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Cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

World Journal of Cardiology 2024年第2期16卷 67-72页

作者： Christos Kourek st.vros dimopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of *** complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality *** the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac *** and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle *** mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance *** exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise *** the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac *** incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

关键词： Cardiac rehabilitation Cardiac surgery Cardiopulmonary exercise testing Early mobilization Treatment Technology

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Effects of combined aerobic,resistance and inspiratory training in patients with pulmonary hypertension:A systematic review

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World Journal of Critical Care Medicine 2024年第2期13卷 168-179页

作者： Christos Kourek Antonia Zachariou Eleftherios Karatzanos Michalis Antonopoulos Theodora Soulele Andreas Karabinis Serafim Nanas st.vros dimopoulos Department of Clinical Ergospirometry Exercise and Rehabilitation Laboratory1^(st)Department of Critical Care MedicineEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece Department of Cardiology 417 Army Share Fund Hospital of AthensAthens 11521Greece Cardiac Surgery ICU Onassis Cardiac Surgery centerAthens 17674AtticaGreece Cardiac Surgery ICU Onassis Cardiac Surgery CenterAthens 17674Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Pulmonary hypertension(PH)is a serious progressive disorder of the modern world,characterized by endothelial dysfunction and impaired *** with PH usually present exercise intolerance from the very early stages and reduced exercise *** training has been shown to have beneficial effects in patients with cardiovascular ***,data regarding the effects of combined exercise training programs in patients with PH still remains *** To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with *** Our search included all available randomized controlled trials(RCTs)regarding combined aerobic,resistance and inspiratory training programs in patients with PH in 4 databases(Pubmed,PEDro,Embase,CINAHL)from 2012 to *** RCTs were included in the final *** capacity,assessed by peak VO_(2)or 6-min walking test(6MWT),as well as quality of life,assessed by the SF-36 questionnaire,were set as the primary outcomes in our *** Peak VO_(2)was measured in 4 out of the 5 RCTs while 6MWT was measured in all *** indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs(Pstrated further improvement in patients performing combined training compared to *** By this systematic review,we have demonstrated that combined aerobic,resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with *** exercise training regimen may be part of the therapeutic strategy of the syndrome.

关键词： Pulmonary hypertension Exercise training Peak VO2 Functional capacity Quality of life

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Spontaneous coronary artery dissection:A review of diagnostic methods and management strategies

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World Journal of Cardiology 2022年第10期14卷 522-536页

作者： Nikolaos Lionakis Alexandros Briasoulis Virginia Zouganeli st.vros dimopoulos Dionisios Kalpakos Christos Kourek Department of Cardiology 417 Army Share Fund Hospital of Athens(NIMTS)Athens 11521Greece Department of Clinical Therapeutics Alexandra HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 11528Greece Division of Cardiovascular Medicine Section of Heart Failure and TransplantationUniversity of Iowa Hospitals and ClinicsIA 52242United States Second Cardiology Department Attikon University HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 12462Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1 st Department of Critical Care MedicineEvangelismos HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 10676Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery *** most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk *** is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery *** with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or *** the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and ***,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the *** of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac *** conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of *** prognosis of SCAD is usually good and long-term mortality seems to be low in these ***-up should be performed on a regular basis.

关键词： Spontaneous coronary artery dissection Non-atherosclerotic coronary artery disease Angiographic classification Percutaneous coronary intervention

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Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes:A systematic review

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World Journal of Cardiology 2023年第4期15卷 184-199页

作者： Christos Kourek Eleftherios Karatzanos Vasiliki Raidou Ourania Papazachou Anastassios Philippou Serafim Nanas st.vros dimopoulos Clinical Ergospirometry Exercise and Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalAthens 10676Greece Department of Cardiology 417 Army Share Fund Hospital of AthensAthens 11521Greece Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece Department of Cardiology "Helena Venizelou"HospitalAthens 10676Greece Department of Physiology School of MedicineNational and Kapodistrian University of AthensAthens 11527Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction,reduced functional capacity and exercise *** aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular *** intensity interval training(HIIT)seems to be superior than moderate-intensity continuous training(MICT)in cardiovascular diseases by improving brachial artery flow-mediated dilation(FMD)and cardiorespiratory fitness to a greater ***,the beneficial effects of HIIT in patients with T2DM still remain under investigation and number of studies is *** To evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with *** We performed a search on PubMed,PEDro and CINAHL databases,selecting papers published between December 2012 and December 2022 and identified published randomized controlled trials(RCTs)in the English language that included community or outpatient exercise training programs in patients with *** were assessed for methodological rigor and risk of bias via the Physiotherapy Evidence Database(PEDro).The primary outcome was peak VO_(2 ) and the secondary outcome was endothelial function assessed either by FMD or other indices of *** Twelve studies were included in our systematic *** 12 RCTs resulted in 661 participants in *** was performed in 310 patients(46.8%),MICT to 271 and the rest 80 belonged to the control *** VO_(2 ) increased in 10 out of 12 studies after *** studies compared HIIT with other exercise regimens(MICT or strength endurance)and 4 of them demonstrated additional beneficial effects of HIIT over MICT or other exercise ***,4 studies explored the effects of HIIT on endothelial function and FMD in T2DM *** 2 of them,HIIT further impro

