Serum hydroxybutyrate dehydrogenase and COVID-19 severity and mortality: a systematic review and meta-analysis with meta-regression.

Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate serum concentrations of hydroxybutyrate dehydrogenase (HBDH), a combined marker of myocardial and renal injury, in hospitalized COVID-19 patients with different disease severity and survival status. We searched PubMed, Web of Science and Scopus, between December 2019 and April 2021, for studies reporting HBDH in COVID-19. Risk of bias was assessed using the Newcastle-Ottawa scale, publication bias was assessed with the Begg's and Egger's tests, and certainty of evidence was assessed using GRADE. In 22 studies in 15,019 COVID-19 patients, serum HBDH concentrations on admission were significantly higher in patients with high disease severity or non-survivor status when compared to patients with low severity or survivor status (standardized mean difference, SMD = 0.90, 95% CI 0.74 to 1.07, p < 0.001; moderate certainty of evidence). Extreme between-study heterogeneity was observed (I2 = 93.5%, p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not substantially modified. A significant publication bias was observed. In meta-regression, the SMD of HBDH concentrations was significantly associated with markers of inflammation, sepsis, liver damage, non-specific tissue damage, myocardial injury, and renal function. Higher HBDH concentrations were significantly associated with higher COVID-19 severity and mortality. This biomarker of cardiac and renal injury might be useful for risk stratification in COVID-19. (PROSPERO registration number: CRD42021258123).

Serum magnesium in patients with severe acute respiratory syndrome coronavirus 2 from Wuhan, China.

The aim of the study was to evaluate the significance of hypomagnesemia in patients with coronavirus disease 2019 (COVID-19) and clarify its possible pathogenesis. A retrospective cohort study was conducted by reviewing 83 patients hospitalized in Guanggu district, Wuhan Third Hospital, China. Clinical histories, laboratory findings and outcome data were collected. Eighteen patients had hypomagnesemia during hospitalization. Fourteen patients were in the critical group and six died. In the critical group, serum magnesium (0.72 ± 0.15 mmol/L) was much lower than that in the moderate and severe groups. At the same time, we also found that several indicators are correlated with the level of magnesium. The level of magnesium was positively associated with the lymphocyte count (r = 0.203, P = 0.004) and platelet count (r = 0.217, P = 0.002) but negatively related to the levels of CRP (r = -0.277, P = 0.000), LDH (r = -0.185, P = 0.011) and α-hydroxybutyrate dehydrogenase (r = -0.198, P = 0.008) in the critical group. Hypomagnesemia might increase symptoms and may be associated with mortality in COVID-19 by affecting enzyme activity and activating the inflammatory response. Thus, magnesium might play a key role in the pathogenesis of COVID-19.

Clinical features, laboratory findings and persistence of virus in 10 children with coronavirus disease 2019 (COVID-19).

BACKGROUND: A pandemic caused by SARS-CoV-2 infection (COVID-19) has rapidly spread across the globe. Although many articles have established the clinical characteristics of adult COVID-19 patients so far, limited data are available for children. The aim of this study was to reveal the clinical features, laboratory findings and nucleic acid test results of ten pediatric cases. METHODS: In this retrospective single-center cohort study, pediatric cases with COVID-19 infection were consecutively enrolled in one hospital in Huangshi, China from January 1 to March 11, 2020. RESULTS: A total of 10 children with COVID-19 were recruited. Of them, four were the asymptomatic type, one was the mild type, and five were the moderate type (including two subclinical ones). All patients were from family clusters. Only fever, nasal discharge and nasal congestion were observed. Lymphopenia and leukopenia were uncommon in our sample but elevated levels of lactate dehydrogenase (LDH) and alpha-hydroxybutyrate dehydrogenase (α-HBDH) were observed frequently. Of these laboratory test variables, no statistical difference was identified between asymptomatic and symptomatic patients. Abnormalities in radiological data were detected in five patients, and representative findings of chest CT images were patchy shadows and ground-glass opacities. There were two cases whose oropharyngeal nucleic acid tests reversed to positive after one negative result, and two patients whose oropharyngeal swabs tested negative but rectal swabs showed positive. CONCLUSIONS: Clinical symptoms were mild in children with COVID-19. Increased levels of LDH and α-HBDH were potential clinical biomarkers for pediatric cases. More attention should be paid to the SARS-CoV-2 viral assessment of rectal swabs before patients are discharged.

Elevated α-hydroxybutyrate dehydrogenase as an independent prognostic factor for mortality in hospitalized patients with COVID-19.

AIMS: Many studies have explored the clinical characteristics of patients with coronavirus disease (COVID-19), especially patients with cardiovascular disease. However, associated mechanisms and markers remain to be further investigated. This study aimed to investigate the effect of α-hydroxybutyrate dehydrogenase (α-HBDH) levels on disease progression and prognosis of patients with COVID-19. METHODS AND RESULTS: One thousand seven hundred and fifty-one patients from the Leishenshan hospital in Wuhan were divided into elevated and normal groups by α-HBDH level, and the clinical information between the two groups was compared retrospectively. The main outcome evaluation criteria included in-hospital death and disease severity. Univariate and multivariate regression analyses, survival curves, logistic regression, and receiver operating characteristic curve models were performed to explore the relationship between elevated α-HBDH and the two outcomes. Besides, curve fitting analyses were conducted to analyse the relationship between computed tomography score and survival. Among 1751 patients with confirmed COVID-19, 15 patients (0.87%) died. The mean (SD) age of patients was 58 years in normal α-HBDH group and 66 years in elevated α-HBDH group (P < 0.001). The mortality during hospitalization was 0.26% (4 of 1559) for patients with normal α-HBDH levels and 5.73% (11 of 192) for those with elevated α-HBDH levels (P < 0.001). Multivariate Cox analysis confirmed an association between elevated α-HBDH levels and higher risk of in-hospital mortality [hazard ratio: 4.411, 95% confidence interval (95% CI), 1.127-17.260; P = 0.033]. Multivariate logistic regression for disease severity and α-HBDH levels showed significant difference between both groups (odds ratio = 3.759; 95% CI, 1.895-7.455; P < 0.001). Kaplan-Meier curves also illustrated the survival difference between normal and elevated α-HBDH patients (P < 0.001). CONCLUSIONS: Our study found that serum α-HBDH is an independent risk factor for in-hospital mortality and disease severity among COVID-19 patients. α-HBDH assessment may aid clinicians in identifying high-risk individuals among COVID-19 patients.

Features of α-HBDH in COVID-19 patients: A cohort study.

BACKGROUND: Coronavirus disease-2019 (COVID-19) has spread all over the world and brought extremely huge losses. At present, there is a lack of study to systematically analyze the features of hydroxybutyrate dehydrogenase (α-HBDH) in COVID-19 patients. METHODS: Electronic medical records including demographics, clinical manifestation, α-HBDH results and outcomes of all included patients were extracted. RESULTS: α-HBDH in COVID-19 group was higher than that in excluded group (p < 0.001), and there was no significant difference in α-HBDH before and after the exclusion of 5 patients with comorbidity in heart or kidney (p = 0.671). In COVID-19 group, the α-HBDH value in ≥61 years old group, severe group, and critical group, death group all increased at first and then decreased, while no obvious changes were observed in other groups. And there were significant differences of the α-HBDH value among different age groups (p < 0.001), clinical type groups (p < 0.001), and outcome groups (p < 0.001). The optimal scale regression model showed that α-HBDH value (p < 0.001) and age (p < 0.001) were related to clinical type. CONCLUSIONS: α-HBDH was increased in COVID-19 patients, obviously in ≥61 years old, death and critical group, indicating that patients in these three groups suffer from more serious heart and kidney and other tissues and organs damage, higher α-HBDH value, and risk of death. The difference between death and survival group in early stage might provide a approach to judge the prognosis. The accuracy of the model to distinguish severe/critical type and other types was 85.84%, suggesting that α-HBDH could judge the clinical type accurately.

Feasibility of computed tomography-guided irreversible electroporation for porcine kidney ablation.

OBJECTIVE: The objective was to evaluate the feasibility and safety of computed tomography (CT)-guided percutaneous irreversible electroporation (IRE) in porcine kidneys. MATERIALS AND METHODS: Under CT guidance, two monopole probes were used to precisely puncture through the renal parenchyma into the renal hilum in nine anesthetized adult Bama miniature pigs. After which, IRE ablation was performed. Biochemical and pathological examinations were carried out 2 h, 2, 7, and 14 days after the procedure. RESULTS: All procedures were performed successfully without any serious complications such as bleeding, infection, or death. All pigs survived until the end of the study. Pathological examinations showed that cells in the ablation area were dead within 2 days after the procedure, whereas the vascular endothelium showed only slight damage. After 2 days, endothelialization ensued and regrowth of smooth muscle cells was observed after 14 days. Hemogram tests indicated a transient increase but gradually returned to baseline levels 14 days after the procedure. CONCLUSION: IRE was essentially safe, however further studies on tumor ablation using several different animal models are needed.

Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study.

OBJECTIVES: Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. METHODS: We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. RESULTS: During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97-3.33), male sex (HR 1.79, 95% CI 1.41-2.28), presence of hypertension (HR 1.44, 95% CI 1.11-1.88), diabetes (HR 1.82, 95% CI 1.35-2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38-2.93) and coronary artery disease (HR 1.83, 95% CI 1.26-2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34-0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02-2.90), urea nitrogen (HR 1.72, 95% CI 1.21-2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26-7.21) and D-dimer (HR 2.01, 95% CI 1.12-3.58) at baseline were also associated with risk for disease progression. CONCLUSIONS: This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.

Associations between estimated glomerular filtration rate and cardiac biomarkers.

BACKGROUND: Chronic kidney disease (CKD) is associated with an increased cardiovascular disease (CVD) mortality risk. Elevation of cardiac biomarkers in patients with renal dysfunction is ambiguous in the diagnosis of CVD. The purpose of this study was to investigate the associations between estimated glomerular filtration rate (eGFR) and cardiac biomarkers, and the influence of renal dysfunction on the cardiac biomarkers. METHODS: We examined the cross-sectional associations of eGFR with cardiac troponin I (cTnI), creatine kinase (CK), CK-MB, lactic dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), and brain natriuretic peptide (BNP) in 812 adults and 215 child. Spearman correlation and logistic regression analysis were performed to evaluate the associations. RESULTS: For adults, lower eGFR CKD-EPI had significantly higher cTnI, CK-MB, LDH, HBDH, and BNP. There were negative correlations between eGFRCKD-EPI and cTnI, CK-MB, LDH, HBDH, and BNP. After adjustment for potential confounders, as compared with eGFRCKD-EPI  ≥ 90 mL/min/1.73 m2 , eGFRCKD-EPI  < 60 mL/min/1.73 m2 remained associated with a 2.83 (1.08-7.41) [ratio (95% CI)] times higher cTnI and a 6.50 (2.32-18.22) [ratio (95% CI)] times higher HBDH. For child, lower eGFRSchwartz had significant higher CK and CK-MB. There were negative correlations between eGFRSchwartz and CK, and eGFRSchwartz and CK-MB. After adjustment for potential confounders, as compared with eGFRSchwartz  ≥ 90 mL/min/1.73 m2 , eGFRSchwartz  < 90 mL/min/1.73 m2 revealed no significant higher CVD biomarkers. CONCLUSION: Reduced eGFR is associated with elevated cTnI and HBDH among adults without clinically evident CVD, but not child.

α-Hydroxybutyrate dehydrogenase is associated with atherothrombotic events following infrainguinal angioplasty and stenting.

Besides clinical characteristics, easy-accessible laboratory markers could be of value to refine risk stratification in peripheral artery disease. In the current study, we investigated whether α-hydroxybutyrate dehydrogenase (HBDH) is associated with atherothrombotic events in 83 stable patients undergoing infrainguinal angioplasty and stenting. The primary endpoint was defined as the composite of the first occurrence of nonfatal myocardial infarction, nonfatal stroke or transient ischemic attack and cardiovascular death within 2 years after angioplasty and stenting, and occurred in 6 patients (7.2%). HBDH levels at baseline were significantly higher in patients who subsequently developed the primary endpoint (126 U/L [116-137 U/L] vs. 105 U/L [95-120 U/L]; p = 0.04). ROC curve analysis revealed that HBDH could distinguish between patients without and with future atherothrombotic events. A HBDH concentration ≥ 115 U/L was identified as the best threshold to predict the composite endpoint, providing a sensitivity of 83.3% and a specificity of 71.4%, and was therefore defined as high HBDH. High HBDH was seen in 28 patients (33.7%). Ischemic events occurred significantly more often in patients with high HBDH than in patients with lower HBDH levels (5 vs. 1 patients, p = 0.007). In conclusion, HBDH is associated with the occurrence of atherothrombotic events after infrainguinal angioplasty with stent implantation. Future trials are warranted to study the predictive role of HBDH for ischemic outcomes and to investigate underlying mechanisms.

[Effects of Rutin on Myocardial Enzyme and Cardiac Morphology in Diabetic Mice].

OBJECTIVE: To study the effects of rutin on myocardial enzyme in serum and myocardial morphology in diabetic mice induced by streptozotocin (STZ). METHODS: A model of type 1 diabetic mice was established in 48 male kunming mice with daily intraperitoneal injection of streptozotocin (STZ) 62.5 mg/kg for 5 consecutive days. 12 male Kunming mice were selected as normal group randomly. The established successfully diabetic mice were randomly divided into the model group, irbesartan group [45 mg/ (kg?d)], low-, high-dose rutin groups [50, 100 mg/ (kg?d)]. The mice in the normal and the model groups were given sodium carboxymethyl cellulose solution (CMC-Na, 1 g/L) by intragastric administration respectively. After administration for 8 weeks, the levels of creatine kinase (CK), creatine kinase isoenzymes (CK-MB), hydroxybutyrate dehydrogenase (HBDH), and lactate dehydrogenase (LDH) in serum were detected by blood biochemical analyzer. The cardiac myocardial morphology was observed by HE staining, Masson trichrome staining and electron microscope. RESULTS: Compare to the normal group, the levels of the myocardial enzyme in serum evidently increased in the model group (P<0.01); Compare to the model group, the levels of the myocardial enzyme in serum decreased in low-, high-dose rutin groups; The levels of HBDH and LDH declined remarkably in the high-dose rutin group relative to the low-dose group (P<0.05); Compared to the high-dose group, the level of LDH increased in the irbesartan group (P<0.05).Moreover, relative to the model group, the morphology of myocardial tissue, the degree of fibrosis and the ultrastructure of myocardial tissue in mice were significantly improved in low-, high-dose rutin groups, and the effects were more significant in the high-dose rutin group. CONCLUSION: Rutin could decrease the levels of myocardial enzyme in serum in diabetic mice, improve the cardiac cell morphology and alleviate myocardial injury.

The Acute Effects of Simple Sugar Ingestion on Appetite, Gut-Derived Hormone Response, and Metabolic Markers in Men.

This pilot study aimed to investigate the effect of simple sugar ingestion, in amounts typical of common ingestion, on appetite and the gut-derived hormone response. Seven healthy men ingested water (W) and equicaloric solutions containing 39.6 g glucose monohydrate (G), 36 g fructose (F), 36 g sucrose (S), and 19.8 g glucose monohydrate + 18 g fructose (C), in a randomised order. Serum concentrations of ghrelin, glucose dependent insulinotropic polypeptide (GIP), glucagon like peptide-1 (GLP-1), insulin, lactate, triglycerides, non-esterified fatty acids (NEFA), and d-3 hydroxybutyrate, were measured for 60 min. Appetite was measured using visual analogue scales (VAS). The ingestion of F and S resulted in a lower GIP incremental area under the curve (iAUC) compared to the ingestion of G (p < 0.05). No differences in the iAUC for GLP-1 or ghrelin were present between the trials, nor for insulin between the sugars. No differences in appetite ratings or hepatic metabolism measures were found, except for lactate, which was greater following the ingestion of F, S, and C, when compared to W and G (p < 0.05). The acute ingestion of typical amounts of fructose, in a variety of forms, results in marked differences in circulating GIP and lactate concentration, but no differences in appetite ratings, triglyceride concentration, indicative lipolysis, or NEFA metabolism, when compared to glucose.

[The protective effects of Haematococcus pluvialis on the exercise-induced myocardial injury in rat].

OBJECTIVE: To study the protective effects of Haematococcus pluvialis (H. pluvialis) on myocardial injury of rats induced by endurance and intensive exercise. METHODS: The model was based on intensive endurance training. Sixty-five male aged 42 days Wistar rats were randomly divided into 5 groups:control group (C group), general training group (M group), low dose H. pluvialis + training group (HM I group), middle dose H. Pluvialis + training group (HM Ⅱ group), high dose H. pluvialis + training group (HM Ⅲ group). Each group included 12 rats, and the rats were assigned to go on a 42-day swimming training regime. Professional gavage were taken daily. The rats in HM I, HM Ⅱ and HM Ⅲ group were treated with H. pluvialis at the doses of 0.067,0.133 and 0.4 g/kg by ig at 5 ml/kg and the normal saline were given to other groups. After a 42-day swimming training regime, myocardial injury markers such as serum alanine aminotransferase (ALT), myocardial superoxide dismutase(SOD) and malondialdehyde (MDA) were detected, the biochemical indexes such as serum and myocardial endothelin (ET) and calcitonin gene related peptide (CGRP)were detected. RESULTS: Serum ALT, lactate dehydrogenase(LDH), creatine kinase(CK), a-hydroxybutyrate dehydrogenase(a-HBDH), ET, myocardial MDA and ET in M group were significantly higher than those in C group (P<0.05 or P<0.01). The myocardial SOD activity and the myocardial and serum CGRP in M group were significantly lower than those in C group(P<0.05 or P<0.01). The contents of serum ALT, LDH and CK in HM groups were lower than those in the M group but there was no significant difference between the two groups. Compared with M group, H. pluvialis could decrease the levels of serum a-HBDH, ET and myocardial ET in a dose-dependent manner (P<0.05 or P<0.01). The above mentioned three parameters in HM Ⅲ group were lower than those in HM I group (P<0.05). H. pluvialis could decrease the levels of myocardial MDA and increase the levels of myocardial SOD activity and serum or myocardial CGRP in a dose-dependent manner (P<0.05 or P<0.01). CONCLUSIONS: The different doses of H.pluvialis can effectively reduce the free radicals caused by endurance and intensive training and enhance the immune function. Meanwhile H.pluvialis is able to guarantee the relative balance in ET an CGRP`s concentration. Therefore, the myocardial lipid peroxidation and myocardial injury are encumbered. Additionaly, high dose of H. pluvialis is proven to be the most effective.

Lactate Dehydrogenase as a Biomarker for Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Children.

BACKGROUND: Corticosteroids have been used for refractory Mycoplasma pneumoniae pneumonia and have beneficial effects. The aim of this study was to identify the biomarkers for predicting refractory M. pneumoniae pneumonia in a timely fashion to initiate steroid therapy. METHODS: This was a prospective cohort study of children with M. pneumoniae pneumonia admitted to the Children's Hospital of Fudan University from September 2012 to August 2013. Lactate dehydrogenase (LDH) and other laboratory tests, including complete blood counts, C-reactive protein, erythrocyte sedimentation rate (ESR), alanine aminotransferase, aspartate aminotransferase, α-hydroxybutyrate dehydrogenase (HBDH), creatine kinase, and creatine kinase MB, were performed on admission. Based on the definition of refractory M. pneumoniae pneumonia, subjects were divided into 2 groups: refractory M. pneumoniae pneumonia and usual M. pneumoniae pneumonia. The diagnostic values of laboratory findings were analyzed. RESULTS: In total, 653 subjects were enrolled, including 300 in the refractory pneumonia group and 353 in the usual pneumonia group. There was no significant difference in sex distribution between the 2 groups. The average age in the refractory M. pneumoniae pneumonia group was greater than that in the usual M. pneumoniae pneumonia group. Compared with the usual pneumonia group, the refractory pneumonia group showed significantly higher levels of C-reactive protein, serum LDH, serum HBDH, serum alanine aminotransferase, serum aspartate aminotransferase, and neutrophils and higher ESRs. Logistic regression showed that age, LDH, and ESR were the significant factors in predicting refractory M. pneumoniae pneumonia. In addition, LDH and HBDH were strongly correlated, and receiver operating characteristic curve analysis showed that the area under the curve of LDH was 0.718 with a cutoff of 379 IU/L, that of ESR was 0.683 with a cutoff of 32.5 IU/L, and that of HBDH was 0.691 with a cutoff of 259.5 IU/L. CONCLUSIONS: Serum LDH can be used as a biomarker to predict refractory M. pneumoniae pneumonia at the early stage of hospitalization.

[Preliminary analysis of serum enzymes indicators in childhood amputees due to earthquake resulting trauma].

OBJECTIVE: To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake, and to discuss their clinical significance. METHODS: From 150 children amputees who were victims of Sichuan Wenchuan earthquake in 2008 and Sichuan Lushan earthquake in 2013, 45 cases with complete records of serum enzymes examinations were reviewed retrospectively. They were divided into three groups: amputation group (n=6), fasciotomy decompression group (n=5), general trauma without injury to extremity group (n=34). Serum enzyme examination data were compared for statistical analysis to find the difference among groups. Ten children who were not victims of earthquake were selected from department of orthopaedics to serve as controls, and 20 adult amputees as a result of earthquake served as another control group. RESULTS: There were significant differences in injury severity scale (ISS) and the contents of all serum enzymes, including aspartate transaminase (AST), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH), between the amputation group and other patients (FISS=15.474, P<0.001; FAST=10.770, P<0.001; FALT=12.799, P<0.001; FCK=12.848, P<0.001; FLDH=13.126, P<0.001; FHBDH=13.186, P<0.001), and the difference in amputation group was even more significant. AST, LDH, HBDH in childhood amputees group were significantly higher than those in adult amputation group. The contents of ALT and CK were slightly increased. Serum enzyme contents were found to be significantly helpful for prediction of disease condition and prognosis. It was also found that CK was extremely helpful in assessing the degree of illness in patients with severe trauma, especially in patients complicated by severe soft tissue injury. In all the groups, of patients, it was found that CK rose from (129±62) U/L in non-earthquake induced trauma group to (44 208±39,788) U/L in earthquake amputation group, and it was thus increased more than 300 times. Its highest value even reached 117,513 U/L, which was more than 840 times of the normal. If a timely amputation or muscle compartment decompression was performed, CK might decline rapidly down to the normal value. CONCLUSIONS: The comprehensive and continuous assessment of serum enzymes is mandatory during the treatment of children with acute trauma. It is of important clinical significance to correctly judge the condition and to determine optional treatment measures.

Serum carbohydrate antigen 19-9 as an indicator of liver metastasis in colorectal carcinoma cases.

PURPOSE: The liver is the organ to which colorectal carcinomas (CRCs) most commonly metastasize, and surgical resection has been established as the most effective and potentially curative treatment for CRC with liver metastasis (LM). Therefore, surveillance of LM is vital for improvement of prognosis of CRC patients. In this study, we aimed to explore the potential value of carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), and marker enzymes in indicating LM with CRC. METHODS: Three groups of eligible patients with metastatic cancers were retrospectively included: CRC patients with LM (CRC-LM) or without LM (CRC- NLM), and non-CRC patients with LM (NCRC-LM). All metastatic lesions were identified by CT or MRI. Data on characteristics of the patients, the primary site, the locations of metastasis, CA 19-9, CEA, and biochemical parameters were collected for analysis. RESULTS: A total of 493 patients were retrospectively included. More alcohol consumption was found in CRC-LM than CRC-NLM. Some biochemical enzymes were found to be significantly higher in groups with LM than without (CRC-LM or NCRC-LM v.s CRC-NLM). Both CEA and CA 19-9 were much higher in CRC-LM than CRC-NLM or NCRC-LM. For CRC patients, CA 19-9, γ-glutamyl transpeptidase, CEA and alcohol consumption were identified as independent factors associated with LM. CONCLUSION: Our analysis suggested the CA 19-9 might be a potential valuable indicator for LM of CRC in the clinic.

The effect of folic acid on ovine fetuses in utero during late gestation.

To investigate whether folic acid would have toxic effects on fetal cardiac, hepatic, and renal functions, this was the first in utero fetal study testing acute effects of folic acid at the last third of gestation. Folic acid (5 mg/day) or 0.9% saline as the control was intragastricly administrated into pregnant ewes. Both maternal and fetal blood were analyzed for pH, PO(2), PCO(2), SO(2)%, hemoglobin, hematocrit, glucose, lactic acid, osmolality, Na(+), and K(+) concentrations. Maternal and fetal cardiovascular functions were assessed by examining cardiac enzymes and cardiovascular responses in vivo. Fetal hepatic and renal functions were examined by analysis of biochemistry index and renal excretion. Folic acid did not alter the blood values in both ewes and fetuses. Cardiac enzyme activities remained unchanged, and no alteration in cardiovascular responses was observed. Folic acid did not affect fetal urine volume, urine electrolytes, and osmolality. Enzyme activities related to hepatic and renal functions were not changed. In addition, maternal application of folic acid had no effect on maternal and fetal lipid profile. The results showed that folic acid used (5 mg/day) during the last third of gestation did not cause biochemical changes related to cardiac, hepatic, and renal functions in both maternal and fetal sheep, providing new information for use of folic acid during late pregnancy.

Centrifugation after irradiation of red blood cells does not accelerate haemolysis.

BACKGROUND: For intrauterine transfusion and some other rare indications, irradiation and washing or adjustment to an elevated haematocrit is necessary. No data are currently available indicating whether irradiation of red blood cell concentrates (RBCs) might impair the mechanical stability of erythrocytes during centrifugation leading to elevated haemolysis. Consequently, if irradiation and centrifugation of RBCs is necessary, there is no definitive recommendation about the preferred sequence of steps. METHODS: We divided 20 RBC units that were not older than 9 days into two subunits. These subunits were prepared to yield irradiated RBCs with an elevated haematocrit, as they are used for intrauterine transfusion. One subunit was centrifuged and then irradiated, the other subunit was irradiated and then centrifuged. The units were evaluated in vitro before preparation and on days 1 and 7. RESULTS: We could not find any difference in the haemolysis rate, extracellular LDH or alpha-HBDH between the two groups of RBCs. This observation indicates that centrifugation after irradiation of RBCs does not accelerate haemolysis. A similar ATP content in the two subunits demonstrated no difference in energy metabolism. The extracellular potassium concentration was significantly lower in the subunits washed after irradiation. CONCLUSIONS: There is no difference in the haemolysis caused by centrifugation between irradiated and non-irradiated RBCs. However, it is well known that washing RBCs after irradiation significantly lowers the potassium content. Summarising these two findings leads to the conclusion that it is optimal first to irradiate and then to wash RBCs.

Resting and post-exercise serum biomarkers of cardiac and skeletal muscle damage in adolescent runners.

This study examined the response of serum biomarkers of cardiac and skeletal muscle damage at rest and after a routine workout of 21 km run in 12 male adolescent (16.2±0.6 years) long-distance runners. Biomarkers of cardiac [troponins (cTnT, cTnI), creatine kinase MB mass (CK-Mbmass)] and skeletal muscle [creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hydroxybutyrate dehydrogenase (HBD)] damage were assayed at rest, 2, 4 and 24 h post-exercise. At rest, cTnT and cTnI were not detectable; however, CK, CK-MBmass, AST, ALT and HBD were above corresponding clinical cut-off values. Post-exercise significant elevations above rest were observed for all biomarkers, except ALT, 2 and 4 h following the run, and remained elevated in cTnI, CK, CK-MBmass, LDH and AST 24 h post-workout. A significant increase in data points above clinical cut-off values from rest to post-exercise was reported for cTnT, cTnI and CK at 2 and 4 h, and in cTnI and CK 24 h post-exercise. In conclusion, a 21 km run in adolescent runners increased post-exercise biomarkers of cardiac and skeletal muscle damage.

Intermediate coronary revascularization using the Deltastream blood pump: results from an experimental study.

BACKGROUND: Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization. METHODS: In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation. RESULTS: Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4-/+41.2 to 279.7-/+29 U/L vs. 274-/+142.7 to 288.1-/+118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1-/+0.3 to 2.9-/+1 ng/mL vs. 1.1-/+0.9 to 3-/+3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7-/+54.3 to 299.9-/+39.8 U/L vs. 274.9-/+59.7 to 263.8-/+57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9-/+34.7 to 200-/+39.2 U/L vs. group B: 195.4-/+41.7 to 274.9-/+51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9-/+0.6 U/L; B: 3.5-/+1 U/L,p=0.001) were also superior in the study group. CONCLUSION: The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.

[Dynamic changes of LDH and HBDH activity in rabbit serum after low voltage electrical injury].

OBJECTIVE: To investigate changes of LDH and HBDH activity in rabbit serum after non-thermal low voltage electrical injury and to provide diagnostic criteria for non-thermal low voltage electrical injury. METHODS: Forty New Zealand rabbits were randomly distributed into control group and electrical injury group (EI-groups; designated 7 time points: 0 h, 2 h, 4 h, 12 h, 1 d, 2 d, 3 d), 5 rabbits per each group. EI-groups were treated with the method of non-thermal low voltage electrical injury established in our laboratory. Ventricular blood (5 mL) was obtained under anesthesia at designated time points after electrical injury. The activities of LDH and HBDH were measured. RESULTS: Dynamic changes were observed with certain patterns from target serum enzyme activities after electrical injury. Compared with control group, the activities of LDH increased markedly at 4 h, 12 h, and on days 1, 2, and 3 after injury (4 h, 12 h, and day 1 P<0.01; day 2 and day 3 P<0.05). Activities of HBDH increased markedly at day 2 and day 3 after injury (P<0.05). The ratio of HBDH/LDH decreased markedly at 2 h, 4 h, and 12 h after injury (P<0.01). CONCLUSION: Dynamic changes of LDH and HBDH activities may be useful in diagnosis of non-thermal low voltage electrical injury and in estimation of post injury intervals.