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Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan–Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. Results: At a median follow-up of 42 months (IQR 27–54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan–Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11–0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1–1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32–6.1; p = 0.007) was the only independent predictor of absent clinical success. Conclusions: TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery. [ABSTRACT FROM AUTHOR]

Objective: Primary aldosteronism (PA) is the most common cause of endocrine hypertension and adrenalectomy is the firstline treatment for unilateral PA. Suppression of aldosterone secretion of the nondominant adrenal gland at adrenal venous sampling (AVS), that is, contralateral suppression (CLS) has been suggested as a marker of disease severity. However, whether factors such as CLS, age, gender or comorbidities are associated with remission after surgery is controversial. The objective of this study is to investigate the prognostic value of CLS, age, gender, aldosterone‐to‐renin ratio, antihypertensives and comorbidities for clinical and biochemical remission following unilateral adrenalectomy in patients with PA. Design and patients: A retrospective study of patients with PA referred for AVS at Rigshospitalet from May 2011 to September 2020, who subsequently underwent adrenalectomy. Clinical remission was defined according to the PA surgical outcome criteria, whereas complete biochemical remission was defined as normalization of hypokalaemia without potassium substitution. Results: Eighty‐four patients were available for analysis of primary outcome. Among patients with CLS, 28/58 (48.3%) obtained complete clinical remission after surgery compared with 10/26 (38.5%) without CLS (p =.40). Complete biochemical remission was obtained in 55/58 (94.8%) of patients with CLS compared with 25/28 (89.3%) without CLS (p =.44). Female gender and lower number of antihypertensives at baseline were associated with higher odds for complete clinical remission, whereas none of the investigated variables were associated with biochemical remission. Conclusion: CLS was not significantly associated with complete clinical or biochemical remission in this cohort. Our results confirmed that female gender and lower number of antihypertensives were predictors of clinical remission. [ABSTRACT FROM AUTHOR]

This study investigates the predominant moves and move patterns used in the separate final conclusion chapters of 48 PhD theses of computer science at a UK university. The focus is on the most salient connections of steps in the review of the study (Move 1) with steps for the consolidation of research space (Move 2). The most common combinations relate (1) a summary of the thesis work to the product and the evaluation of the product, (2) the purpose, thesis statement or hypothesis to the findings or results, (3) the research questions to the methodology, product or claim, (4) a problem or need to a specific methodology, a new product and/or a claim, and (5) a summary of the work done in each thesis chapter to the findings and claims. Some findings are specific of the field of computer science. The study has pedagogical implications for courses of English for Academic Purposes (EAP). [ABSTRACT FROM AUTHOR]

The Pie de Vaca locality in the State of Puebla stands out for its important abundance of fossil mammal footprints, among them, the most representatives have been referred to camelids and felids. The purpose of the present study was the formal characterization of this set of footprints and comment on some paleobiological aspects related to their size, speed, and mode of progression of the track-makers. The sample consists of 233 footprints including 154 referable to nine trackways produced by camelids and 79 referable to three trackways produced by felids. The characterization of the tracks was made by comparing their size and morphology with others produced by fossil and recent taxa. The impressions of camelids, based on their shape and size, were designated to the icnospecies Lamaichnum guanicoe because they show the typical morphological pattern of this group of artiodactyls. It is suggested that they were produced by some member of the genus Hemiauchenia, which corresponds to the most common camelid of the Late Cenozoic of Mexico. On the other hand, the tracks of felids were only referred to the morphofamily Felipedidae due to the bad preservation of its ichnotaxonomic characters; however, being larger than traces of the ichnogenera Felipeda, Pycnodactylopus, Pumaeichnum and Mitsupes, it is suggested that they were produced by some form of medium to large size, a machairodontid or a pantherine, for instance. The mode of progression of both producers corresponds to that of relatively fast walking organisms that move at a speed lower than 4 m/s. The direction and number of individuals of camelids trackways, are indicative of gregarious behavior, probably associated with a certain social organization. In the case of felids, solitary or couple behavior is proposed. [ABSTRACT FROM AUTHOR]

Background Ablation of cardiac arrhythmias in children and teenagers often necessitates the use of anesthesia, which can suppress ventricular arrhythmias (VAs), making it difficult to map the site of origin using activation time (AT). Pace mapping, a technique employed to assist with VA origin localization, depends on subjective comparison of paced and targeted QRS morphology. We assessed the utility of a quantitative approach to paced QRS to VA morphology matching using the PaSo software (Carto 3, Biosense Webster), to localize the VA site of origin. Methods Twenty-four patients underwent 26 procedures for frequent VAs, 29 for targeted VA. If AT mapping was precluded due to infrequent VA, pace mapping was executed using the PaSo software, after regionalization based on targeted VA QRS morphology. Results Subjects were aged 1-32 (mean 14 ± 6) years; 10 were male. Heart disease was present in six patients. PVC frequency prior to onset of anesthesia was 15 ± 16/min, decreasing to 0-1 PVC/min in 17 cases prior to ablation. Arrhythmia localization was performed by AT mapping + PaSo (12) or PaSo only (17). Pace mapping exhibited an intraventricular gradient of percent QRS morphology match. Highest achieved QRS match averaged 96 ± 2%. Successful ablation (> 1-month follow-up) was achieved in 24/29 targeted VAs, 11/12 ablated using AT and pace mapping, and 13/17 VA ablated using pace mapping only, P = 0.29. Conclusions (1) Spontaneous VA frequency was markedly reduced following anesthesia, despite catecholamine administration. (2) Notwithstanding the ability to perform AT mapping, successful ablation can still be performed using pace mapping only, facilitated by the PaSo software. [ABSTRACT FROM AUTHOR]

From the anarchic Persian hordes of Xerxes to the phlegmatic British battalions of Churchill, the attempt to crossing the Dardanelles has resulted not only challenging but costly and deadly. Paradoxically, the only harmless to jump from Europe to Asia was Alexander the Great to begin the victorious conquest of the Achaemenid Empire. [ABSTRACT FROM AUTHOR]

Background: This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary aldosteronism (uPHA). Material and Methods: Multiple scientific databases (PUBMED, Web of Science, and Cochrane Library) were searched up to November 2021 for surgical series comparing mi-PA vs. mi-TA for uPHA according to the PRISMA statement. Primary outcomes of interest were perioperative and functional outcomes. Results: Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% (n = 324) and 59.6% (n = 478) of cases, respectively. No differences were recorded between the two groups according to number of transfusions, EBL and Clavien–Dindo complications ≥2. Similarly, no differences in clinical success, persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA. Conclusions: In a uPHA setting, mi-PA and mi-TA provide comparable perioperative and functional outcomes despite the use of mi-PA remains limited to patients with small adenoma size, or hereditary/bilateral disease. Due to limited use of standardized reporting criteria in most of current series, the quest for a superiority of mi-PA over mi-TA in the treatment of uPHA still remains open. [ABSTRACT FROM AUTHOR]

Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA. [ABSTRACT FROM AUTHOR]