Abstract:Objective To explore the correlation and gender differences between metacognition function and anhedonia in patients with stable schizophrenia.Methods A total of 87 patients with stable schizophrenia who were treated at the Mental Health Hospital of Anhui Medical University(the Fourth People's Hospital of Hefei)between October 2022 and January 2024 were included.Based on gender,the patients were divided into a male group(n=43)and a female group(n=44).The Indiana Psychiatric Illness Interview(IPII),revised Metacognition Assessment Scale-Abbreviated(MAS-A),Temporal Experience of Pleasure Scale(TEPS),and Positive and Negative Symptom Scale(PANSS)were used to assess patients'metacognition function,anhedonia,and psychotic symptoms.Differences in clinical data between male group(n=43)and female group(n=44)were compared.Multivariable linear regression analysis was conducted to investigate the association between patients'metacognition function and anhedonia.Results Male group's total metacognition score[(6.98±2.87)vs.(8.25±2.95)]and decentralization score[0(0,0)vs.(0(0,0.50)],and positive symptom score on the PANSS[8.00(7.00,11.00)vs.11.00(9.00,14.75)]were lower than those in female group,with statistically significant differences(t=-2.038,-3.009,-3.827;all P＜0.05).Multivariate linear regression analysis revealed that scores of understanding others'thoughts,decentralization,and the MAS-A total score were predictors of TEPS scores(β=0.278,0.249,0.255;all P＜0.05),understanding others'thoughts score was a predictor of anticipatory anhedonia scores(β=0.249,P＜0.05),understanding others'thoughts score,decentralization score,and MAS-A total score were predictors of consummatory anhedonia scores(β=0.269,0.331,0.289;all P＜0.05).Subgroup analysis revealed that in female group,scores on self-reflection,understanding others'thoughts,decentralization,self-control,and the MAS-A total score were statistical predictors of consummatory anhedonia scores(β=0.366,0.395,0.365,0.471、0.586;all P＜0.05),and scores on understanding others'thoughts,and the MAS-A total score were statistical predictors of the TEPS total score(β=0.335,0.461;all P＜0.05).These findings were not replicated in male group.Conclusions In patients with stable schizophrenia,metacognition function is strongly associated with anhedonia,and this correlation is particularly pronounced in the female population.

Abstract:Objective To explore the relationship between inferiority complex and ventromedial prefrontal cortex(vmPFC)neurometabolites and personality traits in patients with bipolar depression.Methods From February 2024 to March 2025,40 patients with bipolar depression who were either outpatient or inpatient at the Department of Clinical Psychology of People's Hospital of Xinjiang Uygur Autonomous Region were selected as study subjects.Patients were grouped based on their inferiority complex scores on the 24-item Hamilton Depression Rating Scale(HAMD-24).Those with an inferiority complex score>1 were assigned to the inferiority complex group,while those with an inferiority complex score≤1 were assigned to the non-inferiority complex group.Each group comprised 20 patients.General Information Questionnaire and Eysenck Personality Questionnaire were used to collect patients'general information and evaluate their personality traits.The 1H-magnetic resonance spectroscopy(1H-MRS)was used to detect the ratios of N-acetyl-aspartate(NAA)/creatine(Cr),choline(Cho)/Cr,myo-inositol(mI)/Cr,and glutamate/glutamine(Glx)/Cr in the vmPFC.Results Patients with bipolar disorder experiencing inferiority complex had a mean mI/Cr value of 0.43(0.35,0.52),which was statistically lower than the 0.52(0.43,0.59)in patients without inferiority complex(Z=-2.124,P<0.05).Compared with non-inferiority complex group,inferiority complex group scored lower on introversion extraversion score[(42.75±6.97)vs.(51.75±10.04)],with a statistically significant difference(t=3.294,P<0.05).Correlation analysis revealed that NAA/Cr in non-inferiority complex group were negatively correlated with disease duration and age(r=-0.474,-0.511;both P<0.05),mI/Cr positively correlated with neuroticism scores(r=0.576,P<0.01),and Cho/Cr positively correlated with age(r=0.613,P<0.01),all differences were statistically significant.Multivariate Logistic regression analysis showed that introversion extroversion was an influencing factor of inferiority complex in patients with bipolar depression,with a statistical difference[OR=0.870,95％CI(0.782,0.968),P<0.05].Conclusions Low mI/Cr values in the vmPFC may be associated with inferiority complex in patients with bipolar depression.The inferiority complex in patients with bipolar depression is associated with introversion extroversion personality traits,and extroversion may serve as a protective factor against this inferiority complex in such patients.

Abstract:Objective To explore the prognostic value of peripheral blood neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and systemic inflammatory response index(SIRI)in patients with myasthenia gravis(MG).Methods Clinical data from 117 MG patients admitted to the Affiliated Hospital of Xuzhou Medical University between September 2018 and June 2022 were retrospectively analyzed.All patients underwent blood routine examination upon admission,with calculation of the NLR,PLR,SII and SIRI.The severity of MG was assessed using the Myasthenia Gravis Foundation of America(MGFA)clinical classification.The Myasthenia Gravis Foundation of America-Post Intervention Status(MGFA-PIS)was used to assess the prognosis of MG patients.Complete stable remission,pharmacological remission,and minimal manifestations were considered favorable prognoses,while states below minimal manifestations were considered poor prognoses.Patient prognosis was recorded through telephone and outpatient follow-up.Logistic regression model was employed to analyze the data,and receiver operating characteristic(ROC)curve was used to evaluate the discriminatory efficacy of various immune markers in predicting the prognosis of MG patients.Based on the optimal cutoff values from the ROC curves of each model,samples were divided into high-expression and low-expression groups for further intergroup comparative analysis and Spearman correlation analysis.Results The favorable prognosis group(85 cases)and the poor prognosis group(32 cases)exhibited statistically significant differences in disease classification,disease duration,hematological indicators(white blood cell count,neutrophil count,lymphocyte count),NLR,PLR,SII,and SIRI(P＜0.05).ROC curve analysis indicated that NLR and SIRI demonstrated good efficacy in predicting the prognosis of MG.The optimal cutoff value for NLR was 3.62,with an area under the curve(AUC)of 0.765,specificity of 84.7%,and sensitivity of 71.9%.The optimal cutoff value for SIRI was 1.08,with an AUC of 0.754,specificity of 75.3%,and sensitivity of 71.9%.Based on optimal cutoff values(NLR:3.62,PLR:128.33,SII:962.42,SIRI:1.08),the results showed that the high and low NLR and SIRI groups were all statistically correlated with the duration of MG and MGFA clinical classification,the high and low SII group was startistically correlated with MGFA clinical classification(all P＜0.05).Spearman correlation analysis showed that SII was strongly positively correlated with prognosis(ρ=0.555,P＜0.001),SIRI(ρ=0.447,P＜0.001)was moderately positively correlated with NLR(ρ=0.386,P＜0.001),and PLR was weakly positively correlated with prognosis(ρ=0.271,P=0.003),with statistically significant differences.Conclusions NLR,PLR,SII,and SIRI can serve as important immune markers for prognostic evaluation of patients with MG.In particular,NLR and SIRI demonstrate strong predictive value,aiding clinicians in evaluating patients'prognostic risk and providing reference for developing personalized treatment plans.

Abstract:Objective To explore the neuro-metabolism and thyroid function in female adolescents with bipolar depression and obsessive-compulsive symptoms(OCS).Methods From January 2024 to February 2025,35 female adolescents with bipolar depression who received outpatient or inpatient treatment at the Department of Clinical Psychology of People's Hospital of Xinjiang Uygur Autonomous Region were selected as study subjects.According to whether there was significant OCS and the Children's Yale-Brown Obsessive Compulsive Scale(CY-BOCS)score,patients were divided into an OCS group(n=20,CY-BOCS score≥16)and non-OCS group(n=15,CY-BOCS score≤7).The 24-item Hamilton Depression Scale(HAMD-24)and Young Mania Rating Scale(YMRS)were used to assess patients'depressive and manic symptoms,respectively.1H-magnetic resonance spectroscopy(1H-MRS)was employed to assess metabolic levels of N-acetyl-aspartate(NAA),choline(Cho),myo-inositol(mI),and glutamate/glutamine complex(Glx),and creatine(Cr)in the ventromedial prefrontal cortex(vmPFC)of patients.Chemiluminescent immunoassay was utilized to detect serum thyroid function indicators.Binary Logistic regression was used to examine the association between neuro-metabolism,thyroid function,and OCS.The calibration and discriminatory performance of the model were assessed using the Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve.Results Patients in OCS group had higher HAMD-24 scores[(26.8±5.8)vs.(23.2±3.9)]and longer disease duration[3.0(1.0,5.0)years vs.1.0(0.5,2.0)years]than those in non-OCS group,with statistically significant differences(t=-2.070,Z=-2.190;both P＜0.05).Patients in OCS group exhibited lower NAA/Cr values and FT3 levels compared to non-OCS group[1.56(1.18,1.72)vs.1.87(1.72,2.04),(3.13±0.49)vs.(3.48±0.50)],with statistically significant differences(Z=-3.200,t=2.049;both P＜0.05).Binary Logistic regression analysis revealed that the NAA/Cr value[OR=0.091,95%CI(0.014,0.588),P=0.012)]was a protective factor for patients with OCS,with a statistically significant difference(Hosmer-Lemeshow test χ2=9.00,P=0.253;area under the ROC curve was 0.820,P＜0.001).Conclusions Among female adolescents with bipolar depression,those with comorbid OCS exhibit severe depression,long disease duration,and low NAA/Cr values and serum FT3 levels in vmPFC.Decreased NAA/Cr is independently associated with comorbid OCS,suggesting its potential as a biological marker for identifying such comorbidities.

Abstract:Adolescent bipolar disorder(BD)exhibits complex pathophysiological associations with overweight/obesity in brain-metabolism,involving maternal pregnancy,brain structure,cerebral blood flow,blood lipids,and appetite hormones.This paper reviews the relationship between adolescent BD and overweight/obesity in terms of brain-metabolism and treatment,and explores potential research directions.

Abstract:Objective To explore the relationship between the brain biochemical metabolism of the ventromedial prefrontal cortex(vmPFC)and childhood trauma in pediatric bipolar disorder using 1H-magnetic resonance spectroscopy(1H-MRS).Methods From March to September 2023,43 children and adolescent patients with bipolar disorder who were either outpatient or inpatient at the Department of Clinical Psychology of People's Hospital of Xinjiang Uygur Autonomous Region were selected as study subjects.Childhood Trauma Questionnaire(CTQ)was used to assess the childhood trauma in children and adolescents with bipolar disorder,subsequently dividing patients into a trauma group(n=20)and a non-trauma group(n=23).Using 1H-MRS,the ratios of the vmPFC neurometabolites N-acetyl-aspartate(NAA)/creatinine(Cr),myo-inositol(mI)/Cr,and choline(Cho)/Cr were compared between the two groups of patients.Results There were no statistically significant differences between the two groups of patients in terms of age,gender,only-child status,place of residence,years of education,age at onset,disease duration,or family history(all P＞0.05).The NAA/Cr value in trauma group was(1.49±0.17),which was statistically lower than that in non-trauma group[(1.67±0.10)](t=4.397,P＜0.001).There was no statistically significant difference in Cho/Cr and mI/Cr values between the two groups of patients(both P＞0.05).Conclusions Compared to patients without trauma,those with trauma may exhibit lower levels of NAA in the vmPFC.

Abstract:Objective To compare the characteristics of attempted suicide in patients with schizophrenia,major depressive disorder,and bipolar disorder,to provide a scientific basis for developing suicide prevention frameworks for patients with different mental illnesses and to promote the further advancement of suicide prevention efforts.Methods This study was a cross-sectional study.From October 2022 to October 2024,256 patients were enrolled from Beijing Huilongguan Hospital,Tianjin Anding Hospital,and the First Hospital of Shanxi Medical University.All patients met the diagnostic criteria for schizophrenia,major depressive disorder,or bipolar disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)and reported a history of suicide attempts.Demographic characteristics,clinical features,and characteristics of the most recent suicide attempt were collected through patient interviews.Multiple Logistic regression analysis was conducted to compare clinical and suicide attempt characteristics across groups.Results This study included patients who reported suicide attempts,including 57 patients with schizophrenia,140 patients with major depressive disorder and 59 patients with bipolar disorder.Compared with major depressive disorder group and bipolar disorder group,individuals with schizophrenia exhibited a higher proportion of"very few"suicidal ideation before their most recent attempted suicide[29.8%(17/57)vs.7.9%(11/140)and 16.9%(10/59)],with a statistically significant difference(χ2=27.00,P＜0.01).The proportion of individuals with attempted suicide in major depressive disorder group was higher than that in schizophrenia group[65.2%(90/140)vs.45.6%(26/57)],and the intensity of suicide intention was also higher than that in schizophrenia group[14.0(11.0,15.8)vs.12.0(11.0,14.0)],with statistically significant differences(χ2/H=6.39,7.10;both P＜0.05).The primary methods of suicide attempts across the three patient groups were low-lethality methods such as medication and cutting[66.7%(38/57),68.6%(96/140),67.8%(40/59)],with no statistically significant differences(χ2=0.37,P＞0.05).Multiple Logistic regression analysis revealed that compared with major depressive disorder group,patients with schizophrenia were significantly more likely to experience infrequent suicidal ideation before suicide attempts[OR(95%CI)=15.47(1.25,191.52)].Compared with major depressive disorder group or bipolar disorder group,schizophrenia group had lower levels of depressive disorder[OR(95%CI)=0.77(0.69,0.86),0.82(0.73,0.92)],higher levels of hallucinations[OR(95%CI)=1.09(1.04,1.15),1.07(1.02,1.11)],and higher levels of delusions[OR(95%CI)=1.07(1.01,1.14),1.08(1.01,1.16)].The level of social support in schizophrenia group was lower than that in bipolar disorder group[OR(95%CI)=0.86(0.79,0.95)].Conclusions Patients with schizophrenia exhibited significantly lower frequencies of suicidal ideation before attempting suicide compared to those with MDD and BD.Low-lethal methods such as medication and cutting were main methods of attempted suicide among all three groups.Therefore,suicide prevention efforts should strengthen the standardized management of medications and sharp objects to reduce accessibility risks.For patients with schizophrenia specifically,it is necessary to move beyond the suicide ideation-centered risk assessment model,and integrate their psychiatric symptoms to establish a more comprehensive evaluation and prevention system,which will facilitate precise suicide intervention for patients with different mental disorders.

Abstract:Bipolar disorder(BD)is a severe mental disorder characterized primarily by recurrent mood swings,with a prolonged course and high recurrence rate.Epidemiological evidence indicates that individuals with BD have a significantly higher risk of developing physical diseases compared to the general population.These comorbidities exhibit a multisystem clustering pattern and exert a substantial impact on functional outcomes and mortality risk.The comorbidity relationship between BD and physical diseases is relatively complex,and its mechanisms may involve pathological and physiological changes in BD patients,adverse drug reactions,shared biological mechanisms,or unhealthy lifestyles.Accordingly,this paper reviews the epidemiological characteristics and potential mechanisms of BD and common physical disease comorbidities,analyzes the management difficulties posed by comorbidity in diagnostic identification,medication selection,treatment adherence,and medical collaboration,and proposes clinical response strategies centered on early risk stratification,regular physical monitoring,and multidisciplinary integrated care,aiming to provide references for improving the long-term outcome of BD patients.

Abstract:Sleep disorders are a critical public health issue,and their association with quality of life is receiving increasing attention.Research suggests that diet is one of the factors affecting sleep,and adjusting diet to improve sleep quality is a relatively simple,feasible,and widely accepted intervention strategy.This paper summarizes and analyzes existing research and explores the regulatory effects of the three major nutrients and typical dietary patterns on sleep quality,duration,and structure.Research has found that a high-carbohydrate diet may be associated with increased rapid eye movement sleep,while dietary fiber helps prolong slow-wave sleep time;the Mediterranean diet rich in fruits and vegetables improves sleep quality through anti-inflammatory and antioxidant effects;the ketogenic diet shows potential for stabilizing sleep in specific populations.Future research should consider the bidirectional effects between sleep and diet,focusing on differences in their mutual influence among different populations,and observing the impact of dietary patterns on sleep in natural conditions through cohort studies.

Abstract:Traumatic brain injury is the most common neurosurgical disease,characterized by high morbidity and mortality.On the basis of primary external force injury,secondary brain injury arises from pathophysiological changes such as oxidative stress,apoptosis,and neuroinflammation,leading to impaired cellular function and brain function.Therefore,finding ways to improve the treatment of secondary brain injury has become particularly important.Autophagy is the process of cell self-phagocytosis.Increasing evidence indicates that the autophagy pathway following traumatic brain injury can affect pathophysiological processes such as oxidative stress,apoptosis,neuroinflammation and so on.This paper reviews the autophagy process and research on autophagy in traumatic brain injury,aiming to identify novel therapeutic targets for traumatic brain injury.

Abstract:Early screening for mild cognitive impairment(MCI)is important in preventing the onset of dementia or slowing its progression.Numerous studies have shown that balance function evaluation has an important role in the identification and early warning of patients with MCI.Currently,MCI screening in China is still dominated by neuropsychological scales,which fails to reflect the research and application value of balance function-related indicators in MCI screening.By reviewing and analyzing the previous literature,this paper starts from the dimensions of balance function in MCI patients to clarify the concept of balance function,the neurological basis of balance abnormalities in MCI patients,the commonly used balance assessment methods,and the correlation between balance function and cognitive function,with the aim of providing a theoretical basis for the future development of a balance function-based early screening tool for MCI.

Abstract:Objective To investigate the interaction effects of hyperactive behaviors in children with autism spectrum disorder(ASD)and parental self-esteem on parental depressive disorder,along with subgroup differences,so as to provide theoretical support for developing targeted psychological intervention strategies for parents of children with ASD.Methods Parents of all children with ASD who met the inclusion and exclusion criteria and attended outpatient visits at the Fourth People's Hospital of Wuhu from November 2023 to February 2025 were consecutively enrolled.Concurrently,convenience sampling was used to sequentially recruit 273 parents of children with ASD who were diagnosed at the Fourth People's Hospital of Wuhu or had a diagnosis documentation from a ClassⅢ Grade A psychiatric hospital and voluntarily participated in the study.General Information Questionnaire,Self-Rating Depression Scale(SDS),Rosenberg Self-Esteem Scale(RSES),and Swanson,Nolan and Pelham,Version IV(SNAP-Ⅳ)were used to assess demographic data,children's hyperactive behaviors,parental depressive symptoms,and self-esteem levels,respectively.The χ2 test was performed using SPSS 26.0.Stratified binary Logistic regression analysis was conducted to examine the independent effects,interaction effects,and subgroup differences between hyperactive behaviors in children with ASD and parental self-esteem on parental depressive symptoms.Results Among 273 parents of children with ASD,167(61.2%,167/273)exhibited depressive symptoms.Univariate analysis revealed statistically significant differences in the incidence of depressive symptoms among parents of children with ASD across various factors,including parental self-esteem levels,questionnaire respondents,monthly household income,child's school type,educational attainment,and children's hyperactive behavior(all P＜0.05).Regression analysis showed that both children's hyperactive behavior and parental low self-esteem increased the risk of parental depressive disorder,and the risk of depressive disorder among mothers of these children was 2.288 times higher than that among fathers,with a statistically significant difference(P＜0.01).Subgroup analysis revealed that in the male pediatric subgroup,hyperactive behavior significantly increased the risk of parental depressive disorder by 4.831 times,with a statistically significant difference(P＜0.01).Interaction effect analysis showed a statistically significant positive additive interaction effect between children's hyperactive behavior and parental low self-esteem on parental depressive symptoms.The relative excess risk of interaction(RERI),attributable proportion(AP),and synergy index(S)were 6.751[95%CI(0.365,27.922)],0.561[95%CI(0.041,0.830)],and 2.578[95%CI(1.039,7.763)],respectively.Conclusions Mothers of children with ASD exhibit significant depressive disorder,and hyperactive behaviors in male children further exacerbate parental depressive disorder.Hyperactive behaviors of children and parental self-esteem show a significant additive interaction effect on parental depressive disorder.

Abstract:low-grade developmental and epilepsy-associated brain tumors(LEAT)are the second most common cause of focal epilepsy in adolescents.These tumors present primarily with epileptic seizures and carry a favorable prognosis.Common types include ganglioglioma(GG)and dysembryoplastic neuroepithelial tumor(DNT).The 2021 fifth edition of the WHO Classification of Tumors of the Central Nervous System(CNS WHO 5th)has introduced molecular typing,which aids in the diagnosis and classification of LEAT.LEAT molecular types include tumors predominantly driven by BRAF V600E mutation,fibroblast growth factor receptor 1(FGFR1)mutation,and MYB alterations.Surgical treatment is the primary method for this condition.Most patients experience relief from epileptic symptoms after surgery.However,for patients with persistent seizures,long-term use of antiepileptic drugs is recommended.At present,the impact of LEAT molecular typing on treatment and prognosis requires further investigation.This paper provides a review of LEAT based on CNS WHO 5th,aiming to provide reference for the diagnosis and treatment of LEAT.

