Hyper-reactive platelets and type 2 diabetes / 中南大学学报(医学版)

Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.

Estados protrombóticos y pérdida de embarazo / Prothrombotic states and pregnancy loss / Estados protrombóticos e perda de gravidez

Resumen: Las pérdidas de embarazos son una complicación obstétrica frecuente. Se conoce que, 15% de las mujeres embarazadas tienen al menos una pérdida esporádica. El 5% experimentan 2 pérdidas, y hasta un 1% 3 o más. La edad materna avanzada, la multiparidad y el antecedente de pérdida de embarazo previo aumentan el riesgo. La vinculación de los estados protrombóticos, hereditarios y adquiridos, con las pérdidas de embarazo se relaciona con el hecho de que para que se mantenga el embarazo es necesario exista una adecuada circulación placentaria. A lo largo de los años se ha estudiado la relación que existe entre los diferentes estados protrombóticos hereditarios y adquiridos con estas complicaciones vasculares que determinan pérdidas de embarazo y complicaciones obstétricas. Se realiza una revisión sobre las trombofilias hereditarias y adquiridas con ésta entidad.

Abstract: Pregnancy losses are a common obstetric complication. It is known that 15% of pregnant women have at least one sporadic loss. 5% experience 2 losses, and up to 1% 3 or more. Advanced maternal age, multiparity, and a history of prior pregnancy loss increase the risk. The link between hereditary and acquired prothrombotic states with pregnancy losses is related to the fact that adequate placental circulation is necessary for the pregnancy to be maintained. Over the years, the relationship between the different hereditary and acquired prothrombotic states with these vascular complications that lead to pregnancy losses and obstetric complications has been studied. A review is carried out on the hereditary and acquired thrombophilias with this entity.

Resumo: A perda da gravidez é uma complicação obstétrica comum. Sabe-se que 15% das gestantes apresentam pelo menos uma perda esporádica. 5% experimentam 2 perdas e até 1% 3 ou mais. Idade materna avançada, multiparidade e história de perda de gravidez anterior aumentam o risco. A ligação entre os estados protrombóticos hereditários e adquiridos com as perdas gestacionais está relacionada ao fato de que a circulação placentária adequada é necessária para a manutenção da gravidez. Ao longo dos anos, estudou-se a relação entre os diferentes estados pró-trombóticos hereditários e adquiridos com essas complicações vasculares que levam à perda da gravidez e complicações obstétricas. É realizada uma revisão das trombofilias hereditárias e adquiridas com essa entidade.

Manifestaciones trombóticas en la neumonía viral por SARS-CoV-2 pacientes hospitalizados en el Hospital «Irma de Lourdes Tzanetatos¼, Panamá, Panamá. De marzo de 2020 a septiembre de 2020 / Thrombotic manifestations in viral neumonia by CoV-2-SARS hospitalized patients at «Irma Lourdes Tzanetatos¼ Hospital, Panama, Panama. March 2020 to September 2020

La respuesta a la infección viral produce un estado de trombosis o hipercoagulabilidad que, unido a la inflamación de las células endoteliales, puede generar disfunción plaquetaria y predisposición a la formación de trombos que, aunque con frecuencia son más venosos, también pueden aparecer en el sistema arterial y producir infartos a cualquier nivel así como tromboembolia e hipertensión pulmonar. Estas manifestaciones han sido captadas hospitalariamente y al egreso de los pacientes detectados por SARS-CoV-2 habiendo ya cumplido el tiempo establecido de virulencia. Los criterios diagnósticos de respuesta inmunológica trombótica asociada a COVID-19 (RITAC) ayudan a seleccionar al paciente que está predispuesto a esta condición; a esto se añade que el paciente ya tiene un diagnóstico de infección por SARS-CoV-2 (AU)

The response to viral infection produces a prothrombotic state of hypercoagulability , united with an inflammation of endothelial cells, It can generate platelet dysfunction and predisposition to the formation of thrombus, that, although, are more frequently venous, Also, it can appear in the arterial system and cause heart attacks at any level; thromboembolism and pulmonary hypertension, as well. These manifestations have been captured hospitably and with the egress of patients detected by SARS-CoV-2. The diagnostic criteria of RITAC (abbreviation in Spanish of Thrombotic Immune Response Associated to COVID-19), help to select the patient who is predisposed to this condition; adding that the patient already has a diagnosis of SARS-CoV-2 infection (AU)

Analysis of Clinical Features, Risk Factors and Laboratory Parameters in Cerebral Venous Thrombosis: A Study of 70 Cases

Introduction: Cerebral venous thrombosis (CVT) has variableclinical presentations mimicking other neurological disorders.There is variation in risk factors for CVT in different areas.Study was done with the aim of analyzing the clinical features,risk factors and laboratory parameters on patients diagnosedwith CVT on Magnetic Resonance Venography (MRV) andMRI.Material and Methods: In this retrospective study, data of70 consecutive patients attending a private neurology centerwith CVT confirmed on MRV and MRI from May 2016 toApril 2019 was analyzed. Laboratory parameters emphasizedwere hemoglobin content, serum homocysteine level and lipidprofile.Results: Out of 70 patients, 48 were men and 22 women inthe age range of 14 to 71 years. Most common presentingsymptom was progressive headache (63 cases,90%) aloneor in combination with other symptoms like vomiting (22cases, 31.42%), hemiparesis (17 cases, 24.28%), ataxia(17 cases, 24.28%) and seizures (15 cases, 21.42%).Hyperhomocysteinemia was seen in 15 cases (21.42%),anemia in total 30 cases (42.85%), and alcoholism in sevencases (10%). Twenty four patients (34.28%) had high densitylipoprotein (HDL) level of less than 40mg/dl, five patients(7.14%) had total cholesterol more than 200mg/dl and threepatients (4.28%) had triglycerides more than 200mg/dl. Onepatient (1.42%) had protein S deficiency.Conclusion: CVT is an uncommon but treatable cause ofstroke in young patients. Due to variety of clinical presentation,a high degree of clinical suspicion is neccessory for correctdiagnosis and early treatment.

Effect of modified Tongyou decoction combined with FOLFOX4 chemotherapy on pre-thrombus state of patients with advanced prostatic cancer / 中国生化药物杂志

Objective To analyze the effect of modified Tongyou decoction combined with FOLFOX4 chemotherapy on pre-thrombus state and curative effect of patients with advanced prostatic cancer.Methods 142 patients with advanced prostatic cancer were collected,all patients were randomly divided into study group and control group,71 cases in each group.The control group was given FOLFOX4 chemotherapy and the study group was given modified Tongyou decoction on the baseis of the control group.After treatment,the serum levels of homocysteine(Hcy),D-two dimer(D-D),fibrinogen(FIB),the level of hemorrheology,clinical effect,the incidence of venous thrombosis in one years,the six month survival rate,the one year survival rate were detected in all patients.Resutls After treatment,compared with control group,the serum levels of Hcy,D-D,FIB,the whole blood high,middle and low-shear viscosities,plasma viscosity and the incidence of venous thrombosis in one years were higher in the study group and the difference was statistically significant(P<0.05);the erythrocyte deformability index,effective rate and one year survival rate were higher were higher in the study group and the difference was statistically significant(P<0.05).Conclusion The modified Tongyou decoction combined with FOLFOX4 chemotherapy in treatment of patients with advanced prostatic cancer can improve the prethrombotic state,improve the therapeutic effect,reduce the incidence of venous thrombosis and increase the one year survival rate,and have a guiding significance for clinic.

Effects of Menopause on Prothrombotic State in Ovariectomized Rats / 医学研究杂志

Objective To observe the effects of menopause on prothrombotic profiles in ovariectomized rats .Methods Thirty two healthy female SD rats of 9 to 10 months were divided into 4 groups, the control shamed and the observation groups ovariectomized .Rats in the baseline group and the early menopause group were sacrificed one week later , and the control and late menopause group 10 weeks later.The prothrombotic profiles were detected including plasma FIB , ATⅢ activity, PAI-1 levels, D-D level, vWF levels and NO concentration, TXA2 and PGI2 levels.Results In early menopause, plasma FIB increased dramatically while ATⅢactivity remained lit-tle changed.PAI-1 demonstrated an increasing trend .vWF significantly increased but NO significantly decreased .In later menopausal stage, PAI-1 increased dramatically but FIB somewhat decreased .Plasma ATⅢactivity significantly increased and vWF still remained a high level.NO increased a little.In both early and later stage, TXA2 and PGI2 simultaneously increased while D -D showed little change between groups .Conclusion Menopause plays different roles in different aspects of thromoembolism , resulting in increased risk in early menopause due to prothrombotic state and decreased risk in later menopause when new balances between profiles were established .

Clinical evaluation of simvastatin on prothrombotic state in OSAS pa-tients with hypertension without hyperlipemia / 中国现代医生

Objective To investigate the effect of simvastatin on prothrombotic state in OSAS patients with hypertension without hyperlipemia. Methods Eighty OSAS patients with hypertension without hyperlipemia were enrolled from Jan-uary 2011 to June 2014,and randomly divided into simvastatin group(40 cases)and conventional group(40 cases)(oral taken simvastatin or placeb once every night in addition of routine antihypertensive drugs).Forty healthy subjects were also recruited as control.All cases were followed up for eight weeks. Serum holesterol,nitric oxide(NO),emdothelin-1(ET-1),von Willebrand-factor(vWF) and tissue-type plasminogen activator(t-PA) levels were determined in each case before and after eight weeks orsuvastatin medication. Results Before treatment NO,t-PA levels in simvastatin group and conventional group were lower than the healthy group,ET-1, vWF levels were higher than those of control group,the differences were statistically significant(P<0.05). After treatment NO,t-PA levels in simvastatin group and conventional group increased compared with before treatment,but simvastatin group increased more significantly,ET-1,vWF levels in simvastatin group and conventional group were lower than before treatment,but simvastatin group they were more significantly lower, with statistically significant difference (P<0.05). Conclusion In patients of OSAS pa-tients with hypertension without hyper-lipemia,simvastatin can increase plasma NO,t-PA concentration and decrease ET-1,vWF concentration and thus to improve the prothrombotic status.

Determinación de marcadores séricos de trombosis e inflamación en sujetos con intolerancia a la glucosa: evidencia de un estado protrombótico / Determination of blood markers and inflammation in subjects with impaired glucose tolerance

Objetivo: Este estudio fue diseñado para explorar la presencia de un estado protrombótico, disfunción fibrinolítica e inflamación en sujetos con intolerancia a la glucosa, mediante la evaluación de los marcadores séricos de trombosis, fibrinólisis e inflamación. Métodos: Se estudiaron 48 individuos consecutivos, 25 intolerantes a la glucosa: (nueve hombres y 16 mujeres, 50.0 ±9.2 años) y 23 sujetos control (seis hombres y 17 mujeres, 48.0 ±11 años). Se compararon entre ambos grupos los niveles de dímero-D y fibrinógeno como marcadores de trombosis, el PAI-1 como marcador de fibrinólisis y la proteína C reactiva ultrasensible (PCR-us) como marcador de inflamación. Resultados: En los sujetos intolerantes a la glucosa respecto al grupo control, se observaron diferencias significativas en los marcadores de trombosis: fibrinógeno 317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL (p<0.0001), dímero-D 489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL (p<0.01) y en el marcador de fibrinólisis PAI-1 66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL (p<0.006). En el marcador de inflamación, PCR-us no se observó diferencia significativa, respecto al grupo control 0.45 ± 0.6 vs. 0.38 ± 0.4 mg/dL (p<0.28). Conclusiones: Estos resultados sugieren la presencia de un estado protrombótico con disfunción del sistema fibrinolítico, en sujetos intolerantes a la glucosa.

Objective: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and infammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and infammation. Methods: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ±9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ±11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfuntion was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the infammatory marker studied was hs-C reactive protein (hs-CRP). Results: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p < 0.01) and fibrinogen (317.7 ±32.1 vs. 266.7 ±25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/ mL) (p < 0.006). However, hs-CRP, as infammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). Conclusion: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

Changes of molecular markers of prothrombotic c state in plasma and puerarin for treatment of acute pancreatitis / 中国综合临床

ObjectiveTo study changes of molecular markers of prothrombotic state:Platelet granule membrane protein ( GMP-140 ),Von Willebrand factor ( vWF:Ag),thrombomodulin (TM),Two-D dimer ( DD),antithrombin Ⅲ ( AT- Ⅲ ) in plasma and puerarin for treatment functions of acute pancreatitis (AP).MethodsIn 78 patients with AP [ severe acute pancreatitis (SAP):26 cases,mild acute pancreatitis (MAP):52 cases ],using a random number table,the patients were given puerarin treated base (n =40) and conventional treated base group (n =38 ).The two groups were given fast,continuous gastrointestinal decompression,correction of electrolyte and acid-base balance disorders,vein support,antisecretory drugs,antibiotics inhibit pancreatic secretion and inhibition of trypsin activity of drug treatment.Puerarin group:Puerarin injection 0.5 g in 5％glucose injection intravenous infusion of 500 ml,1 time a day.GMP-140 vWF:Ag,TM,DD were measured by the methods of analysis of enzyme-linked immunosorbent assay and AT-Ⅲ was measured by the methods of analysis of chromogenic substrate method preformed in all patients,plasma amylase and uric amylase were determined by the method of somogyi and after the treatment.And 22 healthy people were selected as normal controls ( NC,Group C,n =22).ResultsCompared with the Group C and MAP,the plasma GMP-140 [ ( 86.26 ± 15.28 )ng/Lvs (32.56 ± 18.17) ng/L and (58.68 ± 15.86)ng/L],vWF[(236.22 ±31.78)％vs (95.12 ±31.68)％ and (126.68 ± 17.06)％ ],TM [(65.70 ± 12.27) μg/L vs (4.26 ±0.92) μg/L and (9.80 ± 6.98) μg,/L],DD [ (0.87 ±0.04) mg/L vs (0.36 ±0.06) mg/L and (0.56 ±0.05) mg/L] were significantly elevated,however the AT-Ⅲ [ (56.13 ± 15.78) U/ml vs (98.76 ±22.68) U/ml and (80.38 ± 18.29)U/ml )was significantly decreased SAP ( P ＜ 0.01 ).There were significant differences on the levels of GMP-140 [ (31.52 ± 15.81 ) ng/L vs (59.62 ± 13.73 ) ng/L,t =- 23.283 ],vWF [ ( 93.32 ± 28.62) ％ vs ( 128.81 ±16.23)％,t=-28.205,P＜0.01 ],TM[ (4.36 ± 0.82) μg,/L vs (11.23 ± 7.62)μg/L,t =-43.419,P ＜0.001],DD[ (0.32 ±0.05) mg/L vs (0.68 ±0.04) mg/L,t =- 15.642,P ＜0.001],AT-Ⅲ ((97.68 ±21.69) U/ml vs (76.86 ± 17.92) U/m,t =14.967,P ＜ 0.01 ) between puerarin treated base group and conventional treated base group.Comparing with treated base,the group given puerarin obviously shortened the increased of plasma [ ( 81.26 ± 17.12) U/L vs ( 119.63 ± 51.87 ) U/L,t =- 7.618,P ＜ 0.001 ],uric amylase [ (416.37 ± 116.50) U/L vs (576.32 ± 126.58) U/L,t =- 36.659,P ＜ 0.001 ],the time of abdominal pain relief and therapy to spend [ ( 2.18 ± 0.76 ) d vs ( 5.26 ± 0.58 ) d,t =- 13.619,P ＜ 0.001 ].Conclusion The molecular markers of prothrombotic state:GMP-140,vWF:Ag,TM,DD,AT- Ⅲ might all play key roles in the development of AP.Puerarin can improve the pancreatic microcirculation and adjust molecular markers of prothrombotic state,and had certain treatment functions with AP.

Fribrinolysis Kinetics and Its Application / 华中科技大学学报（医学）（英德文版）

A new, convenient, and rapid method for kinetic measurement of human fibrinolysis was established. The alteration of absorbance (A) in the process of blood coagulation and lyses was automatically scanned and recorded using a UV2000 spectrophotometer connected to a computer. The parameters of human fibrinolysis kinetics were established. Urokinase at 20 U/mL was the optimal concentration used. There was significant difference in fibrinolysis kinetics and plasma plasminogen concentration between 22 normal subjects and 27 patients with acute myeloblastic leukemia (P＜0.05 and ＜0.01 respectively). The coefficience of variation was (5.24±1.51)%. This method could also be used to measure the plasma fibrinogen concentration at the same time. It was concluded that this method was stable and was capable of providing dynamic, direct experimental data and multiparemeters for clinicians. It was also valuable in evaluating the anti- and pro-fibrinolytic capcity of patients' plasmas, allowing for monitoring of therapy, choice of drugs and adjustment of drug concentrations.

Application of overall hemostasis potential experiment in the high-risk population of prethrombotic state / 西安交通大学学报(医学版)

Objective To investgate the application of overall hemostasis potential (OHP) experiment in the high-risk population of prethrombotic state (PTS). Methods The change of absorbance in fibrin formation and degradation was measured with a spectrophotometer at 340 nm when the plasma clotting was triggered by the low concentration of TF in the presence of urokinase. The OHP,overall coagulation potential (OCP) and the overall fibrinolysis potential (OFP) were obtained from the coagulation-fibrinolysis curve based on the computer analysis. To evaluate this OHP method,52 cancer patients,31 coronary artery disease patients,27 mid/late-stage pregnancy women and 100 healthy controls were detected. In addition,the plasma fibrinogen was detected and its correlation with OHP was studied. Results The level of OCP and OHP in PTS high-risk population was significantly higher in cancer,coronary heart disease patients and the mid/late-stage pregnancy women than in the healthy controls (P0.05). Conclusion The OHP assay may indicate the hemostatic balance; therefore,it can be used for evaluation of PTS.