Pain, Impairment Linger Months After ECMO for Most

 Many extracorporeal membrane oxygenation (ECMO) patients experienced long-term neuropsychiatric symptoms, cognitive impairment, or functional impairment, a meta-analysis found. ECMO can help patients with a range of severe heart and lung conditions, from cardiac arrest to respiratory failure. But in most cases, ECMO therapy is used only when all other conventional treatments have failed to resolve the underlying heart or lung disorders.

Fully 41% of ECMO patients had neuropsychiatric symptoms at 6 months or longer follow-up, with pain or discomfort (52%), sleep disturbance (37%), and anxiety (36%) as the most common symptoms, reported Sung-Min Cho, DO, MHS, of Johns Hopkins Hospital in Baltimore, Maryland, and colleagues.

Long-term follow-up at 6 months and beyond also showed the secondary outcomes of neurocognitive impairment in 38% and functional impairment in 52%.

"For ECMO patients, these outcomes are especially critical because they are associated with long-term mortality, quality of life, and economic impact," Cho and colleagues wrote in Neurologyopens in a new tab or window.

ECMO use is on the rise, but "the outlook of ECMO survivorship remains uncertain," according to an invited commentaryopens in a new tab or window in Neurology by Imad Khan, MD, of the University of Rochester Medical Center in New York, and Nicholas Morris, MD, of the University of Maryland in Baltimore.

"ECMO is associated with direct neurologic injury, including both macrohemorrhages and microhemorrhages, infarcts, and diffuse hypoxic-ischemic brain injury that likely contribute to long-term outcomes," they wrote. However, they added, "In patients who do not experience acute brain injury, we have not established whether ECMO directly contributes to poor long-term neurologic outcomes or merely serves as a surrogate for severe critical illness."

They pointed to a number of limitations of the current body of evidence, such as the more than 10 different data collection instruments used across the studies in Cho's analysis and inadequate controls to adjust for confounding.

The findings emphasize that "clinical standardization in assessment, outpatient care, and multi-specialty consultation is necessary in the clinic," Cho added in an email to MedPage Today.

The editorialists agreed, noting that a "contribution of this study may be in assisting power calculations for clinical trials of interventions to improve long-term patient-centered outcomes," such as neuromonitoring, early mobilization, and sedation reduction.

"As survival increases with improvements in care delivery, refinements in patient selection, and technological advances, the mission shifts from helping patients survive to helping survivors thrive," Khan and Morris concluded.

The meta-analysis and systematic review included 59 studies with a variety of designs (10 prospective cohort, three retrospective case-control, 45 retrospective cohort, and one randomized controlled trial). Of the 3,280 patients analyzed, 69% were male, and the median age was 54.

Most of the patients had venoarterial ECMO (VA-ECMO, 86%), with the remaining 14% getting venovenous (VV) ECMO. The most common indication for VA-ECMO was extracorporeal cardiopulmonary resuscitation; the most common indication for VV-ECMO was acute respiratory failure, and these patients were typically supported longer (median 12.5 vs 3.7 days).

The studies measured neuropsychiatric, neurocognitive, and functional outcomes, evaluated postdischarge by questionnaire. Median follow-up lasted 15.8 months.

Functional impairment, typically defined by the European Quality of Life 5 Dimensions Questionnaire, most commonly impacted daily activities (54%), followed by physical activity or mobility (41%), and personal or self-care (21%).

Favorable neurologic outcomes were reported in 23% at 3 months, 25% at 6 months, and 28% at 1 year and beyond when including nonsurvivors and defined as a modified Rankin scale of 3 or less, cerebral performance category score of 2 or less, or a Glasgow Outcome Scale score of 4 or greater. When excluding those who died during follow-up, the rates were 59%, 84%, and 90% across the three time points.

Neurocognitive impairment -- which encompassed memory, attention, and reasoning issues -- was numerically but not significantly more common with VV-ECMO (50% vs 24%, P=0.30). More VV-ECMO patients had neuropsychiatric symptoms than VA-ECMO (55% vs 32%, P=0.01).

Study authors acknowledged that they were limited by heterogeneity in instruments used to measure neuropsychiatric symptoms and neurocognitive impairment, as well as a broad range of follow-up endpoints and diverse outcomes. Most of the studies were retrospective, which could have introduced recall bias, and patient characteristics were not consistent across studies. The most common indication for VA-ECMO, accounting for most of patients studied, might not be the most common indication for ECMO outside the study, the researchers cautioned.

Disclosures

Funding for this study came from the National Heart, Lung, and Blood Institute (NHLBI).

Cho reported receiving support from the NHLBI. Co-authors reported relationships with LivaNova, Abiomed, Xenios, Medtronic, Inspira, Cellenkos, the Extracorporeal Life Support Organization, the International ECMO Network, and UpToDate.

Khan reported receiving grants from the NIH. Morris reported no conflicts of interest.

Primary Source

Neurology

Source Reference: opens in a new tab or windowKalra A, et al "Long-term neuropsychiatric, neurocognitive, and functional outcomes of patients receiving ECMO" Neurology 2024; DOI: 10.1212/WNL.0000000000208081.

Secondary Source

Neurology

Source Reference: opens in a new tab or windowKhan IM, Morris NA "After ECMO decannulation, are patients thriving or just surviving?" Neurology 2024; DOI: 10.1212/WNL.0000000000209144.

https://www.medpagetoday.com/neurology/generalneurology/108224

COVID Takes Center Stage at Trump Town Hall

 Former President Donald Trump offered his take on the history of the COVID-19 pandemic -- ranging from its origins, to lockdowns, to his relationship with Anthony Fauci, MD -- during a town hall event in Iowa that also touched on Medicare solvency and abortion.

During the Wednesday-night event, which was hosted by Fox News and moderated by Martha MacCallum and Bret Baier, Trump launched unprompted into his explanation for COVID's origins, charging that the virus sprung from a Wuhan lab, though not purposely.

"I think it was done out of incompetence," he said. "I believe that a scientist went out, said 'hello' to his girlfriend, and that was the end of that. She died, and then people started dying all over the place. But who knows."

Scientists hold clashing viewsopens in a new tab or window of the "lab leak" hypothesisopens in a new tab or window.

On a different pandemic issue, this time prompted by an audience question about the potential of a COVID lockdown in the future, Trump said, "I didn't actually have a shutdown, despite the fact that some people wanted to and some people didn't want to." (In March 2020, the Trump administration unveiled its "Slow the Spread"opens in a new tab or window guidelines that included avoiding travelopens in a new tab or window, large social gatherings, and visiting people in hospitals or nursing homes.)

Trump stressed that he "let the governors make their decisions." Some states like Tennessee, North Dakota, and South Carolina did not shut down at all, he said (partially true, in that North Dakota did not shut downopens in a new tab or window). And he said his Republican primary rival, Florida Gov. Ron DeSantis (R), shut down his state "very violently."

"The governors that did the best job were Republican governors, and they were the ones that didn't shut down," Trump said. (Some studiesopens in a new tab or window have suggested the oppositeopens in a new tab or window in terms of death toll.)

Asked how he would respond to those who felt that Fauci, the former Director of the National Institute of Allergy and Infectious Diseases, held too much influence over the former administration's actions during the pandemic, Trump claimed DeSantis was "the biggest fan" of Fauci. "He said ... 'I go by what Dr. Fauci said,'" until that position was no longer popular, said Trump.

More recently, DeSantis pledged on Xopens in a new tab or window (formerly Twitter) that if elected he would "bring a reckoning for what tyrants like Fauci did to our country during COVID."

During his own administration, Trump said, "Dr. Fauci was not a huge factor.... He became a much bigger factor in Biden's administration."

In speaking of healthcare topics outside the pandemic, Trump claimed that DeSantis and former South Carolina Gov. Nikki Haley -- another rival in the race for the 2024 Republican presidential nomination -- want to cut Medicare.

"Nikki Haley wanted to raise the ageopens in a new tab or window [of Medicare eligibility] from 65 to 74, 75," he said.

And while moderator MacCallum interjected that Haley's policy changes would only impact "young people in their 20s," Trump was skeptical.

"That's what they say when it starts. ... 'It's only for young people.' And then it doesn't work for young people, and they end up getting up to people that are of the age where it matters," he said.

On the issue of abortion, Trump attempted to walk a fine line when asked by an audience member to reassure her "that you can protect all life, every person's right to life without compromise."

Trump told the voter she would not even be asking the question if he hadn't helped to end Roe v. Wade. Trump is credited with choosing three key members of the Supreme Courtopens in a new tab or window -- Justices Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett -- who voted to overturn the Roe v. Wade decision, eliminating federal abortion protections.

"We did it. We did something that was a miracle," he said. Trump clarified, however, that like former President Ronald Reaganopens in a new tab or window, he supports exceptions for the life of the mother, rape, and incest.

"But I will say this. You have to win elections," he continued. "Otherwise, you're going to be back where you were, and you can't let that happen again."

Trump also took aim at 6-week abortion bansopens in a new tab or window, which he has publicly criticized previously.

"A lot of women don't know if they're pregnant in 5 or 6 weeks," he said. "We're going to come up with something that people want and people like."

https://www.medpagetoday.com/washington-watch/electioncoverage/108232

Reactions to US, British strikes against Houthis in Yemen

The United States and Britain launched a series of strikes on Yemen on Thursday aimed at the Iran-backed Houthi militia that started targeting international shipping in the Red Sea late last year.

Initial reactions from the U.S. Congress were highly critical of President Joe Biden:

REPRESENTATIVE RO KHANNA, DEMOCRAT, CALIFORNIA

"The President needs to come to Congress before launching a strike against the Houthis in Yemen and involving us in another Middle East conflict. That is Article I of the Constitution. I will stand up for that regardless of whether a Democrat or Republican is in the White House."

REPRESENTATIVE VAL HOYLE, DEMOCRAT, OREGON

"These airstrikes have NOT been authorized by Congress. The Constitution is clear: Congress has the sole authority to authorize military involvement in overseas conflicts. Every president must first come to Congress and ask for military authorization, regardless of party." REPRESENTATIVE JASON CROW, DEMOCRAT, COLORADO

"I would not support us being pulled into a broader war."

REPRESENTATIVE MARK POCAN, DEMOCRAT, WISCONSIN

"The United States cannot risk getting entangled into another decades-long conflict without Congressional authorization. The White House must work with Congress before continuing these airstrikes in Yemen."

https://www.marketscreener.com/news/latest/Reactions-to-US-British-strikes-against-Houthis-in-Yemen-45727443/

Tesla Berlin to suspend most production for two weeks over Red Sea supply gap

 Tesla will suspend most car production at its factory near Berlin from Jan. 29 to Feb. 11, the company said on Thursday, citing a lack of components due to shifts in transport routes because of armed conflict in the Red Sea.

"The armed conflicts in the Red Sea and the associated shifts in transport routes between Europe and Asia via the Cape of Good Hope are also having an impact on production in Gruenheide," Tesla said in a statement.

"The considerably longer transportation times are creating a gap in supply chains."

https://www.marketscreener.com/quote/stock/TESLA-INC-6344549/news/Exclusive-Tesla-Berlin-to-suspend-most-production-for-two-weeks-over-Red-Sea-supply-gap-45726331/

China Says It Cracked Apple's AirDrop Encryption To Track Senders

by Dorothy Li via The Epoch Times (emphasis ours),

Chinese authorities have claimed that they can identify individuals who use Apple’s wireless file-sharing tool to spread content that Beijing considers “inappropriate.”

Experts had managed to identify the phone number and email address of an AirDrop sending device using logs found on the receiving device, the Beijing Municipal Bureau of Justice said in an article published on Jan. 8. That allows local police to find “several suspects” who use the iPhone feature to transmit files containing what authorities have referred to as “inappropriate remarks,” according to the agency.

AirDrop, designed to function over short distances, was created as a program reliant on direct connections between phones. By forming a local network of devices without relying on the internet to communicate, AirDrop makes it hard for authorities to regulate “through conventional network monitoring methods,” according to the article.

The file-sharing feature, which is available on iPhones and other Apple devices, has been a critical tool for protesters in both mainland China and Hong Kong to evade censorship and maintain communication. Users can’t review the transmission history, and the recipient’s device may only show the user-defined name of the sender.

The Beijing judicial agency stated in the article that experts extracted AirDrop’s encrypted records by analyzing the iPhone’s logs. They praised experts from Beijing Wangshendongjian Technology Co. Ltd., a local forensic appraisal institute, for assisting authorities to “break through technical difficulties of tracing anonymous AirDrops.”

The Epoch Times contacted Apple for comment but didn’t receive a response by press time.

iPhone Censorship

AirDrop was used widely as a communication tool during Hong Kong’s pro-democracy protests in 2019. Demonstrators deployed the program to bypass China’s so-called Great Firewall, delivering crucial messages to the public and ensuring ongoing communication among themselves.

In late 2022, after protests against Beijing’s draconian COVID-19 measures erupted in Shanghai and other major Chinese cities, Apple restricted the sharing feature in the mainland following reports that young demonstrators used the AirDrop function to share images and slogans denouncing the Chinese Communist Party (CCP) and its leader, Xi Jinping.

On Nov. 9, 2022, Apple released iOS 16.1.1., a new version of its mobile operating system. The tech firm noted that the “update includes bug fixes and security updates and is recommended for all users.” However, Chinese readers of 9to5Mac, a website covering news about Apple and its products, noticed a modification in the update that was specific to iPhones sold in China.

Following the operating system update, AirDrop on iPhones sold in China can only be configured to receive messages from “everyone” for 10 minutes before switching off. Typically, AirDrop users can choose to receive files from “everyone”—contacts and noncontacts—for an unlimited time. Before the update, the “everyone” setting could be turned on permanently on Chinese iPhones.

Apple has stated that the feature was an effort to cut down on spam content sent in crowded areas such as malls, and it originally planned to roll out the feature globally starting in 2023.

However, Apple hasn’t offered an explanation as to why it chose China to be the first country with AirDrop restrictions.

China Censorship

For years, Apple kept Chinese customers’ data locally on servers run by a state-owned company, adhering to Beijing’s request to keep information within its borders.

Experts have pointed out that this method gives the CCP unfettered access to consumer data. Apple, in response, stated that it holds encryption keys to the data stored in those server facilities and has “never compromised the security” of its users and their data.

This local storage means that although the United States has laws against companies sharing data with Chinese authorities, Beijing can demand the data from the server storage company rather than from Apple.

Apple has already been subjected to restrictions in China, one of the company’s biggest markets and responsible for nearly 20 percent of the Cupertino, California-based firm’s revenue.

Multiple media outlets reported in September 2023 that Beijing instructed state employees and officials at some government agencies to not use iPhones and other foreign cell phones for work. Local officials from three provinces previously told The Epoch Times that they had already been told to not bring iPhones and foreign cell phones to important meetings. These officials, who spoke on the condition of anonymity for fear of reprisal, said there were no formal documents regarding that order.

When asked about the reported iPhone ban at a briefing at the time, a Chinese Foreign Ministry official didn’t directly comment on the issue but said phone companies operating in China must adhere to its laws and regulations.

China observers have noted that the CCP has long sought to tighten control over its people. The regime has poured massive resources into constructing a nationwide surveillance system, clamping down on both domestic and foreign businesses and penalizing individuals perceived as threats to national security. The money Chinese authorities have spent on policing the whole society has surpassed its national defense budget under Xi, according to Nikkei Asia’s analysis of official data.

Andrew Moran, Catherine Yang, and Lear Zhou contributed to this report.

https://www.zerohedge.com/political/china-says-it-cracked-apples-airdrop-encryption-track-senders

Alibaba Trading at Half Hong Kong Utility’s Valuation After Drop

 

• Alibaba trades at 7.6 times forward earnings vs CLP’s 13 times
• E-commerce firm also trading at half Tencent’s valuation

The years-long rout in shares of Alibaba Group Holding Ltd. amid regulatory crackdowns and weak consumption has left the Chinese e-commerce giant trading at just half the valuation of venerable utility CLP Holdings Ltd.

Alibaba’s valuation almost halved in the past year, after it was hit by sluggish domestic online sales, fierce competition and skepticism over its future as it scrapped plans to spin off its cloud business and changed leadership. Its Hong Kong-listed stock is now trading at just 7.6 times estimated earnings for the next 12 months, compared with more than 13 times for CLP.

https://www.bloomberg.com/news/articles/2024-01-11/alibaba-trading-at-half-hong-kong-utility-s-valuation-after-drop

Liz Cheney Vs. Stefan Passantino: The Jan. 6 Committee Fraud

 by Newt Gingrich via RealClear Wire,

It’s becoming increasingly clear that U.S. Rep. Liz Cheney was dishonest, manipulative, and destructive while serving on the Jan. 6 Committee.

A lawsuit filed by my friend and long-time attorney Stefan Passantino on Dec. 20, 2023 lays it out.

I know both participants well. I entered Congress in 1978 with Liz Cheney’s father, Dick Cheney. I watched Liz Cheney become a competent, effective implementor of American policy around the world. Few things have made me sadder than watching her drift into an anti-Trump fanaticism – which ultimately convinced her that breaking the rules, destroying innocent people, and pandering fake news were justified behaviors.

Years later, I got to know Stefan Passantino. Since 1998, he has been legal counsel for me and for our companies. He is a thoughtful, scholarly, and deeply ethical attorney. Passantino represents his clients with integrity and a passionate commitment to protecting them and seeing justice done.

I was proud of Passantino when he served as Deputy White House Counsel focusing on federal compliance and government ethics. We could not have imagined how he would later be smeared and lied about by Congresswoman Liz Cheney and the Jan. 6 Committee.

Liz Cheney and the committee’s ongoing process of dishonesty, violating attorney-client privilege, and leaking to friendly leftwing media was a total perversion of the congressional system. It was a dishonest effort to destroy innocent people of integrity with one-sided lies and smears.

Fortunately, Chairman Barry Loudermilk, who leads the House Administration Subcommittee on Oversight (on which I served for over a decade), has doggedly looked into the Jan. 6 Committee’s lies and manipulations. In the coming months, we will be shocked at the stunning dishonesty Chairman Loudermilk will reveal.

Passantino represented several witnesses before the Jan. 6 Committee with no problems. He represented Cassidy Hutchinson with precisely the same integrity. In fact, he represented Hutchinson through multiple interviews covering about 20 hours.

Hutchinson was a desirable witness for the Committee, because she entered the White House in her early 20s and became Special Assistant to the President and Coordinator for Legislative Affairs. She reported to Chief of Staff Mark Meadows and had an office in the West Wing just a few feet from the Oval Office.

Liz Cheney apparently decided Hutchinson would make a star witness – if only she would say the right things.

In an amazingly inappropriate and unethical move, Liz Cheney herself (along with a small number of senior staff) approached Hutchinson after her second committee interview without informing her Passantino. Liz Cheney then called Cassidy in for a third interview, with Passantino again serving as counsel, with neither Cassidy nor Cheney ever informing Passantino that they had been speaking without his knowledge. Contacting Hutchinson without informing Passantino was clearly unethical, and it appears as if Liz Cheney instructed Cassidy not to tell Passantino they had spoken. This was a profound breach of legal ethics. Liz Cheney knew this well. She earned her law degree from the University of Chicago.

As a senior member of Congress (and the national media’s anointed hero), Liz Cheney approached and sought to manipulate an isolated, frightened woman in her mid-20s. Does that sound appropriate? I suspect Liz Cheney knew she was doing something wrong because she apparently did not tell her fellow committee members.

After being manipulated by Cheney, Hutchinson dismissed Passantino and hired a new lawyer who was eager to cooperate with the committee. Suddenly, Hutchinson’s testimony started changing. As Chairman Loudermilk has said:

“Cassidy Hutchinson tried to explain her dramatic changes in testimony by blaming her initial lawyer, Stefan Passantino. Our discovery of Cassidy’s errata sheet showing just how substantially her story changed, raises serious concerns about her credibility. Until now, her version of the story was the only one.”

As John Solomon at Just the News reported:

“As the Jan. 6 congressional investigation rushed to a close in 2022, one of the House Democrats' star witnesses waived her attorney-client privilege with her first lawyer in a move that could now open the door for House Republicans to question both her and her attorney, correspondence obtained by Just the News shows. Former Trump White House aide Cassidy Hutchinson's testimony played a large role in shaping House Democrats' final report sharply criticizing Donald Trump for the Capitol riot that ensued on Jan. 6, 2021, but Republicans on the House Administration's Subcommittee on Oversight led by Chairman Barry Loudermilk recently discovered an errata sheet she submitted to Congress that made substantial changes to her account midway through the Democrat-led inquiry. Errata sheets are routinely provided to deponents and witnesses by stenographers to allow for correction of typographic errors and dropped words.”

The Jan. 6 Committee did everything it could to avoid being reviewed. It has not released transcripts of many interviews. It claims to have destroyed some videos of interviews. In one deliberately opaque move, the committee seems to have sent some of its documents to various other agencies, making them difficult to gather.

Further, the committee called in thousands of witnesses to interview. Yet, it never interviewed Passantino. This is the biggest clue that Liz Cheney and the committee were interested in promoting their narrative rather than finding the truth.

The Republican House has since brought the Jan. 6 Committee materials back from the National Archives, and they are being studied by the Committee on House Administration. Some surprisingly bad examples of rule-breaking and simply lying to the American people are beginning to emerge.

Passantino’s courage in bringing his lawsuit will accelerate the process of learning just how bad the Jan. 6 Committee was – and reveal the depth of its most aggressive members’ dishonesty and manipulation.

History will not grant Liz Cheney or the Jan. 6 Committee members the profile in courage they wanted. It will record a profile in deception, distortion, and vengeance.

I have no doubt Stefan Passantino will emerge from this lawsuit with his integrity intact and reputation restored. I can’t say the same for Liz Cheney.

https://www.zerohedge.com/political/liz-cheney-vs-stefan-passantino-jan-6-committee-fraud