Podcasts about ischaemia

The Lancet Commission calls for a shift from focusing on late-stage ischaemia to targeting early atherosclerosis (ACAD)

In today's podcast, Laurence Bertrand and Suzanne Stokmans dissect this multicentre observational study from Japan recently published in the EJVES looking at infra popliteal revascularisation in CLTI. This study focuses on choosing the appropriate target lesion to achieve infrapopliteal revascularisation. They compare targeting in line flow to the wound based on personalised angiograms as opposed to in line flow to the foot based on the traditional angiosome concept. Link to the full article (Open Access): https://www.ejves.com/article/S1078-5884(24)00634-8/fulltext

Welcome to the Transatlantic series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today's episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS).   Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and is also a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia.    Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honorary Professor in the School of Health Science at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on the prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians.   Dr. Nicolaas Schaper is an emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was the coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium (ISDF 2023) and is Chair of the IWGDF.   Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society, and is currently a member of the Surgery Residency Review Committee of the ACGME.   Further reading and links:   The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer. Global vascular guidelines for CLTI Best-CLI Engaging patients and caregivers to establish priorities for the management of diabetic foot ulcers A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events Low-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis Diabetes, Lower-Extremity Amputation, and Death Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review.  Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review. Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial.   Mobile Applications:   Society for Vascular Surgery Mobile App for Staging of Chronic Limb-Threatening Ischemia.  European Society for Vascular Surgery Clinical Practice Guidelines Mobile Edition.   Hosts:    Dr. Naveed A. Rahman is a chief surgery resident at SUNY Upstate in Syracuse, NY. He will pursue a vascular surgery fellowship at the University of Maryland starting in 2024. His Doximity profile is https://www.doximity.com/pub/naveed-rahman-md. Twitter: @naveedrahmanmd Dr. Suzanne Stokmans is a fifth-year vascular surgery resident at the Isala Hospital in Zwolle, the Netherlands. Dr. Ezra Schwartz is a medical graduate from McGill University currently completing a Master of Medical Science in Medical Education at Harvard Medical School. He is an aspiring vascular surgeon and surgical education researcher. Twitter: @ezraschwartz10   Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Welcome to the Transatlantic Series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today's episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot, the European Society for Vascular Surgery, and the Society for Vascular Surgery.Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia. Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honarary Professor in the School of Health SCiences at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians.Dr. Nicolaas Schaper is emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium and is Chair of the IWGDF.Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society and is currently a member of the Surgery Residency Review Committee of the ACGME.Further reading:The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer.Global vascular guidelines for CLTIBest-CLIEngaging patients and caregivers to establish priorities for the management of diabetic foot ulcersA systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcersA vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trialRelease of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentaryESVS 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular DiseasesResults of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic eventsLow-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis*Diabetes, Lower-Extremity Amputation, and DeathHosts: Dr. Naveed A. Rahman is chief surgery resident at SUNY Upstate in Syracuse, NY. He will be pursuing vascular surgery fellowship at University of Maryland starting in 2024. His Doximity profile is www.doximity.com/pub/naveed-rahman-md. X: @naveedrahmanmdDr. Suzanne Stokmans is a 5th year vascular surgery resident in the Isala hospital in Zwolle, the Netherlands.Dr. Ezra Schwartz is a medical graduate from McGill University currently completing a Masters of Medical Science in Medical Eduation at Harvard Medical School. He is an aspiring vascular surgeon and surgical education researcher. X: @ezraschwartz10

On today's episode, we challenge the long-held belief about avoiding the use of adrenaline (or epinephrine) in fingers, toes, ears, and noses, a fear largely rooted in the risk of gangrene or tissue necrosis. Key points from today's conversation include: The Origins: We explore the origins of this belief, tracing it back to the pioneering work of Braun in the early 20th century. He used a combination of cocaine and adrenaline for anesthesia, yet cautioned against excessive use, especially in the fingers. Shaky Evidence: Despite the caution, we highlight that there have been only 48 reported cases of digital necrosis attributed to local anesthetics in the past 120 years. Interestingly, none involved the use of Xylocaine (lidocaine), and only 21 involved the use of epinephrine. Persistent Dogma: Despite contradicting evidence, this cautionary stance has been ingrained in medical practice, thanks in part to influential textbooks such as Bunnell's 'Surgery of the Hand' and Frederick Christopher's 'Textbook of Surgery.' Current Evidence: We delve into current studies, like the 2005 "Dalhousie Project," and a 2008 randomized-controlled study, both of which show no significant evidence of ischemia or tissue damage when using adrenaline. Furthermore, a peer-reviewed survey shows that the fear of using adrenaline in digits is still prevalent among junior doctors and medical students, highlighting the endurance of this myth. The Cochrane Review: Although the Cochrane Review didn't add much to the discussion, it agreed with the other evidence that there's no conclusive proof that adrenaline causes finger Ischaemia. Clinical Efficiency: The use of adrenaline in hand and finger surgeries could potentially increase clinical efficiency by eliminating the need for tourniquets and associated risks with sedation or general anesthesia.

This is the second part of the mesenteric ischemia interview with expert in the field professor Geelkerken. This podcast is solely focused on the median arcuate ligament syndrome (MALS) and whether it exists or not. We talk about aetiology, diagnostic tools & treatment and will talk about the CARoSO study.Shownotes:Metz et al; Systematic Review of the Efficacy of Treatment for Median Arcuate Ligament Syndrome. Eur J Vasc Endovasc Surg. 2022 Dec;64(6):720-732DOI: 10.1016/j.ejvs.2022.08.033Blauw et al; Coeliac Artery Release or Sham Operation in Patients Suspected of Having Median Arcuate Ligament Syndrome: The CARoSO study. Eur J Vasc Endovasc Surg. 2022 Nov;64(5):573-574DOI: 10.1016/j.ejvs.2022.07.043 Terlouw et al; The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center. Clin Transl Gastroenterol. 2020 Aug;11(8):e00200. DOI: 10.14309/ctg.0000000000000200Mensink et al; Gastric exercise tonometry: the key investigation in patients with suspected celiac artery compression syndrome. J Vasc Surg. 2006 Aug;44(2):277-81DOI: 10.1016/j.jvs.2006.03.038Van Petersen et al; Retroperitoneal endoscopic release in the management of celiac artery compression syndrome. J Vasc Surg. 2009 Jul;50(1):140-7DOI: 10.1016/j.jvs.2008.12.077ESVS 2017 guidelines Management of the Diseases of Mesenteric Arteries and VeinsDOI: https://doi.org/10.1016/j.ejvs.2017.01.010

The first of a 2-part interview on mesenteric ischaemia with expert in the field professor Bob Geelkerken.In this episode we talk about the different forms of mesenteric ischemia (acute, chronic, venous) and clinical challenges in diagnosis and treatment. Great to refresh or deepen your knowledge on this topic.Please also check the show notes for literature references if you are interested. Keep an eye out for the second part of the interview which is focussed completely on median arcuate ligament syndrome (MALS) - and if it exists or not..!Shownotes:Björk et al; Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS), European Journal of Vascular and Endovascular Surgery, Volume 53, Issue 4, 2017, Pages 460-510,DOI: https://doi.org/10.1016/j.ejvs.2017.01.010Terlouw et al; European guidelines on chronic mesenteric ischaemia. United European Gastroenterol J. 2020 May;8(4):371-395DOI: 10.1177/2050640620916681Huber et al; Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg 2021 Jan;73(1S):87S-115SDOI: 10.1016/j.jvs.2020.10.029Bjork and Huber; Chronic Mesenteric Ischaemia, the Transatlantic Perspective. Eur J Vasc Endovasc Surg 2021 Feb;61(2):177-178DOI: 10.1016/j.ejvs.2020.12.013Van Dijk et al; Validation of a score chart to predict the risk of chronic mesenteric ischemia and development of an updated score chart. United European Gastroenterol J 2019 Nov;7(9):1261-1270DOI 10.1177/2050640619856765Vaassen et al; Intraoperative quantification of fluorescence angiography for assessment of intestinal perfusion: in vivo exploration of clinical value. BJS Open 2022 May 2;6(3):zrac058DOI: 10.1093/bjsopen/zrac058Contact the mesenteric ischemia expert group in the Medisch Spectrum Twente trough: vaatchirurgie@mst.nl

