Abstract:Depressive disorder is one of the most burdensome mental disorders globally， involving multiple abnormalities in neuroendocrine， immune inflammatory， metabolic， and neuroplastic areas. In recent years， the introduction of the "gut-brain axis" concept has provided a new perspective for research into the pathological mechanisms of depressive disorder. Numerous studies indicate that gut microbiota dysbiosis， intestinal barrier dysfunction， and associated metabolic abnormalities are closely associated with depressive disorder. Therapeutic strategies based on the gut microbiota， such as probiotics， prebiotics， synbiotics， and fecal microbiota transplantation， have demonstrated significant potential in both basic and clinical research. This paper systematically summarizes the mechanisms of gut microbiota in depressive disorder and reviews the clinical research progress， limitations， and future directions of related microbiota interventions， aiming to provide reference for the comprehensive treatment of depressive disorder.

Abstract:Objective To analyze the association between postoperative sleep disorders， pain and postoperative delirium in patients with mild to moderate traumatic brain injury. Methods This study was a retrospective study based on medical records. The study included a total of 318 patients with mild to moderate traumatic brain injury who were hospitalized at the First Affiliated Hospital of Harbin Medical University from January 2022 to December 2024. Patients were divided into a postoperative delirium group（ n=112） and a nonpostoperative delirium group（ n=206） based on whether postoperative delirium occurred 7 days after surgery. Pittsburgh Sleep Quality Index was used to assess postoperative sleep quality， and Numerical Rating Scale was used to assess pain intensity. Multivariate Logistic regression was used to analyze the impact of postoperative sleep disorders and postoperative pain on postoperative delirium， and the receiver operating characteristic （ROC） curve was used to evaluate their predictive performance for postoperative delirium. Results The proportion of postoperative sleep disorders（ 58.04% vs. 30.10%） and moderate-to-severe postoperative pain （64.29% vs. 40.78%） was statistically higher in postoperative delirium group than in non-postoperative delirium group（ χ2=23.609， 16.045； both P ＜ 0.05）. There were statistically significant differences between the two groups in terms of age， proportion of diabetes， serum sodium， albumin， CRP， and duration of surgery （t/χ2=2.915，7.630，3.314，3.519，3.738，2.004； all P＜ 0.05）， which constituted confounding factors. After adjusting for confounding factors， multivariable Logistic regression revealed that postoperative sleep disorders ［OR=1.998，95%CI（ 1.959，2.821）］ and postoperative pain［ OR=1.702，95%C（I 1.669，2.559）］ were risk factors for postoperative delirium in patients with mild to moderate traumatic brain injury（ both P ＜ 0.05）. The area under the ROC curve（ AUC） for predicting postoperative delirium based on postoperative sleep disorders was 0.640［ 95%CI（ 0.575，0.704）］， with a sensitivity of 58.04% and a specificity of 69.90%. The AUC for predicting postoperative delirium using postoperative pain was 0.618［ 95%CI（ 0.553，0.682）］， with a sensitivity of 64.29% and a specificity of 59.22%. The combined use of these two factors provided the highest predictive value for postoperative delirium［ AUC=0.773， 95%CI（ 0.721， 0.825）， sensitivity 91.96%， specificity 62.62%］. Conclusions Postoperative sleep disorders and postoperative pain are independent risk factors for postoperative delirium in patients with mild to moderate traumatic brain injury， when considered together， they have some predictive value for postoperative delirium.

Abstract:Objective To investigate the association between the single nucleotide polymorphism （SNP） rs3924999 of neuregulin 1（ NRG1） and the SNP rs6265 of brain-derived neurotrophic factor（ BDNF） with susceptibility to and clinical symptoms of geriatric depressive disorder. Methods The case group consisted of 76 patients with first-episode geriatric depressive disorder recruited from the outpatient clinics and inpatients wards of Beijing Anding Hospital， Capital Medical University between February and December 2021. The control group comprised 37 healthy geriatric volunteers recruited from communities in the Beijing during the same period. Genetic polymorphism in the NRG1（ rs3924999） and BDNF（ rs6265） were analyzed in two groups， and the chi-square test was used to compare differences in genotype distribution between the groups. One-way analysis of variance（ ANOVA） was used to compare differences between genotypes within case group and scores of the 17-item Hamilton Depression Scale（ HAMD-17）， Hamilton Anxiety Scale（ HAMA）， 9-item Patient Health Questionnaire（ PHQ-9）， 7-item Generalized Anxiety Disorder（ GAD-7）， Mini-Mental State Examination（ MMSE）， Montreal Cognitive Assessment（ MoCA）， Insomnia Severity Index（ ISI）， and Activities of Daily Living Scale（ ADL）. Multiple comparisons were corrected using the Bonferroni method. Results There was a statistically significant difference in the distribution of the NRG1 rs3924999 genotype between the two groups（ χ2=7.123， P=0.028）； however， after correction for multiple comparisons using the Bonferroni method （corrected significance threshold P=0.025）， the difference was no statistically significant（ P＞0.05）. There was no statistically significant difference in the distribution of the BDNF rs6265 genotype between the two groups （χ2=0.369，P=0.831）. There were no statistically significant differences in clinical symptom scores or cognitive function scores among different genotypes（ AA， GA， GG） of the NRG1 rs3924999 in case group（ all P＞0.05）. There were statistically significant differences in MoCA scores among the different BDNF rs6265 genotypes （CC，TC，TT）（ F=3.355， P=0.040）. After multiple comparison correction using the Bonferroni method， the difference between the CC and TC genotypes was statistically significant［ mean difference=-3.179， 95%CI （-6.19， -0.17）， P=0.035］. Conclusions The polymorphism at the rs3924999 locus of the NRG1 gene may be associated with susceptibility to geriatric depressive disorder， while the polymorphism at the rs6265 locus of the BDNF gene may be associated with cognitive impairment in geriatric depressive disorder.

Abstract:Objective To explore the relationship between adolescent depression severity and anhedonia， as well as the mediating effect of metacognition between the two. Methods Using convenience sampling， 118 adolescents with depressive disorder who visited the outpatient department at Beijing Huilongguan Hospital， Capital Medical University from July to October 2024 were selected as study subjects. The depression severity， anhedonia， metacognition， and anxiety were assessed using the General Information Questionnaire， 17-item Hamilton Depression Rating Scale（ HAMD-17）， Dimensional Anhedonia Rating Scale （DARS）， Metacognition Questionnaire-30（ MCQ-30）， and Generalized Anxiety Disorder-7（ GAD-7）. Spearman correlation was used to analyze the correlation between metacognitive factors， depression severity， and anhedonia.AMOS 23.0 was used to analyze the mediating role of metacognition between depression severity and anhedonia among adolescents with depressive disorder. A total of 118 questionnaires were distributed in this study， and 113 valid questionnaires were ultimately recovered， with an effective response rate of 95.76%. Results The total scores for the HAMD-17， DARS， and MCQ-30 among 113 adolescents with depressive disorder were （21.4±7.0），（ 37.6±17.6）， and（ 71.1±16.1）， respectively. The total scores for each factor of the MCQ-30 were as follows： cognitive confidence（ 16.3±4.8）， positive beliefs about worry（ 11.0±4.4）， cognitive selfconsciousness（ 15.7±4.0）， uncontrollability and danger of worry（ 15.8±4.7）， and need for control（ 12.3±4.4）. Spearman correlation analysis showed that the total score of HAMD-17 was negatively correlated with the total score of DARS（ r=-0.50， P＜0.01）， while the total score of HAMD-17 was positively correlated with the total score of MCQ-30 and scores of cognitive confidence， cognitive self-consciousness， uncontrollability and danger of worry， and need for control（ r=0.42， 0.40， 0.26， 0.50， 0.34； all P＜0.01）， and the total score of DARS was negatively correlated with the total score of MCQ-30 and scores of cognitive confidence， uncontrollability and danger of worry， and need for control（ r=-0.31， -0.35， -0.38， -0.36； all P＜0.01）， and the differences were statistically significant. The mediating effect of metacognition between depression severity and anhedonia was 29.2%， with a mediating effect value of -0.35. Among the factors of the MCQ-30， uncontrollability and danger of worry had the highest effect size of 19.8% across all metacognitive components. Conclusions Metacognition plays a mediating role between depression severity and anhedonia adolescents， with the uncontrollability and danger of worry playing a central role in the mediating effect.

Abstract:Depressive disorder is a common mental disorder characterized by high recurrence rates and significant disability， ranking among the world's most disabling mental illnesses. Conventional antidepressants take effect slowly and have a high rate of resistance to discontinuation. Theta-burst stimulation（ TBS） has emerged as a novel clinical treatment option for depressive disorder due to its advantages of "short duration and high efficacy". This paper systematically reviews clinical research advances on TBS and its sub-paradigms intermittent theta burst stimulation（ iTBS） and accelerated intermittent theta burst stimulation（ aiTBS） in depressive disorder. The mechanisms of iTBS and aiTBS are elucidated from three aspects of synaptic plasticitybrain network remodeling-immune metabolic regulation. Potential optimization directions are proposed for the future， offering insights and references for acute intervention and prevention of patients with depressive disorder.

Abstract:Objective To explore the effects of music therapy combined with primary medical gymnastics on motor function， emotional state， dopamine， 5-hydroxytryptamine（ 5-HT）， and norepinephrine （NE） in patients with first-time stroke and depressive disorder. Methods A total of 130 patients with firsttime stroke and depressive disorder admitted to the Department of Rehabilitation of Nanfang Hospital， Southern Medical University from January 2021 to December 2023 were selected as study subjects. Patients were assigned using a random number table method to either the control group（ n=65， conventional treatment） or the observation group（ n=65， music therapy combined with primary medical gymnastics on the basis of the control group）. After four weeks of treatment， the efficacy， motor function［ Fugl-Meyer Assessment （FMA）， Modified Barthel Index（ MBI） scores］， emotional state［ Hamilton Depression Scale-17（ HAMD- 17）， Self-Rating Anxiety Scale（ SAS）， and Self-Rating Depression Scale（ SDS） scores］， and neurotransmitter levels were compared between the two groups. Results The total effective rate of observation group patients was 89.23%（ 58/65）， which was higher than the 75.38%（ 49/65） of control group patients， and the difference was statistically significant（ χ2=4.279，P=0.039）. Observation group patients showed FMA scores［ （40.36±5.81） vs.（ 35.89±6.33）］， MBI scores［ （28.48±8.01） vs.（ 21.33±6.42）］， HAMD-17 scores ［（22.32±1.52） vs.（ 19.39±1.50）］， SDS scores［ （11.51±1.60） vs.（ 7.19±1.46）］， SAS scores［ （8.88± 1.92） vs.（ 7.55±1.83）］， dopamine［ （79.16±18.43） μg/L vs.（ 49.46±16.30） μg/L］， 5-HT level ［（75.14±23.81） μg/L vs.（ 64.91±20.16） μg/L］， and NE level difference before and after treatment ［（25.86±4.07） ng/L vs.（ 22.38±4.46） ng/L］ were significantly higher than those in control group（ t=4.194， 5.616， 11.062， 16.080， 4.043， 9.732， 2.644， 4.648； all P＜ 0.05）. Conclusions The combination of music therapy and primary medical gymnastics can effectively enhance the motor function of first-time stroke patients with depressive disorder， while also helping to improve their emotional state and dopamine， 5-HT， NE levels.

Abstract:Objective To conduct a meta-analysis of risk prediction models for non-suicidal selfinjury（ NSSI） among adolescents， so as to provide scientific evidence for selecting appropriate models. Methods Relevant studies were systematically retrieved from PubMed， CINAHL， Web of Science， PsycINFO， Embase， SinoMed， The Cochrane Library， China National Knowledge Infrastructure， VIP， and WanFang Data. The search period was from database establishment to February 20， 2025. Two researchers independently conducted literature screening and data extraction. Model quality was assessed using the prediction model risk of bias assessment tool（ PROBAST）. Meta-analysis of the area under the curve for predictive models was performed using MedCalc 22.016. Meta-analysis of co-predictive factors was conducted using RevMan 5.4. Results A total of 13 studies were included. The area under the curve for the predictive model ranged from 0.74 to 0.976. The meta-analysis showed that the area under the curve of the pooled model was 0.859［ 95%CI（ 0.848， 0.869）］. Female［ OR=0.75， 95%CI（ 0.66， 0.85）］， depression severity［ OR=0.55， 95%CI（ 0.16， 1.87）］， childhood trauma［ OR=2.93， 95%CI（ 1.17， 2.21）］， and sleep disorders［ OR=1.44， 95%CI（ 0.84， 2.46）］ were predictive factors for adolescent NSSI. Conclusions Risk predictive models for adolescent NSSI are still in the developmental stage. It is recommended that the existing model be further optimized in the future.

Abstract:The gut microbiota forms a bidirectional regulatory network with the central nervous system through the gut-brain axis， playing an important role in neurological function regulation and rehabilitation. Dysbiosis of the gut microbiota can affect neuroplasticity， exacerbate neuroinflammation， and disrupt neurotransmitter metabolism， and is closely associated with the onset and progression of neurological disorders such as Alzheimer's disease， Parkinson's disease， and stroke. Gut microbiota-based intervention strategies， such as probiotic and prebiotic supplementation， fecal microbiota transplantation， and dietary and lifestyle adjustments， can optimize the gut microenvironment， reduce neuroinflammation， and promote neurological recovery. Currently， this field still faces challenges such as unclear mechanisms of action， insufficient sample sizes in clinical studies， and a lack of standardized intervention protocols. This review comprehensively and systematically summarizes and analyzes research progress on the association between gut microbiota and neurological rehabilitation， as well as intervention strategies， aiming to provide reference for further research and clinical application in this field.

Abstract:The central amygdala（ CeA） plays a key role in the pathophysiological mechanisms of chronic pain comorbid with anxiety and depression. Numerous studies have shown that patients with chronic pain often suffer from emotional disorders such as anxiety and depression， forming a mutually reinforcing vicious cycle. As the main output nucleus of the amygdala， the CeA plays an important role in emotional regulation and is closely related to the generation and persistence of various negative emotions. Notably， the CeA can also regulate the balance of the intestinal microbiota through the vagus nerve pathway. Chronic stress-induced suppression of CeA activity leads to a significant reduction in the number of intestinal lactobacilli， thereby impairing immune function. This paper systematically elucidates the mechanisms underlying the role of the CeA in the onset and progression of chronic pain comorbid with anxiety and depression from multiple perspectives， including neuronal functional characteristics， neural circuit connections， and gut-brain axis regulation， providing important theoretical basis for the development of innovative treatment strategies.

Abstract:Skull defects compromise aesthetic appearance and may even hinder the recovery of neurological function in patients. Autologous skull is a commonly used material for cranioplasty， and the prerequisite for successful autologous cranioplasty is reliable preservation of the bone flap. When bone resorption and infection risks can be controlled， autologous skull demonstrates clear advantages. Currently， there are no unified standards or regulations for the preservation and use of autologous skull in China. Therefore， the Expert Consensus Collaborative Group for Autologous Cranioplasty organized experts with extensive clinical experience in autologous skull application to develop the Chinese expert consensus on autogenous cranioplasty （2026 edition） according to evidence-based medical evidence and clinical practice. This consensus presents 20 recommendations on the indications， surgical timing， preservation and treatment of autologous skull， surgical procedures， prevention and treatment of postoperative complications， and postoperative follow-up for autologous cranioplasty， guiding the selection and application of autologous cranioplasty strategies to meet patient needs and improve treatment outcomes.

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