Abstract:Objective To construct the random forest and decision tree prediction model for recurrence of minor ischemic stroke （MIS） within two years， and analyze the predicted performance of the models. Methods The medical records of 520 MIS patients who visited Department of Neurology of Shanxi Cardiovascular Hospital from July 1 to December 31， 2020 were retrospectively collected. Patients were divided into a recurrent group and a non-recurrent group based on whether they relapsed within two years. This study filled in the data through the missing forest. Based on literature search and expert discussion， predictive variables were selected and univariate analysis was conducted， and addressed data imbalance through the synthetic minority over-sampling technique-nominal continuity （SMOTE-NC）. Random forest and decision tree models were constructed using Bayesian optimization 10-fold cross validation and compared with the Logistic regression model. The discrimination and calibration of the models were evaluated based on the area under the receiver operating characteristic curve （AUC）， Brier score （BS）， and calibration curve. The prediction results of the model with the excellent predictive performance were explained using the SHapley Additive exPlanations （SHAP） model. Results A total of 93 patients （17.9%） experienced recurrence within two years. There were statistical differences between the two groups in age， smoking， diabetes， location of circulatory infarction，multiple cerebral infarction， diastolic pressure， hematocrit， platelet count， and low-density lipoprotein （P＜ 0.05）. The AUC （95%CI） of the testing set of Logistic regression model， decision tree model， and random forest model for predicting recurrence within two years in patients with MIS were 0.764 （0.691， 0.835）， 0.743 （0.668， 0.818）， 0.892 （0.843， 0.941）， and BS were 0.200， 0.211， and 0.142， respectively. The random forest model had the excellent prediction performance， with an accuracy of 0.822， a sensitivity of 0.818， a positive prediction value of 0.808， and a negative prediction value of 0.835. SHAP analysis showed that the top five variables in the random forest model were age， low-density lipoprotein， smoking， diabetes， and diastolic pressure. Conclusions Compared with decision tree model and Logistic regression model， the random forest model performs better in predicting the recurrence of MIS within two years.

Abstract:Objective To assess the role of multiple serological markers in the prediction of poststroke cognitive impairment （PSCI） in elderly patients with acute ischemic stroke （AIS）. Methods A total of 326 patients with AIS treated in the Department of Neurology of the First Affiliated Hospital of Harbin Medical University from January 2019 to January 2023 were retrospectively enrolled. According to the Mini Mental State Scale （MMSE） score at 6 months after onset， patients were divided into PSCI group （MMSE score ≤ 26 points） and non PSCI group （MMSE score ＞ 26 points）. General information and serological indicators were compared between the two groups. Risk factors for PSCI were screened using multifactorial Logistic regression. The efficacy of serological markers in predicting PSCI was rated using receiver operating characteristic （ROC） area under curve （AUC）. Results Among 326 patients， 127 （38.96%） experienced PSCI 6 months after onset. The proportion of patients with age ＞ 75， diabetes and stroke history， NIHSS score， homocysteine， uric acid， neutrophil/lymphocyte ratio （NLR）， low-density lipoprotein cholesterol （LDL-C）， C-reactive protein （CRP） at admission of PSCI group were significantly higher than those of non PSCI group （P＜ 0.05）； The high-density lipoprotein cholesterol （HDL-C） of PSCI group was lower than that of non PSCI group， and the difference was statistically significant （P ＜ 0.05）. The results of multifactorial logistic regression analysis showed that age ＞ 75 years （OR=1.422， 95%CI：1.050-1.926， P=0.023）， high NIHSS score at admission （OR=1.791， 95%CI：1.324-2.423，P ＜ 0.001）， high CRP （OR=1.305， 95%CI：1.077-1.581， P=0.007）， high NLR （OR=1.520， 95%CI： 1.196-1.933， P ＜ 0.001）， and high LDL-C （OR=1.387， 95%CI：1.132-1.699， P=0.002） were all the independent risk factors for the development of PSCI in elderly patients with AIS. The ROC curve analysis results showed that the AUC of CRP， NLR， and LDL-C predicting PSCI in elderly AIS patients were 0.655 （95%CI： 0.595-0.715）， 0.813 （95%CI： 0.766-0.859）， and 0.735 （95%CI： 0.680-0.789）， respectively. Conclusions CRP， NLR and LDL-C are independent risk factors for the occurrence of PSCI in elderly patients with AIS， and they have a certain predictive ability for PSCI， with NLR having the highest predictive performance.

