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Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids:A randomized controlled trial

World Journal of Gastroenterology 2015年第23期21卷 7305-7312页

作者： Francisco Hernández-Bernal Georgina Castellanos-Sierra Carmen M Valenzuela-Silva Karem M Catasús-Alvarez Osmany Martínez-Serrano Odalys C Lazo-Diago Cimara H Bermúdez-Badell José R Causa-García Juan E Domínguez-Suárez Pedro A López-Saura 无 Clinical Research Direction Center for Genetic Engineering and Biotechnology Juan B.Zayas Hospital Ernesto Guevara Hospital Celia Sánchez Hospital Manzanillo Gustavo Aldereguía Hospital THERESA-4(Treatment of HEmorrhoids with REcombinant Streptokinase Application)Group of Investigators

AIM: To compare the efficacy and safety of recombinant streptokinase(rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal ***: A multicenter(11 sites), randomized(1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written,informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h(first 3 units)and afterwards every 12 h until 8 administrations were completed(schedule A), one unit every 8 h until 6 units were completed(schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5,and 10 d post-inclusion. The main end-point was the 5thday response(disappearance of pain and bleeding, and≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also ***: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170(91.8%; 95%CI:87.3-96.2), 155/170(91.2%; 95%CI: 86.6%-95.7%),and 46/170(27.1%; 95%CI: 20.1%-34.0%) with rSK(schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9%differences(95%CI: 56.7%-72.2% and 55.7%-72.0%)were highly significant(P < 0.001). This advantage was detected since the early 3rd day evaluation(68.8% and64.1% vs 7.1% for the rSK and active control groups,respectively; P < 0.001) and was maintained even at the late 10 th day assessment(97.1% and 93.5% vs67.1% for rSK and hydrocortisone acetate, respectively;P < 0.001). Time to response was 3 d(95%CI: 2.9-3.1)for both rSK groups and 10 d(95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant(P < 0.001). All subgroup stratified analyses(with or without thrombosis and he

关键词： Streptokinase Suppository Hydrocortisoneacetate thrombolysis Hemorrhoids Randomizedclinical trial

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Massive Pulmonary Embolism in Recovery Period of General Anesthesia： Rapid Diagnosis and Successful Rescue by the Guidance of Transthoracic Echocardiography

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Chinese Medical Journal 2017年第2期130卷 245-246页

作者： Mao Xu Cheng-Mei Shi Jiao Li Jun Wang Xiang-Yang Guo Department of Anesthesiology Peking University Third Hospital Beijing 100191 China

Massive pulmonary embolism （PE）, an uncommon event in the perioperative period, is a major challenge to anesthesia management. Massive PE is often associated with an unexpected hemodynamic collapse and severe desaturation without other characteristic changes. It is difficult to make a rapid diagnosis during the perioperative period, especially under general anesthesia. We present a rare case of massive PE diagnosed with transthoracic echocardiography （TTE） in the recovery period of general anesthesia.

关键词： Diagnosis Massive Pulmonary Embolism McConnell Sign thrombolysis Transthoracic Echocardiography

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Comparison of Efficacy of Different Treatments for Pulmonary Embolism

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2016年第2期36卷 254-258页

作者：范阳黄鹤熊君杨媚孔彬廖佳芬贺王伟王志强 Department of Cardiology Renmin Hospital of Wuhan University Cardiovascular Research Institute Renmin Hospital of Wuhan University Hubei Key Laboratory of Cardiology Renmin Hospital of Wuhan University

An optimal therapy for pulmonary embolism（PE） was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography（CTA） were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients（92%） in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group（87%, n=39, P〈0.05）. However, there was no significant difference in the rate of mortality between thrombolysis group and anticoagulation only group. In the surgery/interventional group（n=15）, the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups（both P〈0.05）. Log-rank analysis of the data of 5-year follow-up revealed that the survival time in surgery/intervention group was significantly shorter than in the other two groups（P0.05）. It was suggested that it is of importance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy.

关键词： pulmonary embolism treatment choice evaluation of therapeutic efficacy anticoagulation thrombolysis

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CARDIOVASCULAR SYSTEM

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China Medical Abstracts(Internal Medicine) 1996年第3期13卷 149-160页

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CARDIOVASCULAR SYSTEM

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China Medical Abstracts(Internal Medicine) 2002年第1期19卷 13-22页

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rAcAP5: high-yield strain screening, expression, purification and thrombolytic effect evaluation in rat embolic middle cerebral artery occlusion model

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Journal of Chinese Pharmaceutical Sciences 2014年第1期23卷 22-27页

作者：朱亚楠朱元军卜琦鑫刘晓岩王银叶北京大学医学部药学院分子与细胞药理学系北京100191

Recombinant ancylostoma caninum anticoagulant peptide-5 （rAcAP5） has been reported to inhibit thrombin-activatable fibrinolysis inhibitor （TAFIa） activity and have thrombolytic effect. The present study was to screen a strain expressing high-yield of rAcAP5 and to assess its thrombolytic effect on embolic middle cerebral artery occlusion （MCAO） model in rats. Codons encoding for AcAP5 were optimized. Six expression plasmids and eleven E. coli strains with different characteristics were used, a total of 66 recombinant expression strains were generated and the one with the highest yield was selected to express rAcAP5, which was purified through anion- and cation-exchange chromatography. The purity of rAcAP5 and its molecular weight were determined by HPLC and mass spectrometry, respectively. The thrombolytic effect of rAcAP5 was evaluated on embolic MCAO model in rats; regional cerebral blood flow （rCBF） was monitored with a Laser-Doppler flowmetry to test the occlusion and recanalization of MCA. The highest yield recombinant strain was C2566H/pTYB 1-rAcAP5. AcAP5 （28 mg） with 90% of purity was obtained from 1 L of cell culture. In rat embolic MCAO model, vehicle （normal saline） treatment did not change the rCBF, while treatment with rAcAP5 （50-200 μg/kg, i.v.） increased the rCBF in a dose-dependent manner. In conclusion, we prepared and characterized the rAcAP5 peptide and revealed its thrombolytic effect in embolic MCAO model and our results suggested that this peptide had the potential to be used as a thrombolytic agent.

