Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a metaanalysis

OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020,and meta-analysis was performed by STATA software(version 15.1).Using standardized data-collection forms,the authors screened the studies and independently extracted data,and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies.Cohort studies that examined the following results were included in the current study:in-hospital mortality,all-cause bleeding rate,gastrointestinal bleeding rate,intracranial hemorrhage rate,the incidence of shock,and hospital length of stay.RESULTS A total of eight articles,with 13,242 participants,involving 3962 participants in the CDT group and 9280 participants in the ST group were included.CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate[odds ratio(OR)=0.41,95%CI:0.30–0.56,P<0.05],all-cause bleeding rate(OR=1.20,95%CI:1.04–1.39,P=0.012),gastrointestinal bleeding rate(OR=1.43,95%CI:1.13–1.81,P=0.003),the incidence of shock(OR=0.46,95%CI:0.37–0.57,P<0.05),and hospital length of stay[standard mean difference(SMD)=0.16,95%CI:0.07–0.25,P<0.05].However,there was no significant effect on intracranial hemorrhage rate in patients with PE(OR=0.70,95%CI:0.47–1.03,P=0.070).CONCLUSIONS CDT is a viable alternative to ST in the treatment of PE,as it can significantly reduce in-hospital mortality rate,all-cause bleeding rate,gastrointestinal bleeding rate,and incidence of shock.However,CDT may prolong hospital length of stay to a certain extent.Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

Epithelial mesenchymal transition of non-small-cell lung cancer cells A549 induced by SPHK1

Objective:To explore the effect and molecular mechanism of SPHK1 in the invasion and metastasis process of non-small-cell lung cancer cells(A549).Methods:Recombinant retrovirus was used to mediate the production of A549/vector,A549/SPHK1,A549/scramble,and A549/SPHK1/RNAi that stably expressed or silenced SPHK1.The invasion and migration capacities of A549 cells overexpressing or silencing SPHK1 were determined using Transwell invasion assay and scratch wound repair experiment.The protein and mRNA expression levels of E-cadherin,fibronectin,vimentin in A549/vector,A549/SPHK1,A549/scramble,A549/SPHK1/RNAi were detected with Western blot(WB) and quantitative PCR(QPCR) methods,respectively.Results:Transwell invasion assay and scratch wound repair experiments showed that over-expression of SPHK1 obviously enhanced the invasion and migration capacities of A549 cells.WB and QPCR detection results showed that,the expression of E-cadherin(a molecular marker of epithelial cells) and fibronectin,vimentin(molecular markers of mesenchymal cells) in A549 cells was upregulated after overexpression of SPHK1;while SPHK1 silencing significantly reduced the invasion and metastasis capacities of A549 cells,upregulated the expression of molecular marker of epithelial cells,and downregulated the expression of molecular marker of mesenchymal cells.Conclusions:SPHK1 promotes epithelial mesenchymal transition of non-small-cell lung cancer cells and affects the invasion and metastasis capacities of these cells.