Objective: To evaluate the efficacy and safety of acupuncture therapy for children with cerebral palsy. Data Sources: We conducted electronic searches of PUBMED (1950/2017), EMBASE (1974/2017), ScienceDirect (1986/2017), Academic Source Premier (1887/2017), the Cochrane Library (Issue 4, April 2017), Science Citation Index Expanded (1900/2017), China National Knowledge Infrastructure (1915/2017), China Biological Medicine (1990/2017-04), WanFang (1980/2017), VIP (1989/2017), and Chinese Science Citation Database (1989/2017). Data Selection: We included randomized controlled trials that aimed to compare the effect of acupuncture plus rehabilitation training versus rehabilitation training alone. Data about functional motor abilities, daily activity/social participation, effective rate, intellectual development, and adverse effects were included. We used Revman 5.2 software for statistical analysis. Outcome Measures: The primary outcomes included functional motor abilities, daily activity, and effective rate. The secondary outcomes included intellectual development and adverse effects. Results: Twenty-one studies with a total of 1718 participants met the inclusion criteria. The effect size of gross motor function (SMD = 0.64, 95% CI: 0.52 to 0.76, P < 0.00001; I² = 0%, P = 0.69; in 13 studies with 1144 patients) and the total effective rate (RR = 1.28, 95% CI: 1.20 to 1.37, P < 0.00001; I² = 18%, P = 0.27; in 12 studies with 1106 patients) suggested that acupuncture plus rehabilitation produced a significant improvement in gross motor function and a high total effective rate. The pooled fine motor function (SMD = 3.48, 95% CI: 2.62 to 4.34, P < 0.00001; I² = 64%, P = 0.10; in 2 studies with 193 patients), modified Ashworth scale scores (SMD = –0.31, 95% CI: –0.52 to –0.11, P = 0.003; I² = 74%, P = 0.004; in 5 studies with 363 patients) and activities of daily living (SMD = 1.45, 95% CI: 1.20 to 1.71, P < 0.00001; I² = 78%, P = 0.004; in 4 studies with 313 patients) also indicated improvements in children with cerebral palsy. Publication bias was not observed. Only mild adverse events related to acupuncture were reported. Conclusion: Acupuncture plus rehabilitation training improved gross motor function, reduced muscle spasms, and enhanced daily life activities in children with cerebral palsy. However, this conclusion should be interpreted with caution due to the small number of randomized controlled trials available and the small sample sizes. More high-quality and large-scale studies are needed.

Background and objective: Acupuncture is a promising non-pharmacological therapy for patients with prolonged disorder of consciousness (PDOC); however, its underlying mechanism remains uncertain. This study aimed to reveal the modulatory effects of acupuncture on the cerebral cortex activity among patients with PDOC.Materials and methods: Twenty-eight PDOC patients were randomly assigned to the treatment (n = 14) or control (n = 14) group. The treatment group received one session of acupuncture, while the control group received one session of sham acupuncture. All patients underwent evaluation of the functional connectivity and activation response of the dorsolateral prefrontal cortex (DLPFC), primary motor cortex (M1), and primary somatosensory cortex (S1) via functional near-infrared spectroscopy. We further explored the potential correlation of the consciousness level and activation response/functional connectivity with acupuncture.Results: Compared to the control group, a single session of acupuncture significantly tended to enhance resting-state functional connectivity (rsFC) in DLPFC-M1, DLPFC-M1, and S1-S1. And the activation level of the DLPFC (both sides) in the acupuncture group is significantly higher than those in sham acupuncture group. However, no significant correlation was found between the consciousness level and activation response/functional connectivity.Conclusion: One session of acupuncture has a significant modulation of rsFC and activation in the DLPFC, M1, and S1 with PDOC patients. Acupuncture-evoked effect may have some functional significance in PDOC patients. This is an important step toward exploring the acupuncture effects on PDOC patients.

Background: Most studies on improvements in respiratory muscle strength, activities of daily living (ADL) and quality of life (QoL) in stroke patients receiving threshold respiratory muscle training (TRMT) have small sample sizes, and some studies have contradictory results. Objectives: To evaluate the effectiveness of TRMT on respiratory muscle strength, pulmonary function and exercise endurance in stroke patients. Materials and Methods: PubMed, Cochrane Library, Physical Therapy Evidence Database (PEDro), Embase (via OVID) and Web of Science databases were searched for randomized controlled trial (RCT) from inception to January 17, 2024. The primary outcome was maximum inspiratory pressure (MIP) or maximum expiratory pressure (MEP). Secondary outcomes included pulmonary function measured by forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF), and exercise endurance measured by 6-minute walk test (6MWT). Results: A total of eight randomized controlled trials(RCTs), including 305 persons, were included in this study. The training time ranged from 3 weeks to 10 weeks. Among them, the intervention group in 4 studies used inspiratory muscle training, and the other 4 studies used inspiratory muscle training and expiratory muscle training. For the primary outcome, TRMT significantly improved MIP (mean=14.68 cmH(2)O, 95 %CI=2.28 to 27.09 cmH(2)O, P=0.02) and MEP (mean=9.37 cmH(2)O, 95 %CI=2.89 to 15.84 cmH(2)O, P=0.005) in stroke patients. Regarding the secondary outcomes, TRMT improved FVC, FEV1 and 6MWT (P<0.05) but did not significantly improve PEF. Conclusion: TRMT improved inspiratory muscle strength and expiratory muscle strength, improved exercise endurance, and improved FVC and FEV1 of pulmonary function but did not significantly improve PEF.

