Treatment of neurosurgical intensive care patients infected with multidrug resistant (MDR) or extensive drug resistant (XDR) Acinetobacter baumannii presents significant challenges and is associated with high mortality rates. Sulbactam has long been an effective treatment for MDR Acinetobacter baumannii, particularly due to its ability to penetrate the inflamed blood-brain barrier, making it highly suitable for use in severe neurosurgical cases. However, in recent years, increasing resistance to sulbactam among Acinetobacter baumannii strains has become a concern. There is a lack of standardized guidelines regarding the dosage, administration methods, routes and combination therapy strategies for sulbactam in the treatment of these resistant infections. Thus, Chinese Neurosurgical Intensive Care Management Collaborative Group has developed the "Chinese expert consensus on the use of sulbactam to treat patients infected with Acinetobacter baumannii in the neurosurgical intensive care unit", through a thorough review of relevant evidence-based medical literature and extensive discussion and revision. This consensus includes 28 recommendations aimed at providing scientific and feasible clinical guidance for the application of sulbactam in the management of neurosurgical intensive care patients.

Several anti-Aβ monoclonal antibody drugs have been approved for clinical use at home and abroad recently. In order to facilitate its safe and effective treatment of anti-Aβ monoclonal antibody drugs for Alzheimer's disease (AD) in China, we present recommendations for the clinical use of anti-Aβ monoclonal antibody drugs based on existing clinical trials and the clinical practice of AD treatment with Aducanumab at Ruijin Hospital Hainan Branch, Shanghai Jiaotong University School of Medicine. The recommendations include clinical indications, pre-medication assessment and preparation, medication instructions and precautions, as well as post-medication clinical monitoring, which is aimed to furnish clinicians with comprehensive medication guidance.

Brain and heart comorbidity is one of the major public health problems in China, which seriously threatens national health. After many years of exploration, the concept of "synchronous treatment for brain and heart" has become more and more accepted. This article summarizes the pathophysiological mechanism of brain-heart interaction, the clinical and research practice of the theory of "synchronous treatment for brain and heart", and its future development direction, and jointly help the diagnosis and treatment of brain and heart comorbidity.

Lipid metabolism may play a role in the onset and progression of Parkinson's disease (PD), involving various pathological mechanisms such as abnormal folding and accumulation of α-synuclein (α-Syn), ferroptosis, GBA1 gene mutation, and mitochondrial dysfunction, etc.. This article reviews the lipid metabolism abnormalities associated with Parkinson's disease and explores potential related pathophysiological mechanism, aiming to provide new insights into the early diagnosis and treatment of Parkinson's disease.

Gait disorder is one of common motor symptoms in patients with Parkinson's disease (PD), significantly affecting their quality of life and mobility. Robot - assisted gait training (RAGT) can improve the motor symptoms of PD patients, particularly in terms of lower limb motor function. It corrects abnormal spatiotemporal parameters of gait, such as gait velocity, step length, and step frequency, reduces the occurrence of freezing of gait, improves endurance, enhances balance ability, and ultimately improves quality of life. This paper focuses on the classification and construction, clinical efficacy and mechanism of exoskeleton robot, which can be used to guide the rehabilitation treatment of PD.

The heart and brain are important organs of human body, which are closely related in genetic, structural and functional aspects. It is of great significance to elucidate the correlation between heart and brain and its mechanism for prevention and treatment of cardiovascular and cerebrovascular diseases. This paper reviews the genetic, structural and functional correlations between heart and brain, and discusses mechanisms of correlations from the perspective of common clinical heart diseases and brain diseases, so as to provide theoretical basis for the research and treatment of brain and heart comorbidity.

Atherosclerosis, a chronic inflammatory disease of the arterial wall, serves as the pathophysiological basis for ischemic stroke and coronary heart disease, and stands as the primary cause of cardiovascular and cerebrovascular comorbidity. Both the heart and brain share similar risk factors, including hypertension, hyperlipidemia and diabetes, and so on. Furthermore, most patients with cardiovascular and cerebrovascular comorbidity experience more severe disease and poorer prognosis. This article comprehensively reviews research progress in the pathophysiology of cardiovascular and cerebrovascular comorbidity, their related risk factors, and proposes the strategies of "synchronous treatment for brain and heart" to offer new insights for the prevention and management of cardiovascular and cerebrovascular comorbidity.

