To investigate the effectiveness and safety of double stent-retriever thrombectomy in the treatment of acute intracranial macrovascular occlusion at bifurcation.

The clinical and imaging materials of patients with acute intracranial macrovascular occlusion at the bifurcation treated with double stent-retriever thrombectomy from May 2019 to October 2021 in the Neurology Department of Xuyi County People's Hospital and Interventional Radiology Department of Jiangsu Provincial People's Hospital were retrospectively analyzed. The recanalization rate and complications were determined and the clinical outcomes were assessed. Also, neurological functions of the patients before treatment and discharge from hospital, measured by National Institute of Health stroke scale (NIHSS) score, were compared via Wilcoxon test and the clinical outcomes were assessed by modified Rankin score (mRs) at 90 d after treatment.

A total of 11 patients were treated with double stents after single stent thrombectomy failed, 9 patients resulted in successfully recanalization (modified thrombolysis in cerebrai infarction score of 2b to 3), and 2 patients failed. There were 4 patients with symptomatic intracranial hemorrhage occurred after operation. Compared with preoperative conditions, the NIHSS score discharge from hospital was markedly lower (12 vs 16, P=0.012). At 90 d, 2 patients died (mRs 6), 3 patients seriously disabled (mRs 5), 1 patient moderately seriously disabled (mRs 4), 1 patient resulted in moderate outcome (mRs 3) and the other 4 patients achieved good outcome (mRs 0-2).

Double stent-retriever thrombectomy is safe and effective in the treatment of acute intracranial macrovascular occlusion at bifurcation with high vascular recanalization rate. It can be used as a rescue strategy for the failure of single stent thrombectomy.

To explore the effect of electroacupuncture (EA) with Quchi and Zusanli acupoints on the regulation of microRNA-34a (miR-34a) on the proliferation of reactive astrocytes in the ischemic peripheral area of rats with cerebral ischemia-reperfusion injury.

A total of 40 male rats were randomly assigned into sham group, model group, EA group, EA+miR-34a inhibitor group and EA+dimethyl sulfoxide (DMSO) group, with 8 rats in each group. Preparation of a left focal middle cerebral artery ischemia-reperfusion injury (MCAO) rat model using the Koizumi method. EA was applied at ipsilateral Quchi and Zusanli after operation, 30 min once a day until animals were sacrificed. The neurological scores of rats in each group before and after the EA intervention were compared, the behavioral Rat Rota-Rod test was performed after 3 d of the EA intervention, and the co-location condition of glial fibrillary acidic protein (GFAP) and 5-bromodeoxyuridine (Brdu) was detected by immunofluorescence staining; Reverse transcription real-time quantitative PCR was used to detect the relative expression of miR-34a in the ischemic peripheral area.

After 3 d of EA intervention, the neurological deficit symptoms and residence time on Rota-Rod rotating rod of MCAO rats were significantly improved compared to the EA group, with a statistically significant difference (P<0.05). The expression of miR-34a in the model group was significantly higher than that in the Sham surgery group, the expression of miR-34a in the EA group and the EA+DMSO group was higher than that in the model group, with a statistically significant difference (P<0.05). The expression of GFAP⁺/Brdu⁺ positive cells in the ischemic pericortical area of rats in both the model group and the EA group increased, and the increase was more significant in the EA group compared to the model group, the expression of GFAP⁺/Brdu⁺ positive cells in the EA+miR-34a inhibitor group was lower than that of the EA group and the EA+DMSO group, and the differences were statistically significant (P<0.05).

Electroacupuncture could promote the reactive astrocyte proliferation in ischemic peripheral areas by regulation of miR-34a expression.

To construct a predictive model of cerebral hemorrhage prognosis prognosis using multimodal medical data and machine learning, and to explore its predictive value.

A total of 400 cerebral hemorrhage data was retrospective analyzed, included 98 cerebral hemorrhage patients in the Neurology Department of Peking Union Medical College Shenzhen Hospital, Huazhong University of Science and Technology from January to December 2020 and 302 cerebral hemorrhage patients from the National Multicenter Intracranial Hemorrhage Database established by Peking Union Medical College Hospital from January to December 2020 to build an imaging database of cerebral hemorrhage, extract the labels of imaging omics and clinical related factors, and build a model to predict patients' prognosis. Another 100 patients with intracerebral hemorrhage in the Neurology Department of Peking Union Medical College Shenzhen Hospital, Huazhong University of Science and Technology from January to December 2021 were selected for prospective verification of the model.

The incidence of poor prognosis in 400 patients was 19.00%. The results of univariate analysis and multivariate logistic regression analysis showed that GCS score, systolic blood pressure, diastolic blood pressure, blood glucose, hematoma volume, peripheral edema volume, fibrinogen were all the influencing factors of poor prognosis (P<0.05). The sensitivity, specificity, accuracy and area under curve (AUC) [95% confidence interval (95%CI)] of self coding image feature clinical data model for predicting prognosis in patients with cerebral hemorrhage were 100.00%, 99.38%, 99.50% and 0.994 (0.935-0.998) respectively, which were higher than those of self coding image feature model and traditional model (P<0.05), and those of the self coding image feature model were higher than those of traditional model (P<0.05). After verification, the sensitivity, specificity, accuracy and AUC (95%CI) of the self coded image feature clinical data model for predicting prognosis in patients with cerebral hemorrhage were 100.00%, 97.47%, 98.00% and 0.974 (0.922-0.996) respectively.

The self coding image feature clinical data model based on multi-modal medical data and machine learning has high efficiency in predicting cerebral hemorrhage prognosis.

To investigate the correlation between the expression of tyrosine kinase 2 (TYK2) and signal transducers and activators of transcription 3 (STAT3) in non-functioning pituitary adenoma (NFPA) and invasiveness.

Clinical data and surgical specimens of 24 patients with NFPA treated in our hospital from June 2020 to May 2021 were collected and divided into invasive and non-invasive NFPA groups based on their pre-operative imaging and intra-operative information, comprising 12 patients for each group. TYK2 and STAT3 expressions in the NFPA tissues of the two groups were measured by quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemistry (IHC) and Western blotting, and the correlation among their expressions in NFPA and invasiveness was analysed.

The results of qRT-PCR, Western blot and immunohistochemistry showed that low TYK2 and high STAT3 expressed in the NFPA of the invasive group compared to the non-invasive group (P<0.05).

The expression of TYK2 in invasive NFPA is down-regulated and its low expression may be associated with NFPA invasiveness; The expression of STAT3 in invasive NFPA is up-regulated and its high expression may be associated with NFPA invasiveness.

To investigate whether edaravone pretreatment can prolong the thrombolytic time window of acute ischemic stroke (AIS) rat model and its mechanism.

Sixty-four healthy SD rats were randomly divided into sham operation group, AIS group, recombinant tissue plasminogen activator (rt-PA) treatment group and rt-PA+edaravone treatment group. The AIS model was constructed by autologous thrombosis. The neurological function of rats in each group was evaluated after AIS, and the volume of cerebral infarction was measured by TTC method; Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling was used to observe the changes of cell apoptosis in rats; The levels of ROS and superoxide dismutase (SOD) in brain were detected by enzyme-linked immunosorbent assay; The content of malondialdehyde (MDA) in brain was detected by thiobarbituric acid; The content of hemoglobin in brain was detected by colorimetry; The content of hemoglobin in brain was measured by hemoglobin assay; The protein expression level of ASC, TXNIP, Caspase-1, IL-18 and IL-1β related to ROS/TXNIP/NLRP3 pathway were detected by Western blot.

The Longa score of the rt-PA+edaravone treatment group was lower than that in the rt-PA treatment group after intravenous thrombolysis at 6 and 7 h, and the improvement of cerebral edema degree and cerebral infarction volume at different intervention time points were better than those in the rt-PA treatment group (P<0.05). The apoptosis rate was significantly lower than that in the AIS group and rt-PA treatment group, with a statistically significant difference (P<0.05). Compared with the rt-PA treatment group, the levels of ROS protein, MDA and hemoglobin of the rt-PA+edaravone treatment group after intravenous thrombolysis at 7 h were significantly reduced, and the SOD level after intravenous thrombolysis at 7 and 8 h were higher (P<0.05). The protein expression level of NLRP3, ASC, IL-18 and IL-1β of the rt-PA treatment group and rt-PA+edaravone treatment group after intravenous thrombolysis at 4.5 h were lower than those of AIS group, and the protein expression level of ASC, TXNIP, Caspase-1, IL-1 of rt-PA+edaravone treatment group after intravenous thrombolysis at 6 and 7 h were decreased (P<0.05). Compared with the rt-PA treatment group, the protein expression level of NLRP3 after intravenous thrombolysis at 6 h, the protein expression levels of ASC and TXNIP after intravenous thrombolysis at 7 h, and the protein expression level of IL-18 after intravenous thrombolysis at 7 and 8 h of the rt-PA+edaravone treatment group were decreased, with statistical significance (P<0.05).

Edaravone pretreatment can appropriately prolong the thrombolytic time window of rt-PA treatment in AIS rats, and its mechanism may be related to the participation of ROS/TXNIP/NLRP3 pathway.

To analysis the safety and efficiency of stereo-electroencephalography (SEEG)-guided multiple electrodes stereo-conformal radiofrequency thermocoagulation in the treatment of drug-resistant insular epilepsy.

Twenty-three patients with drug-resistant insular epilepsy, underwent SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation at Functional Neurosurgery Department of Sanbo Brain Hospital Capital Medical University were retrospective analyzed from February 2016 to January 2020. Standard presurgical evaluation, including semiology, video electro-encephalographic recordings, magnetic resonance imaging, positron emission tomography, and magneto-encephalography, were performed on all the 23 patients, suggesting that the epileptogenic focus located in the insula lobe. According to the diagnosis, electrodes implantation was designed. As the epileptogenic focus inside the insular lobe was verified, the multi-electrode stereo-conformed radiofrequency thermocoagulation treatment was performed. Patients were followed up in hospital, outpatient department or by telephone. Engel classification was used to evaluate the prognosis, and the operative complications were observed.

All the 23 patients were followed up at 3, 6, 12 and 24 months after surgery. By the last follow-up, 12 patients were seizure free (Engel grade Ⅰ), 5 patients had rare seizures (Engel gradeⅡ), 5 patients had seizure reduced by 75% (Engel grade Ⅲ), and 1 patient had a <75% seizure reduction (Engel grade Ⅳ). Two patients developed restorable deep sensory disturbance or motor aphasia after operation, all recovered within 1 month, without permanent neurological dysfunction.

As a minimally invasive, safe and effective treatment for the drug-resistant insular epilepsy patients, SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation can be a complementary treatment for resection surgery.

To observe the clinical effect of bevacizumab in the treatment of refractory brain edema.

Eight patients with refractory brain edema who were treated with regular dehydration and hormone for one week in the neurosurgical intensive care unit of Neurosurgery Department of Nanjin Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from July 2020 to June 2021 were selected as the research objects. All patients were given bevacizumab 200 mg, diluted to 0.8 mg/mL with 250 mL normal saline under sterile technology, and continued intravenous drip for more than 90 min. The amount of brain edema and the improvement of GCS score were compared before and after treatment.

For patients with refractory brain edema, bevacizumab could significantly improve brain edema. Imaging examination showed that brain edema was improved 2 d after treatment. The amount of brain edema measured 1 week after treatment of all patients were relieved compared with that before treatment, and the GCS score of all patients were higher than that before treatment.

Bevacizumab is effective in the treatment of neurosurgical refractory brain edema, which can reduce brain edema and improve the clinical prognosis.

To observe the clinical effect of early hyperbaric oxygen on traumatic cerebral infarction and analyze its safety.

From January 2018 to January 2021, a total of 68 patients with combined cerebral infarction and craniocerebral injury were treated in the Neurosurgery Department of the 901^st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army. According to the treatment method, the patients were divided into two groups. Among them, the control group (32 cases) received routine drug therapy and surgical treatment if necessary after hospitalization, while the treatment group (36 cases) received hyperbaric oxygen therapy after stabilization on the basis of the control group. A course of treatment lasted 10 d. The Fugl-Meyer Assessment (FMA) and the Neurological Deficit Scale (NDS) were used to evaluate the four-limb motor function and neurological deficit degree of patients before and 60 d after treatment. After 180 d of treatment, the modified Rankin scale (mRS) was used to assess the long-term efficacy, and Kaplan-Meier analysis was performed on the two groups of patients.

The FMA score of the two groups at 60 d after treatment was higher than that before treatment, while the NDS score at 60 d after treatment was lower than that before treatment (P<0.05); The FMA score of the treatment group at 60 d after treatment was higher than that of the control group, and the NDS score was lower than that of the control group (P<0.05). After 180 d of treatment, the mRS score of the treatment group was significantly better than that of the control group, and the Kaplan-Meier curve of the treatment group patients was significantly higher than that of the control group patients, with a statistically significant difference (P<0.05). No serious adverse reactions occurred in 2 groups.

Early hyperbaric oxygen therapy can improve the clinical efficacy of traumatic cerebral infarction patients, reduce their mortality, and no serious adverse reactions, worthy of clinical use.

To systematically evaluate the effectiveness of virtual reality (VR)-based administration of transcranial direct current stimulation on upper limb function in stroke patients.

A computer search of PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang Data was conducted to screen a randomised controlled study of upper limb function in stroke patients using transcranial direct current stimulation based on virtual reality technology. The PEDro scale and the Cochrane Risk Assessment Tool were used for quality assessment and risk of bias assessment. Meta-analysis, subgroup analysis, sensitivity analysis and publication bias analysis were performed on the included literature using Review Manager 5.3 software.

A total of 6 papers and 159 patients were included. The scores of Fugl-Meyer motor function scale, Black box testing, modified Ashworth spasticity scale and modified Barthel index in the test group were significantly different from those in the control group (MD=3.38, 95%CI: 0.57-6.19, P<0.05; MD=6.20, 95%CI: 2.67-9.74, P<0.05; MD=0.33, 95%CI: 0.62-0.05, P<0.05; MD=9.65, 95%CI: 4.28-15.01, P<0.05); There was no statistically significant difference in Wolf motor function scale task performance and completion time (MD=0.27, 95%CI: -0.63-1.16, P>0.05; MD=-0.25, 95%CI: -4.25-3.75, P>0.05).

Transcranial direct current stimulation based on virtual reality techniques is beneficial for the recovery of upper limb motor function in stroke patients, and has shown positive effects on improving manual dexterity, reducing muscle tone and improving quality of life.