Background:The therapeutic efficacy of acupuncture in treating Alzheimer disease (AD) largely depends on consistent treatment adherence. Therefore, identifying key factors influencing adherence and developing targeted interventions are crucial for enhancing clinical outcomes. Objective:This study aims to develop and validate a predictive model for identifying patients with AD who are likely to maintain good adherence to acupuncture treatment. Methods:This secondary analysis included 108 patients with probable AD, aged 50 to 85 years, from 2 independent randomized controlled trials conducted at Guang'anmen Hospital, China Academy of Chinese Medical Sciences. Of all, 66 patients were assigned to the development cohort and 42 to the external validation cohort. Acupuncture adherence was defined as the proportion of completed sessions relative to scheduled sessions, with good adherence defined as ≥80% completion. Baseline data included demographic, clinical, cognitive, functional, psychological, and caregiving variables. Multivariable logistic regression with backward stepwise selection was used to identify significant predictors, and a nomogram was constructed based on the final model. Model performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis, with external validation performed by receiver operating characteristic analysis. Sensitivity analysis was performed using alternative adherence thresholds of 70% and 90%. Results:A higher number of treatments during the first month was associated with a significant increase in the odds of good adherence (odds ratio [OR] 3.06, 95% CI 1.68-7.01; P=.002), while longer disease duration (OR 0.97, 95% CI 0.94-1.00; P=.049) and receiving care from a part-time caregiver (OR 0.19, 95% CI 0.04-0.72; P=.022) were associated with lower odds of adherence. Sensitivity analyses further supported the stability and reliability of the model. Conclusions:This study is the first to develop and validate a predictive model for acupuncture adherence in patients with AD. In clinical research, it can facilitate participant stratification and help identify individuals who may need additional adherence support, thereby reducing bias and enhancing trial quality. In clinical practice, the nomogram enables proactive adherence management by prospectively identifying high-risk patients and guiding targeted strategies to improve adherence and optimize therapeutic outcomes.

Introduction:The long-term efficacy of electroacupuncture (EA) in treating cognitive symptoms of Alzheimer's disease (AD) remains unclear, and its time-dependent relationship requires further investigation. Methods:Sixty-six patients were allocated to the EA or sham EA group, with stimulation for 20 minutes, for a 24-week treatment period, and were followed-up at 4 weeks. The primary outcome was the mean change in the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) score. Activities of daily living and behavioral and psychological symptoms were also assessed. Results:After 24 weeks of intervention, patients demonstrated significant improvements in ADAS-Cog scores, with sustained benefits observed during the 4-week follow-up period. In addition, improvements were observed in activities of daily living and behavioral and psychological symptoms. Discussion:The use of EA as a promising nonpharmacological intervention for AD. Clinical Trial Registration:https://www.chictr.org.cn/showproj.html?proj=151275, identifier (ChiCTR2200056329).

The role of noise pollution as a risk factor for Alzheimer disease (AD) is unclear, with observational studies yielding conflicting results susceptible to confounding and reverse causality. To clarify this relationship, we performed a 2-sample Mendelian randomization (MR) study using summary statistics from large-scale genome-wide association studies of European populations. Genetically predicted daytime and evening noise exposure was used as an instrumental variable to assess a causal effect on AD risk. The primary analysis was conducted using the inverse-variance weighted method, with weighted median and MR-Egger methods as key sensitivity analyses. We assessed instrument validity and pleiotropy using the Cochran Q test, the MR-Egger intercept, and leave-one-out analysis. Our MR analysis found no evidence of a causal association between genetically predicted daytime noise (odds ratio [95% confidence interval] = 0.999 [0.993-1.006], P = .819) or evening noise (odds ratio [95% confidence interval] = 0.999 [0.993-1.005], P = .643) and the risk of AD. Sensitivity analyses were consistent, with no evidence of heterogeneity or directional pleiotropy. In conclusion, this study does not support a direct causal link between noise and AD. While our findings mitigate common observational biases, they do not preclude indirect mechanisms whereby noise may influence AD pathogenesis via established risk pathways, such as chronic sleep disruption and cardiovascular stress. Studies are needed to focus on disentangling these potential indirect effects.

