Reliability of force per unit cross-sectional area measurements of the first dorsal interosseus muscle

Background: Force per unit cross-sectional area (CSA) measurements of the first dorsal interosseus (FDI) muscle have previously been used as a measure of strength, although the reliability of these techniques has not been reported. Purpose: To determine the test-retest reliability of maximum voluntary isometric force (MVIF), CSA and force per unit CSA measurements of the FDI muscle, using a custom-built dynamometer and ultrasonography. Methods: Following approval from the institutions ethical advisory committee, twenty-seven recreationally active participants, thirteen males (age 22 ± 6 years; height 1.80 ± 0.05 m; body mass 77.5 ± 6.7 kg) and fourteen females (age 24 ± 5 years; height 1.65 ± 0.05 m; body mass 65.1 ± 0.1 kg), completed MVIF and CSA measurements on two separate occasions (Trial 1 and Trial 2) under the same conditions, less than 7 days apart. Reliability was determined using ratio systematic bias and limits of agreement (rLoA), intra-class correlation (ICC), coefficient of variation (CV) and paired samples t-tests. Results: MVIF of the FDI muscle was not significantly different between trials (mean ± SD; 31.8 ± 7.6 N vs. 31.6 ± 7.3 N, P=0.63); rLoA between trials were 1.00 x/÷ 1.09, ICC = 0.990 and CV = 3.22%. CSA of the FDI muscle was not significantly different between trials (22.6 ± 6.9 vs. 22.9 ± 6.9 mm2, P=0.31); rLoA between trials were 0.98 x/÷ 1.19, ICC = 0.979 and CV=6.61%. Force per unit CSA was not significantly different between trials (1.49 ± 0.43 vs. 1.46 ± 0.44 N·mm2; P=0.18); rLoA were 1.02 x/÷ 1.17, ICC = 0.985 and CV = 5.76%. Conclusions: The techniques used to determine MVIF and CSA of the FDI muscle were reliable and can be combined to calculate force per unit CSA. This technique can be used to assess both acute and longitudinal changes in muscle function between and within populations

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit