Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.

Objective To investigate the effects of octacosanol on the behavioral changes and its potential mechanism in 6-hydroxydopamineinduced Parkinsonism rats. Methods 6-hydroxydopamine-induced Parkinsonism rats accepted octacosanol orally in the dosage of 17.5mg/kg (low dose), 35 mg/kg (medium dose) and 70 mg/kg (high dose) for 2 weeks, and then assessed with rotating test and narrow beam test. The apoptosis cells were counted with TUNEL assay, and the expression of nerve growth factor (NGF), precursor of nerve growth factor (proNGF), as well as their receptors were detected with Western blotting. Results The achievement of behavioral tests significantly improved after administration of octacosanol (P<0.05), with the decrease of the apoptotic cells, more expression of NGF and its receptors TrkA, and less expression of caspase-3, proNGF and its receptors p75NTR and sortilin, especially at the dosage of 70 mg/kg (P<0.05). Conclusion Octacosanol may protect the neurol impairment from 6-hydroxydopamine through NGF mediated pathway to decrease the apoptosis.

Objective To assess the local treatment efficacy of percutaneous radiofrequency ablation(PRFA) in combination with percutaneous ethanol injection(PEI) therapy protocol for liver metastases in patients with colorectal cancer.Methods From February 2000 to February 2004, total of 61 liver metastatic lesions(1.5～7.8 cm) from 37 colorectal cancer patients were ablated by using RF-2000 generator and 10-needle LeVeen electrode percutaneously guided by B-ultrasound.Tumors larger than 2.5 cm in diameter were treated by multiple overlapping radiofrequency ablations encompassing the entire lesion as well as a rim of normal liver tissue(approximately 1.0 cm).PEI was performed additionally.The Chiba needle and Quadra-Fuse multi-pronged injection needle were used for tumors ranged 1～2 cm and for those larger than 3 cm respectively.Results The procedures were performed successfully in all patients.The post-PRFA/PEI complication rate was 5.4%.The follow-up rate was 97.3%(36/37).Thirteen patients achieved a complete response(CR),and 21 achieved a partial response(PR).The effective rate(CR+PR) was 94.4%.The patients' survival rates were 97.2% at 1 year,75.0% at 2 years,and 52.8% at 3 years respectively.Conclusion The results of this study suggest that the treatment protocol of PRFA in combination with PEI was an effective mini-invasive local ablation therapy,which was part of the comprehensive management of the colorectal liver metastases.

OBJECTIVETo evaluate the use of free/total prostate-specific antigen ratio (fPSA/tPSA ratio) in improving the early diagnosis of prostate cancer.

METHODSfPSA/tPSA ratio in the serum was analyzed prospectively in 187 men with tPSA ranging between 4.0 and 20.0 microg/L. All of them underwent ultrasound-guided sextant prostatic biopsies. Sensitivity, specificity, positive and negative predictive values were calculated by SPSS 10.0 software.

RESULTSProstate cancer detection rates were 18.1% and 22.5% when tPSA was within the ranges of 4.0-10.0 g/L and 10.0-20.0 g/L respectively. fPSA/tPSA ratio was more significant than tPSA in all the men. When the cut-off value of fPSA/tPSA ratio was set at 0.25, 90.5% and 87.5% of cancers could be detected; and 26.7% and 11.3% of biopsies could be avoided within the tPSA ranges of 4.0-10.0 g/L and 10.0-20.0 g/L, respectively.

CONCLUSIONThe use of fPSA/tPSA ratio can improve prostate cancer detection and reduce unnecessary biopsies when tPSA is within the range of 4.0-10.0 microg/L and 10.0-20.0 microg/L.

Aged ; Aged, 80 and over ; Area Under Curve ; Early Diagnosis ; Humans ; Male ; Mass Screening ; Middle Aged ; Prospective Studies ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; Sensitivity and Specificity

Objective:To evaluate the efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart disease.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ pediatric patients, aged 1-3 yr, undergoing elective cardiac surgery for left-to-right shunt type congenital heart diseases, were divided into dexmedetomidine group (group D, n=25) or dexmedetomidine combined with esketamine group (group DK, n=25) using a random number table method.Dexmedetomidine 3.9 μg/kg was intranasally delivered in group D. Dexmedetomidine 3.3 μg/kg combined with esketamine 2 mg/kg was intranasally administered in group DK.The Children′s Hospital of Wisconsin Sedation Scale score, SpO 2, HR, and pulmonary artery systolic pressure (PAP) were recorded before and at 30 min after administration, and the rate of decrease in SpO 2, HR and PAP after administration was calculated.The onset time of sedation and occurrence of adverse effects such as nausea and vomiting, bradycardia and respiratory depression during sedation were recorded. Results:Inadequate sedation and over-sedation were not observed in either group.Compared with group D, Children′s Hospital of Wisconsin Sedation Scale scores were significantly decreased at 30 min after administration, the onset time of sedation was shortened, and the decrease rate of HR was decreased in group DK ( P<0.05), and there were no significant changes in HR, SpO 2 and PAP before and after administration ( P>0.05). In group DK, nausea and vomiting occurred in 2 cases, but the symptoms were mild and no medication intervention was needed.No other adverse effects such as bradycardia and respiratory depression were found in either group. Conclusion:Combination of intranasal dexmedetomidine and esketamine can optimize the efficacy of preoperative sedation in pediatric patients with congenital heart disease, esketamine may induce nausea and vomiting, and the fasting time should be strictly controlled during sedation.

【Objective】 To explore the relationship between preoperative anemia and perioperative red blood cell (RBC) transfusion and postoperative outcomes in patients undergoing mitral valve surgery. 【Methods】 The clinical data, laboratory findings, blood transfused and outcomes data of 493 patients who underwent mitral valve surgery in Fuwai Hospital in 2017 were collected by blood transfusion management system and retrospectively analyzed by SPSS. The patients were divided into anemia group (n=34, male Hb<120 g/L and female Hb<110 g/L) and non-anemia group (n=459) .The measurement data were statistically analyzed with t test or rank sum test, and enumeration data by Fisher test and Chi-square test, and then all analyzed by binary logistics regression. 【Results】 The incidence of anemia before mitral valve surgery was 6.90% (34/493). Perioperative erythrocyte dosage (U) (median), erythrocyte transfusion rate, ICU stay time (d) (median) and hospital mortality rate(%) in anemia group and non-anemia group were 4.00 vs 0.00 (OR: 2.55, 95% CI: 1.70~3.40, P<0.05), 67.65% vs 21.35% (OR: 12.98, 95% Cl: 5.21~31.15, P<0.05), 2.50 vs 2.00 (B: 0.71, 95% Cl: 0.08~1.33, P<0.05) and 5.88 vs 0.22(P<0.05)respectively. 【Conclusion】 Preoperative anemic is independently associated with perioperative RBC transfusion in patients undergoing mitral valve surgery, and may increase ICU length of stay and hospital mortality.