Objective:To analyze the clinical characteristics of cerebrospinal fluid (CSF) in patients with central nervous system (CNS) damage caused by brucellosis and to explore its value in the clinical diagnosis of brucellosis.Methods:A retrospective analysis was conducted on medical records of patients with CNS damage due to brucellosis who were admitted to the Department of Infectious Diseases, Beidahuang Group General Hospital from December 2007 to December 2022. Epidemiological, clinical features, and CSF test results were analyzed.Results:There were a total of 50 patients with CNS damage caused by brucellosis, including 32 males and 18 females, with an age range of 18 to 72 years and a median of 45 years. All patients had a history of sheep contact. Among the 50 patients, 15 case (30.0%) had combined meningitis, 5 case (10.0%) had meningoencephalitis, 28 case (56.0%) had myelitis, 2 case (4.0%) had brain abscesses, 29 cases (58.0%) had limb motor and sensory dysfunction, 22 case (44.0%) had nausea, vomiting, and cervical stiffness, and 4 case (8.0%) experienced seizures and persistent coma. Abnormal CSF changes were observed in 48 patients, including increased intracranial pressure (> 200 mmH 2O, 1 mmH 2O = 0.009 8 kPa) in 30 cases, elevated white blood cell count in 40 cases, increased globulin levels in 47 cases, and decreased glucose and chloride levels in 38 and 40 cases, respectively. Conclusions:Patients with CNS damage caused by brucellosis exhibit diverse clinical manifestations, and abnormalities in CSF biochemical analysis are relatively commom. Epidemiological contact history and CSF analysis are of significant diagnostic value.

Objective:To analyze the clinical characteristics of cerebrospinal fluid (CSF) in patients with central nervous system (CNS) damage caused by brucellosis and to explore its value in the clinical diagnosis of brucellosis.Methods:A retrospective analysis was conducted on medical records of patients with CNS damage due to brucellosis who were admitted to the Department of Infectious Diseases, Beidahuang Group General Hospital from December 2007 to December 2022. Epidemiological, clinical features, and CSF test results were analyzed.Results:There were a total of 50 patients with CNS damage caused by brucellosis, including 32 males and 18 females, with an age range of 18 to 72 years and a median of 45 years. All patients had a history of sheep contact. Among the 50 patients, 15 case (30.0%) had combined meningitis, 5 case (10.0%) had meningoencephalitis, 28 case (56.0%) had myelitis, 2 case (4.0%) had brain abscesses, 29 cases (58.0%) had limb motor and sensory dysfunction, 22 case (44.0%) had nausea, vomiting, and cervical stiffness, and 4 case (8.0%) experienced seizures and persistent coma. Abnormal CSF changes were observed in 48 patients, including increased intracranial pressure (> 200 mmH 2O, 1 mmH 2O = 0.009 8 kPa) in 30 cases, elevated white blood cell count in 40 cases, increased globulin levels in 47 cases, and decreased glucose and chloride levels in 38 and 40 cases, respectively. Conclusions:Patients with CNS damage caused by brucellosis exhibit diverse clinical manifestations, and abnormalities in CSF biochemical analysis are relatively commom. Epidemiological contact history and CSF analysis are of significant diagnostic value.

Pan-immune inflammation value (PIV) is a comprehensive immune inflammatory biomarker based on complete blood cell counts, which has been proven to predict treatment response and survival outcomes for different types of tumors. However, the predictive value of the PIV varies in different strategies for tumor treatment. This paper aims to systematically review the latest progress of PIV in predicting survival outcomes and tumor prognosis for immunotherapy, radiotherapy, targeted therapy, endocrine therapy, surgical treatment and neoadjuvant therapy, and analyze its existing challenges and issues, as well as look forward to its future development direction and application prospects.

Objective To investigate the correlation between pre-treatment pan-immune inflammation value (PIV) and clinicopathological features in esophageal squamous cell carcinoma (ESCC) patients with postoperative adjuvant radiotherapy and evaluate its value in prognosis assessment combined with T stage. Methods A retrospective analysis was conducted on data of 85 ESCC patients with postoperative adjuvant radiotherapy in the Department of Radiation Oncology of the Affiliated Hospital of Yangzhou University from January 2019 to January 2023. The receiver operating characteristic (ROC) curve was drew to obtain the optimal cut-off value of PIV and other immune-inflammatory biomarkers. The area under the curve (AUC) and clinical applicability of PIV and other immune-inflammatory biomarkers were compared based on the ROC curve and decision curve analysis (DCA). According to the optimal cut-off value, patients were divided into high PIV group and low PIV group, and the correlation between PIV level and clinicopathological features of ESCC was evaluated. Kaplan-Meier method was used for survival analysis, the Cox proportional hazards model was used for multivariate analysis, and a risk stratification model combining PIV and T stage was established by recursive partitioning analysis (RPA). Results The optimal cut-off value of pre-treatment PIV was determined as 187.22 based on the ROC curve. The AUC of PIV was 0.679, which was greater than 0.640, 0.583, 0.656 and 0.644 of the other four immune-inflammatory biomarkers such as the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR). The 85 patients were divided into low PIV group (< 187.22, n=48) and high PIV group (≥187.22, n=37). The level of PIV was significantly correlated with tumor diameter (P < 0.05). The 3-year overall survival (OS) (75.6% versus 30.6%, P < 0.001) and 3-year disease-free survival (DFS) (56.1% versus 21.0%, P < 0.001) were significantly higher in the low PIV group than the high PIV group. Tumor diameter, T stage and PIV were independent factors affecting OS in ESCC patients (P < 0.05), and T stage and PIV were independent factors affecting DFS in ESCC patients (P < 0.05). A new staging system with three risk groups was established by the RPA stratification model based on T stage and PIV, which further improved the predictive value of prognosis compared with T stage or PIV alone. Conclusion Pre-treatment PIV is helpful in predicting the prognosis of ESCC patients with postoperative adjuvant radiotherapy, and the combination of PIV and T stage can improve the predictive value.

Complete androgen insensitivity syndrome(CAIS) is characterized by lack of androgen response in target organs due to androgen receptor dysfunction, resulting in feminized external genitalia. Individuals with CAIS are typically advised to live as females. This article reports a patient diagnosed with CAIS and gender dysphoria in adulthood. Following the removal of a left pelvic mass, pathology indicated cryptorchidism with a concurrent Leydig cell tumor. Genetic testing revealed a deletion mutation in exon 3 of androgen receptor gene. During follow-up, the patient underwent gender reassignment, transitioning socially from female to male. This case provides new insights into gender allocation for CAIS patients.

The key treatment for overlap syndrome should focus on maximizing the therapeutic effect of each condition and concentrate of interventions that have showed benefit in both diseases. The goal of therapy includes the improvement in objective data including the reduction in sleep fragmentation, exacerbation rate, hospitalization frequency and mortality, and subjective data such as daytime functioning, quality of life and sleep quality. At present, the treatment of overlap syndrome is mainly rely on the positive airway pressure to improve ventilatory capacity and gas exchange function. Oxygen therapy as auxiliary treatment can alleviate hypoxemia. The key of drug therapy is to dilate the bronchus, clear secretions, reduce in?flammatory response to improve the ventilation function. Meanwhile, daily exercise and dietary habits of life activity are indis?pensable in the treatment of the disease as important supporting role to improve the motor function and the quality of life in patients.

Objective To explore the difference in pulmonary function between overlap syndrome and chronic obstructive pulmonary disease (COPD) in patients. Methods One-hundred-ninty-four patients came from respiratory department in Tianjin Medical University General Hospital, from October 2012 to August 2014, were included in this study. After inquisition of medical history, evaluation of lung function and polysomnography (PSG), patients were divided into overlap syndrome (OS, n=78) group, COPD group (n=76) and healthy control group (n=40). The indexes of lung function and the pulse oscillation index of pulmonary function were compared between three groups. Results Values of the peak expiratory flow rate (PEF) and the remaining 75%FVC when expiratory flow rate (MEF75) were significantly decreased in OS group than those of COPD group (P<0.05). Patients with sleep apnea hypopnea index (AHI)≥30 times/h showed significantly decreased MEF25 and the maximum mid expiratory flow (MMEF) in OS group than those of COPD group (P<0.05). Values of the total impedance (Zrs), the resonant frequency (Fres), viscosity resistance when oscillation frequency was 5 Hz (R5), R20 were significantly increased in OS group than those of COPD group (P<0.05). Patients with AHI≥30 times/h were increased significantly than COPD group in R5-R20 and X5 besides Zrs, Fres, R5, R20. Conclusion There is more serious airway obstruction in patients with OS than that in patients with COPD. Severe sleep disordered breathing can aggravate small airway obstruction in patients with COPD.