Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension

OBJECTIVE: Obstructive sleep apnea (OSA) and primary aldosteronism are common in subjects with resistant hypertension; it is unknown, however, if the two disorders are causally related. This study relates plasma aldosterone and renin levels to OSA severity in subjects with resistant hypertension, and in those with equally severe OSA but without resistant hypertension serving as control subjects. METHODS: Seventy-one consecutive subjects referred to the University of Alabama at Birmingham (UAB) for resistant hypertension (BP uncontrolled on three medications) and 29 control subjects referred to UAB Sleep Disorders Center for suspected OSA were prospectively evaluated by an early morning plasma aldosterone concentration (PAC) and renin level, and by overnight, attended polysomnography. RESULTS: OSA (apnea-hypopnea index [AHI] > or = 5/h) was present in 85% of subjects with resistant hypertension. In these subjects, PAC correlated with AHI (rho = 0.44, p = 0.0002) but not renin concentration. Median PAC was significantly lower in control subjects compared to subjects with resistant hypertension (5.5 ng/dL vs 11.0 ng/dL, p < 0.05) and not related to AHI. In male subjects compared to female subjects with resistant hypertension, OSA was more common (90% vs 77%) and more severe (median AHI, 20.8/h vs 10.8/h; p = 0.01), and median PAC was significantly higher (12.0 ng/dL vs 8.8 ng/dL, p = 0.006). CONCLUSION: OSA is extremely common in subjects with resistant hypertension. A significant correlation between PAC and OSA severity is observed in subjects with resistant hypertension but not in control subjects. While cause and effect cannot be inferred, the data suggest that aldosterone excess may contribute to OSA severity.     

妇科肿瘤后装逆向调强放射治疗的剂量学和疗效研究

目的：探讨后装逆向调强放射治疗在妇科肿瘤治疗中的应用价值,为临床治疗的技术选择提供依据。方法：选取20例I-Ⅲ期宫颈癌患者,随机分为A、B两组,各10例。Ib期2例,Ⅱa期4例,Ⅱb期12例,Ⅲa期2例。病理分型：鳞癌16例,腺癌4例。以上诊断均经过病理学证实。平均年龄55．67岁（32岁一65岁）。A组病例行后装逆向调强放射治疗,采用InversePlanningSimulatedAnnealing（IPSA）技术进行剂量优化设计,B组病例行三维适形后装放射治疗。A、B组患者均采用3根施源器．进行腔内照射并同步箱式四野等中心外照射,剂量为46Gy／23次。依据曼彻斯特剂量学系统,给予A点（宫口上2cm,宫腔中轴线左右旁开2em处为A点位置）处方剂量6Gy肷,照射次数5次,2次／周。对比分析A、B两组患者的靶区剂量分布,危及器官（直肠、膀胱）受量,放射性并发症及近期疗效。结果：A组患者的靶区剂量适形度和均匀性均好于B组患者。患者0．5年～1．0年的肿瘤局部和区域控制率：A组患者分别为96％（95％CI,85％～99％）和95％（95％CI,81％～99％）。B组患者局分别为93％（95％CI,85％-99％）和92％（95％CI,81％-99％）。危及器官（直肠、膀胱）受量：A组患者的直肠、膀胱最大受量比B组患者小约35％。A组患者的直肠、膀胱75％处方剂量受照体积v。约只为B组患者的二分之一。放射性并发症：RTOG1级反应：A组患者为1例,B组患者为6例。RTOG2级反应：A组患者为0例,B组患者为3例。RTOG3级反应：A组患者为0例,B组患者为1例。近期疗效：在A、B组患者放疗期间及治疗结束后,几乎所有患者的肿瘤均有不同程度的缩小,有效率（CR＋PR）均为92％以上。结论：后装逆向调强放射治疗技术具有近期疗效明显,靶区剂量适形度、均匀性好,危及器官受量低,放射性并发症少等优点,值得在妇科肿瘤治疗中广泛应用。     

Regional patterns of birthweights in Papua New Guinea in relation to diet,environment and socio-economic factors

Regional differences in mean birthweight in rural Papua New Guinea (PNG) and the importance of differences in family diet and maternal education and socio-economic status on such patterns were explored using birthweight data collected by the 1982/83 PNG National Nutrition Survey. A total of 6137 birthweight measurements from 85 PNG districts were available, representing 22% of all children included in the survey. The nature of possible selection biases are assessed and their implications discussed. Hierarchical Bayesian spatial models based on conditional autoregressive (CAR) priors were used to model spatial patterns in birthweights and their relation to different sets of covariates. Birthweights were found to exhibit striking geographical differences. Children from the central PNG highlands and from affluent lowland areas had the highest birthweights, while they were lowest in the (largely lowland) Sepik, Western, Madang and Milne Bay Provinces and in remote highland fringe areas. Maternal education, socio-economic status and diet were all important predictors, but only differences in family diet were correlated with the observed spatial patterns. The results of the present study highlight the importance of nutrition and socio-economic status in explaining differences in birthweights in PNG. Besides improving maternal health, interventions for improving birthweights in PNG should therefore aim at strengthening the economic base of rural populations and promote the cultivation and consumption of high quality foods.