Dysnatremia and risk of bloodstream infection in dialysis patients.

Background: Emerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by coexisting conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function).

A challenging ECG: a case of a lengthening PR interval.

A 62-year-old man presented to the emergency department with shortness of breath and chest tightness. His initial ECG appeared to have an ectopic P-wave with a lengthening PR interval consistent with second degree AV block - Mobitz Type I. But closer inspection showed a faster, independent atrial rate.

Ambulatory ECG monitoring in the age of smartphones.

Ambulatory electrocardiography (ECG) allows for extended monitoring of arrhythmias in a real-world setting. This article reviews the currently available ambulatory ECG devices and their differences in design, function, indications, efficacy, cost, and optimal use in clinical practice.

Why does FFR-guided PCI improve clinical outcomes? The missing link of post-PCI ischemia reduction.

This study demonstrates that FFR-guided PCI reduces noninvasively assessed ischemia more effectively than angiography-guided PCI. Improved ischemia resolution was associated with improved clinical outcomes. Superior ischemia resolution is likely the dominant mechanism of improved outcomes with FFR in clinical outcome trials, as opposed to avoidance of inappropriate stenting and its associated adverse events.

Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder.

Objective: To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D).

Design: Retrospective, cross-sectional, observational study.

Setting: Outpatient clinics and pharmacies.

Neuropathic pain and SCI: Identification and treatment strategies in the 21st century.

Pain is a common complication in patients following spinal cord injury (SCI), with studies citing up to 80% of patients reporting some form of pain. Neuropathic pain (NP) makes up a substantial percentage of all pain symptoms in patients with SCI and is often complex. Given the high prevalence of NP in patients with SCI, proper identification and treatment is imperative.

Deferred lesion failure in diabetes: A truly bad actor.

DM patients with stenoses whose FFR > 0.80 have a relatively high 14% rate of deferred lesion failure (i.e.

Association of comorbid disease burden at diagnosis with higher tumor grade in men with non-metastatic prostate cancer.

Background: While older age is associated with higher tumor grade, it is unknown whether comorbid disease burden has a similar, independent association. We sought to evaluate the impact of comorbid disease burden on tumor grade at diagnosis as indicated by biopsy Gleason score.

Methods: We conducted an observational cohort study of 1260 men newly diagnosed with non-metastatic prostate cancer from 1998 to 2004 at two Veterans Affairs Medical Centers.

Late breaking trials of 2016 in coronary artery disease: Commentary covering SCAI, ACC, TCT, EuroPCR, ESC, and AHA.

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2016, including SCAI, ACC, TCT, EuroPCR, ESC, and AHA. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2017 Wiley Periodicals, Inc.

Limitations of the National Comprehensive Cancer Network (NCCN) Guidelines for Prediction of Limited Life Expectancy in Men with Prostate Cancer.

Purpose: National Comprehensive Cancer Network prostate cancer guidelines for the prediction of life expectancy recommend subtracting 50% of life table predicted longevity for those in the lowest quartile of health. However, it is unclear how to identify these men and if their survival is uniform.

Materials And Methods: We sampled records of 1,482 men diagnosed with prostate cancer from 1998 to 2004 at 2 VA hospitals.

Transulnar catheterization: The road less traveled.

Transulnar is a reasonable alternative to transradial access. This meta-analysis shows that the transulnar route is as safe as transradial, but may be more difficult to successfully perform. Ultrasound imaging can determine whether the radial or ulnar route would be preferable in a particular patient.

Late breaking trials of 2015 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA.

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2015, including the MATRIX, ABSORB, and TOTAL trials. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2016 Wiley Periodicals, Inc.

AVERTing contrast nephropathy--delivering less to get more?

Delivered contrast volume is the major modifiable risk factor for contrast nephropathy. The AVERT system can divert 31-40% of contrast for peripheral angiography. The upcoming results of the AVERT clinical trial will demonstrate whether the AVERT system reduces contrast nephropathy.

Limitations and Pitfalls of Fractional Flow Reserve Measurements and Adenosine-Induced Hyperemia.

Coronary hemodynamic measurements provide a critical tool to assess the ischemic potential of coronary stenoses. Fractional flow reserve (FFR) is a reliable method to relate translesional coronary pressures to hyperemic myocardial blood flow. Although a basic understanding in FFR can be quickly achieved, many of the nuances and potential pitfalls require special attention.

Generalized benign cutaneous reaction to cytarabine.

Background: Cytarabine-induced toxicity manifests as various cutaneous morphologies. A generalized papular purpuric eruption has not been well described.

Objectives: We aimed to characterize a distinct cytarabine-related eruption.

Coronary perforation: What color is your parachute?

Coronary perforation is a rare but devastating complication of PCI, requiring rescue devices such as covered stents. This paper documents the successful use of a pericardial covered stent in 9/9 patients for coronary perforation. Pericardial covered stents have theoretical advantages over PTFE covered stents, but clinical studies proving this are not feasible.

Is the left main just another artery to FFR?

This meta-analysis includes all prospective FFR studies of the left main artery with outcomes. Patients who had deferral of revascularization in FFR-negative stenoses had no difference in cardiovascular events compared with patients who underwent revascularization. FFR-guided revascularization of left main stenosis is safe and effective.

Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial).

Objectives: This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access.

Background: US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization.

Methods: We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization.

63-year-old male with gastric outlet obstruction.

We describe a case of a 63-year-old male with complicated Bouveret's syndrome, both in its presentation and in its management. Bouveret's syndrome is a rare cause of gastric outlet obstruction resulting from mechanical obstruction from gallstones at the pyloroduodenal segment. As Bouveret's syndrome can be a diagnostic and therapeutic challenge for clinicians, we aim to identify clinical and radiologic pearls that can lower the threshold for the diagnosis of Bouveret's syndrome.

Extranuclear estrogen receptor's roles in physiology: lessons from mouse models.

Steroid receptors exist and function in multiple compartments of cells in most organs. Although the functions and nature of some of these receptors is being defined, important aspects of receptor localization and signaling to physiology and pathophysiology have been identified. In particular, extranuclear sex steroid receptors have been found in many normal cells and in epithelial tumors, where they enact signal transduction that impacts both nongenomic and genomic functions.