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Pubblicazioni recenti - cardiac rehabilitation
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Voluntary exercise training attenuated the middle-aged maturity-induced cardiac apoptosis.
Life Sci2020 Aug;():118187. doi: S0024-3205(20)30939-5.
Cui Jia-Wen, Hong Yi, Kuo Yu-Min, Yu Shao-Hong, Wu Xu-Bo, Cui Zhen-Yang, Lee Shin-Da,
Abstract
AIMS:
Voluntary exercise training has cardioprotective effects in humans, but the underlying mechanism is unknown. This research was done to estimate the effect of voluntary exercise training to attenuate middle-aged maturity-induced cardiac apoptosis.
MATERIALS AND METHODS:
The study was designed to divide 64 male mice randomly into four groups, consisting of a 9-month sedentary pre-middle-aged group (9M), 15-month sedentary middle-aged group (15M), and two exercise groups using a voluntary wheel running respectively (9M+EX, 15M+EX). After 3?months, the condition of cardiac apoptosis in different groups was measured by HE dying, TUNEL and DAPI staining, and Western Blot analysis.
KEY FINDINGS:
HW, HW/BW and CS in exercise groups were higher compared with their control groups respectively. TUNEL-positive cells were increased in 15M group compared with 9M group, while decreased in 9M+EX and 15M+EX groups compared with their control groups respectively. Protein levels of AIF, Endo G, TNF-?, TNFR1, TRAF2, TRADD, Fas, FASL, FADD, activated caspase 8, 3, 9, Bax/Bcl2, Bak/BclxL, and tBid were decreased in 9M+EX and 15M+EX groups compared with their control groups respectively. The protein levels of pBad/Bad, 14-3-3, IGF1, IGFR1, pPI3K/PI3K, and pAKT/AKT were more activated in the 9M+EX and 15M+EX groups than those in their control groups respectively. Significant differences were found between 9M group and 15M group for the protein levels of TRAF2, FADD, Bax/Bcl2, tBid and pAKT/AKT.
SIGNIFICANCE:
Voluntary exercise training as an important lifestyle modification may prevent cardiac widely dispersed apoptosis and enhance cardiac survival at middle-aged maturity.
Copyright © 2018. Published by Elsevier Inc.
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The scientific basis for secondary prevention of coronary artery disease: recent contributions from the Netherlands.
Neth Heart J2020 Aug;28(Suppl 1):136-140. doi: 10.1007/s12471-020-01450-w.
Jørstad H T, Snaterse M, Ter Hoeve N, Sunamura M, Brouwers R, Kemps H, Scholte Op Reimer W J M, Peters R J G,
Abstract
While the beneficial effects of secondary prevention of cardiovascular disease are undisputed, implementation remains challenging. A gap between guideline-mandated risk factor targets and clinical reality was documented as early as the 1990s. To address this issue, research groups in the Netherlands have performed several major projects. These projects address innovative, multidisciplinary strategies to improve medication adherence and to stimulate healthy lifestyles, both in the setting of cardiac rehabilitation and at dedicated outpatient clinics. The findings of these projects have led to changes in prevention and rehabilitation guidelines.
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Updates in Spontaneous Coronary Artery Dissection.
Curr Cardiol Rep2020 Aug;22(10):123. doi: 10.1007/s11886-020-01378-y.
Krittanawong Chayakrit, Saw Jacqueline, Olin Jeffrey W,
Abstract
PURPOSE OF REVIEW:
To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data.
RECENT FINDINGS:
SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. After reviewing the current evidence to date, we recommend conservative management, including cardiac rehabilitation for SCAD with low-risk features, while coronary revascularization should be considered in SCAD with high-risk features. Non-invasive imaging (e.g., coronary computed tomography angiography, cardiac magnetic resonance, myocardial perfusion imaging) should be considered in diagnosing specific SCAD phenotypes. The standard guideline-based medical therapy for acute coronary syndrome, in the absence of contraindications, should be considered along with appropriate SCAD phenotypes. Discharge counseling and follow-up using emerging imaging modalities should be based on individuals' profiles and approached on a case by case basis.
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A Call for Preventive Medicine Attention for Indonesian Physicians.
Acta Med Indones2020 Apr;52(2):99-101.
Pramono Laurentius Aswin,
Abstract
The year of 2020 teaches us to prevent is always better than to cure. It is an old phrase that is being used for decades, but it is never been implemented cordially by our society nowadays. Covid-19 is a good lesson that reminds us to carefully prevent the spread of coronavirus which is now a pandemic worldwide. People now wash their hands more often and clean, wear a mask everywhere - everytime, do physical distancing, do healthy lifestyle such as physical activity, healthy diet, and consume multivitamins. They obey the cough and sneeze etiquette. Prevention awareness is never been such popular like todays.For internal medicine specialist, the role for prevention is very broad. Besides we still have a role in primary prevention, we can take our part in both secondary and (of course) tertiary prevention. Primary prevention can be defined as an action not allow a disease to occur, for examples vaccination (for internal medicine specialist more specific as adult vaccination), smoking cessation, physical activity (exercise) and healthy diet. Health promotion and prevention is the core of primary prevention. Secondary prevention aims to detect the disease as early as possible, in at risk population, such as mammography for breast cancer, swab test for Covid-19, colonoscopy for colon cancer in high risk patients. Last, tertiary prevention propose to hamper the progress of clinical disease and prevent more severe complications of the disease, for examples cardiac rehabilitation, or medications for prevent chronic kidney disease in patients with diabetes or hypertension. It is overlapping the curative or treatment strategies as it is states "to cure is to prevent". In 2020, in which each underlying conditions require effective treatment and each disease should be prevented. We are now facing the era of preventive medicine. As an internal medicine specialist, we need to put in mind a philosophy of prevention in every of our action towards patient's care and services.
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Identifying elements for a comprehensive paediatric cardiac rehabilitation programme.
Cardiol Young2020 Aug;():1-9. doi: 10.1017/S1047951120002346.
Curran Tracy, Gauthier Naomi, Duty Susan M, Pojednic Rachele,
Abstract
INTRODUCTION:
The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.
METHODS:
A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.
RESULTS:
Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.
CONCLUSION:
This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
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Clinical Outcome of Right Ventricular Outflow Tract Stenting Versus Blalock-Taussig Shunt in Tetralogy of Fallot: A systematic Review and Meta-Analysis.
Curr Probl Cardiol2020 Jun;():100643. doi: S0146-2806(20)30120-1.
Ghaderian Mehdi, Ahmadi Alireza, Sabri Mohammad Reza, Behdad Samin, Dehghan Bahar, Mahdavi Chehreh, Mansourian Marjan, Shahsanaei Farzad,
Abstract
AIM:
Several studies assessed the effectiveness of different therapeutic procedures for repairing right ventricular outflow tract (RVOT) in tetralogy of Fallot (TOF) patients reporting contradictory results. What has been systematically summarized in the present study was to assess the outcome of RVOT stenting in TOF patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure.
METHODS AND RESULTS:
This study was performed according to established methods and in compliance with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. Two investigators searched the manuscript databases including Medline, Web of knowledge, Google scholar, Scopus, and Cochrane Central Register of Controlled Trials in the Cochrane Library for all eligible studies in accordance with the considered keywords. In final, 10 articles were eligible for the final analysis. The pooled success rate of RVOT stenting was found to be 93.6% (95% confidence interval [CI]: 89.6% to 96.2%). The overall improvement in arterial oxygen saturation following RVOT stenting was also shown to be 20.1%% (95% CI: 15.8% to 25.3%). The procedural-related death was also 3.7% (95% CI: 1.9% to 7.3%). The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation (Odds ratio = 1.419, 95% CI: 0.645 to 3.123, P= 0.384) and death rate (risk ratios?=?0.341, 95% CI: 0.057 to 2.024, P= 0.236).
CONCLUSION:
RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels. Classifications: Right Ventricular Outflow Tract (RVOT), Tetralogy Of Fallot (TOF), BT shunt.
CONDENSED ABSTRACT:
Aim: Present study was to assess the outcome of right ventricular outflow tract (RVOT) stenting in tetralogy of Fallot (TOF) patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure.
METHODS AND RESULTS:
This study was performed according to established methods and in compliance with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. In final, 10 articles were eligible for the final analysis. The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation and death rate.
CONCLUSION:
RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Lung Ultrasound in COVID-19 A Role Beyond the Acute Phase?
J Ultrasound Med2020 Aug;():. doi: 10.1002/jum.15425.
Gaspardone Carlo, Meloni Carlo, Preda Alberto, Romagnolo Davide, Brugliera Luigia, Castellazzi Paola, Tettamanti Andrea, Conte Caterina, Secchi Antonio, Maranta Francesco, Iannaccone Sandro, Cianflone Domenico,
Abstract
OBJECTIVES:
Coronavirus disease 2019 (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2. With the increasing number of improved and discharged patients with COVID-19, the definition of an adequate follow-up strategy is needed. The purpose of this study was to assess whether lung ultrasound (LUS) is an effective indicator of subclinical residual lung damage in patients with COVID-19 who meet discharge criteria.
METHODS:
We prospectively enrolled 70 consecutive patients with COVID-19 who had a prolonged hospitalization with inpatient rehabilitation between April 6 and May 22, 2020. All of the patients underwent an LUS evaluation at discharge. Data of patients with more severe disease during the acute phase (ie, required ventilatory support) were compared to those of patients with milder disease.
RESULTS:
Among the 70 patients with COVID-19 (22 women and 48 men; mean age?±?SD, 68?±?13?years), the LUS score before discharge was still frankly pathologic and higher in patients who had more severe disease during the acute phase compared to patients with milder disease (median [interquartile range], 8.0 [5.5-13.5] versus 2.0 [1.0-7.0]; P?
CONCLUSIONS:
Lung ultrasound can identify the persistence of subclinical residual lung damage in patients with severe COVID-19 even if they meet discharge criteria. Considering the low cost, easy application, and lack of radiation exposure, LUS seems the ideal tool to be adopted in outpatient and primary care settings for the follow-up of patients with COVID-19.
© 2020 American Institute of Ultrasound in Medicine.
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Ventilatory efficiency during ramp exercise in relation to age and sex in a healthy Japanese population.
J Cardiol2020 Aug;():. doi: S0914-5087(20)30249-5.
Ashikaga Kohei, Itoh Haruki, Maeda Tomoko, Itoh Hidetaka, Ichikawa Yuri, Tanaka Shiori, Ajisaka Ryuichi, Koike Akira, Makita Shigeru, Omiya Kazuto, Kato Yuko, Adachi Hitoshi, Nagayama Masatoshi, Tajima Akihiko, Harada Naomi, Akashi Yoshihiro J, ,
Abstract
BACKGROUND:
The current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V?E) to the ramp exercise test in the normal Japanese population are not known.
METHODS:
A total of 529 healthy Japanese subjects aged 20-78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V?E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V?E versus carbon dioxide (V?CO) (V?E vs. V?CO slope), minimum V?E/V?CO, and oxygen uptake efficiency slope (OUES) were determined.
RESULTS:
For males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V?E (V?Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V?E vs. V?CO slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V?E/V?CO was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V?Epeak decreased with age and increased with weight and height. The V?E vs. V?CO slope and minimum V?E/V?CO increased with age, while conversely, the OUES decreased with age.
CONCLUSIONS:
We have established the normal range of VT and V?E responses, the V?E vs. V?CO slope, the minimum V?E/V?CO, and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients.
Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction.
Head Neck2020 Aug;():. doi: 10.1002/hed.26371.
Cohen William, Mirzai Saeid, Combs Pamela, Rose Rebecca, Kagan Viktoriya, Correia Camil, Gottlieb Lawrence J, Song Tae,
Abstract
BACKGROUND:
Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients.
METHODS:
We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway.
RESULTS:
By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74?days of ECMO.
CONCLUSION:
ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.
© 2020 Wiley Periodicals LLC.
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Feasibility of studying the association between intraoperative regional cerebral oxygen saturation and postoperative functional decline (ReFUNCTION): a pilot sub-study of NeuroVISION-Cardiac Surgery.
Can J Anaesth2020 Aug;():. doi: 10.1007/s12630-020-01777-3.
Spence Jessica, Lamy Andre, Bosch Jackie, Thabane Lehana, Gagnon Stephanie, Power Patricia, Browne Austin, Murkin John, Devereaux P J,
Abstract
PURPOSE:
Function describes an individual's ability to perform everyday activities. In the context of cardiac surgery, functional changes quantify the effect of surgery on one's day-to-day life. Decreases in regional cerebral oxygen saturation (rScO) measured using near-infrared spectroscopy (NIRS) has been associated with postoperative cognitive decline but its relationship with function has not been studied. We sought to determine the feasibility of conducting a large observational study examining the relationship between decreases in rScO during cardiac surgery and postoperative functional decline.
METHODS:
We undertook a single-centre, pilot sub-study of the NeuroVISION-Cardiac Surgery pilot study, which included adults undergoing isolated coronary artery bypass grafting on cardiopulmonary bypass; all patients enrolled in NeuroVISION-Cardiac Surgery were included. Function was evaluated at baseline, 30 days, and three months using the Standardized Assessment of Global activities in the Elderly (SAGE) scale. Blinded NIRS monitors were affixed for the duration of surgery. Our feasibility outcomes were to recruit one patient per week, obtain complete NIRS data in ? 90%, obtain SAGE at all time-points in ? 90%, and determine the time required for NIRS data to be transcribed into case report forms.
RESULTS:
49/50 patients enrolled in NeuroVISION-Cardiac Surgery were recruited over 48 weeks (1.02 patients/week). Of the 49 included patients, 49 (100%) had complete NIRS data and 44 (90%) had complete SAGE data. The time required for NIRS data collection was a mean (standard deviation) of 5.5 (1.8) min per patient.
CONCLUSION:
This pilot study shows the feasibility of conducting a large observational study examining the relationship between decreases in cerebral saturation during cardiac surgery and postoperative functional decline.
TRIAL REGISTRATION:
www.clinicaltrials.gov (NCT04241289); registered 27 January 2020.
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Positive psychology in health care: defining key stakeholders and their roles.
Transl Behav Med2020 Aug;10(3):637-647. doi: 10.1093/tbm/ibz150.
Lianov Liana S, Barron Grace Caroline, Fredrickson Barbara L, Hashmi Sean, Klemes Andrea, Krishnaswami Janani, Lee Jenny, Le Pertel Noémie, Matthews Jessica A, Millstein Rachel A, Phillips Edward M, Sannidhi Deepa, Purpur de Vries Patty, Wallace Anne, Winter Sandra J,
Abstract
Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.
Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2020.
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Pulmonary Artery Banding for Ventricular Rehabilitation in Infants With Dilated Cardiomyopathy: Early Results in a Single-Center Experience.
Front Pediatr2020 ;8():347. doi: 10.3389/fped.2020.00347.
Di Candia Angela, Castaldi Biagio, Bordin Giulia, Cerutti Alessia, Reffo Elena, Biffanti Roberta, Di Salvo Giovanni, Vida Vladimiro L, Padalino Massimo A,
Abstract
Pulmonary artery banding (PAB) is reported as an innovative strategy for children with end-stage heart failure (ESHF) to bridge to transplantation or recovery. We report our early experience with PAB to evaluate outcomes, indications, and limitations. This is a single-center prospective clinical study, including infants and children admitted for ESHF owing to dilated cardiomyopathy (DCM) with preserved right ventricular function after failure of maximal conventional therapy. All patients underwent perioperative anticongestive medical therapy with ACE inhibitor, beta blocker, and spironolactone. Post-operatively, all patients underwent echocardiographic follow-up to assess myocardial recovery. We selected five patients (four males) who underwent PAB at a median age of 8.6 months (range 3.9-42.2 months), with preoperative ejection fraction (EF) <30%. Sternal closure was delayed in all. One patient did not improve after PAB and underwent Berlin Heart implantation after 33 days, followed by heart transplant after 13 months. Four patients were discharged home on full anticongestive therapy. However, 2 months after discharge, one patient experienced severe acute heart failure secondary to pneumonia, which required mechanical circulatory support, and the patient underwent a successful heart transplant after 21 days. The remaining three patients are doing well at home, 22.4, 16.9, and 15.4 months after PAB. They all underwent elective percutaneous de-banding, 18.5, 4.8, and 10.7 months after PAB. EF increased from 17.7 ± 8.5% to 63.3 ± 7.6% ( = 0.03), and they have all been delisted. Use of PAB may be an effective alternative to mechanical support in selected infants for bridging to transplant or recovery. Better results seem to occur in patients aged <12 months. Further experience and research are required to identify responders and non-responders to this approach.
Copyright © 2020 Di Candia, Castaldi, Bordin, Cerutti, Reffo, Biffanti, Di Salvo, Vida and Padalino.
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Psychosocial Cardiological Schedule-Revised (PCS-R) in a Cardiac Rehabilitation Unit: Reflections Upon Data Collection (2010-2017) and New Challenges.
Front Psychol2020 ;11():1720. doi: 10.3389/fpsyg.2020.01720.
Granata Nicolò, Nissanova Ekaterina, Torlaschi Valeria, Ferrari Marina, Vigorè Martina, Sommaruga Marinella, Angelino Elisabetta, Rizza Claudia, Caprino Alessandra, Pierobon Antonia,
Abstract
Introduction:
The Psychosocial Cardiological Schedule (PCS) was developed as a screening tool for patients undergoing cardiac rehabilitation (CR) to detect clinically relevant psychosocial/cognitive problems requiring psychological assessment/intervention. Filled out by a trained nurse, it classifies patients according to their need or not for a psychological interview and intervention provided by the psychologist (PCS-Yes vs. PCS-No).
Aims:
The main aim was to compare PCS data collected, respectively, in 2010 and 2017, regarding patients' socio-demographic characteristics, clinical variables, and the inclusion criteria for psychological counseling. Subsequently, the original Italian PCS was revised and an English version of the schedule was provided [PCS-Revised (PCS-R)].
Results:
28 patients (aged 53.5 + 12.6 years, M = 20) of the 87 recruited in 2010 vs. 35 (aged 64.9 + 12.7 years, M = 28) of the 83 recruited in 2017 met the criteria for PCS-Yes: age < 55 years, social problems (living alone, no social support), manifest psychological/behavioral problems, suspected neuropsychological disorders, low prescription adherence, inadequate disease awareness. Comparing the two samples (2010 vs. 2017), clinical variables were similar, and the need for a psychological interview did not differ substantially (32.2 vs. 42.2%), but age increased significantly (PCS-Yes: 53.5 ± 12.6 vs. 64.9 ± 12.7 years, = 0.001; PCS-No: 68.3 ± 8.0 vs. 75.0 ± 7.7 years, = 0.0001). A significant increase was observed in the recommendation for neuropsychological assessment (3.6 vs. 25.7%, = 0.02) to confirm eventual cognitive deficits. These results, the clinical experience, and the recent evidences from literature led to the PCS-R, incorporating a psychosocial screening, a psychological/neuropsychological deeper assessment, and a recommendation for a specific intervention to be carried out either during rehabilitation or in outpatient services.
Conclusion:
The data comparison highlight changes in the cardiac population, which is aging and more frequently requires neuropsychological assessment. The PCS-R could be considered in clinical practice as a useful screening tool to implement a timely coordinated interdisciplinary intervention, comprehensive of specific and tailored psychotherapeutic techniques.
Copyright © 2020 Granata, Nissanova, Torlaschi, Ferrari, Vigorè, Sommaruga, Angelino, Rizza, Caprino and Pierobon.
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SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media.
Clin Mol Allergy2020 ;18():13. doi: 10.1186/s12948-020-00128-3.
Costantino Maria Teresa, Romanini Laura, Gaeta Francesco, Stacul Fulvio, Valluzzi Rocco Luigi, Passamonti Matteo, Bonadonna Patrizia, Cerri Giovanni, Pucci Stefano, Ricci Paolo, Savi Eleonora, Galluzzo Michele, Mauro Marina, Grassedonio Emanuele, Yacoub Mona Rita, Reginelli Alfonso, Testi Sergio, Ridolo Erminia, Nettis Eustacchio, Di Leo Elisabetta, Rossi Oliviero, Montuschi Paolo, Incorvaia Cristoforo, Romano Antonino,
Abstract
Hypersensitivity reactions (HRs) to contrast media (CM) can be distinguished in immune-mediated (including allergic reactions) and non-immune-mediated reactions, even if clinical manifestations could be similar. Such manifestations range from mild skin eruptions to severe anaphylaxis, making it important for radiologists to know how to identify and manage them. A panel of experts from the Società Italiana di Radiologia Medica e Interventistica (SIRM) and the Società Italiana di Allergologia, Asma e Immunologia Clinica (SIAAIC) provided a consensus document on the management of patients who must undergo radiological investigations with CM. Consensus topics included: the risk stratification of patients, the identification of the culprit CM and of a safe alternative by an allergy workup, as well as the use of premedication and the correct procedure to safely perform an elective (i.e., scheduled) or urgent examination. The most important recommendations are: (1) in all patients, a thorough medical history must be taken by the prescribing physician and/or the radiologist to identify at-risk patients; (2) in patients with hypersensitivity reactions to CM, the radiologist must consider an alternative, non-contrast imaging study with a comparable diagnostic value, or prescribe a different investigation with another class of CM; (3) if such options are not feasible, the radiologist must address at-risk patients to a reference centre for an allergy evaluation; (4) if timely referral to an allergist is not viable, it is recommended to use a CM other than the responsible one, taking into account cross-reactivity patterns; in the case of patients with histories of severe reactions, the presence of an anesthesiologist is also recommended and a premedication is suggested.
© The Author(s) 2020.
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Beneficial Effects of Baduanjin Exercise on Left Ventricular Remodelling in Patients after Acute Myocardial Infarction: an Exploratory Clinical Trial and Proteomic Analysis.
Cardiovasc Drugs Ther2020 Aug;():. doi: 10.1007/s10557-020-07047-0.
Mao Shuai, Zhang Xiaoxuan, Chen Minggui, Wang Chuyang, Chen Qubo, Guo Liheng, Zhang Minzhou, Hinek Aleksander,
Abstract
BACKGROUND:
The beneficial effects of physical exercise on cardiac remodelling improvement after myocardial infarction have already been suggested. However, the results of previous clinical trials have not been consistent. Moreover, the putative molecular mechanisms leading to the clinically observed effects of physical exercise still remain elusive.
AIM:
We aimed to evaluate whether the well-defined and strictly controlled traditional Chinese Qigong Baduanjin exercise (BE) would attenuate the adverse left ventricular (LV) remodelling in patients with ST-elevation myocardial infarction (STEMI).
METHODS:
A total of 110 clinically stable STEMI patients, following successful revascularization of their infarcted coronary arteries, were randomized and enrolled in two groups: 56 were subjected to a 12-week BE-based cardiac rehabilitation programme (BE group), and the remaining 54 were exposed to the usual physical exercise (control group) for the same time period. The primary outcome was the change from baseline to 6 months in the echocardiographic LV end-diastolic volume index (?LVEDVi). Proteomic analysis was also performed to uncover associated mechanisms.
RESULTS:
Compared with the control group, the BE group showed significantly lower ?LVEDVi (-5.1?±?1.1 vs. 0.3?±?1.2 mL/m, P?
CONCLUSION:
This is the first study indicating that BE in STEMI patients can alleviate adverse LV remodelling associated with beneficial energy metabolism adaptation, inflammation curbing, and extracellular matrix organization adjustment.
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2020 French recommendations on the management of septic arthritis in an adult native joint.
Joint Bone Spine2020 Aug;():. doi: S1297-319X(20)30148-2.
Marion Couderc, Géraldine Bart, Guillaume Coiffier, Sophie Godot, Raphaele Seror, Jean-Marc Ziza, Pascal Coquerelle, Christelle Darrieutort-Laffite, Christian Lormeau, Carine Salliot, Eric Veillard, Louis Bernard, Marion Baldeyrou, Thomas Bauer, Beate Hyem, Robert Touitou, Bernard Fouquet, Denis Mulleman, René-Marc Flipo, Pascal Guggenbuhl, ,
Abstract
Septic arthritis (SA) in an adult native joint is a rare condition but a diagnostic emergency due to the morbidity and mortality and the functional risk related to structural damage. Current management varies and the recommendations available are dated. The French Rheumatology Society (SFR) Bone and Joint Infection Working Group, together with the French Language Infectious Diseases Society (SPILF) and the French Orthopaedic and Trauma Surgery Society (SOFCOT) have worked according to the HAS methodology to devise clinical practice recommendations to diagnose and treat SA in an adult native joint. One new focus is on the importance of microbiological documentation (blood cultures and joint aspiration) before starting antibiotic treatment, looking for differential diagnoses (microcrystal detection), the relevance of a joint ultrasound to guide aspiration, and the indication to perform a reference X-ray. A cardiac ultrasound is indicated only in cases of SA involving Staphylococcus aureus, oral streptococci, Streptococcus gallolyticus or Enterococcus faecalis, or when infective endocarditis is clinically suspected. Regarding treatment, we stress the importance of medical and surgical collaboration. Antibiotic therapies (drugs and durations) are presented in the form of didactic tables according to the main bacteria in question (staphylococci, streptococci and gram-negative rods). Probabilistic antibiotic therapy should only be used for patients with serious symptoms. Lastly, non-drug treatments such as joint drainage and early physical therapy are the subject of specific recommendations.
Copyright © 2020. Published by Elsevier Masson SAS.
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Cardiac Rehabilitation and Endothelial Function.
J Clin Med2020 Aug;9(8):. doi: E2487.
Lanza Gaetano Antonio, Golino Michele, Villano Angelo, Lanza Oreste, Lamendola Priscilla, Fusco Augusto, Leggio Massimo,
Abstract
Endothelial dysfunction is an early abnormality in the process of atherosclerosis and cardiovascular disease and has been associated with worse clinical outcome. Cardiac rehabilitation (CR) has been reported to be helpful to reduce cardiovascular events in various types of cardiac disease, but the mechanisms of its beneficial effects remain only partially known. In this article, we review the studies that assessed the effect of CR on endothelial function in patients with various cardiac conditions. Available data show that CR significantly improves impaired endothelial function in these patients, which may contribute to the beneficial effects of CR on clinical outcome.
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Effects of Yangxinshi tablet on exercise tolerance in patients with coronary heart disease: A protocol of randomized, double-blind, placebo-controlled, and multi-center trial.
Medicine (Baltimore)2020 Jul;99(31):e21485. doi: 10.1097/MD.0000000000021485.
Zhang Sisi, Liang Congying, Yang Yang, Zhao Zhijia, Li Jiaojiao, Meng Xiaoping,
Abstract
BACKGROUND:
Exercise intolerance is very common in patients with coronary heart disease (CHD). Although some researches confirming the validation of traditional Chinese medicine (TCM) on CHD treatment, the effect of TCM on improving the exercise tolerance of patients with CHD remains unclear so far. Our trial is to investigate whether the Yangxinshi (YXS) tablet can improve exercise tolerance as well as the quality of life among CHD patients.
METHODS:
It is a randomized, double-blind, placebo-controlled, multi-center trial. A total of 90 patients with CHD from 3 hospitals in China will be enrolled and randomly assigned to one of 2 groups: YXS group, N?=?45; placebo group, N?=?45. The 2 groups will simultaneously receive standardized western medicine and exercise-based cardiac rehabilitation program for 12 weeks. The primary outcome measure is the exercise capacity, which will be evaluated by the cardiopulmonary exercise test and 6-minute walking test. The 2nd outcomes include symptom improvement, psychologic issues, laboratory tests, side effects, and adverse events.
DISCUSSION:
To our knowledge, it is the 1st randomized controlled trial to evaluate the effect of TCM YXS tablet on exercise tolerance in patients with CHD. The results will provide more evidence for future studies in this area.
TRIAL REGISTRATION:
This study protocol was registered in Research Registry (researchregistry5752).
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The role and effectiveness of self-management in a home-based cardiac rehabilitation program: A protocol for systematic review and meta analysis.
Medicine (Baltimore)2020 Jul;99(31):e20972. doi: 10.1097/MD.0000000000020972.
Zhang Sisi, Liang Congying, Zhang Jingxian, Yang Xue, Meng Xiaoping,
Abstract
BACKGROUND:
Home-based cardiac rehabilitation is considered as an alternative strategy of cardiac rehabilitation, aims to enhance patients participation rate. Since it emphasizes patients subjective initiative, patients require a better understanding of their illness and manage their conditions. We perform this systematic review and meta-analysis to identify the role and effectiveness of the self-management program in home-based cardiac rehabilitation.
METHOD:
We conduct the search strategy from an online database: PubMed, web of science, CINAL, EMBASE, OVID/Medline, and google scholar. Studies meet the inclusion criterion and published in the English language in recent 10 years will be screened by 2 independent reviewers. Then they extract data and assess the risk of bias. The disagreement between them will be resolved by the third reviewer. Data analysis is performed by Review Manager (Version 5.3).
RESULT:
This is systematic review and meta-analysis will identify the role of self-management in home-based cardiac rehabilitation program and evaluate its effectiveness.
CONCLUSION:
The findings of this study will be published in a related peer-reviewed journal.Protocol registration number: INPLASY202050093.
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Effects of real-time feedback on cardiopulmonary resuscitation quality on outcomes in adult patients with cardiac arrest: A systematic review and meta-analysis.
Resuscitation2020 Aug;():. doi: S0300-9572(20)30301-4.
Wang Shao-An, Su Chan-Ping, Fan Hsien-Yu, Hou Wen-Hsuan, Chen Yang-Ching,
Abstract
AIM:
To investigate the relationship between the implementation of real-time audiovisual cardiopulmonary resuscitation (CPR) feedback devices with cardiac arrest patient outcomes, such as return of spontaneous circulation (ROSC), short-term survival, and neurological outcome.
METHODS:
We systematically searched PubMed, Embase, and the Cochrane CENTRAL from inception date until April 30, 2020, for eligible randomized and nonrandomized studies. Pooled odds ratio (OR) for each binary outcome was calculated using R system. The primary patient outcome was ROSC. The secondary outcomes were short-term survival and favorable neurological outcomes (cerebral performance category scores: 1 or 2).
RESULTS:
We identified 11 studies (8 nonrandomized and 3 randomized studies) including 4,851 patients. Seven studies documented patients with out-of-hospital cardiac arrest and four studies documented patients with in-hospital cardiac arrest. The pooled results did not confirm the effectiveness of CPR feedback device, possibly because of the high heterogeneity in ROSC (OR: 1.42, 95% CI: 1.03-1.94, I: 80%, tau: 0.1875, heterogeneity test p?
CONCLUSIONS:
Whether real-time CPR feedback devices can improve patient outcomes (ROSC and short-term survival) depend on the type of device used. Portable devices led to better outcomes than did AED-associated devices. Future studies comparing different types of devices are required to reach robust conclusion.
PROTOCOL REGISTRATION:
Prospero registration ID CRD42020155388.
Copyright © 2020. Published by Elsevier B.V.
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