Neuropathic pain (NP) presents significant management challenges due to the limited efficacy and adverse effects associated with current therapeutic options. In this study, we present an innovative nanocomposite hydrogel designed for acupoint administration (PG@PLGA-gels) that synergistically combines nanomedicine with traditional acupuncture principles. This system is engineered by incorporating pregabalin (PG)-loaded poly (lactic-co-glycolic acid) nanoparticles into a chitosan/β-glycerophosphate thermosensitive hydrogel, facilitating minimally invasive administration at the Huantiao (GB30) acupoint. Compared to PG solution, PG@PLGA-gels exhibited a sustained drug release profile, extending over 12 days, with an initial release of 46.44% within the first 24 h, and increased systemic exposure by a factor of 2.6-fold. Following acupoint injection, plasma PG concentrations reached their peaked at 16 h (7985.94 ± 96.19 ng/mL) and remained detectable for up to 288 h, whereas PG solution peaked at 4 h (4928.33 ± 124.71 ng/mL) and declined to near-baseline levels by 192 h. In rat models of paclitaxel-induced neuropathy and chronic constriction injury, acupoint administration of PG@PLGA-gels significantly mitigates mechanical and cold allodynia from day 8 to day 20, while no obvious sedation-related behaviors were observed. Transcriptomic analysis identified treatment-associated changes in spinal cord gene expression profiles, with enrichment in pathways related to neuronal structure, synaptic organization, excitatory signaling, and neuroendocrine regulation. Together, these results support PG@PLGA-gels as an acupoint nanomedicine platform that combines controlled drug delivery with acupoint-based modulation to achieve prolonged analgesia with minimized adverse effects.

Acupuncture anesthesia (AA) is an important practical application of the enhanced recovery after surgery concept, and it has demonstrated considerable potential in perioperative management by reducing anesthetic dosage, enhancing organ protection, and lowering complications. However, the field still faces challenges such as a lack of high-quality evidence-based medical data, the absence of standardized guidelines, and unclear acupuncture mechanisms, which hinder further advancements in clinical efficacy prediction and personalized application. To systematically integrate heterogeneous multi-source knowledge in AA, this study proposed the first publicly available Acupuncture Anesthesia Knowledge Database (AAKD). AAKD adheres to a comprehensive development process, including public data collection, extraction, curation and evaluation, standardization, a multi-dimensional quality control system construction, data analysis, and integration. AAKD includes 17,921 clinical data, 29,462 mechanism research data, 143 omics datasets, and 2034 articles. It covers 12 species, 1068 genes, 111 surgeries, 227 diseases/symptoms, and 260 acupoints. Taking IL1B gene as an example, it demonstrates a potential way for AAKD in integrating multi-level data, offering knowledge support for users exploring basic research or clinical decision-making. It also reveals cross-module association in facilitating the discovery of new scientific questions. AAKD is a visual, systematic, and standardized platform, which has the potential to support the evidence-based practice and mechanism research in AA, and lay the foundation for future artificial intelligence-driven analgesic strategies. AAKD is available at http://www.biomedinfo.cn/AAKD/index_en.php or http://www.bmtongji.cn/AAKD/index_en.php.

Objective To analyze the rules of clinical application of acupuncture in the prevention and treatment of perioperative neurocognitive disorder(PND)by using data mining method.Methods Randomized controlled trials on acupuncture for preventing and treating PND from PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),VIP Database,and Wanfang Database were retrieved,with the retrieval time ranging from the establishment of each database to July 16,2024.A relevant database was established to statistically analyze the application of acupuncture methods,selected acupoints,timing of acupuncture intervention,acupuncture stimulation parameters,and stimulation intensity.Additionally,association rules and cluster analysis of acupoints were carried out.Results A total of 69 articles were included,with 69 acupuncture prescriptions extracted,involving 40 acupoints.The top 5 acupoints in terms of usage frequency were Neiguan(PC6),Baihui(GV20),Zusanli(ST36),Hegu(LI4),and Sanyinjiao(SP6).The top 3 meridians by usage frequency were the Pericardium Meridian of Hand-Jueyin(49 times,21.68%),Governor Vessel(44 times,19.47%),and Stomach Meridian of Foot-Yangming(30 times,13.27%).The top 3 specific acupoints in terms of usage frequency were the crossing acupoints(66 times,29.20%),confluence points of the eight vessels(50 times,22.12%),and luo-connecting acupoints(49 times,21.68%).Regarding acupoints compatibility,the top 3 high-frequency acupoint pairs were PC6-ST36,PC6-GV20,and PC6-LI4.The high-frequency acupoints could be classified into 4 categories:Category 1 includes PC6,ST36,GV20,SP6,and LI4;Category 2 includes Shenmen(HT7)and Yintang(GV24+);Category 3 includes Benshen(GB13),Taichong(LR3),Sishencong(EX-HN1),and Shenting(GV24);Category 4 is Fengchi(GB20).The top 2 acupuncture treatment methods by usage frequency and times were transcutaneous electrical acupoint stimulation(TEAS)and electroacupuncture(EA).The intervention timing was mostly selected during and before surgery.For EA stimulation,sparse-dense waves were commonly used,with a frequency of 2 Hz/100 Hz,adjusted to the patient's tolerance.Conclusion PC6,GV20,ST36,LI4 and SP6 are the core acupoints for the prevention and treatment of PND,and TEAS or EA is usually performed during or before the operation.

Background:Perioperative neurocognitive disorder (PND) is a common complication following major surgery under general anesthesia, particularly among elderly patients, and adversely impacts postoperative recovery and quality of life. Although electroacupuncture (EA) has shown potential in preventing PND, conclusive evidence remains lacking. This study aimed to evaluate the effectiveness and safety of perioperative EA intervention for preventing PND in elderly patients undergoing general anesthesia surgery. Methods:We systematically searched eight electronic databases [PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (CQVIP), Wan Fang Database, and China Biology Medicine disc (CBM)] and three clinical trial registries from inception to March 16, 2025. Eligible studies were randomized controlled trials (RCTs) investigating perioperative EA for PND prevention in patients aged ≥ 60 years receiving general anesthesia. Control interventions included sham EA, standard care, or no intervention. Primary outcome was PND incidence. Secondary outcomes included neuropsychological assessment scores [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)], inflammatory biomarkers [serum interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels], neurological damage markers [serum neuron-specific enolase (NSE), S100 calcium-binding protein β (S100β) levels], and safety outcomes (incidence of adverse events). Two reviewers independently performed blind screening, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Meta-analyses were conducted using RevMan 5.4, with random-effects or fixed-effect models applied based on heterogeneity (I 2 statistics). The certainty of evidence was evaluated with the GRADE. Results:Twenty-six RCTs (n = 2,309) were included. Compared to the control groups, perioperative EA significantly reduced the incidence of PND (RR = 0.47, 95% CI: 0.42 to 0.54, p < 0.00001; I 2 = 0%; moderate to low certainty), improved MMSE scores (MD = 1.92, 95% CI: 1.59 to 2.26, p < 0.00001; I 2 = 96%; low to very low certainty), lowered serum IL-6 (SMD = -1.09, 95% CI: -1.73 to -0.44, p = 0.0010; I 2 = 88%; very low certainty), IL-1β (SMD = -2.85, 95% CI: -5.32 to -0.39, p = 0.02; I 2 = 99%; very low certainty), TNF-α (SMD = -2.64, 95% CI: -4.16 to -1.12, p = 0.0007; I 2 = 98%; low certainty), and S100β (SMD = -1.56, 95% CI: -2.77 to -0.35, p = 0.01; I 2 = 97%; low certainty) levels, and reduced adverse events (RR = 0.52, 95% CI: 0.37 to 0.72, p < 0.0001; I 2 = 0%; moderate certainty). MoCA scores and serum NSE levels could not be meta-analyzed due to insufficient data. Conclusion:Perioperative EA intervention demonstrates significant clinical benefits in elderly patients undergoing general anesthesia surgery, effectively reducing PND incidence, improving cognitive function, attenuating neuroinflammation, and reducing neurological injury with a favorable safety profile. However, current evidence is constrained by methodological limitations, including potential selection bias and insufficient blinding in the included studies. Future rigorously designed multicenter RCTs with standardized EA featuring standardized EA protocols and long-term cognitive monitoring are needed to confirm its neuroprotective effects. Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD420251035172.

BackgroundSlow flow/no-reflow (SF-NR) complicates up to 44% of percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI), worsening prognosis. Electroacupuncture (EA) may mitigate SF-NR, but clinical evidence is limited.ObjectiveThis trial was designed to assess the feasibility and effectiveness of intraoperative EA in reducing SF-NR during PCI for AMI patients.Design, setting, and participants and interventionsThis single-center, randomized, assessor-blinded pilot trial enrolled 60 eligible AMI patients undergoing PCI at Yueyang Hospital, China, from August 2023 to March 2024. Participants were randomized to receive PCI with electroacupuncture (EA) stimulating Neiguan (PC6) and Ximen (PC4) acupoints, or PCI alone (control group).Main outcomes and measuresThe primary outcome was the incidence of SF-NR. Secondary outcomes included chest pain (Numerical Rating Scale, NRS), anxiety (Visual Analog Scale for Anxiety, VAS-A), and the occurrence of major adverse cardiac and cerebrovascular events (MACCE) within 30 days, cardiac biomarkers, inflammatory markers.ResultsAll 60 patients completed the trial (mean [SD] age, 63.2 [11.4] years; 86.7% male [52/60]). EA significantly reduced SF-NR incidence compared with control (6.7% [2/30] vs. 26.7% [8/30]; RR, 0.2; 95% CI, 0.0 to 0.4; P = .04). EA also significantly reduced median pain scores (0 h post-PCI: median difference, −2.5 [95% CI, −3.3 to −0.7]; 12 h post-PCI: median difference, −3.0 [95% CI, −3.5 to −1.9]; both P < .001), anxiety scores (0 h post-PCI: median difference, −2.0 [95% CI, −2.8 to −0.2]; 12 h post-PCI: median difference, −2.0 [95% CI, −3.3 to −1.1]; both P < .001). No significant differences were found in cardiac biomarkers or 30-day MACCE (16.7% [5/30] vs. 36.7% [11/30]; P = .09). However, EA was associated with inflammatory markers at 12 h (Leukocytes, P = .03; Neutrophils, P = .04; high-sensitivity C-reactive protein, P = .03). No adverse events were reported.ConclusionsIntraoperative EA during PCI was associated with reduced SF-NR and attenuated early inflammation. Improvements in patient-reported pain and anxiety were also observed, though the influence of non-specific effects cannot be ruled out. These preliminary findings demonstrate the feasibility of EA as a PCI adjunct and indicate a potential signal for efficacy, larger multicenter, sham-controlled trials larger multicenter, sham-controlled trials are needed.Clinical Trial Registrationhttps://www.chictr.org.cn/, ChiCTR2300072265.