Alzheimer's disease (AD) is the most common type of dementia in the elderly. The ApoE ε4 gene is the main genetic risk factors for sporadic AD, and is associated with the changes in the amyloid β-protein (Aβ) and tau protein, the core pathological features of AD. ApoE ε4 has great potential as a genetic biomarker for AD. Clinical studies have shown the important role of peripheral blood ApoE ε4 in AD risk assessment and disease detection. But in the current clinical practice, there are many weak points of insufficient understanding and insufficient attention about the clinical use of ApoE ε4. The importance of ApoE ε4 is highlighted especially with the development of high-quality clinical drug trials or the arrival of clinical drug therapy targeting Aβ for AD. So far, there is still a lack of Chinese expert consensus on the standardized application of ApoE ε4 in AD. Given that, this article systematically summarizes the current domestic and international research on the application of ApoE ε4 in AD. The consensus is written and aimed to fully reflect the clinical application value of ApoE ε4 in AD, and improve the diagnosis and treatment level of AD, and guide further clinical research.

Objective: To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV-1) encephalitis. Methods: A total of 51 patients with HSV-1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV-1 encephalitis. Results: The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV-1 encephalitis patients. Conclusions: Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV-1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV-1 encephalitis, so as to achieve early detection, diagnosis and treatment.

Objective: To analyze the clinical characteristics of anti-neuronal antibody positive paraneoplastic neurological syndrome related to immune checkpoint inhibitors (ICI-PNS). Methods and Results: A total of 5 patients with anti-neuronal antibody positive ICI-PNS in Peking Union Medical College Hospital from January 2012 to March 2024 were included. Tumor types included small cell lung cancer (2 cases), malignant melanoma (one case), Hodgkin lymphoma (one case) and cervical cancer (one case). Immune checkpoint inhibitors (ICIs) included programmed death 1 (PD-1) inhibitors (3 cases), programmed cell death ligand 1 (PD-L1) inhibitors (one case) and bispecific PD-1/cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors (one case). All 5 patients presented with high-risk neurologic phenotypes of paraneoplastic neurological syndrome (PNS), of which 4 presented with limbic encephalitis and one presented with rapidly progressive cerebellar syndrome. Anti-neuronal antibodies detected in serum and/or cerebrospinal fluid of patients included anti-Hu, γ-aminobutyric acid receptor type B (GABA_BR), sex-determining region of Y chromosome-related high mobility group box 1 (SOX1), metabotropic glutamate receptor 5 (mGluR5) and Yo antibodies. Neurological syndromes occurred within 2 weeks after receiving ICIs in 4 patients. The modified Rankin Score (mRS) of 4 patients was 3 at peak of illness, and one patient was 5 at peak of illness. The Common Terminology Criteria for Adverse Events (CTCAE) was grade 3 in all 5 patients. After withdrawal of ICIs and treatment with glucocorticoids and intravenous immunoglobulin (IVIg), the neurological symptoms of the patients were improved. Conclusions: High/intermediate-risk anti-neuronal antibodies are diagnostic markers of ICI-PNS. Evaluation of ICI-PNS clinical phenotypes and CTCAE grading are important for immunotherapy. Discontinuation of ICIs, administration of glucocorticoids and IVIg can improve the prognosis of patients.

Objective: To investigate the rehabilitation effects of vestibular rehabilitation in acute brainstem infarction patients with subjective visual vertical (SVV) tilting, and the correlation between the SVV, balance confidence, dizziness/vertigo and walking function. Methods: All 45 acute brainstem infarction patients with SVV tilting who were hospitalized in Tianjin Huanhu Hospital from July 2022 to July 2023 were collected. Patients were divided into vestibular rehabilitation group (n = 25) and general rehabilitation group (n = 20), Bucket Test was used to test SVV tilting angle, Activities - Specific Balance Confidence Scale (ABC) was used to evaluate balance confidence, Visual Analog Scales (VAS) was used to evaluate dizziness/vertigo and Functional Ambulation Category Scale (FAC) was used to evaluate walking function before and after 2 weeks of treatment. Results: The SVV tilting angle (F = 4.356, P = 0.043), ABC score (F = 4.389, P = 0.042), dizziness/vertigo VAS score (F = 4.138, P = 0.048) were significantly different between vestibular rehabilitation group and general rehabilitation group. After treatment, the SVV tilting angle (t = - 2.139, P = 0.038) and the dizziness/vertigo VAS score (t = - 2.952, P = 0.005) in vestibular rehabilitation group were lower than those in general rehabilitation group, and the ABC score was higher than that in general rehabilitation group (t = 2.920, P = 0.006). SVV tilting angle (F = 196.923, P = 0.000), ABC score (F = 89.050, P = 0.000), dizziness/vertigo VAS score (F = 81.803, P = 0.000), FAC grade (F = 72.866, P = 0.000) were statistically significant. The SVV tilting angle (t = 0.763, P = 0.000; t = 0.972, P = 0.000) and dizziness/vertigo VAS score (t = 8.815, P = 0.000; t = 5.107, P = 0.000) after treatment were lower than those before treatment of 2 groups, and the ABC score (t = 0.689, P = 0.001; t = 0.703, P = 0.001) and FAC grade (t = - 6.721, P = 0.000; t = - 5.772, P = 0.000) were higher than those before treatment of 2 groups. Correlation analysis showed a positive correlation between SVV tilting angle and dizziness/vertigo VAS score in acute brainstem infarction patients with SVV tilting (r = 0.627, P = 0.000). Conclusions: Vestibular rehabilitation can effectively improve the SVV tilting, balance confidence and dizziness/vertigo symptoms of acute brainstem infarction patients with SVV tilting, and the SVV tilting angle is closely related to the degree of dizziness/vertigo.

The concomitant of brain and heart diseases has progressively garnered the attention of neurosurgeons and cardiovascular surgeons, who have initiated synchronous surgical treatment for brain and heart. The concept of "pan-vascular medicine" advocates a research model and development philosophy that fosters interdisciplinary collaboration and integration. The principles of "pan-vascular medicine" serve as a crucial guiding force for the synchronous surgical treatment for brain and heart, while the latter enhances the completeness and depth of the former's theoretical framework. Presently, we persist in designing specific surgical interventions based on atherosclerosis diseases. In the future, synchronous surgical treatment for brain and heart will transcend the conventional boundaries of concurrent carotid and coronary artery surgery, and evolve towards a development axis centered on vascular reconstruction. This will thereby expand the scope of the "pan-vascular medicine" concept from a surgical standpoint.

Cardiovascular and cerebrovascular diseases are homologous diseases and can be comorbidities. Atherosclerosis is the pathological basis of the comorbidities of cardiovascular and cerebrovascular diseases. In recent years, with the improvement of surgical technique and the progress of drug intervention, the synchronous surgical treatment for brain and heart of cardiovascular and cerebrovascular diseases can improve clinical outcome. This article reviews the synchronous surgical treatment for brain and heart of cardiovascular and cerebrovascular diseases, in order to provide theoretical basis and clinical guidance for the cardiovascular and cerebrovascular diseases.

Postural disorder is a common disabling movement complication of Parkinson's disease (PD), in which camptocormia is the most common disabling postural disorder, which further aggravates the movement disorder of PD, and seriously reduces the activities of daily living and quality of life of patients. This paper reviews the pathogenesis and treatment progress of PD with camptocormia, providing theoretical basis for further investigation of the pathogenesis of camptocormia in PD, and assisting the clinical diagnosis and treatment of the disease.

Objective: To analyze relationship between autonomic nervous function function in elderly patients with Parkinson's disease (PD). Methods: A total of 130 elderly patients with PD admitted to The Affiliated Brain Hospital of Nanjing Medical University from January 2020 to December 2022 were included. Hoehn-Yahr staging was used to evaluate stage of the disease, Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) was used to evaluate the severity of motor disorders, Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) was used to evaluate autonomic nervous function, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function, Non-Μotor Symptoms Scale (NMSS) was used to evaluate the severity of non-motor symptoms. Results: According to whether the patients were accompanied by Alzheimer's disease (AD), they were divided into a group with AD (n = 82) and a group without AD (n = 48). The proportion of Hoehn-Yahr staging 3 to 5 (χ² = 5.689, P = 0.017), UPDRS Ⅲ score (t = 21.490, P = 0.000), SCOPA-AUT score (t = 21.330, P = 0.000), dysregulation of body temperature (χ² = 8.512, P = 0.004), urinary dysfunction (χ² = 17.270, P = 0.000), gastrointestinal dysfunction (χ² = 24.471, P = 0.000), dysregulation of pupil (χ² = 5. 299, P = 0.021), cardiovascular dysfunction (χ² = 15.355, P = 0.000) and NMSS score (t = 32.309, P = 0.000) in the group with AD were higher than those in the group without AD, the MMSE (t = 4.730, P = 0.000) and MoCA (t = 6.840, P = 0.000) total scores and subtype scores (P = 0.000, for all) in the group with AD were lower than those in the group without AD. Correlation analysis showed that the SCOPA-AUT score of PD patients with AD was negatively correlated with MMSE and MoCA total scores and subtype scores (P = 0.000, for all). Conclusions: The autonomic dysfunction of elderly PD patients with AD is more serious, and the autonomic nervous function is closely related to cognitive function.

Objective: To explore the relationship between the levels of serum 8 - hydroxy deoxyguanosine (8 - OHdG) and malondialdehyde (MDA) and cognitive dysfunction in patients with Parkinson's disease (PD). Methods: From February 2021 to February 2022, 126 patients with PD in The Affiliated Hospital of Xuzhou Medical University were divided into normal cognitive function group (PDN group, n = 41), mild cognitive impairment group (PD - MCI group, n = 47) and Parkinson's disease dementia group (PDD group, n = 38), and 50 healthy subjects were selected as control group. Hoehn - Yahr staging was used to evaluate the severity of patients with PD during the "close" period of anti - PD drugs, and the motor function of patients with PD was evaluated by the Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ). Montreal Cognitive Assessment (MoCA) was used to evaluate the severity of cognitive dysfunction at rest and in the "on" period of anti - PD drugs, and the serum 8 - OHdG and MDA of PD patients and controls were collected. Pearson and partial correlation analyses were used to analyze the correlation between the levels of serum 8-OHdG and MDA and MoCA score in PD patients. Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of cognitive dysfunction in PD patients. The efficacy analysis of serum 8 - OHdG and MDA levels in predicting the risk of cognitive dysfunction in PD patients was carried out by using receiver operating characteristic curve (ROC curve). Results: The results of correlation analysis showed that there was a negative correlation between the MoCA score and the duration (r = - 0.241, P = 0.007), Hoehn - Yahr staging (r = - 0.333, P = 0.007), 8 - OHdG (r = - 0.310, P = 0.000) and MDA (r = - 0.291, P = 0.004) in PD patients. The results of Logistic regression analysis showed that the elevated levels of 8 - OHdG (OR = 1.335, 95%CI: 1.137-1.568; P = 0.000) and MDA (OR = 2.928, 95%CI: 1.676-5.115; P = 0.000) were risk factors for cognitive dysfunction in PD patients. The results of ROC curve showed the areas under the curve of 8-OHdG, MDA and their combination in predicting cognitive dysfunction in PD patients were 0.831 (95%CI: 0.761-0.902, P = 0.000), 0.846 (95%CI: 0.775-0.916, P = 0.000) and 0.922 (95%CI: 0.878- 0.966, P = 0.000), respectively. Conclusions: The detection of 8 - OHdG and MDA in peripheral blood is expected to be a serum marker to evaluate the severity of cognitive dysfunction in patients with PD, and to predict cognitive dysfunction in patients with PD.

Parkinson's disease (PD) is a common neurological degenerative disease in clinical practice. Dysarthria is a common motor symptom, with a high incidence and diverse clinical manifestations. PD patients often ignore their dysarthria symptoms until they reach the decompensation stage, and only a small number of patients receive treatment. This article reviews the pathogenesis, evaluation and treatment of dysarthria in PD, providing theoretical basis for early diagnosis and timely treatment of dysarthria in PD.

Neuromyelitis optica spectrum disorders (NMOSDs) are most common in anti -aquaporin 4 (AQP4) antibody positive NMOSDs, which are characterized by recurrent episodes of optic neuritis and myelitis, etc., and severely reduce the quality of life. In recent years, new insights into the diagnostic techniques, diagonstic markers, and immunotherapy of anti-AQP4 antibody positive NMOSDs have continued to emerge, and here we focus on synthesizing new advances in the diagnostic techniques and diagonstic markers of anti-AQP4 antibody positive NMOSDs and the most recent recommendations for its treatment, in hopes of summarizing to promote the understanding and application of new diagnostic and therapeutic techniques for anti-AQP4 antibody positive NMOSDs in China, and to explore more possible clinical diagnostic and therapeutic approaches.

Myasthenia gravis (MG) treatment has entered an era of targeted therapies. Different targeted therapies take effect in various aspects of pathogenic mechanisms in MG. For a steady long-term control of MG symptoms, immunotherapies that reduce the production of pathogenic autoantibodies should be used. The glucocorticosteroid acts on multiple aspects of pathogenic mechanisms relevant to autoantibody production and regulation of the immune network, which renders glucocorticosteroid the basis of MG therapy. A definite therapeutic target has been established in MG. Glucocorticosteroid can be used alone or in combination with traditional immunosuppressants or targeted therapies at different stages of the treat-to-target process. Based on the evaluation of the beneficial characteristics of patients using the traditional glucocorticosteroid escalation strategy, the implementation of the glucocorticosteroid-based and treat-to-target-oriented individualized treatment helps to obtain better long-to-term efficacy.

Objective: To report and analyze the clinical features of the first documented case in China of anti-neurofilament heavy chain (NfH) antibody-associated encephalitis. Methods and Results: A 63-year-old female presented with cognitive impairment, recurrent epileptic episodes, and aphasia. Head MRI showed multiple abnormal signals in bilateral frontal and parietal lobes, and slight swelling in some gyri, dilatation of the supratentorial ventricular system and brain atrophy, especially in bilateral temporal lobes and hippocampus. ¹⁸F-DPA714 PET/MRI showed abnormal uptake in multiple brain regions in the frontal, temporal, parietal and occipital lobes, suggesting neuroinflammation in the brain. EEG showed frequent epileptiform discharges. Cerebrospinal fluid white cell count and glucose were elevated. Serum and cerebrospinal fluid antibodies related to autoimmune encephalitis were negative. Serum tissue-based indirect immunofluorescence assay showed cerebellar neurofilament-like fluorescence surrounding Purkinje cells, further detection of neurofilament protein-related antibodies, it suggested high titer of serum NfH-IgG (1∶1000). The patient was diagnosed with anti-NfH antibody-associated encephalitis. After treatment with intravenous immunoglobulin and methylprednisolone, the prognosis was improved. Conclusions: Anti-NfH antibody-associated encephalitis is a rare and clinically complex condition. The myriad of symptoms complicates early diagnosis and differential identification. Early initiation of immunomodulatory therapy may offer prognostic advantages.

