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CTNNB1 Mutation in Aldosterone Producing Adenoma
Jian-Jhong Wang,Kang-Yung Peng,Vin-Cent Wu,Fen-Yu Tseng,Kwan-Dun Wu 대한내분비학회 2017 Endocrinology and metabolism Vol.32 No.3
Discoveries of somatic mutations permit the recognition of subtypes of aldosterone-producing adenomas (APAs) with distinct clinical presentations and pathological features. Catenin β1 (CTNNB1) mutation in APAs has been recently described and discussed in the literature. However, significant knowledge gaps still remain regarding the prevalence, clinical characteristics, pathophysiology, and outcomes in APA patients harboring CTNNB1 mutations. Aberrant activation of the Wnt/β-catenin signaling pathway will further modulate tumorigenesis. We also discuss the recent knowledge of CTNNB1 mutation in adrenal adenomas.
Primary Aldosteronism and Cerebrovascular Diseases
Zheng-Wei Chen,Chi-Sheng Hung,Vin-Cent Wu,Yen-Hung Lin,TAIPAI study group 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.4
As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease,myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemicattack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-todate findings on the association between PA and cerebrovascular diseases.
Yu-Fang Lin,Kang-Yung Peng,Chia-Hui Chang,Ya-Hui Hu,Vin-Cent Wu,Shiu-Dong Chung,Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.4
Background: Data on the effects of excess aldosterone on glucose metabolism are inconsistent. This study compared the changes in glucose metabolism in patients with primary aldosteronism (PA) after adrenalectomy or treatment with a mineralocorticoid receptor antagonist (MRA). Methods: Overall, 241 patients were enrolled; 153 underwent adrenalectomy and 88 received an MRA. Fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), and homeostatic model assessment of β-cell function (HOMA-β) were compared between the treatment groups after 1 year. Plasma aldosterone concentration (PAC) and factors determining HOMA-IR and PAC were evaluated. Results: No baseline differences were observed between the groups. Fasting insulin, HOMA-IR, and HOMA-β increased in both groups and there were no significant differences in fasting glucose following treatment. Multiple regression analysis showed associations between PAC and HOMA-IR (β=0.172, P=0.017) after treatment. Treatment with spironolactone was the only risk factor associated with PAC >30 ng/dL (odds ratio, 5.2; 95% confidence interval [CI], 2.7 to 10; P<0.001) and conferred a 2.48-fold risk of insulin resistance after 1 year compared with surgery (95% CI, 1.3 to 4.8; P=0.007). Conclusion: Spironolactone treatment might increase insulin resistance in patients with PA. This strengthened the current recommendation that adrenalectomy is the preferred strategy for patient with positive lateralization test. Achieving a post-treatment PAC of <30 ng/dL for improved insulin sensitivity may be appropriate.
Psoas Abscess Caused by Non-Typhoid Salmonella in a Patient with Severe Aplastic Anemia
Chin-Chi Kuo,Shih-Chi Ku,Jann-Tay Wang,Ching-Wei Tsai,Vin-Cent Wu,Wen-Chien Chou 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.3
The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever,bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS),which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infection caused by NTS.
Min-Hsiang Chuang,Yu-Shuo Tang,Jui-Yi Chen,Heng-Chih Pan,Hung-Wei Liao,Wen-Kai Chu,Chung-Yi Cheng,Vin-Cent Wu,Michael Heung 대한당뇨병학회 2024 Diabetes and Metabolism Journal Vol.48 No.2
Background: The initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) typically leads to a reversible initial dip in estimated glomerular filtration rate (eGFR). The implications of this phenomenon on clinical outcomes are not well-defined.Methods: We searched MEDLINE, Embase, and Cochrane Library from inception to March 23, 2023 to identify randomized controlled trials and cohort studies comparing kidney and cardiovascular outcomes in patients with and without initial eGFR dip after initiating SGLT2i. Pooled estimates were calculated using random-effect meta-analysis.Results: We included seven studies in our analysis, which revealed that an initial eGFR dip following the initiation of SGLT2i was associated with less annual eGFR decline (mean difference, 0.64; 95% confidence interval [CI], 0.437 to 0.843) regardless of baseline eGFR. The risk of major adverse kidney events was similar between the non-dipping and dipping groups but reduced in patients with a ≤10% eGFR dip (hazard ratio [HR], 0.915; 95% CI, 0.865 to 0.967). No significant differences were observed in the composite of hospitalized heart failure and cardiovascular death (HR, 0.824; 95% CI, 0.633 to 1.074), hospitalized heart failure (HR, 1.059; 95% CI, 0.574 to 1.952), or all-cause mortality (HR, 0.83; 95% CI, 0.589 to 1.170). The risk of serious adverse events (AEs), discontinuation of SGLT2i due to AEs, kidney-related AEs, and volume depletion were similar between the two groups. Patients with >10% eGFR dip had increased risk of hyperkalemia compared to the non-dipping group.Conclusion: Initial eGFR dip after initiating SGLT2i might be associated with less annual eGFR decline. There were no significant disparities in the risks of adverse cardiovascular outcomes between the dipping and non-dipping groups.