Peripheral Vascular Disorders Research Articles

Intravascular ultrasound guidance for lower extremity arterial and venous interventions.

This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.

Clustering of 31 health conditions among multimorbid people in Fife and Tayside, Scotland: E-cohort analysis.

BackgroundA deeper understanding of the clustering of multimorbidity (2+) (MM) conditions by age, sex, and deprivation could help prepare health systems for adequate and effective preventive intervention. We identified the commonest conditions and their clusters contributing to MM stratified age, sex, and deprivation.
 MethodsRetrospective cohort of 431,772 patients aged >25 years, registered with a general practice in Fife/Tayside, Scotland and alive in January 2000 were followed till December 2019. We developed Multimorbidity e-Cohort for Fife/Tayside (MCFT), Scotland. MCFT combined anonymised Scottish demographic dataset, prescribing information systems records from 2009 and secondary care: hospital admission and day-case records, mental health inpatient and accident and emergency attendances from 2000 from the Scottish Safe Havens Health Informatics Centre. Elixhauser comorbidity classifications were used to identify the presence of 31 conditions. Besides descriptive statistics, dissimilarity algorithm in association rule mining techniques were used for the analysis.
 Results33.6% and 13.3% had MM and complex MM (4+) respectively, which varied across age, sex and deprivation of the patients. The commonest condition among <50 years with MM are alcohol abuse (32%), chronic pulmonary disease and depression (24% each) compared with uncomplicated hypertension (57%), and cardiac arrhythmia (40%) among those aged 80+ years. We identified four unique clusters among multimorbid individuals (a) liver disease, alcohol, other neurological disorders and depression; (b) weight loss, Rheumatoid Arthritis/collagenm, hypothyroidism, deficiency anemia; (c) solid tumor and metastatic cancer; (4) peripheral vascular disorders, renal failure, fluid & electrolyte disorders, chronic pulmonary disease, uncomplicated hypertension/diabetes, pulmonary circulation disorders, valvular disease, congestive heart failure and cardiac arrhythmias. The clusters varied across sex, age and deprivation.
 ConclusionClusters of disease conditions in the MM population varied mostly by age. Alcohol misuse contributed to MM among a third of under-50. Almost half of the oldest age group have hypertension and cardiac arrythmia. When considering clustering of conditions, it is important to consider age, sex and deprivation.

Evaluation of hand-arm vibration(HAV) exposure levels among grounds maintenance workers: An observational human exposure measurement study.

Evaluation of hand-arm vibration(HAV) exposure levels among grounds maintenance workers: An observational human exposure measurement study.

Predictive Model for Heart Failure Readmission Using Nationwide Readmissions Database.

ObjectiveTo generate a heart failure (HF) readmission prediction model using the Nationwide Readmissions Database to guide management and reduce HF readmissions.Patients and MethodsA retrospective analysis was performed for patients listed for HF admissions in the Nationwide Readmissions Database from January 1, 2010, to December 31, 2014. A Cox proportional hazards model for sample survey data for the prediction of readmission for all patients with HF was implemented using a derivation cohort (2010-2012). We generated receiver operating characteristic (ROC) curves and estimated area under the ROC curve at each time point (30, 60, 90, and 180 days) to assess the accuracy of our predictive model using the derivation cohort (2010-2012) and compared it with the validation cohort (2013-2014). A risk score was computed for the validation cohort. On the basis of the total risk score, we calculated the probability of readmission at 30, 60, 90, and 180 days.ResultsApproximately 1,420,564 patients were admitted for HF, contributing to 1,817,735 total HF admissions. Of these, 665,867 patients had at least 1 readmission for HF. The 10 most common comorbidities for readmitted patients included hypertension, diabetes mellitus, renal failure, chronic pulmonary disease, deficiency anemia, fluid and electrolyte disorders, obesity, hypothyroidism, peripheral vascular disorders, and depression. The area under the ROC curve for the prediction model was 0.58 in the derivation cohort and 0.59 in the validation cohort.ConclusionThe prediction model will find clinical utility at point of care in optimizing the management of patients with HF and reducing HF readmissions.

Abstract 215: Increasing Risk Of Hospitalizations For Young-onset Stroke With Improving Survival Odds - A Nationwide Analysis Of Two Cohorts A Decade Apart In The United States

Background: The scarcity of large-scale trends data on young-onset stroke prompted us to explore the difference in stroke hospitalization and inpatient outcomes among young adults from two nationwide cohorts 10 years apart. Methods: The National Inpatient Sample (2007 & 2017) was utilized to identify stroke admissions among young adults(18-44 years). We compared demographics, comorbidities, inpatient outcomes and gender/racial disparities in frequency of stroke admissions and mortality between the two cohorts 10-years apart. Results: There was an increase in stroke admissions of young adults in 2017 (0.7%, n=58965/8,568,874, aOR: 1.48, 95%CI:1.46-1.5, p<0.001) compared to 2007 (0.4%, n=41379/10,330,126) [Table 1] . The 2017 cohort often included female (49.0% vs 48.4%), non-elective admissions (94.0% vs 90.9%), Medicaid beneficiary (35% vs 23.4%) and urban teaching hospitalizations (81% vs 61.6%)(p<0.05) vs. the 2007 cohort. Cardiovascular comorbidities like hypertension, hyperlipidemia, obesity, peripheral vascular disorders, congestive heart failure and atrial fibrillation/flutter were significantly more prevalent in the 2017 cohort vs. 2007. Reassuringly, with advanced medical and interventional therapeutics in the last decade, the odds of in-hospital mortality decreased in 2017 (aOR 0.84, 95%CI: 0.79-0.89) vs. 2007. Females, Caucasians and Hispanics witnessed a higher relative increase in stroke hospitalizations in 2017. In addition, compared to 2007, a significant decline in mortality was noticed among both sexes but Hispanics and Asians did not show an improvement in survival odds in2017 vs 2007. Conclusion: Comparison of two young stroke cohorts a decade apart shows an alarming rise in stroke hospitalizations (nearly 50% higher) with cardiovascular disease risk factors, particularly in the female gender, with declining in-hospital mortality. Persistent racial disparities warrant an inclusive approach in preventive care.

Comparison and Analysis of Different Thermography Techniques in the Biomedical Applications

Thermography is a technique that involves using a thermal camera to make a thermogram image that depicts the quantity of infrared energy emitted, transmitted, and reflected by an object. Body surface temperature monitoring, which varies when blood flow increases or decreases due to clinical irregularities, has been frequently utilised to diagnose medical problems such as breast cancer, diabetes neuropathy, and peripheral vascular disorders using thermography. Thermography has become a significant tool, particularly for fever screening during infectious disease epidemics such as Ebola and COVID-19, due to its non-invasive and non-contact nature. Thermography is a sensory instrument that can be particularly valuable in protecting human health when paired with thermal physiology data. In this review, we analyze and compare several thermography processes and aspects to come up with the optimal methodology for use in the medical field.

Incidence of Venous Thromboembolism in Patients Receiving Anticoagulation for Foot and Ankle Surgery

Venous thromboembolism (VTE) is a serious medical condition that can be an unfortunate complication arising from foot and ankle surgery. Many factors may predispose a patient to a VTE event including prolonged postoperative immobilization, comorbidities, extended length of tourniquet time, and higher risk surgeries. Unfortunately, there is no clinical consensus for guidelines on VTE prophylaxis following foot and ankle surgery. In this retrospective cohort study, we present our patient population who were prophylactically anticoagulated following foot and ankle surgery along with their incidence of deep vein thrombosis and pulmonary embolism (PE). Included in the study were patients who had undergone elective and traumatic foot and ankle surgery from June 2017 to December 2018. Using retrospective data obtained we compared patient demographics, surgery type, length of tourniquet time, postoperative immobilization, type of VTE prophylaxis, and comorbidities including history of smoking, peripheral vascular disease, bleeding disorders, and patients undergoing dialysis. Five of 425 (1.2%) patients were diagnosed with a deep vein thrombosis and 1 of 425 (0.2%) patients was diagnosed with a pulmonary embolism. Risks factors statistically significant for developing a VTE in our patient population included extended periods of immobilization and an increasing patient age. We were able to conclude that routine prophylaxis for elective and traumatic foot and ankle surgery is both effective and safe for especially in older patients requiring extended immobilization. It's also important to take into consideration comorbidities, smoking history, tourniquet time, and the type of surgery that is being performed.

Abstract EP14: Traditional And Non-traditional Cardiometabolic Risk Factors For Type 2 Myocardial Infarction Compared To Type 1 Myocardial Infarction In Young Women (18-44 Years): A National Inpatient Analysis

Background: There has been growing interest in studying demand ischemia as a cause of type 2 myocardial infarction (T2MI) in younger patients. Conventional cardiovascular risk factors and their association (and degree) are vaguely defined as predictors of T2MI. Women may be noted to have different predictors given their underrepresentation in clinical trials. Methods: We analyzed young female (18-44 years) hospitalizations from the National Inpatient Sample 2018 for multivariate-adjusted predictors (aOR, 95% confidence interval) of T2MI, STEMI and NSTEMI admissions, and divided the significance level into p<0.01, p<0.05 & p<0.1. Results: Young females (n=6,152,028) had 0.05% STEMI, 0.16% NSTEMI and 0.08% T2MI admissions. Predictors (Table 1) with the highest significance level of association for T2MI (p<0.01), compared to ST/NSTEMI (either 0.01<p<0.05 or not significant), were black race (aOR 1.49) and CHF (aOR 1.97), pulmonary circulation disorder (aOR 1.83) and OSA (aOR 1.62). Valvular heart disease, paralysis, COPD, deficiency anemia predicted a higher risk of T2MI admissions in young women (p<0.05) but not STEMI/NSTEMI admissions. Hypertension, prior MI, dyslipidemia, family history of coronary artery disease, peripheral vascular disease, coagulopathy and fluid-electrolyte disorder predicted a higher risk of T2MI or STEMI/NSTEMI. Collagen vascular disorders and obesity had a higher risk of T2MI/NSTEMI (p<0.01) but not of STEMI (p=0.07). DM, and cocaine abuse predicted higher odds of STEMI/NSTEMI but not of T2MI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol abuse and cannabis abuse did not predict a higher risk of T2MI or STEMI/NSTEMI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol and cannabis abuse did not predict higher odds of T2MI or STEMI/NSTEMI in young women. Conclusion: Predictors associated with T2MI in young females with a higher order of significance than ST/NSTEMI can be utilized to build a risk score for T2MI in young females.

Incidence and risk factors of postoperative delirium following total knee arthroplasty: A retrospective Nationwide Inpatient Sample database study

BackgroundPostoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after primary total knee arthroplasty (TKA) has not been well studied using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent primary TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of payer, in-hospital mortality, and perioperative complications were evaluated. ResultsA total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008.Patients with delirium after TKA presented increased comorbidities, LOS, hospital charges, usage of medicare, and in-hospital mortality (P < 0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease, pulmonary circulation disorders, peripheral vascular disorders, chronic renal failure, and teaching hospital. Notably, neurological disorders were found to have the strongest association with the occurrence of postoperative delirium. ConclusionA relatively low incidence of delirium after TKA was identified. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.

Abstract TP228: Sex Specific Predictors Of Short Term Stroke Readmission After Hypertensive Urgency: Insights From National Readmission Database

Background: Short term outcomes of patients hospitalized with hypertension urgency defined as sudden elevation of Blood pressure above 180 systolic or 110 diastolic is poorly studied in literature. Uncontrolled Hypertension is a major risk factor of stroke. Sex differences exist in stroke presentation and risk factors. Objective: To evaluate the sex specific predictors of short term (90-day) readmission with stroke in patients hospitalized with hypertension urgency. Methods: The study is a retrospective analysis of National Readmission Database (NRD) of years 2016-2018. Adult patients admitted with a primary diagnosis of hypertension urgency were included. Patients were excluded if they had stroke or transient ischemic attack (TIA) in index admission. October to December admissions were excluded to allow for 90 day follow up. Univariate logistic regression was performed on each variable. Variables with a p value &gt;0.2 were included in multivariate logistic regression model (figure1). Results: A total of 104813 patients (58% female) included in our cohort of whom 1057 (1%) were readmitted with ischemic stroke or TIA within 90 days. Mean age of stroke readmissions was higher in female (68±16 vs 61±14 years, p&lt;0.001). Diabetes Mellitus was an independent predictor of stroke readmission in both sexes. Independent predictors specific to females were peripheral vascular disorders (aOR:1.60 95% CI[1.13-2.28], P=0.008) and Hypothyroidism (aOR: 1.38, 95% CI[1.02-1.85], P=0.035). Independent predictor specific to males was age (aOR: 1.016, 95% CI [1.005-1.027], P=0.005). Paradoxically, prior CABG was associated with decreased risk of stroke readmission in females (aOR: 0.39. 95% CI[0.20-078], P=0.007) but not in males (P=0.229). Conclusion: We identified several sex specific predictors of 90-day readmission with stroke in patients admitted with hypertensive crisis. Knowledge of these predictors would help identify patients at risk and improve quality of care.

Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study

AimTo examine the incidence and risk factors associated with hospital-acquired pressure ulcers (HAPUs) following total hip arthroplasty (THA) using a large-scale national database. Material and methodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed. ResultsThe general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors associated with HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n ≥ 3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Conclusion: It is beneficial to study the risk factors associated with HAPUs after THA to ensure the preventive management and optimize outcomes although a low incidence was identified.

Vibration Disease: Exposure Level and Duration-Dependent Characteristics and Features of the Clinical Picture Following Local and Combined Local and Whole Body Vibration

Introduction: Vibration disease is induced by a long-term occupational exposure to vibration above the maximum permissible level and is manifested by damage to the peripheral vascular and nervous systems and disorders of the musculoskeletal system. Objective: To study the exposure level and duration dependency and features of the clinical picture of vibration disease in workers exposed to local and combined local and whole body vibration. Materials and methods: The study included 136 male workers. Cohort I consisted of 60 patients (mean age: 49.5 ± 7.4 years) with vibration disease related to the local vibration exposure; cohort II included 76 patients (mean age: 55.7 ± 4.8 years) with vibration disease induced by the combined exposure to hand-arm and whole body vibration. Results: The examined subjects worked in harmful working conditions of classes 3.1–3.4. Measured vibration exceeded maximum permissible values at most workplaces. Levels of local vibration did not differ significantly between the cohorts and amounted to 115.0 and 118.0 dB; the level of whole body vibration in cohort II was 116.0 dB. Shorter work experience and younger age at the time of diagnosing the occupational disease were registered in people exposed to local vibration only compared to those with a combined exposure. The angiodystonic syndrome was twice as frequent in cohort I, while cohort II had a larger proportion of patients with concomitant diseases (low back pain, periarthrosis, etc.). Conclusion: Our findings indicate the necessity to reduce occupational exposures to vibration and take appropriate therapeutic and preventive measures in order to maintain health and work ability of employees.

Germanium-Titanium-π Polymer Composites as Functional Textiles for Clinical Strategy to Evaluate Blood Circulation Improvement and Sexual Satisfaction.

By continuously enhancing the blood flow, far-infrared (FIR) textile is anticipated to be a potential non-pharmacological therapy in patients with peripheral vascular disorders, for instance, patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and experiencing vasculogenic erectile dysfunction (VED). Hence, we manufactured a novel polymer composite, namely, germanium-titanium-π (Ge-Ti-π) textile and aimed to evaluate its characteristics and quality. We also investigated the immediate and long-term effects of the textile on patients with ESRD undergoing HD and experiencing VED. The Ge-Ti-π textile was found to have 0.93 FIR emissivity, 3.05 g/d strength, and 18.98% elongation. The results also showed a 51.6% bacteria reduction and negative fungal growth. On application in patients receiving HD, the Ge-Ti-π textile significantly reduced the limb numbness/pain (p < 0.001) and pain score on the visual analog scale (p < 0.001). Moreover, the Doppler ultrasound assessment data indicated a significant enhancement of blood flow in the right hand after 1 week of Ge-Ti-π textile treatment (p < 0.041). In VED patients, the Ge-Ti-π underpants treatment significantly improved the quality of sexual function and increased the average penile blood flow velocity after 3 months of the treatment. Our study suggests that the Ge-Ti-π textile could be beneficial for patients with blood circulation disorders.

Abstract 10058: Increased Prevalence and Worsened Outcomes of Peripheral Vascular Disorders Hospitalizations in Young Adults: A National Decade Apart Analysis, 2007 vs. 2017

Background: Prevalence and trends in peripheral vascular disease (PVD) admissions among young adults have been infrequently evaluated on a large scale. We aimed to study the demographics, comorbidities, and outcomes of PVD in young adults from data selected from two nationwide cohorts a decade apart (2007 vs 2017). Methods: We queried National Inpatient Sample (2007 &amp; 2017) to identify PVD admissions among young adults (18-44 years) and compare the burden, demographics, comorbidities between 2017 and 2007 cohorts. Primary outcomes were all cause mortality, MACE (all-cause mortality, AMI, cardiogenic shock, cardiac arrest, ventricular fibrillation/flutter, pulmonary embolism, coronary intervention) and stroke, and secondary outcomes were hospital resource utilization. Results: There was an increase in young PVD hospitalizations in 2017 (0.5%/n=46,760) vs. 2007 (0.4% /n=37,099). The 2017 cohort often included younger (37 vs 40 years), white (54.8% vs 57.7%), female (48.6% vs 47.5%), Medicaid enrollees admitted non-electively (85.2% vs 80.0%) (p&lt;0.05) vs. 2007 cohort. Comorbidities like smoking, drug abuse, fluid and electrolyte disorders, and pulmonary circulation disorders were the most frequent comorbidities in 2017 cohort vs. 2007 cohort. Despite lower rate of hypertension, renal failure, hyperlipidemia, complicated diabetes decreased in young PVD admissions from 2007 to 2017 (p&lt;0.001), there was alarming increase in all-cause mortality (1.5% vs 3.4%, aOR1.39, 95%CI:1.23-1.59) and stroke (4.2% vs. 10.4%, aOR2.43, 95%CI:2.25-2.63) on adjusted multivariable analysis (p&lt;0.001) with comparable MACE (8.9% vs 10.4%, aOR0.99, p=0.697) in 2017 vs. 2007. There was fewer routine discharges, prolonged hospital stay and charges in 2017 PVD cohort. Conclusion: The comparison of two national cohorts selected a decade apart showed an increased frequency of admissions of young PVD with higher substance abuse and higher all-cause mortality and stroke.

Does the availability of transcatheter aortic valve replacement impact inpatient outcomes after surgical aortic valve replacement? Analysis of the national inpatient sample

Abstract Background With the introduction of transcatheter aortic valve replacement (TAVR), the treatment of aortic stenosis (AS) has experienced a paradigm shift, altering patient selection for surgical aortic valve replacement (SAVR) over the past decade. What remains to be determined is the impact of a hospital's ability to offer TAVR, in the contemporary era, on inpatient outcomes following SAVR. Purpose The goal of this study was to assess inpatient mortality and the use of mechanical aortic valve replacement (mAVR) in patients undergoing SAVR at TAVR versus non-TAVR centers in the United States. Methods The National Inpatient Sample (2011–18), a probability sample of inpatient visits in the United States, was used to study trends in admissions for SAVR at TAVR and non-TAVR centers; in-hospital mortality was trended over time. Survey estimation commands were used to determine weighted national estimates. Results There were 559,365 inpatient visits for SAVR with 75.2% (95% CI 74.2%-76.2%) and 24.7% (95% CI 23.8%-25.8%) receiving bioprosthetic SAVR (bAVR) and mAVR, respectively at TAVR centers and 64.5% (95% CI 63.3%-65.6%) and 35.5% (95% CI 34.4%-36.7%) receiving bAVR and mAVR, respectively at non-TAVR centers. SAVR recipients at non-TAVR centers were older when compared to recipients at TAVR centers (68.3±0.09 vs 66.9±0.11 years p&amp;lt;0.001). Heart failure, cardiac arrhythmias, peripheral vascular disorders, complicated hypertension and diabetes, renal failure and liver disease were more common in patients undergoing SAVR at TAVR-centers. During the study period, both crude (OR = 0.78 95% CI 0.73–0.83) and adjusted (OR = 0.79 95% CI 0.73–0.86) inpatient mortality was lower amongst SAVR recipients at TAVR centers. The utilization rates of mAVR at both TAVR and non-TAVR centers decreased over time amongst all age groups (p trend &amp;lt;0.001). Conclusions Patients undergoing SAVR at TAVR centers were younger and had more co-morbidities compared to patients undergoing SAVR at non-TAVR centers. Although patients undergoing SAVR at TAVR centers had significantly more co-morbidities, inpatient mortality was lower at TAVR centers compared to non-TAVR centers. Further research is needed to determine whether the impact of a multidisciplinary cardiac approach resulted in significant differences in patient selection for SAVR, due to the availability of TAVR, influencing patient outcomes. Funding Acknowledgement Type of funding sources: None.

Prescribing of disease modifying agents in older adults with multiple sclerosis

BackgroundThe use of disease-modifying agents (DMAs) to treat Multiple Sclerosis (MS) in older adults is debated as the disease activity decreases with aging. However, limited data exist regarding prescribing patterns of DMAs among older adults with MS. ObjectiveTo examine prescribing patterns of DMAs and the factors associated with DMA prescribing practices among older adults with MS using electronic medical records (EMR) data. MethodsA retrospective longitudinal cohort study was conducted using the TriNetX, a federated EMR network from the US, data from 2016 to 2019. The study included older adults (≥60 years) with MS diagnosis and at least one prescription record during the study period. Patients with DMA prescriptions were identified and further classified into injectable, oral, or infusion users based on their last DMA prescription. A multivariable logistic regression model was used to evaluate the factors associated with prescribing of DMAs. A multinomial logistic regression model was also used to determine the factors associated with prescribing a particular dosage form of DMA. ResultsThe study cohort consisted of 12,922 older adults with MS, with 2,455 (18.99%) receiving DMA prescriptions. The commonly prescribed DMAs were injectables (10.46%), followed by orals (6.06%) and infusions (2.40%). Multivariable logistic regression revealed that older adults between 60– to 64 years (Adjusted Odds Ratio [aOR]= 2.38) and 65–69 years (aOR=1.60) had higher odds of receiving DMA compared to older adults of 70 years and above. African Americans (aOR=1.71) had higher odds of receiving DMA prescriptions compared to Caucasians. The presence of symptoms (pain, fatigue, speech, walking difficulty) and use of symptomatic medication (anti-fatigue medication, bladder dysfunction medication, antispasmodics, antidepressants, and relapse medication) increased the odds of being prescribed DMAs. Multinomial logistic regression found that patients 60–64 years of age had higher odds of being prescribed infusion (aOR, 95% Confidence Interval [CI] =2.06, 1.35–3.15) and oral (65–69 years: aOR=1.60, 1.24–2.07) over injectable DMAs compared to the older adults aged 70 years and above.Older males (aOR=1.68, 95% CI: 1.23–2.30) were associated with increased odds of being prescribed infusion DMA over injectable DMA compared to females. The presence of comorbidities such as coagulopathy and peripheral vascular disorders decreased the odds of being prescribed oral DMA over injectable DMA. Patients with cerebellar symptoms had an increased likelihood of being prescribed with an infusion DMA over injectable DMA. Patients using drugs for treating relapses had higher odds of being prescribed an infusion DMA over an injectable DMA. In terms of healthcare utilization, older adults with outpatient visits had higher odds of being prescribed an infusion DMA over an injectable DMA, while older adults with inpatient visits had lower odds of being prescribed an infusion DMA over an injectable DMA. ConclusionNearly one in five older adults with MS are prescribed DMAs, with a majority receiving injectable DMAs. Several demographic and clinical factors were associated with DMA prescribing . This study fills the data gap regarding the utilization of DMAs in older adults with MS.

Proximal heat stress up-regulates angiopoietin-1 in fingers and reduces the severity of Raynaud's phenomenon in systemic sclerosis: a single-centre pilot study.

Raynaud's phenomenon (RP) is a peripheral vascular disorder that frequently occurs in systemic sclerosis (SSc). Although therapeutic heating seems reasonable given that RP is elicited by cold stimuli, the effects of heating are still unclear. We examined the effects of heating applied on various body parts in SSc patients with RP of fingers. Fourteen SSc patients heated their neck, elbows, and wrists with disposable heating pads for 1 week each. The visual analogue scale (VAS) for RP during each heating period was compared with that of each 1-week pre-treatment interval. On the day after the expiration of each heating period, their finger temperature, the finger blood flow, and angiogenesis-related factors (vascular endothelial growth factor, endostatin, angiopoietin-1, and angiopoietin-2) obtained from the cubital vein and fingertip were measured. The mean VAS was significantly reduced during the heating of the neck and elbows. Fingertip blood samples showed significantly increased angiopoietin-1 after each of the heating periods and increased endostatin after wrist heating. After the termination of heating, changes in finger temperature or blood flow could not be detected. Heating the neck or elbows can alleviate RP in SSc. The heat up-regulates angiopoietin-1 in the fingers.

Ocular surface temperature measurement in diabetic retinopathy

Infrared thermography provides functional imaging by picturing the temperature pattern of the region imaged. The temperature correlates to the blood flow pattern and is used in the diagnosis of diseases like breast cancer, peripheral vascular disorders, diabetic neuropathy and fever screening. In the present study, the usage of ocular thermography for diagnosis of diabetic retinopathy is explored. Ocular thermograms using infrared imaging camera were obtained for normal subjects (80 volunteers – 40 males and 40 females) age groups 21–30, 31–40, 41–50 and 51–60 years, non-proliferative diabetic retinopathy (NPDR) patients (50 volunteers −25 males and 25 females) and proliferative diabetic retinopathy (PDR) patients (20 volunteers −10 males and 10 females) belonging to age group of 51–60 years. The temperature at various points of interest (POIs) and horizontal temperature profiles were studied. Ocular surface temperature (OST) and effect of eye dilation on OST was studied for control, age matched NPDR and PDR. Statistical analyses were carried out to find the significance of correlation between OST of controls and NPDR and PDR. The global minimum temperature on the ocular surface for controls (21–60 years) was found to be at cornea which is about 34.79 ± 0.68 °C, and maximum at the inner canthus viz. 36.08 ± 0.62 °C. Dilation studies showed an average increase of 0.82 ± 0.13 °C in cornea and 0.75 ± 0.14 °C in conjunctiva and limbus (p < 0.001). The temperature of cornea is around 33.22 ± 0.12 °C and 32.64 ± 0.12 °C for NPDR and PDR patients respectively, in the age group of 51–60 years. OST of NPDR patients was 0.60 ± 0.15 °C lesser than that of age matched normal eyes (p < 0.001) at cornea and limbus regions and 0.71 ± 0.20 °C at inner canthus. The OST of PDR patients was lesser than age matched controls by 1.18 ± 0.12 °C at cornea, 0.9 ± 0.13 °C at inner canthus and 1.0 ± 0.14 °C at other POIs. During dilation studies a positive variation of 0.61 ± 0.12 °C in cornea and 0.48 ± 0.13 °C in conjunctiva and limbus was observed (p < 0.001) in NPDR eyes. Similarly an average increase of 0.62 ± 0.11 °C in cornea and an average increase of 0.47 ± 0.15 °C in conjunctiva and limbus were observed (p < 0.001) in PDR eyes. The OST of NPDR and PDR patients was less compared with age matched counterparts in both pre and post dilation studies. Dilation of eye showed increase in OST for both controls and diabetic retinopathy patients. The degree of increase is less compared with controls. The variation in OST observed during pre and post dilatation studies of diabetic retinopathy patients is a functional marker of pathology, and can be used as a parameter for diagnosis.

Recent Advances of Cell Membrane Coated Nanoparticles in Treating Cardiovascular Disorders.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, causing approximately 17.9 million deaths annually, an estimated 31% of all deaths, according to the WHO. CVDs are essentially rooted in atherosclerosis and are clinically classified into coronary heart disease, stroke and peripheral vascular disorders. Current clinical interventions include early diagnosis, the insertion of stents, and long-term preventive therapy. However, clinical diagnostic and therapeutic tools are subject to a number of limitations including, but not limited to, potential toxicity induced by contrast agents and unexpected bleeding caused by anti-platelet drugs. Nanomedicine has achieved great advancements in biomedical area. Among them, cell membrane coated nanoparticles, denoted as CMCNPs, have acquired enormous expectations due to their biomimetic properties. Such membrane coating technology not only helps avoid immune clearance, but also endows nanoparticles with diverse cellular and functional mimicry. In this review, we will describe the superiorities of CMCNPs in treating cardiovascular diseases and their potentials in optimizing current clinical managements.

Factors associated with wound healing outcome among Diabetic Foot patients- A cross sectional Study

Diabetic foot ulcer (DFU) has been identified as the leading reason for hospitalization among patients with diabetes. Patients with diabetes are at greater risk of complications, the most important of them are diabetic neuropathy and peripheral vascular disorders leading to the development of foot ulcers. The problem is generally faced and as well is considered as one among the most common complications of diabetes that affect millions of people all over the world. The current study, aimed to document the clinical profile and healing outcome of diabetic foot ulcer management which may become guidance for further improvement in wound management among diabetic foot ulcer patients. Cross sectional descriptive study was conducted over one-year period of time. A total of 246 Diabetic patients with a foot ulcer of Grade 1 to 3 participated in the study. Patients with higher grade ulcers of Grade 4 and 5 were excluded from the study. Final data analysis of 160 patients was done using SPSS version 20. The prevalence of Grade 2 and 3 ulcers were observed 54.37% and 31.8 % while Grade 1 ulcer was observed 13.75%. No risk factors were found to be significantly associated with diabetic foot ulcer. Wound was healed well in 50 % and partially healed in 21 % of the participants. Wound remains unchanged in 3 % of study participants, while 8% of participants underwent toe amputation. Foot ulceration is a preventable in many diabetic patients with adequate education, routine foot care and attention to foot wear.