The present study establishes a comprehensive evaluation system for assessing medical quality in specialized neurological hospitals, developed based on the performance indicators of national tertiary public hospitals. The system comprises 5 dimensions and 14 sub-indicators, carefully selected through rigorous consideration of three key factors: policy compliance, professional suitability, and targeted management needs.To ensure robust evaluation, we employed a combined methodological approach utilizing both entropy-weighted TOPSIS and RSR methods, with cross-validation of results demonstrating strong consistency between the two techniques. The analysis revealed Ci values ranging from 0.405 to 0.653 and RSR values spanning 0.486 to 0.793, with 2023 emerging as the highest-performing year and 2020 ranking lowest in terms of overall medical quality.Through obstacle degree analysis, we identified critical limiting factors affecting hospital performance. While obstacles related to medical service volume showed a welcome decline, we observed concerning increases in operational efficiency barriers. Notably, indicators within the medical safety dimension consistently ranked as the most significant obstacles throughout the study period.The longitudinal analysis from 2019 to 2023 demonstrates progressive improvement in the hospital’s overall medical quality, particularly in addressing service volume challenges. However, the upward trends in social evaluation and operational efficiency obstacles, coupled with persistent medical safety concerns, highlight areas requiring ongoing management attention and targeted intervention strategies.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-20085-8.

Abstract BACKGROUND Glioma-associated macrophages (GAMs), originating from intracranial-resident microglia and bone marrow-derived monocytes, often exhibit pro-tumorigenic polarization within the glioma microenvironment, promoting tumor progression. This study aims to reveal the evolutionary trajectory features of GAMs from these two origins through single-cell transcriptomic analysis, construct a prognosis model based on differentiation-related genes (DRGs), screen potential targeted drugs, and investigate their therapeutic mechanisms. MATERIAL AND METHODS Single-cell transcriptome sequencing data from primary and recurrent gliomas were analyzed. Pseudotime analysis was employed to construct evolutionary trajectories of GAMs derived from microglia and monocyte lineages, identifying shared DRGs. Prognostic value of DRGs was assessed using univariate Cox regression and least absolute shrinkage and selection operator (LASSO) regression in the training cohort (The Cancer Genome Atlas, TCGA). The prognostic model was validated in the test cohort (Chinese Glioma Genome Atlas, CGGA) via survival analysis and receiver operating characteristic (ROC) curves. Drug screening was performed using the Cancer Therapeutics Response Portal (CTRP). Direct/indirect co-culture models of THP1 (human monocyte-macrophage cell line) and glioblastoma cell lines were established. Phenotypic effects on GAMs and glioma cells were studied in direct co-culture, while drug mechanisms on GAM polarization were evaluated in indirect co-culture at mRNA and protein levels. RESULTS Fifteen DRGs (RPL3, TIMP1, SPP1, FABP5, EMP3, MTRNR2L8, KIF20A, CENPA, PLAUR, SMC4, HSPB1, TMSB10, GGH, CTSL, MND1) were identified to construct the prognostic model, which demonstrated robust performance in both TCGA and CGGA cohorts. Screening via CTRP prioritized a histone deacetylase (HDAC) inhibitor, Panobinostat. Three HDAC inhibitors (Panobinostat, Vorinostat, and Sodium Valproate) were tested. HDAC inhibitors suppressed glioma cell proliferation in direct co-culture and inhibited pro-tumorigenic polarization markers of GAMs at mRNA and protein levels in indirect co-culture. CONCLUSION This study highlights the prognostic value of DRGs in GAMs and identifies HDAC inhibitors as potential therapeutic agents. Mechanistically, HDAC inhibitors may impede glioma progression by suppressing pro-tumorigenic polarization of GAMs, suggesting an immunotherapeutic strategy targeting glioma-microenvironment interactions.

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune inflammatory disease of the central nervous system characterized by microglial activation and neuroinflammation. Chitotriosidase (CHIT1), a microglial activation biomarker, has been implicated in neurodegenerative and neuroinflammatory diseases, but its role in NMOSD remains unclear. Thirty-four patients with NMOSD, 30 healthy controls (HCs), and 30 patients with other noninflammatory neurological disorders (ONNDs) were included. Cerebrospinal fluid (CSF) and serum CHIT1 levels were measured via enzyme-linked immunosorbent assay. Comprehensive clinical parameters were collected from all participants. Statistical comparisons and receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of CHIT1 for NMOSD. CSF CHIT1 levels were significantly higher in the NMOSD group than in the ONND group (p < 0.001). In contrast, serum CHIT1 levels did not differ significantly between NMOSD patients and either ONND or HC groups. Subgroup analysis revealed higher CSF CHIT1 concentrations in NMOSD patients with gadolinium-enhancing lesions than in those without such lesions (p = 0.035). ROC analysis demonstrated that CSF CHIT1 could distinguish NMOSD patients from patients with ONNDs, with an area under the curve of 0.730. Additionally, CSF CHIT1 levels correlated positively with the Expanded Disability Status Scale score (r = 0.457, p = 0.007). An elevated CSF CHIT1 level in NMOSD patients is significantly associated with greater disease severity, suggesting its potential as a diagnostic and prognostic biomarker. These findings highlight the role of CHIT1 in the pathogenesis of NMOSD and warrant further investigation into its clinical applicability.

Repetitive transcranial magnetic stimulation (rTMS) improves cognition in Alzheimer's disease (AD), yet its biomarker and neuroplasticity effects remain unclear. Cognitive scale scores, plasma biomarker levels, and resting-state fMRI brain network in AD patients were analyzed before and after a 14-day 20Hz rTMS intervention. The results demonstrated that rTMS intervention significantly improved cognitive performance (MMSE: Z = - 2.863, q = 0.017; MoCA: t = - 6.137, q < 0.001; RAVLT_I: t = - 3.436, q = 0.011) and reduced neuropsychiatric symptoms (NPI: Z = - 2.547, q = 0.037; HAMD: Z = - 3.472, q = 0.009). A 9.4% reduction in neurofilament light chain levels was demonstrated (Z = - 2.371, P = 0.018), with baseline p-Tau181 levels being inversely correlated to Aβ42 changes (R = - 0.428, P = 0.033). Enhanced global efficiency (GE: t = - 1.865, P = 0.081, r = 0.423) and increased connection density (CD: Z = - 1.823, P = 0.068, r = 0.442) were identified in neural networks. Notably, GE improvements positively correlated with elevated Aβ42/40 (R = 0.596, P = 0.025), while cognitive gains measured by the MoCA were significantly associated with network reorganization metrics (GE: R = 0.486, P = 0.048; CD: R = 0.514, P = 0.035). rTMS demonstrates potential in mitigating neurodegeneration by enhancing brain network integration and modulating Aβ metabolism. This effect was particularly pronounced in early-stage AD patients who exhibit preserved neural integrity. These findings advance therapeutic assessment frameworks and decode TMS neuromodulation mechanisms. The trial was prospectively registered (ChiCTR2400080657, ClinicalTrials.gov; 2024-02-04).

BackgroundInterleukin-40 (IL-40), as an immune regulatory factor discovered in recent years, mainly plays a role in B-cell-related immune responses and is involved in the pathological processes of various inflammatory diseases, autoimmune disorders, and infectious diseases. However, its role in myasthenia gravis (MG) has rarely been reported.MethodsWe used enzyme-linked immunosorbent assay (ELISA) to measure the serum IL-40 levels in 58 MG patients and 55 healthy controls, and conducted a detailed analysis of the clinical data.ResultsThe serum IL-40 level in MG patients was significantly higher than that in healthy controls (p < 0.0001). After immunotherapy, the serum IL-40 level in MG patients significantly decreased (p < 0.0001). In MG, the IL-40 level of severe patients was significantly higher than that of mild patients (p < 0.0001). The ROC curve determined that the cut-off value for distinguishing IL-40 in MG from healthy controls was 15.63 pg/mL, with an AUC of 0.846 (95% CI: 0.773–0.919), 74.1% specificity, and 85.5% sensitivity.ConclusionThe serum IL-40 level in MG patients is elevated and is correlated with the severity of the disease. High levels of IL-40 may serve as a specific indicator for monitoring disease activity, which supports its potential as a non-invasive biomarker for disease monitoring.

Objective. Glioma resection remains one of the most challenging procedures in neurosurgery due to the tumor's high malignancy and prevalence. As a critical step in surgical intervention, craniotomy requires meticulous planning to achieve maximal tumor removal while minimizing neurological damage. However, current automated surgical planning methods face significant limitations in addressing craniotomy design, primarily due to the lack of explicit visual targets (e.g., vascular structures) and standardized geometric constraints for bone flap delineation. In this study, we propose an innovative learning-based framework specifically designed for automated craniotomy planning in glioma resection.Approach. Our approach effectively integrates preoperative imaging data and expert demonstrations into a reinforcement learning (RL) model to determine the optimal bone flap geometry. The key innovations of our method include: (1) a self-supervised learning strategy for implicit quantification of glioma, (2) an encoding method for craniotomy pattern designs, (3) a physics-based simulation engine for craniotomy policy training, and (4) an imitation learning-inspired planner for craniotomy planning. Experimental validation was conducted using a dataset derived from publicly available glioma patient images.Main results. The proposed method presents a success rate of 92.31%±3.85% when processing known craniotomy parameters, and a success rate of 80.77%±3.14% in end-to-end craniotomy planning from raw preoperative images to definitive surgical plans.Significance. The results demonstrate that our proposed method achieves human-level performance in craniotomy planning, and shows promising potential for end-to-end craniotomy planning from raw preoperative images to definitive surgical plans. Our research provides a valuable reference for the development of intelligent decision-support tools for future neurosurgical procedures.

PurposeTo determine the impact of 24-hour post-reperfusion glycemic control on 90-day functional outcomes in acute large vessel occlusion (ALVO) patients after successful recanalization.Materials and MethodsThis multi-center retrospective study analyzed 2056 ALVO patients (male: 1488; female: 568) from three cerebrovascular centers achieving successful reperfusion via mechanical thrombectomy with/without bridging thrombolysis. Using 1:1 propensity score matching (covariates: gender, age, Diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, smoking status, glucose measurement timing, baseline NIHSS, and preoperative mRS), 194 matched pairs (mean age 63[IQR 55–71] years; male: 278) were stratified by 90-day modified Rankin Scale (mRS) outcomes into favorable (mRS 0–2) and poor prognosis (mRS 3–6) cohorts.ResultsThe poor prognosis cohort demonstrated significantly elevated mean fasting blood glucose (MFBG) levels (7.22 mmol/L [6.66–8.50] vs 6.86 mmol/L [6.28–7.58], P<0.001). Multivariable logistic regression adjusted for sex, age, vascular risk profile, and baseline NIHSS (adjusted OR=0.819, 95% CI 0.714–0.940, P=0.004) confirmed MFBG elevation as an independent risk factor for unfavorable outcomes.ConclusionSustained hyperglycemia during the initial 24-hour post-recanalization period independently predicts impaired 90-day functional recovery in ALVO patients. These findings highlight the imperative for standardized glucose monitoring protocols during the hyperacute post-thrombectomy phase, while optimal glycemic targets (<7.0 mmol/L vs individualized thresholds) and therapeutic windows for neuroprotection warrant validation through prospective multicenter RCTs.

Despite successful mechanical thrombectomy (MT), approximately 50% of patients with large vessel occlusion (LVO) stroke experience poor outcomes due to reperfusion injury. Intra-arterial infusion of human serum albumin (HSA) may offer neuroprotective benefits; however, its safety and feasibility have not been established when delivered via the internal carotid artery. In this study we aimed to evaluate the safety and technical feasibility of HSA infusion through the guiding catheter placed during MT in patients with anterior circulation LVO stroke following successful reperfusion. We conducted a prospective, single-center, open-label, pilot trial evaluating intra-arterial infusion of 20% HSA immediately after MT in patients with anterior circulation LVO stroke. The study included a 3+3 dose-escalation and a dose-expansion phase. Eligible patients achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b) and received HSA infusion via the guiding catheter. Safety endpoints included 90-day mortality, symptomatic intracranial hemorrhage (sICH), and serious adverse events. Post-hoc analyses explored infarct volume, immune markers, and proteomic/metabolomic signatures. Between September 2023 and February 2024, 42 patients received intra-arterial HSA infusion. In the dose-escalation phase (n=27), two deaths and two mild infusion-related adverse events occurred, with no sICH. In the dose-expansion phase (n=15), one death and one case of sICH were reported, with no HSA-related adverse events. Post-hoc analysis showed that the HSA group had a significantly smaller infarct volume at 24 hours compared with controls. Intra-arterial infusion of 20% HSA in combination with MT is safe and feasible. Preliminary findings suggest a potential therapeutic benefit in reducing infarct volume. NCT05953623.

ObjectiveThis study explores the impact of microsurgery on postoperative serum neurotransmitter levels and long-term neurological outcomes in elderly spontaneous intracerebral hemorrhage (SICH) patients.MethodsA single-center, prospective, and single-arm cohort study was conducted, enrolling 106 elderly SICH patients aged ≥60 years who underwent microsurgical hematoma evacuation within 24 h of onset. Serum levels of glutamate (Glu), gamma-aminobutyric acid (GABA), norepinephrine (NE), and serotonin (5-hydroxytryptamine, 5-HT) were measured before surgery and on postoperative day 7. Neurological outcomes were assessed at 180 days using the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Subgroup analyses were performed based on hematoma volume (≥30 mL vs. <30 mL), hemorrhage location (basal ganglia, thalamus, or lobar), and preoperative Glasgow Coma Scale (GCS) scores (3–8, 9–12, or 13–15). Pearson correlation analysis evaluated the relationship between neurotransmitter levels and outcomes.ResultsOn postoperative day 7, Glu and NE levels decreased, while GABA and 5-HT levels increased. Larger hematoma volume, lobar location, and moderate GCS (9–12) were associated with higher Glu/NE, lower GABA/5-HT, and worse mRS/GOS scores. Glu and NE levels positively correlated with mRS and negatively with GOS (p < 0.05); opposite trends were seen with GABA and 5-HT. A composite neurotransmitter score showed good prognostic accuracy, with an AUC of 0.894 (95% CI: 0.796–0.992) for mRS > 2 and 0.846 (95% CI: 0.782–0.910) for GOS < 4.ConclusionFollowing microsurgical hematoma evacuation in elderly SICH patients, postoperative neurotransmitter profiles were associated with long-term functional outcomes. Persistently high Glu/NE and low GABA/5-HT levels predicted poor recovery, especially in those with large or lobar hematomas.