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BACKGROUND AND AIMS: Loneliness is a risk factor for cardiovascular disease (CVD), and the levels at which individuals experience it can transition over time. However, the impact of increased loneliness or decreased loneliness on later CVD risk remains unexplored. We aimed to identify the age-specific association between loneliness status transitions and subsequent CVD incidences in middle-aged and older adults. METHODS AND RESULTS: Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS) on 8463 adults to evaluate how loneliness status transitions across two data collection points were associated with the subsequent CVD incidence at a five-year follow-up. Loneliness status transitions were divided into four categories: stable low loneliness, decreased loneliness, increased loneliness, and stable high loneliness. Data were analyzed using a Cox-proportional hazards model with age subgroups, accounting for covariates at baseline. During follow-up, the incidence rate of CVD per 1000 person-years was lower for the stable low loneliness group and decreased loneliness group compared to the increased loneliness and stable high loneliness group. Increased loneliness is associated with the highest risk of overall CVD and heart disease (HR 2.44, P < 0.001; HR 2.34, P < 0.001), while stable high loneliness is associated with the highest risk of stroke among the four loneliness categories (HR 4.29, P < 0.05). The age-specific analyses revealed no statistically significant interaction in terms of loneliness status transitions and age group. CONCLUSION: Increased loneliness and stable high loneliness are associated with higher CVD risk. In clinical practice, it is important to monitor patients' loneliness status transitions to reduce CVD incidences.
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Enfermedades Cardiovasculares , Cardiopatías , Persona de Mediana Edad , Humanos , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Soledad , Estudios Longitudinales , China/epidemiologíaRESUMEN
BACKGROUND: Clinical notes contain contextualized information beyond structured data related to patients' past and current health status. OBJECTIVE: This study aimed to design a multimodal deep learning approach to improve the evaluation precision of hospital outcomes for heart failure (HF) using admission clinical notes and easily collected tabular data. METHODS: Data for the development and validation of the multimodal model were retrospectively derived from 3 open-access US databases, including the Medical Information Mart for Intensive Care III v1.4 (MIMIC-III) and MIMIC-IV v1.0, collected from a teaching hospital from 2001 to 2019, and the eICU Collaborative Research Database v1.2, collected from 208 hospitals from 2014 to 2015. The study cohorts consisted of all patients with critical HF. The clinical notes, including chief complaint, history of present illness, physical examination, medical history, and admission medication, as well as clinical variables recorded in electronic health records, were analyzed. We developed a deep learning mortality prediction model for in-hospital patients, which underwent complete internal, prospective, and external evaluation. The Integrated Gradients and SHapley Additive exPlanations (SHAP) methods were used to analyze the importance of risk factors. RESULTS: The study included 9989 (16.4%) patients in the development set, 2497 (14.1%) patients in the internal validation set, 1896 (18.3%) in the prospective validation set, and 7432 (15%) patients in the external validation set. The area under the receiver operating characteristic curve of the models was 0.838 (95% CI 0.827-0.851), 0.849 (95% CI 0.841-0.856), and 0.767 (95% CI 0.762-0.772), for the internal, prospective, and external validation sets, respectively. The area under the receiver operating characteristic curve of the multimodal model outperformed that of the unimodal models in all test sets, and tabular data contributed to higher discrimination. The medical history and physical examination were more useful than other factors in early assessments. CONCLUSIONS: The multimodal deep learning model for combining admission notes and clinical tabular data showed promising efficacy as a potentially novel method in evaluating the risk of mortality in patients with HF, providing more accurate and timely decision support.
