Background-The maximal oxygen uptake (peak V O 2 ) is used in risk stratification of patients with chronic heart failure (CHF). Peak V O 2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator. In contrast, the anaerobic threshold (V O 2 AT) and the ventilatory efficiency (V E versus V CO 2 slope) are less subject to these influences. Thus, we compared these parameters with peak V O 2 in identifying patients with CHF at increased risk for death within 6 months after evaluation. Methods and Results-We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF (114 coronary artery disease, 92 dilated cardiomyopathy, 17 others) at the Herzzentrum Ludwigshafen between 1995 and 1998. We measured peak V O 2 , V O 2 AT and V E versus V CO 2 slope. We selected peak V O 2 of Յ14 mL/kg per minute, V O 2 AT of Ͻ11 mL/kg per minute, and V E versus V CO 2 slope of Ͼ34 as threshold values for high risk of death. The median follow-up time was 644 days. Patients with peak V O 2 of Յ14 mL/kg per minute had a Ͼ3-fold-increased risk (ORϭ3.4; CI, 1.3 to 9.1), with V O 2 AT Ͻ11 mL/min per kg or V E versus V CO 2 slope Ͼ34 a 5-fold increased risk for early death (ORϭ5.3; CI, 1.5 to 19.0; ORϭ4.8; CI, 1.7 to 13.8, respectively). In patients with both V O 2 AT Ͻ11 mL/kg per minute and V E versus V CO 2 slope Ͼ34, the risk of early death was 10-fold higher (ORϭ9.6; CI, 2.1 to 44.7). After correction for age, sex, left ventricular ejection fraction, and New York Heart Association class in a multivariate analysis, the combination of V O 2 AT Ͻ11 mL/kg per minute and V E versus V CO 2 slope Ͼ34 was the best predictor of 6-month mortality (RRϭ5.1, Pϭ0.001). Conclusions-V O 2 AT of Ͻ11 mL/kg per minute and slope of V E versus V CO 2 Ͼ34, combined, better identified patients at high risk for early death from CHF than did peak V O 2 and should therefore be considered when prioritizing patients for heart transplantation. (Circulation. 2002;106:3079-3084.)

We have developed a rat model of inflammation-mediated osteopenia. Generalized loss of trabecular bone occurs in the rat after sc injection of nonspecific irritants such as talcum (magnesium silicate) and cotton wool (Cellulose). Although it appears likely that a systemic mediator of bone resorption is responsible for these effects, the loss of bone was not due to increased PTH secretion, since it occurred in parathyroidectomized rats, nor due to excessive 1,25-dihydroxyvitamin-D3 production. In parathyroidectomized rats, this inflammation was associated with significant increase in serum calcium within 4-7 days independent of its cause. Identification and characterization of this mechanism may provide insight into the bone loss associated with chronic inflammatory diseases such as rheumatoid arthritis and periodontal disease.

Hybrid NOTES reduces postoperative pain and is associated with greater cosmetic satisfaction in selected patients.

Extensive endoscopic mucosal resection (EMR) for Barrett's esophagus (BE) may lead to stenosis. Laparoscopic, transgastric, stapler-assisted mucosectomy (SAM) with the retrieval of a circumferential specimen is proposed. SAM was evaluated in two phases. The feasibility of SAM and the quality of specimens were assessed in eight animals. The mucosal healing was evaluated in a 6-week survival experiment comparing SAM (n = 6) with EMR (n = 6). The ratio of the esophageal lumen width (REL) at the resection level measured on fluoroscopy at 6 weeks divided by the width immediately after resection was compared. In all animals, a circular mucosectomy specimen was successfully obtained, with a median area of 492 mm (interquartile range [IQR] 426 - 573 mm) and 941 mm (IQR 813 - 1209 mm) using a 21 mm and 25 mm stapler, respectively. In the survival experiments, symptomatic stenosis developed in two animals after EMR and in none after SAM. The REL was 0.27 (0.18 - 0.39) and 0.96 (0.9 - 1.04; < 0.0001) for EMR and SAM, respectively. SAM provides a novel technique for en bloc mucosectomy in BE. In contrast to EMR, mucosal healing after SAM was not associated with stenosis up to 6 weeks after intervention.