BNP与老年心力衰竭患者LVEF、心功能分级及预后相关性研究

目的分析老年心力衰竭(心衰)患者血浆脑钠肽(BNP)水平与左室射血分数(LVEF)、6分钟步行试验距离(6MWT)、NYHA心功能分级及预后的相关性。方法选取2009年2月至2013年11月在上海市徐汇区中心医院老年病科治疗的老年心衰患者100例,男性48例,女性52例,年龄55~72岁,平均年龄(68.26±5.23)岁。根据血浆BNP水平分为4组,A组[(8.0~93.9)pg/mL]22例;B组[(94.0~349.9)pg/mL]30例;C组[(350.0~988.9)pg/mL]21例;D组[(989.0~5000.0)pg/mL]27例。检测患者血浆BNP水平,测量各组患者LVEF、6MWT、心功能分级以及随访出院2个月后不良心脏事件发生情况。结果与A组[(135.13±32.24)pg/mL]比较,B组[(323.14±52.37)pg/mL]、C组[(568.47±132.13)pg/mL]、D组[(1687.57±432.66)pg/mL]血浆BNP水平呈逐渐增高趋势,差异具有统计学意义(P均0.05)。与A组[(49.56±8.63)%]比较,C组[(42.24±4.41)%]、D组[(35.03±3.87)%]下降,差异具有统计学意义(P均0.05)。随着血浆BNP水平升高,6MWT呈下降的趋势,差异具有统计学意义(P均0.05),心功能也逐渐下降,MACE发生率增加。老年心衰患者血浆BNP水平与LVEF呈负相关(r=-0.893,P0.05),与6MWT呈负相关(r=-0.913,P0.05),与心功能NYHA分级呈正相关(r=0.927,P0.05),与2个月MACE发生率呈正相关(r=0.909,P0.05)。结论老年心衰患者血浆BNP水平与LVEF、心功能分级、6MWT及预后密切相关,为临床诊断老年心衰以及评估心衰严重程度提供重要参考。     

芪苈强心胶囊对扩张型心肌病患者心功能及高迁移率族蛋白B1表达的影响

目的观察芪苈强心胶囊对扩张型心肌病患者心功能及高迁移率族蛋白B1(HMGB1)表达的影响。方法连续入选2012年1月～2013年8月在宜昌市中心人民医院心内科住院心功能(NYHA分级)Ⅱ～Ⅲ级的扩张型心肌病患者48例,随机分为观察组和对照组(各24例),两组患者均给予规范的西药治疗,观察组在此基础上加用芪苈强心胶囊(0.3 g/粒),每次4粒,3/日,疗程12周。分别测量两组患者治疗前后的6分钟步行距离(6MWT)及左室射血分数(LVEF);采用ELISA法检测两组患者血清中HMGB1、白细胞介素6(IL-6)及肿瘤坏死因子-α(TNF-α)的表达水平。结果与治疗前比较,治疗后两组患者6MWT、LVEF均显著提高(P0.01),血清中HMGB1、IL-6及TNF-α的表达水平明显降低(P0.01)。对照组治疗后6MWT为(365±59)m,LVEF为(39.3±8.8)%,与对照组比较,观察组治疗后6MWT[(389±63)m]、LVEF[(44.6±9.3)%]显著升高(P0.05)。对照组治疗后,血清中HMGB1、IL-6及TNF-α的水平分别为(13.37±3.86)pg/ml,(89.1±18.5)ng/ml,(18.3±4.2)ng/ml。与对照组治疗后比较,观察组治疗后血清中HMGB1[(9.61±3.25)pg/ml]、IL-6[(65.9±12.4)ng/ml]及TNF-α[(13.6±3.5)ng/ml]的表达水平降低(P0.05)。结论芪苈强心胶囊辅助治疗能进一步改善扩张型心肌病患者的心功能,同时降低HMGB1及IL-6、TNF-α的表达。     