Acute type A aortic dissection (aTAAD) is a common aortic disease with a very high mortality rate. Due to its frequent involvement of vessels above aortic arch, it is highly prone to cause neurological complications. This review comprehensively elaborates on the possible risk factors of aTAAD combined with neurological complications, and summarizes the commonly used surgical treatment strategies, in order to provide a theoretical basis for finding intervention methods for aTAAD combined with neurological complications.

Objective: To analyze the relationship between biceps, triceps surface integrated electromyography (iEMG) recorded by surface electromyography (sEMG) and the degree of myotonia in patients with Parkinson's disease (PD), and to explore the feasibility of iEMG value as an objective quantitative index of the degree of myotonia in patients with PD. Methods: A total of 51 patients with PD who were admitted to The First Affiliated Hospital of Anhui Medical University from September 2022 to November 2023 were included, as well as 19 healthy controls matched by sex and age. The motor symptoms and myotonic degree of the subjects were evaluated by Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ). sEMG was used to collect the sEMG signals of the biceps and triceps of the subjects during passive upper limb movement, and the iEMG value was calculated. A total of 32 patients with PD were randomly selected for Levodopa Shock Test. iEMG values and UPDRS Ⅲ myotonic scores of upper limbs were collected before and after the test. Spearman rank correlation analysis was used to analyze the correlation between iEMG values and UPDRS Ⅲ myotonic scores of upper limbs. Results: In PD group, the iEMG values of biceps muscle (Z = - 4.874, P = 0.000) and triceps muscle (Z = - 4.880, P = 0.000) of more severe symptoms side were higher than those of less severe symptoms side. Spearman rank correlation analysis showed that myotonic scores of upper limbs (0-3 points) in PD group was positively correlated with biceps (r_s = 0.735, P = 0.000) and triceps (r_s = 0.545, P = 0.000) iEMG values. The iEMG values of muscles with myotonia score of 1 (biceps Z = 5.344, P = 0.000; triceps Z = 5.146, P = 0.000), 2 (biceps Z = 7.421, P = 0.000; triceps Z = 6.891, P = 0.000), 3 (biceps Z = 5.340, P = 0.000; triceps Z = 5.145, P = 0.000) in PD group were higher than those in control group. In addition, before levodopa impact (biceps r_s = 0.664, P = 0.000; triceps r_s = 0.386, P = 0.029) and after impact (biceps r_s = 0.620, P = 0.000; triceps r_s = 0.588, P = 0.000) in PD group, there was a positive correlation between myotonic scores of upper limbs and iEMG values. Conclusions: The iEMG values of biceps and triceps can reflect the severity of myotonia in PD patients, and can be used as a quantitative evaluation index of myotonia in PD patients.

Since 2017, human encephalitis caused by pseudorabies virus (PRV) has been reported in 28 cases in China. The clinical symptoms include fever, headache, seizures, focal neurological loss, disturbance of consciousness, etc.. This disease has the high disability rate and fatality rate. PRV is mainly transmitted through close contact with infected pigs or their excrement, or spread via blood - borne. Patients are mostly practitioners in the live pig industry chain. Early diagnosis and treatment are critical to the prognosis of patients. Therefore, this article reviews the progress on diagnosis and treatment of human encephalitis caused by PRV, in order to improve the clinical diagnosis and treatment of this disease.

