🫀 Rethinking DCD Heart Transplantation

A new JAMA Original Investigation reports encouraging early outcomes using rapid recovery with extended ultraoxygenated preservation (REUP) for donation after circulatory death (DCD) heart transplantation—without donor heart reanimation or machine perfusion.

🔬 In a 24-patient case series, REUP achieved 96% 30-day survival, low primary graft dysfunction (4%), and minimal early rejection, even with older donors and prolonged ischemic times.

⚖️ By avoiding reanimation, REUP may reduce ethical concerns, cost, and logistical complexity, while expanding the usable donor pool.

🌍 A potentially scalable, globally relevant step forward in transplant medicine.

Sometimes progress is not about doing more—but about doing just enough, better.

⏰🧬 Timing matters in cancer.

A superb JCI Review, Rhythms of risk: the intersection of clocks, cancer, and chronotherapy, shows how circadian clocks regulate cell cycle, DNA repair, metabolism, immunity, hypoxia, and even metastasis—and how circadian disruption (e.g., night-shift work) can reshape cancer risk and treatment response. ⚖️💊

The takeaway: clock biology is context-specific, and aligning therapy with circadian phase may enhance efficacy while reducing toxicity—an underused lever in precision oncology. 🎯

Worth a careful read for clinicians, scientists, and trialists thinking about the fourth dimension of cancer: time. ⏱️

🫀 Residual Risk in Coronary Artery Disease

Even after "optimal" therapy, many patients remain at risk. Why? Because atherosclerosis is more than LDL—it's thrombosis 🩸, inflammation 🔥, and metabolism ⚖️ working in concert.

This FAQ-based slide deck distills contemporary insights on residual thrombotic, lipid, metabolic, and inflammatory risk, and highlights emerging therapies—from dual-pathway inhibition 💊 to GLP-1 receptor agonists 🧬 and colchicine—that help close the gap between treatment and outcomes.

📊 Key message: precision, not complacency.

#Cardiology #SecondaryPrevention #ResidualRisk #CAD #PrecisionMedicine

Swami Vivekananda reminded the world that spiritual strength and social service are inseparable 🕉️🔥

From Chicago in 1893 to India's national awakening, his message was simple yet radical: each soul is potentially divine—and serving humanity is serving the Divine 🌍🤝

More than a monk or philosopher, Vivekananda remains a timeless call to courage, compassion, and inner awakening ✨📚

🫀🧠🛡️ Sense. Signal. Scar.

A striking Cell study reframes myocardial infarction as a systems disease, not a heart-only event. Using single-cell and spatial transcriptomics in murine MI, the authors identify a triple-node heart–brain–immune loop: TRPV1-positive vagal sensory neurons (injury sensing) → hypothalamic paraventricular nucleus AT1aR neurons (central integration) → superior cervical ganglion IL-1β signaling (sympathetic–immune effector arm).

Intervening at any node improved ejection fraction, reduced infarct size, and normalized autonomic balance—pointing to neuroimmune modulation as a new therapeutic frontier beyond myocardium-centric care.

📌 Key takeaway: Treat the circuit, not just the scar.

📖 Yadav et al., Cell (2026)

🦵🌙 Restless Legs Syndrome: more than a sleep complaint

RLS affects ~3% of adults and is frequently missed or misdiagnosed as insomnia or anxiety. The latest evidence underscores three practical shifts: think iron (even when "normal"), choose gabapentinoids first, and beware dopaminergic augmentation.

For internists and frontline clinicians, recognizing RLS early can meaningfully improve sleep, mood, and quality of life—and may even reduce downstream cardiovascular risk. 🧠🩺💤

#RestlessLegsSyndrome #SleepMedicine #InternalMedicine #IronDeficiency #Gabapentinoids #Augmentation #PLMS #ClinicalPractice

🧠🩺 Why cancers behave the way they do—and why treatments fail

For internists, cancer is not just an oncologic diagnosis but a systems disease: driven by dysregulated growth, immune evasion, metabolic reprogramming, inflammation, and adaptive resistance.

The Hallmarks of Cancer framework offers a unifying clinical lens—explaining recurrence, cachexia, immunotherapy variability, and late relapse—without drowning us in molecular minutiae.

Understanding how tumors survive stress, therapy, and time sharpens prognosis, improves cross-disciplinary care, and strengthens bedside reasoning.

🔬 From biology to bedside. 🧩 From mechanisms to meaning. 📈 From treatment to trajectory.

📟🪑🏃‍♂️ A striking accelerometer-based analysis in The Lancet suggests that small, realistic behavior shifts could translate into meaningful mortality gains at the population level. For the least active adults, +5 minutes/day of moderate-to-vigorous physical activity (MVPA) was associated with preventing ~6% of deaths; applying a similar increase broadly (excluding the most active) could prevent ~10%. Reducing sedentary time by 30 minutes/day was associated with preventing ~3% (high-risk) to ~7% (population) of deaths (with smaller—but still meaningful—effects in UK Biobank).

🎯 Practical takeaway: "5 minutes more exercise, 30 minutes less sitting." Small hinges, big doors.

(Ekelund et al., The Lancet, 2026)

🦵❤️ Peripheral Artery Disease is not just a leg problem—it's a life-threatening cardiovascular signal.

Up to 60% of patients are asymptomatic, yet PAD doubles to triples the risk of myocardial infarction, stroke, and death. Evidence is clear: exercise therapy, statins, antiplatelet or rivaroxaban-based strategies, blood-pressure control, and GLP-1/SGLT2 therapies save limbs and lives.

🚶‍♂️💊🫀 When walking hurts—or quietly fades—cardiovascular risk rises. PAD deserves the same urgency as coronary disease.

#PeripheralArteryDisease #PreventiveCardiology #Claudication #ExerciseMedicine #Atherosclerosis #CardioVascularRisk

🫀 What do the 2026 AHA Statistics really tell us?

The latest AHA update makes one message unmistakably clear: prevention works—but only when systems work. From Life's Essential 8 🧭 to the rise of cardiovascular–kidney–metabolic (CKM) health 🩺🧪, the data show that blood pressure control, sleep 😴, physical activity 🚶‍♂️, nutrition 🥗, and nicotine cessation 🚭 shape not only heart outcomes, but brain health 🧠, equity ⚖️, and healthcare costs 💰.

The challenge ahead isn't discovering new risk factors—it's implementing what we already know, at scale and with fairness. Prevention is no longer aspirational; it's clinical, economic, and moral necessity.