Alzheimer’s disease (AD) is the most common type of dementia and a major disease seriously endangering the health of the elderly. Clinical trials are the important parts of AD drug researches and development. In recent years, the update of international AD diagnostic criteria and the application of biomarkers provide new help to improve the scientificity and rationality of AD clinical trials. Based on the review of previous AD clinical trials and guidelines, and the advances of drug and intervention research designs for AD, the experts group wrote the guideline on AD drug clinical trials, which aims to further standardize AD drug clinical trials, promote the development of drug research, and provide support for the effectiveness and safety of clinical drugs in China.

Trigeminal neuralgia (TN) is a common severe painful disease, which seriously harms people's health. Percutaneous balloon compression (PBC) is one of the main treatment methods of TN, which provides a new direction for improving the scientific and rational treatment of TN. Based on searching the literature and guidelines on clinical treatment of TN, and combining the new progress of international TN treatment. The experts wrote the guideline on PBC for TN treatment, which aims to further standardize PBC for TN treatment, promote the progress of TN treatment, and provide effective and safe support for TN treatment.

Stroke has become a major nervous system disease that endangers human health. The key to cure is to solve the "bottleneck" problem of immediate diagnosis and treatment within the "1 h golden time" . In 2022, the "European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management" was published, which is the first mobile stroke unit (MSU) prehospital stroke management guide in the world. Guideline recommendations: For patients with confirmed acute ischemic stroke, using MSU for prehospital management can improve their clinical function, increase the rate of IVT treatment, and shorten the time to start thrombolytic therapy. For patients with intracranial hemorrhage, using MSU for prehospital management can increase the proportion of patients directly assigned to tertiary medical stroke centers without concern about short-term mortality. No relevant safety concerns were identified with MSU management in suspected stroke patients. This article will interpret this guideline to better guide clinical practice.

Periperial nerve stimulation (PNS) is a non-pharmacological intervention used to treat a variety of neurological disorders. This technique works by stimulating the peripheral nerves to regulate neural conduction and achieve the goal of treatment and symptom relief. In recent years, significant progress has been made in the clinical application and research of PNS. In the field of pain management, PNS has been widely used for the treatment of chronic pain, such as postherpetic neuralgia and diabetic peripheral neuropathy. It can reduce pain symptoms, improve quality of life, and reduce dependence on medications. In addition, PNS has also been applied in the treatment of other neurological disorders, such as migraines, arousal of comatose patients, and peripheral nerve injuries. Extensive research has been conducted in these areas of application, and many studies have shown the potential of PNS in improving symptoms, promoting rehabilitation, and enhancing quality of life. This article aims to provide an overview of the mechanisms and progress of PNS in the treatment of the aforementioned diseases.

Extracranial-intracranial (EC-IC) bypass surgery is a commonly used technique in neurosurgery, but abnormal perfusion caused by surgical operation can lead to postoperative complications such as new-onset cerebral ischemia and neurological dysfunction, which seriously affects the prognosis of patients. Intraoperative neurophysiological monitoring (IONM) can effectively identify early intraoperative ischemia, reduce surgical complications, and assess the improvement of cerebral perfusion after the establishment of EC-IC bypass. However, no relevant norms or consensus have been developed around the world. Based on the review of reported clinical evidence, our team developed this expert consensus after Delphi expert consultation, forming a consensus on 5 aspects: the significance of IONM for EC-IC bypass surgery, the method of IONM for EC-IC bypass surgery, indications and contraindications for IONM for EC-IC bypass surgery, the monitoring strategy and interpretation of IONM results for EC-IC bypass surgery in different diseases, and other notes. Based on the GRADE evidence level standard, this expert consensus combines the national expert opinions on neurophysiology and EC-IC bypass to give eight comments on the clinical practice of IONM for EC-IC bypass surgery.

Objective

To analyze the evolution of white matter microstructural integrity in acute ischemic stroke (AIS) patients with impaired cognitive functions using diffusion tensor imaging (DTI) and post-processing method based on tract based spatial statistics (TBSS), and to explore imaging biomarkers for early prediction of post-stroke cognitive impairment (PSCI).

Methods

A prospective study was conducted on 55 patients with cognitive impairment within 3 d after AIS who were hospitalized or followed up in the Neurology Department of Wusong Branch, Zhongshan Hospital Affiliated to Fudan University from August 2021 to April 2023.DTI scans and cognitive assessments were performed on all patients before and 6 months after treatment.According to the cognitive scores after 6 months, patients were divided into PSCI group and post-stroke non-cognitive impairment (N-PSCI)group.By TBSS,horizontally analyzed the differences in fractional anisotropy (FA) and mean diffusivity (MD) between two groups, and vertically analyzed the changes in FA and MD values before and 6 months after treatment within the group.

Results

Among the 55 patients, 4 patients lost contact, 3 patients refused further participation,and 1 patient died,47 patients were enrolled,including 22 in the PSCI group and 25 in the N-PSCI group.Compared with baseline, cognitive performance improved in 33 patients and remained unchanged in 14 patients after 6 months of treatment.Horizontal analysis between groups showed that the FA value of right superior longitudinal fasciculus (SLF) in the PSCI group was lower than that in the N-PSCI group before treatment, and the difference was statistically significant (P＜0.05).Longitudinal analysis showed that the dispersion of multiple white matter tracts (SLF, anterior thalamic radiation, corticospinal tract, etc.)recorded after 6 months of treatment worsened than those recorded before treatment in both groups with statistically significant (P＜0.05).

Conclusion

Patients with baseline impaired cognitive functions still have white matter microstructural damages at 6 months, even if their cognitive function has improved or returned to normal, which may have a negative impact on long-term cognition.The change of FA value of the right SLF fiber bundle has a certain predictive effect on the occurrence of PSCI.

Brain dysfunction after cardiopulmonary resuscitation is the main factor affecting the mortality and morbidity of patients. However, the treatment of global cerebral ischemia-reperfusion injury after cardiopulmonary resuscitation is still very limited. How to effectively protect the brain after global cerebral ischemia-reperfusion injury caused by cardiac arrest is a big problem to be solved urgently. This review is based on the concept, epidemiology, pathophysiological mechanisms and therapies of global cerebral ischemia reperfusion injury after cardiopulmonary resuscitation in order to introduce its research progress.

The typical characteristics of dystonia are slow involuntary movements， abnormal postures， and muscle tone fluctuations， which are common in children with cerebral palsy and have a significant impact on motor function， pain， sleep， and home care. Due to its complex etiology， there is currently no specific treatment method available. Drug and neurosurgical interventions are important treatment methods for improving muscle tone disorders， but their evidence-based basis is limited and lacks clinical application standards. In March 2024， an international expert group consisting of 10 research centers from 6 countries released the “Pharmacological and neurosurgical management of cerebral palsy and dystonia： Clinical practice guideline update”， which updated and supplemented the intervention recommendations published in 2018. It proposed 10 evidence-based recommendations for drug treatment and neurosurgical intervention in patients with cerebral palsy and Muscular Dysfunction to guide clinical application decision-making. This article interprets the key content of this guideline in conjunction with the consensus of Chinese experts in the diagnosis and treatment of muscle tone disorders， in order to provide guidance and reference for the treatment of cerebral palsy and muscle tone disorders in China.

Multi-modal three-dimensional (3D) image fusion technology can obtain multi-modal 3D image fusion of various anatomical structures by inputting two or more different digital 3D image data (CT, MR, DSA, etc.) into a post-processing workstation and using image fusion software for reconstruction, anatomical registration and image fusion. Among them, "image fusion" refers to the fusion technology, and "fusion image" is the fusion result. This fusion image can more comprehensively and accurately display the adjacent anatomical relationship of cerebrospinal vascular disease, which is conducive to the accurate diagnosis of cerebrospinal vascular disease and guide treatment plans. It can also further feedback the DSA system and navigation system to directly guide surgical treatment, so as to improve surgical efficacy and reducing surgical risk. This article reviews the establishment of multi-mode 3D image fusion technology system and its application in diagnosis and treatment of cerebrovascular disease.

Cardiovascular and cerebrovascular diseases are the leading causes of harm to human health and life， with the Jiangxi region located in a central area characterized by high incidence and mortality rates. Cardiogenic stroke （CES） accounts for 65% to 70% of all types of stroke. The prevention and treatment of CES are hindered by barriers between cardiology and neurology， and the diagnostic and treatment processes are not well standardized. This highlights the urgent need to optimize the current diagnosis and treatment procedures and improve specialized techniques， with a multidisciplinary and close cooperation system of“heart-brain treatment”. This consensus has been developed through the exploration of a series of scientific issues to guide clinical practice， promote the prevention and treatment of CES， and explore multidisciplinary collaborative diagnostic and treatment models. By leveraging a multidisciplinary， comprehensive diagnostic and treatment network， the aim is to establish a joint“screening-prevention-treatment”model across provincial，municipal，and county-level hospitals.

The diagnosis of cerebral edema mainly relies on traditional monitoring techniques such as CT and MRI, but traditional techniques often do not have the ideal monitoring method of economy, real-time dynamic, and bedside monitoring. At present, there are an increasing number of new Brain edema monitoring devices that are popular at home and abroad. These new non-invasive monitoring technologies are used to monitor the situation of brain edema in patients with craniocerebral injury and the profile of intracranial pressure in high-risk populations with craniocerebral diseases. It may play a key role in assisting and guiding the decision-making of specialized medical behavior. Therefore, a reliable, inexpensive and widely applicable brain edema monitoring technology has become an urgent need for scientific researchers, clinical staff and patients. This article reviews the research status and prospect of noninvasive brain edema monitoring techniques.

Chiari畸形是神经系统最常见的先天畸形之一，临床上以成人ChiariⅠ型多见，约50%~75%的患者合并脊髓空洞，患者一旦出现神经系统症状常会进行性恶化。枕下减压术是当今Chiari畸形的治疗共识，鉴于Chiari畸形的亚型和临床表现复杂多变，而且对该病的病理机制尚不完全清楚，加之目前缺乏相关的专家共识或指南，致使临床对Chiari畸形的诊断和治疗相当混乱，手术方式极不统一，临床效果千差万别，漏诊、误诊时有发生。为规范临床对Chiari畸形的手术治疗，本文重点对Chiari畸形的术前多维度评估和个体化的手术策略进行总结，以期提高Chiari畸形的临床疗效。