The technology of optical coherence tomography angiography (OCTA) has become a key tool in the non-invasive, high-resolution imaging for the diagnosis and treatment monitoring of neuromyelitis optica spectrum disorders (NMOSD). This review focuses on the application of OCTA in revealing retinal microvascular changes and its use in the management of NMOSD. The dynamic information on retinal blood flow provided by OCTA offers a scientific basis for formulating personalized treatment plans and complements traditional imaging techniques well. Further exploration of its necessity and potential value in the application within NMOSD is warranted.

Alzheimer’s disease (AD) is the most common neurodegenerative disease, primarily characterized by detrimental and irreversible cognitive dysfunction. Sleep-wake rhythm disturban is a common symptom in AD patients, and extensive researches have shown that sleep-wake rhythm disturban predates the onset of behavioral symptoms of AD. The normal sleep-wake rhythm facilitates the metabolism of Amyloid-β-protein (A β) and tau protein. However, when the sleep-wake cycle is disturbed, the central nervous system’s ability to clear harmful metabolic waste diminishes. Moreover, sleep-wake rhythm disturban can also lead to neuroinflammation and oxidative stress in the central nervous system, accelerating cognitive impairment. Therefore, this review primarily explores the relationship between the disturban of the sleep-wake cycle and the development of AD.

Spinal cord injury (SCI) elicits sensory, motor, and autonomic dysfunctions caudal to the lesion site, resulting in enduring functional deficits. Successful recovery hinges upon compensatory axonal sprouting from intact neurons or regeneration of damaged axons, a process constrained by transcriptional regulatory dynamics. Epigenetics emerges as a pivotal determinant in instigating and sustaining regenerative transcriptional cascades. Specifically, histone covalent modifications intricately modulate post-injury chromatin restructuring, consequently influencing transcriptional dynamics. This review delineates the epigenetic regulatory framework governing post-SCI axonal regeneration, emphasizing the role of histone covalent modifications as potential therapeutic targets to enhance clinical interventions for SCI repair.

About 15% to 20% of patients with myasthenia gravis (MG) develop a myasthenic crisis, which involves the respiratory muscles, leading to weakness in coughing, difficulty breathing, and an inability to maintain normal ventilation. Early assessment of respiratory muscle function in MG patients helps provide a basis for judging the risk of developing a myasthenic crisis. The diaphragm is the main respiratory muscle, and examining diaphragmatic function is beneficial for early evaluation of respiratory function in MG patients. However, previous literature on diaphragmatic function research lacks effective integration. This article will summarize and review factors affecting MG antibodies, clinical classifications, mechanisms of diaphragmatic dysfunction occurrence, manifestations, examinations, diagnostic methods, etc., providing references for in-depth research and clinical applications of respiratory function in MG patients.

To investigate whether general anesthesia exposure during infancy (0～2 years old) affects attention in school-aged children. Methods: School-aged children who underwent general anesthesia during infancy (0～2 years old) between June 2009 and December 2013 at Nanjing Children's Hospital and were currently in primary school were selected as the exposed group (n=203). Healthy school-aged children without general anesthesia exposure were matched as the control group (n=208). The children underwent standardized attention tests and parent questionnaires. The exposed group was further subdivided into different subgroups based on the age of first exposure, duration of exposure, and number of exposures. The primary assessment tools were the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) and the Chinese version of Sw anson Nolan and Pelham, Version Scale-parent form（SNAP- Ⅳ）rating scale. Results: Auditory attention quotient was significantly correlated with gestational age at birth, singleton birth, number of exposures, age at first exposure, and duration of first anesthesia. Attention deficit and visual persistence quotient were significantly correlated with gestational age at birth, number of exposures, age at first exposure, and duration of first anesthesia. Visual sensory/motor quotient was significantly correlated with singleton birth, number of exposures, age at first exposure, and duration of first anesthesia. Auditory attention quotient was also significantly correlated with gestational age at birth, singleton birth, number of exposures, age at first exposure, and duration of first anesthesia. Conclusion: General anesthesia exposure during infancy (0～2 years old) has a certain impact on the development of attention in school-aged children, with multiple exposures being a prominent factor.

睡眠剥夺是导致神经炎症、氧化应激及认知功能障碍的重要诱因，其机制与星形胶质细胞的活化密 切相关。星形胶质细胞作为中枢神经系统的关键调控者，通过A1/A2极化表型在睡眠剥夺中发挥双重作 用：A1型通过释放促炎因子和神经毒素加剧神经炎症及突触损伤，而A2型则通过分泌神经营养因子和抗 炎介质促进神经修复。本文系统综述了睡眠剥夺中星形胶质细胞的活化机制及相关信号通路：NF-κB通 路、MAPK通路在、SHH通路和JAK-STAT通路。研究表明，慢性睡眠剥夺通过炎症介质积累及星形胶质 细胞过度激活导致认知障碍，而调控其极化表型（如抑制A1型或增强A2型）可能成为干预睡眠剥夺相关 神经损伤的新策略。未来需进一步解析星形胶质细胞极化的时空特异性及信号网络交互作用，为靶向治 疗提供理论依据。

Parkinson's disease (PD) is a common neurodegenerative disorder. Early symptoms are often subtle, and by the time of diagnosis, patients typically exhibit significant motor and non-motor impairments. Currently, there is a lack of specific tests for early PD diagnosis or prognostic evaluation, underscoring the urgent need to identify biomarkers that can elucidate the underlying mechanisms of PD. This paper mainly reviews the expression of markers such as α-Synuclein (α-Syn), YKL-40, neurofilament light chain (NfL), amyloid β (Aβ) 1-42, and Tau protein in the cerebrospinal fluid or blood of patients with PD. Additionally, it summarizes the different roles of inflammatory factors such as interleukin (IL)-1β, IL-2, IL-6, and tumor necrosis factor-α (TNF-α) in PD-related cognitive dysfunction. By exploring the dynamic changes in these biomarkers, new avenues may emerge for early PD diagnosis and prognosis prediction.

