Predictors of Resolution of Hypertension after Adrenalectomy in Patients with Aldosterone-producing Adenoma

Primary aldosteronism (PA) is a frequent cause of secondary hypertension and is amenable to surgical intervention when it is caused by aldosterone-producing adenoma (APA). Many patients, however, continue to require antihypertensive medications to control their blood pressure after adrenalectomy. The aim of this study was to determine the preoperative factors that predict clinical outcomes after adrenalectomy in patients with APA. We studied 27 patients (mean age 45±4 yr) who had APA and underwent unilateral adrenalectomy between December 1995 and September 2008 at our institution. Clinical and biochemical data were evaluated at baseline and after a mean follow-up of 51.8±47.0 months (range, 6-159). At the end of the follow-up, 16 patients (59.3%) were considered to experience "complete resolution" without postoperative medications, whereas 7 patients (25.9%) "improved" with medications and 4 patients (14.8%) were "uncontrolled." Three factors (≤2 antihypertensive medications [P=0.007], duration of hypertension <6 yr [P=0.002], and serum aldosterone <350 pg/mL [P<0.001]) were the predictive for complete resolution in univariate analysis. Multivariate regression analysis showed that serum aldosterone level (<350 pg/mL) was the single most important factor that predicted complete resolution after surgery (P<0.001). The best preoperative clinical factor that predicted resolution of postoperative hypertension after adrenalectomy is serum aldosterone level (<350 pg/mL)

Do large thyroid nodules (≥4 cm) without suspicious cytology need surgery?

BackgroundFine-needle aspiration biopsy (FNAB) is a good diagnostic tool for thyroid nodules; however, its high false-negative rate for giant nodules remains controversial. Many clinicians recommend surgical resection for nodules &gt;4 cm owing to an increased risk of malignancy and an increased false-negative rate. This study aimed to examine the feasibility of this approach and investigate the incidence of malignancy in thyroid nodules &gt;4 cm without suspicious cytology based on medical records in our center.MethodsThis was a retrospective analysis of 453 patients that underwent preoperative FNAB for nodules measuring &gt;4 cm between January 2017 and August 2022 at Severance Hospital, Seoul.ResultsAmong the 453 patients, 140 nodules were benign and 119 were indeterminate. Among 259 patients, the final pathology results were divided into benign (149) and cancerous (110) groups, and the prevalence of malignancy was 38.9% in the benign group and 55.5% in the indeterminate group. Among the malignancies, follicular carcinoma and follicular variants of papillary carcinoma were observed in 83% of the cytologically benign group and 62.8% of the indeterminate group.ConclusionPreoperative FNAB had high false-negative rates and low diagnostic accuracy in patients with thyroid nodules &gt;4 cm without suspicious cytologic features; therefore, diagnostic surgery may be considered a treatment option

Clinicopathologic Features and Treatment Outcomes in Differentiated Thyroid Carcinoma Patients with Concurrent Graves' Disease

The clinical behaviors and treatment outcomes of thyroid carcinomas in patients with Graves' disease is a matter of controversy. This study aimed to identify the clinicopathologic features, treatment outcome, and the indicators for predicting recurrence, and to suggest the optimal extent of surgery in these patients. We retrospectively analyzed data of 58 patients who underwent surgical treatment for differentiated thyroid cancer and concurrent Graves' disease. The follow-up period ranged from 23 to 260 months (mean±standard devuation, 116.8±54.0). In our series, the mean age was 40.8±12.7 yr (range, 15-70), with a male-to-female ratio of 1:6.25. The mean tumor size was 13±9 mm (range, 3-62). The surgical methods included 19 cases of total thyroidectomy, 38 cases of subtotal thyroidectomy, and 1 case of completion total thyroidectomy. Locoregional recurrence occurred in four patients (6.9%). The 10-yr overall survival and disease-free survival of patients were 95.8% and 91.1%, respectively. Age over 45 yr (p=0.031), tumor size over 10 mm (p=0.049), multiplicity (p=0.007), extracapsular invasion (p=0.021), and clinical cancer (p=0.035) were significantly more prevalent in patients with locoregional recurrence than in those without recurrence. We recommend that Graves' disease patients should undergo regular ultrasonography screening for early detection of thyroid carcinoma. We also suggest that the choice of extent of surgery should depend on the diagnostic timing (clinical or incidental) and factors for predicting recurrence

Therapist Responses to Observable In-Session Engagement Challenges: Contributing Factors and Implications for Delivering Evidence-Based Practices with Youth

This dissertation investigates community mental health therapists’ responses to youth engagement challenges when delivering evidence-based practices. The study provides a typography of observable responses that naturally occur in treatment sessions, identifies therapist, client, and session level correlates of responses, and in turn, how these responses are related to the intensity of evidence-based practice implementation within sessions

Impact of thyroid cancer on the cancer risk in patients with non-alcoholic fatty liver disease or dyslipidemia

