Objective To compare clinical effects of continuous spinal, epidural and combined spinal-epidural anesthesia for arthroplasty in the elderly over 70 years. Methods Sixty geriatric patients, ASA status Ⅱ~Ⅲ degree, aged 71~98 yr, undergoing arthroplasty operation on hip or knee joint, were randomly assigned to group of continuous spinal anesthesia, group of combined spinal-epidural anesthesia, or group of continuous epidural anesthesia, with twenty patients of per group. T_ 10 anesthesia level was aimed by 0.5% bupivacaine titrated carefully. Results All anesthesia were clinically satisfied with average anesthesia level T_ 10(T_ 7~11). Bromage's motor blockade scale in group of continuous spinal anesthesia was higher than that in group of continuous epidural anesthesia. Amount of bupivacaine consumptions were (8.0?1.8)mg, (13.7?9.7)mg, (39.4?16.6)mg in groups of continuous spinal anesthesia, combined spinal-epidural anesthesia, and continuous epidural anesthesia respectively (P0.05). Conclusions With 0.5% bupivacaine titrated carefully, all kinds of continuous spinal, epidural and combined spinal-epidural anesthesia are clinical efficient in the elderly over 70 years for arthroplasty, of which continuous spinal anesthesia is recommended due to the most stable hemodynamics.

Objective:To investigate the attention deficit/hyperactivity disorder(ADHD) like behavior of offspring mice induced by stress during pregnancy and its mechanism.Methods:Chronic unpredictable stress was applied to ICR pregnant mice in different gestational periods. The offspring mice were randomly selected and the behavior changes of each group were observed in open field experiment (CG: control group; SG1: cums stress stimulation from 8 to 14 days of gestation; SG2: cums stress stimulation from 15 days of gestation to childbirth). The plasma concentrations of GABA, its metabolic enzymes and dopamine were detected by ELISA.Results:The results of open field experiment showed that the total distance, the time of stay in central area, the speed in central area, and the speed in surrounding area in SG1 group, SG2 group and CG group were statistically significant ( F=8.30, 5.01, 8.05, 7.15, all P<0.05). The total distances of SG1 group and SG2 group were significantly longer than that of CG group ((5 221.07±469.95)mm, (4 825.63±545.49)mm, (3 781.17±111.34)mm, both P<0.05).The times of stay in central area of SG1 and SG2 groups were shorter than that in CG group ((5.95±3.32)s, (8.59±3.42)s, (11.10±3.61)s, all P<0.05). The speeds in central area of SG1 and SG2 groups were faster than that of CG group ((30.93±5.79)mm/s, (32.48±9.06)mm/s, (20.57±5.07)mm/s, all P<0.05).The speed in surrounding area in SG1 group was faster than that in CG group ((16.91±1.64)mm/s), (12.42±3.77)mm/s, P<0.05). ELISA results showed that there were significant differences in mice plasma GABA, GAD65, GAD67 and DA among CG group, SG1 group and SG2 group ( F=16.52, 6.42, 11.04, 7.26, all P<0.05).The plasma concentrations of GABA in SG1 group and SG2 group were lower than that in CG group ((3.70±0.80)μmol/L, (4.40±0.80)μmol/L, (6.06±1.01)μmol/L, all P<0.05).The plasma concentrations of GAD65 ((5.36±0.75)μg/L, (6.99±1.01)μg/L, P<0.05)and GAD67((10.52±1.09)μg/L, (9.84±1.35)μg/L, (12.83±1.67)μg/L, P<0.05)in SG1 group were lower than those in CG group. The plasma DA concentration in SG1 group ((82.81±8.59)ng/L) was higher than that in CG group ((69.43±9.42)ng/L, P<0.05) and SG2 group ((66.36±10.77)ng/L, P<0.05). Conclusion:Prenatal stress can induce ADHD-like behavioural phenotypes in offspring mice, which may be related to the influence of plasma GABA metabolism and DA concentration.