Post-stroke aphasia is a common post-stroke functional disorder, and conventional speech-language therapy (SLT) has limited efficacy. As a non-invasive brain stimulation technique, repetitive transcranial magnetic stimulation (rTMS) promotes neural network reorganization and facilitates language recovery by modulating cortical excitability and interhemispheric inhibitory balance. This article reviews the mechanisms of action, intervention timing, stimulation targets, and current therapeutic applications of rTMS across different types of aphasia. Future research could integrate functional neuroimaging technologies to optimize personalized treatment and evaluation protocols, thereby enhancing the clinical translational value of rTMS.

To systematically evaluate the impact of virtual reality (VR) technology on cognitive function in stroke patients. Methods: A computer-based search was conducted across multiple domestic and international databases for randomized controlled trials (RCTs) investigating VR interventions in patients with post-stroke cognitive impairment. The search period spanned from the inception of the databases to January 7, 2025. The Cochrane Collaboration's Risk of Bias tool and the Physiotherapy Evidence Database (PEDro) scale were employed to assess the quality of the included studies. Data analysis was performed using RevMan 5.4.1 software. Results: A total of 14 studies, involving 723 patients, were ultimately included. All included studies were of high quality, with PEDro scale scores ranging from 6 to 10. Meta-analysis results indicated that VR technology significantly improved the Montreal Cognitive Assessment (MoCA) score [MD=2.53, 95% CI (0.82, 4.24), P=0.004], the Mini-Mental State Examination (MMSE) score [MD=1.68, 95% CI (1.12, 2.24), P<0.00001], the P300 latency [MD=－25.48, 95% CI (－38.99, －11.96), P=0.0002], the P300 amplitude [MD=0.72, 95% CI (0.14, 1.30), P=0.02], and the Barthel Index or Modified Barthel Index (BI or MBI) score [MD=5.14, 95% CI (3.25, 7.03), P<0.00001] in stroke patients with cognitive impairment. However, no significant effects were observed on the Trail Making Test Part A (TMT-A) score [MD=－12.47, 95% CI (－27.16, 2.23), P=0.10] or the TMT-B score [MD=－ 44.35, 95% CI (－ 117.45, 28.74), P=0.23]. Conclusion: VR technology can improve cognitive function and activities of daily living (ADL) abilities in stroke patients.

By analyzing the clinical data, tremor analysis results, and final diagnoses of patients with tremor, this study aims to clarify the significance of tremor analysis and provide assistance for clinicians. Methods: Patients who underwent tremor analysis in the electromyography laboratory of the Neurology Department at Beijing Friendship Hospital from January 2022 to January 2024 were screened according to inclusion and exclusion criteria. Clinical data and tremor analysis results of enrolled patients were summarized. Comparisons were made between the clinical data and tremor analysis results of two groups--essential tremor (ET) and Parkinson's disease (PD)--while clinical and tremor analysis findings for other tremor patients were also summarized. Results: A total of 192 patients were enrolled in this study, including 103 cases of essential tremor (53.6% ), 74 cases of Parkinson's disease (38.5% ), 4 cases of dystonia (2.1% ), 3 cases of peripheral neuropathy-associated tremor (1.6% ), 3 cases of orthostatic tremor (1.6% ), 4 cases of enhanced physiological tremor (2.1%), and 1 case of multiple system atrophy (0.5%). Comparisons between ET and PD groups revealed statistically significant differences in age, disease duration, family history, onset site, tremor pattern, contraction form, and presence of harmonic components (P<0.05). Significant differences in tremor frequency were observed between the two groups under resting, postural, intentional, and 1 kg load conditions (P<0.05), while no significant differences in tremor amplitude were found (P>0.05). Conclusion: This real-world study on tremor analysis demonstrates the complexity and diversity of tremor-related disorders. Tremor analysis is a valuable diagnostic tool, particularly in differentiating between ET and PD.

Parkinson's disease (PD) is one of the most common neurodegenerative diseases. Quantitative Susceptibility Mapping (QSM), a non-invasive method that utilizes magnetic resonance data acquisition, makes it possible to quantify brain iron content. This helps to understand the role of iron deposition in the pathogenesis of PD and is expected to become a new type of biomarker for PD. This paper briefly describes the research progress of QSM based on the principle of intracranial iron deposition in the motor symptoms, non-motor symptoms, treatment, and differential diagnosis of PD, providing a reliable imaging basis for QSM in the early diagnosis of PD and diseases. It is of great significance for the assessment of the condition of PD patients and the search for new treatment methods, thus proposing a new approach to understanding the brain iron physiology under disease conditions.

Spinal cord injury (SCI) is a severe traumatic disease that has a profound impact on society, families, and patients. After SCI, neuronal axons exhibit limited spontaneous regenerative capacity, and effective clinical treatments remain lacking. Previous studies have demonstrated that various growth factors play crucial roles in protecting neural tissue, stimulating axonal regeneration and remyelination, and reducing scar formation after SCI. Hydrogels are currently considered ideal biomaterial scaffolds, as they can protect growth factors from degradation, enable localized delivery and sustained release of growth factors, and play significant roles in both the early phase and subsequent tissue regeneration stages after SCI. This article focuses on reviewing the research progress on hydrogel-delivered growth factor therapies for SCI during different stages of secondary damage and tissue regeneration.

As a fat-soluble steroid hormone, vitamin D is crucial not only for bone health but also may influence the occurrence and development of diabetes mellitus and its complications. Studies have shown that vitamin D deficiency may be involved in insulin resistance and pancreatic β-cell dysfunction, leading to the development of type 1 and type 2 diabetes. Vitamin D supplementation may help prevent type 1 diabetes and improve blood glucose control in patients with type 2 diabetes. This article reviews the research progress on vitamin D and diabetes mellitus and its related complications.

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease. Neuroinflammation, oxidative stress, demyelination, and apoptosis are important pathogenesis of MS. The phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway is closely related to the above pathophysiological processes. Currently, the immunosuppressive treatment for MS mainly focuses on disease-modifying therapies, aiming to reduce relapse rates and short-term exacerbations. However, it cannot cure the disease. With in-depth research into the pathological mechanism of MS, new pathogenic mechanisms and therapeutic targets urgently need to be explored. This paper takes“multiple sclerosis, PI3K/Akt signaling pathway, inflammatory response, oxidative stress, apoptosis”s keywords and retrieves relevant literature from the“Pubmed, China National Knowledge Infrastructure, and Web of Science”databases between 2004 and 2024. It reviews the research progress on the relationship between the PI3K/Akt signaling pathway and MS neuroinflammation, oxidative stress, demyelination, and apoptosis, aiming to provide new ideas for the treatment of MS.

