Cleavage of rat prolactin occurs within rat mammary tissue, and the cleaved form is present in serum but not in milk

A biofeedback gait training system for step length is proposed, adapted to the correction of spatial walking asymmetries by means of a simple, quick and reliable method for daily clinical use. The system is composed of a walkway and a gait analysis device (locometer) measuring the main temporal and distance factors of gait. The step length is imposed on the subject by lighted targets appearing on the walkway, alternately on the right and left side; the subject is asked to place a swinging foot on the lighted target. Feedback to the subject is supplied by direct visual information (the subject looking at the movement and the position of the foot with respect to the lighted target) and an acoustic signal delivered in real time when the length step error is greater than an allowed value. The method is validated on a population of hemiparetic patients who have suffered from a stroke and who have been reeducated with traditional rehabilitation methods. The patients were divided into two groups; one group following a gait training with biofeedback (BFB group) and one group following a gait training without biofeedback (reference group). Preliminary results are presented, showing a significant beneficial effect of the biofeedback method in increasing the step length of paretic limbs and in correcting step-length asymmetry.     

Epidural anesthesia for labor in an ambulatory patient

The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.     

Coexisting psoriatic arthritis, gout, and chondrocalcinosis

BACKGROUND: Constructional impairment following left vs. right hemisphere damage has been extensively studied drawing tasks. A confounding factor in these studies is that right-handed patients with left hemisphere damage (LHD) are often forced by weakness to use their non-dominant (left) hand or hemiparetic dominant hand. Qualitative differences in the drawing characteristics of left and right hand drawings by normal subjects have not previously been characterized. The present study was undertaken to determine the qualitative differences between left and right hand drawings of normal subjects. METHODS: Thirty right-handed, elderly subjects without a history of neurological disease were asked to draw, from memory, seven objects using the right and left hand. Half of the subjects were randomly assigned to draw with the left hand first, and half the right hand first. Right and left hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Each drawing was scored on eighteen criteria. Right and left hand drawing scores were then compared using the t-test for paired samples or the Wilcoxon matched-pairs test. RESULTS: Drawings made using the left hand were found to be significantly simpler, more tremulous and of poorer overall quality than drawings made by the same subjects using the right hand. CONCLUSIONS: The deficits found in left versus right hand drawings of normals are similar to those found in patients with LHD, suggesting that much of the drawing impairment seen following LDH is due to an elementary motor disturbance related to use of the non-dominant hand.     

Vasoseal hemostasis following coronary interventions with Abciximab

Femoral arteriotomy management using a collagen vascular hemostasis device (VasoSeal) was studied in 50 consecutive patients following interventional coronary procedures performed with Abciximab (ReoPro). Low dose weight adjusted or no heparin was employed. The first 25 patients were permitted to sit up after 6 hours with ambulation the following day. The second 25 patients were allowed to sit up after 1 hour and ambulate after 6 hours. Despite early activity and ambulation, there were no hemorrhagic complications including hematoma, pseudoaneurysm, blood transfusion, or surgical repair. Hemoglobin and platelet counts remained stable overnight prior to discharge. This pilot study demonstrates the potential efficacy of VasoSeal in achieving early sheath removal and ambulation in patients undergoing interventional procedures using ReoPro.     

Gesture laterality in aphasic and apraxic stroke patients

Limb preference during conversational gestures may be a reflection of functional hemispheric asymmetries. In right-handers, speech and praxis are usually mediated by the left hemisphere and in conversation, right-handers gesture more with their right than left hand. However, patients with left hemisphere brain damage, who are aphasic and apraxic but not hemiplegic, may use their right hemisphere to compensate for their left. Therefore, we investigated spontaneous lateralized gesture production during conversation in a group of left hemisphere-damaged stroke patients, who were aphasic and apraxic but not hemiparetic, and compared their performance to a group of matched controls. Whereas the control group had a strong right-hand preference, the nonparetic but apraxic and aphasic stroke patients were as likely to produce gestures with the right, left, or both hands.     

