BACKGROUND: Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare and life-threatening autoimmune disease of the central nervous system. So far, only ten cases of PERM have been reported in children worldwide, including the one in this study.
METHODS: We report a case of an 11-year-old boy with PERM with an initial presentation of abdominal pain, skin itching, dysuria, urinary retention, truncal and limb rigidity, spasms of the trunk and limbs during sleep, deep and peripheral sensory disturbances, and dysphagia. A tissue-based assay using peripheral blood was positive, demonstrated by fluorescent staining of mouse cerebellar sections. He showed gradual and persistent clinical improvement after immunotherapy with intravenous immunoglobulin, steroids, plasmapheresis and rituximab.
CONCLUSIONS: We summarized the diagnosis and treatment of a patient with PERM and performed a literature review of pediatric PERM to raise awareness among pediatric neurologists. A better comprehension of this disease is required to improve its early diagnosis, treatment, and prognosis.

A 21-year-old female patient presented to the Ophthalmology Department of Yunnan University Affiliated Hospital with complaints of \"bilateral blurred vision accompanied by diplopia for 3 weeks\". The patient\'s main symptoms included intermittent visual blurring, diplopia, headaches, and ocular discomfort. Ocular examination revealed intermittent exotropia, sometimes accompanied by esotropia or orthotropia, along with signs of pupillary constriction and pseudomyopia. Based on the clinical presentation, a diagnosis of intermittent exotropia complicated by spasm of the near reflex (SNR) was made. The patient underwent bilateral exotropia surgery, which corrected the ocular alignment and resolved the symptoms and signs of SNR postoperatively.
患者女性，21岁，因“双眼视物模糊伴重影3周”就诊于云南大学附属医院眼科。患者主要症状为间歇性视物模糊、复视、头痛眼胀。眼部检查显示患者存在间歇性外斜视，有时合并内斜视或正位，伴有瞳孔缩小和假性近视等体征。综合临床表现，诊断为间歇性外斜视并发近反射痉挛。患者接受了双眼外斜视手术，术后眼位得到纠正，未再出现近反射痉挛的症状和体征。.

Objective: To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy. Methods: A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T0 (baseline period), T1 (after anesthesia induction), T2 (colonoscopy over sigmoid colon), T3 (colonoscopy over the liver region), T4 (after the end of examination), and T5 (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert\'s four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. Results: The general data at baseline were not statistically different between the two groups (P>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C (P=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C (P<0.05), and intraoperative norepinephrine use was also lower than in the group C (P=0.034). Postoperative visual analog scale pain scores were lower in group G (P=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth (P=0.035). Conclusion: During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.
目的： 探讨格隆溴铵对患者接受无痛肠镜中肠痉挛和血流动力学的影响。 方法： 选择温州医科大学附属金华医院（金华市人民医院）2022年3月至2023年12月100例拟行无痛肠镜检查的患者作为研究对象，采用计算机随机数字法分为2组，试验组患者在麻醉前注射0.2 mg格隆溴铵，对照组患者在麻醉前注射等量生理盐水。两组中共有10例患者因研究方案中断而退出，每组各45例患者纳入分析。记录患者在T0（基线期）、T1（麻醉诱导后）、T2（肠镜过乙状结肠）、T3（肠镜过肝区）、T4（检查结束时）、T5（患者苏醒后）的心率、血压及术中去甲肾上腺素使用剂量，术中采用Likert四级评分法评估患者肠痉挛程度，术前术后采用数字模拟评分量表（NRS）用于评估疼痛情况，记录两组不良事件的发生率及进镜时间、腺瘤发现率和结肠镜并发症等。 结果： 两组患者基线期一般数据差异无统计学意义（均P>0.05）。试验组患者术中低血压、心动过缓发生率低于对照组患者（P<0.05），术中去甲肾上腺素使用剂量低于对照组患者（P=0.034）。试验组患者术中肠痉挛评分更低（P=0.028）。术后试验组患者NRS疼痛评分更低（P=0.047），但试验组患者术后发生口干比例更高（P=0.035）。两组进镜时间、腺瘤发现率差异无统计学意义，均未发生结肠镜并发症。 结论： 在无痛肠镜检查过程中，术前给予格隆溴铵可显著改善术中血流动力学波动，减少术中低血压和心动过缓的发生率，缓解肠道痉挛导致的术后疼痛，但有口干的风险。.

