Podcasts about Ischemia

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

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This week on Heart Doc VIP, Dr. Joel Kahn explores new and historic data showing that heart disease can begin shockingly early—sometimes before age 30. A pivotal 1998 study revealed that up to one-third of young adults already show signs of atherosclerosis, emphasizing the urgent need for primordial prevention starting in childhood. Dr. Kahn outlines the key health screenings every parent should know: blood pressure checks, body weight monitoring, and essential lab work. Later in the episode, Dr. Kahn revisits new findings on the Paleo diet, showing it may have included more plant- and starch-based foods than often assumed. He also discusses concerning links between processed meats and dementia, plus a cautionary look at a recent study on a specific group following the KETO diet—don't buy into the hype just yet. Additional topics include: The ISCHEMIA trial's insights on blood pressure control New research on the risk of dementia in people diagnosed with atrial fibrillation (AFIB) before age 70 Thanks to our partner endur.com. Use code KahnMD10 for a discount on Endur-Thine.

In this episode I am discussing one more cause of Acute Abdomen - Mesenteric Ischemia. I have discussed about the epidemiology, etiopathogenesis, clinical features, investigations, complications and treatment of Mesenteric Ischemia.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on TIMI Frame Count and Coronary Function in Women With Suspected Ischemia and Nonobstructed Coronary Arteries

In this episode, Dr. Valentin Fuster reviews the ischemia trial's findings on invasive versus conservative treatment strategies for patients with chronic total occlusions (CTOs). The trial revealed that while revascularization of CTOs improved quality of life for angina, the invasive approach did not significantly reduce heart-related deaths or heart attacks compared to conservative management.

In this episode, Dr. Valentin Fuster discusses a study from the ISCHEMIA trial, showing that achieving multiple guideline-directed medical therapy (GDMT) goals—especially blood pressure control—reduces cardiovascular events in chronic coronary artery disease patients. The study highlights the importance of early goal attainment and adherence, with the POLYPILL offering a potential solution to improve patient compliance.

In this episode of the Award-winning PRS Journal Club Podcast, 2025 Resident Ambassadors to the PRS Editorial Board – Christopher Kalmar, Ilana Margulies, and Amanda Sergesketter- and special guest, Brad Hill, MD, discuss the following articles from the March 2025 issue: “Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition” by Brogan, Lee, Beamer, and Dy. Read the article for FREE: https://bit.ly/IschemiaNerveStim Special guest, Brad Hill, MD, completed combined residency training in General Surgery and Plastic and Reconstructive Surgery at New York University, followed by a Fellowship in Hand and Upper Extremity Surgery at the Curtis National Hand Center. Dr Hill currently serves as the Director of Hand and Peripheral Nerve Surgery Education at Vanderbilt University Medical Center. He is an avid educator and guest on several other national medical podcasts. READ the articles discussed in this podcast as well as free related content: https://bit.ly/March25JCCollection

On this episode of JHLT: The Podcast, the Digital Media Editors invite lead author Jan Van Slambrouck, MD, to discuss the paper, “The effect of rewarming ischemia on tissue transcriptome and metabolome signatures: A clinical observational study in lung transplantation.”   Dr. Van Slambrouck is a general surgeon who's just finished his PhD training at the KU Leuven lab of respiratory disease and thoracic surgery in Belgium.   The episode explores:  How rewarming ischemia time (RIT) affects donor lungs, especially on the molecular level The pace of rewarming and how prior literature prepared the team to track and evaluate it Clinical strategies to reduce RIT and directly address molecular changes   For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Those involved in the pulmonary vascular disease space should tune in again later this month for a study on the safety and efficacy of riociguat in patients with PAH.   Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

N Engl J Med 2013;369:1115-23Background: The COURAGE trial was published in 2007. It compared up-front PCI to medical therapy alone in patients with stable CAD. Preventive PCI did not reduce the chance of dying or having a heart attack over a median follow up time of 5 years. The results rocked the cardiology world because for years prior to the publication of COURAGE, the standard of care called for revascularization of obstructive coronary stenosis. Despite what we would consider minor criticisms of COURAGE, the results have held over time as a preventive PCI strategy has failed repeatedly to reduce death or MI compared to medicine alone in subsequent large trials (BARI 2D, FAME 2, ISCHEMIA and ISCHEMIA-CKD) involving patients with stable CAD. But what about patients with acute coronary syndromes who have, a clearly defined “culprit” lesion and stable coronary stenosis of a non-infarct vessel? On the surface, the answer might seem simple - treat the “culprit” lesion with PCI and leave the stable disease alone. Continue optimal medical treatment of stable CAD indefinitely with consideration of revascularization only if new symptoms arise. But what if a stable coronary stenosis behaves differently in a patient with an acute coronary syndrome than in patients without it? Are these patients predisposed or particularly susceptible to acute plaque rupture and thrombogenesis to such an extent that they would benefit from a preventive revascularization strategy? The Primary Angioplasty in Myocardial Infarction (PRAMI) trial sought to test the hypothesis that immediate preventive PCI of non-culprit vessels plus the culprit vessel compared to culprit vessel only PCI would improve outcomes in patients with a STEMI and coronary stenosis of a non-infarct related artery.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: From 2008 through 2013, patients were enrolled from 5 coronary care centers in the United Kingdom. Patients could be any age with acute STEMI and multivessel CAD detected at the time of emergency PCI. The trial was limited to patients with STEMI because ST-segment elevation, unlike ST-segment depression, localizes the area of ischemia in the myocardium and an “infarct-artery” is usually easy to distinguish. Clinically stable patients were considered for eligibility after undergoing PCI of the infarct artery while they were in the catheterization lab. They were eligible if successful PCI of infarct artery was performed and there was stenosis of 50% or more in one or more non-infarct arteries. Exclusion criteria included cardiogenic shock, previous CABG, had left main or significant disease in the ostia of both the LAD and circumflex vessels, or if the only non-infarct stenosis was a chronic total occlusion.Baseline characteristics: The trial screened 2,428 patients and randomized 465 patients (19%) with 234 to preventive PCI and 231 to no preventive-PCI. The majority of patients were excluded for single vessel disease (1122/1922 [58%]). The average age of patients was 62 years and more than 75% were men. Close to 50% were current smokers. The infarct artery was anterior in 35%, inferior in 60% and lateral in 5%. Approximately 65% of patients had 2 vessel disease and 35% had 3 vessel disease.Procedures: After completion of PCI in the infarct artery, eligible patients were randomized and those assigned to the preventive-PCI group underwent the procedure immediately in all non-infarct arteries with a coronary stenosis >50%. PCI was discouraged at a later date (sometimes this strategy is referred to as “staged PCI”) in the no preventive-PCI group unless it was symptom driven. Any patient in the trial with subsequent symptoms of angina that were not controlled with medicine was required to undergo objective assessment of ischemia to secure a diagnosis of refractory angina. Follow-up information was collected at 6 weeks and then yearly thereafter.Endpoints: The primary endpoint was a composite of death from cardiac causes, nonfatal MI, or refractory angina. Secondary outcomes included the individual components of the composite endpoint along with noncardiac death and repeat revascularization. Myocardial infarction was defined as symptoms of cardiac ischemia and a troponin level >99% URL. However, within 14 days after randomization, MI diagnosis also required ECG evidence of new STE or left bundle branch block and angiographic evidence of coronary artery occlusion (essentially this makes it so only in-stent thrombosis or spontaneous STEMI count and other causes of peri-procedural MI do not - this would bias the trial in favor of the preventive-PCI group).Refractory angina was defined as angina despite medical therapy and objective evidence of myocardial ischemia (i.e., ischemia on ECG during spontaneous episode of pain or abnormal results on functional testing).It was determined that 600 patients would be needed to achieve 80% power to detect a 30% relative reduction in the preventive-PCI group, at a 5% level of significance, assuming an annual rate of the primary outcome of 20% in the control group. Stopping criteria were prespecified if the results from the trial showed a primary outcome difference at the 0.001 level of significance. Results: The trial was stopped early based on a significant difference (P50%, preventive PCI significantly reduced a primary composite outcome of cardiac death, nonfatal MI and refractory angina in the PRAMI trial with an estimated NNT of 7 patients over 2 years. Individual components of the primary endpoint that were significantly reduced included nonfatal MI and refractory angina by similarly large margins. These results may seem impressive at first glance but we urge extreme caution in their interpretation. First, this is a relatively small trial with a historically large effect size, especially when considering hard endpoints like cardiac death and nonfatal MI were included. Such results are often later found to be falsely positive when larger, confirmatory studies are conducted. Second, the trial was stopped early and early stopping is prone to yield false positive and/or exaggerated results. Third, inclusion of refractory angina in the primary endpoint, an endpoint susceptible to bias in an unblinded study (see earlier discussion of “faith healing” and “subtraction anxiety” in FAME 2; consideration also must be given to nocebo effects in patients who know they have “untreated blockages”), clouds the main findings by inflating the effect size and making the trial susceptible to large differences in underpowered endpoints before sufficient data can be accumulated on hard outcomes. For example, if the trial had sought to detect a conservative difference of 30% in a primary composite endpoint that only included cardiac death or nonfatal MI, based on an event rate of 12% in the control group (the actual event rate in the trial), over 2,200 patients would be needed for 80% power at a 5% level of significance. The estimated number of actual events would be around 230. However, only 47 events occurred in PRAMI making the results highly susceptible to noise.While results of PRAMI suggest a beneficial role for preventive-PCI in patients with STEMI, more evidence is needed to confirm the results.Thanks for reading Cardiology Trial's Substack! This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

