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A simple surgical technique during cardiac surgery was associated with a 56 percent reduction in the incidence of an irregular heart rhythm known as atrial fibrillation that can lead to stroke, with no added risks or side effects, according to a new study by Weill Cornell Medicine and NewYork-Presbyterian investigators. The findings suggest that the method, called posterior left pericardiotomy, has significant potential for preventing prolonged hospital stays and the need for additional interventions and drugs to reduce the risk of strokes and heart failure associated with atrial fibrillation.
The study evaluated whether a posterior left pericardiotomy, a slit in the backside of the sac around the heart to drain excess fluid, could help prevent atrial fibrillation in patients who underwent cardiac surgeries. The randomized controlled trial was published Nov. 14 in The Lancet. Study investigators also presented the findings in a live virtual Late-Breaking Science session on Nov. 14 as part of the American Heart Association’s Scientific Sessions 2021.
“Previous studies were small with major limitations in study design, so there was no clear direction on whether posterior left pericardiotomy is beneficial for preventing atrial fibrillation,” said lead investigator Dr. Mario Gaudino, the Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery at Weill Cornell Medicine and a cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. “Our study is the first to provide rigorous evidence of the benefits of the technique in a large group of patients at a single institution.”
A buildup of excess fluid and small clots is common after cardiac surgery, occurring in about two-thirds of patients. Even a small buildup can trigger the development of atrial fibrillation, a complication in which irregular electrical signals prevent the heart’s upper chambers from contracting effectively. Atrial fibrillation is the most frequent adverse event after heart surgery, reported in about 35 percent of patients. Treatment may involve an electrical shock to restore a regular heart rhythm, followed by taking drugs for controlling heart rhythm and lowering the risk of blood clots, which all have side effects and complications.
To perform a posterior left pericardiotomy, the surgeon makes an incision in the back side of the sac around the heart, called the pericardium. This allows excess fluid and small clots from the pericardium to drain into the space around the left lung, called the left pleural cavity. The procedure adds just a few minutes to the overall cardiac surgery time. A left pleural drainage tube is inserted and generally removed few days after surgery as part of standard care. Excess fluid continues to drain through the slit in the pericardium until it heals on its own.
For their study, called “Posterior Left Pericardiotomy for the Prevention of Postoperative Atrial fibrillation after Cardiac Surgery” (PALACS), the investigators randomly assigned 420 patients undergoing elective surgery to coronary arteries, the aortic valve or ascending aorta to two groups: 212 patients received a posterior left pericardiotomy during their surgeries and 208 patients did not receive the additional surgical procedure.
Atrial fibrillation developed in 37 of 212 patients (18 percent) in the pericardiotomy group, significantly lower than 66 of 208 patients (32 percent) in the no-pericardiotomy group. Importantly, no complications were associated with pericardiotomies.
The study was funded entirely by the Department of Cardiothoracic Surgery at Weill Cornell Medicine, made possible through philanthropy from patients and fundraising efforts. “This study demonstrates our commitment to conducting rigorous clinical research and answering important questions that are meaningful to patients,” said Dr. Gaudino, who is also director of the Joint Clinical Trials Office at Weill Cornell Medicine and NewYork-Presbyterian.
Drs. Gaudino and a team of investigators from the Department of Cardiothoracic Surgery at Weill Cornell Medicine are now working with international colleagues to design a multicenter clinical trial that will include more patients and types of heart surgeries, such as mitral valve repair.
“We are excited that our proof-of-concept clinical trial has demonstrated the benefits of posterior left pericardiotomy, with no additional risks to patients,” said senior author Dr. Leonard Girardi, chairman of the Department of Cardiothoracic Surgery and the O. Wayne Isom Professor of Cardiothoracic Surgery at Weill Cornell Medicine, and cardiothoracic surgeon-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. “We look forward to confirming our results in a multicenter study in the future and hope this technique may one day become the standard of care for heart surgery patients across the globe.”
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A new study using genetically engineered mice and human cell and tissue samples has added to evidence that higher levels of inflammatory chemicals involved in fat metabolism occur in people with amyotrophic lateral sclerosis (ALS), the neuromuscular disorder, also known as Lou Gehrig’s disease.
The study, which focused on genetic pathways involved in how spinal motor cells process fats, found that compared with people without ALS, those with the disorder have about 2.5-fold higher levels of arachidonic acid, a lipid commonly found in the fatty parts of meat and fish and that is known to spur on inflammatory processes needed to repair wounds or tissue damage.
Notably, by tampering with the arachidonic acid pathway in mice bred to develop the biological hallmarks of ALS, the researchers say they were able to reduce the condition’s muscle-weakening symptoms in the mice — which experienced a 20%-25% increase in grip strength — and extend their survival by two to three weeks.
A report on the work, led by Johns Hopkins Medicine researchers, appears in the Nov. 15 issue of Nature Neuroscience.
The scientists used caffeic acid, an anti-inflammatory compound found naturally in coffee, tea, tomatoes and wine, to tamp down the arachidonic acid pathway, but they caution that people with ALS should not rush to treat themselves with the substance, which is sold as an unregulated dietary supplement. More studies are needed to determine safe levels of a caffeic acid supplement — some reports have indicated potentially harmful side effects, including cancers and gut problems.
Also sold in alleged muscle enhancement powders, arachidonic acid in inappropriate and untested amounts can be toxic, triggering brain cells to die off, experts say.

Doctors and scientists from the German Cancer Research Center (DKFZ) and from Heidelberg University’s Medical Faculty Mannheim have successfully tested a neoantigen-specific transgenic immune cell therapy for malignant brain tumors for the first time using an experimental model in mice.
Cellular immunotherapies that specifically target malignant tumors are thought to be a promising approach in cancer medicine. However, a basic requirement for this kind of targeted immunotherapy is to identify target molecules that are found exclusively on the tumor cells and are recognized by the immune system.
Malignant gliomas are incurable brain tumors that spread in the brain and cannot be completely removed by surgery. “Gliomas are very difficult to treat, and the lack of suitable target structures is a considerable challenge for developing immunotherapies,” explained Lukas Bunse, an immunologist at the DKFZ and a doctor at University Hospital Mannheim (UMM).
Using an experimental mouse model, Bunse and his team have now demonstrated for the first time that transgenic T cells targeting tumor neoepitopes can be used to treat gliomas.
Tumor neoepitopes arise as a result of genetic mutations in cancer cells that lead to structural changes in the proteins produced. They therefore occur exclusively in the cancer cells. Using a prediction model, Bunse and his team identified a segment of the CIC protein (capicua transcriptional repressor) as a promising target structure for T cell attacks; around two percent of all gliomas show a recurrent mutation in this protein.
Mice vaccinated with the CIC neoepitope developed a population of T helper cells that showed a high level of activation in response to the vaccine peptide. The researchers used particularly active T cells to isolate the gene for the T cell receptor (TCR) responsible for epitope recognition.
They subsequently transferred the isolated TCR gene to cells and were thus able to grow large amounts of “transgenic” T cells in a petri dish that all had an identical, highly active TCR targeting the CIC neoepitope.
In order to study their efficacy, the researchers injected the transgenic cells directly into the brain ventricles of glioma-bearing mice. In combination with radiotherapy, the T cell therapy led to glioma rejection in some of the animals.
“Here we have shown for the first time in an experimental model that a neoantigen-specific TCR-transgenic cell therapy can be effective against gliomas,” explained Michael Kilian, first author of the study. “These kinds of neoepitope-specific TCR-transgenic T cells could be used in future in cancer patients who cannot be treated using CAR T cells,” he added.
Chimeric antigen receptor (CAR) T cells, which have already been approved for treating patients with B cell leukemia, can only attack tumor antigens present on the surface of the cancer cells. However, these proteins are not usually found exclusively on tumor cells, so CAR T cells could damage healthy tissue too.
In contrast, the TCR-transgenic T cells can also attack mutated proteins from the cell interior, which must be exposed on the cell surface by special presentation molecules known as major histocompatibility complex (MHC) proteins. Most T cells respond solely to antigens presented by MHC molecules. To achieve results that can be transferred to humans, Lukas Bunse and his team therefore needed to work with mice transgenic for human MHC molecules.
“Our work suggests that TCR-transgenic T cells can also be used to treat patients with brain tumors,” remarked Michael Platten, head of the Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology at the DKFZ and Medical Director of Mannheim University Hospital’s Department of Neurology. In collaboration with Wolfgang Wick, Medical Director of the Medical Faculty of Heidelberg’s Department of Neurology, Platten and the team of neurooncologists hope to use comparable approaches to refine the TCR-transgenic T cell therapy and to study it in early clinical trials.

A University of Pennsylvania study published today in Nature Communications offers striking evidence that network science can be used to remove race and gender bias in clinical settings. The study, led by Professor Damon Centola of the Annenberg School for Communication and the School of Engineering and Applied Science, offers an effective new way to ensure safer, more equitable health care for women and minorities through managing clinician peer networks.
Using an experimental design, researchers showed that clinicians who initially exhibited significant race and gender bias in their treatment of a clinical case, could be influenced to change their clinical recommendations to exhibit no bias.
“We found that by changing the structure of information-sharing networks among clinicians, we could change doctors’ biased perceptions of their patients’ clinical information,” says Centola, who also directs the Network Dynamics Group at the Annenberg School and is a Senior Fellow of Health Economics at the Leonard Davis Institute. “Put simply, doctors tend to think differently in networks than they do when they are alone.”
In the experiment, the researchers asked 840 clinicians to watch a video of a patient giving a clinical history detailing risk factors for heart disease. Half of the clinicians saw a white male actor portraying the patient, while the other half saw a Black female actor. The videos were otherwise identical.
Clinicians then chose one of four treatment recommendations based on the patient’s information: an unsafe option, an under-treatment option, the correct guideline-recommended option, or an over-treatment option.
Initial results showed the Black female patient was 49% more likely than the white male patient to be sent home. Conversely, the white male patient was 78% more likely than the Black female patient to be referred to the emergency department. The results reinforced a well-documented fact of American health care: extensive race and gender bias in medicine.

Professor Jonathan Van-Tam has said that “waning” protection against Covid, has led to a recommendation that everyone over the age of 40 receives a third booster dose of the vaccine.The Joint Committee on Vaccination and Immunisation also recommended that 16 and 17 years olds should receive a second dose.England’s deputy chief medical officer said that “vaccines have fundamentally changed the course of the pandemic in the UK.”

Scientists have developed vaccines for cats and dogs, but vaccinating companion animals is not necessary, experts said.Over the past year, coronavirus vaccines have gone into billions of human arms — and into the fuzzy haunches of an ark’s worth of zoo animals. Jaguars are getting the jab. Bonobos are being dosed. So are orangutans and otters, ferrets and fruit bats, and, of course, lions and tigers and bears (oh, my!).Largely left behind, however, are two creatures much closer to home: domestic cats and dogs.Pet owners have noticed.“I get so many questions about this issue,” Dr. Elizabeth Lennon, a veterinarian at the University of Pennsylvania, said. “Will there be a vaccine? When will there be a vaccine?”Technically, a pet vaccine is feasible. In fact, several research teams say that they have already developed promising cat or dog vaccines; the shots that zoo animals are receiving were initially designed for dogs.

Cardiac stress tests, X-rays and other medical tests may not provide useful information before operations, and they could cause harm.Let’s say you’re scheduled for a common and relatively low-risk operation, like a cataract removal, hernia repair or a hip or knee replacement. It’s normal to feel anxious about any upcoming surgery. But what if one of the presurgical tests your doctor orders — for example, a chest X-ray or cardiac stress test — turns up something unexpected, like a suspicious nodule or a mild heart abnormality? Now you have even more reason to worry, and your surgery will likely be delayed until further tests assure the doctor it would be safe to operate.Experts say that presurgical testing is often unjustified for many common operations. Many of these tests are a waste of time and money, a growing body of research shows, and the tests themselves can sometimes result in complications.For more than two decades, experts in various medical specialties, including cardiology, ophthalmology and anesthesiology, have issued guidelines directed at reducing preoperative tests that rarely provide findings relevant to a patient’s surgical risk. Yet practicing doctors often do not follow this advice. Guidelines published in 2002, for example, from the American College of Cardiology, the American Heart Association and the American Society of Anesthesiologists resulted in almost no change in doctors’ presurgical orders nearly a decade later, according to a report in JAMA Internal Medicine. The only exception was a decline in the use of electrocardiograms, or EKGs, a noninvasive test that checks heart function at rest.Sometimes a preoperative test of questionable value results in unanticipated complications, as happened to a man in his 50s scheduled for repair of a very painful hernia. Two Colorado doctors reported in 2014 that the man’s lab tests and physical exam were normal. But a chest X-ray, ordered because he had a history of mild asthma, suggested he had a nodule on a lung.Doctors delayed the surgery until he got a CT scan, which did not confirm a lung nodule but did find one on an adrenal gland. Again, doctors postponed surgery to allow for further work-up of the adrenal nodule, which was ultimately found to be benign. The man finally had his hernia repaired after six additional months of debilitating pain and repeated anxiety over incidental test findings suggesting he could have cancer.However, doctors are making some headway. In 2019 in JAMA Internal Medicine, Dr. John N. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and his colleagues described an effort to reduce “low-value preoperative care” for patients about to have cataract surgery. New guidelines were issued, and a specially trained quality improvement nurse advised the surgeons about the new recommended protocol. The result, as assessed in a controlled clinical trial of 1,054 patients, was a dramatic decline in preoperative testing, a significant projected cost saving after the first year and “no measurable adverse effects” on the patients’ surgery, he said.Cardiac stress tests show over-testing persists.Perhaps most problematic among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physicians’ responses to preoperative guidelines, said in an interview, “Cardiac stress testing is over-ordered. If there’s no indication of a heart problem, like shortness of breath, there’s no reason to do this test prior to surgery.”The latest guidelines, which the American College of Cardiology and American Heart Association issued in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients lacking symptoms suggestive of heart disease. The guidelines leave the decision to test up to the doctor, and you might think it’s better to rule out a possible heart problem before surgery. But existing evidence shows no health or lifesaving benefit from a preoperative stress test when the patient lacks cardiac symptoms or has fewer than two major risk factors for having a heart attack, like high blood pressure and smoking, especially when the prospective surgery itself is low-risk.Yet despite these guidelines and a national campaign called Choosing Wisely, aimed at curbing unnecessary tests and procedures, a recent study by Dr. Daniel S. Rubin and his colleagues at the University of Chicago found that many doctors persist in ordering preoperative stress tests among patients at very low risk for cardiac complications. The study, published in JAMA Cardiology in January, looked at more than 800,000 patients having a hip or knee replaced, which is usually considered a low-risk surgery. It found that nearly half the patients who were given a preoperative stress test had no cardiac risk factors that might justify its use. Furthermore, the stress test did not lessen the risk of suffering a heart attack or cardiac arrest during or immediately after surgery, even among patients with one or more cardiac risk factors.In fact, the stress test might have been counterproductive. For reasons Dr. Rubin could not explain, patients without risk factors who were given a cardiac stress test had double the surgical complication rate experienced by comparable patients who did not have one.Whatever the explanation for that finding, testing itself is not free of risk, as noted by Dr. Ravi Chopra, a resident in neurology at Washington University School of Medicine. In JAMA Internal Medicine in October, Dr. Chopra and his colleagues described a 72-year-old patient with no known cardiovascular disease or cardiac symptoms who was given a stress test before a hip replacement. The test showed a mild heart abnormality, prompting a catheterization that resulted in damage to two blood vessels that then had to be surgically repaired.“Testing can cause harm,” Dr. Chopra said. “We need to think hard about whom we’re testing. There should be a really good reason.”What patients can do.Experts suggest you’d be wise to ask whether the prescribed tests would reveal anything relevant to your surgical risk that the doctor could not determine by asking you a few questions during a routine physical. For example, answering a simple question like, “Do you get out of breath climbing a flight of stairs or walking four city blocks?” might provide a quick assessment of whether you might be having heart symptoms.Dr. Mafi added that “it’s hard to change physician behavior with guidelines,” especially when doctors fear being sued if something goes wrong that might have been prevented by a presurgical test. He suggested that patients can help by questioning what a particular test might show and whether it’s really needed. Also helpful, he said, is to choose a doctor “who’s thoughtful, takes time to listen and is judicious about testing. You don’t have to order 100 tests if just one test will do.”

What to Know About the Coronavirus in PetsEmily Anthes��Reporting from New York Can I give the virus to my pets?Yes. Humans can transmit the virus to their pets the same way they transmit it to other people: through tiny, respiratory droplets. Most dogs and cats that catch the virus appear to get it from infected humans in their household. Cats are more likely to become infected than dogs, for reasons that scientists do not completely understand. (Biology and behavior may both play a role.)

SharecloseShare pageCopy linkAbout sharingAll over 40s should be offered a third dose of a Covid vaccine, according to the UK government’s vaccine advisors. The move would top up protection and help limit the spread of the virus over winter. Evidence suggests the chance of testing positive for Covid falls by more than 80% two weeks after a booster.The Joint Committee on Vaccination and Immunisation also said 16 and 17 year olds, who were initially offered only a single dose, should now get a second. So far, 12.6 million people have had a booster dose. They have been given to the over 50s, front-line medical staff and people with health conditions that put them at greater risk. Is my Covid vaccine wearing off?People aged 40-49 years old will be topped up with either Pfizer or a half dose of the Moderna jab. This should be offered six months after the second dose. The UK’s drug safety regulator – the Medicines and Healthcare products Regulatory Agency (MHRA) – said the booster doses were safe and side-effects were either a sore arm or flu-like symptoms.Dr June Raine, regulator’s chief executive, said: “We welcome today’s announcement by the JCVI, on the extension of the booster campaign to 40-49 year olds. This further strengthens our ability to ensure people are protected against COVID-19 and saves lives.”Our proactive monitoring of the safety of booster doses does not raise any new concerns.”The amount of protective given by the vaccines does fall after the second the dose. Prof Neil Ferguson said there was “no reason” not to give boosters to younger age groups and it “could make quite a big difference to driving down transmission to low levels”. Children – aged 16 and 17 – have only been offered one dose of a Covid vaccine so far. They will now get a second dose – at least 12 weeks after their first.Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesAbout two million people who have not been fully vaccinated against Covid-19 have been placed in lockdown in Austria as the country faces a surge in cases.”We are not taking this step lightly, but unfortunately it is necessary,” Chancellor Alexander Schallenberg said.Unvaccinated people will only be permitted to leave home for limited reasons, like working or buying food.About 65% of Austria’s population is fully vaccinated – one of the lowest rates in Western Europe.Meanwhile, the seven-day infection rate is more than 800 cases per 100,000 people, which is one of the highest in Europe. Overall, Europe has again become the region most seriously affected by the pandemic and several countries are introducing restrictions and warning of rising cases.However, the UK, which has one of the highest Covid infection rates, has yet to reintroduce restrictions, despite health leaders calling for rules like mandatory face coverings in crowded and enclosed spaces to be brought back to avoid a winter crisis.Covid passes set to stay as Europe heads for winterHow fast is vaccine progress around the world?The measures introduced in Austria on Monday, which come amid growing pressure on the nation’s hospitals, will initially last for 10 days. Children under the age of 12 and people who have recently recovered from the virus will be exempt.Over the weekend, hundreds of people protested outside the chancellery in the capital, Vienna, waving banners that read: “Our bodies, our freedom to decide.”One female protester said she was demonstrating “to fight for my rights”. “It is totally discriminatory what is happening here,” she said. But Prof Eva Schernhammer, of the Medical University of Vienna, said the measures were needed, warning that hospital intensive care units were filling up. “It’s already projected that within two weeks we’ll have reached the limit,” she said. Unvaccinated people were already barred from visiting restaurants, hairdressers and cinemas, but will now be expected to stay at home.”In reality we have told one third of the population: you will not leave your [home] apart from for certain reasons,” Mr Schallenberg said. “That is a massive reduction in contacts between the vaccinated and the unvaccinated.”The government says police will carry out spot checks in public spaces to determine the vaccination status of individuals, and issue fines to those caught breaking the rules. There was a last-minute rush at vaccination centres in Upper Austria on the eve of the new restrictions.But critics have questioned whether the move is constitutional. The far-right Freedom Party has said it will create a group of second-class citizens.In neighbouring Germany, where Health Minister Jens Spahn has warned of a pandemic of the unvaccinated, the federal government and state leaders are due to meet later this week to discuss possible new restrictions.Germany’s 67.3% vaccination rate is higher than in Austria, but not by much. Germany has designated Austria a high-risk area, meaning anyone arriving from the country must go into quarantine.In the Netherlands, “lockdown-lite” measures have been imposed to limit social contacts in response to a sharp increase in infections. The measures include early closing for restaurants and shops, and barring spectators from sporting events.About 84% of Dutch adults have been fully vaccinated. Most patients in Dutch hospitals have not had their jab.Vaccination rates are significantly lower in some eastern European nations.Latvia, where 59% of the population are fully vaccinated, re-imposed lockdown last month and has banned lawmakers who refuse the vaccine from voting on laws and taking part in debates until the middle of next year. They will also see their pay docked. In Russia, only about 35% of the population has been fully vaccinated, according to Our World In Data. At the end of October, Moscow shut shops, restaurants and schools in a partial lockdown and workers were given nine days paid holiday to curb infections.Some other countries are also introducing measures applying only to the unvaccinated. In Australia, the state of Queensland will bar unvaccinated people from restaurants, pubs and sports events from 17 December.And Singapore has said that those who remain unvaccinated by choice will have to pay for their own medical bills from December.You may also be interested in:This video can not be playedTo play this video you need to enable JavaScript in your browser.