Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial

AbstractObjectivesWe examined the clinical, angiographic, and procedural characteristics determining survival after percutaneous coronary intervention (PCI) for cardiogenic shock.BackgroundThe SHOCK (SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK?) trial prospectively enrolled patients with shock complicating acute myocardial infarction (MI). Patients were randomized to a strategy of early revascularization or initial medical stabilization.MethodsPatients randomized to early revascularization underwent PCI or bypass surgery on the basis of predefined clinical criteria. Patients randomized to early revascularization who underwent PCI and had angiographic films available for analysis are the subject of this report (n = 82).ResultsThe median time from MI to PCI was 11 h. The majority of patients had occluded culprit arteries (Thrombolysis In Myocardial Infarction [TIMI] grade 0 or 1 flow in 62%) and multivessel disease (81%). One-year mortality in PCI patients was 50%. Mortality was 39% if PCI was successful but 85% if unsuccessful (p < 0.001). Mortality was 38% if TIMI flow grade 3 was achieved, 55% with TIMI grade 2 flow, and 100% with TIMI grade 0 or 1 flow (p < 0.001). Mortality was 67% if severe mitral regurgitation was documented. Independent correlates of mortality were as follows: increasing age (p < 0.001), lower systolic blood pressure (p = 0.009), increasing time from randomization to PCI (p = 0.019), lower post-PCI TIMI flow (0/1 vs. 2/3) (p < 0.001), and multivessel PCI (p = 0.040).ConclusionsRestoration of coronary blood flow is a major predictor of survival in cardiogenic shock. Benefit appears to extend beyond the generally accepted 12-h post-infarction window. Surgery should be considered in shock patients with severe mitral insufficiency or multivessel disease not amenable to relatively complete percutaneous revascularization

Acute Effects of Dry Needling on Myofascial Trigger Points in the Triceps Surae of Ballet Dancers: A Pilot Randomized Controlled Trial

# Background There is convincing evidence that dancers suffer injuries to the triceps surae musculature. Research on the immediate effects of dry needling (DN) is limited, and it is important to understand the acute effects of this treatment prior to performance. # Purpose The purpose of this pilot study was to assess the immediate effects of DN on myofascial trigger points in terms of skin surface temperature, pain, active and passive range of motion, and torque production in the triceps surae of ballet dancers. # Study Design Randomized, double-blinded pilot study # Methods Professional ballet dancers that fit inclusion and exclusion criteria (n=11) were randomly assigned to an experimental or control group. The dancers had three pre-determined standard point (SP) measurement spots that were used as a baseline for surface temperature comparisons. The dancers were also palpated for trigger point (TP) spots. Both SP and TP spots were marked for future measurements. The experimental group received DN, while the control group received sham DN (SHAM) to their bilateral calves at the TP spots. Immediately prior to and following treatment, both DN and SHAM groups were tested for skin surface temperature, pain, range of motion, and plantar flexion torque by blinded assessors. Paired t-tests and independent t-tests were performed to examine for differences between groups. # Results The surface temperature for the TP was higher than the SP measurements prior to intervention (Right calf p= .014; Left calf p= .031). There were no significant changes in VAS scale reported pain and ROM. The plantar flexion torque measurements showed an increase in the DN group of the left calf at the angular velocity of 60 degrees/sec. # Conclusion This was a unique pilot study examining the acute effects of DN on professional ballet dancers. The results were limited due to low sample size. However, the methodology for this study and surface temperature results invites future research. # Level of evidence Level 1

Therapeutic Neonatal Hepatic Gene Therapy in Mucopolysaccharidosis VII Dogs

Dogs with mucopolysaccharidosis VII (MPS VII) were injected intravenously at 2–3 days of age with a retroviral vector (RV) expressing canine β-glucuronidase (cGUSB). Five animals received RV alone, and two dogs received hepatocyte growth factor (HGF) before RV in an attempt to increase transduction efficiency. Transduced hepatocytes expanded clonally during normal liver growth and secreted enzyme with mannose 6-phosphate. Serum GUSB activity was stable for up to 14 months at normal levels for the RV-treated dogs, and for 17 months at 67-fold normal for the HGF/RV-treated dog. GUSB activity in other organs was 1.5–60% of normal at 6 months for two RV-treated dogs, which was likely because of uptake of enzyme from blood by the mannose 6-phosphate receptor. The body weights of untreated MPS VII dogs are 50% of normal at 6 months. MPS VII dogs cannot walk or stand after 6 months, and progressively develop eye and heart disease. RV- and HGF/RV-treated MPS VII dogs achieved 87% and 84% of normal body weight, respectively. Treated animals could run at all times of evaluation for 6–17 months because of improvements in bone and joint abnormalities, and had little or no corneal clouding and no mitral valve thickening. Despite higher GUSB expression, the clinical improvements in the HGF/RV-treated dog were similar to those in the RV-treated animals. This is the first successful application of gene therapy in preventing the clinical manifestations of a lysosomal storage disease in a large animal

The effect of an equi-intensity treadmill running and swimming training protocol on the adipocyte insulin sensitivity and responsiveness in the rat

Forty Sprague Dawley rats were randomly separated into one of three experimental groups: Run-Trained (RT), Swim-Trained (SW), or Control (CON). The runners were further separated into 2 groups: Good-runners (RT1), or Poor-runners (RT2) according to their performance on the treadmill. All of the trained groups were endurance trained at approximately 80% V02 max for two hours per day, five days per week in the appropriate mode of exercise. After nine weeks of equi-intensity training, the perimetrial fat pads were removed and the calls isolated. The adipocytes from the trained animals were significantly smaller in volume and diameter than the adipocytes from the controls. Adipocytes from all of the trained groups were significantly more sensitive to insulin than the CON group according to the definition by Kahn (60). The cells from the RT1 and SW groups were significantly more responsive to insulin than both the RT2 and CON groups. The adipocytes from the RT1 group were also significantly more responsive to insulin than the SW group. The differences in cell responsiveness to insulin were highly correlated to the average size of the cells studied. From the data presented in this study threeconclusions were drawn: 1) Both running and swimming at the reported intensity, duration, and frequency have a significant effect on the morphology and metabolism of the isolated adipocyte, 2) Adipocyte morphology, insulin sensitivity, and insulin responsiveness are dependent on the frequency, intensity, and duration of a given exercise training protocol, and 3) Each type of exercise training has its own drawbacks: with swimming, the rats may experience some hypoxia which may alter their metabolic fuel utilization, and during running not all of the animals may be capable or willing to complete the run.Ball State UniversityMuncie, IN 47306Thesis (M.S.)--Ball State University, 1987

Development of a Reliable and Valid Means to Measure the Physical Abilities of Young Male Gymnasts

Study Design: Cross Sectional Objectives: To develop a functional measurement tool to assess the physical abilities in male gymnasts and to evaluate the test-retest reliability and face validity of that measurement tool. Background: Despite the availability of physical fitness field-tests for many competitive sports, a reliable and valid test to measure the physical abilities (strength, endurance, balance, coordination, agility, and flexibility) of male gymnasts has not been explored or developed. The Men\u27s Gymnastics Functional Measurement Tool (MGFMT) is a set of functional measurements used to objectively measure physical abilities required of male gymnasts. The MGFMT is a field-test designed to improve coaches\u27 abilities to monitor their gymnasts\u27 physical fitness levels and to help identify physical weaknesses that can be improved to create a more all-around physically fit gymnast. Methods: Eighty-three, 7 to 18 year-old competitive male club gymnasts (Level 4-10) were assessed. From these 83 total subjects, a convenience sample of 30 subjects was chosen to participate to establish the test-retest reliability of individual items and performance of the entire tool. These 30 subjects were retested with the MGFMT one week after initial testing. Test conditions and administration were consistent between the 2 administrations of the MGFMT including warm-up and item order. Statistics: Test-retest reliability was analyzed for each of the individual items using Intraclass Correlation Coefficient. Validity was analyzed using linear regression of the athletes\u27 USA-Gymnastics competition level, predicting the component-test raw scores as well as the MGFMT total test score, resulting in a coefficient of determination (r2). Hypotheses: 1) The MGFMT individual items and the MGFMT total composite score demonstrated good test re-test reliability (Intraclass Correlation coefficient (ICC) \u3e0.80). 2) There is a strong relationship between the MGFMT total composite score and the current competitive level of the gymnasts tested (r \u3e 0.80). Results: The mean age of participating subjects was 11.07 years (range 7 - 18) with subjects reporting participation in competitive gymnastics for a mean of 4.36 years. Mean height and weight of the subjects were 37.5 kg and 142.8 cm respectively. Thirteen potential component tests were originally considered for inclusion in the MGFMT. Three component tests were eliminated based on physical ability tested, ease of test application, statistical analysis, and consultation with an informal panel of experts. Several of the relationships between the subjects\u27 current USA Gymnastics competitive level and individual component test item raw scores were statistically significant, however, those relationships ranged from poor to good based on r2 scores (r2 = 0.004-0.64). The relationship between MGFMT composite test score (out of a possible score of 100) and the subjects\u27 current USA Gymnastics competitive level was found to be good (r2 = 0.63). To rule out alternative explanations for the relationship between USA Gymnastics competitive level and MGFMT composite test scores, the relationships between MGFMT composite test scores and age, MGFMT composite test scores and bodyweight and MGFMT total composite scores and total hours training per week were also explored (r2 = 0.30, 0.48, and 0.56, respectively). Reliability testing of the MGFMT composite test score showed excellent test-retest reliability over a one-week period (ICC=0.97). Test-retest reliability of the individual component tests ranged from good to excellent (ICC = 0.75-0.97). Conclusion: The MGFMT, a 10-component field test of male gymnast physical abilities was found to be reliable and valid

Sport-Specific Fitness Testing and Intervention for an Adolescent With Cerebral Palsy: A Case Report

BACKGROUND AND PURPOSE: This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy. CASE DESCRIPTION: The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling. OUTCOMES: Scores on all tests and measures were higher after the intervention. DISCUSSION: The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy