Objective To evaluate the reliability of gas sampling from the distal end of the tracheal tube for partial pressure of end-tidal CO2 (PETCO2) monitoring in neonates.Methods A total of 50 fullterm neonates,scheduled for elective abdominal surgery under general anesthesia,aged 1-28 days,weighing 2.55-4.00 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n =25 each) using a random number table:gas samples collected from proximal end of tracheal tube group (group P) and gas samples collected from distal end of tracheal tube group (group D).Epidural catheters of 1 mm in external diameter were used.One end of the catheter was connected to a tube for carbon dioxide sampling,and the other end was inserted into the endotracheal tube and advanced toward the distal hole of the tube.At 15 min of mechanical ventilation,blood samples were collected from the radial artery for record of PETCO2 and for blood gas analysis.Consistency test was performed between PETCO2 and partial pressure of arterial CO2 (PaCO2).Results PET CO2 was significantly lower than PaCO2 in the two groups.There was no significant difference in PaCO2between the two groups.PETCO2 was significantly higher in group D than in group P.Kappa was significantly higher in group D than in group P.Conclusion Gas sampling from the distal end of the tracheal tube is more reliable than gas sampling from the proximal end in monitoring PETCO2 in the neonates.

BACKGROUNDMedical superstitions remain prevalent in today's stressful and technology driven healthcare environment. These irrational beliefs commonly involve night calls, which are periods of volatile workload. In Singapore and Hong Kong, it is commonly held that consumption of steamed buns ("bao") by on-call physicians is associated with increased patient admissions and mortality, due to a homonymous interpretation of the word "bao" in dialect.

MATERIALS AND METHODSA prospective unblinded randomised controlled trial with a permuted block randomisation design was performed on weekdays over 6 weeks. Steamed buns or control food were offered to the internal medicine night-call team of a tertiary-care hospital on a nightly basis. Information on admissions and mortality was collected from the hospital electronic database. Data on sleep patterns and shift duration were obtained by interview.

RESULTSThere were no significant differences in the median number of hours slept on days on "bao" administration versus "control" intervention (2 +/- median absolute variation of 1.5 h vs 2 +/- 1.5 h, P = 0.30) or in the number of hours spent in the hospital (30.8 +/- 1.9 h vs 30.5 +/- 2.2 h, P = 0.09). There were no significant differences in the median number of general ward admissions per night (n = 73 +/- 6 versus 71 +/- 7 admissions, P = 0.35), monitored care unit admissions (4 +/- 1.5 vs 4 +/- 1.5 admissions, P = 0.65) or inpatient mortality (2 +/- 1.5 vs 2 +/- 1.5 deaths per night, P = 0.47).

CONCLUSIONThe consumption of steamed buns ("bao") has no effect on inpatient admissions, mortality, or sleep duration on call. Regardless, our results indicate that the night call in Singapore remains a challenge in terms of workload and shift duration.

Food ; Hospital Mortality ; Humans ; Medical Staff, Hospital ; Night Care ; Patient Admission ; Superstitions ; Workload

Objective: To investigate the inhibitory effect of AKR1B10 inhibitor combined with sorafenib on hepatocellular carcinoma (HCC) xenograft growth. Methods: HepG2 xenograft model was established in nude mice. The mice were then randomly divided into four groups: control group, epalrestat monotherapy group, sorafenib monotherapy group and combination treatment group. Tumor volume, tumor weight, T/C ratio and the change in body weight of nude mice in each group were compared to evaluate the curative effect. Immunohistochemistry staining was used to detect the expression of Ki-67 in tumor tissues to evaluate the proliferation status of tumor cells. One-way analysis of variance was used to compare the differences between the groups. Student’s t-test was used to test means of two groups and chi-square test was used for multiple samples. Results: The differences of the grafted tumor volume before and after treatment between the control group, epalrestat group, sorafenib group and combined therapy group was 238.940 ± 39.813, 124.991 ± 84.670, -26.111 ± 11.518, and -54.072 ± 17.673(mm³), respectively, (F = 37.048, P < 0.001). The tumor mass were 0.273 ± 0.140, 0.158 ± 0.078, 0.079 ± 0.054, 0.045 ± 0.024 (g), (F = 16.594, P < 0.001); T/C ratio were 100%, 57.9%, 28.9%, 16.5%, and Ki-67 positive rate were 23.295 ± 6.218, 13.503 ± 3.392, 7.325 ± 2.257, 4.664 ± 1.189 (%), (χ² = 822.203, P < 0.001) . The tumor volume (t = -3.579, P = 0.002) and Ki-67 positive rate (t = -10.003, P < 0.001) in epalrestat monotherapy group were significantly lower than control group. The tumor volume (t = 2.056, P = 0.025), tumor mass (t = 2.101, P = 0.043), and Ki-67 positive rate (t = -2.850, P = 0.005) in combination treatment group were significantly lower than sorafenib monotherapy group. Compared with the control group, the body weight of nude mice in the treatment group decreased to a certain extent, but there was no statistically significant difference between epalrestat monotherapy group and control group (t = -1.599, P = 0.262), and combined therapy and sorafenib monotherapy group (t = -0.051, P = 0.96). Conclusion AKR1B10 inhibitor enhanced the inhibitory effect of sorafenib on hepatocellular carcinoma xenograft.