简介：AbstractPurpose:Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI).Methods:Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.Results:The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ2 = 7.359, p = 0.007). The total scores of the T-DSM-IVS (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058).Conclusion:ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.

简介：AbstractIntroduction:Eruptive cutaneous collagenoma is non familial connective tissue nevi of unknown etiology presented with an abrupt onset. To date, the literatures on eruptive cutaneous collagenoma are extremely rare in china.Here, we report two women with eruptive cutaneous collagenoma.Case present:Two women presented with multiple asymptomatic, skin-colored papules and nodules on the trunk and extremities with no systemic involvement. Histopathology revealed dense, coarse collagen fibers by hematoxylin-esoin stain and decreased, fragmented elastic fibers by Elastic stain compared with the normal skin. Basing on these findings, the diagnosis of eruptive cutaneous collagenoma was made. No specific treatment was given.Discussion:Eruptive cutaneous collagenoma is a very rare dermatosis that is often misdiagnosed as other connective tissue nevi. The pathogenesis is unclear, and also no efficient treatment is available. It is usually diagnosed based on clinical and histopathological findings.Conclusion:The present cases are relatively rare type of eruptive cutaneous collagenoma that provide more experience for clinician, and may be helpful for them to make correct diagnosis for suspicious cases.

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简介：AbstractBackground:The diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy.Methods:The present study was a cross-sectional study, and the data were collected through an anonymous, Internet-based survey platform between October 2018 and October 2019 from 250 participants aged 22-65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale.Result:Among the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4) and 46.4% (116/250) had anxiety symptoms (7-item Generalized Anxiety Disorder [GAD-7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182-0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130-0.614), positive coping (OR = 0.947, 95% CI = 0.903-0.992), and negative coping (OR = 1.287, 95% CI = 1.179-1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207-0.835) and negative coping (OR = 1.155, 95% CI = 1.087-1.228).Conclusions:The present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.

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简介：AbstractHuman-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.

简介：摘要BACKGROUNDCoronavirus disease 2019 (COVID-19) caused by a new Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a global pandemic. Gathered clinicopathological evidence in COVID-19 patients shows that alveoli injuries and interstitial changes are the major mechanisms of impaired O2/CO2 exchange. Few rehabilitation exercises concerning COVID-19 patients were reported. Here, we present a modified version of rehabilitation exercises based on the underlying mechanism of the disease to mild cases of COVID-19. These exercises aimed to improve the pulmonary function of patients and ease the expectoration process. Additionally, an essential branch of Traditional Chinese Medicine (TCM) named acupressure was integrated into the exercises to facilitate the recovery and maintenance of pulmonary function.METHODSFrom March 4, 2020 to May 5, 2020, a total of 60 COVID-19 patients who completed the full course of MRE were enrolled in this observational study. The diagnostic and classification criteria were based on the 7th edition of Diagnosis and Treatment Guideline of COVID-19 published by the National Health Commission of the People′s Republic of China. We prospectively gathered patients′ reported outcomes concerning respiration-related symptoms at four different time points, including: (I) at admission; (II) at the time of hospital discharge; (III) two weeks after discharge; (IV) four weeks after discharge. The reported respiratory symptoms included dry cough, productive cough, difficulty in expectoration, and dyspnea.RESULTSIn total, 60 confirmed mild COVID-19 cases were enrolled with a median age of 54 years old. The baseline prevalence for dry cough, productive cough, difficulty in expectoration, and dyspnea were 41.7%, 43.3%, 35.0%, and 50.0%, respectively. The pronounced decline in symptom prevalence was recorded over time. Interestingly, four weeks after discharge, we noticed a lower remission rate in productive cough and difficulty in expectoration.CONCLUSIONThe modified rehabilitation exercises were retrieved from the Eight-Section Brocade, and are specifically designed for rehabilitation of COVID-19 patients at home or health facilities. Based on current findings on pronouncedly improved remission rate in respiratory symptoms, we recommend the MRE as suitable rehabilitation exercise to smooth respiration and ease the expectoration process in mild COVID-19 cases.

