Ventilatory strategies in the six-minute walk test in older patients receiving a three-week rehabilitation programme after cardiac surgery through median sternotomy.

BACKGROUND: Although the six-minute walk test (6MWT) is widely used in cardiac rehabilitation, little is known about the ventilatory strategies adopted by older patients who have recently undergone median sternotomy, in order to meet the increased metabolic demand in the 6MWT. METHODS: Using a portable gas-analyser we assessed the breathing patterns in the 6MWT before and after a 3-week rehabilitation programme in 84 older patients, 58 men and 26 women, mean age 71 years (standard deviation (SD) 6 years), who had undergone median sternotomy. RESULTS: After rehabilitation, patients increased end-test ventilation (33.1 l (SD 9.8) vs. 30.9 l (SD 8.4), p < 0.001) by increasing tidal volume (1.158 l (SD 0.298) vs. 1.065 l (SD 0.255), p < 0.001), while breathing frequency remained unchanged (29.9 bpm (SD 5.4) vs. 30.2 bpm (SD 5.8), p = 0.621). As a consequence, the ventilatory equivalent for CO2, was significantly improved (39.9 (SD 5.3) vs. 43.5 (SD 7.4), p < 0.001). Furthermore, the improvement in ventilatory efficiency was significantly (p < 0.001) correlated with the improvement in the distance walked on the 6MWT. CONCLUSION: Older patients who have undergone median sternotomy meet the increased metabolic demand on the 6MWT after cardiac rehabilitation by increasing tidal volume. Accordingly, we should consider including as a routine specific exercises for inspiratory muscle training in current rehabilitation programmes to reduce inspiratory muscle effort and further improve ventilatory efficiency.

Salvianolic acid B and its liposomal formulations: anti-hyperalgesic activity in the treatment of neuropathic pain.

Salvianolic acid B (SalB) represents the most characteristic constituent of Salvia miltiorrhiza Bge. with a strong free radicals scavenger activity. This property may be useful in the treatment of some severe chronic diseases, where there is an imbalance of reactive oxygen species formation and where intracellular reactive oxygen and nitrogen species level can cause severe cell damage and even cell death. In particular, SalB can protect against the oxidative stress as well as the antioxidant superoxide dismutase and reduced activity of glutathione, important determinants of neuropathological and behavioural consequences in neuropathic pain. This is a chronic disease defined by the WHO as an untreatable illness because therapeutics are unsatisfactory in many cases and there is an urgent need to discover and develop novel active drugs. In the present work, SalB has been extracted and purified with an efficient and rapid method from the roots and rhizome of S. miltiorrhiza Bge. It was firstly submitted to pharmacological studies using the paw-pressure test, in an animal model of neuropathic pain where a peripheral mono neuropathy was produced by a chronic constriction injury of the sciatic nerve. SalB was effective against mechanical hyperalgesia when administered intraperitoneally at the dose of 100mg/kg, 15 min after administration. Due to the poor chemical stability and bioavailability of SalB, liposomes were developed as drug carriers for parental administration. SalB-loaded liposomes were characterised in terms of particle size, polydispersity index, encapsulation efficacy and morphology. According to the in vivo studies, encapsulation, especially into PEGylated liposomes, increased and prolonged the antihyperalgesic activity 30 min after i.p. administration and the effect was still significant at 45 min. Thus, PEGylated formulation ameliorated the performance of drug delaying, increasing and prolonging in time its antihyperalgesic effect.

Endocardial blood cyst: a rare site and age of presentation.

Cardiac blood cysts are rare findings in clinical practice. They usually involve the valves and are very uncommon in adult age. Their clinical manifestation varies broadly, as they can interfere with intracardiac flow, or even be completely silent. We report a case of a newly developed cyst of the atrial septum, incidentally detected by transthoracic echocardiography in a 69-year-old asymptomatic patient. The diagnosis was confirmed by postsurgery histopathological examination.