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 propose a convenient and highly reproducible method for repeat collection of rat cerebrospinal fluid (CSF) samples. Methods: Twenty-five SD rats were randomly divided into control group and experimental group. After anesthesia, the rats in the experimental group were positioned with their heads at an angle of 45° to 90° relative to their bodies. A needle was inserted at the center point between the occipital protuberance and the first cervical vertebra, with the needle tip directed toward the head and inserted slowly parallel to the curve of the rat's head, reaching a depth of approximately 5 mm. CSF was then slowly aspirated, and the sample volume was recorded. Comprehensive assessments were conducted by observing changes in rat body weight and Bederson scores, as well as through Evans blue staining and hematoxylin and eosin (HE) staining, and by measuring interleukin-6 (IL-6) levels in the CSF. Results: In the experimental group, successful first-time sampling was achieved in 14 rats (70.0% ) with a sample volume of (93.30±13.33) μL. Successful consecutive second-time sampling was achieved in 10 rats (50.0%) with a sample volume of (93.00± 19.86) μL. Successful consecutive third-time sampling was achieved in 8 rats (40.0%) with a sample volume of (89.75±7.72) μL. Rats in the group with successful consecutive three-time sampling showed an increase in body weight of (47.6±1.51) g, which was not statistically significant compared to the control group (P>0.05). The Bederson scores of the rats in the experimental group were all 0, indicating no significant neurological deficits. No obvious Evans blue staining or morphological changes in brain tissue were observed. The IL-6 levels in the CSF samples collected during the three samplings were (28.98±4.70) pg/mL, (29.37±6.06) pg/mL, and (30.06± 5.47) pg/mL, respectively, with no statistically significant differences among the three collections (P>0.05). However, an increase in IL-6 levels was observed in CSF samples successfully collected after an initial failed attempt (P<0.05). Conclusion: The method of percutaneous cerebellomedullary cistern puncture for CSF collection requires simple equipment, has a short operating time, can be performed by a single individual, and causes minimal trauma to the animals.

Alzheimer's disease (AD), commonly observed in the elderly, manifests clinically with symptoms such as memory decline and neuropsychiatric abnormalities. The pathogenesis of AD remains unclear to date, as the various existing hypotheses fail to fully account for all the disease characteristics of AD. Microglia, specialized macrophages in brain tissue, monitor the health of surrounding neurons and glial cells, exhibiting both neuroprotective and neurotoxic effects. Recent in-depth research on AD has revealed that microglia participate in the pathogenesis of AD through the triggering receptor expressed on myeloid cells 2 (TREM2). Loss of TREM2 function exacerbates the progression of AD. This article reviews the role of TREM2 and its mutants in mediating microglial functional alterations during the occurrence and development of AD.

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.

The importance of the cholinergic system in the central nervous system lies in its regulatory role in cognitive functions, particularly in higher cognitive processes such as attention, memory, and learning. Cholinergic projection neurons from the basal forebrain regulate the activity of brain regions such as the hippocampus and prefrontal cortex through the release of acetylcholine. Research has shown that dysfunction of the cholinergic system is closely associated with various neurodegenerative diseases. In these diseases, degeneration of basal forebrain cholinergic neurons and the dysregulation of acetylcholine synthesis and transport are considered key contributors to cognitive impairments. Recent therapeutic strategies based on the cholinergic system for neurodegenerative diseases have shown certain therapeutic effects. Therefore, this paper primarily explores the impact of cholinergic system dysfunction on the development and progression of neurodegenerative diseases, aiming to deepen the understanding of the mechanisms underlying cholinergic system function and to provide more precise therapeutic approaches for neurodegenerative disorders.

The vestibular system not only plays a role in maintaining body balance and orientation but may also affect sleep quality and duration. Sleep, in turn, may be related to the effective repair of vestibular nerves, and vestibular-related structures or functions can change in cases of sleep disorders. The interaction between the vestibular system and sleep has increasingly attracted attention. In recent years, scholars at home and abroad have conducted research on the mutual influence and related mechanisms between the vestibular system and sleep, achieving certain progress. This article reviews the recent research progress on the interaction and mechanisms between vestibular disorders and sleep disorders, aiming to provide better guidance for the diagnosis, treatment, and effectiveness evaluation when vestibular system diseases coexist with sleep disorders.

Acute ischemic stroke (AIS) ranks as the leading cause of disability and mortality among Chinese residents, posing severe challenges to societal economic development and public health. Mechanical thrombectomy, as a rapidly evolving treatment method in recent years, has gained global recognition for its efficacy. This article summarizes three major aspects: recent research on select indications within mechanical thrombectomy, comparisons of effectiveness and safety between direct thrombectomy and bridging therapy, and failures in mechanical thrombectomy due to anatomical access challenges.

To monitor the cerebral cortical activation in healthy subjects and stroke patients during walking under virtual reality (VR) environment in real-time using functional near-infrared spectroscopy (fNIRS), and to preliminarily explore the changes in brain activity of stroke patients under VR gait rehabilitation training. Methods: A total of 17 stroke patients and 17 healthy volunteers were recruited and assigned to the stroke group and the control group, respectively. The Berg Balance Scale (BBS) was used to assess the balance function of the subjects, and the Timed Up and Go Test (TUGT) was used to evaluate their walking function. The fNIRS was employed to collect data on the concentration of oxyhemoglobin (HbO) in the brain regions of the two groups of subjects at rest, during stepping in a general environment, and during stepping in a VR environment. The correlation between the significantly activated channels in the brain regions of the two groups and the scores of BBS and TUGT was analyzed. Results: (1) At rest, compared with the control group, the stroke group had a lower HbO concentration in the left sensorimotor cortex (P< 0.05) and a higher HbO concentration in the right sensorimotor cortex (P<0.05). (2) During the general stepping task, the activation of the right motor cortex decreased in stroke patients (P<0.05), while the activation of the left sensory cortex increased (P<0.05). In the VR stepping task, the activation of the left prefrontal cortex increased in stroke patients (P<0.05). (3) Spearman correlation analysis of the channels with significant differences in brain region activation between the two groups and the total scores of Berg and TUGT scores showed that in the VR stepping task, the activation of the prefrontal cortex (ch9) was negatively correlated with the total scores of Berg (r=－0.521, P=0.003), and positively correlated with the TUGT scores (r=0.434, P=0.017). Conclusion: The mechanism by which VR affects the walking function of stroke patients may be related to changes in the activation of the prefrontal cortex.

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。

Microglia are very important immune cells, which are widely distributed in the central nervous system. They continuously monitor and sense the surrounding microenvironment, balancing the body's immune response by releasing various cellular inflammatory factors on the one hand, and regulating neural network function through phagocytosis of synapses and cells on the other. Dysfunction of microglia is a primary mechanism involved in the onset or exacerbation of neurodegenerative diseases, thus restoring microglial function may represent a potential therapeutic modality. CD22, an important member of the sialic acid-binding immunoglobulin-like lectin family, is typically expressed on the surface of B cells and serves an immunoinhibitory role. Recently, CD22 has been shown to improve cognitive function in aged mice through microglia, a discovery that holds promise for CD22 to become a novel target in the treatment of neurodegenerative diseases.

To investigate the impact of oral antiplatelet medication administration prior to onset on the efficacy and safety of rt-PA intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods: A retrospective analysis was conducted on 209 AIS patients who underwent rt-PA intravenous thrombolysis at Puren Hospital Affiliated to Wuhan University of Science and Technology between January 2020 and January 2023. Based on whether the patients had taken oral antiplatelet medication within 24 hours before onset, they were divided into two groups: the antiplatelet group (53 patients who were taking antiplatelet medication before thrombolysis) and the non-antiplatelet group (156 patients who did not take antiplatelet medication). The National Institutes of Health Stroke Scale (NIHSS) was used to assess the short-term efficacy before thrombolysis, at 24 hours post-thrombolysis, and at 7 days post-thrombolysis. The modified Rankin Scale (mRS) at 90 days post-thrombolysis was used to evaluate long-term prognosis. The incidence of bleeding at various sites and mortality rates were recorded to assess treatment safety. Results: There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). In the antiplatelet group, the good prognosis rates at 24 hours and 7 days post-thrombolysis were 49.1% (26/53) and 75.5% (40/53), respectively. In the non-antiplatelet group, the corresponding rates were 41.7% (65/156) and 72.4% (113/156). The excellent prognosis rate at 90 days was 54.7% (29/53) and the good prognosis rate was 75.5% (40/53) in the antiplatelet group, compared to 59.0% (92/156) and 80.8% (126/156) in the non-antiplatelet group. There were no statistically significant differences in short-term efficacy and long-term prognosis between the two groups after thrombolysis (P>0.05). The incidence of bleeding was 15.1% in the antiplatelet group and 11.5% in the non-antiplatelet group, while the mortality rates were 5.7% and 1.9%, respectively. There were no statistically significant differences in bleeding incidence and mortality between the two groups (P>0.05). Multivariate Logistic regression analysis showed that the NIHSS score before thrombolysis was a risk factor for long-term prognosis in AIS patients (OR=1.293, 95% CI 1.181～1.415, P<0.001). History of antiplatelet medication use was not associated with long-term prognosis or bleeding in AIS patients (OR=1.182, 95% CI 0.505～2.765, P=0.700). Conclusion: The history of oral antiplatelet medication has no significant impact on the clinical efficacy of intravenous thrombolysis in AIS patients and does not increase the risk of bleeding or mortality after thrombolysis.

