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Pressure Index (pressure + index)
Kinds of Pressure Index Selected AbstractsPeripheral arterial disease in diabetes,a reviewDIABETIC MEDICINE, Issue 1 2010E. B. Jude Diabet. Med. 27, 4,14 (2010) Abstract Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD. [source] Evaluation of the one-minute exercise test to detect peripheral arterial diseaseEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 5 2008E. K. Hoogeveen ABSTRACT Background,, Asymptomatic peripheral arterial disease (PAD) is common amongst the elderly and is a risk factor for cardiovascular morbidity and mortality. PAD can be assessed by non-invasive tests such as the ankle/brachial pressure index (ABPI) at rest and Doppler flow velocity (DFV) scanning, but these tests may underestimate the prevalence of PAD. The aim of this study was to estimate the added value, for the detection of PAD, of the one-minute exercise test, defined as positive if the drop of the ankle systolic pressure was more than 30 mmHg. We also investigated whether the combination of the ABPI at rest and the one-minute exercise test could replace DFV scanning. Materials and methods,, We studied this in a random sample (n = 631) of a 50- to 75-year-old population. Results,, Of these subjects 11% (66/631) had an abnormal ABPI (< 0·9) and 16% (102/631) had an abnormal DFV curve. Of this sample 72% of the subjects performed a one-minute exercise test. Of all subjects 6% (27/451) had an abnormal ABPI (< 0·9) and 12% (54/451) had an abnormal DFV curve. The one-minute exercise test revealed seven cases of PAD (beyond the 67 already identified) which were not detected by an abnormal ABPI at rest and/or DFV scanning. As a result the prevalence of PAD increased by 2%. All patients with an aortoiliac or femoropopliteal obstruction had an ABPI at rest < 0·9. The sensitivity of the combination of the ABPI at rest and the one-minute exercise test to detect abnormal DFV curves was low for crural obstructions. Conclusion,, The one-minute exercise test slightly improves the detection of peripheral arterial disease in the general population. [source] Pacific herring, Clupea pallasi, recruitment in the Bering Sea and north-east Pacific Ocean, II: relationships to environmental variables and implications for forecastingFISHERIES OCEANOGRAPHY, Issue 4 2000Erik H. Williams Previous studies have shown that Pacific herring populations in the Bering Sea and north-east Pacific Ocean can be grouped based on similar recruitment time series. The scale of these groups suggests large-scale influence on recruitment fluctuations from the environment. Recruitment time series from 14 populations were analysed to determine links to various environmental variables and to develop recruitment forecasting models using a Ricker-type environmentally dependent spawner,recruit model. The environmental variables used for this investigation included monthly time series of the following: southern oscillation index, North Pacific pressure index, sea surface temperatures, air temperatures, coastal upwelling indices, Bering Sea wind, Bering Sea ice cover, and Bering Sea bottom temperatures. Exploratory correlation analysis was used for focusing the time period examined for each environmental variable. Candidate models for forecasting herring recruitment were selected by the ordinary and recent cross-validation prediction errors. Results indicated that forecasting models using air and sea surface temperature data lagged to the year of spawning generally produced the best forecasting models. Multiple environmental variables showed marked improvements in prediction over single-environmental-variable models. [source] Effects of atmospheric circulation on ice conditions in the southern Baltic coastal lagoonsINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 13 2001Józef Piotr Girjatowicz Abstract Relationships between atmospheric circulation patterns and ice conditions in the southern Baltic coastal lagoons were explored. Ice data consisted of number of ice days (L) and duration of ice season (S) in the Szczecin Lagoon (off Karnin), the Puck Bay (off Puck) and the Vistula Lagoon (off Krasnoflotskoye) from 1950/1951 to 1989/1990. Atmospheric circulation patterns for the period studied were extracted from Lity,ski's ,Calendar of atmospheric circulation types' developed at the Institute of Meteorology and Water Management (IMWM). A circulation pattern was identified by three numerical parameters: the zonal circulation index, the meridional circulation index, both pertaining to a zone delimited by coordinates 40,60°N, 0,35°E, and the surface pressure index for Warsaw. The number of days with individual atmospheric circulation patterns occurring from October to March was calculated. Subsequently, the selected patterns were combined by wind direction sectors and several month-long periods that most closely correlated with ice conditions. The highest linear correlation coefficients (r>0.8) were obtained for the relationship between the number of days with winds from the east from December to February and December to March and the winter number of ice days (L). Somewhat higher were multiple correlation