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The endurance physical activities proposed for cardiac rehabilitation (CR) widely use mainly training on cyclo-ergometers or treadmill. We hypothesized that soft karate training would be at least as effective as conventional CR programs. The primary outcome was the maximal O2 consumption (VO2 peak) during a symptom limited cardiopulmonary exercise test at the end of the CR program. We conducted a single-blind, randomized non-inferiority trial conducted at two centres in patients with Heart Failure (HF) and reduced ejection fraction (HFrEF). Patients were trained in sessions of 1 hour/day, 5 days/week using either karate (kicks and punches without combat) or conventional physical training. Patients completed HF quality of life questionnaires: visual analogue score (VAS), Kansas City Cardiomyopathy Questionnaire KCCQ-12 and Depression Anxiety Stress Scale (DASS 21) for depression, anxiety and stress at baseline and at the end of the CR program. 112 patients completed the study (age: 62 ± 12 years, male: 74.1%) and performed an average of 36 sessions. At baseline, peak VO2 was 18.5 ± 5.7 ml/kg/min in the karate group and 18.0 ± 6.4 ml/kg/min in the conventional group. The VO2 peak was non inferior in the karate group versus the conventional group (non-inferiority limit: 2 ml/kg/min, p < 0.0001). Therefore, we tested all variables for a superiority hypothesis. At the end of the study both the VO2 peak and the first ventilatory threshold were significantly greater in the karate group than in the conventional group (23.0 ± 7.4 vs. 19.6 ± 6.8 ml/kg/min, p < 0.0001 and 17.4 ± 5.5 vs. 15.2 ± 4.4, P = 0.027 respectively) see Figure 1. The mean values of the VAS, KCCQ12Q and DASS 21 scores were comparable between the 2 groups. No adverse events related to karate training were observed. Exercise capacity at the end of a cardiac rehabilitation program based on karate training was more improved compared to a conventional program. This type of non-conventional exercise training can therefore be proposed as a safe alternative in HFrEF patients. [ABSTRACT FROM AUTHOR]

The consequences of indoor and outdoor air pollution on human health are of great concern nowadays. In this study, we firstly evaluated indoor and outdoor air pollution levels (CO, CO 2 , NO, NO 2 , PM 10) at an urban site in Dakar city center and at a rural site. Then, the individual exposure levels to selected pollutants and the variations in the levels of biomarkers of exposure were investigated in different groups of persons (bus drivers, traders working along the main roads and housemaids). Benzene exposure levels were higher for housemaids than for bus drivers and traders. High indoor exposure to benzene is probably due to cooking habits (cooking with charcoal), local practices (burning of incense), the use of cleaning products or solvent products which are important emitters of this compound. These results are confirmed by the values of S-PMA, which were higher in housemaids group compared to the others. Urinary 1-HOP levels were significantly higher for urban site housemaids compared to semirural district ones. Moreover, urinary levels of DNA oxidative stress damage (8-OHdG) and inflammatory (interleukin-6 and -8) biomarkers were higher in urban subjects in comparison to rural ones. The air quality measurement campaign showed that the bus interior was more polluted with PM 10 , CO, CO 2 and NO than the market and urban or rural households. However, the interior of households showed higher concentration of VOCs than outdoor sites confirming previous observations of higher indoor individual exposure level to specific classes of pollutants. Image 1 • Indoor organic volatile pollution higher than outdoor one. • Highest urinary levels of oxidative stress and inflammatory biomarkers in urban subjects. • Importance of indoor air pollution on the benzene metabolite S-PMA. • Relevance of indoor habit to determine the exposure levels to selected VOCs. • Correlation of biomarker of exposure with selected VOCs. Outdoor and indoor air pollution analysis and human biomarker exposure evaluation. [ABSTRACT FROM AUTHOR]

Abstract Exposure to atmospheric pollutants has been recognized as a major risk factor of respiratory and cardiovascular diseases. Fine particles (PM 2.5) and a coarser fraction (PM >2.5) sampled at an urban site in Dakar (HLM), characterized by high road traffic emissions, were compared with particles sampled at a rural area, Toubab Dialaw located about 40 km from Dakar. The physicochemical characteristics of samples revealed that PMs differ for their physical (surface area) and chemical properties (in terms of CHN, metals, ions, paraffins, VOCs and PAHs) that were 65–75% higher in urban samples. Moreover the fine PMs contain higher amounts of anthropogenic related pollutants than the PM >2.5 one. These differences are sustained by the ratios reported for the analysed PAHs which suggest as predominant primary emission sources vehicle exhausts at urban site and biomass combustion at the rural site. The inflammatory response and the oxidative damages were evaluated in BEAS-2B cells by the quantification of 4 selected inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8) and of total carbonylated proteins and the oxidative DNA adduct 8-OHdG after 8 or 24 h exposure. In accordance with the different sources and different physical and chemical properties, the inflammatory response and the oxidative damages were found higher in bronchial cells exposed to urban PMs. These data confirm the importance, also for West African countries, to evaluate the correlation between PM physico-chemical properties and potential biological impacts. Graphical abstract Image 1 Highlights • Urban and rural PM chemical and physical composition is reported. • Both fine and coarse PM induced inflammatory responses. • Fine PM emission sources are defined. • Urban PM was more inflammogenic than rural PM. • Both fine and coarse PM induced oxidative damages. Dakar air pollution, influenced by anthropogenic activities, causes inflammatory responses and oxidative damages in vitro. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (DM2) is associated with a high prevalence of cardio vascular (CV) disorders including heart failure. The prevalence of asymptomatic cardiac dysfunction in DM2 remains poorly documented in patients without a history of cardio vascular disease. The purpose of DIACAR is to characterize cardiac function by doppler-echocardiography in a population of DM2 without documented CV disease. One hundred and sixteen consecutive outpatients (63 males, 53 females) with DM2 were evaluated prospectively in a single center: 2D (Simpson biplane) & 3D (Heart Model Philips) left ventricular (LV) ejection fraction (EF), LV and left atrial (LA) volumes, 2D global longitudinal strain, diastolic function and LV mass index were measured. All patients with a documented history of CV disease or presenting with symptoms suggestive of any cardiac disorder were excluded. Patients were 57.8 ± 10.9 years old and had a history of DM2 of 12.7 ± 8.7 years. Fifty-two patients (45%) were treated with insulin. Body mass index was 29 ± 4.9 kg/m2. Mean values of the echo Doppler parameters were in the normal range (Table 1). 2D Simpson EF and E/e' were normal in all except one and two patients respectively. However, LV mass index was increased in 8/63 men and 10/53 women and LA volume index was increased in 14/116 patients whereas 2D Simpson LV volumes were all in the normal range. Finally, 2D global longitudinal strain was reduced in 44/105 patients. In a selected population of DM2 without documented CV disease, cardiac function assessed by EF and E/e' was in the normal range in nearly all patients. By contrast, subtle abnormalities of LV and LA morphology as well as 2D global longitudinal strain were found in a significant proportion of these asymptomatic patients. These results suggest that a systematic screening of DM2 patients by doppler- echocardiography with 2D global longitudinal strain is useful for the early detection of cardiac abnormalities. [ABSTRACT FROM AUTHOR]

The PRADO program was designed to improve post-discharge patient care in heart failure (HF). In this context, prediction of readmission or death in HF is of critical importance and is currently based on a limited number of variables selected by experts/literature. Artificial intelligence (AI) allows to include a non-limited and non-selected number of variables. The objective was to predict the probability of HF readmission and/or death inpatients with a new diagnosis of HF included or not in the PRADO program at the cardiologist's discretion, using medical records and machine learning models, without a priori. This pilot monocentric study included all patients having a first HF admission between January 1st, 2015 and December 31, 2018, enrolled by data record (ICD-10) from the department of cardiology Paris Saint-Joseph Hospital. One thousand variables extracted from electronic health records/local hospital discharge database (PMSI) were used to create models. Data from the national PMSI were also included using the Hawkes process. Models were constructed on patients admitted between 2015 and 2017 to predict 1 and 3 months probability of HF readmission and HF readmission or mortality. Discrimination was tested using the area under the ROC curves (AUC) inpatients admitted in 2018. The discrimination value was limited overall (Table 1). It was better for the 1 month than for the 3 months prediction of clinical outcomes. The models predicted better the composite outcome than HF readmissions and performed better for non-PRADO patients. The predictive value of these models using AI in our population is limited and performed better at 1 month than 3 months. The better discriminating value in non-PRADO patients might result from different clinical profiles, from the arbitrary nature of the selection by cardiologists and from the limited sample size compared to the high number of variables included in the models. [ABSTRACT FROM AUTHOR]

The article discusses the consequences of using cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) as a genetic model vascular depression.

The evaluation of the coronary flow velocity reserve (CFVR) in the left anterior descending coronary artery (LAD) during a Dobutamine stress echocardiography (DSE) is few realized in current practice. A threshold < 2 would be in favor of myocardial ischemia according to some studies. The main purposes of this study are to analyze the feasibility of the CFVR and to search for a pathological threshold in order to make it a complementary tool in the non-invasive detection for myocardial ischemia in the LAD territory. One hundred and ninety-six consecutive patients referred for detection of myocardial ischemia with contrast-enhanced DSE were evaluated in the GHPSJ from July 2017 to July 2018. CFVR was calculated as a ratio of the distal LAD diastolic peak velocity at rest and peak of stress. The result of the echocardiography was rendered only on the analysis of wall motion abnormalities as a standard reference. The feasibility of CFVR is 94.9%. The pathological threshold of CFVR is ≤ 2.1 (sensitivity of 84.2%, specificity of 70%). The CFVR is altered at 1.87 ± 0.52 in the positive DSE in the LAD territory vs. 2.67 ± 0.91 in the normal ones (P < 0.001). No significant difference was found between the diabetic and non-diabetic populations (P = 0.194). The coronary reserve is a non-invasive feasible technique in current practice, sensitive, allowing to add a quantitative criterion to the detection of a myocardial ischemia during a DSE even in non-echogenic patients who needed contrast agent. (Figure 1 , Cut off value of CFVR). [ABSTRACT FROM AUTHOR]