Objective: To analyze the risk factors for dismal prognosis in patients with cryptococcal meningitis and construct a prediction scoring system Nomogram model. Methods: A total of 100 patients with cryptococcal meningitis who treated with anticryptococcal therapy admitted to Affiliated Hospital of Zunyi Medical University from January 2010 to August 2022 were selected. The patients were divided into favorable prognosis group (n = 19) and dismal prognosis group (n = 81) according to the results of cerebrospinal fluid (CSF) cryptococcal culture during hospitalization and clinical symptoms and signs at the time of discharge. Risk factors were screened by using univariate and multivariate stepwise Logistic regression analyses. A Nomogram model was constructed based on the risk factors, the receiver operating characteristic (ROC) curve and calibration curves of the model were plotted, and Hosmer-Lemeshow goodness-of-fit test was performed. Results: The proportion of patients in the dismal prognosis group with Nutritional Risk Screening 2002 (NRS 2002) score (Z = -3.898, P = 0.000), CSF pressure > 250 mm H₂O (χ² = 9.512, P = 0.002) and duration of antifungal treatment < 14 d (χ² = 17.847, P = 0.000) on admission were higher than those in the favorable prognosis group, and the blood routine red blood cell count (t = -2.802, P = 0.006) and lymphocyte count (Z = -2.878, P = 0.004), plasma albumin (t = -4.332, P = 0.000), and the proportion of amphotericin B application (χ² = 4.597, P = 0.032) were lower than those in the favorable prognosis group. Logistic regression analysis showed the admission high NRS 2002 score (OR = 3.258, 95%CI: 1.337-7.940; P = 0.009), CBF pressure > 250 mm H₂O (OR = 0.108, 95%CI: 0.018-0.659; P = 0.016), and the duration of antifungal treatment < 14 d (OR = 0.092, 95%CI: 0.011-0.742; P = 0.025) were risk factors for dismal prognosis of cryptococcal meningitis. A Nomogram model was constructed based on the above 3 risk factors, and the area under the ROC curve was 0.927 (95%CI: 0.873-0.980, P = 0.000), which predicted a cut-off value of 53.50 points for dismal prognosis in cryptococcal meningitis; the calibration curve (with good consistency), and the Hosmer-Lemeshow goodness-of-fit test (χ² = 2.694, P = 0.912) indicated that the model had good discrimination, calibration and stability. Conclusions: Patients with cryptococcal meningitis with a high NRS 2002 score, CSF pressure > 250 mm H₂O, and antifungal treatment < 14 d had a dismal prognosis, and the Nomogram model constructed accordingly has a high predictive value of dismal prognostic risk.

Objective: To summarize the clinical characteristics of peripheral nerve hyperexcitability syndrome (PNHS). Methods and Results: Ten patients with PNHS were admitted to He'nan Provincial People's Hospital from October 2018 to April 2022, with the clinical phenotypes of Morvan syndrome in 5 cases, Issacs syndrome in 4 cases, and cramp-fasciculation syndrome (CFS) in one case. There were 10 cases with clinical manifestations of muscle twitching, 8 of dysautonomia, 7 of central nervous system symptoms, 7 of limb weakness, 6 of sensory deficits, and 2 of cramping and muscle stiffness. Five cases were positive for autoimmune antibodies. Two cases had MRI abnormalities located in the brainstem, left occipital lobe and right thalamus. Ten cases had EMG abnormalities, including afterdischarges of F-wave in 10 cases, unit potential of spontaneous motion abnormalities in 10 cases, fasciculation potentials in 10 cases, myokymic discharges in 8 cases, and neuromyotonic and myokymic discharges in 3 cases. Three cases underwent only symptomatic therapy, and 7 cases underwent symptomatic therapy and immunomodulatory treatments. Except for one case who lost of follow-up, 5 cases had a good prognosis, 2 cases with poor prognosis, and 2 cases died. Conclusions: PNHS is a heterogeneous group of clinical manifestations. Electrophysiological appearance of afterdischarges may be a sensitive indicator for the diagnosis of PNHS.

The comorbidity of cardiovascular diseases and nervous system diseases ("cardio-brain comorbidity") is increasingly gaining attention in the field of cardiovascular surgery. The synchronous surgical treatment for heart and brain as a comprehensive treatment concept, emphasizes the interaction and balance between the heart and the brain, offering a new perspective for the concurrent treatment of "cardio-brain comorbidity". This article focuses on common diseases in cardiovascular surgery and their perioperative nervous system complications, elaborating on the synchronous surgical treatment for heart and brain, to provide clinical physicians with more scientific and effective treatment guidance.

With the aggravation of population aging, the health of the elderly has become an important issue in the aging society. The Mediterranean diet (MD) contributes to healthy aging by changing dietary patterns to delay and prevent disease onset. This paper summarizes the concepts related to the MD pattern and its relationship with cardiovascular diseases, cognitive dysfunction, depression, chronic inflammation and other brain and heart comorbidity in the elderly, so as to provide thinking and reference for the optimization and upgrading of the elderly, and contribute to the development of healthy China.

Objective: To summarize the clinical characteristics of Vogt-Koyanagi-Harada syndrome (VKHS) combing with meningitis/encephalitis patients. Methods and Results: The clinical data of the inpatients of Beijing Tongren Hospital, Capital Medical University from January 2009 to December 2022 with VKHS combing with meningitis/encephalitis were retrospectively analyzed. A total of 23 patients were included in the study, of which 20 patients (86.96%) had neurological symptoms, with headache being the most common (19 cases, 82.61%), 11 patients (47.83%) had increased cerebrospinal fluid (CBF) pressure, 14 patients (60.87%) had increased CBF white blood cells, and 11 patients (47.83%) had increased CBF protein. The brain MRI mainly showed white matter demyelination (8/14 cases). Optic nerve MRI showed inflammatory lesions of optic nerve and optic papilla (12/14 cases). The visual evoked potential (VEP) mainly showed prolonged latency (10/16 cases). The optical coherence tomography (OCT) showed retinal exudation (8/15 cases) and retinal neurocortical detachment (7/15 cases). The main results of fundus photography were disc edema (17/18 cases). The main manifestation of fundus fluorescein angiography (FFA) was uveitis (9/15 cases). After intravenous hormone and intravenous immunoglobulin (IVIg) treatment, 14 patients were followed up, and neurological symptoms were completely relieved, 11 patients had good visual prognosis, and 3 patients had no obvious visual improvement. Conclusions: VKHS might present with meningitis/encephalitis symptoms, and the CSF characteristics of these patients were similar to those of viral meningitis. For those with early suspicions of VKHS, CBF examination and imaging examination might assist in early diagnosis and treatment.

Parkinson's disease (PD) is a common neurodegenerative disease in clinical practice. Patients with PD are usually accompanied by non-motor symptoms (NMS) such as gastrointestinal dysfunction, hyposmia, sleep disorders, depression, pain and hallucinations, which seriously reduce the quality of life. Recent studies have found that PD patients were accompanied by diffuse pathological changes in non-dopaminergic system such as progressive degeneration of 5 -hydroxytryptamine (5-HT) ergic neurons, and 5-HT plays an important role in the regulation of emotion, cognitive function, pain and other neural functions, and is closely related to non-motor symptoms of PD. This article reviews the correlation between 5-HT and non-motor symptoms of PD and its research progress, in order to further clarify the pathogenesis of non-motor symptoms of PD and provide a theoretical basis for the treatment of PD.

Objective: To investigate the efficacy and neuromyelitis optica spectrum disorders (NMOSDs). Methods: The clinical data of 25 patients with NMOSDs hospitalized in The First Affiliated Hospital of Zhengzhou University from April 2022 to March 2023 and treated with ofatumumab were retrospectively analyzed. They were divided into 2 groups, Group A with 12 cases receiving regular medication, and Group B with 13 cases receiving medication based on the percentage of CD19⁺B lymphocytes. Annual relapse rate (ARR), the number of relapses, the frequency and time of relapses, and the symptoms of relapses were calculated before and at one year of medication. The neurological function was assessed by Expanded Disability Status Scale (EDSS) before and at one year of medication. The adverse drug reactions were recorded during medication. Results: After one year treatment with ofatumumab, 3 patients (12%) experienced recurrence. One patient in Group A experienced recurrence twice, one month and 5 months after treatment, respectively. At the second recurrence, the percentage of CD19⁺B lymphocytes was 2.80%. Two patients in Group B experienced recurrence, one patient relapsed twice at 2 and 6 months after medication. The percentage of CD19⁺B lymphocytes was 0.80% and 0.21%, respectively; another patient relapsed once at 2 months after medication. At the time of recurrence, the percentage of CD19⁺B lymphocytes was 0.70%. There was a statistically significant difference in ARR before and after one year treatment (F = 29.061, P = 0.000). After one year's treatment, the ARR of Group A (t = 13.215, P = 0.001) and Group B (t = 19.259, P = 0.000) was decreased than before. There were 8 cases of the injection site pain, 3 cases of fever after injection, and one case of headache after injection. There were no serious adverse reactions such as disability and death, and EDSS scores were not increased. Conclusions: Continuous administration of ofatumumab every 3 months or based on the percentage of CD19⁺B lymphocyte can reduce recurrence. Combination with corticosteroids should be alert to the risk of infection.

Autonomic nerve dysfunction is a common non-motor symptom of Parkinson's disease (PD). It has a high incidence and involves multiple organ system disorders with various manifestations, seriously affecting the quality of life. Autonomic nerve dysfunction can be a major symptom of advanced PD and a major cause of disability. Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced PD, and its improvement of motor symptoms in PD patients has been widely recognized. However, the effect of STN-DBS on the symptoms of autonomic nerve dysfunction in PD patients is still unclear. Here, the efficacy of STN-DBS on PD autonomic nerve dysfunction is briefly reviewed. Therefore, we should pay more attention to the symptoms of autonomic nerve dysfunction in PD patients, and conduct preoperative evaluation of DBS in PD patients, so as to comprehensively consider the postoperative efficacy, target selection, stimulus parameter setting, drug adjustment, develop an individualized treatment plan.

Central α -synucleinopathy includes Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). The clinical manifestations of these diseases usually overlap, which make the differential diagnosis difficult in clinical practice. Autonomic dysfunction is a common feature of these diseases. Recent studies indicated the autonomic dysfunction would contribute to our further understanding of central α-synucleinopathy. This article reviews the value of autonomic dysfunction in the predictive diagnosis, differential diagnosis and prognosis of the above diseases, to help clinical practice.

Cardiovascular and cerebrovascular diseases are one of the most common cause of death in the world, atherosclerosis is the main pathologic change, and often involving cardiovascular and cerebrovascular concurrently. No consensus has been reached on whether carotid endarterectomy (CEA) combined with coronary artery bypass grafting (CABG) should be performed at concurrent operation or staged operation (CEA after CABG or CABG after CEA) in patients with ischemic cardiovascular and cerebrovascular diseases. However, with the deepening of research on cardiovascular and cerebrovascular diseases, the improvement of surgical techniques and development of intravascular intervention techniques, it provides theoretical basis and technical support for simultaneous surgical intervention.

The neurological complications following cardiovascular surgery can significantly affect the prognosis of patients. As a convenient and non-invasive intraoperative neurological monitoring method, transcranial Doppler ultrasonography (TCD) can provide real-time assessment of cerebral hemodynamics and microemboli signals, guide the development of neuroprotective strategies, and reduce the brain injury events. This review systematically summarizes the basic methods and technical performance of TCD monitoring, its clinical application in cardiovascular surgery, as well as the main limitations and future trends of this technology, in order to improve perioperative safety.

Patent foramen ovale (PFO) is closely related to neurological diseases such as stroke, migraine, obstructive sleep apnea syndrome (OSAS) and decompression sickness (DCS). It has been suggested that PFO closure could be effectively prevent and treat these neurological diseases. This article focus on exploration of the pathogenesis, epidemiology and clinical characteristics of neurological diseases related to PFO, and to discuss the potential complexity and future development of PFO closure for the treatment of these diseases. The aim is to provide guidance for the diagnosis and treatment of neurological diseases related to PFO.

With the progress of medical and health conditions, the incidence and mortality of encephalitis and meningitis caused by traditional pathogens have decreased. However, due to the change of pathogen spectrum of neurological infection, the improvement of detection methods of neurological infection pathogens and the emergence of new evidence of pathogens causing neurodegenerative diseases, it is necessary to rethink the clinical characteristics and diagnosis and treatment of neurological infectious diseases (NID). At the same time, post-infectious/para-infectious nervous system diseases (PPINDs) that do not directly enter the central nervous system are increasing after the SARS-CoV-2 epidemic. Therefore, we propose to attach importance to the disciplinary characteristics and discipline construction of Infectious Neurology with NID and PPINDs as the two major themes, and to improve the diagnosis and treatment of NID and PPINDs through multi-disciplinary cooperation and specialized training.

Vestibular evoked myogenic potentials (VEMPs), a key electrophysiological technique, is extensively utilized for the clinical evaluation of vestibular function. Patients with Parkinson's disease (PD) often have vestibular dysfunction, with VEMPs abnormalities being the most common. Based on the brief introduction of VEMPs technique, this review summarizes the features of VEMPs abnormalities, its association with clinical phenotype and underlying pathophysiological basis in patients with PD, so as to provide guidance for clinical research and practical application.

Stroke can lead to long-term motor disorders and reduced quality of life. Despite advances in conventional rehabilitation, many patients are still faced with limited efficacy of rehabilitation. Neuromodulation techniques have shown breakthrough therapeutic potential. The purpose of this article is to provide an overview of the mechanism of poststroke neuroplasticity, to explore the mechanism of dentate nucleus deep brain stimulation (DN-DBS) to improve poststroke motor function, and to summarize the progress of the study, in order to provide a scientific basis and a new therapeutic perspective for clinical practice of DN-DBS.

Objective: To explore the therapeutic effect of transcranial (tDCS) with different current density on upper limb motor disorder in stroke patients. Methods: A total of 45 stroke patients with upper limb motor disorder hospitalized in Xuanwu Hospital, Capital Medical University from March 2019 to June 2022 were selected and randomly divided into low current density stimulation group (low density group, 0.028 mA/cm 2), medium current density stimulation group (medium density group, 0.057 mA/cm²), high current density stimulation group (high density group, 0.080 mA/cm²), 15 cases in each group. Upper limb motor function was evaluated by Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) before and one week after treatment, and activity of daily living was evaluated by modified Barthel Index (mBI). Results: After treatment of tDCS, FMA -UE (F = 284.343, P = 0.000), ARAT (F = 180.427, P = 0.000) and mBI (F = 487.159, P = 0.000) scores in 3 groups were improved compared with those before treatment. FMA-UE (F = 2.293, P = 0.000) and ARAT (F = 2.572, P = 0.000) scores were significantly different among 3 groups, FMA-UE (t = 2.426, P = 0.029; t = 2.140, P = 0.035) and ARAT (t = 2.537, P = 0.024; t = 2.353, P = 0.028) scores in high density group and medium density group were higher than those in low density group. Conclusions: tDCS is safe and effective in the treatment of upper limb motor disorder after stroke. Current densities of 0.057 and 0.080 mA/cm² are more effective than those of 0.028 mA/cm².