Background: Prolonged disorders of consciousness (pDOC), including vegetative/unresponsive wakefulness state (VS/UWS) and minimally conscious state (MCS), pose significant diagnostic and prognostic challenges. Multimodal neuroimaging has emerged as a promising tool to uncover neural biomarkers that reflect residual brain function and guide management. This pilot feasibility study aimed to preliminarily characterize metabolic, functional, and structural brain alterations in pDOC patients using simultaneous positron emission tomography/magnetic resonance (PET/MR) imaging, and to examine their tentative associations with clinical behavioral responsiveness. Methods: Eight pDOC patients and eight matched healthy controls underwent hybrid 18F-FDG PET/MR scanning. Resting-state fMRI, diffusion tensor imaging (DTI), and FDG-PET were processed to assess amplitude of low-frequency fluctuations (ALFF), fractional anisotropy (FA), and glucose metabolism, respectively. Group differences were analyzed, and correlations with Coma Recovery Scale-Revised (CRS-R) scores were evaluated. Multimodal integration was performed across imaging modalities. Results: Compared to controls, pDOC patients exhibited reduced ALFF and FDG uptake in the posterior cingulate cortex (PCC) and anterior cingulate cortex (ACC), with exploratory increased ALFF in the visual cortex inversely correlated with visual responsiveness. Functional connectivity analyses revealed attenuated intra- and inter-network connectivity in the DMN, SN, and DAN. FDG-PET identified metabolic hypofunction in the insula, frontal cortex, and cerebellum, while DTI demonstrated widespread white matter FA reductions. Multimodal correspondence revealed partially overlapping abnormalities in the PCC and occipital regions, highlighting candidate hubs that may be relevant to consciousness level and warrant further validation. Conclusion: Simultaneous FDG-PET/MR was feasible in this pilot pDOC cohort and provided a convergent, multimodal assessment of metabolic-functional-structural alterations. The PCC and occipital visual cortices emerge as key regions linked to consciousness levels. Given the small sample size and cross-sectional design, these findings are preliminary, and warrant validation in larger longitudinal cohorts before clinical translation.

Background: Chemokines play a pivotal role in the progression of osteoarthritis (OA), but their exact mechanisms remain unclear. This study aimed to identify potential chemokine-associated biomarkers and investigate their causal relationships with OA. Methods: Transcriptome and genome-wide association study (GWAS) data were obtained from public databases, while chemokine-related genes (CRGs) were sourced from the literature. Initially, CRGs were expanded, followed by Mendelian randomization (MR) analysis, differential expression analysis, machine learning, and receiver operating characteristic (ROC) curve plotting to identify potential biomarkers. The causal relationships between these biomarkers and OA, as well as their biological functions, were further explored. Results: Fourteen candidate genes were identified for machine learning analysis, with DDIT3, CEBPB, CX3CR1, and ARHGAP25 emerging as feature genes. CEBPB and CX3CR1, which exhibited AUCs > 0.7 in the GSE55235 and GSE55457 datasets, were selected as potential biomarkers. Notably, CEBPB expression was lower, while CX3CR1 expression was elevated in the case group. Furthermore, both genes were co-enriched in spliceosome, lysosome, and cell adhesion molecule pathways. MR analysis confirmed that CEBPB and CX3CR1 were causally linked to OA and acted as protective factors (IVW model for CEBPB: OR = 0.9051, p = 0.0001; IVW model for CX3CR1: OR = 0.8141, p = 0.0282). Conclusions: CEBPB and CX3CR1 were identified as potential chemokine-related biomarkers, offering insights into OA and suggesting new avenues for further investigation.

Objective: To explore the effectiveness and safety of electroacupuncture (EA) as an adjunct to conventional rehabilitation (CR) in patients with upper limb spasticity after brain injury. Methods: This study was a single-blind, prospective, two-group parallel randomized controlled trial. Eligible patients were randomly divided into an intervention group and a control group. Participants in the control group received CR only, whereas those in the intervention group received CR supplemented with EA, administered five times weekly for 2 weeks. Modified Ashworth scale (MAS), shear modulus of biceps brachii muscle (BBM), Fugl-Meyer motor scale (FMMS), Barthel index (BI) and safety were assessed at baseline and after 2 weeks of treatment. Results: A total of 64 patients were randomized, with 58 included in the final (per protocol) analysis. The baseline data of the two groups were comparable. Following the 2-week treatment period, improvements were observed in both groups compared to baseline. However, no significant differences were noted between the two groups in MAS ( Z = −1.692, p = 0.091), BBM shear modulus short axis of 0° elbow flexion (mean difference (MD) −1.079, 95% confidence interval (CI) −2.786 to 0.628), long axis of 0° elbow flexion (MD −0.499, 95% CI −1.699 to 0.700), short axis of 90° elbow flexion (MD −0.005, 95% CI −0.933 to 0.923), long axis of 90° elbow flexion (MD −0.845, 95% CI −1.355 to 1.113), FMMS (MD −0.890, 95% CI −2.243 to 0.462) or BI (MD 0.024, 95% CI −2.955 to 3.002) scores. One participant reported an itchy sensation at the acupuncture site, with no other adverse events observed during or after the trial. Conclusion: EA was not effective when added to CR as a 2-week intervention for upper limb spasticity after brain injury, but appears to be a safe intervention in this population. Trial registration number: ChiCTR2200060819 (Chinese Clinical Trial Registry)