In this episode of the Award-winning PRS Journal Club Podcast, 2025 Resident Ambassadors to the PRS Editorial Board – Christopher Kalmar, Ilana Margulies, and Amanda Sergesketter- and special guest, Brad Hill, MD, discuss the following articles from the March 2025 issue: “Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition” by Brogan, Lee, Beamer, and Dy. “Eaton-Littler Ligament Reconstruction in Thumb Carpometacarpal Joint Instability: Outcomes and Prognostic Factors in 74 Patients” by Nieuwdrop, Jongen, Hundepool, et al. “Cost Comparison of Digital Nerve Repair Techniques” Hu, Williams, Kammien, et al. Special guest, Brad Hill, MD, completed combined residency training in General Surgery and Plastic and Reconstructive Surgery at New York University, followed by a Fellowship in Hand and Upper Extremity Surgery at the Curtis National Hand Center. Dr Hill currently serves as the Director of Hand and Peripheral Nerve Surgery Education at Vanderbilt University Medical Center. He is an avid educator and guest on several other national medical podcasts. READ the articles discussed in this podcast as well as free related content: https://bit.ly/March25JCCollection

In this Journal of Vascular and Interventional Radiology (JVIR) audio episode, JVIR blog Editor Peter Li, MD, MS, uses artificial intelligence (AI) platforms ChatGPT and DeScript to produce a podcast discussion on a Dec. 9 blog entry by Isabel Okinedo on the paper, "Primary Limb-Based Patency for Chronic Limb-Threatening Ischemia Treated with Endovascular Therapy Based on the Global Limb Anatomic Staging System."Related resources:Read the original article, "Primary Limb-Based Patency for Chronic Limb-Threatening Ischemia Treated with Endovascular Therapy Based on the Global Limb Anatomic Staging System," by Minyong Peng, MD, Chao Li, MMed, Chengli Nie, MMed, Jiangwei Chen, MMed, and Jincai Tan, MMedRead the blog entry, "GLASS Classification Correlates with Primary Patency in Chronic Limb-Threatening Ischemia Patients Treated Endovascularly"SIR thanks BD for its generous support of the Kinked Wire.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

#molecularhydrogen #h2 #tylerlebaron #inflammation #nafld To say I was starstruck to have Dr Tyler LeBaron on the podcast today to discuss all things molecular hydrogen was an understatement. I have been the biggest fan of his ever since I discovered molecular hydrogen in 2019. We had an awesome conversation on; - what is molecular hydrogen - the therapeutic effects of H2 - inflammation, metabolic syndrome and fatty liver and how H2 can be beneficial - dosing and preparation of H2 - some interesting stories of my experience with H2 And lots more! You will definitely understand what molecular hydrogen in by the end of this conversation and please let us know if you have any questions in the comments. :) Tyler W. LeBaron, MSc, Ph.D., is the Founder and Executive Director of the science-based, nonprofit, Molecular Hydrogen Institute. His background is in biochemistry, physiology, and exercise science. He has taught physiology and currently teaches exercise physiology and chemistry lab classes at Southern Utah University as an adjunct instructor. Find out more about Dr LeBaron here; https://molecularhydrogeninstitute.org/tyler-lebaron-phd/ https://www.instagram.com/h2mhi/ https://www.instagram.com/tylerwlebaron/?hl=en @molecularhydrogeninstitute2797 Liver studies; https://molecularhydrogeninstitute.org/liver/ Ischemia and stroke studies; https://molecularhydrogeninstitute.org/ischemia-reperfusion-injuries/ Pain and inflammation studies; https://molecularhydrogeninstitute.org/pain-and-others/ As always, please like and subscribe. And please share with anyone you feel might benefit from this information. Thank you!

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on the Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events in a Multicenter Study.

