Researchers at Loma Linda University Health found that kidney transplantation can be safely performed using organs testing positive for the hepatitis C virus (HCV) antibody but negative for active viral infection. Their findings, published July 24, 2018 in the American Journal of Transplantation, could expand the number of kidneys available for those in need.
“One way of increasing the kidney donor pool is to utilize more organs from HCV positive donors,” said the study’s lead author, Michael E. de Vera, MD, director of Loma Linda University (LLU) Transplant Institute. “Currently, HCV positive donors are defined by donors that have previously had HCV even if they were cured. Now there has been a call to redefine the definition of an HCV positive donor in hopes that more organs can be used from these donors.”
Co-author of the study, Michael Volk, MD, director of transplant hepatology at LLU Tansplant Institute, participated in a 2017 American Society of Transplantation consensus conference, which encouraged the use of organs testing positive for HCV — those with only a positive antibody, as well as those testing positive for the virus. This recommendation stems in part from the availability of newer and better medications to cure people of the virus. “These organs testing positive for HCV are frequently discarded and often come from younger donors,” Volk said. “This approach has the potential to save lives by increasing the numbers of transplants.”
Although there is a record number of deceased organ donors, de Vera said the gap between the number of kidney transplants performed and the number of patients on the waiting list remains substantial. There are now nearly 95,000 kidney patients on the waiting list, but less than 20,000 kidney transplants occurred in 2017, according to the United Network for Organ Sharing. The problem is even wider in California, where nearly 2,300 people received a kidney in 2017, while nearly 19,000 remained on the waitlist.
HCV is tested in organ donors by checking for the presence of HCV antibodies (Ab) and HCV RNA, de Vera said. The presence of HCV antibodies shows that the virus at some point affected the host, but does not reveal if the host was cured. The presence of HCV RNA, on the other hand, indicates active infection. Many organ donors are HCV Ab positive but HCV RNA negative, and doctors have been reluctant to transplant kidneys from these donors for fear of transmitting HCV to the recipient. As a result, many of these kidneys have not been used in the past.
“Our hope is that this study will convince transplant doctors that the use of these donor kidneys is safe and does not lead to HCV transmission,” said de Vera. “And hopefully, more patients will receive these life-saving organs.”
The study was titled, “Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia.” The study looked at 32 patients who were transplanted with HCV Ab+/NAT- kidneys at Loma Linda University Medical Center from January 2017 to February 2018. All patients consented to the surgeries. Recipient ages ranged from early 40s to late 60s, and donor ages ranged from late 20s to mid 50s. All 32 patients are doing well without evidence of hepatitis C virus infection.
https://lluh.org/?rsource=lluhealth.org/

The two synergistic trade exhibitions for the medical, healthcare and MedTech sectors, Medical Fair Asia and Medical Manufacturing Asia 2018 closed to resounding success on 31st August. With its largest edition to date, more than 14,000 trade visitors from 72 countries visited the fairgrounds of Medical Fair Asia this year — a 16 per cent increase from 2016. Medical Manufacturing Asia 2018 registered some 6,000 visitors from 56 countries – making it a 12 per cent increase from the previous edition.
The three-day synergistic exhibitions hosted more than 1,220 exhibitors from 62 countries who reached out to a diverse, international profile of visitors. While 40 percent of the visitors came from outside Singapore, the majority were from Asia with neighbouring ASEAN countries particularly well represented. As Dr Chew Wei Lun, a certified functional medicine practitioner and first-time visitor observed, “I was impressed by the breadth of products on show and the wide internationality of exhibitors. In fact, I even learned more about the rehabilitative products which I was on the lookout for.”
Confirming its position as the region’s leading business platform for the healthcare and medical sector, Medical Fair Asia 2018 hosted a total of 23 national pavilions and country groups — its strongest line-up yet. The Russian Pavilion was among the nine new country pavilions which made their debut at the show.

The positive market outlook for the medical and MedTech sectors was well-reflected by the number of high-quality visitors seeking cutting-edge solutions among the more than 10,000 products showcased at the exhibition, representing the entire end-to-end value chain from medical manufacturing processes and machinery, to finished products and components.
New technology and digital health solutions were the big draws at the exhibitions, with the new Start-up Park gaining much interest as a dedicated showcase for young companies to pitch to top decision makers and seek potential investors.
On the Medical Manufacturing Asia front, companies with new approaches to innovation also took centre stage, underlined by the opening speech by Dr Koh Poh Koon, Senior Minister of State for Trade and Industry. He emphasized the growing trend of medical technology companies moving up the value chain and the need for new approaches and greater collaboration.
Strengthening their positions as the sourcing and procurement platforms of choice, both exhibitions welcomed visiting delegations and VIP buyers from Malaysia, Indonesia, Thailand, and Vietnam.

Complementing Medical Fair Asia and Medical Manufacturing Asia 2018 were a series of industry-focused conferences, seminars and workshops covering a wide-range of topics such as sports medicine, wearable technologies, robotic surgery, community care and MedTech that attracted 700 international attendees.
The next editions of the co-located exhibitions will take place from 9 to 11 September 2020 at the Marina Bay Sands, Singapore.

