Cardiorespiratory fitness is not associated with risk of venous thromboembolism: a cohort study

Abstract

Objectives. The inverse and independent association between cardiorespiratory fitness (CRF) and arterial thrombotic disease is well established. However, the potential association between CRF and venous thromboembolism (VTE) is not well known. We aimed to assess the prospective association of CRF with the risk of VTE. Design. Cardiorespiratory fitness, as measured by maximal oxygen uptake (VO_2max), was assessed using a respiratory gas exchange analyser in 2,249 men aged 42–61 years without a history of VTE at baseline in the Kuopio Ischemic Heart Disease prospective cohort. Cox-regression models were used to calculate hazard ratios (HR) with 95% confidence interval (CI) for VTE. We corrected for within-person variability in CRF levels using data from repeat measurements taken several years apart. Results. There were 144 (6.4%) incident VTE events recorded during a median follow-up of 25.2 years. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI: 0.53–0.64). The risk of VTE did not significantly decrease per 1 standard deviation increase in CRF in age-adjusted analysis (HR 0.90; 95% CI 0.75–1.08). The association remained consistent in analyses adjusted for several established and emerging risk factors (HR 0.90; 95% CI 0.73–1.12). The corresponding adjusted HRs were 0.80 (95% CI: 0.52–1.23) and 0.82 (95% CI: 0.51–1.32) respectively, when comparing the extreme tertiles of CRF levels. Conclusions. In a middle-aged Caucasian male population, CRF was not associated with future risk of VTE. Further studies are required to confirm and to generalize these findings, particulary in women and other age groups.     

Laser Doppler Flowmetry Detects Early Risk of Tracheal Anastomotic Complications after Lung Transplantation

Healing of tracheal anastomosis after en bloc double-lung or heart-lung transplantation was analysed with the aid of endoscopic laser Doppler flowmetry in 7 patients (group I) with successful bronchial artery revascularization (BAR) and in 5 patients (group II) without or with failed BAR. Fifteen patients undergoing coronary surgery served as a control group. Airway anastomotic index (AAI) was used to express the ratio of Doppler flowmetry values between donor and recipient airway. On postoperative day 1 the mean (range) AAI was 1.3 (1.1-1.6) in group I, 0.74 (0.25-1.0) in group II and 0.95 (0.7-1.4) in the controls.The difference was statistically significant between groups I and II (p = 0.01) and also between group I and the control group (p = 0.003). Two group II patients had low AAI (<0.5), and both developed airway anastomotic complications. We conclude that successful BAR increases blood flow in the airway anastomotic region, and that low AAI on the first postoperative day is a strong predictor of late airway anastomotic complications.     

Magnetic Resonance Imaging Angiography in Patency Evaluation of Bronchial Artery Revascularization Grafts

In this report we present our experience of non-invasive magnetic resonance imaging (MR) angiography and selective catheter angiography in assessing the patency of bronchial artery revascularization grafts after an en bloc double-lung and heart-lung transplantation. We studied 8 patients who had undergone pulmonary transplantation with direct bronchial artery revascularization. Catheter angiography was performed 10 days to 63 months postoperatively. MR angiography was performed within 24 h of the catheter procedure and the results were compared with the findings from catheter angiography. Catheter angiography showed the bronchial revascularization graft to be patent in 6 patients and occluded in 2. At MR angiography, the patency of bronchial artery revascularization grafts was reliably identified in 7 of the 8 patients. One patient had inadequate image quality because of void artefacts caused by haemostatic clips. It is concluded that MR angiography is a reliable method for assessing the patency of bronchial artery revascularization grafts.     

Bronchial Artery Revascularization Improves Tracheal Anastomotic Healing after Lung Transplantation

The study aimed to clarify the role of direct bronchial artery revascularization (BAR) after en bloc double-lung (DLT) and heart-lung transplantation (HLT). Group I comprised eight patients with en bloc DLT or HLT and successful BAR, while group II included 14 DLT or HLT cases without BAR or with failed BAR. From these groups, 2 subgroups were extracted: group III, including 6 cases of en bloc DLT with successful BAR and group IV 10 HLT cases without or with failed BAR. Airway healing was evaluated at bronchoscopy and patency of BAR with angiography. Pulmonary viral, bacterial and fungal infections, rejections and bronchiolitis obliterans syndrome (BOS) were registered. Tracheal healing at 2 weeks and 3 months was better in group I than in group II (p = 0.003 and p = 0.05, respectively). Compared with group IV, tracheal anastomotic healing at 2 weeks was better in group III (p = 0.007) and tended to be better also after 3 months (p = 0.07). The incidence of infections, rejection or BOS did not differ between groups I and II. BAR thus improved healing of tracheal anastomosis.     

Load-bearing capacity of all-ceramic posterior four-unit fixed partial dentures with different zirconia frameworks

The aim of this in vitro study was to compare the load-bearing capacity of posterior four-unit fixed partial dentures (FPDs) produced with two different yttria-stabilized polycrystalline tetragonal zirconia (Y-TZP) ceramics, one being a presintered material, the other a fully sintered, hot isostatically pressed material. Additionally, as a novel approach, the influence of preliminary mechanical damage upon the fracture force of an FPD has been investigated. A total of 20 frameworks each were milled from presintered zirconia and from fully sintered zirconia. Prior to veneering, 10 frameworks of each material were 'damaged' by a defined saw cut similar to an accidental flaw generated during shape cutting. Before fracture testing, all FPDs were subjected to thermal and mechanical cycling. Additionally, scanning electron microscopy was used to investigate fracture surfaces. Statistical analysis showed that FPDs milled from fully sintered zirconia had a significantly higher fracture resistance compared with specimens made from presintered material, whereas preliminary damage did not have a significant effect. After aging, FPDs made from both materials were capable of withstanding occlusal forces reported in the literature. Therefore, both types of Y-TZP may be suitable for posterior four-unit all-ceramic FPDs, although further prolonged aging experiments and prospective clinical trials are required to prove their fitness for clinical use.     

Construct and predictive validity of a self-reported measure of preclinical mobility limitation

OBJECTIVES: To validate self-reported preclinical mobility limitation concept and self-report assessment method against muscle power and walking speed, and to study the predictive validity of preclinical mobility limitation with respect to future risk of manifest mobility limitation. DESIGN: Observational prospective cohort study and cross-sectional analysis. SETTING: Research laboratory and community. PARTICIPANTS: A total of 632 community-living (age range, 75-81 y) women and men took part in the baseline assessments and 302 persons in the semi-annual interviews on mobility limitation over 2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Walking speed, muscle power, and self-reported preclinical and manifest mobility limitation. Preclinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty. At baseline, 4 subgroups were created according to self-reported preclinical mobility limitation in any of 3 mobility tasks (walking 2 km, walking 0.5 km, climbing up stairs): no limitation, preclinical limitation, and minor and major manifest limitation. RESULTS: At baseline, participants with preclinical mobility limitation showed intermediate levels of walking speed and muscle power, compared with those with no limitation or manifest mobility limitation. Participants reporting baseline preclinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline, whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation. CONCLUSIONS: The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability.