Clinical determinants of adrenal vein sampling success

Background: Primary aldosteronism (PA) is one of the most prevalent forms of secondary hypertension, which may be cured by unilateral adrenalectomy. Adrenal vein sampling (AVS) is considered the gold-standard procedure for distinction between bilateral and unilateral aldosterone hypersecretion. However, the procedure is viewed as a technical challenge. The objectives of this study were to define the success rate of AVS, and its clinical determinants, and to compare the accuracy of high-resolution adrenal computed tomography (CT) with AVS. Methods: In this single-centre retrospective study, patients with biologically proven PA who were referred for AVS between 2009 and 2014 were included. Adrenal vein catheterisation was considered selective if the selectivity index (adrenal vein / inferior vena cava cortisol) was ≥2. Results: Data from 68 patients (48% women) were available. The success rate of catheterisation in bilateral AVS was 60% (41/68). The significant clinical determinants of success were male sex (r = 0.35, p = 0.004), a higher body mass index (BMI) (r = 0.54, p = 0.001) and plasma creatinine (r = 0.25, p = 0.048) in univariate analysis. In multivariate linear regression analysis, only BMI was associated with success (coefficient = 0.049, p = 0.004). CT was discordant with AVS in 53% of patients, and would have resulted in inappropriate adrenalectomy in 43% of the patients and inappropriate exclusion from surgery in 10% of the cases. Conclusion: Clinical characteristics such as BMI and sex may influence the success rate of AVS. The inaccuracy of CT may result in inappropriate treatment proposals if the indication for surgical intervention is based on CT only

Sarcopenia in hospitalized geriatric patients: insights into prevalence and associated parameters using new EWGSOP2 guidelines.

BACKGROUND Data on prevalence of sarcopenia and its associated parameters in hospitalized geriatric patients are heterogeneous due to various definitions of the disease. The aim of this study was to determine the prevalence of sarcopenia using latest recommendations of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and to investigate associated parameters in patients admitted to acute geriatrics and geriatric rehabilitation. METHODS In this cross-sectional single-centre study including 305 hospitalized geriatric patients, handgrip strength (pneumatic hand dynamometer) and muscle quantity (body impedance analysis) were assessed. Probable sarcopenia was defined by low handgrip strength, and the diagnosis was confirmed when both handgrip strength and muscle quantity were below cut-off points. Furthermore, parameters of the geriatric baseline examination were analyzed for association with probable and confirmed sarcopenia using logistic regression models. RESULTS Median age of the study population was 84.0 years, and 65.6% were female. The prevalence of probable sarcopenia was 24.6% (CI 19.8-29.4%), and the prevalence of confirmed sarcopenia was 22.6% (CI 17.9-27.3%). Low calf circumference, low body mass index, cognitive impairment and an increased risk of malnutrition were found to be associated with confirmed sarcopenia. In contrast, only cognitive impairment was positively associated with probable sarcopenia. CONCLUSIONS Sarcopenia is highly prevalent in geriatric inpatients, and multiple parameters were found to be associated with the disease. To reduce negative clinical outcomes, our findings support the need for routinely performed admission examinations for prompt diagnosis of sarcopenia, and a timely start of treatment in hospitalized geriatric patients

Safety and efficacy of recombinant human erythropoietin treatment of anaemia associated with multiple myeloma in haemodialysed patients

Recombinant human erythropoietin (rHuEpo) was used to treat the anaemia of four haemodialysed patients (3 males, 1 female) with advanced multiple myeloma; the type of serum M component was IgG kappa in all cases. During the 6-month period preceding rHuEpo therapy the patients received multiple blood transfusions (range 4-22 units of packed red cells per patient). After the first month of treatment haematocrit increased from 23±3 (SD) to 32±4% and during the last 3 months the maintenance dose of rHuEpo was 143±37 U/kg per week to achieve a mean haematocrit of 35±1%. After introduction of rHuEpo, blood transfusions were no longer required and the patients reported an improvement in wellbeing. No apparent worsening of multiple myeloma has been observed over the treatment period ranging from 5 to 34 months (cumulative duration of treatment 55 months). Anti-hypertensive therapy was started in one case and increased in two patients. We conclude that rHuEpo appears to be effective and safe in treating anaemia associated with multiple myeloma in patients requiring haemodialysi

Limitations and challenges of EIT-based monitoring of stroke volume and pulmonary artery pressure.

Electrical impedance tomography (EIT) shows potential for radiation-free and noninvasive hemodynamic monitoring. However, many factors degrade the accuracy and repeatability of these measurements. Our goal is to estimate the impact of this variability on the EIT-based monitoring of two important central hemodynamic parameters: stroke volume (SV) and pulmonary artery pressure (PAP). We performed simulations on a 4D ([Formula: see text]) bioimpedance model of a human volunteer to study the influence of four potential confounding factors (electrode belt displacement, electrode detachment, changes in hematocrit and lung air volume) on the performance of EIT-based SV and PAP estimation. Results were used to estimate how these factors affect the EIT measures of either absolute values or relative changes (i.e. trending). Our findings reveal that the absolute measurement of SV via EIT is very sensitive to electrode belt displacements and lung conductivity changes. Nonetheless, the trending ability of SV EIT might be a promising alternative. The timing-based measurement of PAP is more robust to lung conductivity changes but sensitive to longitudinal belt displacements at severe hypertensive levels and to rotational displacements (independent of the PAP level). We identify and quantify the challenges of EIT-based SV and PAP monitoring. Absolute SV via EIT is challenging, but trending is feasible, while both the absolute and trending of PAP via EIT are mostly impaired by belt displacements

Female sex hormones, salt, and blood pressure regulation

There are gender-associated differences in blood pressure (BP) in humans, with men having higher BP than age-matched pre-menopausal women and being at greater risk for cardiovascular and renal diseases. The mechanisms responsible for the gender differences in BP control and regulation are not clear, although there is some evidence that interactions between sex hormones and the kidneys could play a role. However, the response to salt in pre- and post-menopausal women, and in particular the influence of exogenous and endogenous female sex hormones on renal hemodynamics and tubular segmental sodium handling, have been poorly investigated. Recently we have shown that both endogenous and exogenous female sex hormones markedly influence the systemic and renal hemodynamic response to salt. We have found that BP in young normotensive women, regardless of oral contraceptive use, is rather insensitive to salt. However, the renal hemodynamic and the tubular responses to salt vary significantly during the normal menstrual cycle and with the administration of oral contraceptives. Furthermore, after the menopause, BP tends to become salt sensitive, a pattern that could be due to aging as well as to the modification of the sex hormone profile. These observations provide new insights pertaining to potential mechanisms explaining the lower incidence of cardiovascular disease and progression of renal disease in pre-menopausal women (which tend to disappear with the menopause); these observations also emphasize the importance of considering more carefully the phase of the menstrual cycle whenever conducting physiologic studies in women and enrolling women in clinical studies. Finally, increased salt sensitivity in menopausal women strongly encourages the use of diuretics

Evaluation of Adsorption Effects on Measurements of Ammonia, Acetic Acid, and Methanol

[1] We examined how adsorption and desorption of gases from inlets and a cell could affect the accuracy of closed-cell FTIR measurements of carbon dioxide (CO2), carbon monoxide (CO), methane (CH4), nitric oxide (NO), nitrogen dioxide (NO2), methanol (CH3OH), acetic acid (CH3COOH), and ammonia (NH3). When standards were delivered to the cell through a stainless steel inlet, temporarily reduced transmission was observed for CH3OH and NH3. However, a halocarbon wax coated inlet (normally used on the system) had excellent transmission (comparable to room temperature Teflon) for both CH3OH and NH3, even at temperatures as low as 5°C. Thus the wax is valuable for coating sampling system components that cannot be fashioned from Teflon. The instrument had a delayed response (∼10–40 s) for NH3 only, which was attributed to passivation of the Pyrex multipass cell. To determine sampling artifacts that could arise from the complex sample matrix presented by smoke, the closed-cell FTIR system was intercompared with an open-path FTIR system (which is immune to sampling artifacts) in well-mixed smoke. A similar cell passivation delay for NH3 was the only artifact found in this test. Overall, the results suggest that ∼10 s is sufficient to detect \u3e80% of an NH3/CO ratio sampled by our fast-flow, closed-cell system. Longer sampling times or consecutive samples return better results. In field campaigns the closed-cell system sampling times were normally 10 to \u3e100 s so NH3 was probably underestimated by 5–15%

Impact of sarcopenia on daily functioning: a cross-sectional study among older inpatients.

