Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation

OBJECTIVE: To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR. METHOD: All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9+/-10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%). RESULTS: The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours). CONCLUSION: Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.

Prognostic Influences of Cardiac Rehabilitation in Korean Acute Myocardial Infarction Patients

OBJECTIVE: To observe the prognostic influences of the cardiac rehabilitation (CR) program in Korean acute myocardial infarction (AMI) patients during the first year after an occurrence of the disease. METHOD: A total of 141 AMI patients who underwent percutaneous coronary intervention (PCI) were recruited consecutively for this study and divided into the CR group and the control group. The CR group completed the phase 2 CR program in the hospital for a period of 6-8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI. We performed a prospective comparison of the patients' demographic data, high sensitive C-reactive protein (hs-CRP) level after the 4-month CR program, and the rate of recurrence (AMI, re-hospitalization, positive coronary angiogram, needed revascularization procedure, or death) between the two groups. RESULTS: Compared to the control group (0.33+/-0.48 mg/dl), the hs-CRP level was lower in the CR group (0.18+/-0.32 mg/dl) after 4 months of exercise. The recurrence rate was lower (10%, 7/69) in the CR group, compared to the control group (24%, 17/72, p<0.05). The number of disease-free days was larger in the CR group (354+/-38.34), compared to the control group (316+/-99.96, p<0.05). In a comparison of statistical methods used for testing the equality of two survivor distributions, the CR group showed a lower recurrence rate than the control group (p<0.05). CONCLUSION: Participation in the CR program designed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14% during the first year.

Retrodiscal Approach of Lumbar Epidural Block

OBJECTIVE: To compare the technical strengths and weaknesses between retrodiscal (RD) and conventional subpedicular (SP) approaches of transforaminal epidural block (TF-EPB). METHOD: Sixty-one patients with L5 radiculopathy who planned to undergo TF-EPB were consecutively enrolled as study subjects. Subjects were randomly assigned to one of two groups. For the RD approach, the positioning of the patient and the C-arm were similar to that for lumbar discography. We compared the pattern of dye spreads, the frequency of complications during the procedures, and the effect of the pain block 2 weeks after the procedure between the two groups. RESULTS: For the RD group (n=24), the contrast dye diffused around the L5 and S1 nerve roots in 16 cases (67%), but it diffused around only the L5 root in 27 cases (73%) in the SP group (n=37) (p<0.05). Two weeks after the procedure, the visual analogue scale (VAS) decreased by the same amount in both groups (RD group: 3.1+/-1.6, SP group: 3.2+/-2.6). Symptoms of nerve root irritation occurred in 1 case of the RD group and in 10 cases of the SD group (p<0.05). CONCLUSION: The RD approach was as efficient as the SP approach for temporary diagnostic relief and offered considerable advantages, such as lower nerve root irritation possible lower risk of vascular injection. Thus, it could be a useful technique when a herniated disc segment is stuck or when the foraminal stenosis is severe.

Chimerism Proven by Flow Cytomety in the Setting of an ABO Discrepancy: A Case Report / 대한수혈학회지

Chimerism is an important, yet uncommon cause of ABO phenotype/genotype discrepancies. The propositus was a 28 year-old pregnant women who had an ABO discrepancy, expressing an A(weak)B RBC phenotype and AB reverse type. Sequencing of ABO exons 6 and 7 revealed a B101/O01 genotype. Neither analysis of 9 short tandem repeats (STR) loci nor HLA typing on DNA extracted from white blood cells demonstrated evidence of chimerism. However, flow cytometric analysis using a PE-conjugated anti-A mouse monoclonal antibody detected a small population (3.8%) of red cells expressing normal A antigen. Based on this, we suggest that flow cytometric analysis is an effective method for the identification of small chimeric populations of RBCs in the immunohematology laboratory.

Central Venous Catheter-Related Microbacterium Bacteremia Identified by 16S ribosomal RNA Gene Sequencing / 대한임상미생물학회지

We describe here a case of central venous catheter (CVC)-related bacteremia caused by Microbacterium species in a 14-year-old patient, who had received chemotherapy for acute lymphoblastic leukemia. All nine blood cultures obtained from admission day 2 to day 62 yielded the same yellow-pigmented coryneform rod. Both Vitek 2 (bioMerieux, USA) and MicroScan (Dade Behring, USA) identified the isolate as Micrococcus species, and the API Coryne (bioMerieux, France) identified the isolate as Rhodococcus or Brevibacterium species. However, the 16S rRNA gene sequence showed a 99% identity with Microbacterium species. The bacteremia was recurrent or persistent over 60 days despite alternate systemic antibiotic therapy, but blood culture became negative after an addition of teicoplanin lock therapy for eradicating CVC-related bacteremia. This represents the first report of CVC-related Microbacterium bacteremia cured by antibiotic lock therapy in Korea.

Species-Specific Differences in Rhodamine 6G Accumulation of Candida Isolates Detected by Flow Cytometric Analysis / 대한진단검사의학회지

BACKGROUND: Fluorescent dye Rhodamine 6G (R6G) is a substrate of multidrug resistance pumps and its accumulation is reduced in some azole-resistant Candida isolates with the upregulation of multidrug efflux transporter genes. Despite reports on species-specific differences in azole susceptibility in various Candida species, only a few studies have been reported on the R6G accumulation among clinical isolates of Candida species. In this study, we compared R6G accumulation between six different Candida species. METHODS: The intracellular accumulation of R6G and minimal inhibitory concentrations (MICs) of three triazole agents were investigated in 48 strains of six Candida species (14 C. albicans, 9 C. tropicalis, 8 C. glabrata, 8 C. krusei, 7 C. parapsilosis, and 2 C. haemulonii). R6G accumulation was measured by using flow cytometry and the geometric mean of the fluorescence intensity (GMF) was used to compare the accumulation between the Candida isolates. RESULTS: The GMF values for the C. tropicalis, C. albicans, C. krusei, C. parapsilosis, and C. glabrata isolates were 167.3+/-18.5, 126.9+/-6.6, 88.5+/-18.5, 50.8+/-7.0, and 38.1+/-3.9, respectively. C. glabrata had a significantly lower mean GMF than all the other Candida species (P<0.05). While some Candida strains with trailing growth phenomenon and increased fluconazole MIC did not have a reduced GMF, three Candida strains with increased MICs to all three triazole agents had a reduced GMF. CONCLUSIONS: This study found species-specific differences in R6G accumulation in Candida. In addition, the intracellular R6G accumulation can be used to investigate the drug efflux mechanism in azole-resistant Candida strains.