BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine...BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)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 c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn 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-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn 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-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.展开更多
A 68-year-old male was complained of chest pain for two years and fatigue for one week. He was admitted to other hospitals two years ago because of severe chest pain. A diagnosis of acute non-ST segment elevation myoc...A 68-year-old male was complained of chest pain for two years and fatigue for one week. He was admitted to other hospitals two years ago because of severe chest pain. A diagnosis of acute non-ST segment elevation myocardial infarction （NSTEMI） was made. But the coronary angiography was refused by himself. After effective conservative treatment, he got better and discharged. A regular administration of aspirin, metoprolol and simvastatin was taken. No recurrent sympotoms occurred. However, he felt fatigue and palpitation after 30-m walking one week ago without predisposing factors.展开更多
BACKGROUND: This study aimed to investigate the epidemiological and clinical characteristics of patients with heat-related illness, and guide the prevention, diagnosis and treatment of heat-related illness.METHODS: Fr...BACKGROUND: This study aimed to investigate the epidemiological and clinical characteristics of patients with heat-related illness, and guide the prevention, diagnosis and treatment of heat-related illness.METHODS: From June 2013 to August 2013, seventy patients with heat-related illness were treated at Jinshan Hospital of Fudan University, and their epidemiological characteristics, laboratory results, treatment and prognosis were retrospectively analyzed.RESULTS: In the 70 patients, 18 patients suffered from heat stroke and 52 patients from nonheat stroke. When the environmnent temperature was above 35 °C, the body temperature of the patients began to increase markedly. The patients with heat stroke were significantly older than those with non-heat stroke(P<0.05). The body temperature, heart rate, blood glucose, blood lactate dehydrogenase and blood creatine kinase in the patients with heat stroke were higher than those in the patients with non-heat stroke(P<0.05). Blood lactate dehydrogenase and blood creatine kinase were positively correlated with body temperature(r=0.801).CONCLUSION: When the environmental temperature goes above 35 °C, heat-related illness should be prevented, especially in the elderly. The body temperature, heart rate, blood glucose, blood lactate dehydrogenase and blood creatine kinase in patients with heat stroke are higher than those in patients with non-heat stroke. Blood lactate dehydrogenase and blood creatine kinase are positively correlated with body temperature, but their relationship with heat-related illness awaits further study.展开更多
Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of...Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of serum enzymes (creatine kinase, CK; hybrid muscle-brain CK isoenzyme, CK-MB; aspartate aminotransferase, ASTF and 1actic dehydrogenase, LDH) was determined pre-and post-operatively. DUring the first 72 h post-operation, release of CK, CK-MB, AST and LDH in the 2 groups was different, In case of tetralogy of Fallot (TOF) the CK-MB released in l3CP and CCP 12 h after operation were 51. 29±9. 42 and 85. 77±22. 39 U/L respectively (P<0. 05). In the CCP group of TOF, CK-MB level increased significantly even at 72 h after operation (30. 91±14. 32 U/L vs the pre-operative value of 14. 57±7. 51 U/L). The results show a better myocardial preservation in the BCP group as compared with the CCP group. BCP can maintain metabolic homeostasis of the myocardium, reduce myocardial injury and increase the content of myocardial high energy phosphate during ischemia. Tolerance to ischemia is poor in patients with complex congenital heart disease. Therefore, preservation of high energy phosphates is necessary for severe-grade patients and BCP is superior to crysta1loid cardioplegia in this regard. It is concluded that CCP results in a higher release of CK-MB as compared with BCP group. BCP is superior to CCP for myocardial protection in patients with complex congenital heart disease.展开更多
基金This study was supported by grants from the National Key R&D Program of China (2017YFC0908700, 2017YFC0908703)National S&T Fundamental Resources Investigation Project (2018FY100600, 2018FY100602)+2 种基金Taishan Pandeng Scholar Program of Shandong Province (tspd20181220)Taishan Young Scholar Program of Shandong Province (tsqn20161065, tsqn201812129)Key R&D Program of Shandong Province (2020SFXGFY03, 2019GSF108073)
文摘BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)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 c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn 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-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn 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-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.
文摘A 68-year-old male was complained of chest pain for two years and fatigue for one week. He was admitted to other hospitals two years ago because of severe chest pain. A diagnosis of acute non-ST segment elevation myocardial infarction （NSTEMI） was made. But the coronary angiography was refused by himself. After effective conservative treatment, he got better and discharged. A regular administration of aspirin, metoprolol and simvastatin was taken. No recurrent sympotoms occurred. However, he felt fatigue and palpitation after 30-m walking one week ago without predisposing factors.
文摘BACKGROUND: This study aimed to investigate the epidemiological and clinical characteristics of patients with heat-related illness, and guide the prevention, diagnosis and treatment of heat-related illness.METHODS: From June 2013 to August 2013, seventy patients with heat-related illness were treated at Jinshan Hospital of Fudan University, and their epidemiological characteristics, laboratory results, treatment and prognosis were retrospectively analyzed.RESULTS: In the 70 patients, 18 patients suffered from heat stroke and 52 patients from nonheat stroke. When the environmnent temperature was above 35 °C, the body temperature of the patients began to increase markedly. The patients with heat stroke were significantly older than those with non-heat stroke(P<0.05). The body temperature, heart rate, blood glucose, blood lactate dehydrogenase and blood creatine kinase in the patients with heat stroke were higher than those in the patients with non-heat stroke(P<0.05). Blood lactate dehydrogenase and blood creatine kinase were positively correlated with body temperature(r=0.801).CONCLUSION: When the environmental temperature goes above 35 °C, heat-related illness should be prevented, especially in the elderly. The body temperature, heart rate, blood glucose, blood lactate dehydrogenase and blood creatine kinase in patients with heat stroke are higher than those in patients with non-heat stroke. Blood lactate dehydrogenase and blood creatine kinase are positively correlated with body temperature, but their relationship with heat-related illness awaits further study.
文摘Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of serum enzymes (creatine kinase, CK; hybrid muscle-brain CK isoenzyme, CK-MB; aspartate aminotransferase, ASTF and 1actic dehydrogenase, LDH) was determined pre-and post-operatively. DUring the first 72 h post-operation, release of CK, CK-MB, AST and LDH in the 2 groups was different, In case of tetralogy of Fallot (TOF) the CK-MB released in l3CP and CCP 12 h after operation were 51. 29±9. 42 and 85. 77±22. 39 U/L respectively (P<0. 05). In the CCP group of TOF, CK-MB level increased significantly even at 72 h after operation (30. 91±14. 32 U/L vs the pre-operative value of 14. 57±7. 51 U/L). The results show a better myocardial preservation in the BCP group as compared with the CCP group. BCP can maintain metabolic homeostasis of the myocardium, reduce myocardial injury and increase the content of myocardial high energy phosphate during ischemia. Tolerance to ischemia is poor in patients with complex congenital heart disease. Therefore, preservation of high energy phosphates is necessary for severe-grade patients and BCP is superior to crysta1loid cardioplegia in this regard. It is concluded that CCP results in a higher release of CK-MB as compared with BCP group. BCP is superior to CCP for myocardial protection in patients with complex congenital heart disease.
