ABSTRACT
Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.
ABSTRACT
BACKGROUND@#Preventing the need for long-term care (LTC) by identifying physical function risk factors are important to decrease the LTC burden. The objective of this study was to investigate whether grip strength and/or walking speed, which are components of the frailty definition, are associated with LTC in community-dwelling older and oldest people.@*METHODS@#The participants were 1098 community-dwelling older and oldest people who had not received LTC at the baseline. The endpoint was receiving LTC after the baseline survey. The independent variables were grip strength and walking speed, and participants were divided into two groups based on these variables. The confounding factors were age, sex, the Japanese version of the Montreal Cognitive Assessment (MoCA-J), hypertension, diabetes mellitus, stroke, joint diseases, living alone, body mass index, and serum albumin. We calculated the hazard ratio of receiving LTC using the Cox proportional hazard model.@*RESULTS@#Among the 1098 participants, 107 (9.7%) newly received LTC during the follow-up. Regarding the physical function, only slow walking speed was significantly correlated with LTC after adjusting for all confounding factors except the MoCA-J score (HR = 1.74, 95% CI = 1.10-2.75, P = .018). However, slow walking speed was still a risk factor for LTC after adjusting for the MoCA-J score and other confounding factors (HR = 1.64, 95% CI = 1.03-2.60, P = .037).@*CONCLUSIONS@#The findings from this study may contribute to a better understanding of slow walking speed as a factor related to LTC, which might be a criterion for disability prevention and could serve as an outcome measure for physical function in older people.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Exercise , Independent Living , Japan , Long-Term Care , Proportional Hazards ModelsABSTRACT
An increasing number of children who have ADHD are visiting pediatric clinics. In this study, we focused on the behavior of ADHD children in different situations.The behavior of ADHD children was evaluated with a specially designed checklist in a person-to-person situation in which the subject was face to face with the clinical psychologist at the counseling room and in a group situation in which the subject participated in an outdoor program organized by the Department of Pediatries of Enshu General Hospital.In the person-to-person context, all of the performance scores with respect to attention-deficit, impulsivity, hyperactivity and difficulty with communication were decreased after psychotherapy. This suggested the regular person-to-person therapy with medication could improve the behaviors and development of ADHD children. On the other hand, the hyperactivity score was increased in the group context because of a lot of stimulation. These findings suggested ADHD children’s behavior changes according to the situation, and that we should take care of them with this fact in mind.