关键词： Type 2 diabetes mellitus Exercise High intensity interval training Cardiorespiratory fitness Peak VO_(2) Endothelial function

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Non-coronary myocardial infarction in myasthenia gravis: Case report and review of the literature

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World Journal of Cardiology 2013年第7期5卷 265-269页

作者： Panagiotis Zis st.vros dimopoulos Vasiliki Markaki Antonios Tavernarakis Serafim Nanas Department of Neurology Evangelismos Hospital10676 AthensGreece 1st Critical Care Medicine Department Evangelismos HospitalNational Kapodistrian University of Athens10676 AthensGreece

Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a noncoronary myocardial infarction (MI) during the initial treatment period with pyridostigmine bromide in a female patient with MG. Clinicians should be cautious about the appearance of potential MI in patients with MG. A baseline electrocardiogram is advocated, when the early recognition of the MI clinical signs and the laboratory findings (myocardial markers) are vital to the immediate and appropriate management of this medical emergency, as well as to prevent future cardio-vascular events. In this case report possible causes of myocardial adverse events in the context of MG, which may occur during the ongoing treatment and the clinical course of the disease, are discussed.

关键词： Myasthenia gravis Myocardial infarction Pyridostigmine

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Circulating endothelial and progenitor cells:Evidence from acute and long-term exercise effects

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World Journal of Cardiology 2012年第12期4卷 312-326页

作者： Matina Koutroumpi st.vros dimopoulos Katherini Psarra Theodoros Kyprianou Serafim Nanas Cardiopulmonary Exercise Testing and Rehabilitation Laboratory 1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of Athens10676 AthensGreece Department of Immunology Evangelismos Hospital10676 AthensGreece Critical Care Department Nicosia General Hospital2029 NikosiaCyprus

Circulating bone-marrow-derived cells,named endothelial progenitor cells(EPCs),are capable of maintaining,generating,and replacing terminally differentiated cells within their own specific tissue as a consequence of physiological cell turnover or tissue damage due to *** maintenance and restoration of normal endothelial cell function is guaranteed by a complex physiological procedure in which EPCs play a significant *** number of peripheral blood EPCs has been associated with endothelial dysfunction and high cardiovascular *** this review,we initially report current knowledge with regard to the role of EPCs in healthy subjects and the clinical value of EPCs in different disease populations such as arterial hypertension,obstructive sleep-apnea syndrome,obesity,diabetes mellitus,peripheral arterial disease,coronary artery disease,pulmonary hypertension,and heart *** studies have introduced the novel concept that physical activity,either performed as a single exercise session or performed as part of an exercise training program,results in a significant increase of circulating *** the second part of this review we provide preliminary evidence from recent studies investigating the effects of acute and long-term exercise in healthy subjects and athletes as well as in disease populations.

关键词： Circulating endothelial cells Circulating progenitor cells Exercise Cardiovascular disease

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Neuroticism personality trait is associated with Quality of Life in patients with Chronic Heart Failure

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World Journal of Cardiology 2014年第10期6卷 1113-1121页

作者： Lampros Samartzis st.vros dimopoulos Christos Manetos Varvara Agapitou Athanasios Tasoulis Eleni Tseliou Iraklis Pozios Elisavet Kaldara John Terrovitis Serafim Nanas st. George’s University of London Medical School at University of Nicosia 2408 Nicosia Cyprus Department of Psychiatry Nicosia Mental Health Services Athalassa Psychiatric Hospital 1432 Nicosia Cyprus 1st Critical Care Medicine Department Cardiopulmonary Exercise Testing and Rehabilitation Laboratory "Evgenidio" Hospital Na-tional and Kapodistrian University of Athens 15128 Athens Greece 3rd Cardiology Department "Laiko" Hospital National and Kapodistrian University of Athens 15128 Athens Greece

AIM: To evaluate Quality of life(QoL) in chronic heart failure(CHF) in relation to Neuroticism personality trait and CHF ***: Thirty six consecutive, outpatients with Chronic Heart Failure(6 females and 30 males, mean age: 54 ± 12 years), with a left ventricular ejection fraction ≤ 45% at optimal medical treatment at the time of inclusion, were asked to answer the Kansas City Cardiomyopathy Questionnaire(KCCQ) for Quality ofLife assessment and the NEO Five-Factor Personality Inventory for personality assessment. All patients un-derwent a symptom limited cardiopulmonary exercise testing on a cycle-ergometer, in order to access CHF severity. A multivariate linear regression analysis us-ing simultaneous entry of predictors was performed to examine which of the CHF variables and of the person-ality variables were correlated independently to QoL scores in the two summary scales of the KCCQ, namely the Overall Summary Scale and the Clinical Summary ***: The Neuroticism personality trait score had a significant inverse correlation with the Clinical Sum-mary Score and Overall Summary Score of the KCCQ(r =-0.621, P st linear combination of statistically significant univari-ate predictors such as Neuroticism, VE/VCO2 slope and VO2 peak, for predicting KCCQ Clinical Summary Score. The results show Neuroticism(β =-0.37, P < 0.05), VE/VCO2 slope(β =-0.31, P < 0.05) and VO2 peak(β = 0.37, P < 0.05) to be independent predictors of QoL. In multivariate regression analysis Neuroticism(b =-0.37, P < 0.05), the slope of ventilatory equivalent for carbon dioxide output during exercise,(VE/VCO2 slope)(b =-0.31, P < 0.05) and peak oxygen uptake(VO2 peak)

关键词： Chronic heart failure Five-Factor Personality Inventory Kansas City Cardiomyopathy Questionnaire Quality of Life

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AME证据系列001--转化医学协会:脓毒症诊断和早期识别的临床实践指南

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临床与病理杂志 2016年第10期36卷 1467-1476页

作者： Zhongheng Zhang Nathan J.Smischney Haibo Zhang Sven Van Poucke Panagiotis Tsirigotis Jordi Rello Patrick M.Honore Win Sen Kuan Juliet June Ray Jiancang Zhou You Shang Yuetian Yu Christian Jung Chiara Robba Fabio Silvio Taccone Pietro Caironi David Grimaldi stefan Hofer George dimopoulos Marc Leone Sang-Bum Hong Mabrouk Bahloul Laurent Argaud Won Young Kim Herbert D.Spapen Jose Rodolfo Rocco 张建成(译) 尚游(译) 钟鸣(校) Department of Emergency Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care Medicine Jinhua Hospital of Zhejiang UniversityJinhua Zhejiang 321000 Department of Anesthesiology Mayo ClinicRochesterMNUSA Keenan Research Center for Biomedical Science of st.Michael's Hospital Departments of Anesthesia and PhysiologyInterdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoONCanada Departments of Anesthesiology Critical CareEmergency Medicine and Pain TherapyZiekenhuis Oost-Limburgy GenkBelgium 2nd Department of Internal Medicine Attikcon University HospitalMedical SchoolNational and Kapodistrian University of AthensAthensGreece CIBERES Vall d'Hebron Institut of ResearchUniversitat Autonoma de BarcelonaSpain Universitair Ziekenhuis Brussely Vrije Universiteit Brussel Brussels BrusselsBelgium Emergency Medicine Department National University HospitalNational University Health SystemSingapore and the Department of SurgeryYong Loo Lin School of MedicineNational University of SingaporeSingapore DeWitt Daughtry Family Department of Surgery Jackson Memorial HospitalUniversity of Miami Leonard M.Miller School of MedicineMiamiFLUSA Department of Critical Care Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care Medicine Union HospitalTongji Medical CollegueHuazhong University of Science and TechnologyWuhan 430022 Department of Critical Care Medicine Renji HospitalShanghai Jiao Tong University School of MedicineShanghai 200001 University Hospital Dusseldorf Heinrich-Heine-University DusseldorfMedical FacultyDivision of CardiologyPulmonology and Vascular MedicineDusseldorfGermany Neurosciences Critical Care Unit Addenbrooke's HospitalCambridgeUK Department of Intensive Care Hopital ErasmeUniversite Libre de Bruxelles(ULB)BrusselsBelgium Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Fondazione IRCCS Ca'Granda-Ospedale

脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊... 详细信息

脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。

关键词：脓毒症早期识别诊断

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