Progresses and analysis in fibrinolytic drugs induced hemorrhage / 药学学报

At present, most clinical thrombolytic drugs are plasminogen activators, which are highly dependent on the plasminogen level of the patient. Therefore, the efficacy of those drugs is restricted. Unlike the conventional thrombolytic plasminogen activator drugs, fibrinolytic drugs have direct fibrinolytic activity. Thus, fibrinolytic drugs can directly dissolve the thrombus, and its thromlysis efficacy is not restricted by the patients' plasminogen. This is a new type of thrombolytic drug with higher thrombolytic efficiency and safety, and has become one of the research hotspots at present. Although more and more agents that can be used as fibrinolytic drugs have been discovered, only a few of them can successfully be applied in clinical practice. The mainly underlying reason is the risk of bleeding. In this paper, based on the latest research progress of fibrinolytic drugs, the bleeding mechanisms and coping strategies of fibrinolytic drugs were systematically reviewed, five types of bleeding mechanisms of fibrinolytic drugs were summarized, and three types of coping strategies were proposed. We hope our work can provide theoretical basis for the development of safer and more efficient fibrinolytic drugs.

Intervention effect of Tongxinluo capsule on renal fibrosis in diabetic nephropathy rats / 中国药房

OBJECTIVE To explore the intervention effect and related mechanism of Tongxinluo capsule on renal fibrosis in rats with diabetic nephropathy （DN）. METHODS Eight rats were selected as control group （ordinary feed）， the remaining rats were given high-glucose and high-fat diet combined with ip injection of streptozotocin （35 mg/kg） to induce DN model. Model rats were randomly divided into model group （purified water）， irbesartan group （positive control， 14.12 mg/kg） and Tongxinluo capsule group （0.3 g/kg）， including 12 rats in the model group and 11 rats for each of the other two groups. All groups were given relevant medicine or water intragastrically， once a day， for 16 consecutive weeks. After the last medication， fasting blood glucose and 24 h urinary total protein （24 h UTP） were detected. Pathological changes in renal cortex of rats in each group were observed. Serum levels of tissue-type plasminogen activator （PA） and plasminogen activator inhibitor 1 （PAI-1） were measured. mRNA expressions of transforming growth factor-β（1 TGF-β1）， type Ⅳ collagen（COL-Ⅳ）， Wnt4 and β-catenin in renal cortex of rats were detected. The protein depositions or expressions of TGF-β1， COL-Ⅳ， focal adhesion kinase （FAK）， integrin-linked kinase （ILK）， E-cadherin， PA， PAI-1， Wnt4 and β-catenin in renal cortex of rats were observed or determined. RESULTS Compared with model group， 24 h UTP of rats in Tongxinluo capsule group were all significantly reduced （P＜0.05）； pathological damage and fibrosis of renal cortex were relieved； the expression of PA in serum and renal cortex was significantly increased， while PAI-1 level was significantly reduced （P＜0.05）； the depositions of COL-Ⅳ and TGF-β1 in renal cortex were all reduced， and corresponding mRNA expression was decreased significantly （P＜0.05）； the depositions of ILK and FAK were decreased， while the deposition of E-cadherin was increased； protein and mRNA expressions of Wnt4 and β-catenin were significantly reduced （P＜0.05）. CONCLUSIONS Tongxinluo capsule can relieve pathological damage to renal tissue and renal fibrosis of DN model rats， and reduce extracellular matrix deposition. The mechanism may be related to regulation of fibrinolytic system activity， the decrease of ILK and FAK expression， and inhibition of Wnt/β-catenin signaling pathway.

Risk of Bleeding after Transcatheter Aortic Valve Replacement: impact of Preoperative Antithrombotic Regimens

Abstract Introduction: Bleeding after transcatheter aortic valve replacement (TAVR) has a negative impact on the outcome of the procedure. Risk factors for bleeding vary widely in the literature, and the impact of preoperative antithrombotic agents has not been fully established. The objectives of our study were to assess bleeding after TAVR as defined by the Valve Academic Research Consortium-2 (VARC-2), identify its risk factors, and correlate with antithrombotic treatment in addition to its effect on procedural mortality. Methods: The study included 374 patients who underwent TAVR from 2009 to 2018. We grouped the patients into four groups according to the VARC-2 definition of bleeding. Group 1 included patients without bleeding (n=265), group 2 with minor bleeding (n=22), group 3 with major bleeding (n=61), and group 4 with life-threatening bleeding (n=26). The median age was 78 (25th-75th percentiles: 71-82), and 226 (60.4%) were male. The median EuroSCORE was 3.4 (2-6.3), and there was no difference among groups (P=0.886). The TAVR approach was transfemoral (90.9%), transapical (5.6%), and trans-subclavian (1.9%). Results: Predictors of bleeding were stroke (OR: 2.465; P=0.024) and kidney failure (OR: 2.060; P=0.046). Preoperative single and dual antiplatelet therapy did not increase the risk of bleeding (P=0.163 and 0.1, respectively). Thirty-day mortality occurred in 14 patients (3.7%), and was significantly higher in patients with life-threatening bleeding (n=8 [30.8%]; P<0.001). Conclusion: Bleeding after TAVR is common and can be predicted based on preprocedural comorbidities. Preprocedural antithrombotic therapy did not affect bleeding after TAVR in our population.

Trombolisis sistémica complicada en embolia cerebral múltiple por trombo intraventricular / Systemic thrombolysis following multiple embolic cerebral lesions in a patient with myocardial infarction and intraventricular thrombus

RESUMEN Se presenta un caso de trombólisis sistémica complicada con transformación hemorrágica en paciente con evento isquémico cerebral sintomático por embolia múltiple a partir de trombo intraventricular en contexto de infarto agudo de miocardio por oclusión total de arteria descendente anterior con deterioro severo de función sistólica de ventrículo izquierdo.

ABSTRACT: We describe a case of complicated systemic thrombolysis with hemorrhagic transformation in a patient with a cerebral ischemic event due to multiple embolisms from intraventricular thrombus in the context of acute myocardial infarction due to total occlusion of the anterior descending artery and severe deterioration of left ventricular systolic function.

Study of the fibrinolytic activity of serrapeptase and its in vitro thrombolytic effects

Abstract Serrapeptase, a proteolytic enzyme, has been used for the adjuvant treatment of many diseases. However, its fibrinolytic activity is still uncertain. Herein, the fibrinolytic activity of serrapeptase and its in vitro thrombolytic effects were investigated. The results showed that the fibrinolytic activity of serrapeptase was 1295 U/mg, and the specific activity was 3867 U/mg of protein when its proteolytic activity toward casein was 2800 U/mg. The optimum temperature and pH for serrapeptase activity were 37-40°C and 9.0, respectively. At 1 mmol/L, Zn2+, Mn2+ and Fe2+ could activate the fibrinolytic activity of serrapeptase, while K+, Cu2+, sodium dodecyl sulfate (SDS) and ethylene diamine tetraacetic acid (EDTA) inhibited it. In vitro tests showed that serrapeptase could completely prevent blood coagulation at 150 U/mL, and the percentage of blood clot lysis reached 96.6% at 37°C after 4 h at 300 U/mL. These results indicate that serrapeptase has excellent fibrinolytic activity, and can be used as a health food or candidate drug for the prevention or treatment of thrombotic diseases.

Study on influencing factors of plasma FDP and D-dimer levels of newborns in NICU / 国际儿科学杂志

Objective:To investigate the influencing factors of physiological and pathological conditions at birth of newborn and gestational conditions of pregnant mothers on plasma fibrin/fibrinogen degradation products(FDP)and D-dimer levels.Methods:From May 1, 2018 to October 31, 2018, 222 newborns admitted to NICU of the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were enrolled in this study.Newborns were sent to NICU within 2 hours after birth and venous blood was collected immediately.The levels of FDP and D-dimer were detected by immunoturbidimetry.Groups were divided according to different gender, gestational age, birth weight, relationship between gestational age and birth weight, mode of delivery, asphyxia at birth, acidosis, antenatal hormone use, anticoagulant drugs, and perinatal risk factors(gestational hypertension, premature rupture of membranes, abnormal placenta, gestational diabetes). The levels of plasma FDP and D-dimer were compared among the groups.Mann Whitney U test, Kruskal Wallis H test, Spearman rank correlation and generalized linear model were used for statistical analysis. Results:The plasma FDP and D-dimer values of 222 NICU neonates were skewed at birth, with median values of 6.00 mg/L and 1.74 mg/L, and quartile distances of 10.40 mg/L and 2.55 mg/L, respectively.The concentrations of FDP in neonates born to natural labour and cesarean section were 11.70 mg/L and 5.30 mg/L, respectively, and D-dimer concentrations were 2.92 mg/L and 1.52 mg/L, respectively.The FDP and D-dimer levels were significantly higher in the former(Z values were -4.006 and -4.198, respectively, P<0.05). The levels of FDP and D-dimer in newborns with different gestational age, different birth weight and different blood pH values were compared respectively, and the differences were statistically significant( χ2 values were 15.322, 18.394, 9.677, 11.492, 7.023 and 8.345, respectively, P<0.05). Further analysis showed that the levels of FDP and D-dimer in neonates with gestational age < 34 weeks were significantly higher than those in~<37 weeks group and ≥37 weeks group( P<0.05). The FDP and D-dimer levels in the birth weight<1 500 g group were significantly higher than those in~<2 500 g group and ≥2 500 g group( P<0.05). Higher FDP and D-dimer levels were found in the pH<7.20 group than in the pH ≥7.35 group( P<0.05). A generalized linear model was established for multifactor analysis.The results showed that the concentration of FDP and D-dimer in plasma was related to gestational age, birth weight and arterial pH value. Conclusion:The levels of plasma FDP and D-dimer in NICU newborns at birth were influenced by gestational age, birth weight and acid-base balance.

The use of antifibrinolytics in hip trauma surgery in a public health system: a prospective study / O uso de antifibrinolíticos em cirurgia de trauma de quadril em um serviço público de sáude: estudo prospectivo

ABSTRACT Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study.

RESUMO Objetivo: Avaliar o uso do ácido tranexâmico (ATX) e aminocapróico (AEAC) na redução da perda sanguínea em cirurgias para trauma do quadril e femur proximal. Métodos: Estudo prospectivo com 49 pacientes operados em hospital de trauma entre nov./15 e fev./17. Pacientes divididos em dois grupos: ATX (n = 24) e AEAC (n = 25). Comparações feitas de acordo com o sexo, idade na cirurgia, ASA, tipo de fratura e cirurgia, perda sanguínea estimada durante a cirurgia, níveis de hemoglobina e hematócrito pré e pós-operatório e o custo das medicações. Dados processados no SPSS 22.0 com nível de significância de p < 0,05. Resultados: Não foram encontradas diferenças significativas entre as seguintes variáveis: idade, sexo, ASA e perda sanguínea estimada durante a cirurgia. Nenhum paciente necessitou de transfusão sanguínea nos dois grupos. Na avaliação pós-operatória, não houve diferença significativa entre os grupos nos valores de queda da hemoglobina e hematócrito (p > 0,05). Analisando os custos de ambos as medicações, observou-se um custo mais elevado do AEAC em relação ao ATX (R$ 90,00 - R$ 15), resultando em R$ 75, 00 a mais por paciente. Conclusão: O uso dos antifibrinolíticos foi eficiente na redução da perda sanguínea, sem a necessidade de hemotransfusões. Nível de evidência II, Estudo Prospectivo Comparativo.

FGFC1 Inhibits Proliferation and Migration of Non-Small Cell Lung Cancer Cells via the PI3K/Akt/mTOR Signaling Pathway / 中国生物化学与分子生物学报

FGFC1 (Fungi fibrinolytic compound1) is a bisindole compound with good biological activity, which was first derived from the Stachybotrys longispora FG216. However, the anti-tumor effects of FGFC1 have not been reported. This study investigated the effect and mechanism of FGFC1 on the proliferation, apoptosis, migration and invasion of non-small cell lung cancer (NSCLC) cells.Firstly, PC9, H1975, HCT116, HeLa and 293T cells were treated with different concentrations of FGFC1, and the cell counting kit-8 assay was used to determine relative cell viability; flow cytometry was used to evaluate apoptosis; real-time PCR and Western blotting analysis were performed to measure the expression of apoptosis-related genes in PC9 cells; wound healing and Transwell invasion assays were used to measure the ability of migration and invasion; Western blotting was performed to measure the expression of kinase proteins involved in the PI3K/Akt/mTOR signaling pathway, exploring the influence of FGFC1 on this signaling pathway. We found that FGFC1 selectively inhibited the proliferation of PC9 cells. It also up-regulated the expression of apoptosis-promoting protein cleaved-caspase-3 and cleaved-PARP, and induced apoptosis in a dose-dependent manner (P < 0. 05). FGFC1 also significantly inhibited the migratory and invasive capacity of PC9 cells in a dose-dependent manner (P < 0. 05). Further studies confirmed that FGFC1 could inhibit the activation of the PI3K/Akt/mTOR signaling pathway with the down-regulation of the protein expression levels of p-PI3K, p-Akt and p-mTOR. Thus, we conclude that FGFC1 inhibited the proliferation of PC9 and H1975 cells, induced the apoptosis and inhibited the migration and invasion of PC9 cells, which may take place through down-regulating the PI3K/Akt/mTOR signaling pathway. These findings suggest that FGFC1 might be a new therapeutic target in NSCLC treatment in the future.

Potential of modulating fibrinolytic activity in intervention of transfusion-related acute lung injury / 中国输血杂志

Transfusion-related acute lung injury (TRALI), with clinical manifestation, diagnosis and pathological mechanism consistent with acute lung injury(ALI), belongs to a sub-category of ALI. Excessive deposition of fibrin in lung is one of the characteristic of ALI, and reversing fibrin formation is of great significance to intervene ALI. The decrease of fibrinolytic activity is one of the important causes of excessive deposition of fibrin in lung, and also the important pathological feature of TRALI. This article discusses the potential of modulating fibrinolytic activity to intervene TRALI from the perspective of regulating the effectiveness of fibrinolytic activity to intervene ALI.

Rapid Enrichment and Activity Research of Antithrombotic Proteins from Pheretima vulgaris / 中国实验方剂学杂志

Objective:A strong antithrombotic protein component， named PvQ， was purified and enriched from total protein of <italic>Pheretima vulgaris</italic>，<italic> </italic>a<italic> </italic>traditional Chinese medicine. Moreover， we evaluated its fibrinolytic and anticoagulant activity， and expected to provide reference for the research on antithrombotic substances of Pheretima. Method:A rapid <italic>in</italic> <italic>vitro</italic> activity-oriented separation combined with the AKTA-Pure protein purification system conducted on <italic>P. vulgaris</italic>. Meanwhile， the fibrinolytic and anticoagulant activities of PvQ were measured by fibrin plate method and fibrinogen-thrombin time （Fibg-TT） method. And the <italic>in vitro</italic> thrombolysis assay was used for evaluating the lysis ability of PvQ to thrombus. Then the stability of PvQ was also analyzed for its anticoagulant activity at different pH and temperature. Result:The PvQ was successfully enriched and its activity was determined to have significant fibrinolytic and anticoagulant activities. And the result of <italic>in vitro</italic> thrombolysis assay revealed that PvQ could hydrolyze more than 80% of thrombus after 5 h of incubation at 37 ℃. In addition， the changes of temperature and pH had significant effects on antithrombotic activity， and this study showed that PvQ was rapidly inactivated at ≥60 ℃ or in acidic conditions （pH<7）. While， the activity of PvQ was unaffected or less affected at ≤50 ℃ and under alkaline conditions. Conclusion:A feasible preparation method of PvQ is established， and it can affect fibrin and fibrinogen at the same time， thus exerting a dual fibrinolytic effect and possessing significant fibrinolytic and anticoagulant activities. It provides a scientific interpretation for the treatment of thrombotic diseases by PvQ and a reference for the development of antithrombotic protein products of Pheretima.

Epidermal growth factor receptor regulates fibrinolytic pathway elements in cervical cancer: functional and prognostic implications

Epidermal growth factor receptor (EGFR) signaling and components of the fibrinolytic system, including urokinase-type plasminogen activator (uPA) and thrombomodulin (TM), have been implicated in tumor progression. In the present study, we employed cBioPortal platform (http://www.cbioportal.org/), cancer cell lines, and an in vivo model of immunocompromised mice to evaluate a possible cooperation between EGFR signaling, uPA, and TM expression/function in the context of cervical cancer. cBioPortal analysis revealed that EGFR, uPA, and TM are positively correlated in tumor samples of cervical cancer patients, showing a negative prognostic impact. Aggressive human cervical cancer cells (CASKI) presented higher gene expression levels of EGFR, uPA, and TM compared to its less aggressive counterpart (C-33A cells). EGFR induces uPA expression in CASKI cells through both PI3K-Akt and MEK1/2-ERK1/2 downstream effectors, whereas TM expression induced by EGFR was dependent on PI3K/Akt signaling alone. uPA induced cell-morphology modifications and cell migration in an EGFR-dependent and -independent manner, respectively. Finally, treatment with cetuximab reduced in vivo CASKI xenografted-tumor growth in nude mice, and decreased intratumoral uPA expression, while TM expression was unaltered. In conclusion, we showed that EGFR signaling regulated expression of the fibrinolytic system component uPA in both in vitro and in vivo settings, while uPA also participated in cell-morphology modifications and migration in a human cervical cancer model.

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.

Habilidades dos enfermeiros no uso terapêutico do alteplase em unidade de pronto atendimento / Abilities of nurses in therapeutic use of alteplase in emergency care unit / Habilidades de enfermeros en el uso terapéutico de alteplase en una unidad de atención de emergencia

Objetivo: avaliar as habilidades dos enfermeiros, no uso terapêutico do Alteplase, como terapia fibrinolítica, em pacientes com diagnóstico de infarto agudo do miocárdio. Método: A pesquisa foi realizada por meio de um estudo descritivo transversal, quantitativo, realizado por meio de questionário como instrumento de coleta, contendo 10 questões de múltipla escolha elaboradas pelo autor. A amostra foi constituída por 24 enfermeiros. A coleta de dados foi realizada em julho de 2019, com CAAE n° 13159219.7.0000.5493. Os dados foram analisados e tratados por meio da análise descritiva. Resultado: Os resultados mostraram que os participantes da pesquisa possuem habilidades para o manuseio e aplicabilidade da terapia fibrinolítica, Alteplase, em pacientes acometidos por infarto agudo do miocárdio. Conclusão:Os resultados obtidos demonstram que os enfermeiros possuem habilidade para o manuseio, administração, aplicabilidade do Alteplase, bem como na avaliação dos sintomas e contraindicações do medicamento em pacientes acometidos por Infarto Agudo do Miocárdio. Entretanto, foi identificado uma porcentagem que apresentam dificuldades na execução de todas as atividades. Portanto, o estudo contribuirá na elaboração de protocolos aos profissionais da área da saúde envolvidos de modo direto ou indireto aos cuidados aos pacientes que necessitam desta intervenção farmacológica como tratamento.(AU)

Objective: to evaluate the abilities of nurses in the therapeutic use of Alteplase, as fibrinolytic therapy, in patients diagnosed with acute myocardial infarction. Method: The research was carried out by means of a transversal, quantitative descriptive study, carried out by means of a questionnaire as a collection instrument, containing 10 multiple choice questions elaborated by the author. The sample consisted of 24 nurses. The data collection was carried out in July 2019, with CAAE No. 13159219.7.0000.5493. The data were analyzed and treated through descriptive analysis. Result: The results showed that the research participants have skills for the handling and applicability of fibrinolytic therapy, Alteplase, in patients affected by acute myocardial infarction. Conclusion: The results show that the nurses have skills in the handling, administration and applicability of Alteplase, as well as in the evaluation of the symptoms and contraindications of the drug in patients affected by Acute Myocardial Infarction. However, it was identified a percentage that present difficulties in performing all activities. Therefore, the study will contribute in the elaboration of protocols to the professionals of the health area involved in a direct or indirect way to the care of patients who need this pharmacological intervention as treatment.(AU)

Objetivo: evaluar las capacidades de las enfermeras en el uso terapéutico de la Alteplasa, como terapia fibrinolítica, en pacientes diagnosticados con infarto agudo de miocardio. Material y método: La investigación se realizó mediante un estudio descriptivo cuantitativo transversal, realizado mediante un cuestionario como instrumento de recopilación, que contenía 10 preguntas de opción múltiple preparadas por el autor. La muestra constaba de 24 enfermeras. La recopilación de datos se llevó a cabo en julio de 2019, con el CAAE Nº 13159219.7.0000.5493. Los datos fueron analizados y tratados mediante un análisis descriptivo. Resultado: Los resultados mostraron que los participantes en la investigación tienen habilidades en el manejo y la aplicabilidad del tratamiento fibrinolítico, Alteplase, en pacientes afectados por un infarto agudo de miocardio. Conclusión: Los resultados muestran que las enfermeras tienen aptitudes para el manejo, la administración y la aplicabilidad del Alteplase, así como para la evaluación de los síntomas y las contraindicaciones del fármaco en los pacientes afectados por un infarto agudo de miocardio. Sin embargo, se identificó un porcentaje que presenta dificultades para realizar todas las actividades. Por lo tanto, el estudio contribuirá a la elaboración de protocolos para los profesionales de la salud que participan directa o indirectamente en la atención de los pacientes que necesitan esta intervención farmacológica como tratamiento.(AU)

Guía de práctica clínica en derrame pleural paraneumónico y empiema pleural / Guide of clinical practice on parapneumonic pleural efussion and pleural empyema

La acumulación de fluido purulento o la presencia de bacterias en la tinción de Gram en el líquido pleural se define como empiema, se puede desarrollar entre 2- 12 por ciento de los niños con neumonía, por lo general bacteriana. Evoluciona en tres fases, la exudativa, fibrinopurulenta y organizada. El cuadro clínico está dado por manifestaciones respiratorias con fiebre persistente y malestar general. Los estudios radiológicos son importantes para el diagnóstico y es el ultrasonido pleural la modalidad de imagen preferida pues confirma la presencia y volumen de fluido pleural, así como la existencia de septos o tabiques. El tratamiento se basa en antibioticoterapia y drenaje a través de una pleurostomía; si hay presencia de tabiques, esfacelos o el estudio bioquímico del líquido pleural informa pH /7; glucosa /2,2 mmol/L; LDH/ 1000 UI, se comienza con estreptoquinasa intrapleural. El tratamiento quirúrgico se indica si hay deterioro clínico y radiológico después de concluir el uso de fibrinolíticos, persistencia de sepsis asociada a colección pleural a pesar del drenaje, coraza de fibrina que impide la reexpansión pulmonar y fístula broncopleural con neumotórax. La mortalidad es baja(AU)

The accumulation of purulent fluids or the presence of bacteria in the Gram´s stain in the pleural liquid is defined as empyema. It can develop in the 2 to 12 percent of children with pneumonia, generally the bacterial one. It evolves in three phases: exudative, fibrinopurulent and organized. The clinical picture is a consequence of respiratory manifestations with persistent fever and general discomfort. The radiology studies are important for the diagnosis and the pleural ultrasound is the preferred imaging modality because it confirms the presence and volume of the pleural fluid, as well as the existence of septa. The treatment is based in the use of antibiotic therapy and the drainage through a pleurostomy; if there is presence of septa, slough or the biochemical study of the pleural liquid informs of pH/7, glucose /2.2 mmol/L, LDH / 1000 UI, so it is started the use of intrapleural streptokinase. The surgical treatment is indicated if there is a clinical and radiological worsening after finishing the use of fibrinolytics, persistence of sepsis associated to pleural collection in spite of the drainage, fibrin shell that hampers pulmonar reexpanding; and bronchopleural fistula with pneumothorax(AU)

Exploration of new effective fibrinolytic agent from Alcaligenes aquatilis PJS_1 from polluted soil

Aim: To isolate and identify Alcaligenes aquatilis PJS_1 from slaughter house soil samples for production of enzymatic fibrinolytic agent productionMethodology: Fibrinolytic enzyme producing bacterium was isolated from slaughter house soil samples and identified by biochemical tests and 16S rRNA sequencing. The fibrinolytic enzyme production media was optimized by various factors like energy sources, pH and temperature. Bioreactor used in the experiment was designed with suitable parameters for effective production and purification is by gel filtration chromatography. Blood clotting assay was performed to determine its anticoagulant property. Results: The isolated enzyme producing bacterium was identified as Alcaligenes aquatilis PJS_1. The medium with fructose and urea at pH 7.0 was found to have optimum production when incubated for 24 hr at 37ºC. The crude enzyme was purified by acetone precipitation followed by gel filtration chromatography. The enzyme showed a final specific activity of 629.32 Umg-1 with of 88.24% yield Interpretation: The present study provides information that the enzyme produced by Alcaligenes aquatilis PJS_1 acts as an effective fibrinolytic agent