Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism

Abstract

Objective

To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing's syndrome (CS) and with adrenal incidentaloma (AI).

Methods

We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years.

Results

The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L).

Conclusion

The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

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Photocatalytic reduction of CO2 on Cu2O-loaded Zn-Cr layered double hydroxides

Publication date: May 2018
Source:Applied Catalysis B: Environmental, Volume 224
Author(s): Haoyang Jiang, Ken-ichi Katsumata, Jeongsoo Hong, Akira Yamaguchi, Kazuya Nakata, Chiaki Terashima, Nobuhiro Matsushita, Masahiro Miyauchi, Akira Fujishima
A series of Cu2O-loaded Zn-Cr layered double hydroxides (LDHs) was prepared via an in situ reduction process from Cu-Zn-Cr ternary LDHs and applied to the photoreduction of CO2. The formation of Cu2O nanoparticles and the preservation of the LDH structure was confirmed by X-ray diffraction and transmission electron microscopy. Among the loaded LDHs, the 0.1Cu2O@Zn1.8Cr LDH exhibited optimal activity for the conversion of CO2 into CO in pure water and was superior to both the corresponding Cu-Zn-Cr ternary LDH and pristine Zn2Cr LDHs. In addition, the production of CO was further promoted by increasing the solubility of CO2 using a nano-bubble solution instead of pure water. The loaded Cu2O nanoparticles probably function as effective electron traps, promoting charge separation and providing active sites for CO2 reduction.

Graphical abstract

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Ion-exchange modified zeolites X for selective adsorption desulfurization from Claus tail gas: Experimental and computational investigations

Publication date: 1 May 2018
Source:Microporous and Mesoporous Materials, Volume 261
Author(s): Xi Chen, Benxian Shen, Hui Sun, Guoxiong zhan
Zn, Co and Ag modified NaX zeolites were prepared by ion-exchange method and the post-synthesized samples were characterized using EDS, XRD, FT-IR, SEM and N2 adsorption. The selective adsorption performances for H2S and COS from Claus tail gas were evaluated in a fixed bed adsorption column. In addition, the underlying mechanism for H2S and COS adsorption on zeolites X was revealed by DFT computation. Among all the samples, AgX shows the most excellent adsorption performance, which shows the highest H2S and COS breakthrough adsorption capacities up to 1.53 mmol/g and 10.5 μmol/g, respectively. The used AgX zeolite can also be regenerated by thermal treatment at 350 °C under air atmosphere. The DFT study indicates that the S-M bond between H2S or COS and metal ion can be formed during the adsorption process. Furthermore, the Ag-sulfide complex shows the strongest S-M interaction, hence, benefits the adsorption of H2S and COS on Ag-exchanged zeolite X.

Graphical abstract

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Cone-beam computed tomography and anatomical observations of normal variants in the mandible: variant dentists should recognize

Abstract

Many types of cone-beam computed tomography (CBCT) have recently been developed and are being used in many dental clinics. CBCT has significantly changed imaging diagnosis in dentistry by showing detailed structures in multiple dimensions with high spatial resolution. This allows dentists to confirm what cannot be recognized with conventional two-dimensional images, such as small neurovascular canals, the buccolingual location of structures/lesions, and the three-dimensional shapes of hard tissue structures. The aim of this study was to review the normal variants of detailed anatomical structures in relation with the mandibular canal by comparing the previous reports and anatomical evaluations. These structures are likely to be observed on CBCT images by dental practitioners prior to dental procedures involving the mandibular teeth and bone. Understanding the relationship of these structures is useful for dental practitioners and oral surgeons to reduce the possibility of causing damage and patient discomfort during dental procedures.

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Mercury in organs of Pacific walruses ( Odobenus rosmarus divergens ) from the Bering Sea

Abstract

The Pacific walrus (Odobenus rosmarus divergens) is still used as an important source of protein-rich food by indigenous peoples of Chukotka, Alaska, and other Arctic regions. Total mercury (THg) concentration was measured in eight internal organs of walruses. Samples were taken from 22 individuals (11 males and 11 females). Age of the animals ranged from 1 to 30 years. All the walruses were harvested by local hunters from the coastal waters off the Chukchi Peninsula (Russia) during the autumn of 2011. Total mercury concentration in the samples was determined by atomic absorption method. No statistically significant difference in the level of mercury was found between males and females. Mercury was detected in all the organs of the studied walruses. The highest total mercury concentration was recorded from excretory organs: liver and kidneys. The level of mercury in liver (mean = 1.87 μg/g, range = 0.05–5.87) was by an order of magnitude higher than in kidneys (mean = 0.54 μg/g, range = 0.09–1.64.); in kidneys, it was by an order of magnitude higher than in the rest of the organs. The analyzed organs can be arranged in the order of decreasing Hg concentration as follows: liver >> kidney >> muscle > spleen ≥ heart ≥ intestine > lung ≥ testis. The mercury concentration values in walruses from the coastal waters off the Chukchi Peninsula are lower than those obtained from walruses in Alaska and the Canadian Arctic. Our findings may provide a basis for the further long-term monitoring of the condition of the Pacific walrus population and pollution of the Arctic ecosystem.

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Not All Head and Neck Squamous Cell Carcinomas Are Created Equal: Some Are More Aggressive

International Journal of Radiation Oncology, Biology, Physics, Volume 99, Issue 5, 2017 Dec 1 | Man, Lillian C., MD; Axelrod, Rita, MD
1. We favor initial radiation therapy (RTacrnm1) for this patient (1) given direct tumor extension to the sternocleidomastoid muscle. 2. We defer to the radiation oncology commentator on matters of doses and fields. 3. We favor the addition of con...

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Photon and Proton Radiation Therapy Utilization in a Population of More Than 100 Million Commercially Insured Patients

International Journal of Radiation Oncology, Biology, Physics, Volume 99, Issue 5, 2017 Dec 1 | Waddle, Mark R., MD; Sio, Terence T., MD, MS; Van Houten, Holly K., BA;...
Summary This is the largest and most geographically diverse description of RT utilization to date. Proton beam utilization remains low and has had little impact on overall utilization compared with Radiotherapy, Intensity-Modulated. The utilizatio...

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