Objective To evaluate the accuracy of bispectral index (BIS) for monitoring the depth of sevoflurane anesthesia in children of different ages.Methods One hundred and five children (0-14 yr) undergoing abdominal surgery were divided into 3 age groups (n=35 each): group Ⅰ 4-14 yr (older children); group Ⅱ 1-3 yr (young children) and group Ⅲ < 1 yr (infants). All of the patients were anesthetized with sevoflurane combined with epidural or caudal blockade. Anesthesia was induced with 5 % sevoflurane in O_2. After tracheal intubation, the patients were mechanically ventilated. P_(ET) CO_2 was maintained at 35-45 mm Hg. The end-tidal sevoflurane concentration (C_(ET)Sev) Was maintained at 3.2%, 2.6%, 1.9% and 1.4% in infants < 6 months andat 2.5%, 2.0%, 1.5% and 1.0% in children > 6 months. Each C_(ET)Sev was maintained for at least 15 min. MAP, HR, P_(ET)CO_2 and BIS were monitored and recorded before anesthesia (T_1, baseline), at loss of consciousness (T_2), immediately after tracheal intuhation (T_3), at the 4 C_(ET)Sev (T_(4-7)), recovery of pharyngeal reflex (T_8), extubation (T_9) and emergence of anesthesia (T_10). Results BIS values were significantly higher in children of 1-3 yr (group Ⅱ) than in children of 3-14 yr (group Ⅰ) at T_(4,6,7). BIS values were significantly lower in infants (group Ⅲ) than in children of 3-14 yr (group Ⅰ) at T_(5-9). BIS values were significantly lower in infants (group Ⅲ) than in children of 1-3 yr (groupⅡ) at T_(3-10). There was significant negative correlation between BIS and C_(ET)Sev in all 3groups(γ=-0.768,-0.709,-0.357).Conclusion BIS can accurately reflect the depth of sevoflurane anesthesia in children (> 1 yr). BIS should be interpreted cautiously in infants (< 1 yr).

Objective To investigate the effect of electro-acupuncture on the spinal nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signal pathway in a rat model of neuropathic pain (NP). Methods Forty-eight pathogen-free male SD rats weighing 190-210 g were randomly divided into 3 groups (n = 16 each):group Ⅰ sham operation (group S); group Ⅱ group NP and group Ⅲ electro-acupuncture + NP (group E). NP was induced by chronic constrictive injury (CCI). Right sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 chromic catgut. In group E Huantiao and Weizhong points on the operated side were stimulated with electric stimulator (frequency 2 Hz, wave length 0.6 ms, starting at a voltage of 1mA and increasing by 1 mA every 10 min) for 30 min once a day at 11-17 d after CCI. Pain threshold to mechanical and thermal nociceptive stimuli was measured before (T0 , baseline) and at 10 and 16 d after CCI (T1, T2). The animals were sacrificed at 17 d after CCI and the lumbar segment (L4-6) was removed for determination of the activities of total NO synthase (tNOS), induced and neural NOS (iNOS, nNOS) (by spectrophotometry), NO content (by nitrate reductase method) and cGMP content (by immuno-histochemistry) in the spinal cord in 8 animals and the expression of iNOS and nNOS in the dorsal horn of the spinal cord (by immuno-histochemistry) in another 8 animals in each group. Results CCI significantly decreased the mechanical and thermal pain threshold at T1 and T2 as compared with the baseline at T0 in group NP and E. Hyperalgesia induced by CCI was significantly attenuated by electro-acupuncture at T2 in group E as compared with group NP.CCI significantly increased tNOS and nNOS activities, NO and cGMP content in the spinal cord and up-regulated nNOS expression in the spinal dorsal horn. Electro-acupuncture significantly attenuated the CCI-induced increases in tNOS and nNOS activities, NO and cGMP content in the spinal cord and nNOS expression in the spinal dorsal horn. There was no significant difference in the iNOS activity among the 3 groups. Conclusion NO-cGMP signal pathway in the spinal cord is involved in the acupuncture analgesia.

Objective To study the correlation between radial artery graft patency and the degree of native coronary stenosis in coronary artery bypass grafting. Methods The clinical data of 290 patients who had underwent off-pump coronary artery bypass grafting were retrospectively analyzed. The left internal mammary artery, radial artery and saphenous veins were as grafts. The patients were divided into 3 groups according to the stenosis of right coronary artery before operation:group Ⅰ(right coronary artery stenosis 50%-75%, 85 cases), groupⅡ(right coronary artery stenosis 76%-89%, 95 cases) and group Ⅲ (right coronary artery stenosis 90%-100%, 110 cases). The patients were followed up for 2 to 5 years, and the graft patency was assessed using CT coronary angiography. Results There was no death and serious complications in 3 groups. Among the 3 groups, the total graft patency rate of left internal mammary artery grafts was 93.3% (270/290), the total graft patency rate of saphenous veins grafts was 70.2%(433/617), and the total graft patency rate of radial artery grafts was 69.7%(202/290). There was no statistical difference in the graft patency rate of radial artery grafts between group Ⅱ and group Ⅰ(P>0.05). The graft patency rate of radial artery grafts in group Ⅲwas significantly higher than that in groupⅡand group Ⅰ:85.5%(94/110) vs. 68.4%(65/95) and 50.6%(43/85), and there was statistical difference (P<0.05). The graft patency rate of radial artery grafts was significantly higher than the graft patency rate of saphenous veins grafts in group Ⅲ :85.5%(94/110) vs. 71.5%(168/235), and there was statistical difference (P<0.05). There were no statistical differences in the graft patency rates of left internal mammary artery grafts and saphenous veins grafts among 3 group (P>0.05). Conclusions The correlation between radial artery graft patency and the degree of native coronary stenosis is significant in coronary artery bypass grafting. Patients with severe proximal right coronary artery stenosis (≥90%) may have better patency rates at mid-term follow up after using radial artery grafts.

Objective To study the expression of NF-κB p50 in nodal peripheral T-cell lymphomasunspecified (PTCL-U),and investigated the relationship between NF-κB and PTCL-U's complex biological behavior. Methods 51 patients with nodal PTCL-U were analysed by detecting the expression of NF-κB p50, p170 by immunohistochemistry and correlation between them and PTCL-U' s clinical feature, treatment effectiveness and prognosis were also studied. Results 11 patients(21.6 %, 11/51) and 31patients (60.8 %,31/51) were respectively positive for N F-κB p50 and p 170 expression. Expression of NF-κB were significantly correlated with p170 expression, poor performance status (PS＞2) and non-complete remission in first line treatment(Spearman correlation= 0.459, 0.313, 0.284; P = 0.001, 0.025, 0.044). Overall survival rate of NFκB p50-positive PTCL-U was significantly lower than that of NF-κB p50-negative patients by Log-Rank test (P =0.0451). Multivariate analysis showed poor performance and higher Ki-67 were independent prognostic factor for PTCL-U, while NF-κB p50 was not. Conclusion The expression of NF-κB pS0 was correlated with muhidrug resistance and poor prognosis in nodal PTCL-U.

Objective To evaluate the international prognostic index (IPI) in peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods From May 2005 to May 2008, 75 patients of PTCL--NOS were reviewed. All the patients were diagnosed again by immunohistochemical staining. According to IPI, they were divided into four groups:low risk (0-1), intermediate-low(2), intermediate-high(3), high risk (4-5), then the difference of treatment effectiveness and prognosis among them were analysed. Results IPI scoring of 75 patients were classified as low risk , 10 (13.3%); as intermediate-low, 14 (18.7%); as intermediate-high, 28 (37.3 %); as high risk, 23 (30.7%). There was a significant difference in complete remission rates with first line treatment(X2=16.677,P=0.001), and overall survival rates (P=0.0000) among four groups. Median survival time among 4 groups were 36+, 29.00, 17.00, 10.00 months. 1-year OS were 100.00 %, 89.05 %, 64.24 %, 15.73 %; 2-year OS were: 75.00 %, 53.01%, 34.42 %, 2.00 % respectively. Multivariate analysis showed that both complete remission rates of first line treatment(P=0.002) and IPI(P = 0.049) were independent prognostic factor for PTCL-NOS, while single index of IPI was not. Conclusion At a certain extent, IPI model was able to predict response of treatment effective and prognosis in PTCL-NOS.

Objective To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement. Methods The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 (12 - 40) months. The postoperative effective orifice area (EOA) of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results:measured EOA=referred EOA and measured EOA0.85 cm2/m2 and EOAI<0.85 cm2/m2. The reasons of high transprothetic pressure gradient were analyzed according to the above different standard. Results In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis-patient mismatch (PPM) was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus (3 cases improved after increasing the dosage of warfarin, 2 cases underwent re-aortic valve replacement), 3 cases were because of severe bioprosthetic calcification (underwent re-aortic valve replacement), and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets (underwent re-aortic valve replacement). High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac. Conclusions Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

OBJECTIVETo evaluate safety and immunogenicity of inactivated hepatitis A vaccine in HBsAg carriers and healthy children.

METHODSOne hundred and twenty-one healthy children and ten HBsAg carriers, aged 1-10 years HAV susceptible were enrolled in the study. The inactivated hepatitis A vaccine was produced by Tangshan Biogenetic Company. The dosage of the vaccine was 1000 U/Dosage and 500 U/Dosage. The vaccination schedule was six month apart for two injections. The serum anti-HAV level was detected with EIA at one month after first injection and at one and six month after the booster injection, respectively.

RESULTSThe anti-HAV appeared in all the children. One month after the booster injection, the serum anti-HAV level in children vaccinated 500 U/Dosage was 4684.9 mIU and 4535.6 mIU, respectively and in the children vaccinated 1000 U/Dosage, 5399.8 mIU and 7347.1 mIU, respectively. The anti-HAV level was not statistically different between the two groups of children. There was no adverse reaction after the vaccination. The anti-HAV level was still high one year after first injection.

CONCLUSIONSThe data indicated that the safety and immunogenicity of the domestic inactivated hepatitis A vaccine were excellent in both groups of children.

Child ; Child, Preschool ; Hepatitis A Antibodies ; blood ; Hepatitis A Vaccines ; immunology ; Hepatitis B Surface Antigens ; blood ; Humans ; Immunization ; Infant ; Vaccines, Inactivated ; immunology