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| 1 | Relationship between homocysteine level and prognosis of elderly patients with acute ischemic stroke treated by thrombolysis with recombinant tissue plasminogen activator显示文摘BACKGROUND Acute ischemic stroke(AIS)is mainly caused by cerebral blood flow disorders,which further leads to ischemic brain necrosis or encephalomalacia.The role of homocysteine(Hcy),an independent risk factor for cardiovascular disease,in the development of atherosclerosis is gradually revealed.However,studies are still rare and little is known about the relationship of Hcy level with the prognosis.AIM To explore the relationship between Hcy level and prognosis in elderly patients with AIS after thrombolytic therapy with recombinant tissue plasminogen activator(rtPA).METHODS A total of 120 patients with acute ischemic stroke who were admitted to Jingzhou Central Hospital and underwent recombinant tissue plasminogen activator treatment were randomly selected from January 2017 to December 2018.They were divided into two groups according to the level of Hcy,with 60 patients in each group.Patients with Hcy≥18.54 umol/L were included into a high-level group and those with Hcy<18.54 umol/L were included into a low-level group.The outcomes were analyzed in the two groups after the treatment.RESULTS The National institute of Health Stroke Scale(NIHSS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in NIHSS scores between the two groups at 12 and 24 h after the treatment(P>0.05).The Modified Rankin scale(MRS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in MRS scores between the two groups at 12 and 24 h after the treatment(P>0.05).NIHSS and MRS scores were positively correlated with the prognosis after thrombolytic therapy(P<0.05).CONCLUSION The level of Hcy is closely related to the prognosis of elderly patients with acute ischemic stroke,and after rtPA treatment,the prognosis of elderly patients is improved significantly. | Juan Li Fan Zhou Feng-Xue Wu | 2019 | World Journal of Clinical Cases2019，7，22： | 16 |
| 2 | Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?显示文摘AIM: To use perfusion-derived permeability-surface area product maps to predict hemorrhagic transformation following thrombolytic treatment for acute ischemic stroke.METHODS: We retrospectively analyzed our prospectively kept acute stroke database over five consecutive months for patients with symptoms of acute ischemic stroke(AIS) who had computed tomography(CT) perfusion(CTP) done at arrival. Patients included in the analyses also had to have a follow-up CT. The permeability-surface area product maps(PS) was calculated for the side of the ischemia and/or infarction and for the contralateral unaffected side at the same level. The cerebral blood flow map was used to delineate the ischemic territory. Next, a region of interest was drawn at the centre of this territory on the PS parametric map. Finally, a mirror region of interest was created on the contralateral side at the same level. The relative permeability-surface area product maps(r PS) provided an internal control and was calculated as the ratio of the PS on the side of the AIS to the PS on the contralateral side. A student t-test was performed after log conversion of r PS between patients with and without hemorrhagic transformation. Log conversion was used to convert the data into normal distribution to use t-test. For the group of patients who experienced intracranial bleed, a student t-test was performed between those with only petechial hemorrhage and those with more severe parenchymal hematoma with subarachnoid haemorrhage.RESULTS: Of 84 patients with AIS and CTP at admission, only 42 patients had a follow-up CT. The r PSderived using the normal side as the internal control was significantly higher(P = 0.003) for the 15 cases of hemorrhagic transformation(1.71 + 1.64) compared to 27 cases that did not have any(1.07 + 1.30). Patients with values above the overall mean r PS of 1.3 had an increased likelihood of subsequent hemorrhagic transformation. The sensitivity of using this score to predict hemorrhagic transformation was 71.4, the specificity was 78.6, with a positive predictive value of 62.5 and negative predictive value of 84.6. The accuracy was 76.2. The odds ratio of an event occurring with such an r PS was 9.2. Of the 15 cases of hemorrhagic transformation, there was no difference(P = 0.35) in the r PS between the eight cases of petechial and the seven cases of more severe hemorrhagic events.CONCLUSION: Pretreatment PS can predict the occurrence of hemorrhagic transformation on follow-up of AIS patients with relatively high sensitivity, specificity, positive and negative predictive value. | Peggy Yen Allison Cobb Jai Jai Shiva Shankar | 2016 | World Journal of Radiology2016，8，6： | 10 |
| 3 | Thrombosis: Novel nanomedical concepts of diagnosis and treatment显示文摘Intravascular thrombosis, a critical pathophysiological feature of many cardiovascular disorders, leads to the formation of life-threatening obstructive blood clots within the vessels. Rapid recanalization of occluded vessels is essential for the patients' outcome, but the currently available systemic fibrinolytic therapy is associated with low efficacy and tremendous side effects. Additionally, many patients are ineligible for systemic thrombolytic therapy, either due to delayed admission to the hospital after symptom onset, or because of recent surgery, or bleeding. In order to improve the treatment efficacy and to limit the risk of hemorrhagic complications, both precise imaging of the affected vascular regions, and the localized application of fibrinolytic agents, are required. Recent years have brought about considerable advances in nanomedical approaches to thrombosis. Although these thrombustargeting imaging agents and nanotherapies are not yet implemented in humans, substantial amount of successful in vivo applications have been reported, including animal models of stroke, acute arterial thrombosis, and pulmonary embolism. It is evident that the future progress in diagnosis and treatment of thrombosis will be closely bound with the development of novel nanotechnology-based strategies. This Editorial focuses on the recently reported approaches, which hold a great promise for personalized, disease-targeted treatment and reduced side effects in the patients suffering from this life-threatening condition. | Iwona Cicha | 2015 | World Journal of Cardiology2015，7，8： | 4 |
| 4 | Reproducibility of thrombus volume quantification in multicenter computed tomography pulmonary angiography studies显示文摘AIM To evaluate reproducibility of pulmonary embolism(PE) clot volume quantification using computed tomography pulmonary angiogram(CTPA) in a multicenter setting.METHODS This study was performed using anonymized data in conformance with HIPAA and IRB Regulations(March 2015-November 2016). Anonymized CTPA data was acquired from 23 scanners from 18 imaging centers using each site's standard PE protocol. Two independent analysts measured PE volumes using a semi-automated region-growing algorithm on an FDA-approved image analysis platform. Total thrombus volume(TTV) was calculated per patient as the primary endpoint. Secondary endpoints were individual thrombus volume(ITV), Qanadli score and modified Qanadli score per patient. Inter-and intra-observer reproducibility were assessed using intra-class correlation coefficient(ICC) and BlandAltman analysis. RESULTS Analyst 1 found 72 emboli in the 23 patients with a mean number of emboli of 3.13 per patient with a range of 0-11 emboli per patient. The clot volumes ranged from 0.0041-47.34 cm3(mean +/-SD, 5.93 +/-10.15 cm3). On the second read, analyst 1 found the same number and distribution of emboli with a range of volumes for read 2 from 0.0041 – 45.52 cm3(mean +/-SD, 5.42 +/-9.53 cm3). Analyst 2 found 73 emboli in the 23 patients with a mean number of emboli of 3.17 per patient with a range of 0-11 emboli per patient. The clot volumes ranged from 0.00459-46.29 cm3(mean +/-SD, 5.91 +/-10.06 cm3). Inter-and intraobserver variability measurements indicated excellent reproducibility of the semi-automated method for quantifying PE volume burden. ICC for all endpoints was greater than 0.95 for inter-and intra-observer analysis. Bland-Altman analysis indicated no significant biases.CONCLUSION Semi-automated region growing algorithm for quantifying PE is reproducible using data from multiple scanners and is a suitable method for image analysis in multicenter clinical trials. | Audrey E Kaufman Alison N Pruzan Ching Hsu Sarayu Ramachandran Adam Jacobi Indravadan Patel Lee Schwocho Michele F Mercuri Zahi A Fayad Venkatesh Mani | 2018 | World Journal of Radiology2018，10，10： | 3 |
| 5 | Effect of varying computed tomography acquisition and reconstruction parameters on semi-automated clot volume quantification显示文摘AIM To examine effects of computed tomography(CT)image acquisition/reconstruction parameters on clot volume quantification in vitro for research method validation purposes.METHODS This study was performed in conformance with HIPAA and IRB Regulations(March 2015-November 2016).A ten blood clot phantom was designed and scanned on a dual-energy CT scanner(SOMATOM Force,Siemens Healthcare Gm BH,Erlangen,Germany)with varying pitch,iterative reconstruction,energy level and slicethickness.A range of clot and tube sizes were used in an attempt to replicate in vivo emboli found within central and segmental branches of the pulmonary arteries in patients with pulmonary emboli.Clot volume was the measured parameter and was analyzed by a single image analyst using a semi-automated region growing algorithm implemented in the FDA-approved Siemens syngo.via image analysis platform.Mixed model analysis was performed on the data.RESULTS On the acquisition side,the continuous factor of energy showed no statistically significant effect on absolute clot volume quantification(P=0.9898).On the other hand,when considering the fixed factor of pitch,there were statistically significant differences in clot volume quantification(P<0.0001).On the reconstruction side,with the continuous factor of reconstruction slice thickness no statistically significant effect on absolute clot volume quantification was demonstrated(P=0.4500).Also on the reconstruction side,with the fixed factor of using iterative reconstructions there was also no statistically significant effect on absolute clot volume quantification(P=0.3011).In addition,there was excellent R^2 correlation between the scale-measured mass of the clots both with respect to the CT measured volumes and with respect to volumes measure by the water displacement method.CONCLUSION Aside from varying pitch,changing CT acquisition parameters and using iterative reconstructions had no significant impact on clot volume quantification with a semi-automated region growing algorithm. | Audrey E Kaufman Alison N Pruzan Ching Hsu Sarayu Ramachandran Adam Jacobi Zahi A Fayad Venkatesh Mani | 2018 | World Journal of Radiology2018，10，3： | 3 |
| 6 | Targeted Thrombolytic Therapy显示文摘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. | 胡豫 | 2004 | 血栓与止血学2004，10，3： | 2 |
| 7 | Preparation and toxicity evaluation of a novel nattokinase-tauroursodeoxycholate complex显示文摘Nattokinase(NK), which has been identified as a potent fibrinolytic protease, has remarkable potential in treatment of thrombolysis, and even has the ability to ameliorate chronic vein thrombosis. To reduce the hemorrhagic risk from an intravenous injection of NK,nattokinase-tauroursodeoxycholate(NK-TUDCA) complex was prepared at different pH values and with different ratios of NK and TUDCA. When assessing survival time, survival state,tail injury, and the body weight of mice, it was found that the NK-TUDCA complex(NK: 10 k IU/ml; TUDCA: 10 mg/ml; pH 5.0) had a lower toxicity when administered at an NK dosage of 130 kIU/kg in the acute toxicity test and 13 kIU/kg in the repeated low-dose challenge. From the results of the in vitro thrombolytic test and characterization of NKTUDCA, we speculated that the delayed release of NK-TUDCA might be the main cause of toxicity reduction by the complex. This study described the preparation of an NK complex with low toxicity following intravenous administration, which could be utilized for further clinical study of NK. | Rui Feng Jing Li Jiepeng Chen Lili Duan XinRong Liu Donghua Di Yihui Deng Yanzhi Song | 2018 | Asian Journal of Pharmaceutical Sciences2018，13，2： | 2 |
| 8 | Progress in study of structure-function relationship and protein engineering of plasminogen activators显示文摘Thrombolytic agents play an important role in the treatment of thrombus diseases. In clinic,traditional thrombolytic agents always resulted in the side effect of systemic thrombolysis because of the shortcomings, such as short half-life, poor specificity of thrombus. Recently, with the development of knowledge of the relationship between their structure and function, a series of new thrombolytic agents were constructed by means of molecular biological techniques. Developing new types of thrombolytic agents is of great significance for more effective treatment of cardiovascular diseases. The latest knowledge of the structure-function relationship of t-PA and u-PA and the progress in development of new thrombolytic agents are reviewed. | Fuxiang Zhu Fuchu He | 1999 | Chinese Science Bulletin1999，44，4： | 2 |
| 9 | Phytochemical screening and in vitro bioactivities of the extracts of aerial part of Boerhavia diffusa Linn.显示文摘Objective:To investigate the bioactivities of crude n-hexane,ethyl acetate and methanol extracts of aerial part of Boerhavia diffusa Linn.(B.diffusa) and its phytochemical analysis.Methods: the identification of phyloconstituents and assay of antioxidant,thrombolytic,cytotoxic, antimicrobial activities were conducted using specific standard in vitro procedures.Results:The results showed that the plant extracts were a rich source of phytoconstituents.Methanol extract showed higher antioxidant,thrombolytic activity and less cytotoxic activity than those of n-hexane and ethyl acetate extracts of A diffusa.Among the bioactivities,antioxidant activity was the most notable compared to the positive control and thus could be a potential rich source of natural antioxidant.In case of antimicrobial screening,crude extracts of the plant showed remarkable antibacterial activity against tested microorganisms.All the extracts showed significant inhibitory activity against Candida albicuns,at a concentration of 1000 μg/disc.Conclusions:The present findings suggest that,the plant widely available in Bangladesh,could be a prominent source of medicinally important natural compounds. | Apurba Sarker Apu Mahmuda Sultana Liza A.T.M.Jamaluddin Md.Amran Howlader Repon Kumer Saha Farhana Rizwan Nishat Nasrin | 2012 | Asian Pacific Journal of Tropical Biomedicine2012，2，9： | 1 |
| 10 | Horseshoe thrombus in a patient with mechanical prosthetic mitral valve: A case report and review of literature显示文摘Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications. | Sanjay Mehra Assad Movahed Carlos Espinoza Constantin B Marcu | 2015 | World Journal of Clinical Cases2015，3，9： | 1 |
| 11 | A comparative study of the antioxidant,antimicrobial,cytotoxic and thrombolytic potential of the fruits and leaves of Spondias dulcis显示文摘Objective:To investigate the antioxidant,antimicrobial,cytotoxic and thrombolytic property of the fruits and leaves of Spondias dulcis(S.dulcis).Methods:Methanolic extracts of fruits and leaves of S.dulcis were partitioned with chloroform and dichloromethane.The antioxidant potential of the crude extract and partitioned fractions were evaluated in terms of total phenolic content,total flavonoid content,DPPH radical scavenging potential,reducing potential and total antioxidant capacity by specific standard procedures.The antimicrobial activity was evaluated using disc diffusion method.The cytotoxicity was evaluated by using brine shrimp lethality bioassay and compared with vincristine sulfate.The thrombolytic activity was compared with streptokinase.Results:The methanolic fruit extract exhibited the highest phenolic content,flavonoid content and antioxidant capacity,among the other extracts,with the highest DPPH radical scavenging activity at a concentration of 10μg/mL(IC_(50):1.91μg/mL)and maximum reducing power at a concentration of 100μg/ml.(EC_(50):3.58μg/mL).Though all extract showed moderate antimicrobial activity against the bacterial strains,weak or no activity against fungus.The range of LC_(50)value of all extracts was 1.335-14.057μg/mL which was far lower than the cut off index for cytotoxicity.All extracts exhibited statistically significant(P<0.001)thrombolytic activity.Conclusions:Our study suggested that 5.dulcis exhibits antimicrobial activities against a wide variety of strains while it possesses significant antioxidant,cytotoxic and thrombolytic aclivily. | shawkat Md.Aminul Islam kh Tanvir Ahmed Mohammad Kawsar Manik Md.Arif Wahid chowdhury shafayat ibne Kamal | 2013 | Asian Pacific Journal of Tropical Biomedicine2013，3，9： | 1 |
| 12 | Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation显示文摘BACKGROUND:Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients.In case of acute ischemic stroke in pediatric age group,management is different from that of adult ischemic stroke where thrombolysis is a good option.METHODS:We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry.The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously.He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke.RESULTS:The patient recovered from acute ischemic stroke without being thrombolyzed.CONCLUSION:In pediatric patients,acute ischemic stroke usually is evolving and may not require thrombolysis. | Misbahuddin Mohammad Anish F.James Raheel S.Qureshi Sapan Saraf Tina Ahluwalia Joy Dev Mukherji Tamorish Kole | 2012 | World Journal of Emergency Medicine2012，3，2： | 0 |
| 13 | The Changes of Vasoactive Substances Originated Endotheiium in Patients with Unstable Angina Pectoris Treated by Improved Thrombolytic Therapy显示文摘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. | 王聪侠 牛小麟 李永勤 张明娟 丁抗宁 | 2004 | South China Journal of Cardiology2004，5，2： | 0 |
| 14 | Multicenter clinical trial using an accelerated streptokinase regimen in patients with acute myocardial infarction显示文摘 | 徐成斌 张彤 | 2000 | Chinese Medical Journal2000，，8： | 0 |
