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Urban noise is a common environmental exposure that may increase the burden of hypertension in communities, yet it is largely unstudied in the United States, and it has not been studied in relation to blood pressure (BP) control. We investigated associations of urban noise with BP levels and control in the United States. We used repeated BP and medication data from Chicago-based participants of the Chicago Health and Aging Project (≥65 years) and MESA (Multi-Ethnic Study of Atherosclerosis; ≥45 years). Using a spatial prediction model with project-specific measurements, we estimated noise at participant homes. We imputed BP levels for those on medication and used mixed-effects models to evaluate associations with noise. Logistic regression was used for uncontrolled and apparent treatment-resistant hypertension. Models were run separately by cohort and altogether, all with adjustment for age, sex, sociodemographic factors, and other plausible sources of confounding. We evaluated 16 462 BP measurements from 6764 participants (6073 Chicago Health and Aging Project and 691 MESA) over an average of 4 years. For both cohorts, we found that greater levels of noise were associated with higher BP levels and greater risk of apparent treatment-resistant hypertension. In our pooled models, 10-dBA higher residential noise levels corresponded to 1.2 (95% CI, 0.1–2.2) and 1.1 mm Hg greater (95% CI, 0.6–1.7) systolic and diastolic BPs as well as a 20% increased odds of apparent treatment-resistant hypertension (odds ratio per 10 dBA: 1.2 [95% CI, 1.0–1.4], P =0.04). Urban noise may increase BP levels and complicate hypertension treatment in the United States.

Falk Neto, JH, Parent, E, and Kennedy, MD. Long-term athlete development: Seasonal and longitudinal fitness changes in female university rugby players. J Strength Cond Res 35(12): 3459-3465, 2021-The Long-Term Athlete Development model is used by organizations to determine the expected improvements from athletes at different stages of their careers. For female rugby athletes, university sports should provide continued support for athlete development during the Training to Perform stage (18-21 years old). However, little evidence exists for longitudinal changes across years of participation in university sports in this group. The purpose of this study was to assess changes in anthropometric and fitness characteristics in female university rugby players across different seasons. Seventeen players were divided into forwards (n = 9, 21.1 ± 2.6 years) and backs (n = 8, 19.62 ± 0.9 years) and assessed across 5 points over 3 years: preseason 1, postseason 1, preseason 2, postseason 2, and preseason 3. Anthropometric (height, body mass, and body mass index) and performance measurements (grip strength, flexibility, trunk muscular endurance, upper-body muscular endurance, 40-m sprint, vertical jump, and 20-m shuttle run) were collected. V̇o2max was higher at preseason 2 compared with postseason 1 (p = 0.02), postseason 2 (p = 0.01), and preseason 3 (p = 0.015), and trunk muscular endurance was higher at preseason 3 (p = 0.02). Performance in the first 5 m of the sprint test decreased at postseason 1 (p = 0.018) and preseason 2 (p = 0.016) when compared with preseason 1. The results indicate that these female athletes did not improve their fitness across the Training to Perform stage when participating in university sports. These female rugby players likely developed their fitness at earlier stages and, at this stage, already possessed well-developed fitness levels, which were merely maintained throughout years.

Alveolar bone grafts are the golden standard in treating patients with oral cleft and hence, the long-term success of this treatment is the subject of many studies. The aim of this study was to systematically review literature that examined the long-term stability of alveolar bone grafting in patients with cleft lip and palate.In this study, data was collected via a comprehensive search of random and nonrandom studies evaluating the success of bone grafts in patients with cleft lip and palate in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until July 3, 2020. Also, a search was conducted for ongoing studies in the trial registry and a hand search of related gray literature and references of the relevant studies. The relevant data of the included studies were extracted using predefined extraction forms. Meta-analysis was performed using inverse-variance for calculating the pooled outcome of outcome measures. The pooled mean success rate of alveolar bone graft and mean difference of cleft volume after 1 year was presented as the outcome of the analysis.Eight studies (1 randomized clinical trial study and 7 controlled prospective studies) were included in this meta-analysis. The results of the analyses showed that the total percentage of secondary alveolar success in the follow-up period of at least 1 year according to the Bergland index was 76.52% (pooled success = 76.52%, 44.92-98.10). Also, bone defect in the cleft area reduced significantly after bone grafting (MD = 0.62 cm3, 0.48-0.75, P 0.00001). The total percentage of bone filling after 1 year and according to CBCT (cone beam computed tomography) was about 63.38%, and the rate of definite natural eruption of canine within the graft was 80.89%.The total success rate of secondary alveolar bone grafting in the follow-up period of at least 1 year was clinically significant and alveolar bone grafting significantly reduced bone defect volume. Also, there was no difference in the amount of bone remaining after 1 year in patients whose canine had erupted through the grafted bone and in those whose canine had not erupted.

Background Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures. Objective To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion. Methods In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value Results Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P = .03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap. Conclusion Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.

Loturco, I, Pereira, LA, Kobal, R, Fernandes, V, Reis, VP, Romano, F, Alves, M, Freitas, TT, and McGuigan, M. Transference effect of short-term optimum power load training on the punching impact of elite boxers. J Strength Cond Res 35(9): 2373-2378, 2021-This study examined the changes in bench press (BP), jump squat (JS), and half-squat (HS) power outputs induced by a short-term (1 week) training scheme based on the optimum power load (OPL) applied to national boxing athletes and measured the transference effect coefficient (TEC) of these exercises on punching impact. Eight elite boxing athletes from the Brazilian National team participated in this study. Athletes were tested before and after 3 power-oriented training sessions performed at the OPL. The physical assessments comprised punching impact measures (jabs and crosses) at fixed and self-selected distances, and bar-power output in BP, HS, and JS exercises. Magnitude-based differences were used to compare pre-training and post-training sessions. Transference effect coefficient was calculated as the ratio between the result gain in the "untrained exercises" (punching impact in jabs and crosses) and "trained exercises" (HS, JS, and BP), for variables presenting an effect size of at least 0.2. The OPL training elicited meaningful increases in the punching impact forces (∼8%) and in both JS and HS power outputs (∼12 and ∼14%, respectively), but not in BP power output. There was an effective transference (TEC = ∼0.80) of JS and HS performance gains to punching impact force, suggesting that increases in lower-limb power can be directly transferred to punching impact. These results provide coaches and practitioners with valuable information about how to rapidly and effectively increase the punching impact force of elite amateur boxers.

In response to a question posed by a valued colleague, this column will discuss 4 fundamental pharmacokinetic concepts: (1) What does the term clearance encompass? (2) What do the terms first order and second order pharmacokinetics mean? (3) What does the term nonlinear pharmacokinetics mean and is it just a synonym for zero order pharmacokinetics? (4) What is the clinical relevance, if any, of these concepts and why? In addition, this column cites several earlier columns that are relevant to aspects of each of the answers. Thus, readers interested in more details can refer to these earlier publications that include case examples and figures that further illustrate various points. In considering the clinical relevance of these pharmacokinetic concepts, this column discusses relative binding affinity for targets and the concept of selective versus nonselective drugs, which are foundational cornerstones for understanding and optimally using currently available psychopharmaceutical agents.

We analyzed the incidence rate of long-term events in patients on antiretroviral therapy (ART) previously exposed to therapy interruption.A single-center cohort study involving participants in ART interruptions (ARTI) clinical trials (n = 10) was conducted.Non-AIDS events after ART resumption were analyzed. A control group not exposed to ARTI was randomly selected from the same cohort and a propensity score of belonging to ARTI group was estimated based on age, sex, CD4+ nadir value, time from HIV diagnosis to ARTI, time from HIV diagnosis to starting ART and time of suppressed viral load, and used to adjust effect estimates.One hundred and eighty-one patients were included, 136 in ARTI and 45 in the control arm. Median time of known HIV-1 infection was 21 years and median time from ART resumption to first non-AIDS event was 5.2 years. A significantly higher proportion of patients with ARTI had an event as compared with control group [raw percentages: 43% (n = 53) vs. 23% (n = 10), P = 0.015]. These differences were confirmed when only the non-AIDS events occurring after ART resumption were analyzed [adjusted hazard ratio (aHR) = 2.43, 95% confidence interval (CI) 1.15-5.12]. The logistic model adjusted for the propensity score indicated that patients with an ARTI had a four-fold higher risk of having at least one non-AIDS event (P = 0.002).We found a higher risk of having at least one non-AIDS event years after ART resumption in HIV-infected patients exposed to ARTI as compared with controls. These data should be taken into consideration for future functional cure clinical trials.

