Background Perioperative neurocognitive disorders (PND), including delirium and postoperative cognitive dysfunction (POCD), are common and debilitating complications in elderly patients undergoing total hip arthroplasty (THA). Electroacupuncture (EA) has shown potential in modulating neuroinflammation and oxidative stress, yet its preoperative efficacy in preventing cognitive decline remains unclear.Methods A single-center, randomized, patient- and assessor-blinded, sham-controlled trial was conducted with 150 patients aged 65 and older undergoing elective THA. Participants were assigned to receive EA pretreatment at acupoints Baihui (GV20) and Dazhui (GV14), or sham stimulation. The primary outcome was the change in Montreal Cognitive Assessment (MoCA) score from baseline to postoperative day 3 (POD3), a timepoint corresponding to the typical peak period of early postoperative cognitive decline. Early PND was predefined as a >= 2-point decline in MoCA score at POD3 compared with baseline. Secondary outcomes included delirium incidence, serum biomarkers (S100 beta, NSE, IL-1 beta, IL-6, TNF-alpha, cortisol), pain scores, opioid consumption, quality of recovery (QoR), and cognitive assessments at 1, 3, and 6 months after surgery.Results EA significantly attenuated cognitive decline (Delta MoCA -1.1 +/- 2.0 vs -2.8 +/- 2.5; p = 0.002) and reduced the incidence of early PND (>= 2-point MoCA decline at POD3) (13.3% vs 28.0%; p = 0.028). EA also lowered postoperative biomarkers of neuronal injury and inflammation, including S100 beta, NSE, and pro-inflammatory cytokines, while improving pain control, reducing opioid consumption, and enhancing QoR. No serious adverse events occurred, and blinding integrity was maintained.Conclusion Preoperative EA at Baihui and Dazhui significantly improved early cognitive outcomes and reduced neuroinflammation in elderly patients undergoing THA. EA represents a feasible, non-pharmacological adjunct to perioperative care aimed at reducing early PND, with a favorable safety profile.

Background:Endoscopic treatment of early colon neoplasms has evolved as a valid and less traumatic alternative to surgical resection. It can usually be performed with sedation on an outpatient basis. The present study was performed to determine the safety and effectiveness of electroacupuncture (EA) versus propofol sedation during endoscopic submucosal dissection (ESD) for early colon neoplasm. Methods:A total of 150 adult outpatients undergoing ESD were selected and divided into the EA combined with propofol group (EP group), remifentanil combined with propofol group (RP group), and propofol group (SP group), with 50 patients in each group. All patients received standard sedation with propofol. Acupuncture was performed before intravenous propofol injection in the EP group. A density wave of 1-3 mA, 2/100 hz current was administered for 20 min before the induction of anesthesia. The effectiveness of sedation was measured by satisfaction levels, and pain and sedation scores were measured by questionnaires. Respiratory and hemodynamic complications were monitored and compared as indices of safety. Results:Demographic data were comparable among the three groups. The total dose of propofol and the percentage of body movement in the EP group were lower than in the SP and RP groups (P<0.01). The incidence of hypotension and bradycardia in the SP and RP groups was higher than in the EP group. Patients who received the EA intervention showed a significant reduction in hypoxemia. The endoscopists felt that the procedure was more favorable in the EP group, but, there was no significant difference of patient satisfaction scores among three groups. Conclusion:Sedation with EA is effective and safe for patients undergoing ESD, and could improve the satisfaction levels of patients and gastroendoscopists.

