Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve Comparison of stentless versus stented bioprostheses

AbstractOBJECTIVESThe objective of this study was to compare stentless bioprostheses with stented bioprostheses with regard to their hemodynamic behavior during exercise.BACKGROUNDStentless aortic bioprostheses have better hemodynamic performances at rest than stented bioprostheses, but very few comparisons were performed during exercise.METHODSThirty-eight patients with normally functioning stentless (n = 19) or stented (n = 19) bioprostheses were submitted to a maximal ramp upright bicycle exercise test. Valve effective orifice area and mean transvalvular pressure gradient at rest and during peak exercise were successfully measured using Doppler echocardiography in 30 of the 38 patients.RESULTSAt peak exercise, the mean gradient increased significantly less in stentless than in stented bioprostheses (+5 ± 3 vs. +12 ± 8 mm Hg; p = 0.002) despite similar increases in mean flow rates (+137 ± 58 vs. +125 ± 65 ml/s; p = 0.58); valve area also increased but with no significant difference between groups. Despite this hemodynamic difference, exercise capacity was not significantly different, but left ventricular (LV) mass and function were closer to normal in stentless bioprostheses. Overall, there was a strong inverse relation between the mean gradient during peak exercise and the indexed valve area at rest (r = 0.90).CONCLUSIONSHemodynamics during exercise are better in stentless than stented bioprostheses due to the larger resting indexed valve area of stentless bioprostheses. This is associated with beneficial effects with regard to LV mass and function. The relation found between the resting indexed valve area and the gradient during exercise can be used to project the hemodynamic behavior of these bioprostheses at the time of operation. It should thus be useful to select the optimal prosthesis given the patient’s body surface area and level of physical activity

User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions.</p> <p>Discussion</p> <p>This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.</p

Gilles Jobin Final residency lecture - Collision between dance and physics

CERN, the Republic and Canton of Geneva, and the City of Geneva are delighted to invite you to the final public lecture about collisions between dance and physics by the first winner of Collide@CERN Geneva, the choreographer Gilles Jobin. The event marks the end of his residency and will be held at the CERN Globe of Science and Innovation on 6th November at 1800. Doors open at 17.30 Programme 18.00 - Opening address by Rolf-Dieter Heuer, CERN Director General, Ariane Koek, CERN Cultural Specialist, Sami Kanaan, Administrative Councilor in charge of the Department of Culture and Sport of the City of Geneva, and Charles Beer, Vice President of the State Council in charge of the Department of Education, Culture and Sport. 18.30 - Presentation by Gilles Jobin (Switzerland) of his residency experience at CERN with live demonstrations with his dancers 19.15 - Discussion on CERN as a Place of Collisions and Interventions between Dance and Physics with Gilles Jobin (Switzerland) and CERN scientists Maria Dimou (Greece) and Michael Doser (Austria) Moderated by Ariane Koek, CERN cultural specialist The audience will have the opportunity to ask questions 19.45 - Cocktail Please note that the event will be mainly in English. To make a reservation, please send an email to Collide@CERN Cordinator: [email protected]

Cuerpo e imagen en la nueva danza

Cuerpos sobre blanco es el resultado de tres años de reflexión y debate en torno a las propuestas artísticas presentadas en Desviaciones. Se recogen en él conferencias, mesas redondas y encuentros celebrados durante las ediciones de 1999, 2000 y 2001, a los que se añaden ensayos y entrevistas realizadas en diferentes momentos y lugares. El titulo alude a la decisión tomada por Blanca Calvo y La Ribot en Desviaciones 2000 de transformar la sala Cuarta Pared, un teatro de paredes negras, en un espacio blanco y abierto, haciéndose eco del interés de numerosos creadores escénicos por situar sus trabajos en galerías, salas de arte y otros lugares de exhibición o bien en espacios que remitieran al tipo de recepción propio de las artes visuales. A pesar de ser muchos los artistas que en los últimos años han confrontado sus cuerpos con el blanco (Xavier LeRoy, Bobby Baker, Gary Stevens, Miriam Gourfink, La Ribot, Ion Munduate, Cuqui Jerez y Olga Mesa...), no debe entenderse esta opción como una tendencia, sino más bien como una coincidencia de intereses en un momento, que no excluye otras propuestas como las de Jeróme Bel, Raymund Hoghe o Philipe Gehmacher, que juegan con otros recursos del espacio escénico

Is Prolonged and Repeated Exercise-Induced Myocardial Ischemic Training Deleterious?

Background: In patients with ischemic heart disease (IHD), the current guidelines on exercise prescription recommend that exercise training intensity be 10 beats/min below the heart rate at which there is >1 mm ST-segment depression (ischemic threshold). However, it is not well established that exercise training above the ischemic threshold is harmful. Methods: Twenty-two patients with angiographically documented IHD (>70% stenosis) were randomized to exercise training either at a target intensity that induced myocardial ischemia (ischemic group) or that adhered to current guidelines (control group). Training was progressively increased to 60 min under continuous ECG monitoring. Cardiac troponin T (cTnT) was measured at regular intervals. Ambulatory ECG monitoring was performed before and after 6 wkof training and left ventricular function was evaluated by echocardiography in the ischemic group after at least 6 wk of training. Results: The ischemic training sessions were very well tolerated. The ischemic group had myocardial ischemia during the first 20, 40, and 60 min exercise sessions for 12.3 &#177; 6.8 min, 29.0 &#177; 12.9 min and 49.8 &#177; 2.2 min, respectively, with ST-segment depression ranging from 1.0 to 2.1 mm. The estimated myocardial work (as expressed by RPP) during the training session was also higher in the ischemic than in the control group for the first 20 min (17 354 &#177; 6 528 vs 13 355 &#177; 2 936 beats/min &#8226; mmHg, respectively; P=0.08), 40 min (16 329 &#177; 5 407 vs 12 452 &#177; 2 330 beats/min &#8226; mmHg, respectively; P=0.04), and 60 min training sessions (18 750 &#177; 5 698 vs 13 352 &#177; 2 947 beats/min &#8226; mmHg, respectively; P=0.02) No patient in either group demonstrated significant arrhythmias nor increased cTnT. The measured cTnT stayed below the detectable values of the essay (>0.01&#956;g/l) for all patients at all times. Left ventricular function remained unchanged in the ischemic group. Conclusion: In patients with IHD, prolonged and repeated ischemic training sessions up to 60 min can be well tolerated without evidence of myocardial injury, significant arrhythmias or left ventricular dysfunction. Thus exercising at or above the ischemic threshold does not appear deleterious under this kind of supervision