Studies have suggested that the nucleus accumbens (NAc) is implicated in the pathophysiology of major depression; however, the regulatory strategy that targets the NAc to achieve an exclusive and outstanding anti-depression benefit has not been elucidated. Here, we identified a specific reduction of cyclic adenosine monophosphate (cAMP) in the subset of dopamine D1 receptor medium spiny neurons (D1-MSNs) in the NAc that promoted stress susceptibility, while the stimulation of cAMP production in NAc D1-MSNs efficiently rescued depression-like behaviors. Ketamine treatment enhanced cAMP both in D1-MSNs and dopamine D2 receptor medium spiny neurons (D2-MSNs) of depressed mice, however, the rapid antidepressant effect of ketamine solely depended on elevating cAMP in NAc D1-MSNs. We discovered that a higher dose of crocin markedly increased cAMP in the NAc and consistently relieved depression 24 h after oral administration, but not a lower dose. The fast onset property of crocin was verified through multicenter studies. Moreover, crocin specifically targeted at D1-MSN cAMP signaling in the NAc to relieve depression and had no effect on D2-MSN. These findings characterize a new strategy to achieve an exclusive and outstanding anti-depression benefit by elevating cAMP in D1-MSNs in the NAc, and provide a potential rapid antidepressant drug candidate, crocin.

Objective·To analyze the diversity and composition of the maternal gut microbiota and vaginal microbiota in late pregnancy,neonatal meconium microbiota and vernix caseosa microbiota,and analyze the similarities,differences and correlations.Methods·This is a prospective study.Maternal stool samples and vaginal swabs in late-pregnancy,and neonatal meconium samples were collected from 11 mother-infant pairs at Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from August to November 2018;the vernix caseosa from three sites(forehead,axilla,and inguinal crease)and meconium samples were collected from 14 healthy newborns at International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine in December 2018.All births were vaginal deliveries.The 16S rRNA gene V3?V4 region sequencing was used.The diversity,composition and similarities/differences of the maternal gut microbiota,the vaginal microbiota,and the neonatal meconium microbiota from the 11 mother-infant pairs,as well as the neonatal vernix caseosa microbiota and the meconium microbiota from the 14 newborns were analyzed.Results·The number of operational taxonomic units(OTUs),ACE index,Chao1 index,and Shannon index of maternal gut microbiota were all higher than those of vaginal microbiota;the ACE indices and the Chao1 indices of the vernix caseosa microbiota at three sites were all higher than those of meconium microbiota(P<0.01).The β diversity varied among the maternal gut microbiota,vaginal microbiota,and neonatal meconium microbiota(P<0.01).The β diversity of neonatal vernix caseosa microbiota from three sites(forehead,axilla,and inguinal crease)was similar,but different from meconium microbiota(P<0.01).At the phylum level,the dominant bacteria were Firmicutes(52.76%)and Bacteroidetes(41.67%)in the maternal gut microbiota,Firmicutes(74.36%)and Actinobacteria(21.25%)in the maternal vaginal microbiota,and Firmicutes(84.22%)and Proteobacteria(8.80%)in the neonatal vernix caseosa microbiota.The dominant bacterium in the neonatal meconium was Proteobacteria in the two batches of samples(81.11%and 88.72%,respectively).At the genus level,the dominant bacteria were Bacteroides(35.42%)and Faecalibacterium(10.12%)in the maternal gut microbiota,Lactobacillus(69.10%)and Bifidobacterium(11.30%)in the vaginal microbiota,and Lactobacillus(79.81%)and Pseudomonas(3.23%)in the vernix caseosa microbiota.The dominant bacterium in the neonatal meconium was Escherichia in the two batches of samples(55.21%and 31.18%,respectively).Conclusion·The α diversity of maternal gut microbiota is higher than that of vaginal microbiota and neonatal meconium microbiota,and it is higher in neonatal vernix caseosa than that in meconium microbiota.The Firmicutes is the predominant phylum in the maternal late-pregnancy gut microbiota,vaginal microbiota,and neonatal vernix microbiota.Lactobacillus is the predominant genus in both maternal vaginal and neonatal vernix caseosa microbiota.Proteobacteria in phylum and Escherichia in genus are predominant in meconium microbiota.The microbiota composition is similar in vernix caseosa at different body sites,but there are differences between the vernix caseosa microbiota and meconium microbiota.

Objective:To evaluate the effect of electroacupuncture preconditioning on emergence agitation in the patients undergoing total laparoscopic hysterectomy.Methods:This was a randomized controlled trial. Ninety American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, aged 40-60 yr, with a body mass index of 50-70 kg, scheduled for elective total laparoscopic hysterectomy, were divided into control group (C group) and electroacupuncture preconditioning group (E group) using a random number table method, with 45 patients in each group. At 30 min before anesthesia induction, Zusanli and Neiguan acupoints were stimulated for 30 min with disperse-dense waves at a frequency of 2 Hz/100 Hz, an intensity of 3 mA, in group E. Group C did not receive electroacupuncture treatment. The occurrence of emergence agitation, usage of vasoactive drugs and rescue analgesia were recorded in two groups. Peripheral venous blood samples from the upper extremity were obtained before electroacupuncture stimulation (T 0) and at 2 h after operation (T 1) for determination of the plasma concentrations of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay. Results:The plasma CRP and TNF-α concentrations in group C and plasma IL-10 concentrations in group E were significantly higher at T 1 than at T 0 ( P<0.05). Compared with group C, the usage rate of vasoactive drugs, rate of rescue analgesia, and incidence of emergence agitation were significantly decreased, and the plasma concentrations of CRP and TNF-α were decreased and the plasma IL-10 concentrations were increased at T 1 in group E ( P<0.05). Conclusions:Electroacupuncture preconditioning can decrease the occurrence of emergence agitation in the patients undergoing total laparoscopic hysterectomy, which may be related to inhibiting inflammatory responses.

Objective:To evaluate the effect of electroacupuncture preconditioning on cellular immune function in the patients undergoing thyroid surgery.Methods:Sixty-six patients of either sex, aged 30-55 yr, with body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification ⅠorⅡ, were selected and divided into electroacupuncture preconditioning group (group D) and control group (group C) by a random number table method, with 33 cases in each group. Patients in both groups received combined intravenous-inhalational anesthesia. Before anesthesia induction, both Hegu and Neiguan acupoints were stimulated for 30 min using a continuous wave at a frequency of 2/100 Hz, and the stimulation intensity was subjected to patient tolerance in group D. Group C received sham electroacupuncture for 30 min without stimulation. Venous blood samples were collected at 30 min before anesthesia induction (T 0) and 12, 24 and 48 h after anesthesia (T 1-3). The percentages of T lymphocyte subsets (CD3 +, CD4 +, CD8 +, CD4 + /CD8 + ) and natural killer cells and concentrations of interleukin-6 and tumor necrosis factor-alpha in the serum were measured by flow cytometry. Results:Compared with group C, the percentage of CD3 +, CD4 + and natural killer cells and ratio of CD4 + /CD8 + were significantly increased at T 1, 2, and the concentrations of interleukin-6 and tumor necrosis factor-alpha in the serum were decreased at T 1-3 in group D ( P<0.05). Conclusions:Electroacupuncture preconditioning can improve cellular immune function in the patients undergoing thyroid surgery.

Objective:To estimate the incidence and risk factors of acute kidney injury (AKI) in preterm infants, and provide basis for better evaluation and treatment of renal function in preterm infants.Methods:All the hospitalized premature infants who were admitted to three research centers (Department of Neonatology at Beijing Children′s Hospital; Department of Neonatology at Beijing Obstetrics and Gynecology Hospital; Department of Neonatology at Shunyi Maternal and Children′s Hospital of Beijing Children′s Hospital)from January 1, 2017 to June 30, 2019 and had more than two serum creatinine values or urine output were included.The incidence of AKI in preterm infants was calculated and the difference among different gestational weeks was compared.Preterm infants were divided into AKI and non-AKI groups according to AKI diagnostic criteria, and the clinical characteristics between two groups were compared, and the risk factors of AKI in preterm infants were analyzed.Results:A total of 763 premature infants were included in the analysis.Twenty two cases were diagnosed with AKI.The incidence of AKI in premature infants was 2.9%.The incidence of AKI was 33.3% (3/9), 3.7% (5/134), and 2.3% (14/620) in the 24-27 + 6 weeks, 28-31 + 6 weeks, and 32-36 + 6 weeks gestational age, respectively, and the difference was statistically significant ( χ2=31.010, P<0.001). Preterm infants in AKI group had a higher proportion of males(77.3% vs. 53.3%), lower gestational weeks[29(27, 33) weeks vs.31(29, 33)weeks], higher proportions of infants with diabetic mothers(40.9% vs.19.4%), lower Apgar scores at 1 and 5 minutes[8(7, 10) vs.9(8, 10), 9(9, 10) vs.10(9, 10), respectively], higher proportions of invasive and noninvasive respiratory support(45.5% vs.11.3%, 63.6% vs.19.2%, respectively), longer duration of invasive respiratory support[260(136, 742)h vs.72(18, 160)h], longer hospital stays[66(19, 88)d vs.42(26, 58)d], and higher rates of sepsis (27.3% vs. 6.5%), respiratory distress syndrome(40.9% vs. 11.6%), and patent ductus arteriosus that requiring ibuprofen or surgical closure(13.6% vs. 3.0%), diuretic(27.3% vs. 3.9%), and vasoactive drug use (22.7% vs. 3.6%) than those in non-AKI group, and the differences were statistically significant(all P<0.05). Multivariate regression analysis showed that sepsis was an independent risk factor for AKI in preterm infants ( P=0.039, OR=3.498, 95% CI 1.065-11.490) after adjustment of gestational age and birth weight. Conclusion:The incidence of AKI is relatively high in preterm infants with gestational age<28 weeks.Compared with preterm infants without AKI, preterm infants with AKI have smaller gestational weeks and longer hospital stay.Sepsis is an independent risk factor for AKI in preterm infants.

