scholarly journals KCNJ5 Somatic Mutations in Aldosterone-Producing Adenoma Are Associated with a Greater Recovery of Arterial Stiffness

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4313
Author(s):  
Yi-Yao Chang ◽  
Chien-Ting Pan ◽  
Zheng-Wei Chen ◽  
Cheng-Hsuan Tsai ◽  
Shih-Yuan Peng ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Somatic Mutations ◽  
Secondary Hypertension ◽  
Plasma Aldosterone Concentration ◽  
Aldosterone Level ◽  
Mutation Carriers ◽  
Before And After ◽  
Aldosterone Producing Adenoma ◽  
One Year ◽  
The Impact

Primary aldosteronism is the most common form of secondary hypertension and induces various cardiovascular injuries. In aldosterone-producing adenoma (APA), the impact of KCNJ5 somatic mutations on arterial stiffness excluding the influence of confounding factors is uncertain. We enrolled 213 APA patients who were scheduled to undergo adrenalectomy. KCNJ5 gene sequencing of APA was performed. After propensity score matching (PSM) for age, sex, body mass index, blood pressure, number of hypertensive medications, and hypertension duration, there were 66 patients in each group with and without KCNJ5 mutations. The mutation carriers had a higher aldosterone level and lower log transformed brachial–ankle pulse wave velocity (baPWV) than the non-carriers before PSM, but no difference in log baPWV after PSM. One year after adrenalectomy, the mutation carriers had greater decreases in log plasma aldosterone concentration, log aldosterone–renin activity ratio, and log baPWV than the non-carriers after PSM. Only the mutation carriers had a significant decrease in log baPWV after surgery both before and after PSM. KCNJ5 mutations were not correlated with baseline baPWV after PSM but were significantly correlated with ∆baPWV after surgery both before and after PSM. Conclusively, APA patients with KCNJ5 mutations had a greater regression in arterial stiffness after adrenalectomy than those without mutations.

Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair

Vascular ◽  
2020 ◽  
pp. 170853812098369
Author(s):  
Stefano Fazzini ◽  
Giovanni Torsello ◽  
Martin Austermann ◽  
Efthymios Beropoulis ◽  
Roberta Munaò ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Main Body ◽  
Thoracoabdominal Aneurysm ◽  
Before And After ◽  
Long Term Follow Up ◽  
Instability Rate ◽  
One Year ◽  
The Impact

Objectives The results of branched endovascular repair of thoracoabdominal aneurysms are mainly dependent on durability of the graft used. The purpose of this study was to evaluate postoperative aortic main body and bridging stent-graft remodeling, and their impact on bridging stent-graft instability at one year. Methods Computed tomoangiographies of 43 patients (43 aortic main body mated with 171 bridging stent-grafts) were analyzed before and after branched endovascular repair as well as after a follow-up of 12 months. Primary endpoint was aortic main body remodeling (migration >5 mm, shortening >5 mm, scoliosis >5° or lordosis >5°). Shortening was defined as a reduced length in the long axis, scoliosis as left-right curvature, and lordosis as antero-posterior curvature. Aortic main body remodeling, aneurysm sac changes, and bridging stent-graft tortuosity were evaluated to study their correlations and the impact on the bridging stent-graft instability. Results At 12 months, aortic main body remodeling was observed in 72% of the cases, migration in 39.5% (mean 5.21 mm), shortening in 41.9% (mean 5.79 mm), scoliosis in 58.1%, (mean 10.10°), lordosis in 44.2% (mean 5.78°). Migration, shortening, and scoliosis were more frequent in patients with larger aneurysms ( p = .005), while scoliosis was significantly more frequent in type II thoracoabdominal aneurysm ( p = .019). Aortic main body remodeling was significantly associated to bridging stent-graft remodeling (r: 0.3–0.48). The bridging stent-graft instability rate was 9.3%. Despite a trend toward significance ( p = .07), none of the evaluated aortic main body and bridging stent-graft changes were associated with bridging stent-graft instability at 12 months. Conclusions Aortic main body remodeling is frequent especially in large and extended thoracoabdominal aneurysm aneurysms. Aortic main body and bridging stent-graft remodeling was significantly correlated. While these geometric changes had no significant impact on bridging stent-graft instability at one year, a close long-term follow-up after branched endovascular repair could predict bridging stent-graft failures.

Abstract 12591: Impact of Aldosterone Producing Adenoma on Endothelial Function and Rho-Associated Kinase Activity in Patients With Primary Aldosteronism

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takeshi Matsumoto ◽  
Yukihito Higashi ◽  
Nozomu Oda ◽  
Akimichi Iwamoto ◽  
Yumiko Iwamoto ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Primary Aldosteronism ◽  
Vascular Function ◽  
Cardiovascular Events ◽  
Plasma Renin ◽  
Secondary Hypertension ◽  
Plasma Aldosterone Concentration ◽  
Significant Difference ◽  
Aldosterone Producing Adenoma ◽  
Rock Activity

Background: Hypertension is associated with endothelial dysfunction and activated Rho-associated kinases (ROCKs) activity. Primary aldosteronism (PA) is a most common cause of secondary hypertension. Recent studies have shown that risk of cardiovascular events is higher in patients with PA than in patients with essential hypertension (EH). However, there is little information on the relationship between subtype of PA and the grade of atherosclerosis. The purpose of this study was to evaluate the vascular function and ROCK activity in patients with PA. Methods: Vascular function, including flow-mediated vasodilation (FMD) and nitroglycerin-induced vasodilation, and ROCK activity in peripheral leukocytes were evaluated in 21 patients with aldosterone producing adenoma (APA) group (50.7±14.3 years, 9 males), 23 patients with idiopathic hyperaldosteronism (IHA) group (55.8±9.9 years, 12 males), and 33 age-, gender-, and blood pressure-matched EH group (54.9 ± 10.7 years, 18 males). Results: FMD was significantly lower in the APA group than in the IHA group and EH group (3.2±2.0% vs. 4.6±2.3% and 4.4±2.2%, P<0.05, respectively), whereas there was no significant difference in FMD between the IHA group and EH group. There was no significant difference in the response of nitroglycerine in three groups. ROCK activity was significantly higher in the APA group than in the IHA group and EH group (1.29±0.57 vs. 1.00±0.46 and 0.81±0.36, P<0.05 and P<0.001, respectively), whereas there was no significant difference in ROCK activity between the IHA group and EH group. FMD correlated with age (r=-0.31, P<0.01), brachial arterial diameter (r=-0.44, P<0.01), plasma aldosterone concentration (PAC) (r=-0.35, P<0.01) and plasma renin activity ratio (ARR) (r=-0.34, P<0.01). ROCK activity correlated with age (r=-0.24, P=0.04), PAC (r=0.33, P<0.01) and ARR (r=0.46, P<0.01). Conclusions: APA was associated with both endothelial dysfunction and increased ROCK activity compared with those in IHA and EH. These findings suggest that APA may have a higher risk of future cardiovascular events.

scholarly journals Subtidal littering: Indirect effects on soft substratum macrofauna?

2008 ◽  
Vol 9 (2) ◽  
pp. 35 ◽  
Author(s):  
I. AKOUMIANAKI ◽  
P. KONTOLEFAS ◽  
S. KATSANEVAKIS ◽  
A. NICOLAIDOU ◽  
G. VERRIOPOULOS
Keyword(s):  
Community Structure ◽  
Sediment Surface ◽  
Long Run ◽  
Significant Difference ◽  
Before And After ◽  
Soft Substratum ◽  
One Year ◽  
The Impact ◽  
Control Surfaces ◽  
Macrofauna Community

Changes in macrofauna community structure, abundance and species richness were examined both before and one year after the deployment of plastic and glass bottles at littered (litter density: 16 items / 100 m2) and non-littered (control) surfaces at three unimpacted coastal areas of the western Saronikos Gulf (Greece). In parallel, LOI% at the adjacent sediments and changes in the composition of feeding types of the megaepifauna that colonized the litter were examined across treatments. Significant changes in macrofauna community structure were demonstrated between before and after littering. At only one of the sites was there detected a significant difference in macrofauna community structure between control and littered plots after littering. This difference was linked with a significant increase in the abundance of opportunistic polychaete species and LOI% levels in the sediment surface due to the entrapment of macrophytal debris within the littered surface. The study did not show a consistent direct response of macroinfauna community to litter and the associated megafauna. Unlike the megafauna attracted by litter items, soft-substratum macrofauna is less responsive to the addition of novel hard substrates in adjacent sediments. Alternatively, it could be that the impact of littering with small items triggers a macrofauna response detectable in the long-run.

scholarly journals Restoring Democracy to the Workplace? An Analysis of Union Membership Patters Before and After the Employment Contracts Act

1970 ◽  
Vol 20 (1) ◽  
Author(s):  
Christina Cregan ◽  
Chris Rudd ◽  
Stewart Johnston
Keyword(s):  
Labour Market ◽  
Trade Union ◽  
Union Membership ◽  
Industrial Relations ◽  
Short Term ◽  
Employment Contracts ◽  
Market Participants ◽  
Before And After ◽  
One Year ◽  
The Impact

This paper investigates the impact of the Employment Contracts Act on trade union membership. Two separate surveys of labour market participants lvere conducted in Dunedin on the eve of the legislation and one year later. The findings demonstrated that for these samples, trade union membership in aggregate was not based on compulsion before the legislation and remained at a similar level a year later. Democracy was not restored to the workplace it was already apparent there. This implies that changes in the industrial relations system had already taken place prior to the legislation and it is suggested that these findings are explicable if the effect of the exigencies of the recession on both parries is taken account of In the ensuing discussion, reasons for the persistence of the same level of union membership after the legislation were considered. It was demonstrated that most members li'anted the union to act as their bargaining agent and felt few pressures regarding their choice of employment contract. In other words, employers did not utilise the provisions of the Act to weaken union membership, at least in the short term.

scholarly journals Analysis of Mobile Phone Data to Compare Mobility Flows and Hotspots Before and After the Opening of High-Speed Railway: Case Study of Honam KTX in Korea

2020 ◽  
Vol 10 (14) ◽  
pp. 5009
Author(s):  
Jin Ki Eom ◽  
Kwang-Sub Lee ◽  
Ji Young Song ◽  
Jun Lee
Keyword(s):  
Mobile Phone ◽  
High Speed ◽  
Mobile Phone Data ◽  
High Speed Railway ◽  
Railway Stations ◽  
Intercity Travel ◽  
Before And After ◽  
Transit Agencies ◽  
One Year ◽  
The Impact

Mobile phone data provides information, such as the home (origin) and current locations of people. The data can be used to analyze the impact of new high-speed railway (HSR) openings. This study examined the population observed in stations and cities of the Honam HSR line in Korea, based on mobile phone data recorded one year before and after its opening. We analyzed the volume of the population observed at each railway station, density of the distance between home and station, and activity hotspots in a city. The results show that the number of people and travel distance increased after the opening of the HSR. The distance to access railway stations increased, as the HSR saves travel time. Moreover, the activity hotspots in a city increased after the opening of the HSR, as more people gathered near the station area. The findings show that the mobility measures enhanced after the opening of the HSR for regional travel and local activities. These measures can help transit agencies and planners in providing better intercity travel.

scholarly journals The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment

2019 ◽  
Vol 13 (3) ◽  
pp. 132-136
Author(s):  
Eduard J Langenegger ◽  
DR Hall ◽  
F Mattheyse ◽  
J Harvey
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Maternal Morbidity ◽  
Prospective Comparison ◽  
Labor Ward ◽  
Evaluation Scores ◽  
Maternal Morbidity And Mortality ◽  
Before And After ◽  
One Year ◽  
The Impact

Objective To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa. Methods Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality. Results In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure ( p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group ( p = 0.01). Conclusion The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality. Trial registration: Not applicable.

scholarly journals Endothelial Progenitor Cells in Primary Aldosteronism: A Biomarker of Severity for Aldosterone Vasculopathy and Prognosis

2011 ◽  
Vol 96 (10) ◽  
pp. 3175-3183 ◽  
Author(s):  
Vin-Cent Wu ◽  
Shyh-Chyi Lo ◽  
Yuh-Lien Chen ◽  
Po-Hsun Huang ◽  
Chia-Ti Tsai ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Primary Aldosteronism ◽  
Medical Center ◽  
High Dose ◽  
Endothelial Progenitor ◽  
Plasma Aldosterone Concentration ◽  
Unilateral Adrenalectomy ◽  
Aldosterone Producing Adenoma

Abstract Context: Primary aldosteronism (PA) is associated with a higher incidence of cardiovascular events, probably through mineralocorticoid receptor (MR)-dependent endothelial cell dysfunction, in comparison with essential hypertension (EH). Objective: Our objective was to investigate the number and function of endothelial progenitor cells (EPC) in PA and the relationship with arterial stiffness and disease progression. Design and Setting: We conducted a prospective study of the change of EPC number and outcome of PA patients after treatment at a tertiary medical center. Primary Outcomes: Changes in arterial stiffness and EPC number after treatment and the curability of hypertension were assessed. Patients: A total of 113 PA patients (87 patients diagnosed with aldosterone-producing adenoma, 26 with idiopathic hyperaldosteronism) and 55 patients with EH participated. Results: PA patients had higher arterial stiffness than EH patients (P = 0.006), with a lower numbers of circulating EPC and endothelial colony-forming units (P &lt; 0.05). The differences were ameliorated at 6 months after unilateral adrenalectomy or treatment with spironolactone. Expression of MR was identified in the EPC. The number of circulating EPC was inversely correlated with the plasma aldosterone concentration (P = 0.021), arterial stiffness (P = 0.029) and serum high-sensitivity C-reactive protein (P = 0.03). High-dose aldosterone (10−5 and 10−6m) attenuated EPC proliferation and angiogenesis in vitro. Among the 45 patients who underwent unilateral adrenalectomy, 32 (71%) were cured of hypertension. The preoperative number of EPC [log(EPC number percent) &gt;−3.6] predicted the curability of hypertension after adrenalectomy (P = 0.003). Conclusions: The relative deficiency of EPC in PA patients may contribute to aldosterone vasculopathy, which can be reversed by adrenalectomy and spironolactone. High aldosterone levels attenuated EPC proliferation and angiogenesis. Circulating EPC number may be a valuable biomarker to identify PA patients with a high incidence of arterial stiffness and to predict postoperative residual hypertension of aldosterone-producing adenoma.

scholarly journals Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

2016 ◽  
Vol 98 (2) ◽  
pp. 107-115 ◽  
Author(s):  
S Bokhari ◽  
U Walsh ◽  
K Qurashi ◽  
L Liasis ◽  
J Watfah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Best Practice ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Early Laparoscopic Cholecystectomy ◽  
Before And After ◽  
One Year ◽  
The Impact ◽  
Surgical Unit

Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

A Comparison of Adrenalectomy and Eplerenone on Vascular Function in Patients with Aldosterone-producing Adenoma

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Shinji Kishimoto ◽  
Kenji Oki ◽  
Tatsuya Maruhashi ◽  
Masato Kajikawa ◽  
Haruki Hashimoto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vascular Function ◽  
Mineralocorticoid Receptor Antagonist ◽  
Plasma Aldosterone Concentration ◽  
Beneficial Effects ◽  
Significant Relationships ◽  
Before And After ◽  
Registration Number ◽  
Aldosterone Producing Adenoma ◽  
Flow Mediated Vasodilation

Abstract Context It remains unclear whether adrenalectomy has more beneficial effects than treatment with a mineralocorticoid receptor antagonist on vascular function in patients with aldosterone-producing adenoma (APA). Objective The aim of this study was to compare the effects of adrenalectomy and treatment with eplerenone on vascular function in patients with APA. Design, Setting, and Patients Flow-mediated vasodilation (FMD), as an index of endothelium-dependent vasodilation, and nitroglycerine-induced vasodilation (NID), as an index of endothelium-independent vasodilation, were measured to assess vascular function before and after a 3-month treatment with eplerenone and at 3 months after adrenalectomy in 23 patients with APA. Results Flow-mediated vasodilation and NID after adrenalectomy were significantly higher than those before treatment with eplerenone (5.4 ± 2.6% vs 2.7 ± 1.9% and 14.8 ± 4.7% vs 9.6 ± 4.6%, P &lt; 0.01, respectively) and those after treatment with eplerenone (5.4 ± 2.6% vs 3.1 ± 2.3% and 14.8 ± 4.7% vs 11.0 ± 5.3%, P &lt; 0.01 and P = 0.03, respectively), while treatment with eplerenone did not alter FMD and NID compared with those before treatment with eplerenone. After adrenalectomy, the increase in FMD and NID were significantly correlated with a decrease in plasma aldosterone concentration and a decrease in the aldosterone-renin ratio. There were no significant relationships between FMD and changes in other parameters or between NID and changes in other parameters. Conclusions Adrenalectomy, but not treatment with eplerenone, improved vascular function in patients with APA. Adrenalectomy may be more effective than treatment with eplerenone for reducing the incidence of future cardiovascular events in patients with APA. Clinical Trial Information: URL for the clinical trial: http://UMIN; Registration Number for the clinical trial: UMIN000003409.

The impact of the TelEmergency program on rural emergency care: An implementation study

2016 ◽  
Vol 23 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Sarah A Sterling ◽  
Samantha R Seals ◽  
Alan E Jones ◽  
Melissa H King ◽  
Robert L Galli ◽  
...  
Keyword(s):  
Emergency Care ◽  
Rural Areas ◽  
Patient Discharge ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
P Value ◽  
Discharge Rates ◽  
Before And After ◽  
One Year ◽  
The Impact

Introduction Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations. Methods Methods included a before and after study of the effect of the TE program on participating rural hospitals between January 2007 and December 2008. Data on ED and hospital operations were collected one year prior to and one year following the implementation of TE. Data from participating hospitals were combined and compared for the two time periods. Results Nine hospitals met criteria for inclusion and participated in the study. Total ED volumes did not significantly change with TE implementation, but ED admissions to the same rural hospital significantly increased following TE implementation (6.7% to 8.1%, p-value = 0.02). Likewise, discharge rates from the ED declined post-initiation (87.1% to 80.0%, p-value = 0.003). ED deaths and transfer rates showed no significant change, while the rate of patient discharge against medical advice significantly increased with TE use. Discussion In this analysis, we found a significant increase in the rate of ED admissions to rural hospitals with TE use. These findings may have important implications for the quality of emergency care in rural areas and the sustainability of rural hospitals’ EDs.

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