Diagnostic value of aldosterone to renin ratio calculated by plasma renin activity or plasma renin concentration in primary aldosteronism: a meta-analysis.

BACKGROUND: Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis. METHODS: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. RESULTS: The pooled results showed that ARR (plasma aldosterone concentration [PAC]/PRC) had a sensitivity of 0.82 (95% confidence interval [CI]: 0.78-0.86), a specificity of 0.94 (95% CI: 0.92-0.95), a positive-likelihood ratio (LR) of 12.77 (95% CI: 7.04-23.73), a negative LR of 0.11 (95% CI: 0.07-0.17), and symmetric area under the curve (SAUC) of 0.982, respectively. Furthermore, the diagnostic odds ratio (DOR) of ARR (PAC/PRC) was 180.21. Additionally, the pooled results showed that ARR (PAC/PRA) had a sensitivity of 0.91 (95% CI: 0.86-0.95), a specificity of 0.91 (95% CI: 0.90-0.93), a positive LR of 7.30 (95% CI: 2.99-17.99), a negative LR of 0.10 (95% CI: 0.04-0.26), and SAUC of 0.976, respectively. The DOR of ARR (PAC/PRA) was 155.52. Additionally, we conducted a subgroup analysis for the different thresholds (<35 or ≥35) of PAC/PRC. The results showed that the DOR of the cut-off ≥35 groups was higher than the cut-off <35 groups (DOR = 340.15, 95% CI: 38.32-3019.66; DOR = 116.40, 95% CI = 23.28-581.92). CONCLUSIONS: The research results suggest that the determination of ARR (PAC/PRC) and ARR (PAC/PRA) was all effective screening tools for PA. The diagnostic accuracy and diagnostic value of ARR (PAC/PRC) are higher than ARR (PAC/PRA). In addition, within a certain range, the higher the threshold, the better the diagnostic value.

3D organoids derived from the small intestine: An emerging tool for drug transport research.

Small intestine in vitro models play a crucial role in drug transport research. Although conventional 2D cell culture models, such as Caco-2 monolayer, possess many advantages, they should be interpreted with caution because they have relatively poor physiologically reproducible phenotypes and functions. With the development of 3D culture technology, pluripotent stem cells (PSCs) and adult somatic stem cells (ASCs) show remarkable self-organization characteristics, which leads to the development of intestinal organoids. Based on previous studies, this paper reviews the application of intestinal 3D organoids in drug transport mediated by P-glycoprotein (P-gp), breast cancer resistance protein (BCRP) and multidrug resistance protein 2 (MRP2). The advantages and limitations of this model are also discussed. Although there are still many challenges, intestinal 3D organoid model has the potential to be an excellent tool for drug transport research.

New insights of CYP1A in endogenous metabolism: a focus on single nucleotide polymorphisms and diseases.

Cytochrome P450 1A (CYP1A), one of the major CYP subfamily in humans, not only metabolizes xenobiotics including clinical drugs and pollutants in the environment, but also mediates the biotransformation of important endogenous substances. In particular, some single nucleotide polymorphisms (SNPs) for CYP1A genes may affect the metabolic ability of endogenous substances, leading to some physiological or pathological changes in humans. This review first summarizes the metabolism of endogenous substances by CYP1A, and then introduces the research progress of CYP1A SNPs, especially the research related to human diseases. Finally, the relationship between SNPs and diseases is discussed. In addition, potential animal models for CYP1A gene editing are summarized. In conclusion, CYP1A plays an important role in maintaining the health in the body.

Dexmedetomidine for antiemesis in gynecologic surgery: a meta-analysis of randomized controlled trials.

PURPOSE: Postoperative nausea and vomiting (PONV) is a common complication after gynecological surgeries. This meta-analysis was conducted to evaluate the efficacy of dexmedetomidine on PONV after gynecological surgeries. METHODS: Three main electronic databases including Pub Med, Embase and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) were searched by two researchers independently. The metaanalysis was completed using Review Manager. RESULTS: Eleven RCTs with 692 patients were included in this metaanalysis. Dexmedetomidine a bridged postoperative nausea [Risk Ratio (RR)=0.59, 95% confidence interval (CI): 0.44 to 0.79] and vomiting [RR=0.48, 95% CI: 0.36 to 0.64] compared with placebo. Despite of higher incidence of intra operative bradycardia [RR 2.87, 95% CI 1.08 to 7.58] and hypotension [RR 4.26, 95% CI 1.43 to 12.69], we found significant decrease in postoperative shivering [RR 0.23, 95% CI 0.13 to 0.40] and pruritus [RR 0.40, 95% CI 0.17 to 0.93] in dexmedetomidine group, as well as the pain scores [standard mean difference (SMD)-0.96, 95% CI-1.37 to-0.54]. Significant reductions in the need for intraoperative fentanyl (RR 0.10, 95% CI 0.01-0.76, I(2) 0%), antiemetic (RR 0.62, 95% CI 0.39-0.99, I(2) 0%) and postoperative analgesic (RR 0.18, 95% CI 0.08-0.42, I(2) 0%) were also elicited. CONCLUSIONS: The current meta-analysis exhibits that dexmedetomidine is superiority to placebo in attenuating the incidence of PONV, postoperative shivering, pruritus, as well as the pain scores in patients undergoing gynecological surgeries. Still, the potential cardiovascular complications should be taken seriously.