As the longest and most widely distributed pair of nerves in the brain,the vagus nerve is involved in the regulation of many systems and organs.Recent studies have found that the vagus nerve may be involved in the occurrence of a variety of neuropsychiatric diseases by regulating the release of neurotransmitters(such as norepinephrine,5-hydroxytryptamine,gamma-aminobutyric acid and acetylcholine)and regulating the immune system and gut-brain axis.This article focuses on the regulatory mechanisms of the vagus nerve on neurotransmitters,immune system function,and the gut-brain axis,as well the therapeutic advances in vagus nerve stimulation for neurological and psychi-atric diseases such as epilepsy,depression and anxiety disorders.

As the longest and most widely distributed pair of nerves in the brain,the vagus nerve is involved in the regulation of many systems and organs.Recent studies have found that the vagus nerve may be involved in the occurrence of a variety of neuropsychiatric diseases by regulating the release of neurotransmitters(such as norepinephrine,5-hydroxytryptamine,gamma-aminobutyric acid and acetylcholine)and regulating the immune system and gut-brain axis.This article focuses on the regulatory mechanisms of the vagus nerve on neurotransmitters,immune system function,and the gut-brain axis,as well the therapeutic advances in vagus nerve stimulation for neurological and psychi-atric diseases such as epilepsy,depression and anxiety disorders.

Objective: This study’s objective is to assess the efficacy and safety of Pulsed Magnetic Therapy System (PMTS) in improving insomnia disorder. Methods: Participants with insomnia disorder were randomly assigned to receive either PMTS or sham treatment for four weeks (n= 153; PMTS: 76, sham: 77). Primary outcomes are the Insomnia Severity Index (ISI) scores at week 0 (baseline), 1, 2, 3, 4 (treatment), and 5 (follow-up). Secondary outcomes are the Pittsburgh Sleep Quality Index at baseline and week 4, and weekly sleep diary-derived values for sleep latency, sleep efficiency, real sleep time, waking after sleep onset, and sleep duration. Results: The ISI scores of the PMTS group and the sham group were 7.13±0.50, 11.07±0.51 at week 4, respectively. There was a significant group×time interaction for ISI (F3.214, 485.271=24.25, p<0.001, ηp 2=0.138). Only the PMTS group experienced continuous improvement throughout the study; in contrast, the sham group only experienced a modest improvement after the first week of therapy. At the end of the treatment and one week after it, the response of the PMTS group were 69.7% (95% confidence interval [CI]: 58.6%–79.0%), 75.0% (95% CI: 64.1%–83.4%), respectively, which were higher than the response of the sham group (p<0.001). For each of the secondary outcomes, similar group×time interactions were discovered. The effects of the treatment persisted for at least a week. Conclusion PMTS is safe and effective in improving insomnia disorders.

Objective: To investigate the potential risk factors for influencing renal recovery at discharge in critically ill patients with acute kidney injury (AKI) requiringcontinuous renal replacement therapy (CRRT). Methods: This was a single-center, retrospective study. Critically ill patients with AKI requiring CRRT adimitted to the Department of Intensive Care Unit (ICU) in Taizhou Municipal Hospital, Zhejiang province, from June 2014 to December 2017 were included and divided into two groups according to the status of renal recovery at discharge as renal recovery group and renal non-recovery group. The data of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score at adimission to ICU, initial serum creatinine (initial SCr) and lactate level and initial estimated glomerular filtration rate (initial eGFR) at time of AKI diagnosis, and total time of RRT and duration of anuria before CRRT were analyzed. Length of ICU stay and length of hospital stay in both groups were also analyzed. Multivariate logistic regression was taken to analyze the potential risk factors for influencing renal recovery at discharge in critically ill patients with AKI. Results: A total of 115 critically ill patients with AKI requiring CRRT were included, of which whom 45 cases were in renal recovery group and 70 cases were in renal non-recovery group, and the renal recovery rate at discharge was 39.1%(45/115); 59 patients were dead during hospitalization and the hospital mortality was 51.3%(59/115). Compared with renal non-recovery group, renal recovery group have a lower value of APACHEⅡ score [(21.73 ± 2.66) scores vs. (23.19 ± 4.41) scores, P=0.03), SOFA score [(11.02 ± 2.22) scores vs. (12.79 ± 2.82) scores, P=0.001], lactate level [(3.82 ± 1.34) mmol/L vs. (4.47 ± 1.52) mmol/L, P=0.021], initial SCr [(2.151 ± 0.677) mg/dl vs. (2.505 ± 0.792) mg/dl, P=0.015], duration of anuria before CRRT[(11.80 ± 4.71) h vs. (19.11 ± 5.98) h, P=0.005] and total time of RRT [(8.64 ± 3.42) d vs. (15.81 ± 5.07) d, P=0.001], and have a higher value of initial eGFR [(36.26 ± 14.74) ml/(min·1.73 m²) vs. (30.07 ± 10.38) ml/(min·1.73 m²), P=0.009]. In addition, length of ICU stay [(12.58 ± 4.78) d vs. (15.30 ± 5.45) d, P=0.007] and length of hospital stay [(19.58 ± 6.44) d vs. (22.11 ± 5.90) d, P=0.032] in renal recovery group were also significantly lower than those in renal non-recovery group. Multivariate logistic regression analysis indicated that SOFA score (OR=0.700, 95% CI 0.521-0.941, P=0.018), duration of anuria before CRRT (OR=0.782, 95%CI 0.689-0.888,P < 0.01) and total time of RRT (OR=0.673, 95% CI 0.565-0.801; P < 0.01) were independent risk factors influencing renal recovery at discharge in critically ill patients with AKI, and initial eGFR was a independent protective factor. Conclusions As to critically ill patients with AKI requiring CRRT, there are many factors that affect renal recovery at discharge,. SOFA score, duration of anuria before CRRT and total time of RRT are independent risk factors, and initial eGFR is an independent protective factor.

