Worldwide > 50,000 hematopoietic stem cell transplants (HSCTs) are performed annually. HSCT patients receive multiple cardiotoxic therapies (chemotherapy and radiation therapy) in addition to severe ...physical deconditioning during hospital admission. We hypothesized that guided exercise in a cardiac rehabilitation (CR) program following autologous HSCT is a safe and feasible intervention.
Pilot project to assess for safety, feasibility and impact of 8 weeks of CR in HSCT patients following transplant. Consecutive patients with lymphoma underwent standard activity protocol testing before HSCT, at 6 weeks following HSCT (prior to CR), and at 14 weeks following HSCT (at completion of CR), consisting of grip strength (GS), gait speed (GtS), timed up-and-go (TUG), and 6-minute walk test (6MWT). CR consisted of 8 weekly visits for guided exercise.
Activity tolerance protocol data of 30 patients (24 male, 6 female) from December 2014 to December 2016 were analyzed using repeated measures (analysis of variance ANOVA) to observe for changes in GS, GtS, TUG, and 6MWT. Statistically significant improvements were found in GS (P < 0.005), GtS (P = 0.02), and 6MWT (P = 0.001). These improvements show that guided CR-based exercise may assist HSCT survivors to meet or even surpass baseline exercise levels and improve physical functioning. There were no adverse events (ie, death or injury) during the study period. Fifty-seven percent of referred patients participated in CR, exceeding documented CR adherence in cardiac populations.
The addition of CR-based exercise programming in HSCT survivorship care of patients with lymphoma is a safe and feasible intervention to assist in recovery following transplant.
Chaque année, plus de 50 000 greffes de cellules souches hématopoïétiques (GCSH) sont réalisées dans le monde. Les patients ayant subi une GCSH reçoivent de nombreux traitements cardiotoxiques (chimiothérapie et radiothérapie) et subissent de surcroît une perte importante de leur forme physique durant l’hospitalisation. Nous avons posé l’hypothèse que des exercices guidés dans le cadre d’un programme de réadaptation cardiaque (RC) après une GCSH autologue constituent une intervention sûre et réalisable.
L’étude pilote avait pour objectif d’évaluer l’innocuité, la faisabilité et les répercussions d’une RC de 8 semaines chez les patients après la GCSH. Des patients consécutifs atteints d’un lymphome ont subi avant la GCSH, 6 semaines après la GCSH (avant la RC) et 14 semaines après la GCSH (après la RC) les épreuves d’un protocole d’activités standardisées qui consistaient en la force de préhension (FP), la vitesse de marche (VM), l’épreuve chronométrée Timed Up-and-Go (TUG) et le test de marche de 6 minutes (TM6). La RC comptait 8 séances d’exercices guidés hebdomadaires.
Nous avons utilisé l’analyse de variance à mesures répétées (ANOVA) pour traiter les données du protocole de tolérance à l’exercice de 30 patients (24 hommes, 6 femmes) de décembre 2014 à décembre 2016 et avons observé des changements dans la FP, la VM, la TUG et le TM6. Sur le plan statistique, nous avons observé des améliorations importantes de la FP (P < 0,005), de la VM (P = 0,02) et du TM6 (P = 0,001). Ces améliorations démontrent que les exercices guidés en RC peuvent aider les survivants de GCSH à atteindre ou même à dépasser le niveau d’exercices initial et à améliorer leur fonctionnement physique. Nous n’avons noté aucun événement indésirable (c.-à-d. la mort ou les blessures) durant la période d’étude. Cinquante-sept pour cent des patients orientés en RC y ont participé, c’est-à-dire une participation qui excède l’observance à la RC décrite dans la documentation sur les populations cardiaques.
L’ajout d’exercices au programme de RC dans le cadre des soins offerts aux patients atteints d’un lymphome qui ont survécu à la GCSH constitue une intervention sûre et réalisable pour favoriser leur rétablissement à la suite de la transplantation.
IMPORTANCE: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The ...role of TAVI in patients at lower risk is unclear. OBJECTIVE: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS: Among 913 patients randomized (median age, 81 years IQR, 78 to 84 years; 424 46% were female; median Society of Thoracic Surgeons mortality risk score, 2.6% IQR, 2.0% to 3.4%), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days IQR, 2 to 5 days vs 8 days IQR, 6 to 13 days in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio HR, 0.33 95% CI, 0.24 to 0.45) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 95% CI, 2.54 to 7.71), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 95% CI, 1.43 to 2.94), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe no instance of severe reported aortic regurgitation combined vs none, 4.89 95% CI, 3.08 to 7.75). CONCLUSIONS AND RELEVANCE: Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN57819173
Abstract Atrial fibrillation (AF) is an extremely common clinical problem with an important population morbidity and mortality burden. The management of AF is complex and fraught with many uncertain ...and contentious issues, which are being addressed by extensive ongoing basic and clinical research. The Canadian Cardiovascular Society AF Guidelines Committee produced an extensive set of evidence-based AF management guidelines in 2010 and updated them in the areas of anticoagulation and rate/rhythm control in 2012. In late 2013, the committee judged that sufficient new information regarding AF management had become available since 2012 to warrant an update to the Canadian Cardiovascular Society AF Guidelines. After extensive evaluation of the new evidence, the committee has updated the guidelines for: (1) stroke prevention principles; (2) anticoagulation of AF patients with chronic kidney disease; (3) detection of AF in patients with stroke; (4) investigation and management of subclinical AF; (5) left atrial appendage closure in stroke prevention; (6) emergency department management of AF; (7) periprocedural anticoagulation management; and (8) rate and rhythm control including catheter ablation. This report presents the details of the updated recommendations, along with their background and rationale. In addition, a complete set of presently applicable recommendations, those that have been updated and those that remain in force from previous guideline versions, is provided in the Supplementary Material.
OBJECTIVES
The purpose of this study was to investigate the relationship between arterial and coronary sinus endothelin (ET) concentrations and coronary vasomotor responses during rapid atrial pacing ...in patients with chest pain and normal coronary arteriograms (CPNA).
BACKGROUND
Plasma ET concentrations are significantly higher in CPNA patients than in healthy control subjects.
METHODS
We investigated 19 carefully characterized CPNA patients (14 women; mean age 53 ± 9 years) of whom 10 had positive electrocardiographic responses to exercise. The percentage fall in coronary vascular resistance (%d.CVR) after 10 min of rapid atrial pacing was determined using a thermodilution pacing catheter. Plasma ET concentrations were measured by radioimmunoassay on simultaneously drawn arterial and coronary sinus samples.
RESULTS
No significant differences in ET concentrations were observed between men and women, but a strong statistical trend suggested that %d.CVR was lower in women than men (2723 to 31% vs. 3429 to 45%—medianinterquartile range; p = 0.07). Simple regression analysis including only the women (n = 14) suggested a significant relationship between baseline arterial ET concentrations and %d.CVR (R2= 0.34; p = 0.06). Furthermore, stepwise multivariate regression analysis of the group as a whole indicated that both gender (p = 0.03) and baseline arterial ET concentration (p = 0.02) were independently predictive of %d.CVR (R2= 0.44; overall p = 0.02); this relationship predicts that women with high ET levels would have the lowest %d.CVR during pacing.
CONCLUSIONS
These data support the hypothesis that elevated ET activity may be associated with reduced coronary flow responses during rapid atrial pacing in CPNA patients.
A global lab against influenza Layne, S P; Beugelsdijk, T J; Patel, C K ...
Science,
2001-Sep-07, 2001-09-07, 20010907, Letnik:
293, Številka:
5536
Journal Article
Two recent studies have found that small samples of panic disorder patients appear to have elevated levels of alexithymia and raised the possibility that panic patients may constrict emotional ...experience. An alternate hypothesis is that there is conceptual and measurement overlap between alexithymia and cognitive aspects of panic disorder, and panic patients may in fact score high on only one dimension of alexithymia. One hundred panic disorder patients and 46 social phobics completed the revised 20-item Toronto Alexithymia Scale (TAS) and several anxiety-related measures. Thirty-four percent of panic patients and 28.3% of social phobics were classified as alexithymics, a nonsignificant difference. However, the alexithymia dimension related to difficulties in identifying and differentiating emotions and physical sensations was significantly elevated as compared with the alexithymia dimension related to external-oriented thinking. The former dimension was also significantly correlated with anxiety measures. The apparent finding that a sizeable proportion of panic patients are alexithymic may be an artifact of conceptual and psychometric overlap with cognitive aspects of panic disorder, specifically the interoceptive focus and sensitivity often associated with panic attacks.
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