[Clinical analysis of 10 patients of chronic subdural hematoma associated with arachnoid cyst].

Objective: To investigate the clinical characteristics, pathogenesis and surgical strategy for the chronic subdural hematoma associated with arachnoid cyst (AC). Method: Ten patients of chronic subdural hematoma associated with AC were retrospectively enrolled from the Neurosurgery Department of Tianjin Medical University General Hospital from January 2012 to September 2015, with a mean age of 27.5±5.6 years (range, 18-37 years). All patients simply performed a burr hole drainage of hematoma and left the AC intact, then followed up for 12 to 18 months after discharge respectively. Results: In this study, the AC in 8 of 10 cases occurs in the middle cranial fossa, and the other 2 cases root in the cerebral hemisphere.The AC of 10 patients all locate near the hematoma cavity.Nine patients had a full recovery, and only one patient had a recurrent subdural hematoma with a secondary operation, then recovery in 3 months postoperation.All patients lived completely free of neurological symptom and showed no recurrence in the follow-up period with a Barthel index more than 90. Conclusion: Simply burr hole drainage of hematoma and leave intact AC achieves satisfied outcome and provides a reliable therapy strategy for chronic subdural hematoma associated with arachnoid cyst.

[Efficacy and prognostic factors of 178 advanced non-small lung cancer patients undergoing different second-line chemotherapeutic regimens].

OBJECTIVE: The purpose of this study is to explore the efficacy and predictors of second-line chemotherpy in advanced non-small cell lung cancer patients and suggest optimal protocols suitable for differently characterized patients. METHODS: The clinical data of 178 advanced NSCLC patients second-line-treated in Tianjin Cancer Hospital from 2009.1.1 to 2013.12.31 were retrospectively analyzed. According to the different second-line treatments, the patients were divided into standard mono-drug therapy group (46 cases), endostar combined with standard mono-drug therapy group (42 cases), and platinum-based doublet chemotherapy group (90 cases). Kaplan-Meier and Log-rank analyses were used to estimate and compare the survival rates in the groups, and Cox's hazard regression model was used to determine the prognostic factors. Chi-square test was used to analyze the differences among different groups. RESULTS: The median progression-free survivals (mPFS) were 50 days, 54 days, and 79 days (P=0.042) for the standard mono-drug therapy group, endostar combined with standard mono-drug therapy group, and platinum-based doublet chemotherapy group, respectively. The differences between the mono-drug therapy group and doublet chemotherapy group were statistically significant (P=0.011). The disease control rate (DCR) for each group was 26.1%, 47.6% and 46.7% (P=0.041), and the DCR were statistically significantly different between the mono-drug therapy group and doublet chemotherapy group (P=0.016), and between the mono-drug therapy group and endostar combined with standard mono-drug therapy group (P=0.041). The overall response rate (ORR) for each group was 2.2%, 0, and 4.4% (P>0.05 for all). Multivariate analysis showed that the period from the begining of first-line to second-line chemotherapy (progression-free time), base-line clinical stage, neuron specific enolase (NSE) before second-line therapy, the cycles of second-line chemotherapy and the response to second-line therapy were independent predictors for PFS (P<0.005 for all). Subgroup analysis indicated that the patients obtained more clinical benefit from doublet chemotherapy rather than mono-drug therapy, with following factors: age<60 years, paclitaxel plus cisplatin for first-line treatment, chemotherapy cycles ≤4, CR, PR and SD for response, progression time within 3-6 months from the begining of first-line to second-line chemotherapy, performance status score≤1 at the begining of second-line therapy, Ⅳ stage, and mild leukopenia (P<0.05 for all). The patients whose progression-free survival time within 3-6 months from the begining of the first-line to second-line chemotherapy got more clinical benefit from endostar combined with standard mono-drug chemotherapy than mono-drug therapy (P=0.006). CONCLUSIONS: The period from the begining of first-line to second-line chemotherapy, base-line TNM stage, NSE before second-line chemotherapy, the cycles of second-line chemotherapy and the response to second-line therapy were independent predictors for PFS. Platinum-based doublet chemotherapy and endostar plus standard second-line regimen can improve the efficacy in some characterized advanced NSCLC as compared with the patients by standard mono-drug therapy, wherein the platinum-based chemotherapy revealed the best efficacy.

[Study on the difference of blood coagulation function in patients with traumatic brain injury in plain and plateau area].

Objective: In this study, we tested platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), and other indicators of coagulation function, and revealed their difference in patients with traumatic brain injury (TBI) between plain and plateau area. Base on the results, we may provide research basis for the therapy of TBI associated coagulopathy in different areas. Methods: 151 TBI patients from Tianjin Medical University General Hospital, and 74 from People's Hospital of Tibet Autonomous Region in the period from Dec 2013 to Dec 2015 were enrolled.Coagulation function, including PC, platelet distribution width (PDW), mean platelet volume (MPV), platelet - large cell ratio (P- LCR), PT, APTT, fibrinogen (FIB), and D- Dimer were tested within 8 h. The difference in patients with TBI between plain and plateau areas were compared and analyzed. Results: Compared with plain area, the PC of patients with TBI in plateau area is lower [(168±49)×109/L vs (196±72)×109/L, P<0.05], while PT and APTT were extended [(13.5±1.3) s vs (12.0±4.0) s, (38±4) s vs(27±6) s, P<0.01]. On the other hand, FIB increases [(3.1±1.2) g/L vs (2.6±1.0) g/L, P<0.01] and D-Dimer decreases [(3.1±3.3) µg/L vs (4.7±3.6) µg/L, P<0.01] in plateau area compared with plain area. Conclusion: Due to the people of plateau area living in hypoxia state, the coagulation function is activated for a long time.Once TBI happens, the platelets and coagulation factors may be excessive consumption, resulting in hypocoagulable state and high risk of rebleeding, while the fibrinolysis system in patients with TBI of plateau area is not activated obviously.Therefore, it should give full consideration to these differences in the treatment of patients with TBI in plateau area, instead of directly copying the standard therapy of the people in plain area.The treatment recommendations should primarily supplement coagulation materials, and antifibrinolytics may unlikely have the therapy effect.

Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection.

BACKGROUND: Postoperative supraventricular arrhythmias (SVA) are common after pulmonary resection and autonomic imbalance is thought to be one of the triggers. Opioids can increase parasympathetic activity and may balance heightened sympathetic tone after operation. We have examined the effect of postoperative patient-controlled analgesia (PCA) with opioids on postoperative SVA. METHODS: Forty-eight patients were randomly assigned to two groups. The GA group received general anaesthesia PCA and PCA with opioids (fentanyl 6 microg ml(-1) and tramadol 3 mg ml(-1)). The GEA group received combined general/epidural anaesthesia plus patient-controlled epidural analgesia (PCEA). Holter recording was completed for 12 h before operation and 12 and 48 h after operation. The incidence of supraventricular tachycardias (SVT), atrial fibrillation, and supraventricular ectopic beats (SVEBs) was evaluated. RESULTS: The incidence of postoperative SVT was significantly lower in the GA group than in the GEA group (3/22 vs 10/22, P=0.021). The incidence of postoperative SVEBs was not statistically different between the groups, but the frequency of postoperative SVEBs increased less in the GA than the GEA group (7/22 vs 15/22, P=0.016). CONCLUSIONS: PCA with opioids (fentanyl and tramadol) can reduce postoperative SVA after pulmonary resection compared with PCEA with ropivacaine.