To conduct a systematic review of qualitative studies on rehabilitation barriers in stroke patients during the rehabilitation phase. Methods: A computer-based search was conducted in Embase, Web of Science, CINAHL, PubMed, Wanfang Database, and CNKI Database, with a cutoff date of September 9, 2023. Results: This systematic review included 22 articles that met the criteria and ultimately categorized into 4 themes and 13 subcategories. Conclusion: It systematically integrates the multi-level barriers encountered by stroke survivors during their rehabilitation process.

To investigate the risk factors for recurrence of intracranial aneurysms (IAs) after stent-assisted coiling (SAC). Methods: Total 446 patients with a total of 486 aneurysms who underwent SAC treatment and completed digital subtraction angiography (DSA) follow-up at our institution between January 2014 and December 2023 were enrolled. Based on imaging follow-up results, the aneurysms were categorized into a recurrence group (n=38) and a stable group (n=448). Demographic, clinical, surgical, and morphological characteristics were analyzed using Logistic regression. Variables with significance in univariate analysis were included in a multivariate Logistic regression using a stepwise forward method to identify independent risk factors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to assess the predictive performance of the independent risk factors. Results: Independent risk factors for recurrence after SAC included neck (P<0.001, OR=1.287), size ratio (P<0.001, OR=1.877), Raymond scale II or III (P=0.034, OR=2.304), and Ruptured aneurysms (P=0.010, OR=3.058). The AUC values for neck size, size ratio, Raymond Class II or III, and ruptured aneurysms were 0.807, 0.797, 0.636, and 0.567, respectively. Conclusion: Neck, size ratio, Raymond grade II or III, and ruptured aneurysms are significant risk factors for recurrence following SAC of IAs.

目的：探讨莫旺综合征的临床特点、治疗及预后。方法：报道我院2例莫旺综合征并结合文献进行回 顾性分析。结果：2例中年男性患者均表现为全身发麻、烧灼感、肉跳，多汗，失眠、焦虑；肌电图可见较多束 颤电位、F波可见M波后放电位，血清电压门控钾离子通道(VGKC)复合物抗体阳性。搜索既往的莫旺综合 征 89 例，男多于女，平均年龄 53 岁，最主要临床表现肌束颤动、肌颤搐、肌痉挛和肌强直（100%），多汗 （92.1%）；90.6%患者被肌电图证实有异常自发活动、束颤电位、纤颤电位、F波后M波后放电位；25.8%患者 脑电图 REM期异常；血清抗体CASPR2抗体阳性多于 LGI1抗体阳性，有12.4%患者两种抗体同时存在。 结论：莫旺综合征是一种极少见的自身免疫性疾病，患者周围神经、自主神经、中枢神经系统过度兴奋症状 结合肌电图和血清抗体的检测可以尽早进行诊断和鉴别。

To analyze the influencing factors of ineffective treatment with lamotrigine combined with sodium valproate in patients with post-stroke epilepsy. Methods: The clinical data were collected from 269 patients with post-stroke epilepsy in the Zhongnan Hospital of Wuhan University between March 2020 and April 2023. According to curative effect of lamotrigine combined with sodium valproate, patients were divided into effective group (n=215) and ineffective group (n=54). Among them, 219 cases were randomly selected as the training set and the other 50 cases were selected as the verification set. The patients in effective group and ineffective group were matched by propensity score matching method. In data set of balanced covariates, influencing factors of the curative effect were analyzed by Logistic regression model. The prediction model for the curative effect was constructed, and its predictive efficiency was evaluated by receiver operating characteristic (ROC) curves. Results: In the 219 patients with post-stroke epilepsy after 1 ∶ 1 propensity score matching method, there were 42 pairs of patients with successful matching, and the data such as age, gender, underlying diseases, smoking history and drinking history were basically balanced. The proportions of NIHSS score >14 points and monthly onset frequency ≥4 times, levels of homocysteine and uric acid in effective group were lower than those in ineffective group (P<0.05). The results of Logistic regression analysis showed that NIHSS score >14 points, monthly onset frequency ≥4 times and high level of homocysteine were independent influencing factors of ineffective treatment (P<0.05). The prediction model was as follow: P=e X /(1+e X ), X=－8.423+0.532×NIHSS score +0.575× monthly onset frequency +0.436× homocysteine. Hsomer-Lemeshow goodness-fit test showed that there was no significant difference between predicted value of the model and the actual observed value (P>0.05). Internal verification of the prediction model showed that AUC, sensitivity and specificity were 0.818, 78.57% and 73.81%, respectively (P<0.05). External verification of the prediction model with validation set data showed that AUC, sensitivity and specificity were 0.815, 62.50% and 88.10%, respectively. Conclusion: NIHSS score >14 points, monthly onset frequency ≥4 times and high level of homocysteine are independent influencing factors of ineffective treatment with lamotrigine combined with sodium valproate. The prediction model has good predictive efficiency for the curative effect.

