Polish version of the Intermittent Claudication Questionnaire

Introduction. The assessment of health-related quality of life includes the assessment of physical condition and motor skills, mental condition, social and economic situation, and somatic experiences. The specific ques-tionnaires used in patients with intermittent claudication include i.a. Peripheral Artery Questionnaire, Vascular Quality of Life Questionnaire, PAD Quality of Life Questionnaire, and Walking Impairment Questionnaire, which is the only one of the aforementioned questionnaires that is available in Polish. The Intermittent Claudication Questionnaire (ICQ) available in English is a specific instrument for assessing the quality of life of patients with intermittent claudication. This paper attempts at evaluating the reliability of the Polish version of ICQ. Material and methods. The process of validation of the Polish version of the questionnaire involved translating the questionnaire and evaluating the newly translated tool in order to compare the results on international level for the possibility of its practical use for assessment of health-related quality of life in patients with intermittent claudication in Poland. In order to evaluate the reliability and coherence of the questionnaire, the methods of internal consistency in Cronbach’s a, as well as the intraclass correlation coefficient were applied for specific questions and for the final result of the questionnaire. Results. The Cronbach’s a as the questionnaire’s reliability index was 0.915. Intraclass correlation calculated for the total score of the questionnaire’s answers was 0.97. Conclusions. The Polish version of the Intermittent Claudication Questionnaire is a repeatable and reliable research tool for assessing the health-related quality of life in patients with intermittent claudication

Risk of intracerebral aneurysm rupture during carotid revascularization

ObjectiveRobust guidelines exist for the treatment of carotid stenosis and intracranial aneurysms independently, however, the management of tandem carotid stenosis and intracranial aneurysms remains uncertain. Although the prevalence of tandem pathologies is small (1.9%-3.2%), treating carotid stenosis can alter intracranial hemodynamics potentially predisposing to aneurysm rupture. In this review, our aim was to assess the safety of intervention in this cohort, by analyzing outcomes from the published literature.MethodsThe preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct the review. Articles from 1947 to 2012 were searched using EMBASE Classic and EMBASE (November, 1947 -March, 2012) and Ovid MEDLINE(R) In-Process and other NonIndexed Citations and Ovid MEDLINE(R) on Ovid SP, http://ClinicalTrials.gov, http://controlled-trials.com and the Cochrane review database using a predefined search strategy.ResultsOne hundred forty-one patients from 27 articles were included. Interventions ranged from single (n = 104, 74%), staged (n = 26, 18%) to simultaneous procedures (n = 11, 8%). The largest cohort of patients was treated by carotid endarterectomy alone (n = 92, 66%). The majority of patients presented with a symptomatic carotid stenosis and an asymptomatic ipsilateral intracranial aneurysm (n = 70, 50%). Five subarachnoid hemorrhages occurred (4% [5/140], three within 30 days of the procedure and two thereafter) of which two were fatal. All five occurred in patients who underwent carotid endarterectomy as a single procedure (5%). Two of the five patients presented with ruptured posterior communicating artery aneurysms.ConclusionsPublished reports of perioperative aneurysm rupture are rare in individuals with tandem carotid stenosis and intracranial aneurysms. This is the first analysis of all published cases. However, it is limited by the small number of studies and the possible underreporting due to publication bias and underdiagnosis where angiography was not performed. Although we report a low incidence of subarachnoid hemorrhage, analysis of registry data with a larger cohort is warranted to confirm these findings

Innate immunity and monocyte-macrophage activation in atherosclerosis

Innate inflammation is a hallmark of both experimental and human atherosclerosis. The predominant innate immune cell in the atherosclerotic plaque is the monocyte-macrophage. The behaviour of this cell type within the plaque is heterogeneous and depends on the recruitment of diverse monocyte subsets. Furthermore, the plaque microenvironment offers polarisation and activation signals which impact on phenotype. Microenvironmental signals are sensed through pattern recognition receptors, including toll-like and NOD-like receptors - the latter of which are components of the inflammasome - thus dictating macrophage behaviour and outcome in atherosclerosis. Recently cholesterol crystals and modified lipoproteins have been recognised as able to directly engage these pattern recognition receptors. The convergent role of such pathways in terms of macrophage activation is discussed in this review

Multiple arterial emboli secondary to left ventricular thrombus in a 35-year-old obese male

The very unusual case of a 35-year-old obese male patient with a left ventricular (LV) thrombus secondary to a silent myocardial infarction and resultant shower emboli to multiple arterial sites is described. His presentation with acute limb ischemia led to arterial imaging and the identification of the underlying cardiac pathology in addition to splenic and bilateral renal infarcts. He was also found to suffer from previously undiagnosed hypertension. He underwent femoral embolectomy and multiple arterial revascularization attempts but required bilateral above knee amputations and a prolonged intensive care unit stay. This rare and extreme example of a LV thrombus in a young male emphasizes the potential sequellae of the condition. Furthermore, with the increasing incidence of obesity this case demonstrates the importance of considering undiagnosed cardiovascular risk factors when assessing obese patients

Lipotoxicity and immunometabolism in ischemic acute kidney injury: current perspectives and future directions

Dysregulated lipid metabolism is implicated in the pathophysiology of a range of kidney diseases. The specific mechanisms through which lipotoxicity contributes to acute kidney injury (AKI) remain poorly understood. Herein we review the cardinal features of lipotoxic injury in ischemic kidney injury; lipid accumulation and mitochondrial lipotoxicity. We then explore a new mechanism of lipotoxicity, what we define as “immunometabolic” lipotoxicity, and discuss the potential therapeutic implications of targeting this lipotoxicity using lipid lowering medications

Sclerotherapy: Indications and safety volumes

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Chemical composition and quality loss during technological treatment in coho salmon (Oncorhynchus kisutch)

Coho salmon (Oncorhynchus kisutch) supports an important farming production in parallel with capture delivery, giving rise to products of great economic importance in many countries. This review covers the research carried out during the last decades related to its employment as a food product. In a first part, studies carried out concerning the chemical constituent composition and nutritional value are reviewed; a special attention is accorded to the wild/ farmed fish comparison and to the effect of diet on lipid composition variations. In agreement to the great lability of chemical constituents of aquatic foods, the second part of the manuscript provides a revision of coho salmon research related to the chemical component changes produced during technological processing and their effects on nutritional and sensory losses; in this case, a special attention is accorded to studies employing advanced technological strategies focused to partially inhibit the development of the different damage pathways.support provided by the Universidad de Chile (Chile)- Consejo Superior de Investigaciones Científicas (CSIC, Spain) research program through the following projects: Project 2003 CL 0013, Project 2004 CL 0038 and Project 2006 CL 0034. 43Peer reviewe

Determinants of carotid microembolization

AbstractPurpose: Earlier studies have highlighted risk factors for perioperative stroke after carotid endarterectomy, such as female sex, preoperative symptoms, and cerebral infarction. In this study, we investigated the relationship between these factors and perioperative microembolization. Methods: A total of 235 patients were entered in the study at two centers. Transcranial Doppler ultrasound scanning was possible in 190 patients (81%) and was performed for 1 hour preoperatively and continuously intraoperatively as a means of detecting microemboli and monitoring mean middle cerebral artery velocity. The findings of transcranial Doppler ultrasound scanning were related to perioperative risk factors by means of univariate analysis. Results: Microemboli were detected in 28 (15%), 79 (42%), and 98 (52%) patients preoperatively, during carotid artery dissection, and after closure of the artery, respectively. Having 10 or more emboli after carotid artery closure was more common in women (P =.04) and in patients with symptomatic carotid artery disease (P =.04) and was demonstrated in three of the six patients who had a perioperative stroke. These three patients also had preoperative evidence of cerebral infarction and an intraoperative middle cerebral artery velocity less than 40 cm/s. Conclusion: In this study, perioperative microembolization was more common in women and patients with symptomatic carotid artery disease. These findings may explain the increased risk of carotid surgery in these patients. (J Vasc Surg 2001;34:1060-4.

A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status.

Funder: Actergy HealthBACKGROUND: This randomised controlled trial investigates the dosing effect of neuromuscular electrical stimulation (NMES) in patients with chronic venous disease (CVD). METHODS: Seventy-six patients with CEAP C3-C5 were randomised to Group A (no NMES), B (30 minutes of NMES daily) or C (60 minutes of NMES daily). Primary outcome was percentage change in Femoral Vein Time Averaged Mean Velocity (TAMV) at 6 weeks. Clinical severity scores, disease-specific and generic quality of life (QoL) were assessed. RESULTS: Seventy-six patients were recruited - mean age 60.8 (SD14.4) and 47:29 male. Six patients lost to follow-up. Percentage change in TAMV (p<0.001) was significantly increased in Groups B and C. Aberdeen Varicose Veins Questionnaire Score (-6.9, p=0.029) and Venous Clinical Severity Score (-4, p-0.003) improved in Group C, and worsened in Group A (+1, p=0.025). CONCLUSIONS: Daily NMES usage increases flow parameters, with twice daily usage improving QoL and clinical severity at 6 weeks in CVD patients