Abstract:Gliomas are primary tumors originating from intracranial glial cells and is also one of the most common malignant intracranial tumors. The initiation and progression are often accompanied by genetic mutations， among which 40% to 60% of gliomas have epidermal growth factor receptor（ EGFR） mutations. The abnormal expression and sustained activation of EGFR promote tumor cell proliferation， migration， and survival through various downstream signaling pathways， and EGFR mutations in gliomas typically indicate poor overall survival. Therefore， EGFR targeted therapy for glioma is of great significance. A comprehensive understanding of the role and mechanisms of EGFR mutations in the initiation and progression of gliomas can help further refine potential EGFR targeted treatment strategies.

Abstract:Objective To explore the differences in levels of serum zonulin and claudin-5 between melancholic and atypical depressive disorder and their clinical significance for subtype differentiation. Methods From March 2023 to June 2024， 42 cases each of melancholic and atypical depressive disorder patients meeting the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders（ 5th edition） （DSM-5） in the outpatient department of Beijing Huilongguan Hospital were selected as melancholic group and atypical group， and 40 cases of healthy volunteers who had medical checkups in the hospital during the same time period were selected as healthy control group. The severity of the patients' depressive disorder was assessed using the 17-item version of the Hamilton Depression Scale（ HAMD-17）. Serum zonulin and claudin-5 levels were measured in the three groups using enzyme-linked immunosorbent assay to compare the differences between the groups. The differential diagnostic value of the two proteins alone and in combination for the two subtypes of depressive disorder was also assessed using the receiver operating characteristic（ ROC） curve. Results The serum zonulin levels in melancholic， atypical， and healthy control groups were 1 040.69（ 827.23， 1 348.38） ng/ml， 748.38（ 146.46， 954.15） ng/ml， 543.86（ 361.84， 1 015.35） ng/ml， and the claudin-5 levels were 194.20（ 161.79， 268.28） pg/ml， 164.57（ 36.33， 205.77） pg/ml， and 118.60（ 84.86， 190.40） pg/ml， and the differences between the three groups were statistically significant（ all P ＜ 0.05）. The levels of both serum proteins were higher in melancholic group than those in atypical group and healthy control group with statistical differences（ both P＜ 0.05）. There was no statistically significant difference in the levels of the two serum proteins between atypical group and healthy control group（ both P＞0.05）. The area under the ROC curve for serum zonulin to differentiate between melancholic and atypical depressive disorder was 0.741［ 95% confidence interval（ 95%CI）（ 0.635， 0.847）， P ＜ 0.05］， with a sensitivity of 64.3% and a specificity of 76.2%. The area under the ROC curve for serum claudin-5 prediction was 0.679［ 95%C（I 0.564，0.793），P ＜ 0.05］， with a sensitivity of 92.9% and a specificity of 35.7%. The area under the ROC curve for the combined prediction of the two proteins was 0.815 ［95%CI（0.723，0.908），P＜ 0.05）］， with a sensitivity of 85.7% and a specificity of 71.4%. Conclusions Two proteins， serum zonulin and claudin-5， are higher in patients with melancholic depressive disorder than those in patients with atypical depressive disorder and may be effective biomarkers for differential diagnosis of the two subtypes. Zonulin combined with claudin-5 has high clinical value for subtype differential diagnosis.

