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RESULTS | There were 348 tertiary ( n = 7,455 patients ) and 89 primary hospitals [ n = 1,749 patients ( 729 transferred ; 1,020 non-transfer ) ] . |
RESULTS | Significant delays occurred in time from symptom onset to angiography ( 49 hr ) , PCI ( 53h ) , and CABG ( 178 hr ) for transferred patients ( P < 0.001 ) . |
RESULTS | Non-transfer patients had less 30-day death/myocardial infarction [ 9.4 % vs. 11.7 % ( tertiary ) ; adjusted odds ratio ( OR ) : 0.78 ( 0.62-0 .97 ) , P = 0.026 ] ; transferred ( 14.0 % ) and tertiary patients were similar [ adjusted OR : 1.23 ( 0.98-1 .53 ) , P = 0.074 ] . |
RESULTS | Non-transfer patients had lower 1-year mortality [ 4.3 % vs. 6.3 % ( tertiary ) ; adjusted hazard ratio ( HR ) : 0.64 ( 0.47-0 .87 ) , P = 0.005 ] : there was no difference between transferred and tertiary patients [ 5.2 % vs. 6.3 % ; adjusted HR : 0.80 ( 0.58-1 .12 ) , P = 0.202 ] . |
RESULTS | Despite similar rates of catheterization , GUSTO severe/moderate bleeding within 120 hr was less in non-transfer [ 3.1 % vs. 6.7 % ( tertiary ) ; adjusted OR : 0.47 ( 0.32-0 .68 ) , P < 0.001 ] , whereas transferred ( 6.1 % ) and tertiary patients were similar [ adjusted OR : 0.94 ( 0.68-1 .30 ) , P = 0.693 ] . |
RESULTS | There was no difference in non-CABG bleeding . |
CONCLUSIONS | Timely angiography and revascularization were often not achieved in transferred patients . |
CONCLUSIONS | Non-transferred patients presenting to primary sites had the lowest event rates and the best long-term survival . |
###25001475 | null |
OBJECTIVE | We hypothesized that a targeted temperature of 33 C as compared to that of 36 C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest ( OHCA ) . |
METHODS | The recently published Target Temperature Management trial ( TTM-trial ) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission . |
METHODS | Shock was defined as a systolic blood pressure of < 90 mm Hg for > 30 min or the need of supportive measures to maintain a blood pressure 90 mmHg and/or clinical signs of end-organ hypoperfusion . |
METHODS | In this post hoc analysis reported here , we further analyzed the 139 patients with shock at admission ; all had been randomized to receive intervention at 33 C ( TTM33 ; n = 71 ) or 36 C ( TTM36 ; n = 68 ) . |
METHODS | Primary outcome was 180-day mortality . |
METHODS | Secondary outcomes were intensive care unit ( ICU ) and 30-day mortality , severity of circulatory shock assessed by mean arterial pressure , serum lactate , fluid balance and the extended Sequential Organ Failure assessment ( SOFA ) score . |
RESULTS | There was no significance difference between targeted temperature management at 33 C or 36 C on 180-day mortality [ log-rank test , p = 0.17 , hazard ratio 1.33 , 95 % confidence interval ( CI ) 0.88-1 .98 ] or ICU mortality ( 61 vs. 44 % , p = 0.06 ; relative risk 1.37 , 95 % CI 0.99-1 .91 ) . |
RESULTS | Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group ( p < 0.01 ) . |
CONCLUSIONS | We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 C as compared to 36 C in patients with shock on admission after OHCA . |
###25406902 | null |
BACKGROUND | Youths with a family history of alcohol and other drug use disorders ( FH + ) are at a greater risk of developing substance use disorders than their peers with no such family histories ( FH - ) , and this increased risk may be related to impaired maturation of forebrain circuitry . |
BACKGROUND | FH + individuals have shown altered forebrain activity at rest and while performing cognitive tasks . |
BACKGROUND | However , it is not fully understood how forebrain activity is altered in FH + individuals , and ultimately how these alterations may contribute to substance use disorder risk . |
METHODS | In this study , we tested 72 FH + and 32 FH - youths performing a go/no-go task and examined activations in blocks with only go trials ( Go Only ) , blocks with 50 % go and 50 % no-go trials ( Go/NoGo ) , and a contrast of those 2 blocks . |
RESULTS | FH + youths had significantly greater cerebral activations in both the Go and Go/NoGo blocks than FH - youths in regions including the posterior cingulate/precuneus , bilateral middle/superior temporal gyrus , and medial superior frontal gyrus with no significant group differences in the subtraction between Go Only and Go/NoGo blocks . |
RESULTS | Additionally , FH + youths had moderately slower reaction times on go trials in the Go Only blocks . |
CONCLUSIONS | Our findings suggest that global activation increase in FH + youths are modulated by FH density and are not specific to the inhibitory components of the task . |
CONCLUSIONS | This pattern of increased activations in FH + youths may be at least partially due to impaired forebrain white matter development leading to greater activations/less efficient neural communication during task performance . |
###25471989 | null |
BACKGROUND | Risk factors have been proposed for running injuries including ( a ) reduced muscular strength , ( b ) excessive joint movements and ( c ) excessive joint moments in the frontal and transverse planes . |
BACKGROUND | To date , many running injury prevention programs have focused on a `` top down '' approach to strengthen the hip musculature in the attempt to reduce movements and moments at the hip , knee , and/or ankle joints . |
BACKGROUND | However , running mechanics did not change when hip muscle strength increased . |
BACKGROUND | It could be speculated that emphasis should be placed on increasing the strength of the ankle joint for a `` ground up '' approach . |
BACKGROUND | Strengthening of the large and small muscles crossing the ankle joint is assumed to change the force distribution for these muscles and to increase the use of smaller muscles . |
BACKGROUND | This would be associated with a reduction of joint and insertion forces , which could have a beneficial effect on injury prevention . |
BACKGROUND | However , training of the ankle joint as an injury prevention strategy has not been studied . |
BACKGROUND | Ankle strengthening techniques include isolated strengthening or movement-related strengthening such as functional balance training . |
BACKGROUND | There is little knowledge about the efficacy of such training programs on strength alteration , gait or injury reduction . |
METHODS | Novice runners will be randomly assigned to one of three groups : an isolated ankle strengthening group ( strength , n = 40 ) , a functional balance training group ( balance , n = 40 ) or an activity-matched control group ( control , n = 40 ) . |
METHODS | Isokinetic strength will be measured using a Biodex System 3 dynamometer . |
METHODS | Running kinematics and kinetics will be assessed using 3D motion analysis and a force platform . |
METHODS | Postural control will be assessed by quantifying the magnitude and temporal structure of the center of pressure trace during single leg stance on a force platform . |
METHODS | The change pre - and post-training in isokinetic strength , running mechanics , and postural control variables will be compared following the interventions . |
METHODS | Injuries rates will be compared between groups over 6months . |
CONCLUSIONS | Avoiding injury will allow individuals to enjoy the benefits of participating in aerobic activities and reduce the healthcare costs associated with running injuries . |
BACKGROUND | Current Controlled Trial NCT01900262 . |
###24694205 | null |
BACKGROUND | Vitamin B12 deficiency causes neurologic and psychiatric disease , especially in older adults . |
BACKGROUND | Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract . |
OBJECTIVE | To test corticospinal tract projections using motor evoked potentials ( MEPs ) by transcranial magnetic stimulation ( TMS ) in asymptomatic older adults with low vitamin B12 ( B12 ) levels . |
METHODS | Cross-sectional study of 53 healthy older adults ( > 70 years ) . |
METHODS | MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles , at rest and during slight tonic contraction . |
METHODS | Central motor conduction time ( CMCT ) was derived from the latency of MEPs and peripheral motor conduction time ( PMCT ) . |
METHODS | Neurophysiological variables were analyzed statistically according to B12 status . |
RESULTS | Median age was 74.33.6 years ( 58.5 % women ) . |
RESULTS | Twenty-six out of the 53 subjects had low vitamin B12 levels ( B12 < 221pmol/l ) . |
RESULTS | MEPs were recorded for all subjects in upper and lower extremities . |
RESULTS | There were no significant differences in either latency or amplitude of MEPs and CMCT between low and normal B12 groups . |
RESULTS | There was a significant PMCT delay in the lower extremities in the low B12 group ( p = 0.014 ) . |
CONCLUSIONS | No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12-deficient older adults . |
CONCLUSIONS | The peripheral nervous system appears to be more vulnerable to damage attributable to this vitamin deficit . |
CONCLUSIONS | The neurophysiological evaluation of asymptomatic older adults with lower B12 levels should be focused mainly in peripheral nervous system evaluation . |
###24576512 | null |
BACKGROUND | Uncontrolled hypertension ( HTN ) is a significant public health problem among blacks in the United States . |
BACKGROUND | Despite the proven efficacy of therapeutic lifestyle change ( TLC ) on blood pressure ( BP ) reduction in clinical trials , few studies have examined their effectiveness in church-based settings-an influential institution for health promotion in black communities . |
METHODS | Using a cluster-randomized , 2-arm trial design , this study evaluates the effectiveness of a faith-based TLC intervention vs health education ( HE ) control on BP reduction among hypertensive black adults . |
METHODS | The intervention is delivered by trained lay health advisors through group TLC sessions plus motivational interviewing in 32 black churches . |
METHODS | Participants in the intervention group receive 11 weekly TLC sessions targeting weight loss , increasing physical activity , fruit , vegetable and low-fat dairy intake , and decreasing fat and sodium intake , plus 3 monthly individual motivational interviewing sessions . |
