Early outcomes from a randomized, controlled trial of supervised exercise, angioplasty, and combined therapy in intermittent claudication

BACKGROUND: To compare angioplasty (PTA), supervised exercise (SEP) and PTA + SEP in the treatment of intermittent claudication (IC) due to femoropopliteal disease. METHODS: Over a 6-year period, 178 patients (108 men; median age, 70 years) with femoropopliteal lesions suitable for angioplasty were randomized to PTA, SEP, or PTA + SEP. Patients were assessed prior to and at 1 and 3 months post treatment. ISCVS outcome criteria (ankle pressures, treadmill walking distances) and quality of life (QoL) questionnaires (SF-36 and VascuQoL) were analyzed. RESULTS: All groups were well matched at baseline. Twenty-one patients withdrew. Results are as follows: Intragroup analysis: All groups demonstrated significant clinical and QoL improvements (Friedman test, p 0.05). CONCLUSION: SEP should be the primary treatment for the patients with claudication and PTA should be supplemented by an SEP

Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study

Background: The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods: We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results: Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age \u3e50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33-1.95) and fungal (OR, 2.20; 95% CI, 1.28-3.76) coinfections. Conclusions: Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes

Does peak wall stress correlate better with abdominal aortic aneurysm expansion than aortic diameter?

Objective: Level 1 evidence clearly supports ultrasound surveillance in abdominal aortic aneurysm (AAA) <5.5 cm in maximum AP diameter, with scanning interval set according to the size of aneurysm. Larger aneurysms tend to expand at a greater rate than smaller aneurysms. However, AAA expansion is variable and difficult to predict, and size may not always predict expansion. We aimed to assess whether peak wall stress (PWS) measured through finite element analysis, correlates better with AAA expansion. Methods: Thirty-eight patients, 31 men, median age of 76.5 (range 54–93) years, currently under AAA surveillance were studied. All patients underwent abdominal CT scan to characterise the aneurysms and measure PWS through finite element analysis. Expansion rates were derived from sequential ultrasound scans. Correlation between PWS and expansion rate, as well as between size and expansion rate was analysed using Spearman Test (SPSS for Windows v14). Results: Mean aortic diameter was 4.68±0.74 cm and mean PWS was 0.41±0.14 MPa. Spearman rank order correlation coefficient (rs) of PWS and AAA expansion rate was 0.28 (P=0.08). Spearman rank order correlation coefficient (rs) of aorta AP diameter and AAA expansion rate was 0.17 (P=0.30). Conclusions: In this cohort of patients the correlation between PWS and AAA expansion rate was not significant however, the correlation was superior to that between AAA diameter and expansion rate, and this deserves further investigation