MB Levels Research Articles

Attentional mechanisms driven adaptive quantization and selective bit allocation scheme for H.264/AVC

Rate control algorithm adopted in H.264/AVC reference software shows several shortcomings that have been highlighted by different studies. For instance, in the baseline profile, the frame target bit-rate estimation assumes similar characteristics for all frames and the quantization parameter determination uses the Mean Absolute Difference for complexity estimation. Consequently, an inefficient bit allocation is performed leading to important quality variation of decoded sequences. A saliency-based rate-control is proposed in this paper to achieve bit-rate saving and improve perceived quality. The saliency map of each frame, simulating the human visual attention by a bottom-up approach, is used at the frame level to adjust the quantization parameter and at the macroblock level to guide the bit allocation process. Simulation results show that the proposed attentional model is well correlated to human behavior. When compared to JM15.0 reference software, at the frame level, the saliency map exploitation achieves bit-rate savings of up to 26%. At the MB level and under the same quality constraint, bit-rate improvement is up to 42% and buffer level variation is reduced by up to 71%.

A Novel Signal-Amplified Immunoassay for Myoglobin Using Magnetic Core-Shell Fe3O4@Au- Multi Walled Carbon Nanotubes Composites as Labels Based on One Piezoelectric Sensor

An ultrasensitive and amplified piezoelectric immunosensor (PEI) with highly sensitivity has been proposed for the detection of ultra-trace of Myoglobin (Mb) in human serum based on precipitation of an insoluble product on the functionalized gold electrode. The core-shell Fe3O4@Au (with 85 nm as particle size)-multi-walled carbon nanotubes nanostructures labeling with Myoglobin first antibody (Mb Ab1) was firstly synthesized as capture probe(Fe3O4@Au-Mb Ab1-MWCNTs). It was modified on the surface of quartz crystal gold electrode. After a sandwich-type immunoreactions, the immunocomplex formed between Fe3O4@Au-Mb Ab1-MWCNTs/Mb and the HRP linked secondary antibody (HRP-Mb Ab2), can lead to the decrease of frequency (Δf) of the piezoelectric crystal electrode. Moreover, HRP enzyme labeled on the immunocomplex can catalyze 3- Amino-9-ethylcarbazole (AEC) in the presence of H2O2, resulting in an insoluble product on the electrode surface. The above two matters, immunocomplex and AEC's oxidation product, can add more weight on the detector and achieve a great amplification of Δf. Based on the change of Δf, ultrasensitive Mb detection was achieved. Under optimal conditions, Δf depended linearly on the Mb concentration with a range from 0.001 to 5 ng/mL, with a detection limit of 0.3 pg/mL. Comparing with the conventional ELISA, the immunoassay provides a more stable, specific protocol for Mb, which can greatly lower the sensitivity for detection of ultra-trace level of Mb in serum. It can be employed to quantify other biomarker if changed the detection antibody.

Which Is the Better Option During Neonatal Cardiopulmonary Bypass

The optimal myocardial protection strategy for newborns/infants undergoing congenital heart surgery remains controversial. The purpose of this study was to compare myocardial protection using histidine-tryptophan-ketoglutarate (HTK) and cold blood cardioplegia in a neonatal piglet model. Twenty-one piglets were randomized to three groups: the control group (C group, n = 7), a single dose of HTK group (H group, n = 7), and multidose cold blood cardioplegia group (B group, n = 7). Animals in the two experimental groups were placed on hypothermic cardiopulmonary bypass, after which the ascending aorta was clamped for 2 hours. Immediately after declamping, both the difference between arterial and coronary sinus blood lactate concentrations and the oxygen extraction did not differ between the H group and the B group. At 3 hours after declamping, rise in serum troponin-T and creatine kinase isoenzyme MB levels showed no significant differences between the H group and the B group (p = 0.735 and p = 0.103, respectively). No significant differences were noted in the myocardial lactate content, ATP content, and histopathological score between the H group and the B group (p = 0.810, p = 0.158, and p = 0.399, respectively). Transfusion requirement in the B group was significantly more than that in the H group (p = 0.003). HTK solution provides equivalent myocardial protection to multidose cold blood cardioplegia for the neonatal heart with less transfusion requirement.

Association of cardiac and renal function with extreme N-terminal fragment Pro-B-type natriuretic peptide levels in elderly patients

BackgroundThe data are inconsistent regarding whether extreme N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP) levels are associated with impaired renal function. Furthermore, the relationship between extreme NT pro-BNP levels and cardiac and renal function in elderly patients has not been reported. The aim of the present study was to examine a hypothesis that extreme NT pro-BNP levels may be associated with impaired cardiac and renal function in elderly patients.MethodsWe retrospectively analyzed the data of demographic, clinical, and echocardiographic features on 152 consecutive elderly patients aged more than 80 years old (average age, 83.65 ± 3.58 years) with NT pro-BNP levels ≥ 3000 pg/ml. The participants were divided into two categories according to their NT pro-BNP levels: (1) 3000–10000 pg/mL and (2) >10000 pg /mL.ResultsThe number of patients with impaired renal function (P = 0.019) and the mortality (P < 0.001) in the period of inpatient was higher in the group with NT pro-BNP > 10000 pg /mL. The levels of serum creatinine and creatine kinase MB (CK-MB) in the group of NT pro-BNP > 10000 pg / mL were higher than those in the group of NT pro-BNP = 3000-10000 pg/mL (P = 0.001 and P = 0.023, respectively). Furthermore, no significant difference in the distribution by NYHA class in different NT pro-BNP levels was observed. Multiple linear regression analyses demonstrated that with NT pro-BNP levels as the dependent variable, NT pro-BNP levels were positively correlated with CK-MB (β = 0.182, P = 0.024) and creatinine levels (β = 0.281, P = 0.001). The area under the receiver-operating characteristic (ROC) curve of NT pro-BNP levels and clinical diagnosis of impaired renal function was 0.596 and reached significant difference (95%CI:0.503-0.688, P = 0.044).ConclusionThese data suggest that the extreme elevation of NT pro-BNP levels (≥3000 pg/ml) is mainly determined by impaired renal function in elderly patients above 80 years. Extreme NT pro-BNP levels may be useful for assessing the severity of impaired renal function.

Aldehyde Dehydrogenase-2 Activation during Cardioplegic Arrest Enhances the Cardioprotection against Myocardial Ischemia–Reperfusion Injury

Ischemia/reperfusion damage is common during open-heart surgery. Activation of aldehyde dehydrogenase-2 can significantly reduce ischemia/reperfusion damage. We hypothesized that adding aldehyde dehydrogenase-2 agonist to regular cardioplegia solution would further ameliorate ischemia/reperfusion damage. Alda-1 was used as an aldehyde dehydrogenase-2 agonist. Cardioprotection by histidine-tryptophan-ketoglutarate solution with and without Alda-1 was compared using an ex vivo perfused rat heart model of ischemia/reperfusion. Three groups of ex vivo rat hearts endured different treatments with variant ischemia or an ischemia/reperfusion time course: sham, no ischemia/reperfusion; histidine-tryptophan-ketoglutarate; and histidine-tryptophan-ketoglutarate plus Alda-1. Aldehyde dehydrogenase-2 expressions and activities, oxidative parameters (including 4-hydroxy-2-nonenal-His adducts, malondialdehyde levels, and glutathione/oxidized glutathione ratios), myocardial protein carbonyl levels, coronary effluents creatine kinase isoenzyme MB levels, and heart function parameters were measured and compared. Alda-1 significantly elevated myocardium aldehyde dehydrogenase-2 activity (P < .01). Increased aldehyde dehydrogenase-2 activity in turn attenuated ischemia/reperfusion-induced elevation in cardiac aldehydes, creatine kinase isoenzyme MB leakage, and protein carbonyl formation (P < .01). The Alda-1 group also obtained higher glutathione/oxidized glutathione ratios (P < .01). Aldehyde dehydrogenase-2 activation alleviated ischemia/reperfusion-induced cardiomyocyte contractile function impairment as evidenced by improved maximal velocity of pressure development and decline, left ventricular developed pressure, and heart rate (P < .01). Alda-1 supplementation can significantly improve the cardioprotection effect of cardioplegia solution, possibly through activation of aldehyde dehydrogenase-2, to remove toxic aldehydes. This may aid in the identification of novel cardioplegia solutions.

Metformin Attenuates Doxorubicin‐induced Cardiotoxicity In Rats

The clinical use of doxorubicin (DOX), a potent chemotherapeutic agent, is limited by its cardiotoxic side effects that are attributed to free radical generation. Recent studies have established that metformin (MET), an oral antidiabetic drug, possesses an antioxidant activity. However, whether it can protect against DOX‐induced cardiotoxicity has not been reported before. The goal of the present study was to assess the extent to which MET can prevent cardiotoxicity induced by DOX. Results of our study in a rat model of DOX‐induced cardiotoxicity show that DOX treatment caused significant increases in serum levels of lactate dehydrogenase (LDH) and creatine phosphokinase isoenzyme MB (CK‐MB), indicators of cardiac injury. In addition, DOX therapy decreased cardiac glutathione, an endogenous antioxidant; CoA‐SH, an activator in mitochondrial energy providing systems. These biochemical changes were associated with myocardial histopathological and ultrastructural deteriorations. Co‐treatment with MET eliminated all DOX‐induced increases of LDH and CK‐MB and prevented GSH, CoA‐SH and ATP depletions. MET therapy also prevented all the myocardial histopathological and ultrastructural deteriorations. These findings demonstrate, that MET successfully prevents DOX‐induced cardiotoxicity.

The effects of running a 308 km ultra-marathon on cardiac markers

The aim of this study was to investigate the expression of cardiac strain and damage in 18 male marathoners with average age of 52.8±5.0 years running at a 308 km ultra-marathon. Blood samples were collected at pre-race, 100 km, 200 km and 308 km check points for the analysis of cardiac muscle injury markers, creatine kinase (CK), creatine kinase–myocardial band (CK–MB), cardiac troponin I (cTnI) and cardiac muscle strain marker, N-terminal pro-brain natriuretic peptide (NT-proBNP). The CK levels increased 1127.2±507.9 IU/L, 5133.8±2492.7 IU/L and 4958.4±2087.9 IU/L at 100 km, 200 km and 308 km, respectively, compared to the pre-race levels. The CK–MB levels increased 20.2±11.2 ng/mL, 73.3±35.6 ng/mL and 68.6±42.6 ng/mL at 100, 200 and 308 km, respectively, compared to the pre-race levels. The CK–MB/CK ratio showed that the CK–MB mass index was within the normal range (<2.5%) at 100 km, 200 km and 308 km. The cTnI levels showed no significant difference in all check points. The NT-proBNP levels increased 146.55±92.7 pg/mL, 167.95±111.9 pg/mL and 241.23±121.2 pg/mL at 100, 200 and 308 km, respectively, compared to the pre-race levels. The normal CK–MB mass index (<5.0 ng/mL) and the absence of an increase in the cTnI levels during the 308 km ultra-marathon suggested that no myocardial injury despite an elevation in CK–MB. The increase in NT-proBNP levels probably resulted from continuous hemodynamic cardiac stress and represents a transient physiological myocardial protective response.

A Randomly-Controlled Study on the Cardiac Function at the Early Stage of Return to the Plains after Short-Term Exposure to High Altitude

High altitude acclimatization and adaptation mechanisms have been well clarified, however, high altitude de-adaptation mechanism remains unclear. In this study, we conducted a controlled study on cardiac functions in 96 healthy young male who rapidly entered the high altitude (3700 m) and returned to the plains (1500 m) after 50 days. Ninety eight healthy male who remained at low altitude were recruited as control group. The mean pulmonary arterial pressure (mPAP), left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), cardiac function index (Tei index) were tested. Levels of serum creatine kinase isoform MB (CK-MB), lactate dehydrogenase isoenzyme-1 (LDH-1), endothelin-1 (ET-1), nitrogen oxide (NO), serum hypoxia-inducible factor-1α (HIF-1α), 8-iso-prostaglandin F2α (8-iso PGF2α), superoxide dismutase (SOD) and malonaldehyde (MDA) were measured at an altitude of 3700 m and 1500 m respectively. The results showed that after short-term exposure to high altitude mPAP and Tei index increased significantly, while LVEF and LVFS decreased significantly. These changes were positively correlated with altitude. On the 15th day after the subjects returned to low altitude, mPAP, LVEF and LVFS levels returned to the same level as those of the control subjects, but the Tei index in the returned subjects was still significantly higher than that in the control subjects (P<0.01). We also found that changes in Tei index was positively correlated with mPAP, ET-1, HIF-1α and 8-iso PGF2α levels, and negatively correlated with the level of NO, LVEF, LVFS, CK-MB and LDH-1. These findings suggest that cardiac function de-adapts when returning to the plains after short-term exposure to high altitude and the function recovery takes a relatively long time.

Spatiotemporal distribution of the seismicity along the Mid‐Atlantic Ridge north of the Azores from hydroacoustic data: Insights into seismogenic processes in a ridge–hot spot context

The seismicity of the North Atlantic was monitored from May 2002 to September 2003 by the ‘SIRENA array’ of autonomous hydrophones. The hydroacoustic signals provide a unique data set documenting numerous low‐magnitude earthquakes along the section of the Mid‐Atlantic Ridge (MAR) located in a ridge‐hot spot interaction context. During the experiment, 1696 events were detected along the MAR axis between 40°N and 51°N, with a magnitude of completeness level ofmb≈ 2.4. Inside the array, location errors are in the order of 2 km, and errors in the origin time are less than 1 s. From this catalog, 15 clusters were detected. The distribution of source level (SL) versus time within each cluster is used to discriminate clusters occurring in a tectonic context from those attributed to non‐tectonic (i.e. volcanic or hydrothermal) processes. The location of tectonic and non‐tectonic sequences correlates well with regions with positive and negative Mantle Bouguer Anomalies (MBAs), indicating the presence of thinner/colder and thicker/warmer crust respectively. At the scale of the entire array, both the complete and declustered catalogs derived from the hydroacoustic signals show an increase of the seismicity rate from the Azores up to 43°30′N suggesting a diminishing influence of the Azores hot spot on the ridge‐axis temperature, and well correlated with a similar increase in the along‐axis MBAs. The comparison of the MAR seismicity with the Residual MBA (RMBA) at different scales leads us to think that the low‐magnitude seismicity rates are directly related to along‐axis variations in lithosphere rheology and temperatures.

Relationship between gender and in-hospital morbidity and mortality after coronary artery bypass grafting surgery in an Iranian population.

Background:Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery (CABG) outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and women. Multiple studies have shown that women are at higher risk of postoperative complications than men, particularly in the perioperative period.Objectives:The goal of this study was to determine whether sex differences exist in preoperative variables between men and women, and to evaluate the effect of gender on short-term mortality and morbidity after CABG in an Iranian population.Patients and Methods:Data were collected prospectively from 690 consecutive patients (495 men and 195 women) who underwent isolated CABG. Preoperative, intraoperative, and postoperative variables, major complications and death were compared between the male and female patients until hospital discharge using multivariate analysis.Results:Women were older (P = 0.020), had more diabetes (P = 0.0001), more obesity (P = 0.010), a higher New York Heart Association functional class (P = 0.030), and there was less use of arterial grafts (P = 0.016). Men had more tobacco smokers (P = 0.0001) and lower preoperative ejection fractions (EF) (P = 0.030). After surgery, women had a higher incidence of respiratory complications (P = 0.003), higher creatine kinase (CK) – MB levels (P = 0.0001), and higher inotropic support requirements (P = 0.030). They also had a higher incidence of decreased postoperative EF versus preoperative values (P = 0.020). The length of ICU stay, incidence of return to ICU and postoperative death, were similar between men and women. Nevertheless, after adjusting for age and diabetes, female gender was still independently associated with higher morbidity in patients over 50 years of age.Conclusions:Women had more risk factors, comorbidities, and postoperative complications. Women older than 50 years of age were at a higher risk of postoperative complications than men. This difference decreased with younger age. In-hospital mortality rates were not influenced by sex, as there was no difference found between the two groups (2.5% women vs. 2.2% men; P > 0.05).

Clinical evaluation of leukocyte filtration as an alternative anti-inflammatory strategy to aprotinin in high-risk patients undergoing coronary revascularization

The use of aprotinin in cardiac surgery is associated with overriding safety concerns. Therefore, there is increased research on alternatives. This study investigated the relative benefits of strategic leukofiltration on polymer-coated extracorporeal circuits (ECC), aprotinin, and combined therapy in high-risk patients. Eight hundred and seventy-five patients (EuroSCORE 6+) undergoing coronary revascularization over a 4-year period were prospectively randomized to one of four perfusion protocols: Group 1: polymethoxyethylacrylate (PMEA)-coated circuits + leukocyte filters (n=214); Group 2: uncoated ECC + full Hammersmith aprotinin (n=212); Group 3: PMEA-coated ECC + leukofilters + full Hammersmith aprotinin (n=199); and Group 4: control-no treatment (n=250). Blood samples were collected at times T1: following the induction of anesthesia; T2: following heparin administration; T3: 15min after cardiopulmonary bypass (CPB); T4: before cessation of CPB; T5: 15min after protamine reversal; and T6: in the intensive care unit. The serum interleukin-2 levels were significantly lower at T3, T4, and T5 in all study groups. C3a levels were significantly lower at T3. Creatine kinase MB and lactate levels demonstrated well-preserved myocardia in both leukofiltration groups (P<0.05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups. Postoperative bleeding and respiratory support time were lower in all study groups. Leukofiltration on coated circuits significantly reduced bleeding and inflammatory response related to CPB with no adverse effects, and may be a possible alternative to pharmacological intervention.

Statistical optimization of cultural conditions for decolorization of methylene blue by mono and mixed bacterial culture techniques

Acinetobacter baumannii, Corynebacterium sp., Cytophaga columnaris, Escherichia coli,Pseudomonas fluorescence and Pseudomonas luteola were locally isolated bacteria from sewage Disposal Lake at Jeddah, Saudi Arabia and they can decolorize methylene blue.E. coli was the most potent MB decolorizing and to a lesser extend P. luteola. Five different media were tested to elucidate medium formulation in favor of MB decolorization by E. coli and P. luteola. Ingredients of the basal medium favored the complete decolorization of 50 µ QUOTE QUOTE g MB/ml after 84 h of fermentation. Time course decolorization of MB by E. coli indicated that 75 h of fermentation was satisfactory to decolorize 50 µ QUOTE QUOTE g MB/ml. It was also able to decolorize different levels of MB up to 150 µ QUOTE QUOTE g MB/ml after 95 h of fermentation. Bacterial consortium of E. coli and P. luteola was highly efficient to decolorize MB than monoculture, where the decolorization period reduced by more than 37% and increased decolorization rate (µgMB/h) up to 58%. Statistical designs of two phase multifactorial optimization (Plackett-Burman and Box-Behnken) were carried out to optimize cultural conditions to increase the efficiency of mixed culture to decolorize 150 µg MB/ml. Under the optimized conditions the decolorization period was reduced by about 31.7% and with increased decolorization rate by 46.4%. Methylene blue can be efficiently decolorized by facultative aerobic bacteria (E. coli and P. luteola). The decolorization process was markedly influenced by the composition of the fermentation medium and concentration of MB. Mixed culture of E. coli and P. luteola was highly efficient to decolorize MB than monoculture technique. The cultural conditions were considerably optimized using statistical experimental designs of Plackett-Burman and Box-Behnken. Key words: Methylene blue, Escherichia coli, Pseudomonas luteola, mixed culture, statistical optimization.

Does Lack of ST-Segment Resolution Still Have Prognostic Value 6 Years After an Acute Myocardial Infarction Treated With Coronary Intervention?

Background Limited data exist in regard to the correlation between ST-segment resolution (STR) in patients treated with primary percutaneous coronary intervention (pPCI) and very late mortality. The aim of the study was to determine the correlation between STR and 6-year mortality in patients successfully treated with pPCI. Methods We prospectively studied a group of 303 patients who had sustained an acute myocardial infarction with ST-segment elevation and subsequently exhibited TIMI 3 flow after pPCI. The patients were analyzed in 2 groups according to STR. Results There were 222 patients (73.3%) with STR and 81 patients (26.7%) without it. The mean “pain-to-balloon” time was 4.3 ± 2.1 hours in the former group vs 4.9 ± 2.8 hours in the latter ( P = 0.016). In total, 64 people (21%) died during the 6-year follow-up period: 37 (17%) showed STR and 28 (35%) did not ( P < 0.001). In multivariate analysis, STR, ejection fraction, and maximum creatine kinase and creatine kinase–MB levels were all associated with death. Anterior myocardial infarction, “pain-to-balloon” time, and ejection fraction were all further associated with lack of STR. Conclusions Lack of early STR is associated with significantly higher mortality rates after successful pPCI during a 6-year follow-up period. Absence of an early STR appears to identify patients who are less likely to benefit from the early restoration of infarct-affected artery, possibly due to microvascular damage. STR therefore appears to be a powerful prognostic marker for the occurrence of an acute myocardial infarction 6 years later.

Serum heart-type fatty acid-binding protein and platelet activating factor levels in Kawasaki disease and their clinical significance

Forty six children with Kawasaki disease (observer group) were classified as coronary artery lesions (CAL) subgroup (19 cases) and non-coronary artery lesions (NCAL) subgroup (27 cases)according to echocardiography; 50 healthy children served as control group.Serum heart-type fatty acidbinding protein (h-FABP), platelet activating factor (PAF), cardiac tropnin Ⅰ (cTnI) and creatine kinase isoenzyme MB (CK-MB) levels of all subjects were detected.The results showed that the h-FABP and cTnI levels and positive rate in observer group were higher those in control group (P ＜ 0.05 ), while there were no differences in CK-MB level and positive rate between two groups ( P ＞ 0.05 ).The h-FABP positive rate in observation group was higher than the positive rates of cTnI and CK-MB (P ＜0.05).The PAF level, PLT and polymorphonuclear neutrophil count in observer group were higher than those in control group ( P ＜0.05).The h-FABP and PAF levels in CAL subgroup were higher than those in NCAL subgroup (P ＜0.05).The results suggest that serum h-FABP and PAF can be used as diagnostic indicators for Kawasaki disease complicated with coronary artery lesions. Key words: Mucocutaneous lymph node syndrome; Fatty acid-binding proteins

Omega-3 Fatty Acids Supplementation Attenuates Inflammatory Markers After Eccentric Exercise in Untrained Men

To examine the effect of ingestion of omega-3 (N-3) fatty acids on the production of interleukin (IL) 6, tumor necrosis factor (TNF) α, prostaglandin (PG) E2, lactate dehydrogenase (LDH), creatine kinase (CK), and myoglobin (Mb) during an eccentric exercise program. A randomized, double-blinded, repeated measures design was used for this study. The study was performed in the Exercise Physiology Laboratory of the Urmia University. Forty-five men, who had not participated in any training program for 60 days before their participation in this study, were recruited. Plasma levels of PGE2, IL-6, TNF-α, CK, LDH, and Mb were taken before supplementation, pre-exercise, and immediately, 24, and 48 hours after eccentric exercise. Subjects were assigned to one of the experimental (1.8 g/d N-3), placebo, or control groups. Plasma levels of PGE2, IL-6, and TNF-α were assessed using enzyme-linked immunosorbent assays kits. Plasma level of LDH, Mb, and CK were measured using an autoanalyzer, a c-counter, and an automatic blood analyzer, respectively. The experimental group showed less elevation in TNF-α and PGE2 immediately, 24, and 48 hours after exercise, when compared with the other groups. Significantly less elevation was shown in the concentration of IL-6, CK, and Mb for the experimental group at 24 and 48 hours after exercise. The experimental group also demonstrated a significant trend toward reduction in the plasma concentration of LDH immediately, 24, and 48 hours after the exercise program. Ingestion of N-3 can be effective in ameliorating, eccentric exercise-induced, inflammatory markers.

Analysis of factors influencing limb amputation in high-voltage electrically injured patients

Background Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods Eighty-two high-voltage electrically injured patients were admitted to our hospital during a 17-year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for day 1 creatine kinase-isoenzyme MB (CK-MB) level. A serum CK-MB level above 80 ng/ml predicted high risk of limb amputation with high specificity (84%) and sensitivity (77%). Only one patient with a remarkable decrease of creatine kinase (CK) and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusion Our results suggest that CK-MB level is an independent factor for prediction of limb amputation. We suggest that the addition of CK-MB evaluation to clinical symptoms screening may be a valuable method to early detection of muscle damage.

Comparison of Prognostic Outcome Between Left Circumflex Artery–Related and Right Coronary Artery–Related Acute Inferior Wall Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

This study evaluated the 30-day clinical outcome of patients with acute inferior wall ST-elevation myocardial infarction (AIW-STEMI) from occlusion of the left circumflex artery (LCX) vs the right coronary artery (RCA) undergoing primary percutaneous coronary intervention (PCI). The clinical outcomes of AIW-STEMI caused by RCA and LCX occlusion may be different for patients undergoing primary PCI. Between May 2002 and September 2009, 646 consecutive patients with AIW-STEMI undergoing primary PCI were enrolled. Of these patients, 520 (80.5%) with AIW-STEMI caused by RCA occlusion were categorized into group 1, whereas the remaining 126 (19.5%) whose AIW-STEMI was caused by LCX occlusion served as group 2. The results demonstrated that the frequency of advanced congestive heart failure, respiratory failure requiring mechanical ventilatory support, and 30-day mortality were remarkably higher in group 2 than in group 1 (all P < 0.01). Conversely, the incidence of right ventricular infarction and complete heart block were notably higher in group 1 than in group 2 (all P < 0.001). Additionally, the peak level of creatine kinase-isoenzyme MB was significantly higher, whereas the left ventricular ejection fraction was notably lower in group 2 than in group 1. Multivariate analysis demonstrated that advanced CHF, high serum creatinine level, low systolic blood pressure, low left ventricular ejection fraction, and LCX as the infarct-related artery were significantly and independently predictive of 30-day mortality (all P < 0.05). The 30-day prognostic outcome was less favorable in LCX-related AIW-STEMI compared with RCA-related AIW-STEMI undergoing primary PCI.

Ischemic postconditioning protects cardiomyocytes against ischemia/reperfusion injury by inducing MIP2

Cardiomyocytes can resist ischemia/reperfusion (I/R) injury through ischemic postconditioning (IPoC) which is repetitive ischemia induced during the onset of reperfusion. Myocardial ischemic preconditioning up-regulated protein 2 (MIP2) is a member of the WD-40 family proteins, we previously showed that MIP2 was up-regulated during ischemic preconditioning (IPC). As IPC and IPoC engaged similar molecular mechanisms in cardioprotection, this study aimed to elucidate whether MIP2 was up-regulated during IPoC and contributed to IPoC-mediated protection against I/R injury. The experiment was conducted on two models, an in vivo open chest rat coronary artery occlusion model and an in vitro model with H9c2 myogenic cells. In both models, 3 groups were constituted and randomly designated as the sham, I/R and IPoC/hypoxia postconditioning (HPoC) groups. In the IPoC group, after 45 min of ischemia, hearts were allowed three cycles of reperfusion/ischemia phases (each of 30 s duration) followed by reperfusion. In the HPoC group, after 6 h of hypoxia, H9c2 cells were subjected to three cycles of 10 minute reoxygenation and 10 minute hypoxia followed by reoxygenation. IPoC significantly reduced the infarct size, plasma level of Lactate dehydrogenase and creatine kinase MB in rats. 12 h after the reperfusion, MIP2 mRNA levels in the IPoC group were 10 folds that of the sham group and 1.4 folds that of the I/R group. Increased expression of MIP2 mRNA and attenuation of apoptosis were similarly observed in the HPoC group in the in vitro model. These effects were blunted by transfection with MIP2 siRNA in the H9c2 cells. This study demonstrated that IPoC induced protection was associated with increased expression of MIP2. Both MIP2 overexpression and MIP2 suppression can influence the IPoC induced protection.

Myocardial Protective Effect of Human Atrial Natriuretic Peptide in Cardiac Surgery - "hANP Shot" in Clinical Safety Trial -

We studied low-dose human atrial natriuretic peptide (hANP) infusion therapy during cardiac surgery and reported the cardiac and renal protective effects. The efficacy of a bolus injection of hANP (the "hANP shot") simultaneously with induction of cardioplegia has been proven in animal experiments. In the present study the clinical effects of this "hANP shot" were examined. The subjects were 67 patients undergoing Coronary artery bypass grafting. At the time of inducing cardioplegia, 1 group received a simultaneous bolus injection of 100 μg of hANP (hANP group) and the other group received an injection of physiological saline (placebo group). The primary endpoints were (1) operative mortality and complications, and (2) the creatine kinase isoenzyme MB (CPK-MB), troponin-I, and human heart fatty acid binding protein (H-FABP) levels. The secondary endpoints were (1) the incidence of arrhythmia, and levels of (2) atrial and B-type natriuretic peptides, and cyclic guanosine monophosphate (cGMP), and (3) renin, angiotensin II, and aldosterone. Postoperative CPK-MB, troponin-I, and H-FABP levels were significantly lower in the hANP group than in the placebo group. Postoperative arrhythmia was significantly less frequent in the hANP group than in the placebo group. It is possible to achieve cardioprotective effects based on the safety of the "hANP shot", as well as from biomarkers of ischemia and results related to arrhythmia. The "hANP shot" should also be evaluated as a safer and new cardioprotective method for cardiac surgery.

H-FABP in cases of carbon monoxide intoxication admitted to the emergency room

Carbon monoxide (CO) intoxication causes cardiovascular problems as a result of diffuse tissue hypoxia. Cardiac biochemical markers and electrocardiographic changes have been reported in CO intoxications. Human fatty acid-binding protein (H-FABP) has been recently used as a reliable marker in identifying early cardiac damage. In this prospective study, we aimed to investigate the advantages of the use of H-FABP, in evaluating the findings of myocardial ischemia in patients with CO intoxication in our region. Twenty four successive patients admitted to the emergency department with acute CO intoxication were included in our study. Serum traditional markers and H-FABP were also taken in the earliest period for evaluation of cardiac damage. The creatinine kinase MB (CKMB) levels were positive in 11 of the patients; however, H-FABP and troponin T levels were positive in only 3 of them. One of these subjects had elevated level of H-FABP in the short-term and increasing troponin T level increasing level of troponin T during the follow-up period. The obtained data supports the use of H-FABP, a specific indicator in identifying the cardiotoxicity of CO intoxications at an early phase.