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Background and Objectives: According to the International Working Group on Diabetic Foot (IWGDF) risk classification, the estimated risk of developing a diabetic foot ulcer (DFU) is much higher in patients with a history of DFUs (Grade 3) compared to those with a peripheral neuropathy but without a history of DFUs (Grades 1 and 2). It has been suggested that microcirculation impairment is involved in DFU genesis and could be taken into account to refine the existing risk classification. The aim of this study was to evaluate microcirculation parameters in patients with diabetes according to their estimated DFU risk. Materials and Methods: A total of 172 patients with type 2 diabetes associated with a peripheral neuropathy and/or a history of DFUs were included and classified into two groups (Grade 1–2 and Grade 3) according to the IWGDF classification. All patients underwent an evaluation of peripheral neuropathy, plantar sudomotor function, and skin microcirculation parameters. These different parameters were compared between both groups. Results: There was no significant difference between the two groups in terms of age, diabetes duration, transcutaneous oxygen pressure level, skin microcirculatory reactivity, neuropathy disability score, neuropathy symptom score, or thermal sensitivity. Patients in Grade 3 were more likely to present with retinopathy (OR 3.15, 95%CI [1.53; 6.49]) and severe sudomotor dysfunction (OR 2.73 95%CI [1.29; 5.80] but less likely to have abnormal VPT (OR 0.20 95%CI [0.05; 0.80]). Conclusions: The present study found more retinopathy and a more pronounced alteration to sudomotor function in Grade 3 patients, suggesting that these parameters could be considered to better identify patients at high risk of DFUs. [ABSTRACT FROM AUTHOR]

Whether saline-induced hyperemia captures exercise-induced coronary flow regulation remains unknown. To describe absolute coronary flow (Q) and microvascular resistance (Rμ) adaptation during exercise in participants with Angina with Non-Obstructive Coronary Arteries (ANOCA). To explore correlations between saline and exercise-derived Coronary Flow Reserve (CFR) and Microvascular Resistance Reserve (MRR). Rμ, Q, CFR and MRR were assessed in the left anterior descending artery using continuous thermodilution with saline infusion at 10 mL/min (rest), 20 mL/min (hyperemia) and finally at 10 mL/min infusion rate during stress testing with a dedicated supine cycling ergometer. Incremental workload of 30 watts every two minutes was applied. A CFRsaline < 2.5 cutoff was used to identify coronary microvascular dysfunction (CMD). A minimal sample size of 29 participants was required to detect a hypothesized Spearman coefficient correlation r = 0.5 between CFRsaline and CFRexercise using a 80% power and 5% significance level test. CFRsaline-defined CMD was observed in 53.3% of the participants (16/30). During cycling, these patients had a lower ability to increase Q (7 [30.5;103.0] versus 21 [5.8;45.0] mL/min/30watts, P = 0.01) due to a lower reduction of Rμ (-109 [32;286] versus -202 [102;379] WU/30watts, P < 0.01) as compared with the normal CFRsaline group. In the overall population, CFRsaline and CFRexercise were 2.70 ± 0.90 and 2.85 ± 1.54 respectively, with an agreement classification of 83.3%. A good correlation between saline and exercise techniques for both CFR (r = 0.73, P < 0.0001) and MRR (r = 0.76, P < 0.0001) was observed (Fig. 1). Among participants with normal CFRsaline, 28.7% (4/14) had impaired CFRexercise < 2.5 at peak of exercise due to a moderate and late decrease of Rμ. Saline-induced hyperemia provided a valid surrogate for exercise physiology independently of the absolute level of CFR and MRR, although exercise provided more granularity to evaluate adaptation among participants with exercise related CMD. [ABSTRACT FROM AUTHOR]

Objectives: Antiphospholipid syndrome (APS) is an autoimmune disease combining the occurrence of thrombotic and/or obstetric events with the persistent presence of antiphospholipid antibodies (i.e. lupus anticoagulant (LA), anti-cardiolipin (aCL) and anti-beta-2-glycoprotein I (aβ2GPI) antibodies). Among the autoantibodies regularly found in patients with APS, antiphosphatidylserine/prothrombin (anti-PS/PT) antibodies seem promising because of their high correlation with LA positivity. The main objective of this study was to characterise the population of anti-PS/PT and/or anti-PT-antibody-positive patients in terms of APS severity and organ damage., Methods: We performed a prospective, monocentric, descriptive study of patients who had a dosage of IgG and IgG anti-PS/PT between March 2019 and May 2020. Clinical and biological data were collected from 148 patients, 128 had thrombosis including 64 with known APS according to the Sydney criteria, and 20 patients with antiphospholipid-antibody positivity (mainly LA positivity) without clinical manifestation of APS. Cases with active neoplasia including myeloproliferative disorders at the time of inclusion were excluded., Results: Anti-PS/PT positive patients did not display any particular thrombotic phenotype but had significantly more renal impairment (renal failure p=0.01 and proteinuria p=0.04), migraine (p=0.03), and thrombocytopenia (p=0.001) than negative patients, notably in the associated-APS patient group. Moreover, tetra-positivity (LA+, aCL+, a2βGPI+, and anti-PS/PT+) was associated with more severe APS (thrombotic recurrences, thrombosis under anticoagulant treatment, and a trend of more frequent catastrophic antiphospholipid syndrome). To a lesser extent, a similar phenotype was observed with anti-PT antibody positivity, but the 58.7% agreement with anti-PS/PT antibodies, suggests the presence of common but also specific PS/PT epitopes., Conclusions: The increased thrombotic risk associated with the aPS/PT antibodies would justify their testing in all APS patients in complementarity with the conventional anti-phospholipid antibodies to propose the best-adjusted treatment.