Immunological alterations and changes in neurotransmission are considered to be crucial in the pathological process of depression. An immune activation including increased production of proinflammatory cytokines has repeatedly been described in depression, which shines a clue for new anti-depression therapy. Immune activation will lead to depression through serotonin and glutamate systems. This paper is attempted to review the immune mediated alterations on serotonin and glutamate systems.

Aim To study the pharmacodynamics of antianxietic compound prescription capsule ( ACPC ) on acute stress in rats and the influence upon the ex-pression of ERK/CREB signal pathway and brain-de-rived neurotrophic factor ( BDNF) in the cerebral cor-tex and hippocampus of rats. Methods The elevated plus maze ( EPM ) test was applied to observe the effects of ACPC on acute stress rats administered 7 d low-, medium- and high-dose ( 0. 75 , 1. 5 , 3 g · kg-1 ) . The expression of ERK/CREB signal pathway and BDNF in the cerebral cortex and hippocampus of rats were studied by using Western blot method. Re-sults In EPM, high-dose of ACPC increased signifi-cantly the rat open arm time ( OT%) ( P<0 . 05 ) and the percentage of open arm entries ( OE%) ( P <0. 05). In Western blot, the medium-dose of ACPC reduced significantly p-ERK1/2 expression in hippo-campus ( P <0. 05 ) , and high-dose group decreased significantly the expression of p-ERK1/2 and p-CREB in the cortex and hippocampus of rats ( P <0. 05 ) . High-dose group increased significantly the expression of BDNF in the cortex and hippocampus of rats ( P<0. 05 , P<0. 01 ) . Conclusion ACPC has anti-anxie-ty effect in the model of EPM, and its mechanism may be related to the ERK/CREB signal pathway and in-creased BDNF expression.

Post-traumatic stress disorder is a persistent psychological disorder that occurs for a period of time after an individual has been directly or indirectly exposed to a traumatic event, and this disorder can seriously affect the individual's daily living status and work situation. According to studies, about 1/3 of people with PTSD have the disorder for life, and the suicide rate is 6 times higher than that of the general population. The pathogenesis of the disease is still inconclusive, and the effect of conventional clinical drug therapy is limited and has significant side effects. At the same time, increasing attention has been paid to the importance of neuropeptide Y (NPY) for individuals to cope with stress and recover from traumatic events. In this paper, we explore the relationship between neuropeptide Y and the hypothalamic-pituitary-adrenal axis, Glutamate and γ-aminobutyric acid neurons, locus coeruleus-norepinephrine system, and corticotropin releasing factor, which are closely related to posttraumatic stress disorder, to identify the neural circuit of neuropeptide Y. It may provide a new perspective for the prevention and treatment of PTSD and for the understanding of its developmental mechanisms.

Gingseng is commonly used in traditional Chinese medicine community for the treatment of depression-like disorders. Ginsenosides is considered to be the major active components of ginseng. Previous studies have demonstrated that ginsenosides produced antidepressant-like action in various mouse models of behavioral despair. The present study aimed to examine whether ginsenosides could affect the chronic unpredictable mild stress (CUMS)-induced depression in rats. The mechanism(s) underlying the antidepressant-like action was investigated by measuring serum corticosterone level, glucocorticoid receptor (GR), mineralocorticoid receptor (MR) and brain-derived neurotrophic factor (BDNF) mRNA levels in brain tissues. CUMS, being lasted for 6 weeks, caused depression-like behavior in rats, as indicated by the significant decrease in sucrose consumption and increase in immobility time in the forced swim test. Whereas serum corticosterone level was significantly increased in rats exposed to CUMS, expressions of GR mRNA in hippocampus, and BDNF mRNA in hippocampus and frontal cortex, were decreased in CUMS-treated rats. Daily intragastric administration of ginsenosides (12.5, 25, 50 mg x kg(-1)) during the six weeks of CUMS significantly suppressed behavioral and biochemical changes induced by CUMS. However, there was no significant difference in MR mRNA level among groups. The results suggest that the antidepressant-like action of ginsenosides is likely mediated by modulating the function of hypothalamic- pituitary -adrenal axis and increasing the expression of BDNF in brain tissues.
Adrenal Glands ; drug effects ; metabolism ; Animals ; Brain-Derived Neurotrophic Factor ; genetics ; metabolism ; Depression ; drug therapy ; genetics ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Ginsenosides ; administration & dosage ; Humans ; Hypothalamus ; drug effects ; metabolism ; Male ; Panax ; chemistry ; Pituitary Gland ; drug effects ; metabolism ; Random Allocation ; Rats ; Rats, Wistar