Abstract:Objective To construct and compare five risk prediction models for delay in seeking medical care in patients with acute ischemic stroke（ AIS） based machine learning， so as to provide support for early identification of high-risk patients in clinical practice. Methods Convenience sampling was used to select 380 AIS patients who visited the Emergency Department of Northern Jiangsu People's Hospital from November 2023 to March 2024 as study subjects. Using stratified sampling， patients were randomly divided into a training set（ n=266） and a validation set（ n=114） in a 7∶3 ratio. An additional 120 AIS patients who visited the Emergency Department of Northern Jiangsu People's Hospital from April to June 2024 were selected as the test set. Missing values were imputed using the mean method and random interpolation method. Singlefactor analysis was employed to examine the factors influencing delay in seeking medical care. Feature selection was performed using the least absolute shrinkage and selection operator（ LASSO） regression analysis. Data imbalance was addressed using a linear function normalization method， and five machine learning models were constructed， including Logistic regression， random forest， gradient boosting tree， bootstrap aggvegating （Bagging）， and extreme gradient boosting（ XGBoost）. The correlation between variables was analyzed by drawing a heat map. Model performance was evaluated based on the area under the receiver operating characteristic curve（ AUC）， accuracy， sensitivity， specificity， F1 score， and decision curve. A variable feature importance map was generated for the optimal model. Results Single-factor and LASSO regression analysis of the training set collectively identified 16 risk factors. The heat map results indicated that correlations among variables were generally weak and did not exhibit significant multicollinearity. The AUC of the five machine learning models ranged from 0.825 to 0.945， with sensitivities between 0.810 and 0.967， specificities from 0.842 to 0.991， accuracies between 0.765 and 0.959， and F1 scores from 0.785 to 0.964. Among these， the XGBoost model emerged as the optimal model， achieving AUC of 0.946 for the validation set and 0.931 for the test set. The decision curve analysis further demonstrated its superior clinical net benefit across most threshold intervals， indicating robust stability. The top 10 risk factors ranked by importance were as follows： Stroke Pre-Hospital Delay Behavior Intention Scale scores， whether there were others around the patient at the time of onset， level of stroke cognition， smoothness of hospital green channels， mode of transport， time of onset， whether the patient knew to use the balance-eyes-face-arm-speech-time（ BEFAST） method for stroke recognition， whether the patient experienced transfer or referral， monthly per capita household income and whether family members knew to use BEFAST for stroke recognition. Conclusions Among five machine learning algorithms， the XGBoost model demonstrates optimal predictive performance， aiding healthcare professionals in early identification of patients at high risk for delay in seeking medical care and providing a scientific basis for formulating precise intervention strategies.