INTRODUCTION:Previous studies have explored the effect of Ginkgo biloba extract (Gbe) on hyperlipidemia; however, the results were inconclusive. We aimed to assess the efficacy and safety of Gbe on hyperlipidemia. METHODS:PubMed, Wanfang, China National Knowledge Infrastructure were searched until December 31, 2024. Mean difference was pooled using random-effects models. RESULTS:Ten randomized controlled trials were included in our study. Compared with proprietary Chinese medicine, the effect of Gbe on hyperlipidemia was not statistically significant, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL). Compared with western medicine, the effect of Gbe on HDL was statistically significant (MD = 0.14, 95% CI = 0.01, 0.28, I2 = 81.06%, p = 0.017), not on TC, TG, and LDL. In the age-specific analysis, we found that the effect of Gbe on TC was statistically significant among 50-60 age group (MD = -0.43, 95% CI = -0.85, -0.01, I2 = 83.76%, p = 0.042). Notably, among participants aged ≤50 years, TG reduction is greater in the control group than in the Gbe group (MD = 0.12, 95% CI = 0.03, 0.21, I2 = 0.00%, p = 0.012). In the dose-specific analysis, the medium-dose group of Gbe had a more significant reduction on TC and TG (TC: MD = -0.69, 95% CI = -1.02, -0.37, I2 = 51.3%, p < 0.001; TG: MD = -0.34, 95% CI = -0.53, -0.15, I2 = 0.00%, p = 0.001). CONCLUSIONS:Gbe demonstrates a greater therapeutic effect on HDL compared with Western medicine and shows non-inferiority to proprietary Chinese medicine in improving HDL levels. Gbe shows a significant therapeutic effect on TC levels among individuals aged 50-60 years and in the medium-dose group.

Chronic pain is a multifaceted condition characterized by persistent nociceptive signaling and maladaptive central nervous system plasticity, in which the hippocampus has emerged as a critical hub of structural, functional, metabolic, and molecular remodeling. This review systematically synthesizes current evidence on hippocampal alterations in chronic pain across multiple levels, including structural remodeling (e.g., gray matter atrophy and impaired neurogenesis), functional and circuit-level disruptions, metabolic dysregulation, and cellular and molecular mechanisms. In particular, we highlight convergent pathways involving neurotransmitter and receptor dysregulation, cytokine-driven neuroinflammation, neurotrophic signaling deficits, and additional molecular alterations that collectively impair synaptic plasticity and hippocampal network stability. Importantly, we propose a multiscale integrative framework in which synaptic imbalance, neuroimmune activation, and neurotrophic dysregulation interact to drive hippocampal dysfunction, forming a bidirectional loop that links pain, emotion, and cognition. We further discuss therapeutic strategies targeting hippocampal remodeling, including pharmacological, metabolic, neuroimmune, and circuit-level neuromodulation approaches, as well as emerging precision medicine strategies. By integrating preclinical and clinical evidence, this review positions the hippocampus as a central node in chronic pain pathophysiology and a promising target for developing interventions that address both nociceptive and comorbid affective and cognitive symptoms. These insights support a unified model of hippocampal remodeling in chronic pain that may guide future precision diagnostics and targeted interventions.

Objective:This study investigated whether electroacupuncture (EA) at Neiguan (PC6) acupoint alleviates adverse myocardial remodeling in post-myocardial infarction (MI) heart failure (HF) by activating the vagus nerve-mediated cholinergic pathway and its downstream α7nAChR-Akt-HIF-1α-VEGF signaling cascade. Methods:Male Sprague Dawley (SD) rats were randomized into sham, MI model, and EA groups (n = 6 per group). MI was induced by ligation of the left anterior descending coronary artery. EA was applied at PC6 for 14 days starting 1 week after MI induction. Cardiac function and structure were evaluated using echocardiography and histological examination. The expression levels of choline acetyltransferase (ChAT), α7-nicotinic acetylcholine receptor (α7nAChR), phosphorylated Akt (p-Akt), hypoxia-inducible factor-1α (HIF-1α), and vascular endothelial growth factor (VEGF) were analyzed by real-time quantitative PCR, Western blotting, and immunohistochemistry. Results:EA intervention significantly attenuated pathological myocardial remodeling and improved cardiac function. Compared with the model group, EA treatment markedly enhanced cardiac function, increased contractility, reduced ventricular dilation, restored autonomic balance, and alleviated myocardial necrosis and fibrosis. Molecular studies revealed that EA treatment increased the expression of ChAT and α7nAChR, elevated p-Akt levels, and upregulated the expression of HIF-1α and VEGF. These findings suggest the activation of the vagus nerve-cholinergic signaling pathway and its downstream prosurvival and pro-angiogenic pathways. Conclusions:EA attenuated maladaptive ventricular remodeling and improved cardiac performance. These effects were associated with modulation of autonomic function and engagement of the α7nAChR/Akt/HIF-1α/VEGF signaling axis, supporting a potential neuro-immune-angiogenic mechanism underlying EA-mediated myocardial repair during the subacute post-MI phase.

e12654 Background: Multimodal thermal therapy (MTT), consisting of alternated liquid nitrogen cooling and radiofrequency heating, was proven to effectively trigger systemic antitumor immunity. However, their immune response induced by this emerging therapy has not been fully reported in breast cancer. This pilot study (ClinicalTrials.gov: NCT06636591) was conducted to determine the effect of MTT combined with preoperative chemoimmunotherapy in the treatment of early-stage HER2-negative breast cancer. Methods: Twelve HER2-negative breast cancer patients were recruited to preoperatively receive MTT followed by chemoimmunotherapy [6 cycles of Paclitaxel, Carboplatin and Camrelizumab (an anti-PD-1 antibody)]. Single-cell RNA sequencing was performed on peripheral blood mononuclear cells (PBMCs) from all patients at three timepoints [baseline (Day 0); prior to chemoimmunotherapy (Day 7); mid-on-treatment (Cycle 3)]. The primary goal was to explore the changes of PBMCs induced by the combination of MTT and chemoimmunotherapy. Results: MTT and chemoimmunotherapy were well tolerated in combination without any delay in prescheduled surgery. No treatment-related grade III/IV adverse events were observed. Single-cell RNA sequencing analysis of PBMCs revealed early systemic immune priming on Day 7 post-MTT but prior to chemoimmunotherapy. Specifically, increased plasma-cell frequency, elevated KLRK1 expression in NK cells, upregulated HLA molecules in antigen-presenting cells (APCs), and higher CCR2 expression in circulating monocytes were observed in patients achieving favorable axillary/breast responses and total pathological complete response (tpCR). These findings suggest that early peripheral signatures may serve as predictors of clinical benefit from subsequent therapy. By Cycle 3 of chemoimmunotherapy, peripheral plasma cells and APCs increased across the cohort, with expansion being most pronounced in patients with tpCR. This was accompanied by heightened expression of effector molecules and Fcγ receptor–related gene in NK cells and APCs. Furthermore, HLA molecules and CD40 expression on APCs were significantly upregulated than those on Day 7 after MTT, followed by increased CX3CR1 and PDCD1 expression on CD4⁺/CD8⁺ T cells. Additionally, enhanced interactions between monocytes/B cells and effector T/NK cells, coupled with the upregulation of tumor-homing chemokine receptors, indicating reinforced lymphocyte trafficking to tumor sites in patients with favorable response. Conclusions: The study reported global characteristics of the MTT-induced systemic immune response, providing an opportunity for the identification of potential targets to improve the efficacy of combined chemoimmunotherapy. Clinical trial information: NCT06636591 .

This study aimed to explore the acute effects of aerobic and resistance exercise on craving, as well as their emotional and cognitive impacts in individuals with methamphetamine use disorder (MUD). Thirty-five male participants with MUD completed a within-group crossover design, involving three randomised tasks: a moderate-intensity aerobic exercise task (AET), a moderate-intensity resistance exercise task (RET), and a control task (COT). Craving and immediate emotional states were assessed at multiple time points before and after each task. Cognitive functions, including attentional bias, working memory, inhibitory control, and cognitive flexibility, were also evaluated before and after the tasks. Both AET and RET significantly reduced craving compared to the COT during and after the tasks. Participants in both exercise conditions reported higher positive emotional states (happiness, excitement) compared to COT, with no significant changes in other emotional states. Cognitive assessments revealed that attentional bias and working memory were lower following exercise tasks compared to COT, while no significant changes were found in inhibitory control or cognitive flexibility. Notably, attentional bias was identified as a mediator in the relationship between exercise and craving reduction. The effects of AET and RET were similar across all outcome measures. These results suggest that both aerobic and resistance exercises are effective in reducing craving and enhancing emotional and cognitive factors in MUD, particularly through improvements in attentional bias and working memory. These findings have implications for developing exercise-based rehabilitation strategies and highlight the need for further research in this area.

BACKGROUND:Depression is a common emotional and affective disorder in clinical practice. Its core symptoms include significant and persistent low mood, decreased interest, etc. To date, the treatment approaches for depression primarily consist of pharmacotherapy, psychological counseling and treatment, as well as physical therapy. Drug therapy is the main treatment method in clinical practice, but it is limited by slow onset, low response rate, and many adverse reactions. Electroacupuncture (EA) therapy in traditional medicine has significant advantages of multi-pathway, multi-level, and multi-target in the intervention of depression, but its mechanisms are not fully understood. METHODS:In this study, we constructed a mouse olfactory bulbectomy depression model (OBx), and electroacupuncture treatment was performed on the Neiguan (PC6) acupoint for 7 days. In vivo multi - channel, chemogenetic, immunofluorescence and other techniques were used to study the neurophysiological mechanism of this treatment. RESULTS:1. Electroacupuncture at Neiguan acupoint can improve the depression - like behaviors of OBx mice. 2. Electroacupuncture at Neiguan acupoint re - activates the electrophysiological activities of hippocampal CA1 neurons in OBx mice. 3. Chemogenetic verification shows that electroacupuncture treats the depressive state of mice by re - activating CA1 Pyramidal neurons. 4. Electroacupuncture restores the dendritic complexity of neurons in the hippocampal CA1 region of OBx mice. CONCLUSION:We speculate that the absence of the olfactory bulb not only inhibits the activity of CA1 neurons through the neural circuit pathway but also is associated with a long - term stress state of anosmia, which may collectively contribute to the observed neuronal atrophy and causing the electrophysiological activities of CA1 pyramidal neurons to be lower than normal levels. This includes a decrease in local field potentials (LFP), a weakening of spike discharges, and a reduction in the coherence between the two. The treatment of EA at the PC6 acupoint, to some extent, restores the dendritic structure and morphology of neurons and restores the discharge activities of CA1 neurons, thereby improving the depressive state of OBx mice.

The evolution of acupuncture anesthesia (AA) has spanned six decades. Cardiothoracic surgery serves as a representative case study to illustrate this evolution. Reflecting on its historical development, the use of AA in cardiothoracic surgery has advanced from basic AA procedures in the 1960s to combined acupuncture and drug anesthesia techniques in the early 1980s. Since 2005, the innovative use of non-intubation AA combined anesthesia has been implemented extensively in cardiothoracic surgery. As the medical industry continues to evolve, the techniques applied in AA have expanded to encompass the entire perioperative period in cardiothoracic surgery, leading to the introduction of the concept of modern AA. The use of AA in cardiothoracic surgery exemplifies the ongoing advances and integration of traditional Chinese and Western medicine. Moving forward, it is imperative to enhance the theoretical framework of AA through the execution of rigorous multicenter clinical trials, to further strengthen the body of evidence supporting evidence-based medicine, and to finally explore the underlying mechanisms of AA. Please cite this article as: Wu XD, Wei XQ, Chen TY, Zhou WX, Wang K, Zhou J. From pioneering to innovation: A comprehensive review of acupuncture anesthesia in cardiothoracic surgeries. J Integr Med. 2025; 23(6):623-629.

This study aimed to evaluate the effects of electroacupuncture (EA) on cancer-induced bone pain (CIBP) and investigate its interaction with the STING/IFN-I pathway. A CIBP model was established in female rats. EA was administered for six consecutive days at bilateral L3–L5 Jia Ji points (EX-B2). EA-induced antinociception was evaluated through mechanical, thermal, and cold sensitivity assessments. EA significantly increased the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in rats with CIBP ( p < 0.01). In the spinal cord of CIBP model rats, western blot analysis demonstrated that the application of EA upregulated the expression of STING, IRF3, and IFNAR ( p < 0.05). The ELISA results indicated that EA significantly increased the expression of IFN-α ( p < 0.005) and IFN-β ( p < 0.01) and reduced the expression of TNF-α and IL-1β ( p < 0.05). Immunofluorescence analysis revealed that STING was predominantly localized in microglia, with a minimal presence in neuronal cells. Furthermore, intrathecal administration of the STING antagonist C-176 attenuated the analgesic effects of EA in CIBP ( p < 0.05). Both EA and STING agonist were effective in alleviating pain in rats with CIBP, possibly through the activation of the STING/IFN-I pathway. Notably, EA treatment reduced pro-inflammatory cytokines and increased anti-inflammatory cytokines. In contrast, while the STING agonist exhibited analgesic effects, it was associated with elevated levels of pro-inflammatory cytokines. These finding underscore the therapeutic potential of EA in the management of CIBP.

Patients undergoing video-assisted thoracoscopic surgery (VATS) often experience preoperative anxiety, which can significantly impact the surgical process and postoperative recovery. However, the efficacy of Transcutaneous Electrical Acupoint Stimulation (TEAS) in managing preoperative anxiety in VATS patients is unknown. A total of 82 patients scheduled for thoracoscopic surgery were randomly divided into TEAS group (n = 41) and sham TEAS (STEAS) group (n = 41). The TEAS/STEAS intervention began 3 days before the thoracoscopic surgery, with one session lasting 30 min per day for three consecutive days. The primary outcome measure will be the change in Generalized Anxiety Disorder Scale scores between the day before surgery and the baseline. Secondary outcome include intraoperative anesthetic consumption, time to postoperative chest tube removal, postoperative analgesic consumption and pain scores, length of postoperative hospital stay, serum concentrations of 5-hydroxytryptamine (5-HT), norepinephrine (NE), and gamma-aminobutyric acid (GABA). On the third intervention day, anxiety levels in the TEAS group were significantly lower than in the STEAS group (p < 0.01). TEAS patients required less intraoperative sufentanil, remifentanil, and dexamethasone (p < 0.01). Chest tube removal time and hospital stay were shorter in the TEAS group (p < 0.01). Postoperative meperidine consumption and VAS pain scores were lower in the TEAS group (p < 0.01). Serum 5-HT levels were lower in the TEAS group on day three (p < 0.01), while NE levels remained lower from day three of intervention to postoperative day three (p < 0.05). GABA levels were higher in the TEAS group (p < 0.01). TEAS effectively reduces preoperative anxiety, decreases intraoperative anesthetic and anti-inflammatory drug use, shortens postoperative chest tube removal time and hospitalization, and alleviates postoperative pain. These results indicate that TEAS, as an adjunctive therapy, has valuable potential in improving surgical outcomes and postoperative experience for patients with pulmonary nodules. https://clinicaltrials.gov, NCT04887090.

BACKGROUND & AIMS:Electroacupuncture (EA) may reduce the duration of postoperative ileus (POI) after laparoscopic gastrectomy for gastric cancer, although evidence is limited. We investigated the efficacy of EA in reducing POI duration and enhancing gastrointestinal (GI) recovery in patients undergoing laparoscopic surgery for gastric cancer. METHODS:This multicenter randomized trial was conducted at 7 hospitals in China, enrolling 585 participants who underwent laparoscopic resection for gastric cancer from October 27, 2021, to December 21, 2023. Participants received perioperative standard care and were randomized to 4 sessions of EA, 4 sessions of sham EA (SA), or standard care only. The primary outcome was the time to first flatus. Secondary outcomes included time to first defecation, dietary recovery, quality of life, postoperative mobilization, and duration of hospital stay. RESULTS:A total of 578 participants were in the full analysis set. EA exhibited a shorter time to first flatus compared with both SA and standard care, with differences of -12.96 hours (95% confidence interval (CI), -19.17 to -6.75; P < .001) and -24.46 hours (95% CI, -30.61 to -18.30; P < .001), respectively. Similarly, EA significantly reduced the time to first defecation: -15.41 hours (95% CI, -27.73 to -3.09; P = .007) vs SA; -24.66 hours (95% CI, -36.76 to -12.55; P < .001) vs standard care. Incidence of prolonged POI was significantly lower in the EA group than in the SA and standard care groups, with group differences of -0.41 (95% CI, -0.66 to -0.16; P < .001) and -0.56 (95% CI, -0.82 to -0.31; P < .001), respectively. No severe adverse events were reported. CONCLUSIONS:EA was superior to SA and standard care only for reducing POI duration and the risk of prolonged POI in patients undergoing laparoscopic gastrectomy for gastric cancer (Chinese Clinical Trials Register identifier: ChiCTR2100050660).

Background:Perioperative neurocognitive disorder (PND) is a prevalent complication among older patients undergoing general anesthesia, imposing significant burdens on individuals, health care systems, and society. While electroacupuncture shows promise for PND prevention, current evidence remains inconclusive. Objective:This study aims to critically evaluate the effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing surgery under general anesthesia. Methods:A comprehensive literature search will be conducted in 8 electronic databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP Chinese Science and Technology Periodical Database, Wan Fang Database, and China Biomedical Literature Database) and 3 clinical trial registries from inception to March 16, 2025. The search strategy aims to identify all relevant randomized controlled trials evaluating perioperative electroacupuncture for PND prevention in older patients (aged ≥60 years) undergoing general anesthesia. The primary outcome will be the incidence of PND. Secondary outcomes will include (1) neuropsychological assessment scores (Mini-Mental State Examination and Montreal Cognitive Assessment), (2) serum inflammatory biomarker levels (interleukin-1β, interleukin-6, and tumor necrosis factor-α), (3) serum neurological damage marker levels (neuron-specific enolase and S100 calcium-binding protein β), and (4) safety outcomes (incidence of adverse events). Two independent reviewers will perform study selection, data extraction, and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. All statistical analyses will be conducted in RevMan 5.4 using suitable meta-analysis models based on heterogeneity testing. The certainty of evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results:The study selection process will be presented through a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram, detailing the number of records identified, screened, and included. Characteristics of eligible studies will be summarized in evidence tables, including study designs and populations, intervention protocols, and outcome measures. The results will be visualized through a risk of bias graph, forest plots displaying pooled effect estimates with 95% CIs, and funnel plots for publication bias evaluation (when ≥10 studies are available). This protocol is currently in the active phase. The literature search has been completed as of April 2025, with an updated search planned until December 31, 2025. Data extraction is scheduled to commence on January 15, 2026, followed by data analysis starting February 1, 2026. Results are expected to be submitted for publication in March 2026. Conclusions:The effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing general anesthesia remain uncertain. This systematic review will provide an evidence-based evaluation of perioperative electroacupuncture's effectiveness in preventing PND, offer practical recommendations for optimizing surgical care for older adults, and identify knowledge gaps to inform future research.

ObjectiveThis study aimed to assess the effects of electroacupuncture (EA) at the contralateral, ipsilateral, or bilateral “Zusanli (ST36)” and “Yanglingquan(GB34)” on neuropathic pain caused by chronic contractile injury (CCI) and to explore the role of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway in the effects of EA.MethodsMale Sprague-Dawley rats were subjected to the CCI model to induce neuropathic pain. A total of 45 rats were randomly divided into five groups (n = 9): sham, CCI, EA-Co (CCI + EA at contralateral acupoints), EA-Ip (CCI + EA at ipsilateral acupoints), and EA-Bi (CCI + EA at bilateral acupoints). The rats received EA treatment on day 8 after CCI, once every alternate day, for a total of eight times. The time courses of mechanical pain threshold (MWT), hind paw withdrawal latency (HWL), and sciatic functional index (SFI) were determined. The expression levels of 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), superoxide dismutase (SOD) activity, interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor factor-alpha (TNF-α) in the spinal cord were measured. The distribution of Nrf2, its expression of Nrf2 in both the cytosol and nucleus, and the protein levels of its downstream target genes, NQO1 and HO-1, were detected via double immunofluorescence staining and western blotting, respectively.ResultsFollowing CCI, both MWT and HWL in the CCI group significantly decreased from day 14 after surgery (P < 0.001). EA treatment exhibited significant antinociceptive effects induced by CCI by increasing the MWT and HWL values, especially bilateral EA (P < 0.05). The SFI of the CCI group was significantly lower than that of the sham group (P < 0.001). Only bilateral EA improved the SFI scores compared to the CCI group (P < 0.05). 8-OHdG levels in the spinal cord of the CCI group were significantly higher than those in the sham group (P < 0.05), whereas GSH levels and SOD activity in the spinal cord of the CCI group were significantly lower than those in the sham group (P < 0.001 and P < 0.01, respectively). Bilateral EA administration significantly downregulated 8-OHdG levels (P < 0.01) and upregulated GSH levels and SOD activity in the spinal cord (P < 0.01). CCI significantly enhanced the production of IL-1β, IL-6, and TNF-α in the spinal cord compared with that in the sham group (all p < 0.001). Meanwhile, the effects of EA were also accompanied by markedly decreased expression of IL-1β and IL-6 in the spinal cord (P < 0.05). TNF-α levels were only decreased in the EA-Ip and EA-Bi groups compared with those in the CCI group (p < 0.001). Confocal microscopy revealed that Nrf2 was mainly localized in the neurons of the spinal cord. Notably, EA treatment enhanced nuclear translocation of Nrf2 in neurons. CCI significantly decreased the production of Nrf2, HO-1, and NQO1 in the spinal cord compared to the sham group (P < 0.001), and bilateral EA up-regulated the protein levels of Nrf2 and its target genes HO-1 and NQO1(all P < 0.001).ConclusionOur results suggest that bilateral EA is an optimal therapeutic strategy for neuropathic pain. The effects of EA on neuropathic pain may be mediated by the restoration of the Nrf2 pathway in the spinal cord.

Background Perioperative neurocognitive disorder (PND) is a critical concern for older patients undergoing cardiac surgery, impacting cognitive function and quality of life. Electroacupuncture and transcutaneous electrical acupoint stimulation (TEAS) hold promise for mitigating PND. This protocol outlines a systematic review and meta-analysis to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. Objective This study aimed to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. Methods A comprehensive and systematic approach will be used to identify eligible studies from a diverse range of electronic databases, including 9 major sources such as PubMed (NLM) and Cochrane (Wiley), as well as 2 clinical trial registration websites. These studies will focus on investigating the effects of electroacupuncture and TEAS on PND in older patients undergoing cardiac surgery. The study selection will adhere to the criteria outlined in the patient, intervention, comparison, outcome, and studies (PICOS) format. Data extraction will be carried out by 2 independent researchers (YP and LS), using established tools to evaluate the risk of bias. The primary outcome will be PND incidence, with secondary outcomes including Mini Mental State Examination scores, neuron-specific enolase, S100β, interleukin-1β, interleukin-6, tumor necrosis factor-α, time to first flatus, first defecation, bowel sound recovery, and hospitalization duration to be selectively reported. Adverse events linked to acupuncture, such as bleeding, needle site pain, and local reactions, rather than serious adverse events, will also be considered. Meta-analysis will be performed using appropriate statistical methods to assess the overall effect of electroacupuncture and TEAS on PND prevention, treatment, or other relevant outcomes. The Cochrane Collaboration Risk of Bias tool will be used for assessment, and data synthesis will be executed using the RevMan 5.4 software (Cochrane). Results We plan to summarize the eligible studies through the use of a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The findings will be showcased in the form of a summary table of evidence. Figures and forest plots will be used to illustrate the outcomes of the meta-analysis. Conclusions The impacts of electroacupuncture and TEAS interventions on PND in older patients undergoing cardiac surgery have not yet been established. This protocol addresses a critical gap by thoroughly assessing electroacupuncture and TEAS for PND in older patients undergoing cardiac surgery, enhancing understanding of nonpharmacological interventions, and guiding future research and clinical practices in this field. Its strength lies in rigorous methodology, including comprehensive search strategies, independent review processes, and thorough assessments of the risk of bias. Trial Registration PROSPERO CRD42023411927; https://tinyurl.com/39xdz6jb International Registered Report Identifier (IRRID) PRR1-10.2196/55996

OBJECTIVES:To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery. METHODS:The randomized controlled trials (RCTs) related to combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery were searched in PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP database, Wanfang database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) from the inception of each database up to July 12, 2022. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and Meta-analysis was conducted using RevMan5.4. RESULTS:A total of 33 RCTs were included, involving 2 526 participants. The Meta-analysis results showed that compared to conventional anesthesia, the patients receiving combined anesthesia of acupuncture-pharmacotherapy had more stable vital signs during surgery, reduced intraoperative fentanyl usage [SMD=-3.73, 95%CI(-5.28, -2.18), Z=4.72, P<0.000 01], decreased postoperative sufentanil consumption [MD=-20.85, 95%CI(-24.84, -16.86), Z=10.24, P<0.000 01], reduced total/effective presses of the postoperative patient-controlled analgesia pump [MD=-5.70, 95% CI(-9.04, -2.36), Z=3.35, P=0.000 8], lowered postoperative pain visual analogue scale (VAS) [MD=-1.63, 95%CI(-2.02, -1.23), Z=7.97, P<0.000 01], shorter length of postoperative hospital stay [MD=-1.14, 95%CI(-1.85, -0.43), Z=3.15, P=0.002], and higher levels of CD 4+ T lymphocytes, CD 8+ T lymphocytes, natural killer (NK) cell activity, and superoxide dismutase (SOD). Additionally, tumor necrosis factor-alpha (TNF-α), adrenaline and cortisol levels were decreased (P<0.05). No adverse events related to acupuncture or electrical stimulation were reported, and the incidence of postoperative complications was lower than that of conventional anesthesia [RR=0.47, 95%CI(0.36, 0.62), Z=5.36, P<0.000 01]. CONCLUSIONS:The combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery could improve anesthesia and analgesia effectiveness, reduce anesthesia drug usage, regulate immune responses, suppress stress reactions, and the safety is satisfactory. However, there is substantial heterogeneity among the included studies, and outcome measures vary widely. Further large-sample, high-quality, internationally standardized clinical trials are needed to clarify its clinical value and safety, providing reliable evidence for clinical practice.

AbstractBackgroundMotor impairments are the defining cardinal features of Parkinson's disease (PD), resulting from malfunction of the cortico‐basal ganglia circuit. Clinical data have demonstrated that electroacupuncture (EA) stimulation may benefit motor symptoms in PD without adverse effects. However, the specific effects of EA on PD and the underlying mechanisms remain largely unclear.MethodsThis study investigated the effects of EA stimulation during and after 100 Hz application in a rat model of PD created by unilateral injection of 6‐hydroxydopamine (6‐OHDA). To establish optimal treatment parameters of EA, motor behaviours were dynamically assessed using open field and rotarod tests. Additionally, we evaluated corticostriatal spine plasticity using immunoelectron microscopy and measured the levels of dopaminergic and glutamatergic neurotransmitters through microdialysis, in vivo electrochemistry and high‐performance liquid chromatography. Neural activity dynamics were recorded by measuring local field potentials in both the motor cortex and the striatum. Furthermore, chemogenetic techniques were employed to manipulate corticostriatal glutamatergic neurons and clarify the mechanisms that contribute to the therapeutic benefits of EA in the PD rat model.ResultsChronic EA stimulation resulted in a gradual and long‐lasting alleviation of motor symptoms, independent of nigrostriatal dopamine (DA) restoration. Notably, EA stimulation modulated corticostriatal spine plasticity and reduced excessive glutamate transmission in PD model rats. Moreover, EA effectively inhibited aberrant corticostriatal synchronised high‐beta (25–40 Hz) oscillations, which serves as a pathological biomarker of PD. Conversely, chronic chemogenetic activation of corticostriatal glutamatergic neurons hindered these positive outcomes of EA treatment in PD model rats.ConclusionsThis study sheds light on the temporal dynamics and optimal parameters of EA treatment in PD. It emphasises the significance of inhibiting corticostriatal glutamate transmission in EA's therapeutic benefits for PD. Targeting glutamatergic neurons with EA holds promise as a non‐dopaminergic intervention for managing motor symptoms and abnormal neural activity with PD.Key points EA commonly protects dopaminergic neuronsby reducing neuroinflammation, oxidative stress, and apoptosis. New findings reveal that EA alleviates motor symptoms in a parkinsonian rat model without restoring striatal dopamine levels. EA effectively suppresses excessiveglutamate transmission and high‐beta synchronization, contributing to motorsymptom relief. Activation of corticostriatalglutamatergic projections may hinder the efficacy of EA.