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The effect of the angiotensin-converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators.
BACKGROUND: Left ventricular dilatation and neuroendocrine activation are common after acute anterior myocardial infarction. Long-term treatment with an angiotensin-converting-enzyme (ACE) inhibitor may improve outcome by attenuating these processes. We investigated whether the ACE inhibitor zofenopril, administered for six weeks after anterior myocardial infarction, could improve both short-term and long-term outcome. METHODS: A total of 1556 patients were enrolled within 24 hours after the onset of symptoms of acute anterior myocardial infarction, and they were randomly assigned in a double-blind fashion to receive either placebo (784 patients) or zofenopril (772 patients) for six weeks. At this time we assessed the incidence of death or severe congestive heart failure. The patients were reexamined after one year to assess survival. RESULTS: The incidence of death or severe congestive heart failure at six weeks was significantly reduced in the zofenopril group (55 patients, 7.1 percent), as compared with the placebo group (83 patients, 10.6 percent); the cumulative reduction in the risk of death or severe congestive heart failure was 34 percent (95 percent confidence interval, 8 to 54 percent; P = 0.018). The reduction in risk was 46 percent (95 percent confidence interval, 11 to 71 percent; P = 0.018) for severe congestive heart failure and 25 percent (95 percent confidence interval, -11 to 60 percent; P = 0.19) for death. After one year of observation, the mortality rate was significantly lower in the zofenopril group (10.0 percent) than in the placebo group (14.1 percent); the reduction in risk was 29 percent (95 percent confidence interval, 6 to 51 percent; P = 0.011). CONCLUSIONS: Treatment with zofenopril significantly improved both short-term and long-term outcome when this drug was started within 24 hours after the onset of acute anterior myocardial infarction and continued for six weeks.
Images in clinical medicine. "Smiling" alveolar macrophage.
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The bicycle makes the eyes smile: exercise, aging, and psychophysical well-being in older Italian cyclists.
Despite a cultural and biomedical consensus about the health benefits of physical activity, most adults do not exercise regularly and their activity tends to decline further in older age. This study reports on a group of older-age Italian bicyclists who maintain extraordinary activity levels. It explores the physical and mental health effects of intensive exercise in older people, the meanings and motivations associated with it, and the cultural and social features that support and promote bicycling in Italy. The findings suggest some public health implications for the prevention of chronic diseases caused by inactivity and excessive body weight.
Welcome little fishes in-with gently smiling jaws. Maude Abbott Lecture.
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Associations of social-environmental and individual-level factors with adolescent soft drink consumption: results from the SMILE study.
Adolescent obesity is positively associated with soft drink consumption. We investigated the association of social-environmental and individual-level factors with soft drink consumption in a Dutch adolescent sample. Data were gathered in a longitudinal Dutch adolescent sample (n = 208, 62% girls). Soft drink consumption, social cognitions from the Theory of Planned Behaviour and parenting practices towards limited soft drink intake, and Big Five personality dimensions were assessed. Data were analyzed using three-step linear regression analyses. Effect sizes were used as the informational source for the explanatory value of the model. Interaction terms were computed to test the individual-environment interaction. Attitude and subjective norm were significantly associated with soft drink consumption. When controlling for social cognitions, the distal variables parenting practices and the personality dimension Agreeableness remained significantly associated with soft drink consumption. Agreeableness moderated the association of parenting practices with adolescent soft drink consumption. Standardized regression coefficients ranged from 0.16 to 0.24 and explained 14% of the variance in soft drink consumption, indicating a medium effect size. Stricter parenting practices were associated with less soft drink consumption and these effects were moderated by adolescent personality. The direct effects of practices and personality are noteworthy from a theoretical perspective. Implications for obesity prevention interventions are discussed.
Polylactic acid implants. A new smile for lipoatrophic faces?
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Smiles rearrangement. A new synthetic pathway to the synthesis of 5-(hydroxyacyl) amino-2,4,6,-triiodoisophthalamides.
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To smile again.
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Say it with a smile.
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The anatomy of a smile: its importance in the treatment of facial paralysis.
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Operation smile and its help in the development of plastic and reconstructive surgery in Russia.
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Cleft lip repair: rub off the sutures, not the smile!
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