Cerebral cortical hyperactivation in response to mental stress in patients with coronary artery disease

The central nervous system (CNS) effects of mental stress in patients with coronary artery disease (CAD) are unexplored. The present study used positron emission tomography (PET) to measure brain correlates of mental stress induced by an arithmetic serial subtraction task in CAD and healthy subjects. Mental stress resulted in hyperactivation in CAD patients compared with healthy subjects in several brain areas including the left parietal cortex [angular gyrus/parallel sulcus (area 39)], left anterior cingulate (area 32), right visual association cortex (area 18), left fusiform gyrus, and cerebellum. These same regions were activated within the CAD patient group during mental stress versus control conditions. In the group of healthy subjects, activation was significant only in the left inferior frontal gyrus during mental stress compared with counting control. Decreases in blood flow also were produced by mental stress in CAD versus healthy subjects in right thalamus (lateral dorsal, lateral posterior), right superior frontal gyrus (areas 32, 24, and 10), and right middle temporal gyrus (area 21) (in the region of the auditory association cortex). Of particular interest, a subgroup of CAD patients that developed painless myocardial ischemia during mental stress had hyperactivation in the left hippocampus and inferior parietal lobule (area 40), left middle (area 10) and superior frontal gyrus (area 8), temporal pole, and visual association cortex (area 18), and a concomitant decrease in activation observed in the anterior cingulate bilaterally, right middle and superior frontal gyri, and right visual association cortex (area 18) compared with CAD patients without myocardial ischemia. These findings demonstrate an exaggerated cerebral cortical response and exaggerated asymmetry to mental stress in individuals with CAD.     

Enhanced rehabilitation of gait after stroke: a case report of a therapeutic approach using multichannel functional electrical stimulation

The beneficial effects of using multichannel functional electrical stimulation (MFES) for gait rehabilitation in nonambulatory hemiplegic patients have already been shown. The methodology of application and the results presented were pooled for the whole group of participants, which blurs the exact picture of each particular subject and many vital details are not presented. The purpose of this article is to focus on a single subject from the study and to present all the details of the treatment. The presented subject participated six weeks in the study, first three weeks in MFES therapy and second three weeks in conventional therapy. The effects of each therapy were evaluated by the following measures: temporal-distance parameters of gait, ground reaction forces, goniograms in hip knee and ankle, and assessment of the physical status of the patient according to the Fugl-Meyer evaluation scale. An analysis of the measured parameters showed improved performance of the patient during MFES therapy and stagnation or even slight recession during conventional therapy. The patient achieved independent gait during the three weeks of MFES therapy. At 30 months after the beginning of therapy, the patient was still able to ambulate independently without any significant changes in his gait pattern. The accomplishment was mainly attributed to the avoidance of pathological gait pattern development by using MFES assisted gait training and to the high motivation of the patient to walk and exercise during therapy as well as after he was released to go home.     

Neural mechanisms of global and local processing. A combined PET and ERP study

The neural mechanisms of hierarchical stimulus processing were investigated using a combined event-related potentials (ERPs) and positron emission tomography (PET) approach. Healthy subjects were tested under two conditions that involved selective or divided attention between local and global levels of hierarchical letter stimuli in order to determine whether and where hemispheric differences might exist in the processing of local versus global information. When attention was divided between global and local levels, the N2 component of the ERPs (260- to 360-msec latency) elicited by the target stimuli showed asymmetries in amplitude over the two hemispheres. The N2 to local targets was larger over the left hemisphere, but the N2 to global targets tended to be slightly larger over the right hemisphere. However, the shorter-latency, sensory-evoked P1 component (90- to 150-msec latency) was not different for global versus local targets under conditions of divided attention. In contrast, during selective attention to either global or local targets, asymmetries in the N2 component were not observed. But under selective attention conditions, the sensory-evoked P1 components in the extrastriate cortex were enlarged for global versus local attention. Increased regional cerebral blood flow in the posterior fusiform gyrus bilaterally was observed in the PET data during selective attention to either global or local targets, but neither these nor the P1 component showed any tendency toward hemispheric difference for global versus local attention. Neither were there any activations observed in the parietal lobe during selective attention to global versus local targets. Together these data indicate that early sensory inputs are not modulated to gate global versus local information differentially into the two hemispheres. Rather, later stages of processing that may be asymmetrically organized in the left and right hemispheres operate in parallel to process global and local aspects of complex stimuli (i.e., the N2 effect of the ERPs). This pattern of results supports models proposing that spatial frequency analysis is only asymmetric at higher stages of perceptual processing and not at the earliest stages of visual cortical analysis.     

