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1.
J Formos Med Assoc ; 119(7): 1185-1192, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32386674

RESUMO

BACKGROUND/PURPOSE: The aim of this study was to predict outcomes of adrenalectomy for unilateral primary aldosteronism (PA) using non-stimulated adrenal venous sampling (AVS) indices and the standardized Primary Aldosteronism Surgical Outcome (PASO) criteria. METHODS: Patients with unilateral PA who underwent adrenalectomy based on non-stimulated AVS and had follow-up data regarding surgical outcomes between 2011 and 2016 were enrolled. Demographic data and non-stimulated AVS indices, including lateralization index (LI) and contralateral suppression, were collected for analysis. RESULTS: This study included 54 patients who underwent adrenalectomy. Clinical and biochemical outcomes were evaluated in all patients and in 52 (96.3%) patients, respectively. Complete clinical and biochemical success was achieved in 31 (57.4%) of 54 patients and 42 (80.8%) of 52 patients, respectively. An LI > 4 was significantly associated with complete clinical and biochemical success (OR = 4.30, 95% CI 1.18-15.68, p = 0.03, and OR = 7.55, 95% CI 1.28-44.47, p = 0.03, respectively). Contralateral suppression was an independent predictor of complete biochemical success (OR = 17.27, 95% CI 1.95-153.21, p = 0.01). CONCLUSION: Non-stimulated AVS indices including LI and contralateral suppression are reliable preoperative determinants for predicting the outcomes of adrenalectomy in patients with unilateral PA. Our findings provide more evidence and confidence to clinicians when applying non-stimulated AVS to determine PA treatment.

2.
J Am Heart Assoc ; 9(5): e013699, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32070205

RESUMO

Background Primary aldosteronism (PA) is associated with higher atrial fibrillation prevalence and other cardiovascular complications. However, the effect of target treatment to prevent new-onset atrial fibrillation (NOAF) remains unclear. This study investigated incidence of NOAF under different treatment strategies in patients with PA. Methods and Results We analyzed longitudinal data for patients with PA without atrial fibrillation history from 1997 to 2009 within the National Health Insurance Research Database in Taiwan. Patients with essential hypertension matched by propensity score were enrolled as controls. The primary outcome measurement was NOAF, and secondary outcome measurements were mortality, major cardiac and cardiac/cerebrovascular events, and a combined end point of NOAF and mortality. We identified 2202 patients with PA (534 adrenalectomy, 1668 mineralocorticoid receptor antagonist [MRA] therapy) and 8808 essential hypertension controls with mean follow-up of 4.4 years. In primary outcome measurement, patients with PA who underwent adrenalectomy had a lower incidence of NOAF (adjusted hazard ratio; 0.28, P=0.011) than controls. In contrast, the patients with PA who received MRA therapy had comparable risk of NOAF (adjusted hazard ratio, 1.20; P=0.224). In secondary outcome measurement, patients with PA who underwent adrenalectomy had a lower rate of mortality and combined end point of NOAF and mortality than controls. Patients with PA who received MRA therapy had a higher risk of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality than the essential hypertension controls. Conclusions Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF. However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32100478

RESUMO

BACKGROUND: Pancreatic cancer-associated diabetes mellitus (PCDM) is a paraneoplastic phenomenon characterized by worsening hyperglycaemia and weight loss. Galectin-3 and S100A9, mediators of PCDM, have pro-inflammatory functions and might thereby induce systemic inflammation and cachexia. We aimed to examine whether PCDM directly mediates cachexia. METHODS: Consecutive pancreatic cancer (PC) patients with and without PCDM (n = 88 each) with complete information were included. Cachexia was defined as weight loss >5% within 6 months or weight loss >2% and body mass index <20 kg/m2 or sarcopenia. Skeletal muscle mass was measured with lumbar skeletal muscle index (SMI) using computed tomography images. Cachexia-related parameters (prevalence of cachexia, weight loss, and SMI) were compared between patients with and without PCDM. Relations between cachexia-related parameters and fasting blood glucose or serum levels of galectin-3 and S100A9 were analysed by Spearman correlation and logistic regression analyses. RESULTS: One hundred two (58.0%) patients had cachexia at diagnosis. No significant differences existed between patients with and without PCDM in prevalence of cachexia (64.8% vs. 51.1%, P = 0.093), percentage of weight loss (median 6.8 vs. 4.0, P = 0.085), and SMI (median 45.8 vs. 45.3 cm2 /m2 in men, P = 0.119; 34.9 vs. 36.3 cm2 /m2 in women, P = 0.418). In patients with cachexia, the percentage of weight loss and SMI were also similar between patients with and without PCDM. In patients with PCDM, fasting blood glucose was comparable between patients with and without cachexia (P = 0.458) and did not correlate with the percentage of weight loss (P = 0.085) or SMI (P = 0.797 in men and 0.679 in women). Serum S100A9 level correlated with fasting blood glucose (correlation coefficient 0.213, P = 0.047) but not with the percentage of weight loss (P = 0.977) or SMI (P = 0.247 in men and 0.458 in women). Serum galectin-3 level also did not correlate with the percentage of weight loss (P = 0.226) and SMI (P = 0.201 in men and 0.826 in women). Primary tumour size was associated with cachexia (adjusted odds ratio per 1 cm increase 1.28, 95% confidence interval 1.02-1.60, P = 0.034), whereas PCDM, fasting blood glucose, and levels of galectin-3 and S100A9 were not predictors of cachexia. CONCLUSIONS: Neither fasting blood glucose nor levels of galectin-3 and S100A9 were associated with cachexia-related parameters. Mediators of PCDM and hyperglycaemia do not directly mediate PC-induced cachexia.

4.
J Clin Endocrinol Metab ; 105(6)2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31536622

RESUMO

CONTEXT: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients. OBJECTIVES: To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS. DESIGN AND SETTINGS: In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes. RESULTS: AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy was as low as <25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but reduced lateralization rates (P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria. CONCLUSION: Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test. (J Clin Endocrinol Metab XX: 0-0, 2020).

5.
J Hypertens ; 38(4): 745-754, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31764584

RESUMO

OBJECTIVE: The association between hyperaldosteronism and autoimmune disorders has been postulated. However, long-term incidence of a variety of new-onset autoimmune diseases (NOAD) among patients with primary aldosteronism has not been well investigated. METHODS: From Taiwan's National Health Insurance Research Database with a 23-million population insurance registry, the identification of primary aldosteronism, essential hypertension and NOAD as well as all-cause mortality were ascertained by a validated algorithm. RESULTS: From 1997 to 2009, 2319 primary aldosteronism patients without previously autoimmune disease were identified and propensity score-matched with 9276 patients with essential hypertension. Among those primary aldosteronism patients, 806 patients with aldosterone-producing adenomas (APA) were identified and matched with 3224 essential hypertension controls. NOAD incidence is augmented in primary aldosteronism patients compared with its matched essential hypertension (hazard ratio 3.82, P < 0.001, versus essential hypertension). Furthermore, NOAD incidence is also higher in APA patients compared with its matched essential hypertension (hazard ratio = 2.96, P < 0.001, versus essential hypertension). However, after a mean 8.9 years of follow-up, primary aldosteronism patients who underwent adrenalectomy (hazard ratio = 3.10, P < 0.001, versus essential hypertension) and took mineralocorticoid receptor antagonist (MRA) still had increased NOAD incidence (hazard ratio = 4.04, P < 0.001, versus essential hypertension). CONCLUSION: Primary aldosteronism patients had an augmented risk for a variety of incident NOAD and all-cause of mortality, compared with matched essential hypertension controls. Notably, the risk of incident NOAD remained increased in patients treated by adrenalectomy or MRA compared with matched essential hypertension controls. This observation supports the theory of primary aldosteronism being associated with a higher risk of multiple autoimmune diseases.

6.
Math Biosci Eng ; 16(6): 6350-6366, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31698566

RESUMO

Secret image sharing has been widely applied in numerous areas, such as military imaging systems, remote sensing, and so on. One of the problems for image sharing schemes is to efficiently recover original images from their shares preserved by the shareholders. However, most of the existing schemes are based on the assumption that the shares are distortion-free. Moreover, the correspondence between secret images and their shares is definite. To overcome these shortcomings, we propose a novel secret sharing scheme using multiple share images based on the generalized Chinese remainder theorem (CRT) in this paper, where all of the shares are needed to recover the original images. Two categories of distortions are considered. In the first category, some pairs of shares with the same moduli are exchanged, while in the second category, some of pixels in the pairs of shares with the same moduli are exchanged. Based on these two sharing methods, we propose a generalized CRT based recovery method. Compared with the existing CRT based methods as well as combinatorial based methods, the proposed approach is much more efficient and secure. Furthermore, the conditions for successful recovery of two images from the given distorted shares are obtained. Simulations are also presented to show the efficiency of the proposed scheme.

7.
Math Biosci Eng ; 16(6): 7934-7949, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31698648

RESUMO

An efficient data hiding method with modulo-2 operation and Hamming code (3, 2) based on absolute moment block truncation coding (AMBTC) is proposed. In order to obtain good data hiding performance, different textures are assigned to different embedding strategies. The AMBTC compressed codes are divided into smooth and complex blocks according to texture. In the smooth block, the secret data and the four most significant bits plane of the two quantization levels are calculated using modulo-2 operation to replace the bitmap in order to improve the security of data transmission. Moreover, Hamming code (3, 2) is used to embed the two additional secret bits in the three significant bits planes of the two quantization levels. In the complex block, one secret bit is embedded by swapping the order of two quantization levels and flipping the bitmap. Experimental results show that the proposed method achieves higher capacity than the existing data hiding methods and maintains good visual quality.

8.
Math Biosci Eng ; 16(5): 3435-3449, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-31499622

RESUMO

Since most of the previous video watermark algorithms regard a video as a series of consecutive images, the embedding and extraction of watermark are performed on these images, and the correlation and redundancy among frames of a video are not considered. Such algorithms are weak in protecting against frame attacks. In order to improve the robustness, we take into consideration the correlation and redundancy among the frames of a video to propose a blind video watermark algorithm based on tensor decomposition. First, a grayscale video is represented as a 3-order tensor, and the core tensor is obtained by tensor decomposition. Second, the watermark embedding position is selected based on the stability of the maximum value in the core tensor because the core tensor represents the main energy of a video. Then, the watermark is embedded by quantifying the maximum value in the core tensor. Finally, the watermark is uniformly distributed across frames of a video by inverse tensor decomposition. The experiments show that our algorithm based on tensor decomposition has better imperceptibility and robustness against common video attacks.

9.
Math Biosci Eng ; 16(5): 3947-3964, 2019 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31499644

RESUMO

With the extensive use of cloud services in different applications, it's a problem for the cloud service provider to manage or process the privacy data that are encrypted by the content owner. Therefore, signal processing technology in the encrypted domain has attracted the attention of researchers. In this paper, we propose a new reversible data hiding method for encrypted images based on two-phase histogram shifting. In the proposed method, the original image is encrypted by using special image division and additive homomorphic encryption. After image encryption, the encrypted image can partially maintain spatial correlation for data embedding while the content security of the encrypted image is ensured. Due to the spatial correlation, the data hider can generate two difference histograms from the encrypted image, which provide high embedding capacity. A two-phase histogram shift scheme is used to embed the secret data into the two difference histograms. At the receiver side, the secret data can be extracted from the encrypted image or the decrypted image, and the image can be recovered to its original version without any error. The experimental results demonstrated that the proposed method can efficiently improve the capacity of data embedding and outperform other related methods, while the visual quality of the marked image can be maintained.

10.
Hypertension ; 74(4): 800-808, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476901

RESUMO

We sought to measure the clinical benefits of adrenal venous sampling (AVS), a test recommended by guidelines for primary aldosteronism (PA) patients seeking surgical cure, in a large registry of PA patients submitted to AVS. Data of 1625 consecutive patients submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America were collected in a large multicenter international registry. The primary end points were the rate of bilateral success, ascertained lateralization of PA, adrenalectomy, and of cured arterial hypertension among AVS-guided and non AVS-guided adrenalectomy patients. AVS was successful in 80.1% of all cases but allowed identification of unilateral PA in only 45.5% by the criteria in use at each center. Adrenalectomy was performed in 41.8% of all patients and cured arterial hypertension in 19.6% of the patients, 2-fold more frequently in women than men (P<0.001). When AVS-guided, surgery provided a higher rate of cure of hypertension than when non-AVS-guided (40.0% versus 30.5%; P=0.027). Compared with surgical cases, patients treated medically needed more antihypertensive medications (P<0.001) and exhibited a higher rate of persistent hypokalemia requiring potassium supplementation (4.9% versus 2.3%; P<0.01). The low rate of adrenalectomy and cure of hypertension in PA patients seeking surgical cure indicates suboptimal AVS use, possibly related to issues in patient selection, technical success, and AVS data interpretation. Given the better outcomes of AVS-guided adrenalectomy, these results call for actions to improve the diagnostic use of this test that is necessary for detection of surgical PA candidates. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01234220.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Adrenalectomia , Aldosterona/sangue , Hiperaldosteronismo/sangue , Adulto , Coleta de Amostras Sanguíneas , Feminino , Humanos , Hiperaldosteronismo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
Hypertension ; 74(3): 623-629, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352825