Abstract:Objective To explore the expression characteristics,clinical correlations,and potential biological functions of the ATPase Na+/K+transporting subunit alpha 2(ATP1A2)gene in glioma,and thoroughly analyze its biological role in the pathological progression of glioma.Methods mRNA sequencing data from the Chinese Glioma Genome Atlas(CGGA)(n=325)and The Cancer Genome Atlas(TCGA)(n=675)glioma cohorts were retrospectively analyzed to assess ATP1A2 expression levels.Based on the X-tile platform and the surv_cutpoint function in the R language's survminer package,the cutoff value most significantly associated with survival was selected(CGGA:6.446 1,TCGA:12.660 23).The group with ATP1A2 expression levels above the most significant cutoff value was classified as the ATP1A2 high-expression group,while the group with levels below the cutoff was classified as the ATP1A2 low-expression group.Kaplan-Meier curve,log-rank test,and Cox proportional hazard model were employed to evaluate the relationship between ATP1A2 expression and overall survival in patients.The functions of genes co-expressed with ATP1A2 were explored through Gene Ontology(GO)annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Results The comparison of clinical and pathological characteristics between CGGA and TCGA cohorts revealed statistically significant differences between the two cohorts in primary WHO grading,isocitrate dehydrogenase(IDH)mutation status,and 1p/19q co-deletion(all P＜0.05).mRNA sequencing data from two cohorts showed statistically significant differences in ATP1A2 expression levels in WHO grade 2 to 4 glioma tissues(F=28.67,48.26;both P＜0.01),with a decreasing trend observed as tumor grade increased.Further analysis revealed that in both the CGGA and TCGA databases,ATP1A2 expression was statistically higher in IDH-mutant gliomas compared to IDH wild-type gliomas(both P＜0.01).No statistical differences in ATP1A2 expression were observed across different O6-methylguanine-DNA methyltransferase(MGMT)promoter methylation states(all P＞0.05).Analysis of CGGA and GSE131928 single-cell data indicated that ATP1A2 was primarily expressed in tumor cells.Patients with low ATP1A2 expression exhibited significantly short overall survival in both the CGGA and TCGA cohorts,with statistically significant differences(CGGA:ATP1A2 high-expression group 6.411 years,ATP1A2 low-expression group 1.203 years,χ2=41.05,P＜0.01;TCGA:ATP1A2 high-expression group 4.233 years,ATP1A2 low-expression group 1.467 years,χ2=28.81,P＜0.01).Univariate[HR=0.721,95%CI(0.654,0.794)]and multivariate Cox[HR=0.793,95%CI(0.716,0.879)]analysis demonstrated that ATP1A2 expression was an independent risk factor for glioma,with statistically significant differences(P＜0.01).GO enrichment analysis revealed that genes positively correlated with ATP1A2 in the TCGA and CGGA databases were primarily involved in biological processes such as acidic amino acid transport,L-glutamate transmembrane transport,and amino acid transport.KEGG pathway enrichment analysis indicated that genes positively correlated with ATP1A2 in the CGGA database were associated with GABAergic synapses and neuroactive ligand signaling.Genes positively correlated with ATP1A2 in the TCGA database were associated with the metabolism of alanine,aspartate,and glutamate,as well as the reabsorption of bicarbonate in the proximal tubule.Conclusions This study confirms that ATP1A2 is an independent prognostic biomarker for glioma,with its low expression indicating poor patient prognosis.This discovery not only provides a novel molecular tool for assessing the prognosis of gliomas,but also identifies potential targets within associated biological pathways for developing new therapeutic strategies targeting ion metabolism and neurotransmitter homeostasis within the tumor microenvironment.

Abstract:Glioma is the most common primary malignant brain tumor in adults and is difficult to cure with current treatment methods.Isocitrate dehydrogenase(IDH)mutant gliomas exhibit molecular heterogeneity.The mutated IDH gene product D-2-Hydroxyglutarate(D-2-HG)promotes DNA hypermethylation and immune suppression thereby driving tumor growth.In recent years,IDH inhibitors such as Ivosidenib and Vorasidenib have demonstrated the ability to reduce D-2-HG levels and induce cellular differentiation in preclinical models and early-phase clinical trials.The Phase Ⅲ INDIGO trial demonstrates that Vorasidenib significantly prolongs progression-free survival in patients with non-amplified grade 2 IDH mutant gliomas,and receives FDA approval in 2024.This paper provides a detailed overview of the progress of IDH inhibitors for gliomas treatment,highlighting their role as a well-tolerated therapeutic option that offers benefits for selected patient populations.Future research combining novel drugs and combination therapies may further expand its therapeutic potential.

Abstract:Objective To explore the relationship between laboratory tests,infarct site,respiratory events,sleep quality,neurological function of obstructive sleep apnea(OSA)primarily characterized by rapid eye movement(REM)and clinical prognosis of acute cerebral infarction.Methods This study was a retrospective cohort study.From September 2023 to September 2024,270 patients with acute cerebral infarction and underwent polysomnography(PSG)in the Department of Neurology of the Affiliated Hospital of Yangzhou University were selected as study subjects.Patients'general information,blood routine,magnetic resonance imaging(MRI)Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index(PSQI),the National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI)Rating Scale,Modified Rankin Scal(mRs),objective sleep data obtained from PSG,and prognostic indicators obtained from follow-up were collected.Linear regression was applied to analyze the relationship between rapid eye movement apnea hypopnea index(REM-AHI)and clinical data,and binary Logistic regression was applied to analyze the factors influencing the REM-OSA in patients with acute cerebral infarction.Results A total of 270 patients in the entire acute cerebral infarction cohort received overnight PSG.A total of 229(84.8%)patients with acute cerebral infarction were diagnosed with OSA,including 37(16.2%)in REM-OSA group and 192(83.8%)in NREM-OSA group.Leukocyte and neutrophil counts were higher in REM-OSA group than those in NREM-OSA group,and the differences were statistically significant(both P＜0.05).The percentage of patients in REM-OSA group with acute cerebral infarction sites in the basal ganglia was higher than that in NREM-OSA group,and the difference was statistically significant(P＜0.05).The ESS score was lower in EEM-OSA group than that in NREM-OSA group,the PSQI scores for time to sleep and sleep efficiency dimensions were higher in REM-OSA group than those in NREM-OSA group,and the differences were statistically significant(all P＜0.05).The N2 duration,number of NREM apneas,NREM-AHI,AHI,oxygen desaturation index(ODI),arousal index,and respiratory event-related arousal index in REM-OSA group were lower than those in NREM-OSA group,and the REM-AHI in REM-OSA group was higher than that in NREM-OSA group,which were statistically significant differences(all P＜0.05).Binomial Logistic regression showed that mRS scores was an influencing factor of REM-OSA in acute cerebral infarction,and the difference was statistically significant(P＜0.05).Linear regression analysis showed that body mass index and leukocytes were the influencing factors of REM-AHI in patients with acute cerebral infarction,and the difference was statistically significant(both P＜0.05).Conclusions Compared with NREM-OSA,patients with acute cerebral infarction complicated by REM-OSA exhibit high inflammatory markers,a great tendency for infarction to involve the basal ganglia,prominent respiratory events during REM,and poor sleep quality and neurological functional outcomes.

