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Premenopausal women are much less prone to develop cardiovascular disease than men of similar age, but this advantage no longer applies after menopause. We previously found that male mice have a significantly higher rate of cardiac rupture than females during the acute phase of myocardial infarction (MI); however, the effects of sexual hormones on chronic remodeling are unknown. We hypothesized that estrogen (E) may protect the heart from chronic remodeling and deterioration of function post-MI, whereas testosterone (T) may have adverse effects. Mice (4 wk old) of both genders were divided into four groups: female groups consisted of 1) sham ovariectomy (S-Ovx) + placebo (P) (S-Ovx + P), 2) S-Ovx + T, 3) Ovx + P, and 4) Ovx + T; and male groups consisted of 1) sham castration (S-Cas)+ P (S-Cas + P), 2) S-Cas + 17β-estradiol (E), 3) Cas + P, and 4) Cas + E. MI was induced 6 wk later. Echocardiography was performed to assess cardiac function and left ventricular dimensions (LVD). Myocyte cross-sectional area (MCSA) was measured at the end of the study. In females, both testosterone and ovariectomy decreased ejection fraction (EF) and increased LVD, and when combined they aggravated cardiac function and remodeling further. Testosterone significantly increased MCSA. In males, castration or estrogen increased EF and reduced LVD, whereas castration significantly reduced MCSA. Our data suggest that estrogen prevents deterioration of cardiac function and remodeling after MI, but testosterone worsens cardiac dysfunction and remodeling and has a pronounced effect when estrogen levels are reduced. [ABSTRACT FROM AUTHOR]

Abstract: Current guidelines for treatment of diabetic ketoacidosis (DKA) recommend administration of an intravenous bolus dose of insulin followed by a continuous infusion. This study was designed to investigate whether the initial bolus dose is of significant benefit to adult patients with DKA and if it is associated with increased complications. This was a non-concurrent, prospective observational cohort study of adult patients who presented with DKA in a 12-month period. Charts were divided into two groups depending on whether they received an initial bolus dose of insulin. Data on glucose levels, anion gap (AG), intravenous fluid administration (IVF), and length of stay (LOS) were collected. Primary outcome was hypoglycemia (need for administration of 50% dextrose). Of 157 charts, 78 received a bolus of insulin and were designated the treatment group, the remaining 79 formed the control group. Groups were similar at baseline and received equivalent IVF and insulin drips. There were no statistically significant differences in the incidence of hypoglycemia (6% vs. 1%, respectively, p = 0.12), rate of change of glucose (60 vs. 56 mg/dL/h, respectively, p = 0.54) or AG (1.9 vs. 1.9 mEq/L/h, respectively, p = 0.66), LOS in the Emergency Department (8 vs. 7 h, respectively, p = 0.37) or hospital (5.6 vs. 5.9 days, p = 0.81). Equivalence testing revealed no clinically relevant differences in IVF change, rate of change of glucose, or AG. Administration of an initial bolus dose of insulin was not associated with significant benefit to patients with DKA and demonstrated equivalent changes in clinically relevant endpoints when compared to patients not administered the bolus. [Copyright &y& Elsevier]

Abstract: Study Objectives: To compare the efficacy of continuous radiofrequency (CRF) thermocoagulation with pulsed radiofrequency (PRF) in the treatment of lumbar facet syndrome. Design: Prospective, randomized, double-blinded study. Setting: Ambulatory pain clinic at a level-I trauma center and teaching institution. Patients: 50 ASA physical status I, II, and III patients, at least 18 years of age, scheduled to undergo CRF or PRF for lumbar back pain. Interventions: Target facet joints were identified with oblique radiographic views. Continuous radiofrequency thermocoagulation was delivered at 80°C for 75 seconds, while PRF was delivered at 42°C with a pulse duration of 20 ms and pulse rate of two Hz for 120 seconds. Measurements: Visual analog scale (VAS) pain assessment and Oswestry Low Back Pain and Disability Questionnaire (OSW) were administered at baseline and then at three months. Comparisons between groups and within groups were made of the relative percentage improvement in VAS and OSW scores. Main Results: No significant differences in the relative percentage improvement were noted between groups in either VAS (P = 0.46) or OSW scores (P = 0.35). Within the PRF group, comparisons of the relative change over time for both VAS (P = 0.21) and OSW scores (P = 0.61) were not significant. However, within the CRF group, VAS (P = 0.02) and OSW scores (P = 0.03) showed significant improvement. Conclusions: Although there was no significant difference between CRF and PRF therapy in long-term outcome in the treatment of lumbar facet syndrome, there was a greater improvement over time noted within the CRF group. [Copyright &y& Elsevier]

Summary: Introduction: Early, effective lactate clearance has been shown to be associated with improved mortality in patients with trauma, burns, and sepsis. We investigated whether early, high lactate clearance was associated with reduced mortality in post-cardiac arrest patients. Methods: We performed a retrospective analysis of post-cardiac arrest patients in an urban emergency department. Inclusion criteria included pre-hospital cardiac arrest patients over the age of 18. Exclusion criteria were traumatic arrest, successful resuscitation prior to the arrival of emergency medical services, and cardiac arrest in the presence of pre-hospital providers. Primary endpoints consisted of survival to 24h and survival to hospital discharge. Results: A total of 79 patients were analyzed with a mean age of 64±17 and mean APACHE II score of 37.7±5. Of the 79 patients, 27 (34%) died within 24h and 66 (84%) died during the hospital course. The mean initial lactate level for the overall group was 15±5.2mmol/dl with a mean lactate of 14.4±5.1mmol/dl in the survivors and 16±5.3mmol/dl in the non-survivors (p >0.05). Lactate clearance at both 6 and 12h was significantly higher for both 24-h and overall in-hospital survival (p <0.05). A multivariable analysis showed that high lactate clearance at 12h was predictive of 24-h survival (p <0.05). Conclusions: Early, effective lactate clearance is associated with decreased early and overall in-hospital mortality in post-cardiac arrest patients. These findings suggest that post-arrest tissue hypo-perfusion plays in an important role in early as well as overall mortality. [Copyright &y& Elsevier]

: ObjectivesWe studied the role of angiotensin II type 2 (AT2) receptors and kinins in the cardioprotective effect of angiotensin II type 1 antagonists (AT1-ant) in rats with heart failure (HF) after myocardial infarction.: BackgroundThe AT1-ant is as effective as angiotensin-converting enzyme inhibitors in treating HF, but the mechanisms whereby AT1-ant exert their benefits on HF in vivo are more complex than previously understood.: MethodsBrown Norway Katholiek rats (BNK), which are deficient in kinins because of a mutation in the kininogen gene, and their wild-type control (Brown Norway [BN]) underwent myocardial infarction. Two months later, they were treated for two months with: 1) vehicle; 2) AT1-ant (L158809, Merck, Rahway, New Jersey); 3) AT1-ant + AT2-ant (PD-123319, Parke Davis, Ann Arbor, Michigan); or 4) AT1-ant + kinin B2 receptor antagonist (B2-ant) (icatibant) (only BN). We measured left ventricular weight (LVW) gravimetrically, myocyte cross-sectional area (MCSA) and interstitial collagen fraction (ICF) histologically, and ejection fraction by ventriculography.: ResultsDevelopment of HF was comparable in BN and BNK rats. The AT1-ant reduced LVW and MCSA and the AT2-ant blocked these effects in BN rats, but the B2-ant did not. The AT1-ant reduced LVW and MCSA in BNK rats, and this effect was reversed by the AT2-ant. In BN rats, ICF was reduced and LVEF increased by AT1-ant, and both AT2-ant and B2-ant reversed these effects. In BNK rats, the AT1-ant failed to reduce ICF, and its therapeutic effect on LVEF was significantly blunted.: ConclusionsIn HF, the AT2 receptor plays an important role in the therapeutic effects of AT1-ant, and this effect may be mediated partly through kinins; however, kinins appear to play a lesser role in the antihypertrophic effect of AT1-ant. [Copyright &y& Elsevier]

Presents a study to test an intervention to improve performance of coronary artery bypass grafting (CABG) surgery. Context; Design and setting; Patients; Intervention; Main outcome measures; Results; Conclusion.