Workload accomplished in phase III cardiac rehabilitation

Exercise training is an important component of clinical exercise programs. Although there are recognized guidelines for the amount of exercise to be accomplished (≥70,000 steps per week or ≥150 min per week at moderate intensity), there is virtually no documentation of how much exercise is actually accomplished in contemporary exercise programs. Having guidelines without evidence of whether they are being met is of limited value. We analyzed both the weekly step count and the session rating of perceived exertion (sRPE) of patients (n = 26) enrolled in a community clinical exercise (e.g., Phase III) program over a 3-week reference period. Step counts averaged 39,818 ± 18,612 per week, with 18% of the steps accomplished in the program and 82% of steps accomplished outside the program. Using the sRPE method, inside the program, the patients averaged 162.4 ± 93.1 min per week, at a sRPE of 12.5 ± 1.9 and a frequency of 1.8 ± 0.7 times per week, for a calculated exercise load of 2042.5 ± 1244.9 AU. Outside the program, the patients averaged 144.9 ± 126.4 min, at a sRPE of 11.8 ± 5.8 and a frequency of 2.4 ± 1.5 times per week, for a calculated exercise load of 1723.9 ± 1526.2 AU. The total exercise load using sRPE was 266.4 ± 170.8 min per week, at a sRPE of 12.6 ± 3.8, and frequency of 4.2 ± 1.1 times per week, for a calculated exercise load of 3359.8 ± 2145.9 AU. There was a non-linear relationship between steps per week and the sRPE derived training load, apparently attributable to the amount of non-walking exercise accomplished in the program. The results suggest that patients in a community clinical exercise program are achieving American College of Sports Medicine guidelines, based on the sRPE method, but are accomplishing less steps than recommended by guidelines

Clinical application of cardiac scintigraphy with bone tracers: controversies and pitfalls in cardiac amyloidosis

Cardiac amyloidosis (CA) is a life-threatening disease caused by extracellular deposition of amyloidogenic proteins in the heart tissue; it could be associated with a poor prognosis and remains underdiagnosed and underestimated. During the last years, bone scintigraphy has been widely used to facilitate the diagnosis of CA, avoid endomyocardial biopsy, and differentiate amyloid light-chain amyloidosis from transthyretin amyloidosis. Technetium-99m pyrophosphate (99mTc-PYP) is the most used tracer in the United States, but a standardized and shared acquisition protocol is still lacking; technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) is widely used in Europe and can count on a more grounded data than 99mTc-PYP. Both tracers suffer from some diagnostic limitations (due to their biochemical characteristics) and pitfalls that can lead to a misdiagnosis of CA. We aim to briefly describe the main differences between 99mTc-PYP and 99mTc-DPD, analyzing the data available in the literature and highlighting the most frequent causes of misdiagnosis and pitfalls. Both 99mTc-DPD and 99mTc-PYP show good accuracy for the diagnosis of CA with high specificity and sensibility. Nevertheless, to achieve this accuracy, the correct acquisition protocols must be followed for each tracer, as suggested in the latest recommendation. Proper diagnosis of CA has a crucial role in patient management; therefore, it is important for nuclear physicians to have the most specific approaches in acquiring and interpreting bone scintigraphy for transthyretin cardiac amyloidosis

Iperpotassiemia nello scompenso cardiaco: nuove soluzioni per un vecchio problema

Il potassio \ue8 il principale ione intracellulare e la sua omeostasi \ue8 finemente regolata dall\u2019apparato renale e gastrointestinale. L\u2019insufficienza renale e l\u2019iperpotassiemia sono condizioni di comune riscontro nei pazienti con scompenso cardiaco, risultato di una complessa interazione tra cuore e rene (es. sindrome cardio-renale) e degli effetti collaterali dei farmaci comunemente impiegati per il trattamento della malattia cardiaca (es. inibitori del sistema renina-angiotensina-aldosterone). Sebbene l\u2019iperpotassiemia incrementi il rischio di disturbi di conduzione ed aritmie minacciose per la vita, il suo significato prognostico nello scompenso cardiaco \ue8 incerto. L\u2019iperpotassiemia e la progressione del danno renale costituiscono i principali limiti all\u2019introduzione e alla titolazione delle terapie eziologiche dello scompenso cardiaco. L\u2019ingresso in commercio di nuovi farmaci per la prevenzione e il trattamento cronico dell\u2019iperpotassiemia permette di introdurre e modulare la terapia anti-neurormonale in pazienti con scompenso cardiaco altrimenti esclusi per i livelli di potassio sierico eccessivamente elevati. Questa rassegna tratta gli aspetti fisiopatologici ed epidemiologico-prognostici dell\u2019iperpotassiemia, offrendo, inoltre, un\u2019analisi sulle possibili strategie di trattamento della disionia nello scompenso cardiaco

Validation and Performance Comparison of Two Scoring Systems Created Specifically to Predict the Risk of Deep Sternal Wound Infection after Bilateral Internal Thoracic Artery Grafting

Background: The Gatti and the bilateral internal mammary artery (BIMA) scores were created to predict the risk of deep sternal wound infection (DSWI) after bilateral internal thoracic artery (BITA) grafting. Methods: Both scores were evaluated retrospectively in two consecutive series of patients undergoing isolated multi-vessel coronary surgical procedures - i.e., the Trieste (n = 1,122; BITA use, 52.1%; rate of DSWI, 5.7%) and the Besan\ue7on cohort (n = 721; BITA use, 100%; rate of DSWI, 2.5%). Baseline patient characteristics were compared between the two validation samples. For each score, the accuracy of prediction and predictive power were assessed by the area under the receiver-operating characteristic curve (AUC) and the Goodman-Kruskal gamma coefficient, respectively. Results: There were significant differences between the two series in terms of age, gender, New York Heart Association functional class, chronic lung disease, left ventricular function, surgical priority, and the surgical techniques used. In the Trieste series, accuracy of prediction of the Gatti score for DSWI was higher than that of the BIMA score (AUC, 0.729 vs. 0.620, p = 0.0033). The difference was not significant, however, in the Besan\ue7on series (AUC, 0.845 vs. 0.853, p = 0.880) and when only BITA patients of the Trieste series were considered for analysis (AUC, 0.738 vs. 0.665, p = 0.157). In both series, predictive power was at least moderate for the Gatti score and low for the BIMA score. Conclusions: The Gatti and the BIMA scores seem to be useful for pre-operative evaluation of the risk of DSWI after BITA grafting. Further validation studies should be performed

L-DOPA preloading increases the uptake of borophenylalanine in C6 glioma rat model: a new strategy to improve BNCT efficacy.

Purpose: Boron neutron capture therapy (BNCT) is a radiotherapeutic modality based on 10B(n,a)7Li reaction, for the treatment of malignant gliomas. One of the main limitations for BNCT effectiveness is the insufficient intake of 10B nuclei in the tumor cells. This work was aimed at investigating the use of L-DOPA as a putative enhancer for 10B-drug 4-dihydroxy-borylphenylalanine (BPA) uptake in the C6-glioma model. The investigation was first per- formed in vitro and then extended to the animal model. Methods and Materials: BPA accumulation in C6-glioma cells was assessed using radiowave dielectric spectros- copy, with and without L-DOPA preloading. Two L-DOPA incubation times (2 and 4 hours) were investigated, and the corresponding effects on BPA accumulation were quantified. C6-glioma cells were also implanted in the brain of 32 rats, and tumor growth was monitored by magnetic resonance imaging. Rats were assigned to two experimental branches: (1) BPA administration; (2) BPA administration after pretreatment with L-DOPA. All an- imals were sacrificed, and assessments of BPA concentrations in tumor tissue, normal brain, and blood samples were performed using high-performance liquid chromatography. Results: L-DOPA preloading induced a massive increase of BPA concentration in C6-glioma cells only after a 4-hour incubation. In the animal model, L-DOPA pretreatment produced a significantly higher accumulation of BPA in tumor tissue but not in normal brain and blood samples. Conclusions: This study suggests the potential use of L-DOPA as enhancer for BPA accumulation in malig- nant gliomas eligible for BNCT. L-DOPA preloading effect is discussed in terms of membrane transport mechanisms