First transplant of 'dead' heart








By James Gallagher
Health editor, BBC News website


Transmedic machineThe console where the heart is “reactivated” is being called the heart-in-a-box machine


Surgeons in Australia say they have performed the first heart transplant using a “dead heart”.

Donor hearts from adults usually come from people who are confirmed as brain dead but with a heart still beating.

A team at St Vincent’s Hospital in Sydney revived and then transplanted hearts that had stopped beating for up to 20 minutes.

The first patient who received a heart said she felt a decade younger and was now a “different person”.

Hearts are the only organ that is not used after the heart has stopped beating – known as donation after circulatory death.

Beating hearts are normally taken from brain-dead people, kept on ice for around four hours and then transplanted to patients.


‘Significant development’

The novel technique used in Sydney involved taking a heart that had stopped beating and reviving it in a machine known as a “heart-in-a-box”.

The heart is kept warm, the heartbeat is restored and a nourishing fluid helps reduce damage to the heart muscle.

The first person to have the surgery was Michelle Gribilas, 57, who was suffering from congenital heart failure. She had the surgery more than two months ago.

“Now I’m a different person altogether,” she said. “I feel like I’m 40 years old – I’m very lucky.”

There have since been a further two successful operations.

Prof Peter MacDonald, head of St Vincent’s heart transplant unit, said: “This breakthrough represents a major inroad to reducing the shortage of donor organs.”

It is thought the heart-in-a-box, which is being tested at sites around the world, could save up to 30% more lives by increasing the number of available organs.

The breakthrough has been welcomed around the world.

The British Heart Foundation described it as a “significant development”.

Maureen Talbot, a senior cardiac nurse at the charity, told the BBC: “It is wonderful to see these people recovering so well from heart transplantation when, without this development, they may still be waiting for a donor heart.”


Liver warming


Liver machineThis machine keeps the donor liver functioning at body temperature

Similar methods of warming and nourishing organs before transplant have been used to improve the quality of lung and liver transplants.

James Neuberger, the associate medical director at the UK’s NHS Blood and Transplant service, said: “Machine perfusion is an opportunity to improve the number and quality of organs available for transplant.

“We look forward to more work being carried out to determine the impact of this technology on increasing the number of organs that can safely be used for transplant and on improving the quality of those organs.

“It is too early to predict how many lives could be saved through transplantation each year if this technology were to be adopted as standard transplant practice in the future.”

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New York City says hospital testing doctor with Ebola-like symptoms

A volunteer of the German army Bundeswehr, wearing a protective suit, is disinfected by a colleague during an Ebola training session at the Marseille barracks in Appen, October 23, 2014. REUTERS/Fabian Bimmer

A volunteer of the German army Bundeswehr, wearing a protective suit, is disinfected by a colleague during an Ebola training session at the Marseille barracks in Appen, October 23, 2014.

Credit: Reuters/Fabian Bimmer


(Reuters) – A New York City hospital is running Ebola tests on a healthcare worker who returned to the United States from West Africa with a fever and gastrointestinal symptoms, the city’s Health Department said on Thursday.

Preliminary test results were expected in the next 12 hours, the New York City Department of Health and Mental Hygiene said in a statement.

The patient being treated at Bellevue Hospital is a healthcare worker who returned to the United States within the past 21 days from one of the three African countries facing the Ebola outbreak, it said.

The Health Department said it was tracing all of the patient’s contacts to identify anyone who may be at potential risk. It also said the patient had been transported by a specially trained unit wearing protective gear.

(Editing By Ellen Wulfhorst and Sandra Maler)

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Rheumatoid arthritis: Researchers identify new signaling pathway thought to play role

A new study by researchers at Hospital for Special Surgery (HSS) identifies a new cell signaling pathway that contributes to the development and progression of inflammatory bone erosion, which occurs in patients with rheumatoid arthritis (RA).

Rheumatoid arthritis is a systemic inflammatory autoimmune disease that affects millions of people worldwide. Bone erosion in joints is a major cause of disability in RA patients.

