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1.
Front Cardiovasc Med ; 9: 869104, 2022.
Article in English | MEDLINE | ID: mdl-35924212

ABSTRACT

Background: Singing is a physical activity involving components of the vagal nerves manifested as changes in cardiac autonomic regulation. Aims: The aim of this pilot study is to investigate the acute effects of singing on biomarkers of cardiovascular health. Methods: Adult subjects were recruited from cardiology clinics to participate in a single 90-min study visit. Vascular function was measured at the fingertips with peripheral arterial tonometry (PAT) before and after singing to a 14-min video led by a voice expert. Heart rate variability (HRV) was measured with a chest strap sensor at baseline, during, and after singing. PAT measurements were expressed as reactive hyperemia index (RHI) and Framingham reactive hyperemia index (fRHI). Measures of HRV included root mean square of successive RR interval differences (RMSSD) and standard deviation of NN (or RR) intervals (SDNN). Results: Sixty subjects completed the study (68% female, mean age 61 ±13 years, mean BMI 32 ± 8). There was a significant increase in fRHI (1.88 ± 0.14 to 2.10 ± 0.14, p = 0.02) after singing with no significant change in the RHI (1.99 ± 0.10 to 2.12 ± 0.09, p = 0.22). There was a reduction in HRV during singing (compared to baseline) (RMSSD: 42.0 ± 5 to 32.6 ± 4, p = 0.004 and SDNN: 54 ± 4 to 33.5 ± 3, p = 0.009). HRV measures trended back toward baseline after singing. Conclusions: A short duration of singing improved vascular function acutely. Improvements were more substantial in subjects with abnormal baseline endothelial function. HRV patterns were similar to that of light-intensity exercise. Future studies should confirm favorable vascular adaptation to more sustained singing interventions. Clinical trial registration: ClinicalTrials.gov, identifer: NCT03805529.

2.
Obesity (Silver Spring) ; 29(7): 1102-1113, 2021 07.
Article in English | MEDLINE | ID: mdl-34159755

ABSTRACT

OBJECTIVE: Dietary supplements and alternative therapies are commercialized as a panacea for obesity/weight gain as a result of the minimal regulatory requirements in demonstrating efficacy. These products may indirectly undermine the value of guideline-driven obesity treatments. Included in this study is a systematic review of the literature of purported dietary supplements and alternative therapies for weight loss. METHODS: A systematic review was conducted to evaluate the efficacy of dietary supplements and alternative therapies for weight loss in participants aged ≥18 years. Searches of Medline (PubMed), Cochrane Library, Web of Science, CINAHL, and Embase (Ovid) were conducted. Risk of bias and results were summarized qualitatively. RESULTS: Of the 20,504 citations retrieved in the database search, 1,743 full-text articles were reviewed, 315 of which were randomized controlled trials evaluating the efficacy of 14 purported dietary supplements, therapies, or a combination thereof. Risk of bias and sufficiency of data varied widely. Few studies (n = 52 [16.5%]) were classified as low risk and sufficient to support efficacy. Of these, only 16 (31%) noted significant pre/post intergroup differences in weight (range: 0.3-4.93 kg). CONCLUSIONS: Dietary supplements and alternative therapies for weight loss have a limited high-quality evidence base of efficacy. Practitioners and patients should be aware of the scientific evidence of claims before recommending use.


Subject(s)
Complementary Therapies , Weight Loss , Adolescent , Adult , Dietary Supplements , Humans , Obesity/therapy
3.
Catheter Cardiovasc Interv ; 97(3): E343-E345, 2021 Feb 15.
Article in English | MEDLINE | ID: mdl-32433796

ABSTRACT

Coronavirus disease-2019 (COVID-19) pandemic is the biggest global health threat in the 21st century. We describe a case of a patient with suspected COVID-19 who needed urgent coronary artery interrogation, in which we utilized robotic assistance to minimize the risk of exposure to COVID-19 and reduced personal protective equipment needed by the procedural team.


Subject(s)
COVID-19/diagnosis , Infection Control , Percutaneous Coronary Intervention , Robotic Surgical Procedures , ST Elevation Myocardial Infarction/surgery , ST Elevation Myocardial Infarction/virology , COVID-19/complications , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , ST Elevation Myocardial Infarction/diagnosis
4.
J Cardiovasc Pharmacol ; 77(2): 153-158, 2021 02 01.
Article in English | MEDLINE | ID: mdl-33235031

ABSTRACT

ABSTRACT: The efficacy of renal sympathetic denervation (RSD) in the treatment of uncontrolled hypertension (HTN) remains uncertain. A systematic review of randomized controlled trials was performed to evaluate the efficacy and safety of RSD for resistant HTN. PubMed, EMBASE, MEDLINE, Cochrane, Directory of Open Access Journals, CINAHL, and Google Scholar were searched from January 01, 2001, through July 30, 2020. Randomized controlled trials comparing RSD with the sham procedure for uncontrolled HTN were selected. The primary efficacy outcome was the reduction in ambulatory systolic blood pressure. We used random-effects models. Nine prospective clinical trials met the inclusion criteria. The ReSet and Symplicity HTN-3 Trial showed no significant changes because of discrepancies in complete circumferential ablation during RSD. The Relief study, The Radiance HTN solo, and the SPYRAL HTN OFF medical trials showed a significant reduction in systolic blood pressure in the group that had undergone the intervention compared with the sham group attributed to rigorous trial design. In conclusion, our systematic review suggests that efficacy of RSD seems to be superior to sham-controlled interventions provided circumferential denervation is performed. However, difference in efficacy is marginal.


Subject(s)
Blood Pressure , Catheter Ablation , Hypertension/surgery , Kidney/blood supply , Renal Artery/innervation , Sympathectomy , Sympathetic Nervous System/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Catheter Ablation/adverse effects , Drug Resistance , Female , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Male , Middle Aged , Randomized Controlled Trials as Topic , Sympathetic Nervous System/physiopathology , Treatment Outcome , Young Adult
5.
Cardiovasc Revasc Med ; 28S: 232-235, 2021 07.
Article in English | MEDLINE | ID: mdl-32736980

ABSTRACT

Severely calcified lesions are the leading cause of stent under-expansion in peripheral vascular interventions. Current approved treatment options are limited to high pressure balloon angioplasty and laser atherectomy, both of which often yield sub-optimal results. Intravascular Lithotripsy offers a promising new treatment option for calcium-mediated peripheral vascular stent under-expansion.


Subject(s)
Lithotripsy , Vascular Calcification , Calcium , Humans , Stents , Treatment Outcome , Vascular Calcification/diagnostic imaging , Vascular Calcification/therapy
6.
J Invasive Cardiol ; 32(12): E338-E348, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32829310

ABSTRACT

OBJECTIVES: To develop and validate a hybrid algorithm to approach complex superficial femoral artery (SFA) chronic total occlusions (CTOs) in a step-wise fashion. BACKGROUND: SFA-CTO represents one of the most challenging subsets of lower-extremity peripheral arterial disease. Depending on lesion characteristics, successful percutaneous crossing of the occluded segment may prove to be very difficult. METHODS: We retrospectively evaluated all consecutive patients with SFA-CTO at our institution. The included patients had baseline Rutherford category (2-4) symptoms and were graded using the femoral artery chronic total occlusion revascularization (FACTOR) score. Multiple modalities (wire-based strategies, CTO devices, re-entry devices) were used to cross the occlusions based on the proposed FACTOR algorithm. Primary endpoint was technical success, defined as successful CTO crossing. RESULTS: A total of 150 patients (mean age, 71 years) with SFA-CTO were retrospectively reviewed to evaluate the feasibility and utility of the FACTOR score and algorithm in a single center across multiple experienced operators. Following the FACTOR algorithm, overall procedural success was achieved in 143 out of 150 patients (95%). Successful antegrade CTO crossing occurred in 59%; success rates increased to 85% when additional retrograde popliteal, tibiopedal, and direct SFA accesses were used. In multivariate analysis, retrograde wire crossing, stent placement, and atherectomy were independent predictors of successful revascularization. CONCLUSIONS: The results of our study show that utilization of the FACTOR score and algorithm can result in high rates of successful SFA-CTO revascularization.


Subject(s)
Algorithms , Femoral Artery , Aged , Chronic Disease , Feasibility Studies , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Retrospective Studies , Treatment Outcome
7.
Catheter Cardiovasc Interv ; 96(2): 410-412, 2020 08.
Article in English | MEDLINE | ID: mdl-32369662

ABSTRACT

The use of robotic assistance in endovascular interventions may facilitate smoother procedures with fewer device manipulations, improve precision and accuracy of device deployment, and reduce exposure to fluoroscopic radiation. We used the CorPath GRX Robotic System for carotid balloon angioplasty and stent placement in a patient with limited surgical options.


Subject(s)
Angioplasty, Balloon/instrumentation , Carotid Stenosis/therapy , Embolic Protection Devices , Robotics , Stents , Aged , Carotid Stenosis/diagnostic imaging , Contraindications, Procedure , Humans , Male , Risk Factors , Treatment Outcome
9.
Catheter Cardiovasc Interv ; 95(2): E66-E70, 2020 02.
Article in English | MEDLINE | ID: mdl-31313483

ABSTRACT

Femoropopliteal in-stent chronic total occlusions (CTOs) remain one of the most challenging subsets of peripheral arterial disease to treat percutaneously. Advances in available CTO crossing technology and operator experience have increased percutaneous intervention success rates. We report a case of critical limb ischemia in a patient with chronically occluded femoropopliteal nonoverlapping stents treated with a novel percutaneous approach of subintimal retrograde angioplasty using high compression resistant nitinol stents to crush the occluded previous stents to create a neo-lumen.


Subject(s)
Endovascular Procedures/instrumentation , Femoral Artery , Intermittent Claudication/therapy , Ischemia/therapy , Peripheral Arterial Disease/therapy , Popliteal Artery , Stents , Constriction, Pathologic , Critical Illness , Endovascular Procedures/adverse effects , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Humans , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/physiopathology , Ischemia/diagnostic imaging , Ischemia/physiopathology , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Popliteal Artery/diagnostic imaging , Popliteal Artery/physiopathology , Prosthesis Design , Retreatment , Treatment Outcome , Vascular Patency
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