Still, by the late 1950s and early 1960s players such as Bill Russell and Wilt Chamberlain had incorporated the move into their offensive arsenal. The dunk became a fan-favorite, as offensive players began to aggressively intimidate defenders with the threat of vicious slams. Through the 1970s, the slam dunk was standard fare; David Thompson, Julius Erving, Darryl Dawkins, and others wowed crowds with high-flying moves.
Overall, 309 patients (18.4%) had an arrhythmia; the most common type of arrhythmia was atrial fibrillation, which occurred in 266 patients (86.1%). More patients had an arrhythmia, especially atrial fibrillation, in the dopamine group than in the norepinephrine group (Table 3). The study drug was discontinued in 65 patients owing to severe arrhythmias — 52 patients (6.1%) in the dopamine group and 13 patients (1.6%) in the norepinephrine group (P<0.001). These patients were included in the intention-to-treat analysis. There were no significant differences between the groups in the incidences of other adverse events.
For women's basketball, to dunk or not to dunk has long been the question. It’s the ‘wow factor’ that WNBA haters often point to as proof that the women's game doesn't deserve the fandom, fame and fortune that the guys get. Cristen and Caroline talk to two dunking superstars of past and present to sort through the courtside gender politics and controversy of stuffing the net and find out whether more women bringing the slams could settle the score.
The rate of death at 28 days in this study was close to 50%, which is to be expected in a study with very few exclusion criteria and is similar to the rate in previous observational studies.3,9,21-24 Our trial was a pragmatic study that included all patients who were treated for shock states, and therefore, it has high external validity. The study design allowed for maximal exposure to the study drug, since we included patients who had received open-label vasopressors for a maximum of 4 hours before randomization and since during the 28-day study period, the study drug was withdrawn last when patients were weaned from vasopressor therapies and was resumed first if resumption of vasopressor therapy was necessary.
Circulatory shock is a life-threatening condition that is associated with high mortality.1,2 The administration of fluids, which is the first-line therapeutic strategy, is often insufficient to stabilize the patient's condition, and adrenergic agents are frequently required to correct hypotension. Among these agents, dopamine and norepinephrine are used most frequently.3 Both of these agents influence alpha-adrenergic and beta-adrenergic receptors, but to different degrees. Alpha-adrenergic effects increase vascular tone but may decrease cardiac output and regional blood flow, especially in cutaneous, splanchnic, and renal beds. Beta-adrenergic effects help to maintain blood flow through inotropic and chronotropic effects and to increase splanchnic perfusion. This beta-adrenergic stimulation can have unwanted consequences as well, including increased cellular metabolism and immunosuppressive effects. Dopamine also stimulates dopaminergic receptors, resulting in a proportionately greater increase in splanchnic and renal perfusion, and it may facilitate resolution of lung edema.4 However, dopaminergic stimulation can have harmful immunologic effects by altering hypothalamo–pituitary function, resulting in a marked decrease in prolactin and growth hormone levels. 5
No, I think there’s a practical aspect to that. It’s hard to grip a basketball. I mean, that’s another physical challenge. I have pretty small hands, and one thing I had to train myself to do, which I couldn’t do at the start of this project, is palm a basketball. So that involved fingertip push-ups, to get the tips of your fingers much stronger. It involves, while hanging out and watching television, trying to palm a basketball for as long as you can. You want to get into a quick, full sprint, and you want to be able to grip the basketball as you go up to jam it. So doing those things can be a challenge. That’s partly what’s behind people doing the alley-oop-type things or throwing it up off the backboard. In some cases, they simply can’t grip the ball on the way to the hoop, so their solution is to throw it in the air, catch it, and try to bring it down.
Thus, dopamine and norepinephrine may have different effects on the kidney, the splanchnic region, and the pituitary axis, but the clinical implications of these differences are still uncertain. Consensus guidelines and expert recommendations suggest that either agent may be used as a first-choice vasopressor in patients with shock.6-8 However, observational studies have shown that the administration of dopamine may be associated with rates of death that are higher than those associated with the administration of norepinephrine.3,9,10 The Sepsis Occurrence in Acutely Ill Patients (SOAP) study,3 which involved 1058 patients who were in shock, showed that administration of dopamine was an independent risk factor for death in the intensive care unit (ICU). In a meta-analysis,11 only three randomized studies, with a total of just 62 patients, were identified that compared the effects of dopamine and norepinephrine in patients with septic shock. The lack of data from clinical trials in the face of growing observational evidence that norepinephrine may be associated with better outcomes called for a randomized, controlled trial. Our study was designed to evaluate whether the choice of norepinephrine over dopamine as the first-line vasopressor agent could reduce the rate of death among patients in shock.
“Put in the work. It’s muscle memory, first and foremost. Trainingwise, people say, ‘You gotta do this, you gotta do that.’ I didn’t believe in that. I never worked on my legs in high school or middle school. I would just go through this routine over and over and over, visualizing that day when you dunk on the court. And then you live in that moment.”
A predefined subgroup analysis was conducted according to the type of shock — septic shock, which occurred in 1044 patients (542 in the dopamine group and 502 in the norepinephrine group); cardiogenic shock, which occurred in 280 patients (135 in the dopamine group and 145 in the norepinephrine group); or hypovolemic shock, which occurred in 263 patients (138 in the dopamine group and 125 in the norepinephrine group). The overall effect of treatment did not differ significantly among these subgroups (P=0.87 for interaction), although the rate of death at 28 days was significantly higher among patients with cardiogenic shock who were treated with dopamine than among those with cardiogenic shock who were treated with norepinephrine (P=0.03) (Figure 3). The Kaplan–Meier curves for the subgroup analysis according to type of shock are shown in Figure 7 in the Supplementary Appendix.
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