Venous and arterial thrombosis are closely related to many severe diseases, especially to cardiovascular and cerebrovasular disorders. Thrombolytic therapy has been proven to be an effective method to treat such disea...Venous and arterial thrombosis are closely related to many severe diseases, especially to cardiovascular and cerebrovasular disorders. Thrombolytic therapy has been proven to be an effective method to treat such disease, which decreased the mortality and morbidity greatly.展开更多
A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography re...A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava (lVC). Thrombolytic therapy with systemic streptokinase (250 000 IU loading + 100 000 IU/h infusion) was started. At the end of 72 h infusion, the patient's general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the lVC. Percutanous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.展开更多
Objectives To analyze the changes of vasoactive substances originated from endo- theiium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mech- anisms of the drug to t...Objectives To analyze the changes of vasoactive substances originated from endo- theiium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mech- anisms of the drug to treat unstable angina pectoris. Methods 120 patients with unstable angina pectoris who were not well responsed to common medication were studied. Their ECG stress tests were abnormal and there were ischemic changes in Holter. Urokinase 300,000 U was added in 100 ml normal saline and in- jected within 30 min once a day for 3 days. 300 mg as- pirin was administrated a day before and during uroki- nase applications. Before and after urokinase treat- ments , endothelin-1 , plasma tissue plasminogen activa- tor and its inhibitor-lwere determined. Results Compared with pretreatments, after treatments, the ac- tivities of tissue plasminogen activator increased, endo- thelin-1 and the inhibitor-1 decreased. The changes were significant. Conclusions Modified thrombolytic therapy can regulate the vasoactive substances origina- ted endotheiium in patients with unstable angina pecto- ris . The major substances include endothelin-1, plasma tissue plasminogen activator and inhibitor-1. This mechanism may suggest that urokinase can treat coro- nary heart disease effectively.展开更多
BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommende...BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.展开更多
目的探讨脑梗死患者静脉溶栓疗程中视椎蛋白样蛋白1(visinin like protein-1,VILIP-1)、膜联蛋白A2(Annexin A2)、可溶性血管内皮蛋白C受体(solubleendothelium protein c receptor,sEPCR)动态变化及与病情转归相关性,为临床预测、改善...目的探讨脑梗死患者静脉溶栓疗程中视椎蛋白样蛋白1(visinin like protein-1,VILIP-1)、膜联蛋白A2(Annexin A2)、可溶性血管内皮蛋白C受体(solubleendothelium protein c receptor,sEPCR)动态变化及与病情转归相关性,为临床预测、改善患者预后提供参考。方法选取急性脑梗死患者105例进行前瞻性研究,均接受静脉溶栓治疗。以门诊方式随访28 d,根据患者病情转归情况分为良好组、不良组,检测2组溶栓前、溶栓后1 d、3 d的VILIP-1、Annexin A2、sEPCR水平,分析其与mRS评分的相关性,随机森林算法筛选特征变量,并分析病情转归的影响因素,分析不同时间点VILIP-1、Annexin A2、sEPCR及联合预测病情转归价值。结果不良组美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、D-二聚体、纤维蛋白原、三酰甘油高于良好组(P<0.05)。2组VILIP-1、sEPCR水平随着溶栓时间的延长而减低,Annexin A2随着溶栓时间的延长而升高(P<0.05);不良组VILIP-1、sEPCR和Annexin A2波动高于良好组(P<0.05)。溶栓后1 d、溶栓后3 d的VILIP-1、sEPCR与mRS评分呈正相关,Annexin A2与mRS评分呈负相关(P<0.05)。选取决策树数量ntree为390颗,得到最优结果,重要性排序前4的变量分别是sEPCR、Annexin A2、NIHSS评分、VILIP-1,均与mRS评分相关(P<0.05);溶栓后3 d三者联合的AUC最大,其预测敏感度为78.79%,特异度为95.83%。结论血清VILIP-1、Annexin A2、sEPCR异常表达与脑梗死患者脑损伤程度、溶栓预后有关,溶栓后3 d联合检测的预后价值较高,可作为脑梗死患者预后预测的重要标志物。展开更多
文摘Venous and arterial thrombosis are closely related to many severe diseases, especially to cardiovascular and cerebrovasular disorders. Thrombolytic therapy has been proven to be an effective method to treat such disease, which decreased the mortality and morbidity greatly.
文摘A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava (lVC). Thrombolytic therapy with systemic streptokinase (250 000 IU loading + 100 000 IU/h infusion) was started. At the end of 72 h infusion, the patient's general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the lVC. Percutanous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.
文摘Objectives To analyze the changes of vasoactive substances originated from endo- theiium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mech- anisms of the drug to treat unstable angina pectoris. Methods 120 patients with unstable angina pectoris who were not well responsed to common medication were studied. Their ECG stress tests were abnormal and there were ischemic changes in Holter. Urokinase 300,000 U was added in 100 ml normal saline and in- jected within 30 min once a day for 3 days. 300 mg as- pirin was administrated a day before and during uroki- nase applications. Before and after urokinase treat- ments , endothelin-1 , plasma tissue plasminogen activa- tor and its inhibitor-lwere determined. Results Compared with pretreatments, after treatments, the ac- tivities of tissue plasminogen activator increased, endo- thelin-1 and the inhibitor-1 decreased. The changes were significant. Conclusions Modified thrombolytic therapy can regulate the vasoactive substances origina- ted endotheiium in patients with unstable angina pecto- ris . The major substances include endothelin-1, plasma tissue plasminogen activator and inhibitor-1. This mechanism may suggest that urokinase can treat coro- nary heart disease effectively.
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
