WorldWideScience

Sample records for brachial pressure index

  1. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes

    Directory of Open Access Journals (Sweden)

    Perrin Byron M

    2010-12-01

    Full Text Available Abstract Background The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system. Methods This was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45 and a standardised measurement protocol. Results The mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28. The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22. Conclusion Despite the reasonable intra-class correlation results, the range of error (95% LOA was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

  2. Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice

    DEFF Research Database (Denmark)

    Nexøe, Jørgen; Damsbo, Bent; Lund, Jens Otto

    2012-01-01

    BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values......BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values...

  3. Validity and reliability of the ankle-brachial index by oscillometric blood pressure and automated ankle-brachial index.

    Science.gov (United States)

    Chongthawonsatid, Sukanya; Dutsadeevettakul, Somchai

    2017-01-01

    This study was conducted to assess the validity and reliability of ankle-brachial index (ABI) by oscillometric blood pressure (BP) measurement as compared with an automated ABI as a gold standard. This study was conducted at Golden Jubilee Medical Center, Thailand. All the data were collected from 303 patients at risk of peripheral arterial disease (PAD) who were 45 years of age or above and who underwent treatment at the outpatient medical clinic between June and December 2015. Patients who were followed up at the medical clinic had both oscillometric BP measurement (Terumo, ES-P600) and an automated ABI (oscillometric method) at the same time. Sensitivity, specificity, positive predictive value, and negative predictive value of the oscillometric BP measurements to predict an abnormal ABI (oscillometric BP method for determining an ABI (cutoff point oscillometric BP method by Kappa statistics was 0.84 on the right side and 0.77 on the left side (P = 0.000). The oscillometric BP method is a reliable and useful alternative to conventional automated ABI determination in patients with no severe arterial occlusion for estimation of the prevalence and screening of PAD in primary health-care settings.

  4. Validity and reliability of the ankle-brachial index by oscillometric blood pressure and automated ankle-brachial index

    Directory of Open Access Journals (Sweden)

    Sukanya Chongthawonsatid

    2017-01-01

    Full Text Available Background: This study was conducted to assess the validity and reliability of ankle-brachial index (ABI by oscillometric blood pressure (BP measurement as compared with an automated ABI as a gold standard. Materials and Methods: This study was conducted at Golden Jubilee Medical Center, Thailand. All the data were collected from 303 patients at risk of peripheral arterial disease (PAD who were 45 years of age or above and who underwent treatment at the outpatient medical clinic between June and December 2015. Patients who were followed up at the medical clinic had both oscillometric BP measurement (Terumo, ES-P600 and an automated ABI (oscillometric method at the same time. Sensitivity, specificity, positive predictive value, and negative predictive value of the oscillometric BP measurements to predict an abnormal ABI (<0.90 were determined using the automated ABI as the gold standard. Results: ABI values were similar between the two methods. The oscillometric BP method for determining an ABI (cutoff point <0.90 on the right side had a sensitivity of 88.89%, specificity of 99.32%, an accuracy of 99.01%, a positive predictive value of 80%, and a negative predictive value of 99.32% whereas ABI on the left side had a sensitivity of 69.23%, a specificity of 99.66%, an accuracy of 98.35%, a positive predictive value of 90%, and a negative predictive value of 98.63%. Reliability of the oscillometric BP method by Kappa statistics was 0.84 on the right side and 0.77 on the left side (P = 0.000. Conclusion: The oscillometric BP method is a reliable and useful alternative to conventional automated ABI determination in patients with no severe arterial occlusion for estimation of the prevalence and screening of PAD in primary health-care settings.

  5. Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients.

    Science.gov (United States)

    Kitahara, Tokuyuki; Ono, Kumeo; Tsuchida, Akiyasu; Kawai, Hironobu; Shinohara, Masahiko; Ishii, Yoshitaka; Koyanagi, Hikaru; Noguchi, Toshiharu; Matsumoto, Takayuki; Sekihara, Tetsuo; Watanabe, Yukiyasu; Kanai, Hideo; Ishida, Hideki; Nojima, Yoshihisa

    2005-10-01

    Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use. To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months. Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.

  6. Post-Exercise Ankle-Brachial Pressure Index Demonstrates Altered Endothelial Function in the Elderly

    Directory of Open Access Journals (Sweden)

    Shinji Sato

    2011-01-01

    Full Text Available Background The ankle-brachial pressure index (ABI, the ratio of the systolic blood pressure of the ankle to the systolic brachial pressure, is commonly measured at rest, but ABI values post-exercise enhance the sensitivity of the test and can be used to identify atherosclerotic vascular damage. However, it has not been established whether or not enhanced post-exercise ABI is also associated with endothelial dysfunction. We hypothesized that a decrease in post-exercise ABI is related to impaired endothelial function. Purpose To investigate alterations in post-exercise ABI values and endothelial dysfunction in the elderly. Methods The study population comprised 35 men and women aged 51–77 years (mean age: 66 years. Patients with peripheral arterial disease or a history of heart failure were excluded. The ABI was estimated at rest and immediately after exercise. The exercise protocol comprised 2.5 min of active pedal flexion exercises at a speed of 60 times/min. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD in the brachial artery using ultrasound imaging. Results No correlation was found between FMD and the ABI at rest. However, a weak correlation was found between FMD and post-exercise ABI (r = 0.46, P = 0.06. A strong correlation was observed between FMD and a decrease in post-exercise ABI compared to baseline readings (r = –0.52, P = 0.01. Multiple linear regression analysis was used to generate a prediction equation for FMD using the percentage decrease in post-exercise ABI. Significant correlations were observed between the ultrasound imaging-measured FMD and the predicted FMD (R 2 = 0.27, P = 0.001. Conclusions Post-exercise ABI appears to be a simple surrogate marker for endothelial function in the elderly, although larger studies are required for validation.

  7. Exercise-Ankle Brachial Pressure Index with One-Minute Treadmill Walking in Patients on Maintenance Hemodialysis

    OpenAIRE

    Tsuyuki, Kazuo; Kohno, Kenji; Ebine, Kunio; Obara, Takehiro; Aoki, Toshiyuki; Muto, Atsuhiko; Ninomiya, Kenji; Kumagai, Kenta; Yokouchi, Itaru; Yazaki, Yoshiyuki; Watanabe, Shinichi

    2012-01-01

    Background: The ankle-brachial pressure index (ABI) is widely used as a standard screening method for arterial occlusive lesion above the knee. However, the sensitivity of ABI is low in hemodialysis (HD) patients. Exercise stress (Ex-ABI) may reduce the false negative results.

  8. Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index.

    Science.gov (United States)

    Wittke, Estefânia; Fuchs, Sandra C; Fuchs, Flávio D; Moreira, Leila B; Ferlin, Elton; Cichelero, Fábio T; Moreira, Carolina M; Neyeloff, Jeruza; Moreira, Marina B; Gus, Miguel

    2010-11-05

    Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

  9. Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index

    Directory of Open Access Journals (Sweden)

    Moreira Leila B

    2010-11-01

    Full Text Available Abstract Background Blood pressure (BP variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM. We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI. Methods and Results In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time, standard deviation (SD of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40 was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007. In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04. In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P Conclusion Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

  10. Effects of the ankle-brachial blood pressure index and skin perfusion pressure on mortality in hemodialysis patients.

    Science.gov (United States)

    Otani, Yumi; Otsubo, Shigeru; Kimata, Naoki; Takano, Mari; Abe, Takayuki; Okajima, Tomoki; Miwa, Naoko; Tsuchiya, Ken; Nitta, Kosaku; Akiba, Takashi

    2013-01-01

    Clinically, the ankle-brachial blood pressure index (ABI) and skin perfusion pressure (SPP) are used to screen for subclinical peripheral artery disease. However, the association between the SPP and mortality in hemodialysis patients has not been previously reported. We investigated these factors and compared the ABI and SPP in patients receiving hemodialysis. A total of 102 patients receiving maintenance hemodialysis were enrolled in this study. The ABI was determined using an ABI-form (Colin, Japan). The SPP was measured using a SensiLase(TM) PAD3000 (Kaneka, Osaka, Japan). The mean follow-up period was 3.2 ± 1.4 years. A multivariate Cox analysis identified a low ABI (p=0.019) and a low SPP (p=0.047) as being independent predictors of mortality. A receiver operating characteristic (ROC) analysis of the ABI revealed a cutoff point of 1.1 and an area under the curve (AUC) of 0.79, with a sensitivity of 90% and a specificity of 62%. A ROC analysis of the SPP revealed a cutoff point of 54.0 mmHg and an AUC of 0.71, with a sensitivity of 55% and a specificity of 84%. Both low ABI and SPP values were found to be independent risk factors for mortality among hemodialysis patients. The cutoff point for ABI as a predictor of mortality was 1.1, while that for SPP was 54.0 mmHg.

  11. Exercise-ankle brachial pressure index with one-minute treadmill walking in patients on maintenance hemodialysis.

    Science.gov (United States)

    Tsuyuki, Kazuo; Kohno, Kenji; Ebine, Kunio; Obara, Takehiro; Aoki, Toshiyuki; Muto, Atsuhiko; Ninomiya, Kenji; Kumagai, Kenta; Yokouchi, Itaru; Yazaki, Yoshiyuki; Watanabe, Shinichi

    2013-01-01

    The ankle-brachial pressure index (ABI) is widely used as a standard screening method for arterial occlusive lesion above the knee. However, the sensitivity of ABI is low in hemodialysis (HD) patients. Exercise stress (Ex-ABI) may reduce the false negative results. After measuring resting ABI and toe-brachial pressure index (TBI), ankle pressure and ABI immediately after walking (Post-AP, Post-ABI) were measured using one-minute treadmill walking in 52 lower limbs of 26 HD patients. The definition of peripheral arterial occlusive disease (PAD) required an ABI value of less than 0.90, TBI value of less than 0.60, and decrease of more than 15% of the Post-ABI value and 20 mmHg of Post-AP in Ex-ABI. Computed tomographic angiography (CTA) was performed in 32 lower limbs of 16 HD patients. PAD is defined as presence of stenosis of more than 75% in the case of lesions from an iliac artery to knee on CTA. The accuracy of Ex-ABI (Sensitivity, 85.7%; Specificity, 77.7%) was higher than those of ABI (Sensitivity, 42.9%; Specificity, 83.3%) or TBI (Sensitivity, 78.6%; Specificity, 61.1%). Ex-ABI with one-minute treadmill walking is the most useful tool for the screening of arterial occlusive lesions above the knee in maintenance HD patients.

  12. Ankle-brachial blood pressure index predicts all-cause and cardiovascular mortality in hemodialysis patients.

    Science.gov (United States)

    Ono, Kumeo; Tsuchida, Akiyasu; Kawai, Hironobu; Matsuo, Hidenori; Wakamatsu, Ryouji; Maezawa, Akira; Yano, Shintarou; Kawada, Tomoyuki; Nojima, Yoshihisa

    2003-06-01

    A reduction in ankle-brachial BP index (ABPI) is associated with generalized atherosclerotic diseases and predicts cardiovascular mortality and morbidity in several patient populations. However, a large-scale analysis of ABPI is lacking for hemodialysis (HD) patients, and its use in this population is not fully validated. A cohort of 1010 Japanese patients undergoing chronic hemodialysis was studied between November 1999 and May 2002. Mean age at entry was 60.6 +/- 12.5 yr, and duration of follow-up was 22.3 +/- 5.6 mo. Patients were stratified into five groups ( or = 0.9 to or = 1.0 to or = 1.1 to or = 1.3) by ABPI measured at entry by an oscillometric method. The frequency distribution of ABPI was 16.5% of patients or = 0.9 to or = to or 1.1 to or = 1.3). The relative risk of a history of diabetes mellitus (DM), cardiovascular, and cerebrovascular disease was significantly higher in patients with lower ABPI than those with ABPI > or = 1.1 to or = 0.9 to or = 1.3) also had poor prognosis (HR, 2.33 [1.11 to 4.89] and 3.04 [1.14 to 8.12] for all-cause and cardiovascular mortality, respectively). Thus, the present findings validate ABPI as a powerful and independent predictor for all-cause and cardiovascular mortality among hemodialysis patients.

  13. Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia.

    Science.gov (United States)

    Takahara, Mitsuyoshi; Kaneto, Hideaki; Iida, Osamu; Katakami, Naoto; Matsuoka, Taka-Aki; Ikeda, Masahiko; Shimomura, Iichiro

    2012-10-01

    To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI). We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI. Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.

  14. Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Scanlon Christopher

    2012-06-01

    Full Text Available Abstract Background A reliable tool to measure arterial flow to the feet in people with diabetes is required given that they are particularly prone to peripheral arterial disease. Traditionally, the ankle brachial index (ABI has been used to measure arterial circulation, but its application is limited due to calcification of larger arteries. More recently, toe pressure and the toe brachial index (TBI has been suggested as superior to ABI measurements because they assess smaller digital arteries less prone to arterial calcification. However, reliability studies for the clinical use of photoplethysmography (PPG in people with diabetes are lacking. Methods Sixty people with diabetes mellitus (35 males and 25 females, mean age 59.6 yrs consented to take part in the study. The majority (92% had type 2 diabetes and 8% had type 1 diabetes. Forty-three percent were diagnosed as having peripheral neuropathy when tested using a biothesiometer and 15% were current smokers (10 – 40/day. A podiatrist and a diabetes educator measured toe and brachial blood pressure independently and in a random order using PPG. These measurements were repeated again seven days later, and subsequently analysed with intraclass correlation coefficients (ICC, 95% confidence intervals (CI and standard error of measurement (SEM. Results The intrarater reliability of measuring toe pressures was excellent (ICC3,1 =0.78-0.79, SEM 8 mmHg and interrater reliability was also excellent (ICC2,2 = 0.93, SEM 4 mmHg. The intrarater reliability for measuring brachial pressures was generally poor (ICC3,1 = 0.40 – 0.42, SEM 19 mmHg and interrater reliability was fair-good (ICC2,2. 0.65, SEM 14 mmHg. The TBI intrarater reliability was fair-good (ICC3,1 = 0.51-0.72, SEM 0.08, whilst the interrater reliability of TBI was excellent (ICC2,2 = 0.85, SEM 0.07. Conclusions Based on these results, interrater and intrarater reliability of PPG is excellent for measuring toe

  15. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index.

    Science.gov (United States)

    Manisty, Charlotte H; Hughes, Alun D

    2013-01-01

    Brachial systolic blood pressure (bSBP) exceeds aortic pressure by a variable amount, and estimated central systolic blood pressure (cSBP) may be a better indicator of cardiovascular risk than bSBP. We undertook a systematic review and meta-analysis to compare the effect of single and multiple antihypertensive agents on bSBP, cSBP and augmentation index (AIx). A random effects meta-analysis was performed on 24 randomized controlled trials of antihypertensives with measurements of bSBP, cSBP and/or AIx. Separate analyses were performed for drug comparisons with or without placebo, and drug combinations. In the placebo vs. drug meta-analysis, antihypertensive therapy reduced bSBP more than cSBP and there was no statistically significant evidence of heterogeneity by drug class, although the number of individual studies was small. In placebo-adjusted drug vs. drug comparison, treatment with β-blockers, omapatrilat and thiazide diuretics lowered cSBP significantly less than bSBP (i.e. central to brachial amplification decreased), whereas other monotherapies lowered cSBP and bSBP to similar extents. Sample sizes were too small and effect estimates insufficiently precise to allow firm conclusions to be made regarding comparisons between individual drug classes. Antihypertensive combinations that included β-blockers decreased central to brachial amplification. β-Blockers increased AIx, whereas all other antihypertensive agents reduced AIx to similar extents. A reduction in central to brachial amplification by some classes of antihypertensive drug will result in lesser reductions in cSBP despite achievement of target bSBP. This effect could contribute to differences in outcomes in randomized clinical trials when β-blocker- and/or diuretic-based antihypertensive therapy are compared with other regimens. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  16. Fish oil induced increase in walking distance, but not ankle brachial pressure index, in peripheral arterial disease is dependent on both body mass index and inflammatory genotype.

    Science.gov (United States)

    Madden, Jacqueline; Brunner, Andreas; Dastur, Neville D; Tan, Rebecca M; Nash, Gerard B; Rainger, G Ed; Shearman, Cliff P; Calder, Philip C; Grimble, Robert F

    2007-06-01

    Peripheral arterial disease (PAD) is an atherosclerotic disease. Evidence suggests that atherosclerosis is an inflammatory condition and long chain n-3 fatty acids, found in oily fish and fish oils, have been shown to reduce inflammation. Genetic and lifestyle factors such as body mass index (BMI) also influence inflammation. In this study we have examined the effect of fish oil in patients with claudication secondary to PAD. Fish oil supplementation, providing 1g EPA and 0.7 g DHA per day for 12 weeks, increased walking distance on a treadmill set at 3.2 km/h with a 7% incline. Walking distance to first pain increased from 76.2+/-8.5 m before fish oil to 140.6+/-25.5 m after fish oil (mean+/-SEM, p=0.004) and total distance walked increased from 160.0+/-21.5 m before fish oil to 242.1+/-34.5 m after fish oil (p=0.002). Fish oil supplementation also improved ankle brachial pressure index (ABPI) from 0.599+/-0.017 before fish oil to 0.776+/-0.030 after fish oil (p<0.001). The increase in walking distance was dependent on both BMI and genotype for single nucleotide polymorphisms in the genes encoding the pro-inflammatory cytokines tumour necrosis factor-alpha and interleukin (IL)-1beta and the anti-inflammatory cytokine IL-10 (detected using amplification refractory mutation system polymerase chain reaction). Neither BMI nor any of the genotypes examined affected the ability of fish oil to increase ABPI. The mechanisms by which fish oil affects walking distance and ABPI do not appear to be the same.

  17. Validation of brachial artery pressure reconstruction from finger arterial pressure

    NARCIS (Netherlands)

    Guelen, Ilja; Westerhof, Berend E.; van der Sar, Gertrude L.; van Montfrans, Gert A.; Kiemeneij, Ferdinand; Wesseling, Karel H.; Bos, Willem Jan W.

    2008-01-01

    Objective Measurement of finger artery pressure with Finapres offers noninvasive continuous blood pressure, which, however, differs from brachial artery pressure. Generalized waveform filtering and level correction may convert the finger artery pressure waveform to a brachial waveform. An upper-arm

  18. Time and reliability issues associated with automatic vs. manual measurements of Ankle to Brachial pressure Index (ABI) following heavy load exercise.

    Science.gov (United States)

    Congnard, Florian; Bruneau, Antoine; Abraham, Pierre; Colas-Ribas, Christophe; Picquet, Jean; Noury-Desvaux, Benedicte

    2015-11-01

    Ankle to brachial index after heavy load exercise is the most accurate way of diagnosing minor arterial lesions in athletes, such as endofibrosis. The reliability and practical aspects of ankle to brachial index measurements after heavy-load exercise have not been studied. The purpose of this study was to analyze the interest of oscillometric automatic vs. manual Doppler measurements, for the calculation of ankle to brachial index, after heavy-load exercise in athletes. Prospective single-center study. Fifteen healthy trained athletes performed an incremental test twice. Ankle to brachial index measurements were performed at Rest, as soon as possible after exercise (Rec-0), and then started at the 3rd minute of recovery (Rec-3), by two operators using each one of the two ankle to brachial index measurement methods. Mean times for automatic vs. manual ankle to brachial availability were 99 ± 18 s vs. 113 ± 25 s (p = 0.005) and 44 ± 25 s vs. 53 ± 12 s (p = 0.001) respectively at Rec-0 and Rec-3. Ankle to brachial index values from the two methods were highly correlated (r = 0.89). Mean absolute differences of automatic vs. manual ankle to brachial values from test-retest were 0.04 ± 0.05 vs. 0.08 ± 0.08 (p > 0.05) and 0.07 ± 0.05 vs. 0.09 ± 0.10 (p > 0.05) at Rest and Rec-0. Automatic method allows obtaining faster and simultaneously post-exercise ankle to brachial index measurement compare to the manual Doppler. This time issue does not result in a significant change in absolute ankle to brachial index values, nor in the absolute differences of these in test-retest. Nevertheless, the test-retest variability of post-exercise ankle to brachial index results seems smaller with the automatic than the manual method. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  19. Reconstruction of brachial artery pressure from noninvasive finger pressure measurements

    NARCIS (Netherlands)

    Bos, W. J.; van Goudoever, J.; van Montfrans, G. A.; van den Meiracker, A. H.; Wesseling, K. H.

    1996-01-01

    Pulse wave distortions, mainly caused by reflections, and pressure gradients, caused by flow in the resistive vascular tree, may cause differences between finger and brachial artery pressures. These differences may limit the use of finger pressure measurements. We investigated whether brachial

  20. Arterial compliance across the spectrum of ankle-brachial index: the Multiethnic Study of Atherosclerosis.

    Science.gov (United States)

    Lilly, Scott M; Jacobs, David R; Kronmal, Richard; Bluemke, David A; Criqui, Michael; Lima, Joao; Allison, Matthew; Duprez, Daniel; Segers, Patrick; Chirinos, Julio A

    2014-04-01

    A low ankle-brachial index is associated with cardiovascular disease and reduced arterial compliance. A high ankle-brachial index is also associated with an increased risk of cardiovascular events. We tested the hypothesis that subjects with a high ankle-brachial index demonstrate a lower arterial compliance. In addition, we assessed whether pulse pressure amplification is increased among subjects with a high ankle-brachial index. We studied 6814 adults enrolled in the Multiethnic Study of Atherosclerosis who were, by definition, free of clinical cardiovascular disease at baseline. Differences in total arterial compliance (ratio of stroke volume to pulse pressure), aortic and carotid distensibility (measured with magnetic resonance imaging and duplex ultrasound, respectively) were compared across ankle-brachial index subclasses (≤0.90, 0.91-1.29; ≥1.30) with analyses adjusted for cardiovascular risk factors and subclinical atherosclerosis. Peripheral arterial disease was detected in 230 (3.4%) and high ABI in 648 (9.6%) of subjects. Those with high ankle-brachial index demonstrated greater aortic/radial pulse pressure amplification than those with a normal ankle-brachial index. In adjusted models aortic and carotid distensibility as well as total arterial compliance, were lowest among those with ankle-brachial index≤0.9 (p<0.01 vs. all), but were not reduced in subjects with an ankle-brachial index≥1.3. Lower aortic, carotid and total arterial compliance is not present in subjects free of overt cardiovascular disease and with a high ankle-brachial index. However, increased pulse pressure amplification contributes to a greater ankle-brachial index in the general population and may allow better characterization of individuals with this phenotype. Published by Elsevier Ireland Ltd.

  1. Ankle-brachial pressure index estimated by laser Doppler in patients suffering from peripheral arterial obstructive disease.

    Science.gov (United States)

    Ludyga, Tomasz; Kuczmik, Waclaw B; Kazibudzki, Marek; Nowakowski, Przemyslaw; Orawczyk, Tomasz; Glanowski, Michal; Kucharzewski, Marcin; Ziaja, Damion; Szaniewski, Krzysztof; Ziaja, Krzysztof

    2007-07-01

    Ankle-brachial index (ABI) measurements are widely used for evaluating the functional state of circulation in the lower limbs. However, there is some evidence that the value of ABI does not accurately reflect the degree of walking impairment in symptomatic patients with peripheral arterial obstructive disease (PAOD). We investigated the diagnostic value of ABI estimated by means of laser Doppler flowmetry (IT) for evaluating limb ischemia. We wanted to know whether laser Doppler could be more sensitive than the Doppler method in predicting walking capacity in patients with stable intermittent claudication. We analyzed a group of 30 patients with intermittent claudication (Fontain II, II/III) who were admitted for reconstructive treatment. There were 21 men and 9 women, aged 46-74 (mean 61) years. All patients underwent the treadmill test, and pain-free walking distances were measured. In each patient, we measured ABI using the two different methods: Doppler ultrasound device (ABI-Doppler) and laser Doppler (ABI-laser Doppler). The claudication distances were 25-200 m (mean 73 +/- 50.2 m). ABI-Doppler was 0.2-0.7 (0.582 +/- 0.195). ABI-laser Doppler measurements were 0.581 (+/-0.218). A correlation was found between ABI-Doppler and claudication distance (r = 0.46, P = 0.009). Also, ABI-laser Doppler values significantly correlated with claudication distances (r = 0.536, P = 0.002). The ABI evaluated by laser Doppler correlated well with claudication distances in patients with PAOD. Comparison of Doppler and laser Doppler measurements used for determining ABI showed that both methods have similar predictive power for walking capacity; however, higher correlation was observed between claudication distances and ABI measured by laser Doppler flowmetry. ABI-laser Doppler measurements are easier, are quicker, and seem to be better suited for noncompliant patients. Further investigation should be undertaken to determine whether laser Doppler is superior to the Doppler

  2. Pulse Pressure and Upstroke Time Are Useful Parameters for the Diagnosis of Peripheral Artery Disease in Patients With Normal Ankle Brachial Index.

    Science.gov (United States)

    Kiuchi, Shunsuke; Hisatake, Shinji; Watanabe, Ippei; Toda, Mikihito; Kabuki, Takayuki; Oka, Takashi; Dobashi, Shintaro; Ikeda, Takanori

    2016-10-01

    Some peripheral artery disease (PAD) patients have normal ankle brachial index (ABI) (0.9 - 1.4), although ABI is a useful parameter for the diagnosis of PAD. We investigated whether other parameters of ABI report sheet are useful to detect these patients. We initially enrolled 3,912 patients (7,824 limbs) who underwent ABI for the first time. Subjects who have normal ABI were divided into the PAD group (n = 136) and the non-PAD group (n = 240) by lower extremity ultrasonography. We investigated blood pressures (BP) (systolic (SBP), diastolic (DBP), mean (mBP) and pulse pressure (PP)), heart rate, upstroke time (UT), and %mean arterial pressure (%MAP). SBP, mBP, PP, UT, and %MAP in the PAD group were significantly higher. A multivariate analysis showed that mBP, DBP, PP, UT and %MAP were independently associated with the presence of PAD (mBP: odds ratio (OR) 2.30, 95% confidence interval (CI) 1.22 - 4.37, P = 0.010; DBP: OR 0.52, 95% CI 0.28 - 0.97, P = 0.039; PP: OR 1.30, 95% CI 0.69 - 2.46, P = 0.041; UT: OR 3.40, 95% CI 2.03 - 5.83, P normal ABI. The measurement of BPs could provide additional information for the diagnosis of PAD.

  3. Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease.

    Science.gov (United States)

    Wickström, J-E; Laivuori, M; Aro, E; Sund, R T; Hautero, O; Venermo, M; Jalkanen, J; Hakovirta, H

    2017-05-01

    Peripheral haemodynamic parameters are used to assess the presence and severity of peripheral artery disease (PAD). The prognostic value of ankle brachial index (ABI) has been thoroughly delineated. Nonetheless, the relative usefulness of ankle pressure (AP), ABI, toe pressure (TP), and toe brachial index (TBI) in assessing patient outcome has not been investigated in a concurrent study setting. This study aimed to resolve the association of all four non-invasive haemodynamic parameters in clinically symptomatic patients with PAD with cardiovascular mortality, overall mortality, and amputation free survival (AFS). In total, 732 symptomatic patients with PAD admitted to the Department of Vascular Surgery for conventional angiography at Turku University Hospital, Turku, Finland, between January 2009 and August 2011 were reviewed retrospectively. Demographic factors, cardiovascular mortality, all-cause mortality, and above foot level amputations were obtained and assessed in relation to AP, ABI, TP, and TBI by means of Kaplan-Meier life tables and a multivariate Cox regression model. The haemodynamic parameter that was associated with poor 36 month general outcome was TP < 30 mmHg. Univariate Cox regression analysis of stratified values showed that TP and TBI associated significantly with mortality. In multivariate analysis both TP and TBI were associated with a significant risk of death. For TP < 30 mmHg and TBI < 0.25 the risk of cardiovascular mortality was hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.75-4.61 [p<.001]; HR 3.68, 95% CI 1.48-9.19 [p=.050], respectively; all-cause mortality (HR 2.05, 95% CI 1.44-2.92 [p<.001]; HR 2.53, 95% CI 1.35-4.74 [p=.040], respectively); and amputation or death (HR 2.13, 95% CI 1.52-2.98 [p<.001]; HR 2.46, 95% CI 1.38-4.40 [p=.050], respectively)... Among non-invasive haemodynamic measurements and pressure indices both TP and TBI appear to be associated with cardiovascular and overall mortality and AFS for patients

  4. Reconstruction of brachial pressure from finger arterial pressure during orthostasis

    DEFF Research Database (Denmark)

    Bogert, Lysander W J; Harms, Mark P M; Pott, Frank

    2004-01-01

    In patients with recurrent syncope, monitoring of intra-arterial pressure during orthostatic stress testing is recommended because of the potentially sudden and rapid development of hypotension. Replacing brachial arterial pressure (BAP) by the non-invasively obtained finger arterial pressure (Fin...

  5. Automated determination of the ankle-brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile.

    Science.gov (United States)

    Kollias, Anastasios; Xilomenos, Apostolos; Protogerou, Athanase; Dimakakos, Evangelos; Stergiou, George S

    2011-07-01

    The ankle-brachial index (ABI) is a method used widely for peripheral arterial disease (PAD) diagnosis and cardiovascular risk prediction. This study validated automated ABI measurements taken using an oscillometric blood pressure (BP) monitor allowing simultaneous arm-leg BP measurements. A total of 93 patients (hypertension 83%; dyslipidemia 72%; diabetes 45%; cardiovascular disease 23%; smoking 15%) were submitted to Doppler and automated ABI measurements, performed using a professional oscillometric BP monitor (Microlife WatchBP Office; triplicate simultaneous arm-leg BP measurements), in a randomized order. The mean difference between the Doppler reading (1.08 ± 0.17) and (1) the first oscillometric ABI reading was 0.03 ± 0.11, (2) the average of two oscillometric readings was 0.02 ± 0.10 and (3) the average of three oscillometric readings was 0.02 ± 0.09 (P oscillometric and Doppler ABI (r 0.80, 0.85 and 0.86 for single and average of two and three oscillometric readings, respectively; P oscillometric and Doppler ABI in diagnosing PAD (Doppler ABI oscillometric ABI cutoff for optimal sensitivity (92%) and specificity (92%) in diagnosing PAD. Average time for automated ABI measurement was 5.8 vs. 9.3 min for Doppler (P oscillometric ABI were associated and predicted (multivariate regression analysis) by the same cardiovascular risk factors (pulse pressure, smoking and cardiovascular disease history). Automated ABI measurement using a professional BP monitor allowing simultaneous arm-leg BP measurements appears to be a reliable and faster alternative to Doppler measurement.

  6. Ankle-brachial index in HIV infection

    Directory of Open Access Journals (Sweden)

    Martos Francisco

    2009-04-01

    Full Text Available Abstract Prognosis for patients with the human immunodeficiency virus (HIV has improved with the introduction of highly active antiretroviral therapy (HAART. Evidence over recent years suggests that the incidence of cardiovascular disease is increasing in HIV patients. The ankle-brachial index (ABI is a cheap and easy test that has been validated in the general population. Abnormal ABI values are associated with increased cardiovascular mortality. To date, six series of ABI values in persons with HIV have been published, but none was a prospective study. No agreement exists concerning the risk factors for an abnormal ABI, though its prevalence is clearly higher in these patients than in the general population. Whether this higher prevalence of an abnormal ABI is associated with a higher incidence of vascular events remains to be determined.

  7. Comparison of atherosclerotic indicators between cardio ankle vascular index and brachial ankle pulse wave velocity.

    Science.gov (United States)

    Horinaka, Shigeo; Yabe, Akihisa; Yagi, Hiroshi; Ishimura, Kimihiko; Hara, Hitoshi; Iemua, Tomoyuki; Matsuoka, Hiroaki

    2009-01-01

    Aortic pulse wave velocity has been used for evaluating atherosclerosis. Recently, the development of the volume plethysmographic method has made it possible to easily measure the index of the pulse wave velocity. The brachial ankle pulse wave velocity and cardio ankle vascular index are used for estimating the extent of atherosclerosis. The diagnostic usefulness of these indexes in predicting coronary artery disease was examined. The brachial ankle pulse wave velocity, the cardio ankle vascular index, and the high-sensitivity C-reactive protein were measured in 696 patients who had chest pain and underwent coronary angiography. Measurement values of brachial ankle pulse wave velocity were compared with those of cardio ankle vascular index in terms of the baseline covariates and the number of major coronary vessels involved (vessel disease). The brachial ankle pulse wave velocity was significantly correlated with age, systolic blood pressure, and diastolic blood pressure but not with the high-sensitivity C-reactive protein. The cardio ankle vascular index was correlated only with age and the high-sensitivity C-reactive protein. The average of both brachial ankle pulse wave velocity and cardio ankle vascular index values was greater in 3 vessel disease group than in 0 vessel disease group. The receiver operating characteristic curve showed that the diagnostic accuracy of coronary artery disease was significantly higher in the cardio ankle vascular index than in the brachial ankle pulse wave velocity (area under the curve +/- standard error: 0.691 +/- 0.025 vs. 0.584 +/- 0.026; P cardio ankle vascular index are useful and that cardio ankle vascular index may have some advantages in its application to patients taking blood pressure-lowering medication because of the minimum effect of blood pressure on its measurement values. The cardio ankle vascular index has increased performance over brachial ankle pulse wave velocity in predicting the coronary artery disease.

  8. Can the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) be new early stage markers of subclinical atherosclerosis in patients with rheumatoid arthritis?

    Science.gov (United States)

    Kurt, Tolga; Temiz, Ahmet; Gokmen, Ferhat; Adam, Gurhan; Ozcan, Sedat; Ozbudak, Ersan; Sacar, Mustafa

    2015-07-01

    It takes years for atherosclerosis to manifest symptoms. However, it needs to be identified earlier because of the premature cardiovascular risk factors in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate the effect of atherosclerosis on the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) in patients with RA. RA patients attending the rheumatology clinic were examined retrospectively; then we called them for the measurements of ABPI and CIMT prospectively. Subjects were divided into four groups, as follows (Table 1): group 1 comprised RA patients with an ABPI less than 0.9; group 2 included RA patients with an ABPI between 0.9 and 1.2; group 3 was made up of RA patients with an ABPI greater than 1.2; and group 4 included patients without RA with an ABPI between 0.9 and 1.2 as a control group. Patients' demographic data were recorded. Hypertension (HT), diabetes mellitus, ABPI and CIMT measurements were taken by specialists. Duration of RA and disease scores (disease activity score-28, health assessment questionnaire score and visual assessment score) were recorded. The prevalence of peripheral vascular disease in patients with RA was twice as high as that in the normal population of equivalent age. Patients in group 2, with RA and normal ABPI, exhibited a significant higher mean in CIMT (mm) compared with the control group (p markers such as C-reactive protein and rheumatoid factor, anti-cyclic citrullinated peptide and white blood cell counts. Based on the present findings, patients with RA need to be evaluated in the early stage of the disease for subclinical peripheral artery disease using the ABPI, as well as CIMT, which is also a non-invasive technique, in terms of cerebrovascular events. Inflammatory markers exhibited no statistically significant difference. We think that the atherosclerotic process stems not only from the inflammatory effects of RA, but also perhaps from its immunological nature.

  9. Ankle-Brachial Pressure Index Measured Using an Automated Oscillometric Method as a Predictor of the Severity of Coronary Atherosclerosis in Patients with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2004-06-01

    Full Text Available Ankle-brachial pressure index (ABI measured using a conventional Doppler method is an independent predictor of the number of coronary vessels affected in coronary artery disease (CAD. Recently, a new clinical device has been developed to measure ABI using an oscillometric method. It is unclear whether ABI measured using this device is a significant predictor of the severity of coronary atherosclerosis. We retrospectively included 87 patients from our outpatient clinic who had ever undergone coronary angiography. ABI was determined in all subjects using the new ABI-form device. The lower value of ABI in either limb was used for analysis. We divided our subjects into two groups, with either ABI less than 0.9 or at least 0.9, and compared basal characteristics between groups. We analyzed the relationship between ABI and the severity of CAD. In addition, we calculated the sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel (two-vessel + three-vessel involvement in our patients. There were 15 patients with ABI less than 0.9 and 72 with ABI at least 0.9. Patients with ABI less than 0.9 were older and had higher plasma levels of uric acid. The prevalence of diabetes mellitus, hypertension, smoking, and diuretic use was significantly higher in patients with ABI less than 0.9. In addition, the group with ABI less than 0.9 had a lower prevalence of one-vessel CAD and higher prevalence of three-vessel or multivessel CAD. The sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel CAD were 22%, 96%, 93%, and 34%, respectively. In conclusion, ABI measured using the automated oscillometric method can be used to predict the severity of coronary atherosclerosis in patients with CAD.

  10. The importance of community screening of asymptomatic elderly for peripheral arterial disease by Doppler ultrasound and ankle-brachial index.

    Science.gov (United States)

    Keven, Ayşe; Durmaz, Mehmet Sedat

    2017-12-01

    Peripheral arterial disease is an atherosclerotic disease characterized by an increase in morbidity and mortality. For these reasons early diagnosis of peripheral arterial disease is important. Ankle-brachial systolic pressure index measurement is frequently used in screening studies. Evaluating waveforms of distal lower extremities with Doppler ultrasound can be used as a screening program and provides more accurate information on peripheral arterial disease. We investigate the prevalence of peripheral arterial disease, compare the efficacy of Doppler ultrasound evaluation of distal lower extremity waveforms and ankle-brachial systolic pressure index measurement in screening programs, and discuss the importance of early diagnosis of asymptomatic cases. A total of 457 patients over the age of 65 (between 65 and 94, mean age: 71.4) including 270 males and 187 females were examined with Doppler ultrasound, had ankle-brachial systolic pressure index measurement taken and were screened for peripheral arterial disease. The correlation between Doppler ultrasound findings and ankle-brachial systolic pressure index was examined. According to the Doppler ultrasound findings, in the aortoiliac ( r = 0.648) and femoropopliteal ( r = 0.564) area, there is a medium level of correlation between severe stenosis and occlusions and a low ankle-brachial systolic pressure index value, and a low level of correlation between such abnormalities in the tibioperoneal region ( r = 0.116) and a low ankle-brachial systolic pressure index value. Therefore, while the sensitivity of ankle-brachial systolic pressure index increases in proximal stenosis, it decreases in distal stenosis. Despite the fact that ankle-brachial systolic pressure index is a diagnostic test commonly used in screening studies, evaluation of distal arteries by means of Doppler ultrasound provides more accurate information in terms of the identification of peripheral arterial disease.

  11. Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity

    Directory of Open Access Journals (Sweden)

    Lan LI

    2012-11-01

    Full Text Available Objective  To investigate the clinical application and its influencing factors of ankle-brachial index (ABI and toe-brachial index (TBI in the diagnosis of arterial disease of lower extremity. Methods  ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9, normal group (0.9≤ABI < 1.3, and calcification group (ABI≥1.3 according to the value of ABI, and also into narrow group (TBI < 0.7 and normal group (TBI≥0.7 according to the value of TBI. The correlation of ABI with TBI was analyzed, and the differences in age, obesity parameters, biochemical indicators and other factors were compared between the groups. Influence of high-sensitivity C-reactive protein (hs-CRP on ABI and TBI was further analyzed. Results  Only when ABI < 0.9, ABI and TBI have significant correlation (r=0.826, P < 0.01. W hen the group comparison based on ABI values, it was shown that the age and hs-CRP were significantly higher in the narrow group than in the normal group and calcification group (P < 0.01. The comparison between groups based on TBI values indicated that the age, systolic blood pressure and hs-CRP in the narrow group were significantly higher than those in the normal group (P < 0.01 or P < 0.05. ABI and TBI in the normal hs-CRP group were significantly higher than those in high hs-CRP group (P < 0.05. Conclusion  Hs-CRP may play an important role in the development and progression in peripheral arterial atherosclerosis. Therefore, ABI and TBI measurements in combination with hs-CRP level can improve early diagnosis of arterial disease of lower extremity.

  12. Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity

    OpenAIRE

    Li, Lan; ZHAO, ZHI-GANG; Zhen-cheng YAN; Yin-xing NI; Sun, Fang; Sun, Jin; Xing-sen XU; Yu, Hao; Ying-sha LI; Dao-yan LIU; Zhi-ming ZHU

    2012-01-01

    Objective  To investigate the clinical application and its influencing factors of ankle-brachial index (ABI) and toe-brachial index (TBI) in the diagnosis of arterial disease of lower extremity. Methods  ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9), normal group (0.9≤ABI < 1.3), and calcification group (ABI≥1.3) according to the value of ABI, and al...

  13. Genetic determinants of the ankle-brachial index

    DEFF Research Database (Denmark)

    Wassel, Christina L; Lamina, Claudia; Nambi, Vijay

    2012-01-01

    Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of ∼50,000 SNPs across ∼2100 candidate genes to iden...

  14. Risk factors of normal ankle-brachial index and low toe-brachial index in hemodialysis patients.

    Science.gov (United States)

    Morimoto, Satoshi; Nakajima, Fumitaka; Yurugi, Takatomi; Morita, Tatsuyori; Jo, Fusakazu; Nishikawa, Mitsushige; Iwasaka, Toshiji; Maki, Kei

    2009-04-01

    The prevalence of peripheral arterial occlusive disease is high in patients with terminal renal failure, and it is a major problem in those on dialysis. A low ankle-brachial index (ABI) suggests the presence of arterial stenotic lesions between the aorta and the ankle joint, while a low toe-brachial index (TBI) suggests stenotic lesions between the aorta and the toes. Therefore, a normal ABI (> or =0.9) and a low TBI ( or =0.6) (N group) were compared. Low ankle-brachial and toe-brachial indices were detected in 13% and 22% of the patients, respectively. Comparison of the background factors and laboratory data between the N and L groups showed that the ratio of diabetes mellitus, interdialytic body weight gain, and Hb(A1c) values were significantly higher in the L group than in the N group. It was clarified that diabetes and excess body weight gain are involved as risk factors in dialysis patients with normal ABI/low TBI.

  15. Brachial versus central blood pressure and vascular stiffness

    DEFF Research Database (Denmark)

    Rasmussen, Susanne; Hansen, Tine; Frimodt-Møller, Marie

    2009-01-01

    Central blood pressure (BP) estimates the true load imposed on the left ventricle to a higher degree than does brachial BP. Increased aortic pulse wave velocity (aPWV) and central BP are risk markers for cardiovascular disease. Both can be measured by simple and noninvasive methods. Guidelines...

  16. Brachial versus central blood pressure and vascular stiffness

    DEFF Research Database (Denmark)

    Rasmussen, Susanne; Hansen, Tine; Frimodt-Møller, Marie

    2010-01-01

    Central blood pressure (BP) estimates the true load imposed on the left ventricle to a higher degree than does brachial BP. Increased aortic pulse wave velocity (aPWV) and central BP are risk markers for cardiovascular disease. Both can be measured by simple and noninvasive methods. Guidelines re...... are still lacking. Udgivelsesdato: 2009-Jun-8...

  17. Oscillometric measurement of the ankle-brachial index

    Science.gov (United States)

    MacDougall, Andrea M; Tandon, Vikas; Wilson, Merne P; Wilson, Thomas W

    2008-01-01

    INTRODUCTION Peripheral arterial disease is a coronary risk equivalent; a low ankle-brachial index (ABI) is indicative of systemic vascular disease, and should place a patient in the high-risk category. Few physicians measure ABI because it is technically challenging and time consuming. Oscillometric blood pressure monitors are readily available and easy to use. The use of a simple method of documenting ABI was assessed and compared with the conventional method. METHODS The oscillometric ABI (OABI) was measured for normal volunteers, patients attending a cardiovascular risk clinic (Cardiovascular Risk Factor Reduction Unit [CRFRU] at the University of Saskatchewan, Saskatoon) and patients referred to a vascular laboratory (vasc lab). The latter group had Doppler ABI (DABI) measurements and served to validate OABI. An Omron HEM 711C oscillometric system (Omron Canada Inc) with appropriate cuff size for arm and leg circumference was used. RESULTS The mean ± SEM OABI was 1.13±0.08 in normal volunteers (n=26), 1.10±0.10 in CRFRU patients (n=11, P not significant) and 1.03±0.14 in vasc lab patients (n=57, P<0.05 compared with normal volunteers). No difference was found between sexes, and there was no correlation with age. In the vasc lab group, the correlation with DABI was 0.71 (P<0.05). The sensitivity of OABI to detect DABI of less than 0.9 was 0.71, and the specificity was 0.89. OABI was found to be less sensitive at detecting low values in patients with nonpalpable pulses on physical examination. CONCLUSION The OABI is feasible and operator-independent, but does not detect low ABI efficiently. If OABI is abnormal, low DABI is likely. The OABI is less likely to detect disease in patients with nonpalpable peripheral pulses. Such patients are better referred directly to a vascular laboratory for DABI testing. PMID:18209769

  18. The run-off resistance (ROR) assessed on MR angiograms may serve as a valid scoring system in patients with symptomatic peripheral arterial disease (PAD) and correlates with the ankle-brachial pressure index (ABI).

    Science.gov (United States)

    Gorny, O; Santner, W; Fraedrich, G; Jaschke, W; Greiner, A; Schocke, M F

    2012-06-01

    To investigate the correlation between the hemodynamic parameter ankle-brachial pressure index (ABI) and the run-off resistance (ROR) assessed on MR angiograms (MRA) in patients with peripheral arterial disease (PAD) Fontaine Stage I and II and its potential as reliable reporting system in clinical routine. Contrast-enhanced MRA was performed in 321 PAD patients using a 1.5T MR scanner with moving bed technique. The ROR and resting ABI were determined in each patient's leg and correlation analysis was performed using the Pearson test. A significant negative correlation (r = -.513; pROR (mean 11.03±5.42) and resting ABI (mean .81±.26) was identified. An even more pronounced correlation was found in patients younger than median age who had higher ABI values (r = -.608; pROR scoring system evaluated in this series correlates better with the ABI than previously published scoring systems and could be suggested as reporting system for routine MRA evaluation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Cardiovascular Risk Factors and Distributions of the Ankle-Brachial Index among Type 2 Diabetes Mellitus Patients

    Directory of Open Access Journals (Sweden)

    Badaruddoza Doza

    2012-01-01

    Full Text Available Background. The aim of present study is to observe the association between the levels of ankle-brachial index (ABI and cardiovascular risk factors among people with type 2 diabetes mellitus in north India. A cross-sectional study was carried out at a centre for heart and diabetic clinic in the state of Punjab on 1121 subjects (671 males and 450 females with type 2 diabetes mellitus. History of symptoms related to cardiovascular diseases was noted, and blood pressure and anthropometric measurements were recorded. Ankle-brachial index (ABI was measured using ultrasonic Doppler flow detector. Subjects with ABI ≤0.9 and ≥1.30 were classified as having low and high ABI, respectively. Females had a higher BMI and brachial-ankle pulse wave velocity (<0.001. Whereas, males had higher diastolic blood pressure and duration of type 2 diabetes mellitus. The differences of systolic blood pressure and ankle-brachial index were not found significant between the sexes. The prevalence of low ABI (<0.9 was 4.47% in men and 4.67% in women and high ABI (≥1.30 was prevalent in 14% of men and 10.45% of women. Age, BMI, baPWV, and blood pressures were significantly associated with ABI value in both sexes. The results suggested that the ABI might be used as a strong indicator for cardiovascular risk factors in type 2 diabetic subjects.

  20. Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis

    DEFF Research Database (Denmark)

    Eldrup, Nikolaj; Sillesen, Henrik; Prescott, Eva

    2006-01-01

    We examined the ability of ankle brachial index, C-reactive protein and central augmentation index to identify individuals in the general population with severe atherosclerosis, diagnosed as those with ischaemic cardiovascular disease.......We examined the ability of ankle brachial index, C-reactive protein and central augmentation index to identify individuals in the general population with severe atherosclerosis, diagnosed as those with ischaemic cardiovascular disease....

  1. Relationship between ankle-brachial index and left ventricle ejection fraction in patients on hemodialysis.

    Science.gov (United States)

    Tayebi Khosroshahi, Hamid; Abbasnejad, Mohsen; Gojazade, Morteza; Mansouri, Saeed; Ahadi, Hamid Reza; Moghadaszade, Majid

    2015-11-01

    Ankle-brachial index (ABI) is a noninvasive test which employs as a diagnostic marker of atherosclerotic peripheral vascular disease in hemodialysis patients. This study aimed to investigate the association between ABI and left ventricular ejection fraction (LVEF) in patients on hemodialysis. Eighty-six patients with end-stage renal disease undergoing hemodialysis and 100 patients referred for echocardiography without apparent kidney disease were included. Ankle-brachial index was calculated by dividing the highest ankle pressure (the left and right dorsalis pedis and posterior tibial) by the brachial systolic blood pressure on the arm with no arteriovenous fistula. The relationship between ABI and LVEF was investigated. The hemodialysis patients were older on average than the control group (P = .004). The total average of ABI in the hemodialysis group was less than 0.9 in 20 patients (23.3%) and 0.9 to 1.3 in 66 (76.7%). These were 11 (11%) and 89 (89%), respectively, among the controls (P = .02). The mean LVEF was 49.7 ± 8.6% in the hemodialysis patients and 53.8 ± 9.5% in the controls (P = .003). There was a significant correlation between LVEF and ABI in the hemodialysis patients (r = 0.06; P = .001), and ABI could predict the LVEF with sensitivity and specificity of 90% and 94.1%, respectively (positive predictive value, 34.6%; negative predictive value, 48.5%). These findings show that ABI may be applied in predicting the presence of left ventricular systolic dysfunction in hemodialysis patients. Further studies are recommended to confirm this association.

  2. Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

    Directory of Open Access Journals (Sweden)

    Seong Chul Park

    2012-05-01

    Full Text Available BackgroundThe ankle brachial pressure index (ABI is a simple, useful method for diagnosing peripheral artery disease (PAD. Although the ABI is an objective diagnostic method, it has limited reliability in certain scenarios. The aim of the present study was to determine the accuracy and reliability of the toe brachial index (TBI as a diagnostic tool for detecting stenosis in PAD, associated with normal or low ABI values.MethodsABI and TBI values were measured in 15 patients with diabetic gangrene who were suspected of having lower extremity arterial insufficiency. The ABI and TBI values were measured using a device that allowed the simultaneous measurement of systolic blood pressure in the upper and lower extremities. In addition, the ABI and TBI values were compared pre- and post-angiography.ResultsPatients with an ABI of 0.9-1.3 showed almost no difference between the 2 measurements. The patients with TBI >0.6 had no arterial insufficiency. The patients with TBI <0.6 required vascular intervention with ballooning. After the angiography, the gangrenous wounds decreased in size more rapidly than they did prior to the intervention.ConclusionsOur findings suggest that TBI is the method of choice for evaluating lower limb perfusion disorders. This result requires further studies of TBI in a larger number of patients. Future long-term studies should therefore evaluate the utility of TBI as a means of screening for PAD and the present findings should be regarded as preliminary outcomes.

  3. Consistency of Toe Systolic Pressures, Brachial Systolic Pressures, and Toe-Brachial Indices in People with and without Diabetes.

    Science.gov (United States)

    Trevethan, Robert

    2018-01-22

    Toe systolic blood pressures (TSPs) and toe-brachial indices (TBIs) have been identified as useful adjuncts in the identification of pedal ischemia, peripheral artery occlusive diseases, and risk for either nonhealing of lower extremity wounds or for amputation. Valid measurement of TSPs and TBIs is therefore essential. However, it could be jeopardized by rater, instrument, and intratestee inconsistency. These three sources of inconsistency were examined in this research. Five publications addressing TSP and TBI consistency were identified and their results were analyzed using intraclass correlation coefficients. Moderate variability in TSPs was found across all studies; greater variability was evidenced in brachial systolic pressure, particularly for people who had diabetes; and TBI values also exhibited considerable variability, but little difference between people who did and did not have diabetes. These findings provide qualified evidence of consistency regarding measurement of TSPs but challenge the TBI as a valid and useful indicator in screening, prognostic, and monitoring contexts, particularly for people who have diabetes. However, there is a prospect that TBI assessment could be improved by adherence to standardized protocols and by obtaining multiple measurements from toes and arms on a single occasion as well as on different occasions. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography.

    Science.gov (United States)

    Weir-McCall, Jonathan R; Khan, Faisel; Lambert, Matthew A; Adamson, Carly L; Gardner, Michael; Gandy, Stephen J; Ramkumar, Prasad Guntur; Belch, Jill J F; Struthers, Allan D; Rauchhaus, Petra; Morris, Andrew D; Houston, J Graeme

    2014-01-01

    Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50-70%, 3 = 70-99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β -0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β -0.45 p = 0.005). ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to

  5. The association between ankle-brachial index and quality of life in chronic hemodialysis patients.

    Science.gov (United States)

    Chen, Li-Ching; Kuo, Li-Ying; Tsao, Yu-Feng; Hong, Ling-Show; Wang, Chin-Suey; Lee, Chia-Chi; Lin, Lih-Jen; Chou, Che-Yi; Tsieng, Yu-Hsiung

    2010-08-01

    Ankle-brachial index (ABI) is an important indicator of peripheral arterial disease (PAD) and PAD has a negative impact on quality of life (QOL). However, the correlation between ABI and QOL is unknown among chronic hemodialysis patients. Ankle-brachial index was measured, and WHOQOL-BRIEF (TW) questionnaire was completed. The association between ABI and QOL was analyzed using linear regression. A total of 54 chronic hemodialysis patients (mean age of 56.2 +/- 14.6 years) were included. Ankle-brachial index was positively associated with QOL (r = .448, P = .001). The QOL scores were 3.1 +/- 2.9 and 2.6 +/- 0.4 for 37 patients with an ABI more than 0.9 and 17 patients with an ABI less than 0.9 or more than 1.3 (p Ankle-brachial index is positively correlated to QOL among chronic hemodialysis patients.

  6. Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study

    National Research Council Canada - National Science Library

    Jair Baptista Miguel; Jorge Paulo Strogoff de Matos; Jocemir Ronaldo Lugon

    Abstract Background: Abnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years. Objective...

  7. Ankle-brachial index by automated method and renal function

    Directory of Open Access Journals (Sweden)

    Ricardo Pereira Silva

    2017-05-01

    Full Text Available Background The Ankle-brachial index (ABI is a non-invasive method used for the diagnosis of peripheral arterial occlusive disease (PAOD. Aims To determine the clinical features of patients submitted to ABI measurement by automatic method. To investigate association between ABI and renal function. Methods The present is a cross-sectional study. The study was performed in a private clinic in the city of Fortaleza (Ce- Brazil. For ABI analysis, we utilized automatic methodology using a Microlife device. Data collection took place from March 2012 to January 2016. During this period, ABI was measured in 375 patients aged >50 years, who had a diagnosis of hypertension, diabetes or vascular disease. Results Of the 375 patients, 18 were categorized as having abnormal ABI (4.8 per cent and 357 were normal ABI (95.2 per cent. Patients with abnormal ABI showed older mean age when compared to patients with normal ABI. Among patients with normal renal function, only 0.95 per cent showed abnormal ABI; among patients with abnormal renal function, 6 per cent showed abnormal ABI. Conclusion 1 No differences were observed when comparing the groups regarding gender or the prevalence of hypertension, diabetes, dyslipidaemia or CAD. 2 Group with abnormal ABI had renal function greater impairment.

  8. Ankle-Brachial Index: Nurses Strategy To Cardiovascular Disease Risk Factors Identification

    Directory of Open Access Journals (Sweden)

    Daniela Luisa Maggi

    2014-04-01

    Full Text Available Elevated risk of fatal and non-fatal cardiovascular events is associated with high prevalence of peripheral arterial disease, with assessment through the ankle-brachial index (ABI. This study aimed to demonstrate that the ABI and the Edinburgh Claudication Questionnaire are tools to be used by nurses in prevention and/or treatment of CVD (cardiovascular disease. A cross-sectional study was carried out with patients from a cardiovascular clinic. The Edinburgh Claudication Questionnaire was applied and the ABI was measured with the formula (ABI= Blood Pressure Ankle/Blood Pressure Brachial. A total of 115 patients were included, most were females (57.4%, aged 60.6 ± 12.5 years. The most prevalent risk factors were hypertension (64.3%, physical inactivity (48.7% and family history (58.3%. The study showed that abnormal ABI was frequently found and 42.6% of the patients with abnormal ABI showed intermittent claudication. The method to evaluate the ABI associated to the Edinburg Claudication Questionnaire, can be easily used by nurses in the clinical evaluation of asymptomatic and symptomatic CVD patients.

  9. Ankle-brachial index and bone turnover in patients on dialysis.

    Science.gov (United States)

    London, Gérard M; Marchais, Sylvain J; Guérin, Alain P; de Vernejoul, Marie-Christine

    2015-02-01

    An association between atherosclerosis and osteoporosis has been reported in several studies. This association could result from local intraosseous atherosclerosis and ischemia, which is shown by limb osteoporosis in patients with peripheral artery disease (PAD), but also could result from bidirectional communication between the skeleton and blood vessels. Systemic bone disorders and PAD are frequent in ESRD. Here, we investigated the possible interaction of these disorders. For 65 prevalent nondiabetic patients on hemodialysis, we measured ankle-brachial pressure index (ABix) and evaluated mineral and bone disorders with bone histomorphometry. In prevalent patients on hemodialysis, PAD (ABix1.4/incompressible) was associated with low bone turnover and pronounced osteoblast resistance to parathyroid hormone (PTH), which is indicated by decreased double-labeled surface and osteoblast surface (Phemodialysis vintage. These results indicate that, in prevalent nondiabetic patients with ESRD, PAD associates with low bone turnover and pronounced osteoblast resistance to PTH. Copyright © 2015 by the American Society of Nephrology.

  10. Comparison of ankle-brachial index and brachial-ankle pulse wave velocity between patients with chronic kidney disease and hemodialysis.

    Science.gov (United States)

    Chen, Szu-Chia; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Jui-Hsin; Lin, Feng-Hsien; Su, Ho-Ming; Chen, Hung-Chun

    2009-01-01

    Patients with chronic renal failure are highly predisposed to atherosclerosis. However, there is limited data about the direct comparison of atherosclerosis between patients with chronic kidney disease (CKD) and hemodialysis. The aim of this study was to compare ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) between patients with CKD and hemodialysis and thus examined the status of peripheral artery occlusive disease (PAOD) and arterial stiffness between them. We enrolled 169 patients with CKD stage 3-5 and 225 hemodialysis patients in one regional hospital. ABI and baPWV were measured by using an ABI-form device (VP1000, Colin). A higher prevalence of ABI hemodialysis patients than in CKD patients (15.6 vs. 8.3%, p = 0.030). After a multivariate analysis, ABI hemodialysis treatment. The baPWV was positively associated with age, DM, systolic and diastolic blood pressures, and negatively with body mass index. However, after adjusting for other variables, baPWV was comparable between patients with CKD and hemodialysis. The study revealed that PAOD might be more prevalent in patients with hemodialysis than in patients with CKD, but arterial stiffness might be comparable between them. Copyright (c) 2008 S. Karger AG, Basel.

  11. Factors affecting the validity of the oscillometric ankle brachial index to detect peripheral arterial disease.

    Science.gov (United States)

    Herráiz-Adillo, Ángel; Cavero-Redondo, Iván; Álvarez-Bueno, Celia; Martínez-Vizcaíno, Vicente; Pozuelo-Carrascosa, Diana P; Notario-Pacheco, Blanca

    2017-09-08

    The use of oscillometric ankle brachial index (ABI) to diagnose peripheral arterial disease (PAD) has raised concern, especially due to a lack of agreement and sensitivity. This study aimed to evaluate those factors affecting the validity of oscillometric ABI in comparison to Doppler ABI to detect PAD. Through univariate and multivariate linear regression, we studied those factors affecting the differences between oscillometric and Doppler ABI; through univariate and multivariate logistic regression we analyzed the false negative rate of oscillometric ABI to detect PAD. We analyzed 197 consecutive subjects (394 legs) from two settings: Primary Care and Vascular Service. The means of oscillometric ABI and Doppler ABI were 1.094 (95%CI: 0.843-1.345) and 1.073 (95%CI: 0.769-1.374) (poscillometric and Doppler ABI were Doppler ankle blood pressure (β=‒0.610, poscillometric brachial blood pressure (β=0.136, p=0.037); in women, those were weight (β=0.351, pblood pressure (β=‒0.318, poscillometric ABI to detect PAD were 80.6% and 97.4%, respectively, and covariates explaining the rate of false negatives in PAD population were setting (Exp(β)=17.21, p=0.009) and tobacco (packs/year) (Exp(β)=1.049, p=0.002). Although some factors influencing the lack of agreement between oscillometric and Doppler ABI were identified, the correction of oscillometric ABI seems impractical, since Doppler is needed, the bias is not always uniformly distributed and its clinical relevance is small. According to sensitivity, borderline oscillometric ABI in Primary Care settings and smokers suggest PAD.

  12. Comparison between Central and Brachial Blood Pressure in Hypertensive Elderly Women and Men

    Directory of Open Access Journals (Sweden)

    Bruno Bordin Pelazza

    2017-01-01

    Full Text Available Aim. To compare the values of central and brachial systemic blood pressure (SBP between women and men over 60 years of age with systemic arterial hypertension. Methods. This study was a quantitative, descriptive, cross-sectional study with elderly patients admitted to and selected from spontaneous and scheduled demand at basic health units in Uberlândia, Minas Gerais, Brazil, between March 2013 and March 2014. We included 69 study participants and compared central and brachial SBP using a Sphygmocor® XCEL device (AtCor Medical, Sydney, Australia. Results. Significant differences were found in the blood pressure values of the whole population in the central versus brachial systolic blood pressure (SP [140(21 versus 153(23 mmHg] and in the central versus brachial pulse pressure (PP [55(18 versus 70(18 mmHg]. Additionally, females exhibited higher blood pressure levels than males [central SP 144(23 versus 134(16 mmHg and brachial SP 161(26 versus 148(18 mmHg and central PP 62(17 versus 45(14 mmHg and brachial PP 80(21 versus 63(15 mmHg, resp.]. Conclusion. Elderly women exhibited higher blood pressure values than elderly hypertensive men.

  13. Influence of different measurement time points on brachial-ankle pulse wave velocity and ankle-brachial index in hemodialysis patients.

    Science.gov (United States)

    Su, Ho-Ming; Chang, Jer-Ming; Lin, Feng-Hsien; Chen, Szu-Chia; Voon, Wen-Chol; Cheng, Kai-Hung; Wang, Chuan-Sheng; Lin, Tsung-Hsien; Lai, Wen-Ter; Sheu, Sheng-Hsiung

    2007-10-01

    In order to ensure that they are reliable markers of atherosclerosis and suitable for repetitive follow-up of disease progression and management responses in hemodialysis (HD) patients, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) should be tested to see whether they change with different measurement time points. The aim of this study was to assess whether baPWV and ABI vary according to whether they are measured before HD, after HD, or on the next dialysis-free day. Eighty-nine patients undergoing regular HD were enrolled. The baPWV and ABI were measured 10-30 min before and after HD, and if patients agreed, on the next dialysis-free day. The third measurement of baPWV and ABI, performed 22+/-2 h after HD, was taken in 72 patients (81%). The body weight reduction after HD was 2.5+/-0.9 kg (por=0.498). In conclusion, despite the significant decrease in body weight and blood pressures, baPWV increased significantly after HD. In addition, baPWV, but not ABI, may vary at different measurement time points. Therefore, baPWV, but not ABI, should be assessed in a timely manner in HD patients.

