The multifocal glioblastomas (GBM) are tumors with multiple discrete areas of contrast enhancing tumors which have considerably poorer prognosis than solitary GBM. Median overall survival of diagnosed patients almost twice as less than solitary presentation. We present a case report of multifocal GBM. A 72-year old right-handed male was evaluated at the Neuro-Oncology Clinic of Baylor Scott and White Hospital (Central Division). Patient presented at this hospital because of persistent progressive headaches, confusion, and an incident of fall. Physical evaluation revealed neurological impairments. Brain magnetic resonance imaging (MRI) revealed heterogeneous contrast enhancing lesions with associated vasogenic oedema. Patient underwent a stereotactic biopsy analysis of the larger lesion and pathology evaluation concluded an isocitrate dehydrogenase 1 and 2 wild type GBM with unmethylated O-6-methylguanine-DNA methyltransferase. Treatment remedies: Patient received 4 weeks concurrent radiation therapy along with combination of temozolomide at dose of 75 mg/m2 followed adjuvant temozolomide for 10 cycles with bevacizumab at 10 mg/kg every 2 weeks and Optune treatment. Post treatment evaluation: Repeat MRIs showed near complete resolution of the tumors at 26 months of treatment along with improvement of neurological status. Conclusion: Due to limitations of surgical manipulations in multifocal GBM diagnosed patients, combinational chemo and radiation therapy is the treatment of choice for most cases. Using additional novel treatment with non-invasive therapeutic device proven to be effective is another excellent approach to the established practice. Therefore, combination therapy of Optune plus temozolomide and bevacizumab might be a promising remedy for newly diagnosed multifocal glioblastomas.

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. It is a complex syndrome with heterogeneous aetiologies, pathogenesis and manifestations. Patients with PD may present with motor symptoms and various non-motor symptoms (NMSs). NMSs have been reported in almost every diagnosed case of PD and usually precede motor symptoms. Multiple factors have been proved to be associated with the occurrence of NMSs in PD, among which genetic differentiation is a featured one. With the development of sequencing techniques, an increasing number of NMS-related genetic factors have been identified. This article reviews some of the latest discoveries in this regard.

Acute ischemic stroke has the characteristics of high disability, lethality and recurrence rate, which seriously threatens the health of middle-aged and elderly people. This article describes the acute ischemic stroke with internal carotid artery occlusion as the main clinical feature and discusses its treatment strategy. Treatment remedies: clinical diagnosis was carried out based on the present medical history, physical examination and craniocerebral CT (computed tomography). Neurological function was improved by intravenous thrombolysis, cerebrovascular angiography was used to clarify cerebrovascular occlusion, cerebral blood supply was identified by CT perfusion, and neurological function recovery was followed up. After intravenous thrombolysis, the patient’s consciousness turned clear and the right limb muscle strength recovery was not obvious, but the patient did not receive bridging therapy. Cerebral angiography showed about 90% stenosis at the beginning of the left internal carotid artery, and the blood flow terminated at the C7 segment. Cerebral CT perfusion imaging showed decreased perfusion in the left cerebral hemisphere, but the patient did not receive carotid endarterectomy and vascular bypass treatment. Post treatment evaluating: follow-up showed that NIHSS (National Institute of Health stroke scale) score was significantly decreased and limb function was significantly restored. Conclusion: early intravenous thrombolytic therapy can help reduce the area of ischemic penumbra and improve long-term prognosis. Severe vascular stenosis can stimulate vascular compensation, significantly reduce the range of ischemia when thrombus occurs, and effectively reduce the disability rate without bridging therapy. Whether vascular stenosis and occlusion are treated by vascular bypass, etc., individualized plans should be made according to vascular compensation.