Objective To investigate the protective effect of green tea-based cream at different con- centrations on photoaging and photo-immunosuppression. Methods Twenty healthy female volunteers were enrolled into this study with informed consent. Green tea-based cream with a mass fraction of 2%-5% (pre- pared by adding green tea extracts to an emollient formulation), excipient or green tea extracts alone were applied to six unexposed sites on the back of these volunteers. Thirty minutes later, these treated sites were subjected to solar-simulated ultraviolet irradiation (ssUVR) with a 1.5-fold minimal erythema dose once a day for 4 days. At 6, 24 and 48 hours after the last irradiation, green tea-based cream were applied repeatedly to the corresponding sites. Biopsy specimens were obtained from the seven sites 72 hours following the last irradiation, and immunohistochemical staining was performed to detect cytokeratin 5/6 and 16 expression, as well as the densities of CDla- or HLA-DR-positive cells. Resttlts Green tea-based cream at a mass fraction of 2% to 3% could effectively prevent ssUVR-induced obvious erythema and hyperpigmentation. The posi- tivity (+) rates plus strong positivity (++) rates reached 50% and 25% for CK5/6 in the sites treated with ssUVR only and those irradiated and protected with green tea cream at a mass fraction of 3%, respectively, 69% and 31% in the sites treated with ssUVR only and those irradiated and protected with green tea-based cream at a mass fraction of 2%, respectively. Compared with the control site without irradiation or protec- tion, a decrease over 75% was noticed in the density of epidermal CD1a- or HLA-DR- positive Langerhans cells in the irradiated sites without protection, and green tea-based cream, especially those at a mass fraction of 3%, could effectively inhibit the density decrease. Conclusion Green tea extracts could effectively pro- tect skin from photoaging and photo-immunosuppression with the optimal mass fraction at 2% or 3%.

Objective To evaluate the suppressive effect of dezocine ,lidocaine and ephedrine on fentanyl-induced cough . Methods A total of 120 patients ASA I-II ,scheduled for elective surgery under general anesthesia ,were randomly allocated into four groups (n= 30 ,each group) .Group Ⅰ ,Ⅱ ,Ⅲ ,Ⅳ were given saline (2 ml) ,dezocine (0 .1 mg/kg) ,lidocaine (1 mg/kg) or ephedrine(5 mg) ,respectively .One minute later all patients were injected with 4μg/kg of fentanyl ,after anoth-er one minute ,all patients were given midazolam (0 .1 mg/kg)+ propofol(2 mg/kg ,0 .4 ml/s)+cisatracurium (0 .2 mg/kg) . The incidence rate and severity of cough were recorded and hemodynamic parameters were also observed .Results The inci-dence rate of cough was 50% ,16 .7% ,13 .3% and 20% for group Ⅰ ,Ⅱ ,Ⅲ and Ⅳ ,respectively .Comparing to group I ,the incidence rate of cough was significantly lower (P<0 .05) in other groups ,but among the three experimental groups there was no significant difference in cough incidence rate and intensity .The hemodynamic changed of each group before and after the in-duction was consistent .Conclusion A priming dose of dezocine(0 .1 mg/kg) ,lidocaine (1 mg/kg) or ephedrine (5 mg) could effectively reduce the Fentanyl-induced cough response .

Objectives To investigate the incidence of depression status and the related factors in patients with maintenance hemodialysis (MHD).Methods One hundred and forty three MHD patients were enrolled in the study.According to Hospital Anxiety and Depression Scale (HADS-D) score,50 patients (35.0％) were classified in depression group and 93 were in non-depression group.The basic clinical information,demographic characteristics and laboratory parameters were collected.Univariate analysis,Pearson correlation and hierarchical regression analysis were used to assess the related factors of depression status.Results The average HADS-D score in 143 MHD patients was 6.22 ± 2.35,and that in depression group and in non-depression group was 9.76 ± 3.85 and 3.64 ± 2.91,respectively.The prevalence of the symptoms in MHD patients varied from 15.9％ to 98.4％,and the score of symptom burden was 12-136 (72.54 ± 34.86).Univariate analysis revealed that marital status (x2 =4.493,P =0.034),economic status (x2 =4.187,P =0.04),symptom burden(r =0.68,P ＜ 0.001),symptom severity (r =0.59,P ＜ 0.001) and social support (r =-0.38,P =0.002) were associated with the depression.Hierarchical regression analysis revealed that depression was associated significantly with symptom burden(β =0.546,P ＜ 0.001),symptom severity (β =0.428,P ＜ 0.001) and social support (β =0.205,P =0.032).Symptom burden and severity could explain 30.5％ of the depression variance.Conclusions The prevalence of depression status is high in MHD patients,which is positively correlated with symptom burden.Among all influencing factors,symptom burden has the greatest impact on the depression status,and maybe an important predicting factor of depression.

Objective To explore specific magnetic resonance imaging(MRI)features of somatic symptoms in depression by comparing the differences of brain gray matter volume in depression patients with and without somatic symptoms using voxel-based morphometry(VBM).Methods A total of 52 depression patients were recruited and divided into somatic and no somatic symptoms group according to the patient health questionnaire-15 score(＞9 and≤9,respectively).Forty gender-age-matched healthy volunteers were recruited as the control group.All subjects underwent MRI scanning.Imaging data were analyzed to explore the differences in brain gray matter between groups using VBM.Results Compared with control group,gray matter volume increased in the right superior temporal gyrus,and decreased in the right inferior orbitofrontal gyrus,right inferior temporal gyrus,left inferior orbitofrontal gyrus,and left superior temporal gyrus for depressive patients with somatic symptoms(P＜0.001);gray matter volume increased in the right middle temporal gyrus,and decreased in the right superior temporal gyrus and right inferior temporal gyrus for depressive patients without somatic symptoms(P＜0.001).Only the volume in the right tongue and left cingulate gyrus increased in depressive patients with somatic symptoms compared with that in patients without somatic symptoms(P＜0.01).Conclusion VBM-MRI has demonstrated increased volume in the tongue and cingulate gyrus in the somatic symptoms of depression.

Vitiligo， a skin pigmentation disorder caused by the loss of melanocytes in the basal layer of the skin， is manifested as creamy white or ivory white pigmented islands on the head， face， hair， areola， genitals， mucous membranes and traumatic areas with distinct borders， seriously affecting the patient’s social， physical， and mental health. The disease has attracted wide attention in the medical circle as a difficult aesthetic dermatosis with an increasing prevalence year by year. There are still blind spots in the hypotheses that autoimmunity， melanocyte autophagy， oxidative stress， autocytotoxicity， neurohumors， and genetic and environmental factors are associated with the pathogenesis of this disease. The commonly used Western medical therapies， including glucocorticoids， small-molecule antagonists， calcium-regulated neurophosphatase inhibitors， biologics， vitamin D derivatives， phototherapy， and surgery are flawed with side effects and prone to recurrence. Traditional Chinese Medicine （TCM） can treat vitiligo via a wide range of pathways and targets， with definite effects and low adverse reactions. Studies have demonstrated that TCM can promote autophagy of melanocytes and protect them from oxidative stress. However， there are few systematic summaries of the signaling pathways in the TCM treatment of vitiligo. Therefore， this paper introduces the main signaling pathways involved in the TCM treatment of vitiligo by reviewing the relevant articles published at home and abroad in recent years. Specifically， the signaling pathways include the molecular hydrogen-activated nuclear factor erythroid-related factor 2 （Nrf2）， tyrosine kinase receptor （c-Kit）， nuclear transcription factor-κB （NF-κB）， Janus tyrosine protein kinase （JAK）， mitogen-activated protein kinase （MAPK）， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， and adenosine monophosphate-activated protein kinase （AMPK） signaling pathways.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.