Data Reveals Evidence Of Molecular Absorption In The Atmosphere Of A Hot Neptune (Planetary Science)

An international team of scientists recently measured the spectrum of the atmosphere of a rare hot Neptune exoplanet, whose discovery by NASA’s Transiting Exoplanet Survey Satellite (TESS) was announced just last month.

This artist’s impression shows LTT9779b transiting the star it orbits. This transit briefly blocks an appreciable fraction of the star’s light, and is how the planet was first discovered by NASA’s TESS mission. ©Ethen Schmidt , Kansas University.

The discovery was made with data provided from the now-retired NASA Spitzer Space Telescope, which allows a unique, infrared view of the universe to look into regions of space that are hidden from optical telescopes.

One of the main goals of NASA’s TESS mission is to find new, small planets that would be good targets for atmospheric characterization. Early in its mission, it found LTT9779b, a planet orbiting a Sun-like star located 260 light years away from Earth. This planet, a little larger than Neptune, orbits very close to its star. The planet is found in the “hot Neptune desert,” where planets shouldn’t exist. Indeed, most close-in hot exoplanets are either gas giants the size of Jupiter or Saturn that have enough mass to retain most of their atmosphere using their high gravity against the evaporation caused by the star, or small rocky exoplanets that have lost their atmosphere to the star long ago.

“This ultra-hot Neptune is a ‘medium-sized’ exoplanet that orbits very close to its star (it takes just 19 hours to complete an orbit), but its low density indicates that it still has an atmosphere weighing at least 10 percent of the planet’s mass,” explained University of New Mexico Physics and Astronomy Assistant Professor Diana Dragomir, who is leading the work which involved more than 25 institutions.

The age of this system is 2 billion years. At this high temperature, the planet’s atmosphere should have evaporated long ago, early in the system’s life. “Hot Neptunes are rare, and one in such an extreme environment as this one is difficult to explain because its mass isn’t large enough to hold on to an atmosphere for very long. So how did it manage? LTT9779b had us scratching our heads, but the fact that it has an atmosphere gives us a rare way to investigate this type of planet, so we decided to probe it with another telescope,” Dragomir added.

To investigate its atmospheric composition and shed further light on its origin, scientists obtained secondary eclipse observations with the Spitzer Infrared Array Camera (IRAC) of the hot Neptune. The Spitzer observations confirmed an atmospheric presence and enabled a measurement of the planet’s very high temperature, approximately 2,000 Kelvin (about 3,000 degrees Fahrenheit). “For the first time, we measured light coming from a planet that shouldn’t exist!” Said Dragomir.

After combining the Spitzer observations with a measurement of the secondary eclipse in the TESS bandpass, the scientists studied the resulting emission spectrum and identified evidence of molecular absorption in the planet’s atmosphere, which they believe is likely due to carbon monoxide. This molecule is not unexpected in the atmospheres of hot large planets (hot Jupiters), but to find it in a hot Neptune may provide clues on the origin of this planet and how it managed to hold onto its atmosphere. This result constitutes the first detection of atmospheric features in an exoplanet discovered by TESS, and the first-ever for an ultra-hot Neptune.

“If there’s a lot of atmosphere surrounding the planet, as is the case for LTT9779b, then you can study it more easily,” said Dragomir. “A smaller atmosphere would be much harder to observe.” The results indicate that LTT9779b is an excellent target for additional characterization with NASA’s upcoming James Webb Space Telescope (JWST), which could also verify whether the observed molecular absorption is indeed due to carbon monoxide.

A companion paper, led by Kansas University Assistant Professor Ian Crossfield, also found signs that point to the planet’s atmosphere having a higher level of heavy elements than expected. This is additionally intriguing because the two similarly-sized planets in our Solar System, Neptune and Uranus, are primarily composed of light elements like hydrogen and helium.

“LTT9779 is one of those super-exciting targets, a very rare gemstone for our understanding of hot Neptunes. We believe we detected carbon-monoxide in its atmosphere and that the permanent dayside is very hot, while very little heat is transported to the night side,” said Björn Benneke, professor at Université de Montréal and member of the Institute for Research on exoplanets (iREx). “Both findings make LTT9779b say that there is a very strong signal to be observed making the planet a very intriguing target for future detailed characterization with JWST.”

Together, these results set the stage for similar investigations of a larger sample of exoplanets discovered in this hot Neptune desert, which are key to uncovering the origin of this unique population of exoplanets.

References: http://dx.doi.org/10.3847/2041-8213/abbc70

Provided by University Of New Mexico

Red And Black Ink From Egyptian Papyri Unveil Ancient Writing Practices (Archeology)

Scientists led by the ESRF, the European Synchrotron, Grenoble, France and the University of Copenhagen, Denmark, have discovered the composition of red and black inks in ancient Egyptian papyri from circa 100-200 AD, leading to different hypotheses about writing practices. The analysis, based on synchrotron techniques, shows that lead was probably used as a dryer rather than as a pigment, similar to its usage in 15th century Europe during the development of oil paintings. They publish their results today in PNAS.

Detail of a medical treatise (inv. P. Carlsberg 930) from the Tebtunis temple library with headings marked in red ink. Image credit: The Papyrus Carlsberg Collection. ©The Papyrus Carlsberg Collection.

In ancient Egypt, Egyptians used black ink for writing the main body of text, while red ink was often used to highlight headings, instructions or keywords. During the last decade, many scientific studies have been conducted to elucidate the invention and history of ink in ancient Egypt and in the Mediterranean cultures, for instance ancient Greece and Rome.

A team of scientists led by the ESRF, the European Synchrotron, and the University of Copenhagen used the powerful X-rays of the ESRF to study the red and black ink in papyri from the only large-scale institutional library known to have survived from ancient Egypt: the Tebtunis temple library. The samples studied in this research project are exceptional, not only because they derive from the famous Tebtunis temple library, but also because the analysis includes as many as 12 ancient Egyptian papyrus fragments, all inscribed with red and black inks.

“By applying 21st century, state-of-the-art technology to reveal the hidden secrets of ancient ink technology, we are contributing to the unveiling the origin of writing practices.”, explains Marine Cotte, scientist at the ESRF and co-corresponding author of the paper.

“Something very striking was that we found that lead was added to the ink mixture, not as a dye, but as a dryer of the ink, so that the ink would stay on the papyrus”, says Cotte. The researchers came to this conclusion because they did not find any other type of lead, like lead white or minium, which should be present if lead was used as a pigment. “The fact that the lead was not added as a pigment but as a dryer infers that the ink had quite a complex recipe and could not be made by just anyone.”, adds Thomas Christiansen, Egyptologist from the University of Copenhagen and co-corresponding author .

A papyrus fragment from a long astrological treatise (inv. P. Carlsberg 89) from the Tebtunis temple library and the ESRF X-ray fluorescence maps showing the distribution of iron (red) and lead (blue) in the red letters that write out the ancient Egyptian word for “star”. Image credit: The Papyrus Carlsberg Collection and the ESRF. ©The Papyrus Carlsberg Collection and the ESRF.

A surprising fact is that the ink recipe can be related to paint practices developed many centuries later during the Renaissance. “In the XV Century, when artists rediscovered the oil painting in Europe, the challenge was to dry the oil in a reasonable amount of time”, says Marine Cotte. “Painters realised that some lead compounds could be used as efficient dryers”, she explains.

This finding was only possible thanks to the different techniques the team used at the ESRF’s beamline ID21 to study the fragments of papyri. They combined several synchrotron techniques (micro X-ray fluorescence, micro X-ray diffraction and micro-infrared spectroscopy) to probe the chemical composition from the millimetre to the sub-micrometre scale to provide information not only on the elemental, but also on the molecular and structural composition of the inks. The scientists discovered that lead was associated to different elements: a complex mixture of lead phosphates, potassium lead sulphates, lead carboxylates and lead chlorides.

Expectedly, the scientists found that the red colour in the ink is given by the ochre. More surprisingly, they discovered that this red pigment is present as coarse particles while the lead compounds are diffused into papyrus cells, at the micrometre scale, wrapping the cell walls, and creating, at the letter scale, a coffee-ring effect around the iron particles, as if the letters were outlined. “We think that lead must have been present in a finely ground and maybe in a soluble state and that when applied, big particles stayed in place, whilst the smaller ones ‘diffused’ around them”, explains Cotte. In these halos, lead is associated with sulphur and phosphorus. The origin of these lead sulphates and phosphates, i.e. were they initially present in ink or did they form during ink alteration, remains an open question. If they were part of the original ink, understanding their role in the writing process is also puzzling and the motivation of on-going research.

The team that came to the ESRF brings together chemists, physicists and Egyptologists. Sine Larsen, former director of research at the ESRF and currently Emerita professor at the Department of Chemistry, University of Copenhagen, was the mastermind that put the group together, back in 2016, and has coordinated it ever since. Several publications later, the collaboration keeps going strong. “I am fascinated by this subject of research, but also by the very diverse profiles that make up this truly interdisciplinary and successful collaboration”, she says.

References: Thomas Christiansen, Marine Cotte, Wout de Nolf, Elouan Mouro, Juan Reyes-Herrera, Steven de Meyer, Frederik Vanmeert, Nati Salvadó, Victor Gonzalez, Poul Erik Lindelof, Kell Mortensen, Kim Ryholt, Koen Janssens, Sine Larsen, “Insights into the composition of ancient Egyptian red and black inks on papyri achieved by synchrotron-based microanalyses”, Proceedings of the National Academy of Sciences Oct 2020, 202004534; DOI: 10.1073/pnas.2004534117

Provided by European Synchrotron Radiation Facility

Ultrasounds Show Impact Of COVID-19 on The Heart (Medicine)

Cardiac ultrasounds (also known as echocardiograms) are providing a view of the heart and the impact of the COVID-19 virus on patients. A new study by researchers at Icahn School of Medicine at Mount Sinai identifies different types of cardiac structural damage experienced by COVID-19 patients after cardiac injury that can be associated with deadly conditions including heart attack, pulmonary embolism, heart failure, and myocarditis. These abnormalities are associated with higher risk of death among hospitalized patients. The findings, published the October 26 issue of the Journal of the American College of Cardiology, offer new insights that may help doctors better understand the mechanism of cardiac injury, leading to quicker identification of patients at risk and guidance on future therapies.

Kaplan-Meier curves for all-cause mortality in patients with versus without myocardial injury (Panel A) and in patients with versus without myocardial injury according to the presence or absence of major echocardiographic abnormalities (Panel B). *Includes wall motion abnormalities, global left ventricular dysfunction, diastolic dysfunction, right ventricular dysfunction and presence of pericardial effusion. Event rates are censored at 20 days from hospital admission. ©Mount Sinai Health System.

“Early detection of structural abnormalities may dictate more appropriate treatments, including anticoagulation and other approaches for hospitalized and post-hospitalized patients,” says author Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The international, retrospective study expands on Mount Sinai’s previous research showing that myocardial injury (heart damage) is prevalent among patients hospitalized with COVID-19 and is associated with higher risk of mortality. That study focused on the patients’ levels of troponin–proteins that are released when the heart muscle becomes damaged–and their outcomes (higher troponin levels mean greater heart damage).

This new work looked at the presence of cardiac troponin elevations in combination with the presence of echocardiographic abnormalities, and found that the combination was associated with worse prognosis and mortality than troponin elevations alone.

“This is one of the first studies to provide detailed echocardiographic and electrocardiographic data in hospitalized patients with COVID-19 and laboratory evidence of myocardial injury,” explains first and corresponding author Gennaro Giustino, MD, Cardiology Fellow at The Mount Sinai Hospital. “We found that among COVID-19 patients who underwent transthoracic echocardiography, these cardiac structural abnormalities were diverse and present in nearly two-thirds of patients.”

Researchers looked at transthoracic echocardiographic (TTE) and electrocardiographic (ECG) scans of 305 adult patients with confirmed positive COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System (The Mount Sinai Hospital, Mount Sinai West, Mount Sinai Queens, and Mount Sinai Beth Israel), Elmhurst Hospital in Queens, and two hospitals in Milan, Italy, between March and May 2020. Median age was 63 years and 67.2 percent were men. 190 patients (62.6 percent) had evidence of myocardial injury; 118 of them had heart damage at the time of hospitalization admission and 72 developed myocardial injury during hospitalization. Researchers found that patients with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers, and an increased prevalence of TTE abnormalities when compared to patients without heart injury.

Among patients with Covid-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Cardiac structural abnormalities included right ventricular dysfunction, left ventricular wall motion abnormalities, global left ventricular dysfunction, diastolic dysfunction and pericardial effusions. LV = Left Ventricular. ©Mount Sinai Health System.

Abnormalities were diverse, with some patients exhibiting multiple abnormalities. 26.3 percent had right ventricular dysfunction (which can be associated with pulmonary embolism and severe respiratory failure), 23.7 percent had regional left ventricular wall motion abnormalities (which can be associated with heart attacks), 18.4 percent had diffuse left ventricular dysfunction (which can be associated with heart failure/myocarditis), 13.2 percent had grade II or III diastolic dysfunction (a condition leading to stiffer cardiac chambers), and 7.2 percent had pericardial effusions (extra fluid around the heart that causes abnormal pumping of the heart).