  14. The correlation between the ankle-brachial index and the metabolic syndrome. .

    Science.gov (United States)

    Mitu, F; Mitu, O; Leon, Maria-Magdalena; Jitaru, Alexandra

    2014-01-01

    On a global scale, the cardiovascular diseases constitute the prime factor of death and invalidity. The premature mortality percentage caused by these varies from 4% in high developed countries to 40% in underdeveloped countries. Atherosclerosis is the most important etiological factor. The presence of various degrees of atherosclerosis in a certain vascular area (in our case, the lower limb arteries), increases the probability of affecting other areas as well (coronary, cerebral, renal, mesenteric arteries). The evaluation and description of the correlations between the ankle-brachial index levels and the cardiovascular risk factors, taken individually or as part of the metabolic syndrome. The values of the ankle-brachial index were divided in normal and abnormal. The evaluated cardiovascular risk factors were: age, sex, arterial hypertension, obesity, smoking, high levels of cholesterol and basal glucose, low levels of HDL-cholesterol. There were significant statistical differences between the normal ankle-brachial index lot and the one with abnormal values, specifically in patients with diabetes mellitus and metabolic syndrome. More so, the study demonstrates that the ankle-brachial index is considerably smaller in patients with metabolic syndrome. The simple measurement of the afore mentioned index, as a atherosclerosis marker for the lower limb arteries, represents an independent prediction over the metabolic syndrome and the conventional risk factors, in the development of the cardiovascular diseases. The routine measurement of this parameter in medical practice might imply the early diagnosis of high risk manifested cardiovascular disease patients.

  15. Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Fabiane Noronha Bergonse

    2006-03-01

    Full Text Available FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1 em 9/22 (40,9% doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7% doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.BACKGROUND: Chronic venous ulcers are extremely frequent and have a significant impact on quality of life and work productivity of individuals, in addition to high costs to public health. OBJECTIVES: Detection of arterial circulation alterations in chronic venous ulcer legs using a non-invasive method to discriminate patients not indicated to have compressive treatment. METHODS: Forty patients with chronic venous ulcers were investigated for the presence of peripheral arterial disease with measurement of the ankle/brachial index by Doppler ultrasound. RESULTS: The resting ankle/brachial pressure index was abnormal (lower than 1 in 9/22 (40.9% patients with concomitant chronic venous ulcers and hypertension and only in one out of 13 (7.7% patients with chronic venous ulcers and no hypertension. CONCLUSIONS: Patients with concomitant chronic venous

  16. Associated Risk Factors for Abnormal Ankle-brachial Index in Hemodialysis Patients in a Hospital

    Directory of Open Access Journals (Sweden)

    Szu-Chia Chen

    2008-09-01

    Full Text Available Ankle-brachial index (ABI is a marker for peripheral artery disease and can predict mortality in hemodialysis patients. However, it is seldom studied in southern Taiwan, an area with high prevalence of end-stage renal disease (ESRD. The aim of this study was to investigate the prevalence and associated risk factors for peripheral artery disease in the ESRD population in a hospital. All routine hemodialysis patients in one regional hospital were included except for six patients who refused ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. ABI was measured using an ABI-form device (Colin VP1000. The prevalence of ABI < 0.9 and 3 1.3 was 15.6% and 5.8%, respectively. ABI < 0.9 was independently associated with advanced age (p = 0.027, increased pulse pressure (p = 0.005, increased hemat-ocrit (p = 0.008 and decreased serum albumin level (p = 0.009. In addition, ABI 3 1.3 was significantly associated with diabetes mellitus (p = 0.019. This study demonstrated the associated risk factors of peripheral artery disease in patients with hemodialysis in a hospital. ESRD patients of advanced age and with increased pulse pressure, increased hematocrit and decreased serum albumin level had a relatively high risk for ABI < 0.9 and patients with diabetes had a relatively high risk for ABI 3 1.3.

  17. Associated risk factors for abnormal ankle-brachial index in hemodialysis patients in a hospital.

    Science.gov (United States)

    Chen, Szu-Chia; Su, Ho-Ming; Mai, Hsiu-Chin; Chen, Jui-Hsin; Chen, Chiu-Yueh; Chang, Jer-Ming; Chen, Hung-Chun

    2008-09-01

    Ankle-brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in hemodialysis patients. However, it is seldom studied in southern Taiwan, an area with high prevalence of end-stage renal disease (ESRD). The aim of this study was to investigate the prevalence and associated risk factors for peripheral artery disease in the ESRD population in a hospital. All routine hemodialysis patients in one regional hospital were included except for six patients who refused ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. ABI was measured using an ABI-form device (Colin VP1000). The prevalence of ABI or = 1.3 was 15.6% and 5.8%, respectively. ABI or = 1.3 was significantly associated with diabetes mellitus (p = 0.019). This study demonstrated the associated risk factors of peripheral artery disease in patients with hemodialysis in a hospital. ESRD patients of advanced age and with increased pulse pressure, increased hematocrit and decreased serum albumin level had a relatively high risk for ABI or = 1.3.

  18. A small reduction in the ankle-brachial index is associated with increased mortality in patients on chronic hemodialysis.

    Science.gov (United States)

    Kato, Akihiko; Takita, Takako; Furuhashi, Mitsuyoshi; Kumagai, Hiromichi; Hishida, Akira

    2010-01-01

    High pulse wave velocity (PWV) and a low ankle-brachial index (ABI) are associated with mortality in hemodialysis (HD) patients. Recently, the cardio-ankle vascular index (CAVI) was developed as a novel index of arterial stiffness independent of blood pressure. We compared brachial-ankle PWV (baPWV), the ABI and the CAVI as predictors of mortality in 194 HD patients (age 64 +/- 12 years; time on HD 111 +/- 96 months) during a follow-up period of 39 +/- 4 months (range 31-46). The ABI was significantly positively correlated with serum albumin and negatively with log-transformed highly sensitive C-reactive protein (p 1.1; hazard ratio 3.50 (95% confidence interval 1.20-10.20); p = 0.02]. In contrast, baPWV and the CAVI were not associated with mortality. These findings suggest that a small reduction in the ABI (<1.0) is an independent predictor of all-cause mortality in chronic HD patients. Copyright 2009 S. Karger AG, Basel.

  19. The Optimal Cut-off Value of Ankle Brachial Index for Screening Cardiovascular Disease Risk in Hemodialysis Patients

    National Research Council Canada - National Science Library

    HARADA, Makoto; TSUKADA, Wataru; TSUKADA, Osamu; HASHIMOTO, Koji; KAMIJO, Yuji

    2016-01-01

    ...), are frequently detected in hemodialysis (HD) patients. Ankle brachial index (ABI) is a useful marker for detecting PAD, as well as being predictive of the development of cardiovascular diseases (CVD...

  20. Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

    OpenAIRE

    Chen, Szu-Chia; Chang, Jer-Ming; Hwang, Shang-Jyh; Tsai, Jer-Chia; Wang, Chuan-Sheng; Mai, Hsiu-Chin; Lin, Feng-Hsien; Su, Ho-Ming; Chen, Hung-Chun

    2009-01-01

    Background and objectives: Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. The most common cause of VAF is stenosis at the arteriovenous anastomosis because of abnormal neointimal proliferation and extracellular matrix deposition. These two changes are also observed in the classic atheroma, which means atherosclerotic lesions and venous stenosis in VAF may share some similar pathogenic mechanisms. The ankle–brachial index (ABI) is a...

  1. Atrial fibrillation does not affect ankle-brachial index measured using the Doppler method.

    Science.gov (United States)

    Dąbrowski, Michał; Lewandowski, Jacek; Abramczyk, Piotr; Łoń, Izabela; Gaciong, Zbigniew; Siński, Maciej

    2017-11-02

    Atrial fibrillation may affect blood pressure measurements. The ankle-brachial index (ABI) is a ratio of systolic blood pressure measured on the lower and upper limbs that may also be affected by arrhythmia. The purpose of the study was to investigate whether atrial fibrillation influenced ABI results. Ninety-nine patients (age 66.6±11 years, 63 males and 36 females) who underwent electrical cardioversion of atrial fibrillation were investigated. ABI measurements using the Doppler method were performed on both lower extremities before and after electrical cardioversion. Measurements were repeated three times and then averaged. The ABI using both lower limbs was lower before electrical cardioversion than after restoration to sinus rhythm (right side: 1.132 (1.065-1.210) during atrial fibrillation vs. 1.179 (1.080-1.242) in sinus rhythm, P=0.019; left side: 1.142 (1.075-1.222) during atrial fibrillation vs. 1.170 (1.098-1.255) in sinus rhythm, P=0.011). However, the upper 95% confidence interval (CI) margins for the median differences in ABI were 0.045 and 0.040 for right and left, respectively, suggesting that the observed difference was clinically insignificant. There was a significant correlation between measurements obtained before and after electrical cardioversion on both lower limbs (r=0.61, P<0.001 and r=0.67, P<0.001). The Bland-Altman plot showed good agreement between measurements performed using the Doppler method during atrial fibrillation and sinus rhythm. Study results showed that atrial fibrillation did not have a clinically important effect on ABI measurements.Hypertension Research advance online publication, 2 November 2017; doi:10.1038/hr.2017.89.

  2. Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis.

    Science.gov (United States)

    Verberk, Willem J; Kollias, Anastasios; Stergiou, George S

    2012-09-01

    Measurement of the ankle-brachial index (ABI) using a Doppler device is widely used to identify subjects with peripheral artery disease (PAD), and those who are at high risk of cardiovascular disease. This paper presents a systematic review (Medline/PubMed, Embase and Cochrane) and meta-analysis of studies assessing the usefulness of automated oscillometric devices for ABI estimation and PAD detection compared with the conventional Doppler method. A total of 25 studies including 4186 subjects were analyzed. A random-effects model analysis showed that the average oscillometric ABI was similar to the Doppler ABI (mean difference ± s.e. 0.020 ± 0.018, P=0.3) but that the absolute differences were significant (0.048 ± 0.009, Poscillometric and Doppler ABI was 0.71 ± 0.05. Simultaneous arm-leg measurements resulted in a smaller difference between the average oscillometric ABI value and the average Doppler ABI value than did sequential measurements (-0.012 ± 0.022 vs. 0.040 ± 0.026, respectively, Poscillometric ABI estimation in PAD diagnosis was 69 ± 6% and 96 ± 1%, respectively (with Doppler ABI taken as the reference). These data suggest that an automated ABI measurement obtained by oscillometric blood pressure monitors is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD. To increase the sensitivity of the PAD diagnosis based on an oscillometric ABI, a higher threshold of 1.0 might be preferable.

  3. Ankle-brachial index, a screening for peripheral obstructive arterial disease, and migraine - a controlled study.

    Science.gov (United States)

    Jurno, Mauro Eduardo; Chevtchouk, Liliana; Nunes, Aida Aguilar; de Rezende, Dilermando Fazito; Jevoux, Carla da Cunha; de Souza, Jano Alves; Moreira Filho, Pedro Ferreira

    2010-04-01

    Epidemiological studies support the association between migraine, especially migraine with aura, and vascular disorders. The ankle-brachial index (ABI) is largely used as a surrogate of peripheral obstructive arterial disorders (POAD). Accordingly, in this study we contrasted the ABI in individuals with migraine and in controls. We investigated 50 migraineurs and 38 controls and obtained the ABI (ratio between the systolic arterial pressure obtained in the legs and in the arms) using digital sphygmomanometry. As per validation studies, we used the cut-off of 0.9 as the normal limit for the ABI. We adjusted for gender, use of contraceptive hormones, tabagism, and other cardiovascular risk factors. We found abnormal values of ABI, suggestive of mild or moderate POAD, in 31 individuals (35.2%). Mean value was 0.96 (standard deviation = 0.10). None of our patients had ABI < 0.4, which would suggest severe POAD. Mean ABI for migraineurs was 0.94 (0.11), and for controls it was 0.99 (0.09). Difference was significant (t = 2.21 and P = .022). After adjustments, ABI remained significantly associated with migraine status (P = .024). Adjustments were reasonably effective (chi(2) of Hosmer-Lemeshow = 1.06, P = .590). Our findings suggest that decreased values of ABI are more common in migraineurs than in controls. Although causality was not assessed by us, the relationship is of importance per se. Doctors should measure the ABI in individuals with migraine as an easy way to screen for cardiovascular risk.

  4. [Estimation of body mass index based on brachial circumference in patients with permanent or temporary incapacity].

    Science.gov (United States)

    Mill-Ferreyra, E; Cameno-Carrillo, V; Saúl-Gordo, H; Camí-Lavado, M C

    2017-09-21

    Many patients are affected by various conditions, which make it impossible to calculate body mass index (BMI) by measuring weight and height. For this reason, the purpose of this study was to develop a mathematical tool that allows the approximate calculation of the brachial circumference for diagnosis and follow-up. The formula proposed for both sexes is: brachial circumference (cm)×30/32. Results≥28 must be added 2 points. Prospective, descriptive, observational study performed in a primary care clinic, including 224 men and 248 women. Weight, height, brachial circumference, and BMI were calculated using Quetelet's formula and the proposed formula. In men, BMI (CI 95%)=0.63, while BCF (CI 95%)=0.49 (P=.95), while in women BMI (CI 95%)=0.73 and BCF (CI 95%)=0.56 (P=.95). The numerical ratio showed r=0.82, R2=0.67, PQuetelet, being applicable in patients in special condition due to physical limitations for the measurement of weight and height for the calculation of BMI. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Prognostic significance of ankle-brachial index, brachial-ankle pulse wave velocity, flow-mediated dilation, and nitroglycerin-mediated dilation in end-stage renal disease.

    Science.gov (United States)

    Morimoto, Satoshi; Yurugi, Takatomi; Aota, Yasuko; Sakuma, Takao; Jo, Fusakazu; Nishikawa, Mitsushige; Iwasaka, Toshiji; Maki, Kei

    2009-01-01

    Identifying patients at high risk of cardiovascular disease is important in managing patients undergoing hemodialysis. We evaluated a series of prognostic values: flow-mediated dilation (FMD) and nitrogen-mediated dilation (NMD), an index of endothelium-dependent and endothelium-independent function, respectively, ankle-brachial index (ABI), and brachial-ankle pulse wave velocity (baPWV) in patients undergoing chronic hemodialysis. A cohort of 199 patients was studied. At entry, these values were examined and the prognostic significances were investigated. In estimating the significance of baPWV, patients with ABI hemodialysis patients by means of ABI and baPWV but not FMD or NMD provides complementary information in identifying a high-risk population in these patients.

  6. [Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk].

    Science.gov (United States)

    Rada, C; Oummou, S; Merzouk, F; Amarir, B; Boussabnia, G; Bougrini, H; Benzaroual, D; Elkarimi, S; Elhattaoui, M

    2016-12-01

    Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease. This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied. Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin. PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Hubungan Hipertensi dan Penyakit Arteri Perifer Berdasarkan Nilai Ankle-Brachial Index

    Directory of Open Access Journals (Sweden)

    Tessa Thendria

    2014-06-01

    Full Text Available Penyakit arteri perifer (PAP merupakan penyakit vaskular yang memiliki morbiditas dan mortalitas yang tinggi. Pasien dengan PAP memiliki resiko tinggi menderita infark miokard, stroke iskemik dan kematian. Hipertensi merupakan salah satu faktor risiko PAP dan belum pernah dilakukan penelitian tentang hipertensi dan PAP di RSU Dokter Soedarso Pontianak. Penelitian ini bertujuan untuk mengetahui hubungan hipertensi dan PAP berdasarkan nilai ankle-brachialindex (ABI. Penelitian ini merupakan penelitian observasional dengan rancangan cross-sectional. Sebanyak 58 sampel penelitian dipilih dengan teknik consecutive sampling berdasarkan kriteria inklusi dan eksklusi. Data dikumpulkan dari wawancara, rekam medis, pemeriksaan tekanan darahdan ABI. Diagnosis PAP ditegakkan jika ditemukan nilai ABI ≤0,9 pada salah satu kaki. Prevalensi PAP pada pasien hipertensi ditemukan sebesar 21% (IK95% 11-31%. Kejadian PAP paling banyak ditemukan pada kelompok umur 60-69 tahun yakni sebesar 48%. Terdapat hubungan yang bermakna antara hipertensi dan PAP berdasarkan nilai ABI (p=0,000. Hipertensi berhubungan dengan penyakit arteri perifer berdasarkan nilai ankle-brachial index. Kata kunci: penyakit arteri perifer, faktor resiko, hipertensi, ankle-brachial index

  8. Casein improves brachial and central aortic diastolic blood pressure in overweight adolescents: a randomised, controlled trial

    DEFF Research Database (Denmark)

    Arnberg, Karina; Larnkjær, Anni; Michaelsen, Kim F.

    2013-01-01

    Arterial stiffness, blood pressure (BP) and blood lipids may be improved by milk in adults and the effects may be mediated via proteins. However, limited is known about the effects of milk proteins on central aortic BP and no studies have examined the effects in children. Therefore, the present...... trial examined the effect of milk and milk proteins on brachial and central aortic BP, blood lipids, inflammation and arterial stiffness in overweight adolescents. A randomised controlled trial was conducted in 193 overweight adolescents aged 12–15 years. They were randomly assigned to drink 1 litre...... of water, skimmed milk, whey or casein for 12 weeks. The milk-based test drinks contained 35 g protein/l. The effects were compared with the water group and a pretest control group consisting of thirty-two of the adolescents followed 12 weeks before the start of the intervention. Outcomes were brachial...

  9. ANKLE-BRACHIAL INDEX AND LDL-RECEPTOR GENE IN ASYMPTOMATIC SEVERE HYPERCHOLESTEROLEMIA

    Directory of Open Access Journals (Sweden)

    L. Vladimirova-Kitova

    2011-08-01

    Full Text Available The issue with the different levels of ankle-brachial index, as screening for LDL-receptor defective gene in newly detected asymptomatic severe hypercholesterolemia is less studied, but quite interesting. There have not been any studies on ankle-brachial index in patients with severe hypercholesterolemia in Bulgaria. Aim: To examine the difference between patients with severe hypercholesterolemia, who are carriers and non-carriers of LDL-R defective gene, with respect to their structural (ankle-brachial index characteristics of arterial wall. Methods and materials: 60 patients with documented severe hypercholesterolemia >7.5 mmol/l satisfying the Simon-Broom criteria for clinically established and probable Familial Hypercholesterolemia were studied. All of the patients had a negative stress echocardiography and not known coronary artery disease. The laboratory used was the Clinical Laboratory at the Medical University Plovdiv. The total cholesterol and triglycerides were measured with enzyme-colorimetry and cholesterol in high density lipoprotein and cholesterol in low density lipoprotein with direct automatic analyses. Apolipoproteins were calculated by immunoturbodimetric method. The biochemical analyzer Konelab 60i was used in all the measurements. Results: According to whether there were or were not molecular defects, patients were assigned to two groups: carriers (11 patients, 18 % and non-carriers (49 patients, 82 %.There was a statistically significant difference (p 0.05. We found no statistically significant difference between non-carriers and carriers with respect to body mass index (25.30 ± 0.40 vs 24.63 ± 0.45, respectively, t = 0.50; p > 0.05. There was not a statistically significant difference in levels of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol between carries (p>0.05. The cholesterol x years. score was significantly higher in the carries (440.36 ± 0.25 mmol-y/L, than in the non-carries (390.30 ± 0

  10. Rate of ankle-brachial index decline predicts cardiovascular mortality in hemodialysis patients.

    Science.gov (United States)

    Kuwahara, Michio; Hasumi, Syoko; Mandai, Shintaro; Tanaka, Tomomi; Shikuma, Satomi; Akita, Wataru; Mori, Yoshihiro; Sasaki, Sei

    2014-02-01

    Chronic kidney disease is a risk factor for cardiovascular mortality and morbidity of cardiovascular events (CVEs). We obtained baseline data regarding blood biochemistry, ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV) and echocardiographic parameters from 300 patients on hemodialysis in 2005. We also measured ABI and baPWV annually from June 2005 until June 2012 and calculated rates of changes in ABI and baPWV to identify factors associated with CVEs. Seventy-three patients died of cardiovascular disease and 199 CVEs occurred in 164 patients during the study period. Cardiac, cerebrovascular and peripheral artery disease (PAD) events occurred in 124, 43 and 32 patients, respectively, and 30 patients had more than two types of CVEs. Analysis using the Cox proportional hazards model showed that a higher rate of decline in ABI (hazard ratio [HR], 4.034; P hemodialysis in Japan. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  11. Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients

    DEFF Research Database (Denmark)

    Gerage, A. M.; Benedetti, T. R. B.; Farah, B. Q.

    2015-01-01

    their physical activity assessed over a 7 day period using an accelerometer and the time spent in sedentary activities, light physical activities, moderate physical activities and moderate-to-vigorous physical activities was obtained. The primary outcomes were brachial and central blood pressure. Arterial...... stiffness parameters (augmentation index and pulse wave velocity) and cardiac autonomic modulation (sympathetic and parasympathetic modulation in the heart) were also obtained as secondary outcomes. Results Sedentary activities and light physical activities were positively and inversely associated......-to-vigorous physical activities. Arterial stiffness parameters and cardiac autonomic modulation were not associated with the time spent in sedentary activities and in light physical activities (P > 0.05). Conclusion Lower time spent in sedentary activities and higher time spent in light physical activities...

  12. Are the complications of arteriovenous fistulas associated with an abnormal Ankle-Brachial Index in hemodialysis patients?

    OpenAIRE

    XHIGNESSE, Patricia; Saint-Remy, Annie; Dubois, Bernard; Philips, Jean-Christophe; Krzesinski, Jean-Marie

    2010-01-01

    The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We analysed the relationship between ABI abnormal values and arteriovenous fistulas (AVF) complications such as stenosis and thrombosis among chronically hemodialysis pat ients (HD). Peer reviewed

  13. Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study

    NARCIS (Netherlands)

    Bendermacher, Bianca L. W.; Teijink, Joep A. W.; Willigendael, Edith M.; Bartelink, Marie-Louise; Peters, Ron J. G.; Langenberg, Machteld; Büller, Harry R.; Prins, Martin H.

    2012-01-01

    Background: Screening with ankle-brachial index (ABI) measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the

  14. Decrease in ankle-brachial index over time and cardiovascular outcomes in patients with hemodialysis.

    Science.gov (United States)

    Chen, Szu-Chia; Chang, Jer-Ming; Liu, Wan-Chun; Huang, Jiun-Chi; Chen, Yi-Yu; Yang, Tsung-Kun; Su, Ho-Ming; Chen, Hung-Chun

    2012-12-01

    Abnormal ankle-brachial index (ABI) is associated with increased morbidity and mortality in hemodialysis patients. However, whether the decrease in ABI over time carries the prognostic value is unknown. The aim of this study was to assess whether the decrease in ABI over time was a good predictor of poor cardiovascular (CV) prognosis in hemodialysis patients. This study enrolled 234 routine hemodialysis patients and 173 patients completed the follow-up. The ABI was measured by an ABI-form device at baseline and at the first year follow-up. The ΔABI was defined as ABI measured at the first year follow-up minus ABI measured at baseline. Progressors of ABI were defined as patients with ΔABI hemodialysis patients.

  15. Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study.

    Science.gov (United States)

    Miguel, Jair Baptista; Matos, Jorge Paulo Strogoff de; Lugon, Jocemir Ronaldo

    2017-03-01

    Abnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years. This study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up. A total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: 1.3) and followed for a 60-month period. The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, Phemodialysis patients.

  16. Senam Kaki Diabetik Efektif Meningkatkan Ankle Brachial Index Pasien Diabetes Melitus Tipe 2

    Directory of Open Access Journals (Sweden)

    Aria Wahyuni

    2016-02-01

    Full Text Available AbstrakPenelitian ini bertujuan untuk mengetahui efektifitas senam kaki diabetik terhadap Ankle Brachial Index pada pasien Diabetes Melitus Tipe 2. Desain yang digunakan adalah Quasi eksperimen dengan pendekatan one-group pre-test – post-test. Populasi penelitian ini adalah pasien DM tipe 2 yang ada di salah satu wilayah kerja puskesmas yang ada di kota Payakumbuh sebanyak 77 orang. Sampel diambil menggunakan teknik purposive sampling  sebanyak 10 orang sampel yang memenuhi kriteria yaitu pasien DM tipe 2 tanpa penyakit penyerta. Rata-rata ABI sebelum dilakukan senam kaki diabetik adalah 0.62 dan rata-rata ABI setelah dilakukan senam kaki diabetik adalah 0.93. Hasil analisis statistik menunjukkan ada perbedaan nilai ABI yang signifikan antara sebelum dan setelah dilakukan senam kaki diabetik (p value = 0,005. Disimpulkan bahwa pelaksanaan senam kaki diabetik dapat meningkatkan ABI pada pasien DM tipe 2. Penelitian ini merekomendasikan bahwa pasien DM tipe 2 diharapkan untuk dapat memanfaatkan senam kaki diabetik sebagai senam alami yang praktis dalam meningkatkan perfusi ke perifer serta sebagai pencegahan komplikasi pada pasien DM tipe 2 khususnya ke daerah kaki. Rekomendasi untuk penelitian selanjutnya adalah membandingkan efektifitas senam kaki diabetik terhadap gula darah, sensitifitas kak, nilai ABI, dan waktu pengisian kapiler Kata Kunci : Ankle Brachial Index; Diabetes Melitus Tipe 2; Senam Kaki Diabetik. AbstractThis study aims to determine the effect of diabetic foot exercise on Ankle Brachial Index (ABI in patients with Diabetes Mellitus Type 2. A design used quasy experiment with one-group pre-test –post-test. The population in this study were patients DM type 2 in one of health public centre in Payakumbuh city. The sample was recruited with purposive sampling technique as many as 10 samples that satisfies the criteria of patient namely DM type 2 without comorbidities. The average ABI before diabetic foot exercise is 0.77 and

  17. Ankle-Brachial Index: An Ubiquitous Marker of Cognitive Impairment-The EPIDEMCA Study.

    Science.gov (United States)

    Desormais, Ileana; Aboyans, Victor; Guerchet, Maëlenn; Ndamba-Bandzouzi, Bébène; Mbelesso, Pascal; Mohty, Dania; Marin, Benoît; Dartigues, Jean Francois; Preux, Pierre-Marie; Lacroix, Philippe

    2017-01-01

    Epidemiological research on the implication of atherosclerosis in the development of cognitive impairment is lacking in low- and middle-income countries, where two-thirds of the individuals affected by dementia live. Individuals aged ≥65 years living in urban and rural areas of 2 countries in Central Africa were invited. Demographic, clinical, and biological data were collected, and the ankle-brachial index (ABI) was measured. Cognitive impairment was defined according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among 1662 participants (age 72.9 years, 59.3% females), the prevalence of cognitive impairment was 13.6%, which is higher in individuals with ABI ≤ 0.90 and ABI ≥ 1.40 than those with 0.90 ubiquitous marker of atherosclerosis, provides independent and incremental information on susceptibility to present with cognitive disorders.

  18. Central blood pressure assessment using 24-hour brachial pulse wave analysis

    Directory of Open Access Journals (Sweden)

    Muiesan ML

    2014-10-01

    Full Text Available Maria Lorenza Muiesan, Massimo Salvetti, Fabio Bertacchini, Claudia Agabiti-Rosei, Giulia Maruelli, Efrem Colonetti, Anna Paini Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy Abstract: This review describes the use of central blood pressure (BP measurements during ambulatory monitoring, using noninvasive devices. The principles of measuring central BP by applanation tonometry and by oscillometry are reported, and information on device validation studies is described. The pathophysiological basis for the differences between brachial and aortic pressure is discussed. The currently available methods for central aortic pressure measurement are relatively accurate, and their use has important clinical implications, such as improving diagnostic and prognostic stratification of hypertension and providing a more accurate assessment of the effect of treatment on BP. Keywords: aortic blood pressure measurements, ambulatory monitoring, pulse wave analysis

  19. Severe aortic coarctation in an adult patient with normal brachial blood pressure

    DEFF Research Database (Denmark)

    Leetmaa, Tina H; Nørgaard, Bjarne L; Mølgaard, Henning

    2014-01-01

    The present case shows that a normal brachial blood pressure (BP) does not exclude severe coarctation and should be considered in normotensive patients presenting with a systolic murmur and/or unexplained severe left ventricular hypertrophy. Congenital coarctation of the aorta is a narrowing...... of the descending aorta, usually located distal to the origin of the subclavian artery, causing hypertension in the upper part of the body. This condition may be undiagnosed until adult life where the clinical presentation most often is high BP in the upper extremities. A 57-year-old patient with severe aortic...

  20. Comparison of invasive and brachial cuff-based noninvasive measurements for the assessment of blood pressure amplification.

    Science.gov (United States)

    Nakagomi, Atsushi; Okada, Sho; Shoji, Toshihiro; Kobayashi, Yoshio

    2017-03-01

    Our aim was to assess the discrepancy in the blood pressure amplification (BPA) value defined as the aortic-to-brachial increase in systolic BP (SBP) between invasive and noninvasive brachial cuff-based methods. In 45 patients undergoing cardiac catheterization, BP in the brachial artery and ascending aorta were measured with an invasive catheter and a brachial cuff-based oscillometric device. To calculate aortic SBP, brachial waveforms were calibrated by the brachial systolic and diastolic BP (DBP) (C1 calibration) or by the brachial mean BP and DBP (C2 calibration). C1 calibration underestimated aortic SBP (-17.7 mm Hg (95% confidence interval: -21.9 to -13.5)), whereas C2 calibration generated an approximately accurate aortic SBP (1.8 mm Hg (-2.4 to 5.9)). Regarding brachial SBP, noninvasively measured values were markedly underestimated (22.2 mm Hg (-26.4 to -18.0)), resulting in a slightly low BPA value in C1 calibration (11.9±6.3 mm Hg) and a paradoxical negative BPA value in C2 calibration (-7.6±6.7 mm Hg). Multiple linear regression analysis showed that the cuff-catheter difference of BPA was positively correlated with the cuff-catheter difference of brachial SBP in both calibrations (C1 calibration: β=0.51; C2 calibration: β=0.50; both Pinvasively measured BPA only in C1 calibration (r=0.33, P=0.03), when using invasively measured brachial SBP instead of a cuff-based measurement, the BPA was well associated with invasively measured BPA in both calibrations (C1 calibration: r=0.57; C2 calibration: r=0.52; both P<0.001). In conclusion, there was a trade-off in accuracy between brachial cuff-based noninvasive aortic SBP and BPA because of the inherent inaccuracies in the cuff-based method. This finding should be fully considered in establishing standardized reference values for aortic BP.

  1. Polycyclic aromatic hydrocarbons, brachial artery distensibility and blood pressure among children residing near an oil refinery.

    Science.gov (United States)

    Trasande, Leonardo; Urbina, Elaine M; Khoder, Mamdouh; Alghamdi, Mansour; Shabaj, Ibrahim; Alam, Mohammed S; Harrison, Roy M; Shamy, Magdy

    2015-01-01

    Polycyclic aromatic hydrocarbons (PAH) are produced by the burning and processing of fuel oils, and have been associated with oxidant stress, insulin resistance and hypertension in adults. Few studies have examined whether adolescents are susceptible to cardiovascular effects of PAHs. To study associations of PAH exposure with blood pressure (BP) and brachial artery distensibility (BAD), an early marker of arterial wall stiffness, in young boys attending three schools in Jeddah, Saudi Arabia in varying proximity to an oil refinery. Air samples collected from the three schools were analyzed for PAHs. PAH metabolites (total hydroxyphenanthrenes and 1-hydroxypyrene) were measured in urine samples from 184 adolescent males, in whom anthropometrics, heart rate, pulse pressure, brachial artery distensibility and blood pressure were measured. Descriptive, bivariate and multivariable analyses were performed to assess relationships of school location and urinary PAH metabolites with cardiovascular measures. Total suspended matter was significantly higher (444 ± 143 μg/m(3)) at the school near the refinery compared to a school located near a ring road (395 ± 65 μg/m(3)) and a school located away from vehicle traffic (232 ± 137 μg/m(3)), as were PAHs. Systolic (0.47 S D units, p = 0.006) and diastolic (0.53 SD units, p refinery, with a 4.36-fold increase in prehypertension (p = 0.001), controlling for confounders. No differences in pulse pressure, BAD and heart rate were noted in relationship to school location. Urinary total hydroxyphenanthrenes and 1-hydroxypyrene were not associated with cardiovascular outcomes. Proximity to an oil refinery in Saudi Arabia is associated with prehypertension and increases in PAH and particulate matter exposures. Further study including insulin resistance measurements, better control for confounding, and longitudinal measurement is indicated. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Índice tornozelo-braço em pacientes hemodialíticos Ankle-brachial index in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Mariane Torres Uchôa

    2012-12-01

    . The ankle-brachial index was calculated for each artery of the lower limb. It was considered normal ankle-brachial index from 0.9 to 1.3. RESULTS: We diagnosed peripheral arterial disease and poorly compressible arteries in 26.9 and 30.8% of hemodialysis patients and in 33 and 22.7% of the Control Group. In hemodialysis patients, we found abnormal ankle-brachial index in 75% of symptomatic patients (p=0.005, in 67.3% of men and 31% of women (p<0.005, in 78.6% of the elderly, 34.8% of young adults (p<0.01, and 76.9% of diabetics (p<0.005 versus nondiabetic. These patients had a higher prevalence of severe peripheral arterial disease than the Control Group. CONCLUSIONS: Abnormal ankle-brachial index was very prevalent in the groups studied; however, hemodialysis patients had more severe changes, when compared to the Control Group. Diabetes mellitus, male gender, and advanced age were important risk factors for abnormal ankle-brachial index in hemodialysis patients. The ankle-brachial index was a good method of screening for the studied changes; therefore, we suggest the routine use in the management of hemodialysis patients.

  3. Ankle-brachial index: a simple way to predict mortality among patients on hemodialysis--a prospective study.

    Science.gov (United States)

    Jimenez, Zaida Noemy Cabrera; Pereira, Benedito Jorge; Romão, João Egidio; Makida, Sonia Cristina da Silva; Abensur, Hugo; Moyses, Rosa Maria Affonso; Elias, Rosilene Motta

    2012-01-01

    Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3) or abnormal (1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.

  4. Ankle-Brachial Index: A Simple Way to Predict Mortality among Patients on Hemodialysis - A Prospective Study

    Science.gov (United States)

    Jimenez, Zaida Noemy Cabrera; Pereira, Benedito Jorge; Romão, João Egidio; Makida, Sonia Cristina da Silva; Abensur, Hugo; Moyses, Rosa Maria Affonso; Elias, Rosilene Motta

    2012-01-01

    Background Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Findings We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9–1.3) or abnormal (1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. Conclusions An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population. PMID:22860108

  5. Ankle-brachial index: a simple way to predict mortality among patients on hemodialysis--a prospective study.

    Directory of Open Access Journals (Sweden)

    Zaida Noemy Cabrera Jimenez

    Full Text Available BACKGROUND: Ankle-brachial index (ABI can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. METHODOLOGY/PRINCIPAL FINDINGS: We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3 or abnormal (1.3. There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months. Age (1 year (hazard of ratio, 1.026; p = 0.014 and ABI abnormal (hazard ratio, 3.664; p = 0.001 were independently related to mortality in a multiple regression analysis. CONCLUSIONS: An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.

  6. Association of the Cardioankle Vascular Index and Ankle-Brachial Index with Carotid Artery Intima Media Thickness in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Tomohito Gohda

    2013-01-01

    Full Text Available The objectives of the present study are (1 to compare the cardioankle vascular index (CAVI, ankle-brachial index (ABI, and carotid artery intima-media thickness (CA-IMT between HD patients with and without type 2 diabetes (T2D or prevalence of cardiovascular (CV disease and (2 also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95.

  7. Association of the cardioankle vascular index and ankle-brachial index with carotid artery intima media thickness in hemodialysis patients.

    Science.gov (United States)

    Gohda, Tomohito; Gotoh, Hiromichi; Gotoh, Yoshikazu; Yamaguchi, Saori; Tomino, Yasuhiko

    2013-01-01

    The objectives of the present study are (1) to compare the cardioankle vascular index (CAVI), ankle-brachial index (ABI), and carotid artery intima-media thickness (CA-IMT) between HD patients with and without type 2 diabetes (T2D) or prevalence of cardiovascular (CV) disease and (2) also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95.

  8. [Concordance between 3 methods of measurement the ankle-brachial index to diagnose peripheral artery disease].

    Science.gov (United States)

    Forés, Rosa; Alzamora, Maria Teresa; Pera, Guillem; Torán, Pere; Urrea, Magalí; Heras, Antonio

    2014-10-21

    To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity. ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI<0.9, calcified if ABI≥1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values. Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for 100%, 97% using Omron and 95% using triple. ABI means (standard deviation) were: doppler 1.089 (0.236), Omron 1.082 (0.110), triple 1.146 (0.134), with poor agreement (ICC doppler/Omron=0.27, doppler/triple=0.13, and triple/Omron=0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron=0.22, doppler/triple=0.01, triple/Omron=0.17). Both triple and Omron were highly specific (97%) but had very low sensitivity (8 and 33%, respectively) compared to doppler. Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  9. Ankle-Brachial Index: A Simple Way to Predict Mortality among Patients on Hemodialysis - A Prospective Study

    OpenAIRE

    Zaida Noemy Cabrera Jimenez; Benedito Jorge Pereira; João Egidio Romão; Sonia Cristina da Silva Makida; Hugo Abensur; Rosa Maria Affonso Moyses; Rosilene Motta Elias

    2012-01-01

    Background: Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Finding...

  10. Correlation between ankle brachial index, carotid intima media thickness and left ventricular hypertrophy in patients on maintenance hemodialysis

    OpenAIRE

    Hayam A. Hebah; Khaled A. Fouad

    2012-01-01

    Introduction: Left ventricular hypertrophy (LVH) is a major cardiovascular risk factor in patients on maintenance hemodialysis (HD). The aim of our study is to find correlation between ankle brachial index (ABI), carotid intima media thickness (IMT) and left ventricular hypertrophy in this population. Patient and methods: Twenty consecutive patients on maintenance hemodialysis were studied, all clinical data were included and laboratory data recorded, three most recent pre-dialysis blood p...

  11. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis

    OpenAIRE

    Szu-Chia Chen; Mei-Yueh Lee; Jiun-Chi Huang; Ming-Chen Paul Shih; Jer-Ming Chang; Hung-Chun Chen

    2016-01-01

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcificati...

  12. Blood urea level and diabetes duration are independently associated with ankle-brachial index in type 2 diabetic patients.

    NARCIS (Netherlands)

    Bosevski, M.; Soedamah-Muthu, S.S.

    2012-01-01

    Aim

    The purpose of the study was to determine factors of ankle-brachial index (ABI) in a population of patients with type 2 diabetes and coronary artery disease.

    Material and methods

    370 patients (mean age 60.3 ± 8.3 years and diabetes duration 8.6 ± 6.2 years) with type 2

  13. Training to Perform Ankle-Brachial Index: Systematic Review and Perspectives to Improve Teaching and Learning.

    Science.gov (United States)

    Chaudru, S; de Müllenheim, P-Y; Le Faucheur, A; Kaladji, A; Jaquinandi, V; Mahé, G

    2016-02-01

    To conduct a systematic review focusing on the impact of training programs on ankle-brachial index (ABI) performance by medical students, doctors and primary care providers. Lower extremity peripheral artery disease (PAD) is a highly prevalent disease affecting ∼202 million people worldwide. ABI is an essential component of medical education because of its ability to diagnose PAD, and as it is a powerful prognostic marker for overall and cardiovascular related mortality. A systematic search was conducted (up to May 2015) using Medline, Embase, and Web of Science databases. Five studies have addressed the impact of a training program on ABI performance by either medical students, doctors or primary care providers. All were assigned a low GRADE system quality. The components of the training vary greatly either in substance (what was taught) or in form (duration of the training, and type of support which was used). No consistency was found in the outcome measures. According to this systematic review, only few studies, with a low quality rating, have addressed which training program should be performed to provide the best way of teaching how to perform ABI. Future high quality researches are required to define objectively the best training program to facilitate ABI teaching and learning. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  14. Ankle-Brachial Index and Long-Term (10 Years) Survival of Nondiabetic Hemodialysis Patients.

    Science.gov (United States)

    Bevc, Sebastjan; Purg, Darinka; Knehtl, Maša; Hren, Martin; Turnšek, Nina; Hojs, Nina; Zorman, Tadej; Dvoršak, Benjamin; Ekart, Robert; Hojs, Radovan

    2016-06-01

    Low (1.4) ankle brachial index (ABI) is associated with a higher cardiovascular (CV) mortality in the general and hemodialysis (HD) population. The aim of our study was to determine the impact of ABI on long-term survival of 52 non-diabetic HD patients. The ABI was determined using an automated, non-invasive waveform analysis device. Patients were divided into three groups: low (1.4) ABI. Patients were observed from the date of ABI measurement until their death or ten years. Survival analysis showed higher risk for CV death in HD patients with high ABI compared to normal ABI (log rank test P < 0.027). In Cox regression model adjusted for arterial hypertension, smoking, serum cholesterol and triglycerides, high ABI (P < 0.049) remained a predictor of mortality. The results indicate an association between ABI and long-term survival of non-diabetic HD patients and only high ABI was associated with higher CV mortality. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  15. Significant correlation between ankle-brachial index and vascular access failure in hemodialysis patients.

    Science.gov (United States)

    Chen, Szu-Chia; Chang, Jer-Ming; Hwang, Shang-Jyh; Tsai, Jer-Chia; Wang, Chuan-Sheng; Mai, Hsiu-Chin; Lin, Feng-Hsien; Su, Ho-Ming; Chen, Hung-Chun

    2009-01-01

    Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. The most common cause of VAF is stenosis at the arteriovenous anastomosis because of abnormal neointimal proliferation and extracellular matrix deposition. These two changes are also observed in the classic atheroma, which means atherosclerotic lesions and venous stenosis in VAF may share some similar pathogenic mechanisms. The ankle-brachial index (ABI) is a reliable marker for atherosclerosis. The aim of this study was to evaluate the relationship between ABI hemodialysis patients in one regional hospital were included except for six patients refusing ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. The study subjects were observed from arteriovenous access creation until the first episode of VAF. The mean observation period was 42.2 +/- 42.8 mo. The relative VAF risk was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. VAF episodes were recorded in 111 patients. In multivariate analysis, ABI hemodialysis patients by means of ABI may help to identify a high-risk group for VAF.

  16. Functional MRI in peripheral arterial disease: arterial peak flow versus ankle-brachial index.

    Directory of Open Access Journals (Sweden)

    Bas Versluis

    Full Text Available OBJECTIVES: The purpose of this study was to compare the success rate of successful arterial peak flow (APF and ankle-brachial index (ABI measurements in patients with suspected or known peripheral arterial disease (PAD. MATERIALS AND METHODS: 183 patients with varying degrees of PAD were included. All subjects underwent ABI measurements and MR imaging of the popliteal artery to determine APF. Proportions of patients with successful APF and ABI measurements were compared and the discriminative capability was evaluated. RESULTS: APF was successfully measured in 91% of the patients, whereas the ABI could be determined in 71% of the patients (p<0.01. Success rates of APF and ABI were significantly higher in patients with intermittent claudication (95% and 80%, respectively than in patients with critical ischemia (87% and 62%, respectively. CONCLUSIONS: Compared to the assessment of PAD severity with ABI, the success rate of MRI-based APF measurements in patients with a clinical indication for MRA is 20% higher, with similar discriminatory capacity for disease severity. Therefore, APF is an especially convenient and valuable measure to assess severity in PAD patients scheduled to undergo MR angiography to obtain additional functional information concerning the vascular status.

  17. Serum Phosphorus Levels and the Spectrum of Ankle-Brachial Index in Older Men

    Science.gov (United States)

    Meng, Jerry; Wassel, Christina L.; Kestenbaum, Bryan R.; Collins, Tracie C.; Criqui, Michael H.; Lewis, Cora E.; Cummings, Steve R.; Ix, Joachim H.

    2010-01-01

    A higher serum phosphorus level is associated with cardiovascular disease (CVD) events among community-living populations. Mechanisms are unknown. The ankle-brachial index (ABI) provides information on both atherosclerosis and arterial stiffness. In this cross-sectional study (2000–2002), the authors evaluated the association of serum phosphorus levels with low (phosphorus level was 3.2 mg/dL (standard deviation, 0.4), 6% had a low ABI, and 5% had a high ABI. Each 1-mg/dL increase in serum phosphorus level was associated with a 1.6-fold greater prevalence of low ABI (95% confidence interval (CI): 1.2, 2.1; P phosphorus with high ABI differed by chronic kidney disease (CKD) status (in persons with CKD, prevalence ratio = 2.96, 95% CI: 1.61, 5.45; in persons without CKD, prevalence ratio = 1.14, 95% CI: 0.81, 1.61; interaction P = 0.04). In conclusion, among community-living older men, higher phosphorus levels are associated with low ABI and are also associated with high ABI in persons with CKD. These associations may explain the link between serum phosphorus levels and CVD events. PMID:20237150

  18. [Ankle-brachial index measurement: Methods of teaching in French medical schools and review of literature].

    Science.gov (United States)

    Mahé, G

    2015-05-01

    The ankle-brachial index (ABI) can be measured to diagnose peripheral artery disease (PAD) and used as an independent marker of cardiovascular risk. What are the teaching methods for ABI in French medical schools? What are the data in the literature showing the link between and educational interventions and ABI competency? A questionnaire to assess how ABI is taught in the second and third cycles of French medical schools was sent to vascular medicine chairs of each faculty. A systematic review of the literature in PubMed was performed including articles that studied the effect of an educational intervention on this competency. Sixty-five percent of vascular medicine chairs (teachers) responded. ABI was taught in the second cycle in all medical schools. In 75% of schools, ABI was taught as part of lectures on PAD. Practical training was implemented in the second cycle in 20% of medical schools and in the third cycle in 60%. Teachers are statistically less satisfied with their way of teaching in the second cycle compared with the third cycle. Four articles have studied the effect of an educational intervention. Practical training improves student performance. Most of vascular medicine teachers used lectures to teach ABI. This type of teaching does not favor the development of this medical competency. The best way of teaching this competency should be addressed. Homogenization in the way ABI is taught would be necessary at national and international levels. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Cary, Theodore W.; Sultan, Laith R.; Sehgal, Chandra M., E-mail: sehgalc@uphs.upenn.edu [Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104 (United States); Reamer, Courtney B.; Mohler, Emile R. [Department of Medicine, Division of Cardiovascular Medicine, Section of Vascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104 (United States)

    2014-02-15

    Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Methods: Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced each phase of the cardiac cycle. Results: FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. Conclusions: FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging.

  20. Association of polymorphisms in NOS3 with the ankle-brachial index in hypertensive adults.

    Science.gov (United States)

    Kullo, Iftikhar J; Greene, M Todd; Boerwinkle, Eric; Chu, Jian; Turner, Stephen T; Kardia, Sharon L R

    2008-02-01

    We investigated the association of 14 polymorphisms in the endothelial nitric oxide synthase gene (NOS3) with ankle brachial index (ABI) in non-Hispanic white hypertensives belonging to hypertensive sibships. Subjects (n=659, mean age 61+/-9 years, 54% women) underwent measurement of ABI using a standard protocol, and the lowest of 4 ABI values was used in the analyses. Non-synonymous SNPs with a minor allele frequency >0.02 and tag SNPs selected based on a measure of linkage disequilibrium (r(2)) were genotyped. We reduced the chance of false positives by testing for replication, randomly selecting 1 hypertensive sib from each sibship to create Subset 1 (n=330) and Subset 2 (n=329). Multivariable linear regression models were used to assess the associations of single NOS3 polymorphisms and haplotypes with ABI after adjustment for covariates (age, sex, body mass index, smoking, total cholesterol, HDL cholesterol, and diabetes). Two specific SNPs in significant LD with each other (rs891512 and rs1808593) were significantly associated with ABI in both subsets. Based on a sliding window approach with a window size of 2, estimated haplotypes from 2 SNP pairs (rs2070744-rs3918226 and rs1808593-rs7830) were also significantly associated with ABI in both subsets. In conclusion, specific NOS3 SNPs and haplotypes were associated with inter-individual variation in ABI, a non-invasive marker of peripheral arterial disease, in replicate subsets of hypertensive subjects. These findings motivate further investigation of the role of NOS3 variants in determining susceptibility to peripheral arterial disease.

  1. The reliability of the ankle-brachial index in the Atherosclerosis Risk in Communities (ARIC study and the NHLBI Family Heart Study (FHS

    Directory of Open Access Journals (Sweden)

    Catellier Diane J

    2006-02-01

    Full Text Available Abstract Background A low ankle-brachial index (ABI is associated with increased risk of coronary heart disease, stroke, and death. Regression model parameter estimates may be biased due to measurement error when the ABI is included as a predictor in regression models, but may be corrected if the reliability coefficient, R, is known. The R for the ABI computed from DINAMAP™ readings of the ankle and brachial SBP is not known. Methods A total of 119 participants in both the Atherosclerosis Risk in Communities (ARIC study and the NHLBI Family Heart Study (FHS had repeat ABIs taken within 1 year, using a common protocol, automated oscillometric blood pressure measurement devices, and technician pool. Results The estimated reliability coefficient for the ankle systolic blood pressure (SBP was 0.68 (95% CI: 0.57, 0.77 and for the brachial SBP was 0.74 (95% CI: 0.62, 0.83. The reliability for the ABI based on single ankle and arm SBPs was 0.61 (95% CI: 0.50, 0.70 and the reliability of the ABI computed as the ratio of the average of two ankle SBPs to two arm SBPs was estimated from simulated data as 0.70. Conclusion These reliability estimates may be used to obtain unbiased parameter estimates if the ABI is included in regression models. Our results suggest the need for repeated measures of the ABI in clinical practice, preferably within visits and also over time, before diagnosing peripheral artery disease and before making therapeutic decisions.

  2. Ability of the Ankle Brachial Index and Brachial-Ankle Pulse Wave Velocity to Predict the 3-Month Outcome in Patients with Non-Cardioembolic Stroke.

    Science.gov (United States)

    Matsushima, Hayato; Hosomi, Naohisa; Hara, Naoyuki; Yoshimoto, Takeshi; Neshige, Shuichiro; Kono, Ryuhei; Himeno, Takahiro; Takeshima, Shinichi; Takamatsu, Kazuhiro; Shimoe, Yutaka; Ota, Taisei; Maruyama, Hirofumi; Ohtsuki, Toshiho; Kuriyama, Masaru; Matsumoto, Masayasu

    2017-11-01

    Both the ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are surrogates for atherosclerosis. In this study, we aimed to evaluate the ability of ABI and baPWV to predict stroke outcome in patients with first-ever non-cardioembolic stroke. This study included consecutive patients with first-ever non-cardioembolic stroke admitted within 1 week after onset to Ota Memorial Hospital between January 2011 and December 2013. Baseline characteristics and National Institutes of Health stroke scale scores at admission were noted. ABI and baPWV were evaluated within 5 days of admission. The patients were categorized according to ABI (cut-off 0.9) and baPWV (cut-off 1870 cm/s) determined using the receiver operation curve for poor outcome. Clinical outcomes were defined based on the modified Rankin scale (mRS) scores 3 months after stroke onset as good (0 and 1) or poor (2-6). A total of 861 patients were available for evaluation. ABI <0.9 and baPWV >1870 cm/s were associated with poor outcome in the univariate analysis (p<0.001 and p<0.001, respectively). After adjusting for factors that showed differences between groups, ABI <0.9 was associated with poor outcome. Among patients with ABI ≥ 0.9, higher baPWV showed a slight association with poor outcome after adjustment [odds ratio 1.46 (95% CI 0.95-2.27)]. Our study suggests that the stroke outcome can be predicted using ABI and to an extent using baPWV when ABI ≥ 0.9 in patients with non-cardioembolic stroke.

  3. Ankle-brachial index and brachial-ankle pulse wave velocity are associated with albuminuria in community-based Han Chinese.

    Science.gov (United States)

    Xu, Xiqi; He, Jinggui; Wang, Shuxia; Zhu, Ping; Chen, Qian; Zhang, Xiujin; Tao, Tao; Wang, Hao; Liu, Jianfeng; Wang, Haijun; Li, Xiaoying

    Our study aimed to explore whether the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were associated with albuminuria in community-based Han Chinese. Total 2127 subjects (860 men and 1267 women) aged 60 years and over were recruited in Beijing. Albuminuria was assessed by the urinary albumin-to-creatinine ratio (UACR) of ≥30 mg/g. BaPWV was divided by quartile. The logistic regression was used to determine the odds ratio (OR) and 95% confidence intervals (CIs) of ABI and baPWV with albuminuria. ABI was associated with albuminuria in the interaction model (OR 0.89, 95% CI 0.81-0.99 by every 0.1 unit increase of ABI), especially in hypertension (OR 0.82, 95% CI 0.73-0.92) and diabetes (OR 0.83, 95% CI 0.68-0.98) groups. BaPWV groups were also significantly associated with albuminuria, ORs of having albuminuria for baPWV quartile II, III, and IV were 1.02(0.65-1.52), 1.05(0.72-1.61), and 1.18(1.04-1.47) in the interaction model. For hypertension and diabetes patients, only the baPWV quartile IV group had higher OR. ABI and baPWV were associated with albuminuria after adjusting for other risk factors in Chinese community-based elderly Han population. The association of ABI with albuminuria was stronger in hypertension and diabetes patients.

  4. Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study

    Directory of Open Access Journals (Sweden)

    Jair Baptista Miguel

    Full Text Available Abstract Background: Abnormal ankle-brachial index (ABI has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years. Objective: This study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up. Methods: A total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: 1.3 and followed for a 60-month period. Results: The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, P<0.0001 and high ABI (60.8%, P= 0.025 than in the group with normal ABI (71.7%. Cox regression was used to evaluate the association between ABI and mortality, adjusting for potential confounders. Using normal ABI as reference, a low, but not a high ABI was found to be an independent risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62; 95% CI, 0.93-2.83, respectively. Conclusions: long-term survival rates of patients with either low or high ABI were lower than the one from those with normal ABI. However, after adjustment for potential confounders, only low ABI persisted as an independent risk factor for all-cause mortality among hemodialysis patients.

  5. Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study.

    Science.gov (United States)

    Hua, Simin; Loehr, Laura R; Tanaka, Hirofumi; Heiss, Gerardo; Coresh, Josef; Selvin, Elizabeth; Matsushita, Kunihiro

    2016-12-07

    Individuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. We examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987-1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990-92, 1993-95, and 1996-98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011. A total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91-1.00) ABI had 30-40% higher risk of future diabetes as compared to those with ABI of 1.10-1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91-1.00 (HR = 1.17, 95% CI 1.04-1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99-1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts. Low ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes.

  6. ANNUAL FORECAST IN PATIENTS WITH ACUTE ISCHEMIC STROKE: ROLE OF PATHOLOGICAL ANKLE-BRACHIAL INDEX

    Directory of Open Access Journals (Sweden)

    A. N. Sumin

    2016-01-01

    Full Text Available Aim. To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI.Material and methods. The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry.Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001. A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis.Conclusions. Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease. 

  7. Cardiovascular morbidity-mortality associated to ankle-brachial index in the general population.

    Science.gov (United States)

    Lahoz, C; Barrionuevo, M; García-Fernández, T; Vicente, I; García-Iglesias, M F; Mostaza, J M

    2014-01-01

    Abnormal ankle-brachial index (ABI) is associated with a high risk of cardiovascular disease. This study has aimed to investigate the association between low ABI and risk of cardiovascular death in a general population attended in a primary care center. A total of 1,361 volunteers aged between 60 and 79 years without any evidence of peripheral artery disease who attended a primary care center participated in the study. They underwent a complete physical examination, together with standard blood tests and ABI was determined. The participants were contacted by telephone 4 years later and asked about any cardiovascular problems for that period. Causes of death and hospitalization were confirmed in the medical records in the primary care center and/or hospital. Information was obtained about the clinical evolution of 1,300 participants (mean age 69.9 years, 38.2% men). Mean follow-up was 49.8 months. There were 13 cardiovascular death and 49 major cardiovascular events. Low ABI (<0.9) was associated with a significant higher risk of cardiovascular death (adjusted relative risk 6.83; 95% confidence interval 1.36-34.30, P=.020), and with a higher risk of major cardiovascular events (adjusted relative risk 2.42; 95% confidence interval 0.99-5.91, P=.051). High or uncompressible ABI was not associated with higher cardiovascular risk. A low ABI was associated with higher risk of cardiovascular death in the general population followed-up in a primary care center. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  8. Prognostic value of an increase in post-exercise ankle-brachial index.

    Science.gov (United States)

    Hammad, Tarek A; Hiatt, William R; Gornik, Heather L; Shishehbor, Mehdi H

    2017-06-01

    Prior studies have assessed the prognostic value of a decrease, not an increase, of the post-exercise ankle-brachial index (ABI) among patients with normal resting results. Thus, we sought to evaluate the prognostic significance of an increase in post-exercise ABI among these patients. From a single center vascular laboratory database between September 2005 and January 2010, we retrospectively identified 1437 consecutive patients with a normal resting ABI (1.00-1.40) and available post-exercise results. We classified them into group 1 (normal subjects; post-exercise ABI drop ⩽ 20%, 58%) and group 2 (post-exercise ABI increase, 42%) after excluding those with an ABI drop > 20% (peripheral artery disease) as they had known disease ( n=192). The primary outcome was to assess the risk of ischemic events, defined as a composite of unadjudicated death, stroke, or myocardial infraction (MACE). Associations between groups and outcomes were examined using multivariable Cox proportional hazard and propensity analyses. Both groups had similar prevalence of cardiovascular comorbidities. In unadjusted analysis, group 2 was more likely to have MACE ( p = 0.001). After adjusting for all baseline characteristics, an increase in post-exercise ABI compared to normal subjects was associated with a higher MACE (adjusted HR: 1.70, 95% CI: 1.14-2.53; p=0.009). This association stayed statistically significant after propensity matching (adjusted HR: 1.80, 95% CI: 1.17-2.76; p=0.007). This hypothesis-generating analysis showed that an increase in post-exercise ABI appears to identify a population with a higher risk for MACE. A prospective study of this association and mechanisms of risk should be conducted.

  9. Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients.

    Science.gov (United States)

    Jong, Ing-Chin; Tsai, Hung-Bin; Lin, Chien-Hung; Ma, Tsung-Liang; Guo, How-Ran; Hung, Peir-Haur; Hung, Kuan-Yu

    2017-08-01

    As both of peripheral arterial disease (PAD) and depression carried a poor prognosis in patients on maintenance hemodialysis (MHD), we investigated the correlation between the ankle-brachial index (ABI), an indicator of subclinical PAD, and symptoms of depression in patients on MHD. One hundred and twenty-nine patients on MHD (75 males and 54 females, mean age 64.8 ± 12 years) were enrolled in this cross-sectional study, which aimed at evaluating the relationship between symptoms of depression and ABI. Demographic as well as clinical and laboratory variables including status of diabetes, chronic hepatitis C infection, dialysis duration, Charlson comorbidity index (CCI), plasma levels of albumin, C-peptide, insulin, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin, and lipid profile were obtained. The self-administered beck depression inventory (BDI) was used to determine the presence or absence of symptoms of depression, and depression was defined as a BDI score ≧14. Multivariable-adjusted linear regression models were constructed to confirm the independent association of biologic parameters of symptoms of depression. Significance was defined as P < 0.05. Statistical analyses were performed using SPSS/Windows software (SPSS Science, v. 15.0, Chicago, IL). The mode of multivariate analysis showed that diabetes (β = 3.594; P = 0.040), hepatitis C infection (β = 4.057; P = 0.008), levels of serum albumin (β = -5.656; P = 0.024), C-peptide (β = -0.292; P = 0.002), ABI (β = -9.041; P = 0.031), and Ln-transformed hsCRP were significantly associated with BDI. Hepatitis C infection, serum levels of albumin, C-peptide, and ABI levels were found to be correlated with BDI (P < 0.05).

  10. Ankle-brachial index and cardiovascular mortality in nondiabetic hemodialysis patients.

    Science.gov (United States)

    Bevc, Sebastjan; Purg, Darinka; Turnšek, Nina; Hren, Martin; Hojs, Nina; Zorman, Tadej; Pečovnik-Balon, Breda; Dvoršak, Benjamin; Ekart, Robert; Hojs, Radovan

    2013-08-01

    Atherosclerosis is a leading cause of morbidity and mortality in hemodialysis (HD) patients. Low (1.40) ankle-brachial index (ABI) is known as a non-invasive diagnostic marker for generalized atherosclerosis associated with higher cardiovascular (CV) mortality in the general population. Less is known about associations between ABI and CV mortality in HD patients. The aim of our study was to determine the impact of the ABI on CV mortality in nondiabetic HD patients. Fifty-two nondiabetic HD patients (mean age 59 years, range 22 - 76 years) were enrolled in our study. Twenty-three (44%) were women and 29 (56%) men. The ABI was determined using an automated, non-invasive, waveform analysis device. All patients were divided according to the ABI into three groups: low ABI (1.4). The presence of arterial hypertension and smoking was established. Serum cholesterol (HDL and LDL) and triglycerides were measured by routine laboratory methods. Survival rates were analyzed using Kaplan-Meier survival curves. The Cox regression model was used to assess the influence of the ABI on CV outcomes. The model was adjusted for age, arterial hypertension, smoking, cholesterol and triglycerides. Mean ABI value was 1.2 ± 0.3 (range 0.2-2.2). Patients were observed from the date of the ABI measurement until their death or maximally up to 1620 days. Kaplan-Meier survival analysis showed that the risk for CV death was higher for HD patients with low and high ABI compared to normal ABI (log rank test: P < 0.006; P < 0.0001). In the adjusted Cox multivariable regression model low and high ABI (P < 0.011; P < 0.003) remained predictors of mortality in our patients. The results indicate a U-shaped association between the ABI and CV mortality in nondiabetic HD patients and showed that low and high ABI were directly associated with higher mortality of our patients. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  11. Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia

    Directory of Open Access Journals (Sweden)

    Chen Pamela Y

    2012-07-01

    Full Text Available Abstract Background The ankle brachial index (ABI is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists. Methods This study was a cross sectional survey which evaluated the perceptions of the ABI amongst registered podiatrists in Western Australia. The study sample was obtained from the register of podiatrists listed with the Podiatrists Registration Board of Western Australia. Podiatrists were contacted by telephone and invited to participate in a telephone questionnaire. Chi-square tests were performed to determine if there was a statistically significant relationship between use of the ABI and podiatrists’ profile which included: sector of employment; geographical location; and length of time in practice. Results There is a statistically significant relationship (p=0.004 between podiatrists’ profile and the use of ABI, with higher usage in the tertiary hospital setting than in private practice. Length of time spent in practice had no significant impact on ABI usage (p=0.098. Time constraints and lack of equipment were key limiting factors to performing the ABI, and no preferred technique was indicated. Conclusion Western Australian podiatrists agree that the ABI is a useful tool for lower limb vascular assessment, however, various factors influence uptake in the clinical setting. This study suggests that a podiatrists’ profile has a significant influence on the use of the ABI, which may be attributed to different patient types across the various settings. The influence of time spent in practice on ABI usage may be attributed to differences in clinical

  12. Invasive validation of a novel brachial cuff-based oscillometric device (SphygmoCor XCEL) for measuring central blood pressure.

    Science.gov (United States)

    Shoji, Toshihiro; Nakagomi, Atsushi; Okada, Sho; Ohno, Yuji; Kobayashi, Yoshio

    2017-01-01

    Studies have established the prognostic value of central SBP and pulse pressure (PP). The SphygmoCor XCEL (AtCor Medical, Sydney, Australia) device provides practical central blood pressure (BP) measurement for daily clinical use with its easy-to-use, operator-independent procedure. However, this device has not been validated against invasive measurement. Simultaneous oscillometric and high-fidelity invasive measurements of central SBP and PP were compared for 36 patients who underwent coronary arteriography. Invasive measurement of brachial BP was also performed. Oscillometrically measured brachial SBP and DBP were used for calibration. The differences between the invasive and the oscillometric measurements were -4.6 ± 9.9 mmHg for central SBP and -18.5 ± 10.6 mmHg for central PP (mean ± SD). We found strong correlation between the invasive and oscillometric measurements (central SBP and central PP, respectively: r = 0.91 and 0.89; slope, 1.28 and 1.38; both P pressure ranges, the bias was mainly due to calibration error rather than device-specific error because errors of the central measurements correlated well with those of brachial measurements (SBP and PP, respectively: r = 0.80 and 0.77; both P invasive measurements indicates that SphygmoCor XCEL warrants future investigations to determine the clinical validity of this device.

  13. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease.

    Science.gov (United States)

    Nam, Su Chung; Han, Seung Hwan; Lim, Sang Hyun; Hong, You Sun; Won, Je Hwan; Bae, Jae Ik; Jo, Joon

    2010-05-01

    We evaluated 158 legs from 79 consecutive patients who had undergone both ankle-brachial index (ABI) measurements and angiography for claudication symptoms between January 2007 and December 2008. The diagnosis of peripheral arterial disease (PAD) in the individual legs was established by angiography. Ankle-brachial index was considered abnormal if it was <0.9. The sensitivity and specificity of ABI was 61% and 87%, respectively. To assess the factors affecting the validity of ABI in the diagnosis of PAD, multivariate logistic regression analysis was conducted. The odds ratios (ORs) for the false negative result of ABI were 4.36 (95% confidence interval [CI] 1.36-13.92) in patients with diabetes mellitus (DM), 3.41 (95% CI 1.10-10.48) in patients with distal lesions, 3.02 (95% CI 1.07-8.49) in elderly patients, and 1.13 (95% CI 0.34-3.42) in patients with mild stenosis. Although ABI is the method of choice for the primary diagnosis of PAD, other supplementary investigations should be considered when there is clinical suspicion of PAD but an ABI <0.9.

  14. The association between cholesterol levels and brachial/aortic augmentation index versus cognitive status in patients with cardiovascular risk factors

    Directory of Open Access Journals (Sweden)

    Joacabine Catalin

    2012-01-01

    Full Text Available Cardiovascular pathology appears to have a major impact in cognitive decline, and early identification and correction of cardiovascular morbidity could have a major protective impact on cognitive functioning. However, it is not clear how the risk factors for vascular disease can also be risk factors for a general cognitive decline. Regarding cholesterol, its implications in cognitive decline are not very well understood, considering that a high level of cholesterol has been associated with both an increased and decreased risk of dementia. In the present context, we decided to study correlations between cholesterol concentration and the various subdomains of some main psychometric tests, such as MMSE (Mini-Mental State Examination and MoCA (The Montreal Cognitive Assessment, as well as some measurements for systemic arterial stiffness (brachial and aortic augmentation index and how they correlate with the aforementioned psychometric parameters. Our results provide additional evidence for a correlation between cholesterol levels and cognitive subdomains (with special focus on orientation, attention, recent memory and long-term memory. Additionally, a significant correlation was found between the brachial and aortic augmentation index and the results of both MMSE and MOCA tests.

  15. Brachial-ankle pulse wave velocity and the cardio-ankle vascular index as a predictor of cardiovascular outcomes in patients on regular hemodialysis.

    Science.gov (United States)

    Kato, Akihiko; Takita, Takako; Furuhashi, Mitsuyoshi; Maruyama, Yukitaka; Miyajima, Hiroaki; Kumagai, Hiromichi

    2012-06-01

    Brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) are both used to evaluate arterial stiffness. The aim of the present study is to determine whether baPWV or CAVI is superior as a marker of arterial stiffness in hemodialysis (HD) patients. Of 194 patients, 59 patients had been excluded from the study due to advanced age over 76 years old (n = 29), or abnormal ankle-brachial pressure index (ABI) (<0.90 or ≥1.30) (n = 30). We then followed the 135 patients (age: 60 ± 11 years, time on HD: 110 ± 93 months) for the 63 ± 4 (55-70) months. Thirty-two (23.7%) patients had expired, 22 of them of cardiovascular (CV) causes. There were 37 fatal and non-fatal CV events. Kaplan-Meier analysis revealed that the patients with the highest tertile of baPWV (≥16.6 m/s) had a significantly lower survival rate (P < 0.01) when compared with the second (13.4 ≤ baPWV < 16.6 m/s) and the lowest tertiles (<13.4 m/s). Cox hazards analysis after adjustment for comorbid risk factors revealed that the top tertile of baPWV was a determinant of CV death (hazards ratio [HR]: 16.9 [1.1-251.8], P < 0.05) In contrast, CAVI did not associate with CV mortality or events. These findings suggest that baPWV is superior to CAVI as a predictor of CV outcomes in patients on regular HD. © 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

  16. El índice tobillo-brazo como predictor de mortalidad vascular Ankle brachial index as indicator for vascular mortality

    Directory of Open Access Journals (Sweden)

    Juan José Arévalo Manso

    2012-06-01

    Full Text Available El índice tobillo-brazo (ITB es un parámetro que muestra la relación entre la tensión arterial sistólica de la extremidad superior y la extremidad inferior. Este indicador, ampliamente estudiado y presente en la bibliografía, se ha mostrado como excelente predictor de mortalidad tanto vascular como por causas generales cuando presenta valores fuera del rango establecido como normal (0,90-1,30. En dichas situaciones la utilidad del ITB reside en detectar precozmente la existencia de enfermedad arterial periférica (EAP durante su fase asintomática y servir como parámetro de corte para el establecimiento de medidas preventivas más contundentes antes de que el daño vascular existente se haga sintomático. Para el profesional de enfermería este parámetro constituye una potente herramienta de valoración, objetiva y cuantitativa, que permite seleccionar aquellos pacientes en los que es preciso potenciar al máximo los cuidados preventivos.The ankle-brachial index (ABI is a simple test showing the relationship between systolic blood pressure in the upper and the lower limbs. This parameter widely studied in literature has been reported as an excellent vascular and all-cause death predictor when exceeds the normal values (0.90-1.30. In such situation the ABI can early detect periferic arterial disease (PAD in asymptomatic phase and be a cutoff parameter to consider more aggressive preventive interventions before the existing vascular damage becomes symptomatic. This test is a powerful assessment tool for nurses to select those patients needing to maximize preventive cares. The nursing staff training for ABI measurement, the provision of suitable equipment by the Health Institutions and the development of reliable and more simple measurement methods are key issues that would facilitate its routinely and systematically use to improve the preventive strategy in vascular diseases.

  17. Different methods of calculating ankle-brachial index in mid-elderly men and women: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil

    Directory of Open Access Journals (Sweden)

    M. Miname

    Full Text Available The ankle-brachial index (ABI is a marker of subclinical atherosclerosis related to health-adverse outcomes. ABI is inexpensive compared to other indexes, such as coronary calcium score and determination of carotid artery intima-media thickness (IMT. Our objective was to identify how the ABI can be applied to primary care. Three different methods of calculating the ABI were compared among 13,921 men and women aged 35 to 74 years who were free of cardiovascular diseases and enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. The ABI ratio had the same denominator for the three categories created (the highest value for arm systolic blood pressure, and the numerator was based on the four readings for leg systolic blood pressure: the highest (ABI-HIGH, the mean (ABI-MEAN, and the lowest (ABI-LOW. The cut-off for analysis was ABI20% without the inclusion of ABI<1.0 was 4.9%. For ABI-HIGH, ABI-MEAN and ABI-LOW, the increase in percentage points was 0.3, 0.7, and 2.3%, respectively, and the relative increment was 6.1, 14.3, and 46.9%. In conclusion, all methods were acceptable, but ABI-LOW was more suitable for prevention purposes.

  18. Different methods of calculating ankle-brachial index in mid-elderly men and women: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

    Science.gov (United States)

    Miname, M; Bensenor, I M; Lotufo, P A

    2016-01-01

    The ankle-brachial index (ABI) is a marker of subclinical atherosclerosis related to health-adverse outcomes. ABI is inexpensive compared to other indexes, such as coronary calcium score and determination of carotid artery intima-media thickness (IMT). Our objective was to identify how the ABI can be applied to primary care. Three different methods of calculating the ABI were compared among 13,921 men and women aged 35 to 74 years who were free of cardiovascular diseases and enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ABI ratio had the same denominator for the three categories created (the highest value for arm systolic blood pressure), and the numerator was based on the four readings for leg systolic blood pressure: the highest (ABI-HIGH), the mean (ABI-MEAN), and the lowest (ABI-LOW). The cut-off for analysis was ABI20% without the inclusion of ABI<1.0 was 4.9%. For ABI-HIGH, ABI-MEAN and ABI-LOW, the increase in percentage points was 0.3, 0.7, and 2.3%, respectively, and the relative increment was 6.1, 14.3, and 46.9%. In conclusion, all methods were acceptable, but ABI-LOW was more suitable for prevention purposes.

  19. Periodontal disease and atherosclerosis from the viewpoint of the relationship between community periodontal index of treatment needs and brachial-ankle pulse wave velocity

    Directory of Open Access Journals (Sweden)

    Hoshi Keika

    2006-05-01

    Full Text Available Abstract Background It has been suggested that periodontal disease may be an independent risk factor for the development of atherosclerosis. However, the relationship between periodontal disease and atherosclerosis has not been fully elucidated. This study aimed to assess the effects of periodontal disease on atherosclerosis. Methods The study design was a cross-sectional study. Subjects were 291 healthy male workers in Japan. We used the Community Periodontal Index of Treatment Needs (CPITN score, average probing depth and gingival bleeding index (rate of bleeding gums to assess the severity of periodontal disease. We also used the Brachial-Ankle Pulse Wave Velocity (baPWV as the index for the development of atherosclerosis. Results The unadjusted odds ratio (OR of atherosclerosis in relation to the CPITN score was 1.41 [95% CI: 1.16–1.73]. However, after adjustment for age, systolic blood pressure and smoking, the CPITN score had no relationship with atherosclerosis (adjusted OR: 0.91 [0.68–1.20]. Conclusion Our results show no relationship between mild periodontal disease and atherosclerosis after appropriate adjustments.

  20. Relationship of lower extremity skin blood flow to the ankle brachial index in patients with peripheral arterial disease and normal volunteers.

    Science.gov (United States)

    Otah, Kenneth E; Otah, Eseroghene; Clark, Luther T; Salifu, Moro O

    2005-08-03

    Changes in posture of the lower extremities induce changes in skin blood flow, known as veno-arteriolar response (VAR). We investigated the relationship between ankle brachial index (ABI) and VAR in patients (ABInormal controls (ABI>1). We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change (extended-flexed/extended) in blood flow (VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure (PVAR) at which the VAR was similar to that in the flexed position was recorded. Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients (95.8% vs. 4.3%, p=0.001). VAR and PVAR were significantly lower in patients than controls (0.42+/-0.16 vs. 0.65+/-0.11 flux/min, p=0.001 and 29+/-8 vs. 48+/-9 mm Hg, p=0.001, respectively). There was significant correlation between ABI-post and VAR (r=0.6, p=0.01) and between the VAR and PVAR (r=0.8, p=0.001). VARblood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis.

  1. Association Between Chromosome 9p21 Variants and the Ankle-Brachial Index Identified by a Meta-Analysis of 21 Genome-Wide Association Studies

    NARCIS (Netherlands)

    Murabito, Joanne M.; White, Charles C.; Kavousi, Maryam; Sun, Yan V.; Feitosa, Mary F.; Nambi, Vijay; Lamina, Claudia; Schillert, Arne; Coassin, Stefan; Bis, Joshua C.; Broer, Linda; Crawford, Dana C.; Franceschini, Nora; Frikke-Schmidt, Ruth; Haun, Margot; Holewijn, Suzanne; Huffman, Jennifer E.; Hwang, Shih-Jen; Kiechl, Stefan; Kollerits, Barbara; Montasser, May E.; Nolte, Ilja M.; Rudock, Megan E.; Senft, Andrea; Teumer, Alexander; van der Harst, Pim; Vitart, Veronique; Waite, Lindsay L.; Wood, Andrew R.; Wassel, Christina L.; Absher, Devin M.; Allison, Matthew A.; Amin, Najaf; Arnold, Alice; Asselbergs, Folkert W.; Aulchenko, Yurii; Bandinelli, Stefania; Barbalic, Maja; Boban, Mladen; Brown-Gentry, Kristin; Couper, David J.; Criqui, Michael H.; Dehghan, Abbas; den Heijer, Martin; Dieplinger, Benjamin; Ding, Jingzhong; Doerr, Marcus; Espinola-Klein, Christine; Felix, Stephan B.; Ferrucci, Luigi; Folsom, Aaron R.; Fraedrich, Gustav; Gibson, Quince; Goodloe, Robert; Gunjaca, Grgo; Haltmayer, Meinhard; Heiss, Gerardo; Hofman, Albert; Kieback, Arne; Kiemeney, Lambertus A.; Kolcic, Ivana; Kullo, Iftikhar J.; Kritchevsky, Stephen B.; Lackner, Karl J.; Li, Xiaohui; Lieb, Wolfgang; Lohman, Kurt; Meisinger, Christa; Melzer, David; Mohler, Emile R.; Mudnic, Ivana; Mueller, Thomas; Navis, Gerjan; Oberhollenzer, Friedrich; Olin, Jeffrey W.; O'Connell, Jeff; O'Donnell, Christopher J.; Palmas, Walter; Penninx, Brenda W.; Petersmann, Astrid; Polasek, Ozren; Psaty, Bruce M.; Rantner, Barbara; Rice, Ken; Rivadeneira, Fernando; Rotter, Jerome I.; Seldenrijk, Adrie; Stadler, Marietta; Summerer, Monika; Tanaka, Toshiko; Tybjaerg-Hansen, Anne; Uitterlinden, Andre G.; van Gilst, Wiek H.; Vermeulen, Sita H.; Wild, Sarah H.; Wild, Philipp S.; Willeit, Johann; Zeller, Tanja; Zemunik, Tatijana; Zgaga, Lina; Assimes, Themistocles L.; Blankenberg, Stefan; Campbell, Harry; Boerwinkle, Eric; Cooke, John P.; de Graaf, Jacqueline; Herrington, David; Kardia, Sharon L. R.; Mitchell, Braxton D.; Murray, Anna; Muenzel, Thomas; Newman, Anne B.; Oostra, Ben A.; Rudan, Igor; Shuldiner, Alan R.; Snieder, Harold; van Duijn, Cornelia M.; Voelker, Uwe; Wright, Alan F.; Wichmann, H. -Erich; Wilson, James F.; Witteman, Jacqueline C. M.; Liu, Yongmei; Hayward, Caroline; Borecki, Ingrid B.; Ziegler, Andreas; North, Kari E.; Cupples, L. Adrienne; Kronenberg, Florian; Dorr, M.; Munzel, T.; Volker, U.

    Background-Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts.

  2. Cuff-Based Oscillometric Central and Brachial Blood Pressures Obtained Through ABPM are Similarly Associated with Renal Organ Damage in Arterial Hypertension.

    Science.gov (United States)

    Fernández-Llama, Patricia; Pareja, Júlia; Yun, Sergi; Vázquez, Susana; Oliveras, Anna; Armario, Pedro; Blanch, Pedro; Calero, Francesca; Sierra, Cristina; de la Sierra, Alejandro

    2017-12-04

    Central blood pressure (BP) has been suggested to be a better estimator of hypertension-associated risks. We aimed to evaluate the association of 24-hour central BP, in comparison with 24-hour peripheral BP, with the presence of renal organ damage in hypertensive patients. Brachial and central (calculated by an oscillometric system through brachial pulse wave analysis) office BP and ambulatory BP monitoring (ABPM) data and aortic pulse wave velocity (PWV) were measured in 208 hypertensive patients. Renal organ damage was evaluated by means of the albumin to creatinine ratio and the estimated glomerular filtration rate. Fifty-four patients (25.9%) were affected by renal organ damage, displaying either microalbuminuria (urinary albumin excretion ≥30 mg/g creatinine) or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Compared to those without renal abnormalities, hypertensive patients with kidney damage had higher values of office brachial systolic BP (SBP) and pulse pressure (PP), and 24-h, daytime, and nighttime central and brachial SBP and PP. They also had a blunted nocturnal decrease in both central and brachial BP, and higher values of aortic PWV. After adjustment for age, gender, and antihypertensive treatment, only ABPM-derived BP estimates (both central and brachial) showed significant associations with the presence of renal damage. Odds ratios for central BP estimates were not significantly higher than those obtained for brachial BP. Compared with peripheral ABPM, cuff-based oscillometric central ABPM does not show a closer association with presence of renal organ damage in hypertensive patients. More studies, however, need to be done to better identify the role of central BP in clinical practice. © 2017 The Author(s). Published by S. Karger AG, Basel.

  3. Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study.

    Science.gov (United States)

    Nishimura, Hitoshi; Miura, Takashi; Minamisawa, Masatoshi; Ueki, Yasushi; Abe, Naoyuki; Hashizume, Naoto; Mochidome, Tomoaki; Harada, Mikiko; Shimizu, Kunihiko; Shoin, Wataru; Yoshie, Koji; Oguchi, Yasutaka; Ebisawa, Soichiro; Motoki, Hirohiko; Izawa, Atsushi; Koyama, Jun; Ikeda, Uichi; Kuwahara, Koichiro

    2016-01-01

    Reduced ankle-brachial index (ABI) is a predictor of cardiovascular events. However, the significance of high ABI remains poorly understood. This study aimed to assess the characteristics and outcomes of patients with high ABI. The IMPACT-ABI study was a retrospective cohort study that enrolled and examined ABI in 3,131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 2,419 patients were identified and stratified into two groups: high ABI (> 1.4; 2.6%) and normal ABI (1.0-1.4; 97.3%). The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE), including cardiovascular-associated death, myocardial infarction, and stroke. Compared with the normal ABI group, patients in the high ABI group showed significantly lower body mass index (BMI) and hemoglobin level, but had higher incidence of chronic kidney disease and hemodialysis. Multivariate logistic regression analysis revealed that hemodialysis was the strongest predictor of high ABI (odds ratio, 6.18; 95% confidence interval (CI), 3.05-12.52; P hemodialysis are more frequent in patients with high ABI. Hemodialysis is the strongest predictor of high ABI. High ABI is a parameter that independently predicts MACE.

  4. Is plasma-soluble CD36 associated with density of atheromatous plaque and ankle-brachial index in early-onset coronary artery disease patients?

    Science.gov (United States)

    Rać, Monika; Krzystolik, Andrzej; Rać, Michał; Safranow, Krzysztof; Dziedziejko, Violetta; Goschorska, Marta; Poncyljusz, Wojciech; Chlubek, Dariusz

    2016-01-01

    CD36 is a major macrophage scavenger receptor for oxidised low-density lipoprotein particles. Soluble CD36 (sCD36) is circulating as a ligand-bound complex and may be present in microparticles shed from cells such as platelets, monocytes/macrophages, or adipocytes. Positive association of plasma sCD36 with insulin resistance has been reported, and it has been proposed that sCD36 might represent a marker of macrophage activation and inflammation leading to atherosclerosis. Recently we have identified an association between CD36 polymorphism and low thickness of atheromatous plaque, suggesting its protective effect against atherosclerosis development. To obtain insight into the relationship between plasma concentration of sCD36 and radiological parameters of atherosclerosis in patients with early-onset coronary artery disease (CAD). The study group comprised 70 clinically stable patients (18 women and 52 men) with early CAD (aged no more than 50 years for men and 55 years for women). Fasting blood sample was taken for serum glucose, lipid profile, ApoA1, ApoB, Lp(a), and plasma sCD36 protein measurements. Each subject's weight, height, waist and hip circumference, and systolic and diastolic blood pressure were measured, and the body mass index, waist-to-hip ratio, and mean arterial pressure were calculated. Doppler ultrasound examinations of carotid and peripheral arteries were performed in all patients. Thickness of intima-media complex (IMC) of common carotid (CCA) and brachial arteries, as well as density and thickness of atheromatous plaque at CCA bifurcation, were measured with M'Ath programme. Plasma concentrations of CD36 antigen were measured by ELISA. Correlations between quantitative variables and sCD36 plasma concentration were assessed with the Spearman rank correlation coefficient (Rs). Associations between qualitative variables and sCD36 plasma concentration were tested with the Mann-Whitney U test. We observed no significant correlations between sCD36

  5. Association of diabetes mellitus with decline in ankle-brachial index among patients on hemodialysis: A 6-year follow-up study.

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Mai, Hsiu-Chin; Kuo, Po-Lin; Chang, Jer-Ming; Chen, Hung-Chun; Yang, Yi-Hsin

    2017-01-01

    Peripheral artery occlusive disease is common among diabetes mellitus (DM) and end-stage renal disease patients, and tends to progress faster and lead to worse outcomes. This study compared the association of DM with the decline in ankle-brachial index (ABI) among patients on hemodialysis (HD). This was a longitudinal analysis of ABI in HD patients from 2009 to 2015. Medical records and yearly ABI values were obtained. A longitudinal mixed-model analysis was used to evaluate ABI changing trends while accounting for within-patients correlation. There were 296 patients on HD in the period of 2009-2015. In a 6-year follow-up, those with DM had a more rapid ABI decline compared to non-DM patients (slopes: -0.014 vs. 0.010 per year, interaction p < 0.001). In DM patients, female sex, high pulse pressure, high triglyceride, low creatinine, and high uric acid were associated with a decrease in ABI. In non-DM patients, old age, high pulse pressure, high low-density lipoprotein cholesterol, and high uric acid were associated with a decreased in ABI. There were 49.6% of patients with a normal ABI experienced a decrease at least 0.1 of ABI from baseline, and 35.3% had a final ABI < 0.9 in patients with a baseline ABI ≥ 0.9 (n = 232). In this study, DM patients on HD tend to develop a more rapid decline in ABI than non-DM patients on HD. Age, sex, pulse pressure, lipid profile, creatinine, and uric acid are associated with a decreased in ABI.

  6. Study on Effect of Electromagnetic Therapy on Nitric Oxide Level and Ankle Brachial Index of Type 2 Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Touraj Rahmani

    2014-09-01

    Full Text Available Background & objectives: Type 2 diabetes mellitus results in vascular dysfunction and reduction of nitric oxide (NO level. In this study the effect of electromagnetic field (EMF on NO level, an effective factor in increasing blood flow, and on ankle brachial index (ABI as a n index of lower extremity blood flow in type 2 diabetic patients, have been investigated.   Methods: This study was a randomized controlled clinical trial carried out in Imam Khomeini hospital of Ardabil and Mehr physiotherapy center in 2013. Thirty diabetic patients after initial pilot study participated in this experiment based on inclusion and exclusion criteria. Then, they were randomly assigned into two equal groups, electromagnetic therapy and control. The baseline levels of ABI and NO of both groups were measured. Patients in electromagnetic group were exposed to 10 Hz EMF radiation (with intensity of 8 mT together with scanning lower limbs (three sessions per week, and 40 minutes per session for 8 weeks. The control group did not receive any treatment. After eight weeks, the amount of ABI and NO level were recorded. For statistical analysis paired t-test and independent t-test were used in SPSS 19 software.   Results: Statistical analysis showed significant differences between pre (1.009±0.02 and post (1.052±0.02 measurement of ABI of diabetic patient after applying magnetic field ( P = 0.013. However, there was no significant difference between p and after measurement of ABI and NO level in controlgroup and also NO level in magnet groups ( P> 0.05. Difference between pre and post therapy of ABI in electromagnetic group (0.05±0.01 showed significant increase compared with control group (0.004±0.003 ( P = 0.001.   Conclusion: Increase in ABI after 8 weeks electromagnetic therapy could be considered as an accretion index in blood flow in lower extremity.

  7. Brachial plexus

    Science.gov (United States)

    The brachial plexus is a group of nerves that run from the lower neck through the upper shoulder area. These nerves ... Damage to the brachial plexus nerves can cause muscle and sensation ... associated with pain in the same area. Symptoms may include: ...

  8. Association of interleg difference of ankle brachial index with overall and cardiovascular mortality in chronic hemodialysis patients.

    Science.gov (United States)

    Lin, Chin-Yao; Leu, Jyh-Gang; Fang, Yu-Wei; Tsai, Ming-Hsien

    2015-02-01

    The ankle-brachial index (ABI) is associated with peripheral vascular atherosclerosis, adverse cardiovascular outcomes, and all-cause mortality. However, there were limited data available on studying the effect of interleg ABI difference. We investigated the association of the interleg ABI difference with overall and cardiovascular mortality in chronic hemodialysis in a retrospective observational cohort of 369 Taiwanese patients undergoing chronic hemodialysis. An interleg ABI difference of ≥0.15 in hemodialysis patients had significant predictive power for all-cause and cardiovascular mortality in crude analysis. The hazard ratio (HR) for all-cause mortality was 3.00 [95% confidence interval (CI), 1.91-4.71]; the HR for cardiovascular mortality was 3.13 (95% CI, 1.82-5.38). After adjustment for confounding variables, this difference continued to have significant predictive power for all-cause mortality but lost its predictive power for fatal cardiac outcome. ABI hemodialysis patients. Moreover, in the subgroup analysis, we found that this difference was an independent factor for overall and cardiovascular mortality, particularly in elder patients, female patients, or those with ABI hemodialysis patients but it may affect cardiovascular mortality through the effect of peripheral vascular disease.

  9. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis.

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Shih, Ming-Chen Paul; Chang, Jer-Ming; Chen, Hung-Chun

    2016-09-09

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI 4 or ≤4 according to receiver operating characteristic curve. Those with an ABI  4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD.

  10. Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study

    Directory of Open Access Journals (Sweden)

    Bendermacher Bianca LW

    2012-07-01

    Full Text Available Abstract Background Screening with ankle-brachial index (ABI measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the corresponding number needed to screen, including the required time investment, and the feasibility of ABI performance, was assessed. Methods An observational study was performed in the setting of 955 general practices in the Netherlands. Overall, 13,038 subjects of ≥55 years presenting with symptoms of intermittent claudication and/or presenting with ≥ one vascular risk factor were included. Several guidelines recommend the ABI as an additional measurement in selected populations for risk assessment for cardiovascular morbidity. Results Screening of the overall population of ≥50 years results in ≈862 subjects per general practice who should be screened, resulting in a time-requirement of approximately 6 weeks of full time work. Using an existing clinical prediction model, 247 patients per general practice should be screened for PAD by ABI measurement. Conclusion Screening the entire population of ≥50 years will in our opinion not be feasible in general practice. A more rationale and efficient approach might be screening of subsets of the population of ≥55 years based on a clinical prediction model.

  11. Ankle-Brachial Index Is a Powerful Predictor of Renal Outcome and Cardiovascular Events in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Fu-An Chen

    2012-01-01

    Full Text Available Ankle-brachial index (ABI is an accurate tool to diagnose peripheral arterial disease. The aim of this study was to evaluate whether ABI is also a good predictor of renal outcome and cardiovascular events in patients with chronic kidney disease (CKD. We enrolled 436 patients with stage 3–5 CKD who had not been undergoing dialysis. Patients were stratified into two groups according to the ABI value with a cut point of 0.9. The composite renal outcome, including doubling of serum creatinine level and commencement of dialysis, and the incidence of cardiovascular events were compared between the two groups. After a median follow-up period of 13 months, the lower ABI group had a poorer composite renal outcome (OR=2.719, P=0.015 and a higher incidence of cardiovascular events (OR=3.260, P=0.001. Our findings illustrated that ABI is a powerful predictor of cardiovascular events and renal outcome in patients with CKD.

  12. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    Science.gov (United States)

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-01-01

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s revascularization (p revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization. PMID:25993299

  13. Brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Satish V Khadilkar

    2013-01-01

    Full Text Available Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN, often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise.

  14. How to assess mean blood pressure properly at the brachial artery level

    NARCIS (Netherlands)

    Bos, Willem J. W.; Verrij, Elisabeth; Vincent, Hieronymus H.; Westerhof, Berend E.; Parati, Gianfranco; van Montfrans, Gert A.

    2007-01-01

    OBJECTIVES: Mean arterial pressure at the upper arm is traditionally calculated by adding one-third of the pulse pressure to the diastolic pressure. We questioned the general validity of this formula. METHODS: We used previously recorded resting intrabrachial pressure and Riva-Rocci Korotkoff blood

  15. How to become proficient in performance of the resting ankle-brachial index: Results of the first randomized controlled trial.

    Science.gov (United States)

    Donnou, Céline; Chaudru, Ségolène; Stivalet, Olivier; Paul, Eunice; Charasson, Marie; Selli, Jean-Marc; Mauger, Chadi; Chapron, Anthony; Le Faucheur, Alexis; Jaquinandi, Vincent; Mahé, Guillaume

    2017-11-01

    The resting ankle-brachial index (ABI) is a first-line test to diagnose peripheral artery disease (PAD). No randomized controlled trial (RCT) has yet been conducted to determine the best teaching method to become proficient in the ABI procedure. We conducted a monocentric RCT to determine whether didactic learning alone or didactic learning combined with experiential learning improved proficiency in the ABI procedure. Medical students ( n = 30) received didactic learning, including (i) a presentation of the ABI guidelines and (ii) a video demonstration. Each student was then randomized into two groups ('no experiential learning group' and 'experiential learning group'). An initial evaluation was performed after the didactic learning and a final evaluation at the end of the intervention. A student was considered to be proficient when he or she performed a correct ABI procedure on a healthy individual and a patient. The correct procedure corresponds to (i) following guidelines and (ii) a difference in ABI measurement between a vascular specialist and a student of ≤ 0.15. No student was proficient at the initial evaluation. At the final evaluation, in the didactic learning group, the number of proficient students was not improved compared with the initial evaluation (0/10 vs 1/10). In the experiential learning group, the number of proficient students was significantly improved (0/20 vs 11/20; p < 0.05). At the final evaluation, there was a significant difference between the number of proficient students depending on their learning group. In conclusion, didactic learning alone is insufficient to gain proficiency in the ABI procedure. Combining didactic learning with experiential learning significantly improved the students' proficiency.

  16. [A survey of ankle-brachial index among natural population in Shanghai and Inner Mongolia Autonomous Region].

    Science.gov (United States)

    Xie, Xiao-liang; Xing, Yan; Li, Jue; Hu, Da-yi

    2012-10-01

    To investigate epidemiological characteristics and differences in ankle-brachial index (ABI) among the natural population in Shanghai and Inner Mongolia, and to observe the prevalence of lower extremity peripheral arterial disease (PAD). A total of 2604 volunteers from Shanghai and Inner Mongolia were selected by stratified cluster random sample. ABI was measured and related data were collected. The ABI value in Shanghai was 1.074 ± 0.095, while it was 1.062 ± 0.075 in Inner Mongolia (P Mongolia (P Mongolia (P > 0.05). For females, the ABI value in Shanghai was 1.073 ± 0.089, while it was 1.052 ± 0.070 in Inner Mongolia (P Mongolia (P Mongolia (P Mongolia were 1.037 ± 0.082 and 1.055 ± 0.068, respectively (P Mongolia were 7.6% and 1.2%, respectively (P Mongolia in both age group of 50 - 69 years and ≥ 70 years (all P values > 0.05). The ABI value in Shanghai is higher than that in Inner Mongolia and the prevalence of lower extremity PAD in both males and females in Shanghai is significantly higher than that in Inner Mongolia. But they are lower than the level of western countries. In different age groups, the difference of the prevalence of lower extremity PAD between Shanghai and Inner Mongolia is only displayed in the age group of < 50 years, which may be related to the limited sample size. The natural population in Shanghai exposed artery atherosclerotic disease risk factors may increase and we need to pay more attention to the lower extremity PAD.

  17. Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study.

    Science.gov (United States)

    Arroyo, David; Betriu, Angels; Valls, Joan; Gorriz, Jose L; Pallares, Vicente; Abajo, Maria; Gracia, Marta; Valdivielso, Jose Manuel; Fernandez, Elvira

    2017-03-01

    The ankle-brachial index (ABI) is widely used to diagnose subclinical peripheral artery disease (PAD) in the general population, but data assessing its prevalence and related factors in different chronic kidney disease (CKD) stages are scarce. The aim of this study is to evaluate the prevalence and associated factors of pathological ABI values in CKD patients. NEFRONA is a multicentre prospective project that included 2445 CKD patients from 81 centres and 559 non-CKD subjects from 9 primary care centres across Spain. A trained team collected clinical and laboratory data, performed vascular ultrasounds and measured the ABI. PAD prevalence was higher in CKD than in controls (28.0 versus 12.3%, P < 0.001). Prevalence increased in more advanced CKD stages, due to more patients with an ABI ≥1.4, rather than ≤0.9. Diabetes was the only factor predicting both pathological values in all CKD stages. Age, female sex, carotid plaques, higher carotid intima-media thickness, higher high-sensitivity C-reactive protein (hsCRP) and triglycerides, and lower 25-hydroxi-vitamin D were independently associated with an ABI ≤0.9. Higher phosphate and hsCRP, lower low-density lipoprotein (LDL)-cholesterol and dialysis were associated with an ABI ≥1.4. A stratified analysis showed different associated factors in each CKD stage, with phosphate being especially important in earlier CKD, and LDL-cholesterol being an independent predictor only in Sage 5D CKD. Asymptomatic PAD is very prevalent in all CKD stages, but factors related to a low or high pathological ABI differ, revealing different pathogenic pathways. Diabetes, dyslipidaemia, inflammation and mineral-bone disorders play a role in the appearance of PAD in CKD.

  18. Arterial stiffness in patients after Kawasaki disease without coronary artery involvement: Assessment by performing brachial ankle pulse wave velocity and cardio-ankle vascular index.

    Science.gov (United States)

    Nakagawa, Ryo; Kuwata, Seiko; Kurishima, Clara; Saiki, Hirofumi; Iwamoto, Yoichi; Sugimoto, Masaya; Ishido, Hirotaka; Masutani, Satoshi; Senzaki, Hideaki

    2015-08-01

    It remains unclear whether systemic arterial beds other than the coronary arteries are truly healthy in patients without coronary artery lesions (CAL) after Kawasaki disease (KD). We tested the hypothesis that patients with KD without echocardiographic evidence of CAL during the acute phase of the disease have abnormal mechanical properties in systemic arteries later. We studied 201 consecutive patients with KD (age 2-23 years, mean 10±4 years; 109 male, 92 female) without CAL during the acute phase. Data were compared with those in 129 control subjects (age 2-25 years, mean 10±4 years; 73 male, 56 female; control group). We examined arterial stiffness by using the brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI). The baPWV in the KD group was significantly higher than that in the control group (913±121cm/s vs. 886±135cm/s, p=0.04). In contrast, there was no significant difference in CAVI (4.0±1.0 vs. 4.2±1.0, p=0.9) between the two groups. Multivariate analysis indicated a highly significant difference in baPWV (higher baPWV in patients with KD than in controls, p=0.004), after controlling for age, gender, body height and weight, and systolic and diastolic blood pressure, but no difference in CAVI between the groups. Years after KD occurs in patients without apparent CAL during the acute phase, there is a small but significant change in systemic arterial properties, characterized by increased wall stiffness. The clinical importance of these findings must be clarified by performing long-term follow-up studies. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  19. Lower Mitochondrial Energy Production of the Thigh Muscles in Patients With Low-Normal Ankle-Brachial Index.

    Science.gov (United States)

    AlGhatrif, Majd; Zane, Ariel; Oberdier, Matt; Canepa, Marco; Studenski, Stephanie; Simonsick, Eleanor; Spencer, Richard G; Fishbein, Kenneth; Reiter, David; Lakatta, Edward G; McDermott, Mary M; Ferrucci, Luigi

    2017-08-30

    Lower muscle mitochondrial energy production may contribute to impaired walking endurance in patients with peripheral arterial disease. A borderline ankle-brachial index (ABI) of 0.91 to 1.10 is associated with poorer walking endurance compared with higher ABI. We hypothesized that in the absence of peripheral arterial disease, lower ABI is associated with lower mitochondrial energy production. We examined 363 men and women participating in the Baltimore Longitudinal Study of Aging with an ABI between 0.90 and 1.40. Muscle mitochondrial energy production was assessed by post-exercise phosphocreatine recovery rate constant (kPCr) measured by phosphorus magnetic resonance spectroscopy of the left thigh. A lower post-exercise phosphocreatine recovery rate constant reflects decreased mitochondria energy production.The mean age of the participants was 71±12 years. A total of 18.4% had diabetes mellitus and 4% were current and 40% were former smokers. Compared with participants with an ABI of 1.11 to 1.40, those with an ABI of 0.90 to 1.10 had significantly lower post-exercise phosphocreatine recovery rate constant (19.3 versus 20.8 ms-1, P=0.015). This difference remained significant after adjusting for age, sex, race, smoking status, diabetes mellitus, body mass index, and cholesterol levels (P=0.028). Similarly, post-exercise phosphocreatine recovery rate constant was linearly associated with ABI as a continuous variable, both in the ABI ranges of 0.90 to 1.40 (standardized coefficient=0.15, P=0.003) and 1.1 to 1.4 (standardized coefficient=0.12, P=0.0405). An ABI of 0.90 to 1.10 is associated with lower mitochondrial energy production compared with an ABI of 1.11 to 1.40. These data demonstrate adverse associations of lower ABI values with impaired mitochondrial activity even within the range of a clinically accepted definition of a normal ABI. Further study is needed to determine whether interventions in persons with ABIs of 0.90 to 1.10 can prevent subsequent

  20. Brachial plexopathy

    DEFF Research Database (Denmark)

    Jepsen, Jørgen Riis

    2015-01-01

    or days/week, most physical exposures, in particular upper limb posture and repetition, were significant risk indicators with clear dose–response relationships. These findings were supported by psychophysical responses that also identified perceived work pace and the use of force as risk indicators...... occupational physical exposures and brachial plexopathy. Methods 80 patients with brachial plexopathy according to defined criteria and 65 controls of similar age and sex without upper limb complaints were recruited by general practitioners. Patients and controls completed a questionnaire on physical....... The identified psychosocial relations were limited to measures reflecting physical exposures. Conclusions While the identified risk indicators have previously been associated to upper limb symptoms as well as to diagnosed disorders other than brachial plexopathy, this study indicates an association between...

  1. Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia.

    Science.gov (United States)

    Lakhal, Karim; Martin, Maëlle; Ehrmann, Stephan; Faiz, Sofian; Rozec, Bertrand; Boulain, Thierry

    2017-09-27

    Arrhythmia-induced beat-to-beat variability of blood pressure (BP) is deemed to hinder the reliability of non-invasive oscillometric measurements (NIBP) but few data support this belief. We assessed the impact of arrhythmia on a NIBP device never tested for this purpose. We compared, in intensive care unit patients with and without arrhythmia, the agreement between three pairs of NIBP (Infinity™ Delta monitor, Dräger medical systems) and invasive readings. For systolic, diastolic and mean BP, the mean bias between NIBP and invasive measurements was not higher, in 89 patients with arrhythmia, than that observed in 127 patients with regular rhythm (p = 0.93 for mean BP). Averaging three measurements overcame the higher within-subject variability of NIBP measurements during arrhythmia, and yielded similar agreement between the two techniques in patients with arrhythmia and with regular rhythm. The international organization for standardization criteria (mean bias invasive BP invasive BP invasive BP > 140 mmHg) by NIBP was similar during arrhythmia and regular rhythm [areas under the receiver operating characteristic curves (AUCROC) of 0.88-0.92, p > 0.13]. The detection of a 10% increase in mean invasive BP after cardiovascular intervention was also associated with similar AUCROCs between the two groups. Provided that triplicates are averaged, the agreement between NIBP measured with the tested device and invasive measurements was not worse during arrhythmia than during regular rhythm.

  2. Genetic determinants of the ankle-brachial index : A meta-analysis of a cardiovascular candidate gene 50K SNP panel in the candidate gene association resource (CARe) consortium

    NARCIS (Netherlands)

    Wassel, Christina L.; Lamina, Claudia; Nambi, Vijay; Coassin, Stefan; Mukamal, Kenneth J.; Ganesh, Santhi K.; Jacobs, David R.; Franceschini, Nora; Papanicolaou, George J.; Gibson, Quince; Yanek, Lisa R.; van der Harst, Pim; Ferguson, Jane F.; Crawford, Dana C.; Waite, Lindsay L.; Allison, Matthew A.; Criqui, Michael H.; McDermott, Mary M.; Mehra, Reena; Cupples, L. Adrienne; Hwang, Shih-Jen; Redline, Susan; Kaplan, Robert C.; Heiss, Gerardo; Rotter, Jerome I.; Boerwinkle, Eric; Taylor, Herman A.; Eraso, Luis H.; Haun, Margot; Li, Mingyao; Meisinger, Christa; O'Connell, Jeffrey R.; Shuldineri, Alan R.; Tybjaerg-Hansen, Anne; Frikke-Schmidt, Ruth; Kollerits, Barbara; Rantner, Barbara; Dieplinger, Benjamin; Stadler, Marietta; Mueller, Thomas; Haltmayer, Meinhard; Klein-Weigel, Peter; Summerer, Monika; Wichmann, H. -Erich; Asselbergs, Folkert W.; Navis, Gerjan; Mateo Leach, Irene; Brown-Gentry, Kristin; Goodloe, Robert; Assimes, Themistocles L.; Becker, Diane M.; Cooke, John P.; Absher, Devin M.; Olin, Jeffrey W.; Mitchell, Braxton D.; Reilly, Muredach P.; Mohler, Emile R.; North, Kari E.; Reiner, Alexander P.; Kronenberg, Florian; Murabito, Joanne M.

    Background: Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of similar to 50,000 SNPs across similar to

  3. Combination of high ankle-brachial index and hard coronary heart disease Framingham Risk Score in predicting the risk of ischemic stroke in general population.

    Science.gov (United States)

    Zhang, Yinyin; Chen, Jie; Zhang, Kun; Wang, Tong; Kong, Minyi; Chen, Renhua; Liu, Yu; Chen, Jianping; Wang, Zhiyu; Wang, Jingfeng; Huang, Hui

    2014-01-01

    Our previous study showed that the patients with more metabolic risk factors had higher risk of high ankle-brachial index (ABI), but the relationship between high ABI and the risk of severe cardiovascular and cerebrovascular diseases is still under debate. This study aims to evaluate this association in the general population. 1486 subjects of South China were recruited in the study. 61 subjects were defined as high ABI group (ABI≥1.3) and 65 subjects were randomly selected as normal ABI group (0.9smoking were proved to be the independent factors and effective predictors for high ABI (P<0.05). In conclusion, high ABI combined with high HCHD FRS should be a potential predictor of ischemic stroke in the general population of South China.

  4. Radiographic assessment of vascular calcification, aortic pulse wave velocity, ankle-brachial index and fibroblast growth factor-23 in chronic hemodialysis patients.

    Science.gov (United States)

    Breznik, Silva; Ekart, Robert; Hren, Martin; Rupreht, Mitja; Balon, Breda Pečovnik

    2013-08-01

    Vascular calcification is a frequent complication of chronic kidney disease and end stage renal disease. In both the general population and patients with end stage renal disease, vascular calcification is related to arterial stiffness and is a predictor of cardiovascular morbidity and mortality. Various diagnostic methods are currently used to assess vascular calcification. There is a preference for simple, reliable methods that can be used in daily practice. Therefore, several imaging and laboratory methods are investigated. Twenty-eight patients with mean age of 62 years on chronic hemodialysis were enrolled in the study. The mean duration of hemodialysis treatment was 70 months (range 3 to 350 months). Vascular calcification was assessed with coronary computed tomography and lateral lumbar, pelvic and hand radiographs. Vascular stiffness was evaluated using aortic pulse wave velocity and ankle-brachial index measurements, and finally serum levels of fibroblast growth factor-23 were followed. A statistically significant correlation was demonstrated between all the following parameters: coronary artery calcification score, aortic pulse wave velocity, abdominal aortic calcification score, simple vascular calcification scores in pelvis and hand. A statistically significant correlation of ankle-brachial index >1.3 to coronary artery calcification score was found. There was no correlation between the previous parameters and fibroblast growth factor-23. The results of our study indicate that simple imaging methods could provide confident vascular damage assessment and therefore potentially guide therapy adjustments. An association between fibroblast growth factor-23 and the other diagnostic modalities in our study was not found. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  5. Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: a prospective multicentre cohort study

    Science.gov (United States)

    Violi, Francesco; Pastori, Daniele; Perticone, Francesco; Hiatt, William R; Sciacqua, Angela; Basili, Stefania; Proietti, Marco; Corazza, Gino R; Lip, Gregory Y H; Pignatelli, Pasquale

    2015-01-01

    Objective To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). Design Observational prospective multicentre cohort study. Setting Atherothrombosis Center of I Clinica Medica of ‘Sapienza’ University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. Participants 897 AF patients on treatment with vitamin K antagonists. Main outcome measures The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m2/year, and incident eGFR60 mL/min/1.73 m2, 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m2. ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m2 (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). Conclusions In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m2. ABI measurement may help identify patients with AF at risk of renal function deterioration. Trial registration number NCT01161251. PMID:25998039

  6. Peripheral arterial disease and ankle-brachial index abnormalites in young and middle-aged HIV-positive patients in lower Silesia, Poland.

    Science.gov (United States)

    Kwiatkowska, Wiesława; Knysz, Brygida; Arczyńska, Katarzyna; Drelichowska, Justyna; Czarnecki, Marcin; Gąsiorowski, Jacek; Karczewski, Maciej; Witkiewicz, Wojciech

    2014-01-01

    Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis and mainly refers to elderly patients, having a negative impact on their functionality and quality of life. The findings of previous studies in HIV-infected patients have shown that cardiovascular risk is higher and PAD occurs more frequently than in the general population. There are also contradictory observations. Much less is known about the ankle-brachial index (ABI) value in asymptomatic HIV-infected patients. The aim of this study was to evaluate the prevalence of PAD and ankle-brachial index abnormalities as well as to determine risk factors related to the disease in a group of Polish HIV-positive patients. One hundred and eleven young to middle aged HIV-positive subjects and 40 noninfected subjects were enrolled into the study. Resting ABI measurements were performed and cardiovascular risk was analysed as well. Subgroups were created according to the ABI values: low (PAD), borderline, normal, high and altered ABI. Symptomatic PAD was observed in 2 HIV-positive patients, asymptomatic PAD was not diagnosed. The ABI value is lower and more varied, in 22.5% of the study group altered ABI values were found. Six subjects demonstrated borderline ABI, and 15 high ABI, including >1.4. In the control group no low or very high values were reported. A relation between low ABI and cardiovascular family history and between altered ABI and high-density-lipoprotein cholesterol (HDL-C) level was demonstrated. In young and middle-aged HIV-positive patients, symptomatic PAD prevalence is comparable to that observed in the overall population. Among asymptomatic patients PAD is not reported. The ABI value in HIV-positive patients is more varied compared to the HIV-negative subjects; the altered ABI shows a strong relation with low HDL-C levels and metabolic syndrome.

  7. Indian monsoon variability in relation to Regional Pressure Index

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    Indian Institute of Tropical Meteorology, Pune 411 008, India. In this paper Regional Pressure Index (RPI) over the Indian region (20◦N–40◦N and ... zonal index cycle in Northern Hemisphere (NH) and Southern Hemisphere (SH). But in spite of these zonal indices the Regional Pressure Index. (RPI) may play quite a ...

  8. Older age is associated with greater central aortic blood pressure following the exercise stress test in subjects with similar brachial systolic blood pressure.

    Science.gov (United States)

    Kobayashi, Masatake; Oshima, Kazutaka; Iwasaki, Yoichi; Kumai, Yuto; Avolio, Alberto; Yamashina, Akira; Takazawa, Kenji

    2016-08-01

    Brachial systolic pressure (BSP) is often monitored during exercise by the stress test; however, central systolic pressure (CSP) is thought to be a more direct measure of cardiovascular events. Although some studies reported that exercise and aging may play roles in changes of both BSP and CSP, the relationship between BSP and CSP with age following the exercise stress test remains unclear. The aim of this study was to evaluate the effect of age on the relationship between BSP and CSP measured after exercise. Ninety-six subjects underwent the diagnostic treadmill exercise stress test, and we retrospectively divided them into the following 3 groups by age: the younger age group (43 ± 4 years), middle age group (58 ± 4 years), and older age group (70 ± 4 years). Subjects exercised according to the Bruce protocol, to achieve 85 % of their age-predicted maximum heart rate or until the appearance of exercise-associated symptoms. BSP, CSP, and pulse rate (PR) were measured using a HEM-9000AI (Omron Healthcare, Japan) at rest and after exercise. BSP, CSP, and PR at rest were not significantly different among the 3 groups (p = 0.92, 0.21, and 0.99, respectively). BSP and PR immediately after exercise were not significantly different among the groups (p = 0.70 and 0.38, respectively). However, CSP immediately after exercise was 144 ± 18 mmHg (younger age), 149 ± 17 mmHg (middle age), and 158 ± 19 mmHg (older age). CSP in the older age group was significantly higher than that in the younger age group (p age groups after exercise, CSP was higher in the older age group. Therefore, older subjects have a higher CSP after exercise, which is not readily assessed by conventional measurements of BSP.

  9. Relationship between blood pressure, body mass index and health ...

    African Journals Online (AJOL)

    Objective: Globally, studies have shown that the trend of overweight and obesity has increased astronomically and there is a close link between body mass index and blood pressure. This study determined the link between the body mass index (BMI), blood pressure and health promoting practices of women in rural and ...

  10. Radial artery pulse pressure variation correlates with brachial artery peak velocity variation in ventilated subjects when measured by internal medicine residents using hand-carried ultrasound devices.

    Science.gov (United States)

    Brennan, J Matthew; Blair, John E A; Hampole, Chetan; Goonewardena, Sascha; Vasaiwala, Samip; Shah, Dipak; Spencer, Kirk T; Schmidt, Gregory A

    2007-05-01

    Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (DeltaPP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools. We sought to determine whether respiratory changes in the brachial artery blood flow velocity (DeltaVpeak-BA) as measured by internal medicine residents using a hand-carried ultrasound (HCU) device could provide an accurate corollary to DeltaPP in patients receiving mechanical ventilation. Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician. A Doppler signal was obtained in all 30 subjects. The DeltaVpeak-BA correlated well with DeltaPP (r = 0.84) with excellent agreement (weighted kappa, 0.82) and limited intraobserver variability (2.8 +/- 2.8%) [mean +/- SD]. A DeltaVpeak-BA cutoff of 16% was highly predictive of DeltaPP > or = 13% (sensitivity, 91%; specificity, 95%). A poor correlation existed between the CVP and both DeltaVpeak-BA (r = - 0.21) and DeltaPP (r = - 0.16). The HCU Doppler assessment of the DeltaVpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to DeltaPP, and a DeltaVpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.

  11. Brachial Plexus Injuries

    Science.gov (United States)

    ... sensation in the arm or hand Brachial plexus injuries can happen because of shoulder trauma, tumors, or ... the nerves stretch or tear. Some brachial plexus injuries may heal without treatment. Many children who are ...

  12. Brachial plexus (image)

    Science.gov (United States)

    The brachial plexus is a group of nerves that originate from the neck region and branch off to give rise to ... in the upper limb. Injuries to the brachial plexus are common and can be debilitating. If the ...

  13. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry.

    Science.gov (United States)

    Hashizume, Naoto; Miura, Takashi; Miyashita, Yusuke; Motoki, Hirohiko; Ebisawa, Soichiro; Izawa, Atsushi; Koyama, Jun; Ikeda, Uichi; Kuwahara, Koichiro

    2017-11-01

    Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.

  14. [Screening for asymptomatic peripheral arterial occlusive disease of the lower limbs by measuring the ankle-brachial index in the general population (Senegal)].

    Science.gov (United States)

    Pessinaba, S; Mbaye, A; Kane, Ad; Guene, B D; Mbaye Ndour, M; Niang, K; Jobe, M; Cazaubon, M; Mathieu, J-B S; Kane, M; Sow, D Diagne; Diack, B; Kane, A

    2012-07-01

    The purpose of this study was to investigate the prevalence of peripheral arterial disease (PAOD) and cardiovascular risk factors associated with the ankle-brachial index (ABI) in Senegalese patients aged 40 years and over. We prospectively studied a random sample of Senegalese aged 40 years and older, residing in the city of St.-Louis, Senegal. The ABI was measured with a portable doppler (DIADOP 50) using 4 and 8Hz dual frequency probes. The standards were: normal ABI 0.9 to 1.3; peripheral artery obstructive disease (PAOD) ABI less than 0.9; incompressible artery ABI greater than 1.3. Cardiovascular risk factors were also studied. Seven hundred and seventy-one subjects (mean age 57 ± 11.2 years, 559 women) were examined. Cardiovascular risk factors were: sedentary lifestyle (76.4%), hypertension (68%), obesity (32.1%), elevated LDL-cholesterolemia (27.8%), diabetes (18.3%) and tobacco smoking (6.9%). Ninety-three subjects (12.1%) had PAOD and 37 subjects (4.8%) had an incompressible artery. PAOD was significantly more common in sedentary subjects (P=0.008), in the elderly (P=0.0006) and in patients with a history of coronary artery disease (P=0.04). Smoking was not strongly associated with PAOD. PAOD is common in Senegalese and is associated with high prevalence of cardiovascular risk factors. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  15. [The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: The ARTPER study].

    Science.gov (United States)

    Ruiz Comellas, Anna; Pera, Guillem; Baena Díez, José Miguel; Heras, Antonio; Alzamora Sas, Maria Teresa; Forés Raurell, Rosa; Torán Monserrat, Pere; Mundet Tudurí, Xavier

    2015-11-20

    High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population. Baseline data from the ARTPER study cohort corresponding to 2,840 subjects>49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI<0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD. Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P<.001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors. In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  16. CD36 gene is associated with thickness of atheromatous plaque and ankle-brachial index in patients with early coronary artery disease.

    Science.gov (United States)

    Rać, Monika Ewa; Safranow, Krzysztof; Rać, Michał; Kurzawski, Grzegorz; Krzystolik, Andrzej; Sagasz-Tysiewicz, Dagmara; Jakubowska, Katarzyna; Poncyljusz, Wojciech; Chlubek, Dariusz

    2012-01-01

    CD36 is a multifunctional molecule engaged in the removal of oxidised LDL from plasma. It is unclear whether mutation of the CD36 gene protects against, or increases, the risk of hypercholesterolaemia, atherosclerosis and its complications. To search for associations between the CD36 gene polymorphisms and radiological markers of atherosclerosis progress in Caucasian patients with coronary artery disease (CAD) diagnosed at a young age. The study group comprised 70 patients with early CAD. Doppler ultrasound of carotid and peripheral arteries was carried out and genomic DNA was isolated from each patient. We found two single nucleotide substitutions in introns (IVS3-6 T/C - rs3173798 and IVS4-10 G/A - rs3211892) and two synonymous polymorphisms in exon 6 (G573A - rs5956 and A591T). The allele frequencies were: 10.7% for the IVS3-6C, 3.6% for the IVS4-10A, 3.6% for the 573A, and 2.1% for the 591T. The 573A allele of CD36 rs5956 polymorphism is associated with low thickness of atheromatous plaque. The 591T allele is associated with lower ankle-brachial index. The 573A allele has a protective effect against atherosclerosis development and the 591T allele is a cardiovascular risk factor. Assessment of their functional implications requires further research.

  17. Index Driven Price Pressure in Corporate Bonds

    DEFF Research Database (Denmark)

    Dick-Nielsen, Jens

    Inclusion and exclusion of bonds from major indices are information-free, monthly events. At these events, liquidity providers get a significant abnormal return by trading against index trackers. The return is highest for bonds that are excluded because of a recent downgrade with a one-day return...

  18. The Association of Ankle Brachial Index, Protein-Energy Wasting, and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Hideki Ishii

    2017-04-01

    Full Text Available Protein-energy wasting (PEW is highly prevalent in hemodialysis (HD patients. We investigated the association of abnormal ankle brachial index (ABI, PEW, and chronic inflammation status with clinical prognosis in HD patients. A total of 973 HD patients were enrolled and were followed-up for 8 years. As a marker of the PEW, geriatric nutritional risk index (GNRI was used. Cut-off levels were 91.2 for GNRI defined from previous studies and 1.9 mg/L for C-reactive protein (CRP as median value, respectively. Abnormal ABI was seen in 332 (34.1% patients. Declined GNRI and elevated CRP levels were independently associated with abnormal ABI (odds ratio (OR 0.97, 95% confidence interval (CI 0.96–0.99, p = 0.0009 and OR 1.40, 95% CI 1.07–1.83, p = 0.013, respectively. GNRI levels were also independently correlated with CRP levels (β = −0.126, p < 0.0001. During follow-up period, 283 (29.1% patients died, including 123 (12.6% due to cardiovascular disease (CVD. Abnormal ABI (adjusted hazard ratio (HR 1.62, 95% CI 1.13–2.32, p = 0.0096, GNRI < 91.2 (adjusted HR 1.57, 95% CI 1.06–2.33, p = 0.023 and CRP > 1.9 mg/L (adjusted HR 1.89, 95% CI 1.31–2.77, p = 0.0007 independently predicted mortality due to CVD, respectively. In conclusion, abnormal ABI, GNRI, and CRP levels were closely associated with each other, and the combination of these variables increase their predictive values for the risk of mortality due to CVD and all-cause mortality in HD patients.

  19. Índice Tornozelo-Braquial (ITB determinado por esfigmomanômetros oscilométricos automáticos Assessing Ankle-Brachial Index (ABI by using automated oscillometric devices

    Directory of Open Access Journals (Sweden)

    Takao Kawamura

    2008-05-01

    Full Text Available FUNDAMENTO: Índice Tornozelo-Braquial (ITB é essencial na prática clínica, mas dificuldades técnicas na sua execução pelo padrão de referência Doppler vascular (DV tornam-no ainda pouco utilizado. OBJETIVO: Avaliar aplicabilidade da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos (EOA e sugerir a utilização dos índices delta-Bráquio-Braquial (delta-BB e delta-ITB como marcadores de risco cardiovascular. MÉTODOS: Estudo descritivo e observacional de 247 pacientes ambulatoriais (56,2% feminino, média 62,0 anos submetidos à determinação do ITB com aferição simultânea da pressão arterial (PA em membros superiores (MMSS e inferiores (MMII utilizando-se dois EOA (OMRON-HEM705CP. Nos casos em que não foi possível aferir PA em pelo menos um dos MMII utilizou-se DV. Os pacientes divididos em Grupo N (ITB normal: 0,91 a 1,30 e Grupo A (ITB alterado: 1,30 tiveram comparados entre si os valores de delta-ITB (diferença absoluta ITB/MMII e delta-BB (diferença absoluta PAS/MMSS. RESULTADOS: Utilizando-se EOA foi possível determinar ITB em 90,7%. Com dados do Grupo N determinaram-se valores de referência (VR no percentil 95 de delta-ITB (0-0,13 e delta-BB (0-8 mmHg. Quando comparado com o Grupo N, o Grupo A apresentou prevalência mais elevada tanto de delta-ITB (30/52 contra 10/195; Razão de Chances: 25,23; pBACKGROUND: Assessing Ankle-Brachial Index is an essential procedure in clinical settings, but since its measurement by the gold standard Doppler Ultrasonic (DU technique is impaired by technical difficulties, it is underperformed. OBJECTIVE: The aim of this study was to assess the efficacy of an automated oscillometric device (AOD by performing Ankle-Brachial Index (ABI assessments and to suggest delta brachial-brachial (delta-BB and delta-ABI as markers of cardiovascular risk. METHODS: In this observational and descriptive study, 247 patients (56.2% females, mean age 62.0 years had their

  20. Assessment of Body Mass Index and Blood Pressure among ...

    African Journals Online (AJOL)

    Body Mass Index (BMI) has been described as a significant predictor of Blood Pressure (B.P) but few studies have demonstrated this association in our environment. The study aims to determine the pattern of relationship between BMI and blood pressure in our environment Two thousand and ninety six (2096) students in ...

  1. Association of Far-Infrared Radiation Therapy and Ankle-Brachial Index of Patients on Hemodialysis with Peripheral Artery Occlusive Disease.

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Kuo, I-Ching; Mai, Hsiu-Chin; Kuo, Po-Lin; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Hung-Chun

    2016-01-01

    Background and Aim: The ankle-brachial index (ABI) is recognized to be a good marker for atherosclerosis, and is useful in the diagnosis of peripheral artery occlusive disease (PAOD) which is prevalent among patients on hemodialysis (HD). Methods: This randomized trial aimed to evaluate the effect of far-infrared radiation (FIR) therapy on ABI in HD patients with PAOD. PAOD was defined as patients with ABI < 0.95. One hundred and eight HD patients were enrolled, including 50 in the control group and 58 in the FIR group. A WS TY101 FIR emitter was applied for 40 minutes during each HD session, three times per week for six months. The ABI was measured before and after the FIR therapy. Results: Regardless of FIR therapy, the bilateral ABI decreased (in the FIR group, left: 0.88±0.22 to 0.85±0.24, p = 0.188; right: 0.92±0.20 to 0.90±0.23, p = 0.372; in control group, left: 0.91±0.23 to 0.88±0.21, p = 0144; right: 0.93±0.17 to 0.89±0.21, p = 0.082). Multivariate logistic analysis of the FIR group revealed that high uric acid (odds ratio [OR]: 2.335; 95% confidence interval [CI]: 1.117-4.882; p=0.024) and aspirin use (OR: 16.463; 95% CI: 1.787-151.638; p=0.013) were independently associated with increased bilateral ABI after FIR therapy. Conclusions: This study demonstrates that ABI is not increased after FIR therapy in HD patients with PAOD. However, in the FIR group, patients with higher uric acid level or those who used aspirin have increased bilateral ABI after FIR therapy.

  2. Abnormal ankle-brachial index and risk of cardiovascular or all-cause mortality in patients with chronic kidney disease: a meta-analysis.

    Science.gov (United States)

    Chen, Hai-Yan; Wei, Fang; Wang, Li-Hua; Wang, Zhe; Meng, Jia; Yu, Hai-Bo; Zhang, Rui-Ning; Sun, Gui-Jiang; Jiang, Ai-Li; Wang, Lin

    2017-08-01

    Prognostic role of ankle-brachial index (ABI) in patients with chronic kidney disease (CKD) is controversial. We aimed to evaluate whether abnormal ABI was an independent predictor of cardiovascular or all-cause mortality in CKD patients with or without hemodialysis by conducting a meta-analysis. We systematically searched Pubmed and Embase databases for prospective observational studies that investigated baseline abnormal ABI and subsequent cardiovascular or all-cause mortality risk in CKD patients with or without hemodialysis. An ABI value of 0.9 to 1.3 was defined as normal. Pooled hazard risk (HR) with 95% confidence interval (CI) was calculated for the abnormal vs. normal ABI category. Six studies enrolling 5820 patients were identified and analyzed. Overall, abnormal ABI was associated with an increased risk of all-cause mortality (HR 2.26; 95% CI 1.60-3.18) and cardiovascular mortality (HR 3.58; 95% CI 2.53-5.06). Subgroup analysis indicated that patients with abnormally low ABI increased by 2.45-fold all-cause mortality and 5.18-fold cardiovascular mortality. Similarly, an abnormally high ABI increased by 1.94-fold all-cause mortality and 4.04-fold cardiovascular mortality. In addition, the effect of abnormal ABI on all-cause mortality was more pronounced among hemodialysis patients (HR 3.06; 95% CI 2.30-4.07) but not in CKD patients (HR 1.42; 95% CI 0.98-2.05). Abnormally low and high ABI are independently associated with cardiovascular or all-cause mortality risk in maintenance hemodialysis patients. This meta-analysis highlighted an U-shaped relationship between ABI and mortality risk in CKD patients undergoing hemodialysis. However, findings of this meta-analysis were undermined by the small number of included studies.

  3. Low ankle-brachial index is associated with early-stage chronic kidney disease in type 2 diabetic patients independent of albuminuria.

    Science.gov (United States)

    Dong, Xuehong; Wu, Dingting; Jia, Chengfang; Ruan, Yu; Feng, Xiaocheng; Wang, Guoxing; Liu, Jun; Shen, Yi; Li, Hong; Li, Lianxi

    2014-01-01

    The role of low ankle-brachial index (ABI) in early-stage chronic kidney disease (CKD) is not fully known. This study was designed to investigate the prevalence of low ABI in early-stage CKD defined as an estimated glomerular filtration rate (eGFR) between 60-89 ml/min/1.73 m2 of type 2 diabetic patients without albuminuria and to determine the association between the low ABI and mildly decreased eGFR. The cross-sectional study enrolled 448 type 2 diabetic patients with normoalbuminuria. The patients were stratified into two groups according to the CKD-EPI eGFR level: the normal group with eGFR level ≥ 90 mL/min/1.73 m2 and the lower group with eGFR of 60-89. ABI was categorized as normal (1.0-1.39), low-normal (0.9-0.99), and low (early-stage CKD. The prevalence of low ABI in early-stage CKD of type 2 diabetic patients without albuminuria was 39.5%. Low ABI was associated with an approximate 3-fold greater risk of early-stage CKD in bivariate logistic regression analysis, and remained significantly associated with a 2.2 fold risk (95% confidence interval: 1.188-4.077; P = 0.012) after adjusting traditional chronic kidney disease risk factors. There was a high prevalence of low ABI in early-stage CKD patients of type 2 diabetes with normoalbuminuria and a close relation between low ABI and early-stage CKD, suggesting that we should pay much more attention to the patients who have only mildly decreased eGFR and normoalbuminuria but have already had a low ABI in clinic work and consider the preventive therapy in early stage.

