Search

Background Various diagnostic tests are available to establish the primary aldosteronism (PA) diagnosis and to determine the disease laterality. Combined with the controversies in the literature, unawareness of guidelines and technical demands and high costs of some of these diagnostics, this could lead to significant differences in work-up strategies worldwide. Therefore, we investigated the work-up before surgery for PA in daily clinical practice within a multicenter study. Methods Patients who underwent unilateral adrenalectomy for PA within 16 centers in Europe, Canada, Australia and the USA between 2010 and 2016 were included. We did not exclude patients based on the performed diagnostic tests during work-up to make our data representative for current clinical practice. Adherence to the Endocrine Society Guideline and variables associated with not performing adrenal venous sampling (AVS) were analyzed. Results In total, 435 patients were eligible. An aldosterone-to-renin ratio, confirmatory test, computed tomography (CT), magnetic resonance imaging and AVS were performed in 82.9%, 32.9%, 86.9%, 17.0% and 65.3% of patients, respectively. A complete work-up, as recommended by the guideline, was performed in 13.1% of patients. Bilateral disease or normal adrenal anatomy on CT (OR 16.19; CI 3.50–74.99), smaller tumor size on CT (OR 0.06; CI 0.04–0.08) and presence of hypokalemia (OR 2.00; CI 1.19–3.32) were independently associated with performing AVS. Conclusions This study is the first to examine the daily clinical practice work-up of PA within a worldwide cohort of surgical patients. The results demonstrate significant variability in work-up strategies and low adherence to The Endocrine Society guideline.

Background: Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. Methods: Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG (n = 172) or traditional (n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. Results: Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9–24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference–19.9 min (95% CI–14.6 to −34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. Conclusions: Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. Trial registration: This trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12620000919910. © The Author(s) 2022.

Older adults tend to focus on positive information over negative information; a phenomenon commonly referred to as the ‘positivity effect’. Socioemotional Selectivity Theory posits that this effect stems from age-related shifts in goals and relies heavily on the active suppression of negative information. The current study tested the hypothesis that inhibitory control is a key determinant of positivity biases in older adults using anti-saccade and recognition memory tasks. Results indicated a significant correlation between levels of inhibitory control and the positivity effect. These findings highlight the key role played by inhibitory control in determining positivity biases amongst older adults.

Bos taurus taurus and Bos taurus indicus cattle subspecies present different capabilities in coping with situations of elevated temperatures, the latter being more tolerant to heat stress. Thus, some breeding programs crossed these subspecies to produce a high producing yet heat-tolerant breed (Girolando). Nineteen Holstein (H100) and 19 Girolando cows [(½ Holstein × Gir (H50) and ¾ Holstein × Gir (H75)] with similar milk production were used in a six-day experiment to evaluate the consequences of heat stress due to shade deprivation on their physiological, blood and milk traits. Cows were exposed to a non-shaded environment between morning (06:00h; GMT -3:00) and evening milking (14:30h; GMT -3:00) with access to water ad libitum. Procedures were conducted before morning and evening milkings. Physiological parameters related to mechanisms of heat dissipation were measured, as well as the milk composition. Blood traits were evaluated. The temperature-humidity index (THI) was calculated. Statistical procedures included analysis of variance, correlation, and principal factors. THI was elevated during the trial and negatively impacted physiological, milk, and blood parameters in H100, H75, and H50. Alterations in physiology, milk stability, milk composition, and blood traits were more pronounced in H100. Holstein cows presented changes in physiological parameters in a more pronounced manner and in some milk and blood traits related to the reduced capability of this breed in dealing with elevated THI. The similarity in milk production levels excludes this parameter as a justification for differences in heat tolerance, with genetic composition being the main reason for these results. Made available in DSpace on 2021-11-25T12:04:23Z (GMT). No. of bitstreams: 1 Elevated-temperature-humidity.pdf: 761551 bytes, checksum: 0e2950a57ff402580f102316e5cd8df9 (MD5) Previous issue date: 2021