Velocity In Patients Research Articles

Short-term effects of sevelamer-carbonate on fibroblast growth factor 23 and pulse wave velocity in patients with normophosphataemic chronic kidney disease Stage 3.

BackgroundHigh concentrations of both phosphate and fibroblast growth factor 23 (FGF23) observed in chronic kidney disease (CKD) are associated with an increased risk of cardiovascular morbidity and mortality. Pulse wave velocity (PWV) is a surrogate marker for cardiovascular events and all-cause mortality. It is not known whether a reduction of FGF23 or phosphate alters cardiovascular risk. Sevelamer has shown to have the ability to reduce both phosphate and FGF23 concentrations. Furthermore, reduction of PWV is reported with sevelamer use as well, but it is unclear if this is mediated by decline of phosphate or FGF23. We investigated if sevelamer induced a decline in PWV and if this was associated with a reduction in FGF23.Methods In all, 24 normophosphataemic CKD Stage 3 patients started treatment with a fixed dose of sevelamer-carbonate (Renvela®) 2.4 g twice daily, with their usual diet for 8 weeks in a single-arm study. PWV was measured and blood samples were obtained before, during and after washout of treatment with sevelamer. Vascular calcification was quantified using the Kauppila Index (KI). The primary outcome was the change of PWV from baseline to 8 weeks of treatment and the secondary endpoint was the difference of FGF23 following treatment with sevelamer. One of the linear mixed models was used to analyse the association between treatment and outcome. Mediation analysis was performed as a sensitivity analysis. The study was registered in the Dutch trial register (http://www.trialregister.nl: NTR2383).Results A total of 18 patients completed 8 weeks of treatment with sevelamer and were analysed. Overall, treatment with sevelamer did not induce a significant reduction of PWV (β = −0.36, P = 0.12). However, in patients with less vascular calcification (lower KI score), there was a statistically significant reduction of PWV, adjusted for mean arterial pressure, after treatment (β = 0.63, P = 0.02). Addition of FGF23 to the model did not alter this association. Mediation analysis yielded similar results. FGF23 did not decrease during treatment with sevelamer.Conclusion In this short-term pilot study in normophosphataemic CKD patients, treatment with sevelamer did not improve PWV. In subgroup analysis, however, PWV improved in patients with no or limited abdominal aorta calcifications. This was not associated with a decline of FGF23.

Regional Disparities of Left Atrial Appendage Wall Contraction in Patients With Sinus Rhythm and Atrial Fibrillation

Patients with atrial fibrillation (AF) exhibit impaired left atrial appendage (LAA) function. However, regional characteristics of LAA function in patients with AF are not defined. Consecutive patients (n=1,195) undergoing transesophageal echocardiography at a university hospital were included. Patients were divided into three groups on the basis of their rhythm: sinus rhythm (SR), paroxysmal AF, and permanent or persistent AF. Regional LAA wall velocities were determined using color Doppler tissue imaging, placing regions of interest at the lateral and medial wall of the LAA. Of the 1,182 patients ultimately included, 691 (59%) were in SR, 371 (32%) had permanent or persistent AF, and 120 (10%) had paroxysmal AF with SR at the time of transesophageal echocardiography. Both lateral and medial LAA wall velocities were lower in patients with AF in comparison with those in SR. Nearly 90% of patients in both groups of patients with AF exhibited a pattern of medial LAA wall velocity greater than lateral LAA wall velocity, in comparison with 20% of patients with SR. The odds ratio for the association of this LAA contraction pattern with AF was 22.14 (95% CI, 12.06-40.64; P<.001). The movement of lateral LAA wall velocity showed the highest correlation with LAA emptying velocity compared with the medial LAA wall (r=0.67, P<.001). Lateral LAA wall velocity is higher than medial LAA wall velocity in patients in SR, which reverses in patients with AF. Assessment of LAA regional wall velocity using Doppler tissue imaging appears to be a promising approach to identify patients with paroxysmal AF.

The impact of intravitreal dexamethasone implant (Ozurdex®) on retrobulbar hemodynamics in patients with diabetic macular edema and retinal vein occlusions

Objective: To evaluate the effect of single intravitreal dexamethasone implant (Ozurdex®) on ocular blood flow velocities in patients with diabetic macular oedema (DME) and retinal vein occlusions (RVO).Methods: This prospective non-randomized interventional study included injected and fellow eyes of 12 patients with DME and of 16 patients with RVO treated with intravitreal Ozurdex®. Colour Doppler Ultrasonography (CDU) measures of the central retinal artery (CRA), posterior ciliary artery (PCA), ophthalmic artery (OA) those are peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were performed in both injected and uninjected eyes before injection, at one week, one month after injection, and prior to re-injection.Results: Inter-eye comparison of all the measured CDU data (baseline, first week, first month, reinjection) showed no statistically significant difference in both DME and RVO group. PSV and EDV values of the CRA, OA, and PCA showed a decreasing trend in the first week and first-month visits and then increased at reinjection time. RI and PI measures of the CRA, OA, and PCA measures showed minimal alterations in the follow-up. But all these differences were not statistically significant. Significant visual gain and anatomic recovery were obtained by the intravitreal dex-implant both in the DME and RVO group.Conclusions: Single intravitreal dex-implant did not alter ocular blood flow in the treatment of macular oedema due to RVO and diabetes.

Muscle power, contraction velocity and functional performance after stroke

ObjectiveThe goal of this study was to describe muscle function deficit in patients after stroke as well as to define the relationship between maximal muscle power (Pmax) and optimal shortening velocity (υopt) with functional efficiency in stroke survivors.Material and MethodsA total of 134 participants were enrolled in the study, including 67 patients after a stroke and 67 volunteers, matched for age and sex (controls). Functional performance was measured with the timed Up and Go test (TUG) and additionally with Rivermead Motor Assessment (RMA) and Barthel Index (BI) in stroke survivors. To assess Pmax and υopt of the knee extensor muscles, a specially equipped Monark cycle ergometer was used.ResultsThe power generated by stroke survivors was 49.6% that of their peers and muscle contraction velocity was 65.5%. Pmax/kg and υopt were associated with TUG outcomes in both groups. Pmax/kg and υopt were associated with age in the control group, but not in patients after stroke. In multivariate analysis in patients after stroke, TUG was better predicted by Pmax/kg or υopt than by the age. In stroke survivors, both Pmax/kg and υopt were related to the BI and to the RMA total results. Both BI and RMA total were not determined by age.ConclusionsMuscle power and muscle contraction velocity in patients who have had a stroke within three months have reduced markedly. These factors significantly affect functional performance. Muscle power and optimal shortening velocity are more important determinants of functional status than age in these stroke survivors.

Horizontal Saccadic Velocity in Patients with Exotropia before and after Unilateral Resection and Recession Surgery.

Purpose The effects of strabismus surgery on eye movement are not known in detail, as few studies have compared saccade velocities before and after strabismus surgery. In this study, horizontal saccades were recorded using an eye-tracker in patients with only exotropia to compare the peak velocities (PVs), before and after undergoing strabismus surgery of the same type (unilateral resection and recession). Methods Horizontal saccades of monocular vision were recorded using an eye-tracking device in 18 patients with exotropia and 20 normal subjects. All patients were examined using the same method after strabismus surgery. Results The PVs of adduction and abduction in the patients were higher than those in the normal subjects (in dominant eye, P=0.032 for adduction and P=0.049 for abduction; in nondominant eye, P=0.016 for adduction and P=0.037 for abduction). Following the surgery, the PVs of abduction of the surgical eye (nondominant eye) decreased to the level of the normal subjects (P=0.016). However, there were no correlations between changes in the PVs and the extent of surgery (resection and recession). Conclusion Strabismus surgery normalized the patient's increased PV in the operated eye for abduction of horizontal saccade. Not only peripheral (extraocular muscle) but also central sensory-motor mechanisms may be involved in the changes in PV of horizontal saccades, both of which could result from the improvement of the primary eye position.

Immediate And Long Term Effects Of Percutaneous Mitral Balloon Valvuloplasty On Atrial Conduction Velocities In Patients With Mitral Stenosis.

P-wave dispersion (PWD) is an electrocardiographic (ECG) marker of nonuniform and heterogeneous atrial conduction with ECG leads of different orientation. The aim of our study was to investigate the immediate and long term effects of successful percutaneous mitral balloon valvuloplasty (PMBV) on PWD in severe rheumatic MS patients and to analyse the restenosis, atrial fibrillation (AF) and redo balloon valvuloplasty rate. We enrolled 41 consecutive MS patients with sinus rhythm who underwent PMBV. A 12-lead ECG and transthoracic echocardiography were performed for each patient one day before, within 72 hours after the procedure and followed up by clinical visit at a mean of 5,57±1,46 (3-8) year.The mean patient age was 44.1±10.86 years. Pmax 1(pre PMBV) and PWD 1(pre PMBV) decreased 1-3 days after PMBV. MVA improved immediately after the procedure; but lately the mean MVA decreased significantly indicating the initiation of restenosis. Composite endpoints were associated with LA 1 (p = 0.02), MVA 2 (1-3 days after PMBV) (p= 0.019), mean gradient 2 (p= 0.028), PWD 3 (3 years after PMBV) (p < 0.001) and Pmax 3 (3 years after PMBV) (<0,001). AF incidence was associated with PWD 2 (p=0,019) and PWD 3 (p=0,010). There was 14 composite endpoint on follow up and at multivariate analysis PWD 3 was identified as an independent predictor of the composite endpoint (p=0.048, hazard ratio=1.36, 95% confidence interval (CI): 1,002-1.867). This study has demonstrated that Pmax and PWD significantly decreased within 3 days after PMBV. Furthermore, long term PWD was associated with AF and identified as an independent predictor of the composite endpoint.

Changing Ischemic Lesion Patterns and Hemodynamics of the Posterior Cerebral Artery in Moyamoya Disease

The aim of this study was to determine how hemodynamics of the posterior cerebral artery (PCA) are associated with cerebral ischemic lesions in moyamoya disease (MMD). Thirty-six patients with ischemic MMD (Suzuki grade IV-V) were retrospectively analyzed. Hemodynamic parameters of the PCA were measured by transcranial color-coded sonography. We classified the range of ischemic lesions into 3 grades and perfusion levels into 3 grades according to computed tomography (CT) results. PCA steno-occlusion and leptomeningeal collaterals were confirmed by digital subtraction angiography. Ultrasonographic parameters in the PCA were compared with these radiographic findings. The velocity in the involved PCA (mean flow velocity [MFV] median, 42.00 [range, 34.50-58.00] cm/s) was significantly lower than that in the normal PCA (MFV median, 95.00 [range, 76.50-119.50] cm/s) (P < .001). The velocity in the PCA increased significantly as the leptomeningeal collateral stage advanced (MFV stage 1: median, 38.50 [range, 29.75-63.50] cm/s; stage 2: median, 55.00 [range, 44.00-96.00] cm/s; stage 3: median, 94.00 [range, 54.00-118.25] cm/s; stage 4: median, 85.50 [range, 70.50-117.75] cm/s, respectively) (P < .05). Decreased PCA velocities were associated with a larger ischemic area on CT (P ≤ .001). PCA velocity had no correlation with CT perfusion level of the temporal and frontal lobes. PCA velocity had significant correlations with perfusion level in the occipital (P < .001) and parietal lobes (P < .05). Our results suggest ischemic lesion patterns (as demonstrated on CT imaging) are associated with PCA velocity measurements in the advanced stage of MMD. Thus, monitoring PCA velocity in patients with advanced MMD may provide additional information to assist in managing these patients.

Association of Matched Sibling Donor Hematopoietic Stem Cell Transplantation With Transcranial Doppler Velocities in Children With Sickle Cell Anemia

In children with sickle cell anemia (SCA), high transcranial Doppler (TCD) velocities are associated with stroke risk, which is reduced by chronic transfusion. Whether matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) can reduce velocities in patients with SCA is unknown. To determine the association of MSD-HSCT with TCD velocities as a surrogate for the occurrence of ischemic stroke in children with SCA. Nonrandomized controlled intervention study conducted at 9 French centers. Patients with SCA were enrolled between December 2010 and June 2013, with 3-year follow-up ending in January 2017. Children with SCA were eligible if younger than 15 years, required chronic transfusions for persistently elevated TCD velocities, and had at least 1 sibling without SCA from the same 2 parents. Families agreed to HLA antigen typing and transplantation if a matched sibling donor was identified or to standard care in the absence of a matched sibling donor. MSD-HSCT (n = 32), compared with standard care (n = 35) (transfusions for ≥1 year with potential switch to hydroxyurea thereafter), using propensity score matching. The primary outcome was the highest time-averaged mean of maximum velocities in 8 cerebral arteries, measured by TCD (TCD velocity) at 1 year. Twenty-five of 29 secondary outcomes were analyzed, including the highest TCD velocity at 3 years and normalization of velocities (<170 cm/s) and ferritin levels at 1 and 3 years. Sixty-seven children with SCA (median age, 7.6 years; 35 girls [52%]) were enrolled (7 with stroke history). In the matched sample, highest TCD velocities at 1 year were significantly lower on average in the transplantation group (129.6 cm/s) vs the standard care group (170.4 cm/s; difference, -40.8 cm/s [95% CI, -62.9 to -18.6]; P < .001). Of the 25 analyzed secondary end points, 4 showed significant differences, including the highest TCD velocity at 3 years (112.4 cm/s in the transplantation group vs 156.7 cm/s in the standard care group; difference, -44.3 [95% CI, -71.9 to -21.1]; P = .001); normalization rate at 1 year (80.0% in the transplantation group vs 48.0% in the standard care group; difference, 32.0% [95% CI, 0.2% to 58.6%]; P = .045); and ferritin levels at 1 year (905 ng/mL in the transplantation group vs 2529 ng/mL in the standard care group; difference, -1624 [95% CI, -2370 to -879]; P < .001) and 3 years (382 ng/mL in the transplantation group vs 2170 ng/mL in the standard care group; difference, -1788 [95% CI, -2570 to -1006]; P < .001). Among children with SCA requiring chronic transfusion because of persistently elevated TCD velocities, MSD-HSCT was significantly associated with lower TCD velocities at 1 year compared with standard care. Further research is warranted to assess the effects of MSD-HSCT on clinical outcomes and over longer follow-up. ClinicalTrials.gov Identifier: NCT01340404.

Effects of robot-assisted gait training in patients with Parkinson\u2019s disease: study protocol for a randomized controlled trial

BackgroundRobot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson’s disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects.MethodsThis is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant’s height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44.DiscussionThis study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks.Trial registrationClinicalTrials.gov, NCT03490578. Registered on 21 March 2018.

Characterization of retinal microvasculature in acute non-arteritic anterior ischemic optic neuropathy using the retinal functional imager: a prospective case series

BackgroundNon-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic neuropathy in patients over 50 years of age, and many affected individuals are left with permanent visual deficits. Despite the frequency of NAION and its often devastating effects on vision, no effective treatment has been established. Further understanding of the acute vascular effects in NAION, using advanced ophthalmic imaging techniques like the retinal function imager, may shed light on potential treatment targets.MethodsFive patients with acute NAION underwent retinal functional imaging within 2 weeks of the onset of their visual symptoms, and at 1 month and 3 months after onset. Average arteriolar and venular blood flow velocities were calculated for each eye at each time point. The Wilcoxon rank sum test was used to compare blood flow velocity results with a normative database.ResultsThe average arteriolar blood flow velocity in the normative group was 3.8 mm/s, and the average venular blood flow velocity was 3.0 mm/s, versus 4.1 mm/s and 2.7 mm/s, respectively, in the NAION-affected group at presentation. Average arteriolar blood flow increased slightly to 4.2 mm/s one month after the acute NAION event, then decreased to 3.8 mm/s three months after the event. Average venular blood flow velocity was 2.8 mm/s 1 month after the NAION event and 2.7 mm/s 3 months after the event. Differences in blood flow velocity between the NAION-affected and control groups were not statistically significant at any time point; however, there was a trend toward increasing blood flow velocity initially after an NAION, with a decrease over time.ConclusionsThis study demonstrates the feasibility of retinal function imaging to quantify macular blood flow velocity in patients with acute NAION. There were no statistically significant differences in blood flow velocity detected between NAION-affected eyes and healthy controls at any of the time points examined; however, there was a trend toward an increase in both arteriolar and venular BFV subacutely, then a decrease in the chronic phase after NAION, which could be suggestive of a mechanism of attempted compensation in the setting of acute ischemia.

Osteocalcin and carotid-femoral pulse wave velocity in patients on peritoneal dialysis.

Objective:Vascular calcification is a cardiovascular risk factor in dialysis patients. Vascular calcification involves a complex process of biomineralization resembling osteogenesis, which leads to arterial stiffness. Osteocalcin is the most abundant noncollagenous protein in the bone matrix. It is synthesized in the bone by osteoblasts and reflects the rate of bone formation. The aim of this study was to evaluate the relationship between serum osteocalcin levels and the carotid–femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients.Materials and Methods:Serum intact osteocalcin and cfPWV were measured in 62 PD patients. Those with CfPWV values >10 m/s were defined as the high central arterial stiffness group, while those with values ≤10 m/s were regarded as the low central arterial stiffness group, according to the European Society of Hypertension and of the European Society of Cardiology guidelines.Results:Seventeen of the 62 PD patients (27.4%) were in the high central arterial stiffness group. The high central arterial stiffness group were older (P = 0.002), had a longer PD vintage (P = 0.018), and had higher serum osteocalcin levels (P = 0.001) than those in the low group. Multivariate logistic regression analysis showed that the osteocalcin level (odds ratio: 1.069, 95% confidence interval (CI): 1.005–1.137, P = 0.035), PD vintage (odds ratio: 1.028, 95% CI: 1.010–1.048, P = 0.003), and age (odds ratio: 1.081, 95% CI: 1.005–1.162, P = 0.035) were independently associated with central arterial stiffness in PD patients. Among these patients, cfPWV (β: 0.216, P = 0.001) values and log-transformed intact parathyroid hormone (β: −’0.447, P < 0.001) levels were independently associated with the osteocalcin level in PD patients after multivariate forward stepwise linear regression analysis.Conclusion:Older PD patients with a longer PD vintage and higher serum osteocalcin levels had higher central arterial stiffness as measured by cfPWV. The serum osteocalcin level is an independent marker of central arterial stiffness in PD patients.

Aortic pulse wave velocity in patients with COPD: 5-year data from the ARCADE study

BackgroundCardiovascular (CV) disease is a major cause of morbidity and mortality in COPD 1 . Aortic pulse wave velocity (AoPWV), an independent predictor of CV risk, is elevated in COPD 2 , however, there have been no longitudinal studies of AoPWV in COPD. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) aims to study CV risk factors longitudinally, in COPD. We hypothesised that patients with COPD would have increased AoPWV over 5 years compared to controls.MethodsThus far, 26 patients with COPD and 26 controls subjects have completed the assessments at baseline and after 5 years. Assessments included: AoPWV (SphygmoCor device), blood pressure (BP), heart rate, BMI and lung function (spirometry).ResultsAt baseline, patients and controls were similar in age, gender, BP, heart rate and BMI but patients had a trend of greater PWV (p < 0.055). After 5 years both COPD and comparators had increased AoPWV (p < 0.05). There was no change BP in COPD, but BP increased in controls (p < 0.05), while lung function declined in patients with COPD (p < 0.05) but not controls. The rate of change of AoPWV was similar in patients and controls after adjustment for changes in BP (Figure 1) (p > 0.05).ConclusionsAlthough the increase in AoPWV over 5 years was similar in COPD and controls, AoPWV was greater in patients with COPD than controls at baseline and after 5 years which may suggest earlier stiffening in COPD. Further longitudinal assessments will inform the understanding of the development of arterial stiffness and may indicate possible therapeutic targets.

Clinical value of transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause

Objective To investigate the clinical value of transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause. Methods From April 2015 to April 2017, the imaging data of transvaginal three-dimensional ultrasonography of 184 patients with benign and malignant breast tumors in the Second People's Hospital of Yuhang District were retrospectively analyzed.The peak systolic flow velocity, resistance index, peak systolic velocity, intimal arterial resistance index and blood flow display rate of uterine artery of benign and malignant endometrial diseases were compared. Results The accuracy, sensitivity and specificity of transvaginal three-dimensional ultrasonography in the diagnosis of endometrial diseases were 91.30%(168/184), 92.00%(46/50), 91.04%(122/134), respectively.There were no statistically significant differences in the peak systolic flow velocity, resistance index, peak systolic velocity of patients with benign and malignant endometrial diseases by transvaginal three-dimensional ultrasonography(t=1.17, 0.88, 0.51, all P>0.05). The intimal arterial resistance index of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly lower than patients with benign endometrial diseases(t=2.59, P<0.05). The blood flow display rates of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography were 19.40%(26/134), 92.00%(46/50). The blood flow display rate of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly higher than patients with benign endometrial diseases(χ2=7.26, P<0.05). Conclusion Transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause has higher accuracy, sensitivity and specificity. Key words: transvaginal three-dimensional ultrasonography; after menopause; endometrial diseases; differential diagnosis

Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity

ObjectivesIn this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve. BackgroundA significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied. MethodsTwenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR. ResultsFlow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001). ConclusionsSystolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.

Horizontal saccadic velocity in patients with exotropia before and after strabismus surgery

Horizontal saccadic velocity in patients with exotropia before and after strabismus surgery

Changes of video head impulse test results in lateral semicircular canal plane by different peak head velocities in patients with vestibular neuritis

Background: The peak head velocity influences on the video head impulse test (vHIT) results, but it has been not known how much the difference is.Aims: To evaluate the clinical evidence for the superiority of high-velocity compared to low-velocity vHIT.Material and methods: vHIT was performed in 30 patients with vestibular neuritis using two peak head velocities (mean 80 vs. 240°/s). vHIT gains and parameters of corrective saccades (CSs) were compared. A vHIT gain of ≤0.8 or a peak CS velocity of ≥100°/s was considered pathologic.Results: The vHIT gains were significantly lower (mean 0.5 vs. 0.6), and GA was larger (35 vs. 25%) at high-velocity vHIT, compared to low-velocity vHIT. CSs were significantly more frequent (100 vs. 80%) and peak CS velocities were larger (252 vs. 112°/s) at high-velocity vHIT. The abnormal rates based on vHIT gains were higher (90% vs. 73%) and CSs occurred more frequently (100% vs. 80%) at high-velocity vHIT. The abnormal rates based on the peak CS velocity were significantly higher at high-velocity vHIT (100% vs. 57%).Conclusion: High-velocity vHIT is superior to low-velocity vHIT with a difference of 17–20% based on pathologic vHIT gains and presence of CSs.

CHARACTERISTICS OF CLINICAL CURRENT AND STRUCTURAL-FUNCTIONAL STATE OF LEFT VENTRICULAR IN DECOMPENSATION OF CHRONIC HEART FAILURE IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE WITH SYSTOLIC DYSFUNCTION AND INFLAMMATION OF THE MYOCARDIUM

The aimwas to study the clinical course of CHF decompensation and the structural and functional state of the left ventricle in patients with ischemic CHF with systolic dysfunction and myocardial inflammation.Material and Methods.This study is open, non-randomized, prospective, registered on the ClinicalTrials.gov website, identification number: NCT02649517. The analysis included 25 patients (84% men, LVEF 29.17±9.4%) with ADHF of ischemic etiology. The average age of the patients was 60.12±9.3 years. All the patients underwent an echocardiography including 2D-speckle tracking technique to assess LV deformation. All patients underwent invasive coronary angiography to exclude the progression of coronary atherosclerosis, as a cause of CHC decompensation. An endomyocardial biopsy was performed to diagnose the presence of myocardial inflammation. We performed a comparative analysis of clinical, laboratory, instrumental indicators depending on the fact of diagnosis of inflammation in the myocardium.Results.There were no specific features of the clinical course of decompensation of ischemic CHF with systolic LV dysfunction depending on the inflammation in the myocardial tissue. However, in patients with inflammation, aortocoronary bypass surgery was more often performed (p=0.00650). In addition, in patients with inflammation, there was a decrease in apical rotation (p=0.0313), its systolic velocity (p=0.0157 with decompensation of CHF. A year later, improvement in LV biomechanics, but a continuing decrease in the absolute modulus of global longitudinal LV deformation (p=0.0431) after the anti-inflammatory treatment. Also a year later, in both groups there was an increase in the LV end-diastolic volume index (p=0.0180 and p=0.0280, respectively), a decrease in the interventricular septum of the LV (p=0.0491) in the group with inflammation, and an increase in the myocardial mass index of the LV (p=0.04995) in patients with inflammation.Conclusion.Decreased apical LV rotation and its systolic velocity in patients with ischemic CHF and LV systolic dysfunction, in view of the lack of clinical improvement after optimal myocardial revascularization, may be an additional criterion of concomitant inflammation in the myocardium. Among patients with ischemic CHF and LV systolic dysfunction, more pronounced cardiac remodeling, manifested by LV dilatation and thinning of LV wall, was observed in the group with inflammation.

Do Pain, Functional Disability, and Gait in End-stage Ankle Arthritis Worsen with Associated Varus Coronal Plane Deformity?

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature on quantitative gait changes in patients with increased coronal plane deformity along with end stage ankle arthritis. We aimed to study the difference in spatial temporal parameters of gait and patient reported functional measure in patients with end stage arthritis and no coronal plane deformity vs. varus deformity of &gt;10? Methods: All patients diagnosed with end stage arthritis between April 2016 and December 2017 underwent an objective gait assessment using Tekscan system (BioSense Medicals, UK) as part of routine clinical practice. Of this cohort, patients with bilateral ankle arthritis, previous reconstructive surgery, inflammatory arthritis, hip and knee arthritis, spinal pathology and underlying neurological conditions were excluded. Patients with unilateral ankle arthritis for a diagnosis of osteoarthritis or post traumatic arthritis were included in this study. These patients were grouped into Group A (no coronal plane deformity) vs. Group B (varus deformity of more than 10?). In these patients differences were studied between the groups for temporal spatial parameters of gait and functional disability levels measured by MOX-FQ scores. Statistical tests included normality tests, student t’tests, chi square evaluation and analysis of variance tests with SPSS. Results: Of 33 patients, 22 were in Group A (N=22) and 10 in Group B (N=10). There was no difference in mean age between groups (61.5 vs. 65.07; p=0.335; diagnosis was predominantly OA in both groups MOX-FQ: - There were similar levels of pain (p=0.570), difficulty with walking / standing (p=0.492) and restriction in social activities (p=0.869) reported Quantitative gait measures: - For spatial parameters, there was no difference between groups; p&gt;0.05. - For temporal parameters, there was decreased step time(s) (0.67 vs. 0.61) and mid stance times (0.38 s vs. 0.30 s) in Group B; borderline statistical significance (p=0.052). - There was increase in stride velocity measured in Group B (79.1 ± 22.7 m/s) compared to Group A (64.0 ± 18.1 m/s), (p=0.05). Conclusion: - Although there were no differences in functional levels of pain, difficulty with walking / standing and restriction in social activities, measured by MOX-FQ, there were differences observed in objective gait parameters. - Patients in both groups demonstrated antalgic gait patterns; this was slightly increased in varus group. - There is a trend for reduction in temporal parameters and stride velocity in patients with end stage ankle arthritis and coronal plane deformity &gt;10?, when compared to patients with end stage arthritis and no coronal plane deformity - Larger clinical study with increased sample size is required to confirm these findings.

Fasudil combined with methylcobalamin or lipoic acid can improve the nerve conduction velocity in patients with diabetic peripheral neuropathy: A meta-analysis.

Background:Fasudil (F) plus methylcobalamin (M) or lipoic acid (L) treatment has been suggested as a therapeutic approach for diabetic peripheral neuropathy (DPN) in numerous studies. However, the effect of the combined use still remains dubious.Objective:The aim of this report was to evaluate the efficacy of F plus M or L (F + M or F + L) for the treatment of DPN compared with that of M or L monotherapy, respectively, in order to provide the basis and reference for clinical rational drug use.Methods:Randomized controlled trials (RCTs) of F for DPN published up to September 2017 were searched. Relative risk (RR), mean difference (MD), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I2 test. Sensitivity analyses were also performed. The outcomes measured were as follows: the clinical efficacy, median motor nerve conduction velocities (NCVs) (MNCVs), median sensory NCV (SNCV), peroneal MNCV, peroneal SNCV, and adverse effects.Results:Thirteen RCTs with 1148 participants were included. Clinical efficacy of F + M combination therapy was significantly better than M monotherapy (8 trials; RR 1.26, 95% CI 1.17–1.35, P < .00001, I2 = 0%), the efficacy of F + L combination therapy was also obviously better than L monotherapy (4 trials; RR 1.27, 95% CI 1.16–1.39, P < .00001, I2 = 0%). Compared with monotherapy, the pooled effects of combination therapy on NCV were (MD 6.69, 95% CI 4.74–8.64, P < .00001, I2 = 92%) for median MNCV, (MD 6.71, 95% CI 1.77–11.65, P = .008, I2 = 99%) for median SNCV, (MD 4.18, 95% CI 2.37–5.99, P < .00001, I2 = 94%) for peroneal MNCV, (MD 5.89, 95% CI 3.57–8.20, P < .00001, I2 = 95%) for peroneal SNCV. Furthermore, there were no serious adverse events associated with drug intervention.Conclusion:Combination therapy with F plus M or L was superior to M or L monotherapy for improvement of neuropathic symptoms and NCVs in DPN patients, respectively. Moreover, no serious adverse events occur in combination therapy.

Triglycerides and aortic pulse wave velocity in patients with chronic inflammation.

Triglycerides and aortic pulse wave velocity in patients with chronic inflammation.