This article reports a case of multiple cranial nerve injury after gamma knife radiosurgery treated with acupuncture and moxibustion combined with rehabilitation therapy. The patient presented with weakness of facial and tongue muscles, hoarseness, choking on water, and swallowing difficulties. The syndrome was attributed to qi and blood deficiency, and blood stasis obstructing the collaterals. The treatment principle focused on replenishing qi and blood, promoting blood circulation and unblocking collaterals. Yintang (GV24+), Lianquan (CV23), Qihai (CV6), Guanyuan (CV4), and Cuanzhu (BL2), Yangbai (GB14), Jingming (BL1), Sizhukong (TE23), Yingxiang (LI20), Sibai (ST2), Juliao (ST3), Quanliao (SI18), Dicang (ST4), Jiache (ST6), Xiaguan (ST7), Taiyang (EX-HN5) on the affected side, bilateral Jinjin (EX-HN12), Yuye (EX-HN13), Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6), Tianshu (ST25) were selected. Among these, bilateral Jinjin (EX-HN12) and Yuye (EX-HN13) were treated with pricking, Dicang (ST4) and Jiache (ST6) on the affected side were connected to an electroacupuncture device, and warming acupuncture was applied at Guanyuan (CV4). Rehabilitation therapy and electromyographic biofeedback were also incorporated. The treatments were given 2-3 times a week. After 18 months of intermittent treatment, the patient reported significant improvement, House Brackmann (H-B) facial nerve function grade was Ⅳ, and Sunnybrook facial nerve rating scale score was 53 points. After 2-month of follow-up, the patient reported normal swallowing ability and restored social engagement.

This article reports 2 cases of urinary retention in Alzheimer's disease with agitation treated by acupuncture. Based on patients' clinical symptoms, the etiology and pathogenesis were determined, and acupuncture was applied to Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), and bilateral Ciliao (BL32), Zhongliao (BL33), Fengchi (GB20), Taiyang (EX-HN5), etc. to regulate the mind and promote water metabolism. The positive and negative electrodes of the SDZ-Ⅴ type electroacupuncture device were attached to ipsilateral Ciliao (BL32), Zhongliao (BL33) respectively, with continuous wave, at the frequency of 15 Hz, and the current of 3 to 10 mA, depending on patients' tolerance. The needles were retained for 20 min. The treatment was delivered once every other day, 3 interventions a week and 12 interventions as 1 course. Both patients reported the micturition desire after 1 intervention with acupuncture and the catheter was removed on the same day. The urination was ameliorated without dysuresia after 1-2 courses of treatment, and the agitated behavior was alleviated. It can be the reference for the clinical treatment of urinary retention in patients with Alzheimer's disease with agitation.

患者,男,68岁,于2021年11月4日初诊.主诉:语速减慢、行走不稳3年余,伴二便障碍1月余.现病史:2018年11月无明显诱因缓慢出现语速减慢,找词困难,沟通减少,行走不稳,易向后倾,伴记忆力下降和饮水呛咳.于北京市某医院诊断为"帕金森叠加综合征",予多巴丝肼片口服,每次62.5 mg,每日3次,丁苯肽软胶囊口服,每次0.2 g,每日3次,效果不佳.

Implantable cervical vagus nerve stimulation (iVNS) is a representative and promising neuromodulation. However, the invasive nature restricts its application. Traditional auricular acupuncture treatment has a long history. The auricular branch of the vagus nerve (ABVN) is a branch on the surface of the ear. Some studies demonstrates that transcutaneous auricular vagus nerve stimulation (taVNS) would achieve similar effects as iVNS. TaVNS and iVNS share a common anatomical basis and acting mechanism. In this article, we made a comparison between iVNS and taVNS in indications and efficacy. The recent studies have revealed similar clinical efficacy of taVNS, taVNS would expand the indication of iVNS. High-quality clinical evidences are needed before taVNS become be an alternative of iVNS.

缺血再灌注损伤(IRI)在组织损伤中非常常见,其病理过程较为复杂,可通过多种细胞因子及相关信号通路参与细胞损伤,对机体损伤严重.中医认为缺血再灌注损伤乃气血瘀滞所致,而中药三七具有活血化瘀、且毒副作用小的特点,其活性成分药理作用广泛,参与改善微循环、调节代谢、减轻应激及自噬等过程,从而改善重要器官缺血再灌注损伤.本文主要对近年来三七及其活性成分对缺血再灌注损伤的保护机制进行简要综述,为以后的研究提供参考.

Alzheimer’s disease（AD） is one of the most common neurodegenerative diseases among the elderly and it accounts for nearly 80% of all dementias.The pathogenesis of AD is complicated and enigmatic thus far.The mitochondrial cascade hypothesis assumes that mitochondrial damage may mediate,drive,or contribute to a variety of AD pathologies and may be the main factor in late-onset AD.Currently,there are no widely recognized drugs able to attenuate mitochondrial damage in AD.Notably,increasing evidence supports the efficacy of acupuncture for improving the mitochondrial structure and protecting mitochondrial functions in AD.This review reports the mechanisms by which acupuncture regulates mitochondrial dynamics,energy metabolism,calcium homeostasis and apoptosis.In conclusion,these findings suggest that AD mitochondrial dysfunction represents a reasonable therapeutic target and acupuncture could play a significant role in preventing and treating AD.

患者,女,40岁,于2020年5月22日初诊.主诉:头颤 1 个月.现病史:平素使用手机和伏案时间较多,时感头部发沉,1个月前项部不慎感受风寒后出现头颤,项部着凉、劳累后加重,睡眠时消失,影响工作和生活.

Alzheimer's disease (AD), also called senile dementia, is a neurodegenerative disease, characterized by progressive memory and cognitive impairment and different degrees of behavior-mental dysfunction. Clinical trials displayed that acupuncture therapy is effective in relieving symptoms of AD patients. In recent years, many experimental studies have been conducted in SAMP8 mice to explore the underlying mechanisms of acupuncture in improving AD. Results showed that acupuncture therapy can intervene the central pathological process of AD in multiple approaches, including reducing formation of cerebral β amyloid protein and promoting its removal, intervening the phosphorylation process of Tau protein, improving mitochondrial and synaptic structure, enhancing autophagy activity, accelerating cerebral blood flow, and increasing the levels of estrogen content, and improving the learning and memory ability, etc.

Pro-inflammatory factors may be associated with abnormalities in functional brain networks, which may be a mechanism in the pathogenesis of major depressive disorder (MDD). Electroencephalogram (EEG) microstates reflect the functioning of brain networks. However, the relationship between pro-inflammatory factors and the microstate abnormalities in patients with MDD is poorly understood. 24 MDD patients and 24 age-and sex-matched healthy controls (HC) were recruited. Montgomery-Asberg Depression Rating Scale(MADRS) were assessed. Serum (interleukin- 2(IL- 2), tumor necrosis factor-α (TNF-α) and hs-C-reactive protein (CRP)and EEG data were collected. K-means clustering was performed to characterize different microstates. For each microstate, duration, occurrence and coverage were estimated. Four microstates (e.g. A, B, C, D) were characterized, MDD group showed lower duration, occurrence and coverage of microstate B and microstate D, while higher duration of microstate A and microstate C and levels of IL-2, TNF-α, hs-CRP than HC group. The duration, occurrence and coverage of microstate D were negatively correlated with levels of pro-inflammatory factors (IL-2, TNF- α and hs- CRP) (all P < 0.05). Serum pro-inflammatory induced the abnormalities of microstate D. Together, these findings add to the understanding of the pathophysiology of MDD and point to pro-inflammatory factors contribute to EEG microstate abnormalities in patients with MDD.

