First, a brief history of the development of foreign neurology and the current situation 1, the history of the development of neurology Neurology is an ancient clinical discipline, almost accompanied by the emergence of medicine. As early as in the 17th century BC, the earliest medical literature – Edwin? Smith Papyrus (Edwin Smith Papyrus)-had already described in detail the structure of the cranium, the meninges, the external surface of the brain, the cerebrospinal fluid, and the fluctuations of intracranial pressure. There are numerous descriptions of neurological signs in many other manuscripts since then, such as the Sumerians’ description of a lion paralyzed in its lower limbs after being struck in the back by an arrow in a shallow relief sculpture, and the Egyptians’ description of a human being after a transection of the spinal cord. This was the beginning of human understanding of neurological disorders. But for a long time thereafter, the development of medicine, including neurology, was relatively stagnant due to religious constraints. Modern neurology began to develop in the sixteenth century, when Vesalius (1514-1564) described in detail the anatomy of the brain as well as other parts of the brain, and Thomas Willis (1621-1675) published his Anatomy of the Brain and Pathology of the Brain in 1664 and 1676, respectively. His description of the ring of the basilar artery, which bears his name to this day, and some of his vague ideas on reflexes and localization were among the earliest insights into the functioning of the brain, in addition to describing neurological signs such as epilepsy, stroke, and hemiplegia. The term neurology was used for the first time in his literature. In the nineteenth century, the study of neurology was further developed by the use of microscopic techniques.Purkinje (1787-1869) first described the morphology of neurons in 1837, and thereafter Golgi and Cajal and others discovered the branching of nerve cells and synapses.LuigiGalvani (1737-1798) found that electrical stimulation of nerves induces muscle contraction, and CharlesBell(1774-1842) and FrancoisMagendie(1783-1855) found that the anterior horns of the spinal cord were associated with movement while the posterior horns were associated with sensation.Since then, the functional localization of the nervous system has been well understood thanks to the efforts of many neurologists. With the development of basic disciplines such as physiology, pathology, microbiology and immunology, and the advancement of experimental techniques, the level of diagnosis and treatment has been improved, and neurology has been pushed to a new stage of development. The twentieth century was a period of rapid development of neurology. Neurology in the inheritance of the previous neuroanatomy, neurophysiology and neuropathology on the basis of fruitful results continue to make great progress. Computed tomography (CT) and the successive emergence of magnetic resonance technology have greatly improved the diagnostic level of neurological diseases, accelerated the development of clinical neurology, and benefited countless people with neurological diseases. The Human Genome Project, launched in 1990, has completed the complete sequencing of human genes, revealing the mysteries of genes will surely provide new methods and ideas for the genetic diagnosis and treatment of hundreds of various neurogenetic and degenerative diseases. The twenty-first century will be a century of vigorous development of neurology. Following the approval by the U.S. Congress of the American Academy of Neurology’s “Decade of the Brain” (1991-2000), the U.S. government has proposed that the twenty-first century is the “Century of the Brain,” and neuroscience research has become the most active field of research. Progress in the fields of neuropathology, neuroimmunology, neurovirus, genetics and proteomics will enable people to understand the etiology and pathology of neurological diseases at various levels; the development of neuroimaging and interventional techniques has provided new diagnostic and treatment methods for many diseases; research at the molecular level of genes and proteins has promoted the development of neuropharmacology, and drug research and development have made great progress; stem cell technology has provided new hope for the treatment of neurological diseases; and research on the treatment of neurological diseases has provided new hope for the treatment of neurological disorders. Stem cell technology provides new hope for the treatment of neurological diseases; research on neural network and functional reconstruction has led to better neurological rehabilitation for stroke patients. 2. The most influential major events in neurology and their major impact on the discipline. (1) Computed tomography (CT): This is a technology that appeared in the 1970s and was applied to the examination of the central nervous system, and also marked a milestone in neurological examination technology. CT enabled neurologists to observe for the first time the normal and abnormal morphology and structure of different parts of the living brain, and is still the most direct and objective examination tool to determine the presence of intracranial space-occupying lesions, hemorrhage, calcification, and foreign bodies. It is still the most direct and objective means to determine the presence of intracranial occupying lesions, hemorrhage, calcification and foreign bodies. (2) Magnetic Resonance Imaging (MRI): This technology was widely used in the late 1980s and early 1990s. It can observe the structure and lesions of the central nervous system more accurately and more clearly than CT technology, especially the spinal cord structure and its lesions which cannot be observed by CT technology, and it can detect cerebral and spinal cord foci at an earlier stage than CT technology, especially the foci at the early stage of ischemia. (3) Application of levodopa and other central nervous system receptor modulation drugs: Arvid Carlsson, a Swedish pharmacologist, proved in the 1960s that dopamine has a special distribution and function in the brain, and then invented a method of treating Parkinson’s disease with levodopa on the basis of his research. It has not only enabled tens of millions of Parkinson’s disease patients around the world to regain a normal life, but also directly guided the production of a large number of other central nervous system receptor modulation drugs, which has had a far-reaching impact on neuropharmacology research. Second, a brief history of the development of domestic neurology and the current situation 1, a brief history of the development of neurology The history of the development of domestic neurology appeared in the early part of the last century, in 1921, Beijing established an independent Department of Neurology to teach neurology in 1949 before the country had only more than 30 neurologists. By 1957, neurology departments were established in major hospitals across the country, and a large number of neurologists were trained. 1952 saw the establishment of the Neuropsychiatric Society of the Chinese Medical Association (CMA), and the academic activities of the Neuropsychiatry Society of the CMA were very active, contributing much to the promotion of China’s neurology, training of specialists, and catching up with the international level. Nine academic groups were established under the Society, namely, the Electromyography and Neurophysiology Group (1984), the Neuropathology Group (1986), the Neurobiochemistry Group (1986), the Electroencephalogram and Epilepsy Group (1987), the Neuropsychology Group (1987), the Neuroimmunology Group (1989), the Neuromyopathy Group (1991), the Neurological Rehabilitation Group (1991), and the Cerebrospinal Fluid In 1993, the Chinese Neuropsychiatric Association was separated into the Chinese Neurological Association and the Chinese Psychiatric Association, and in January 1998, the Beijing Neurology Academic Salon was established under the joint initiative of Zhang Weihui and other neurological clinical specialists, with 8,852 members from first-line clinicians in 31 provinces, autonomous regions, and municipalities directly under the central government, making it a very influential academic organization of neurology in China. It has become a very influential academic organization of neurology in China. It has published the first monograph “Stroke Unit”, which reflects the current situation of stroke unit in China, and “Progress in Modern Neurology” and “BNC Cerebrovascular Disease Guidelines”. At present, neurology has developed into a very complete clinical discipline and has many strong specialized branches. 2, in recent years, the current situation of the development of neuroscience: (1) cerebrovascular disease: stroke is the second cause of death in China. How to effectively control the occurrence and recurrence of stroke and reduce the death rate and disability rate has become the concern of the whole society. In the treatment of acute ischemic cerebrovascular disease, the effective thrombolytic method recognized by evidence-based medicine in the international arena is r-TPA thrombolytic therapy within 3 hours after cerebral infarction, and the complications of intracranial hemorrhage do not increase. The national “Ninth Five-Year Plan” research project of 1-1.5 million units of urokinase for the treatment of cerebral infarction within 6 hours after the onset of the application of a definite effect, and the complications of intracranial hemorrhage does not increase, and has been widely used. Currently it is emphasized that the application of neuroprotective agents prevents further neuronal damage by neurocytotoxic substances in the semi-dark band caused by acute cerebral ischemia. The stroke unit is an effective treatment and medical management model, which is superior to thrombolysis, antiplatelet, and anticoagulation alone in evidence-based medical analysis, and is currently the most effective way to treat stroke internationally. The stroke unit model promotes limb use and improves quality of life. In the past decade or so, interventional techniques originating from cardiovascular sources have been applied to cerebrovascular disease, and have soon been widely used with excellent results. In the treatment of elective cerebrovascular disease, the treatment has been widely carried out in China, including endarterectomy, carotid artery stenting, and intensive mechanical crushing of blood clots, which have been applied and achieved better results. The development of modern science and technology has led to the rapid development of neuroscience. Vascular intervention technology has a greater role in the diagnosis and prevention of cerebrovascular disease, magnetic resonance technology such as MRI diffusion weighting can determine acute ultra-early ischemic cerebrovascular lesions; multi-row (64-row) CT three-dimensional structural reconstruction of brain tissues and angiographic technology for clinical early diagnosis of ischemic