With Alessia Gimelli, Fondazione Toscana Gabriele Monasterio, Pisa - Italy & Riccardo Liga, University of Pisa, Pisa - Italy Link to paper Link to editorial

James Anstey provides his thoughts on the recent developments in delayed cerebral ischaemia following a subarachnoid haemorrhage (SAH). Unlike TBI, where outcomes have plateaued after 20 years, outcomes have steadily improved for aneurysmal SAH. Early intervention, with an increasing amount of coiling as opposed to clipping as well as ICU all likely playing a part.   However, there is still a subsection of patients who deteriorate three days or more post their event. This is likely due to delayed cerebral ischaemia (as opposed to pure vasospasm). This is a diagnosis of exclusion in a patient who deteriorates after three days post bleed and without hydrocephalus, seizures, infection or another identifiable causal pathology.   There are several pathophysiological factors at play. Firstly, microcirculatory problems, including vasoconstriction in capillary beds and clumping with endothelial damage. This is perhaps why treatments to improve perfusion have had little success. Next, a combination of cortical spreading ischaemia and angiographic vasospasm.   Gold standard diagnosis of vasospasm remains the catheters angiography. Transcranial Doppler and CT angiography are both being used more and more and certainly have a role to play. CT angiography in particular stacks up reasonably well to catheter angiography and has a negative predictive value approaching 100%. One potential problem is overcalling the narrowing at times and has occasional artefacts. Transcranial Doppler is used occasionally however has challenges with reliable operators, is user dependent and only visualises a part of the cerebral circulation.    Patients deteriorate, and we of course want to make sense of it. But what do we do thereafter? Hypertensive therapy with the aim to improve cerebral perfusion is often the go to method. James shares his thoughts on this technique, with reference to the current literature. Similarly, we diagnose vessel narrowing as the problem, however therapies that reverses this does not seem to confer good clinical outcomes. There is a large list of failed therapies because of this fact.    This raises lots of questions about this patient group. Jame's main messages are to not become obsessive with vasospasm, use CT angiography as a good substitute for catheter angiography and be cautious of vasodilator therapies as they generally do not seem to affect long term prognosis. This #CodaPodcast was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting. For more like this, head to our podcast page. #CodaPodcast

The impact of resuscitation strategies on the gut is often neglected, as attention to circulatory and respiratory support takes priority. Leading ICU dietitian Varsha Asrani joins Todd to chat about the implications of gut ischaemia for the longterm recovery of our patients. See omnystudio.com/listener for privacy information.

Catalina Sokoloff presents Milrinone for treatment of post-aneurysmal subarachnoid haemorrhage vasospasm (delayed cerebral ischaemia.) Catalina firsts explains the pathophysiology of delayed cerebral ischaemia. She makes the point that there is still much we do not know. Probable mechanisms at the microcirculation level include release of free radicals, lipid peroxidation, cortical depression spreading and microthrombi formation. The ideal treatment once delayed cerebral ischaemia is present is therefore unknown. Mechanical angioplasty seems to be favourable in some instances however has its shortcomings. As such it is often reserved as a rescue option. ‘Triple H' therapy is intended to improve blood flow beyond constricted vessels; however, each component is flawed as Catalina explains. Intraarterial drugs have been tried however similarly, the evidence is lacking. This brings Catalina to Milrinone. This drug is a phosphodiesterase 3 inhibitor that has vasodilating and inotropic properties. Relevantly, the cerebrovascular smooth muscle contains large amounts of phosphodiesterase 3, making Milrinone promising. The combination of increased cardiac output, alongside decreased afterload theoretically should increase cerebral blood flow and subsequently brain perfusion. Milrinone has also been shown to be a potent anti-platelet aggregator as well as possessing anti-inflammatory properties. Both processes are likely involved in the pathophysiology of delayed cerebral ischaemia. Catalina continues to discuss the trials (both animal and human studies) that look at the effect of this drug. Whilst there are still no randomised control trials (at the time of the talk) looking at Milrinone, the early retrospective trial data is promising. There are of course still obstacles surrounding the drugs Namely, no standard dose, no guidelines regarding titration and concerns surrounding the vasodilating properties. Catalina concludes by proposing the pros of this treatment as she sees it. She argues that the apparent improvement in mortality, the non-invasive nature, and the lack of haemodynamic compromise are all indicators of the potential future of the treatment.   Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info. For more like this, head to our podcast page #CodaPodcast

In this episode, Dr Jennie Han discusses key points from a recent case report published in EHJ – Case Reports.

Welcome to the WellMedic podcast. In this podcast series. I will focus on going through several MRCGP AKT scenarios that will focus on the application of your knowledge. Each episode will cover a clinical topic taken from within the MRCPG curriculum guide. In this AKT podcast episode, we will cover chronic limb ischaemia in a housebound patient. The key is to focus on the application of your knowledge, but also some of the finer details covered within the relevant guidelines. WellMedic.co.uk hosts this MRCGP AKT podcast. WellMedic is a platform that focuses on the wellbeing of doctors across the UK. As a founder of WellMedic, I have developed online courses to help GP trainees PASS the MRCGP AKT.

This episode covers everything we need to know about acute limb ischaemia. - definition- aetiology- risk factors- severity assessment- pathophysiology- presentation- workup- managementIncluding how to perform embolectomy and fasciotomy DisclaimerThe information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this document.The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.The information contained in this podcast has not been independently verified.© Amanda Nikolic 2022

This week's episode starts us off with the vascular module of the general surgical curriculum.We cover chronic limb ischaemia, also known as chronic arterial disease. - definition- presentation- pathophysiology - risk factors- the rutherford classification - workup - severity classifications- management DisclaimerThe information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this document.The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.The information contained in this podcast has not been independently verified.© Amanda Nikolic 2022

This episode is an overview of Acute Limb Ischaemia - from basic pathophysiology to evaluation and treatment. Our guest is Andrew, a 3rd year medical student with a strong interest in surgery, hosted by Serge...

In this episode, Thomas Slater discusses key points from a recent case report published in EHJ – Case Reports.

It used to be thought that acute mental stress wasn't that bad for the heart, but over the years there's been a change of opinion. A group at Emory University in the US has used a public speaking exercise like a medical test for your risk of developing what's called myocardial ischaemia—a shortage of blood to the heart.

Chris provides a brief update on some of the postulated underlying mechanisms involved in subarachnoid haemorrhage associated brain injury. These mechanisms provide hints to future therapeutic targets that will hopefully expand our currently limited repertoire of options. Subarachnoid haemorrhage is a catastrophic type of stroke. Subarachnoid haemorrhage represents only 5% of the total stroke burden. Notably however, as it is most common in people aged 40-60 years, it has a disproportionate effect from a personal, social and economic perspective. Subarachnoid haemorrhage classically presents as a thunder clap headache and loss of consciousness. Unfortunately, it is associated with high morbidity and mortality rates. There is limited research in this area and there is significant opportunity to improve the way that we manage these cases.  The key is understanding the link between early brain injury and why we develop delayed cerebral ischemia. How can we stop this from happening? How can we better understand why good brains go bad? From #CodaZero Live, Christopher Andersen provides an update on delayed cerebral ischaemia. Join Chris as he looks for future treatment options through the mechanism of brain injury in subarachnoid haemorrhage. For more like this, head to our podcast page. #CodaPodcast 

This episode covers mesenteric ischaemia.Written notes can be found at https://zerotofinals.com/surgery/general/mesentericischaemia/ or in the general surgery section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

In this episode of The Retrograde Approach, Yogi and Sam delve into the world of acute limb ischaemia.

Sickle cell disease is an inherited abnormality of haemoglobin (which is the oxygen-carrying protein found in red blood cells). It is characterised by red blood cells changing shape to become sickle (or crescent)-shaped which then causes them to block tiny blood vessels causing ischaemia and also makes them more prone to haemolysing, causing anaemia. Links and resources: Follow us on Instagram @yourekiddingrightdoctors Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)

EJVES Editor's Choice

Are you trying to keep up with the general medicine literature but you are saturated with Covid Coughs, Swabs, Oxygenation, Isolation, Ventilation, and the Mortality of the Nation? Your ears are in the right place as we bring you last months most relevant (and sometimes less relevant) general medicine articles.---------------------------------------------------------- In this month's episode......why we shouldn't leave all the cycling to work to the anaesthetists...Association of injury-related hospital admissions with commuting by bicycle in the UK: a prospective population-based study. BMJ.https://doi.org/10.1136/bmj.m336...ACEI/ARBs shine through some difficult COVID related PR...Qiao, Yao et al. “Association Between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons With Low Estimated Glomerular Filtration Rate.” JAMA internal medicine, e200193. 9 Mar. 2020, doi:10.1001/jamainternmed.2020.0193...a new treatment regimen injects some life into HIV care...Orkin, Chloe et al. “Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection.” The New England journal of medicine vol. 382,12 (2020): 1124-1135. doi:10.1056/NEJMoa1909512....the ISCHAEMIA trial, morbidly expensive but no extra mortality...Maron, David J et al. “Initial Invasive or Conservative Strategy for Stable Coronary Disease.” The New England journal of medicine vol. 382,15 (2020): 1395-1407. doi:10.1056/NEJMoa1915922...brush up on treatment options for CFS/ME...Kim, Do-Young et al. “Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).” Journal of translational medicine vol. 18,1 7. 6 Jan. 2020, doi:10.1186/s12967-019-02196-9...a few pearls to help with your ICU redeployment...Lee, Robert Y et al. “Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life.” JAMA, vol. 323,10 950–960. 16 Feb. 2020, doi:10.1001/jama.2019.22523Lamontagne, François et al. “Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial.” JAMA, vol. 323,10 938–949. 12 Feb. 2020, doi:10.1001/jama.2020.0930...and finally, the great medical conundrum of our time...Ukai, Tomohiko et al. “Habitual tub bathing and risks of incident coronary heart disease and stroke.” Heart (British Cardiac Society), heartjnl-2019-315752. 24 Mar. 2020, doi:10.1136/heartjnl-2019-315752---------------------------------------------------------- Get in touch! @JournalSpotting or journalspotting@gmail.comWe'd love to hear from you: what you thought of the show, what you would like to hear, and if you have any articles that you would like us to share with the general medicine world! A wise man at your ARCP once said: "It didn't happen unless you've filled in a feedback form". (But seriously, we'd love to hear what you think!)

In this podcast, Professor Ashok Handa from the MDU’s cases committee discusses common questions around acute limb ischaemia and its diagnosis, looking at the potential medico-legal issues and what can be done to minimise risk.

In this episode, Mr Afshin Alijani will be asking Mr Stuart Suttie, consultant vascular surgeon in Dundee, to describe the management of an acutely ischaemic limb. The topics covered include how to diagnose acute limb ischaemia from the history and examination, how to differentiate a salvageable from a non-salvageable ischaemic limb, and the technique of arterial embolectomy.

After discussing the effects of an acute event threatening a limb, we discuss the effect of chronic ischaemia on the limb.

Much apologies for the delay in releasing episodes. We talk a little bit about the vascular component of cardiovascular disease as we near the end of this section.

Is Suspended Animation only in the realms of science fiction, or is this a realsitic treatment option? Mervyn Singer questions if we can prevent secondary reperfusion injury following cerbral ischaemia.

ABPI is not a credit card interest rate, but just about the most important measurement you can make in vascular surgery.Find out what it is, what it means, who not to do it on, and a video on how to perform it quickly and efficiently using our point of view technique (like you're really there!) with James Blackwell (research fellow in surgery) and Greg McMahon (consultant in Vascular Surgery, Royal Derby Hospital, UK). This comes up in OSCEs a lot and so is essential knowledge for exams, both undergraduate and postgraduate, and you never know, might actually be useful when you're treating patients! If you just want to watch how to do the ABPI and not hear the what and why, skip to 6:30 in the video

Gabrielle deVeber discusses a Review on childhood stroke.

Steve Smith enthralls the crowd with an eye-opening exploration of subtle ECG changes with potentially catastrophic outcomes

Louise Cullen and Rick Body fuel a contentious debate on the clinical significance of the high sensitivity troponin assay. Will your patients benefit from that extra digit ?

Louise Cullen and Rick Body fuel a contentious debate on the clinical significance of the high sensitivity troponin assay. Will your patients benefit from that extra digit ?

Types of cerebral infarct and causes of cerebral ischaemia.

Gerd Heusch discusses the potential of remote ischaemic preconditioning for people undergoing coronary artery bypass surgery.

Keaton Jones, Academic trainee at University of Nottingham and Royal Derby Hospital, UK, introduces stomas. In this video podcast stoma is defined, types of stoma discussed (especially ileostomy and colostomy, loop and end stomas) and complications listed. Keaton also takes you through how to examine a patient with a stoma (these patients tend to crop up in exams!) This video podcast will be useful for medical students as learning and interns and junior residents (foundation and core trainees) as revision for exams

Keaton Jones talks to Daren Forward, Consultant (Attending) Trauma and Orthopaedic Surgeon at Queens Medical Centre Nottingham, Regional Trauma Centre for the East Midlands of England, about the definition, presentation and management of compartment syndrome. The podcast is useful for medical students, foundation doctors/interns, surgeons in training and any healthcare professional involved in the management of trauma.

Klaus Fassbender discusses a Review about streamlining pre-hospital management of stroke.

Professor Chris Pugh tells us about the links between genetics, renal disease and oxygen sensing. The kidney plays a central role in our metabolism, by controlling various physiological balances. Genetics is central to these mechanisms, since gene defects lead to all sorts of malfunctions. Oxygen sensing mechanisms were first discovered as a result of studies on the production of the kidney hormone erythropoietin. We now know that the underlying system controls about 1000 genes. Professor Chris Pugh is working on the oxygen sensing functions of the body to assist in designing better therapies for disorders that involve oxygenation problems, such as angina and cancer.

Professor Chris Pugh tells us about the links between genetics, renal disease and oxygen sensing. The kidney plays a central role in our metabolism, by controlling various physiological balances. Genetics is central to these mechanisms, since gene defects lead to all sorts of malfunctions. Oxygen sensing mechanisms were first discovered as a result of studies on the production of the kidney hormone erythropoietin. We now know that the underlying system controls about 1000 genes. Professor Chris Pugh is working on the oxygen sensing functions of the body to assist in designing better therapies for disorders that involve oxygenation problems, such as angina and cancer.

Types of cerebral infarct and causes of cerebral ischaemia.

Alison Rowan discusses issue highlights, including PET imaging for the diagnosis of Parkinson's disease.

Helen Frankish discusses articles about Huntington's disease and stroke.

Alison Rowan discusses epilepsy services in the UK, and a review about CADASIL.

Helen Frankish discusses research on childhood stroke, and add-on drug therapy for MS.

Helen Frankish discusses the global incidence of stroke, and a research article assessing the malaria drug quinacrine for the treatment of prion disease.

Helen Frankish discusses articles on stroke prevention after TIA, and the potential of stem-cell therapy for the treatment of multiple sclerosis.

Background and aims: The transcription factor nuclear factor kappa B (NF-kB) has risen as a promising target for anti-inflammatory therapeutics. In the liver, however, NFkB inhibition mediates both damaging and protective effects. The outcome is deemed to depend on the liver cell type addressed. Recent gene knock-out studies focused on the role of NF-kB in hepatocytes, whereas the role of NF-kB in Kupffer cells has not yet been investigated in vivo. Here we present a novel approach, which may be suitable for clinical application, to selectively target NF-kB in Kupffer cells and analyse the effects in experimental models of liver injury. Methods: NF-kB inhibiting decoy oligodeoxynucleotides were loaded upon gelatin nanoparticles (D-NPs) and their in vivo distribution was determined by confocal microscopy. Liver damage, NF-kB activity, cytokine levels and apoptotic protein expression were evaluated after lipopolysaccharide (LPS), D-galactosamine (GalN)/LPS, or concanavalin A (ConA) challenge and partial warm ischaemia and subsequent reperfusion, respectively. Results: D-NPs were selectively taken up by Kupffer cells and inhibited NF-kB activation. Inhibition of NF-kB in Kupffer cells improved survival and reduced liver injury after GalN/LPS as well as after ConA challenge. While anti-apoptotic protein expression in liver tissue was not reduced, pro-apoptotic players such as cJun N-terminal kinase (JNK) were inhibited. In contrast, selective inhibition of NF-kB augmented reperfusion injury. Conclusions: NF-kB inhibiting decoy oligodeoxynucleotide- loaded gelatin nanoparticles is a novel tool to selectively inhibit NF-kB activation in Kupffer cells in vivo. Thus, liver injury can be reduced in experimental fulminant hepatitis, but increased at ischaemia–reperfusion.

