External Validation of the “Walking Estimated Limitation Calculated by History” (WELCH) Questionnaire in Patients with Claudication

ObjectiveTo externally validate the recently proposed “Walking Estimated Limitation Calculated by History” (WELCH) questionnaire.MethodsA prospective study was performed on 450 new patients referred to our laboratory for treadmill testing (constant load 3.2 km/h and 10% slope for 15 minutes and then incremental increases). Results are presented as mean ± SD or median [25th–75th percentiles] or number (percentage). An ankle brachial index <0.90 defined the presence of peripheral artery disease (PAD). Typical “vascular-type claudication” is a lower-limb pain or discomfort that is absent at rest, appears at exercise, forces stopping, and disappears within 10 minutes of exercise stopping. The Spearman r coefficient of correlation between maximal walking time (MWT) on treadmill and WELCH scores was calculated for patients with (PAD+) or without (PAD−) PAD, and reporting typical vascular-type claudication (VTC+) or not (VTC−).ResultsThe WELCH score was obtained in all included patients. The number (%) of patients with a WELCH score <25 was 37 (54%), 198 (65%), 14 (44%), and 18 (38%), and the Spearman correlation coefficient between WELCH score and treadmill MWT was 0.588, 0.609, 0.581, and 0.591 in the VTC−/PAD+, VTC+/PAD+, VTC−/PAD−, and VTC+/PAD− groups respectively (all p < .001). In PAD+/VTC+ patients, the WELCH positive predictive value for the inability to walk for 5 minutes on the treadmill was 79%.ConclusionThe WELCH score correlates moderately with treadmill-walking capacity in patients with or without PAD, and with or without typical VTC. It appears to be a simple to complete and easily scored instrument to help clinicians standardise the subjective estimation of walking capacity in their patients

Serum markers of deranged myocardial collagen turnover: their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure

BACKGROUND: Pathologic collagen remodeling has been involved in the occurrence of ventricular arrhythmias and sudden cardiac death in heart failure. The aim of the study was to investigate the relationship between malignant ventricular arrhythmias and cardiac collagen turnover indexes, expressing specific types of derangement in collagen physiology, in stable patients with an implantable cardioverter-defibrillator (ICD). METHODS: Seventy-four patients with an ICD and heart failure were studied. They had coronary artery disease (n = 42) or dilated cardiomyopathy, New York Heart Association classes I and II, and left ventricular ejection fraction 29% +/- 1%. An ICD had been implanted for secondary (n = 36) or primary prevention of sudden cardiac death. We assessed (1) markers of collagen types I and III synthesis and their ratio: procollagen type I carboxyterminal peptide (PICP), procollagen type III aminoterminal peptide (PIIINP), and PICP/PIIINP; (2) markers of collagen degradation, degradation inhibition, and their ratio: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase (TIMP) 1 (TIMP-1), and MMP-9/TIMP-1. Patients were prospectively followed up for 1 year. The number of episodes necessitating appropriate interventions for ventricular tachyarrhythmias (&gt;170 beat/min) was related to the assessed parameters. RESULTS: Multivariate analysis revealed a significant relation between the number of tachyarrhythmic episodes and MMP-9/TIMP-1 (P = .007), PICP/PIIINP (P = .007), and ejection fraction (P = .04). No other significant relation was observed between arrhythmias and the remaining parameters. CONCLUSION: In heart failure, biochemical markers indicative of a deranged equilirium in myocardial collagen deposition/degradation and collagen I/III synthesis are related to ventricular arrhythmogenesis. Further studies are needed to investigate their predictive ability

Prévention de la syncope chez l'homme

- Cette étude propose d'améliorer les valeurs de sensibilité et de spécificité d'un test médical de diagnostic de la syncope chez l'homme. Cette amélioration repose notamment sur l'utilisation d'un réseau de neurones

The use of the multi-electrode duty-cycled radiofrequency ablation catheter PVAC for the ablation of a left atrial tachycardia

The multi-electrode ablation catheter PVAC is used to simplify pulmonary vein isolation in patients undergoing ablation of atrial fibrillation. The use of the PVAC in cases of atrial tachycardia has not been reported before. In the present report, we present the use of the PVAC for the ablation of a left atrial tachycardia following pulmonary vein isolation. This case may suggest that the PVAC could ablate some atrial tachycardias without any adjunctive ablation catheter, given its ability to map, pace and apply energy over a relatively broad area

Spironolactone improves endothelial and cardiac autonomic function in non heart failure hemodialysis patients

OBJECTIVES: Hemodialysis patients have a cardiovascular mortality rate of 20-40 times that of the general population. Aldosterone inhibition by spironolactone has exerted beneficial, prognostically significant cardiovascular effects in patients with heart failure maintained on hemodialysis or peritoneal dialysis. Our aim was to investigate spironolactone\u27s effect in non heart failure hemodialysis patients. METHODS: Fourteen stable chronic hemodialysis patients (nine men), 59.5 +/- 3.1 years of age were evaluated in a sequential, fixed-dose, placebo-controlled study. Heart failure was diagnosed on the basis of signs and symptoms of heart failure or left ventricular ejection fraction less than 50%. Following an initial 4-month period of placebo administration after each dialysis, patients received spironolactone (25 mg thrice weekly after dialysis) for the next 4 months. Data were recorded at baseline, at the end of placebo administration, and at the end of spironolactone treatment and included endothelial function by forearm reactive hyperemia during venous occlusion plethysmography, cardiac autonomic status by heart rate variability in the time and frequency domain, blood pressure response, and echocardiographic and laboratory data. RESULTS: Placebo induced no changes in the aforementioned parameters. Following spironolactone, salutary effects were observed in the extent and duration of reactive hyperemia (P &lt; 0.05 for both), as well as in heart rate variability (P &lt; 0.05) and blood pressure control (P &lt; 0.05). No changes occurred in echocardiographically derived left ventricular dimensions or mass. CONCLUSION: Low-dose spironolactone therapy in clinically stable non heart failure hemodialysis patients is associated with favorable effects on cardiovascular parameters known to adversely affect survival, such as endothelial dysfunction and heart rate variability. Spironolactone treatment might benefit long-term cardiovascular outcome of such patients

Neurovisceral phenotypes in the expression of psychiatric symptoms

This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brainbody mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in 'emotional' brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognised factors causing vasodilatation (as noted post prandially, post exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety

A Proposed Model

Rocha-Penedo, R., Cruz-Jesus, F., & Oliveira, T. (2021). Opposite Outcomes of Social Media Use: A Proposed Model. In S. K. Sharma, Y. K. Dwivedi, B. Metri, & N. P. Rana (Eds.), Re-imagining Diffusion and Adoption of Information Technology and Systems: A Continuing Conversation - IFIP WG 8.6 International Conference on Transfer and Diffusion of IT, TDIT 2020, Proceedings (pp. 524-537). (IFIP Advances in Information and Communication Technology; Vol. 618). Springer. https://doi.org/10.1007/978-3-030-64861-9_46Social media are probably one of the most influential and disruptive technology of the present times. It is ubiquitous and has the capability to influence virtually every aspect of one’s life while, at the same time, also influence the way firms and public organizations operate and communicate with individuals. Although there is a plethora of studies in the IS literature focused on SM adoption and outcomes, studies hypothesizing positive and negative outcomes together are scarce. We propose a comprehensive research model to shed light on SM positive and negative outcomes, and how these affect one’s happiness. We also explore how personality traits can influence these relationships.authorsversionpublishe

Can we identify response markers to antihypertensive drugs? First results from the Ideal Trial

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.Journal of Human Hypertension advance online publication, 17 April 2014; doi:10.1038/jhh.2014.29

In-depth analysis and simulation study of an innovative fuzzy approach for ranking alternatives in multiple attribute decision making problems based on TOPSIS

In this paper, an innovative fuzzy approach for ranking alternatives in multiple attribute decision making problems based on TOPSIS is presented in-depth and studied through simulation comparison with the original method. The TOPSIS method provides the principle of compromise that the chosen alternative should have the shortest distance from the ideal solution and, simultaneously, the farthest distance from the negative ideal solution. However, the TOPSIS method does not always produce results in harmony with this principle due to an oversimplified definition of its aggregation function which does not grasp the contradictory nature of the principle&apos;s formulation. Our approach addresses this issue through the introduction of a fuzzy set representation of the closeness to the ideal and to the negative ideal solution for the definition of the aggregation function which is modeled as the membership function of the intersection of two fuzzy sets. This model enables a parameterization of the method according to the risk attitude of the decision maker. Thus, a class of methods is formulated whose different instances correspond to different risk attitudes of the decision makers. In order to define some clear advises for decision makers facilitating a proper parameterization of the method, a comparative analysis of the proposed class of methods with the original TOPSIS method is performed according to well defined simulation techniques. The results of the simulation experiment show on the one hand that there is no direct correspondence between the proposed class of methods and TOPSIS, and on the other hand that it is adequate to distinguish three instances that correspond respectively to risk-averse, risk-neutral and risk-seeking decision makers. Finally, a numerical example pertaining to the problem of service provider selection is presented to illustrate the application of the proposed class of methods and its functioning. © 2010 Elsevier B.V. All rights reserved