"Pre-Pregnancy Obesity and Associations with Stroke and Myocardial Infarction in Women in the Years after Childbirth: A Nationwide Cohort Study"

"Pre-Pregnancy Obesity and Associations with Stroke and Myocardial Infarction in Women in the Years after Childbirth: A Nationwide Cohort Study"
Circ
http://circ.ahajournals.org/content/early/2013/10/20/CIRCULATIONAHA.113.003142.abstract
"Conclusions—In apparently healthy women of fertile age, obesity was associated with increased risks of ischemic stroke and myocardial infarction."

"Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: an open-label, non-inferiority randomised trial"  
Lancet
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70021-4/fulltext 
"Interpretation

This study provides evidence that acarbose is similar to metformin in efficacy, and is therefore a viable choice for initial therapy in Chinese patients newly diagnosed with type 2 diabetes."

"Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1308789
"CONCLUSIONS

Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI."

"Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock"
JAMA Oct 2013
http://jama.jamanetwork.com/article.aspx?articleid=1752246 
"Conclusions and Relevance  For patients in septic shock, open-label use of esmolol vs standard care was associated with reductions in heart rates to achieve target levels, without increased adverse events. The observed improvement in mortality and other secondary clinical outcomes warrants further investigation."

Weekly Guideline

"CLINICAL PRACTICE GUIDELINES FOR HEALTHY EATING FOR  THE PREVENTION AND TREATMENT OF METABOLIC AND ENDOCRINE DISEASES IN ADULTS"Endocrine Practice Sep/Oct 2013
http://www.medpagetoday.com/upload/2013/10/17/clinical-practice-guidelines.pdf

"Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force"
Annals Oct 2013
http://annals.org/article.aspx?articleid=1760977
"Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear."

"Survival After Shock Therapy in Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy-Defibrillator Recipients According to Rhythm Shocked"
JACC
http://content.onlinejacc.org/article.aspx?articleid=1709453
"Conclusions  Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself."

"Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis"
BMJ Oct 27
http://www.bmj.com/content/347/bmj.f5980
"Conclusion One additional infant could survive to 36 weeks without bronchopulmonary dysplasia for every 25 babies treated with nasal CPAP in the delivery room rather than being intubated."

"Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1304369?query=featured_home
"CONCLUSIONS

In patients with metastatic pancreatic adenocarcinoma, nab-paclitaxel plus gemcitabine significantly improved overall survival, progression-free survival, and response rate, but rates of peripheral neuropathy and myelosuppression were increased. (Funded by Celgene; ClinicalTrials.gov number, NCT00844649.)"

"Metoclopramide in Pregnancy and Risk of Major Congenital Malformations and Fetal Death" 
JAMA Oct 16 2013
http://jama.jamanetwork.com/article.aspx?articleid=1752754
"Conclusions and Relevance  Metoclopramide use in pregnancy was not associated with increased risk of major congenital malformations overall, any of the 20 individual malformation categories assessed, spontaneous abortion, or stillbirth. These safety data may help inform decision making when treatment with metoclopramide is considered in pregnancy."

"Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes: A Systematic Review and Meta-analysis"
Annals Oct 15http://annals.org/article.aspx?articleid=1748845
"Conclusion: Comprehensive lifestyle interventions effectively decrease the incidence of type 2 diabetes in high-risk patients. In patients who already have type 2 diabetes, there is no evidence of reduced all-cause mortality and insufficient evidence to suggest benefit on cardiovascular and microvascular outcomes."

"AHA Scientific Statement
Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches A Scientific Statement From the American Heart Association"
Circ (online Sep 9)
http://circ.ahajournals.org/content/128/15/1689.full
"Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery  . . . "

"Ambient air pollution and low birthweight: a European cohort study (ESCAPE)"
Lancet Oct 15
http://www.thelancet.com/journals/lancet/article/PIIS2213-2600(13)70192-9/fulltext
"Interpretation

Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced."

"Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study"
BMJ Oct 9
http://www.bmj.com/content/347/bmj.f5906
"Conclusions This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune, neurological, and venous thromboembolic adverse events. Although associations for three autoimmune events were initially observed, on further assessment these were weak and not temporally related to vaccine exposure. Furthermore, the findings need to be interpreted considering the multiple outcomes assessed."

"Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism"
NEJM Oct 10
http://www.nejm.org/doi/full/10.1056/NEJMoa1306638?query=featured_home
"CONCLUSIONS 

Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism."

"Evaluation of Surveillance Bias and the Validity of the Venous Thromboembolism Quality Measure"  
JAMA Oct 9  
http://jama.jamanetwork.com/article.aspx?articleid=1748150 
"Conclusions and Relevance  Hospitals with higher quality scores had higher VTE prophylaxis rates but worse risk-adjusted VTE rates. Increased hospital VTE event rates were associated with increasing hospital VTE imaging use rates. Surveillance bias limits the usefulness of the VTE quality measure for hospitals working to improve quality and patients seeking to identify a high-quality hospital."

"Screening for Primary Hypertension in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement"
Annals Oct 2013
http://annals.org/article.aspx?articleid=1747317 
"Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood."

"Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation: A Randomized Controlled Trial"  
Circ Oct 4
http://circ.ahajournals.org/content/early/2013/10/04/CIRCULATIONAHA.113.003303.abstract
"Conclusions—Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction or stroke."

"Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study"
Lancet Oct 9 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61747-X/fulltext
"Interpretation

This study shows that chronic cerebrospinal venous insufficiency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent finding in patients with multiple sclerosis, unaffected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. The significance of venous narrowing to multiple sclerosis symptomatology remains unknown."

"Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium"
BMJ Oct 2013
http://www.bmj.com/content/347/bmj.f5446
"Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians."

"A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy"
NEJM Oct 9
http://www.nejm.org/doi/full/10.1056/NEJMoa1214939?query=featured_home 
"CONCLUSIONS

In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery."

"Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest" 
JAMA Oct 2
http://jama.jamanetwork.com/article.aspx?articleid=1745678 
"Conclusions and Relevance  In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain."

"Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians"  
Annals Oct 1
http://annals.org/article.aspx?articleid=1742606
"Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)

Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)

Recommendation 3: ACP recommends mandibular advancement devices as an alternative therapy to continuous positive airway pressure treatment for patients diagnosed with OSA who prefer mandibular advancement devices or for those with adverse effects associated with continuous positive airway pressure treatment. (Grade: weak recommendation; low-quality evidence)"

"State-Of-The-Art Paper

Childhood Obesity and Cardiovascular Dysfunction"

JACC Oct 2013
http://content.onlinejacc.org/article.aspx?articleid=1729180
"Obesity-related cardiovascular disease in children is becoming more prevalent in conjunction with the rise in childhood obesity. Children with obesity are predisposed to an increased risk of cardiovascular morbidity and mortality in adulthood. Importantly, research in children with obesity over the last decade has demonstrated that children may exhibit early signs of cardiovascular dysfunction as a result of their excess adiposity, often independent of other obesity-related comorbidities such as dyslipidemia and insulin resistance. The clinical evidence is accumulating to suggest that the cardiovascular damage, once observed only in adults, is also occurring in obese children. The objective of this review is to provide a synopsis of the current research on cardiovascular abnormalities in children with obesity and highlight the importance and need for early detection and prevention programs to mitigate this potentially serious health problem." 

"AHA Scientific Statement
Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions: A Scientific Statement From the American Heart Association"
Circ Sep 30
http://circ.ahajournals.org/content/early/2013/09/30/CIR.0b013e3182a88099.full.pdf+html 

"Preclinical Alzheimer's disease and its outcome: a longitudinal cohort study" 
Lancet Neurology Oct 2013 (online Sep 2013)
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70194-7/fulltext
"Findings

Of 311 participants, 129 (41%) were classed as normal, 47 (15%) as stage 1, 36 (12%) as stage 2, 13 (4%) as stage 3, 72 (23%) as SNAP, and 14 (5%) remained unclassified. The 5-year progression rate to CDR at least 0·5, symptomatic Alzheimer's disease was 2% for participants classed as normal, 11% for stage 1, 26% for stage 2, 56% for stage 3, and 5% for SNAP. Compared with individuals classed as normal, participants with preclinical Alzheimer's disease had an increased risk of death after adjusting for covariates (hazard ratio 6·2, 95% CI 1·1—35·0; p=0·040).

Interpretation

Preclinical Alzheimer's disease is common in cognitively normal elderly people and is associated with future cognitive decline and mortality. Thus, preclinical Alzheimer's disease could be an important target for therapeutic intervention."

"Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis"
BMJ Sep 20
http://www.bmj.com/content/347/bmj.f5555
"Conclusions As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis."