Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes.

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years.

Siddha Self-Inquiry for Flow, Bliss, and Uvagai: Mindfulness for Intuitive Lifestyle in Complex Cardiac Disease.

Cardiovascular disease (CVD) and mental health disorders contribute to significant healthcare expenses. Lifestyle approaches that empower and enable patients to participate in their recovery are needed with the increasing complexity of cardiac patients. Traditional Tamil medical practice of Siddha self-inquiry meditation targets holistic health through intuitive lifestyle transformation.

Totally Robotic Three-Vessel Percutaneous Coronary Intervention With Total Occlusion Using Robotic Automation.

Robotic-assisted percutaneous coronary intervention (PCI) has emerged as an alternative to manual PCI to mitigate the risk of occupational hazards for operators, and to increase precision of device placement. Previous studies have reported the safety and efficacy of robotic-assisted PCI in simpler lesions, and recently the safety and efficacy of robotic-assisted chronic total occlusion PCI have been reported. Herein, we report two cases with three-vessel disease, including total occlusions, successfully treated robotically utilizing newer guidewire and device automation.

Home-Based Arm Cardiac Rehabilitation in Disabled Veterans: A Pilot Study.

One of the cornerstones of treatment after acute coronary syndromes is cardiac rehabilitation (CR). However, traditional CR remains underused in the United States due to comorbidities and geographical limitations. To evaluate feasibility and safety of our individually tailored CR program, we evaluated twelve weeks of tele-monitored home-based arm ergometer and weight training exercises in seven Veterans.

A High-Reliability Organization Framework for Health Care: A Multiyear Implementation Strategy and Associated Outcomes.

Objectives: Applying high-reliability organization (HRO) principles to health care is complex. No consensus exists as to an effective framework for HRO implementation or the direct impact of adoption.

Methods: The Veterans Health Administration (VHA) National Center for Patient Safety established the high-reliability hospital (HRH) model for HRO adoption and piloted HRH in collaboration with the Truman VA Medical Center (Truman) during a 3-year intervention period (January 1, 2016-December 31, 2018).

A rare case of osteomyelitis and tenosynovitis in secondary syphilis.

We describe a case of secondary syphilis presenting with osteomyelitis and tenosynovitis of the thumb. With appropriate therapy, the patient's symptoms resolved and seroreversion occurred. MRI showed improvement with treatment.

Depletion of dendritic cells in perivascular adipose tissue improves arterial relaxation responses in type 2 diabetic mice.

Background: Accumulation of multiple subtypes of immune cells in perivascular adipose tissue (PVAT) has been proposed to cause vascular inflammation and dysfunction in type 2 diabetes (T2DM). This study was designed to investigate specific roles for dendritic cells in PVAT in the development of vascular inflammation and impaired PVAT-mediated vasorelaxation in T2DM.

Methods And Results: Studies were performed using db/db mice (model of T2DM) and their Db heterozygote (DbHET), lean and normoglycemic controls.

Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms.

Stress cardiomyopathy (SC) typically presents as potential acute coronary syndrome (ACS) in previously healthy people. While there may be physical or mental stressors, the initial symptom is usually chest pain. This form conforms to the published Mayo diagnostic criteria, is well reported and as the presentation is initially cardiac, is considered primary SC.

Awareness of kidney disease and relationship to end-stage renal disease and mortality.

Background: Often, patients with chronic kidney disease are reported to be unaware of it. We prospectively evaluated the association between awareness of kidney disease to end-stage renal disease and mortality.

Methods: We utilized 2000-2009 data from the National Kidney Foundation's Kidney Early Evaluation Program.

Oxidative stress in the cardiorenal metabolic syndrome.

Excess visceral adiposity contributes to inappropriate activation of the renin-angiotensin-aldosterone system despite a state of volume expansion and of salt retention that contributes to subclinical elevations of pro-oxidant mechanisms. These adverse effects are mediated by excess generation of reactive oxygen species (ROS) and diminished antioxidant defense mechanisms. Excess tissue (i.

Combination of direct renin inhibition with angiotensin type 1 receptor blockade improves aldosterone but does not improve kidney injury in the transgenic Ren2 rat.

Enhanced renin-angiotensin-aldosterone system (RAAS) activation contributes to proteinuria and chronic kidney disease by increasing glomerular and tubulointerstitial oxidative stress, promotion of fibrosis. Renin activation is the rate limiting step in angiotensin (Ang II) and aldosterone generation, and recent work suggests direct renin inhibition improves proteinuria comparable to that seen with Ang type 1 receptor (AT(1)R) blockade. This is important as, even with contemporary use of AT(1)R blockade, the burden of kidney disease remains high.

Evidence-based hypertension treatment in patients with diabetes.

Both impaired glucose tolerance and diabetes are associated with substantially increased prevalence of hypertension, cardiovascular and renal disease. The goal for hypertension treatment in diabetic patients is in evolution, because of recent clinical trials. For example, the results of the recent Action to Control Cardiovascular Risk in Diabetes-BP Arm (ACCORD BP) trial failed to show an additional benefit on cardiovascular event reduction at a mean systolic BP of 119 mm Hg.

Mineralocorticoid receptor-dependent proximal tubule injury is mediated by a redox-sensitive mTOR/S6K1 pathway.

Background/aims: The mammalian target of rapamycin (mTOR) is a serine kinase that regulates phosphorylation (p) of its target ribosomal S6 kinase (S6K1), whose activation can lead to glomerular and proximal tubular cell (PTC) injury and associated proteinuria. Increased mTOR/S6K1 signaling regulates signaling pathways that target fibrosis through adherens junctions. Recent data indicate aldosterone signaling through the mineralocorticoid receptor (MR) can activate the mTOR pathway.

A Case for Early Screening for Diabetic Kidney Disease.

Chronic kidney disease (CKD) is a public health dilemma contributing to increasing global morbidity and mortality. There is increasing recognition that early detection and management of CKD is critical in delaying disease progression as well as improving mortality rates. However, kidney disease is a silent process and usually goes undetected until more advanced stages, wherein the opportunity to intervene and improve kidney-related outcome is diminished, since awareness of CKD is low in earlier stages.

Hypertension in Cardiovascular and Kidney Disease.

The relationship between hypertension and chronic kidney disease (CKD) is bidirectional in nature and, generally, management strategies for cardiovascular risk reduction also attenuate progression of CKD. Prevalent hypertension increases with diminishing kidney function, and the management strategy changes with level of kidney function. In this review, we will examine the evidence for management of hypertension, as a modifiable risk factor for cardiovascular disease in CKD, and the impact of this management on progression of CKD.

Angiotensin II activation of mTOR results in tubulointerstitial fibrosis through loss of N-cadherin.

Background/aims: Angiotensin (Ang) II contributes to tubulointerstitial fibrosis. Recent data highlight mammalian target of rapamycin (mTOR)/S6 kinase 1 (S6K1) signaling in tubulointerstitial fibrosis; however, the mechanisms remain unclear. Thereby, we investigated the role of Ang II on mTOR/S6K1-dependent proximal tubule (PT) injury, remodeling, and fibrosis.

RETRACTED: Ventricular Ectopic Beats: An Overview of Management Considerations.

Ventricular ectopic beats are commonly seen in daily clinical practice. Majority of them being asymptomatic, some can cause symptoms. In a normal heart, their occurrence is of no clinical significance.