This study aimed to verify the brain targeting and peripheral toxicity of Deltorphin A(1-8) [DYN-A(1-8)] nanoparticles in rats with cerebral ischemia-reperfusion injury. Methods: DYN-A(1-8) was encapsulated into poly (citric acid)-g-arginine (PCGA) based nanoparticles, and the characteristics of DYN-PCGA nanoparticles were evaluated. Fluorescent Cy5-labeled DYN-A(1-8) or DYN-PCGA was injected into middle cerebral artery occlusion (MCAO) rats via the tail vein, and an in vivo imaging system was used to validate the brain targeting ability of DYN-PCGA. The effects of DYN-A(1-8) nanoparticles on the histopathology of heart, liver, spleen, lung, and kidney tissues in MCAO rats were observed by HE staining to assess the in vivo toxicity of DYN-PCGA administered via the tail vein. Results: The characterization results showed that DYN-PCGA(1∶5) exhibited small particle size, high stability, and strong drug loading capacity. In vivo imaging results indicated that DYN-PCGA could effectively transport drugs across the blood-brain barrier to the brain after administration, demonstrating good brain targeting. HE staining results revealed that the tissue sections of heart, liver, spleen, lung, and kidney in MCAO rats showed normal cellular structure without edema or inflammatory cell infiltration, and no abnormal histopathological changes were found. Conclusion: DYN-PCGA nanoparticles extended the plasma half-life of DYN-A(1-8), exhibiting good brain targeting and certain safety.

To compare the efficacy of dopaminergic (levodopa) and anticholinergic (benzhexol) medications in the treatment of tremor in patients with Parkinson’s disease (PD), and to evaluate the factors influencing response to these two medications in patients with resting tremor. Methods: A prospective study enrolled 141 patients with PD presenting with tremor, recruited at Beijing Tiantan Hospital between December 2021 and March 2024. On two consecutive mornings in a fasting state, participants underwent pharmacological challenge tests with levopoda and benzhexol. Resting, postural, intentional and kinetic tremors in patients with PD were evaluated using the Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and the Fahn-Tolosa-Marin Tremor Rating Scale (TRS). Tremor power across different contexts was analyzed via electromyography (EMG). The study compared improvement rates in tremor scale scores and absolute changes in tremor power following administration of each drug. Univariate and multiple linear regression analyses were employed to identify factors associated with drug response in resting tremor. Results: Levopoda outperformed benzohexol in improving all tested PD tremor types: resting (UPDRS-III P=0.003; TRS P=0.007), postural (TRS P<0.001), intentional (TRS P=0.002), and kinetic (TRS P<0.001). It also achieved greater reductions in tremor power during resting, resting + task, postural, and weight conditions (all P<0.05 v.s.benzohexol). Regression analyses indicated that better responses to levopoda for resting tremor were associated with higher rigidity-bradykinesia ( β =0.215, P=0.033) and anxiety scores ( β =0.211, P=0.015). Presence of dyskinesia enhanced response to levopoda ( β =0.300, P=0.001) but diminished response to benzohexol ( β =－0.357, P< 0.001). Worse responses to both drugs for resting tremor occurred in patients with higher kinetic tremor scores (levopoda β=－0.276, P=0.007; benzohexol β=－0.195, P=0.024). Conclusion: Dopaminergic medications are the preferred treatment for tremor in PD, particularly for patients with dyskinesia, and for those with severe bradykinesia, rigidity, and anxiety. The benefit of adding anticholinergic agents to treat dopamine-resistant resting tremor may be smaller in patients with pronounced kinetic tremor.