Previous experimental studies have identified specific foods or nutrients are capable of mitigating adverse effects induced by air pollution. However, whether the dietary pattern can modify the associations between long-term particulate matter (PM) and increasing blood pressure (BP) among adults has not yet been assessed. We assessed whether the dietary pattern and various foods modify the associations between long-term exposure to PM (PM 1 , PM 2.5 , and PM 10 ), hypertensive BP (BP≥140/90 mm Hg, HBP), and BP in Chinese adults. This study included 61 081 participants from China Multi-Ethnic Cohort. PM was assessed through satellite-based random forest approaches. Outcomes were analyzed with logistic regression models and linear regression models. The dietary approaches to stop hypertension (DASH) diet was calculated for each participant. This study founds long-term exposure to PM was associated with HBP, systolic BP, and pulse pressure. The DASH diet modified the associations between PM, HBP, and some BP components. For each 10 μg/m 3 increase in PM 1 , PM 2.5 , and PM 10 , the participants with the lowest quintile of DASH score had HBP risks with odds ratios (95% CI) of 1.196 (1.084–1.319), 1.145 (1.09–1.202), and 1.080 (1.045–1.117), whereas those with the highest quintile of DASH score had lower HBP risks with odds ratios (95% CI) of 1.063 (0.953–1.185), 1.074 (1.017–1.133), and 1.038 (1.000–1.077). Consuming more fresh fruits, vegetables, dairy, and whole grains would reduce the risk of raised BP caused by PM. In conclusion, the DASH diet rich in antioxidant compounds may be a wide-reaching intervention to reduce the deleterious impact of PM.

There is a lack of data regarding mid-term outcomes of extracorporeal membrane oxygenation (ECMO) for refractory postcardiotomy cardiogenic shock (PCS). In this context, this research aimed to assess the mid-term survival and quality of life of PCS patients who receive ECMO by comparing them with cardiac surgery patients who do not receive ECMO. A retrospective analysis was performed on the clinical data of patients who had undergone ECMO treatment after cardiac surgery from January 2013 to June 2017 in a tertiary hospital (n = 102); non-ECMO patients who had undergone cardiac surgery and were discharged successfully were selected as the control group (n = 102). Survival and mid-term quality of life were assessed and compared through the Short-Form 36 (SF-36). Both groups were followed up by telephone, and SF-36 scores were obtained from the surviving patients. The data were available for 89 patients (87.3%) and 88 patients (86.3%) in the ECMO group and the control group, respectively. After discharge, the control group outperformed the ECMO group in survival (93.1% vs. 82.4%; p = 0.013). No significant differences in complications, all-cause mortality, first readmission for any cause, or work condition between the ECMO group and the control group were observed. The SF-36 scores in general health (GH) and vitality (VT) were significantly lower among the ECMO survivors (p0.05). The results of this study indicate that ECMO can provide acceptable mid-term survival with good quality of life for patients with refractory cardiogenic shock.

OBJECTIVES: Standard parenteral nutrition (PN) solutions are safe and can meet the nutritional requirements of a significant number of pediatric patients. However, they may not always be adequate for those on long term PN. We aimed to compare the composition of individually tailored prescriptions in a pediatric population on home PN with that of available commercial PN formulations. METHODS: Retrospective analysis of the individual prescriptions of metabolically stable pediatric patients on home PN over a 1-year period (March 2019 to March 2020). These were compared with commercially available solutions with electrolytes, and replacement was considered adequate if three successive criteria were met: non-protein calorie to volume ratio (maximum variation 15%); non-protein calorie to nitrogen ratio (NPC:N) (maximum variation either 20% for long term use or 35% for possible short term use); electrolyte concentration (maximum increase 20%). RESULTS: Twenty-four patients were included (67% male; median age 7.5 years). The most common diagnosis was short bowel syndrome (58%). Replacement with a standard formulation was considered appropriate for possible short term use (maximum variation of 35% in NPC:N) in 16 (67%) patients and for long term use (maximum variation of 20% in NPC:N), the number of patients decreased to 10 (42%). CONCLUSIONS: Standard PN solutions can be adequate for a significant proportion of pediatric patients on home PN. Their use in the short term may also be appropriate in holiday periods or in settings of limited resources or restricted access to hospital facilities, such as those imposed by the COVID-19 pandemic.

Introduction The Stop the Bleed (STB) program trains the general public on identifying and treating life-threatening bleeding. Data on efficacy and retention of skills taught through this program are limited, with the role of high-technology modalities to augment the program, such as simulation and feedback devices, untested. Methods A convenience sample of 66 school personnel participated in an open-label observational study from January to August 2019. The control group received the standard bleeding control course, while the intervention group received the bleeding control course with addition of a simulation and a feedback device for wound packing. Assessment was performed by STB instructors using performance metrics from prior studies as well as a feedback device. Retention testing was performed 2 to 8 months after intervention. The study was approved by the hospital's institutional review board. Results The intervention group performed better than the control group on correct tourniquet application [90.3% vs. 71.0%; odds ratio (OR) = 11.28; P = 0.015; 95% confidence interval (CI) = 1.86 to 104.67] wound packing scores (59.5% vs. 29.6%; OR = 0.33; P = 0.007; 95% CI = 9.36 to 56.00) and were more likely to assess their safety (OR = 5.49; P = 0.034; 95% CI = 1.28 to 27.66), and reported higher comfort scores on stepping into an emergency scenario (OR = 11.19; P = 0.004; 95% CI = 2.51 to 63.11), wound packing (OR = 5.16; P = 0.025; 95% CI = 1.35 to 22.46), and using a tourniquet (OR = 11.41; P = 0.003; 95% CI = 2.57 to 67.59). Thirty-one participants (46.9%) were assessed again at retention 2 to 8 months later where scores for tourniquet placement and wound packing were not significantly different in the two groups. Conclusions Augmenting STB with simulation and feedback improved both self-reported comfort level and skill set of participants, but the retention of skills was poor in both groups.

ObjectiveTo determine whether autologous hematopoietic stem cell transplantation (aHSCT) is able to induce durable disease remission in people with multiple sclerosis (MS), we analyzed the long-term outcomes after transplantation in a large cohort of patients with MS.MethodsTo be included, a minimum dataset (consisting of age, MS phenotype, Expanded Disability Status Scale [EDSS] score at baseline, information on transplantation technology, and at least 1 follow-up visit after transplantation) was required.ResultsTwo hundred ten patients were included (relapsing-remitting [RR] MS 122 [58%]). Median baseline EDSS score was 6 (1–9); mean follow-up was 6.2 (±5.0) years. Among patients with RRMS, disability worsening–free survival (95% confidence interval [CI]) was 85.5% (76.9%–94.1%) at 5 years and 71.3% (57.8%–84.8%) at 10 years. In patients with progressive MS, disability worsening–free survival was 71.0% (59.4%–82.6%) and 57.2% (41.8%–72.7%) at 5 and 10 years, respectively. In patients with RRMS, EDSS significantly reduced after aHSCT (p = 0.001; mean EDSS change per year −0.09 [95% CI −0.15% to −0.04%]). In patients with RRMS, the use of the BCNU+Etoposide+Ara-C+Melphalan (BEAM) + anti-thymocyte globulin (ATG) conditioning protocol was independently associated with a reduced risk of no evidence of disease activity 3 failure (hazard ratio 0.27 [95% CI 0.14–0.50], p < 0.001). Three patients died within 100 days from aHSCT (1.4%); no deaths occurred in patients transplanted after 2007.ConclusionsaHSCT prevents disability worsening in the majority of patients and induces durable improvement in disability in patients with RRMS. The BEAM + ATG conditioning protocol is associated with a more pronounced suppression of clinical relapses and MRI inflammatory activity.Classification of EvidenceThis study provides Class IV evidence that for people with MS, aHSCT induces durable disease remission in most patients.

ObjectiveTo determine whether functional MRI connectivity can predict long-term cognitive function 36 months after minor stroke.MethodsSeventy-two participants with first-ever stroke were included at baseline and followed up for 36 months. A ridge regression machine learning algorithm was developed and used to predict cognitive scores 36 months poststroke on the basis of the functional networks measured using MRI at 6 months (referred to here as the poststroke cognitive impairment [PSCI] network). The prediction accuracy was evaluated in 4 domains (memory, attention/executive, language, and visuospatial functions) and compared with clinical data and other functional networks. The models' statistical significance was probed with permutation tests. The potential involvement of cortical atrophy was assessed 6 months poststroke. A second, independent dataset (n = 40) was used to validate the results and assess their generalizability.ResultsBased on the PSCI network, a machine learning model was able to predict memory, attention, visuospatial functions, and language functions 36 months poststroke (r2: 0.67, 0.73, 0.55, and 0.48, respectively). The PSCI-based model was at least as accurate as models based on other functional networks or clinical data. Specific patterns were demonstrated for the 4 cognitive domains, with involvement of the left superior frontal cortex for memory, attention, and visuospatial functions. The cortical thickness 6 months poststroke was not correlated with cognitive function 36 months poststroke. The independent validation dataset gave similar results.ConclusionsA machine learning model based on the PSCI network can predict long-term cognitive outcome after stroke.

© 2022 Lippincott Williams and Wilkins. All rights reserved.One of the methods applied to ensure the long-term continuity of the desired result in rhinoplasty is to detect it by placing columellar strut between the medial crus. Columellar strut helps to increase tip support and projection. However, the placement of the strut between the medial crus can disrupt the divergence angle and prevent the tip rotation to be at the desired level due to the interaction of the septum with the caudal. in this study, the data obtained by fixing the columellar strut to the lateral faces of the medial crus are shared. in 51 primary rhinoplasty patients who underwent open rhinoplasty, the medial crus was dissected and released. The distance between the footplates and the new domes was measured and the length of the columellar struts was determined. Grafts obtained from cartilage septum were shaped. After symmetry was achieved between the medial crus, the prepared grafts were fixed to the lateral face of the medial crus. Preoperative and postoperative 12th month images were transferred to computer- aided program and nasolabial angles were measured. The obtained data were transferred to SPSS 22.0 (IBM Corp., Armonk, New York, USA) program and statistical comparisons were made. Fifty one patients were included in the study. Thirty eight of the patients were female and 13 were male. The mean age of the patients included in the study was 29.2 years. The mean preoperative nasolabial angle was 90.2 degrees postoperatively, and the average nasolabial angle was 104.2 degrees at 6 months. A statistically significant difference was found between preoperative and postoperative measurements (P < 0.05). Lateral columellar strut is an effective and reliable and novel method for increasing the stability of medial crus, maintaining tip support in postoperative period and increasing tip rotation.

To describe the clinical characteristics and outcomes of adult patients with coronavirus disease 2019 requiring weaning from prolonged mechanical ventilation.Observational cohort study of patients admitted to two long-term acute care hospitals from April 1, 2020, to March 31, 2021.Two long-term acute care hospitals specialized in weaning from prolonged mechanical ventilation in the Chicagoland area, Illinois, United States.Adult (≥ 18 yr old) ICU survivors of respiratory failure caused by severe acute respiratory syndrome coronavirus 2 pneumonia receiving prolonged mechanical ventilation.None.During the study period, 158 consecutive patients were transferred to the long-term acute care hospitals for weaning from prolonged ventilation. Demographic, clinical, and laboratory data were collected and analyzed. Final date of follow-up was June 1, 2021. Prior to long-term acute care hospital transfer, median length of stay at the acute care hospital was 41.0 days and median number of ventilator days was 35. Median age was 60.0 years, 34.8% of patients were women, 91.8% had a least one comorbidity, most commonly hypertension (65.8%) and diabetes (53.2%). The percentage of weaning success was 70.9%. The median duration of successful weaning was 8 days. Mortality was 9.6%. As of June 1, 2021, 19.0% of patients had been discharged home, 70.3% had been discharged to other facilities, and 1.3% were still in the long-term acute care hospitals.Most patients with coronavirus disease 2019 transferred to two Chicago-area long-term acute care hospitals successfully weaned from prolonged mechanical ventilation.

OBJECTIVE The aim of this prospective clinical study is to compare short-term outcome of laparoscopic right hemicolectomy using the Complete Mesocolic Excision (CME group) with patients who underwent conventional right-sided colonic resection (NCME group). SUMMARY BACKGROUND DATA Although CME with central vascular ligation in laparoscopic right hemicolectomy is associated with a significant decrease in local recurrence rates and improvements in cancer-related 5-year survival, there may be additional risks associated with this technique because of increased surgical complications. As a result, there is controversy surrounding its use. METHODS In this randomized controlled trial, several primary endpoints (operative time, intraoperative blood loss, other complications, conversion rate, and anastomotic leak) and secondary endpoints (overall postoperative complications) were evaluated. In addition, we evaluated histopathologic data, including specimen length and the number of lymph nodes harvested, as objective signs of the quality of CME, related to oncological outcomes. RESULTS The CME group had a significantly longer mean operative time than the NCME group (216.3 minutes vs 191.5 minutes, P = 0.005). However, the CME group had a higher number of lymph nodes (23.8 vs 16.6; P < 0.001) and larger surgical specimens (34.3 cm vs 29.3 cm; P = 0.002). No differences were reported with respect to intraoperative blood loss, conversion rate, leakage, or other postoperative complications. CONCLUSIONS In this study laparoscopic CME were a safe and feasible technique with improvement in lymph nodes harvesting and length of surgical specimens with no increase of surgical intraoperative and postoperative complications.

Human milk has repeatedly been shown to be the best form of infant nutrition. Many reasons may prevent a family from providing human milk to their child, leaving them to seek other options. One alternative is informal milk sharing, where individuals and families find donor milk through online communities. We present perspectives from three mothers who used informal milk sharing for at least 6 months. Common themes identified are sadness, guilt, and stigmatization of informal milk sharing. Implications for practice include providing families and practitioners with resources for learning about informal milk sharing and navigating the community safely.

Article published in Strength and Conditioning Journal available at https://doi.org/10.1519/SSC.0000000000000608

Background and Purpose: Data on long-term survival and recurrence after stroke are lacking. We investigated time trends in ischemic stroke case-fatality and recurrence rates over 20-years stratified by etiological subtype according to the Trial of ORG 10172 in Acute Stroke Treatment classification within a population-based stroke register in Germany. Methods: Data was collected within the Erlangen Stroke Project, a prospective, population-based stroke register covering a source population of 105 164 inhabitants (2010). Case fatality and recurrence rates for 3 months, 1 year, and 5 years were estimated with Kaplan-Meier estimates. Sex-specific time trends for case-fatality and recurrence rates were estimated with Cox regression. We adjusted for age, sex, and year of event and stratified for etiological subtypes. A sensitivity analysis with competing risk analysis for time trends in recurrence were performed. Results: Between 1996 and 2015, 3346 patients with first ischemic stroke were included; age-standardized incidence per 100 000 was 75.8 in women and 131.6 in men (2015). Overall, 5-year survival probabilities were 50.4% (95% CI, 47.9–53.1) in women and 59.2% (95% CI, 56.4–62.0) in men; 5-year survival was highest in patients with first stroke due to small-artery occlusion (women, 71.8% [95% CI, 67.1–76.9]; men, 75.9% [95% CI, 71.3–80.9]) and lowest in cardioembolic stroke (women, 35.7% [95% CI, 31.0–41.1]; men, 47.8% [95% CI, 42.2–54.3]). Five-year recurrence rates were 20.1% (95% CI, 17.5–22.6) in women and 20.1% (95% CI, 17.5–22.7) in men; 5-year recurrence rate was lowest in women in stroke due to small artery occlusion 16.0% (95% CI, 11.7–20.1) and in men in large-artery atherosclerosis 16.6% (95% CI, 8.7–23.9); highest risk of recurrence was observed in undefined strokes (women, 22.3% [95% CI, 17.8–26.6]; men, 21.4% [95% CI, 16.7–25.9]). Cox regression revealed improvements in case-fatality rates over time with differences in stroke causes. No time trends in recurrence rates were observed. Conclusions: Long-term survival and recurrence varied substantially by first stroke cause. Survival probabilities improved over the past 2 decades; no major trends in stroke recurrence rates were observed.

Feltz, DL, Hill, CR, Samendinger, S, Myers, ND, Pivarnik, JM, Winn, B, Ede, A, and Ploutz-Snyder, L. Can simulated partners boost workout effort in long-term exercise? J Strength Cond Res 34(9): 2434-2442, 2020-We tested whether exercising with a stronger simulated (i.e., software-generated) partner leads to greater work effort compared to exercising alone, to help those seeking to maintain or improve fitness levels with long-term high-intensity training, but who find it necessary or practical to exercise in social isolation. Forty-one middle-aged adults, who participated in at least 30 minutes of vigorous exercise 3x·wk, trained on a cycle ergometer 6 days per week for 24 weeks in an alternating regimen of moderate-intensity 30-minute continuous and 3 types of high-intensity interval sessions (8 × 30-second sprints, 6 × 2-minute ladders, and 4 × 4-minute intervals). They were assigned either no partner (control), an always superior partner, or a not always superior partner. Participants varied cycle power output to increase or decrease session intensity during the repeated moderate-intensity sessions (30-minute continuous) and 1 of the 3 high-intensity sessions (4 × 4-minute intervals). Changes in intensity were used as a measure of effort motivation over time. Nested multilevel models of effort trajectory were developed and alpha was set to 0.05. For continuous and interval sessions, effort trajectory was positive and significant for those with an always superior partner, but not significantly different from control. Within interval sessions, those with an always superior partner significantly increased effort in the fourth interval compared to control (p = 0.02). Exercising with an always superior partner leads to greater work efforts during the hardest interval training compared to exercising alone.

SUMMARY Around 50 years after the first EEG acquisition by Hans Berger, its use in ambulatory setting was demonstrated. Ever since, ambulatory EEG has been widely available and routinely used in the United States (and to a lesser extent in Europe) for diagnosis and management of patients with epilepsy. This technology alone cannot help with semiological characterization, and absence of video is one of its main drawbacks. Addition of video to ambulatory EEG potentially improves diagnostic yield and opens new aspects of utility for better characterization of patient's events, including differential diagnosis, classification, and quantification of seizure burden. Studies evaluating quality of ambulatory video EEG (aVEEG) suggest good quality recordings are feasible. In the utilization of aVEEG, to maximize yield, it is important to consider pretest probability. Having clear pretest questions and a strong index of suspicion for focal, generalized convulsive or non-epileptic seizures further increases the usefulness of aVEEG. In this article, which is part of the topical issue "Ambulatory EEG," the authors compare long-term home aVEEG to inpatient video EEG monitoring, discuss aVEEG's use in diagnosis and follow-up of patients, and present the authors' own experience of the utility of aVEEG in a teaching hospital setting.

Rodriguez-Fernandez, A, Villa, JG, Sanchez-Sanchez, J, and Rodriguez-Marroyo, JA. Effectiveness of a generic vs. specific program training to prevent the short-term detraining on repeated-sprint ability of youth soccer players. J Strength Cond Res 34(8): 2128-2135, 2020-The aim of this study was to analyze the effects of 2 short-term training programs to prevent the negative effect of detraining on repeated-sprint ability (RSA) performance. The study was performed during a 2-week midseason break without official matches. Forty-five youth soccer players (17.7 ± 0.8 years, 175.4 ± 5.5 cm, and 67.2 ± 5.1 kg) were split into 3 groups during the intervention period: inactivity group (IN; N = 16), generic high-intensity training group (GG; N = 15), and specific training group (SG; N = 14). IN was instructed to avoid performing physical activity during the 2-week training intervention. However, GG and SG performed 8 training sessions. GG performed a generic aerobic interval training consisting of 4 repetitions of 4 minutes of exercise at 90-95% of maximal heart rate. SG performed a specific conditioning through small-sided games (4 vs. 4, 4 × 4-minute) and repeated sprints (6 × 30-m). Testing sessions included an RSA test and a Yo-Yo intermittent recovery test level 1 (YYIR1). Repeated-sprint ability performance only improved after the training intervention in SG (∼2%, p < 0.01, (Equation is included in full-text article.)= 0.23-0.25). Both GG and IN declined their performance in post-test (∼2%, p < 0.01, (Equation is included in full-text article.)= 0.19-0.22). No significant effect, group × time, was analyzed for YYIR1 performance. This study suggests that only specific training, based on small-sided games and repeated sprints, leads to short-term improvements on RSA performance in youth soccer players.

The gut microbiome impacts metabolic homeostasis, and several inflammatory pathologies including obesity, glucose intolerance, and worsened cardiovascular disease outcomes are associated with an altered gut microbiome. We have previously demonstrated Bifidobacterium animalis lactis 420 ([B420], a probiotic) attenuates myocardial infarct injury in mice following ischemic reperfusion (IR) injury. Further, Oligofructose ([OFS], a prebiotic) improves glucose tolerance, and reduces weight gain in high-fat-diet (HFD) mice. However, the combined ability of B420 and OFS (a synbiotic) on cardiovascular and metabolic disease is unknown. We hypothesized that short-term (2 weeks) synbiotic treatment improves adiposity and glucose tolerance and reduces IR infarct size in HFD fed male mice more than prebiotic or probiotic treatments alone. Adult male mice were fed HFD (45% fat) for 2 weeks and were then treated with OFS (10microliters/gram weight, 200miligram OFS/ 300microliters saline), B420 (10microliters/gram weight, 10 9 CFU/ 300microliters saline), or B420+OFS (synbiotic treatment) via daily gavage for 2 weeks. Following treatment mice underwent an IR protocol, (45-minute ligation followed by reperfusion). Oral glucose tolerance tests were conducted prior to and after treatment to determine blood glucose. Fasted mice were gavaged with glucose (2.5g/kg glucose) and blood glucose was measured over 120 minutes. Body weight, and kcal intake were measured weekly. Upon sacrifice epididymal fat mas was weighed to determine adiposity. Data were analyzed by one-way ANOVA or T-test. We found that short-term synbiotic treatment with B420+OFS during HFD-feeding reduced adiposity and improved glucose tolerance, while probiotic or prebiotic treatment alone had no effect. However, short-term treatment, including synbiotic, did not significantly reduce heart infarct size as previously demonstrated with longer treatment periods. Taken together, these results suggest that synbiotic treatment improves metabolic impairments more rapidly than B420 or OFS alone, and precedes improvements in infarct size.

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Severe caloric restriction (sCR) increases the risk for acute cardiovascular disease. Less understood are the long-term effects on cardiovascular disease risk after the sCR period has ended. We investigated the effects of sCR on heart structure and function months after refeeding (sCR-Refed). Female Fischer rats (3-months-old) were maintained on (CT) ad libitum or a 60% caloric restricted diet for 2 weeks. Thereafter, all rats received ad libitum chow for 3 months and they were analyzed by precision ultrasound to assess their heart function. After imaging, the animals were sacrificed and the hearts were subjected to ischemia-reperfusion (I/R) using a Langendorff preparation. After 2 weeks of sCR, rats lost 15% of their initial body weight (BW) [% (100*(Final-Initial/Initial)): CT, 1.5±0.8 vs sCR, -15.4±1.1; pdata not shown ) and remained doubled 3 months later [Arrhythmias (% of time): CT, 34±8 vs sCR-Refed, 68±9; p=0.02; n=8]. Ultrasound imaging showed no difference in stroke volume, coronary perfusion pressure and left ventricular mass. However, the thickness of the left ventricular posterior wall was significantly reduced in sCR-Refed rats [(mm): CT, 2.55 ±0.03 vs sCR-Refed, 2.10±0.04; p=0.002; n=4]. These findings indicate heart structure and function remained damaged months after the sCR period ended and BW was restored. These studies have adverse cardiovascular risk implications for who are subjected either voluntarily (crash diets) or involuntarily (very low food security) to periods of inadequate caloric intake.