Objective:To evaluate the effect of electroacupuncture preconditioning on the immune function of elderly patients after radical resection for gastric cancer.Methods:A total of 70 patients, aged 65 to 75 yr, with body mass index of 18-25 kg/m 2, scheduled for elective radical resection for gastric cancer, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, were divided into 2 groups ( n=35 each) by a random number table method: electroacupuncture pretreatment group (group EP) and control group (group C). Combined intravenous-inhalational anesthesia was used in both groups.In group EP, electroacupuncture (continuous wave, frequency 2/100Hz, current 1 mA) of the internal anesthesia point and Zusanli acupoint was performed for 30 min before induction of anesthesia.In group C, electroacupuncture was not performed, and patient-controlled intravenous analgesia was used after operation.Before electroacupuncture and at 2, 12, 24 and 48 h after operation (T 0-4), the rating of safety and efficacy was assessed, and central venous blood samples were collected, and the percentages of CD3 + , CD4 + and CD8 + T cells were measured by flow cytometry, and the CD4 + /CD8 + ratio was calculated. Results:There was no significant difference in the rating of safety and efficacy between the two groups ( P>0.05). Compared with the baseline at T 0, the percentages of serum CD3 + and CD4 + T cells and CD4 + /CD8 + ratio at T 1-4 and percentage of CD8 + T cells at T 3 were significantly decreased in group C ( P<0.05). Compared with group C, the percentages of serum CD 3+ and CD4 + T cells and CD4 + /CD8 + ratio at T 1-4 and percentage of CD8 + T cells at T 3 were significantly increased in group EP ( P<0.05). Conclusion:Electroacupuncture of internal anesthesia points and Zusanli acupoint preconditioning can improve the immune function of elderly patients after radical resection for gastric cancer.

Objective To develop an effective decision tree management model for smart triage of nervous system diseases based on artificial neural networks and Bayesian decision theory. Methods Bayesian decision theory was used as the theoretical basis, and convolutional neural network was used to complete the rapid specialist / sub-specialist machine learning. For the specialist or sub-specialist triage data, circular neural network and Bayesian algorithm were performed to complete the probability distribution and convergence of disease symptoms and diagnosis. Results The decision tree management model and theoretical demonstration were established. According to the characteristics of the transfer learning, the rapid learning of nervous system diseases and accurate triage system, and the remote smart triage system were successfully constructed. Conclusions The management model could provide theoretical references for further use, and alleviate to some extent the currently high rate of outpatient appointment withdrawal and changes.

BACKGROUNDThe aim of this research was to analyze the perioperative factors of regular hepatectomy and irregular hepatectomy. The superiority of the clinical application of the two methods was compared in the perioperative period.

METHODSFrom 1986 to 2011, 1798 patients underwent consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of People's Liberation Army and the General Hospital of Chinese People's Liberation Army. Their medical documentation was investigated retrospectively.

RESULTSIn patients on whom regular hepatectomy and irregular hepatectomy were performed, there was no significant difference in perioperative blood loss, complications, in-hospital mortality, hospital stay, and so on. But in regular hepatectomy, operating time was an independent risk factor (P < 0.001, OR = 1.004).

CONCLUSIONSThere was no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

Objective To explore the clinical method and effect of ultrasonic osteotomy in mandibular angle reduction.Methods Under intronasal approach and general anesthesia,30 patients (5 male patients and 25 female patients) underwent intraoral prominent mandibular angle reductions with ultrasonic osteotomy.The jaw bone under periosteum was explored and the mental nerves protected.According to the clinical features of mandibular angle,curved mandibular angle osteotomy,mandible margin osteotomy or outer cotex splitting osteotomy were performed.Results All the osteotomy of prominent mandibular angle reductions could be completed with ultrasonic osteotomy.There were no complications of bleeding,nerve injury and malfracture happened.After 1 year following-up,the outlines of lower mandible were natural and concordant.Compared with traditional osteotomy devices,ultrasonic osteotomy was smoother and more precisely.Conclusions Ultrasonic osteotomy can improve the precise and safty of mandibular angle reduction.but compared with traditional osteotomy devices,it takes more time for osteotomy procedure.Surgeons need adapt to the different feeling and control methods.

ObjectiveTo explore the changes in gene expression in tissues of patients with gastric carcinoma by cDNA microarray.MethodsA 44,000 gene cDNA microarray (Affymetfix) was used to examine gene expression in the tissues of patients with gastric carcinoma.The Sirt1 genes were identified and subjected to realtime PCR analysis.Results The expression of Sirt1 in tissues of gastric carcinoma [(0.318 ±0.032) ～ (0.169 ±0.013 ) time] was extremely lower than in tissues of para- gastric carcinoma ( 1 time).The results of Real-time PCR were consistent with those of genechip analysis.ConclusionsThe expression of Sirt1 was obviously different between tissues of gastric carcinoma and para - gastric carcinoma.Sirt1 may be associated with carcinogenesis of HCC.