Parkinson’s disease (PD) is a neurodegenerative disease characterized by various motor and non-motor symptoms. The complexity of its symptoms suggests that PD is a heterogeneous neurological disorder. Its pathological changes are not limited to the substantia nigra-striatal system, but gradually extending to other regions including the cerebellum. The cerebellum is connected to a wide range of central nervous system regions that form essential neural circuits affected by PD. In addition, altered dopaminergic activity and α-synuclein pathology are found in the cerebellum, further suggesting its role in the PD progression. Furthermore, an increasing evidence obtained from imaging studies has demonstrated that cerebellar structure, functional connectivity, and neural metabolism are altered in PD when compared to healthy controls, as well as among different PD subtypes. This review provides a comprehensive summary of the cerebellar pathophysiology and results from neuroimaging studies related to both motor and non-motor symptoms of PD, highlighting the potential significance of cerebellar assessment in PD diagnosis, differential diagnosis, and disease monitoring.

Pathological,electrophysiological,and neuroimaging changes in the cerebellum can occur in neurodegenerative diseases such as Alzheimer disease,Parkinson disease,and amyotrophic lateral sclerosis.The activation and neurodegeneration of neurons in specific cerebellar regions may contribute to the clinical symptoms and pathological processes of these neurodegenerative diseases.This article reviews the clinical assessment methods and neuroimaging studies related to cerebellar symptoms in neurodegenerative diseases.The findings suggest that structural and functional abnormalities of the cerebellum are associated with symptoms such as motor,cognitive,and emotional dysfunction in these diseases.Developing a multidimensional,systematic clinical and imaging evaluation approach centered on the cerebellum will help deepen our understanding of the cerebellum's role in the pathogenesis of neurodegenerative diseases.It will also provide new directions for the early identification of symptoms,differential diagnosis,and the formulation of precise treatment plans.

Objective To investigate the status quo of self-regulated fatigue in patients with recurrent ovarian cancer,and analyze the correlation between self-perceived burden,social support level and self-regulated fatigue.Methods From January 2020 to January 2023,120 patients with recurrent ovarian cancer in Fujian Cancer Hospital were selected by convenient sampling method,and data were collected by self-made general information questionnaire,self-perceived burden scale,social support scale and self-regulated fatigue scale.Results The score of self-regulated fatigue in 120 patients with recurrent ovarian cancer was(57.39±8.88)points,which was positively correlated with the score of self-perceived burden(68.28±18.98)points(r=0.431,P＜0.05)and negatively correlated with the score of social support(31.32±10.28)points(r=-0.321,P＜0.05).The results show that self-perceived burden,social support,education level,per capita monthly average income and course of disease are independent factors affecting self-regulated fatigue in patients with recurrent ovarian cancer.Conclusion Self-regulated fatigue in patients with recurrent ovarian cancer is in the middle and high level,which is positively correlated with self-perceived burden and negatively correlated with social support level.Clinical nurses should take corresponding measures to reduce the degree of self-regulation fatigue in patients with recurrent ovarian cancer.

BackgroundThe incidence of delirium in critically ill psychiatric patients is high， and there are many factors affecting delirium occurrence. At present， epidemiological studies on delirium among critically ill patients in psychiatric hospitals are limited. ObjectiveTo explore the risk factors for delirium in critically ill patients in a psychiatric hospital， so as to guide the clinical management of delirium in psychiatric hospitals. MethodsThis retrospective study included 427 critically ill patients who were admitted to Shenzhen Kangning Hospital from January 1， 2019 to May 31， 2021. The delirium situation， gender， age， pre-admission course of illness （duration from the onset of acute mental state changes to in-patient registration at a psychiatric hospital）， history of mental illness， history of cognitive dysfunction， history of using psychoactive substances， history of using sedative and hypnotic drugs， number of combined chronic diseases， number of combined drugs and type of disease were examined as potential risk factors for delirium. Single Logistic regression was used to analyze the potential risk factors for delirium， and the potential risk factors were incorporated into the multi-factor Logistic regression analysis model so as to gradually screen out the risk factors for delirium in critically ill psychiatric patients. ResultsDelirium was present in 33.49% （143/427） of critically ill patients. Multi-factor Logistic regression analysis demonstrated that the presence of delirium was associated with mental and behavioral disorders caused by psychoactive substances （OR=8.949， P<0.01）， absent history of mental illness （OR=4.202， P<0.01）， number of combined chronic diseases （OR=1.249， P<0.01）， age （OR=1.031， P<0.01） and pre-admission course of illness （OR=0.942， P<0.01） . ConclusionDelirium was present in nearly 1/3 critically ill patients in the psychiatric hospital. The risk factors for delirium included short course of illness before admission， age， more combined chronic diseases， absent history of mental illness， mental and behavioral disorders caused by psychoactive substances. ［Funded by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties （number， SZGSP013）］

ObjectiveTo picture the trajectory of changes in glucose and lipid metabolism among schizophrenic patients in long-term hospitalization. MethodsA total of 109 inpatients of Shenzhen Kangning Hospital from 2014 to 2022， who were diagnosed with schizophrenia based on the International Classification of Diseases， tenth edition （ICD-10） criteria， were recruited as subjects. Real-world follow-up data on longitudinal glucose metabolism （fasting blood glucose， glycosylated hemoglobin， C-peptide） and lipid metabolism （triglycerides， low density lipoprotein， high density lipoprotein， total cholesterol） were observed. The frequency of visit was once a year， with a total of 9 visits over 8 years. ResultsIn terms of glucose metabolism parameters， fasting blood glucose level decreased to 4.87 mmol/L at the 7^th visit， lower than the baseline level （P<0.01）. Glycated hemoglobin level was 6.08% at the 9^th visit， higher than the baseline level （P<0.05）. C-peptide level was 3.14 ng/mL at the 7^th visit， higher than the baseline level （P<0.01）. As for the trajectory of lipid metabolism parameters， high-density lipoprotein level were significantly lower than baseline level at the second visit （P<0.01） and stayed basically stable thereafter. Total cholesterol levels at the last three visits were 4.06， 4.07 and 3.95 mmol/L， respectively， all lower than the baseline level （P<0.01）. ConclusionThe changes of glycolipid metabolism parameters in long-term inpatients with schizophrenia were generally smooth during the 8-year follow-up period.

Objective:To confirm the efficacy and safety of cinepazide maleate injection in acute ischemic stroke patients with obvious motor function deficit.Methods:This study is a subgroup analysis of multi-center, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial. A total 812 patients of acute ischemic stroke with obvious limb motor deficit [motor function of limbs score in National Institutes of Health Stroke Scale (NIHSS) ≥4] were enrolled in this subgroup analysis. Patients received either cinepazide maleate injection or placebo. The treatment period was 14 days and follow-up was 90 days. The efficacy endpoints included the proportions of patients with a modified Rankin Scale (mRS) score ≤2, mRS score ≤1 and Barthel Index <95 on day 90. Safety was evaluated by recording all adverse events, monitoring vital signs, laboratory parameters and electrocardiogram.Results:A total of 732 patients were involved in the final efficacy analysis (361 in cinepazide maleate group and 371 in control group). The baseline limb motor function score of NIHSS was 5.23±1.43 in the cinepazide maleate group whereas 5.20±1.36 in the control group. Logistic regression analysis showed that following treatment for 90 days, the proportion of patients with a mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group [56.0% (202/361) vs 44.2% (164/371), OR=0.60, 95% CI 0.44-0.82, P=0.002]. The proportion of patients with a mRS score ≤1 was higher in the cinepazide maleate group than in the control group [43.3% (139/361) vs 35.2% (118/371), OR=0.69, 95% CI 0.50-0.97, P=0.031]. The proportion of patients with a Barthel Index <95 on day 90 was significantly lower in the cinepazide maleate group than in the control group [45.2% (145/361) vs 55.2% (185/371), OR=0.64, 95% CI 0.46-0.88, P=0.007]. During the treatment and follow-up period, the incidence of the most common adverse events in the cinepazide maleate group was 50.4% (199/395). Constipation and abnormal liver function were more common, but there were no statistically significant differences between the two groups. Conclusion:Cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery and safe in patients with acute ischemic stroke with obvious limb motor deficit.

Objective:To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection.Methods:This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes.Results:This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%, P>0.05) between cinepazide maleate group and control group. Conclusion:Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

Objective:To assess the efficacy of immunosuppressor on treatment of Henoch-Sch?nlein purpura nephritis(HSPN).Methods:Literatures were searched in PubMed, Cochrane library, Web of Science, Wanfang database, CNKI and CBM database from inception to January 2021.The studies that investigated the effect of immunosuppressor on HSPN outcomes were included.Article screening, data extraction and quality assessment were accomplished by two investigators independently, and statistical analyses were performed by STATA 14.Results:Ten studies were included with 443 cases, of which, 245 cases were in the experimental group while 198 cases were in the control group.The Meta-analysis showed that the experimental group had higher complete remission rate( OR=1.95, 95% CI 1.19-3.22, P=0.009), total remission rate ( OR=2.92, 95% CI 1.74-4.88, P<0.001), proteinuria decreasing level ( SMD=0.35, 95% CI 0.09-0.61, P=0.008), the increasing level of serum albumin ( SMD=1.27, 95% CI 0.43-2.11, P=0.003) and the increasing level of estimated glomerular filtration rate ( SMD=0.48, 95% CI 0.21-0.76, P=0.001), lower relapse rate ( OR=0.19, 95% CI 0.05-0.72, P=0.015) as well as death rate ( OR=0.19, 95% CI 0.04-0.78, P=0.021)than those of the control group. Conclusion:The immunosuppressor could enhance complete remission rate, total remission rate, proteinuria decreasing level, the increasing level of serum albumin and the increasing level of estimated glomerular filtration rate, reduce relapse rate and death rate of HSPN patients.

Objective:To assess the efficacy and safety of cinepazide maleate injection in the treatment of patients with acute ischemic stroke.Methods:A multicenter, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial, led by Peking Union Medical College Hospital, was conducted in 65 Hospitals in China. The efficacy of cinepazide maleate injection in patients with acute anterior circulation cerebral infarction with onset time of ≤48 hours, 7≤National Institute of Health stroke scale (NIHSS) score ≤25 was assessed from August 2016 to February 2019, using the proportion of modified Rankin scale (mRS) score≤1 and Barthel index (BI) score≤95 on day 14 as efficacy endpoint. The patients were divided into treatment group who were treated with cinepazide maleate injection and control group who were treated with placebo.Results:A total 937 patients were involved in the final efficacy analysis (466 in treatment group and 471 in control group). The proportion of subjects with mRS score≤1 on day 14 after treatment were higher in the treatment group than that in the control group (102/466(21.89%) vs76/471(16.14%)). Logistic regression analysis showed that patients treated with cinepazide maleate were significantly more likely to have a favorable outcome (mRS score≤1) than patients treated with placebo on day 14 ( OR=0.677, 95% CI 0.484-0.948 , P=0.023), and patients treated with cinepazide maleate were more likely to reach independence in activities of daily living (Barthel Index ≥95) than those treated with placebo on day 14 (125/466(26.82%) vs 91/471(19.32%); OR=0.632, 95% CI0.459-0.869, P=0.005). The rate of adverse events was similar between the treatment and control groups. Conclusion:The 14-day treatment with cinepazide maleate injection could reduce the degree of disability whereas did not increase the risk of adverse events.

