Abstract:Parkinson disease （PD） is a common neurodegenerative disease in middle-aged and older adults. Its etiology is strongly related to degeneration， heredity， environment factors. Motor symptoms and nonmotor symptoms gradually worsen with disease progression which can reduce quality of life of patients. Drug therapy and neuromodulatory therapy are currently the main treatment methods for PD， but they can only improve the clinical symptoms of patients and can not cure the disease. There is no definite means to delay the progression of the disease. The PD prodromal warning， early diagnosis， and research on disease modification therapy is of great significance. Multidisciplinary diagnosis and treatment models and full disease cycle management involving patients can better help patients improve their quality of life. This article introduces the relevant progress in the diagnosis and treatment of PD， in order to deepen understanding of the disease， explore new treatment methods and disease management models.

Abstract:Objective To explore the influencing factors of cognitive dysfunction in patients with primary cerebral hemorrhage and establish a predictive model and validate it. Methods Using convenience sampling method， 195 patients with primary cerebral hemorrhage who were admitted to the Department of Neurosurgery， the First Affiliated Hospital of Nanjing Medical University from June 2019 to June 2022 were retrospective analyzed. All patients were followed up for over 6 months after discharge. All patients were assessed by Montreal Cognitive Assessment （MoCA） and Mini-Mental State Examination （MMSE） for cognitive function. The patients were divided into the cognitive dysfunction group （n=120） and the non-cognitive impairment group （n=75）. Binomial Logistic regression analysis was used to determine the influencing factors for cognitive dysfunction in patients with primary cerebral hemorrhage. According to the results of the analysis， a nomogram prediction model was constructed. The consistency coefficient （C-index） and calibration curve were used to evaluate the prediction efficiency and compliance of the nomogram model. Results The differences in age， education， National Institutes of Health Stroke Scale （NIHSS） score at the time of discharge， comorbid epilepsy，comorbid debridement， comorbid insular sign or high number of satellite foci， status of intensive caregiver， and distribution of bleeding sites were statistically significant when compared between the two groups （P ＜ 0.05）. Binomial Logistic regression analysis showed that age ＞ 60 years old （OR=4.689， 95%CI=1.420 to 15.470， P=0.011）， history of epilepsy （OR=3.007， 95%CI=1.270 to 7.118， P=0.012）， NHISS score ＞ 15 points at discharge （OR=2.699， 95%CI=1.257 to 5.797， P=0.011）， and the hemorrhage site were risk factors of cognitive dysfunction after primary cerebral hemorrhage. Primary school education level or below （OR=0.382， 95%CI=0.159 to 0.913， P=0.030）， the site of hemorrhage being the parieto-occipital lobe （OR=0.105， 95%CI=0.019 to 0.579， P=0.010） was a protective factor for patients with primary cerebral hemorrhage with concomitant cognitive deficits. The results of the model validation showed that，the C-index of the nomogram model was 0.785， the calibration curve is relatively consistent with the trend of the ideal curve， showed that the prediction model had good accuracy and consistency. Conclusions Patients with primary cerebral hemorrhage who are older， with lower educational level， higher discharged NHISS score， epilepsy history and hemorrhage in brain stem， basal ganglia thalamus region and frontotemporal region are prone to post-stroke cognitive dysfunction. The nomogram model constructed based on the above variables has high prediction efficiency.

Abstract:Objective To investigate the predictive value of lipoprotein-associated phospholipase A2 （Lp-PLA2） in acute cerebral infarction patients with atherosclerotic stenosis of intracranial and extracranial arteries. Methods Retrospectively， a total of 1 045 patients with acute cerebral infarction who visited the Department of Neurology in Shandong Provincial Qianfoshan Hospital from May 2019 to April 2022 were selected. According to gender and location of stenosis of patients with cerebral infarction， they were divided into male non-cerebral atherosclerotic stenosis group （n=282）， male intracranial atherosclerotic stenosis group （n=265）， male extracranial atherosclerotic stenosis group （n=105）， female non-cerebral atherosclerotic stenosis group （n=173）， female intracranial atherosclerotic stenosis group （n=156）， female extracranial atherosclerotic stenosis group （n=64）. The correlation between Lp-PLA2 and symptomatic intracranial and extracranial stenosis was analyzed by multifactor Logistic regression. Results The comparison of Lp-PLA2 levels in patients with different age， gender， stroke history， coronary heart disease history， and homocysteine levels was statistically significant （P＜ 0.05）. The comparison of the number of patient cases with different Lp-PLA2 levels among male patients in the 3 groups showed a statistically significant difference （χ2 =65.276， P ＜ 0.01）. However， there was no significant differences in the comparison of the number of patient cases with different Lp-PLA2 levels among the three groups in female patients（χ2 =7.061，P＞ 0.05）. Multifactor Logistic regression analysis showed that Lp-PLA2 levels of 520.3 to 606.5 IU/L （OR=1.842， 95%CI=1.060 to 3.199， P=0.030） and ＞ 606.5 IU/L （OR=3.966， 95%CI=2.174 to 7.235， P ＜ 0.001） were risky factors for the combination of intracranial atherosclerotic stenosis in male patients with acute cerebral infarction， whereas no association was found between Lp-PLA2 and the risk of intracranial or extracranial atherosclerotic stenosis in female patients （P ＞ 0.05）. Conclusions Lp-PLA2 levels are significantly increased in male patients with acute cerebral infarction combined with intracranial atherosclerotic stenosis， and Lp-PLA2 may be used as a predictor of intracranial atherosclerotic stenosis in male patients.

Abstract:Objective To identify the gene co-expression modules and hub genes of obsessivecompulsive disorder （OCD） through weighted gene co-expression network analysis （WGCNA） of gene expression profiles. Methods The GSE60190 dataset was downloaded from the Gene Expression Database （GEO）. The gene expression data from the dorsolateral prefrontal cortex （DLPFC） of postmortem brain of 15 OCD patients and 14 healthy controls were used to detected the co-expression module related to OCD. The co-expression modules related to OCD were identified by WGCNA. GO enrichment analysis was performed on key modules related to OCD by Metascape database. Protein-protein interaction （PPI） networks for key modules were constructed through STRING database. CytoHubba in Cytoscape was used to identify hub gene candidates. Results A total of 9 co-expression modules of OCD genes were identified， with module characteristic gene values ranging from 168 to 2 676. The green module （MEgreen） was positively correlated with OCD （r=0.52， Pcorrected=0.036）. The enrichment analysis results showed that MEgreen involves multiple biological processes （BPs）， including response to steroid hormones， response to ionizing radiation， regulation of reactive oxygen species biosynthesis process， regulation of striated muscle cell differentiation， regulation of ATPase activity， "de novo" protein folding， protein import， and microtubule cytoskeletal organization. PSMD12， PSMD1， CDKN1B， CDC34，SRSF1， and CCT2 were identified as hub genes that might be associated with the development of OCD. Conclusions MEgreen and six genes， including PSMD12， PSMD1， CDKN1B， CDC34， SRSF1， and CCT2， may play a certain role in the occurrence and development of obsessive-compulsive disorder through ubiquitin system， cell cycle， stress response， and steroid hormone response.

Abstract:Objective To explore the effect of insomnia disorder on social function， and the chain mediation effect of fatigue and depression. Methods A total of 131 patients with insomnia disorder， who were treated in the sleep clinic of Beijing Huilongguan Hospital from February to August 2022， were recruited as the research objects by convenience sampling method. The insomnia level， fatigue status， depressive mood and social function of patients were assessed by Pittsburgh Sleep Quality Index （PSQI）， the Multidimensional Fatigue Inventory-20 （MFI-20）， Patient Health Questionnaire-9 （PHQ-9）， Sheehan Disability Scale （SDS）. Spearman correlation analysis was conducted to investigate the correlation among patients' social function， depressive mood， insomnia disorder and fatigue. The chain mediating model was constructed by Model 6 in SPSS PROCESS V4.1 plug-in. Non-parametric percentile Bootstrap method with deviation correction was used to test the significance of the mediation effect. Results The score of SDS was （14.12±6.46）， PHQ-9 （9.23±5.29）， MFI-20 （57.97±11.82）， PSQI （15.74±4.89）. The correlation analysis results showed that there was a positive correlation between patients' social function， depression， insomnia， and fatigue （r=0.383-0.657， P ＜ 0.01）. The results of mediating effect showed that the total effect value was 0.736. Insomnia had a direct effect on social function， and the effect value was 0.294， accounting for 39.95% of the total effect. Fatigue and depression had a mediating effect between insomnia and social function， with effect value of 0.266 and 0.089， respectively， accounting for 36.14% and 12.09% of the total effect. Fatigue and depression had a chain mediating effect between depression and social function. The effect value was 0.086， accounting for 11.68% of the total effect. Conclusions The insomnia situation of patients with insomnia disorder can damage their social function， and it can also indirectly damage their social function through the chain mediating effect of fatigue and depression emotions.

Abstract:Objective To analyze the rehospitalization rate and influencing factors of patients with bipolar depressive episode after effective treatment in acute phase for 3 years. Methods A total of 315 patients with bipolar depression during acute phase， who were hospitalized and received effective treatment in Beijing Anding Hospital of Capital Medical University from September 2015 to September 2018， were recruited as research objects by convenience sampling method. Demographic information， medical history， clinical features and other data of patients were collected. The patients were followed up for 3 years， and their rehospitalization conditions were tracked. The Cox proportional risk model was used to analyze the influencing factors of rehospitalization of patients with bipolar depressive episode after effective treatment in acute phase for 3 years. Results A total of 289 patients completed follow-up， and 39.45% （114/289） of them were readmitted to hospital within 3 years. Multivariate Cox regression analysis showed that the total number of attacks was a risk factor for readmission 3 years after treatment （HR=1.081， 95%CI：1.040-1.124，P＜ 0.01）， and the baseline treatment of mood stabilizers/antipsychotic was a protective factor for readmission 3 years after treatment （HR=0.471， 95%CI： 0.321-0.692， P ＜ 0.01）. Conclusions Multiple episodes， mood stabilizers/antipsychotics combined with antidepressant in the acute phase are the risk factors for patients with bipolar disorder to be readmitted within 3 years after effective treatment in the acute phase. Clinical attention should be paid enough and corresponding intervention should be carried out.

Abstract:Objective To explore the application value of multidimensional rehabilitation management mode in patients with dysphagia after stroke. Methods A total of 66 patients with dysphagia after stroke in Shanghai Ruijin Rehabilitation Hospital between December 2019 and October 2021 were selected as the subjects. In the control group， 35 cases were from the comprehensive rehabilitation ward， and the routine comprehensive rehabilitation intervention program was adopted. In the observation group， 31 cases were from the encephalopathy rehabilitation ward. On the basis of the control group， the multidimensional rehabilitation management mode including multidisciplinary collaboration， risk management and delicacy management was used for intervention. The swallowing function of both groups was evaluated respectively by Sub-water Test Score， Videofluoroscopic Swallowing Study （VFSS） and Penetration Aspiration Scale （PAS） before and after the 3 weeks' intervention. The functional level of intake of food and liquid was evaluated by Functional Oral Intake Scale （FOIS）. Nutritional status was assessed by measuring serum albumin level. The Chinese version of Swallowing-Quality of Life（SWAL-QOL） was used to assess the quality of life. Results The total effective rate in the observation group was 87.1% （27/31）， higher than that in the control group 64.6% （26/35）， the difference was statistically significant （χ2 =6.150， P ＜ 0.05）. After the intervention， the VFSS and FOIS scores of the 2 groups were higher than before （P ＜ 0.05）. After the intervention， the VFSS score of the observation group was higher than that of the control group［ （8.32±1.28） vs （7.03±1.98） points］. After the intervention， the FOIS score of the observation group was higher than that of the control group ［5.0（4.0，6.0） vs 3.0（1.0，6.0） points］， and the difference was statistically significant （t=3.260， Z=-3.196； all P ＜ 0.01）. After the intervention， the PAS score of the observation group was lower than that of the control group ［1.0 （1.0，1.0） vs 2.0 （1.0， 5.0） points］， and the difference was statistically significant （Z=-2.429， P＜0.05）. The serum albumin level in the observation group after the intervention was higher than that before intervention ［（33.44±3.19） vs （30.90±3.34）g/L］， and the difference was statistically significant （t=6.528， P ＜ 0.01）. The scores of SWAL-QOL in Chinese version of the two groups were higher than those before the intervention， and after the intervention， the score of observation group was higher than that of control group ［135.0 （129.0，149.0） vs 103.0 （94.0，136.0） points］， and the difference was statistically significant （Z=-3.023， P ＜ 0.01）. Conclusions Multidimensional rehabilitation management mode has a positive effect on ensuring the nutritional needs of patients with dysphagia after stroke， improving swallowing function and providing quality of life.

