Plasma aldosterone response to ACTH stimulation test for diagnosis of primary aldosteronism: a cross-sectional study.

BACKGROUND: The diagnosis of primary aldosteronism (PA) requires screening and confirmation testing. The present study examined whether the 1 µg ACTH stimulation test for plasma aldosterone concentration (PAC) can accurately diagnose PA by bypassing the regular confirmatory steps of PA diagnosis. METHODS: A cross-sectional study with a total of 36 patients with an aldosterone-renin ratio (ARR) > 20 ng/dL per ng/m/hr were included. The confirmation test for PA was performed by saline infusion and the patients were categorized into PA and non-PA. PAC was collected at 20 and 40 min after 1 µg ACTH stimulation test. Multivariable logistic regression analysis was performed, and the associations are presented as odds ratios (OR) and 95% confidence intervals (CI). Diagnostic accuracy is presented as AuROC. RESULTS: Multivariable analysis found only PAC at 20 min after ACTH stimulation showed significant association with a diagnosis of PA (OR 1.18, 95%CI (0.99, 1.31), p = 0.040). AuROC for this value was 0.95 and the proposed cut-off was 52 ng/dL with a sensitivity of 71.4% and a specificity of 96.6%. CONCLUSIONS: Diagnosing PA may be aided by PAC at 20 min following 1 µg ACTH stimulation. This value may be used with patients for whom the confirmation test for PA cannot be conducted.

Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger?

BACKGROUND: Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. QUESTION/PURPOSE: Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? METHODS: Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath. No patients were lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-to-treat analysis was performed with all 120 patients, and a per-protocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. RESULTS: There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. CONCLUSION: Splinting alone is recommended as the initial treatment for adults with trigger finger because there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone. LEVEL OF EVIDENCE: Level I, therapeutic study.

Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients?

Background: The association between adrenal insufficiency (AI) and the treatment outcomes of cardiothoracic surgery patients has been little reported. The aims of this study were to investigate the incidence of AI and to compare the post-surgical outcomes of patients with perioperatively treated AI and patients with a normal adrenal response. Methods: A 1.5-year prospective study was conducted in 98 patients scheduled for cardiothoracic surgery. Patients were categorized as either AI or normal-adrenal-response patients. Those with AI were treated with stress doses of glucocorticoid perioperatively. The post-surgical outcomes of patients with AI and of those with a normal adrenaline response were analyzed using multivariable analysis. Results: The overall incidence of AI was 34.7%. There were no statistically significant differences in post-surgical outcomes, including prolonged hospital stay, postoperative infection, prolonged inotropic drug use and relative AI, between the two groups. Only the rate of hyperglycemia requiring insulin infusion was significantly higher in the AI group than in the non-AI group (OR = 14.15, 95% CI = 1.44-138.60, p = 0.02). Conclusions: The proper diagnosis and management of AI can result in surgical outcomes in AI patients comparable to those of normal-adrenal-response patients. Non-life-threatening hyperglycemia requiring insulin infusion was found only in the AI group.

Hormone replacement therapy in women and risk of carpal tunnel syndrome: a systematic review and metaanalysis.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy. Menopausal status and/or estrogen level may play a role in CTS. The evidence regarding the association between hormone replacement therapy (HRT) in postmenopausal women and CTS is still conflicting. This meta-analysis aimed to investigate the association between carpal tunnel syndrome (CTS) and women using hormone replacement therapy (HRT). METHODS: A search was conducted in the PubMed/Medline, Scopus, Embase, and Cochrane databases, from their inception through July 2022. Studies which reported on the association between any type of HRT use and the risk of developing CTS in postmenopausal women compared to a control group were included. Studies which did not include a control group were excluded. Of the 1573 articles extracted from database searches, seven studies involving 270,764 women were included of which 10,746 had CTS. The association between CTS and HRT use was evaluated using the pooled odds ratio (OR) with a 95% confidence interval (CI) under random-effects modelling. Risk of bias in each study was assessed using the Newcastle-Ottawa Scale (NOS) and version 2 of the Cochrane tool for assessing risk of bias in randomized trials (RoB 2). RESULTS: HRT use showed no statistically significant association with a higher risk of CTS with pooled odds ratio (OR) 1.49, 95% confidence interval (CI) 0.99-2.23, and p = 0.06, although high heterogeneity among the studies was observed (I2 97.0%, Q-test p-value < 0.001). Subgroup analysis of groups in non-randomized controlled studies showed a significantly increased risk of CTS, while groups in randomized controlled studies showed a decreased risk of CTS (pooled OR 1.87, 95% CI 1.24-2.83 versus pooled OR 0.79, 95% CI 0.69-0.92, respectively) with the p-value of group difference < 0.001. The risk of bias in most of the included studies was estimated to be low. CONCLUSIONS: This meta-analysis supports the safety of using HRT in postmenopausal women with potential risk factors for CTS. LEVEL OF EVIDENCE: I, Prognosis. REGISTRATION: INPLASY (202280018).

Comparison of patient preferences and responsiveness among common patient-reported outcome measures for hand/wrist injuries or disorders.

BACKGROUND: Patient-reported outcome measures (PROMs) were developed to examine patients' perceptions of functional health. Most studies compare the responsiveness of each type of questionnaire. However, reports of patient preferences among PROMs commonly used with patients with hand/wrist injuries or disorders are limited. This study aimed to compare patient preferences, factors associated with those preferences and responsiveness among the Disability of the Arm, Shoulder, and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), Patient-Rated Wrist/Hand Evaluation (PRWHE) and EQ-5D in patients with hand/wrist injuries or disorders. MATERIAL AND METHODS: This retrospective cohort study collected data on 183 patients with hand/wrist injuries or diseases who had visited a hand/wrist outpatient clinic or were hospitalized for surgery between 2017 and 2020. Patients had to be at least 18 years old and able to complete the four questionnaires included in the study. The four PROMs (DASH, MHQ, PRWHE and EQ-5D) were administered to the patients prior to treatment. After completing the questionnaires, patients were asked to answer two open-ended questions regarding their preferences. Multinomial logistic regression was used to identify factors related to patient preferences. Results are presented as the relative risk ratio (RRR). The standardized response mean (SRM) was used to evaluate questionnaire responsiveness. RESULTS: Of the 183 patients, most preferred the PRWHE questionnaire (n = 74, 41%), with the main reasons cited being "specific to injuries/diseases and reflects hand/wrist function (n = 23, 31%)" and "easy to complete (n = 22, 30%)." Sex was found to be associated with patient preference after adjusting for demographic data and reasons for choosing a PROM as confounders (RRR = 0.46, P value = 0.049). The PRWHE had the highest SRM, followed by DASH (0.92 and 0.88, respectively). CONCLUSIONS: The PRWHE is the most preferred by patients and is the most responsive questionnaire. It is recommended for use in clinical practice in situations where a clinician would like to use only one PROM for evaluating patients with various types of hand/wrist problems. LEVEL OF EVIDENCE: Prognostic III.

The differences of serum lipid profiles between primary aldosteronism and essential hypertension: a meta-analysis and systematic review.

BACKGROUND: The data on lipid profile differences between primary aldosteronism (PA) and essential hypertension (EH) patients are inconsistent and inconclusive. Most studies reported lower levels of lipid profiles in PA than in EH. This meta-analysis aimed to explore differences in serum lipid profiles including triglyceride (TG), total cholesterol (TC), LDL and HDL levels in PA patients and EH patients. METHODS: A search of published studies was performed using PubMed, Embase and Scopus databases from their inception through August 2022. Thirty studies involving 11,175 patients were identified. Inclusion criteria included 1) observational studies which contained data on any of the lipid profiles of interest (TG, TC, LDL and HDL) which could be acquired from baseline data or the outcomes, 2) data which should be compared between adult PA and EH patients and 3) the use of appropriate methods to diagnose PA. Standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated to assess effect size by using STATA program version 15.0. Risk of bias was assessed by Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional, cohort and case-control studies. RESULTS: Levels of the lipid parameters TG (SMD - 0.16 mmol/L; 95%CI (- 0.25, - 0.07)), TC (SMD - 0.30 mmol/L; 95%CI (- 0.41, - 0.19)) and LDL (SMD - 0.17 mmol/L; 95%CI (- 0.27, - 0.08)) were significantly lower in PA than in EH patients. There was no statistically significant difference in HDL between PA and EH patients (SMD - 0.08 mmol/L; 96%CI (- 0.23,0.07)). High levels of heterogeneity for TG, TC, HDL and LDL were observed in all studies. Risk of bias among the studies was low to moderate. CONCLUSION: Lower levels of TG, TC and LDL were observed in PA than in EH patients. Further study should be conducted to address the underlying mechanisms of lipid alteration in PA.

Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities.

TRIAL DESIGN: The prospective randomized controlled trial. BACKGROUND: This study compares outcomes in terms of early postoperative anterior wrist pain and time to return to work or activities of daily living of patients who underwent carpal tunnel syndrome (CTS) release with short incision and those who had minimally invasive surgery (MIS) with CTS kits. METHODS: A total of 24 patients diagnosed with primary CTS confirmed with electrodiagnosis at an academic university hospital were randomly assigned into one of two groups of 12 patients each: a short incision group and an MIS with tool-kit group using computer-generated block randomization (block of four). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. In the short incision group, skin was incised longitudinally from Kaplan's line to the area distal to transverse wrist crease (2.5-4.0 cm) while in the tool-kit group, an incision of less than 2.5 cm. was made using special MIS-CTS kits. Primary outcomes evaluated include visual analogue scale (VAS) measurement of pain intensity in the anterior carpal area both while at rest and while conducting daily activities at the 2nd week postoperatively as well as the time to return to activities of daily living and work. Improvement in the Michigan hand questionnaire (MHQ) score, a secondary outcome, was also measured at the 2nd week postoperatively. Patients, allocator and outcome assessor were blinded. RESULTS: Demographic data, including preoperative electrodiagnostic severity and occupation, were similar in the two groups. There were no significant differences in terms of VAS of the early postoperative anterior carpal area at rest (p > 0.99), while conducting daily activities (p = 0.89) and time to return to activities of daily living (p = 0.46) and work (p = 0.24). The MHQ score improvement at the 2nd week postoperatively showed no significant difference between the groups (p = 0.95). The MIS wound length in the tool-kit group was significantly shorter than in the short incision group (1.95 vs 2.92 cm, p < 0.01). CONCLUSIONS: There is no difference in early postoperative anterior wrist pain, time to return to work or to activities of daily living between the surgical techniques. Short incision is recommended for benefit in term of cost-effectiveness, while MIS with tool-kit could be preferred in patients who concerned in cosmetic appearance between the surgical techniques. TRIAL REGISTRATION: www. CLINICALTRIALS: in.th (TCTR20200530003). Registered 30 May 2020.

Association between diabetes mellitus and risk of infection after trigger finger release: a systematic review and meta-analysis.

PURPOSE: To investigate the association between diabetes mellitus and risk of infection after trigger finger release. METHODS: Reports of adult trigger finger patients who had undergone trigger finger release that included details of patient diabetic status and post-surgery infections were included in the study. Reports of congenital trigger finger release and incomplete data on either diabetic status or infection after surgery were excluded. Search engines were PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Web of Science from inception to third December 2021. The risk of infection after trigger finger release was compared between diabetic and non-diabetic patients by evaluating the pooled risk ratio (RR) with a 95% confident interval (CI) under random effects modeling. Risk of bias in each study was assessed using Newcastle-Ottawa Scale (NOS). RESULTS: A total of 213,071 trigger finger patients described in seven studies were identified. Overall, patients with diabetes mellitus had a 65% higher risk of infection after trigger finger release compared to non-diabetic patients (RR 1.65; 95% CI, 1.39-1.95). Diabetes mellitus increased the risk of infection following trigger finger surgery in both young and old age groups as well as obese and non-obese patients who underwent open release surgery. The risk of bias in each of the included studies was estimated as moderate to high. CONCLUSION: Meta-analysis results demonstrated that diabetes mellitus increases the risk of infection after trigger finger release. Glycemic control and percutaneous rather than open surgery might be strategies to the reduce risk of infection after trigger finger release in diabetic patients.

Hormonal Changes after R-CHOP Chemotherapy in Patients with Diffuse Large B-Cell Lymphoma: A Prospective Study.

