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El estudio de los tumores del sistema nervioso central (SNC) resulta ser un tema de gran consideración y su conocimiento reviste una alta importancia en la práctica médica. Las clasificaciones de las neoplasias del SNC comenzaron a mediados del siglo XIX hasta que en 1979 la Organización Mundial de la Salud (OMS) publicó la primera edición de una sistemática útil con el objetivo de establecer un lenguaje común para todas las especialidades médicas. Al día de hoy, 5 ediciones actualizaron la taxonomía neoplásica. La quinta edición del año 2021 consolida el cambio de paradigma dado por los avances moleculares, si bien todavía la transición se encuentra en proceso entre la caracterización morfológica y la biológica molecular. En este artículo, se analizan las nuevas modificaciones incorporadas en las diferentes familias tumorales más frecuentes en pediatría haciendo hincapié en aquella información de utilidad para el médico pediatra en su práctica diaria y la consulta multidisciplinaria.
The study of central nervous system (CNS) tumors is a subject of great interest and such knowledge is of great importance in medical practice. The classifications of CNS neoplasms began in the mid-19 th century, until the World Health Organization (WHO) published, in 1979, the first edition of a useful systematic review for the purpose of establishing a common language for all medical specialties. To date, 5 updated editions of neoplastic taxonomy have been published.The fifth edition, from 2021, consolidates the paradigm shift brought about by molecular advances, although the transition between morphological and molecular biological characterization is still in progress. In this article, the new modifications introduced in the different most frequent families of tumors in pediatrics are analyzed, emphasizing useful information for pediatricians in their daily practice and multidisciplinary consultations.
الموضوعات
Humans , Child , Central Nervous System Neoplasms/classification , Central Nervous System Neoplasms/diagnosis , World Health Organizationالملخص
El absceso cerebral es una infección localizada, una colección de material purulento en el parénquima cerebral, que puede surgir como complicación de otra infección o por traumatismo o cirugía. La infección por Nocardia spp. es poco común en pacientes inmunocompetentes, considerándose un agente oportunista. Se describe el caso de un paciente de 51 años, previamente sano, que consultó por cuadro insidioso de meses de evolución de cefalea holocraneana, además de convulsiones tónico-clónicas generalizadas, con picos febriles persistentes, en quien se diagnosticaron abscesos múltiples en el sistema nervioso central a un germen infrecuente.
Brain abscess is a localized infection, a collection of purulent material in the brain parenchyma, which can arise as a complication of another infection or from trauma or surgery. Infection by Nocardia spp. is uncommon in patients without immunocompromised, being considered an opportunistic agent. We present a case of a 51-year-old patient, previously healthy, who consulted for an insidious picture of holocranial headache of months of evolution, in addition to generalized tonic-clonic seizures, with persistent feverish peaks, in whom multiple abscesses were diagnosed in the central nervous system to an infrequent germ, such as Nocardia spp.
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Introduction: Multiple sclerosis significantly affects the quality of life of those suffering from this specific condition. Objective: To assess the quality of life of people with multiple sclerosis and analyse the correlation between the disease and its associated effects and different sociodemographic, clinical, and functional variables. Materials and Methods: An observational, cross-sectional, descriptive-correlational and quantitative study conducted using a non-probabilistic convenience sample composed of 70 patients suffering from multiple sclerosis registered with the Multiple Sclerosis Association of the Central Region of Portugal. The data collection protocol included sociodemographic and clinical questions, the Family Apgar Scale, and the Barthel Index. Descriptive and inferential statistics were used to process the data. Data collection took place between April and July 2021. Results: The majority of participants reported a moderate overall quality of life (M=51,78 ± 24,09). Higher scores were observed in the social relationships and environmental health domains, while lower scores were recorded for the physical domain. Better quality of life was found to be positively associated with being under 45 years old, having higher educational qualifications, living in functional families, and experiencing greater functional independence in activities of daily living. Discussion: The variables with the strongest association were those capable of influencing the physical and social domains. Those variables explained 59.00% and 53.00% of the variability. Conclusions: These results indicate that people with multiple sclerosis have a compromised quality of life, highlighting the need for new strategies focusing on early diagnosis and effective preventive interventions meant to improve quality of life across all its domains.
الموضوعات
Patients , Quality of Life , Demyelinating Diseases , Central Nervous System Stimulants , Multiple Sclerosisالملخص
Se presenta el caso clínico de un paciente de 37 años de edad con el antecedente de haber recibido radioterapia por una lesión tumoral en la región frontal derecha, el cual acudió a consulta en el Instituto de Neurología y Neurocirugía de Cuba por presentar cefalea intensa y hemiparesia izquierda. Luego de realizados los exámenes necesarios, se estableció el diagnóstico clínico-imagenológico de lesión por radionecrosis en el hemisferio contralateral, que fue corroborado en el estudio anatomopatológico una vez que se extirpó el tumor; seguidamente, se indicó inmunoterapia. La evolución del paciente fue satisfactoria, pues se logró el control de la enfermedad y la resolución de los síntomas.
The case report of a 37-year-old patient with history of having received radiotherapy due to a tumor lesion in the right frontal region is presented, who attended to the Institute of Neurology and Neurosurgery in Cuba because of intense headache and left hemiparesis. After carrying out the necessary examinations, the clinical-imaging diagnosis of a radionecrosis lesion in the contralateral hemisphere was established, which was corroborated in the pathological examination once the tumor was removed; then, immunotherapy was indicated. The patient had a favorable clinical course because the control of the disease was achieved as well as the resolution of symptoms.
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RESUMEN Las vasculitis de las arterias o vasculitis cerebelosas en el lupus eritematoso sistémico (LES) son extremadamente infrecuentes y podrían estar inmersas o formar parte de los casos de LES neuropsiquiátrico (LESNP), stroke cerebeloso en el LES y grupo de vasculitis del sistema nervioso central (SNC ) por LES. La adición del manejo quirúrgico a esta entidad, mediante descompresión suboccipital, ha sido reportada en muy pocas publicaciones. Se presenta el caso de una paciente mujer de 18 años con LES, LESNP, stroke cerebeloso, con alta sospecha de vasculitis inflamatoria de las arterias cerebelosas a quien, a pesar del manejo médico, se le brindó descompresión suboccipital. La vasculitis inflamatoria de las arterias cerebelosas en el LES es una causa infrecuente de stroke cerebeloso de elevada mortalidad. Existe limitada evidencia científica en la realización de la descompresión suboccipital de esta entidad.
ABSTRACT Arterial vasculitis or cerebellar vasculitis in systemic lupus erythematosus (SLE) are extremely infrequent, and these might be included within cases of neuropsychiatric SLE (NPSLE), cerebellar stroke in SLE, and within the group of central nervous system vasculitis due to SLE. The addition of surgical management to this condition has been reported in few publications. We present the case of a 18- year old female patient with SLE, NPSLE, and cerebellar stroke, highly suspicious of inflammatory vasculitis affecting cerebellar arteries, in whom, in spite of medical management, suboccipital decompression was performed. Inflammatory vasculitis of cerebellar arteries in SLE is an infrequent cause of cerebellar stroke, and it has elevated mortality rates. There is limited scientific evidence with respect to suboccipital decompression for the management of this condition.
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Objective To evaluate the efficacy and safety of tigecycline combined with cefoperazone-sulbactam sodium in the treatment of multi-/extensively-drug resistant Acinetobacter baumannii(MDRAB/XDRAB)associated central nervous system(CNS)infection,and to provide clinical evidence for antibiotic treatment of MDRAB/XDRAB-related intracranial disease.Methods The Wanfang Data Knowledge Service Platform,Chinese Biomedical Literature Database,VIP Chinese Science and Technology Journal Full-text Database,China National Knowledge Infrastructure(CNKI),Pubmed,Embase database,and Cochrane Library were searched to extract the literature of randomized controlled studies on tigecycline and cefoperazone sulbactam in the treatment of MDRAB/XDRAB CNS infection until September 1st,2022.The included studies were assessed for quality using the Cochrane Collaboration Risk of Bias assessment tool,and valid data were extracted and meta-analyzed using RevMan5.4 software.Results A total of 184 articles were screened and 4 Chinese RCTs were finally included,with a sample size of 267 cases.Meta-analysis showed that the overall efficacy of combination therapy for MDRAB/XDRAB CNS infection was better than monotherapy[OR = 4.30,95%CI =(1.93,9.58),P＜0.01].Combination therapy had a better bacterial clearance[OR=4.20,95%CI=(2.08,8.48),P＜0.01].And combination therapy resulted in a lower incidence of adverse effects[OR= 0.19,95%CI =(0.05,0.67),P＜0.05].There was no apparent difference in cure rate between combination therapy and monotherapy(P＞0.05).Conclusion Current evidence suggests that tigecycline combined with cefoperazone-sulbactam sodium may have better clinical efficacy and safety than monotherapy for MDRAB/XDRAB CNS infections.Limited by the number and quality of included studies,needs to be verified by more and higher-quality studies.
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The etiology of central nervous system(CNS)diseases is complex and mostly unknown,and patients are often left with sequelae and poor prognosis.Recently,ferroptosis has emerged as a unique oxidative stress-induced cell death pathway and is important in various CNS diseases.It is an important mode of neuronal cell death.This article summarizes the molecular mechanism of ferroptosis,research progress of ferroptosis in CNS diseases,and application of ferroptosis inhibitors in CNS diseases to provide new targets and clini-cal references for CNS disease treatment.
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Circular RNA(circRNA)is an emerging class of endogenous non-coding RNA,which is widely expressed in the brain and plays an important role in a variety of biological processes.Research has shown that circRNA plays a key role in physiological and pathological processes of the brain,such as neurodevelopment,synaptic plasticity and neurodegenerative diseases through a variety of mecha-nisms such as adsorption of microRNA,binding to proteins and translation of peptides.In the field of drug addiction,the expression of circRNA is significantly changed in animal models and brains of addicts,and the regulation involves neural adaptation in brain regions that form the reward circuit such as the nucleus accumbens and prefrontal cortex.Additionally,addiction-related circRNAs are closely associated with neurotransmitter systems,signaling pathways,and neuroinflammatory responses,and they influ-ence the formation and maintenance of drug addiction by modulating gene expression networks related to drug addiction.Here,the biogenesis and regulatory mechanism of circRNA as well as its important role in brain function and drug addiction are reviewed in order to provide a new perspective for explora-tions of the pathological mechanism of drug addiction.
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Area postrema syndrome(APS)is characterized by intractable hiccup,nausea and vomiting,which could occur in various central nervous system diseases and remain as one of the focuses in the field of neurology in recent years.The status of clinical and MRI researches of APS were reviewed in this article.
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Objective:To investigate the clinical characteristics of non-perinatal adult patients with Listeria monocytogenes (LM) infection. Methods:Twenty-five non-perinatal adult patients who were etiologically confirmed as listeriosis in Tangdu Hospital, Fourth Military Medical University during January 2010 and July 2023 were enrolled in this study. The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, cranial imaging examination, anti-microbial therapeutic schemes and clinical outcomes were retrospectively analyzed. The clinical characteristics were compared between patients with Listeria septicemia and Listerial meningoencephalitis, as well as between survival and death patients. Independent samples t test and Mann-Whitney U test were used for statistical analysis. Results:The age of enrolled patients was (52.84±12.17) years. Eighteen patients were male, and seven patients were female. The major clinical manifestations included fever (23/25(92%)), headache (15/25 (60%)), disorder of consciousness (12/25(48%)) and vomiting (8/25(32%)). Thirteen (52%) patients had underlying diseases (including hematological diseases, autoimmune disorders, solid neoplasms, and liver cirrhosis, etc). There were no significant differences in blood routine test, aminotransferase, protein levels, renal function, electrolyte, blood glucose, and inflammatory indicators between patients with Listeria septicemia and Listerial meningoencephalitis (all P>0.05). The platelet count in the death group was significantly higher than that in the recovery group ((243.10±92.96)×10 9/L vs (157.80±75.55)×10 9/L, t=2.45, P=0.022). There were also no significant differences in blood biochemical index and inflammatory indicators between these two groups (all P>0.05). Cranial imaging examination of patients with Listerial meningoencephalitis manifested as intracranial infection, cerebral edema/hydrocephalus or cerebral hernia. All nineteen patients with Listerial meningoencephalitis had elevated cerebrospinal fluid (CSF) pressure (220.0(130.0, 290.0) mmH 2O (1 mmH 2O=0.009 8 kPa)), elevated CSF total cell count (522.0(350.0, 783.0)×10 6/L), elevated CSF white blood cell count (356.0(266.0, 668.0)×10 6/L), and CSF protein level (1 817.0(822.5, 6 000.0) mg/L). Fifteen patients had reduced CSF chloride level ((111.70±8.51) mmol/L). Ten patients had decreased CSF glucose level (3.71(1.45, 7.11) mmol/L). The drug sensitivity results of blood and CSF cultures revealed that LM was sensitive to ampicillin. One case was resistance to penicillin, three cases were resistance to meropenem, while three cases were resistance to trimethoprim-sulfonamide. Thirteen cases out of seventeen recovery patients were administered with ampicillin or penicillin-based therapy. Conclusions:When patients with underlying diseases or immune dysfunction suffered with clinical symptoms such as high fever, central nervous system infection, they should be alert to the possibility of listeriosis. Early administration of ampicillin-based therapeutic strategy is beneficial for clinical recovery of the patients.
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Objective:To analyze the clinical characteristics of intracranial infection caused by Mycobacterium lentiflavum. Methods:The clinical data of a patient with intracranial infection caused by Mycobacterium lentiflavum admitted to Tianjin Haihe Hospital in May 2023 were collected. Meanwhile relevant literatures in databases were searched. Only 1 English literature (1 patient) was obtained. The clinical characteristics of this patient and the case reported in the literature were analyzed and summarized. Results:Totally 2 patients, including this case, and the patient with meningoencephalitis caused by Mycobacterium lentiflavum reported in the literature, both are females, 42 and 55 years old respectively, both manifested a chronic course, without fever, and presented progressive headache and cognitive impairment. Clinical manifestations also included abnormal mental behavior, limb weakness, and seizure. At the early stage, only intracranial pressure increased, and cerebrospinal fluid tests were negative. As the disease aggravated, there was an elevation of cerebrospinal fluid cells and protein, with normal levels of glucose and chloride. Using brain tissue obtained by biopsy for polymerase chain reaction or next-generation sequencing examination, the pathogenic microorganism was confirmed, which made accurate diagnosis possible. Antibiotic treatment had good efficacy, with a long treatment course and a good prognosis. Conclusions:Central nervous system infection caused by Mycobacterium lentiflavum is very rare, and a chronic disease course makes diagnosis very difficult. The treatment effect is significant, and the prognosis is excellent.
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Sj?gren′s syndrome is a chronic autoimmune inflammatory disease characterized by exocrine gland and extraglandular involvement. Cases of Sj?gren′s syndrome-associated aseptic meningitis (SS-AM) are relatively rare, and a case of recurrent aseptic meningitis with leukopenia and mild anemia associated with primary Sj?gren′s syndrome is reported, whose symptoms basically disappeared after treatment with prednison and hydroxychloroquine. The purpose of reporting this case is to raise awareness of SS-AM among fellow clinicians.
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Tuberculous meningitis is a central nervous system infectious disease caused by Mycobacterium tuberculosis. Its clinical manifestations are nonspecific, and effective pathogenic diagnostic methods are lacking, which often lead to delayed diagnosis and treatment, impacting the prognosis of patients. Therefore, early and rapid etiological diagnosis is crucial for the diagnosis and treatment of tuberculous meningitis. This article provides a review of novel detection technologies developed in recent years that can be used for the diagnosis of tuberculous meningitis, covering nucleic acid detection methods, metabolomics, and proteomics, and offering prospects for future development.
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Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system(CNS)by a single-center analysis.Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020.Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6％),Mycobacterium tuberculosis 249(20.0％),other bacteria 150(12.0％),fungi 68(5.5％),parasites 18(1.4％),Treponema pallidum 18(1.4％)and rickettsia 1(0.1％).The number of cases increased by 177 cases(33.1％)in the latter 10 years compared to the previous 10 years(P<0.05).No significant difference in seasonal distribution pattern of data between disease types(P>0.05).Male to female ratio is 1.87︰1,mostly under 60 years of age.Viruses are more likely to infect students,most often at university/college level and above,farmers are overrepresented among bacteria and Mycobacterium tuberculosis,and more infections of Treponema pallidum in workers.CNS infectious diseases are characterized by fever,headache and signs of meningeal irritation,with the adductor nerve being the more commonly involved cranial nerve.Matagenomic next-generation sequencing improves clinical diagnostic capabilities.The median hospital days for CNS infectious diseases are 18.00(11.00,27.00)and median hospital costs are ￥29,500(￥16,000,￥59,200).The mortality rate from CNS infectious diseases is 1.6％.Conclusions The incidence of CNS infectious diseases is increasing last ten years,with complex clinical presentation,severe symptoms and poor prognosis.Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.
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Objective To analyze the relationship between MyD88L265P and CD79B mutations in tumor tissue and the prognosis of primary central nervous system lymphoma(PCNSL).Methods 18 PCNSL patients with normal immune function(no history of HIV infection and immunosuppressants administration)who were diagnosed by craniotomy or stereotaxic biopsy in the Second Hospital of Lanzhou University from August 2018 to November 2020 were retrospectively analyzed.Real-time quantitative PCR and first-generation sequencing techniques were respectively used to detect MyD88L265P and CD79B mutations in tumor tissues of 18 PCNSL patients.Univariate analysis and Cox regression multivariate analysis were performed for indicators that may be associated with first progression-free survival(PFS)and overall survival in PCNSL.Results The mutation rate of MyD88L265P was 38.9%,the mutation rate of CD79B was 33.3%,and the co-mutation rate of MyD88L265P/CD79B was 27.8%in PCNSL tissue of 18 patients.Univariate analysis showed that the PCNSL patients with multiple lesions,deep involvement of lesions,and tissue CD79B mutation had a statistically significant shorter time of PFS(P<0.05).Multivariate analysis showed that deep lesion involvement(HR=0.135,95%CI 0.023-0.799,P<0.05)and CD79B mutation(HR=0.149,95%CI 0.028-0.800,P<0.05)in PCNSL tissue were independent prognostic factors for PCNSL patients.Conclusion The frequency of MyD88L265P and CD79B mutations was high in tumor tissues of 18 PCNSL patients,and these two gene mutations may be associated with poor prognosis of PCNSL,especially CD79B mutation.
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ObjectiveBased on ultra performance liquid chromatography-mass spectrometry（UPLC-MS） and non-targeted metabolomics technology to discuss the central regulatory effect of Chaishao Liujuntang on chronic atrophic gastritis（CAG） rats with liver-depression and spleen-deficiency， and to look for the correlation between cerebral cortex， hypothalamus and metabolic status of gastric tissues. MethodA CAG rat model with liver-depression and spleen-deficiency was established by chemical induction， hunger and satiety disorders， chronic restraint and tail clamping stimulation， lasting for 16 weeks. Twenty-eight Wistar rats were randomly divided into a blank group of 8 rats and a model group of 20 rats. After the completion of modeling， 4 rats in the model group were taken to observe the pathological changes of gastric mucosa. The remaining model rats were randomly divided into a model group of 8 rats and a Chaishao Liujuntang group of 8 rats. Chaishao Liujuntang group rats were given 5.1 g·kg-1 by gavage， and the remaining rats were given equal volume sterilized water by gavage for 4 weeks. Macroscopic characteristics， behavioral indicators and histopathological changes of the gastric mucosa of rats in each group were observed and compared. UPLC-MS non-targeted metabolomics was used to explore the metabolic regulation effect of Chaishao Liujuntang on the cerebral cortex， hypothalamus and stomach tissues of CAG rats with liver-depression and spleen-deficiency. Pearson correlation coefficient method was used to analyze the correlation between different tissue metabolites. ResultCompared with the model group， the macroscopic characteristics of rats in Chaishao Liujuntang group were improved， such as hair color， mental state and stool properties， and the number of times of crossing and standing in the open field experiment was significantly increased， and the static time of forced swimming was significantly reduced（P<0.01）， and the gastric mucosa atrophy was reduced. The metabolic data from the cerebral cortex of rats in each group identified a total of 3 common potential biomarkers， but not enriched in pathways， 26 common potential biomarkers were identified in the hypothalamus， and the key metabolic pathways involved were mainly enriched in purine metabolism， glycerol phospholipid metabolism， D-glutamine and D-glutamic acid metabolism. Seventeen common potential biomarkers were identified in the stomach， and the key metabolic pathways involved were mainly enriched in thiamine metabolism， valine， leucine and isoleucine biosynthesis， and taurine and taurine metabolism. Correlation analysis of metabolites in different tissues revealed that multiple amino acids and their derivatives mediated metabolic connections between the cerebral cortex， hypothalamus and stomach of rats. ConclusionThe metabolic disorders in the cerebral cortex， hypothalamus and stomach of CAG rats with liver-depression and spleen-deficiency have their own characteristics， mainly manifested by changes in the content of glycerol phospholipids， fatty acids and bile acid metabolites. Moreover， Chaishao Liujuntang may play a central regulatory role in CAG rats with liver-depression and spleen-deficiency by correcting the metabolic disorders of amino acids.
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ObjectiveTo identify the prototypical components and metabolites absorbed into blood and cerebrospinal fluid of Schisandrae Chinensis Fructus（SCF） based on sequential metabolism combined with liquid chromatography-mass spectrometry. MethodBlood and cerebrospinal fluid samples of integrated metabolism， intestinal metabolism and hepatic metabolism were collected from male SD rats after gavage and in situ intestinal perfusion administration， and ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC Q-Exactive Orbitrap MS） was used to analyze and compare the differences in the spectra of SCF extract， blank plasma， administered plasma， blank cerebrospinal fluid and administered cerebrospinal fluid with ACQUITY UPLC BEH Shield RP18 column（2.1 mm×100 mm， 1.7 µm）， the mobile phase was acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-7 min， 95%B； 7-12 min， 95%-35%B； 12-17 min， 35%-15%B； 17-20 min， 15%-12%B； 20-22 min， 12%-5%B； 22-23 min， 5%B； 23-25 min， 5%-95%B； 25-28 min， 95%B）. And heated electrospray ionization（HESI） was used with positive and negative ion modes， the scanning range was m/z 100-1 500. The prototypical constituents and their metabolites absorbed into blood and cerebrospinal fluid of SCF were identified according to the retention time， characteristic fragments， molecular formulae and the information of reference substances. ResultA total of 42 chemical components were identified in the extract of SCF， including lignans， flavonoids， amino acids， tannins， and others， of which lignans were the main ones. A total of 27 prototypical components and 14 metabolites were identified in plasma samples from different sites. A total of 15 prototypical components and 9 metabolites were identified in cerebrospinal fluid. The main metabolic reactions involved in the formation of metabolites were mainly demethylation， methylation， demethoxylation and hydroxylation. ConclusionThrough the systematic identification of the prototypical components and metabolites of SCF in rats， it provides data support for further better exploring the material basis of SCF in the treatment of central nervous system diseases.
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In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China”. Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines, systematic evaluations, case studies, expert consensus. The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system, central nervous system，cardiovascular system, ocular, cutaneous and osteoporosis disorders. The full text focuses on 27 clinical problems and forms 40 recommendations, mainly involving the risk factors, classification, diagnosis, treatment and prevention of various complications. This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine (OCEBM) Grading and Strength of Recommendation criteria, so as to provide reference for the diagnosis and treatment of late complications, comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.
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Exosome is a kind of extracellular vesicles secreted by cells to the outside. Biogenesis mainly involves two invaginations of the cytoplasmic membrane, the formation of multivesicular bodies, and the release of exosomes. Exosomes have abundant and diverse inclusions—including landmark membrane proteins, soluble proteins, various RNA molecules and DNA fragments, etc. Cells can achieve intercellular signal communication by secreting and receiving exosomes. Through interaction of ligand molecules on the exosome membrane with receptors on the surface of other cytoplasmic membranes, exosomes can activate cell signal transduction or fuse with the cell membrane to release its contents into the cytoplasm to exert regulatory functions. In the central nervous system, exosomes secreted by neurons and various glial cells can mediate wired synaptic signal transmission, but mainly play a role similar to neuromodulator by way of volume transmission. In this paper, the biogenesis of exosomes and important functional components are described in detail, and the characteristics of neural exosomes in the biogenesis, content sorting and controlled release are compared with those of synaptic vesicles. We further review the research progress on the physiological functions of neural exosomes on the central nervous system and their roles in the occurrence and development of neurodegenerative diseases and major depressive disorder. We also prospect the application of exosomes in the early diagnosis and targeted therapy of nervous system diseases.
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As a key regulator of neuronal growth， development and synaptic plasticity， BDNF/ TrkB signaling pathway is widely involved in the occurrence and development of central nervous system diseases， such as ischemic stroke， Alzheimer's disease， Parkinson's disease and spinal cord injury. Studies have shown that acupuncture can regulate the activity of BDNF/TrkB signaling pathway， and has significant therapeutic potential for these diseases. Its mechanism of action is related to participating in synaptic remodeling， inhibiting neuronal apoptosis， and promoting neurogenesis or synaptic regeneration. This article reviews the role of BDNF/TrkB signaling pathway in central nervous system diseases and the regulation mechanism of acupuncture on this pathway， in order to provide new ideas for clinical treatment. Future studies should further explore the precise regulatory mechanism of acupuncture on BDNF/TrkB signaling pathway in order to develop more efficient and safe treatment strategies.