Author Correction: Design of amidobenzimidazole STING receptor agonists with systemic activity.

Change history: In this Letter, author Ana Puhl was inadvertently omitted; this error has been corrected online.An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Go Green in Neuroradiology: towards reducing the environmental impact of its practice.

Raising public awareness about the relevance of supporting sustainable practices is required owing to the phenomena of global warming caused by the rising production of greenhouse gases. The healthcare sector generates a relevant proportion of the total carbon emissions in developed countries, and radiology is estimated to be a major contributor to this carbon footprint. Neuroradiology markedly contributes to this negative environmental effect, as this radiological subspecialty generates a high proportion of diagnostic and interventional imaging procedures, the majority of them requiring high energy-intensive equipment. Therefore, neuroradiologists and neuroradiological departments are especially responsible for implementing decisions and initiatives able to reduce the unfavourable environmental effects of their activities, by focusing on four strategic pillars-reducing energy, water, and helium use; properly recycling and/or disposing of waste and residues (including contrast media); encouraging environmentally friendly behaviour; and reducing the effects of ionizing radiation on the environment. The purpose of this article is to alert neuroradiologists about their environmental responsibilities and to analyse the most productive strategic axes, goals, and lines of action that contribute to reducing the environmental impact associated with their professional activities.

Design of amidobenzimidazole STING receptor agonists with systemic activity.

Stimulator of interferon genes (STING) is a receptor in the endoplasmic reticulum that propagates innate immune sensing of cytosolic pathogen-derived and self DNA1. The development of compounds that modulate STING has recently been the focus of intense research for the treatment of cancer and infectious diseases and as vaccine adjuvants2. To our knowledge, current efforts are focused on the development of modified cyclic dinucleotides that mimic the endogenous STING ligand cGAMP; these have progressed into clinical trials in patients with solid accessible tumours amenable to intratumoral delivery3. Here we report the discovery of a small molecule STING agonist that is not a cyclic dinucleotide and is systemically efficacious for treating tumours in mice. We developed a linking strategy to synergize the effect of two symmetry-related amidobenzimidazole (ABZI)-based compounds to create linked ABZIs (diABZIs) with enhanced binding to STING and cellular function. Intravenous administration of a diABZI STING agonist to immunocompetent mice with established syngeneic colon tumours elicited strong anti-tumour activity, with complete and lasting regression of tumours. Our findings represent a milestone in the rapidly growing field of immune-modifying cancer therapies.

Directional Response of Randomly Dispersed Carbon Nanotube Strain Sensors.

Tests on a double lap bonded joint, with transverse strips of randomly oriented carbon nanotubes (CNT) sprayed onto an epoxy adhesive film, showed a positive increment in electrical resistance under tensile load, even though the transverse strains were negative. Other experiments included in this work involved placing longitudinal and transversal CNT sensors in a tensile loaded aluminum plate, and, as reported by other authors, the results confirm that the resistance change is not only dependent on the strains oriented with the electrode line, while the other strain components also influence the response. This behavior is quite different to that of conventional strain gages which have a near zero sensitivity to strains not aligned to the sensor direction. The dependence of the electrical response on all the strain components makes it quite difficult, possibly unfeasible, to experimentally determine the individual strain components with this kind of sensors; however, the manufacturing of aligned CNT sensors could deal with this issue.

Absence of antibodies specific to Besnoitia spp. in European sheep and goats from areas in Spain where bovine besnoitiosis is endemic.

Besnoitia besnoiti and B. caprae, which infect bovids (cattle and antelopes) and goats, respectively, are responsible for besnoitiosis, a chronic and debilitating disease. Bovine besnoitiosis is considered to be a reemerging disease in Central and Western Europe. In addition, infection by Besnoitia spp. has been reported in reindeer from Sweden and Finland. Recently, the parasite was also detected in roe deer and red deer from Spain, where an interconnection between the domestic and sylvatic cycles of B. besnoiti has been presumed. In contrast, caprine besnoitiosis seems to be enzootic to Kenya and Iran. The presence of Besnoitia spp. in small domestic ruminants has never been explored in Europe, and the role that these species might play in the epidemiology of bovine besnoitiosis, as intermediate hosts or reservoirs of B. besnoiti, remains unknown. Herein, the first serosurvey conducted in European sheep and goats from areas in Spain where bovine besnoitiosis is endemic is described. Convenience sampling was conducted of 1943 sheep and 342 goats close to cattle from the Pyrenees and Central Spain that were infected with endemic Besnoitia spp. Serum samples were first analyzed by ELISA and then by confirmatory Western blot. Specific antibodies were not found in any sampled animal. Thus, sheep are unlikely to play a role in the epidemiology of bovine besnoitiosis, at least in the sampled areas. A larger serosurvey is necessary to determine whether goats might be a putative reservoir. To confirm the results of this study, sheep and goats should be further studied in other European countries and regions where their numbers are high and where bovine besnoitiosis is spreading.

