Objective To explore the change of gait of middle-aged and elderly people with mild cognitive impairment in the community,the correlation between gait and cognitive domain,and the role of gait in early recognition of cognitive decline. Methods 140 people over 40 years old in Tongxing Village,Yancheng City,Jiangsu Province were enrolled.The subjects were divided into normal cognitive group (n=64) and mild cognitive impairment group(n=76)through the Montreal Cognitive Assessment and the Minimum Mental State Examination,and gait tests were conducted at the same time.The data were collected and statistically analyzed to explore the difference of gait indicators between the two groups,the relationship between gait indicators and cognitive domains,and the ability of gait indicators to recognize mild cognitive impairment. Results The gait of the mild cognitive impairment group was worse than that of the normal cognitive group in terms of space (stride length,step height,step width) and time (step speed,stride speed,swing speed).Partial correlation analysis showed that step width was negatively correlated with delayed recall;Step size,step width and delayed recall,step height and naming were positively correlated.The logistic regression model constructed by step speed,stride length,stride speed,swing speed,step height and step width can reliably identify the existence of MCI (AUC=0.761,95%CI 0.683-0.840,P<0.05). Conclusion In the middle-aged and elderly community,the spatial and temporal performance of gait of patients with mild cognitive impairment is worse than that of the normal cognitive population.There is a close relationship between spatial indicators and delayed recall and naming.The temporal and spatial characteristics of gait have the potential to identify cognitive decline at an early stage.
Mild cognitive impairment

Previous studies have shown that botulinum toxin A can significantly reduce headache frequency and intensity and headache-related dysfunction in patients with chronic migraine.Recent evidence has discovered that multiple monoclonal antibodies targeting the calcitonin gene-related peptide （CGRP） pathway can also significantly improve the clinical outcome of chronic migraine.Few studies have compared the preventive effects of the two treatments for chronic migraine.This review focuses on the efficacy and safety of botulinum toxin A and monoclonal antibodies against CGRP and CGRP receptor （CGRPr） in the treatment of chronic migraine，as well as the effectiveness of CGRPr monoclonal antibodies following a poor response to botulinum toxin A，aiming to provide a reference for clinical treatment selection.

Migraine and cardiovascular disease （CVD） impose huge economic burdens on societies.Currently，research reports on the association of migraine with CVD are lacking.Recent studies have indicated that the incidence of CVD is significantly higher in patients with migraine compared with the general population.Therefore，this paper provides a concise review of the existing evidence linking migraine to CVD and the potential underlying mechanisms.

Vestibular migraine and patent foramen ovale are closely related conditions with linked incidence rates.This systematic review presents the potential pathophysiological mechanisms underlying the association of patent foramen ovale with vestibular migraine，delves into the clinical features and classifications of vestibular migraine as well as the shunt status and anatomical features of patent foramen ovale，and also discusses the outcome of vestibular migraine following a patent foramen ovale closure.Vasoactive peptide，microemboli，inflammation，and genetic theories have been proposed for the association of the two conditions.Although most studies support a link between vestibular migraine and patent foramen ovale，evidence is lacking to prove that patients with vestibular migraine can gain significant benefits from a patent foramen ovale closure，and moreover，the surgery-related serious adverse events and risks，such as atrial fibrillation and new-onset headache，need careful consideration.

N­methyl­D-aspartate （NMDA） receptors are ionotropic glutamate receptors that are widely expressed in the central nervous system.Through mediating Ca2+ influx for excitatory synaptic transmission，NMDA receptors play an important role in synaptic plasticity，learning，and memory.Migraine is a common primary headache that brings serious life and mental burdens to patients because of frequent attacks.The pathogenesis of migraine is still unclear.Glutamate and NMDA receptors have been demonstrated to be closely related to the occurrence of migraine.This paper reviews progress on the association of NMDA receptors with migraine and the use of NMDA receptor antagonists for the prevention and treatment of migraine，aiming to provide a reference for the pathogenesis and drug treatment of migraine.

Migraine is a common neurological disorder，with a significantly higher prevalence rate in women than in men，and more than half of female patients have headache attacks associated with menstruation.Migraine in women is closely associated with the changes in hormones during the menstrual cycle，and the effect of “estrogen withdrawal” might be one of the possible mechanisms.Changes in hormones may play an important role in the development of migraine.Understanding the relationship between changes in each life stage and physiological cycle of women and headache may help to develop individualized treatment strategies，thereby improving the symptoms and prognosis of patients.

Objective To investigate the etiology，clinical manifestations，imaging features，and treatment of superficial siderosis of the central nervous system （SSCNS）. Methods A patient confirmed with SSCNS was reported.Sixty-one patients confirmed with SSCNS were found through a search of China National Knowledge Infrastructure and Wanfang Data and were analyzed in categories for the epidemiology， etiology， clinical manifestations， and laboratory test results. Results Among the 61 patients with SSCNS reported in the literature， ataxia was the most common clinical symptom （49 cases， 80%）， followed by hearing loss （43 cases，70%） and pyramidal signs（30 cases， 49%）.A probable cause was found in 25 （39%） of these cases. Conclusion SSCNS can last for several years or even decades， with hearing loss， ataxia， and pyramidal signs as its main clinical symptoms.Magnetic resonance imaging is the most valuable basis for diagnosis， and susceptibility-weighted imaging is more sensitive in the diagnosis of microhemorrhage.

Objective To explore the mechanism of the gut microbiota metabolite trimethylamine-N-oxide （TMAO） acting on high mobility group box 1 （HMGB1）/NOD-like receptor protein 3 （NLRP3） to regulate inflammatory response after cerebral ischemia/reperfusion （I/R） injury in mice. Methods A mouse atherosclerosis model was established by feeding on TMAO and high-fat diet.A mouse model of middle cerebral artery occlusion （MCAO） was prepared using the suture method.Mice were randomly divided into sham group，2-week-TMAO-feeding group，and 6-week-TMAO-feeding group.After I/R injury，we measured the protein levels of NLRP3，HMGB1，cleaved interleukin-1β （Cle-IL-1β），and zonula occludens-1 （ZO-1） by Western blotting.After six weeks of TMAO feeding，mice were randomly divided into sham group，I/R group，TMAO+I/R group，and TMAO+DMB+I/R group.For each group，we scored neurological function，determined NLRP3，HMGB1，Cle-IL-1β，and ZO-1 protein expression by Western blot，measured brain infarct volume with TTC staining，and measured the water content of brain tissue. Results Compared with those of the sham group，NLRP3，HMGB1，and Cle-IL-1β protein expression increased significantly and ZO-1 decreased significantly with the length of TMAO feeding （all P<0.05）.Compared with the I/R group，the TMAO+I/R group showed a significant decline in neurological scores，significantly increased NLRP3，HMGB1，and Cle-IL-1β expression，significantly decreased ZO-1 expression，a significant increase in brain infarct volume，and a significant decrease in the water content of brain tissue （all P<0.05）.With DMB lowering TMAO，the TMAO+DMB+I/R group had significantly better neurological scores，significantly lower NLRP3，HMGB1，and Cle-IL-1β levels，a significantly increased ZO-1 level，and significantly reduced brain infarct volume and brain tissue water content，as compared with the TMAO+I/R group （all P<0.05）. Conclusion The gut microbiota metabolite TMAO can upregulate HMGB1/NLRP3-mediated inflammatory response in mice with cerebral I/R injury，worsening the breakdown of the blood-brain barrier to exacerbate brain tissue damage.

Objective To analyze the relationship between the levels of thrombo-inflammatory factors and the prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction （ACI）. Methods The 197 elderly patients with ACI admitted to our hospital from December 2020 to January 2023 were selected as study subjects. According to the prognosis of patients after intravenous thrombolysis， patients were divided into a good prognosis group （n=143） and a poor prognosis group （n=54）. The clinical data of patients in the two groups were compared. Multivariate analysis was used to identify independent risk predictors of poor prognosis in patients undergoing intravenous thrombolysis. The predictive value of thrombo-inflammatory factor levels for poor prognosis of intravenous thrombolysis in elderly patients with ACI was evaluated. A restricted cubic spline model was used to analyze the dose-response relationship between the levels of thrombo-inflammatory factors and the poor prognosis of intravenous thrombolysis in elderly patients with ACI. A nomograph model was constructed， and the effectiveness of the model was verified. Bootstrap resampling was used for external verification. Results Multivariate analysis results showed that the time from onset to receiving thrombolysis， pre-treatment National Institutes of Health Stroke Scale score，Trial of ORG 10 172 in Acute Stroke Treatment typing， monocyte chemoattractant protein-1，t-PA， sCD40L， and P-selectin levels were independent influencing factors for poor prognosis of patients undergoing intravenous thrombolysis （P<0.05）. The levels of thrombo-inflammatory factors had a certain predictive value for poor prognosis of patients undergoing intravenous thrombolysis， and the value of combined detection was higher than that of individual detection（area under the curve=820）. The dose-response relationship analysis results showed that when t-PA≤60 μg/L，the risk of poor prognosis increased with increasing t-PA level （HR 1.005，95%CI 1.003-1.007， P<0.001）；when t-PA>60 μg/L，the risk of poor prognosis almost no longer increased with increasing t-PA level （HR 1.003， 95%CI 1.001-1.006，P=0.614）. The C-index of the nomograph model was 0.814 and 0.823， and the area under the receiver operating characteristic curve was 0.861 and 0.843， indicating that the prediction model had good discrimination. The calibration curve fitted well， indicating high accuracy. The threshold probability of the clinical decision curve ranged from 0.03 to 0.95 and from 0.03 to 0.97， with a high net benefit value， indicating that the method was effective， safe， reliable， and practical. Conclusion The levels of thrombo-inflammatory factors have a certain impact on the prognosis of intravenous thrombolysis in elderly patients with ACI， and have a certain predictive value. The combined detection of various factors shows a higher predictive value.

Objective The purpose of this study is to explore the differences of urine metabolites in carotid atherosclerotic plaque patients of different sexes， explore the different pathogenesis of carotid atherosclerotic plaque in men and women， and try to explain the biological differences caused by gender. Methods Urine of 28 men and 14 women with carotid atherosclerotic plaque were collected and analyzed by ultraperformance liquid chromatography mass spectrometry （UPLC-MS）. Perform metabolomics data analysis based on the Metaboanalysis website to identify differential metabolites between male and female patients. In order to further understand the function of metabolites， biological function and pathway enrichment analysis were conducted on metabolites. Results There were significant differences in the expression of 34 metabolites in the urine of patients with carotid atherosclerotic plaque of different sexes. The functions of these metabolites are mainly enriched in histidine metabolism，β-Alanine metabolism， arginine biosynthesis，pantothenate and coenzyme A biosynthesis，and glutathione metabolism pathways. Conclusion There are significant differences in urine metabolic profiles between male and female patients with carotid atherosclerotic plaque.