This study aims to identify the risk factors associated with distal symmetric polyneuropathy (DSPN) in patients with type 2 diabetes mellitus (T2DM) and to develop a predictive model for assessing the risk of DSPN. Methods: A total of 1,658 eligible T2DM patients were selected from Xiaogan Hospital, affiliated with Wuhan University of Science and Technology, between July 2021 and July 2024. General and clinical data were collected and then split into a training set and a validation set in a 7 ∶ 3 ratio. LASSO regression and binary logistic regression were employed to develop a nomogram model using the training set data, which was subsequently validated with the validation set data. The model’s accuracy, discrimination, and clinical applicability were assessed using calibration curves, the area under the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results: The analysis identified duration of diabetes (OR=1.195, 95% CI: 1.116-1.280), fasting blood glucose (FPG) (OR=1.614, 95% CI: 1.435-1.816), neutrophil-to-lymphocyte ratio (NLR) (OR=1.388, 95%CI: 1.042-1.849) and urinary microalbumin (mALB) (OR=1.536, 95% CI: 1.113-2.120) as independent risk factors for DSPN. Conversely, high-density lipoprotein cholesterol (HDL-C) (OR=0.252, 95%CI: 0.160-0.397) and 25-hydroxyvitamin D[25(OH)D] (OR= 0.845, 95% CI: 0.825-0.864) were identified as independent protective factors. The nomogram model’s predicted DSPN risk probability closely aligned with the actual probability, as demonstrated by the calibration curve. The area under the curve (AUC) for DSPN prediction was 0.896 (95% CI: 0.878-0.913) in the training group and 0.888 (95%CI: 0.860-0.917) in the validation group. The decision curve analysis (DCA) indicated that the model holds significant clinical value across a wide range of thresholds. Conclusion: This study successfully developed a highly accurate nomogram prediction model based on key predictors, including diabetes duration, FPG, NLR, mALB, HDL-C, and 25(OH)D.

To explore the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and Tenecteplase (TNK) in bridging therapy for acute ischemic stroke patients with large vessel occlusion (LVO). Methods: Baseline data and clinical data of LVO patients (n=104) who underwent bridging treatment in Xuzhou Central Hospital from September 2022 to September 2024 were retrospectively collected. They were divided into two groups based on the difference of intravenous thrombolytic drugs, the TNK group (n=49) and the rt-PA group (n=55). The baseline data, primary and secondary efficacy indicators, and safety indicators of the two groups were statistically analyzed. The primary efficacy indicator referred to the 90 days modified Rankin scale (mRS) score (mRS≤2 was good prognosis, mRS>2 was bad prognosis), and the secondary efficacy indicator referred to the postoperative vascular reperfusion rate and the incidence of early neurological function improvement. Safety indicator included 90 days mortality, incidence of symptomatic intracranial hemorrhage, and incidence of hemorrhage from any site. According to the difference of 90 d mRS scores, patients were divided into good prognosis (n=44) and poor prognosis (n=60) groups, and the factors affecting the prognosis of bridging treatment in LVO patients were screened by using univariate and multivariate logistic regression analyses. Results: The successful reperfusion rate, incidence of early neurological function improvement, 90 days mortality rate, symptomatic intracranial hemorrhage, and hemorrhage from any site were not significantly different between the two groups (all P>0.05). The incidence of good 90 days prognosis of patients in the TNK group was higher than that in the rt-PA group (P<0.05). High NIHSS scores on upon admission was an independent risk factor for poor prognosis in LVO patients and TNK reduces the risk of poor prognosis. Conclusion: The use of TNK before thrombolysis is associated with a better functional prognosis in LVO patients with bridging.

Stroke ranks among the leading causes of global disease burden, injury, and risk factors, with acute ischemic stroke (AIS) accounting for approximately 75% of cases. Intravenous thrombolysis stands as one of the most effective treatments for AIS, enabling rapid recanalization of occluded vessels and restoration of blood flow to minimize disability or mortality risks in patients. In recent years, novel intravenous thrombolytic agents with favorable safety profiles and distinct therapeutic benefits have gained significant attention. This review systematically summarizes evidence from multicenter studies and explores potential mechanisms underlying three such drugs—prourokinase, reteplase, and tenecteplase—aiming to provide theoretical support for advancing clinical research and deepening insights into their mechanisms of action.

Acute ischemic stroke (AIS) is a prevalent neurological disorder that can lead to severe disability. During its progression, neutrophils play multifaceted roles-they both drive inflammatory responses and contribute to neural tissue repair. This review comprehensively analyzes the characteristics of neutrophils, their functions in AIS, the dual impacts of inflammation, as well as existing and emerging therapeutic strategies. The aim is to enhance understanding of the pathological mechanisms underlying AIS, identify potential therapeutic targets, and provide scientific evidence for improving long-term patient outcomes.

Breath-hold training (BHT) is an intervention involving voluntary apnea that induces physiological stress. In recent years, it has garnered significant attention in both neuroscience and sports medicine. Research indicates that by inducing a controlled state of hypoxia and hypercapnia, BHT activates compensatory mechanisms against oxygen deprivation, substantially enhancing the adaptive capacity of respiratory, circulatory, and nervous systems. Its unique physiological stress effects suggest that this practice may serve as a novel, non-invasive strategy for cerebral hypoxic preconditioning, offering potential benefits for preventing and treating conditions like ischemic cerebrovascular diseases. This article reviews relevant studies on BHT to provide a comprehensive reference for further research and practical applications in this field.

Respiratory muscle dysfunction is a common complication of stroke, which can lead to decreased strength and atrophy of the respiratory muscles, increased incidence of pulmonary infection, and increased risk of non-vascular death in patients. This paper reviews the mechanisms, main assessment methods, and rehabilitation approaches for respiratory muscle dysfunction in stroke patients, in order to provide references for clinical rehabilitation and research on respiratory muscle dysfunction in stroke patients. The analysis shows that stroke can cause respiratory muscle dysfunction due to primary lesions in the central nervous system, secondary neuromuscular injury, and iatrogenic injury; commonly used clinical assessment methods include ultrasound, peak cough flow, pulmonary ventilation function tests, respiratory mechanics indexes measurement, electrophysiological examination, etc. Acoustic analysis can be used as one of the future visualization assessment and guidance for respiratory rehabilitation. Commonly used clinical rehabilitation approaches include external diaphragm pacing, neuromuscular electrical stimulation, proprioceptive neuromuscular facilitation, airway management, respiratory muscle training, etc. The electric standing bed can be used as one of the means to prevent infection and improve respiratory muscle function in critically ill patients.

Walking disability in stroke patients is an important cause of falls. The assessment of walking function is a significant part of the functional evaluation for stroke patients. Traditional assessment methods, primarily based on observation and scales, are highly subjective and fail to achieve rapid and precise quantitative assessment. Walking function assessment technology based on wearable devices, as a rehabilitation assessment method that can provide real-time and continuous monitoring of gait and balance functions, helps in detecting the walking function and rehabilitation efficacy of stroke patients, and plays a positive role in predicting their prognosis. Therefore, wearable devices have broad application prospects in the assessment of post-stroke walking function. This article reviews the research progress of surface electromyography detection technology, wearable plantar pressure measurement technology, and wearable inertial measurement unit assessment technology in the evaluation of walking function after stroke.

Although the repetitive transcranial magnetic stimulation technique has been widely used in the field of clinical rehabilitation medicine to treat post-stroke aphasia, the recovery mechanism is currently unclear. Given that the advantages of non-invasive brain functional imaging technology in neural mechanism research have been widely recognized by experts and scholars in recent years, this article reviews and summarizes relevant research on repeated transcranial magnetic stimulation therapy for post-stroke aphasia based on non-invasive brain functional imaging at home and abroad, in order to provide certain reference value for clinical rehabilitation.

Multiple sclerosis (MS) pathogenesis is complex, and current clinical treatments cannot halt disease progression and have numerous side effects. There is an urgent need to develop new and effective clinical treatments to improve the clinical symptoms and prognosis of MS patients. Remyelination can provide benefits throughout the entire course of MS, making it a highly promising treatment approach for MS. Oligodendrocyte precursor cells, responsible for myelin regeneration in MS, have their regenerative capacity influenced by various microenvironmental factors. This article provides the first review of the impact and mechanisms of microenvironmental factors such as innate immune cells, myelin debris, extracellular matrix, astrocytes, neurons, pericytes and endothelial cells, adaptive immune cells, peripheral circulation, and aging on MS remyelination, aiming to offer references for the prevention and treatment of MS.

To analyze the clinical features and prognosis of Miller-Fisher Syndrome Manifesting (MFS) with isolated ophthalmoplegia. Methods: We report two cases of MFS presenting with bilateral isolated ophthalmoplegia as the primary clinical manifestation followed by a systematic review of relevant literature. Results: Case 1 involved a 54-year-old female presenting with diplopia and bilateral blepharospasm following infection. Case 2 described a 67-year-old male who developed diplopia without clear triggers, accompanied by unilateral ptosis, dilated pupils with sluggish light reflex, and ocular motility disorders. Both patients tested positive for serum anti-GQ1b IgG antibodies and anti-GT1a IgG antibodies; Intravenous immunoglobulin therapy was administered to both patients, leading to favorable outcomes. By integrating our two new cases with previously reported instances, we identified a total of seven patients manifesting isolated ocular symptoms: five were anti-GQ1b IgG positive, six exhibited external ophthalmoplegia, five had internal ophthalmoplegia, five reported prodromal infections, and all achieved good recovery. Conclusion: Patients with MFS presenting solely with ocular symptoms are exceedingly rare. These cases significantly enhance our understanding of this distinctive clinical entity.