Evaluation of sorafenib for hepatocellular carcinoma by contrast-enhanced ultrasonography:A pilot study

AIM:To determine the usefulness of arrival time parametric imaging(AtPI) using contrast-enhanced ultrasonography(CEUS) with Sonazoid in evaluating early response to sorafenib for hepatocellular carcinoma(HCC).METHODS:Fourteen advanced HCC patients who received sorafenib 400/800 mg/d for at least 4 wk and were followed up by CEUS were enrolled in this study.CEUS was performed before treatment and 2 and 4 wk after treatment,and images of the target lesion in the arterial phase were recorded for each patient.The images were analyzed by AtPI.Color mapping(CM) images obtained by AtPI were compared before and after the treatment.In these CM images,the mean arrival time of the contrast agent in the region of interest from the starting point [mean time(MT)] was calculated.In each patient,differences between MT before and MT 2 and 4 wk after the treatment were compared with responses evaluated 4-8 wk after the treatment by dynamic computed tomography(CT),and statistical analysis was performed.Modified response evaluation criteria in solid tumors was used for the response evaluation.RESULTS:In CM images both 2 and 4 wk after the treatment,delays in the arrival time of the contrast agent were noted in 8 of the 14 patients.In the other 6 patients,no color changes were observed in the tumor,or red and/or yellow increase,suggesting a decrease in blood flow velocity between images 2 and 4 wk after the treatment and those before the treatment.Dynamic CT could be performed 4-8 wk after the treatment in 13 of the 14 patients.Median differences in the MT were 1.13 s and 1.015 s,2 and 4 wk after the treatment,respectively,in the 8 patients who showed stable disease(SD)/partial response(PR) on dynamic CT.Median differences in the MT were-0.39 s and-0.95 s,2 and 4 wk after the treatment,respectively,in the 5 patients who showed progressive disease(PD).Differences in the median MT between SD/PR and PD groups were significant 2 and 4 wk after the treatment with P = 0.019 and P = 0.028,respectively.CONCLUSION:AtPI by CEUS using Sonazoid is suggested to be useful for evaluating early responses to sorafenib.

Genetic insights into familial tumors of the nervous system

Nervous system tumors represent unique neoplasms that arise within the central and peripheral nervous system. While the vast majority of nervous system neoplasm occur sporadically, most of the adult and pediatric forms have a hereditary equivalent. In a little over a decade, we have seen a tremendous increase in knowledge of the primary genetic basis of many of the familial cancer syndromes that involve the nervous system,

Changes in expression of inhibitory substances in the intramural neurons of the stomach following streptozotocininduced diabetes in the pig

AIM Influence of chronic hyperglycemia on chemical coding of enteric neurons in stomach using pig as a model for human diabetic complications.METHODS Ten pigs were divided into two groups: diabetic(D group,n = 5) and control(C group,n = 5). Pigs constituting the experimental group were given streptozotocin(150 mg/kg). Animals were euthanized six weeks after the induction of diabetes. The samples of stomach were collected from animals of both groups. The cryostat sections were processed for double immunofluorescence staining using primary antisera directed towards pan-neuronal marker(Hu C/D) proteins and/or neuronal isoform of nitric oxide synthase(n NOS),vasoactive intestinal peptide(VIP) and galanin(GAL). RESULTS In the control group in the myenteric ganglia(MG) of the corpus we have noted 22.28% ± 1.19% of n NOS positive neurons,while in diabetic group we have found 40.74% ± 2.22% of n NOS immunoreactive perikarya(increase by 82.85 %). In turn in the pylorus we have observed 15.91% ± 0.58% n NOS containing neurons in control animals and 35.38% ± 1.54% in the diabetes group(increase by 122.37%). In the MG of the antrum and submucosal ganglion(SG) in the corpus hyperglycemia did not cause statistically significant changes. With regard to VIP-positive cell bodies in the antrum MG in the control animals we have noted 18.38 ± 1.39% and 40.74% ± 1.77% in the experimental group(increase by 121.65%). While in the corpus we have observed 23.20% ± 0.23% in the control and 30.93% ± 0.86% in the diabetes group(increase by 33.31%). In turn in the pylorus VIP positive cells bodies constituted 23.64% ± 1.56% in the control group and 31.20% ± 1.10% in the experimental group(increase by 31.97%). In the submucosal ganglion in the corpus we have noted 43.61% ± 1.06% in the control animals and 37.00% ± 1.77% in the experimental group(decrease by 15.15%). Expression of GAL-positive perikarya showed statistically significant changes only in the MG of the antrum and pylorus. In the antrum GAL positive perykarya constituted 26.53% ± 1.52% in the control and 36.67% ± 1.02% in the experimental animals(increase by 38.22%). While in the pylorus GAL positive neurons in the control group constituted 16.32% ± 0.92% and 17.99% ± 0.38% in the experimental animals(increase by 10.23%).CONCLUSION Our results support the hypothesis that in the course of diabetes,long term episodes of high glucose serum level may influence the chemical phenotyping of enteric neurons.

Impact of training specificity on exercise-induced cardiac troponin elevation in professional athletes: A pilot study

BACKGROUND Release of cardiac biomarkers is common after strenuous endurance exercise,but data on intermittent exercise are scarce.It has not been investigated whether cardiac troponin elevation is influenced depending on the type of exercise that an athlete is adapted to perform.We hypothesized that intermittent but not continuous exercise induces cardiac troponin elevation in professional athletes adapted to high-intensity intermittent exercise.AIM To examine how training specificity impacts high-sensitivity cardiac troponin T(hs-cTnT)release.METHODS Nine professional floorball players participated in the study,which comprised two different exercise tests:a continuous incremental cycle ergometer test and a Yo-Yo Intermittent Recovery 2(Yo-Yo IR2)test.Serial assessment of hs-cTnT was performed after the cycle ergometer test and the Yo-Yo IR2 test(baseline,0,2,6,and 24 h).RESULTS No hs-cTnT elevation above the myocardial damage cutoff(≥14 ng/L)was shown after the cycle ergometer test,whereas hs-cTnT levels rose over the cutoff in three of nine participants after the Yo-Yo IR2 test.The hs-cTnT levels peaked at 6 h after both tests,but were significantly higher after the Yo-Yo IR2 test compared to the cycle ergometer test(median hs-cTnT concentration 10.6 ng/L vs 7.8 ng/L,P=0.038).All levels returned to baseline within 24 h.CONCLUSION In professional athletes adapted to high-intensity intermittent exercise,hs-cTnT was significantly elevated after intermittent but not continuous exercise.This principle of specificity training should be considered when designing future studies to avoid misinterpretation of hs-cTnT elevation.

Cardiac index (CI) versus cardio ankle vascular index (CAVI) at different degrees of head-up tilt (HUT) in healthy subjects

The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been found but has not yet been validated. The aim of this study was to establish whether any significant relationship exists between cardiac index (CI) and CAVI. Twenty healthy male volunteers with a mean age of 30 ± 5 years and a mean BMI of 23.1 ± 1.1 kg/m2 participated in the study. CO was estimated using a Doppler technique, and CAVI was measured with a VaSeraVS-1000 device. A motorised tilting table was used to achieve head-up tilt (HUT) angles of 0°, 30°and 60°, to modify the peripheral sympathetic outflow. We found that there was a significant inverse correlation between CI and the degree of head-up tilt, ( for 0°and 30°;for 0° and 60°, p for both;for 30° and 60°, ). CAVI showed a significant positive correlation relative with the degree of HUT, ( for 0° and 30°;for 0° and 60°;for 30° and 60°, for all). A significant negative correlation was found between CI and CAVI r = - 0.47, p Additionally, a significant p increase in PVR values was observed for increasing HUT values. In conclusion: An inverse relationship between CI and CAVI was shown;a decrease in cardiac output is associated with an increase in CAVI values at different degrees of HUT. This association provides further insight into the postural link between cardiac output and arterial compliance.