Abstract:Objective To explore the expression characteristics and clinical prognostic significance of tyrosine kinase binding protein(TYROBP)gene in gliomas,providing a theoretical basis for developing targeted therapeutic strategics based on TYROBP.Methods This study conducted multidimensional analysis based on the Chinese Glioma Genome Atlas(CGGA)and The Cancer Genome Atlas(TCGA)databases.Firstly,a retrospective study was conducted on transcriptome sequencing data and corresponding clinical data from two independent cohorts in the CGGA database(Dataset 1 containing 325 samples and Dataset 2 containing 693 samples)and one cohort in the TCGA database(Dataset 3 containing 697 samples)to systematically investigate the relationship between TYROBP gene expression and patient clinical pathological characteristics.Concurrently,six surgical specimens of primary gliomas pathologically confirmed by the Department of Neurosurgery at Beijing Tiantan Hospital were collected between March and April 2025.Immunohistochemical techniques were employed to detect the expression distribution of the TYROBP in tumor tissues of different pathological types.Further research was conducted on the whole exome sequencing data of 286 glioma patients included in the CGGA database(Dataset 4).Based on the median TYROBP expression value(M=148.56),the cases were divided into TYROBP low expression group(expression level≤148.56,n=116)and TYROBP high expression group(expression level＞148.56,n=115),and the copy number variation characteristics and gene mutation spectrums were compared between the two groups.Survival analysis employed the Kaplan-Meier method to evaluate the association between TYROBP expression levels and patient overall survival,with its prognostic value validated through univariate and multivariate Cox proportional hazards models.In terms of mechanism exploration,functional enrichment analysis was performed on Dataset 1 to elucidate the biological processes involving genes co-expressed with TYROBP.The CIBERSORT algorithm was employed to quantitatively analyze the infiltration proportions of 22 immune cells within the tumor microenvironment,investigating the correlation patterns between various immune cell subpopulations and TYROBP expression.Results In Dataset 1,Dataset 2,and Dataset 3,the expression levels of the TYROBP gene increased with higher WHO grades(2-4),with all differences being statistically significant(F=38.379,14.681,76.724;all P＜0.01).TYROBP expression levels were statistically higher in wild-type isocitrate dehydrogenase(IDH)tumors compared to IDH-mutant tumors with 1p/19q deletion[Dataset 1:(7.19±0.10)vs.(5.55±0.11)(F=54.120,P＜0.01);Dataset 2:(7.54±0.11)vs.(6.54±0.10)(F=25.151,P＜0.01),Dataset 3:(3.37±0.17)vs(3.07±0.17)(F=171.19,P＜0.01)].Correlation analysis of clinical pathological characteristics revealed that TYROBP expression was statistically lower in primary tumors,low-grade tumors,and IDH-mutant cases with 1p/19q co-deletion compared to recurrent tumors,high-grade tumors,and non-IDH-mutant cases with 1p/19q co-deletion(P＜0.01).The analysis of gene mutations and copy number changes in Dataset 1 showed that the mutation rates of E3 ubiquitin ligase 1 containing HECT and RLD domains(HERC1)[4%(5/115)]and thrombospondin type 1 domain containing protein 7B(THSD7B)[4%(5/115)]in the TYROBP high expression group were higher than those in the low expression group(both 0%),and the differences were statistically significant(both χ2=4.117,both P＜0.05).In Dataset 1,Dataset 2,and Dataset 3,the overall survival(OS)of the TYROBP high expression group was shorter than that of the low expression group,with statistically significant differences(all P＜0.05).Multivariate Cox regression analysis showed that glioblastoma(GBM)[HR=2.218,95%CI(1.438,3.422),P＜0.001),1p/19q co-deletion[HR=0.279,95%CI(0.163,0.481),P＜0.01],and TYROBP overexpression[HR=1.582,95%CI(1.155,2.168),P＜0.01]were independent risk factors of the prognosis of glioma patients,and the differences were statistically significant.Functional enrichment analysis indicated that TYROBP participated in tumor microenvironment remodeling by regulating leukocyte-mediated immune responses and immunomodulatory processes.Correlation analysis revealed that this gene was positively correlated with the degree of M2 macrophage infiltration(r=0.42,P＜0.001)and negatively correlated with the degree of initial CD4+T cell infiltration(r=-0.45,P＜0.001),with statistically significant differences.The expression of TYROBP was closely related to multiple key genes in leukocyte-mediated immunity.C1QA(r=0.924)and C1QC(r=0.904)were significantly positively correlated with TYROBP expression,and significantly negatively correlated with PIK3CB(r=-0.407)and PIK3R1(r=-0.405),with statistically significant differences(all P＜0.05).Conclusions This study confirms that the expression pattern of TYROBP exhibits significant tumor type specificity.Its expression levels are not only closely associated with patient prognosis but also play a crucial role in regulating the tumor immune microenvironment.These findings provide a theoretical basis for developing targeted therapeutic strategies based on TYROBP.

Abstract:The initiation and progression of brain tumors are jointly regulated by multiple factors.In recent years,skull bone marrow—a crucial immunoregulatory microenvironment—has been increasingly recognized for its key regulatory role in brain tumors.Skull bone marrow not only directly participates in tumor immune evasion processes but also profoundly influences the remodeling of the tumor microenvironment and the efficacy of immunotherapy by regulating the recruitment and function of immune cells.However,the specific mechanisms by which skull bone marrow regulates the immune microenvironment of brain tumors remain largely unexplored.In-depth investigation into the role of skull bone marrow in brain tumors not only aids in understanding the dynamic changes within the tumor immune microenvironment but also provides new theoretical foundations for developing precise and effective immunotherapy strategies.This paper reviews the role of skull bone marrow in the immune microenvironment of brain tumors,focusing on its key functions in tumor immune evasion,immune microenvironment remodeling,and immunotherapy,while also exploring its potential for future clinical translation based on the latest research advances.

Abstract:Objective To explore the incidence and risk factors of delirium in mechanically ventilated adult patients through meta-analysis,so as to provide a reference for early clinical prevention of delirium.Methods Cross-sectional studies,cohort studies,and case-control studies on the incidence and risk factors of delirium in mechanically ventilated patients were retrieved from The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure,WanFang Data,VIP and China Biomedical Literature Database.The search period was from database establishment to August 13,2023.After evaluating the included studies,a meta-analysis of incidence and risk factors was conducted using Stata 17.0.Results A total of 25 studies were included,including 5 936 mechanically ventilated patients.The incidence of delirium in mechanically ventilated patients was 0.42[95%CI(0.34,0.50)].Meta-analysis revealed that risk factors for delirium included advanced age[OR=1.15,95%CI(1.07,1.24)],high Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ)scores[OR=1.40,95%CI(1.24,1.58)],prolonged mechanical ventilation[OR=1.30,95%CI(1.16,1.45)],use of sedatives[OR=1.88,95%CI(1.07,3.29)],hypoxemia[OR=4.09,95%CI(1.77,9.45)],prolonged length of ICU stay[OR=1.18,95%CI(1.04,1.35)],sleep deprivation[OR=12.38,95%CI(4.61,33.22)],pain[OR=2.02,95%CI(1.85,2.21)],physical restraints[OR=2.79,95%CI(1.57,4.98)],history of drinking[OR=2.42,95%CI(1.45,4.05)],and history of hypertension[OR=1.78,95%CI(1.44,2.20)].Conclusions The incidence of delirium is relatively high among mechanically ventilated patients.Advanced age,high APACHE II score,prolonged mechanical ventilation,use of sedatives,hypoxemia,prolonged length of ICU stay,sleep deprivation,pain,physical restraints,history of drinking,and hypertension are risk factors for delirium in mechanically ventilated patients.Early prevention,identification,and implementation of effective preventive measures should be based on the patient's condition and risk factors to reduce the incidence of delirium in mechanically ventilated patients.