Synthesis and Characterization of Multilayered CrAlN/Al2O3 Tandem Coating Using HiPIMS for Solar Selective Applications at High Temperature.

The effect of applying a negative bias during deposition of a previously designed multilayer solar selective absorber coating was studied on two types of substrates (316L stainless steel and Inconel 625). The solar selective coating is composed of different chromium aluminum nitride layers deposited using a combination of radiofrequency (RF), direct current (DC), and high-power impulse magnetron sputtering (HiPIMS) technologies. The chemical composition is varied to generate an infrared reflective/absorber layer (with low Al addition and N vacancies) and two CrAlN intermediate layers with medium and high aluminum content (Al/Cr = 0.6 and 1.2). A top aluminum oxide layer (Al2O3) is deposited as an antireflective layer. In this work, a simultaneous DC-pulsed bias (-100 V, 250 kHz) was applied to the substrates in order to increase the film density. The optical performance, thermal stability, and oxidation resistance was evaluated and compared with the performance obtained with similar unbiased coating and a commercial Pyromark paint reference at 600, 700, and 800 °C. The coating remained stable after 200 h of annealing at 600 °C, with solar absorptance (α) values of 93% and 92% for samples deposited on stainless steel and Inconel, respectively, and a thermal emittance ε25°C of 18%. The introduction of additional ion bombardment during film growth through bias assistance resulted in increased durability, thermal stability, and working temperature limits compared with unbiased coatings. The solar-to-mechanical energy conversion efficiency at 800 °C was found to be up to 2 times higher than Pyromark at C = 100 and comparable at C = 1000.

Molecular Modeling of Double Retrograde Vaporization Using Monte Carlo Simulations and Equations of State.

Vapor-liquid equilibria of binary systems consisting of a low-boiling (i.e., more volatile) and a high-boiling compound may exhibit unexpected behavior near the critical point of the low-boiling compound. Near the critical temperature of the low-boiling compound and for compositions rich in the low-boiling compound, increasing the pressure may result in multiple crossings of the dew- and bubble-point curves. This phenomenon is often called double retrograde vaporization (or condensation) and may play a role in oil field operations and gas transport through pipelines, but the microscopic driving forces for the unusual shape of the dew-point curve are not well understood. Monte Carlo simulations in the constant-pressure, constant-temperature Gibbs ensemble using the united-atom version of the TraPPE force field were carried out for the methane/n-butane mixture at temperatures ranging from 0.95 to 1.05 of the reduced (T/Tc) temperature of methane. The simulations predict a wealth of additional thermodynamic data (densities and free energies of transfer) and structural data that are used to provide much needed molecular-level insights into the fluid properties associated with double retrograde vaporization. Simulated thermodynamic data are also compared with calculations using the Peng-Robinson and PC-SAFT equations of state.

Comparing workload and performance during demanding push force and mental tasks.

BACKGROUND: The effects of performing occupational tasks that demand physical and mental efforts in combined and simultaneous approaches are unknown, especially when pushing force is analyzed as a physical effort and solving arithmetic problems as a mental effort. OBJECTIVE: In this study, physical and mental demands were simulated in a lab environment to assess the workload. METHODS: Using a push force dynamometer, the maximum push force strength of each participant was recorded, and the physical demand was simulated exerting the push force in low, medium, and high levels. Mental demands were simulated solving arithmetic tasks in low, medium, and high levels. Two experimental conditions were defined: (1) task with combined physical and mental workload (performing physical demands first and mental demands after) and (2) task in a simultaneous way (performing both demands at the same time. NASA-TLX Traditional and RAW were applied to assess the workload. RESULTS: The time to complete the tasks was significantly longer in the combined than the simultaneous approach, and performance was significantly higher in the combined than the simultaneous tasks. CONCLUSION: The combined approach obtained better results than simultaneous and Traditional NASA-TLX presented a significantly higher level of global workload index than RAW.

A Highly Stable and Sustainable Low-Temperature Selective Absorber: Structural and Ageing Characterisation.

Solar absorbers in a three-layer configuration have been prepared by dip-coating onto aluminium substrates. They are constituted by two spinel layers with one silica layer on the top and values of solar absorptance above 0.950 and thermal emittance below 0.04 were obtained. The effects of using different sintering conditions of the upper silica layer on the optical behaviour and durability tests have been studied. Results obtained in accelerated ageing methods, such as thermal stability tests and condensation tests, clearly show that the proposed selective absorber exhibits excellent thermal stability and very good humidity resistance. The results show that the protective action is due not only to the silica layer but also to the alumina layer produced during the absorber preparation. The phase composition of the individual layers was independently confirmed using X-ray diffraction and corroborated by X-ray Photoelectron Spectroscopy. Spinel-like phases were obtained in both the first and second layers. The ageing study shows that the three-layer configuration proposed has a very high potential, in terms of both durability and optical behaviour, for solar thermal low-temperature applications.

Analytical modeling for the bending resonant frequency of multilayered microresonators with variable cross-section.

Multilayered microresonators commonly use sensitive coating or piezoelectric layers for detection of mass and gas. Most of these microresonators have a variable cross-section that complicates the prediction of their fundamental resonant frequency (generally of the bending mode) through conventional analytical models. In this paper, we present an analytical model to estimate the first resonant frequency and deflection curve of single-clamped multilayered microresonators with variable cross-section. The analytical model is obtained using the Rayleigh and Macaulay methods, as well as the Euler-Bernoulli beam theory. Our model is applied to two multilayered microresonators with piezoelectric excitation reported in the literature. Both microresonators are composed by layers of seven different materials. The results of our analytical model agree very well with those obtained from finite element models (FEMs) and experimental data. Our analytical model can be used to determine the suitable dimensions of the microresonator's layers in order to obtain a microresonator that operates at a resonant frequency necessary for a particular application.

Laparoscopic aspiration cytology in rheumatoid ascites: a case report.

BACKGROUND: To the best of our knowledge, there are currently no recorded cytologic features of any effusion from rheumatoid peritonitis showing cytologic findings linked to rheumatoid pleural disease, although rheumatoid nodules have been described in the peritoneum. CASE: A 75-year-old man with longstanding, poorly controlled rheumatoid arthritis was seen in our hospital after a motor vehicle collision. Computed tomography showed free fluid in the abdominal cavity. Laparoscopic examination revealed a large amount of nonhemorrhagic ascitic fluid and no traumatic intraabdominal injuries. Abdominal and peritoneal surfaces appeared completely normal. The ascitic fluid was aspirated through the laparoscope and sent for cytologic examination. Cytospin preparations revealed histiocytes and loosely cohesive clusters of small cytologically bland epithelioid cells amid acute inflammatory cells and granular necrotic debris. Cell block material displayed transected fibroconnective tissue fragments lined by hyperplastic mesothelium with squamous metaplasia. Immunohistochemical studies revealed that the mesothelial cells were positive for calretinin, cytokeratin 5/6, and p63. CONCLUSION: The ascites was attributed to peritoneal disease from rheumatoid arthritis, based on the cytologic findings, immuno-profile, exclusion of other possible causes (i.e., cirrhosis, nephrotic syndrome, protein-losing enteropathy, or drugs), and patient's clinical setting.

Synthesis and Characterization of Inulin-Based Responsive Polyurethanes for Breast Cancer Applications.

In this study, new polyurethanes (PUs) were prepared by using inulin and polycaprolactone as polyols. Their structure and morphology were determined by Fourier transform infrared spectroscopy (FTIR), Raman dispersive spectroscopy, Nuclear magnetic resonance spectroscopy (1H NMR and 13C NMR), and scanning electron microscopy (SEM), whereas their mechanical properties were evaluated by a universal testing machine. Additionally, their water uptake, swelling behavior, and degradation were evaluated to be used as drug delivery carriers. Therefore, an anti-cancer drug was loaded to these PUs with 25% of loading efficiency and its release behavior was studied using different theoretical models to unveil its mechanism. Finally, the ability of the new PUs to be used as a clip marker in breast biopsy was evaluated. The results clearly demonstrate that these PUs are safe and can be used as intelligent drug release matrices for targeted drug delivery and exhibits positive results to be used for clip marker and in general for breast cancer applications.

