No abstract

Peripheral artery disease (PAD) is a highly prevalent disease diagnosed by the use of ankle-brachial index (ABI) at rest. In some clinical conditions (diabetes, renal insufficiency, advanced age), ABI can be falsely normal and other tests are required for the PAD diagnosis (American Heart Association statement). This study was conducted to determine the accuracy of exercise transcutaneous oxygen pressure measurement (exercise-TcPo2) in detection of arterial stenosis ≥50% using computed tomography angiography (CTA) as the gold standard.We retrospectively analyzed consecutive patients referred to our vascular unit (University Hospital, Rennes, France) for exercise-TcPo2 testing from 2014 to 2015. All included patients had a CTA performed within 3 months of the exercise-TcPo2 test. Exercise-TcPo2 was performed on treadmill (10% slope; 2 mph speed). We calculated the Delta from Resting Oxygen Pressure (DROP) index (expressed in mm Hg) at the proximal and distal levels. Two blinded physicians performed stenosis quantification on CTA. The receiver operating characteristic (ROC) curve was used to define a cutoff point to detect arterial stenosis ≥50%, stenosis ≥60%, and stenosis ≥70%.A total of 34 patients (mean age 64 ± 2 years old; 74% men) were analyzed. The highest areas under the curve (AUC) were found for 60% stenosis at both proximal and distal levels. For stenosis ≥50%, sensitivity and specificity of proximal minimal DROP were 80.9% [67.1–89.7], 81.0% [59.3–92.7] respectively. For stenosis ≥50%, sensitivity and specificity of distal minimal DROP were 73.2% [60.3–83.1], 83.3% [53.8–96.2], respectively. For stenosis ≥60%, sensitivity and specificity of proximal minimal DROP were 82.5% [67.6–91.5] and 85.7% [67.7–94.8] respectively. For stenosis ≥60%, sensitivity and specificity of distal minimal DROP were 80.4% [67.3–89.1] and 88.2% [64.2–97.7], respectively. For stenosis ≥70%, sensitivity and specificity of proximal minimal DROP were 85.7% [67.7–94.8] and 75.0% [59.6–85.9] respectively. For stenosis ≥70%, sensitivity and specificity of distal minimal DROP were 86.0% [72.2–93.7] and 76.0% [56.1–88.7], respectively.Exercise-TcPo2 using a proximal minimal DROP value ≤−15 mm Hg or a distal minimal DROP value ≤−16 mm Hg is accurate to diagnose arterial stenosis especially stenosis ≥60% on the lower limbs. Exercise-TcPo2 is safe and noninvasive test that might be used in second line for PAD diagnosis.

Montelukast add-on therapy is effective for managing asthma and allergic rhinitis symptoms in patients who were previously uncontrolled with ICS or ICS/LABA treatment.

Objective: Our Canadian multicentre open-label study sought to evaluate, inpatients with moderate/severe lower urinary symptoms (LUTS) secondary tobenign prostatic hyperplasia, the effect on symptoms of 9 months of monotherapywith finasteride 5 mg following 9 months of combination treatment (finasteridewith an α-blocker) as quantified according to the International ProstateSymptom Score (IPSS).Methods: The primary outcome measure for efficacy was the maintenance ofIPSS response after cessation of the α-blocker. Subjects were treated with acombination of finasteride and an α-blocker for 9 months and then with finasteridealone for 3 or 9 months.Results: Results showed that the IPSS scores after 3 months of monotherapy werewithin the criteria for equivalence to those after 9 months of combination therapy.Symptom control equivalence was also found after 9 months of monotherapy.The IPSS response rate was also similar for combination and monotherapy.The safety profile was similar and as expected with these medications.Conclusion: Control of LUTS associated with BPH thus appears to be maintainedfor at least 9 months with finasteride alone, following a 9-month course of combinationtherapy with finasteride and an α-blocker, with similar safety profiles.

Montelukast is an effective and well-tolerated alternative to ICS treatment in patients with mild asthma who are uncontrolled or unsatisfied with low-dose ICS therapy.