Separation/conversion disorders in functional coma with pseudocataplexy are rare.On December 9,2021,a young female patient with separation/conversion disorders was treated in the Department of Neurology in the First Affiliated Hospital of Shandong First Medical University.The main symptoms were episodic consciousness disorders,sudden fainting,and urinary incontinence.Complete laboratory tests and cranial magnetic resonance imaging showed no obvious abnormalities.Standard multi-channel sleep monitoring and multiple sleep latency tests were performed.The patient was unable to wake up during nap and underwent stimulation tests.There was no response to orbital pressure,loud calls,or tapping,while the α rhythm in all electroencephalogram leads and the increased muscular tone in the mandibular electromyography indicated a period of wakefulness.The results of 24-hour sleep monitoring suggested that the patient had sufficient sleep at night and thus was easy to wake up in the morning.The results of daytime unrestricted sleep and wake-up test showed that the patient took one nap in the morning and one nap in the afternoon.When the lead indicated the transition from N3 to N2 sleep,a wake-up test was performed on the patient.At this time,the patient reacted to the surrounding environment and answered questions correctly.Because the level of orexin in the cerebrospinal fluid was over 110 pg/mL,episodic sleep disorder was excluded and the case was diagnosed as functional coma accompanied by pseudocataplexy.The patient did not present obvious symptom remission after taking oral medication,and thus medication withdrawl was recommended.Meanwhile,the patient was introduced to adjust the daily routine and mood.The follow-up was conducted six months later,and the patient reported that she did not experience similar symptoms after adjusting lifestyle.Up to now,no similar symptoms have appeared in multiple follow-up visits for three years.Functional coma with pseudocataplexy is prone to misdiagnosis and needs to be distinguished from true coma and episodic sleep disorders.
功能性昏迷伴假性猝倒发作的分离/转换障碍病例罕见。2021年12月9日山东第一医科大学第一附属医院神经内科收治1例分离/转换障碍青年女性患者,主要表现为发作性意识障碍、猝倒、小便失禁。完善实验室检查及颅脑MRI未见明显异常,行标准多导睡眠监测及多次睡眠潜伏期试验,患者小睡间期无法唤醒,行刺激试验,对压眶、大声呼叫、拍打无反应,但头部导联均为α节律,下颌肌电示肌张力增高,提示为清醒期。行24 h睡眠监测,患者夜间睡眠充足,早晨唤醒容易。行日间无限制睡眠及唤醒试验,患者上午及下午各小睡1次,在导联提示N3期进入N2期睡眠时对患者进行唤醒试验,此时患者可对周围环境进行反应并正确回答问题。检测脑脊液食欲素水平>110 pg/mL,可排除发作性睡病,考虑为伴假性猝倒发作的功能性昏迷。给予口服药物症状改善不明显,建议停口服药并调整作息、情绪,半年后随访,患者诉自行调整生活方式后未再发作,至今3年多次随访均未再出现类似症状。合并有猝倒样发作的功能性昏迷易误诊,需与真性昏迷及发作性睡病相鉴别。.

Dissociative neurological symptoms disorder (DNSD), or conversion disorder, frequently manifests with unexplained neurological symptoms, necessitating referral to psychiatry following preliminary diagnosis in neurology. We present a case of an adolescent female patient with gait disturbance as the predominant clinical presentation, and delve into the diagnosis and interdisciplinary intervention process. Given neuroimaging deviations detected and familial similar presentations, the organic etiology was confirmed. However, the aberrant gait remained unexplained ultimately prompting psychiatric consultation resulting in the diagnosis of DNSD. Interventions consisting of health education, suggestive therapy, and physiotherapy notably improved gait disturbance. However, at follow-up, the patient presented with a depressive episode. It was deduced that undiagnosed psychosocial factors, notably familial dynamics, likely contributed to this decline. Eventually, transformed relation patterns among family members as well as antidepressant treatment were instrumental in attaining symptom remission.

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

Maillard flavor compounds, such as 2,3,5-trimethylpyrazine, have been frequently identified in thermally processed food products, such as popcorn and peanuts. However, the origin of the carbon atoms in 2,3,5-trimethylpyrazine has not been clearly elucidated. Herein, a model reaction showed that precursor methylglyoxal and intermediates glyoxal and formaldehyde contributed to the formation of 2,3,5-trimethylpyrazine via a conversion reaction between methylglyoxal and glyoxal. In addition, carbon module labeling technology and model response validation experiments indicated that this transformation reaction between methylglyoxal and glyoxal brought formaldehyde into the methyl group carbon atoms of the 2,3,5-trimethylpyrazine ring. The proposed novel route provides a new perspective for approaches to control the formation of flavor compounds, such as 2,3,5-trimethylpyrazine.

We describe an unusual case of post-operative conversion aphonia in a pediatric patient. It indicates the importance of discussing its presentation, and amplifies the need for emotional support in the immediate post-operative period for young patients with heightened anxiety. Laryngoscope, 133:1737-1738, 2023.

As a fast and non-destructive detection method, near infrared spectroscopy, mainly containing overtones and combinations, can be used to quantify the components with a concentration of ≥ 1% in the analytical sample. Aquaphotomics uses the characteristic that the water structure changes with the addition of solute, which is reflected in the region of the water spectrum. Thus, it provides the possibility to unlock the information hidden in the spectrum. In our work, near infrared spectroscopy combined with aquaphotomics was used to quantify aqueous solution containing salvianolic acid B. It has shown that the aquaphotomics approach accurately quantifies the aqueous solution\'s salvianolic acid from 0.51 mg/mL to 25.86 mg/mL. The obtained RMSEP, R2, RPD, and MRE of prediction were 0.52 mg/mL, 0.995, 14.88 and 4.74%, respectively. For the salvianolic acid A reaction solution, the predicted R2 was 0.93, RMSEC was 0.85 mg/mL, and RMSEP was 0.82. The results of this study supported the concept of aquaphotomics, and the aquaphotomics approach was successfully applied in the reaction system of salvianolic acid A at 120 °C. This method was conducive to understanding the reaction and improving the accuracy of the quantitative model. It is a rapid and accurate alternative for analysis and measurement of transformation reactions at high temperature and high pressure, even for the substance with a concentration of less than 5 mg/mL.

Traumatic brain injury (TBI) is an important cause of death in young adults and children. Till now, the treatment of TBI in the short- and long-term complications is still a challenge. Our previous evidence implied aquaporin 4 (AQP4) and hypoxia inducible factor-1α (HIF-1α) might be potential targets for TBI. In this study, we explored the roles of AQP4 and HIF-1α on brain edema formation, neuronal damage and neurological functional deficits after TBI using the controlled cortical injury (CCI) model. The adult male Sprague Dawley rats were randomly divided into sham and TBI group, the latter group was further divided into neutralized-AQP4 antibody group, 2-methoxyestradiol (2-ME2) group, and their corresponding control, IgG and isotonic saline groups, respectively. Brain edema was examined by water content. Hippocampal neuronal injury was assessed by neuron loss and neuronal skeleton related protein expressions. Spatial learning and memory deficits were evaluated by Morris water maze test and memory-related proteins were detected by western blot. Our data showed that increased AQP4 protein level was closely correlated with severity of brain edema after TBI. Compared with that in the control group, both blockage of AQP4 with neutralized-AQP4 antibody and inhibition of HIF-1α with 2-ME2 for one-time treatment within 30-60 min post TBI significantly ameliorated brain edema on the 1st day post-TBI, and markedly alleviated hippocampal neuron loss and spatial learning and memory deficits on the 21st day post-TBI. In summary, our preliminary study revealed the short-term and long-term benefits of targeting HIF-1α-AQP4 axis after TBI, which may provide new clues for the selection of potential therapeutic targets for TBI in clinical practice.

Functional neurologic disorders (FNDs), also called conversion disorder (previously called hysteria), can show almost all the symptoms of other neurological diseases, including both physical (for example, seizure, weakness, fatigue) and psychological (for instance, depression, anxiety) symptoms. In spite of our general knowledge about emotional processes and developmental defects in the formation of these somatic symptoms, there is still no systemic and comprehensive research on the effects of emotional developmental variables in FND. Recently, both experimental and theoretical emotion studies have been greatly increased, such as prediction error, conceptual act model, basic emotional theory, and monoamine neuromodulator based three primary emotions. In addition, a large amount of evidence has confirmed the role of psychosocial adversity (such as stressful life events, interpersonal difficulties) as an important risk factor for FND. Here, we review recent advances about emotional stress on FND, and pay special attention to the effects of monoamine neuromodulators, such as how norepinephrine and serotonin affect behaviors. Then, we discuss the significance of these changes for FND, which may contribute to clarifying the pathogenesis of FND, and thus provide potential therapeutic drug targets or psychological intervention methods in the future.

Dissociative (conversion) disorder in children is a complex biopsychosocial disorder with high rates of medical and psychiatric comorbidities. We sought to identify the characteristics and outcomes of children with dissociative (conversion) disorders in western China.
We conducted a retrospective cohort study of 66 children admitted with dissociative (conversion) disorders from January 2017 to July 2019, and analyzed their clinical characteristics, socio-cultural environmental variables, and personality and psychiatric/psychological characteristics. Binary logistic regression was used to analyze the variables associated with clinical efficacy.
Of these 66 patients, 38 (57.6%) were male and 28 (42.4%) were female, 46 (69.7%) had an antecedent stressor, 30 (45.5%) were left-behind adolescents, and 16 (24.2%) were from single-parent families. In addition, 30 patients (45.5%) were not close to their parents, 38 patients (59.4%) had an introverted personality, and 34 (53.1%) had unstable emotions. Thirteen families (19.7%) were uncooperative with the treatment. Patients who had cormorbid anxiety or depression exhibited significantly lower cognitive ability (P < 0.01). Logistic regression found that better treatment outcomes were positively associated with having a close relationship with parents, parental cooperation with treatment, and having a father with a lower level of education (i.e., less than junior college or higher).
The characteristics and outcomes of children with dissociative (conversion) disorders are related to socio-cultural environmental variables and psychiatric/psychological factors. Timely recognition and effective treatment of dissociative (conversion) disorders are important.

To compare the epidemiological and psychological features of globus symptoms between individuals from urban and rural areas in Guangzhou.In total, 3360 individuals aged 18 years and over were selected to participate in our questionnaire investigation using random cluster sampling under the stratification of a urban area and a rural area. The questionnaire comprised questions on personal characteristics and globus symptomatology and psychological characteristic and sleep quality scales.Lifetime prevalence and Glasgow-Edinburgh throat scale scores of globus symptoms were greater in the urban area than in the rural area, but no significant differences in sex ratio or onset age between individuals with globus were found. The incidences and severity of anxiety, depression, and sleep disorders were significantly higher among patients who presented with globus in the urban area than among those in the rural area.The lifetime prevalence of globus symptoms and the psychological features of globus patients differ between urban and rural inhabitants. We should pay more attention to these differences.