cerebrovascular disease to provide conditions. In the treatment of cerebral hemorrhage, the minimally invasive removal of intracranial hematoma carried out in recent years can reduce the damage to the brain caused by craniotomy. (2) Neurological infectious diseases: With the development of neuroimaging, clinical tests and pharmacology, many neurological infectious diseases such as viral encephalitis or meningitis, tuberculous meningitis or cerebrospinal meningitis, suppurative meningitis, cerebral abscess, and addictive coccidioidomycosis can be effectively diagnosed and treated. In particular, the use of acyclic guanosines has significantly reduced the mortality rate in monoherpetic encephalitis. (3) Neurologic demyelinating diseases: In addition to hormonal shock therapy, plasma exchange, immunologic drugs (e.g., cyclosporine A, azathioprine, cyclophosphamide, etc.), and the newer use of gammaglobulin have shown better outcomes in neurologic immune diseases. For example, multiple sclerosis, Guillain-Barre syndrome, CIDP, POEMS syndrome, disseminated cerebrospinal meningitis, polymyositis or dermatomyositis, myasthenia gravis, acute myelitis and other diseases, and in some cases, even completely achieve a radical effect. (4) Myopathy: Through the peroneal nerve and the corresponding muscle tissue biopsy, used for general pathology, muscle histochemistry, ultrastructural or immuno-ultrastructural pathology diagnosis, to make a reliable diagnosis for peripheral nerve and muscle diseases. (5) Degenerative encephalopathy: With the progress of neuropathology and neurobiology research, the research on neurodegenerative encephalopathy has become more in-depth. Neural stem cell transplantation and gene therapy have been carried out. In clinical trial studies, the transplantation of fetal brain nigrostriatal cells for the treatment of Parkinson’s disease has met with initial success, and the transplantation of acetylcholine-expressing neurons can be used for the treatment of Alzheimer’s disease. Transplantation of cells (including neural cells and genetically modified non-neural cells) has good prospects for the treatment of nerve injury and degenerative diseases. Neuronal precursor cells have undifferentiated transmitter phenotypes and can be induced into various types of neurons, so they can be used in the treatment of different types of neuron-deficient neuropathies, such as dopamine-expressing neurons can be used to treat Parkinson’s disease and acetylcholine-expressing neurons can be used to treat Alzheimer’s disease. Since neuronal precursor cells can proliferate almost indefinitely in vitro, it can solve the problem of donor cell source for neural cell transplantation. Neuronal precursor cells, as a kind of primitive cells, are more likely to survive than differentiated mature neurons. Attention to the matching of major histocompatibility antigens to reduce the post-transplantation immune rejection response can help to improve the survival rate of transplantation. III. Limitations and shortcomings of the current technology 1. Limitations of the current technology in the field of neurological diseases (1) In diagnosis: there is still a lack of specific methods for genetic diagnosis and gene therapy for Alzheimer’s disease, mad cow disease, familial amyloidosis and familial hypercholesterolemia. (2) Diseases: Although there are a number of diseases, especially the neurological infections and immune diseases mentioned above, there are still many neurological diseases that are still untreatable, including: (1) diseases that can improve symptoms but cannot be cured, such as Parkinson’s disease, Wilson’s disease, dystonia, primary epilepsy, (2) diseases that cannot be improved or cured, such as Alzheimer’s disease, Huntington’s disease, Alzheimer’s disease, and other diseases that cannot be treated. dementia, Huntington’s disease, hereditary cerebellar ataxia, myotonic dystrophy, and so on. ③ There is still a lack of effective treatment for cerebrovascular diseases with high morbidity, disability and mortality rates. 2, the urgent need to break through the technology and its long-term effects (1) neural stem cell transplantation: neural stem cell transplantation for the treatment of central nervous system diseases provides a new way of thinking, but there are many urgent problems: such as the differentiation of neural stem cells and the function of the repair mechanism is still not very clear, the transplanted cells can be combined with the body cells, the establishment of a normal synaptic connection of the nervous system needs further research. Whether the transplanted neural stem cells have any immune rejection reaction with the organism and whether they can acquire all the characteristics of mature neurons is still not clear. It has been reported that testicular support cells (Sertoli cells) can secrete many nutritional, regulatory, and immunosuppressive factors, which can provide nutrients and anti-immune rejection when transplanted with embryonic neural cells, which not only promotes the recovery of the disease, but also reduces the risk of long-term application of immunosuppressive drugs. It is believed that with the deepening of research, neural stem cells will be able to play an important role in the clinical application of central nervous system degenerative diseases, ischemic injury and tumor treatment. (2) Therapeutic means: At present, there is an urgent need to develop more effective thrombolytic drugs as well as special antiviral drugs, etc. With the development of these drugs, the disability and mortality rates of ischemic cerebrovascular disease and viral infections of the central nervous system will be significantly reduced. (3) At present, certain brain and spinal cord lesions are in urgent need of minimally invasive or non-invasive examinations for qualitative diagnosis. (3) Constraints on technological progress and countermeasures (1) Insufficient investment in research funding and lack of sustainable research and development programs. (2) Increase investment in various aspects and strict scientific management. 4. Basic technical situation and development prospect of the discipline 1. Current situation of technical development of the discipline (1) Highly educated staffing: 7 doctors; 5 masters. (2) Thrombolytic therapy for acute ischemic cerebrovascular disease: our department has started thrombolytic therapy since 1999, and in 8 years of clinical practice, we firstly proposed the treatment method of shock volume rTPA followed by small-dose urokinase pumping, and led the multi-center clinical study of the project, through more than 100 cases of clinical application, the rate of vascular recanalization has reached 80%, and at the same time, we have solved the problem of vascular reocclusion in the previous thrombolytic therapy. (3) For patients with frequent TIA episodes, about 1/3 of them develop complete stroke in about 1 month. To address this clinical problem, our department has taken the lead in proposing antithrombotic/fibrin-lowering therapy, applying small-dose urokinase antithrombotic or fibrin-lowering enzyme, which has led to the abortion of nearly 200 patients with frequent TIA episodes, and their conditions have been stabilized in the long-term follow-up. (4) Minimally invasive removal of intracerebral hematoma: This technique is easy to operate, with little side injury, no need for general anesthesia, and can be carried out by the bedside of the ward, which is especially suitable for cases with advanced age, large amount of bleeding, and unstable vital signs. Since the launch of this program in 2003, we have successfully treated more than 30 cases of spontaneous intracerebral hemorrhage in the middle- to large-volume range, without a single case of surgical complication. (5) Endovascular intervention therapy: (6) Clinical application of botulinum toxin program (7) Neurology Consultation Center for Difficult Cases: After the launch of the program, we have pooled our wisdom and promptly identified many difficult cases, including one case of Creutzfeldt-Jakob disease, one case of carcinomatous meningoencephalopathy, one case of epileptic-like neurological dysfunction, one case of hereditary ataxia, and one case of extremely severe multiple dermatomyositis. In addition to providing clear diagnosis and treatment for the patients, we expanded the popularity of our department and hospital. (8) International Collaborative Research on Acute Ischemic Cerebrovascular Disease: Several International Drug Watch Programs 2. Prospects for the Development of the Department and Technological Development Continuing to Expand the Admission – Striving for the unfolding of the Neurological Critical Care Unit with the support of the hospital to improve the success rate of the rescue of critical cases in the Department of Neurology. In the past 2 years, the beds of our department have been tight, and there are often neurological patients with acute and critical illnesses who are stranded in the emergency department and cannot be treated under full specialized supervision in a timely manner, and even miss the best time window for treatment. Therefore, on the basis of accelerating the turnover of beds, expanding the admission is very important for the development of our department. Utilizing our department’s advantageous position in the field of neuroscience in Beijing, we will continue to deepen arterial and venous thrombolysis, so that the rate of revascularization will reach the international advanced level. Endovascular intervention: Adhere to the consultation center for difficult neurological diseases, expand the visibility of our department and our hospital in China, and solve more practical clinical problems for patients at home and abroad. Continue to expand international cooperation. 3. Militaristic features of the technology of this discipline: Cerebrovascular disease is increasing in the incidence of young and middle-aged people, and infectious diseases of the central nervous system are also common in the army. In recent years, our department admitted the youngest acute cerebral infarction for 25-year-old officer of a ministry, with many cases of junction brain, chemo brain, and diseased brain. Popularization of cerebrovascular disease prevention knowledge, timely detection and control of related risk factors, to improve the combat effectiveness of the troops is of great significance. Wartime or emergencies kind, traumatic brain injury and intracerebral hematoma directly endanger the life of the injured, delayed treatment may cause permanent high disability. Intracranial hematoma minimally invasive fragmentation suction technology can be used in a variety of unconventional conditions, such as war, peacekeeping operations, emergencies, without the need for operating room, paralysis and other ancillary facilities can be carried out. Timely removal of intracranial hematomas on a relatively closed basis greatly reduces the risk of secondary infection, which is essential for preserving life and neurological function.