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Delirium is a common complication in acute stroke patients, occurring in 15–35% of all stroke unit admissions and is associated with prolonged hospital stay and a poor post-stroke prognosis. Managing delirium in acute stroke patients necessitates an intensive and multiprofessional therapeutic approach, placing a significant burden on healthcare staff. However, dedicated practical recommendations for delirium management developed for the population of acute stroke patients are lacking. For this purpose, the Austrian Stroke Society, in cooperation with the Austrian Society of Neurology, the Austrian Society of Neurorehabilitation, and the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics has formulated an evidence-based position paper addressing the management of delirium in acute stroke patients. The paper outlines practical recommendations on the three pillars of care in stroke patients with delirium: (a) Key aspects of delirium prevention including stroke-specific delirium risk factors and delirium prediction scores are described. Moreover, a non-pharmacological delirium prevention bundle is presented. (b) The paper provides recommendations on timing and frequency of delirium screening to ensure early diagnosis of delirium in acute stroke patients. Moreover, it reports on the use of different delirium screening tools in stroke populations. (c) An overview of non-pharmacological and pharmacological treatment strategies in patients with delirium and acute stroke is presented and summarized as key recommendation statements.

The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.

Introduction: In the first part of this White Paper, the European Association of Neurosurgical Societies (EANS) Diversity in Neurosurgery Committee (DC) addressed the obstacles faced by neurosurgeons when planning to have a family and practice during pregnancy, attempting to enumerate potential, easily implementable solutions for departments to be more family-friendly and retain as well as foster talent of parent-neurosurgeons, regardless of their gender identity and/or sexual orientation. Attrition avoidance amongst parent-neurosurgeons is at the heart of these papers. Research question: In this second part, we address the obstacles posed by practice with children and measures to mitigate attrition rates among parent-neurosurgeons. For the methodology employed to compose this White Paper, please refer to Supplementary Electronic Materials (SEM) 1. Materials and methods: For composing these white papers, the European Association of Neurosurgical Societies (EANS)'s Diversity Committee (DC) recruited neurosurgeon volunteers from all member countries, including parents, aspiring parents, and individuals without any desire to have a family to create a diverse and representative working group (WG). Results: In spite of the prevailing heterogeneity in policies across the continent, common difficulties can be identified for both mothers and fathers considering the utilization of parental leave. Discussion and conclusion: Reconciliation of family and a neurosurgical career is challenging, especially for single parents. However, institutional support in form of childcare facilities and/or providers, guaranteed lactation breaks and rooms, flexible schedule models including telemedicine, and clear communication of policies can improve working conditions for parent-neurosurgeons, avoid their attrition, and foster family-friendly work environments.

Objective: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. Methods: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor variability from scanned images. MD and tremor variability were compared with 1) the Bain and Findley scale, 2) the Fahn–Tolosa–Marin tremor rating scale (FTM–TRS), and 3) the peak power and total power of the accelerometer spectra. Inter and intra loop widths were computed to differentiate between the tremor. Results: MD was higher in the tremor group (48.9 ± 26.3) than in HV (26.4 ± 5.3; p < 0.001). The cut-off value of 30.3 had 80.9% sensitivity and 76.0% specificity for the detection of the tremor [area under the curve: 0.83; 95% confidence index (CI): 0.75, 0.91, p < 0.001]. MD correlated with the Bain and Findley ratings (rho = 0.491, p = 0 < 0.001), FTM–TRS part B (rho = 0.260, p = 0.032) and accelerometric measures of postural tremor (total power, rho = 0.366, p < 0.001; peak power, rho = 0.402, p < 0.001). Minimum Detectable Change was 19.9%. Inter loop width distinguished Parkinson’s disease spirals from dystonic tremor (p < 0.001, 95% CI: 54.6, 211.1), essential tremor (p = 0.003, 95% CI: 28.5, 184.9), or HV (p = 0.036, 95% CI: -160.4, -3.9). Conclusion: The automated analysis of pen-on-paper spirals generated robust variables to quantify the tremor and putative variables to distinguish them from each other. Significance: This technique maybe useful for epidemiological surveys and follow-up studies on tremor.

Background: While substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS), a high percentage of treated patients still show progression and persistent inflammatory activity. Autologous haematopoietic stem cell transplantation (AHSCT) aims at eliminating a pathogenic immune repertoire through intense short-term immunosuppression that enables subsequent regeneration of a new and healthy immune system to re-establish immune tolerance for a long period of time. A number of mostly open-label, uncontrolled studies conducted over the past 20 years collected about 4000 cases. They uniformly reported high efficacy of AHSCT in controlling MS inflammatory disease activity, more markedly beneficial in relapsing-remitting MS. Immunological studies provided evidence for qualitative immune resetting following AHSCT. These data and improved safety profiles of transplantation procedures spurred interest in using AHSCT as a treatment option for MS. Objective: To develop expert consensus recommendations on AHSCT in Germany and outline a registry study project. Methods: An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of virtual meetings. Results: We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS based on the Swiss criteria. Current data indicate that patients who are most likely to benefit from AHSCT have relapsing-remitting MS and are young, ambulatory and have high disease activity. Treatment data with AHSCT will be collected within the German REgistry Cohort of autologous haematopoietic stem CeLl trAnsplantation In MS (RECLAIM). Conclusion: Further clinical trials, including registry-based analyses, are urgently needed to better define the patient characteristics, efficacy and safety profile of AHSCT compared with other high-efficacy therapies and to optimally position it as a treatment option in different MS disease stages.

IntroductionThe incidence of stroke is increasing steadily due to factors such as population aging. Approximately 80% of stroke survivors have motor disorders affecting their daily lives. Repetitive transcranial magnetic stimulation (rTMS) has been reported to maximize functional recovery after stroke along with exercise intervention in upper limb rehabilitation treatment. However, whether rTMS affects the recovery of upper limb function in patients with stroke remains unclear. Therefore, in this trial, we will investigate the efficacy of low-frequency rTMS in patients with subcortical and brainstem ischemic stroke.MethodsThis study has been designed as a multi-center, double-blind, randomized controlled trial to compare the efficacy of low-frequency rTMS over the contralesional M1 with sham stimulation. Overall, 88 participants will be allocated to the intervention or control group in a 1:1 ratio, with stratification according to their initial upper extremity Fugl-Meyer assessment (UE-FMA) score. The participants will receive either 30 min of real rTMS (intervention group) or sham rTMS (control group), followed by 30 min of occupational therapy for 10 consecutive workdays. All the participants will receive the same amount of rehabilitation therapy throughout the intervention period. Evaluations will be performed at baseline (T0), at the end of treatment (T1), and 4 weeks after the end of treatment (T2), including the box and block test (BBT), UE-FMA, Korean version of the Modified Barthel Index, and NIH Stroke Scale scores, Finger tapping test, Brunnstrom stage, modified Ashworth scale, and grip strength. The primary outcome will be the change in the BBT score between T0 and T2.ConclusionThis study will provide evidence on the efficacy of low-frequency rTMS in motor function recovery of the upper limb in patients with subacute, subcortical, and brainstem ischemic stroke.Clinical trial registrationClinicalTrials.gov, identifier [NCT05535504].

This article presents updated and revised diagnostic criteria for epilepsy syndromes proposed in 2021 by the Nosology and Definitions Taskforce of the International League Against Epilepsy (ILAE). The current classification of epilepsy syndromes was developed in 1989. The new ILAE Classification and Definition of Epilepsy Syndromes is a result of huge work of many experts from all over the world. The draft of the new classification is presented on the ILAE website for wide discussion. It includes 4 main sections: 1) classification and definition of epilepsy syndrome with onset in neonates and infants; 2) classification and definition of epilepsy syndromes with onset in childhood; 3) classification and definition of epilepsy syndromes with onset at a variable age; 4) definition of the idiopathic generalized epilepsy syndromes. Each section is based on a thorough analysis of literature and clinical experience of experts. Its main purpose is to identify epilepsy syndromes using the 2017 ILAE classification of epilepsy forms and types of epileptic seizures, as well as to identify specific characteristics of each syndrome to improve clinical diagnosis. For each syndrome, the document provides the details on its epidemiology, clinical manifestations, types of seizures, electroencephalographic features, neuroimaging signs, genetic examination, as well as differential diagnosis with other epilepsy syndromes and various non-epileptic conditions. It introduces mandatory criteria that must be present in order to diagnose the syndrome and alert criteria that are absent in the vast majority of cases within a syndrome, but rarely can be seen. Particular attention is paid to exclusionary criteria that must be absent in order to diagnose the syndrome. When developing the criteria for each epilepsy syndrome, the ILAE Task Force used the latest literature data, including Internet resources and the opinion of experts in this area. The international classification should be applied by specialists from all over the world. It should contain clear and easy-to-understand definitions; the language should be simple and understandable. The new ILAE classification demonstrates revised definitions of well-known electroclinical epilepsy syndromes and proposes a new concept of defining epilepsy syndromes by their etiology (including those syndromes in which pathogenic mutations or structural changes correlate significantly with certain electroclinical phenotype). It also introduces a new etiology-defined class of epilepsy syndromes characterized by specific genetic, metabolic, and structural causes. The document does not cover therapy for epilepsy syndromes; however, for some of them, it specifies the most effective or potentially aggravating antiepileptic drugs. The prospect of further targeted gene therapies development and approval of antiepileptic drugs specific for certain epilepsy syndromes after randomized clinical trials had served as a powerful motivation to introduce the concept of epilepsy syndromes determined primarily by etiology. In conclusion, the authors discuss the Classification and Definition of Epilepsy Syndromes, propose their ideas, comments, suggestions, and observations. This article aims to familiarize a wide range of specialists with the new ILAE classification and its details. In addition to a detailed description of the abovementioned document, the article provides information on the currently existing classification principles for epilepsy and epileptic seizures. There is also a discussion with the authors’ comments on the ILAE Classification and Definition of Epilepsy Syndromes.

Introduction: Family and work have immensely changed and become intertwined over the past half century for both men and women. Additionally, alongside to traditional family structures prevalent, other forms of families such as single parents, LGBTQ + parents, and bonus families are becoming more common. Previous studies have shown that surgical trainees regularly leave residency when considering becoming a parent due to the negative stigma associated with pregnancy during training, dissatisfaction with parental leave options, inadequate lactation and childcare support, and desire for greater mentorship on work-life integration. Indeed, parenthood is one of the factors contributing to attrition in surgical specialities, neurosurgery not being an exception. Research question: The Diversity in Neurosurgery Committee (DC) of the European Association of Neurosurgical Societies (EANS) recognizes the challenges individuals face in parenthood with neurosurgery and wishes to address them in this white paper. Materials and methods: In the following sections, the authors will focus on the issues pertaining to family planning and neurosurgical practice during pregnancy in itemized fashion based on an exhaustive literature search and will make recommendations to address the matters raised. Results: Potential solutions would be to further improve the work-family time ration as well as improving working conditions in the hospital. Discussion and conclusion: While many obstacles have been quoted in the literature pertaining to parenthood in medicine, and in neurosurgery specifically, initiatives can and should be undertaken to ensure not only retention of colleagues, but also to increase productivity and job satisfaction of those seeking to combine neurosurgery and a family life, regardless of their sexual identity and orientation.

During the second wave of COVID-19 pandemic, there is a sudden increase in number of cases mucormycosis infection in India. This communication by the Tropical Neurology subsection expert group of the Indian Academy of Neurology (IAN) describes the clinical and diagnostic features, treatment of the disease and gives recommendations about the ways forward.

Cognitive impairment in schizophrenia represents one of the main obstacles to clinical and functional recovery. This expert group paper brings together experts in schizophrenia treatment to discuss scientific progress in the domain of cognitive impairment to address cognitive impairments and their consequences in the most effective way. We report on the onset and course of cognitive deficits, linking them to the alterations in brain function and structure in schizophrenia and discussing their role in predicting the transition to psychosis in people at risk. We then address the assessment tools with reference to functioning and social cognition, examining the role of subjective measures and addressing new methods for measuring functional outcomes including technology based approaches. Finally, we briefly review treatment options for cognitive deficits, focusing on cognitive remediation programs, highlighting their effects on brain activity and conclude with the potential benefit of individualized integrated interventions combing cognitive remediation with other approaches.

Machine learning (ML), a form of artificial intelligence (AI), is being increasingly employed in neurology. Reported performance metrics often match or exceed the efficiency of average clinicians. The neurologist is easily baffled by the underlying concepts and terminologies associated with ML studies. The superlative performance metrics of ML algorithms often hide the opaque nature of its inner workings. Questions regarding ML model's interpretability and reproducibility of its results in real-world scenarios, need emphasis. Given an abundance of time and information, the expert clinician should be able to deliver comparable predictions to ML models, a useful benchmark while evaluating its performance. Predictive performance metrics of ML models should not be confused with causal inference between its input and output. ML and clinical gestalt should compete in a randomized controlled trial before they can complement each other for screening, triaging, providing second opinions and modifying treatment.

Long Zhen,1,2 Gang Wang,1 Gailing Xu,2 Le Xiao,1 Lei Feng,1 Xu Chen,1 Man Liu,1 Xuequan Zhu1 1The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders and Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China; 2Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin 300222, People’s Republic of ChinaCorrespondence: Gang WangThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of ChinaTel +86-13672146258Fax +86-02288188856Email andingyjs@163.comPurpose: Smartphone-based questionnaires have advantages compared with their paper versions, but there is a lack of consistent research on depressive disorder questionnaires. This study aimed to assess the equivalence between the paper and smartphone versions of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) and Patient Health Questionnaire-9 (PHQ-9) for patients with depressive disorders in psychiatric hospitals in China.Patients and Methods: This was a randomized crossover study of 110 depressed patients recruited from the outpatient department of Beijing Anding Hospital from March 2016 to September 2018. Group 1 completed both the QIDS-SR16 and PHQ-9 in paper format and then completed the smartphone version 1– 2 h later. Group 2 completed the scales in the reverse order. Reliability was evaluated using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI). The expected ICC was 0.9 (α=0.05).Results: The overall ICC score of the QIDS-SR16 paper and smartphone versions was 0.904 (95% CI: 0.861– 0.934), and the ICCs of each item ranged from 0.769 to 0.923. The overall ICC score of the PHQ-9 paper and smartphone versions was 0.951 (95% CI: 0.929– 0.967), and the ICCs of each item ranged from 0.779 to 0.914.Conclusion: This study demonstrated the equivalence of the paper and smartphone versions of the PHQ-9 and QIDS-SR16 in depressed patients in China.Keywords: depressive disorder, equivalence, intraclass correlation coefficient, questionnaires, smartphone

Abstract The regulations for fitness to drive after a cerebrovascular accident in the German Driving License Regulations (FeV) and the German Evaluation Guidelines for Driving Ability (BGL). are not up to date with the current medical knowledge and not consistent with regulations regarding cardiovascular diseases. This position paper presented by six medical and neuropsychological societies in Germany provides a guideline for the assessment of driving ability after diagnosis of a cerebrovascular disease and addresses three major questions: If there is a functional limitation, how can it be compensated for? What is the risk of sudden loss of control while driving in the future? Are there behavioral or personality changes or cognitive deficiencies interfering with safety while driving? Recommendations for the assessment of driving ability in different cerebrovascular diseases are presented. This article is a translation of the position paper published in Nervenarzt: Marx, P., Hamann, G.F., Busse, O. et al. Nervenarzt 90(4): 388–398.

Background: Neuropathic pain research has grown impressively in the past two decades, as evidenced by improvements in research quality and increments in the number of research papers. In views of this situation, the use of quantitative measurements to analyze and characterize existing research has become imperative. The aim of this research is to identify and analyze the 100 most-cited papers in neuropathic pain research.Methods: Neuropathic pain-related articles published between 2000 and 2020 were screened from Web of Science (WOS) by using the following subject terms: TI = (Neuralgia$ OR Neurodynia$ OR “Neuropathic pain” OR sciatica OR “Nerve pain$”). The publications were ranked in a descending order on the basis of citation counts, and the top 100 most-cited neuropathic pain papers were determined. Subsequently, we conducted a bibliometric study to determine the authors, journals, countries, and institutions that contributed the most to the top 100 neuropathic pain lists; describe the keywords and hotspots of the top 100 most-cited papers; and explore the factors associated with successful citations.Results: The top 100 most-cited papers were published from 2000 to 2017, and 2003 had the largest number of published papers (n = 16). The mean number of citations per paper was 480.72, with a range of 262–1,569. Forty-four kinds of journals contributed to the top 100 most-cited papers, which were predominantly published in “Pain” (n = 23). The USA was determined to be the leader of neuropathic pain research in terms of quality and quantity.Conclusion: This study provides a comprehensive list of the most influential papers on neuropathic pain and demonstrates the important advances in this field to help understand academic concerns and the directions of technological innovations in neuropathic pain worldwide.

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).

Background: A large number of published articlesexists, centered on pediatric and adult medulloblastomas. Objective: To accomplish a systematic review and meta-analysis concerningmedulloblastoma, focusing on the clinical features, diagnostic and currenttreatment modalities, as well as prognostic factors. Methods: In March 2020, we performed a title- focused search using Thomson Reuters Web of Science database in order to identify the most cited articles centered on adult and pediatric medulloblastomas. Results: Our search resulted in 4.779 articles, published from 1975 until March 2020. All of them combined have been cited 118,703 times, with an average citation per item of 24.84. The most cited article was published by Pomeroy SL, et al. in 2002 in Nature Journal, whereas the least cited one was published by Huang E., et al, in 2002. Conclusions: The aim of the study is, via the presentation of the 100 most cited papers focused on medulloblastoma, to describe their relevant contribution regarding advances in therapeutic prospects, prognosis, molecular characteristics andreconsideration of treatment protocols.We describe how, and to what degree, the treatment guidelines and management of this tumor have changed from 1975 to 2020. We reviewrecent advances in cancer genomics which have revealed 4 distinct subgroups of medulloblastomas, as well asthe importance of molecular biology on the development of new treatment features. We aim not only to answer the question: WHAT were the most cited publications, but also to approach the question of WHY the most-cited sources were so.

脑血流自动调节（cerebral autoregulation，CA）是血压变化时大脑维持足够脑灌注的内在能 力。过去的30年，研究者已经提出了诸多分析CA的方法，但至今无公认的金标准，采用什么方法定量 CA仍是个人主观的选择。尽管如此，由于CA的概念代表了血压（刺激或者输入信号）与脑血流（反应 或者输出信号）之间的动态关系，故目前最通用的研究血压自发波动的分析方法是传递函数分析。虽 然理论上可行，但是文献显示，传递函数分析方法在实践中存在相当大的主观性，这限制了研究之 间的比较，也阻碍了其临床应用。因此，本白皮书旨在规范化研究动态CA的传递函数分析方法的参 数及设置，建立标准，以利于其临床应用，该推荐的研发始于（但不限于）脑血流自动调节研究网络 （CARNet-www.car-net.org）。

Background: There is a vast amount of published articles, centered on tethered cord syndrome, which is related to a constellation of diverse pathological entities, included under the term occult spinal dysraphism. Objective: To present the 100 most-cited articles dedicated to the entity of tethered cord syndrome and to present a comprehensive review of the relevant literature. Methods: In April 2020, we executed a title- focused search using Thomson Reuters Web of Science database in order to identify the most cited articles relevant to tethered cord syndrome. Consequently, we reviewed the results to certify that they were relevant to the criteria of our research protocol. The 100 most cited papers were chosen and further analyzed. Results: Our search resulted in 769 articles, published from 1976 until now. All of them combined, have been cited 5.340 times, in a total of 2.097 different articles, with an average citation per item of 53.4.The most cited article was published by Yamada S., in 1981, while the last in our list was published by Walton, M et al in 1995. Conclusions: We distinguished the top 100 most-cited articles dedicated to tethered cord syndrome, all of which are demonstrating important aspects and conclusions, being well-supported and methodologically fully adequate. We also reviewed the relevant evolution of the concept of management and the knowledge of the natural history, as well as new data in tethered cord syndrome research, alongside with the relevant contributions of different authors, fields of special interest, and countries.

Background: There is a large amount of articles centered on ependymoma. Objective: To present the 100 most-cited articles on ependymoma and to perform a bibliometric analysis. Methods: We performed a search on January 2020, using Thomson Reuters Web of Science database to identify the most noteworthy papers about ependymomas, without publication date restrictions. The top 100 most cited articles were detected and reviewed. Results: Our search resulted in 4.254 articles, published from 1975 until now (January 2020). All articles are in English. All of them combined have been cited 10.128 times, in 4.531 different articles, with an average citation per item of 101.28. The article that was accompanied by the greatest citation count was published by Taylor, MD, et al in 2005. The paper has received 532 citations, with an average of 33,25 citations per year. Conclusions: A large proportion of the most cited articles were neither written by authors that were neurosurgeons, nor were published in neurosurgery journals. The review provided an excellent opportunity to summarize the historical development and advances achieved in the field of ependymoma and the important contributions of different authors, specialty fields, and countries.

Background: Surgery of brain tumors has made excellent progresses over time. Its characteristic is to be an extremely invasive surgery, becoming a limit that neurosurgeons have tried to overcome with the discovery of more and more modern diagnostic tools. Aim: In brain tumor surgery the aim is to excise the tumor without creating superior function deficits, so try to spare the so-called eloquent areas. Since the early twentieth century, neurosurgeons like Penfield and Ojemann have paid attention to the preservation of the language areas as well as of the motor pathways during brain surgery. Methods and results: Cortical electrical stimulation and brain mapping were used with good results. The problem was for a long time the invasiveness of the surgery which however foresaw a craniotomy. A few years ago a new and revolutionary technique has established itself. The diffusion tensor Imaging (DTI) is a non-invasive method that includes the use of MRI, allowing the study of white matter and therefore of the cortico-spinal tracts. Then, DTI tractography is able to distinguish normal nerve fibers from those infiltrated by the tumor, detecting pathological features of white matter such as axonal damage, ischemia, inflammation, edema. Conclusions: The literature is rich in cases related to the use of DTI in brain tumors, the results are excellent if one thinks of the saving of functionally important brain areas. Therefore, the excision of malignant tumors such as gliomas and glioblastomas is followed by a different and better outcome and a different quality of life. DTI tractography today represents the best and safest way of preserving the superior cortical functions in brain tumor surgery. Keywords: Diffusion tensor imaging, Tractography, Brain tumors

Magnetic resonance imaging (MRI) is the most important paraclinical tool for assessing drug response in multiple sclerosis (MS) clinical trials. As such, MRI has also been widely used in preclinical research to investigate drug efficacy and pathogenic aspects in MS animal models. Keeping track of all published preclinical imaging studies, and possible new therapeutic approaches, has become difficult considering the abundance of studies. Moreover, comparisons between studies are hampered by methodological differences, especially since small differences in an MRI protocol can lead to large differences in tissue contrast. We therefore provide a comprehensive qualitative overview of preclinical MRI studies in the field of neuroinflammatory and demyelinating diseases, aiming to summarize experimental setup, MRI methodology, and risk of bias. We also provide estimates of the effects of tested therapeutic interventions by a meta-analysis. Finally, to improve the standardization of preclinical experiments, we propose guidelines on technical aspects of MRI and reporting that can serve as a framework for future preclinical studies using MRI in MS animal models. By implementing these guidelines, clinical translation of findings will be facilitated, and could possibly reduce experimental animal numbers.

Abstract Body fluid biomarkers have great potential for different clinical purposes, including diagnosis, prognosis, patient stratification and treatment effect monitoring. This is exemplified by current use of several excellent biomarkers, such as the Alzheimer’s disease cerebrospinal fluid (CSF) biomarkers, anti-neuromyelitis optica antibodies and blood neurofilament light. We still, however, have a strong need for additional biomarkers and several gaps in their development and implementation should be filled. Examples of such gaps are i) limited knowledge of the causes of neurological diseases, and thus hypotheses about the best biomarkers to detect subclinical stages of these diseases; ii) the limited success translating discoveries obtained by e.g. initial mass spectrometry proteomic low-throughput studies into immunoassays for widespread clinical implementation; iii) lack of interaction among all stakeholders to optimise and adapt study designs throughout the biomarker development process to medical needs, which may change during the long period needed for biomarker development. The Society for CSF Analysis and Clinical Neurochemistry (established in 2015) has been founded as a concerted follow-up of large standardisation projects, including BIOMARKAPD and SOPHIA, and the BioMS-consortium. The main aims of the CSF society are to exchange high level international scientific experience, to facilitate the incorporation of CSF diagnostics into clinical practice and to give advice on inclusion of CSF analysis into clinical guidelines. The society has a broad scope, as its vision is that the gaps in development and implementation of biomarkers are shared among almost all neurological diseases and thus they can benefit from the activities of the society.

Abstract Background The original paper Self-Administered Gerocognitive Examination (SAGE) is a valid and reliable cognitive assessment tool used to identify individuals with mild cognitive impairment (MCI) or early dementia. We evaluated identical test questions in a digital format (eSAGE) made for tablet use with the goals of calibrating it against SAGE and establishing its association with other neuropsychological tests and clinical assessments of cognitive impairment. Methods Subjects aged 50 and over who had taken SAGE were recruited from community and clinic settings. Subjects were randomly selected to participate in a clinical evaluation including neuropsychological evaluations. SAGE and eSAGE were administered using a crossover design. Subjects were identified as dementia, MCI, or normal based on standard clinical criteria. Associations were investigated using Spearman correlations, linear regression, and sensitivity and specificity measures. Results Of the 426 subjects screened, 66 completed the evaluation. eSAGE score correlation to a battery of neuropsychological tests was 0.73 (p

Mohamed H Elshahidi Faculty of Medicine, Mansoura University, Mansoura, EgyptI read with interest the article by Kang et al,1 in which they reviewed the literature to summarize current evidence about spinal cord injury worldwide. Although the topic is interesting and important, some considerations of their review design are discussed. First, the authors have searched Embase, PubMed, Medline, and Web of Science. Although these databases index many of the published research, there are also other databases that should be considered. For example, Index Medicus for the Eastern Mediterranean Region (IMEMR) and African Index Medicus contain articles published in journals that are not indexed in some of these main databases. This affects the review’s ability to screen all available evidence in order to end up with a more accurate and sound summary of the literature. Also, this may lead to some limitations (database bias).2View the original paper by Kang and colleagues.

Tracey D Graves Department of Neurology, North West Anglia NHS Foundation Trust, Hinchingbrooke Hospital, Huntingdon, UKI have just read this article.1 I have issues with the authors denoting the insertion of CAG as a new mutation. This is located within a polyglutamine tract, which is known to be polymorphic in this gene. The normal number of CAG repeats in exon 47 of the CACNA1A gene ranges from 4 to 18; over 21 CAG repeats lead to the neurological condition SCA6.2 Indeed, in this paper, Lv et al1 call the mutation insertion c.6975_6976insCAG, that is, the insertion of one CAG codon; however, on the sequencing figure, the two affected members of the pedigree have 14 CAG repeats, whereas the control and unaffected descendant have 11 repeats. So, if they were going to call this a mutation, it would be an insertion of three CAG repeats. They also seem somewhat confused about the nature of this mutation, as in a later figure they suggest that the insertion of glutamine also causes deletion of alanine, which is not backed up by the data given on their sequencing figure, showing an in-frame insertion of CAG, which would not delete the following alanine residue.1View the original paper by Lv and colleagues.

Clinically, peripheral nerve reconstructions in neonates are most frequently applied in brachial plexus birth injuries. Most surgical concepts, however, have investigated nerve reconstructions in adult animal models. The immature neuromuscular system reacts differently to the effects of nerve lesion and surgery and is poorly investigated due to the lack of reliable experimental models. Here, we describe an experimental forelimb model in the neonatal rat, to study these effects on both the peripheral and central nervous systems. Within 24 hours after birth, three groups were prepared: In the nerve transfer group, a lesion of the musculocutaneous nerve was reconstructed by selectively transferring the ulnar nerve. In the negative control group, the musculocutaneous nerve was divided and not reconstructed and in the positive control group, a sham surgery was performed. The animal´s ability to adapt to nerve lesions and progressive improvement over time were depict by the Bertelli test, which observes the development of grooming. Twelve weeks postoperatively, animals were fully matured and the nerve transfer successfully reinnervated their target muscles, which was indicated by muscle force, muscle weight, and cross sectional area evaluation. On the contrary, no spontaneous regeneration was found in the negative control group. In the positive control group, reference values were established. Retrograde labeling indicated that the motoneuron pool of the ulnar nerve was reduced following nerve transfer. Due to this post-axotomy motoneuron death, a diminished amount of motoneurons reinnervated the biceps muscle in the nerve transfer group, when compared to the native motoneuron pool of the musculocutaneous nerve. These findings indicate that the immature neuromuscular system behaves profoundly different than similar lesions in adult rats and explains reduced muscle force. Ultimately, pathophysiologic adaptations are inevitable. The maturing neuromuscular system, however, utilizes neonatal capacity of regeneration and seizes a variety of compensation mechanism to restore a functional extremity. The above described neonatal rat model demonstrates a constant anatomy, suitable for nerve transfers and allows all standard neuromuscular analyses. Hence, detailed investigations on the pathophysiological changes and subsequent effects of trauma on the various levels within the neuromuscular system as well as neural reorganization of the neonatal rat may be elucidated. This study was approved by the Ethics Committee of the Medical University of Vienna and the Austrian Ministry for Research and Science (BMWF-66.009/0187-WF/V/3b/2015) on March 20, 2015.

After spinal cord injury, the upward conduction of the spinal cord is lost, resulting in the loss of micturition control, which manifests as detrusor sphincter dyssynergia and insufficient micturition. Studies have shown that serotonergic axons play important roles in the control of the descending urination tract. In this study, mouse models of moderate spinal cord contusions were established. The serotonin agonists quipazine (0.2 mg/kg), 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DAPT, 0.1 mg/kg), buspirone (1 mg/kg), sumatriptan (1 mg/kg), and rizatriptan (50 mg/kg), the serotonin reuptake inhibitors fluoxetine (20 mg/kg) and duloxetine (1 mg/kg), and the dopamine receptor agonist SKF-82197 (0.1 mg/kg) were intraperitoneally administered to the model mice 35 days post-injury in an acute manner. The voided stain on paper method and urodynamics revealed that fluoxetine reduced the amount of residual urine in the bladder and decreased bladder and external urethral sphincter pressure in a mouse model of moderate spinal cord injury. However, fluoxetine did not improve the micturition function in a mouse model of severe spinal cord injury. In contrast, the other serotonergic drugs had no effects on the micturition functions of spinal cord injury model mice. This study was ethically approved by the Institutional Animal Care and Use Committee of Jiangsu Province Hospital of Chinese Medicine (approval No. 2020DW-20-02) on September 11, 2020.

A structured reporting system which is based on a uniform template will permit uniform data collection and future statistics and will facilitate and validate independent or comparative audit of performance and quality of care. The successful establishment of a multi-center registry depends on the development of a concise data entry form, data entry system and data analysis to continuously maintain the registry. In the first phase we introduced the paper data collection form, in second phase this data form was converted to an electronic interface. In this second phase of the study the paper proforma which was developed in the first phase was converted into an electronic database by using the FileMaker Pro 13 Advanced®. The FileMaker Pro 13 Advanced® is capable to store the data, provides user friendly interface to enter data and can be converted the standalone runtime program to install in any other computer system. The next step is to explore the possibility whether it would be feasible to use this as a multi-center traumatic brain injury registry.

Abstract For centuries, the meninges have been described as three membranes: the inner pia, middle arachnoid and outer dura. It was therefore sensational when in early 2023 Science magazine published a report of a previously unrecognized — 4th — meningeal membrane located between the pia and arachnoid. Multiple features were claimed for this new membrane: a single cell layer marked by the transcription factor Prox1 that formed a barrier to low molecular weight substances and separated the subarachnoid space (SAS) into two fluid-filled compartments, not one as previously described. These features were further claimed to facilitate unidirectional glymphatic cerebrospinal fluid transport. These claims were immediately questioned by several researchers as misinterpretations of the authors’ own data. The critics argued that (i) the 4th meningeal membrane as claimed did not exist as a separate structure but was part of the arachnoid, (ii) the “outer SAS” compartment was likely an artifactual subdural space created by the experimental procedures, and (iii) the 4th membrane barrier property was confused with the arachnoid barrier. Subsequent publications in late 2023 indeed showed that Prox1 + cells are embedded within the arachnoid and located immediately inside of and firmly attached to the arachnoid barrier cells by adherens junctions and gap junctions. In a follow-up study, published in this journal, the lead authors of the Science paper Kjeld Møllgård and Maiken Nedergaard reported additional observations they claim support the existence of a 4th meningeal membrane and the compartmentalization of the SAS into two non-communicating spaces. Their minor modification to the original paper was the 4th meningeal membrane was better observable at the ventral side of the brain than at the dorsal side where it was originally reported. The authors also claimed support for the existence of a 4th meningeal membrane in classical literature. Here, we outline multiple concerns over the new data and interpretation and argue against the claim there is prior support in the literature for a 4th meningeal membrane.

Abstract The diagnosis of neurodegenerative diseases (NDDs) remains challenging, and existing therapeutic approaches demonstrate little efficacy. NDD drug delivery can be achieved through the utilization of nanostructures, hence enabling multimodal NDD theranostics. Nevertheless, both biomembrane and non-biomembrane nanostructures possess intrinsic shortcomings that must be addressed by hybridization to create novel nanostructures with versatile applications in NDD theranostics. Hybrid nanostructures display improved biocompatibility, inherent targeting capabilities, intelligent responsiveness, and controlled drug release. This paper provides a concise overview of the latest developments in hybrid nanostructures for NDD theranostics and emphasizes various engineering methodologies for the integration of diverse nanostructures, including liposomes, exosomes, cell membranes, and non-biomembrane nanostructures such as polymers, metals, and hydrogels. The use of a combination technique can significantly augment the precision, intelligence, and efficacy of hybrid nanostructures, therefore functioning as a more robust theranostic approach for NDDs. This paper also addresses the issues that arise in the therapeutic translation of hybrid nanostructures and explores potential future prospects in this field.

肺叶楔形切除术后围手术期并发急性缺血性卒中的发生率虽然不高，但严重者可导致终身残疾甚至死亡，影响患者预后，其发病机制目前仍不明确。本文报道了2例肺癌手术后并发急性缺血性卒中经介入取栓治疗的病例，病例1行胸腔镜下左肺上叶楔形切除术后当天，左侧大脑中动脉急性栓塞导致左侧大脑半球大面积梗死，经介入取栓治疗血管再通[脑梗死溶栓分级（TICI 3级）后，患者预后良好（NIHSS评分4分）。病例2行胸腔镜下右下肺楔形切除术后当天，基底动脉闭塞导致小脑大面积梗死，经介入取栓治疗后血管再通良好（TICI 3级），但患者术后脑水肿严重，最终放弃治疗。本文通过总结诊疗经验并回顾相关文献，分析肺叶楔形切除术后并发急性缺血性卒中的可能机制，以供临床参考。 Abstract: The incidence of acute ischemic stroke during the perioperative period after wedge resection of pulmonary lobes is not high, but it may lead to life-long disability and even death in severe cases, thus affecting the prognosis of patients. At present, the pathogenesis is still unclear. This paper reported two cases of interventional thrombectomy in patients with acute ischemic stroke after lung cancer surgery. Patient 1 underwent wedge resection of the upper lobe of the left lung under thoracoscope. On the same day, acute embolism of the left middle cerebral artery caused extensive infarction in the left cerebral hemisphere. After interventional thrombectomy and recanalization (TICI grade 3), the patient had a good prognosis (NIHSS score of 4). Patient 2 underwent the right inferior pulmonary wedge resection under thoracoscope. On the same day, basilar artery occlusion caused extensive cerebellar infarction. After interventional thrombectomy, the blood vessels reopened well (TICI grade 3), but the patient had severe postoperative brain edema and ultimately gave up treatment. This paper summarized the experience, reviewed relevant literature and analyzed the high-risk factors for acute ischemic stroke after wedge resection of pulmonary lobes, to provide a reference for clinical practice.

Abstract Chromosomal abnormalities are associated with a broad spectrum of clinical manifestations, one of the more commonly observed of which is epilepsy. The frequency, severity, and type of epileptic seizures vary according to the macro‐ and microrearrangements present. Even within a single chromosomal anomaly, we most often deal with a phenotypic spectrum. The aim of the study was to look for chromosomal rearrangements with a characteristic electroencephalographic pattern. Only a few disorders have peculiar electroclinical abnormalities: 1p36, 4p16, 6q terminal or trisomy 12p, Angelman syndrome, inv dup 15, 15q13.3 deletions, ring 20, Down syndrome, or Xp11.22–11.23 duplication. We also reviewed studies on epileptic seizures and typical electroencephalographic patterns described in certain chromosomal rearrangements, focusing on the quest for potential electroclinical biomarkers. The comprehensive review concludes with clinical presentations of the most common micro and macro chromosomal rearrangements, such as 17q21.31 microdeletion, 6q terminal deletion, 15q inv dup syndrome, 2q24.4 deletion, Xp11.22–11.23 duplication, 15q13.3 microdeletion, 1p36 terminal deletion, 5q14.3 microdeletion, and Xq28 duplication. The papers reviewed did not identify any specific interictal electroencephalographic patterns that were unique and significant biomarkers for a given chromosomal microrearrangement. The types of seizures described varied, with both generalized and focal seizures of various morphologies being reported. Patients with chromosomal anomalies may also meet the criteria for specific epileptic syndromes such as Infantile Epilepsy Spasms Syndrome (IESS, West syndrome): 16p13.11, 15q13.3 and 17q21.31 microdeletions, 5q inv dup. syndrome; Dravet syndrome (2q24.4 deletion), Lennox–Gastaut syndrome (15q11 duplication. 1q13.3, 5q inv dup.); or Self‐Limited Epilepsy with Autonomic Features (SeLEAS, Panayiotopoulos syndrome: terminal deletion of 6q.n), Self‐Limited Epilepsy with Centrotemporal Spikes (SeLECT): fragile X syndrome. It is essential to better characterize groups of patients to more accurately define patterns of epilepsy and EEG abnormalities. This could lead to new treatment strategies. Future research is required to better understand epileptic syndromes and chromosomal rearrangements. Plain Language Summary This paper presents EEG recording abnormalities in patients with various gene abnormalities that can cause epilepsy. The authors summarize these EEG variations based on a literature review to see if they occur frequently enough in other chromosomal abnormalities (in addition to those already known) to be a clue for further diagnosis.

Yuru He,1,2 Xing Wang,1,2 Zuowei Wang,3,4 Ping Zhang,5 Xiaojia Huang,3,4 Meihong Yu,5 Jill K Murphy,6 Erin E Michalak,6 Jing Liu,6 Tao Yang,1,2 Xiaorui Yang,7 Yiru Fang,1,8,9 Raymond W Lam,6 Jun Chen1,2 1Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China; 3Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, People’s Republic of China; 4Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, People’s Republic of China; 5Fengxian District Mental Health Center, Shanghai, People’s Republic of China; 6Department of Psychiatry, University of British Columbia, Vancouver, Canada; 7Department of Psychology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 8Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 9CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of ChinaCorrespondence: Jun Chen, Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People’s Republic of China, Tel +86 21-34773367, Email doctorcj2010@gmail.com Raymond W Lam, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada, Tel +1 604-822-7325, Email r.lam@ubc.caPurpose: To validate the efficacy of enhanced measurement-based care against standard measurement-based care in patients with major depressive disorder.Patients and Methods: In this pilot study of an ongoing multicenter cluster randomized controlled trails, 160 patients diagnosed with major depressive disorder were enrolled from 2 mental health centers, with a plan to include 12 centers in total. One hundred patients engaged in a six-month evaluation using a technology-enhanced measurement-based care tool, including assessments of clinical symptoms, side effects, and functionality at baseline, two months, four months and six months. Simultaneously, the remaining 60 patients underwent standard paper-based measurement-based care, utilizing the same set of scales over the same six-month period, with assessments at the same time points.Results: Patients utilizing the enhanced measurement-based care tool demonstrated a significantly higher reduction rate in PHQ-9 scores compared to those using standard paper-based measurement-based care during the two-month follow-up. Additionally, a notable positive correlation was observed between the frequency of enhanced measurement-based care tool usage and the quality of life during the two-month follow-up.Conclusion: Enhanced measurement-based care has the effect of reducing depressive symptoms. Our study emphasized that using enhanced measurement-based care via smartphones is a feasible tool for patients with major depressive disorder. Our future study, including results from additional research centers, may further validate the effectiveness of enhanced measurement-based care.Keywords: major depressive disorder, measurement-based care, enhanced measurement-based care, smartphone-based intervention

Abstract Background Maintaining the structural and functional integrity of the blood–brain barrier (BBB) is vital for neuronal equilibrium and optimal brain function. Disruptions to BBB performance are implicated in the pathology of neurodegenerative diseases. Main body Early indicators of multiple neurodegenerative disorders in humans and animal models include impaired BBB stability, regional cerebral blood flow shortfalls, and vascular inflammation associated with BBB dysfunction. Understanding the cellular and molecular mechanisms of BBB dysfunction in brain disorders is crucial for elucidating the sustenance of neural computations under pathological conditions and for developing treatments for these diseases. This paper initially explores the cellular and molecular definition of the BBB, along with the signaling pathways regulating BBB stability, cerebral blood flow, and vascular inflammation. Subsequently, we review current insights into BBB dynamics in Alzheimer’s disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. The paper concludes by proposing a unified mechanism whereby BBB dysfunction contributes to neurodegenerative disorders, highlights potential BBB-focused therapeutic strategies and targets, and outlines lessons learned and future research directions. Conclusions BBB breakdown significantly impacts the development and progression of neurodegenerative diseases, and unraveling the cellular and molecular mechanisms underlying BBB dysfunction is vital to elucidate how neural computations are sustained under pathological conditions and to devise therapeutic approaches.

Abstract Objectives The objective of this systematic review was (1) to give an overview of the available short screening instruments for the early detection of Alzheimer’s disease (AD) and (2) to review the psychometric properties of these instruments. Methods First, a systematic search of titles and abstracts of PubMed and Web of Science was conducted between February and July 2015 and updated in April 2016 and May 2018. Only papers written in English or Dutch were considered. All full-text papers about cognitive screening instruments for the early detection of AD were included, resulting in the identification of 38 pencil and paper tests and 12 computer tests. In a second step, the psychometric quality of these instruments was evaluated. Therefore, the same databases were searched again to identify papers that described the psychometric properties of the instruments meanwhile applying diagnostic criteria for the diagnostic groups included. Results Out of 1454 papers, 96 clearly discussed the psychometric properties of the instruments. Eighty-nine papers discussed pencil and paper tests of which 80 were validated in a memory clinic setting. Based on the number of studies (31 articles) and the sensitivity (84%) and specificity (74%) values, the Montreal Cognitive Assessment (MoCA) seems to be a promising (pencil and paper) screening test for memory clinic testing as well as for population screening. Regarding computer tests, validation studies were only available for 7 out of 12 tests. Conclusions A large number of screening tests for AD are available. However, most tests are only validated in a memory clinic setting and description of the psychometric properties of the instruments is limited. Especially, computer tests require further research. The MoCA is a promising instrument, but the specificity to detect early AD is rather low.

可逆性后部脑病综合征（posterior reversible encephalopathy syndrome，PRES）是一种以可逆性神经系统损害和特异性影像学表现为主的临床-影像学综合征，阵发性睡眠性血红蛋白尿症（paroxysmal nocturnal hemoglobinuria，PNH）是临床上的罕见疾病。本文介绍1例有PNH的老年男性患者，患者长期慢性溶血性贫血，不规律服用小剂量免疫抑制剂，短期间断输入共计10 U洗涤红细胞后，出现伴有头痛、痫性发作、精神行为异常、血压异常增高及微量蛛网膜下腔出血的PRES，此病需与脑静脉及静脉窦血栓形成和可逆性脑血管收缩综合征等疾病相鉴别。本文旨在提高临床医师对此类患者的预防、早期识别及应对能力。 Abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinical-imaging syndrome dominated by reversible neurological damage and specific imaging manifestations, and paroxysmal nocturnal hemoglobinuria (PNH) is a clinically rare disease. This paper described a case of an elderly male patient with PNH who had long-term chronic hemolytic anemia. After irregularly taking low-dose immunosuppressants and short-term intermittent infusion of 10 U of washed erythrocytes, he developed a PRES with headache, seizures, mental behavioural abnormalities, abnormally high blood pressure, and trace subarachnoid hemorrhage. It should be differentiated from diseases such as cerebral venous and venous sinus thrombosis and reversible cerebral vasoconstriction syndrome. The aim of this paper is to improve the clinicians’ ability to prevent and identify this type of patients at an early stage.

摘要： 预测模型是用来预测个体发生目标事件概率或预测结局值的统计模型。预测模型结果可视化展现是开发预测模型全流程中必不可少的一部分。良好的预测模型展现形式不仅可以使预测结果具有更好的可读性、可解释性，也在很大程度上决定了其使用方式和便利性。本文将详细介绍各种预测模型的展现形式，并阐述各自的优缺点。随后结合脑血管病临床预测模型研究，通过研究示例逐一介绍不同展现形式在脑血管病研究中的应用。 Abstract: A prediction model is a statistical model used to predict the probability of an individual with a target event or to predict the outcome value. Visualization of prediction model results is an essential part of the whole process of developing a prediction model. A good presentation of a prediction model can not only make the prediction results more readable and interpretable, but also determine its use and convenience to a large extent. This paper provided a detailed introduction to various forms of prediction model presentation and reported their advantages and disadvantages. Combining clinical prediction model research on cerebrovascular disease, this paper introduced the application of each presentation in cerebrovascular disease research through research examples.

目的 对卒中和血脑屏障相关文献进行文献计量学分析得到研究图谱，探索热点和发展趋势，为临床治疗和研究提供参考。 方法 在Web of Science核心数据库中检索2001年1月1日—2023年2月28日关于卒中和血脑屏障的文献，采用文献计量学方法，运用CiteSpace V6.1.R6对年份分布、国家/地区、研究机构/体系、作者、发行刊物、被引文献、关键词和研究趋势进行分析。 结果 筛选后共纳入文献5028篇，发文量整体呈上升趋势，美国对此的研究最多，其次是中国大陆、德国等。发文量排名前10位的研究机构/体系大多来自美国、法国和中国，各国家/地区和研究机构/体系之间的合作很紧密。在研究作者中，来自美国的Chopp Michael发表文章49篇，位列第1位。在研究趋势中，缺血性卒中、非编码RNA中miR-126、血脑屏障功能障碍和药物递送是近3年的热点。 结论 血脑屏障和卒中密不可分，卒中时血脑屏障的功能障碍和修复机制、血脑屏障所释放的循环生物标志物及利用血脑屏障开放时间增加药物吸收值得进一步研究。 Abstract: Objective A bibliometric analysis of the literature related to stroke and the blood-brain barrier was conducted to obtain a research map, explore hotspots and trends, and provide references for clinical treatment and research. Methods The literature related to stroke and blood-brain barrier from 1 January 2001 to 28 February 2023 was explored in the Web of Science core database. Using bibliometrics, CiteSpace V6.1.R6 was used to analyze the distribution of years, countries/regions, research institutions/system, authors, publications, cited literature, keywords and research trends. Results A total of 5028 papers were included after screening, with an overall upward trend in the number of published papers. The United States had the most research on this topic, followed by China’s mainland and Germany. Most of the top 10 research institutions/system were from the United States, France and China, with strong collaboration between countries/regions and research institutions/system. Among the authors, Chopp Michael from the United States ranked first with 49 papers. Among the research trends, ischemic stroke, miR-126 in non-coding RNA, blood-brain barrier dysfunction and drug delivery were the hot spots in the last three years. Conclusions Blood-brain barrier and stroke are inextricably linked. The dysfunction and repair mechanism of blood-brain barrier during stroke, the circulation biomarkers released by blood-brain barrier and the use of blood-brain barrier opening time to increase drug absorption are worthy of further study.

BackgroundParkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder primarily affecting the elderly. Relevant studies suggest a significant connection between the mitochondria and PD. Publications exploring this connection have steadily increased in recent years. This study employs a bibliometric approach to comprehensively analyze the current status and future directions of the research on mitochondria and PD.MethodWe retrieved data from the Web of Science database and used CiteSpace, VOSviewer, and “Bibliometrix” software to visually analyze various aspects of the research field. These aspects included the number of published papers, contributing countries and institutions, authors, publishing journals, cited references, and keywords.ResultsOur analysis identified a total of 3,291 publications involving 14,670 authors from 2,836 organizations across 78 countries. The publication volume exhibited a continuous upward trend from 1999 to 2023. The United States emerged as the leading force in this research area, contributing the highest number of high-quality publications. Notably, the United States collaborated extensively with Germany and the United Kingdom. The University of Pittsburgh stood out as the most prolific institution. Harvard University had the highest academic influence and closely cooperated with the University of Pittsburgh, Juntendo University, and McGill University. Dr. Hattori Nobutaka was identified as the most prolific author, while Dr. Youle, Richard J emerged as the most influential author based on the highest average citation frequency. The Journal of Neurochemistry was the most published journal. The most co-cited paper was titled “Hereditary early-onset Parkinson’s disease caused by mutations in PINK1.” The major keywords included oxidative stress, alpha-synuclein, pink1, mitophagy, and mitochondrial dysfunction. Mitofusin 2, ubiquitin, and mitochondrial quality control have been identified as new research hotspots in recent years.ConclusionMitochondria-PD research is experiencing a steady increase in activity, fueled by increasing close collaboration between countries and different institutions. However, there is a need to further strengthen collaboration and communication between developed and developing nations. Current research has focused on the specific mechanisms of mitochondrial dysfunction and their relationship with PD. Mitofusin 2, ubiquitin, and mitochondrial quality control are positioned to be the hotspots and future research directions.

Paragangliomas are rare tumors originating from the paraventricular bodies of the autonomic nervous system located in the adrenal glands, chest, abdomen, pelvis and head and neck. Tumors of this type account for 0.5% of head and neck cancers, 0.03% of all cancers and their incidence is estimated at 1–30/100,000 per year. Head and Neck Paragangliomas (HNPGL) are localized in carotid body, tympanic cavity or jugular foramen. It is established that HNPGL may be associated with mutations of the SDH complex, with SDHD being the most prevalent. However, SDHB, SDHC and SDHAF are also potential causes. The aforementioned mutations are influenced by various risk factors, including young age, a positive family history of paraganglioma, the presence of metastases and gender The purpose of this study is to summarize the results of genetic testing performed on patients with head and neck paraganglioma and to create an up-to-date genetic diagnosis algorithm for patients with HNPGL based on previous studies published in the literature that can be used in daily practice. Several papers observed that among SDHD mutation carriers, most or all of those studied had HNPGL, and SDHB mutations were more frequently found in the presence of metastasis. Based on the results, it was concluded that there is no basis for genetic testing for VHL in patients without a positive family history. In each algorithm proposed by different authors, proposals for rational genetic diagnosis were analyzed based on the studies cited by the author and the analyses included in our paper. For the analysis of the treatment algorithms, the following were included: Martin, Mannelli, Neumann, Gupta. Subsequently, publications related to the genetic diagnosis of HNPGL were analyzed to verify the proposed algorithms in light of the latest genetic studies and to establish an updated diagnostic management scheme.

BackgroundFrontotemporal dementia (FTD) is a neurodegenerative disease with clinical, pathological, and genetic heterogeneity. FTD is receiving increasing attention because it is the second leading cause of early-onset dementia after Alzheimer’s disease. This study aimed to analyse the research trends and hotspots of FTD from 2000 to 2022 using bibliometrics.MethodsPapers related to FTD from 2000 to 2020 were systematically searched through the Web of Science Core Collection (WOSCC). Citespace and Vosviewer software were used to visually analyse the retrieved data of countries/regions, institutions, journals, authors, references, and keywords. Microsoft Excel was used to generate the annual publications and growth trends.ResultsThere were 10,227 papers included in the bibliometric analysis. The annual publication output on FTD has increased significantly from 2000 to 2022, with papers published in 934 academic journals and 87 countries/regions. The Journal of Alzheimer’s Disease was the most popular, with 488 papers about FTD. The most productive countries/regions, institutions, and authors are the United States (n = 4,037), the University of California San Francisco (n = 687), and Miller, Bruce L. (n = 427), respectively. The article by Katya Rascovsky and her colleagues published on Brain in 2011 was the most cocited paper, with 625 citations. The research hotspots in this field were the clinical diagnostic criteria, subdivision, and pathological mechanism of FTD, such as tau protein, chromosome 17, progranulin, TDP-43, and C9orf72.ConclusionThe future research direction is based on biomarkers and pathological mechanisms to diagnose and differential diagnose FTD from the aspects of behavior, neuropathology, neuroimaging, and serum markers.

This paper reviews the current research progress in the application of Artificial Intelligence (AI) based on ischemic stroke imaging, analyzes the main challenges, and explores future research directions. This study emphasizes the application of AI in areas such as automatic segmentation of infarct areas, detection of large vessel occlusion, prediction of stroke outcomes, assessment of hemorrhagic transformation risk, forecasting of recurrent ischemic stroke risk, and automatic grading of collateral circulation. The research indicates that Machine Learning (ML) and Deep Learning (DL) technologies have tremendous potential for improving diagnostic accuracy, accelerating disease identification, and predicting disease progression and treatment responses. However, the clinical application of these technologies still faces challenges such as limitations in data volume, model interpretability, and the need for real-time monitoring and updating. Additionally, this paper discusses the prospects of applying large language models, such as the transformer architecture, in ischemic stroke imaging analysis, emphasizing the importance of establishing large public databases and the need for future research to focus on the interpretability of algorithms and the comprehensiveness of clinical decision support. Overall, AI has significant application value in the management of ischemic stroke; however, existing technological and practical challenges must be overcome to achieve its widespread application in clinical practice.