Primary MI Research Articles

The role of insurance status in the association between short-term temperature exposure and myocardial infarction hospitalizations in New York State.

To evaluate effect modification of the relationship between short-term ambient temperature and MI, by individual-level insurance status (insured vs. uninsured). We identified MI hospitalizations and insurance status across New York State (NYS) hospitals from 1995 to 2015 in the New York Department of Health Statewide Planning and Research Cooperative System database, using International Classification of Diseases codes. We linked short-term ambient temperature (averaging the 6 hours preceding the event [MI hospitalization]) or nonevent control period in patient residential zip codes. We employed a time-stratified case-crossover study design for both insured and uninsured strata, and then compared the group-specific rate ratios. Over the study period, there were 1,095,051 primary MI admissions, 966,475 (88%) among insured patients. During extremely cold temperatures (<5.8 °C) insured patients experienced reduced rates of MI; this was not observed among the uninsured counterparts. At warmer temperatures starting at the 65th percentile (15.7 °C), uninsured patients had higher rates than insured patients (e.g., for a 6-hour pre-event average temperature increase from the median to the 75th percentile, the rate of MI increased was 2.0% [0.0%-4.0%] higher in uninsured group). Uninsured individuals may face disproportionate rates of MI hospitalization during extreme temperatures.

An integrated signature of extracellular matrix proteins and a diastolic function imaging parameter predicts post-MI long-term outcomes.

Patients suffering from acute myocardial infarction (AMI) are at risk of secondary outcomes including major adverse cardiovascular events (MACE) and heart failure (HF). Comprehensive molecular phenotyping and cardiac imaging during the post-discharge time window may provide cues for risk stratification for the outcomes. In a prospective AMI cohort in New Zealand (N = 464), we measured plasma proteins and lipids 30 days after hospital discharge and inferred a unified partial correlation network with echocardiographic variables and established clinical biomarkers (creatinine, c-reactive protein, cardiac troponin I and natriuretic peptides). Using a network-based data integration approach (iOmicsPASS+), we identified predictive signatures of long-term secondary outcomes based on plasma protein, lipid, imaging markers and clinical biomarkers and assessed the prognostic potential in an independent cohort from Singapore (N = 190). The post-discharge levels of plasma proteins and lipids showed strong correlations within each molecular type, reflecting concerted homeostatic regulation after primary MI events. However, the two molecular types were largely independent with distinct correlation structures with established prognostic imaging parameters and clinical biomarkers. To deal with massively correlated predictive features, we used iOmicsPASS + to identify subnetwork signatures of 211 and 189 data features (nodes) predictive of MACE and HF events, respectively (160 overlapping). The predictive features were primarily imaging parameters, including left ventricular and atrial parameters, tissue Doppler parameters, and proteins involved in extracellular matrix (ECM) organization, cell differentiation, chemotaxis, and inflammation. The network signatures contained plasma protein pairs with area-under-the-curve (AUC) values up to 0.74 for HF prediction in the validation cohort, but the pair of NT-proBNP and fibulin-3 (EFEMP1) was the best predictor (AUC = 0.80). This suggests that there were a handful of plasma proteins with mechanistic and functional roles in predisposing patients to the secondary outcomes, although they may be weaker prognostic markers than natriuretic peptides individually. Among those, the diastolic function parameter (E/e' - an indicator of left ventricular filling pressure) and two ECM proteins, EFEMP1 and follistatin-like 3 (FSTL3) showed comparable performance to NT-proBNP and outperformed left ventricular measures as benchmark prognostic factors for post-MI HF. Post-discharge levels of E/e', EFEMP1 and FSTL3 are promising complementary markers of secondary adverse outcomes in AMI patients.

Outcomes of minimally invasive retroperitoneal lymph node dissection (Primary MI- RPLND) followed by adjuvant carboplatin (AUC7) for clinical stage IIa/b seminoma

Outcomes of minimally invasive retroperitoneal lymph node dissection (Primary MI- RPLND) followed by adjuvant carboplatin (AUC7) for clinical stage IIa/b seminoma

Contribution of hypertriglyceridemia to ischemic cardiovascular disease in Korean women: A nationwide population-based study

The independent effect of serum triglyceride levels on the development of ischemic cardiovascular disease (CVD) remains inconclusive, which might be due to heterogeneity among study populations. To evaluate the effect of triglyceride levels on ischemic CVD and mortality in Korean women, with stratification according to the menopausal status, diabetes mellitus, or low-density lipoprotein cholesterol levels (LDL-C). We retrospectively investigated Korean women aged 40-69 years who underwent health examination in 2009 and were followed up until 2018 using nationwide claim data. The subjects were divided according to triglyceride quartiles (Q): Q1 <70 mg/dL, Q2 71-99 mg/dL, Q3 100-142 mg/dL, and Q4 ≥143 mg/dL. The primary outcome was the incidence of CVD defined as a composite of myocardial infarction and ischemic stroke. Among 2,208,347 women, primary outcome occurred in 62,255 (2.8%) subjects. As triglyceride levels increased, the event rate of primary outcome increased in both premenopausal and postmenopausal women in the fully adjusted model (hazard ratio [HR] per 1 Q, 1.10 [95% confidence interval (CI), 1.08-1.12] and 1.08 [95% CI, 1.07-1.09], respectively), which was maintained on further stratification according to diabetes or LDL-C (P<0.05 in all). Higher triglyceride levels were more significantly associated with the primary outcome, MI, and stroke risk among women with optimal non-high-density lipoprotein cholesterol levels (non-HDL-C) <130 mg/dL, but only weakly with stroke for women with non-optimal non-HDL-C. Triglyceride is an independent prognosticator in the development of ischemic CVD in Korean women aged 40-69 years.

Natural History and Outcomes of Patients with Critical Limb Ischemia in the Euclid Trial

Introduction - Critical limb ischemia (CLI) implies a heightened risk for cardiovascular morbidity and mortality. Methods - The EUCLID trial (NCT01732822) investigated the effect of antithrombotic monotherapy, ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily, in patients with symptomatic peripheral arterial disease (PAD). Inclusion criteria were previous lower extremity revascularization (LER) or ankle-brachial index (ABI) ≤0.80, randomizing 13,885 patients. Ticagrelor was not superior to clopidogrel in the reduction of cardiovascular events, nor did major bleeding differ between groups. The present study focuses on patients with CLI at baseline, defined by rest pain, minor or major tissue loss. Results - At baseline 643 patients (4.6 %) had CLI (Rutherford 4 (58.8%), Rutherford 5-6 (41.2%)). The proportion of patients with CLI in the LER group (351/7873, 4.5%) or low ABI group (292/6009, 4.9%) was similar.Diabetes mellitus was more common in the CLI group (49.3% vs 38.0%, p<0.0001), while a history of coronary artery disease was more common for the non-CLI group (29.2% vs 25.3%, p=0.035). A history of carotid disease was more frequent in non-CLI patients (18.0% vs 12.1%, p=0.0002) and a corresponding relationship was recorded for hypertension (non-CLI 78.4%, CLI 74.2%, p=0.01). Before randomization, more CLI than non-CLI patients were on clopidogrel (40.0% vs 31.8%, p<0.0001) whereas aspirin treatment was more common in the non-CLI group (67.3% vs 55.5%, p<0.0001). Dual antiplatelet therapy (aspirin and clopidogrel) was used by 16.2 % of CLI patients and 16.3 % of the non-CLI group. Statins were used by 73.8% of non-CLI patients, and 64.1% of the CLI group (p<0.0001). A history of major amputation was more common in patients with CLI (10.3%) compared to non-CLI patients (2.1%), p<0.0001. The primary efficacy endpoint, cardiovascular death, MI or ischemic stroke occurred significantly more frequently among CLI patients with a rate of 8.85 versus 4.28 per 100 patient-years (HR 2.07(1.72-2.48), p<0.0001; Fig), and this difference remained significant after adjustment for baseline characteristics (HR 1.43(1.16-1.76), p=0.0009). When including acute limb ischemia requiring hospitalization with MACE, significant differences remained, also after adjustment for baseline characteristics (HR 1.38(1.13-1.69), p=0.0016). LER was more common in CLI compared with non-CLI patients (HR 1.29(1.05-1.59), p=0.018), the difference not remaining significant after adjustment (HR 1.19(0.96-1.49), p=0.12). Bleeding did not differ between patients with and without CLI.The primary efficacy endpoint did not differ between ticagrelor and clopidogrel treated patients in the respective CLI and non-CLI groups, nor did bleeding. Conclusion - Patients suffering CLI represented nearly 5% of patients enrolled in the EUCLID trial. The low amputation rate at baseline suggests milder forms of CLI dominated. CLI patients had a 2-fold higher rate of cardiovascular mortality and morbidity compared to non-CLI patients. Further efforts are required to reduce the risk for cardiovascular events in PAD, especially in patients with CLI.

