Achalasia is a rare esophageal motility disorder, and peroral endoscopic myotomy (POEM) is an effective treatment. However, symptom recurrence after POEM poses challenges for clinical management. This study aims to evaluate the short-term efficacy of repeat POEM (re-POEM) in patients with recurrent achalasia. This retrospective study included patients with achalasia who underwent re-POEM at Tongji University Affiliated East Hospital between March 2019 and June 2023. Data were collected on patient characteristics, perioperative details, and symptom assessments, including Eckardt scores (evaluating dysphagia, regurgitation, chest pain, and weight loss), the interval between initial and re-POEM, intraoperative and postoperative complications, and follow-up outcomes. Eight patients (aged 25-76 years, 2 males) underwent re-POEM successfully (including 2 cases of achalasia with concurrent esophageal spasm, and individualized treatment was carried out for these 2 patients, including a long muscle incision). Procedure duration ranged from 39 to 107 minutes. Within 6 months post-procedure, all patients experienced symptom relief. During follow-up, 7 patients maintained an Eckardt score of 0. One patient developed mild dysphagia, which was managed with balloon dilation, and another reported occasional mild acid reflux. Re-POEM appears to be a safe and effective therapeutic option for patients with recurrent achalasia. Patients with concurrent esophageal spasm also need more personalized treatment. These preliminary observations require confirmation in larger studies with longer follow-up.

A 67-year-old unvaccinated male patient was analyzed. Clinical manifestations, laboratory and imaging findings, treatment, and disease progression were evaluated using hospital records. Eight days after facial trauma from a bicycle accident, the patient developed progressive trismus, dysphagia, neck stiffness, and respiratory discomfort. He was hospitalized on day 10 post-injury. Initial treatment included 500 IU of tetanus immunoglobulin. Two days later, his condition deteriorated with progression to generalized tetanus, requiring ICU admission. Additional 2000 IU of tetanus immunoglobulin, sedation, and oxygen therapy were administered. The course was complicated by pneumonia. Gradual improvement occurred, and he was discharged in stable condition on day 35. Cephalic tetanus is a rare but severe form that may progress to generalized disease. Early recognition and prompt administration of tetanus immunoglobulin are crucial for favorable outcomes.

Background: Neurovascular compression syndromes (NVCS) represent a spectrum of disabling neurologic disorders caused by vascular or structural compression of cranial nerves, most commonly at the root entry zone. Conditions such as trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN) are associated with significant pain, functional impairment, and reduced quality of life. This review provides a multidisciplinary, anatomically grounded overview of the pathophysiology, diagnosis, imaging, and contemporary management strategies for NVCS. Methods: A narrative review of the literature was conducted, synthesizing historical perspectives, neuroanatomy of the cerebellopontine angle, mechanisms of neurovascular conflict, advances in imaging and neuromonitoring, and current treatment modalities. Medical, percutaneous, surgical, radiosurgical, and neuromodulatory approaches were evaluated, with emphasis on patient selection and outcome considerations. Results: Neurovascular compression, most frequently arterial compression at the root entry zone, leads to focal demyelination, ephaptic transmission, and neuronal hyperexcitability. High-resolution Magnetic resonance imagin (MRI) remains the diagnostic gold standard. First-line management for TN and related syndromes typically includes pharmacotherapy, particularly sodium channel blockers. Refractory cases may benefit from percutaneous rhizotomy, balloon compression, stereotactic radiosurgery, or microvascular decompression (MVD), which offers the most durable relief in appropriately selected patients. Emerging technologies, including endoscopic visualization, advanced neuromodulation, and virtual reality-assisted surgical planning, continue to refine treatment precision and safety. Conclusions: Effective management of NVCS requires a comprehensive understanding of neuroanatomy, pathogenesis, and individualized risk-benefit profiles. A multidisciplinary, stepwise approach optimizes outcomes and improves quality of life in patients with these complex disorders.

