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Pubblicazioni recenti - cardiac rehabilitation
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Use of Robotics in Gait Rehabilitation Following Stroke: A Review.
Cureus2022 Nov;14(11):e31075. doi: e31075.
Warutkar Vaishnavi, Dadgal Ragini, Mangulkar Utkarsha R,
Abstract
A stroke is an acute disruption of focal or global brain activity that last for a day or leads to death. Most stroke patients have an asymmetric gait, lower-extremity stiffness of the affected (hemiplegia) side, and impaired single stance and weight transfer capacity, restricting their locomotor function. Although between 65% and 85% of individuals can walk alone within six months after a stroke with appropriate surgical/pharmaceutical procedures and rehabilitative therapy, poor walking and cardiac efficiency continue to impede everyday walking for hemiplegia patients. Various methods are used to improve gait in stroke patients. Robotic-assisted gait training (RAGT) is given via a robot system device. Ground exoskeletons, end-effector devices, wearable exoskeletons are three types of rehabilitation robots that have been developed. The HAL (Hybrid Assistive Limb) exoskeleton and RoboGait is also modified gait device to enhance gait. Robotic Neurorehabilitation can be a useful technique for reducing gait impairments and, as a result, increasing the standard of living of post-stroke individuals.
Copyright © 2022, Warutkar et al.
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COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.
Turk J Phys Med Rehabil2022 Sep;68(3):317-335. doi: 10.5606/tftrd.2022.11435.
Sonel Tur Birkan, Köseo?lu Belma Füsun, Kutay Ordu Gökkaya Nilüfer, Kurtai? Aytür Ye?im, Özyemi?ci Ta?k?ran Özden, Demirba? Kabayel Derya, Kesikta? Nur, T?k?z Canan, Özdemir Hande, Alemdaro?lu Ebru, Bilir Kaya Ba?ak, Genç Aysun, Tomruk Sütbeyaz Serap,
Abstract
Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.
Copyright © 2022, Turkish Society of Physical Medicine and Rehabilitation.
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Management of Polyneuromyopathy in a Critically Ill Patient with a Left Ventricular Assist Device.
Pril (Makedon Akad Nauk Umet Odd Med Nauki)2022 Nov;43(3):67-72. doi: 10.2478/prilozi-2022-0038.
Savevska Cvetanka Gjerakaroska, Radovikj Marija Gjerakaroska, Gechevska Daniela, Koevska Valentina, Mitrevska Biljana, Gocevska Marija, Matjanoska Lidija Stojanoska, Ivanovsk Biljana Kalcovska, Manoleva Maja,
Abstract
Critical illness polyneuromyopathy after cardiac surgery is often unrecognized and is a rarely reported clinical condition. It is characterized by more proximal than distal symmetrical flaccid muscle weakness and difficulty in weaning from a respirator. When done in a timely manner, rehabilitation prevents early complications and reduces the length of hospitalization. Rehabilitation leads to better motor outcome, improves short-term and long-term functionality, and results in a better quality of life.
© 2022 Cvetanka Gjerakaroska Savevska et al., published by Sciendo.
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Heart Failure as the Initial Clinical Manifestation of Becker Muscular Dystrophy in an Adult.
Tex Heart Inst J2022 Nov;49(6):. doi: e217634.
Del Rio-Pertuz Gaspar, Morataya Cristina, Ratheal Kelly, Rios Steven R, Sethi Pooja, Argueta-Sosa Erwin,
Abstract
Congestive heart failure is an uncommon initial presentation for dystrophin-deficient muscular dystrophies. Cardiac manifestations may appear in late disease stages, although they classically present after musculoskeletal symptoms develop. This case report describes a patient who presented with heart failure and was newly diagnosed with Becker muscular dystrophy. The objective is to recognize Becker muscular dystrophy as a potential cause of dilated cardiomyopathy in young patients, even in the absence of clinically overt musculoskeletal symptoms.
© 2022 by the Texas Heart® Institute, Houston.
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Cardiovascular telerehabilitation improves functional capacity, cardiorespiratory fitness and quality of life in older adults: A systematic review and meta-analysis.
J Telemed Telecare2022 Dec;():1357633X221137626. doi: 10.1177/1357633X221137626.
Nacarato Diego, Sardeli Amanda V, Mariano Lilian O, Chacon-Mikahil Mara Patrícia T,
Abstract
INTRODUCTION:
The aim was to identify whether cardiovascular telerehabilitation programs (CV-T-REHAB) can improve functional capacity, cardiorespiratory fitness and quality of life (QoL) to the same extent of presential rehabilitation (CV-P-REHAB) in older adults, by meta-analysis of previous studies.
METHODS:
Literature search was conducted in October 2020 in four databases to select controlled trials of CV-T-REHAB effects on functional capacity (six-minute walk test [6MWT]), cardiorespiratory fitness (maximal oxygen consumption [O]), and QoL in older adults (> 50 years) and included new articles in April 2022.
RESULTS:
CV-T-REHAB improved 6MWT (11.14?m [CI95%?=?8.03; 14.26], ?0.001), O (1.18?ml/kg/min [CI95%?=?0.70; 1.66], ?0.001), and QoL (standardized mean difference [SMD]?=?0.36 [CI95%?=?0.05; 0.67], ?=?0.02). CV-T-REHAB increased O to a greater extent than CV-P-REHAB (1.08?ml/kg/min [0.39; 1.76], ?=?0.002). Although the 6MWT and O analyses proved consistent and homogeneous, the QoL analysis showed considerable inconsistency (?=?92.90%), suggesting the need for studies exploring the effect of CV-T-REHAB on QoL in this population. Part of the heterogeneity was explained by age differences, as CV-T-REHAB improved QoL in adults >65 years, but not in adults
CONCLUSION:
CV-T-REHAB improved cardiorespiratory fitness to a level equal to or higher than CV-P-REHAB and improved functional capacity and QoL; being mainly effective for QoL in older adults >65 years. Thus, CV-T-REHAB can be a good alternative, when not the best option and might be considered especially for individuals with limited access to participate in face-to-face programs.
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Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study.
Eur J Cardiovasc Nurs2022 Dec;():. doi: zvac111.
Thomas Emma E, Chambers Rebecca, Phillips Samara, Rawstorn Jonathan C, Cartledge Susie,
Abstract
METHODS AND RESULTS:
Semi-structured interviews (n?=?8) and focus groups (n?=?7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June-August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: 1. Variable levels of readiness; 2. Greater telehealth uptake in pulmonary versus cardiac rehabilitation; 3. Safety and risk management; 4. Client willingness - targeted support required; 5. Equity and access; and, 6. New models of care. We found sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g., co-design), clinicians (e.g. shared learning), health services (e.g., increasing platform functionality), and the profession (e.g., sharing resources).
CONCLUSIONS:
There are opportunities for telehealth programs servicing large geographic areas, and to increase program participation rates more broadly. Centralised models of care serving large geographic areas could maximise sustainability with current resource limitations; however, realising the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organisations both have roles to play in sustaining telehealth in cardiac and pulmonary services.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Case Report: De novo variant in myelin regulatory factor in a Chinese child with 46,XY disorder/difference of sex development, cardiac and urogenital anomalies, and short stature.
Front Pediatr2022 ;10():1027832. doi: 1027832.
Wang Hui, Wu Dian, Wu De-Hua, Tian Hong-Juan, Li Hai-Feng, Jiang Ke-Wen, Zou Chao-Chun,
Abstract
The myelin regulatory factor (; MIM# 608329) gene was first identified as a critical transcription factor involved in oligodendrocyte differentiation and central nervous system myelination. With the recent development of exome sequencing, pathogenic variants of had been considered as the cause of cardiac-urogenital syndrome (CUGS), 46,XY and 46,XX disorders/differences of sex development (DSDs), and nanophthalmos. Herein, we described a 4-year-7-month-old "girl" with ventricular septal defect, atrial septal defect, patent ductus arteriosus, severe pulmonary hypertension, moderate-to-severe tricuspid regurgitation, enlarged coronary sinus, left superior vena cava, and right lung hypoplasia at birth. Later, the patient developed short stature and amblyopia. Further examination revealed a karyotype 46,XY and visible uterus, whereas the presence of gonads were not explored. Laparoscopy revealed dysplasia of testicular gonad. Whole-exome sequencing (WES) was performed and a heterozygous mutation in was identified, known as c.2817G?>?A/p. W939* (NM_001127392.3). Therefore, this case report presented multiple clinical manifestations with syndromic symptoms of CUGS, 46,XY DSD, and ocular symptoms. These new data expanded the phenotype of the variant and may benefit to characterize the phenotypes caused by the variants of this gene.
© 2022 Wang, Wu, Wu, Tian, Li, Jiang and Zou.
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A giant and double-walled left atrial ball thrombus complicating a mitral stenosis: case report-a truck tire into the heart.
Eur Heart J Case Rep2022 Nov;6(11):ytac443. doi: ytac443.
Selimi Adelina, Ianni Umberto, Molisana Michela, Parato Vito Maurizio,
Abstract
BACKGROUND:
High thromboembolic risk associated with rheumatic mitral stenosis has been well established, especially in concomitant atrial fibrillation; however, the presence of left atrium ball thrombus is an uncommon finding.
CASE SUMMARY:
A 75-year-old woman with a history of mild rheumatic mitral stenosis was admitted to Emergency Department with cardiogenic shock and high ventricular rate atrial fibrillation. Emergency electrical cardioversion was performed-before trans-oesophageal echocardiography (TOE)-due to haemodynamic deterioration which restored sinus rhythm.Transthoracic echocardiography (TTE) revealed severe reduction of left ventricular ejection fraction (LVEF: 15%), severe rheumatic mitral stenosis and a large, perfectly rounded mass, situated at the ostium of left upper pulmonary vein. Due to the persistence of haemodynamic instability and acute pulmonary oedema the patient was intubated and mechanically ventilated and treated with intravenous administration of inotropes and high doses of diuretics. During the stay in Intensive Care Unit, a TOE confirmed a spherical and double-walled mass suggesting a working diagnosis of left atrial ball thrombus (LABT). The case was discussed in Heart Team and considering the poor haemodynamic status in the contest of refractory cardiogenic shock with evidence of multi-organ failure, emergency surgical thrombectomy and mitral valve replacement was deemed prohibitive. Patient developed cardiac arrest and emergency TTE showed left atrial mass engaged into the mitral valve totally obstructing the left ventricle inflow tract. The autopsy and histologic examination confirmed the thrombotic nature of the mass.
DISCUSSION:
A free-floating ball thrombus in the left atrium is an unusual occurrence in rheumatic mitral stenosis and it may cause fatal systemic embolization or acute left ventricular inflow obstruction, resulting in syncope, pulmonary congestion, and sudden cardiac death. When possible, emergency surgical thrombectomy and mitral valve replacement can be life-saving.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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A High Level of Fibrinogen Degradation Product on Arrival as the Only Clue Suggesting Deterioration in a Blunt Trauma Patient.
Cureus2022 Oct;14(10):e30914. doi: e30914.
Yanagawa Youichi, Nagasawa Hiroki, Ishikawa Kouhei,
Abstract
We report the case of an 89-year-old woman who was struck by a car while walking and fell to the ground. She had hypertension, dyslipidemia, and cerebral infarction requiring medication. She was transported to a nearby acute critical care center. Upon arrival, her vital signs were stable. A physical examination showed right facial and hip contusion, right shoulder tenderness, a right elbow contusional lacerated wound, and bilateral knee abrasion wounds. She vomited when her face moved. Radiological studies showed a right proximal humerus fracture and a right minor ischial fracture. Her injury severity score (ISS) was 5 points, and her probability of surviving was 97.8%. However, a blood test revealed an extremely high fibrinogen degradation product (FDP) level (573.3 ?g/mL). Because of this elevated FDP value and her inability to walk due to vomiting on motion, she remained in the emergency room (ER) for monitoring. At five hours from arrival, she became comatose, and hypotension and bradycardia (30 beats per minute) were noted followed by cardiac arrest. She underwent advanced cardiac life support and obtained spontaneous circulation. Repeated blood tests showed hyperkalemia, anemia, and hypoglycemia. She immediately underwent infusion of glucose and insulin and continuous infusion of catecholamine. Repeated whole-body CT scans revealed only increased hematomas where the fractures and contusions existed. She was admitted to the ICU. Her post-admission course was quite eventful. She required transfusion until the fourth hospital day to control circulation and anemia and underwent transfusion of 28 units of red blood cells, 30 units of platelets, and four units of fresh-frozen plasma in total. After her circulation and respiratory function had stabilized, she was extubated. However, her condition became complicated with the deterioration of her knee wounds and gall bladder inflammation in the ward. All complications were treated by non-operative management. She was transferred to another hospital for rehabilitation on day 70. This report discusses our experience with a blunt trauma patient in whom a high FDP level on arrival was the only clue indicating the deterioration of her condition. Such patients need close observation with hospitalization.
Copyright © 2022, Yanagawa et al.
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Development and validation of a machine learning model to predict the risk of lymph node metastasis in renal carcinoma.
Front Endocrinol (Lausanne)2022 ;13():1054358. doi: 1054358.
Feng Xiaowei, Hong Tao, Liu Wencai, Xu Chan, Li Wanying, Yang Bing, Song Yang, Li Ting, Li Wenle, Zhou Hui, Yin Chengliang,
Abstract
SIMPLE SUMMARY:
Studies have shown that about 30% of kidney cancer patients will have metastasis, and lymph node metastasis (LNM) may be related to a poor prognosis. Our retrospective study aims to provide a reliable machine learning-based model to predict the occurrence of LNM in kidney cancer. We screened the pathological grade, liver metastasis, M staging, primary site, T staging, and tumor size from the training group (n=39016) formed by the SEER database and the validation group (n=771) formed by the medical center. Independent predictors of LNM in cancer patients. Using six different algorithms to build a prediction model, it is found that the prediction performance of the XGB model in the training group and the validation group is significantly better than any other machine learning model. The results show that prediction tools based on machine learning can accurately predict the probability of LNM in patients with kidney cancer and have satisfactory clinical application prospects.
BACKGROUND:
Lymph node metastasis (LNM) is associated with the prognosis of patients with kidney cancer. This study aimed to provide reliable machine learning-based (ML-based) models to predict the probability of LNM in kidney cancer.
METHODS:
Data on patients diagnosed with kidney cancer were extracted from the Surveillance, Epidemiology and Outcomes (SEER) database from 2010 to 2017, and variables were filtered by least absolute shrinkage and selection operator (LASSO), univariate and multivariate logistic regression analyses. Statistically significant risk factors were used to build predictive models. We used 10-fold cross-validation in the validation of the model. The area under the receiver operating characteristic curve (AUC) was used to assess the performance of the model. Correlation heat maps were used to investigate the correlation of features using permutation analysis to assess the importance of predictors. Probability density functions (PDFs) and clinical utility curves (CUCs) were used to determine clinical utility thresholds.
RESULTS:
The training cohort of this study included 39,016 patients, and the validation cohort included 771 patients. In the two cohorts, 2544 (6.5%) and 66 (8.1%) patients had LNM, respectively. Pathological grade, liver metastasis, M stage, primary site, T stage, and tumor size were independent predictive factors of LNM. In both model validation, the XGB model significantly outperformed any of the machine learning models with an AUC value of 0.916.A web calculator (https://share.streamlit.io/liuwencai4/renal_lnm/main/renal_lnm.py) were built based on the XGB model. Based on the PDF and CUC, we suggested 54.6% as a threshold probability for guiding the diagnosis of LNM, which could distinguish about 89% of LNM patients.
CONCLUSIONS:
The predictive tool based on machine learning can precisely indicate the probability of LNM in kidney cancer patients and has a satisfying application prospect in clinical practice.
Copyright © 2022 Feng, Hong, Liu, Xu, Li, Yang, Song, Li, Li, Zhou and Yin.
