Post-exercise ankle blood pressure and ankle to brachial index after heavy load bicycle exercise.

The American Heart Association (AHA) recommendations for diagnosing peripheral artery disease (PAD) after exercise are a decrease >20% of ankle brachial index (ABI) or >30 mm Hg of ankle systolic blood pressure (ASBP) from resting values. We evaluated ABI and ASBP values during incremental maximal exercise in physically active and asymptomatic patients. Patients (n = 726) underwent incremental bicycle tests with pre- and post-exercise recording of all four limbs arterial pressures simultaneously. Univariate and multivariate analyses were performed to define the correlation between post-exercise ABI with various clinical factors, including age. Thereafter, the population was divided into groups of age: less than 40 (G < 40), from 40 to 44 (G40/44) from 45 to 49 (G45/49), from 50 to 54 (G50/54), from 55 to 59 (G55/59), from 60 to 64 (G60/64), and 65 and above (G ≥ 65) years. Results are mean ± SD. * is two-tailed P < .05 for ANOVA with Dunnett's post-hoc test from G40. Changes from rest in ASBP were -3 ± 22 (G < 40), -2 ± 20 (G40/44), 4 ± 22* (G45/49), 10 ± 25* (G50/54), 18 ± 21* (G55/59), 23 ± 27* (G60/64), and 16 ± 22* (G ≥ 65) mm Hg. Decreases from rest in ABI were 32 ± 9 (G < 40), 33 ± 9 (G40/44), 29 ± 8 (G45/49), 27 ± 10* (G50/54), 24 ± 7* (G55/59), 22 ± 12* (G60/64), and 21 ± 12* (G ≥ 65) % of resting ABI. Maximal incremental exercise results in ABI and ASBP changes are mostly dependent on age. The AHA limits for post-exercise ABI are inadequate following maximal incremental bicycle testing. Future studies detecting PAD in active patients should account for the effect of age.

External validation of the "walking estimated limitation calculated by history" (WELCH) questionnaire in patients with claudication.

OBJECTIVE: To externally validate the recently proposed "Walking Estimated Limitation Calculated by History" (WELCH) questionnaire. METHODS: A prospective study was performed on 450 new patients referred to our laboratory for treadmill testing (constant load 3.2 km/h and 10% slope for 15 minutes and then incremental increases). Results are presented as mean ± SD or median [25th-75th percentiles] or number (percentage). An ankle brachial index <0.90 defined the presence of peripheral artery disease (PAD). Typical "vascular-type claudication" is a lower-limb pain or discomfort that is absent at rest, appears at exercise, forces stopping, and disappears within 10 minutes of exercise stopping. The Spearman r coefficient of correlation between maximal walking time (MWT) on treadmill and WELCH scores was calculated for patients with (PAD+) or without (PAD-) PAD, and reporting typical vascular-type claudication (VTC+) or not (VTC-). RESULTS: The WELCH score was obtained in all included patients. The number (%) of patients with a WELCH score <25 was 37 (54%), 198 (65%), 14 (44%), and 18 (38%), and the Spearman correlation coefficient between WELCH score and treadmill MWT was 0.588, 0.609, 0.581, and 0.591 in the VTC-/PAD+, VTC+/PAD+, VTC-/PAD-, and VTC+/PAD- groups respectively (all p < .001). In PAD+/VTC+ patients, the WELCH positive predictive value for the inability to walk for 5 minutes on the treadmill was 79%. CONCLUSION: The WELCH score correlates moderately with treadmill-walking capacity in patients with or without PAD, and with or without typical VTC. It appears to be a simple to complete and easily scored instrument to help clinicians standardise the subjective estimation of walking capacity in their patients.

[Giant mitochondria in the A cells of the pancreas of a lizard: Varanus niloticus]. / Mitochondries géantes dans les cellules A du pancréas d'un varan: Varanus niloticus.

Pancreatic A cells of the lizard Varanus niloticus are characterized by the presence of two types of mitochondria: (a) normal, small mitochondria (about 0.4 X 1 micron), and (b) giant mitochondria, measuring up to 9 micron in length and 1 micron in diameter. Giant mitochondria show various shapes. Their matrix is filled with tubules, filaments, and dense granules. Transverse sections of tubules are polygonal in shape and about 20 nm in diameter. They are grouped in bundles. The filaments, about 9-10 nm in diameter, are arranged in parallel layers crossing each other at a 57 degree angle. In a closely related species, Varanus exanthematicus, pancreatic A cells do not show these peculiar features.

Alterations of endocrine pancreas B cells in a sahelian reptile (Varanus exanthematicus) during starvation.

During the long starvation period (November to June) of the lizard (Varanus exanthematicus), pancreatic B cells undergo profound modification. The degeneration of beta granules observed in electron microscopy appears correlated with the diminution of the immunoreactive insulin-like content of the pancreas. The analogy between the phenomena observed here and those reported in animals treated with alloxan is discussed.