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BackgroundAs a non-pharmacological therapy, acupuncture has significant efficacy in treating Mild Cognitive Impairment (MCI) compared to pharmacological therapies. In recent years, advances in neuroimaging techniques have provided new perspectives to elucidate the central mechanisms of acupuncture for MCI. Many acupuncture brain imaging studies have found significant improvements in brain function after acupuncture treatment of MCI, but the underlying mechanisms of brain regions modulation are unclear.ObjectiveA meta-analysis of functional magnetic resonance imaging studies of MCI patients treated with acupuncture was conducted to summarize the effects of acupuncture on the modulation of MCI brain regions from a neuroimaging perspective.MethodsUsing acupuncture, neuroimaging, magnetic resonance, and Mild Cognitive Impairment as search terms, PubMed, EMBASE, Web of Science, Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects (DARE), Google Scholar, China National Knowledge Infrastructure (CNKI), China Biology Medicine disk (CBM disk), Wanfang and Chinese Scientific Journal Database (VIP) for brain imaging studies on acupuncture on MCI published up to April 2022. Voxel-based neuroimaging meta-analysis of fMRI data was performed using voxel-based d Mapping with Permutation of Subject Images (SDM-PSI), allowing for Family-Wise Error Rate (FWER) correction correction for correction multiple comparisons of results. Subgroup analysis was used to compare the differences in brain regions between the acupuncture treatment group and other control groups. Meta-regression was used to explore demographic information and altered cognitive function effects on brain imaging outcomes. Linear models were drawn using MATLAB 2017a, and visual graphs for quality evaluation were produced using R software and RStudio software.ResultsA total of seven studies met the inclusion criteria, with 94 patients in the treatment group and 112 patients in the control group. All studies were analyzed using the regional homogeneity (ReHo) method. The experimental design of fMRI included six task state studies and one resting-state study. The meta-analysis showed that MCI patients had enhanced activity in the right insula, left anterior cingulate/paracingulate gyri, right thalamus, right middle frontal gyrus, right median cingulate/paracingulate gyri, and right middle temporal gyrus brain regions after acupuncture treatment. Further analysis of RCT and longitudinal studies showed that Reho values were significantly elevated in two brain regions, the left anterior cingulate/paracingulate gyrus and the right insula, after acupuncture. The MCI group showed stronger activity in the right supramarginal gyrus after acupuncture treatment compared to healthy controls. Meta-regression analysis showed that the right anterior thalamic projection ReHo index was significantly correlated with the MMSE score after acupuncture treatment in all MCI patients.ConclusionsAcupuncture therapy has a modulating effect on the brain regions of MCI patients. However, due to the inadequate experimental design of neuroimaging studies, multi-center neuroimaging studies with large samples are needed better to understand the potential neuroimaging mechanisms of acupuncture for MCI. In addition, machine learning algorithm-based predictive models for evaluating the efficacy of acupuncture for MCI may become a focus of future research.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022287826, identifier: CRD 42022287826.

Background: Long term insomnia and low sleep quality often lead to depression, anxiety and other negative emotions, and often interact with each other. Many studies have confirmed the effectiveness of acupuncture in the treatment of insomnia comorbid with emotional disorders, but its specific mechanism needs to be further explored. Resting-state functional magnetic resonance (rsfMRI) is an important means to study the changes of brain activity. However, the results are inconsistent and lack of systematic evaluation and analysis. Methods: Nine databases will be searched, including PubMed, EMBASE, EBSCOhost-medline, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP Database and Wan-Fang Database, Chinese Biomedical Literature Database from inception to January 2021. And screening clinical registration platform related research, in order to obtain more relevant studies. The outcomes include the change of rs-fMRI, sleep quality, depression, and anxiety. Quality assessment of the included studies will be performed according to the Cochrane Risk of Bias tool. Evidence quality will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RevMan software (Version 5.3) and stata13.1will be used for statistical analyses. Subgroup analysis will be performed if necessary. If the data is insufficient, qualitative synthesis will be conducted instead of quantitative synthesis. Results: This study will analyze the effect of acupuncture on the brain activity changes, improvement of sleep quality and clinical symptoms of anxiety and depression with insomnia comorbid with emotional disorders. Conclusion: This study used meta-analysis method to explore the characteristics of acupuncture on brain activity changes in insomnia comorbid with emotional disorders, so as to provide effective evidence for clarifying its pathogenesis.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Muhammad Imran Shah,1 Irfan Ullah,2 Xiao Xingjian,2 Huang Haipeng,2 Alam Rehman,3 Muhammad Zeeshan,4 Fakhr E Alam Afridi5 1School of Mathematics and Statistics, Wuhan University, Wuhan, People’s Republic of China; 2Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 3Faculty of Management Sciences, National University of Modern Languages Islamabad, Islamabad, Pakistan; 4College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People’s Republic of China; 5Islamia College Peshawar, Peshawar, PakistanCorrespondence: Irfan UllahReading Academy, Nanjing University of Information Science and Technology, People’s Republic of ChinaEmail irfnecon@nuist.edu.cnObjective: This study investigates life expectancy and trade openness in China for the period 1960– 2018.Methods: We purposed a theoretical model that is tested for China by applying regime-switching regression.Results: Our findings suggest that trade openness increases life expectancy in China; trade affects life expectancy from two aspects; firstly, trade expansion and industrialization lead to high economic activities and resulted in raise the income of the people in society leading to improve life expectancy. Secondly, industrial expansion increases the CO2 emissions which leads to imposes a negative implication on human health and thus reduces life expectancy.Conclusion: Thus, the net effect of trade liberalization depends on the value of income effect and volume of CO2 emissions. Therefore, the government needs to support the trade policies which causes a low level of CO2 emissions, the government may provide incentives to exports and industrialists to adopted green energy in the production process. Besides, the government may impose some regulations such as carbon tax to mitigate the CO2 emissions in society.Keywords: trade, life expectancy, CO2 emissions, health quality, regime-switching regression, China