RESUMO

Primary aldosteronism (PA) is hemodynamically independently associated with arterial wall stiffness as assessed by pulse wave velocity (PWV) compared with essential hypertension. Arterial wave reflection parameters derived from pulse wave analysis, such as forward and backward wave amplitudes (Pf and Pb), are promising vascular markers to predict cardiovascular outcomes in addition to PWV. These vascular parameters have never been studied in patients with PA before. In study part A, we prospectively enrolled 67 patients with PA and 132 patients with essential hypertension. In study part B, another 54 patients with PA were enrolled. Heart-carotid PWV was measured, and carotid pressure waveforms were recorded to calculate Pf, Pb, and augmentation index at baseline (part A and B) and 6 months after treatment (part B). The results showed that the patients with PA had significantly higher Pf (P=0.001), Pb (P=0.01), and PWV (P=0.021) than the patients with essential hypertension. In univariate correlation analysis, both log Pf and Pb were significantly correlated with age, office blood pressure, serum potassium level, log PWV, and the presence of PA. However, only Pb was significantly correlated with log plasma renin activity and log aldosterone to renin ratio. In multivariate analysis, log Pf was significantly correlated with the presence of PA (P=0.001), male sex, age, and mean arterial blood pressure. Pb was significantly correlated with the presence of PA (P=0.031), age, and mean arterial pressure. Six months after treatment, Pf and Pb decreased significantly. In conclusion, the patients with PA had significantly increased wave reflections compared with the patients with essential hypertension. Our results provide clinical evidence of aldosterone-related extensive vascular dysfunction of the arterial system.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/tratamento farmacológico , Hiperaldosteronismo/complicações , Hipertensão/tratamento farmacológico , Adulto , Aldosterona/sangue , Anti-Hipertensivos/farmacologia , Área Sob a Curva , Pressão Arterial/efeitos dos fármacos , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/diagnóstico , Hipertensão/etiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
12.
Surgery ; 166(3): 362-368, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31208863

RESUMO

BACKGROUND: The saline infusion test is widely used as a confirmatory test for primary aldosteronism, and we hypothesized that post-saline-infusion test aldosterone levels might predict the clinical outcomes in primary aldosteronism patients after adrenalectomy. METHODS: An observational cohort study was performed. We included primary aldosteronism patients who had undergone adrenalectomy from the Taiwan Primary Aldosteronism Investigation database between 1995 and 2017. The patients were divided into the following 2 groups: the clinical success group and the resist hypertension group, according to the criteria from the Primary Aldosteronism Surgery Outcome consensus. RESULTS: We enrolled 236 patients with primary aldosteronism (male, 41.1%; mean age, 49.8 years). A total of 79.7% patients achieved clinical success after adrenalectomy after 12-month follow-up. The clinical success group had higher mean blood pressure, higher aldosterone-to-renin ratio, lower potassium, and lower renin levels than that of the resist hypertension group. In multivariate logistic regression analysis, post saline-infusion test aldosterone levels higher than 48 ng/dL (odds ratio, 2.51; 95% confidence interval, 1.04-6.06; P = .040), body mass index less than 25 kg/m2 (odds ratio, 2.22; 95% confidence interval, 1.12-4.40; P = .023) and mean blood pressure higher than 115 mmHg (odds ratio, 2.79; 95% confidence interval, 1.37-5.68; P = .005) could predict better clinical success rates after adrenalectomy in primary aldosteronism patients. CONCLUSION: Our study demonstrated that the post-saline-infusion test aldosterone level could not only confirm primary aldosteronism but also forecast clinical outcomes in primary aldosteronism patients after adrenalectomy.


Assuntos
Adrenalectomia , Aldosterona/sangue , Biomarcadores , Hiperaldosteronismo/sangue , Hiperaldosteronismo/cirurgia , Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Adulto , Idoso , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Resultado do Tratamento
13.
Am J Hypertens ; 32(11): 1066-1074, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31216359

RESUMO

OBJECTIVE: The saline infusion test (SIT) and the captopril test (CT) are widely used as confirmatory tests for primary aldosteronism (PA). We hypothesized that post-SIT and post-CT plasma aldosterone concentrations (PAC) indicate the severity of aldosterone-producing adenoma (APA) and might predict clinical outcome. METHODS: We recruited 216 patients with APA in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry who received both seated SIT and CT as confirmatory tests. The data of 143 patients who underwent adrenalectomy with complete follow-up after diagnosis were included in the final analysis. We determined the proportion of patients achieving clinical success in accordance with the Primary Aldosteronism Surgical Outcome consensus. Logistic regression analysis was conducted to identify preoperative factors associated with cure of hypertension. RESULTS: Complete clinical success was achieved in 48 (33.6%) patients and partial clinical success in 59 (41.2%) patients; absent clinical success was seen in 36 (25.2%) of 143 patients. Post-SIT PAC but not post-CT PAC was independently associated with clinical outcome. Higher levels of post-SIT PAC had a higher likelihood of clinical benefit (complete plus partial clinical success; odds ratio = 1.04 per ng/dl increase, 95% confidence interval = 1.01, 1.06; P = 0.004). Patients with post-SIT PAC > 25 ng/dl were more likely to have a favorable clinical outcome after adrenalectomy. This cutoff value translated into a positive predictive value of 86.0%. CONCLUSIONS: We suggest that post-SIT PAC is a better predictor than post-CT PAC for clinical success in PA post adrenalectomy.

15.
Abdom Radiol (NY) ; 44(1): 292-303, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30019297

RESUMO

Solid pancreatic or peripancreatic lesions comprise a heterogeneous group of diseases that rely on a multimodality imaging approach for subsequent tissue procurement. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA)/biopsy is an effective and safe method for tissue diagnosis in this region. The failure to obtain adequate tissue for diagnosis under EUS guidance is still a rare but important issue. Percutaneous core needle biopsy (CNB) provides an alternative pathway for adequate specimen acquisition. Because of the deep retroperitoneal location, the percutaneous biopsy of pancreatic or peripancreatic lesions may inevitably pass through visceral organs. The procedure is relatively risky and difficult for general radiologists, particularly beginners, and an adequate knowledge of the abdominal anatomy and biopsy technique is indispensable. In this review, various aspects of percutaneous CNB for solid pancreatic or peripancreatic lesions using different trans-organ approaches are reviewed to increase the chance of successful biopsy.


Assuntos
Endossonografia/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Biópsia por Agulha Fina , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/patologia , Neoplasias do Sistema Digestório , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/patologia
16.
Eur Radiol ; 29(2): 628-635, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29974220

RESUMO

OBJECTIVES: The aim of this study was to compare single and tandem ureteral stenting in the management of malignant ureteral obstruction (MUO). METHODS: Our hospital's institutional review board approved this prospective study. Between November 2014 and June 2017, single ureteral stenting was performed in 56 patients (94 renal units) and tandem ureteral stenting in 48 patients (63 renal units) for MUO. A comparative analysis of the technical success rate, patient survival, stent patency, and complications was performed. RESULTS: Similar demographic data were observed in patients receiving either single or tandem ureteral stenting. The technical success rate was 93.6% (88/94) for single ureteral stenting and 95.2% (60/63) for tandem ureteral stenting. There was no difference in overall survival between patients receiving single or tandem ureteral stenting (p = 0.41), but the duration of stent patency in tandem ureteral stenting was significantly longer (p = 0.022). The mean patency time was 176.7 ± 21.3 days for single ureteral stenting, and 214.7 ± 21.0 days for tandem ureteral stenting. The complications of ureteral stenting were urinary tract infection (n = 18), lower urinary tract symptoms (n = 5), haematuria (n = 3), and stent migration (n = 1). CONCLUSIONS: Tandem ureteral stenting is a safe and feasible treatment for MUO, and had better efficacy compared to single ureteral stenting. KEY POINTS: • Ureteral stenting is an established treatment for the management of malignant ureteral obstruction (MUO) • Prospective single-centre study showed that tandem ureteral stenting is a safe and feasible treatment for MUO • Tandem ureteral stenting provides longer stent patency compared to single ureteral stenting in patient with MUO.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Feminino , Hematúria/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Cuidados Paliativos/métodos , Estudos Prospectivos , Stents/efeitos adversos , Ultrassonografia de Intervenção/métodos , Ureter , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Infecções Urinárias/etiologia
17.
J Formos Med Assoc ; 118(1 Pt 1): 72-82, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29506889

RESUMO

BACKGROUND/PURPOSE: Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS: The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS: In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION: We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.


Assuntos
Hiperaldosteronismo/terapia , Adrenalectomia/métodos , Consenso , Humanos , Laparoscopia , Saúde Mental , Metanálise como Assunto , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Sociedades Médicas , Revisões Sistemáticas como Assunto , Taiwan
18.
Crit Care ; 22(1): 313, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-30463626

RESUMO

BACKGROUND: The interaction between hyperaldosteronism and immune dysfunction has been reported and glucocorticoid co-secretion is frequently found in primary aldosteronism (PA). The aforementioned conditions raise the possibility of the infection risk; however, clinical episodes of sepsis have not been reported in PA. METHODS: Using Taiwan's National Health Insurance Research Database between 1997 and 2009, we identified PA and aldosterone-producing adenoma (APA) matched with essential hypertension (EH) at a 1:1 ratio by propensity scores. The incidences of sepsis and mortality after the index date were evaluated, and the risk factors of outcomes were identified using adjusted Cox proportional hazards models and taking mortality as a competing risk. RESULTS: We enrolled 2448 patients with PA (male, 46.08%; mean age, 48.4 years). There were 875 patients who could be ascertained as APA. Taking mortality as the competing risk, APA patients had a lower incidence of sepsis than their matched EH patients (hazard ratio (HR) 0.29; P < 0.001) after target treatments. Patients receiving adrenalectomy showed a benefit of decreasing the risk of sepsis (PA vs EH, HR 0.14, P = 0.001; APA vs EH, HR 0.16, P = 0.003), but mineralocorticoid receptor antagonist treatment may differ. Compared with matched control cohorts, patients with APA had a lower risk of all-cause mortality (PA, adjusted HR 0.84, P = 0.050; APA, adjusted HR 0.31, P < 0.001) after target treatments. CONCLUSIONS: Our study demonstrated that patients with PA/APA who underwent adrenalectomy could attenuate the risk of sepsis compared with their matched EH patients. We further found that APA patients with target treatments could decrease all-cause mortality compared with EH patients.


Assuntos
Hiperaldosteronismo/complicações , Sepse/etiologia , Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Adulto , Feminino , Humanos , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Medição de Risco/métodos , Fatores de Risco , Sepse/epidemiologia , Taiwan/epidemiologia
19.
J Clin Med ; 7(10)2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30332741

RESUMO

Accumulated evidence has shown that low renin hypertension is common in patients with diabetic nephropathy. However, the performance of aldosterone to renin ratio (ARR) in primary aldosteronism (PA) patients with diabetes has not been well validated. Here, we report the performance of screening ARR in PA patients with diabetes. The study enrolled consecutive patients and they underwent ARR testing at screening. Then the diagnosis of PA was confirmed from the Taiwan Primary Aldosteronism Investigation registration dataset. Generalized additive model smoothing plot was used to validate the performance of screening ARR in PA patients with or without diabetes. During this study period, 844 PA patients were confirmed and 136 (16.0%) among them had diabetes. Other 816 patients were diagnosed with essential hypertension and used as the control group and 89 (10.9%) among them had diabetes. PA patients with diabetes were older and had a longer duration of hypertensive latency, higher systolic blood pressure and lower glomerular filtration rate than those PA patients without diabetes. The cut-off value of ARR in the generalized additive model predicting PA was 65 ng/dL per ng/mL/h in diabetic patients, while 45 ng/dL per ng/mL/h in non-diabetic patients. There was a considerable prevalence of diabetes among PA patients, which might be capable of interfering with the conventional screening test. The best cut-off value of ARR, more than 65 ng/dL per ng/mL/h in PA patients with diabetes, was higher than those without diabetes.

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