Surgical teams now have four new tools to help them improve outcomes for their patients in the form of screening checklists from the American College of Surgeons (ACS) Strong for Surgery program (S4S). The four common risk areas targeted address the following issues:
Delirium – The recognition and treatment of delirium is critically important because postoperative delirium is associated with poor outcomes including functional decline, longer hospitalization, institutionalization, greater costs, and higher mortality. Studies have shown that age, alcohol abuse, poor cognitive and physical functioning, and abnormal laboratory values have been associated with delirium. High-risk patients identified for exhibiting some of the risk criteria can be candidates for interventions designed to prevent or reduce the impact of postoperative delirium.
Prehabilitation – Cognitive, gait, balance, and nutritional and functional impairments place patients at higher risk of perioperative and postoperative complications. Prehabilitation is an opportunity to help patients return quickly to the highest level of functioning possible after operation, thereby reducing surgery‐related morbidity and/or mortality, decreasing the length of stay in hospital and rehabilitation, and reducing readmissions.
Pain Management – Unrelieved pain can result in longer hospital stays, increased rate of readmission, increased outpatient visits, and decreased ability to function fully. To ensure safe, effective pain management after the surgical procedure, it is recommended that patients receive counselling prior to their operations about pain management options. Presurgery counselling with patients that involves expectation setting, potential adverse effects, and the use of non-prescribed medication for pain relief can help patients set realistic goals for recovery.
Patient Directives – An important aspect of patient safety is patient education. Patient education before surgery helps minimize presurgery anxiety related to the operation itself. During this time, discussion referencing the financial burden, post-procedure pain, surgical risks and the necessity of the procedure are also important. The patient should feel supported in the preoperative period and should be encouraged to express his or her feelings about the surgical experience.Checklists, which are the cornerstone of S4S, are integrated into the preoperative phase of clinical practice for elective operations by surgeons and surgical staff. By screening patients for potential risk factors that can lead to surgical complications, these checklists open the door for appropriate interventions to ensure better outcomes for patients. Global research has shown that use of a checklist improves patient optimization for an operation and helps ensure that important aspects of care are followed for each case.“Strong for Surgery brings a well-researched presurgery checklist to surgeons’ offices to help with patient education, communication, and standardization of best practices to improve clinical outcomes.  A patient’s risk of negative outcomes from an operation can be improved by using best practices to prepare them for an operation, and we’re starting to see study results where these checklists have helped to do just that,” said Dr. Varghese.
American College of Surgeonhttps://tinyurl.com/y7s6gpzt

Peripheral intravenous cannula (PIVC) insertion in the emergency department can be reduced using a multimodal approach designed to support critical thinking and promote clinically appropriate peripheral intravenous cannula insertion and use.
The lead author of the study is Tracey Hawkins, Grad Cert (ENurse), in the Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia.
The study, by Hawkins, et al, showed that multimodal intervention not only reduced PIVC placement in the ED, it also increased the percentage of PIVCs placed that were used. These findings suggest that this program benefits patients and health services alike, with potential for large cost savings. Ali Tann, BSN, RN, CEN a registered nurse in the emergency department at IU Health Methodist Hospital, Indianapolis, commented:
“Many PIVs are placed because we know that labs will be ordered, but may not be sure about fluids and/or meds and don’t want to stick the patient too many times. Simply stated, the more sticks the unhappier the patient. But ultimately, in order for PIV campaigns to be successful, there needs to be more consensus among the providers. In other words, if the gut works, use it!”

Medical Newshttps://tinyurl.com/y72ktac7

Researchers at Mayo Clinic have identified an important new pathway by which HER2 positive breast cancers grow and have discovered that a dietary supplement called cyclocreatine may block the growth of HER2 positive breast cancer.
“The HER2 receptor tyrosine kinase, which functions as an ‘on’ or ‘off’ switch in cellular functions, is a key driver of breast cancer, and is overexpressed in about a quarter of all breast cancers,” says Taro Hitosugi, Ph.D., a pharmacologist at Mayo Clinic and corresponding author of the paper. “While drugs such as trastuzumab improved outcomes for some patients with HER2 positive breast cancer, some tumours are or may become resistant to this drug.”
Dr. Hitosugi and his colleagues decided to explore ways to resolve this unmet clinical need. Their strategy was to develop a treatment to target tumour mitochondrial energy metabolism, which is the process cancer cells use to manipulate energy during cell metabolism in order to grow.
The challenge for researchers was to determine which mitochondrial enzymes were activated by HER2 cancer cells. “We employed metabolomics and proteomics approaches to identify HER2-dependent metabolic events, and discovered that HER2 signalling activates mitochondrial creatine kinase 1,” says Dr. Hitosugi.
Dr. Hitosugi and his colleagues discovered that cyclocreatine, a dietary supplement used in sports drinks, effectively targets mitochondrial creatine kinase 1 enzyme and reduces cancer growth without toxicity. This finding was confirmed in mice models where a patient-derived, trastuzumab-resistant HER2 positive tumours were administered to the mice.
“Mitochondrial creatine kinase 1 may be a new drug target for the treatment of HER2 positive breast cancer,” says Matthew Goetz, M.D., director of the Mayo Clinic Breast Cancer research program. “Future clinical trials will be necessary to determine the effectiveness of this drug for HER2 positive breast cancer resistant to standard therapies.”

Mayo Clinichttps://tinyurl.com/y73252og