Time-restricted Eating for the Prevention and Management of Metabolic Diseases.

Time-restricted feeding (TRF, animal-based studies) and time-restricted eating (TRE, humans) are an emerging behavioral intervention approach based on the understanding of the role of circadian rhythms in physiology and metabolism. In this approach, all calorie intake is restricted within a consistent interval of less than 12 hours without overtly attempting to reduce calories. This article will summarize the origin of TRF/TRE starting with concept of circadian rhythms and the role of chronic circadian rhythm disruption in increasing the risk for chronic metabolic diseases.

Aortic aneurysm screening using duplex ultrasound: Choosing wisely who to examine.

The noninvasive vascular laboratory plays a critical role in screening patients at risk for development of abdominal aortic aneurysm (AAA). One-time duplex ultrasound screening reduces aneurysm-related mortality due to rupture and is cost-effective. Population screening based on AAA risk factors is recommended, as it allows for proactive, elective repair of aneurysms at risk for rupture, and surveillance of smaller aneurysms for enlargement.

Planned Robotic Chronic Total Occlusion Percutaneous Coronary Intervention: Feasibility Report.

Background: Complex robotic percutaneous coronary intervention (R-PCI) is technically possible and leads to clinically comparable outcomes compared with the manual approach. However, there are limited data on the feasibility of chronic total occlusion (CTO) revascularization via the R-PCI approach.

Methods: Ten consecutive patients undergoing R-PCI for a coronary CTO at a single tertiary academic center were analyzed.

Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome.

In animal models, time-restricted feeding (TRF) can prevent and reverse aspects of metabolic diseases. Time-restricted eating (TRE) in human pilot studies reduces the risks of metabolic diseases in otherwise healthy individuals. However, patients with diagnosed metabolic syndrome often undergo pharmacotherapy, and it has never been tested whether TRE can act synergistically with pharmacotherapy in animal models or humans.

Vascular surgery resident education and hands-on training in vascular laboratory testing.

Diagnostic testing performed in the noninvasive vascular laboratory is a cornerstone of care for patients with suspected or known vascular disease. The Society for Vascular Surgery has mandated that vascular surgery resident training include mentored experience in performing vascular laboratory testing and interpreting its results. The trainee should be experienced with vascular laboratory instrumentation and testing protocols, be knowledgeable in ultrasound imaging of vascular anatomy, and be competent to classify disease severity relevant to the study indication.

Cardiorenal Syndrome: Pathophysiology.

Cardiorenal syndrome commonly refers to the collective dysfunction of heart and kidney resulting in a cascade of feedback mechanism causing damage to both the organs and is associated with adverse clinical outcomes. The pathophysiology of cardiorenal syndrome is complex, multifactorial, and dynamic. Improving the understanding of disease mechanisms will aid in developing targeted pharmacologic and nonpharmacologic therapies for the management of this syndrome.

Optimal Technique for Performing Invasive Pulmonary Angiography for Chronic Thromboembolic Pulmonary Disease.

High-quality invasive pulmonary angiography is invaluable for the evaluation of chronic pulmonary thromboembolic disease. Optimization of multiple technical factors enables optimal angiography, crucial for identifying both high-grade pulmonary thromboembolic disease warranting surgical resection, and surgically inaccessible disease for interventional and/or targeted medical therapy. Appropriate strategies to address the pitfalls encountered during angiography are highlighted.

Robotic-Assisted Percutaneous Coronary Intervention: Concept, Data, and Clinical Application.

The occupational hazards for interventional cardiologists include the risk of cataracts, malignancy, and orthopedic injury. Robotic technology is now available with the introduction of platforms for performing percutaneous coronary and peripheral interventions. The original remote navigation system has evolved into the current CorPath robotic system, now approved for robotic-assisted cardiovascular interventions.

Bacterial Contamination of Lead Aprons in a High-Volume Cardiac Catheterization Laboratory and Disinfection Using an Automated Ultraviolet-C Radiation System.

Objectives: Quantify and characterize bacterial contamination of lead aprons in a high-volume catheterization laboratory and evaluate the efficacy of decontamination using an ultraviolet-C (UV-C) radiation system.

Background: Bacterial contamination and ineffective disinfection of personal protective equipment in medical centers pose potential health risks to patients and medical staff. The contamination burden of lead aprons and a reliable disinfection strategy are unknown.

The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers.

Purpose Of Review: Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves-without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used.

The use of cangrelor with heparin for left ventricular assist device implantation in a patient with acute heparin-induced thrombocytopenia.

Background: Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent - cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015.

Safety and Feasibility of a Novel, Second-Generation Robotic-Assisted System for Percutaneous Coronary Intervention: First-in-Human Report.

Objectives: The goal of this study is to evaluate the safety and efficacy of the second-generation robotic-assisted system CorPath GRX (Corindus) for percutaneous coronary intervention (PCI).

Background: The first-generation CorPath 200 robotic-assisted system for PCI is effective, but is limited by the lack of an active robotic guide-catheter control. The CorPath GRX device enables robotic guide-catheter manipulation, in addition to guidewire and balloon/stent delivery.

The diabetic foot: Pathophysiology, evaluation, and treatment.

The pathophysiology of the diabetic foot ulcer and soft-tissue infection is due to neuropathy, trauma, and, in many patients, concomitant peripheral artery occlusive disease. Diabetic neuropathy results in foot deformity, leading to increased skin pressure with walking. Once a foot ulcer develops, the limb is at high risk for invasive infection and, when combined with peripheral artery occlusive disease, the patient should be considered to have critical limb ischemia.

A Bleeding Heart: Coronary-Cameral Fistula After Septal Myomectomy.

Coronary-cameral fistulas are relatively rare communications arising within the coronary vasculature entering into one of the four cardiac chambers. This case highlights a striking angiographic example of coronary-cameral fistula occurring after septal myomectomy, a complication occurring somewhat frequently with typical spontaneous resolution.

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with several risk factors but is most frequently seen as a rare consequence of an acute pulmonary embolism. Surgical pulmonary thromboendarterectomy (PTE) is potentially curative for CTEPH with the best outcomes seen for the treatment of primarily proximal, accessible lobar or segmental disease. For surgically inoperable patients, percutaneous balloon pulmonary angioplasty (BPA) is feasible and has good short- to mid-term efficacy outcomes.

sternal wound infection treated with ceftaroline: case report and literature review.

Case reports have emerged with identification of infections including sternal wound infections and foreign bodies such as central lines and shunts. We present a case that demonstrates the need to consider infection as a cause of sternal wound infection and highlights the utility of novel diagnostics to aid in the identification of unusual pathogens that can cause post-operative infections. We report here the first successful use of ceftaroline for treatment of a sternal wound infection.

Intervention after endovascular aneurysm repair: Endosalvage techniques including perigraft arterial sac embolization and endograft relining.

Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak.

Immune cell screening of a nanoparticle library improves atherosclerosis therapy.

Immunological complexity in atherosclerosis warrants targeted treatment of specific inflammatory cells that aggravate the disease. With the initiation of large phase III trials investigating immunomodulatory drugs for atherosclerosis, cardiovascular disease treatment enters a new era. We here propose a radically different approach: implementing and evaluating in vivo a combinatorial library of nanoparticles with distinct physiochemical properties and differential immune cell specificities.

Vascular surgical site infection: risk factors and preventive measures.

Surgical site infection (SSI) after arterial intervention is a common nosocomial vascular complication and an important cause of postoperative morbidity. Its prevention requires the vascular surgeon and the health care team to be cognizant of its epidemiology and patient-specific risk factors to apply effective measures to reduce the incidence. The majority of vascular SSIs are caused by Gram-positive bacteria with methicillin-resistant Staphylococcus aureus (MRSA) now a prevalent pathogen that is involved in more than one-third of cases.

Computerized tomography measured liver fat is associated with low levels of N-terminal pro-brain natriuretic protein (NT-proBNP). Multi-Ethnic Study of Atherosclerosis.

Background And Aims: N-terminal pro B-type natriuretic peptide (NT-proBNP) is inversely associated with diabetes mellitus, obesity and metabolic syndrome. We aim to characterize the association between NT-proBNP and nonalcoholic fatty liver disease (NAFLD), a condition strongly associated with metabolic syndrome.

Methods: 4529 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) free of cardiovascular disease, without self-reported liver disease and not diabetic at their baseline visit in 2000-2002 were included in this analysis.

Surveillance and follow-up after revascularization for critical limb ischemia.

The purpose of a structured and cost-effective surveillance program after surgical or endovascular intervention for critical limb ischemia is to optimize limb salvage and preserve arterial repair function. Surveillance programs should include clinical, vascular laboratory, and radiographic follow-up, and, when a high-grade progressive stenosis is identified, appropriately timed intervention should be performed. Because many patients with critical limb ischemia are older and many are frail with limited mobility, optimizing the durability of arterial intervention and keeping these patients ambulatory is an important factor in retaining an independent lifestyle and quality of life.

Angiosome-directed revascularization for critical limb ischemia.

The angiosome hypothesis states that the surface of the lower extremity is supplied by arteries consistently corresponding to regions of the foot. There is limited and conflicting evidence suggesting that angiosome-directed interventions improve wound healing and limb salvage. As peripheral arterial disease progresses, collaterals may develop that confound a predetermined angiosome map.

Cor triatriatum sinister identified after new onset atrial fibrillation in an elderly man.

A 73-year-old man with new onset atrial fibrillation with rapid ventricular response underwent transthoracic echocardiography that revealed an echogenic linear structure along the left atrium, suggestive of cor triatriatum sinister (CTS). CTS was confirmed with transesophageal echocardiography which demonstrated a proximal accessory atrium receiving pulmonary venous flow separated from a distal true atrium by a fibromuscular membrane with a large fenestration allowing flow between the chambers. In CTS, the left atrium is divided into proximal and distal chambers by a fenestrated fibromuscular septum.

Interpretation of duplex ultrasound dialysis access testing.

Conditions producing dialysis access dysfunction include failure of access maturation, cannulation injury to the conduit wall, thrombosis, low-volume flow, and aneurysmal degeneration. Duplex ultrasound is an accurate diagnostic technique to assess dialysis access anatomy and function, including the obligatory criteria for maturation, eg, volume flow >800 mL/min, conduit depth 0.6 cm from skin surface, and adequate (>5 mm) conduit diameter for cannulation.