BACKGROUND: Neurobrucellosis (NB) is a rare and serious complication of brucellosis. Its clinical manifestations vary, with no obvious specificity. At present, there is no clear clinical diagnosis or treatment for reference. In this study, we retrospectively analyzed the clinical data for 21 patients with NB to provide reference data for its further study.
METHODS: We analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China.
RESULTS: The ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown.
CONCLUSIONS: The clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.

A cross-sectional study method combined with two types of traditional Chinese medicine(TCM) syndrome differentiation methods was adopted to investigate the clinical symptoms and distribution characteristics of TCM syndromes in patients with pulmonary nodules from the perspectives of number, size, nature, and stability of pulmonary nodules by using the χ~2 test, systematic clustering and Apriori algorithm correlation analysis. The common clinical symptoms of pulmonary nodules were fatigue(77.35%) and irritability(75.40%), and 40 symptoms were clustered into 3 groups(digestive system symptoms, respiratory system symptoms, and emotional and systemic symptoms) and 8 major symptom categories. The proportion of cold and heat in complexity syndrome(63.43%) was higher based on cold-heat syndrome differentiation. The top two syndromes were Qi deficiency syndrome(88.03%) and Qi depression syndrome(83.17%) based on disease syndrome differentiation. Yang deficiency syndrome(60.52%) was more than Yin deficiency syndrome(50.16%). There were higher proportions of phlegm syndrome(78.67%) and Yang deficiency syndrome(69.33%) of so-litary pulmonary nodules in terms of the number of pulmonary nodules. In terms of size, the proportion of phlegm syndrome decreased as the mean diameter of pulmonary nodules increased, while the proportions of Yang deficiency syndrome and blood stasis syndrome increased. The distribution of Qi depression syndrome was more in those with mean diameter<10 mm(85.02%, P=0.044) and cold syndrome was more in those with mean diameter ≥10 mm(16.67%, P=0.024). In terms of the nature of pulmonary nodules, the proportions of Qi depression syndrome and heat syndrome decreased with the increase in solid components of pulmonary nodules, while the proportions of Yin deficiency syndrome and cold and heat in complexity syndrome increased. The blood stasis syndrome accounted for a higher proportion of pulmonary nodules with solid components. In terms of the stability of pulmonary nodules, dampness syndrome(72.97%), blood stasis syndrome(37.84%), and cold and heat in complexity syndrome(70.27%) accounted for higher proportions. In addition, patients with new nodules presented higher proportions in Qi inversion syndrome(52.00%, P=0.007) and cold and heat in complexity syndrome(66.00%, P=0.008). Meanwhile, 11 syndromes were associated and 4 common compound syndromes were obtained(Qi deficiency and depression syndrome, Qi depression and phlegm coagulation syndrome, Qi deficiency and phlegm coagulation syndrome, and Qi deficiency and dampness obstruction syndrome). Qi deficiency syndrome and Qi depression syndrome could be associated with other syndromes. The results show that the main clinical symptoms of pulmonary nodules are fatigue and irritability. The main TCM syndromes of pulmonary nodules are Qi deficiency syndrome, Qi depression syndrome, Yang deficiency syndrome, and cold and heat in complexity syndrome. The distribution of TCM syndromes is significantly correlated with the size of pulmonary nodules and the presence or absence of new nodules. The common compound syndromes are Qi deficiency and depression syndrome, Qi depression and phlegm coagulation syndrome, Qi deficiency and phlegm coagulation syndrome, and Qi deficiency and dampness obstruction syndrome.

Schizophrenia is a serious mental disorder that significantly impacts social functioning and quality of life. However, current diagnostic methods lack objective biomarker support. While some studies have indicated differences in audio features between patients with schizophrenia and healthy controls, these findings are influenced by demographic information and variations in experimental paradigms. Therefore, it is crucial to explore stable and reliable audio biomarkers for an auxiliary diagnosis and disease severity prediction of schizophrenia.
A total of 130 individuals (65 patients with schizophrenia and 65 healthy controls) read three fixed texts containing positive, neutral, and negative emotions, and recorded them. All audio signals were preprocessed and acoustic features were extracted by a librosa-0.9.2 toolkit. Independent sample t-tests were performed on two sets of acoustic features, and Pearson correlation on the acoustic features and Positive and Negative Syndrome Scale (PANSS) scores of the schizophrenia group. Classification algorithms in scikit-learn were used to diagnose schizophrenia and predict the level of negative symptoms.
Significant differences were observed between the two groups in the mfcc_8, mfcc_11, and mfcc_33 of mel-frequency cepstral coefficient (MFCC). Furthermore, a significant correlation was found between mfcc_7 and the negative PANSS scores. Through acoustic features, we could not only differentiate patients with schizophrenia from healthy controls with an accuracy of 0.815 but also predict the grade of the negative symptoms in schizophrenia with an average accuracy of 0.691.
The results demonstrated the considerable potential of acoustic characteristics as reliable biomarkers for diagnosing schizophrenia and predicting clinical symptoms.

