Objective:Urocortin 1 (UCN1) has vasodilator, diuretic, and natriuretic effects, and its expression increases in heart failure (HF). Adrenomedullin (ADM) increases cardiac output and lowers blood pressure in healthy men and in patients with heart failure. The aim of the study was to determine UCN1 and ADM levels in patients with HF, to evaluate the relationship of UCN1 and ADM with various clinical parameters, and to assess UCN1 and ADM as diagnostic markers in HF, in comparison with pro-brain natriuretic peptide (pro-BNP).Methods:We investigated serum levels of UCN1, ADM, and pro-BNP in 86 consecutive patients with systolic HF [ejection fraction (EF) ≤45%] and 85 healthy controls. Serum UCN1, ADM, and pro-BNP levels were measured with the ELISA method. Transthoracic echocardiography was performed to determine left ventricular EF and pulmonary artery systolic pressure.Results:UCN1 and ADM levels were higher in HF patients (446.2±145.7 pg/mL, p<0.001; 87.9±4.2 pg/mL, p<0.001 respectively). UCN1 was positively correlated with pro-BNP (r=0.963, p<0.001), ADM (r=0.915, p<0.001), and NYHA (r=0.879, p<0.001); ADM was positively correlated with pro-BNP (r=0.956, p<0.001) and NYHA (r=0.944, p<0.001). Receiver operating characteristic curves yielded an area under the curve of 1.00 (p<0.001) for UCN1, 1.00 (p<0.001) for ADM, and 0.99 (p<0.001) for pro-BNP in the diagnosis of HF.Conclusion:UCN1 and ADM increase with worsening HF and left ventricular dysfunction. They may be used as diagnostic biomarkers in systolic HF, but the incremental value of measuring UCN1 and ADM in patients tested for pro-BNP is questionable.
Özet: Pseudoeksfoliasyon sendromu (PES) göz ve göz dışı pek çok dokuda anormal hücre dışı fibriler mataryelin birikimi ile karakterize sistemik bir hastalıktır. Pseudoeksfoliasyon sendromu ile kardiyovasküler ve serebrovasküler hastalıklar arasında ciddi ilişkiler bulunmuştur. Atriyal fibrilasyonun (AF) da dahil olduğu kardiyak aritmi riskinin PES hastalarında arttığına dair bazı deliller mevcuttur. Bozulmuş atriyal elektromekanik fonksiyon AF gelişiminde önemli bir rol oynar. Bu çalışma PES hastalarında atriyal elektromekanik gecikme (EMG) sürelerinin değerlendirilmesini amaçlamaktadır. Otuz dört PES hastası ve PES materyeli olmayan 29 yaş ve cinsiyet uyumlu sağlıklı kontrol çalışmaya alındı. Açlık kan örnekleri alındı, transtorasik ekokardiyografi ve atriyal EMG sürelerini belirlemek için doku Doppler inceleme yapıldı. Septal anulusta S dalga hızı, lateral anulusta S dalga hızı, lateral anulusta izovolümetrik kasılma hızı PES olan grupta kontrol grubuna göre daha düşüktü (sırasıyla p=0.010, 0.025 ve 0.014). Doppler ekokardiyografi ölçümleri atriyal elektromekanik bağlama süresi (PA) lateral, septal ve trikuspit'in PES hastalarında kontrollerden daha fazla olduğunu gösterdi (sırasıyla p<0.001, 0.010 ve 0.046). İnteratriyal EMG [39.00 ms (28.00-44.00) vs 28.00 ms (23.50-33.00), p=0.001] ve intra-sol atriyal EMG [17.00 ms (15.00-23.25) vs 11.00 ms (10.00-17.50), p=0.003] PES hastalarında daha fazlaydı.Pseudoeksfoliasyon sendromu uzamış atriyal EMG süreleri ile ilişkilidir. Ayrıca miyokardiyal sistolik hızlar PES hastalarında daha düşüktür.
Focusing on discussion of China's soft power resources, this article argues that China performs two kinds of soft power strategies in developing and developed countries: offensive and defensive, respectively. While China's charm offensive aims to consolidate her comprehensive power through a development model, aid, investment, traditional culture, foreign policy, and international broadcasting in developing countries, the defensive aspect of China's soft power strategy aims to soften the rise of China with traditional culture by introducing appealing parts of Chinese culture through investments and international broadcasting in Western countries. China applies classical soft power tools in developing countries while she endeavors to protect her image in Western countries defensively. China's alternative defensive approach to soft power is mostly implemented through the acquisition of media outlets, and via the entertainment sector and gaming industry by Chinese‐owned companies. However, even in the defensive and offensive bifurcation, if charm attacks result in failure, China could turn take a defensive stance in developing countries.
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