Transcutaneous vagus nerve stimulation (tVNS) is an emerging non-invasive technique designed to stimulate branches of the vagus nerve distributed over the body surface. Studies suggest a correlation between the brain-gut-microbiota (BGM) axis and the pathogenesis of Alzheimer’s disease (AD). The BGM axis represents a complex bidirectional communication system, with the vagus nerve being a crucial component. Therefore, non-invasive electrical stimulation of the vagus nerve might have the potential to modify—most of the time probably in a non-physiological way—the signal transmission within the BGM axis, potentially influencing the progression or symptoms of AD. This review explores the interaction between percutaneous vagus nerve stimulation and the BGM axis, emphasizing its potential effects on AD. It examines various aspects, such as specific brain regions, gut microbiota composition, maintenance of intestinal environmental homeostasis, inflammatory responses, brain plasticity, and hypothalamic–pituitary–adrenal (HPA) axis regulation. The review suggests that tVNS could serve as an effective strategy to modulate the BGM axis and potentially intervene in the progression or treatment of Alzheimer’s disease in the future.

BackgroundRepetitive transcranial magnetic stimulation (rTMS), as an emerging non-invasive neuromodulation technique, is now widely employed in rehabilitation therapy. The purpose of this paper is to comprehensively summarize existing evidence regarding rTMS intervention for lower limb motor function in patients at different stages of stroke.MethodsA systematic search was conducted to identify randomized controlled trials (RCTs) assessing the efficacy of rTMS for treating lower limb motor dysfunction after stroke. Multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library, were searched. The search period extended from the inception of the libraries to June 2024. Literature information was extracted, and methodological quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook. Meta-analysis was performed using Stata 17.0 software.ResultsOverall, 49 appropriate studies (including 3,558 stroke subjects) were found. Meta-analysis results demonstrated that rTMS effectively improved lower limb motor function across all stages of stroke. The intervention was particularly more effective in patients in the subacute stage than in the acute or chronic stages. Subgroup analysis revealed that, for acute-stage patients, low-frequency stimulation targeting the M1 or DLPFC brain regions on the unaffected side with 20–40 sessions significantly improved FMA-LE scores. In subacute-phase patients, low-frequency stimulation targeting the M1 brain regions on the unaffected side with 18 sessions significantly improved FMA-LE scores. The results demonstrated that HF-rTMS was more effective than LF-rTMS in improving walking speed, with the greatest efficacy observed at 20 sessions. While for enhancing gait balance in stroke patients, LF-rTMS with the best therapeutic effect was observed at a frequency of 20–40 treatments.ConclusionThis study demonstrates the efficacy of rTMS in improving lower limb motor function, balance, and walking speed in stroke patients at various stages. The findings provide a valuable reference for the development of optimized rTMS treatment plans in clinical practice.Systematic review registration: PROSPERO: CRD42023466094.

BackgroundVCI is a severe public health problem facing the world today. In addition to pharmacological treatment, non-invasive neuromodulation techniques have also been effective. At this stage, non-invasive neuromodulation techniques combined with pharmacological treatment are the mainstay of clinical treatment, and clinical trials are continuing to be conducted, which is becoming the direction of treatment for VCI. Therefore, we outline this systematic review and network meta-analysis protocol to evaluate and rank clinical data in future studies which can develop optimal protocols for the clinical treatment of VCI with non-invasive neuromodulation techniques in combination with drugs.MethodsThe network meta-analysis will search eight databases, including PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Infrastructure Library (CNKI), China Biology Medicine disc (CBM)), Wanfang Data Knowledge Service Platform and Vipshop Journal Service Platform (VIP), for a period of from the establishment of the library to January 30 2022. The quality of the studies will be evaluated using the Cochrane Review's Handbook 5.1 and the PEDro scale to assess the evidence and quality of the included randomised controlled trials. Risk of bias assessment and heterogeneity tests will be performed using the Review Manager 5.4 program, and Bayesian network meta-analysis will be performed using the Stata 16.0 and WinBUGS 1.4.3 program.ResultsThe results of the network meta-analysis will be published in a peer-reviewed journal.ConclusionsOur study is expected to provide high quality evidence-based medical evidence for the treatment of VCI by clinicians.Trial registrationPROSPERO: CRD42022308580.

BackgroundTranscutaneous Vagal Nerve Stimulation (tVNS) has been used as a promising noninvasive neuromodulation technique for the treatment of various systems.The aim of this study was to analyze the research hotspots and future directions of tVNS in the 21st century by using bibliometric methods.MethodsThe study object was the literature related to tVNS from the Web of Science database from 2000 to May 2024. In order to measure and analyze the number of literature issuance, institutions, authors, countries, keywords, co-citations, and journals of publication, we used VOSviewer, Citespace, Bibliometrix R-package, and Scimago Graphica software. A narrative review of the current research content of tVNS was conducted to gain a better understanding of the current state of the field.ResultsA total of 569 papers were included in the study. The results show that from 2000 to 2024, the number of publications shows an increasing trend year by year, involving a total of 326 research institutions. The United States, China, and Germany are the major research centers. The study identified 399 keywords, which roughly formed 11 natural clusters, revealing that the current hotspots of related research are mainly reflected in 3 areas: intervention efficacy on nervous system diseases, mechanism of action of tVNS, and stimulation mode of tVNS. The top 10 most cited references focus on research into the mechanism of action of tVNS.ConclusionThe efficacy and safety of tVNS have been confirmed in previous studies, but a standardized tVNS treatment protocol has not yet been developed, and most clinical studies have small sample sizes and lack multicenter and multidisciplinary collaboration. Currently, tVNS is used in the treatment of neurological diseases, psychiatric diseases, cardiovascular diseases, and some autoimmune diseases. It is expected that future research in this field will continue to focus on the application of tVNS in central nervous system diseases and the exploration of related mechanisms, and at the same time, with the rise of non-invasive neuromodulation technology, the application of tVNS in other diseases also has great potential for development.

Alzheimer’s disease, one of the most severe and common neurodegenerative diseases, has no effective cure. Therefore it is crucial to explore novel and effective therapeutic targets. The gut microbiota - brain axis has been found to play a role in Alzheimer’s disease by regulating the neuro-immune and endocrine systems. At the same time, acupuncture can modulate the gut microbiota and may impact the course of Alzheimer’s disease. In this Review, we discuss recent studies on the role of acupuncture on the gut microbiota as well current challenges and future opportunities of acupuncture as potential treatment for the prevention and treatment of Alzheimer’s disease.

阿尔茨海默病(AD)是严重的神经退行性疾病之一.近年来研究发现,脑-肠-微生物轴(BGMA)与神经退行性病变的病理生理相关,而针刺可显著改善AD患者的认知行为和日常生活能力.对近年有关BGMA相关研究及针刺治疗AD机制进行综述,发现针刺能够通过调控肠道微生物群、迷走神经、下丘脑-垂体-肾上腺轴(HPA轴)及神经-免疫过程影响BGMA系统中的信息交流,从而治疗AD.因此,针刺调节BGMA可以在未来成为预防和治疗AD的潜在手段.

Objective:To explore the law of acupoints selection in treatment of vascular dementia（VD）based on data mining.Methods:Literature met the inclusion criteria were selected from the databases of CNKI,CBM,Wanfang,VIP,PubMed,EMbase and Cochrane,and the data were analyzed by Microsoft Excel2019,IBM SPSS Statistics 26.0 and IBM SPSS Modeler 18.0 to perform cluster analysis and association rule analysis.Results:A total of 164 acupuncture prescriptions with 142 acupoints were included,involving 1,832 acupoints frequencies.The top five points used in descending order were Baihui（DU20）,Zusanli（ST36）,Sishencong（EX-HN1）,Neiguan（P6） and Sanyinjiao（SP6）.Four valid clusters were obtained,that is Shenmen（HT7）-Taixi（KI3）,Xuehai（SP10）-ST36,SP6-P6 and Fengchi（GB20）-DU20.2 acupoints groups were obtained,namely P6-SP6-EX-HN1-DU20-GB20-Shuigou（DU26） and ST36-SP10-Fenglong（ST40）-Shenshu（BL23）-KI3-HT7-Taichong（LR3）-Shenting（DU24）,Conclusion:Acupuncture treatment for VD is mostly based on DU20,ST36,EX-HN1,P6 and SP6,Yang meridian and specific points are mainly selected,the compatibility of upper points and lower points and the compatibility of distant points and local points are applied,which provides a reference for clinical treatment of VD.

近年研究发现脑-肠-微生物轴(BGMA)与阿尔茨海默病(AD)的发生发展息息相关,BGMA能够在神经-免疫、肠道微生物群等多方面影响AD,是治疗AD的潜在新靶点.三焦针法是全国名中医韩景献教授依据其提出的"三焦气化失司-衰老"理论所创立,在临床被广泛运用于AD等老年性疾病的治疗.本文就三焦理论及三焦针法与BGMA的联系做一综述,以期在未来三焦针法调控BGMA能够成为治疗AD的新靶点.

目的:观察"调阴和阳"针法结合镜像疗法对脑卒中后腕手功能障碍的疗效。方法:选取符合入选和排除标准的脑卒中后腕手功能障碍患者62例，采用随机数字表法分为对照组和治疗组，每组患者31例。2组患者均接受常规药物(个体化的脑卒中二级预防药物治疗)和常规康复治疗，同时给予"调阴和阳"针法治疗，治疗组则在此基础上增加镜像疗法。"调阴和阳"针法和镜像疗法均为每日1次，每周6次，连续治疗2周。于治疗前和治疗2周后(治疗后)由同一康复医师采用简式Fugl-Meyer运动功能量表上肢部分(FMA-UE)和改良Barthel指数(MBI)分别评估2组患者的上肢运动功能和日常生活活动能力，并采集其腕屈、伸肌的表面肌电信号。结果:治疗后，2组患者的FMA-UE和MBI评分较组内治疗前均显著改善( P<0.01)，且治疗组治疗后的FMA-UE和MBI评分分别为(29.58±13.79)分和(74.68±14.85)分，显著优于对照组治疗后，差异均有统计学意义( P<0.05)。治疗后，2组患者的腕伸肌和腕屈肌的iEMG较组内治疗前均显著改善( P<0.01)，且治疗组治疗后腕伸肌和腕屈肌iEMG显著优于对照组治疗后，差异均有统计学意义( P<0.05)。 结论:"调阴和阳"针法结合镜像疗法可有效改善脑卒中后腕手功能障碍患者的上肢运动功能和日常生活活动能力，促进患侧腕关节屈伸肌肉的激活。

在针灸治疗颈椎病方面,临床上常采用针灸、拔罐和刺络放血等方法,但多为单一方法治疗,几种治疗方法联合使用相对较少。郭义教授经多年临床经验的积累,根据颈椎病病因病机、证候特点,创建针灸治疗颈椎病四通法——"一针、二罐、三刺络、四艾灸",取得较好疗效。即先采用毫针针刺颈肩部腧穴以疏通气机,后在肩背部腧穴拔罐、走罐以畅通气机,拔罐后大椎穴等局部瘀斑处刺络放血以强通经脉,最后在大椎等穴实施艾灸以温通气机。通过四通法疏通气机、畅通气机、强通气机和温通气机,从而达到治疗颈椎病的效果。