BackgroundSyphilis is a sexually transmitted disease (STD) caused by Treponema pallidum (TP) which could progress to neurosyphilis affecting the nervous system. However, the pathogenesis of neurosyphilis remain unknown. In addition, current diagnosis of neurosyphilis is mainly based on serological tests and cerebrospinal fluid (CSF) analysis, with limitations in terms of sensitivity and specificity.MethodsFrom April 2021 to April 2023, 129 patients with syphilis were enrolled and divided into the non-neurosyphilis group (common syphilis, CS, n=19), asymptomatic neurosyphilis group (AN, n=77), symptomatic neurosyphilis group (NS, n=33) and a control group (n=15). Forty-eight cytokines/chemokines in the CSF samples were measured and analysed in combination with clinical indices. Feature selections were further analysed for the using different machine learning model for the diagnosis and progression predicting of neurosyphilis.ResultsMachine learning-based feature selection identified a three-cytokine panel (RANTES, MIP-1β, and IL-3) that effectively distinguished syphilis patients from controls (AUC = 0.869, 95% CI: 0.821–0.917). For prediction of symptomatic neurosyphilis progression, IL-2Rα emerged as the optimal standalone biomarker, achieving an AUROC of 0.843 (95% CI: 0.784–0.902) for discriminating asymptomatic from symptomatic disease. Multivariable analysis confirmed IL-2Rα retained independent discriminatory power after adjusting for age (multivariable AUC = 0.876, 95% CI: 0.827–0.925). Age-stratified ROC analysis revealed IL-2Rα maintains robust diagnostic utility across all adult age groups, with optimal Youden-derived cut-offs of 21.82 U/mL (sensitivity 100.0%, specificity 85.7%, AUC 0.939) for 35–45 years; 25.48 U/mL (sensitivity 83.3%, specificity 88.9%, AUC 0.889) for 45–55 years; and 24.54 U/mL (sensitivity 73.7%, specificity 84.6%, AUC 0.789) for >55 years. The combination of IL-2Rα and IP-10 significantly improved predictive accuracy within specific age strata, achieving AUCs of 0.949 (35–45 years), 1.000 (45–55 years), and 0.814 (>55 years) when distinguishing symptomatic from asymptomatic neurosyphilis.ConclusionIn conclusion, IL-2Rα and IP-10 represent promising predictive biomarkers for neurosyphilis progression, with their combined application achieving high diagnostic accuracy for distinguishing symptomatic from asymptomatic disease. These findings establish a foundation for CSF cytokine-guided risk stratification in syphilis patients, although prospective validation in larger, age-matched cohorts is warranted to optimize clinical cut-offs and confirm generalizability across diverse populations.

Rationale: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. Patient concerns: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. Diagnosis: Emergency brain computed tomography revealed massive pneumocephalus. Interventions: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. Outcomes: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. Lessons: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.

This study aimed to investigate factors affecting coronavirus disease 2019 (COVID-19) progression, also to explore the clinical features and prognosis of nervous system symptom (NSS) involved COVID-19 patients. 417 COVID-19 patients were analyzed in this retrospective study, and they were clinically classified as severe patients and non-severe patients. According to NSS involved status, COVID-19 patients were further divided into NSS patients and non-NSS patients. Elderly cases, males, common comorbidities, NSS, respiratory/cardiovascular/gastrointestinal symptoms, bilateral lesion, multifocal lesion, bacterial infection, bacterial&fungal infection were more common in severe patients compared to non-severe patients. Meanwhile, severe COVID-19 patients showed increased baseline APTT, TT, D-dimer, CRP, ESR, CK-MB, creatine kinase, AST, ALT, creatinine, but decreased baseline platelet level, lymphocyte, albumin, GFR compared to non-severe patients. Notably, the continuous differences of lymphocyte, D-dimer, CRP, AST, ALT, albumin, GFR between severe patients and non-severe patients during treatment were observed. Age, NSS, bacterial & fungal infection, CRP and creatinine were further identified as independent risk factors for severe COVID-19, which could predict severe COVID-19 with area under curve of 0.861. Furthermore, severe patients presented with worse prognosis. Regrading NSS patients, they were related to older age, surgery history, diabetes comorbidities, respiratory/cardiovascular/gastrointestinal symptoms, bilateral lesion, multifocal lesion, bacterial infection, bacterial&fungal infection and more dysregulated laboratory indexes compared to non-NSS patients. Besides, NSS patients were correlated with poor prognosis to some extent. More intensive attention should be paid to COVID-19 patients with severe-disease risk factors and those with NSS involvement, in case of rapid deterioration.

肌萎缩侧索硬化(ALS)是临床最常见的运动神经元病,其被认为是最具破坏性的成年发病的神经变性疾病.ALS特征在于上运动神经元和下运动神经元同时受累,临床表现为肌无力和萎缩、延髓麻痹及锥体束征,大部分患者的平均生存时间为2～4年.ALS的发病可能与遗传和基因突变相关,超氧化物歧化酶1是最常见的突变基因.目前有3种关于ALS发病机制的假说,但其均不能单独解释ALS的整个发病过程.ALS的确诊主要依赖临床表现及神经电生理检查结果,而利鲁唑是唯一一种国际承认的对ALS有治疗作用的药物.

Background and purpose: Numerous clinical studies have indicated that the incidence of cervical spondylosis increases with age. However, the relationship between age and the incidence of cervical spondylosis is still unclear. It is essential to address the relationship between age the incidence of cervical spondylosis via more clinical data. Methods: A retrospective analysis of 4271 cases of cervical spondylosis has been done in this study. A chi-square test was used to analyze the associations between different variables. A One-Way Analysis of Variance was used to test the equality of three or more means at one time by using variances for risk factors. Results: The most prominent features of cervical spondylosis were bulge or herniation at C3-4, C4-5 and C5-6. The incidence of cervical spondylosis increased with age before 50 years old and decreased with age after 59. The age risk factors have no relationship with the incidence of cervical spondylosis. There was an increase with age before 50 years old and a decrease with age after 59 for the occurrence of imaging features for cervical spondylosis patients. Conclusion: The incidence of cervical spondylosis decreases with aging in the elderly and increases with aging in the young and the adults. This analysis suggests that aging is not a contributor to the occurrence of cervical spondylosis in the elderly.

Background and purpose: Numerous clinical studies have indicated that the incidence of cervical spondylosis increases with age. However, the relationship between age and the incidence of cervical spondylosis is still unclear. It is essential to address the relationship between age the incidence of cervical spondylosis via more clinical data. Methods: A retrospective analysis of 4271 cases of cervical spondylosis has been done in this study. A chi-square test was used to analyze the associations between different variables. A One-Way Analysis of Variance was used to test the equality of three or more means at one time by using variances for risk factors. Results: The most prominent features of cervical spondylosis were bulge or herniation at C3-4, C4-5 and C5-6. The incidence of cervical spondylosis increased with age before 50 years old and decreased with age after 59. The age risk factors have no relationship with the incidence of cervical spondylosis. There was an increase with age before 50 years old and a decrease with age after 59 for the occurrence of imaging features for cervical spondylosis patients. Conclusion: The incidence of cervical spondylosis decreases with aging in the elderly and increases with aging in the young and the adults. This analysis suggests that aging is not a contributor to the occurrence of cervical spondylosis in the elderly.