Clinical effectiveness of therapy with continuous-flow left ventricular assist devices in nonischemic versus ischemic cardiomyopathy: a systematic review and meta-analysis.

Background: Clinicians may be less inclined to consider long-term left ventricular assist device (LVAD) therapy in end-stage heart failure (ESHF) as a result of nonischemic cardiomyopathy (NICM) versus ischemic cardiomyopathy (ICM) owing to potentially greater right ventricular involvement in the former; however, it is unknown whether the cause of heart failure has a clinically meaningful effect on outcomes following LVAD implantation. In this systematic review, we aimed to determine whether ischemic versus nonischemic etiology has any impact on patient-relevant outcomes. Methods: We searched MEDLINE, Embase, PubMed and the Cochrane Library for studies published in English between Jan. 1, 2000, and Nov. 22, 2018, that examined survival and transplantation rates following LVAD implantation in patients with NICM or ICM. Randomized clinical trials, cohort studies, case-control studies, cross-sectional studies and case series with a sample size of at least 8 patients were eligible for inclusion. To be included in the meta-analysis, outcomes had to include at least death reported at 30 days or 1 year after LVAD implantation. Quality of included studies was assessed by 2 independent reviewers using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality-assessment tool was used to assess outcomes (30-d survival, 1-yr survival and cardiac transplantation following LVAD therapy) across studies. Results: From a total of 2843 citations identified, 7 studies met all inclusion criteria. Studies were generally of good quality, but reporting of patient demographic characteristics, outcomes and complications was heterogeneous. We found no significant difference in 30-day or 1-year survival or in cardiac transplantation rates after device implantation between the NICM and ICM groups. Patients in the 2 groups had similar outcomes up to 1 year with LVAD therapy. Conclusion: Early outcomes of LVAD therapy do not appear to be affected by heart failure etiology. Ongoing investigation is required to determine the long-term outcomes of LVAD therapy in ICM and NICM. Systematic review registration: PROSPERO register, record ID 76483.

Contexte: Les professionnels de la santé peuvent être moins enclins à envisager un traitement à long terme par dispositif d'assistance ventriculaire gauche (DAVG) en cas d'insuffisance cardiaque terminale résultant d'une myocardiopathie non ischémique plutôt que d'une myocardiopathie ischémique, en raison du risque potentiellement accru d'atteinte du ventricule droit dans le premier cas. Cependant, on ne sait pas si la cause de l'insuffisance cardiaque a un effet clinique significatif sur les issues après l'implantation d'un DAVG. Dans cette revue systématique, nous avons voulu déterminer si l'étiologie ischémique ou non ischémique a une incidence sur les issues pour les patients. Méthodes: Nous avons interrogé MEDLINE, Embase, PubMed et la Bibliothèque Cochrane pour trouver les études publiées en anglais entre le 1er janvier 2000 et le 22 novembre 2018 qui examinaient la survie et le taux de greffe après l'implantation d'un DAVG chez les patients atteints d'une insuffisance cardiaque ischémique ou non ischémique. Les essais cliniques randomisés, les études de cohorte, les études cas­témoins, les études transversales et les séries de cas ayant un échantillon d'au moins 8 patients étaient admissibles pour inclusion. Pour qu'une publication soit incluse dans la méta-analyse, les issues à l'étude devaient comprendre au minimum les décès dans les 30 jours ou dans l'année suivant l'implantation du DAVG. La qualité des études retenues a été évaluée par 2 évaluateurs indépendants au moyen de l'échelle Newcastle­Ottawa pour l'évaluation de la qualité des études de cohorte. L'outil GRADE (Grading of Recommendations Assessment, Development and Evaluation) a servi à évaluer la qualité des données sur les issues (survie après 30 jours, survie après 1 an et greffe cardiaque après le traitement par DAVG) dans l'ensemble des études. Résultats: Sur les 2843 citations recensées, 7 études respectaient tous les critères d'inclusion. Elles étaient généralement de bonne qualité, mais l'indication des caractéristiques démographiques des patients, des issues et des complications était hétérogène. Nous n'avons trouvé aucune différence significative dans la survie après 30 jours ou après 1 an, ni dans le taux de greffe cardiaque après l'implantation du dispositif entre les groupes ischémique et non ischémique. Les patients des 2 groupes avaient des issues similaires jusqu'à 1 an après le traitement par DAVG. Conclusion: Les issues à court terme du traitement par DAVG ne semblent pas influencées par l'étiologie de l'insuffisance cardiaque. Il faudra faire d'autres études pour caractériser les issues à long terme en présence d'insuffisance cardiaque ischémique et non ischémique. Enregistrement de la revue systématique: Registre PROSPERO, numéro 76483.

Altered muscle satellite cell activation following 16 wk of resistance training in young men.

Skeletal muscle satellite cells (SC) play an important role in muscle adaptation. In untrained individuals, SC content and activation status have been observed to increase in response to a single bout of exercise. Muscle fiber characteristics change considerably when resistance exercise is performed chronically, but whether training status affects the activity of SC in response to a single bout of exercise remains unknown. We examined the changes in SC content and activation status following a single bout of resistance exercise, before and following a 16-wk progressive resistance training (RT) program in 14 young (25 ± 3 yr) men. Before and after RT, percutaneous biopsies from the vastus lateralis muscle were taken before a single bout of resistance exercise and after 24 and 72 h of postexercise recovery. Muscle fiber size, capillarization, and SC response were determined by immunohistochemistry. Following RT, there was a greater activation of SC after 24 h in response to a single bout of resistance exercise (Pre, 1.4 ± 0.3; 24 h, 3.1 ± 0.3 Pax7+/MyoD+ cells per 100 fibers) compared with before RT (Pre, 1.4 ± 0.3; 24 h, 2.2 ± 0.3 Pax7+/MyoD+ cells per 100 fibers, P < 0.05); no difference was observed 72 h postexercise. Following 16 wk of RT, MyoD mRNA expression increased from basal to 24 h after the single bout of exercise (P < 0.05); this change was not observed before training. Individual capillary-to-fiber ratio (C/Fi) increased in both type I (1.8 ± 0.3 to 2.0 ± 0.3 C/Fi, P < 0.05) and type II (1.7 ± 0.3 to 2.2 ± 0.3 C/Fi, P < 0.05) fibers in response to RT. After RT, enhanced activation of SC in response to resistance exercise is accompanied by increases in muscle fiber capillarization.

The SETPACE Trial: Stroke Survivors Impressions of the Education and Teaching Provided Regarding Physical Activity and Patient Confidence Regarding Exercise.

OBJECTIVE: The aim of the study is to investigate the association between patient self-efficacy, impression of exercise education, and physical activity among stroke survivors. We hypothesized that low self-efficacy and/or poor impressions of exercise education after stroke would be associated with reduced exercise participation. DESIGN: This is a cross-sectional investigation of patients' poststroke with physical activity as the primary outcome variable. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Self-efficacy was measured with the Self-Efficacy for Exercise questionnaire. Impression of exercise education measured by the Exercise Impression Questionnaire. RESULTS: There was a low but significant correlation between Self-Efficacy for Exercise questionnaire and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.272, P = 0.012). There was an insignificant correlation between Exercise Impression Questionnaire and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.174, P = 0.078). There was a low but significant correlation between age and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = -0.269, P = 0.013). There was no correlation between sex and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.051, P = 0.339). Age, sex, Exercise Impression Questionnaire, and Self-Efficacy for Exercise questionnaire predict 17.1% of Physical Activity Scale for Individuals with Physical Disabilities variance ( R2 = 0.171). CONCLUSION: Self-efficacy was the strongest predictor of physical activity participation. There was a lack of association between the impressions of exercise education and physical activity. Addressing patient confidence to complete exercise has the potential to improve exercise participation in patients after stroke.

A dataset of simulated patient-physician medical interviews with a focus on respiratory cases.

Artificial Intelligence (AI) is playing a major role in medical education, diagnosis, and outbreak detection through Natural Language Processing (NLP), machine learning models and deep learning tools. However, in order to train AI to facilitate these medical fields, well-documented and accurate medical conversations are needed. The dataset presented covers a series of medical conversations in the format of Objective Structured Clinical Examinations (OSCE), with a focus on respiratory cases in audio format and corresponding text documents. These cases were simulated, recorded, transcribed, and manually corrected with the underlying aim of providing a comprehensive set of medical conversation data to the academic and industry community. Potential applications include speech recognition detection for speech-to-text errors, training NLP models to extract symptoms, detecting diseases, or for educational purposes, including training an avatar to converse with healthcare professional students as a standardized patient during clinical examinations. The application opportunities for the presented dataset are vast, given that this calibre of data is difficult to access and costly to develop.

Neither load nor systemic hormones determine resistance training-mediated hypertrophy or strength gains in resistance-trained young men.

We reported, using a unilateral resistance training (RT) model, that training with high or low loads (mass per repetition) resulted in similar muscle hypertrophy and strength improvements in RT-naïve subjects. Here we aimed to determine whether the same was true in men with previous RT experience using a whole-body RT program and whether postexercise systemic hormone concentrations were related to changes in hypertrophy and strength. Forty-nine resistance-trained men (23 ± 1 yr, mean ± SE) performed 12 wk of whole-body RT. Subjects were randomly allocated into a higher-repetition (HR) group who lifted loads of ∼30-50% of their maximal strength (1RM) for 20-25 repetitions/set (n = 24) or a lower-repetition (LR) group (∼75-90% 1RM, 8-12 repetitions/set, n = 25), with all sets being performed to volitional failure. Skeletal muscle biopsies, strength testing, dual-energy X-ray absorptiometry scans, and acute changes in systemic hormone concentrations were examined pretraining and posttraining. In response to RT, 1RM strength increased for all exercises in both groups (P < 0.01), with only the change in bench press being significantly different between groups (HR, 9 ± 1, vs. LR, 14 ± 1 kg, P = 0.012). Fat- and bone-free (lean) body mass and type I and type II muscle fiber cross-sectional area increased following training (P < 0.01) with no significant differences between groups. No significant correlations between the acute postexercise rise in any purported anabolic hormone and the change in strength or hypertrophy were found. In congruence with our previous work, acute postexercise systemic hormonal rises are not related to or in any way indicative of RT-mediated gains in muscle mass or strength. Our data show that in resistance-trained individuals, load, when exercises are performed to volitional failure, does not dictate hypertrophy or, for the most part, strength gains.