Peripheral Vascular Disorders Research Articles

Coexisting anxiety disorders alter associations with physical disorders in the elderly: A Taiwan cross-sectional nationwide study.

We used population-based analyses to explore whether anxiety disorders are associated with certain physical illnesses, as previous studies have suggested, and whether a greater number of comorbid anxiety disorders would influence physical illnesses in the elderly. Using the National Health Insurance Research Database, we included subjects aged over 60 years. The study included 954 subjects with anxiety disorders (as defined by the ICD-9-CM) and 4770 control subjects without anxiety disorders. Odds ratios (OR) were calculated for the risks of physical illnesses in both groups. Subjects with anxiety disorders had higher OR for cardiovascular disease (OR = 1.33-2.80), cerebrovascular disease (OR = 2.07), peptic ulcer (OR = 3.41), and hyperlipidemia (OR = 2.99). Furthermore, a greater number of comorbid anxiety disorders may further increase the OR of the aforementioned physical illnesses, except for peripheral vascular disorder, when compared to those without anxiety disorders. Elderly subjects with more anxiety disorders may be associated with vascular and metabolic problems. Clinicians should carefully assess the physical illnesses of elderly patients with anxiety disorders.

Effect of Cigarette Smoking on Serum Lipid Profile in Male Population of Udaipur

Cigarette smoking is associated with adverse effects on lipid profile and homocysteine thus increasing risk for atherosclerosis and coronary heart disease. Smoking is a prominent risk factor for coronary artery disease, atherosclerosis and peripheral vascular disorders. This study was undertaken to evaluate serum lipid profile in chronic smokers and to compare it with healthy non-smokers, considered as controls. Serum lipid profile was measured in 300 male subjects. Out of which 150 were smokers and 150 non-smokers (controls) with an age range of 50 to 60 years. Only chronic smokers who were smoking for more than 20 years were included in the study. It was revealed that mean serum Total Cholesterol (268.88 ± 29.23 mg/dl), Triglyceride(192.12 ± 56.42 mg/dl), Low Density Lipoprotein Cholesterol (189.76 ± 15.74 mg/dl), Very Low Density Lipoprotein Cholesterol (38.42 ± 11.28 mg/dl) were significantly higher in chronic smokers as compared to non-smokers with mean serum Total Cholesterol (182.56 ± 21.33 mg/dl), Triglyceride(115.71 ± 32.11mg/dl), Low Density Lipoprotein Cholesterol(107.68 ± 9.55 mg/ dl), Very Low Density Lipoprotein Cholesterol(23.14 ± 6.42 mg/dl). On the other hand value of mean serum High Density Lipoprotein Cholesterol was lower in chronic smokers (40.7 ± 2.21 mg/dl) than in non-smokers (51.74 ± 5.36 mg/dl). Thus this study concludes that cigarette smoking produced adverse effects on lipid profile, leading to increase cardiovascular disease risk among smokers.

A morphometric study of arch of the great saphenous vein and its clinical significance

Objective: Varicosities in the lower limbs are the most important afflictions of the venous system, as well as of the peripheral vascular disorders. They are always caused by a fault in the valves inside the veins at the point where the superficial veins communicate with the deep veins. If the valve leaks, the blood flows backwards and this increases the pressure in the superficial veins, which, as blood stagnates, becomes swollen and varicose. The treatment of these varicose veins is surgery, for which the surgeons should have a sound knowledge of the anatomy of the great saphenous vein (GSV). So, the aim of our study was to establish palpable anatomical markers for its exploration and surgical approach. Materials and Methods: In this study, 25 inguinofemoral regions of lower limbs were dissected. After exposing the arch of the GSV, we took the following measurements using a calliper - the distance separating the top of the arch of the GSV a) from the ventral-cranial iliac spine, b) from the pubic tubercle, and c) from the inguinal ligament. Statistical analysis of the measurements was done. Results: The mean distance of the arch of the GSV from the ventral cranial iliac spine, pubic tubercle, and the inguinal ligament was 9.46 cm, 4.66 cm, and 2.75 cm respectively. In addition, we found in one case a duplication of the GSV just above the knee. Conclusion: These measurements will help the surgeons in identifying the arch of the GSV before it opens into the anterior-internal surface of the femoral vein.

Introducing Brazilian Thermology Society, ICGMT and PAJMT

Introducing Brazilian Thermology Society, ICGMT and PAJMT

Physiotherapeutic intervention in peripheral arterial disease by functional hyperemia in diabetic patients

Abstract Introduction : Diabetes Mellitus (DM) is conceptualized as a public health problem with varying degrees of morbidity. The physical and functional alternatives for the treatment of circulatory complications of diabetes, such as intermittent claudication, are poorly explored. This indicates the need to search for ancillary techniques that can be used in the physical therapy treatment of diabetic patients. Objective : To investigate the effects of functional hyperemia on peripheral arterial disease in patients with diabetes. Materials and methods: This study was conducted with a group of five volunteers from the Diabetics Association of Parana (Associação Paranaense do Diabético , APAD ), who suffered from peripheral vascular disorders in the lower limbs. All subjects attended 10 sessions (twice weekly). Functional hyperemia was induced by programmed exercise therapy that consisted of walking on a treadmill. Results : There was a significant increase in mean activity time (F9,36 = 13.710; p < 0.001 ), mean walking distance (F9,36 = 27.689 ; p < 001), and mean speed (F9,36 = 15.638 ; p < .001). No statistically significant differences in the ankle-brachial index were noted. Conclusion : There was a significant increase in walking distance, time, and speed for diabetic subjects. Our findings indicate the importance of physical therapists in the supervised treatment of peripheral vascular disorders in diabetic patients.

Wound Healing Following Open Groin Hernia Surgery: The Impact of Comorbidity.

The aim of this study was to explore the impact of chronic concomitant disease on the risk for postoperative complications following open groin hernia surgery. During the study period (2002-2011), 133,074 open repairs were registered in the Swedish Hernia Register. History of peripheral vascular disorders, connective tissue disease, chronic renal failure, obesity, and liver cirrhosis as well as data on hemorrhage or hematoma, wound dehiscence, postoperative infection, and reoperation for superficial infection or bleeding within 30 days after surgery were obtained by matching with the Swedish Patient Register. In the multivariate logistic regression analysis, a significantly increased risk for hemorrhage or hematoma within 30 days after surgery was seen for older patients, males, liver cirrhosis, peripheral vascular disease, and connective tissue disease (p < 0.05). High age (>80 years), previous history of peripheral vascular disease, connective tissue disease, and male gender were risk factors for wound dehiscence (p < 0.05). Liver cirrhosis, chronic kidney disease, BMI > 25, and male gender were associated with increased risk for postoperative wound infection (p < 0.05). A significantly increased risk for reoperation for superficial infection or bleeding was seen in patients with peripheral vascular disease and elderly patients (p < 0.05). Risk for postoperative complications in open groin hernia surgery is increased in elderly patients, patients with liver cirrhosis, and those with peripheral vascular disease. The indications for surgery should be weighed against the risk for wound-healing complications in these patient groups. Watchful waiting may be an alternative, although this carries the risk of emergency surgery.

EFFICACY OF ACTOVEGIN IN THE TREATMENT OF THE CENTRAL AND THE PERIPHERAL NERVOUS SYSTEM

The stimulator of tissue regeneration Actovegin is used in many diseases associated with blood circulation. It’s given to patients with neurological, endocrinological, cardiac and even ophthalmic diseases. Its efficacy is observed in disorders of the brain with the metabolic and vascular nature. It improves the trophism of tissues with injuries, burns and ulcers of the different etiology. It prevents the development of adverse effects as a result of peripheral vascular disorders. Actovegin has received the active application in patients with the long-standing diabetes as a prevention and the treatment of complications, particularly the vascular dementia and the diabetic distal polyneuropathy. The basis for these diseases is the hypoxic nature of the tissue damage. It’s mechanisms direct to the reduction of the influence pathological factors and the recovery of the antioxidant activity of cells.

Risk Factors of Postoperative Myocardial Infarction after Colorectal Surgeries

There are limited data regarding the specific risk factors of postoperative myocardial infarction (MI) in patients undergoing colorectal resectional surgery. We sought to identify risk factors of acute MI after colorectal resection operations. The National Inpatient Sample database was used to identify patients who had postoperative MI after colorectal resection operations between 2002 and 2010. Statistical analysis was performed to identify factors predictive of postoperative MI. We sampled a total of 2,513,124 patients undergoing colorectal resection, of whom 38,317 (1.5%) sustained a postoperative MI. Patients with postoperative MI had associated 28.5 per cent in-hospital mortality. Risk factors identified include (P < 0.01): history of congestive heart failure (odds ratio [OR], 8.18), chronic renal failure (OR, 3.86), age 70 years or older (OR, 3.68), peripheral vascular disorders (OR, 2.93), fluid and electrolyte disorders (OR, 2.69), emergency admission (OR, 2.56), preoperative weight loss (OR, 2.49), cardiac valvular disease (OR, 2.46), chronic lung disease (OR, 1.75), deficiency anemia (OR, 1.22), colorectal cancer (OR, 1.77), and hypertension (OR, 1.14). Postoperative MI occurs in less than 2 per cent of colorectal resections. However, patients sustaining postoperative MI are over six times more likely to die. Congestive heart failure and chronic renal failure are the strongest predictors of postoperative MI.

In-vitro comparative degradation study of different brands of Flunarizine dihydrochloride tablet using UV Spectrophotometer

The objective of this study was to develop the degradation studies of different brands of Flunarizine dihydrochloride tablet available in market. Forced degradation is a process that involves degradation of drug products and drug substances at conditions more severe than accelerated conditions and thus generates degradation products that can be studied to determine the stability of the molecule. Flunarizine dihydrochloride is a calcium channel blocker which reduces arterial and arteriolar smooth muscle spasm by reducing intracellular Caoverload due to brain hypoxia. It is widely used in cerebral and peripheral vascular disorders and also as antihistaminic & sedative. This drug was subjected to different stress conditions as per International Conference on Harmonization guidelines (ICH). An ultraviolet UV spectroscopic method was developed for analysis of the drug in the presence of the degradation products. Ethanol was used as a solvent. The amount of degraded drugs was calculated by taking the absorbance at 253 nm. According to the assay limit of USP specified that the content should not be less than 95% and not more than 105% of labelled amount. In case of acidic pH and basic pH except Fluver amd Minium other brands were degraded. In addition to heat exposure only brand Norium was Stable. It was concluded that all brands werent degraded from ranges for all the stresses applied for degradation studies.

Sonoelastographıc assessment of the age-related changes of the Achilles tendon.

Tendons are crucial for optimal muscle force transfer and subject to changes with aging which may impair functional ability of elderly individuals. Achilles is the largest and the strongest tendon in the body; therefore it is an excellent site for the radiologic investigation of aging of tendons. Sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on elastic properties and stiffness of tissues. The aim of our study was to investigate the age-related alterations in Achilles tendons using SE. Forty five geriatric (age ≥ 65 years) and 42 young (age 18-40 years) healthy consecutive subjects were enrolled. Subjects with known history of metabolic or endocrine diseases, sports or traumatic injuries, peripheral vascular disorders were excluded. Both Achilles tendons were scanned with a real-time SE probe at a frequency of 6-15 MHz. Strains of Achilles tendons' proximal, middle and distal parts were assessed semi-quantitatively with comparing a reference tissue. Both SE methods -color coded evaluation and strain measurement- showed a remarkably stiffer tendon in the elderly subjects compared to young subjects in all thirds of Achilles tendons. In young subjects 84.9 % tendon thirds were blue, and 15.1% were green whereas, in elders 93.7% were blue and 6.3% were green (p=0.024). There was a significant correlation between age and stiffness of tendons assessed with strain indices. Our result showed increased tendon stiffness in elderly subjects which might be responsible for the high prevalence of Achilles tendinopathies observed in elderly subjects.

