To investigate the relationship between health literacy, social support and perceived risk of stroke recurrence in elderly stroke patients and the factors influencing them.

One hundred and fourteen elderly stroke patients admitted to Neurology Department of Second Hospital of Shanxi Medical University from January 2022 to October 2023 were investigated by convenience sampling method, general information questionnaire, recurrence risk perception assessment scale, health literacy scale and understanding social support scale. Pearson correlation analysis was used to analyze the correlation between recurrence risk perception of elderly stroke patients and health literacy and social support, and single factor and multiple linear regression analysis were used to analyze the influencing factors of recurrence risk perception of elderly stroke patients.

The total score of perceived risk of recurrence in patients with elderly stroke was (63.33±13.72), the total score of health literacy was (64.65±12.85), and the total score of social support was (66.17±11.50). The results of Pearson correlation analysis showed that the scores of perceived risk factors for recurrent diseases, perceived risk factors for recurrent behaviors, and severity of recurrence in patients with elderly stroke were positively correlated with the scores of health literacy and social support scales (P<0.05). The results of univariate analysis showed that there were statistically significant differences in the total score of recurrence risk perception among elderly stroke patients with different levels of education, types of underlying diseases, and frequency of stroke attacks (P<0.05). The results of multiple linear regression analysis showed that the number of stroke episodes and health literacy scale scores were the influencing factors for the perceived recurrence risk of elderly stroke patients (P<0.05).

Elderly patients with stroke recurrence risk perception, health literacy and social support were all at a moderately level, and their influencing factors involve the number of stroke episodes and health literacy, so it was recommended that healthcare professionals provide patients with health education knowledge in addition to health management using multimedia resources, in order to improve the level of patients' recurrence risk perception.

To evaluate the therapeutic efficacy of transcutaneous auricular vagus nerve stimulation (ta-VNS) in post-stroke dysphagia rehabilitation.

Patients with post-stroke dysphagia admitted to the Rehabilitation Medicine Department of Shanghai General Hospital from January to June 2024 were selected as study subjects,and were divided into an experimental group and a control group using a random number table method. Two groups of patients received conventional swallowing rehabilitation therapy, while the experimental group underwent ta-VNS targeting the concha region, and the control group received sham ta-VNS stimulation at the earlobe. The intervention was administered at a frequency of 20 min/d, 5 d/week, for a total duration of 4 weeks. The swallowing function of subjects in both the experimental and control groups was assessed before and after treatment using the water swallow test, SSA score, soft palate movement, mandibular movement, lip movement, tongue movement, pharyngeal reflex, gag reflex, and cough reflex.

A total of 52 patients were included, including 26 in the experimental group and 26 in the control group. After treatment, the scores of water swallowing test, SSA, palatal movement, mandibular movement, labial movement, lingual movement, pharyngeal reflex, gag reflex, and cough reflex in two groups of patients were better than before treatment, and the differences were statistically significant (P<0.05). The scores of water swallowing test, SSA, palatal movement, mandibular movement, labial movement, lingual movement, pharyngeal reflex, and gag reflex in the experimental group after treatment were better than those in the control group, and the differences were statistically significant (P<0.05), while there was no statistically significant difference in cough reflex scores (P>0.05).

ta-VNS is a safe and effective intervention for improving post-stroke dysphagia.

To systematically evaluate the efficacy of virtual reality (VR) technology in improving cognitive function and alleviating negative emotions among stroke patients.

Randomized controlled trials (RCTs) investigating VR-based 1nterventions for cognitive and mental health outcomes in stroke patients were retrieved from China Knowledge Network, WANFANG, Wipro database, PubMed, Embase, Web of Science, and Cochrane Library databases (inception to June 21, 2024). After screening 5545 records, two researchers independently performed deduplication, study selection, data extraction, and risk-of-bias assessment. The VR group used VR technology combined with conventional therapy, while the control group only used the conventional therapy. A total of 12 outcome indicators were categorized into 9 domains. Meta-analyses were conducted using RevMan 5.4 and Stata 17.0.

A total of 29 RCTs were included, including 1516 patients, including 727 in the VR group and 789 in the control group. In the VR training group, the scores of overall cognitive function (SMD=0.69, 95%CI: 0.40-0.99), perceptual function (MD=2.19, 95%CI: 1.30~3.19), language function (MD=9.87, 95%CI: 7.47-12.26), memory function (MD=2.59, 95%CI: 2.00-3.18), depression [MD=-2.92, 95%CI: (-4.55)-(-1.29)] and anxiety [SMD=-0.61, 95%CI: (-1.17)-(-0.04)] of stroke patients were the difference was statistically significant (P<0.05); There was no significant difference in the scores of executive ability, attention and visuospatial ability between the two groups (P>0.05).

VR training effectively improves global cognition, language function, and alleviates anxiety/depression in stroke patients, while its effects on executive function, attention, and visuospatial ability require further validation.

To explore the characteristic electrophysiological markers of patients with prolonged disorders of consciousness (pDOC) by analyzing the resting-state electroencephalogram (EEG) microstate features of patients with pDOC.

Twenty three patients with pDOC admitted to the Neurosurgery Department of Lu'an People's Hospital Affiliated to Anhui Medical University from January 2021 to March 2024 were selected as the pDOC group, and 17 healthy subjects who underwent physical examination in our hospital were collected as the healthy group at the same time. Video EEG data of resting-state were collected. Microstate clustering was performed using the EEGLAB toolkit based on the Matlab mathematical calculation platform, and statistical analysis was conducted on micro-state indicators (average duration, occurrence frequency, time coverage) between two groups.

The microstate topographic maps A, C and D of the two groups were similar, while the topographic maps of microstate B were significantly different. The time coverage rate of microstate B in the pDOC group (0.37±0.14) was higher than that in the healthy group (0.29±0.10), and the frequency of microstate D (2.96±0.75) and time coverage rate [0.27 (0.23, 0.42)] were lower than those in the healthy group [3.36±0.42, 0.35 (0.30, 0.39)], with statistically significant differences (P<0.05).

The microstate B of pDOC patients has a marked left-right distribution, which may serve as an electrophysiological marker for future assessment of pDOC and degree of consciousness impairment.

To investigate the technical methods, effectiveness and safety of short-course peripheral nerve stimulation (st-PNS) in the treatment of postherpetic neuralgia (PHN).

The clinical data of fifteen patients with PHN treated with st-PNS from October 2023 to October 2024 were collected retrospectively. Numeric rating scale (NRS) was used for pain scoring, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) was used for evaluation of psychological status. The data of gender, age, the duration of pain, preoperative SAS, preoperative SDS, the time of st-PNS, perioperative NRS and the improvement rate of NRS were collected and analyzed, to evaluate the effectiveness and side effects of st-PNS, and the related Factors-of the rate of NRS improvement.

The stimulation time of this group of patients ranged from 7 to 16 d, with a median (quartile) of 14 (13, 15) d; The preoperative NRS score ranged from 7 to 10 points, with a median (quartile) of 8 (7, 9) points, mean postoperative NRS was 2.27 points. The pain degree of all patients was improved compared with that before operation, the effective rate was 100%, and the mean decline of NRS was (5.87±1.25) points, the mean improvement rate of NRS after surgery was 73.20%±18.15%. The average preoperative SDS score was 37.27, the preoperative SAS score was 20-75, and the median (quartile) score was 32 (23, 58). There was a significant correlation between preoperative NRS, preoperative SDS, and preoperative SAS and improvement rate of NRS (r=-0.517, P=0.048; r=-0.928, P<0.001; r=-0.895, P<0.001). There was no infection or other adverse reactions had happened.

st-PNS is safe and effective in improving PHN, but the effectiveness is affected by factors such as preoperative NRS, preoperative SDS, and preoperative SAS.

Historically, scholars believed that the central nervous system (CNS) lacked a lymphatic system. Instead, subarachnoid cerebrospinal fluid (CSF) and interstitial fluid (ISF) were thought to facilitate the excretion of harmful metabolites from the CNS, although the exact mechanisms remain incompletely understood. Recent studies in both animal and human samples have revealed that the cerebral lymphatic system comprises two main components: the meningeal lymphatic vessels located within the dura mater and the glymphatic system situated in the brain parenchyma. Building on these findings, numerous investigations have explored the functional significance of this system. The cerebral lymphatic system serves as a perivascular transport channel specifically for CSF transport and ISF exchange, thereby facilitating the clearance of metabolic waste from the brain. This review will discuss the anatomy of the cerebral lymphatic system, methods for its visual assessment, and its role and value in the diagnosis and treatment of neurosurgical conditions, aiming to better understand the functions of the cerebral lymphatic system and develop targeted treatment methods.

Parkinson disease (PD) is a progressive neurodegenerative disorder marked by the loss of dopaminergic neurons in the substantia nigra. Clinically, PD presents with motor symptoms such as bradykinesia, tremor, and rigidity, which significantly compromise patients' daily function and quality of life. Deep brain stimulation (DBS) has become a cornerstone in the management of advanced PD, delivering high-frequency electrical stimulation to specific brain targets to alleviate motor deficits. However, conventional DBS operates with fixed parameters, lacking the ability to adapt in real-time to symptom fluctuations. This rigidity can lead to suboptimal outcomes including overstimulation or inadequate symptom control.Adaptive DBS (aDBS) represents an advanced therapeutic approach that continuously monitors neural activity, such as local field potentials (LFPs), and dynamically adjusts stimulation parameters through a closed-loop "sense-decode-stimulate" system. This facilitates personalized therapy that responds in real-time to the patient's clinical state. aDBS has been shown to not only enhance motor symptom control but also reduce stimulation-induced side effects such as dysarthria and dysphagia. Despite its promise, several clinical and technical challenges remain. These include the miniaturization of pulse generators, precision placement of flexible electrodes, reliable signal decoding and feedback, safety of compact high-energy batteries and wireless charging, and minimizing surgical invasiveness and related complications. Future developments in implantable brain-computer interface (BCI) technologies, such as integrated circuit-based implantable pulse generators, microelectrode array, high-performance computing, and secure high-bandwidth communication, hold disruptive potential that may benefit not only PD but also other neurological and psychiatric conditions including Alzheimer disease and depression. This article reviews the fundamental principles, clinical benefits, biomarker validation, trial design considerations, and technological advancements in aDBS systems, and discusses current limitations and future directions to guide further clinical translation.

To investigate the mechanism of tanshinone ⅡA (TIIA) in improving diabetic peripheral neuropathy (DPN) by regulating pyroptosis pathway.

(1) Type 2 diabetes mellitus (T2DM)-DPN mouse models was established through high-fat diet feeding combined with intraperitoneal streptozotocin (STZ). The experimental animals were randomly divided into three groups: control group, model group (110 mg/kg STZ-induced), TIIA group (DPN model+20 mg/kg TIIA sodium sulfonate injection), with 10 mice in each group; (2) Pain behavioral assessments were conducted using Von Frey filaments for mechanical allodynia and the hot plate test to quantify thermal hyperalgesia thresholds; (3) Sciatic nerve sections underwent hematoxylin-eosin (HE) staining and Luxol fast blue (LFB) staining for myelin integrity, and transmission electron microscopy (TEM) to evaluate ultrastructural alterations in myelin-axon units; (4) Epidermal nerve fiber density in plantar skin specimens was quantified through immunofluorescence staining using anti-PGP9.5 antibodies; (5) Protein expression levels of nod-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), cysteinyl aspartate specific proteinase-1 (Caspase-1), gasdermin-D (GSDMD), and interleukin-1β (IL-1β) in sciatic nerves were quantitatively analyzed through Western blot combined with immunofluorescence assay; (6) RSC96 cells were cultured in vitro with hyperglycemic injury model established; (7) Cytotoxic effects of TIIA were assessed using lactate dehydrogenase (LDH) release assay across a concentration gradient (5, 10, 20, 40 μmol/L), with dose-response analysis identifying 20 μmol/L as the optimal therapeutic concentration for subsequent experiments; (8) Schwann cell were divided into three groups: control group (5.5 mmol/L glucose), hyperglycemic injury model group (50 mmol/L glucose), and pharmacological intervention (50 mmol/L glucose + 20 μmol/L TIIA); (9) Intracellular reactive oxygen species (ROS) levels were quantified via flow cytometry using DCFH-DA fluorescent probe; (10) The protein expression levels of NLRP-3, ASC, GSDMD, Caspase-1, and IL-1β in each group were analyze by Western blot.

(1) TIIA ameliorated chronic hyperglycemia-induced myelin sheath structural pathology and neuropathic progression; (2) TIIA treatment significantly ameliorated the loss of intraepidermal nerve fibers density in DPN model mice; (3) TIIA inhibited hyperglycemia-induced ROS overproduction in RSC96 cells; (4) TIIA ameliorates chronic hyperglycemia-induced peripheral neuropathy through inhibiting suppression of NLRP3 inflammasome assembly, Caspase-1-mediated GSDMD cleavage, and subsequent IL-1β secretion, effectively disrupting the pyroptosis-inflammation axis.

TIIA alleviates hyperglycemia-induced peripheral neuropathic damage by scavenging intracellular ROS overaccumulation, thereby blocking NLRP3 inflammasome activation and subsequent Caspase-1/GSDMD-mediated pyroptosis in Schwann cells, ultimately preserving myelin-axon structural integrity.

To observe the effects of high-frequency and low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment on the expression of brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrkB) signalling pathway and MBP content in rats with delayed encephalopathy in acute carbon monoxide poisoning (DEACMP) and to explore the therapeutic effects.

Cognitively qualified male 24 SD rats were screened by Morris water maze, 6 were randomly selected as the blank group (NC group), and 18 were randomly divided into the sham stimulation group (Sham group), the high frequency 5 Hz group (5 Hz group), and the low frequency 1 Hz group (1 Hz group), each with 6 rats in each group, after the establishment of the DEACMP model. The treatment group was given 5 Hz and 1 Hz rTMS treatment respectively, and the Sham group was given sham stimulation. Cognitive function was assessed by Morris water maze after treatment. Hematoxylin-eosin (HE) staining was used to observe the changes in the hippocampal region of rats; enzyme-linked immunosorbent assay (ELISA) was used to analyse the serum concentration of BDNF, TrkB and myelin basic protein (MBP); immunohistochemical staining (IHC) was used to detect the positive expression of BDNF, TrkB and MBP in each group.

(1) The results of Morris water maze showed that 21 d after CO poisoning, the mean avoidance latency was significantly longer in the Sham group, 1 Hz group and 5 Hz group compared with the NC group (P<0.05); the mean avoidance latency was significantly shorter in the 1 Hz and 5 Hz groups compared with that in the Sham group (P<0.05); and the mean avoidance latency was even shorter in the 5 Hz group compared with that in the 1 Hz group (P<0.05). (2) The results of HE staining showed that the cells in the hippocampus of the NC group were neatly arranged, with clear boundaries and normal cell number, while the cells in the hippocampus of the Sham group were disorganised, with a reduced cell number and some of them showed nuclear necrosis. The hippocampal area of the 1 Hz and 5 Hz groups was more neatly arranged, with occasional cell necrosis. (3) The ELISA results indicated that compared with the NC group, the expression content of BDNF and TrkB in the Sham group decreased, and the expression content of MBP increased (P<0.05); in the 1 Hz and 5 Hz groups, the expression content of BDNF and TrkB increased significantly compared with that of the Sham group, and the expression content of MBP increased significantly compared with that of the Sham group. MBP expression content was significantly lower than that in the Sham group (P<0.05). (4) IHC staining indicated that the mean optical density values of BDNF and TrkB in the Sham group were decreased compared with that in the NC group (P<0.05); the mean optical density values of BDNF and TrkB in both the 1 Hz group and the 5 Hz group were higher than that in the Sham group (P<0.05); the MBP mean optical density values of BDNF and TrkB in the Sham group and the 5 Hz group were higher than those in the Sham group (P<0.05); the mean optical density values of MBP in the Sham group were significantly higher than those in the NC group, and the mean optical density values of MBP in the 1 Hz and 5 Hz groups were lower than those in the Sham group (P<0.05).

Both high-frequency (5 Hz) and low-frequency (1 Hz) rTMS can improve the cognitive function of DEACMP mice, and the possible mechanism is to improve demyelinating lesions by up-regulating the expression of BDNF/TrkB pathway, so as to reduce the expression content of MBP, thus improving cognitive ability.

To explore the effectiveness of early rehabilitation physical therapy in patients with critical cerebrovascular disease based on propensity score matching.

A retrospective analysis was performed on clinical data from patients with critical cerebrovascular disease admitted to the Rehabilitation Medicine Department of West China Hospital of Sichuan University from 2011 to 2019. According to whether early rehabilitation physical therapy was administered during the intensive care unit (ICU) stay, patients were divided into an early rehabilitation physical therapy group and a non-early rehabilitation physical therapy group. Propensity score matching (1∶1, caliper 0.02) was used to balance baseline differences. Linear regression or quantile regression was used to compare ICU length of stay and final GCS scores between the groups, while binary logistic regression was used to analyze differences in discharge outcomes. Multivariate Logistic regression was performed to assess the independent impact on discharge outcomes.

A total of 1211 patients were included, of which 474 (39.1%) received early rehabilitation physical treatment and the remaining 737 did not receive early rehabilitation physical therapy. After propensity score matching, there were 390 cases in each of the two groups, and the baseline characteristics between the two groups were balanced and comparable. There were no statistically significant differences in ICU length of stay or GCS scores between the matched groups (P>0.05). The incidence of favorable outcomes in the early rehabilitation physical therapy group was 67.4%, which was significantly higher than that in the non-early rehabilitation group (49.5%) (P<0.05). Multivariate Logistic analysis showed that not receiving rehabilitation therapy, cerebral infarction with hemorrhage, and infection were independent risk factors for unfavorable outcomes, while cranial surgery was identified as an independent protective factor.

Early rehabilitation physical therapy significantly increased the likelihood of achieving a favorable outcome at discharge in patients with critical cerebrovascular disease and has important clinical value in improving patient outcomes.

To identify biomarkers associated with vestibular schwannomas (VS) by integrating bioinformatics and machine learning techniques, and to investigate their biological functions and mechanisms within the immune microenvironment.

VS patient data (GSE56597 and GSE39645) were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) analysis and weighted gene co-expression network analysis (WGCNA) were employed to identify feature genes. Least absolute shrinkage and selection operator (LASSO) regression, random forest (RF) and Boruta algorithm were applied to precisely identify VS immune microenvironment biomarkers. Diagnostic value was evaluated using receiver operating characteristic (ROC) curve analysis. Pseudotime trajectory analysis was performed to explore the cellular distribution and functional roles of these biomarkers.

(1) DEGs analysis identified 1331 VS-associated DEGs. (2) WGCNA screened seven gene modules related to VS, yielding 2055 candidate genes. (3) From the overlapping DEGs and module hub genes, 722 genes were selected. LASSO regression, Boruta, and RF algorithms identified four signature genes (C10orf11, NCAM2, MLLT4, PI16). (4) In dataset GSE56597, the area under the ROC curve (AUC) values for NCAM2, PI16, C10orf11, and MLLT4 were 0.982, 0.918, 1, and 1, respectively. In validation set GSE39645, the AUCs were 1, 0.968, 1, and 1. (5) Single-cell RNA sequencing (GSE216783) revealed heterogeneous cell clusters in the VS tumor microenvironment, including myeloid cells, natural killer cells, non-myelinating Schwann cells, fibroblasts, myelinating Schwann cells, circulating cells, and B cells/plasma cells, all contributing to tumor progression. NCAM2 exhibited high expression and density in non-myelinating Schwann cells. (6) Pseudotime analysis of single-cell RNA sequencing data revealed that NCAM2+ Schwann cells exhibit enhanced differentiation capacity compared to NCAM2-counterparts. Further cell-cell communication analysis and pathway enrichment analysis demonstrated that NCAM2+ Schwann cells establish robust interactions with other cell types through MIF-(CD74+CD44) and MIF-(CD74+CXCR4) ligand-receptor pairs, indicating more active intercellular communication.

C10orf11, NCAM2, MLLT4, and PI16 were identified as biomarkers of VS, demonstrating significant roles in the immune microenvironment and high diagnostic value.

Glioblastoma (GBM) remains one of the most aggressive malignancies of the central nervous system. Its treatment faces significant hurdles due to the blood-brain barrier (BBB), the profoundly immunosuppressive tumor microenvironment (TME), and inherent tumor heterogeneity, which limit the efficacy of current immunotherapies, including immune checkpoint inhibitors. This has shifted focus towards harnessing the innate immune system, particularly the cGAS-STING pathway. As a critical sensor of cytosolic DNA and a central hub for type I interferon (IFN-I) production, this pathway plays a vital role in initiating anti-tumor immunity. However, its activity is often suppressed in GBM through mechanisms such as epigenetic silencing of the STING gene promoter and extracellular cyclic GMP-AMP degradation. Recently, nanomaterials have emerged as advanced drug delivery systems offering novel strategies to overcome these obstacles. This review aims to systematically summarize the biological functions of the cGAS-STING pathway, the key factors contributing to its suppression in GBM, and critically evaluates the advancements in utilizing nanomaterials for crossing the BBB, achieving targeted delivery, intracellular release, and environment-responsive regulation of STING agonists. Furthermore, it delves into how nanotechnology-based STING pathway activation strategies can synergize with existing therapies like immune checkpoint blockade, tumor vaccines, radiotherapy, and chemotherapy to enhance anti-tumor efficacy, overcome immunosuppression, and induce durable immune memory. Finally, this review outlines the major challenges currently facing the field (including in vivo delivery assessment, biosafety, and personalized therapeutic approaches), intending to provide insights for the development of more effective immunotherapy strategies against GBM.