The Ratio of Urine N-Terminal Pro B-Type Natriuretic Peptide to Cyclic Guanosine Monophosphate Predicts Emergency Department Visits for Heart Failure.

INTRODUCTION: Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes. Plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) and cyclic guanosine monophosphate (cGMP) are used in diagnosis and prognosis of HF patients, while clinical values of urine NT-proBNP/cGMP ratio have been rarely explored. This study aims to compare the predictive values of urine NT-proBNP/cGMP ratio versus plasma NT-proBNP for ED visits for decompensated HF. METHODS: This prospective study included 126 HF patients with reduced left ventricular ejection fraction (<50%) and without chronic kidney disease. Baseline data included demographics, co-morbidities, and co-medications. Medical records were used to determine the incidence of ED visits for decompensated HF during the 3 months following the last visit. RESULTS: Patients with subsequent ED visits had significantly higher levels of plasma and urine NT-proBNP and urine cGMP in than those without. Multivariate Cox regression analysis disclosed that Lg10urine NT-proBNP/cGMP was an independent risk factor for subsequent ED visits (OR = 3.267; 95% CI: 1.105-9.663; p = 0.032). ROC analysis revealed an Lg10urine NT-proBNP/cGMP ratio optimal cut-off value of 0.1706 (AUC, 0.700; 95% CI: 0.543-0.857; p = 0.036) for predicting subsequent HF-related ED visits. CONCLUSION: A single measurement of urinary NT-proBNP/cGMP ratio is predictive of subsequent ED visits for decompensated HF. This noninvasive and easy measurement may be a clinically useful tool for identifying a subset of patients at higher risk of ED visits.

Study of Influence of Different Models of E-Learning Content Product Design on Students' Learning Motivation and Effectiveness.

As teachers provide one-way teaching demonstration or reference materials in class, students lack of the opportunities for direct operation. The provision of interactive e-materials could reduce the need for instructors to prepare complicated teaching aids and could deal with issues of climate and location. Learners could learn any time, anywhere, and learning could be reinforced by repeating the instruction with no need to disrupt timetables. The participants in the experimental teaching study were 275 product design students who engaged in e-learning for 15 weeks (3 h per week for a total of 45 h). The research results are summarized as follows: (1) Interactive teaching materials can enhance students' active learning styles so that, in the product design area, this method could reduce learning differences in students. (2) E-materials deliver knowledge using simple and specific images, animation, audio, and video, making learning interesting and relaxed for the product design students. E-learning is easy and practical and reduces learners' cognitive load. (3) Students' cognitive development and prior knowledge should be considered in the development of e-materials. Simple images, animations, text, and language could improve the attention and learning motivation of product design students and allow students to learn based on prior knowledge. A suggestion, based on the findings, is the application of various communication teaching models using e-materials to course work for the product design students, enabling discussion, analysis, concept formation, and problem-solving.

A Portable Wireless Urine Detection System With Power-Efficient Electrochemical Readout ASIC and ABTS-CNT Biosensor for UACR Detection.

This work presents a portable wireless urine detection system which consists of an electrochemical readout application specific integrated circuit (ASIC) and a biosensor composed of 2, 2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) and carbon nanotube (ABTS-CNT) for the detection of urine albumin-to-creatinine ratio (UACR). The ASIC includes a potentiostat, a digital circuitry and a power management circuit which can perform electrochemistry techniques with a dual-channel screen-printing carbon electrode (SPCE). Electrochemical experiments on the proposed biosensor (SPCE|ABTS-CNT|Nafion) have revealed promising sensing characteristics for creatinine and human serum albumin detection. Practical urine tests has demonstrated the capability of the proposed urine detection system for UACR detection with both the power-efficient readout ASIC and the ABTS-CNT biosensor. A user-friendly prototype has also been designed which can be useful for either personal health administrationor homecare.

Urine High-Sensitivity Troponin I Predict Incident Cardiovascular Events in Patients with Diabetes Mellitus.

In patients with diabetes mellitus (DM), incident cardiovascular (CV) events are associated with poor long-term outcomes. Serum high-sensitivity troponin I (hs-TnI) is widely used to diagnose and predict outcomes in patients with acute coronary syndrome, however, few studies have investigated the accuracy of urine hs-TnI as a predictor for incident CV events in patients with DM. The enrolled participants included patients with DM. Fresh urine hs-TnI levels were measured. Medical records of enrolled patients were used to determine the number of incident CV events prospectively for 3 months. The study cohort comprised 378 participants. We observed significantly higher levels of urine hs-TnI in those with than without subsequent incident CV events. The multivariate logistic regression analysis using different models consistently showed that urine hs-TnI > 4.10 pg/mL was an independent factor predictive of incident CV events. The ROC-AUC analysis revealed that the optimal cutoff value for urine hs-TnI for predicting incident CV events was 1.55 pg/mL and the area was 0.611 (p = 0.027). A single measurement of urinary hs-TnI, collected easily and non-invasively, may be an acceptable biomarker for predicting subsequent incident CV events in patients with DM.

Urine N-terminal pro b-type natriuretic peptide is predictive of heart failure-related emergency department visits.

AIMS: Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes in patients with HF. Serum N-terminal pro b-type natriuretic peptide (NT-proBNP) is widely used to assist diagnosis and predict clinical outcomes in HF patients. Few studies have investigated the use of urine NT-proBNP as an HF biomarker. This study aims to assess the value of urine NT-proBNP for predicting ED visits for decompensated HF as compared with that of serum NT-proBNP. METHODS AND RESULTS: This study included 122 HF patients with reduced left ventricular ejection fraction (<50%). Serum and urine NT-proBNP levels were measured. Baseline data included demographics, comorbidities, and co-medications. Medical records were used to determine the incidence of visits to the ED for decompensated HF during the 3 months following the last visit. We observed significantly higher levels of both serum and urine NT-proBNP in patients with subsequent ED visits than in those without. Multivariate logistic regression analysis showed that urine NT-proBNP/creatinine ratio (OR, 1.031; 95% CI, 1.001-1.061; P = 0.046) but not serum NT-proBNP was an independent factor associated with subsequent ED visits. According to receiver-operating characteristic-area under the curve analysis, the optimal cut-off value of urine NT-proBNP/creatinine ratio for predicting subsequent heart-failure related ED visits was 0.272 pg/µg Cr (area under the curve, 0.675; P = 0.011). CONCLUSIONS: For HF patients with reduced left ventricular ejection fraction, a single measurement of urinary NT-proBNP/creatinine ratio is predictive of subsequent ED visits for decompensated HF. This non-invasive and easy measurement may be a clinically useful tool for monitoring clinical outcomes and identifying a subset of patients at higher risk of ED visits within a short time.