This research intends to explore the characteristics of functional brain networks during intense urinary states in healthy adults. Methods: Healthy subjects were included and underwent resting-state functional near-infrared spectroscopy(fNIRS) testing when the bladder was full and empty, respectively. Automatic anatomical labelling atlas(AAL) was applied to divide the cerebral cortex into 23 regions of interest (ROIs), and interstate HbO2 levels were compared for each ROI. Gaussian graphical model with nonconvex regularization was built based on the time-series data of each ROI, and the edge weights of the graphical model indicated the strength of functional connectivity(FC). The backbone structure of the brain network of each subject was extracted and used to compare the difference in strength of the same side weights in the two bladder states. Finally, in each state, the time-series data of all subjects were averaged, resulting in total data for the construction of the graph model, and then the backbone subnetworks were extracted for visualization and analysis. Results: A total of 19 healthy subjects. The median HbO2 was significantly higher in the right supraoccipital gyrus during the bladder empty state compared to the bladder full state(P=0.0401). No significant interstate differences were seen in the remaining ROIs. The FCs that were significantly stronger in the full state were“left orbital middle frontal gyrus-right orbital inferior frontal gyrus”(P=0.0036) and“right temporal pole superior temporal gyrus-right middle temporal gyrus”(P=0.0245); and the FC that was significantly stronger in the empty state was“left superior frontal gyrus - left orbital middle frontal gyrus”(P=0.0411). Compared to the empty state, the frontal lobes had more and stronger internal and external FCs during the bladder-filling state, especially the left frontal lobe’s cross-hemispheric FCs with the right audiovisual, motor and somatosensory, cingulate gyrus-insula system, and ventral temporal lobe association systems. Conclusion: The functional brain networks related to urination awareness involve multiple brain network modules in scope, including the frontal-parietal system, somatosensory areas, audio-visual system, cingulate-insula system, and ventral temporal lobe associative systems. In terms of activity patterns, it exhibits characteristics of a functional dark network.

To evaluate and explore the efficacy and safety of immunoadsorption treatment in patients with acute severe/refractory Guillain-Barré syndrome (GBS) who have unsatisfactory responses to conventional first-line immunotherapy. Methods: Six patients with acute severe/refractory GBS who had poor responses to conventional first-line immunotherapy were selected and subsequently received protein A immunoadsorption treatment. The clinical data, treatment conditions, efficacy, changes in immunoglobulins and complements, and adverse reactions of the six patients were retrospectively analyzed. Results: After immunoadsorption treatment, the clinical symptoms and signs of the six patients were improved, including muscle strength, spontaneous breathing function, eye movement, and consciousness state among other aspects. The IgG levels of the six patients significantly decreased after the first immunoadsorption treatment, and the IgM, IgA, complement C3, and C4 also decreased to varying degrees. Only two of the six patients experienced mild adverse reactions. Conclusion: For patients with acute severe/refractory GBS who do not achieve satisfactory results with conventional first-line immunotherapy, subsequent immunoadsorption treatment may help improve neurological function, enhance the quality of life, and has good safety.

To explore the feasibility of using the Non-motor Symptoms Scale (NMSS) to assist in differentiating drug-induced parkinsonism (DIP) from Parkinson's disease (PD). Methods: A total of 21 patients with DIP (DIP group), 25 patients with PD who had not received medication treatment (PD group), and 22 patients without Parkinson's symptoms (control group) were selected from May 2023 to May 2024 in the Department of Neurology of our hospital. Clinical data of the patients were collected, and they were assessed using the Unified Parkinson's Disease Rating Scale Part III (UPDRS III) and the Hoehn and Yahr Staging Scale (H-Y). At the same time, the NMSS was used to evaluate the non-motor symptoms. The scale scores and their correlations among the three groups were compared and analyzed. Results: The scores of the NMSS in the DIP group and PD group showed significant differences compared with the control group. Except for perception (delusions of persecution, diplopia), attention and memory (difficulty remembering recent events, forgetting to do some things), gastrointestinal symptoms (dysphagia), and others (increased sweating), the differences in other items were statistically significant (P<0.05). Compared with the PD group, the scores of vascular symptoms, sleep and physical strength (daytime sleepiness, restless legs syndrome), attention and memory (inattentiveness), gastrointestinal symptoms (ptyalism), urinary symptoms, sexual function, and others (unexplained pain, alteration of taste and smell sense) in the DIP group were statistically significant (P<0.05). Spearman correlation analysis showed that the motor symptoms correlation (UPDRS III and H-Y) in the DIP group and PD group was low to moderately correlated (rs=－0.254, －0.519). Among other items, only sleep and physical strength (daytime sleepiness), attention and memory (inattentiveness), urinary symptoms, and others (alteration of taste and smell senses) in the DIP group were moderately correlated with those in the PD group (rs=0.370～0.497); sleep and physical strength (restless legs syndrome) was lowly correlated with the PD group (rs=0.279). No significant correlation was found in the remaining items (P>0.05). Conclusion: The NMSS score is helpful to improve the accuracy of differentiating early DIP from PD patients.