To explore the clinical characteristics of recurrence in pediatric epilepsy after treatment and analyze the electroencephalogram (EEG) features during the interictal period in epileptic children. Methods: A retrospective analysis was conducted on 168 pediatric patients with epilepsy admitted to our hospital. The patients were divided into a recurrence group (n=64) and a non-recurrence group (n=104) based on follow-up results. A multivariate Logistic regression model was used to analyze the independent influencing factors of prognosis recurrence in the patients, as well as the correlation between EEG parameters and clinical characteristics of epilepsy recurrence. A Bayesian network was employed to construct a prediction model for epilepsy recurrence in the patients. The Kaplan-Meier survival curve model was utilized to draw the cumulative recurrence curve during the follow-up period and analyze the recurrence situation of the patients during the follow-up. Results: Male gender, neurological dysfunction, sleep disorders, time to effective control exceeding one year, seizure frequency exceeding five times per year, MRI showing intracranial lesions, negative FAT1 expression, and anxiety were identified as independent risk factors for recurrence in the patients (P<0.05). Independent protective factors for recurrence included no seizure for at least five years before medication reduction, medication reduction duration exceeding six months, age of onset between 3 and 14 years, and α, θ, and δ bands after medication withdrawal (P<0.05). The α, θ, and δ waves were lower in the recurrence group compared to the non-recurrence group after medication withdrawal (P<0.05). There was a significant positive correlation between medication reduction duration and the frequencies of α, θ, and δ bands (P<0.05), while sleep disorders, time to effective control, seizure frequency, and neurological dysfunction were significantly negatively correlated with the frequencies of α, θ, and δ bands (P<0.05). Most recurrences occurred within 24 months after treatment. Conclusion: Male gender, neurological dysfunction, sleep disorders, time to effective control exceeding one year, seizure frequency exceeding five times per year, MRI showing intracranial lesions, negative FAT1 expression, and anxiety are independent risk factors for recurrence in pediatric patients with epilepsy. Independent protective factors for recurrence include no seizure for at least five years before medication reduction, medication reduction duration exceeding six months, age of onset between 3 and 14 years, and α, θ, and δ bands after medication withdrawal.

目的：探究急性颅内大血管闭塞患者临床特征及血管造影闭塞端形态的病因学预测价值。方法：回 顾性分析2020年7月至2023年4月张家界市人民医院神经外科收治接受机械取栓治疗的92例急性颅内大 血管闭塞患者的临床资料和脑血管造影闭塞端图像特点。根据病因将患者分为颅内动脉粥样硬化性闭塞 (intracranial atherosclerotic disease-related occlusion，ICAD-O)组和栓塞性闭塞(embolic occlusion，EMB-O) 组，比较2组患者临床资料和脑血管造影闭塞端图像特点。针对有显著差异的临床特征绘制受试者工作特 征（receiver operating characteristic，ROC）曲线分析其预测 ICAD-O、EMB-O 的价值。结果：92 例患者中， ICAD-O组49例，EMB-O组43例。ICAD-O组楔形征45例，非楔形征4例；EMB-O组楔形征5例，非楔形征 38例。2组患者性别差异无统计学意义（P＞0.05），年龄、房颤、栓塞部位、闭塞端形态差异均有统计学意义 （均P＜0.05）。ROC曲线结果显示，年龄、房颤、闭塞端形态可以预测ICAD-O和EMB-O（均P＜0.05），栓塞 部位无法预测 ICAD-O 和 EMB-O（P＞0.05），其中楔形征预测 ICAD-O 的敏感度、特异性分别为 91.8%、 88.4%，非楔形征预测EMB-O的敏感度、特异性分别为88.4%、91.8%。结论：年龄、房颤、血管造影闭塞端形 态可以帮助术者及时预测ICAD-O和EMB-O，有助于最佳干预策略的制定。

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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。

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.

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.

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.

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。

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.