关键词： rAcAP5 Over-expression Purification thrombolysis

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Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

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World Journal of Cardiovascular Diseases 2018年第2期8卷 152-161页

作者： Simona Campa Raymund Gantioque California State University Los Angeles CA USA

Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success.?The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting.?In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic *** literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.

关键词： Pulmonary Embolism (PE) Aspiration Catheters (The 10 F Pronto .035” and 14 F XL Extraction Catheter (Vascular Solutions Minneapolis MN)) The Ultrasound-Assisted Catheter-Directed thrombolysis (USAT) Systemic thrombolysis

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Antithrombotic Effects of Different Strains of Lactic Acid Bacteria

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Health 2014年第18期6卷 2433-2443页

作者： Hiromasa Ooe Masaru Kato Kanae Hyodo Keiko Nakashima Hiroshi Ashigai Kyoko Kato Toshinori Sasaki Yuko Fukushima John C. Giddings Junichiro Yamamoto Research Laboratories for Health Science and Food Technologies Kirin Company Limited Yokohama Japan Research Laboratories for Brewing Technologies Kirin Company Limited Yokohama Japan Laboratory of Physiology Faculty of Nutrition Kobe Gakuin University Kobe Japan Central Laboratories for Key Technologies Kirin Company Limited Yokohama Japan Formerly Department of Haematology School of Medicine Cardiff University UK

Objective: The aim of the present study was to assess the antithrombotic properties of different strains of orally available antithrombotic lactic acid bacteria (LAB). Research Methods & Procedures: Antithrombotic activity, antiplatelet reactivity and/or thrombolytic activity, were measured in seven strains of LAB and LAB cell-free-extracts (LAB filtrates) using the shear-induced platelet reactivity/thrombolytic activity, The Global Thrombosis Test (GTT), with non-anticoagulated rat blood in vitro. Subsequently, the most potent antithrombotic strains identified in vitro were assessed in vivo after oral administration in mouse carotid arteries using a helium-neon laser-induced thrombosis model. Result: Five strains out of seven LAB (Lactobacillus paracasei KW 3100, Lactobacillus fermentum NBRC 3961, Lactobacillus pentosus JCM 8333, Leuconostoc oeni Elios 1, Pediococcus pentosaceus NK-2) promoted significant endogenous thrombolysis in vitro. In addition, one strain (Lactobacillus fermentum NBRC 3961) significantly inhibited shear-induced platelet re-activity. Three antithrombotic strains, Lactobacillus fermentum NBRC 3961, Leuconostoc oeni Elios 1, and Lactobacillus pentosus JCM 8333, were further assessed in vivo. The results demonstrated that filtrates, and the cells per se of these LAB, modulated antiplatelet activity and/or thrombolytic activity, and that the antithrombotic mechanisms were mainly influenced by protein content (60% - 70% of dry matter). Conclusion: The findings suggested that some strains of lactic acid bacteria could usefully provide the basis for the production of oral antithrombotic probiotics.

关键词： Antithrombotic Lactic Acid Bacteria Shear-Induced Thrombosis Global Thrombosis Test (GTT) Laser-Induced Thrombosis Endogenous thrombolysis

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Cardiovascular System

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China Medical Abstracts(Internal Medicine) 2012年第3期29卷 152-158页

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Management of Acute Ischemic Stroke in a Patient with a Past History of Intracranial Hemorrhage

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Neuroscience & Medicine 2020年第1期11卷 29-35页

作者： Ghadeer Al-Shabeeb Fatimah Al Zawad Osama Basheir College of Medicine Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia Department of Neurology King Fahad University Hospital Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia.

Intravenous thrombolysis remains the gold standard in the management of acute ischemic stroke if the patient presents within the window period. Endovascular thrombectomy is another line of therapy in selected cases. Nonetheless, one of the most devastating complications of IV thrombolysis is intracranial hemorrhage (ICH);in such cases, the previous history of ICH is considered a potential contraindication to thrombolysis. Evidence regarding the safety of thrombolysis administration in patients with a previous history of ICH is scarce. We encountered a patient with acute ischemic stroke with a past history of hypertensive ICH. A 59-year-old female, presented with complete right-sided body weakness, global aphasia and gaze preference. A computed tomography (CT) brain perfusion scan revealed a mismatch suggestive of left middle cerebral artery (MCA) ischemic stroke. The patient received intravenous thrombolysis and showed significant clinical improvement with no subsequent complications or ICH. In reporting this case, we aim to provide evidence supporting the safety of thrombolytic therapy in selected cases with a previous history of ICH when no alternative line of management is available.

关键词： Ischemic Stroke Acute Ischemic Stroke IVtPA in History of Hemorrhagic Stroke Hemorrhagic Stroke Intravenous thrombolysis

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