Modified ankle-brachial index detects more patients at risk in a Finnish primary health care

OBJECTIVES

Despite peripheral arterial disease (PAD), defined as ankle-brachial index (ABI)<or=0.9, being an independent predictor of cardiovascular morbidity and mortality, it is rarely used in the primary care. Various definitions for PAD (i.e., ABI<or=0.9 or ABI<or=0.95) exist. In addition, a modified ABI (ABI(mod)) using the lowest ankle pressure improves identification of patients at risk. The prevalence of PAD in primary care and association of different ABI calculations with atherosclerotic disease burden is not known.

DESIGN

The research was conducted as a prospective cross-sectional study. Finnish health centres and 99 general practitioners were selected and trained for ABI measurement. Consecutive patients were recruited using inclusion criteria: age 50-69 years and one or more cardiovascular risk factors or age >or=70 years or calf pain during exercise. A total of 817 patients were recruited.

METHODS

Research methods included interview and Doppler measurement of brachial and ankle pressures.

RESULTS

An ABI(mod)<or=0.9 yielded the highest prevalence of PAD (47.7%), had the best sensitivity and identified the highest number of patients with coronary artery disease (CAD), cerebrovascular disease (CVD), PAD, CAD/CVD/PAD and polyvascular disease (PVD) at the cost of reduced specificity. All ABI calculations were independently associated with atherosclerotic disease burden. Interestingly, ABI>or=1.4 had the strongest association with CVD.

CONCLUSIONS

PAD is highly prevalent among patients presenting to primary care. ABI(mod) calculation detects more number of patients at risk at the cost of reduced specificity. The association of high ABI with CVD noted in this study warrants future research for validation.

Neonatal estrogenization of the male mouse results in urethral dysfunction

PURPOSE

Analysis of voiding pattern, urodynamic measurements and immunohistochemical methods were performed in order to evaluate the effects of neonatal estrogenization on voiding functions of adult male mice.

MATERIALS AND METHODS

Metabolic cages were used for recording the voiding volumes and frequencies. Bladder pressure and mean flow during voiding were measured in transvesical cystometry. Location of estrogen receptors and organization of smooth muscles in lower urinary track were demonstrated using immunohistochemical staining.

RESULTS

Neonatally estrogenized (neoDES) male mice had lower voided urine volumes (the average voided urine volume and average of the three largest volumes) and higher voiding frequencies than control mice. In transvesical cystometry, the maximum bladder pressure during the high-frequency oscillation phase of voiding was significantly elevated. The average urinary flow rate was decreased.

CONCLUSIONS

Urodynamically, these findings are consistent with the concept that neonatally estrogenized mice have infravesical obstruction. The predominance of estrogen receptors in the periurethral region and changes in urethral smooth muscle cells immunocytochemically stained with alpha-actin-antibody support the concept of urethral wall musculature as a target of estrogen action.