Background and Objectives: There is a lack of data regarding hormonal metabolic abnormalities resulting from the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone), a commonly used chemotherapy in diffuse large B-cell lymphoma (DLBCL). This study aimed to determine the incidence of hormonal and metabolic changes after R-CHOP therapy. Methods and Methods: This prospective cohort study initially included 17 DLBCL patients. Hormonal tests, including gonadal function, thyroid function, and ACTH stimulation tests for cortisol and metabolic markers, were performed before the 1st and after the 5th cycle of R-CHOP. The paired t-test was used to evaluate the changes. Statistical significance was set at p < 0.05. Results: Out of 17 patients, two died before the last follow-up, and 15 completed the study. LH levels were significantly higher in males after the 5th cycle (p = 0.04), while no significant changes were observed in other hormonal levels. After the 5th cycle, the only trend toward statistical significance was observed with higher FSH in males, higher blood glucose, and cholesterol. After the 5th cycle of chemotherapy, seven patients had at least one hormonal dysfunction, three patients had alterations in their thyroid function tests. Three patients had adrenal insufficiency (AI), one of whom also had secondary hypothyroidism concomitant with hypogonadism and AI. Additionally, two males had hypogonadism, and impaired fasting glucose was observed in three patients. Conclusions: Hormonal and metabolic abnormalities can occur in DLBCL after the 5th R-CHOP cycle. A high level of awareness and careful observation is of value in detecting these abnormalities, as some can be lethal.

Predictive Factors of Functioning Adrenal Incidentaloma: A 15-Year Retrospective Study.

Background and Objectives: Adrenal incidentaloma is an adrenal mass that is found incidentally in abdominal imaging studies. It is important to categorize whether the mass is a functioning or non-functioning incidentaloma to determine the appropriate management and follow-up. Our study aimed to identify predictive factors for functioning adrenal incidentaloma that could assist in early detection and in determining which patients may require hormonal investigations. Materials and methods: This 15-year retrospective study was performed in a tertiary care medical center. A total of 244 patients with adrenal incidentaloma were identified, of whom 88 had functioning adrenal incidentaloma. The patients' clinical biochemical factors and radiographic parameters were reviewed. Multivariable analysis using logistic regression with backward stepwise selection analysis was performed. Results are presented as odds ratios (ORs) with 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results: A significant clinical predictor for functioning adrenal incidentaloma is a history of hypertension (OR 2.72, 95% CI(1.53, 4.82)), while significant radiological predictors include mass size >4 cm (OR 2.20, 95% CI(1.20, 4.02)) and Hounsfield units (HU) < 10 (OR 2.47, 95% CI(1.23, 4.94)). Conclusions: These easy-to-obtain clinical and radiological predictors can be used to help identify functioning adrenal incidentaloma. In clinical practice, taking these factors into consideration could potentially reduce the number of investigations required to diagnose functioning adrenal incidentaloma.

Cross­cultural adaptation, construct validity, reliability, and responsiveness of the Thai version of the Patient-Rated Wrist/Hand Evaluation (Thai PRWHE).

PURPOSE: To translate the Patient-Rated Wrist/Hand Evaluation (PRWHE) which is widely used as the evaluation in healthcare and research system in wrist/hand disorder patients into Thai (Thai PRWHE) and to examine its psychometric properties. METHODS: The PRWHE was translated to Thai, including cross-cultural adaptations, following standard guidelines. Psychometric properties were evaluated with 292 wrist/hand musculoskeletal disorder patients. Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability over a 7-day interval. Construct validity was evaluated using two methods: Spearman's rank correlation of related and unrelated subscales and confirmatory factor analysis (CFA). Responsiveness was analyzed using the standardized response mean (SRM). RESULTS: All subscales had high Cronbach's alpha (0.91-0.96). Evaluation of the Pain subscale found good correlations with the Thai PRWHE and the Thai version of disabilities of the arm, shoulder, and hand (Thai DASH) questionnaire (r = 0.55, P < 0.0001) in related dimensions. Unrelated dimensions, the Total Function subscale of the Thai PRWHE, and the Mobility subscale of the Thai EQ-5D-5L had a weak correlation (r = 0.09, P < 0.12). Comparison of the one-factor solution and the bifactor model found the first-order three-factor solution fitted the data better than other models. The test-retest reliability with 61 patients in each subscale revealed excellent reliability (ICC = 0.94-0.96). In the assessment of responsiveness, the SRM with 54 patients was large (0.94). CONCLUSIONS: The Thai PRWHE has excellent internal consistency in all modules and good construct validity and reliability for Thai patients and provides a large standardized response mean after treatment.

Predicting Survival in Thai Patients After Low Impact Hip Fracture Using Flexible Parametric Modelling: A Retrospective Cohort Study.

