BACKGROUND

The aim of the present study was to investigate serum ischemia-modified albumin (IMA), homocysteine, malondialdehyde (MDA), vitamin B(12) and folic acid levels in patients with severe sepsis, compared to healthy control subjects. Also, we examined associations of these parameters with high-sensitivity C-reactive protein (hsCRP) in patients with severe sepsis and healthy control subjects.

METHODS

This study was performed on 71 (40 male, 31 female) patients with severe sepsis aged 18-65 years and 70 (34 male, 36 female) healthy control subjects aged 18-65 years. Samples of patients were obtained at study entry within 24 h of onset of severe sepsis.

RESULTS

Serum IMA, homocysteine and MDA levels of the patients with severe sepsis were significantly higher than those of the healthy control subjects (p<0.01 for IMA and homocysteine, and p<0.001 for MDA). There was no significant difference between serum vitamin B(12) and folic acid levels of the groups. Serum hsCRP levels were positively correlated with IMA (p<0.01) and MDA (p<0.01) in the patients with severe sepsis.

CONCLUSIONS

Our findings show that IMA may be useful as a prognostic biomarker because it can indicate the severity of illness in patients with sepsis.

The aim of the present study was to evaluate the impact of obstructive sleep apnoea syndrome (OSAS) and the effects of nasal continuous positive airway pressure (CPAP) on circulating ischaemia-modified albumin (IMA) concentrations. The study included 97 newly diagnosed OSAS patients and 30 nonapnoeic controls. Blood samples were obtained in the morning after polysomnography. After 3 months of CPAP treatment, 31 patients with moderate-severe OSAS were reassessed for serum IMA concentrations. Significantly higher serum IMA concentrations were measured in the OSAS group than in the control group [0.518 ± 0.091 absorbance units (ABSU), 0.415 ± 0.068 ABSU, P < 0.001]. Serum IMA concentrations correlated significantly with the apnoea-hypopnoea index, mean SaO2, desaturation index, and C-reactive protein concentrations. Multiple logistic regression analyses showed that OSAS increased the serum IMA concentration independent of age, sex, body mass index, smoking habit, and cardiovascular disease. After 3 months of treatment with CPAP, OSAS patients had significantly lower serum IMA concentrations (0.555 ± 0.062 ABSU to 0.431 ± 0.063 ABSU, P < 0.001). The results showed that OSAS is associated with elevated concentrations of IMA, which can be reversed by effective CPAP treatment.

BACKGROUND

Ischaemia-modified albumin (IMA) is proposed as a marker of cardiac ischaemia. Release kinetics of IMA have not been investigated during ongoing acute coronary syndrome. We evaluated IMA kinetics in patients with ongoing ST-segment elevation MI (STEMI) and revascularization by primary percutaneous coronary intervention (pPCI) as a model.

METHODS

Twenty-five patients with STEMI undergoing successful pPCI (Age: median 65 y, range 41-79 y; symptoms duration: median 4 h, range 1-7 h). Fourteen blood samples were collected (11 during the first 24 h following pPCI) and analyzed for IMA, cardiac troponin T, CKMBmass, myoglobin, and heart-type fatty acid binding protein.

RESULTS

Following pPCI, mean IMA increased to 16% above baseline, normalizing within less than 3 h. At the time of pPCI, patients with TIMI 0 flow in the infarct artery had low levels of IMA and only exhibited a rise in IMA levels after pPCI, whereas patients with TIMI 1-3 flow had high IMA levels on arrival with a subsequent decrease (p < 0.036). There was no statistically significant association between IMA and other variables, e.g. ECG, symptoms duration, sex, age, blood pressure, and number of vessels affected. Relative concentrations of IMA were low compared with other cardiac biomarkers.

CONCLUSIONS

Our results indicate that IMA release may depend on reperfusion-induced events rather than ischaemia per se. Further, we find a narrow diagnostic time window and a low sensitivity of the IMA assay. Improved understanding of the release mechanisms of IMA is needed before clinical application of the test.

The purpose of this study was to investigate whether levels of fetal hypoxia markers, S100 and ischaemia modified albumin (IMA) change in cases of intrauterine growth restriction (IUGR). This case-control study included 15 intrauterine growth restricted fetuses and 20 age-matched controls. During delivery of the fetuses, cord blood and maternal blood S100 and IMA levels were studied. The fetal weight and umbilical cord pH values of IUGR fetuses were significantly lower than the control group. The mean maternal and umbilical cord blood values of S100 and IMA were similar in the two groups. IMA levels in cord blood of the IUGR group were significantly higher than maternal levels, whereas umbilical and maternal levels of IMA did not differ among control cases. In cases without brain sparing effect in Doppler ultrasonography, umbilical cord S100 and IMA levels do not change significantly in IUGR when compared with appropriate-for-gestational-age (AGA) fetuses.

Welders' lung disease refers to mixed exposure to different kinds of metals and chemicals from welding fumes, which affect all parts of the respiratory tract including airways and parenchyma together. This study aimed to investigate the oxidative status in patients with welders' lung (PWL) by means of thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels. The male welder workers diagnosed with welders' lung disease and healthy individuals were recruited in the study. Plasma levels of disulfide, disulfide/native thiol ratio, disulfide/total thiol ratio, IMA, and catalase (CAT) were determined. Pulmonary function test parameters of both groups were compared. The thiol-disulfide homeostasis parameters of PWL and control group were as follows: disulfide (20.5 ± 6.3 vs. 16.2 ± 3.9 μmol L^-1, p < 0.001), disulfide/native thiol (4.36 (1.59) vs. 4.0 (1.64), p = 0.024), and disulfide/total thiol (4.01 (1.34) vs. 3.71 (1.41), p = 0.024). IMA levels in PWL were significantly higher than the control group (1.37 (0.27) mg dL^-1 vs. 0.49 (0.61) mg dL^-1, p < 0.001), whereas CAT activities were significantly higher in the control group (106.6 (54.5) kU L^-1 vs. 78.3 (67.8) kU L^-1, p = 0.003). The findings of the present study revealed that oxidative stress plays a key role in the pathogenesis of welders' lung disease. Plasma thiol-disulfide homeostasis and IMA levels might be indicators of oxidative stress in PWL.

OBJECTIVE

To investigate the possible association between admission ischemia modified albumin (IMA) levels and ST-segment resolution (STR) in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).

METHODS

We studied 117 patients with a first STEMI within 6h of the onset of pain. Admission serum IMA concentration was measured using a validated assay. The worst single electrocardiogram lead before and 90min after primary PCI was analyzed, and patients were divided into two groups according to the degree of STR: complete >> or =70%) or incomplete (<70%).

RESULTS

Of the 117 patients, 70 (60%) had complete STR, and 47 (40%) incomplete STR. Serum IMA concentrations were significantly higher in patients that had incomplete STR (0.383+/-0.060A.U. vs. 0.297+/-0.056A.U., p<0.001). IMA levels >0.325A.U. demonstrated a sensitivity of 91.4% and a specificity of 45.7% for the diagnosis of incomplete STR; the area under the receiver operator characteristic curve was 0.849 (95% CI 0.77-0.92, p=0.0001). Moreover, IMA values were an independent predictor of incomplete STR even after adjustment for potential confounders (OR 2.34; 95% CI 1.20-4.64, p=0.01).

CONCLUSIONS

IMA may be a useful biomarker for the identification of incomplete STR in STEMI patients presenting to hospital within 6h of the onset of pain.

BACKGROUND

Serum ischemia modified albumin (IMA) levels have been previously studied and found to correlate with some anthropometric and laboratory measurements in adult obesity. IMA had not been studied in obese children and adolescents.

OBJECTIVE

The aim of the study is to analyze serum IMA levels and to evaluate their correlation with cardiovascular risk factors in obese children and adolescents with and without metabolic syndrome (MS).

METHODS

Sixty-one obese children/adolescents and 33 healthy children were included in the study. The obese group was divided into four subgroups, including MS (n=25), non-MS (n=36), liver steatosis (n=19) and non-liver steatosis (n=42) groups. Blood was collected to analyze biochemical parameters and IMA. Epicardial adipose tissue thickness was measured with echocardiography, and liver steotosis was determined with ultrasonography for each subject.

RESULTS

Body mass index (BMI), waist circumferences (WC), left ventricular mass (LVM) and epicardial adipose tissue (EAT) thickness were significantly higher in obese subjects. Serum IMA levels were significantly higher in the metabolic syndrome (MS) and hepatosteotosis groups. Additionally, LVM and EAT thickness were found to be correlated with serum IMA levels in these groups.

CONCLUSIONS

Our study suggests that serum IMA levels may be used to predict cardiovascular risk in obese children with MS and hepatosteotosis. This may be related to the duration of obesity in childhood ending in adulthood.

BACKGROUND

Any increase of cardiac biomarkers after coronary artery bypass grafting (CABG) indicates myocyte necrosis and is likely to be related to an impaired outcome. We investigated whether ischaemia-modified albumin (IMA), a biomarker of ischaemia, is also raised following CABG.

METHODS

We studied 50 stable consecutive patients undergoing elective isolated CABG on cardiopulmonary bypass, of whom 46 were men and four women, aged 64 +/- 9 years. Blood samples were obtained the day before the operation (pre-op) as well as immediately after the operation, 24 h postoperatively (post-op) and the fourth day post-op and assayed for creatine kinase, the MB isoenzyme of creatine kinase, cardiac troponin-I, albumin and IMA.

RESULTS

The typical rising and falling pattern of myocardial necrosis of all three cardiac enzymes was observed post-op (p <0.0001). IMA increased significantly following CABG at all three time points (113 +/- 43, 106.7 +/- 22.6 and 110.2 +/- 12.5 U ml(-1), respectively) compared with pre-op values (91.7 +/- 10.5 U ml(-1)), (p <0.0001); the sample immediately post-op was significantly higher compared with the following samples (immediately post-op vs 24 h, p = 0.008 and immediately post-op vs 4 days, p = 0.03, with no significant difference between the last two). IMA level changes during the study course were independent of the albumin changes. Haemoglobin decreased significantly post-op (p <0.0001 vs baseline) whereas serum creatinine did not differ during the study period.

CONCLUSIONS

IMA increases significantly following CABG but whether or not this carries a prognostic significance remains to be elucidated.

We assessed the perioperative pattern of serum ischemia-modified albumin and its role as a myocardial ischemia indicator for early detection of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting. Venous blood samples were collected from 63 consecutive patients before the operation, immediately after the operation, and at 3, 6, 12, and 24 h postoperatively. Serum ischemia-modified albumin levels were analyzed using an albumin cobalt binding test. The patients were divided into 2 groups retrospectively, according to the occurrence of perioperative myocardial infarction. The serum ischemia-modified albumin levels were compared between groups. The levels peaked immediately after the operation, followed by a gradual regression, but remained elevated during the first 24 h in all patients. The occurrence of perioperative myocardial infarction was identified in 10 patients who had significantly higher ischemia-modified albumin levels at 3 h postoperatively and slower regression rates. Perioperative serum ischemia-modified albumin levels might be helpful in predicting perioperative myocardial infarction.

BACKGROUND

In the presence of ischaemia, albumin undergoes changes resulting in the formation of ischaemia-modified albumin (IMA). Increased serum concentrations of IMA have been found in patients with myocardial ischaemia. The purpose of this study was threefold: to evaluate the albumin cobalt binding (ACB) assay for measurement of IMA on the Beckman Coulter LX-20; to establish a reference range for IMA; and to investigate the relationship between IMA and total albumin concentrations.

METHODS

The ACB assay was evaluated under the following headings: imprecision, accuracy and reliability. A reference range was established on a population of 81 healthy subjects.

RESULTS

The within-batch coefficient of variation (CV) at IMA concentrations of 88, 99 and 120 KU/L were 1.4, 2.0 and 2.5%, respectively. The between-batch CVs at 74, 84 and 123 KU/L were 3.4, 3.3 and 3.0%, respectively. Comparison with the Cobas Mira Plus showed a mean negative bias of 7 KU/L. The 97.5th percentile established on our reference population was 110 KU/L. A significant inverse relationship was found between total serum albumin and IMA concentrations (r = -0.66, P < 0.0001). Correcting the IMA concentrations for total albumin in our reference population, using a formula devised in this study, yielded a range similar to that of uncorrected IMA.

CONCLUSIONS

The ACB assay was found to have acceptable precision and performed very satisfactorily on the Beckman Coulter LX-20. A correction to measured IMA concentrations, to take into account total albumin concentrations, may need to be applied for the proper interpretation of IMA results.

BACKGROUND

Percutaneous coronary intervention (PCI) is accepted as a model of myocardial ischaemia in studies of ischaemia markers, especially of ischaemia-modified albumin (IMA). However, there is concern that IMA levels may reflect changes in albumin concentrations rather than myocardial ischaemia also during PCI.

METHODS

Twenty-one consecutive patients (17 men and 4 women) undergoing single-vessel percutaneous coronary angioplasty were enrolled in the study. IMA and albumin levels were measured together with myoglobin, creatine kinase 2 and cardiac troponin I, before (Group 1), immediately after (Group 2) and 6 h after (Group 3) the procedure of PCI.

RESULTS

The IMA levels of Group 2 were significantly higher than those of Group 1 and Group 3 (P < 0.05 for both). However, correction of IMA by multiplying with the (individual albumin concentration of the patient/median albumin concentration of Group 1) ratio gave no statistical differences between the groups (P>> 0.05). There were strong negative correlations between IMA levels and albumin concentrations within individual groups (r = -0.757, P < 0.001; r = -0.712, P < 0.001; and r = -0.705, P < 0.001 for Group 1, Group 2 and Group 3, respectively).

CONCLUSIONS

The results confirm the close dependency of IMA results on albumin concentrations. Therefore, IMA results reflect albumin concentrations rather than myocardial ischaemia also in PCI. This situation and lack of standard reference materials for the albumin cobalt binding assay can lessen the diagnostic performance of IMA.

OBJECTIVE

To determine the possible underlying cause of a false-positive first or second trimester biochemical Down syndrome screening test result by means of second trimester amniotic fluid cytokine level analysis.

METHODS

A total of 74 consecutive patients undergoing amniocentesis for karyotype analysis at 16-20 weeks' gestation were included in this prospective age-matched case-control study. The study group (n=38) had abnormal first or second trimester screening test results and normal karyotype results, while controls (n=36) included those admitted for genetic amniocentesis for other reasons who had normal first or second trimester screening test and normal karyotype results. Four markers [interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, and ischemia-modified albumin (IMA)] were studied in amniotic fluid.

RESULTS

The mean age of the women in the study and control groups was 34.0+/-5.6 and 33.6+/-7.2 years, respectively. The women in the study and control groups had similar clinical and laboratory characteristics. The mean amniotic fluid IL-6 (414.84+/-83.96 vs. 343.02+/-110.59, p=0.002) and IL-8 (377.61+/-243.31 vs. 261.90+/-201.29, p=0.029), TNF-alpha (24.91+/-5.78 vs. 21.60+/-5.55, p=0.014), and IMA (1.19+/- 0.10 vs. 1.05+/-0.12, p<0.001) values were significantly increased in the study group when compared to controls.

CONCLUSIONS

The higher amniotic fluid cytokine and ischemia-modified albumin levels in patients with false-positive first or second trimester biochemical Down syndrome screening test may result from subclinical fetal membrane inflammation and/or ischemia.

BACKGROUND

To investigate the effect of the tadalafil in experimental renal I/R injury and to evaluate these changes with IMA (nonspesific early biomarker of ischemia), NO and MDA levels.

METHODS

Twenty four female Wistar rats were randomly divided into 3 groups (n=8): Group I, sham; Group II, 60 min I/R; Group III, 60 min I/R plus tadalafil. Tadalafil was administered via an orogastric tube (10 mg/kg) 24 h prior to the procedure. After ischemia of the left kidney and 1 h of reperfusion, blood samples were obtained, and the kidney was removed.

RESULTS

Statistically significant histopathologic changes were exist between groups, with the most severe injury was determined in group II in comparison to the others (X(2)=21,803, P=0.000). Also mean serum IMA levels were higher in group II, but not statistically significant (19.83±7.81 U/ml, 22.26±7.14 U/ml and 19.82±7.77 U/ml, P=0.613). In addition, NO values were lower in I/R groups (P=0.049). There were no differences among the groups in terms of MDA.

CONCLUSIONS

IMA may be used as a nonselective biomarker for IR injury before the occurrence of necrosis. Decreased IMA levels may indicate the nephroprotective effect of tadalafil in renal IR injury.

Angina represents the earliest stage of symptomatic atherothrombotic disease and is part of the continuum that ultimately results in myocardial infarction. Development of plaque is related to conventional risk factors. The progression to active disease occurs as a result of plaque destabilisation and rupture. This is a continuous process with clinically apparent disease occurring when there are multiple episodes of plaque rupture. Elevation of inflammatory markers including C reactive protein is predictive of the risk of development of cardiac events. However, it appears that B type natriuretic peptide is single most powerful predictor of cardiovascular mortality. This probably reflects its role as the integrator of the cardiac neuroendocrine system and marker of global cardiac performance. Progression of disease to occlusion will initially produce myocardial ischaemia, which may then progress to infarction. Ischaemia modified albumin is currently the most promising of the markers for early detection of ischaemia at first presentation.

Remarkable advances in understanding human biology in health and disease, propelled by technological innovations, have contributed to an increase in the number and quality of diagnostic tests. This evolving scenario has been accompanied by the proliferation of false myths and legends in laboratory diagnostics, consuming valuable human and economic resources and jeopardizing the clinical reasoning. The aim of this article is to provide a synthetic overview about some paradigmatic examples of false beliefs in laboratory diagnostics involving activated partial thromboplastin time (APTT), cardiospecific troponins, ischemia modified albumin (IMA), D-dimer, prostate specific antigen (PSA), dibucaine number, Bence Jones protein (BJP), lipoprotein(a), neutrophil gelatinase-associated lipocalin (NGAL), potassium and reference ranges. Although the suggestive cases described in this article are not intended to be comprehensive, we hope that their description may help remove some mysticisms in laboratory diagnostics.

Ischemia-modified albumin (IMA) levels were measured after radiofrequency (RF) catheter ablation to evaluate the effect of direct myocardial necrosis on IMA formation. IMA levels have been shown to increase in patients after RF catheter ablation compared with those who undergo diagnostic electrophysiologic studies. The results of this study suggest that IMA may be a marker of myocardial injury.

BACKGROUND

The aims were to investigate the role of serum ischemia-modified albumin (IMA), tumor necrosis factor α (TNF-α), and myeloperoxidase (MPO) and to evaluate the relationship between IMA and cardiac markers (creatine kinase myocardial isoenzyme [CK-MB] and cardiac troponin I [cTnI]) related to cardiac abnormalities in adult patients after nontraumatic subarachnoid hemorrhage (SAH).

METHODS

Twenty-nine patients with nontraumatic SAH admitted to the emergency department and 20 healthy adults as the control group were included in the study. Ischemia-modified albumin, TNF-α, MPO, CK-MB, cTnI, and leukocyte count (white blood cell [WBC]) in the circulation were measured on admission.

RESULTS

Ischemia-modified albumin, TNF-α, and MPO levels were higher by mean values of 11.6%, 9.5%, and 2.9%, respectively, in patients with SAH compared with control group. However, levels of these parameters were not statistically different between the groups (P>> .05). However, WBC, CK-MB, and cTnI values were significantly higher in patients with SAH compared with healthy control (P < .001, P < .01, and P < .05, respectively). White blood cell and cTnI levels in the circulation were positively correlated with patients' clinical severity (r = 0.598, P = .001 and r = 0.461, P = .012, respectively). Ischemia-modified albumin has a poor diagnostic value in comparison with WBC, CK-MB, and cTnI tests to differentiate between patients after SAH and controls according to receiver operating characteristic curve.

CONCLUSIONS

The results suggest that IMA is not better than CK-MB and cTnI in predicting a cardiac injury in patients after nontraumatic SAH.

OBJECTIVE

To investigate the diagnostic value of ischemia-modified albumin (IMA) for patients with acute coronary syndrome (ACS).

METHODS

We detected the IMA levels by albumin cobalt-binding (ACB) test and observed its dynamic changes in 492 patients with ACS, 74 patients with high blood pressure, 78 patients with viral myocarditis (VMC), 395 patients with acute chest pain (133 patients with acute ACS and 262 follow-up patients due to chest pain), 68 patients underwent percutaneous coronary intervention (PCI) and 830 healthy controls. Cardiac troponin I (cTnI) levels were assayed and electrocardiogram (ECG) recorded in patients with ACS.

RESULTS

The optimal diagnostic cutoff point for IMA in this study population was found to be 0.45 ABSU by ROC analysis. The IMA level (ABSU) in ACS group (0.55 +/- 0.11) was significantly higher than that in VMC group (0.38 +/- 0.11) and IMA levels in ACS and VMC groups were both higher than that in control and high blood pressure groups (0.34 +/- 0.08 and 0.35 +/- 0.08, all P < 0.05). IMA levels and the positive rates in patients with ACS were significantly higher (0.54 +/- 0.12 vs 0.44 +/- 0.12, 77.4% vs 39.3%, all P < 0.01) than those in chest pain follow-up group. In 133 patients with ACS, positive rate for IMA was significantly higher than that for cTnI within 1 h of admission (82.0% vs 40.6%, P < 0.01), and was similar at 6 - 24 h after admission (96.2% vs. 95.5%, P>> 0.05). In 72 patients presenting to the emergency center within 3 h of acute chest pain and with negative cTnI, positive rate for IMA was 86.1% and for ECG 72.2%, the sensitivity for ACS diagnosis rised to 93.1% with both methods. The IMA leve was higher immediately after PCI than that before PCI (P < 0.05). IMA levels peaked 1d after hospitalization, then decreased gradually and returned to normal 14 days later.

CONCLUSIONS

IMA was a useful biochemical marker for the early diagnosis of ACS.

Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Ischaemia-modified albumin (IMA), a product deriving from albumin as a result of the modification by oxidative free radicals in response to hypoxia, was previously used as a marker of ischaemia in acute coronary syndrome. We performed this study to determine whether umbilical venous IMA levels are associated with IUGR. A total of 40 pregnancies with IUGR were compared with 40 of normal fetal development. Blood samples were obtained from the umbilical vein after delivery. IMA levels in the IUGR group were higher than in the control group (78.74 ± 6.87 vs 74.43 ± 7.84 U/ml, respectively, p = 0.011). An elevated IMA level was associated with IUGR (OR: 1.079, 95% CI: 1.000-1.163, p = 0.049). We suggest that IMA, which was formerly proved to arise in ischaemic conditions, may also be a valuable marker in perinatal hypoxia and IUGR detection.

BACKGROUND

Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis-related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT).

OBJECTIVE

To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT.

METHODS

Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty-two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age- and sex-matched control group of 46 healthy subjects were included in this study.

RESULTS

No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively).

CONCLUSIONS

Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients.

The Albumin Cobalt Binding Test is a quantitative in vitro diagnostic test used on human serum that detects ischemia-modified albumin by measuring the cobalt binding capacity of albumin in human serum. Ischemia modified albumin is intended for use in conjunction with ECG and cardiac troponin as an aid to short term risk stratification of patients presenting with chest pain suggestive of cardiac origin. Thus, in patients with chest pain or equivalent symptoms suggestive of cardiac origin, with non-diagnostic ECG and normal troponin, a negative IMA can be used as an aid to rule out acute coronary syndrome (ACS) in low risk patients.

Increased oxidative stress levels play a key role in idiosyncratic drug-induced liver injury (DILI) pathogenesis. To investigated whether advanced oxidation protein products (AOPPs) and ischaemia-modified albumin (IMA) can be used to monitor oxidative stress in DILI patients and to assess disease severity. We performed spectrophotometric assays to assess AOPPs and IMA in 68 DILI patients with severity grade 0-2 (non-severe group), 60 with severity grade 3-5 (severe group), and 38 healthy controls. The results showed that baseline AOPPs and IMA serum levels and AOPPs/albumin and IMA/albumin ratios were significantly higher in DILI patients than in healthy controls. Besides, in comparison to the non-severe group, the severe group showed higher baseline AOPPs and IMA serum levels and AOPPs/albumin and IMA/albumin ratios. AOPPs and IMA serum levels and AOPPs/albumin and IMA/albumin ratios decreased after treatment in both patient groups. Combining the correlation analysis and areas under the receiver operating curve (AUROCs) analysis results, that IMA outperformed to be one is the most reliable marker to assess disease severity of DILI. Our findings indicated that AOPPs and IMA can serve as key biomarkers for monitoring oxidative stress levels in DILI patients and can indicate disease severity. The IMA outperformed to be one of the most reliable oxidative stress biomarkers to assess disease severity of DILI.

OBJECTIVE

To investigate the clinical efficacy of modified huanglian wendan decoction (MHWD) on diabetic asymptomatic myocardial ischemia.

METHODS

Ninety patients were randomly divided into two groups. The control group (n=30) was given Xinkang tablet (XKT) at a dose of 20 mg, twice a day. The treated group (n=35) was given MHWD besides XKT as that given to the control group. The treatment course for both groups was 1 month. Indexes, including blood glucose, glycosylated hemoglobin, blood lipids, myocardial zymogram, hemorheologic parameters, urinary albumin, routine examination of blood and urine, function of liver and kidney, as well as 24h dynamic electrocardiogram and electrocardiogram exercise test were measured in the two groups before and after treatment.

RESULTS

The total clinical effective rate in the treated group and the control group was 88.33% and 56.67% respectively (P < 0.05), showing significant difference between them. The frequency of ischemia attacking, paroxysmal cumulative time, motion related incidence were lower in the treated group after treatment than those in the control group. Besides, in the treated group after treatment, the level of blood lipids and hemorheologic parameters were significantly improved (P < 0.05 or P < 0.01), hematocrit was unchanged and triglyceride, red blood cell agglutination index and erythrocyte deformability index were obviously different to those in the control group (P < 0.05). While in the control group after treatment, except the improving of whole blood viscosity (P < 0.05), no significant change was found in the other indices.

CONCLUSIONS

MHWD has effects in improving myocardial ischemia, bettering hemorheologic condition and reducing blood lipids.