Impact and cost of care of venous thromboembolism following pituitary surgery

In 2008, the Centers for Medicare and Medicaid Services discontinued reimbursement for postoperative venous thromboembolism (VTE) events such as deep venous thrombosis and pulmonary embolism, citing them as preventable postoperative complications. We examined the impact of postoperative VTE on patients undergoing pituitary surgery. The Nationwide Inpatient Sample (NIS) was evaluated for patients undergoing pituitary resection from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were analyzed. Eighty-seven patients who underwent pituitary surgery developed a VTE. Patients who underwent pituitary surgery that developed VTE were older (55.9 ± 15.2 years) than those who did not develop VTE (50.1 ± 17.2 years) (P = 0.002). VTE occurred at a significantly higher rate in patients with coagulopathy, peripheral vascular disorder, and weight loss (P < 0.05). VTE was associated with increased rates of postoperative neurological, pulmonary, cardiac, urinary, renal, hemorrhage, fluid and electrolytes, diabetes insipidus, and cerebrospinal fluid rhinorrhea complications (P < 0.01)-as well as increased mortality rate (P < 0.001), length of stay (P < 0.001), and cost of care (P < 0.001). Analysis of the data from the NIS database showed that risk factors for the development of VTE following pituitary surgery include older age, preexisting coagulopathy, peripheral vascular disorder, and weight loss. Patients who developed postoperative VTE had a longer length of hospital stay, higher hospital charges, and increased morbidity and mortality.

Cold exposure and health effects among frozen food processing workers in eastern Thailand.

Frozen food processing workers work under a cold environment which can cause several adverse health effects.This study explored factors affecting workers' health in the frozen food industry in Thailand. Participants comprised 497 workers exposed to a cold working environment and 255 office workers who served as the controls.Data were collected by a survey on the work environment, and the interview of workers for abnormal symptoms. The exposed group had the following characteristics: 52.7% male, overall average age of 27 (SD 6.6) years old, attained elementary education (Grade 4 and Grade 6) (54.1%), married (48.9%), smokers (21.3%), alcohol consumption (31.0%), duration of work was between 1 and 5 years (65.2%), working 6 days a week (82.7%), 1–5 hours of overtime per week (33.8%), office workers (33.9%); work category: sizing (6.9%), peeling (28.3%) dissecting (22.2%), and in the warehouse (8.6%). The temperature in the work environment ranged from 17.2°C to 19.2°C in most sections, −18.0°C in the warehouse, and 25°C in the office areas. Warehouse workers had more abnormal symptoms than controls including repeated pain in the musculoskeletal system (OR 11.9; 95% CI 6.12–23.45), disturbance throughout the body (OR 4.60; 95% CI 2.00–10.56), respiratory symptoms (OR 9.73; 95% CI 3.53–26.80), episodic finger symptoms (OR 13.51; 95% CI 5.17–35.33).The study results suggest that workers' health should be monitored especially with regard to back and muscle pain, respiratory symptoms, episodic finger symptoms, and cardiovascular symptoms. Health promotion campaigns such as antismoking and reduction of alcohol consumption should be established because smoking and alcohol consumption are contributing factors to the pathogenesis of Raynaud's phenomenon and peripheral vascular disorders such as hypertension and heart disease.

Prevalence and risk of developing comorbid conditions in patients with chronic constipation

Objective:To estimate the prevalence of gastrointestinal (GI) and non-GI comorbidities and the risk of incident comorbidities among patients with and without chronic constipation (CC).Research design and methods:Adults with CC were identified from a large retrospective US claims database. Each CC patient was matched 1:3 to CC-free patients by birth year, sex, and region of residence.Main outcome measures:Prevalence of GI and non-GI comorbidities was measured over a 1-year period. Relative risk of new comorbidities was also estimated among patients who were free of the studied comorbidity prior to the index date.Results:Mean age was 61.9 years; 33.3% of patients were male. The 1-year prevalence of GI comorbidities was significantly higher in CC (N = 28,854) vs. CC-free (N = 86,562) patients (all p < 0.05). The risk of developing new GI conditions was also significantly higher in CC patients for all studied conditions except ulcerative colitis: megacolon (hazard ratio [95% confidence interval] HR [CI] = 11.96 [8.16–17.53]), intestinal impaction (10.56 [9.22–12.10]), volvulus (7.12 [5.42–9.35]), other specified functional intestinal disorders (6.67 [5.57–8.00]), and other unspecified functional disorders of intestine (4.60 [3.61–5.87]). Similarly, 1-year prevalence of non-GI comorbidities was higher in CC patients, as was the risk of developing new conditions: depression and mood disorder (HR [CI] = 1.84 [1.77–1.90]), neurological disorders (1.68 [1.62–1.74]), iron deficiency anemia (1.52 [1.47–1.57]), hypothyroidism (1.40 [1.34–1.46]), and peripheral vascular disorders (1.40 [1.34–1.46]).Limitations:An algorithm was used to define CC as there is no specific diagnosis code to identify CC.Conclusions:CC patients had significantly higher prevalence and were at increased risk of developing new GI and non-GI comorbidities than age-, gender- and region-matched CC-free patients. Future research is warranted to better understand these associations.

Burn injury associated with comorbidities: Impact on the outcome

Aims and Objectives: To evaluate the impact of comorbidities on the outcome of burn injuries. Materials and Methods: A retrospective analysis of 108 patients, treated between August 2010 and July 2013, was carried out. All patients were admitted, assessed and managed. The medical notes on 72 patients with comorbidity (Study group) were analyzed and matched with 36 other patients, without comorbidities (Control group), according to age, gender, and interval time between injury and admission. Information regarding types of burn injuries, depth of burn, comorbidities, operative procedures and final outcome were noted. Results: Patients were evaluated in terms of their duration of stay in the hospital and mortality. The comorbidities that influence these factors are renal disease, liver disease, cancer, pulmonary disorders, cardiac disease, obesity, peripheral vascular disorders, alcohol abuse, smoking and neurological disorders. Conclusion: It was found that the associated comorbid conditions influence the outcome of patients, injured due to burn, in terms of the duration of their stay in the hospital and mortality.

Predictive Accuracy of 29-Comorbidity Index for In-Hospital Deaths in US Adult Hospitalizations with a Diagnosis of Venous Thromboembolism

BackgroundVenous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), we evaluated the predictive accuracy of the AHRQ’s 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE.MethodsWe assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT). We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models.ResultsIn 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE) occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%−125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802.ConclusionThe results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult hospitalizations with VTE and among those with DVT or PE.

Cyclic AMP-Rap1A signaling mediates cell surface translocation of microvascular smooth muscle α2C-adrenoceptors through the actin-binding protein filamin-2

The second messenger cyclic AMP (cAMP) plays a vital role in vascular physiology, including vasodilation of large blood vessels. We recently demonstrated cAMP activation of Epac-Rap1A and RhoA-Rho-associated kinase (ROCK)-F-actin signaling in arteriolar-derived smooth muscle cells increases expression and cell surface translocation of functional α2C-adrenoceptors (α2C-ARs) that mediate vasoconstriction in small blood vessels (arterioles). The Ras-related small GTPAse Rap1A increased expression of α2C-ARs and also increased translocation of perinuclear α2C-ARs to intracellular F-actin and to the plasma membrane. This study examined the mechanism of translocation to better understand the role of these newly discovered mediators of blood flow control, potentially activated in peripheral vascular disorders. We utilized a yeast two-hybrid screen with human microvascular smooth muscle cells (microVSM) cDNA library and the α2C-AR COOH terminus to identify a novel interaction with the actin cross-linker filamin-2. Yeast α-galactosidase assays, site-directed mutagenesis, and coimmunoprecipitation experiments in heterologous human embryonic kidney (HEK) 293 cells and in human microVSM demonstrated that α2C-ARs, but not α2A-AR subtype, interacted with filamin. In Rap1-stimulated human microVSM, α2C-ARs colocalized with filamin on intracellular filaments and at the plasma membrane. Small interfering RNA-mediated knockdown of filamin-2 inhibited Rap1-induced redistribution of α2C-ARs to the cell surface and inhibited receptor function. The studies suggest that cAMP-Rap1-Rho-ROCK signaling facilitates receptor translocation and function via phosphorylation of filamin-2 Ser(2113). Together, these studies extend our previous findings to show that functional rescue of α2C-ARs is mediated through Rap1-filamin signaling. Perturbation of this signaling pathway may lead to alterations in α2C-AR trafficking and physiological function.

Comparison of discontinuation, health care resource utilization (HRU), and costs between metastatic breast cancer (mBC) patients (pts) who received trastuzumab (T) in an office clinic versus outpatient hospital setting.

642 Background: T treatment for mBC may be administered in an office clinic or outpatient hospital setting. This study assesses the impact of the site of care on T discontinuation risk, HRU, and costs. Methods: Adult women with mBC who received ≥2 T infusions in an outpatient hospital or office clinic setting were selected from the US-based Humana database (2007-2012). Pts were required to be continuous eligible in their healthcare plan for ≥6 months prior and ≥2 months following the first T infusion (index date). Pts were classified, based on their index site of care, into one of the following cohorts: 1) office clinic, or 2) outpatient hospital. Outcomes were measured from the index date up to the end of continuous eligibility/data availability, a change in the site of care, or 12 months after the index date, whichever occurred first. Treatment discontinuation (gap ≥45 consecutive days) was compared between cohorts using multivariate Cox-proportional hazards model. Monthly healthcare costs (2012 USD) and HRU were compared between cohorts using multivariate generalized linear/two-part models, and multivariate negative binomial regression models, respectively. Results: A total of 280 pts met the inclusion criteria; 64% and 36% in the office clinic and outpatient hospital cohort, respectively. Baseline characteristics were similar between cohorts. However, differences were found in terms of insurance plan type, year of index date and comorbid conditions (chronic pulmonary disease and peripheral vascular disorder). After adjusting for confounding factors, the outpatient hospital cohort had a 1.5 time higher risk of treatment discontinuation (p=.043) and incurred an incremental monthly cost of $1,954 (p=&lt;.001), mainly driven by higher office clinic and outpatient hospital costs ($1,483 p=.016). No differences were observed in HRU. Conclusions: Pts in the office clinics cohort were less likely to discontinue T and were associated with lower monthly total healthcare costs. Future research should examine the impact early discontinuation may have on clinical outcomes.

Neuropathic pain needs systematic classification

Neuropathic pain needs systematic classification

Ultra-widefield fluorescein angiography of white without pressure

PurposeTo describe ultra-widefield fluorescein angiography (UWFA) findings in eyes with white without pressure (WWOP) and in eyes without any obvious peripheral chorioretinal disease, and to determine if a difference exists between these two groups.MethodsA retrospective review of 379 eyes undergoing diagnostic UWFA using the Optos 200Tx imaging system. Eyes were excluded if the quality of the color photograph or UWFA prevented reliable evaluation. Eyes were also excluded if there was any evidence of peripheral retinal or choroidal disease, which was thought to have an effect on UWFA (eg, peripheral background diabetic or hypertensive retinopathy, vein occlusion, or any other peripheral vascular disorder). Eyes were determined to have WWOP, based on a dilated fundus examination and color fundus photography that contained areas of peripheral retinal whitening consistent with the diagnosis. UWFA was evaluated by trained masked graders, and determined to have or not have peripheral vascular leakage and/or staining.ResultsOf the 379 eyes evaluated, 45 eyes were included in the study. Twelve eyes were determined to have peripheral WWOP; 33 eyes did not have WWOP on examination or color fundus photography. Three common UWFA peripheral patterns were visualized. Eyes with and without WWOP were grouped into one of three patterns. The majority of eyes without WWOP demonstrated UWFA pattern one (69.7%), while those in the WWOP group demonstrated pattern three (50%). The distribution of UWFA patterns is statistically different between those with and without WWOP (P = 0.002). In eyes without WWOP, in patients with no documented systemic microvascular disease (diabetes, hypertension), 71.4% of eyes had UWFA pattern one while 14.3% had both patterns two and three.ConclusionThis study is one of the first to specifically evaluate peripheral vascular leakage/staining in eyes with WWOP as well as in eyes without any obvious peripheral chorioretinal disease. We demonstrate that a significant portion of WWOP eyes exhibit peripheral findings on UWFA (pattern one) compared to eyes without WWOP. Importantly, even in eyes that are apparently unremarkable in the periphery on exam and color photography, UWFA can still show peripheral vascular abnormalities. These results warrant further investigation.

Clustering Patterns of Comorbidities Associated with In-Hospital Death in Hospitalizations of US Adults with Venous Thromboembolism

Background: Venous thromboembolism (VTE) is a significant source of mortality, morbidity, disability, and impaired health-related quality of life in the world.Objective: We aimed to evaluate the clustering patterns and associations of 29 comorbidities with in-hospital death among adult hospitalizations with a diagnosis of VTE in the United States by analyzing data from the 2009 Nationwide Inpatient Sample.Methods: This cross-sectional study included 153,124 adult hospitalizations with a diagnosis of VTE. Adjusted rate ratios and 95% confidence intervals (CI) for in-hospital death were generated by using multivariable log-linear regression models to measure independent associations between comorbidities and in-hospital death.Results: We estimated that 44,200 in-hospital deaths occurred in 2009 among 773,273 US adult hospitalizations with a diagnosis of VTE. Subgroups of hospitalizations with comorbidities of “congestive heart failure,” “chronic pulmonary disease,” “coagulopathy,” “liver disease,” “lymphoma,” “fluid and electrolyte disorders,” “metastatic cancer,” “peripheral vascular disorders,” “pulmonary circulation disorders,” “renal failure,” “solid tumor without metastasis,” or “weight loss” were positively and independently associated with 1.07 (95% CI: 1.02-1.12 ) to 2.06 (95% CI: 1.97-2.16) times increased likelihoods of in-hospital death, when compared to those without the corresponding comorbidities. The clustering patterns of these comorbidities by 4 disease categories (i.e., “cancer,” “cardiovascular/respiratory/blood,” “gastrointestinal/urologic,” and “nutritional/bodyweight”) were associated with 2.74 to 10.28 times increased likelihoods of in-hospital death, as compared to hospitalizations without any of these comorbidities. The overall increase in the cumulative number of comorbidities corresponded to significantly elevated risks (P-trend<0.01) for in-hospital death among hospitalizations with a diagnosis of VTE.Conclusion: The presence of multiple comorbidities is ubiquitous among hospitalizations of adults with VTE and among in-hospital deaths with VTE in the United States. The findings of our study further suggest that, among hospitalizations of adults with VTE, the presence of certain comorbidities or clustering of these comorbidities significantly elevates the risk of in-hospital death.