Objective:To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods:A total of 150 patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective painless gastroscopy, were divided into 3 groups ( n=50 each) using a random number table method: propofol combined with remifentanil group (group P), remimazolam 0.3 mg/kg combined with remifentanil group (group R1) and remimazolam 12 mg combined with remifentanil group (group R2). Drugs were administrated according to body weight, and calculation was carried out according to ideal body weight.Remifentanil 0.25 μg/kg was injected intravenously, propofol 1.5 mg/kg was then injected intravenously in group P, remimazolam 0.3 mg/kg was injected intravenously in group R1, and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation (MOAA/S) score was≤3, gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still ≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred, 1/4 of the initial dose of propofol was injected intravenously in group P, 1/4 of the initial dose of remimazolam was injected intravenously in group R1, and remimazolam 2.5 mg was injected intravenously in group R2 to maintain MOAA/S score ≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation, time for gastroscopy, emergence time and discharge time were recorded.The occurrence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was recorded. Results:Compared with group P, no significant change was found in the success rate of sedation ( P>0.05), and the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was decreased in group R1, and the success rate of sedation was significantly decreased, the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, coughing and injection pain was decreased, and the incidence of hiccup was increased in group R2 ( P<0.05). Compared with group R2, the success rate of sedation was significantly increased, and the incidence of intraoperative body movement, coughing and hiccup was decreased in group R1 ( P<0.05). Conclusion:Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.

Objective:To evaluate the efficacy of perioperative analgesia with esketamine in the patients undergoing thoracoscopic surgery.Methods:A total of 90 patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into 3 groups ( n=30 each) by a random number table method: control group (C group) and different doses of esketamine groups (S 1 group, S 2 group). Before induction of anesthesia, esketamine 0.1 and 0.2 mg/kg were intravenously injected in S 1 group and S 2 group, respectively, while esketamine was not given in group C. Anesthesia was routinely induced in all the three groups. During anesthesia maintenance, esketamine 0.1 and 0.2 mg·kg -1·h -1 were intravenously infused in group S 1 and group S 2, respectively, and the remaining drugs used for anesthesia maintenance were the same in the three groups. Patient-controlled intravenous analgesia (PCIA) was used after operation, and PCIA solution contained sufentanil 2 μg/kg in group C, and esketamine 1 mg/kg was mixed on the basis as previously described in S 1 and S 2 groups. Aminotriol ketorolac was given as rescue analgesia to maintain numeric rating scale score at rest ≤3. The total amount of propofol and remifentanil during operation, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, and requirement for rescue analgesia were recorded. The occurrence of adverse reactions such as respiratory depression, nausea and vomiting, dizziness and salivation, and emergence time were recorded after surgery. The serum interleukin-6 (IL-6) concentration was measured by enzyme-linked immunosorbent assay at 30 min before and after surgery, and the malondialdehyde (MDA) concentration in serum was measured by thiobarbituric acid colorimetric analysis. The postoperative recovery was assessed using the 50-item quality of recovery scale at 1 and 2 days after surgery. The development of chronic pain was followed up by telephone within 1-3 months after surgery. Results:Compared with group C, the intraoperative consumption of remifentanil, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, rate of rescue analgesia, and postoperative serum IL-6 concentration were significantly decreased, and the 50-item quality of recovery scale score was increased in S 1 and S 2 groups, and the postoperative serum MDA concentration was significantly decreased in group S 2 ( P<0.05). Compared with group S 1, the consumption of intraoperative remifentanil was significantly decreased ( P<0.05), and no significant change was found in postoperative serum IL-6 and MDA concentrations in group S 2 ( P>0.05). Compared with group S 2, the postoperative emergence time was significantly shortened in S 1 and C groups ( P<0.05). There was no statistically significant difference in the intraoperative consumption of propofol, incidence of adverse effects and incidence of chronic pain among the three groups ( P>0.05). Conclusions:Esketamine for perioperative analgesia (dose before anesthesia induction 0.1 mg/kg, dose for maintenance of anesthesia 0.1 mg·kg -1·h -1, dose for postoperative PCIA 1 mg/kg) can raise the quality of analgesia and improve the quality of early postoperative recovery in the patients undergoing thoracoscopic lobectomy.