1. The mechanism of post-ischaemic ectopic impulse generation in nerve is not known, and previous measurements of excitability changes in human motor axons have appeared to conflict. We have used automatic threshold tracking and different stimulus-response combinations to follow the effects on excitability of brief (5-10 min) periods of ischaemia, too short to induce motor fasciculations. Excitability changes have been compared at different sites in axons innervating hand, arm and foot muscles. 2. Threshold was determined as the percutaneous stimulus current required to excite a single motor unit, or to evoke a constant multiunit response, after rectifying and integrating the electromyogram (EMG). Three different waveforms of stimulus current were compared: short (less than or equal to 2 ms) pulses, long (100-200 ms) pulses to measure rheobase, and 100 ms current ramps. We also measured accommodation by recording the effects of subthreshold depolarizing currents on excitability. 3. Ischaemic and post-ischaemic excitability changes were greatest in the proximal parts of the longest motor axons, and greater if the sphygmomanometer cuff was inflated over, rather than proximal to, the stimulating site. 4. Using integrated EMG responses from abductor digiti minimi, the ulnar nerve stimulated above the elbow became rapidly much less excitable after ischaemia when tested with short pulses, but more excitable when tested with current ramps. The rheobase rose briefly, but then fell, often below resting level, always staying below the pulse and ramp thresholds. 5. The latency of the response to a rheobasic stimulus altered in parallel with the threshold to short current pulses, and increased dramatically after ischaemia. This latency increase was associated with a prolonged phase of 'negative accommodation', i.e. the continued increase in excitability to a maintained subthreshold depolarizing current. 6. Changes in excitability and accommodation similar to those occurring after ischaemia were recorded following high frequency trains of stimuli. They were attributed primarily to hyperpolarization by the electrogenic sodium pump, since comparable changes could be induced by passing a steady hyperpolarizing current through the stimulating electrode. 7. Threshold and latency recordings from single motor units during and after ischaemia resembled in most respects the multiunit responses, but single unit rheobase did not show a post-ischaemic fall below the resting level. Repetitive firing contributed to the low multiunit thresholds recorded with long current pulses during the post-ischaemic period. 8. We conclude that human motor nerves become simultaneously both more and less excitable than normal after 10 min of ischaemia, depending on the choice of stimulus and response.

The reasons for the resistance to ischaemia of peripheral nerves in diabetics are not well understood. We have now explored whether axonal depolarization underlies this phenomenon, as has previously been proposed. Resistance to ischaemia was determined by the new method of “threshold tracking”. This method revealed an increase in excitability of the peroneal nerve at the popliteal fossa during ischaemia, and a decrease in excitability in the post-ischaemic period. The extent of these alterations in 28 type 1 diabetics without peripheral neuropathy showed a strong correlation with the mean blood glucose concentrations during the last 24 h before examination. To test whether the ischaemic resistance was related to membrane potential, we also measured axonal superexcitability in 11 selected diabetics, since it has been shown that post-spike changes in excitability depend on membrane potential. Changes in excitability of the peroneal nerve were measured in the period between 10 and 30 msec following a conditioning supramaximal compound action potential. Under resting conditions, no differences in the post-spike superexcitability were found between controls and diabetics, despite striking differences in their responses to a 10-min pressure cuff. These observations indicate that membrane depolarization is not involved in the resistance to ischaemia of motor axons in diabetic subjects.