Schizophrenia is a typical mental disorder characterized by cognitive, social, and emotional impairments and by psychotic symptoms. For nearly a century, there have been ongoing discussions on the anatomical-functional connections between brain abnormalities and symptoms in patients with schizophrenia. Neuroimaging studies in such patients show abnormalities in the prefrontal cortex (PFC), a brain region that acts as an executive center in cognition processing. The disrupted brain connectivity between PFC and other brain structures (such as the limbic system, basal ganglia and thalamus) results in faulty information processing and cognition deficits. Dopamine receptors, which have his torically acted as vital targets in schizophrenia therapies, have complex roles in cognition. Here we reviewed dopamine’s role as a widespread neurotransmitter mediating the PFC-cognitive system. The imbalance of braindopamine level, especially the abnormal D1/D2receptors ratio, leads to dysfunctions in brain connectivity in patients with schizophrenia. Recent neurocognitive modeling studies suggest the imbalance of dopamine receptors affects the internal noise within brain networks, which may lead to reduced signal-to-noise ratio in the PFC neuron populations. Going forward, more researches focusing on the relationship between pharmacology and neurocognitive models are needed, in an effort to identify more effective and efficient ways to treat cognitive impairment in patients with schizophrenia.

Clinical observation shows that men and women are different in prevalence, symptoms, and responses to treatment of several psychiatric disorders, including schizophrenia. While the etiology of gender differences in schizophrenia is only partially understood, recent genetic studies suggest significant sex-specific pathways in the schizophrenia between men and women. More research is needed to understand the causal roles of sex differences in schizophrenia in order to ultimately develop sex-specific treatment of this serious mental illness. In the present review, we will outline the current evidence on the sex-related factors interaction with disease onset, symptoms and treatment of schizophrenia, and discuss the potential molecular mechanisms that may mediate their cooperative actions in schizophrenia pathogenesis.

Spinal cord injury (SCI) impairs the autonomic nervous system and is associated with dysfunction or failure of multiple organs. Rehabilitation after SCI is a complicated process that involves improvement of motor and sensory function and amelioration of complications. Accumulating evidence has demonstrated that melatonin treatment could protect the neural tissues of the spinal cord from secondary injury after SCI. Melatonin is an indoleamine naturally produced by the pineal gland and other tissues. It can easily cross the blood-brain barrier and has been shown to have neuroprotective properties in animal models with neurological injury, such as traumatic brain injury and SCI. We reviewed the potential mechanisms of melatonin treatment reducing SCI-related complications such as disruption of microcirculation, neurogenic bowel dysfunction, and circadian disorders.

Objective: Although lithium has been a commonly prescribed neurotrophic/neuroprotective mood-stabilizing agents, its effect on spontaneous brain activity in patients with bipolar depression remains unclear. The aim of this study is to reveal the basic mechanism underlying the pathological influences of lithium on resting-state brain function of bipolar depression patients. Methods: 97 subjects including 9 bipolar depression patients with lithium treatment, 19 bipolar depression patients without lithium treatment and 69 healthy controls, were recruited to participate in this study. Amplitude of low-frequency fluctuation (ALFF) and fractional amplitude of low-frequency fluctuation (fALFF) were used to capture the changes of spontaneous brain activity among different groups. In addition, further analysis in terms of Hamilton Depression Rating Scale, the number of depressive episodes, and illness duration in pooled bipolar depression patients were conducted, which combined FLEF and fALEF to identify the basic neural features of bipolar depression patients. Results: It was observed from the imaging results that both the bipolar depression patients receiving lithium treatment and healthy control subjects showed significantly decreased ALFF/fALFF values in the right anterior cingulate cortex and right middle frontal gyrus compared to that from the bipolar depression patients without lithium treatmetn. The ALFF values of the right middle temporal gyrus was also found to be negative related to the number of depressive episode and the total episodes. Conclusions: Our findings suggested that the bipolar depression subjects were identified to have abnormal ALFF/ fALFF in the cortico-limbic systems, including regions like right anterior cingulate cortex, bilateral middle frontal gyrus, right orbital frontal gyrus, and right middle temporal gyrus. In addition, it was also revealed that the decreased ALFF/fALFF in the right anterior cingulate cortex and right middle frontal gyrus might be a biomarker that is related to the lithium effects.

