in.(4) Prognoses:7 children (77.8％) recovered well,one (11.1％) left frequent seizures during 2 years of follow up,one (11.1％) left mental retardation.Conclusion Methotrexate,cyclosporine A and other agents are important incentives in children with PRES during the treatment of hematological diseases;seizures and hypertension are the main clinical manifestations;MR imaging is important in diagnosing the disease;and PRES is not completely reversible.

BACKGROUNDHemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Information on Chinese patients with HFS has not been well-characterized. This study aimed to evaluate the clinical feature and the treatment status of HFS across China.

METHODSA cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012. The investigated information was acquired from questionnaires and medical records including demographic data, site of onset, aggravating and relieving factors, treatments prior to the investigation, etc.

RESULTSIn this study, the ratio of male to female was 1.0:1.8, the mean age at onset was (46.6 ± 11.5) years. About 1.0% patients were bilaterally affected. The most often site of initial onset was the orbicularis oculi muscle. The most often affected sites were orbicularis oculi, zygomatic, and orbicularis oris muscles. Stress/anxiety and relaxation were most often aggravating and relieving factors, respectively; 2.3% patients had family history, 28.4% cases were combined with hypertension, and 1.4% patients were with trigeminal neuralgia. Botulinum toxin type A (BTX-A) injection was the most commonly used treatment, followed by acupuncture and oral medication. BTX-A maintained the highest repeat treatment ratio (68.7%), while 98.4% patients gave up acupuncture. The mean latency of BTX-A effect was (5.0 ± 4.7) days, the mean total duration of the effect was (19.5 ± 11.7) weeks, and 95.9% patients developed improvements no worse than moderate in both severity and function. The most common side effect was droopy mouth.

CONCLUSIONSThe onset age of HFS in China is earlier than that in western countries. The most often used two treatments are BTX-A injection and acupuncture, while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect.

Adult ; Botulinum Toxins, Type A ; therapeutic use ; China ; Cross-Sectional Studies ; Female ; Hemifacial Spasm ; diagnosis ; drug therapy ; Humans ; Male ; Middle Aged ; Neuromuscular Agents ; therapeutic use