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Aprendizaje Profundo , Insuficiencia Cardíaca , Humanos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Masculino , Femenino , Pronóstico , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Registros Electrónicos de Salud , Hospitalización/estadística & datos numéricos , Mortalidad Hospitalaria , Anciano de 80 o más AñosRESUMEN
Background: Despite gradually increasing evidence for pre-rehabilitation for heart valve surgery, it remains underused, especially in developing countries with limited resources. The study aimed to investigate the feasibility and effects of an innovative three-day pre-rehabilitation bundle for patients undergoing elective heart valve surgery. Methods: This was a single-center, assessor-blind, randomized clinical trial. A total of 165 patients were randomly assigned to either usual care (control group, n = 83) or usual care with an additional 3-day pre-rehabilitation bundle (Three-day of Inspiratory muscle training, aerobic Muscle training, and Education (TIME) group, n = 82). The main outcome of the study was the incidence of postoperative pulmonary complications (PPCs). Secondary outcomes included the feasibility of the intervention, duration of the non-invasive ventilator, length of stay, and PPCs-related medical costs on discharge. Results: Of 165 patients 53.94% were male, the mean age was 63.41 years, and PPCs were present in 26 of 82 patients in the TIME group and 44 of 83 in the control group (odds ratio (OR), 0.60; 95% CI, 0.41-0.87, p = 0.006). The feasibility of the pre-rehabilitation bundle was good, and no adverse events were observed. Treatment satisfaction and motivation scored on 10-point scales, were 9.1 ± 0.8 and 8.6 ± 1.4, respectively. The TIME group also had fewer additional PPCs-related medical costs compared to the control group (6.96 vs. 9.57 thousand CNY (1.01 vs. 1.39 thousand USD), p < 0.001). Conclusions: The three-day accessible pre-rehabilitation bundle reduces the incidence of PPCs, length of stay, and PPCs-related medical costs in patients undergoing elective valve surgery. It may provide an accessible model for the expansion of pre-rehabilitation in countries and regions with limited medical resources. Clinical Trial Registration: This trial was based on the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This trial was registered in the Chinese Clinical Trial Registry (identifier ChiCTR2000039671).
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OBJECTIVES: To review the efficacy of 2 score tools for identifying pulmonary complications after cardiac surgery. DESIGN: A retrospective observational study. SETTING: At the West China Hospital of Sichuan University General Hospital. PARTICIPANTS: Patients who underwent elective cardiac surgery (N = 508). INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 508 patients who underwent elective cardiac surgery between March 2021 and December 2021 were included in this observational study. Three independent physiotherapists used 2 different sets of score tools, as described by Kroenke et al. (Kroenke Score) and Reeve et al. (Melbourne Group Scale), to evaluate clinically defined pulmonary complications according to the European Perioperative Clinical Outcome definitions (including atelectasis, pneumonia, and respiratory failure) daily after surgery at midday. The incidence of postoperative pulmonary complications (PPCs) was 51.6% (262/508) with the Kroenke Score and 21.9% (111/508) with the Melbourne Group Scale. The clinically observed incidence of atelectasis was 51.4%, pneumonia was 20.9%, and respiratory failure at 6.5%. The receiver operator characteristics curve showed that the overall validity of the Kroenke Score was better than that of the Melbourne Group Scale in atelectasis (area under the curve [AUC], 91.5% v 71.3%). The Melbourne Group Scale performed better in pneumonia (AUC, 99.4% v 80.0%) and respiratory failure (AUC, 88.5% v 75.9%) than the Kroenke Score. CONCLUSION: The incidence of PPCs after cardiac surgery was highly prevalent. Both the Kroenke Score and the Melbourne Group Scale are effective in identifying patients with PPCs. Kroenke Score can identify patients with mild pulmonary adverse events, whereas the Melbourne Group Scale is more dominant in identifying moderate-to-severe pulmonary complications.
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Procedimientos Quirúrgicos Cardíacos , Neumonía , Atelectasia Pulmonar , Insuficiencia Respiratoria , Humanos , Pulmón , Neumonía/diagnóstico , Neumonía/epidemiología , Neumonía/etiología , Atelectasia Pulmonar/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Insuficiencia Respiratoria/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.