Hepatocyte Growth Factor Is a Reliable Marker for Efficient Anti-Bacterial Therapy within the First Day of Treatment

Rapid diagnosis and choice of appropriate antibiotic treatment might be life-saving in serious infectious diseases. Still the available markers that can evaluate and monitor the diagnosis and treatment are few. Hepatocyte growth factor (HGF) has been studied as a potent regenerative factor produced and released during injuries such as infectious diseases. Monitoring of HGF levels might predict therapy results better than C-reactive protein (CRP) within the first day of treatment in pneumonia. For further investigation of previous observations we aimed to study HGF as a first-day marker in over-representing infectious diseases in comparison to procalcitonin (PCT), CRP and body temperature. Fifty-one patients with community acquired infectious diseases were included consequently at admittance and the serum samples were collected before and within 18 - 24 hours of treatment. HGF levels decreased significantly in case of efficient antibiotic therapy and HGF was shown to be better than PCT, CRP and body temperature to evaluate treatment. In patients with pneumonia, monitoring of HGF was most reasonable. HGF might be used as a therapeutic marker within the first day of empiric antibiotic treatment during infection.

A New Approach to the Presentation of Myocardial SPECT Images——Radial Slices——Data Reduction without Loss of Information

Objective: SPECT data from myocardial perfusion imaging (MPI) are normally displayed as a set of three slices orthogonal to the left ventricular (LV) long axis. For data presentation, the images are orientated about the LV long axis. Therefore, radial slices provide a suitable alternative to standard orthogonal slices, with the advantage of requiring fewer slices to adequately represent the data. In this study, a semi-automatic method is developed for displaying MPI SPECT data as a set of radial slices orientated about the LV axis. The aim is to reduce the number of slices viewed without loss of information and independently from the heart size. Method: Standard short axis slices, orientated perpendicular to the LV axis, are utilized.The skeleton of the segmented myocardium is found and the true LV axis is determined in each central long slice. The LV axis of the whole volume is determined by aligning the axes of all slices. Result: Radial slices centered about this axis were generated by integration over a sector equal to the resolution of the imaging system which was of the order of 1.2 cm. Therefore, assuming a mean LV diameter of 8 cm, 20 slices were sufficient to represent a non-gated study. Gated information could be adequately displayed with 4 slices integrated over an angle of 45. Conclusion: A semi-automatic method for generating radial slices from SPECT MPI short axis slices has been developed.

Is There an Association between Temperament and Apolipoprotein E? A Replication of a 1993 Young Finns Study

Background: An association between apolipoprotein E (apoE) gene polymorphism and temperament has been found in the Young Finns cohort. Motor activity in childhood and mental vitality, sociability and positive emotionality in adolescence were associated with apoE. Two research groups have attempted to replicate these findings but no associations have been found. Purpose: The purpose of the present study was to confirm the original findings with new and more reliable genotyping from a larger sample derived from the same Young Finns Study as the original finding.Methods: The study included 2808 participants aged 3 - 18 years in 1980. The same methods in assessing temperament were used as in the original study. Temperament was operationalized as motor activity, cooperativeness, negative emotionality, mental vitality, sociability and positive emotionality. Temperament was assessed by participants’ mothers in 1980 and 1983 and self-rated in 1983 by adolescent participants. Results: Motor activity was not associated with apoE polymerphisms. All other previous results were replicated. Adolescents’ positive emotionality, mental vitality and sociability were associated with apoE. Conclusions: The results indicated that there is an association between temperament and apoE. The previous absence of association between temperament and apoE in the replication studies may be due to the fact that researchers used different dimensions of temperament and thus probably studied different phenomena. Cultural differences in personality assessment might also explain the contradictory findings.

Cardiopulmonary,complications in chronic liver disease

有肝硬化和门静脉高血压的病人展出典型心血管、肺的血液动力学的变化。一个 vasodilatatory 状态和影响心脏、肺的功能的亢奋的动态发行量统治发行量。最近定义的肝脏硬化症的心肌症可以影响收缩、心脏舒张的功能，并且暗示机电的畸形。另外，循环 homoeostasis 的压力感受器功能和规定被损害。肺的机能障碍涉及在一些病人与肝肺症候群和 portopulmonary 高血压的发展传播畸形。最近的研究集中于血液动力学、神经元介质的 dysregulation 具有为在肝硬化的心血管、肺的复杂并发症的发展的主要重要性的断言。这个方面是重要的在这些病人的管理考虑。

Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects

In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. This affects both the haemodynamic and functional homeostasis of many organs and largely determines the course of the disease. With the progression of the disease, the circulation becomes hyperdynamic with cardiac, pulmonary as well as renal consequences for dysfunction and reduced survival. Infections and a changed cardiac function known as cirrhotic cardiomyopathy may be involved in further aggravation of other complications such as renal failure precipitatingthe hepatorenal syndrome.Patients with end-stage liver disease and related complications as for example the hepatopulmonary syndrome can only radically be treated by liver transplantation.As a bridge to this treatment,knowledge on the mechanisms of the pathophysiology of complications is essential for the choice of vasoactive drugs,antibiotics,drugs with specific effects on fibrogenesis and inflammation,and drugs that target specific receptors.

Circulating inflammatory factors associated with worse long-term prognosis in colorectal cancer

AIM To investigate association of circulating inflammatory factors at the time of colorectal cancer(CRC) surgery with survival.METHODS Plasma levels from 174 CRC patients(69 females and 105 men), with median age 70 years(range 29-90), localized in the colon(n = 105) or rectum(n = 69), with stage Ⅰ(n = 24), stage Ⅱ(n = 54), stage Ⅲ(n = 67) and stage Ⅳ(n = 29) were measured using commercially available Bio-Plex Pro? Human Chemokine Panel 40-Plex, including 40 different chemokines, cytokines and interleukins. The prognostic association of each inflammatory factor was analysed as CRC-specific and total mortality.RESULTS Out of 174 patients, 66 died during the follow-up, 40 because of CRC specific mortality. High tertile levels of 8 factors were significantly associated with increased CRC-specific mortality, of which CCL1, CCL20, CCL24, CX3CL1, IL-4 and TNF-α remained significant in a multivariate Cox regression analysis. High tertile levels of 14 factors were associated with increased total mortality, of which CCL1, CCL15, CCL20, CX3CL1, CXCL13, IFN-γ, IL-2, IL-4 and IL-10 remained significant after adjustment for clinical covariates. For most of the inflammatory factors the association between higher tertile levels and an increased mortality in general appeared two years after surgery. High tertile levels of TNF-α and CCL24 were exclusively associated with CRC-specific mortality. The distribution of these factors were not associated with TNM stage with exception for CCL20.CONCLUSION High plasma levels of inflammatory factors are associated with increased risk of mortality among CRC patients and could be potential biomarkers for revealing prognosis.

Liver cirrhosis and arterial hypertension

在有肝硬化的病人的典型调查结果是有低全面全身的脉管的抵抗的血管舒张，高动脉的依从，增加的心输出量，柜台规章的系统的第二等的激活(renin-angiotensin-aldosterone 系统，交感神经系统，加压素的版本) ，并且抵抗到 vasopressors。vasodilatory 状态通过 adrenomedullin 被调停， calcitonin 基因相关的肽，氮的氧化物，和另外的血管扩张药，并且最在内脏的区域被读。这组成一有效(尽管亲戚) 抵销到增加的动脉的血压。这评论在与肾的起源的本质性高血压和高动脉压的关系与肝硬化在病人在全身的血液动力学考虑改变。有高动脉压的题目(必要，第二等) 可以在肝硬化的发展期间变得正常血压，并且高动脉压很少与肝硬化在病人被表明，甚至在有 renovascular 疾病和高传播高血压蛋白原酶活动的情况中。至于在有明白高动脉压的肝脏硬化症的病人的 homoeostatic 规定的理解有许多争论。这很可能在平行包括血管舒张和血管缩小的联合。

Interferon-γ inhibits ghrelin expression and secretion via a somatostatin-mediated mechanism

AIM:To investigate if and how the proinflammatory cytokine interferon γ(IFNγ) affects ghrelin expression in mice.METHODS:The plasma concentration of ghrelin,andgastric ghrelin and somatostatin expression,were examined in wild-type mice and mice infected with Helicobacter pylori(H.pylori).Furthermore,ghrelin expression was examined in two achlorhydric mouse models with varying degrees of gastritis due to bacterial overgrowth.To study the effect of IFNγ alone,mice were given a subcutaneous infusion of IFNγ for 7 d.Finally,the influence of IFNγ and somatostatin on the ghrelin promoter was characterized.RESULTS:H.pylori infection was associated with a 50% reduction in ghrelin expression and plasma concentration.Suppression of ghrelin expression was inversely correlated with gastric inflammation in achlorhdyric mouse models.Subcutaneous infusion of IFNγ suppressed fundic ghrelin mRNA expression and plasma ghrelin concentrations.Finally,we showed that the ghrelin promoter operates under the control of somatostatin but not under that of IFNγ.CONCLUSION:Gastric infection and inflammation is associated with increased IFNγ expression and reduced ghrelin expression.IFNγ does not directly control ghrelin expression but inhibits it indirectly via somatostatin.

T1 and ECV Mapping in Myocardial Disease

T1 mapping using cardiovascular magnetic resonance(CMR)introduces novel techniques for myocardial tissue characterization to detect and quantify disease processes occurring at the microscopic level.Even though T1 mapping has limited spatial resolution,cellular and molecular changes occurring within each voxel can affect the aggregate T1 signal rendering them quantifi able.The estimated T1-based parameters quantifi ed on a“map”demonstrate the spatial localization of these changes whereby each pixel expresses the quantitative value of that parameter.This quantifi cation permits detection of diffuse disease even if it is not directly visible.Rather than relying on nonspecifi c functional measures,T1 mapping focuses on intrinsic changes of myocardial composition that advances understanding about specifi c disease pathways.These changes in myocardial tissue composition inform diagnosis and prognosis.T1 mapping encompasses two key parameters:native(i.e.,precontrast)T1 and extracellular volume fraction(ECV)derived from additional postcontrast T1 and blood T1 measurements.These advances introduce new tools to detect focal and diffuse myocardial derangements occurring in cardiac disease that can be otherwise diffi cult to detect.T1 and ECV mapping foster precision medicine and personalized care,promising to improve patient outcomes through targeted therapy.Capitalizing on the opportunities introduced by T1 mapping and ECV requires further investigation.

肝硬化中动脉压过高:动脉顺应性、容积分布、中心血流动力学

Background and aim: Arterial hypertension is a common disorder. Hyperkinetic circulation and reduced effective volaemia are central elements in the haemodynamic dysfunction in cirrhosis. The aim of the present study was to investigate whether cirrhotic patients with arterial hypertension are normokinetic and normovolaemic or whether they reveal the same circulatory dysfunction as their normotensive counterparts. Material and methods: Thirty three patients with arterial hypertension were identified among 648 patients with cirrhosis: 14 in Child class A, 12 in class B, and seven in class C. Controls were 130 normotensive cirrhotic patients, 19 controls with normal arterial blood pressure and without liver disease, and 16 patients with essential arterial hypertension. All groups underwent haemodynamic investigation with determination of cardiac output (CO), plasma volume (PV), central blood volume (CBV), hepatic venous pressure gradient (HVPG), hepatic blood flow (HBF), arterial compliance (AC), and systemic vascular resistance (SVR) in the supine position. Results: Liver function, as evaluated by galactose elimination capacity, indocyanine green clearance, HBF, and Child score, was significantly better in hypertensive cirrhotics than in their normotensive counterparts (p < 0.05- 0.01) but portal pressure was similar (HVPG 13 v 15 mm Hg; NS). AC was significantly lower and normal in the arterial hypertensive cirrhotic group (1.07 v 1.39 mm Hg/ml; p < 0.02) and SVR was significantly higher and normal (1475 v 1020 dyn xs/cm5; p< 0.01). Arterial hypertensive cirrhotic patients were hyperdynamic (CO 6.80 v 7.14 l/min; NS) and central hypovolaemic (CBV 19.8 v 20.6 ml/kg; NS), as were normotensive patients, but differences were found in relation to arterial blood pressure. Whereas arterial pressure was inversely correlated with CO, PV, and Child score in the normotensive group (p< 0.01), the same correlations were either direct or insignificant in arterial hypertensive cirrhotics. Conclusion: Arterial hypertensive cirrhotic patients are hyperkinetic and central hypovolaemic, in common with their normotensive counterparts, but vasodilatation is reduced and regulation of arterial blood pressure may be less deranged.

Chronic intestinal ischemia and splanchnic blood-flow:Reference values and correlation with body-composition

AIM:To determine the splanchnic blood flow and oxygen uptake in healthy-subjects and patients and to relate the findings to body-composition.METHODS:The total splanchnic blood flow (SBF) and oxygen uptake (SO2U) were measured in 20 healthy volunteers (10 women) and 29 patients with suspected chronic intestinal ischemia (15 women),age 40-85 years,prior to and after a standard meal.The method is based on the Fick principle using the continuous infusion of an indicator (99mTechnetium-labelled mebrofenin) and catheterization of an artery and the hepatic vein.An angiography of the intestinal arteries was performed during the same investigation.A whole-body dual-energy x-ray absorptiometry scan was performedin healthy volunteers to determine body composition.RESULTS:Angiography revealed no atherosclerotic lesions in the intestinal arteries.The mean baseline SBF was 1087mL/min (731-1390),and this value increased significantly to 1787 mL/min after the meal in healthy volunteers (P<0.001).The baseline SBF in patients was 1080 mL/min,which increased to 1718 mL/min postprandially (P<0.001).The baseline SBF was independent of age,sex,lean body mass and percentage of body fat.The mean meal-induced increase in SBF was equal to 282mL/min + 5.4mL/min × bodyweight,(P=0.025).The SO2U in healthy volunteers and patients was 50.7mL/min and 48.0mL/min,respectively,and these values increased to 77.5 mL/min and 75mL/min postprandially,respectively.Both baseline and postprandial SO2U were directly related to lean body mass.Age and sex exerted no impact on SO2U.CONCLUSION:A direct correlation between body weight and the postprandial increase in SBF was observed.The effect of body weight should be considered in the diagnosis of chronic intestinal ischemia.

Functional PET Scan in Four Patients with Higher Order Neglect-Like Cognitive Dysfunction Associated to Chiasm Related Pathology

Cognitive disturbances with neglect-like features have been reported occasionally in patients with chiasmal disorders, so far however with no obvious substrate by conventional brain imaging. Thus, there were no right hemisphere lesions that could explain the lateralised visual inattention as observed in particular during monocular visual acuity testing. On this background, we further examined four adult patients who consented to functional 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) scan. In three there were no significant findings. The fourth patient, a 26-year-old male with cognitive defects after surgery for craniopharyngioma, will be discussed in more detail. His PET scan demonstrated a widespread reduction of regional metabolic activity in left hemisphere primary visual cortex and higher order visual areas, despite absence of explanatory pathological signal changes on MRI. As present in only one out of four patients, however, the findings do not allow specific pathogenetic mechanisms to be suggested, nor generally to substantiate involvement of higher cerebral circuits. Obviously, even developed imaging has its limits, and in the very theory the visual dysfunctions observed might still depend on higher brain centres’ faulty adaptation to loss of pre-geniculate visual information.

Myocardial perfusion imaging in patients with a recent, normal exercise test

AIM: To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG). METHODS: This study was a retrospective analysis of consecutive patients referred for MPI during a 2-year period from 2006-2007 at one clinic. All eligible patients were suspected of suffering from CAD, and had performed a satisfactory bicycle exercise test (i.e. , peak heart rate > 85% of the expected, age-predicted maximum) within 6 mo of referral, their exercise ECG was had no signs of ischemia, there was no exercise-limiting angina, and no cardiac events occurred between the exercise test and referral. The patients subsequently underwent a standard 2-d, stress-rest exercise MPI. Ischemia was defined based on visual scoring supported by quantitative segmental analysis (i.e. , sum of stress score > 3). The results of cardiac catheterizationwere analyzed, and clinical follow up was performed by review of electronic medical files. RESULTS: A total of 56 patients fulfilled the eligibility criteria. Most patients had a low or intermediate ATPⅢ pretest risk of CAD (6 patients had a high pre-test risk). The referral exercise test showed a mean Duke score of 5 (range: 2 to 11), which translated to a low postexercise risk in 66% and intermediate risk in 34%. A total of seven patients were reported with ischemia by MPI. Three of these patients had high ATPⅢ pre-test risk scores. Six of these seven patients underwent cardiac catheterization, which showed significant stenosis in one patient with a high pre-test risk of CAD, and indeterminate lesions in three patients (two of whom had high pre-test risk scores). With MPI as a gate keeper for catheterization, no significant, epicardial stenosis was observed in any of the 50 patients (0%, 95% confidence interval 0.0 to 7.1) with low to intermediate pre-test risk of CAD and a negative exercise test. No cardiac events occurred in any patients within a median follow up period of > 1200 d. CONCLUSION: The added diagnostic value of MPI in patients with low or intermediate risk of CAD and a recent, normal exercise test is marginal.

氯沙坦和阿替洛尔对高血压伴左室肥大患者利钠肽的相反作用:LIFE的一项亚研究

Background: Secretion of natriuretic peptides is related to cardiac wall stress and influenced by the renin-angiotensin system. Therefore,we investigated the influence of blood pressure(BP)reduction with losartan versus atenolol on N-terminal pro-atrial natriuretic peptide(Nt-proANP) and N-terminal pro-brain natriuretic peptide(Nt-proBNP). Methods: In 183 patients with hypertension and electrocardiographic left ventricular(LV) hypertrophy, enrolled in the LIFE Study, we measured BP and serum Nt-proANP and Nt-proBNP by immunoassay after 2 weeks of placebo treatment and after 1, 2, 4, 6, 12, 24, 36 and 48 months of randomized treatment with losartan-or atenolol-based antihypertensive regimens. Results: There was no significant difference in BP at any time point between the two treatment groups. In patients treated with losartan, median Nt-proANP decreased gradually throughout the study, reaching significance after 6months of treatment(1125-1060 pmol/l,P< 0.001), and Nt-proBNP decreased within the first month(24.7-18.7 pmol/l, P< 0.01) and stayed reduced throughout the study. During losartan-based antihypertensive treatment, Nt-proANP and Nt-proBNP as a percentage of baseline values were correlated to reductions in systolic BP(r=0.11, P< 0.01 and r=0.10, P=0.01) and diastolic BP(r=0.17, P< 0.001 and r=0.07, P=0.09). In atenolol-treated patients, Nt-proANP(1100-1640 pmol/l, P< 0.001) and Nt-proBNP(20.0-37.7 pmol/l, P< 0.001) increased during the first month, and remained elevated throughout the study. During atenolol-based antihypertensive treatment, changes in Nt-proANP(r=-0.16, P< 0.001) and NtproBNP(r=-0.07, P=0.08) were negatively related to change in heart rate. Conclusion: Nt-proANP and Nt-proBNP were reduced in parallel with BP in losartan-treated patients whereas they increased in parallel with decreased heart rate in atenolol-treated patients.