Abstract:Objective To investigate the relationship between fatigue and depressive symptoms in patients with multiple sclerosis. Methods A total of 108 patients with multiple sclerosis who visited the Neurology Clinic of Nanjing Meishan Hospital from August 2018 to July 2021 were selected as the study subjects. Fatigue was assessed using the Modified Fatigue Impact Scale （MFIS）， with an MFIS score of 38 or higher defined as fatigue. Depressive symptoms were evaluated using the Chinese version of Beck Depression Inventory- Ⅱ （BDI- Ⅱ）. The degree of neurological damage was assessed by the Extended Disability Status Scale （EDSS）， and perceived health-related quality of life and health status were measured using the ShortForm-36 Health Survey （SF-36）. The correlation segmented effect between patient fatigue and depression level was analyzed by using generalized additive mixed model to smooth curve fitting and segmented multivariate Logistic regression. Results The incidence of fatigue in patients with multiple sclerosis was 50.9% （55/108）. The multivariate Logistic regression analysis displayed a significant positive correlation between fatigue and BDI- Ⅱ score （OR=1.18， 95%CI=1.09-1.28， P ＜ 0.01）. The generalized additive mixed model to smooth curve fitting showed the results that there was a non-linear relationship between BDI- Ⅱ score and fatigue， with one inflection point. Using the inflection point for segmented multivariate logistic regression analysis， the results showed that when the BDI- Ⅱ score was less than 12.0， fatigue was positively correlated with the BDI-Ⅱ score （OR=1.33， 95%CI=1.15-1.54， P＜ 0.01）. When the BDI-Ⅱ score was ≥ 12.0， there was no statistically significant correlation between fatigue and BDI-Ⅱ score （OR=1.04， 95%CI=0.91-1.19， P＞ 0.05）.Conclusions There was a non-linear correlation between BDI- Ⅱ score and fatigue in patients with multiple sclerosis， and appropriate depression management may help alleviate fatigue symptoms in patients with multiple sclerosis.

Abstract:Objective To analyze the recurrence influencing factors of acute ischemic stroke based on propensity score matching. Methods A total of 913 patients with first diagnosis as acute ischemic stroke who were discharged from Shanxi Cardiovascular Hospital from January to July 2021 were selected as the research subjects. The patients were divided into recurrent group （n=276） and non-recurrent group （n=637） based on the presence of new infarcts. The general data of the two groups were compared before matching. The propensity score matching method was used to match the general data with statistically significant differences between the two groups， with a ratio of 1∶1 and 1∶2， and a caliper value of 0.02. After 1st matching， both the recurrent and non-recurrent groups consist of 273 patients. 265 patients were included in the recurrent group and 528 patients were included in the non-recurrent group in the 2nd match.Multivariate Logistic regression model was used to analyze the influencing factors of recurrence in patients with acute ischemic stroke. Results There was a statistically significant difference in age， gender， smoking， and alcohol consumption between the recurrent group and non-recurrent group before matching （P ＜ 0.05）. After twice matches， there was no statistically significant difference in age， gender， smoking， and alcohol consumption between the two groups of patients （P ＞ 0.05）. The 1st multivariate stepwise Logistic regression analysis showed that hypertension （OR=1.868， 95%CI=1.251-2.790）， diabetes （OR=1.589， 95%CI=1.063-2.375）， systolic pressure（OR=0.983，95%CI=0.972-0.994）， low-density lipoprotein （OR=0.793， 95%CI=0.639-0.983）， homocysteine （OR=0.984， 95%CI=0.970-0.997）， D-dimer （OR=2.537， 95%CI=1.477- 4.357） were recurrence influencing factors in patients with acute ischemic stroke. After the 2nd matching， multivariate stepwise Logistic regression analysis showed that hypertension （OR=1.904， 95%CI=1.344-2.698）， diabetes （OR=1.637， 95%CI=1.157-2.315）， triglycerides （OR=0.800， 95%CI=0.644-0.995）， low-density lipoprotein （OR=0.776， 95%CI=0.629-0.958）， homocysteine （OR=0.987， 95%CI=0.975-1.000）， and D-dimer （OR=1.515， 95%CI=1.160-1.977） were influencing factors for recurrence in patients with acute ischemic stroke （P ＜ 0.05）. Conclusions The recurrence influencing factors of acute ischemic stroke include hypertension， diabetes mellitus， low density lipoprotein， homocysteine， and D-dimer.

Abstract:Transcranial magnetic stimulation as a non-invasive brain stimulation technique， can regulate cortical excitability and promote functional compensation， which has been widely used in the rehabilitation of upper limb motor dysfunction after stroke. Under the guidance of neural function recovery model theory， different treatment programs of transcranial magnetic stimulation appeared. This paper describes the clinical application of transcranial magnetic stimulation under the guidance of different neurofunctional recovery models， and compares the curative effect， influencing factors and clinical application of different transcranial magnetic stimulation regimens， to provide reference for clinical treatment.

Abstract:Ischemic stroke is the common type of stroke， with the characteristics of high recurrence rate and high disability， and has become one of the main causes of death and disability. Platelet plays an important role in the pathogenesis of ischemic stroke. In recent years， studies have found that platelet related ratio has important clinical value in predicting the prognosis and outcome of ischemic stroke. In this review， we summarize the recent development of prognostic relevance between derived platelet-related ratios and ischemic stroke， such as the mean platelet volume-to-platelet count （MPV/PC） ratio， platelet-to-lymphocyte ratio （PLR）， mean platelet volume-to-lymphocyte ratio （MPVLR）， platelet-to-neutrophil ratio （PNR）， red blood cell distribution width-to-platelet ratio （RPR）.

Abstract:Ischemic stroke has a high morbidity， disability and fatality rate， which brings a huge burden to the patient's family and society. Mitochondria are known as the power factories of cells， which are extremely sensitive to changes in blood oxygen and play a key role in maintaining cellular metabolism. In recent years， more and more studies have shown that mitochondrial dynamics and mitophagy are closely related to the occurrence of cerebrovascular diseases. This article mainly summarizes the mechanisms of mitochondrial dynamics and mitophagy and their roles in ischemic stroke， to provide new ideas for the diagnosis and treatment of ischemic stroke.

Abstract:Objective To investigate the genetic alterations and histopathological features of IDHmutant astrocytoma grade 4. Methods From July 2021 to July 2022， in the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University， a total of 73 patients were recruited， who undertook surgery treatment and diagnosed as IDH-mutant astrocytoma grade 4 by postoperative histopathology. These cases' epidemiological and morphological characteristics were gathered and studied. The second generation sequencing method was used to detect the molecular pathology characteristics of tumors； Immunohistochemical staining was used to detect the characteristic protein expression in tumor cells. Results The median age of the IDH-mutant astrocytoma grade 4 patients （n=73） was 38 years old， male accounting for 56.2% （41/73）. 75.3% （55/73） of the tumors were in the frontal lobes. Necrosis and/or microvascular proliferation were absent in 13.7% of the tumors， which histopathological grade conforms to grade 2/3 astrocytoma. Other 86.3% （63/73） of tumors showed microvascular proliferation and necrosis， consistent with the characteristics of grade 4 astrocytoma. Immunohistochemistrical examination revealed significant IDH R132H positivity in the 73 tumors. The positive rate of P53 was 88.1% （59/67）. The loss of ATRX （α-thalassemia/mental retardation， X-linked） expression is 83.6% （56/67）. Molecular pathology test results showed that all patients had IDH1 R132H mutation. The promoter region of O-6-methylguanine DNA methyltransferase was methylated in 76.7% （56/73） of patients， and the mutation rate of TP53 and ATRX was 96.6% （57/59） and 64.3% （36/56） respectively. The proportion of homozygous deletion of cyclin dependent kinase inhibitor 2A/B （CDKN2A/B） was 46.6% （34/73）. Conclusions Necrosis and/or microvascular proliferation can be seen in the majority of grade 4 IDHmutant astrocytomas. However， some cases with homozygous CDKN2A/2B deletion displayed morphological characteristics aligned to lower-grade astrocytomas. For IDH mutant astrocytomas， molecular pathological testing including CDKN2A/B copy number is necessary.

Abstract:Objective To explore the influence of alexithymia on self-injury addiction of non-suicidal self-injury （NSSI） adolescents and the mediating role of internal emotional regulation in it， so as to provide reference for reducing self-injury addiction of NSSI teenagers. Methods A total of 123 adolescents diagnosed as NSSI in psychiatric outpatient department and inpatient department of the First Affiliated Hospital of Chongqing Medical University from December 2021 to August 2022 were recruited. The subscales of function and addiction of Ottawa Self-injury Inventory （OSI） and 20-Item Toronto Alexithymia Scale （TAS-20） were applied to investigate the cause of NSSI， self-injury addiction， and alexithymia. Pearson correlation analysis was used to analyze the correlation among the three. The mediating effect of internal emotion regulation between alexithymia and self-injury addiction was analyzed and tested using the Process plug-in and Bootstrap method. Results The total score of TAS-20 in 123 NSSI adolescents was （68.70±11.17）， the score of the functional subscale was （19.32±6.02）， the social influence was （15.29±6.24）， the external emotional regulation was （10.04±2.96）， the stimulation seeking was （6.30±3.21）， and the score of the addiction subscale was （20.26±8.16）. There was a statistically significant difference in the total TAS-20 scores among NSSI adolescents f different genders and whether they were only children （t=-2.64， -2.84； P ＜ 0.01）. The comparison of addiction subscale scores among NSSI adolescents with different parental marital status showed statistically significant differences （t=-2.03， P ＜ 0.05）. The score of TAS-20 was positively correlated with internal emotion regulation， social influence， external emotion regulation， stimulus-seeking dimension scores and addiction subscale score （r=0.24-0.58， P ＜ 0.01）. The internal emotional regulation of NSSI adolescents has a significant mediating effect between alexithymia and self-injury addiction， accounting for 46.34% of the total effect. Conclusions NSSI adolescent self-injury addiction may be related to internal emotional regulation and alexithymia， and internal emotional regulation plays a partial mediating role between alexithymia and self-injury addiction.

