The accelerated aging of China's population has contributed to the increasing prominence of chronic disease comorbidities, significantly increasing the medical burden and threatening patients' physical and mental health. Elderly patients with chronic disease comorbidities are more likely to have psychological problems such as anxiety and depression due to multiple comorbidities, and their symptom detection rate is significantly higher than that of the healthy or single chronic disease population. Although the pathogenesis is unclear, demographic (age, gender, education), socioeconomic (household income, place of residence), social support, health status, and lifestyle factors are strongly associated with mental health, and elucidation of these factors is essential for the development of precise intervention strategies. Existing interventions are classified as both pharmacological and non-pharmacological. Although medications provide symptomatic relief, the risk of polypharmacy limits how they're used. Non-pharmacological interventions show unique advantages through diversified means: group psychological intervention strengthens the social support network, cognitive behavioral therapy corrects negative cognition, exercise therapy improves both physical and psychological health, music/nostalgia/narrative therapy regulates emotional states, Internet+ technology breaks through time and space constraints to increase accessibility of interventions, traditional Chinese medicine therapy realizes physical and mental co-treatment, and health education and co-psychological care enhance self-management ability through knowledge and empowerment. These interventions have been shown to be effective in improving the mental health of comorbid patients. This article reviews national and international studies focusing on the epidemiology, influencing factors, and intervention strategies of elderly multimorbid patients to provide a basis for mental health promotion. In the future, it is necessary to deepen research on the mechanism of multidisease interaction, establish a personalized intervention system based on risk assessment, and verify the effect of intervention through multicenter long-term follow-up, in order to achieve the goal of healthy aging.

Parkinson's disease (PD) is a common neurodegenerative disorder, and its global disease burden continues to increase. Due to China's large population base and rapid aging process, the country faces even more severe challenges.

Based on the Global Burden of Disease (GBD) 2021 database, this study analyzes the differences and trends in the disease burden of PD between China and the global level from 1990 to 2021, predicts future changes in disease burden, and provides a scientific basis for optimizing PD prevention and treatment strategies.

Using data from GBD 2021, indicators such as PD incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for China and the global level from 1990 to 2021 were extracted. An age-period-cohort model was employed to analyze epidemiological trends, and a Bayesian age-period-cohort model was applied to predict the disease burden from 2022 to 2035.

From 1990 to 2021, the number of PD incident cases in China increased by 455.7% (compared to a 220.1% increase globally). The age-standardized incidence rate (ASIR) showed an upward trend, rising from 12.83 per 100 000 to 24.34 per 100 000, with an estimated annual percentage change (EAPC) of 2.16% (compared to 1.09% globally). The number of prevalent cases increased by 678.9% (compared to 273.8% globally). In China, the age-standardized mortality rate (ASMR) exhibited a declining trend, decreasing from 6.11 per 100 000 to 5.03 per 100 000, with an EAPC of -0.76%. In contrast, the global ASMR showed an upward trend (EAPC=0.18%). The age-period-cohort model revealed that the growth rate of the PD burden in China was higher than the global average, particularly among males and individuals aged 75-79 years. Predictions from the Bayesian age-period-cohort model indicated that by 2035, China's ASIR (32.26 per 100 000) and age-standardized prevalence rate (ASPR) (332.67 per 100 000) for PD would far exceed global levels.

The disease burden of PD is growing rapidly, primarily driven by population aging. However, China demonstrates a more favorable trend in mortality control compared to the global average. PD shows a higher incidence among elderly individuals and males. Future efforts should focus on strengthening management, optimizing policies, and emphasizing comorbid disease management to reduce the overall burden. This study provides data-driven support for formulating targeted PD prevention and control strategies.

Cognitive dysfunction is a frequent consequence of acute ischemic stroke (AIS). Early detection of post-stroke cognitive impairment (PSCI) is critical for optimizing the prognosis of stroke patients. To date, however, there remains a lack of widely accepted blood-based biomarkers for PSCI.

This study aimed to examine the association between serum levels of vascular endothelial cadherin (VE-Cad) and the development of PSCI in individuals with AIS.

The present study enrolled patients with AIS who were admitted to the Department of Neurology, the Second Affiliated Hospital of Nanjing Medical University, between July 2023 and May 2024. Patients completed the MoCA and the MMSE at admission and three months after discharge, respectively. In this study, a MoCA score ≤26 was used as the criterion for determining cognitive decline, while the MMSE served only as an auxiliary assessment. Patients with persistent cognitive decline for three months or longer were assigned to the post-stroke cognitive impairment group (PSCI group), and the remaining patients were assigned to the post-stroke non-cognitive impairment group (PSNCI group). Demographic characteristics and laboratory parameters were compared between the two groups. Multivariate Logistic regression analysis was performed to explore the association between serum VE-Cad levels and the risk of PSCI. Restricted cubic spline (RCS) regression was employed to visualize the dose-response relationship between VE-Cad levels and PSCI risk.

A total of 261 patients with AIS were included in the final analysis, with a mean age of (66.6±10.9) years. Based on cognitive assessments conducted during hospitalization and at 3-month follow-up, 176 patients were classified into the PSCI group and 85 into the PSNCI group. Multivariate Logistic regression analysis identified serum VE-Cad as an independent influencing factor for PSCI (OR=1.119, 95%CI=1.024-1.223, P<0.05). Restricted cubic spline analysis revealed a nonlinear association between VE-Cad levels and the risk of PSCI (χ²=28.10, P<0.001), with the risk increasing significantly when VE-Cad concentrations exceeded 13.87 μg/L.

Serum VE-Cad levels are associated with the risk of post-stroke cognitive impairment in patients with AIS, exhibiting a nonlinear dose-response relationship.

Obstructive sleep apnea (OSA) is associated with cardiac structural remodeling and functional impairment. Most studies have focused on the overall OSA population, with limited attention given to the impact of different distributions of hypopnea and apnea events on cardiac structure and function.

To compare the impact of different hypopnea/ apnea ratio (HAR) classifications on cardiac structure and function in patients with OSA.

A retrospective analysis was conducted on 193 hospitalized patients with OSA and 44 control subjects at the Department of General Practice, Daping Hospital, Army Medical University from January 2023 to February 2025. All participants underwent comprehensive echocardiography during the same period. Based on the HAR, OSA patients were classified into apnea-dominant (n=66) and hypopnea-dominant (n=127) groups. They were also divided into mild (n=68), moderate (n=73), and severe (n=52) OSA groups according to the apnea hypopnea index (AHI). General demographics, comorbidities, sleep monitor parameters, and echocardiography data were collected to analyze the impact of different HAR classifications on cardiac structure and function in patients with OSA.

Left atrial systolic diameter (LADs), left ventricular diastolic diameter (LVDd), right atrial systolic diameter (RADs), aortic sinus diameter (AOAs), main pulmonary artery systolic diameter (MPAs), interventricular septum diastolic thickness (IVSTd), and left ventricular posterior wall diastolic thickness (LVPWd) were significantly higher in apnea-dominant OSA patients than those in hypopnea-dominant patients (P<0.05). Spearman correlation analysis revealed that in patients with OSA, LADs, LVDd, RADs, AOAs, MPAs, IVSTd, and LVPWd were positively correlated with AHI, and oxygen desaturation index (ODI), while negatively correlated with HAR. The lowest SpO₂ (LSpO₂) was negatively correlated with MPAs. The percentage of total sleep time with SpO₂ <90% (T₉₀) was positively correlated with LADs, LVDd, RADs, AOAs, and MPAs (P<0.05). Multiple linear regression analysis revealed that after adjusting for the effects of gender, age, BMI, and AHI, there were no significant differences in cardiac structural indicators between the two types of OSA. Gender, age, and BMI were significant predictors of multiple cardiac structural parameters (P<0.05), while AHI was identified as an independent predictor of MPAs (P<0.05).

The distribution patterns of hypopnea and apnea events show no difference in their impact on cardiac structure and function in OSA patients. Gender, age, BMI, and AHI may have more significant impacts on cardiac remodeling.

Dementia imposes a substantial burden in China, Subjective cognitive decline (SCD) represents an early warning sign of dementia. Interventions initiated during this stage, prior to the onset of objective cognitive impairment, are significantly more effective than treatments administered after a formal dementia diagnosis, offering potential to delay or even prevent disease progression.

To investigate the prevalence, epidemiological characteristics, and determinants of SCD among older adults (aged≥65 years) with a history of stroke in China, thereby providing a scientific basis for early intervention strategies.

This study utilised data from the 2024 China Aging and Health Survey (CAHS), conducted from May 2023 to June 2024. We included 2 647 older adults with stroke from 31 provinces (autonomous regions, municipalities). SCD was assessed using the validated Subjective Cognitive Decline-9 (SCD-9) scale. A weighted complex sampling design was applied to account for the survey structure, and multivariable Logistic regression analysis was employed to identify factors associated with SCD.

The weighted data showed that the rate of SCD among elderly stroke patients in China was 62.53%, and there were significant regional differences. The rates in the central region are 74.74%, in the northeast 72.37%, in the west 58.75%, and in the east 50.14%. Multivariate Logistic regression analysis showed that, compared with the eastern region, elderly stroke patients in the northeastern region had the highest risk of subjective cognitive decline (OR=1.289, 95%CI=1.189-1.398), followed by those in the central and western regions (central: OR=1.123, 95%CI=1.065-1.184; western: OR=1.069, 95%CI=1.012-1.129). Age (≥75 years: OR=1.901, 95%CI=1.805-2.001; 70-74 years: OR=1.260, 95%CI=1.192-1.330), residence (rural: OR=1.072, 95%CI=1.023-1.122), education level (high school and above: OR=0.835, 95%CI=0.787-0.887; junior high school: OR=0.766, 95%CI=0.726-0.808), monthly household income (≥10 000 yuan: OR=0.828, 95%CI=0.764-0.897; 6 000-9 999 yuan: OR=0.875, 95%CI=0.819-0.936; 3 000-5 999 yuan: OR=0.810, 95%CI=0.764-0.858), anxiety (yes: OR=1.258, 95%CI=1.184-1.338), and depression (yes: OR=3.239, 95%CI=3.063-3.425) were identified as influencing factors for subjective cognitive decline in elderly stroke patients (P<0.05).

The prevalence of SCD is high among older adults with stroke in China, with marked regional disparities. Depression and anxiety are major modifiable influencing factors. There is a need to develop regionalized early intervention strategies targeting high-risk populations to delay the progression of cognitive impairment.

The actual capacity of community health service institutions in Shanghai for the diagnosis and treatment of depressive disorders has not been systematically evaluated, and there is a lack of empirical research on the urban-suburban differences.

To assess the current capacity of community health service institutions in Shanghai in the screening, diagnosis, treatment and management of depressive disorders, investigate the knowledge mastery and practical difficulties of community general practitioners, focus on analyzing urban-suburban differences, and provide evidence for optimizing the primary mental health service system.

A cross-sectional questionnaire survey was conducted among 244 community health service centers across 16 administrative districts in Shanghai from July to August 2025. A total of 2 222 valid questionnaires were collected from institutional managers and general practitioners (244 and 1 978 questionnaires from institutions and doctors, respectively). The institutional survey mainly covered: screening tools for depressive disorders, relevant laboratory/examination items, drug allocation, psychotherapy, related management, and the establishment of specialized clinics in medical institutions. The survey for community general practitioners mainly focused on: knowledge of diagnosis and treatment of depressive disorders, cognition of screening tools for depressive disorders, cognition of differential diagnosis between depressive disorders and bipolar disorder, cognition of follow-up for depressive disorders, and difficulties in the diagnosis, treatment and management of depressive disorders.

Among the 244 community health service institutions in 16 districts of Shanghai, 80 (32.8%) and 164 (67.2%) subjects were urban and suburban institutions, respectively; among 1 978 general practitioners, 505 (25.5%) and 1 473 (74.5%) subjects were urban and suburban practitioners, respectively. Regarding screening tools for depressive disorders, the allocation rate of Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) in urban institutions was 47.5%, 43.8% and 12.5%, respectively, compared with 44.5%, 38.4% and 7.3% in suburban institutions. In terms of examinations, the availability rate of electroencephalography and echocardiography in urban and suburban community health service centers was 17.5% vs 4.3% and 70.0% vs 51.8%, respectively; the proportion of electroencephalography and echocardiography was higher in urban areas than in suburban areas (P<0.05). In terms of therapeutic drugs, the allocation rate of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in urban and suburban community health service centers was 95.0% vs 91.5% and 38.8% vs 33.5%, respectively. In terms of specialized clinics, the availability rates of psychosomatic disease clinics and psychological counseling clinics in urban and suburban community health service centers were 17.5% vs 4.3% and 15.0% vs 28.0%, respectively; the rate of psychosomatic disease clinics was higher in urban areas, while the rate of psychological counseling clinics was lower in urban centers than in suburban centers (P<0.05). The main difficulties in the management of depressive disorders in community health service centers included: limited medical resources, limited dedicated managerial staff and time (95.1%), lack of therapeutic drugs and psychotherapy skills (87.7%), and poor patient compliance with distrust in community medical staff (60.2%). The awareness rate of the diagnostic duration of depressive symptoms (minimum duration of depressive symptoms for diagnostic significance) among urban and suburban general practitioners was 52.3% and 57.6%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rates of PHQ-9 and SDS among urban and suburban general practitioners were 64.0% vs 57.8% and 65.9% vs 59.5% respectively, indicating the urban community general practitioners were higher than the suburban community general practitioners (P<0.05). The awareness rates of decreased sleep need, distractibility and inflated self-esteem were 61.2% vs 67.3%, 41.2% vs 49.6% and 57.2% vs 64.3%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rate of monthly follow-up was 73.9% in urban areas and 82.1% in suburban areas, indicating that the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The suburban general practitioners reported the higher rates of difficulties in diagnosis and treatment (including insufficient suicide risk assessment ability, insufficient non-pharmacological treatment ability and insufficient post-treatment efficacy evaluation ability) than the urban general practitioners (P<0.05). In management difficulties, suburban practitioners also reported the higher rates of insufficient health education capacity on depressive disorders, lack of expert guidance in communities, and lack of two-way referral channels with higher-level hospitals (P<0.05).

Community health service institutions in Shanghai, especially those in suburban areas, should strengthen the allocation of screening tools, relevant examinations and medications. It is necessary to improve general practitioners' mastery of depressive disorder knowledge, health education ability and psychotherapy skills. Institutional construction, resource allocation and capacity improvement should be strengthened to promote an integrated management system and enhance the efficiency of primary mental health services.

In recent years, the prevalence of sleep disturbances during pregnancy has significantly increased due to rising social pressures and lifestyle changes. Studies suggest that circadian rhythm disruption may contribute to blood pressure dysregulation through mechanisms such as hypothalamic-pituitary-adrenal (HPA) axis activation and inflammatory responses. However, the interaction between environmental factors and genetic susceptibility remains unclear. Melatonin receptor 1B (MTNR1B), a key regulator of melatonin signaling, not only modulates circadian rhythms but also plays a critical role in maintaining placental vascular endothelial function. While MTNR1B polymorphisms are strongly associated with type 2 diabetes and insulin resistance, their role in gestational hypertension (GH) susceptibility remains undetermined.

To investigate potential synergistic effects between maternal sleep quality during pregnancy and peripheral blood MTNR1B polymorphisms on GH development.

This study enrolled 235 mid-pregnancy women receiving prenatal care at a provincial hospital in Gansu from March to December 2021, with 235 age-matched healthy pregnant women as controls. Assessments included the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and a pregnancy-specific sleep health questionnaire. Peripheral venous blood was collected before delivery, and improved multiplex ligation detection reaction (im-LDR) technology was employed for genotyping three MTNR1B single-nucleotide polymorphisms (rs3781638, rs10830963, rs3781637). Logistic regression analyzed associations between late-pregnancy sleep parameters, MTNR1B polymorphisms, and GH risk, with multiplicative interaction models evaluating sleep-genotype interactions.

The genotype, allele type, dominant, and over-dominant genotypes comparison of the MTNR1B gene rs3781638 locus in the case group and the control group showed statistically significant differences (P<0.05); there was no statistically significant difference in the comparison of the MTNR1B gene rs10830963 and rs3781637 loci between the two groups (P>0.05). The results of the multivariate Logistics regression analysis showed that carrying the genotype GT (OR=1.88, 95%CI=1.24-2.84), allele type T (OR=1.28, 95%CI=1.02-1.71), dominant genotype GG+GT (OR=1.93, 95%CI=1.29-2.89), and over-dominant genotype GT (OR=1.84, 95%CI=1.22-2.72) were independent risk factors for the occurrence of GH; the interaction analysis results showed that carrying the TT genotype and coughing/snoring 1~2 times/week during nighttime sleep (OR=2.82, 95%CI=1.36-5.84) and coughing/snoring ≥3 times/week (OR=2.21, 95%CI=1.09-4.48) had a significantly higher risk of GH compared to carrying the TT genotype and no coughing/snoring during nighttime sleep (P<0.05); compared to carrying the TT genotype and no coughing/snoring during nighttime sleep, carrying the GT+GG genotype, regardless of coughing/snoring during nighttime sleep, increased the risk of GH, with the highest risk of GH occurring when coughing/snoring ≥3 times/week (OR=4.90, 95%CI=2.24-10.75).

The MTNR1B rs3781638 (G>T) polymorphism may confer GH susceptibility and demonstrate synergistic effects with nocturnal snoring on GH pathogenesis.

Cognitive impairment is one of the serious risk factors leading to disability and death in the elderly. Some studies have found an association between parental literacy and cognitive function, but research on mediating role of socioeconomic status (SES) between the two is relatively scarce.

To examine the mediating role of SES between childhood parental literacy (CPL) and late-life cognitive function.

Based on the baseline data in phase 3 of Guangzhou Biobank Cohort Study (GBCS), 8 891 Guangzhou residents aged 50 and above were included. Data on general demographic characteristics, SES, lifestyle, CPL, health conditions, and cognitive function were collected. R 4.1.1 software was used to analyze the mediating effects of SES and its representative indicators (education, family income, and occupation) between CPL and cognitive function. Pearson correlation analysis was employed to examine the associations among CPL, SES, and cognitive function. Multivariable linear regression was used to examine the association between CPL and cognitive function, and logistic regression model was used to examine the associations of CPL with mild cognitive impairment (MCI) and mild short-memory impairment (MMI).

The prevalence of MCI among the study subjects was 12.60% (1 120/8 891). Correlation analysis showed that childhood parental literacy was positively correlated with SES (r=0.312, P<0.001), cognitive function (r=0.306, P<0.001), and short-term memory function (r=0.218, P<0.001) ; and SES was positively correlated with cognitive function (r=0.337, P<0.001) and short-term memory function (r=0.240, P<0.001). After adjustment for covariates, multivariable linear and logistic regression analysis showed that, compared with both parents couldn't read/write, only father/mother could read/write and both parents could read/write were associated with higher cognitive function [β(95%CI)=1.00 (0.84-1.14), 1.46 (1.30-1.62)] and short-term memory function [β(95%CI)=0.44 (0.33-0.56), 0.64 (0.52-0.77)] (P<0.001), and the risks of MCI [OR (95%CI)=0.48 (0.41-0.57), 0.27 (0.22-0.34)] and MMI [OR (95%CI)=0.65 (0.56-0.74), 0.50 (0.43-0.59)] (P<0.001) were lower, the increases and decreases exhibit a certain trend (P_trend<0.001). The proportions of the mediating effects of SES and its representative indicators (education, family income, and occupation) between CPL and cognitive function were 21.77% (18.79%-24.77%), 18.44% (15.49%-21.50%), 6.56% (5.08%-8.24%) and 6.67% (5.07%-8.34%), respectively, and were 25.51% (21.10%-30.61%), 23.65% (19.25%-29.03%), 7.03% (5.14%-9.85%) and 7.02% (4.74%-9.68%), respectively, between CPL and short-term memory function.

SES, mainly education, may partially mediate the association between CPL and cognitive function. Strengthening early education and SES (especially education) could help delay and prevent the occurrence of cognitive impairment in middle and old age.

Diabetic neuropathy (DN) is a common and serious long-term complication of diabetes, with autonomic neuropathy gaining considerable attention due to its effects on various organ systems. The dysfunction of autonomic nerves is caused by pathological mechanisms such as metabolic imbalances, oxidative stress, and microvascular damage due to high blood sugar levels, leading to clinical symptoms like resting tachycardia, delayed stomach emptying, and bladder issues. The management of diabetic autonomic neuropathy (DAN) involves a foundational approach of stringent glycemic control, complemented by a combination of aldose reductase inhibitors, antioxidants, and neurotrophic agents to synergistically alleviate clinical symptoms. Furthermore, the utilization of neuromodulation techniques and the implementation of personalized treatments enable targeted modulation of the systemic impairments. This article provides a comprehensive review of the pathophysiological mechanisms of DAN, its clinical manifestations across multiple tissues and organs, and treatment strategies based on autonomic nervous system regulation, aiming to establish a theoretical foundation for in-depth analysis of DN pathological mechanisms and optimization of clinical intervention approaches.

Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disease of central nervous system characterized by high recurrence rate and high disability rate. Biomarkers play an important role in the diagnosis, differential diagnosis, treatment and prognosis assessment of NMOSD, which can better help clinicians to diagnose NMOSD, distinguish it from multiple sclerosis (MS) and other demyelinating diseases of the central nervous system, and help doctors to evaluate the treatment effect and prognosis of the disease. Finding more potential biomarkers and tapping the application potential of the discovered biomarkers can not only further elucidate the pathogenesis of NMOSD, but also discover new therapeutic targets. This will help doctors develop better treatment plans, more accurately assess the risk and severity of disease recurrence, and reduce the recurrence and disability rate of NMOSD. This article reviewed the research progress of newly discovered NMOSD biomarkers with potential value in recent years, including lncRNA, complement components, markers of neuronal and astrocyte damage, granulocyte activation markers, AQP-4 antibody titers, and cytokines.

Subjective Cognitive Decline (SCD) is an asymptomatic early stage of Alzheimer's Disease (AD). There are few studies on the comparative study of SCD status and influencing factors in the elderly between urban and rural areas in China.

To investigate the current status and influencing factors of SCD in the urban and rural elderly in Xinjiang, and to provide a reference for the development of relevant evaluation and intervention measures.

From July to September 2023, a multi-stage stratified cluster random sampling method was used to select elderly people from 9 urban communities in 13 rural areas of Xinjiang Uygur Autonomous Region as the research object. The general demographic characteristics, physiological health status, mental health status and social support status of the elderly were collected by questionnaire. The physical function status of the elderly was collected by physical measurement. Binary Logistic regression was used to analyze the influencing factors of SCD in the elderly in Xinjiang.

A total of 1 377 valid questionnaires were collected, and the effective recovery rate was 95.22%. The incidence of SCD among the elderly in urban and rural areas of Xinjiang region was 44.88% (618/1 377), among which the incidence of SCD in rural areas was 47.02% (292/621), and that in urban areas was 43.12% (326/756), there was no statistically significant difference between the two (P>0.05). Binary Logistic regression analysis showed that: financial resources, vision, hearing, aCCI, depression and anxiety were the influencing factors of SCD in the rural elderly in Xinjiang (P<0.05); gender, vision, hearing and anxiety were the influencing factors of SCD in the urban elderly in Xinjiang (P<0.05).

The incidence of SCD is high in the urban and rural elderly in Xinjiang, and the risk factors for SCD are different between urban and rural elderly. Medical staff should strengthen the screening, diagnosis and health education of SCD risk in the elderly, and consider the urban-rural differences in the intervention of the elderly, improve the cognitive function of the elderly and delay the occurrence and development of SCD.

Patients with major depressive disorder (MDD) have certain cognitive function impairment, but there are still research gaps in the heterogeneity of cognitive function impairment and the influencing factors of different types.

To explore the potential cognitive function impairment subtypes in MDD patients and analyze the influencing factors of subtypes.

The subjects were MDD patients (n=209) in the outpatient and inpatient Department of Psychiatry in the First Hospital of Shanxi Medical University from July 2020 to December 2023, and healthy controls (n=51) recruited in the same period. The demographic data questionnaires, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Hamilton Depression Scale (HAMD-17), and Pittsburgh Sleep Quality Index (PSQI) were used to investigate. Latent profile analysis was conducted on cognitive function classification of MDD patients based on RBANS scores in various dimensions, and unordered multinomial Logistic regression analysis was used to explore the influencing factors of potential cognitive function classifications.

The latent profile analysis results showed that the cognitive function of MDD patients could be divided into three potential subtypes: good cognitive function type (64.6%, 136/209), poor cognitive function-high perceptual type (27.7%, 57/209), and poor cognitive function-low perceptual and attention type (7.7%, 16/209). There were significant differences (P<0.05) in the total RBANS score and various dimension scores, HAMD-17 total score, PSQI total score, age, and education years between MDD patients with different cognitive function subtypes and healthy control groups. The results of the unordered multinomial Logistic regression analysis showed that taking good cognitive function type as the reference, MDD patients with fewer years of education had a higher risk of being classified into poor cognitive function-low perceptual and attention type and poor cognitive function-high perceptual type (P<0.05). In addition, MDD patients with higher HAMD-17 total scores and higher PSQI total scores were more likely to be classified into poor cognitive function-low perceptual and attention type (P<0.05).

The cognitive function impairment of MDD patients has significant heterogeneity, and the risk factors of further cognitive impairment are high degree of depression, poor sleep quality and low years of education.

Depression has a high disability rate and is projected to become the leading cause of disability worldwide by 2030. Real-world evidence indicates that even after systematic treatment and clinical symptom remission, functional impairment often persists among depression patients. However, there is a lack of research on long-term functional outcomes and influencing factors in first-episode depression patients in China.

To investigate the overall functional outcome of patients with first-episode depressive disorder after 7 years and to analyse the influencing factors of adverse functional outcome.

A total of 346 patients were enrolled from outpatient and inpatient settings at the Hebei Mental Health Center between May 2013 and May 2016. Eligible participants met the following criteria: Hamilton Depression Scale-17 (HAMD-17) score≥18, aged 18-60 years, who met the diagnostic criteria for single episode of major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-Ⅳ) were included. Through naturalistic observational follow-up, demographic characteristics, disease features, and treatment details were collected. At the 7-year follow-up, the Treatment Emergent Symptom Scale (TESS) was used to assess adverse drug reactions, the Medication Adherence Rating Scale (MARS) evaluated treatment adherence, and the Global Assessment of Functioning (GAF) measured overall functional level. Patients in remission at the 7-year follow-up were divided into two groups based on GAF scores: the good functional outcome group (GAF>70) and the poor functional outcome group (GAF≤70). Multivariate Logistic regression analysis was performed to identify factors associated with poor functional outcomes.

A total of 138 cases were completed 7-year follow-up, including 127 cases in remission stage. The good overall function group was 46 cases (36.2%). The poor overall function group was 81 cases (63.8%). At the initial onset, there were significant differences between the overall poor-function group and the good-function group in terms of occupation and educational level (P<0.05). The total number of episodes during the 7-year period in the group with overall poor function, the proportion of episodes with psychotic symptoms, and the TESS total score at follow-up after 7 years were higher than those in the group with good function (P<0.05). The multivariate Logistic regression analysis results showed that a higher total number of episodes over 7 years (OR=1.509, 95%CI=1.083-2.102) and a higher TESS total score at 7-year follow-up (OR=1.067, 95%CI=1.002-1.136) were risk factors for poor global functional outcomes in patients after 7 years, while a higher education level at first onset (OR=0.486, 95%CI=0.268-0.878) served as a protective factor (P<0.05).

Among patients with first-episode depressive disorder, 63.8% had poor global functioning after 7 years. A higher number of relapses and more severe medication side effects increased the risk of adverse outcomes, while patients with higher education levels had relatively better functional outcomes at the 7-year follow-up.

Sleep apnea is a high incidence sleep disorder disease in clinic. With the change of lifestyle, the incidence rate continues to rise, which can cause cardiovascular, metabolic and other multiple system damage. In recent years, it has been found that female sleep apnea patients often experience reproductive dysfunction such as menstrual disorders and infertility. However, the immune regulatory mechanism of sleep apnea induced damage to the female reproductive system, especially the abnormal immune response mediated by dendritic cells (DCs), still lacks in-depth analysis.

To study the effects of sleep apnea induced immune dysfunction on the reproductive system of female rats.

The research period was from January 2023 to December 2024. Thirty 4-6 month female SD rats (SPF grade) with regular estrous cycles were randomly divided into a blank control group, a short-term group, and a long-term group, with 10 rats in each group. The blank control group was fed normally for 6 weeks, the short-term group was fed for 3 weeks on the basis of preparing a sleep apnea model, and the long-term group was fed for 6 weeks on the basis of preparing a sleep apnea model. The estrous cycle of each group of rats, the expression levels of estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) subtypes in ovarian tissue, and the number of follicles in ovarian tissue were analyzed. The migration ability of DCs, the ability of DCs to stimulate homologous T lymphocyte proliferation response (MLR), and the changes in Toll-like receptor 4 (TLR4) and RelB expression levels in DCs were observed. The fertility of each group and the growth and development of offspring mice were analyzed.

Compared with the blank control group, the long-term groups showed an increased rate of dysregulation in the estrous cycle (P<0.017). Compared with the blank control group, the expression levels of ERα and ERβ in ovarian tissues were reduced in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the expression levels of ER α and ERβ in ovarian tissue (P<0.05). Compared with the blank control group, the number of primordial follicles, primary follicles, and antral follicles decreased in the short-term and long-term groups, while the number of blocked follicles increased (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the number of primordial follicles, primary follicles, and antral follicles, and an increase in the number of blocked follicles (P<0.05). Compared with the blank control group, the migration rate of DCs decreased and the MLR increased in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the migration rate of DCs and an increase in MLR (P<0.05). Compared with the blank control group, the expression levels of TLR4 and RelB in DCs in both the short-term and long-term groups increased (P<0.05). Compared with the short-term group, the long-term group showed an increase in the expression levels of TLR4 and RelB in DCs (P<0.05). Compared with the blank control group, the pregnancy rate and live birth rate of long-term groups decreased (P<0.05). Three groups of live born offspring mice showed an increase in daily weight after 21 days of birth, but compared with the blank control group, the short-term and long-term groups showed growth retardation, especially the long-term group.

Sleep apnea can cause ovarian dysfunction and reduced fertility in female rats, suggesting that it may activate TLR4/RelB by altering the migration ability of DCs, leading to immune damage and reproductive system disorders.

Perimenopausal insomnia adversely affects women's health. Western medicine primarily employs hormone replacement therapy (HRT) and sedative-hypnotic drugs for its treatment. However, HRT is associated with a high recurrence rate and carries increased risks of thrombosis and carcinogenesis, while sedative-hypnotics often lead to issues of dependence and addiction. Therefore, exploring safe and effective non-pharmacological treatments holds significant clinical importance.

To investigate the potential mechanism of action of dynamic moxibustion in treating perimenopausal insomnia.

Forty SPF-grade adult female SD rats were randomly divided into a sham-operated group, a model group, a dynamic moxibustion group, a suspended moxibustion group, and a positive control group using a block randomization method, with 8 rats per group. A rat model of perimenopausal insomnia was established. Rats in the sham-operated and model groups received intragastric administration of 0.9% NaCl solution (10 mL/kg). The dynamic moxibustion group received treatment with dynamic moxibustion. The suspended moxibustion group received intervention with circling moxibustion. The positive control group received intragastric administration of 0.1 mg/L estazolam solution (10 mL/kg), once daily. All interventions lasted for 15 consecutive days. One week after ovariectomy, vaginal exfoliated cells were collected for Giemsa staining. After the intervention period, a pentobarbital sodium cooperative sleep test was conducted to evaluate sleep duration. The Morris water maze test was used to assess learning and memory abilities in the perimenopausal rat model. After the completion of the Morris water maze and pentobarbital sodium tests, rats were anesthetized and sacrificed, and hypothalamic and colon tissues were collected. Hematoxylin-eosin (HE) staining was performed to observe pathological changes in colon tissue. Immunohistochemical staining was used to detect the protein expression of substance P (SP) and neuropeptide Y (NPY) in the hypothalamus and colon tissues. Western blot analysis was used to detect SP and NPY protein expression in thalamic tissue. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of SP, NPY, 5-hydroxytryptamine (5-HT), norepinephrine (NE) and estradiol (E2).

Giemsa staining results showed that rats in the sham-operated group maintained a regular estrous cycle, while the modeling success rate, indicated by loss of the estrous cycle, was 100% in the model group, suggesting the rats entered a perimenopausal state. Compared with the sham-operated group, the model group exhibited prolonged sleep latency and shortened sleep duration. Compared with the model group, all treatment groups showed shortened sleep latency and prolonged sleep duration. Compared with the suspended moxibustion group, the dynamic moxibustion group demonstrated shortened sleep latency and significantly prolonged sleep duration (P<0.05). Morris water maze results indicated that compared with the sham-operated group, the model group showed decreased platform crossings, prolonged escape latency, and increased total path length. Compared with the model group, all intervention groups exhibited a shortened total path length, decreased escape latency, and increased platform crossings (P<0.05). HE staining revealed that the sham-operated group had regular, intact, and orderly arranged colonic tissue structure with abundant neurons. The model group showed irregular colonic tissue surfaces, structural changes, and a decreased number of neuronal cells. Compared with the model group, all intervention groups demonstrated more uniformly and orderly arranged colonic crypts and an increased number of neuronal cells, with the abdominal dynamic moxibustion group showing marked improvement. Immunohistochemical staining results showed that compared with the sham-operated group, the model group had decreased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Compared with the model group, all intervention groups showed increased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Compared with the suspended moxibustion group, the dynamic moxibustion and positive control groups exhibited increased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Western blot results indicated that compared with the sham-operated group, the model group had increased protein expression of SP and NPY in the thalamic tissue (P<0.05). Compared with the model group, all intervention groups showed decreased protein expression of SP and NPY in the thalamic tissue (P<0.05). Compared with the suspended moxibustion group, the dynamic moxibustion and positive control groups exhibited increased SP protein expression (P<0.05). ELISA results demonstrated that compared with the sham-operated group, the model group had significantly decreased serum levels of SP, NPY, 5-HT, and E2, and significantly increased NE levels. Compared with the model group, all intervention groups showed significantly increased serum levels of SP, NPY, and 5-HT, and decreased NE levels. Compared with the suspended moxibustion group, the dynamic moxibustion group showed significantly increased serum SP and 5-HT levels, and decreased NE levels (P<0.05).

Abdominal dynamic moxibustion can improve sleep and spatial cognitive ability in a rat model of perimenopausal insomnia. Its mechanism of action may be associated with the regulation of brain-gut peptide and monoamine neurotransmitter expression.

Resilience can effectively improve health outcomes and enhance the quality of life for adolescents with type 1 diabetes mellitus (T1DM). However, this population is plagued by multi-sourced stigma, which severely undermines their resilience. Currently, the mechanism of how stigma from different sources affects resilience remains unclear.

To explore the pathways of multi-sourced stigma on the resilience of adolescents with T1DM, and identify the core sources of stigma.

From July 2022 to July 2024, a total of 364 adolescents with T1DM were conveniently selected from two tertiary hospitals in Nanjing. The data were collected by the Type 1 Diabetes Stigma Assessment Scale, the Short Form of the Chinese version Diabetes Quality of Life for Youth Scale, and the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes. Complex network analysis was performed using the R software, and subgroup analysis was performed based on age.

Within multi-sourced stigma, "being perceived as defectiv" (1.248), "worrying about negative reactions from others" (1.132), and "being excluded by others" (1.125) had the greatest expected influence in the network. "Worrying about negative reactions from others" and "concealing diabetes" showed the strongest positive correlation (r=0.562). Concealment of the disease was negatively related with the resilience dimension "help-seeking" (r=-0.098), while parental over protection was positively related with the resilience dimension "family resources" (r=0.007). The network connections were tighter in the early adolescent group compared to the late adolescent group (S=0.10, GS_pre=10.47, GS_post=10.36, P=0.789).

Public misunderstanding, social exclusion, and individual anticipated discrimination are core sources of stigma that hinder the development of resilience in adolescents with T1DM. Moreover, the early adolescence group are more susceptible to stigma. Healthcare professionals should identify and address the core sources of stigma.

Fragmented sleep is recognized as a significant contributing factor to arteriosclerosis (AS) in middle-aged and elderly populations; however, the specific associations between fragmentation across distinct sleep stages and AS have not been fully elucidated.

To investigate the association between sleep fragmentation indices and AS in middle-aged and older adults.

From March to November 2022, individuals aged 40-65 years who underwent physical examinations at the Physical Examination Center of the First People's Hospital of Fuquan City were selected. Questionnaire surveys, brachial-ankle pulse wave velocity (baPWV) measurements, and sleep data collection using smart wristbands were conducted. Unconditional binary Logistic regression models and restricted cubic spline analyses were used to assess the associations of the sleep fragmentation index (SFI), NREM fragmentation index (NFI), and REM fragmentation index (RFI) with the risk of AS. Subgroup analyses were conducted by sex, habitual snoring, and overweight/obesity status.

A total of 706 participants with complete baPWV measurements and continuous 3-day sleep monitoring data were included, of whom 347 (49.15%) were classified as having AS. After adjusting for confounding variables, SFI, NFI, and RFI showed "U"-shaped or "J"-shaped non-linear associations with AS risk (P_{SFI-Non-linear}=0.007, P_{NFI-Non-linear}=0.031, P_{RFI-Non-linear}=0.044), with the risk curves reaching the lowest levels around the inflection points (SFI≈5.75, NFI≈5.77, RFI≈8.25). Multivariable unconditional binary Logistic regression analysis showed that, after adjustment for potential confounders, compared with the SFI T2 group (5.13-<6.39), the SFI T1 group (2.59-<5.13) was marginally associated with an increased risk of AS (OR=1.515, 95%CI=1.001-2.295, P=0.05), whereas participants in the SFI T3 group (6.39-8.72) had a significantly higher risk of AS (OR=1.706, 95%CI=1.053-2.766, P<0.05); compared with the RFI T1 group (0-<7.46), the RFI T3 group (9.22-19.35) was associated with an increased risk of AS (OR=1.706, 95%CI=1.053-2.766, P<0.05). Subgroup analyses indicated that, at comparable levels of sleep fragmentation, men, habitual snorers, and overweight/obese individuals tended to exhibit higher risks of AS compared with women, non-habitual snorers, and normal-weight/underweight individuals (P<0.05).

Sleep fragmentation was nonlinearly associated with AS. Excessively high or low SFI levels and elevated RFI may be related to an increased risk of AS. Future large-scale prospective cohort studies are needed to further evaluate the utility of sleep fragmentation indices in AS risk assessment.

Hyperuricemia (HUA) is a global health concern, with its prevalence on the rise in China. Sleep, as an important lifestyle factor, shows an inconsistent relationship with serum uric acid (SUA) levels in previous observational studies, and the causal relationship between them remains unclear. Therefore, it is necessary to employ more reliable methods to clarify their intrinsic association.

To investigate the bidirectional causal relationships between sleep duration, daytime napping frequency, and SUA levels using a bidirectional Mendelian randomization (MR) approach.

This study was based on publicly available summary data from large-scale genome-wide association studies (GWAS). Data on sleep duration (n=127 573), daytime napping frequency (n=452 633), and SUA levels (n=288 649) were derived from European populations. A bidirectional two-sample MR design was employed, screening eligible single nucleotide polymorphisms (SNPs) as instrumental variables. The inverse variance weighted (IVW) method, MR-Egger regression, weighted median method, and MR-PRESSO method were used to assess causal effects. Sensitivity analyses, including heterogeneity tests and leave-one-out analysis, were conducted to verify the robustness of the results.

The MR analysis results showed that the genetic prediction of sleep duration was a negative causal relationship with the SUA level (OR=0.81, 95%CI=0.67-0.98, P=0.03), while the frequency of daytime naps predicted by genetics has a positive causal relationship with the level of SUA (OR=1.20, 95%CI=1.05-1.37, P=0.009). Reverse MR analysis found no causal effect of SUA levels on either sleep duration or daytime napping frequency (P>0.05). Sensitivity analyses detected no significant horizontal pleiotropy, indicating robust findings.

This study provides genetic evidence that shorter sleep duration and higher daytime napping frequency are independent risk factors for elevated SUA levels. Improving sleep habits may serve as an effective non-pharmacological intervention strategy for the prevention and management of HUA.

Stroke has an extremely high mortality and disability rate, making it a critical public health issue. Patients with stroke are often accompanied by lower limb motor dysfunction, which severely impairs their quality of life. In the past, one-on-one manual rehabilitation training was commonly administered to such patients, which consumes a large amount of human resources and makes it difficult to guarantee the training quality. In recent years, the advent of exoskeleton robots is expected to address this pain point. Exoskeleton robots can be classified into two major categories, fixed and mobile based on their structural forms and operational postures. However, it remains unclear whether these two distinctly designed robots are effective in improving lower limb motor function and quality of life in stroke patients, and whether there are differences in their therapeutic effects.

To investigate the effects and therapeutic benefits of stationary versus mobile exoskeleton robots in enhancing lower limb function and quality of life among stroke patients.

Forty stroke inpatients admitted to the Department of Rehabilitation Medicine at the First Medical Center of Chinese PLA General Hospital between 2021 and 2024 were enrolled as study participants. Using a random number table method, they were randomly assigned to either the fixed robot group (n=20) or the mobile robot group (n=20). In addition to conventional rehabilitation training, the fixed robot group underwent Lokomat robotic-assisted gait training for 20 minutes per session, five times weekly, over two consecutive weeks. The mobile robot group received Aikang robotic-assisted training under the same regimen: 20 minutes per day, five times per week, for two consecutive weeks, alongside standard rehabilitation. Outcome measures were collected before and after the intervention period and included the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), peak torque (PT) of hip and knee flexion and extension, absolute error angle (AE) angular error of the affected knee joint, Functional Ambulation Category (FAC) scale, gait analysis parameters, and the Modified Barthel Index (MBI).

All 40 patients completed the entire trial protocol with no dropouts reported during the study. Intergroup comparisons: prior to training, there were no statistically significant differences between the two groups in FMA-LE scores, AE angle of the affected knee joint, MBI scores, PT of hip and knee flexion/extension, and FAC grades (P>0.05). After training, no statistically significant differences were found between the two groups in FMA-LE scores, MBI scores, PT of hip and knee flexion/extension, and FAC grades (P>0.05), whereas the AE angle of the affected knee joint in the fixed robot group was significantly lower than that in the mobile robot group (P<0.05). Intragroup comparisons: after training, both groups exhibited a significant increase in the lower extremity FMA-LE scores and MBI scores, with a significant improvement in the AE angle of the affected knee joint and the PT of hip and knee flexion/extension compared with the baseline (P<0.05). The FAC grades of both groups were significantly better than those at baseline (P<0.05). Gait analysis was conducted in only 7 patients in the fixed robot group and 8 patients in the mobile robot group. For gait parameters, intergroup comparisons showed no statistically significant differences in walking speed, step length and gait cycle between the two groups both before and after training (P>0.05). Intragroup comparisons indicated that walking speed was significantly increased after training in both groups (P<0.05); the fixed robot group had a significant increase in step length (P<0.05) and a significant reduction in gait cycle (P<0.05) compared with the baseline.

Both fixed exoskeleton robots and mobile exoskeleton robots can effectively improve the lower limb function and quality of life of stroke patients, and fixed exoskeleton robots have more advantages in improving patients' knee joint proprioception.

Stroke hand dysfunction seriously affects the quality of life of patients. In recent years, studies of robot-assisted training for functional recovery of stroke patients has gradually increased, but the improvement effect lacks effective systematic evaluation and analysis, and assist specific training programs still needs to be further explored.

To systematically evaluate the intervention effect of rehabilitation robot-assisted training on the hand motor function in stroke patients.

Randomized controlled trials of rehabilitation robot-assisted training for hand motor function in stroke patients were searched in PubMed, Embase, Scopus, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed, the time limit for searching was from the establishment of each database to December 2023. Literature screening, extraction of raw data and evaluation of the methodological quality of the literature were carried out in strict accordance with the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 and Stata 17.0.

A total of 23 studies and 693 stroke patients were included in the literature. The results of meta-analysis showed that the experimental group's Fugl-Meyer Motor Function Assessment-Upper Limb(FMA-UL) (SMD=0.37, 95%CI=0.17-0.58, P<0.001), FMA-UL of wrist (MD=1.66, 95%CI=0.14-3.17, P=0.03) and hand portion (MD=2.00, 95%CI=1.17-2.83, P<0.001), Upper Extremity Movement Study Scale (SMD=0.27, 95%CI=0.01-0.53, P=0.04), handgrip strength (SMD=0.54, 95%CI=0.09-1.00, P=0.02), and hand pinch (SMD=0.62, 95%CI=0.16-1.09, P=0.008) scores improved better than those of the control group, there were significant differences between two groups. There were no significant differences in Block-Box Test (MD=1.23, 95%CI=-0.90 to 3.35, P=0.26), Modified Ashworth Scale (SMD=-0.47, 95%CI=-1.28 to 0.35, P=0.26), and Barthel Index (SMD=0.38, 95%CI=-0.07 to 0.83, P=0.10) scores.