Predictive post-hip fracture mortality models have been presented for specific time points (in-hospital, 30-days or 1-year) and most provide marginal predictions based on the patient's risk group. However, the predictive model for individual survival probability following hip fracture is not available. This study aimed to develop a flexible parametric model for predicting individual survival probability for hip fracture patients. In this retrospective study, the medical charts of 765 Thai patients admitted to hospital with a hip fracture resulting from low-impact injury from January 2014 to December 2018 were reviewed. Predictors for all-cause mortality were identified using flexible parametric survival analysis and were used to develop the predictive model. The model was calibrated using a calibration graph and discrimination performance was evaluated using the C-statistic. Internal validity was assessed using bootstrapping. The overall mortality rate of the hip fracture patients was 14%. Predictors significantly associated with survival after hip fracture were age, active malignancy, dementia or Alzheimer's disease, chronic obstructive pulmonary disorder, diabetes mellitus, hemoglobin concentration, eGFR<30 mL/min/1.73m2 and operative treatments. The model-predicted survival was similar to that actually observed in the very low survival group in the first year after hip fracture. In bootstrapping, the apparent C-statistic and the test C-statistic of the reduced model were 0.79 (95% CI 0.77-0.81) and 0.79 (95% CI 0.78-0.80), respectively. The flexible survival model provides good predictive power for individual survival probability at any given time point within the first year after hip fracture and would be an easy to use tool in clinical practice.

A Thai version of the Michigan hand questionnaire (Thai MHQ): an investigation of the psychometric properties.

BACKGROUND: The Michigan Hand Questionnaire (MHQ) is widely used to assess the hand/wrist conditions. We translated the original version into Thai (Thai MHQ) and evaluated its psychometric properties. METHODS: After receiving permission, the original MHQ was translated and cross-culturally adapted to Thai following standard guidelines. Two hundred and seventeen patients who had hand/wrist injuries or disorders were included in the study. Internal consistency was evaluated using Cronbach's alpha. Test-retest reliability was analyzed using the intraclass correlation coefficient (ICC). Spearman's rank correlation among the subscales of Thai MHQ, Thai DASH and Thai EQ-5D-5L and also confirmatory factor analysis (CFA) were used to explore construct validity. The standardized response mean (SRM) was used to evaluate the responsiveness of the Thai MHQ. RESULTS: All subscales showed an acceptable Cronbach's alpha (0.79-0.98). The test-retest reliability of each subscale was good (ICC = 0.83-0.95). In related dimensions, strong correlation was demonstrated between the Activities of daily living subscale of the Thai MHQ and the Common activities subscale in the Thai DASH (r = 0.77, P < 0.0001). For unrelated dimensions, a weak correlation was found between the Aesthetics subscale in the Thai MHQ and the Mobility subscale in the Thai EQ-5D-5L (r = - 0.13, P = 0.05). The Thai MHQ had strong correlation with Thai DASH (r = - 0.79, P < 0.0001) and Thai EQ-5D-5L (r = 0.63, P < 0.0001). CFA showed that the 6-factor model demonstrated an acceptable fit to the data. The SRM of the Thai MHQ was 0.78, indicating relatively large responsiveness. The MIC of Thai MHQ using distribution methods (SEM) was 5.2. CONCLUSIONS: The Thai MHQ provides adequate internal consistency in all subscales as well as good construct validity and reliability for Thai patients and a relatively large standardized response mean at 2 months after treatment.

High body fat percentage is associated with primary aldosteronism: a cross-sectional study.

BACKGROUND: Excess aldosterone has been shown to be associated with obesity; however, there is currently a lack of data regarding the relationship between percentage of body fat and primary aldosteronism (PA), particularly pertaining to Asian populations. Furthermore, essential hypertension may mimic the condition of PA and there needs to be differentiation between the two. This study aimed to assess the association between percentage of body fat and PA. METHODS: A cross-sectional study was conducted in the outpatient department of the Endocrine and Metabolism Unit of the tertiary care medical center in Thailand. Data was obtained from 79 patients who had been screened for PA due to hypertension in young-onset, hypokalemia, adrenal incidentaloma or resistance hypertension. Essential hypertension was defined as patients who had high blood pressure and were negative for PA screening. Body fat percentage was assessed by bioelectrical impedance analysis. The relationship between percentage of body fat and a diagnosis of PA was assessed using logistic regression analysis, including adjustment for confounding factors. RESULTS: The participants were divided into a PA group (n = 41) and an essential hypertension group (n = 38). After controlling for confounding variables (age, sex, body mass index, cholesterol and insulin resistance status), the odds ratio of having PA in males with a percentage of body fat > 25% and females with percentage > 30% was 1.82 (95%CI = 1.79-1.86, p < 0.001). CONCLUSION: A higher percentage of body fat is associated with an increased risk of PA. Further studies need to be conducted to confirm the relationship between body fat percentage and PA.

Clinical and biochemical factors to predict biochemical adrenal insufficiency in hospitalized patients with indeterminate cortisol levels: a retrospective study.

BACKGROUND: Adrenal insufficiency (AI) in hospitalized patients is a fatal condition if left undiagnosed. Most patients may require an adrenocorticotropic hormone (ACTH) stimulation test to facilitate AI diagnosis. We aim to identify simple biochemical and clinical factors and derive a predictive model to help identify hospitalized patients with biochemical AI who have indeterminate 0800 h serum cortisol levels. METHODS: A seven-year retrospective study was performed in a tertiary care medical center. We identified 128 inpatients who had undergone low-dose or high-dose ACTH stimulation tests. The association between biochemical AI and other factors was evaluated using a logistic regression model clustering by ACTH dose. Stepwise regression analysis was used to demonstrate the predictive model. Diagnostic performance was evaluated using ROC analysis. RESULTS: Of the 128 patients, 28.1% had biochemical AI. The factors associated with biochemical AI were serum random cortisol < 10 µg/dL (OR = 8.69, p < 0.001), cholesterol < 150 mg/dL (OR = 2.64, p = 0.003), sodium < 140 mmol/L (OR = 1.73, p = 0.004)). Among clinical factors, cirrhosis (OR = 9.05, p < 0.001), Cushingoid appearance in those with exogenous steroid use (OR = 8.56, p < 0.001), and chronic kidney disease (OR = 2.21, p < 0.001) were significantly linked to biochemical AI. The AUC-ROC of the final model incorporating all factors was 83%. CONCLUSIONS: These easy-to-perform biochemical tests and easy-to-assess clinical factors could help predict biochemical AI in hospitalized patients with high accuracy. The physician should therefore have a high index of suspicion to perform dynamic tests for AI diagnosis in those who meet the proposed model criteria.

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study.

Background and Objectives: To diagnose adrenal insufficiency (AI), adrenocorticotropic hormone (ACTH) stimulation tests may need to be performed, but those tests may not be available in some institutions. In addition, they may not be necessary for some patients. The objective of this study was to identify clinical and biochemical factors that could facilitate AI diagnosis in outpatient departments and decrease the number of unnecessary dynamic tests. Materials and Methods: This seven-year retrospective study was performed in a tertiary care medical center. A total of 517 patients who had undergone ACTH stimulation tests in the outpatient department were identified. AI was described as a peak serum cortisol level of <18 µg/dL at 30 or 60 min after stimulation. The associations between clinical factors, biochemical factors, and AI were analyzed using the Poisson regression model and reported by the risk ratio (RR). Results: AI was identified in 128 patients (24.7%). Significant predictive factors for the diagnosis of AI were chronic kidney disease (RR = 2.52, p < 0.001), Cushingoid appearance (RR = 3.44, p < 0.001), nausea and/or vomiting (RR = 1.84, p = 0.003), fatigue (RR = 1.23, p < 0.001), serum basal cortisol <9 µg/dL (RR = 3.36, p < 0.001), serum cholesterol <150 mg/dL (RR = 1.26, p < 0.001), and serum sodium <135 mEq/L (RR = 1.09, p = 0.001). The predictive ability of the model was 83% based on the area under the curve. Conclusion: The easy-to-obtain clinical and biochemical factors identified may facilitate AI diagnosis and help identify patients with suspected AI. Using these factors in clinical practice may also reduce the number of nonessential dynamic tests for AI.

Prognostic Factors for All-Cause Mortality in Thai Patients with Fragility Fracture of Hip: Comorbidities and Laboratory Evaluations.

