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Prognostic outcome of intravenous thrombolysis in elderly patients aged ≥ 60 years with acute ischemic stroke by ASTRAL and THRIVE scales. ASTRAL 和 THRIVE 量表对≥60 岁急性缺血性脑卒中老年患者静脉溶栓预后的评估。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-09-06 DOI: 10.1007/s11239-024-03039-1
Yani Fan, Guoyan Shi, Sujie Wang, Yadan Lu, Xianghui Kong, Lili Chen

This study aimed to validate the predictive performance of ASTRAL and THRIVE scales when used for patients aged 60 years and older with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). All enrolled patients received IVT therapy. The enrolled patients were divided into two groups in accordance with the modified Rankin scale(mRS) score at the time of discharge: good-outcome (mRS ≤ 2) and poor-outcome (mRS ≥ 3) groups. The receiver operating characteristic (ROC) curve was plotted using MedCalc software, the area under the ROC curve (AUC) was calculated. The Delong test was used to compare the predictive performance of ASTRAL and THRIVE scales, with P < 0.05 being considered a statistically significant difference. The AUCs of ASTRAL and THRIVE in predicting poor outcomes after thrombolysis in elderly patients with AIS were 0.771 and 0.701, respectively. The difference in AUC between ASTRAL and THRIVE was 0.070, and a statistically significant difference (P < 0.05) was found. ASTRAL's predictive performance was better than that of THRIVE. ASTRAL is a reliable predictive tool for assessing the poor outcome of IVT therapy for elderly patients aged ≥ 60 years with AIS.

本研究旨在验证 ASTRAL 和 THRIVE 量表对 60 岁及以上急性缺血性脑卒中(AIS)患者静脉溶栓(IVT)后的预测性能。所有入组患者均接受了静脉溶栓治疗。根据患者出院时的改良Rankin量表(mRS)评分将其分为两组:良好结果组(mRS≤2)和不良结果组(mRS≥3)。使用 MedCalc 软件绘制接收者操作特征(ROC)曲线,并计算 ROC 曲线下面积(AUC)。德隆检验用于比较 ASTRAL 和 THRIVE 量表的预测性能,P
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引用次数: 0
Letter to the editor to ''Elevated plasma protein carbonylation increases the risk of ischemic cerebrovascular events in patients with atrial fibrillation: association with a prothrombotic state''. 致编辑的信 "血浆蛋白羰基化升高会增加心房颤动患者发生缺血性脑血管事件的风险:与促血栓形成状态有关"。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-10-05 DOI: 10.1007/s11239-024-03035-5
Qinmei Huang, Wenjing Cheng
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引用次数: 0
The COVID-19 thrombus: distinguishing pathological, mechanistic, and phenotypic features and management. COVID-19血栓:病理、机制和表型特征的区分及处理。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-11-04 DOI: 10.1007/s11239-024-03056-0
Luis Del Carpio-Orantes
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引用次数: 0
Ghrelin may protect against vascular endothelial injury in Acute traumatic coagulopathy by mediating the RhoA/ROCK/MLC2 pathway. 胃泌素可通过介导 RhoA/ROCK/MLC2 通路,防止急性创伤性凝血病的血管内皮损伤。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-23 DOI: 10.1007/s11239-024-03029-3
Chengjian He, Xiaojing Song, Zigui Zhu, Yan Xiao, Jiacheng Chen, Hongyi Yao, Rongjun Xie

Ghrelin exerts widespread effects in several diseases, but its role and mechanism in Acute Traumatic Coagulopathy (ATC) are largely unknown. The effect of ghrelin on cell proliferation was examined using three assays: 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT), Lactate Dehydrogenase (LDH), and flow cytometry. The barrier function of the endothelial cells was evaluated using the Trans-Endothelial Electrical Resistance (TEER) and the endothelial permeability assay. An ATC mouse model was established to evaluate the in vivo effects of ghrelin. The Ras homolog family member A (RhoA) overexpression plasmid or adenovirus was used to examine the molecular mechanism of ghrelin. Ghrelin enhanced Human Umbilical Vein Endothelial Cells (HUVEC) proliferation and endothelial cell barrier function and inhibited HUVEC permeability damage in vitro. Additionally, ghrelin decreased the activated Partial Thromboplastin Time (aPTT) and Prothrombin Time (PT) in mice blood samples in the ATC mouse model. Ghrelin also improved the pathological alterations in postcava. Mechanistically, ghrelin acts through the RhoA/ Rho-associated Coiled-coil Containing Kinases (ROCK)/ Myosin Light Chain 2 (MLC2) pathway. Furthermore, the protective effects of ghrelin, both in vitro and in vivo, were reversed by RhoA overexpression. Our findings demonstrate that ghrelin may reduce vascular endothelial cell damage and endothelial barrier dysfunction by blocking the RhoA pathway, suggesting that ghrelin may serve as a potential therapeutic target for ATC treatment.

胃泌素在多种疾病中发挥着广泛的作用,但它在急性创伤性凝血病(ATC)中的作用和机制却大多不为人知。研究人员使用 3-(4,5-二甲基-2-噻唑基)-2,5-二苯基-2-H-溴化四氮唑(MTT)、乳酸脱氢酶(LDH)和流式细胞术三种检测方法研究了胃泌素对细胞增殖的影响。使用跨内皮电阻(TEER)和内皮通透性试验评估了内皮细胞的屏障功能。为了评估胃泌素的体内效应,我们建立了一个 ATC 小鼠模型。利用Ras同源家族成员A(RhoA)过表达质粒或腺病毒来研究胃泌素的分子机制。胃泌素在体外增强了人脐静脉内皮细胞(HUVEC)的增殖和内皮细胞屏障功能,并抑制了HUVEC的通透性损伤。此外,胃泌素还能降低 ATC 小鼠模型中小鼠血液样本的活化部分凝血活酶时间(aPTT)和凝血酶原时间(PT)。胃泌素还能改善腔静脉后的病理改变。从机理上讲,胃泌素是通过RhoA/Rho相关线圈包含激酶(ROCK)/肌球蛋白轻链2(MLC2)途径发挥作用的。此外,体外和体内胃泌素的保护作用会因 RhoA 的过表达而逆转。我们的研究结果表明,胃泌素可通过阻断 RhoA 通路减轻血管内皮细胞损伤和内皮屏障功能障碍,这表明胃泌素可作为治疗 ATC 的潜在治疗靶点。
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引用次数: 0
Correction to: Anticoagulation control among patients on vitamin K antagonists in nine countries in SubSaharan Africa. 更正:撒哈拉以南非洲九国维生素 K 拮抗剂患者的抗凝控制。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1007/s11239-024-03037-3
Julius Chacha Mwita, Joel Msafri Francis, Chriselda Pillay, Okechukwu S Ogah, Yadeta Dejuma Goshu, Francis Agyekum, John Mukuka Musonda, Maduka Chiedozie James, Endale Tefera, Tsie Kabo, Irene Keolebile Ditlhabolo, Kagiso Ndlovu, Ayoola Yekeen Ayodele, Wigilya P Mikomangwa, Pilly Chillo, Albertino Damasceno, Aba Ankomaba Folson, Anthony Oyekunle, Erius Tebuka, Fredrick Kalokola, Karen Forrest, Helena Dunn, Kamilu Karaye, Fina Lubaki Jean-Pierre, Chala Fekadu Oljira, Tamrat Assefa, Tolulope Shogade Taiwo, Chibuike E Nwafor, Olufemi Omole, Raphael Anakwue, Karen Cohen
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引用次数: 0
E-Cigarettes induce expression of procoagulant tissue factor in cultivated human endothelial cells. 电子烟诱导培养的人类内皮细胞表达促凝血组织因子。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-29 DOI: 10.1007/s11239-024-03018-6
Plinio Cirillo, Mariarosaria Morello, Gisella Titolo, Laura Marra, Andrea Morello, Gennaro De Rosa, Domenico Cozzolino, Akhmetzhan Sugraliyev, Giovanni Cimmino

Background: E-cigarettes (ECIG) are proposed as an alternative for regular tobacco users with less dangerous effects for health. Several studies demonstrated that ECIG exert deleterious cardiovascular effects and promote platelet dependent thrombosis. However, ECIG role on Tissue Factor-dependent thrombosis is still unknown. Dysfunctional endothelial cells (ECs) are known to express Tissue Factor (TF) on their surface. Aim of the present study was to investigate whether ECIG might promote TF expression in ECs, shifting them to a pro thrombotic phenotype.

Methods: Human Umbilical Vein Endothelial Cells (HUVEC) were incubated with increasing doses of ECIG (commercially available and mix of propylene glycol/vegetable glycerine/nicotine 18 mg/mL) up to 1.8 mg/mL. TF gene expression and protein levels were assessed at different time points by Real Time PCR and Western Blot, respectively. TF surface expression and activity were also measured by FACS analysis and coagulation assay. Finally, NF-kB translocation was investigated as possible mechanism of action. Potential protective effects by Rosuvastatin were also investigated.

Results: ECIG significantly increased TF expression at both gene and protein levels in a time and dose dependent manner. Surface expression and procoagulant activity were increased as well. These phenomena appeared modulated by the NF-κB pathway. Rosuvastatin reduced ECIG effects on TF-mRNA.

Conclusions: Although in vitro, we indicate that ECIG promote a pro thrombotic phenotype in ECs via expression of functional TF. Data of the present study permit to shed a brighter light on the still partially unresolved issue about the role of ECIG in development of cardiovascular diseases suggesting that they might represent a potential risk factor for thrombotic cardiovascular events.

背景:电子烟(ECIG)被建议作为普通烟草使用者的替代品,对健康的危害较小。多项研究表明,电子烟对心血管产生有害影响,并促进血小板依赖性血栓形成。然而,ECIG 对组织因子依赖性血栓形成的作用尚不清楚。已知功能失调的内皮细胞(ECs)表面会表达组织因子(TF)。本研究旨在探讨 ECIG 是否会促进内皮细胞中 TF 的表达,使其转变为有利于血栓形成的表型。方法:将人脐静脉内皮细胞(HUVEC)与剂量不断增加的 ECIG(市售,丙二醇/植物甘油/烟碱 18 毫克/毫升的混合物)培养,最高剂量为 1.8 毫克/毫升。在不同的时间点,分别通过 Real Time PCR 和 Western Blot 评估 TF 基因表达和蛋白水平。此外,还通过 FACS 分析和凝血试验测定了 TF 的表面表达和活性。最后,还研究了 NF-kB 迁移的可能作用机制。此外,还研究了瑞舒伐他汀的潜在保护作用:结果:ECIG 以时间和剂量依赖的方式在基因和蛋白水平上明显增加了 TF 的表达。表面表达和促凝活性也有所增加。这些现象似乎受 NF-κB 通路的调节。瑞舒伐他汀降低了 ECIG 对 TF-mRNA 的影响:尽管是在体外,但我们发现 ECIG 通过表达功能性 TF 促进了 EC 的促血栓形成表型。本研究的数据使人们对 ECIG 在心血管疾病发展中的作用这一仍未解决的问题有了更清晰的认识,表明 ECIG 可能是血栓性心血管事件的潜在风险因素。
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引用次数: 0
Interindividual variability in platelet reactivity among individuals with or without antiplatelet therapy: results from a large tertiary care hospital. 接受或未接受抗血小板治疗者的血小板反应性个体间差异:一家大型三级医院的研究结果。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-09-06 DOI: 10.1007/s11239-024-03022-w
Mattia Galli, Sergio Terracina, Eleonora Schiera, Massimo Mancone, Luigi Frati, Dominick J Angiolillo, Fabio M Pulcinelli

Antiplatelet therapy is crucial for reducing thrombotic events in patients with atherosclerotic disease, but the response vary widely among individuals. The identification of patients at high (HPR), optimal (OPR) or low platelet reactivity (LPR) is dependent on high interlaboratory variability. We report results of a large dataset of patients to assess the gold standard light transmission aggregometry (LTA). A total of 11,913 patients who sequentially underwent LTA assessment using several stimuli (ADP-2µM, collagen-2 µg/ml, arachidonic acid 0.5 mM, epinephrine 10µM) with a standardized methodology between 2004 and 2022 were screened. After application of inclusion-exclusion criteria, 5,901 patients were included and divided into five groups: healthy-volunteers (HV; N = 534); controls (CTR; N = 1073); aspirin-treated patients (ASA; 75-150 mg/die; N = 3280); clopidogrel-treated patients (CLOP; 75 mg/die; N = 495) and patients treated with dual antiplatelet therapy, ASA plus CLOP (DAPT; N = 519). The mean PA% in response to ADP 2 μm was 72.4 ± 33.3 in the CTR population, 40.6 ± 29.9 in the ASA group, 25.1 ± 35.1 in the CLOP group and 10.2 ± 18.5 in the DAPT group. The mean PA% in response to collagen 2 ug/ml was 90.7 ± 10.5 in the CTR population, 40.8 ± 26.3 in the ASA group, 79.4 ± 21.8 in the CLOP group and 17.9 ± 19.9 in the DAPT group. The percentage of patients at OPR following ADP stimuli was 66%, 25%, and 26%, in the ASA, CLOP, and DAPT group, respectively. The percentage of patients at OPR following collagen stimuli was 56%, 22%, and 41%, in the ASA, CLOP, and DAPT group, respectively. LTA was significantly increased in response to ADP (72.4 ± 33.3vs62.7 ± 37.1; p < 0.001) and AA (90.7 ± 15.6vs87.6 ± 20.5; p < 0.001) in CTR compared to HV. Our findings support the concept that a significant proportion of individuals present a hyper- or hypo-reactive platelet phenotype potentially affecting the safety and efficacy of antiplatelet therapy. The variability in response to antiplatelet therapy was particularly evident in patients undergoing single as opposed to dual antiplatelet therapy regimens. These data support ongoing strategies of guided selection of antiplatelet therapy in patients with cardiovascular disease.

抗血小板治疗对减少动脉粥样硬化患者的血栓事件至关重要,但不同个体的反应差异很大。对高血小板反应性(HPR)、最佳血小板反应性(OPR)或低血小板反应性(LPR)患者的识别取决于实验室间的高变异性。我们报告了一个大型患者数据集的结果,以评估黄金标准透光聚集测定法(LTA)。2004年至2022年期间,共有11913名患者采用标准化方法(ADP-2µM、胶原蛋白-2 µg/ml、花生四烯酸0.5 mM、肾上腺素10µM)依次接受了LTA评估。在应用纳入-排除标准后,5901 名患者被纳入并分为五组:健康志愿者(HV;N = 534);对照组(CTR;N = 1073);阿司匹林治疗患者(ASA;75-150 mg/die;N = 3280);氯吡格雷治疗患者(CLOP;75 mg/die;N = 495)和接受双重抗血小板疗法(ASA 加 CLOP;DAPT;N = 519)的患者。CTR 患者对 ADP 2 μm 反应的平均 PA% 为 72.4 ± 33.3,ASA 组为 40.6 ± 29.9,CLOP 组为 25.1 ± 35.1,DAPT 组为 10.2 ± 18.5。CTR人群对胶原蛋白2微克/毫升反应的平均PA%为(90.7 ± 10.5),ASA组为(40.8 ± 26.3),CLOP组为(79.4 ± 21.8),DAPT组为(17.9 ± 19.9)。ASA 组、CLOP 组和 DAPT 组患者在受到 ADP 刺激后出现 OPR 的比例分别为 66%、25% 和 26%。ASA 组、CLOP 组和 DAPT 组患者在受到胶原刺激后出现 OPR 的比例分别为 56%、22% 和 41%。LTA对ADP的反应明显增加(72.4 ± 33.3vs62.7 ± 37.1; p
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引用次数: 0
The COVID-19 thrombus: distinguishing pathological, mechanistic, and phenotypic features and management. COVID-19血栓:病理、机制和表型特征的区分及处理。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-08-23 DOI: 10.1007/s11239-024-03028-4
Richard C Becker, Udaya S Tantry, Muhammad Khan, Paul A Gurbel

A heightened risk for thrombosis is a hallmark of COVID-19. Expansive clinical experience and medical literature have characterized small (micro) and large (macro) vessel involvement of the venous and arterial circulatory systems. Most events occur in patients with serious or critical illness in the hyperacute (first 1-2 weeks) or acute phases (2-4 weeks) of SARS-CoV-2 infection. However, thrombosis involving the venous, arterial, and microcirculatory systems has been reported in the subacute (4-8 weeks), convalescent (> 8-12 weeks) and chronic phases (> 12 weeks) among patients with mild-to-moderate illness. The purpose of the current focused review is to highlight the distinguishing clinical features, pathological components, and potential mechanisms of venous, arterial, and microvascular thrombosis in patients with COVID-19. The overarching objective is to better understand the proclivity for thrombosis, laying a solid foundation for screening and surveillance modalities, preventive strategies, and optimal patient management.

血栓形成风险增加是 COVID-19 的特征之一。丰富的临床经验和医学文献描述了静脉和动脉循环系统小(微)血管和大(宏)血管受累的特点。大多数事件发生在 SARS-CoV-2 感染的超急性期(最初 1-2 周)或急性期(2-4 周)的重症或危重病人身上。不过,也有报道称,在轻中度患者的亚急性期(4-8 周)、康复期(> 8-12 周)和慢性期(> 12 周),静脉、动脉和微循环系统也会出现血栓形成。本次重点综述旨在强调 COVID-19 患者静脉、动脉和微血管血栓形成的临床特征、病理成分和潜在机制。总体目标是更好地了解血栓形成的倾向,为筛查和监测方式、预防策略和最佳患者管理奠定坚实的基础。
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引用次数: 0
A nomogram predicting venous thromboembolism risk in primary liver cancer patients. 预测原发性肝癌患者静脉血栓栓塞风险的提名图。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-09-21 DOI: 10.1007/s11239-024-03041-7
Haike Lei, Xiaosheng Li, Zuhai Hu, Qianjie Xu, Qingdong Li, Rong Zhou, Qianwen Yu, Jing Xiao

Cancer frequently causes venous thromboembolism (VTE), a leading cause of cancer-related mortality. Primary liver cancer (PLC) is prevalent and highly fatal, with an increased risk of venous thrombotic complications. Thus, we aimed to develop a nomogram model for predicting VTE in patients with PLC. We retrospectively analyzed 1,565 patients diagnosed with PLC between January 2018 and December 2022 at Chongqing University Cancer Hospital. Univariate logistic analysis and multivariate logistic regression identified eight significant risk factors: activated partial thromboplastin time (APTT) ≤ 32.20 s, D-dimer > 1.44 mg/L, lymphocyte count (LYM) ≤ 1.18 × 109/L, monocyte count (MONO) > 0.42 × 109/L, transarterial chemoembolization (TACE), surgical intervention, immunotherapy, and β2-microglobulin. The nomogram model exhibited strong discriminatory power, with C indices of 0.753 and 0.710 for the training and validation cohorts, respectively. The calibration curve showed a strong correlation between predicted and actual probabilities. Additionally, decision curve analysis (DCA) and clinical impact curves (CIC) confirmed the model's clinical utility. This nomogram facilitates the identification of high-risk PLC patients, allowing for timely preventive and therapeutic interventions to reduce the risk of thrombosis.

癌症经常导致静脉血栓栓塞(VTE),这是癌症相关死亡的主要原因。原发性肝癌(PLC)发病率高,死亡率高,静脉血栓并发症的风险增加。因此,我们的目标是建立一个预测 PLC 患者 VTE 的提名图模型。我们回顾性分析了重庆大学附属肿瘤医院2018年1月至2022年12月期间确诊的1565例PLC患者。单变量逻辑分析和多变量逻辑回归确定了8个重要的风险因素:活化部分凝血活酶时间(APTT)≤32.20 s、D-二聚体>1.44 mg/L、淋巴细胞计数(LYM)≤1.18 × 109/L、单核细胞计数(MONO)>0.42 × 109/L、经动脉化疗栓塞(TACE)、手术干预、免疫治疗和β2-微球蛋白。提名图模型具有很强的判别能力,训练组和验证组的 C 指数分别为 0.753 和 0.710。校准曲线显示,预测概率与实际概率之间具有很强的相关性。此外,决策曲线分析(DCA)和临床影响曲线(CIC)证实了该模型的临床实用性。该提名图有助于识别高风险的 PLC 患者,以便及时采取预防和治疗干预措施,降低血栓形成的风险。
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引用次数: 0
Intravenous thrombolysis or dual antiplatelet therapy for minor ischemic stroke? 轻微缺血性中风的静脉溶栓治疗还是双重抗血小板治疗?
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 Epub Date: 2024-10-03 DOI: 10.1007/s11239-024-03046-2
Li Zhou, Mingxin Wang
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引用次数: 0
期刊
Journal of Thrombosis and Thrombolysis
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