Rehabilitation robot-assisted training is beneficial to the recovery of hand motor function in stroke patients, which can effectively improve hand mobility, grip and pinch ability, but the improvement in hand tone, dexterity and daily living ability scores is relatively small. Future studies with large samples, multi-center, and longer follow-up periods are needed to further evaluate its efficacy and safety.

The medication management of patients with severe mental disorders has become an important task for primary medical institutions in China. However, there is currently a lack of a systematic review on the medication management of patients and the restrictive factors for their regular medication.

To systematically review the situation and influencing factors associated with medication management in Chinese patients with severe mental disorders, and to provide evidence-based evidence for optimizing patients' medication management.

CNKI, WanFang, VIP and PubMed Data were searched to collect cross-sectional studies on medication management in Chinese patients with severe mental disorders and discussing the influencing factors of regular medication. The search time limit was from the establishment of the database to August 2024. Two reviewers independently screened studies, extracted data and assessed the risk of bias of included studies. Meta-analysis was conducted on the management rate, standardized management rate, medication rate, and regular medication rate in the quantitative studies using Stata 17.0 software. At the same time, a qualitative summary analysis was conducted on the influencing factors of regular medication compliance among patients with severe mental disorders.

A total of fifty-nine studies were included, among which 41 studies quantitatively reported four indicators of patients' medication management. The results of meta-analysis indicated that the management rate of patients with severe mental disorders in China was 91.0% (95%CI=89.0%-93.0%), the standardized management rate was 77.0% (95%CI=70.0%-83.0%), and the medication rate was 72.00% (95%CI=66.0%-79.0%). The rate of regular medication was 50.0% (95%CI=44.0%-56.0%). From 2014 to 2021, the management rate, standardized management rate, medication rate and regular medication rate of patients increased from 73.7%, 35.8%, 35.0% and 17.9% to 96.7%, 94.1%, 87.0% and 84.2%, respectively. The management rate remained at a similar level in the eastern (92.3%), central (94.4%) and western (92.0%) regions. The standardized management rate, medication rate and regular medication rate were all higher in the eastern (86.5%, 82.5%, 62.7%), and central (81.2%, 88.1%, 57.9%) regions compared to the western (73.8%, 64.5%, 38.2%) region. Moreover, 18 studies qualitatively reported the influencing factors of regular medication in patients with severe mental disorders. The summary analysis showed that the restrictive factors affecting patients' regular medication was complex and diverse, mainly coming from five aspects: patients themselves, family caregivers, community management, hospital diagnosis and treatment, and government support.

The medication management ability of patients with severe mental disorders in China has significantly improved in recent years, but the differences among different regions are still considerable. In the future, based on multiple restrictive factors affecting patients' regular medication, collaborative management should be carried out to achieve the goal connotation of mental health management in China.

The overlap in clinical presentation between bipolarⅡdisorder (BD-Ⅱ) and depressive disorders (DD) poses a significant challenge for differential diagnosis in primary care. Early and accurate diagnosis is critical to improve patient prognosis, and general practitioners (GPs), as frontline healthcare providers, play a pivotal role in initial screening, diagnosis, and treatment planning. However, GPs currently face challenges in accurately distinguishing BD-Ⅱ from DD. This paper summarises recent research advances in the differential diagnosis of BD-Ⅱ and DD, with a focus on clinical features, use of screening tools and follow-up strategies, and further evaluates the strengths and limitations of existing screening instruments in primary care settings. Additionally, emerging tools such as artificial intelligence, biomarkers and remote monitoring technologies are discussed for their potential to enhance diagnostic accuracy, offering valuable insights for follow-up research and clinical practice.

In clinical practice, patients with mixed hemorrhoids complicated by chronic constipation often experience postoperative difficulties in bowel movements, delayed wound healing, and increased recurrence rates. Although previous studies have confirmed that press needle therapy can improve postoperative bowel function in patients with uncomplicated mixed hemorrhoids, there is limited research on postoperative bowel management in patients with mixed hemorrhoids and a background of chronic constipation.

To observe the clinical effects of press needle therapy on postoperative bowel management in patients with chronic constipation and gradeⅢ-Ⅳ mixed hemorrhoids through a prospective randomized controlled trial, with the goal of improving patients' quality of life.

From March 2023 to March 2024, 96 patients with chronic constipation and gradeⅢ-Ⅳ mixed hemorrhoids, who were scheduled for hemorrhoidectomy, were enrolled at the Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. The patients were randomly divided into a treatment group and a control group, each comprising 48 patients. The treatment group received press needle therapy combined with oral lactulose, while the control group received oral lactulose alone for 28 days. The study measured changes in the average weekly number of spontaneous bowel movements and the time to the first postoperative spontaneous bowel movement. Traditional Chinese Medicine syndrome scores, Self-rating Anxiety Scale (SAS) scores, and Self-rating Depression Scale (SDS) scores were assessed before and after treatment. Postoperative wound pain was evaluated on days 1, 3, 5, 7, 14, and 28, and wound oedema was assessed on days 1, 3, 5, 7, and 14. The Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire was administered before treatment and on postoperative days 5, 7, 14, and 28. Clinical efficacy was evaluated before and after treatment.

The treatment group showed a greater increase in the average weekly number of spontaneous bowel movements compared to the control group (P<0.05). The time of the first postoperative spontaneous bowel movement was significantly shorter in the treatment group (P<0.05). After treatment, TCM syndrome scores and depression scores were significantly lower in the treatment group than in the control group (P<0.05). Generalized estimating equation (GEE) analysis showed significant main effects of group and time on postoperative pain scores, oedema scores, and PAC-SYM scores (P<0.001), as well as significant group-time interaction effects (P<0.001). On postoperative days 3, 5, 7, and 14, VAS scores were significantly lower in the treatment group than in the control group (P<0.05). On postoperative day 7, wound oedema scores were significantly lower in the treatment group (P<0.05). PAC-SYM scores on postoperative days 5, 7, 14, and 28 were significantly lower in the treatment group (P<0.05). The overall response rate in the treatment group was 87.5% (42/48), significantly higher than the control group's 56.2% (27/48)(P<0.05).

Press needle therapy can improve postoperative bowel function in patients with chronic constipation and mixed hemorrhoids, promote wound recovery, and alleviate adverse postoperative reactions such as pain and oedema. Its effects may be related to the regulation of the gut-brain axis and the improvement of intestinal motility. This method is safe, simple, and well-accepted by patients, making it a viable option for perioperative comprehensive management of patients with constipation-hemorrhoid comorbidity.

Balance dysfunction is one of the most common sequelae in patients with supratentorial stroke. The cerebellum, which plays a crucial role in balance, has been targeted with intermittent theta burst stimulation (iTBS) to improve balance function in these patients. However, the improvement of different types of balance abilities by this approach remains unclear.

To explore the influence of cerebellum iTBS intervention on the three types of balance abilities of static balance, dynamic balance and dual-task balance in supratentorial stroke patients.

Forty supratentorial stroke patients who were admitted to the Rehabilitation Medicine Center of Changzhou Dean Hospital from July 2023 to December 2024 were selected and divided into an experimental group (n=20) and a control group (n=20) by using a random number table. Both groups of subjects received conventional rehabilitation intervention. The experimental group received cerebellar iTBS intervention on this basis, while the control group received sham cerebellar iTBS intervention. The Berg Balance Scale (BBS) and Trunk Injury Scale (TIS) were used for assessment before the intervention and 2 weeks after the intervention. They were classified and statistically analyzed according to the static balance items and dynamic balance items. In addition, a balancing instrument was used to measure the overall stability index (OSI), anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI) of the patients in the stable platform, unstable platform and dual-task stable platform.

One participant in each of the experimental and control groups dropped out during the treatment period; thus, 19 patients in each group were ultimately included in the analysis. After 2 weeks of intervention, the static balance subscore of the BBS increased significantly compared with baseline within both groups (P<0.05). After 2 weeks of intervention, the OSI, APSI, and MLSI under the stable surface condition were all significantly reduced compared with pre-intervention values within both groups (P<0.05). After 2 weeks of intervention, the dynamic balance subscores of the BBS and TIS were significantly increased compared with baseline within both groups (P<0.05). After 2 weeks of intervention, patients in the experimental group showed significant reductions in the OSI and APSI under the unstable surface condition compared with pre-intervention values (P<0.05). After 2 weeks of intervention, both groups exhibited significant reductions in the OSI and MLSI under the dual-task stable surface condition compared with baseline (P<0.05). Between-group comparisons demonstrated that improvements in the experimental group were significantly greater than those in the control group in terms of the total scores of the static and dynamic balance items of the BBS, the total scores of the dynamic balance items of the TIS, the OSI and APSI under the unstable surface condition, and the OSI under the dual-task stable surface condition (P<0.05).

Cerebellar iTBS can effectively improve the balance function of patients with supratentorial stroke, and has a positive impact on static balance, dynamic balance and dual-task balance.

Neurofilament light chain (NfL), a sensitive biomarker of neuroal injury and neuroinflammation, has attracted increasing attention. Previous studies have demonstrated its associations with hypertension and adverse cardiovascular events;however, the potential relationship between NfL and left ventricular hypertrophy (LVH) in patients with nocturnal hypertension remains remains unclear.

To examine the association between serum NfL levels and the risk of LVH in patients with nocturnal hypertension.

A total of 351 patients with nocturnal hypertension who underwent 24-hour ambulatory blood pressure monitoring (ABPM) with complete clinical data at Renmin Hospital of Wuhan University from December 2022 to December 2024 were enrolled. Patients were divided into four groups according to NfL quartiles:Q1 (NfL≤62.82, n=88), Q2 (62.82<NfL≤92.00, n=88), Q3 (92.00<NfL≤136.40, n=87), and Q4 (NfL>136.40, n=88). Baseline characteristics, 24-hour ABPM data, laboratory results, and transthoracic echocardiographic parameters were collected. Left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated using the formula recommended by the American Society of Echocardiography. Spearman's rank correlation analysis was used to assess associations between NfL and echocardiographic parameters. Generalized linear models were applied to analyze the associations between NfL quartiles and LVMI. Logistic regression analysis was used to evaluate the relationship between NfL levels and the risk of LVH. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of NfL and autonomic function-related indicators for the risk of LVH in patients with nocturnal hypertension, and subgroup analyses were conducted.

Significant differences were observed among the four groups in age, interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness at end-diastole (LVPWd), LVM, and LVMI (P<0.05). Spearman correlation analysis showed that NfL levels were positively correlated with left ventricular internal diameter at end-diastole (LVIDd)(r_s=0.135, P=0.011), IVSd (r_s=0.128, P=0.016), LVPWd (r_s=0.146, P=0.006), LVM (r_s=0.162, P=0.002), and LVMI (r_s=0.277, P<0.001). After adjustment for confounding factors, the generalized linear model showed that, compared with Q1, NfL levels in Q3 (β=0.110, 95%CI=0.003-0.217, P=0.044) and Q4 (β=0.288, 95%CI=0.180-0.395, P<0.001) were significantly associated with LVMI. Logistic regression analysis showed that elevated NfL levels were an independent risk factor for LVH in patients with nocturnal hypertension (OR=1.012, 95%CI=1.007-1.016, P<0.001). Compared with Q1, NfL levels in Q3 (OR=3.328, 95%CI=1.152-9.611, P=0.026) and Q4 (OR=9.059, 95%CI=3.278-25.036, P<0.001) were associated with a significantly increased risk of LVH. ROC curve analysis showed that the areas under the ROC curve of NfL, norepinephrine (NE), acetylcholine (ACh), and the NE/ACh ratio for predicting LVH risk were 0.744, 0.618, 0.577, and 0.603, respectively, with sensitivities of 75.0%, 50.0%, 48.5%, and 48.5% and specificities of 63.3%, 69.3%, 51.5%, and 75.3%. Subgroup analyses indicated that NfL levels were positively associated with LVH risk in subgroups defined by age, male sex, BMI, and estimated glomerular filtration rate (P<0.05).

In patients with nocturnal hypertension, serum NfL levels are independently associated with the risk of LVH and may have clinical value in identifying individuals at high risk of LVH.

Statins are the cornerstone of secondary prevention after ischemic stroke (IS) through low-density lipoprotein cholesterol (LDL-C) reduction, as endorsed by major clinical guidelines. Their effectiveness depends on both treatment intensity and long-term adherence. The cumulative defined daily dose (cDDD) integrates exposure intensity and adherence, yet its association with recurrent IS remains unclear.

To investigate the impact of statin cDDD on recurrence risk in IS patients.

The study enrolled patients aged≥18 years with first-ever acute ischemic stroke (AIS) admitted to the North China University of Science and Technology Affiliated Hospital between January 2023 and March 2024. Baseline data were collected within 24 h of admission. Standardized secondary prevention education was provided at discharge, and patients were followed for 1 year. Participants were categorized into quartiles according to statin cDDD (Group 1-Group 4). Low-, medium-, and high-dose groups were defined by cumulative dose. Kaplan-Meier analysis assessed 1-year recurrence. Restricted cubic splines (RCS) and Cox proportional hazards models were used to evaluate the association between cDDD and recurrence.

The study enrolled 728 patients (males: 455, 62.5%; females: 273, 37.5%). Patients were stratified into quartiles as follows: Group 1 (cDDD≤101, n=173), Group 2 (101<cDDD≤152, n=191), Group 3 (152<cDDD≤205, n=179), Group 4 (cDDD>205, n=185). During follow-up, 100 recurrent strokes occurred (13.7%). Kaplan-Meier analysis demonstrated significant differences among cDDD quartiles (P<0.000 1). Cumulative recurrence rates decreased from Group 1 to Group 4: 29.5% (51/173), 16.2%(31/191), 6.7%(12/179), and 3.2%(6/185), respectively. Patients were categorized into low- (<2 400 mg, n=245), medium- (2 400-3 600 mg, n=251), and high-dose (>3 600 mg, n=232) groups based on cumulative statin exposure. Recurrence rates differed significantly among groups (χ²=62.46, P<0.000 1), with the highest rate in the low-dose group (26.9%, 66/245), followed by the medium-dose (10.7%, 27/251), and high-dose groups (3.0%, 7/232). RCS analysis revealed a nonlinear inverse association between cDDD and recurrence (P_nonlinear<0.001), with significantly reduced risk when cDDD exceeded 75. Multivariable Cox proportional hazards models consistently demonstrated a significantly lower recurrence risk in Group 4 compared to Group 1, Model 1 (HR=0.103, 95%CI=0.044-0.241), Model 2 (HR=0.107, 95%CI=0.046-0.251), and Model 3 (HR=0.123, 95%CI=0.052-0.289) (P<0.05).

Statin cDDD shows a significant nonlinear inverse association with IS recurrence, with evidence of a dose-dependent threshold effect.

Cognitive impairment poses a major health challenge in China's aging society, profoundly affecting patients' quality of life and increasing the care burden. Currently, home-based rehabilitation for cognitive impairment in China faces several issues, including low detection rates, fragmented intervention measures, and an inadequate family support system. To establish a home-based rehabilitation framework suited to China's context, the Community Rehabilitation Working Committee of Chinese Rehabilitation Medicine Association organized a multidisciplinary expert panel to develop the Chinese Expert Consensus on the Management of Home-based Rehabilitation for Cognitive Impairment (2026 Edition), based on a systematic review of domestic and international evidence. This consensus retrieved relevant guidelines and high-quality studies from both Chinese and international databases and developed recommendations following evidence-based medicine principles. It focused on key issues such as early screening, non-pharmacological interventions, home environment adaptation, and caregiver support and training. The document aimed to provide scientific and practical guidance for community healthcare workers and caregivers, enhance family rehabilitation capacity, delay disease progression, and improve the quality of life for both patients and caregivers.

Cardiovascular metabolic diseases are closely associated with depression. Although the management of cardiovascular metabolic diseases at the community level has been established, psychological issues such as depression in patients have not received sufficient attention. Moreover, there is a lack of simple, accurate, and efficient screening and assessment tools for depression.

To apply single-lead wearable electrocardiographic devices to predict the risk of depression in elderly patients with cardiovascular metabolic diseases at the community level of Ning Xia Hui Autonomous Region.

A total of 3 121 elderly patients (aged over 65) with hypertension, diabetes, coronary heart disease, and other cardiovascular metabolic diseases were selected from 20 primary medical and health care institutions in Ningxia between January 2022 and June 2023. Electrocardiographic data collected via single-lead wearable electrocardiographic devices were uploaded to a cloud platform. Additionally, sociodemographic, lifestyle, and mental health data were collected from the same platform. The data were divided into a training set (2 341 cases) and a validation set (780 cases) using a simple random sampling method at a 3∶1 ratio. LASSO regression analysis and cross-validation were performed using RStudio 4.1.1 software to identify the best predictors. A multivariable Logistic regression model was then established using the predictors selected by LASSO regression. A nomogram model for predicting the risk of depression in elderly patients with cardiovascular metabolic diseases was constructed. The model's efficacy was evaluated using the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis.

In the training set, LASSO regression combined with Logistic regression analysis identified several significant factors associated with depression in elderly patients with cardiovascular metabolic diseases: gender (OR=1.747, 95%CI=1.258-2.434) , BMI (OR=1.073, 95%CI=1.024-1.125) , urban and rural areas (OR=1.684, 95%CI=1.172-2.456) , exercise (OR=0.610, 95%CI=0.460-0.799) , anxiety (OR=3.041, 95%CI=1.597-5.484) , coronary heart disease (OR=2.743, 95%CI=1.971-3.815), premature beats (OR=4.745, 95%CI=1.681-19.977) , standard deviation of average normal-to-normal Intervals (SDANN) (OR=4.745, 95%CI=1.681-19.977) , root mean square deviation (rMSSD) (OR=0.986, 95%CI=0.972-0.999) , and sleep efficiency (OR=0.988, 95%CI=0.982-0.995) . The differences were statistically significant (P<0.05) . The Logistic regression equation Logit (P) =4.322+0.558×gender+0.071×BMI+0.521×urban and rural areas-0.494×exercise+1.112×anxiety+1.009×coronary heart disease+1.557×premature beat-0.011×SDANN-0.014×rMSSD-0.012×sleep efficiency was used to construct a column chart prediction model. The area under the curve for predicting the risk of depression in elderly chronic disease patients in the training and validation sets were 0.748 (95%CI=0.707-0.786, P<0.001) , 75.2%, 63.4% and 0.751 (95%CI=0.692-0.809) , 76.7%, 60.6%, respectively. The clinical decision curve analysis showed that when the probability threshold for depression risk was between 8% and 35% in the training set and between 8% and 37% in the validation set, the net benefit of predicting the risk of depression in elderly patients with cardiovascular metabolic diseases was higher.

Gender, BMI, urban and rural areas, exercise, anxiety, coronary heart disease, premature beats, SDANN, rMSSD, sleep efficiency are contributing factors to the risk of depression in elderly patients with cardiovascular metabolic diseases. This study successfully constructed a nomogram model for predicting the risk of depression in elderly patients with cardiovascular metabolic diseases at the community level, based on single-lead wearable electrocardiographic devices. The model demonstrated good predictive efficacy and clinical application value. It can assist primary medical and health care institutions in conducting depression screening and formulating individualized intervention measures for patients, thereby aiding in the prevention and control of cardiovascular diseases at the community level.

Depression belongs to the category of emotional disorders in traditional Chinese medicine, and its pathogenesis can be explained by the theory of "kidney brain harmony". Whether kidney tonifying and brain strengthening acupuncture therapy can be used to treat elderly depression has not been reported in the past.

Exploring the effect of tonifying the kidney and strengthening the brain acupuncture therapy based on the theory of "kidney brain coordination" combined with sertraline on improving the emotional and cognitive functions of elderly depression patients.

This trial has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400081227). Eighty-six elderly patients with depression admitted to the Department of Mental Health and Psychology of the General Hospital of Northern Theater Command between March 2023 and March 2024 were selected as the research subjects, they were randomly divided into an observation group (n=43) and a control group (n=43). The patients in the control group were treated with sertraline alone, while the patients in the observation group were treated with kidney tonifying and brain strengthening acupuncture combined with sertraline. All patients were treated for 4 weeks. Before and after treatment, evaluate depressive mood using the 17 item Hamilton Depression Scale (HAMD-17), evaluate cognitive function using the Wisconsin Card Sorting Test, detect platelet count (PLT), mononuclear cell count (MONO), neutrophil count (NC), lymphocyte count (LC), and calculate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI). Compare the HAMD-17 scores, cognitive function, SII and SIRI of the two groups before and after treatment. The relationship between the change values of HAMD-17 scores and cognitive function with SII and SIRI in the observation group was analyzed by Pearson correlation analysis, and the clinical efficacy of the two groups was compared.

The HAMD-17 score in the observation group was lower than the control group after treatment (P<0.05). The percentage of correct responses and conceptualization level in the Wisconsin Card Sorting Test in the observation group after treatment was higher than that in the control group (P<0.05). The SII and SIRI of the observation group was lower than the control group after treatment (P<0.05). The changes in SII before and after treatment in the observation group were positively correlated with the changes in HAMD-17 score (r=0.536, P<0.05). The changes in SII were negatively correlated with the percentage of correct responses to the Wisconsin Card Sorting Test (r=-0.621, P<0.05) and the percentage of conceptualization level (r=-0.482, P<0.05), respectively. The change in SIRI score was positively correlated with the change in HAMD-17 score (r=0.429, P<0.05). The SIRI change values were negatively correlated with the percentage of correct responses to the Wisconsin Card Sorting Test (r=-0.378, P<0.05) and the percentage of conceptualization level (r=-0.434, P<0.05), respectively. The therapeutic effect of the observation group was better than the control group (P<0.05).

Kidney tonifying and brain strengthening acupuncture therapy can improve the effectiveness of sertraline in treating elderly depression, and its mechanism of alleviating depressive mood and cognitive function may be related to improving immune inflammation.

Acute ischemic stroke (AIS) is caused by a sudden interruption of cerebral blood flow, leading to ischemic injury of brain tissue. Currently, the prediction, prevention, and treatment of AIS still primarily rely on traditional glycolipid markers. However, their sensitivity, specificity, and correlation with AIS need further improvement. There is an urgent need to optimize the combination of these parameters to enhance their efficacy in diagnosis and treatment of AIS.

To investigate the predictive value of non-conventional lipid indices (TG/HDL-C ratio, remnant cholesterol, etc) and triglyceride-glucose index (TyG index) for AIS, and their correlation with the severity of neurological injury.

A total of 313 newly diagnosed AIS patients admitted to the Department of Encephalopathy Center in Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine between April 2023 and May 2024 were enrolled as the stroke group. At the same time, 709 healthy control people from the same hospital were collected as the control group. General demographic and laboratory data were collected from both groups. Multivariate Logistic regression analysis was used to identify independent factors for AIS. Spearman rank correlation analysis was performed to evaluate the correlation between indicators such as TyG, FPG, TG/HDL-C and National Institutes of Health Stroke Scale (NIHSS) scores in AIS patients, and receiver operating characteristic (ROC) curves were used to assess the predictive value of individual and combined indicators (including TyG, FPG, and TG/HDL-C) for AIS.

No significant differences were observed between the two groups in terms of age, gender, LDL-C, or total cholesterol (TC) (P>0.05). However, statistically significant differences were found in the proportions of patients with a history of hypertension, diabetes, atrial fibrillation, hyperlipidemia, as well as in the levels of TG, HDL-C, RC, TyG index, TG/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C), FPG, platelet count, and the platelet to HDL-C ratio (PHR) (P<0.05). Multivariate Logistic regression analysis identified the TyG (OR=2.710, 95%CI=1.192-6.160, P=0.017), TG/HDL-C (OR=1.765, 95%CI=1.033-3.014, P=0.037), FPG (OR=1.288, 95%CI=1.101-1.506, P=0.002), and PHR (OR=1.003, 95%CI=1.000-1.006, P=0.043) as independent influencing factors for AIS occurrence. Spearman rank correlation analysis revealed positive correlations between the TyG index, TG/HDL-C ratio, TG levels, and the NIHSS score in AIS patients (r_s=0.148, 0.140, 0.119, respectively; P<0.05). The results of the ROC curve showed that the AUCs of the TyG index, TG/HDL-C, TG, FPG, and PHR for predicting AIS were 0.712, 0.674, 0.646, 0.723, and 0.588, respectively. The AUC of the combined prediction of TyG index + FPG + TG + TG/HDL-C for AIS was 0.762, with a sensitivity of 64.0% and a specificity of 78.7%, indicating stable performance at multiple thresholds and strong overall discrimination ability, its Youden index was 0.426. Other combinations showed: FPG+TG had an AUC of 0.750, sensitivity of 74.0%, specificity of 69.3%, and a Youden index of 0.432; FPG+TG/HDL-C had an AUC of 0.761, sensitivity of 76.7%, specificity of 68.3%, and a Youden index of 0.450; FPG+PHR had an AUC of 0.740, sensitivity of 72.1%, specificity of 71.7%, and a Youden index of 0.438; FPG+TyG index+PHR had an AUC of 0.757, sensitivity of 69.3%, specificity of 74.0%, and a Youden index of 0.432. The results indicate that while the combination of TyG index+FPG+TG+TG/HDL-C demonstrates excellent comprehensive performance at specific thresholds.

The TyG index, TG/HDL-C, FPG, and PHR are independently associated with the risk of AIS occurrence, and can reflect the severity of neurological damage in AIS. The combined use of TyG index, FPG, TG and TG/HDL-C for diagnosing AIS yields a relatively high AUC, while the combination of FPG and TG/HDL-C demonstrates a higher Youden index.

Diabetes and depression have become two major public health challenges. Depression can reduce the treatment adherence of patients with diabetes, exacerbate diabetic complications and mortality, and severely affect the quality of life of patients. However, currently, clinicians tend to focus on biological factors while neglecting psychological factors. As a result, the diagnosis rate of depression in diabetic patients is low. Therefore, it is of great clinical significance to actively identify and screen type 2 diabetic patients at risk of depression and to conduct in-depth analysis of various influencing factors.

With the increasing incidence of diabetes, the related psychological problems are also becoming more and more concerned. In order to overcome the limitations of selection bias in single-center surveys, we conducted a nationwide multicenter survey to investigate the prevalence of depression and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in China, and to provide a basis for developing mental health intervention strategies for diabetic patients.

A nationwide multicenter observational study was conducted using a probability proportional to size (PPS) sampling method. A total of 2 137 patients with T2DM were recruited from 52 hospitals across China. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (PHQ-9≥10 indicated depression). Through a review of the literature, 29influential factors were identified: fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, and lipid profiles, triglyceride-glucose index (TyG), diabetes duration, diabetes complications, anddiabetes comorbidities. Multivariate logistic regression analysis was performed to identify factors associated with depression in T2DM patients. Use the statistical software R package to analyze whether there is a nonlinear relationship between age, TyG, and depression and calculate the inflection point.

Among 1 659 patients with type 2 diabetes, the prevalence of depression was 13.3% (220 cases). Multivariate logistic regression analysis identified the following independent risk factors for depression in type 2 diabetes patients: gender (female OR=1.815, 95%CI=1.220-2.701), age (OR=0.969, 95%CI=0.952-0.987), education level (below high school: OR=1.488, 95%CI=1.049-2.11), marital status (unmarried and others: OR=1.864, 95%CI=1.068-3.254), BMI (OR=0.936, 95%CI=0.896-0.977), ecomomic difficulties (OR=3.654, 95%CI=2.403-5.558), duration of disease (OR=1.031, 95%CI=1.006-1.057), diabetic peripheral neuropathy (OR=2.17, 95%CI=1.275-3.693), cardiovascular disease (OR=1.844, 95%CI=1.248-2.723), hypertension (OR=1.625, 95%CI=1.163-2.271), and TyG (OR=1.717, 95%CI=1.026-2.874)(P<0.05). After controlling for confounding factors, TyG showed a linear positive correlation with depression (P_nonlinear=0.191), while age exhibited a linear negative correlation with depression in the male population (P_nonlinear=0.946). The age of women was not linearly related to depression (P_nonlinear=0.013), and the time inflection point of the relationship was 49 years old (OR=0.921, 95%CI=0.857-0.99, P_nonlinear=0.025; OR=1.036, 95%CI=1.003-1.07, P_nonlinear=0.0323).

The prevalence of depression among Chinese patients with T2DM was 13.3%. Patients with low education levels, non-marital status, financial difficulties, high TyG index, and comorbid conditions such as diabetic peripheral neuropathy, cardiovascular disease, and hypertension were more likely to develop depression. Among male patients, the prevalence of depression decreased with increasing age. Among female patients, the relationship between age and the incidence of depression in the diabetic population followed a J-shaped curve, The risk of depression increases again after the age of 49. Early screening and intervention for depression are recommended for these high-risk groups to improve the overall health status and quality of life of T2DM patients.

The detection rate of internet addiction among Chinese adolescents is high, and its harmful effects are increasingly prominent. Previous studies have indicated strong associations between childhood trauma, depressive symptoms, and academic burnout with internet addiction, while gender factors may also play a moderating role. However, the underlying mechanisms among these variables remain to be further investigated.

This study aims to construct a moderated chain mediation model to examine the relationships among childhood trauma, depressive symptoms, academic burnout, gender, and internet addiction, providing a theoretical basis for prevention and intervention.

In February 2022, students from all 10 secondary schools in a district of Chengdu were selected as the study subjects. General information was collected through questionnaires, and childhood trauma, depressive symptoms, academic burnout, and internet addiction levels were assessed using the Childhood Trauma Questionnaire Short Form (CTQ-SF), Patient Health Questionnaire Depression Scale (PHQ-9), Adolescent Academic Burnout Scale (AABS), and Internet Addiction Diagnostic Scale for Adolescents (IADDS), respectively. Spearman correlation analysis was used to examine the relationships between the scores of the scales. Moderated chain mediation model analysis was performed using the SPSS macro program Process 3.5, and Bootstrap method was used to test the mediation and moderation effects. Simple slope analysis was applied to compare the interaction effects.

A total of 34 534 valid questionnaires were collected, with an effective response rate of 84.60%. Among them, 5 869 adolescents self-reported childhood trauma experiences and completed the CTQ-SF scale, which were included in the final analysis. Correlation analysis showed that the CTQ-SF score was positively correlated with the PHQ-9 score (r_s=0.266, P<0.01), AABS score (r_s=0.203, P<0.01), and IADDS score (r_s=0.156, P<0.01). The PHQ-9 score was positively correlated with both the AABS score (r_s=0.307, P<0.01) and the IADDS score (r_s=0.184, P<0.01). The AABS score was positively correlated with the IADDS score (r_s=0.278, P<0.01). PHQ-9 scores and AABS scores partially mediated the relationship between CTQ-SF scores and IADDS scores, accounting for 13.51% and 16.22% of the total effect, respectively. The chain mediation effect of both was 10.81% of the total effect. Gender moderated the relationship between CTQ-SF scores and PHQ-9 scores (β=0.020, P<0.01) and IADDS scores (β=-0.013, P<0.01). The simple slope analysis showed that the predictive effect of CTQ-SF scores on male IADDS scores (β=0.029, P<0.001) was significantly higher than on females (β=0.016, P<0.001); whereas the predictive effect of CTQ-SF scores on female PHQ-9 scores (β=0.085, P<0.001) was significantly higher than on males (β=0.064, P<0.001).

Depression symptoms and academic burnout play a chain mediating role in the relationship between childhood trauma and internet addiction. Childhood trauma predicts internet addiction more strongly in males, while its predictive effect on depression symptoms is stronger in females.

Alzheimer's disease and related cognitive disorders are characterized by an insidious onset and long disease course, making early identification a critical strategy for reducing disease burden. The 10th edition of the Guidelines for Preventive Activities in General Practice issued by the Royal Australian College of General Practitioners (RACGP) adopts a strong primary care orientation and emphasizes opportunistic case-finding among high-risk populations, integrating evidence-based principles on screening, selection of cognitive assessment tools, and multidimensional management of modifiable risk factors. Drawing on the 2024 Lancet Commission on Dementia Prevention, Intervention and Care, World Health Organization evidence, and the life-course management framework, this paper systematically interprets the key recommendations of the RACGP guideline from a general practice perspective, with a focus on risk identification, exclusion of reversible causes, stratified use of screening instruments, and longitudinal management. The analysis suggests that commonly used tools such as the MoCA, GPCOG, RUDAS and AD8 demonstrate complementary strengths across different community populations and clinical contexts, supporting their integration into opportunistic screening pathways in primary care. In addition, interventions targeting physical activity, metabolic control, hearing impairment, sleep disorders and medication optimization constitute a feasible life-course prevention package. In the Chinese primary care context, early identification of cognitive impairment remains constrained by insufficient linkage between screening and referral, limited workforce training and resource integration, and low public awareness. This paper proposes embedding cognitive screening into family doctor contract services and chronic disease management programmes, and leveraging integrated care networks to establish a closed-loop pathway encompassing screening, assessment, referral, intervention and follow-up, thereby advancing earlier prevention and strengthening the role of primary care in dementia risk reduction.

Community screening and diagnosis of mild cognitive impairment (MCI) in the community are of great value in the prevention of dementia. Currently, there is still no consensus on the management of community screening and diagnosis in the MCI population. This study conducted a detailed review of the current management of community screening and diagnosis, specific items for screening and diagnosis, and peri-diagnostic support for the MCI population, and found that community screening and diagnosis of MCI need to be comprehensively assessed in terms of population definition, history taking, cognitive assessment and auxiliary testing; peri-diagnostic support should include post-diagnostic disclosure, development of post-diagnostic support program and guidance on post-diagnostic support. Thus, it is suggested that community healthcare workers should carry out comprehensive assessment and diagnosis of the MCI population, and actively carry out rapid post-diagnostic support actions to promote the dementia prevention to be really moved forward.