Scoprire Un Ictus In Anticipo: Ora È Possibile Grazie Agli Esperti!Gli esperti hanno scoperto un nuovo rivoluzionario metodo per poter capire se si avrà in un futuro prossimo un ictus. Ecco di che cosa si tratta!#breakingnews #ultimenotizie #notiziedelgiorno #notizie #cronaca #anomalia #anticipo #salute #esperti #ictus #ischemia #occhi #retina #scoprire #studiosi

Alcohol and cancer, GLP-1 trial representativeness, diagnosing CAD, changing stroke rates in patients with AF, blanking periods after AF ablation are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Surgeon General Causes Hoopla Regarding ETOH Warning Dry January: Should Doctors Make It Year-Round? https://www.medscape.com/viewarticle/dry-january-should-doctors-make-it-year-round-2025a100009t Surgeon General Warning https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html GBD 2016 Collaboration Lancet https://doi.org/10.1016/S0140-6736(18)31310-2 RCT Voskobonik and colleagues https://www.nejm.org/doi/full/10.1056/NEJMoa1817591 Marcus and colleagues; UCSF https://pubmed.ncbi.nlm.nih.gov/33516710/ Review of ETOH AF https://doi.org/10.1016/j.jacc.2016.08.074 II. GLP-1 Agonists for Obesity –Trial vs Real World Generalizability of Trial Results https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826335 HRS Document ICD http://dx.doi.org/10.1016/j.hrthm.2014.03.041 III. Stress Testing and CAD Severity Reynolds and colleagues. Observational ISCHEMIA Sub-analysis https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013743 Foy Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 ISCHEMIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915922 IV. Changing Stroke Rates with AF Teppo and colleagues. Finnish Study https://doi.org/10.1016/j.jacep.2024.10.029 Quinn and colleagues. https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057 V. Patients' Lives Don't Pause for Blanking Periods Ruzieh and colleagues. https://doi.org/10.1016/j.ahjo.2024.100497 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2024 Emergency Medicine Practice article, Diagnosis and Management of Acute Mesenteric Ischemia in the Emergency DepartmentIntroduction to Acute Mesenteric IschemiaStatistics on prevalence and mortalityPathophysiology and EtiologyMesenteric artery embolismMesenteric artery thrombosisMesenteric venous thrombosisNon-occlusive mesenteric ischemiaDiagnosisManagement and TreatmentSpecial PopulationsPediatric patientsPregnant patientsElderly patientsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net 

Why Australian women tend to have poorer cardiac disease outcomes than their male counterparts The intricacies of INOCA, ANOCA and MINOCA and how they are diagnosed Spontaneous coronary artery dissection and its outcomes Takotsubo cardiomyopathy: Diagnosis, treatment and potential recurrence Host: Dr Terri Foran | Total Time: 29 mins Expert: Dr Fiona Foo, Clinical and Interventional Cardiologist Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Contributor: Travis Barlock MD Educational Pearls: What is the ST segment? The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of ventricular repolarization (T-wave).  It should appear isoelectric (flat) in a normal ECG. What if the ST segment is elevated? This is evidence that there is an injury that goes all the way through the muscular wall of the heart (transmural) This is very concerning for a heart attack (STEMI) but can be occasionally caused by other pathology, such as pericarditis What if the ST segment is depressed? This is evidence that only the innermost part of the muscular wall of the heart is becoming ischemic This has a much broader differential and includes a partial occlusion of a coronary artery but also any other stress on the body that could cause a supply-and-demand mismatch between the oxygen the coronaries can deliver and the oxygen the heart needs This is called subendocardial ischemia What else should you look for in the ECG to identify subendocardial ischemia? The ST-depressions should be at least 1 mm The ST depressions should be present in leads I, II, V4-6 and a variable number of additional leads. There is often reciprocal ST elevation in aVR > 1 mm The most important thing to remember when you see subendocardial ischemia is…history Still, keep all cardiac causes on your differential, such as unstable angina, stable angina, Prinzmetal angina, etc. Also consider a wide array of non-cardiac causes such as severe anemia, severe hypertension, pulmonary embolism, COPD, severe pneumonia, sepsis, shock, thyrotoxicosis, stimulant use, DKA, or any other state that lead to reduced oxygen supply to the subendocardium and/or increased myocardial oxygen demand. References Birnbaum, Y., Wilson, J. M., Fiol, M., de Luna, A. B., Eskola, M., & Nikus, K. (2014). ECG diagnosis and classification of acute coronary syndromes. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 19(1), 4–14. https://doi.org/10.1111/anec.12130 Buttà, C., Zappia, L., Laterra, G., & Roberto, M. (2020). Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 25(3), e12726. https://doi.org/10.1111/anec.12726 Cadogan, E. B. a. M. (2024, October 8). Myocardial Ischaemia. Life in the Fast Lane • LITFL. Retrieved December 7, 2024, from https://litfl.com/myocardial-ischaemia-ecg-library/#:~:text=ST%20depression%20due%20to%20subendocardial,left%20main%20coronary%20artery%20occlusion. Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Broadcast from KSQD, Santa Cruz on 11-07-2024: Dr. Dawn opens with a guided deep breathing exercise to help listeners manage stress and maintain emotional balance in challenging times. She helps an emailer understand a stress test result for a 72-year-old patient, explaining ST changes, ischemia, and the importance of follow-up angiography tests for heart health evaluation. The show addresses another email from a listener asking for advice about managing alcohol use in an 85-year-old dementia patient. Dr. Dawn discusses medical detox options and medications like Naltrexone for treatment. Dr. Dawn explores the use of low-dose Naltrexone for chronic pain management, particularly in diabetic neuropathy and fibromyalgia. She discusses cataract formation risks associated with St. John's Wort and also mentions the adverse interaction between prostate medications and cataract surgery which increases the risk of complications. Make sure your ophthalmologist knows you are on prostate medications The show features an in-depth explanation of A1 versus A2 milk proteins, their digestive impacts, and potential inflammatory effects in the body. Dr. Dawn concludes with groundbreaking research on creating viable oocytes from stem cells in mice, discussing implications for future fertility treatments.

N Engl J Med 2016;375:2223-2235Background: Smaller randomized trials have shown that outcomes are not significantly different when patients with left main disease are treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In the subgroup of patients with left main disease in the SYNTAX trial, outcomes were similar between PCI and CABG in patients with low or intermediate SYNTAX score but PCI was associated with worse outcomes in patients with high SYNTAX score.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial sought to assess if PCI was noninferior to CABG in patients with left main coronary artery disease.Patients: Eligible patients had left main stenosis of 70% or more. Patients with stenosis of 50% to 69% were enrolled if the stenosis was hemodynamically significant as determined by non-invasive or invasive testing. Patients were also required to have low or intermediate SYNTAX score defined as a score of 32 or less.Patients were excluded if they had prior PCI to the left main coronary artery, PCI to any other coronary artery within 1 year, prior CABG, a need for a concomitant cardiac surgery, elevated CK-MB, or life expectancy less than 3 years due to non-cardiac conditions.Baseline characteristics: The trial randomized 1,905 patients – 948 randomized to PCI and 957 to CABG.The average age of patients was 66 years and 77% were men. Approximately 74% had hypertension, 70% had hyperlipidemia, 29% had diabetes, 17% had prior myocardial infarction and 22% were current smokers. The average left ventricular ejection fraction was 57%.The clinical presentation was myocardial infarction within 7 days in 14% of the patients, unstable angina in 24%, stable angina in 53%, and silent ischemia or other in 8%.Distal left main bifurcation or trifurcation disease was present in 81% of the patients, and 2- or 3-vessel coronary artery disease was present in 51%. SYNTAX score based on a core laboratory evaluation was low (22 or less) in 36% of the patients, intermediate (23-32) in 40% and high (33 or more) in 24%. However, based on site assessment, SYNTAX score was low in 61% of the patients and intermediate in 39%.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo CABG or PCI using fluoropolymer-based cobalt–chromium everolimus-eluting stents (XIENCE, Abbott Vascular). Randomization was stratified based on the presence of diabetes, SYNTAX score (low vs intermediate) and study center.Dual antiplatelets were given for at least 12 months following PCI.CABG was performed with or without cardiopulmonary bypass based on the operator discretion. The use of arterial grafts was recommended.Endpoints: The primary endpoint was a composite of death from any cause, myocardial infarction and stroke at 3 years. Secondary endpoints included the components of the primary endpoint as well as repeat revascularization.Analysis was performed based on the intention-to-treat principle. Sample size was calculated based on non-inferiority. The sample size to provided 80% power with one-sided alpha of 0.025 was 1,900 patients. This calculation was based on an assumed 11% event rate in each study group and 4.2% absolute difference non-inferiority margin.The original sample size was 2,600 patients which would have provided 90% power. However, both were adjusted due to slow enrollment.Results: Among the 948 patients assigned to the PCI arm, 99% underwent the procedure. The mean number of stents implanted per patient was 2.4. Among the 957 patients assigned to the CABG arm, 96% underwent the surgery. The mean number of grafts per patient was 2.6. An internal mammary artery graft was used in 99% of the patients. The median follow up time was 3 years.The primary composite endpoint was not significantly different between CABG and PCI (14.7% with CABG vs 15.4% with PCI, absolute difference: 0.7%, upper bound of the 97.5% CI: 4.0%; p= 0.02 for non-inferiority). There was no significant difference in death from any cause (5.9% with CABG vs 8.2% with PCI; p= 0.11), myocardial infarction (8.3% with CABG vs 8.0% with PCI, p= 0.64) or stroke (2.9% with CABG vs 2.3% with PCI; p= 0.37). Ischemia-driven revascularization was higher with PCI (12.6% vs 7.5%; p

Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General. Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios. El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito. La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen. Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Si los comentarios son positivos, traduciremos todo nuestro curso al español. presentadores de podcast: - Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University. - Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador. Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes. ------ Behind the Knife is the world's leading surgical podcast and surgical education platform.  Our mission is to create innovative surgical education content that is accessible to all.  We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week. Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios.  The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors. The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test. Our content is available on our iOS and Android apps and website (behindtheknife.org).  Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material.  If feedback is positive, we will translate our entire course to Spanish.  Hosts: - Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University. - Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

N Engl J Med 2023;389:2319-2330Background: Percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction as seen in COURAGE, FAME 2, ISCHEMIA and ISCHEMIA-CKD. However, unblinded studies have indicated that revascularization may improve symptoms, which is a key factor in driving PCI decisions for many patients. ORBITA was the first blinded, placebo-controlled trial of PCI for stable angina and found no significant improvement in exercise time with PCI. The trial had a high use of anti-anginal medications, with an average of 3 medications per patient  pre-randomization. However, this level of medication use is not always achievable in clinical practice due to side effects and challenges with adherence.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The ORBITA-2 trial sought to test the hypothesis that PCI improves symptoms in patients with stable angina who are not receiving background antianginal medications.Patients: Eligible patients had angina or angina equivalent, severe coronary stenosis of 70% or more in at least one coronary artery and evidence of ischemia on non-invasive testing or by invasive pressure wire assessment.Main exclusion criteria were acute coronary syndrome within 6 months, previous CABG, left main disease, chronic total occlusion of target vessel, and left ventricular ejection fraction of 35% or less.Baseline characteristics: The trial randomized 301 patients – 151 randomized to PCI and 150 to placebo PCI.The average age of patients was 64 years and 79% were men. Approximately 63% had hypertension, 28% had diabetes, 72% had hyperlipidemia, and 62% were current or previous smokers. Left ventricular systolic function was normal in 96% of the patients.Angina class based on the Canadian Cardiovascular Society (CCS) angina grade was 2 in 58% of the patients and 3 in 39%. Approximately 80% had single vessel disease, 17% had 2-vessel disease and 2% had 3-vessel disease. Left anterior descending coronary artery was the target vessel in 55% of the patients.Procedures: Patients initially underwent coronary angiogram and invasive physiologic assessment was performed in each vessel with 50% or more stenosis. Patients underwent the coronary angiography while wearing headphones with music playing for auditory isolation throughout the procedure. Patients who had evidence of ischemia in at least one territory were then randomized in a 1:1 ratio to PCI or placebo PCI. Patients were sedated until they were unresponsive to verbal and tactile stimuli. In the PCI group, all target vessels were treated during the index procedure. Patients in the placebo group did not receive intervention and were kept sedated for at least 15 minutes after randomization.The recovery room staff and all subsequent medical providers were unaware of the treatment assignments. The operator and research staff who were present during the randomization procedure had no further contact with the patients.Anti-anginal medications were stopped at enrollment. Antihypertensive medications that has antianginal properties were replaced with different agents.Patients were followed up for 12 weeks during which they reported daily angina symptoms using a smart phone application. New anti-anginal medications or increase in the dose of anti-anginal medications were also tracked. At the end of the 12 weeks, patients completed symptom and quality-of-life questionnaires, had an assessment of CCS class, and underwent a treadmill exercise test and dobutamine stress echocardiography. After all of these were completed, patients and medical staff were unblinded.Endpoints: The primary endpoint was an angina symptom score calculated based on the number of angina episodes that a patient reported on a given day and the number of units of antianginal medication prescribed on that day. In this score, each episode of angina on a particular day counts as 1 point for a maximum of 6 points per day (0 points given to no angina), and each unit of anti-anginal medications counts as 7 points (0 points given for no antianginal medications prescribed that day). In supplement table 3, authors provided what counted as one unit of anti-anginal medications. For example, atenolol 25 mg counted as 1 unit and amlodipine 2.5 mg counted as one unit.Secondary endpoints included frequency of angina, use of ant-anginal medications, exercise time on treadmill test and symptoms questionnaires.Analysis was performed based on the intention-to-treat principle. The estimated sample size to achieve 80% power at 0.05 alpha was 284 patients. This is based on assumed standard deviation of 6 angina symptom score units and a difference of 2 units between PCI and placebo.Results: Data were available on 99.7% of the total patient-days.Compared to placebo, PCI reduced the mean angina symptom score (2.9 vs 5.6, OR: 2.2, 95% CI: 1.4 - 3.5; p

For full review of the trials, please visit https://cardiologytrials.substack.com/ Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

