Objective To investigate the efficacy and safety of tranexamic acid in patients with the age>70 years during off-pump coronary artery bypass grafting (OPCABG). Methods From June 2014 to August 2016, 340 patients undergoing elective OPCABG were included in this study. All the patients were more than 70 years old, among whom 282 were males and 58 were females. According to the random number generation method, the patients were randomly assigned to receive either tranexamic acid (30 mg/kg, infusion time was longer than 30 min after anesthesia induction; n=170) or a placebo (infusion equivalent volume of saline solution; n=170). The primary end point was chest tube drainage 6 h and 24 h postoperatively. The secondary end points were blood transfusion volumes, incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay. Results Compared with patients in the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at postoperative 6 h (275.6±105.1 ml vs. 459.6±110.2 ml, P<0.001) and 24 h (685.3±202.5 ml vs. 915.9±223.6 ml, P<0.001). There was also a significant reduction in allogeneic red blood cell transfusion (0.80±0.66 U vs. 1.60±1.30 U, P<0.001) and fresh frozen plasma transfusion (166±25 ml vs. 257±30 ml, P<0.001). There were no significant differences in incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay between the two groups. Conclusion Tranexamic acid can significantly reduce blood loss and transfusion in elderly patients 6 h and 24 h after OPCABG and the incidence of thrombotic events will not increase.
Small cell lung cancer is a pathological type with higher malignancy in lung cancer, and has biological characteristics different from non-small cell lung cancer, such as rapid growth, high malignancy and poor prognosis. Mediastinal lymph node and distant metastasis occur frequently. In recent years, the treatment of limited-stage small cell lung cancer has been stagnant, and various treatments are poor. The operation is mainly suitable for patients with small cell lung cancer (T1-2N0M0). Small cell lung cancer has strong sensitivity to chemotherapy, but the clinical application of neoadjuvant chemotherapy in T1-2N0M0 small cell lung cancer remains controversial. This article reviewed the value of neoadjuvant chemotherapy in the treatment of T1-2N0M0 small cell lung cancer.
ObjectiveTo evaluate the safety and myocardial protective results of single high-dose Atorvastatin loading before off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 140 patients undergoing selective OPCAB in Jiangsu Province Hospital between February 2010 and August 2011 were recruited in this study. All the patients were randomly divided into a control group and an Atorvastatin loading group (single oral atorvastatin 80 mg)with 70 patients in each group. Biomarkers of cardiac injury including Troponin T (TnT), creatine kinase-MB (CK-MB)and myoglobin (Mb)were measured on admission, 6, 12, 24, 48, 72, 96 and 120 hours after OPCAB. Liver function (alanine aminotransferase (ALT), aspartate aminotransferase (AST)and total bilirubin (TBIL)), serum lipids (total cholesterol (TC), trigl-yceride (TG)and low-density lipoprotein cholesterol (LDL-C))and high-sensitivity C-reactive protein (hsCRP)were measured 2 days before OPCAB, 1, 4 and 7 days after OPCAB as well as before discharge. ResultsAll the patients successfully received OPCAB and were discharged. There was no statistical difference in preoperative clinical characteristics or above indexes between the 2 groups (P > 0.05). There was no statistical difference in ALT or AST between the 2 groups. Incidences of ALT (4.29% vs. 5.71%, P=1.000)and AST (4.29% vs. 0%, P=0.245)greater than 3 times above the upper normal limit were not statistically different between the 2 groups. Peak levels of postoperative TnT (0.23±0.27 ng/ml vs. 0.16±0.24 ng/ml, P=0.011), CK-MB (29.57±30.04 U/L vs. 17.73±14.07 U/L, P=0.001)and hsCRP (31.85±22.89 mg/L vs. 20.81±10.96 mg/L, P=0.001)of the control group were significantly higher than those of Atorvastatin loading group. Incidences of TnT greater than the upper normal limit (47.1% vs. 65.7%, P=0.041)and TnT greater than 5 times above the upper normal limit (8.6% vs. 22.9%, P=0.037)of Atorvastatin loading group were significantly lower than those of the control group. Incidence of CK-MB greater than the upper normal limit of Atorvastatin loading group was significantly lower than that of the control group (20.0% vs. 54.3%, P=0.000). ConclusionSingle high-dose Atorvastatin loading before OPCAB is safe and can alleviate postoperative myocardial injury.
Objective To investigate the significance of neoadjuvant chemotherapy in the treatment of limited-disease small cell lung cancer (LD-SCLC). Methods We retrospectively analyzed the clinical data of 55 LD-SCLC patients who underwent surgery in the Department of Thoracic Surgery, China-Japan Friendship Hospital from May 2007 to August 2016. There were 42 males and 13 females with a mean age of 57 years. All patients underwent clinical staging before treatment. According to the different treatments, the patients were divided into two groups, a preoperative neoadjuvant chemotherapy group and a direct surgery group. The comparison of long-term survival rates was made between the two groups. Results Among the 55 patients, median survival time was 27 months. The 1-, 3-, 5-year survival rate was 89.1%, 45.0%, 33.8% respectively. Treatment methods and clinical N stage were significantly different in prognosis (P<0. 05). The results of Cox proportional hazards regression model showed that clinical N stage was prognostic factor of LD-SCLC patients (P<0. 05). Conclusion Patients with clinical stage Ⅰ and Ⅱ SCLC are better to receive direct surgery. For patients with clinical stage Ⅲ, it is recommended to reach partial response or complete response with neoadjuvant chemotherapy before surgery. The status of lymph node metastasis is closely related to survival, thus identifying the accurate clinical stage is crucial before treatment.