77 research outputs found
Natriuretic peptides in heart failure: where we are, where we are going.
Tremendous advances have been made in understanding the pathophysiology and
treatment of congestive heart failure (CHF). However, diagnosis still remains
difficult, even with a comprehensive physical examination. Symptoms such as
dyspnea are non-specific and poorly sensitive indicators for early CHF that can
be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic
biomarkers has been one of the most critical advances for heart failure
diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role
in the diagnosis of heart failure, as well as in prognostic risk assessment. A
single determination of BNP at any time during the progression of chronic HF
provides a clinically useful tool for risk stratification. The hypothesis that
repeated measurements might carry prognostic information beyond a single measure
was confirmed in different settings. One of the main interests is given to the
values of repeated determinations for monitoring progression of disease, and for
the evaluation of the clinical effects of medical therapy. Nevertheless, despite
thousands of papers describing their potential utility, current guidelines have
not endorsed the highest level of recommendation for their use, in part, because
the application in clinical practice is often limited for the absence of well
codified cut off. Recently, European guidelines emphasized the role of
natriuretic peptides as potential laboratory markers. In the near future,
algorithm building will take into consideration clinical and echocardiographic
parameters as well as NP measurements, and this may lead to a correct diagnosis
and identification of patients at high risk. The purpose of this review is to
discuss the clinical approaches and future applications of natriuretic peptides
in heart failure and coronary diseas
Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure
For patients presenting with acute dyspnea, an incorrect diagnosis could increase the mortality risk. When used in the evaluation of patients with acute symptoms, brain natriuretic peptide and N-terminal pro-brain natriuretic peptide (BNP and NT-proBNP, respectively) testing is highly sensitive for the diagnosis or exclusion of acute or chronic decompensated heart failure (HF). It has been demonstrated that BNP and proBNP levels can facilitate diagnosis and guide HF therapy. Natriuretic peptide (NP) levels are strictly related with HF severity; they are particularly increased in more advanced New York Heart Association (NYHA) classes and in patients with poor outcome. Therefore elevated NP levels were found to correlate with the severity of left ventricular systolic dysfunction, right ventricular dysfunction and pressures, and left ventricular filling alterations. However, the optimal use of NP determination agrees with patient history, physical examination, and all other diagnostic tools. There are some clinical conditions (ie, obesity, renal insufficiency anemia) for which the NP measurement is not diagnostic. Algorithm building taking into consideration all clinical and echocardiographic parameters, as well as NP measurements, may lead to the earlier identification and better risk stratification of patients with chronic HF, independently from etiology
Anemia correction by erythropoietin reduces BNP levels, hospitalization rate, and NYHA class in patients with cardio-renal anemia syndrome.
Little is known about the effect of anemia correction with erythropoietin (EPO)
on B-type natriuretic peptide (BNP) levels, NYHA class, and hospitalization rate.
The aim of the study was to investigate, in patients with cardio-renal anemia
syndrome, the effects of EPO on hemochrome and renal function parameters and BNP
levels. We also analyzed the effect of EPO therapy on hospitalization rate and
NYHA class after 12 months in comparison with a population undergoing to standard
therapy. We performed a randomized double-blind controlled study of correction of
the anemia with subcutaneous ? (group A n = 13) or ? (group B n = 14) EPO for 12
months in addition to standard therapy with oral iron in 27 subjects. Control
group (n = 25 patients) received only oral iron. Significant increase in
hemoglobin (Hb), hematocrit (Hct), and red blood cells (RBC) were revealed in EPO
groups at 12 months; Hb, group A 12.3 ± 0.6; group B 11.7 ± 0.8; control group
10.6 ± 0.5 g/dl P < 0.0001; Hct group A 34.2 ± 2.3, group B 34 ± 2, control group
32.3 ± 1.8% P < 0.01; RBC, group A 3.9 ± 0.2, group B 3.8 ± 0.2, control group
3.3 ± 0.2, (P < 0.0001). Plasma BNP levels in EPO groups were significantly
reduced after 12 months (group A: 335 ± 138 vs. group B: 449 ± 274 pg/ml control
group 582 ± 209 pg/ml (P < 0.01). After 12 months of treatment, hospitalization
rate and NYHA class were reduced in EPO groups with respect to control group (P <
0.05). Finally, an inverse correlation was observed between BNP and Hb levels in
EPO Groups (r = -0.70 P < 0.001). EPO treatment reduces BNP levels and
hospitalization rate in patients with cardio-renal anemia syndrome. The
correction of anemia by EPO treatment appears able to improve clinical outcome in
this subset of patients with heart failur
B-type natriuretic peptide levels predict extent and severity of coronary disease in non-ST elevation coronary syndromes and normal left ventricular systolic function.
BACKGROUND: B-type natriuretic peptide (BNP) has been used recently as a
biological marker in patients with coronary artery disease (CAD) with
ST-elevation, as well as without ST-elevation. BNP is able to predict systolic
dysfunction, adding new prognostic information to existing traditional markers.
However is not known if there is a relation between the quantity of BNP levels
and the severity of coronary artery disease.
METHODS: This study compared B-type natriuretic peptide (BNP) levels in patients
with stable angina (SA) and acute coronary syndromes (ACS) without ST-elevation
in relation to angiographic lesions using TIMI and Gensini Scores. We studied 282
patients with CAD without ST elevation and preserved systolic function. BNP
samples were measured in all recruited patients within 24 hours of
hospitalization.
RESULTS: BNP values were progressively increased in relation to the severity of
diagnosis: SA (52.6±49.4 pg/mL ) UA (243.3±212 pg/mL) NSTE-ACS (421.7±334 pg/mL)
(p<0.0001 and p<0.007 respectively). No statistically significant difference was
observed between patients with SA and controls (21.2±6.8 pg/mL). The analysis of
BNP levels in relation to the number of involved vessels demonstrated
significantly increased levels in patients with multivessel disease compared to
patients with 1 or 2 vessel disease (1-86.2±46.3 pg/mL; 2-127±297 pg/mL;
3-295±318 pg/mL; 4-297±347 pg/mL p<0.001 and p<0.003). Evaluation of BNP using
Gensini Score showed a strong relation between BNP and coronary disease extension
(r=0.38 p<0.0001).This trend was maintained in all CAD groups (SA=r 0.54; UA
r=0.36 NSTE-ACS r=0.28).
CONCLUSIONS: Circulating BNP levels appear elevated in ACS with diffuse coronary
involvement, even in the absence of systolic dysfunction. BNP is also associated
with multi-vessel disease and the extension of coronary disease
Efficacy and safety of extracranial vein angioplasty in multiple sclerosis: A randomized clinical trial
Importance: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective: To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants: We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions: Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures: Two primary end pointswere assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results: Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7%vs 48.7%; odds ratio, 0.75; 95%CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95%CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95%CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95%CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95%CI, 0.81-4.01; P = .15; adjusted P = .30). Conclusion and Relevance: Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS
Guidelines for the use of flow cytometry and cell sorting in immunological studies (third edition)
The third edition of Flow Cytometry Guidelines provides the key aspects to consider when performing flow cytometry experiments and includes comprehensive sections describing phenotypes and functional assays of all major human and murine immune cell subsets. Notably, the Guidelines contain helpful tables highlighting phenotypes and key differences between human and murine cells. Another useful feature of this edition is the flow cytometry analysis of clinical samples with examples of flow cytometry applications in the context of autoimmune diseases, cancers as well as acute and chronic infectious diseases. Furthermore, there are sections detailing tips, tricks and pitfalls to avoid. All sections are written and peer-reviewed by leading flow cytometry experts and immunologists, making this edition an essential and state-of-the-art handbook for basic and clinical researchers
Persistent Gastric Colonization with Burkholderia pseudomallei and Dissemination from the Gastrointestinal Tract following Mucosal Inoculation of Mice
Melioidosis is a disease of humans caused by opportunistic infection with the soil and water bacterium Burkholderia pseudomallei. Melioidosis can manifest as an acute, overwhelming infection or as a chronic, recurrent infection. At present, it is not clear where B. pseudomallei resides in the mammalian host during the chronic, recurrent phase of infection. To address this question, we developed a mouse low-dose mucosal challenge model of chronic B. pseudomallei infection and investigated sites of bacterial persistence over 60 days. Sensitive culture techniques and selective media were used to quantitate bacterial burden in major organs, including the gastrointestinal (GI) tract. We found that the GI tract was the primary site of bacterial persistence during the chronic infection phase, and was the only site from which the organism could be consistently cultured during a 60-day infection period. The organism could be repeatedly recovered from all levels of the GI tract, and chronic infection was accompanied by sustained low-level fecal shedding. The stomach was identified as the primary site of GI colonization as determined by fluorescent in situ hybridization. Organisms in the stomach were associated with the gastric mucosal surface, and the propensity to colonize the gastric mucosa was observed with 4 different B. pseudomallei isolates. In contrast, B. pseudomallei organisms were present at low numbers within luminal contents in the small and large intestine and cecum relative to the stomach. Notably, inflammatory lesions were not detected in any GI tissue examined in chronically-infected mice. Only low-dose oral or intranasal inoculation led to GI colonization and development of chronic infection of the spleen and liver. Thus, we concluded that in a mouse model of melioidosis B. pseudomallei preferentially colonizes the stomach following oral inoculation, and that the chronically colonized GI tract likely serves as a reservoir for dissemination of infection to extra-intestinal sites
Guidelines for the use of flow cytometry and cell sorting in immunological studies (third edition)
The third edition of Flow Cytometry Guidelines provides the key aspects to consider when performing flow cytometry experiments and includes comprehensive sections describing phenotypes and functional assays of all major human and murine immune cell subsets. Notably, the Guidelines contain helpful tables highlighting phenotypes and key differences between human and murine cells. Another useful feature of this edition is the flow cytometry analysis of clinical samples with examples of flow cytometry applications in the context of autoimmune diseases, cancers as well as acute and chronic infectious diseases. Furthermore, there are sections detailing tips, tricks and pitfalls to avoid. All sections are written and peer-reviewed by leading flow cytometry experts and immunologists, making this edition an essential and state-of-the-art handbook for basic and clinical researchers
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