快速测定血浆B型钠尿肽对心力衰竭的诊断和危险分层作用

目的评估快速测定血浆B型钠尿肽(BNP)能否鉴别心源性与非心源性呼吸困难及判断充血性心力衰竭(CHF)预后.方法应用快速检测方法测定249例呼吸困难患者的血浆BNP水平.由不知BNP测定结果的2名心内科医生判定临床诊断.结果240例患者中呼吸困难单纯由CHF所致者131例,非CHF所致者64例,CHF与非CHF共同参与者45例,其BNP水平分别为(756±293)pg/ml,(48±21)pg/ml,(461±292)pg/ml组间比较差异有统计学意义(P＜0.01).BNP预测CHF的准确性为93%,优于各项临床指标.CHF患者心功能(NYHA)分级Ⅱ-Ⅳ级的BNP数值分别为(387±172)pg/ml,(694±321)pg/ml,(955±243)pg/ml,组间比较差异有统计学意义(P＜0.01).对CHF患者出院后随访6个月发现,有23例发生心血管事件,其BNP水平显著高于其他患者P＜0.01.结论快速测定血浆BNP有助于鉴别心源性与非心源性呼吸困难,并且BNP是一种判断CHF预后的客观性指标.     

急性冠脉综合征患者血清BNP与cTNI相关性研究

目的 探讨血清脑钠肽( BNP)和心肌肌钙蛋白I(cTNI)在急性冠脉综合征(acute coronary syndrome,ACS)患者中的水平及两者之间相关性.方法 2010年4月-2012年2月我院收治的ACS患者35例(作为实验组),其中不稳定心绞痛患者(UAP)17例,急性心肌梗死患者(AMI)18例.同期收治的稳定型心绞痛患者(SAP)22例和健康查体者25例作为对照组.酶联免疫吸附法和化学发光法分别测定血清BNP和cTNI水平.结果 AMI组、UAP组、SAP组和健康查体组血浆BNP水平分别为336.7 pg /mL±103.0 pg /mL,172.2 pg /mL±58.8 pg /mL,55.1 pg /mL±29.9 pg /mL 和16.9 pg /mL±10.6 pg /mL,AMI组患者最高,且差别有统计学意义(P＜0.001);血浆cTNI水平分别18.13 ng/mL±7.21 ng/mL,0.61 ng/mL±0.33 ng/mL,0.22 ng/mL±0.11 ng/mL和0.18 ng/mL±0.14 ng/mL,AMI组患者最高,且差别有统计学意义(P＜0.001).AIM组患者血浆BNP与cTNI之间存在相关性,Pearson相关系数为0.86(P＜0.001).结论 血清BNP水平在ACS患者中明显升高,AMI患者升高最为显著且与cTNI存在正相关,BNP、cTNI可作为辅助诊断急性心梗危险分层的指标之一.     

贝那普利并曲美他嗪对冠心病并心衰患者血清FSTL1、PAF及血管内皮功能的影响

目的:观察贝那普利联合曲美他嗪对冠心病合并心衰患者血清卵泡抑素样蛋白1(FSTL1)、血小板活化因子(PAF)水平及血管内皮功能的影响。方法:选择我院120例冠心病合并慢性心衰患者,随机均分为贝那普利组和联合治疗组(贝那普利联合曲美他嗪治疗),治疗6个月。测定两组患者治疗前后血清N末端脑钠肽前体(NTpro BNP)、FSTL1、PAF水平,内皮祖细胞(EPCs)数量及肱动脉血管舒张功能(FM D)等指标,并进行比较分析。结果:与治疗前比较,治疗后两组患者的左室射血分数(LVEF)、6min步行距离、EPCs值、FMD值均明显增加,血清NT-pro BNP、FSTL1及PAF水平明显降低(P0.05或0.01);且与贝那普利组比较,联合治疗组LVEF[(41.94±9.19)%比(46.15±10.04)%]、6min步行距离[(333.94±58.29)m比(383.14±77.84)m]、EPCs值[(0.059±0.029)pg/ml比(0.083±0.014)pg/ml]、FM D值[(7.53±2.02)%比(8.24±1.42)%]增加更显著,血清NT-pro BNP[(2.74±0.69)ng/ml比(2.05±0.34)ng/ml]、FSTL1[(5.38±1.29)ng/ml比(4.64±0.84)ng/ml]及PAF[(5.16±0.92)μg/ml比(4.20±1.05)μg/ml]水平降低更显著(P0.05或0.01)。结论:贝那普利联合曲美他嗪能有效降低冠心病合并慢性心衰患者的NT-pro BNP、FSTL1和PAF水平,促进血管内皮功能的恢复。     

B型利钠肽在结缔组织病相关肺动脉高压中的诊断价值

目的 通过观察结缔组织病(CTD)相关肺动脉高压(PAH)患者外周血B型利钠肽(BNP)和N末端B型利钠肽原(NT-proBNP)的水平,探讨BNP在CTD相关PAH中的诊断价值.方法 对2006-2009年北京协和医院收治的30例CTD合并PAH患者进行超声心动图、右心导管检查及外周血BNP和NT-proBNP水平测定.结果 (1)30例CTD相关PAH患者全部为女性,年龄(39.5±11.6)岁,均经右心导管检查证实为PAH.患者血BNP水平[(325.2±426.3)(8.0～1590.0)ng/L]、NT-proBNP水平[(1444.9±1651.4)(55.0～7839.6)ng/L]升高.(2)不同程度PAH患者WHO临床功能分级、右心房压(RAP)、右心室舒张末压(RVEDP)、肺毛细血管楔压(PCWP)、肺血管阻力(PVR)、心指数(CI)、混合静脉血氧饱和度(SvO2)、左心室舒张末内径(LVEDd)、右房大小、右心室与左心室舒张末内径比值(RV/LV)、三尖瓣跨瓣压差(TGP)、心包积液发生情况、NT-proBNP差异有统计学意义.(3)应用受试者工作特征曲线(ROC)分析NT-proBNP、BNP对重度PAH的诊断价值,其曲线下面积(AUC)分别为0.74、0.64,提示NT-proBNP优于BNP.NT-proBNP为745.2 ng/L对区分重度PAH的敏感性为68.8%,特异性为57.1%;BNP为141.5 ng/L时的敏感性为62.5%,特异性为64.3%.(4)相关性分析:NT-proBNP与WHO临床功能分级、RAP、RVEDP、平均肺动脉压(MPAP)、PVR呈正相关(r分别为0.55、0.55、0.36、0.53、0.69,P＜0.05),与CI、S(v)O2呈负相关(r分别为-0.58、-0.62,P≤0.001).BNP与RAP、MPAP、PVR呈正相关(r分别为0.42、0.40、0.61,P＜0.05),与CI、S(v)O2呈负相关(r分别为-0.46、-0.54,P=0.005),与RVEDP、WHO临床功能分级无相关性(r分别为-0.46、-0.54,P＞0.05).NT-proBNP与LVEDd呈负相关(r=-0.41,P=0.025),与RA1、RA2、RV、RV/LV比值、TGP呈正相关(r分别为0.40、0.53、0.55、0.49、0.45,P＜0.05).BNP与RA1、RA2、RV、RV/LV比值、TGP呈正相关(r分别为0.39、0.45、0.37、0.40、0.36,P＜0.05).NT-proBNP、BNP均与心包积液明显相关(r分别为0.46、0.43,P＜0.05).结论 CTD相关PAH患者血BNP、NT-proBNP均升高,与WHO临床功能分级、血流动力学参数、超声心动图反映右心室功能参数之间有显著的相关性.提示BNP是判断CTD合并PAH严重程度和预后的一种简单、无创和可信的指标.

Abstract：

Objective To explore the potential role of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the assessment of patients with connective tissuediseases(CTD) associated pulmonary arterial hypertension (PAH). Methods Thirty patients with CTD associated PAH were evaluated by WHO function, echocardiography, right heart catheterization and blood biomarkers. All the clinical data was analyzed statistically. Results All patients [age (39.5 ± 11.6) yr]were female. Both NT-proBNP and BNP were significantly increased and significantly correlated ( all P ＜0. 05 ) respectively with mean pulmonary arterial pressure ( r = 0. 53 and r = 0. 40 ), right arterial pressure ( r = 0. 55 and r = 0. 42 ), pulmonary vascular resistance ( r = 0. 69 and r = 0. 61 ), cardiac index ( r = - 0. 58and r = - 0. 46), mixed venous blood oxygen saturation ( r = - 0. 62 and r = - 0. 54 ), pericardial effusion ( r = 0. 46 and r = 0. 43 ), right atrial sizes ( r = 0. 40 and 0. 53, and r = 0. 39 and 0. 45 ) and right ventricular size ( r = 0. 55 and r = 0. 37 ). Furthmore, NT-proBNP, but not BNP, significantly correlated with WHO function class ( r = 0. 55 ). Conclusion Blood NT-proBNP and BNP were elevated in patients with CTD associated PAH and paralleled the extent of function class, pulmonary hemodynamic changes and right ventricular remodeling.     

急性冠状动脉综合征患者血清BNP与cTnI相关性研究

目的探讨血清脑钠肽(Brain natriuretic peptide,BNP)和心肌肌钙蛋白I(Cardiac troponin I,c Tn I)在急性冠状动脉综合征(Acute Coronary Syndrome,ACS)患者血清中的水平有无差异及两者之间的相关性。方法回顾性分析我院收治的ACS患者41例,其中急性心肌梗死患者(AMI)22例,不稳定心绞痛患者(UAP)19例,同期收治的稳定型心绞痛患者(SAP)31例和健康查体者42例作为研究对象。分别测定上述患者血清BNP和c Tn I水平,并比较四组患者BNP、c Tn I水平有无差异及BNP和c Tn I之间的相关性。结果 AMI组、UAP组、SAP组和对照组血清BNP分别为(330.5±93.9)pg/ml,(164.3±54.9)pg/ml,(57.6±27.0)pg/ml和(18.2±10.2)pg/ml,AMI组显著高于其他三组,且差异有统计学意义(P0.01);血清c Tn I水平分别(19.2±8.2)ng/ml,(0.62±0.36)ng/ml,(0.26±0.14)ng/ml和(0.16±0.12)ng/ml,AMI组患者最高,且差异有统计学意义(P0.01)。应用BNP作为鉴别诊断AMI与UAP的指标,ROC曲线下面积(AUC)为0.94(95%CI:0.88~0.96,P0.01),最佳Cut_off值为BNP=214.5pg/ml,该Cut_off值下鉴别AMI与UAP的敏感性为89.5%,特异性为81.8%。AIM组患者血清BNP与c Tn I之间存在相关性,Pearson相关系数r为0.69(P0.01)。结论与健康人比较,ACS患者血清BNP和c Tn I显著升高,其中AMI患者升高最为显著。血清BNP鉴别AMI与UAP的敏感性和特异性较高,可作为辅助诊断AMI的指标之一。     

慢性重度心力衰竭患者血B型利钠肽浓度正常的临床意义探讨

目的 探讨慢性重度心力衰竭(心衰)患者出现血B型利钠肽(B-type natriuretic peptide,BNP)浓度正常的临床意义.方法 采用前瞻性对照研究的方法观察心功能Ⅲ～Ⅳ级的慢性重度心衰患者57例.血BNP浓度正常的13例患者为研究组(A组),血BNP浓度明显升高的44例为对照组(B组),分析两组患者的临床特点,判定血BNP浓度正常对于慢性重度心衰患者的意义.结果 两组患者的基线情况差异无统计学意义.A组的左室舒张末期内径大于B组[(70.56±4.33)mm与(63.73±3.75)mm,P＜0.05];A组的左室射血分数小于B组[(24.16±2.50)%与(28.49±2.63)%,P＜0.05].A组中能耐受美托洛尔的人数比例少于B组[(7/13)与(39/44),P＜0.05],耐受剂量低于B组[(12.5±6.25)mg/d与(24.20±11.22)mg/d,P＜0.05].两组血BNP浓度在稳定期各时间段无明显改变,但在慢性心衰急性发作与缓解后,A组无显著性改变[(74.03±11.18)ng/L与(71.38±11.68)ng/L,P＞0.05],而B组改变明显[(962.73±165.00)ng/L与(876.24±167.70)ng/L,P＜0.05].随访中,A组病死率高于B组(11/13与6/44,P＜0.05).Logistic多因素回归分析显示:血BNP降低为预测重度慢性心衰患者心原性死亡的独立危险因素(OR值45.488,95%可信区间5.322～388.791),P＜0.05.结论 慢性重度心衰患者出现血BNP浓度正常提示BNP分泌机制的耗竭和心脏功能的进一步恶化.     

盐酸曲美他嗪对老年心衰患者血浆脑钠肽及6min步行试验的影响

目的：观察曲美他嗪对慢性充血性心力衰竭（CHF）患者心功能的影响。方法：70例符合入选标准的 CHF患者按数字表法被随机均分为曲美他嗪组和常规治疗组,各35例。常规治疗组根据病情给予洋地黄、利尿剂、血管紧张素转化酶抑制剂等治疗,曲美他嗪组在常规治疗组基础上加用曲美他嗪,疗程4周,分别于治疗前后检测患者血浆脑钠肽（BNP）水平,并对患者进行6 min步行试验（6 MWT）。结果：两组患者治疗后血浆 BNP水平均较治疗前明显降低（P＜0.01）,且曲美他嗪组降低幅度较常规治疗组降低更显著[（715.60±181.22）pg/ml 比（655.89±135.61）pg/ml,P＜0.05];两组患者治疗后6min步行距离均较治疗前显著增加（P＜0.01）,且曲美他嗪组增加幅度较常规治疗组更显著[（226.06±65.18）m比（181.46±51.16）m,P＜0.01]。结论：曲美他嗪在常规治疗基础上能明显降低心衰患者血浆脑钠肽水平,增强运动能力。     

雷米普利与硝苯地平对老年高血压性心脏病患者心功能、炎性因子的影响

目的:探讨雷米普利片与硝苯地平控释片对老年高血压性心脏病患者心功能、炎性因子的影响及其疗效。方法:选择186例老年高血压性心脏病患者,随机均分为雷米普利组、硝苯地平组、联合治疗组(雷米普利+硝苯地平),各62例,观察各组治疗8周后的疗效。结果:与治疗前比较,三组治疗后LVEF、心脏指数(CI)、左室舒张早期/晚期峰值流速(E/A)、6min步行距离(6MWD)均显著增加,BNP、CRP、白细胞介素(IL)-1、IL-6水平均显著下降(P均0.01);且与雷米普利、硝苯地平组比较,联合治疗组治疗后LVEF [(43.44±5.75)%、(43.41±5.73)%比(49.89±5.84)%]、CI [(2.23±0.64)L·min-1·m-2、(2.28±0.69)L·min-1·m-2比(2.87±0.71)L·min-1·m-2]、E/A [(0.87±0.31)、(0.90±0.32)比(1.21±0.39)]、6MWD [(233.44±38.95)m、(236.45±39.13)m比(299.77±45.77)m]显著增加,血浆BNP [(199.67±27.86)ng/L、(194.55±25.46)ng/L比(124.67±29.45)ng/L]、CRP [(10.32±3.18)mg/L、(10.21±2.89)mg/L比(8.35±2.12)mg/L]、肿瘤坏死因子(TNF)-α[(45.52±14.56)pg/ml、(45.45±13.78)pg/ml比(37.86±10.35)pg/ml]、IL-1 [(6.34±2.54)pg/ml、(6.31±2.31)pg/ml比(3.42±1.89)pg/ml]、IL-6 [(6.71±2.23)pg/ml、(6.68±2.11)pg/ml比(4.11±1.75)pg/ml]水平均显著降低(P均=0.001)。临床治疗整体疗效显著优于雷米普利组(Z=3.747,P=0.001)和硝苯地平组(Z=3.838,P=0.001)。结论:雷米普利与硝苯地平联合应用能提高对老年高血压性心脏病患者疗效,改善心功能,降低炎性因子水平。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.     

Formoterol Delivered via the Dry Powder Aerolizer® Inhaler Versus Albuterol MDI and Placebo in Mild-to-Moderate Asthma: A Randomized, Double-Blind, Double-Dummy Trial

The objectives of this study were to compare the efficacy and tolerability of twice-daily formoterol dry powder 12 µg and 24 µg (Foradil) delivered via Aerolizer inhaler with four times daily albuterol (salbutamol) 180 µg delivered via metered dose inhaler (MDI) and placebo. A total of 554 adolescents and adults (ages 12-75 years) with mild-to-moderate asthma were randomized to this 12-week, multicenter, double-blind, double-dummy, placebo-controlled, parallel-group study. Twelve-hour spirometry measurements were taken at weeks 0, 4, 8, and 12. A total of 484 patients completed the study (122, 116, 127, and 119 given formoterol 12 µg, formoterol 24 µg, albuterol, and placebo, respectively). For the primary efficacy variable, the forced expiratory volume in 1 second (FEV₁), both formoterol 12 µg and 24 µg were statistically superior to placebo at all time points on all test days (p ≤ 0.017) and to albuterol at most time points on all test days (p ≤ 0.001). The onset of improvement in FEV₁ was rapid, with 15% increase within 5 min in 57%, 71%, and 65% of formoterol 12 µg, formoterol 24 µg, and albuterol patients, respectively. Formoterol was also superior to placebo and albuterol in terms of secondary efficacy variables: FEV₁ area under the curve, percentage of predicted FEV₁, forced vital capacity and forced expiratory flow, asthma symptom scores, and peak expiratory flows. In conclusion, both formoterol doses were superior to placebo in all lung function measurements. Overall, compared with albuterol, both formoterol doses produced superior bronchodilation. Formoterol and albuterol were safe and well-tolerated.