To observe the clinical efficacy of repetitive peripheral magnetic stimulation (rPMS) combined with repetitive transcranial magnetic stimulation (rTMS) on post-stroke hemiplegic shoulder pain (HSP) and its impact on the somatosensory evoked potentials (SEPs) of the median nerve in the affected upper limb. Methods: Forty patients with HSP were randomly divided into an observation group (20 cases) and a control group (20 cases) using a random number table method. Both groups received conventional rehabilitation training. In addition, the control group was treated with high-frequency rTMS over the primary motor cortex of the affected side, while the observation group was treated with high-frequency rPMS targeting the painful trigger points of the rotator cuff muscles of the affected shoulder, combined with high-frequency rTMS over the primary motor cortex of the affected side. Treatments were administered once daily, five days a week, for four weeks. Before and after the intervention, subjects were assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), passive joint range of motion (PROM) of the pain-free hemiplegic shoulder, Neer shoulder function score, Modified Barthel Index (MBI), and the latency and amplitude of the N20 component of the median nerve SEP in the affected upper limb. Results: Before the intervention, there were no significant differences in baseline characteristics, SF-MPQ scores, PROM, Neer shoulder function scores, MBI, or the latency and amplitude of the N20 component of the median nerve SEP between the two groups (P>0.05). After the intervention, both groups showed a significant decrease in SF-MPQ scores compared to baseline (P<0.01), with a more pronounced decrease observed in the observation group than in the control group (P<0.05). Both groups also demonstrated significant improvements in PROM, Neer shoulder function scores, MBI, and N20 amplitude compared to baseline (P<0.05), with more significant improvements observed in the observation group than in the control group (P<0.05). After the intervention, the N20 latency in the observation group was significantly shorter than before the intervention (P<0.05), and the difference in N20 latency before and after the intervention was more pronounced in the observation group than in the control group (P<0.05). However, no significant difference in N20 latency was observed in the control group after the intervention (P>0.05). Conclusion: Peripheral-central combined magnetic stimulation is significantly effective in improving shoulder pain, shoulder joint function, and activities of daily living in patients with HSP. It also has a beneficial effect on the latency and amplitude of the N20 component of the median nerve SEP, with superior outcomes compared to rTMS treatment alone.

To investigate the characteristics of tremor in patients with dopamine-resistant and dopamine-responsive tremor in Parkinson's disease (PD). Methods: This study is a retrospective analysis. A total of 197 PD patients with at least one limb exhibiting resting or postural tremor were included. All patients underwent an acute levodopa challenge test and tremor analysis. Patients with a tremor improvement score of less than 5 points were classified as dopamine-resistant (116 cases), while those with a tremor improvement score of 5 points or more were classified as dopamine-responsive (81 cases). The tremor patterns and frequencies in the resting, postural, intentional, and object-holding states were compared between the two groups. Results: Compared to the dopamine-resistant group, the dopamine-responsive group had a higher baseline Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) total score and tremor total score, longer disease duration, and higher levodopa equivalent dose (all P<0.05). The maximum improvement rate and improvement value of tremor during the acute levodopa challenge test were also greater in the dopamine-responsive group (both P<0.05). There were statistically significant differences in the distribution of tremor muscle contraction patterns and frequencies between the two groups in the upper limb intentional tremor and upper limb object-holding state (P<0.05). Additionally, there were statistically significant differences in the distribution of tremor muscle contraction patterns and frequencies between the two groups in the lower limb resting and postural tremor states (P<0.05). Conclusion: The tremor of PD exhibits heterogeneity in its response to levodopa. Different responsive types show variations in the distribution of tremor muscle contraction patterns and frequencies under different conditions. Tremor analysis can provide objective and practical evidence for the differentiation and treatment of various dopamine-responsive types of Parkinson's tremor.

To investigate the differential expression of microRNAs (miRNAs) in the peripheral blood of children with refractory epilepsy. Methods: A total of 46 pediatric patients with epilepsy were enrolled and divided into a refractory epilepsy group (R group, n=20) and a well-controlled epilepsy group (C group, n= 26). Additionally, 26 healthy children undergoing routine health examinations in the pediatric healthcare department during the same period were included as the healthy control group (N group). High-throughput sequencing technology was used to detect the expression of miRNAs in the peripheral whole blood of children in the three groups, and DEseq2 software was employed to screen for differentially expressed miRNAs. Under the same conditions, an additional 30 children were enrolled in each of the R, C, and N groups, and peripheral blood samples were collected. Fluorescent quantitative polymerase chain reaction (qRT-PCR) amplification technology was used to validate the expression levels of target miRNAs in the peripheral blood of children. The miRanda and RNAhybrid online databases were utilized to predict the target genes of the differentially expressed miRNAs, and Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were conducted for the candidate target genes. Results: Compared with the N group, a total of 124 differentially expressed miRNAs were identified in the R group, including 74 upregulated and 50 downregulated miRNAs, while 66 differentially expressed miRNAs were found in the C group, with 21 upregulated and 45 downregulated. When compared with the C group, the R group exhibited 337 differentially expressed miRNAs, of which 197 were upregulated and 140 were downregulated. Among these, miR-15a-5p showed the most significant difference (P=9.00×10－8 , |log2(fold change)|=2.93). qRT-PCR amplification of miR-15a-5p revealed a statistically significant difference in its expression among the three groups of children (P<0.001), consistent with the high-throughput sequencing results. The receiver operating characteristic (ROC) curve demonstrated that miR-15a-5p had a good area under the curve (AUC) value (0.884), sensitivity (90% ), and specificity (83.3% ) in diagnosing refractory epilepsy in children. Target gene prediction for the differentially expressed miRNAs, along with GO and KEGG analysis of the candidate target genes, suggested that miR-15a-5p may be involved in regulating signaling pathways related to refractory epilepsy (RE) in children, including the MAPK signaling pathway, cAMP signaling pathway, platinum drug resistance signaling pathway, p53 signaling pathway, Ras signaling pathway, Fc-γ-R-mediated phagocytosis signaling pathway, and neurodegenerative disease signaling pathway. Conclusion: The expression profile of miRNAs in the peripheral blood of children with refractory epilepsy differs significantly from that of children with well-controlled epilepsy and healthy children. Among these, miR-15a-5p exhibits the most prominent differential expression and may participate in the pathophysiological process of epilepsy by regulating multiple pathways.

Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide, with complex and diverse pathological factors. Chronic, persistent stimulation-induced neuroinflammation stands as one of the major pathological contributors. During the pathogenesis of PD, the misfolding of α-synuclein and the release of mitochondrial DNA (mtDNA) due to mitochondrial damage both induce the activation of microglia, disrupting the balance of inflammatory cytokines in the brain region and leading to neuronal injury. Consequently, the inflammatory response mediated by microglia serves as a critical link in the pathogenesis of PD and represents one of the most promising therapeutic targets. Therefore, this review summarizes the origin, types, and functions of microglia, as well as their potential mechanisms in the pathogenesis of PD and PD therapies targeting microglia, aiming to provide a deeper understanding of the role played by microglia in PD and the underlying potential therapeutic strategies.

