BMI correlated with PAC independent of age, sex, and sodium intake in PH, but not in PA patients. This association of BMI is particularly evident in overweight-obese PH patients, and suggests a pathophysiological link between visceral adiposity and aldosterone secretion. However, it does not impact on the diagnostic accuracy of the ARR for discriminating PA from PH patients.

Abstract-The plasma aldosterone concentration:renin ratio (ARR) is widely used for the screening of primary aldosteronism, but its reproducibility is unknown. We, therefore, investigated the within-patient reproducibility of the ARR in a prospective multicenter study of consecutive hypertensive patients referred to specialized centers for hypertension in Italy. After the patients were carefully prepared from the pharmacological standpoint, the ARR was determined at baseline in 1136 patients and repeated after, on average, 4 weeks in the patients who had initially an ARR Ն40 and in 1 of every 4 of those with an ARR Ͻ40. The reproducibility of the ARR was assessed with Passing and Bablok and Deming regression, coefficient of reproducibility, and Bland-Altman and Mountain plots. Within-patient ARR comparison was available in 268 patients, of whom 49 had an aldosterone-producing adenoma, on the basis of the "4-corner criteria." The ARR showed a highly significant within-patient correlation (rϭ0.69; PϽ0.0001) and reproducibility. Bland-Altman plot showed no proportional, magnitude-related, or absolute systematic error between the ARR; moreover, only 7% of the values, for example, slightly more than what could be expected by chance, fell out of the 95% CI for the between-test difference. The accuracy of each ARR for pinpointing aldosterone-producing adenoma patients was Ϸ80%. Thus, although it was performed under different conditions in a multicenter study, the ARR showed a good within-patient reproducibility. Hence, contrary to previously claimed poor reproducibility of the ARR, these data support its use for the screening of primary aldosteronism. Key Words: secondary hypertension Ⅲ aldosteronism Ⅲ renin assay Ⅲ aldosterone Ⅲ diagnosis R ecent compelling evidence indicates that primary aldosteronism (PA) is associated with prominent cardiovascular and renal damage, adverse metabolic consequences, and an excess rate of cardiovascular events. [1][2][3] In the Primary Aldosteronism Prevalence in hYpertension (PAPY) Study, PA was diagnosed in 11.2% of 1125 newly diagnosed hypertensive patients referred to hypertension centers; moreover, in 4.8% it was attributed to an aldosterone-producing adenoma (APA). 4 Therefore, it is likely that PA represents the most common form of endocrine arterial hypertension that is surgically curable in a substantial proportion of the cases.Currently the plasma aldosterone concentration (PAC):renin ratio (ARR) is the most popular screening test for identifying PA, 4,5 and although it has obvious limitations, 6 its widespread adoption can enhance the identification of PA. 7Nonetheless, the within-patient reproducibility of this test remains unknown. 8 We report here the results of the study of within-patient comparison of the ARR that was determined at the baseline screening and repeated on average after a month. Subjects and MethodsAll of the patients originally recruited in the PAPY Study and 11 additional patients who were investigated with an identical protocol at the internal medicine d...

Longer and/or more frequent dialyses and better efforts to increase compliance to low salt diets than those put in place in this study are needed to reduce the high prevalence of hypertension in the HD population.

An updated review of cases of reactivated visceral leishmaniasis (VL) in transplant patients is presented, with a new report of a kidney transplant patient who had VL caused by reactivation of a dormant infection contracted 21 years previously. Close to the time of disease reactivation, the patient had a primary varicella-zoster infection.

The paper presents a study of the undrained behaviour of an uncemented carbonate sand (Quiou sand) under simple shear loading conditions. The experimental study was conducted through cyclic and monotonic undrained/constant volume simple shear tests carried out on reconstituted specimens prepared by using the sedimentation in water (WS) method. Tests were carried out on specimens reconstituted at two void ratios (i.e. loose and dense) and different effective consolidation stresses. Furthermore, to account for the effect of non-zero mean shear stress level, cyclic simple shear tests were performed under both symmetrical and non-symmetrical cyclic loading. Two types of failure modes have been observed in cyclic tests, that is ‘cyclic liquefaction’ or ‘cyclic mobility’, depending on whether or not they were conducted under shear stress reversal conditions. A unified framework seems to exist whereby undrained monotonic and cyclic response can be comparatively analysed. In particular, normalising the cyclic liquefaction resistances obtained from symmetrical tests by phase transformation strengths determined in corresponding monotonic tests, provides a cyclic liquefaction resistance curve which was found to be unique, irrespective of initial void ratio and vertical effective stress. Undrained cyclic shear strength of the tested sand appears to be affected by the presence of a non-zero mean shear stress, following a pattern of behaviour, which is similar for both loose and dense specimens. Furthermore, the normalised stress–strain curves of the cyclic tests show back-bone curves that are practically coincident with the equivalent monotonic curves.