Objective: To observe the effect of different doses and timing of normal saline (NS) resuscitation combined with norepinephrine (NE) on endothelial glycocalyx in rabbits with early septic shock. Methods: Thirty New Zealand male rabbits were randomly divided into sham group, model group, 30 mL and 60 mL timely resuscitation groups (30 mL and 60 mL timely group), and 30 mL delayed resuscitation group (30 mL delayed group) with 6 rabbits in each group. The rabbit model of septic shock was reproduced by cecal ligation and puncture (CLP). The rabbits in sham group were only received abdominal cavity open without cecal and ligation. The rabbits in 30 mL and 60 mL timely groups and 30 mL delayed group were intravenous infused with 30 mL/kg or 60 mL/kg NS immediately or 1 hour after model reproduction for 1 hour, and the mean arterial pressure (MAP) was maintained over 75 mmHg (1 mmHg = 0.133 kPa) compared with intravenous pumping of 0.02-0.05 μg·kg^-1·min^-1 NE followed by 5 mL/h NS infusion till the end of the experiment. The rabbits in sham and model groups were only given 5 mL/h NS. The changes in arterial blood gas before and immediately after resuscitation were observed in three fluid resuscitation groups. The internal jugular vein blood was collected at 0, 3, 6 hours after model reproduction. The levels of syndecan-1 (polysaccharide envelope marker) in plasma were determined by enzyme linked immunosorbent assay (ELISA). The rabbits were sacrificed at 6 hours after model reproduction, and the lung tissue was harvested. Western Blot was used to determine the protein expressions of intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase 2 (MMP-2) and syndecan-1. The positive expression of syndecan-1 in lung tissue was observed by immunohistochemical method. Results: ① Blood gas analysis: compared with the results before resuscitation, the levels of lactic acid (Lac) after resuscitation in three fluid resuscitation groups were significantly decreased, especially in 30 mL timely group; the central venous blood oxygen saturation (ScvO₂) was significantly increased, especially in 30 mL delayed group. Oxygenation index (PaO₂/FiO₂) was improved in 30 mL timely and 30 mL delayed resuscitation groups, which was decreased in 60 mL delayed group. ② Plasma marker: compared with sham group, plasma syndecan-1 level in model group was significantly increased with a time-dependent manner. Plasma syndecan-1 levels at 3 hours in 30 mL timely and 30 mL delayed groups were significantly decreased as compared with those of model group (ng/L: 138.0±2.4, 139.7±15.7 vs. 161.5±4.1, both P < 0.05), but it was significantly increased at 6 hours in 30 mL delayed group (ng/L: 213.1±19.4 vs. 206.4±15.5, P < 0.05). The plasma syndecan-1 levels at 3 hours and 6 hours in 60 mL timely group were significantly higher than those in model group (ng/L: 233.0±28.9 vs. 161.5±4.1, 252.3±27.2 vs. 206.4±15.5, both P < 0.05). ③ Protein expression in lung tissue: compared with sham group, the protein expressions of ICAM-1 and MMP-2 in lung tissue of model group were significantly increased, and syndecan-1 protein expression was significantly decreased. After 30 mL timely or 30 mL delayed resuscitation, the protein expressions of ICAM-1 and MMP-2 in lung tissue were significantly decreased, and syndecan-1 protein expression was significantly increased, especially in 30 mL timely group, which showed statistical differences as compared with those of model group (ICAM-1 protein: 0.56±0.09 vs. 1.04±0.05, MMP-2 protein: 0.83±0.15 vs. 1.06±0.06, syndecan-1 protein: 2.09±0.08 vs. 0.99±0.03, all P < 0.05). The change tendency of protein expressions in 60 mL timely group was opposite to the other two resuscitation groups. ④ Immunohistochemistry: the positive expression of syndecan-1 in lung tissues was significant in the sham group, and it was lowered in model group. The positive expression of syndecan-1 was increased after 30 mL timely or 30 mL delayed resuscitation, but further weakened in 60 mL timely group. Conclusions The dose and timing of resuscitation with NS in septic shock can affect pulmonary vascular endothelial glycocalyx function. The timely resuscitation with 30 mL NS in combination with NE plays a protective effect on endothelial cell and glycocalyx. However, NS resuscitation which was not timely or excessive infusion can make the glycocalyx degradation more obvious, resulting in increased endothelial permeability, microcirculation damaged, thus aggravate lung injury.