Transthoracic Doppler echocardiography of normally originating coronary arteries in children

Transthoracic Doppler color flow and spectral velocity patterns of normal coronary arteries in children have not been well studied. We designed this study to evaluate coronary artery flow velocity characteristics in normal and hypertrophied hearts. Sixty-eight children with optimal two-dimensional echocardiographic images of the left coronary artery (LCA) and right coronary artery (RCA) were prospectively studied. The heart was normal in 45 children, and 23 had left and/or right ventricular hypertrophy assessed by echocardiography (mean age 5.8 versus 5.2 years, p = NS). Color flow signals were detected in the LCA in 63(92%) of the 68 children studied, and pulsed Doppler spectral waveforms were recorded in 47 (69%). The latter were recorded in 26 (58%) of 45 normal children and in 21 (91%) of 23 children with left ventricular hypertrophy. Diastolic RCA flow signals were detected mostly in those with right ventricular hypertrophy (10 of 10). Higher levels of LCA maximum diastolic velocity (42 +/- 23 versus 24 +/- 6 cm/sec, p = 0.0004), increased diastolic flow (16 +/- 15 versus 6 +/- 4 ml/min, p = 0.01), and delayed time to peak diastolic velocity expressed as a percentage of diastolic spectral duration (38% +/- 14% versus 20% +/- 8%, p = 0.0001) were observed in children with left ventricular hypertrophy than in those in normal children. A strong correlation was present between Doppler-derived LCA flow and left ventricular mass/m2 (r = 0.7, p = 0.001). In normal hearts, LCA spectral velocity pattern did not change with increasing age, but the time velocity integral became progressively larger, resulting in a strong correlation with weight (p < 0.001, r = 0.78). This study demonstrates (1) LCA flow signals can be detected and quantitated in the majority of children with and those without left ventricular hypertrophy. (2) Left ventricular hypertrophy is associated with increased LCA flow, higher diastolic velocity, and delayed peak diastolic velocity. (3) RCA flow signals are mostly detected when there is right ventricular hypertrophy. Studies on larger groups of patients are needed to further confirm our observations and to enhance understanding of coronary artery flow reserve.     

Motivation for smoking cessation among the Norwegian public

We evaluated eight children with thoracic or high lumbar-level paraparesis for metabolic performance while ambulating with custom fabricated thermoplastic hip-knee-ankle-foot orthoses (HKAFOs) and reciprocating-gait orthoses (RGOs). Seven of the eight children had myelomeningocele. Each patient was tested in both systems at self-selected speeds in a crossover study design. At self-selected speeds, the level of exercise intensity for both thoracic and high-lumbar patients with either orthosis was lower than that for normal children. The average metabolic cost of walking in the RGO was twice that of normal children, as compared with six times normal in HKAFOs. For the four thoracic-level patients, there was a significantly higher oxygen cost of ambulation in using HKAFOs versus RGOs. No significant difference in metabolic performance was found for the high-lumbar patients. Velocity of ambulation was faster in the RGOs than in the HKAFOs. For thoracic-level patients, our data suggest that an RGO will provide a faster, more energy-efficient gait than a statically locked HKAFO. For high-lumbar patients, no significant difference was found between the two orthoses. Seven of eight children preferred the RGO over the HKAFO.     

