Cardiopulmonary exercise testing for personalized job reintegration after acute cardiovascular attacks: a pilot cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD), particularly the ischemic heart disease, are a growing public health issue. In addition, the return to work after an acute cardiovascular attack represents a complex challenge. OBJECTIVES: To evaluate utility and safety of cardiopulmonary exercise testing (CPET), particularly performed "on site", to promote a return to work in line with the residual working capacity. METHODS: Fifty-nine workers affected by a major cardiovascular event, aged 18-63 years, have been enrolled between 2015 and 2018. All the patients underwent a cardiopulmonary exercise testing (CPET) in outpatient clinic. Eleven workers also underwent the "on site" CPET, recorded during their working activities. RESULTS: Outpatient clinic CPET outcomes (i.e. normal, mild impairment or moderate/severe impairment of cardiopulmonary function) were associated with the subjective perception of workers' health status after returning to work. The "on site" CPET was found to be safe and reliable to promote a personalized return to work of patients. In 7 out of 11 patients, the values of O2 consumption (VO2) during the working activity were higher than 40% of VO2 max as obtained from laboratory CPET. CONCLUSIONS: This study provides evidence for safety and usefulness of "on site" CPET for a personalized statement of fitness for work. This may facilitate the job retention of patients characterized by a high risk of unnecessary job loss. The use of CPET represents a first step of energy expenditure evaluation associated with specific working tasks.

Preoperative localization of parathyroid adenoma in video-assisted era: is cervical ultrasound or 99mTc Sesta MIBI scintigraphy better?

BACKGROUND: Endocrine surgeon localizes solitary adenoma (SA) in preoperative time by cervical ultrasound (c-US) and/or 99mTc Sesta MIBI scintigraphy (MIBI-S), but in clinical practice they often show discordant results. The aim of our study is to verify if c-US and MIBI-S have different sensitivity in preoperative localization of SA, depending on its localization, in planning minimally invasive video-assisted parathyroidectomy (MIVAP). METHODS: This is a retrospective analysis of data (demographics data, preoperative localization of SA by US and MIBI-S, presence of associated thyroid disease, preoperative calcemia, preoperative serum PTH, surgical time, intraoperative PTH values, day 1 postoperative calcemia, definitive histological report) about patients consecutively submitted to MIVAP because of SA between January 2011 and January 2014 in the department of endocrine and general surgery of the University Hospital of Parma (Italy). The data, expressed as percentages (%) and means (±SD), were analyzed with SPSS Statistics 22.0 program. RESULTS: The c-US detected 56.25% of the superior SA (9/16 patients) and it failed to identify 7 superior adenomas (43.75%); MIBI-S identified 6/16 superior SA (37.5%) and failed in the identification of 10 superior adenomas (62.5%). For inferior SA, c-US was positive in 39/45 patients (86.66%) and falsely negative in 6/45 patients (13.33%); MIBI-S correctly showed 31/45 inferior adenomas (68.88%) and it was falsely negative in 14/45 patients (31.11%). MIBI-S showed decreased sensitivity in the identification of superior SA (P=0.0383). C-US had a high sensitivity in the identification of the inferior SA (P=0.0280). CONCLUSIONS: C-US and MIBI-S are the best diagnostic tools for preoperative localization of SA, but both have decreased sensitivity in the presence of a concomitant thyroid diseases. In our experience c-US showed high sensitivity in the identification of inferior SA and MIBI-S showed a decreased sensitivity in the identification of superior SA. Discordant results in the identification of SA did not contraindicate MIVAP. Intraoperative parathormone dosage is fundamental to guide the endocrine surgeon and to verify the completeness of surgical resection.

Behavioral and physiological responses of guide dogs to a situation of emotional distress.

The aim of this study was to analyze the behavioral and physiological reactions of guide dogs in a distressing situation which promotes attachment behaviors towards their blind owners, and to compare such reactions with those of untrained or trainee dogs. The subjects were 57 adult Labrador and Golden retriever dogs (14 males, 43 females) belonging to four different groups: 19 Custody dogs, 13 Apprentice dogs, 10 Guide dogs and 15 Pet dogs. Dogs were tested using the Strange Situation Test, consisting in seven 3-minute episodes in which the dogs were placed in an unfamiliar environment, introduced to an unfamiliar woman and subjected to separation from their human companion. Tests were video-recorded and behaviors were scored using a 5-second point sampling method. Polar Vantage telemetric system was used to record cardiac activity. ANOVAs for repeated measures with groups and breeds as independent variables, showed a more anxious reaction in pet dogs, which revealed a high degree of proximity seeking behavior. Cardiac activity increased during episodes characterized by the exclusive presence of the stranger, but this increase was more conspicuous in guide dogs than in custody and apprentice dogs. Golden retrievers showed more behaviors suggesting distress compared to Labrador retrievers. This study showed that guide dogs, when separated from their blind owner, reveal a controlled behavioral reaction that is however accompanied by a stronger cardiac activation.