Influence of Adrenal Venous Sampling on Management in Patients with Primary Aldosteronism Independent of Lateralization on Cross-Sectional Imaging.

BACKGROUND: Patients with primary aldosteronism undergo imaging of the adrenal glands after confirmation of the disease. Adrenal venous sampling (AVS) is a useful adjunct to imaging, and advocates believe that AVS should be performed before surgical management. Others argue that patients with unilateral lesions on imaging do not require AVS. Although AVS accuracy has been established, few studies have evaluated how AVS alters management. Our study aimed to determine how AVS affected management of these patients. STUDY DESIGN: Patient data were collected retrospectively from the electronic medical records at a single institution. Patients aged 18 years or older who underwent AVS with successful adrenal vein cannulation from 2007 to 2016 were included. The laterality of AVS was compared with laterality of preprocedural imaging for each patient. The management plan before AVS was determined by laterality on preprocedural imaging. The primary outcomes were management of primary aldosteronism, change in management compared with the plan before AVS, and antihypertensive medication use after therapy. RESULTS: Seventy-four patients had successful adrenal venous cannulation. Thirty-three (44.6%) patients had AVS lateralization that was concordant with preprocedural imaging. Forty-one (55.4%) patients had AVS lateralization that was non-concordant with preprocedural imaging. There was a change in management in 29 (39.2%) patients. CONCLUSIONS: Adrenal venous sampling can delineate the source of aldosterone hypersecretion, and often this is not concordant with cross-sectional imaging. We found that many patients avoided a potentially non-curative operation due to AVS. Adrenal venous sampling frequently alters the management of aldosteronomas and should be highly considered in patients before surgical intervention.

Disparities in the Care of Differentiated Thyroid Cancer in the United States: Exploring the National Cancer Database.

Differentiated thyroid cancer (DTC) treatment is multifaceted, and may be influenced by socioeconomic factors. The goal of this study is to examine disparities in DTC treatment. DTC patients from 1998 to 2012 were identified using the National Cancer Database. DTC was identified in 262,041 patients. The mean age was 48.2. The majority of patients (52%) received care at Comprehensive Community Cancer Programs (CCCPs). Total thyroidectomy was less common at Community Cancer Programs (CCPs) [odds ratio (OR): 0.735; 95% confidence interval (CI): 0.707-0.764), and more common at academic centers (OR: 1.129; 95% CI: 1.102-1.157) compared with CCCP. A central neck dissection was performed most often at academic center (20.6%) versus CCP (10.0%). Black patients were less likely to undergo central neck dissection compared with white patients (OR: 0.468; 95% CI: 0.452-0.484). Patients more likely to receive radioactive iodine were white compared with black patients (hazard ratio: 0.833; 95% CI: 0.806-0.861), privately insured compared with uninsured patients (hazard ratio: 1.272; 95% CI: 1.210-1.341), and patients treated at CCCP. Disparities exist in DTC treatment. Individuals at risk for under-treatment are black patients, uninsured patients, and those treated at CCP. As the Affordable Care Act changes access to health care, future studies will be needed to readdress disparities.

Evaluation of upper body kinematics and muscle activity during milking attachment task.

The objective of the study was to evaluate the effects of udder height on upper body kinematics and muscle activity during a simulated attachment task in a parallel parlor set up, and the effects of udder access method (back or side) on the task biomechanics. Twenty males performed the task under conditions that simulated three udder heights and two udder access methods. The muscular load and kinematics during the task confirmed that milking is a physically demanding task. Trunk flexion angle increased with decreasing udder height, and the erector spinae activation was higher when the udder was below shoulder height compared to at or above. Compared to accessing the udder from side of the cow (herringbone parlor style), accessing from behind (Parallel parlor style) was associated with lower trunk flexion, greater shoulder horizontal adduction, lower shoulder elevation, and greater anterior deltoid activation. Milking in herringbone parlor style and with the udder at or above shoulder level may help reduce strain on the trunk/neck.

Reliability and Validity of Quantitative Video Analysis of Baseball Pitching Motion.

Video recordings are used to quantitatively analyze pitchers' techniques. However, reliability and validity of such analysis is unknown. The purpose of the study was to investigate the reliability and validity of joint and segment angles identified during a pitching motion using video analysis. Thirty high school baseball pitchers participated. The pitching motion was captured using 2 high-speed video cameras and a motion capture system. Two raters reviewed the videos to digitize the body segments to calculate 2-dimensional angles. The corresponding 3-dimensional angles were calculated from the motion capture data. Intrarater reliability, interrater reliability, and validity of the 2-dimensional angles were determined. The intrarater and interrater reliability of the 2-dimensional angles were high for most variables. The trunk contralateral flexion at maximum external rotation was the only variable with high validity. Trunk contralateral flexion at ball release, trunk forward flexion at foot contact and ball release, shoulder elevation angle at foot contact, and maximum shoulder external rotation had moderate validity. Two-dimensional angles at the shoulder, elbow, and trunk could be measured with high reliability. However, the angles are not necessarily anatomically correct, and thus use of quantitative video analysis should be limited to angles that can be measured with good validity.