Effect of moderate-intensity treadmill exercise on increased adiponectin levels in type 2 diabetes mellitus patients / Efecto del ejercicio en cinta de correr de intensidad moderada sobre el aumento de los niveles de adiponectina en pacientes con diabetes mellitus tipo 2 psİcológİca / Efeito do exercício em esteira de intensidade moderada no aumento dos níveis de adiponectina em pacientes com diabetes mellitus tipo 2

ABSTRACT Introduction: Adiponectin plays a significant role in the metabolic system in proinflammatory cytokine inhibition and glucose uptake utilization. The treadmill is an aerobic walking device that stimulates natural walking features. Exercises increase adiponectin levels leading to improvement in insulin sensitivity. Objectives: To analyze the effect of aerobic exercise using a moderate-intensity treadmill with a gradual increase in speed and inclination on adiponectin levels in men with type 2 diabetes mellitus (T2DM). Methods: Twenty-two participants with T2DM were randomized into treadmill exercise and control groups. The experimental group underwent 30-minute sessions of moderate-intensity treadmill exercise with increasing speed and gradual inclination three times a week for four weeks. The control group underwent individual exercise for 150 minutes per week. Participants were assessed for clinical and laboratory parameters before and after the four-week program. Results: There was a significant increase in the adiponectin level from 456.3 ± 42 pg/ml to 586.3 ± 87.8 pg/ml (p=0.04, p<0.05) in the treadmill exercise group. In the control group, adiponectin only increased from 466.7 ± 85 pg/ml to 471.8 ± 59 pg/ml (p=0.646). Conclusions: Moderate-intensity treadmill with increasing speed and gradual inclination was found to lead to a significantly better outcome in improving adiponectin levels than standard individual physical exercise in managing T2DM. Level of evidence II; Therapeutic studies - Investigation of the treatment results.

RESUMEN Introducción: La adiponectina desempeña un papel importante en el sistema metabólico al inhibir las citoquinas proinflamatorias y al utilizar la captación de glucosa. La cinta de correr es un dispositivo de caminata aeróbica que estimula las características de la marcha natural. Los ejercicios aumentan el nivel de adiponectina, lo que se traduce en una mayor sensibilidad a la insulina. Objetivos: Analizar el efecto de los ejercicios aeróbicos en una cinta de correr de intensidad moderada con un aumento gradual de la velocidad y la inclinación sobre los niveles de adiponectina en hombres con diabetes mellitus tipo 2 (DMT2). Método: Veintidós participantes con DMT2 fueron asignados aleatoriamente a grupos de ejercicio en cinta de correr y de control. El grupo experimental realizó sesiones de ejercicio en cinta de correr de 30 minutos de intensidad moderada con velocidad creciente e inclinación gradual tres veces por semana durante cuatro semanas. El grupo de control se sometió a ejercicios individuales durante 150 minutos a la semana. Se evaluaron los parámetros clínicos y de laboratorio de los participantes antes y después del programa de cuatro semanas. Resultados: Hubo un aumento significativo del nivel de adiponectina de 456,3 ± 42 pg/ml a 586,3 ± 87,8 pg/ml (p=0,04, p<0,05) en el grupo de ejercicio en cinta de correr. En el grupo de control, la adiponectina presentó un pequeño aumento de 466,7 ± 85 pg/ml a 471,8 ± 59 pg/ml (p=0,646). Conclusión: Se descubrió que los ejercicios en cinta de correr de intensidad moderada con velocidad creciente e inclinación gradual conducen a un resultado significativamente superior en la mejora de los niveles de adiponectina en comparación con los ejercicios individuales estándar en el tratamiento de la DMT2. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados del tratamiento.

RESUMO Introdução: A adiponectina desempenha um papel significativo no sistema metabólico na inibição da citocina pró-inflamatória e na utilização da captação de glicose. A esteira é um aparelho de caminhada aeróbica que estimula as características da caminhada natural. Os exercícios aumentam o nível de adiponectina, resultando na melhora da sensibilidade à insulina. Objetivos: Analisar o efeito de exercícios aeróbicos em uma esteira de intensidade moderada com um aumento gradual de velocidade e inclinação sobre os níveis de adiponectina em homens com diabetes mellitus tipo 2 (DMT2). Método: Vinte e dois participantes com DMT2 foram randomizados para grupos de exercício em esteira e controle. O grupo experimental realizou sessões de 30 minutos de exercício em esteira de intensidade moderada com velocidade crescente e inclinação gradual três vezes por semana durante quatro semanas. O grupo de controle se submeteu a exercício individual durante 150 minutos por semana. Os participantes foram avaliados em relação aos parâmetros clínicos e laboratoriais antes e após o programa de quatro semanas. Resultados: Houve um aumento significativo no nível de adiponectina de 456,3 ± 42 pg/ml para 586,3 ± 87,8 pg/ml (p=0,04, p<0,05) no grupo de exercício em esteira. No grupo de controle, a adiponectina apresentou um pequeno aumento de 466,7 ± 85 pg/ml para 471,8 ± 59 pg/ml (p=0,646). Conclusão: Descobriu-se que exercícios na esteira de intensidade moderada com velocidade crescente e inclinação gradual conduzem a um resultado significativamente superior na melhora dos níveis de adiponectina em relação a exercícios físicos individuais padrão ao tratar o DMT2. Nível de evidência II; Estudos terapêuticos - Investigação de resultados do tratamento.

Indirect Determination of Maximal Oxygen Consumption (VO2Max) and Its Correlation with Body Mass Index

Background: The current study was designed to evaluate cardio respiratory fitness in terms of VO2max in young healthy males and to correlate between body mass index and cardio respiratory fitness. Methods: One hundred twenty-five apparently healthy male subjects in the age group of 18 to 25 years were included in this study group. Body mass index was measured as weight in kilograms divided by height in meters square. Cardio respiratory fitness in terms of VO2max was predicted by following the protocol of Treadmill Jogging Test (TMJ). Results: There was a highly significant negative correlation between body mass index and VO2max, r = -0.75 p<0.0001. Conclusion: The result suggests that the reduced cardiac performance during progressive work rate exercise in obese individuals. Greater the BMI, more severe will be the functional impairment, suggesting excessive amount of body fat on cardio-respiratory functions and oxygen uptake by working muscles

A Comparative Study Of Cardiovascular Response In Two Acute Submaximal Treadmill Exercise Tests And Its Correlation With Anthropometric Variables

Aim: (i) To assess and compare the cardiovascular response in two sub-maximal exercise tests. (ii) to see correlation between cardiovascular response and anthropometric variables. Method: 125 males 18-25 years underwent first three stages of the original Bruce protocol in one session and exercise according to Treadmill jogging test in another session in randomised order. Heart rate, blood pressure and ECG were recorded before, during and after taking the treadmill test. Results: During the exercise heart rate and systolic BP rose and diastolic BP fell in both the tests. Correlation analysis showed highly significant positive correlation between BMI and pre-exercise systolic BP, post-exercise heart rate and post-exercise systolic BPin both the tests. ECG showed no significant ST/Tor rhythm changes during or after the exercise. Conclusion: Heart rate and BPchanges were more in Bruce submaximal exercise test as compared to treadmill jogging test. Higher BMI was found to be correlated with higher resting systolic BP, higher post-exercise heart rate as well as higher post-exercise systolic BP.

Treadmill test for premature ventricular contraction / 国际儿科学杂志

Premature ventricular contraction is one of the most common arrhythmias in pediatric.Its incidence increases with age.The clinical symptoms of children's premature ventricular beats vary greatly,and the pediatric patients may have no discomforts,while the serious patients may have life-threatening events such as malignant ventricular arrhythmia and cardiac arrest.How to evaluate premature ventricular contraction and to guide the life and activities of children with premature ventricular contraction is of great significance.By adjusting the speed and slope of the plate,the motion of the subject is adjusted to increase the work and increase the heart rate,then the arrhythmia that is absent in the static state can be found or the original arrhythmia can be changed or disappeared.Treadmill test has been carried out in China for more than 30 years.Though some clinical experience has been accumulated,but there are still a lot of problems.This article reviews the present state and precision management of treadmill test's effect on children with ventricular premature contraction.

Treadmill stress tests should not be part of “routine health check package”

A treadmill ECG stress test (TMT) often forms part of the popular health check packages recommended for people who are asymptomatic on the premise that it can detect disease at an early stage and treatment be prescribed to prevent or reduce future morbidity and mortality. Such a recommendation does not take into account the properties of this procedure as a diagnostic test. It has an average sensitivity and specificity of 68% and 77%, respectively. However, these figures depend on the probability of coronary artery disease (CAD) in the test subject. In asymptomatic persons with few or no risk factors, the likelihood of a false positive is high and will result in psychological stress and/or expensive and possibly invasive test. Recommendation for a TMT should be made by a physician after evaluating the subject to have at least an intermediate risk of having CAD.

A novel approach for the prediction of treadmill test in cardiology using data mining algorithms implemented as a mobile application

Objective To develop a mobile app called “TMT Predict” to predict the results of Treadmill Test (TMT), using data mining techniques applied to a clinical dataset using minimal clinical attributes. To prospectively test the results of the app in realtime to TMT and correlate with coronary angiogram results. Methods In this study, instead of statistics, data mining approach has been utilized for the prediction of the results of TMT by analyzing the clinical records of 1000 cardiac patients. This research employed the Decision Tree algorithm, a new modified version of K-Nearest Neighbor (KNN) algorithm, K-Sorting and Searching (KSS). Furthermore, curve fitting mathematical technique was used to improve the Accuracy. The system used six clinical attributes such as age, gender, body mass index (BMI), dyslipidemia, diabetes mellitus and systemic hypertension. An Android app called “TMT Predict” was developed, wherein all three inputs were combined and analyzed. The final result is based on the dominating values of the three results. The app was further tested prospectively in 300 patients to predict the results of TMT and correlate with Coronary angiography. Results The accuracy of predicting the result of a TMT using data mining algorithms, Decision Tree and K-Sorting & Searching (KSS) were 73% and 78%, respectively. The mathematical method curve fitting predicted with 82% accuracy. The accuracy of the mobile app “TMT Predict”, improved to 84%. Age-wise analysis of the results show that the accuracy of the app dips when the age is more than 60 years indicating that there may be other factors like retirement stress that may have to be included. This gives scope for future research also. In the prospective study, the positive and negative predictive values of the app for the results of TMT and coronary angiogram were found to be 40% and 83% for TMT and 52% and 80% for coronary angiogram. The negative predictive value of the app was high, indicating that it is a good screening tool to rule out coronary artery heart disease (CAHD). Conclusion “TMT Predict” is a simple user-friendly android app, which uses six simple clinical attributes to predict the results of TMT. The app has a high negative predictive value indicating that it is a useful tool to rule out CAHD. The “TMT Predict” could be a future digital replacement for the manual TMT as an initial screening tool to rule out CAHD.

Research on the effect of optimizing protocol activity on the cardiac function in patients with hypertension / 中国综合临床

Objective To investigate the effect of optimizing protocol activity on the cardiac function in patients with hypertension.Methods One hundred and one patients with mild and moderate hypertension in Navy General Hospital were enrolled in the study.The patients took regular exercise(6 min walking activity and treadmill test),Echocardiogram was performed 24 h after 6 min walking activity and treadmill test.The cardiac function related parameters were obtained through M-mode,2DE,pulse Doppler and DTI detection to compare the effect of 6 min walking activity and treadmill test on cardiac function.Results The results showed that in the male hypertensive patients,EF and E/E' after treadmill test were superior to those after 6 min walking activity (EF:(59.33±4.46)% vs.(56.05±4.57)%;E/E':(4.12±1.66)vs.(4.95±1.79)),the differences were statistically significant(P=0.02,0.01),while among the female hypertensive patients,there were no significant differences in cardiac function(P>0.05).Conclusion Appropriate activity can improve the cardiac function in male hypertensive patients.EF and E/E' after the treadmill test performed better than those after the 6 min walking activity,while its influence on female hypertensive patients was not significant.

Achilles tendon of wistar rats treated with laser therapy and eccentric exercise / Tendão calcanear de ratos wistar tratados com laserterapia e exercício excêntrico / Tendón de aquiles de ratas wistar tratados con laserterapia y ejercicio excéntrico

ABSTRACTIntroduction:Both laser therapy and eccentric exercises are used in tendon injuries. However, the association of these physiotherapeutic modalities is yet little investigated.Objective:To evaluate the effect of low-level laser therapy associated to eccentric exercise (downhill walking) on Achilles tendinopathy of Wistar rats.Method:Eighteen Achilles tendon from 15 adult male Wistar rats were used. Tendons were distributed in six groups (laser, eccentric exercise, laser and eccentric exercise, rest, contralateral tendon, and healthy tendon). Unilateral tendinopathy was surgically induced by transversal compression followed by scarification of tendon fibers. The treatments laser therapy (904 nm, 3J/cm²) and/or eccentric exercise (downhill walking; 12 m/min; 50 min/day; 15o inclination treadmill) began 24 hours after surgery and remained for 20 days. Clinical and biomechanical analyzes were conducted. Achilles tendon was macroscopically evaluated and the transversal diameter measured. Euthanasia was performed 21 days after lesion induction. Tendons of both limbs were collected and frozen at -20°C until biomechanical analysis, on which the characteristic of maximum load (N), stress at ultimate (MPa) and maximum extension (mm) were analyzed.Results:Swelling was observed within 72 hours postoperative. No fibrous adhesions were observed nor increase in transversal diameter of tendons. Animals with the exercised tendons, but not treated with laser therapy, presented lower (p=0.0000) locomotor capacity. No difference occurred be-tween groups for the biomechanical characteristics maximum load (p=0.4379), stress at ultimate (p=0.4605) and maximum extension (p=0.3820) evaluated, even considering healthy and contralateral tendons.Conclusion:The concomitant use of low-level laser and the eccentric exercise of downhill walking, starting 24 hours after surgically induced tendinopathy, do not result in a tendon with the same biomechanical resistance or elasticity as a healthy tendon. On the other hand, it also does not influence negatively the structure and function of the Achilles tendon.

RESUMOIntrodução:Tanto a laserterapia como exercícios excêntricos são utilizados em lesões tendíneas. Entretanto, a asso-ciação dessas modalidades fisioterapêuticas ainda é pouco investigada.Objetivo:Avaliar o efeito da terapia com laser de baixa potência associada a exercício excêntrico (caminhada em declive) na tendinopatia do tendão calcanear de ratos Wistar.Método:Foram utilizados 18 tendões calcaneares provenientes de 15 ratos Wistar machos adultos. Os tendões foram distribuídos em seis grupos (laser, exercício excêntrico, laser e exercício excêntrico, repouso, tendão contralateral e tendão sadio). A tendinopatia unilateral foi cirurgicamente induzida mediante compressão transversal seguida pela escarificação das fibras tendíneas. Os tratamentos de laserterapia (904 nm, 3J/cm²) e/ou exercício excêntrico (caminhada em declive; 12 m/min; 50 min/dia; esteira com 15o de inclinação) se iniciaram 24 horas após a cirurgia e permaneceram por 20 dias. Foram conduzidas análises clínica e biomecânica. O tendão calcanear foi examinado macroscopicamente, e seu diâmetro transversal mensurado. Eutanásia foi realizada 21 dias após indução da lesão. Os tendões de ambos os membros foram obtidos e congelados a -20°C até realização da análise biomecânica, na qual foram testadas as características de carga máxima (N), tensão na carga (MPa) e extensão (mm) máxima.Resultados:Edema local foi observado nas primeiras 72 horas do pós-operatório. Não foram observadas aderências fibrosas, nem aumento no diâmetro transversal dos tendões. Animais com tendões exercitados, porém não tratados com laserterapia, apresenta-ram menor (p=0,0000) capacidade de locomoção. Não houve diferença entre grupos nas características biomecânicas de carga máxima (p=0,4379), tensão na carga (p=0,4605) e extensão máxima (p=0,3820), inclusive considerando-se tendões sadios e contralaterais.Conclusão:A utilização concomitante de laser de baixa potência e exercício excêntrico de caminhada em declive, iniciados 24 horas após tendinopatia induzida cirurgicamente, não resulta em um tendão biomecanicamente tão resistente ou elástico quanto um tendão saudável. Por outro lado, também não influencia negativamente na estrutura e função do tendão calcanear.

RESUMENIntroducción:Tanto la laserterapia como ejercicios excéntricos son utilizados en lesiones tendíneas. Entretanto, la asociación de esas modalidades fisioterapéuticas aún es poco investigada.Objetivo:Evaluar el efecto de la terapia con láser de baja potencia asociada a ejercicio excéntrico (caminata en declive) en la tendinopatía del tendón de Aquiles de ratas Wistar.Método:Fueron utilizados 18 tendones de Aquiles provenientes de 15 ratas Wistar machos adultos. Los tendones fueron distribuidos en seis grupos (láser, ejercicio excéntrico, láser y ejercicio excéntrico, reposo, tendón contralateral y tendón sano). La tendinopatía unilateral fue quirúrgicamente inducida mediante compre-sión transversal seguida por la escarificación de las fibras tendíneas. Los tratamientos de laserterapia (904 nm, 3J/ cm²) y/o ejercicio excéntrico (caminata en declive; 12 m/min; 50 min/día; cinta con 15o de inclinación) se iniciaron 24 horas después de la cirugía y permanecieron por 20 días. Fueron conducidos análisis clínico y biomecánico. El tendón de Aquiles fue examinado macroscópicamente, y su diámetro transversal medido. Fue realizada eutanasia 21 días después de la inducción de la lesión. Los tendones de ambos miembros fueron obtenidos y congelados a -20°C hasta la realización del análisis biomecánico, en el que fueron probadas las características de carga máxima (N), tensión en la carga (MPa) y extensión (mm) máxima.Resultados:Fue observado edema local en las primeras 72 horas del postoperatorio. No fueron observadas adherencias fibrosas, ni aumento en el diámetro transversal de los tendones. Los animales con tendones ejercitados, aunque no tratados con laserterapia, presentaron menor (p=0,0000) capacidad de locomoción. No hubo diferencia entre grupos en las características biomecánicas de carga máxima (p=0,4379), tensión en la carga (p=0,4605) y extensión máxima (p=0,3820), incluso considerándose tendones sanos y contralaterales.Conclusión:El uso concomitante de láser de baja potencia y ejercicio excéntrico de caminata en declive, iniciados 24 horas después de la tendinopatía inducida quirúrgicamente, no resulta en un tendón biome-cánicamente tan resistente o elástico cuanto un tendón sano. Por otro lado, tampoco influencia negativamente en la estructura y función del tendón de Aquiles.

Exercise Stress Testing In Diabetics with Asymptomatic Coronary Artery Disease.

Background: Coronary artery disease (CAD) is a common cause of premature morbidity and mortality in diabetics and is often asymptomatic because of silent myocardial ischemia. Early detection of silent myocardial ischemia may prevent catastrophic cardiac events. Objectives: to study the prevalence of latent coronary artery disease in diabetics by maximal treadmill exercise testing and to correlate CAD with severity and duration of diabetes. Materials and methods: The present one year observational cross sectional study was conducted at Gurugobind Singh hospital, Jamnagar in 100 diabetic patients without clinical evidence of coronary artery disease. All participants undergone exercise stress testing using Bruce protocol to detect silent myocardial ischemia. Results: Out of 100 patients, TMT was positive in 32(32%) and negative in 68(68%) patients. TMT was positive in 10/56(17.85%), 8/24(33.33%), 8/12(66.66%) and 6/8(75%) patients with duration of diabetes ≤5, 6 to 10, 11 to 15 and 16 to 20 years respectively. Conclusion and interpretation: The prevalence of asymptomatic coronary artery disease in diabetes mellitus without past history of ischemic heart disease or hypertension is 32%. Longer the duration and poor control of diabetes, greater the risk of asymptomatic coronary artery disease.

Risk profile in asymptomatic first degree relatives of Coronary Artery Disease (CAD) patients.

Aim: Cardiovascular disease is on the rise and is expected to be a leading cause of death and disability worldwide. Identification of risk in asymptomatic individual in higher risk group could help to plan individual patient’s management. Positive family history is one of the risk factors and screening at this level may help in determining individual therapy. Studies have shown relation of positive family history but are lacking in this part of world, so we considered it worthwhile to assess FRS in asymptomatic sibling of CAD Patients Materials and methods: 75 volunteers were enrolled in the study and they underwent Bruce treadmill exercise protocol after their initial evaluation, these volunteers than also underwent biochemical test – Fasting blood sugar and lipid profile. These volunteers were divided into two groups based upon their Treadmill test results. Results: 31 out of 75 volunteers were TMT positive and they were kept in one group. These volunteers differed significantly (p<0.05) in higher age, fasting blood sugar and Low density lipoprotein level (LDL). This group also had a significantly lower metabolic equivalents and higher Framingham Risk Score. Conclusion: Our study showed that positive family history is associated with a higher Framingham risk score in asymptomatic volunteers.

Improved Detection of Ischemic Heart Disease by Combining High-Frequency Electrocardiogram Analysis with Exercise Stress Echocardiography

BACKGROUND AND OBJECTIVES: Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE). SUBJECTS AND METHODS: We evaluated 175 patients (age 57+/-9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis. RESULTS: Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766). CONCLUSION: HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.

Preoperative assessment value of treadmill experimental Duke score of coronary artery disease in patients with non-cardiac surgery / 中国综合临床

Objective To analysis of treadmill exercise test Duke score(DTS) in patients with coronary heart disease than the evaluation functions of heart operation perioperative cardiac events.Methods One hundred and eighty-four patients with coronary heart disease,45 ～ 75 years of medium-sized non cardiac operation,were chose from May,2010 to May,2011 in our hospital,Cardiac ultrasound,treadmill exercise test were taken before operation,preoperative examination department of internal medicine disease history and physical examinations.According to the Duke score,they were divided into DTS in low risk group (5 ≤ Duke ≤ 15,n =124),medium risk group DTS(DTS:(-10≤Duke≤5,n =60),the exclusions of patients with high-risk DTS group,and the high-risk group of patients were excluded.Comparative analysis of operations,the main type of Department of internal medicine disease history,intraoperative and postoperative major cardiovascular complications.Results In the two groups of operation type and the type of anesthesia and cardiovascular disease,there is no significant difference (P ＞ 0.05) ; in DTS low risk group the age (59.2 ± 4.1) years,preoperative cardiac dysfunction were 2 cases,left ventricular ejection fraction ＜ 0.50 were 2 case (1.6％),diabetes history 12 case(9.6％),with angina pectoris symptoms of 51 case(41.1％),ECG ischemic changes in 55 (44.3 ％),in the medium DTS risk group,the age(65.2 ± 2.6)years,preoperative cardiac dysfunction were 8 cases(13.3％),left ventricular ejection fraction of ＜ 0.50 was 5 case (8.3％),diabetes history 23 case (38.3 ％),angina pectoris and 60 case (100％),ECG ischemic changes in 40 case (66.7 ％) (t =2.98,P =0.042,x2 values were 4.93,3.84,4.67,5.24,3.58,P ＜0.05).The low risk group of patients with arrhythmia,hypertension incidence rate were 6.5％ (8/124) and 22.5％ (28/124),medium risk group of patients with arrhythmia,hypertension incidence rate were 11.6％ (7/60) and 18.3％ (11/60),compared with DTS in low risk group,DTS medium risk group of arrhythmia and hypertension odds ratio(Odds Ratio,OR) and 95％ confidence intervals were 1.7 (0.8-3.3),0.8 (0.4-1.4),the P values were 0.062,0.074,has no significant difference.Controlling for age and sex DTS in low risk group postoperative myocardial infarction,cardiogenic pulmonary edema rate were 0.8％ (1/124) and 2.4％ (3/124),medium risk group after DTS myocardial infarction,cardiogenic pulmonary edema rate were 10％ (6/60) and 11.7％ (7/60),compared with DTS in low risk group,DTS medium risk group after myocardial infarction and heart pulmonary edema ratios (Odds Ratio,OR) and 95％ confidence intervals were 19.3 (5.6-66.2),5.7 (2.5-12.9),the P values were 0.002,0.003,had significant diflerence.Conclusion DTS medium risk group patients undergoing non cardiac operation preoperative heart failure,diabetes,angina symptoms,peri operation period of cardiac event rate is high and heavy.

Teste de esforço cardiopulmonar com protocolo de rampa em adultos com insuficiência cardíaca / Cardiopulmonary exercise test with ramp protocol in adults with heart failure

INTRODUÇÃO E OBJETIVO: O teste de esforço com protocolo de rampa é descrito como o que mais se adéqua à condição física de indivíduos com insuficiência cardíaca (IC). Porém, não há padronização descrita sobre incrementos de velocidade e inclinação. Este estudo teve como objetivo descrever resultados encontrados a partir da aplicação de um teste de esforço com protocolo de rampa adaptado para indivíduos com IC, classes II e III da New York Heart Association (NYHA). MÉTODOS: 41 indivíduos com média de idade de 46,37 ± 8,98 anos e fração de ejeção de 31,51 ± 9,45% fizeram o teste de esforço com análise de gases expirados em esteira, com protocolo de rampa desenvolvido a partir de critérios definidos pelo estudo de Barbosa e Silva e Sobral. Análise estatística: Foi realizada análise descritiva com distribuição de frequência e o tempo de teste foi apresentado como média ± desvio padrão. Foi realizado o modelo de regressão linear incluindo classe da NYHA, idade e fração de ejeção como variáveis explicativas para tempo de teste. Foi considerado significativo p < 0,05. RESULTADOS: O tempo médio do teste foi 8,89 ± 3,57 minutos e o R alcançado foi 1,12 ± 0,11. Sessenta e um porcento da amostra apresentou duração do teste entre seis e 12 minutos, considerando intervalo de média ± 1 desvio padrão, e 73,2% da amostra apresentou duração entre seis e 15 minutos. CONCLUSÃO: Os achados deste estudo demonstraram que a maioria dos indivíduos com IC finalizou o teste com o protocolo de rampa adaptado dentro da duração considerada adequada pela literatura.

INTRODUCTION AND OBJECTIVE: The exercise test with ramp protocol is described as the one which best adapts to physical condition of subjects with heart failure (HF). However, velocity and inclination standard increments have not been described yet. This study aimed to describe the results found after application of an exercise test with ramp protocol adjusted for subjects with HF, New York Heart Association (NYHA) class II and III. METHODS: 41 subjects with mean age 46.37 ± 8.98 years and ejection fraction of 31.51 ± 9.45% performed the exercise test with expired gas analysis on treadmill with ramp protocol developed from criteria defined in a study by Barbosa and Silva et al. Statistical Analysis: descriptive analysis was performed with frequency distribution and the test time was presented as mean ± standard deviation. Linear regression model was used and NYHA class, age and ejection fraction were included as explanation variables for the test time. A p value of < 0.05 was considered statistically significant. RESULTS: Mean test time was 8.89 ± 3.57 minutes and the R was 1.12 ± 0.11. Sixty-one percent of the sample presented test duration between 6 and 12 minutes - mean ± 1 standard deviation interval - and 73.2% presented duration between 6 and 15 minutes. CONCLUSION: This study demonstrated that the majority of the subjects with HF concluded the test with ramp protocol adjusted in time considered adequate in the literature.

Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus

BACKGROUND: The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD). METHODS: A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT). RESULTS: Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1+/-9.4 vs. 53.7+/-10.1 years, P=0.008) and duration of diabetes (16.0+/-7.5 vs. 5.5+/-5.7 years, P or =60 years) with a long duration of diabetes (> or =10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%. CONCLUSION: In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes > or =10 years.

The Clinical Effectiveness of Traditional Japanese Harbal-medicine, Tokishigyakukagoshuyushyokyoto for Vascular Intermittent Claudication / 日本東洋医学雑誌

The clinical effects of tokishigyakukagoshuyushyokyoto for vascular intermittent claudication were investigated by treadmill test with 2.4 km/hour and 12 degree. Thirty three patients with Arteriosclerosis Obliterans (ASO) chose either administration of cilostazol (Group I) or tokishigyakukagoshuyushyokyoto (Group II). After limitation of improvement by cilostazol in Group I, tokishigyakukagoshuyushyokyoto was administered (Group III). The distance where patients were able to walk to the limit was assumed to be the maximum walking distance. Change rate of absolute claudication distance (ACD) was calculated as ratio of maximum walking distance after and before treatment.The median of change rate of ACD in Group I one and three month after treatment were 130.5% and 145.5%, respectively. The median of change rate of ACD in Group II one and three month after treatment were 111.6% and 122.7%, respectively. Finally, the median of change rate of ACD in Group III one and three month after treatment were 112.0% and 112.3%, respectively.Either cilostazol or tokishigyakukagoshuyushyokyoto was effective for vascular intermittent claudication. Moreover, tokishigyakukagoshuyushyokyoto showed additional effect after limitation of improvement by cilostazol.

A safety and feasibility study of cell therapy in dilated cardiomyopathy

The aim of this study was to determine if bone marrow mononuclear cell (BMMC) transplantation is safe for moderate to severe idiopathic dilated cardiomyopathy (IDC). Clinical trials have shown that this procedure is safe and effective for ischemic patients, but little information is available regarding non-ischemic patients. Twenty-four patients with IDC, optimized therapy, age 46 ± 11.6 years, 17 males, NYHA classes II-IV, and left ventricular ejection fraction <35 percent were enrolled in the study. Clinical evaluation at baseline and 6 months after stem cell therapy to assess heart function included echocardiogram, magnetic resonance imaging, cardiopulmonary test, Minnesota Quality of Life Questionnaire, and NYHA classification. After cell transplantation 1 patient showed a transient increase in enzyme levels and 2 patients presented arrhythmias that were reversed within 72 h. Four patients died during follow-up, between 6 and 12 weeks after therapy. Clinical evaluation showed improvement in most patients as reflected by statistically significant decreases in Minnesota Quality of Life Questionnaire (63 ± 17.9 baseline vs 28.8 ± 16.75 at 6 months) and in class III-IV NYHA patients (18/24 baseline vs 2/20 at 6 months). Cardiopulmonary exercise tests demonstrated increased peak oxygen consumption (12.2 ± 2.4 at baseline vs 15.8 ± 7.1 mL·kg-1·min-1 at 6 months) and walked distance (377.2 ± 85.4 vs 444.1 ± 77.9 m at 6 months) in the 6-min walk test, which was not accompanied by increased left ventricular ejection fraction. Our findings indicate that BMMC therapy in IDC patients with severe ventricular dysfunction is feasible and that larger, randomized and placebo-controlled trials are warranted.

Effect of Treadmill Exercise on Leak-point pressure and Neuronal Activation in Brain of Rats with Stress Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: Stress urinary incontinence (SUI) commonly occurs in women, and it causes enormous impact on quality of life. Surgery, drugs, and exercise have been recommended for the treatment of this disease. Among these exercise is also known to be effective for relieving thesymptoms of SUI, however, the efficacy and underlying mechanisms of exercise on SUI are poorly understood. In the present study, we investigated the effect of treadmill exercise on abdominal leak-point pressure and neuronal activity in the medial preoptic nucleus (MPA), ventrolateral periaqueductal gray (vlPAG), and pontine micturition center (PMC) following urethrolysis in rats. MATERIALS AND METHODS: Adult female Sprague-Dawley rats, weighing 250+/-10 g (9 weeks old), were used in this study. After having undergone transabdominal urethrolysis to induce SUI, the rats were divided into three groups (n=6 in each group): a sham operation group, an SUI-induced group, and an SUI-induced and treadmill exercise group. The rats in the exercise group performed treadmill running for 30 min once a day starting 2 weeks after the induction of SUI and continuing for 4 weeks after surgery. For this study, determination of abdominal leak point pressure and immunohistochemistry for c-Fos in the brain were performed. RESULTS: Induction of transabdominal urethrolysis significantly reduced the abdominal leak point pressure, thereby contributing to the induction of SUI. In contrast, abdominal leak point pressure was significantly improved by treadmill exercise. The expression of c-Fosin the MPA, vlPAG, and PMC, the brain areas relating to micturition, was enhanced by the induction of SUI, whereas treadmill exercise significantly suppressed SUI-induced c-Fos expression, suggesting that neuronal activation in the micturition centers was suppressed by treadmill exercise. CONCLUSION: The present results suggest that treadmill exercise may be an effective therapeutic modality for ameliorating the symptoms of SUI.

Aortic Valve Sclerosis on Echocardiography is a Good Predictor of Coronary Artery Disease in Patients With an Inconclusive Treadmill Exercise Test

BACKGROUND AND OBJECTIVES: The treadmill exercise test (TMT) is used as a first-line test for diagnosing coronary artery disease (CAD). However, the findings of a TMT can be inconclusive, such as incomplete or equivocal results. Aortic valve sclerosis (AVS) is known to be a good predictor of CAD. We determined the usefulness of assessing AVS on 2-dimensional (2D) echocardiography for making the diagnosis of CAD in patients with inconclusive results on a TMT. SUBJECTS AND METHODS: This prospective study involved 165 consecutive patients who underwent a TMT that resulted in inconclusive findings, 2D echocardiography to detect AVS, and coronary angiography to detect CAD. Following echocardiography, AVS was classified as none, mild, or severe. CAD was defined as > or =70% narrowing of the luminal diameter on coronary angiography. RESULTS: CAD was more common in patients with AVS than in patients without AVS (75% vs. 47%, respectively, p<0.01). Multiple logistic regression analysis showed that AVS was the only independent predictor of CAD {odds ratio=8.576; 95% confidence interval (CI), 3.739-19.672}. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the presence of AVS for predicting CAD in a patient with an inconclusive TMT were 62%, 67%, 64%, 75%, and 53%, respectively. During a 1-year clinical follow-up, patients with and without AVS were similar in terms of event-free survival rates. CONCLUSION: If the results of TMT for patients with chest pain on exertion are inconclusive, the presence of AVS on echocardiography is a good predictor of CAD.

Diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease / 上海交通大学学报（医学版）

Objective To explore the diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease ( CAD). Methods Eighty-six patients suspected of CAD were divided into low risk group, intermediate risk group and high risk group according to estimated pretest probabilities of CAD. All patients underwent coronary angiography, 64-slice spiral CT and exercise treadmill test. With coronary artery stenosis rate >50% as positive findings, the sensitivity, specificity, positive predictive value ( PPV), negative predictive value ( NPV) and accuracy of 64-slice spiral CT and 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were calculated. Results With coronary angiography as the "golden criteria", the sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT in diagnosis of CAD were 95.2% , 88.6% , 88.9% , 95.1% and 91.9% , respectively. The sensitivity of low risk group, intermediate risk group and high risk group was 100% , 100% and 92.6%, specificity was 94.4% , 94.1% and 66.7%, PPV was 80.0%, 91.7% and 89.3%, NPV was 100% , 100% and 75.0%, and accuracy was 95.5% , 96.4% and 86.1%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were 97.6%, 97.7%, 97.6%, 97.7% and 97.7%, respectively. Conclusion 64-slice spiral CT combined with exercise treadmill test works well in screening CAD, especially for those with a low or intermediate estimated pretest probability.