As an oral chemotherapy drug, capecitabine is safe, effective and easy to use, has been widely used in the treatment of esophageal cancer, gastric cancer, colorectal cancer, breast cancer, ovarian cancer and other solid tumor.The chemotherapy scheme is mainly for 3 weeks, each cycle of capecitabine for 14 days, and 7 days off.As a modification to conventional chemotherapy, the biweekly scheme with capecitabine showed low toxicity and well tolerated by patients, short hospitalization time and other characteristics, it is worth of application in clinical.

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 evaluate the accuracy of BIS value for monitoring the depth of sevoflurane-nitrous oxide in children. Methods Seventy-two ASA Ⅰ or Ⅱ children aged 1-14 yr undergoing abdominal surgery were randomly assigned into 3 groups ( n = 24 each) :sevoflurane group (group S), sevoflurane + 30% N2O group (group SN1 )and sevoflurane + 60% N2O (group SN2 ). Anesthesia was induced with atropine, lidocaine, propofol, rocuronium and remifentanil. After tracheal intubation, the patients were mechanically ventilated. PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with 2.5% sevoflurane combined with 0, 30% and 60% nitrous oxide in group S, SN1 and SN2 respectively. The end-tidal sevoflurane concentration (CETSev) was maintained at 2.5%, 2.0% and 1.5%. Each CETSev was maintained for at least 10 min after the begining of the surgery. Then the CETSev was modified to maintain BIS value at 40-60. BIS value was recorded before anesthesia induction and each stable CETSev. CETSev was recorded at maintaining BIS value of 40-60 for at least 20 min ( C50 ).Results BIS value and C50 were significantly lower in group SN2 than in group S and SN1 ( P ＜ 0.05), while no significant difference was found between group S and SN1 ( P ＞ 0.05). BIS value was negatively correlated with CETSev in all 3 groups (r = -0.736, -0.817, -0.729, P ＜ 0.01).There was no significant difference in the correlation coefficients among the 3 groups ( P ＞ 0.05 ). Conclusion BIS value can accurately reflect the depth of sevoflurane-nitrous oxide anesthesia in children.

ObjectiveTo approach the value of diagnosis with the 256-slice spiral CT in severe tetralogy of Fallot of infant.MethodsFrom January 2008 to December 2010,48 cases (severe tetralogy of Fallot of infant) were examined with 256-slice spiral CT preoperatively.All cases were then analyzed in workspace with maximum intensity projection(MIP),multiplanar reconstruction(MPR) and volume rendering (VR),while compared with transthoracic echocardiography (TTE) and surgical results.Results CT examination found that TTE misdiagnosis 4 cases of patent ductus arteriosus and 6 cases of aortic coarctation.Meanwhile,CT showed 6 aorta pulmonary collateral arteries in 5 cases.In 48 cases,surgical results confirmed 47 cases by 256-shce spiral CT,while 33 cases by TTE.The diagnosis accuracy rate of 256-slice spiral CT and TTE was 97.9％ (47/48) and 68.8％ (33/48) respectively.There was statistically significant difference of the two inspections in diagnostic accuracy (P ＜ 0.05).ConclusionThe inspection of 256-slice spiral CT can benefit the preoperative diagnosis and operation program in severe tetralogy of Fallot of infant.

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 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 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 compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children.MethodsNinety-two ASA Ⅰ or Ⅱ children (46 cases aged 1-3 yr and 46 cases aged 4-6 yr) scheduled for elective general or urologic surgeries,were enrolled in this study.The children were randomly divided into 2 groups (n =46 each):midazolam group (group M) and dexmedetomidine group (group D).The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 min before induction of anesthesia,and midazolam 0.1 mg/kg òr dexmedetomidine 1 μg/kg was infused intravenously over 10 min.Anesthesia was induced with proporol-rocuroniume-remifentanil,and maintained with sevoflurane-remifentanil-rocuroniume.Modified Yale Preoperative Anxiety Scale (mYPAS) score,sedation score,HR,mean arterial pressure (MAP),respiratory rate (RR) and SpO2 were recorded before premedication (T1),before separation from their parents (T2) and when entering the operating room (T3).The incidence of sleep (a sedation score of 4) was recorded at T2,3.The end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also retorded.ResultsCompared to that at T1,the mYPAS score was significantly decreased at T2,3,and the sedation score was significantly increased at T2,3 in both groups ( P ＜ 0.05),HR at T2 and MAP at T2,3 were significantly decreased in group D,and HR at T3 was significantly increased in group M ( P ＜ 0.05 ).Compared to group M,the sedation scores and the incidence of sleep were significantly increased at T2,3,and the HR was significantly decreased at T2 in group D ( P ＜ 0.05).There was no significant difference in the mYPAS score,RR,MAP,SpO2,end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiting rescue analgesic,and incidence of adverse effects between D and M groups ( P ＞ 0.05).ConclusionThe sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children,but it exerts much influence on hemodynamics,and the changes in hemodynamics should be noted.

Objective To compare the efficacy of closed-loop infusion of propofol for surgery in pe-diatric patients of different ages. Methods Forty-five pediatric patients of both sexes, weighing 10-63 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective urologic sur-gery under general anesthesia, were divided into 3 groups(n=15 each)according to the age: infant group (1-3 yr), pre-school group(4-6 yr)and school-age group(7-12 yr). The bispectral index(BIS)moni-tor was connected to the closed-loop anesthesia delivery system, and the system automatically regulated the target plasma concentration of propofol to achieve a target BIS value of 45-55 during maintenance of anes-thesia. Remifentanil was given by target-controlled infusion at a target plasma concentration and rocuronium was intravenously injected when necessary during surgery. BIS40-60time percentage(percentage of time of BIS value maintaining at 40-60 in time of closed-loop infusion), median performance error(MDPE), me-dian absolute performance error(MDAPE), wobble and global score were recorded. The consumption of propofol, mean target plasma concentration and regulating frequency and consumption of remifentanil and rocuronium were recorded during surgery. Extubation time or laryngeal mask airway removal time, time to eye-opening and time of regaining consciousness were recorded. Results The BIS40-60time percentage was significantly higher, MDPE, MDAPE, wobble and global score were lower in pre-school and school-age groups than in infant group(P<005). Compared with pre-school group, the consumption of remifentanil was significantly decreased(P<005), and no significant change was found in BIS40-60time percentage, MDPE, MDAPE, wobble or global score in school-age group(P>005). There was no significant differ-ence in the consumption of propofol, mean target plasma concentration, regulating frequency, consumption of rocuronium, extubation time or laryngeal mask airway removal time, time to eye-opening or time of regai-ning consciousness among the 3 groups(P>005). Conclusion Closed-loop infusion of propofol produces better stability for surgery in pre-school and school-age children than in infants.