OBJECTIVE: With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model.
METHODS: Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors.
RESULTS: Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997).
CONCLUSIONS: Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

暂无摘要。

OBJECTIVE: To investigate the effect of electroacupuncture (EA) on Rho/Rho-associated coiled-coil-forming kinases (ROCK) signaling pathway of uterus tissue in rats with dysmenorrhea, so as to explore the underlying mechanism of EA treating primary dysmenorrhea (PD) and uterine smooth muscle spasm, and to observe whether there is a difference in the effect of meridian acupoints in Conception Vessel (CV) and Governer Vessel (GV).
METHODS: Sixty female SD rats were randomly divided into saline, model, CV, GV, and non-acupoint groups, with 12 rats in each group. The dysmenorrhea model was established by subcutaneous injection of estradiol diphenhydrate combined with intraperitoneal injection of oxytocin (OT). EA (2 Hz) was applied to \"Qihai\" (CV6) and \"Zhongji\" (CV3) for CV group, \"Mingmen\" (GV4) and \"Yaoshu\" (GV2) for GV group, \"non-acupoint 1\" and \"non-acupoint 3\" on the left side for non-acupoint group, and manual acupuncture was applied to \"Guanyuan\" (CV4) for CV group, \"Yaoyangguan\" (GV3) for GV group, \"non-acupoint 2\" on the left side for non-acupoint group. The treatment was conducted for 20 min each time, once daily for 10 days. The writhing score was evaluated. The smooth myoelectric signals of rats\' uterus in vivo were recorded by multi-channel physiological recorder. The uterine histopathological changes were observed by HE staining. The contents of prostaglandin F2α (PGF2α), OT and calcium ion (Ca2+) in uterine tissue of rats were detected by ELISA. The protein and mRNA expression levels of smooth muscle 22-α (SM22-α), RhoA and ROCKⅡ in uterine tissue were detected by Western blot and fluorescence quantitative PCR, respectively.
RESULTS: Compared with the saline group, the writhing score of rats in the model group was increased (P<0.01), the amplitude voltage of uterine smooth muscle in vivo was elevated (P<0.01), the contents of PGF2α, OT and Ca2+, the protein and mRNA expression of SM22-α, RhoA and ROCK Ⅱ in uterine tissue were all increased (P<0.01). Compared with the model and the non-acupoint groups, the writhing scores of the CV and the GV groups were decreased (P<0.01, P<0.05), the amplitude voltage of uterine smooth muscle was decreased (P<0.01), the contents of PGF2α, OT and Ca2+ in uterine tissue were decreased (P<0.01, P<0.05), and the protein expression and mRNA expression of SM22-α, RhoA and ROCKⅡ in uterine tissue were decreased (P<0.01, P<0.05). HE staining showed extensive exfoliation of uterine intima with severe edema and increased glandular secretion in the model group, which was alleviated in the CV and GV groups.
CONCLUSIONS: EA at acupoints of CV and GV can significantly reduce the writhing score, uterine smooth muscle amplitude voltage, pathological injury degree of uterus, and relieve spasm of uterine smooth muscle in dysmenorrhea rats, which may be related to its effect in regulating PGF2α and OT contents, inhibiting the Rho/ROCK signaling pathway, and reducing the SM22-α, RhoA, ROCKⅡ protein and mRNA expression, and Ca2+ content in uterine tissue.
目的: 基于Rho/Rho激酶（ROCK）信号通路，探讨电针任、督二脉经穴缓解子宫平滑肌痉挛、改善原发性痛经（PD）的作用机制并观察任、督二脉经穴作用是否存在差异。方法: SD雌性大鼠随机分为盐水组、模型组、任脉组、督脉组及非经非穴组，每组12只。采用苯甲酸雌二醇联合缩宫素（OT）建立类痛经大鼠模型。任脉组电针“气海”“中极”并针刺“关元”，督脉组电针“命门”“腰俞”并针刺“腰阳关”，非经非穴组电针左侧“非穴1”“非穴3”并针刺“非穴2”，每次20 min，1次/d，连续10 d。观察各组大鼠腹腔注射OT（2 U/只） 30 min内的扭体反应；多导生理记录仪记录大鼠在体子宫平滑肌电信号，HE染色法观察大鼠子宫组织的病理形态变化；ELISA法检测大鼠子宫组织前列腺素F2α（PGF2α）、OT、钙离子（Ca2+）的含量，Western blot及荧光定量PCR 法检测子宫组织平滑肌22-α（SM22-α）、RhoA、ROCKⅡ蛋白及mRNA表达水平。结果: 与盐水组比较，模型组大鼠扭体评分升高（P<0.01），在体子宫平滑肌振幅电压升高（P<0.01），HE染色可见子宫内膜大范围剥脱伴有严重的水肿，且腺体分泌增加，子宫组织中PGF2α、OT、Ca2+含量升高（P<0.01），子宫组织SM22-α、RhoA、ROCKⅡ的蛋白及mRNA的表达升高（P<0.01）。与模型组和非经非穴组比较，任脉组、督脉组扭体评分均降低（P<0.01，P<0.05），子宫平滑肌振幅电压降低（P<0.01），子宫内膜水肿程度较轻，腺体分泌减少，子宫组织中PGF2α、OT、Ca2+的含量降低（P<0.01，P<0.05），子宫组织SM22-α、RhoA、ROCKⅡ的蛋白及mRNA的表达降低（P<0.01，P<0.05）。结论: 电针任脉、督脉经穴均可降低类痛经大鼠的扭体评分、子宫平滑肌振幅电压、子宫病理损伤程度，缓解子宫平滑肌的痉挛。其机制可能与通过调控子宫组织PGF2α、OT含量，抑制子宫组织Rho/ROCK信号通路，降低SM22-α、RhoA、ROCKⅡ蛋白与mRNA表达及Ca2+含量有关。.

Objective: To investigate the feasibility and safety of distal radial artery approach in emergency percutaneous coronary intervention(PCI) of elderly ST-segment elevation myocardial infarction(STEMI) patients. Methods: This study is a cross-sectional study. Elderly patients with acute myocardial infarction who received emergency PCI at the Third Central Hospital of Tianjin from January 2020 to December 2022 were selected. They were divided into the distal radial artery group and the classic radial artery group based on the puncture location. The success rate, puncture time, surgical success rate, and surgical time of the two groups were observed; The incidence of complications in patients, including radial artery occlusion rate, radial artery spasm rate, local hematoma rate, aneurysm incidence rate were recorded. Results: There were 70 cases in the distal radial artery group, including 33 males (47.1%), aged (65.6±6.7) years old; There were 70 cases in the classic radial artery group, including 35 males (50.0%), aged (66.4±6.9) years old. There was no statistically significant difference in puncture success rate, puncture time, surgical success rate, and surgical time between the distal radial artery group and the classical radial artery group (P>0.05). The incidence of radial artery occlusion in the distal radial artery group was significantly lower than that in the classical radial artery group (1.4% vs. 8.6%, P=0.024). The postoperative compression time in the distal radial artery group was significantly shorter than that in the classical radial artery group ((291.6±10.5) min vs. (343.5±9.8) min, P=0.047). There was no statistically significant difference in the incidence of radial artery spasm, local hematoma, and aneurysm between the two groups (P>0.05). Conclusions: The distal radial artery approach has a lower radial artery occlusion rate, shorter compression time, and better safety. It can be used as a new approach for emergency PCI in elderly patients with STEMI for clinical application.
目的： 探讨老年ST段抬高型心肌梗死（STEMI）患者经远端桡动脉行急诊经皮冠状动脉介入治疗（PCI）的疗效及安全性。 方法： 该研究为横断面研究。选取2020年1月—2022年12月就诊于天津市第三中心医院并行急诊PCI的STEMI老年患者，根据穿刺位置不同分为远端桡动脉组和经典桡动脉组。记录2组穿刺成功率、穿刺时间、手术成功率及手术时间；记录患者并发症发生情况，包括桡动脉闭塞率、桡动脉痉挛率、局部血肿率、动脉瘤发生率等。 结果： 远端桡动脉组70例，其中男性33例（47.1%），年龄（65.6±6.7）岁；经典桡动脉组70例，男性35例（50.0%），年龄（66.4±6.9）岁。远端桡动脉组与经典桡动脉组穿刺成功率、穿刺时间、手术成功率及手术时间比较，差异无统计学意义（P>0.05）。远端桡动脉组桡动脉闭塞发生率低于经典桡动脉组，差异有统计学意义（1.4%比8.6%，P=0.024），远端桡动脉组术后压迫时间小于经典桡动脉组，差异有统计学意义［（291.6±10.5）min比（343.5±9.8）min，P=0.047］。2组桡动脉痉挛发生率、局部血肿发生率、动脉瘤发生率比较，差异无统计学意义（P>0.05）。 结论： 经远端桡动脉行急诊PCI的桡动脉闭塞率低，压迫时间短，安全性好，可以作为老年STEMI患者急诊PCI入径应用于临床。.

BACKGROUND: Literature on systemic envenomation caused by tarantula bites, particularly from the Theraphosidae family, is relatively scarce. This case report provides a formal description of the first known instance of systemic envenomation caused by the Socotra Island Blue Baboon Tarantula (Monocentropus balfouri).
METHODS: In this case, a 23-year-old employee of an exotic pet shop suffered from perioral paresthesia, generalized muscle cramps, and rhabdomyolysis because of a Monocentropus balfouri bite. His symptoms were successfully relieved with oral benzodiazepines. EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the potential for serious complications resulting from the bite of Monocentropus balfouri, a species gaining popularity among global exotic pet collectors.

BACKGROUND: Infantile epileptic spasms syndrome (IESS) would accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microwould accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microanatomic structure alteration.
METHODS: The IESS group had 21 males and 13 females (mean age: 17.7 ± 15.6 months), whereas the healthy controls group had 22 males and 10 females (mean age: 29.4 ± 18.7 months). High-resolution 3D T1WI was performed. Computational Anatomy Toolbox implemented in Statistical Parametric Mapping 12 was used to measure the gray matter and white matter volume, and the cortical thickness separately. Independent sample t test was used to assess between-group differences. IESS group was assessed using the Bayley Scales of Infant Development.
RESULTS: The IESS group showed a significantly decreased volume of gray matter in right middle temporal gyrus, inferior temporal gyrus, superior temporal gyrus, right fusiform, and bilateral precuneus (P < 0.001). There were no significant between-group differences with respect to white matter volume or cortical thickness (P > 0.001). The results of Bayley Scales of Infant Development showed that the Mental Development Index (MDI) and Psychomotor Development Index scores of children with IESS were almost concentrated in the range of <70. MDI score showed a positive correlation with gray matter reduction area in IESS group.
CONCLUSIONS: Children with IESS had impaired cognitive and delayed motor development. And the decreased gray matter in the right temporal lobe, fusiform, and bilateral precuneus could be the potential anatomic basis for impaired function, such as hearing, visual, and language.

To observe clinical effect of Tongdu Tiaoshen (promoting the circulation of the governor vessel and regulating the spirit) acupuncture combined with Bobath rehabilitation training in the treatment of upper limb spasm after stroke.
A total of 66 patients with upper limb spasm after stroke were randomly divided into an observation group (33 cases, 1 case dropped out) and a control group (33 cases, 2 cases dropped out). The control group received Bobath rehabilitation training. On the basis of the control group, the patients in the observation group received Tongdu Tiaoshen acupuncture at Baihui (GV 20), Fengfu (GV 16), Mingmen (GV 4), Yaoyangguan (GV 3) and bilateral C4-T1 Jiaji points (EX-B 2), etc. Both groups were treated once a day, with 6 days of continuous treatment followed by 1 day of rest, and totally 4 weeks were required. The modified Ashworth scale ( MAS ) grade, Fugl-Meyer assessment of upper extremity ( FMA-UE ) score, modified Barthel index ( MBI ) score, serum level of neurotransmitter (glutamic acid [Glu] and γ-aminobutyric acid [GABA]) were compared between the two groups before and after treatment, and the clinical effect was evaluated.
After treatment, MAS grade and serum level of Glu in the two groups were lower than those before treatment (P<0.05), and FMA-UE, MBI scores and serum level of GABA were higher than those before treatment (P<0.05). The MAS grade and serum level of Glu in the observation group were lower than those in the control group (P<0.05), and the FMA-UE, MBI scores and serum level of GABA were higher than those in the control group (P<0.05). The total effective rate of the observation group was 87.5% (28/32), which was better than 45.2% (14/31) of the control group (P<0.05).
The combination of Tongdu Tiaoshen acupuncture and Bobath rehabilitation training can effectively reduce the upper limb muscle tension level of patients with upper limb spasm after stroke, improve upper limb motor function, enhance self-care ability, and regulate serum level of neurotransmitter.
目的: 观察通督调神法针刺联合Bobath康复训练治疗卒中后上肢痉挛的临床疗效。方法: 将66例卒中后上肢痉挛患者随机分为观察组（33例，脱落1例）和对照组（33例，脱落2例）。对照组采用Bobath康复训练；观察组在对照组基础上予通督调神法针刺，穴取百会、风府、命门、腰阳关及双侧C4-T1夹脊穴等。两组均每日治疗1次，连续治疗6 d后休息1 d，共治疗4周。比较两组患者治疗前后改良Ashworth量表（MAS）评级、上肢Fugl-Meyer运动量表（FMA-UE）评分、改良Barthel指数（MBI）评分及血清神经递质谷氨酸（Glu）、γ-氨基丁酸（GABA）水平，并评定临床疗效。结果: 治疗后，两组患者MAS评级、血清Glu水平均较治疗前降低（P<0.05），FMA-UE、MBI评分及血清GABA水平均较治疗前升高（P<0.05）；观察组MAS评级、血清Glu水平低于对照组（P<0.05），FMA-UE、MBI评分及血清GABA水平高于对照组（P<0.05）。观察组总有效率为87.5%（28/32），高于对照组的45.2%（14/31，P<0.05）。结论: 通督调神法针刺联合Bobath康复训练可有效降低卒中后上肢痉挛患者的上肢肌张力，改善上肢运动功能，提升生活自理能力，调控血清神经递质水平。.