Day care service is an important component of the community care service system for elderly people with dementia. However, the concept of dementia day care has not been unified, and its connotation and implementation framework have not been clarified, which greatly affects the continuous construction and high-quality service supply of dementia day care service. The Walker classic concept analysis method was used and five attributes of the concept was introduced including (1) daytime intensive, non-residential care; (2) professional coordination and integrated care focused on families with dementia; (3) public respite care support for families with dementia; (4) a crucial complement to high-quality care for dementia; (5) a driving force in promoting a dementia-friendly community. The preconditions of dementia day care include high care needs, weakened family functions and the dominant role of public care, and the consequences involve dementia, family caregivers and social welfare. The implementation factors identification, implementation strategy design, implementation and effect evaluation were carried out respectively using the consolidated framework for implementation research, the replicating effective programs implementation framework and the RE-AIM evaluation framework in the field of implementation science. The specialization, high quality, integrated care, and the philosophy of the friendly community should be highlighted in the future development of dementia day care. The service content, facilities and implementation process need to be improved to promote the quality of dementia day care service.

China has now launched the Alzheimer's disease prevention and treatment promotion action, and local communities are actively carrying out cognitive function screening around the community elderly population. However, there is no suitable evaluation standard to be used as the basis for the screening of cognitive impairment in the community.

To construct an evaluation system for cognitive impairment screening services applicable to the community, and to provide a reference for the appraisal and quality control of large-scale community-based cognitive function screening programs among older adults in various regions of China.

By literature research and policy analysis, the first draft of the indicator system was proposed around the five elements of the RE-AIM framework, and 15 experts were selected to carry out a Delphi expert consultation to construct an evaluation indicator system for community-based cognitive impairment screening services from October 2023 to January 2024. The weights of the indicators were determined using the multiplier method.

The positive coefficients of experts in the two rounds of Delphi were 100.0% and 93.3%, the experts' authority coefficients were 0.83 and 0.86, and the coordination coefficients of experts' opinions were 0.242 and 0.265 (P<0.001), and the final evaluation system consisted of 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators. The first-level indicators and their weights were screening reachability (0.203 5), screening efficacy (0.203 5), program adoption by the organization (0.194 8), program implementation (0.203 5), and program maintenance (0.194 8).

The evaluation index system of the community cognitive impairment screening service initially constructed in this study, which contains 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators, is of good scientific validity and reliability, and has certain reference value for improving the assessment system of cognitive impairment screening.

With the socioeconomic development in China, the prevalence of overweight/obesity has risen significantly, becoming a major public health issue. Currently, commonly used obesity indicators, such as BMI and waist circumference (WC) cannot differentiate between subcutaneous fat and visceral fat, while visceral fat is closely associated to chronic diseases. Therefore, exploring the correlation between novel anthropometric indices and stroke risk holds significant importance.

To explore the correlation of different anthropometric indices with the incidence of stroke, and their predictive capacity for the risk of stroke, aiming to provide evidence for community-based chronic disease health management and cardiovascular/cerebrovascular disease surveillance.

Based on the Pudong New Area Chronic Disease and Risk Factors Surveillance Cohort Study Project, a nested case-control study was performed involving participants enrolled in the 2016 and 2019 field surveys. They were followed up until December 31, 2023. Individuals who developed stroke during follow-up were assigned to the case group, and those without developing stroke were served as controls. Data on demographics, medical history, family history, and major risk factors were collected using standardized epidemiological questionnaires. Physical and laboratory examination indicators were recorded. Logistic regression and restricted cubic spline (RCS) regression models were applied to analyze the correlation between anthropometric indices and stroke. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance, with pairwise comparisons conducted via DeLong's test.

Among the 15 440 study subjects included in the analysis, a total of 930 had strokes. For every one-unit increase in BMI, WC, body roundness index (BRI), and Chinese visceral adiposity index (CVAI), the risk of stroke increased by 3.8% (OR=1.038, 95%CI=1.017-1.058), 1.2% (OR=1.012, 95%CI=1.004-1.020), 10.6% (OR=1.106, 95%CI=1.042-1.174), and 0.5% (OR=1.005, 95%CI=1.003-1.007), respectively (P<0.05). The RCS regression model showed a linear dose-response correlation of BMI, WC, and BRI with the risk of stroke (P_total<0.05, P_non-linear >0.05), and a non-linear dose-response relationship between CVAI and the risk of stroke (P_total<0.001, P_non-linear=0.009). The ROC curve results indicated that the predictive ability of CVAI for the risk of stroke (area under the curve=0.66) was better than that of BMI (Z=-12.713, P<0.001), WC (Z=-13.512, P<0.001), and BRI (Z=-8.696, P<0.001).

BMI, WC, BRI, and CVAI are correlated with the risk of stroke. CVAI is superior to BMI, WC, and BRI in predicting the risk of stroke and can be used as an applicable indicator for the risk of stroke. These findings underscore the need for comprehensive chronic disease management in community health programs, emphasizing weight control and the impact of visceral obesity.

The body roundness index (BRI) is an emerging anthropometric indicator that has been increasingly associated with various cardiometabolic conditions, including hypertension and diabetes. However, its association with obstructive sleep apnea (OSA) and its potential as a predictive tool remain poorly understood.

This study aimed to investigate the association between BRI and OSA risk and to evaluate its predictive performance for OSA in adults.

A cross-sectional analysis was conducted among 638 outpatients suspected of OSA at Shenzhen University Affiliated South China Hospital between January 2024 and March 2025. All participants underwent overnight polysomnography, and OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events per hour. Anthropometric measurements—including height, weight, waist circumference, and neck circumference were collected to calculate BRI, BMI, a body shape index (ABSI), and weight-adjusted waist index (WWI). Multivariable Logistic regression models were used to assess the association between BRI and OSA after adjusting for potential confounders. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of each index, with subgroup analyses performed by sex.

Of the 638 participants, 552 (86.5%) were diagnosed with OSA. The multivariable Logistic regression revealed a significant dose-response relationship between BRI and OSA risk (P_trend<0.001). After adjusting for confounding factors, the risk of OSA in the highest quartile group of BRI (Q4: >5.744) was 6.955 times (95%CI=2.960-16.344) that of the lowest group (Q1: ≤3.931). The ROC analysis demonstrated that BRI achieved an area under the curve (AUC) of 0.740 (95%CI=0.682-0.799) for OSA detection, with an optimal cut-off value of 4.199 yielding 73.4% sensitivity and 68.6% specificity. In comparison, the AUC for ABSI, WWI, and BMI were 0.633, 0.676, and 0.717, respectively. DeLong test results confirmed that BRI's AUC was greater than those of ABSI and WWI (P<0.05). In men, the AUC of BRI in diagnosing OSA was 0.774. In women, the AUC of BRI in diagnosing OSA was 0.654.

BRI serves as a significant influencing factor for the prevalence of OSA among Chinese adults, demonstrating good predictive efficacy. Consequently, BRI can be utilized as an economical and effective tool for the early screening of OSA.

Sarcopenia in patients with acute ischemic stroke (AIS) is significantly associated with poor clinical outcomes. Consequently, there is a growing research interest in identifying simple and practical clinical indicators to screen the high-risk population, forming a key intersection between stroke rehabilitation and clinical nutrition.

This study aimed to explore the feasibility and clinical value of temporal muscle cross-sectional area (TMA) and temporal muscle thickness (TMT) in evaluating sarcopenia in AIS patients.

A total of 531 AIS patients (347 males, 184 females) admitted to the Second Affiliated Hospital of Anhui Medical University between January 2022 and August 2025 were enrolled. Bilateral TMA and TMT were measured via cranial CT or MRI. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Independent predictors were identified using univariate and multivariate Logistic regression analyses. A prediction model was constructed and its performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

The prevalence of sarcopenia among AIS patients was 19.96% (106/531). Based on the diagnostic criteria, patients were categorized into a sarcopenia group (n=106) and a non-sarcopenia group (n=425). Patients in the sarcopenia group had significantly lower TMA and TMT values compared to those in the non-sarcopenia group (P<0.001). Multivariate Logistic regression analysis identified age (OR=1.717, 95%CI=1.223-2.410), NIHSS score (OR=3.213, 95%CI=1.829-5.643), NRS 2002 score (OR=1.337, 95%CI=1.045-1.711), and TMA (OR=0.781, 95%CI=0.639-0.955) as independent influencing factors for sarcopenia in AIS (P<0.05). To construct and validate the sarcopenia risk prediction model, all subjects were randomly divided into a training set (n=398) and a validation set (n=133) according to 3∶1 ratio. The final model formula, based on multivariate logistic regression analysis, was Logit(P)=46.221 22+0.082 11×age+2.078 56×(NRS 2002=1)-0.144 80×TMA+18.327 80×(NIHSS=1). A nomogram was generated to predict the risk of sarcopenia. The area under the ROC curve (AUC) of the prediction model was 0.884 (95%CI=0.782-0.947) in the training set and 0.808 (95%CI=0.679-0.882) in the validation set. The calibration curve demonstrated good consistency between the predicted and actual probabilities. Furthermore, the DCA indicated that the model provided clinical net benefits across a wide range of threshold probabilities.

Temporal muscle measurement is an effective method for evaluating the muscle wasting status of patients with AIS. The prediction model based on age, NIHSS score, NRS 2002 score, and TMA exhibits good discriminatory performance and clinical applicability, providing a practical tool for early identification of sarcopenia in this patient population.

Neurological disorders severely impact patients' quality of life. These disorders have multifactorial etiologies, including genetic, infectious, and immunological factors. Emerging evidence highlights the role of gut microbiota in these disorders through the gut-brain axis. However, the research hotspots and trends in this field remain inadequately characterized.

This study aims to conduct a visual analysis of the literature related to neurological disorders and gut microbiota, with the goal of understanding the current research landscape both domestically and internationally. Furthermore, it seeks to explore the research hotspots and emerging trends, thereby providing a reference for future studies.

Relevant literature was retrieved from the Web of Science Core Collection database from January 1, 2000 to July 29, 2024. Using CiteSpace software, a visual analysis was performed from multiple aspects, including publication volume, co-citation analysis, highly cited papers, citation burst papers, keyword co-occurrence, national collaboration, institutional collaboration, and author collaboration.

A total of 5 239 articles were included, with a steady increase in publication volume since 2012, surpassing 1 000 articles in 2022. The research hotspots primarily concentrated on Parkinson's disease, Alzheimer's disease, ischemic stroke, and amyotrophic lateral sclerosis. Citation analysis revealed that the relationship between gut microbiota and CNS diseases had become a prominent research focus in recent years. Moreover, co-occurrence analysis of keywords further highlighted the frequent appearance of important research topics such as short-chain fatty acids, the gut-brain axis, and gut microbiota dysbiosis, indicating a high level of attention to these areas. High-citation articles and citation burst analysis showed that the research trend was centered on the mechanisms through which gut microbiota influence neurodegenerative diseases and other CNS disorders, particularly focusing on the regulatory roles of short-chain fatty acids, gut microbiota diversity, and the gut-brain axis.

CiteSpace-based bibliometric analysis suggests a potential association between gut microbiota and neurological disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. Modulation of gut microbiota may offer a promising therapeutic avenue for the management of these conditions. Further longitudinal studies and clinical trials are warranted to validate this hypothesis and to elucidate the underlying mechanisms by which the gut microbiota influences neurological disease pathogenesis.