In the past 20 years, with the continuous integration of cutting-edge technologies such as new equipments, new materials and artificial intelligence, neurointerventional radiology has developed rapidly. The therapeutic effect of neurointerventional radiology on cerebrovascular diseases such as intracranial aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistulas, acute large vessel occlusive stroke, and head and carotid atherosclerotic stenosis has been continuously improved, and the indications have been gradually expanded. Neurointerventional radiology has become the first-line or even preferred treatment for some diseases. This article reviews the clinical application status and possible development trend of neurointerventional radiology, so as to provide references for clinical practice.

Objective:To investigate the mechanism of recombinant human mesencephalic astrocyte-derived neurotrophic factor (rhMANF) in spinal cord injury (SCI) repair promoted by A2 reactive astrocyte polarization.Methods:One hundred and twenty female SPF SD rats were randomly divided into sham-operated group, SCI group, SCI+control group and SCI+rhMANF group ( n=30 in each group). SCI models were prepared by heavy drop method in the later 3 groups, and 10 μL sterile saline or 10 μL sterile saline+5 μg rhMANF were injected intrathecally in the later 2 groups 30 min after modeling. Basso-Beattie-Bresnahan (BBB) scale was used to evaluate the motor function in each group 1, 3, 7, 14, 21 and 28 days after injection. After behavioral assessment 3 days after injection, the protein expressions of ReIB, p52, phosphorylated (p)-ReIB and p-p52 in the spinal cord tissues were detected by Western blotting, and the expressions of anti-inflammatory cytokine and neurotrophic factor in the spinal cord tissues were detected by ELISA. After behavioral assessment 14 days after injection, immunofluorescent staining was performed to detect the expressions of neuronal nuclear antigen (NeuN), Syn and S100A10 in the spinal cord tissues. After behavioral assessment 28 days after injection, HE staining and uranyl acetate-lead citrate double staining were used to observe the pathological changes of the spinal cord under light microscope and electron microscope, respectively. Results:On 14, 21, and 28 days after injection, the BBB score in the SCI+rhMANF group was significantly higher than that in the SCI group and SCI+control group ( P<0.05). On 3 days after injection, the p-ReiB and p-p52 protein expressions in the SCI+rhMANF group (1.17±0.02 and 1.00±0.07) were significantly higher than those in the SCI group (0.74±0.01 and 0.42±0.11) and SCI+control group (0.79±0.00 and 0.64±0.02, P<0.05); the SCI+rhMANF group had significantly increased interleukin (IL)-4, IL-10, IL-13, neurotrophin-3, transforming growth factor-β and granulocyte colony-stimulating factor expressions ([217.58±16.06] pg/mg, [276.53±15.00]) pg/mg, [178.88±7.03] pg/mg, [172.61±16.43] pg/mg, [241.00±15.80] pg/mg, and [166.63±14.61] pg/mg) compared with the SCI group ([132.15±18.86] pg/mg, [173.48±18.24] pg/mg, [109.01±3.79] pg/mg, [104.64±18.21] pg/mg, [138.09±9.93] pg/mg, and [91.26±11.09] pg/mg), and SCI+control group ([137.80±27.70] pg/mg, [185.78±19.20] pg/mg, [112.44±13.51] pg/mg, [93.13±22.09] pg/mg, [159.48±32.50] pg/mg, and [112.67±18.32] pg/mg, P<0.05). On 14 days after injection, the immunofluorescent staining intensities of NeuN/S100A10, NeuN/Syn in the SCI+rhMANF group (2.51±0.24/2.85±0.27 and 2.48±0.35/1.92±0.32) were significantly higher than those in the SCI group (0.99±0.11/1.00±0.18 and 1.00±0.19/1.00±0.08) and SCI+control group (1.39±0.09/0.93±0.20 and 1.26±0.35/0.94±0.19, P<0.05). Light microscopy showed that the spinal cord nerve tissues in the SCI group and SCI+control group had loose structure, with edema and vacuolar degeneration; those in the sham-operated group and SCI+rhMANF group had dense structure, with round and cone-shaped neurons and large and round nucleus, and without vacuolar degeneration. Transmission electron microscopy showed intact structure of myelin sheath and axon in the sham-operated group, loose and shrunked spinal cord nerve cells (chromatin condensation, and cell membrane bleb formation) in the SCI group and SCI+control group, and relatively complete cell structure in the SCI+rhMANF group. Conclusion:The rhMANF can activate ReIB/P52 nuclear translocation phosphorylation, up-regulate the anti-inflammatory factor and neurotrophic factor expressions, induce the A2 astrocyte polarization, and promote the synaptic growth and spinal cord injury recovery.

Objective:To investigate the incidence of basal ganglia calcification (BGC), and risk factors for BGC in acute ischemic stroke (AIS) patients.Methods:A total of 730 patients with nervous system diseases hospitalized in Department of Neurology, Shanghai Punan Hospital of Pudong New Area from January 2023 to December 2023 were enrolled. These patients were divided into AIS group ( n=380) and non-AIS group ( n=350). Propensity score matching (PSM) was firstly used for 1:1 matching to eliminate the differences in baseline data of these patients; BGC incidence was compared between the two groups. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for BGC in AIS patients. Results:After PSM, there were 251 patients in the AIS group and 251 patients in the non-AIS group. No significant difference was noted between the two groups in age, gender, histories of hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking and drinking, ratio of previous stroke, and serum calcium, low-density lipoprotein cholesterol, homocysteine, uric acid, estimated glomerular filtration rate, or parathyroid hormone ( P>0.05). BGC incidence in the AIS group was 33.1% (83/251), with mild BGC in 55 patients (21.9%), moderate BGC in 19 patients (7.6%), and severe BGC in 9 patients (3.6%). BGC incidence in the AIS group was significantly higher than that in the non-AIS group (33.1% vs. 16.7%, P<0.05). Univariate and multivariate Logistic regression analyses showed that female ( OR=1.842, 95% CI: 1.021-3.324, P=0.043) and diabetes ( OR=1.953, 95% CI: 1.205-3.167, P=0.007) were independent risk factors for BGC in AIS patients. Conclusion:Compared with non-AIS patients, AIS patients trend to have BGC; female AIS patients with diabetes mellitus are more likely to have BGC.

Human brain organoids are three-dimensional miniature brain tissue models cultured from human stem cells, containing a variety of nerve cells and specific spatial organization structures, which can simulate key features of human brain development. Faced with the difficulties of obtaining human brain tissues and inability of animal models in reflecting the disease characteristics, brain-like organ models with similarities to brain function and structure have become a valuable tool for studying AD. This article reviews the development of brain-like organ models and their application in AD, and discusses how emerging technologies can achieve breakthroughs in AD research through brain-like organ models, with the aim of providing new ideas for early diagnosis and treatment of AD.

Microglia are specialized immune cells in the brain, primarily responsible for clearing debris and responding to inflammation. One of the pathological features of Alzheimer's disease (AD) is the extensive activation of immune system in the brain, and the dynamic changes and dysfunction of microglia could become key factors for AD progression. This article reviews the research progress of regulated effect of microglial on AD pathology, and summarizes its potential value in AD treatment, in order to provide theoretical basis for exploring new therapeutic strategies and intervention targets for AD.

Objective:To investigate the effect of hypericin (Hyp) on neurologic impairment, ferroptosis and cuproptosis in mice with acute cerebral infarction.Methods:Sixty 8-week old male C57BL/6 mice were randomly divided into sham-operated group, middle cerebral artery occlusion (MCAO) group, MCAO+Hyp low-dose treatment group (L-Hyp group), and MCAO+Hyp high-dose treatment group (H-Hyp group), with 15 mice in each group. Intraluminal filament MCAO models in the later 3 groups were established. Saline was given intraperitoneally into the sham-operated group and MCAO group, and Hyp was given intraperitoneally at 0.5 mg/kg or 1 mg/kg into the L-Hyp group and H-Hyp group 24 hours after modeling. Twenty-four hours after Hyp, neurologic function was assessed using Garcia score, grip strength test, and fatigue baton test; brain tissue edema was assessed by dry-wet weight method; neuronal necrosis, survival and apoptosis were detected by HE staining, Nissl staining and TUNEL, respectively; ferroptosis and oxidative stress were assessed using iron assay kit, and reactive oxygen species (ROS), malondialdehyde (MDA) and glutathione (GSH) assay kits; cuproptosis was assessed using copper assay kit and mitochondrial oxidative phosphorylation was evaluated by mitochondrial respiratory chain complex Ⅲ and Ⅳ activity detection kits; morphological changes in neuronal mitochondria after ferroptosis and cuproptosis were observed by electron microscopy; protein expressions of ferroptosis-associated solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), cuproptosis-associated solute carrier family 31 member 1 (SLC31A1), and ferredoxin 1 (FDX1) were detected by Western blotting.Results:(1) Compared with the MCAO group, the L-Hyp group and H-Hyp group had decreased modified Garcia score and brain water content, increased grip strength and rod-turning time, decreased number of necrotic and apoptotic neurons, increased number of survived neurons, decreased Fe 2+, ROS and MDA levels, increased GSH level and mitochondrial respiratory control rate, and decreased copper content, with significant differences ( P<0.05); and the above changes in the H-Hyp group were more obvious than those in the L-Hyp group, with significant differences ( P<0.05). Compared with the MCAO group, neurons in the L-Hyp group and H-Hyp group had significantly improved status in mitochondrial shrinkage, vacuolation, reduced cristulation, increased membrane density, ruptured cell membrane, endoplasmic reticulum damage and chromatin disruption ( P<0.05); and the H-Hyp group had signficantly more obvious improvement than the L-Hyp group ( P<0.05). (2) Compared with the MCAO group (0.38±0.09, 0.28±0.05), the L-Hyp group and H-Hyp group had significantly increased protein expressions of SLC7A11 and GPX4 (0.83±0.11, 0.49±0.06; 1.27±0.08, 0.84±0.04; P<0.05); the H-Hyp group had significantly higher SLC7A11 and GPX4 expressions than the L-Hyp group ( P<0.05). Compared with the MCAO group (2.76±0.17, 0.67±0.07), the L-Hyp group and H-Hyp group had significantly decreased protein expressions of SLC31A1 and FDX1 (1.72±0.07, 0.51±0.05; 1.12±0.06, 0.34±0.05; P<0.05); the H-Hyp group had significantly lower SLC31A1 and FDX1 expressions than the L-Hyp group ( P<0.05). Conclusion:Hyp can ameliorate ferroptosis and cuproptosis by regulating the protein expressions of SLC7A11, GPX4, SLC31A1 and FDX1, to alleviate oxidative stress injury in MCAO mice, thereby promoting the recovery of neurological function.

Objective:To explore the correlative factors for insomnia severity in chronic insomnia patients using MemTrax memory test.Methods:Two hundred and twenty-two chronic insomnia patients (insomnia≥3 days per week with a duration≥3 months) recruited from Center for Preventive Treatment of Diseases, Guangdong Provincial Hospital of Chinese Medicine or through in-hospital advertisements from April 2024 to September 2024 were chosen. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality over the last month; according to PSQI score, these patients were divided into mild insomnia group (scores of 7-10), moderate insomnia group (scores of 11-15) and severe insomnia group (scores of 16-21). MemTrax memory test was used to record the picture recognition accuracy and picture recognition reaction time, and MemTrax comprehensive index (MTx-Cp) was calculated; Patients' Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder-7 scale(GAD-7) were used to evaluate the depression and anxiety status of these patients in recent 2 weeks. The clinical data, MemTrax test results, PHQ-9 and GAD-7 scores of patients with different degrees of chronic insomnia were compared. Spearman rank correlation analysis was used to investigate the correlation between insomnia severity and clinical data such as cognitive memory function in chronic insomnia patients.Results:Among the 220 chronic insomnia patients, 54 had mild insomnia, 111 had moderate insomnia, and 55 had severe insomnia. Severe insomnia patients had significantly higher percentages of those>50 years old and those using hypnotics compared with mild insomnia patients and moderate insomnia patients ( P<0.05). Compared with the mild insomnia patients and moderate insomnia patients, the severe insomnia patients exhibited significantly lower picture recognition accuracy (90%[86%, 94%], 88%[82%, 94%], 84%[78%, 92%]), significantly lower MTx-Cp (88.55±18.67, 84.41±20.93, 76.69±17.43), and significantly higher PHQ-9 score (9[6, 11], 9[6, 15], 12[8, 16], P<0.05). Moreover, severe insomnia patients had significantly longer picture recognition reaction time and higher GAD-7 score than mild insomnia patients (1.11[1.03, 1.24] s vs. 1.04[0.90, 1.15] s; 7[5, 13] vs. 6[3, 9], P<0.05). Spearman rank correlation analysis showed that insomnia severity in chronic insomnia patients was positively correlated with age, PHQ-9 score, GAD-7 score, and picture recognition reaction time, and negatively correlated with picture recognition accuracy and MTx-Cp ( P<0.05). Conclusion:Insomnia severity in patients with chronic insomnia is correlated with age, cognitive memory function, depression and anxiety.

Objective:To investigate the clinical efficacy and major complications (postoperative hemorrhage and cerebral edema) of 3 surgical methods in spontaneous supratentorial intracerebral hemorrhage (SSICH).Methods:A retrospective analysis was performed; 294 patients with SSICH admitted to Department of Neurosurgery, Renmin Hospital of Wuhan University from December 2018 to October 2021 were selected. According to different surgical methods, these patients were divided into neuroendoscopic hematoma removal group ( n=126), stereotactic drilling and drainage group ( n=98), and craniotomy hematoma removal group ( n=70). The surgical efficacy and complications in the 3 groups were analyzed, and the postoperative residual hematoma and edema volumes were quantitatively calculated based on 3D Slicer software. Results:The hematoma evacuation rate in the neuroendoscopic hematoma removal group, stereotactic drilling and drainage group, and craniotomy hematoma removal group was 86.25%±2.27%, 44.45%±3.61%, and 75.45%±2.89%, respectively; Glasgow coma Scale scores at discharge were 13.51±1.28, 11.24±2.17 and 10.25±2.56, respectively; postoperative hemorrhage incidence was 16.1%, 26.0% and 22.9%, respectively; postoperative residual hematoma volume was (18.90±12.33) mL, (25.75±11.43) mL and (22.91±7.93) mL, and postoperative peak edema volume was (37.43±11.07) mL, (39.54±9.43) mL, and (42.26±10.94) mL, respectively; percentage of patients with peak edema on 3-5 days after surgery was 31.0%, 65.3% and 68.6%; the diameter of edema zone was (20.04±2.98) mm, (24.12±5.85) mm and (23.59±3.81) mm, respectively, on 7 days after surgery; percentage of patients with edema resolution was 45.2%, 24.5%, 42.9% and 76.2%, 57.1%, 62.9%, respectively, on 9-11 days and 12-14 days after surgery; these indexes in the neuroendoscopic hematoma removal group were significantly different compared with those in the other two groups ( P<0.05). Conclusion:Compared with stereotactic drilling and drainage or craniotomy hematoma removal, neuroendoscopic surgery can effectively remove the hematoma and reduce the occurrences of postoperative hemorrhage and brain edema.

Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To explore the safety and efficacy of intrasaccular flow disruptor in intracranial aneurysms, including wide-necked aneurysms.Methods:A retrospective analysis was performed; 102 patients with intracranial aneurysms treated with intrasaccular flow disruptor at Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from August 2022 to November 2024 were enrolled; their clinical and imaging data were collected. The aneurysm characteristics and perioperative complications were summarized; aneurysm occlusion was evaluated by Woven EndoBridge occlusion scale (WOS) immediately after surgery and during the follow-up period.Results:Among the 102 aneurysms, 33 were anterior cerebral artery aneurysms, 40 were middle cerebral artery aneurysms, 17 were internal carotid artery aneurysms and 12 were basilar artery aneurysms; 73 aneurysms were regular intracranial saccular aneurysms and 29 were irregular saccular ones (17 of them with daughter sacs); 12 aneurysms were ruptured at acute phase. The surgical success rate was 100%: single intrasaccular flow disruptor was implanted into 95 patients, and stent-assisted or salvage treatments were given to 7 patients). Immediately after surgery, WOS grading A was noted in 5 patients, grading B in 7, grading C in 31, and grading D in 59. Two patients suffered severe perioperative complications and passed away: one patient died for ischemic complications that ensued after stent salvage treatment (parent artery being compressed by intrasaccular flow disruptor); the other patient died for hemorrhagic complications triggered by rupture of an initially unruptured aneurysm following intrasaccular flow disruptor implantation. Among them, 52 patients completed postoperative DSA follow-up, with a median follow-up of 205 (168, 292) days; WOS grading A was noted in 31 patients, grading B in 9, grading C in 8, and grading D in 4 at the last follow-up; the full occlusion rate was 92.3%, and no ischemic or hemorrhagic adverse events occurred.Conclusion:Intrasaccular flow disruptor shows high short-term safety and good efficacy in the treatment of intracranial aneurysms.