Risk factors for acute myocardial infarction in patients younger and middle age

We investigated 300 patients with primary and repeat MI, among them 197 have been complicated by myocardial infarction, including 142 patients with - myocardial infarction with tooth Q. Patients were divided into two age groups: young (under 45 years) - 70 people and middle-aged (46 to 60 years) - 230. All patients were treated between 2006 and 2012 in Bukhara branch and regional RSCEMH Heart Hospital.&#x0D; The results of these studies indicate that the major risk factors for coronary heart disease are (male sex, lipid disorders, hypertension, physical inactivity, smoking, chronic foci of infections, excessive body weight) are found in most patients with myocardial infarction before the age of 60 years. The most important for the prevention of the disease and its complications in both groups of patients were corrected lipid metabolism disorders, smoking cessation, rehabilitation centers of infections, the normalization of physical activity.

Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control.Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations.Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review.Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies.Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.

Association of Mef2a gene polymorphisms in early onset of coronary artery disease of south Indian cohort

Myocyte enhancer factor-2A (MEF2A), encoding a member of the MEF2 family of transcription factors, has been identified for primary CAD and MI without other accompanying clinical feature. It plays a role in vascular ontogeny and shows its predominant expression in the coronary artery endothelium. In the present study, we sought to evaluate the possible role of Mef2A polymorphisms as a risk determinant of CAD.A total of 300 angiographically documented cases and 300 healthy controls were recruited for the study. Polymorphisms of Mef2A 279 C>T in exon 8 and 452 G>T, 481 A>G in exon 11 were determined by PCR-RFLP method. The Mef2a 279 C>T variation and 452 G>T was found to be significantly associated with CAD (p<0.001 & p<0.001). The ‘CT’ and ‘TT’ genotype was found to be predominant in CAD with two & single fold increased risk to CAD and the association being statistically significant. However we did not find significant association of 481 A > G polymorphism with CAD in addition haplotype analysis revealed that T-G-A and C-T-A haplotype was found to be about three & single fold higher in CAD than controls with the association being statistically significant (p<0.0001) & (p<0.04) conferring risk towards CAD. Further MLR analysis revealed that Family History, Diet, Alcoholism, LDL and Triglycerides Levels were associated independently with CAD (p<0.01) Since Mef2a is highly expressed in endothelium the mutation in this gene would reduce the activation activity of MEF2A. Here we found significantly a greater frequency of 279Leu and 452 Gly among patients with myocardial infarction and this allele could be a genetic risk factor for myocardial infarction in our population.

Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients

This study was conducted to determine the protective effect of influenza vaccine against primary major adverse cardiovascular events (MACEs) in elderly patients, especially those with influenza-like illness (ILI). This retrospective, population-based case-control study of an elderly population (age≥65 years) was conducted using Taiwan's National Health Insurance Research Database (2000-2013). One control was selected for each MACE case (n=80,363 each), matched according to age, year of study entry, and predisposing factors for MACEs. ILI and MACEs (myocardial infarction [MI] and ischemic stroke) were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Odds ratios (ORs) were calculated for the association between MACEs and vaccination. Influenza vaccination received in the previous year was associated with reduced risks of primary MACEs overall (adjusted OR [aOR] 0.80, 95% CI 0.78-0.82, P<.001), MI (aOR 0.80, 95% CI 0.76-0.84, P<.001), and ischemic stroke (aOR 0.80, 95% CI 0.77-0.82, P<.001). ILI diagnosed in the previous year was associated with increased risks of MACEs (aOR 1.24, 95% CI 1.18-1.29, P<.001), MI (aOR 1.46, 95% CI 1.34-1.59, P<.001), and ischemic stroke (aOR 1.16, 95% CI 1.10-1.22, P<.001). Vaccination attenuated the heightened risks associated with ILI (MACEs: aOR 0.99, 95% CI 0.92-1.07, P=.834; MI: aOR 1.05, 95% CI 0.92-1.21, P=.440; ischemic stroke: aOR 0.96, 95% CI 0.89-1.05, P=.398). Results of this study suggest that influenza vaccination is associated with reduced primary MACE risks in the elderly population, including those with ILI.

Impact of Coronary Artery Disease Severity Assessed With the SYNTAX Score on Outcomes Following Transcatheter Aortic Valve Replacement

BackgroundThe influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR.Methods and ResultsA total of 377 patients who underwent TAVR in 2 high‐volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0); (2) low SS (SS between 1 and 22); (3) intermediate SS (SS between 23 and 32); and (4) high SS (SS ≥33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (<8 and ≥8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all‐cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all‐cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS ≥8 versus residual SS <8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all‐cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year.ConclusionsIn our core laboratory–validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.

QLF-D를 활용한 국내 시판 불소 바니쉬의 재광화 효과에 대한 융합적 연구

본 연구의 목적은 치과임상에서 불소 바니쉬 선택 시 고려해야 할 정보를 제공하고자 국내에서 사용하는 모든 불소 바니쉬를 선정하여 초기우식병소의 재광화 효과를 분석하고자 하였다. 7종의 불소 바니쉬를 무작위 배분하여 영구치(56)는 7종(CS, MI, CW, VV, EP, FP, FN)을, 유치(20)는 그중 CS, MI, CW, FP를 사용하였다. 시편은 네일바니쉬로 <TEX>$3{\times}3mm^2$</TEX> 윈도우 형성 후 4일간 탈회시키고, 영구치와 유치로 구분하여 불소 바니쉬 도포 후 1주간 인공타액에서 교반하였다. QLF-D을 이용하여 우식 병소크기 변화를 분석한 결과, 영구치에서 바니쉬 도포전에 비해 도포 후 CS(4,64), MI(4.86), CW(4.50), EP(5.50)바니쉬가 <TEX>${\Delta}F$</TEX>값이 감소하였고, 유치에서 FP(3.00), MI(3.00)바니쉬에서 재광화 효과가 나타났다. 그러므로 MI바니쉬는 치과임상에서 성인과 아동 모두에게 우식예방을 위한 불소도포 제제로 유용하게 활용될 수 있을 것이다. This study is to analyze seven fluoride varnishes remineralizing effects on early carious lesions in the clinical field. While CS, MI, CW, VV, EP, FP and FN were used for permanent teeth, CS, MI, CW and FP were used for primary teeth. The specimens were demineralized for 4 days after forming a <TEX>$3{\times}3mm^2$</TEX> window with nail varnish, applied with varnishes separately, then were stirred in artificial saliva for 1 week. QLF-D analysis of carious lesion size showed that permanent teeth's <TEX>${\Delta}F$</TEX> value decreased after applying CS(4,64), MI(4.86), CW(4.50), and EP(5.50), while for primary teeth, FP(3.00) and MI(3.00) displayed a remineralizing effect. Thus, MI can be used effectively for preventing caries for both adults and children in the clinical field.

Blood Calcification Propensity, Cardiovascular Events, and Survival in Patients Receiving Hemodialysis in the EVOLVE Trial.

Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (T50 test) determines the individual calcification propensity of blood. T50 was determined in 2785 baseline serum samples of patients receiving hemodialysis enrolled in the Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) trial and the T50 results were related to patient outcomes. Serum albumin, bicarbonate, HDL cholesterol, and creatinine were the main factors positively/directly and phosphate was the main factor negatively/inversely associated with T50. The primary composite end point (all-cause mortality, myocardial infarction [MI], hospitalization for unstable angina, heart failure, or peripheral vascular event [PVE]) was reached in 1350 patients after a median follow-up time of 619 days. After adjustments for confounding, a lower T50 was independently associated with a higher risk of the primary composite end point as a continuous measure (hazard ratio [HR] per 1 SD lower T50, 1.15; 95% confidence interval [95% CI], 1.08 to 1.22; P<0.001). Furthermore, lower T50 was associated with a higher risk in all-cause mortality (HR per 1 SD lower T50, 1.10; 95% CI, 1.02 to 1.17; P=0.001), MI (HR per 1 SD lower T50, 1.38; 95% CI, 1.19 to 1.60; P<0.001), and PVE (HR per 1 SD lower T50, 1.22; 95% CI, 1.05 to 1.42; P=0.01). T50 improved risk prediction (integrated discrimination improvement and net reclassification improvement, P<0.001 and P=0.001) of the primary composite end point. Blood calcification propensity was independently associated with the primary composite end point, all-cause mortality, MI, and PVE in the EVOLVE study and improved risk prediction. Prospective trials should clarify whether T50-guided therapies improve outcomes.

LONG TERM CLINICAL RESULTS OF AUTOLOGOUS CD133+ BONE MARROW CELLS TRANSPLANTATION IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS

Aim. To study the long-term effectiveness and safety of CD133+ bone marrow cells transplantation in ST elevation myocardial infarction (STEMI) patients. Material and methods. To the open-label, randomized study we included 26 patients, admitted with primary MI during years 2006-2007 to SRI of Cardiology. Patients were randomized to two groups: 1st — stenting of infarction-related coronary artery (IRA) and transplantation of CD133+ bone marrow cells (n=10), 2nd — only stenting of IRA (n=16). Baseline clinical and anamnestic parameters were similar. In 7,70±0,42 years after MI we performed control investigation, that included physical examination, 6-minute walking test (6WT), echocardiography. Results. It is found, that in the 1st group comparing to the 2nd, total and cardiovasular mortality was lower (20% (2) vs 44% (7), p=0,11; 22% (2) vs 25% (4), p=0,58, resp.). In the 2nd there were 7 cases of recurrent MI (44% of patients), 4 of those were fatal, but in the 1st group there were no any recurrent MI (p=0,01). During the whole followup, unstable angina was more common in the 2nd group (11 (69%) vs 2 (20%) in 1st, р=0,04). CHF of II FC and higher was more common in 2nd group: 8 (50%) vs 2 (20%) in 1st, р=0,07. Also, there were significant differences in analysis of volumetrics of the left ventricle (EDV — 100,7±50,2 mL vs 144,4±42,7 mL, р=0,049; ESV — 56,3±37,8 mL vs 89,7±38,7 mL, р=0,049, resp.). These values were lower in the 1st group. Conclusion. The results demonstrated that transplantation of autologous CD133+ bone marrow cells positively influences long-term survival of patients, CHD course and volumetric LV parameters.

How Much Work Effort is Involved in Minimally Invasive Sacroiliac Joint Fusion?

Minimally invasive sacroiliac joint fusion is increasing significantly. Starting January 1, 2015, it has a category I CPT code. The current RVU for this procedure is not equal to the amount of work involved. There is not a published RUC validated survey to establish the work effort of MI SI fusion. Our hospital system has been doing this procedure for 4 years and has been tracking surgeon time through a commercial tracking system (Navicare). Our study looks at time utilization for performance of MI SI joint fusion and a comparator of primary lumbar discectomy (PLD), presumably similar in time and work effort. This study was a retrospective review of prospectively collected data using Navicare. The data for 3 surgeons who perform MI SI joint fusion and lumbar discectomies from January 1, 2013 through November 30, 2014 was retrieved. Surgeon room time was identified as the time the patient entered the OR to the time they exited the OR. This was used as opposed to skin to skin time seen in similar studies as it was more accurately and consistently recorded in the medical record. Mean and standard deviations were then compared using student's t-test. In 50 primary MI SI joint fusions, the average in-room time was 112 minutes (SD=23). In 89 cases of PLD, the average in-room time was 119 minutes (SD=26). When comparing mean in-room times, MI SI and PLD were not statistically significantly different (p=0.135, 2-tailed t-test). Post-operative work effort was found to be greater for MI SI joint fusion than PLD. Surgical time was found to be comparable between MI SI joint fusion and PLD, while work effort was found to be greater for MI SI joint fusion. This signifies at a minimum an equal RVU for PLD should be used for MI SI joint fusion. This study was approved by the Institutional Review Board at the University of Minnesota. 3.

MENINGKATKAN PRESTASI AKADEMIK MATA KULIAH MATERI FIQH MELALUI STRATEGI KOOPERATIF TIPE JIGSAW PADA MAHASISWA FAKULTAS TARBIYAH JURUSAN PGMI TAHUN 2013/2014

Lecture method is applied lecturers are less varied and often use the method of discussion and seminars, it can be considered to be the cause of poor performance and activity of students in learning, especially in subjects in primary Fiqh MI in the majors. Classroom Action Research is done to improve student academic achievement and activity in primary department at the Faculty of Tarbiyah fiqh MI subject matter. Hypothesis action in this classroom action research is: by implementing jigsaw cooperative strategies can increase academic achievement and student activities in learning fiqh MI Classroom. Action research was conducted on the fifth semester of university students majoring in primary education academic year 2013/2014, as many as 35 people. This research was conducted as many as three cycles, each cycle meeting.the techinics of data collection are done by observation, interview and test learning outcomes. The findings of this study is the application of cooperative strategies in primary jigsaw fifth semester student of the Tarbiyah Faculty IAIN Antasari Banjarmasin in the academic year 2013/2014 on the subject matter of fiqh MI declared a success by the results of the activities of faculty and students at the end of the cycle that is good once. The implementation strategy jigsaw cooperative learning can improve student achievement in the fifth semester in primary department Faculty of Tarbiyah IAIN Antasari Banjarmasin academic year 2013/2014 on the subject matter of Fiqh MI. There are three factors that affect the implementation of cooperative learning strategies on the course material jigsaw Fiqh MI for fifth semester Faculty of IAIN Tarbiyah Antasari Banjarmasin academic year 2013/2014, namely: 1) a lecturer in the learning activities went well and increases every cycle. 2) the activity is more active and enthusiastic student each meeting. 3) improved student learning outcomes of each meeting and has achieved Complete Standard Minimum set.

Characteristics of Corticocortical Ipsilateral Connections of the Primary, Secondary, and Tertiary Sensorimotor Zones of the Cat Cerebral Cortex

Experiments on 30 cats using the Nauta–Gigax method addressed the comparative distribution of associative fibers in the primary motor MI (field 4y) and the secondary SMII (2pri) and tertiary SMIII (field 5) sensorimotor zones of the cortex. A minor proportion of associative fibers was found to project to the primary sensory zone SI (fields 1, 2, 3a, 3b). Massive bilateral connections between the MI and the SMII (2pri) and SMIII (field 5) were demonstrated. It is suggested that recovery of motor functions after local lesions to SMI, SMII, and SMIII occur as a result of these multiple horizontal associative connections between the functional circuits of these sensorimotor centers.

Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty

Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown. We therefore investigated whether the time to revision in our referral practice was shorter for patients who underwent primary MI THA compared to primary traditional THA. We retrospectively reviewed 46 revision THAs performed during a 3-year period. We excluded revisions performed for infection and rerevisions. Patients with incisions less than or equal to 10 cm were defined as having had MI THA. Fifteen of the 46 patients (33%) had undergone primary MI THA. At the time of primary index THA, the mean ages of the MI and non-MI patients were 65 years and 55 years, respectively. The mean time to revision was 1.4 years for the MI patients compared with 14.7 years for the non-MI patients. Twelve of the 15 patients having MI THA required revision within 2 years of primary THA compared to 4 of the 31 patients without MI surgery (OR = 26.5, 95% CI 4.4-160.0). There were no differences between the groups with regard to age, gender, or body mass index. The most common reasons for revision in the MI THA group were intraoperative fracture and failure of femoral component osseointegration. Our data suggest MI THA may be a risk factor for early revision surgery and the long-term survival therefore may be lower than that for non-MI surgery. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Depressive Symptoms Do Not Reduce The Benefits Of Physical Activity On Recurrent Cardiovascular Disease Events

PURPOSE: To examine prospectively whether depressive symptoms attenuate the benefits recreational physical activity on the risk of recurrent CVD in a population based sample of primary incident MI survivors. METHODS: Cases (1063 men, 430 women) 35-69 yrs old were recruited from 12 of 15 Western New York hospitals and completed an interviewer-administered survey and clinic exam (mean 4 months post-MI). Recreational physical activity (RPA) was assessed using the Stanford 7-day physical activity recall and depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). A score of ≥16 on the CES-D was used to define depression. Recurrent events (RE) included non-fatal and fatal CVD (ICD9 390-450) and revascularizations (ICD9 36-39). Age and sex-adjusted Cox regression models were used to examine the effect of depression on the association between RPA and RE. RESULTS: During a mean follow-up period of 2.4 yrs a total of 314 RE occurred. Depression was associated with an increased risk of recurrent events (HR 1.34 95%CI 1.02-1.75), whereas RPA had a protective effect on RE (HR 0.63 95%CI 0.50-0.79). The protective effect of RPA on RE remained after adjustment for age and sex (HR 0.66 95% CI: 0.52-0.83). Further adjustment for the presence of depressive symptoms did not change the association between RPA and RE (HR = 0.66, 95% CI: 0.52-0.83). CONCLUSIONS: Depressive symptoms did not reduce the protective effect of RPA on recurrent events in this population-based prospective study of MI survivors. These findings have important implications for MI survivors since depression is common in CHD patients.

Abstract 4128: Evaluating Sex Differences in Population-Based Utilization of Implantable Cardioverter Defibrillators (ICDs): The Role of Cardiac Conditions and Non-Cardiac Comorbidities

BACKGROUND: Although sex differences exist in the use of ICDs, reasons for the disparities are poorly understood. We determined if age, comorbid conditions, or ICD indication explained the sex differences. METHODS: We examined all patients in Ontario, Canada, with cardiac arrest (CA, 1998 –2007), myocardial infarction (MI, 2002–2007), or heart failure (HF, 2005–2007), using the Canadian Institute for Health Information Database. MI and HF cohorts excluded those with prior CA, and included patients post-MADIT-2 and SCD-HeFT trials. Patients were followed until ICD implant using Cox regression, with hazard ratio (HR) &gt;1.0 indicating greater likelihood of ICD implant in men. RESULTS: Among 9246 patients eligible for ICD implantation after CA, 237 (2.6%) women and 725 (7.8%) men received ICDs. In 105,516 primary prevention MI patients, 172 (0.2%) women and 836 (0.8%) men received ICDs. Among 61,160 primary prevention HF patients, 221 (0.4%) women and 852 (1.4%) men received ICDs. The rate of ICD implant was significantly higher in men across indications adjusting for age, prior arrhythmia, and comorbidities (Figure ). Post-CA, the HR for secondary prevention ICD was 1.92 (95%CI, 1.66 –2.23). Men were more likely to undergo ICD implant than women for primary prevention, with HRs 3.00 (95%CI, 2.53–3.55) post-MI and 3.01 (95%CI, 2.59 –3.50) in HF patients. Although death after primary prevention ICD did not differ by sex, mortality risk was higher in men after CA (HR 1.42; 95%CI, 1.03–1.95). CONCLUSIONS: Differences in ICD use for all indications were not explained by age or comorbidities. Despite increased use, men had reduced post-implant survival after cardiac arrest.

Dogma Disputed: Can Aggressively Lowering Blood Pressure in Hypertensive Patients with Coronary Artery Disease Be Dangerous?

Because coronary perfusion occurs mainly during diastole, patients with coronary artery disease (CAD) could be at increased risk for coronary events if diastolic pressure falls below critical levels. To determine whether low blood pressure could be associated with excess mortality and morbidity in this population. A secondary analysis of data from the International Verapamil-Trandolapril Study (INVEST), which was conducted from September 1997 to February 2003. 862 sites in 14 countries. 22 576 patients with hypertension and CAD. Patients from INVEST were randomly assigned to a verapamil sustained-release- or atenolol-based strategy; blood pressure control and outcomes were equivalent. An unadjusted quadratic proportional hazards model was used to evaluate the relationship between average on-treatment blood pressure and risk for the primary outcome (all-cause death, nonfatal stroke, and nonfatal myocardial infarction [MI]), all-cause death, total MI, and total stroke. A second model adjusted for differences in baseline covariates. The relationship between blood pressure and the primary outcome, all-cause death, and total MI was J-shaped, particularly for diastolic pressure, with a nadir at 119/84 mm Hg. After adjustment, the J-shaped relationship persisted between diastolic pressure and primary outcome. The MI-stroke ratio remained constant over a wide blood pressure range, but at a lower diastolic blood pressure, there were substantially more MIs than strokes. An interaction between decreased diastolic pressure and history of revascularization was observed; low diastolic pressure was associated with a relatively lower risk for the primary outcome in patients with revascularization than in those without revascularization. This is a post hoc analysis of hypertensive patients with CAD. The risk for the primary outcome, all-cause death, and MI, but not stroke, progressively increased with low diastolic blood pressure. Excessive reduction in diastolic pressure should be avoided in patients with CAD who are being treated for hypertension.