Abstract The raised prevalence of obesity has increased the incidence of obesity-related metabolic diseases such as dyslipidemia (DL) and non-alcoholic fatty liver disease (NAFLD), along with the development and progression of various types of cancer, including thyroid cancer. In this study, we investigated whether thyroid cancer in patients with DL and NAFLD could be a risk factor for other cancers. To achieve our goal, we generated two independent cohorts from our institution and from the National Health Insurance System in South Korea. Based on the ICD-10 code, we conducted exact matching (1:5 matching) and estimated the overall risk of thyroid cancer for other cancers in patients with DL or NAFLD. Univariate and multivariate analyses showed that the hazard ratio (HR) of thyroid cancer was 2.007 (95% Confidence Interval [CI], 1.597–2.522) and 2.092 (95% CI, 1.546–2.829), respectively in the institutional cohort and 1.329 (95% CI, 1.153–1.533) and 1.301 (95% CI, 1.115–1.517), respectively in the nationwide cohort. Risk analysis revealed a significant increase in the HR in lip, tongue, mouth, lung, bone, joint, soft tissue, skin, brain, male cancers and lymphoma after thyroid cancer occurred. Thyroid cancer in patients with DL or NAFLD might be a valuable factor for predicting the development of other cancers

Self-Assembled Monolayer of a Redox-Active Calix[4]arene: Voltammetric Recognition of the Ba^(2+) Ion in Aqueous Media

The Redox-active monolayer of a novel calix[4]arene recognizing redox-inactive ionic species by voltammetry is reported. Calix[4]arene-disulfide-diquinone, which is not only redox-active but is also a highly selective ionophore for the Ba^(2+) ion, spontaneously forms a stable and dense monolayer film on gold. The redox-active calixarene monolayer selectively recognizes Ba^(2+) ion in aqueous media, and the voltammetric signals are proportional to the ionic concentration. A new voltammetric peak can be detected by square-wave voltammetry upon adding a dilute solution containing Ba^(2+) ion having a concentration as low as 1.0 x 10^(-6) M. The Langmuir plot (1/i_(p) vs 1/[Ba^(2+)]) shows a linear slope in the range from 1.0 x 10^(-6) M to 1.0 x 10^(-4) M. This modified electrode does not show any significant interference from alkali and alkaline earth metal ions except for Sr^(2+) and Ca^(2+). Only 100- and 500-fold concentrations of Sr^(2+) and Ca^(2+) ions, respectively, can lead to voltammetric responses comparable to that of Ba^(2+)

Contrasting Electrochemical Behavior of CO, Hydrogen, and Ethanol on Single-Layered and Multiple-Layered Pt Islands on Au Surfaces

This work presents formation of single-layered Pt islands on Au electrodes using the CO route, and the electrochemical behavior of CO, hydrogen, and ethanol was investigated with scanning tunneling microscopy (STM), X-ray photoelectron spectroscopy (XPS), and cyclic voltammetry. The conventional route, consisting of irreversible adsorption of Pt precursor ions (10^–3 M PtCl₄^2– in 0.05 M H₂SO₄) and subsequent electrochemical reduction, resulted in multiple-layered Pt islands; the CO route, utilizing CO adsorption to protect pre-existing Pt islands from irreversible adsorption of Pt, exclusively produced single-layered Pt islands. Furthermore, STM results implied that single-layered Pt islands on Au(111) were islands of alloyed Pt in a (√3 × √3)<i>R</i>30° arrangement, while multiple-layered islands were stacked layers of Pt in an (1 × 1) array. The coverages of deposited Pt estimated from STM and XPS measurements were quantitatively consistent with each other to confirm existence of the single-layered Pt islands. Coulometric analyses of adsorbed CO and hydrogen indicated lower adsorption stoichiometry of hydrogen on Pt islands prepared by the two deposition routes, especially when the deposited amount of Pt was small. Comparison of the coulometric coverages of CO and hydrogen with electrochemically active Pt coverages estimated with STM results supported that the adsorption stoichiometries of CO and hydrogen were higher on single-layered Pt islands than on multiple-layered ones, roughly by a factor of ∼1.8. Also, ethanol oxidation was enhanced on single-layered Pt islands approximately ∼4 times on average referring to Pt­(poly), while the enhancement factor on multiple-layered ones was ∼1.5. Thus, this work demonstrated that the CO route exclusively produced single-layered Pt islands on Au, contrasting with multiple-layered islands in various electrochemical aspects

Simultaneous Expression of Long Non-Coding RNA FAL1 and Extracellular Matrix Protein 1 Defines Tumour Behaviour in Young Patients with Papillary Thyroid Cancer

We investigated the regulatory mechanism of FAL1 and unravelled the molecular biological features of FAL1 upregulation in papillary thyroid cancer (PTC). Correlation analyses of FAL1 and neighbouring genes adjacent to chromosome 1q21.3 were performed. Focal amplification was performed using data from copy number alterations in The Cancer Genome Atlas (TCGA) database. To identify putative transcriptional factors, PROMO and the Encyclopaedia of DNA Elements (ENCODE) were used. To validate c-JUN and JUND as master transcription factors for FAL1 and ECM1, gene set enrichment analysis was performed according to FAL1 and ECM1 expression. Statistical analyses of the molecular biological features of FAL1- and ECM1-upregulated PTCs were conducted. FAL1 expression significantly correlated with that of neighbouring genes. Focal amplification of chromosome 1q21.3 was observed in ovarian cancer but not in thyroid carcinoma. However, PROMO suggested 53 transcription factors as putative common transcriptional factors for FAL1 and ECM1 simultaneously. Among them, we selected c-JUN and JUND as the best candidates based on ENCODE results. The expression of target genes of JUND simultaneously increased in FAL1- and ECM1-upregulated PTCs, especially in young patients. The molecular biological features represented RAS-driven PTC and simultaneously enriched immune-related gene sets. FAL1 and ECM1 expression frequently increased simultaneously and could be operated by JUND. The simultaneous upregulation might be a potential diagnostic and therapeutic target for RAS-driven PTC