coefficients with winds from the east and west as circulation type predictors. Slightly lower correlation coefficients for the sectors and circulation periods mentioned were obtained for the duration of the ice season (S), although some of the coefficients were significant even at the probability level of ,=0.01. Higher correlation coefficients were obtained for correlations involving ,cold' circulation patterns (sector NE+E+SE winds) and ice conditions than for those involving ,warm' patterns (sector SW+W+NW). Copyright © 2001 Royal Meteorological Society [source] Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trialINTERNATIONAL WOUND JOURNAL, Issue 2 2008Jean-Luc Schmutz Abstract The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran® matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index ,0·80] ranged from 5 to 25 cm2 with a duration ,3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with ,40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71·3 ± 13·5 years, body mass index was ,30 kg/m2 in 39·3% and 15·4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11·2 ± 7·4 cm2. At the last evaluation, mean difference between the groups for %RR was 33·6 ± 15·0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8·6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0·0059 for superiority test). The median of the wound area reduction was 61·1% and 7·7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54·4% versus 12·9% in intent-to-treat analysis (p = 0·0286). Median AR was 4·2 cm2 in the NOSF group and 1·0 cm2 with ORC (P = 0·01). Median HR was ,0·056 and ,0·015 cm2/day in NOSF and ORC groups, respectively (P = 0·029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2·4 (95% CI: 1·1,5·3; P = 0·026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis. [source] LDL-apheresis up-regulates VEGF and IGF-I in patients with ischemic limbJOURNAL OF CLINICAL APHERESIS, Issue 3 2003Shuzo Kobayashi Abstract Although it is known that LDL-apheresis improves ischemic limb seen in patients with peripheral arterial occlusive disease (PAOD), the underlying mechanism(s) still remains unknown. We studied whether vascular endothelial growth factor (VEGF) and/or insulin-like growth factor-I (IGF-I) levels correlated with improvement of ischemic limbs after LDL-apheresis. Sixteen patients with PAOD (13 men, 3 women) were enrolled in our study. LDL-apheresis was performed 10 times (treated plasma 3,000 ml) for 5 weeks. Serum level of VEGF significantly increased from 262 ± 171 pg/ml to 306 ± 165 pg/ml before and after LDL-apheresis (P < 0.05). This value further increased up to 441 ± 175 pg/ml 3 months after the end of this therapy (P < 0.01, compared with the basal value and P < 0.05, compared with the value at the end of 10-times session). Increased levels of VEGF paralleled increases in the ankle-brachial pressure index (ABI). After 10-times therapy, IGF-I significantly decreased (P < 0.05), but increased over the basal value 3 months after this therapy. Plasma fibrinogen statistically decreased and remained low for 3 months. The favorable effects of LDL-apheresis may be ascribed to up-regulation of VEGF and IGF-I associated with decreased fibrinogen levels. J. Clin. Apheresis, 18:115,119, 2003. © 2003 Wiley-Liss, Inc. [source] Diabetic foot ulcer burden may be modified by high-dose atorvastatin: A 6-month randomized controlled pilot trialJOURNAL OF DIABETES, Issue 3 2009Odd Erik JOHANSEN Abstract Background:, Diabetic foot ulcers (DFUs) are common complications of diabetes mellitus (DM), with a complex pathogenesis. Treatment is difficult and no single treatment with measurable clinical impact is available. In the present clinical pilot trial, we investigated whether statins could be of use against some of the pathogenic factors in DFUs. Methods:, Thirteen diabetic patients (10 men; 11 with Type 2 DM; mean age 64 years; mean duration of DM 18 years) with neuropathic DFUs <4 months were randomized to treatment with either 10 mg (six patients; six ulcers) or 80 mg (seven patients; nine ulcers) atorvastatin for 6 months in addition to conventional DFU care (i.e. prompt debridement, DFU pressure relief, and management of any underlying infection). Results:, There were no significant differences in background factors (i.e. HbA1c 8.9%, micro- and macrovascular complications, concomitant medications) or DFU characteristics (duration, surface area, grading) between the two groups. All ulcers in the group receiving 10 mg atorvastatin healed, compared with six of nine ulcers in the group receiving 80 mg atorvastatin (NS). However, two previously healed DFUs recurred and six new DFUs developed in the low-dose group compared with none and one, respectively, in the high-dose group (P = 0.048). There was a significant decrease in C-reactive protein (,1.5 mg/L; P = 0.044) and a non-significant trend towards beneficial effects on lipids and the ankle,arm blood pressure index in the high-dose compared with the low-dose group. Conclusions:, We observed a possible beneficial effect of 6-months high-dose atorvastatin on DFUs, which should be tested in appropriately sized prospective studies. [source] The impact of tourism on dune lakes on Fraser Island, AustraliaLAKES & RESERVOIRS: RESEARCH AND MANAGEMENT, Issue 1 2003Wade L. Hadwen Abstract In view of the increasing tourism to Fraser Island, Queensland, a tourist pressure index (TPI) was developed to assess the potential threat of tourism to 15 of the most accessible dune lakes on the island. Tourist pressure index scores indicated that the two clear lakes on the island, Lake McKenzie and Lake Birrabeen, are most threatened by tourist activities owing to their accessibility, facilities and prominence in advertising campaigns. In addition, limnological investigations of the same 15 lakes were conducted in February 1999 to determine their current trophic status and potential susceptibility to adverse impacts from tourism, particularly with reference to eutrophication. On the basis of nutrient and chlorophyll a concentrations, the two water table window lakes, Ocean Lake and Lake Wabby, were classed as mesotrophic and oligo-mesotrophic, while all of the perched dune lakes were oligotrophic. Lake McKenzie and Lake Birrabeen, the two most threatened lakes according to TPI scores, had the lowest nutrient concentrations of all of the lakes examined and, consequently, we suggest that nutrient additions might elicit rapid algal growth responses in these systems. Comparisons between current data and historical data from Arthington et al. (1990) indicate that increases in planktonic chlorophyll a concentrations were not always directly mirrored by increases in total phosphorus concentrations. We found that while chlorophyll a concentrations were significantly higher in the 1999 samples than in the 1990 samples for all lakes, total phosphorus concentrations were higher in Ocean Lake, lower in Lake Jennings and similar in lakes McKenzie, Birrabeen and Wabby. [source] Management of mixed arterial and venous leg ulcers,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2007M. L. Humphreys Background: The aim was to assess healing in patients with mixed arterial and venous leg ulcers after protocol-driven treatment in a specialist leg ulcer clinic. Methods: The study included consecutive patients referred with leg ulceration and venous reflux over 6 years. Legs without arterial disease (ankle : brachial pressure index (ABPI) above 0·85) were treated with multilayer compression bandaging and patients with severe disease (ABPI 0·5 or less) were considered for immediate revascularization. Those with moderate arterial compromise (ABPI above 0·5 up to 0·85) were initially managed with supervised modified compression and considered for revascularization if their ulcer did not heal. Healing rates were determined using life-table analysis. Results: Of 2011 ulcerated legs, 1416 (70·4 per cent) had venous reflux. Of these 1416, 193 (13·6 per cent) had moderate and 31 (2·2 per cent) had severe arterial disease. Healing rates by 36 weeks were 87, 68 and 53 per cent for legs with insignificant, moderate and severe arterial disease respectively (P < 0·001). Seventeen legs with moderate and 15 with severe arterial disease were revascularized. Of these, ulcers healed in four legs with moderate and seven with severe disease within 36 weeks of revascularization (P = 0·270). Combined 30-day mortality for revascularization was 6·5 per cent. Conclusion: A protocol including supervised modified compression and selective revascularization achieved good healing rates for mixed arterial and venous leg ulceration. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Association between hyperhomocysteinaemia and abdominal aortic aneurysmBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001S. Caldwell Background: Hyperhomocysteinaemia is associated with occlusive vascular disease. In vitro evidence has demonstrated the induction of a serine elastase by homocysteine in vascular smooth muscle. Anecdotal evidence from case reports and post-mortem studies has suggested an association with abdominal aortic aneurysm (AAA). The aim was to determine the prevalence of hyperhomocysteinaemia in patients with AAA. Methods: Some 120 subjects (60 controls and 60 patients with AAA) were studied prospectively. Epidemiological, clinical and haematological data were collected. Patients were defined as having AAA if ultrasonographic measurement of the aorta was greater than 4·5 cm. Those with evidence of occlusive peripheral vascular disease or an ankle: brachial pressure index lower than 0·8 were excluded. Homocysteine was measured with a commercial high-pressure liquid chromatography analyser. The reference range from age-matched controls was 8·9,14·3 µmol l,1. Results: The median(s.d.) value of homocysteine for patients was significantly higher than that for the control group: 13·1(7·88) versus 10·9(5·07) µmol l,1 (P = 0·03, Mann,Whitney U test). Hyperhomocysteinaemia (homocysteine concentration greater than 14·3 µu;mol l,1) was present in 48 per cent of patients with AAA, compared with 24 per cent of the control population (P < 0·01, ,2 test). There were no significant differences between groups with regard to age, folate levels, vitamin B12 concentration or renal function. Conclusion: These results strongly suggest an association between hyperhomocysteinaemia and AAA. If studies currently ongoing demonstrate a causal relationship between hyperhomocysteinaemia and vascular disease progression, it raises the possibility of treating small aneurysms with vitamin supplementation to slow their growth. © 2001 British Journal of Surgery Society Ltd [source] Near-infrared spectroscopy grades the severity of intermittent claudication in diabetics more accurately than ankle pressure measurement,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000Dr T. Komiyama Background: The aim of this study was to evaluate near-infrared spectroscopy (NIRS), combined with a treadmill-walking test, as a method of assessment of intermittent claudication (IC) in diabetic patients. Methods: Some 208 symptomatic legs in 153 consecutive patients who complained of calf IC due to atherosclerotic disease were studied with NIRS and resting ankle: brachial pressure index (ABPI). Results: There was good reproducibility of NIRS measurements. Three distinct types of IC were detected by NIRS. ABPI was significantly different between these three types in non-diabetic patients, but could not grade the severity of IC in diabetic patients. Recovery time (RT) of muscle oxygenation differentiated more accurately between severe and moderate claudication than ABPI in diabetics, although RT and ABPI had similar accuracy in non-diabetics. There was a significant correlation between RT and ABPI in non-diabetic patients and patients who had been diabetic for less than 10 years, while there was no correlation in patients who had had diabetes for over 10 years. Conclusion: Measurement of muscle oxygenation during exercise by NIRS graded the severity of IC in diabetic patients more accurately than resting ABPI. © 2000 British Journal of Surgery Society Ltd [source] Rupture of a peripheral popliteal artery plaque documented by intravascular ultrasound: A case report,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2009Hiroaki Kohno MD Abstract A 58-year-old male with dyslipidemia and coronary spastic angina suddenly experienced pain in the right limb while walking on November 1, 2008. Right-ankle brachial pressure index (ABI) was decreased (0.80) and left-ABI was normal (1.24). Bilateral ABI was normal during January 2008. Ultrasonography in the right-lower limb artery revealed severe stenosis in the right-popliteal artery with extended and large echolucent plaques containing an isoechoic area. We carried out lower limb angiography: subtotal occlusion of the popliteal artery was found. By intravascular ultrasound (IVUS), right-popliteal artery plaques were echolucent and eccentric; ulceration with a thin fibrous cap was noted. Percutaneous transluminal angioplasty was done and popliteal artery blood flow was improved. Right-ABI improved to 1.13 after 4 days. To prevent the progression and rupture of the plaques, lipid-lowering therapy and antiplatelet therapy were started. Plaque rupture of the popliteal artery was diagnosed by these characteristics on IVUS. Patients with peripheral artery disease may have plaque rupture similar to those with acute coronary syndromes who have identical unstable plaques and unstable atheromas. In addition to appropriate local revascularization, systemic therapy to stabilize the unstable plaque is indicated because failure to do so may cause recurrent events. © 2009 Wiley-Liss, Inc. [source] The influence of exercise on foot perfusion in diabetesDIABETIC MEDICINE, Issue 10 2007D. T. Williams Abstract Aims, Diabetic foot disease is associated with both macro- and microvascular disease. Exercise has both positive and negative effects on the perfusion of lower limbs with peripheral arterial occlusive disease (PAOD). We aimed to measure changes in foot perfusion following a brief period of lower-limb exercise in individuals with and without Type 2 diabetes and non-critical PAOD. Methods, Subjects were allocated to groups according to the presence or absence of diabetes, PAOD on colour duplex imaging and clinically detectable peripheral neuropaÍthy. Transcutaneous oxygen tension (TcPO2), transcutaneous carbon dioxide tension (TcPCO2), ankle-brachial pressure indices, toe pressures and toe-brachial pressure indices (TBI) were measured. Results, One hundred and sixteen limbs were studied in 61 subjects. Post-exercise, toe pressure and TBI increased in the non-diabetic group with arterial disease, but not in the groups with diabetes. Foot TcPO2 values increased in groups with diabetes and TcPCO2 decreased in all groups with arterial disease. Increased chest TcPO2 and decreased TcPCO2 were demonstrated in the groups with diabetes. Conclusions, Elevations in foot TcPO2 and reductions in TcPCO2 indicate improved cutaneous perfusion response to local heating post-exercise. Elevated toe pressures in the non-diabetes group suggest that improved perfusion may be associated with enhanced lower limb macrovascular haemodynamics. However, improvements in TcPO2 and TcPCO2 at foot and chest sites in diabetes imply a global change in cutaneous perfusion. The results suggest that brief exercise results in an improvement in cutaneous perfusion in non-critical PAOD, particularly in individuals with diabetes. [source] | |||||||||||||