Jia Liu

Background and ObjectivesLongitudinally extensive transverse myelitis (LETM) is a core feature of neuromyelitis optica spectrum disorder (NMOSD), which leads to spinal cord atrophy. We aim to deter...

Background: Multiple sclerosis (MS) is an incurable, chronic, disabling disease that primarily affects young adults. Chinese herbal medicine (CHM) is increasingly recognized as a major form of complementary and alternative medicine; however, there is a limited number of systematic analyses regarding its therapeutic effects on MS.Aim of the study: This study aimed to evaluate whether CHM, when used alongside conventional treatment, offers additional therapeutic benefits for patients with MS, focusing on clinical efficacy and safety.Materials and methods: We searched eight databases from their inception until July 2025 to identify eligible randomized controlled trials (RCTs) involving CHM therapy for MS. Key outcomes assessed included the expanded disability status scale (EDSS), annual relapse rate (ARR), neurological signs scores, clinical symptoms scores, and modified fatigue impact scale (MFIS). The risk of bias was evaluated using the Cochrane Handbook for systematic reviews, while quantitative synthesis was performed with RevMan (version 5.4.1) and Stata (version 18.0) software. This review has been registered at the International Prospective Register of Systematic Reviews database (Registration No. CRD42024605890).Results: This systematic review and meta-analysis included 28 RCTs involving a total of 1,971 participants. The combination of CHM and conventional therapy was superior to conventional therapy alone for individuals with MS. This was evidenced by a decrease in the EDSS (mean difference (MD) = −0.65; 95% confidence interval (CI): −0.96, −0.35; P < 0.0001; MD = −0.65, ARR (relative risk (RR) = 0.48; 95% CI: 0.31, 0.73; P = 0.0007), neurological signs scores (MD = −2.96; 95% CI: −4.52, −1.39; P = 0.0002), and MFIS (MD = −8.55; 95% CI: −10.20, −6.89; P < 0.00001). Additionally, there was an improvement in clinical effects (RR = 1.25; 95% CI: 1.19, 1.32; P < 0.00001). No serious adverse effect was reported.Conclusion: Although the methodological quality of the included RCTs was relatively suboptimal, CHM therapy combined with conventional therapy manifests a promising effectiveness and safety for managing MS. Therefore, well-designed clinical studies are necessary to provide high-quality evidence.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024605890, identifer CRD42024605890.

Background and aim: Traditional Chinese medicine (TCM) is widely used by patients with amyotrophic lateral sclerosis (ALS). However, their reasons and experience in using TCM have received insufficient attention. Therefore, we conducted a mixed method study to gain insights into this issue. Materials and methods: This study was conducted on the basis of the China Amyotrophic Lateral Sclerosis Registry of Patients with Traditional Chinese Medicine (CARE-TCM). Data were collected from Dongzhimen Hospital through a mixed method approach, including a questionnaire and a semi-structured interview. Patients with ALS who were using TCM when they were initially registered with CARE-TCM and who had been followed-up for over six months were recruited. The questionnaires’ outcomes were statistically outlined, and the interview transcripts were thematically analysed to identify themes and sub-themes. Results: Fifty-two and sixteen patients were included in the questionnaire and semi-structured interview groups, respectively. Patients used TCM with the hope of regulating their body holistically to improve nonmotor symptoms and quality of life (QOL). Those who recognised TCM as ineffective tended to discontinue it after a three-month trial period. Although quality was a major concern, herbal medicine (HM) was the most frequently used modality among all participants (n = 52), with the majority (n = 44, 84.6%) continuing to use it. Patients emphasised in-person consultations as a crucial part of TCM treatment. However, the disability caused by disease often made this interaction unattainable. Conclusion: Nonmotor symptoms and QOL hold substantial importance for patients with ALS using TCM. HM is a more suitable modality than other TCM treatment modalities, but patients are facing challenges in seeking HM treatment. It is necessary to promote the implementation of hierarchical diagnosis and treatment, thus making TCM more accessible. Trial registration: ClinicalTrials.gov identifier: NCT04885374 (registered on May 13, 2021).

Mitochondrial damage is associated with the development of Parkinson's disease (PD), indicating that mitochondrial‐targeted treatments could hold promise as disease‐modifying approaches for PD. Notably, natural compounds have demonstrated the ability to modulate mitochondrial‐related processes. In this review article, we discussed the possible neuroprotective mechanisms of natural compounds against PD in modulating mitophagy and mitochondrial function. A comprehensive literature search on natural compounds related to the treatment of PD by regulating mitophagy and mitochondrial function was conducted from PubMed, Web of Science and Chinese National Knowledge Infrastructure databases from their inception until April 2023. We summarize recent advancements in mitophagy's molecular mechanisms, including upstream and downstream processes, and its relationship with PD‐related genes or proteins. Importantly, we highlight how natural compounds can therapeutically regulate various mitochondrial processes through multiple targets and pathways to alleviate oxidative stress, neuroinflammation, Lewy's body aggregation and apoptosis, which are key contributors to PD pathogenesis. Unlike the single‐target strategy of modern medicine, natural compounds provide neuroprotection against PD by modulating various mitochondrial‐related processes, including ameliorating mitophagy by targeting the PINK1/parkin pathway, the NIX/BNIP3 pathway, and autophagosome formation (i.e., LC3 and p62). Given the prevalence of mitochondrial damage in various neurodegenerative diseases, exploring the exact mechanism of natural compounds on mitophagy and mitochondrial dysfunction could shed light on the development of highly effective disease‐modifying or adjuvant therapies targeting PD and other neurodegenerative disorders.

Objective: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune-mediated disorder with aquaporin 4-immunoglobulin G (AQP4-IgG) in most settings. Soluble programmed death-1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) play key roles in immunomodulation. We aim to assess the association of sPD-1 and sPD-L1 with cytokines and their clinical significance in AQP4-IgG (+) NMOSD. Method: We measured plasma sPD-1, sPD-L1, and 10 cytokines levels of 66 AQP4-IgG (+) NMOSD patients, including 40 patients in attack (attack-NMOSD) and 26 patients in remission (remission-NMOSD) phases, and 28 healthy controls through ultrasensitive Simoa and SP-X platform, respectively. We also performed >2 years (median) of follow-up after testing and analyzed the relationship between the detection index and current and future clinical parameters. Result: Plasma sPD-1 level discriminated attack-NMOSD from remission-NMOSD (AUC = 0.692, p = 0.009). sPD-1 and sPD-L1 levels positively correlated with IL-6 (r(sPD-1) = 0.313; r(sPD-L1) = 0.508), IFN-gamma (r(sPD-1) = 0.331; r(sPD-L1) = 0.456), and TNF-alpha (r(sPD-1) = 0.451; r(sPD-L1) = 0.531) expression, as well as clinical indicators, including the EDSS score (r(sPD-1) = 0.331; r(sPD-L1) = 0.402), number of attacks (r(sPD-1) = 0.431) and segments of spinal cord involvement (r(sPD-1) = 0.462; r(sPD-L1) = 0.508). The risk of relapse within 2 years after sampling was associated with higher sPD-1/sPD-L1 ratio in attack-NMOSD (p = 0.022; Exp(B) = 1.589). Interpretation: Plasma sPD-1 and sPD-L1 levels reflected current disease severity and activity, and predicted future relapses in AQP4-IgG (+) NMOSD, suggesting that they hold the potential to guide timely and targeted treatment.

Dear Editor,We are pleased that our case report entitled “Miller-Fisher syndrome and Guillain – Barre syndrome overlap syndrome following inactivated COVID-19 vaccine: Case report and scope review”...

Miller-Fisher syndrome (MFS) is a rare variant of Guillain–Barré syndrome (GBS) manifesting as the triad of ataxia, areflexia, and ophthalmoplegia. With the extensive 2019 coronavirus disease (COVID-19) immunization program, cases of GBS or MFS following vaccination are increasingly being reported. A 64-y-old Chinese man presented with new-onset paresthesia of the extremities, bilateral abduction limitation, right facial palsy, areflexia of bilateral lower limbs, and left-dominant limb ataxia 12 d after the second dose of inactivated vaccine against COVID-19. Cerebrospinal fluid analysis indicated albumin-cytological dissociation and was positive for anti-GQ1b IgG and anti-GT1b IgG. Nerve conduction studies of limbs showed evidence of axonal neuropathy with reduced sensory amplitudes. Based on the clinical presentations, temporal progression of symptoms, and laboratory findings, the diagnosis of MFS–GBS overlap syndrome was made. The patient was treated with intravenous immunoglobulin and acupuncture and made a complete recovery 54 d after the onset of his initial neurological signs. To the best of our knowledge, we report the first case of MFS–GBS overlap syndrome following the inactivated COVID-19 vaccination. However, a coincidental relationship with this inactivated vaccine cannot be excluded. Although the benefits of COVID-19 vaccination largely outweigh its risk and the prognosis of MFS is generally favorable, a close surveillance of neurological complications post-COVID-19 vaccination is always necessary, considering its potentially disabling and lethal effects on vaccinated populations.

Objective: This study aimed to assess the physical, emotional, medical, and socioeconomic conditions of patients with neuromyelitis optica spectrum disorder (NMOSD) in North China.Methods: A cross-sectional survey of patients with NMOSD was performed, based on an established questionnaire from the Multiple Sclerosis Patient Survival Report 2018. Logistic regression analysis was conducted to define the significant determinants of certain physical or emotional characteristics of patients. A total of 123 patients were included.Results: A total of 63.4% of participants were initially diagnosed with conditions other than NMOSD, with a median delay of 6 months for accurate diagnosis. An aggregate of 72.2% of patients had one or more relapses, corresponding to an annual relapse rate of 0.8. Paresthesia was the most frequent physical symptom among patients both at disease onset (53.7%) and throughout the duration of the disease (86.2%). Onset in elderly (>50 years) patients was associated with an annual Expanded Disability Status Scale increase ≥1, compared with onset in younger (P = 0.001, OR = 7.83). A total of 76.4% of patients had received attack-prevention treatments in the remission phase, and 31.7 and 10.6% of patients had ever been administered rituximab and traditional Chinese medicine, respectively. Additionally, 63.4 and 43.1% of patients reported participating in few or no social activities and being out of work because of the disease. To be noted, 76.4% of patients reported suffering from negative emotions, with the most frequent being worry (60.2%), with 20.3% of patients experiencing suicidal thoughts. The inability to work and participating in few or no social activities due to NMOSD were two determinants of experiencing negative emotions (P_work = 0.03, OR_work = 3.34; P_{socialactivities} = 0.02, OR_{socialactivities} = 3.19).Conclusion: This study reported patient perspectives on NMOSD in North China, whereby demonstrating that the inability to work and participating in few or no social activities due to NMOSD rather than the physical impairment caused by the disease, was directly associated with patients experiencing negative emotions. This insight offers potential ways to manage patients' negative emotions by enhancing family and social support and facilitating active employment.