BACKGROUND AND AIM Geriatric patients with sarcopenia are at increased risk for functional decline with loss of independence in daily living. This cross-sectional study aims to investigate the impact of sarcopenia on different domains of functional status in hospitalized geriatric patients. METHODS Sarcopenia was assessed at hospital admission using the recommendations of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Body impedance analysis (BIA) was performed to determine muscle mass, and a pneumatic hand dynamometer was used to assess muscle strength. The functional independence measure (FIM) score, an 18-item tool exploring an individual's physical, cognitive and social functions, was used to measure functional status. RESULTS In 305 included inpatients with a median age of 84.0 years (65.6% female), prevalence of sarcopenia was 22.6%. Overall, sarcopenic patients had significant lower FIM scores compared to non-sarcopenic patients (p = 0.006). An association with sarcopenia was found for the FIM items bed/chair/wheelchair transfer (p = 0.047), transfer to toilet (p = 0.048), locomotion (p = 0.001), climbing stairs (p = 0.012), comprehension (p = 0.029), and social interaction (p = 0.028). CONCLUSION In hospitalized geriatric patients, sarcopenia was found to be associated with both cognitive and mobility domains, but not with self-care domains of the FIM score. Therefore, when addressing sarcopenia in inpatients, tailored and multi-dimensional training interventions mainly should focus on motor-cognitive abilities

Effects of the peroxisome proliferator-activated receptor (PPAR)-γ agonist pioglitazone on renal and hormonal responses to salt in diabetic and hypertensive individuals

Aims/hypothesis: Glitazones are powerful insulin sensitisers prescribed for the treatment of type 2 diabetes. Their use is, however, associated with fluid retention and an increased risk of congestive heart failure. We previously demonstrated that pioglitazone increases proximal sodium reabsorption in healthy volunteers. This study examines the effects of pioglitazone on renal sodium handling in individuals prone to insulin resistance, i.e. those with diabetes and/or hypertension. Methods: In this double-blind randomised placebo-controlled four-way crossover study, we examined the effects of pioglitazone (45mg daily during 6weeks) or placebo on renal, systemic and hormonal responses to changes in sodium intake in 16 individuals, eight with type 2 diabetes and eight with hypertension. Results: Pioglitazone was associated with a rapid increase in body weight and an increase in diurnal proximal sodium reabsorption, without any change in renal haemodynamics or in the modulation of the renin-angiotensin aldosterone system to changes in salt intake. A compensatory increase in brain natriuretic peptide levels was observed. In spite of sodium retention, pioglitazone dissociated the blood-pressure response to salt and abolished salt sensitivity in salt-sensitive individuals. Conclusions/interpretation: Pioglitazone increases diurnal proximal sodium retention in diabetic and hypertensive individuals. These effects cause fluid retention and may contribute to the increased incidence of congestive heart failure with glitazones. Trial registration:: ClinicalTrial.gov NCT01090752 Funding:: Hypertension Research Foundation Lausann

Predictive Abilities of the Frailty Phenotype and the Swiss Frailty Network and Repository Frailty Index for Non-Home Discharge and Functional Decline in Hospitalized Geriatric Patients

BACKGROUND: Frailty is increasingly applied as a measure to predict clinical outcomes, but data on the predictive abilities of frailty measures for non-home discharge and functional decline in acutely hospitalized geriatric patients are scarce. OBJECTIVES: The aim of this study was to investigate the predictive ability of the frailty phenotype and a frailty index currently validated as part of the ongoing Swiss Frailty Network and Repository Study based on clinical admission data for non-home discharge and functional decline in acutely hospitalized older patients. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Data were analyzed from 334 consecutive hospitalized patients of a tertiary acute care geriatric inpatient clinic admitted between August 2020 and March 2021. MEASUREMENTS: We assessed frailty using 1) the frailty phenotype and 2) the Swiss Frailty Network and Repository Study (SFNR) frailty index based on routinely available clinical admission data. Predictive abilities of both frailty measures were analyzed for the clinical outcomes of non-home discharge and functional decline using multivariate logistic regression models and receiver operating characteristic curves (ROC). RESULTS: Mean age was 82.8 (SD 7.2) years and 55.4% were women. Overall, 170 (53.1%) were frail based on the frailty phenotype and 220 (65.9%) based on the frailty index. Frail patients based on the frailty phenotype were more likely to be discharged non-home (55 (32.4%) vs. 26 (17.3%); adjusted OR 2.4 (95% CI, 1.4, 5.1)). Similarly, frail patients based on the frailty index were more likely to be discharged non-home compared to non-frail patients (76 (34.6%) vs. 9 (7.9%); adjusted OR, 5.5 (95% CI, 2.6, 11.5)). Both, the frailty phenotype and the frailty index were similarly associated with functional decline (adjusted OR 2.7 (95% CI, 1.5, 4.9); adjusted OR 2.8 (95% CI 1.4, 5.5)). ROC analyses showed best discriminatory accuracy for the frailty index for non-home discharge (area under the curve 0.76). CONCLUSIONS: Frailty using the SFNR-frailty index and the frailty phenotype is a promising measure for prediction of non-home discharge and functional decline in acutely hospitalized geriatric patients. Further study is needed to define the most valid frailty measure