Migraine is a neurological disorder with high prevalence, often coexisting with various diseases to form comorbidities. These comorbid conditions are bidirectionally interconnected with migraine through shared genetic, environmental, and pathophysiological mechanisms. This review summarizes the comorbidity relationships between migraine and cardiovascular/cerebrovascular diseases, endocrine disorders, epilepsy, psychiatric disorders, sleep-related diseases, gastrointestinal conditions, and immune-mediated diseases. Identifying comorbidities aids in elucidating the etiology of migraine, guiding research on its pathophysiology, and facilitating individualized comprehensive management for migraine patients.

Objective: To explore the impact of nonverbal cue-based psychological counseling intervention on anxiety emotions and sleep quality in patients with tinnitus. Methods: A total of 104 patients with tinnitus were randomly divided into a control group and an observation group, with 52 patients in each group. Both groups received routine interventions, while the observation group additionally received nonverbal cue-based psychological counseling intervention. The Anxiety State Trait Questionnaire (STAI), Pittsburgh Sleep Quality Index (PSQI), Connor-Davidson Resilience Scale (CD-RISC), and Comprehensive Assessment Scale of Quality of Life (GQOLI-74) were used to evaluate and compare anxiety emotions, sleep quality, psychological resilience, quality of life, and satisfaction between the two groups. Results: After the intervention, all STAI scores in the observation group were lower than those in the control group (P<0.05), sleep indicators were better than those in the control group (P<0.05), CD-RISC scores were higher than those in the control group (P<0.05), and all GQOLI scores were higher than those in the control group (P<0.05). The total satisfaction rate of intervention in the observation group was higher than that in the control group (P<0.05). Conclusion: Nonverbal cue-based psychological counseling intervention has a significant application effect on patients with tinnitus, reducing anxiety emotions, improving sleep quality, psychological resilience function, and quality of life, with good patient satisfaction.

To investigate the effect of adipose-derived mesenchymal stem cells (ADSCs) combined with arginine-glycine-aspartic acid (Arg-Gly-Asp, RGD) peptide modified hydrogel on regenerative repair after spinal cord injury (SCI) in rats. Methods: Fifty SD rats were randomly divided into five groups: sham operation group (Sham group), model group (SCI group), adipose-derived mesenchymal stem cell group (ADSCs group), RGD peptide-modified hydrogel group (p-Gel group), and adipose-derived mesenchymal stem cell combined with hydrogel group (ADSCs-pGel group), with 10 rats in each group. The SCI model was established using a transection method, and each group was injected with 100 μL of normal saline, ADSCs, RGD peptide-modified hydrogel, or a mixture of ADSCs and RGD peptide-modified hydrogel at the site of spinal cord injury. The Basso Beattie Bresnahan (BBB) scale was used to score the motor function of the rats' hindlimbs on days 1, 3, 7, 14, 21, and 28 after modeling. On day 7 after modeling, immunofluorescence staining was used to detect the expression levels of CD68 (clone ED-1), glial fibrillary acidic protein (GFAP), and neurofilament-200 (NF-200). Results: Starting from day 7, the BBB scores of the ADSCs-pGel group were higher than those of the SCI group (P<0.05). From day 14 onwards, the BBB scores of the ADSCs-pGel group were higher than those of the ADSCs group (P<0.05), and the BBB scores of the p-Gel group and ADSCs group were higher than those of the SCI group (P<0.05). The fluorescence expression levels of ED-1 and GFAP in all groups were significantly higher than those in the Sham group (P<0.001), but the fluorescence expression levels of ED-1 and GFAP in the ADSCs-pGel group were significantly lower than those in the p-Gel group and ADSCs group (P<0.01). The fluorescence expression level of NF-200 in all groups was significantly lower than that in the Sham group (P<0.001), but the fluorescence expression level of NF-200 in the ADSCs-pGel group was significantly higher than that in the p-Gel group and ADSCs group (P<0.001). Conclusion: Transplantation of ADSCs combined with RGD peptide-modified hydrogel to the SCI site can promote the recovery of motor function in the hindlimbs of rats, and the effect is more significant than the single application of ADSCs or RGD peptide-modified hydrogel.

The broad immune response of the central nervous system (CNS) includes innate immune response and adaptive immune response, involving a variety of immune effector cells. Hyperimmune-induced neuroinflammation is a key process in most neurological diseases, even more damaging than the primary damage. At present, the neuroimmunotherapy for CNS diseases mainly focuses on drugs. Electroacupuncture, has the characteristics of few side effects and high safety, and the therapeutic effect in the treatment of the CNS diseases has been confirmed, but the biological mechanism involved in the therapeutic effect is more complex. Starting from neuroinflammation induced by neuroimmune system activation, this paper summarizes the types of immune effector cells that play a major role in CNS diseases in recent years, describes the mechanism of immune cells, and discusses the molecular biological mechanism of how electroacupuncture can inhibit neuroinflammation by regulating the neuro-immune system and immune effector cells to treat diseases.

The mechanism of the occurrence and development of neonatal brain injury remains largely unknown, but the inflammatory damage has been recognized to play an important role. As an important receptor for the innate immune response, the Toll-like receptor-related signaling pathway is closely related to the activation of inflammation. Toll-like receptor family members TLR2, TLR3 and TLR4 could promote the expression of inflammatory cytokines through various mechanisms, thereby affecting the progression and prognosis of neonatal brain injury. The authors now review the research progress of TLR 2, TLR 3 and TLR 4 in neonatal brain injury, in order to provide help for the mechanistic understanding of the disease, and also provide some ideas and reference for the drug development of targeted Toll-like receptors that can be used in the treatment of neonatal brain injury.

