Changes and significance of the fibrinolytic system following two pulmonary thromboembolisms in a rabbit model.

In this study, we examined the changes in the fibrinolytic system in a rabbit model of two acute pulmonary thromboembolisms (PTE). Fourteen healthy adult New Zealand white rabbits were divided into three groups: the single PTE group (five rabbits), the double PTE group (five rabbits), and the control group (four rabbits). A rabbit model of acute pulmonary embolism was established, and immunohistochemistry and polymerase chain reaction (PCR) were performed on tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) in plasma, and pulmonary embolism tissue. Plasma results: 1) t-PA levels: one hour following the initial modeling, the levels of t-PA in the modeling groups were significantly lower than those in the control group (P<0.05). In addition, the t-PA levels in the double PTE group were found to be lower after the modeling, as compared to the pre-modeling period (P<0.05). One hour after the second modeling, the double PTE group had lower t-PA levels compared to the control group (P<0.05). However, t-PA rebounded two hours after modeling in the double PTE group. One week after the second modeling, the double PTE group had higher t-PA levels compared to the other two groups (P<0.05). 2) PAI-1 results: one hour after the initial modeling, PAI-1 levels in the two modeling groups were lower compared to the pre-modeling period and control groups (P<0.05). Two hours following modeling, PAI-1 levels in both modeling groups were lower compared to the control group (P<0.05). PAI-1 levels were lower in the double PTE group one and two hours after the second modeling compared to the other two groups and pre-modeling period (P<0.05). 3) The immunohistochemistry results: the expression of PAI-1 decreased in the two modeling groups, while t-PA expression increased compared to the control group. 4) PCR results: t-PA mRNA expression did not differ among the three groups. The PAI-1 mRNA expression was lower in the two PTE groups compared to the control group. We conclude that in the early stages of PTE, the local fibrinolytic activity of the thrombus is increased, which is favorable for thrombolysis. However, as the thrombus persists, the activity of the fibrinolytic system is inhibited, contributing to the development of chronic thromboembolic pulmonary hypertension.

[The effect of tri-modality therapy on the treatment of muscle-invasive bladder cancer].

Objective: To explore the effect of radical TURBT combing with concomitant chemo-radiotherapy for muscle-invasive bladder cancer (MIBC). Methods: From 2010 to 2015, 73 patients were diagnosed as MIBC, in which 28 patients (TMT Group) received tri-modality bladder sparing treatment, including 21 males and 7 females, mean age (68.9±8.9) yr. There were 16 cases of T(2), 12 cases of T(3). 45 patients (RC Group) received radical cystectomy (RC), including 32 males and 13 females, mean age (66.3±9.6) yr. There were 25 cases of T(2), 18 cases of T(3) and 2 cases of T(4a). The effect of two treatment modality and influence for patient's life quality were retrospective analysis. Results: The overall survival (OS) rate of TMT group was 64.3%, cancer specific survival (CSS) rate was 78.6%. And the OS rate of RC group was 66.7%, CSS rate was 82.2%. There was no statistical difference between two groups. The life quality of TMT group was better than that of RC group. Conclusion: In strict control of indication criterion, rigorous postoperative follow-up and timely salvage radical cystectomy, tri-modality therapy can be used as a new option of muscle-invasive bladder cancer.

[Selective bladder preservation in muscle-invasive bladder cancer by transurethral resection combined with intravesical instillation therapy: analysis of clinical effect in the elderly].

OBJECTIVE: To explore the therapeutic effect and quality of life in elderly patients of muscle-invasive bladder cancer by transurethral resection combined with intravesical instillation therapy. METHODS: From January 2005 to January 2015, 136 cases were diagnosed with T2 bladder cancer by transurethralplasmakinetic therapy or transurethral laser therapy. The data of 136 cases were analyzed retrospectively. RESULTS: In transurethralplasmakinetic therapy group, the overall survival rate was 73.3%, the cancer-specific survival rate was 85.6%, the average survival time were 65 months. In transurethral laser therapy group, the overall survival rate was 73.9%, the cancer-specific survivalrate was 87.2%, the average survival time were 70 months. Two methods also can improve the patient's quality of life. CONCLUSION: For the aged with invasive bladder cancer (T2), we could try the transurethral resection combined with intravesical instillation therapy.

Consequences of additional use of contrast-enhanced (18)F-FDG PET/CT in target volume delineation and dose distribution for pancreatic cancer.

OBJECTIVE: To compare the differences between contrast-enhanced (CE) fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and CECT in target volume delineation and radiotherapy (RT) dose distribution, and to evaluate the sparing of organs at risk (OARs) in the treatment plan of locally advanced pancreatic cancer (LAPC). METHODS: 21 consecutive patients with LAPC with histologically or cytologically confirmed adenocarcinoma underwent both non-CECT and (18)F-FDG scans; 11 of whom also underwent CECT scans. Intensity-modulated RT plans (prescribed dose, 54 Gy) were constructed to cover the corresponding gross tumour volume (GTV). The differences among GTVCT, GTVPET, GTVPET-CT and OARs in these different image sets as well as the uniformity of target dose were analysed. RESULTS: The mean non-CE GTVCT, GTVPET and GTVPET-CT were 76.9 ± 47.8, 47.0 ± 40.2 and 44.5 ± 34.7 cm(3) (mean ± standard deviation), respectively. The non-CE GTVPET-CT was significantly smaller than the non-CE GTVCT (p < 0.001). The CE GTVPET-CT was significantly smaller than the CE GTVCT (p = 0.033). For both the non-CE GTVCT and the CE GTVCT, the intestine V40 (the percentage of the intestine volume irradiated by 40 Gy), intestine V50, intestine Dmax (the mean maximum dose), cord Dmax, left kidney V30, right kidney V30, left kidney Dmean (the mean dose), right kidney Dmean and liver V30 were 5.90%, 2.52%, 5500 cGy, 2194 cGy, 3.40%, 0.68%, 747 cGy, 550 cGy and 5.37%, respectively. There are significant differences between the non-CE CT and the non-CE PET-CT in intestine Dmax (p = 0.023) and right kidney Dmean (p = 0.029). CONCLUSION: Co-registration of (18)F-FDG PET with CECT may improve the accuracy of GTV delineation in LAPC and might reduce the adverse effect of irradiation. ADVANCES IN KNOWLEDGE: Individual adaptation of RT based on functional CE (18)F-FDG PET/CT imaging is possible and highly promising in LAPC.

[Prolactin in normal pregnancy and severe pregnancy-induced hypertension].

OBJECTIVE: This study was to investigate the relationship between serum prolactin and pregnancy-induced hypertension. METHOD: Maternal serum prolactin was estimated by radioimmunoassay in 89 normal pregnant women and 52 patients with severe pregnancy-induced hypertension at 28 to 42 week gestation. RESULTS: In normal pregnancy, prolactin level increased progressively from a mean value of 270 mg.L-1 in the 24th week to 440 mg.L-1 in the 34th week and decreased progressively from the 38th week to the 40th week. In severe pregnancy-induced hypertension increased progressively too; 31 of 52 patients with severe prolactin showed high prolactin levels in zone A (> mean value + standard of prolactin values in the normal pregnancy), 10 patients in zone B (mean + standard to mean) and 11 patients in zone C (< mean). CONCLUSION: These results suggest that high prolactin levels may play an important role in the pathogenesis of severe pregnancy-induced hypertension.

[Intravesical instillation of combined adriamycin and verapamil in preventing recurrence of superficial bladder tumor].

Multidrug-resistance of the tumor cells is the main cause for failure of chemotherapy. Such resistance is correlated to P-glycoprotein 170, which can pump the chemotherapeutic agent out of the tumor cells. This action could be reversed by verapamil through competition for closely related binding sites on P-glycoprotein. Twenty-four postoperative cases of superficial bladder tumors were treated by intravesical instillation of combined adriamycin and verapamil, and they were followed up for 17-35 months (average 24.5 months). Two cases (8.7%) had recurrence. NO marked toxicity and side-effects were observed. Verapamil working as a drug-resistance reversing agent might be used in some other tumors not sensitive to chemotherapy.