{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:44:09Z","timestamp":1792395849976,"version":"4.4.0"},"reference-count":75,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Poststroke dysphagia (PSD) may reflect not only focal motor pathway injury but also instability of the brainstem swallowing network under neuroimmune, glial, and vascular microenvironmental stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This mechanism\u2010oriented narrative review synthesized evidence on swallowing central pattern generator (CPG) organization, nucleus tractus solitarius (NTS)\u2010related sensory integration within the medullary swallowing network, poststroke neuroinflammation, altered glial responses, blood\u2013brain barrier\/neurovascular unit (BBB\/NVU) dysfunction, vagus\u2010related anti\u2010inflammatory regulation, and acupuncture\u2010mediated neuromodulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence suggests that inflammatory amplification, altered glial responses, and BBB\/NVU instability may be associated with reduced reserve in the distributed medullary swallowing network. Within this broader dorsal and ventral swallowing circuitry, the NTS contributes to sensory integration and premotor organization rather than serving as the sole center of swallowing pattern generation. Such disturbances may contribute to respiratory\u2013swallow discoordination in vulnerable patients. Acupuncture and electroacupuncture may indirectly support swallowing\u2010network recovery by modifying inflammatory burden, glial state, autonomic balance, and microenvironmental permissiveness. However, most mechanistic evidence is derived from ischemic stroke models in which swallowing was not the primary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We propose an NTS\u2010focused, hypothesis\u2010generating framework in which acupuncture may support PSD recovery by modifying neuroimmune, glial, vascular, and autonomic background conditions relevant to brainstem swallowing\u2010network stability. This framework should not be interpreted as evidence that acupuncture directly acts through a confirmed NTS\u2013vagal anti\u2010inflammatory pathway. Future studies should distinguish direct PSD evidence from indirect mechanistic evidence, stratify patients by inflammatory burden and autonomic tone, and incorporate physiological proxies of respiratory\u2013swallow phase stability as mechanistically informative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71732","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:17:08Z","timestamp":1789712228000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acupuncture for Poststroke Dysphagia: An NTS\u2010Centered Hypothesis\u2010Generating Framework Linking the Brainstem Swallowing Network, Neuroimmune Regulation, and Vagal Anti\u2010Inflammatory Signaling"],"prefix":"10.1002","volume":"16","author":[{"given":"Wei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Hubei Rongjun Hospital  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lebin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Hubei Rongjun Hospital  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine The Second Hospital of Huangshi  Huangshi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongjiu","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine The Second Hospital of Huangshi  Huangshi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Hubei Rongjun Hospital  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1799-5311","authenticated-orcid":false,"given":"Jiuguo","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Hubei Rongjun Hospital  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1115164"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974\u2010019\u20101512\u20106"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/life15010047"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42466\u2010022\u201000222\u20108"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2015.10.012"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.834649"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.16174"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109343(99)00340\u2010x"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1590\/0004\u2010282x20200087"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/1673\u20105374.297061"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13121694"},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/1673\u20105374.230272"},{"key":"e_1_2_16_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1241521"},{"key":"e_1_2_16_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEG.S111820"},{"key":"e_1_2_16_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12035\u2010024\u201004337\u20108"},{"key":"e_1_2_16_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/audiolres15060153"},{"key":"e_1_2_16_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974\u2010024\u201003101\u2010y"},{"key":"e_1_2_16_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1388\u20102457(03)00237\u20102"},{"key":"e_1_2_16_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2023.1173987"},{"key":"e_1_2_16_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2024.1181670"},{"key":"e_1_2_16_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141\u2010013\u20100017\u2010y"},{"key":"e_1_2_16_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756286418774254"},{"key":"e_1_2_16_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2024.1391576"},{"key":"e_1_2_16_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12964\u2010025\u201002287\u20109"},{"key":"e_1_2_16_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jne.13132"},{"key":"e_1_2_16_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40473\u2010014\u20100010\u20105"},{"key":"e_1_2_16_28_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.2001.81.2.929"},{"key":"e_1_2_16_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12265\u2010013\u20109508\u20106"},{"key":"e_1_2_16_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/09645284251365647"},{"key":"e_1_2_16_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1319863"},{"key":"e_1_2_16_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(24)00053\u2010x"},{"key":"e_1_2_16_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13071659"},{"key":"e_1_2_16_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25147546"},{"key":"e_1_2_16_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1305056"},{"key":"e_1_2_16_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2022.1038945"},{"key":"e_1_2_16_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13041\u2010024\u201001135\u20100"},{"key":"e_1_2_16_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12906\u2010024\u201004657\u20101"},{"key":"e_1_2_16_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2022.811419"},{"key":"e_1_2_16_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/sji.13092"},{"key":"e_1_2_16_41_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2025.1694110"},{"key":"e_1_2_16_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2020.112982"},{"key":"e_1_2_16_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010024\u201054619\u2010x"},{"key":"e_1_2_16_44_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00254.2020"},{"key":"e_1_2_16_45_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.1438\u201019.2020"},{"key":"e_1_2_16_46_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.37324"},{"key":"e_1_2_16_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells9122650"},{"key":"e_1_2_16_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.70231"},{"key":"e_1_2_16_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2005.03.015"},{"key":"e_1_2_16_50_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2012.189"},{"key":"e_1_2_16_51_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0199903"},{"key":"e_1_2_16_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/3\u2010211\u201027577\u20100_13"},{"key":"e_1_2_16_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms222413427"},{"key":"e_1_2_16_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14618"},{"key":"e_1_2_16_55_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2012.00132"},{"key":"e_1_2_16_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010016\u20109695\u20109"},{"key":"e_1_2_16_57_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23020960"},{"key":"e_1_2_16_58_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2013.256024"},{"key":"e_1_2_16_59_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00292.2016"},{"key":"e_1_2_16_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2023.110332"},{"key":"e_1_2_16_61_1","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S350109"},{"key":"e_1_2_16_62_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2025.1619532"},{"key":"e_1_2_16_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresbull.2022.02.008"},{"key":"e_1_2_16_64_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S526827"},{"key":"e_1_2_16_65_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00294"},{"key":"e_1_2_16_66_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00588.2024"},{"key":"e_1_2_16_67_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.70567"},{"key":"e_1_2_16_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14442"},{"key":"e_1_2_16_69_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.792522"},{"key":"e_1_2_16_70_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010022\u201009470\u20109"},{"key":"e_1_2_16_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14920"},{"key":"e_1_2_16_72_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2022.1062807"},{"key":"e_1_2_16_73_1","doi-asserted-by":"publisher","DOI":"10.1136\/svn\u20102018\u2010000196"},{"key":"e_1_2_16_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresbull.2024.111035"},{"key":"e_1_2_16_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11064\u2010025\u201004603\u20108"},{"key":"e_1_2_16_76_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2025.1562925"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71732","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.71732","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71732","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:20:00Z","timestamp":1792394400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.71732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":75,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/brb3.71732"],"URL":"https:\/\/doi.org\/10.1002\/brb3.71732","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71732"}}