The study went on to look at in-hospital mortality and troponin elevation. It shows that troponin elevation was 5.2 percent among patients who did not have heart injury, compared to 18.6 percent for patients with myocardial injury but without echocardiographic abnormalities, and 31.7 percent for patients with myocardial injury who also had echocardiographic abnormalities. Researchers adjusted for other major complications from COVID-19 including shock, acute respiratory distress syndrome, and renal failure.

“Our study shows that an echocardiogram performed with appropriate personal protection considerations is a useful and important tool in early identification of patients at greater risk for COVID-19-related cardiac injury, who may benefit from a more aggressive therapeutic approach earlier in their hospitalization,” says corresponding author Martin Goldman, MD, Arthur M. and Hilda A. Master Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. “Additionally, because this is a new disease with lingering symptoms, we plan on following these patients closely using imaging to evaluate the evolution and hopefully resolution of these cardiac issues.”

“Echocardiograms have shown to be invaluable in providing critical information on patients who present with multiple cardiac complaints. Echocardiography is the only imaging modality that can be taken to the bedside and safely used for patients including those on ventilators,” says Lori Croft, MD, Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai and Director of the Echocardiography Laboratory at The Mount Sinai Hospital. “Our findings will help guide care of Covid-19 patients during a critical time.”

Provided by Mount Sinai Health System

Tiny Moon Shadows May Harbor Hidden Stores Of Ice (Planetary Science)

Hidden pockets of water could be much more common on the surface of the moon than scientists once suspected, according to new research led by the University of Colorado Boulder. In some cases, these tiny patches of ice might exist in permanent shadows no bigger than a penny.

“If you can imagine standing on the surface of the moon near one of its poles, you would see shadows all over the place,” said Paul Hayne, assistant professor in the Laboratory of Atmospheric and Space Physics at CU Boulder. “Many of those tiny shadows could be full of ice.”

In a study published today in the journal Nature Astronomy, Hayne and his colleagues explored phenomena on the moon called “cold traps”–shadowy regions of the surface that exist in a state of eternal darkness.

Many have gone without a single ray of sunlight for potentially billions of years. And these nooks and crannies may be a lot more numerous than previous data suggest. Drawing on detailed data from NASA’s Lunar Reconnaissance Orbiter, the researchers estimate that the moon could harbor roughly 15,000 square miles of permanent shadows in various shapes and sizes–reservoirs that, according to theory, might also be capable of preserving water via ice.

Future lunar residents, in other words, may be in luck.

“If we’re right, water is going to be more accessible for drinking water, for rocket fuel, everything that NASA needs water for,” said Hayne, also of the Department of Astrophysical and Planetary Sciences.

Visiting a crater

To understand cold traps, first take a trip to Shackleton Crater near the moon’s south pole. This humungous impact crater reaches several miles deep and stretches about 13 miles across. Because of the moon’s position in relation to the sun, much of the crater’s interior is permanently in shadow–a complete lack of direct sunlight that causes temperatures inside to hover at around minus 300 degrees Fahrenheit.

“You look down into Shackleton Crater or Shoemaker Crater, you’re looking into this vast, dark inaccessible region,” Hayne said. “It’s very forbidding.”

That forbidding nature, however, may also be key to these craters’ importance for planned lunar bases. Scientists have long believed that such cold traps could be ideal environments for hosting ice–a valuable resource that is scarce on the moon but is occasionally delivered in large quantities when water-rich comets or asteroids crash down.

“The temperatures are so low in cold traps that ice would behave like a rock,” Hayne said. “If water gets in there, it’s not going anywhere for a billion years.”

In their latest research, however, Hayne and his colleagues wanted to know how common such traps might be. Do they only exist in big craters, or do they spread over the face of the moon?

To find out, the team pulled data from real-life observations of the moon, then used mathematical tools to recreate what its surface might look like at a very small scale. The answer: a bit like a golf ball.

Based on the team’s calculations, the moon’s north and south poles could contain a tremendous number of bumps and knicks capable of hosting permanent shadows–many of them just a centimeter wide. Previous estimates pegged the area of cold traps on the moon at around 7,000 square miles, about half of what Hayne and his colleagues have predicted.

Mining for water

Hayne notes that his team can’t prove that these shadows actually hold pockets of ice–the only way to do that would be to go there in person or with rovers and dig.

But the results are promising, and future missions could shed even more light, literally, on the moon’s water resources. Hayne, for example, is leading a NASA effort called the Lunar Compact Infrared Imaging System (L-CIRiS) that will take heat-sensing panoramic images of the moon’s surface near its south pole in 2022.

If his team’s findings bear out, locating the ingredients for a hot shower on the moon may have just gotten a lot easier.

“Astronauts may not need to go into these deep, dark shadows,” Hayne said. “They could walk around and find one that’s a meter wide and that might be just as likely to harbor ice.”

References: Hayne, P.O., Aharonson, O. & Schörghofer, N. Micro cold traps on the Moon. Nat Astron (2020). https://doi.org/10.1038/s41550-020-1198-9 http://dx.doi.org/10.1038/s41550-020-1198-9

Provided by University Of Colorado At Boulder

Time-keeping Brain Protein Influences Memory (Neuroscience)

Upsetting the brain’s timekeeping can cause cognitive impairments, like when jetlag makes you feel foggy and forgetful. These impairments may stem from disrupting a protein that aligns the brain’s time-keeping mechanism to the correct time of day, according to new research in fruit flies published in JNeurosci.

The core clock regulates distinct behaviors via discrete PDF targets: a proposed model. Localization of PDFR to the clock permits control of locomotor activity independently from control of memory. Signaling through PDFR in a population of interneurons extrinsic to both the clock and mushroom bodies (here shown as IN1) permits regulation of appetitive memory. We propose that, in place of PDF-PDFR signaling, PDF activation of a novel unidentified receptor (here called PDFR2) in a separate population of interneurons (IN2) is required for aversive memory. ©Flyer-Adams et al., JNeurosci 2020.

The brain contains ‘clock’ neurons that mold circadian behaviors and link them to cues from the environment, like light and seasonal changes. In fruit flies, the clock releases the peptide Pigment-dispersing factor (PDF) to synchronize the activity of the clock neurons and drive time-based behaviors like mating and sleep. PDF may also underlie memory formation, explaining the cognitive dysfunction that occurs when the clock is desynchronized from the environment.

Flyer-Adams et al. tested how well fruit flies with a functioning core clock but lacking the PDF output signal could learn. Flies without PDF had severely impaired memory . However, memory regulation by PDF likely occurs without direct signaling to the main memory structure of flies. These results suggest that PDF from the clock may promote normal memory throughout the day by acting as a timestamp to learning. The VIP pathway in humans may play a similar role.

References: http://dx.doi.org/10.1523/JNEUROSCI.0782-20.2020

Provided by The Society for Neuroscience

Why Chinese Look Like Chinese? Indians Look like Indians?…… Well, I Have An Answer (Biology)

Did we look different from each other, right from the past..?? Today by just looking at faces we can differentiate if the person belongs to China, India, Russia etc.. But what if I say, we all look same in the past.. Yeah its true, there were no countries, no religion, no discrimination, no hate.. We used to live with each other happily like a family.. Wanna know lets travel back 3 lakh years before..

We all used to live in Africa at that time. The environment was warm and naturally rich. We all looked same. Our only objective was ‘survival’. As one couldn’t able to survive alone, we used to live and hunt in groups and stay at one place. Earth was actually the heaven at that time as there were no racism. And yeah, our ancestors prefer grass bedding to create comfortable areas for sleeping and working on, at least 2 lakh years ago.

These beds consisting of sheaves of grass of the broad-leafed Panicoideae subfamily were placed near the back of the cave on ash layers. The layers of ash was used to protect our ancestors against crawling insects while sleeping. Our ancestors also used hot springs as a cooking resource to boil fresh kills, long before humans are thought to have used fire as a controlled source for cooking.

But around 1.3 lakh years before, an interglacial period changed everything. Climate of the earth started increasing rapidly and this started melting icy routes which goes out of Africa. So, some of our ancestors decided to migrate to other countries, while others decided to stay in Africa. Our migrating ancestors took only required food with them, while shared remaining with others. This act of kindness we call today, ‘Law of Sharing’.

Out of Africa, our ancestors went to levantine regions first and started spreading to Syria, Lebanon, Jordan, Israel, Palestine and Turkey.. And just after 1000 years, some of them migrated towards europe and asia. And for 40000 years, our ancestors had spread to India and China. And that’s how 4 human raeces born.

Do you know, that 4 human races? They are white/Caucasian, Mongoloid/Asian, Negroid/Black, and Australoid. According to darwin theory of evolution, Indians are the mixture of Caucasian, australiazoid and mongoloid. North India people have more caucasoin genes, South India have more Australiazoid genes. While, North East have mongoloid genes..

But what about china? Well friends, they all belongs to mongolian races. But the question is, why they have small eyes and flat faces. Friends, its not because god created them like this, that was the gift given to them by evolution through natural selection. Yeah friends, when they came to siberia from africa. It was necessary to protect eyes from snow blindness and natural selection given them low exposure eyes i.e. squinty eyes, to protect them against it..

But what about their flat facial features? You know well about the siberia’s extreme cold temperatures. In order to survive such extreme cold temperatures it is necessary to prevent heat loss. So, natural selection bought changes in their facial features and had given them extra face fat. It also helped them to eat icy-meats. Epicanthel fold is also believed to have evolved in them in order to provide defense from the extreme cold and extreme light that occur in Eurasian arctic and northern regions.

But what about Europeans? How they got their pale colour? Ancestors who were migrated to northern latitudes often don’t get enough UV to synthesize vitamin D in their skin so natural selection has favored two genetic solutions to that problem—evolving pale skin that absorbs UV more efficiently or favoring lactose tolerance to be able to digest the sugars and vitamin D naturally found in milk. That’s why we look different from each other. Share it as much as you can and make people aware of truth.. Because knowledge can only save this beautiful world from ‘destruction’ which may cause from ‘discrimination’..

You can read more about the evolution of human face on the article given below:

https://theuncoverreality.wordpress.com/2020/10/05/why-your-face-looks-different-from-a-chimps-biology/

Copyright of this article totally belongs to uncover reality.. Author of this article is S. Aman.. One is allowed to use it only by giving proper credit to author and to us.

Emerging Treatment Helps Reverse Heart Failure In Some Patients (Medicine)

For the more than 6.2 million Americans living with heart failure, the disease is a cruel thief. It robs patients of vitality, making even the simplest tasks seem exhausting and stealing years off of their lives.

But a glimmer of hope is rising. In a new multicenter study, researchers report that an emerging heart failure treatment could potentially reverse structural damage to the heart, allowing it to heal itself over time. They say the treatment could eliminate the need for heart transplants and long-term use of artificial heart pumps in certain cases.

The research team, co-led by University of Utah Health physicians, concluded that this approach, which combines the use of medications with temporary use of an artificial heart pump, known as a left ventricular assist device (LVAD), could help a select group of patients live longer, healthier, and more productive lives.

“For decades, heart transplantation and LVADs have been the therapeutic cornerstones of advanced heart failure,” says Stavros Drakos, M.D., PhD, co-corresponding author of the study, cardiologist and director of Cardiovascular Research for the U of U Health Division of Cardiology. “But this alternative approach is different. It appears to be a bridge to heart recovery without requiring transplantation or long-term use of an artificial heart pump.”

The study, which was conducted at six specialized medical centers nationwide, appears in Circulation, an American Heart Association journal.

What hadn’t been appreciated until relatively recently is that LVADs significantly reduce the strain on failing hearts. In some cases, using LVADs for limited periods of time has allowed hearts to “rest” and remodel their damaged structures. As a result of these repairs, described as “reverse remodeling,” heart function improves to the point that the LVAD can be removed.

In initial trials, researchers developed a treatment that combines LVAD uses with standard heart failure drugs known to enhance repair of heart tissue. The treatment appeared to be successful, with several patients surviving more than three years after their LVADs were removed.

The new study sought to broaden the reach of the research with a multicenter trial involving physicians and scientists at U of U Health, the University of Louisville, University of Pennsylvania, the Albert Einstein College of Medicine/Montefiore Medical Center, the Cleveland Clinic, and the University of Nebraska Medical Center.

The researchers recruited 40 advanced heart failure patients between the ages of 18 to 59 who were so severely ill that they required surgical implantation of a LVAD pump to remain alive. Overall, 19 patients (40%) who were treated with this protocol that combined LVAD support with standard heart failure medications had sufficient improvement in their cardiovascular health that the LVAD could be removed. These improvements included successfully completing a six-minute treadmill test and having sustained blood flow and blood pressure with the LVAD at low pump settings.

Following up, the researchers found that 90% of these patients were still alive one year after the removal of the LVAD, while 77% survived and were doing very well at two and three years of follow up. This rate of recovery is significantly higher than expected for this stage of the heart failure disease.

The research team concluded that this strategy of LVAD support combined with standardized medication and regular cardiovascular checkups led to high rates of LVAD removal, demonstrating it as a feasible substitute for transplantation or lifelong LVAD use. LVADs are physically burdensome and can be a source of complications, while heart transplants are difficult to come by.

“People that look at heart disease are usually trying to figure out why a heart is becoming worse,” says Craig Selzman, M.D., a study co-author and chief of U of U Health’s Division of Cardiothoracic Surgery. “This research is important because it’s an alternative approach that is trying to figure out why these failing hearts are actually getting better.”

The study had limitations, including a small number of patients, a lack of a control group, and a focus on patients younger than 60 years old. However, the researchers note that this does not necessarily mean that older patients and those who have varying degrees of heart failure would not benefit from this treatment.

Moving forward, the U of U Health researchers in conjunction with others plan to continue exploring how and why this treatment works. In particular, they have been focused on the metabolic pathways in the heart. Based on recent findings the team also published in Circulation, Drakos says these pathways appear to play a key role in the restructuring and remodeling that occurs.

“This multi-center study builds on and validates more than a decade of research conducted by Utah physician-scientists in this exciting field of heart recovery,” Drakos says. “We are invested in figuring how to help a failing heart recover its function with just a little help from us.”

References: Emma J. Birks , Stavros G. Drakos , Snehal R. Patel , Brian D. Lowes , Craig H. Selzman , Randall C. Starling , Jaimin Trivedi , Mark S. Slaughter , Pavan Atluri , Daniel Goldstein , Simon Maybaum , John Y. Um , Kenneth B. Margulies , Josef Stehlik , Christopher Cunningham , David J. Farrar , and Jesus E. Rame, “A Prospective Multicentre Study of Myocardial Recovery Using Left Ventricular Assist Devices (REmission from Stage D Heart Failure: RESTAGE-HF): Medium Term and Primary Endpoint Results”, Circulation, 26 Oct 2020. Doi: https://doi.org/10.1161/CIRCULATIONAHA.120.046415 link: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.046415

Provided by University of Utah Health

Improved Survival After Obesity Operation In Patients With Previous Myocardial Infarction (Medicine)

Researchers at Karolinska Institutet and Danderyd Hospital in Sweden have studied the risk of additional myocardial infarctions and early death in severely obese patients who undergo metabolic surgery following a myocardial event. The registry study covering 1,018 individuals shows a lower risk of additional myocardial infarctions and improved survival that cannot be simply attributed to the loss of weight. The study is published in the journal Circulation.

©gettyimages

According to the WHO and the Body Mass Index measurement it devised, there are currently two billion people who are overweight today, 650 million of whom are classified as obese, with a body mass index (BMI) greater than 30 kg/m2.

Severe obesity (in this study defined as BMI greater than 35 kg/m2) increases the risk of several health problems, including type 2 diabetes, hypertension, cardiovascular disease and cancer.

People who lose weight can improve their health and it has previously been shown that after metabolic surgery, diabetes and hypertensions go into a period of remission in which the symptoms disappear, at least temporarily.

In the current study, researchers at Karolinska Institutet, Orebro University and Uppsala University examined the risk of additional myocardial infarction and early death in people with severe obesity and a previous infarction who subsequently underwent metabolic surgery.

By cross-referencing the quality registries SOReg (Scandinavian Obesity Surgery Registry) and SWEDHEART (for people who have suffered myocardial infarction) between 1995 and 2018, the researchers were able to identify severely obese individuals who underwent a gastric bypass or gastric sleeve procedure as a treatment for their obesity after suffering a myocardial infarction.

A gastric bypass involves disconnecting much of the stomach and part of the small intestine; a gastric sleeve involves removing most of the stomach to leave a tube-like structure that leads food into the intestines.

The group of 509 individuals who underwent surgery was matched with people of the same gender, age and BMI, and who had suffered a myocardial infarction in the same year but not undergone metabolic surgery.

“We found that individuals operated on for their obesity were at a much lower risk of suffering another myocardial infarction, of death and of developing heart failure,” says the study’s first author Erik Naslund, professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet and consultant surgeon at Danderyd Hospital. “These data suggest that severely obese people who suffer a myocardial infarction should be offered metabolic surgery for their obesity as a secondary prevention.”

According to the researchers, it is unlikely the weight loss is the only reason for the study’s observed correlation between metabolic surgery and a lower risk of cardiopathic events, such as stroke, myocardial infarction or early death.

One theory is that metabolic surgery per se has a positive impact on cardiometabolic risk factors, which is to say physiological conditions that increase the risk of cardiovascular disease.

“Many of the patients who underwent metabolic surgery in this study had clinical remission of type 2 diabetes, hypertension and dyslipidemia (high blood lipids). An earlier study, Look AHEAD, demonstrated that long, intensive non-surgical lifestyle intervention in patients with type 2 diabetes resulted in weight loss of 6 per cent, but did not lower the risk of myocardial infarction.”

Before the results of the study can become part of clinical praxis, more research is needed in which severely obese people who have suffered myocardial infarction are randomly assigned to either surgery or to regular post-infarction care.

References: “Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity: a nationwide cohort study”. Erik Naslund, Erik Stenberg, Robin Hofmann, Johan Ottosson, Magnus Sundbom, Richard Marsk, Per Svensson, Karolina Szummer, and Tomas Jernberg. Circulation, online 26 October 2020, doi: 10.1161/CIRCULATIONAHA.120.048585 link: http://dx.doi.org/10.1161/CIRCULATIONAHA.120.048585

Provided by Karolinska Institute

Weight-reduction Surgery For Severely Obese Adults May Prevent Second Heart Attack, Death (Medicine)

People with severe obesity (BMI >35) and a prior heart attack who undergo weight-reduction surgery may lower their risk of a second heart attack, major cardiovascular event, heart failure and death compared to people with similar medical histories who did not have weight-reduction surgery, according to new research published today in Circulation, the flagship journal of the American Heart Association.

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“It is well known that obesity is associated with an increased risk for Type 2 diabetes and heart disease,” said lead study author Erik Näslund, M.D., Ph.D., professor in the department of clinical sciences, Danderyd Hospital, Karolinska Institutet in Sweden. “It has also been shown that weight-reduction surgery can improve Type 2 diabetes and cardiovascular disease. What has yet to be proven is: if you have had a heart attack, can weight-reduction surgery reduce your risk of having another heart attack, which was the focus of our study.”

In the study from Sweden, Näslund and colleagues measured the trends between weight-reduction surgery and subsequent heart attacks, stroke and death in people with severe obesity who had experienced a prior heart attack. The study linked information from two health registries–the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry and the nationwide Scandinavian Obesity Surgery Registry (SOReg).

Researchers compared data from 2005 to 2018 of 509 severely obese patients who had heart attacks to 509 severely obese patients who had heart attacks and then subsequently had either gastric bypass surgery or sleeve gastrectomy surgery (the two most common types of weight-reduction surgery) between 2007 and 2018. Each patient in the study who had weight-reduction surgery was matched to a patient who did not have surgery and with the same degree of obesity, (the average BMI of both groups was 40). The patients were also matched according to gender, age, health status and health history.

Patient data was gathered for a follow-up period of up to eight years (median of 4.6 years), and researchers statistically analyzed variables that may have affected risk for the patients who had heart attacks, strokes or died during the follow-up period.

Researchers found:

Weight-reduction surgery was associated with a lower risk of heart attack and a lower risk of new onset heart failure, yet there was no statistical difference in the risk of stroke between the surgery and non-surgery groups.

The patients who had weight-reduction surgery had half the risk of death compared to those who did not have surgery.

The rate of serious surgical complications was similar to that seen among weight-reduction surgery patients without prior heart attacks.

While patients’ weight in the surgery group was markedly lower one year after surgery (median BMI was 29 after one year), researchers note that the weight loss alone was likely not the driving force in the association between surgery and decreased risk. Additional health changes at two years after surgery included:

A large number of surgery patients had significant improvements in sleep apnea (67% remission) as well as improvement in hypertension (22 % remission), cholesterol and triglyceride levels (29 % remission); and

more than half of the patients with Type 2 diabetes experienced clinical remission of the disease after the weight-reduction surgery.

The study authors did not have information about the socioeconomic status of patients, and there was no data on weight beyond the two-year follow-up mark for the group who had surgery, and no follow-up weight data for the non-surgery group. Additionally, within the surgery group, there was a substantially higher number of patients who had gastric bypass, thus, any difference in outcomes between gastric bypass patients and the patients who had the sleeve gastrectomy procedure could not be evaluated. Researchers were also unable to assess if the timing between each surgery group patient’s heart attack and weight-reduction surgery was a key factor for complications. A randomized controlled trial is needed to confirm the results of this study.

References: Erik Näslund , Erik Stenberg , Robin Hofmann , Johan Ottosson , Magnus Sundbom , Richard Marsk , Per Svensson , Karolina Szummer , and Tomas Jernberg, “Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity: A Nationwide Cohort Study”, 26 Oct 2020. Doi: https://doi.org/10.1161/CIRCULATIONAHA.120.048585 link: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048585

Provided by American Heart Association