How I Freed Myself Spiritually with 3 Life Changes


When I decided to start making a conscious effort to develop my spiritual life, I was at a point when life’s biggest questions needed answers fast: Who am I? Why am I? What is God? What is the purpose of life? I was in college, when my goals and my reasons for having them were important to figure out in order to navigate my schooling. But these questions are also important for life in general.

Wrestling with these questions while trying to engage seriously in the spiritual side of life and re-evaluate what I had already been taught or learned caused turmoil, confusion, resistance, instability, and a feeling of being lost. I was only truly able to grow spiritually when I made the following changes.

1. Release Guilt.

We tend to get caught up in whether or not our actions are right or wrong. We’ve all made mistakes, done things we later regretted, and acted against others as well as ourselves. Some of these things have kept me up at night tossing and turning and begging for forgiveness or release. One day I heard a spiritual leader on the radio talking about how guilt did more damage to us than the “wrong act” itself. Something clicked inside of me, confirming that the worst thing I could do was to continue to hold on to guilt. I had to free myself.

It wasn’t until I granted myself permission to let go of the idea that I had done something “bad” and accepted that it was mostly an experience to grow that I began to feel free and able to be a greater version of myself. Experience is our greatest source of knowledge and wisdom. Allowing ourselves to be and feel forgiven is not only healing and transforming, but is also one of the most courageous things we can do.

2. Re-Create Yourself.

Take a good hard look at yourself on every level: mentally, emotionally, physically and spiritually. What has created your worldview? How have your upbringing, your experiences, your neighborhood, institutions, and environment shaped who you are now? Ask yourself, “Why am I me?” Then take the lens through which you see the world off. Why? A lot of the answers I could come up before I committed to change were external things.

This really made me sit back and rethink myself. If I hadn’t grown up in this town or with this faith, who would I be and what would I believe to be true? At some point, you’re no longer the product of your environment but a creator in your life, free to choose who you are. I personally wanted not to be so heavily dependent on my outside world, but to be driven by something greater, something more internal: my divine self.

3. See Perfection.

A zen proverb suggests that when someone points at something, we initially tend to observe their finger instead of the object itself. We focus on things that don’t serve us well or mask the truth. The proverb says, “To look at the moon, it is necessary to gaze beyond the finger, right?” Yet when life throws us transformative experiences, which can also be very painful, we’re at a loss as to why these things are happening to us. We let the scariness and disappointments cripple us and keep us down, instead of seeing the situation for what it really is: an opportunity to heal and grow, which can transform us.

By being more mindful in life and observing things as they really are, we can be more like masters and creators and less like victims or reactors. It’s a simple choice, and it will give you a great sense of freedom to see past the surface of our experiences into the perfection and blessing in all things.

I’ve found it to be an amazing experience to live knowing that even the seemingly problematic issues in my life are actually the answers to my prayers.

 

About the author:

Gogo Thule Ngane is a Sangoma Traditional Healer, Priestess, and Medicine Woman. She is guided by the Amadlozi, Elevated Ancestors of her lineage. Her work includes divination, traditional healing, and leads workshops, ceremonies, and retreats on ancient African healing and spirituality. She is devoted to awakening ancestral wisdom on the earth.

 

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

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6 Health Benefits of Liver Cleansing


Your liver is responsible for processing toxins in the body, so you’ll want to keep it working at its best. Sometimes, though, diet or lifestyle can catch up to us, and if that happens, a liver cleanse becomes necessary. With a cleanse, you’ll certainly get rid of all that toxic buildup, but there are lots of other perks as well.

6 Benefits of Liver Cleansing

Many people disregard liver cleansing, but there are many benefits associated with the practice. Not only does it jump start a healthy eating program, it may also help you lose weight. Just what can liver cleansing do for you?

1. Weight Loss

Your liver produces bile, which the digestive systems use to break down fat. And since liver cleansing promotes bile production, detoxing your liver might be just the place to start if you want to lose weight.

2. Immune System Support

Since the liver reduces toxins, among other things, it makes sense that a healthy liver is crucial to a strong immune system[1] [2] Cleansing your liver could even give your immune system a boost.

3. Discourages Liver Stones

Liver stones, a product of diet, form because of too much cholesterol in the liver. [3] The extra cholesterol makes bile harden into tiny stones that can block the liver and gall bladder; you could even have up to 200 to 300 of these affecting your liver’s ability to detox. When you cleanse, though, somewhere between 100 to 300 of the stones could actually be purged from your body.

4. Supports Whole Body Detox

Since the liver removes toxins, turning them into harmless byproducts, there are usually small amounts of toxins in your liver. This is generally not a problem. Issues start, however, when there’s a buildup of too many toxins. That’s when you need to detox in order to get your liver working exactly as it should.

5. Boosts Energy

Some of the harmless byproducts the liver makes are actually nutrients the body will use. Whether from liver stones or too much toxic build up, some of those nutrients simply won’t make it back into the bloodstream. When that happens, your energy levels will likely drop, so liver cleansing will make you feel better because not only will you have all of your nutrients — but also all of your energy.

6. Increases Vitality

Remember that by cleansing the liver, you’re restoring it to peak efficiency. Reducing all that toxic buildup will make your skin look brighter and healthier. And since promoting bile production helps with fat breakdown, you’ll also tone your body easier and could even look and feel at least five years younger!

If you’re ready to make a change for the better, a liver cleanse might be a great start. You can get my recommended liver cleanse instructions here. You’ll also find valuable information in the following articles:

If you’ve performed a liver cleanse before, leave a comment below and let us know what difference it made for you!

References:

  1. Parker, G. A. & Picut, C. A. Liver Immunobiology. Toxicologic Pathology. 33 (1).
  2. Racanelli, V. & Rehermann, B. The Liver as an Immunological Organ. Hepatology. 43 (2, Supplement 1).
  3. Grünhage, F. et al. Increased gallstone risk in humans conferred by common variant of hepatic ATP-binding cassette transporter for cholesterol. Hepatology. 46 (3).

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

The Age of Synthesis: Fluid Boundaries, Limitless Possibilities


“Love is the affinity which links and draws together the elements of the world. … Love, in fact, is the agent of universal synthesis.” — Pierre Teilhard de Chardin, Activation of Energy.

Fluid Boundaries and Concrescence

Concrescence for humanity is possible through the art of letting go. By letting go of preconceived ideas, limiting reality constructs, and rigid notions of reality, we open into the realm of curiosity and creativity where anything can happen. We transform our placeholders to graceholders. By living in our hearts and applying Fluid Boundaries to what appears to be happening, we can move into the gap of the unknown to make new collective heart-prints. There is not just one way to move forward.

Concrescence is defined as “the coalescence or growing together of parts originally separate.” The concept of concrescence originated in biology and was later adopted by philosopher Alfred North Whitehead in his book Process and Reality as part of a philosophical ontology.

Every event in Whitehead’s ontology is thus a unique combination of possibility and actuality. The process of combining the two is imagined by Whitehead to be organic and is consequently called “concrescence.” The term concrescence stands for the process that is fundamental for existence. It can be thought of as the growing together of the multiple entities in the world to one single actual entity, which then becomes the material for new entities. Because of being organic, a concrescence is different from a mere combination where the whole is the sum of its parts.[1]

According to Whitehead, concrescence can occur through creative synthesis where the act of decision merges the already decided past with the not yet decided future.[2]

Human nature is to look to past experiences to create future expectations. We think things will be a certain way because they were that way before. The presence of the past creates the future. But concrescence integrates past experiences not as predictions of the future but as references only to catalyze new potentials, new probabilities, new creative expressions. Many existing perspectives and models working together will build concrescence.

Consider that concrescence is already occurring in many paradigms when viewed from a heart-centered, vertical perspective. None of the models are absolutely true, but all of the models are relatively true for the scale they are describing.

The scale we use to look at reality matters.

Scale is defined as a range of numbers used as a system to measure or compare things. According to world-renowned Harvard professor of theoretical physics Lisa Randall:

Effective theories are keeping track of measurable details without getting caught in unmeasurable components. … The speed of light is finite and the universe we know has existed a finite amount of time. This doesn’t mean the universe isn’t bigger. It is just that we can’t make observations beyond that scale.[3]

A Theory of Everything

Wouldn’t it be great if we had a theory to explain everything? In physics, string theory is currently under development. This model aims to reconcile quantum mechanics with general relativity and seems to have all the necessary characteristics for becoming a Theory of Everything. It is founded on the principle that matter, energy, and, under certain hypotheses, space and time are manifestations of physical entities below which, according to the number of dimensions they develop in, they are called “strings.” For the theory to be valid, physicists propose that there are ten dimensions.[4]

A true Theory of Everything would possibly include all theories, as there is not one ultimate reality. All realities are a matter of scale or, more simply, a matter of perspective. Each model often describes the respective dimension it is observing.

Consider that the evolution of physics and science may simply be an evolution of our perspectives based on scales. Current research builds on and is a logical extension of what is previously known. Current research comes from the past and is based on measurable observations. Aspects of string theory known as super-symmetry and Brane models seem to hold the most promise of being able to build on what is already known and linking to the unknown. However, none of these models can get there alone. They rely on a delicate balance between what has been discovered in the past (predictability) and the unexplained mysteries of the universe (probability).

Predictability and Probabilities

The science of our three-dimensional life is Newtonian physics. Newtonian physics explains how objects obey the laws of gravity. This is the world of physicality and matter. This is a science of predictability.

The science of 4-D is a realm of probabilities. Traditional models consider 4-D to be space-time, which includes four-dimensional combinations of width, height, depth, and time. Because space consists of three dimensions, and time is assumed to be one-dimensional, spacetime must, therefore, be a four-dimensional object. Oxford physicist and mathematician Roger Penrose proposed that space and time themselves are secondary constructs that emerge out of a deeper level of reality. Mathematics professor Andrew Hodges of Oxford University says that “This idea of points of space-time as being primary objects is artificial.”[5]

Quantum physics explores an unknown future of probability states. Quantum entanglement experiments reveal that particles can instantaneously communicate over infinite distances. This is a model of a world in which everything is connected. At the subatomic level, the reason electrons are able to communicate with each other from thousands of miles away is because they are not separate. Quantum physics challenges our basic ideas about space-time. Relativity from a quantum physics perspective reveals a realm of possibilities. This is also a realm of the mind in which probabilities can be explored before they fully actualize as experience. We can traverse the past via memories and explore the future through imagination.

However, moving beyond 4-D is problematic for science due to the measurement problem. But nonetheless, there is compelling evidence that there is more than meets the eye, and portals into infinite dimensions may soon be discovered.

Harvard cosmologist and theoretical physicist Lisa Randall, author of Knocking on Heaven’s Door, posits that there is a hidden fifth dimension that we can’t see. According to her widely recognized model, which dovetails with string theory, “The fifth dimension could be so warped that the number of dimensions you see would depend on where you were. … The fifth dimension could actually be infinite and we would not have noticed it.”[6]

Infinite extra dimensions, depending on our perspective.

Randall has made some astounding discoveries in theoretical physics linking tiny quantum particles to a model of the cosmos. While she utilizes a very pragmatic approach, starting from what science already has proven, her colleagues cite her “amazing nose” in terms of knowing where to look for hidden variables. She has a knowing without knowing how she knows, and her intuitive hunches consistently enable her to follow her nose (knows).

Dimensions are simply the different facets of what we perceive to be reality. We are aware of the three dimensions that surround us—length, width, and depth—because we can see them in everyday life. String theory proposes that beyond these three dimensions are additional dimensions that are not immediately apparent to us but that can be still be perceived as having a direct effect on the universe and reality as we know it.

Consider that that hidden fifth dimension, too small to measure and too vast to quantify, can possibly be found without measuring devices and mathematical computations. This hidden dimension is found in the field of the heart.

The field of the heart is the gateway to infinite potential and infinite expression, as well as infinite dimensions,[7] beyond the realities we can see and measure into the realm of the unknown. The heart-field is where predictability meets boundless possibility.

The heart-field is the timeless transformative treasure that moves us beyond past experiential patterns of linear time into the holofractal realm of new patterned potentials; we are able to move up, down, right, and left, any which way in all dimensions, esoterically and practically, for they are one and the same from the field of the heart. Vertical and horizontal awareness meets perpendicular planes of possibilities simultaneously.

The field of the heart is a counter-rotating torsion field or tube torus. Torsion fields are instantaneous signal transmitters and receivers linking local linear effects with nonlocal, nonlinear reality. Our heart-field enables us to traverse all axes of reality from zero-point to all points of perspectives inclusively.

The heart-field is where infinite potentials meet infinite expressions. Infinite perspectives. Infinite choices. Infinite dimensions.

Curiously enough, the physics of heart-centered awareness, a physics of torsion fields, would conceivably enable scientists to reconcile electromagnetism and gravity and would enable mainstream science to prove the existence of unknown dimensions. More than 4,000 papers have been published by more than 150 teams of scientists in the past 120 years describing what a torsion field is, what function it performs, how it works, and where it may be located. Despite this fact, widespread scientific knowledge of this critical, fundamental aspect of physics and biology has been almost completely excluded from the world of academic scientists and mainstream research institutions.[8]

Torsion fields or scalar waves are still considered “fringe science.” Part of the reason for this is that torsion fields are characteristically supraluminal; they travel faster than the speed of light. Because our measuring devices are based on the electromagnetic spectrum and these tools (based on light) cannot go faster than the speed of light itself, we can’t measure torsion fields. However, we can measure the effects of torsion fields.[9] Nonetheless, mainstream science dismisses torsion fields as junk science. In other words, traditional mainstream science has dismissed the existence of scalar wave energy (torsion fields) simply because current measurement tools are based on electromagnetic frequencies, action, and motion, and these measurement tools cannot seem to measure scalar or torsion waves. As we learned from renowned theoretical physicist Lisa Randall, effective theories are keeping track of measurable details without getting caught in unmeasurable components.

The prevailing scientific paradigm is that which is not measurable must not be included.

According to MIT- and Princeton-educated physicist Dr. Claude Swanson, in his Synchronized Universe model, the new sciences of biophotons and torsion fields provide a bridge between two views of life: the old 20th-century view of an organism as a chemical machine and the emerging view of life as communication and energetic flows.[10]

The physics of torsion fields also reveals how language can reprogram our DNA. Russian biophysicist Peter Gariaev and his team have proven the existence of torsion fields. Gariaev’s work, wave genetics, utilizes the principles of laser light and sound and scientifically demonstrates that torsion fields carry information to the biophotons of the body, informing the body to heal and grow. Despite the fact that he is healing so-called genetic diseases, the dead-end dogma of prevailing paradigms has yet to accept his progressive research into mainstream avenues.[11]

Age of Synthesis

Moving toward concrescence entails our ability to see truth in all models. Moving toward concrescence will entail our ability to occupy multiple perspectives simultaneously. Concrescence at the collective level begins with concrescence at the individual level.

So are things really falling apart, or are they coming together in a new way?

Everything at the collective level is moving toward integration. The historic split between mind and body has melded. Wave particle duality has been resolved. Science and spirituality are merging, and even separate masculine and feminine constructs are evolving in an integrated, holistic manner. There is an emergence of synthesis.

Today, many disparate systems are synthesizing. Nothing seems as separate as it did in the past. The boundaries between so-called opposites are beginning to dissolve, and dualities are transforming into an integrated expression of wholeness.

Scientist Dr. Carl W. Hall considered the 21st century the The Age of Synthesis:

Synthesis is a way of thinking and doing, of providing a vision, in which an idea or a thing, imagined or real, is seen as a coherent whole; often consisting of parts, from which thought can be developed, action can be rejected or taken, and the thing made, assembled, or constructed; either as a new creation or activity or as a duplicate or substitute of known substances.[12]

Fluid Boundaries

To bridge the gaps between all paradigms, fostering synthesis and a movement toward concrescence, we are invited to leverage Fluid Boundaries in relation to our models and maps to describe reality and the way we relate to others.

The art of limitless living includes releasing the fixed boundaries we may have previously established relative to our models and maps, parameters that create a false sense of control over our lives and reality, but that also create a real form of limitation and segregation for collective humanity.

Fluid Boundaries are boundaries that aren’t predefined in anticipation of situations or experiences. In truth, we never know how a circumstance will present itself before it actually happens. At the quantum level, reality is a series of probabilities that only seem to actualize when we observe them. Fluid Boundaries allow us to move freely among the patterns we encounter in the moment so as to allow for maximal flexibility and flow.

Fluid Boundaries at the interpersonal level are a game-changer. We never know what is going to happen in the very next moment. For example, we never really know how another person is going to show up or respond to us. If boundaries are established in advance, those very boundaries may serve to inform and restrict a situation of circumstance, with the preset limitation triggering a reaction. Thus, boundaries can bind us rather than liberate us. Predefined boundaries create separation rather than connection.

For example, we may create boundaries in advance to withstand an expectation of our spouse becoming angry with us, and subsequently guilt-tripping us when we say we would rather stay home next weekend than go to the firing range. The very expectation of the future behavior may indeed be based on prior reactions. Establishing boundaries based on past experiences may actually serve as the trigger for the pattern we were attempting to avoid. This is because an associative reference for the behavior is encoded in the boundary. So instead of avoiding the anger and guilt, the boundary triggers the very pattern we are trying to circumnavigate or avoid.

Conversely, approaching this same anticipated circumstance centered in an open heart, without preconceived notions, with a commitment to notice when circumstances come up as placeholders that may take us out of our hearts, allows for Fluid Boundaries to be created.

When the tendency to move out of the heart occurs, this can serve as a cue to bring in Fluid Boundaries, moving parameters that honor our needs while still allowing others to have their experiences. Fluid Boundaries without expectations can lead to a softening of the interactions, with others wielding very powerful and often surprising results. Whatever the outcome, the possibilities become limitless when navigating with Fluid Boundaries.

References:

  1. Daniel J. Ott, “Process Communitarianism,” Concrescence 10 (2009): 67–75.
  2. Alfred North Whitehead, Process and Reality, Corrected ed. (New York: Free Press, 1978).
  3. Lisa Randall, “Knocking on Heaven’s Door,” lecture at Harvard University, November 2011, https://m.youtube.com/watch?v=FiCNLZMhScI.
  4. “Looking for Extra Dimensions,” http://www.superstringtheory.com/experm/exper51.html.
  5. “SpaceTime, Relativity, and Quantum Physics,” http://www.ws5.com/spacetime/.
  6. Dennis Overbye, “On Gravity, Oreos, and a Theory of Everything,” New York Times, November 1, 2005, http://www.nytimes.com/2005/11/01/science/on-gravity-oreos-and-a-theoryof-everything.html; Lisa Randall, Knocking on Heaven’s Door: How Physics and Scientific Thinking Illuminate the Universe and the Modern World (New York: HarperCollins, 2011).
  7. Barbara Hand Clow and Gerry Clow, The Alchemy of Nine Dimensions (Charlottesville, Va.: Hampton Roads, 2010).
  8. David Yurth, Seeing Past the Edge (Mesa, