Soldiers' Heart: A Prospective Study of Cardiac Remodeling in Soldiers Undergoing Progressive Intensity Exercise Training.

PURPOSE: Most studies reporting cardiac changes with exercise have been cross sectional. The few available longitudinal studies have lacked standardization for environmental confounders. We prospectively assessed the relationship between increasing exercise intensity and cardiac remodeling in a highly standardized cohort of healthy young army soldiers. METHODS: Sixty-three male army recruits (22 ± 3 yr) underwent a 12-wk moderate-intensity mixed strength and endurance exercise program, followed by a further 15-wk high-intensity exercise program, with highly controlled exercise, diet, and sleep patterns. Fitness (multistage fitness test), anthropometry, and 2D echocardiography were assessed. RESULTS: Moderate-intensity exercise was associated with increased fitness and decreased body fat % (both P < 0.01). There was no significant incremental change in these parameters after high-intensity exercise. By contrast, both moderate- and high-intensity exercises were associated with dose-dependent increases in left atrial and left ventricular (LV) volumes, LV mass, and right ventricular (RV) size (all P < 0.01). At the end of high-intensity training, 51% had a dilated LV and 59% had a dilated RV compared with published normal ranges. Almost all had normal LV systolic function and strain before and after exercise training. A small number of soldiers had mildly decreased RV systolic function at baseline and after moderate-intensity exercise (3% and 6%, respectively). CONCLUSIONS: We describe "soldiers' heart," which is characterized by balanced chamber dilatation, normal LV mass, and largely normal systolic function and myocardial strain. This prospective and highly controlled longitudinal study also found that increasing intensity exercise was associated with increasing chamber dimensions, which paralleled an increase in fitness after moderate-intensity exercise. After high-intensity exercise, however, cardiac chamber size continued to increase, but fitness did not increase further.

Are Statins Indicated in Senior Citizens? A Review of Statin Therapy in the Elderly.

The use of statin therapy in atherosclerotic cardiovascular disease (ASCVD) has demonstrated substantial improvement in morbidity and mortality of the aging population. Despite exhaustive studies demonstrating the benefits of statin therapy linking lower cholesterol levels to decreased vascular events, statin guidelines vary greatly with age, and recommendations are unclear regarding initiation and discontinuation of statin therapy in patients 65 years and older. Data suggest that statins are highly effective at secondary prevention of major cardiovascular events and development of coronary heart disease in patients with a history of vascular disease or risk factors such as diabetes mellitus, hypertension, hypercholesterolemia, or smoking. Therefore, patients who meet these criteria, regardless of age, should begin statin therapy. There is also some evidence to suggest that statin therapy may be beneficial in primary prevention of major cardiovascular events, although these data are not as well studied as secondary prevention use of statin therapy, and should therefore be individualized for each patient.

A Strong Approach to a Weak Gastric Wall in Bariatric Surgery: Concurrent Diverticulectomy and Sleeve Gastrectomy.

A gastric diverticulum is a rare finding in which the wall of the stomach forms an abnormal sac-like projection. Gastric diverticula can be problematic causing symptoms including but not limited to chronic gastroesophageal reflux, abdominal pain, and bloating. When a gastric diverticulum becomes symptomatic, removal is indicated. In specific cases, laparoscopic gastric diverticula resection can be completed with concurrent bariatric surgery. We report the perioperative approach used in a 34-year-old obese woman with a confirmed symptomatic gastric diverticulum undergoing a gastric diverticulum resection with a concurrent laparoscopic sleeve gastrectomy.

Evaluating perceptions of the effectiveness of the community advisory panel model for enhancing service delivery to marginalized populations.

OBJECTIVE: The objective of this study was to evaluate perceptions of the effectiveness of the community advisory panels (CAPs) at St. Michael's Hospital, in Toronto, Canada. DESIGN AND SAMPLE: A qualitative design was employed. Participants included hospital staff, patients, Community Advisory Panel chairs, and key informants from community services in the St. Michael's Hospital catchment area. MEASURES: An online survey about awareness of the CAPs and CAP accomplishments; (2) Key informants interviews; and (3) Review of memos and meeting minutes of the CAPs to assess their impact in the hospital and the community. St. Michael's Hospital was the setting of the study. Descriptive statistics were generated for the survey data. Qualitative interview data were coded for major themes. Participants included hospital staff, patients, CAP chairs, and key informants from community services in the St. Michael's Hospital catchment area. RESULTS: Although the CAPs initiated and implemented an array of programs and services at St. Michael's Hospital, the visibility of the CAPs and their service to the hospital and community were very low. Themes that emerged from the semistructured interviews involved the visibility, effectiveness, and role of the CAPs in the hospital. CONCLUSIONS: Although the CAPs at St. Michael's Hospital appear to be an effective model for community responsiveness, the visibility of their work in the hospital and community was very low.

Synthesis of amino-substituted indoles using the Bartoli reaction.

We report herein the concise preparation of a range of functionalised aminoindoles via a new application of the Bartoli reaction. Scope and limitations of the methodology have been extensively studied to reveal the importance of protecting groups and substitution patterns. The use of amino substituted nitroanilines for the Bartoli reaction is to our knowledge unprecedented. Our work thus represents a novel entry into substituted aminoindoles which are relevant building blocks for both the fine chemical and pharmaceutical industry.