Background Dorsal root ganglia (DRG) plays an important role in mediating the peripheral sensation transduction through the primary afferent neurons in pain research. Neuropathic pain (NP) is a syndrome of hyperalgesia, spontaneous pain and allodynia caused by central or peripheral nerve injury. Recent trends of study are turning towards the development of therapies for the management of NP. Activation of autophagy in glial cells in the spinal cord has been reported to be associated with attenuation of NP, but the autophagic process in DRG is rarely studied. Methods The analgesic effect of electroacupuncture (EA) was evaluated in NP-induced rats developed using spared nerve injury (SNI). Acupuncture or EA was performed after 7 days of SNI at Zusanli (ST36) and Huantiao (GB30) acupoints. Then, the activation status of autophagy process in DRGs of rats treated with SNI and EA were investigated, and the possible mechanism of the analgesic effect of EA were explored. Results Application of EA has been found to reduce mechanical hyperalgesia. Autophagy indicator p62 was colocalized with the marker proteins for macrophages (CD11b), but not with NeuN (marker protein for neurons) or GFAP (marker protein for satellite glial cells), as shown by immunofluorescence. Western blots results indicate that the expression levels of p62, Beclin-1 and LC3-II in the L4-L6 DRG of rats in the SNI group were increased, compared with that in the control group. EA treatment resulted in decreased expression of p62 and increased expression of Beclin-1 and LC3-II/LC3-I. Furthermore, we explored the causal relationship between EA-induced suppression of NP and increased levels of autophagy in DRG using electron microscopy and the AMPK (AMP-activated protein kinase) inhibitor compound C. Conclusions SNI achieved a significant upregulation of autophagy levels in DRG macrophages. Furthermore, EA attenuated NP, which may contribute to the promotion of AMPK/mTOR (mammalian target of rapamycin)-mediated autophagy in DRG macrophages. Therefore, this strategy provides a new target for therapeutic intervention of NP.

Background: Neuropathic pain (NP) is a syndrome that arises from central or peripheral nerve injury, which manifests primarily as hyperalgesia, spontaneous pain, and allodynia. The recent trend has exhibited a shift towards the development of therapies for managing NP. Activation of autophagy is involved in the function of the glial cells, which may be implicated further to attenuate pain. Methods: In this study, the analgesic effects of electroacupuncture (EA) were evaluated among NP rats developed using spared nerve injury (SNI). Acupuncture treatment or EA was carried out after 7 days of SNI at two acupoints, i.e., the Zusanli (ST36) and Huantiao (GB30). Results: The application of EA was found to attenuate mechanical hyperalgesia. The marker protein for microglial cells (CD11b) alone, without either the astrocyte marker or neuronal marker, was co-expressed with the autophagy indicator p62, as illustrated with immunofluorescence staining. Western blotting demonstrated that the expression levels of p62, Beclin-1, and LC3-II/LC3-I were elevated in the spinal cords of rats in the SNI group compared to the control levels. EA treatment resulted in reduced expression of p62, while the expressions of Beclin-1 and LC3-II/LC3-I were increased. The electron microscopy results indicated that EA could induce autophagy progression in the microglia of the spinal dorsal horn in SNI rats. Furthermore, we explored the causal relationship between EA-induced inhibition of NP and increased autophagic levels in microglia using the AMPK inhibitor compound C, and found that the mechanism of EA-induced analgesia may contribute to the promotion of AMPK/mTOR-mediated autophagy in spinal microglia. Conclusions: Our work showed that the analgesic impact of EA is partly related to AMPK/mTOR pathway activation and autophagy induction in microglial cells, providing a potential therapeutic target for NP.

Postoperative cognitive dysfunction (POCD) is a common complication after surgery in elderly patients. Electroacupuncture (EA) has been reported to relieve POCD in animal models, but the mechanism remains fully elucidated. The objective of this work was to clarify whether EA could alleviate POCD via regulating autophagy. In this study, aged rats were assigned into 4 groups: control, surgery (rats underwent exploratory laparotomy to induce POCD), EA + S (rats received EA pre-stimulation before surgery), and EA + S + Chloroquine (CQ) (rats were intraperitoneally injected with CQ before EA stimulation and then underwent surgery). The cognitive function of rats was assessed by Morris Water Maze (MWM) test after surgery, and autophagy in hippocampal tissues of rats was evaluated by western blotting and transmission electron microscope. Results indicated that the MWM test revealed that rats showed reduced platform crossing and increased total swimming distance after surgery. However, this impaired spatial memory was improved by EA and EA plus CQ pre-treatment. Besides, the surgery caused an increased expression in LC3II, Beclin-1, AMP-activated protein kinase (AMPK), and p-AMPK in hippocampal tissues of rats, while EA and EA plus CQ pre-treatment also reversed this effect. In addition, the surgery-induced increased amount of autophagic vesicles in hippocampal tissues of rats was reduced by EA and EA plus CQ pre-treatment. In conclusion, EA pre-stimulation could effectively attenuate cognitive impairment in aged rats with POCD via inhibiting AMPK signaling-mediated autophagy.