Observation of serum erythropoietin concentrations in female athletes for up to eight days after a marathon run

Erythropoietin (EPO) was studied in 13 female marathon runners before and up to 8 days after a competition marathon run. The median baseline control value was 13.7 U/l. No change in EPO concentration was found immediately (15 min.) and one day after the run. However, a median increase in EPO concentration (18.1 U/l) was found on day three post-exercise (p< 0.05). On day 8 no change was found compared to pre-exercise values. This late increase in EPO concentration would seem to be responsible for the well known increase of red blood cell mass in long distance runners.     

降钙素原、BNP、心肌肌钙蛋白I及D-二聚体评估慢性心力衰竭患者预后的价值

【目的】探讨降钙素原(PCT)、B型利钠肽(BNP)、心肌肌钙蛋白I(cTnI)及D-二聚体(D-D)评估慢性心力衰竭(CHF)患者预后的价值。【方法】本院就诊的70例CHF患者作为CHF组,根据美国纽约心脏病协会颁布的心功能分级标准(NYHA)分级法分为心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组,分别为33例、26例、11例。同时选取同一时期本院70例体检正常者分为对照组。采集所有研究对象入院时及1个月后的血液标本,对所有研究对象血清PCT、BNP、cTnI及D-D进行检测,并进行统计分析。【结果】CHF组血清PCT、BNP、cTnI及D-D水平均较对照组高,其差异具有显著性(P均<0.05)。CHF组中心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组血清PCT、BNP、cTnI及D-D水平随着心衰程度加重而逐渐升高,三组间两两比较差异均具有显著性(P均<0.05)。CHF患者经治疗1月后,血清PCT、BNP、cTnI、D-D水平明显较治疗前降低,其差异具有显著性(P<0.01);CHF患者经治疗1月后左室射血分数(LVEF)较治疗前升高,且差异具有显著性(P<0.01);CHF患者经治疗1月后NYHA心功能级别较治疗前明显降低,且差异具有显著性(P<0.01)。血清PCT、BNP、cTnI、D-D水平与NYHA心功能级别均呈正相关(P均<0.05),与LVEF均呈负相关(P均<0.05)。【结论】血清中PCT、BNP、CTnI、D-D水平均可对CHF患者病情变化进行反映,对于CHF患者疗效监测具有重要预测价值。     

不稳定型心绞痛介入治疗前后肌钙蛋白I的变化

目的　观察不稳定型心绞痛 (UAP)患者介入治疗前后心肌肌钙蛋白I(cTnI)的变化特点。方法　选取接受冠状动脉介入治疗的UAP患者 49例 ,按照病变特征分为三组 ,术中测定球囊扩张时间、球囊最大充盈压 (MIP) ,并于术前 ,术后 1、6、2 4、48小时检测cTnI水平。结果　A型病变组球囊扩张时间、MIP均明显小于B、C型病变组。 2 4小时后A型病变组cTnI水平明显低于B、C型病变组。结论　UAP患者介入治疗后cTnI水平升高 ,其中C型病变升高明显 ,需进一步给予改善心肌代谢的药物辅助治疗。     

Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock

BACKGROUND: Cardiac depression in severe sepsis and septic shock is characterized by left ventricular (LV) failure. To date, it is unclear whether clinically unrecognized myocardial cell injury accompanies, causes, or results from this decreased cardiac performance. We therefore studied the relationship between cardiac troponin I (cTnI) and T (cTnT) and LV dysfunction in early septic shock. METHODS: Forty-six patients were consecutively enrolled, fluid-resuscitated, and treated with catecholamines. Cardiac markers were measured at study entry and after 24 and 48 h. LV function was assessed by two-dimensional transesophageal echocardiography. RESULTS: Increased plasma concentrations of cTnI (>/=0.4 microgram/L) and cTnT (>/=0.1 microgram/L) were found in 50% and 36%, respectively, of the patients at one or more time points. cTnI and cTnT were significantly correlated (r = 0.847; P <0.0001). Compared with cTnI-negative patients, cTnI-positive subjects were older, presented higher Acute Physiology and Chronic Health Evaluation II scores at diagnosis, and tended to have a worse survival rate and a more frequent history of arterial hypertension or previous myocardial infarction. In contrast, the two groups did not differ in type of infection or pathogen, or in dose and type of catecholamine administered. Continuous electrocardiographic monitoring in all patients and autopsy in 12 nonsurvivors did not disclose the occurrence of acute ischemia during the first 48 h of observation. LV dysfunction was strongly associated with cTnI positivity (78% vs 9% in cTnI-negative patients; P <0.001). In multiple regression analysis, both cTnI and cTnT were exclusively associated with LV dysfunction (P <0.0001). CONCLUSIONS: These findings suggest that in septic shock, clinically unrecognized myocardial cell injury is a marker of LV dysfunction. The latter condition tends to occur more often in severely ill older patients with underlying cardiovascular disease. Further studies are needed to determine the extent to which myocardial damage is a cause or a consequence of LV dysfunction.     

Serum lipoprotein lipids and haematological variables in veteran runners,before and after a 2100 km relay run

Summary. Plasma lipids and lipoprotein lipids, body characteristics, serum insulin concentration, distance run during training and haematological variables were determined in nine men aged between 62 and 72 years and who were regular runners. Multiple regression analysis showed that much of the variation in HDL cholesterol levels was explained by plasma triglycerides, and, to a lesser extent, by the distance run during training; although these variables contributed about equally to the variation in plasma HDL₂ cholesterol levels. The effects on measured variables of a 2100 km relay, run over a 17-day period, were also studied. During the relay the men were running an average 20% further, per week, than during their training before the relay. Plasma LDL cholesterol concentration, red blood cell volume, red cell count and haemoglobin levels fell significantly during the relay, and in three men raised serum insulin levels were reduced to within the normal range. Reticulocyte counts were not raised after the relay which suggests that the anaemia, seen in these men, was not due to erythrocyte destruction. The results indicate that in elderly runners, plasma triglycerides are an important predictor of plasma HDL cholesterol levels.     

Cardiac troponin I and troponin T: recent players in the field of myocardial markers.

The troponin (Tn) complex consists of three subunits referred to as TnT, TnI and TnC. Myocardium contains TnT and TnI isoforms which are not present in skeletal muscles and which can be separated from the muscular isoforms by immunological techniques. Using commercially available immunoassays, clinical laboratories are able to determine cardiac TnT and TnI (cTnT and cTnI) quickly and reliably as classical cardiac markers. After acute myocardial infarction, cTnT and cTnI concentrations start to increase in serum in a rather similar way than CK-MB, but return to normal after longer periods of time (approximately one week). Because of their excellent cardiac specificity, Tn subunits appear ideally suited for the differential diagnosis of myocardial and muscular damage, for example in noncardiac surgery patients, in patients with muscular trauma or with chronic muscular diseases, or after intense physical exercise. cTnT and cTnI may also be used for detecting evidence of minor myocardial damage: therefore they have found new clinical applications, in particular risk stratification in patients with unstable angina. In spite of the possible reexpression of cTnT in human skeletal muscles, and of the lack of standardization of cTnI assays, Tn subunits are not far to meet the criteria of ideal markers for acute myocardial injury. Only an insufficient sensitivity in the first hours following the acute coronary syndroms requiries to maintain an early myocardial marker in the cardiac panel for routine laboratory testing.     

肌钙蛋白I在心脏瓣膜病患者术前与术后浓度变化及其临床意义

目的 探讨血清肌钙蛋白I (cTnI)在心脏瓣膜病患者术前、后浓度变化及其对判定心肌损伤程度和预后的临床意义.方法 通过对近2年来心胸外科76例心脏瓣膜病患者(合并冠心病者除外)手术前(入院时及术前1 d)与术后(心脏复跳后2 h、复跳后12 h、术后第7天)血清cTnI的浓度测定,分析其心肌损伤程度、修复及预后.cTnI >0.5 ng/mL为阳性.结果 76例心脏瓣膜病患者中,82.89%的患者入院时血清cTnI>0.5 ng/mL,其中76.32%的患者血清cTnI≥5 ng/mL;78.95%的患者术前1 d血清cTnI>0.5 ng/mL,其中60.53%的患者血清cTnI≥5 ng/mL;所有患者心脏复跳后2 h其血清cTnI≥5 ng/mL;96.05%的患者心脏复跳后12 h血清cTnI>0.5 ng/mL,其中85.53%的患者血清cTnI浓度高于正常高值10倍;74例患者中(有2例因低心排血量综合征死于术后24 h),90.54%的患者术后第7天血清cTnI>0.5 ng/mL,其中79.73%的患者血清cTnI≥5 ng/mL.结论 cTnI是高度特异、高度灵敏的反映心肌细胞损伤和坏死的标志物,其存在着长时间的诊断窗口,为临床判断患者心肌细胞损伤的修复提供可靠依据.     

36例乙型肝炎病人病毒核糖核酸、肌钙蛋白Ⅰ与心电图改变关系的探讨

目的:研究乙型肝炎(HB)病人血清乙型肝炎病毒脱氧核糖核酸(HBV-DNA)、肌钙蛋白Ⅰ(cTnⅠ)与心电图(ECG)改变三者的关系,探讨HBV对心肌损伤的机理。方法:收集36例HB的临床资料及ECG的变化,并检测血清HBV-DNA、cTn Ⅰ含量。结果:急性肝炎患者血清HBV-DNA含量明显高于慢性肝炎;各型肝炎cTn Ⅰ的阳性率不等,总阳性率为22.2%(8 36)。急性、慢性重度、慢性中度、肝硬化、慢性轻度的阳性率分别为50%(2/4)、25%(1/4)、23.4%(3、1 3)、14.2%、(1 7)、12.1%(1/8),急性肝炎明显高于其它各组(P<0.01)。慢性中度、莺度与慢性轻度、肝硬化之间也有显著差异(P<0.01)。慢性轻度与肝硬化之间、慢性中度与慢性重度之间无显著差异。HB病人ECG异常发生率为36.1%(13/36),4例急性肝炎患者均有过ECG改变,显著高于其它各组(P<0.01)。结论:1)cTn Ⅰ阳性与ECG异常表现并不一致,cTn Ⅰ可以作为判断HB心肌损伤的敏感和特异性指标;2)在HB急性期的心肌损伤可能是HBV直接作用,慢性HB心肌损伤是自身免疫作用的结果。     

早期运动锻炼对大鼠急性心肌梗死后心肌组织中细胞因子、血浆脑钠肽及心功能的影响

目的探讨早期运动锻炼对大鼠急性心肌梗死（acute myocardial infarction,AMI）后心肌组织中细胞因子[肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素10（interleukin-10,IL-10）]、血浆脑钠肽（brain natri-uretic peptide,BNP）以及心功能的影响。方法利用结扎大鼠冠状动脉左前降支,制作大鼠AMI模型。于1周后将存活的21只大鼠按随机数字表法分为2组：耐力运动组11只和对照组10只。另设假手术组10只。耐力运动组行游泳锻炼4周。4周后运用超声心动图检测各组大鼠心功能[左室舒张末期内径（LVEDd）、左室射血分数（LVEF）和短轴缩短率（FS）],并检测心肌组织上清液中TNF-αI、L-10及血浆BNP水平。结果与假手术组比较,耐力运动组和对照组心肌组织上清液中TNF-α、TNF-α/IL-10及血浆BNP水平均明显上升（均P〈0.05）,LVEDd均明显升高（均P〈0.05）、LVEF和FS均明显下降（均P〈0.05）。耐力运动组心肌组织上清液中TNF-α、TNF-α/IL-10和血浆BNP水平及LVEDd均较对照组明显下降（均P〈0.05）,LVEF、FS均较对照组明显升高（均P〈0.05）。耐力运动组血浆BNP水平与LVEF呈负相关（r=-0.928,P〈0.05）,耐力运动组血浆BNP水平与心肌组织上清液中TNF-α水平呈正相关（r=0.868,P〈0.05）。结论早期运动锻炼对AMI大鼠具有心脏保护作用,其保护作用的机制之一可能是下调致炎因子/抗炎因子比例,改善心肌重塑。     

Early cytomegalovirus (CMV) gastrointestinal disease that developed 19 days after bone marrow transplantation,with a high-level of CMV antigenemia,of up to 1120 cells/slide

We report a 19-year-old male with acute myeloid leukemia who developed an early cytomegalovirus gastrointestinal disease with a high level of cytomegalovirus antigenemia after bone marrow transplantation. He underwent bone marrow transplantation from HLA-matched related donor. He developed acute graft-versus-host disease on day 15, and he immediately went on prednisolone. The graft-versus-host disease disappeared immediately, but he developed a severe epigastralgia on day 23. Although absolute neutrophil count was 0.5 × 10⁹/l, the pp65 cytomegalovirus antigenemia increased up to 1120 cells/slide. The endoscope examination was performed on day 29 and it showed erosive gastritis, and microscopical examination revealed nuclear inclusion bodies and positive cells of cytomegalovirus antigen. Ganciclovir treatment was started, and it continued until negative cytomegalovirus antigenemia was confirmed. He consequently discharged to outpatient without late phase CMV diseases or recurrence of AML. We assessed that the patient had two risk factors. First, he was the cytomegalovirus seropositive patient and received bone marrow from seronegative donor. Second, he was treated with prednisolone for acute graft-versus-host disease. The ganciclovir treatment turned out to be successful, but the cytomegalovirus disease developed too early to start the antigenemia guided preemptive treatment. The high-risk patients could develop the early cytomegalovirus disease even though under the status of myelosuppression after bone marrow transplantation.     

Adipose tissue and muscle volume determination by computed tomography in acromegaly, before and I year after adenomectomy

Abstract. The adipose tissue volume, skeletal muscle and skin volume and visceral organ volume were determined using the multiscan CT (computed tomography) technique in 15 patients with acromegaly. The examinations were performed before treatment and 1 year after transsphenoidal adenectomy.
The mean body weight did not change significantly after treatment; 91–3 kg and 92–3 kg pre and postoperatively in men and 66.7 kg and 65.9 kg in women respectively. The total adipose tissue volume increased by 7.1 1 (59.2%, P< 0.01) in the male group and 3.9 1 (20.39%, P< 0.05) in the female group. Muscle and skin mass and visceral organ mass decreased significantly after treatment. The muscle and skin mass decreased by 3.6 1 (-7.4%, P< 0.01) in males and by 3.2 1 in females (-11.5%, P< 0.02). The corresponding decrease in visceral organ mass was 1.5 1 (-17.0%, P< 0.01) in males and 1.0 1 (15.4%, P<0.05) in females respectively.
On average, the fractions of adipose tissue in the subcutaneous trunk and the intra-abdominal depots increased after treatment, while the fractions of adipose tissue in the limbs and the head and neck region decreased. The change in adipose tissue distribution pattern reached significance (P<0.005) in men only.     

Alterations in cytotoxic and helper T cell function after infection of T cell clones with human T cell leukemia virus, type I

HTLV-I is a transforming human retrovirus that is an etiologic agent of adult T cell leukemia/lymphoma. To investigate the effects of this virus on T cell functions, two OKT3+, OKT4+, OKT8- cytotoxic clones (8.7 and 8.8) specific for allogeneic cells bearing DPw2, a class II histocompatibility antigen, were studied before and after infection with HTLV-I. The clones retained cytotoxic function for up to 70 d after exposure to HTLV-I, even without subsequent antigenic stimulation, but then lost their cytotoxic activity. Prior to infection with HTLV-I, clone 8.8 also lysed OKT3 hybridoma cells; after infection, cytotoxic activity against these OKT3-antibody bearing cells was lost in parallel with the loss of activity against DPw2-bearing target cells. In addition, expression of T3 surface antigen by HTLV-I-infected 8.8 cells was decreased at a time when they lost their cytotoxic activity, possibly contributing to the loss of cytotoxic function. Finally, clone 8.8 could provide help for nonspecific IgG production by autologous B cells when stimulated with irradiated DPw2-bearing non-T cells. After infection with HTLV-I, this helper function became independent of DPw2-stimulation and persisted even when the cytotoxic activity was lost. An OKT4+ T cell clone thus could simultaneously manifest both cytotoxic and helper T cell activities, and these activities were differentially affected after HTLV-I infection.     

Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before,during, and after Cardiopulmonary Bypass

Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veterinarians, technicians, and researchers developing and implementing protocols with this model.Abbreviation: ACT, activated clotting time; CPB, cardiopulmonary bypass; CVP, central venous pressure; MAP, mean arterial pressure; RAP, retrograde autologous primingThe recent focus on rapidly translating findings in the laboratory to clinical applications has resulted in a shift to large animal models that closely correlate with human anatomy and physiology. The field of cardiac surgery is perhaps the most apparent beneficiary of animal research.⁶ Sheep (Ovis aries) have emerged as a widely used model for cardiovascular surgical device testing, especially that involving cardiac valves.^30,42,62 Despite the widespread use of sheep in the research setting, there are no comprehensive reviews of the relevant anatomy and surgical approaches, animal preparation, anesthetic protocols and monitoring, and postoperative care. The unique physiology of sheep coupled with the complexity of cardiovascular surgical research results in significant morbidity and mortality in this animal model.⁴²After IACUC approval, our institution undertook investigations of several novel cardiac devices and interventions in sheep, thus requiring the development of a conditioning and management protocol for animals before, during, and after major cardiac surgery involving cardiopulmonary bypass (CPB). Because neither a thorough review of sheep anatomy and physiology nor an adequate discussion of all the layers of anesthetic management during these complex procedures existed in the literature, our procedures were developed through a review of published literature, extrapolation from humans, clinical experience, and continued refinements as outcomes were evaluated. In this review, we aim to provide a comprehensive overview of relevant literature and share our experience from studies conducted in our AAALAC-accredited, NIH-assured institution to provide a concise source for researchers and veterinarians who are developing cardiovascular surgical protocols in sheep and to minimize adverse events during their implementation.     

Changes in coagulation factor activity and content of di(2-ethylhexyl)phthalate in frozen plasma units during refrigerated storage for up to five days after thawing

BACKGROUND: Thawed plasma is typically transfused to supply coagulation factors but factor activity declines during refrigerated storage. Refrigerating thawed plasma for longer than 24 hours could reduce plasma wastage and make plasma more readily available for emergency transfusions. We measured coagulation factor activity and di(2‐ethylhexyl)phthalate (DEHP) concentration in frozen plasma (FP) thawed and stored at 1 to 6°C for up to 5 days. STUDY DESIGN AND METHODS: FP units prepared using “top‐and‐bottom” collection sets were thawed, refrigerated, and sampled aseptically at 0, 24, 72, and 120 hours after thawing (n = 54). Clotting factor activities and prothrombin times (PTs) were measured using an automated coagulation factor analyzer. DEHP was measured by high‐performance liquid chromatography after hexane extraction (n = 11). Unit sterility was confirmed using an automated microbial detection system. RESULTS: Factor (F)V and FVIII, but not FVII, declined significantly within 24 hours. By Day 5, mean losses were 20, 14, and 41%, in FV, FVII, and FVIII, respectively; fibrinogen activity did not change. PT values were prolonged by 9% on Day 5. Mean DEHP levels increased from 22 ppm at thaw to 66 ppm on Day 5. CONCLUSIONS: The bulk of coagulation factor activity losses during storage occurred in the first 24 hours. Coagulation factor activities remaining in FP after 5 days did not differ from those previously reported in similar products frozen within 24 hours of phlebotomy. While DEHP levels in 5‐day‐thawed FP are not of concern for adult patients, for infants, DEHP levels can be minimized by using FP refrigerated for no more than 24 hours.     

Cardiospecificity of the 3<Superscript>rd</Superscript> generation cardiac troponin T assay during and after a 216 km ultra-endurance marathon run in Death Valley

Background The reasons for the appearance of cardiacspecific troponin (cTnT) after strenuous exercise are unclear. The aim of the present study was to evaluate the cardiospecificity of the 3^rd generation cardiac cTnT assay during and after an ultra-endurance race of 216 km at extreme environmental conditions in Death Valley. Study design and methods We measured serially cTnT, creatine kinase (CK), activity and mass of the isoenzyme MB of CK (CK-MB_act and CK-MB_mass), and myoglobin in 10 well-trained athletes before, repeatedly during and after the race. Results Six of 10 participants finished the race within a preset time of 60 hours. Postrace values of biochemical markers CK, CK-MB_act, CKMB_mass, and myoglobin were significantly increased compared to baseline (p<0.05). CK-MB_act increased from (median (25^th/ 75^thpercentile) 12 (10/13) U/L to 72 (32/110) U/L, CK-MB_mass from 3.9 (2.9/5.6) U/L to 65 (18/80) U/L and CK increased from median 136 (98/ 228) U/L to 3,570 (985/6,884) U/L respectively. Pre-race myoglobin was 27 (22/31) μg/l compared to 530 (178/657) μg/l after the run. One runner developed significant exercise-induced rhabdomyolysis with spontaneous recovery. cTnT values remained below the 99^th percentile reference limit in all athletes including the runner who developed significant rhabdomyolysis (peak CK 27,951 U/L). Conclusions Strenuous endurance exercise, even under extreme environmental conditions, does not result in structural myocardial damage in well-trained ultra-endurance athletes. We found no crossreactivity between cTnT and CK, neither in exercise-induced skeletal muscle trauma nor after rhabdomyolysis underscoring the excellent analytical performance of 3^rd generation cTnT assay.