N Engl J Med 2020;382:1395-407 - ISCHEMIAN Engl J Med 2020;382:1608-16 - ISCHEMIA-CKDBackground: The COURAGE trial, published in 2007, represented a major reversal in cardiovascular medicine. In patients with stable CAD an initial strategy of revascularization plus medical therapy did not reduce the chance of dying or having a heart attack compared to an initial strategy of medical therapy alone. Prior to these results, patients with stable CAD were routinely managed with an initial invasive approach and the field of cardiology was intensely focused on finding coronary blockages and “fixing” them in symptomatic and asymptomatic patients alike. Thus, it's not surprising that following results from COURAGE, the practice continued to be vigorously defended and applied routinely in the management of patients with stable CAD.The first major attempt to reverse the results of COURAGE came from the FAME 2 trial, published in 2012, which tested the hypothesis that patients with stable CAD and an abnormal fractional flow reserve (FFR) in the cath lab would do better with an initial invasive strategy compared to medical therapy alone. The trial was stopped early for efficacy but the positive results were driven entirely by revascularization during follow up - not death or heart attack. The trial was criticized for being stopped inappropriately without providing an answer to whether an early invasive strategy improved hard endpoints compared to initial medical therapy alone. The concepts of “faith healing” and “subtraction anxiety” are useful for understanding the results and limitations of the FAME 2 trial.The ISCHEMIA trial which began enrolling patients in 2012 sought to overcome limitations of COURAGE and FAME. The investigative aim of the study was to test the hypothesis that in patients with stable CAD and moderate to severe ischemia on provocative testing, an initial invasive strategy reduced a composite of major cardiac events compared to initial medical therapy alone. The ISCHEMIA-CKD trial was performed in conjunction with the ISCHEMIA Research Group to address an important knowledge gap in managing patients with CAD. Patients with advanced chronic kidney disease (CKD) experience a higher rate of cardiac events than their counterparts without CKD; however, they are also at a higher risk of procedural complications. The standard of care at the time was generally to manage a patient with stable CAD and CKD like any other patient with CAD despite the fact that such patients were historically excluded from participation in clinical trials and thus, there was really no data from clinical trials to guide decision making.The ISCHEMIA-CKD investigators sought to test the hypothesis that in patients with advanced CKD and stable CAD and moderate to severe ischemia on stress testing, an initial invasive strategy reduced death or MI compared to initial medical therapy alone.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: For the ISCHEMIA trial, eligible patients had to be at least 21 years of age or older with at least moderate ischemia on a qualifying stress test based on the following criteria:* Nuclear perfusion with SPECT or PET with >/= 10% ischemic myocardium* Echocardiography with >/= 3/16 segments with stress-induced severe hypokinesis or akinesis* Cardiac MRI with >/= 10% ischemic myocardium on perfusion imaging and/or >/= 3/16 segments with stress-induced severe hypokinesis or akinesis on wall motion assessment* Exercise treadmill test without imaging that met all 4 following criteria* clinical history of typical angina or typical angina during the stress test* absence of resting ST depression > 1.0 mm or confounders that render exercise EKG non-interpretable (LBBB, LVH with repolarization, pacemaker, etc.)* exercise-induced horizontal or downsloping ST depression >/= 1.5 mm in 2 leads or >/= 2.0 mm in any lead or ST elevation >/= 1.0 mm in a non-infarct territory* either of the following:* workload at which ST segment criteria are met is NOT to exceed completion of stage 2 of a standard Bruce protocol or 7 METS if a non-Bruce protocol is used* ST segment criteria are met at

On this month's EM Quick Hits podcast: Ian Chernoff on the often elusive diagnosis of traumatic coronary artery dissection, Anand Swaminathan on proper use of insulin in DKA and in hyperkalemia, Brit Long and Hans Rosenberg on mesenteric ischemia pearls and pitfalls in diagnosis and management, Dave Jerome on recognition and management exercise-associated hyponatremia and heat illness and Jesse McLaren on the Queen of Hearts AI model in helping identify occlusion MI on ECG... Help Support EM Cases by Giving a Donation here: https://emergencymedicinecases.com/donation/

When Michelle discovered her patient was paralyzed, it surprised the whole medical team. This patient who was previously mobile and recovering from septic shock was now paralyzed and ultimately diagnosed with spinal cord ischemia, but could early intervention have changed the outcome?In this episode, we discuss the causes, signs, diagnosis and treatment of spinal cord ischemia. Michelle shares powerful insights from her work in neurocritical care, including a technique for detecting easy-to-miss neurological changes.Tune in to find out how you can improve patient outcomes when managing spinal cord ischemia!Topics discussed in this episode:Michelle's passion for patient care and nurse advocacyCritical case study: discovering a spinal cord abscessHow the patient developed spinal cord ischemiaPathophysiology and signs of spinal cord ischemiaNeurological assessment tipsPeripheral versus central nervous system assessmentsDiagnostic criteria and the diagnostic processPrognosis and patient recoveryTreatment options and challengesThe role of the ABCDEF bundle in critical careConnect with Michelle:https://www.michellededeo.com/https://www.instagram.com/michellededeo/Listen to Michelle's podcasts, the SCRN Prep Podcast and Narrative Nurse Project Podcast!Get 20% off Michelle's Stroke Review Bootcamp with code RAPIDRN20!https://www.nicolekupchikconsulting.com/booksAndCourses/online-courses/61/stroke-review-bootcamp-case-studies-in-optimizing-careMentioned in this episode:Rapid Response and Rescue Intro CourseCONNECT

This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the questions reviewed with Professor of Pediatrics at U. Colorado, Dr. Scott R. Auerbach. DOI: 10.1016/j.healun.2024.03.002

Image par Michal Jarmoluk de Pixabay Émission en partenariat avec l’INSERM Grand-Ouest ISCHEMIA, le retour ! Sébastien Roger revient dans la Méridienne, avec trois doctorants. Ils nous présentent leurs sujets de thèse ! – Oumnia Benouna : Le syndrome cardio-rénal et modes d’action des inhibiteurs du co-transporteur sodium-glucose de type 2– Simon Chesseron : Étude […] L'article La Méridienne – ISCHEMIA – Les doctorants ont du talent ! est apparu en premier sur Radio Campus Tours - 99.5 FM.

Dr. Linda Chu discusses predictors of intestinal resection-free survival in patients with acute arterial mesenteric ischemia with Dr. Lorenzo Garzelli and Dr. Maxime Ronot.   Predictors of Survival Without Intestinal Resection after First-Line Endovascular Revascularization in Patients with Acute Arterial Mesenteric Ischemia. Garzelli et al. Radiology 2024; 311(3):e230830.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

