Bundle Branch Block and Acute Myocardial Infarction: Treatment and Outcome

Objective - To study early diagnosis, treatment and outcome in patients with bundle branch block and clinically suspected acute myocardial infarction. Design - A prospective multicenter study including 14 Swedish coronary care units. The study included 257 consecutive patients with bundle branch block and clinical suspicion of acute myocardial infarction. Results - Left bundle branch block was present in 62% of patients and right bundle branch block in 38%. Thrombolytic treatment of acute myocardial infarction in the left and right bundle branch block was 16% and 36%, respectively. Of those undergoing thrombolytic therapy, 20% of patients with left and 13% with right bundle branch block did not develop an acute myocardial infarction. Patients with left bundle branch block had higher mortality rates than those with right bundle branch block. After one year there was no difference in mortality rates between patients with and those without acute myocardial infarction on admission. Conclusion - Patients with bundle branch block and suspected acute myocardial infarction receive suboptimal treatment. Thus better diagnostic regimes are needed to identify those patients with bundle branch block and acute myocardial infarction who are suitable for thrombolytic treatment.     

In‐season adaptations to intense intermittent training and sprint interval training in sub‐elite football players

This study investigated the in‐season effect of intensified training comparing the efficacy of duration‐matched intense intermittent exercise training with sprint interval training in increasing intermittent running performance, sprint ability, and muscle content of proteins related to ion handling and metabolism in football players. After the first two weeks in the season, 22 sub‐elite football players completed either 10 weeks of intense intermittent training using the 10‐20‐30 training concept (10‐20‐30, n = 12) or sprint interval training (SIT, n = 10; work/rest ratio: 6‐s/54‐s) three times weekly, with a ~20% reduction in weekly training time. Before and after the intervention, players performed a Yo‐Yo intermittent recovery test level 1 (Yo‐Yo IR1) and a 30‐m sprint test. Furthermore, players had a muscle biopsy taken from the vastus lateralis. Yo‐Yo IR1 performance increased by 330 m (95%CI: 178‐482, P ≤ 0.01) in 10‐20‐30, whereas no change was observed in SIT. Sprint time did not change in 10‐20‐30 but decreased by 0.04 second (95%CI: 0.00‐0.09, P ≤ 0.05) in SIT. Muscle content of HADHA (24%, P ≤ 0.01), PDH‐E1α (40%, P ≤ 0.01), complex I‐V of the electron transport chain (ETC) (51%, P ≤ 0.01) and Na⁺, K⁺‐ATPase subunits α₂ (33%, P ≤ 0.05) and β₁ (27%, P ≤ 0.05) increased in 10‐20‐30, whereas content of DHPR (27%, P ≤ 0.01) and complex I‐V of the ETC (31%, P ≤ 0.05) increased in SIT. Intense intermittent training, combining short sprints and a high aerobic load, is superior to regular sprint interval training in increasing intense intermittent running performance during a Yo‐Yo IR1 test and muscle content of PDH‐E1α and HADHA in sub‐elite football players.     

A polymorphic variant in the MHC2TA gene is not associated with systemic lupus erythematosus

Single-nucleotide polymorphisms (SNPs) in the major histocompatibility complex class II transactivator (MHC2TA) gene encoding the class II transactivator have been associated with multiple sclerosis, rheumatoid arthritis, and myocardial infarction in the Swedish population. We used a case-control approach to investigate the prevalence of a relevant variant in Swedish systemic lupus erythematosus (SLE) cohorts to determine whether SLE shares the same MHC2TA susceptibility allele as the other diseases. No differences were observed between cases and control subjects at either the allele or genotype levels. Furthermore, no significant correlations were found when comparing different clinical and serological SLE phenotypes. This particular polymorphism rs3087456 of the MHC2TA gene does not appear to influence genetic susceptibility to SLE in the Swedish population. We conclude that our data support neither allelic nor genotype association between the MHC2TA SNP and SLE.     

Surgical Services for Breast Cancer Patients in Australia,is There a Gap for Aboriginal and/or Torres Strait Islander Women?

World Journal of Surgery - Breast cancer is the most commonly diagnosed cancer in Aboriginal and/or Torres Strait Islander women. When compared to other Australians, Aboriginal and/or Torres Strait...     

Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively

Purpose

To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.

Methods

Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland–Altman plots (BA plots) and calculated using Lin’s Concordance Correlation Coefficient (CCC).

Results

The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (?0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.

Conclusion

Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.