Giving birth after fertility-sparing treatment for primary leiomyosarcoma of the fallopian tube.

Primary leiomyosarcoma of the fallopian tube (PLFT) is an extremely rare gynecological malignancy that has only been described in case reports. Fertility-sparing treatment for PLFT has not been reported previously. A 24-year-old nulligravida woman was diagnosed with stage IC1 PLFT in the right fallopian tube after experiencing right lower quadrant pain for 2 weeks. She underwent laparoscopic right salpingectomy to preserve fertility followed by adjuvant chemotherapy with gemcitabine/docetaxel. She subsequently became pregnant spontaneously, delivering a term baby 27 months after treatment. This appears to be the only report of the use of fertility-preserving treatment for PLFT. The success of the treatment provides valuable information on the preservation of fertility in young women with PLFT.

Thermodynamic Derivation of the Reciprocal Relation of Thermoelectricity.

The Kelvin relation, relating the Seebeck coefficient and the Peltier coefficient, is a theoretical basis of thermoelectricity. It was first derived by Kelvin using a quasi-thermodynamic approach. However, Kelvin's approach was subjected to much criticism due to the rude neglect of irreversible factors. It was only later that a seemingly plausible proof of the Kelvin relation was given using the Onsager reciprocal relation with full consideration of irreversibility. Despite this, a critical issue remains. It is believed that the Seebeck and Peltier effects are thermodynamically reversible, and therefore, the Kelvin relation should also be independent of irreversibility. Kelvin's quasi-thermodynamic approach, although seemingly irrational, may well have touched on the essence of thermoelectricity. To avoid Kelvin's dilemma, this study conceives the physical scenarios of equilibrium thermodynamics to explore thermoelectricity. Unlike Kelvin's quasi-thermodynamic approach, here, a completely reversible thermodynamic approach is used to establish the reciprocal relations of thermoelectricity, on the basis of which the Kelvin relation is once again derived. Moreover, a direct thermodynamic derivation of the Onsager reciprocal relations for fluxes defined as the time derivative of an extensive state variable is given using the method of equilibrium thermodynamics. The present theory can be extended to other coupled phenomena.

A Symmetric Form of the Clausius Statement of the Second Law of Thermodynamics.

Bridgman once reflected on thermodynamics that the laws of thermodynamics were formulated in their present form by the great founders of thermodynamics, Kelvin and Clausius, before all the essential physical facts were in, and there has been no adequate reexamination of the fundamentals since. Thermodynamics still has unknown possibilities waiting to be explored. This paper begins with a brief review of Clausius's work on the second law of thermodynamics and a reassessment of the content of Clausius's statement. The review tells that what Clausius originally referred to as the second law of thermodynamics was, in fact, the theorem of equivalence of transformations (TET) in a reversible cycle. On this basis, a new symmetric form of Clausius's TET is proposed. This theorem says that the two transformations, i.e., the transformation of heat to work and the transformation of work from high pressure to low pressure, should be equivalent in a reversible work-to-heat cycle. New thermodynamic cyclic laws are developed on the basis of the cycle with two work reservoirs (two pressures), which enriches the fundamental of the second law of thermodynamics.

G3BP1 Inhibition Alleviates Intracellular Nucleic Acid-Induced Autoimmune Responses.

The detection of intracellular nucleic acids is a fundamental mechanism of host defense against infections. The dysregulated nucleic acid sensing, however, is a major cause for a number of autoimmune diseases. In this study, we report that GTPase-activating protein SH3 domain-binding protein 1 (G3BP1) is critical for both intracellular DNA- and RNA-induced immune responses. We found that in both human and mouse cells, the deletion of G3BP1 led to the dampened cGAS activation by DNA and the insufficient binding of RNA by RIG-I. We further found that resveratrol (RSVL), a natural compound found in grape skin, suppressed both intracellular DNA- and RNA-induced type I IFN production through inhibiting G3BP1. Importantly, using experimental mouse models for Aicardi-Goutières syndrome, an autoimmune disorder found in humans, we demonstrated that RSVL effectively alleviated intracellular nucleic acid-stimulated autoimmune responses. Thus, our study demonstrated a broader role of G3BP1 in sensing different kinds of intracellular nucleic acids and presented RSVL as a potential treatment for autoimmune conditions caused by dysregulated nucleic acid sensing.

Thermoelectric Cycle and the Second Law of Thermodynamics.

In 2019, Schilling et al. claimed that they achieved the supercooling of a body without external intervention in their thermoelectric experiments, thus arguing that the second law of thermodynamics was bent. Kostic suggested that their claim lacked full comprehension of the second law of thermodynamics. A review of history shows that what Clausius referred to as the second law of thermodynamics is the theorem of the equivalence of transformations (unfairly ignored historically) in a reversible heat-work cycle, rather than "heat can never pass from a cold to a hot body without some other change" that was only viewed by Clausius as a natural phenomenon. Here, we propose the theorem of the equivalence of transformations for reversible thermoelectric cycles. The analysis shows that the supercooling phenomenon Schilling et al. observed is achieved by a reversible combined power-refrigeration cycle. According to the theorem of equivalence of transformations in reversible thermoelectric cycles, the reduction in body temperature to below the ambient temperature requires the body itself to have a higher initial temperature than ambient as compensation. Not only does the supercooling phenomenon not bend the second law, but it provides strong evidence of the second law.

Correspondence of the Symmetry of Thermodynamic Properties of Matter with the Symmetry of Equations of State.

Thermodynamics contains rich symmetries. These symmetries are usually considered independent of the structure of matter or the thermodynamic state where matter is located and, thus, highly universal. As Callen stated, the connection between the symmetry of fundamental laws and the macroscopic properties of matter is not trivially evident. However, this view is now being challenged. Recently, with symmetry to the ideal gas equation of state (EOS), an ideal dense matter EOS has been proposed, which has been verified to be in good agreement with the thermodynamic properties of high-density substances. This indicates that there is a certain symmetry between the thermodynamic properties of substances in their high- and low-density limits. This paper focuses on the distinctive features and the significance of this symmetry. It is a new class of symmetry that is dependent on the thermodynamic state of matter and can be incorporated into the existing symmetrical theoretical system of thermodynamics. A potential path for developing the EOS theory arising from this symmetry is discussed. EOS at high densities could be developed by correcting or extrapolating the ideal dense matter EOS based on this symmetry, which might fundamentally solve the difficulty of constructing EOS at high densities.

An exploration of registered dietitian accreditation system development in China.

The registered dietitian system started late in China, and since 2014 a working committee of registered dietitians has been formed by the Chinese Nutrition Society to establish a national accreditation system in accordance with the international standard academic and internship requirements. The data from the certification examinations and registrations were collected and analyzed. 8,328 registered dietitians were included in the study, with 5,673 registered dietitians (RD) and 2,655 registered dietetic technicians (DTR). Among them, 45.27% of RDs have master degree or above, and 66.44% of DTRs have bachelor or above. 53.25% RDs work in medical institutions, 14.77% in colleges and universities, and 14.56% in enterprises; 48.21% DTRs work in the medical institutions, 30.28% in enterprises, and 7.34% in the community. Although six years of work has initially established a foundation of standardized registered dietitian accreditation system, the problems of limited resources for academic education and the lack of legislative protection for the profession remain prominent.

Measurement of Equilibrium Angiotensin II in the Diagnosis of Primary Aldosteronism.

BACKGROUND: Many medications (including most antihypertensives) and physiological factors affect the aldosterone/renin ratio (ARR) when screening for primary aldosteronism (PA). We sought to validate a novel equilibrium angiotensin II (eqAngII) assay and compare correlations between the aldosterone/angiotensin II ratio (AA2R) and the current ARR under conditions affecting the renin-angiotensin system. METHODS: Among 78 patients recruited, PA was excluded in 22 and confirmed in 56 by fludrocortisone suppression testing (FST). Peripheral levels of eqAngII, plasma renin activity (PRA) and direct renin concentration (DRC) were measured. RESULTS: EqAngII showed good consistency with DRC and PRA independent of PA diagnosis, posture, and fludrocortisone administration. EqAngII showed close (P < 0.01) correlations with DRC (r = 0.691) and PRA (r = 0.754) during FST. DRC and PRA were below their assays' functional sensitivity in 43.9% and 15.1%, respectively, of the total 312 samples compared with only 7.4% for eqAngII (P < 0.01). Bland-Altman analysis revealed an overestimation of PRA and DRC compared with eqAngII in a subset of samples with low renin levels. The AA2R showed not only consistent changes with the ARR but also close (P < 0.01) correlations with the ARR, whether renin was measured by DRC (r = 0.878) or PRA (r = 0.880). CONCLUSIONS: Dynamic changes of eqAngII and the AA2R show good consistency and close correlations with renin and the ARR. The eqAngII assay shows better sensitivity than DRC and PRA assays, especially at low concentrations. Whether the AA2R can reduce the impact of some factors that influence the diagnostic power of the ARR warrants further study.

Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life.

BACKGROUND/OBJECTIVES: The assessment of nutritional status and the quality of life in patients with gastric cancer has become one of the important goals of current clinical treatment. The purpose of this study was to assess the nutritional status in hospitalized gastric cancer patients by using patient-generated subjective global assessment (PG-SGA) and to analyze the influence of nutritional status on the patients' quality of life (QOL). METHODS: We reviewed the pathological diagnosis of gastric cancer for 2322 hospitalized patients using PG-SGA to assess their nutritional status and collected data on clinical symptoms, the anthropometric parameters (height, weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF), and hand-grip strength (HGS). We also collected laboratory data (prealbumin, albumin, hemoglobin) within 48 h after the patient was admitted to the hospital. The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) was used for QOL assessment in all patients. RESULTS: By using PG-SGA, we found 80.4% of the patients were malnourished (score ≥ 4) and 45.1% of the patients required urgent nutritional support (score ≥ 9). In univariate analysis, old age (> 65 years, p < 0.001), female (p = 0.007), residence in a village (p = 0.004), a lower level of education (p < 0.001), and self-paying (p < 0.001) were indicated as risk factors of patients with gastric cancer to be suffering from severe malnutrition. There was a negative correlation between PG-SGA and various nutritional parameters (p < 0.05). The quality of life was significantly different in gastric cancer patients with different nutritional status (p < 0.01). CONCLUSION: Malnutrition of hospitalized patients with gastric cancer in China is common and seriously affects the patients' quality of life. The nutritional status should be evaluated in a timely manner and reasonable nutritional intervention should be provided as soon as possible. The PG-SGA was fit for using as a clinical nutrition assessment method, being worthy of clinical application.

Thermomass Theory in the Framework of GENERIC.

Thermomass theory was developed to deal with the non-Fourier heat conduction phenomena involving the influence of heat inertia. However, its structure, derived from an analogy to fluid mechanics, requires further mathematical verification. In this paper, General Equation for Non-Equilibrium Reversible-Irreversible Coupling (GENERIC) framework, which is a geometrical and mathematical structure in nonequilibrium thermodynamics, was employed to verify the thermomass theory. At first, the thermomass theory was introduced briefly; then, the GENERIC framework was applied in the thermomass gas system with state variables, thermomass gas density ρh and thermomass momentum mh, and the time evolution equations obtained from GENERIC framework were compared with those in thermomass theory. It was demonstrated that the equations generated by GENERIC theory were the same as the continuity and momentum equations in thermomass theory with proper potentials and eta-function. Thermomass theory gives a physical interpretation to the GENERIC theory in non-Fourier heat conduction phenomena. By combining these two theories, it was found that the Hamiltonian energy in reversible process and the dissipation potential in irreversible process could be unified into one formulation, i.e., the thermomass energy. Furthermore, via the framework of GENERIC, thermomass theory could be extended to involve more state variables, such as internal source term and distortion matrix term. Numerical simulations investigated the influences of the convective term and distortion matrix term in the equations. It was found that the convective term changed the shape of thermal energy distribution and enhanced the spreading behaviors of thermal energy. The distortion matrix implies the elasticity and viscosity of the thermomass gas.

[Ingredients changes in Rehmanniae Radix processing based by HPLC-ELSD specific chromatogram].

To establish the HPLC-ELSD specific chromatogram analysis method of Rehmanniae Radix and Rehmanniae Radix Prae-parata, and analyze and compare their chemical compositions, so as to reveal the change regularity of compositions during the proces-sing. By HPLC-ELSD method, the chromatographic column for Prevail Carbohydrate ES(4.6 mm ×250 mm, 5 µm) was adopted, with acetonitrile(A)-water(B) as mobile phase for gradient elution, and the evaporative light-scattering detector was used. A total of 23 batches of Rehmannia Radix samples, and 25 batches of Rehmanniae Radix Praeparata samples and processing dynamic samples were compared. The established method had a great repeatability, precision and stability. Eight common chromatographic peaks were extracted from 23 batches of Rehmanniae Radix samples, 8 common peaks were extracted from 25 Rehmanniae Radix Praeparata, and 7 chromatographic peaks were identified. The composition ratio of Rehmannia Radix was changed greatly during the processing. When the simila-rity≥0.95 and the fructose peak area was more than 2 times of stachyose tetrahydrate or more than 20 times of raffinose, the processing degree conformed to the requirements of empirical identification. The three main oligosaccharides of Rehmanniae Radix were sucrose that was heated to generate fructose and glucose, stachyose tetrahydrate that was heated to generate melibiose, sucrose and fructose, and stachyose tetrahydrate that was heated to generate manninotriose. The change in the index of proportion between monosaccharides and oligosaccharides can be used as the quantitative criterion for the processing quality of Rehmanniae Radix Praeparata.

[Biological characteristics of wild Angelica sinensis seed].

Wild Angelica sinensis is almost endangered, studying the biological characteristics of wild A. sinensis seeds is helpful for varietal improvement and its conservation. This paper systematically studied the morphological structure, thousand seed weight, viability, storage and other basic biological characteristics of wild A. sinensis fruits and seeds, and focused on the germination of excised embryos,the development of embryo, the effects of the temperature,light and hormones on seed germination.The study found that:①The embryos are not fully developed when harvested, the initial germination rate was low, the embryos can develop. After 15 days of low temperature storage, the embryos can develop completely and the germination rate is significantly increased. These results show that wild A. sinensis seeds have no dormancy, and the low germination rate is due to the low maturity of wild A. sinensis seeds. ②The sui-table germination temperature of wild A. sinensis is 15-25 ℃,and the optimal temperature is 20 ℃. Light does not affect the germination of A. sinensis seeds.③The applicable concentration of GA_3 can promote seeds germination, IAA and 6-BA has no significant effect on germination.④The optimum storage condition is dry storage at 4 ℃. Wild A. sinensis seeds can be stored for 1.5 years and cultivated seeds can be stored for 1 year.During the introduction and conservation, the best treatment conditions were dry storage at 4 ℃ for 30 d and soaking seeds with 200 mg·L~(-1) GA_3, the germination rate can reach 86.7%.

[Transcriptomic data analyses of wild and cultivated Angelica sinensis root by high-throughput sequencing technology].

The root of Angelica sinensis is known throughout Asia for its traditional efficacy in invigorating and promoting blood circulation. The wild germplasm resources of A. sinensis was in short supply, and most of the commercial medicinal materials come from cultivation. To obtain the differences in the transcriptional levels of wild and cultivated of A. sinensis, the full-length transcriptome of A. sinensis was analyzed using PacBio SMRT three-generation high-throughput sequencing technology. Using the high-throughput sequencing platform Illumina HiSeq X Ten PE150, a root transcriptome dataset of wild and cultivated A.sinensis was obtained. The transcriptome sequencing analyses obtained 16.5 Gb database in wild and cultivated A.sinensis, after assembly steps, we obtain 113 906 transcript sequences(insfroms) with an average length of 1 466 nt. BLAST analysis indicated that 109 113(accounting for 95.79% of the total insfroms), 93 276(81.89%),60 638(53.24%),48 928(42.95%),42 876(37.64%)isofroms were successfully annotated in the NR, Swiss-port, GO, KO and KOG databases, respectively. The annotation information can be classified into three categories of biological processes, cellular components and molecular functions of GO classification, involving 128 KEGG standard metabolic pathways. Analysis of 25 463 differential insfroms, 15 090 higher expression in wild A. sinensis, and 10 373 higher in cultivated A. sinensis. In the enrichment analysis of GO and KEGG, differential insfroms were concentrated on the pathway of plant-pathogen interaction, MAPK signaling pathway-plant and plant hormone signal transduction. In this study, high-throughput sequencing was used to obtain the full-length transcription information of A. sinensis, and the overall characteristics of A. sinensis genetic information were clarified. By comparing the differential expression of wild and cultivated A. sinensis at the genetic level, it provides basic information for further screening and breeding of A. sinensis germplasm resources, resistance research and secondary metabolic pathway analysis.

Association Between Serum C-Reactive Protein Concentration and Nutritional Status of Malignant Tumor Patients.

BACKGROUND: The level of the systemic inflammatory marker C-reactive protein (CRP) is elevated in many patients with malignant disease and may be related to nutritional status. OBJECTIVE: To analyze the association between serum CRP levels in patients with malignant tumors and their nutritional status. METHOD: A total of 3,692 cases were analyzed and the serum CRP levels were determined using an immunometric assay. Nutritional status was assessed by using patient-generated subjective global assessment (PG-SGA). The biochemical evaluation of prealbumin (PA), albumin (ALB), cholesterol (CHOL), and triglycerides (TG) were assayed within 48 h admission to the hospital. The association between serum CRP concentration and the nutritional status, the stage of the tumor and other factors was analyzed by univariate and multivariate logistic regression analysis. RESULT: Elevated serum CRP was observed in 47.6% (1,548/3,269) of patients compared with the reference value, and the median CRP concentration was 18.29 mg/l. Patient serum CRP concentrations in the malnourished group (PG-SGA B + C) were higher than in the well-nourished (PG-SGA A) patients (P < 0.05). The serum CRP level was related to the patients' age, gender, tumor stage, and was affected by hepatitis, liver cirrhosis, diabetes, but it has no effect on hypertension. The CRP high patients had lower PA and ALB levels, lower Karnofsky performance status scores, and higher PG-SGA scores (P < 0.05), and there was no relationship with CHOL and TG levels. Weight loss in the previous 1 mo was seen with CRP positive patients (P < 0.05). CONCLUSION: Almost 50% of malignant tumor patients had elevated serum CRP levels indicating a systemic inflammatory state. The nutritional status was worse in cancer patients with higher concentrations of serum CRP. The level of CRP was associated with the tumor stage, and, as stage is a prognostic factor, so can CRP be used as a prognostic maker in malignant tumors patients.

[Population characteristics and threatened of wild Angelica sinensis in Gansu province].

The study aims to investigate spatial distribution pattern and age structure of wild Angelica sinensis in Gansu province.Ten plots each with an area of 100 m2 were set and the spatial coordinates of all wild A. sinensis individuals were measured within each plot. Based on plant individual mapping data,we explored the spatial distribution pattern and its differences between different life history stages of wild A. sinensis in Gansu province by using nearest neighbor distance statistics. Correlation analysis were carried out to explore the relationship between spatial aggregation degree and topographic factors. We also distinguished individuals to three life history stages( i.e. seedlings,adults and boltings) and then test the differences among/between them using nonparametric test.(1)We found that the dominant spatial distribution pattern of wild A. sinensis population in Gansu was aggregated distribution. There was no significant correlation between spatial aggregation degree of wild A. sinensis and altitude,slope and aspect. There was no significant difference between the average distance from seedlings to their nearest bolting individuals; the average distance from adult individuals to their nearest seedlings was significantly larger than the average distance from adult individuals to their nearest adult individuals; and the average distance from bolting individuals to their nearest adult individuals was significantly smaller than the average distance from bolting individuals to their nearest bolting individuals.(2)The age structure was showed as a declining population,characterized by less seedlings and bolting individuals,while more adult individuals within population. The population characteristics of wild A. sinensis,characterized by aggregated distribution pattern and senescent type of age structure,are disadvantage to its population development. The factors,such as habitat specialization,human activities and intraspecific competition,which shapes the current population characteristics,may increase the threatened status of wild A. sinensis. We suggest to strengthen the protection of wild A. sinensis.

Irreversibility and Action of the Heat Conduction Process.

Irreversibility (that is, the "one-sidedness" of time) of a physical process can be characterized by using Lyapunov functions in the modern theory of stability. In this theoretical framework, entropy and its production rate have been generally regarded as Lyapunov functions in order to measure the irreversibility of various physical processes. In fact, the Lyapunov function is not always unique. In the represent work, a rigorous proof is given that the entransy and its dissipation rate can also serve as Lyapunov functions associated with the irreversibility of the heat conduction process without the conversion between heat and work. In addition, the variation of the entransy dissipation rate can lead to Fourier's heat conduction law, while the entropy production rate cannot. This shows that the entransy dissipation rate, rather than the entropy production rate, is the unique action for the heat conduction process, and can be used to establish the finite element method for the approximate solution of heat conduction problems and the optimization of heat transfer processes.

The Principle of Least Action for Reversible Thermodynamic Processes and Cycles.

The principle of least action, which is usually applied to natural phenomena, can also be used in optimization problems with manual intervention. Following a brief introduction to the brachistochrone problem in classical mechanics, the principle of least action was applied to the optimization of reversible thermodynamic processes and cycles in this study. Analyses indicated that the entropy variation per unit of heat exchanged is the mode of action for reversible heat absorption or heat release processes. Minimizing this action led to the optimization of heat absorption or heat release processes, and the corresponding optimal path was the first or second half of a Carnot cycle. Finally, the action of an entire reversible thermodynamic cycle was determined as the sum of the actions of the heat absorption and release processes. Minimizing this action led to a Carnot cycle. This implies that the Carnot cycle can also be derived using the principle of least action derived from the entropy concept.

Reply to the Comments on: Tian Zhao et al. The Principle of Least Action for Reversible Thermodynamic Processes and Cycles. Entropy 2018, 20, 542.

The purpose of this reply is to provide a discussion and closure for the comment paper by Dr. Bormashenko on the present authors' article, which discussed the application of the principle of least action in reversible thermodynamic processes and cycles. Dr. Bormashenko's questions and misunderstandings are responded to, and the differences between the present authors' work and Lucia's are also presented.

[Study on original plant species and geographical distribution of Fructus Aurantii].

The original plant species of Fructus Aurantii are multitudinous and complex, and their requirements to the growing environment is strict. In order to clarify the original plant species and geographical distribution of Fructus Aurantii which recorded in the standards and circulated, used in commodity. The national and local standards of Chinese medicinal materials were collected and the original plants of Fructus Aurantii recoded in standards were found. Ten original plant species of Fructus Aurantii (including varieties of cultivars, the same below) were recorded in the Chinese pharmacopoeia and six local standards of Zhejiang, Yunnan and Guizhou etc. The producing areas and commodity in markets of Fructus Aurantii were investigated. The growth environment and geographical distribution of them were analyzed. There are six types of Fructus Aurantii i.e., Fructus Aurantii Chuan, Fructus Aurantii Xiang, Fructus Aurantii Jiang, Fructus Aurantii Qu, Fructus Aurantii Su, Fructus Aurantii Wen, and nineteen species of original plants in the practical commodities. There are four major Fructus Aurantii producing areas: Sichuan Basin, Dongting Lake Plain, Poyang Lake Plain, Jinqu Basin and its surrounding hilly areas. All of them are located in the area of the east longitude 104° to 121° and the northern latitudes 27° to 31°. There is a certain difference between the actual commodity and the standards of medicinal materials. It is suggested that the traditional mainstream types of Fructus Aurantii with fine quality should be accepted into Chinese Pharmacopoeia, and the types with poor quality should be withdrawn from Chinese Pharmacopoeia.

Can Screening and Confirmatory Testing in the Management of Patients with Primary Aldosteronism be Improved?

Widespread application of the plasma aldosterone/renin ratio (ARR) as a screening test has led to the recognition that primary aldosteronism (PA) is the most common specifically treatable and potentially curable form of hypertension, accounting for 5-10% of patients. Maximal detection requires accurate diagnostic approaches and awareness and control of factors that confound results, including most antihypertensives, posture, time of day, dietary salt, and plasma potassium. Recent studies have revealed potential for false positives in patients on beta-adrenoceptor blockers, and, when direct renin concentration (but not plasma renin activity) is used to measure renin, in women during the luteal phase of the menstrual cycle or receiving estrogen-containing contraceptives or hormonal replacement therapy. In addition to verapamil slow release, hydralazine and prazosin, moxonidine has minimal effects on the ARR and can be used to control hypertension during work-up. Fludrocortisone suppression testing, while probably the most reliable means of definitively confirming or excluding PA, is time consuming and expensive, requiring a five day inpatient stay. A novel approach, upright (seated) saline infusion suppression testing (SST), has shown excellent reliability with much greater sensitivity than conventional recumbent SST in a recent pilot study, and requires only a day visit. Accurate measurement of aldosterone is essential for each step of PA workup: introduction of new, highly reliable high-throughput mass spectrometric methods into clinical practice has represented a major advance. In response to concerns raised about accuracy of renin assays, new mass spectrometric methods for measuring angiotensin II are currently being assessed in the clinical setting.