Objective To retrospectively analyze and compare the clinical application value of core-needle biopsy (CNB) histology and fine needle aspiration (FNA) cytology in diagnosing malignant thyroid nodules. Methods A total of 134 patients with 137 thyroid nodules (93 malignant nodules and 44 benign nodules) were included in this study. Under ultrasound guidance, successive use of 22 G fine needle and18 G core-needle to puncture each nodule was performed for sampling of thyroid nodule. Surgical findings and pathological manifestations were compared with clinical follow-up results. The success rate of sampling and the diagnostic accuracy, sensitivity as well as specificity for malignant thyroid nodules were compared among FNA, CNB, and CNB/FNA. Results The success rate of puncture sampling with FNA, CNB and FNA/CNB for thyroid nodules was 89.1％, 97.8％ and 100％ respectively. For malignant thyroid nodules, the diagnostic accuracy of FNA, CNB and FNA/CNB was 79.6％, 91.9％ and 96.4％ respectively, the sensitivity was 81.7％, 94.6％ and 97.8％ respectively, and the specificity was 75.0％, 86.4％ and 93.2％ respectively. The success rate of puncture sampling by using CNB or FNA/CNB was significantly higher than that by using FNA (P<0.01), moreover, the diagnostic accuracy and sensitivity for malignant thyroid nodules by using CNB or FNA/CNB was also remarkably higher than those by using FNA (P<0.01) . Conclusion In making diagnosis of malignant thyroid nodules, CNB is accurate, safe and reliable. CNB can be used as a complementary or alternative technique to FNA in clinical practice.

Objective To evaluate the effect of three different doses of oxycodone hydrochloride injection on uterine cramping pain and emotion in patients of artificial abortion.Methods Four hundred female patients, aged 17-38 years, BMI 18.5-23.9 kg/m2, falling into ASA physical statusⅠ orⅡ, undergoing elective artificial abortion were randomized into four groups using a random number table:group O1 (oxycodone 0.06 mg/kg), group O2 (oxycodone 0.08 mg/kg), group O3 (oxycodone 0.1 mg/kg), and group F, 100 cases in each.In group O1, group O2 and group O3, oxycodone 0.06, 0.08, 0.1 mg/kg were intravenously injected respectively, while in group F fentanyl1μg/kg was intravenously injected.Then, propofol 2.5 mg/kg was intravenously injected as induced dose.The operation was started when eyelash reflexes disappeared, propofol 0.4 mg/kg was intravenously injected when body movement appeared during the operation.The propofol doses, operation time and recovery time were recorded.HR, MAP, RR before anesthesia (T0), when loss of eyelash reflex (T1), operation (T2) and recovery (T3) were recorded.The uterine cramping pain was assessed with numerical rating scale (NRS) at recovery, 10, 30, 60 min after operation.Patients'satisfaction was recorded after operation.Patients'emotion was assessed with positive and negative affect scale (PANAS) both before and after operation in one hour.Rescue analgesia, nausea and vomiting, dizziness, respiratory depression, pruritus, uroschesis, cognitive dysfunction, sweatiness were recorded.Results The propofol doses and recovery time in groups O2, O3 and F were significantly lower than those in group O1 (P<0.05).The NRS score of uterine cramping pain in groups O1, O2 and O3 were significantly lower than that in group F (P<0.05).Patients'satisfaction in groups O1, O2 and O3 were significantly higher than that in group F (P<0.05).The positive affective score after operation in one hour among the four groups were significantly higher than that before operation (P<0.05), and the negative affective score after operation in one hour among the four groups were significantly lower than that before operation (P<0.05).The positive affective score after operation in one hour in groups O1, O2 and O3 were significantly higher than that in group F (P<0.05), and the rescue analgesia in groups O1, O2 and O3 were significantly lower than that in group F (P<0.05).There were no significant differences among the four groups as to the dizziness, nausea and vomiting.No respiratory depression, pruritus, emergence agitation, cognitive dysfunction, uroschesis and sweatiness were reported.Conclusion Oxycodone 0.08 mg/kg combined with propofol in patients undergoing artificial abortion is effective in preventing uterine cramping pain.Furthermore, the patients'satisfaction and positive affective score can also be improved.

Objective To investigate the effectiveness of the affinity adsorption material developed by our team for the specific removal of exogenous endotoxin in the blood circulation. Methods Fifteen beagle dogs were intravenously injected with endotoxin to establish a dog model of endotoxemia, and then they were randomly divided into the treatment group(n=10)and the control group(n=5). The treatment group received an extracorporeal perfusion to remove the endotoxin using the self-made disposable hemoperfusion device,while the control group using routine perfusion device. The levels of endotoxin, tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), interleukin 6(IL-6)and interleukin 8 (IL-8)in the blood of the dogs were measured at the beginning and 120 min after hemoperfusion for 120 minutes. The vital signs of the dogs were monitored during the hemoperfusion. Results After successful establishment of the endotoxemia model,the level of endotoxin at the beginning of hemoperfusion in the treatment group and control group was 118.63 ± 27.98 EU/mL and 117.16 ± 22.95 EU/mL,respectively. After hemoperfusion for 120 min,it was 0.039 ± 0.01 EU/mL and 131.98 ± 7.01 EU/mL, showing a significant difference(P﹤0.05). The clearance rate of hemoperfusion in the treatment group was 94.07%. At the beginning of hemoperfusion, the levels of TNF-α, IL-1β, IL-6 and IL-8 in the treatment group were 1.53 ± 0.27 ng/mL,12.82 ± 1.66 ng/mL,54.77 ± 3.98 ng/mL and 0.25 ± 0.32 ng/mL, and the levels in the control group were 1.53 ± 0.06 ng/mL,13.05 ± 0.18 ng/mL,54.58 ± 0.19 ng/mL and 0.28 ± 0.06 ng/mL, respectively. After hemoperfusion for 120 min, the levels of TNF-α, IL-1β, IL-6 and IL-8 in the treatment group were 0.13 ± 0.06 ng/mL, 0.70 ± 0.36 ng/mL, 1.62 ± 0.80 ng/mL and 0.01 ± 0.00 ng/mL, respectively, and as for the control group,the levels were 2.26 ± 0.15 ng/mL,15.12 ± 0.18 ng/mL,62.54 ± 0.93 ng/mL and 0.73 ± 0.93 ng/mL. There were significant differences between the beginning and after perfusion for 120 min in those two groups(P< 0.05). Conclusions This affinity adsorption material can effectively remove endotoxin and the inflammatory mediators in the blood of experimental dogs,with a clearance rate of 94.07%.

Objective To evaluate the effectiveness and safety of three different doses of oxycodone hydrochloride injection in treatment of postoperative uterus contraction pain after painless artificial abortion surgery.Methods A total of 150 early pregnancy patients with painless artificial abortion surgery were randomly divided into Q1 group (oxycodone 0.04 mg/kg),Q2 group (oxycodone 0.07 mg/kg) and Q3 group (oxycodone 0.1 mg/kg),50 cases in each group.Another 50 patients refused to sign the informed consent were selected as group N.The uterine contraction pain score at the time points of immediately after recovery and 10,30,and 60 min after recovery were recorded in four groups,and postoperative satisfaction degree were recorded as well.Preoperative degree of dysmenorrhea,surgery time,propofol dosage,postoperative recovery time,agitation and strength were recorded.At the time points of before administration (To),loss of eyelash reflex (T1),uterine cavity operation (T2),postoperative wake (T3),the heart rate (HR),mean arterial pressure (MAP),respiratory rate (RR) and pulse oxygen saturation (SpO2) were recorded.The incidence of adverse reactions such as dizziness,nausea and vomiting,cognitive impairment,sweating,skin itching,urinary retention,respiratory suppression were recorded.Results The VAS of uterus contraction pain in Group Q2 and Q3 were significantly lower than Group Q1 and Group N (P ＜ 0.05).The satisfaction degree of the patients after surgery in Group Q2 and Q3 were significantly higher than Group Q1 and Group N (P ＜ 0.05).The dose of propofol and recovery time in Group Q2 and Q3 were significantly lower than Group Q1 and group N (P ＜ 0.05).There was no significant difference between the four groups in the age,weight,dysmenorrhea,operation time,nausea and vomiting,vital signs,dizziness and cognitive dysfunction (P ＞ 0.05).There were no adverse reactions such as restlessness,pruritus,sweating,urinary retention,respiratory depression in the 4 groups.Conclusion 0.07 mg/kg oxycodone hydrochloride injection for patients with painless artificial abortion surgery can get perfect analgesic effect and high satisfaction degree,so it is worthy of clinical application.

Objective To evaluate the effectiveness and safety of three different doses of oxycodone hydrochloride injection in treatment of postoperative uterus contraction pain after painless artificial abortion surgery.Methods A total of 150 early pregnancy patients with painless artificial abortion surgery were randomly divided into Q1 group (oxycodone 0.04 mg/kg),Q2 group (oxycodone 0.07 mg/kg) and Q3 group (oxycodone 0.1 mg/kg),50 cases in each group.Another 50 patients refused to sign the informed consent were selected as group N.The uterine contraction pain score at the time points of immediately after recovery and 10,30,and 60 min after recovery were recorded in four groups,and postoperative satisfaction degree were recorded as well.Preoperative degree of dysmenorrhea,surgery time,propofol dosage,postoperative recovery time,agitation and strength were recorded.At the time points of before administration (To),loss of eyelash reflex (T1),uterine cavity operation (T2),postoperative wake (T3),the heart rate (HR),mean arterial pressure (MAP),respiratory rate (RR) and pulse oxygen saturation (SpO2) were recorded.The incidence of adverse reactions such as dizziness,nausea and vomiting,cognitive impairment,sweating,skin itching,urinary retention,respiratory suppression were recorded.Results The VAS of uterus contraction pain in Group Q2 and Q3 were significantly lower than Group Q1 and Group N (P ＜ 0.05).The satisfaction degree of the patients after surgery in Group Q2 and Q3 were significantly higher than Group Q1 and Group N (P ＜ 0.05).The dose of propofol and recovery time in Group Q2 and Q3 were significantly lower than Group Q1 and group N (P ＜ 0.05).There was no significant difference between the four groups in the age,weight,dysmenorrhea,operation time,nausea and vomiting,vital signs,dizziness and cognitive dysfunction (P ＞ 0.05).There were no adverse reactions such as restlessness,pruritus,sweating,urinary retention,respiratory depression in the 4 groups.Conclusion 0.07 mg/kg oxycodone hydrochloride injection for patients with painless artificial abortion surgery can get perfect analgesic effect and high satisfaction degree,so it is worthy of clinical application.

Objective To establish a HPLC method for simultaneous determination of seven active components in Fufang Danshen tablets and Fufang Danshen dripping pills. Methods These seven compounds were analyzed simultaneously with a Zorbax C18 column by gradient elution using acetonitrile-0. 1% phosphoric acid solution as mobile phase, the flow rate was 1 mL·min-1 and the detection wavelength was set at 203, 270 and 281 nm, respectively. Results All the seven components showed good linear relation between peak area and concentration of the test, and the average recoveries were between 95. 1%-100. 4%. Tanshinone ⅡA was not detected in samples of dropping pills. Conclusion The HPLC method to determine the components including tanshinone ⅡA, salvianolic acid B, propanoid acid, protocatechuic aldehyde, notoginsenoside R1 , ginsenoside Rg1 and ginsenoside Rb1 of the two different Danshen preparations has been established, and it has the advantages of simplicity, high precision, good repeatability, and can be used for the quality control of two kinds of Fufang Danshen preparations. The content of tanshinone Ⅱ A in Fufang Danshen tablet was distinctly higher than that of dropping pills.