Abstract:Objective Using bioinformatics analysis to explore possible molecular mechanisms in the pathogenesis of schizophrenia and to search for biomarkers for the diagnosis of schizophrenia. Methods The GSE48072 dataset from the Gene Expression Omnibus （GEO） database was selected for bioinformatic analysis of the mRNA expression profiles of 31 schizophrenia patients and 35 healthy controls. Functional enrichment analysis was performed on the differential genes obtained from the screening. The protein-protein interaction （PPI） network of differential genes was constructed using string database and key genes were screened by Cytoscape software. The Cytoscape plugin CytoHubba was used to search for hub genes. The diagnostic value of key genes was verified by subject operating characteristic （ROC） curves. Results A total of 82 differential genes were screened. The results of the enrichment analysis showed that the differential genes were mainly concentrated in inflammation， immune regulation and unsaturated fatty acid metabolism. A total of 5 hub genes， CD244， GZMH， GZMA， KLRD1 and GZMK， were obtained after screening， and the areas under the ROC curves were 0.817， 0.725， 0.724， 0.717 and 0.693， respectively. Conclusions Patients with schizophrenia have abnormalities in inflammatory pathways， unsaturated fatty acids， and vitamin metabolism. The expression changes of CD244 and other 5 related genes can be used as biological markers for the diagnosis of schizophrenia.

Abstract:Objective To systematically evaluate the association between Helicobacter pylori （H.pylori） infection and Alzheimer disease （AD） by using Meta-analysis. Methods The databases were searched for casecontrol studies and cohort studies on the association between H.pylori infection and AD， including PubMed， Embase， Cochrane Library， Web of Science， CNKI， Wanfang Database， VIP database， and CBM. The search was limited to January 2000 through November 2022. Two researchers screened， extracted， and evaluated the quality of literature independently. Meta-analysis was conducted using RevMan 5.3 software. Results A total of 15 studies were included： 9 case-control studies (n=1 404) and 6 cohort studies （n=7 893）. Meta-analysis showed that the infection rate of H.pylori of AD group was higher than that of control group ［OR=1.58， 95%CI （1.21-2.06）， P＜ 0.01］； the content of HP-IgG antibody in AD patients was higher than that in control group ［MD=6.14， 95%CI （2.99-9.29）， P＜ 0.01］； the Minimum Mental State Examination score in AD patients was lower than that in control group ［MD=-9.89， 95%CI （-14.04- -5.74）， P ＜ 0.01］. The incidence of AD in patients with confirmed H.pylori infection was greater than that in normal controls ［RR=1.33， 95%CI （1.11- 1.59）， P ＜ 0.01］. All the differences were statistically significant. Conclusions Current limited evidence suggests a close link between AD and H.pylori infection. For AD， H.pylori plays an important role in both etiology， progression and prognosis of AD.

Abstract:Obsessive-compulsive disorder is a common chronic mental disorder in clinical practice. Its symptoms and the cognitive characteristics behind them are of complexity. The main psychological treatment method are traditional cognitive behavioral therapy， "third-generation" cognitive behavioral therapy and some psychological treatment technology with other characteristics. These treatment techniques have their own priorities. Therefore， this article expounds the defects of neurocognition， self-knowledge， cognitive and metacognitive beliefs， social cognition， and psychological treatment techniques in patients with obsessivecompulsive disorder. It is aiming to understand the pathological cognitive characteristics of patients with obsessive-compulsive disorder and provide more targeted treatment plans for patients with obsessive-compulsive disorder on this basis.

Abstract:Epilepsy is a common disease in children's nervous system diseases. With the application of gene sequencing technology in clinical practice， more and more children are found to be genetic associated epilepsy. γ-Aminobutyric acid type A receptor （GABAAR） is a ligand-gated chloride channel， which mediates the main inhibitory function of the central nervous system. Its dysfunction plays an important role in the etiology of epilepsy. It has been confirmed that the subunits of GABAAR including GABRA1， GABRA6， GABRB2， GABRB3， GABRG2 and GABRD are related to epilepsy. In this paper， we review the mechanism and clinical phenotype of the GABAAR subunit related epilepsy for the precise treatment of these patients.

Abstract:The management and treatment of glycolipid metabolism disorder caused by antipsychotic drugs have been a concern of clinicians in recent years. Antipsychotics will cause glycolipid metabolism disorder though influencing the balance of intestinal flora， while probiotics can maintain intestinal flora homeostasis. This paper reviews the relevant researches on the use of probiotics to treat disorders of glycolipid metabolism caused by antipsychotic drugs， to provide the basis for the treatment of such disorders in psychiatric patients.