BACKGROUND: Few studies have identified the links between physical activity (PA), clinical symptoms, and the quality of life (QoL) among mildly infected individuals with COVID-19. This cross-sectional study aims to evaluate how PA levels before infections affect the infectious symptoms and the QoL in mildly infected patients with COVID-19.
METHODS: An online questionnaire link including participants\' sociodemographic and anthropometric characteristics, clinical symptoms during the COVID-19 infectious period, the QoL of the worst symptomatic day, and PA in the last seven days before COVID-19 infections was disclosed. Logistic regression and multiple linear regression analyses were applied to assess the relationships between PA levels in the last seven days before infections and COVID-19-related outcomes. The level of statistical significance was set at p < 0.05.
RESULTS: Compared to the low-PA-level group, the moderate-PA-level group presented a higher risk of headaches (OR = 1.34, 95% CI = 1.03 to 1.75, and p = 0.03) and the high-PA-level group presented a higher risk of muscle/body aches (OR = 1.42, 95% CI = 1.04 to 1.93, and p = 0.03). The adjusted linear regression analysis showed that no associations were found between PA levels in the last seven days before infections and the QoL index value on the worst symptomatic day (moderate-PA-level group: β = -0.04, and p = 0.08; high-PA-level group: β = -0.04, and p = 0.17). However, for the mobility and usual activities dimensions of EQ-5D-5L, the lower-PA-level group had a lower burden of QoL than the higher-PA-level group did on the worst-symptomatic day.
CONCLUSIONS: Among mildly infected patients with COVID-19, a higher PA level is associated with a higher risk of experiencing clinical symptoms and a lower QoL.

(1) Introduction: Symptom spectrum can be of great diversity and heterogeneity in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) patients in clinical practice. Here, we report a case of MELAS presenting asymptomatic refractory hypotension with m.3243 A>G mutation. (2) Case representation: A 51-year-old male patient presented with a headache, vertigo, and difficulty in expression and understanding. The magnetic resonance imaging of the brain revealed an acute stroke-like lesion involving the left temporoparietal lobe. A definitive diagnosis of MELAS was given after the genetic test identified the chrM-3243 A>G mutation. The patient suffered recurrent stroke-like episodes in the 1-year follow-up. Notably, refractory hypotension was observed during hospitalizations, and no significant improvement in blood pressure was found after continuous use of vasopressor drugs and fluid infusion therapy. (3) Conclusions: We report a case of refractory hypotension which was unresponsive to fluid infusion therapy found in a patient with MELAS. Our case suggests that comprehensive management should be paid attention to during treatment. A further study on the pathological mechanism of the multisystem symptoms in MELAS would be beneficial to the treatment of patients.

Previous studies found that Jinlida granules could significantly reduce blood glucose levels and enhance the low-glucose action of metformin. However, the role of Jinlida in the standard-reaching rate of blood glucose and improving clinical symptoms has yet to be studied. We aimed to elaborate on the efficacy of Jinlida in type 2 diabetes (T2D) patients who experience clinical symptoms based on secondary analysis of a randomized controlled trial.
Data were analyzed from a 12-week, randomized, placebo-controlled study of Jinlida. The standard-reaching rate of blood glucose, the symptom disappearance rate, the symptom improvement rate, the efficacy of single symptoms, and the total symptom score were evaluated. The correlation between HbA1c and the improvement of clinical symptoms was analyzed.
For 12 weeks straight, 192 T2D patients were randomly assigned to receive either Jinlida or a placebo. The treatment group showed statistically significant differences in the standard-reaching rate of HbA1c < 6.5% (p = 0.046) and 2hPG (< 10 mmol/L, 11.1 mmol/L) (p < 0.001), compared with the control group. The standard-reaching rate of HbA1c < 7% (p = 0.06) and FBG < 7.0 mmol/L (p = 0.079) were not significantly different between the treatment and control groups. Five symptoms exhibited a statistical difference in symptom disappearance rate (p < 0.05). All the symptoms exhibited a significant difference in symptom improvement rate (p < 0.05). The mean change in total symptom score from baseline to week 12 was -5.45 ± 3.98 in the treatment group and -2.38 ± 3.11 in the control group, with statistically significant differences (p < 0.001). No significant correlations were noted between symptom improvement and HbA1c after 12 weeks of continuous intervention with Jinlida granules or placebo.
Jinlida granules can effectively improve the standard-reaching rate of blood glucose and clinical symptoms of T2D patients, including thirst, fatigue, increased eating with rapid hungering, polyuria, dry mouth, spontaneous sweating, night sweat, vexing heat in the chest, palms, and soles, and constipation. Jinlida granules can be used as an effective adjuvant treatment for T2D patients who experience those symptoms.

UNASSIGNED: To explore the relationship between the Duration of Untreated Psychosis (DUP) and long-term clinical outcome, cognitive and social function in patients with chronic schizophrenia (SCZ).
UNASSIGNED: A total of 248 subjects with chronic SCZ were enrolled in this study, including 156 in the short DUP group and 92 in the long DUP group. The Positive and Negative Symptoms Scale (PANSS), the Brief Negative Symptoms Scale (BNSS), the Global Assessment of Functioning (GAF) scale and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess all of the subjects.
UNASSIGNED: The negative symptom scores (the PANSS and BNSS) of subjects with long DUP were significantly higher than that in subjects with short DUP. The scores of visual span and speech function in the short DUP group were significantly higher, indicative of decreasing cognitive function with time. In terms of social function, the short DUP group scored higher, with a statistically significant difference. Meanwhile, we found that the length of DUP was positively correlated with the negative symptom score of the PANSS, negatively correlated with visual span scores, and GAF scores.
UNASSIGNED: This study demonstrated that the DUP remained a significant association with negative symptom and cognition in long period of chronic SCZ.

Spontaneous internal carotid artery dissection (ICAD) is a rare disease and an important cause of stroke in young patients. The presentation of ICAD is variable and atypical. We have used three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition to help diagnose ICAD. ICAD should be considered in young patients presenting with relevant symptoms in an emergency setting. We herein report ICAD with an unexplained onset in two patients. Neither had a history of large or small cervical trauma, but both had a history of hypertension. The first patient was a 33-year-old man who presented with upper extremity numbness and mobility impairment, and the second patient was a 40-year-old man with onset of visual impairment. There were no obvious triggers in either case. Both patients were diagnosed with ICAD by blood vessel examination. However, their prognoses differed. The first patient recovered after endovascular therapy, whereas the second patient was successfully managed with medical treatment. ICAD can cause different symptoms depending on where the dissection occurs. Clinicians must be aware of the different clinical manifestations of ICAD, make the correct diagnosis in a timely manner, make appropriate treatment plans according to the patient\'s condition, and strive for timely recanalization of the blood vessels.

Insomnia is a major public health concern that often occurs in patients with schizophrenia, complicating the treatment and prognosis of patients. This study aimed to investigate the prevalence of insomnia and its relationship with cognitive function in Chinese patients with chronic schizophrenia.
We recruited patients with schizophrenia and collected their clinical and demographic data. Insomnia data were collected through a self-reported questionnaire consisting of three questions. The positive and negative syndrome scale (PANSS) was used to measure psychopathological symptoms, while the repeatable battery for the assessment of neuropsychological status (RBANS) was used to measure cognitive performance.
Of 957 Chinese patients with chronic schizophrenia 20.2% reported having insomnia (193/957). Male patients (107/630, 17.0%) had a lower rate of insomnia than female patients (86/327, 26.3%) (x2 = 11.60, p = 0.001). Patients with insomnia exhibited significantly higher PANSS total score and positive symptom, negative symptom, and general psychopathology scores, but significantly lower RBANS total score, language, attention and delayed memory scores compared to patients without insomnia (all p < 0.05). Logistic regression analysis showed that female sex, high PANSS total score and the use of diazepam were independently associated with insomnia (all p < 0.05).
Insomnia is relatively common in Chinese patients with chronic schizophrenia. Some demographic data and clinical symptoms are associated with insomnia. Patients with schizophrenia and insomnia perform poorly on cognition tests suggesting that insomnia and cognitive function are closely related in patients with schizophrenia.

OBJECTIVE: It is generally recognized that there are sex differences in many aspects of schizophrenia. The main purpose of this study was to investigate the sex differences in the prevalence and clinical correlates of insomnia in patients with chronic schizophrenia.
METHODS: A total of 957 patients who met the DSM-IV diagnostic criteria for schizophrenia were recruited in this cross-sectional study (male/female = 630/327). Demographic, clinical, and insomnia data were collected using self-reported questionnaires. Fasting blood samples were collected to evaluate the status of blood lipids. Psychopathological symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS).
RESULTS: The prevalence rate of insomnia in female patients with schizophrenia was significantly higher than that in male patients (17.3% for males and 26.3% for females; χ2 = 10.74, p = 0.001). Regression analysis showed that in male patients, insomnia was independently associated with severe PANSS positive symptoms, severe PANSS depressive factor, and high levels of low-density lipoprotein levels, while in female patients, insomnia was associated with low education level, high PANSS depressive factor, and high levels of apolipoprotein B levels.
CONCLUSIONS: This study illustrates that insomnia is more frequent in female than male schizophrenia patients, and that there are differences in the clinical correlates of insomnia by sex, suggesting that sex differences should be considered in prevention and treatment strategies for coexisting insomnia in schizophrenia patients.