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Objectives To analyze the evidence comparing the benefits and risks of continuous versus intermittent milk feeding in low birth weight (LBW) infants. Methods Three electronic databases were searched and screened to identify randomized controlled trials of continuous and intermittent milk feeding of LBW infants up to October 2016. Results Eight trials were included in this meta-analysis. Continuous feeding had no effect on days to full feeds and time to regain birth weight. There were no significant differences in the number of apneas, invasive ventilation, changes in body length, occipitofrontal circumference, skinfold thickness, and total protein, and in the number of stools between the two feeding strategies. Continuous feeding was associated with higher gastric residual volume, noninvasive ventilation, weight gain, increase in bilirubin, and longer nil by mouth. There were no significant differences in adverse events and confounders between the two feeding strategies. Conclusions Continuous milk feeding was superior to intermittent feeding in LBW infants in terms of weight gain. However, continuous feeding was also associated with increased nil by mouth duration, increased bilirubin, increased noninvasive support, and increased gastric residuals. Continuous feeding thus confers advantages in terms of weight gain, but also has disadvantages compared with bolus feeding.

Background: Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED50) and the 95% effective dose (ED95) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone. Methods: Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon’s up-and-down method was used to obtain ED50 data for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the ED50 and ED95 to blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection. Results: Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED50 and ED95 of oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220–0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297–2.563 mg/kg), respectively. In men, the ED50 and ED95 were 0.324 mg/kg (95% CI, 0.274–0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384–2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%). Conclusions: Oxycodone can be used for induction to prevent intubation reactions. Gender affected the ED50 and ED95 of oxycodone for blunting the tracheal intubation reaction. Key words: Adverse Events; Hemodynamics; Induction; Intubation; Oxycodone

Purpose There is currently no standard treatment strategy for patients with advanced metastatic gastric cancer experiencing progression after two or more lines of chemotherapy. We assessed the efficacy and safety of apatinib, a novel vascular endothelial growth factor receptor 2 tyrosine kinase inhibitor, in patients with advanced gastric or gastroesophageal junction adenocarcinoma for whom at least two lines of prior chemotherapy had failed. Patients and Methods This was a randomized, double-blind, placebo-controlled phase III trial. Patients from 32 centers in China with advanced gastric or gastroesophageal junction adenocarcinoma, for whom two or more prior lines of chemotherapy had failed, were enrolled. Patients were randomly assigned to oral apatinib 850 mg or placebo once daily. The primary end points were overall (OS) and progression-free survival (PFS). Results Between January 2011 and November 2012, 267 patients were enrolled. Median OS was significantly improved in the apatinib group compared with the placebo group (6.5 months; 95% CI, 4.8 to 7.6 v 4.7 months; 95% CI, 3.6 to 5.4; P = .0149; hazard ratio, 0.709; 95% CI, 0.537 to 0.937; P = .0156). Similarly, apatinib significantly prolonged median PFS compared with placebo (2.6 months; 95% CI, 2.0 to 2.9 v 1.8 months; 95% CI, 1.4 to 1.9; P < .001; hazard ratio, 0.444; 95% CI, 0.331 to 0.595; P < .001). The most common grade 3 to 4 nonhematologic adverse events were hand-foot syndrome, proteinuria, and hypertension. Conclusion These data show that apatinib treatment significantly improved OS and PFS with an acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy.

Glycogen phosphorylase (GP) acts in the first step in release of glucose from glycogen, a form of energy storage for most organisms. To investigate the characteristics and expression pattern of GP gene (Ofgp) in the Asian corn borer, Ostrinia furnacalis (Guenee), larvae, we cloned and analyzed tissue transcription of Ofgp. The results indicate that the open reading frame (ORF) is 2,526 bp, encoding 841 amino acid. The calculated three-dimensional structure shows 33 α-helices and 24 β-sheets. Ofgp transcription levels varied significantly during the second to fifth instars under long-day (28 °C, 16:8 L:D photoperiod, and 70-80% relative humidity (RH)) and short-day (24.5 °C, 11:13 L:D photoperiod, and 70-80% RH) conditions, remained low during the prediapause phase, and then increased after about 36 d under short-day photoperiod. In the larvae reared under long-day condition, hemolymph ranked the highest in the transcript level of Ofgp. The highest transcription was recorded in the fat body and was lower in the other tissues in larvae reared under short-day condition. We found that Ofgp transcription increased linearly from October 2012 to January 2013. The transcript level was negatively correlated with environmental temperature. We infer the higher Ofgp transcription may enhance the cold hardiness of the diapause larvae.

Objectives This study presented the feasibility of oxycodone as the sole opioid for general anaesthesia in minor/moderate surgery. Methods In this prospective, observational, descriptive study, 62 patients were enrolled and received intravenous oxycodone as the sole opioid for the induction and maintenance of general anaesthesia. We observed all of these patients to determine whether oxycodone alone could provide sufficient intraoperative and postoperative analgesia, as well as to record the extubation times and adverse events. Results A total oxycodone dose of 0.316 ± 0.05 mg/kg was used for induction and maintenance of general anaesthesia. The dose could maintain haemodynamic stability during surgery and good postoperative analgesia. Oxycodone caused deep sedation (nine patients had Ramsey sedation scores ≥4), leading to respiratory depression and long stays in the post-anaesthesia care unit (PACU). The extubation time (16.9 ± 6.4 minutes) increased with increasing oxycodone doses. Conclusion Oxycodone can be used as the sole opioid for general anaesthesia in minor/moderate surgery. However, care should be taken because of its deep sedation effect. Trial registration: This study is registered at the Chinese Clinical Trial Registry ( www.chictr.org.cn ): ChiCTR-opc-16009175

Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures. To this end, anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan. Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews, consider cervical spinal cord movement and compression during airway management, and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations. During induction, anesthesiologists should avoid hypotension and depolarizing muscle relaxants. Mean artery pressure should be maintained within 85–90 mmHg (1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management). Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained. Intraoperative neurophysiological monitoring is a useful option. Anesthesiologists should be attentive to postoperative respiratory insufficiency (carefully considering postoperative extubation), thrombus, and infection. In conclusion, anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.

OBJECTIVES: Several recent lines of evidence indicate that endothelial microparticles are a new biomarker that can be used to monitor endothelial dysfunction in coronary artery disease (CAD). However, data concerning the detection of small microparticles (diameter

Objective: To examine the phenotypes of endothelial microparticles and platelet microparticles in order to identify a sensitive endothelial microparticle biomarker for monitoring endothelial dysfunction in patients with coronary artery disease, and to examine the mechanisms underlying endothelial dysfunction. Methods: Thirty-three coronary artery disease patients and 53 healthy subjects were recruited. The absolute numbers of endothelial microparticles and platelet microparticles were measured by flow cytometry, and the clinical characteristics of patients and healthy subjects were recorded. Spearman’s correlation analysis and multiple linear regression analysis were performed to analyse the correlation between endothelial microparticles and platelet microparticles, and between microparticles and clinical data. Results: There was a significant difference in the number of CD31+/CD42b- endothelial microparticles and CD62E+ endotheial microparticles between patients with coronary artery diease and healthy subjects (p

Purpose: Metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) are complex diseases affected by both dietary intake and genetic background. Whether N-5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, high-sensitivity C-reactive protein (hs-CRP) and dietary components folate and vitamin B12 are associated with MS in Asian has not been determined. Methods: We hypothesized that MTHFR gene C677T, folate, vitamin B12 and hs-CRP are associated with MS and factors related to MS in northern Han Chinese. To test this hypothesis, MTHFR C677T gene polymorphism was determined by PCR-RFLP, serum insulin, folate and vitamin B12 levels by radioimmunoassay, and hs-CRP by immunoturbidimetry in newly diagnosed T2DM patients with MS (118) and without MS (40), and in 55 healthy subjects. Results: Results indicated that MS-associated T2DM accounts for 75% of newly diagnosed T2DM in Han Chinese. Serum hs-CRP was higher and serum vitamin B12 was lower in subjects with TT genotype in comparison with those with CC or CT genotypes. Total T frequency was significantly higher in MS-associated T2DM patients (45.3%) compared to 26.3% in non-MS-associated T2DM patients. MTHFR C677T gene polymorphism and vitamin B12 levels were associated with MS-associated T2DM. Conclusion: MTHFR C677T gene polymorphism may contribute to insulin resistance in Han Chinese with MS by increasing hs-CRP and decreasing vitamin B12, and consequently play an important role in development of MS-associated T2DM.

In a multispectral color imaging system, the spectral reflectance of the object being imaged always needs to be accurately reconstructed by employing the training samples on specific color charts. Considering that the workload is heavy when all those color samples are used in practical applications, it is important to select only a limited number of the most representative samples. This is possible as the color charts are usually designed to cover the range of commonly imaged colors, and the color samples are redundant for spectral image reconstruction. We propose an eigenvector-based method and a virtual-imaging-based method for representative color selection by minimizing the total reflectance root-mean-squares errors. The effectiveness of the proposed methods is confirmed by experimental results when compared with existing techniques.

181 Background: To compare the efficacy of docetaxel plus FOLFOX4 to FOLFOX4 as adjuvant chemotherapy for gastric cancer patients. Methods: 320 patients with stage IB-IV (M0) gastric cancer were enrolled into the retrospective study. All patients received a total or subtotal gastrectomy with at least D1 lymph nodes dissection. 193 patients received FOLFOX4 as adjuvant chemotherapy. 127 patients received biweekly docetaxel plus FOLFOX4 (DOF regimen) as adjuvant chemotherapy. Docetaxel was administered at 40 mg/m2 on day 1, followed by FOLFOX4 regimen. Both of the regimens were repeated every 2 weeks for a maximum of 12 cycles. Results: In comparison with patients in FOLFOX4 group, patients in DOF group were relatively younger (p=.001), with more advanced disease in pN stage (p=.035) and pTNM stage (p=.031), received more cycles of adjuvant chemotherapy (p=.004), and had a higher percentage of adjuvant radiation (p =.002). After adjustment of unbalanced variables as mentioned above, no statistical difference was observed between DOF group and FOLFOX4 group in terms of 3-year disease-free survival (54% vs 69%, p = 0.100, HR 1.362, 95% CI (0.943-1.967)) and 3-year overall survival(70% vs 72%, p = 0.810, HR 1.049, 95% CI (0.711-1.548)). Stratified analysis according to clinicopathologic characters showed that there were almost no statistical differences of 3-year overall survival rates between two groups, except the primary site (middle 1/3) (p =.025) and pTNM stage (IIb stage) (p =.035) in favor of FOLFOX4 group. The incidences of grade 3/4 adverse events were obviously higher in DOF group than in FOLFOX4 group,including decreased appetite (18.1% V 10.4%, P = 0.046), diarrhea (4.7% V 0%, p=0.004 ), hypersensitivity reactions to oxaliplatin (3.1% V 0%, p=0.024) and neutropenia (47.3% V 31.6%, p=0.004). Conclusions: Compared to FOLFOX4 regimen, adjuvant docetaxel plus FOLFOX4 did not show significant survival advantages in gastric cancer patients. However, a more serious toxicity profile was observed in docetaxel plus FOLFOX4 arm. Further studies are needed to decide whether triplet regimen is appropriate as adjuvant chemotherapy of gastric cancer.