【Abstract】Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator( t-PA) and plasminogen activator inhibitor-1( PAI-1) in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion. t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ ( 52. 49 ±31. 46) ng /mL and ( 58. 12 ±23. 14) ng /mL vs ( 37. 39 ±22. 44) ng /mL, P lt; 0. 05] , but was not statistically different between malignant pleural fluid and transudative ( P gt; 0. 05) . PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ ( 164. 86 ±150. 22) ng/mL and ( 232. 42 ±175. 77) ng/mL vs ( 46. 38 ±16. 13) ng/mL, P lt; 0. 01] , but was not statistically different between malignant and infectious pleural fluid( P gt;0. 05) . D-dimer levels in the three types of pleural fluid were significantly different, which was ( 23. 66 ±25. 18) mg/L, ( 6. 36 ±10. 87) mg/L and ( 66. 90 ±42. 17) mg/L in malignant, transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was gt; 38. 7 ng/mL( area under ROC curve was 64. 0 ) , with sensitivity of 60. 0% , specificity of 63. 6%, positive predictive value of 66. 7%, negative predictive value of 56. 8% and accuracy of 61. 6% .The cutoff of D-dimer was lt; 27. 0 mg/L( area under ROC curve was 85. 5) , with sensitivity of 84. 8% ,specificity of 72. 5% , positive predictive value of 85. 3% , negative predictive value of 71. 8% and accuracy of78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination( t-PA + D-dimer) were 92. 5% , 60. 6% , 74. 0% , 87. 0% , 78. 1% , respectively.Conclusions The t-PA, PAI-1 and D-dimer levels are significantly different in the three types of pleural fluid. The detection of fibrinolytic parameters in pleural fluid, especially the value of D-dimer,may be helpful in the differential diagnosis of pleural effusion.
Objective To observe the effect of medicineinduced posterior vitreous detachment (PVD) on proliferative vitreoretinopathy (PVR). Methods PVR was induced in the left eyes of 24 pigmented rabbits by intravitreal injection with platelet rich plasma. The rabbits were randomly divided into two experimental groups (group A and B) and one control group with 8 eyes in each group. Three hours later, the eyes in group A and B and the control group underwent intravireal injection with 1 U plasmin 0.05 ml+20 U hyaluronidase 0.05 ml, plasmin 0.1 ml, and balance salt solution 0.1 ml, respectively. The grade of PVR was recorded 1, 7, and 28 days after the intravitreal injection, and the eyes were examined by flash electroretinogram (FERG), B-scan, and retinal histopathological examination. Results The PVR models of rabbit eyes were induced successfully. On the 7th day after injection, complete and partial PVD was found in 5 and 3 eyes respectively in group A; partial PVD in 5 eyes and no complete PVD was observed in group B; there was no PVD in the other 3 eyes in group B and also in the eyes in the control group. On the 28th day after intravitreal injection, PVR grade of group A and B were both obviously lower than that of the control group（D=75.6, 98.9；P=0.003，P=0.011）; On the 7th and 28th day after injection, the b-wave amplitude in group A and B was significantly higher than that in the control group; PVR grade of the PVD eyes was lower than that of nonPVD eyes; PVR grade of the complete PVD eyes was only 0～1. Conclusions Three hours after the PVR models of rabbit eyes were induced, complete PVD induced by intravitreal injection of plasmin combined with hyaluronidase could prevent the development of PVR of rabbit eyes in some degree; partial PVD induced by plasmin alone or combined with hyaluronidase could relieve the development of PVR.
Objective To observe the therapeutic effects of vitrectomy combined with tissue plasminogen activator(r-tPA) and fraxiparine on bacterial endophthalmitis. Methods Forty pigmented rabbits were randomly divided into experimental and control group with 20 rabbits in each. The left eyes underwent intra-vitreous injection with 10 5/ml bacteria of staphylococcus epidermidis 0.1 ml. After 8-4 hours, vitrectomy was performed on all of the animals. Fraxiparine with the final concentration of 6 IU/ml was only added to balanced salt solution in the experimental group during the operation, and the extend of intraocular fibrin exudation was observed by slit lamp and indirect ophthalmoscope after the operation. If the exudation occurred on the 1st, 3rd, 7th, 14th and 21st day postoperatively, 125 mg/ml r-tPA 0.1 ml should be injected into vitreous from the 1st day after operation on. Results Fibrin exudation in the pupil area and vitreous body was much less in experimental group than that in the control group after the surgery. Conclusion vitrectomy combined with r-tPA and fraxiparine may alleviate the extent of fibrosis in bacterial endophthalmitis and improve the prognosis. (Chin J Ocul Fundus Dis, 2005, 21: 391-393)
Objective To detect the effects of plasmin combined with hyaluronidase or hexafluoride SF6 on inducing posterior vitreous detachment (PVD). Methods Eighteen young pigmented rabbits were randomly divided into group A, B, and C with 6 rabbits in each. All of the right eyes were the experimental eyes and the left ones was the control. The right eyes in group A, B, and C were injected with plasmin 1 U, plasmin 1 U and hyaluronidase 20 U, and plasmin 1 U and SF6 0.5 ml, respectively; while all of the left eyes underwent intra-vitreous injection with balanced salt solution 0.1 ml. The eyes were observed by indirect ophthalmoscopy, slit lamp examination, biomicroscopy, B-ultrasonography, and electroretinography (ERG) before and after injection respectively. At last, the retinal sections were examined by light microscopy, scanning and transmission electron microscopy. Results The results of scanning microscopy showed incomplete PVD in 2 (33.3%) experimental eyes in group A, and complete PVD in 4 (66.7%) experimental eyes in both group B and C, and the positive rate of PVD in both group B and C significantly differed from that in group A (Plt;0.05). The b-wave amplitudes of ERG in the three groups after injection didn’t differ much from that in the control group or before the injection（Pgt;0.05）. The results of transmission electron microscopy and light microscopy indicated unchanged retinal structure. Conclusions Compared with the application of only plasmin, plasmin combined with hyaluronidase or hexafluoride SF6 can induce complete PVD more efficiently and do no harm to the retina. (Chin J Ocul Fundus Dis, 2005, 21: 388-390)
Objective To observe the content of thromboxane (TXA2 ) and prostacyclin (PGI2) in optic nerves after forehead impact injury.Methods The right forehead zones of 32 rabbits were struck by biology impact machine. Tweenty-four rabbits that had afferent papillary defect after injury were chosen, and randomly divided into four groups: 1 day, 2, 4, and 7 days group. Right eyes were in the experimental group and left eyes were in the control group. Flash visual evoked potentials were examined before and after the traumatic injury. The rabbits ′eyes were removed, the optic nerves were pathologically examined, and the content of TXB2 and 6-Keto-PGF1αwhich were the products of TXA2 and PGI2 were assayed 1, 2, 4, and 7 days after traumatic injury respectively.Results Histopath ological examination revealed the findings of injuries of optic nerves of all the 24 rabbits. The latency of wave P1 was significantly delayed after traum atic injury (Plt;0.01), and amplitude of wave P1 was significantly decreased after traumatic injury (Plt;0.01). The content of TXB2 ［(172.35±26.52) pg/mg ］and 6-Keto-PGF1α［(161.78±24.83) pg/mg］were significantly higher in the injured optic nerves than in the uninjured ones 1 day after the traumatic injury (Plt;0.01). The rate of TXB2 /6-Keto-PGF1α (1.077±0.18) was significantly increased compared to the control group (Plt;0.05), and lasted to the 7th day.Conclusions The content of TXA2 and PGI2 significantly increases and the ratio of them is lopsided after forehead impact injury in rabbits. (Chin J Ocul Fundus Dis，2003，19：49-51)
Objective To investigate the dosage, efficacy and safety of intrav itreal injection of plasmin in producing posterior vitreous detachment (PVD), an d the possible role of plasmin in degrading adhesion glycoproteins of inner limiting membrane (ILM).Methods Twenty eyes of young human cadavers within 24 hours after death were divided into 4 groups that received 0.1 ml balanced salt solution (group 1) as control, 1 (group 2), 2 (group 3), or 3 (group 4) U of human plasmin. Optical and transmission electron microcopies were performed to examine the ultrastructure of the vitreoretinal interface. Electron-immunocytochemical techniques were carried out on ILM to estimate the content of fibronectin (FN) and laminin (LN). Flow cytometry was used for cell viability analysis of variance (ANOVA) and Tukey-test was employed for statistical analysis. Results Microscopy demonstrated that plasmin especially in group 4 cleaved the attachment of the vitreous collagen fibrils to the ILM with no evident damage to the inner retina. The content of LN, FN in ILM decreased with injection of plasmin (group 3 and 4 had statistical significance from control group for FN,P＜0.05; for LN in group 4, P＜0.05). Retinal cell viability was similar for plasmin-treated and control eyes. Conclusion Human plasmin disrupts the attachment of posterior hyaloid to the ILM with no morphologic changes of the inner retina. PVD is induced mostly with injection of 3 U plasmin. (Chin J Ocul Fundus Dis，2003，19：42-45)
Objective To reveal the fibrillar network in vitreous and the effect of plasmin on this network.Methods 20 vitreous gels of freshly slaughtered pigs were divided into 2 groups, the gels in first group were digested by 3 Uplasmin (3 U/ml) at 37c for 24 hours respectively, the second group received the same PBS as control. After digestion, gels were fixed in neutral buffered formalin solution. Samples from vitreous base, cortex and the central region were observed by the technique of freeze etching electron microscopy.Results In vitreous collagen fibril network was in a three-dimensional array, collagen fibril density showed marked differences, central vitreous had the sparse fibril density, the cortex denser and the basal vitreous densest. After digestion by plasmin, the collagen fibrillar network was destructed.Conclusion Collagen fibrils in vitreous present spatial arrangement regularly, plasmin can lead to destruction of the fibrillar network.(Chin J Ocul Fundus Dis，2003，19：179-181)
Objective To determine whether kringle 4-5 could inhibit choroidal neovascularization (CNV) in mice induced by argon laser photocoagulat ion. Methods Fundus laser photocoagulation was performed on C57BL/6J mice to induce CNV. In treatment group, 20 μg (low dosage group) and 50 μg (high dosage group) kringle 4-5 were injected retrobulbarly after photocoagulation. In control group, equilibrium liquid was injected retrobulbarly. Choroidal neovascularization was evaluated on the 7th and 14th day after photocoagulation by fundus fluorescein ang iography. The mice were killed on the 14th day after photocoagulation, the lesions were evaluated histologically and immunohistochemically, and the expression of CD105 was detected. The Expression of VEGF and bFGF was detected by immunohist ochemistry on the 4th day after photocoagulation.Results The incidence of CNV was 64.3% in control group, 51.2%（P＜0.05）in low dosage group, and 44. 1% (P＜0.01) in high dosage group. The CNV lesions were smaller in kringle 4-5 injected eyes in a dose-dependent manner and the number of proliferative vascular endothelial cells in the subretinal membrane of the treated eyes was smaller than that of the control eyes. There was no significant difference of the expression of VEGF and bFGF between the mice in control and treatment group.Conclus ions Kringle 4-5 could inhibit the development of choroidal neovascularization in the experimental mice model.(Chin J Ocul Fundus Dis，2003，19：201-268)
Objective To explore the effect of xue-shuan-tong(panax notoginsang saponins,PNS)or isovalaemic haemodilution(IHD)and PNS combining IHD treatment on activities of fibrinolysis and hemorrheology in patients with retinal vein occlusion (RVO). Methods Seventy-three patients with RVO were allocated at random to 3 groups which were treated with PNS,IHD and PNS combining IHD.The activities of t-PA and PAI,rheological parameters and visual acuity before and after treatment were observed. Results At the end of treatment,significantly increased activity of t-PA and decrease of PAI was found in combined treatment group and PNS group,but the difference before and after treatment was not significant in IHD group.Furthermore,except the plasma viscosity in IHD group,the other hemorrheological parameters in all the petients of 3 groups revealed to be improving.One month after treatment,the parameters return completely to normal in both PNS and IHD groups; while the whole blood apparent relative viscosity in low shear rate,RBC aggregation and RBC deformability maintained still in lower level,and also the visual acuity resumed better and quicker in combined group. Conclusion Combined treatment of PNS and IHD can both regulate the activity of fibrinolysis and decrease the blood viscosity of patients with RVO for a period of relatively long time and increase the effect of treatment. (Chin J Ocul Fundus Dis,1998,14:7-9)
ObjectiveTo investigate the therapeutic effect of kinetin on bleomycin A5 (BLM-A5)-induced pulmonary fibrosis in rats. MethodsSixty female Wistar rats were randomly divided into three groups. Group A (n=20) was intratracheally injected with saline as control. Group B (n=20) were intratracheally injected with BLM-A5 to establish pulmonary fibrosis model. Group C (n=20) was intratracheally injected with BLM-A5 and received intraperitoneal injection of kinetin at 0.5 mL/100 g once daily. The rats were sacrificed on the 3rd,7th,14th and 28th day respectively. HE and Masson staining were performed to observe lung pathological changes. The contents of hydroxyproline (HYP),urokinase-type plasminogen activator (u-PA),tissue-type plasminogen activator (t-PA),and PAI-1 in lung and plasma were measured by ELISA. ResultsAlveolitis was most obvious on the 7th day and pulmonary fibrosis was most severe on the 28th day in group B compared with other two groups (P<0.05). Alveolitis and pulmonary fibrosis in group C were significantly alleviated compared with group B (P<0.05),but still more severe than group A (P<0.05). The HYP contents in group B,coincided with fibrosis,began to increase on the 7th day and reached the peak on the 28th day,significantly higher than those in other two groups (P<0.05). The u-PA contents of lung tissue in group B began to decline on the 3rd day,reached the minimum on the 7th day,and was still significantly lower than those in other two groups (P<0.05).On the 14th day, the u-PA contents had no significant difference among three groups. The u-PA plasma contents in group B began to decline on the 3rd day,reached the minimum and had significant difference compared with other two groups on the 7th day (P<0.05),and there was no significantly difference among three groups after the 14th day. The t-PA contents change of lung tissue and plasma in three groups were generally consistent with u-PA,but the t-PA plasma contents in group B were still significantly lower than those in group A on the 14th day (P<0.05). The PAI-1 contents of lung tissue in group B began to increase on the 3rd day,reached the maximum on the 7th day,was still significantly higher than those in other two groups (P<0.05),and there was no significant difference among three groups on the 14th day. The PAI-1 contents in group C decreased compared with those in group B (P<0.05),but still higher than those in group A (P<0.05),and there was no difference among them on the 14th day. The PAI-1 plasma contents in group B began to increase on the 3rd day,reached the maximum and was significantly higher than other two groups on the 7th day (P<0.05),and there was no significant difference among three groups on the 14th day. ConclusionThe contents of u-PA and t-PA are increased by inhibiting PAI-1 generation in lung tissue through kinetin treatment,so that,kinetin can suppress pulmonary fibrosis induced by BLM-A5.