Serum Creatine Research Articles

Does Pregnancy-associated Plasma Protein A have a Role in Allergic Rhinitis?

Pregnancy-associated plasma protein A (PAPP-A), also known as insulin-like growth factor binding protein 4 protease, is postulated to be a new inflammatory marker in various clinical situations such as cardiovascular events, dialysis, renal transplantation, and asthma. PAPP-A also is produced in high concentrations by trophoblasts during pregnancy. We evaluated PAPP-A levels in allergic rhinitis patients and compared these with levels in healthy subjects. Thirty-one newly diagnosed allergic rhinitis patients and 29 healthy controls were included in the study. Serum PAPP-A, IgE, urea, creatinine, aspartate aminotransferase, creatine kinase (CK), CK-MB isoenzyme, total cholesterol, and triglyceride levels were determined. The serum PAPP-A level was significantly higher (p = 0.013) in the allergic rhinitis group (6.1 +/- 2.9 mU/L) than in the control group (4.5 +/- 1.7 mU/L). The PAPP-A level in patients with allergic rhinitis and asthma (6.1 +/- 2.3 mU/L) was not significantly different (p = 0.959) from that in patients with allergic rhinitis alone (6.1 +/- 3.3 mU/L). The serum PAPP-A level in allergic rhinitis patients who had turbinate hypertrophy (6.9 +/- 2.2 mU/L) had a tendency to be higher than that in patients who had no turbinate hypertrophy (5.5 +/- 3.2 mU/L); however, this difference was not statistically significant (p = 0.151). Increased PAPP-A activity may be involved in the inflammation and tissue remodelling that occurs in allergic rhinitis.

Effects of rhein on renal tubular epithelial cells transdifferentiation in diabetic rats

Objective To study the effect of rhein on the process of tubular epithelial-mesenchymat transformation in kidney of diabetic rats. Methods Wistar male rats were randomly assigned to 3 groups: Control group (N group, n=12),diabetic group(D group, n=12), rhein treatment group(R group, n=12).The rats of rhein treatment group were treated with daily intragastric administration of periment. The excretion of urinary protein and serum creatine were measured. Histological changes of renal tissue were observed by HE and MASSON stain. Immunohistochemistry was performed to investigate the expression of E-cadherin, α-SMA,FN and TGF-β1 in kidney. Results Compared with the control group, the tubulointerstitial injury and the accumulation of extraeellular matrix protein in diabetic models were obvious(P＜0.01).Compared with the control group, the expression of E-cadherin was decreased significantly and the expression of α-SMA,FN and TGF-β1 was increased significantly in diabetic group. E-cadherin was negatively correlated with TGF-β1(rs=-0.60,P＜0.05),α-SMA and FN was positively correlated with TGF-β1(rs=0.88,P＜0.05;rs:0.91,P＜0.01).In comparison with diabetic group,rhein could up-regulate the expression of E-cad and down-regulate the expression of α-SMA and FN in renal tubular epithelial cells(P＜0.01).Conclusion Rhein could protect kidney by ameliorating interstitial fibrosis in diabetic rats. The mechanism may be depend on down-regulating the expression of TGF-β1 and suppressing tubular epithelial-mesenchymal transformation. Key words: Rhein/PD; Diabetes mellitus; Kidney tubules; Epithelial cells

Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients

To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis. Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo. The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 +/- 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score. The CPT score displays the same prognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.

Serum magnesium in recovering acute renal failure

We studied the manifestations of hypomagnesemia in 50 patients with acute renal failure who had been admitted in our hospital over a period of ten months. All patients with serum creatine ≥ 2 mg/dL and normal baseline levels of serum calcium, magnesium, and potassium as well as normal ECG were included in the study. Patients with multi-organ failure, drug-induced acute renal failure, obstructive uropathy, and alcohol addiction were excluded. The mean age of our study population was 40 ± 15 years, 37 of the patients were male and 13 were female. Hypomagnesemia was observed in 31 patients out of 50 during the recovery period of acute renal failure with symptomatic hypomagnesemia being seen in 23 patients. Serum magnesium levels on the day of admission and during the recovery phase were 2.11 ± 0.38 mg/dL and 1.64 ± 0.41 mg/dL respectively. Paresthesia, irritability, agitation, dysartharia, vertigo, and associated hypokalemia and hypocalcemia were noted in symptomatic hypomagnesemic patients. Treatment of hypomagnesaemia and hypokalemia ameliorated the symptoms. We conclude that these abnormalities produce clinically significant manifestations in recovery phase of acute renal failure and clinicians should pay attention to these.

Angina in a 41-year-old man with a congenital coronary abnormality and cardiac surgery 27 years earlier

Patient presentation. A 41-year-old man with unknown heart surgery at 14 years of age was admitted with exertional chest heaviness, radiating to the left arm, associated with dyspnea and nausea. The findings of the physical examination were unremarkable, with no murmur. Serial creatine phosphokinase and troponin levels and the electrocardiogram were all normal. The patient’s medical history is significant for an asymptomatic heart murmur noted at 14 years of age. Cardiac catheterization and heart surgery were performed. However, his clinicians were unable to locate any information about the diagnosis or procedure that had been performed. During the current admission, the patient underwent repeat cardiac catheterization. Single photon emission computed tomography perfusion imaging was considered but was not performed, given the classical cardiac symptoms and risk factors of smoking, hypertension, and hyperlipidemia, as well as a family history of premature coronary disease. Left ventricular function was normal, and selective angiography of the left coronary artery (LCA) revealed ectatic left main, left anterior descending, and left circumflex arteries, all of which were nonobstructive (Figure 1). Collaterals filled the posterior descending artery (PDA) and posterior left ventricular (PLV) branches of the distal right coronary artery (RCA), as well as the acute right ventricular marginal (RVM) branch (Figure 2). The orifice of the RCA could not be located. Additional collaterals originating near the proximal RCA remnant supplied blood flow to the upper right and left ventricles. A coronary computed tomography angiogram (CTA) was ordered after invasive coronary angiography in an attempt to locate the origin of the RCA, to better explain the patient’s symptoms and to define his previous heart surgery. A GE 64-slice multidetector computed tomography scanner (GE Healthcare, Buckinghamshire, England) with reconstruction at the 70% to 80% phase provided the most optimal images. The coronary CTA revealed similar findings of an ectatic, nonobstructive left coronary system (Figure 3). The CTA of the RCA revealed a remnant originating from the pulmonary artery (PA) (Figure 4). Collateral filling to the RVM, PDA, and PLV branches was noted coming from the LCA system. We observed minimal antegrade flow from a collateral near the mediastinum feeding the proximal remnant of the RCA with blood flow to the upper region of the right ventricle and to a vessel that extended around

Myocardial protection by isoflurane vs. sevoflurane in ultra-fast-track anaesthesia for off-pump aortocoronary bypass grafting

Volatile anaesthetics have gained more popularity recently due to the potential for cardiac protection. Ultra-fast-track anaesthesia implies the immediate extubation after cardiac surgery. The purpose of this prospective randomized double-blind controlled study is to compare the cardioprotective effects of sevoflurane and isoflurane in off-pump cardiac bypass surgery. Forty patients undergoing elective off-pump cardiac bypass surgery with high thoracic epidural analgesia and immediate extubation at the end of surgery were randomized into two groups. During surgery, anaesthesia was provided with either 1 minimum alvelolar anaesthetic concentration of sevoflurane or 1 minimum alvelolar anaesthetic concentration of isoflurane. Troponin-T, creatine kinase-MB, left ventricular wall motion anomalies, time to extubation, respiratory functions and haemodynamic parameters were compared between the two groups by analysis of variance. All patients were successfully extubated in the operating theatre with minimal postoperative pain. Serial creatine kinase-MB and troponin-T concentrations were not significantly different between the two volatile agents. Haemodynamic stability throughout surgery and contractility was not different between groups. However, extubation time was significantly shorter with sevoflurane (10 +/- 5 min) compared to isoflurane (18 +/- 4 min). This study indicates that during off-pump cardiac bypass surgery, sevoflurane and isoflurane provide the same ischaemic cardioprotective effects. There is no difference for heart contractility and haemodynamic values during and after off-pump cardiac bypass surgery between the two agents. Sevoflurane allows a more rapid recovery from anaesthesia, but this does not translate into better pulmonary function or haemodynamics. Both agents are similar in ultra-fast-track off-pump cardiac bypass surgery.

Effect of ulinastatin in promotion of graft recovery in early stage after kidney transplantation: a clinical study

To investigate the effects of ulinastatin (UTI), a urinary trypsin inhibitor, on the promotion of the function recovery of transplanted kidney, especially for those with acute tubular necrosis (ATN). Thirty patients underwent general cadaver kidney transplantation were randomly allocated to 2 equal groups: Group A (UTI-treatment group) and Group B (control group). 40 patients whose allografts were presumed to be with acute tubular necrosis (ATN) were also divided into 2 equal groups: Group C (UTI-treatment group) and Group D (control group). Group A and C were given ulinastatin perioperatively. 1, 3, 7, and 10 days after the transplantation blood and urine samples were collected. The levels of urine and blood alpha1-microglobulin (MG) were detected by radioimmunoassay. Blood IL-8, IL-10, and serum creatine (sCr) were detected by ELISA. Within 10 days after the transplantation the urine volume of Group A significantly increased, especially the urine volumes of days 2, 6, 7, 9, and 10 were significant greater than those of Group B (all P < 0.05). The levels of blood IL-8 of Group A in days 1 and 3 were (93.75 +/- 31.5) ng/L and (41.98 +/- 24.01) ng/L respectively, significantly lower than those of Group B [(135.0 +/- 31.2) ng/L and (78.34 +/- 76.39) ng/L respectively, both P < 0.05]. The levels of urine alpha1-MG in days 1 and 3 were (69.89 +/- 32.60) mg/L and (35.33 +/- 34.54) mg/L respectively, both significantly lower than those of Group B [(91.15 +/- 28.39) mg/L and (65.84 +/- 33.38) mg/L respectively, both P < 0.05]. In group C, the levels of blood alpha1-MG in days 7 and 10 of Group C were (118.26 +/- 41.23) mg/L and (99.49 +/- 68.63) mg/L respectively, both significantly lower than those of Group D [(187.15 +/- 55.23) mg/L and (151.27 +/- 87.42) mg/L respectively, both P < 0.05]. The urine alpha1-MG in days 7 and 10 were (39.89 +/- 22.32) mg/L and (38.21 +/- 20.36) mg/L respectively, both significantly lower than those of Group D [(67.34 +/- 21.56) mg/L and (62.26 +/- 29.24) mg/L respectively, both P < 0.05]. Compared to Group D, the increasing tendency of blood IL-8 was better suppressed in Group C, and the diuretic phases appeared earlier. UTI significantly improves the microcirculation, protects the tubule of transplanted kidney, increases the volume of urine, inhibits the inflammatory response, and promotes the recovery of ATN during the perioperative period of kidney transplantation.

Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine

Backgrounds The potential role of hydration in prevention of contrast-induced nephropathy (CIN) still remains to be unclear. Methods Nine-hundred and thirty-six patients scheduled for percutaneous coronary intervention (PCI) were enrolled into the present study, and divided into normal (serum creatinine < 1.5 mg/dl) and abnormal (serum creatine ≥ 1.5 mg/dl) groups according to their baseline serum concentration of creatinine. Each group was further randomly divided into two subgroups: hydration and nonhydration. All patients in abnormal group took twice orally loading dose of 1200 mg acetylcysteine (ATLS) at 12 h before scheduled time for coronary angiogram and immediately after procedure. Creatinine concentration was remeasured at the time of admission (just before catheterization), every day for the following three days. The primary end point during 6-month follow-up included clinical driven revascularization (either PCI or CABG), death from all causes, and requiring emergency renal-replacement therapy. Results The incidence of CIN was more commonly in abnormal group that in normal group (6.52% vs. 37.68%, p < 0.001). Hydration had potentials in prevention of CIN only in patients with elevated baseline concentration of creatinine. Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: age ≥ 70 years (odds ration [OR] 5.27, 95% confidence interval [CI] 1.94 to 13.07, p = 0.0007), contrast volume ≥ 320 ml (OR 3.26, 95% CL 2.14 to 7.58, p = 0.01), diabetes mellitus (OR 9.86, 95% CL 5.38 to 31.67, p < 0.0001), and peripheral arterial disease (OR 11.25, 95% CL 5.12 to 43.19, p < 0.0001). Patients with CIN in abnormal group had worse clinical outcomes, compared to patients with CIN in normal group. Conclusion Patients with CIN and preexisting renal insufficiency had worse clinical outcomes. Hydration with 0.45% sodium chloride alone had no potential effect on the occurrence of CIN in patients with normal renal function. Combination of hydration with ATLS could reduce the incidence of CIN in patients at high risk.

Comparison of the Usefulness of Gadodiamide and Iodine Mixture Versus Iodinated Contrast Alone for Prevention of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Coronary Angiography

Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired renal failure. Gadolinium-based contrast agents have been proposed as alternatives to iodinated contrast in patients at high risk for CIN. The use of high-dose intraarterial gadolinium chelates in the catheterization laboratory has been investigated in only a small number of patients. We compared patients with a creatinine clearance <60 ml/min/1.73 m2 who received intravenous hydration (> or =1,500 ml) and oral n-acetylcysteine prophylaxis with those who received a gadodiamide-iodine mixture (n = 90) or iodinated contrast alone (n = 79) in the cardiac catheterization laboratory. CIN was defined as an increase of 0.5 mg/dl in serum creatine from baseline. The 2 groups were similar with respect to demographics and risk factors. Although less iodinated contrast was used in the gadolinium mixture group, there was no difference in the incidence of CIN between the 2 groups. However, the initiation of dialysis (n = 7) and death (n = 8) only occurred in the diluted gadolinium contrast group. A stepdown multivariate analysis found diabetes mellitus to be the only independent predictor of CIN (p = 0.02, odds ratio 3.35, 95% confidence interval 1.21 to 9.29, c-statistic 0.66). In conclusion, the incidence of CIN was not decreased in high-risk patients receiving a gadolinium-iodinated contrast mixture versus iodinated contrast alone.

Cardiac Troponin I in Patients With Acute Lower Limb Ischemia

The presence, cause, and clinical significance of elevated cardiac troponin I in patients with acute lower limb ischemia is yet unknown. Forty-six patients (20 men [43%]; mean age 72 +/- 10 years, range 42 to 92) with acute lower limb ischemia were enrolled in this study. Serial creatine kinase (CK), CK isoenzyme MB (CK-MB), and troponin I measurements were obtained in all consecutive patients. Peak levels were evaluated for each patient. Twenty-four patients (52%) had elevated peak troponin I levels (>0.2 ng/ml) during their hospitalization. Patients were divided into 3 groups according to their peak troponin I levels: 11 patients (24%) had peak troponin I levels >1 ng/ml (the high troponin I group), 13 (28%) had levels of 0.2 to 1 ng/ml (the intermediate troponin I group), and the remaining 22 (48%) had peak troponin I levels <0.2 ng/ml (the low troponin I group). The peak CK levels were 10,263 +/- 16,513, 1,294 +/- 1,512, and 934 +/- 1,045 IU/ml (p = 0.04) in the 3 different troponin I subgroups, respectively, and the peak CK-MB levels were 143 +/- 170, 38 +/- 31, and 38 +/- 43, respectively (p = 0.04). Troponin I was positively correlated with CK (R = 0.35, p = 0.017) and CK-MB (R = 0.38, p = 0.009). The mean length of hospitalization was 8.3 +/- 6.2 days for the whole study group and did not vary among the 3 troponin I groups (10.5 +/- 10.9 vs 8.6 +/- 4.9 vs 7.2 +/- 4.0 days, p = 0.762). There were no differences in mortality during hospitalization among the 3 groups (4 of 11 vs 1 of 13 vs 4 of 22 patients, p = 0.22). In conclusion, patients with acute lower limb ischemia often have elevated cardiac troponin I levels. Elevated troponin I levels were not associated with the duration of hospitalization or with in-hospital mortality in this group of patients.

Prospective study of cardiac troponin I release in patients with upper gastrointestinal bleeding

The rate of cardiac injury in upper gastrointestinal hemorrhage is unclear. The aims of this study were to determine prospectively the risk of cardiac troponin I release and associated adverse cardiac events in patients with acute upper gastrointestinal hemorrhage. From January to September 2003, we prospectively studied patients with documented hematemesis and melena referred to the gastroenterology unit in a tertiary teaching hospital in Melbourne, Australia. Serial assays for cardiac troponin I were performed at 0, 12 and 24 h. Serial creatine kinase levels and electrocardiographs were also performed. Clinical and biochemical data were collected. The primary endpoint was a troponin level >0.5 microg/L within 24 h of recruitment. Various clinical variables were then compared between the groups of patients with or without troponin rise. A total of 156 patients were included in the study. The mean age was 67 years (range 19-96). There were 104 (67%) male patients. A troponin level of greater than 0.5 microg/L was found in 30/156 (19%); 126 (81%) patients had normal troponin levels. Age greater than 65 years, signs of hemodynamic instability at presentation, a recent history of cardiac disease, cardiovascular compromise following endoscopy, and re-bleeding were associated with troponin release. Upper gastrointestinal bleeding is associated with a risk of cardiac injury of up to 19%. Troponin assay could be used to screen for cardiac damage, especially in elderly patients who present with hemodynamic instability.

Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction

Objectives:The aim of this study was to use late gadolinium hyper-enhancement cardiac magnetic resonance (LGE-CMR) imaging to determine if a 72-h troponin-I measurement would provide a more accurate estimation of...

Reversible renal vasoconstriction in a patient with acute renal failure after exercise

Acute renal failure (ARF) with severe loin pain induced by anaerobic exercise is a rare condition that is accompanied by wedge-shaped contrast enhancement seen on computerized tomographic (CT) scan without evidence of rhabdomyolysis. An 18-year-old Korean male was transferred to our hospital for evaluation of mild azotemia, that developed after anaerobic exercise. The laboratory tests revealed that the serum creatinine was 2.1 mg/dl and the serum uric acid level was 1.6 mg/dl without any elevation of the serum myoglobin or creatine phosphokinase. Under the impression of exercise-induced ARF, we tried to determine the relationship between the occurrence of clinical symptoms, renal dysfunction and the characteristic CT findings by observing those changes prospectively before and after anaerobic exercise. After obtaining a written consent, the patient underwent a strenuous period of anaerobic exercise to induce the clinical symptoms. Before exercise, he was completely asymptomatic; his serum creatinine level was 0.9 mg/dl and CT scan of the kidneys showed no abnormalities. Loin pain developed 2 hours after exercise, and the serum creatinine level increased to 1.2 mg/dl 18 hours after the exercise. CT scan 18 hours after exercise showed multiple perfusion defects, and a 24-hour delayed CT scan showed multiple areas of wedge-shaped enhancement on both kidneys. These changes were completely resolved on the follow-up CT scan obtained 13 days after exercise with the return of a normal serum creatinine level. We conclude that reversible renal vasoconstriction is probably the main pathophysiologic mechanism of acute renal failure induced by anaerobic exercise.

Effects of stocking density, flock size and management on the welfare of laying hens in single-tier aviaries

1. Management practices, stocking rate and flock size may affect laying hen welfare but there have been few replicated studies in commercial non-cage systems that investigate this. This study used a broad range of physical and physiological indicators to assess the welfare of hens in 36 commercial flocks. 2. Six laying period treatments were examined with each treatment replicated 6 times. It was not possible to randomly allocate treatments to houses, so treatment and house were largely confounded. 3. Three stocking rates were compared: 7 birds/m2 (n = 2450), 9 birds/m2 (n = 3150) and 12 birds/m2 in either small (n = 2450) or large (n = 4200) flocks. In addition, at 12 birds/m2, in both small and large flocks, birds were subjected to either standard (SM) or modified (MM) management. MM flocks had nipple drinkers and no nest-box lights. 4. Bone strength, fracture incidence, heterophil:lympocyte (H:L) ratio, live weight, organ weights, serum creatine, serum osmolality, muscle pH and faecal corticosterone were measured on samples of birds at the end of the rearing period and at the end of lay. During the laying period, mortality, production and integument condition were recorded at regular intervals. 5 Birds housed at 9 birds/m2 had higher mortality than birds housed at 12 birds/m2 by the end of lay, but not higher than birds housed at 7 birds/m2. Birds housed at 7 and 9 birds/m2 had lower percent liver weight, and worse plumage condition than most of the 12 bird/m2 treatments. Modified management tended to improve plumage condition. There were no clear effects of flock size on the welfare indicators recorded. 6. At the end of the rearing period fracture incidence was almost negligible and H:L ratio was within a normal range. 7. By the end of lay fracture incidence was 60% and H:L ratio was high, with no treatment effect for either measure. This, together with information on faecal corticosterone, feather loss and mortality, suggests that the welfare of birds in all treatments was relatively poor by the end of lay.

プラバスタチン製剤先発医薬品と後発医薬品における臨床効果の比較

In the present study, we retrospectively evaluated the efficacy and safety of pravastatin sodium after switching from the branded product to a generic. Our subjects were 27 type II diabetes mellitus patients aged 52-87 years with hyperlipidemia as a complication, who received the branded product for 12 weeks and were followed up for more than 12 weeks after switching to the generic product.No significant differences were noted between the branded and generic products as regards serum lipids, creatine phosphokinase (measured in 6 patients), or biochemical parameters of hepatic and renal function. We may therefore conclude that the branded and generic pravastatin administered in this study had similar efficacy and safety profiles.

Serum Levels of NT-ProBNP as an Early Cardiac Marker of Carbon Monoxide Poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this sudy we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.

Troponin‐T levels in perinatally asphyxiated infants during the first 15 days of life

To measure serial cardiac troponin-T, creatine kinase, creatine kinase-MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life. Troponin-T, creatine kinase, creatine kinase-MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase (LDH) concentrations were measured prospectively in blood samples obtained from 45 asphyxiated and 15 healthy term neonates within the first 2-4 h, third, seventh and 15th days. Infants with severe asphyxia had significantly higher cardiac troponin-T levels than grade I and II asphyxiated and healthy neonates within the first 2-4 h of life (0.34+/-0.21 ag/ml vs 0.07+/-0.03 ag/ml, 0.12+/-0.07 ag/ml, 0.04+/-0.02 ag/ml, respectively). Troponin-T levels remained high on days 3 and 7 in severely asphyxiated neonates. The creatinine kinase-MB levels were significantly higher in grade II and III asphyxiated neonates than grade I asphyxiated and healthy neonates within the first 2-4 h. No difference was found in creatinine kinase-MB on day 3. There was cardiac involvement in 12 (80%) newborns of group III on B mode echocardiographic images on day 1. However, no echocardigraphic pathology was found in the seventh- and 15th-day echocardiographic analysis in any groups. Our results suggest that asphyxia-related cardiac changes were significant but reversible in severely asphyxiated neonates, and troponin T is a good determinant of the degree of injury to the heart within the first week of life. Cardiac troponin T also has a wider diagnostic frame than other diagnostic markers of myocardial damage.

The Comparison and Validity of Troponin I Assay Systems in Diagnosing Myocardial Ischemic Injury After Surgical Coronary Revascularization

A prospective observational study was conducted to test the agreement between 2 commercially available automated cardiac troponin-I immunoassay systems (Opus Plus, Behring Diagnostics UK Ltd, Hounslow, UK; AxSYM, Abbott Laboratories, Abbott Park, IL) and to determine a normal reference range and threshold value indicative of perioperative myocardial infarction (PMI) after elective coronary artery bypass graft (CABG) surgery for the Opus Plus system. Prospective, observational study. Setting : Single institution, cardiothoracic specialty hospital. Seventy patients undergoing elective CABG surgery. After institutional review board approval, patients received standardized anesthetic, surgical, and myocardial preservation techniques. Serial electrocardiographs, creatine kinase-MB, troponin-I, and perioperative outcome data were collected. Correlation between the immunoassay systems was tested using 124 duplicate samples from the first 18 patients. The normal reference range and threshold value indicative of PMI were tested for the Opus Plus system using duplicate samples from all 70 patients. Peak troponin-I concentrations (median [interquartile range]) differed significantly when measured by the Opus Plus and AxSYM immunoassay systems (5.61 [3.20-22.35] microg/L v 46.50 [14.55-70.95] microg/L, respectively; p < 0.001). There was clear proportional bias that was corrected with log transformation of the raw data. By using confidence interval and receiver operating characteristic curve analysis, the authors showed that a value > or =15 mug/L was indicative of PMI (Opus Plus system) and accordingly report a 35.7% (2.9% Q-wave) overall incidence of PMI in this study population (n = 70). These data highlight differences between commercially available troponin-I assay systems. The authors recommend that each institution establish a local reference range and threshold indicative of perioperative myocardial infarction for its specific patient population and assay system and provide sample methodology.

Right Bundle Branch Block in Acute Myocardial Infarction Treated by Primary Coronary Angioplasty and Stenting

Patients with right bundle branch block (RBBB) in acute myocardial infarction (AMI) have a significantly higher mortality rate even with the advent of thrombolytic therapy. This study was undertaken to assess the impact of primary percutaneous transluminal coronary angioplasty (PTCA) and stenting on the outcome of patients with RBBB in AMI. A total of 600 patients with AMI who underwent primary PTCA and stenting (rate: 61%) < 12 hours of onset were studied. A 12-lead ECG was obtained at least every 6 hours. Serial creatine kinase was measured, and left ventricular ejection fraction was obtained during the hospital stay. Among 600 patients with AMI, 94 patients (15.7%) had RBBB; it was persistent in 31 (33%) and transient in 63 (67%). In-hospital mortality rate was 7.3% in patients without RBBB, 7.9% in transient RBBB, and 25.8% in persistent RBBB (p < 0.02). The incidence of heart failure was 26.5% in those without RBBB, 34.9% in transient RBBB, and 58.1% in persistent RBBB (p < 0.001). There was no significant difference among these 3 groups in ventricular arrhythmias and complete atrioventricular block. Peak creatine kinase was 3,214+/-2,293 U/L in those without RBBB, 4,558+/-3,316 U/L in transient RBBB (p < 0.001), and 5,635+/-3,920 U/L in persistent RBBB (p < 0.001). Left ventricular ejection fraction was 50+/-11% in those without RBBB, 47+/-11% in transient RBBB (p < 0.05), and 42+/-13% in persistent RBBB (p < 0.001). Patients with AMI treated by primary PTCA and stenting had an increased incidence of transient RBBB, especially following reperfusion therapy, although the clinical outcome was similar to that of those without RBBB. In contrast, there was no satisfactory improvement in clinical outcomes in those with persistent RBBB.

Percutaneous coronary intervention with stent deployment for the treatment of graft vasculopathy after cardiac trasnplantation-a single center experience

with either adverse events related to statin therapy necessitating discontinuation of this class of medication (n 6) or refractorylipids despite maximal doses of a statin (n 6). Baseline lipid profiles were obtained in both groups prior to instituting therapy with ezetimibe at a dose of 10 mg/day. There was no washout period. Serum lipids, transaminases and creatine kinase were periodically measured thereafter. Results: Median follow-up in the cohort with refractory lipids was 4 months and in the group with adverse events on statins was 3 months. Median change in lipid parameters for the 2 groups is shown below.