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Wednesday, January 30, 2019

What If You Were Your Own Blood Donor for Surgery?

Heart surgery patients may fare better if they have their own blood “recycled” and given back to them during the procedure, a preliminary study suggests.
The study focused on so-called “intraoperative autologous” blood donation — where patients have some blood removed at the start of surgery for their own use. The goal is to avoid transfusions of donor blood during surgeries where patients typically have a lot of bleeding.
Among nearly 700 heart surgery patients studied, researchers found the tactic did seem to reduce blood transfusions. Patients who self-donated also had shorter hospital stays.
This type of blood donation is already done at some hospitals, though experts said it’s hard to tell how common it is.
Dr. Robbin Cohen, a surgeon at the University of Southern California in Los Angeles, said he has been using the approach for a few years.
It’s simple and, in his experience, beneficial, said Cohen, who was not involved in the new study.
That said, the findings do not prove self-donation during heart surgery is the way to go, according to Cohen. The study looked back at patient records; it was not a trial that randomly assigned patients to either self-donate or not.
“What you need are well-designed prospective trials,” Cohen said.
But, he added, “this study is a good start. The suggestion of benefit is there.”
The findings were presented at the annual meeting of the Society of Thoracic Surgeons, being held this week in San Diego. Studies presented at meetings are generally considered preliminary until published in a peer-reviewed journal.
Dr. Eric Zimmermann led the research when he was based at New York-Presbyterian Queens (NYPQ) Hospital in New York City.
He agreed that more studies are needed in order to spur wider use of self-donation during heart surgery. It’s different, he noted, from another practice known as blood banking — where patients have blood removed and stored weeks before surgery, to use in case they need a transfusion.
Zimmermann, who is now a research fellow at Oregon Health & Science University in Portland, pointed to some advantages of the intraoperative tactic: It eliminates the cost of blood banking. Plus, the quality of banked blood degrades somewhat during storage, he said.
With intraoperative donation, doctors remove some of the patient’s blood at the start of surgery and store it as “whole blood,” with only clot-preventing medication added to it. “Whole” means the blood contains all of its natural components. Banked blood is often separated into different parts, like red blood cells and platelets (cells that help prevent bleeding by clumping together).
For the new study, Zimmermann’s team analyzed records from patients who had heart surgery at NYPQ Hospital between 2009 and 2017. In 2013, the hospital launched a “more aggressive” approach to intraoperative donation in which most patients having open-heart surgery self-donated.
The study group included 420 patients who had surgery after that policy shift, and 268 who had surgery before it. Only a small percentage of the latter group self-donated, according to Zimmermann.
Overall, the study found, the more aggressive policy seemed to reduce blood transfusions. Only 40 percent of patients needed a transfusion after the change, compared to 70 percent before.
And when patients in the more-recent group needed a transfusion, they typically required less blood. Their hospital stay was a day shorter, on average.
What’s not clear, though, is whether the self-donations are the reason patients got out of the hospital sooner. In fact, Zimmermann said, it’s not clear precisely how the tactic benefits patients.
“We need a better scientific explanation for why it works,” he said.
Cohen said returning whole blood to patients’ bodies may help prevent bleeding because it contains their natural clotting factors and platelets.
For now, both he and Zimmermann said patients who are scheduled for heart surgery can ask whether intraoperative donation is an option for them.
“Most surgeons discuss the potential need for transfusion with patients, so this could enter into that conversation,” Cohen said.
Even self-donation comes with potential risks, though. According to Zimmermann, it can deplete patients of oxygen-carrying red blood cells, and it’s possible for the extracted blood to become contaminated with bacteria or viruses.
More information
The U.S. National Heart, Lung, and Blood Institute has more on blood transfusions.
SOURCES: Eric Zimmermann, M.D., postdoctoral research fellow, Oregon Health & Science University, Portland; Robbin Cohen, M.D., associate professor of surgery and director, Huntington Memorial Hospital cardiothoracic and lung cancer surgery program, University of Southern California Keck School of Medicine, Los Angeles; Jan. 28, 2019 presentation, Society of Thoracic Surgeons annual meeting, San Diego
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Another Opioid Scourge: Infection-Related Strokes

As abuse of injected heroin and other addictive opioids spreads throughout the United States, heart experts warn of a growing threat: strokes caused by infections contracted through dirty needles.
“People need to be more aware that stroke can be a devastating complication of injecting opioids,” said the lead author of a new study, Dr. Setareh Salehi Omran. She’s a fellow in vascular neurology at the Weill Cornell Medical Center and Columbia University Medical Center in New York City.
Reporting this week at the annual meeting of the American Stroke Association, Omran’s team said the rate of hospitalizations for stroke rose 20 percent per year between 2008 and 2015, coinciding with the worsening of the opioid epidemic.
As the researchers explained, injecting heroin or other opioids can enable bacteria to get into the body. These germs then travel via the bloodstream to infect and inflame heart valves — a dangerous condition called infective endocarditis.
Looking at U.S. data on hospitalizations between 1993 and 2015, the researchers identified nearly 5,300 patients hospitalized with stroke from opioid-related infective endocarditis. These cases have risen steadily: from 2.4 per 10 million people in 1993 to 18.8 per 10 million people in 2015, the findings showed.
Once infective endocarditis occurs, clumps of infected tissue can break off and travel to the brain’s blood vessels and block them, triggering stroke.
These types of stroke have become more common in recent years, Omran’s team said, with the largest increase among whites in the northeastern and southern United States.
Stroke hospitalizations rose among Americans of all ages and genders, but the greatest increases over the past decade have occurred among women and people younger than 45, the study authors said.
All of this “parallels the rise in heroin overdose-related complications and deaths, which tripled between 2010 and 2015,” Omran noted in a meeting news release.
Two doctors who’ve seen these tragic cases firsthand agreed there’s cause for alarm.
“This study is a wake-up call,” said neurologist and stroke expert Dr. Richard Libman.
“These types of strokes can be devastating,” added Libman, who helps direct neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y.
“Antibiotics are sometimes useful for the prevention of recurrent stroke, but at other times, antibiotics are insufficient and these patients may require major cardiac surgery to prevent recurrent stroke,” he said.
Dr. Nicole Berwald directs emergency medicine at Staten Island University Hospital in New York City. She believes opioid abuse is lowering the age at which stroke typically hits.
“Emergency medicine physicians are on the front lines of stroke care,” Berwald said, and “we are [now] looking at a younger patient population than that with the usual health problems typically associated with stroke.”
What to do? According to Omran, “efforts to minimize prescription opioid abuse are important in addressing this public health problem, since the highly addictive nature of opioids can lead some people to turn to cheaper alternatives, such as injectable opioids like heroin.”
The study was also published Jan. 30 in the journal Stroke.
More information
The American Heart Association has more on infective endocarditis.
SOURCES: Richard Libman, M.D., vice chair, neurology, Long Island Jewish MedicalCenter, New Hyde Park, N.Y.; Nicole Berwald, M.D., chair, emergency medicine, Staten Island University Hospital, New York City; American Stroke Association, news release, Jan. 30, 2019
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Vaping Beats Nicotine Patch, Gum in Helping Smokers Quit

For those who want to kick their smoking habit, switching to electronic cigarettes may offer better odds of success than nicotine patches, lozenges or gum, new research suggests.
The finding follows a small year-long study that tracked about 120 British smokers enrolled in a National Health Service smoking cessation program.
“E-cigarettes provide nicotine, which is important when someone is trying to quit smoking,” said study author Dunja Przulj. “Going ‘cold turkey’ with no nicotine can make it difficult to deal with nicotine withdrawal symptoms. Having some kind of nicotine replacement improves your chances of quitting,” she explained.
“In our study, smokers used e-cigarettes much like other nicotine replacement treatments. They were asked to set a ‘quit day,’ and advised to use their e-cigarette regularly throughout the day, and whenever they felt they needed it,” Przulj added. “Everyone was encouraged to try and avoid smoking any normal cigarettes.”
In the end, study results suggested that “e-cigarettes would almost double your chances of quitting at one year compared to nicotine replacement [products],” she reported.
Przulj is a research health psychologist with the Health and Lifestyles Research Unit at Queen Mary University of London.
For the roughly 15 percent of Americans who smoke, the U.S. Food and Drug Administration has not approved e-cigs as a means for quitting.
But as a practical matter, the investigators noted that more American smokers chose e-cigs as a cessation tool than FDA-approved treatments.
In the British study group, a total of 79 smokers were enrolled in an “e-cig group” and given a refillable e-cigarette to use. The remaining 44 smokers were given a three-month supply of any approved nicotine replacement product they wanted.
In the end, the investigators found that while nearly 10 percent of the nicotine replacement group were not smoking traditional cigarettes a year later, that figure nearly doubled, to 18 percent, among those using e-cigs to quit.
The study team acknowledged, however, that prior research has demonstrated that when nicotine replacement products are paired with prescription medications — such as the nicotine receptor blocker Chantix (varenicline) and/or bupropion — one year abstinence rates are the same or higher as the e-cig results.
What’s more, 80 percent of those in the study’s e-cig group were still using e-cigs at the one-year mark. This compared with just 9 percent of those in the nicotine replacement products group by that point.
So, might encouraging smokers to rely on e-cigarettes to help kick their habit raise the risk that quitters just end up swapping out one form of nicotine addiction for another? Przulj thinks that’s a risk definitely worth taking.
“E-cigarettes are at least 95 percent less risky than cigarettes,” she said, “and so even if someone is still using an e-cigarette, the benefits outweigh any cons.”
In fact, “doctors should encourage any smokers to try e-cigarettes,” Przulj suggested, “especially if they have tried other methods before and these have not been helpful.”
The report was published online Jan. 30 in the New England Journal of Medicine.
Belinda Borrelli is co-author of an accompanying editorial and director of the Center for Behavioral Science Research at Boston University. She interpreted the results more cautiously.
Borrelli noted, for example, that whether the findings might apply to all smokers is limited by the fact that all the participants were British and all were smokers trying to quit. She further stressed that very few studies have actually explored the pros and cons of using e-cigs to assist with quitting.
“It is a step in the right direction, but it is only one study,” said Borelli.
“We do not have the evidence to say that e-cigarettes meet the standards for evidenced-based practice recommendations,” she continued. “There is substantial evidence that they are less harmful than traditional cigarettes, but that doesn’t mean they are not harmful.”
For now, Borelli added, “the best way to quit smoking right now is to use FDA-approved evidence-based treatment as a first-line choice. And then if that fails, consider short-term use of e-cigs to quit smoking.”
The study was funded by the National Institute for Health Research and Cancer Research UK.
More information
There’s more on quitting smoking at the U.S. National Cancer Institute.
SOURCES: Dunja Przulj, Ph.D., research health psychologist, Health and Lifestyles Research Unit, Queen Mary University of London; Belinda Borrelli, Ph.D., director, Center for Behavioral Science Research, and professor, department of health policy and health services research, Henry M. Goldman School of Dental Medicine, Boston University; Jan. 30, 2019, New England Journal of Medicine, online
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Medical Marijuana Dispensary Opens Brooklyn Location

The company behind the city’s first marijuana dispensary is expanding to Brooklyn. Columbia Care, which opened in the city in 2016, has taken 7K SF at 44 Court St. in Downtown Brooklyn, The Real Deal reports. The lease spans the ground floor and the lower level. Its first lease in the city was at 212 East 14th St. on the Lower East Side.
“As the medical cannabis industry has evolved, more and more communities have welcomed companies like Columbia Care that provide a vital service to patients,” Savitt Partners’ Hector Rodriguez, who represented Columbia with Michael Dubin, said in a statement. “The Court Street space represents a first-of-its-kind facility in this neighborhood.”
Other dispensaries in the borough include Citiva dispensary, which opened at 202 Flatbush Ave. earlier this year, according to TRD. Last year, Los Angeles-based marijuana giant MedMen announced plans to open up in a 10K SF dispensary on Fifth Avenue.
Gov. Andrew Cuomo is pushing to make recreational marijuana legal this year in New York state, and revealed a bill in the state budget proposal earlier this year that would allow licenses for the production and sale of cannabis.
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Chinese Investment Pulling Out Of U.S. In Record Numbers

Chinese capital’s retreat from the U.S. real estate market has now hit historic levels, and shows no sign of slowing.
Chinese investors sold $854M more in American real estate in the fourth quarter than they bought, according to a Real Capital Analytics survey reported by the Wall Street Journal. It is the third straight quarter in which China has been a net seller in the U.S., the longest such stretch on record.
