Aim: Foot being the most distal segment represents a relatively small Base of Support (BOS) on which theentire body maintains balance. Postural control is not a fully automatic process, requires a certain level ofattention to maintain balance. A minor biomechanical alteration can disrupt the process. Hence the currentstudy aims to assess the static and dynamic balance of contemporary dancers with altered foot posture.Methodology: Altered foot posture was assessed using the Navicular drop test following that the staticbalance (using the flamingo balance test) and dynamic balance (using star excursion balance test (SEBT))were assessed in 30 contemporary dancers.Results: Out of 30 dancers (21 had pronated foot, 8 had neutral and 1 with supinated foot). Strong correlationwas found between the foot posture and the static balance (r=0.753; right foot and r=0.702; left foot). SEBTshowed that balance was affected in certain directions which were different for the dancers with differentfoot alterations. Supinated foot showed affection in anterior and antero-medial directions and pronated footshowed alterations in posterior, postero-lateral and lateral directions.Conclusion: Overall the study showed that contemporary dancers are affected most with the pronated footproposing higher risk of injuries in future and the overall reach distance was affected in supinated footcompared to neutral foot and pronated foot.
Background. Diabetes is increasing at an alarming rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in diabetics. However, randomized clinical trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) many not accurately reflect current clinical practice. We therefore undertook a prospective registry of coronary revascularization (CR) in diabetic patients with CABG, on-pump and off-pump, and PCI with bare-metal and drug-eluting stents to determine long-term clinical outcomes.Methods. All patients undergoing isolated CR in 8 community hospitals were enrolled. Follow-up was obtained after 5 to 8 years; all mortalities were checked against the Social Security Death Index. The ST-elevation myocardial infarction and salvage patients were excluded. Propensity matching was used to account for differences between PCI and CABG groups. Survival curves were derived using Kaplan-Meier methods, whereas hazard ratios and cumulative hazards were calculated using the Cox proportional hazard model.Results. Of the 3,156 patients in the registry, there were 1,082 diabetics; 334 CABG and 748 PCI. Due to the differences in baseline characteristics between the 2 groups, propensity score matching was used to achieve clinically comparable groups of 240 patients each. In matched patient groups mortality was more common in the PCI group with an odds ratio (OR) of 0.60 (95% confidence interval [CI] 0.39% to 0.93%; p = 0.023). Similarly, occurrence of any major cardiac adverse event (MACE) (mortality, non-fatal myocardial infarction, or revascularization) was more frequent in the PCI group with an OR of 0.57 (95% CI 0.31% to 0.70%, p < 0.001). Kaplan-Meier event-free survival of matched groups was significantly improved in the CABG versus PCI group (p = 0.001).Conclusions. In the current era of on-pump and off-pump CABG surgery and bare-metal and drug-eluting stents, this registry which unselectively records all non-ST elevation myocardial infarction patients undergoing coronary revascularization, diabetic patients benefit from improved long-term survival and reduced MACE with CABG versus PCI. These findings corroborate recent evidence from prospective randomized trials and thus provide clinically relevant validation of their broad applicability to diabetics with extensive coronary artery disease in need of revascularization. (C) 2015 by The Society of Thoracic Surgeons
Acute coronary syndromes (ACS) encompass a broad spectrum of clinical presentations based on underlying pathology that results in myocardial ischemia and/or infarction. Despite advancements in invasive management and secondary preventive therapies, recurrent atherothrombotic coronary events remain a prevalent cause of death and recurrent cardiac events after ACS and, in those who survive, the root of long-standing cardiac comorbidities. Antiplatelet drug therapy has proven beneficial in the reduction of these events, and novel antiplatelet agents have resulted in significant improvement in clinical outcomes over the last decade. However, the balance of optimal platelet inhibition with minimal bleeding complications remains a clinical challenge. This review focuses on more recent advances in antiplatelet therapies used in the treatment of ACS.
Introduction: Multiple studies have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to determine the optimal strategy for coronary revascularization (CR). Very few have evaluated the impact of medication history on the relative outcomes. Hypothesis: Evidence-based medical therapy influences outcomes of CABG vs. PCI Methods: All non-STEMI patients (N=3871 PCI, 1181 CABG) undergoing isolated CR in eight community-based hospitals were enrolled. Follow-up (63.5±27.9, median 79.7 months) was obtained at 12, 18 and >60 months by patient/physician contact and Social Security Death Index. Kaplan-Meier curves were used to compare survival free of MACE (nonfatal myocardial infarction, PCI, CABG, mortality) between groups,. Results: Compliance with appropriate anti-platelet therapy improved long-term freedom from MACE in both PCI and CABG patients (Figure 1). Similarly, lipid-lowering therapy improved MACE-free survival in both PCI and CABG patients (Figure 2). Interestingly, treatment with beta blockers appeared to have either a negative (PCI) or marginal (CABG) impact.(Figure 3), most likely representing patient selection. Conclusion: Medication history has a dramatic impact on the long-term outcomes of both PCI and CABG patients and therefore must be included in the evaluation of comparative strategies for revascularization.
Coronary artery disease (CAD) mortality has been declining in the United States and in regions where health care systems are relatively advanced. Still, CAD remains the number one cause of death in both men and women in the United States, and coronary events have increased in women. Many traditional risk factors for CAD are related to lifestyle, and preventative treatment can be tailored to modifying specific factors. Novel risk factors also may contribute to CAD. Finally, as the risk for CAD is largely understood to be inherited, further genetic testing should play a role in preventative treatment of the disease.
