scholarly journals Random ‘spot’ urinary metanephrines compared with 24-h-urinary and plasma results in phaeochromocytomas and paragangliomas

2020 ◽  
Vol 183 (2) ◽  
pp. 129-139 ◽  
Author(s):  
Emilia Sbardella ◽  
Zoe Maunsell ◽  
Christine J H May ◽  
Michael Tadman ◽  
Tim James ◽  
...  
Keyword(s):  
Urine Output ◽  
Plasma Concentrations ◽  
Correlation Coefficients ◽  
Reference Intervals ◽  
Spot Urine ◽  
Upper Limit ◽  
Plasma Metanephrines ◽  
Urinary Metanephrines ◽  
Urine Specimens

Background In patients with phaeochromocytomas or paragangliomas (PPGLs), 24-h urine collections for metanephrines (uMNs) are cumbersome. Objective To evaluate the diagnostic utility of ratios to creatinine of ‘spot’ uMNs. Methods Concentrations of uMNs and plasma metanephrines (pMNs) were measured by HPLC-mass-spectrometry. We retrospectively compared correlations of 24-h-urine output and ratio to creatinine in historical specimens and prospectively assessed 24-h and contemporaneous spot urines and, where possible, pMNs. Using trimmed log-transformed values, we derived reference intervals based on age and sex for spot urines. We used multiples of upper limit of normal (ULNs) to compare areas under curves (AUCs) for receiver-operator characteristic curves of individual, and sum and product of, components. Results In 3143 24-h-urine specimens on 2416 patients, the correlation coefficients between the ratios and outputs of metanephrine, normetanephrine and 3-methoxytyramine in 24-h urines were 0.983, 0.905 and 0.875, respectively. In 96 patients, the correlations between plasma concentrations, urine output and ratios in spot specimens were similar to those for raw output or ratios in 24-h specimens. Of the 160 patients with PPGLs, the CIs for AUCs for individual metabolites overlapped for all four types of measurement, as did those for the sum of the multiple ULNs although these were slightly higher (AUC for spot urine: 0.838 (0.529–1), plasma: 0.929 (0.874–0.984) and output: 0.858 (0.764–0.952)). Conclusions Ratios of fractionated metanephrines to creatinine in spot urine samples appear to have a similar diagnostic power to other measurements. The ease of spot urine collection may facilitate diagnosis and follow-up of PPGLs through improved patient compliance.

Amylase activity in serum and urine: comparison of results by the amyloclastic, dyed-starch, and nephelometric techniques.

1977 ◽  
Vol 23 (6) ◽  
pp. 1061-1065 ◽  
Author(s):  
D P Lehane ◽  
P J Wissert ◽  
G Lum ◽  
A L Levy
Keyword(s):  
Normal Values ◽  
Amylase Activity ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Spearman Rank Correlation ◽  
Upper Limit ◽  
Kolmogorov Smirnov ◽  
Urine Specimens ◽  
Smirnov Statistic ◽  
Serum And Urine

Abstract We assayed serum and urine specimens for amylase activity by the nephelometric (I),dyed-starch (Amylochrome) (II), and mayloclastic (III) techniques. For serum, the correlation coefficients of the regression lines were: I vs. II, 0.978 (n = 106); I vs. III, 0.736 (n = 110); and II vs. III, 0.739 (n = 108). For urine, they were I vs. II, 0.938 (n = 49); and I vs. III, 0.752 (n = 46). Because calculation of the Kolmogorov-Smirnov statistic showed the distributions to be nongaussian, Spearman rank correlation coefficients were determined and showed that I and II correlated well but neither method correlated with III. The clinical data show that I and II gave above-normal activities in every case of pancreatitis, but III gave normal values in two of eight cases. In all cases, I and II were more sensitive, giving higher amylase activities (as compared with the upper limit of normal) than did III. The nephelometric procedure is most suitable for routine and emergency testing; the dyed-starch assay is equally sensitive and reliable, but less convenient. The amyloclastic procedure appears to be less reliable.

Prediction of lymph node metastase in NSCLC

2010 ◽  
Vol 01 (05) ◽  
pp. 219-226 ◽  
Author(s):  
F. Beyer ◽  
B. Buerke ◽  
J. Gerss ◽  
K. Scheffe ◽  
M. Puesken ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Fdg Pet ◽  
Automatic Segmentation ◽  
Correlation Coefficients ◽  
Mediastinal Lymph Nodes ◽  
Intra Class Correlation ◽  
Axial Diameter ◽  
Pet Ct ◽  
Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

Safety_and_Pharmacokinetics_of_Dapivirine_Delivery.7

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Adverse Events ◽  
Hiv Transmission ◽  
Plasma Concentrations ◽  
Vaginal Fluid ◽  
Time Curve ◽  
Vaginal Microbicides ◽  
Intravaginal Rings ◽  
Lower Genital Tract ◽  
The Matrix

Vaginal microbicides for the prevention of HIV transmission maybe an important option for protecting women from infection.Incorporation of dapivirine, a lead candidate nonnucleoside reversetranscriptase inhibitor, into intravaginal rings (IVRs) for sustainedmucosal delivery may increase microbicide product adherence andefficacy compared with conventional vaginal formulations. Twentyfourhealthy HIV-negative women 18–35 years of age were randomlyassigned (1:1:1) to dapivirine matrix IVR, dapivirine reservoir IVR,or placebo IVR. Dapivirine concentrations were measured in plasmaand vaginal fluid samples collected at sequential time points over the33-day study period (28 days of IVR use, 5 days of follow-up). Safetywas assessed by pelvic/colposcopic examinations, clinical laboratorytests, and adverse events. Both IVR types were safe and well toleratedwith similar adverse events observed in the placebo and dapivirinegroups. Dapivirine from both IVR types was successfully distributedthroughout the lower genital tract at concentrations over 4 logs greaterthan the EC50 against wild-type HIV-1 (LAI) in MT4 cells. Maximumconcentration (Cmax) and area under the concentration–time curve(AUC) values were significantly higher with the matrix than reservoirIVR. Mean plasma concentrations of dapivirine were ,2 ng/mL.These findings suggest that IVR delivery of microbicides is a viableoption meriting further study.Key Words: dapivirine, HIV, intravaginal ring, microbicide,pharmacokinetics, prevention

scholarly journals The Sum of Plasma Fatty Acids iso16:0, iso17:0, trans11-18:1, cis9, trans11-CLA, and cis6-18:1 as Biomarker of Dairy Intake Established in an Intervention Study and Validated in the EPIC Cohort of Gipuzkoa

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 702
Author(s):  
Alaitz Berriozabalgoitia ◽  
Juan Carlos Ruiz de Gordoa ◽  
Mertxe de Renobales ◽  
Gustavo Amores ◽  
Luis Javier R. Barron ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Dairy Products ◽  
Intervention Study ◽  
Dairy Product ◽  
Plasma Concentrations ◽  
Correlation Coefficients ◽  
Dairy Intake ◽  
Dairy Fat ◽  
Product Consumption ◽  
Dairy Product Consumption

The questioned reliability of 15:0, 17:0, and trans9-16:1 acids as biomarkers of dairy fat intake also questions the relationship between the intake of these products and their health effects. Two studies were conducted in the same geographical region. In an intervention study, volunteers followed a diet rich in dairy products followed by a diet without dairy products. Plasma and erythrocyte fatty acids (FA) were analyzed, and their correlations with dairy product intakes were tested. The FA biomarkers selected were validated in the Gipuzkoa cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) observational study. The correlation coefficients between plasma concentrations of iso16:0, iso17:0, trans11-18:1, cis9, trans11-18:2, and cis6-18:1 and the dairy fat ingested are similar in both studies, indicating that their concentration increases by 0.8 µmol/L per gram of dairy fat ingested. The biomarkers are positively related to plasma triglycerides (r = 0.324 and 0.204 in the intervention and observational studies, respectively) and total cholesterol (r = 0.459 and 0.382), but no correlation was found between the biomarkers and atherogenicity indexes. In conclusion, the sum of the plasma concentration of the selected FAs can be used as biomarkers of dairy product consumption. A linear relationship exists between their plasma concentrations and ruminant product intake. These biomarkers allow for obtaining consistent relationships between dairy intake and plasma biochemical parameters.

Biological Variation in Urinary Excretion of Pyridinium Crosslinks: Recommendations for the Optimum Specimen

1996 ◽  
Vol 33 (1) ◽  
pp. 36-42 ◽  
Author(s):  
M Panteghini ◽  
F Pagani
Keyword(s):  
Early Morning ◽  
Reference Intervals ◽  
Biological Variation ◽  
Creatinine Ratio ◽  
Pyridinium Crosslinks ◽  
Number Of Patients ◽  
Analytical Imprecision ◽  
Optimum Specimen ◽  
The Difference ◽  
Urine Specimens

We assessed the analytical and biological variation of pyridinium crosslinks in early morning, 2 h fasting, and 24 h urine specimens from 14 healthy adults over a 1 month period. The results were expressed both in terms of pyridinoline concentration and pyridinoline/creatinine ratio. The data obtained were used to select the optimum specimen for clinical purposes. We found that: ( a) early morning specimens are preferred; ( b) results should be expressed as pyridinoline/creatinine ratio; ( c) reference intervals should be stratified according to gender; ( d) the necessary analytical imprecision (CV≤ 9%), derived from biological variation, is not easily achieved by current methods; ( e) the difference between serial results from an individual must be > 50% to be statistically significant; and ( f) assessment of risk for osteoporotic fracture by means of the pyridinium crosslink assay would, in a significant number of patients, require analysis of multiple urine specimens.

Abstract P262: Spot Urine Sodium to Potassium Ratio Predicts Increasing Blood Pressure Levels in a General Population: The Nagahama Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Yasuharu Tabara ◽  
Yoshimitsu Takahashi ◽  
Takeo Nakayama ◽  
Fumihiko Matsuda
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Linear Regression Analysis ◽  
Prognostic Significance ◽  
Reverse Causality ◽  
Cross Sectional ◽  
Salt Loading ◽  
Available N ◽  
Spot Urine

Excessive salt intake is a risk factor for hypertension. The most reliable method for estimating daily salt intake is measurement of 24-h urinary sodium excretion, while it is inconvenient. Sodium-to-potassium ratio (Na/K) of a urine sample is another index of salt loading. We previously reported that a simple measure of spot urine Na/K might be a representative of salt loading in a cross-sectional setting. Here, we conducted a longitudinal study aiming to clarify a prognostic significance of spot urine Na/K for increasing blood pressure (BP) levels. Study subjects consists of 9,769 general individuals. Among them, individuals whose baseline Na/K was available (n=9,328), who were normotensive at baseline (n=6,392), and who participated in the follow-up measurement (n=5,209) were included in this analysis (51.8±12.9 years old, male: 29.2%). Mean follow-up duration was 5.0±0.5 years. Mean Na/K at baseline was 3.1±1.7, and showed step-wise increase with BP levels (optimal: 3.0±1.6, normal: 3.3±1.8, high normal: 3.4±1.8, P<0.001). Other major factors that were significantly associated with Na/K was fasting time (r=-0.220, P<0.001), and CKD (CKD (n=694): 2.7±1.6, control: 3.2±1.7, P<0.001). Mean SBP was significantly increased during follow-up period (baseline: 116±12, follow-up: 119±15 mmHg), and 805 individuals (15.5%) were newly diagnosed as hypertension (HT). These individuals were significantly older (HT: 60.3±9.9, NT: 50.3±12.8 years), were frequently male (36.4%, 27.9%), and had higher SBP (127±9, 115±11 mmHg) at baseline (P<0.001). In contrast, baseline spot urine Na/K was slightly lower in individuals who developed HT (3.0±1.6, 3.1±1.8, P=0.013), while that measured at follow-up investigation was oppositely higher in hypertensives (3.1±1.8, 2.8±1.5, P<0.001). Multiple linear regression analysis adjusted for the covariates identified baseline Na/K (β=0.108, P<0.001) and changes in Na/K during follow-up period (β=0.222, P<0.001) as independent determinants for future SBP levels. Higher spot urine Na/K, as well as increases in the Na/K levels, was significant determinant for future BP levels. The apparently lower baseline Na/K levels in individuals who developed HT might be due to reverse causality.

scholarly journals Best Albuminuria Measurement to Predict Cardiovascular and Renal Events

2016 ◽  
Vol 43 (5) ◽  
pp. 383-388 ◽  
Author(s):  
Lucie Bauer ◽  
Insa E. Emrich ◽  
John W. Pickering ◽  
Kathrin Untersteller ◽  
Franziska Sandermann ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Cardiovascular Events ◽  
Albumin Excretion Rate ◽  
Primary Analysis ◽  
Home Study ◽  
Spot Urine ◽  
Albumin Excretion ◽  
Net Reclassification Improvement ◽  
Kdigo Guidelines

Background: Kidney Disease Improving Global Outcomes (KDIGO) guidelines encourage clinicians to estimate 24-hour albuminuria as albumin to creatinine ratio (ACR) from spot urine samples. However, ACR underestimates 24-hour albumin excretion in muscular individuals. Equations that adjust ACR for surrogates of muscle mass to yield an estimated albumin excretion rate (eAER) were developed. We hypothesised that eAER is a better predictor of cardiovascular and renal outcomes than ACR. Methods: We determined ACR and eAER among 443 patients with chronic kidney disease G2-G4 recruited into the CARE FOR HOMe study. Patients were classified into KDIGO albuminuria categories, and followed for cardiovascular and renal events. The primary analysis was the net reclassification improvement (NRI) for those with and without events within 3 years of follow-up. Results: Eighty five patients experienced cardiovascular events during 3 years of follow-up, 13 of whom were reclassified to a more advanced albuminuria category, and 1 patient to a less advanced category by eAER compared to ACR (NRIevent: 14.1% (95% CI 5.8-22.4)). Among 358 patients without a cardiovascular event, 17 patients were reclassified to a more advanced albuminuria category, and 2 patients to a less advanced category by eAER (NRIno event: -4.2%, 95% CI -8.5 to -1.8). Sixty patients went through renal events, and 383 patients had event-free 3-year follow-up. NRIevent was 6.7% (95% CI -1.2 to 14.5), and NRIno event was -6.0% (95% CI -10.6 to 3.4) for renal events. Conclusion: Compared to ACR albuminuria categories, eAER categories are better associated with future cardiovascular events, but not with renal events.

Morphometric analysis of posterior fossa after in utero myelomeningocele repair

2011 ◽  
Vol 7 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Ryan A. Grant ◽  
Gregory G. Heuer ◽  
Geneive M. Carrión ◽  
N. Scott Adzick ◽  
Erin S. Schwartz ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Surgical Repair ◽  
Correlation Coefficients ◽  
In Utero ◽  
Clinical Effects ◽  
Type Ii ◽  
Tonsillar Herniation ◽  
Myelomeningocele Repair ◽  
Repair Group

Object Myelomeningocele (MMC) is characterized by a defect in caudal neurulation and appears at birth with a constellation of neuroanatomical abnormalities, including Chiari malformation Type II. The authors investigated the effects of antenatal versus postnatal repair of MMC through a quantitative analysis of morphometric changes in the posterior fossa (PF). Methods The authors retrospectively reviewed the records of 29 patients who underwent in utero MMC repair, 24 patients who underwent postnatal repair, and 114 fetal and pediatric controls. Tonsillar displacement, cerebellum length, pons length, clivus-supraocciput (CSO) angle, and PF area were compared in antenatal and postnatal MMC repair groups as well as in controls without neural tube defects by using t-tests and correlation coefficients. Results Initially, the in utero CSO angle was significantly more acute in all patients with MMC—prenatally and postnatally repaired—as compared with controls (57.8° vs 75.4°, p < 0.001); however, the angle rapidly changed and became similar to that in controls between 30 and 31 weeks' gestation to approximately 80°, with antenatal repair having little effect. Postnatally, the CSO angle decreased in controls (R = −0.58) and in the antenatal repair group (R = −0.17). The cerebellum and pons length demonstrated no significant differences in any group. Overall, tonsil descent was corrected in the antenatal repair group as compared with postnatal repair (p < 0.001), and the PF area increased in all 3 groups in utero. Growth was less rapid in patients with MMC compared with controls, but this was corrected by antenatal repair (p = 0.015). Conclusions Myelomeningocele was associated with tonsillar herniation and a smaller PF than in control fetuses. Antenatal surgical repair corrected both abnormalities. The CSO angle began significantly more acutely in patients with MMC, but normalized with development regardless of when surgery was performed. Determining the clinical effects of antenatal repair requires further follow-up.

scholarly journals SUN-932 Successful Response of Temozolomide (TMZ) in two Patients with Metastatic Pheochromocytoma/Paragangliomas (PPGLs)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tobias Skrebsky de Almeida ◽  
Roberta P Borges ◽  
Janeczko Laís ◽  
Giovana Caroline Marx Becker ◽  
Ticiana Costa Rodrigues ◽  
...  
Keyword(s):  
Lung Metastases ◽  
Left Lung ◽  
Vena Cava ◽  
Lung Lesion ◽  
Chest Ct ◽  
Complete Regression ◽  
Lung Lesions ◽  
The Right ◽  
Urinary Metanephrines

Abstract Introduction: PPGLs are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla or their neural crest progenitors, being able to secrete catecholamines. Its treatment is primarily surgical; however, for metastatic/inoperable tumors, effective treatments are lacking. The use of TMZ, an oral alkylating agent, has been scarcely reported with variable response rates. We report 2 patients with reasonable clinical, biochemical and structural responses. Case Reports: Case 1) A 14-year old girl presented with neck pain, sweating, hypertension and tachycardia. Urinary hormonal profile revealed metanephrines 80 (up to 320 ug/24h) and normetanephrines 2983 (up to 390 ug/24h). Abdominal MRI showed a 10x6x5 cm retroperitoneal lesion in close contact with celiac trunk, superior mesenteric artery, renal arteries, aorta, left renal vein and vertebral bodies of T10, T11 and T12. A chest CT revealed multiple lung metastases. After 11 months, both the primary abdominal lesion and lung metastases increased in size.. Due to disease severity, after excluding surgical possibilities and confirming diagnosis by lesion biopsy, rescue treatment with TMZ was started for 5 days on a 28-day cycle. After 11 cycles, lung and abdominal lesions decreased more than 30% in size, and urinary metanephrines decreased 53.4%. After 21 cycles, there is no evidence of disease progression. Case 2) A 44-year old female was first diagnosed at the age of 31 with a right adrenal mass invading the kidney and the inferior vena cava associated with hypertension, sweating, headaches and palpitations. She underwent right adrenalectomy and nephrectomy. Immunohistochemistry confirmed the diagnosis of pheochromocytoma. Seven years later, follow-up CT`s showed a 3 x 2 cm liver metastasis, which was resected, and two lung lesions, one located at the right inferior lobe (1.6 cm) and the other at the left superior lobe (0.9 cm), which initially were just followed-up. At this time, a 7-month sorafenib trial was performed but the drug was stopped due to intolerable side effects. After 3 years of follow-up, the lung lesions increased in size and the right lesion was resected, but the patient refused surgery for the remainder left lung lesion. After 1 year, left lung lesion increased to 2.4 cm and mediastinal and paratracheal lymphadenomegaly developed. TMZ in the same aforementioned schedule was prescribed and after 7 cycles a new chest CT revealed complete regression of the lung and lymph node metastases.. Urinary metanephrines were 2.1 times the upper limit of normal before TMZ and decreased to normal range. Conclusion: These cases highlight the promising role of a well-tolerated single drug chemotherapy regimen in severe cases of metastatic and inoperable PPGLs. TMZ could be considered an alternative strategy for the treatment of these cases and, if possible, should be tested in adequate clinical trials.

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