President Xi Jinping has directed investment firms to recapture capital that had been invested abroad to shore up the slowing growth of the Chinese economy.
Before then, Chinese investors’ appetite for U.S. properties was voracious, especially for urban trophy buildings, which they bought at record prices. Chinese capital had been flowing into the U.S. at such a pace that even with three quarters of net selling, it still ended 2018 as net buyers by $2.68B. The eye-popping prices often paid by Chinese firms may mean that some buildings could sell for less than they were purchased, but still may net a profit for firms like HNA Group, Anbang Insurance Group and Dalian Wanda Group.
The Chinese yuan has lost value against the U.S. dollar over the past few years, so bringing the money home will increase its relative value, the WSJ reports. Part of Chinese pullback can also be attributed to worsening diplomatic relations between China and the U.S., which escalated into a trade war in 2018.
But as the eastern power has receded from the country’s market, other foreign capital sources have stepped in. Canada passed China as the biggest foreign investor in the country last year with $44B in purchases, according to RCA. The number represents a massive increase from the $14.6B in American property Canadian capital purchased in 2016.
Chinese investors will not stop buying in the U.S. altogether, the WSJ reports. Instead, it will be focusing on more stable, less headline-grabbing property types such as neighborhood shopping centers and industrial properties, favoring stability over prestige and potential return, according to RCA.
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‘Groundhog Day’ For NYCHA Residents With Heat Outages During Arctic Blast

The bone-chilling polar vortex that has transformed much of the Midwest into a dangerous freeze box is now coming for New York City, with temperatures set to plummet tonight and remain in the single digits for much of the next two days. If you’re an apartment-dwelling New Yorker whose home isn’t sufficiently warm, the city’s housing department has promised to hold your landlord accountable. But for the tens of thousands of NYCHA residents who’ve already gone without heat and hot water this winter, there’s little option but to wait and see.
“The super called this morning and told me there’s something wrong with the boiler,” said Rosa Pinero, a tenant advocate at the Moore Houses in Mott Haven. “It happened when it was real cold the other day too. We get people on the upper floors complaining, and we hope they repair it as soon as possible.”
More than 1,200 residents at the Moore Houses have been without heat since 7:30 a.m. this morning, according to NYCHA’s database of service interruptions. Repairs are underway, with the intention of getting the heat back on by later this afternoon. As of 2:30 p.m. on Wednesday, unplanned heat and hot water outages had hit at least five NYCHA buildings in the Bronx and three buildings in Manhattan, impacting over 2,000 residents.
“This is like living through Groundhog Day, except it’s not funny,” Bronx Borough President Ruben Diaz Jr., who grew up in the Moore Houses, told Gothamist. “We need them to start being proactive…this is something we’d never accept from private landlords.”
On Wednesday, the Mayor’s Office sent out a press release specifically touting the city’s “proactive efforts” to minimize service interruptions. But that approach—activating a “situation room” in Long Island City, beefing up heating response teams, and establishing a warming center in each borough—seemed to take it as a given that some tenants would be left in the cold.
In a statement, NYCHA General Manager Vito Mustaciuolo said that staff were “fully prepared to respond to any emergencies that may arise while also working hard to anticipate problems this cold spell may bring—just like we have been throughout this heating season.” He noted that the authority had managed to decrease response times during service interruptions to 10 hours on average, down from 36 hours at this time last year. But less than two weeks ago, thousands of NYCHA residents went without heat for a 24-hour period in which temperatures hovered around 10 degrees.
“To actually have a preemptive approach you need to do analysis of heating systems and boilers, instead of waiting for children and seniors to suffer every time it’s cold,” noted Diaz. The failure to do so, the borough president added, “epitomizes the ineptitude of the [de Blasio] administration.” In the first three weeks of “heat season,” more than 35,000 NYCHA residentswent without heat and hot water—including at one of the developments that the mayor toured to promote a freshly installed boiler.