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Pulmón , Caminata , Humanos , Caminata/fisiología , Prueba de Paso , Válvulas Cardíacas/cirugía , Periodo Posoperatorio , Complicaciones Posoperatorias/etiologíaRESUMEN
Patients with acute heart failure (AHF) often experience dyspnea, and monitoring and quantifying their breathing patterns can provide reference information for disease and prognosis assessment. In this study, 39 AHF patients and 24 healthy subjects were included. Nighttime chest-abdominal respiratory signals were collected using wearable devices, and the differences in nocturnal breathing patterns between the two groups were quantitatively analyzed. Compared with the healthy group, the AHF group showed a higher mean breathing rate (BR_mean) [(21.03 ± 3.84) beat/min vs. (15.95 ± 3.08) beat/min, P < 0.001], and larger R_RSBI_cv [70.96% (54.34%-104.28)% vs. 58.48% (45.34%-65.95)%, P = 0.005], greater AB_ratio_cv [(22.52 ± 7.14)% vs. (17.10 ± 6.83)%, P = 0.004], and smaller SampEn (0.67 ± 0.37 vs. 1.01 ± 0.29, P < 0.001). Additionally, the mean inspiratory time (TI_mean) and expiration time (TE_mean) were shorter, TI_cv and TE_cv were greater. Furthermore, the LBI_cv was greater, while SD1 and SD2 on the Poincare plot were larger in the AHF group, all of which showed statistically significant differences. Logistic regression calibration revealed that the TI_mean reduction was a risk factor for AHF. The BR_ mean demonstrated the strongest ability to distinguish between the two groups, with an area under the curve (AUC) of 0.846. Parameters such as breathing period, amplitude, coordination, and nonlinear parameters effectively quantify abnormal breathing patterns in AHF patients. Specifically, the reduction in TI_mean serves as a risk factor for AHF, while the BR_mean distinguishes between the two groups. These findings have the potential to provide new information for the assessment of AHF patients.
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Insuficiencia Cardíaca , Dispositivos Electrónicos Vestibles , Humanos , Insuficiencia Cardíaca/diagnóstico , Pronóstico , Respiración , Enfermedad AgudaRESUMEN
PURPOSE: To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs). METHODS: Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software. RESULTS: Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP: MD = 7.14 cmH2O, P = 0.006; MEP: MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1%: MD = 6.15%, P<0.001; FVC%: MD = 4.65%, P<0.001; MVV: MD = 8.66 L, P<0.001; FEV1/FVC%: MD = 5.27%, P = 0.03; FVC: MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT: MD = 66.99 m, P = 0.02; Borg index: MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score: MD = -2.26, P<0.001; HADS depression score: MD = -1.34, P<0.001; NHP total score: MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications. CONCLUSION: IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.
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Ejercicios Respiratorios , Neoplasias Esofágicas , Esofagectomía , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Músculos Respiratorios , Humanos , Neoplasias Esofágicas/cirugía , Ejercicios Respiratorios/métodos , Músculos Respiratorios/fisiopatología , Inhalación/fisiología , Complicaciones Posoperatorias , Pruebas de Función RespiratoriaRESUMEN
Objectives: Prolonged intubation (PI) is a frequently encountered severe complication among patients following cardiac surgery (CS). Solely concentrating on preoperative data, devoid of sufficient consideration for the ongoing impact of surgical, anesthetic, and cardiopulmonary bypass procedures on subsequent respiratory system function, could potentially compromise the predictive accuracy of disease prognosis. In response to this challenge, we formulated and externally validated an intelligible prediction model tailored for CS patients, leveraging both preoperative information and early intensive care unit (ICU) data to facilitate early prophylaxis for PI. Methods: We conducted a retrospective cohort study, analyzing adult patients who underwent CS and utilizing data from two publicly available ICU databases, namely, the Medical Information Mart for Intensive Care and the eICU Collaborative Research Database. PI was defined as necessitating intubation for over 24â h. The predictive model was constructed using multivariable logistic regression. External validation of the model's predictive performance was conducted, and the findings were elucidated through visualization techniques. Results: The incidence rates of PI in the training, testing, and external validation cohorts were 11.8%, 12.1%, and 17.5%, respectively. We identified 11 predictive factors associated with PI following CS: plateau pressure [odds ratio (OR), 1.133; 95% confidence interval (CI), 1.111-1.157], lactate level (OR, 1.131; 95% CI, 1.067-1.2), Charlson Comorbidity Index (OR, 1.166; 95% CI, 1.115-1.219), Sequential Organ Failure Assessment score (OR, 1.096; 95% CI, 1.061-1.132), central venous pressure (OR, 1.052; 95% CI, 1.033-1.073), anion gap (OR, 1.075; 95% CI, 1.043-1.107), positive end-expiratory pressure (OR, 1.087; 95% CI, 1.047-1.129), vasopressor usage (OR, 1.521; 95% CI, 1.23-1.879), Visual Analog Scale score (OR, 0.928; 95% CI, 0.893-0.964), pH value (OR, 0.757; 95% CI, 0.629-0.913), and blood urea nitrogen level (OR, 1.011; 95% CI, 1.003-1.02). The model exhibited an area under the receiver operating characteristic curve (AUROC) of 0.853 (95% CI, 0.840-0.865) in the training cohort, 0.867 (95% CI, 0.853-0.882) in the testing cohort, and 0.704 (95% CI, 0.679-0.727) in the external validation cohort. Conclusions: Through multicenter internal and external validation, our model, which integrates early ICU data and preoperative information, exhibited outstanding discriminative capability. This integration allows for the accurate assessment of PI risk in the initial phases following CS, facilitating timely interventions to mitigate adverse outcomes.
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OBJECTIVE: To determine the effect of video-assisted thoracoscopic lobectomy on the pulmonary rehabilitation of patients with lung cancers. METHODS: Between September 2010 and December 2011, 138 patients. with lung cancers were treated with lobectomy: 68 using video-assisted thoracoscopic surgery (VATS) and 70 using thoracotomy. The preoperative and postoperative (7 d and 30 d) pulmonary functions and Cardio-pulmonary Exercise Capacities as well as postoperative (7 d and 30 d) DE Morton Index of the two groups of patients were assessed. The two groups of patients had similar in clinical characteristics. RESULTS: (1) Patients in the VATS group had greater FEV1 (1.64 +/- 0.21) L and PEF [(310.58 +/- 30.13) L/min] on the 7 d after operations than those with thoracotomy [FEV1 (1.34 +/- 0.11) L and PEF (270.18 +/- 25.67) L/min], P < 0.05. (2) Patients in the VATS group had lower fatigue index (0.27 +/- 0.08) and dyspnea index (0.28 +/- 0.17) on the 7 d after operations than those with thoracotomy (0.44 +/- 0.10 fatigue index and 0.39 +/- 0.09 dyspnea index), P < 0.05. (3) Patients in the VATS group had longer 6-min walking distance on the 7 d [(490.57 +/- 118.33) m] and 30 d [(524.32 +/- 140.87) m] after operations than those with thoracotomy [(395.07 +/- 100.19) m at 7 d and (471.10 +/- 118.57) m at 30 d], P < 0.05. (4) Patients in the VATS group had higher DE Morton index (74.58 +/- 16.23) on the 7 d after operations than those with thoracotomy (55.87 +/- 14.79), P < 0.05. CONCLUSION: VATS lobectomy for curative lung cancer resection appears to provide a superior functional health recovery compared with thoracotomy.
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Tolerancia al Ejercicio , Neoplasias Pulmonares/cirugía , Neumonectomía , Cirugía Torácica Asistida por Video , Toracotomía , Humanos , Pulmón , Neoplasias Pulmonares/rehabilitaciónRESUMEN
Aim: This study innovatively proposed the 1-min sit-to-stand test (1-min STST) as an assessment tool for functional capacity in acute decompensated heart failure (ADHF), in which its feasibility and safety were investigated. Methods: This was a prospective, single-center cohort study. The 1-min STST was performed after the first 48 h of admission when vital signs and Borg score were collected. Lung ultrasound was used to measure pulmonary edema by B-lines before and after the test. Results: Seventy-five patients were enrolled in the study, of whom 40% were in functional class IV on admission. The mean age was 58.3 ± 15.7 years and 40% of the patients were male. 95% patients accomplished the test and the average number of repetitions was 18 ± 7. No adverse event was recorded during or after the 1-min STST. Blood pressure, heart rate, and degree of dyspnea were increased after the test (all p < 0.001), while oxygen saturation was slightly decreased (97.0 ± 1.6 vs. 96.3 ± 2.0%, p = 0.003). The degree of pulmonary edema (χ2 = 8.300, p = 0.081) was not significantly changed, while there was a reduction in the absolute number of B-lines [9 (3, 16) vs. 7 (3, 13), p = 0.008]. Conclusion: The application of the 1-min STST in early stage of ADHF appeared to be safe and feasible, which induce neither adverse event nor pulmonary edema. It may serve as a new tool of functional capacity assessment, as well as a reference of exercise rehabilitation.
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BACKGROUND: Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients. Cardiac surgery is an important way to treat cardiovascular disease, but it can prolong mechanical ventilation time, intensive care unit (ICU) stay, and postoperative hospitalization for patients. Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications. AIM: To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time, length of ICU stay, and duration of postoperative hospitalization after cardiac surgery. METHODS: A literature search of PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WanFang, and the China Science and Technology journal VIP database was performed on April 13, 2022. The data was independently extracted by two authors. The inclusion criteria were: (1) Randomized controlled trial; (2) Accessible as a full paper; (3) Patients who received cardiac surgery; (4) Preoperative inspiratory muscle training was implemented in these patients; (5) The study reported at least one of the following: Mechanical ventilation time, length of ICU stay, and/or duration of postoperative hospitalization; and (6) In English language. RESULTS: We analyzed six randomized controlled trials with a total of 925 participants. The pooled mean difference of mechanical ventilation time was -0.45 h [95% confidence interval (CI): -1.59-0.69], which was not statistically significant between the intervention group and the control group. The pooled mean difference of length of ICU stay was 0.44 h (95%CI: -0.58-1.45). The pooled mean difference of postoperative hospitalization was -1.77 d in the intervention group vs the control group [95%CI: -2.41-(-1.12)]. CONCLUSION: Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery. More high-quality studies are needed to confirm our conclusion.
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OBJECTIVES: With the characteristics of mindfulness and breathing techniques, Tai Chi has been recommended with therapeutic values in chronic obstructive pulmonary disease (COPD). However, its strengths as a complementary exercise for conventional pulmonary rehabilitation (PR) remain unclear. DESIGN AND SETTING: This single-blinded randomised controlled trial recruited patients with mild to severe stable COPD. Eligible participants were randomly assigned to the group with usual care (control), total body recumbent stepper (TBRS) exercise, Tai Chi (TC), or combined TBRS exercise and Tai Chi (TBRS-TC). Patients received a two-month hospital-based supervised exercise, followed by a ten-month community- or home-based rehabilitation program. RESULTS: A total of 120 participants were recruited, and 102 were included in the per-protocol analysis. The mean changes in St George's Respiratory Questionnaire (SGRQ) total score from baseline to the post-hospital exercise in the control group, TBRS group, TC group, and TBRS-TC group was 2.62 (95 % CI -8.99 to 8.99), -9.28 (95 % CI -13.96 to -4.60), -10.19 (95 % CI -13.72 to -6.67), and -16.75 (95 % CI -20.25 to -13.24), respectively, with a statistically significant difference between groups in favor of the TBRS-TC exercise (P < 0.001). The remarkable effect of TBRS-TC exercise in improving the quality of life maintained until the end of the community- or home-based rehabilitation training (P < 0.001). Besides, a statistically better effect with the TBRS-TC exercise was also observed in the outcomes regarding exercise capacity, pulmonary function, symptom burden, and systemic inflammation after the whole process of 12-month integrative PR exercise programme. CONCLUSIONS: Based on the results, a novel integrated exercise modality combining Tai Chi and conventional pulmonary rehabilitation was developed. It might contribute to more positive effects in patients with stable COPD. REGISTRATION: The study was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-15006874) prior to commencing recruitment.
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Enfermedad Pulmonar Obstructiva Crónica , Taichi Chuan , Humanos , Calidad de Vida , Pulmón , Ejercicio FísicoRESUMEN
OBJECTIVE: To evaluate the therapeutic effects of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients. METHODS: One hundred and twenty hemiplegia patients with stage I shoulder-hand syndrome were randomly divided into a group treated with standardized electric acupuncture and massage, and a group treated with rehabilitation therapy for 6 weeks. The primary indices evaluated were pain on passive movement of the shoulder using the numeric pain rating scale (NPRS), and the number of patients with shoulder-hand syndrome at Steinbrocker stage II or III after treatment. The secondary indices were Fugl-Meyer evaluation of functional movement of the upper limb and hand using the modified rankin scale (MRS). RESULTS: At post-treatment evaluation and a 12-week follow-up visit, NPRS score, number of patients with stage II or III shoulder-hand syndrome, and MRS score were all improved in the acupuncture-massage group compared with the rehabilitation group (P<0.05). On Fugl-Meyer evaluation, functional movement of the upper limb was also improved in the acupuncture-massage group compared with the rehabilitation group (P<0.05). CONCLUSION: Standardized acupuncture-massage therapy may have curative effects on shoulder-hand syndrome in hemiplegia patients.
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Terapia por Acupuntura , Hemiplejía/terapia , Masaje , Distrofia Simpática Refleja/terapia , Adolescente , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial.
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COVID-19 , Rehabilitación Cardiaca , Insuficiencia Cardíaca , Humanos , Anciano , Rehabilitación Cardiaca/métodos , Calidad de Vida , COVID-19/epidemiología , Insuficiencia Cardíaca/rehabilitación , Ejercicio FísicoRESUMEN
PURPOSE: To evaluate whether postoperative exercise training is effective in improving clinical outcomes such as the quality of life (QoL), exercise capacity and respiratory function of patients receiving pulmonary resection. DATA SOURCES: The PubMed, EMBASE, Web of Science and PEDro electronic databases were comprehensively searched to identify eligible randomized controlled trials (RCTs). METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The primary outcome was postoperative QoL and secondary outcomes were exercise capacity and respiratory function. RESULTS: A total of eight studies involving 691 participants were enrolled in this systematic review and meta-analysis. For the postoperative QoL measured by 36-Item Short Form Health Survey (SF-36), the pooled results demonstrated that postoperative exercise training could significantly improve the SF-36 physical domain score [weighted mean difference (WMD) = 5.87, 95% confidence interval (CI): 3.96 to 7.78, Pï¼0.001] and SF-36 mental domain score (WMD = 8.15, 95% CI: 0.13 to 16.16, P = 0.05). The results of further analysis for the eight dimensions of SF-36 were similar to the overall results. However, for secondary outcomes, no significant effects of postoperative exercise training on exercise capacity and respiratory function were observed. CONCLUSION: Postoperative exercise training could significantly improve the QoL of patients undergoing lung surgery. However, more RCTs with large samples are still needed to verify the effects of postoperative exercise rehabilitation on clinical outcomes of patients who receive pulmonary resection.
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Ejercicio Físico , Calidad de Vida , Terapia por Ejercicio , Tolerancia al Ejercicio , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Background: Inspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients. Methods: PubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I 2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated. Results: We ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43-28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39-13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53-58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score. Conclusion: Based on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients. Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972].
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BACKGROUND: The clinical role of perioperative respiratory muscle training (RMT), including inspiratory muscle training (IMT) and expiratory muscle training (EMT) in patients undergoing pulmonary surgery remains unclear up to now. AIM: To evaluate whether perioperative RMT is effective in improving postoperative outcomes such as the respiratory muscle strength and physical activity level of patients receiving lung surgery. METHODS: The PubMed, EMBASE (via OVID), Web of Science, Cochrane Library and Physiotherapy Evidence Database (PEDro) were systematically searched to obtain eligible randomized controlled trials (RCTs). Primary outcome was postoperative respiratory muscle strength expressed as the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Secondary outcomes were physical activity, exercise capacity, including the 6-min walking distance and peak oxygen consumption during the cardio-pulmonary exercise test, pulmonary function and the quality of life. RESULTS: Seven studies involving 240 participants were included in this systematic review and meta-analysis. Among them, four studies focused on IMT and the other three studies focused on RMT, one of which included IMT, EMT and also combined RMT (IMT-EMT-RMT). Three studies applied the intervention postoperative, one study preoperative and the other three studies included both pre- and postoperative training. For primary outcomes, the pooled results indicated that perioperative RMT improved the postoperative MIP (mean = 8.13 cmH2O, 95%CI: 1.31 to 14.95, P = 0.02) and tended to increase MEP (mean = 13.51 cmH2O, 95%CI: -4.47 to 31.48, P = 0.14). For secondary outcomes, perioperative RMT enhanced postoperative physical activity significantly (P = 0.006) and a trend of improved postoperative pulmonary function was observed. CONCLUSION: Perioperative RMT enhanced postoperative respiratory muscle strength and physical activity level of patients receiving lung surgery. However, RCTs with large samples are needed to evaluate effects of perioperative RMT on postoperative outcomes in patients undergoing lung surgery.
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The objective of this work was to investigate the effect of magnetic resonance cholangiopancreatography (MRCP) based on super-paramagnetic iron oxide nanoparticles (SPIONs) on the recurrence diagnosis of periampullary diverticulum (PAD) and bile duct stone (BDS), so as to provide a scientific research basis for the recidivation factors of bile duct stones in clinic. Patients with PAD diagnosed in hospital from July 2019 to March 2021 (who had undergone endoscopic gallstone surgery) were selected for study in this work. They were rolled into two groups, the parapapillary group (123 cases) and the cholangiopancreatic duct directly opening in the diverticulum group (97 cases), according to the clinical classification. Then, 100 patients without PAD who had undergone bile duct node therapy were selected as the control group. The recidivation of BDS, serological index, and biliary pressure index before and after treatment were compared. The relationship between PAD and recidivation of bile duct stones was analyzed. The results showed that the average particle size, hydration kinetic particle size, effective time, and duration of polyethylene glycol (PEG)/polyethyleneimine (PEI)/poly aspartic acid-super-paramagnetic iron oxide nanoparticles(PASP-SPIONs) were better than PEG/PEI-SPIONs and SPIONs. The recidivation rate of BDS in Groups R and X was remarkably higher than the rate in control group (P < 0.05). Before treatment, common bile duct pressure in the control group was lower obviously than that in Groups R and X (P < 0.05). After treatment, the indexes including total bilirubin, direct bilirubin, and alkaline phosphatase in control group were lower than those in Groups R and X (P < 0.05). The incidence of complications in Groups R and X was much higher than in contrast to the control group (P < 0.05). Therefore, PEG/PEI/PASP-SPIONs had good contrast effect and could be used as magnetic resonance imaging contrast agent. Complications such as common bile duct pressure and infection were increased by PAD, which may be the main factor for the recidivation of BDS.
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Divertículo , Enfermedades Duodenales , Cálculos Biliares , Nanopartículas de Magnetita , Bilirrubina , Divertículo/diagnóstico por imagen , Enfermedades Duodenales/diagnóstico , Endoscopía , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/cirugía , Humanos , Imagen por Resonancia Magnética , PolietilenglicolesRESUMEN
AIMS: We aim to investigate the additive effect of B-lines on lung ultrasound (LUS) for predicting outcome in patients with heart failure (HF) when combined with conventional assessment of clinical congestion. METHODS AND RESULTS: This study prospectively enrolled 117 hospitalized HF patients (61 ± 16 years, 70.1% males) who underwent congestion assessment by the 'wet/dry' status, clinical congestion score (CCS), and B-lines on LUS. The primary endpoint was all-cause mortality or hospitalization for HF during the 180-day follow-up after discharge. The 'Wet', CCS ≥ 3, and B-lines >5, indicators of congestion positive (+), were observed in 83.8%, 76.1%, and 70.1% of the patients on admission, respectively; and the numbers significantly decreased to 41.9%, 41.9%, and 35.9% at discharge, respectively. The agreement between the 'wet/dry' status and B-lines (58.1%) or between CCS and B-lines (56.4%) was moderate at discharge, in terms of both positive and both negative. By incorporating the B-lines with assessment of clinical congestion, the patients at discharge were divided into three phenotypes as clinical congestion (+), clinical congestion (-) with B-lines (+), and clinical congestion (-) with B-lines (-). The Kaplan-Meier analysis showed a better survival in the both (-) group ('wet/dry' with B-lines: Chi-square 10.591, P = 0.005; CCS with B-lines: χ2 6.239, P = 0.031). When the 'wet' patients (n = 49) being taken as the reference, the 'dry' patients with B-lines (+) (n = 21) had an identical risk of the composite endpoint (hazard ratio [HR] adjusted for clinical covariates 1.021, 95% confidence interval [CI] 0.480-2.134, P = 0.974), while the 'dry' patients with B-lines (-) (n = 47) had a lower risk (HR 0.264, 95% CI 0.113-0.617, P = 0.002). When the CCS (+) patients (n = 49) being regarded as the reference, similar results were obtained in the patients with CCS (-) but B-lines (+) (n = 22) (HR 1.348, 95% CI 0.627-2.896, P = 0.444) as well as in those with both CCS (-) and B-lines (-) (n = 46) (HR 0.447, 95% CI 0.202-0.992, P = 0.048). CONCLUSIONS: The combination of B-lines on LUS and conventional assessment helped to identify new phenotypes of congestion that aid in the risk stratification of discharged HF patients. Further investigation is warranted to determine whether this strategy could be adopted as a guide for decongestion therapy.
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Insuficiencia Cardíaca , Edema Pulmonar , Humanos , Masculino , Femenino , Alta del Paciente , Pronóstico , Edema Pulmonar/etiología , Insuficiencia Cardíaca/complicaciones , PulmónRESUMEN
Progress in medical and surgical care has tremendously improved the survival rates of children with congenital heart disease (CHD). However, reduced aerobic capacity and health-related issues remain a threaten to quality survival and prevention of related complications among children and adolescents with CHD. This research program aims to develop and evaluate a WeChat-based health platform (HeartFIT) to facilitate cardiac rehabilitation and promote physical fitness for this rapidly expanding young population. The study protocol describes the use of an iterative process of using a mixed-methods strategy to develop, refine, and pilot test the proposed HeartFIT platform. A sequential problem-solving process comprising four iterative phases with ongoing end-user input will be implemented. In phase 1, relevant literature was systematically reviewed (completed) and then child-parent dyads will be interviewed to understand the broad context and the requirements and considerations of the target population toward the WeChat-based rehabilitation platform. In phase 2, key features and priority functionalities for the platform will be ideated and refined, and a digital interactive prototype will be created. In phase 3, heuristic evaluation and three rounds of end-user testing will be conducted to ensure further refinement and usability of the prototype. In phase 4, a prospective pilot study will be performed to investigate the feasibility, acceptability, and preliminary efficacy of the developed platform over a 12-week intervention period. If HeartFIT intervention is feasible, acceptable, and demonstrates promising efficacy, an adequately powered randomized controlled trial (future work) will be deployed to test the real-world effectiveness of the intervention.