The present study was undertaken to identify the congestive heart failure patients by BNP test. To measure BNP levels in Patients with congestive heart disease, to use the BNP in the heart failure treatment and Routine use of BNP assays may help to more rapidly identify patients with heart failure, thereby saving money on unnecessary echocardiograms. In the present study observe the measurement of B-type natriuretic peptide in the heart failure patients. Heart failure, also called congestive heart failure, is a automated rapid assays have been made available condition in which the heart cannot pump enough to hospital laboratories, an increasing number of oxygenated blood to meet the needs of the body's other studies that were performed by clinical investigators organs. The heart keeps pumping, but not as efficiently as have documented the usefulness of these markers in the a healthy heart. Usually, the loss in the heart's pumping process of diagnosis, prognosis and treatment of cardiac action is a symptom of an underlying heart problem. Heart disease (5). failure affects nearly 35 million adults in world total The present study was undertaken to identify the population (1). It is on the rise with an estimated 4 congestive heart failure patients by BNP test.To measure to7 millions new cases each year. More than 7.5 million BNP levels in Patients with congestive heart disease , to Indian's suffer from CHF and nearly a million new use the BNP in the heart failure treatment and Routine use cases arise each year. Congestive heart failure (CHF), of BNP assays may help to more rapidly identify patients congestive cardiac failure (CCF) or just heart failure is a with heart failure, thereby saving money on unnecessary condition that can result from any structural or functional echocardiograms. cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the

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Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure

• We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients. (Arch Intern Med1986;146:259-261)

Central Vein Catheterization. Failure and Complication Rates by Three Percutaneous Approaches

Complications of Femoral and Subclavian Venous Catheterization in Critically Ill Patients: A Randomized Controlled Trial

Elevated serum uric acid concentration is a common laboratory finding in subjects with metabolic syndrome/obesity, hypertension, kidney disease and cardiovascular events. Hyperuricemia has been attributed to hyperinsulinemia in metabolic syndrome and to decreased uric acid excretion in kidney dysfunction, and is not acknowledged as a main mediator of metabolic syndrome, renal disease, and cardiovascular disorder development. However, more recent investigations have altered this traditional view and shown, by providing compelling evidence, to support an independent link between hyperuricemia and increased risk of metabolic syndrome, diabetes, hypertension, kidney disease and cardiovascular disorders. However, despite these new findings, controversy regarding the exact role of uric acid in inducing these diseases remains to be unfolded. Furthermore, recent data suggest that the high-fructose diet in the United State, as a major cause of hyperuricemia, may be contributing to the metabolic syndrome/obesity epidemic, diabetes, hypertension, kidney disease and cardiovascular disorder. Our focus in this review is to discuss the available evidence supporting a role for uric acid in the development of metabolic syndrome, hypertension, renal disease, and cardiovascular disorder; and the potential pathophysiology mechanisms involved.

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Potential role of uric acid in metabolic syndrome, hypertension, kidney injury, and cardiovascular diseases: is it time for reappraisal?

In this study, we aimed to investigate ultrasonographic (US) changes suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic individuals with hyperuricemia. We conducted a cross-sectional, controlled study including US examinations of the knees and first metatarsal-phalangeal joints (first MTPJs), as well as of the tendons and enthesis of the lower limbs. Differences were estimated by χ2 or unpaired t-tests as appropriate. Associations were calculated using the Spearman's correlation coefficient rank test. Fifty asymptomatic individuals with hyperuricemia and 52 normouricemic subjects were included. Hyperechoic enhancement of the superficial margin of the hyaline cartilage (double contour sign) was found in 25% of the first MTPJs from hyperuricemic individuals, in contrast to none in the control group (P < 0.0001). Similar results were found on the femoral cartilage (17% versus 0; P < 0.0001). Patellar enthesopathy (12% versus 2.9%; P = 0.01) and tophi (6% versus 0; P = 0.01) as well as Achilles enthesopathy (15% versus 1.9%; P = 0.0007) were more frequent in hyperuricemic than in normouricemic individuals. Intra-articular tophi were found in eight hyperuricemic individuals but in none of the normouricemic subjects (P = 0.003). These data demonstrate that morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically asymptomatic individuals.

https://link.springer.com/content/pdf/10.1186%2Far3223.pdf

Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study

Glaucoma is associated with peripheral vascular endothelial dysfunction.

Genetic variations of apolipoprotein A5 gene is associated with the risk of coronary artery disease among Chinese in Taiwan.

Objective. We used high-resolution peripheral vascular ultrasound imaging to assess endothelial function in hyperuricaemic patients. Methods. Hyperuricaemia was defined as a serum uric acid concentration of >7.7 mg/dl in men or >6.6 mg/dl in women. Measurements of endothelium-dependent flow-mediated vasodilation (FMD) and endothelium-independent nitroglycerin-mediated vasodilation were performed in 46 hyperuricaemic patients and an equal number of healthy age- and gender-matched normal controls by high-resolution two-dimensional ultrasonographic imaging of the brachial artery. The serum levels of glucose, creatinine, alanine aminotransferase (ALT), lipid profiles and high-sensitivity CRP were measured for both the study groups. Results. The serum uric acid levels averaged 9.24 (1.16) and 6.18 (0.99) mg/dl in the hyperuricaemic and control groups, respectively. Body weight and BMI were significantly higher in the hyperuricaemic group than in the control group. The serum levels of creatinine, ALT, triglyceride and high-sensitivity CRP were significantly different between the two groups. The FMD values were significantly lower in the hyperuricaemic patients than in the controls [4.45% (3.13%) vs 7.10% (2.48%); P < 0.001]. The FMD values were negatively associated with serum uric acid levels (r =0.273; P = 0.009). Multivariate regression analysis showed that the presence of hyperuricaemia (� =0.384; P < 0.001) and body weight (� = 0.215; P = 0.017) were independent determinants of low FMD values.

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Association between endothelial dysfunction and hyperuricaemia

PURPOSE. To assess peripheral vascular endothelial function in patients with normal-tension glaucoma (NTG) by using a noninvasive method: endothelium-dependent flow-mediated vasodilation (FMD). METHODS. Forty patients with NTG and 40 healthy age- and sex-matched normal control subjects underwent measurement of FMD and endothelium-independent nitroglycerin-mediated vasodilation (NMD) via high-resolution, two-dimensional (2D) ultrasonographic imaging of the brachial artery. The patients also underwent blood sampling for biochemistry, lipid profile, and high-sensitivity C-reactive protein (hsCRP) analysis. RESULTS. The NTG group exhibited significant impairment of FMD compared with the control group (NTG: 2.64% 2.22%, control: 5.96% 2.50%, P 0.001). Multivariate analysis demonstrated that the presence of NTG was the strongest independent predictor of FMD. The lipid profile and hsCRP did not differ significantly between the two groups. CONCLUSIONS. This study demonstrated impaired FMD in patients with NTG and the results provide evidence of a generalized peripheral vascular endothelial dysfunction in patients with NTG. (Invest Ophthalmol Vis Sci. 2006;47:3390‐3394) DOI:10.1167/iovs.06-0024

Abnormal flow-mediated vasodilation in normal-tension glaucoma using a noninvasive determination for peripheral endothelial dysfunction.

Background Mechanical discoordination as studied by magnetic resonance imaging has been shown to be a better predictor of left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) compared with mechanical dyssynchrony. Materials and Methods This study assessed the value of acute recoordination derived from speckle-tracking echocardiography for predicting response to CRT compared with acute resynchronization. Thirty patients with heart failure scheduled for CRT were studied at baseline, immediately after CRT, and after 6 months of CRT. Acute recoordination after CRT was indexed by an acute reduction in radial discoordination index (RDI), defined as the ratio of average myocardial thinning to thickening during the ejection phase. Results CRT responders were defined as those patients whose LV end-systolic volume decreased by ≥ 15% at the 6-month follow-up. Immediately after CRT, the responders (n = 18) demonstrated a significant reduction in RDI ( P P r = 0.75, P r = 0.43; P = .02). Conclusions Receiver operating characteristic analysis revealed that acute recoordination provided the best separation for prediction of CRT responders compared with acute resynchronization, baseline dyssynchrony, or baseline discoordination. LV recoordination after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up better than resynchronization.

Wan-Jing Ho

Papers

Glaucoma is associated with peripheral vascular endothelial dysfunction.

Genetic variations of apolipoprotein A5 gene is associated with the risk of coronary artery disease among Chinese in Taiwan.

Association between endothelial dysfunction and hyperuricaemia

Abnormal flow-mediated vasodilation in normal-tension glaucoma using a noninvasive determination for peripheral endothelial dysfunction.

Recoordination Rather than Resynchronization Predicts Reverse Remodeling after Cardiac Resynchronization Therapy