The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/ contemporary cardiac troponin for the early diagnosis of acute myocardial infarction / 世界急诊医学杂志（英文）

@#BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis. METHODS: This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC). RESULTS: Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, P<0.001; 82.7% vs. 84.3%, P=0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, P>0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, P=0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, P=0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, P=0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h. CONCLUSIONS: The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available.

Protocatechuic aldehyde protects cardiomycoytes against ischemic injury

Rescuing cells from stress damage emerges a potential therapeutic strategy to combat myocardial infarction. Protocatechuic aldehyde (PCA) is a major phenolic acid in Chinese herb Danshen (

Value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis and prognosis of emergency chest pain / 中国医师杂志

Objective:To explore the value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis of emergency chest pain patients.Methods:310 patients with emergency chest pain treated in Langfang People's Hospital from January 2018 to December 2018 were retrospectively selected. The HEART score was evaluated at admission, and the levels of serum creatine kinase isoenzyme (CK-MB), myoglobin (Myo) and troponin I (cTnI) were detected.Results:Among 310 patients, 232 cases were diagnosed as cardiogenic chest pain, 78 cases were non cardiogenic chest pain; In cardiogenic chest pain, 151 cases were acute coronary syndrome and 81 cases were stable angina pectoris; The HEART score, CK-MB, Myo and cTnI in patients with cardiogenic chest pain were (5.00±1.01)points, (14.45±3.11)ng/ml, (60.20±11.34)ng/ml and (2.30±0.89)ng/ml, respectively, which were significantly higher than those in patients with non cardiogenic chest pain ( P<0.05); The HEART score, CK-MB, myo and cTnI in patients with acute coronary syndrome were (5.83±1.12), (16.02±2.88)ng/ml, (64.49±12.01)ng/ml and (2.54±0.91)ng/ml, which were significantly higher than those in patients with stable angina pectoris ( P<0.05); The area under receiver operating characteristic (ROC) curve of HEART score combined with myocardial infarction in the diagnosis of cardiogenic chest pain was 0.811 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 85.28% and 82.50% respectively; The area under ROC curve of HEART score combined with myocardial infarction in the diagnosis of acute coronary syndrome was 0.901 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 90.00% and 85.00% respectively; The HEART score of patients with acute coronary death was (6.88±1.02), which was significantly higher than that of patients with survival ( P<0.05); The area under ROC curve predicted by HEART score was 0.674 ( P<0.05). When the cut-off value was 6, the sensitivity and specificity were 78.00% and 70.00%, respectively; the CK-MB, Myo and cTnI increased with the risk of cardiogenic chest pain ( P<0.05). Conclusions:HEART score combined with three bedside tests of myocardial infarction has a good application value in the emergency chest pain, which is worthy of clinical use.

The value of growth differentiation factor 15 in early diagnosis of acute chest pain / 中华急诊医学杂志

Objective:To explore the value of growth differentiation factor 15 (GDF15) in the early diagnosis of acute chest pain.Methods:A total of 96 patients with acute chest pain admitted to the Emergency Department of Hainan Hospital of PLA General Hospital from January to November 2020 were retrospectively collected. The sex, age, troponin T, creatine kinase, creatine kinase isoenzyme, GDF15 and B-type natriuretic peptide of patients within 30 min after admission were recorded, and the differences of each index in different groups were compared. ROC curve was drawn to evaluate the diagnostic value of GDF15 and TNT/BNP in acute coronary syndrome (ACS). The Gensini score, left ventricular ejection fraction, length of stay in hospital and the number of stents were calculated, and the correlation between these indexes and GDF15 concentration was evaluated.Results:The general trend of acute chest pain was more male than female (72.92% vs. 27.08%) , the oldest group was the UA group (64.67 ± 13.87) years old , the youngest group was cardiac arrest group (47.29 ± 9.99) years old . There were higher rates of hypertension in the STEMI group, NSTEMI group and UA group, and none of the groups showed significant advantage in diabetes. The GDF15 concentration was higher in ACS related chest pain group [(2.360 ± 1.710) ng/mL vs. (1.380 ± 1.040) ng/mL, P<0.01]. The area under the Receiver Operating Characteristic Curve (AUC) of GDF15 combined with TNT was up to 0.863. GDF15 concentration was negatively correlated with ejection fraction, positively correlated with Gensini score, positively correlated with the number of stents implanted, and positively correlated with the length of hospital stay. Conclusions:GDF15 is valuable in the diagnosis and prognosis of acute chest pain. The combination of GDF15 and TNT can improve the diagnostic rate of ACS.

SGOLl Promotes Proliferation and Invasion of Lung Cancer Cells Through PKM2 / 中国生物化学与分子生物学报

Shugoshin-1 (SGOLl) is one of the human homologues of yeast Shugoshin that locates in the centromeric region. It prevents premature division of the eentromerie cohesin complex and maintaining chromosome stability. Very recently, the role of SGOLl in tumors has emerged, but its role in lung cancer is unclear. In this study, we identify that SGOLl was upregulated in lung cancer samples from the TCGA database (n=529, P< 0.00001), which was correlated to the overall survival time of lung cancer patients (P = 0.0049). Detected by qRT-PCR and Western blotting, we demonstrate that SGOLl was consistently upregulated in lung cancer cell lines than normal epithelial cell line. Regulatory effects of SGOLl on cell viability, clonality, migration and invasion of lung cancer cells A549 and NCI-H2405 were examined by Cell Counting Kit-8 (CCK8), Colony formation, Scratch and Transwell assays, respectively. Compared with the control group, knockdown of SGOLl significantly inhibited proliferation, migration and invasion in A549 and NCI-H2405 cells (P<0. 05). A positive correlation was identified between expression levels of pyruvate kinase muscle isoenzyme 2 (PKM2) and SGOLl in the TCGA data-base (r=0. 38, P = 0). Western blotting results showed that knockdown of SGOLl in A549 and NCI-H2405 cells down-regulated PKM2 as well. In addition, co-interventions of SGOLl and PKM2 were performed in A549 and NCI-H2405 cells to clarify the interaction mechanism between them. The results showed that overexpression of PKM2 in lung cancer cells could partially reverse the regulatory effects of SGOLl knockdown on proliferation, migration and invasion (P<0. 05). Therefore, our study showed that SGOLl promoted the proliferation, migration and invasion of lung cancer cells by regulating PKM2. This study provided a theoretical basis for the mechanism of SGOLl in lung cancer.

Effect of Jianpi Yangzheng Recipe on Apoptosis and EMT of HCT116 Cells in Colorectal Cancer by Inhibiting Aerobic Glycolysis Regulated by PKM2 / 中国实验方剂学杂志

Objective:To investigate the mechanism of Jianpi Yangzheng recipe in inhibiting aerobic glycolysis by down-regulating the expression of pyruvate kinase isoenzyme M2 (PKM2) protein, in order to promote apoptosis and inhibite epithelial-mesenchymal transition（EMT）in HCT116 cells of colorectal cancer. Method:The effect of different concentrations of Jianpi Yangzheng recipe on HCT116 cell proliferation was detected by methylthiazolyldiphenyl-tetrazolium bromide（MTT）colorimetry. Flow cytometry was used to detect the effect of different concentrations of Jianpi Yangzheng recipe（2.0, 4.0, 8.0 g·L-1） on HCT116 cell apoptosis. The effect of Jianpi Yangzheng recipe（2.0, 4.0, 8.0 g·L-1） on the migration and invasion ability of HCT116 cells was observed by cell scratch and cell invasion assay (Transwell). The effect of different concentrations of Jianpi Yangzheng recipe（2.0, 4.0, 8.0 g·L-1） on glycolysis metabolism of HCT116 cells were detected by lactic acid (LD) test kit and glucose assay kit, respectively. Western blot was used to detect the expressions of apoptosis-related proteins, like B lymphocyte tumor-2 gene (Bcl-2), Bcl-2 related X protein (Bax) and EMT-related proteins, like epithelial cadherin (E-cadherin)，neurogenic cadherin（N-cadherin）, Vimentin, and PKM2, the key protein of glycolysis, in each group. Result:MTT assay showed that, compared with the blank group, HCT116 cells were treated with Jianpi Yangzheng recipe for 48 h. With the increase of drug concentration, the inhibitory effect of Jianpi Yangzheng recipe on the proliferation of HCT116 cells was also increased; and when the concentration was 4.0 g·L-1, the inhibition rate of HCT116 cells was about 53.87%. Therefore, 2.0，4.0，8.0 g·L-1 were selected as low, medium and high-dose groups for the study. The cell flow cytometry results indicated that, compared with the blank group, the low, medium and high-dose groups all significantly induced the apoptosis of HCT116 cells (P<0.05), and the effect in inducing apoptosis was more obvious with the increase of drug concentration (P<0.05). Cell scratch and Transwell showed that, compared with the blank group, all the groups had an inhibitory effect on migration and invasion of HCT116 cells (P<0.05), and the effect was more significant with the increase of drug concentration (P<0.05). The determination of lactic acid and glucose indicated that compared with the blank group, with the increase of drug concentration, the amount of lactic acid produced by cells in each group gradually decreased (P<0.05), while the glucose dosage also gradually decreased (P<0.05). Western blot showed that, compared with the blank group, the protein expressions of E-cadherin and Bax were up-regulated in groups with different concentrations, whereas the protein expressions of N-cadherin, Vimentin, Bcl-2 and PKM2 were down-regulated (P<0.05). Conclusion:Jianpi Yangzheng recipe can effectively induce the apoptosis of HCT116 cells and inhibit EMT in colorectal cancer. The possible mechanism may be related to the inhibition of aerobic glycolysis pathway of HCT116 cells by down-regulating PKM2 protein expression.

The predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB in prognosis of patients with acute paraquat poisoning / 中华急诊医学杂志

Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning.Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017.The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning.The patients' data were retrieved,including general information,the dose of poison,urinary paraquat concentration,arterial blood gas analysis,alanine transaminase (ALT),total bilirubin (TBIL),uric acid (UA),aspartate transaminase (AST),creatine kinase (CK),CK-MB,B type natriuretic peptide (BNP),lactic dehydrogenase (LDH),high sensitivity troponin T (hsTnT),C-reaction protein (CRP) and procaicitonin (PCT).According to the patient's prognosis within 3 months,the patients were divided into a survival group and a non-survival group.The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve.Collect the last arterial blood gas analysis,and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning.Results Among the 641 patients with acute paraquat poisoning,315 (49.1％) patients survived and 326 (50.9％) died.Compared with the survival group,patients in the non-survival groupthere were older,had a shorter hospital stay,and had a higher oral paraquat dose and urinary paraquat concentration;Lac,TBIL,UA,AST,CK,CK-MB,BNP,LDH,CRP and PCT were higher,while blood gas analysis index were lower in the non-survival group (P＜0.05).Binary logistic regression analysis showed that the dose of paraquat,CK-MB and AST were closely related to the prognosis of patients with acute paraquat poisoning.The optimal cut-off value of ingestion dose,the first urinary paraquat concentration on admission and CK-MB in predicting the prognosis of patients with acute paraquat poisoning were 7 g (AUC=0.918,sensitivity 80.6％,specificity 87.5％,Yoden index 0.681,P＜0.01),5.16 μg/mL (AUC=0.879,sensitivity 93.8％,specificity 70.1％,Yoden index 0.639,P＜0.01),and 18.2 U/L (AUC=0.846,sensitivity 83.9％,specificity 71.9％,Yoden index 0.558,P＜0.01),respectively.Binary logistic regression analysis of the last biochemical indicators of paraquat poisoning showed that the dose of poison,the last CK-MB,the last SCr,urinary paraquat concentration,and the last blood Na+ were closely related to the prognosis of patients with acute paraquat poisoning.Among them,the last CK-MB＞18.05 U/L often indicated poor prognosis (AUC=0.808,sensitivity 79.7％,specificity 65.8％,Yoden index 0.455,P＜0.01).Conclusions In the treatment of patients with acute paraquat poisoning,there are significant differences in extra pulmonary factors such as heart,liver,kidney,electrolytes and inflammatory markers in patients with different prognosis,so the monitoring and follow-up should be improved,in addition to focusing on the presence and treatment of pulmonary fibrosis.In particular,CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning.In the late stage of poisoning,CK-MB,SCr,and blood Na+ have a strong predictive value for the prognosis of the patients,and we should pay attention to the regular follow-up of the above mentioned laboratory items.

Study on effects of different habitat processing methods of Salviae Miltiorrhizae Radix et Rhizoma in rats with acute myocardial ischemia / 中国中药杂志

To investigate the effects of different habitat processing methods of Salviae Miltiorrhizae Radix et Rhizoma on acute myocardial ischemia induced by pituitrin in rats. In this experiment, the tail vein injection of pituitrin was used to induce acute myocardial ischemia in rats. Electrocardiograph(ECG) heart rate and ΔST changes were recorded, and the levels of creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH), superoxide dismutase(SOD) and malondialdehyde(MDA) in serum of rats were detected to comprehensively evaluate the effects of six processing methods of Salviae Miltiorrhizae Radix et Rhizoma on serum biochemical indexes of rats with acute myocardial injury. The ECG results showed that the Salviae Miltiorrhizae Radix et Rhizoma dried in a drying oven had a good effect on the improvement of heart rate and ΔST of electrocardiogram after ischemia, and all the other groups had some protective effects to different degrees. The results of biochemical indexes in serum of each group after ischemia showed that the activity of CK-MB decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in a drying oven after sweating and losing weight in a drying oven, high-dose group with drying in the shade and low-dose group with drying in the shade. The activity of LDH decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in the shade and low-dose group of drying in the shade. The activity of SOD increased most significantly in Salviae Miltiorrhizae Radix et Rhizoma low-dose group with drying in sun, low-dose group with drying in sun after sweating and losing weight in sun, and low-dose group with drying in a drying oven. The activity of MDA decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma low-dose group with drying in sun. The comprehensive scoring results showed that the highest score was obtained in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in the shade while the scores of other treatment groups were higher than that of the model group. It could be seen that the Salviae Miltiorrhizae Radix et Rhizoma dried in a drying oven had a good improvement effect on electrocardiograph indexes after acute myocardial injury, the Salviae Miltiorrhizae Radix et Rhizoma dried in the shade had a good improvement effect on serum myocardial enzymes after acute myocardial injury, and the other processing methods had a certain protective effect on myocardial injury. The six processing methods evaluated by pharmacodynamics showed that the Salviae Miltiorrhizae Radix et Rhizoma dried in the shade and dried in a drying oven had good efficacy.

Study on the distribution of human alanine aminotransferase isoenzyme in human tissues / 生物工程学报

This study intends to obtain recombinant proteins of ALT1 and ALT2 isozymes by using genetic recombination technology. Monoclonal antibodies ALT1 and ALT2 with high specificity and high activity were prepared and screened (ALT1 monoclonal antibody has been successfully prepared and published). The localization, distribution and expression of ALT1 and ALT2 isozymes in human tissues were discussed. The ALT2 genes were amplified from human liver cancer cell (HepG2) by RT-PCR method. The mature ALT2 gene was subcloned into the pET32a-ALT2 prokaryotic expression vector. Its ligation product was transformed into BL21(DE3) competent cells, and transformed into competent cells to express ALT2 proteins induced by IPTG. The recombinant proteins of ALT2 were purified by nickel column (Ni⁺) affinity chromatography. Balb/c mice were immunized with recombinant proteins of ALT2. Positive serum mouse spleen cells and myeloma cells SP2/0 were selected for cell fusion. The positive cell lines were selected by indirect ELISA and subcloned by limited dilution method. Affinity chromatography was used to purify ALT2 antibodies. The expression and distribution of ALT2 in human normal tissues were detected by RT-PCR and Western blotting. Results show that the expression of ALT isoenzyme in tissues was almost the same at gene mRNA level and protein level. ALT1 is highly expressed in liver, kidney and skeletal muscle, and moderately expressed in gastrointestinal smooth muscle. ALT2 is highly expressed in fat, skeletal muscle and myocardium, and is poorly expressed in gastrointestinal smooth muscle. Immunohistochemical studies show that ALT1 is highly expressed in hepatocytes, renal medullary tubules and muscle fibers, ALT2 is highly expressed in adipocytes and myocardial cells, and ALT1 and ALT2 in gastrointestinal tissues are mainly expressed in mucosa of upper intestinal wall region. The results showed that the isoenzymes ALT1 and ALT2 were mainly expressed in the mucosa of the upper part of the intestinal wall. It is widely distributed in the tissues, providing theoretical basis for understanding the mechanism of ALT activity increase under different pathological conditions.

The perioperative effect of magnesium sulfate in patients with concentric left ventricular hypertrophy undergoing cardiac surgery: A double-blinded randomized study

Objective: The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery. Design: The study was a double-blinded randomized study. Setting: This study was conducted at a cardiac center. Patients: The study included 250 patients. Intervention: The study included two groups (each = 125): Group M – the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C – the patients who received an equal amount of normal saline. Measurements: The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support. Main Results: The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C (P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C (P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C (P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C (P < 0.05). Conclusion: The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.

Effects of different fluid replenishment methods on internal environment, body thermal regulation response and severe heatstroke of 5-km armed cross-country training soldiers / 中华危重病急救医学

To explore the effects of different fluid replenishment methods on the internal environment, body thermal regulatory response and severe heatstroke of 5-km armed cross-country training soldiers. Methods A Special Force officers and soldiers who participated in 5-km armed cross-country training (2-3 times a week, 25-30 minutes each time for 3 weeks) during summer training from June to July in 2018 were enrolled, and they were divided into three groups according to the random number table, with 300 trainees in each group. 200 mL of drinking fluids were given to each group 15 minutes before and after each 5-km armed cross-country training: A group with boiled water, B group with purified water, and C group with beverage prepared by pharmaceutical laboratory of the 990th Hospital of PLA Joint Logistics Support Force (100 mL containing 6 g carbohydrates, 42 mg sodium, and 11 mg potassium). The venous blood was collected before and after the last training or during the onset of severe heatstroke to do the following tests: serum cardiac troponin I (cTnI, chemiluminescence), MB isoenzyme of creatine kinase (CK-MB, immunosuppressive), serum creatinine (SCr, enzymatic method), urea nitrogen (BUN, enzymatic method), alanine aminotransferase (ALT, tryptase), aspartate transaminase (AST, tryptase), and Na+, K+, Cl- (electrode method). The heart rate (HR) and core temperature (Tc, anal temperature) were monitored at the same time. The amount of sweat in training and the occurrence of severe heatstroke were also recorded. Results There was no significant difference in heart, liver, kidney function, electrolyte and body heat regulation reaction among three groups of 5-km armed cross-country trainees before training. Compared with before training, the levels of serum cTnI, CK-MB, SCr, BUN, ALT, AST, HR and Tc were significantly increased after training or during the onset of severe heatstroke in three groups, while the contents of Na+, K+, Cl- were significantly decreased, but the increase or decrease of group C was relatively smaller compared with group A and group B [cTnI (μg/L): 0.9 (0.6, 1.4) vs. 1.1 (0.7, 2.8), 1.0 (0.6, 3.3); CK-MB (U/L): 7.0 (5.0, 11.0) vs. 9.0 (6.0, 14.5), 8.0 (6.0, 15.0); SCr (μmol/L): 92.09±18.64 vs. 102.78±18.77, 103.64±20.07; BUN (mmol/L): 7 (6, 9) vs. 9 (8, 11), 10 (8, 13); ALT (U/L): 27 (22, 34) vs. 36 (30, 43), 34 (27, 43); AST (U/L): 37 (31, 48) vs. 41 (34, 50), 39 (34, 51); HR (bpm):87.01±17.07 vs. 95.88±21.06, 96.59±22.04; Tc (℃): 37.73±0.81 vs. 38.03±1.05, 38.10±1.04; Na+ (mmol/L):150.14±3.86 vs. 144.18±8.89, 144.04±9.39; K+ (mmol/L): 4.32±0.57 vs. 4.15±0.62, 4.13±0.51; Cl- (mmol/L):100.43±3.71 vs. 98.42±4.24, 98.41±4.58; all P < 0.01]. The incidence of severe heatstroke in group C was significantly lower than that in group A and group B [1.67% (5/300) vs. 5.00% (15/300), 5.33% (16/300), χ2 = 6.424, P = 0.040]. There was no significant difference in sweating volume in groups A, B, C (g: 370.47±48.71, 370.85±50.66, 370.17±50.21, F = 0.014, P = 0.986). There was no significant difference in the above indexes between group A and group B (all P > 0.05). Bi-classification Logistic regression analysis showed that the increase of HR, Tc and excessive loss of Na+, K+, Cl- were risk factors for severe heatstroke [odds ratio (OR) was 0.848, 0.138, 1.565, 17.996 and 2.328 respectively, all P < 0.01]. Conclusions Timely supplementation of carbohydrate, sodium and potassium ions can effectively change the internal environment and body heat regulation reaction of 5-km armed cross-country trainees, so as to reduce the occurrence of severe heatstroke. The increases of HR, Tc and excessive loss of Na+, K+, Cl- are risk factors for severe heatstroke.

Caso clínico: hipofosfatasia de la niñez. Seguimiento clínico / Clinical case: childhood hypophosphatasia. Clinical follow-up

La hipofosfatasia (HP) es una enfermedad congénita, causada por mutaciones con pérdida de función en el gen ALPL que codifica la isoenzima no específica de tejido de la fosfatasa alcalina (TNSALP). Su expresión clínica es muy variable, desde casos de muerte intraútero por alteración grave de la mineralización ósea, hasta casos solo con caída prematura de la dentición. Se presenta el caso clínico de un varón al que se le diagnosticó odontohipofosfatasia a los 30 meses por pérdida temprana de piezas dentarias y niveles anormalmente bajos de fosfatasa alcalina, sin signos de raquitismo ni deformidades óseas. Durante su seguimiento, hasta los 13 años, presentó síntomas compatibles con HP infantil leve, como cansancio al caminar, incoordinación en la marcha y dolor en miembros inferiores que aumentaban con la actividad física. Ante la aparición de edema bimaleolar y poca respuesta al tratamiento con calcitonina y antiinflamatorios, se descartaron patologías infecciosas o reumáticas o ambas y se diagnosticó, por biopsia de tibia y peroné, periostitis sin detección de cristales de pirofosfato. Los controles radiológicos durante su evolución mostraron ensanchamiento metafisario en muñeca, falta de remodelado de metacarpianos, hojaldrado perióstico en tibia y peroné e hipomineralización en metáfisis tibiales, con "lenguas radiolúcidas" características de HP. Como conclusión, la hipofosfatasia debe considerarse como una entidad clínica para descartar en niños que presentan pérdida temprana de dientes. La presencia de este cuadro clínico es en general suficiente para realizar el diagnóstico de HP de la niñez. (AU)

Hypophosphatasia (HP) is a congenital disease, caused by mutations with loss of function in the gene ALPL that encodes the non-specific tissue isoenzyme of alkaline phosphatase (TNSALP). Its clinical expression displays considerable variability, from cases of intrauterine death due to severe alteration of bone mineralization, to cases with only early loss of teeth. We report the case of a male, diagnosed as odontohypophosphatasia at 30 months of age due to early loss of teeth and abnormally low levels of alkaline phosphatase, without signs of rickets or bone deformities. During follow-up, up to 13 years of age, he presented symptoms consistent with mild infantile HP such as tiredness when walking, lack of gait coordination, and pain in lower limbs, especially after physical activity. Due to the appearance of bimalleolar edema and poor response to treatment with calcitonin and anti-inflammatory drugs, infectious and / or rheumatic pathologies were ruled out. Periostitis without pyrophosphate crystal detection was diagnosed by tibial and fibular biopsy. Radiological controls during follow up showed metaphyseal wrist enlargement, lack of remodeling of metacarpals, periosteal flaking in the tibia and fibula and hypomineralization in the tibial metaphysis, with "radiolucent tongues"; characteristic of HP. In conclusion, hypophosphatasia should be considered as a clinical entity in children who present early loss of teeth. The presentation of this clinical case is generally sufficient to make the diagnosis of childhood HP. (AU)

Changes of CK,CK-MB,cTnI and electrocardiogram before and after treatment in children with pneumonia / 国际检验医学杂志

Objective To investigate the changes of serum creatine kinase (CK),creatine kinase isoenzyme (CK-MB),cardiac troponin I(cTnI)and electrocardiogram (ECG) before and after the treatment of pneumo-nia in children.Methods From December 2014 to December 2016,95 children with pneumonia were selected as the study group,and 48 healthy subjects who underwent the healthy assessment from December 2014 to January 2016 were selected as the control group.All children with pneumonia were treated after admission.2 mL of venous blood were collected from each research subject after the admission and patients in study group after treatment,serum was seperated,and levels of CK,CK-MB,cTnI were measured and the ECG record was conducted.Results The serum levels of CK,CK-MB and cTnI in the study group were higher than those in the control group (P<0.05);the incidences of ST segment elevation or depression,atrial premature beat,ven-tricular premature beat,sinus tachycardia and sinus bradycardia in the study group were higher than those in the control group,and the differences were statistically significant (P<0.05);the serum levels of CK,CK-MB and cTnI in the study group were lower than those before treatment,and the difference was statistically signif-icant (P<0.05);the incidences of atrial premature beat,ventricular premature beat,sinus tachycardia and si-nus bradycardia in the study group after treatment were lower than those before treatment,and the difference was statistically significant (P<0.05);the incidence of ST segment elevation or depression after treatment in the study group was lower than that before treatment,and there was no significant difference (P>0.05).Con-clusion The serum levels of CK,CK-MB,cTnI and ECG were obviously abnormal in children with pneumoni-a.After treatment,serum CK,CK-MB and cTnI levels can be reduced and ECG abnormalities can be ameliora-ted.

Diagnostic value of serum miR-1 on acute myocardial infarction / 国际检验医学杂志

Objective To explore the diagnostic value of miR-1 in acute myocardial infarction(AMI).Meth-ods 148 patients with chest pain in the emergency department of this hospital from February 2013 to Decem-ber 2016 were selected and divided into the AMI group(82 cases)and non-AMI group(66 cases)according to the diagnostic criteria of acute AMI.Contemporaneous 74 healthy persons undergoing physical examination were selected as the healthy control group.The levels of serum miR-1,cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)were measured in 3 groups.The correlation between miR-1 level with cTnI and CK-MB levels in the AMI group.The sensitivity and specificity of miR-1,cTnI,and CK-MB in the diagnosis of acute AMI were analyzed.Results The serum miR-1,cTnI and CK-MB levels in the AMI group were signifi-cantly higher than those in the non-AMI group,while the serum miR-1,cTnI and CK-MB levels in the non-AMI group were higher than those in the healthy control group,the difference among 3 groups was statistical-ly significant(P<0.05);the miR-1 level was positively correlated with cTnI and CK-MB levels in the AMI group(r=0.733,0.779,P<0.05);the receiver operating characteristic curve analysis showed that the sensi-tivity and specificity of miR-1 in the early diagnosis of acute AMI was 90.57% and 97.53% respectively.Con-clusion miR-1 can be used as a new index for early diagnosing acute AMI and assessing severity degree,more-over its sensitivity is higher than cTnI and CK-MB.

Application of plasma CK-MB ,NT-proBNP and CT-1 in diagnosis of neonatal asphyxia complicating myocardial injury / 国际检验医学杂志

Objective To investigate the application of plasma creatine kinase isoenzyme (CK-MB) ,N-ter-minal pro-brain natriuretic peptide(NT-proBNP)and myocardial nutrient-1(CT-1)in the diagnosis of neonatal asphyxia complicating myocardial injury .Methods Eighty cases of neonatal asphyxia in the hospital from Jan-uary to December 2016 were selected ,including 28 cases in the asphyxia non-myocardial injury group ,32 cases in the mild asphyxia myocardial injury group and 20 cases in the severe asphyxia myocardial injury group .Oth-er 80 healthy neonates were selected as the control group .The levels of plasma CK-MB ,NT-proBNP and CT-1 on 1 ,3 ,5 d after birth were measured by adopting the ELISA method .The relationship between plasma CK-MB ,NT-proBNP and CT-1 levels with prognosis in neonatal asphyxia was analyzed .Then the application value of plasma CK-MB ,NT-proBNP and CT-1 in the prognosis evaluation of neonatal asphyxia complicating myo-cardial injury was analyzed by using the receiver operating characteristic (ROC) curve .Results Plasma NT-proBNP ,CK-MB and CT-1 levels in the control group had no statistically significant difference among 1 ,2 ,3 d after birth (P>0 .05) ,but plasma CK-MB ,NT-proBNP and CT-1 levels on postnatal 3 d in the neonatal as-phyxia group reached the peak value ,plasma CK-MB ,NT-proBNP and CT-1 level on postnatal 1 ,3 d in the se-vere asphyxia myocardial injury group and mild asphyxia myocardial injury group were significantly higher than those in the non-myocardial injury group and control group ,and w hich in the non-myocardial injury group were higher than those in the control group ,the differences were statistically significant (P<0 .05) .Plasma NT-proBNP ,CK-MB and CT-1 levels on postnatal 5 d in the non-myocardial injury group and mild asphyxia myocardial injury group returned to normal levels ,w hile w hich in the severe asphyxia myocardial injury group were still higher than those in the other groups ,the differences were statistically significant (P<0 .05) .The levels of plasma CK-MB ,NT-proBNP and CT-1 in the death neonates with neonatal asphyxia were higher than those in the survival neonates ,and the difference was statistically significant (P<0 .05) .The sensitivity and specificity of combined detection of plasma CK-MB ,NT-proBNP and CT-1 for the prognosis diagnosis in neo-nates with asphyxia complicating myocardial injury were higher than that of single index .Conclusion The early determination of plasma CK-MB ,NT-proBNP and CT-1 levels will be helpful to effectively evaluate the myocardial injury severity and prognosis in asphyxia neonates and has an important clinical value .

Changes in creatine kinase and its isoenzymes in children and adolescents with vasovagal syncope / 中华实用儿科临床杂志

Objective To investigate the changes in creatine kinase (CK) and its isoenzymes (CK-MB) in children and adolescents with vasovagal syncope (VVS).Methods The VVS group included 150 patients with unexplained syncope or prodromata[69 males and 81 females,aged from 4 to 17 years old,with the average age (11.21 ±2.40) years old],who had been diagnosed as VVS by using head-up tilt table test(HUTT) in the Second Xiangya Hospital,Central South University from October 2015 to August 2017.The healthy control group included 99 healthy children [58 males and 41 females,aged from 4 to 17 years old,with the average age (10.78 ± 2.26)years old] with gender and age-matched.The differences in serum CK and CK-MB levels between 2 groups were compared,and receiver operating characteristic (ROC) curve was used to explore the predictive value of CK and CK-MB for diagnosing VVS.Results (1) Compared with the healthy control group,both CK [(93.77 ± 33.01) U/L vs.(125.02 ± 58.06) U/L] and CK-MB [(21.31 ± 6.99) U/L vs.(26.93 ± 8.78) U/L] levels decreased in the VVS group,and there were statistically significant differences(all P ＜0.05).When the value of CK was 89.22 U/L,the sensitivity to diagnostic VVS was 76.80％,and the specificity was 54.70％;while the value of CK-MB was 23.93 U/L,the sensitivity to diagnostic VVS was 66.70％,and the specificity was 71.30％.(2) In VVS group,the CK levels of the females were significantly lower than those of the males [(85.25 ± 29.43) U/L vs.(103.77 ± 34.36) U/L],and there was a statistical difference (P ＜ 0.05);while there was no significant difference in CK-MB between the males and the females in VVS group.(3) There were no significant differences between 3 types of VVS (all P＞0.05).Compared with the healthy control group,CK decreased in all the 3 types of VVS (all P ＜ 0.05),while CK-MB decreased only in the vasodepressor type and mixed type (all P ＜ 0.05).Conclusions Compared with the healthy children and adolescents,the serum CK and CK-MB levels will decrease in children with VVS,which indicates that CK and CK-MB may be involved in the pathogenesis of VVS.

Significance of heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type in septic myocardial injury / 中国小儿急救医学

Objective@#To demonstrate the relevance of heart-type fatty acid binding protein(H-FABP) and brain glycogen phosphorylase isoenzyme type(GPBB) with myocardial injury in sepsis.To explore the effect of H-FABP and GPBB on the severity of disease and clinical prognosis.@*Methods@#A total of 40 cases of children with sepsis were selected in this study from January 1, 2017 to October 31, 2017.According to the illness severity, they were divided into sepsis group(n=15), severe sepsis group(n=13) and septic shock group(n=12), 19 cases of children with non-infectious diseases were selected as the control group for the same period.The levels of serum WBC, C-reactive protein, procalcitonin, cTnI, CK, CK-MB, CK-MB isoenzyme quality and NT-proBNP were collected within 24 hours of admission.The APECHEⅡ scores were calculated for each child.The peripheral blood of the patients within 24 hours after admission was used to determine the levels of serum H-FABP and GPBB by ELISA method.The differences of clinical indicators among the groups were analyzed.According to the survival of patients with sepsis, they were divided into 37 cases in the improved group and 3 cases in the death group.All patients with sepsis were divided into left ventricular ejection fraction(LVEF) normal group(n=26) and LVEF decreased group(n=14). According to whether the serum cTnI was elevated, all children with sepsis were divided into cTnI normal group (n=29) and cTnI increased group (n=11). The differences of H-FABP and GPBB levels were compared.According to the presence or absence of LVEF decline, the area under the ROC curve was used to evaluate the predictive power of each index for myocardial injury in sepsis.Based on the decrease of LVEF, the area under the ROC curve was used to evaluate the prediction of each index for myocardial injury in sepsis.@*Results@#There were significant differences in H-FABP and GPBB levels among the control group, sepsis group, severe sepsis group and the septic shock group (H=42.241, P<0.05; H=32.486, P<0.05). Although there was no significant difference between the improved group and the death group(P>0.05), there was an elevated trend of H-FABP and GPBB in the death group.The levels of H-FABP (t=-3.770, P=0.001) and GPBB (Z=-2.113, P=0.033) were statistically significant in the LVEF normal group and the LVEF decreased group (LVEF≤60%). There were no significant differences in the levels of H-FABP and GPBB between the cTnI normal group and the cTnI increased group (P>0.05), but the cTnI increased group had an increasing trend.The area under the ROC curve in the diagnosis of myocardial injury in sepsis were H-FABP 0.821, NT-ProBNP 0.738, GPBB 0.661, CK 0.560, cTnI 0.512, in which the sensitivity(0.833) and specificity(0.786)of H-FABP were both higher.@*Conclusion@#The serum H-FABP and the GPBB levels can be used to monitor for myocardial damage, and it has a correlation with the severity of the disease and the prognosis.H-FABP has a significant advantage over traditional myocardial markers in sensitivity and specificity to determine the myocardial injury of sepsis.

Protective effect of mild hypothermia at different starting times on organ function in patient with exertional heat stroke / 中华危重病急救医学

Objective To investigate the protective effect of mild hypothermia at different starting times on the physiological functions of the viscera of exertional heat stroke (EHS). Methods A prospective randomized controlled trial was conducted. EHS patients admitted to intensive care unit of the 159th Hospital of People's Liberation Army and the First Affiliated Hospital of Zhengzhou University from June 2015 to June 2017 were enrolled. The patients were divided into 2, 4, 6 hours start hypothermia treatment groups according to the random number table method, the mild hypothermia was initiated at 2, 4 and 6 hours after the disease onset respectively, and the methods were the same in each group. After treatment of 2, 12, 24 hours, the venous blood in the three groups was collected to detect serum cardiac troponin I (cTnI) with chemiluminescence method, MB isoenzyme of creatine kinase (CK-MB) with immunosuppressive method, creatinine (Cr) with creatine oxidase method, β2-microglobulin (β2-MG) with turbidimetry, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with enzyme method. Multiple organ dysfunction syndrome (MODS) within 24 hours after treatment was recorded. Linear regression analysis of the correlation between mild hypothermia start-up time and MODS was done. Results Ninety-three cases of EHS were included,with 32, 31 and 30 patients in 2, 4, 6 hours start treatment groups respectively. There were no significant differences in gender, age, core temperature, onset time to admission, Glasgow coma scale (GCS), acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) score at admission among the three groups. There were no significant differences in the levels of serum cTnI, CK-MB, Cr, β2-MG, ALT and AST at 2 hours after treatment. But with the prolongation of the treatment time, all indicators gradually increased. And the earlier start of the mild hypothermia, the less significant of the above indexes. All indexes in 2 hours start treatment group were significantly lower than those of 2 hours and 6 hours start treatment groups at 24 hours after treatment [cTnI (ng/L): 49.53±9.25 vs. 56.52±10.05, 64.57±11.21; CK-MB (U/L):51.47±11.83 vs. 57.87±7.43, 64.40±7.93; Cr (μmol/L): 140.97±11.33 vs. 148.16±10.39,155.57±8.65; β2-MG (mg/L): 10.28±1.46 vs. 11.58±2.13, 12.93±1.98; ALT (U/L): 248.53±75.47 vs. 341.42±129.58, 425.77±101.23;AST (U/L): 197.25±42.59 vs. 292.81±58.49, 351.20±60.41, all P < 0.05]. There was significant difference in the incidence of MODS in 2, 4, 6 hours start treatment groups [43.75% (14/32), 64.52% (20/31), 80.08% (24/30), χ2= 8.761, P = 0.013]. Linear regression analysis showed that the earlier onset time of mild hypothermia, the lower incidence of MODS (R2= 0.915, P = 0.013). Conclusion The application of mild hypothermia in 2 hours can effectively protect the physiological function of EHS organs and reduce the incidence of MODS.

Clinical effect of Reduning in the treatment of children with herpangina and its influence on serum creatine kinase (CK), CK-MB activity, CK-MB quality, cTnⅠ / 中国基层医药

Objective To explore the clinical effect of Reduning in the treatment of children with herpangina,and its influence on serum creatine kinase (CK),creatine phosphate kinase isoenzyme (CK-MB) activity,CK-MB quality,cardiac troponin Ⅰ (cTnⅠ).Methods 104 children with herpangina were divided into control group and research group according to the draw method,with 52 cases in each group.The control group was given conventional treatment,the research group was treated with Reduning on the basis of conventional treatment.The clinical curative effect,clinical symptoms disappear time,CK,CK-MB activity,CK-MB quality,inflammation factors,immune function before and after treatment,and adverse reactions were compared between the two groups.Results The total effective rate of the research group was higher thanthat of the control group (98.07％ vs.84.61％),the difference was statistically significant (P ＜ 0.05).Before treatment,the CK,CK-MB activity,CK-MB quality,cTnⅠ of the two groups had no statistically significant differences (all P ＞ 0.05).After treatment,the CK,CK-MB activity,CK-MB quality,cTnⅠ of the research group were lower than those of the control group [(55.87 ± 6.98) U/L vs.(68.42 ± 8.55) U/L,(22.70 ±2.84)U/L vs.(29.45 ± 3.65)U/L,(2.99 ± 0.37) μg/L vs.(4.48 ±0.56) μg/L,(0.16 ± 0.02) μg/L vs.(0.74 ± 0.09) μg/L],the differences were statistically significant (all P ＜ 0.05).The incidence rate of adverse reaction of the research group was lower than that of the control group,the difference was statistically significant(P＜0.05).Conclusion Theclinical effect of Reduning in the treatment of children with herpangina is sure,it can help to relieve clinical manifestations,reduce serum levels of CK,CK-MB activity,CK-MB quality,cTnⅠ,and can alleviate the body's inflammatory response and immune function.

Development and application of CK-MB specific monoclonal antibodies / 生物工程学报

The aim of this study is to develop creatine kinase isoenzyme MB (CK-MB) specific monoclonal antibodies (mAb), and characterize the monoclonal antibody and further development of quantitative detection assay for CK-MB. The BALB/c mice were immunized with purchased CK-MB antigen, then monoclonal antibodies were prepared according to conventional hybridoma technique and screened by indirect and capture ELISA method. To identify the epitopes and evaluate the classification, purchased creatine kinase isoenzyme MB (CK-MM/BB/MB) antigen was used to identify the epitopes, with immunoblotting and synthetic CK-MM and CK-BB in different linear epitope. A double antibody sandwich ELISA was applied to screen the mAb pairs for CK-MB detection, and the quantitative detection assay for CK-MB was developed. We used 74 cases of clinical specimens for comparison of our assay with Roche's CK-MB assay. We successfully developed 22 strains of hybridoms against CK-MB, these mAbs can be divided into linear, partial conformational CK-MB, CK-MM or CK-BB cross monoclonal antibody and CK-MB specific reaction with partial conformational monoclonal antibody, and CK-MB quantitative detection assay was developed by using partial conformational monoclonal antibody. The correlation coefficient factor r of our reagent and Roche's was 0.930 9. This study established a screening method for CK-MB partial conformational specific monoclonal antibody, and these monoclonal antibodies were analyzed and an established quantitative detection assay was developed. The new assay had a high concordance with Roche's.