SummaryBackgroundStents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.MethodsThe International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470.FindingsThe trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4·0%) events of disabling stroke or death in the stenting group compared with 27 (3·2%) events in the endarterectomy group (hazard ratio [HR] 1·28, 95% CI 0·77–2·11). The incidence of stroke, death, or procedural myocardial infarction was 8·5% in the stenting group compared with 5·2% in the endarterectomy group (72 vs 44 events; HR 1·69, 1·16–2·45, p=0·006). Risks of any stroke (65 vs 35 events; HR 1·92, 1·27–2·89) and all-cause death (19 vs seven events; HR 2·76, 1·16–6·56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0·0197).InterpretationCompletion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.FundingMedical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union.

Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

Object control skills provide children the tools to be physically active-a major societal priority. At the fundamental movement level, object control skills form the foundation of further sports skill development. The purpose of this study was to examine children's (ages 5 to 14 years, Grades K-8) development of four key object control skills: catching, throwing, kicking, and striking. 186 children were tested on selected items from the Object Control Subtest of the Test of Gross Motor Development-2, using a cross-sectional and correlational design. As anticipated, significant differences were found for age on all four skills. These improvements were characterized by early, rapid gains at ages 9 to 10, beyond which development occurred at a slower rate for catching, throwing, and kicking; striking development continued at a steady rate to age 14 years. Contrary to previous findings, no overall sex differences were found for catching or kicking. Overall sex differences favoring boys were observed for throwing and striking. Implications for evolutionary contributions to throwing and striking were discussed.

The Timed Up and Go (TUG) Test is recommended by the U.S. Centers for Disease Control and Prevention as an easy to administer clinical test to evaluate a senior citizen's fall risk. Limited evidence has been presented in the literature validating the TUG Test. In this study we sought to assess correlations between the TUG Test and various balance markers utilizing the OptoGait system. Fifty-one healthy seniors completed randomized trials of the TUG Test and a Gait Test utilizing OptoGait photoelectric technology. Correlations among mean and standard deviation values for these variables and TUG performance were calculated. Utilizing a Bonferroni adjustment and an alpha level of .05, eight significant correlations of a moderately strong degree (absolute r scores between .51 and .78) emerged. Correlation results indicate that the TUG Test is a valid tool for screening balance deficits that lead to increased fall risk in senior citizens.

Accurate measures of muscular strength can yield insights about children's growth and development. The purpose of this study was to examine grip strength performances by boys and girls ages 5 to 19 years. A Jamar dynamometer was used to measure grip strength by 736 boys and girls ages 5 to 19 years. Multiple regression equations were applied to analyze the data. Overall, age-sex trends were similar to previous reports as boys and girls increased their performances across age levels. After age 12, boys' mean grip strength increased at a faster rate than girls'. However, participants in the present study performed better in the upper age ranges (13-19 yr.) than did boys and girls tested a generation ago. Potential associations between activity choices and grip strength are discussed.