The ongoing heat outages come amid a fierce battle over the future of NYCHA, with Department of Housing and Urban Development Secretary Ben Carson threatening a possible federal takeover of the authority if the city doesn’t show that it can meet basic standards of safety and habitability by the end of the month. The city has until tomorrow to present a plan to rescue the agency to U.S. District Judge William Pauley III, who’s presiding over a federal lawsuit alleging that NYCHA exposed residents to dangerous lead levels and then lied to prosecutors about their remediation efforts.
“One day before City Hall submits its joint status report on NYCHA to a Federal judge, over 1,400 public housing residents are again without working heat and hot water,” Judith Goldiner, Attorney-In-Charge of the Civil Law Reform Unit at the Legal Aid Society, said in a statement. “This further underscores the need for governments to bolster NYCHA’s funding so that the Authority may more quickly replace antiquated boilers and other dated utility systems that have already failed thousands of residents during this winter season.”
At the same time, few are confident that putting HUD Secretary Ben Carson in charge of the ailing agency would help solve the rampant boiler problems, or the many other basic maintenance issues plaguing tenants. “We still believe that NYCHA’s imperiled state would be exacerbated under a Federal receivership, and that it would be subjected to politics prioritized above the real interests of tenants,” said Goldiner. “NYCHA’s woes have long been rooted in divestment; for this reason, increased funding on an unprecedented scale must be first and foremost.”
Diaz says that he’s also concerned about a possible federal takeover. Many NYCHA residents seem to agree.
“I think all of the residents and all of NYCHA should get together and communicate with each other and put online like, ‘I have my ceiling open,’ or ‘mushrooms in my bathroom,’ because NYCHA lies about statistics,” Viviana Wrenn, a 28-year-old mother who’s dealt with heat outages and a rats nest behind her sink, told Gothamist earlier week. “I think if we all got together and unified, I think we would be able to really show what’s going on and be able to get these issues resolved without needing to have the federal government take over.”
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Plunging temperatures a threat to people with Alzheimer’s

The polar vortex that has enveloped much of the United States this week poses a special danger to people with Alzheimer’s disease and other types of dementia.
“This type of weather can be hazardous for everyone, but even more so for individuals living with Alzheimer’s disease, who may have difficulty noticing temperature and weather changes or knowing who to call for help,” said Charles Fuschillo Jr., CEO and president of the Alzheimer’s Foundation of America.
“A few easy steps can go a long way to help keep their loved one with Alzheimer’s disease safe,” he added in a foundation news release.
It’s important for family members and caregivers to know the signs of hypothermia. Be alert for shivering, exhaustion, sleepiness, slurred speech, memory loss and clumsy motor skills, the foundation advised.
Caution is needed when using electric space heaters. They can pose a , especially when used with extension cords or if they get knocked over. For Alzheimer’s or dementia patients, use space heaters that automatically turn off when they reach a set temperature or tip over, the foundation said.
Don’t use electric blankets to keep people with Alzheimer’s or dementia warm, because the blankets could burn their skin without them realizing the blanket is too hot, the foundation noted.
Snow and ice increase the risks of slips or falls, and people with Alzheimer’s or dementia may have  that can make it harder for them to see ice or realize that a walkway is slippery. Keep outside stairs, walkways and driveways clear of snow and ice.
Wandering is a common problem among people with Alzheimer’s or dementia, and that is especially dangerous in cold weather. Be sure to have an action plan in case your loved one wanders off, the foundation said.
That includes using a permanent marker or sewing identification into their clothes with your . Keep a recent photo and medical information on hand, as well as details about familiar destinations they used to frequent, to provide to police and others who might assist in a search. Another option is to join a program that can track your loved one with GPS.
Know the contingency plans when storms or extreme weather may affect home care service. Ask your loved one’s home care provider about contingency plans to deliver services in such situations, the foundation said.
Ensure the person with Alzheimer’s or  has enough food and water to see them through weather that might limit road travel. They should have easy access to flashlights (not candles), blankets and warm clothing, and their cellphones and tablets should be charged in case the power goes out.
If your loved one doesn’t live nearby, try to find someone who lives closer who can check up on them before and after a storm. Inform those people of emergency contacts and where to find important , including insurance cards, the foundation added.
Reduce the risk of carbon monoxide poisoning by having the heating system checked at least once a year, and install carbon monoxide detectors on each level of the home.
Explore further
More information: The U.S. National Institute on Aging offers cold weather safety tips for seniors.
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