Objective:To evaluate the optimization efficacy of pressure-volume (P-V) curve-based individualized lung-protective ventilation strategy combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) mode (LPVS+ PCV-VG) for one-lung ventilation (OLV) in elderly patients undergoing radical resection of lung cancer.Methods:Seventy American Society of Anesthesiologists Physical Status classificationⅡ-Ⅲ patients, aged 65-74 yr, with body mass index of 18-24 kg/m 2, undergoing elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=35 each) using a random number table method: PCV-VG group and LPVS+ PCV-VG group. Blood samples were collected from the radial artery for blood gas analysis before induction of general anesthesia (T 0), at 5 min of two lung ventilation after endotracheal intubation (T 1), at 30 min of OLV (T 2), at the end of OLV (T 3), and at 5 min of two lung ventilation in supine position (T 4). Ppeak, mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were recorded. The use of antibiotics, lung-related complications and rehabilitation were recorded within 7 days after operation. Results:Compared with PCV-VG group, PaO 2, PaCO 2 and Cdyn were significantly increased at T 2-4, Ppeak was decreased at T 2, 3, Pmean was increased at T 3, the requirement for antibiotics within 7 days after operation was decreased, the incidence of 1 grade lung-related complications was decreased, and the thoracic drainage tube indwelling time and length of hospital stay were shortened in LPVS+ PCV-VG group ( P<0.05). Conclusions:Individualized LPVS based on P-V curve combined with PCV-VG mode provides better efficacy for OLV in elderly patients undergoing radical resection of lung cancer.

Objective To observe the effect of pressure-controlled ventilation volume-guaranteed(PCV-VG)mode on respiratory mechanics,lung injury markers and postoperative pulmonary complications(PPCs)in thoracoscopic patients.Methods Fifty-nine patients undergoing elective thoracoscopic lobecto-my,29 males and 30 females,aged 18-64 years,BMI 18.5-26.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using a random number table method:the PCV-VG mode group(group P,n=29)and the volume-controlled ventilation(VCV)mode group(group V,n=30).The PCV-VG mode was used for one-lung ventilation(OLV)in group P,and the VCV mode was used in group V.Anesthesia in-duction and maintenance medications were consistent in all patients.PaO2 was recorded before induction of anesthesia,5 minutes after intubation,15 minutes after OLV,30 minutes after OLV,and 3 days postopera-tively,and oxygenation index(OI)and intrapulmonary shunt rate(Qs/Qt)were calculated.Peak airway pressure(Ppeak),pulmonary dynamic compliance(Cdyn),and driving pressure(DP)were recorded 5 minutes after intubation,15 minutes after OLV,and 30 minutes after OLV.Clara cell secretory protein-16(CC-16)and interleukin-6(IL-6)concentration were measured before induction of anesthesia and after ex-tubation.Recording the occurrence of PPCs within 1 week after surgery.Results Compared with group V,Ppeak and DP were significantly reduced,Cdyn was increased significantly in group P 15 minutes and 30 minutes after OLV(P＜0.05),PaO2 and OI were significantly increased in group P 3 days postoperatively(P＜0.05),CC-16 and IL-6 concentrations were significantly reduced in group P after extubation(P＜0.05).Compared with group V,the incidence of PPCs was significantly reduced in group P(P＜0.05).Conclusion During one-lung ventilation for thoracoscopic surgery,the pressure-controlled ventilation vol-ume-guaranteed mode reduces peak airway pressure and driving pressure,improves pulmonary dynamic compliance and improves oxygenation,reduces the incidence of PPCs.

Objective To explore the effects of Xingpi Jieyu Fang (XPJYF, Spleen-invigorating Depression-relieving Formula) on behaviors and mitochondria ultrastructure of hippocampus neurons and skeletal muscle in depressed rats.Methods Wister rats were randomly divided into five groups: blank control group, model group, sertraline group, XPJYF high-dose and low-dose groups.Chronic unpredictable stress (CUS)was applied to establish depression models in rats for 28 days.Intragastric gavage was used to offer corresponding medication in treatment groups or distilled water in model and blank control groups.Weight change, sugar/water preference test and open-field test were used to evaluate depressive behavior in rats.Changes in ultrastructure of mitochondria in hippocampus neurons and skeletal muscles of depressive rats were measured by using transmission-electron microscope.Results Compared with the blank control group, weight gain in model group rats was significantly slowed while the sugar/water preference rate and total moving distance of open-field test decreased significantly (P<0.01).The number of mitochondria in hippocampal neurons and skeletal muscle in the model group was also reduced with irregular swelling, fractured and fuzzy cristae as well as vacuolar degeneration.under the transmission-electron microscope Compared with the model group, body weight, total sugar/water preference rate, and total moving distance of open-field test in XPJYF high-dose, low-dose group and sertraline group were significantly increased (P<0.01).No swelling or vacuolar degeneration were observed in mitochondria of hippocampal neurons and skeletal muscle in XPJYF high-dose group, which were close to the normal level.Hippocampal neuron and skeletal muscle mitochondria of XPJYF low-dose group and sertraline group were slightly swollen with partly fractured and fuzzy cristae.Conclusion The mitochondria structure of hippocampal neurons and skeletal muscle were damaged in depression induced by chronic stress, which may be a key factor in severe fatigue and symptoms involving multiple systems.Xingpi Jieyu formula could improve depressive behavior and mitochondria structure damage in depressed rats.To some extent, the effects of high-dose Xingpi Jieyu formula were better than sertraline in improving depression of rats.

Objective: To investigate the mid-term outcomes of the dual mobility total hip prosthesis in primary total hip arthroplasty. Methods: A total of 101 patients who underwent primary total hip arthroplasty with dual mobility total hip prosthesis from May 2010 to March 2013 were enrolled in the present study with complete follow-up information. There were 56 females and 45 males with the mean age of 66.36 years (rang from 58 to 77 years). There were 35 patients with femoral neck fracture, 33 patients with femoral head necrosis, 10 patients with hip osteoarthritis, 18 patients with secondary osteoarthritis to hip dysplasia and 5 patients with ankylosing spondylitis. The dual mobility total hip prosthesis was used for all 101 patients by the posterior-lateral approach of hip joint. Harris hip score was used to evaluate the clinical effects. Radiographic analysis was also performed to evaluate the biological fixation effects of the prosthesis, dislocation of the prosthesis, osteolysis and migration of the acetabular cup. Results: The mean operation duration was 80.68±6.59 min (range from 70 to 90 min). The average blood loss during the operation was 180.67±18.76 ml (range from 150 to 200 ml). All incisions were healed at the first stage. All patients were followed up with an average of 65±3 months (range from 62 to 75 months). Harris hip score improved from 56.70±16.71 before surgery to 94.26±1.91 at the last follow-up. The differences among different follow-up times were of statistical significance. The Hip flexion and extension, adduction and abduction, and internal and external rotation improved from 86.67°±16.70°, 34.06°±7.05°, 34.53°±7.45° preoperatively to 141.73°±6.56°, 57.06°±3.83°, 75.18°±4.00° at the last follow-up, respectively. At 3 months after the operation, the X-ray showed satisfied bone integration. There were no acetabular and femoral shaft fractures, sciatic nerve, femoral artery and vein injuries during the operation, and no joint dislocation, prosthesis loosening, infection and deep venous thrombosis of lower limbs during the postoperative and follow-up duration. Conclusion The dual mobility total hip prosthesis has the advantages in good initial and middle stability, rapid bone growth, low dislocation rate and repid recovery of postoperative motion range. It is suitable for patients over 65 years old or younger patients with postoperatively high dislocation.