AimsIn congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure.
Methods and resultsEndothelial function was assessed in 242 patients with CHF by forearm reactive hyperaemia measured with intermittent venous occlusion plethysmography using a mercury strain gauge. The main endpoints were: 'total events' (death, heart attack, angina, stroke, NYHA class IV, or hospitalization due to heart failure) analysed using Cox regression for repeated events and 'death'. Patients were followed-up for 5 years. Post-hyperaemia forearm blood flow (PHFABF) was an independent predictor of total events [P ¼ 0.01; hazard ratio [Exp(B)] 0.665, standard error (SE) 0.182]. Risk stratification by basal forearm blood flow (BFABF) showed that patients with basal blood flow above the median (3.03 mL min 21 100 mL 21 ) benefited from an increase in PHFABF, whereas in patients with a BFABF below the median, the increase in PHFABF did not diminish the risk of events. There was no relation between variations in PHFABF and death.
ConclusionPost-hyperaemia forearm blood flow, as a measure of ED, is an independent predictor of major events in patients with CHF. A BFABF below the median is more predictive of an increased risk of complications.-Heart failure † Endothelial function † Strain gauge plethysmography † Reactive hyperaemia † Post-hyperaemia forearm blood flow
BPI is increased in cirrhotic patients, especially in those with more severe liver disease. The amount of BPI in the plasma correlated with the TNF-alpha level and was able to reduce LPS-mediated TNF production by monocytes. BPI possibly plays a regulatory role by antagonizing the pro-inflammatory mechanisms mediated by TNF-alpha.
Resumen
Introducción
El diagnóstico actual del virus de la hepatitis B (VHB) está basado en la detección mediante técnicas moleculares de ADN de VHB y ensayos serológicos, como el antígeno de superficie (HBsAg) y anticuerpos frente al core VHB (anti-HBc). Existe un grupo de pacientes con infección oculta de VHB (OBI) en los que estos ensayos no son capaces de detectar el HBsAg ni la cuantificación de ADN de VHB en sangre, aunque exista replicación activa en hígado.
Contenido
El documento define la OBI, y los métodos actuales para su diagnóstico. También aborda la detección de pacientes con factores de riesgo y la necesidad de realizar el cribado de OBI en ellos.
Resumen
Un correcto diagnóstico de OBI, previene la reactivación del VHB y su transmisión. El diagnóstico de OBI actualmente está basado en la detección de ADN de VHB en pacientes con HBsAg indetectable en sangre.
Perspectivas
Un número elevado de pacientes con OBI puede permanecer sin diagnosticar. Es importante realizar el cribado de OBI en determinados pacientes con factores de riesgo. La introducción de nuevos marcadores, como el HBsAg ultrasensible, y estudios más profundos de marcadores, como el ADNccc hepático, serán necesarios para un correcto diagnóstico de OBI.
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