  4. A literature review of intercostal-to-musculocutaneous-nerve transfers in brachial plexus injury patients: Does body mass index influence results in Eastern versus Western countries?

    Science.gov (United States)

    Socolovsky, Mariano; Paez, Miguel Domínguez

    2013-01-01

    Background: A wide range of results have appeared in the literature for intercostal nerve transfers in brachial plexus patients. Oriental countries generally have a lower body mass index (BMI) than their occidental counterparts. We analyzed published series of intercostal nerve transfers for elbow reinnervation to determine if a difference in outcomes exists between Eastern and Western series that could be inversely related to BMI. Methods: A PubMed search was conducted. Inclusion criteria were: (1) time from trauma to surgery <12 months, (2) minimum follow-up one year, (3) intercostal to musculocutaneous nerve transfer the only surgical procedure performed to reestablish elbow flexion, and (4) males comprising more than 75% of cases. Two groups were created: Series from western countries, including America, Europe, and Africa; and series from Asia. Pearson correlation analysis was performed to assess for the degree of correlation between percent responders and mean national BMI. Results: A total of 26 series were included, 14 from western countries and 12 from Eastern countries, encompassing a total of 274 and 432 surgical cases, respectively. The two groups were almost identical in mean age, but quite different in mean national BMI (26.3 vs. 22.5) and in the percentage of patients who achieved at least a Medical Research Council (MRC) level 3 (59.5% vs. 79.3%). Time from trauma to surgery was slightly shorter in Eastern (3.4 months) versus Western countries (5.0 months). Conclusions: The percentage of responders to intercostal to musculocutaneous nerve transfer was inversely correlated with the mean national BMI among male residents of the country where the series was performed. PMID:24381795

  5. Combination of high ankle-brachial index and hard coronary heart disease Framingham Risk Score in predicting the risk of ischemic stroke in general population.

    Directory of Open Access Journals (Sweden)

    Yinyin Zhang

    Full Text Available Our previous study showed that the patients with more metabolic risk factors had higher risk of high ankle-brachial index (ABI, but the relationship between high ABI and the risk of severe cardiovascular and cerebrovascular diseases is still under debate. This study aims to evaluate this association in the general population. 1486 subjects of South China were recruited in the study. 61 subjects were defined as high ABI group (ABI≥1.3 and 65 subjects were randomly selected as normal ABI group (0.9

  6. Associations of work hours with carotid intima-media thickness and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

    Science.gov (United States)

    Charles, Luenda E; Fekedulegn, Desta; Burchfiel, Cecil M; Fujishiro, Kaori; Landsbergis, Paul; Diez Roux, Ana V; Macdonald, Leslie; Foy, Capri G; Andrew, Michael E; Stukovsky, Karen H; Baron, Sherry

    2012-10-01

    Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI). Participants were 1694 women and 1868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using standard protocols. Information on work hours was obtained from questionnaires. Mean values of CIMT and ABI were examined across five categories of hours worked per week (≤20, 21-39, 40, 41-50 and >50) using analysis of variance/analysis of covariance. p Values for trend were obtained from linear regression models. Mean age of participants was 56.9±8.4 years; 52.4% were men. Distinct patterns of association between work hours and the subclinical CVD biomarkers were found for women and men, although this heterogeneity by gender was not statistically significant. Among women only, work hours were positively associated with common (but not internal) CIMT (p=0.073) after full risk factor adjustment. Compared with women working 40 h, those working >50 h were more likely to have an ABI work hours and ABI were inversely associated (p=0.046). There was some evidence that the association between work hours and ABI was modified by occupational category (interaction p=0.061). Among persons classified as management/professionals, longer work hours was associated with lower ABI (p=0.015). No significant associations were observed among other occupational groups. Working longer hours may be associated with subclinical CVD. These associations should be investigated using longitudinal studies.

  7. Resting and Post-Exercise Ankle-Brachial Index Measurements to Diagnose Asymptomatic Peripheral Arterial Disease in Middle Aged and Elderly Chronic Obstructive Pulmonary Disease Patients: A Pilot Study.

    Science.gov (United States)

    Alagiakrishnan, Kannayiram; Brokop, Michael; Cave, Andrew; Rowe, Brian H; Wong, Eric; Senthilselvan, Ambikaipakan

    2016-04-01

    Chronic obstructive pulmonary disease (COPD) patients are at risk for asymptomatic peripheral arterial disease (PAD) because smoking is a risk factor for COPD and PAD. The objectives of this study were to determine the proportion of COPD patients with asymptomatic PAD and to investigate whether the estimated risk of asymptomatic PAD in subjects with COPD differs using resting and exercise ankle-brachial index (ABI) in smokers. Using a cross-sectional study design, consecutive smokers > 50 years old were recruited over 2 months from the inpatient units and the outpatient clinics. Subjects previously diagnosed with PAD, unstable angina, recent (< 3 months) myocardial infarction or abdominal, intracranial, eye or lung surgery, and palliative care patients were excluded. Vascular risk factors, ABI (supine and post-3-minute walk supine), self-reported PAD symptoms, and spirometry were obtained. Two measurements of systolic blood pressure on all limbs were obtained using a sphygmomanometer and a Doppler ultrasound, and the ABI was calculated. Data were expressed as means ± standard deviation (SD). Dichotomous outcomes were assessed using Chi-square statistics; P-values of < 0.05 were considered significant. Thirty patients with no previous diagnosis of PAD were recruited. Mean age was 67.7 years (SD: 10.5). Overall, 21 subjects (70%) had spirometry-proven COPD. Significant ABI for PAD (< 0.9) was seen in 7/21 COPD (33.5%) and 0/9 non-COPD subjects in the supine resting position (P = 0.07), and in 9/21 COPD (42.9%) vs. 0/9 non-COPD subjects after exercise (P = 0.03). A significant proportion of patients with spirometry-proven COPD screened positive for asymptomatic PAD after exercise. Resting ABI may not be very sensitive to diagnose asymptomatic PAD in COPD subjects. ABI may be a reliable, sensitive and practical screening tool to assess cardiovascular risk in COPD patients. Future large-scale studies are required to confirm this finding.

  8. Plasma Renalase is Not Associated with Blood Pressure and Brachial-Ankle Pulse Wave Velocity in Chinese Adults With Normal Renal Function

    Directory of Open Access Journals (Sweden)

    Yang Wang

    2016-11-01

    Full Text Available Background/Aims: This study aimed to investigate the association of renalase with blood pressure (BP and brachial-ankle pulse wave velocity (baPWV in order to better understand the role of renalase in the pathogenesis of hypertension and atherosclerosis. Methods: A total of 344 subjects with normal kidney function were recruited from our previously established cohort in Shaanxi Province, China. They were divided into the normotensive (NT and hypertensive (HT groups or high baPWV and normal baPWV on the basis of BP levels or baPWV measured with an automatic waveform analyzer. Plasma renalase was determined through an enzyme-linked immunosorbent assay. Results: Plasma renalase did not significantly differ between HT and NT groups (3.71 ± 0.69 µg/mL vs. 3.72 ± 0.73 μg/mL, P = 0.905 and between subjects with and without high baPWV (3.67 ± 0.66 µg/mL vs. 3.73 ± 0.74 µg/mL, P = 0.505. However, baPWV was significantly higher in the HT group than in the NT group (1460.4 ± 236.7 vs. 1240.7 ± 174.5 cm/s, P Conclusion: Plasma renalase may not be associated with BP and baPWV in Chinese subjects with normal renal function.

  9. Investigating the complex genetic architecture of ankle-brachial index, a measure of peripheral arterial disease, in non-Hispanic whites

    Directory of Open Access Journals (Sweden)

    Turner Stephen T

    2008-05-01

    Full Text Available Abstract Background Atherosclerotic peripheral arterial disease (PAD affects 8–10 million people in the United States and is associated with a marked impairment in quality of life and an increased risk of cardiovascular events. Noninvasive assessment of PAD is performed by measuring the ankle-brachial index (ABI. Complex traits, such as ABI, are influenced by a large array of genetic and environmental factors and their interactions. We attempted to characterize the genetic architecture of ABI by examining the main and interactive effects of individual single nucleotide polymorphisms (SNPs and conventional risk factors. Methods We applied linear regression analysis to investigate the association of 435 SNPs in 112 positional and biological candidate genes with ABI and related physiological and biochemical traits in 1046 non-Hispanic white, hypertensive participants from the Genetic Epidemiology Network of Arteriopathy (GENOA study. The main effects of each SNP, as well as SNP-covariate and SNP-SNP interactions, were assessed to investigate how they contribute to the inter-individual variation in ABI. Multivariable linear regression models were then used to assess the joint contributions of the top SNP associations and interactions to ABI after adjustment for covariates. We reduced the chance of false positives by 1 correcting for multiple testing using the false discovery rate, 2 internal replication, and 3 four-fold cross-validation. Results When the results from these three procedures were combined, only two SNP main effects in NOS3, three SNP-covariate interactions (ADRB2 Gly 16 – lipoprotein(a and SLC4A5 – diabetes interactions, and 25 SNP-SNP interactions (involving SNPs from 29 different genes were significant, replicated, and cross-validated. Combining the top SNPs, risk factors, and their interactions into a model explained nearly 18% of variation in ABI in the sample. SNPs in six genes (ADD2, ATP6V1B1, PRKAR2B, SLC17A2, SLC22A3

  10. Low ankle-brachial index is associated with early-stage chronic kidney disease in type 2 diabetic patients independent of albuminuria.

    Directory of Open Access Journals (Sweden)

    Xuehong Dong

    Full Text Available AIMS: The role of low ankle-brachial index (ABI in early-stage chronic kidney disease (CKD is not fully known. This study was designed to investigate the prevalence of low ABI in early-stage CKD defined as an estimated glomerular filtration rate (eGFR between 60-89 ml/min/1.73 m2 of type 2 diabetic patients without albuminuria and to determine the association between the low ABI and mildly decreased eGFR. METHODS: The cross-sectional study enrolled 448 type 2 diabetic patients with normoalbuminuria. The patients were stratified into two groups according to the CKD-EPI eGFR level: the normal group with eGFR level ≥ 90 mL/min/1.73 m2 and the lower group with eGFR of 60-89. ABI was categorized as normal (1.0-1.39, low-normal (0.9-0.99, and low (<0.9. Both stepwise forward multiple linear regression and binary logistic regression analyses were performed to examine the association between ABI categories and eGFR levels and to assess the relation of low ABI and early-stage CKD. RESULTS: The prevalence of low ABI in early-stage CKD of type 2 diabetic patients without albuminuria was 39.5%. Low ABI was associated with an approximate 3-fold greater risk of early-stage CKD in bivariate logistic regression analysis, and remained significantly associated with a 2.2 fold risk (95% confidence interval: 1.188-4.077; P = 0.012 after adjusting traditional chronic kidney disease risk factors. CONCLUSIONS: There was a high prevalence of low ABI in early-stage CKD patients of type 2 diabetes with normoalbuminuria and a close relation between low ABI and early-stage CKD, suggesting that we should pay much more attention to the patients who have only mildly decreased eGFR and normoalbuminuria but have already had a low ABI in clinic work and consider the preventive therapy in early stage.

  11. Brachial Plexus Injuries

    Science.gov (United States)

    ... as a result of shoulder trauma, tumors, or inflammation. There is a rare syndrome called Parsonage-Turner Syndrome, or brachial plexitis , which ... as a result of shoulder trauma, tumors, or inflammation. There is a rare syndrome called Parsonage-Turner Syndrome, or brachial plexitis , which ...

  12. Physical activity, body mass index and blood pressure in primary ...

    African Journals Online (AJOL)

    Background: Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. Objective: The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils attending private ...

  13. Physical activity, body mass index and blood pressure in primary ...

    African Journals Online (AJOL)

    Abstract. Background: Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. Objective: The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils ...

  14. Multivariate Modeling of Body Mass Index, Pulse Pressure, Systolic and Diastolic Blood Pressure in Chinese Twins

    DEFF Research Database (Denmark)

    Wu, Yili; Zhang, Dongfeng; Pang, Zengchang

    2015-01-01

    Systolic and diastolic blood pressure, pulse pressure (PP), and body mass index (BMI) are heritable traits in human metabolic health but their common genetic and environmental backgrounds are not well investigated. The aim of this article was to explore the phenotypic and genetic associations among...... PP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. The studied sample contained 615 twin pairs (17-84 years) collected in the Qingdao municipality. Univariate and multivariate structural equation models were fitted for assessing the genetic and environmental contributions...

  15. Indian monsoon variability in relation to Regional Pressure Index

    Indian Academy of Sciences (India)

    In this paper Regional Pressure Index (RPI) over the Indian region (20°N-40°N and 70°E-85°E) has been constructed for 101 years (1899-1999) on a monthly scale. The relationship of these indices was carried out with the Indian Summer Monsoon Rainfall (June-September) (ISMR) over the various homogeneous regions, ...

  16. Etiological risk factors for brachial plexus palsy.

    Science.gov (United States)

    Hudić, Igor; Fatusić, Zlatan; Sinanović, Osman; Skokić, Fahrija

    2006-10-01

    To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004. The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index >or=29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of brachial plexus damage was 3858.1+/-587.7 g, which for an average gestational age of 38.8+/-1.8 weeks, corresponds to eutrophic newborns. Both male and female newborns were

  17. Doença arterial obstrutiva periférica e índice tornozelo-braço em pacientes submetidos à angiografia coronariana Peripheral arterial occlusive disease and ankle-brachial index in patients who had coronary angiography

    Directory of Open Access Journals (Sweden)

    Sthefano Atique Gabriel

    2007-03-01

    Full Text Available OBJETIVO: Avaliar a prevalência de doença arterial obstrutiva periférica (DAOP em coronariopatas. Avaliar a relação entre Índice Tornozelo-Braço (ITB e doença coronariana, e sua correlação com fatores de risco cardiovascular. MÉTODO: ITB investigado com ultra-sonografia Doppler. Características clínicas pesquisadas: idade, sexo, diabetes mellitus, hipertensão arterial sistêmica, etilismo, tabagismo e obesidade. População: 113 pacientes submetidos à angiografia coronariana. Primeira análise: 2 grupos - ausência e presença de coronariopatia. Segunda análise: 3 grupos - Grupo 1 - ausência de lesão coronariana; Grupo 2 - estenose 70%. Terceira análise: 2 grupos - ausência e presença de DAOP. RESULTADOS: 90,76% dos coronariopatas apresentaram DAOP. Houve diferença significante quanto à faixa etária (pOBJECTIVE: To evaluate the prevalence of peripheral arterial disease (PAD in patients with coronary arterial disease. To evaluate the relation between ankle-brachial index (ABI and coronary arterial disease, and its correlation with cardiovascular risk factors. METHOD: ABI investigated with Doppler ultrasonic device. Clinical characteristics researched: age, gender, diabetes, hypertension, alcoholism, smoking and obesity. Population: 113 patients who had coronary angiography. First analyses: 2 groups - absence and presence of coronary arterial disease. Second analyses: 3 groups - Group 1 - absence of coronary lesion; Group 2 - stenosis 70%. Third analyses: 2 groups - absence and presence of PAD. RESULTS: 90.76% of patients with coronary arterial disease presented PAD. There were significant difference including age (p<0.001, hypertension (p<0.001. smoking (p<0.001, body mass index (BMI (p<0.001, systolic blood pressure (SBP (p<0.001, diastolic blood pressure (DBP (p<0.001 and pulse pressure (PP (p<0.001 and ABI (p<0.001 between patients with and without coronary lesion. There were significant difference including age (p<0

  18. The concept of cerebral circulatory-pressure index (CCPI).

    Science.gov (United States)

    Wroński, J; Juniewicz, H; Mierzwa, J; Zub, L

    2000-01-01

    The theoretical relations between blood pressure (MABP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as the new Cerebral Circulation-Pressure Index (CCPI) are presented in the paper. The special nomogram collecting all of these parameters was constructed. CPPI was defined as a quotient of CPP and ICP: [formula: see text] CCPI reflects the relationship between the systemic MABP and ICP and for ensuring the normal conditions of intracranial circulation the MABP must be at least 4 divided by 5 times higher than ICP. The low values of CCPI, if they are not immediately corrected, results on severe brain disability or even death. We didn't find till now what should be the upper limit of CCPI, which overcrossing may be danger for the patient, especially with impaired autoregulation. Based on analysis of patients operated due to intracranial disorders as brain tumours, spontaneous and traumatic haematomas as well as ruptured aneurysms we find that the values of CCPI over 3 have a good prognosis, between 3 and 2 is a field for intensive treatment consisting on decreasing ICP or increasing the systemic blood pressure or both. If CCPI is below 1.5 the prognosis is pessimistic and all the patients died. CCPI together with the nomogram are useful in current evaluation of the state of patients and of the efficacy of treatment and prediction of the treatment results.

  19. Body mass index and blood pressure measurement during pregnancy.

    LENUS (Irish Health Repository)

    Hogan, Jennifer L

    2012-02-01

    OBJECTIVE: The accurate measurement of blood pressure requires the use of a large cuff in subjects with a high mid-arm circumference (MAC). This prospective study examined the need for a large cuff during pregnancy and its correlation with maternal obesity. METHODS: Maternal body mass index (BMI), fat mass, and MAC were measured. RESULTS: Of 179 women studied, 15.6% were obese. With a BMI of level 1 obesity, 44% needed a large cuff and with a BMI of level 2 obesity 100% needed a large cuff. CONCLUSION: All women booking for antenatal care should have their MAC measured to avoid the overdiagnosis of pregnancy hypertension.

  20. A Proposed New Index for Clinical Evaluation of Interproximal Soft Tissues: The Interdental Pressure Index

    Directory of Open Access Journals (Sweden)

    Checchi Luigi

    2014-01-01

    Full Text Available The interdental pressure index (IPI is introduced to specifically evaluate clinical interproximal-tissue conditions and assess the effect of interproximal hygiene stimulation. This index scores clinical responses of periodontal tissues to the apical pressure of a horizontally placed periodontal probe. It is negative when gingival tissues are firm, bleeding-free, and slightly ischemic by the stimulation; otherwise it is positive. The clinical validation showed high intraoperator agreement (0.92; 95% CI: 0.82–0.96; P=0.0001 and excellent interoperator agreement (0.76; 95% CI: 0.14–1.38; P=0.02. High internal consistency with bleeding on probing (κ=0.88 and gingival index (Cronbach’s α=0.81 was obtained. Histological validation obtained high sensitivity (100% and specificity (80% for IPI+ toward inflammatory active form. The same results were recorded for IPI− toward chronic inactive form. IPI results as a simple and noninvasive method with low error probability and good reflection of histological condition that can be applied for oral hygiene motivation. Patient compliance to oral hygiene instructions is essential in periodontal therapy and IPI index can be a practical and intuitive tool to check and reinforce this important aspect.

  1. A comparison between brachial and echocardiographic systolic time intervals.

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    Full Text Available Systolic time interval (STI is an established noninvasive technique for the assessment of cardiac function. Brachial STIs can be automatically determined by an ankle-brachial index (ABI-form device. The aims of this study are to evaluate whether the STIs measured from ABI-form device can represent those measured from echocardiography and to compare the diagnostic values of brachial and echocardiographic STIs in the prediction of left ventricular ejection fraction (LVEF <50%. A total of 849 patients were included in the study. Brachial pre-ejection period (bPEP and brachial ejection time (bET were measured using an ABI-form device and pre-ejection period (PEP and ejection time (ET were measured from echocardiography. Agreement was assessed by correlation coefficient and Bland-Altman plot. Brachial STIs had a significant correlation with echocardiographic STIs (r = 0.644, P<0.001 for bPEP and PEP; r  = 0.850, P<0.001 for bET and ET; r = 0.708, P<0.001 for bPEP/bET and PEP/ET. The disagreement between brachial and echocardiographic STIs (brachial STIs minus echocardiographic STIs was 28.55 ms for bPEP and PEP, -4.15 ms for bET and ET and -0.11 for bPEP/bET and PEP/ET. The areas under the curve for bPEP/bET and PEP/ET in the prediction of LVEF <50% were 0.771 and 0.765, respectively. Brachial STIs were good alternatives to STIs obtained from echocardiography and also helpful in prediction of LVEF <50%. Brachial STIs automatically obtained from an ABI-form device may be helpful for evaluation of left ventricular systolic dysfunction.

  2. Effect of sodium nitrite on renal function, sodium and water excretion and brachial and central blood pressure in healthy subjects. A dose-response study

    DEFF Research Database (Denmark)

    Rosenbaek, Jeppe Bakkestroem; Therwani, Safa Al; Jensen, Janni Majgaard

    2017-01-01

    Sodium nitrite (NaNO2) is converted to nitric oxide (NO) in vivo and has vasodilatory and natriuretic effects. Our aim was to examine the effects of NaNO2 on hemodynamics, sodium excretion and GFR. In a single-blinded, placebo-controlled, cross-over study, we infused placebo (0.9% NaCl) or 0.58, 1...... (P-NO2(-)), GFR by Cr-EDTA clearance, fractional excretion of sodium (FENa) free water clearance (CH2O), and urinary excretion rate of guanosine 3',5'-cyclic monophosphate (U-cGMP). The highest dose reduced brachial systolic BP (5.6 mmHg, p=0.003), central systolic BP (5.6 mmHg, p=0.035) and CH2O......, intravenous NaNO2 induced a dose-dependent reduction of brachial and central BP. The hemodynamic effect was not mediated by the renin-angiotensin-aldosterone system. NaNO2 infusion resulted in a vasopressin-independent decrease in CH2O and urine output, but no change in urinary sodium excretion or GFR...

  3. Oscillometric measurement of brachial artery cross-sectional area and its relationship with cardiovascular risk factors and arterial stiffness in a middle-aged male population.

    Science.gov (United States)

    Otsuka, Toshiaki; Munakata, Ryo; Kato, Katsuhito; Kodani, Eitaro; Ibuki, Chikao; Kusama, Yoshiki; Seino, Yoshihiko; Kawada, Tomoyuki

    2013-10-01

    An enlarged arterial diameter is associated with an increased risk for cardiovascular disease. This study examined the relationship of noninvasively measured brachial artery cross-sectional area with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Absolute volumetric changes of the brachial artery were measured with a newly developed oscillometric method during a general health examination in 387 men (mean age: 38±9 years) without known cardiovascular disease. Based on the measurement, the estimated area (eA) of the brachial artery at end-diastole was obtained. Brachial artery volume elastic modulus (VE) and brachial-ankle pulse wave velocity (baPWV) were simultaneously measured as indices of arterial stiffness by the same device. The relationships of eA with cardiovascular risk factors, including age, obesity, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus (IFG/DM), hyperuricemia, smoking and their associated continuous variables, as well as VE and baPWV, were examined. Overall, the mean eA was 12.9 ± 2.9 mm². The eA was significantly higher in subjects with obesity, hypertension or IFG/DM than in those without each of these risk factors. In a multiple linear regression analysis, body mass index (β=0.31, P<0.001), age (β=0.25, P<0.001), systolic blood pressure (β=0.16, P=0.004) and pulse rate (β=-0.13, P=0.005) were independent determinants of eA. In contrast, neither VE nor baPWV were selected as independent determinants of eA. In conclusion, enlarged brachial artery cross-sectional area was significantly associated with cardiovascular risk factors such as age, body mass index and systolic blood pressure, but it was not associated with increased arterial stiffness.

  4. Reference values of one-point carotid stiffness parameters determined by carotid echo-tracking and brachial pulse pressure in a large population of healthy subjects.

    Science.gov (United States)

    Vriz, Olga; Aboyans, Victor; Minisini, Rosalba; Magne, Julien; Bertin, Nicole; Pirisi, Mario; Bossone, Eduardo

    2017-07-01

    Arterial stiffness can predict cardiovascular events, and the aim of this study was to produce age- and sex-specific reference values for echo-tracking carotid stiffness in healthy subjects. A total of 900 subjects (500 males, mean age 45.8±19 years) were enrolled. Common carotid artery stiffness and compliance, using a high-definition echo-tracking ultrasound system, were evaluated. To compare stiffness parameters across the different age groups, individual scores were transformed into T-scores, indicating how many standard deviation (s.d.) units an individual's score was above or below the mean that was observed in the group including same-sex individuals aged 36 to 44 years. Carotid stiffness was similar among genders, except compliance, which was lower in women (Pparameters increased significantly with age, but the opposite occurred for compliance. The T-score was found to increase significantly across all age groups, with a steeper increase in stiffness around the age of 60 years in women. For each T-score s.d., the corresponding carotid absolute values for arterial stiffness and compliance were obtained. In a multivariate model, carotid stiffness parameters were constantly and independently associated with age, mean arterial pressure, pulse pressure, heart rate and body mass index. Our study provides a normogram of carotid arterial stiffness and compliance indices obtained with the echo-tracking method in a large population of healthy subjects stratified by gender and age that can be used in clinical practice.

  5. Obstetric brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

    Full Text Available Obstetric brachial plexus injury (OBPI, also known as birth brachial plexus injury (BBPI, is unfortunately a rather common injury in newborn children. Incidence varies between 0.15 and 3 per 1000 live births in various series and countries. Although spontaneous recovery is known, there is a large subset which does not recover and needs primary or secondary surgical intervention. An extensive review of peer-reviewed publications has been done in this study, including clinical papers, review articles and systematic review of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Causes of OBPI, indications of primary nerve surgery and secondary reconstruction of shoulder, etc. are discussed in detail. Although all affected children do not require surgery in infancy, a substantial proportion of them, however, require it and are better off for it. Secondary surgery is needed for shoulder elbow and hand problems. Results of nerve surgery are very encouraging. Children with OBPI should be seen early by a hand surgeon dealing with brachial plexus injuries. Good results are possible with early and appropriate intervention even in severe cases.

  6. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    Directory of Open Access Journals (Sweden)

    Su T

    2011-08-01

    Full Text Available Ta-Chen Su1, Pao-Ling Torng2, Jiann-Shing Jeng3, Ming-Fong Chen1, Chiau-Suong Liau1,41Division of Cardiology, Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, 4Cardiovascular Center, Taipei Buddist Tzu-Chi Hospital, Hsin-Dian, Taipei, TaiwanBackground: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited.Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD, compliance (BAC, and resistance (BAR. Fasting blood levels of glucose, lipids, lipoprotein (a, high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured.Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity.Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than

  7. Comparison of ankle-brachial index measured by an automated oscillometric apparatus with that by standard Doppler technique in vascular patients

    DEFF Research Database (Denmark)

    Korno, M.; Eldrup, N.; Sillesen, H.

    2009-01-01

    was calculated twice using both the methods on both legs. MATERIALS AND METHODS: We tested the automated oscillometric blood pressure device, CASMED 740, for measuring ankle and arm blood pressure and compared it with the current gold standard, the hand-held Doppler technique, by the Bland-Altman analysis....... RESULTS: Using the Doppler-derived ABI as the gold standard, the sensitivity and specificity of the oscillometric method for determining an ABI Udgivelsesdato: 2009/11...

  8. Prediction of Cerebral Hyperperfusion Syndrome with Velocity Blood Pressure Index

    Directory of Open Access Journals (Sweden)

    Zhi-Chao Lai

    2015-01-01

    Full Text Available Background: Cerebral hyperperfusion syndrome is an important complication of carotid endarterectomy (CEA. An >100% increase in middle cerebral artery velocity (MCAV after CEA is used to predict the cerebral hyperperfusion syndrome (CHS development, but the accuracy is limited. The increase in blood pressure (BP after surgery is a risk factor of CHS, but no study uses it to predict CHS. This study was to create a more precise parameter for prediction of CHS by combined the increase of MCAV and BP after CEA. Methods: Systolic MCAV measured by transcranial Doppler and systematic BP were recorded preoperatively; 30 min postoperatively. The new parameter velocity BP index (VBI was calculated from the postoperative increase ratios of MCAV and BP. The prediction powers of VBI and the increase ratio of MCAV (velocity ratio [VR] were compared for predicting CHS occurrence. Results: Totally, 6/185 cases suffered CHS. The best-fit cut-off point of 2.0 for VBI was identified, which had 83.3% sensitivity, 98.3% specificity, 62.5% positive predictive value and 99.4% negative predictive value for CHS development. This result is significantly better than VR (33.3%, 97.2%, 28.6% and 97.8%. The area under the curve (AUC of receiver operating characteristic: AUC VBI = 0.981, 95% confidence interval [CI] 0.949-0.995; AUC VR = 0.935, 95% CI 0.890-0.966, P = 0.02. Conclusions: The new parameter VBI can more accurately predict patients at risk of CHS after CEA. This observation needs to be validated by larger studies.

  9. Management of Brachial Plexus Injuries

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-02-01

    Full Text Available The results of early neurosurgical treatment of 58 infants with various types of brachial plexus birth injury have been compared with non-surgical intervention in 91 patients followed by a multidisciplinary team at the Brachial Plexus Program, Miami Children’s Hospital, FL.

  10. MRI of the brachial plexus

    Energy Technology Data Exchange (ETDEWEB)

    Es, H.W. van [Dept. of Radiology, St. Antonius Ziekenhuis, Nieuwegein (Netherlands)

    2001-02-01

    Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). (orig.)

  11. A sensor for combined temperature, pressure, and refractive index detection

    OpenAIRE

    Thomas Reinsch; Kort Bremer; Elfed Lewis; Gabriel Leen; Steffen Lochmann

    2013-01-01

    A sensor (1) has a light conductor (2) having a grating (FBG), a cavity (5), and a transparent cavity end wall (4), a light emitter for directing light through the conductor, and a light detector for detecting reflected light, and a processor. The processor is adapted to analyse light reflected due to the grating (FBG, 6) to determine an indication of temperature, light reflected from the end (7) of the cavity (5) to determine an indication of pressure, and also light reflected from the outer...

  12. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication Valor preditivo do índice tornozelo-braço na evolução de pacientes com claudicação intermitente

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    2000-04-01

    Full Text Available The purpose of this study was to determine whether the ankle-brachial index (ABI could be used to predict the prognosis for a patient with intermittent claudication (IC. We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy and sensitivity (association with a poor outcome after exercise rehabilitation therapy. We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.O objetivo deste estudo foi determinar a evolução da distância de marcha de pacientes com claudicação intermitente relacionando com o índice tornozelo-braço (ITB e o valor deste índice como fator preditivo para o prognóstico desses pacientes. Observou-se prospectivamente a evolução de 611 pacientes durante 28 meses. Analisamos o valor preditivo do ITB inicial usando vários valores de corte - 0.30 a 0.70 em incrementos de 0.05 - em relação à especificidade (associação com uma evolução favorável após tratamento clínico e sensibilidade (associação com uma evolução desfavorável após tratamento clínico. Encontramos o ITB de 0.30 como o valor de corte produzindo a menor margem de erro, mas seu valor preditivo ainda foi baixo para identificar os pacientes com mau prognóstico para o tratamento não invasivo. Estudos adicionais são necessários para se identificar um fator adicional que possa aumentar a sensibilidade do teste.

  13. Association between the ankle–brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

    Science.gov (United States)

    Nardi Gomes, Tiago José; Martins de Albuquerque, Isabella; de Moraes Costa, Patrícia; Cardoso, Dannuey Machado; de Moraes Costa, Gabriela; da Costa Vieira, José Luiz

    2015-01-01

    Background Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle–brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied. Objective The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients. Patients and methods This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD). Results The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=−0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively). Conclusion The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease

  14. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure

    NARCIS (Netherlands)

    de Vries, Durk R.; van Herwaarden, Margot A.; Smout, André J. P. M.; Samsom, Melvin

    2008-01-01

    OBJECTIVES: The roles of intragastric pressure (IGP), intraesophageal pressure (IEP), gastroesophageal pressure gradient (GEPG), and body mass index (BMI) in the pathophysiology of gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are only partly understood. METHODS: In total, 149 GERD

  15. Pressure dependence of the refractive index in wurtzite and rocksalt indium nitride

    Energy Technology Data Exchange (ETDEWEB)

    Oliva, R. [Institut Jaume Almera, Consell Superior d' Investigacions Científiques (CSIC), Lluís Solé i Sabarís s.n., 08028 Barcelona, Catalonia (Spain); MALTA-Consolider Team, Departament de Física Aplicada, ICMUV, Universitat de València, c/Dr. Moliner 50, 46100 Burjassot, València (Spain); Segura, A. [MALTA-Consolider Team, Departament de Física Aplicada, ICMUV, Universitat de València, c/Dr. Moliner 50, 46100 Burjassot, València (Spain); Ibáñez, J., E-mail: jibanez@ictja.csic.es; Artús, L. [Institut Jaume Almera, Consell Superior d' Investigacions Científiques (CSIC), Lluís Solé i Sabarís s.n., 08028 Barcelona, Catalonia (Spain); Yamaguchi, T.; Nanishi, Y. [Faculty of Science and Engineering, Ritsumeikan University, Shiga 525-8577 (Japan)

    2014-12-08

    We have performed high-pressure Fourier transform infrared reflectance measurements on a freestanding InN thin film to determine the refractive index of wurtzite InN and its high-pressure rocksalt phase as a function of hydrostatic pressure. From a fit to the experimental refractive-index curves including the effect of the high-energy optical gaps, phonons, free carriers, and the direct (fundamental) band-gap in the case of wurtzite InN, we obtain pressure coefficients for the low-frequency (electronic) dielectric constant ε{sub ∞}. Negative pressure coefficients of −8.8 × 10{sup −2 }GPa{sup −1} and −14.8 × 10{sup −2 }GPa{sup −1} are obtained for the wurtzite and rocksalt phases, respectively. The results are discussed in terms of the electronic band structure and the compressibility of both phases.

  16. Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure.

    Science.gov (United States)

    Pan, Chun; Chen, Lu; Zhang, Yun-Hang; Liu, Wei; Urbino, Rosario; Ranieri, V Marco; Qiu, Hai-Bo; Yang, Yi

    2016-07-20

    Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients. However, airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance. This study was to evaluate the Pawstress index on lung mechanics and the correlation between Pawstress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients. Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital, Nanjing, China and Ospedale S. Giovanni Battista-Molinette Hospital, Turin, Italy. All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min. PEEP was set according to the ARDSnet study protocol. The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio. The high elastance group (H group, n = 14) had a ratio ≥30%, and the low elastance group (L group, n = 10) had a ratio Respiratory elastance, gas-exchange, Pawstress index, and PLstress index were measured. Student's t-test, regression analysis, and Bland-Altman analysis were used for statistical analysis. Pneumonia was the major cause of respiratory failure (71.0%). Compared with the L group, PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs. 9.0 ± 2.3 cmH2O, P < 0.01). Compared with the H group, lung elastance was higher (20.0 ± 7.8 cmH2O/L vs. 11.6 ± 3.6 cmH2O/L, P < 0.01), and stress was higher in the L group (7.0 ± 1.9 vs. 4.9 ± 1.9, P = 0.02). A linear relationship was observed between the Pawstress index and the PLstress index in H group (R2 = 0.56, P < 0.01) and L group (R2 = 0.85, P < 0.01). In the ARF patients with MV, Pawstress index can substitute for PLto guide ventilator settings. ClinicalTrials.gov NCT02196870 (https://clinicaltrials.gov/ct2/show/NCT02196870).

  17. Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    deSouza, Ian S; Benabbas, Roshanak; McKee, Sean; Zangbar, Bardiya; Jain, Ashika; Paladino, Lorenzo; Boudourakis, Leon; Sinert, Richard

    2017-08-01

    Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Timely, accurate diagnosis is essential for potential intervention in order to prevent significant morbidity. Using a systematic review/meta-analytic approach, we determined the utility of physical examination, Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in emergency department (ED) patients who have sustained PET. We applied a test-treatment threshold model to determine which evaluations may obviate CT Angiography (CTA). We searched PubMed, Embase, and Scopus from inception to November 2016 for studies of ED patients with PET. We included studies on adult and pediatric subjects. We defined the reference standard to include CTA, catheter angiography, or surgical exploration. When low-risk patients did not undergo the reference standard, trials must have specified that patients were observed for at least 24 hours. We used the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) to evaluate bias and applicability of the included studies. We calculated positive and negative likelihood ratios (LR+ and LR-) of physical examination ("hard signs" of vascular injury), US, and ABI. Using established CTA test characteristics (sensitivity = 96.2%, specificity = 99.2%) and applying the Pauker-Kassirer method, we developed a test-treatment threshold model (testing threshold = 0.14%, treatment threshold = 72.9%). We included eight studies (n = 2,161, arterial injury prevalence = 15.5%). Studies had variable quality with most at high risk for partial and double verification bias. Some studies investigated multiple index tests: physical examination (hard signs) in three studies (n = 1,170), ABI in five studies (n = 1,040), and US in four studies (n = 173). Due to high heterogeneity (I(2)  > 75%) of the results, we could not calculate LR+ or LR- for hard signs or LR+ for ABI. The

  18. Association between the ankle–brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

    Directory of Open Access Journals (Sweden)

    Nardi Gomes TJ

    2015-01-01

    Full Text Available Tiago José Nardi Gomes,1 Isabella Martins de Albuquerque,2 Patrícia de Moraes Costa,3 Dannuey Machado Cardoso,4 Gabriela de Moraes Costa,5 José Luiz da Costa Vieira6 1Department of Physiotherapy, UNIFRA, Centro Universitário Franciscano, Santa Maria, RS, Brazil; 2Department of Physiotherapy and Rehabilitation, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; 3Department of Clinical Medicine, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; 4Department of Physiotherapy, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil; 5Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; 6Fundação Universitária de Cardiologia, Instituto de Cardiologia, Porto Alegre, RS, Brazil Background: Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC, abnormal ankle–brachial index (ABI, and physical activity level on functional capacity of these patients has not been fully studied. Objective: The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD in this sample of patients. Patients and methods: This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40; borderline PAD (n=23, values between 0.91 and 1.00; and patients with PAD (n=35, ≤0.90. The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the

  19. Sex Differences in Peripheral Augmentation Index and Arterial Reservoir Pressure during Upper Limb Postural Shifts

    Directory of Open Access Journals (Sweden)

    Kevin S. Heffernan

    2014-01-01

    Full Text Available We examined the peripheral hemodynamic response to passive arm postural changes in young men and women. Radial artery pulse waveforms were captured using applanation tonometry in 20 men (age 27 ± 2 yrs, BMI 25 ± 1 kg/m2 and 20 women (age 27 ± 2 yrs, BMI 23±1 kg/m2. Arm position was maintained at either heart level or supported 14 cm above/below heart level in a randomized fashion. Systolic augmentation index (sAIx and diastolic augmentation index (dAIx were used as estimates of pressure from wave reflections arriving in systole and diastole, respectively. A novel reservoir-wave separation technique was used to obtain arterial reservoir pressure (pressure generated by arterial capacitance. Women showed a significant reduction in radial diastolic pressure-time integral (DPTI (P0.05 or dAIx (P>0.05 when moving the arm from below to above heart level. Conversely, men showed an attenuated change in radial DPTI (P>0.05 concomitant with significant increases in reservoir pressure (P<0.05, sAIx (P<0.05, and dAIx (P<0.05. Gravity-mediated changes in regional hemodynamics produced by passive arm postural shifts are sex specific. Men demonstrate less change in regional diastolic pressure concomitant with increased augmentation index and arterial reservoir pressure.

  20. Restoration and protection of brachial plexus injury: hot topics in the last decade

    Science.gov (United States)

    Zhang, Kaizhi; Lv, Zheng; Liu, Jun; Zhu, He; Li, Rui

    2014-01-01

    Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the development of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for protection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimulation, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this field change according to the hot topic of research. PMID:25374596

  1. Influence of high glycemic index and glycemic load diets on blood pressure during adolescence.

    Science.gov (United States)

    Gopinath, Bamini; Flood, Victoria M; Rochtchina, Elena; Baur, Louise A; Smith, Wayne; Mitchell, Paul

    2012-06-01

    We aimed to prospectively examine the association between the glycemic index and glycemic load of foods consumed and the dietary intakes of carbohydrates, sugars, fiber, and principal carbohydrate-containing food groups (eg, breads, cereals, and sugary drinks) with changes in blood pressure during adolescence. A total of 858 students aged 12 years at baseline (422 girls and 436 boys) were examined from 2004-2005 to 2009-2011. Dietary data were assessed from validated semiquantitative food frequency questionnaires. Blood pressure was measured using a standard protocol. In girls, after adjusting for age, ethnicity, parental education, parental history of hypertension, baseline height, baseline blood pressure, change in body mass index, and time spent in physical and sedentary activities, each 1-SD (1-SD = 7.10 g/d) increase in baseline dietary intake of total fiber was associated with a 0.96-, 0.62-, and 0.75-mmHg decrease in mean systolic (P = 0.02), diastolic (P = 0.01), and arterial blood pressures (P = 0.002), respectively, 5 years later. In girls, each 1-SD increase in dietary glycemic index, glycemic load, carbohydrate, and fructose was concurrently related to increases of 1.81 (P = 0.001), 4.02 (P = 0.01), 4.74 (P = 0.01), and 1.80 mm Hg (P = 0.03) in systolic blood pressure, respectively, >5 years. Significant associations between carbohydrate nutrition variables and blood pressure were not observed among boys. Excessive dietary intake of carbohydrates, specifically from high glycemic index/glycemic load foods, could adversely influence blood pressure, particularly in girls, whereas fiber-rich diets may be protective against elevated blood pressure during adolescence.

  2. [Complications in brachial plexus surgery].

    Science.gov (United States)

    Martínez, Fernando; Pinazzo, Samantha; Moragues, Rodrigo; Suarez, Elizabeth

    2015-01-01

    Although traumatic brachial plexus injuries are relatively rare in trauma patients, their effects on the functionality of the upper limb can be very disabling. The authors' objective was to assess the complications in a series of patients operated for brachial plexus injuries. This was a retrospective evaluation of patients operated on by the authors between August 2009 and March 2013. We performed 36 surgeries on 33 patients. The incidence of complications was 27.7%. Of these, only 1 (2.7%) was considered serious and associated with the procedure (iatrogenic injury of brachial artery). There was another serious complication (hypoxia in patients with airway injury) but it was not directly related to the surgical procedure. All other complications were considered minor (wound dehiscence, hematoma, infection). There was no mortality in our series. The complications in our series are similar to those reported in the literature. Serious complications (vascular, neural) are rare and represent less than 5% in all the different series. Given the rate of surgical complications and the poor functional perspective for a brachial plexus injury without surgery, we believe that surgery should be the treatment of choice. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  3. Correlação entre o índice tornozelo-braço antes e após teste de deslocamento bidirecional progressivo Correlation between ankle-brachial index before and after shuttle walk test

    Directory of Open Access Journals (Sweden)

    Inácio Teixeira da Cunha-Filho

    2007-12-01

    Full Text Available CONTEXTO: A alteração de fluxo sangüíneo observada nos pacientes com doença arterial obstrutiva periférica (DAOP contribui para a redução da capacidade deambulatórida. Entretanto, ainda existe uma grande variabilidade nas correlações entre medidas inferenciais de comprometimento de fluxo e testes de deslocamento. OBJETIVO: Estabelecer o nível de correlação entre as medidas do índice tornozelo-braço (ITB, pré e pós-esforço, com um novo teste de deambulação chamado teste de deslocamento bidirecional progressivo (TDBP. MÉTODOS: Vinte e um pacientes claudicantes, com diagnóstico de DAOP, tiveram registrados o ITB antes e após a realização de um teste de caminhada no solo, com controle externo e progressivo de velocidade (TDBP. RESULTADOS: Foram registrados a distância (261,07±160,63 metros, o tempo (292,30±122,61 segundos e a velocidade (1,23±0,34 m/s obtidos no início do surgimento de sintoma claudicante, bem como durante o surgimento de sintoma limitante (369,52±157,97 metros, 377,71±104,60 segundos, 1,46±0,29 m/s, respectivamente. A média do ITB de repouso foi de 0,66±0,14, e de pós-esforço foi de 0,42±0,19. Não se observou nenhuma correlação importante entre as variáveis do teste (distância, tempo e velocidade com o ITB de repouso e nem após esforço. CONCLUSÃO: O tempo, velocidade e distância de surgimento de sintoma claudicante e de sintoma claudicante limitante durante o teste de caminhada progressiva são independentes da medida inferencial de fluxo sangüíneo através do ITB de repouso e pós-exercício.BACKGROUND: Patients with peripheral occlusive artery disease (POAD show changes in blood flow that may impair their walking ability. However, variability between inferential measurements of blood flow and walking performance is still high. OBJECTIVE: To correlate the ankle-brachial index (ABI before and after performing the shuttle walk test (SWT. METHODS: Twenty-one patients with claudication

  4. Measurements of intracranial pressure and compliance index using 1.5-T clinical MRI machine.

    Science.gov (United States)

    Atsumi, Hideki; Matsumae, Mitsunori; Hirayama, Akihiro; Kuroda, Kagayaki

    2014-03-20

    To assess a newly proposed noninvasive technique for evaluating intracranial pressure (ICP) index and brain compliance (BC) index based on an inverse analysis of a brain-circulation-equivalent electrical circuit (EC) model, in which cerebrospinal fluid (CSF) flow and arterial flow rates measured by using the phase contrast method are used as currents. Quantitative phase contrast flow measurements were performed by using a 1.5-T scanner for 25 volunteers and 23 patients with chronic increased ICP state. Bilateral carotid and verrtebral arteries and CSF flows were modeled by a pair of electrical circuits inductively coupled by a transformer. The ICP index was defined as the voltage of the second order circuit, while the BC index was calculated as the ratio between the mutual indeuctance of the transformer and the reactance in the second order circuit. The ICP index obtained by the EC correlated well with the pressure gradient obtained by the Navier-Stokes Technique (NS-PG). The combination of NS-PG and BC index by the EC appeared to be appropriate for characterizing the brain circulation status of the volunteers. This noninvasive ICP and BC index measurement technique is more useful for asessment of intracranial condition.

  5. Cerebral Pulsatility Index Is Elevated in Patients with Elevated Right Atrial Pressure.

    Science.gov (United States)

    Lahiri, Shouri; Schlick, Konrad H; Padrick, Matthew M; Rinsky, Brenda; Gonzalez, Nestor; Jones, Heather; Mayer, Stephan A; Lyden, Patrick D

    2018-01-01

    Extracerebral venous congestion can precipitate intracranial hypertension due to obstruction of cerebral blood outflow. Conditions that increase right atrial pressure, such as hypervolemia, are thought to increase resistance to jugular venous outflow and contribute to cerebro-venous congestion. Cerebral pulsatility index (CPI) is considered a surrogate marker of distal cerebrovascular resistance and is elevated with intracranial hypertension. Thus, we sought to test the hypothesis that elevated right atrial pressure is associated with increased CPI compared to normal right atrial pressure. We retrospectively reviewed 61 consecutive patients with subarachnoid hemorrhage. We calculated CPI from transcranial Doppler studies and correlated these with echocardiographic measures of right atrial pressure. CPIs were compared from patients with elevated and normal right atrial pressure. There was a significant difference between CPI obtained from all patients with elevated right atrial pressure compared to those with normal right atrial pressure (P right and left hemispheric CPI from patients with both elevated and normal right atrial pressure. Patients with elevated right atrial pressure had significantly higher CPI compared to patients with normal right atrial pressure. These findings suggest that cerebro-venous congestion due to impaired jugular venous outflow may increase distal cerebrovascular resistance as measured by CPI. Since elevated CPI is associated with poor outcome in numerous neurological conditions, future studies are needed to elucidate the significance of these results in other populations. Copyright © 2017 by the American Society of Neuroimaging.

  6. Increasing Body Mass Index, Blood Pressure, and Acanthosis Nigricans Abnormalities in School-Age Children

    Science.gov (United States)

    Otto, Debra E.; Wang, Xiaohui; Garza, Viola; Fuentes, Lilia A.; Rodriguez, Melinda C.; Sullivan, Pamela

    2013-01-01

    This retrospective quantitative study examined the relationships among gender, Acanthosis Nigricans (AN), body mass index (BMI), and blood pressure (BP) in children attending school Grades 1-9 in Southwest Texas. Of the 34,897 health screening records obtained for the secondary analysis, 32,788 were included for the study. A logistic regression…

  7. A Comparison of Blood Pressure, Body Mass Index, and Acanthosis Nigricans in School-Age Children

    Science.gov (United States)

    Otto, Debra E.; Wang, Xiaohui; Tijerina, Sandra L.; Reyna, Maria Elena; Farooqi, Mohammad I.; Shelton, Margarette L.

    2010-01-01

    The purpose of this retrospective quantitative study was to examine the relationships among acanthosis nigricans (AN), body mass index (BMI), blood pressure (BP), school grade, and gender in children attending elementary school located in South West Texas. Data were collected by attending school district nurses. Researchers reviewed 7,026…

  8. Liquid sinusoidal pressure measurement by laser interferometry based on the refractive index of water.

    Science.gov (United States)

    Yang, Jun; Fan, Shangchun; Li, Cheng; Guo, Zhanshe; Li, Bo; Shi, Bo

    2016-12-01

    A new method with laser interferometry is used to enhance the traceability for sinusoidal pressure calibration in water. The laser vibrometer measures the dynamic pressure based on the acousto-optic effect. The relation of the refractive index of water and the optical path length with the pressure's change is built based on the Lorentz-Lorenz equation, and the conversion coefficients are tested by static calibration in situ. A device with a piezoelectric transducer and resonant pressure pipe with water is set up to generate sinusoidal pressure up to 20 kHz. With the conversion coefficients, the reference sinusoidal pressure is measured by the laser interferometer for pressure sensors' dynamic calibration. The experiment results show that under 10 kHz, the measurement results between the laser vibrometer and a piezoelectric sensor are in basic agreement and indicate that this new method and its measurement system are feasible in sinusoidal pressure calibration. Some disturbing components including small amplitude, temperature change, pressure maldistribution, and glass windows' vibration are also analyzed, especially for the dynamic calibrations above 10 kHz.

  9. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease

    Directory of Open Access Journals (Sweden)

    Naidu Otikunta

    2011-12-01

    Full Text Available Abstract Background Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. Methods We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects. Results Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p 11.11(p Conclusions The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.

  10. Influence of lean body-mass index versus that of fat mass index on blood pressure of gujarati school going adolescents.

    Science.gov (United States)

    Verma, Vivek; Sinah, S K

    2014-01-01

    There are so many studies associating blood pressure in children and adolescents with body fatness i.e. stating that high body fat is associated with high blood pressure in children and adolescents. The purpose of this study was to determine that which portion of the body mass index, fat or fat free mass index is more influencing the blood pressure in Gujarati Indian adolescents. 733 schoolchildren of 10-18 years of both genders were chosen for this study. The body fat percentage and blood pressure were measured and on the basis of body mass and fat mass, fat free mass index and various other indices were calculated. The association of fat mass index and fat free mass index with blood pressure was computed using correlations. The relationship of BMI with mean blood pressure of boys (R = .326) was more strong than that in girls (R = .149). The blood pressure was having more strong positive correlation with lean body mass index than that with fat mass index in all subjects (R = 0.230 versus R = 0.184), boys (R = 0.285 versus R = 0.242), & girls (R = 0.179 versus R = -0.081). Fat free mass index has more strong association with blood pressure than fat mass index in the adolescent population irrespective of gender. However as far as prevention of hypertension is concerned, reducing body fat (rather than only body weight) may remain an important measure to prevent hypertension as body fat mass is reducible while lean body mass may not be reducible and, in long term, obesity itself can lead to hypertension by various mechanisms.

  11. Reoperation for failed shoulder reconstruction following brachial plexus birth injury

    Science.gov (United States)

    2013-01-01

    Background Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure. Case presentations This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation. Conclusions This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction. PMID:23883413

  12. Workplace physical exercises, obesity anthropometric indexes, blood pressure and static muscle strength

    Directory of Open Access Journals (Sweden)

    Marcos Roberto Queiroga

    2014-03-01

    Current analysis compares anthropometric indexes of obesity, blood pressure and static muscle strength among workers who exercised or did not exercise themselves on the workplace. Three hundred and fifty-four workers, of whom 178 did not perform any physical exercises and 176 who did, were evaluated by means of a query on their participation in workplace exercises during the last 30 days. Their systolic (SBP and diastolic blood pressure (DBP was measured; height, body mass and waist circumference (WC were taken; four static muscle strength tests (right and left handgrip strength, scapular strength and lumbar strength were performed. The Shapiro Wilk test revealed asymmetry in the data presented as median and interquartile variance. Mann-Whitney test was used to compare data between the two groups. Results did not reveal any difference for body mass index (BMI, WC, SBP, DBP and mean blood pressure (MBP between the groups. However, greater performance was an asset for all participants in workplace exercises for all static strength tests. There is evidence that workers who performed workplace exercises may increase muscle strength without any changes in BMI, WC and blood pressure.

  13. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Fuglsang, S; Bendtsen, F; Christensen, E

    2001-01-01

    /PP on one side and age, sex, body weight, portal pressure, systemic hemodynamics, biochemical variables, and severity of disease on the other. In the multiple-regression analysis, sex, age, mean arterial blood pressure, systemic vascular resistance, and biochemical variables were significant independent......Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40......%, respectively; P close correlation between C(1) and SV/PP was found in both cirrhotic patients (r = 0.86, P

  14. MR imaging of the brachial plexus

    NARCIS (Netherlands)

    Es, Hendrik Wouter van

    1997-01-01

    In this retrospective study we describe the MR imaging findings in 230 consecutive patients with suspected pathology in or near the brachial plexus. These patients were studied from 1991 through to 1996. Chapter 2 describes the anatomy and the MR imaging techniques. As the anatomy of the brachial

  15. Ankle blood pressure as a predictor of total and cardiovascular mortality

    Directory of Open Access Journals (Sweden)

    Salomaa Veikko

    2008-02-01

    Full Text Available Abstract Background The ankle blood pressure is commonly used as a ratio to the brachial blood pressure, called ankle-brachial index (ABI. Very few studies have considered the independent value of the ankle blood pressure without indexing it to the brachial blood pressure. We examined the value of ankle blood pressure, together with the exercise blood pressure, as a predictor of cardiovascular (CVD and total mortality. Methods A prospective follow-up study of 3,858 consecutive ambulatory patients (mean age 51 years, 65,9% male referred to a symptom-limited exercise test between August 1989 and December 1995. The cohort was followed up for all-cause and CVD mortality until December 31, 2004, by record linkage with the National Causes-of-Death Register. The independent value of ankle blood pressure as a predictor of cardiovascular and total mortality was assessed using Cox proportional hazards modelling. Results The average follow-up time was 14 years, during which 346 persons died, 108 of them due to CVD. Persons with normal ( Conclusion These results suggest that the ankle blood pressure has an independent value as a marker of arterial stiffness or subclinical atherosclerosis and a risk of future mortality in middle-aged, asymptomatic persons.

  16. Correlation between the pressure-to-cornea index and both structural and functional measures of glaucoma

    Directory of Open Access Journals (Sweden)

    Andrea MBV Franco

    2014-01-01

    Full Text Available Purpose: the pressure-to-cornea index (PCI was proposed in order to integrate intraocular pressure and central cornea thickness as a single-risk factor for glaucoma. The purpose of this study was to correlate the PCI with a structural and two functional measures of glaucoma. Setting: University Hospital in South America. Materials and Methods: Pressure-to-cornea index was calculated for 70 eyes of 36 subjects (glaucoma and suspects. Cup-to-disc (C/D ratio, mean deviation (MD and pattern standard deviation (PSD as recorded by Humphrey automated perimetry (SITA 24-2 were correlated with PCI (Pearson′s correlation coefficient. Results: Pearson′s correlation coefficient between PCI and C/D was 0.329 (95% confidence interval [95% CI], 0.09-0.526; P = 0.006; between PCI and MD was − 0.356 MD (95% CI, −0.549 to − 0.126; P = 0.003; and between PCI and PSD was − 0.215 (95% CI, −0.433 to 0.025; P = 0.07. Conclusion: In addition to serve as a single-risk factor, PCI can be used to stage glaucoma severity as well.

  17. Pressure induced optical absorption and refractive index changes of a shallow hydrogenic impurity in a quantum wire

    Science.gov (United States)

    Arunachalam, N.; John Peter, A.; Woo Lee, Chang

    2011-10-01

    Pressure induced binding energy of a hydrogenic impurity in an InAs/GaAs quantum wire is investigated. Calculations are performed using Bessel functions as an orthonormal basis within a single band effective mass approximation using variational method. Photoionization cross-section of the hydrogenic impurity in the influence of pressure is studied. The total optical absorption and the refractive index changes as a function of normalized photon energy between the ground and the first excited state in the presence of pressure are analyzed. The optical absorption coefficients and the refractive index changes strongly depend on the incident optical intensity and pressure. The occurred blue shift of the resonant peak due to the pressure gives the information about the variation of two energy levels in the quantum well wire. The optical absorption coefficients and the refractive index changes are strongly dependent on the incident optical intensity and the pressure.

  18. Relationship Between Diastolic Dysfunction and Atherosclerosis and Vascular Calcification in Hemodialysis Patients: Diagnostic Potential of the Cardio-Ankle Vascular Index.

    Science.gov (United States)

    Unagami, Kohei; Nitta, Kosaku; Tago, Kiichiro; Matsushita, Kazumichi

    2016-04-01

    Diastolic dysfunction (DD) commonly causes heart failure with preserved ejection fraction (EF). Here, we examine associations between DD severity and atherosclerosis/vascular calcification in hemodialysis patients. Echocardiography was performed on 101 patients undergoing hemodialysis therapy. Twelve patients (EF cardio-ankle vascular index (CAVI), ankle-brachial pressure index (ABI), toe-brachial pressure index (TBI), and aortic calcification area index (ACAI). Seventy-seven patients (86.5%) with EF ≥ 50% had DD. Associations with advanced age and comorbid diabetes mellitus and cardiovascular disease were observed. The CAVI, TBI, and ACAI, but not ABI, increased proportionally with DD grades. Thus, many hemodialysis patients developed DD, with systolic function maintained. Strong associations between DD grades and progression of both atherosclerosis and vascular calcification could be inferred. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  19. Independent association between brachial-ankle pulse wave velocity and global longitudinal strain of left ventricle.

    Science.gov (United States)

    Kim, Hack-Lyoung; Seo, Jae-Bin; Chung, Woo-Young; Kim, Sang-Hyun; Kim, Myung-A; Zo, Joo-Hee

    2015-12-01

    Data regarding the influence of arterial stiffness on left ventricular (LV) long-axis function has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and LV global longitudinal strain (GLS). A total of 248 subjects (mean age 59.2 ± 12.3 years; 50% were men) without structural heart problems were retrospectively evaluated. LV GLS was measured by 2-dimensional speckle-tracking echocardiography. baPWV measurements were made on the same day of echocardiography. The incidences of hypertension, diabetes mellitus, and dyslipidemia were 51.2, 19.4, and 22.2%, respectively. The mean value of baPWV was 1557 ± 285 cm/s. In simple linear regression analysis, baPWV had a significant positive association with LV GLS (β = 0.215, P = 0.001). In multiple linear regression analysis, baPWV was independently associated with LV GLS even after controlling for potential confounders, including age, gender, body mass index, systolic blood pressure, heart rate, HbA1c, total cholesterol, estimated glomerular filtration rate, left ventricular mass index, E/A, septal e' velocity and pulmonary artery systolic pressure (β = 0.211, P = 0.028). The results of this study suggest that baPWV may be independently associated with LV GLS, supporting the evidence of a close interaction between arterial stiffness and LV function. Increased arterial stiffness may result in impaired LV longitudinal function.

  20. Validación del índice tobillo brazo oscilométrico comparado con eco-Doppler arterial de miembros inferiores para enfermedad arterial Validation of oscillometric measurement of ankle-brachial index compared with arterial lower limb echo-doppler for arterial disease

    Directory of Open Access Journals (Sweden)

    Astrid N Páez E

    2010-08-01

    Full Text Available INTRODUCCIÓN: estudios previos reportan la validación y correspondencia, o ambas, del índice tobillo brazo oscilométrico frente al índice tobillo brazo con Doppler, pero este último no corresponde al patrón de oro. OBJETIVO: determinar la validez de criterio del índice tobillo brazo oscilométrico comparado con la ecografía dúplex arterial de miembros inferiores para detectar enfermedad arterial periférica. METODOLOGÍA: estudio de evaluación de tecnologías diagnósticas realizado por muestreo transversal. De manera consecutiva, se reclutaron 101 personas del Instituto del Corazón de Bucaramanga con mínimo un factor de riesgo cardiovascular. Se midió el índice tobillo brazo oscilométrico con equipo OMRON® M7 HEM 780 y posteriormente se hizo ecografía dúplex arterial de miembros inferiores, esta última patrón de oro; los evaluadores estaban enmascarados. RESULTADOS: las mediciones repetidas de la presión arterial en cada miembro, mostraron una reproducibilidad casi perfecta, pues sus coeficientes de correlación intraclase son superiores a 0,86 y el acuerdo del método fue adecuado ± 15 mm Hg, para la mayoría de las mediciones. Según el análisis de la curva ROC, el punto de corte 90,48%, sensibilidad regular ( 70,37%, razón de probabilidad positiva cercana o superior al ideal (7-10, moderada calidad de la sensibilidad (0,58, sustancial calidad de la especificidad (0,66-0,78 y eficiencia o capacidad discriminatoria (0,62-0,67. CONCLUSIÓN: los hallazgos permiten recomendar la medición del índice tobillo brazo oscilométrico en personas con factores de riesgo cardiovasculares, como una prueba de rutina, bien sea para tamizaje (punto de corte INTRODUCTION: previous studies reported validation and/or correspondence of ankle-brachial index measured by OMRON (ABIO versus an ABI measured by Doppler, but the latter is not the gold standard. Objective: to determine the criterion validity of ABIO versus arterial duplex

  1. Severe Brachial Plexus Injuries in American Football.

    Science.gov (United States)

    Daly, Charles A; Payne, S Houston; Seiler, John G

    2016-11-01

    This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.]. Copyright 2016, SLACK Incorporated.

  2. Brachial Plexus Anatomy: Normal and Variant

    Directory of Open Access Journals (Sweden)

    Steven L. Orebaugh

    2009-01-01

    Full Text Available Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

  3. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

    Science.gov (United States)

    Liu, Ying; Xu, Xun-cheng; Zou, Yi; Li, Su-rong; Zhang, Bin; Wang, Yue

    2015-01-01

    Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘excellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery. PMID:25883637

  4. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

    Directory of Open Access Journals (Sweden)

    Ying Liu

    2015-01-01

    Full Text Available Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ′excellent′ and ′good′ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

  5. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    Science.gov (United States)

    Jin, Hua; Yang, Qi; Ji, Feng; Zhang, Ya-jie; Zhao, Yan; Luo, Min

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3 μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals. PMID:25883625

  6. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    Directory of Open Access Journals (Sweden)

    Hua Jin

    2015-01-01

    Full Text Available The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C 6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C 6 brachial plexus injury site (1 × 10 6 cells/mL, 3 μL/injection, 25 injections immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C 6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

  7. Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function Evaluation) study: CAFE-Heart Rate.

    Science.gov (United States)

    Williams, Bryan; Lacy, Peter S

    2009-08-18

    The CAFE (Conduit Artery Function Evaluation) study showed less effective central aortic pressure lowering with atenolol-based therapy versus amlodipine-based therapy in people with hypertension. The present study examined the importance of heart rate (HR) as a determinant of this effect. Recent analyses have suggested that beta-blockers are less effective at reducing cardiovascular events than alternative blood pressure (BP)-lowering therapies. There has been much debate about the mechanism for this shortfall in benefit and specifically the role of HR lowering by beta-blockers. Central pressures were derived from brachial pressure and radial pulse wave analysis in 2,073 patients, and 7,146 measurements were recorded and analyzed over follow-up for up to 4 years. There was no impact of HR on brachial systolic or pulse pressures; however, there was a highly significant inverse relationship between HR and central aortic systolic and pulse pressures (p < 0.001). This was dependent on a strong inverse relationship between HR and augmentation index, indicative of increased wave reflection at lower HRs. Multiple regression, adjusted for brachial BP, showed HR to be the major determinant of central pressures. Moreover, HR and brachial BP accounted for 92% of the variability in central systolic and pulse pressures. Consequently, drug-related differences in central aortic pressures were markedly attenuated after adjustment for HR. When comparing beta-blocker-based treatments with other BP-lowering strategies, HR reduction with beta-blockers is a major mechanism accounting for less effective central aortic pressure reduction per unit change in brachial pressure.

  8. Ambulatory blood pressure and Doppler echocardiographic indexes of borderline hypertensive men presenting an exaggerated blood pressure response during dynamic exercise

    Directory of Open Access Journals (Sweden)

    F.L. Herkenhoff

    2001-10-01

    Full Text Available Borderline hypertension (BH has been associated with an exaggerated blood pressure (BP response during laboratory stressors. However, the incidence of target organ damage in this condition and its relation to BP hyperreactivity is an unsettled issue. Thus, we assessed the Doppler echocardiographic profile of a group of BH men (N = 36 according to office BP measurements with exaggerated BP in the cycloergometric test. A group of normotensive men (NT, N = 36 with a normal BP response during the cycloergometric test was used as control. To assess vascular function and reactivity, all subjects were submitted to the cold pressor test. Before Doppler echocardiography, the BP profile of all subjects was evaluated by 24-h ambulatory BP monitoring. All subjects from the NT group presented normal monitored levels of BP. In contrast, 19 subjects from the original BH group presented normal monitored BP levels and 17 presented elevated monitored BP levels. In the NT group all Doppler echocardiographic indexes were normal. All subjects from the original BH group presented normal left ventricular mass and geometrical pattern. However, in the subjects with elevated monitored BP levels, fractional shortening was greater, isovolumetric relaxation time longer, and early to late flow velocity ratio was reduced in relation to subjects from the original BH group with normal monitored BP levels (P<0.05. These subjects also presented an exaggerated BP response during the cold pressor test. These results support the notion of an integrated pattern of cardiac and vascular adaptation during the development of hypertension.

  9. Left ventricular mass index and sports: the influence of different sports activities and arterial blood pressure.

    Science.gov (United States)

    Iglesias Cubero, G; Batalla, A; Rodriguez Reguero, J J; Barriales, R; González, V; de la Iglesia, J L; Terrados, N

    2000-09-15

    The mechanisms by which endurance training produces physiological hypertrophy have been thoroughly investigated but not with young athletes. The aim of our study was to investigate arterial blood pressure exercise responses in young athletes who started heavy training by the age of 11, participating in metabolically different sports (cycling, kayaking, and soccer) and to analyse the influence that arterial blood pressure at maximum exercise and VO(2) max could have on the development of cardiac mass in these subjects. We studied a group of well trained normotensive male subjects, comprising 37 cyclists, 15 soccer players and 12 canoeists (mean age, 16+/-1 years). Evaluation included a clinical history and physical examination, M-mode and two-dimensional echocardiography, 12-lead resting electrocardiogram and a graded exercise test with direct determination of VO(2) max. Systolic and diastolic blood pressure were measured at rest and maximum exercise. Determination of the left ventricular mass index (LVMI) was performed using Devereux's formula with correction for the body surface area. Cyclists showed values of LVMI in g m(-2) significantly higher than those of other subjects (123 vs. 92 and 113). Canoeists showed the maximal arterial blood pressure at maximum exercise in mmHg (190 vs. 172 and 170) and cyclists showed the maximal VO(2) ml kg(-1) min(-1) uptake (57.6 vs. 48.5 and 53.3). A linear correlation was found between LVMI and VO(2) max (r=0.4727, P<0.001) and this correlation was also significant with systolic blood pressure at maximum exercise (r=0.2909, P<0.01). No differences in LVMI were found when comparing those subjects who presented systolic blood pressure at maximum exercise equal or greater than 195 mmHg with those who presented less than this value. It can be concluded that VO(2) max is the variable that better correlates with the LVMI. Athletes who reach greater systolic blood pressures at peak exercise have a tendency to develop greater LVMI. In

  10. Platelet to Lymphocyte Percentage Ratio Is Associated With Brachial-Ankle Pulse Wave Velocity in Hemodialysis.

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Mai, Hsiu-Chin; Su, Ho-Ming; Chang, Jer-Ming; Chen, Hung-Chun

    2016-02-01

    Increased arterial stiffness in patients receiving hemodialysis (HD) is highly prevalent and is associated with cardiovascular morbidity and mortality. In HD, inflammation is one of the major causes of increased arterial stiffness. Activation of platelets and decreased lymphocyte percentage (LYMPH%) may exhibit inflammation. The aim of this study is to examine the relationship between platelet to LYMPH% ratio and arterial stiffness in HD patients.A total of 220 patients receiving HD were enrolled in this study. The brachial-ankle pulse wave velocity (baPWV) was measured using an ankle-brachial index form device. Multivariate linear regression analysis was performed to investigate the relations of the platelet to LYMPH% ratio and baPWV. The value of the platelet to LYMPH% ratio was 59.2 ± 33.3 (10 cells/L/%). After multivariate stepwise analysis, diabetes (β: 163.973, P = 0.02), high systolic blood pressure (per 1 mm Hg, β: 9.010, P < 0.001), high platelet to LYMPH% ratio (per 10 cells/L/%, β: 3.334, P < 0.01), and low albumin (per 0.1 mg/dL, β: -55.912, P < 0.001) were independently associated with an increased baPWV. Furthermore, high white blood cells (per 10 cells/L, β: 3.941, P < 0.001), high neutrophil percentage (per 1%, β: 1.144, P < 0.001), and high CRP (per 1 mg/L, β: 9.161, P = 0.03) were independently associated with an increased platelet to LYMPH% ratio.An increased platelet to LYMPH% ratio is associated with an increased baPWV in HD patients. An easy and inexpensive laboratory measure of platelet to LYMPH% ratio may provide an important information regarding arterial stiffness in patients with HD.

  11. Neonatal brachial plexus palsy: a permanent challenge

    Directory of Open Access Journals (Sweden)

    Carlos Otto Heise

    2015-09-01

    Full Text Available Neonatal brachial plexus palsy (NBPP has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

  12. A PRESSURE ULCER AND FALL RATE QUALITY COMPOSITE INDEX FOR ACUTE CARE UNITS: A MEASURE DEVELOPMENT STUDY

    Science.gov (United States)

    Jayawardhana, Ananda; Burman, Mary E.; Dunton, Nancy E.; Staggs, Vincent S.; Bergquist-Beringer, Sandra; Gajewski, Byron J.

    2016-01-01

    Background Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. Objective The study objective was to develop a unit-level inpatient composite nursing care quality performance index – the Pressure Ulcer and Fall Rate Quality Composite Index. Design Two-phase measure development study. Settings 5,144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013. Methods The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. Results The Pressure Ulcer and Fall Rate Quality Composite Index = 100 − PUR − FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of

  13. Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury.

    Science.gov (United States)

    Kachramanoglou, Carolina; Carlstedt, Thomas; Koltzenburg, Martin; Choi, David

    2017-07-01

    Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury. We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing. We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome. Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  14. The relationship between blood pressure and left ventricular mass index depends on an excess adiposity.

    Science.gov (United States)

    Norton, Gavin R; Majane, Olebogeng Hi; Libhaber, Elena; Maseko, Muzi J; Makaula, Siyanda; Libhaber, Carlos; Woodiwiss, Angela J

    2009-09-01

    To determine whether blood pressure (BP)-LVM relationships depend in-part on the influence of an excess adiposity and whether this translates into a greater effect of hypertension on LVM in obese as compared with lean people. In 399 randomly recruited participants from a general population with a high prevalence of excess adiposity ( approximately 68%), we assessed whether the relationships between conventional blood pressure (BP) and LVM indexed for height (LVMI) (determined from echocardiography) are influenced by adiposity. We confirmed these outcomes using 24-h ambulatory measurements in 297 participants; and carotid-femoral pulse wave velocity (PWV) (applanation tonometry) in 328 participants and from plasma leptin concentrations, we assessed whether leptin could mediate this effect. After adjustments for appropriate confounders, including the individual terms for adiposity and BP, interactions between adiposity indices (either waist circumference or the mean of subscapular and triceps skin-fold thickness) and either conventional systolic BP (SBP), 24-h SBP, PWV, conventional pulse pressure (PP), or 24-h PP were independently associated with LVMI (P obese as compared with lean participants. Every one SD increase in conventional SBP ( approximately 22 mmHg) was associated with a 1.61 g/m increase in LVMI in participants with a normal waist circumference, in comparison to a 5.24 g/m increase in LVMI in those with an increased waist circumference (P obesity (LVMI, normotensives = 45.6 g/m, hypertensives = 51.0 g/m, P obese, but not in lean people in groups of African descent in South Africa.

  15. Efeito da terapia antirretroviral e dos níveis de carga viral no complexo médio-intimal e no índice tornozelo-braço em pacientes infectados pelo HIV Antirretroviral therapy effect in the intima-medio complex and ankle-brachial index in patients infected by HIV

    Directory of Open Access Journals (Sweden)

    Emmanuelle Tenório Albuquerque Madruga Godoi

    2012-06-01

    Full Text Available OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral. MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular, as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1% fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4% estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7% e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index

  16. Assessment of central haemomodynamics from a brachial cuff in a community setting

    Directory of Open Access Journals (Sweden)

    Nunan David

    2012-06-01

    Full Text Available Abstract Background Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed. Methods One-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP and pulse pressure and wave reflection parameters (augmentation pressure (AP and index, AIx were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from 80 years in the whole population and a subset with a systolic BP  Results We obtained 1,793 measures of peripheral and central BP, PP and augmentation parameters. Age and gender associations with central haemodynamic and augmentation parameters reflected those previously established from reference standard non-invasive techniques under specialised settings. Findings were the same for patients with a systolic BP below 140 mmHg (i.e. normotensive. Lower values for AIx in the current study are possibly due to differences in sampling rates, detection frequency and/or averaging procedures and to lower numbers of volunteers in younger age groups. Conclusion A novel transfer-function like algorithm, using brachial cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings.

  17. Estimating central systolic blood pressure during oscillometric determination of blood pressure: proof of concept and validation by comparison with intra-aortic pressure recording and arterial tonometry.

    Science.gov (United States)

    Brett, Sally Emma; Guilcher, Antoine; Clapp, Brian; Chowienczyk, Phil

    2012-06-01

    Central systolic blood pressure is usually estimated by transformation of a peripheral arterial waveform obtained by tonometry and calibrated from conventional measurements of brachial artery blood pressure from a brachial cuff using the oscillometric principle. We investigated whether central blood pressure could be obtained directly from a brachial cuff waveform, allowing the measurement of central blood pressure to be incorporated into the standard oscillometric determination of blood pressure. Values of central systolic blood pressure obtained from a brachial cuff waveform were compared with those obtained using a pressure-tipped intra-aortic catheter in 29 individuals undergoing cardiac catheterization. To remove errors introduced by the measurement of peripheral blood pressure, transformed brachial waveforms were calibrated using values of mean and diastolic pressure from the intra-aortic catheter. In a second study, the values obtained from the brachial cuff were compared with those obtained using a noninvasive tonometric method using calibration from mean and diastolic and from systolic and diastolic blood pressure derived from a standard oscillometric algorithm in 100 individuals (46 women, 19-81 years) with blood pressure ranging from 89/52 to 230/117 mmHg. In study 1, the mean difference ± SD of brachial cuff-derived values and intra-aortic values was 0.0 ± 5.9 mmHg. In study 2, the mean difference for brachial cuff-derived values and tonometer values was -0.6 ± 3.9 and 1.6 ± 4.5 mmHg when calibrated using brachial mean and diastolic and brachial systolic and diastolic pressures, respectively. Central systolic blood pressure can be obtained from a brachial cuff waveform with an accuracy comparable to that of a tonometer.

  18. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

    NARCIS (Netherlands)

    Eng, GD; Binder, H; Getson, P; ODonnell, R

    Resurgence of neurosurgical intervention oi obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus

  19. The correlation between body mass index and intraocular pressure in children

    Directory of Open Access Journals (Sweden)

    Luciano Lira de Albuquerque

    2013-02-01

    Full Text Available PURPOSE: There is evidence from some studies that support an association between obesity in adults and higher intraocular pressure (IOP. However, this association has not been completely studied in children. Our aim is to evaluate the association between child body mass index (BMI and IOP. METHODS: Ninety-six children attending the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP in Brazil were studied. Thirty-three were overweight/obese with a mean BMI of 29.7 ± 5.2 and 63 with a mean BMI of 20.8 ± 3.3. IOP was measured using the Goldmann applanation tonometer and was corrected for corneal thickness. The coefficient of correlation between BMI and IOP was calculated. RESULTS: There was no significant difference in the IOP of children with or without overweight/obesity. The mean IOP was 13.5 and 13.0 mmHg for the right eye and 13.1 and 12.9 mmHg for left eye, respectively (p=0.38 and p=0.71. The results remained the same after correction by pachymetry; 13.0 and 13.1 mmHg for the right eye and 12.4 and 12.9 mmHg for the left eye, respectively (p=0.88 and p=0.41. The coefficient of correlation between BMI and IOP was 0.070 (p=0.496. CONCLUSION: These results do not show a correlation between body mass index and IOP in children. Further studies are warranted to clarify the association between BMI and IOP in children.

  20. High hydrostatic pressure processing reduces the glycemic index of fresh mango puree in healthy subjects.

    Science.gov (United States)

    Elizondo-Montemayor, Leticia; Hernández-Brenes, Carmen; Ramos-Parra, Perla A; Moreno-Sánchez, Diana; Nieblas, Bianca; Rosas-Pérez, Aratza M; Lamadrid-Zertuche, Ana C

    2015-04-01

    Dietary guidelines recommend the daily consumption of fruits; however, healthy and type 2 diabetes mellitus (T2DM) subjects receive conflicting messages regarding ingestion of fruits, such as mango, because of its sugar content. We investigated the effects of high hydrostatic pressure (HHP) processing of fresh mango puree (MP) on the glycemic indexes (GIs) and postprandial glycemic responses of 38 healthy Mexican subjects in a randomized cross-over clinical trial. Physicochemical characterization of MP included sugar profiles by HPLC-ELSD, starch, fibers, moisture, viscosity, swelling capacity and solubility properties of alcohol insoluble residue (AIR). The mean GI for HHP-MP was significantly lower (32.7 ± 13.4) than that of unprocessed-MP (42.7 ± 19.5). A significantly higher proportion of subjects showed a low GI following the consumption of HHP-MP compared to unprocessed-MP and none of them showed a high GI for the HHP-MP, compared to a significantly higher proportion for the unprocessed-MP. The viscosity and AIR solubility values of HHP-MP samples were significantly higher, which influenced glucose peaking later (Tmax) at 45 minutes and induced 20% lower AUC values than unprocessed-MP, corresponding to greater retardation indexes. The study findings support data stating that low GI fruits are appropriate for glycemic control and that mango may be included as part of healthy subjects' diets and potentially T2DM subjects' diets. Furthermore, HHP processing of mango may offer additional benefits for glycemic control, as its performance regarding GI, AUC and Tmax was significantly better than that of the unprocessed-MP. To our knowledge, this is the first report on the impact of this commercial non-thermal pasteurization technology on glucose metabolism.

  1. Familial correlation and aggregation of body mass index and blood pressure in Chinese Han population.

    Science.gov (United States)

    Hu, Yang; He, Liu; Wu, Yangfeng; Ma, Guansheng; Li, Liming; Hu, Yonghua

    2013-07-26

    It remains unclear whether the body mass index (BMI) and blood pressure (BP) profile are clustered within families in Chinese Han population. The aim of this study is to explore familial aggregation and parent-offspring correlations of BMI and blood pressure in Chinese Han population. 6,369 Han nucleus families, consisting of parents and at least one biological adult child who were living together, were enrolled from the nation-wide cross-sectional study (China National Nutrition and Health Survey) which was conducted in 2002, with a total number of 19,107 participants aged 18-64 years (6,369 sets of parents, 4,132 sons and 2,237 daughters). Family aggregation (Intra-class correlations, ICCs) and parent-offspring correlations in BMI, systolic BP (SBP) and diastolic BP (DBP) were estimated using linear mixed effect regression models. BMI and BP levels in two generations and ICCs of BMI, SBP and DBP varied across the country. Familial aggregation of overweight/obesity was observed in rural area (ICC=5.4%, p<0.05), and high BP (defined as SBP ≥ 120 mmHg or DBP ≥ 80 mmHg) was more common in low income families (ICC=4.4%, p<0.05) compared to middle income (ICC=1.9%) and high income families (ICC=2.6%). Additionally, offspring with more parents being overweight/obese tend to have higher BMI. The similar trend was found for high BP. However, we did not observe that same-sex parent-offspring correlations of BMI and BP were stronger than the correlations for mother-son or father-daughter. Our study suggested that familial environments, alongside the impact of genetic factors, could be important non-communicable chronic diseases (NCD) risk factors. Family-based intervention taking both mother and father into account might have great potential in NCD prevention for younger generation.

  2. Indexed

    CERN Document Server

    Hagy, Jessica

    2008-01-01

    Jessica Hagy is a different kind of thinker. She has an astonishing talent for visualizing relationships, capturing in pictures what is difficult for most of us to express in words. At indexed.blogspot.com, she posts charts, graphs, and Venn diagrams drawn on index cards that reveal in a simple and intuitive way the large and small truths of modern life. Praised throughout the blogosphere as “brilliant,” “incredibly creative,” and “comic genius,” Jessica turns her incisive, deadpan sense of humor on everything from office politics to relationships to religion. With new material along with some of Jessica’s greatest hits, this utterly unique book will thrill readers who demand humor that makes them both laugh and think.

  3. Nitroglycerine-induced vasodilation in coronary and brachial arteries in patients with suspected coronary artery disease.

    Science.gov (United States)

    Maruhashi, Tatsuya; Kajikawa, Masato; Nakashima, Ayumu; Iwamoto, Yumiko; Iwamoto, Akimichi; Oda, Nozomu; Kishimoto, Shinji; Matsui, Shogo; Higaki, Tadanao; Shimonaga, Takashi; Watanabe, Noriaki; Ikenaga, Hiroki; Hidaka, Takayuki; Kihara, Yasuki; Chayama, Kazuaki; Goto, Chikara; Aibara, Yoshiki; Noma, Kensuke; Higashi, Yukihito

    2016-09-15

    Nitroglycerine-induced vasodilation, an index of endothelium-independent vasodilation, is measured for the assessment of vascular smooth muscle cell function or alterations of vascular structure. Both coronary and brachial artery responses to nitroglycerine have been demonstrated to be independent prognostic markers of cardiovascular events. The purpose of this study was to evaluate the nitroglycerine-induced vasodilation in coronary and brachial arteries in the same patients. We measured nitroglycerine-induced vasodilation in coronary and brachial arteries in 30 subjects with suspected coronary artery disease who underwent coronary angiography (19 men and 11 women; mean age, 69.0±8.8years; age range, 42-85years). The mean values of nitroglycerine-induced vasodilation in the brachial artery, left anterior descending coronary artery, and left circumflex coronary artery were 12.6±5.2%, 11.6±10.3%, and 11.9±11.0%, respectively. Nitroglycerine-induced vasodilation in the brachial artery correlated significantly with that in the left anterior descending coronary artery (r=0.43, P=0.02) and that in the left circumflex coronary artery (r=0.49, P=0.006). There was also a significant correlation between nitroglycerine-induced vasodilation in the left anterior descending coronary artery and that in the left circumflex coronary artery (r=0.72, Parteries and that in coronary arteries are simultaneously present. Nitroglycerine-induced vasodilation in the brachial artery could be used as a surrogate for that in a coronary artery and as a prognostic marker for cardiovascular events. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Intramuscular pressure and electromyography as indexes of force during isokinetic exercise

    Science.gov (United States)

    Aratow, M.; Ballard, R. E.; Grenshaw, A. G.; Styf, J.; Watenpaugh, D. E.; Kahan, N. J.; Hargens, A. R.

    1993-01-01

    A direct method for measuring force production of specific muscles during dynamic exercise is presently unavailable. Previous studies indicate that both intramuscular pressure (IMP) and electromyography (EMG) correlate linearly with muscle contraction force during isometric exercise. The objective of this study was to compare IMP and EMG as linear assessors of muscle contraction force during dynamic exercise. IMP and surface EMG activity were recorded during concentric and eccentric isokinetic plantarflexion and dorsiflexion of the ankle joint from the tibialis anterior (TA) and soleus (SOL) muscles of nine male volunteers. Ankle torque was measured using a dynamometer, and IMP was measured via catheterization. IMP exhibited better linear correlation than EMG with ankle joint torque during concentric contractions of the SOL and the TA, as well as during eccentric contractions. IMP provides a better index of muscle contraction force than EMG during concentric and eccentric exercise through the entire range of torque. IMP reflects intrinsic mechanical properties of individual muscles, such as length-tension relationships, which EMG is unable to assess.

  5. The Relationship Between Breast Feeding and Body Mass Index and Blood Pressure in Pre-School Children

    Directory of Open Access Journals (Sweden)

    Mostafa Behjati-Ardakani

    2012-07-01

    Full Text Available Introduction: It is generally accepted that breast feeding has a beneficial effect on the health of infants and children. The evidence that breast feeding protects against obesity is inconclusive also the influence of breast feeding on blood pressure in later life is uncertain. The major aim of this study was to assess the association between method of infant breast feeding and components of the body mass index and blood pressure in pre-school children. Materials & Methods: In a cohort study, a total of 800 pre-school children, 359 (47.2% males, and 402 (52.8% females, born in 2003 in Yazd, Iran were selected based on a systematic stratified random model. Of eight hundred questionnaires sent, 761 (95% were returned to the investigators. At 6 years, blood pressure was measured on the right arm at rest. Body mass index (BMI was calculated by dividing the weight in kilograms by the square of height in meters (kg/m2.Data on infants feeding were collected respectively during first two years of life .Data were managed and analyzed using SPSS (SPSS, Inc, version 13.0 Results: Of the 761 subjects included in this study, 452 (59.4% were exclusively breast fed, 136 (17.9% were bottle fed and 173 (22.7% were partially breast fed. Body mass index was not significantly different between bottle feeding, partial and exclusive breast feeding groups (P=0.398 ..No relationship was found between method and duration of breast feeding, and systolic blood pressure (P=0.244, diastolic blood pressure (P=0.781 and mean blood pressure (P=0.483. Conclusion: We did not find association between method of infant feeding, duration of breast feeding and systolic, diastolic mean blood pressures and also with body mass index

  6. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis.

    Science.gov (United States)

    Pai, Rohini V Bhat; Hegde, Harihar V; Santhosh, McB; Roopa, S; Deshpande, Shrinivas S; Rao, P Raghavendra

    2013-01-01

    Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis) and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

  7. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis

    Directory of Open Access Journals (Sweden)

    Rohini V Bhat Pai

    2013-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

  8. Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report

    Directory of Open Access Journals (Sweden)

    Francisco Ferrero-Manzanal

    2016-01-01

    Conclusion: When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus.

  9. Percentile distribution of blood pressure readings in relation to body mass index: a populationbased cross-sectional study ADOPOLNOR

    Directory of Open Access Journals (Sweden)

    Krzyżaniak Alicja

    2015-03-01

    Full Text Available Recent upward trends toward elevated blood pressure and increased weight expressed in terms of body mass index in children and adolescents call for regular monitoring of their physical growth and age-related changes in blood pressure. This requires adequate tools - reference values of a normal blood pressure range. The main objective of this study was to provide sex- and BMI-specific percentile reference values for systolic and diastolic blood pressure based on the adolescent Polish population, participants in the ADOPOLNOR study. A cross-sectional survey was carried out on a representative, randomly selected cohort of 4,941; 2,451 male and 2,490 female students aged 10-18 years, residents in Wielkopolska province and its capital, the city of Poznań. All examinations were performed in school nursery rooms during morning hours according to standard procedures. Body height and weight were measured and BMI was calculated. Blood pressure was measured twice on each occasion on the right arm using a fully calibrated TECH MED TM-Z mercury gauge sphygmomanometer with sets of exchangeable cuffs and a clinical stethoscope. The blood pressure classification was determined using the surveillance method. For each participant, the mean of measurements taken on each of the three occasions was calculated and served as his/her final blood pressure value. Using the LMS method, fitted percentile curves were created for BMI-related systolic and diastolic blood pressure. The findings revealed that age related blood pressure pattern was similar in boys and girls. It showed a steady increase of systolic and diastolic blood pressure with age. There was a positive correlation between the systolic and diastolic blood pressure indicating that when systolic blood pressure increased so diastolic did (r=0.61 at p<0.01. Boys were likely to have relatively higher mean values of systolic and diastolic blood pressure and steeper slope for BMI-related change in blood pressure

  10. Ultrasound-guided supraclavicular brachial plexus anaesthesia ...

    African Journals Online (AJOL)

    Ultrasound-guided supraclavicular brachial plexus anaesthesia improves arteriovenous fistula flow characteristics in end-stage renal disease patients. ... In all patients, a radiocephalic arteriovenous fistula was created by an experienced surgeon using a standard surgical technique. In both groups 20 ml of 0.375% ...

  11. MR evaluation of brachial plexus injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, R.K.; Jain, R.K. (Institute of Nuclear Medicine and Allied Sciences, New Delhi (India). NMR Research Center); Mehta, V.S.; Banerji, A.K. (All India Inst. of Medical Sciences, New Delhi (India). Dept. of Neurosurgery)

    1989-11-01

    Ten cases of brachial plexus injury were subjected to magnetic resonance (MR) to demonstrate the roots, trunks, divisions or cord abnormalities. Both normal and abnormal brachial plexuses were imaged in sagittal, axial, coronal and axial oblique planes. Myelography, using water soluble contrast agents, was performed in seven cases. MR demonstrated one traumatic meningocele, one extradural cerebrospinal fluid (CSF) collection, trunk and/or root neuromas in four, focal root fibrosis in two and diffuse fibrosis in the remaining two cases. Results of MR were confirmed at surgery in four cases with neuromas, while myelography was normal in two and was not carried out in the remaining two. In two cases, where MR demonstrated diffuse fibrosis of the brachial plexus, myelography showed C7 and T1 traumatic meningocele in one and was normal in the other. Both these patients showed excellent clinical and electrophysiological correlation with MR findings and in one of them surgical confirmation was also obtained. In the other two cases with focal nerve root fibrosis, myelography was normal in one and showed a traumatic meningocele in another. Operative findings in these cases confirmed focal root fibrosis but no root avulsion was observed although seen on one myelogram. Focal fibrosis, however, was noted at operation in more roots than was observed with MR. Initial experience suggests that MR may be the diagnostic procedure of choice for complete evaluation of brachial plexus injuries. (orig.).

  12. Brachial artery approach for outpatient arteriography

    Energy Technology Data Exchange (ETDEWEB)

    You, Jai Kyung; Park, Sung Il; Lee, Do Yun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Jae Hwan [Ajou Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, with particular regard to safety and image quality. The angiographic findings and follow-up medical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 F pigtail catheters were used in 125 cases and 5-F OCU-A catheters were used in three cases of renal arteriography, and three of upper extremity arteriography without catheter. Except for three cases of brachial artery puncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremity arteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were three in which there was multiple obstruction at the distal common iliac artery and one with insufficient contrast amount due to renal failure In four cases there were complications : two involved arterial thrombosis, one was an intramuscular hematoma, and one an A-V fistula. For outpatients, brachial approach arteriography can replace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate of complications is relatively low.

  13. Obstetric brachial plexus lesions: CT myelography

    NARCIS (Netherlands)

    Steens, S.C.A.; Pondaag, W.; Malessy, M.J.; Verbist, B.M.

    2011-01-01

    PURPOSE: To evaluate the value of computed tomographic (CT) myelography in the detection of root damage and differentiation of root avulsions from neurotmesis in a large cohort of patients with an obstetric brachial plexus lesion (OBPL). MATERIALS AND METHODS: Institutional review board approval was

  14. Effects of age at menopause on serum cholesterol, body mass index, and blood pressure.

    Science.gov (United States)

    Akahoshi, M; Soda, M; Nakashima, E; Tsuruta, M; Ichimaru, S; Seto, S; Yano, K

    2001-05-01

    Pre- and postmenopausal cholesterol (mg/dl), body mass index (BMI; kg/m(2)), and systolic blood pressure (SBP; mmHg) levels were compared in three age-at-time-of-menopause (ATM) groups to examine the relationship between the three risk factors and age ATM. Cholesterol, BMI, and SBP levels recorded 4 years prior to and 8 years after menopause were examined and increases in these risk factors between the two measurements were noted. The three age groups were: group A (n=49; age ATM [44+/-1]50), and group C (n=578; age ATM [52+/-2]> or =50). Cholesterol levels in premenopausal groups A (169+/-31 mg/dl, 40 years) and B (174+/-31, 44 years) were lower than those in group C (179+/-30, 48 years) (0.05cholesterol were greater in group A (41+/-28 mg/dl) than in groups B (32+/-28) and C (29+/-28) (0.05cholesterol levels were identical among groups despite age differences upon reaching the postmenopause phase: group A (210+/-34, 51 years), group B (206+/-35, 56 years) and group C (208+/-35, 60 years). BMI and SBP increases were not different in groups A, B, and C. Differences in BMI and SBP levels among groups in order of premenopausal age were still observed after menopause. These data suggest that the greater increase in cholesterol associated with early menopause may be related to a higher prevalence of ischemic heart disease (IHD) in younger menopausal women.

  15. Blood pressure levels and body mass index in Brazilian adults with Down syndrome

    Directory of Open Access Journals (Sweden)

    Felipe Pucci

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Increased life expectancy among people with Down syndrome (DS has introduced new environmental factors that may affect blood pressure (BP and/or lead to obesity in this population. The aim here was to investigate BP levels and body mass index (BMI in adults with DS, correlating these data with the patients' sex and age. DESIGN AND SETTING: Analytical cross-sectional observational study conducted in special schools in Curitiba (PR, Brazil. METHODS: 97 adult patients were included. BP was measured in accordance with the established guidelines. BMI was calculated by dividing the weight by the height squared (kg/m2. RESULTS: Sex had no influence on BMI; nor did systolic BP (SBP or diastolic BP (DBP. The age range was from 18 to 56 years. No correlation was observed between increasing age and greater BMI or BP. Eighty-six individuals (88.7% presented normal BP, eleven (11.3% prehypertension and none hypertension. Twenty patients (20.4% presented BP lower than 90 × 60 mmHg. BMI ranged from 18 to 48 kg/m2 (mean of 28.8 ± 3.92 kg/m2: 21.9% had normal weight; 40.7% were overweight; and 25.3% had obesity class I, 9.9% class II and 2.2% class III. Higher BMI was associated with significantly greater SBP and DBP (P = 0.0175 and P = 0.0015. CONCLUSION: Sex and age did not influence SBP, DBP or BMI in Brazilian adults with DS. Higher BMI was associated with greater BP (both systolic and diastolic.

  16. Longitudinal relationship of parental hypertension with body mass index, blood pressure, and cardiovascular reactivity in children.

    Science.gov (United States)

    Li, Rongling; Alpert, Bruce S; Walker, Sammie S; Somes, Grant W

    2007-05-01

    To investigate whether parental hypertension (HTN) affects children's body mass index (BMI) and cardiovascular reactivity (CVR) over time. A longitudinal study of 315 students (black: 23 females, 19 males; white: 142 females, 131 males) was conducted in the public schools of Obion County, Tennessee, between 1987 and 1992. BMI and BMI z scores were calculated. The CVR task was a series of video games (taking approximately 10 minutes to play) given to the same students in their third-, fourth-, fifth-, seventh-, and eighth-grade years. CVR was defined as the change in blood pressure (delta_BP) or heart rate (delta_HR) between before playing and while playing the video game. Positive parental history of HTN (27.6%) was defined as at least 1 parent with HTN. Multivariable regression analyses were performed to estimate the effects of parental HTN on children's BMI and CVR over time. Children with parental HTN had significant higher BMI, BMI z score, and R_BP than did children without parental HTN (BMI: 21.6 vs 19.9, P = .001; BMI z score: 1.6 vs 1.1, P = .003; R_SBP: 112.6 vs 110.4 mm Hg, P = .01; R_DBP 62.7 vs 60.6 mm Hg, P = .003) after adjustment for covariates. Increased CVR was observed in children with parental HTN compared with children without parental HTN but was statistically significant only for SBP (delta_SBP: 17.2 vs 14.9 mm Hg; P = .01) after adjustment for covariates. Parental HTN independently predicted children's BMI, BMI z score, resting BP, and BP reactivity.

  17. Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx).

    Science.gov (United States)

    Johnson, Ulf; Engquist, Henrik; Howells, Tim; Nilsson, Pelle; Ronne-Engström, Elisabeth; Lewén, Anders; Rostami, Elham; Enblad, Per

    2016-08-01

    Subarachnoid hemorrhage (SAH) is a disease with a high rate of unfavorable outcome, often related to delayed cerebral ischemia (DCI), i.e., ischemic injury that develops days-weeks after onset, with a multifactorial etiology. Disturbances in cerebral pressure autoregulation, the ability to maintain a steady cerebral blood flow (CBF), despite fluctuations in systemic blood pressure, have been suggested to play a role in the development of DCI. Pressure reactivity index (PRx) is a well-established measure of cerebral pressure autoregulation that has been used to study traumatic brain injury, but not extensively in SAH. To study the relation between PRx and CBF in SAH patients, and to examine if PRx can be used to predict DCI. Retrospective analysis of prospectively collected data. PRx was calculated as the correlation coefficient between mean arterial blood pressure (MABP) and intracranial pressure (ICP) in a 5 min moving window. CBF was measured using bedside Xenon-CT (Xe-CT). DCI was diagnosed clinically. 47 poor-grade mechanically ventilated patients were studied. Patients with disturbed pressure autoregulation (high PRx values) had lower CBF, as measured by bedside Xe-CT; both in the early (day 0-3) and late (day 4-14) acute phase of the disease. PRx did not differ significantly between patients who developed DCI or not. In mechanically ventilated and sedated SAH patients, high PRx (more disturbed CBF pressure autoregulation) is associated with low CBF, both day 0-3 and day 4-14 after onset. The role of PRx as a monitoring tool in SAH patients needs further studying.

  18. Effects of exercise on central aortic pressure before and after treatment with renin-angiotensin system blockade in patients with hypertension.

    OpenAIRE

    Lacy, P. S.; Brunel, P.; Baschiera, F; J. Botha; Williams, B

    2014-01-01

    Brachial blood pressure increases with exercise and an excessive rise predicts increased cardiovascular risk. Measurement of brachial blood pressure alone may exaggerate the true blood pressure elevation due to exercise-induced change to pressure amplification. Whether blood pressure-lowering treatment modulates pressure amplification during exercise is unknown.

  19. [The evaluation of the end-ejection pressure-length relation as an index of regional contractility].

    Science.gov (United States)

    Perlini, S; Meyer, T E; Bernardi, L; Soldà, P L; Calciati, A; Finardi, G; Foëx, P

    1992-08-01

    Although end-systolic pressure-length relationship (ESPLR) is now widely used as a regional substitute for the end-systolic pressure-volume relationship, there are some reservations about its use as an index of systolic performance. This study aimed at assessing whether by using end-ejection (zero aortic flow) as a definition of end-systole, ESPLR can be used to characterize myocardial performance independent of load, and if the choice of the region where to implant the sonomicrometers is critical. Ten anaesthetized dogs (16 +/- 2 kg) were instrumented with a left ventricular (LV) pressure micromanometer and an aortic flow probe. Sonomicrometers were implanted in the apical (L1) and the mid-ventricular (L2) regions of the anterior LV wall, and in the basal region of the lateral wall (L3). End-systolic pressure-length relationships were obtained during acute preload reduction induced by the inflation of a vena caval balloon. This evaluation was repeated after increasing end-diastolic pressure to 14-18 mmHg (delta PL), after increasing systolic pressure by 15 (delta P-I) and 25 mmHg (delta P-II) with graded descending aorta occlusion, and during dobutamine infusions at 2.5 (Db 2.5) and 5 micrograms/kg/min (Db5). End-systolic pressure-length relationships (r > 0.97; pressure range: 70-100 mmHg) were characterized by their slopes (Ees), the extrapolated intercept at zero pressure (L0) and the values of segment length at a pressure of 75 (L75) and 100 mmHg (L100). In all the myocardial regions studied by sonomicrometry, the increments in preload and afterload did not significantly shift ESPLR.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Automated method to compute Evans index for diagnosis of idiopathic normal pressure hydrocephalus on brain CT images

    Science.gov (United States)

    Takahashi, Noriyuki; Kinoshita, Toshibumi; Ohmura, Tomomi; Matsuyama, Eri; Toyoshima, Hideto

    2017-03-01

    The early diagnosis of idiopathic normal pressure hydrocephalus (iNPH) considered as a treatable dementia is important. The iNPH causes enlargement of lateral ventricles (LVs). The degree of the enlargement of the LVs on CT or MR images is evaluated by using a diagnostic imaging criterion, Evans index. Evans index is defined as the ratio of the maximal width of frontal horns (FH) of the LVs to the maximal width of the inner skull (IS). Evans index is the most commonly used parameter for the evaluation of ventricular enlargement. However, manual measurement of Evans index is a time-consuming process. In this study, we present an automated method to compute Evans index on brain CT images. The algorithm of the method consisted of five major steps: standardization of CT data to an atlas, extraction of FH and IS regions, the search for the outmost points of bilateral FH regions, determination of the maximal widths of both the FH and the IS, and calculation of Evans index. The standardization to the atlas was performed by using linear affine transformation and non-linear wrapping techniques. The FH regions were segmented by using a three dimensional region growing technique. This scheme was applied to CT scans from 44 subjects, including 13 iNPH patients. The average difference in Evans index between the proposed method and manual measurement was 0.01 (1.6%), and the correlation coefficient of these data for the Evans index was 0.98. Therefore, this computerized method may have the potential to accurately compute Evans index for the diagnosis of iNPH on CT images.

  1. MR neurography in traumatic brachial plexopathy

    Energy Technology Data Exchange (ETDEWEB)

    Upadhyaya, Vaishali, E-mail: vshali77@yahoo.co.in [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Upadhyaya, Divya N. [Department of Plastic Surgery, King George Medical University, Shah Meena Road, Chowk, Lucknow 226 003 (India); Kumar, Adarsh [Department of Plastic Surgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Gujral, Ratni B. [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India)

    2015-05-15

    Highlights: • MR neurography is the imaging modality of choice in patients who have sustained brachial plexus injury. It is helpful in determining the level and extent of injury. • The authors have used a Visual Per-operative Scoring system to assess the usefulness of MR neurography in delineating the level and type of the lesion. • The imaging findings were classified based on the level of injury—root, trunk or cord. These findings were correlated with those seen on surgical exploration. A good correlation was found in the majority (65%) of patients and average correlation (30%) in others. - Abstract: Objectives: Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. Methods: Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus—roots, trunks and cords. Results: Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative

  2. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis.

    Science.gov (United States)

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-05-01

    Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD).We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4.Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003-1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046-1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4.Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients.

  3. The effect of moderate running on foot posture index and plantar pressure distribution in male recreational runners.

    Science.gov (United States)

    Escamilla-Martínez, Elena; Martínez-Nova, Alfonso; Gómez-Martín, Beatriz; Sánchez-Rodríguez, Raquel; Fernández-Seguín, Lourdes María

    2013-01-01

    Fatigue due to running has been shown to contribute to changes in plantar pressure distribution. However, little is known about changes in foot posture after running. We sought to compare the foot posture index before and after moderate exercise and to relate any changes to plantar pressure patterns. A baropodometric evaluation was made, using the FootScan platform (RSscan International, Olen, Belgium), of 30 men who were regular runners and their foot posture was examined using the Foot Posture Index before and after a 60-min continuous run at a moderate pace (3.3 m/sec). Foot posture showed a tendency toward pronation after the 60-min run, gaining 2 points in the foot posture index. The total support and medial heel contact areas increased, as did pressures under the second metatarsal head and medial heel. Continuous running at a moderate speed (3.3 m/sec) induced changes in heel strike related to enhanced pronation posture, indicative of greater stress on that zone after physical activity. This observation may help us understand the functioning of the foot, prevent injuries, and design effective plantar orthoses in sport.

  4. Pressure Sensing in High-Refractive-Index Liquids Using Long-Period Gratings Nanocoated with Silicon Nitride

    Directory of Open Access Journals (Sweden)

    Jiahua Chen

    2010-12-01

    Full Text Available The paper presents a novel pressure sensor based on a silicon nitride (SiNx nanocoated long-period grating (LPG. The high-temperature, radio-frequency plasma-enhanced chemical-vapor-deposited (RF PECVD SiNx nanocoating was applied to tune the sensitivity of the LPG to the external refractive index. The technique allows for deposition of good quality, hard and wear-resistant nanofilms as required for optical sensors. Thanks to the SiNx nanocoating it is possible to overcome a limitation of working in the external-refractive-index range, which for a bare fiber cannot be close to that of the cladding. The nanocoated LPG-based sensing structure we developed is functional in high-refractive-index liquids (nD > 1.46 such as oil or gasoline, with pressure sensitivity as high as when water is used as a working liquid. The nanocoating developed for this experiment not only has the highest refractive index ever achieved in LPGs (n > 2.2 at λ = 1,550 nm, but is also the thinnest (

  5. Evaluation of blood pressure control using a new arterial stiffness parameter, cardio-ankle vascular index (CAVI).

    Science.gov (United States)

    Shirai, Kohji; Utino, Junji; Saiki, Atsuhito; Endo, Kei; Ohira, Masahiro; Nagayama, Daiji; Tatsuno, Ichiro; Shimizu, Kazuhiro; Takahashi, Mao; Takahara, Akira

    2013-02-01

    Arterial stiffness has been known to be a surrogate marker of arteriosclerosis, and also of vascular function. Pulse wave velocity (PWV) had been the most popular index and was known to be a predictor of cardiovascular events. But, it depends on blood pressure at measuring time. To overcome this problem, cardio-ankle vascular index (CAVI) is developed. CAVI is derived from stiffness parameter β by Hayashi, and the equation of Bramwell-Hill, and is independent from blood pressure at a measuring time. Then, CAVI might reflect the proper change of arterial wall by antihypertensive agents. CAVI shows high value with aging and in many arteriosclerotic diseases and is also high in persons with main coronary risk factors. Furthermore, CAVI is decreased by an administration of α1 blocker, doxazosin for 2-4 hours, Those results suggested that CAVI reflected the arterial stiffness composed of organic components and of smooth muscle cell contracture. Angiotensin II receptor blocker, olmesartan decreased CAVI much more than that of calcium channel antagonist, amlodipine, even though the rates of decreased blood pressure were almost same. CAVI might differentiate the blood pressure-lowering agents from the point of the effects on proper arterial stiffness. This paper reviewed the principle and rationale of CAVI, and the possibilities of clinical applications, especially in the studies of hypertension.

  6. Brachial blood flow under relative levels of blood flow restriction is decreased in a nonlinear fashion.

    Science.gov (United States)

    Mouser, J Grant; Ade, Carl J; Black, Christopher D; Bemben, Debra A; Bemben, Michael G

    2017-04-12

    Blood flow restriction (BFR), the application of external pressure to occlude venous return and restrict arterial inflow, has been shown to increase muscular size and strength when combined with low-load resistance exercise. BFR in the research setting uses a wide range of pressures, applying a pressure based upon an individual's systolic pressure or a percentage of occlusion pressure; not a directly determined reduction in blood flow. The relationship between relative pressure and blood flow has not been established. To measure blood flow in the arm under relative levels of BFR. Forty-five people (18-40 years old) participated. Arterial occlusion pressure in the right arm was measured using a 5-cm pneumatic cuff. Blood flow in the brachial artery was measured at rest and at pressures between 10% and 90% of occlusion using ultrasound. Blood flow decreased in a nonlinear, stepped fashion. Blood flow decreased at 10% of occlusion and remained constant until decreasing again at 40%, where it remained until 90% of occlusion. The decrease in brachial blood flow is not proportional to the applied relative pressure. The prescription of blood flow restriction should take into account the stimulus provided at each relative level of blood flow. © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  7. Axillary brachial plexus blockade in moyamoya disease?

    Directory of Open Access Journals (Sweden)

    Saban Yalcin

    2011-01-01

    Full Text Available Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.

  8. Brachial Plexus Neuropraxia: A Case Report

    Directory of Open Access Journals (Sweden)

    Bayram Kelle

    2012-08-01

    Full Text Available Neuropraxia develops as a result of localized nerve compression. The anatomical structure of the nerve is protected. Motor loss and paresthesias may occur, pain sensation is rarely affected. The distal portion of the extremities are affected more often. Clinical symptoms respond well to treatments. In this case was presented brachial plexus neuropraxia which is a very rare situation und the literature was reviewed. [Cukurova Med J 2012; 37(4.000: 247-250

  9. Brachial Plexus Neuropraxia: A Case Report

    OpenAIRE

    Bayram Kelle; Filiz Koc

    2012-01-01

    Neuropraxia develops as a result of localized nerve compression. The anatomical structure of the nerve is protected. Motor loss and paresthesias may occur, pain sensation is rarely affected. The distal portion of the extremities are affected more often. Clinical symptoms respond well to treatments. In this case was presented brachial plexus neuropraxia which is a very rare situation und the literature was reviewed. [Cukurova Med J 2012; 37(4.000): 247-250

  10. Brachial artery diameter as a marker for cardiovascular risk assessment: FMD-J study.

    Science.gov (United States)

    Maruhashi, Tatsuya; Soga, Junko; Fujimura, Noritaka; Idei, Naomi; Mikami, Shinsuke; Iwamoto, Yumiko; Iwamoto, Akimichi; Kajikawa, Masato; Matsumoto, Takeshi; Oda, Nozomu; Kishimoto, Shinji; Matsui, Shogo; Hashimoto, Haruki; Aibara, Yoshiki; Yusoff, Farina Mohamad; Hidaka, Takayuki; Kihara, Yasuki; Chayama, Kazuaki; Noma, Kensuke; Nakashima, Ayumu; Goto, Chikara; Tomiyama, Hirofumi; Takase, Bonpei; Kohro, Takahide; Suzuki, Toru; Ishizu, Tomoko; Ueda, Shinichiro; Yamazaki, Tsutomu; Furumoto, Tomoo; Kario, Kazuomi; Inoue, Teruo; Koba, Shinji; Watanabe, Kentaro; Takemoto, Yasuhiko; Hano, Takuzo; Sata, Masataka; Ishibashi, Yutaka; Node, Koichi; Maemura, Koji; Ohya, Yusuke; Furukawa, Taiji; Ito, Hiroshi; Ikeda, Hisao; Yamashina, Akira; Higashi, Yukihito

    2018-01-01

    Baseline brachial artery (BBA) diameter has been reported to be a potential confounding factor of flow-mediated vasodilation (FMD). The purpose of this study was to evaluate the relationships between BBA diameter and cardiovascular risk factors and compare the diagnostic accuracy of BBA diameter in subjects without cardiovascular risk factors and patients with cardiovascular disease (CVD) with that of FMD. We measured BBA diameter and FMD in 5695 male subjects. In addition, we retrospectively investigated the incidence of cardiovascular events using another population sample consisting of 440 male subjects, to compare the accuracy of BBA diameter with that of FMD in predicting cardiovascular events. BBA diameter and FMD significantly correlated with age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose as well as Framingham risk score. The prevalence of cardiovascular risk factors and CVD increased with the increase in BBA diameter and FMD. Area under the curve (AUC) value of the receiver operating characteristic (ROC) curve for BBA diameter to diagnose subjects without cardiovascular risk factors (0.59 vs. 0.62, p = 0.001) or patients with CVD (0.58 vs. 0.64, p FMD. In the retrospective study, the AUC value of the ROC curve for BBA diameter to predict first major cardiovascular events was significantly lower than that of FMD (0.50 vs. 0.62, p = 0.03). In men, BBA diameter was inferior to FMD for assessment of cardiovascular risk. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting.

    Science.gov (United States)

    Raper, Daniel M S; Ding, Dale; Buell, Thomas J; Crowley, R Webster; Starke, Robert M; Liu, Kenneth C

    2017-04-20

    Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre- and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. Increasing BMI was significantly correlated with higher maximum MVP ( P = .013) and higher trans-stenosis pressure gradient ( P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m 2 ). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

  12. Morphometric Atlas Selection for Automatic Brachial Plexus Segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Van de Velde, Joris, E-mail: joris.vandevelde@ugent.be [Department of Anatomy, Ghent University, Ghent (Belgium); Department of Radiotherapy, Ghent University, Ghent (Belgium); Wouters, Johan [Department of Anatomy, Ghent University, Ghent (Belgium); Vercauteren, Tom; De Gersem, Werner; Duprez, Fréderic; De Neve, Wilfried [Department of Radiotherapy, Ghent University, Ghent (Belgium); Van Hoof, Tom [Department of Anatomy, Ghent University, Ghent (Belgium)

    2015-07-01

    Purpose: The purpose of this study was to determine the effects of atlas selection based on different morphometric parameters, on the accuracy of automatic brachial plexus (BP) segmentation for radiation therapy planning. The segmentation accuracy was measured by comparing all of the generated automatic segmentations with anatomically validated gold standard atlases developed using cadavers. Methods and Materials: Twelve cadaver computed tomography (CT) atlases (3 males, 9 females; mean age: 73 years) were included in the study. One atlas was selected to serve as a patient, and the other 11 atlases were registered separately onto this “patient” using deformable image registration. This procedure was repeated for every atlas as a patient. Next, the Dice and Jaccard similarity indices and inclusion index were calculated for every registered BP with the original gold standard BP. In parallel, differences in several morphometric parameters that may influence the BP segmentation accuracy were measured for the different atlases. Specific brachial plexus-related CT-visible bony points were used to define the morphometric parameters. Subsequently, correlations between the similarity indices and morphometric parameters were calculated. Results: A clear negative correlation between difference in protraction-retraction distance and the similarity indices was observed (mean Pearson correlation coefficient = −0.546). All of the other investigated Pearson correlation coefficients were weak. Conclusions: Differences in the shoulder protraction-retraction position between the atlas and the patient during planning CT influence the BP autosegmentation accuracy. A greater difference in the protraction-retraction distance between the atlas and the patient reduces the accuracy of the BP automatic segmentation result.

  13. A longitudinal study of the associations of children's body mass index and physical activity with blood pressure.

    Directory of Open Access Journals (Sweden)

    Corrie Macdonald-Wallis

    Full Text Available Childhood blood pressure is a marker of cardiovascular disease risk in later life. We examined how body mass index (BMI and physical activity, and changes in these, are associated with blood pressure in primary school-aged children. Data are from 1223 children aged 9 years (Year 4 in Bristol, UK, 685 of whom had been assessed at 6 years (Year 1. Child height and weight were measured, and children wore accelerometers for five days, from which average counts per minute, and moderate-to-vigorous-intensity physical activity and sedentary minutes per day were derived. At age 9 years, blood pressure was measured. Multiple imputation of missing data and adjusted linear regression models were used to examine associations. Child BMI at 9 years was cross-sectionally associated with higher systolic (SBP and diastolic (DBP blood pressure (mean difference [95% CI]: 1.10 [0.34, 1.87] mmHg and 0.86 [0.13, 1.60] mmHg, respectively, per SD of BMI. Prospective associations of BMI at age 6 with blood pressure at age 9 were consistent with these cross-sectional associations. However, change in BMI between 6 and 9 years was not strongly associated with subsequent SBP or DBP (0.68 [-0.61, 1.98] mmHg and 1.23 [-0.09, 2.54] mmHg, respectively. There was little evidence that physical activity or sedentary time were associated with blood pressure in either cross-sectional or prospective analyses. Greater childhood BMI is associated with higher blood pressure, and this association persists over several years. Prevention of excessive bodyweight from early childhood may be important in stemming the development of cardiovascular risk.

  14. Central aortic blood pressure and augmentation index: comparison between Vasotens® and SphygmoCor® technology

    Directory of Open Access Journals (Sweden)

    Rogoza AN

    2012-05-01

    Full Text Available Anatoliy N Rogoza,1 Aleksandr A Kuznetsov21Cardiology Research Complex, Moscow, Russian Federation; 2Therapy Research Institute, Siberian branch of Russian Academy of Medical Science, Novosibirsk, Russian FederationIntroduction: The aim of this study is the comparison of Vasotens® technology as used in a device with an oscillometric method of blood pressure measurement (BPLab, Petr Telegin Ltd, Nizhny Novgorod, Russian Federation against the validated tonometric system (SphygmoCor®, AtCor Medical Pty Ltd, West Ryde, Australia.Methods: The examinations were carried out in two medical centers. Exclusion criteria included atrial fibrillation, severe cardiac anomalies, heart failure, arrhythmia, decompensated diabetes, the presence of an artificial pacemaker, pregnancy, and BMI > 30. Overall, 160 patients and healthy volunteers were examined. Central aortic systolic blood pressure (aSBP and augmentation index (aAIx were obtained by means of applanation tonometry and the oscillometric method was compared.Results: aSBP and aAIx measured using the BPLab device equates significantly with the same parameters measured by SphygmoCor.Conclusion: This finding allows the recommendation of Vasotens technology, which can be used with the 24-hour BPLab monitoring system for wide clinical use.Keywords: central aortic blood pressure, augmentation index, validation, Vasotens®, BPLab®

  15. Non-invasive determination of instantaneous brachial blood flow using the oscillometric method.

    Science.gov (United States)

    Liu, Shing-Hong; Wang, Jia-Jung; Cheng, Da-Chuan

    2009-08-01

    The oscillometric method has been widely used to measure arterial systolic and diastolic blood pressures, but its potential for arterial blood flow measurements still remains to be explored. The aim of this study was to non-invasively determine arterial blood flow using an oscillometric blood flow measurement system. The system consists of a pneumatic elastic cuff, an air-pumping motor, a releaser valve, a pressure transducer, and an airflow meter. To build a non-linear cuff model, we measured airflow pumped into the pneumatic cuff and cuff pressure using an airflow meter and pressure transducer during the inflation period, respectively. During the deflation period, only the pressure transducer was used to record cuff pressure. Based on the cuff model, the oscillometric blood flow waveform was obtained by integrating the oscillometric pressure waveform. We compared arterial blood flow derived from the maximum amplitude of the oscillometric blood flow waveform with Doppler-measured blood flow calculated with the diameters and blood velocities of the brachial arteries in 32 subjects who underwent diagnostic evaluations for peripheral arterial embolism. A linear correlation coefficient of r = 0.716 was found between the oscillometry- and Doppler-based blood flow measurements in the 32 subjects. These results suggest that blood flow passing through the brachial artery can be quantified non-invasively using the oscillometric approach after appropriate calibration.

  16. Hydrostatic pressure on optical absorption and refractive index changes of a shallow hydrogenic impurity in a GaAs/GaAlAs quantum wire

    Science.gov (United States)

    Santhi, M.; John Peter, A.; Yoo, ChangKyoo

    2012-08-01

    The effect of hydrostatic pressure on the binding energy of a hydrogenic impurity in a GaAs/GaAlAs quantum wire is discussed. Calculations have been performed using Bessel functions as an orthonormal basis within a single band effective mass approximation. Pressure induced photoionization cross section of the hydrogenic impurity is investigated. The total optical absorption and the refractive index changes as a function of normalized photon energy between the ground and the first excited state in the presence of pressure are analysed. The optical absorption coefficients and the refractive index changes strongly depend on the incident optical intensity and the pressure.

  17. Body mass index and blood pressure among men of three ethnic groups of Darjeeling, West Bengal, India.

    Science.gov (United States)

    Datta Banik, Sudip

    2014-01-01

    This study was undertaken from 2009-2011 to understand the association between body mass index (BMI) and blood pressure (BP) (systolic or SBP and diastolic or DBP) among randomly chosen men, aged 30 to 59 years, of three endogamous communities in Darjeeling, West Bengal, India: Dhimal (n = 88), Mech (n = 71), and Rajbanshi (n = 83). Analysis of variance was applied. Remarkable rates of BMI-based undernutrition (chronic energy deficiency or CED) were recorded among Dhimals (31%) and Rajbanshis (18%). Notable prevalence of overweight (20%) was recorded among men of Mech community. None were found to be obese in three samples. Mean SBP and DBP were found to rise consistently at levels of BMI (undernutrition, normal, and overweight). BMI was observed to rise consistently at levels of blood pressures (normotensive, prehypertensive, and hypertensive). Among Mech, this pattern was found to be more conspicuous. DBP was found to be more sensitive with changes of BMI in men.

  18. [Effect of smoking cessation on body mass index, blood pressure and serum lipids in middle-aged male workers].

    Science.gov (United States)

    Kushima, K; Takamoto, N; Sato, H; Munaka, M

    1998-10-01

    The purpose of this study was to examine the effects of smoking cessation on body mass index (BMI), blood pressure and serum lipids in middle-aged male workers considering the effect of BMI which would increase by smoking cessation. The subjects were 1431 middle-aged men who worked in an enterprise in Hiroshima prefecture. Cross-sectional data measured in 1989 and longitudinal data measured from 1985 to 1989 were used in this analysis. The effect of smoking cessation on BMI, blood pressure and serum lipids were evaluated by two models of analysis of covariance (PC-SAS: GLM procedure) for the cross-sectional data and longitudinal data. In analysis of the cross-sectional data, model 1 was controlled for BMI and model 2 was not controlled for BMI. In analysis of the longitudinal data, model 3 was controlled for BMI change and model 4 was not controlled for BMI change. The main results are summarized as follows: 1. BMI was increased over the short period by smoking cessation, but over the long period BMI of ex-smokers remained at almost the same level as non-smokers'. 2. Blood pressure was increased over the short period by both the effect of smoking cessation and BMI increase from abstention from smoking. But over the long period blood pressure of ex-smokers remained at almost the same level as non-smokers. 3. Triglycerides (TG) and atherogenic index (AI) tended to decrease and HDL-cholesterol (HDLC) tended to increase over the short period by smoking cessation, but the concomitant BMI increase may have blunted any independent beneficial effect of smoking cessation on TG, AI and HDLC. But over the long period TG, AI and HDLC of ex-smokers recovered to almost the same level as non-smokers', and remained at that level. 4. These results suggest that smoking cessation have beneficial effects for health promotion in middle-aged men.

  19. The impact of exercise on derived measures of central pressure and augmentation index obtained from the SphygmoCor device.

    Science.gov (United States)

    Dawson, Ellen A; Black, Mark A; Pybis, Jennifer; Cable, N Timothy; Green, Daniel J

    2009-06-01

    The purpose of this study was to investigate whether measures derived from the SphygmoCor device and its associated transfer function are influenced by exercise-induced alterations in vascular tone. Measurements were taken from either the exercised or the contralateral nonexercised limb during repeated and identical incremental hand-grip protocols. Eight male subjects performed three 3-min bouts of hand-grip exercise on two occasions. The exercise intensities were set at 3 kg, 5 kg, with a final 1.5-kg bout performed during cuff ischemia (1.5Isch). Blood pressure waveforms were recorded from the radial artery of either the exercised or nonexercised limb using applanation tonometry (SphygmoCor) during a 90-s rest period immediately after each exercise bout. Central blood pressures and augmentation indexes (AIx), an index of arterial stiffness, were derived using the peripheral waveform and the inbuilt SphygmoCor transfer function (TF). AIx was consistently approximately 10% higher in the exercised arm during all trials compared with the nonexercised limb. Similarly, there was a consistent and significant difference ( approximately 3 mmHg; P < 0.05) between exercised and nonexercised arms for the derived central systolic and mean arterial blood pressures. Despite identical bouts of exercise, AIx and central systolic and mean arterial blood pressures derived from applanation tonometry at the peripheral radial artery were statistically different when assessed at the exercising arm vs. the nonexercising arm. Changes in vascular tone with exercise may modify the intrinsic characteristics of the vessel wall and could compromise the assumptions underlying transfer functions used to derive central measures using applanation tonometry.

  20. Ultrasonography for neonatal brachial plexus palsy.

    Science.gov (United States)

    Joseph, Jacob Rahul; DiPietro, Michael A; Somashekar, Deepak; Parmar, Hemant A; Yang, Lynda J S

    2014-11-01

    Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative

  1. Influence of age, body mass index, and blood pressure on the carotid intima-media thickness in normotensive and hypertensive patients.

    Science.gov (United States)

    Honzikova, Natasa; Labrova, Ruzena; Fiser, Bohumil; Maderova, Eva; Novakova, Zuzana; Zavodna, Eva; Semrad, Borivoj

    2006-10-01

    We investigated whether body mass index and blood pressure have an additive influence on the carotid intima-media thickness (IMT). In 27 patients treated for hypertension (47.2+/-8.7 years) and 23 normotensive subjects (44.1+/-8.1 years), 24-h recording of blood pressure was performed. The carotid IMT was determined by ultrasonography and baroreflex sensitivity by a spectral method from 5-min recordings of blood pressure. Significant differences between hypertensive and normotensive subjects were observed for carotid IMT (0.60+/-0.08 vs. 0.51+/-0.07 mm; pbody mass index (pinfluenced by either age or body mass index. Baroreflex sensitivity decreased with age (pinfluence of age and body mass index on the development of carotid IMT is essential only in normotensive subjects. In hypertensive subjects the influence of blood pressure predominates, as documented by a comparison of the carotid IMT between hypertensive and normotensive subjects.

  2. Refractive-index and absorption fluctuations in the infrared caused by temperature, humidity, and pressure fluctuations

    Science.gov (United States)

    Hill, R. J.; Clifford, S. F.; Lawrence, R. S.

    1980-10-01

    The dependence of fluctuations in atmospheric absorption and refraction upon fluctuations in temperature, humidity, and pressure is found for infrared frequencies. This dependence has contributions from line and continuum absorption and from anomalous refraction by water vapor. The functions that relate these fluctuations are necessary for evaluating degradation of electromagnetic radiation by turbulence. They are computed for a given choice of mean atmospheric conditions and graphed as functions of frequency in the wavelength range 5.7 microns to radio waves. It is found that turbulent fluctuations in total pressure give a negligible contribution to absorption and refraction fluctuations. Humidity fluctuations dominate absorption fluctuations, but contributions by temperature and humidity affect refraction fluctuations. Sufficiently strong humidity fluctuations can dominate the refraction fluctuations for some infrared frequencies but not for visible frequencies. The variance of log amplitude is examined for scintillation of infrared light to determine whether absorption or refraction fluctuations dominate under several conditions.

  3. Neonatal brachial plexus palsy : impact throughout the lifespan

    NARCIS (Netherlands)

    Holst, van der M.

    2017-01-01

    Neonatal brachial plexus palsy (NBPP) is a nerve injury to the brachial plexus which controls arm-movements. This thesis describes the impact of this injury on the lives of patients in terms of quality of life, participation, healthcare use and treatment outcomes. Findings in this thesis

  4. Variations in the formation of supraclavicular brachial plexus among ...

    African Journals Online (AJOL)

    Objective: To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a. Kenyan population. Study design: Descriptive cross-sectional study. Materials and methods: Ninety-four brachial plexuses from forty-seven formalin fixed cadavers were displayed by gross

  5. Anomalous patterns of formation and distribution of the brachial ...

    African Journals Online (AJOL)

    block Background: Structural variations in the patterns of formation and distribution of the brachial plexus have drawn attentions both in anatomy and anaesthesia. Method: An observational study. Results: The brachial plexus was carefully inspected in both the right and left arms in 90 Nigerian cadavers, comprising of 74 ...

  6. hoarseness and Horner's after supraclavicular brachial plexus block

    African Journals Online (AJOL)

    to compressive effects on the axillary fascial sheath. However, further studies are required to prove this. Keywords: combined incidence, Horner's syndrome, recurrent laryngeal nerve palsy, supraclavicular brachial plexus block. Introduction. Supraclavicular block is performed at the level of divisions of the brachial plexus.