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Identification and verification of immune-related biomarkers and immune infiltration in diabetic heart failure.
Front Cardiovasc Med2022 ;9():931066. doi: 931066.
Zhong Zuoquan, Zhang Hanlin, Xu Ting, Hao Jinjin, Chen Xing, Sun Shimin, Yang Jinjin, Sun Jing, Lin Hui, Guo Hangyuan,
Abstract
PURPOSE:
Diabetic heart failure (DHF) or cardiomyopathy is a common complication of diabetes; however, the underlying mechanism is not clear. In the present study, the authors searched for differentially expressed genes associated with DHF and the molecular types of immune cells based on bioinformatics.
METHODS:
The RNA expression dataset of DHF was obtained from the NCBI Gene Expression Omnibus (GEO) database. After preprocessing the data, the differentially expressed genes (DEGs) between the DHF group and the non-diabetic heart failure (NHF) group were screened and intersected with immune-related genes (IRGs) in the ImmPort database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using the DAVID tool. The ssGSEA algorithm was used to evaluate immune infiltration of the heart tissue in each group. In addition, the protein-protein interaction (PPI) network and miRNA-mRNA network were constructed using the STRING online website and Cytoscape program. Finally, validation analysis was performed using animal models.
RESULTS:
Eight immune-related core genes were identified. GO and KEGG showed that core genes were mainly enriched in angiogenesis and cytokine-cytokine receptor interaction. Immune infiltration results showed that activated dendritic cells, central memory CD4 T cells, central memory CD8 T cells, myeloid-derived suppressor cells (MDSCs), neutrophils, and regulatory T cells may be involved in DHF. Neutrophils may play a key role in the pathogenesis of HF in diabetes.
CONCLUSION:
Immune-related core genes and immune infiltrating cells provide a new perspective on the pathogenesis of DHF.
Copyright © 2022 Zhong, Zhang, Xu, Hao, Chen, Sun, Yang, Sun, Lin and Guo.
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PAH-specific therapy for pulmonary hypertension and interstitial lung disease: A systemic review and meta-analysis.
Front Cardiovasc Med2022 ;9():992879. doi: 992879.
Zhao Ning, Chen Jun, Zhang Mingming, Zhou Lihui, Liu Lisong, Yuan Jie, Pang Xingxue, Hu Dayi, Ren Xiaoxia, Jin Zhongyi,
Abstract
OBJECTIVE:
Pulmonary hypertension (PH) in context with interstitial lung disease (ILD) portends serious clinical consequences and a high rate of mortality. Recently published randomized controlled trials (RCTs) which assessed the pulmonary arterial hypertension (PAH)-specific drugs for pulmonary hypertension and interstitial lung disease (PH-ILD) revealed inconsistent clinical outcomes with previous studies. We conducted a systemic review and meta-analysis to further investigate the effect of PAH-specific therapies for PH-ILD.
METHODS:
Clinical trials were searched from the EMBASE, PUBMED, and CENTRAL databases. The duration from the establishment of the database to June 2022 for RCTs evaluates the effect of PAH-specific therapy in patients with PH-ILD. RevMan 5.4 was used for the meta-analysis.
RESULTS:
A total of six articles (with a total of 791 patients) were included, including 412 patients in the treated group and 379 patients in the control group. As compared to placebo, the change of 6MWD was a significant improvement with PAH-specific therapy in the six RCTs (23.09; 95% CI, 12.07-34.12
CONCLUSION:
PAH-specific therapy significantly improved exercise capacity in the patients with PH-ILD, but this is due to the greater contribution of the study with inhaled treprostinil. Therefore, our findings still did not support the routine use of the whole PAH-specific drugs for PH-ILD.
Copyright © 2022 Zhao, Chen, Zhang, Zhou, Liu, Yuan, Pang, Hu, Ren and Jin.
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Associations between myeloperoxidase and paraoxonase-1 and type 2 diabetes in patients with ischemic heart disease.
BMC Cardiovasc Disord2022 Dec;22(1):521. doi: 10.1186/s12872-022-02928-8.
Nessler Katarzyna, Grzybczak Rafal, Nessler Michal, Zalewski Jaros?aw, Gajos Grzegorz, Windak Adam,
Abstract
BACKGROUND:
The phrase "dysfunctional high-density lipoprotein" has been developed in the literature to describe the particle which loses its basic role- anti-oxidative and anti-inflammatory activity. In this porcess, the significance of enzymes- pro-oxidant myeloperoxidase (MPO) and antioxidant paraoxonase-1 (PON-1) from the perspective of HDL-C function has been noted.
AIMS:
The objective of this study was to analyze the associations between two enzymes -MPO and PON-1 and type 2 diabetes (T2DM) in patients with ischemic heart disease (IHD).
METHODS:
An observational cross-sectional study including 70 patients with IHD of whom 35 had also T2DM, and 35 had no T2DM. Laboratory tests (MPO, PON-1, fasting glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and high-sensitivity C-reactive protein) were performed.
RESULTS:
The study revealed a significant difference in the serum concentration of the enzymes between patients with IHD with and without T2DM. Our results showed increased MPO concentration levels in diabetic patients. The analysis also revealed that T2DM is independently associated with an increase in MPO levels. Simultaneously, a decrease in PON-1 levels was observed in patients with T2DM. The study also revealed that T2DM is independently associated with a decrease in PON-1 levels.
CONCLUSIONS:
In patients with type 2 diabetes the profile of enzymes involved in high-density lipoprotein metabolism in patients with IHD is worse than in patients without T2DM. The increase in the levels of MPO, an enzyme with oxidative and atherogenic properties and on a decrease in PON-1 levels, an enzyme with antioxidant and atheroprotective properties is observed.
© 2022. The Author(s).
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CD44 promotes angiogenesis in myocardial infarction through regulating plasma exosome uptake and further enhancing FGFR2 signaling transduction.
Mol Med2022 Dec;28(1):145. doi: 10.1186/s10020-022-00575-5.
Zhang Qing, Chen Li, Huang Liyi, Cheng Hongxin, Wang Lu, Xu Lin, Hu Danrong, He Chengqi, Fu Chenying, Wei Quan,
Abstract
BACKGROUND:
Since angiogenesis occurs as the pathological process following myocardial infarction to alleviate ischemia, therapeutic angiogenesis has been proposed to be a cardioprotective strategy. CD44 has been implicated in endothelial cell functions and its role has been well established in angiogenesis for years. Although recent studies indicate the close correlation between CD44 and exosome, as well as the two being implicated in myocardial ischemia pathological processes, the effect and the underlying mechanism of CD44 and its regulated plasma exosome in pathological angiogenesis post-myocardial infarction have not been fully elucidated.
METHODS:
In this study, we used CD44 knockout mice to study the in vivo impacts of CD44 on ischemic angiogenesis in myocardial infarction. Mouse cardiac function was measured by echocardiography, histological changes were observed by Evans Blue and TTC-double staining and Masson's trichrome staining, and molecular changes were detected by immunofluorescence. In the in vitro study, CD44 knockout HUVECs were generated and CD44 inhibitor was used to study the mechanism of CD44 on angiogenesis. We performed the immunoprecipitation, proximity ligation assay, and super-resolution imaging to study the mechanistic regulation of FGFR2 signaling transduction by CD44. Importantly, we also isolated plasma exosomes from myocardial infarction model mice and studied the effect of plasma exosomes on the activation of the FGFR2 signaling pathway and the related phenotypic alterations, including exosomes uptake and angiogenic function in primary mouse microvascular endothelial cells, and further discovered the regulation mechanism of exosomal miRNAs.
RESULTS:
We observed that the expression of CD44 in the border zone of the infarcted heart was tightly related to pathological angiogenesis following myocardial ischemia. The depletion of CD44 impaired angiogenesis and impacts biogenesis and proangiogenic function of plasma exosomes. Subsequently, we found that CD44 mediated the activation of the FGFR2 signaling pathway as well as the caveolin 1-dependent uptake of exosomes in vascular endothelial cells. Most importantly, the proangiogenic therapeutic effect of plasma exosomal miRNAs depended upon the participation of CD44/FGFR2 signaling transduction in vascular endothelial cells.
CONCLUSION:
CD44 and its regulated plasma exosomes have crucial potent angiogenic activity. Our studies elucidate that CD44 plays a key role in plasma exosomal miRNA-enhanced angiogenic FGFR2 singling transduction and ischemic angiogenesis in the early stage of myocardial infarction.
© 2022. The Author(s).
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Optimizing exercise testing-based risk stratification to predict poor prognosis after acute heart failure.
ESC Heart Fail2022 Dec;():. doi: 10.1002/ehf2.14240.
Chen Shyh-Ming, Wu Po-Jui, Wang Lin-Yi, Wei Chin-Ling, Cheng Cheng-I, Fang Hsiu-Yu, Fang Yen-Nan, Chen Yung-Lung, Huang David Kwan-Ru, Lee Fan-Yen, Chen Mien-Cheng,
Abstract
AIMS:
The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO ) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline-directed medical therapy (GDMT) era.
METHODS AND RESULTS:
We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all-cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO and HFSS in predicting primary outcomes. The median follow-up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P
CONCLUSIONS:
Optimizing the cutoff value of peak VO is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Postoperative morbidity and mortality in patients with diabetes after colorectal surgery with an enhanced recovery program: A monocentric retrospective study.
J Visc Surg2022 Nov;():. doi: S1878-7886(22)00157-6.
Lejeune D, Hardy P-Y, Kaba A, Joris J,
Abstract
BACKGROUND:
Diabetes mellitus may increase the risk of adverse perioperative outcomes and prolong hospital stay. An enhanced recovery program (ERP) reduces surgical stress and its metabolic consequences, so attenuating the impact of preoperative risk factors. We tested the hypothesis that diabetes would have only a minor impact on outcome after colorectal surgery with an ERP.
METHODS:
The data for patients scheduled for colorectal surgery between 2015 and 2021, were analyzed (n=769). All the patients were managed with the same protocol. Demographic data, preoperative risk factors, postoperative complications, and length of stay were compared between patients with and without diabetes.
RESULTS:
In all, 124 patients (16.1%) had diabetes, of whom 30 (24.1%) required insulin. The following preoperative risk factors for postoperative complications were significantly more frequent in the patients with diabetes: age>70 years, ASA score ? III, renal failure, cardiac disease, BMI>30 kg/m, anemia, and cancer as indication for surgery. Despite more risk factors, patients with diabetes did not experience more overall postoperative complications than controls (OR (95%IC): 0.9 [0.6-1.5], p=0.85). Length of hospital stay was not significantly longer in patients with diabetes than in those without (4 [2-7] vs. 3 [2-7] days; p=0.45).
CONCLUSIONS:
Despite more risk factors, patients with diabetes did not experience more complications or longer length of stay after colorectal surgery with an ERP. The multimodal, multidisciplinary approach of ERP to reducing surgical stress may thus help mitigate the reported deleterious effects of diabetes.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
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[Not Available].
Rev Port Cardiol2022 Nov;():. doi: S0870-2551(22)00488-7.
Silva Vasco, Vilela Eduardo M, Teixeira Madalena, Fontes-Carvalho Ricardo,
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Muscle Oxygenation of the Paretic and Nonparetic Legs During and After Exercise in Chronic Stroke: Implications for Mobility.
PM R2022 Dec;():. doi: 10.1002/pmrj.12927.
Whyte Elizabeth, Thomas Scott, Marzolini Susan,
Abstract
INTRODUCTION:
Oxygen delivery and demand are reduced in the paretic leg of post-stroke individuals. However, it is unknown how muscle oxygenation, the balance between delivery and utilization of oxygen at the muscle is altered post-stroke during aerobic exercise and how it relates to mobility.
OBJECTIVES:
The objective of this study was to monitor muscle oxygenation changes between the paretic and nonparetic legs of post-stroke individuals during treadmill exercise and the six-minute walk test and analyze the association with mobility.
DESIGN:
Cross-sectional study.
SETTING:
Cardiac rehabilitation program.
PATIENTS:
Eleven male subjects were enrolled in the study. Ten male subjects (30.8±4.1 months post-stroke; age 63.9±13.9?years) with hemiparetic gait pattern finished the study.
INTERVENTIONS:
Not applicable.
MAIN OUTCOME MEASURES:
Muscle oxygenation was measured with near-infrared spectroscopy placed on the vastus lateralis of each leg during treadmill exercise at the first ventilatory threshold and during a six-minute walk test.
RESULTS:
The desaturation slope during treadmill exercise was significantly steeper (p=0.047) in the paretic (-0.7±0.6%/s) compared to the nonparetic leg (-0.3±0.2%/s). There was no other significant difference between legs. The six-minute walk test distance was not correlated with six-minute walk test muscle oxygenation in either leg (paretic: r=0.20, p=0.590; nonparetic: r=0.42, p=0.232).
CONCLUSIONS:
At the onset of treadmill exercise, the paretic leg was unable to effectively match oxygen demand and extraction as well as the nonparetic leg, suggesting the need for an immediate cardiovascular warmup prior to initiating moderate intensity exercise in this population. Since the exercise desaturation rate is thought to indicate increased anaerobic metabolism and lactate production, efforts to delay rapid desaturation could improve sustainability of activities of daily living and exercise.
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Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis.
JMIR Mhealth Uhealth2022 Dec;10(12):e39593. doi: 10.2196/39593.
Cruz-Cobo Celia, Bernal-Jiménez María Ángeles, Vázquez-García Rafael, Santi-Cano María José,
Abstract
BACKGROUND:
Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions.
OBJECTIVE:
In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event.
METHODS:
A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I test.
RESULTS:
A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001 physical activity mean difference ci p=".03)," and adherence to treatment were significantly superior in the mhealth group. furthermore both mental dimensions of quality life better group smd="0.27," respectively addition hospital readmissions for all causes cardiovascular statistically higher control than vs>
CONCLUSIONS:
mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes.
TRIAL REGISTRATION:
PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931.
©Celia Cruz-Cobo, María Ángeles Bernal-Jiménez, Rafael Vázquez-García, María José Santi-Cano. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 02.12.2022.
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Frailty and rehabilitation outcome in older patients with cardiorespiratory disease: Preliminary multidimensional data.
Monaldi Arch Chest Dis2022 Dec;():. doi: 10.4081/monaldi.2022.2447.
Vigorè Martina, Granata Nicolo, Callegari Giovanna, Vaninetti Raffaella, Conti Simona, Maestri Roberto, Piaggi Giancarlo, Cremonese Gioele, Pierobon Antonia,
Abstract
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with cognitive dysfunctions, psychological distress, poor quality of life (QoL), and functional worsening. In addition, since patients suffering from these conditions are often older adults, frailty syndrome represented a further and important issue to be investigated. The present preliminary study aimed to perform a multidimensional assessment of CHF COPD older patients (age ?65) undergoing cardiac or pulmonary rehabilitation. The characteristics of the included patients (30 CHF and 30 COPD) resulted almost similar, except for the COPD patients' longer duration of illness and better performances in Addenbrooke's cognitive examination III subtests and short physical performance battery (SPPB). No significant differences were found in the frailty evaluation, but a consistent number of patients resulted to be frail (CHF=36.7% vs COPD=26.6%). After the rehabilitation program, a significant improvement was found in the whole sample concerning the executive functions (14.34±2.49 vs 15.62±2.22, p=0.001), quality of life (58.77±18.87 vs 65.82±18.45, p=0.003), depressive and anxious symptoms (6.27±4.21 vs 3.77±3.39, p=0.001 and 5.17±3.40 vs 3.38±3.21, p=0.001), frailty status [4.00 (3.00,5.00) vs 3.00 (3.00,5.00) p=0.035] and functional exercise abilities [SPPB, 7.40±3.10 vs 9.51±3.67, p=0.0002; timed up and go test, 14.62±4.90 vs 11.97±4.51, p=
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