Abstract:The N-methyl-D-aspartic acid （NMDA） receptors are abundant in the hippocampus. NMDA receptors mediate long-term potentiation （LTP） and long-term depression （LTD）， both of which are closely related to cognition. Activation of NMDA receptors may exert both neuroprotective and neurotoxic effects depending on two models， the localization models and the subunit composition models. However， models can only give a relatively macroscopic overview of the different effects induced by activation of NMDA receptors， and the changes in NMDA receptors are unique in different diseases. Therefore， in this paper， Parkinson disease （PD）， Alzheimer disease （AD）， schizophrenia and anti-NMDA receptors encephalitis are taken as examples to explore the alterations of hippocampal NMDA receptors in cognitive impairment in different diseases， and regulating the function of hippocampal NMDA receptors subunits is suggested as a potential target for the treatment of cognitive impairment.

Abstract:Severe mental disorder （SMD） is a disease with high recurrence rate and high hospitalization rate. The social function of patients is damaged obviously， which brings heavy economic burden to the family and society. At present， drug therapy is still the first-line treatment for mental disorders， especially for patients with SMD in acute and maintenance periods. Poor compliance with medication will seriously affect the efficacy of treatment and the prognosis of the disease. SMD patients often have poor drug compliance due to the influence of disease symptoms and insight， monitoring methods， and the availability of medical resources. In recent years， with the development of digital technology， it is gradually applied to the field of drug compliance for chronic diseases. Compared with the traditional monitoring method， it is more accurate， efficient and convenient， which promotes the improvement of SMD patients' medication compliance. In this paper， the application of digital technology in the field of SMD patients' medication compliance is discussed in detail.

Abstract:Exosome is a class of extracellular vesicles of endocytic origin that carries functional messenger RNA， noncoding RNA， proteins， lipids， DNA and other bioactive substances from the source cell and function in many physiological processes. In the brain， they are involved in processes of synaptic plasticity， neuronal stress responses， intercellular communication and neurogenesis. The exosomes can cross the blood cerebrospinal fluid barrier， and their content varies with their secretion and receptor cells， so they can be used as biomarkers of neurological dysfunction. Intercellular communication in the central nervous system is essential for brain growth， development and maintenance of homeostasis. Studying neuron-derived exosomes can provide information for diagnostic and therapeutic interventions. This review focuses specifically on the role of neuronderived exosomes in the central nervous system， and the pathophysiological mechanisms in mental disorders.

Abstract:Alcohol dependence （AD） is a chronic and addictive mental disorder with high relapse rate. Long-term alcoholism can lead to body damage， chronic diseases and other adverse consequences. AD has become a global public health concern. In addition， the safe and effective treatment of AD patients is an important issue that needs to be addressed urgently. Repetitive transcranial magnetic stimulation （rTMS）， as a visual physical therapy， has been widely used in psychiatric disorders. However， there is still no consensus on the therapeutic target， stimulation frequency， clinical efficacy and effects on brain function of rTMS. Therefore， this paper reviews the efficacy of rTMS in alcohol-dependent patients and the mechanism of brain function.

Abstract:Autoimmune encephalitis refers to a class of immune response-mediated encephalitis， and a new type of autoimmune encephalitis mediated by specific antibodies. Psychiatric disorders， as one of the main manifestations of autoimmune encephalitis， has received extensive research attention. As a subclass of mental disorders， depressive syndromes is common in clinical practice， but it has received little attention to diagnosis， treatment and prognosis. In order to enrich clinician awareness of depressive syndromes in patients with autoimmune encephalitis， this article summarizes the prevalence， pathogenesis， diagnosis， treatment and prognosis of depressive syndromes in autoimmune encephalitis.