目的：评估中性粒细胞与淋巴细胞比例（neutrophil-to-lymphocyte ratio，NLR）在预测急性脑梗死患者 发生出血转化（hemorrhagic transformation，HT）方面的潜在作用。方法：急性脑梗死患者1 077 例，在患者 入院后的首个24 h内采集血液样本分析NLR。根据是否有HT，将患者分为非HT组和HT组。采用单因素 分析来评估各项血液指标对脑梗死后HT的独立影响，并利用曲线拟合分析法专门评估NLR在预测急性脑 梗死患者HT中的诊断效能。结果：HT组NLR（6.50±6.70）较非HT组（4.73±3.8）明显升高（P＜0.05）。单因 素分析显示，NLR增加与梗死后HT呈正相关（OR=1.08，95%CI 1.02～1.14）。曲线拟合分析显示NLR与脑 梗死后HT发生线性相关。结论：NLR越高，急性缺血性卒中患者发生HT的风险越大。

目的：分析 2 例以神经系统症状为首发的血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura，TTP)的临床特点并文献复习，提高对这一疾病的认识。方法：收集2例因神经症状入住我院神经内 科的TTP患者的临床资料，包括临床表现、实验室检查、影像学特点及诊治经过，并且进行相关文献复习。 结果：病例1表现为五联征：微血管病性溶血性贫血、血小板减少、神经系统症状及体征、肾损害、发热，入院 诊断为急性脑梗死，因血小板减少会诊转血液内科完善检查，外周血涂片示破碎红细胞3%，ADAMTS13活 性检测为9.1%，普拉斯米克（PLASMIC）评分7分，诊断为TTP。病例2表现为三联征：微血管病性溶血性贫 血、血小板减少、神经精神异常，入院诊断为脑出血，因血小板减少会诊转血液内科完善检查，外周血涂片示 破碎红细胞3%，免疫抗体示抗U1-snRNP抗体弱阳性、抗SSA52抗体阳性、抗SSA60抗体强阳性、ANA-核 型(IIF)核颗粒型(1:1280)，ADAMTS13活性检测为2.2%，PLASMIC评分7分，诊断为TTP。2例患者均给予 甲泼尼龙联合血浆置换，以及对症支持治疗，病情好转。结论：TTP患者症状可表现多样化，特别是以神经 症状为首发的TTP患者初诊非常容易误诊。对于TTP可疑的患者，及时完善相关检查并且加强科室间相互 协作诊断，确诊后及时予以血浆置换能更好地缓解病情并且促进神经症状恢复。

目的：探讨脑源性神经营养因子（BDNF）Val66Met多态性与脑卒中腿部功能障碍患者经颅直流电刺 激（transcranial direct current stimulation，tDCS）治疗效果的联系。方法：研究受试者为2021年2月至2023年 3月期间因卒中后偏瘫康复治疗而入住本院的住院患者。所有患者接受相同疗程的tDCS治疗。在三个不 同阶段采用腿部Fugl-Meyer量表（Fugl-Meyer Assessment，FMA）、改良Barthel指数（modified Barthel index， MBI）对患者的腿部运动功能进行评估：治疗前、治疗后4周和治疗后8周。收集血样用于分析BDNF多态 性和检测BDNF、proBDNF水平。结果：在纳入分析的47例患者中，16例具有met等位基因的患者，纳入 Val66Met组，其余31例患者纳入Val66Val组。在治疗4周和8周后，Val66Val组的FMA、MBI评分明显高于 Val66Met组（P＜0.05）。2组FMA、MBI评分在治疗4周后显著高于治疗前（P＜0.05），并且在治疗8周后高 于治疗4周后（P＜0.05）。2组的血清成熟BDNF水平和成熟BDNF水平与总BDNF水平比率显示显著的 组-时间交互作用（F(组x时间)=4.62、7.43，P=0.037、0.009）。此外，Val66Val组在tDCS治疗后的血清成熟 BDNF水平和成熟BDNF水平与总BDNF水平比率显著高于Val66Met组（P＜0.05）。在Val66Val组中，观 察到tDCS治疗前后患者血清成熟BDNF水平变化与MBI、FMA评分呈显著正相关（r=0.539、0.585，均P＜ 0.001）。结论：tDCS 可显著促进卒中后偏瘫患者腿部运动功能的恢复，且在卒中恢复阶段 tDCS 对纯合 Val66Val携带者的治疗效果优于Val66Met多态性携带者。

To investigate the correlation between depressive state during the acute phase of ischemic stroke and cognitive/functional outcomes one year later. Methods: Clinical data were collected from patients with acute ischemic stroke (AIS) admitted to Wuhan Central Hospital and Tongji Hospital from June 2018 to June 2019. At discharge, the severity of post-stroke depressive state was assessed using the Center for Epidemiological Studies Depression Scale (CES-D). During a one-year follow-up, cognitive function was evaluated using the Mini-Mental State Examination (MMSE), and functional outcome was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression analysis was performed to examine the correlation between post-stroke depressive state (PSDS) and functional prognosis one year after stroke. Results: A total of 219 AIS patients were included and divided into PSDS and non-PSDS groups based on the presence of depressive state during the acute stroke phase. Baseline data analysis revealed significant differences in BMI and stroke type between the PSDS and non-PSDS groups (P<0.05). Multivariate logistic regression analysis indicated that compared to the non-PSDS group, the PSDS group had a significantly lower proportion of patients with cognitive impairment one year after stroke (P<0.001), while no statistically significant difference was observed between the two groups in the proportion of patients with good mRS prognosis. Conclusion: Depressive state during the acute phase of ischemic stroke is significantly associated with an increased risk of cognitive impairment one year after stroke but is not correlated with favorable functional outcome.

目的：报道1例获得性肝性脑部变性（acquired hepatocerebral degeneration，AHCD）的临床特点和诊治 经过。方法：对患者的临床表现、辅助检查、诊断及治疗进行分析。结果：老年女性患者表现出进行性双手 震颤3年，加重2月，震颤主要以持物、紧张时明显。既往有病因不明的肝功能损害。查体可见慢性肝病面 容，头部轻度左右震颤，双上肢姿势性震颤及意向性震颤，未见静止性震颤，四肢肌力正常，左下肢肌张力稍 增高，双侧腱反射对称活跃，双侧病理征未引出，双侧指鼻试验阳性，双侧跟膝胫试验阴性，闭目难立征阳 性，直线行走不能。完善相关辅助检查，肝脏彩超提示肝硬化，门脉高压；头部磁共振平扫提示双侧基底节 区对称性片状混杂稍短T1等T2信号，内见小片状长T1长T2高FLAIR 信号；头部磁敏感加权成像提示双侧基 底节区苍白球对称性顺磁性低信号。诊断AHCD，予以药物治疗两月后患者震颤和行走不稳等症状缓解不 明显，继续门诊随访中。结论：AHCD在临床并不罕见，临床表现特征显著，结合肝功能损害，诊断不易漏 诊。药物治疗AHCD的疗效不一，部分严重AHCD患者在行肝移植后临床症状改善明显。

To explore the clinical features of spinocerebellar ataxia type 3 (SCA3) characterized by tremor as the main feature, and to analyze a family with extrapyramidal signs such as tremor and peripheral neuropathy, providing a basis for clinical diagnosis. Methods: Ten SCA3 patients characterized by tremor were collected, including 4 from the same family. The clinical features, imaging, genetic testing, and drug responsiveness of 6 non-family patients, 4 familial patients, and their family members (5 cases) were summarized, along with a review of related literature. Results: Among the 9 patients in the family, 4 were diagnosed through genetic testing (ATXN3 gene CAG repeats 57～58 times, Sanger validation 60～62 times), and 5 were suspected patients. Among the 4 confirmed cases, 2 presented with tremor as the main symptom (postural/action tremor, exacerbated by activity), 1 was accompanied by bradykinesia and a history of epilepsy, and 1 had peripheral neuropathy. No significant atrophy was observed on brain MRI. Compared with typical SCA3 patients with CAG repeats 66～73 times (mainly ataxia), tremor symptoms were significant in this family, partially relieved by Madopar treatment. Conclusion: The clinical phenotype of SCA3 may be related to the number of CAG repeats (60～62 repeats mainly presenting as tremor/bradykinesia, 66～73 repeats mainly as ataxia). It is necessary to pay attention to the identification of atypical symptoms, with genetic testing being crucial for diagnosis.

To explore the correlation between suicidal attitudes and parental rearing styles in adolescents with depression who have engaged in suicidal behaviors, and to analyze related risk factors. Methods: A cross-sectional survey was conducted on 197 adolescent patients with depression hospitalized in the Department of Clinical Psychology at Jingmen People's Hospital from June 2020 to May 2023, who voluntarily participated in the study. Patients were divided into a suicidal group (115 cases) and a non-suicidal group (82 cases) based on whether they had engaged in suicidal behaviors in the past 6 months. Both groups were assessed using a general information questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Questionnaire on Suicide Atitude (QSA), and the Egna Minnen av Barndoms Uppfostran (EMBU). Group comparisons were made, and all variables were included in a multivariate Logistic regression model for analysis. Results: (1) The suicidal group was younger in age and had a higher rate of alcohol use than the non-suicidal group (both P<0.05). (2) QSA results showed that the suicidal group had lower scores than the non-suicidal group in attitudes toward suicidal behavior and toward suicide victims (P<0.01 and P<0.05, respectively), but higher scores in attitudes toward the families of suicide victims (P<0.01). There was no significant difference in attitudes toward euthanasia between the two groups (P>0.05). (3) EMBU results revealed that the total score of the suicidal group was significantly higher than that of the non-suicidal group (P<0.01). Specifically, the suicidal group scored lower on maternal emotional warmth (P<0.05) and higher on paternal and maternal overprotection, rejecting denial, and harsh punishment (P<0.01). Additionally, the suicidal group had higher scores on paternal overinterference (P<0.01). (4) Logistic regression analysis identified paternal harsh punishment and excessive interference as risk factors for suicidal behavior in adolescents with depression (P<0.05). Conclusion: Adolescents with depression have a high incidence of suicidal behaviors. Those who engage in suicidal behaviors tend to show understanding or approval of suicide and ambivalence toward the families of individuals who have attempted suicide. Their family education models often lack emotional support and involve excessive interference, punishment, and denial. Adolescents raised by fathers with overinterference, harshness, and punitive parenting styles are at greater risk of suicidal behavior.

To systematically review relevant literature in the field of cardiopulmonary rehabilitation in stroke patients from the Web of Science (WOS) core database using bibliometric methods, and to summarize the research hotspots and development trends. Methods: The WOS core database was searched for literature related to cardiopulmonary rehabilitation for stroke, with a search period from 2013 to 2023. Data analysis and visualization maps were created using VOSviewer 1.6.19, Cite Space 6.2.R3, and Scimago Graphica software. Results: A total of 1 635 articles were included, among which 1 272 (77.8% ) were original articles and 363 (22.2% ) were reviews. From 2013 to 2023, the number of publications in the field of cardiopulmonary rehabilitation for stroke showed an overall fluctuating upward trend, stabilizing in recent years. The country (region) with the highest number of publications was the United States (429 articles), the institution with the most publications was the University of Toronto (53 articles), and the author with the most publications was Marzolini S from the University of Toronto (25 articles). Conclusion: Current research hotspots focus on enhancing physical activity, methods for assessing cardiopulmonary function in stroke patients, the management of post-stroke patients through cardiopulmonary training, and the mechanisms of improving cognitive function.

Ischemic stroke is characterized by high morbidity and disability rates. Recent studies have revealed that trimethylamine N-oxide (TMAO), a metabolite derived from gut microbiota, promotes the initiation and progression of atherosclerosis, enhances platelet reactivity, and increases thrombotic risk. This review summarizes the current research progress on the role of TMAO in ischemic stroke.

Stroke is the leading cause of mortality and disability in China. Post-stroke anxiety (PSA) and post-stroke depression (PSD) are common psychiatric sequelae after stroke, significantly reducing patients’quality of life, impairing physical and mental health, and hindering functional recovery. Current research suggests that the pathophysiology primarily involves biological mechanisms and psychosocial factors. Treatment strategies predominantly rely on pharmacotherapy, complemented by physical therapies and psychological interventions. This review summarizes recent advances in the mechanisms and treatment of PSA and PSD, aiming to provide a reference for future research.

The gut microbiota (GM), as a complex ecosystem, exerts influences on human body structure, endocrine levels, metabolic capacity, nervous system, and immune function. It has been discovered that the diversity of GM decreases dramatically with ageing, and even undergoes harmful transformations in functional structure, jeopardizing the health of elderly individuals. Since GM is modifiable, this review systematically analyzes research progress on the role of GM in elderly endocrinology, skeletal muscle systems, cognitive-psychological functions, neurological disorders, and viral infections, while exploring underlying mechanisms. The objective is to investigate novel therapeutic approaches and potential targets for age-related diseases, and to provide references for future GM-omics studies.

To explore the efficacy and safety of right-sided low-frequency repetitive transcranial magnetic stimulation (rTMS) in treating depression comorbid with anxiety in elderly patients. Methods: A total of 72 elderly patients with depression comorbid with anxiety, hospitalized in the Department of Psychiatry of Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2021 to June 2021, were selected and randomly divided into a control group (35 cases) and a low-frequency group (37 cases) using a random number table. Both groups received antidepressant medication. Additionally, the low-frequency group was treated with rTMS (1.0 Hz) on the right dorsolateral prefrontal cortex, 20 minutes per session, once daily, five times per week, for a total of 20 sessions over 4 weeks. The control group received sham stimulation with the same duration and frequency. The Hamilton Depression Rating Scale-24 (HAMD-24) and the Hamilton Anxiety Rating Scale-14 (HAMA-14) were used to evaluate anxiety and depression symptoms and treatment efficacy at baseline and at the end of weeks 1, 2, 3, 4, 6, and 8. Adverse reactions were recorded, and repeated measures ANOVA was used to compare the scores of anxiety and depression between the two groups at different time points. Results: The main effects of time, group, and time-group interaction for HAMD-24 and HAMA-14 scores were statistically significant (P<0.05). Further analysis showed that HAMD-24 scores in both groups were significantly lower than baseline at weeks 1, 2, 3, 4, 6, and 8 (P<0.01). There was no significant difference in HAMD-24 scores between the two groups at weeks 1, 2, 3, and 4 (P>0.05), but the low-frequency group had significantly lower HAMD-24 scores than the control group at week 6 (P<0.01) and week 8 (P<0.05). For HAMA-14 scores, both groups showed significant reductions compared to baseline at weeks 1, 2, 3, 4, 6, and week 8 (P<0.01). The low-frequency group had significantly lower HAMA-14 scores than the control group at weeks 1 and 2 (P<0.05) and at weeks 3, 4, 6, and 8 (P<0.01). After 4 weeks of treatment, the overall response rate in the low-frequency group was higher than that in the control group (P<0.05). After 6 weeks, the marked improvement rate in the low-frequency group was significantly higher (P<0.05), but there was no significant difference in marked improvement rates between the two groups after 8 weeks (P>0.05). No severe adverse reactions were observed in either group. Conclusion: Combined antidepressant and right-sided rTMS therapy effectively alleviates both depressive and anxiety symptoms in elderly patients with comorbid depression and anxiety, demonstrating superiority to antidepressant medication alone while maintaining a favorable safety profile.

To evaluate the proportion of intraplaque hemorrhage (IPH) and its clinical correlation in patients with atherosclerotic stenosis of the middle cerebral artery (MCA) using high-resolution magnetic resonance vessel wall imaging (HRMR-VWI). Methods: We collected clinical and imaging data from patients with moderate to severe stenosis (50%～99%) of the MCA-M1 or M2 segments treated in our hospital from July 2019 to August 2023. IPH was defined as T1 hyperintensity on fat-saturated HRMR-VWI images, with signal intensity>150% of the surrounding muscle tissue. Patients were divided into symptomatic stenosis and asymptomatic stenosis groups based on the presence of ischemic symptoms within the MCA territory within 3 months. The symptomatic stenosis group was further subdivided into artery-to-artery embolism and non-artery-to-artery embolism subgroups according to DWI characteristics. Clinical and imaging data were compared among groups and subgroups. Results: A total of 59 patients were included in the analysis, of whom 14(23.7% ) had IPH in the MCA stenosis lesions. The symptomatic stenosis group comprised 30 patients (50.8%), and the incidence of IPH in symptomatic stenosis patients was 11/30(36.7%), significantly higher than that in asymptomatic stenosis patients [3/29(10.3%)], with a statistically significant difference (P=0.018). Among symptomatic stenosis patients, 11(36.7% ) had artery-to-artery embolism, of whom 7/11(63.6% ) had IPH, a significantly higher incidence than in non-artery-to-artery embolism patients (4/19, 21.1% ), with a statistically significant difference (P=0.047). No significant differences were observed for other factors between the two groups and two subgroups (all P>0.05). Conclusion: The proportion of IPH is higher in symptomatic MCA moderate to severe stenosis patients compared to asymptomatic patients. Moreover, within the symptomatic group, patients with embolic infarction have a higher incidence of IPH. This finding is significant for evaluating the infarction mechanism and stroke risk in MCA stenosis patients.

To improve clinicians' diagnostic and therapeutic skills for neurobrucellosis (NB) and enhance patient outcomes. Methods: Clinical data of 4 patients with NB diagnosed at Beijing Ditan Hospital, Capital Medical University, from January 2024 to September 2024 were retrospectively analyzed. Results: All 4 patients had a clear epidemiological history. Clinical manifestations included meningitis, myelitis, and other neurological symptoms. Lumbar puncture was performed in all cases. Cerebrospinal fluid (CSF) analysis revealed elevated pressure in 3 patients, increased white blood cell counts in all 4, elevated protein levels in all 4, and reduced glucose levels in 3. Serum Brucella agglutination tests were positive in all patients, and CSF Brucella agglutination tests were positive in 3. All patients received triple or quadruple anti-Brucella therapy based on rifampicin and doxycycline. Conclusion: Neurobrucellosis presents with complex and diverse clinical features. Early detection and diagnosis are critical for improving prognosis, while delayed diagnosis leads to poor outcomes and potential long-term sequelae.