Mortality in Peripheral Arterial Disease: A Comparison of Patients Managed by Vascular Specialists and General Practitioners

BACKGROUND: Peripheral arterial disease (PAD) is undertreated by general practitioners (GPs). However, the impact of the suboptimal clinical management is unknown. OBJECTIVE: To assess the mortality rate of PAD patients in relation to the type of physician who provides their care (GP or vascular specialist). DESIGN: Prospective study. SETTING: Primary care practice and academic vascular laboratory. PARTICIPANTS: GP patients (n = 60) were those of the Peripheral Arteriopathy and Cardiovascular Events study (PACE). Patients managed by specialists (n = 82) were consecutive subjects with established PAD who were referred to our vascular laboratory during the enrolment period of the PACE study. MEASUREMENTS: All-cause and cardiovascular mortality. RESULTS: After 32 months of follow-up, specialist management was associated with a lower rate of all-cause mortality (RR = 0.04; 95% CI 0.01–0.34; p = .003) and cardiovascular mortality (RR = 0.07; 95% CI 0.01–0.65; p = .020), after adjustment for patients’ characteristics. Specialists were more likely to use antiplatelet agents (93% vs 73%, p < .001), statins (62% vs 25%, p < .001) and beta blockers (28% vs 3%, p < .001). Survival differences between specialists and GPs disappeared once the use of pharmacotherapies was added to the proportional hazard model. The fully adjusted model showed that the use of statins was significantly associated with a reduced risk of all-cause mortality (RR = 0.02; 95% CI 0.01–0.73, p = .034) and cardiovascular mortality (RR = 0.02; 95% CI 0.01–0.71, p = .033). CONCLUSIONS: Specialist management of patients with symptomatic PAD resulted in better survival than generalist management. This effect appears to be mainly caused by the more frequent use of effective medicines by specialists

Evaluation and optimization of a commercial enzyme linked immunosorbent assay for detection of Chlamydophila pneumoniae IgA antibodies

<p>Abstract</p> <p>Background</p> <p>Serologic diagnosis of <it>Chlamydophila pneumoniae </it>(Cpn) infection routinely involves assays for the presence of IgG and IgM antibodies to Cpn. Although IgA antibodies to Cpn have been found to be of interest in the diagnosis of chronic infections, their significance in serological diagnosis remains unclear. The microimmunofluorescence (MIF) test is the current method for the measurement of Cpn antibodies. While commercial enzyme linked immunosorbent assays (ELISA) have been developed, they have not been fully validated. We therefore evaluated and optimized a commercial ELISA kit, the SeroCP IgA test, for the detection of Cpn IgA antibodies.</p> <p>Methods</p> <p>Serum samples from 94 patients with anti-Cpn IgG titers ≥ 256 (study group) and from 100 healthy blood donors (control group) were tested for the presence of IgA antibodies to Cpn, using our in-house MIF test and the SeroCP IgA test. Two graph receiver operating characteristic (TG-ROC) curves were created to optimize the cut off given by the manufacturer.</p> <p>Results</p> <p>The MIF and SeroCP IgA tests detected Cpn IgA antibodies in 72% and 89%, respectively, of sera from the study group, and in 9% and 35%, respectively, of sera from the control group. Using the MIF test as the reference method and the cut-off value of the ELISA test specified by the manufacturer for seropositivity and negativity, the two tests correlated in 76% of the samples, with an agreement of Ƙ = 0.54. When we applied the optimized cut-off value using TG-ROC analysis, 1.65, we observed better concordance (86%) and agreement (0.72) between the MIF and SeroCP IgA tests.</p> <p>Conclusion</p> <p>Use of TG-ROC analysis may help standardize and optimize ELISAs, which are simpler, more objective and less time consuming than the MIF test. Standardization and optimization of commercial ELISA kits may result in better performance.</p

Effect of plasmin, plasminogen activators and a plasmin inhibitor on bovine in vitro embryo production

In the present study, four experiments were conducted to investigate the possible effects of plasminogen activators (urokinase-type plasminogen activator (u-PA) and tissue-type plasminogen activator (t-PA)), plasmin, and a plasmin inhibitor (epsilon-aminocaproic acid (epsilon-ACA)) on different stages of bovine in vitro embryo production (IVP). The concentrations of these modifiers in IVP media were conditioned according to the plasminogen activator activity of bovine preovulatory follicular fluid. Media were modified in a single phase of IVP with an 18 h or 24 h incubation for in vitro maturation (IVM) and a 24 h or 48 h incubation for the IVF or in vitro culture (IVC), respectively. After IVM the oocytes were either fixed and stained or underwent IVF and IVC. The main findings were: (1) plasmin added to the 18 h IVM medium increased maturation rate without affecting fertilisation or embryo development rates; (2) t-PA added to the IVF medium significantly increased cleavage; (3) u-PA added to the IVC medium significantly increased embryo development rates; (4) the efficiency of all phases of IVP was reduced after the addition of epsilon-ACA; and (5) plasminogen addition had no effect in any IVP phase tested. We conclude that the members of the plasminogen activator-plasmin system contribute in different ways to bovine IVM, IVF and IVC

The effect of repeated follicular aspiration on the onset of puberty and growth rate of winter- or autumn-born lambs

The effects of follicular aspiration for oocyte retrieval on the attainment of puberty and growth rate were studied in winter-born (9 treated and 6 control) and autumn-born (5 treated and 5 control) ewe lambs. In the treated animals (i.e. in which follicular aspiration was performed after ovarian stimulation), laparoscopic oocyte pick-up (OPU) was performed at the age of 12-13, 16-17 and 20-21 weeks. From the 8th until the 57th week of age, serum progesterone concentration was determined in blood samples collected at weekly or bi-weekly intervals. Serum oestradiol concentration was measured in blood samples collected prior to each FSH administration at OPU, and 2 and 24 h thereafter. All lambs were weighed at birth, the 6th and 8th week of age and thereafter at monthly intervals until the 34th (winter-born) or 52nd (autumn-born) week of age. Radiographic images of the right antebrachium and completion of skeletal maturation (radius) were used to assess the growth rate. Serum oestradiol concentration increased in response to FSH administration, but decreased to normal basal values 24h after OPU. Autumn-born ewe lambs attained puberty at a later stage, compared to the winter-born animals. In most OPU-treated winter-born lambs, the first luteal phase was of short duration. This was not observed ill winter-born controls, nor in any of the autumn-born lambs. No differences were detected regarding the age at the onset of puberty between treated and control animals. From the 13th to the 26th week of age, winter-born treated lambs were lighter than the controls (27.3 +/- 1.6 vs 34.3 +/- 1.9 kg at 26 weeks of age, respectively). From the 16th to 34th week of age, radius length differed between the treated and control winter-born lambs, but not between autumn-born lambs. Ossification of the radial growth plate was not complete until the 34th (winter-born labs) or the 52nd (autumn-born lambs) week of age. It is postulated that repeated OPU can be safely applied to prepubertal lambs. with no consequences on the time to onset of puberty, whilst the growth rate of donor animals is also not affected. (C) 2009 Elsevier B.V. All rights reserved

Accuracy of Routine Endoscopy Diagnosing Colonic Ischaemia After Abdominal Aortic Aneurysm Repair:A Meta-analysis

Background: Colonic ischaemia (CI) is a devastating complication after abdominal aortic aneurysm (AAA) surgery. The aim of this review was to evaluate the diagnostic test accuracy of routine endoscopy in diagnosing CI after treatment for elective and acute AAA. Patients and methods: The Pubmed and Embase database searches resulted in 1188 articles. Prospective studies describing routine post-operative colonoscopy or sigmoidoscopy after elective or emergency AAA repair were included. The study quality was assessed with the QUADAS-2 tool. Sensitivity and specificity forest plots were drawn. Diagnostic odds ratios were calculated by a random effect model. Results: Twelve articles were included consisting of 718 AAA patients of whom 44% were treated electively, 56% ruptured and, 6% by endovascular repair. Of all patients, 20.8% were identified with CI (all grades), and 6.5% of patients had Grade 3 CI. The pooled diagnostic odds ratio for all grades of CI on endoscopy was 26.60 (95% CI 8.86–79.88). The sensitivity and specificity of endoscopy for detection of Grade 3 CI after AAA repair was 0.52 (95% CI, 0.31–0.73) and 0.97 (95% CI 0.95–0.99) respectively. The positive post-test probability is up to 60% in all kinds of AAA patients and 68% in ruptured AAA patients. Conclusion: Routine endoscopy is highly accurate for ruling out CI after AAA repair. Clinicians should be aware that endoscopy is less accurate in diagnosing the presence of the clinically relevant transmural CI. Endoscopy is a safe diagnostic test to use routinely as none of the studies reported adverse events