A chitosan-camouflaged nanomedicine triggered by hierarchically stimuli to release drug for multimodal imaging-guided chemotherapy of breast cancer.

Breast cancer remains one of the most intractable diseases, especially the malignant form of metastasis, with which the cancer cells are hard to track and eliminate. Herein, the common known carbohydrate polymer chitosan (CS) was innovatively used as a shelter for the potent tumor-killing agent. The designed nanoparticles (NPs) not only enhance the solubility of hydrophobic paclitaxel (PTX), but also provide a "hide" effect for cytotoxic PTX in physiological condition. Moreover, coupled with the photothermal (PTT) properties of MoS2, results in a potent chemo/PTT platform. The MoS2@PTX-CS-K237 NPs have a uniform size (135 ± 17 nm), potent photothermal properties (η = 31.5 %), and environment-responsive (low pH, hypoxia) and near infrared (NIR) laser irradiation-triggered PTX release. Through a series of in vitro and in vivo experiments, the MoS2@PTX-CS-K237 showed high affinity and specificity for breast cancer cells, impressive tumor killing capacity, as well as the effective inhibitory effect of metastasis. Benefit from the unique optical properties of MoS2, this multifunctional nanomedicine also exhibited favorable thermal/PA/CT multimodality imaging effect on tumor-bearing mice. The system developed in this work represents the advanced design concept of hierarchical stimulus responsive drug release, and merits further investigation as a potential nanotheranostic platform for clinical translation.

Clinical features of plastic bronchitis in children after congenital heart surgery.

BACKGROUND: Plastic bronchitis (PB) can occur in patients who have undergone congenital heart surgery (CHS). This study aimed to investigate the clinical features of PB in children after CHS. METHODS: We conducted a retrospective cohort study using the electronic medical record system. The study population consisted of children diagnosed with PB after bronchoscopy in the cardiac intensive care unit after CHS from May 2016 to October 2021. RESULTS: A total of 68 children after CHS were finally included in the study (32 in the airway abnormalities group and 36 in the right ventricular dysfunction group). All children were examined and treated with fiberoptic bronchoscopy. Pathogens were detected in the bronchoalveolar lavage fluid of 41 children, including 32 cases in the airway abnormalities group and 9 cases in the right ventricular dysfunction group. All patients were treated with antibiotics, corticosteroids (intravenous or oral), and budesonide inhalation suspension. Children with right ventricular dysfunction underwent pharmacological treatment such as reducing pulmonary arterial pressure. Clinical symptoms improved in 64 children, two of whom were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) due to recurrent PB and disease progression. CONCLUSIONS: Children with airway abnormalities or right ventricular dysfunction after CHS should be alerted to the development of PB. Pharmacological treatment such as anti-infection, corticosteroids, or improvement of right ventricular function is the basis of PB treatment, while fiberoptic bronchoscopy is an essential tool for the diagnosis and treatment of PB. ECMO assistance is a vital salvage treatment for recurrent critically ill PB patients.

Cisplatin-loaded mesoporous polydopamine nanoparticles capped with MnO2 and coated with platelet membrane provide synergistic anti-tumor therapy.

A multifunctional nanoplatform was constructed in this work, with the goal of ameliorating the challenges faced with traditional cancer chemotherapy. Cisplatin (CP) was loaded into mesoporous polydopamine (mPDA) nanoparticles (NPs) with a drug loading of 15.8 ± 0.1 %, and MnO2 used as pore sealing agent. Finally, the NPs were wrapped with platelet membrane (PLTM). P-selectin on the PLTM can bind to CD44, which is highly expressed on the tumor cell membrane, so as to improve the targeting performance of the NPs. In addition, the CD47 on the PLTM can prevent the NPs from being phagocytosed by macrophages, which is conducive to immune escape. The final PLTM-CP@mPDA/MnO2 NPs were found to have a particle size of approximately 198 nm. MnO2 is degraded into Mn2+ in the tumor microenvironment, leading to CP release from the pores in the mPDA. CP both acts as a chemotherapy agent and can also increase the concentration of H2O2 in cells. Mn2+ can catalyze the conversion of H2O2 to OH, resulting in oxidative damage and chemodynamic therapy. In addition, Mn2+ can be used as a contrast agent in magnetic resonance imaging (MRI). In vitro and in vivo experiments were performed to explore the therapeutic effect of the NPs. When the concentration of CP is 30 µg/mL, the NPs cause approximately 50 % cell death. It was found that the PLTM-CP@mPDA/MnO2 NPs are targeted to cancerous cells, and in the tumor site cause extensive apoptosis. Tumor growth is thereby repressed. No negative off-target side effects were noted. MRI could be used to confirm the presence of the NPs in the tumor site. Overall, the nano-platform developed here provides cooperative chemotherapy and chemodynamic therapy, and can potentially be used for effective cancer treatment which could be monitored by MRI.

Non-invasive left ventricular pressure-strain loop study on cardiac fibrosis in primary aldosteronism: a comparative study with cardiac magnetic resonance imaging.

We investigated the potential diagnostic value of the myocardial work indices based on speckle tracking echocardiography for cardiac fibrosis in patients with primary aldosteronism. Our observational study included 48 patients with primary aldosteronism. We performed conventional echocardiography and the left ventricular pressure-strain loop analysis. We also performed cardiac magnetic resonance imaging to evaluate cardiac replacement fibrosis defined as late gadolinium enhancement (LGE). Patients with LGE (n = 30, 62.5%) had longer duration of hypertension and higher plasma NT-proBNP than those without LGE. Besides, they had a significantly (P ≤ 0.04) higher left ventricular mass index (121.3 ± 19.5 vs. 103.3 ± 20.0 g/m2) and global wasted work (205 ± 78 vs. 141 ± 36 mmHg%) and lower global longitudinal strain (-17.7 ± 1.8 vs. -19.0 ± 2.4%) and work efficiency (GWE, 90.9 ± 2.4 vs. 93.8 ± 1.5%). Receiver Operating Characteristics analysis showed that GWE ≤ 92% had a sensitivity and specificity of 76.7% and 83.3%, respectively, for LGE with the area under curve 0.85 (P < 0.001). In conclusion, both cardiac structure and function were impaired in patients with primary aldosteronism and cardiac fibrosis. The myocardial work index GWE showed significant value for the indication of cardiac fibrosis. Characterization of cardiac fibrosis in primary aldosteronism and the detective value of clinical and echocardiographic indices. Cardiac fibrosis was presented in 30 of the 48 analyzed primary aldosteronism patients with focal high signal intensity in mid-layer myocardium in limited segments as its characterization. The global work efficiency (GWE) had a significantly higher detective value for myocardial replacement fibrosis than other measurements such as left ventricular mass index (LVMI) and NT-proBNP.

Polydopamine-cloaked Fe-based metal organic frameworks enable synergistic multidimensional treatment of osteosarcoma.

One of the major challenges in effective cancer therapy arises because of the hypoxic microenvironment in the tumor. This compromises the efficacy of both chemo- and radiotherapy, and thus hinders patient outcomes. To solve this problem, we constructed polydopamine (PDA)-cloaked Fe-based metal organic frameworks (MOFs) loaded with d-arginine (d-Arg), glucose oxidase (GOX), and the chemotherapeutic drug tirapazamine (TPZ). These offer simultaneous multifaceted therapy combining chemodynamic therapy (CDT)/radiotherapy (RT)/starvation therapy (ST)/gas therapy (GT) and chemotherapy. The particles further can act as contrast agents in magnetic resonance imaging. GOX catalyses the conversion of endogenous glucose and O2 to hydrogen peroxide and gluconic acid, blocking the cells' energy supply and providing ST. With the resultant acidification of the local environment, the breakdown of the MOF releases TPZ (for chemotherapy) and Fe3+, which reacts with H2O2 to produce reactive oxygen species and thus stimulates the conversion of d-Arg to NO for GT and RT sensitization. The PDA coating not only seals the pores and chelates Fe3+ to enhance the T1-weighted magnetic resonance imaging (MRI) properties, but also is used to graft folate bovine serum albumin (FA-BSA) and thereby target the tumor site. The combined administration of low doses of X-ray irradiation and nanoparticles reduces the side effects on healthy tissue and can prevent lung metastases in mice. This work highlights the synergistic treatment of osteosarcoma via ST/GT/CDT/RT/MRI/ chemotherapy using a PDA-cloaked MOF system.

A multifunctional nanocomposite coated with a BSA membrane for cascaded nitric oxide therapy.

Gas therapy based on nitric oxide (NO) has emerged as a potential therapeutic approach for cancer, and in conjunction with multi-mode combination therapy, offers new possibilities for achieving significant hyperadditive effects. In this study, an integrated AI-MPDA@BSA nanocomposite for diagnosis and treatment was constructed for PDA based photoacoustic imaging (PAI) and cascade NO release. Natural NO donor L-arginine (L-Arg) and photosensitizer (PS) IR780 were loaded into mesoporous polydopamine (MPDA). Bovine serum albumin (BSA) was conjugated to the MPDA to increase the dispersibility and biocompatibility of the nanoparticles, as well as to serve as a gatekeeper controlling IR780 release from the MPDA pores. The AI-MPDA@BSA produced singlet oxygen (1O2) and converted it into NO through a chain reaction based on L-Arg, enabling a combination of photodynamic therapy and gas therapy. Moreover, due to the photothermal properties of MPDA, the AI-MPDA@BSA performed good photothermal conversion, which allowed photoacoustic imaging. As expected, both in vitro and in vivo studies have confirmed that the AI-MPDA@BSA nanoplatform has a significant inhibitory effect on cancer cells and tumors, and no apparent systemic toxicity or side effects were detected during the treatment period.

Comparison of biological behavior of lacrimal gland adenoid cystic carcinoma with high-grade transformation cells.

AIM: To evaluate the differences between human lacrimal gland adenoid cystic carcinoma with high-grade transformation (LACC-HGT) primary cells cultured by high-grade transformation tissue and non-high-grade transformation (non-HGT) primary cells cultured by non-high-grade transformation tissue in proliferation, metastasis, drug susceptibility, and genes. METHODS: LACC-HGT primary cells were established by tissue block culture, and the 4th to 10th generation primary cells were selected as research objects. The cells were preliminarily identified by immunofluorescent staining. The differences between non-HGT and LACC-HGT primary cells in terms of proliferation, metastasis, and drug susceptibility were compared by cell counting kit-8 (CCK-8) assay, wound healing, and drug sensitivity experiments. Differentially expressed genes were screened using mRNA array. Gene expression was analyzed using real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS: LACC-HGT primary cells were successfully cultured by tissue block culture. Immunofluorescence staining results showed that cytokeratin (CK) and CK7 expression levels were positive in LACC-HGT primary cells. CCK-8 results showed that the proliferation ability of LACC-HGT cells was significantly higher than that of non-HGT cells. Wound healing experiment showed that the migration ability of LACC-HGT cells was significantly higher than that of non-HGT cells. LACC-HGT cells were also less sensitive to cisplatin and paclitaxel than non-HGT cells. Compared with non-HGT cells, 9566 differentially expressed genes were found in LACC-HGT primary cells, of which 5162 were up-regulated and 4404 were down-regulated. The expression of N-acetylneuraminate pyruvate lyase (NPL), MARVEL domain containing 3 (MARVELD3), syntabulin (SYBU), and allograft inflammatory factor 1 (AIF1) was higher in LACC-HGT cells than in non-HGT cells, whereas that of periostin (POSTN) was lower. CONCLUSION: LACC-HGT primary cells have faster proliferation, stronger migration ability, and poorer sensitivity to chemotherapy drugs than non-HGT primary cells. The expression of mRNAs in non-HGT and LACC-HGT primary cells are significantly different. These features are speculated to be the reasons why high-grade transformation tissues exhibit higher malignant degree and poorer prognosis than their counterparts.

Data-driven fractional order feedback and model-less feedforward control of a XY reluctance-actuated micropositioning stage.

This paper proposes a compound data-driven control method to solve the problems of low damping resonance, different dynamic properties, and hysteresis in the large-range compliant micropositioning stage driven by a Maxwell reluctance actuator. First, in order to verify the proposed control algorithm, a reluctance-actuated, XY compliant micropositioning stage is constructed according to the principle of operation of a reluctance actuator. Second, in order to eliminate the influence of complex dynamics on the controller design, a fractional order proportional-integral feedback controller is designed using a data iterative feedback turning algorithm. Third, the finite impulse response feedforward filter is optimized using experimental data, and the on-line inverse estimation of the system frequency response function and its iterative feedforward compensation are carried out to further eliminate the influence of light damping resonance. Finally, the proposed control method is used for tracking the experiment and compared with other methods. The experimental results show that the proposed control method can better meet the requirements of high precision, fast speed, and strong anti-interference ability for large stroke micro/nanopositioning and tracking.

Erratum: Biomineralized Bimetallic Oxide Nanotheranostics for Multimodal Imaging-Guided Combination Therapy: Erratum.

[This corrects the article DOI: 10.7150/thno.40715.].

A new chitosan-based thermosensitive nanoplatform for combined photothermal and chemotherapy.

Targeting the delivery of anti-cancer drugs to a tumor site is essential for effective treatment and to ensure minimal damage to healthy cells and tissues. In this work, a chitosan-based nanoplatform was constructed for combined photothermal therapy and chemotherapy of breast cancer. The pH-sensitive and biocompatible biopolymer chitosan (CS) was grafted with N-vinylcaprolactam (NVCL) and modified with biotin (Bio), imparting it with temperature sensitive property and also the ability for active targeting. The polymer self-assembled to give nanoparticles (NPs) loaded with indocyanine green (ICG) and doxorubicin (DOX). When the NPs are exposed to near-infrared (NIR) laser irradiation, ICG converts the light to heat, inducing a significant phase transition in the NPs and facilitating the release of the drug cargo. In addition, the solubility of chitosan is increased in the slightly acidic microenvironment of the tumor site, which also promotes drug release. A detailed analysis of the NPs both in vitro and in vivo showed that the carrier system is biocompatible, while the drug-loaded NPs are selectively taken up by cancer cells. Particularly when augmented with NIR irradiation, this leads to potent cell death in vitro and also in an in vivo murine xenograft model of breast cancer.

Cu2+-Chelating Mesoporous Silica Nanoparticles for Synergistic Chemotherapy/Chemodynamic Therapy.

In this study, a pH-responsive controlled-release mesoporous silica nanoparticle (MSN) formulation was developed. The MSNs were functionalized with a histidine (His)-tagged targeting peptide (B3int) through an amide bond, and loaded with an anticancer drug (cisplatin (CP)) and a lysosomal destabilization mediator (chloroquine (CQ)). Cu2+ was then used to seal the pores of the MSNs via chelation with the His-tag. The resultant nanoparticles showed pH-responsive drug release, and could effectively target tumor cells via the targeting effect of B3int. The presence of CP and Cu2+ permits reactive oxygen species to be generated inside cells; thus, the chemotherapeutic effect of CP is augmented by chemodynamic therapy. In vitro and in vivo experiments showed that the nanoparticles are able to effectively kill tumor cells. An in vivo cancer model revealed that the nanoparticles increase apoptosis in tumor cells, and thereby diminish the tumor volume. No off-target toxicity was noted. It thus appears that the functionalized MSNs developed in this work have great potential for targeted, synergistic anticancer therapies.

Mesoporous Doxorubicin-Loaded Polydopamine Nanoparticles Coated with a Platelet Membrane Suppress Tumor Growth in a Murine Model of Human Breast Cancer.

Bringing together photothermal therapy and chemotherapy (photothermal-chemotherapy, PT-CT) is a highly promising clinical approach but requires the development of intelligent multifunctional delivery vectors. In this work, we prepared mesoporous polydopamine nanoparticles (MPDA NPs) loaded with the chemotherapeutic drug doxorubicin (DOX). These NPs were then coated with the platelet membrane (PLTM). The coated MPDA NPs are spherical and clearly mesoporous in structure. They have a particle size of approximately 184 nm and pore size of ca. 45 nm. The NPs are potent photothermal agents and efficient DOX carriers, with increased rates of drug release observed in vitro in conditions representative of the tumor microenvironment. The NPs are preferentially taken up by cancer cells but not by macrophage cells, and while cytocompatible with healthy cells are highly toxic to cancer cells. An in vivo murine model of human breast cancer revealed that the NPs can markedly slow the growth of a tumor (ca. 9-fold smaller after 14 days' treatment), have extended pharmacokinetics compared to free DOX (with DOX still detectable in the bloodstream after 24 h when the NPs are applied), and are highly targeted with minimal off-site effects on the heart, liver, spleen, kidney, and lungs.

Scalable Gamma-Driven Multilayer Network for Brain Workload Detection Through Functional Near-Infrared Spectroscopy.

This work proposes a scalable gamma non-negative matrix network (SGNMN), which uses a Poisson randomized Gamma factor analysis to obtain the neurons of the first layer of a network. These neurons obey Gamma distribution whose shape parameter infers the neurons of the next layer of the network and their related weights. Upsampling the connection weights follows a Dirichlet distribution. Downsampling hidden units obey Gamma distribution. This work performs up-down sampling on each layer to learn the parameters of SGNMN. Experimental results indicate that the width and depth of SGNMN are closely related, and a reasonable network structure for accurately detecting brain fatigue through functional near-infrared spectroscopy can be obtained by considering network width, depth, and parameters.

Fatigue Detection of Pilots' Brain Through Brains Cognitive Map and Multilayer Latent Incremental Learning Model.

This work proposes a nonparametric prior induced deep sum-logarithmic-multinomial mixture (DSLMM) model to detect pilots' cognitive states through the developed brain power map. DSLMM uses multinormal distribution to infer the latent variable of each neuron in the first layer of the network. These latent variables obeyed a sum-logarithmic distribution that is backpropagated to its observation vector and the number of neurons in the next layer. Multinormal distribution is used to segment the extended observation vector to form a matrix associated with the width of the next layer. This work also proposes an adaptive topic-layer stochastic gradient Riemann (ATL-SGR) Markov chain Monte Carlo (MCMC) inference method to learn its global parameters without heuristic assumptions. The experimental results indicate that DSLMM can extract more probability distribution contained in the brain power map layer by layer, and achieve higher pilot cognition detection accuracy.

Self-Paced Dynamic Infinite Mixture Model for Fatigue Evaluation of Pilots' Brains.

Current brain cognitive models are insufficient in handling outliers and dynamics of electroencephalogram (EEG) signals. This article presents a novel self-paced dynamic infinite mixture model to infer the dynamics of EEG fatigue signals. The instantaneous spectrum features provided by ensemble wavelet transform and Hilbert transform are extracted to form four fatigue indicators. The covariance of log likelihood of the complete data is proposed to accurately identify similar components and dynamics of the developed mixture model. Compared with its seven peers, the proposed model shows better performance in automatically identifying a pilot's brain workload.

Functionalized layered double hydroxide nanoparticles as an intelligent nanoplatform for synergistic photothermal therapy and chemotherapy of tumors.

In this work, a novel layered double hydroxide (LDH)-based multifunctional nanoplatform was built for synergistic photothermal therapy (PTT)/chemotherapy. The platform was modified using the peptide B3int to target cancer cells with overexpression of integrin αvß3. Indocyanine green (ICG) and doxorubicin (DOX) were loaded into the nanocarrier (LDH-PEG-B3int NPs) to form a system having a high drug loading (18.62%) and a remarkable photothermal conversion efficiency of 25.38%. It also showed pH-responsive and near-infrared (NIR)-triggered DOX release. In vitro and in vivo studies indicated that the anti-tumor activity of the combined delivery system was significantly higher than that of a single delivery system. This co-delivery nanosystem may be helpful for future application in the clinical treatment of cancer.

A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism.

Background: Current guideline recommends both surgery and drug treatment for primary aldosteronism. Treatment effects on the cardiac structure and function remain under investigation. Objective: We performed a prospective study in patients with primary aldosteronism to compare effects of surgery and drug treatment on the cardiac structure and function as assessed by the left ventricular (LV) pressure-strain loop, a novel echocardiographic technique that incorporates myocardial deformation and LV pressure. Methods: Our study included 39 and 28 patients treated with surgery and a mineralocorticoid antagonist, respectively. We performed conventional and speckle tracking echocardiography at baseline and 3 and 6 months of follow-up. Results: During follow-up, both surgery and drug treatment normalized serum potassium concentration and significantly reduced blood pressure. Both treatments significantly and similarly decreased LV mass index and left atrial volume index. However, only in the surgery group did global wasted work significantly decrease (200.8 ± 86.7 at baseline vs. 142.1 ± 58.1 mmHg% at 6 months) and global work efficiency (91.5 ± 3.1 vs. 93.6 ± 2.3%) and global longitudinal strain (-18.3 ± 2.7 vs. -19.2 ± 1.9%) significantly (p < 0.01) increase at 6 months of follow-up. The corresponding differences from the changes in the drug treatment group were 39.5 mmHg% (95% CI, 17.1, 62.0 mmHg%), -1.64% (95% CI, -2.56, -0.71%), and -0.85% (95% CI, -1.51, -0.20%), respectively. In addition, the changes in global wasted work at 6 months of follow-up was significantly correlated with that in 24-h urinary aldosterone excretion in the drug treatment group (r = 0.54) and two groups combined (r = 0.55), but not the surgery group. Conclusion: In spite of similar serum potassium normalization and blood pressure control, surgical removal of an adrenal gland, but not mineralocorticoid receptor antagonism, showed early improvement in cardiac function.

[Emission Characteristics and Environment Impacts of VOCs from Typical Rubber Manufacture].

The emission characteristics of VOCs from three typical rubber manufacture industries were studied by GC-MS/FID. Maximum incremental reactivity(MIR) and fractional aerosol coefficient(FAC) were employed to evaluate the ozone formation potential(OFP) and secondary organic aerosol(SOA) formation potential. The results show that the VOC types emitted from the manufacturing of rubber products mainly include alkanes, ketones, aldehydes, alcohols, and benzene series. For traditional rubber products manufactured through rubber mixing and vulcanization, the main pollutants are ketones and alcohols, whereas for production processes involving gluing and painting, the main pollutants belong to the benzene series. In terms of ozone impact, the traditional processes contribute to ozone formation mainly through oxygenated hydrocarbons. In industries that utilize adhesives and paints, the extensive use of these organic solvents lead to a significantly higher contribution of the benzene series than other VOC species to ozone formation; the benzene series account for 82.9% of the total contribution. In terms of SOA impact, the benzene series are the main contributor to SOA, whereas the contribution of VOCs from traditional processes is small; hence, SOA primarily originates from the gluing and painting processes. Therefore, in traditional production of rubber products through rubber mixing and vulcanization, the emission of oxygenated hydrocarbons should be preferentially controlled, whereas for rubber industries utilizing gluing and painting processes, the emission of benzene series should be preferentially controlled.

A non-invasive left ventricular pressure-strain loop study on myocardial work in primary aldosteronism.

We investigated the myocardial work derived from left ventricular pressure-strain loop in patients with primary aldosteronism or primary hypertension. We enrolled 50 patients with primary aldosteronism, 50 age- and sex-matched patients with primary hypertension, and 25 normotensive control subjects. We performed transthoracic echocardiography and speckle-tracking echocardiography-based left ventricular pressure-strain loop analysis to evaluate cardiac structure and function. Patients with primary aldosteronism and those with primary hypertension had similar clinic and ambulatory blood pressures, except that the former had a significantly (P = 0.03) higher nighttime systolic blood pressure. All subjects had normal left ventricular ejection fraction (66.4 ± 4.7%). Patients with primary aldosteronism had a greater left ventricular mass index than those with primary hypertension and the normal controls (111.0 ± 21.6 g/m2 versus 95.7 ± 17.7 and 77.9 ± 13.5 g/m2, respectively, P < 0.001). The global myocardial work index (GWI, 2336 ± 333, 2366 ± 288, and 2292 ± 249 mmHg%, respectively), and global constructive work (GCW, 2494 ± 325, 2524 ± 301, and 2391 ± 193 mmHg%, respectively), were comparable in the three groups (P ≥ 0.18). However, the global work efficiency (GWE) differed significantly (P < 0.001), being lowest in primary aldosteronism (91.1 ± 2.7%), intermediate in primary hypertension (93.5 ± 2.5%) and highest in controls (95.3 ± 1.5%). The opposite was true for the global wasted work (GWW) (205.6 ± 74.6, 142.0 ± 56.4 and 99.4 ± 33.7 mmHg%, respectively, P < 0.001). GWE was significantly correlated with the logarithmically transformed plasma concentration and the urinary excretion of aldosterone in patients with primary aldosteronism or primary hypertension (r = -0.43 for both, P < 0.001). The associations remained statistically significant (P ≤ 0.04) after further adjustment for several factors, including left ventricular mass index and clinic or nighttime blood pressure. In conclusion, GWE decreased and GWW increased in primary hypertension and further in primary aldosteronism, probably because of the adrenal aldosterone hypersecretion and the left ventricular mass index increase, while GWI and GCW were similar, indicating that similar and normalized total myocardial work might be a compensation in hypertension at the expense of work efficiency.