Sat.Feb 24, 2024 - Fri.Mar 01, 2024

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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

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Cannabis use linked to increase in heart attack and stroke risk

American Heart News - Heart News

Research Highlights: An analysis of survey data for 430,000 adults in the U.S. found that using cannabis has a significant association with an increased risk of heart attack and stroke, independent of tobacco use, with higher odds among the adults.

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A humanized IL-2 mutein expands Tregs and prolongs transplant survival in preclinical models

Journal of Clinical Investigation - Cardiology

Long-term organ transplant survival remains suboptimal, and life-long immunosuppression predisposes transplant recipients to an increased risk of infection, malignancy, and kidney toxicity. Promoting the regulatory arm of the immune system by expanding Tregs may allow immunosuppression minimization and improve long-term graft outcomes. While low-dose IL-2 treatment can expand Tregs, it has a short half-life and off-target expansion of NK and effector T cells, limiting its clinical applicability.

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Patients with Behavioral Health Disorders Less Likely to Have Surgery for Cancer

HCPLive

Cancer patients with behavioral health disorders, such as substance abuse, eating disorders, and sleep disorders have a 7.76% increase in health care costs, a new study found.

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Even Modest Lp(a) Elevations Bode Poorly for Cardiovascular Health

Med Page Today

(MedPage Today) -- Lipoprotein(a), or Lp(a), at levels well below currently accepted risk thresholds correlated with increased cardiovascular risk in a large registry study, suggesting a wider patient pool that could benefit from future preventive.

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Here’s your wake-up call: Daylight saving time may impact your heart health

American Heart News - Heart News

DALLAS, March 1, 2024 – Losing an extra hour of sleep may not be the worst thing that could happen when you “spring forward” at the start of daylight saving time. According to the American Heart Association, celebrating one hundred years of lifesaving.

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Increased LL37 in psoriasis and other inflammatory disorders promotes LDL uptake and atherosclerosis

Journal of Clinical Investigation - Cardiology

Patients with chronic inflammatory disorders such as psoriasis have an increased risk of cardiovascular disease and elevated levels of LL37, a cathelicidin host defense peptide that has both antimicrobial and proinflammatory properties. To explore whether LL37 could contribute to the risk of heart disease, we examined its effects on lipoprotein metabolism and show that LL37 enhanced LDL uptake in macrophages through the LDL receptor (LDLR), scavenger receptor class B member 1 (SR-B1), and CD36.

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Mean platelet volume (MPV) as new marker of diabetic macrovascular complications in patients with different glucose homeostasis

Cardiovascular Diabetology

Platelets play an important role in the development of cardiovascular disease (CVD). Mean platelet volume (MPV) is considered as biological marker of platelets activity and function. The aim of the present stu.

Diabetes 111
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Living near pubs, bars and fast-food restaurants could be bad for heart health

American Heart News - Heart News

Research Highlights Closer proximity to and a higher number of ready-to-eat food outlets — particularly pubs, bars and fast-food restaurants — may be associated with a greater risk of developing heart failure, according to a study of half a million.

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Neutrophil extracellular traps induced by chemotherapy inhibit tumor growth in murine models of colorectal cancer

Journal of Clinical Investigation - Cardiology

Neutrophil extracellular traps (NETs), a web-like structure of cytosolic and granule proteins assembled on decondensed chromatin, kill pathogens and cause tissue damage in diseases. Whether NETs can kill cancer cells is unexplored. Here, we report that a combination of glutaminase inhibitor CB-839 and 5-FU inhibited the growth of PIK3CA-mutant colorectal cancers (CRCs) in xenograft, syngeneic, and genetically engineered mouse models in part through NETs.

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Dermatology Month in Review: February 2024

HCPLive

In the February edition of Dermatology Month in Review, new acne guidelines released by AAD, an FDA decision on nemolizumab, and an interview on potentially the first oral IL-23 inhibitor for psoriasis were among the major stories.

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Why Waiting Until Age 50 To Address Risk Factors For Heart Disease Is Too Late.

Dr. Paddy Barrett

Most people only start to worry about cardiovascular risk later in life. This is a bad idea. Here’s why. When you look at the risk of having a heart attack, it is true that the older you are, the greater the odds of having a heart attack 1. So far, so good. But this graph is very misleading. While only 1-2% of those having a heart attack are less than 65 years of age, 1-2% of this very large number means a LOT of heart attacks.

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Fatty liver index is an independent risk factor for all-cause mortality and major cardiovascular events in type 1 diabetes: an 11-year observational study

Cardiovascular Diabetology

Non-alcoholic fatty liver disease (NAFLD), identified by the Fatty Liver Index (FLI), is associated with increased mortality and cardiovascular (CV) outcomes. Whether this also applies to type 1 diabetes (T1D).

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Ohio State First in Central Ohio to Use Novel Heart Failure Therapy

DAIC

milla1cf Mon, 02/26/2024 - 12:40 February 26, 2024 — More than 6 million Americans live with heart failure , and about half have an enlarged left ventricle, which causes stress on the heart and less blood pumped with each heartbeat. The Ohio State University Wexner Medical Center is the first in central Ohio to take part in a global clinical trial to use a novel therapy to reduce the size of the left ventricle without open-heart surgery.

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Novel drug therapies for atrial fibrillation

Nature Reviews - Cardiology

Nature Reviews Cardiology, Published online: 28 February 2024; doi:10.1038/s41569-024-01004-2 Atrial fibrillation is the most common sustained arrhythmia and imposes a substantial burden on patients and health-care providers. Clinical evidence suggests that antiarrhythmic therapy to restore and maintain sinus rhythm (rhythm control) can reduce adverse cardiovascular outcomes in patients with new-onset atrial fibrillation.

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World's best cardiology hospitals, per Newsweek

Becker's Hospital Review - Cardiology

Discover the top 10 cardiology hospitals in the world, with seven based in the U.S. according to Newsweek's 2024 "World's Best Hospitals" list.

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Serum amyloid A expression in liver promotes synovial macrophage activation and chronic arthritis via NFAT5

Journal of Clinical Investigation - Cardiology

Nuclear factor of activated T-cells 5 (NFAT5), an osmo-sensitive transcription factor, can be activated by isotonic stimuli, such as infection. It remains unclear, however, whether NFAT5 is required for damage-associated molecular pattern–triggered (DAMP-triggered) inflammation and immunity. Here, we found that several DAMPs increased NFAT5 expression in macrophages.

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Abdominal Fat and Dementia; Mask Ban Lawsuit Tossed; FDA Rejects Psych Drug

Med Page Today

(MedPage Today) -- Note that some links may require registration or subscription. In middle-age men with high Alzheimer's dementia risk, higher pancreatic fat was linked with lower cognition and brain volumes. (Obesity) The Department of Justice.

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Smartphone App with AI Detects Depression Onset from Facial Expressions

HCPLive

MoodCapture, an app with AI that can detect depression onset from facial cues, accurately diagnosed 75% of participants in a study with early symptoms of depression.

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Blanchard Valley Health cuts open-heart surgery program

Becker's Hospital Review - Cardiology

Findley, Ohio-based Blanchard Valley Health System is cutting its open-heart surgery program and will instead transfer patients to other systems as needed.

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Targeting mitochondrial dynamics of morphine-responsive dopaminergic neurons ameliorates opiate withdrawal

Journal of Clinical Investigation - Cardiology

Converging studies demonstrate the dysfunction of the dopaminergic neurons following chronic opioid administration. However, the therapeutic strategies targeting opioid-responsive dopaminergic ensembles that contribute to the development of opioid withdrawal remain to be elucidated. Here, we used the neuronal activity-dependent Tet-Off system to label dopaminergic ensembles in response to initial morphine exposure (Mor-Ens) in the ventral tegmental area (VTA).

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Bariatric Surgery a Long-Term Winner for Type 2 Diabetes

Med Page Today

(MedPage Today) -- Patients with type 2 diabetes had better glycemic control and higher rates of diabetes remission over the long term with bariatric surgery compared with lifestyle and medical management in the pre-GLP-1 receptor agonist era.

Diabetes 101
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Melanoma Screening Delays During Lockdowns Linked to Deaths, Significant Economic Cost

HCPLive

This analysis emphasizes the necessity of prevention of melanoma as well as the public health and economic consequences of patients’ delaying of skin cancer diagnoses.

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EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesias, Preventing Burnout

ECG Cases

Anand Swaminathan on an update on the appropriate selection of induction agents. Hans Rosenberg on when to use gabapentinoids for pain control in the ED. Katie Lin on pearls for neuroprotective intubation. Nour Khatib and Hamza Jalal on an approach to paresthesias in the ED. Eric Wortmann on preventing burnout in emergency medicine. Please support EM Cases with a donation [link] The post EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesi

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APOL1-mediated monovalent cation transport contributes to APOL1-mediated podocytopathy in kidney disease

Journal of Clinical Investigation - Cardiology

Two coding variants of apolipoprotein L1 (APOL1), called G1 and G2, explain much of the excess risk of kidney disease in African Americans. While various cytotoxic phenotypes have been reported in experimental models, the proximal mechanism by which G1 and G2 cause kidney disease is poorly understood. Here, we leveraged 3 experimental models and a recently reported small molecule blocker of APOL1 protein, VX-147, to identify the upstream mechanism of G1-induced cytotoxicity.

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What to Know About the Factor XIa Inhibitors on the Horizon

Med Page Today

(MedPage Today) -- A novel class of antithrombotic medication, the factor XIa inhibitors, has had a rocky start but is powering through phase III trials, which are now underway. MedPage Today sat down to discuss the novel agents with Graeme Hankey.

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Midterm outcomes of transcatheter aortic valve replacement in patients with active cancer

Open Heart

Objectives The clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) and concomitant active cancer remain insufficiently explored. This study aimed to assess the midterm outcomes of TAVR in patients diagnosed with AS and active cancer. Methods Data from the OCEAN-TAVI, a prospective Japanese registry of TAVR procedures, was analysed to compare prognoses and clinical outcomes in patients with and without active cancer at the time of TAVR.

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New Studies: AI Captures Electrocardiogram Patterns That Could Signal a Future Sudden Cardiac Arrest

DAIC

Sumeet Chugh, MD. Photo by Cedars-Sinai milla1cf Fri, 03/01/2024 - 08:25 March 1, 2024 — Two new studies by Cedars-Sinai investigators support using artificial intelligence (AI) to predict sudden cardiac arrest-a health emergency that in 90% of cases leads to death within minutes. “Sudden cardiac arrest is a mostly lethal condition, and prevention will make the biggest impact, but we need to find novel clinical tools to make that possible,” said Sumeet Chugh, MD , director of the Division of A

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TRIM56 protects against nonalcoholic fatty liver disease by promoting the degradation of fatty acid synthase

Journal of Clinical Investigation - Cardiology

Nonalcoholic fatty liver disease (NAFLD) encompasses a disease continuum from simple steatosis to nonalcoholic steatohepatitis (NASH). However, there are currently no approved pharmacotherapies for NAFLD, although several drugs are in advanced stages of clinical development. Because of the complex pathophysiology and heterogeneity of NAFLD, the identification of potential therapeutic targets is clinically important.

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The Risks and Benefits of 'Too Much' Exercise

Physiologically Speaking

Athens, Greece September 12, 490 BCE This is the site of the first known fatality related to endurance running. Upon arrival to Athens, running the now-revered distance of 26 miles (and change) to deliver a message of a military victory against the Persians, Pheidippides, our Greek hero, collapsed, most likely due to sheer exhaustion on behalf of his previous effort. “Joy to you, we’ve won” he said, and there and then he died, breathing his last breath with the words “Joy

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Multimodal AI Chatbot Presents Mixed Results in Ophthalmic Imaging Analysis

HCPLive

The newest version of ChatGPT accurately responded to most multiple-choice questions on ophthalmic cases but performed better on non-image–based questions.

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Biosense Webster Begins Enrollment of Pivotal Trial Evaluating the Laminar Left Atrial Appendage Elimination Device?

DAIC

Getty Images milla1cf Tue, 02/27/2024 - 17:24 February 27, 2024 — Biosense Webster, Inc. , a global leader in cardiac arrhythmia treatment and part of Johnson & Johnson MedTechi , announced the commencement of patient cases with the investigational Laminar Left Atrial Appendage Elimination (LAAX) System as part of its pivotal investigational device exemption (IDE) study.

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Mechanosensitive channels TMEM63A and TMEM63B mediate lung inflation–induced surfactant secretion

Journal of Clinical Investigation - Cardiology

Pulmonary surfactant is a lipoprotein complex lining the alveolar surface to decrease the surface tension and facilitate inspiration. Surfactant deficiency is often seen in premature infants and in children and adults with respiratory distress syndrome. Mechanical stretch of alveolar type 2 epithelial (AT2) cells during lung expansion is the primary physiological factor that stimulates surfactant secretion; however, it is unclear whether there is a mechanosensor dedicated to this process.

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RNA Therapeutics for the Cardiovascular System

Circulation

Circulation, Volume 149, Issue 9 , Page 707-716, February 27, 2024. RNA therapeutics hold significant promise in the treatment of cardiovascular diseases. RNAs are biologically diverse and functionally specific and can be used for gain- or loss-of-function purposes. The effectiveness of mRNA-based vaccines in the recent COVID-19 pandemic has undoubtedly proven the benefits of an RNA-based approach.

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Valvular and perivalvular thrombus after TAVR: Risks and Outcomes

Cardiology Update

Transcatheter aortic valve replacement (TAVR) is the standard treatment for severe aortic stenosis, but post-TAVR leaflet thrombus, identified by hypoattenuated leaflet thickening (HALT), poses potential risks like cerebral thromboembolic events. Perivalvular thrombus has also been reported. The ADAPT-TAVR study compared edoxaban with dual antiplatelet therapy (DAPT) to prevent leaflet thrombus and associated risks post-TAVR.

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Long-term Survivors of Childhood Cancer at Higher Risk of Death Following Heart Issues; Threshold for Treating Risk Factors Should be Lower

DAIC

Wendy Bottinor, MD. Image courtesy of VCU Massey Comprehensive Cancer Center milla1cf Wed, 02/28/2024 - 19:24 February 28, 2024 — New research out of VCU Massey Comprehensive Cancer Center and VCU Health Pauley Heart Center indicates that survivors of childhood cancer are at a significantly higher risk of death following a major cardiovascular event — including heart failure , heart attack or stroke — than the general public.

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PIEZO1 is a distal nephron mechanosensor and is required for flow-induced K+ secretion

Journal of Clinical Investigation - Cardiology

Ca2+-activated BK channels in renal intercalated cells (ICs) mediate luminal flow–induced K+ secretion (FIKS), but how ICs sense increased flow remains uncertain. We examined whether PIEZO1, a mechanosensitive Ca2+-permeable channel expressed in the basolateral membranes of ICs, is required for FIKS. In isolated cortical collecting ducts (CCDs), the mechanosensitive cation-selective channel inhibitor GsMTx4 dampened flow-induced increases in intracellular Ca2+ concentration ([Ca2+]i), whereas th

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