Objective To investigate the expression of right open reading frame kinase 2(RIOK2)and programmed death-ligand 1(PD-L1)in brain gliomas and their relationships with clin-icopathological features and prognosis.Methods A total of 139 patients with brain gliomas were en-rolled in this study.Brain glioma tissues and adjacent normal tissues were collected intraoperatively.The expression of RIOK2 and PD-L1 was detected by immunohistochemical staining,and their rela-tionships with clinicopathological features and prognosis were analyzed.Results The positive expres-sion rates of RIOK2 and PD-L1 in brain glioma tissues were 76.26％and 72.66％,respectively,which were significantly higher than 15.11％and 18.71％in adjacent tissues(P＜0.05).Univari-ate analysis showed that the positive expression of RIOK2 and PD-L1 in brain glioma tissues was relat-ed to distant metastasis and World Health Organization(WHO)grading(P＜0.05),but showed no correlations with age,gender,tumor diameter,tumor location,or tumor type(P＞0.05).Multivari-ate Logistic regression analysis revealed that high WHO grading,distant metastasis,positive expres-sion of RIOK2,and positive expression of PD-L1 were independent risk factors for poor prognosis in patients with brain gliomas(P＜0.05).The 3-year follow-up results showed that 96 patients survived and 43 patients died.The positive expression rates of RIOK2 and PD-L1 in surviving patients were lower than those in deceased patients(P＜0.05).Conclusion RIOK2 and PD-L1 are highly expressed in brain glioma tissues and are closely related to WHO grading and distant metastasis.Patients with brain gliomas who have lower positive expression rates of RIOK2 and PD-L1 have a better prognosis compared to those with higher positive expression rates.

Objective To investigate the influencing factors of disease progression and prognosis in patients with large artery atherosclerotic(LAA)cerebral infarction and analyze the value of plasma cyclin-dependent kinase 9(CDK9)level in the diagnosis and treatment of LAA cerebral infarction.Methods Patients with acute cerebral infarction admitted to the Department of Neurology of the Affili-ated Hospital of Yangzhou University between March 1,2022,and November 20,2023,were select-ed.According to the diagnostic criteria,98 patients with acute LAA(LAA group)and 33 patients with acute small artery occlusion(SAO)cerebral infarction(SAO group)were selected.Additionally,40 healthy individuals matched for age and gender from the Health Examination Center were included as control group.Based on whether the condition of LAA cerebral infarction patients progressing,they were divided into progressive cerebral infarction(PCI)group(39 patients)and the non-pro-gressive cerebral infarction(NPCI)group(59 patients).During the 3-month follow-up period,6 patients from the 98 LAA cerebral infarction patients were lost.According to the modified Rankin Scale(mRS)score at 90 days of follow-up,patients were divided into good prognosis group(mRS score≤2,59 patients)and poor prognosis group(mRS score＞2,33 patients).Fasting lipid in-dices[total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),glucose(GLU),glycated hemoglobin(HbA1c),and homocysteine(Hey)]were collected on the second day after admission.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the degree of neurological impairment in cerebral infarction patients.Enzyme-linked immunosorbent assay(ELISA)was used to measure plasma CDK9 levels in different groups;factors influencing disease progression in patients with acute LAA cerebral infarction were explored;and receiver operating characteristic curves were plotted to evalu-ate the predictive value of CDK9 in patients with acute LAA cerebral infarction.Results Compared with the control group,the LAA group had lower HDL-C level and higher CDK9 level(P＜0.05).The LAA group had a higher proportion of diabetes history,larger infarction volume,higher NIHSS score at admission,and higher CDK9 level compared with the SAO group(P＜0.05).Binary Logistic regression analysis showed that diabetes history and plasma CDK9 levels were influencing factors for LAA cerebral infarction.There were statistically significant differences in the proportion of diabetes history,HbA1c,random GLU,and CDK9 levels between the NPCI and PCI groups(P＜0.05).Diabetes history and plasma CDK9 levels were influencing factors for disease progression in patients with acute LAA cerebral infarction.The area under the ROC curve for CDK9 in predicting acute LAA cerebral infarction was 0.854 5(95％CI,0.794 1 to 0.9148).When the CDK9 level was 602.1 ng/L,the Youden index was maximum(0.604),with a corresponding sensitivity of 0.849 and specificity of 0.755.The NIHSS score,infarction volume,and plasma CDK9 level were higher in the poor prognosis group compared with the good prognosis group(P＜0.01).Correlation analysis showed a positive correlation between mRS scores and CDK9 levels(r=0.485,P＜0.01).Conclusion Plasma CDK9 levels are significantly elevated,and is an influencing factor.It is positively correlated with disease progression and poor prognosis in acute cerebral infarction and has certain predictive value for the progression of LAA cerebral infarction.

Objective To investigate the correlation between the expression level of absent in melanoma 2(AIM2)in serum and the severity of acute cerebral infarction(ACI),and to evaluate the value of AIM2 in predicting early neurological deterioration(END)after intravenous thrombolysis with alteplase in ACI patients.Methods A total of 150 ACI patients were enrolled in ACI group,and an-other 30 healthy individuals physical examination were selected as control group.ACI patients were further divided into mild,moderate and severe groups according to the National Institutes of Health Stroke Scale(NIHSS)score at admission,and they were also divided into END and non-END groups based on the occurrence of END after intravenous thrombolysis.Clinical materials of ACI patients were collected;the expression level of serum AIM2 was measured by enzyme-linked immunosorbent assay(ELISA);the Logistic regression analysis was performed to identify the factors influencing END after intravenous thrombolysis in ACI patients;the receiver operating characteristic(ROC)curve was plot-ted to analyze the clinical performance of serum AIM2 expression level in predicting END after intravenous thrombolysis in ACI patients.Results The serum AIM2 expression level in the ACI group and the control group was(58.29±5.97)and(36.81±3.03)ng/mL respectively,with a significant be-tween-group difference(t=43.23,P＜0.05).The serum AIM2 expression level gradually in-creased in the mild,moderate and severe groups,with significant differences between each pair of groups(P＜0.01).The serum AIM2 expression level in ACI patients was positively correlated with the NIHSS score(r=0.941,P＜0.01).The NIHSS score,time from admission to thrombolysis,low-density lipoprotein cholesterol(LDL-C),C-reactive protein,and AIM2 level in the END group were significantly higher or longer than those in the non-END group(P＜0.05).The results of mul-tivariate Logistic regression analysis showed that NIHSS score(OR=3.871,P＜0.001),time from admission to thrombolysis(OR=2.885,P=0.002),LDL-C(OR=3.118,P＜0.001)and AIM2(OR=3.761,P＜0.001)were influencing factors for END after intravenous thrombolysis in ACI patients.ROC curve showed that the area under the curve(AUC)for predicting END after in-travenous thrombolysis based on the serum AIM2 expression level at admission in ACI patients was 0.911;when the cut-off value of AIM2 was 66.56 ng/mL,the diagnostic sensitivity and specificity were 91.23％and 90.15％,respectively.Conclusion The expression level of serum AIM2 is sig-nificantly increased in ACI patients,and AIM2 expression level has certain advantages in predicting END after intravenous thrombolysis in ACI patients.

Objective To explore the potential mechanism of propofol in relieving postoperative pain in rats through p38 mitogen-activated protein kinase(MAPK)signaling pathway.Methods A postoperative neuropathic pain model was constructed by transient clamping with vascular clips,and thir-ty-six SD rats were randomly divided into four groups using a random number table method:control group(untreated),surgery group(receiving PELD treatment),surgery+propofol treatment group[re-ceiving PELD treatment and an intravenous injection of propofol at 1.5 mg/(kg·min)through the lat-eral tail vein of the rats],and surgery+propofol+p38MAPK agonist Diprovocim group[receiving PELD treatment,with an intravenous injection of 1.5 mg/(kg·min)propofol and 5 nmol/L of the p38MAPK agonist Diprovocim through the lateral tail vein of the rats].After 14 d of continuous drug administration,the rats were tested for mechanical nociceptive thresholds using the Von-Frey test probe,and thermal nociceptive thresholds were detected by the Hargreaves experiment;the activation of spinal cord dorsal horn glial cells was detected by immunofluorescence assay;p38 phosphorylation(p-p38),MAPK phosphorylation(p-MAPK)and downstream interleukin-1 β(IL-1β),P53,and CHOP protein expression levels were detected by immunoprotein blotting assay(Western blotting).Results Rats in the surgery group exhibited neuropathic pain 12 hours postoperatively ollowing probe stimulation,with pain peaking on postoperative day 10 and gradually subsiding thereafter.Rats in the surgery+propofol treatment group also experienced neuropathic pain 12 hours postoperatively,but the pain intensity decreased at 24 hours,and gradually subsided by postoperative day 14.Rats in the surgery+propofol+p38MAPK agonist Diprovocim group developed neuropathic pain 12 hours postoperatively,with no significant decrease in pain threshold at 24 hours,and pain peaked on post-operative day 10 before gradually subsiding.Compared with the control group,the surgery group showed increased levels of P53 protein,p-p38 and p-MAPK in the posterior horn of the spinal cord,increased expression of downstream interleukin-1 β(IL-1 β)and CHOP proteins,and enhanced glial cell activation on the operated side(P＜0.05).When compared with the surgery group,the surgery+propofol treatment group exhibited decreased levels of p-p38,p-MAPK,and downstream IL-1 β,P53,and CHOP protein expression,as well as reduced glial cell activation(P＜0.05).Compared with the surgery+propofol treatment group,the surgery+propofol+p38MAPK agonist Diprovocim group showed decreased expression levels of IL-1 β,P53,and CHOP proteins and levels of p-p38,p-MAPK(P＜0.05).Conclusion Propofol can relieve postoperative pain in rats through p38MAPK signaling pathway.

Objective To analyze the awakening effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with multi-sensory environmental stimulation in patients with persistent vegetative state(PVS).Methods Sixty PVS patients were selected as study subjects,and randomly divided into control group(n=30)and observation group(n=30).Three patients in the control group shed 3 cases and eventually included 27 cases,and the observation group shed 2 cases and e-ventually included 28 cases.Both groups received basic treatment and routine rehabilitation training.The observation group was treated with multi-sensory environmental stimulation combined with taVNS,while the control group received multi-sensory environmental stimulation combined with sham stimula-tion.Both groups were treated once per day,five times per week,for eight consecutive weeks.The Glasgow Coma Scale(GCS)and the Coma Recovery Scale-Revised(CRS-R)scores were compared between the two groups before treatment,after 4,8 weeks of treatment and during follow-up(12 weeks).The electroencephalogram(EEG)grading was analyzed before and after 8 weeks of treat-ment.The awakening effect during follow-up was compared between the two groups.Results After 4,8 weeks of treatment and during follow-up,the GCS and CRS-R scores of both groups were signifi-cantly higher than before treatment,and the observation group had significantly higher scores than the control group(P＜0.05).After 8 weeks of treatment,the EEG grading of both groups was signifi-cantly better than before treatment,and the observation group was significantly better than the control group(P＜0.05).During follow-up,the awakening rate in the observation group was 46.43％,which was significantly higher than 29.63％in the control group(P＜0.05).Conclusion The method of taVNS combined with multi-sensory environmental stimulation has a good awakening effect in PVS patients,and can improve their level of consciousness disorder with high safety.

Objective To explore the efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with virtual reality interactive robot training in improving upper limb function of patients with stroke.Methods From February to December 2023,92 patients in the hos-pital were randomly divided into control group(n=30),virtual reality group(n=31),and com-bined group(n=31).The control group received conventional rehabilitation therapy;the virtual re-ality group received conventional rehabilitation therapy and virtual reality interactive robot training for upper limb;the combined group received low-frequency rTMS on the therapeutic basis of the virtual reality group.Before treatment and 4 weeks after treatment,the Upper Extremity Fugl-Meyer Assess-ment(UFMA)score,the Functional Test for the Hemiplegic Upper Extremity-Hong Kong Version(FTHUE-HK)score,motor evoked potential(MEP)amplitude,cortical latency(CL)value,and the ratio of root mean square of myoelectricity(RMS)of wrist dorsiflexor muscles between the affect-ed and unaffected sides were compared among the three groups.Results Four weeks after treatment,the UFMA and FTHUE-HK scores of the three groups significantly improved compared with those before treatment,the UFMA and FTHUE-HK scores of the combined group were significantly higher than those of the control group and the virtual reality group,and the UFMA score of the virtual reality group was significantly higher than that of the control group(P＜0.05);the RMS ratios and MEP amplitudes of the three groups significantly increased compared with those before treatment,the RMS ratios and MEP amplitudes of the combined group were significantly higher than those of the control group and the virtual reality group,and the virtual reality group had higher values than the control group,with significant between-group differences(P＜0.05);the CL of the three groups significantly shortened compared with that before treatment,the CL of the combined group was significantly shorter than that of the control group and the virtual reality group,and the CL of the virtual reality group was significantly shorter than that of the control group(P＜0.05).Conclusion The rTMS assisted virtu-al reality interactive robot training can effectively improve upper limb function in stroke patients.

Objective To investigate the diagnostic value of electromyographic(EMG)tremor indicators for Parkinson's disease(PD)using the Logistic regression model.Methods A total of 65 patients with PD(PD group)and 39 patients with essential tremor(ET)(ET group)were enrolled and underwent EMG tremor analysis.General information,disease-related data,and EMG tremor characteristics were compared between the two groups.Multivariate Logistic regression analysis was performed to screen for independent influencing factors of PD,and receiver operating characteristic(ROC)curves were plotted.The area under the curve(AUC)was used to evaluate the diagnostic value of EMG tremor indicators for PD.Results Compared with the ET group,the PD group had a higher proportion of patients with unilateral onset and those with tremor spectrum frequency≥2 times,and a lower proportion of patients with a family history of tremor(P＜0.05).The tremor peak frequencies in the resting,postural,and weight-bearing(1 000 g)states were lower in the PD group than in the ET group(P＜0.05).There were statistically significant differences in the tremor rhythm patterns between the two groups in the resting and weight-bearing states(P＜0.05),with the PD group dominated by alternating contraction patterns and the ET group by synchronous contraction pat-terns.Multivariate Logistic regression analysis revealed that the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum were independent influencing factors of PD(P＜0.05).The ROC curves showed that the AUCs of the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum for diagnosing PD were 0.886,0.750,and 0.779,respec-tively.The combination of these three indicators yielded the highest AUC(0.936)for diagnosing PD,with a sensitivity of 81.54％and a specificity of 94.87％.Conclusion The tremor peak fre-quency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum provided by EMG tremor analysis can serve as clinical indicators for early diagno-sis of PD,and their combined use offers higher diagnostic value,which can be used to differentiate PD from ET.

Objective To investigate the relationship between morphometric parameters of the cerebral cortex and the efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of tardive dyskinesia(TD).Methods A total of 105 schizophrenic patients with TD undergoing basic treatment were enrolled,and randomly divided into group A(n=35),group B(n=35)and group C(n=35).Group A received rTMS at 1 Hz,group B received rTMS at 10 Hz,and group C received sham stimulation.All groups were treated for 12 weeks.The severity of TD was assessed using the Ab-normal Involuntary Movement Scale(AIMS)before and after treatment.The Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)and the Positive and Negative Syndrome Scale(PANSS)in Chinese were used to evaluate patients'neuropsychological status and symptom severity.magnetic resonance imaging(MRI)was employed to scan the left prefrontal cortex of patients to obtain parameters of cortical thickness,surface area and volume.Pearson correlation analysis was used to an-alyze the relationship between cortical morphological parameters and the efficacy of rTMS for TD in pa-tients.Results After treatment,AIMS scores in the three groups were significantly lower than before treatment,and the group A was significantly lower than the group B and group C(P＜0.05).After treatment,RBANS scores were significantly higher and PANSS scores were significantly lower in three groups than before treatment(P＜0.05).After treatment,the RBANS score of the group A was significantly higher than that of the group B and group C,and the group B was significantly higher than the group C(P＜0.05);the PANSS score of the group A was significantly lower than that of the group B and group C,and the group B was significantly lower than the group C(P＜0.05).Af-ter treatment,cortical morphological parameters(cortical thickness,surface area and volume)in the group A and group B were significantly higher than before treatment,and the group A was signif-icantly higher than the group B(P＜0.05).The therapeutic effect of the group A was positively correlated with cortical thickness,surface area and volume(P＜0.05).Conclusion The morpho-metric parameters of the left prefrontal cortex are associated with the efficacy of rTMS in treating TD.The rTMS at 1 Hz can facilitate structural remodeling of the motor cortex,thereby improving treat-ment outcomes for TD patients.

Objective To explore the mechanism of acupuncture's effect on hippocampal neuron apoptosis in a post-traumatic stress disorder(PTSD)rat model via the reactive oxygen species(ROS)/c-Jun N-terminal kinase(JNK)/p53 pathway.Methods Thirty rats were randomly divided into normal control group(NC group),PTSD rat model group(PTSD group)and electroacupuncture intervention group(EA group),with 10 rats in each group.The results of behavioral test(open field experiment and elevated cross maze experiment)were compared.The terminal deoxynucleotidyl trans-ferase dUTP nick-end labeling(TUNEL)staining method was used to detect hippocampal neuron apoptosis in each group.DHE fluorescence staining was employed to measure ROS levels in the brain tissue of each group.The content of Ros index[malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione(GSH)]in brain tissue of each group was detected.Western blot analysis was per-formed to determine the protein expression levels of JNK,p-JNK,p53 and PUMA in hippocampal tissue.Results The total movement distance of rats in the PTSD group was significantly shorter,and the total number of uprightand central cell entry times were significantly shorter than those in the NC group(P＜0.05).The total distance moved by rats in the EA group was significantly longer,and the total number of upright and central lattice entry times were significantly higher than those in the PTSD group(P＜0.05).The percentage of times and time of entering the open arm in the PTSD group was significantly lower,and the anxiety index was significantly higher than that in the NC group(P＜0.05).The percentage of times and time of entering the open arm in the EA group was significantly higher,and the anxiety index was significantly lower than that in the PTSD group(P＜0.05).The neuronal apoptosis rate of the PTSD group was significantly higher than that of the NC group(P＜0.05);the neuronal apoptosis rate in the EA group was significantly lower than that in the PTSD group(P＜0.05).The mean fluorescence intensity of ROS in brain tissue of the PTSD group was significantly higher than that of the NC group(P＜0.05);the mean fluorescence intensi-ty of ROS in the EA group was significantly lower than that in the PTSD group(P＜0.05).The MDA content in brain tissue of the PTSD group was significantly higher,and SOD activity and GSH content were significantly lower than those of the NC group(P＜0.05);the MDA content in the brain tissue of the EA group was significantly lower,and the SOD activity and GSH content were sig-nificantly higher than those of the PTSD group(P＜0.05).The p-JNK/JNK and the expression levels of p53 and PUMA in brain tissue of the PTSD group were significantly higher than those of the NC group(P＜0.05);the p-JNK/JNK and the expression levels of p53 and PUMA in the brain tissue of the EA group were significantly lower than those of the PTSD group(P＜0.05).Conclusion Acu-puncture can inhibit hippocampal neuron apoptosis and relieve fear symptoms in PTSD rats,possibly through the activation of the ROS/JNK/p53 pathway.

Objective To investigate the relationships of cerebrospinal fluid levels of collagen triple helix repeat containing-1(CTHRC1)and olfactomedin-3(OLFM3)with cognitive impairment and cere-brospinal fluid biomarker levels in patients with Alzheimer's disease(AD).Methods Ninety-six patients with AD were selected as study objects(AD group),and divided into mild group(n=34),moderate group(n=39)and severe group(n=33)according to Clinical Deentia Scale(CDR)score.Sixty patients without cognitive impairment who underwent lumbar puncture during the same period served as the control group.Enzyme-linked immunosorbent assays were used to measure cere-brospinal fluid levels of CTHRC1,OLFM3 and biomarkers[β-amyloid(Aβ)-40,Aβ-42,Aβ42/Aβ-40,total tau(T-tau)and phosphorylated tau(P-tau)].Cognitive impairment in AD patients was as-sessed using the Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA).The relationships of CSF CTHRC1 and OLFM3 levels with cognitive impairment and cerebrospinal flu-id biomarkers were analyzed.Results The AD group showed significantly higher cerebrospinal fluid levels of CTHRC1,T-tau and P-tau,and significantly lower levels of OLFM3,Aβ-42 and Aβ42/Aβ-40 compared to the control group(P＜0.05).The area under the curve(AUC)for diagnosing AD with cerebrospinal fluid CTHRC1 and OLFM3 was 0.839 and 0.822,respectively,and the com-bined AUC was 0.923.Cerebrospinal fluid CTHRC1 of mild group,moderate group and severe group were increased successively,and OLFM3 was decreased successively,the difference was sta-tistically significant(P＜0.05).Cerebrospinal fluid Aβ-42 and Aβ-42/Aβ-40 in mild,moderate and severe groups were decreased successively,while T-tau and P-tau were increased successively,with statistical significance(P＜0.05).The MMSE and MoCA scores of mild group,moderate group and severe group decreased successively,and the difference was statistically significant(P＜0.05).Cerebrospinal fluid CTHRC1 levels were positively correlated with disease severity,while OLFM3 levels were negatively correlated(P＜0.05).Cerebrospinal fluid CTHRC1 was negatively correlated with Aβ42,Aβ42/Aβ-40,MMSE scores and MoCA scores,and positively correlated with T-tau and P-tau(P＜0.05).Cerebrospinal fluid OLFM3 was positively correlated with Aβ-42,Aβ42/Aβ-40,MMSE scores and MoCA scores,and negatively correlated with T-tau and P-tau(P＜0.05).Conclusion In the cerebrospinal fluid of patients with AD,CTHRC1 is elevated while OLFM3 is decreased.Both CTHRC1 and OLFM3 are associated with the severity of AD,cog-nitive impairment and levels of cerebrospinal fluid biomarkers.