Background: Epicardial coronary artery spasm (CAS) is a frequent and important cause of myocardial ischemia. We aimed to develop and validate a noninvasive, artificial intelligence (AI)-driven risk score using routine clinical data to predict CAS in patients without obstructive coronary artery disease (CAD). Methods: This retrospective study analyzed a derivation cohort of 1050 patients and an external validation cohort of 600 patients who underwent intracoronary methylergonovine provocation testing between September 2008 and March 2025. A random forest (RF) model was developed using 15 clinical variables and simplified to a nine-variable model. Additionally, a convolutional neural network-long short-term memory (CNN-LSTM) deep learning model was implemented to predict CAS from raw digital electrocardiogram data (2611 electrocardiogram records). Results: The final nine-variable RF model, including predictors such as diastolic/systolic blood pressure, age, BSA, hemoglobin, smoking, heart rate, sex, and estimated glomerular filtration rate, demonstrated strong discriminatory power. The area under the curve was 85.8% (95% confidence interval [CI]: 85.8-89.9%) in the derivation cohort and 84.1% in the validation cohort (95% CI: 80.6-87.7%). A dose-response relationship was confirmed, with CAS prevalence increasing from 42.1% (0-1 risk factors) to 82.4% (≥5 risk factors). The electrocardiogram-based CNN-LSTM deep learning model achieved high sensitivity (91.4%) but limited specificity (11.9%); therefore, it should be considered a proof of concept rather than a clinical screening tool until further refinement is achieved. Conclusions: The nine-variable RF model provides a practical and accurate tool for early identification and risk stratification of CAS. The electrocardiogram deep learning model complements the RF model to improve clinical decisions and resource allocation in diagnosing CAS.

The primary dental care team commonly encounters patients presenting with trismus as the result of various benign causes. Common among these causes are the range of temporomandibular disorder diagnoses. In a rare but significant number of cases the cause may be an underlying malignancy in which case urgent referral is mandatory. This article describes the implementation of the Trismus Checklist, a nine-item screening tool designed to improve patient safety by structuring the diagnostic process for trismus. Objective measurement techniques, including recording the intra-incisal distance, while emphasising the need to account for a pre-existing overbite or open bite are outlined. A passive stretch test is recommended to differentiate between myogenic limitations and mechanical obstructions. The routine use of the described Trismus Checklist helps safeguard clinicians against missing significant pathology. It is suggested that objective monitoring and follow-up are essential for all patients presenting with trismus, regardless of the initial suspected diagnosis.

A 45-year-old male patient presented with recurrent nocturnal or early morning chest pain following coronary stent implantation, and the electrocardiogram findings were consistent with Wellens' syndrome. Due to a low baseline heart rate, the patient could not tolerate diltiazem, and the response to standard anti-spastic medical therapy was poor. Intracoronary ergonovine provocation testing induced severe spasms of the left anterior descending and left circumflex arteries and reproduced the patient's chest pain. Given the typical presentation of heightened vagal tone, catheter ablation of cardiac autonomic ganglia was performed under the guidance of a three-dimensional electroanatomical mapping system. Post-ablation, repeat ergonovine testing showed markedly attenuated coronary artery spasm that resolved spontaneously, and the patient experienced no chest pain. At the 2-month follow-up, angina had completely resolved. This case suggests that cardiac autonomic ganglion ablation may be a valuable non-pharmacological treatment option for patients with refractory vasospastic angina after PCI who exhibit heightened vagal tone.

