N-terminal pro-brain natriuretic peptide as a predictor of reoperation in children with surgically corrected tetralogy of fallot.

BACKGROUND: Most patients with surgically corrected tetralogy of Fallot (TOF) are faced with multiple residua and sequelae such as pulmonary regurgitation (PR), resulting in reoperation for pulmonary valve replacement (PVR). Plasma brain natriuretic peptide (BNP) level and serum N-terminal pro-BNP (NT-pro-BNP) level are useful as diagnostic objective markers of chronic heart failure (CHF). The aim of the study was to examine whether these markers have predictive ability for reoperation in children with surgically corrected TOF. METHODS AND RESULTS: Fifty-eight patients (38 male, 20 female) aged 1-18 years (median, 7 years) were enrolled. Serum NT-pro-BNP in TOF patients was significantly higher than in age-matched hospital controls without CHF (359.5±449.7pg/ml vs. 86.1±45.1pg/ml, respectively; P<0.0001). BNP and NT-pro-BNP had a better correlation with CHF index, RVEDP, and LVEDV in TOF groups. Children with surgically corrected TOF who had indication for PVR had higher BNP and NT-pro-BNP and more severe PR than those without indication for PVR. On multivariate logistic regression analysis, NT-pro-BNP was the strongest predictor for reoperation in patients with surgically corrected TOF. Area under the curve of NT-pro-BNP for reoperation was 0.950 (P<0.001) with a sensitivity of 88.9% and specificity of 91.8%. CONCLUSIONS: NT-pro-BNP is a good biomarker for monitoring CHF, and is a good predictor of PVR in children with surgically repaired TOF.

[Problems facing undergraduate clinical practice training in laboratory medicine and proposed solution: remodeling of a point-of-care automatic analyzer].

It is essential that medical students learn how to precisely assess the results of laboratory tests. This may be accomplished by improving students' understanding of the processes involved in the laboratory testing of specimens, from blood collection to analysis, and by discovering factors that may influence these processes and impact results. Currently, medical students are generally taught the process by using a large automatic analyzer. However, because the students cannot observe the actual operation of the analyzer, they do not learn the process of analysis, that is, the chemical analysis of the specimen. To solve this problem, we remodeled a point-of-care automatic analyzer. The analyzer enabled students to observe its actual operation during specimen analysis. We used this analyzer for clinical practice training and obtained information on its effectiveness as a learning tool by means of a questionnaire survey. The questionnaire survey indicated that most of the students agree that the analyzer helped them learn more about the following, aspects of clinical practice: general clinical laboratory medicine (68.5%); method of analysis (57.5%); sampling method (70.0%); and point-of-care tests (52.8%). Above all, 60% of the students became interested in clinical laboratory medicine after their practical experience with the analyzer. The analyzer enables medical students to observe directly the process of biochemical analyses, and is a valuable learning tool for the students.