Frailty and depressive disorders exhibit a high prevalence and comorbidity rate in the elderly population.Their coexistence significantly reduces patients'quality of life,increases the risk of disability and mortality,and substantially exacerbates the socioeconomic burden.Emerging evidence indicates a significant bidirectional causal relationship between frailty and depressive disorders.The underlying comorbid mechanisms may be related to elevated levels of pro-inflammatory cytokines such as C-reactive protein,neutrophils,and white blood cells.Grey matter volume reduces in specific brain regions including the bilateral thalamus and right precentral gyrus.And abnormal hormone secretion,such as cortisol,resulting from the overactivation of the hypothalamic-pituitary-adrenal axis.Exercise interventions demonstrate positive effects in preventing and managing both frailty and depressive disorders,indicating broad application prospects.However,the underlying mechanisms require further validation.In summary,the comorbidity of frailty and depressive disorders in the elderly requires greater attention.Current evidence supports exercise intervention as an effective therapeutic strategy for improving health outcomes in this population.

Objective To investigate the potential role of plasma adiponectin concentration in predicting the response of patients with depression to electroconvulsive therapy(ECT).Methods This study enrolled depressive patients scheduled for ECT at the First Hospital of Shanxi Medical University between January 2022 and March 2024.Patients were categorized as either ECT responders(>50%reduction)or non-responders(≤50%reduction)based on post-ECT reduction rate of the 24-item Hamilton depression scale(HAMD)scores from baseline.Plasma adiponectin levels were measured in all patients before their first ECT treatment.To identify predictors of ECT response in patients with depression,the predictive value of plasma adiponectin was evaluated using receiver operating characteristic(ROC)curve analysis.Results A total of 80 patients with depression were enrolled including 44 in the ECT-responsive group and 36 in the non-responsive group.The plasma adiponectin level was significantly higher in the responsive group than in the non-responsive group[5.67(3.64,10.55)μg/mL vs.4.01(2.59,5.04)μg/mL,P=0.002].Pearson correlation analysis revealed a significant positive correlation between plasma adiponectin levels and the HAMD reduction rate(r=0.300,P=0.007).Multivariate logistic regression analysis showed that plasma adiponectin was independently associated with the response to ECT in patients with depression(OR=1.218,95%CI:1.009-1.470,P=0.040).Furthermore,ROC curve analysis demonstrated that the area under the curve(AUC)for adiponectin in predicting ECT response was 0.748(95%CI:0.583-0.813).Conclusion Pretreatment plasma adiponectin may serve as a potential biomarker for predicting response to ECT in patients with depression.

Enhanced External Counterpulsation(EECP)is a non-invasive auxiliary circulation technique that enhances blood perfusion to vital organs such as the heart and brain by elevating diastolic blood pressure in the aorta.It has demonstrated substantial effectiveness in treating ischemic heart disease.However,the application of EECP in ischemic cerebrovascular disease is not widely used both domestically and internationally.Its,indications,influencing factors,and operational procedures lack standardization.Therefore,this expert taskforce comprehensively reviewed relevant literature and combined clinical experience to summarize and propose recommendations for EECP in treating ischemic cerebrovascular disease.This document outlines the working principles,biological effects,and impact of EECP on cerebral blood flow autoregulation.It also proposes indications,influencing factors,treatment protocols,and monitoring indicators for EECP in ischemic cerebrovascular disease,advocating for the establishment of EECP centers with neurological specialties and conducting clinical trials to explore the efficacy and safety of EECP in treating ischemic cerebrovascular disease,thereby expanding its clinical applications.

Rumination is a core cognitive symptom of post-traumatic stress disorder(PTSD),which significantly exacerbates difficulties in emotional regulation and impedes symptom recovery.Its occurrence is closely associated with gray matter structural impairments and abnormal white matter connectivity in the prefrontal-limbic system,including the hippocampus,amygdala,and prefrontal cortex.Functional neuroimaging studies indicate that the neural basis of rumination involves hyperactivation of the default mode network and the salience network,coupled with reduced functionality of the executive control network.Neurochemical research suggests that metabolic imbalances in the glutamate/γ-aminobutyric acid system may further contribute to the maintenance and reinforcement of rumination.Systematically elucidating the neural mechanisms of rumination in PTSD patients based on multimodal neuroimaging evidence will facilitate a deeper understanding of its neuropathological mechanisms and help expand future research directions.

Objective To investigate the relationship between serum trimethylamine oxide(TMAO),neurofilament light chain protein(NfL),peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α)expression levels and short-term prognosis in aneurysmal subarachnoid hemorrhage(aSAH)patients.Method A total of 125 aSAH patients(aSAH group)and 125 healthy volunteers in the same period(control group)who were admitted in heji hospital affiliated to Changzhi Medical College from March 2020 to June 2023 were selected.The serum expression levels of TMAO,NfL and PGC-1α were compared between control group and aSAH group.The aSAH patients were followed up for 6 months after discharge.Their prognosis were evaluated using Glasgow Outcome Scale(GOS)and they were further divided into good prognosis and poor prognosis groups according to the GOS results.The serum expression levels of TMAO,NfL and PGC-1α were compared between the two groups.The poor prognosis influencing factors were analyzed by multivariate Logistic regression analysis,the serum TMAO,NfL and PGC-1α value in predicting poor prognosis were analyzed by receiver operating characteristic(ROC)curve.Result The expression levels of serum TMAO and PGC-1 α in the aSAH group were(2.63±0.36)μmol/L and(0.51±0.13)ng/mL,respectively,which were lower than those in the control group(3.18±0.57)μmol/L and(0.81±0.16)ng/mL(P<0.05).The expression level of serum NfL was significantly higher in the aSAH group(64.48±14.35 pg/mL)than in the control group(28.36±8.82 pg/mL)(P<0.05).Compared with the good prognosis group whose serum levels of TMAO and PGC-1 α were(2.80±0.80)μmol/L and(0.58±0.16)ng/mL,respectively,the poor prognosis group had significantly lower serum TMAO[(2.29±0.63)μmol/L]and PGC-1 α[(0.36±0.12)ng/mL](P<0.05).In contrast,poor prognosis group had a significantly higher level of NfL(76.70±15.61)pg/mL compared to good prognosis group(58.52±10.52)pg/mL(P<0.05).The proportion of patients with hypertension,patients with diabetes,patients with large or giant aneurysms,patients with Hunt Hess grade Ⅲ-Ⅳ,patients with onset to hospital time>12 h,and the level of C-reactive protein(CRP)were higher in the poor prognosis group than in the good prognosis group(P<0.05).Hunt Hess grade Ⅲ-Ⅳ,elevated serum CRP and NfL were independent risk factors for poor prognosis in aSAH patients(P<0.05),while elevated TMAO and PGC-1 α were protective factors(P<0.05).The area under the curve(AUC)of serum TMAO,NfL,PGC-1 α,and their combined prediction of poor prognosis in aSAH patients were 0.726,0.830,0.862,and 0.956,respectively.The AUC of the combined detection was greater than that of each indicator detected separately.Conclusion Serum TMAO and PGC-1α are lowly expressed in aSAH patients,and serum NfL is highly expressed,which are related to the occurrence of short-term poor prognosis,the combined detection of the three indicators has a high predictive value for short-term poor prognosis in aSAH patients.

This article systematically reviews the regulatory mechanism of SIRT3,an important mitochondrial deacetylase,in the pathogenesis of Alzheimer disease(AD).As a major mitochondrial deacetylase,SIRT3 participates in cerebral energy metabolism,neuroinflammation,and mitochondrial quality control by regulating mitochondrial protein functions.During the pathological process of AD,the downregulated expression of SIRT3 can induce hyperacetylation of mitochondrial proteins.This not only leads to mitochondrial dysfunction(such as impaired ATP synthesis and excessive reactive oxygen species production)but also impairs mitochondrial quality control mechanisms such as mitophagy and fusion/fission balance,thereby promoting mitochondrial damage.In addition,SIRT3 deficiency can activate neuroinflammatory pathways,prompting the release of inflammatory factors and further exacerbating neuronal damage.Future research will aim to undercover the detailed protective mechanisms of SIRT3 in AD,validate its feasibility as a therapeutic target for AD,and develop specific agonists,providing a theoretical basis for the intervention strategies of AD.

Although chronic neuroinflammation has been established as one of core pathological hallmarks of Alzheimer disease(AD),its role in AD pathological mechanisms still remains elusive.The glia-derived inflammatory mediator chitinase-3-like protein 1(CHI3L1,also known as YKL-40)regulates key pathological processes including neuroinflammation,neuronal degeneration,and cell death.Evidence confirms that YKL-40 promotes the progression of AD core pathology through inhibiting amyloid plaque clearance and enhancing neuronal toxicity.Its expression levels is significantly correlated with early detection,disease severity,and clinical prognosis.A thorough understanding of the relationship between YKL-40 and AD not only deepen our insight into neuroinflammatory mechanisms in AD pathogenesis but also highlights its dual clinical applicability as a novel biomarker and therapeutic target,thereby providing an important direction for development of advanced diagnostic and treatment strategies for AD.

This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Cost-effectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs);and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.

Objective To evaluate the therapeutic efficacy of stenting combined with medication versus medication alone in treating severe extracranial carotid artery stenosis.Methods This prospective,multicenter cohort study enrolled 337 patients with carotid artery stenosis ranging from 70%to 99%.Based on patient preference,they were divided into two groups:a stent combined with medication group(antiplatelet drugs+statins,n=169)and a medication-only group(n=168).The study assessed perioperative safety and the incidence of recurrent cerebrovascular events related to the target vessel within one year.Results The success rate of the stent combined with medication group was 100%.There was one case of hyperperfusion-related intracranial hemorrhage during the perioperative period(1/169)The patient recovered well after medical treatment.There was no statistically significant difference in perioperative complications between the two groups(P=0.318).During the 1-year follow-up,the stent combined with medication group(3/169)had a significantly lower incidence of recurrent ischemic stroke compared to the medication-only group(15/168),with a statistically significant difference(P=0.003).Univariate analysis showed that gender(χ2=4.372,P=0.037),stenosis rate≥85%(χ2=10.738,P=0.001),and non-stent treatment(χ2=7.171,P=0.007)were risk factors for recurrent stroke.However,the number of recurrent ischemic strokes in females was relatively small and after adjusting the chi-square test,the difference was not statistically significant(P=0.075).Logistic regression analysis revealed that stenosis rate≥85%(OR=115.925,95%CI:2.077-122.102,P=0.008)and non-stent treatment(OR=0.158,95%CI:0.044-0.564,P=0.004)were independent risk factors for recurrent cerebrovascular events within one year.Conclusions In patients with≥85%extracranial carotid artery stenosis,stenting combined with medication reduces recurrent ischemic cerebrovascular events within 1 year.

Objectives To explore the clinical and imaging characteristics that related to futile recanalization after mechanical thrombectomy(MT)in patients with large vessel occlusion(LVO)in acute anterior circulation ischemic stroke within 6-24 h after the onset.Methods Retrospectively collected the data(MT-related data;clinical data)of patients with 6-24 h acute anterior circulation ischemic stroke with LVO who underwent MT treatment.Patients were divided into 2 groups:effectiv and ineffective reperfusion groups.Mild-to-moderate acute ischemic stroke group andsevere acute ischemic stroke group.Results A total of 115 patients(Grade mTICI 2b)were divided into two groups,of which 53 patients had effective reperfusion and 62 patients had ineffective reperfusion.The study found that the group with poor collateral circulation before thrombectomy(ASITN/SIR collateral circulation blood flow≤grade 2),those with atrial fibrillation,and those with a decrease in NIHSS by more than 4 points compared to the time of emergency department visit were statistically significant.The effective reperfusion group had a higher hypoperfusion intensity ratio(HIR)value,a higher hemorrhage conversion rate,a higher rate of early neurological deterioration,and a lower rate of good prognosis.Conclusions In the groups of patients with 6-24 h acute anterior circulation ischemic stroke LVO undergoing MT treatment,ASITN/SIR collateral circulation blood flow≤grade 2,HIR,Atrial fibrillation is highly related to futile recanalization.