New research from Karolinska Institutet refutes the findings of a previous study indicating a possible higher risk of death after sex-discordant blood transfusions for cardiac surgery.

In a study researchers from Karolinska Institutet and Lund University examined how sex-discordant blood transfusions (i.e. blood from a woman to a man or vice versa) affected survival following cardiac surgery. The study was conducted on data from the SWEDEHEART registry and the SCANDAT2 database on almost 50,000 patients who underwent cardiac surgery from 1997 to 2012 in Sweden.
This study was done after a previous Swedish study from earlier in the year indicated a possible increased risk of death after cardiac surgery from sex-discordant blood transfusions.

‘The consequences of the findings from this first study, if proved true, would have been immense and necessitated radical changes to how blood transfusions are managed around the world,’ says Martin Holzmann from Karolinska Institutet.

In the new study, however, the team found no association between sex-discordant blood transfusions and post-cardiac surgery survival.

Martin Holzmann, lead author of the new study continues:
‘Our results clearly show that there is no real connection between sex-discordant blood transfusions and the risk of death.’
The reason for the difference between the studies is that the new one fully compensated for the fact that more transfusions increase the risk of death and of a mismatch between the sex of the donor and the patient. The researchers conclude from their results that current gender-blind blood transfusion procedures are safe and do not need changing.

Karolinska Institute ki.se/en/news/no-association-between-sex-discordant-blood-transfusions-and-risk-of-death

Aortic stenosis (AS), the narrowing of the aortic valve in the heart which causes restricted blood flow, is one of the most common and serious valve disease problems. For patients with one type of AS – low flow – transcatheter aortic valve replacement (TAVR), a minimally invasive procedure which corrects the damaged aortic valve, is often the best option for restoring the heart’s normal pumping function. However, approximately one-third of low flow AS patients treated with TAVR continue to suffer persistent low flow AS even after the procedure, ultimately increasing their risk of death. Now, researchers from the Perelman School of Medicine at the University of Pennsylvania have examined this high-risk patient population to determine the cause of this persistent low flow AS and to evaluate their risk of dying during the year following the procedure.
‘There has been a lot of interest in these patients with low flow AS, as their surgical mortality is higher than other patients. TAVR is often a good option, but not all of them will be able to normalize flow following the procedure and these persistently low flow patients have a 60 percent higher rate of mortality at one year,’ said Howard C. Herrmann, MD, FACC, MSCAI, John W. Bryfogle Professor of Cardiovascular Medicine and Surgery, and director of Penn Medicine’s Interventional Cardiology Programme. ‘Low flow before TAVR is one of the most important predictors of mortality following TAVR, but it is one of the harder qualities to measure. This presents a challenge to properly treating patients with low flow AS, and can leave some patients at higher risk.’
To better understand the potential benefits of TAVR for low flow AS, researchers conducted an analysis of 984 patients with low flow AS from the PARTNER trial and continued access registry from April 2014 through January 2016. A baseline and followup echocardiogram, evaluation of post-TAVR hemodynamics – blood flow – and one year outcomes were assessed.
Through this analysis, researchers identified the large subgroup of patients who, following TAVR, failed to regain normal flow despite a successful procedure. In the first six months following TAVR, flow improved in roughly 66 percent of the patients evaluated. However, those with severe low flow AS had the highest mortality rate – 26 percent – at one year, as compared to approximately 20 percent for those with moderate low flow and even less for those with normal flow.
‘Unfortunately, many centres do not routinely measure flow, but rather focus more on a patient’s pressure gradient or valve area when evaluating aortic stenosis pre-and post-TAVR,’ said Herrmann. ‘While low flow is more challenging to monitor, this measurement can better inform the patient’s risk of mortality, and in turn lead to better treatment.’
The researchers noted that the identification of remedial, or treatable, causes of persistent low flow following TAVR, such as severe mitral regurgitation and atrial fibrillation, may represent an opportunity to improve the outcomes of these patients.

Penn Medicine http://tinyurl.com/htz5gvj

A Mayo Clinic research team has found evidence suggesting that the controversial practice of ovary removal in premenopausal women to prevent ovarian cancer should be discontinued in women who are not at high risk of cancer. The study showed that women under 46 who had both ovaries removed experienced a significantly elevated risk of multiple chronic health conditions that included depression, hyperlipidemia, cardiac arrhythmias, coronary artery disease, arthritis, asthma, chronic obstructive pulmonary disease and osteoporosis.

Bilateral oophorectomy is the formal term for removal of both ovaries, often used as a preventive measure against ovarian cancer. For the first time, the team of nine Mayo researchers from multiple disciplines linked bilateral oophorectomy to a marked increase in 8 of the 18 chronic health conditions that were measured.

‘This study provides new and stronger evidence against the use of bilateral oophorectomy for prevention in young women,’ says Walter Rocca, M.D., lead author of the study. ‘Bilateral oophorectomy should not be considered an ethically acceptable option for the prevention of ovarian cancer in the majority of women who do not carry a high-risk genetic variant.’

The study followed two groups of women for a period of approximately 14 years. There were 1,653 women who underwent bilateral oophorectomy and an equal number of women of the same age who did not. The study was made possible by using the records linkage system of the Rochester Epidemiology Project.

Results showed that women under 46 who underwent bilateral oophorectomy experienced a higher incidence of the 18 chronic conditions considered one at a time, except cancer, and an accelerated rate of accumulation of combined conditions, or multi-morbidity. Oestrogen therapy reduced some of the risk in women who had undergone the procedure.

The investigators suggest that the premature loss of oestrogen caused by the oophorectomy may affect a series of aging mechanisms at the cellular and tissue level across the whole body leading to diseases in multiple systems and organs. In summary, the effects of oophorectomy in premenopausal women are much broader and more severe than previously documented.

‘The clinical recommendation is simple and clear,’ Dr. Rocca concludes. ‘In the absence of a documented high-risk genetic variant, bilateral oophorectomy before the age of 50 years (or before menopause) is never to be considered and should not be offered as an option to women.’

Mayo Clinic newsnetwork.mayoclinic.org/discussion/ovarian-removal-to-prevent-ovarian-cancer-should-not-be-an-option-for-premenopausal-women-mayo-research-finds/

A medical device for Cystic Fibrosis (CF) sufferers which lessens their exposure to infections resulting in fewer doctors’ visits, reduced antibiotic usage and shorter hospital stays, is expected to be market ready within two years.
University of Limerick (UL) inventors recently secured funding for the new percussion device that helps remove mucus from the airways and will, they hope, greatly improve the quality of life for cystic fibrosis patients.
Ireland has the highest incidence of CF in the world and CF is the most common, fatal hereditary disease in the United States.
Professor Colum Dunne, who is Foundation Chair and Director of Research at UL’s Graduate Entry Medical School (GEMS), explained the background to the development of the product.
‘Patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary or lung function. One example that we have focused on here is the CF patient airway, which is defective in ciliary function; resulting, due to ineffective removal, in a mucus-rich environment favouring growth of bacteria. These bacteria include potential pathogens, associated with chronic infection, decreased lung function and accelerated respiratory disease’.

Currently, there are percussion-based chest physiotherapy devices on the market, but according to Professor Dunne, these ‘can sometimes become reservoirs for the bacteria that cause infections in Cystic Fibrosis patients’. Because the new device, SoloPep, is disposable, it poses no threat of reinfection.
‘In our research, we have observed that compliance with hygiene practices for reusable devices, by patient, is potentially poor. As such, despite even excellent compliance with prescribed antimicrobial regimens, the devices may become colonised with problematic or opportunistic pathogenic microbes,’ Professor Dunne outlined.

‘The devices may, therefore, function as a reservoir that does not come into contact with the antimicrobial agents. Subsequently, re-infection may occur post-antimicrobial cessation by microbes present in the reservoir. Therefore, there is a need to develop novel inexpensive, single-use devices,’ he added.

‘Ireland has the highest per capita incidence of Cystic Fibrosis globally. Because of this, it is reasonable to expect treatment innovations generated by Irish researchers and carers. In this case, our studies included patient involvement from the outset and allowed us to develop something that is truly technologically disruptive. The design of this new positive expiratory pressure (PEP) device is clever and focused on the end user from the beginning. It removes significant risk for patients by improving their microbiology hygiene and safety,’ Professor Dunne added.

Dr Leonard O’Sullivan from UL’s School of Design is co-principal investigator for this device.
‘SoloPEP is a good example of user-centred design and it will have a dramatic impact on the quality of life of cystic fibrosis patients in a sector with significant commercial opportunity,’ he said.
‘This product has the potential to improve the lives of Cystic Fibrosis and other patients. But for that to happen the product must actually be available to them,’ Professor Dunne concluded.

University of Limerick www.ul.ie/gems/news/new-cystic-fibrosis-device-reduce-antibiotic-usage

Michigan Medicine researchers employ novel technology to monitor vulnerabilities for cardiovascular events, aid in diagnosis and treatment
Strokes and heart attacks often strike without warning. But, a unique application of a medical camera could one day help physicians know who is at risk for a cardiovascular event by providing a better view of potential problem areas.

‘The camera actually goes inside the vessels,’ says first author Luis Savastano, M.D., a Michigan Medicine resident neurosurgeon. ‘We can see with very high resolution the surface of the vessels and any lesions, such as a ruptured plaque, that could cause a stroke. This technology could possibly find the smoking gun’ lesion in patients with strokes of unknown cause, and may even be able to show which silent, but at-risk, plaques may cause a cardiovascular event in the future.’

The scanning fibre endoscope, or SFE, used in the study was invented and developed by co-author and University of Washington mechanical engineering research professor Eric Seibel, Ph.D.. He originally designed it for early cancer detection by clearly imaging cancer cells that are currently invisible with clinical endoscopes.

The Michigan Medicine team used the instrument for a new application: acquiring high-quality images of possible stroke-causing regions of the carotid artery that may not be detected with conventional radiological techniques.

Researchers generated images of human arteries using the SFE, which illuminates tissues with multiple laser beams, and digitally reconstructs high-definition images to determine the severity of atherosclerosis and other qualities of the vessel wall.

A unique application of a medical camera could one day help physicians know who is at risk for a cardiovascular event by providing a better view of potential problem areas.

‘In addition to discovering the cause of the stroke, the endoscope can also assist neurosurgeons with therapeutic interventions by guiding stent placement, releasing drugs and biomaterials and helping with surgeries,’ Seibel says.

In addition, the SFE uses fluorescence indicators to show key biological features associated with increased risk of stroke and heart attacks in the future.

‘The ability to identify and monitor the biological markers that render a plaque unstable and at risk for rupture could enable the detection of individuals within high-risk populations who are most likely to suffer from cardiovascular events, and therefore benefit the most from preventive treatment during the asymptomatic stage,’ says B. Gregory Thompson, M.D., professor of neurosurgery at the University of Michigan Medical School and a senior author on the new paper.

University of Michigan www.uofmhealth.org/news/archive/201702/laser-based-camera-improves-view-carotid-artery