INTRODUCTION/AIMS:Nerve ultrasound is becoming increasingly important for diagnosing and monitoring peripheral nerve disorders in children. This research seeks to determine reference values for ultrasound cross-sectional area (CSA) and elastography of peripheral nerves in healthy children from northern China. METHODS:A total of 150 healthy children aged 2-16 years were recruited. To make the results more intuitive and applicable, the CSA data were divided into five age groups and the elastography data into two. The CSA measurements included nerves of the cervical region (C5, C6, vagus), upper limb (median, ulnar, radial), and lower limb (sciatic, tibial, common peroneal, sural). Shear wave velocity (SWV) measurements were performed solely on the median nerve in the right forearm. t Tests and analysis of variance (ANOVA) were used to compare the data. RESULTS:The average CSA of all nerves increased with age, particularly in the sciatic, tibial, and common peroneal nerves. No sex-based differences were observed in nerve CSA, which increased with weight and height. Among groups categorized by weight and height, significant differences were noted in the larger nerves, with the exception of the vagus and sural nerves. The mean median nerve SWV in this cohort was 3.48 ± 0.62 m/s, with no significant variations attributable to sex, age, height, weight, or CSA. DISCUSSION:In children, nerve CSA as measured by ultrasound changes with age, height, and weight, while median nerve SWV values remain consistent despite these variations.

IntroductionTranscranial sonography-magnetic resonance (TCS-MR) fusion imaging shows promise in neurodegenerative diseases, yet current echogenicity assessment methods remain controversial, and its role in differentiating Parkinson’s disease (PD) from multiple system atrophy-parkinsonian type (MSA-P) remains unknown.ObjectivesThis study aims to evaluate the diagnostic and differential value of TCS-MR fusion imaging for PD versus MSA-P.Patients and methods164 PD, 71 MSA-P, and 118 controls who underwent TCS-MR fusion imaging were prospectively enrolled. Substantia nigra hyperechogenicity (SNH) area was calculated. Three planes, designated as SN1, SN2 and SN3 from fusion images were analyzed using ImageJ for grayscale median and pixel count. ROC curves were employed to assess diagnostic and differential diagnostic power.ResultsStatistically significant differences were observed among the three groups concerning SN grades, area of SNH, the ratio of the area of SNH to the midbrain area (S/M), echogenicity of the bilateral SN1, SN3, left SNH, and the maximum echogenicity of SN1, as well as the pixel count of bilateral SNH (p < 0.05). The maximum echogenicity of SN1 and left SN1 demonstrated the highest diagnostic and differential performance for PD, with AUC values of 0.86 and 0.82 (both p < 0.001). Fusion parameters outperformed the SNH area and S/M in both diagnosis and differential diagnosis of PD (Z = 3.84 and 3.71, p < 0.01).ConclusionTCS-MR fusion imaging demonstrates superior diagnostic and differential performance for PD compared to traditional TCS measurements, suggesting its potential as a novel imaging technique in the diagnosis of PD.

Introduction:Against the backdrop of accelerating population aging, the risk of neurodegenerative diseases (NDDs) has risen significantly. While brain structure plays a critical role in NDDs, the interplay between them remains unclear. This study employed Mendelian randomization (MR) to investigate potential causal relationships between brain structure, region-specific gene expression, and four NDDs - Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS) - providing new directions and genetically informed hypotheses for disease research. Material and methods:MR analyses were conducted using inverse-variance weighted (IVW), MR-Egger, weighted median, weighted mode, and Wald ratio methods. Summary-data-based MR (SMR) was applied to identify brain genes influencing NDDs. We calculated F-statistics, 95% confidence intervals (CIs), odds ratios, and p-values. Sensitivity analyses included the heterogeneity I2 statistic, Cochran's Q test, Egger intercept test, MR-PRESSO, and leave-one-out validation. Results:Data from 512 unsupervised deep-learning imaging phenotypes (UDIPs) were analyzed. Thirty-four UDIPs showed associations consistent with a potential causal role in AD, 56 in PD, 22 in ALS, and 92 in MS. After false discovery rate (FDR) correction, 4 remained significant for AD and PD, 3 for ALS, and 28 for MS (p < 0.05). Brain regions (excluding the cervical spinal cord C-1) exhibited shared causal genetic features across all four NDDs, primarily involving HLA-class genes. Conclusions:This study provides genetic evidence suggestive of potential causal associations between UDIPs, brain gene expression, and NDDs. These findings offer genetically predicted evidence that may generate hypotheses and inform future mechanistic research into NDD pathogenesis.

Background: Cerebral hypoperfusion underlies ischemic encephalopathy. Computed tomography perfusion (CTP) is widely used to assess cerebral perfusion, but it requires ionizing radiation and iodinated contrast, which may limit serial follow-up examinations in some patients. This study developed an integrated cervicocerebral ultrasound (ICCUS)-based scoring system for staging stenosis-related hemodynamic compensation. Methods: This retrospective study included patients who underwent both ICCUS and CTP, with hemisphere-level analysis of the anterior circulation, between January 2020 and April 2025. CTP status was dichotomized as compensated (Stage I1-I2) or decompensated (Stage II1-II2). Candidate ICCUS variables comprised stenosis severity of the common carotid artery (CCA), internal carotid artery (ICA), and intracranial arteries, including the anterior cerebral artery (ACA) and middle cerebral artery (MCA), as well as collateral and communicating pathway status (patent vs. non-patent) via the anterior communicating artery (ACoA) and posterior communicating artery (PCoA), ophthalmic artery (OA), and leptomeningeal routes [ACA-MCA and posterior cerebral artery (PCA)-MCA)]. The variables associated with CTP Stage II by univariate logistic regression were converted into integer points [rounded odds ratios (ORs)] to construct a weighted score, and receiver operating characteristic (ROC) analysis was used for performance evaluation. Results: In total, 111 patients were included in the analysis, providing 222 hemisphere-level observations, of which 59 (26.6%) were classified as CTP Stage II. Age and sex were not associated with CTP Stage II (P=0.096 and P=0.624, respectively). Compared with mild stenosis, moderate and severe ICA stenosis were associated with CTP Stage II (OR =1.57 and OR =5.05, respectively; P<0.001). Severe ACA and MCA stenosis were also associated with CTP Stage II (OR =3.92, P=0.019; OR =8.00, P<0.001). Collateral recruitment via an open OA and the PCA-MCA leptomeningeal pathway was associated with CTP Stage II (OR =2.31, P=0.028; OR =2.28, P=0.036), whereas ACoA/PCoA and ACA-MCA patency showed no significant association with CTP Stage II (all P>0.05). The ICCUS score showed good discrimination for CTP Stage II [area under the curve (AUC) =0.845]; at a cut-off value of >4 points, its sensitivity and specificity were 74.6% and 81.6%, respectively. Conclusions: The ICCUS-based scoring framework provides a standardized, ultrasound-based approach for identifying CTP-defined anterior circulation decompensated hypoperfusion (CTP Stage II1-II2) and may support bedside triage and follow-up assessment.

PURPOSE:To assess the added diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating small breast lesions initially categorized as ACR BI-RADS 4A. MATERIALS AND METHODS:A total of 1595 patients with small breast lesions (≤ 20 mm) from 37 tertiary hospitals were enrolled from August 2021 to August 2022. B-mode ultrasound, color Doppler, and CEUS were performed to evaluate the lesions. The integration of CEUS led to the reclassification of BI-RADS 4A lesions into three pathways: upgrade to 4B, downgrade to 3, or no change in category. The diagnostic performance of CEUS was evaluated, and the contrast modes which could be used to correctly downgrade or upgrade BI-RADS 4A lesions were explored. RESULTS:A total of 1340 lesions were finally included in the analysis of CEUS performance. The average age of all included participants was 43 ± 8 (range from 20 to 84). The average diameter of the lesions was 12.4 ± 3.8 mm (range from 5 mm to 20 mm). The diagnostic performances of CEUS + BI-RADS were 98.3% for sensitivity, 81.7% for specificity, 34.1% for positive predictive value, 99.8% for negative predictive value, and 83.1% for overall accuracy, respectively. The sensitivity was slightly downgraded (98.3% vs. 100%, p = 0.1555), while the specificity and accuracy were greatly elevated (p < 0.05). The receiver operating characteristic curve (ROC) value was calculated using a binary classification threshold, with BI-RADS 3 as low-risk and BI-RADS 4A as high-risk. The area under ROC was 0.896 (95% CI: 0.878, 0.911) for BI-RADS + CEUS. The decision curve analysis showed that using CEUS + BI-RADS to guide biopsy decisions provided net benefit compared to the default strategy of biopsying all lesions. CONCLUSION:The addition of CEUS allows for the correct downgrading of most benign BI-RADS 4A lesions, thereby avoiding unnecessary biopsies. An upgrade from BI-RADS 4A to 4B on CEUS warrants immediate biopsy to ensure prompt diagnosis and treatment. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR2100050719.

Neurovascular coupling contributes to the regulation of cognitive function in Parkinson’s disease (PD). However, the correlation between structural and functional integrity of neurovascular unit in substantia nigra and cognitive impairment in PD remains poorly understood. Using super-resolution ultrasound imaging (SRUS), this study aimed to explore the interplay among dopaminergic neurons, microcirculation, and cognitive function in 6-hydroxydopamine-induced PD rat model. The model exhibited impaired motor and cognitive abilities, along with substantia nigra hyperechogenicity detected via transcranial sonography. SRUS revealed reduced microvascular density, complexity, and velocity, alongside increased vessel tortuosity in the substantia nigra. These changes were accompanied by elevated expression of MMP9, CD4, Iba 1, and GFAP, and decreased levels of TH, GLUT-1 and Laminin. Levodopa treatment prevented dopaminergic neurons degeneration, reduced substantia nigra hyperechogenicity, restored microvascular structure and function, as well as alleviated neuroinflammation, which may contribute to improved cognitive performance. These findings suggest that SRUS can effectively detect microvascular alterations in the substantia nigra in a 6-hydroxydopamine-induced PD rat model. Dysfunction neurovascular coupling, likely mediated by dopaminergic neuronal injury, may play a role in PD-related cognitive impairment.

Background:Parkinson's disease (PD), a common neurodegenerative disorder, severely affects patients' quality of life. This study aims to update the assessment of PD's prevalence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. Analyses were conducted at Socio-demographic Index (SDI), global, regional, and national levels, stratified by gender and age. Methods:PD data from the Global Burden of Disease (GBD) 2021 database was extracted. Trends in age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of PD were assessed, and estimated annual percentage change (EAPC) was calculated during the study period. Analyses were done by gender, age, GBD region, and SDI quintiles, using R statistical software for analyses and mapping. Results:In 2021, the global burden of PD remained substantial. The number of prevalent PD cases grew from 3,148,394.56 in 1990 to 11,767,271.97 in 2021 (a 2.74-fold increase). Incident cases rose from 417,134.69 to 1,335,142.12 (a 2.20-fold increase). Males exhibited higher prevalence, incidence, and mortality rates than females across almost all age groups. High-SDI regions had higher ASPR, ASIR, and ASDR values than low-SDI regions. Countries and regions in Asia, particularly China and Japan, exhibited among the highest ASPR and ASIR globally. Projections indicate global ASPR and ASIR will continue to rise substantially over the next three decades (to 2050), with males exhibiting a faster rate of increase than females, while the ASMR is predicted to remain essentially stable. Conclusion:This study systematically delineates the epidemiological landscape, temporal trends, and burden profiles of Parkinson's disease across global, regional, gender-stratified, and age-specific populations, providing an evidence-based framework to guide precision prevention strategies and optimize healthcare resource prioritization.

Occult cervical lymph node metastasis (CLNM) remains a clinically relevant issue in clinically node-negative (cN0) papillary thyroid carcinoma (PTC), while its preoperative prediction remains challenging. This study aimed to develop and internally validate a multimodal ultrasound-based nomogram for individualized prediction of occult CLNM in patients with cN0 PTC. This retrospective study included 204 patients with pathologically confirmed cN0 PTC who underwent preoperative conventional ultrasonography (US), superb microvascular imaging (SMI), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) between January 2020 and April 2022. Patients were randomly assigned to training (n = 143) and validation (n = 61) cohorts. Clinical characteristics and multimodal ultrasound features were analyzed. Candidate predictors were screened using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Conventional ultrasound and multimodal ultrasound nomograms were constructed and evaluated using receiver operating characteristic analysis, calibration curves, decision curve analysis (DCA), interobserver agreement analysis, and bootstrap internal validation. The multimodal ultrasound nomogram incorporated 12 predictors derived from conventional US, SWE, and CEUS features. The model achieved bootstrap-corrected AUCs of 0.849 (95

ObjectiveThe purpose of the study was to evaluate the anterior communicating artery (ACoA) patency in patients with suboptimal temporal bone windows who were scheduled for carotid endarterectomy (CEA), using contrast-enhanced transcranial color-coded real-time sonography (CE-TCCS) combined with common carotid artery compression (CCC) test.MethodA prospective analysis was conducted on 116 patients with suboptimal temporal bone windows who exhibited symptomatic carotid artery stenosis (sCAS). The display rates of intracranial circle of Willis (CoW) including anterior cerebral artery (ACA), middle cerebral artery, and posterior cerebral artery, were analyzed based on TCCS and CE-TCCS data. The functional patency of the ACoA was assessed by CE-TCCS with and without the CCC test, and the results were compared with the anatomical patency determined by CTA.ResultThe visualization rates of CoW were significantly improved in CE-TCCS (p < 0.001). CE-TCCS excluded 24 patients due to unilateral absence of the ACA-A1 segment. We assessed the patency of the ACoA in 92 patients. With CTA as the anatomical reference standard, CE-TCCS combined with CCC test yielded 94.67% sensitivity, 100% specificity and positive predictive value, 80.95% negative predictive value, and 95.65% overall diagnostic accuracy. Compared with CTA, CE-TCCS combined with CCC test showed no significant difference (p = 0.125) and excellent consistency (Kappa = 0.868, 95% CI: 0.743–0.993, p < 0.001), whereas standalone CE-TCCS differed significantly from CTA (p < 0.001) with poor consistency (Kappa = 0.126, 95% CI: 0.053–0.199, p = 0.013). The functional ACoA patency rate detected by CE-TCCS combined with CCC test was 77.2%, while 70.4% of patent cases were missed by CE-TCCS alone.ConclusionCE-TCCS significantly improve the display rate of intracranial CoW. CE-TCCS combined with the CCC test can serve as a reliable technique in preoperative evaluation of ACoA patency in patients with inadequate temporal bone windows.

Degeneration of dopaminergic neurons in substantia nigra and neuroinflammation caused by microglia is one of the basic pathological features of Parkinson's disease (PD). Currently, therapeutic strategies that enhance dopaminergic neuronal function while simultaneously mitigating neuroinflammation hold great promise but face significant challenges in clinical application. To address these challenges, we developed a neuron-derived exosome biomimetic multifunctional nanoregulator codelivered tyrosine hydroxylase (TH) mRNA and stimulator of interferon genes (STING) antagonist. This nanoregulator system simultaneously delivers TH mRNA to enhance dopaminergic neuronal function and activity while incorporating the STING antagonist H-151 to promote microglial polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype, effectively suppressing neuroinflammation. Both in vitro and in vivo studies demonstrate that via mRNA therapy can precisely target and regulate dopamine (DA) synthesis, and that combined anti-inflammatory treatment effectively enhances this effect, significantly alleviating motor dysfunction in PD mice. Our findings present an effective approach for the development of PD medications and the advanced delivery of mRNA nanomedicines. This innovative nanoregulator represents a promising therapeutic strategy for managing neuroinflammation and improving dopaminergic neuronal function in PD by merging mRNA-based gene therapy with neuroinflammation modulation, addressing DA deficiency at its root and overcoming the current treatment obstacles in PD.

Shear wave elastography (SWE) quantifies tissue stiffness and has demonstrated utility in oncological imaging, but its application to intramedullary spinal cord tumors remains limited. This study evaluated the feasibility and utility of intraoperative SWE for characterizing stiffness properties of intramedullary tumors. We prospectively enrolled 20 patients undergoing intramedullary tumor resection. Intraoperative B-mode and SWE imaging were performed before dural opening. Elastographic parameters were compared across histological grades and tumor types. Of 20 enrolled patients, 15 were included in the final analysis after excluding 4 with inadequate surgical exposure (< 7.5 cm) and 1 due to equipment unavailability. SWE successfully quantified tumor stiffness in all 15 cases without complications. High-grade gliomas (WHO grade 4, n = 2) demonstrated significantly higher stiffness than low-grade tumors (median Emean 69.8 vs. 13.8 kPa, p = 0.038). Within the low-grade cohort (n = 13), no significant stiffness difference was observed between astrocytomas and ependymomas (p = 0.171). Additionally, exploratory analysis in low-grade tumors (n = 13) revealed an association between higher tumor stiffness and better 12-month functional outcomes as measured by the Japanese Orthopedic Association score (p = 0.030). Intraoperative SWE is feasible and safe for real-time quantitative stiffness quantification of intramedullary tumors. These exploratory findings suggest potential utility for tumor grading and prognostic stratification, warranting validation in larger prospective cohorts.

OBJECTIVE:This study aims to investigate the correlation between the triglyceride-glucose (TyG) index and intraplaque neovascularization (IPN), evaluate the predictive efficacy of the TyG index for massive IPN, and provide novel serological markers for the early clinical identification of vulnerable plaques. METHODS:A total of 308 patients enrolled between May 2019 and December 2024 were included. IPN (0-3) was graded by Contrast-enhanced ultrasound (CEUS) and dichotomized (Grade I: none/minimal neovascularization, Grade II: extensive neovascularization). The association between the TyG and Grade II and its predictive performance were evaluated. RESULTS:The proportion of IPN Grade II significantly increased with ascending TyG quartiles (Q1: 37.66% vs. Q4: 85.71%, P < 0.001). After adjusting for confounders, the risk of Grade II in the Q4 group was 7.32 times higher than in the Q1 group (95% CI: 2.81-19.05). Restricted cubic spline analysis revealed an exponential increase in risk when TyG > 8.28. Subgroup analysis demonstrated a stronger association between TyG and IPN Grade II in hypertensive populations. Furthermore, the TyG index yielded an area under the curve of 0.72, with a sensitivity of 81% and specificity of 60% at the optimal cutoff value of 8.645. CONCLUSION:This study demonstrates that the TyG index is significantly and independently associated with extensive IPN in carotid plaques. This finding suggests the TyG index has potential as a supplementary serological marker in the assessment of plaque vulnerability.

Substantia nigra hyperechogenicity (SNH) assessed by transcranial sonography (TCS) is a neuroimaging biomarker of Parkinson’s disease (PD), but its actual location and spatial changes are poorly understood. We aimed to evaluate the location and spatial progression of SNH in PD utilizing TCS-MR fusion imaging. This prospective study enrolled eighty-four PD patients and sixty-two controls. The plane with the largest area of red nucleus, the plane with the largest area of SNH, and the plane where the red nucleus is just out of view were selected and segmented, respectively, and echogenicity indices were calculated. SNH could present in SN, dorsal band of SN, red nucleus, and ventral tegmental area, and had two orientations. In the left midbrain, the anterior-posterior orientation had longer disease duration, larger SNH area, and higher Hoehn-Yahr stage than medial-lateral orientation. The anterior-posterior orientation and accumulation in various nuclei of SNH may serve as promising neuroimaging markers for PD progression.

Background:Cognitive impairment (CI) is a prevalent non-motor symptom in Parkinson's disease (PD) that often leads to disability. This study aimed to explore the association between plasma homocysteine (Hcy) and the width of third ventricle (V3) in PD patients with CI and their potential to predict dementia conversion. Methods:Totals of 118 PD patients with normal cognition (PD-NC), 81 PD patients with mild CI (PD-MCI), 58 PD patients with dementia (PDD), and 35 healthy controls (HCs) were retrospectively recruited. V3 width was measured using transcranial sonography (TCS), plasma Hcy level was quantified using cyclase assay, and cognitive function was analyzed using the Montreal Cognitive Assessment (MoCA). Results:Both V3 width and plasma Hcy concentration were negatively correlated with MoCA scores in PD (r=-0.358, P<0.001; r=-0.187, P=0.013, respectively). Receiver operating characteristic (ROC) analysis suggested that V3 width and Hcy were able to discriminate PDD and PD without dementia [area under the curve (AUC) =0.767 and 0.628, respectively], PD-NC and PD with cognitive decline (AUC =0.735 and 0.657, respectively), and PD-NC and PD-MCI (AUC =0.683 and 0.664, respectively). Following an average follow-up period of 31.04±18.84 months, PD-MCI patients with a V3 width ≥6.55 mm were at a 4.085 times higher risk of developing dementia, whereas PD-NC patients with a V3 width ≥5.75 mm had nearly double the risk of progressing to MCI. However, baseline plasma Hcy levels were unsuitable to predict cognition alternation over time. Conclusions:Plasma Hcy level and V3 width are associated with cognition function severity in PD patients, a V3 width is an independent predictor of MCI-dementia conversion in PD.

Even after successful revascularization in acute ischemic stroke, some patients still develop secondary neuronal damage and functional impairment, known as cerebral ischemia-reperfusion injury (CIRI). The complex pathophysiological cascade within CIRI limits the efficacy of current single-target therapies in clinical practice. To address this, this study innovatively constructs a multifunctional brain-targeted nanoplatform (RFP) designed to synergistically intervene in the multiple pathological pathways of CIRI. This platform co-delivers Pt-based MXene nanozymes (Pt-Ti3C2) with SOD/CAT-like activity and the ferroptosis-specific inhibitor (Fer-1), enabling targeted delivery to the cerebral ischemic region via surface-modified cRGD peptides. The Pt-Ti3C2 nanozyme core within the RFP exhibits SOD/CAT-like enzymatic activity, efficiently scavenging multiple ROS to inhibit oxidative stress. Meanwhile, Fer-1 embedded within the lipid bilayer suppresses lipid peroxidation, thereby blocking ferroptosis. Their synergistic action further mitigates neuroinflammation by suppressing pathological glial activation. In vivo and in vitro studies have demonstrated that RFP exhibits outstanding specific targeting efficacy and significant neuroprotective effects. Multi-omics analysis reveals that RFP exerts multi-effect therapy by synergistically suppressing oxidative stress and ferroptosis, maintaining mitochondrial homeostasis, and modulating inflammatory networks. This multifunctional nanotherapeutic strategy represents a shift from single-target treatment to multi-mechanism synergy, offering a novel approach to overcome CIRI therapeutic challenges.

Skeletal muscle metastasis, though rare in lung cancer, can mimic thromboembolic disease. We describe a patient with squamous cell carcinoma who developed bilateral calf swelling postoperatively. While ultrasound revealed right popliteal vein thrombosis, a left calf hypoechoic lesion exhibited marked hypervascularity on contrast-enhanced and microvascular flow imaging, ultimately diagnosed as metastasis. This case illustrates a critical diagnostic pitfall and advocates for contrast-enhanced ultrasound in evaluating ambiguous limb lesions during cancer care.

OBJECTIVES:To investigate the value of intraoperative conventional and contrast-enhanced ultrasound in the surgical resection of brain metastases (BMs). METHODS:A total of 46 patients with solitary tumors were enrolled. Intraoperative conventional ultrasound was performed to locate the tumors and observe the size, echo characteristics, position, depth, and degree of peritumoral edema of BMs and compare them with the findings from preoperative magnetic resonance imaging (MRI). Contrast-enhanced ultrasound was performed on 7 BMs with unclear borders to observe the borders and perfusion pattern. Completeness of tumor resection was assessed by ultrasound and compared with the assessment from postoperative MRI. RESULTS:All BMs were detected by intraoperative conventional ultrasound. Although BMs had various ultrasonic manifestations, most of them had clear boundaries (32/46, 69.6%), severe peritumoral edema (33/46, 71.7%), and a rich blood supply (35/46, 76.1%). There was no significant difference in assessing tumor size and peritumoral edema between intraoperative conventional ultrasound and preoperative MRI (P = .121 and 1.000, respectively). BMs exhibited a rapidly inhomogeneous high enhancement and a delayed wash-out in enhancement compared with surrounding tissues on contrast-enhanced ultrasound. All the BMs had complete resection as assessed by intraoperative conventional ultrasound, which was confirmed by the postoperative MRI. CONCLUSIONS:BMs have some certain characteristics on both conventional and contrast-enhanced ultrasound. Intraoperative conventional ultrasound plays a useful role in real-time navigation and assessing the completeness of tumor resection for neurosurgeons. In addition, contrast-enhanced ultrasound is helpful in recognizing the tumor borders when the distinction between BMs and surrounding tissues is unclear.

Background:Stroke has the highest individual disability rate of all ischemic cardiovascular diseases. Thus, the early identification of its risk factors are crucial to reduce its incidence and improve unfavorable prognoses. This study investigated the value of the most reliable predictors of ischemic stroke by comprehensively scanning the internal carotid artery system and vertebrobasilar artery system using integrated cervicocerebral ultrasound (ICCUS). Methods:Patients who had undergone ICCUS scanning and who had recently had a non-cardiac ischemic stroke (<30 days) were prospectively included in this study. Relevant ICCUS parameters were recorded for the carotid, vertebral, subclavian, and intracranial arteries, and intracranial collaterals. The independent predictors of ischemic stroke were examined by multivariate logistic regression analysis. The receiver operating characteristic curves and area under the curve (AUC) were used to evaluate the predictive effects. Results:From July 2023 to April 2024, 127 patients were included in the final analysis, of whom, 42 had suffered a stroke and 85 had not suffered a stroke. The multivariate logistic regression analysis showed that the presence of intraplaque hemorrhage (IPH), multiple stenoses in the anterior and posterior cerebral arteries, and opening of the anterior communicating artery within the cerebral collateral on ICCUS scanning were independent predictors of ischemic stroke (all P<0.05). The corresponding odds ratios for these factors were 5.20, 21.63, 19.87, and 4.58, respectively, and the AUC was 0.802 (95% confidence interval: 0.71-0.89, P<0.001). In addition, if the IPH predictor for cervical vessels was combined with any of the one to three predictors for the intracranial vessels, the combined the diagnostic accuracies progressively increased to 68.1-71.4%, 74.5-76.0%, and 80.2%, respectively. Conclusions:This study used ICCUS, a comprehensive, accurate, and efficient ultrasound technology, to identify more reliable independent predictors of ischemic stroke. Our findings may guide the early prevention and timely treatment of patients.

Messenger RNA (mRNA) therapy is an innovative approach that delivers specific protein-coding information. By promoting the ribosomal synthesis of target proteins within cells, it supplements functional or antigenic proteins to treat diseases. Unlike traditional gene therapy, mRNA does not need to enter the cell nucleus, reducing the risks associated with gene integration. Moreover, protein expression levels can be regulated by adjusting the dosage and degradation rates of mRNA. As a new generation gene therapy strategy, mRNA therapy represents the latest advancements and trends in the field. It offers advantages such as precision, safety, and ease of modification. It has been widely used in the prevention of COVID-19. Unlike acute conditions such as cerebral hemorrhage and stroke that often require immediate surgical or interventional treatments, neurodegenerative diseases (NDs) and brain tumors progress relatively slowly and face challenges such as the blood-brain barrier and complex pathogenesis. These characteristics make them particularly suitable for mRNA therapy. With continued research, mRNA-based therapeutics are expected to play a significant role in the prevention and treatment of NDs and brain tumors. This paper reviews the preparation and delivery of mRNA drugs and summarizes the research progress of mRNA gene therapy in treating NDs and brain tumors. It also discusses the current challenges, providing a theoretical basis and reference for future research in this field.