In this episode of the Dr Tyna Show, I explore the latest study linking vision loss to Ozempic. With my inbox flooded with inquiries, I'm joined by Naturopathic cardiology specialist, Dr. Lauren Lattanza. Together we meticulously examine the study's findings, exploring the intricate connections between Ozempic, metabolic health, and vascular integrity. From insights into microvasculature to implications for diabetic patients, join us as we unravel the complexities and implications of this research and unpack this using basic physiology. Ozempic Uncovered FREE 4 Part Video Series  On This Episode We Cover: 01:43 - Study overview  04:12 - The retina and cardiovascular system & compromised metabolic health  07:07 - The endothelial lining  08:39 - Understanding microvasculature 09:38 - Diabetes and your vascular system  12:50 - Relative hypoglycemia  15:43 - Vascular spasms  17:27 - Breaking down the study  19:45 - Ischemia  20:59 - Increased platelet activation  22:36 - The importance of dosing  23:40 - Risks associated with obesity  25:55 - Fasting insulin range 26:30 - Obesity and adipose tissue  28:25 - Effects of burning fat & the Herxheimer reaction  30:36 - The SELECT trial  35:34 - Limitations on the study  36:38 - Ozempic done right  41:55 - Connecting with Dr. Lattanza Sponsored By: Timeline Nutrition Go to timelinenutrition.com/DRTYNA and use code DRTYNA for 10% off NutriSense Get $30 OFF with code DRTYNA at nutrisense.io/drtyna LMNT Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna BIOptimizers Go to bioptimizers.com/drtyna and use code DRTYNA to save 10% and get a free gift with purchase  Show Links Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide Ozempic Done Right University  Further Listening EP. 46: Integrative Cardiology in a Time of COVID with Dr. Lattanza Check Our Dr. Lattanza:  Instagram Website Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.

In this episode, we are going to dive into the medical condition known as Chronic Mesenteric Ischemia. This is a significant health issue characterized by a reduction in the blood flow to the intestines. As a result of this diminished blood supply, individuals suffering from this condition often experience a range of symptoms, most notably abdominal pain and a loss of weight. Throughout the course of our discussion, we'll be tackling the various causes of this complex condition, exploring the different methods of diagnosis, and examining the available treatment options. We will also be placing a heavy emphasis on early intervention in order to maximize the chances of a successful treatment and recovery. Join Dr. Niket Sonpal, who will guide us through this complex medical condition. June 17, 2024 — Do you work in primary care medicine? Primary Care Medicine Essentials is our brand new program specifically designed for primary care providers to increase their core medical knowledge & improve patient flow optimization. Learn more here: Primary Care Essentials —

Chronic Limb Threatening Ischemia   Guest: Arashk Motiei, M.D. Hosts: Sharonne Hayes, M.D.   Chronic limb threatening ischemia is a common problem associated with a high morbidity and mortality. Patients need aggressive multidisciplinary evaluation and treatment to reduce the risk of limb loss and associated cardiovascular risk.   Topics Discussed: What are the key clinical manifestations of chronic limb threatening ischemia? What is the risk of limb loss and mortality in patients with chronic limb threatening ischemia? What are some diagnostic tests and what are the pitfalls of these tests? Can you give us a broad overview of revascularization for these patients?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.  

In this episode, we will explore the complex and often misunderstood condition known as Acute Mesenteric Ischemia. This condition, which involves an interruption of the blood flow to the intestines, can lead to severe abdominal pain and require emergency treatment. We'll discuss the various causes, signs and symptoms, and treatment options for Acute Mesenteric Ischemia. We'll also delve into the importance of early detection and intervention in preventing serious complications. Join Dr. Niket Sonpal as he navigates us through this challenging medical condition. June 10, 2024 — Do you work in primary care medicine? Primary Care Medicine Essentials is our brand new program specifically designed for primary care providers to increase their core medical knowledge & improve patient flow optimization. Learn more here: Primary Care Essentials —

In this episode of the Life of Flow podcast, Dr. Lucas Ferrer and Dr. Miguel Montero Baker are joined by guests Dr. Bret Wiechmann and Dr. Fadi Saab to delve into the complexities of patient care in critical limb ischemia (CLI) and the potential benefits of outpatient models of care. The conversation sheds light on the frustrations within the current hospital-centric approach, where the preference for amputation over revascularization persists despite evidence suggesting better outcomes with the latter. The participants advocate for decentralized care models, stressing the importance of standardized guidelines to ensure quality care for CLI patients while also acknowledging the challenges of balancing oversight with accessibility to care. Amidst discussions about the importance of proper evaluation before major amputations and the role of organizations like the Outpatient Endovascular and Interventional Society (OEIS) in advocating for non-hospital-based care, the conversation emphasizes the significance of data collection in improving CLI patient outcomes. While exploring scenarios where amputation might be deemed appropriate, the participants underscore the need for individualized patient evaluation and care. Overall, the episode provides valuable insights into the challenges and solutions in CLI treatment, advocating for a patient-centric approach, standardized guidelines, and improved coordination among healthcare facilities to enhance outcomes and access to quality care. Follow Dr. Bret Wiechmann on Twitter Follow Dr. Fadi Saab on Twitter Follow Life of Flow on Twitter Follow Miguel Montero-Baker on Twitter

In this episode of the Life of Flow podcast, Dr. Lucas Ferrer and Dr. Miguel Montero Baker are joined by guests Dr. Bret Wiechmann and Dr. Fadi Saab to delve into the complexities of patient care in critical limb ischemia (CLI) and the potential benefits of outpatient models of care. The conversation sheds light on the frustrations within the current hospital-centric approach, where the preference for amputation over revascularization persists despite evidence suggesting better outcomes with the latter. The participants advocate for decentralized care models, stressing the importance of standardized guidelines to ensure quality care for CLI patients while also acknowledging the challenges of balancing oversight with accessibility to care. Amidst discussions about the importance of proper evaluation before major amputations and the role of organizations like the Outpatient Endovascular and Interventional Society (OEIS) in advocating for non-hospital-based care, the conversation emphasizes the significance of data collection in improving CLI patient outcomes. While exploring scenarios where amputation might be deemed appropriate, the participants underscore the need for individualized patient evaluation and care. Overall, the episode provides valuable insights into the challenges and solutions in CLI treatment, advocating for a patient-centric approach, standardized guidelines, and improved coordination among healthcare facilities to enhance outcomes and access to quality care. Follow Dr. Bret Wiechmann on Twitter Follow Dr. Fadi Saab on Twitter Follow Life of Flow on Twitter Follow Miguel Montero-Baker on Twitter

