Elevated Plasma Tissue-type Plasminogen Activator (t-PA) and Soluble Throm-bomodulin in Patients Suffering From Severe Acute Respiratory Syndrome (SARS) as a Possible Index for Prognosis and Treatment Strategy

To detect the presence of endothelial injury in patients with severe acute respiratory syndrome （SARS） via enhanced levels of tissue-type plasminogen activator （t-PA） and soluble thrombomodulin （sTM）. Methods Case patients were from Xuanwu Hospital （Capital University of Medical Sciences, Beijing, China）, and all of them met clinical criteria for SARS. Healthy controls were some of the hospital employees. Endothelial injury bio-markers tPA and sTM were detected by commercial ELISA-methods. Results Classic plasma markers of endothelial injury, tPA and sTM significantly elevated in SARS patients in comparison to controls [t-PA： 1.48±0.16 nmol/L versus 0.25±0.03 nmol/L （P〈0.0001）, and sTM： 0.26±0.06 nmol/L versus 0.14±0.02 nmol/L （P〈0.05）]. The only patient who died had extremely high levels of these endothelial injury markers （t-PA： 2.77 nmol/L and sTM： 1.01 nmol/L）. The likelihood ratio analysis indicated the excellent discriminating power for SARS at the optimal cut-point of 0.49 nmol/L for tPA and 0.20 nmol/L for sTM, respectively. Significant numerical correlations were found among these endothelial injury markers in SARS patients. The numerical coefficient of correlation Pearson r between t-PA and sTM was 0.5867 （P〈0.05）. Conclusion Increased plasma concentrations of tPA and sTM in patients with SARS suggest the possibility of endothelial injury. SARS patients might need anticoagulant therapy or fibrinolytic therapy in order to reverse intraalveolar coagulation, microthrombi formation, alveolar and interstitial fibrin deposition. It may not only provide a useful treatment and prognostic index but also allow a further understanding of the pathological condition of the disease.

通心络对短暂性脑缺血发作患者临床疗效及其对血浆t-PA、PAI-1的影响

通心络胶囊以其特殊通络作用,具有降纤抗凝、增强纤溶系统活性作用,还能修复受损血管内皮,改善内皮功能。关于通心络对纤溶系统影响的研究少有报道。本研究观察通心络胶囊治疗短暂性脑缺血发作（trancient ischemic attack,TIA）的临床疗效,并结合其对血浆组织型纤溶酶原激活物（tissue plas-minogen activator,t-PA）、血浆纤溶酶原激活物抑制物-1（plasminogen activator inhibitor-1,

Inhibitory effect of 3'-untranslated region (3'-UTR) of human tissue-plasminogen activator (ht-PA) mRNA on its expression

A series of t-PA cDNA mutants containing different parts of 3’-UTR sequences have beenconstructed.In vitro translation of t-PA transcripts in rabbit reticulocyte lysates and its expression in COS-7cells show that the 3’-UTR sequence has a very strong inhibitory effect on t-PA translation.The deletion of3’-UTR results in 3—8-fold increase of t-PA expression.Further study shows that an AU-rich sequence of some200 nt at 3’ end of 3’-UTR is responsible for the translational inhibition.RNA stability experiment reveals thatthe AU-rich segment leads to a 3-fold decrease of t-PA mRNA stability.The insertion of this segment into the3’-UTR of luciferase gene results in an obvious inhibition of Luc expression.A model is proposed for theregulation of t-PA expression.

EFFECTS OF EXERCISE ON THE FIBRINOLYTIC ACTIVITY INPATIENTS WITH UNSTABLE ANGINA PECTORIS

Objective The purpose of this study was to evaluate the fibrinolytic response to exercise in patients with unstable angina pectoris(UAP) compared with an age - matched control group. Methods We measuredtissure- type plasminogen activator (t- PA) activity and plasminogen activator inhibitor 1(PAI- 1) activitybefore and after treadmill exercise test in 20 healthy subjects and 25 patients with UAP. ResultsResting t - PA activities were similar between two groups, but resting PAI- 1 activity was higher in UAP groupthan in control. Although both groups showed significant increase in t- PA activity with exercise, post - exerciset - PA activity was significantly lower in patients with UAP than in control (0.96± 0.45IU/ml vs 1.89± 0.68I U/ml,P<0.01), Post - exercise PAI- 1 activity was still much higher in UAP group than in control (8.20±2.28A U/ml vs4.21± 0.68A U/ml, P<0.01). Conclusion There existed impaired fibrinolysis in patients with UAP not only at restbut also alter exercise loading.

Analysis of Plasma Fibrinolysis in the Patients with Acute Cerebral Infarction

In the present study, the plasma fibrinolytic activity in 30 cases of cortical artery territory cerebral infarction (CACI) and 32 cases of perforating artery territory cerebral infarction (PACI) within 3 days after ictus, and 30 sexand age-matched controls without cardio-cerebrovascular diseases were evaluated by a comprehensive panel of assay, including the plasma tPA activity, PAI activity, endothelial capacity of tPA release and PAI/tPA ratio. The results showed that the plasma fibrinolysis and the endothelial potential to release tPA responding to stimulation in boch subtypes of the patients were significantly lower than those in the controls, which provide. the theoretical basis for carrying out the thrombolytic therapy in the ischemic stroke. And the study also suggested that increased Plasma PAI activity could increase the risk of AS chrombotic events with increased serum triglyceride level.

Advances in surgical treatment of intraventricular hemorrhage

Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis.The advantages of surgical intervention in patient management are impressive.This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage(EVD)combined with intraventricular fibrinolysis(IVF)and continuous lumbar cistern drainage(LCD),as well as their safety and efficacy,especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.