Valores del perímetro abdominal e índice cintura-cadera en pacientes con hipertensión arterial / Values of abdominal perimeter and waist-hip ratio in patients with hypertension i: en

Introducción: La hipertensión arterial constituye un problema de salud pública en casi todo el mundo. Entre los factores de riesgo vinculados a ella se destaca la acumulación de grasa, que puede, a su vez, establecer los riesgos, las comorbilidades y la mortalidad asociados a esta entidad nosológica. Objetivo: Determinar las variaciones de los valores del perímetro abdominal y el índice cintura-cadera en pacientes con hipertensión arterial, según variables epidemiológicas y clínicas seleccionadas. Métodos: Se realizó un estudio descriptivo, prospectivo y transversal de 221 pacientes con hipertensión arterial, pertenecientes al Consultorio 19 del Policlínico Docente Josué País García del municipio de Santiago de Cuba, desde junio del 2019 hasta diciembre del 2020. Resultados: Predominó el sexo femenino y el grupo etario de 65-74 años (28,5 %). Los indicadores antropométricos perímetro abdominal e índice cintura-cadera tuvieron valores que superaron los parámetros normales establecidos para ambos sexos. El cálculo del perímetro abdominal reveló un predominio de la obesidad en el sexo femenino, en tanto se clasificó como aumentado en el sexo masculino. Conclusiones: Los valores del índice cintura-cadera y del perímetro abdominal en ambos sexos estuvieron por encima de los clasificados por la Organización Mundial de la Salud como de alto riesgo de presentar la enfermedad.

Introduction: Hypertension constitutes a problem of public health in almost all over the world. Among the risk factors associated with it, the accumulation of fat is notable, which can, in turn, establish risks and determine comorbidities and mortality associated with this nosological entity. Objective: To determine the variations in the values of the abdominal perimeter and waist-hip ratio in patients with hypertension, according to selected epidemiological and clinical variables. Methods: A descriptive, prospective and cross-sectional study was carried out on 221 patients with hypertension, belonging to doctor's office 19 of Josué País García Teaching Polyclinic in Santiago de Cuba municipality, from June, 2019 to December, 2020. Results: There was a prevalence of the female sex and the 65-74 age group (28.5%). The anthropometric indicators, abdominal perimeter and waist-hip ratio, had values that exceeded the established normal parameters for both sexes. The calculation of the abdominal perimeter revealed a predominance of obesity in the female sex, while it was classified as increased in the male sex. Conclusions: The values of the waist-hip ratio and abdominal perimeter exceeded those classified by the World Health Organization as high risk of presenting the disease in both sexes.

Rationale and design of the PHYSICALFAV trial: a randomized controlled trial to evaluate the effect of preoperative isometric exercise on vascular calibre and maturation of autologous arteriovenous fistulas.

BACKGROUND: A good vascular access (VA) is vital for haemodialysis (HD) patients. HD with an autologous arteriovenous fistula (AVF) is associated with higher survival, lower health care costs and fewer complications. Although a distal forearm AVF is the best option, not all patients are good candidates for this approach and the primary failure rate ranges from 20% to 50%. The optimal AVF depends mainly on the anatomical and haemodynamic characteristics of the artery and the vein chosen for the anastomosis. These characteristics can be modified by performing physical exercise. VA guidelines suggest that isometric exercises should be performed both before and after the AVF is created. While the literature contains few data on the potential efficacy of preoperative exercise, small observational studies point to an improvement in venous and arterial calibre. Postoperative exercise also seems to improve maturation, although there is no consensus on the appropriate exercise protocol. METHODS: The PHYSICALFAV trial (NCT03213756) is an open-label, multicentre, prospective, controlled, randomized trial designed to evaluate the usefulness of preoperative isometric exercise (PIE) in pre-dialysis patients or in prevalent HD patients who are candidates for a new AVF. Patients are randomized 1:1 to the PIE group (isometric exercises for 8 weeks) or the control group (no exercise). The main endpoint is whether the rate of primary failure is lower in the PIE group than in the control group. RESULTS: The trial has already started, with 40 patients having been enrolled as of 21 March 2018; 26.5% of the estimated sample.

Abciximab offers greater benefits to insulin-dependent diabetic patients undergoing coronary stent implantation.

INTRODUCTION AND OBJECTIVES: Abciximab use does not exceed 25% in most of the studies on diabetic patients undergoing stent implantation. The aim of this study was to evaluate whether abciximab could be more beneficial in different subgroups such as insulin-dependent (ID) patients and whether its use could provide additional benefits to those afforded by drug-eluting stents in these patients. PATIENTS AND METHODS: A total of 373 consecutive diabetics [223 non-insulin-dependent (NID) and 150 ID patients] who had undergone stent implantation were examined with a follow-up of 25.6+/-16.2 months. Abciximab was used in 21.7%. RESULTS: The abciximab-treated group had a lower rate of revascularization (26.8% vs. 15.8%. P=.02). The results by subgroups were as follows: NID nonabciximab, 23.5%; NID abciximab, 19% (P=NS); ID nonabciximab, 32.7%; ID abciximab, 12.2% (P=.05). In multivariate analysis, the restenosis predictors were insulin dependency (OR, 2.7), abciximab use (OR, 0.18), stent diameter (OR, 0.18). CONCLUSIONS: Abciximab use in diabetics with stent implantation has a favorable effect by reducing the need for new revascularization. This benefit is more evident in ID patients; the negative prognosis effect of being insulin-dependent is eliminated, and the percentage of events in this population over a long follow-up period is equal to those in NID patients.

Bamboo-Polylactic Acid (PLA) Composite Material for Structural Applications.

Developing an eco-friendly industry based on green materials, sustainable technologies, and optimum processes with low environmental impact is a general societal goal, but this remains a considerable challenge to achieve. Despite the large number of research on green structural composites, limited investigation into the most appropriate manufacturing methodology to develop a structural material at industrial level has taken place. Laboratory panels have been manufactured with different natural fibers but the methodologies and values obtained could not be extrapolated at industrial level. Bamboo industry panels have increased in the secondary structural sector such as building application, flooring and sport device, because it is one of the cheapest raw materials. At industrial level, the panels are manufactured with only the inner and intermediate region of the bamboo culm. However, it has been found that the mechanical properties of the external shells of bamboo culm are much better than the average cross-sectional properties. Thin strips of bamboo (1.5 mm thick and 1500 mm long) were machined and arranged with the desired lay-up and shape to obtain laminates with specific properties better than those of conventional E-Glass/Epoxy laminates in terms of both strength and stiffness. The strips of bamboo were bonded together by a natural thermoplastic polylactic acid (PLA) matrix to meet biodegradability requirements. The innovative mechanical extraction process developed in this study can extract natural strip reinforcements with high performance, low cost, and high rate, with no negative environmental impact, as no chemical treatments are used. The process can be performed at the industrial level. Furthermore, in order to validate the structural applications of the composite, the mechanical properties were analyzed under ageing conditions. This material could satisfy the requirements for adequate mechanical properties and life cycle costs at industrial sectors such as energy or automotive.

Analysis of spatial mobility in subjects from a Dengue endemic urban locality in Morelos State, Mexico.

INTRODUCTION: Mathematical models and field data suggest that human mobility is an important driver for Dengue virus transmission. Nonetheless little is known on this matter due the lack of instruments for precise mobility quantification and study design difficulties. MATERIALS AND METHODS: We carried out a cohort-nested, case-control study with 126 individuals (42 cases, 42 intradomestic controls and 42 population controls) with the goal of describing human mobility patterns of recently Dengue virus-infected subjects, and comparing them with those of non-infected subjects living in an urban endemic locality. Mobility was quantified using a GPS-data logger registering waypoints at 60-second intervals for a minimum of 15 natural days. RESULTS: Although absolute displacement was highly biased towards the intradomestic and peridomestic areas, occasional displacements exceeding a 100-Km radius from the center of the studied locality were recorded for all three study groups and individual displacements were recorded traveling across six states from central Mexico. Additionally, cases had a larger number of visits out of the municipality´s administrative limits when compared to intradomestic controls (cases: 10.4 versus intradomestic controls: 2.9, p = 0.0282). We were able to identify extradomestic places within and out of the locality that were independently visited by apparently non-related infected subjects, consistent with houses, working and leisure places. CONCLUSIONS: Results of this study show that human mobility in a small urban setting exceeded that considered by local health authority's administrative limits, and was different between recently infected and non-infected subjects living in the same household. These observations provide important insights about the role that human mobility may have in Dengue virus transmission and persistence across endemic geographic areas that need to be taken into account when planning preventive and control measures. Finally, these results are a valuable reference when setting the parameters for future mathematical modeling studies.

Alcoholic hepatitis with leukemoid reaction after surgery.

Alcoholic hepatitis (AH) is a clinicopathologic syndrome resulting from an excessive intake of alcohol. Leukemoid reactions (LRs) are characterized by a strikingly elevated granulocyte count over 40,000-50,000 cells/mm(3). Although a leukocytosis of 15,000-18,000 cells/mm(3) is frequently seen in AH, LRs are rare in this context. AH-associated LRs are a sign of poor prognosis and have a high mortality. A 64-year-old male with a history of heavy alcohol intake underwent a right hemicolectomy for cecal carcinoma. Preoperative laboratory data were normal with the exception of an albumin of 2.1 g/dL. Liver biopsies that were taken because of a nodular appearance revealed micronodular cirrhosis, steatohepatitis, and Mallory bodies. Postoperatively, the patient developed a leukocytosis that progressively increased to 72.6 cells/mm(3). He also developed signs of impaired hepatic and renal function. Extensive workup failed to reveal a source of infection. A trial of intravenous antibiotics had no impact on the leukocytosis. Methylprednisolone at a dose of 40 mg IV daily was started on postoperative day 9. The patient experienced a progressive decline in white blood count (WBC), which reached 25.2/mm(3) on postoperative day 14. However, he died on postoperative day 16. We conclude that the patient had AH-associated LR in the postoperative period, but died despite successful treatment of the LR with steroids.

Clinical and angiographic follow-up in patients with Cypher or Taxus stents in populations with high percentage of trial-excluded lesions.

BACKGROUND: Drug-eluting stents (DESs) are being used in real life in patients with complex lesions usually excluded from the published trials. It is reasonable to think that the results could be worse, and the performance may be different between DES when these complex lesions are included. METHODS AND MATERIAL: To investigate this issue, we studied our first 82 patients with DES (54 patients with Cypher (C) and 28 patients with Taxus (T) (129 lesions, with 1.57 lesions per patient). Seventy-one complex lesions were treated with C stent, 41 with T stent, and 17 with no DES. It was a high-risk population, as reflected by 64% unstable angina and 40% diabetes mellitus. Of the 112 DES complex lesions treated, 38% would have been excluded from the Sirius and Taxus IV trials. RESULTS: The main data on intra-segment angiographic measures showed a late luminal loss lower for the C stent than for the T stent (0.17+/-0.45 and 0.44+/-0.6, P=.02, respectively). The restenosis and target lesion revascularization percentages were also lower for the C stent (8.4% vs. 24.4%, P=.07 and 5.6% vs. 17.1%, P<.05, respectively). In the complex lesions without restenosis, 28% would have been excluded from the trials, while in complex lesions with restenosis, there were 53% (P=.05) (with a homogeneous percentage between the C and T groups). The predictor variables of restenosis in the 112 DES-treated complex lesions were length (P=.03, IC=0.97-1.6) and the pre-reference diameter (P=.06). CONCLUSIONS: In our experience, the C stent is superior to the T stent when treating populations with a high percentage of complex lesions excluded from the trials.

[Neurohormonal prediction of post-infarction ventricular dysfunction and coronary disease]. / Predicción neurohormonal de disfunción ventricular y enfermedad coronaria postinfarto.

Little information is available about the potential role of brain (type B) natriuretic peptide in patients with acute myocardial infarction. We therefore analyzed peptide levels, measured at discharge from our coronary care unit, in 56 patients admitted with a diagnosis of acute myocardial infarction. We examined peptide concentrations in the light of different features in our patients, and found a significant association between natriuretic peptide levels and the two most important prognostic factors: left ventricular ejection fraction, and the severity and extent of coronary disease. Type B natriuretic peptide was a good predictor of these features, and we conclude that concentration of type B natriuretic peptide, measured at discharge from the coronary care unit, provides important clinical and prognostic information in patients with acute myocardial infarction.