ObjectivesTranscutaneous auricular vagus nerve stimulation (taVNS) has been reported to be effective for chronic insomnia (CI). However, the appropriate population for taVNS to treat insomnia is unclear.MethodsTotal twenty-four patients with CI and eighteen health controls (HC) were recruited. Rest-state functional magnetic resonance imaging (Rs-fMRI) was performed before and after 30 min' taVNS at baseline. The activated and deactivated brain regions were revealed by different voxel-based analyses, then the seed-voxel functional connectivity analysis was calculated. In the CI group, 30 min of taVNS were applied twice daily for 4 weeks. Pittsburgh Sleep Quality Index (PSQI) and Flinders Fatigue Scale (FFS) were also assessed before and after 4 weeks of treatment in the CI group. The HC group did not receive any treatment. The correlations were estimated between the clinical scales' score and the brain changes.ResultsThe scores of PSQI (p < 0.01) and FFS (p < 0.05) decreased after 4 weeks in the CI group. Compared to the HC group, the first taVNS session up-regulated left dorsolateral prefrontal cortex (dlPFC) and decreased the functional connectivity (FCs) between dlPFC and bilateral medial prefrontal cortex in the CI group. The CI groups' baseline voxel wised fMRI value in the dlPFC were negatively correlated to the PSQI and the FFS score after 4 weeks treatment.ConclusionsIt manifests that taVNS has a modulatory effect on the prefrontal cortex in patients with CI. The initial state of dlPFC may predict the efficacy for taVNS on CI.

目的:探索经皮耳穴-迷走神经刺激(taVNS)对原发性失眠(PI)患者奖赏、觉醒相关脑区功能连接的即刻作用.方法:20例PI患者进行30min的taVNS治疗,并于刺激前后进行磁共振检查,对比刺激前后PI患者奖赏环路、觉醒相关结构的多个种子点与全脑各体素之间静息态磁共振功能连接(FC)变化,从脑功能角度阐述taVNS治疗失眠的潜在机制.结果:即刻刺激后,PI患者左侧视前区与后默认网络(包括左侧楔前叶、双侧后扣带回、双侧楔叶)之间FC升高(t=4.2944);右丘脑内侧与左中央前回和左辅助运动区之间FC升高(t=5.9958);双内侧下丘脑与双侧楔前叶、后扣带回之间FC升高(t=4.3032);左丘脑前部与左中央前回、额上回、额中回之间的FC升高(t=5.9617);左前喙部扣带回与右舌回、枕下回之间FC升高(t=4.9384),与右颞下回、右颞中回(t=-4.7624),右顶下小叶、右缘上回、右角回(t=-4.5715)和左顶下小叶、左角回(t=-4.3348)之间的FC降低.余种子点刺激前后与全脑FC变化差异无统计学意义.结论:taVNS即刻刺激调制了分属多个脑网络的脑区之间FC.

目的 探讨石斛酚对高糖诱导的视网膜血管内皮细胞凋亡及炎症反应的影响及机制.方法 建立高糖诱导的视网膜血管内皮细胞模型;用石斛酚(50、60、70μg/ml)治疗处理模型细胞24 h;四甲基偶氮唑蓝(MTT)法检测细胞活力;流式细胞术检测细胞凋亡;酶联免疫吸附试验(ELISA)检测细胞中活性氧(ROS)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)的含量;Western印迹检测细胞中半胱氨酸天冬氨酸蛋白酶(caspase)-3、酶切caspase-3、磷脂酰肌醇-3激酶(PI3K)、p-AKT、T-AKT的蛋白表达.结果 成功构建视网膜血管内皮细胞损伤模型;与模型细胞相比,石斛酚(50、60、70μg/ml)治疗后,细胞活力明显上调,凋亡能力明显下调,抗氧化能力明显增强,AKT信号通路异常活化,下调酶切caspase-3蛋白表达;60μg/ml石斛酚对细胞的治疗作用明显优于50、70μg/ml.结论 石斛酚对高糖诱导的视网膜血管内皮细胞具有抗凋亡、抗炎的功效,其机制与激活AKT信号通路相关.

患者,女,70岁,2019年10月24日主因"左侧面部斑丘疹伴疼痛2 d"就诊.现病史:2 d前过度劳累后左侧面部出现散在红色斑丘疹,以左侧额部、鼻梁、鼻尖部为著,无水疱,伴疼痛,疼痛呈发作性刀割样,主要累及左侧头顶部、额部、颞部,左侧眼睑下垂,影响视野,上眼睑充血红肿.于某医院眼科诊断为"带状疱疹伴三叉神经痛",予更昔洛韦胶囊、妥布霉素地塞米松滴眼液治疗后自觉眼部肿胀改善不明显,仍感疼痛剧烈.刻下症:左侧眼睑肿胀、疼痛,视物不清,无鼻塞、流涕等鼻部症状,口苦,纳可,眠差,二便调,舌淡、苔白腻,脉沉无力.查体:左侧额部、鼻梁、鼻尖部散在红色斑丘疹,左侧上眼睑充血水肿,球结膜轻度水肿,皮损区痛觉超敏,粗测视力正常.西医诊断:带状疱疹伴三叉神经痛;中医诊断:蛇串疮(湿热毒蕴证).治则:泻热拔毒,扶正祛邪.取穴:阿是穴,患侧承泣、睛明、阳白.

目的 研究miR-210-5p对葡萄膜黑色素瘤细胞增殖、迁移、侵袭的影响及其机制.方法 运用qRT-PCR、Western印迹检测人葡萄膜黑色素瘤M23、人正常葡萄膜上皮细胞ARPE-19中miR-210-5p、生长抑制因子(ING)4的表达;将anti-miR-210-5p组(转染anti-miR-210-5p)、anti-miR-NC组(转染anti-miR-NC)、pcDNA组(转染pcDNA)、pcDNA-ING4组(转染pcDNA-ING4)、anti-miR-210-5p+si-con组(共转染anti-miR-210-5p和si-con)、anti-miR-210-5p+si-ING4组(共转染anti-miR-210-5p和si-ING4)均用脂质体法转染至M23细胞;四甲基偶氮唑蓝(MTT)法检测各组细胞增殖;Transwell法检测各组细胞迁移和侵袭;双荧光素酶报告基因检测实验检测各组细胞荧光活性.结果 与正常葡萄膜上皮细胞ARPE-19相比,葡萄膜黑色素瘤M23中miR-210-5p表达显著升高,ING4表达显著降低(P<0.05);抑制miR-210-5p、过表达ING4均可明显抑制ING4细胞增殖、迁移、侵袭;miR-204-5p可靶向负调控ING4的表达;抑制ING4可逆转抑制miR-210-5p对M23细胞增殖、迁移、侵袭的抑制作用.结论 miR-210-5p可促进葡萄膜黑色素瘤细胞的增殖、迁移、侵袭,其机制可能与靶向ING4有关,将可为葡萄膜黑色素瘤的靶向治疗提供新靶点.

In recent years, the newly appeared closed-loop neuromodulation technique composed of closed-loop controlled stimulation system and neuromodulation is the product of medicine and inter-disciplines. In medical clinical practice, the idea of closed-loop controlled stimulation can be seen everywhere. When both the patient and acupuncturist achieve the state of Deqi simultaneously, it is a kind of feedback adjustment process similar to that of the closed-loop stimulation system. Cross-functional multidisciplinary development is the future trend of medical science progress. The acupuncture-moxibustion discipline can draw lessons from the research experience and achievements of closed-loop neuromodulation techniques to explore the origin of the compatibility of meridians, acupoints, and needling manipulations.

术后谵妄是麻醉和手术后出现的一种精神错乱状态,通常在术后早期发生,临床基本特征为意识、注意力、认知和知觉障碍.患者自我行为能力降低,不能配合治疗.术后谵妄治疗护理难度,易出现意识障碍、坠床、意外拔管等,对病情治疗带来不利影响,本文为一阑尾粘液性肿瘤术后谵妄患者治疗护理成功的案例,通过对患者治疗用药护理经过的回顾总结,为此类病患的治疗护理提供有益借鉴.

目的 对我校护理专业毕业生就业意愿、影响因素进行调查分析,提出相应的干预措施,以服务毕业生就业.方法 采用自编问卷对我校2017级150名专科毕业生进行就业调查,用统计学方法对数据进行分析.结果 专科毕业生就业中存在自卑心理,没有合理的求职规划,缺乏求职技巧;部分毕业生就业期望定位与市场需求存在较大差距.结论 引导鼓励大学生到基层医院、医学相关企业、省外医院就业;实施个性化指导、多元化灵活就业;鼓励有意愿的学生进行规范化培训和学历提升;不断改进、完善我校毕业生就业指导工作.