| 15 | Comprehensive Management Strategies for Thrombolytics in Patients with Acute Ischemic Stroke显示文摘Based on the mobile Internet, Internet of Things, big data, cloud computing,“intelligentization” and other technologies, a safe and reliable management platform for integrating information about acute ischemic stroke (AIS) thrombolysis with unified standards should be established. The management platform should include intelligent screening of high-risk groups and servers for monitoring them, server analysis of patient medical records, a server for supervision and integrated management of patient education, an integrated system of healthcare records, and a clinical decision-support system for AIS emergencies. Such a system would constitute a standardized data capture and integrated intelligent analysis system for the key information necessary in thrombolytics. In this way a human-oriented prevention and intervention mechanism for continuous care and prevention of stroke would be formed to achieve the collection and intelligent analysis of key information in drug thrombolysis. It would provide data support for AIS thrombolytics management strategies that would improve the coverage of drug thrombolysis in primary hospitals, and also optimize AIS emergency processes to increase the success rate of thrombolysis. | Yuan-Qiang Lu Da-Gan Yang Yun-Mei Yang | 2018 | Journal of Cerebrovascular Disease2018，1，1： | 0 |
| 16 | Aberrant celio-mesenteric supply of the splenic flexure:Provoking a bleed显示文摘Lower gastrointestinal hemorrhage presents a common indication for hospitalization and account for over300000 admissions per year in the United States.Multimodality imaging is often required to aid in localization of the hemorrhage prior to therapeutic intervention if endoscopic treatment fails.Imaging includes computer tomography angiography,red blood cell tagged scintigraphy and conventional angiography,with scintigraphy being the most sensitive followed by computer tomography angiography.Aberrant celio-mesenteric supply occurs in 2%of the population;however failure to identify this may result in failed endovascular therapy.Computer tomography angiography is sensitive for arterial hemorrhage and delineates the anatomy,allowing the treating physician to plan an endovascular approach.If at the time of conventional angiography,the active bleed is not visualized,but the site of bleeding has been identified on computer tomography angiography,provocative angiography can be utilized in order to stimulate bleeding and subsequent targeted treatment.We describe a case of lower gastrointestinal hemorrhage at the splenic flexure supplied by a celiomesenteric branch in a patient and provocative angiography with tissue plasminogen activator utilized at the time of treatment to illicit the site of hemorrhage and subsequent treatment. | Matthew Wu Darren Klass Evgeny Strovski Baljinder Salh David Liu | 2013 | World Journal of Gastroenterology2013，19，39： | 0 |
| 17 | Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases显示文摘Background Administrative data are frequently used in stroke research.Ensuring accurate identification of patients who had an ischaemic stroke,and those receiving thrombolysis and endovascular thrombectomy(EVT)is critical to ensure representativeness and generalisability.We examined differences in patient samples based on mode of identification,and propose a strategy for future patient and procedure identification in large administrative databases.Methods We used non-public administrative data from the state of California to identify all patients who had an ischaemic stroke discharged from an emergency department(ED)or inpatient hospitalisation from 2010 to 2017 based on International Classification of Disease(ICD-9)(2010-2015),ICD-10(2015-2017)and Medicare Severity-Diagnosis-related Group(MS-DRG)discharge codes.We identified patients with interhospital transfers,patients receiving thrombolytics and patients treated with EVT based on ICD,Current Procedural Terminology(CPT)and MS-DRG codes.We determined what proportion of these transfers and procedures would have been identified with ICD versus MS-DRG discharge codes.Results Of 365099 ischaemic stroke encounters,most(87.70%)had both a stroke-related ICD-9 or ICD-10 code and stroke-related MS-DRG code;12.28% had only an ICD-9 or ICD-10 code and 0.02% had only an MS-DRG code.Nearly all transfers(99.99%)were identified using ICD codes.We identified 32433 thrombolytic-treated patients(8.9% of total)using ICD,CPT and MS-DRG codes;the combination of ICD and CPT codes identified nearly all(98%).We identified 7691 patients treated with EVT(2.1%of total)using ICD and MS-DRG codes;both MS-DRG and ICD-9/ICD-10 codes were necessary because ICD codes alone missed 13.2%of EVTs.CPT codes only pertain to outpatient/ED patients and are not useful for EVT identification.Conclusions ICD-9/ICD-10 diagnosis codes capture nearly all ischaemic stroke encounters and transfers,while the combination of ICD-9/ICD-10 and CPT codes are adequate for identifying thrombolytic treatment in administrative datasets.However,MS-DRG codes are necessary in addition to ICD codes for identifying EVT,likely due to favourable reimbursement for EVT-related MS-DRG codes incentivising accurate coding. | Kori S Zachrison Sijia Li Mathew J Reeves Opeolu Adeoye Carlos A Camargo Lee H Schwamm Renee Y Hsia | 2021 | Stroke & Vascular Neurology2021，6，2： | 0 |
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