To discuss the acupuncture of Tiaoshen Dongjin (regulating the mind and activating the sinews) in treating spastic paralysis after stroke (SPAS) based on the "brain-meridian-sinew". The "brain-meridian-sinew" system takes the brain as its core, with its structural and functional components closely interconnected, forming a limb motor regulation system. The pathogenesis of SPAS presents a dynamic evolution process characterized by damage to brain collaterals,obstruction of orifices and concealment of the spirit, blockage of meridians, imbalance of ying and wei, and spasm of sinews with coexistence of deficiency and stasis. Combined with the ideas and clinical experience of contemporary acupuncture physicians in treating SPAS, the acupuncture differentiation and treatment approach of "regulating the mind and activating the sinews" is summarized. It emphasizes prioritizing "regulating the mind," selecting nearby acupoints such as Baihui(GV20), Sishencong (EX-HN1), Fengchi (GB20), and Yintang (GV24+) to awaken the brain and regulate the mind; and selecting distal acupoints such as acupoints on the Governor Vessel, Jiaji (EX-B2), or Back-shu points to unblock the Governor Vessel, nourish the marrow, and regulate the balance of the five zang organs, thereby stabilizing the spirit."Activating the sinews" is regarded as the key, primarily selecting acupoints of the hand and foot yangming meridians, and emphasizing the importance of applying motion-oriented acupuncture techniques to activate the sinews and regulate qi.Under the guidance of the integration of disease and syndrome differentiation and the theory of tension balance, approaches for activating the sinews and relieving spasm are further expanded.

Functional disorders affecting the cardiorespiratory system are common. Non-cardiac chest pain affects more than 10% of the population. It can result from gastro-oesophageal reflux or chest wall disorders but is also very often associated with anxiodepressive disorders, particularly panic disorder. Postural orthostatic tachycardia syndrome (POTS), a rarer entity, is characterized by a sharp increase in heart rate without orthostatic hypotension when standing. The pathophysiological mechanisms of POTS include 'partial' autonomic neuropathy, hypovolaemia and noradrenergic dysregulation, but it is also closely linked to anxiety disorders and deconditioning to exertion. Functional respiratory disorders, particularly hyperventilation syndrome, are accompanied by various manifestations ranging from tetany to gastrointestinal symptoms. They are highly prevalent, especially among women and people suffering from anxiety, and particularly in the case of associated respiratory disease such as asthma. The diagnosis of hyperventilation syndrome is based on the Nijmegen questionnaire. The pathophysiology does not necessarily involve hypocapnia but is related to cerebral conditioning phenomena and vicious circles linked to anticipatory anxiety. Cardiorespiratory functional disorders are often linked to each other and to other functional somatic disorders and have in common a dysregulation of the autonomic nervous system. Psychological, cognitive and behavioural factors play a central role in their persistence. While each has its specificities, all have a complex circular causality. Their management currently relies primarily on physical rehabilitation, often associated with symptomatic treatments such as beta-blockers. The place of cognitive and behavioral therapies would be well worth exploring in these disorders.

Infantile Epileptic Spasms Syndrome (IESS) represents a severe form of developmental epileptic encephalopathy in infancy, characterized by clusters of spasms and hypsarrhythmia patterns on electroencephalogram (EEG), which often lead to long-term neurodevelopmental impairments if not diagnosed promptly. The inherent non-stationarity and polymorphic complexity of EEG signals complicate interpretation, resulting in time-consuming and error-prone diagnostics that hinder timely therapeutic interventions. To address these challenges, we propose SinTransNet, an innovative EEG-based deep learning framework that combines multi-band signal decomposition, adaptive sinusoidal convolutions, and Transformer-based attention mechanism. This architecture decomposes EEG into five key frequency bands (δ, θ, α, β, γ) to isolate oscillatory features such as spike-and-wave complexes, employs sinusoidal convolutions for frequency-adaptive feature extraction, and utilizes Transformer attention to capture inter-band correlations and long-range dependencies essential for accurate IESS detection. Evaluated on a proprietary dataset comprising 129 EEG recordings with 1,941 epileptic spasm events, SinTransNet demonstrates superior performance with average accuracy of 85.69%, sensitivity of 80.55%, and specificity of 90.76%. By providing an automated, efficient tool for IESS identification, SinTransNet holds promise for enhancing clinical workflows and supporting early interventions in pediatric neurology.