The latest research findings on bidirectional regulation of neuro-immunity through traditional neural circuits shed new light on the theoretical basis of the role of vidian neurectomy (VN). This article aims to provide a comprehensive understanding of VN, including the history of VN, the principle of neuroimmuno-interaction, the applied anatomy of VN as well as the methods of transnasal endoscopic surgery. Additionally, we introduce the concept of the nose-brain axis, which was proposed based on the advancement in the area of neuro-immune interactions.

Purpose: This study aims to comprehensively evaluate the clinical efficacy of chemotherapy or endocrine therapy maintenance in metastatic breast cancer (MBC) patients. Materials and Methods: The meta-analysis of randomized clinical trials (RCTs) and propensity score matching of multicenter cohort study evaluated MBC patients who underwent first-line chemotherapy or endocrine therapy maintenance. This study is registered with PROSPERO: CRD42017071858 and ClinicalTrials.gov: NCT04258163. Results: A total of 2,867 patients from 15 RCTs and 760 patients from multicenter cohort were included. The results from meta-analysis showed that chemotherapy maintenance improved progression-free survival (PFS) (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.54 to 0.73; p < 0.001; moderate-quality evidence) and overall survival (OS) (HR, 0.87; 95% CI 0.78 to 0.97; p=0.016; high-quality evidence) than observation. In the cohort study, for hormone receptor–positive MBC patients, chemotherapy maintenance improved PFS (HR, 0.67; 95% CI, 0.52 to 0.85; p < 0.001) and OS (HR, 0.55; 95% CI 0.42 to 0.73; p < 0.001) compared with observation, and endocrine therapy maintenance also improved PFS (HR, 0.65; 95% CI, 0.53 to 0.80; p < 0.001) and OS (HR, 0.55; 95% CI, 0.44 to 0.69; p < 0.001). There were no differences between chemotherapy and endocrine therapy maintenance in PFS and OS (all p > 0.05). Regardless of the continuum or switch maintenance therapy, showed prolonged survival in MBC patients who were response to first-line treatment. Conclusion This study provided evidences for survival benefits of chemotherapy and endocrine therapy maintenance in MBC patients, and there was no difference efficacy between chemotherapy and endocrine therapy maintenance for hormone receptor–positive patients.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.

Objective To investigate the prevalence of iron deficiency(ID)and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country. Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results The median serum ferritin level during pregnancy was 20.60 μg/L(11.78-36.98 μg/L), the hemoglobin level was(118±12)g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L(34.48-94.01 μg/L), 28.60 μg/L(16.40-50.52 μg/L), and 16.70 μg/L(10.20-27.00 μg/L)respectively(P<0.01). The mean hemoglobin levels were(127 ± 10)g/L,(119 ± 11)g/L and(117 ± 11)g/L respectively(P<0.01). The prevalence of ID in urban pregnant women was 48.16%(5 973/12 403), and IDA prevalence was 13.87% (1 720/12 403). The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019), 8.40%(293/3 487)and 17.82%(1 407/7 897), respectively(P<0.01). The prevalence of standardized ID and IDA were significantly different in various regions of China(P<0.01). The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%,the differents in various regions were significant(all P<0.01). Conclusion The current phenomenon of ID and IDA in pregnant women is still very common,and nutrition and health care during pregnancy should be strengthened.

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) of N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.The 180 slices were divided into 5 groups (n =36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of mEPSCs of NMDA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P＜0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptic mechanisms in rats.

Objective To observe the early changes of related indexes after high dose of 60Co γ-ray irradiation on rhesus monkey hematopoietic system.Methods A total of 33 rhesus monkeys were randomly divided into normal control and different irradiation control group,rhesus monkeys in irradiation control group were given different doses(4,8,12 Gy) irradiation to establish acute radiation sickness(ARS) models.XE-2100 automatic blood cell analyzer detected the peripheral blood before and after the irradiation of 3,6,9,12,24,48,80 h.The rhesus monkeys were sacrificed to have a observation of sternum pathological changes at 6,48 and 80 h after 4,8,12 Gy 60Co γ-ray irradiation.Results The number of white blood cell in peripheral blood of the rhesus monkeys after 4 and 8 Gy 60Co γ-ray irradiation were lower than that before irradiation at 3 h after irradiation,as was significant increased at 6 h after irradiation,the highest values were 136.04%.and 221.38% after 9 h(with before irradiation values was 100.00%,the same below),become obviously drooped from 12 h after irradiation,show clearly temporary peak.But the number of white blood cell after 12 Gy 60Co γ-ray irradiation was significant increased at 6 h after irradiation,at the highest of 9 h,become obviously drooped from 12 h after irradiation.Peripheral blood neutrophile count was significant increased at 6 h after irradiation,at the highest of 9 h,become obviously drooped from 12 h after irradiation.Peripheral blood lymphocyte count fell sharply after irradiation,3 h detection value was only 12.02%-25.04% of before irradiation.Sternal bone marrow nucleated cell number decreased sharply after irradiation,the more irradiation dose,the less residual hematopoietic cells.Conclusion In the early stage of BM-ARS,temporary peaktime node of the white blood cell and neutrophil count could be regarded as the best delivery time of hematopoietic cytokine therapy.