  7. Estimation of Pressure Index and Temperature Sensitivity Coefficient of Solid Rocket Propellants by Static Evaluation

    OpenAIRE

    Himanshu Shekhar

    2009-01-01

    Burning rate of a solid rocket propellant depends on pressure and temperature. Conventional strand burner and Crawford bomb test on propellant strands was conducted to assess these dependent parameters. However, behaviour of propellant in rocket motor is different from its behaviour in strand form. To overcome this anomaly, data from static evaluation of rocket motor was directly used for assessment of these burningrate controlling parameters. The conventional empirical power law (r=aoexp[p{T...

  8. Serum amyloid P (SAP) is associated with impaired brachial artery flow-mediated dilation in chronically HIV-1 infected adults on stable antiretroviral therapy.

    Science.gov (United States)

    Zungsontiporn, Nath; Ndhlovu, Lishomwa C; Mitchell, Brooks I; Stein, James H; Kallianpur, Kalpana J; Nakamoto, Beau; Keating, Sheila M; Norris, Philip J; Souza, Scott A; Shikuma, Cecilia M; Chow, Dominic C

    2015-11-01

    This study aimed to evaluate the relationship between inflammatory biomarkers and endothelial dysfunction (ED), as measured by brachial artery flow-mediated dilation (FMD). We conducted a cross-sectional analysis utilizing baseline data of 135 participants with HIV infection on stable antiretroviral therapy (ART) in the Hawaii Aging with HIV-Cardiovascular (HAHC-CVD) study who had available baseline inflammatory biomarkers and brachial artery FMD measurements. We observed significant associations between brachial artery FMD and baseline brachial artery diameter, age, male gender, traditional cardiovascular disease (CVD) risk factors such as BMI, waist to hip ratio, hypertension, systolic blood pressure (BP), diastolic BP, and LDL cholesterol, and 10-year coronary heart disease (CHD) risk estimated by Framingham risk score (FRS). Of all biomarkers tested, higher level of C-reactive protein (CRP) (beta =  - 0.695, P = 0.030) and serum amyloid P (SAP) (beta =  - 1.318, P = 0.021) were significantly associated with lower brachial artery FMD in univariable regression analysis. After adjusting for baseline brachial artery diameter, age, and selected traditional CVD risk factors in multivariable model, SAP remained significantly associated with brachial artery FMD (beta =  - 1.094, P = 0.030), while CRP was not (beta =  - 0.391, P = 0.181). Serum amyloid P was independently associated with impaired brachial artery FMD and may potentially relate to ED and increased CVD risk in HIV-infected patients on stable ART.

  9. Central aortic blood pressure, augmentation index, and reflected wave transit time: reproducibility and repeatability of data obtained by oscillometry

    Directory of Open Access Journals (Sweden)

    Ageenkova O

    2011-11-01

    Full Text Available Olga A Ageenkova, Marina A Purygina Department of Therapy, Functional and Ultrasound Diagnostics, Postgraduate Training Faculty of Smolensk State Medical Academy, Smolensk, Russian Federation Background: The evidence suggests that arterial stiffness acts as an independent predictor of general as well as cardiovascular mortality, strokes in patients with arterial hypertension, type 2 diabetes mellitus in the elderly, and in the general population. The oscillometric method measures parameters of arterial stiffness by applying special methods of processing oscillograms. This is a study of the reproducibility and repeatability of central aortic systolic blood pressure (SBP, augmentation index, and reflected wave transit time measured by Vasotens® technology. Methods: Anthropometric and hemodynamic measurements for 90 volunteers were made by two observers using the 24-hour blood pressure monitoring system, BPLab®, with Vasotens technology in "office" mode, over a period of two days and always at the same time in the morning. Initialization of the device was performed prior to each measurement cycle for each participant. Results: Analysis of short-term repeatability and reproducibility data for central aortic systolic blood pressure, reflected wave transit time, and augmentation index did not reveal any statistically significant differences. For observer A, SBP was 0.11 ± 7.53 mmHg and aortic SBP was 0.26 ± 6.11 mmHg; for observer B, SBP was 0.14 ± 8.42 and aortic SBP was 0.2 ± 7.25 mmHg. Short-term reproducibility for the different observers with averaging of both measurements was 0.36 ± 5.69 mmHg for SBP and 0.37 ± 6.7 mmHg for aortic SBP; the next day, repeatability for observer A was 0.52 ± 10.7 mmHg for SBP and 0.73 ± 8.98 mmHg for aortic SBP. Conclusion: BPLab with Vasotens technology has good reproducibility and repeatability, and can be recommended for clinical vascular risk estimation. Keywords: arterial stiffness, central aortic

  10. Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study.

    Science.gov (United States)

    Weber, Thomas; Wassertheurer, Siegfried; Schmidt-Trucksäss, Arno; Rodilla, Enrique; Ablasser, Cornelia; Jankowski, Piotr; Lorenza Muiesan, Maria; Giannattasio, Cristina; Mang, Claudia; Wilkinson, Ian; Kellermair, Jörg; Hametner, Bernhard; Pascual, Jose Maria; Zweiker, Robert; Czarnecka, Danuta; Paini, Anna; Salvetti, Massimo; Maloberti, Alessandro; McEniery, Carmel

    2017-12-01

    We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm Hg, respectively. Mean left ventricular mass was 93.3 kg/m2, and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively (P=0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively (P=0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732. © 2017 American Heart Association, Inc.

  11. Motor cortex neuroplasticity following brachial plexus transfer.

    Science.gov (United States)

    Dimou, Stefan; Biggs, Michael; Tonkin, Michael; Hickie, Ian B; Lagopoulos, Jim

    2013-01-01

    In the past decade, research has demonstrated that cortical plasticity, once thought only to exist in the early stages of life, does indeed continue on into adulthood. Brain plasticity is now acknowledged as a core principle of brain function and describes the ability of the central nervous system to adapt and modify its structural organization and function as an adaptive response to functional demand. In this clinical case study we describe how we used neuroimaging techniques to observe the functional topographical expansion of a patch of cortex along the sensorimotor cortex of a 27-year-old woman following brachial plexus transfer surgery to re-innervate her left arm. We found bilateral activations present in the thalamus, caudate, insula as well as across the sensorimotor cortex during an elbow flex motor task. In contrast we found less activity in the sensorimotor cortex for a finger tap motor task in addition to activations lateralized to the left inferior frontal gyrus and thalamus and bilaterally for the insula. From a pain perspective the patient who had experienced extensive phantom limb pain (PLP) before surgery found these sensations were markedly reduced following transfer of the right brachial plexus to the intact left arm. Within the context of this clinical case the results suggest that functional improvements in limb mobility are associated with increased activation in the sensorimotor cortex as well as reduced PLP.

  12. Motor cortex neuroplasticity following brachial plexus transfer

    Directory of Open Access Journals (Sweden)

    Stefan eDimou

    2013-08-01

    Full Text Available In the past decade, research has demonstrated that cortical plasticity, once thought only to exist in the early stages of life, does indeed continue on into adulthood. Brain plasticity is now acknowledged as a core principle of brain function and describes the ability of the central nervous system to adapt and modify its structural organization and function as an adaptive response to functional demand. In this clinical case study we describe how we used neuroimaging techniques to observe the functional topographical expansion of a patch of cortex along the sensorimotor cortex of a 27 year-old woman following brachial plexus transfer surgery to re-innervate her left arm. We found bilateral activations present in the thalamus, caudate, insula as well as across the sensorimotor cortex during an elbow flex motor task. In contrast we found less activity in the sensorimotor cortex for a finger tap motor task in addition to activations lateralised to the left inferior frontal gyrus and thalamus and bilaterally for the insula. From a pain perspective the patient who had experienced extensive phantom limb pain before surgery found these sensations were markedly reduced following transfer of the right brachial plexus to the intact left arm. Within the context of this clinical case the results suggest that functional improvements in limb mobility are associated with increased activation in the sensorimotor cortex as well as reduced phantom limb pain.

  13. Time Course of Changes in Extravascular Lung Water Index, Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders

    Directory of Open Access Journals (Sweden)

    Yu. A. Churlyaev

    2009-01-01

    Full Text Available Objective: to study the time course of changes in extravascular lung water index (ELWI and intracranial and cerebral perfusion pressures (ICP and CPP and to determine their possible relationships in acute cerebral circulatory disorders (ACCD. Subject and methods. ELWI, pulmonary vascular permeability index (PVPI, ICP, CPP, and central hemodynamics were studied by transpulmonary thermodilution and current X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. Results. Examinations revealed a supratentorial dislocation of the brain in 6 persons; its subtento-rial dislocation was found in 1 case; supra- and subtentorial dislocations were seen in 6. In patients, ELWI and PVPI increased from days 1 and 5, respectively. The high baseline ICP increased over time. CPP remained unchanged. Preserved left ventricular contractility, enhanced myocardial one, a significant direct correlation between ELWI and PVPI, as well as their increase confirmed that the noncardiogenic genesis was responsible for increased ELWI. A direct significant correlation was found between ICP and ELWI, ICP and PVPI. Against this background, acute respiratory distress syndrome developed in 14 patients with pneumonia evolving in its presence in 7 patients. Conclusion. In ACCD, ELWI increases in the first 24 hours of the acute period. One of its causes is, along with others, primary and/or secondary damage to the brainstem structures with elevated ICP and progressive brain dislocation. The determination of ICP, unlike CPP, is crucial in the diagnosis and treatment of primary/secondary brain injuries and in prognosis. Key words: acute cerebral circulatory disorder, extravascular lung fluid, pulmonary vascular permeability, intracranial pressure, cerebral perfusion pressure, acute respiratory distress syndrome.

  14. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index : a meta-analysis of randomised trials

    NARCIS (Netherlands)

    Ying, A.; Arima, H.; Czernichow, S.; Woodward, M.; Huxley, R.; Turnbull, F.; Perkovic, V.; Neal, B.; Agodoa, L.; Estacio, R.; Schrier, R.; Lubsen, J.; Chalmers, J.; Cutler, J.; Davis, B.; Wing, L.; Poulter, N. R.; Sever, P.; Remuzzi, G.; Ruggenenti, P.; Nissen, S.; Lindholm, L. H.; Fukui, T.; Ogihara, T.; Saruta, T.; Black, H.; Sleight, P.; Lievre, M.; Suzuki, H.; Fox, K.; Lisheng, L.; Ohkubo, T.; Imai, Y.; Yusuf, S.; Bulpitt, C. J.; Lewis, E.; Brown, M.; Palmer, C.; Wang, J.; Pepine, C.; Ishii, M.; Yui, Y.; Kuramoto, K.; Pfeff, M.; Asselbergs, F. W.; van Gilst, W. H.; Byington, B.; Pitt, B.; Brenner, B.; Remme, W. J.; de Zeeuw, D.; Rahman, M.; Viberti, G.; Teo, K.; Zanchetti, A.; Malacco, E.; Mancia, G.; Staessen, J.; Fagard, R.; Holman, R.

    2015-01-01

    Background The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index

  15. Role of waist measures in characterizing the lipid and blood pressure assessment of adolescents classified by body mass index.

    Science.gov (United States)

    Khoury, Michael; Manlhiot, Cedric; Dobbin, Stafford; Gibson, Don; Chahal, Nita; Wong, Helen; Davies, Jolie; Stearne, Karen; Fisher, Amanda; McCrindle, Brian W

    2012-08-01

    To determine if the interaction of waist circumference percentile and waist to height ratio(WHtR) with body mass index (BMI) may serve to provide further risk specification in the lipid and blood pressure assessment of adolescents beyond BMI classification. Population-based, cross-sectional study. Data collected during the 2009-2010 academic school year. Geographically and administratively defined Niagara Region, Ontario, Canada. Data collected in school, during subjects’ mandatory physical education class. Part of the Heart Niagara Inc Healthy Heart Schools’ Program. Entire population of grade 9 (14- and 15-year-old) students in the Niagara Region, Ontario.Four thousand eight hundred eighty-four students enrolled in grade 9 during the study period, of which 4104 participated (51% male) and 3248 (79%) had complete data. Nonfasting lipid values and blood pressure categories in subjects categorized based on BMI/waist circumference percentile and BMI/WHtR. The associations between blood pressure, lipid profile, and measures of adiposity (BMI alone, BMI/waist circumference percentile, and BMI/WHtR) were statistically significant but had a limited strength and were not statistically significant from each other. For overweight and obese subjects, increased WHtR categories were associated with worsened lipid profile and increased odds of hypertension both relative to subjects with both normal BMI and normal WHtR and subjects with normal WHtR within each BMI category. Waist measures should be included in the screening and assessment of overweight and obese adolescents.

  16. Relationship of ambulatory arterial stiffness index with blood pressure response to exercise in the early stages of hypertension.

    Science.gov (United States)

    Tsiachris, Dimitris; Tsioufis, Costas; Dimitriadis, Kyriakos; Kokkinos, Peter; Faselis, Charles; Tousoulis, Dimitris; Michaelides, Andreas; Papademetriou, Vasilios; Stefanadis, Christodoulos

    2010-06-01

    We sought to investigate the plausible interrelationship of exaggerated blood pressure response during exercise (EBPR) with ambulatory arterial stiffness index (AASI) in never-treated patients with uncomplicated essential hypertension. Ninety-nine never-treated hypertensive patients (aged 50.7 years, 61 male) underwent 24 h ambulatory blood pressure (BP) recording, complete echocardiographic study and treadmill exercise testing and were classified as patients with (n=36) and without EBPR (n=63) based on the systolic BP elevation at peak exercise (>or=210 mmHg for men and >or=190 mmHg for women). Arterial stiffness was evaluated by means of both AASI and pulse wave velocity (PWV). Hypertensives with EBPR, compared with those without EBPR, exhibited significantly higher 24 h systolic BP and pulse pressure (by 3.8 mmHg, P=0.041 and by 7.2 mmHg, Ppressure (beta=0.297, P=0.010), but not AASI, were independently associated with peak exercise systolic BP. EBPR constitutes a sign of premature cardiovascular stiffening in the setting of uncomplicated hypertension. The close relationship between EBPR and PWV but not AASI enhances the concept of PWV as a superior measure of arterial stiffness and constitutes an important factor in the interpretation of EBPR-linked cardiovascular risk.

  17. Impact of age, sex, and exercise on brachial artery flow-mediated dilatation.

    Science.gov (United States)

    Black, Mark A; Cable, N Timothy; Thijssen, Dick H J; Green, Daniel J

    2009-09-01

    Flow-mediated dilatation (%FMD), an index of nitric oxide (NO)-mediated vasodilator function, is regarded as a surrogate marker of cardiovascular disease. Aging is associated with endothelial dysfunction, but underlying sex-related differences may exist and the effects of fitness and exercise on endothelial dysfunction in men (M) and women (W) are poorly understood. We compared %FMD of the brachial artery in 18 young [Y, 26 +/- 1 yr; 9 M and 9 W], 12 older fit (OF, 57 +/- 2 yr; 6 M and 6 W), and 16 older sedentary (OS, 59 +/- 2 yr; 8 M and 8 W) subjects. Glyceryl trinitrate (GTN) administration was used to assess endothelium-independent vasodilatation, and the FMD-to-GTN ratio was calculated to characterize NO dilator function in the context of smooth muscle cell sensitivity. Brachial %FMD in Y (7.1 +/- 0.8%) was significantly higher compared with OS (4.8 +/- 0.7%, P < 0.05), but not OF (6.4 +/- 0.7%). Differences between Y and OS subjects were due primarily to lower FMD in the OS women (4.3 +/- 0.6%). OS women exhibited significantly lower FMD-to-GTN ratios compared with Y (P < 0.05) and OF women (P < 0.05), whereas these differences were not apparent in men. Exercise training improved brachial artery NO dilator function (FMD-to-GTN ratio) after 24 wk (P < 0.05) in OS women, but not men. These findings indicate that maintaining a high level of fitness, or undertaking exercise training, prevents the age-related decline in the brachial artery vasodilator function evident in women. In OS men, who had relatively preserved NO dilator function, no training adaptations were observed. This study has potential implications for the prevention of conduit artery endothelial dysfunction in men and women.

  18. Exercise-induced brachial artery blood flow and vascular function is impaired in systemic sclerosis.

    Science.gov (United States)

    Machin, Daniel R; Clifton, Heather L; Garten, Ryan S; Gifford, Jayson R; Richardson, Russell S; Wray, D Walter; Frech, Tracy M; Donato, Anthony J

    2016-12-01

    Systemic sclerosis (SSc) is a rare autoimmune disease characterized by debilitating fibrosis and vascular dysfunction; however, little is known about the circulatory response to exercise in this population. Therefore, we examined the peripheral hemodynamic and vasodilatory responses to handgrip exercise in 10 patients with SSc (61 ± 4 yr) and 15 age-matched healthy controls (56 ± 5 yr). Brachial artery diameter, blood flow, and mean arterial pressure (MAP) were determined at rest and during progressive static-intermittent handgrip exercise. Patients with SSc and controls were similar in body stature, handgrip strength, and MAP; however, brachial artery blood flow at rest was nearly twofold lower in patients with SSc compared with controls (22 ± 4 vs. 42 ± 5 ml/min, respectively; P exercise, there were no differences in MAP between the groups, exercise-induced hyperemia and therefore vascular conductance were ∼35% lower at all exercise workloads in patients with SSc (P exercise-induced brachial artery blood flow and conduit arterial vasodilatory dysfunction during handgrip exercise in SSc and suggest that elevated oxidative stress may play a role.

  19. Genetically elevated levels of circulating triglycerides and brachial-ankle pulse wave velocity in a Chinese population.

    Science.gov (United States)

    Yao, W-M; Zhang, H-F; Zhu, Z-Y; Zhou, Y-L; Liang, N-X; Xu, D-J; Zhou, F; Sheng, Y-H; Yang, R; Gong, L; Yin, Z-J; Chen, F-K; Cao, K-J; Li, X-L

    2013-04-01

    Elevated levels of circulating triglycerides and increased arterial stiffness are associated with cardiovascular disease. Numerous studies have reported an association between levels of circulating triglycerides and arterial stiffness. We used Mendelian randomization to test whether this association is causal. We investigated the association between circulating triglyceride levels, the apolipoprotein A-V (ApoA5) -1131T>C single nucleotide polymorphism and brachial-ankle pulse wave velocity (baPWV) by examining data from 4421 subjects aged 18-74 years who were recruited from the Chinese population. baPWV was significantly associated with the levels of circulating triglycerides after adjusting for age, sex, body mass index (BMI), systolic blood pressure, heart rate, waist-to-hip ratio, antihypertensive treatment and diabetes mellitus status. The -1131C allele was associated with a 5% (95% confidence interval 3-8%) increase in circulating triglycerides (adjusted for age, sex, BMI, waist-to-hip ratio, diabetes mellitus and antihypertensive treatment). Instrumental variable analysis showed that genetically elevated levels of circulating triglycerides were not associated with increased baPWV. These results do not support the hypothesis that levels of circulating triglycerides have a causal role in the development of arterial stiffness.

  20. Microanatomy of the brachial plexus roots and its clinical significance.

    Science.gov (United States)

    Zhong, Li-Yuan; Wang, Ai-Ping; Hong, Li; Chen, Sheng-Hua; Wang, Xian-Qin; Lv, Yun-Cheng; Peng, Tian-Hong

    2017-06-01

    To provide the anatomical basis of brachial plexus roots for the diagnosis and treatment of brachial plexus root avulsion injury. The morphological features of brachial plexus roots were observed and measured on 15 cervicothoracic spine of adult cadavers. The relationship of brachial plexus nerve roots and the surrounding tissues also were observed, as well as the blood supply of anterior and posterior roots of the brachial plexus. Origination of the nerve roots in the dorsal-ventral direction from the midline was fine-tuned at each level along the spinal cord. The minimum distance of the origin of the nerve root to midline was 2.2 mm at C 5, while the maximum was 3.1 mm at T 1. Inversely, the distance between the origin of the posterior root and the midline of the spinal cord gradually decreased, the maximum being 4.2 mm at C 5 and minimum 2.7 mm at T 1. Meanwhile, there was complicated fibrous connection among posterior roots of the brachial plexus. The C 5-6 nerve roots interlaced with tendons of the scalenus anterior and scalenus medius and fused with the transverse-radicular ligaments in the intervertebral foramina. However, these ligaments were not seen in C 7-8, and T 1. The blood supply of the anterior and posterior roots of the brachial plexus was from the segmental branches of the vertebral artery, deep cervical artery and ascending cervical artery, with a mean outer diameter of 0.61 mm. The systematic and comprehensive anatomic data of the brachial plexus roots provides the anatomical basis to diagnose and treat the brachial plexus root avulsion injury.

  1. Quantitative analysis of replication-related mutation and selection pressures in bacterial chromosomes and plasmids using generalised GC skew index

    Directory of Open Access Journals (Sweden)

    Suzuki Haruo

    2009-12-01

    Full Text Available Abstract Background Due to their bi-directional replication machinery starting from a single finite origin, bacterial genomes show characteristic nucleotide compositional bias between the two replichores, which can be visualised through GC skew or (C-G/(C+G. Although this polarisation is used for computational prediction of replication origins in many bacterial genomes, the degree of GC skew visibility varies widely among different species, necessitating a quantitative measurement of GC skew strength in order to provide confidence measures for GC skew-based predictions of replication origins. Results Here we discuss a quantitative index for the measurement of GC skew strength, named the generalised GC skew index (gGCSI, which is applicable to genomes of any length, including bacterial chromosomes and plasmids. We demonstrate that gGCSI is independent of the window size and can thus be used to compare genomes with different sizes, such as bacterial chromosomes and plasmids. It can suggest the existence of different replication mechanisms in archaea and of rolling-circle replication in plasmids. Correlation of gGCSI values between plasmids and their corresponding host chromosomes suggests that within the same strain, these replicons have reproduced using the same replication machinery and thus exhibit similar strengths of replication strand skew. Conclusions gGCSI can be applied to genomes of any length and thus allows comparative study of replication-related mutation and selection pressures in genomes of different lengths such as bacterial chromosomes and plasmids. Using gGCSI, we showed that replication-related mutation or selection pressure is similar for replicons with similar machinery.

  2. Direct electrical injury to brachial plexus

    Directory of Open Access Journals (Sweden)

    Maksud Mubarak Devale

    2017-01-01

    Full Text Available Electrical current can cause neurological damage directly or by conversion to thermal energy. However, electrical injury causing isolated brachial plexus injury without cutaneous burns is extremely rare. We present a case of a 17-year-old boy who sustained accidental electrical injury to left upper extremity with no associated entry or exit wounds. Complete motor and sensory loss in upper limb were noted immediately after injury. Subsequently, the patient showed partial recovery in muscles around the shoulder and in ulnar nerve distribution at 6 months. However, there was no improvement in muscles supplied by musculocutaneous, median and radial nerves. On exploration at 6 months after trauma, injury to the infraclavicular plexus was identified. Reconstruction of musculocutaneous, median and radial nerves by means of sural nerve cable grafts was performed. The patient has shown excellent recovery in musculocutaneous nerve function with acceptable recovery of radial nerve function at 1-year post-injury.

  3. [A novel approach of using fouling index to evaluate NOM fouling behavior during low pressure ultrafiltration process].

    Science.gov (United States)

    Xiao, Ping; Xiao, Feng; Zhao, Jing-Hui; Qin, Tong; Wang, Dong-Sheng; Feng, Jin-Rong; Xu, Guang

    2012-12-01

    In this study, fouling index (FI) was introduced as a novel approach to investigate NOM fouling behavior during low pressure membrane ultrafiltration process. Three kinds of typical NOMs, humic acid (HA), bovine serum albumin (BSA) and sodium alginate (NaAlg), were used in the experiments. The results indicated that the fouling caused by NOM can be considered as two steps with different FI values. One is the fast fouling phase, and the other is the slow phase. Apparently, the total fouling index of the fast phase (TFI(F)) was much greater than that of the slow phase (TFI(S)), which means the initial interaction between NOM and membrane would play a significant role in the whole fouling process. A higher TFI(F) could lead to a faster fouling and the flux would decline more rapidly. After hydraulic washing, the flux was recovered and the resistance was reduced, indicating that physical cleaning could remove a part of foulants. Additionally, the results also represented that the sequences of NOM causing irreversible fouling and chemical clean irreversible fouling were BSA > HA > NaAlg and NaAlg > BSA > HA, respectively. Humic acid and protein tended to cause irreversible fouling and were easily removed by alkaline cleaning, while irreversible fouling caused by polysaccharide was difficult to remove by alkaline. The main cause of membrane fouling may be the interaction between foulants and membrane, which needs further research. Generally speaking, FI with a simple expression would play a significant role to describe the membrane fouling.

  4. Acute brachial diplegia due to Lyme disease.

    Science.gov (United States)

    Gorson, Kenneth C; Kolb, David A; Marks, Donald S; Hayes, Michael T; Baquis, George D

    2011-01-01

    to describe acute brachial diplegia as the initial manifestation of Lyme disease. bilateral, predominantly motor, cervical radiculoplexus neuropathy, the "dangling arm syndrome," has not been reported as a complication of acute Lyme infection. retrospective series of 5 patients from 2 tertiary neuromuscular centers. there were 4 men and 1 woman with an average age of 69 years. One recalled a tick bite, and preceding constitutional symptoms included headache (2) and fever, arthralgias, and fatigue in 1 patient each. Proximal arm weakness and acute pain developed within 3 weeks from onset; pain was bilateral in 3 patients and unilateral in 2 patients, and was described as severe throbbing. Arm weakness was bilateral at onset in 3 patients, and right sided in 2 patients followed by spread to the left arm within days. All the patients had weakness in the deltoid and biceps that was 3/5 or less (Medical Research Council scale), with variable weakness of the triceps and wrist extensors; 1 patient had a flail right arm and moderate (4/5) weakness of the proximal left arm muscles. Light touch was normal in the regions of weakness, and 1 patient had mildly reduced pin sensation over the forearm. Serum IgM Lyme titers were elevated in all the patients and were detected in the cerebrospinal fluid in 4 tested patients. The cerebrospinal fluid protein ranged between 135 and 176 mg/dL with lymphocytic pleocytosis (range, 42 to 270 cells). Electrodiagnostic studies showed normal median and ulnar motor potentials with asymmetrically reduced sensory amplitudes in the median (4), ulnar (3), and radial, and lateral antebrachial cutaneous potentials in 1 patient each. Two patients had acute denervation in the cervical or proximal arm muscles. There was full recovery after antibiotic therapy in 4 patients and considerable improvement in 1 patient after 2 months. acute brachial diplegia is a rare manifestation of acute Lyme infection and responds promptly to antibiotic therapy.

  5. Glycemic index, glycemic load, and blood pressure: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Evans, Charlotte El; Greenwood, Darren C; Threapleton, Diane E; Gale, Chris P; Cleghorn, Christine L; Burley, Victoria J

    2017-05-01

    Background: High blood pressure is a strong risk factor for cardiovascular disease.Objective: The aim of this study was to determine the associations of dietary glycemic index (GI) and glycemic load (GL) with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in healthy individuals.Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out. Databases were searched for eligible RCTs in 2 phases. MEDLINE, Embase, CAB Abstracts, BIOSIS, ISI Web of Science, and the Cochrane Library were searched from January 1990 to December 2009. An updated search was undertaken with the use of MEDLINE and Embase from January 2010 to September 2016. Trials were included if they reported author-defined high- and low-GI or -GL diets and blood pressure, were of ≥6 wk duration, and comprised healthy participants without chronic conditions. Data were extracted and analyzed with the use of Stata statistical software. Pooled estimates and 95% CIs were calculated with the use of weighted mean differences and random-effects models.Results: Data were extracted from 14 trials comprising 1097 participants. Thirteen trials provided information on differences in GI between control and intervention arms. A median reduction in GI of 10 units reduced the overall pooled estimates for SBP and DBP by 1.1 mm Hg (95% CI: -0.3, 2.5 mm Hg; P = 0.11) and 1.3 mm Hg (95% CI: 0.2 mm Hg, 2.3; P = 0.02), respectively. Nine trials reported information on differences in GL between arms. A median reduction in GL of 28 units reduced the overall pooled estimates for SBP and DBP by 2.0 mm Hg (95% CI: 0.2, 3.8 mm Hg; P = 0.03) and 1.4 mm Hg (95% CI: 0.1, 2.6 mm Hg; P = 0.03), respectively.Conclusions: This review of healthy individuals indicated that a lower glycemic diet may lead to important reductions in blood pressure. However, many of the trials included in the analysis reported important sources of bias. This trial was registered at PROSPERO as CRD

  6. A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients.

    Science.gov (United States)

    Chen, Szu-Chia; Chang, Jer-Ming; Tsai, Jer-Chia; Hsu, Po-Chao; Lin, Tsung-Hsien; Su, Ho-Ming; Voon, Wen-Chol; Hwang, Shang-Jyh; Chen, Hung-Chun

    2010-05-01

    Impaired left ventricular systolic function is an important cause of mortality in hemodialysis patients. An increase in the ratio of pre-ejection period (PEP) to ejection time (ET) is associated with a decrease in left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study was to investigate whether bPEP/bET was a useful predictor for overall and cardiovascular mortality in hemodialysis patients. We enrolled 212 hemodialysis patients in one regional hospital. The bPEP and bET were measured using an ABI-form device. The mean follow-up period was 28.3+/-5.7 months. The relative mortality risk was analyzed by Cox-regression methods. Twenty-two deaths were recorded in 212 patients (10.4%). In a multivariate analysis, the bPEP/bET (hazard ratio [HR], 1.055; P=0.047) and serum creatinine level (P=0.029) were positively and negatively associated with overall mortality, respectively. In addition, increased bPEP/bET (HR, 1.080; P=0.017), increased fasting glucose (P=0.046) and decreased serum creatinine level (P=0.004) were independent predictors for cardiovascular mortality. Our findings show that bPEP/bET, a surrogate of left ventricular systolic function, is a useful predictor for overall and cardiovascular mortality in hemodialysis patients. Screening hemodialysis patients by means of bPEP/bET may help to identify a high-risk group for increased mortality.

  7. Radial Nerve Injury after Brachial Nerve Block - Case Series

    Directory of Open Access Journals (Sweden)

    Szederjesi Janos

    2016-03-01

    Full Text Available Adding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.

  8. Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

    OpenAIRE

    J Gordon Millichap; John J Millichap

    2014-01-01

    Investigators from National University Hospital, Singapore, review the clinical features of 13 cases of pharyngeal-cervical-brachial (PCB) variant of Guillain-Barre syndrome (GBS) and outline new diagnostic criteria.

  9. Detection of positional brachial plexus injury by radial arterial line during spinal exposure before neuromonitoring confirmation: a retrospective case study.

    Science.gov (United States)

    Chen, Zhengyong; Chen, Leo; Kwon, Paul; Montez, Michele; Voegeli, Thomas; Bueff, Hans

    2012-12-01

    To demonstrate the potential usefulness of radial arterial line monitoring in detection of brachial plexus injury in spinal surgery. Multiple neuromonitoring modalities including SEPs, MEPs and EMG were performed for a posterior thoracicolumbar surgery. Radial arterial line (A-line) was placed on the right wrist for arterial blood pressure monitoring. Reliable ulnar nerve SEPs, hand muscle MEPs and arterial blood pressure readings were obtained after patient was placed in a prone position. A-line malfunction was noted about 15 min after incision. Loss of ulnar nerve SEPs and hand muscle MEPs with a cold hand on the right was noticed when neuromonitoring resumed after spine exposure. SEPs, MEPs, A-line readings and hand temperature returned after modification of the right arm position. Radial arterial line monitoring may help detect positional brachial plexus injury in spinal surgery when continuous neuromonitoring is interrupted during spine exposure in prone position.

  10. Electroacupuncture attenuates neuropathic pain after brachial plexus injury

    OpenAIRE

    Zhang, Shenyu; Tang, Hailiang; Zhou, Junming; Gu, Yudong

    2014-01-01

    Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root (associated with upper-limb chronic neuropathic pain) were given electroacupuncture stimulation at bilateral Quchi (LI11), Hegu (LI04), Zusanli (ST36) and Yanglingquan (GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats’ upper limbs was significantly at...

  11. Case Report- Une cause rare de plexopathie brachiale : une ...

    African Journals Online (AJOL)

    Nous rapportons le cas d'une patiente de 50 ans ayant une histoire de cancer du sein et qui accuse une symptomatologie d'atteinte du plexus brachial. L'IRM montre une masse qui envahie le plexus brachial compatible avec une métastase. L'IRM est très utile pour le diagnostic et l'orientation thérapeutique des ...

  12. HIGH BIFURCATION OF THE BRACHIAL ARTERY - A COMMON VARIANT

    Directory of Open Access Journals (Sweden)

    Sesi

    2015-10-01

    Full Text Available 28 cadavers were dissected for variations in the bifurcation of brachial artery bilaterally {n=56} at the department of anatomy, Rangaraya Medical College, Kakinada, A.P. from 2010 to 2015 . Found variations during routine dissections for first year MBBS students. The findings have thrown light on the common as well as rare variants in the anatomy of brachial artery bifurcation and the course of radial and ulnar arteries in current study

  13. Chronic vitamin E administration improves brachial reactivity and increases intracellular magnesium concentration in type II diabetic patients.

    Science.gov (United States)

    Paolisso, G; Tagliamonte, M R; Barbieri, M; Zito, G A; Gambardella, A; Varricchio, G; Ragno, E; Varricchio, M

    2000-01-01

    Vascular disease accounts for the majority of the clinical complications in diabetes mellitus. As an exaggerated oxidative stress degree has been postulated as the link between diabetes mellitus and endothelial function, a possible positive effect of plasma vitamin E (Vit.E) administration on brachial reactivity could be postulated. Our study aims at investigating the possible effect of chronic Vit.E administration on brachial reactivity, oxidative stress indexes, and intracellular magnesium and calcium content in type II diabetic patients free of diabetic complications. Forty adult, type II diabetic patients were enrolled in the study, which was deigned as a double blind, randomized vs. placebo trial. At baseline all patients underwent the following tests: 1) anthropometric and metabolic examinations, 2) evaluation of oxidative stress indexes, 3) intracellular magnesium and calcium measurements, and 4) determination of arterial compliance and distensibility. Then, all patients were randomly assigned to Vit.E treatment at a dose of 600 mg/day (Evion Forte; n = 20) or placebo (n = 20) over 8 weeks. At the end of this treatment period, a complete reevaluation of the patients was made. Vit.E treatment was associated with a significant improvement in the percent change in brachial artery diameter (Pmagnesium and calcium). After adjustment for age, sex, body mass index, and wait/hip ratio, all of these correlations remained significant (Preactivity in patients with type II diabetes mellitus. Such an effect seems mediated by a reduction in oxidative stress and a regulation of intracellular calcium and magnesium contents.

  14. [Central Aortic Blood Pressure: Important Parameter in Diagnosis and Therapy].

    Science.gov (United States)

    Middeke, Martin

    2017-09-01

    In recent years great emphasis has been placed on the role of central aortic blood pressure as measured non invasively using pulse wave analysis in pathophysiology of cardiovascular diseases and clinical aspects of hypertension. The difference of blood pressure between the central aorta and the brachial artery (amplification) is not constant but varies according to physiological, pathological and pharmacological mechanisms. Central aortic blood pressure is more strongly related to cardiovascular organ damages than does brachial pressure. Several antihypertensive drugs have different effects on aortic blood pressure as compared with brachial pressure. Central aortic blood pressure emerges superior to brachial pressure as target blood pressure in antihypertensive treatment. © Georg Thieme Verlag KG Stuttgart · New York.

  15. The brachio-brachial arteriovenous fistula: mid-term results.

    Science.gov (United States)

    Dorobantu, Lucian Florin; Iliescu, Vlad Anton; Stiru, Ovidiu; Bubenek, Serban; Novelli, Eugenio

    2010-01-01

    To evaluate the mid-term results of the brachio-brachial arteriovenous fistula in patients without adequate superficial venous circulation in the upper limb. Retrospective analysis included 49 patients, in whom a brachio-brachial fistula had been created in an end-to-side configuration. After the maturation period (1 month), the brachial vein was transposed into the subcutaneous tissue. Follow-up study was performed in patients with functional brachio-brachial fistula after the superficialization. Forty-nine patients underwent 49 brachio-brachial fistula constructions. All fistulas were functional. One month after surgery, 40 (81.6%) of these patients had a functional fistula, but in only 39 (79.6%) cases was the fistula suitable for hemodialysis (HD) following transposition to subcutaneous tissue. During the 1-month maturation period, the fistula became occluded in nine patients, and in one case the vein was permeable, so the fistula was functional, but too small to permit HD. Seventeen patients developed temporary edema of the forearm during the first month, in three cases the edema was extended to the entire arm, but no other complications were associated with the procedure. Follow-up lasted 18.0 +/- 11.1 (3-37) months, during which 7/39 patients presented with fistula occlusion. Three patients died and another three were out of the study for various reasons. The brachio-brachial fistula is a good alternative to prosthetic grafts in patients without superficial venous circulation in the upper limb.

  16. A Study on Body Mass Index, Blood Pressure, and Red Blood Cell Indices in New Entering Students of the University of Isfahan

    OpenAIRE

    Alireza Moafi; Soheila Rahgozar; Majid Ghias; Elham Vahdatahar; Amirbahador Borumand; Amirhosein Sabbaghi; Amirabass Sameti; Mostafa Hashemi

    2011-01-01

    Objectives: Obesity and increased blood pressure are identified as risk factors for cardiac and pulmonary disorders. On the other hand, iron deficiency (another preventable disease) is common in adolescence and considered as associated with health impairment. The present study evaluates body mass index (BMI) and its association with blood pressure and hematological indices in freshman students entering the University of Isfahan in 2009. Methods: All the 1675 students who entered the Univer...

  17. Blood pressure-independent effect of candesartan on cardio-ankle vascular index in hypertensive patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Kanako Bokuda

    2010-07-01

    Full Text Available Kanako Bokuda1, Atsuhiro Ichihara1,2, Mariyo Sakoda1, Asako Mito1, Kenichiro Kinouchi1, Hiroshi Itoh11Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Endocrinology and Anti-Aging Medicine, Keio University School of Medicine, Tokyo, JapanAbstract: Angiotensin receptor blockers (ARBs are known to reduce the cardiovascular risk in hypertensive patients. This study was designed to examine the effect of an ARB candesartan on subclinical atherosclerosis assessed by cardio-ankle vascular index (CAVI in comparison with calcium channel blockers (CCBs alone in hypertensive patients with metabolic syndrome (MetS. A total of 53 consecutive hypertensive patients with MetS were randomly assigned to the candesartan group, in which candesartan was added on, or the CCBs group, in which CCBs were added on. Clinical and biological parameters were obtained before and after the 12-month treatment period. The primary measure of efficacy was the %change in CAVI. When treated with candesartan, but not CCBs, CAVI significantly decreased from 8.7 to 7.7 by 11%. Blood pressure (BP significantly decreased with both treatments, but the differences between groups were not significant. The changes in other parameters remained unchanged in both the groups. Analysis of covariance found that both the BP reduction and the therapy difference contributed to the decrease in CAVI, but the BP reduction was not involved in the decrease in CAVI caused by the difference in the therapy. Candesartan may be a better antihypertensive drug than CCBs to that subclinical atherosclerosis of patients with MetS.Keywords: albuminuria, ambulatory blood pressure, calcium channel blockers, carotid ­intima-media thickness

  18. Investigation of Peak Pressure Index Parameters for People with Spinal Cord Injury Using Wheelchair Tilt-in-Space and Recline: Methodology and Preliminary Report

    Directory of Open Access Journals (Sweden)

    Chi-Wen Lung

    2014-01-01

    Full Text Available The purpose of this study was to determine the effect of the sensel window’s location and size when calculating the peak pressure index (PPI of pressure mapping with varying degrees of wheelchair tilt-in-space (tilt and recline in people with spinal cord injury (SCI. Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15°, 25°, and 35° and recline (10° and 30° were used by the participants in random order. Displacements of peak pressure and center of pressure were extracted from the left side of the mapping system. Normalized PPI was computed for three sensel window dimensions (3 sensels × 3 sensels, 5 × 5, and 7 × 7. At least 3.33 cm of Euclidean displacement of peak pressures was observed in the tilt and recline. For every tilt angle, peak pressure displacement was not significantly different between 10° and 30° recline, while center of pressure displacement was significantly different (P<.05. For each recline angle, peak pressure displacement was not significantly different between pairs of 15°, 25°, and 35° tilt, while center of pressure displacement was significantly different between 15° versus 35° and 25° versus 35°. Our study showed that peak pressure displacement occurs in response to wheelchair tilt and recline, suggesting that the selected sensel window locations used to calculate PPI should be adjusted during changes in wheelchair configuration.

  19. Intermediate Type of Obstetric Brachial Plexus Palsy.

    Science.gov (United States)

    El-Sayed, Amel A F

    2016-12-01

    Data of 829 infants with obstetric brachial plexus palsy were reviewed to identify any cases that could not be fitted into the any of the well-known types of palsy. These unusual cases were studied in detail with regard to clinical presentation and electrophysiological findings as well as management and spontaneous motor recovery. Erb's, extended Erb's, and total palsies were seen in 42.8%, 28.8%, and 28.0% of cases, respectively. Three cases (0.4%) did not fit into any of the classic types. One case had bilateral palsy, and the remaining 2 cases had unilateral palsy. All affected limbs presented with "abducted arms," "flexed forearms," and electrophysiological evidence of denervation of shoulder adductors and triceps. All cases had excellent spontaneous recovery within 6-12 months. It was concluded that these cases represent mild "intermediate" types of palsy in which the C7 root was the predominant site of injury. Good spontaneous recovery is expected. © The Author(s) 2016.

  20. Brachial artery Doppler flux parameters before and after hot flush in Mexican postmenopausal women: preliminary report.

    Science.gov (United States)

    Carranza-Lira, Sebastián; Rodríguez, Karina Vázquez; Ortiz, Sergio Rosales

    2016-03-01

    To analyse brachial artery flux parameters in postmenopausal women before and after hot flush. Two groups of postmenopausal women were studied: Group I, without vasomotor symptoms (n = 10) and Group II, with vasomotor symptoms (n = 10). In all them a brachial artery Doppler ultrasound was done, measuring before and after hyperaemic stimulus of the arterial diameter (AD), the pulsatility index (PI), and the resistive index (RI). In Group I, measurements were done at baseline and five minutes after. In Group II, measurements were at baseline, and one and five minutes after the hot-flush. Comparison between the groups was done with Mann-Whitney U test, and within the groups with Wilcoxon test. No differences were found among the groups in Doppler parameters. When comparing each group separately, in Group I, at baseline and at five minutes measurements, the AD was greater after the hyperaemic stimulus than before it. In group II at baseline, the PI was significantly greater after the hyperaemic stimulus than before to it. At the first and fifth minute, the AD was significantly greater after the hyperaemic stimulus than before to it. No differences were found between those who did not have and those who had hot flushes.

  1. Maternal Prepregnancy Body Mass Index and Their Children's Blood Pressure and Resting Cardiac Autonomic Balance at Age 5 to 6 Years

    NARCIS (Netherlands)

    Gademan, M.G.J.; van Eijsden, M.; Roseboom, T.J.; van der Post, J.A.M.; Stronks, K.; Vrijkotte, T.G.M.

    2013-01-01

    Adverse intrauterine conditions can program hypertension. Because one of the underlying mechanisms is thought to be cardiac autonomic balance, we investigated the association between prepregnancy body mass index (BMI) and blood pressure and indicators of the autonomic balance in the child at age 5

  2. The added value of cardiac index and pulse pressure variation monitoring to mean arterial pressure-guided volume therapy in moderate-risk abdominal surgery (COGUIDE): a pragmatic multicentre randomised controlled trial.

    Science.gov (United States)

    Stens, J; Hering, J-P; van der Hoeven, C W P; Boom, A; Traast, H S; Garmers, L E; Loer, S A; Boer, C

    2017-09-01

    There is disagreement regarding the benefits of goal-directed therapy in moderate-risk abdominal surgery. Therefore, we tested the hypothesis that the addition of non-invasive cardiac index and pulse pressure variation monitoring to mean arterial pressure-based goal-directed therapy would reduce the incidence of postoperative complications in patients having moderate-risk abdominal surgery. In this pragmatic multicentre randomised controlled trial, we randomly allocated 244 patients by envelope drawing in a 1:1 fashion, stratified per centre. All patients had mean arterial pressure, cardiac index and pulse pressure variation measured continuously. In one group, healthcare professionals were blinded to cardiac index and pulse pressure variation values and were asked to guide haemodynamic therapy only based on mean arterial pressure (control group). In the second group, cardiac index and pulse pressure variation values were displayed and kept within target ranges following a pre-defined algorithm (CI-PPV group). The primary endpoint was the incidence of postoperative complications within 30 days. One hundred and seventy-five patients were eligible for final analysis. Overall complication rates were similar (42/94 (44.7%) vs. 38/81 (46.9%) in the control and CI-PPV groups, respectively; p = 0.95). The CI-PPV group had lower mean (SD) pulse pressure variation values (9.5 (2.0)% vs. 11.9 (4.6)%; p = 0.003) and higher mean (SD) cardiac indices (2.76 (0.62) l min-1 .m-2 vs. 2.53 (0.66) l min-1 .m-2 ; p = 0.004) than the control group. In moderate-risk abdominal surgery, we observed no additional value of cardiac index and pulse pressure variation-guided haemodynamic therapy to mean arterial pressure-guided volume therapy with regard to postoperative complications. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  3. Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report.

    Science.gov (United States)

    Ferrero-Manzanal, Francisco; Lax-Pérez, Raquel; López-Bernabé, Roberto; Betancourt-Bastidas, José Ramiro; Iñiguez de Onzoño-Pérez, Alvaro

    2016-01-01

    Shoulder surgery is often performed with the patient in the so called "beach-chair position" with elevation of the upper part of the body. The anesthetic procedure can be general anesthesia and/or regional block, usually interscalenic brachial plexus block. We present a case of brachial plexus palsy with a possible mechanism of traction based on the electromyographic and clinical findings, although a possible contribution of nerve block cannot be excluded. We present a case of a 62 year-old female, that suffered from shoulder fracture-dislocation. Open reduction and internal fixation were performed in the so-called "beach-chair" position, under combined general-regional anesthesia. In the postoperative period complete motor brachial plexus palsy appeared, with neuropathic pain. Conservative treatment included analgesic drugs, neuromodulators, B-vitamin complex and physiotherapy. Spontaneous recovery appeared at 11 months. DISCUSION: in shoulder surgery, there may be complications related to both anesthetic technique and patient positioning/surgical maneuvers. Regional block often acts as a confusing factor when neurologic damage appears after surgery. Intraoperative maneuvers may cause eventual traction of the brachial plexus, and may be favored by the fixed position of the head using the accessory of the operating table in the beach-chair position. When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Real-time feedback of dynamic foot pressure index for gait training of toe-walking children with spastic diplegia.

    Science.gov (United States)

    Pu, Fang; Ren, Weiyan; Fan, Xiaoya; Chen, Wei; Li, Shuyu; Li, Deyu; Wang, Yu; Fan, Yubo

    2017-09-01

    The aim of this study was to determine whether and how real-time feedback of dynamic foot pressure index (DFPI) could be used to correct toe-walking gait in spastic diplegic children with dynamic equinus. Thirteen spastic diplegic children with dynamic equinus were asked to wear a monitoring device to record their ambulation during daily gait, conventional training gait, and feedback training gait. Parameters based on their DFPI and stride duration were compared among the three test conditions. The results with feedback training were significantly better for all DFPI parameters in comparison to patients' daily gait and showed significant improvements in DFPI for toe-walking gait and percentage of normal gait in comparison to conventional training methods. Moreover, stride duration under two training gaits was longer than patient's daily gait, but there was no significant difference between the two training gaits. Although the stride duration for the two training gaits was similar, gait training with real-time feedback of DFPI did produce noticeably superior results by increasing heel-loading impulse of toe-walking gait and percentage of normal gait in comparison to convention training methods. However, its effectiveness was still impacted by the motion limitations of diplegic children. Implications for Rehabilitation The DFPI-based gait training feedback system introduced in this study was shown to be more effective at toe-walking gait rehabilitation training over conventional training methods. The feedback system accomplished superior improvement in correcting toe-walking gait, but its effectiveness in an increasing heel-loading impulse in normal gait was still limited by the motion limitations of diplegic children. Stride duration of normal gait and toe-walking gait was similar under conventional and feedback gait training.

  5. Subacute brachial diplegia associated with West Nile virus myelitis.

    Science.gov (United States)

    Zafar, Sahar F; Ubogu, Eroboghene E

    2012-06-01

    Brachial diplegia is a clinical term used to describe weakness restricted to the upper extremities. We report a case of brachial diplegia associated with West Nile virus infection. A 48-year-old man developed severe painless bilateral upper extremity weakness within a few weeks of a flu-like illness. Clinical examination revealed marked periscapular, shoulder girdle, and humeral muscle atrophy and bilateral scapular winging, with near symmetrical bilateral hypotonic upper extremity weakness. This was associated with clinical signs of an encephalomyelopathy without cognitive or sensory deficits. Electrophysiological studies demonstrated a subacute disorder of motor neurons, their axons or both, involving the cervical and thoracic myotomes, with ongoing denervation. Serological studies confirmed recent West Nile virus (WNV) infection. Gradual improvement occurred following conservative supportive therapies. Progressive brachial diplegia is a rare neuromuscular presentation of WNV neuroinvasive disease. This case report adds to the clinical spectrum of WNV-induced neurologic sequelae. Copyright © 2012 Wiley Periodicals, Inc.

  6. Prognostic value of thumb pain sensation in birth brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Carlos O. Heise

    2012-08-01

    Full Text Available OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6. The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.

  7. Tolerance of the Brachial Plexus to High-Dose Reirradiation

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: achen5@kumc.edu; Yoshizaki, Taeko; Velez, Maria A.; Mikaeilian, Argin G.; Hsu, Sophia; Cao, Minsong

    2017-05-01

    Purpose: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Methods and Materials: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). Results: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus–related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). Conclusion: The development of brachial plexus–related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.

  8. Tolerance of the Brachial Plexus to High-Dose Reirradiation.

    Science.gov (United States)

    Chen, Allen M; Yoshizaki, Taeko; Velez, Maria A; Mikaeilian, Argin G; Hsu, Sophia; Cao, Minsong

    2017-05-01

    To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus-related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). The development of brachial plexus-related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Permanent upper trunk plexopathy after interscalene brachial plexus block.

    Science.gov (United States)

    Avellanet, Merce; Sala-Blanch, Xavier; Rodrigo, Lidia; Gonzalez-Viejo, Miguel A

    2016-02-01

    Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia.

  10. [Myxoid/round cell liposarcoma of the brachial plexus].

    Science.gov (United States)

    Giner, Javier; Isla, Alberto; Hernández, Borja; Nistal, Manuel

    2014-01-01

    Myxoid/round cell liposarcoma is a soft tissue sarcoma that is extremely rare in the brachial plexus. We report a case of a myxoid/round cell liposarcoma originating in the brachial plexus that was surgically resected and evolved well, with no deficit or recurrence after 2 years of follow-up. To date, there has been no other case of this sarcoma in the literature. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  11. Prognostic role of a new risk index for the prediction of 30-day cardiovascular mortality in patients with acute pulmonary embolism: the Age-Mean Arterial Pressure Index (AMAPI).

    Science.gov (United States)

    Zuin, Marco; Rigatelli, Gianluca; Picariello, Claudio; Carraro, Mauro; Zonzin, Pietro; Roncon, Loris

    2017-12-01

    Acute pulmonary embolism (PE) is the third cause of cardiovascular (CV) mortality. We evaluated a new risk index, named Age-Mean Arterial Pressure Index (AMAPI), to predict 30-day CV mortality in patients with acute PE. Data of 209 patients (44.0% male and 56.0% female, mean age 70.58 ± 14.14 years) with confirmed acute PE were retrospectively analysed. AMAPI was calculated as the ratio between age and mean arterial pressure (MAP), which was defined as [systolic blood pressure + (2 × diastolic blood pressure)]/3. To test AMAPI accuracy, a comparison with shock index (SI) and simplified pulmonary embolism severity index (sPESI) was performed. Patients were divided in two groups according their hemodynamic stability, or not, at admission. 30-day mortality rate, in all cases for CV events, was 10.5% (n = 22). Hemodynamically unstable patients had a higher AMAPI compare to those without hypotension at admission (1.28 ± 0.39 vs 0.78 ± 0.27, p < 0.0001). Receiving operative curve analyses (ROC) found the optimal cut-off for AMAPI in hemodynamically stable and unstable patients ≥0.9 and ≥0.92, respectively. In both groups, patients with an AMAPI over the cut-off were significantly older, hypotensive (both systolic and diastolic blood pressure), with a higher SI and lower MAP. In hemodynamically stable patients, 30-day CV mortality risk prediction was improved adding AMAPI ≥0.9 to both SI and sPESI (net reclassification improvement-NRI-of 14.2%, p = 0.0006 and 11.5%, p = 0.0002, respectively). In hemodynamically unstable patients NRI was 19.2%, p = 0.006. Mantel-Cox analysis revealed a statistical significant difference in the distribution of survival between hemodynamically stable patients with an AMAPI index ≥0.9 compared to those with an AMAPI <0.89 [log rank (Mantel-Cox) p < 0.0001] and in hemodynamically unstable patients with an AMAPI ≥0.92 [log rank (Mantel-Cox) p = 0.001]. AMAPI ≥0.90 and ≥0.92 predict 30-day CV mortality

  12. Effects of smoking cessation on central blood pressure and arterial stiffness

    Directory of Open Access Journals (Sweden)

    Takami T

    2011-10-01

    Full Text Available Takeshi Takami1,Yoshihiko Saito21Department of Internal Medicine, Clinic Jingumae, Kashihara, Nara, Japan; 2First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, JapanPurpose: Smoking affects arterial stiffness, thus causing an elevation in central blood pressure (CBP. The present study was designed to examine whether smoking cessation treatment improved CBP and arterial stiffness.Patients and methods: We conducted an observational study of 70 patients receiving smoking cessation treatment. Before and 60 weeks after the start of a 12-week varenicline treatment, we measured brachial blood pressure, CBP, brachial-ankle pulse wave velocity (baPWV, normalized radial augmentation index (rAIx@75, left ventricular weight, and left ventricular diastolic function of each patient. The data were compared between the patients who succeeded in quitting smoking (smoking cessation group; n = 37 and those who failed to quit smoking (smoking group; n = 33.Results: Baseline characteristics were similar in both groups. Brachial blood pressure remained unchanged in both groups. CBP, baPWV, and rAIx@75 decreased significantly in the smoking cessation group, while these parameters showed no significant change in the smoking group. Thus, CBP, baPWV, and rAIx@75 showed greater decrease in the smoking cessation group than in the smoking group (CBP, −7.1 ± 1.4 mmHg vs 1.2 ± 2.7 mmHg; P < 0.01; baPWV, −204 ± 64 cm/s vs −43 ± 72 cm/s; P < 0.01; rAIx@75, −6.4 ± 2.8% vs −1.0 ± 3.9%; P < 0.01. Left ventricular weight and left ventricular diastolic function remained unchanged in both groups.Conclusion: Patients in the smoking cessation group showed significant improvement in CBP, baPWV, and rAIx@75. These results indicate that smoking cessation can improve arterial stiffness and CBP.Keywords: central blood pressure, augmentation index, brachial-ankle pulse wave velocity, smoking cessation, varenicline

  13. Non-invasive assessment of arterial stiffness using oscillometric blood pressure measurement

    Directory of Open Access Journals (Sweden)

    Komine Hidehiko

    2012-02-01

    Full Text Available Abstract Background Arterial stiffness is a major contributor to cardiovascular diseases. Because current methods of measuring arterial stiffness are technically demanding, the purpose of this study was to develop a simple method of evaluating arterial stiffness using oscillometric blood pressure measurement. Methods Blood pressure was conventionally measured in the left upper arm of 173 individuals using an inflatable cuff. Using the time series of occlusive cuff pressure and the amplitudes of pulse oscillations, we calculated local slopes of the curve between the decreasing cuff pressure and corresponding arterial volume. Whole pressure-volume curve was derived from numerical integration of the local slopes. The curve was fitted using an equation and we identified a numerical coefficient of the equation as an index of arterial stiffness (Arterial Pressure-volume Index, API. We also measured brachial-ankle (baPWV PWV and carotid-femoral (cfPWV PWV using a vascular testing device and compared the values with API. Furthermore, we assessed carotid arterial compliance using ultrasound images to compare with API. Results The slope of the calculated pressure-volume curve was steeper for compliant (low baPWV or cfPWV than stiff (high baPWV or cfPWV arteries. API was related to baPWV (r = -0.53, P r = -0.49, P r = 0.32, P Conclusions These results suggest that our method can simply and simultaneously evaluate arterial stiffness and blood pressure based on oscillometric measurements of blood pressure.

  14. Non-invasive assessment of arterial stiffness using oscillometric blood pressure measurement

    Science.gov (United States)

    2012-01-01

    Background Arterial stiffness is a major contributor to cardiovascular diseases. Because current methods of measuring arterial stiffness are technically demanding, the purpose of this study was to develop a simple method of evaluating arterial stiffness using oscillometric blood pressure measurement. Methods Blood pressure was conventionally measured in the left upper arm of 173 individuals using an inflatable cuff. Using the time series of occlusive cuff pressure and the amplitudes of pulse oscillations, we calculated local slopes of the curve between the decreasing cuff pressure and corresponding arterial volume. Whole pressure-volume curve was derived from numerical integration of the local slopes. The curve was fitted using an equation and we identified a numerical coefficient of the equation as an index of arterial stiffness (Arterial Pressure-volume Index, API). We also measured brachial-ankle (baPWV) PWV and carotid-femoral (cfPWV) PWV using a vascular testing device and compared the values with API. Furthermore, we assessed carotid arterial compliance using ultrasound images to compare with API. Results The slope of the calculated pressure-volume curve was steeper for compliant (low baPWV or cfPWV) than stiff (high baPWV or cfPWV) arteries. API was related to baPWV (r = -0.53, P blood pressure based on oscillometric measurements of blood pressure. PMID:22325084

  15. Non-invasive assessment of arterial stiffness using oscillometric blood pressure measurement.

    Science.gov (United States)

    Komine, Hidehiko; Asai, Yoshiyuki; Yokoi, Takashi; Yoshizawa, Mutsuko

    2012-02-10

    Arterial stiffness is a major contributor to cardiovascular diseases. Because current methods of measuring arterial stiffness are technically demanding, the purpose of this study was to develop a simple method of evaluating arterial stiffness using oscillometric blood pressure measurement. Blood pressure was conventionally measured in the left upper arm of 173 individuals using an inflatable cuff. Using the time series of occlusive cuff pressure and the amplitudes of pulse oscillations, we calculated local slopes of the curve between the decreasing cuff pressure and corresponding arterial volume. Whole pressure-volume curve was derived from numerical integration of the local slopes. The curve was fitted using an equation and we identified a numerical coefficient of the equation as an index of arterial stiffness (Arterial Pressure-volume Index, API). We also measured brachial-ankle (baPWV) PWV and carotid-femoral (cfPWV) PWV using a vascular testing device and compared the values with API. Furthermore, we assessed carotid arterial compliance using ultrasound images to compare with API. The slope of the calculated pressure-volume curve was steeper for compliant (low baPWV or cfPWV) than stiff (high baPWV or cfPWV) arteries. API was related to baPWV (r = -0.53, P blood pressure based on oscillometric measurements of blood pressure.

  16. Brachial plexus block in phantom limb pain: a case report.

    Science.gov (United States)

    Preissler, Sandra; Dietrich, Caroline; Meissner, Winfried; Huonker, Ralph; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2011-11-01

    The purpose of this case report is twofold: first, to present evidence of long-lasting relief in a patient suffering from phantom limb pain after pharmacologically blocking his plexus brachialis and, second, to replicate results from a previous study focusing on cortical reorganization and phantom limb pain. Before regional anesthesia, the patient suffered from a phantom hand that cramped and was immovable. We performed a diagnostic axillary blockade of the brachial plexus to differentiate peripheral from more central contributions to phantom limb pain. During blockade of the brachial plexus, the patient reported a reduction of phantom limb pain for the first time following years of suffering and a complete loss of cramping together with muscle relaxation of the phantom hand. Additionally, we found cortical reorganization in the primary somatosensory cortex (re-reorganization). Strikingly, the relaxed phantom limb together with the reduction of phantom limb pain remained preserved even 6 months after blockade of the brachial plexus. A single temporary blockade of the brachial plexus may relieve phantom limb pain and unpleasant phantom feelings (cramping) for an extended period. Wiley Periodicals, Inc.

  17. The natural history and management of brachial plexus birth palsy.

    Science.gov (United States)

    Buterbaugh, Kristin L; Shah, Apurva S

    2016-12-01

    Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

  18. Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

    Directory of Open Access Journals (Sweden)

    Chung-Lan Kao

    2006-11-01

    Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

  19. Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries

    NARCIS (Netherlands)

    Hoeksma, Agnes F.; ter Steeg, Anne Marie; Dijkstra, Piet; Nelissen, Rob G. H. H.; Beelen, Anita; de Jong, Bareld A.

    2003-01-01

    The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. In a retrospective cohort study, all

  20. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture

    NARCIS (Netherlands)

    Hoeksma, A. F.; Wolf, H.; Oei, S. L.

    2000-01-01

    The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13,366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center,

  1. [Bilateral brachial plexus block. Case report and systematic review].

    Science.gov (United States)

    Mejia-Terrazas, Gabriel Enrique; Garduño-Juárez, María de Ángeles; Limón-Muñoz, Marisol; Torres-Maldonado, Areli Seir; Carrillo-Esper, Raúl

    2015-01-01

    The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block. Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  2. Surgical significance of brachial arterial variants in a Kenyan ...

    African Journals Online (AJOL)

    Methods: This was a cadaveric dissection study of 162 upper limbs at the Department of Human Anatomy University of Nairobi, Kenya. The brachial artery was exposed entirely from the lower border of teres major to its point of termination. The course in relation to the median nerve and the level of termination were recorded ...

  3. Comparison of Two Techniques of Brachial Plexus Block for Upper ...

    African Journals Online (AJOL)

    The study compared trans-arterial approach and mid-humeral technique of axillary brachial plexus block in terms of the clinical benefit of each method; adequacy of block, onset of sensory and motor block, duration of block and complications. .In a prospective randomized study, axillary plexus block was carried out in 50 ...

  4. Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian ...

    African Journals Online (AJOL)

    Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our ...

  5. Transarterial Brachial Plexus Anaesthesia for Upper Limb Surgery ...

    African Journals Online (AJOL)

    Objective: We present our experience with the transarterial brachial plexus anaesthesia as a technique of choice for upper limb procedure in developing countries where nerve stimulator may not be readily available. Methods: For all consenting patients, the axillary block was instituted using a 23G hypodermic needle and ...

  6. Ultrasound of the cervical roots and brachial plexus in neonates

    NARCIS (Netherlands)

    Pillen, S.; Semmekrot, B.; Meulstee, J.; Verrips, A.; Alfen, N. van

    2015-01-01

    INTRODUCTION: In this exploratory study we investigated whether ultrasound can visualize the neonatal cervical roots and brachial plexus. METHODS: In 12 healthy neonates <2 days old, the neck region was studied unilaterally with ultrasound using a small-footprint 15-7-MHz transducer. RESULTS: The

  7. Use Of Continuous Axillary Brachial Plexus Block Facilitates ...

    African Journals Online (AJOL)

    Objective: To report the successful use of continuous axillary brachial plexus block in the assessment of muscle functions during tendon repair. Methods: A prospective observational study carried out at Obafemi Awolowo University Teaching Hospital, Ile-Ife between November 2006 and December 2007. The study included ...

  8. General intravenous anesthesia for brachial plexus surgery in the rabbit.

    Science.gov (United States)

    Reichert, P; Rutowski, R; Kielbowicz, Z; Kuryszko, J; Kielbowicz, M

    2013-01-01

    The rabbit is a good experimental model for brachial plexus surgery. The risks of death during anesthesia were significantly greater in rabbits than cats or dogs. This article presents the protocol of injectable anesthesia for a short surgical procedure, safe for the rabbit patient and convenient for the surgeon.

  9. Anatomical variations of the brachial plexus terminal branches in ...

    African Journals Online (AJOL)

    Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and ...

  10. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    Science.gov (United States)

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

  11. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications.

    Science.gov (United States)

    Van de Velde, Joris; Bogaert, Stephanie; Vandemaele, Pieter; Huysse, Wouter; Achten, Eric; Leijnse, Joris; De Neve, Wilfried; Van Hoof, Tom

    2016-03-01

    The present study aimed to establish a baseline for detailed 3D brachial plexus reconstruction from magnetic resonance imaging (MRI). Concretely, the goal was to determine the individual brachial plexus anatomy with maximum detail and accuracy achievable, as yet irrespective of whether the methods used could be economically and practically applied in the clinical setting. Six embalmed cadavers were randomly taken for MRI imaging of the brachial plexus. Detailed two-dimensional (2D) segmentation for all brachial plexus parts was done. The 2D brachial plexus segmentations were 3D reconstructed using Mimics(®) software. Then, these 3D reconstructions were anatomically validated by dissection of the cadavers. After finalising the cadaver experiments, brachial plexus MRIs were obtained in three healthy male volunteers and the same reconstruction procedure as in vitro was followed. A procedure was developed for brachial plexus 3D reconstruction based on MRI without the use of any contrast agent. Anatomical validation of six cadaver brachial plexus reconstructions showed high correspondence with the dissected brachial plexuses. Anatomical variations of the main branches were equally present in the 3D reconstructions generated. However, there were also some differences that related to the difference between the surface anatomy of the nerve and the internal nerve structure. In vivo, it was possible to reconstruct the complete brachial plexus in such a manner that normal-appearing BPs were derived in a reproducible way. This study showed that the described procedure results in accurate and reproducible brachial plexus 3D reconstructions.

  12. The usefulness of a single arm cuff oscillometric method (Arteriograph) to assess changes in central aortic blood pressure and arterial stiffness by antihypertensive treatment: results from the Doxazosin-Ramipril Study.

    Science.gov (United States)

    Jekell, Andreas; Kahan, Thomas

    2017-10-26

    Inhibition of the renin-angiotensin system may have effects on vascular structure and function beyond the effects on blood pressure (BP) reduction. We studied the ability of a single arm cuff oscillometric method (Arteriograph, TensioMed, Hungary) to assess effects of antihypertensive treatment on BP and arterial stiffness. Furthermore, this technique was compared to pulse wave analysis and applanation tonometry (SphygmoCor, AtCor Medical, Australia). Brachial and aortic BP, augmentation index (AIx), and carotid-femoral pulse wave velocity (PWV) was simultaneously assessed by both techniques in 71 untreated hypertensive patients. Thereafter, 58 completed double-blind randomized treatment for 12 weeks with ramipril or doxazosin. Treatment (assessed by the Arteriograph) reduced aortic more than brachial systolic BP (-13.2 vs. -11.2 mm Hg; p = .002) and improved all indices of arterial stiffness. This greater reduction in aortic to brachial systolic BP was more marked by ramipril than by doxazosin (-20.9 and -17.1 vs. -4.3 and -4.2 mm Hg; p = .006), with a similar trend for AIx (-6.2 vs. -2.2%; p = .058). Both devices showed correlations for aortic and brachial systolic and diastolic BP and AIx (r = 0.75-0.86, all p < .001), while agreement for PWV was weaker (r = 0.28; p = .043). The Arteriograph generally recorded higher values for aortic BP and AIx than the SphygmoCor. Antihypertensive treatment reduced aortic systolic BP more than brachial BP and improved arterial stiffness. Blocking the renin-angiotensin system may have additional effects beyond BP reduction. We demonstrate the feasibility of the Arteriograph to monitor changes in BP and arterial stiffness by treatment.

  13. The association of physical activity, body mass index and the blood pressure levels among urban poor youth in Accra, Ghana

    NARCIS (Netherlands)

    Afrifa-Anane, Ernest; Agyemang, Charles; Codjoe, Samuel Nii Ardey; Ogedegbe, Gbenga; de-Graft Aikins, Ama

    2015-01-01

    Globally, there is an increasing prevalence of high blood pressure (HBP) among adults and youth. However, the mechanisms of how the risk factors (physical inactivity and obesity) relate with blood pressure (BP) are not well known especially among the urban poor youth in low and middle income

  14. Spontaneous recovery of non-operated traumatic brachial plexus injury.

    Science.gov (United States)

    Lim, S H; Lee, J S; Kim, Y H; Kim, T W; Kwon, K M

    2017-06-27

    We investigated the spontaneous recovery of non-operated traumatic brachial plexus injury (BPI). A total of 25 cases of non-operated traumatic BPI were analysed by retrospective review of medical records; in all cases, consecutive electrodiagnostic studies (ES) were conducted from 1 to 4 months and 18 to 24 months post-trauma. Injury severity was assessed using a modified version of Dumitru and Wilbourn's scale (DWS) based on ES. Spontaneous recovery of brachial plexus components per subject was analysed using Wilcoxon's signed-rank test. A two-tailed Fisher's exact or Pearson's Chi-square test was used to examine the associations between initial injury severity (DWS grade 2 vs. 3, complete vs. incomplete), accompanying injury type (open vs. closed), main lesion location (supraclavicular vs. infraclavicular lesion), and spontaneous recovery. The most common cause of BPI was traffic accident (TA) (15 cases, 60%), and the most common type of TA-induced BPI was a motorcycle TA (5 cases), accounting for 20% of all injuries. The second most common type of injury was an occupational injury (6 cases, 24%). Thirty-eight (69%) of 55 injured brachial components in 25 cases had DWS grade 3 and 17 brachial components (31%) had grade 2. The DWS grade of brachial plexus components per subject significantly differed between the first and follow-up ES (p = 0.000). However, initial injury severity, accompanying injury type, and main lesion location were not statistically associated with spontaneous recovery (p > 0.05). Spontaneous recovery may be possible even in severe traumatic BPI. Multiple factors should be considered when predicting the clinical course of traumatic BPI.

  15. A Description of a New Continuous Physiologic Index in TBI using the Correlation Between Pulse Amplitude of ICP and Cerebral Perfusion Pressure.

    Science.gov (United States)

    Zeiler, Frederick Adam; Donnelly, Joseph; Menon, David; Smieleweski, Peter; Hutchinson, Peter John; Czosnyka, Marek

    2017-12-06

    To describe a new continuous index of physiologic measurement in a TBI population, the moving correlation coefficient between intracranial pressure (ICP) pulse amplitude (AMP) and cerebral perfusion pressure (CPP), which we refer to as RAC. We use patient examples of sustained intracranial hypertension, systemic arterial hypotension and plateau waves, as well as the retrospective analysis of 358 non-decompressive craniectomy (DC) traumatic brain injury (TBI) patients with high frequency ICP and ABP data, to explore the relationships of this new index, RAC, with AMP, ICP, CPP, RAP, pressure reactivity index (PRx) and pulse amplitude index (PAx). We compared the RAC-CPP relationship to that observed between CPP and both PRx and PAx. RAC displays temporal responsiveness to sustained increased ICP, arterial hypotension and plateau waves, with positive values found during episodes of high ICP and low CPP. Analysis of AMP versus CPP and AMP versus ICP relationships in data from the entire non-DC cohort, show lower breakpoints for AMP/CPP at CPP= 40 mm Hg; and upper breakpoints for AMP/ICP at ICP=50 to 60 mm Hg. RAC trends to positive values with increasing ICP, particularly with ICP values above the peak in AMP (ICP>50 mm Hg), though it's interpretation requires concomitant interpretation of AMP, RAP and PRx/PAx to determine contributions of compliance and cerebrovascular responsiveness to the changes seen in RAC. There is a parabolic relationship between RAC vs. CPP, with trends towards positive RAC values near (and beyond) limits for low and high CPPs, suggesting that RAC may be used in the determination of optimum CPP (CPPopt). RAC appears to carry information regarding both: cerebrovascular responsiveness and cerebral compliance. This contributes to RAC's uniqueness and complex interpretation. Further prospective clinical studies of RAC in CPP optimum estimation and outcome prediction in TBI are required.

  16. [Prevalence of high blood pressure and their association with body mass index in children between 5 and 11 years of Nahbalam, Yucatan].

    Science.gov (United States)

    Saury-Paredes, Leonel Alejandro

    To determine the prevalence of high blood pressure in children aged between 5-11 years in the community of Nahbalam, Yucatan, and its association with the body mass index. A transversal study with children of the primary school "Lazaro Cardenas del Rio" was performed, measuring blood pressure, height, and weight of 259 girls and boys; systolic and/or diastolic blood pressure equal or greater than percentile 95 for gender, age, and height at three measures was considered as hypertension; prehypertension was considered as blood pressure equal or greater than percentile 90 but lower than percentile 95. A prevalence of 11.9% prehypertension and 6.1% hypertension was found. There is an association between hypertension and overweight and obesity (p ≤ 0.001). The prevalence of high blood pressure in children of the community of Nahbalam, Yucatan, is 18%. The children with overweight and obesity have an almost tenfold greater risk of hypertension than the eutrophic children (OR: 9.896; 95% CI: 2.738-35.764).

  17. Limited accuracy of the hyperbaric index, ambulatory blood pressure and sphygmomanometry measurements in predicting gestational hypertension and preeclampsia

    NARCIS (Netherlands)

    Vollebregt, Karlijn Corien; Gisolf, Janneke; Guelen, Ilja; Boer, Kees; van Montfrans, Gert; Wolf, Hans

    2010-01-01

    Objective The aim of this study was to validate the hyperbaric index (HBI) for first trimester prediction of preeclampsia and gestational hypertension. Methods Participants were low-risk and high-risk nulliparous women and high-risk multiparous women, and were recruited between April 2004 and June

  18. COMPARATIVE STUDY OF ROPIVACAINE V/S ROPIVACAINE WITH MAGNESIUM SULPHATE FOR BRACHIAL PLUXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Nagarjuna Reddy

    2015-09-01

    .92±1.51 and Group II ( 4.86±1.58 ,There was no significant difference in onset of motor blockade between Group I (14.82±2.32 and Group II (13.7±2.82 ,When the duration of analgesia is compared, it is significantly longer in Group II ( 855.8 ± 73.66 than Group I ( 676 ± 89.55 , The changes in pulse rate were not significant between the two groups at various times o f recording., The changes in systolic and diastolic blood pressures are similar in both the groups., No complications were recorded during the procedure and also afterwards. CONCLUSION : Based on the present clinical comparative study addition of Magnesium Sulphate to Ropivacaine is a better choice than plain Ropivacaine for Brachial Plexus Block for upper limb surgeries.

  19. Genetic and environmental influences on blood pressure and body mass index in Han Chinese : a twin study

    NARCIS (Netherlands)

    Wu, Ting; Snieder, Harold; Li, Liming; Cao, Weihua; Zhan, Siyan; Lv, Jun; Gao, Wenjing; Wang, Xiaoling; Ding, Xiuhua; Hu, Yonghua

    The familial aggregation of blood pressure (BP) may be partly due to the familial aggregation of obesity, caused by genetic and/or environmental factors that influence both. Gene-obesity interactions are expected to result in different heritability estimates for BP at different obesity levels.

  20. Technical note: the humeral canal approach to the brachial plexus.

    LENUS (Irish Health Repository)

    Frizelle, H P

    2012-02-03

    Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral\\/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patients were assessed for completeness of motor and sensory block. The overall success rate was 90 percent. Motor block was present in 80 percent of patients. Completion of the block was necessary in 5 patients. Two patients required general anaesthesia. The preponderance of ulnar deficiencies agrees with previously published data on this technique. No complications were described. Initial experience confirms the high success rate described using the Dupre technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.

  1. Upper Trunk Brachial Plexus Palsy Following Chiropractic Manipulation

    Directory of Open Access Journals (Sweden)

    John Cunningham

    2016-11-01

    Full Text Available Introduction:Upper trunk brachial plexus palsy can result from high energy trauma and has never been reported following spinal manipulation.Background:The case is presented of a patient who developed an acute brachial plexus upper trunk palsy following spinal manipulative therapy. Discussion:Discussion is made on the incidence of complications following manipulation and recommendations to prospectively capture all serious complications.Concluding Remarks:Risks exist with spinal manipulative therapy. Neurological injury can occur. Risk assessment and re-examination should occur at every visit. Large rigorous prospective studies are required to identify the true incidence of serious complications resulting from manipulative therapy and the benefit:risk ratio.

  2. Median nerve neuropraxia by a large false brachial artery aneurysm.

    Science.gov (United States)

    Lijftogt, Niki; Cancrinus, Ernst; Hoogervorst, Erwin L J; van de Mortel, Rob H W; de Vries, Jean-Paul P M

    2014-10-01

    Peripheral nerve compression is a rare complication of an iatrogenic false brachial artery aneurysm. We present a 72-year-old patient with median nerve compression due to a false brachial artery aneurysm after removal of an arterial catheter. Surgical exclusion of the false aneurysm was performed in order to release traction of the median nerve. At 3-month assessment, moderate hand recovery in function and sensibility was noted. In the case of neuropraxia of the upper extremity, following a history of hospital stay and arterial lining or catheterization, compression due to pseudoaneurysm should be considered a probable cause directly at presentation. Early recognition and treatment is essential to avoid permanent neurological deficit. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. [Central arterial pressure in patients with chronic obstructive pulmonary disease].

    Science.gov (United States)

    Gel'tser, B I; Brodskaia, T A

    2008-01-01

    To study central (aortic) arterial pressure (CAP) and aortic stiffness in patients with chronic obstructive pulmonary disease (COPD) of different severity. Non-invasive arteriography with Tensio Climo TL1 arteriograph (TensioMed, Hungary) was made to measure aortic stiffness and systolic pressure (SAP) in 54 COPD patients and 25 healthy controls. The difference between the central and peripheral SAP (delta SAP) and central/ peripheral pressure correspondence index (CI) were estimated. Indirect arteriography has found that patients with moderate and severe COPD have stable elevated central SAP which is close to brachial SAP while in healthy controls the difference between central and peripheral SAP is 10.2 +/- 2.1 mmHg. With progression of COPD severity, deltaSAP diminishes while CI rises showing growing disproportion between central and peripheral blood pressure. In severe COPD physiological difference between them disappears. In COPD increased CAP is associated with impaired mechanical properties of the arterial bed and myocardial contractility proved by significant links between CAP and left ventricular ejection fraction index and key parameters of arterial stiffness. Aortic CAP, delta SAP and CI are additional informative criteria of COPD severity and high cardiovascular risk as shown by their close correlation with hypoxemia, severity and duration of the disease.

  4. Whole-body vibration training reduces arterial stiffness, blood pressure and sympathovagal balance in young overweight/obese women.

    Science.gov (United States)

    Figueroa, Arturo; Gil, Ryan; Wong, Alexei; Hooshmand, Shirin; Park, Song Y; Vicil, Florence; Sanchez-Gonzalez, Marcos A

    2012-06-01

    Obesity is associated with early cardiovascular dysfunction and reduced muscle strength. Whole-body vibration (WBV) training may improve arterial function and muscle strength. The effects of WBV training on arterial stiffness (brachial-ankle pulse wave velocity, baPWV), wave reflection (augmentation index, AIx), brachial systolic blood pressure (bSBP), aortic systolic blood pressure (aSBP), heart rate variability, and muscle strength (one-repetition maximum, 1RM) were examined in 10 young (21 ± 2 year) overweight/obese women (body mass index, BMI = 29.9 ± 0.8 kg m(-2)). Participants were randomized to a 6-week WBV training or non-exercising control (CON) period in a crossover design. WBV training (3 days × week) consisted of static and dynamic squats and calf raises with vibration intensity at 25-30 Hz and 1-2 mm amplitude (2.83-4.86 G). There were significant (Pobese normotensive women. WBV training may benefit arterial function and muscle strength in deconditioned individuals who cannot perform conventional exercise.

  5. Relationship between resistant hypertension and arterial stiffness assessed by brachial-ankle pulse wave velocity in the older patient

    Directory of Open Access Journals (Sweden)

    Chung CM

    2014-09-01

    Full Text Available Chang-Min Chung,1,2 Hui-Wen Cheng,2 Jung-Jung Chang,2 Yu-Sheng Lin,2 Ju-Feng Hsiao,2 Shih-Tai Chang,1 Jen-Te Hsu2,31School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, 2Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, 3Department of Medicine, College of Medicine, Chang Gung University, Taoyuan County, TaiwanBackground: Resistant hypertension (RH is a common clinical condition associated with increased cardiovascular mortality and morbidity in older patients. Several factors and conditions interfering with blood pressure (BP control, such as excess sodium intake, obesity, diabetes, older age, kidney disease, and certain identifiable causes of hypertension are common in patients resistant to antihypertensive treatment. Arterial stiffness, measured by brachial-ankle pulse wave velocity (baPWV, is increasingly recognized as an important prognostic index and potential therapeutic target in hypertensive patients. The aim of this study was to determine whether there is an association between RH and arterial stiffness. Methods: This study included 1,620 patients aged ≥65 years who were referred or self-referred to the outpatient hypertension unit located at a single cardiovascular center. They were separated into normotensive, controlled BP, and resistant hypertension groups. Home BP, blood laboratory parameters, echocardiographic studies and baPWV all were measured. Results: The likelihood of diabetes mellitus was significantly greater in the RH group than in the group with controlled BP (odds ratio 2.114, 95% confidence interval [CI] 1.194–3.744, P=0.010. Systolic BP was correlated in the RH group significantly more than in the group with controlled BP (odds ratio 1.032, 95% CI 1.012–1.053, P=0.001. baPWV (odds ratio 1.084, 95% CI 1.016–1.156, P=0.015 was significantly correlated with the presence of RH. The other factors were negatively correlated with the existence of RH.Conclusion: In

  6. Delivery factors for brachial plexus palsy by newborns

    Directory of Open Access Journals (Sweden)

    D. Balić

    2007-02-01

    Full Text Available Brachial plexus injuries represent a low percentage of delivery complications. Most newborns fully recover from the injury, very few retain a permanent neurological deficit whereas some remain unnoticed. An objective of this study was to establish delivery factors for brachial plexus palsy at the Clinic for Gynecology and Obstetrics and relation between the deficits with length of delivery, the length of delivery periods, induction of delivery and surgical interventions at delivery. The analysed group involved 90 newborn babies with an injury of brachial plexus made at the delivery in the period between 01.01.1996 and 31.12.2005. The controlled group included 90 newborns randomly selected. The comparison was made using an χ2 test. The incidence of injuries of plexus brachialis was 1.72 per 1,000 newborns. Analysing the length of delivery there was no difference found between the analysed and controlled group (p > 0.05. In the group of newborns with the injury of brachial plexus it was found that the second delivery period was significantly shorter (p < 0.01. In the analysed group 89 (98.8% newborn babies were delivered vaginally and one (1.2% was delivered by the cesarean section. 13 newborns (14.4% from the analysed group were delivered with application of vacuum extractor and in the controlled group it was the case with one (1.2% newborn baby (p < 0.01. The delivery of 98.8% newborns from the analysed group started spontaneously and two deliveries (1.2% were induced. Risk factors for injuries of plexus brachialis in newborns at the Clinic for Gynaecology and Obstetrics of the University Clinical Centre Tuzla include shortened second delivery period and completion of deliveries applying the vacuum extractor.

  7. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    OpenAIRE

    Coroneos, Christopher J.; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R.; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and childr...

  8. Delayed presentation of a traumatic brachial artery pseudoaneurysm.

    LENUS (Irish Health Repository)

    Forde, James C

    2009-09-01

    Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.

  9. A giant plexiform schwannoma of the brachial plexus: case report

    OpenAIRE

    Kohyama, Sho; Hara, Yuki; Nishiura, Yasumasa; Hara, Tetsuya; Nakagawa, Tanefumi; Ochiai, Naoyuki

    2011-01-01

    Abstract We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enla...

  10. Trapezius transfer to treat flail shoulder after brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Diaz Humberto

    2007-01-01

    Full Text Available Abstract Background After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. Methods We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41, the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years and the average follow-up was 17.5 months (range 6 to 52, reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. Results All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs. Conclusion Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

  11. Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Susan C.; Geannette, Christian; Sneag, Darryl B. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Wolfe, Scott W. [Hospital for Special Surgery, Hand and Upper Extremity, Department of Orthopedics, New York, NY (United States); Feinberg, Joseph H. [Hospital for Special Surgery, Physical Medicine and Rehabilitation, New York, NY (United States)

    2017-08-15

    This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed - and consequently scar tethered - the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy. (orig.)

  12. Effects of obesity and smoking on mental stress-induced blood pressure and augmentation index responses in normotensive young males: the J-SHIPP study.

    Science.gov (United States)

    Tabara, Yasuharu; Kohara, Katsuhiko; Nakagawa, Satoshi; Handa, Jou; Hayashi, Makoto; Hamada, Chizuru; Miyaguchi, Megumi; Shigemi, Yuka; Miki, Tetsuro; Konishi, Masamitsu

    2008-06-01

    Exaggerated blood pressure (BP) response to mental stress has been known to be a prognostic factor for cardiovascular disease. It has been argued that such unusual vascular reactivity to mental stress may arise from insulin resistance. To examine the vascular responses to mental stress, we evaluated the stress-related changes in BP and the augmentation index (AI), an index of arterial stiffness, in normotensive young males. Changes in late systolic BP (SBP2) representing central aortic pressure were also examined. Subjects were 86 males (21+/-2 years), 13 of whom were classified as obese (>or=25 kg/m(2)). AI was obtained from the radial arterial waveform as a ratio of the height of the late systolic peak to that of the first peak. Blood pressure and AI measurements were taken before, during and after a simple mental arithmetic test (MAT) lasting 3 min. Systolic BP (baseline 125+/-13, during MAT 133+/-13, post-MAT 124+/-11 mmHg; p<0.001) and heart rate (74+/-12, 81+/-13, 74+/-11 beats/min; p<0.001) were significantly increased during the MAT, whereas AI showed a slight reduction. In a separate analysis, the opposite response was observed between obese subjects showing increased AI (54+/-11, 56+/-13, 52+/-11%) and non-obese subjects who showed reduced AI (54+/-12, 51+/-12, 53+/-12%; p=0.032). The responses in SBP and SBP2 (obese 103+/-14, 117+/-12, 104+/-12; non-obese 98+/-13, 104+/-12, 97+/-12 mmHg; p=0.007) were also larger in the obese subjects. Stress-related transient increases in arterial stiffness may be involved in the exaggerated responses in aortic pressure in obese subjects.

  13. Distinguishing Different Stages of Parkinson’s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral

    Directory of Open Access Journals (Sweden)

    Poonam Zham

    2017-09-01

    Full Text Available The speed and pen-pressure while sketching a spiral are lower among Parkinson’s disease (PD patients with higher severity of the disease. However, the correlation between these features and the severity level (SL of PD has been reported to be 0.4. There is a need for identifying parameters with a stronger correlation for considering this for accurate diagnosis of the disease. This study has proposed the use of the Composite Index of Speed and Pen-pressure (CISP of sketching as a feature for analyzing the severity of PD. A total of 28 control group (CG and 27 PD patients (total 55 participants were recruited and assessed for Unified Parkinson’s Disease Rating Scale (UPDRS. They drew guided Archimedean spiral on an A3 sheet. Speed, pen-pressure, and CISP were computed and analyzed to obtain their correlation with severity of the disease. The correlation of speed, pen-pressure, and CISP with the severity of PD was −0.415, −0.584, and −0.641, respectively. Mann–Whitney U test confirmed that CISP was suitable to distinguish between PD and CG, while non-parametric k-sample Kruskal–Wallis test confirmed that it was significantly different for PD SL-1 and PD SL-3. This shows that CISP during spiral sketching may be used to differentiate between CG and PD and between PD SL-1 and PD SL-3 but not SL-2.

  14. Intrapartum risk factors for permanent brachial plexus injury.

    Science.gov (United States)

    Poggi, Sarah H; Stallings, Shawn P; Ghidini, Alessandro; Spong, Catherine Y; Deering, Shad H; Allen, Robert H

    2003-09-01

    The purpose of this study was to compare maternal, neonatal, and second stage of labor characteristics in shoulder dystocia deliveries that result in permanent brachial plexus injury with shoulder dystocia deliveries that result in no injury. Our cases were culled from a database of deliveries that resulted in permanent brachial plexus injuries and matched to control cases that were taken from a database of consecutive shoulder dystocia deliveries from one hospital. Deliveries that resulted in injury were excluded from the control cases; those cases with no recorded shoulder dystocia were excluded from the cases. Matching was for birth weight (+/-250 g), parity, and diabetic status. Rates of precipitous and prolonged second stage, operative delivery, neonatal depression, and average number of shoulder dystocia maneuvers used were compared between the two groups with chi(2) test, Fisher exact test, and the Student t test; a probability value of precipitous second stage rate, and sex were not significant between groups. The rates of precipitous second stage for both groups (28.0% injured and 35.0% uninjured) were more than triple the rates of prolonged second stage (9.5% injured and 11.3% uninjured). No characteristic of second-stage of labor predicts permanent brachial plexus injury. Precipitous second stage is the most prevalent labor abnormality that is associated with shoulder dystocia.

  15. A novel technique for teaching the brachial plexus.

    Science.gov (United States)

    Lefroy, Henrietta; Burdon-Bailey, Victoria; Bhangu, Aneel; Abrahams, Peter

    2011-09-01

    The brachial plexus has posed problems for both students and teachers throughout generations of medical education. The anatomy is intricate, and traditional pictorial representations can be difficult to understand and learn. Few innovative teaching methods have been reported. The basic anatomy of the brachial plexus is core knowledge required by medical students to aid clinical examination and diagnosis. A more detailed understanding is necessary for a variety of specialists, including surgeons, anaesthetists and radiologists. Here, we present a novel, cheap and interactive method of teaching the brachial plexus. Using coloured pipe cleaners, teachers and students can construct three-dimensional models using different colours to denote the origin and outflow of each nerve. The three-dimensional nature of the model also allows for a better understanding of certain intricacies of the plexus. Students may use these models as adjuncts for self study, didactic lectures and tutorials. Compared with traditional textbooks and whiteboards, the pipe-cleaner model was preferred by medical students, and provided a higher level of student satisfaction. This was demonstrated and analysed using student feedback forms. Our model could be incorporated into current curricula to provide an effective and enjoyable way of rapidly teaching a difficult concept. Other such novel methods for teaching complex anatomical principles should be encouraged and explored. © Blackwell Publishing Ltd 2011.

  16. Combined whole-body vibration training and l-citrulline supplementation improves pressure wave reflection in obese postmenopausal women.

    Science.gov (United States)

    Wong, Alexei; Alvarez-Alvarado, Stacey; Jaime, Salvador J; Kinsey, Amber W; Spicer, Maria T; Madzima, Takudzwa A; Figueroa, Arturo

    2016-03-01

    Postmenopausal women have increased wave reflection (augmentation pressure (AP) and index (AIx)) and reduced muscle function that predispose them to cardiac diseases and disability. Our aim was to examine the combined and independent effects of whole-body vibration training (WBVT) and l-citrulline supplementation on aortic hemodynamics and plasma nitric oxide metabolites (NOx) in postmenopausal women. Forty-one obese postmenopausal women were randomized to 3 groups: l-citrulline, WBVT+l-citrulline and WBVT+Placebo for 8 weeks. Brachial and aortic systolic blood pressure, diastolic blood pressure, AP, AIx, AIx adjusted to 75 beats/min (AIx@75), and NOx were measured before and after 8 weeks. All groups similarly decreased (P obese postmenopausal women.

  17. CLINICAL RELEVANCE OF AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN WITH METABOLIC SYNDROME IN II TRIMESTER OF PREGNANCY

    Directory of Open Access Journals (Sweden)

    O. A. Lee

    2014-07-01

    Full Text Available Aim – evaluation of ambulatory blood pressure monitoring (ABPM in pregnant women with metabolic syndrome (MS in the II trimester, revealing their relationship with specifics of endothelial function, and determinationof possible predictor values of some indicators of ABPM in the development of preeclampsia and placental insufficiency.Materials and methods. Evaluation ABPM results performed in 82 pregnant patients with MS and 20 healthy pregnant women at 16–22weeks of gestation.\\Results. More than in 50 % of surveyed patients common nature of MC hypertension was confirmed, which was manifested in a moderate increase in their blood pressure with a abnormality of its circadian rhythm. The presence of these symptoms correlated with hypertension in patients with new-onset abnormality of endotheliumependent vasodilatation in reactive hyperemia of brachial artery.Conclusion. Negative predictor role of the daily blood pressure index concerning development of preeclampsia and placental insufficiency inthe future was established.

  18. Can augmentation index be used as an accurate tool in the diagnosis of peripheral obstructive arterial disease?

    Science.gov (United States)

    Coyle, P; Duff, G; Gavin, O; Clarke Moloney, M; Burke, P E; Kavanagh, E G; Grace, P A

    2012-09-01

    The use of radial augmentation index (rAI) as an indicator of vascular disease was investigated in the vascular imaging laboratory in a regional hospital. The aim of this study was to investigate whether a correlation exists between ankle-brachial pressure index (ABPI) and rAI in normal subjects, patients with peripheral obstructive arterial disease, and diabetic patients. A group of 46 patients and 14 controls had ABPI and rAI measured and factors affecting AI were assessed. rAI was found to have a negative correlation with ABPI (Spearman's ρ = -0.513, p peripheral obstructive vascular disease patients compared to normal (normal median 69% lower, p disease and may be a useful tool in the diagnosis of vascular pathology.

  19. Brachial artery reactivity in patients with severe sepsis: an observational study

    OpenAIRE

    Wexler, Orren; M Morgan, Mary Anne; Gough, Michael S.; Steinmetz, Sherry D; Mack, Cynthia M.; Darling, Denise C.; Doolin, Kathleen P.; Apostolakos, Michael J.; Graves, Brian T; Frampton, Mark W.; Chen, Xucai; Pietropaoli, Anthony P.

    2012-01-01

    Introduction Ultrasound measurements of brachial artery reactivity in response to stagnant ischemia provide estimates of microvascular function and conduit artery endothelial function. We hypothesized that brachial artery reactivity would independently predict severe sepsis and severe sepsis mortality. Methods This was a combined case-control and prospective cohort study. We measured brachial artery reactivity in 95 severe sepsis patients admitted to the medical and surgical intensive care un...

  20. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    OpenAIRE

    Jimmy Thomas

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasin...

  1. Remote ischemic preconditioning prevents reduction in brachial artery flow-mediated dilation after strenuous exercise.

    Science.gov (United States)

    Bailey, Tom G; Birk, Gurpreet K; Cable, N Timothy; Atkinson, Greg; Green, Daniel J; Jones, Helen; Thijssen, Dick H J

    2012-09-01

    Strenuous exercise is associated with an immediate decrease in endothelial function. Repeated bouts of ischemia followed by reperfusion, known as remote ischemic preconditioning (RIPC), is able to protect the endothelium against ischemia-induced injury beyond the ischemic area. We examined the hypothesis that RIPC prevents the decrease in endothelial function observed after strenuous exercise in healthy men. In a randomized, crossover study, 13 healthy men performed running exercise preceded by RIPC of the lower limbs (4 × 5-min 220-mmHg bilateral occlusion) or a sham intervention (sham; 4 × 5-min 20-mmHg bilateral occlusion). Participants performed a graded maximal treadmill running test, followed by a 5-km time trial (TT). Brachial artery endothelial function was examined before and after RIPC or sham, as well as after the 5-km TT. We measured flow-mediated dilation (FMD), an index of endothelium-dependent function, using high-resolution echo-Doppler. We also calculated the shear rate area-under-the-curve (from cuff deflation to peak dilatation; SR(AUC)). Data are described as mean and 95% confidence intervals. FMD changed by 0.30). In the sham trial, FMD changed from 5.1 (4.4-5.9) to 3.7% (2.6-4.8) following the 5-km TT (P = 0.02). In the RIPC trial, FMD changed negligibly from 5.4 (4.4-6.4) post-IPC and 5.7% (4.6-6.8) post 5-km TT (P = 0.60). Baseline diameter, SR(AUC), and time-to-peak diameter were all increased following the 5-km TT (P < 0.05), but these changes did not influence the IPC-mediated maintenance of FMD. In conclusion, these data indicate that strenuous lower-limb exercise results in an acute decrease in brachial artery FMD of ~1.4% in healthy men. However, we have shown for the first time that prior RIPC of the lower limbs maintains postexercise brachial artery endothelium-dependent function at preexercise levels.

  2. Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

    Directory of Open Access Journals (Sweden)

    Cihangir Tetik

    2014-01-01

    Full Text Available Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results.

  3. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    Directory of Open Access Journals (Sweden)

    Jimmy Thomas

    2014-01-01

    Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  4. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries.

    Science.gov (United States)

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  5. Oscillometric blood pressure measurement: a simple method in screening for peripheral arterial disease

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Wiinberg, Niels; Bruce, Christopher

    2008-01-01

    Blood pressure at the ankle level is a reliable indicator of peripheral arterial disease (PAD) and the ankle brachial index (ABI) is a useful non-invasive screening tool for the early detection of atherosclerosis. In the first part of the study, systolic blood pressures obtained by oscillometry...... and plethysmography were compared in 80 subjects referred for possible vascular disease. In the second part of the study, 31 general practitioners enrolled 1258 consecutive patients aged more than 60 years. ABI was estimated by oscillometry. Patients with an ABI lower than 0.9 were referred to the local hospital......, the oscillometry showed a positive predictive value of 47%. The presence of PAD was significantly correlated to exercise related leg pain, a diagnosis of hypertension and smoking, whereas no correlation could be found with a diagnosis of heart disease, stroke, or with the presence of diabetes. The prevalence...

  6. [Effect of estradiol valerate and chlormadinone acetate in hormone replacement therapy in postmenopause on Kupperman index, body weight, blood pressure, lipids, enzymes and electrolytes].

    Science.gov (United States)

    Göretzlehner, G; Nikschick, S; Zimmermann, T

    1996-01-01

    Kupperman-index, weight, blood pressure, serum lipids, blood count, thrombocytes, fibrinogen, thrombine time, electrolytes, enzymes, serum proteins, bilirubine and other parameters were studied in 16 healthy post-menopausal women treated for 18 months with 2 mgs estradiol valerate continuously sequentially combined with the antiandrogenic progestogen chlormadinone acetate (CMA) 2 mgs from 1st to 12th every month of treatment. The women were examined after the 1st, 3rd, 6th, 12th, and 18th month during the last 3 days of the progestogen phase, where the CMA had been added to the estradiol valerate for at least 12 days. The combined estradiol-CMA therapy resulted in a significantly reduced Kupperman-index. The total serum cholesterol- and LDLC-levels were also reduced and the HDL-cholesterol and HDLC-cholesterol-quotient increased. Triglycerides, weight, blood pressure, enzymes, and other parameters were unchanged. The positively metabolic effects of estradiol valerate were not altered after the chlormadinone acetate in a sequential regime.

  7. Effect of Positive Airway Pressure Therapy on Body Mass Index in Obese Patients With Obstructive Sleep Apnea Syndrome: A Prospective Study.

    Science.gov (United States)

    Rishi, Muhammad Adeel; Copur, Ahmet Sinan; Nadeem, Rashid; Fulambarker, Ashok

    2016-01-01

    Because obesity is a common cause of obstructive sleep apnea syndrome (OSAS), weight loss can be an effective treatment. OSAS also may cause weight gain in some patients. Effective treatment of sleep apnea may facilitate weight loss in obese patients. We hypothesize that positive airway pressure (PAP) therapy is associated with weight loss in obese patients with OSAS. This was a single-center observational prospective cohort study. Forty-five patients were diagnosed with OSAS after polysomnographic analysis in sleep laboratory and underwent continuous positive airway pressure titration. Patients were followed for 3 months in terms of change in body mass index (BMI) and compliance with PAP therapy. Of the 45 patients recruited, 3 patients were eliminated because of miss recruitment. Nine patients had incomplete data, and the rest (n = 33) were included for analysis. The mean age was 54.9 ± 16.9 years (mean ± SD), 93.9% were male, and 90.9% were whites. Mean apnea-hypopnea index was 36.3 ± 28.17 events per hour. Mean BMI before treatment was 34.7 ± 3.9 kg/m. Fifteen patients (45.5%) were compliant with therapy of OSAS with PAP. There was no difference in age, gender, neck circumference, BMI, and apnea-hypopnea index of patients compliant to therapy when compared with those who were not. There was a significant decrease in BMI in patients compliant with PAP therapy compared with noncompliant patients (-1.2 ± 0.7 vs. 0.3 ± 0.9 kg/m, P ≤ 0.001). PAP therapy may cause significant loss of weight within 3 months in obese patients with OSAS. Further study is needed to elucidate the physiological basis of this change.

  8. Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT.

    Science.gov (United States)

    Gupta, Vipin; Rawat, Ramakant; Shalimar; Saraya, Anoop

    2017-03-01

    Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy. Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg. Standard endotherapy protocol was continued in both groups. HVPG was again measured at 1 month of treatment. Out of 129 patients of index esophageal variceal bleed, 59 patients were eligible and randomized into carvedilol (n = 30) and propranolol (n = 29). At 1 month of treatment, decrease in heart rate, mean arterial blood pressure (MAP) and HVPG was significant within each group (p = 0.001). Percentage decrease in MAP was significantly more in carvedilol group as compared to propranolol group (p = 0.04). Number of HVPG responders (HVPG decrease >20 % or below 12 mmHg) was significantly more in carvedilol group (22/29) as compared to propranolol group (14/28), p = 0.04. Carvedilol is more effective in reducing portal pressure in patients with cirrhosis with esophageal bleed. Though a larger study is required to substantiate this, the results in this study are promising for carvedilol. Clinical trials online government registry (CTRI/2013/10/004119). Trial registration number CTRI/2013/10/004119.

  9. Beat Pressure and Comparing it with Ascending Aorta Pressure in Normal and Abnormal Conditions

    CERN Document Server

    Ghasemalizadeh, Omid; Firoozabadi, Bahar; Sajadi, Behrang; Zolfonoon, Ali

    2014-01-01

    Lumped method (Electrical analogy) is a quick and easy way to model human cardiovascular system. In this paper Lumped method is used for simulating a complete model. It describes a 36-vessel model and cardiac system of human body with details that could show hydrodynamic parameters of cardiovascular system. Also this paper includes modeling of pulmonary, atrium, left and right ventricles with their equivalent circuits. Exact modeling of right and left ventricles pressure with division of ascending aorta into 27 segments increases the accuracy of our simulation. In this paper we show that a calculated pressure for aorta from our complex circuit is near to measured pressure by using advanced medical instruments. Also it is shown that pressure graph from brachial is so near to aortic pressure because of this its pressure signal is usable instead of aortic pressure. Furthermore, obstruction in ascending aorta, brachial and its effects has been showed in different figures.

  10. Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study.

    Science.gov (United States)

    Williams, Bryan; Lacy, Peter S; Cruickshank, J Kennedy; Collier, David; Hughes, Alun D; Stanton, Alice; Thom, Simon; Thurston, Herbert

    2009-01-06

    Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure-lowering treatment strategy in the factorial design. Statin therapy sufficient to significantly reduce cardiovascular events in treated hypertensive patients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT

  11. Estimation of the maximum flow-mediated brachial artery response using local regression methods.

    Science.gov (United States)

    Andrew, M E; Li, S; Fekedulegn, D; Dorn, J; Joseph, P N; Violanti, J; Burchfiel, C M

    2007-10-01

    We consider methods for estimating the maximum from a sequence of measurements of flow-mediated diameter of the brachial artery. Flow-mediated vasodilation (FMD) is represented using the maximum change from a baseline diameter measurement after the release of a blood pressure cuff that has been inflated to reduce flow in the brachial artery. The influence of the measurement error on the maximum diameter from raw data can lead to overestimation of the average maximum change from the baseline for a sample of individuals. Nonparametric regression models provide a potential means for dealing with this problem. When using this approach, it is necessary to make a judicious choice of regression methods and smoothing parameters to avoid overestimation or underestimation of FMD. This study presents results from simulation studies using kernel-based local linear regression methods that characterize the relationship between the measurement error, smoothing and bias in estimates of FMD. Comparisons between fixed or constant smoothing and automated smoothing parameter selection using the generalized cross validation (GCV) statistic are made, and it is shown that GCV-optimized smoothing may over-smooth or under-smooth depending on the heart rate, measurement error and measurement frequency. We also present an example using measured data from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) pilot study. In this example, smoothing resulted in lower estimates of FMD and there was no clear evidence of an optimal smoothing level. The choice to use smoothing and the appropriate smoothing level to use may depend on the application.

  12. Impact of a Glaucoma Severity Index on Results of Trabectome Surgery: Larger Pressure Reduction in More Severe Glaucoma

    Science.gov (United States)

    Loewen, Ralitsa T.; Roy, Pritha; Parikh, Hardik A.; Dang, Yalong; Schuman, Joel S.; Loewen, Nils A.

    2016-01-01

    Purpose To stratify outcomes of trabectome-mediated ab interno trabeculectomy (AIT) by glaucoma severity using a simple and clinically useful glaucoma index. Based on prior data of trabectome after failed trabeculectomy, we hypothesized that more severe glaucoma might have a relatively more reduced facility compared to mild glaucoma and respond with a larger IOP reduction to trabecular meshwork ablation. Methods Patients with primary open angle glaucoma who had undergone AIT without any other same session surgery and without any second eye surgery during the following 12 months were analyzed. Eyes of patients that had less than 12 months follow up or were diagnosed with neovascular glaucoma were excluded. A glaucoma index (GI) was created to capture glaucoma severity based on visual field, number of preoperative medications, and preoperative IOP. Visual field (VF) was separated into 3 categories: mild, moderate, and advanced (assigned 1, 2, and 3 points, respectively). Preoperative number of medications (meds) was divided into 4 categories: ≤1, 2, 3 or ≥4, and assigned with a value of 1 to 4. Baseline IOP (IOP) was divided into 3 categories: 12–18 (Group 3) and >18 (Group 4). Linear regression was used to determine if there was an association between GI group and IOP reduction after one year or age, gender, race, diagnosis, cup to disc (C/D) ratio, and Shaffer grade. Results Out of 1340 patients, 843 were included in the analysis. The GI group distribution was GI1 = 164, GI2 = 202, GI3 = 260, and GI4 = 216. Mean IOP reduction after one year was 4.0±5.4, 6.4±5.8, 9.0±7.6, 12.0±8.0 mmHg for GI groups 1 to 4, respectively. Linear regression showed that IOP reduction was associated with GI group after adjusting for age, gender, race, diagnosis, cup to disc ratio, and Shaffer grade. Each GI group increase of 1 was associated with incremental IOP reductions of 2.95±0.29 mmHg. Success rate at 12 months was 90%, 77%, 77%, and 71% for GI groups 1 to 4. The log

  13. Periodic cohort health examinations in the TAMRISK study show untoward increases in body mass index and blood pressure during 15 years of follow-up

    Directory of Open Access Journals (Sweden)

    Kunnas Tarja

    2012-08-01

    Full Text Available Abstract Background Obesity is a significant risk factor for hypertension and diabetes. A cohort of 50-year-old voluntary periodic health examination (PHE participants was analyzed 15 years retrospectively. Our aim was to evaluate changes in body mass index (BMI and blood pressure in subjects diagnosed with hypertension and/or diabetes in comparison with healthy controls. Methods Voluntary periodic health examinations (PHE of the citizens have been carried out by the city of Tampere, Finland. Health data, including body mass index (BMI and blood pressure, were recorded every five years, starting at the age of 35 (baseline. A total of 339 subjects from the 50-year-old cohort having hypertension and/or diabetes were chosen to the study group. The control group included 604 subjects from the 50-year-old cohort who had the same follow-up information but were not diagnosed with hypertension and/or diabetes. Results In the study group the mean BMI had increased from 26.1 at baseline to 28.5 at the final 15-year follow-up examination. The corresponding increase in the control group was from 23.8 at baseline to 25.5 at the final follow-up. The difference in change with time between the groups was statistically significant (p = 0.04. On the average, the controls gained 4.9 kilograms, whereas subjects in the study group gained 7.0 kilograms over the 15 years of follow-up. Systolic and diastolic blood pressures were also higher in the study group already at baseline and systolic blood pressure increased with time more in the study group than in the control group (p = 0.004. Conclusions BMI and blood pressure were higher in the study group in comparison with the controls already at baseline at 35 years, and the differences were not favorably changed during the follow-up. Apparently, the effect of PHE had not been as efficient as planned on subjects in the study group, who were already slightly overweight at baseline.

  14. [Multiparameter analysis of the ergometric test. Significance of the failure of systolic blood pressure to decrease during recovery phase as an index of coronary disease].

    Science.gov (United States)

    Doria, G; Scaccianoce, G; Artale, S; Francaviglia, B; Platania, F; Circo, A

    1990-10-01

    Ergometric tests were performed in 27 patients who had previously undergone coronarography following instrumental findings and/or symptoms which seemed highly indicative of ischemic cardiopathy. The aim of the study was to assess the diagnostic importance of the failure of systolic blood pressure to decrease during the third minute of the recovery phase of the test as an index of coronary disease. In particular, as reported by other studies, the ratio between systolic blood pressure at the third minute of recovery and maximum systolic blood pressure during the test was also assessed values above 0.7 were considered pathological. Sixteen out the 27 patients examined showed lesions which were hemodynamically significant, whereas 11 patients were free of lesions and 9 had previous myocardial necrosis. The level of the above ratio in subjects without significant coronary lesions was 0.66 +/- 0.05, whereas it was 0.85 +/- 0.04 (p less than 0.01) in patients with coronary disease. Sensitivity, specificity, and positive and negative prognostic values were respectively 91.6%, 62%, 64.7% and 90.9%. In patients with lesions to the three main arteries both the sensitivity and the specificity were 100%. In the same patients, the ST criteria were 85.7%, 50%, 81.8% and 74.3%.

  15. [An urethromanometric study using micro-pressures gauges for female urinary incontinence. A definition of the index of continence. Applications (author's transl)].

    Science.gov (United States)

    Petipré, C; Cardi, S; Marchetta, J; Lefèvre, J; Grosieux, P

    1981-01-01

    The study has resulted from comparing urethral pressure curves measured with the use of a catheter with two micropressure gauges in 34 continent and 100 incontinent women. Two types of tracing were obtained: first of all at rest and then with the woman coughing repeatedly. Of the different parameters that were measured at rest only one seems to be advantageous over the others. That is the pressure at the maximum closure which becomes less with incontinence and with ageing. The curves that have been produced with effort make it possible to analyse what happens to this pressure when maximum closure is effected. This always rises in patients who are continent and always lessens in patients who are incontinent. The ratio of these two values, Pc with maximum effort over Pc at maximum rest, allows an index of continence (IC) to be drawn; and which conveys the ability of the sphincter apparatus to adapt itself, and which gives a quantitative value to female continence. Its practical application makes if possible to confirm the diagnosis and adapt the therapy to be used in many incontinent patients in whom other tests have been unrevealing, and to unmask incontinences that have been masked by prolapse and to identify possible future incontinent patients.

  16. Factors associated with brachial-ankle pulse wave velocity in the general population.

    Science.gov (United States)

    Sonoda, H; Takase, H; Dohi, Y; Kimura, G

    2012-12-01

    The present study investigated factors that modify or affect arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV) in the general population. Subjects had previously participated in a physical checkup program (n=911), and baPWV and urinary albumin and sodium excretion were also measured. Urine albumin was expressed as the ratio of urine albumin to urine creatinine. Individual salt intake was assessed by estimating 24-h urinary salt excretion and expressed as the ratio of estimated salt intake to body weight. The mean blood pressure and baPWV were 127.1±15.2/77.0±9.5 mm Hg and 15.9±3.3 m s(-1), respectively. Univariate analysis demonstrated that baPWV correlated with various factors including age, blood pressure, electrocardiogram voltage (SV(1)+RV(5)), urine albumin and salt intake. Multivariate regression analysis revealed that electrocardiogram voltage (Pblood pressure (P<0.0001), urine albumin (P<0.001) and salt intake (P<0.001), independently correlated with baPWV after adjustment for other possible factors. Similar results were obtained for participants not taking any medication. These results suggest that the baPWV value is independently associated with individual salt intake and cardiac and renal damage, and could be a useful procedure for identifying individuals with concealed risk of cardiovascular disease.

  17. Association of particulate air pollution and secondhand smoke on endothelium-dependent brachial artery dilation in healthy children

    Directory of Open Access Journals (Sweden)

    Mohammad Hashemi

    2012-01-01

    Full Text Available Background: This study aimed to determine the association of particulate matters with endothelial function, measured by flow mediated dilation (FMD of brachial artery, in children with or without exposure to secondhand smoke. Methods: This cross-sectional study was conducted from January to March 2011 in Isfahan, which is the second large and air-polluted city in Iran. The areas of the city with lowest and highest air pollution were determined, and in each area, 25 prepubescent boys with or without exposure to daily tobacco smoke in home were selected, i.e. 100 children were studied in total. Results: FMD was significantly smaller in those living in high-polluted area and those exposed to secondhand smoke. Multiple linear regression analysis, adjusted for age and body mass index, showed that both passive smoking status and living area in terms of particulate air pollution were effective determinants of the brachial artery diameter. The standardized coefficient of passive smoking status was –0.36 (SD = 0.09, P < 0.0001 showing negative association with percent increase in FMD. Likewise, the percent increase in brachial artery diameter was lower in passive smoker children. Similar relationship was documented for PM 10 concentration with a regression coefficient of –0.32 (SD = 0.04, P < 0.0001. Without considering passive smoking variable, PM 10 concentration has significant independent effect on FMD level. Conclusion: Our findings provide evidence on the association of environmental factors on endothelial dysfunction from early life. Studying such associations among healthy children may help identify the underlying mechanisms. The clinical implications of environmental factors on early stages of atherosclerosis should be confirmed in longitudinal studies.

  18. Dietary modification, body mass index (BMI), blood pressure (BP) and cardiovascular risk in medical students of a government medical college of Karachi.

    Science.gov (United States)

    Raza, Sajjad; Sheikh, Muhammad Adil; Hussain, Muhammad Fawwad Ahmed; Siddiqui, Saad Ebrahim; Muhammad, Rabia; Aziz, Sina; Qamar, Salima; Saleem, Mohammad Azfar; Waki, Nida; Faruqi, Hina; Zia, Aisha

    2010-11-01

    To determine the prevalence of major risk factors including dietary modification, Body Mass Index (BMI), Blood Pressure (BP) and physical activity in medical students of government teaching hospitals of Karachi. A cross sectional study was conducted on students of Dow Medical College, Karachi, Pakistan through a structured pre-tested questionnaire. Non-probability purposive sampling was used. Smoking, hypertension, family history of cardiovascular disease (CVD), overweight and low physical activity levels are risk factors the presence of which can lead to development of CVD. Prevalence of these risk factors was determined by asking appropriate questions and through measurement of BMI and blood pressure for overweight and hypertension respectively. Awareness of risk factors was determined through knowledge of the effect of various food substances on development of CVD and of adoption of dietary changes keeping in mind the risk of developing CVD. SPSS 16.0 was used for statistical analysis. A total of 132 medical students were included in the study of which 57 (43.2%) and 75 (56.8%) were male and female respectively with mean age of 20.85 +/- 1.21 years. About 15.9% of students had elevated blood pressure i.e. > or = 140/90 mmHg. Twenty eight percent of the total students were found to be underweight and 17.4% were overweight, 5% had some history of CVD, 56.8% had family history of CVD, 9.4% were smokers and 29.5% had high physical activity level. About 87.1% had modified their diet for preventing CVD. Most of the students had adequate knowledge about the cardiovascular risk factors Majority of students were not overweight. A high prevalence of cardiovascular risk factors; family history and elevated blood pressure was present. Awareness in terms of knowledge was satisfactory but implementation in terms of diet modification and adequate physical activity was lacking.

  19. Physical exercise, fitness and dietary pattern and their relationship with circadian blood pressure pattern, augmentation index and endothelial dysfunction biological markers: EVIDENT study protocol

    Directory of Open Access Journals (Sweden)

    Nicolás Eguskiñe

    2010-05-01

    Full Text Available Abstract Background Healthy lifestyles may help to delay arterial aging. The purpose of this study is to analyze the relationship of physical activity and dietary pattern to the circadian pattern of blood pressure, central and peripheral blood pressure, pulse wave velocity, carotid intima-media thickness and biological markers of endothelial dysfunction in active and sedentary individuals without arteriosclerotic disease. Methods/Design Design: A cross-sectional multicenter study with six research groups. Subjects: From subjects of the PEPAF project cohort, in which 1,163 who were sedentary became active, 1,942 were sedentary and 2,346 were active. By stratified random sampling, 1,500 subjects will be included, 250 in each group. Primary measurements: We will evaluate height, weight, abdominal circumference, clinical and ambulatory blood pressure with the Radial Pulse Wave Acquisition Device (BPro, central blood pressure and augmentation index with Pulse Wave Application Software (A-Pulse and SphymgoCor System Px (Pulse Wave Analysis, pulse wave velocity (PWV with SphymgoCor System Px (Pulse Wave Velocity, nutritional pattern with a food intake frequency questionnaire, physical activity with the 7-day PAR questionnaire and accelerometer (Actigraph GT3X, physical fitness with the cycle ergometer (PWC-170, carotid intima-media thickness by ultrasound (Micromax, and endothelial dysfunction biological markers (endoglin and osteoprotegerin. Discussion Determining that sustained physical activity and the change from sedentary to active as well as a healthy diet improve circadian pattern, arterial elasticity and carotid intima-media thickness may help to propose lifestyle intervention programs. These interventions could improve the cardiovascular risk profile in some parameters not routinely assessed with traditional risk scales. From the results of this study, interventional approaches could be obtained to delay vascular aging that combine physical

  20. Cardio-ankle vascular index (CAVI) differentiates pharmacological properties of vasodilators nicardipine and nitroglycerin in anesthetized rabbits.

    Science.gov (United States)

    Chiba, Tatsuo; Yamanaka, Mari; Takagi, Sachie; Shimizu, Kazuhiro; Takahashi, Mao; Shirai, Kohji; Takahara, Akira

    2015-08-01

    Cardio-ankle vascular index (CAVI) has been developed for measurement of vascular stiffness from the aorta to tibial artery, which is clinically utilized for assessing the progress of arteriosclerosis. In this study, we established measuring system of the CAVI in rabbits, and assessed whether the index could reflect different pharmacological actions of nitroglycerin and nicardipine on the systemic vasculature. Rabbits were anesthetized with halothane, and the CAVI was calculated from the well-established basic equations with variables obtained from brachial and tibial blood pressure and phonocardiogram. Nicardipine (1, 3 and 10 μg/kg, i.v.) decreased the blood pressure, femoral vascular resistance, and heart-ankle pulse wave velocity (haPWV). Meanwhile, no significant change was detected in the CAVI at the low or middle dose, which reflects the defining feature of the CAVI that is independent of blood pressure. The index increased at the high dose. Nitroglycerin (2, 4 and 8 μg/kg, i.v.) decreased the blood pressure, femoral vascular resistance, and haPWV. Meanwhile, the CAVI was decreased during the nitroglycerin infusion, which may reflect its well-known pharmacological action dilating conduit arteries. These results suggest that the CAVI differentiates the properties of these vasodilators in vivo. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  1. DOES BRACHIAL ARTERY FMD PROVIDE A BIOASSAY FOR NITRIC OXIDE?

    Science.gov (United States)

    Wray, D. Walter; Witman, Melissa A. H.; Ives, Stephen J.; McDaniel, John; Trinity, Joel D.; Conklin, Jamie D.; Supiano, Mark A.; Richardson, Russell S.

    2013-01-01

    This study sought to better define the role of nitric oxide (NO) in brachial artery flow-mediated vasodilation (FMD) in young, healthy humans. Brachial artery blood velocity and diameter were determined (ultrasound Doppler) in eight volunteers (26 ± 1 yrs) before and after 5-min forearm circulatory occlusion with and without intra-arterial infusion of the endothelial nitric oxide synthase (eNOS) inhibitor L-NMMA (0.48 mg/dl/min). Control (CON) and L-NMMA trials were performed with the occlusion cuff placed in the traditional distal position, as well as proximal to the measurement site. FMD was significantly reduced, but not abolished, by L-NMMA in the distal cuff trial (8.9 ± 1.3 to 6.0 ± 0.7%, CON vs. L-NMMA, P = 0.02), with no effect of L-NMMA on FMD with proximal cuff placement (10.6 ± 1.2 to 12.4 ± 1.7%, CON vs. L-NMMA, P = 0.39). When the reduction in shear stimulus following L-NMMA was taken into account, no drug difference was observed for either distal (0.26 ± 0.02 to 0.23 ± 0.03, CON vs. L-NMMA, P = 0.40) or proximal (0.23 ± 0.08 to 0.23 ± 0.03, CON vs. L-NMMA, P = 0.89) FMD trials. These findings challenge the assertion that NO is obligatory for brachial artery FMD, and call into question the sensitivity of this procedure for non-invasive determination of NO bioavailability in young, healthy humans. PMID:23774225

  2. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    NARCIS (Netherlands)

    Geffen, G.J. van; Moayeri, N.; Bruhn, J.; Scheffer, G.J.; Chan, V.W.; Groen, G.J.

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound

  3. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    Science.gov (United States)

    van Geffen, Geert J; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J; Chan, Vincent W; Groen, Gerbrand J

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.

  4. Correlation Between Ultrasound Imaging, Cross-Sectional Anatomy, and Histology of the Brachial Plexus A Review

    NARCIS (Netherlands)

    van Geffen, Geert J.; Moayeri, Nizar; Bruhn, Joergen; Scheffer, Gert J.; Chan, Vincent W.; Groen, Gerbrand J.

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound

  5. Brachial plexus magnetic resonance imaging differentiates between inflammatory neuropathies and does not predict disease course

    NARCIS (Netherlands)

    Jongbloed, BA; Bos, Jeroen W; Rutgers, Dirk; van der Pol, WL; van den Berg, Leonard H

    OBJECTIVE: The main objective of this study was to evaluate the correlation between the distribution of brachial plexus magnetic resonance imaging (MRI) abnormalities and clinical weakness, and to evaluate the value of brachial plexus MRI in predicting disease course and response to treatment in

  6. 3 T MR tomography of the brachial plexus: Structural and microstructural evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Mallouhi, Ammar, E-mail: Ammar.Mallouhi@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Marik, Wolfgang, E-mail: Wolfgang.Marik@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Prayer, Daniela, E-mail: Daniela.Prayer@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kainberger, Franz, E-mail: Franz.Kainberger@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Bodner, Gerd, E-mail: Gerd.Bodner@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kasprian, Gregor, E-mail: Gregor.Kasprian@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2012-09-15

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus.

  7. Impact of age, sex and exercise on brachial and popliteal artery remodelling in humans.

    NARCIS (Netherlands)

    Green, D.J.; Swart, A.; Exterkate, A.; Naylor, L.H.; Black, M.A.; Cable, N.T.; Thijssen, D.H.J.

    2010-01-01

    OBJECTIVE: To examine the impact of age, sex and exercise on wall thickness and remodelling in the popliteal and brachial arteries. METHODS: We compared wall thickness, lumen diameter and wall:lumen ratios in the brachial and popliteal arteries of 15 young (Y, 25.4+/-0.8 yr; 7M 8W) and 16 older

  8. Explaining daily functioning in young adults with obstetric brachial plexus lesion

    NARCIS (Netherlands)

    de Heer, J.A.; Beckerman, H.; de Groot, V.

    2015-01-01

    Purpose: To study the influence of obstetric brachial plexus lesion (OBPL) on arm-hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Method: Adults with unilateral OBPL who consulted the brachial plexus team at the

  9. The Olivetti Heart Study: Predictive value of a new adiposity index on risk of hypertension, blood pressure, and subclinical organ damage.

    Science.gov (United States)

    D'Elia, L; Manfredi, M; Sabino, P; Strazzullo, P; Galletti, F

    2016-07-01

    Recently, some studies have indicated that a new anthropometric index, body adiposity index (BAI), could be more strongly correlated with the percentage of body fat than BMI. However, the results on its role in predicting cardiovascular risk were not univocal. Therefore, the aim of our study was to compare the predictive role of BMI and BAI on risk of hypertension (HP), blood pressure (BP) changes, and subclinical organ damage after an 8-year follow-up, in a sample of adult men participating in the Olivetti Heart Study. Participants were 350 untreated normotensive men without diabetes, examined twice at baseline (1994-95) and after 8 years of follow-up [2002-04]. BMI was expressed as kg/m(2). BAI was calculated according to the following formula: [(hip circumference (cm)/height(1.5) (m)) - 18]. Subclinical organ damage was detected by urinary albumin excretion (UAE) and left ventricular mass, evaluated by the Cornell product (CP). At baseline, BAI and BMI were both associated with diastolic blood pressure (DBP) and mean arterial pressure (MAP). After 8 years, both baseline BAI and BMI were associated with changes (Δ) in systolic BP, MAP and pulse pressure, while only BMI was also positively related to ΔDBP. Analysis of HP incidence showed that both indices were significant predictors of HP. In addition, both BAI and BMI were significantly associated with ΔUAE, but not with ΔCP. Analysis of the changes in BAI and BMI confirmed these results, as the two indices were significantly associated with risk of HP and changes in BP and UAE, but not with changes in CP. In this sample of healthy adult men, BAI and BMI were significant predictors of risk of HP and changes in BP, after an 8-years follow-up. In addition both indices predicted UAE changes, but neither was associated with the CP changes. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of

  10. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging.

    Science.gov (United States)

    Cejas, C; Rollán, C; Michelin, G; Nogués, M

    2016-01-01

    The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  11. Association of longer QT interval with arterial waveform and lower pulse pressure amplification: the Nagahama Study.

    Science.gov (United States)

    Tabara, Yasuharu; Takahashi, Yoshimitsu; Kohara, Katsuhiko; Setoh, Kazuya; Kawaguchi, Takahisa; Terao, Chikashi; Igase, Michiya; Yamada, Ryo; Kosugi, Shinji; Sekine, Akihiro; Miki, Tetsuro; Nakayama, Takeo; Matsuda, Fumihiko

    2013-08-01

    Central systolic blood pressure (cSBP) has been postulated to correlate closely with cardiovascular risk. Identifying factors associated with cSBP is therefore important. Prolonged QT interval is known to be associated with cardiovascular outcomes and might also be associated with the arterial waveform and cSBP. We investigated the possible associations between electrocardiogram wave interval and cSBP in general population samples. Brachial blood pressure and radial arterial waveform were measured simultaneously. Augmentation index (AIx) was calculated from the radial waveform as the ratio of the height of the late systolic peak to that of the first peak. cSBP was defined as the absolute pressure of the late systolic peak. In the first panel (n = 8,085), QT interval was strongly association with AIx (r = 0.330; P blood pressure, heart rate, and pulse wave velocity, multivariable analysis with adjustment for these covariables nevertheless identified longer corrected QT interval as an independent determinant of increased AIx and smaller pulse pressure amplification (PPa; brachial SBP minus cSBP) (β = -0.066; P < 0.001). This association was replicated in the independent second panel (n = 1,412) (β = -0.105; P < 0.001). In contrast, QRS interval was positively associated with PPa (β = 0.056; P < 0.001). Longer QT interval and short QRS duration were significantly associated with arterial waveform and PPa. Our results provide a clue to the elucidation of unidentified mechanisms of the increased cardiovascular outcome and mortality risks in subjects with longer QT interval.

  12. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain.

    Science.gov (United States)

    Magri, Laís Valencise; Carvalho, Vinícius Almeida; Rodrigues, Flávia Cássia Cabral; Bataglion, César; Leite-Panissi, Christie Ramos Andrade

    2017-02-01

    Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm(2), 20 mW, 10 s; TMJ area = 7.5 J/cm(2), 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p  0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and

  13. Excess pressure integral predicts cardiovascular events independent of other risk factors in the conduit artery functional evaluation substudy of Anglo-Scandinavian Cardiac Outcomes Trial.

    Science.gov (United States)

    Davies, Justin E; Lacy, Peter; Tillin, Therese; Collier, David; Cruickshank, J Kennedy; Francis, Darrel P; Malaweera, Anura; Mayet, Jamil; Stanton, Alice; Williams, Bryan; Parker, Kim H; McG Thom, Simon A; Hughes, Alun D

    2014-07-01

    Excess pressure integral (XSPI), a new index of surplus work performed by the left ventricle, can be calculated from blood pressure waveforms and may indicate circulatory dysfunction. We investigated whether XSPI predicted future cardiovascular events and target organ damage in treated hypertensive individuals. Radial blood pressure waveforms were acquired by tonometry in 2069 individuals (aged, 63±8 years) in the Conduit Artery Functional Evaluation (CAFE) substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Measurements of left ventricular mass index (n=862) and common carotid artery intima media thickness (n=923) were also performed. XSPI and the integral of reservoir pressure were lower in people treated with amlodipine±perindopril than in those treated with atenolol±bendroflumethiazide, although brachial systolic blood pressure was similar. A total of 134 cardiovascular events accrued during a median 3.4 years of follow-up; XSPI was a significant predictor of cardiovascular events after adjustment for age and sex, and this relationship was unaffected by adjustment for conventional cardiovascular risk factors or Framingham risk score. XSPI, central systolic blood pressure, central augmentation pressure, central pulse pressure, and integral of reservoir pressure were correlated with left ventricular mass index, but only XSPI, augmentation pressure, and central pulse pressure were associated positively with carotid artery intima media thickness. Associations between left ventricular mass index, XSPI, and integral of reservoir pressure and carotid artery intima media thickness and XSPI were unaffected by multivariable adjustment for other covariates. XSPI is a novel indicator of cardiovascular dysfunction and independently predicts cardiovascular events and targets organ damage in a prospective clinical trial. © 2014 American Heart Association, Inc.

  14. Impact of acute changes in perfusion index and blood pressure on the accuracy of non-invasive continuous hemoglobin concentration measurements during induction of anesthesia.

    Science.gov (United States)

    Saito, Junichi; Kitayama, Masato; Amanai, Erika; Toyooka, Kentaro; Hirota, Kazuyoshi

    2017-04-01

    Several factors affect the accuracy of non-invasive continuous hemoglobin concentration (SpHb) measurements. We had previously shown an increase in the perfusion index (PI) following induction of anesthesia which was associated with an increase in the difference between SpHb and total hemoglobin (tHb) (SpHb-tHb). We hypothesized that blunting the increase in PI by maintaining blood pressure during induction of anesthesia would improve the agreement between SpHb and tHb measurements. Twenty-nine adult patients were enrolled. Patients were randomly assigned by use of sequentially numbered, opaque sealed envelopes to a control (group C) or a phenylephrine group (group P). Anesthesia was induced and maintained with propofol, remifentanil, and ketamine. In group P, phenylephrine was infused at 0.5 µg/kg/min during induction of anesthesia. SpHb and PI were monitored with a Radical-7 Pulse CO-Oximeter. tHb and hematocrit were measured with the ABL800 blood gas analyzer. Following induction of anesthesia, PI increased significantly in both groups (p pressure during induction of anesthesia improves the agreement between SpHb and tHb values.

  15. Influence of exercise intensity on respiratory muscle fatigue and brachial artery blood flow during cycling exercise.

    Science.gov (United States)

    Smith, Joshua R; Ade, Carl J; Broxterman, Ryan M; Skutnik, Benjamin C; Barstow, Thomas J; Wong, Brett J; Harms, Craig A

    2014-08-01

    During high intensity exercise, both respiratory muscle fatigue and cardiovascular reflexes occur; however, it is not known how inactive limb blood flow is influenced. The purpose of this study was to determine the influence of moderate and high exercise intensity on respiratory muscle fatigue and inactive limb muscle and cutaneous blood flow during exercise. Twelve men cycled at 70 and 85 % [Formula: see text] for 20 min. Subjects also performed a second 85 % [Formula: see text] test after ingesting 1,800 mg of N-acetylcysteine (NAC), which has been shown to reduce respiratory muscle fatigue (RMF). Maximum inspiratory pressures (P Imax), brachial artery blood flow (BABF), cutaneous vascular conductance (CVC), and mean arterial pressure were measured at rest and during exercise. Significant RMF occurred with 85 % [Formula: see text] (P Imax, -12.8 ± 9.8 %), but not with 70 % [Formula: see text] (P Imax, -5.0 ± 5.9 %). BABF and BA vascular conductance were significantly lower at end exercise of the 85 % [Formula: see text] test compared to the 70 % [Formula: see text] test. CVC during exercise was not different (p > 0.05) between trials. With NAC, RMF was reduced (p RMF, decreases in inactive arm blood flow, and vascular conductance, but not cutaneous blood flow.

  16. Systolic Sac Pressure Index for the Prediction of Persistent Type II Endoleak for 12 Months After Endovascular Abdominal Aortic Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Ikoma, Akira, E-mail: yfb04322@nifty.com; Nakai, Motoki, E-mail: momonga@wakayama-med.ac.jp; Sato, Morio, E-mail: morisato@wakayama-med.ac.jp; Sato, Hirotatsu, E-mail: kuppa1220@yahoo.co.jp; Minamiguchi, Hiroki, E-mail: hiromina4@hotmail.com; Sonomura, Tetsuo, E-mail: sonomura@wakayama-med.ac.jp [Wakayama Medical University, Departments of Radiology (Japan); Nishimura, Yoshiharu, E-mail: nishim-y@wakayama-med.ac.jp; Okamura, Yoshitaka, E-mail: y-ok@wakayama-med.ac.jp [Wakayama Medical University, Thoracic and Cardiovascular Surgery (Japan)

    2016-04-15

    PurposeTo assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR).Materials and MethodsWe performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks.ResultsData were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was −4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002).ConclusionPatients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.

  17. Dual factor pulse pressure: body mass index and outcome in type 2 diabetic subjects on maintenance  hemodialysis. A longitudinal study 2003–2006

    Directory of Open Access Journals (Sweden)

    Lydia Foucan

    2008-12-01

    Full Text Available Lydia Foucan1,2, Kheira Hue3, Jocelyn Inamo1, Jacqueline Deloumeaux1,2, Anne Blanchet-Deverly, et al1Research group Clinical Epidemiology and Medicine of the University of Antilles and Guyane, French West Indies; 2Department of Medical Information and Public Health; 3Nephrology and hemodialysis Unit; 4Cardiology Unit, CHU of Pointe-à-Pitre, Guadeloupe, French West Indies; 5Hemodialysis Unit, Clinic of Choisy Sainte Anne, Guadeloupe, French West IndiesBackground: Inverse associations between risk factors and mortality have been reported in epidemiological studies of patients on maintenance hemodialysis (MHD.Objective: The aim of this prospective study was to estimate the effect of the dual variable pulse pressure (PP – body mass index (BMI on cardiovascular (CV events and death in type 2 diabetic (T2D subjects on MHD in a Caribbean population.Methods: Eighty Afro-Caribbean T2D patients on MHD were studied prospectively from 2003 to 2006. Proportional-hazard modeling was used.Results: Of all, 23.8% had a high PP (PP ≥ 75th percentile, 76.3% had BMI < 30 Kg/m2, 21.3% had the dual factor high PP – absence of obesity. During the study period, 23 patients died and 13 CV events occurred. In the presence of the dual variable and after adjustment for age, gender, duration of MHD, and pre-existing CV complications, the adjusted hazard ratio (HR (95% CI of CV events and death were respectively 2.7 (0.8–8.3; P = 0.09 and 2.4 (1.1–5.9; P = 0.04.Conclusions: The dual factor, high PP – absence of obesity, is a prognosis factor of outcome. In type 2 diabetics on MHD, a specific management strategy should be proposed in nonobese subjects with wide pulse pressure in order to decrease or prevent the incidence of fatal and nonfatal events.Keywords: dual factor, pulse pressure, body mass index, type 2 diabetes, outcome

  18. [Relationship between radial augmentation index and other indices for evaluating arteriosclerosis].

    Science.gov (United States)

    Liu, Yan; Qi, Li-tong; Ma, Wei; Yang, Ying; Meng, Lei; Zhang, Bao-wei; Huo, Yong

    2013-12-18

    To investigate the relationship between radial augmentation index (AI) and other noninvasive indices for evaluating arteriosclerosis. From April to June 2010, a cross-sectional survey was performed in two communities of Shijingshan District, Beijing, China. This study involved 1 752 subjects (aged 23 to 90 years). AI was measured using Colin pulse wave detection device HEM9000AI. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were measured using Colin noninvasive arteriosclerosis tester VP-1000. Color Doppler flow imaging was used to measure intima-media thickness (IMT) of the bilateral carotid arteries. Compared with the control group, baPWV≥14 m/s, ABI≤0.9 and IMT≥0.9 mm groups showed no significant difference in AI75 (P>0.05). Hypertensive individuals had significantly higher baPWV than the healthy group. Elderly hypertensive individuals with diabetes mellitus or (and) dyslipidemia had lower ABI than the control group. There was no significant difference of AI75 between the disease groups and the healthy group (P>0.05). Pearson correlation analysis showed that AI75 was associated with women, central aortic systolic pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, and inversely associated with body mass index, waist hip ratio, triglycerides, fasting serum glucose, and not associated with age (r=0.045, P=0.064). There was negative correlation between AI75 and ABI, IMT. AI75 was positively correlated with baPWV in the male group (r=0.101, P=0.005), but not correlated in the female group. Partial correlation analysis found that AI75 was inversely associated with ABI, baPWV and IMT. There was negative correlation between AI75 and baPWV, IMT in the female and male groups, and no correlation between AI75 and ABI (P>0.05). Multivariate gradual regression analysis demonstrated that the independent positive correlation factors of AI75 included female, age, waist hip ratio, central aortic systolic pressure

  19. [Ultrasonographic evaluation of selected parameters of the endothelial function in brachial arteries and IMT measurements in carotid arteries in children with diabetes type 1 using personal insulin pumps--preliminary report].

    Science.gov (United States)

    Tołwińska, Joanna; Głowińska-Olszewska, Barbara; Urban, Mirosława; Florys, Bozena; Peczyńska, Jadwiga

    2006-01-01

    Type 1 diabetes is a known risk factor for arterial atherosclerosis. The first symptoms can be found even in childhood. The ultrasonographic measurements of intimal plus medial thickness in carotid arteries (IMT) and flow mediated dilatation (FMD) evaluated in brachial arteries, play a known role in the detection in these cases. The diabetes treatment intensification is an important factor in delaying early atherosclerotic changes. Currently, intensive treatment of children's diabetes with use of continuous subcutaneous insulin infusion with personal insulin pumps is gaining more and more popularity. THE AIM OF THIS STUDY was the evaluation of IMT and FMD indexes in children suffering from type 1 diabetes in the context of treatment intensification (multidose insulin injections v. personal insulin pumps). We examined 64 children (29 boys and 35 girls) in the mean age 15.5 years treated with the multidose insulin injections method and 10 children using personal insulin pumps (4 girls and 6 boys) in the mean age 14.5 years. Using high resolution ultrasonography we evaluated IMT values in carotid arteries and FMD parameters in brachial arteries. In our analysis we estimated the blood concentration of lipid parameters, values of systolic and diastolic blood pressure, the age of diabetes onset, duration time of the illness and the values of HbA1c as a marker of metabolic control. We noticed significantly higher FMD values in patients treated with personal insulin pumps (13.7 vs. 5.5%, p=0.001). IMT values were similar in both groups (0.52 vs. 0.5 mm, p=0. 41). The level of HDL cholesterol was higher and triglycerides lower in the group with treatment intensification. The metabolic control was the same in both groups. In patients treated by the multidose insulin injections IMT correlated with systolic blood pressure values. We didn't notice any correlation between IMT and FMD in any group. 1. Treatment intensification (personal insulin pumps) influences better vascular

  20. Perceived spatial stigma, body mass index and blood pressure: a global positioning system study among low-income housing residents in New York City

    Directory of Open Access Journals (Sweden)

    Dustin T. Duncan

    2016-05-01

    Full Text Available Previous research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI, and blood pressure among a sample of low-income housing residents in New York City (NYC. Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample. Global positioning systems (GPS tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051, as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01 and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004. In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR=1.32, 95%CI: 1.1, 1.4, P=0.02 and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007. However, we found no differences in spatial mobility (based GPS data among participants who reported living in neighborhoods with and without spatial stigma (P>0.05. Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals

  1. Association of Brachial-Ankle Pulse Wave Velocity with Asymptomatic Intracranial Arterial Stenosis in Hypertension Patients.

    Science.gov (United States)

    Wang, Yan; Zhang, Jin; Qain, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

    2016-08-01

    Intracranial arterial stenosis is a common cause of ischemic stroke in Asians. We therefore sought to explore the relationship of brachial-ankle pulse wave velocity and intracranial arterial stenosis in 834 stroke-free hypertensive patients. Intracranial arterial stenosis was evaluated through computerized tomographic angiography. Brachial-ankle pulse wave velocity was measured by an automated cuff device. The top decile of brachial-ankle pulse wave velocity was significantly associated with intracranial arterial stenosis (P = .027, odds ratio = 1.82; 95% confidence interval: 1.07-3.10). The patients with the top decile of brachial-ankle pulse wave velocity showed 56% higher risk for the presence of intracranial arterial stenosis to the whole population, which was more significant in patients younger than 65 years old. We also found that brachial-ankle pulse wave velocity related to both intracranial arterial stenosis and homocysteine. Our study showed the association of brachial-ankle pulse wave velocity with asymptomatic intracranial arterial stenosis in hypertension patients, especially in relative younger subjects. Brachial-ankle pulse wave velocity might be a relatively simple and repeatable measurement to detect hypertension patients in high risk of intracranial arterial stenosis. Copyright © 2016. Published by Elsevier Inc.

  2. Perineural spread of melanoma to the brachial plexus: identifying the anatomic pathway(s).

    Science.gov (United States)

    Marek, Tomas; Laughlin, Ruple S; Howe, B Matthew; Spinner, Robert J

    2018-01-08

    Perineural spread of melanoma is a well-known mechanism of metastasis in cases involving cranial nerves. Brachial plexus involvement is rare and the pathway is unknown. A retrospective review of the Mayo Clinic database was performed to identify patients with a history of melanoma and brachial plexus compromise between 1994 and 2017. Inclusion criteria were a history of melanoma, a clinical diagnosis of brachial plexopathy, radiological features consistent with perineural spread and biopsy of melanoma within nerve. We identified 42 cases, 24 men and 18 women with a median age of 61 years (37 - 84 years) with a history of melanoma and a brachial plexopathy. After review of their clinical information, 2 cases fulfilled inclusion criteria. Both patients presented with progressive brachial plexopathy and imaging studies revealed features consistent with perineural spread. In 40 excluded cases, brachial plexopathy was caused by: metastasis to axillary lymph nodes (n = 11); trauma (n = 8); post-surgical sequelae (n = 7); tumors other than melanoma (n = 5); inflammation (n = 5); radiation (n = 2); a combination of radiation and post-surgical changes (n = 1); and radiculopathy (n = 1). The 2 identified cases both showed similar clinical and radiological features. We believe that there is a pattern of perineural spread to the brachial plexus through the cervical plexus. Literature review shows several recently published cases demonstrating an analogous mechanism of melanoma spread involving upper cervical nerves which supports our proposed pathway. Copyright © 2018. Published by Elsevier Inc.

  3. Lipomas of the Brachial Plexus: A Case Series and Review of the Literature.

    Science.gov (United States)

    Graf, Alexander; Yang, Kai; King, David; Dzwierzynski, William; Sanger, James; Hettinger, Patrick

    2017-10-01

    Lipomas are common benign tumors. When they develop in proximity to peripheral nerves, they can cause neurologic symptoms secondary to mass effect. Previous reports have shown symptom resolution after removal of lipomas compressing various upper extremity peripheral nerves. However, brachial plexus lipomas are relatively rare. Our multidisciplinary experience with brachial plexus lipoma resection is reviewed in the largest case series to date. A retrospective chart review of all patients undergoing resection of brachial plexus lipomatous tumors between 2006 and 2016 was performed. Patient demographic data, diagnostic imaging, clinical presentation, operative details, surgical pathology, and clinical outcomes were reviewed. Twelve brachial plexus lipomatous tumors were resected in 11 patients: 10 lipomas, 1 hibernoma, and 1 atypical lipomatous tumor. The most common tumor location was supraclavicular (50%), followed by axillary (42%), and proximal medial arm (8%). The most common brachial plexus segment involved was the upper trunk (50%), followed by posterior cord (25%), lateral pectoral nerve (8%), lower trunk (8%), and proximal median nerve (8%). Most patients presented with an enlarging painless mass (58%). Of the patients who presented with neurologic symptoms, symptoms resolved in the majority (80%). Brachial plexus lipomas are rare causes of compression neuropathy in the upper extremity. Careful resection and knowledge of brachial plexus anatomy, which may be distorted by the tumor, are critical to achieving a successful surgical outcome with predictable symptom resolution. Finally, surveillance magnetic resonance imaging may be warranted for atypical lesions.

  4. CLINICAL COMPARISON BETWEEN 0.25% BUPIVACAINE AND BUPIVACAINE 0.25% AND TRAMADOL (2MG/KG IN BRACHIAL PHLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

    Directory of Open Access Journals (Sweden)

    Suresh

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES : Adjunc ts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Tramadol a synthetic 4 - phenylpiperidine analog of codeine is known to produce antinociception and enhance the effect of local anaesthetics when given epid urally , intrathecally or in various peripheral nerve blocks. The purpose of this study was to assess the effect of Tramadol added to brachial plexus block by supraclavicular approach. METHODS : A prospective , randomized , single blinded study was conducted o n 60 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group I (n=30 were given 38mL of 0.25% Bupivacaine plus 2ml NS and Group II (n = 30 w ere given 38 mL of 0.25% Bupivacaine plus 2 ml Tramadol (2mg/kg. The onset time and duration of sensory and motor blockade were recorded. Haemodynamic variables (i.e. heart rate , noninvasive blood pressure , oxygen saturation , and rescue analgesic require ments were recorded for 24 hrs postoperatively. RESULTS: the onset of sensory and motor block was significantly faster in Group II compared to Group I (P <0.05. Rescue analgesic requirements were significantly less in Group II compared to Group I (P , 0.05 . Haemodynamic variables did not differ between groups in the post - operative period. CONCLUSION: Tramadol (2mg/kg in combination with 38mL of Bupivacaine (0.25% hastened onset of sensory and motor block , and improved postoperative analgesia when used in brachial plexus block , without producing any adverse events.

  5. Concomitant Traumatic Spinal Cord and Brachial Plexus Injuries in Adult Patients

    Science.gov (United States)

    Rhee, Peter C.; Pirola, Elena; Hébert-Blouin, Marie-Noëlle; Kircher, Michelle F.; Spinner, Robert J.; Bishop, Allen T.; Shin, Alexander Y.

    2011-01-01

    Background: Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury. Methods: A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis. Results: A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2%. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95% confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95% CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95% CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95% CI = 1.0, 5.8) compared with the group with only a brachial plexus injury. Conclusion: Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID:22258773

  6. Continuous non-invasive blood pressure monitoring: reliability of Finapres device during the Valsalva manoeuvre

    NARCIS (Netherlands)

    Imholz, B. P.; van Montfrans, G. A.; Settels, J. J.; van der Hoeven, G. M.; Karemaker, J. M.; Wieling, W.

    1988-01-01

    Because of the inherent risks of intra-arterial blood pressure monitoring a new non-invasive device, Finapres, which measures blood pressure continuously in the finger, was evaluated in 14 hypertensive and one normotensive subject. Brachial intra-arterial and finger pressures were compared during a

  7. Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus.

    Science.gov (United States)

    Birch, R

    2015-07-01

    While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well evidence from experimental work and clinical outcomes.In this article Professor Birch argues for early exploration of the brachial plexus as the optimum both to delineate the pathology and undertake reconstructive surgery. © The Author(s) 2014.

  8. Body mass index, blood pressure, and glucose and lipid metabolism among permanent and fixed-term workers in the manufacturing industry: a cross-sectional study.

    Science.gov (United States)

    Inoue, Mariko; Minami, Masahide; Yano, Eiji

    2014-02-27

    Temporary employment, a precarious form of employment, is recognized as social determinant of poor health. However, evidence supporting precarious employment as a risk factor for health is mainly obtained from subjective data. Studies using objective clinical measurement data in the assessment of health status are limited. This study compared body mass index (BMI), lipid and glucose metabolism, and health-related lifestyle factors between permanent workers and fixed-term workers employed in the manufacturing industry. Data of 1,701 male manufacturing industry workers 4.0%), whereas the overweight population (BMI ≥ 25.0) was greater among permanent workers (21.4%) compared with fixed-term workers (18.1%). Although fixed-term workers tended not to be overweight, regression analysis adjusted for age and lifestyle factors suggested that fixed-term employment was significantly associated with higher blood pressure (systolic β = 2.120, diastolic β = 2.793), triglyceride (β = 11.147), fasting blood glucose (β = 2.218), and HbA1c (β = 0.107) compared with permanent workers (all p < 0.01). Fixed-term workers showed more health risks, such as poorer blood pressure and lipid and glucose metabolism, even when adjusted for age and lifestyle variables, although BMI of fixed-term workers were lower than permanent workers. Precarious work might contribute to a deteriorating health status even among less overweight populations.

  9. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2013-01-01

    Full Text Available Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

  10. Outcome following nonoperative treatment of brachial plexus birth injuries.

    Science.gov (United States)

    DiTaranto, Patricia; Campagna, Liliana; Price, Andrew E; Grossman, John A I

    2004-02-01

    Ninety-one infants who sustained a brachial plexus birth injury were treated with only physical and occupational therapy. The children were evaluated at 3-month intervals and followed for a minimum of 2 years. Sixty-three children with an upper or upper-middle plexus injury recovered good to excellent shoulder and hand function. In all of these children, critical marker muscles recovered M4 by 6 months of age. Twelve infants sustained a global palsy, with critical marker muscles remaining at M0-M1 at 6 months, resulting in a useless extremity. Sixteen infants with upper and upper-middle plexus injuries failed to recover greater than M1-M2 deltoid and biceps by 6 months, resulting in a very poor final outcome. These data provide useful guidelines for selection of infants for surgical reconstruction to improve ultimate outcome.

  11. A Review of Brachial Plexus Birth Palsy: Injury and Rehabilitation.

    Science.gov (United States)

    Raducha, Jeremy E; Cohen, Brian; Blood, Travis; Katarincic, Julia

    2017-11-01

    Brachial plexus injuries during the birthing process can leave infants with upper extremity deficits corresponding to the location of the lesion within the complex plexus anatomy. Manifestations can range from mild injuries with complete resolution to severe and permanent disability. Overall, patients have a high rate of spontaneous recovery (66-92%).1,2 Initially, all lesions are managed with passive range motion and observation. Prevention and/or correction of contractures with occupational therapy and serial splinting/casting along with encouraging normal development are the main goals of non-operative treatment. Surgical intervention may be war- ranted, depending on functional recovery. [Full article available at http://rimed.org/rimedicaljournal-2017-11.asp].

  12. Brachial plexus variations in its formation and main branches

    Directory of Open Access Journals (Sweden)

    Valéria Paula Sassoli Fazan

    2003-01-01

    Full Text Available PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua origem até seus

  13. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Science.gov (United States)

    Thatte, Mukund R.; Babhulkar, Sonali; Hiremath, Amita

    2013-01-01

    Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial. PMID:23661959

  14. Differences in Brain Adaptive Functional Reorganization in Right and Left Total Brachial Plexus Injury Patients.

    Science.gov (United States)

    Feng, Jun-Tao; Liu, Han-Qiu; Xu, Jian-Guang; Gu, Yu-Dong; Shen, Yun-Dong

    2015-09-01

    Total brachial plexus avulsion injury (BPAI) results in the total functional loss of the affected limb and induces extensive brain functional reorganization. However, because the dominant hand is responsible for more cognitive-related tasks, injuries on this side induce more adaptive changes in brain function. In this article, we explored the differences in brain functional reorganization after injuries in unilateral BPAI patients. We applied resting-state functional magnetic resonance imaging scanning to 10 left and 10 right BPAI patients and 20 healthy control subjects. The amplitude of low-frequency fluctuation (ALFF), which is a resting-state index, was calculated for all patients as an indication of the functional activity level of the brain. Two-sample t-tests were performed between left BPAI patients and controls, right BPAI patients and controls, and between left and right BPAI patients. Two-sample t-tests of the ALFF values revealed that right BPAIs induced larger scale brain reorganization than did left BPAIs. Both left and right BPAIs elicited a decreased ALFF value in the right precuneus (P right BPAI patients exhibited increased ALFF values in a greater number of brain regions than left BPAI patients, including the inferior temporal gyrus, lingual gyrus, calcarine sulcus, and fusiform gyrus. Our results revealed that right BPAIs induced greater extents of brain functional reorganization than left BPAIs, which reflected the relatively more extensive adaptive process that followed injuries of the dominant hand. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Brain Reorganization in Patients with Brachial Plexus Injury: A Longitudinal Functional MRI Study

    Directory of Open Access Journals (Sweden)

    Takeharu Yoshikawa

    2012-01-01

    Full Text Available The aim of this study is to assess plastic changes of the sensorimotor cortex (SMC in patients with traumatic brachial plexus injury (BPI using functional magnetic resonance imaging (fMRI. Twenty patients with traumatic BPI underwent fMRI using blood oxygen level-dependent technique with echo-planar imaging before the operation. Sixteen patients underwent their second fMRI at approximately one year after injury. The subjects performed two tasks: a flexion-extension task of the affected elbow and a task of the unaffected elbow. After activation, maps were generated, the number of significantly activated voxels in SMC contralateral to the elbow movement in the affected elbow task study (Naf and that in the unaffected task study (Nunaf were counted. An asymmetry index (AI was calculated, where AI=(Naf−Nunaf/(Naf+Nunaf. Ten healthy volunteers were also included in this fMRI study. The AI of the first fMRI of the patients with BPI was significantly lower than that of the healthy subjects (P=0.035. The AI of the second fMRI significantly decreased compared with that of the first fMRI (P=0.045. Brain reorganization associates with peripheral nervous changes after BPI and after operation for functional reconstruction.

  16. Brachial neuropraxia in Canadian Atlantic University sport football players: what is the incidence of "stingers"?

    Science.gov (United States)

    Charbonneau, Rebecca M E; McVeigh, Sonja A; Thompson, Kara

    2012-11-01

    The objectives of this study were (1) to determine the incidence of brachial neuropraxia (stingers) among varsity football players during the 2010 season; (2) to determine if associations exist between sustaining a stinger and previous history of stingers, years played, equipment, age, body mass index (BMI), and conditioning; and (3) to provide descriptive statistics regarding stingers and position played, symptoms, activity during injury, mechanism of tackling, and reporting of stingers. Retrospective. Canadian Atlantic University Sport football league. Two hundred forty-four players. Two written questionnaires. Number of players experiencing stingers that occurred during the 2010 season. The incidence was 26% (64 of 244). A multivariate analysis revealed that previous history of a stinger (P < 0.0001) and years played (P = 0.0018) were associated with sustaining a stinger. There was no statistically significant effect related to additional equipment, a player's age, BMI, or participation in a strength training program. Linebackers, offensive linemen, and wide receivers had the highest incidence of stingers. The most frequent symptoms reported were tingling, numbness, burning, and weakness. Of all stingers sustained, only 59% (38 of 64) were reported to medical staff. Stingers are a common injury in Canadian university football and are underreported to medical staff. Education of players at increased risk is needed.

  17. Psychometric evaluation of the Brachial Assessment Tool Part 1: Reproducibility.

    Science.gov (United States)

    Grad, Bridget Hill; Williams, Gavin; Olver, John; Ferris, Scott; Bialocerkowski, Andrea

    2017-11-06

    To evaluate reproducibility (reliability and agreement) of the Brachial Assessment Tool (BrAT) a new patient-reported outcome measure for adults with traumatic Brachial Plexus Injury (BPI) DESIGN: Prospective repeated measure design SETTING: Outpatient clinics PARTICIPANTS: Adults with confirmed traumatic BPI INTERVENTION: 43 people (age range 19-82) with BPI completed the 31-item 4-response BrAT twice, 2 weeks apart. Results for the 3 subscales and summed score were compared at time 1 and time 2 to determine reliability including systematic differences using paired t tests; test retest using Intraclass Correlation Coefficient (ICC 1,1) and internal consistency using Cronbach alpha. Agreement parameters included standard error of measurement, minimal detectable change and limits of agreement. The BrAT RESULTS: Test retest reliability was excellent (ICC [1,1] = 0.90 - 0.97). Internal consistency was high (Cronbach alpha 0.90 - 0.98). Measurement error was relatively low (SEM range 3.1 - 8.8). A change of >4 for subscale 1, >6 for subscale 2, >4 for subscale 3 and >10 for the summed score is indicative of change over and above measurement error. Limits of agreement ranged from ± 4.4 (subscale 3) to 11.61 (summed score). These findings support the use of the BrAT as a reproducible patient reported outcome measure for adults with traumatic BPI with evidence of appropriate reliability and agreement for both individual and group comparisons. Further psychometric testing is required to establish the construct validity and responsiveness of the BrAT. Copyright © 2017. Published by Elsevier Inc.

  18. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline.

    Science.gov (United States)

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-27

    The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. The process established a new network of opinion leaders and researchers for further guideline development and multicentre research. A structured

  19. Radiation-induced brachial plexus neuropathy in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, N.K.; Pfeiffer, P.; Mondrup, K.; Rose, C. (Odense Univ. Hospital (Denmark). Dept. of Neurology Odense Univ. Hospital (Denmark). Dept. of Clinical Neurophysiology Odense Univ. Hospital (Denmark). Dept. of Oncology R)

    1990-01-01

    The incidence and latency period of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients by a neurological follow-up examination at least 60 months (range 67-130 months) after the primary treatment. All patients were treated primarily with simple mastectomy, axillary nodal sampling and radiotherapy (RT). Postoperatively, pre- and postmenopausal patients were randomly allocated chemotherapy for antiestrogen treatment. All patients were recurrence-free at time of examination. Clinically, 35% (25-47%) of the patients had RBP; 19% (11-29%) had definite RBP, i.e. were physically disabled, and 16% (9-26%) had probable RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-35%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%) of cases assessment of a definite level was not possible. RBP was more common after radiotherapy and chemotherapy (42%) than after radiotherapy alone (26%) but the difference was not statistically significant (p = 0.10). The incidence of definite RBP was significantly higher in the younger age group (p = 0.02). This could be due to more extensive axillary surgery but also to the fact that chemotherapy was given to most premenopausal patients. In most patients with RBP the symptoms began during or immediately after radiotherapy, and were thus without significant latency. Chemotherapy might enhance the radiation-induced effect on nerve tissue, thus diminishing the latency period. Lymphedema was present in 22% (14-32%), especially in the older patients, and not associated with the development of RBP. In conclusion, the damaging effect of RT on peripheral nerve tissue was documented. Since no successful treatment is available, restricted use of RT to the brachial plexus is warranted, especially when administered concomitantly with cytotoxic therapy. (orig.).

  20. [The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males].

    Science.gov (United States)

    Oliveras, Víctor; Martín-Baranera, Montserrat; Gracia, Maya; Del Val, José Luís; Plans, Miquel; Pujol-Moix, Núria

    2015-05-21

    The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  1. Near-infrared spectroscopy provides an index of blood flow and vasoconstriction in calf skeletal muscle during lower body negative pressure.

    Science.gov (United States)

    Hachiya, T; Blaber, A P; Saito, M

    2008-06-01

    Near-infrared spectroscopy (NIRS) has been used previously for forearm blood flow estimation at rest and during exercise. In this study we applied NIRS to selectively monitor deep calf oxygenated haemoglobin (Hb) responses in order to estimate blood flow changes in the calf muscle during lower body negative pressure (LBNP). The purpose of this study was to test the hypothesis that changes in calf skeletal muscle oxygenated-Hb, after the removal of superficial tissue responses, were related to blood flow changes during orthostatic stress, and to determine the efficacy of using NIRS measurements as an index of vasoconstriction. Twenty-nine subjects participated in this study. All attempted a graded LBNP trial from baseline (0 mmHg) to -60 mmHg LBNP in 10 mmHg steps at 5-min intervals. Calf blood flow changes were estimated by oxygenated-Hb responses in relation to changes in mercury strain gauge plethysmography and muscle sympathetic nerve activity (MSNA). Calf selective deep oxygenated-Hb decreased continuously from -10 mmHg LBNP. Regression analysis showed that oxygenated-Hb was significantly related to declines in plethysmography evaluations of blood flow [oxygenated-Hb = (-1.57 +/- 0.26) + (1.86 +/- 0.49) plethysmography, r(2) = 0.87 +/- 0.09]. Changes in MSNA (total activity) were also inversely related to oxygenated-Hb (slope calf oxygenated-Hb can be utilized to estimate calf muscle blood flow changes that are most likely caused by vasoconstriction during graded LBNP.

  2. Re-operative abdominal predictive score: a prognostic model combining Acute Re-intervention Predictive Index and intra-abdominal pressure.

    Science.gov (United States)

    Soler-Morejón, Caridad de Dios; Lombardo-Vaillant, Tomás Ariel; Tamargo-Barbeito, Teddy Osmín; Wise, Robert; Malbrain, Manu L N G

    2017-11-22

    The decision to re-operate after abdominal surgery is still difficult, especially in the setting of intra-abdominal sepsis. Mathematical models provide a good aid to both diagnosis and decision-making. A prospective observational study was conducted with 300 patients consecutively admitted to the intensive care unit of an academic institution affiliated to Calixto García Medical Faculty following abdominal surgery from January 2008 to January 2010. The patients were randomly separated (2:1) into estimation and validation groups. Logistic regression analysis was used in the estimation group to develop three models for decision-making related to re-operation including related factors such as age, ARPI, IAP, type of surgery (elective or emergency), and the duration of surgery. The three models developed were validated on the other group. The acute re-operation predictive index-intra-abdominal pressure (ARPI-IAP) model was the best of the three models, with an excellent calibration, using the Hossmer-Lemeshow goodness-of-fit statistical test (C = 9.976, P = 0.267), as well as discrimination (AUC = 0.989; 95% CI: 0.976-1.000). The combination of IAP with ARPI in a mathematical model can add accuracy to the prediction of need for re-operation related to intra-abdominal infectious complications in patients following abdominal surgery. This may be useful in all medical settings, but especially those with limited resources.

  3. Comparison of Heart Rate and Blood Pressure with Toe Pinch and Bispectral Index for Monitoring the Depth of Anesthesia in Piglets.

    Science.gov (United States)

    Jaber, Samer M; Sullivan, Sarah; Hankenson, F Claire; Kilbaugh, Todd J; Margulies, Susan S

    2015-09-01

    Determining depth of anesthesia (DOA) is a clinical challenge in veterinary medicine, yet it is critical for the appropriate oversight of animals involved in potentially painful experimental procedures. Here, we investigated various parameters used to monitor conscious awareness during surgical procedures and refined the application of noxious stimuli to anesthetized animals. Specifically we used a common stimulus, a compressive toe pinch (TP), to determine physiologic changes that accompanied a positive or negative motion response in isoflurane-anesthetized piglets. A positive response was defined as any reflexive withdrawal, whereas a negative response was defined as the absence of motion after stimulation. We also assessed the utility of the bispectral index (BIS) for its ability to predict a motion response to TP. The average of BIS values over 1 min (BISmean) was recorded before and after TP. In piglets with a positive response to TP, heart rate (HR), but not blood pressure (BP), increased significantly, but receiver operating characteristic (ROC) analysis revealed that HR was not a sensitive, specific predictor of TP motion response. Both before and after TP, BISmean was a strong predictor of a positive motion response. We conclude that HR and noninvasive BP changes are not clinically reliable indicators of anesthetic depth when assessed immediately after a peripherally applied compressive force as an indicator stimulus; however, BISmean and response TP are acceptable for assessing DOA in piglets maintained under isoflurane anesthesia.

  4. THE INFLUENCE OF INTERMITTENT COMPRESSION THERAPY USING SPHGYMOMANOMETER ON PRESSURE CHANGES AND WALKING ABILITY ON INDIVIDUALS AFFECTED WITH PERIPHERAL ARTERIAL DISEASES OF LOWER LIMBS

    Directory of Open Access Journals (Sweden)

    K. Manuja

    2016-10-01

    Full Text Available Background: To find out the influence of intermittent compression therapy using sphygmomanometer on pressure changes and walking ability on individuals affected with peripheral arterial diseases of lower limbs. Methods: Total thirty patients’ age 30 to 70 years post peripheral arterial diseases individuals included for study. These patients were randomly allocated to intervention group (n=15, which underwent a 6- weeks training program & control group (n=15 that received standard care and unsupervised exercise protocol. Primary outcome was change in ABI levels as determined in before and after the intervention program. Secondary outcomes were intermittent claudicating distance and walking capacity as assessed by the walking impairment questionnaire. Results: Paired sample t- test was used to analyze changes from before and after intervention program. There is a statistically significant (p=0.000 improvement in both experimental group and control group but when compared to control group, experimental group shows improvement in the mean values in all parameters. Conclusion: In this study the Ankle Brachial Index (ABI, Intermittent Claudication Distance (ICD and Walking Impairment Questionnaire (WIQ improved significantly in experimental group than control group by applying the pneumatic compression therapy with the sphygmomanometer and graded walking exercise. Hence, the study recommends that intermittent pneumatic therapy along with graded exercise is most effective in improving Ankle Brachial Index (ABI, Intermittent Claudication Distance (ICD and Walking capacity in PAD individuals.

  5. Morphometric analyses of normal pediatric brachial biceps and quadriceps muscle tissue

    National Research Council Canada - National Science Library

    Sallum, Adriana M E; Varsani, Hemlata; Holton, Janice L; Marie, Suely K N; Wedderburn, Lucy R

    2013-01-01

    Pediatric normal brachial biceps (14 specimens) and quadriceps muscles (14 specimens) were studied by immunohistochemistry to quantify fiber-type, diameter and distribution, capillary density, presence of inflammatory cells...

  6. COMPLICATIONS DURING A SUPRACLAVICULAR ANESTHESIA OF THE BRACHIAL PLEXUS WITH INTERSCALENE APPROACH

    Directory of Open Access Journals (Sweden)

    Minko Minkov

    2012-11-01

    Full Text Available A hemidiaphragmatic paresis is one of the most frequently observed complications following the supraclavicular anesthesia of the brachial plexus with interscalene approach. In patients, crucially dependant on adequate diaphragmatic function, hemidiaphragmatic paresis may provoke acute respiratory disturbances. The aim of this study was to analyze the anatomical features the brachial plexus with regard of the anesthesia of specific areas of the shoulder and the upper limb.A dissection of the cervical and the brachial plexuses was done in human cadavers. We established that in some cases the phrenic nerve and the accessory phrenic nerve arise from the superior trunk of the brachial plexus. This type of anatomical arrangement significantly increases the risk of hemidiaphragmatic paresis during supraclavicular anesthesia with interscalene approach because the anesthetic tends to invade the supraclavicular space.

  7. Nerve reconstruction: A cohort study of 93 cases of global brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Anil Bhatia

    2011-01-01

    Conclusion: Acceptable function (restoration of biceps power ≥3 can be obtained in more than two thirds (73% of these global brachial plexus injuries by using the principles of early exploration and nerve transfer with rehabilitation.

  8. Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy.

    Science.gov (United States)

    Zermeño-Rivera, Jaime; Gutiérrez-Amavizca, Bianca Ethel

    2015-06-01

    Brachial plexus avulsion results from excessive stretching and can occur secondary to motor vehicle accidents, mainly in motorcyclists. In a 28-year-old man with panavulsive brachial plexus palsy, we describe an alternative technique to repair brachial plexus avulsion and to stabilize and preserve shoulder function by transferring the contralateral spinal accessory nerve to the suprascapular nerve. We observed positive clinical and electromyographic results in sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps, with good outcome and prognosis for shoulder function at 12 months after surgery. This technique provides a unique opportunity for patients suffering from severe brachial plexus injuries and lacking enough donor nerves to obtain shoulder stability and mobility while avoiding bone fusion and preserving functionality of the contralateral shoulder with favorable postoperative outcomes.

  9. La prise en charge de la paralysie obstétricale du plexus brachial du ...

    African Journals Online (AJOL)

    Averagely, evaluations of the results were uncertain due to a high drop out rate. And finally the authors suggest that prevention should be refrained in our African context. Keywords: Physiotherapy – Obstetrical paralysis- Brachial plexus – Infancy ...

  10. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades.

    LENUS (Irish Health Repository)

    Walsh, Jennifer M

    2011-04-01

    We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia.

  11. A comparison of brachial artery-brachial vein arteriovenous fistulas with arteriovenous grafts in patients with poor superficial venous anatomy.

    Science.gov (United States)

    Pham, Xuan-Binh D; Kim, Jerry J; Ihenachor, Ezinne J; Parrish, Aaron B; Bleck, Jenny D; Kaji, Amy H; Koopmann, Matthew C; de Virgilio, Christian

    2017-02-01

    The autogenous arteriovenous fistula (AVF) has been shown to be superior to the arteriovenous graft (AVG) with respect to cost, complications, and primary patency. Therefore, the National Kidney Foundation Disease Outcomes Quality Initiative guidelines recommend reserving AVGs for patients who do not have adequate superficial venous anatomy to support AVF placement. The brachial artery-brachial vein arteriovenous fistula (BVAVF) has emerged as an autologous last-effort alternative. However, there are limited data comparing BVAVFs and AVGs in patients who are otherwise not candidates for a traditional AVF. Patients who received a BVAVF from July 2009 to July 2014 were compared with those who received an AVG during the same period. At our institution, BVAVF and AVG are only performed in patients with poor superficial venous anatomy. Patient demographic data, operative details, and subsequent follow-up were collected. BVAVFs were performed with a two-stage approach, with initial arteriovenous anastomosis, followed by delayed superficialization or transposition. Our primary outcome measure was primary functional assisted patency at 1 year. Patients lost to follow-up were excluded. A subgroup analysis was also performed for patients in whom the BVAVF or the AVG was their first hemodialysis access surgery. During the study period, 29 patients underwent BVAVF and 32 underwent AVG. There were no differences in age, gender, or presence of diabetes between the two groups. The median days to cannulation from the initial operation were 141 (interquartile range, 94-214) in the BVAVF group and 29 (interquartile range, 14-33) in the AVG group (P functional assisted primary patency rates at 1 year (45% vs 25%; P = .1). Subgroup analysis demonstrated greater 1-year primary functional assisted primary patency (52% vs 19%; P functional maturation expected compared with AVG. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  12. Comparison between Conventional and Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

    OpenAIRE

    Honnannavar, Kiran Abhayakumar; Mudakanagoudar, Mahantesh Shivangouda

    2017-01-01

    Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the...

  13. Nerve Transfers in Birth Related Brachial Plexus Injuries: Where Do We Stand?

    Science.gov (United States)

    Davidge, Kristen M; Clarke, Howard M; Borschel, Gregory H

    2016-05-01

    This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve transfers is reviewed and compared with the recent literature on intraplexal distal nerve transfers in obstetrical brachial plexus injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Changes in brachial artery endothelial function and resting diameter with moderate-intensity continuous but not sprint interval training in sedentary men.

    Science.gov (United States)

    Shenouda, Ninette; Gillen, Jenna B; Gibala, Martin J; MacDonald, Maureen J

    2017-10-01

    Moderate-intensity continuous training (MICT) improves peripheral artery function in healthy adults, a phenomenon that reverses as continued training induces structural remodeling. Sprint interval training (SIT) elicits physiological adaptations similar to MICT, despite a lower exercise volume and time commitment; however, its effect on peripheral artery function and structure is largely unexplored. We compared peripheral artery responses to 12 wk of MICT and SIT in sedentary, healthy men (age = 27 ± 8 yr). Participants performed MICT (45 min of cycling at 70% peak heart rate; n = 10) or SIT (3 × 20-s "all out" cycling sprints with 2 min of recovery; n = 9), and responses were compared with a nontraining control group (CTL, n = 6). Allometrically scaled brachial flow-mediated dilation (FMD) increased 2.2% after 6 wk of MICT and returned to baseline levels by 12 wk, but did not change in SIT or CTL (group × time interaction, P = 0.04). Brachial artery diameter increased after 6 and 12 wk (main effect, P = 0.03), with the largest increases observed in MICT. Neither training protocol affected popliteal relative FMD and diameter, or central and lower limb arterial stiffness (carotid distensibility, central and leg pulse wave velocity) (P > 0.05 for all). Whereas earlier and more frequent measurements are needed to establish the potential presence and time course of arterial responses to low-volume SIT, our findings suggest that MICT was superior to the intense, but brief and intermittent SIT stimulus at inducing brachial artery responses in healthy men.NEW & NOTEWORTHY We compared the effects of 12 wk of moderate-intensity continuous training (MICT) and sprint interval training (SIT) on peripheral artery endothelial function and diameter, and central and lower limb stiffness in sedentary, healthy men. Whereas neither training program affected the popliteal artery or stiffness indexes, we observed changes in brachial artery function and diameter with MICT but not SIT

  15. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy.

    Science.gov (United States)

    Somashekar, Deepak K; Di Pietro, Michael A; Joseph, Jacob R; Yang, Lynda J-S; Parmar, Hemant A

    2016-05-01

    Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology. To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies. In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management. Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting. Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.

  16. Retinal vascular caliber and brachial flow-mediated dilation: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Nguyen, Thanh T; Islam, F M Amirul; Farouque, H M Omar; Klein, Ronald; Klein, Barbara E K; Cotch, Mary Frances; Herrington, David M; Wong, Tien Yin

    2010-07-01

    Retinal vascular caliber changes have been shown to predict stroke, but the underlying mechanism of this association is unknown. We examined the relationship between retinal vascular caliber with brachial flow-mediated dilation (FMD), a measure of systemic endothelial function. The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based study of persons 45 to 84 years of age residing in 6 US communities free of clinical cardiovascular disease at baseline. Brachial FMD data were collected at baseline (July 2000 to June 2002), and retinal vascular caliber was measured from digital retinal photographs at the second examination, immediately after the first (August 2002 to January 2004). Data were available for 2851 participants for analysis. The mean brachial FMD was 4.39+/-2.79%. After adjusting for age and gender, brachial FMD was reduced in persons with wider retinal venular caliber (changes in FMD -0.25, 95% CI, -0.36, - 0.13; PhemoglobinA(1C) (-0.18; 95% CI -0.30, - 0.06; P=0.004, per SD increase in venular caliber). Brachial FMD was not associated with retinal arteriolar caliber. Persons with wider retinal venules have reduced brachial FMD, independent of other vascular risk factors. This suggests that retinal venular caliber, previously shown to predict stroke, may be a marker of underlying systemic endothelial dysfunction.

  17. Characterization and calibration of the central arterial pressure waveform obtained from vibrocardiographic signal

    Science.gov (United States)

    Casacanditella, L.; Cosoli, G.; Casaccia, S.; Rohrbaugh, J. W.; Scalise, L.; Tomasini, E. P.

    2016-06-01

    Laser Doppler Vibrometry (LDV) has been demonstrated to be a non-contact technique with high sensitivity, able to measure the skin vibrations related to cardiac activity. The obtainable mechanical signal (i.e. a velocity signal), VibroCardioGram (VCG), is able to provide significant physiological parameters, such as Heart Rate (HR). In this work, the authors aim to present a non-contact measurement method to obtain the arterial blood pressure signal from the mechanical vibrations assessed by LDV, in a central district of the arterial tree, such as carotid artery. In fact, in this way it is possible to indirectly assess Central Arterial Blood Pressure (CABP), which indicates the hemodynamic load on the heart, so that it is considered an important index predicting the cardiac risk of a subject. The measurement setup involves the use of an oscillometric cuff, to measure peripheral blood pressure at the radial artery level. Diastolic and Mean Arterial Pressure (MAP) at radial level were used to calibrate the integrated LDV signal (i.e. a displacement signal). As regard calibration, an exponential mathematical model was adopted to derive the pressure waveform from the displacement of the vessel detected by LDV. Results show an average difference of around 20% between systolic pressure measured at brachial level (i.e. peripheral pressure value) and systolic pressure derived from VCG signal measured over the carotid artery (i.e. central pressure). This is a physiological difference, consistent with the literature about the physiological increase of Systolic Blood Pressure (SBP) and Pressure Pulse (PP) at increased distances from the heart. However, this non-contact technique is affected by movement artifacts and by reflection phenomena not related to the studied vessel and so it is necessary to account of such issues in the results.

  18. INDEXING AND INDEX FUNDS

    Directory of Open Access Journals (Sweden)

    HAKAN SARITAŞ

    2013-06-01

    Full Text Available Proponents of the efficient market hypothesis believe that active portfolio management is largely wasted effort and unlikely to justify the expenses incurred. Therefore, they advocate a passive investment strategy that makes no attempt to outsmart the market. One common strategy for passive management is indexing where a fund is designed to replicate the performance of a broad-based index of stocks and bonds. Traditionally, indexing was used by institutional investors, but today, the use of index funds proliferated among individual investors. Over the years, both international and domestic index funds have disproportionately outperformed the market more than the actively managed funds have.

  19. Change in the association of body mass index and systolic blood pressure in Germany - national cross-sectional surveys 1998 and 2008-2011.

    Science.gov (United States)

    Adler, Carolin; Schaffrath Rosario, Angelika; Diederichs, Claudia; Neuhauser, Hannelore K

    2015-07-25

    A recent weakening and even decoupling of the association of body mass index (BMI) and systolic blood pressure (SBP) in population data was reported, i. a. for Western Europe. The association of BMI and SBP in recent cross-sectional population data from Germany was investigated in participants aged 18-79 years with BMI 17.5-40 kg/m(2) from national health examination surveys 1998 (n = 6,931) and 2008-2011 (n = 6,861) in Germany. The association was analyzed both in the overall samples and in participants without antihypertensive medication. From 1998 to 2008-11, age- and sex-standardized mean SBP decreased from 129.0 (CI 128.2-129.7) to 124.1 (123.5-124.6) mmHg in all participants and from 126.0 (125.4-126.7) to 122.3 (121.7-122.8) mmHg among persons not on antihypertensive medication. The proportion of persons treated with antihypertensives augmented from 19.2 % (17.7-20.8) to 25.3 % (24.0-26.6). Mean BMI remained constant at around 27 kg/m(2) with a slight increase in obesity prevalence. BMI was positively associated with SBP both in 1998 and 2008-11, yet the association tended to level out with increasing BMI suggesting a non-linear association. The strength of the BMI-SBP-association decreased over time in all and untreated men. In women, the association weakened in the overall sample, but remained similarly strong in untreated women. The unadjusted linear regression models were used to estimate the increase in SBP within 5-unit BMI increases. E. g. for men in 1998, SBP was higher by 7.0 mmHg for a BMI increase from 20 to 25 kg/m(2) and by 3.6 mmHg for BMI 30 to 35 kg/m(2). The corresponding values for 2008-11 were 3.8 mmHg and 1.7 mmHg. The cross-sectional association of BMI and SBP decreased between 1998 and 2008-11 in Germany, however it did not disappear and it is in part explained by improvements in the diagnosis and treatment of high blood pressure.

  20. Ambulatory Arterial Stiffness Index (AASI) is Unable to Estimate Arterial Stiffness of Hypertensive Subjects: Role of Nocturnal Dipping of Blood Pressure.

    Science.gov (United States)

    Di Raimondo, Domenico; Casuccio, Alessandra; Di Liberti, Rosangela; Musiari, Gaia; Zappulla, Valentina; D'Angelo, Alessandra; Pinto, Antonio

    2017-01-01

    Ambulatory Arterial Stiffness Index (AASI) has been proposed as an indirect and simpler method to estimate the Arterial Stiffness (AS). AASI, calculated from a set of data collected during a 24-hours ambulatory blood pressure monitoring (ABPM), is defined as 1 minus the regression slope of diastolic on systolic blood pressure (BP) values. For a given increase in diastolic BP, the increase in systolic BP is smaller in a compliant compared to a stiff artery; the stiffer the arterial tree, the closer AASI is to 1. AASI was demonstrated to predict cardiovascular mortality, cerebrovascular events and to be associated with target organ damage. Taking into account the almost complete absence of data regarding the ability of AASI to predict the different degree of AS when hypertensives are divided into four classes of dipping in relation to the extent of the nocturnal reduction of BP (extreme dippers, dippers, mild dippers and reverse dippers) aim to clarify the ability of AASI to estimate the different degree of AS of hypertensive subjects with different nocturnal BP profile and resulting in different extent of organ damage. We enrolled 816 subjects (403 men and 413 women) with essential hypertension, referred to the U.O.C of Medicina Interna e Cardioangiologia of the University of Palermo; 173 subjects (71 men and 102 women, mean age 44.4 ± 14.6 years) without a history of hypertension were enrolled as controls. The analysis of data was performed by dividing the population into four categories in relation to the extent of the nocturnal decline of BP: 124 extreme dipper (mean age 54,8 ± 12,4 years, men 46.8 %); 287 dipper (mean age 55,9 ± 14,2 years, men 54,0 %); 271 mild dipper (mean age 61,5 ± 14,7 years, men 52,0 %); 134 reverse dipper (mean age 61,5 ± 14,7 years, men 33.6 %). The mean value of AASI was significantly higher for mild and reverse dippers versus control patients and versus the other categories of dipping. The multiple regression analysis with AASI as

  1. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    Science.gov (United States)

    ... CVD, and diabetes. Consider scientific recommendations, like this one from the Task Force. Use this information to become fully informed and to decide whether screening for PAD is right for you. At the same time, take action to reduce your risk for heart ...

  2. A study on the physical fitness index, heart rate and blood pressure in different phases of lunar month on male human subjects

    Science.gov (United States)

    Chakraborty, Ujjwal; Ghosh, Tusharkanti

    2013-09-01

    The gravitational pull of the moon on the earth is not the same in all phases of the lunar month, i.e. new moon (NM), first quarter (FQ), full moon (FM) and third quarter (TQ), and as a result the amplitude of tide differs in different phases. The gravitational pull of the moon may have effects on the fluid compartments of the human body and hence the cardiovascular system may be affected differentially in the different phases of the lunar month. In the present study resting heart rate (HR) and blood pressure (BP), physical fitness index (PFI), peak HR and BP immediately after step test, and recovery HR and BP after step test were measured during different phases of the lunar month in 76 male university students (age 23.7 ± 1.7 years). At rest, both systolic and mean arterial BP were ˜5 mmHg lower in NM and FM compared to FQ and TQ, but resting HR was not significantly different between phases. Further, peak HR and peak systolic BP after step test were lower (˜4 beat/min and ˜5 mmHg, respectively) in NM and FM compared to FQ and TQ. PFI was also higher (˜5) in NM and FM compared to FQ and TQ. Recovery of HR after step test was quicker in NM and FM compared to that of FQ and TQ. It appears from this study that gravitational pull of the moon may affect the cardiovascular functions of the human body. Moreover, the physical efficiency of humans is increased in NM and FM due to these altered cardiovascular regulations.

  3. Relationship between Body Mass Index, Blood Pressure, and Visual Acuity in Residents of Esan West Local Government Area of Edo State, Nigeria

    Directory of Open Access Journals (Sweden)

    I. O. Ernest-Nwoke

    2014-01-01

    Full Text Available Aim. To study the relationship between body mass index (BMI and blood pressure (BP on visual acuity among apparently healthy residents of Ekpoma, Esan West Local Government Area of Edo State, Nigeria. Methodology. This is a cross-sectional descriptive study among 225 subjects (ages of 18–35 years from whom BP, body weight, and height were collected. Visual acuity was measured using the Snellen chart following standard procedures of number of letters seen at 6-metre distance. The data were then analyzed using SPSS version 17. Results. The sampled population consists of 112 male and 113 female (mean age 31.72±14.2 years. Majority (180 of the respondents had normal visual acuity. However, compared with the respondents with normal BMI (R19.61±1.5; L19.67±1.70, visual acuity of underweight (R18.53±2.30; L18.53±2.70 and obese (R15.68±4.79; L17.73±1.70 were more deviated. Similarly, compared with respondent with normal BP (120–125/80–85 mmHg; R18.00±2.53; L18.07±3.11, hypotensive (R15.5±7.35; L15.00±10.20, and hypertensive (R15.01±21.25; L15.00±11.91 respondents had deviated visual acuity. Conclusion. Abnormal body weight (underweight and obese and BP (hypotension and hypertension have potential negative impacts on visual acuity. Based on the observed relationship between weights, BP, and visual acuity, eye examinations can be included as regular screening exercise for abnormal BMI and BP conditions.

  4. Association between CD4 Cell Count and Blood Pressure and Its Variation with Body Mass Index Categories in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Christian Akem Dimala

    2018-01-01

    Full Text Available The aim of this study was to establish whether an independent relationship exists between CD4 count and hypertension and if this relationship is modified or confounded by the body mass index (BMI. Methods. A secondary data analysis of a cross-sectional study on 200 HIV/AIDS patients at a referral hospital in Cameroon was conducted. Linear and logistic regression models were used as appropriate to explore the association between the variables of interest. Results. There was no linear association between log CD4 count and both systolic (p=0.200; r=0.12 and diastolic blood pressures (p=0.123; r=0.14, respectively. After adjusting for BMI, patients with CD4 count ≥ 350 cells/μl were more likely to have hypertension than those with CD4 count < 350 cells/μl (AOR: 2.50, 95% CI: 1.05–5.93, and p=0.032. There was no effect modification from BMI (test of homogeneity, p=0.721. There was no independent relationship between CD4 count and hypertension after controlling for age, sex, family history of hypertension, BMI-defined overweight, HAART use, and duration of HIV infection (AOR: 1.66, 95% CI: 0.48–5.71, and p=0.419. Conclusion. This study did not identify any independent relationship between CD4 count and hypertension. Large prospective studies are recommended to better explore this relationship between hypertension and CD4 count.

  5. Age-period-cohort analysis of trends in blood pressure and body mass index in children and adolescents in Hong Kong.

    Science.gov (United States)

    Kwok, Man Ki; Tu, Yu Kang; Kawachi, Ichiro; Schooling, C Mary

    2017-12-01

    The declining or fluctuating trend in blood pressure (BP) despite the rising trend in body mass index (BMI) during childhood and adolescence is unexplained. We decomposed trends in BP and BMI to identify the relevance of early-life and contemporaneous factors. We assessed the relative contribution of age, period and cohort to secular trends in BP in children and adolescents (9-18 years) from 1999 to 2014 and BMI (6-18 years) from 1996 to 2014 in Hong Kong, China. After accounting for age, period effects contributed more than cohort effects to the overall fluctuating BP trend and the rising BMI trend observed in this Chinese population. For both sexes, BP fell from the start of period to a low point in 2003-2005 but then rose. BMI rose strongly across the period before levelling off in 2009-2010. Earlier cohorts (born in 1983-1984) had higher BP and BMI than later cohorts. With globalisation and associated lifestyle changes, successive generations of children and adolescents in a recently developed Chinese setting had lower BP and BMI, but this fall was offset until recently by population-wide increase in BMI. School-based health promotion efforts could have partly mitigated the population-wide rise in child and adolescent BMI, while socioeconomic transition or other factors could be relevant to changes in BP between generations. Explaining these trends will help identify early-life factors that may contribute to a healthier start as well as contemporaneous factors that may protect against rising trends in adiposity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Surgical outcomes following nerve transfers in upper brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Bhandari P

    2009-01-01

    Full Text Available Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations, surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients, and phrenic nerve to suprascapular nerve (1 patient. In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients, intercostal nerves (2 patients, and phrenic nerve with nerve graft (2 patients. Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients, both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients, spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient, intercostal nerves (3rd, 4th and 5th to musculocutaneous nerve (4 patients and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient. Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170

  7. MRI of the Brachial Plexus: Modified Imaging Technique Leading to a Better Characterization of Its Anatomy and Pathology

    Science.gov (United States)

    Torres, Carlos; Mailley, Kathleen; del Carpio O’Donovan, Raquel

    2013-01-01

    Summary Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of the brachial plexus due to its superior soft tissue resolution and multiplanar capabilities. The evaluation of the brachial plexus however represents a diagnostic challenge for the clinician and the radiologist. The imaging assessment of the brachial plexus, in particular, has been traditionally challenging due to the complexity of its anatomy, its distribution in space and due to technical factors. Herein, we describe a modified technique used in our institution for the evaluation of the brachial plexus which led to a substantial decrease in scanning time and to better visualization of all the segments of the brachial plexus from the roots to the branches, in only one or two images, facilitating therefore the understanding of the anatomy and the interpretation of the study. To our knowledge, we are the first group to describe this technique of imaging the brachial plexus. We illustrate the benefit of this modified technique with an example of a patient with a lesion in the proximal branches of the left brachial plexus that was clinically suspected but missed on conventional brachial plexus imaging for six consecutive years. In addition, we review the common and infrequent benign and malignant pathology that can affect the brachial plexus. PMID:24355190

  8. Brachial artery constriction during brachial artery reactivity testing predicts major adverse clinical outcomes in women with suspected myocardial ischemia: results from the NHLBI-sponsored women's ischemia Syndrome Evaluation (WISE Study.

    Directory of Open Access Journals (Sweden)

    Tara L Sedlak

    Full Text Available Limited brachial artery (BA flow-mediated dilation during brachial artery reactivity testing (BART has been linked to increased cardiovascular risk. We report on the phenomenon of BA constriction (BAC following hyperemia.To determine whether BAC predicts adverse CV outcomes and/or mortality in the women's ischemic Syndrome Evaluation Study (WISE. Further, as a secondary objective we sought to determine the risk factors associated with BAC.We performed BART on 377 women with chest pain referred for coronary angiography and followed for a median of 9.5 years. Forearm ischemia was induced with 4 minutes occlusion by a cuff placed distal to the BA and inflated to 40mm Hg > systolic pressure. BAC was defined as >4.8% artery constriction following release of the cuff. The main outcome was major adverse events (MACE including all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization for heart failure.BA diameter change ranged from -20.6% to +44.9%, and 41 (11% women experienced BAC. Obstructive CAD and traditional CAD risk factors were not predictive of BAC. Overall, 39% of women with BAC experienced MACE vs. 22% without BAC (p=0.004. In multivariate Cox proportional hazards regression, BAC was a significant independent predictor of MACE (p=0.018 when adjusting for obstructive CAD and traditional risk factors.BAC predicts almost double the risk for major adverse events compared to patients without BAC. This risk was not accounted for by CAD or traditional risk factors. The novel risk marker of BAC requires further investigation in women.

  9. Brachial plexus injury in Thailand: a report of 520 cases.

    Science.gov (United States)

    Songcharoen, P

    1995-01-01

    Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty-two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty-seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty-one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to suprascapular, axillary, and musculotaneous) intercostal (to musculotaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo- plexal methods gave a significant number of good results.

  10. Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome.

    Science.gov (United States)

    Wakerley, Benjamin R; Yuki, Nobuhiro

    2014-03-01

    The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome is defined by rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs. Serial nerve conduction studies suggest that PCB represents a localised subtype of Guillain-Barré syndrome characterised by axonal rather than demyelinating neuropathy. Many neurologists are unfamiliar with PCB, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. The presence of additional ophthalmoplegia and ataxia indicates overlap with Fisher syndrome. Half of patients with PCB carry IgG anti-GT1a antibodies which often cross-react with GQ1b, whereas most patients with Fisher syndrome carry IgG anti-GQ1b antibodies which always cross-react with GT1a. Significant overlap between the clinical and serological profiles of these patients supports the view that PCB and Fisher syndrome form a continuous spectrum. In this review, we highlight the clinical features of PCB and outline new diagnostic criteria.

  11. A giant plexiform schwannoma of the brachial plexus: case report

    Directory of Open Access Journals (Sweden)

    Kohyama Sho

    2011-11-01

    Full Text Available Abstract We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed.

  12. Arterial cutdown reduces complications after brachial access for peripheral vascular intervention.

    Science.gov (United States)

    Kret, Marcus R; Dalman, Ronald L; Kalish, Jeffrey; Mell, Matthew

    2016-07-01

    Factors influencing risk for brachial access site complications after peripheral vascular intervention are poorly understood. We queried the Society for Vascular Surgery Vascular Quality Initiative to identify unique demographic and technical risks for such complications. The Vascular Quality Initiative peripheral vascular intervention data files from years 2010 to 2014 were