Tag Archives: Research

2021 HEART RESEARCH: TOP FINDINGS OF CARDIOLOGISTS

Coronary artery bypass graft (CABG) was supported as superior to fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease (CAD). PCI failed to meet noninferiority criteria at 1-year follow-up in a study comparing outcomes between FFR-guided PCI using contemporary stents and CABG. This adds to existing evidence showing superior outcomes with CABG in patients with the most-complex CAD.

The sodium–glucose transporter-2 (SGLT-2) inhibitor empagliflozin was found to be beneficial in heart failure with preserved ejection fraction. Empagliflozin is the first medication shown to improve outcomes in this population. It’s unknown if this is a class effect of all SGLT-2 inhibitors, but this could be a game changer.

Poor-quality carbohydrates were linked to cardiovascular mortality, around the world. Consumption of higher-glycemic-index carbohydrates was associated with higher rates of cardiovascular disease and mortality in countries all around the world. These data are particularly important because lower-income countries often have diets high in refined carbohydrates, which may worsen cardiovascular disparities.

New guidelines for managing valvular heart disease were released. These new guidelines add or elevate several recommendations for transcatheter therapy, and they lower thresholds for intervention in some conditions.

The editors of Circulation: Cardiovascular Quality and Outcomes addressed racial-ethnic disparities. The editors affirmed that structural racism is a public health crisis and that the scientific publishing community can play a role in addressing it.

Tricuspid annuloplasty for moderate regurgitation during mitral-valve surgery was of unclear benefit. Annuloplasty was associated with less progression of moderate tricuspid regurgitation but more pacemakers at 2 years. Unfortunately, this mixed outcome does not clearly inform the decision on performing annuloplasty at the time of surgery, and longer-term follow-up is needed.

Immediate angiography was not beneficial in out-of-hospital cardiac arrest without ST elevation. Patients with out-of-hospital cardiac arrest who did not have ST elevation on their initial ECG did not benefit from immediate angiography. Although a potential coronary culprit was identified in about 40% of patients, neurologic injury was by far the most frequent cause of death, negating any benefit from coronary revascularization.

Many statin side effects are related to the “nocebo” effect. A creative study enrolled 60 people with statin intolerance and gave them 12 randomly ordered 1-month treatment periods: 4 periods of no medication, 4 of placebo, and 4 of statin. Symptom intensity did not differ between placebo and statin periods and, interestingly, some even had more symptoms on placebo. This demonstrates that some cases of “statin intolerance” may be related to the “nocebo” effect.

Shorter duration of dual antiplatelet therapy following PCI/stent placement was found to be acceptable in patients with high bleeding risk. A large, randomized trial found that 1 month of dual antiplatelet therapy provided similar clinical outcomes and a lower bleeding risk than 3-to-6-month regimens for this challenging patient subset.

De-escalation” of dual antiplatelet therapy for patients undergoing PCI for acute myocardial infarction (MI). This industry-funded study evaluated patients who had received 1 month of aspirin plus ticagrelor after acute MI and stent placement and “de-escalated” half to aspirin plus clopidogrel. At 1 year, there was significantly less bleeding in the de-escalation group and a nonsignificant trend toward fewer ischemic events as well.

Covid-19 Vaccination: Risks Of Myocarditis

Given the myriad of cardiac concerns associated with SARS-CoV-2 infection, news that the myocarditis associated with mRNA vaccination is mostly mild and resolves quickly in the rare instances in which it occurs was welcome news. The findings continue to tip scales in favor of vaccination and resulted in this week’s top trending clinical topic.

Views: The Importance Of Detecting Cancer Early

Brain Research: The Many Benefits Of Healthy Sleep

COVID-19: HOW BIONTECH USED ITS CANCER RESEARCH TO CREATE A VACCINE (CNBC)

Over a month and a half before the World Health Organization officially declared a pandemic, BioNTech CEO Uğur Şahin met with his wife, BioNTech’s co-founder and chief medical officer Özlem Türeci, and together they agreed to redirect most of the company’s resources to developing a vaccine. Up until that point, BioNTech was little-known internationally and primarily focused on developing novel cancer treatments. The founders were confident in the potential of their mRNA technology, which they knew could trigger a powerful immune response. That confidence wasn’t necessarily shared by the broader medical community. No mRNA vaccine or treatment had ever been approved before. But the couple’s timely breakthrough was actually decades in the making. CNBC spoke with Şahin and Türeci about how they, along with Pfizer, created a Covid-19 vaccine using mRNA.

COMMENTARY:

This commentary concerns a video showing aspects of the development of MRNA vaccines. It is all about Pfizer’s German partner, BioNtech, which manufactures the vaccine. They have produced the bulk of the worlds mRNA vaccines, due to Pfizer‘s great financial strength and  experience in marketing.

Moderna, a wholly American company and by comparison a small fry, has also been doing decades of work with mRNA platform technology, mainly on cancer treatment.

With $800 million from the U.S. government, Moderna was able to scale up their manufacturing process and deliver a vaccine, approved by the FDA, shortly after Pfizer did so.

These vaccines were made possible by two technical advances.
The first advance was in substituting pseudouridine for uridine in the mRNA, so that the target cells natural defenses would not destroy it. The second involves coating the mRNA with a nano size particle to get it into the target cell.

Each of these advances will probably receive a Nobel prize, and is an elegant example of the sophistication of modern  biotechnology.

—Dr. C.

SCIENCE & MEDICINE: STORY BEHIND THE MRNA VACCINES

As mRNA-based COVID-19 vaccines are deployed to protect hundreds of millions of people across the world from the deadly global pandemic, the University of Pennsylvania scientists whose research breakthroughs laid the foundation for swift vaccine development have been awarded the 2021 Lasker-DeBakey Clinical Medical Research Award. Here, mRNA vaccine pioneers Drew Weissman, MD, PhD, and Katalin Karikó, PhD, share the story behind their development of this groundbreaking technology, and what it means for the future of medicine.

DR. C’S JOURNAL: STEM CELLS

The ultimate stem cell is the fertilized egg from which we came. This omnipotent stem cell divides countless times, “differentiates”, and forms more and more specialized tissues, and our body is the eventual result. All of our tissues contain some stem cells, which grow increasingly rare as we age.

Regenerative medicine takes advantage of stem cells derived from diverse sources. An embryo, an umbilical  cord, or your bone marrow contains stem cells. Even one of your mature connective tissue cells that has been dedifferentiated, or sent back along the pathway that originated from the single cell from which you came, can be induced to form a stem cell (iSC).

If the stem cell originates from your own tissues, it is  accepted by your body, as one of its own.

I have an wealthy acquaintance whose Parkinson’s disease is being treated by one of his own cells induced to form a dopamine containing neuronal stem cell.

The article posted previously regarding rotator cuff surgery apparently used stem cells to shorten the recovery time.

I have heard about the use of stem cells in heart failure, osteoarthritis, and other joint problems, and I’m sure we will hear about this increasingly as time passes. However, there are hurdles to be overcome, moral, legal and medical. The possibility (small) of induced stem cells to evolve into cancer is one medical hurdle, and if the Stem Sell originates from another individual, immunosuppressive treatment must be used in the recipient to allow the stem cells to work. Also, the use of the other individual’s stem cells may involve some moral, legal and possibly religious objections.

Please refer to the following Mayo clinic article for more information.

–Dr. C