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Non-transferred patients presenting to primary sites had the lowest event rates and the best long-term survival .

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 ) .

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 .

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 .

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 ) .

Primary outcome was 180-day mortality .

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 .

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 ) .

Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group ( p < 0.01 ) .

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 .

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 .

FH + individuals have shown altered forebrain activity at rest and while performing cognitive tasks .

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 .

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 .

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 .

Additionally , FH + youths had moderately slower reaction times on go trials in the Go Only blocks .

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 .

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 .

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 .

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 .

However , running mechanics did not change when hip muscle strength increased .

It could be speculated that emphasis should be placed on increasing the strength of the ankle joint for a `` ground up '' approach .

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 .

This would be associated with a reduction of joint and insertion forces , which could have a beneficial effect on injury prevention .

However , training of the ankle joint as an injury prevention strategy has not been studied .

Ankle strengthening techniques include isolated strengthening or movement-related strengthening such as functional balance training .

There is little knowledge about the efficacy of such training programs on strength alteration , gait or injury reduction .

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 ) .

Isokinetic strength will be measured using a Biodex System 3 dynamometer .

Running kinematics and kinetics will be assessed using 3D motion analysis and a force platform .

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 .

The change pre - and post-training in isokinetic strength , running mechanics , and postural control variables will be compared following the interventions .

Injuries rates will be compared between groups over 6months .

Avoiding injury will allow individuals to enjoy the benefits of participating in aerobic activities and reduce the healthcare costs associated with running injuries .

Current Controlled Trial NCT01900262 .

Vitamin B12 deficiency causes neurologic and psychiatric disease , especially in older adults .

Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract .

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 .

Cross-sectional study of 53 healthy older adults ( > 70 years ) .

MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles , at rest and during slight tonic contraction .

Central motor conduction time ( CMCT ) was derived from the latency of MEPs and peripheral motor conduction time ( PMCT ) .

Neurophysiological variables were analyzed statistically according to B12 status .

Median age was 74.33.6 years ( 58.5 % women ) .

Twenty-six out of the 53 subjects had low vitamin B12 levels ( B12 < 221pmol/l ) .

MEPs were recorded for all subjects in upper and lower extremities .

There were no significant differences in either latency or amplitude of MEPs and CMCT between low and normal B12 groups .

There was a significant PMCT delay in the lower extremities in the low B12 group ( p = 0.014 ) .

No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12-deficient older adults .

The peripheral nervous system appears to be more vulnerable to damage attributable to this vitamin deficit .

The neurophysiological evaluation of asymptomatic older adults with lower B12 levels should be focused mainly in peripheral nervous system evaluation .

Uncontrolled hypertension ( HTN ) is a significant public health problem among blacks in the United States .

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 .

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 .

The intervention is delivered by trained lay health advisors through group TLC sessions plus motivational interviewing in 32 black churches .

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 .

Participants in the control group attend 11 weekly classes on HTN and other health topics delivered by health care experts .

The primary outcome is change in BP from baseline to 6 months .

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 .

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 .

The classification of clinical severity of Ebstein anomaly still remains a challenge .

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 .

Twenty-five patients at a mean age of 2614 years with unrepaired Ebstein anomaly were examined in a prospective study .

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 .

All examinations were completed within 24 hours .

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 ) .

Mean total right/left-volume index was 2.61.7 ( normal values : 1.10.1 ) .

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 ) .

Previously described severity indices ( [ RA + aRV ] / [ fRV + LA+LV ] ) and fRV/LV end-diastolic volume corresponded only to some parameters .

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 .

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 .

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 ) .

Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients .

Between November 1 , 2005 and September 30 , 2010 , 20,344 patients were enrolled in nationwide , prospective , multicenter registries .

Among these , we studied STEMI patients undergoing primary PCI who were discharged alive ( n = 8,510 ) .

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 .

Propensity-score matching analysis was also performed in 1,325 patient triplets .

The primary outcome was all-cause death .

The median follow-up duration was 367 days ( interquartile range : 157 to 440 days ) .

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 ) .

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 ) .

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 .

Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI .

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 .

Local anesthetic wound infiltration is widely used as an effective adjunct during multimodal postoperative pain management .

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 .

Forty patients undergoing open hepatectomy were enrolled in this prospective , randomized , double-blinded , placebo-controlled trial .

Patients were divided into 2 groups : the 0.9 % saline continuous infusion group ( the control group ; n = 20 ) and the ropivacaine continuous infusion group ( the Ropi group ; n = 20 ) .

Outcomes measured postoperatively were pain score at rest and on movement , sufentanil consumption , incidence of nausea and vomiting , and sedation score across 48 postoperative hours .

Time to bowel recovery , liver function change , mean length of hospitalization , patient satisfaction , and other data after 48 postoperative hours were collected until hospital discharge .

Pain scores at rest were lower for the ropivacaine group and reached significance after 8 and 16 hours ( P < 0.01 ) .

Sufentanil consumption ( 41.5021.80 vs. 89.7035.22 g ; P < 0.01 ) after 48 hours , time to bowel recovery ( 1.800.70 vs. 3.151.04 d ; P < 0.01 ) , incidence of nausea and vomiting ( 1.750.72 vs. 2.400.68 ; P < 0.05 ) , and mean length of hospitalization ( 5.62.44 vs. 7.352.85 d ; P < 0.01 ) were significantly reduced , and the sedation score and liver function change were also comparable between the 2 groups .

There was no difference with respect to pain scores on movement , nor with respect to patient satisfaction .

Surgical wound infusion with ropivacaine after hepatectomy can improve pain relief at rest and accelerate recovery and discharge .

Tuberculosis ( TB ) is highly prevalent among HIV-infected people , including those receiving combination antiretroviral therapy ( cART ) , necessitating a well tolerated and efficacious TB vaccine for these populations .

We evaluated the safety and immunogenicity of the candidate TB vaccine M72/AS01 in adults with well controlled HIV infection on cART .

A randomized , observer-blind , controlled trial ( NCT00707967 ) .

HIV-infected adults on cART in Switzerland were randomized 3:1:1 to receive two doses , 1 month apart , of M72/AS01 , AS01 or 0.9 % physiological saline ( N = 22 , N = 8 and N = 7 , respectively ) and were followed up to 6 months postdose 2 ( D210 ) .

Individuals with CD4 cell counts below 200 cells/l were excluded .

Adverse events ( AEs ) including HIV-specific and laboratory safety parameters were recorded .

Cell-mediated ( ICS ) and humoral ( ELISA ) responses were evaluated before vaccination , 1 month after each dose ( D30 , D60 ) and D210 .