The study, titled “RBP-J imposes a requirement for ITAM-mediated costimulation of osteoclastogenesis,” was published online in the Journal of Clinical Investigation on October 20. Baohong Zhao, PhD, lead investigator and assistant scientist in the Arthritis and Tissue Degeneration Program at HSS, and colleagues uncovered a novel signaling pathway and elucidated the underlying mechanisms that could contribute to bone destruction in RA.

Recently, other scientists conducted a genome-wide association study to identify genes linked to RA development. They discovered that a certain variant in a gene called RBP-J was associated with the development of RA, but its specific role was unknown.

“We found for the first time that the expression level of this risk gene in RA patients is significantly lower than the level in healthy controls, thus providing important evidence of the link between this risk gene and RA disease,” explained Dr. Zhao.

The scientists also elucidated mechanisms by which the RBP-J protein controlled excessive bone erosion through a newly identified signaling pathway. “We are very excited about our results, because this newly identified RBP-J-controlled signaling pathway will provide potential novel therapeutic targets for the prevention and treatment of RA, thus opening a new avenue for both basic research and clinical care,” said Dr. Zhao.

The scientists used powerful high-tech next generation whole transcriptome sequencing, which can provide information on the expression level of each single gene among thousands of human genes. “This technology enabled us to unravel key components of this new signaling pathway,” said Dr. Zhao.

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The above story is based on materials provided by Hospital for Special Surgery. Note: Materials may be edited for content and length.

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Obama says cautiously more optimistic about Ebola situation in U.S.


U.S. President Barack Obama talks to the press after meeting with his team coordinating the government's Ebola response in the Oval Office of the White House in Washington, October 16, 2014. REUTERS/Larry Downing


U.S. President Barack Obama talks to the press after meeting with his team coordinating the government’s Ebola response in the Oval Office of the White House in Washington, October 16, 2014.

Credit: Reuters/Larry Downing


(Reuters) – President Barack Obama expressed cautious optimism about the Ebola situation in the United States on Wednesday after the U.S. government imposed new screening measures for travelers from West Africa.

Obama sat down for talks with his Ebola response coordinator, Ron Klain, on Klain’s first day on the job since he was appointed last Friday. They were joined by other top officials.

Obama, speaking to reporters, said he is confident that hospitals in Texas and Ohio are prepared if cases of Ebola emerged there. A nurse at a Dallas hospital that treated Ebola victim Thomas Duncan had flown to Ohio a day before she had symptoms of the virus.

The president said modest signs of progress in the fight against the Ebola virus are being reported in hard-hit Liberia.

(Reporting by Jeff Mason and Steve Holland; Editing by Eric Walsh)

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NICE conflicts of interests claim








Adam BrimelowBy Adam Brimelow
Health Correspondent, BBC News


statin pill


A group of leading doctors and researchers has called on MPs to investigate potential conflicts of interest at the watchdog NICE.

In a letter to the Health Select Committee, they have expressed concern about financial ties to drug companies among experts working for NICE.

The concerns follow controversy over the recent NICE guideline on statin drugs.

NICE has defended its procedures on conflicts of interests.

The letter reflects continuing disquiet among some doctors and researchers over the recent decision by NICE to extend the availability of cholesterol-lowering drugs to millions of people at low risk of developing heart disease.

A majority on the NICE panel that recommended this had ties to pharmaceutical companies.

Their interests were declared but the letter argues that is not enough to ensure impartiality.


‘Licensed’ to advise?

“Transparency is important but accuracy and objectivity should be the gold standard expected of an independent panel,” it says.

The letter argues disclosure of a conflict of interest may even make matters worse because experts may feel “licensed” to emphasise their advice still further.

NICE rules stipulate that members of advisory committees should not have had a personal financial interest in a related company in the last 12 months.

One of the letter signatories, the former Conservative shadow health minister Lord Ian McColl, said this was dubious.

“They could have had millions paid before the 12 months. It really needs to be tightened up.”

Another signatory, a London cardiologist Dr Aseem Malhotra, urged NICE to act.

“I have always had tremendous respect for NICE but their conflicts-of-interest policy clearly needs to be strengthened so that the medical profession and patients can feel fully confident that decisions are made completely independent of personal or industry interests.”


Not “fit for purpose”

The letter is clear that there is no suggestion of any impropriety, but it says the governance arrangements for conflicts of interest at NICE are “not fit for purpose”.

It proposes the establishment of “more independent panels” to minimise the possibility of conflicts of interest, and calls on the Health Select Committee to consider looking into the issue “as a matter of urgency”. They will discuss the matter later today.

In June, a letter supported by many of the same signatories argued that plans to extend the use of statins should be scrapped. It said NICE had used data which “grossly underestimated” the side-effects.

NICE says its response to that letter dealt with concerns raised over conflicts of interests, and it has nothing to add. That statement from NICE defended its procedures.

“Where conflicting interest exists, the individual concerned is either not appointed in the first place or asked to withdraw temporarily, or to leave the group altogether, depending on the nature of the conflict.”

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Study identifies new signaling pathway that leads to inflammatory bone erosion in RA patients

A new study by researchers at Hospital for Special Surgery (HSS) identifies a new signaling pathway that contributes to the development and progression of inflammatory bone erosion, which occurs in patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a systemic inflammatory autoimmune disease that affects millions of adults worldwide. Bone erosion in joints is a major cause of disability in RA patients.

The study, titled “RBP-J imposes a requirement for ITAM-mediated costimulation of osteoclastogenesis,” was published online in the Journal of Clinical Investigation on October 20. Baohong Zhao, PhD, lead investigator and assistant scientist in the Arthritis and Tissue Degeneration Program at HSS, and colleagues uncovered a novel signaling pathway and elucidated the underlying mechanisms that could contribute to bone destruction in RA. Recently, other scientists conducted a genome-wide association study to identify genes linked to RA development. They discovered that a certain variant in a gene called RBP-J was associated with the development of RA, but its specific role was unknown.

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“We found for the first time that the expression level of this risk gene in RA patients is significantly lower than the level in healthy controls, thus providing important evidence of the link between this risk gene and RA disease,” explained Dr. Zhao.

The scientists also elucidated mechanisms by which the RBP-J protein controlled excessive bone erosion through a newly identified signaling pathway. “We are very excited about our results, because this newly identified RBP-J-controlled signaling pathway will provide potential novel therapeutic targets for the prevention and treatment of RA, thus opening a new avenue for both basic research and clinical care,” said Dr. Zhao.

The scientists used powerful high-tech next generation whole transcriptome sequencing, which can provide information on the expression level of each single gene among thousands of human genes. “This technology enabled us to unravel key components of this new signaling pathway,” said Dr. Zhao.

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Curfew in Sierra Leone town after rioting, shooting over Ebola case


(Reuters) – Authorities in Sierra Leone imposed a curfew in the eastern town of Koidu on Tuesday after a dispute between youth and police over a suspected case of Ebola degenerated into gunfire and rioting, officials said.

A local civil society leader said he had seen at least two bodies with gunshot wounds. The head of the local police unit said youth had fired at officers with shotguns but denied anyone had been shot dead.

The clashes highlight tensions in Sierra Leone over the government’s attempt to bring the worst Ebola outbreak on record under control. Sierra Leone has recorded 1,200 deaths from just over 3,400 cases of Ebola, according the latest U.N. data.

David Koroma, the police unit commander in Koidu, said rioting began when a former youth leader refused health authorities permission to take her 90-year old grandmother for an Ebola test.

Dr Manso Dumbuya, the district medical officer, said he had been forced to abandon the hospital because of the rioting. The diamond-rich district of Kono, which includes the town of Koidu, does not have an Ebola treatment center and cases are taken to neighboring Kenema or Kailahun.

With cases of Ebola arriving in the West and the prospect of tens of thousands more in West Africa, the global effort to defeat Ebola is picking up pace.

But the lack of trust between communities and governments in West Africa has complicated efforts to contain a disease, for which there is no known cure. Ebola has now killed over 4,500 people this year, mainly in Liberia, Sierra Leone and Guinea.

(Reporting by Umaru Fofana; Writing by David Lewis; Editing by Daniel Flynn)

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Americans back travel ban from Ebola outbreak countries: Reuters/Ipsos poll

Protestor Jeff Hulbert of Annapolis, Maryland holds a sign as he demonstrates in favor of a travel ban to stop the spread of the Ebola virus, in front of the White House in Washington October 16, 2014.  REUTERS/Jim Bourg

Protestor Jeff Hulbert of Annapolis, Maryland holds a sign as he demonstrates in favor of a travel ban to stop the spread of the Ebola virus, in front of the White House in Washington October 16, 2014.

Credit: Reuters/Jim Bourg


(Reuters) – Nearly three-fourths of Americans support a ban on civilian air travel in and out of the West African countries that have experienced an Ebola outbreak, a new Reuters/Ipsos poll shows, suggesting growing pressure on President Barack Obama over the issue.

Republicans have been clamoring for a broad travel ban as they campaign ahead of November’s congressional elections, and in recent days a handful of Obama’s fellow Democrats in close Senate races have joined the fray.

New Hampshire Senator Jeanne Shaheen on Monday became the latest Democratic candidate to join a slew of Republicans in being open to a ban. The issue has surfaced in close races across the country as Republicans look to wrest control of the U.S. Senate from the Democrats.

More than 70 percent of poll respondents said they would support blocking all civilian travel in and out of those countries, even as experts questioned how useful such measures would be in containing the disease.

The Obama administration on Tuesday said travelers to the United States from Liberia, Sierra Leone or Guinea must fly into one of five airports with advanced screening procedures, but it has so far resisted calls for a broader travel ban.

While Americans are split over whether all exports from the affected West African countries should be blocked, 58 percent said food exports should be stopped.

The online poll of 1,602 people, conducted between Oct. 16 and 21, had a confidence interval – similar to a margin of error – of 2.8 points.

(Reporting by Gabriel Debenedetti; Editing by Jonathan Oatis)

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Mummy remains refute antiquity of ankylosing spondylitis

Ankylosing spondylitis is a systemic disease that causes inflammation in the spinal joints and was thought to have affected members of the ancient Egyptian royal families. Now a new study published in Arthritis & Rheumatology, a journal of the American College of Rheumatology (ACR), refutes that claim, finding instead a degenerative spinal condition called diffuse idiopathic skeletal hyperostosis (DISH) in royal Egyptian mummies from the 18th to early 20th Dynasties.

Ankylosing spondylitis is a member of a group of inflammatory conditions called the spondyloarthropathies that cause arthritis and affect up to 2.4 million Americans over the age of 15 according to the ACR. The most common in this rheumatic disease family is ankylosing spondylitis, which causes pain and stiffness in the back, and may lead to bony fusion of the spine. Studies estimate that ankylosing spondylitis affects about one percent of the population, primarily affecting young men.

In DISH the hardening of ligaments along the vertebrae of the spine cause stiffness in the upper back and can affect other joints in the body. While DISH may appear similar to ankylosing spondylitis, it is a degenerative and not an inflammatory type of arthritis, affecting those 60 years of age and older.

Previous research using x-ray images claimed that three Pharaohs (Amenhotep II, Ramesses II, and his son Merenptah) displayed evidence of ankylosing spondylitis. The current study used computed tomography (CT), a more sophisticated imaging technology, to study thirteen royal Egyptian mummies from 1492-1153 BC to determine if signs of ankylosing spondylitis or DISH were present.

A diagnosis of ankylosing spondylitis was ruled out due to the absence of joint erosion in the lower back and pelvis area (sacroiliac joints) or fusion of sacroiliac joints or of small joints between the vertebra in the spine (facet joints) on the CT scans of the mummies. Signs of DISH were found in four Pharaohs (Amenhotep III — 18th Dynasty; Ramesses II, his son Merenptah, and Ramesses III — 19th to early 20th Dynasties).

The study was conducted by Dr. Sahar Saleem with the Kasr Al Ainy Faculty of Medicine in Cairo, Egypt and Dr. Zahi Hawass, Egyptologist and former head of the Egyptian Supreme Council of Antiquities. The authors say, “The mummies of Ancient Egypt offer a wealth of information regarding the history of disease. In studying these ancient remains we may be able to uncover the pathway of diseases — like ankylosing spondylitis or DISH — and how they might impact modern populations.” Dr. Sahar Saleem adds, “The process of mummification could induce spinal changes, which should be considered when investigating diseases in ancient remains.”

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The above story is based on materials provided by Wiley. Note: Materials may be edited for content and length.

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