The average brain weighs about three pounds (less than 2% of the average human weight), yet it accounts for about 20% of the body's total energy consumption. That inherently means the brain is extremely mitochondrial dense, as the mitochondria produce ~95% of all the energy in body. Ok, so all numbers aside, the brain is an immensely important organ from a health, energy and, thus, mitochondrial perspective. That means we need to have strategies in place for both acute trauma to the brain and for chronic conditions like neurodegeneration.In today's solosode, we will review two hot-off-the-press articles that happen to surround this very topic. The first article looks at the potential of methylene blue (MB) as a key substance that can effectively address three exceptionally varying brain conditions: traumatic brain injuries (TBIs), ischemia and Alzheimer's disease. At the end of the day, MB has a profound role to play in all of those ailments.The second article hones in on TBIs and antioxidant therapeutics that specifically target the mitochondria. Based on the abundant information provided in the article (albeit they did not include MB or C60 as an antioxidant strategy; I imagine there results would be even more staggering if they did!), it is quite clear that even in an acute injury, such as TBI, the mitochondria play an ever central role — in this case, both the damage from the physical trauma and also the healing and recovery process.​​Hint hint: we already know that red light therapy is becoming widely accepted as an effective modality for treating head traumas, such as concussions, TBIs, etc,. Now we have this new research looking at the impact of antioxidant therapeutics that target the mitochondria. Antioxidants donate electrons. Methylene blue and C60 are some of the best electron donors available as therapeutics. However, unlike most other antioxidants, both MB and C60 can actually get inside the mitochondria. The Mitochondrial Triad has a massive role to play here!​ If you found the information in today's episode particularly interesting and/or compelling, please share it with a family member, friend, colleague and/or anyone that you think could benefit and be illuminated by this knowledge. Sharing is caring :)As always, light up your health! - Key Points: Introduction (00:00:01 - 00:01:12). Announcement of a new treatment paradigm and explanation of the protocol ecosystem's benefits (00:01:13 - 00:07:14). Details about Hydrate Summit 2024 and discussion on water's importance for health (00:07:14 - 00:12:07). Introduction to methylene blue's potential benefits and its synergy with red light therapy (00:12:07 - 00:15:33). Exploration of methylene blue's potential in treating brain conditions and its challenging of conventional views (00:15:33 - 00:26:45). Discussion on carbon dioxide's role, contrasted with nitric oxide, and the importance of understanding their roles (00:25:08 - 00:28:39). Exploration of mitochondrial-targeted antioxidant therapies and their potential in TBI treatment (00:30:12 - 00:36:15). Highlighting the triad approach of carbon 60, methylene blue, and red light therapy for TBI treatment (00:36:15 - 00:41:34). Discussion on combining red light therapy with other treatments for enhanced results and exploring the gut-brain axis post-TBI (00:40:41 - 00:42:52). Emphasis on proactive health measures, seeking feedback, and sign-off (00:48:49 - 00:51:59). - Articles referenced in the episode: Methylene blue and its potential in the treatment of traumatic brain injury, brain ischemia, and Alzheimer's disease Mitochondria-Targeted Antioxidant Therapeutics for Traumatic Brain Injury - Check out The HYDRATE Summit 2024 w/ Tracy Duhs -   BioLight added TWO new bundles so that you can save BIG!1.) The Mitochondrial Triad Bundle   For this bundle, you choose one of each: one BioBlue product, one BioC60 product and one red light therapy product and save 20% on the entire order!   Click here to check it out.     2.) The BioBundle For this bundle, choose your favorite BioBlue product and your favorite BioC60 product and save 15%!You can save an additional 10% buy subscribing to this bundle.That's correct, you can save a total of 25% via the BioBundle!   Click here to check it out. - Kindle version of Red Light Therapy Treatment Protocols eBook, 4th Edition - To learn more about red light therapy and shop for the highest-quality red light therapy products, visit https://www.biolight.shop - Dr. Mike's #1 recommendations: Grounding products: Earthing.com EMF-mitigating products: Somavedic Blue light-blocking glasses: Ra Optics - Stay up-to-date on social media: Dr. Mike Belkowski: Instagram LinkedIn   BioLight: Website Instagram YouTube Facebook

The Association Between Diagnosis-to-limb Revascularization Time And Clinical Outcomes In Outpatients With Chronic Limb-threatening Ischemia

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Dean Ferrera about treating acute limb ischemia with mechanical thrombectomy. Dr. Ferrera is an interventional cardiologist at Community Care Network in northwestern Indiana. Dr. Ferrera emphasizes the importance of interdisciplinary collaboration, early detection, and selection of appropriate intervention techniques. He also discusses threading issues, bleeding complications, use of lysis, and understanding the nature of clots. He recommends thrombectomy systems such as the Pounce Thrombectomy System for removing thrombus and embolus. Furthermore, Dr. Ferrera highlights the significance of continued learning and mentorship in managing these complex conditions. --- CHECK OUT OUR SPONSOR Surmodics Pounce Thrombectomy https://pouncesystem.com/ --- SHOW NOTES 00:00 - Introduction 04:21 - Patient Presentation and Workup 09:23 - Treatment Options for Acute Limb Ischemia 17:48 - Crossing the Clot and Treatment Options 25:18 - Device Capabilities and Limitations 28:43 - Procedure Steps and Reusability 31:26 - Device Selection and Aspiration Devices 37:07 - Post-Procedure Considerations and Follow-Up 43:16 - Complications and Risk Management --- RESOURCES Pounce Thrombectomy System: https://pouncesystem.com/ Thrombus Structural Composition in Cardiovascular Disease: https://pubmed.ncbi.nlm.nih.gov/34261330/

Contributor: Ricky Dhaliwal, MD Educational Pearls: What can you do to control bleeding in a penetrating wound? Apply direct pinpoint pressure on the wound as well as proximal to the wound. Build a compression dressing. How do you build a compression dressing? Think about building an upside-down pyramid with the gauze. Consider coagulation agents such as an absorbent gelatin sponge material, microporous polysaccharide hemispheres, oxidized cellulose, fibrin sealants, topical thrombin, or tranexamic acid. What are the indications to use a tourniquet? The Stop The Bleed campaign recommends looking for the following features of “life-threatening” bleeding. Pulsatile bleeding. Blood is pooling on the ground. The overlying clothes are soaked. Bandages are ineffective. Partial or full amputation. And if the patient is in shock. How do you put on a tourniquet? If using a Combat Application Tourniquet (C-A-T) tourniquet, apply it proximal to the wound, then rotate the plastic rod until the bleeding stops. Then secure the plastic rod with a clip and make sure the Velcro is in place. Mark the time - generally, there is a spot on the tourniquet to write. Have a plan for the next steps. Does the patient need emergent surgery? Do they need to be transfered? How long can you leave a tourniquet on? Less than 90 minutes. What are the risks? Nerve injury. Ischemia. References Latina R, Iacorossi L, Fauci AJ, Biffi A, Castellini G, Coclite D, D'Angelo D, Gianola S, Mari V, Napoletano A, Porcu G, Ruggeri M, Iannone P, Chiara O, On Behalf Of Inih-Major Trauma. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Dec 6;18(23):12861. doi: 10.3390/ijerph182312861. PMID: 34886586; PMCID: PMC8657739. Martinson J, Park H, Butler FK Jr, Hammesfahr R, DuBose JJ, Scalea TM. Tourniquets USA: A Review of the Current Literature for Commercially Available Alternative Tourniquets for Use in the Prehospital Civilian Environment. J Spec Oper Med. 2020 Summer;20(2):116-122. doi: 10.55460/CT9D-TMZE. PMID: 32573747. Resources poster booklet. (n.d.). Stop the Bleed. https://www.stopthebleed.org/resources-poster-booklet/ Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

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.

In this episode, host Dr. Sabeen Dhand interviews Dr. Charles Bailey about Limb Alert, a hospital protocol devised to expedite the diagnosis and treatment of patients presenting with acute limb ischemia. Dr. Bailey is a vascular surgeon and the Director of Peripheral Artery Disease (PAD) and Limb Salvage at the University of South Florida. Dr. Bailey explains how the Limb Alert program standardizes the care pathway, rapidly alerts necessary personnel, initiates labs, and prepares the Penumbra Lightning Bolt 7 System for endovascular thrombectomy. The incorporated protocol significantly streamlines patient management, resulting in encouraging survival rates. Dr. Bailey further emphasizes the necessity for modern endovascular trials in acute limb ischemia and proposes a multicenter randomized trial to provide evidence for endovascular treatment. --- CHECK OUT OUR SPONSOR Penumbra Lightning Flash https://www.penumbrainc.com/products/lightning-flash/ --- SHOW NOTES 00:00 - Introduction 02:43 - Dr. Bailey's Journey to Florida and His Practice 06:43 - Importance of Timely Intervention in Acute Limb Ischemia 21:29 - Role of Debulking in Acute Limb Ischemia 28:20 - Tips and Tricks for Successful Outcomes 31:17 - Impact of the Limb Alert Program 41:19 - Future of Acute Limb Ischemia Treatment 47:40 - The Need for New Randomized Trials --- RESOURCES Acute Limb Ischemia: An Update on Diagnosis and Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723825/ Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia - STRIDE Study: https://www.jvascsurg.org/article/S0741-5214(23)02196-1/fulltext

Commentary by Dr. Valentin Fuster

VISIT US AT ⁠⁠⁠NCLEXHIGHYIELD.COM⁠⁠⁠ SUBSCRIBE TO OUR YOUTUBE CHANNEL: ⁠⁠⁠YOUTUBE.COM/NCLEXHIGHYIELD⁠⁠⁠ No matter where you are in the world, or what your schedule is like, access the entire course at ⁠⁠⁠⁠⁠www.NCLEXHighYieldCourse.com⁠⁠⁠⁠⁠  The NCLEX High Yield Podcast was featured on ⁠⁠⁠⁠⁠Top 15 NCLEX Podcasts⁠⁠⁠⁠⁠! Make sure you ⁠⁠⁠⁠⁠JOIN OUR NEW VIP FACEBOOK GROUP!⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links⁠⁠⁠⁠⁠ A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: ⁠⁠@NCLEXHighYield ⁠⁠or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. Subscribe to our newsletter at ⁠⁠⁠⁠nclexhighyield.com⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/nclexhighyield/support

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Mesenteric Ischemia⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbull --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

What is the best surgical treatment for a vasculopathy with critical limb threatening ischemia? In this episode of Behind the Knife the vascular surgery subspecialty team discusses two pivotal trials (BEST-CLI and BASIL-2) and how the findings of these trials can help answer this question. In this episode, we will discuss the age old question: open bypass versus best endovascular treatment.  Hosts:  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives Review the definition, prevalence, and prognosis of critical limb threatening ischemia Review basic treatment options for patients with critical limb threatening ischemia Understand the methodology, findings, limitations, and clinical applications of the BEST-CLI trial Understand the methodology, findings, limitations, and clinical applications of the BASIL-2 trial Compare open bypass and best endovascular therapy for patients with critical limb threatening ischemia References Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, Hamza TH, Assmann SF, Creager MA, Cziraky MJ, Dake MD, Jaff MR, Reid D, Siami FS, Sopko G, White CJ, van Over M, Strong MB, Villarreal MF, McKean M, Azene E, Azarbal A, Barleben A, Chew DK, Clavijo LC, Douville Y, Findeiss L, Garg N, Gasper W, Giles KA, Goodney PP, Hawkins BM, Herman CR, Kalish JA, Koopmann MC, Laskowski IA, Mena-Hurtado C, Motaganahalli R, Rowe VL, Schanzer A, Schneider PA, Siracuse JJ, Venermo M, Rosenfield K; BEST-CLI Investigators. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022 Dec 22;387(25):2305-2316. doi: 10.1056/NEJMoa2207899. Epub 2022 Nov 7. PMID: 36342173. https://pubmed.ncbi.nlm.nih.gov/36342173/ Bradbury AW, Moakes CA, Popplewell M, Meecham L, Bate GR, Kelly L, et al. 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. The Lancet. 2023. 401(10390), 1798-1809. https://doi.org/10.1016/S0140-6736(23)00462-2 Conte MS Bradbury AW Kolh P et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019; 58 (109.e33.): S1-109 https://pubmed.ncbi.nlm.nih.gov/31182334/ Bradbury AW Adam DJ Bell J et al. Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial. Health Technol Assess. 2010; 14: 1-210 https://pubmed.ncbi.nlm.nih.gov/20307380/ Adam DJ Beard JD Cleveland T et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366: 1925-1934 https://pubmed.ncbi.nlm.nih.gov/16325694/ Bradbury AW Adam DJ Bell J et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010; 51: 5S-17 https://pubmed.ncbi.nlm.nih.gov/20435258/ Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH; GVG Writing Group. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40. doi: 10.1016/j.jvs.2019.02.016. Epub 2019 May 28. Erratum in: J Vasc Surg. 2019 Aug;70(2):662. PMID: 31159978; PMCID: PMC8365864. https://pubmed.ncbi.nlm.nih.gov/31159978/ Menard MT, Rosenfield K, Farber A. The BEST-CLI Trial: Implications of the Primary Results. Eur J Vasc Endovasc Surg. 2023 Mar;65(3):317-319. doi: 10.1016/j.ejvs.2022.12.032. Epub 2023 Jan 6. PMID: 36621707. https://pubmed.ncbi.nlm.nih.gov/36621707/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other vascular surgery episodes: https://behindtheknife.org/podcast-category/vascular/

4.09 Rheumatologic Emergencies Rheumatology review for USMLE Step 1 Exam Giant Cell Arteritis (GCA) A large vessel vasculitis, mainly in older individuals. Symptoms: headache, jaw claudication, vision loss. Ischemia from granulomas in large vessels causes vision loss. Immediate high-dose corticosteroids are crucial. Scleroderma Renal Crisis A complication of scleroderma. Symptoms: finger edema, skin tightening, sudden hypertension, rising creatinine. Renal artery fibrosis leads to high blood pressure. Treat with IV ACE inhibitor, not steroids. Acute Transverse Myelitis in SLE Inflammation of the spinal cord in lupus. Symptoms: bilateral numbness, tingling, weakness. Treat with corticosteroids. Catastrophic Antiphospholipid Syndrome (CAPS) A rare, life-threatening form of APS. Symptoms: unexplained miscarriages, unexplained clots, multiorgan failure. Treat with anticoagulation followed by immune suppression

Can we bring people back from the dead? Neil deGrasse Tyson and Chuck Nice discuss restoring dead cells, the nature of consciousness, Frankenstein's monster, zombies, and more with neuroscientist, David Andrijevic and consciousness expert, George Mashour. NOTE: StarTalk+ Patrons can listen to this entire episode commercial-free.Thanks to our Patrons Darrell McClendon, Baby Daddy, Chip Towner, Marylee Dewey, and Michael Brockman for supporting us this week.Photo Credit: Thennicke, CC BY-SA 4.0, via Wikimedia Commons