METHODS | Participants in the control group attend 11 weekly classes on HTN and other health topics delivered by health care experts . |
METHODS | The primary outcome is change in BP from baseline to 6 months . |
METHODS | Secondary outcomes include level of physical activity , percent change in weight , and fruit and vegetable consumption at 6 months , and BP control at 9 months . |
CONCLUSIONS | If successful , this trial will provide an alternative and culturally appropriate model for HTN control through evidence-based lifestyle modification delivered in churches by lay health advisors . |
###24807407 | null |
BACKGROUND | The classification of clinical severity of Ebstein anomaly still remains a challenge . |
BACKGROUND | The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically-supposedly-normal left heart and to derive from cardiac magnetic resonance ( CMR ) a simple imaging measure for the clinical severity of Ebstein anomaly . |
RESULTS | Twenty-five patients at a mean age of 2614 years with unrepaired Ebstein anomaly were examined in a prospective study . |
RESULTS | Disease severity was classified using CMR volumes and functional measurements in comparison with heart failure markers from clinical data , ECG , laboratory and cardiopulmonary exercise testing , and echocardiography . |
RESULTS | All examinations were completed within 24 hours . |
RESULTS | A total right/left-volume index was defined from end-diastolic volume measurements in CMR : total right/left-volume index = ( RA + aRV + fRV ) / ( LA+LV ) . |
RESULTS | Mean total right/left-volume index was 2.61.7 ( normal values : 1.10.1 ) . |
RESULTS | This new total right/left-volume index correlated with almost all clinically used biomarkers of heart failure : brain natriuretic peptide ( r = 0.691 ; P = 0.0003 ) , QRS ( r = 0.432 ; P = 0.039 ) , peak oxygen consumption/kg ( r = -0.479 ; P = 0.024 ) , ventilatory response to carbon dioxide production at anaerobic threshold ( r = 0.426 ; P = 0.048 ) , the severity of tricuspid regurgitation ( r = 0.692 ; P = 0.009 ) , tricuspid valve offset ( r = 0.583 ; P = 0.004 ) , and tricuspid annular plane systolic excursion ( r = 0.554 ; P = 0.006 ) . |
RESULTS | Previously described severity indices ( [ RA + aRV ] / [ fRV + LA+LV ] ) and fRV/LV end-diastolic volume corresponded only to some parameters . |
CONCLUSIONS | In patients with Ebstein anomaly , the easily acquired index of right-sided to left-sided heart volumes from CMR correlated well with established heart failure markers . |
CONCLUSIONS | Our data suggest that the total right/left-volume index should be used as a new and simplified CMR measure , allowing more accurate assessment of disease severity than previously described scoring systems . |
###24947717 | null |
OBJECTIVE | This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction ( STEMI ) after primary percutaneous coronary intervention ( PCI ) . |
BACKGROUND | Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients . |
METHODS | Between November 1 , 2005 and September 30 , 2010 , 20,344 patients were enrolled in nationwide , prospective , multicenter registries . |
METHODS | Among these , we studied STEMI patients undergoing primary PCI who were discharged alive ( n = 8,510 ) . |
METHODS | We classified patients into the beta-blocker group ( n = 6,873 ) and no-beta-blocker group ( n = 1,637 ) according to the use of beta-blockers at discharge . |
METHODS | Propensity-score matching analysis was also performed in 1,325 patient triplets . |
METHODS | The primary outcome was all-cause death . |
RESULTS | The median follow-up duration was 367 days ( interquartile range : 157 to 440 days ) . |
RESULTS | All-cause death occurred in 146 patients ( 2.1 % ) of the beta-blocker group versus 59 patients ( 3.6 % ) of the no-beta-blocker group ( p < 0.001 ) . |
RESULTS | After 2:1 propensity-score matching , beta-blocker therapy was associated with a lower incidence of all-cause death ( 2.8 % vs. 4.1 % , adjusted hazard ratio : 0.46 , 95 % confidence interval : 0.27 to 0.78 , p = 0.004 ) . |
RESULTS | The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups , including patients with relatively low-risk profiles such as ejection fraction > 40 % or single-vessel disease . |
CONCLUSIONS | Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI . |
CONCLUSIONS | Our results support the current American College of Cardiology/American Heart Association guidelines , which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile . |
###24281275 | null |
OBJECTIVE | Local anesthetic wound infiltration is widely used as an effective adjunct during multimodal postoperative pain management . |
OBJECTIVE | The aim of this study was to evaluate the effectiveness of continuous wound infusion of ropivacaine in postoperative pain relief , opioid sparing , incidence of nausea and vomiting , and bowel and liver function improvement in patients undergoing open hepatectomy . |