Abstract:Objective To explore the effect of cognitive training synchronized with transcranial direct current stimulation （tDCS） for the treatment of working memory in patients with post-stroke cognitive impairment （PSCI）. Methods From December 2022 to July 2023， 60 patients with PSCI admitted to the Rehabilitation Department of Xuzhou Central Hospital and Xuzhou Rehabilitation Hospital were selected as the research subject. Using the random number table method， patients were randomly divided into the pseudo stimulation group， experimental group A， and experimental group B， with 20 cases in each group. All three groups received conventional medication and rehabilitation training， on which the pseudo stimulation group received both cognitive training and tDCS pseudo stimulation therapy； experimental group A received both cognitive training and tDCS therapy； experimental group B received tDCS therapy 2 h after the end of cognitive training. Both cognitive training and tDCS treatment were 5 times per week for 4 weeks. Before and after treatment， the Montreal Cognitive Assessment （MoCA）， Digital Span Test （DST）， n-back task （including 0-back， 1-back）， Modified Barthel Index （MBI）， and quantitative electroencephalogram ［including delta theta/alpha beta ratio （DTABR）， alpha relative power （αRP）， and θ relative power （θRP）］ were used to compare the cognitive function， working memory storage and information encoding ability， digital working memory， activity of daily living， and cranial nerve function of the three groups of patients. Results There was no statistically significant difference in MoCA scores， DST scores， 0-back scores， 1-back scores， MBI scores， DTABR， αRP and θRP among the three groups of patients before treatment （all P ＞ 0.05）. The difference in MoCA， DST， 0-back， 1-back， and MBI scores and the difference in DTABR， αRP， and θRP before and after treatment of the 3 groups were statistically significant （all P＜ 0.05）. The difference in MoCA， DST， 0-back， 1-back， and MBI scores and the difference in DTABR， αRP， and θRP before and after treatment in the experimental groups A and B were higher than those in the pseudo stimulation group， and the differences were statistically significant （all P ＜ 0.05）. The difference in MoCA， DST， 1-back score and the difference in DTABR， θRP before and after treatment in the experimental group A were higher than that in experimental group B， and the difference were statistically significant （all P＜ 0.05）. Conclusions Cognitive training and synchronized tDCS have more advantages in improving the working memory of patients with PSCI compared to separate treatment.

Abstract:Objective To explore the depression， anxiety， and cognitive function of elderly patients with acute ischemic stroke after 12 months of treatment， and analyze their correlation. Methods This study was a cross-sectional survey. From January 2019 to December 2022， 478 elderly patients with mild to moderate acute ischemic stroke and stable conditions after 12 months of treatment in the Neurology Department of Xuanwu Hospital of Capital Medical University were selected as the study subject. The Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to evaluate the depression and anxiety of patients. The Montreal Cognitive Assessment （MoCA） and Mini-Mental State Examination （MMSE） were used to evaluate the cognitive function of patients， and the modified Rankin Rating Scale （mRS） was used to evaluate the neurological deficit and prognosis of patients. Spearman's correlation analysis was used to analyze the correlation between patients' cognitive function and depression and anxiety. Results 43.51% （208/478） of patients had anxiety symptoms， 39.54% （189/478） had depression symptoms， 64.64% （309/478） had cognitive impairment， and 44.56% （213/478） had cognitive dysfunction. The scores of HAMD and HAMA of female patients were higher than that of male patients， the scores of MoCA and MMSE of patients with≤12 years of education were higher than those of patients with＞12 years of education， the scores of MoCA and MMSE of patients living in rural areas were lower than those of urban patients， and the scores of MoCA and MMSE of patients with hypertension or diabetes were higher than those of patients without hypertension or diabetes， with statistically significant differences （P＜0.01）. Compared with patients with an mRS score of 2， patients with an mRS score of 0 to 1 had lower HAMD and HAMA scores， higher MoCA and MMSE scores， and the differences were statistically significant （all P ＜ 0.001）. Spearman correlation analysis showed that the HAMD score of patients was negatively correlated with the total score of MoCA （r=-0.125， P=0.029）， attention （r=-0.212， P ＜ 0.001）， and speech function （r=-0.129， P=0.024）， and the HAMA score was negatively correlated with the attention （r=-0.180， P=0.002）. Conclusions After 12 months of treatment， some elderly patients with acute ischemic stroke have anxiety， depression， and cognitive dysfunction， and the more severe the symptoms of depression and anxiety， the worse the cognitive function of the patients. Clinical attention should be focused on the emotion and cognition of women， those with low educational years， rural areas， those with severe neurological impairment， hypertension or diabetes.

Abstract:Objective To explore the changes of circRIMS2 in mice with depression like behavior and the influence of circRIMS2 on oxygen-glucose deprivation （OGD） induced apoptosis of HT22 cells. Methods （1） Forty-five C57BL/6 female mice were randomly divided into the control group， model group，and fluoxetine group， with 15 mice in each group. A depression like behavior model was constructed in both the model group and fluoxetine group mice through chronic restraint stress （CRS）， and fluoxetine group mice were treated with 10 mg/kg of fluoxetine. Depression like behavior in mice was evaluated using the sucrose preference test， tail suspension test， forced swimming test， and open field test. After evaluation， mouse serum and hippocampal tissue were collected， and the expression of circular RNA， miR-186， and BDNF mRNA were detected using reverse transcription real-time quantitative polymerase chain reaction （RT-qPCR）. Western blot was used to detect the expression of BDNF protein in mice hippocampus. （2） After adding lentiviral vectors pLO-circCon and pLO-circRIMS2 transfection reagents to HT22 cells， a portion of HT22 cells were subjected to OGD treatment to construct an in vitro apoptosis model. Based on the cell transfection and OGD procedures， HT22 cells were divided into Control+pLO-circCon group， Control+pLO-circRIMS2 group， OGD+pLO-circCon group， and OGD+pLO-circRIMS2 group. RT-qPCR was used to detect the expression of circRIMS2， miR-186， and BDNF mRNA in four groups of cells， and flow cytometry was used to detect and calculate the apoptosis rate of the four groups of cells. Results （1） Compared with the control group， the model group mice had a lower preference for sucrose， longer tail suspension and forced immobility time， lower open field test scores， higher expression levels of circTRAM2， circTNIK， and circTFRC in serum， and lower expression levels of circDOCK4， circRIMS2， and circSTAG1， and the differences were statistically significant （all P ＜ 0.01）. Compared with the model group， the fluoxetine group mice had a higher preference for sucrose， shorter tail suspension and forced swimming immobility time， higher open field test scores， and higher level of circRIMS2 expression in serum， with statistical differences （all P ＜ 0.01）. （2） Compared with the Control+pLO-circCon group， the Control+pLO-circRIMS2 group had higher levels of circRIMS2 and BDNF mRNA expression， lower level of miR-186 expression， and lower cell apoptosis rate， with statistically significant differences （all P ＜ 0.01）. Compared with the OGD+pLO-circCon group， the OGD+pLO-circRIMS2 group had higher levels of circRIMS2 and BDNF mRNA expression， lower level of miR-186 expression， and lower cell apoptosis rate， with statistically significant differences （all P ＜ 0.01）. Conclusions The circRIMS2 gene is associated with depression like behavior in mice. The expression of circRIMS2 in the serum of mice with depression like behavior is reduced， and fluoxetine can increase the expression of circRIMS2. The lentiviral plasmid enhances the expression of circRIMS2 gene in cells and can alleviate OGD induced neuronal apoptosis through miR-186/ BDNF signaling.

Abstract:Objective To explore the prevalence and influencing factors of mental sub-health among adolescents of different genders in Anhui Province. Methods From October 2020 to January 2021， four township middle schools and four urban middle schools in three cities of Chaohu， Xuancheng， and Tongling in Anhui Province were selected， and students from two classes were randomly selected from each school as the research subject. The general information， social support， and mental sub-health of adolescents with different genders were compared using the General Information Questionnaire， Social Support Rating Scale （SSRS）， and Mental Sub-health Questionnaire. Multivariate Logistic regression was used to analyze the influencing factors of mental sub-health among adolescents of different genders. Results A total of 900 questionnaires were distributed offline， and 834 valid questionnaires were collected， with an effective response rate of 92.67%. The incidence of mental sub-health among 834 adolescents was 25.78% （215/834）， among which the incidence of mental sub-health among female adolescents was 28.95% （119/411）， which was higher than that of male adolescents ［22.70% （96/423）］， and the difference was statistically significant （χ2 =4.268， P=0.039）. There were statistically significant differences in parental marital status， boarding at school， being left behind， subjective support dimension score， and utilization of support dimension among male adolescents with different mental health states （all P＜ 0.05）. There were statistically significant differences in boarding at school， being left behind， objective support dimension score， subjective support dimension score， and utilization of support dimension score among female adolescents with different mental health states （all P ＜ 0.05）. Multivariate Logistic regression showed that being left behind was a risk factor for mental sub-health among male adolescents ［OR=2.200， 95%CI （1.259， 3.844）， P=0.006］， while high subjective support scores ［OR=0.920， 95%CI （0.850， 0.995）， P=0.036］ and high utilization of support scores ［OR=0.783， 95%CI （0.681， 0.900）， P=0.001］ were protective factors for mental sub-health. Among female adolescents， boarding at school was a risk factor for mental sub-health ［OR=2.023， 95%CI （1.105， 3.706）， P=0.022］， while high subjective support scores ［OR=0.895， 95%CI （0.829， 0.965）， P=0.004］ and high utilization of support scores ［OR=0.779， 95%CI （0.680， 0.892）， P ＜ 0.001］ were protective factors for mental sub-health. Conclusions The incidence of mental sub-health among male adolescents in Anhui Province is lower than that of female adolescents. Being left behind can increase the risk of mental sub-health among male adolescents， while boarding at school can increase the risk of mental sub-health among female adolescents. The higher the subjective support and its utilization， the lower the risk of mental sub-health in adolescents.

Abstract:Stepped care model （SCM） usually refers to a model that starts with low-intensity treatment and gradually steps up to the higher intensity of treatment for patients who do not respond adequately. At present， the demand for mental health services in society is increasing rapidly， but the utilization rate of medical resources is low and the treatment gap is large. Cognitive behavioral therapy （CBT）， as the mainstream psychotherapy method， needs to incorporate a more flexible model to address the challenges of the times. The article reviewed the application status quo （including primary outcome measures， health economics indexes and process-oriented measures） of SCM in CBT from 2010 to 2022. The existing limitations and possible improvement strategies of SCM application in CBT were discussed， aiming to provide a more flexible model for the clinical practice of CBT in mental health services in China， and to more efficiently utilize existing medical resources to serve more patients with mental disorders.

Abstract:Impulse control disorders （ICDs） are a group of mental disorders in which one repeatedly experiences behaviors that they cannot control and harm others' or their own interests without reasonable motivation. ICDs include pathological gambling， hypersexuality， compulsive shopping， compulsive eating and so on， which cause serious burdens on patients themselves， their families， and society. Third-generation antipsychotics（TGAs）， including aripiprazole， brepiprazole， and caliprazine， with agonism or partial agonism on dopamine D2 and D3 receptors and 5-hydroxytryptamine 1A receptor， may induce ICDs. However， there are still limitations in clinical practice， such as insufficient identification， unclear screening tools， and limited interventions， and disease awareness and intervention for TGA-induced ICDs need to be further improved. This paper reviews the epidemiology， risk factors， physiological mechanisms， clinical evaluation， diagnosis， and treatment of TGAs-induced ICDs， in order to enhance clinicians' understanding of this disease and adopt appropriate treatments to alleviate patients' pain and improve disease prognosis

Abstract:Chemerin is a multifunctional adipokine mainly synthesized and released by adipocytes and liver tissue. It is initially secreted as an inactive precursor and has biological activity after a series of proteases for hydrolysis and cleavage. Chemerin mainly binds to its receptor CMKLR1 and participates in various pathological and physiological processes such as immune inflammation， lipid metabolism， and angiogenesis. There is growing evidence that Chemerin and its receptor are widely expressed in the nervous system and have complex biological regulatory effects， including anti-apoptosis， regulation of immune inflammatory response， promotion of clearance of abnormal deposition proteins， and regulation of tumor occurrence and development. This article elaborates on the structures， biological functions， and roles in nervous system diseases of Chemerin， aiming to provide ideas for the clinical diagnosis and treatment of nervous system diseases.

Abstract:Schizophrenia is a serious mental disease with high incidence， high disability rate and high mortality. A growing body of research has found that the glycolipid metabolism disorder in schizophrenia is related to sleep disorders， and the pathological and physiological mechanisms are not yet clear. At present， research suggests that sleep disorders， as a common clinical symptom in patients with schizophrenia， may affect the occurrence and development of glycolipid metabolism disorders in schizophrenia through the neuroendocrine system， intestinal microbiota， and other factors. The paper focuses on summarizing the research progress of schizophrenia with glycolipid metabolism disorders from four aspects， including insomnia， central disorder of hypersomnolence， circadian sleep-wake disorder， and obstructive sleep apnea， providing new recommendations for the prevention and treatment of cardiovascular diseases in patients with schizophrenia.

Abstract:Transcranial random noise stimulation （tRNS） is a novel， safe， effective， and non-invasive neuromodulation technique that has been initially applied in patients with mental disorders. This paper aims to reviews the mechanism and application of tRNS in mental diseases， in order to improve the understanding of tRNS for clinical and scientific researchers and promote its clinical application.

Abstract:Repetitive transcranial magnetic stimulation （rTMS） is a safe， non-invasive technique that has been widely used in various neurological and psychiatric disorders. At present， rTMS has also achieved certain therapeutic effects in improving post-ischemic stroke cognitive impairment （PISCI）. This paper reviews the basic principles， mechanism， application， safety， and prospects of rTMS in PISCI to provide theoretical basis for the application of rTMS in PISCI.

Abstract: