Increased serum creatine phosphokinase activity in experimental pulmonary embolism

30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study

Italy was the first European country hit by the COVID-19 pandemic and has the highest number of recorded COVID-19 deaths in Europe. This prospective cohort study of the correlates of the risk of death in COVID-19 patients was conducted at the Infectious Diseases and Intensive Care units of Luigi Sacco Hospital, Milan, Italy. The clinical characteristics of all the COVID-19 patients hospitalised in the early days of the epidemic (21 February -19 March 2020) were recorded upon admission, and the time-dependent probability of death was evaluated using the Kaplan-Meier method (censored as of 20 April 2020). Cox proportional hazard models were used to assess the factors independently associated with the risk of death. Forty-eight (20.6 %) of the 233 patients followed up for a median of 40 days (interquartile range 33-47) died during the follow-up. Most were males (69.1 %) and their median age was 61 years (IQR 50-72). The time-dependent probability of death was 19.7 % (95 % CI 14.6-24.9 %) 30 days after hospital admission. Age (adjusted hazard ratio [aHR] 2.08, 95 % CI 1.48-2.92 per ten years more) and obesity (aHR 3.04, 95 % CI 1.42-6.49) were independently associated with an increased risk of death, which was also associated with critical disease (aHR 8.26, 95 % CI 1.41-48.29), C-reactive protein levels (aHR 1.17, 95 % CI 1.02-1.35 per 50 mg/L more) and creatinine kinase levels above 185 U/L (aHR 2.58, 95 % CI 1.37-4.87) upon admission. Case-fatality rate of patients hospitalized with COVID-19 in the early days of the Italian epidemic was about 20 %. Our study adds evidence to the notion that older age, obesity and more advanced illness are factors associated to an increased risk of death among patients hospitalized with COVID-19.

Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism

BACKGROUND

The significance of right-sided chest lead electrocardiogram (ECG) abnormalities in acute pulmonary embolism (APE) is unclear. This study evaluated the characteristics of such abnormalities in APE patients.

METHODS

This retrospective study included consecutive patients who were diagnosed with APE by contrast-enhanced computed tomography or pulmonary artery angiography. A standard 12-lead ECG and a synthesized right-sided chest ECG were obtained from these patients. Waveform differences were noted between the acute and post-treatment phases.

RESULTS

In total, 56 APE patients (18 men and 38 women, mean age 66.7±13.3 years) were included. Traditional ECG findings, such as right-axis deviation, the S₁Q₃T₃ pattern, and clockwise rotation, were found in relatively few patients (14.3%, 32.1%, and 21.4%, respectively). In some cases, a negative T wave in standard 12-lead ECGs was observed in leads III, V1, and V2 (46.4%, 60.7%, and 39.9%, respectively). Syn-V3R ECG showed a higher frequency of negative T waves (66.1%) at the onset and significantly (p<0.01) decreased at the follow-up. Multiple logistic regression analyses for differentiating APE revealed that the negative T waves only in lead syn-V3R were significantly related (odds ratio: 6.95, 95% confidence interval: 2.50-19.32, p<0.001).

CONCLUSIONS

The presence of a negative T wave in a synthesized right-sided chest ECG, particularly in the V3R lead, is a new and distinctive finding denoting pulmonary embolism. To confirm the utility of this characteristic using synthesized right-sided chest ECGs for the diagnosis of APE, further studies with larger populations will be required.

Glucosamine-anchored doxorubicin-loaded targeted nano-niosomes: pharmacokinetic, toxicity and pharmacodynamic evaluation

BACKGROUND

Efficacy of anticancer drug is limited due to non-selectivity and toxicities allied with the drug; therefore the heart of the present work is to formulate drug delivery systems targeted selectively towards cancer cells with minimal toxicity to normal cells.

PURPOSE

Targeted drug delivery system of doxorubicin (DOX)-loaded niosomes using synthesized N-lauryl glucosamine (NLG) as a targeting ligand.

METHODS

NLG-anchored DOX niosomes were developed using ethanol injection method.

RESULTS

Developed niosomes had particle size <150 nm and high entrapment efficiency ∼90%. In vivo pharmacokinetics exhibited long circulating nature of targeted niosomes with improved bioavailability, which significantly reduced CL and Vd than DOX solution and non-targeted niosomes (35 fold and 2.5 fold, respectively). Tissue-distribution study and enzymatic assays revealed higher concentration of DOX solution in heart while no toxicity to major organs with developed targeted niosomes was observed. Solid skin melanoma tumor model in mice manifested the commendable targeting potential of targeted niosomes with significant reduction in tumor volume and high % survival rate without drop in body weight in comparison with DOX solution and non-targeted niosomes of DOX.

CONCLUSION

The glucosamine-anchored DOX-loaded targeted niosomes showed its potential in cancer targeted drug therapy with reduced toxicity. Abbreviations ALT alanine transaminase CL clearance CPK creatinine phosphokinase DOX doxorubicin EDC.HCL ethyl carbidimide hydrochloride GLUT glucose transporter GSH glutathione S-transferase LDH lactate dehydrogenase LHRH luteinizing hormone-releasing hormone MDA malonaldehyde NHS N-hydroxy succinimide NLG N-lauryl glucosamine NTAR DoxNio non-targeted doxorubicin niosomes PBS phosphate buffer saline RGD argynyl glycyl aspartic acid SGOT serum glutamate oxaloacetate transaminase SGPT serum glutamate pyruvate transaminase SOD superoxide dismutase TAR DoxNio targeted doxorubicin niosomes Vd volume of distribution.

Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

BACKGROUND

The significance of inverted T waves remains unclear in patients with acute pulmonary embolism (PE).

METHODS AND RESULTS

The relationship of the number of leads with inverted T waves to the severity of PE in 40 patients with acute PE was studied. Patients were classified into 3 groups according to the number of leads with inverted T waves on the admission electrocardiogram (ECG): 15 patients, <or=3 leads (group L); 12 patients, 4-6 leads (group M); and 13 patients, >or=7 leads (group H). In groups L, M and H, the rates of right ventricular dysfunction on echocardiography were 47%, 92% and 100% (p<0.01), respectively, and the rates of in-hospital complicated events (including death or the need for catecholamine support, cardiopulmonary resuscitation or mechanical cardiovascular support because of hemodynamic instability) were 0%, 8% and 46% (p=0.004), respectively. On multivariate analysis, arterial hypotension at presentation (odds ratio (OR) 8.96, p=0.049) and inverted T waves in >or=7 leads on the admission ECG (OR 16.8, p=0.037) were the only independent predictors of in-hospital complicated events.

CONCLUSIONS

The number of leads with inverted T waves may be a useful and simple marker of increased risk for early complications in patients with acute PE.

Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism

BACKGROUND

Cardiac troponin T (cTnT) is a sensitive and specific marker, allowing the detection of even minor myocardial cell injury. In patients with severe pulmonary embolism (PE), myocardial ischemia may lead to progressive right ventricular dysfunction. It was therefore the purpose of this study to test the presence of cTnT and its prognostic implications in patients with confirmed PE.

METHODS AND RESULTS

Fifty-six consecutive patients with confirmed PE were enrolled in this prospective study. PE was confirmed by pulmonary angiography, lung scan, or echocardiography and subsidiary analyses. Severity of PE was assessed by a clinical scoring system, and cTnT was measured within 12 hours after admission. cTnT was elevated (>/=0.1 microg/L) in 18 (32%) patients with massive and moderate PE but not in patients with small PE. In-hospital death (odds ratio 29. 6, 95% CI 3.3 to 265.3), prolonged hypotension and cardiogenic shock (odds ratio 11.4, 95% CI 2.1 to 63.4), and need for resuscitation (odds ratio 18.0, 95% CI 2.6 to 124.3) were more prevalent in patients with elevated cTnT. cTnT-positive patients more often needed inotropic support (odds ratio 37.6, 95% CI 5.8 to 245.6) and mechanical ventilation (odds ratio 78.8, 95% CI 9.5 to 653.2). After adjustment, cTnT remained an independent predictor of 30-day mortality (odds ratio 15.2, 95% CI 1.22 to 190.4).

CONCLUSIONS

cTnT may improve risk stratification in patients with PE and may aid in the identification of patients in whom a more aggressive therapy may be warranted.

Creatine kinase in the dog: a review

In the dog, creatine kinase (CK) is mostly present in the skeletal muscles, myocardium, brain and intestine. The MM isoenzyme predominates in muscles and myocardium. In plasma, reference values depend on the technique used and CK-MB accounts for about 30-45% of total CK activity. Sex has no influence on plasma CK activity, which is higher in young dogs than in adults. Plasma CK is elevated after physical exercise. After its release from the cells, CK reaches the plasma mostly via the lymphatic route and then remains in the plasma compartment. It is rapidly cleared with a half-life of about 2 hours. Muscle diseases are the main source of plasma CK elevations: inherited myopathies, malignant hyperthermia, hypothyroidism, vitamin E-selenium deficiency, prolonged decubitus, intramuscular injections, surgery, etc. Plasma CK is also increased in experimental myocardial infarction, for which the dog is an interesting model, allowing quantification of the damage by measuring the total CK activity released.

Evaluation of myocardial infarction with enzymatic indices

The severity of myocardial damage appears to be a common denominator contributing to electrophysiologic derangements, impaired ventricular function, and prognosis after myocardial infarction. Physiologically based models of processes affecting appearance and disappearance of CPK from the circulation may improve predictions and estimates of infarct size. Elevation of serum MB CPK isoenzyme activity appears to be a highly sensitive and specific indicator of myocardial injury. Despite the limitations discussed, recently developed enzymatic methods for detection, projection, and quantification of infarct dize have demonstrated that the extent of myocardial injury may be limited in selected patients by appropriate therapeutic measures. Further investigation may help to define the intervals between the onset of infarction and implementation of therapeutic maneuvers during which myocardial protection is possible, and may help to identify and differentiate inter ventions which salvage myocardium, those which improve cardiac performance without altering infarct size, and those which augment cardiac injury despite improving hemodynamics. Thus, in conjunction with electrophysiologic, radioisotopic, and hemodynamic techniques, enzymatic estimates and projection of infarct size should facilitate increased understanding of factors influencing the evolution of infarction and hasten development of effective therapeutic interventions designed to reduce myocardial damage.

Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity

This study was designed to develop a method for quantitative assessment of infarct size in the conscious animal based on serial changes of serum creatine phosphokinase (CPK) activity. From 11 experiments in which myocardial CPK was injected intravenously in conscious dogs, the average CPK distribution space and average CPK fractional disappearance rate from serum were found to be 11.4% of body weight and 0.48% min respectively. In other experiments, myocardial infarction was produced in 22 conscious dogs by constriction of a left coronary artery snare and serum CPK activity was determined at frequent intervals for 24 hr. Since myocardial CPK depletion reflects infarct size, infarct size was determined directly by analysis of myocardial CPK content in the same animals 24 hr after coronary artery occlusion. CPK released from the infarct was determined from observed changes in serum CPK activity analyzed according to a model taking into account the fraction of CPK released from an infarct and the rates of appearance and disappearance of CPK activity from serum. Infarct size was calculated on the basis of observed changes in serum CPK and compared to infarct size determined directly by analysis of myocardial CPK depletion. Agreement was close and results from all experiments fit the equation: [infarct size (g) determined from serum CPK] = 1.13 x [infarct size (g) determined from myocardial CPK] - 1.3, r = 0.96, n = 22. The method described is useful for accurate assessment of infarct size in the conscious animal and for detection of modification of infarct size produced by pharmacologic interventions.