The presidential research program Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative was established 5 years ago in the United States; it has been a driving force of the United States government and private factors to promote technology development in basic and translational neuroscience research. We here summarize the research plan and recent progress in cellular neuroscience, electrical and optical engineering, chemical and systems neurobiology, and brain mapping technologies. The research plan recognizes the importance of identifying different cell populations and unknown cell types in the human brain and diseased models. Technological advances in multielectrode arrays and chemical flow measurement probes not only demonstrate the capacity of detecting neural activities in large areas, but also enable a new era of studying the neural coding information. Large-scale coordination of neuronal activity and brain mapping information will allow for the identification of therapeutic targets in neurological disorders, which is benefited by big data acquisition and analysis. Specifically, increased brain databases will expedite the dissection of thoughts, emotions, cognition, and will thereby help the development of better understanding and treatments of brain disorders. Since cell therapy demonstrates potential for regenerative medicine, the utilization of the newly advanced technologies may further improve the translational potentials and precision controls of transplanted grafts. The development of new diagnostic and therapeutic tools also requires international collaborations on science, technology, advocating, healthcare and medical ethics to advance the innovation and clinical practices.

Deep brain stimulation (DBS) has become an effective therapeutic option for neurological and psychiatric disorders such as Parkinson’s disease (PD), dystonia, and obsessive-compulsive disorder. The subthalamic nucleus (STN) and internal globus pallidus (GPi) are by far the most commonly used targets for DBS in the treatment of PD. However, STN/GPi stimulation sometimes causes side effects, including motor fluctuations, cognitive declines, and worse emotional experience, which affect patients’ postoperative quality of life. Recent invasive electrophysiological studies are driven by the desire to better understand the mechanisms of therapeutic actions and side effects of STN/GPi stimulation. These studies investigated the function of the STN and GPi in motor, cognitive and affective processes by recording single-neuron firing patterns during the surgery or local field potentials after the surgery. Here we review the relevant studies to provide an integrative picture of the functional roles of the STN and GPi within the basal ganglia loops for motor, cognition, and emotion. Previous studies suggested that STN and GPi gamma oscillations encode the strength and speed of voluntary movements (execution), whereas beta oscillations reflect the effort and demand of potential movements (preparation). In the cognitive domain, oscillatory beta activity in the STN is involved when people have to stop an inappropriate action or to suppress salient but task-irrelevant information, whereas theta/delta activity is associated with the adjustment of decision thresholds and cost-benefit trade-off. In the affective domain, STN activity in the alpha band may represent the valence and arousal of emotional information.

Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder characterized by a variable combination of autonomic failure, parkinsonism with poor response to levodopa, cerebellar ataxia and pyramidal symptoms. The pathological hallmark of MSA is the oligodendrocytic glial cytoplasmic inclusions (GCIs) consisting of α-synuclein, and so MSA, together with Parkinson’s disease (PD) and dementia with Lewy bodies (DLB), is an α-synucleinopathy. Currently few effective biomarkers have been identified for the diagnosis or prognosis of MSA, and there is no established therapy to delay its progression. In this review, we discuss the epidemiology, neuropathology, genetics, clinical presentation and diagnostic biomarkers of MSA, as well as recent advances in its treatment.

Physical medicine and rehabilitation focuses on the management of medical and functional consequences of disease and injury including relief of pain. The aging of populations worldwide presents an impending need for expansion of specialized healthcare services including neurorehabilitation. Stroke is a common neurological disease associated with aging, and resulted in 113 million Disability Adjusted Life Years lost worldwide in 2013. The medical rehabilitation team is well suited to manage the different aspects of disability and functioning, with significant benefits in terms of quality of life, societal and financial returns. Neurorehabilitation capacity building is important, along with establishment of standards for training, credentialing, accreditation, and continuing professional education.

In Parkinson’s disease (PD), the alpha-synuclein (α-syn) pathology occurs both in the enteric nervous system (ENS) and parasympathetic nerves in the early stage of PD, which precedes the central nervous system (CNS) pathology and is related to gastrointestinal dysfunction precedes the onset of motor symptoms in PD. Studies have shown that gut microbiota can affect brain activity through the microbiota-gut-brain axis in PD patients. They can promote the development of PD and might be the origin of PD. There are four communication routes between gut microbiota and brain, which respectively are the gut-brain’s neural network, endocrine system, gut immune system, and barrier paths which include intestinal mucosal barrier and blood-brain barrier (BBB). Based on the alteration of fecal microbiota composition in PD, it is worthwhile to investigate whether microbiota analysis could be used as a biomarker for premotor PD. As a potential therapy, fecal microbiota transplantation (FMT) may be a promising treatment for PD patients. Further studies are needed to elucidate the causal relationship between gut microbiota and PD.

Diffusion tensor imaging (DTI) technique can detect the dispersion of water molecules in the white matter of the spinal cord, the integrity of the spinal fiber bundle, and the pathological changes after injury. Clinically, DTI is sensitive to acute and chronic spinal cord injuries, and is most commonly used for the diagnosis of cervical spondylotic myelopathy, multiple sclerosis, secondary brain damage after spinal cord injury, and spinal nerve root damage. In animal studies involving rats, monkeys, cattle, cats, pigs, dogs, etc., DTI could quantitatively analyze the microstructural and pathological changes of the injured spinal cord and provide a powerful auxiliary diagnosis for behavioral evaluation.

Parkinson’s disease (PD) is the second most common neurodegenerative disease. Its most prominent pathological features are the loss of dopaminergic neurons in the substantia nigra pars compacta and the deposition of intraneuronal inclusions named Lewy bodies. Currently, the pathophysiological mechanisms of PD are not fully understood. Growing evidence suggests that insulin resistance, diabetes and PD share similar pathological processes. This raises the possibility that defective insulin signaling pathways contribute to the occurrence and development of PD. In this article, we firstly reviewed the evidence of insulin resistance from epidemiology, PD patients and animal models. We also explained the insulin signal pathways in central nervous system. We then showed the evidence that insulin resistance participates in the pathogenesis of PD via protein aggregation, mitochondrial dysfunction, neural inflammation and cognitive impairment. Finally, we introduced four categories of drugs that facilitate insulin signaling and their effects on neurodegeneration in PD.

Somatotroph adenomas lead to hypersecretion of growth hormones (GH) and may cause mass effects. Patients with somatotroph adenomas may present with acral and soft tissue enlargement, joint pain, heart and respiratory failure, diabetes mellitus and hypertension, resulting in increased morbidity and mortality. Early diagnosis and treatment are therefore important in prolonging life and improving quality of life. Recent studies depicted the landscape of genetic and epigenetic changes in sporadic somatotroph adenomas. New approaches are being developed for genetic testing, diagnosis and surveillance, which are helpful in early diagnosis, treatment and disease control of somatotroph adenomas. Data suggest that patients with somatotroph adenomas are best treated with multidisciplinary teams composed of neuro-endocrinologists, neurosurgeons, radiation oncologists and other specialists. This mini-review summarizes in a concise way the up-to-date discussion on the etiology, new diagnostic techniques and novel treatments of somatotroph adenomas.

Global cerebral ischemia/hypoxia may occur due to various causes such as cardiac arrest, shock, and asphyxiation. Even though the patient’s life may be saved after cardiopulmonary resuscitation, cerebral ischemia-reperfusion injury is likely to occur and often results in neurological dysfunction. Apart from motor and speech impediments, patients with such injury may also suffer from impaired higher-level cognitive functions such as learning and memory, placing a heavy burden on families and society. Brain areas associated with the limbic system include the hippocampus, corpus striatum, and amygdala, which are linked with cognitive function. Those brain regions are easily damaged by hypoxia, and since they are connected with the dopaminergic pathway, global cerebral ischemia-reperfusion can damage the dopaminergic pathway as well and affect the projection of dopaminergic neurons in the limbic system. This review article examines the feasibility of using dopamine, a neurotransmitter heavily involved in cognitive function, in experimental research and clinical treatment of global cerebral ischemia-reperfusion injury. Specifically, we examine the effects of dopamine on post-injury cognition and neuronal plasticity, with the ultimate goal of identifying a new tool for clinical treatment.

Objective: This case series study explored the application of ROSA (robot of stereotactic assistant) robotic-assisted endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus. Methods: Three patients (January 2016 - October 2017) diagnosed with hydrocephalus based on preoperative computed tomograph (CT) and magnetic resonance imaging (MRI) scans were recruited. Navigation planning scan was performed before operation. ROSA robot localization program was used to simulate and analyze the path planning of hydrocephalus ETV and store it in the system. All the three patients underwent robotic-assisted ETV. The patients’ clinical symptoms, imaging manifestations and related complications were evaluated, and a 3-month follow-up survey was conducted. Prognostic factors were also analyzed. Results: ETV under the guidance of ROSA robot was successfully performed on the three patients. CT, MRI and cerebrospinal fluid (CSF) cine showed that the ventricles were narrowed, that the velocity and flow of the stoma were normal, and that the CSF flow was smooth. After discharge, the symptoms of hydrocephalus were significantly improved. Localization of the robot and design of the surgical path were key to success of the operation. Conclusions: ROSA robotic-assisted ETV is a feasible procedure. The patients recovered well, and the symptoms relieved. More efforts are needed to optimize artificial intelligence and the application of precision treatment in the nervous system.

China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council introduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the government, how to implement them remains to be challenging. Like evidence-based medicine, comparative effective research (CER) which started in the US in 2000's can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both individual and population. It also may apply to the conditions of healthcare reform in China. And there are opportunities and challenges of conducting CER in our country. We suggest that the government should establish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.

Intracranial atherosclerotic disease (ICAD) is an important cause for ischemic stroke and transient ischemic stroke (TIA) throughout the world, especially in Asians, which is not fully appreciated, partly due to its inaccessibility and limitations of current neuroimaging methods. The computational fluid dynamics (CFD) modeling technique provides a novel approach to reveal the hemodynamic characteristics in ICAD, e.g., the distributions of pressure, wall shear stress and flow velocity.In this review article, we aim to provide an overview of the general methodology of CFD modeling in arterial stenotic diseases, the established application of this technique in coronary artery disease, and more importantly,perspectives and challenges of this technique in the investigation of ICAD. Promising findings of preliminary studies using a CFD model for hemodynamic analysis in ICAD warrant verifications. Further studies in this area will help rectify loopholes in the current secondary prevention strategy, and inform individualized treatment for ICAD patients in the near future.

No less than 17 Nobel Prizes have been awarded the area of neurosocience and no less than 40 laureates. The first prize was given to Camillo Golgi and Ramón y Cajal in 1906 and the last one so far, to John O’Keefe and May-Britt and Edvard I. Moser in 2014.
This presentation of the laureates will not follow the time sequence of the prizes. Instead, I have grouped them in different categories.

Repair and regeneration after spinal cord injury (SCI) is an unmet need and research into finding new avenues to achieve this are ongoing worldwide. Stem cells with their immense potential to proliferate and differentiate have been identified as prime candidates for spinal cord regeneration. Pre-clinical data on their efficacy has been very encouraging, especially in case of adult stem cells. Although clinical translation of these findings has not been so successful, due to the ease of obtaining autologous adult bone marrow stem cells and their perceived therapeutic potential, these cells have been offered as a “therapy” in many countries without any scientific evidence generated though a valid clinical trial. In this review, we attempt to highlight the need for conducting clinical trials and the challenges faced in case of emerging countries. The current scenario of regulations governing the use of stem cells in emerging countries is also discussed.

More women than men have Alzheimer’s disease (AD) or other dementias. There are a number of potential biological and social reasons for the sex difference in the risk of AD, such as women live longer than men on average, and estrogen depletion after menopause in women, biological or genetic variations, and education, occupation or rates of heart disease. Recent studies showed a link between reproductive history and dementia risk in women. Women with fertility history showed lower risk of dementia compared to women with no child. Other studies also suggested that women’s pregnancy history may influence AD’s risk. In this review, we will focus on the relationship between women fertility and cognition and discuss the potential role of sex hormones in the brain and cognition, especially on AD pathogenesis.

Trigeminal neuralgia (TN) is characterized by recurrent facial acupuncture like, electric shock like, burning like pain and other common clinical cranial nerve diseases in the trigeminal nerve distribution area. Around the world, people who are 40 or more are at risk. The incidence rate of TN of female is slightly higher than that of male and most of the affecting areas are on the right side unilaterally, which affects maxillary nerve and mandibular nerve, yet seldom ophthalmic nerve. Although controversy exists in the pathogenesis of TN, the most accepted theory is microvascular compression, which forces on the demyelination of the sensory axon of the trigeminal nerve root. Additionally, slight touch, conversation and chewing may cause intolerable pain. The diagnosis of TN mainly depends on clinical manifestation. The treatment mainly includes medicine, operation, and some supplementary methods. Among them, antiepileptics and tricyclic antidepressants are the first-line treatment. Surgical treatment is mainly used for patients with TN who have failed in drug treatment or have intolerable side effects. The methods of operation include destructive or non-destructive operation. Deep brain stimulation (DBS) and motor cortex stimulation (MCS) are new therapeutic techniques emerged recently. This method is expected to alleviate the refractory TN with poor drug control or ineffective conventional surgical treatment. At present,this method has not been approved for clinical treatment. Of course, more clinical data collection processes are in progress.

Abstract The quest to find novel therapeutics for mental and neurological disorders has been hindered by the lack of access to live human brain samples and relevant experimental models. Conventional 2D human pluripotent stem cell-derived neuronal cultures and animal models do not fully recapitulate many endogenous human biochemical processes and diseasephenotypes. Currently, the majority of candidate drugs obtained from preclinical testing in conventional systems does not usually translate into success and have a high failure rate in clinical trials. Recent advancements in bioengineering and stem cell technologies have resulted in three-dimensional brain-like tissues, such as oragnoids,which better resemble endogenous tissue and are more physiologically relevant than monolayer cultures. These brain-like tissues can bridge the gap between existing models and the patient, and may revolutionize the field of translational neuroscience. Here, we discuss utilities and challenges of using stem cell-derived human brain tissues in basic research and pharmacotherapy

As biomarkers are important in the early diagnosis of Alzheimer's disease (AD), the first collaborative work of recruiting early-onset familial AD (EOFAD) families in Canada and China was initiated in 2012. The registration networks have collected hundreds of pedigrees, for which genetic screening, neuropsychological tests and amyloid and tau imaging was used to study diagnostic biomarkers for preclinical and mild cognitive impairment (MCI) stages of AD. Besides identifying pedigrees with novel mutations in presenilins (PSENs)/amyloid precursor protein (APP), the program has benefited training of Chinese research fellows, AD clinical trials for prevention, the ethical concerns for clinical findings, and other collaborative projects with Chinese investigators. Further research of the collaborative program may facilitate the testing and clinical use of novel treatments for EOFAD and late onset AD and contribute to dementia prevention strategies in Canada and China.

Rasmussen's encephalitis (RE), which was first described by Rasmussen in 1958, is a rare, dispersed, and progressive neurological syndrome that is characterized by focal epilepsy, unilateral inflammation of the cerebral cortex, progressive hemiplegia and cognitive deterioration. The etiology of this syndrome remains under investigation, and it is hypothesized and widely accepted that RE is a T-cell-mediated autoimmune response. However, the antigenic epitopes and mechanisms are still unknown. The pathological characteristics of RE are cortical inflammation, neuronal loss, and gliosis that are confined to one cerebral hemisphere. Hemispherectomy remains the only cure for the seizures and cognitive deterioration associated with the disease, but this procedure results in inevitable functional loss in the brain. Compared with surgery, immunomodulatory treatments are expected to cause less neurological deficits, but with limited clinical effect.

Medical artificial intelligence (AI) in China is now on the eve of a massive surge. Despite great promise from this emerging field, there remain formidable pitfalls and obstacles, especially the challenges to current legal rules. We review the development of legal rules concerning medical AI in China, discuss risks of liability of commercial organizations and health care providers and whether current rules should be amended, and if so, what are the key issues to be addressed. Finally, we close by sketching possible ways forward for the legal and regulatory system.

Diffuse leptomeningeal glioneuronal tumor (DLGNT) in adolescent female is rare and easy to be misdiagnosed due to its nonspecificity. This article described the characteristics of an adolescent female DLGNT patient with no history of tumor whose first symptoms are headache and vision loss, and analyzed the causes why DLGNT is easy to be misdiagnosed as cryptococcal meningitis. Treatment remedies: the adolescent female presented with progressive exacerbations of headache, vomiting and vision loss after general treatment. Dynamic monitoring of routine biochemical changes in cerebrospinal fluid (CSF) found abnormal high CSF pressure and protein, repeated examination of antibodies and acid-fast bacilli were negative, and high-throughput pathogen gene examination excluded viral meningitis, tuberculous meningitis and other diseases. To save the optic nerve, the Ommaya capsule was implanted to reduce the intracranial pressure. After diagnostic antifungal treatment, the patient’s condition did not improve. To identify the etiology, extensive meningeal enhancement was eventually detected by enhanced magnetic resonance imaging (MRI), and highly atypical tumor cells were identified by repeated examination of fresh CSF cytology. Post treatment evaluating: for DLGNT, consult oncology. Meningeal biopsy and PET-CT (positron emission tomographycomputed tomography) examination were recommended, and intrathecal chemotherapy and whole-brain radiotherapy were performed according to the examination results. But the patient’s family refused to have a meningeal biopsy and asked to be released from the hospital. Conclusions: the adolescent female without a history of tumor can not rule out the disease, and cryptococcal meningitis also has meningeal enhancement. The gold standard for the diagnosis of DLGNT is to find cancer cells. There is no effective cure for DLGNT, the timely placement of Ommaya sac can significantly improve the quality of the patient’s life, and the active adoption of targeted therapy is expected to extend the patient’s survival.

Abstract Multiple sclerosis (MS) is characterized by neurological symptoms that are separated in time and space, which correlate with demyelination and white matter lesions. The conventional pathophysiological model is that an autoimmune reaction against the myelinated nerve sheath results in demyelination, accompanied by axon damage and the death of oligodendrocytes that produce myelin. There is no cure for MS, but current treatments are primarily aimed at suppressing the autoimmune reaction, with the goal of reducing demyelination. These treatments have limited efficacy and developing better treatments for MS remains an important goal. Here we argue that the autoimmune reaction may be secondary to neurodegeneration or neurotoxicity, and that protecting neurons from glutamate-mediated toxicity may be a better therapeutic strategy than targeting the immune system. We have recently demonstrated that a protein-protein interaction between the GluR2 subunit of the AMPA (α-Amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid) glutamate receptor and GAPDH (Glyceraldehyde 3-phosphate dehydrogenase) is elevated in human MS plaques and in an animal model of MS. Disrupting this interaction in a rodent model restores neurological function, preserves myelin, and protects neurons, oligodendrocytes and axons. The peptide we created to block the GluR2-GAPDH interaction also reduces immune system activation, suggesting that autoimmunity is not necessarily the primary etiology in MS. The GluR2-GAPDH interaction may promote cell death via increased calcium influx through non-GluR2-containing AMPA receptors, or through the p53 and Siah1 cell death pathways.

Parkinson’s disease (PD) was first discovered 200 years ago. The current gold standard of clinical treatment is still mainly levodopa replacement therapy. Traditional Chinese medicine is the foundation of traditional medicine in China. Chinese herbs and acupuncture both exhibit remarkable efficacy in the treatment of PD. Clinical studies on the treatment of PD using Chinese herbs have confirmed that the combined use of Chinese herbs and the levodopa formulation can significantly increase the treatment effect and reduce toxic side effects. Basic studies further confirmed that various Chinese herbs and their monomeric substances can protect dopaminergic neurons in PD models. The major mechanisms include anti-inflammation, anti-oxidant, anti-apoptosis, neuroprotection, mitochondrial function protection, and regulation of gut microbiota. The function of acupuncture in the treatment of PD has also gradually received extensive attention in China and other countries. Acupuncture not only has peculiar advantages in the improvement of symptoms of PD patients, but also can attenuate adverse drug reactions, delay disease progression, and increase the quality of life of patients. Basic studies further confirmed that acupuncture can improve many motor symptoms in animal models of PD and has cumulative effects and follow-up effects. The major mechanisms include dopaminergic neuron protection functions, anti-inflammation and anti-oxidant effects, and the regulation of related neurotransmitters and neural circuits. The clinical application of acupuncture and Chinese herbs still requires strict randomized, double-blind, controlled design, multi-centre and large-sample sizeevidence-based clinical studies and follow-up observations of long-term efficacy to support the effect. In addition, the multi-target and multi-pathway therapeutic mechanisms need further studies.