Correlation between ankle-brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

AbstractObjectiveImproving health-related quality of life (HRQL) is the main goal of surgery to treat peripheral vascular disease (PVD); however, HRQL is rarely measured directly. Rather, most surgeons use other measures, such as patient symptoms and ankle-brachial index (ABI) to determine the need for intervention in PVD. The accuracy of these surrogates in representing HRQL has been untested. The purpose of this study was to determine the correlation of these measures with HRQL in patients undergoing evaluation for intervention in symptomatic PVD.MethodsPatients (n = 108) referred to the vascular surgery service with symptoms of PVD were enrolled in a prospective study of HRQL. Patients completed two validated HRQL questionnaires: the short form-36 (SF-36) and the Walking Impairment Questionnaire (WIQ). All patients had symptoms consistent with PVD, including claudication (n = 69; 63.9%), ischemic rest pain (n = 17; 15.7%), or tissue loss (n = 22; 20.4%). ABI was measured at presentation.ResultsThe mean ABI was 0.53 (range, 0.00-0.98). The maximal correlation between SF-36 score and ABI was reflected in the Physical Component Summary score (r = 0.25). WIQ score also exhibited modest correlation with ABI, with maximal correlation noted for stair climbing (r = 0.26). Both SF-36 and WIQ scores exhibited a highly significant association with symptoms. Patients with more severe symptoms, such as lifestyle-limiting claudication or limb-threatening ischemia, had lower HRQL scores compared with patients with non-lifestyle-limiting claudication. Multivariate analysis demonstrated that SF-36 and WIQ physical summary scores are better predicted by symptoms than by ABI (P < .01).ConclusionsHRQL in patients with PVD correlates weakly with ABI, but exhibits a closer association with vascular symptoms. However, neither variable fully expresses patient HRQL. These data suggest that sole reliance on these surrogates may not accurately reflect the effect of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL

The Australian diabetes, obesity and lifestyle study (AusDiab)- methods and response rates

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) addresses the urgent need for data on diabetes prevalence, risk factors and associated conditions in Australia. Here we describe the methods used and the response rates obtained. AusDiab was a population-based cross-sectional survey of national diabetes mellitus prevalence and associated risk factors in people aged ⩾25 years, conducted between May 1999 and December 2000 in the six states and the Northern Territory of Australia. The study involved an initial household interview, followed by a biomedical examination that included an oral glucose tolerance test (OGTT), standard anthropometric tests, blood pressure measurements and the administration of questionnaires. Of the 20 347 eligible people (aged ⩾25 years and resident at the address for ⩾6 months) who completed a household interview, 11 247 (55.3%) attended for the biomedical examination. Of those who completed the biomedical examination 55.1% were female. Comparisons with the 1998 Australian population estimates showed that younger age responders were under-represented at the biomedical examination, while the middle-aged and older age groups were over-represented. Weighting of the AusDiab data for age and gender have corrected for this bias. AusDiab, which is the largest national diabetes prevalence study undertaken in a developed nation to have used an OGTT, provides a valuable national resource for the study of the prevalence and possible causes of diabetes, as well as identifying possible risk factors that may lead to diabetes. Furthermore, it generates the baseline data for a prospective 5-year cohort study. The data will be important for national and regional public health and lifestyle education and health promotion programs

Error analysis of free probability approximations to the density of states of disordered systems

Theoretical studies of localization, anomalous diffusion and ergodicity breaking require solving the electronic structure of disordered systems. We use free probability to approximate the ensemble- averaged density of states without exact diagonalization. We present an error analysis that quantifies the accuracy using a generalized moment expansion, allowing us to distinguish between different approximations. We identify an approximation that is accurate to the eighth moment across all noise strengths, and contrast this with the perturbation theory and isotropic entanglement theory.Comment: 5 pages, 3 figures, submitted to Phys. Rev. Let

Electronically Modified Cobalt Aminopyridine Complexes Reveal an Orthogonal Axis for Catalytic Optimization for CO₂ Reduction

The design of effective electrocatalysts for carbon dioxide reduction requires understanding the mechanistic underpinnings governing the binding, reduction, and protonation of CO₂. A critical aspect to understanding and tuning these factors for optimal catalysis revolves around controlling the electronic environments of the primary and secondary coordination sphere. Herein we report a series of para-substituted cobalt aminopyridine macrocyclic catalysts 2–4 capable of carrying out the electrochemical reduction of CO₂ to CO. Under catalytic conditions, complexes 2–4, as well as the unsubstituted cobalt aminopyridine complex 1, exhibit i_(cat)/i_p values ranging from 144 to 781. Complexes 2 and 4 exhibit a pronounced precatalytic wave suggestive of an ECEC mechanism. A Hammett analysis reveals that ligand modifications with electron-donating groups enhance catalysis (ρ < 0), indicative of positive charge buildup in the transition state. This trend also extends to the Co^(I/0) potential, where complexes possessing more negative E(CoI/0) reductions exhibit greater i_(cat)/i_p values. The reported modifications offer a synthetic lever to tune catalytic activity, orthogonal to our previous study of the role of pendant hydrogen bond donors

A structural and mechanistic study of π-clamp-mediated cysteine perfluoroarylation

Natural enzymes use local environments to tune the reactivity of amino acid side chains. In searching for small peptides with similar properties, we discovered a four-residue π-clamp motif (Phe-Cys-Pro-Phe) for regio- and chemoselective arylation of cysteine in ribosomally produced proteins. Here we report mutational, computational, and structural findings directed toward elucidating the molecular factors that drive π-clamp-mediated arylation. We show the significance of a trans conformation prolyl amide bond for the π-clamp reactivity. The π-clamp cysteine arylation reaction enthalpy of activation (ΔH‡) is significantly lower than a non-π-clamp cysteine. Solid-state NMR chemical shifts indicate the prolyl amide bond in the π-clamp motif adopts a 1:1 ratio of the cis and trans conformation, while in the reaction product Pro3 was exclusively in trans. In two structural models of the perfluoroarylated product, distinct interactions at 4.7 Å between Phe1 side chain and perfluoroaryl electrophile moiety are observed. Further, solution 19F NMR and isothermal titration calorimetry measurements suggest interactions between hydrophobic side chains in a π-clamp mutant and the perfluoroaryl probe. These studies led us to design a π-clamp mutant with an 85-fold rate enhancement. These findings will guide us toward the discovery of small reactive peptides to facilitate abiotic chemistry in water.National Institutes of Health (U.S.) (Grant R01GM110535)National Institutes of Health (U.S.) (Grant GM088204)National Science Foundation (U.S.) (Award CHE-1464804