简介：AbstractBackground:As a congenital malformation that results in infertility and an inability to have vaginal intercourse, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome places a considerable psychological burden on patients, which results in anxiety symptoms. However, only single case studies or a few small to medium-sized cross-sectional studies were identified to focus on anxiety symptoms in MRKH patients. Thus, the aim of this study was to explore the status of anxiety symptoms and the related factors in patients with MRKH syndrome.Methods:This cross-sectional study involving 141 patients with MRKH syndrome and 178 healthy women was conducted from January 2018 to December 2018. All participants were required to complete a demographic questionnaire and the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese, and Chinese Version of the Female Sexual Function Index. The main outcome was the anxiety symptoms measured by the GAD-7. Main outcome was compared between the MRKH syndrome group and the healthy control group. Then, we explored the related factors by comparing patients with and without anxiety symptoms.Results:Of the respondents, 24.1% experienced moderate to severe anxiety symptoms. Patients with MRKH syndrome manifested more severe anxiety symptoms than healthy women. Negative self-evaluation of femininity (odds ratio [OR] 2.706, 95% confidence interval [CI] 1.010-7.247), neurotic personality traits (OR 1.100, 95% CI 1.029-1.175), and coexisting depressive symptoms (OR 4.422, 95% CI 1.498-13.049) were more prevalent in anxious patients.Conclusion:The findings stress the importance of anxiety symptom screening in MRKH patients and identify patients at risk of anxiety symptoms, providing a possible basis for future intervention.

简介：AbstractBackground:The 2019 novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyze the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were retrospectively collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens.Results:None of the 137 patients (61 males, 76 females, aged 20-83 years, median age 57 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their conditions. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.

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简介：AbstractImportance:Several studies conducted worldwide (mostly in Western countries) highlighted the negative effects of problematic internet use, particularly among adolescents aged 12 to 17, including depression, impulsivity, aggression, and social fear and avoidance. In Lebanon, literature on the prevalence and impact of problematic internet use among adolescents is limited.Objective:This study aim was to study the association between problematic internet use and depression, impulsivity, anger, aggression and social phobia among Lebanese adolescents.Methods:A cross-sectional study was performed on 1103 young adolescents (14-17 years), recruited from October 2017 till April 2018. The Internet Addiction Test (IAT) was used to evaluate the level of problematic internet use. Data were analyzed using the MANCOVA analysis. The main independent variable of interest was the IAT, while the dependent variables included the psychological scales.Results:The multivariate analysis taking the psychological scales as the dependent variables and the problematic internet use (IAT score) as an independent variable, showed that problematic internet use was associated with higher depression, impulsivity, aggression, anger, hostility and social anxiety.Interpretation:Problematic internet use has become an important health issue that should not be overlooked, particularly because of the increased use of the internet by adolescents. Educational programs on early exposure to the internet should be developed.

简介：AbstractPlacenta percreta with bladder bleeding can occur during gestation or postpartum, posing a great threat to both mother and fetus. But it is rare and lacks standard management strategies. We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1st, 2011 and December 31th, 2020 in The First Affiliated Hospital of Zhengzhou University. Clinical information, including age, gravidity and parity, ultrasound and magnetic resonance imaging manifestations, onset gestational age, bladder bleeding volume, clinical manifestations under bleeding, diagnosis, hemostatic methods, hospital stay, treatment cost, and prognosis, are presented. Two cases had bladder bleeding during the second trimester, respectively on the 22+3 and 23+5 weeks. Pregnancy was terminated timely. The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity. All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels, and one of them received electrocoagulation hemostasis under cystoscopy, but failed. They all had favorable clinical outcomes and had no long-term complications. The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good. The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy. Timely termination of pregnancy is recommended when such a condition develops during gestation. Diagnosis of bladder bleeding is relatively easy, for it is characterized by fast speed and large volume, with concomitant distension of the lower abdomen, blood discharge from the urethral orifice, or the indwelling catheter. Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta, while electrocoagulation hemostasis under cystoscopy must be applied with great caution. For the pregnant women with a high risk of placenta percreta, timely and accurate diagnosis should be achieved during the gestational age, and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.