Background and Objectives: Although the types of comorbidities and laboratory evaluations are major factors associated with mortality after hip fractures, there have been no studies of the association of these factors and mortality in Thai hip-fracture patients. This study aimed to identify prognostic factors associated with mortality after a hip fracture in the Thai population, including types of comorbidities, treatment-related factors, and laboratory evaluations. Materials and Methods: This five-year retrospective study was conducted in a tertiary care hospital in Thailand. A total of 775 Thai patients who had been admitted with a hip fracture resulting from a simple fall were identified using the International Classification of Disease 10 codes, and a review of their medical charts was conducted. Associations between general factors, comorbidities, laboratory evaluations, treatment factors including type of treatment, and time to death were analyzed using the Cox proportional hazard regression and the hazard ratio (HR). Results: The overall mortality rate of hip fracture patients was 13.94%. Independent prognostic factors found to be significantly associated with mortality were nonoperative treatment (HR = 3.29, p < 0.001), admission glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (HR = 3.40, p < 0.001), admission hemoglobin concentration <10 g/dL. (HR = 2.31, p < 0.001), chronic obstructive pulmonary disorder (HR = 2.63, p < 0.001), dementia or Alzheimer's disease (HR = 4.06, p < 0.001), and active malignancy (HR = 6.80, p < 0.001). Conclusion: The types of comorbidities and laboratory evaluation findings associated with mortality in Thai patients with hip fractures include chronic obstructive pulmonary disorder, dementia or Alzheimer's disease, active malignancy, admission GFR < 30 mL/min/1.73 m2, and admission hemoglobin concentration <10 g/dL. The risks of mortality for Thai hip-fracture patients with these comorbidities or laboratory evaluation findings were 2.5, 4, 7, 3.5, and 2.5 times higher, respectively, than patients without those factors.

Potent Anti-Proliferation on the Colon Cancer Cell Line (HT-29) of Liposomal Formulations Entrapped with Semi-Purified Job's Tears (Coix lacryma-jobi Linn.) Fractions.

Liposomes, entrapped with Job's Tears fractions, were prepared by the supercritical carbon dioxide fluid (scCO2) technique with and without sonication. Physical characteristics, which were the particle size, zeta potential, vesicular morphology, microviscosity and bioactivities including anti-proliferative, apoptotic and antioxidative activities of the S1L-S5L liposomal systems, were investigated. The potent anti-proliferative activity with the IC50 value of 4.44±2.31 ug/ml in a colon cancer cell (HT-29) was observed in the S5L. S5L also showed the apoptotic activity of 4.45±0.92% in an HT-29 cell. For antioxidative activities, the S3L showed the highest free radical scavenging activity and lipid peroxidation inhibition, whereas the S4L gave the highest metal chelating activity. This study has demonstrated the potent anti-proliferative activity on an HT-29 cell of the S5L liposomal formulation prepared by the scCO2 technique which can be further developed towards a novel anticancer drug.

Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial.

BACKGROUND: Recent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks. METHODS: The prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Twenty-five patients with mild to moderately severe CTS were randomized to receive either single-dose rESWT (n = 13) or LCsI (n = 12). Primary outcomes were evaluated using the Boston self-assessment questionnaire (BQ), while secondary outcomes used the Visual analogue scale (VAS) and electrodiagnostic parameters. Evaluations at baseline and at 1, 4, 12 and 24 weeks after treatment were performed. RESULTS: There was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period. CONCLUSIONS: Treatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI. TRIAL REGISTRATION: ( TCTR20150709001 ). Registered 9 July 2015.

Transfollicular enhancement of methyl myristate loaded in cationic niosomes incorporated in hair lotion.

Hair lotion containing methyl myristate loaded in cationic niosomes (HL-MMnio) composed of Brij72/cholesterol/DDAB at 7:3:0.65 molar ratio was developed. The remaining percentages of MM loaded in cationic niosomes in hair lotion were higher than free MM in hair lotion of about 1.2 times. The cumulative amounts in porcine skin and the receiver compartment of MM loaded in cationic niosomes incorporated in hair lotion were higher than those of free MM in hair lotion of 1.45 and 1.32 times, respectively. HL-MMnio showed very slightly irritation on rabbit skin, which was disappeared after 4 d. For melanogenesis induction in C57BL/6 mice with aged-induced grey body coat hairs, the highest pigmentation scores of HL-MMnio applied on the dorsal area were observed after 21 days, while hair lotion containing the free MM indicated after 35 days. This study has suggested that HL-MMnio was the high potential formulation for canities treatment.