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Several limitations should be acknowledged when interpreting the findings of our study. First, this study was a single-center, cross-sectional observational study, and inevitable bias may affect the authenticity of the results, potentially weakening their reliability. Second, due to the lack of uniformity in diagnostic protocols and assay methods for measuring the ARR in different medical centers (17), the resulting cutoff values may vary substantially, limiting the generalization of the results of this study. Multi-center research is needed to further verify our findings among a broader population.
1 Study design and population selection
The center saw boom years in the go-go 1980s followed by lean years in the 1990s amid the economic downturn, which brought many vacant storefronts. The situation left some to wonder whether Pelli’s vision would ever be completed. In 1975, the first building of the Pacific Design Center opened, altering the landscape and beginning decades of debate about whether the interior design and arts complex is an architectural gem or eyesore.
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With this winning combination of multi-disciplinary expertise, successful project completions, industry connections, and ongoing training programs, Sea Pac Engineering is prepared to deliver your most complex and challenging projects. Not all showrooms will allow visits by unaccompanied clients, so please check with the showroom in advance. The PDC is home to over 70 luxury showrooms and offers an unparalleled line-up of residential and commercial products. When the red building finally opened, Pelli said the decades of work and waiting had been worth it. Pelli told The Times he doubted the building could have been built earlier because of the color’s association with communism. Ten years later, just after West Hollywood was officially born — and inherited the Blue Whale as one of its few landmarks — Pelli was commissioned to add the final two buildings to the site.
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Only the green one was finished, and it struggled over the years to find tenants. In the late 1990s, much of it was converted from showrooms to office space, with Pelli helping to add new windows to a facade that hadn’t previously needed them. But the PDC has found new life under [developer Charles S.] Cohen, who purchased it in 1999 for $165 million. But the Pacific Design Center holds a special place in the landscape of Los Angeles, an audacious, still much-debated project that took four decades to complete. The studies involving humans were approved by the Ethics Committee of the Ji'an Central Hospital (No.063056). The studies were conducted in accordance with the local legislation and institutional requirements.
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The optimal cutoff value for PAC was 17, with a relatively lower specificity (78%) than ARR, a sensitivity of 55%, a positive predictive value of 82%, and a negative predictive value of 49% (Table 3). Among the three indicators, ARR at screening, and PAC at screening exhibited potential for the diagnosis of PA in patients with moderate and severe OSAHS combined with RH. OSAHS is recognized as a contributing factor to hypertension and holds a pivotal role in cases of resistant hypertension (RH) (3). A substantial prevalence of OSAHS exists among individuals with RH, with suggestions attributing the hormone aldosterone as a potential contributor to the resistance observed in this population (4).
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3 The diagnosis value of PA among different indicators by ROC graph curves
Our findings shed light on the diagnostic potential of the ARR and PAC as screening tools, with differential ARR cutoff values identified for diagnosing PA in patients with moderate and severe OSAHS (45 for moderate OSAHS and 42 for severe OSAHS). The lower ARR cutoff value for severe OSAHS suggested a higher risk of PA in this population, indicating that patients with more severe OSAHS might require earlier intervention for PA. This study contributes to existing knowledge by advocating for the nuanced application of ARR in screening practices, especially in settings where PA is prevalent among patients with OSAHS and RH. It is important to emphasize, however, that these indicators serve as preliminary aids and should not replace the confirmatory tests in PA diagnosis.
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This study investigated the diagnostic value of common screening indicators, including PRA, PAC, and ARR, for identifying PA among patients with moderate and severe OSAHS combined with RH. It is important to note that while these indicators can be utilized in settings with limited resources, they are not substitutes for definitive diagnostic tests. We found that ARR, across all patients, and PAC, especially in those with severe OSAHS, displayed moderate predictive utility for PA. In contrast, PRA exhibited limited predictive capacity for PA diagnosis, lacking sufficient diagnostic value compared to ARR and PAC. Notably, in the subgroup of patients with severe OSAHS, the screening efficacy of PAC and ARR was particularly significant. Early identification of PA using these indicators can lead to prompt intervention and improve patient outcomes.
While these indicators can streamline the initial assessment process in patients at higher risk of PA and potentially reduce costs, the definitive diagnosis should rely on more conclusive tests. ARR, plasma aldosterone-renin ratio; AVS, adrenal venous sampling; CCT, captopril challenge test; COPD, chronic obstructive pulmonary disease; MRA, mineralocorticoid receptor agonist; OSA, obstructive sleep apnea; PA, primary aldosteronism; SIT, saline infusion test. Using 45 as the cutoff value for ARR at screening, we achieved a sensitivity of 52% and a specificity of 86%, a positive predictive value of 87%, and a negative predictive value of 50%.
Patients willing to undergo adrenalectomy were subjected to adrenal venous sampling (AVS), and the criteria used to determine the lateralization of aldosterone hypersecretion were established according to guideline (17). Designed by architect Cesar Pelli, FAIA, the beautifully landscaped, 14-acre campus is located in the City of West Hollywood, CA. In SIT, patients in the OSAHS-PA group exhibited significantly higher levels of PAC and PRA at both at immediately after the start of the infusion and 4 h compared to patients in the OSAHS-no PA group. In CCT, there was no significant difference in PAC at 0 h between patients in the OSAHS-PA group and those in the OSAHS-no PA group.
ARR, plasma aldosterone-renin ratio; PAC, plasma aldosterone concentration; PA, primary aldosteronism; PRA, plasma renin activity; ROC, receiver operating characteristic. Previous studies have suggested that the co-morbidity of OSAHS and PA may mutually affect and exacerbate each other (9, 10).The prevalence of PA in the OSAHS population is as high as 34% (11), and the prevalence of OSAHS in the PA population is even higher at 78.1% (12). On one hand, excessive aldosterone secretion in patients with PA leads to water and sodium retention, causing edema of pharyngeal wall tissues and aggravating the severity of OSAHS (13). On the other hand, intermittent nocturnal hypoxia in patients with OSAHS may increase the activity of RAAS, which may lead to the occurrence and development of PA (9). Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by apnea, intermittent hypoxia, and sleep fragmentation due to recurrent partial or total collapse of the upper airway during sleep (1).
Additionally, it has been demonstrated that OSAHS severity was strongly correlated with an overnight reduction of leg fluid volume and calf circumference (24). Conversely, intermittent hypoxia caused by OSAHS might, in turn, exacerbate RAAS activation. Besides, significantly increased secretion of cortisol in patients with PA, independent of PA subtype or adenoma tissue genotypes, could also increase the risk of OSAHS (25, 26). The ROC curves of PAC (A), ARR (B) and PRA (C) at screening for the prediction of PA.
From gift baskets, towers and more, hundreds of unique gifts are designed each year with customization based on retailer needs. DesignPac creations can currently be found in more than 80 retailers throughout the United States and internationally. Predictive value of PAC at screening and ARR at screening for the diagnosis of PA according to OSAHS.
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