简介：AbstractBackground:To explore central nervous system (CNS) involvement in this disease, from the perspectives of diagnosis, treatment, and misdiagnosisMethods:Twenty-eight patients with CNS echinococcosis were included in this retrospective study, including 18 males (64.3%) and 10 (35.7%) females. The average age of all the patients were 23.5 years (ranged 4-60 years). Twenty-three (23) patients (82.1%) received the first surgical resection in our hospital. Five (5) patients (17.9%) gave up surgical treatment for multiple-organ hydatidosis and previous surgery history at other hospitals, and albendazole was applied for a long-term (3-6 months) adjunct therapy for the 5 patients. The average follow-up time was 8 years.Results:For the 28 patients, 23 cases received surgical treatments, and the diagnosis was confirmed by pathological examinations. The diagnosis of 4 cases of brain echinococcosis and 2 cases of spinal cord echinococcosis could not be confirmed, resulting in a misdiagnosis rate of 21.4% (6/28). For the pathological examination, a total of 17 cases were infected with Echinococcus granulosus (including 2 cases of spinal cord echinococcosis), and 6 cases were infected with Echinococcus alveolaris.Conclusion:The diagnosis should be specifically considered in endemic regions. The clinical features of CNS hydatidosis were intracranial space-occupying lesions. For the treatment, the surgical removal of cysts should be necessary. In addition, the adjuvant therapy with drug and intraoperative prophylaxis is also suggested. The misdiagnosis may have resulted from atypical clinical features and radiographic manifestations, as well as the accuracy of hydatid immunologic test.

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简介：AbstractBackground:Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors.Methods:Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients’ age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study.Results:The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years’ success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt.Conclusions:Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.

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简介：AbstractPurpose:The pathogenesis of gastrinomas is largely unknown, and there is a lack of reliable genetic determinants that are useful to distinguish malignant and benign forms of this tumor or predict the prognosis of patients with this disease. Loss of heterozygosity (LOH) on chromosome 3p is reported to occur in pancreatic neuroendocrine tumors (PNETs) as well as in non-PNETs and its presence is reported to correlate with tumor prognosis in non-endocrine tumors. However, little data are available from prospective studies on gastrinomas.Experimental design:We assessed occurrence of 3p LOH in 24 gastrinomas and correlated its presence with tumor biological behavior and other clinicopathological features of gastrinomas.Results:Either 3p LOH or microsatellite instability involving 3p occurred in 11 of 24 tumors (46%). Seven (29%) gastrinomas had 3p LOH. Of the 7 gastrinomas with 3p LOH, 5 (71%) had 3p12 LOH with the marker D3S2406, which was the shortest region of highest overlap (SRO). Chromosome 3p LOH was not associated with aggressive biological behavior of gastrinomas or with poor prognosis of patients with gastrinoma. Similarly, 3p12 LOH (SRO) was not correlated with aggressive growth of tumors and/or liver metastases.Conclusion:Gastrinomas have a relative high frequency of 3p12 LOH suggesting this area may harbor putative tumor suppressor gene(s), which may play a role in the tumorigenesis, but not aggressiveness, of a subset of these tumors.

简介：AbstractBackground:The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF.Methods:This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI.Results:The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had <1/5, 1/5-1/3, and >1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase.Conclusion:Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

简介：AbstractTwo cases of type II odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type II odontoid fracture and a 42-year-old man with fracture end hardened type II odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior C1-C2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type II odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type II odontoid fractures.

简介：AbstractBackground:Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain.Methods:A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P < 0.05 was considered a statistically significant difference.Results:One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants.Conclusions:Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.