Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Key points• Contradictory findings have been reported concerning the function of irisin and its precursor gene, skeletal muscle FNDC5, in energy homeostasis and metabolic health, and the associated regulatory role of exercise and PGC-1α.• We analysed the effects of different short-and long-term exercise regimens on muscle FNDC5and PGC-1α, and serum irisin, and studied the associations of irisin and FNDC5 with health parameters.• FNDC5 and serum irisin did not change after acute aerobic, long-term endurance training or endurance training combined with resistance exercise (RE) training, or associate with metabolic disturbances. A single RE bout increased FNDC5 mRNA in young, but not older men (27 vs. 62 years). Changes in PGC-1α or serum irisin were not consistently accompanied by changes in FNDC5.• Our data suggest that the effects of exercise on FNDC5 and irisin are not consistent, and that their role in health is questionable. Moreover, the regulatory mechanisms should be studied further.Abstract Recently, contradictory findings have been reported concerning the function of irisin and its precursor gene, skeletal muscle FNDC5, in energy homeostasis, and the associated regulatory role of exercise and PGC-1α. We therefore evaluated whether muscle FNDC5 mRNA and serum irisin are exercise responsive and whether PGC-1α expression is associated with FNDC5 expression. The male subjects in the study performed single exercises: (1) 1 h low-intensity aerobic exercise (AE) (middle-aged, n = 17), (2) a heavy-intensity resistance exercise (RE) bout (young n = 10, older n = 11) (27 vs. 62 years), (3) long-term 21 weeks endurance exercise (EE) training alone (twice a week, middle-aged, n = 9), or (4) combined EE and RE training (both twice a week, middle-aged, n = 9). Skeletal muscle mRNA expression was analysed by quantitative PCR and serum irisin by ELISA. No significant changes were observed in skeletal muscle PGC-1α, FNDC5 and serum irisin after AE, EE training or combined EE + RE training. However, a single RE bout increased PGC-1α by 4-fold in young and by 2-fold in older men, while FNDC5 mRNA only increased in young men post-RE, by 1.

Worries about the potential negative consequences of popular fat loss regimens for aesthetic purposes in normal weight females have been surfacing in the media. However, longitudinal studies investigating these kinds of diets are lacking. The purpose of the present study was to investigate the effects of a 4-month fat-loss diet in normal weight females competing in fitness-sport. In total 50 participants finished the study with 27 females (27.2 ± 4.1 years) dieting for a competition and 23 (27.7 ± 3.7 years) acting as weight-stable controls. The energy deficit of the diet group was achieved by reducing carbohydrate intake and increasing aerobic exercise while maintaining a high level of protein intake and resistance training in addition to moderate fat intake. The diet led to a ~12% decrease in body weight (P < 0.001) and a ~35–50% decrease in fat mass (DXA, bioimpedance, skinfolds, P < 0.001) whereas the control group maintained their body and fat mass (diet × group interaction P < 0.001). A small decrease in lean mass (bioimpedance and skinfolds) and in vastus lateralis muscle cross-sectional area (ultrasound) were observed in diet (P < 0.05), whereas other results were unaltered (DXA: lean mass, ultrasound: triceps brachii thickness). The hormonal system was altered during the diet with decreased serum concentrations of leptin, triiodothyronine (T3), testosterone (P < 0.001), and estradiol (P < 0.01) coinciding with an increased incidence of menstrual irregularities (P < 0.05). Body weight and all hormones except T3 and testosterone returned to baseline during a 3–4 month recovery period including increased energy intake and decreased levels aerobic exercise. This study shows for the first time that most of the hormonal changes after a 35–50% decrease in body fat in previously normal-weight females can recover within 3–4 months of increased energy intake.

Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis.

Fractal HR dynamics were improved more by combining strength training with endurance training in our older men compared with endurance training alone, although strength training alone produced no changes in fractal HR behavior. The synergistic effect in fractal HR behavior occurred regardless of changes in aerobic capacity.

AimsTo collect information on the use of the Reveal implantable loop recorder (ILR) in the patient care pathway and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope in everyday clinical practice.Methods and resultsProspective, multicentre, observational study conducted in 2006–2009 in 10 European countries and Israel. Eligible patients had recurrent unexplained syncope or pre-syncope. Subjects received a Reveal Plus, DX or XT. Follow up was until the first recurrence of a syncopal event leading to a diagnosis or for ≥1 year. In the course of the study, patients were evaluated by an average of three different specialists for management of their syncope and underwent a median of 13 tests (range 9–20). Significant physical trauma had been experienced in association with a syncopal episode by 36% of patients. Average follow-up time after ILR implant was 10 ± 6 months. Follow-up visit data were available for 570 subjects. The percentages of patients with recurrence of syncope were 19, 26, and 36% after 3, 6, and 12 months, respectively. Of 218 events within the study, ILR-guided diagnosis was obtained in 170 cases (78%), of which 128 (75%) were cardiac.ConclusionA large number of diagnostic tests were undertaken in patients with unexplained syncope without providing conclusive data. In contrast, the ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. The findings support the recommendation in current guidelines that an ILR should be implanted early rather than late in the evaluation of unexplained syncope.

Waist circumference and skinfold thickness seem to reasonably assess changes in percent body fat during training. However, only DXA was capable to separate small differences between the groups in training-induced changes in lean body mass. Combined strength and endurance training is of greater value than either alone in optimizing body composition or improving physical fitness in older men.

In this study adaptations in body composition, physical fitness and metabolic health were examined during 21 weeks of endurance and/or strength training in 39- to 64-year-old healthy women. Subjects (n = 62) were randomized into endurance training (E), strength training (S), combined strength and endurance training (SE), or control groups (C). S and E trained 2 and SE 2 + 2 times in a week. Muscle strength and maximal oxygen uptake (VO(2)max) were measured. Leg extension strength increased 9 +/- 8% in S (P < 0.001), 12 +/- 8% in SE (P < 0.001) and 3 +/- 4% in E (P = 0.036), and isometric bench press 20% only in both S and SE (P < 0.001). VO(2)max increased 23 +/- 18% in E and 16 +/- 12% in SE (both P < 0.001). The changes in the total body fat (dual X-ray absorptiometry) did not differ between groups, but significant decreases were observed in E (-5.9%, P = 0.022) and SE (-4.8%, P = 0.005). Lean mass of the legs increased 2.2-2.9% (P = 0.004-0.010) in S, SE and E. There were no differences between the groups in the changes in blood lipids, blood pressure or serum glucose and insulin. Total cholesterol and low-density lipoprotein cholesterol decreased and high-density lipoprotein cholesterol increased in E. Both S and SE showed small decreases in serum fasting insulin. Both endurance and strength training and their combination led to expected training-specific improvements in physical fitness, without interference in fitness or muscle mass development. All training methods led to increases in lean body mass, but decreases in body fat and modest improvements in metabolic risk factors were more evident with aerobic training than strength training.