The impact of exercise capacity in the atherosclerotic patient: Keep on walking!

__Abstract__ Peripheral arterial disease (PAD) is a manifestation of systemic arteriosclerosis. It is a common disease affecting millions of people. Depending on the age of the investigated population prevalences between 4% to 29% has been reported. It is alarming that the prevalence is expected to rise in the following decades due to the aging of the western population and the increase of risk factors such as diabetes mellitus, obesity and lack of exercise. Patients with PAD are of an increased risk of cardiovascular events and mortality. In addition, they may also experience signifi cant limitations in their physical functioning and impairment in their quality of life. It is important to diagnose patients with PAD early in the course of the disease to provide them optimal treatment as soon as possible in attempting to lower the complication rates, improve morbidity, mortality and subsequent their quality of life. However, symptoms of PAD are diverse. The classical symptoms are intermittent claudication consisted of calf pain provoked by walking and declining at rest. Earlier investigations, on the other hand, have demonstrated a large range of symptoms ranging from no pain at all till pain at rest . A major problem is that between 20% till 50% of the patients are asymptomatic . Commonly, to identify patients with PAD the resting ankle brachial index (ABI) is used. This is the ratio between the ankle’s systolic blood pressure, measured at the dorsalis pedis or posterial tibial arterie using a Doppler ultrasonic instrument, and the systolic blood pressure at the arm. An ABI below 0.90 is associated with angiographic stenosis of more than 50% . According to the guidelines a resting ABI of < 0.90 is defi ned as PAD. Several studies have found that an ABI of < 0.90 is associated with an increased risk of cardiovascular diseases and mortality. Moreover it can also be used for prognostic risk stratifi cation

Morbidity and mortality after anaesthesia in early life

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (&gt;30% decrease in blood pressure) or reduced oxygenation (SpO2 &lt;85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348.</p