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Objective To investigate the value of creatine kinase and computed tomography(CT)angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism(SMAE).Methods The retrospective cross-sectional study was adopted.The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected.The patients received serologic examination and CT angiography firstly,and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations.Observation indices:(1)clinical features,(2)serum indicators results,(3)CT angiography results:①location(main stem and non-main stem)of SMAE and development of distal branches of superior mesenteric artery(SMA),②indirect signs,such as bowel wall thickening,bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis,(4)therapy and prognosis.Measurement data with normal distribution were presented as-x±s,comparisons among groups were analyzed by one-way ANOVA.Measurement data with skewed distribution were presented as M(range)and analyzed by the Kruskal-Wallis rank sum test,and pairwise comparison was done using the Nemenyi test.Results(1)Clinical features:of 26 patients with SMAE,6 patients had intestinal ischemia,8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis(postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients).Duration of symptoms before diagnosis was(1.7±0.8)days in 6 patients with intestinal ischemia and(2.1±1.1)days in 8 patients with partial intestinal necrosis and(1.5±0.7)days in 12 patients with long segmental intestinal necrosis,with no statistically significant difference(F=1.27,P＞0.05).(2)Serum indicators results:levels of serum creatine kinase in patients with intestinal ischemia,partial intestinal necrosis and long segmental intestinal necrosis were 68 U/L(range,50-86 U/L),98 U/L(range,54-244 U/L)and 300 U/L(range,40-873 U/L),respectively,with a statistically significant difference among patients(H=7.32,P＜0.05)and between patients with intestinal ischemia and with long segmental intestinal necrosis(H=7.21,P＜0.05),and with no statistically significant difference between patients with partial intestinal necrosis and with intestinal ischemia or long segmental intestinal necrosis(H=1.53,2.07,P＞0.05).(3)CT angiography results:①developments of SMAE(main stem and non-main stem)and distal branches of SMA:main stem embolism of SMA in 13 patients demonstrated hypodense shadow,with non-contrast of distal branches of artery,including 1 with intestinal ischemia,1 with partial intestinal necrosis and 11 with long segmental intestinal necrosis.Main stem embolism of SMA in 8 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 3 with intestinal ischemia,4 with partial intestinal necrosis and 1 with long segmental intestinal necrosis.Main stem embolism of SMA in 2 patients demonstrated hypodense shadow,with non-contrast of distal branches of SMA,showing partial intestinal necrosis.Non-main stem embolism of SMA in 3 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 2 with intestinal ischemia and 1 with partial intestinal necrosis.②Indirect signs:5 patients had bowel wall thickening,including 3 with intestinal ischemia and 2 with long segmental intestinal necrosis.Seventeen patients had bowel dilatation combined with effusion and air accumulation,with gas fluid level in local intestinal canal,including 2 with intestinal ischemia,5 with partial intestinal necrosis and 10 with long segmental intestinal necrosis.Two patients had pneumatosis intestinalis,with bubble shadow of bowel wall,showing long segmental intestinal necrosis.(4)Therapy and prognosis:of 6 patients with intestinal ischemia,1 underwent embolectomy of SMA and 5 underwent low-molecular-weight heparin anticoagulation and vasodilator alprostadil therapy.Eight patients with partial intestinal necrosis received resection of necrotic intestine.Of 12 patients with long segmental intestinal necrosis,5 with postoperative short bowel syndrome received resection of necrotic intestine combined with postoperative parenteral hyperalimentation.The above-mentioned patients were improved and discharged from hospital after symptomatic treatment and surgery.Twelve patients with long segmental intestinal necrosis,7 with total small bowel necrosis and partial colonic necrosis underwent only exploratory laparotomy and then were dead in a short time.Conclusion Elevated creatine kinase and main stem embolism of SMA combined with non-contrast of distal branches using CT angiography maybe predict poor short-term prognosis of patients with SMAE.
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Objective: To study the correlation between serum resistin (SR) level and blood pressure in patients with type 2 diabetes mellitus (T2DM) complicated hypertension. Methods: A total of 124 patients with T2DM complicated hypertension (T2DM + hypertension group), 85 patients with pure T2DM (pure DM group) and 71 normal subjects (normal control group) were enrolled. According to blood pressure level, T2DM + hypertension group was further divided into stage 1 subgroup (n=34), stage 2 subgroup (n=43) and stage 3 subgroup (n=47). Peripheral venous blood was taken to measure levels of SR and other indexes in three groups. Logistic multi-factor regression analysis was used to analyze the risk factors affecting blood pressure level. Kendall’s tau-b correlation analysis was used to analyze the correlation among SR, fasting insulin, quantitative insulin sensitivity check index, homeostasis model-insulin resistance index and blood pressure level. Results: Compared with normal control group, there were significant rise in SR levels [(7.21±2.65) ng/ml vs. (19.87±3.67) ng/ml vs. (31.32±3.89) ng/ml] in pure DM group and T2DM + hypertension group, and that of T2DM + hypertension group was significantly higher than that of pure DM group, P<0.01 all. Logistic multi-factor regression analysis indicated that SR level was an independent risk factor influencing blood pressure level of patients (R2=0.087, P<0.05). Kendall’ s tau-b correlation analysis indicated that SR level was significantly positively correlated with blood pressure level of patients with hypertension (r=0.202, P=0.001); after other influencing factors were controlled, the significant positive correlation still existed between them (r=0.233, P=0.022). Conclusion: Serum resistin level rise is a risk factor of patients with type 2 diabetes mellitus complicated hypertension, and it is significantly positively correlated with their blood pressure level.
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Objective To observe the effect of salvia miltiorrhiza injection on antioxygen free radicals and its efficacy on viral myocarditis. Methods 72 cases of patients with viral myocarditis were randomly divided into two groups.The traditional group with energy mixture,1.6-diphosphate fructose improving myocardial nutrition,bed rest,intensive use of glucocorticoid,selected the appropriate treatment for arrhythmia;salvia miltiorrhiza group in the control group treatment combined with salvia miltiorrhiza injection of 5 ~15 mL each time,dissolved in 5%glucose intravenous drip,once a day,2 weeks as a course of treatment.To observe two groups of manifestation,the change of myocardial enzyme spectrum and the comparative efficacy before and after the treatment.Through the detection of the treatment group and the control group of serum superoxide dismutase (SOD ), malondialdehyde (MDA)and other indicators to understand the antioxidant effect of salvia miltiorrhiza injection.36 healthy children were taken as control group,detected cardiac troponin (cTnT),high sensitive C reactive protein (hs-CRP),creatine kinase isoenzyme MB (CK-MB)and SOD in three groups,their correlations were evaluated as well.Results Compared with healthy children,the activity of SOD in salvia miltiorrhiza group was statistically significant (P<0.01).The activity of SOD increased significantly (P<0.01).SOD was negatively correlated with cTnT,hs-CRP and CK-MB levels (P<0.05 ).The curative effect of salvia miltiorrhiza group were significantly higher than that of the control group.CTnT,hs-CRP and CK-MB levels decreased significantly after treatment (P<0.05 ),which in salvia miltiorrhiza group decreased significantly than that of the control group.SOD activity increased value was higher than the traditional group (P<0.01 );the decrease in MDA was obvious than that of the traditional group (P<0.05 ).Conclusion Oxygen free radicals are involved in the pathogenesis of viral myocarditis;the efficacy of salvia miltiorrhiza injection in the treatment of viral myocarditis is proved of curative effect;antioxidant effect may be an important mechanism of salvia miltirrhiza injection in the treatment of viral myocarditis.
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ObjectiveTo study the effects of perindopril on myocardial energy metabolism and ultrastructural changes in rats with chronic heart failure (CHF) induce by isoproterenol. MethodsTotally 55 male SD rats were randomly (random number) divided into two groups, namely control group (Group C) and CHF model group. The CHF rat models were made by subcutaneous injection of isopreteronol (ISO) in doses of 20 mg · kg-1 · d-1, 10mg · kg-1 · d-1 and 5 mg/kg/d for successive 3 days and then 3 mg· kg-1· d-1 for9 days. Four weeks later, the rats in CHF model group were randomly further divided into two subgroups, namely untreated subgroup (group M ) and perindopril treated subgroup (group P). After treatment for five weeks in average, echocardiography and myocardial pathology examination carried out to assess the cardiac function and structure changes of these rats. The levels of ATP, ADP, AMP, lactic acid (LA) and sarcoplasmic reticulum Ca2+ -ATPase (SERCA) activity in myocardium were determined by enzymatic reaction. ResultsCompared with rats in group M, the ejection fraction of left ventricle (EF) and fractional shortening of short axis of left ventricle (FS) of the rats in group P increased by 3.25％ and 7. 33％, respectively. Compared with rats in group C, the myocardial ATP, AMP, TAN (total adenosine) and LA significantly decreased in rats of group M. There were no significant differences in the levels of ADP, AMP, ATP/ADP and TAN between group C and group P (P ＞0. 05). Compared with rats in group M, the myocardial SERCA activity increased by 16. 41％ in rats of group P. The myocardial injury found under microscope and electronic microscope was ameliorated by treatment with peidolapril in rats of group P in comparison with rats of group M. ConclusionsPerindopril can improve myocardial energy metabolism,and lessen the pathological changes of ultrastructure, enhancing the cardiac function of rats with CHF induced by ISO.
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BACKGROUND: To apply mouse anti-human cTnI monoclonal antibody as the drug vector in the treatment and diagnosis of myocardial injury, it is important to degrade the immunity of murine antibody and overcome human anti-mouse reaction. Humanization has been applied as an attempt to resolve this problem.OBJECTIVE: To clone murine anti-cTnI Fab fragment and analyse the nucleotide and deduced amino acid sequences.DESIGN: Single sample study.SETTING: An institute of cardiovascular disease under a medical university-affiliated hospitalMATERIALS: The study was conducted in the Institute of Cardiovascular Diseases, First Affiliated Hospital of Nanjing Medical University from January 2003 to May 2004. The hybridoma cell line JS200202 which secrets the anti-cTnI monoclonal antibody was provided by Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University.METHODS: IgG heavy chain primers and κ light chain primers of amplified mouse were designed. Total RNA was extracted from hybridoma cells which secrete cTnI. Reverse transcription polymerase chain reaction(RT-PCR) was amplified. Cloning and subsequent sequence analysis of the Fab fragment was performed. The deduced amino acid sequence was compared and analysed with previously published sequences.MAIN OUTCOME MEASURES: Heavy chain Fd segment and κ light chain gene sequence and its subgroups.RESULTS: A band of approximate 700 and 800 base pairs were amplified using IgG heavy chain primers and κ light chain primers respectively. Sequence analysis indicated that the deduced amino acid sequences were in consistent with the characterization of the amino acid in the murine IgGl Fab fragment(GenBank accession NO AY484430, AY484431; Protein Bank accession NO AAR83243, AAR83244).CONCLUSION: A complete murine anti-cTnI Fab fragment was obtained in this study, which may provide basis for the production of the chimeric anti-cTnI antibody.