Objective To investigate the early diagnostic value of EBV-DNA load in Plasma and peripheral blood mononuclear cells (PBMCs) for Children′s Primary Infectious Mononucleosis(IM).Methods The plasma and PBMCs samples were collected from children of 67 cases with primary IM (IM groups) and 75 healthy cases (H groups) during April, 2015 to March, 2016 in our hospital. The EBV-DNA load in PBMCs and plasma samples were quantified by Real-time PCR. Statistical differences between two groups were analyzed by using Mann-Whitney Test. Receiver operating characteristic curves (ROC) were analyzed to assess the early diagnostic value of EBV-DNA load for primary IM.Results Levels of EBV-DNA in the samples of plasma were significantly higher in the IM groups (median, 380 IU/ml) compared to the H groups (Z=-9.332,P<0.01), and levels of EBV-DNA in the PBMCs samples were also significantly higher (median, 2.51×105 IU/ml, Z=-9.194,P<0.01). According to ROC curve analysis, the AUC of EBV-DNA load in plasma was 0.908, the most appropriate cut-off value was 12.5 IU/ml (sensitivity: 83.6% and specificity: 94.7%),the AUC of EBV-DNA load in PBMCs was 0.944, the most appropriate cut-off value was 2.19×104 IU/ml (sensitivity: 89.6% and specificity: 82.7%), the AUC of combined testing(plasma and PBMCs) was 0.967(sensitivity: 98.3% and specificity: 99.0%).Conclusions Combined testing of plasma and PBMCs have better clinical value, it may be useful for the diagnosis of early stage of Children′s Primary Infectious Mononucleosis.

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.A total of 180 slices were selected and divided into 5 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of NMDA receptors-mediated mEPSCs.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜ 0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P ＜ 0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptie mechanisms in rats.

Objective To evaluate the role of PICK1 in remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by AMPA receptors in spinal dorsal horn neurons and in the expression of AMPA receptors in juvenile rats.Methods Thirty-six male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Eighteen rats were randomly selected,their lumbar segments of the spinal cord were immediately removed,and 108 spinal cord slices (400 μm thick,for wholecell patch-clamp recording) aud 108 spinal cord slices (5 μm thick,for immunofluorescence detection) were prepared.The 108 slices with two kinds of thickness were divided into 3 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R) and remifentanil plus PICK inhibitor group (group R+PlCKi).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the fiual concentration of 4 mnol/L in group R.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the final concentration of 4 nmol/L and 50 μmol PICK inhibitor in group R+PICKi.The whole-cell patch-clamp technique was used to record the amplitude and time interval of AMPA receptors-mediated mEPSCs.The method of immunofluorescence was used to detect the expression of AMPA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened,the expression of GluR1 and GluR3 was up-regulated,and the expression of GluR2 was down-regulated in R and R+PICKi groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval was prolonged,the expression of GluR3 was down-regulated,the expression of GluR2 was up-regulated (P＜0.05),and no significant change was found in GluR1 expression in group R+PICKi (P＞0.05).Conclusion PICK1 is involved in the process of remifentanil-induced mEPSCs mediated by AMPA receptors in spinal dorsal horn neurons and of expression of AMPA receptors in juvenile rats,which may be the mechanism underlying remifentanil-induced hyperalgesia.

Objective To investigate the influence of dexmedetomidine on expressions of protein kinase c (PKC)γ, cal?cium/calmodulin-dependent protein kinase (CaMK)Ⅱαand pCaMKⅡαin spinal cord in rats with incisional pain (IP) and remifentanil-induced hyperalgesia. Methods Forty male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, were randomly divided into 5 groups (n=8 each):blank control group (group C), remifentanil+incisional pain group (group R+I), dexmedetomidine + remifentanil + incisional pain group (group D+R+I), dexmedetomidine + remifentanil + incisional pain+phorbol myristate acetate+DMSO group (group D+R+I+P+DMSO) and dexmedetomidine+remifentanil+incisional pain+DMSO group (group D+R+I+DMSO). The incisional pain rat model was established by a plantar incision in left hind paw. Remifentanil was infused at a rate of 1.2μg·kg-1·min-1 for 90 min via the caudal vein. Dexmedetomidine was adminis?tered subcutaneously at a dose of 50μg/kg at 30 min before plantar incision. Phorbol myristate acetate and DMSO were intra?thecally injected at a dose of 10 μL. Paw withdrawal latency (PWL) to thermal stimulation and paw withdrawal threshold (PWT) to von Frey hair stimulation were measured 24 h before remifentanil infusion (T0) and at 2, 6, 24 and 48 h (T1-4) after intraveonus remifentanil injection. The rats were sacrificed after the last behavioral test and the L 4-6 segment of spinal cord was removed to determine the expressions of PKCγ, CaMKⅡαand pCaMKⅡαin spinal cord by Western blot analysis. Re? sults Compared with group C, the value of PWL was significantly shortened and PWT was significantly decreased except T0, and the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere up-regulated in other groups. Compared with group R+I, the value of PWL was significantly prolonged and PWT was significantly increased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere down-regulated in group D+R+I and group D+R+I+DMSO. Compared with group D+R+I, the value of PWL was significantly shortened and PWT was significantly decreased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere up-regulated in group D+R+I+P+DMSO. Compared with group D+R+I+P+DMSO, the value of PWL was significantly prolonged and PWT was significantly increased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere down-regulated in group D+R+I+DMSO. Conclusion Dexmedetomidine can reduce the expressions of PKCγ, CaMKⅡαand pCaMKⅡαin spinal cord in rats with IP and hyperalgesia induced by remifentanil.