Terminal Brain Natriuretic Peptide Research Articles

КАРДИОМЕТАБОЛИЧЕСКИЙ ПРОФИЛЬ С УЧЕТОМ СТАДИРОВАНИЯ ПО CMDS У ЛИЦ МОЛОДОГО ВОЗРАСТА

Abstract. Introduction. The burden of cardiovascular disease, diabetes mellitus, and the associated mortality remains high. One classification system that predicts the development of cardiovascular events and type 2 diabetes mellitus is Cardiometabolic Disease Staging (CMDS). The study of new cardiometabolic profile parameters is relevant in the context of their association with residual cardiovascular risk. The aim of the study was to evaluate the cardiometabolic profile, including extended parameters, in young adults, while taking into account the CMDS. Materials and Methods. 185 male and female subjects aged 35.0 [30.0–39.0] years were examined. The participants were divided into groups according to the CMDS classification: Stage 0, metabolically healthy; Stage 1 (low risk), one or two risk factors (RFs) other than prediabetes; Stage 2 (intermediate risk), presence of ≥3 risk factors or prediabetes; Stage 3 (high risk), presence of ≥3 risk factors and prediabetes. The study examined visceral adiposity index, visceral fat level, insulin resistance, leptinemia, hyperuricemia, glomerular filtration rate, C–reactive protein, and N–terminal brain natriuretic peptide concentrations. The data were processed in SPSS Statistics 26. Results and Discussion. The cardiometabolic profile demonstrated unfavorable alterations with the progression of CMDS stages. Across the spectrum from CMDS 0 to CMDS 3, we observed a significant rise in the prevalence of abdominal obesity (0% to 100%, p<0,001), body mass index ≥25 kg/m2 (16.2% to 100%, p<0.001), and excess visceral fat level (0% to 23.8%, p<0.001). Simultaneously, the prevalence of hypercholesterolemia demonstrated a significant rise (24.3% to 52.4%, p=0.025), as did elevated low–density lipoprotein cholesterol (32.4% to 76.1%, p=0.014), insulin resistance (2.7% to 66.7%, p<0.001), leptinemia (45.9% to 90.5%, p=0.009), C–reactive protein (2.7% to 57.1%, p<0.001) and hyperuricemia (16.2% to 61.9%, p<0.001). The median values of these parameters also increased. Conclusions. Our data confirm the simultaneous increase in both the quantity and intensity of risk factors, manifestations of adiposopathy associated with increasing residual cardiovascular risk. Our results substantiate the feasibility of using the CMDS classification at the stage of primary prevention of cardiometabolic diseases to identify groups with the most significant metabolism disorders of lipid, carbohydrate and purine metabolism in young adults.

The Utility of Plasma N- Terminal Brain Natriuretic peptide (NT- Pro BNP) as a Biomarker to Differentiate Cardio embolic Stroke from Non-Cardio embolic Stroke.

TITLE: The Utility of Plasma N- Terminal Brain Natriuretic Peptide (NT- Pro BNP) as a Biomarker to Differentiate Cardio embolic Stroke from Non-Cardio embolic Stroke. PURPOSE: To measure plasma NT-Pro BNP in patients with acute ischemic stroke and investigate whether the plasma NT- pro BNP level can be a useful bio marker to differentiate cardio embolic (CE) stroke from non-cardio embolic (NCE) stroke or not. STUDY DESIGN: In our analytic observational prospective study, 66 patients were enrolled within 24 hours of the onset of acute ischemic stroke and met inclusion and exclusion criteria. METHODOLOGY: Plasma NT-pro BNP level was performed in each patient. Clinical observations were recorded on special performa designed for the study. They were classified in to four groups: Cardioembolic (CE), Large artery atherosclerosis (LAA), Small-vessel disease (SVD) and other subtypes according to TOAST classification. Study outcome was measured by applying appropriate statistical tests at the end of all patient enrolments. RESULTS: Out of 66 patients, 21(31.81 %) were cardioembolic whereas 45 (68.18%) patients were in non-cardioembolic (NCE) group. The result showed that plasma NT pro BNP levels were significantly higher in CE group than NCE group (p value<0.001). The optimal cut off point for NT pro BNP levels to differentiate CE stroke from NCE stroke was > 594 pg./ml with 93.33% Specificity and 66.67% Sensitivity. CONCLUSION: As plasma biomarker NT-pro BNP has a good sensitivity, specificity and accuracy for early identification of cardio embolic stroke.

ELEVATED TRIGLYCERIDE GLUCOSE INDEX IS RELATED TO THE PRESENCE OF HEART FAILURE

Objective: Previous studies have shown a significant associa tion between insulin resistance (IR) measured by using different methods and heart failure (HF). In recent years, the triglyceride glucose (TyG) index has been used to measure IR, and there are several reports showing that the TyG index indicates conditions such as metabolic syndrome (MetS) and atherosclerotic process. However, there is no study investigating the association of the TyG index with HF. Therefore, we aimed to evaluate the role of the TyG index in HF presence and its relationship with HF severity in this study. Material and Method: Sixty-nine subjects matched for age and gender were analyzed retrospectively. The TyG index was used to measure IR and was calculated by the formula Ln [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. The severity of HF was assessed by New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N- terminal prohormone brain natriuretic peptide (NT-proBNP). Results: HF patients had higher TyG index (9.11±0.59 vs. 8.55±0.55; p<0.001) but there was no correlation between TyG index with HF severity identified by NYHA functional class, LVEF and NT-proBNP. The ROC curve showed the cut-off point of the TyG index in determining HF as 9.19 with 71% sensitivity and 51% specificity (AUC:0.745, p<0.001). Conclusion: TyG index may be a useful marker for diagnosis of HF, but is not correlated with HF severity.

ELEVATED TRIGLYCERIDE GLUCOSE INDEX IS RELATED TO THE PRESENCE OF HEART FAILURE

Objective: Previous studies have shown a significant associa tion between insulin resistance (IR) measured by using different methods and heart failure (HF). In recent years, the triglyceride glucose (TyG) index has been used to measure IR, and there are several reports showing that the TyG index indicates conditions such as metabolic syndrome (MetS) and atherosclerotic process. However, there is no study investigating the association of the TyG index with HF. Therefore, we aimed to evaluate the role of the TyG index in HF presence and its relationship with HF severity in this study. Material and Method: Sixty-nine subjects matched for age and gender were analyzed retrospectively. The TyG index was used to measure IR and was calculated by the formula Ln [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. The severity of HF was assessed by New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N- terminal prohormone brain natriuretic peptide (NT-proBNP). Results: HF patients had higher TyG index (9.11±0.59 vs. 8.55±0.55; p<0.001) but there was no correlation between TyG index with HF severity identified by NYHA functional class, LVEF and NT-proBNP. The ROC curve showed the cut-off point of the TyG index in determining HF as 9.19 with 71% sensitivity and 51% specificity (AUC:0.745, p<0.001). Conclusion: TyG index may be a useful marker for diagnosis of HF, but is not correlated with HF severity.

Serum CA125 a potential marker of volume status for peritoneal dialysis patients?

Introduction:Serum cancer antigen 125(SeCA125) has been reported to be increased in patients with heart failure and correlate with both extracellular water (ECW) overload and poor prognosis. Ultrafiltration failure and ECW overload are a major cause of peritoneal dialysis (PD) technique failure. We wished to determine whether SeCA125 could also be a marker of volume status in PD patients.Methods:We contemporaneously measured SeCA125, serum N terminal brain natriuretic peptide (NTproBNP) and ECW by bioimpedance in adult PD patients attending for outpatient assessment of peritoneal membrane function.Results:The median SeCA125 was 19 (12–33) U/mL in 489 PD patients, 61.3% male, median age 61.5 (interquartile range 50–75) years. SeCA125 was positively associated with the ratio of ECW/total body water (TBW) (r = 0.29, p < 0.001), 4-h peritoneal dialysate to serum creatinine ratio (r = 0.23, p < 0.001), NTproBNP) (r = 0.18, p < 0.001), and age (r = 00.17, p = 0.001) and negatively with 24-h PD ultrafiltration volume (r = −0.28, p < 0.001) serum albumin (r = −0.22, p < 0.001), and echocardiographic left ventricular ejection fraction (r = −0.20, p < 0.001), but not with residual renal function or C-reactive protein. Patients with above the median SeCA125, had greater median ECW/TBW 0.403(IQR 0.394–0.410) vs 0.395(0.387–0.404), p < 0.001 and NTproBNP (6870 (IQR 1936–20096) vs 4069 (1345–12291) vs) pg/mL, p = 0.03.Conclusion:Heart failure studies have reported SeCA125 is a marker of ECW overload. Our retrospective analysis suggests that SeCA125 is also associated with ECW volume in PD patients. Further studies are required to determine whether serial measurements of SeCA125 trend with changes in ECW status in PD patients and can be used to aid volume assessments.

Study on the relationship between Plasma Pro amino terminal brain natriuretic peptide, left ventricular mass index and the prognosis in elderly heart failure patients with preserved ejection fraction

Objective To investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and Left ventricular mass index(LVMI )in evaluating the prognosis of elderly heart failure patients with preserved ejection fraction (HFpEF). Methods From January 2018 to December 2018, 170 patients with heart failure (age≥65years old) in the Third Affiliated Hospital of Anhui Medical University were selected as the subjects of prospective study.According to the left ventricular ejection fraction (LVEF), the patients were divided into two groups: the heart failure with preserved ejection fraction (HFpEF) group (100 cases), the heart failure with reduced ejection fraction (HFrEF) group (70 cases), and the healthy subjects (58 cases) as the control group.Left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVEDD), LVEF, left ventricular mass index (LVMI) and plasma NT-proBNP concentrations were compared among the three groups.The study group was followed up for 6 months after standardized treatment to observe the occurrence of major cardiovascular adverse events (MACE). Multiple logistic regression was used to analyze the correlation between the above indexes and the occurrence of mace.ROC curve was used to analyze the predictive value of NT proBNP and LVMI. Results There were significant differences in LAD, IVSTt, LVPWT, LVEDD, LVEF and LVMI among each group (F value was 110.878, 75.838, 74.044, 137.985, 495.267 and 122.810, respectively, all P<0.001 ). The LAD, IVST, LVPWT, LVEDD, and LVMI in the HFpEF group((40.81 ±4.46) mm, (9.39±1.15) mm, (9.68±1.11) mm, (55.54±3.67) mm, (125.45±19.17) g/m2) were higher than those in the control group ((32.9±3.20) mm, (7.62±0.64) mm, (7.81±0.58) mm, (47.05±3.13) mm, (77.72±11.79) g/m2), and the LVEF was lower than that of the control group ((59.63±5.23)% vs.(67.7±4.35)%) with statistical significance (all P<0.05). IVST, LVPWT, LVEF in HFpEF group( (9.39±1.15) mm, (9.68±1.11) mm, (9.63±5.23)%) were higher than those in HFrEF group ((7.59±1.28) mm, (8.01±1.39) mm, (36.9±7.63 )%) ; and the LAD, LVEDD in HFpEF group ((40.81±4.46) mm, (55.54±3.67) mm) were lower than those in HFrEF group ((45.51±6.1) mm, (64.77±9.55) mm), and the differences were statistically significant (all P<0.05). The plasma NT-proBNP concentration was the lowest in the control group, followed by the HFpEF group and the highest in the HFrEF group(56.0 (30.0, 78.56), 2 624.5 (1 190.5, 5 558.5), 8 528.5 (2 651.0, 21 582.75), F=81.355, P<0.01). Multivariant Logistic regression analysis showed that NT-proBNP and LVMI were independent risk factors for occurrence of MACE in patients with HFpEF(OR=4.796, 95%CI: 2.348-5.127, P=0.035; OR=1.957, 95%CI: 1.810-3.327, P=0.016). ROC curve analysis showed that the area under the curve of cardiovascular adverse events predicted by NT-proBNP and LVMI for 6 months was 0.888(95%CI: 0.825-0.950, P<0.001) and 0.713(95%CI: 0.613-0.812, P=0.013). Conclusion NT-proBNP and LVMI have important value for prognosis evaluation in elderly patients with HFpEF. Key words: Heart failure; Heart failure with preserved ejection fraction; N-terminal pro-brain natriuretic peptide; Left ventricular mass index; Prognosis

Improvement of cardiac function in CHF patients treated with acupuncture and moxibustion and western conventional medicine

Objective To investigate the effect of warm acupuncture combined with Western medicine on cardiac function in patients with CHF. Methods A total of 120 patients with CHF who met the inclusion criteria were randomly divided into two groups, 60 in each group. The control group was treated with conventional medicine, and the Chinese and western medicine group was combined with warm acupuncture on the basis of the control group. Both groups were treated for 4 weeks. The 6 min walking distance were compared. The LVEF%, LVEDd, and LVESd were measured by color Doppler ultrasound. The Plasma NT-proBNP was detected by ELISA. Results The total effective rate was 95.0% (57/60) in the Chinese and western medicine group and 90.0% (54/60) in the Western medicine group. The difference was statistically significant (Z=-2.218, P=0.027). After treatment, the LVEF% level of the Chinese and western medicine group (49.5% ± 4.7% vs. 47.0% ± 4.5 %, t=2.976), 6 min walking distance (348.9 ± 38.1 m vs. 319.7 ± 35.0 m, t= 5.107) were significantly higher than those of the Western medicine group (P<0.01); and the LVEDd (47.3 ± 4.0 mm vs. 50.0 ± 4.6 mm, t=-3.431), LVESd (38.5 ± 3.5 mm vs. 40.8 ± 3.9 mm, t=-3.400), NT-proBNP (750.2 ± 158.5 ng/L vs. 900.4 ± 183.7 ng/L, t=4.960) were significantly lower than those of the western medicine group (P<0.01). Conclusions Warm acupuncture combined with Western medicine can improve the heart function of CHF patients. Key words: Heart failure; Needle warming therapy; Acupuncture points; Amino terminal brain natriuretic peptide precursor; Integrated Chinese traditional and western medicine therapy

Carvedilol Combined With Ivabradine Improves Left Ventricular Diastolic Dysfunction, Clinical Progression, and Survival in Cirrhosis.

Left ventricular diastolic dysfunction (LVDD) refers to impaired cardiac diastolic relaxation and may be improved by targeted heart rate reduction (THR). The authors evaluated whether a combination of carvedilol and ivabradine, an If channel blocker that reduces heart rate without affecting blood pressure, could improve LVDD and outcomes in cirrhosis. THR was defined as heart rate reduction to 55 to 65 beats per minute. Of 260 patients with cirrhosis, 189 (72%) with LVDD were randomized to THR [group (Gr.)A; n=94; carvedilol±ivabradine)] or standard care (Gr.B; n=95; no β-blockers) and followed for 12 months. In Gr.A, THR was achieved at 4 weeks in 88 (93%) patients (responders, R): 48 (61.5%) with carvedilol alone and 40 (86.9%) of 46 patients with additional ivabradine. In Gr.A, LVDD reversed in 16 (20.5%) and improved from grade 2 to 1 in 34 (35.4%)], whereas in Gr.B, it progressed from grade 1 to 2 in 10 (10.5%) patients. At 12 months, 21 (11.1%) patients died, 6 (14%) in Gr.A and 15 (18%) in Gr.B (P=0.240), but no mortality was seen in those who had persistent THR at 1 year (n=78; P=0.000). In multivariate analysis, model for end-stage liver disease [hazard ratio (HR), 1.52; 95% confidence interval (CI), 1.22-2.75; P=0.034] and E-wave transmitral/early diastolic mitral annular velocity (HR, 1.28; 95% CI, 1.23-2.42; P=0.048) predicted 1-year mortality. Nonresponders had an increased mortality risk (HR, 1.3; 95% CI, 1.2-1.8; P=0.046) independent of age, gender, and baseline model for end-stage liver disease. Levels of norepinephrine, N terminal brain natriuretic peptide, plasma renin activity, and aldosterone were reduced (P<0.01) in responders. More patients in Gr.B developed acute kidney injury (odds ratio, 4.2; 95% CI, 2.8-10.5; P=0.027) and encephalopathy (odds ratio, 6.6; 95% CI, 1.9-9.7; P=0.040). Ivabradine combined with carvedilol improves LVDD, achieves THR more often and reduces risk of encephalopathy, acute kidney injury with improved survival in patients with cirrhosis.

Risk factors of neurodevelopmental outcomes in very/extremely low birth weight infants

Objective To analyze the risk factors of adverse neurodevelopmental prognostic in very /extremely low birth weight infants (VLBWI/ELBWI). Methods The 24 hours VLBWI/ELBWI admitted to the neonatal intensive care unit between January 2016 and October 2016 were enrolled.These infants were followed up and neurodevelopmental evaluation was performed at a corrected age of 12 months by using the Bayley Scales of Infant Development Ⅱ (BSID-Ⅱ). According to the neurodevelopmental outcomes, they were divided into normal and abnormal neurodeve-lopment groups.The data of prenatal, intrapartum and postpartum periods in the two groups were compared.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression. Results A total of 167 VLBWI/ELBWI were enrolled, among which 14 cases died during hospitalization or after giving up treatment.At the corrected age of 12 months, 140(91.5%) infants completed follow-up and 13(8.5%) were lost to follow-up.Among 140 infants who completed neurodevelopmental evaluation at the corrected age of 12 months, there were 86 males, 54 females, and in which 28 cases had extremely low birth weight, 112 cases with very low birth weight, with gestational age of (30.4±2.2) weeks (25.3-36.0 weeks). There were one hundred and twenty-five cases with normal neurodevelopmental outcomes and 15 cases with abnormal neurodevelopmental outcomes.The results of univariate analysis showed that birth weight<1 000 g, exposure to antenatal steroids, N -terminal brain natriuretic peptide (NT-proBNP) ≥35 000 ng/L and bronchopulmonary dysplasia (BPD) in the two groups were statistically significant(P<0.05). Logistic stepwise regression showed that NT-proBNP level≥35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI (OR=22.774, 95%CI: 3.079-168.425, P=0.002). Exposure to antenatal steroids may be a protective factor for neurodevelopmental impairment (OR=0.125, 95%CI: 0.020-0.782, P=0.026). Conclusions Plasma NT-proBNP level ≥35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI.Antenatal corticosteroids may be the protective factor of poor neurodevelopmental outcomes. Key words: Neurodevelopmental prognosis; Bayley Scales of Infant Development Ⅱ; Very low birth weight infant; Extremely low birth weight infant

B-type peptides to predict post-liver transplant mortality: systematic review and meta-analysis.

Cirrhotic patients undergoing liver transplantation are at risk of cardiac complications. Brain natriuretic peptide (BNP) and amino terminal brain natriuretic peptide (NT-BNP) are used in cardiac risk stratification. Their significance in predicting mortality risk in cirrhotic patients during or after liver transplantation is unknown. We conducted a systematic review and meta-analysis to answer this question. An electronic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (2005-September 2016), Google Scholar, and study bibliographies was conducted. Study quality was determined, and demographic and outcome data were gathered. Random effects meta-analyses of mortality-based BNP and NT-BNP level or presence of post-transplant heart failure were conducted. Seven studies including 2,010 patients were identified. Demographics were similar between patients with high or low BNP or NT-BNP levels. Hepatitis C was the most prevalent etiology of cirrhosis (38%). Meta-analysis revealed a pooled relative risk of 3.1 (95% CI 1.9% to 5.0%) for post-transplant mortality based on elevated BNP or NT-BNP level. Meta-analysis also revealed a pooled relative risk of 1.6 (95% CI 1.3% to 2.1%) for post-transplant mortality if patients had demonstrated post-transplant heart failure. Our analysis suggests that BNP or NT-BNP measurement may help in risk stratification and provides data on post-operative mortality in cirrhotic patients undergoing liver transplantation. Discriminatory thresholds are higher in cirrhotic patients relative to prior studies with non-cirrhotic patients. However, the number of analyzed studies is limited, and our findings should be validated further through larger, prospective studies.

Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

Background: Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. Methods: We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. Results: Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion: Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.

Risk factors for coronary artery aneurysms in children with Kawasaki disease

Objective To explore risk factors for coronary artery aneurysms (CAA) in children with Kawasaki disease (KD), and reduce the rate of serious sequelae of cardiovascular diseases. Methods All the patients were diagnosed as KD in Children's Hospital Affiliated to Medical College of Zhejiang University from January 2009 to January 2014. A total of 679 cases was included, and 42 with concurrent CAA, 181 with concurrent coronary artery expansion (CAD), and 456 without coronary artery damage cases (non-coronary artery lesion, NCAL). Coronary artery damage was related to factors such as gender, age, fever, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alanine aminotransferase, serum potassium, plasma amino terminal brain natriuretic peptide precursor (NT-proBNP), and acrylic ball resistance. SPSS 18.0 software package was used for risk factor analysis. Qualitative data using chi-square test, was used to analyze the high risk factors of CAA group, and logistic multivariate regression analysis was also used. Results Chi-square test showed that male, with febrile days >14 d, NT-proBNP ≥ 1 000 ng/L, immunoglobulin resistance was more likely to have KD concurrent CAA (P 14 d [OR=12.436, 95% CI (4.599, 33.631), P=0.000], NT-proBNP≥1 000 ng/L [OR=3.305, 95% CI (1.401, 7.794), P=0.005], and immunoglobulin resistance [OR=3.842, 95% CI (1.562, 9.453), P=0.000] were independent risk factors for KD concurrent CAA. Conclusions Male children, febrile days >14 d, NT-proBNP≥1 000 ng/L, and immunoglobulin resistance were independent risk factors of CAA. Key words: Mucocutaneous lymph node syndrome/CO; Coronary aneurysm/CO; Risk factors

ABSTRACT 336

Background and aims: The dead rate of hand, foot and mouth disease is very high. Aims: To predict the risk of mortality in severe hand-foot and mouth disease, through death cases and survival cases to compare hospital clinical laboratory index (ratio of blood sugar, white blood cells, neutral particles, the lymphocytes and amino terminal brain natriuretic peptide precursor (NT - proBNP))? Methods: rom March to July 2012, a total of 295 hospitalized children enrolled for this retrorspective study. Results: Different NT - proBNP level group, an elevated level of scale differences, and there is statistical significance. Elevated blood sugar has 174, accounts for 58.98%, the proportion of different NT - proBNP level in children with high blood sugar is different, and there is statistical significance. As NT - proBNP levels, white blood cell count and blood sugar levels increasing children’s mortality also will increase. white blood cell count, blood sugar levels and NT - proBNP level as independent variable Logistics more factors regression analysis, the NT - proBNP level and WBC count become independent risk factors of severe hand, foot and mouth disease. Conclusions: in clinical suspected or confirmed after the hand-foot and mouth disease, to keep track of white blood cell count, blood sugar and NT - proBNP level, on the one hand, to prevent hand, foot and mouth disease early from mild to severe, on the other hand can through early intervention to reduce complications and mortality.

What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?

High levels of B-type natriuretic peptide in cancer patients are poorly studied. Previously published data suggest that they are not related to fluid overload and are encountered mostly in solid cancers. The authors investigated the distribution of amino terminal pro-brain natriuretic peptide (NT-proBNP) between hematologic and solid organ malignancies and the relationship of NT-proBNP with volume status in oncologic patients. A total of 145 consecutive patients with at least one occurrence of NT-proBNP exceeding the upper normal range 10-fold were identified. The authors retrospectively reviewed their records including clinical, laboratory, and radiological data and echocardiograms. More than 70% of patients had hematologic malignancies. Patients with NT-proBNP >50,000pg/mL had only hematologic malignancies, primarily multiple myeloma. There was no association between M-spike proteins and NT-proBNP. About 80% of patients had signs of fluid overload. The magnitude of NT-proBNP elevation was similar between those with and without heart failure or volume overload, as well as with solid cancers vs hematologic malignancies. Contrary to prior reports, it was found that very high NT-proBNP in cancer patients is usually encountered in the context of fluid overload and most often in hematologic malignancies.

NT-ProBNP and cardiac troponin I in virulent canine babesiosis

Although cardiac pathology and consequently elevated serum cardiac troponin I (cTnI) have been reported, clinically it remains difficult to diagnose cardiac involvement in canine babesiosis. Thus the use of cardiac biomarkers would be useful in determining if a dog with babesiosis also has concurrent cardiac dysfunction. The objectives of this study were to determine plasma N terminal brain natriuretic peptide (NT-proBNP) in canine babesiosis and if it is correlated with cTnI. Three groups of dogs with babesiosis were used: mild uncomplicated (Group 1), severe uncomplicated (Group 2), and complicated (Group 3), and a control group (Group 4) with 15 dogs per group. Each animal had the following determined: serum urea and creatinine, urea: creatinine ratio, cystatin-C, cTnI, blood lactate, plasma NT-proBNP, fractional shortening (FS), and blood pressure. The median NT-proBNP value in Groups 1–4 was 246, 650, 638, and 106pmol/l. All 3 babesiosis groups had a statistically elevated NT-proBNP level compared to the control group and Groups 2 and 3 showed significantly higher values compared to Group 1. Median cTnI in Group 1–3 was 0.39, 0.4, and 1.45ng/ml, respectively with the control group having concentrations below the detection limit (0.2ng/ml). There was a significant difference in cTnI concentration between the control group and group 3 but no statistical difference between the other babesiosis groups.The study concluded that dogs with babesiosis showed elevated levels NT-proBNP and the more severe the disease process the greater the elevation. This elevation is earlier or independent of the increased cTnI.

Comparison of the Effects of Colloid Preload and Ephedrine Bolus Admınistration on Left Ventricular Loading and Quality of Spinal Anesthesia

Background: We aimed to investigate the effects of colloid preload or ephedrine bolus on ventricular wall stress by measuring plasma N terminal-Brain natriuretic peptide (NT-ProBNP) concentrations in patients undergoing arthroscopic knee surgery under spinal anesthesia. Methods: 60 patients ASA I-II, aged 20-60 were randomly assigned into two groups. Spinal anesthesia was induced with 0.5% 3 ml levobupivacaine. In Group K (n=30) patients received 500 ml of HES (130/0.4) solution 20 minutes prior to spinal anesthesia. In Group E (n=30) ephedrine 15 mg i.v was injected 1 minute after spinal anesthesia. SBP, DBP, MBP, HR were recorded before and 3,5,7,10,15,20,25,30,45,60,120,240 min. after spinal anesthesia spinal anesthesia and in both groups and in group K also recorded before preload. The plasma concentrations of NT-ProBNP were measured before and 1 and 3 hours after the spinal block.

Granulocyte colony stimulating factor in chronic angina to stimulate neovascularisation: a placebo controlled crossover trial

BackgroundExperimental studies demonstrate that granulocyte colony stimulating factor (G-CSF) promotes neovascularisation and confers cardioprotection.ObjectiveTo assess the efficacy of repeated low dose G-CSF plus exercise on myocardial ischaemia in patients with...