Abstract:Objective To investigate the relationship between D-dimer/fibrinogen， triglycerides/highdensity lipoprotein， and blood pressure variability and cognitive impairment in patients with acute cerebral infarction and hypertension. Methods From September 2023 to June 2024， 100 patients with acute cerebral infarction and hypertension admitted to Beijing Shunyi Hospital were selected as the study group. According to the Montreal Cognitive Assessment（ MoCA） score， the patients were divided into cognitive impairment group （MoCA score＜26， n=48） and non-cognitive impairment group（ MoCA score 26 to 30， n=52）. Acute cerebral infarction patients（ n=100） admitted to our hospital during the same period were selected as the control group. Data were collected from two groups regarding age， gender， body mass index， infarct site， infarct volume， educational level， National Institutes of Health Stroke Scale（ NIHSS） score， total cholesterol， triglycerides， low-density lipoprotein， high-density lipoprotein， D-dimer， and fibrinogen. Pearson correlation was used to examine the relationship between D-dimer/fibrinogen， triglycerides/high-density lipoprotein， and blood pressure variability in patients. Logistic regression was employed to analyze factors influencing cognitive impairment in patients with acute cerebral infarction and hypertension. Receiver operating characteristic（ ROC） curves were used to analyze the value of D-dimer/fibrinogen and triglycerides/high-density lipoprotein in assessing cognitive impairment among patients with acute cerebral infarction and hypertension. Results There were statistically significant differences between study group and control group in terms of D-dimer［ （0.48±0.09） mg/L vs.（ 0.41±0.06）mg/L］， fibrinogen［ （3.46±0.51）g/L vs.（ 2.89±0.40）g/L］， triglycerides［ （1.76±0.32） mmol/L vs. （1.38±0.24） mmol/L］， and D-dimer/fibrinogen［ （16.43±3.51）×10-5 vs.（ 13.24±2.76）×10-5］， triglycerides/ high-density lipoprotein［ （1.65±0.47） vs.（ 1.13±0.33）］， 24-hour systolic coefficient of variation（ SCV） ［（12.54±2.97）% vs.（ 10.12±2.20）%］， and 24-hour diastolic coefficient of variation（ DCV）［ （15.09±3.16）% vs. （11.44±2.20）%］（ t=6.472，8.794，9.500，7.144，9.055，6.548，8.805； all P＜0.001）. Pearson correlation analysis revealed that D-dimer/fibrinogen and triglycerides/high-density lipoprotein were both positively correlated with 24-hour SCV and 24-hour DCV（ r=0.542， 0.424， 0.562，0.396； all P ＜ 0.001）. There were statistically significant differences between cognitive impairment group and non-cognitive impairment group in terms of D-dimer［ （0.52±0.11） mg/L vs.（ 0.44±0.07） mg/L］， fibrinogen［ （3.57±0.55） g/L vs.（ 3.36±0.47） g/L］， triglycerides［ （1.85±0.34） mmol/L vs.（ 1.68±0.30） mmol/L］， D-dimer/fibrinogen［ （18.23±3.91） × 10-5 vs. （14.77±3.14）×10-5］， triglycerides/high-density lipoprotein［ （1.87±0.51） vs.（ 1.45±0.43）］， 24-hour SCV ［（13.68±3.22）% vs.（ 11.49±2.74）%］and 24-hour DCV［ （16.29±3.43）% vs.（ 13.98±2.91）%］（t=4.373， 2.057，2.656，4.897，4.464，3.672，3.641； all P ＜ 0.05）. Logistic regression analysis showed that D-dimer/ fibrinogen［ OR=1.874， 95%CI（ 1.230，2.856）］， triglycerides/high-density lipoprotein［ OR=1.756， 95%CI （1.093， 2.822）］， and 24-hour SCV［ OR=1.715， 95%CI（ 1.038，2.833）］were factors affecting cognitive impairment in patients， and the differences were statistically significant（ all P ＜ 0.05）. The combined area under the curve（ AUC） for D-dimer/fibrinogen and triglycerides/high-density lipoprotein in predicting cognitive impairment was 0.901， superior to either single test， and the differences were statistically significant （ZD-dimer/fibrinogen-combined=3.080， P=0.002； Ztriglycerides/high-density lipoprotein-combined=3.223， P=0.001）. Conclusions Ddimer/ fibrinogen， triglycerides/ high-density lipoprotein are positively correlated with blood pressure variability in patients with acute cerebral infarction and hypertension. Furthermore， elevated levels of these biomarkers were identified as significant risk factors for cognitive impairment.

Abstract:Objective To analyze the evidence on blood pressure management during intravenous thrombolysis in patients with acute ischemic stroke. Methods Evidence on target blood pressure management during intravenous thrombolysis in patients with acute ischemic stroke was electronically and systematically retrieved from China National Knowledge Infrastructure， WanFang Data， VIP， and China Biomedical Literature Database， PubMed， Cochrane Library， Embase， Web of Science， BMJ Best Practice， Ovid， UpToDate， and international authoritative websites， such as the Chinese Nursing Association， Guidelines International Network， National Institute for Health and Clinical Excellence， Scottish Intercollegiate Guidelines Network， American Stroke Association， Canadian Stroke Organization， and European Stroke Organisation. The search period was from the establishment of the database to April 30， 2025. Two researchers independently conducted literature screening， quality evaluation， and evidence level assessment. Results A total of 14 articles were included， including 6 clinical guidelines， 2 expert consensus， 1 group standard， 2 systematic reviews， 1 evidence summary， 1 clinical decision， and 1 best practice recommendation. A total of 23 pieces of evidence were extracted from 14 articles and integrated into 7 dimensions， including basic principles， control objectives， selection and maintenance of venous access， nursing of vasoactive drugs， nursing of thrombolytic drugs， blood pressure monitoring， and prevention and management of complications. Conclusions The evidence in this study mainly comes from domestic and international clinical guidelines， expert consensus， and clinical decision， with a high level of evidence and credibility. It is recommended that when conducting evidence transformation in clinical practice， factors such as the patient's age， underlying disease， and stroke time should be fully considered to selectively apply evidence， and scientifically manage the blood pressure during intravenous thrombolysis in patients with acute ischemic stroke， thereby improving patient prognosis.

Abstract:Stroke-related sarcopenia（ SRS） seriously affects the quality of life and long-term prognosis of patients. SRS is a key independent risk factor for poor prognosis in stroke， and their coexistence can significantly impair patients' ability of daily living， cognitive function， exacerbate neurological deficits， and increase the risk of complications and stroke recurrence. This paper reviews the prognostic factors， treatment， prevention， and rehabilitation of SRS， providing a reference for developing precise intervention strategies in clinical practice to improve the outcomes of high-risk patients.

Abstract:Objective To develop the Rating Scale for Schizophrenic Features in Writings（ RSFiW） and analyze its reliability and validity. Methods The preliminary scale was developed by combining literature review and comparing the written language characteristics of 30 patients with schizophrenia hospitalized in Chongqing Mental Health Center from April 2015 to August 2018 with 32 healthy subjects recruited externally between September 2018 and April 2021. The preliminary scale was used to assess 157 patients with schizophrenia （from inpatients of several mental hospitals in Chongqing between September 2018 and April 2021） to carry out item analysis and exploratory factor analysis. Confirmatory factor analysis and internal consistency testing were conducted with an additional 154 patients（ Inpatient and outpatient patients with schizophrenia in Chongqing Mental Health Center during the same period of time） rated with the adjusted scale. Criterion validity was tested using the Positive and Negative Syndrome Scale and the Scale for Thought， Language， and Communication as validity scales. Results The scale contained 15 items that were decomposed into 5 factors of casual-deliberate， planned， fluent， offset， and redundant-abbreviated， explaining 53.912% of the total variance. Confirmatory factor analysis showed a good model fit（ χ2/df=1.248， CFI=0.930， TLI=0.901， SRMR=0.071， RMSEA=0.040）. Cronbach's α for the total scale was 0.565. Content validity was good. The factor scores correlated with some of the factor scores of the validity scale. Retest reliability Spearman r was 0.546. The inter-rater reliability for most items were moderate to strong with statistical differences（ weighted Kappa=0.325-0.787， P＜0.05）. The area under the receiver operating characteristic（ ROC） curve was 0.999（ P＜0.001）. When the maximum cutoff point of the Youden index was 5.5， the sensitivity was 99.4% and the specificity was 96.9%. Conclusions The development process of this scale is reasonable， and the reliability and validity are acceptable.

Abstract:The symptoms of mental illness are mostly associated with changes in speech. Speech is an integration of cognitive and physiological information. Its recording equipment is simple， and patients find it difficult to conceal symptoms， making it an excellent objective biomarker for mental illness. This paper reviews the speech features and development trends of common mental illnesses in recent years. Currently， phonetic research requires large-scale longitudinal studies to identify speech features associated with disorders such as personality disorders， so as to enable the establishment of association with other biological markers， thereby advancing the development of multimodal health technologies and remote screening tools.

Abstract:Bipolar disorder（ BD） is a common affective disorder in children and adolescents and is frequently co-morbid with other mental disorders. Comorbidity often poses significant challenges to the diagnosis， treatment， and prognosis of diseases. This paper reviews the epidemiology， clinical characteristics， and treatment of comorbidities of mental disorders in children and adolescents， including BD， attention deficit/ hyperactivity disorder， autism spectrum disorder， obsessive compulsive disorder， and substance use disorder， aiming to provide reference for clinical diagnosis and treatment.

Abstract:White blood cells， especially neutrophils， are crucial for defending against infections caused by important pathogens such as bacteria and fungi. When it is significantly reduced， life-threatening complications may occur. In clinical practice， leukopenia/neutropenia caused by non-chemotherapy drugs is often asymptomatic in its early stages， making it difficult to detect promptly and potentially leading to serious complications. Nearly all major categories of psychiatric drugs are associated with leukopenia/neutropenia， which may occur at any time during treatment， and the risk is difficult to predict. Therefore， enhancing awareness of psychiatric drug-induced leukopenia/neutropenia is particularly important for psychiatrists. This article provides a review of the incidence， clinical characteristics， mechanisms， and conventional treatment methods for leukopenia/neutropenia induced by commonly psychiatric drugs.