Beyond the Usual Suspects (Aortic Dissection in Patients with Chronic Kidney Disease)

A comprehensive differential diagnosis is essential in the emergency department, even when patient presentations are atypical. Timely recognition of life-threatening conditions, such as aortic dissection, hinges on this critical diagnostic approach.

The Impact of Sun Radiation on the Thermal Comfort in Highly Glazed Buildings Equipped with Floor Heating Systems

Occupants of highly glazed buildings often suffer from thermal discomfort during the mid-seasons when no shadings are used in such buildings,especially when inertial heating systems are used.The present study is devoted to evaluating the impact of long solar beam exposure on the internal thermal discomfort in glazed spaces when heating is implemented through a floor system.A comprehensive experimental study is carried out using an experimental bi-climatic chamber which is fully monitored and controlled,allowing realistic simulations of the dynamic movement of the sun patch on a heated slab.The findings show that a period of discomfort as long as 8 h can occur,and persist far after the sunbeam exposure stops.During this period,the heating slab’s surface temperature,considered from an average point of view,can attain 34°C while the indoor temperature reaches 26°C.Simulations conducted using a previously developed model display a good fit with the measurements.

Predictors of Catheter-related Bladder Discomfort after Urological Surgery

The aim of this study was to figure out the predictors of early postoperative catheter-related bladder discomfort（CRBD） after urological surgery. We designed a prospective observational study in our hospital. Consecutive adult patients undergoing surgery under general anaesthesia or epidural anaesthesia necessitating urinary catheterization were included during a 3-month period. severity of bladder discomfort was assessed on a 4-point scale：（1） no pain,（2） mild pain（revealed only by interviewing the patient）,（3） moderate（a spontaneous complaint by the patient of a burning sensation in the urethra and/or an urge to urinate and/or sensation of urethral foreign body without any emotional agitation） and（4） severe discomfort（agitation, loud complaints and attempt to remove the bladder catheter associated with a burning sensation in the urethra）. Predictors of CRBD were identified by univariate and multivariate analysis. Totally, 116 patients were included, of which 84.5% had CRBD（mild CRBD： 40.5%; moderate or severe CRBD： 44.0%） at day 1, while 31.9% developed CRBD（mild CRBD： 29.3%; moderate or severe CRBD： 2.6%） at day 3. We evaluated 9 potential forecast factors of CRBD, and univariate Chi-square test showed male gender [OR=2.4, 95%CI（1.1–5.6）, P〈0.05], abdominal open surgery compared with transurethral surgery [OR=0.3, 95%CI（0.1–0.6）, P〈0.05], abdominal surgery compared with laparoscopic surgery [OR=3.3, 95%CI（1.2–8.9）, P〈0.05] and history of catheterization [OR=0.5, 95%CI（0.2–0.9）, P〈0.05] were independent predictors of moderate or severe CRBD in the patients after surgery. While multivariate logistic regression analysis showed that the abdominal open surgery [EXP（B）=3.074, 95%CI（1.3–7.4）, P〈0.05] and the history of catheterization [EXP（B）=2.458, 95%CI（1.1–5.9）, P〈0.05] might contribute more to the occurrence of moderate or severe CRBD. In conclusion, this observational study identified that the type of surgery and the history of catheterization might be predictive factors of moderate and severe CRBD after urological surgery.

Objective Evaluation Method of Steering Comfort Based on Movement Quality Evaluation of Driver Steering Maneuver

The existing research of steering comfort mainly focuses on the subjective evaluation,aiming at designing and optimizing the steering system.In the development of steering system,especially the evaluation of steering comfort,the objective evaluation methods considered the kinematic characteristics of driver steering maneuver are not proposed,which means that the objective evaluation of steering cannot be conducted with the evaluation of kinematic characteristics of driver in steering maneuver.In order to propose the objective evaluation methods of steering comfort,the evaluation of steering movement quality of driver is developed on the basis of the study of the kinematic characteristics of steering maneuver.First,the steering motion trajectories of the driver in both comfortable and certain extreme uncomfortable operation conditions are detected using the Vicon motion capture system.The operation conditions are under the restrictions of the vertical height and horizontal distance between steering wheel center and the H-point of driver,and the steering resisting torque else.Next,the movement quality evaluation of driver steering maneuver is assessed using twelve kinds of evaluation indices based on the kinematic analyses of the steering motion trajectories to propose an objective evaluation method.Finally,an integrated discomfort index of steering maneuver is proposed on the basis of the regression analysis of subjective evaluation rating and the movement quality evaluation indices,including the Jerk,Discomfort and Joint Torque indices.The test results show that the proposed integrated discomfort index gives a good fitting with the subjective evaluation of discomfort,which means it can be used to evaluate or predict the discomfort level of steering maneuver.This paper proposes an objective evaluation method of steering comfort based on the movement quality evaluation of driver steering maneuver.

YISHOU JIANGZHI (DE-BLOOD-LIPID) TABLETS IN THE TREATMENT OF HYPERLIPEMIA

The Yishoujiangzhi (de-blood-lipid) tablets (composed of Radix Polygori Multiflori, Rhizoma Polygonati, Fructus Lycii, Crataegus Pinnatifida and Cassia Tora) were used in the treatment of 130 cases of hyperlipemia, achieving an effective rate of 87.0% in lowering serum cholesterol and 80.8% in lowering triglyceride.

Colonoscopy,pain and fears:Is it an indissoluble trinomial?

Colonoscopy is the reference method in the secondary prevention,diagnosis and,in some cases,treatment of colorectal cancer.It can often cause pain associated with embarrassment,anxiety,and physical and emotional discomfort.Pain intensity is influenced by a lot of factors,and there is a strict relationship among pain,pain perception,and mind.Several methods can be used to break the trinomial colonoscopy,pain and fear.Sedoanalgesia is recommended by several guidelines.If no sedation is offered,the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort.Other non-pharmacologic methods such as acupuncture,music,and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia.Furthermore,new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes,or the use of carbon dioxide instead of air for colon insufflation,can reduce the pain caused by colonoscopy.In the future,technical improvements such as wireless capsules or robotic probes,will probably enable to overcome the present concept of colonoscopy,avoiding the use of traditional endoscopes.However,at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified.There are several methods to reduce pain and anxiety and to break the trinomial colonoscopy,pain and fear.We must use them.

Detection and Attribution of Changes in Thermal Discomfort over China during 1961-2014 and Future Projections

In this study, variation in the frequency of thermal discomfort days over China during the period of 1961-2014,including heat discomfort days(HDDs) and cold discomfort days(CDDs), and the influence of external forcings on it are discussed. HDDs are the conditions of overheating and overhumidity(represented by humidity index), and CDDs reflect the dangers from cold temperatures and winds(represented by wind chill index). Observations show significant increases(decreases) in the frequency of HDDs(CDDs) over China from 1961 to 2014, with clear regional distinctions. The historical ALL and greenhouse gas(GHG) simulations can sufficiently reproduce the spatial patterns of the observational trend in the frequency of both HDDs and CDDs over China. Further, the impacts of GHG and anthropogenic forcings on the HDDs(CDDs) are detectable over China, except for central and eastern China, based on the optimal fingerprinting method. GHG forcing is identified as a dominant factor for the observational changes in the frequency of HDDs over southern China;GHG and anthropogenic forcings have dominant effects on the variation in the frequency of CDDs over southwestern China. Although trends in the frequency of HDDs and CDDs in historical aerosol forcing simulations seems to be opposite to observations, an aerosol signal fails to be detected. Natural forcing contributes to the observational variation in the frequency of HDDs over northwestern China. In addition, the future projections of thermal discomfort days indicate that Chinese residents will face more threats of heat discomfort and fewer threats of cold discomfort in the future under global warming.

Role of artificial tears with and without hyaluronic acid in controlling ocular discomfort following PRK: a randomized clinical trial

AIM:To compare outcomes of applying preservative free artificial tears(PFAT)with and without hyaluronic acid(HA)in early postoperative course following photorefractive keratectomy(PRK).METHODS:In this triple-blinded randomized clinical trial,PRK procedure was performed on both eyes of 230 patients.Following PRK,patients were divided into three groups:the HA^(+)group,44 patients PFAT containing HA;the HA-group,71 patients PFAT without HA were administered 5 times per day(every 4 h);the third group,115 patients received no PFAT before lens removal.On the 1st and 4th postoperative day,Visual Analogue Score(VAS)was utilized to evaluate patient’s level of pain.Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10(0=no complaint;10=most severe complaint experienced).RESULTS:In eyes receiving PFAT with or without HA(Drop group),mean scores for epiphora,foreign body sensation,and blurred vision on the 1st postoperative day were statistically lower(P<0.05).Filamentous keratitis(FK)was detected in 11(4.7%)eyes,and recurrent corneal erosion(RCE)was observed in 5(2.1%)eyes.In the control group,FK was noted in 16(6.9%)eyes while 13(5.6%)eyes had RCE and 5(2.1%)eyes had corneal haze.The rate of complications was statistically lower in Drop group(P=0.009).However,the aforementioned scores were not statically different between HA^(+)and HA-group one and two(P=0.29).CONCLUSION:Following PRK,applying PFAT with and without HA yields faster visual recovery,decreases postoperative ocular discomfor t and haze formation;however there is no additive effect for HA.

Ultrathin endoscope flexibility can predict discomfort associated with unsedated transnasal esophagogastroduodenoscopy

AIM: To evaluate the effects of choice of insertion route and ultrathin endoscope types. METHODS: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endo-scope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0maximum discomfort 10). RESULTS: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion. CONCLUSION: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.

Does music reduce anxiety and discomfort during flexible sigmoidoscopy?A systematic review and meta-analysis

To investigate the role of music in reducing anxiety and discomfort during flexible sigmoidoscopy. METHODSA systematic review of all comparative studies up to November 2016, without language restriction that were identified from MEDLINE and the Cochrane Controlled Trials Register (1960-2016), and EMBASE (1991-2016). Further searches were performed using the bibliographies of articles and abstracts from major conferences such as the ESCP, NCRI, ASGBI and ASCRS. MeSH and text word terms used included “sigmoidoscopy”, “music” and “endoscopy” and “anxiety”. All comparative studies reporting on the effect of music on anxiety or pain during flexible sigmoidoscopy, in adults, were included. Outcome data was extracted by 2 authors independently using outcome measures defined a priori. Quality assessment was performed. RESULTSA total of 4 articles published between 1994 and 2010, fulfilled the selection criteria. Data were extracted and analysed using OpenMetaAnalyst. Patients who listened to music during their flexible sigmoidoscopy had less anxiety compared to control groups [Random effects; SMD: 0.851 (0.467, 1.235), S.E = 0.196, P < 0.001]. There was no statistically significant heterogeneity (Q = 0.085, df = 1, P = 0.77, I2 = 0). Patients who listened to music during their flexible sigmoidoscopy had less pain compared to those who did not, but this difference did not reach statistical significance [Random effects; SMD: 0.345 (-0.014, 0.705), S.E = 0.183, P = 0.06]. Patients who listened to music during their flexible sigmoidoscopy felt it was a useful intervention, compared to those who did not (P < 0.001). There was no statistically significant heterogeneity (P = 0.528, I2 = 0). CONCLUSIONMusic appeared to benefit patients undergoing flexible sigmoidoscopies in relation to anxiety and was deemed a helpful intervention. Pain may also be reduced however further investigation is required to ascertain this.

Automated Patient Discomfort Detection Using Deep Learning

The Internet of Things(IoT)has been transformed almost all fields of life,but its impact on the healthcare sector has been notable.Various IoTbased sensors are used in the healthcare sector and offer quality and safe care to patients.This work presents a deep learning-based automated patient discomfort detection system in which patients’discomfort is non-invasively detected.To do this,the overhead view patients’data set has been recorded.For testing and evaluation purposes,we investigate the power of deep learning by choosing a Convolution Neural Network(CNN)based model.The model uses confidence maps and detects 18 different key points at various locations of the body of the patient.Applying association rules and part affinity fields,the detected key points are later converted into six main body organs.Furthermore,the distance of subsequent key points is measured using coordinates information.Finally,distance and the time-based threshold are used for the classification of movements associated with discomfort or normal conditions.The accuracy of the proposed system is assessed on various test sequences.The experimental outcomes reveal the worth of the proposed system’by obtaining a True Positive Rate of 98%with a 2%False Positive Rate.

Sclerosing angiomatoid nodular transformation of the spleen, a rare cause for splenectomy: Two case reports

BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare benign disease of the spleen with unknown origin.Clinical symptoms are inhomogeneous,and suspicious splenic lesion often found incidentally,leading to splenectomy,as malignancy cannot securely be ruled out.Diagnosis is made histologically after resection.CASE SUMMARY Two cases of German,white,non-smoking,and non-drinking patients of normal weight are presented.The first one is a 26-year-old man without medical history who was exhibiting an undesired weight loss of 10 kg and recurring vomiting for about 18 mo.The second one is a 65-year-old woman with hypertension who had previously undergone gynecological surgery,suffering from a lasting feeling of abdominal fullness.Both showed radiologically an inhomogeneous splenic lesion leading to splenectomy approximately 6 and 9 wk after surgical presentation.Both diagnoses of SANT were made histologically.Follow-up went well,and both were treated according to the recommendation for asplenic patients.CONCLUSION SANT is a rare cause of splenectomy and an incidental histological finding.Further research should focus on clinical and radiological diagnosis of SANT as well as on treatment of patients with asymptomatic and small findings.

Is it possible to save the environment and satisify consumers with artificial meat?

Our modern society is facing major challenges such as reducing world hunger by increasing protein resources despite an increase in protein demands due to the presence of more and more human beings on the earth. Other challenges include reducing potential environmental degradation due to human activities and also due to livestock. In addition to that, some people are concerned by reducing potential discomfort of animals on modern farms or maybe avoiding killing animals to eat them.

Diagnosis and surgical treatment of primary duodenal carcinoma

Objective To investigate the early diagnosis of primary duodenal carcinoma and its outcome after surgical procedure. Methods Twenty-two patients with primary doudenal carcinoma treated operatively between 1983 and 1997 were analyzed retrospectively. Eleven patients complained of epigastric pain and discomfort,5 jaundice,4 nausea and vomiting and 2 epigastric fullness. The correct diagnosis rate for endoscopy was 90. 0% (9/10), for June 2003 Vol12 No2 duodenography 86. 7% ( 13/15 ), for ultrasound examination 33. 3% (4/12) and for computerized tomography (CT) scanning 58. 3% (7/12), respectively. All of the 22 patients received surgery including pancreaticoduodenectomy ( 12 patients ), segmental resection (4) and bypass operation (gastrojejunostomy and cholecystojenostomy or cholangiqjejunostomy) (6). Results Primary duodenal carcinoma was characterized nonspecifically, and the correct diagnosis was based on endoscopy and duodenography. The follow-up rate of this group was 86. 4% (19/22). The 1 - , 3 - ,

Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension:A randomized-controlled study

AIM:To explore the effectiveness of acupuncture transcutaneous electrical nerve stimulation(Acu-TENS), a non-invasive modality in reduction of rectal discomfort during barostat-induced rectal distension. METHODS:Forty healthy subjects were randomized to receive 45 min of either Acu-TENS or placebo-TENS(no electrical output)over acupuncture points Hegu(largeintestine 4),Neiguan(pericardium 6)and Zusanli(stomach 36).A balloon catheter attached to a dual-drive barostat machine was then inserted into the subjects'rectum.A step-wise(4 mmHg)increase in balloon pressure was induced until maximal tolerable or 48 mmHg.Visual analogue scale and a 5-point subjective discomfort scale(no perception,first per-ception of distension,urge to defecate,discomfort/ pain and extreme pain)were used to assess rectal discomfort at each distension pressure.Blood beta-endorphin levels were measured before,immediately after intervention,at 24 mmHg and at maximal toler- able distension pressure. RESULTS:There was no difference in the demographic data and baseline plasma beta-endorphin levels between the two groups.Perception threshold levels were higher in the Acu-TENS group when compared to the placebo group,but the difference reached statistical significance only at the sensations"urge to defecate"and"pain".The distension pressures recorded at the"urge to defecate"sensation for the Acu-TENS and placebo-TENS groups were 28.0±4.5 mmHg and 24.6±5.7 mmHg,respectively(P=0.043);and the pressures recorded for the"pain"sensation for these two groups were 36.0±4.2 mmHg and 30.5± 4.3 mmHg respectively(P=0.002).Compared to the placebo group,a higher number of participants in the Acu-TENS group tolerated higher distension pressures (>40 mmHg)(65%in Acu-TENS vs 25%in placebo, P=0.02).The plasma beta-endorphin levels of the Acu-TENS group were significantly higher than that of the placebo group at barostat inflation pressure of 24 mmHg(1.31±0.40 ng/mL vs 1.04±0.43 ng/mL,P= 0.044)and at maximal inflation pressure(1.46±0.53 ng/mL vs 0.95±0.38 ng/mL,P=0.003). CONCLUSION:Acu-TENS reduced rectal discomfort during barostat-induced rectal distension and concur-rently associated with a rise in beta-endorphin level.

TREATMENT OF OCULAR HYPERTENSION AND GLAUCOMA WITH MODIFIED XIAOYAO SAN (EASE POWDER)

The recipe of Xiaoyao San (Ease Powder) is selected from a book entitled " He Ji Ju Fang" ("Prescriptions of Peaceful Benevolent Dispensary" ). It is composed of Dang Gui (Radix Angelicae Sinensis), Bai Shao(Radix Paeoniae Alba), Chai Hu (Radix Bupleuri), Bai Zhu (Rhizoma Atractylodis Macrocephalae). Fu Ling (Poria). Gan Cao (Radix Glycyrrhizae). Bo He

REPORTS ON ILLUSTRATIVE CASES OFVARIOUS DISEASES EFFECTIVELYTREATED WITH MOXIBUSTION

Fleshy Growths Creeping Over the Eyeball Patient Wang, a male cadre of 58, firstvisited on 28 June 1989 with the chief com-plaint of blurred vision in the left eye forhalf a month. For 6 months prior to the visitthe patient felt some discomfort in his lefteye with increase in discharge and tearing,and in the two weeks immediately before thevisit, vision of the left eye became blurred.There was a gritty sensation and

TREATMENT OF PERIPHERAL FACIAL PARALYSIS BY SCALP ACUPUNCTURE——A Report of 100 Cases

It is well known that comparativelysatisfactroy effect can be achieved in thetreatment of cerebrogenic diseases by scalpacupuncture.However,little has been re-ported in the literature on its therapeutic ef-fect in the treatment of peripheral facial pa-ralysis.From August 1972 through Decem-ber 1989 the author treated 100 cases of thisdisease by scalp acupuncture with satisfac-tory results in most cases.A report follows.

Gastrointestinal discomforts and dietary intake in Chinese urban elders:A cross-sectional study in eight cities of China

BACKGROUND Gastrointestinal(GI)discomforts are common in the elderly population;however,whether such discomforts are associated with dietary intake has not been studied.AIM To evaluate GI discomforts in Chinese urban elders and the associated factors.METHODS The gastrointestinal symptom rating scale(GSRS)was used to identify GI discomforts in 688 elders from eight cities of China.The semi-quantitative food frequency questionnaire and one time of 24 h dietary recall were used to access the food intake,identify dietary pattern,and calculate the nutrients intake.RESULTS About 83%of studied elders experienced at least one of GI discomforts in the past 6 mo;dyspepsia was the most commonly reported(66.7%),followed by reflux(44.8%),abdominal pain(35.9%),constipation(35.8%),and diarrhea(34.7%).Female gender,lower education level,and lower family income were associated with a higher GSRS score.Participants who were diagnosed with a GI-related disease had a higher score of constipation,but a lower score of reflux.Chronic diseases were positively associated with certain GI discomforts.Three dietary patterns were identified by the method of principal component analysis,which were characterized as high intake of salt and tea;more frequent intake of tubers,fruits,aquatic products,and soybeans;and high intake of cereal,vegetables,and meat,respectively.However,no associations between dietary patterns and GSRS score were found.The elders with a higher GSRS score had significantly lower intake of bean products.The elders whose GSRS score was≥21 and 18-20 decreased their bean production intake by 7.2(0.3,14.3)g/d and 14.3(1.2,27.3)g/d,respectively,compared with those who had a GSRS score≤17.There were no differences in other food categories,calories,or nutrients intake among elders with different GSRS scores.CONCLUSION GI discomforts are common in Chinese urban elders.GI discomforts might be associated with the choice of food.

TREATMENT OF PERIOMARTHRITIS WITH SCALP ACUPUNCTURE THERAPY——A Report of 210 Cases

Over recent years,the authors haveadopted scalp acupuncture therapy for thetreatment of 210 periomarthritis cases withfair therapeutic results.This mode of treat-ment has the merits of simplicity in selectionof points,easy manipulations,and quickstable results,with the least discomfort forthe patient.