In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement

BACKGROUND: There are some specific high-risk subgroups of patients with acute inferior myocardial infarction, such as older patients and those with right ventricular involvement. However, the clinical implications of right ventricular infarction in elderly subjects have not been studied previously. METHODS AND RESULTS: To determine the clinical impact of right ventricular involvement in elderly patients with inferior myocardial infarction, we studied the in-hospital outcome of 198 consecutive patients > or = 75 years of age with a first acute inferior myocardial infarction according to the presence of ECG or echocardiographic criteria of right ventricular infarction. In patients with right ventricular involvement (41%), in-hospital case fatality rate was 47% (mainly because of nonreversible low cardiac output cardiogenic shock) compared with 10% in patients without right ventricular involvement (P<.001). Patients with right ventricular involvement also had a significantly higher incidence of cardiogenic shock (32% versus 5%), which was independent of left ventricular ejection fraction, complete AV block (33% versus 9%), and interventricular septal rupture (9% versus 0%). After adjustment for age, sex, diabetes, shock on admission, left ventricular systolic dysfunction, and complete AV block, right ventricular infarction remained a powerful independent predictor of in-hospital death (adjusted odds ratio, 4.0; 95% confidence interval, 1.3 to 14.2). CONCLUSIONS: Elderly patients with acute inferior myocardial infarction have a substantially increased risk of death during hospitalization when right ventricular involvement is present. The poorer outcome is due mainly to the high incidence of cardiogenic shock and its infrequent reversibility.     

Prey selection in the leopard frog: choosing in biased and unbiased situations

We evaluated left ventricular function by echocardiography in a prospective study that included 98 consecutive human immunodeficiency virus (HIV)-infected patients and 40 HIV-seronegative normal controls. When compared with controls, HIV patients showed increased isovolumic relaxation time (101+/-18 ms versus 71+/-10 ms; p<0.0001) and left ventricular diastolic diameters (51+/-6 mm versus 47+/-3 mm; p<0.0005), and decreased fractional shortening (31+/-6% versus 37+/-2%; p<0.0001). Diastolic dysfunction was the most frequent finding (63% of the patients). We found depressed ejection fraction in 31 (32%) patients. Only 8 (8%) patients had symptomatic congestive heart failure. Left ventricular dysfunction was not attributable to intravenous drug abuse or to therapy. It was less severe in earlier stages of the infection (fractional shortening: acquired immunodeficiency syndrome=30%+/-6%, asymptomatic HIV-seropositives 34%+/-5%; p<0.005) and in HIV-2-infected patients. Patients with opportunistic infections (all aetiologies mixed) had more frequent congestive heart failure than those without infections (16% of the patients with versus 4% of the patients without infections; p<0.05). The fact that even asymptomatic HIV-seropositives had signs of left ventricular dysfunction (fractional shortening: asymptomatic HIV-seropositives=34%+/-5%; controls=37%+/-2%; p<0.05) favours the hypothesis of the HIV being one of the causes of these abnormalities.     

Differential Effects of Left Versus Right Mesial Temporal Lobe Epilepsy on Wechsler Intelligence Factors.

This study investigates the effects of left versus right mesial temporal lobe epilepsy (MTLE) on Wechsler intelligence factors. In the left MTLE group, the Verbal Comprehension (VC) factor score was significantly lower than the Perceptual Organization (PO) factor score, whereas in the right MTLE group, the PO factor score was significantly lower than the VC factor score. The VC factor score was significantly lower for the left than the right MTLE group, whereas the PO factor score was significantly lower for the right than the left MTLE group. Thus, left versus right MTLE was associated with relative deficits in verbal versus nonverbal intelligence, respectively. These findings indicate that lateralized cognitive deficits in unilateral MTLE patients are not limited to the learning-memory domain but include more global intelligence functions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intermediate-term outcome of cervical spinal cord-injured patients older than 50 years of age

STUDY DESIGN: This study retrospectively reviewed the intermediate-term clinical outcome of patients who were 50 years of age or older at the time they experienced their cervical spinal cord injury. OBJECTIVES: To establish reasonable expectations for the functional outcome in the older patient with cervical spinal cord injury. BACKGROUND DATA: The long-term morbidity and mortality of large groups of patients with spinal cord injury have been reported. The specific functional ability, disposition, morbidity, and mortality of this group of older patients injured after 50 years of age, however, have been less well defined. METHODS: Forty-one consecutive patients older than 50 years of age at the time of cervical cord injury were studied, and functional abilities, independence, need for assistance in activities of daily living, disposition, morbidity, and mortality were assessed. All patients had more than 2 years of follow-up examinations (mean, 5.5 years) by the same spine injury service. RESULTS: There were 13 complete and 28 incomplete cervical cord lesions. The mean age of the patients at follow-up examination was 67.5 years. The average follow-up period was 5.5 years after injury. None of the patients with complete cord injury improved, and all required extensive care. Twenty-one (80%) of 26 of the patients with incomplete cord injury were able to ambulate with some assistance. Nineteen of 26 patients had independent or near-independent abilities with activities of daily living. Twenty (77%) of 26 were able to return home. All patients with complete cord injury (13 of 13) had died by the time of the follow-up visit. Seventy-seven percent (10 of 13) of this patient group had died within the first year. Those surviving lived an average of 3.5 years after their injury. Fourteen of 28 patients with incomplete cord injury (50%) had died by the time of the follow-up visit. Six (43%) of the 14 deaths were attributed to complications of their spinal cord injury. CONCLUSION: The functional outcome of the person older than 50 years with a complete cervical cord injury is poor. Of the 14% who survived the first year, all required extensive attendant care, and no neurologic improvement was seen. The patient with an incomplete cord injury has an overall good outcome regarding ambulation and returning to home.     

Material-specific memory in the intracarotid amobarbital procedure

We examined material-specific memory in 45 left hemisphere language dominant patients with temporal complex partial seizures (24 right, 21 left) during the intracarotid amobarbital procedure (IAP) by showing eight cards displaying two line drawings of common objects, two printed words, one colored shape, one math expression, one face, and one abstract shape following amobarbital injection (mean = 109.9 mg). We assessed delayed recall and recognition following clearing. Patients with right foci recognized significantly fewer verbally mediated stimuli (words, object drawings, colored shape) with left than with right injection. Patients with left foci recognized a nonverbal stimulus (abstract shape) more poorly following right versus left injection. Discriminant function analysis lateralized 85% of the sample from memory predictors, upheld to 81% on crossvalidation. Material-specific memory remains intact in the hemisphere contralateral to a seizure focus, but wider representation may occur for stimuli normally dominant for the hemisphere with the seizure focus. The IAP significantly lateralizes a seizure focus with use of both types of stimuli.     

Surgical treatment of metastatic long bone disease

A retrospective study of the results of operative treatment of 60 long bones secondaries in 46 patients was carried out. The mean period of follow-up was 10 months. The most common primary in this study was carcinoma of the breast (28.2%), followed by carcinoma of the lung (21.7%) and unknown primary (10.9%). Three groups of patients were studied--pathological fracture group, prophylactic fixation group and a mixed group. In the pathological fracture group, 70% of patients achieved good to excellent pain relief and 60.9% was able to walk with or without walking aids. In the prophylactic group, all the patients achieved good to excellent pain relief and 60% were able to ambulate with or without walking aids. In the mixed group, all the patients achieved good to excellent pain relief and 66.6% of the patients were able to walk with aids. The operative mortality in both the pathological fracture group and prophylactic fixation group was 10% and 33.3% in the mixed group. Multiple internal fixation performed at one operative session was associated with high operative mortality (50%).     

Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative study

A prospective multicenter study was conducted within the National Model Spinal Cord Injury System program to examine neurological deficits and recovery patterns following spinal cord injury (SCI) in individuals with cervical spondylosis and without a spinal fracture. Nineteen patients were evaluated. Sixty-eight percent presented initially with motor incomplete lesions. Of those who presented with motor incomplete injuries at their initial examination, 69 percent had less deficit in the lower than in the upper extremities, indicative of a central cord syndrome. At follow-up, 12 subjects were unable to ambulate, four required assistance and three were able to ambulate independently. On the average, subjects doubled their initial Asia Motor Score (AMS) scores by one year following injury. Residual upper extremity weakness, however, limited the ability to ambulate. Recovery of motor strength in this group is comparable to that of individuals with incomplete tetraplegia in general but the proportion who regain ambulatory function is less.     

A behavioral observation system for quantifying arm activity in daily life after stroke.

Objective: Evaluate psychometric properties of the Functional Arm Activity Behavioral Observation System (FAABOS) for measuring hemiparetic arm use. Participants and Measures: All participants acquired their brain injury > 1 year prior to study entry; most had mild-to-moderate upper-extremity hemiparesis. In Study 1, 9 stroke survivors wore accelerometers and were videotaped for 15 min in the hospital or at home after they were asked to behave as usual. In Study 2, 1 traumatic brain injury and 8 stroke survivors wore accelerometers and were videotaped at home for 3 days with a motion-triggered camera. Observers independently rated 15-min segments of the Study 1 and 2 videotapes in 2-s blocks with a 4-step arm-activity coding scheme. Results: Interrater reliability was excellent; the mean Cohen’s κ in each study was ≥ .84. For data from both studies combined, validity was supported by a strong correlation between amount of hemiparetic arm functional activity, as determined by the observers, and the ratio of hemiparetic to other arm movement, as determined by accelerometry. Conclusion: FAABOS reliably and validly quantifies amount of spontaneous hemiparetic arm activity outside the laboratory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the dorsal and ventral systems of the human cerebral cortex: Beyond dichotomies.

Traditionally, characterizations of the macrolevel functional organization of the human cerebral cortex have focused on the left and right cerebral hemispheres. However, the idea of left brain versus right brain functions has been shown to be an oversimplification. We argue here that a top–bottom divide, rather than a left–right divide, is a more fruitful way to organize human cortical brain functions. However, current characterizations of the functions of the dorsal (top) and ventral (bottom) systems have rested on dichotomies, namely where versus what and how versus what. We propose that characterizing information-processing systems leads to a better macrolevel organization of cortical function; specifically, we hypothesize that the dorsal system is driven by expectations and processes sequences, relations, and movement, whereas the ventral system categorizes stimuli in parallel, focuses on individual events, and processes object properties (such as shape in vision and pitch in audition). To test this hypothesis, we reviewed over 100 relevant studies in the human neuroimaging and neuropsychological literatures and coded them relative to 11 variables, some of which characterized our hypothesis and some of which characterized the previous dichotomies. The results of forward stepwise logistic regressions supported our characterization of the 2 systems and showed that this model predicted the empirical findings better than either the traditional dichotomies or a left–right difference. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Bundle-branch block and in-hospital mortality in acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators

BACKGROUND: Left bundle-branch block (BBB) is considered an important predictor of poor outcome in patients with acute myocardial infarction, but the consequences of right BBB are not well understood. OBJECTIVES: To 1) estimate the prevalence of left and right BBB in patients with myocardial infarction; 2) compare the clinical characteristics of and treatments received by patients with left, right, or no BBB; and 3) determine the independent association of left BBB and right BBB with in-hospital death. DESIGN: Retrospective cohort study. SETTING: Multicenter registry of 1571 U.S. hospitals. PATIENTS: 297,832 patients with acute myocardial infarction who had left, right, or no BBB on initial electrocardiography. MEASUREMENTS: Presence and type of BBB, clinical characteristics of patients, therapies given, and in-hospital death. RESULTS: Patients with left BBB (n = 19,967; 6.7%) or right BBB (n = 18,354; 6.2%) were older and had more comorbid illness and congestive heart failure than patients with no BBB. Among patients for whom thrombolytic therapy was clearly indicated, fewer patients with left or right BBB (16.6% and 32.0%, respectively) than patients with no BBB (66.5%) received this therapy (P < 0.001). Fewer patients with left or right BBB (60.6% and 67.3%, respectively) than patients with no BBB (75.6%) received aspirin within the first 24 hours (P < 0.001), and fewer patients with left or right BBB (23.9% and 31.8%, respectively) than patients with no BBB (40.4%) received beta-blockers within the first 24 hours (P < 0.001). Unadjusted in-hospital mortality rates were almost twice as high for patients with left or right BBB (22.6% and 23.0%, respectively) as for patients with no BBB (13.1%) (P < 0.001). Compared with no BBB and no ST-segment elevation, left BBB was associated with a 34% increase (odds ratio, 1.34 [95% CI, 1.28 to 1.39]) and right BBB was associated with a 64% increase (odds ratio, 1.64 [CI, 1.57 to 1.71]) in the risk for in-hospital death, after adjustment for potential confounders. CONCLUSIONS: In patients with acute myocardial infarction, prevalences of right and left BBB are similar. Patients with BBB have more comorbid conditions, are less likely to receive therapy, and have an increased risk for in-hospital death compared with patients with no BBB. Compared with left BBB, right BBB seems to be a stronger independent predictor of in-hospital death.