Cognitive decline is one of the main clinical symptoms of neurodegenerative diseases. There is no specific drug treatment, which seriously affects the quality of life and rehabilitation process of these patients. Non-invasive brain stimulation (NIBS) technology such as transcranial magnetic stimulation and transcranial electrical stimulation known as its advantages of non-invasive, painless, and easy to operate, has been used in clinical treatment of cognitive disorders. In particular, it has a good effect on improving cognitive functions such as memory, attention, orientation and language ability. In recent years, the study of cerebellar involvement in learning and memory through brain-cerebellar circuit has attracted much attention, and cerebellum has become a new target for NIBS technology exploration. However, the correlation between cerebellar NIBS and cognitive function regulation is still unclear. This paper aims to provide the evidences of the anatomic and functional basis of cerebellar involvement in cognitive function regulation and cerebellar non-invasive stimulation on cognitive function regulation.

As cerebellum is involved in sleep regulation, cerebellar dysfunction can lead to sleep disorders, and changes in cerebellar structure and function have also been observed in some patients with sleep disorders. However, the exact mechanism of cerebellum regulation of sleep is still unified. This review summarized the anatomical basis of cerebellar neuronal activity changes with sleep-wake cycle, the changes of cerebellar and brain connection circuits during sleep-wake cycle, the abnormal behaviors caused by cerebellar function/structure disorders, and the abnormal changes of cerebellar structure in patients with different sleep disorders. It is proposed that cerebellar is involved in regulating sleep, and there are different forms of sleep disorders in patients with cerebellar dysfunction. The structural and functional integrity of cerebellum are also affected by sleep, suggesting that there may be a causal relationship between cerebellar structural and functional abnormalities and sleep disorders. Based on the high plasticity of cerebellar neurons, the electrophysiological mechanisms of cerebellar involvement in sleep may be further explored by regulating the electrical activity of cerebellar neurons in the future, so as to verify the possibility of improving sleep disorders through cerebellar regulation.

Objective:To explore the risk factors for depression in patients with cognitive impairment and construct a prediction model to preliminarily validate the predictive performance of the model, aiming to provide medical and nursing staff with a screening tool for high-risk groups.Methods:From January 2020 to December 2021, convenience sampling was used to select 1 130 patients with cognitive impairment admitted to the Affiliated Brain Hospital of Nanjing Medical University as the research subject. The research subjects were divided into a modeling group ( n=791) and a validation group ( n=339) at a ratio of 7∶3. The influencing factors of depression in patients with cognitive impairment were determined using binomial Logistic regression and a risk prediction model was established. The predictive performance of the prediction model was tested using the receiver operating characteristic (ROC) curve. Results:The incidence of depression in 1 130 patients with cognitive impairment was 51.3% (580/1 130). Binomial Logistic regression analysis showed that the influencing factors for depression in patients included age, Activities of Daily Living Scale score, Hamilton Anxiety Scale score, Pittsburgh Sleep Quality Index score, and Lewy Body Composite Risk score ( P<0.05). In the modeling group, the area under the ROC curve was 0.921, the Youden index was 0.716, the sensitivity was 0.834, the specificity was 0.882, and the prediction accuracy was 0.858. In the validation group, the area under the ROC curve was 0.896, the Youden index was 0.651, the sensitivity was 0.824, the specificity was 0.827, and the prediction accuracy was 0.825. Conclusions:The depression risk prediction model can effectively predict the risk of depression in patients with cognitive impairment, and can provide a screening tool for high-risk groups for medical and nursing staff.

Background Indoor air pollution is an important risk factor affecting health of the respiratory system. Studies on indoor air pollution in China are mostly limited to the central and eastern regions, and there are few studies in the rural areas of northwest China. Objective To explore the influencing factors of lung ventilation function and its relationship with indoor air pollution in rural areas of Gansu Province based on a cross-sectional investigation. Methods A total of 399 subjects were selected from four villages in Baiyin and Yuzhong of Gansu Province. Questionnaires were used to collect demographic information, lifestyle, disease history, fuel use, and other information, and physical and functional tests were ordered such as height, weight, and lung function. The Indoor Air Pollution (IAP) exposure index was calculated based on smoking, fuel type, and weekly ventilation. IAP > 5 was defined as a high level of indoor air pollution. Lung function indexes included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, forced vital capacity as a percentage of predicted value (FVC%), and forced expiratory volume in the first second as a percentage of predicted value (FEV1%), which were used to determine pulmonary ventilation dysfunction. Logistic regression model was used to evaluate the relationship between indoor air pollution and pulmonary ventilation function, and subgroup analysis was further conducted according to home address and BMI , in order to identify the high-risk population of pulmonary ventilation dysfunction. Results The mean age of the subjects was (56.75±7.31) years old; 155 subjects (38.85%) had normal pulmonary ventilation function, and the other 244 subjects (61.14%) had impaired pulmonary ventilation function; about 89.97% of the subjects were exposed to high level of indoor air pollution (IAP > 5). We found that IAP > 5 (OR=2.327, 95%CI: 1.089-4.974) and use of bituminous coal as the main heating fuel in winter (OR=3.467, 95%CI: 1.197-10.037) increased the risk of pulmonary ventilation dysfunction after adjusting for age, BMI, residence, gender, smoking, drinking, and cardiovascular disease. The subgroup analysis results showed that no ventilation in the living room/bedroom (OR=3.460, 95%CI: 1.116-10.268) increased the risk of pulmonary ventilation dysfunction in Baiyin. Heating with coal stoves and Chinese Kang in the bedroom (OR=2.092, 95%CI: 1.030-4.247) and cooking in the bedroom in winter ( OR =2.954, 95% CI : 1.046-8.344) also increased the risk of pulmonary ventilation dysfunction in the residents with BMI≤24 kg·m⁻². IAP > 5 (OR=3.739, 95%CI: 1.147-12.182) was associated with a significantly increased risk of pulmonary ventilation dysfunction in the BMI > 24 kg·m⁻² subgroup. Conclusion The pulmonary ventilation function of rural residents in Gansu is poor, which is negatively correlated with indoor air pollution. Coal use, overweight, cooking in bedroom, and use of coal stoves and Chinese Kang for heating may increase the risk of pulmonary ventilation dysfunction, while room ventilation is a beneficial factor.

Most early-stage cervical cancer patients achieve good recovery through surgical treatment and concurrent chemoradiotherapy. However, for patients with recurrent, metastatic cervical cancer, the available effective treatment is rare and the prognosis is poor. In recent years, with the development of immunotherapy, especially immune checkpoint inhibitors targeting programmed death-1 (PD-1) and its ligand (PD-L1) and cytotoxic T-lymphocyte associated protein-4 (CTLA-4) , such as pembrolizumab, nivolumab, ipilimumab, has made breakthrough progress in the treatment of recurrent or metastatic cervical cancer.

Objective:To explore the status and influencing factors of incontinence-associated dermatitis among elderly inpatients in 52 hospitals nationwide, and to analyze the nursing of elderly inpatients with incontinence, so as to provide a reference for clinical intervention.Methods:On March 31, 2021, convenience sampling was used to select 14 675 elderly inpatients from 52 hospitals across the country as the research object. The self-designed Incontinence-associated Dermatitis Questionnaire for Elderly Inpatients was used to collect general demographic data, health status, incontinence, and skin nursing. Binomial Logistic regression was used to investigate the influencing factors of incontinence-associated dermatitis in elderly inpatients.Results:Among 14 675 elderly inpatients, the prevalence rates of xerosis cutis, incontinence and incontinence-associated dermatitis were 38.78% (5 691/14 675) , 11.06% (1 623/14 675) and 1.91% (280/14 675) , respectively. The prevalence of mild, moderate and severe incontinence-associated dermatitis were 1.27% (186/14 675) , 0.55% (81/14 675) , and 0.09% (13/14 675) , respectively. Among the nursing of 1 623 elderly inpatients with incontinence, the items with low implementation rate were the use neutral lotion to clean skin (14.17%, 230/1 623) , use of skin protectant after moisturizing (17.68%, 287/1 623) , moisturizing after cleansing the skin (28.90%, 469/1 623) . The results of binomial Logistic regression analysis showed that xeroderma, fecal incontinence, urinary and fecal incontinence, ≥2 kinds of combined medication, and hospital stay >30 days were risk factors for incontinence-associated dermatitis in elderly inpatients.Conclusions:The risk factors of incontinence-associated dermatitis in elderly inpatients mainly include xerosis cutis, type of incontinence, ≥2 kinds of combined medication, and hospital stay >30 days.

Objective:To explore the relations of changes in the cognitive function with brain structure network in patients with cerebellar infarction.Methods:Thirty-six patients with cerebellar infarction at the posterior lobe, admitted to our hospital from July 2016 to October 2019, were chosen as cerebellar infarction group; and 30 healthy subjects matched with age, gender, and education level at the same time period were used as control group. Neurocognitive and behavioral tests were performed on both groups to assess the cognitive functions, and MR imaging was performed to obtain diffusion tensor imaging (DTI) data. Deterministic tractography and graph theory were used to obtain the structural brain network and network parameters of all subjects. The differences of clinical data and brain network topological characteristic parameters between the two groups were compared, and the correlation between the subjects' brain structural network characteristic parameters and cognitive function was analyzed.Results:As compared with the control group, patients in the cerebellar infarction group had significantly lower Mini-mental State Examination (MMSE), Montreal Cognitive Scale (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test (DST), Clock Drawing Test (CDT) and Berg Balance Scale (BBS) scores, and significantly longer Trail Making Test (TMT) time-consuming ( P<0.05). As compared with the control group, the cerebellar infarction group showed significantly decreased global efficiency (Eglob) and local efficiency (Eloc) in the brain network, and significantly increased clustering coefficient (Cp) and length of path (Lp, P<0.05). As compared with the control group, the cerebellar infarction group had significantly reduced nodal efficiency in 14 brain regions ( P<0.05), including bilateral median cingulate and paracingulate gyri (DCG), left inferior frontal gyrus-opercular part (IFGoperc), bilateral supplementary motor area (SMA), bilateral precuneus (PCUN), left inferior frontal gyrus-orbital part (ORBinf), left temporal pole-superior temporal gyrus (TPOsup), left temporal pole-middle temporal gyrus(TPOmid), left inferior parietal-supramarginal and angular gyri (IPL), bilateral posterior cingulate gyrus (PCG), left inferior frontal gyrus-triangular part (IFGtriang). MoCA scores were significantly negatively correlated with Lp ( r=-0.388, P=0.019), and were significantly positively correlated with Eglob ( r=0.350, P=0.036), and efficiencies in the right DCG ( r=0.428, P=0.009), left DCG ( r=0.359, P=0.031) and right PCG ( r=0.350, P=0.037) in the cerebellar infarction patients. The RAVLT scores showed a significantly positive correlation with Eglob ( r=0.338, P=0.044). The TMT-A time-consuming and left DCG had significant negative correlation ( r=0.357, P=0.032). TMT-B time-consuming was significantly negatively correlated with right DCG ( r=-0.432, P=0.008), right PCUN ( r=-0.350, P=0.036) and left DCG ( r=-0.398, P=0.016), and positively correlated with Lp ( r=0.406, P=0.014). Conclusions:There is cognitive dysfunction in multiple domains after acute cerebellar infarction, including memory, executive function, visuospatial ability and attention. At the same time, there are reduced efficiency of information transmission in bilateral PCUN, PCG and DCG, and the frontal temporal lobe; among them, the abnormal changes of the right PCG, bilateral DCG, and right PCUN may play key roles in cognitive dysfunction.

Neuron-antibody mediated movement disorders are a class of movement disorders caused by abnormal immune responses to nerve auto-antigens,which could be paraneoplastic,infectious or idiopathic.The clinical manifestations of nervous system symptoms varied,and movement disorders can be used as part of various phenotypes,including chorea,dystonia,Parkinson's syndrome,myoclonus,stiffness syndrome,autoimmune encephalitis and cerebellar ataxia and so on.The clinical diagnosis of this disease is mainly based on the positive specific anti-central or peripheral nerve autoantibodies in serum or cerebrospinal fluid.The specificity of antibodies helps to predict associated cancer and its response to immunotherapy.Early and accurate diagnosis is very important because of the good therapeutic effect of early immunization.

Objective:To explore the characteristics of cognitive function in patients with early onset and adult onset schizophrenia.Methods:In this cross-sectional study, 546 patients with schizophrenia who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-Ⅳ) were selected.Among them, 62 cases were defined as early onset schizophrenia (EOS, age of onset＜18 years) and 175 patients were defined as adult onset schizophrenia (AOS, age of onset≥25 years).Patients underwent clinical assessments with the Positive and Negative Symptom Scale (PANSS) and the Personal and Social Performance Scale (PSP), and comprehensive neuropsychological assessments.Results:The EOS patients got lower scores in motor function-PEGDOM T score [ (26±12) vs. (30±11), P＜0.01], working memory-average T score of PASAT and WMSSP[ (34±12) vs. (38±10), P＜0.05]and executive function (inhibition) -Stroop T score [ (35±12) vs. (39±10), P＜0.05]than AOS patients.No differences were fund in processing speed, verbal memory and learning, visual memory and learning (Ps＞0.05) between the two groups.Conclusion:It suggests that the EOS patients have worse motor function, working memory and inhibition.

Objective To investigate the changes of brain function and cognitive function in patients with acute cerebellar stroke using amplitude of low-frequency fluctuation (ALFF) and functional connection (FC).Methods The cognitive function assessment and resting state functional magnetic resonance (rs-fMRI) scan were performed on patients with acute cerebellar stroke hospitalized in Taizhou People's Hospital or Nanjing Brain Hospital from May 2017 to June 2018.The differences of ALFF and FC values were compared.Pearson correlation analysis was used to understand the correlation between FC values and cognitive function scores.A total of 32 patients with acute cerebellar stroke and 34 healthy controls were included.Results Compared with the healthy controls,the scores of Montreal Cognitive Assessment (23.97 ± 6.04 vs 26.56 ± 2.93,t=-2.237,P=0.029),the Rey Auditory Verbal Learning Test (RAVLT;3(2) vs 6(2),Z=-4.136,P=0.000) were significantly lower,and the time consuming of Trail Making Test(TMT)-B ((251.56 ± 112.62) s vs (164.76± 52.37) s) was significantly higher (t=4.054,P=0.000) in the patients with acute cerebellar stroke.The rs-fMRI results showed significant group differences in ALFF values at the four brain regions,including the right frontal lobe,left hippocampus,right cingulate gyrus and cerebellum posterior lobe.The regions that showed significant group differences were set as regions of interest (ROIs),and then the functional connectivity between ROIs and the whole brain were analyzed.The results showed significant positive correlation between the RAVLT scores and the FC values from the left hippocampus to the left frontal lobe (r=0.272,P=0.031).The FC values from the right cingulate gyrus to right inferior parietal lobule were found to be correlated positively with the scores on the TMT-B (r=0.410,P=0.023).Conclusions The patients with cerebellar stroke had cognitive impairment,mainly in memory and executive function.The changes of ALFF and FC values in related brain area from cerebellar stroke enrich our understanding of cerebellar involvement in cognitive performance.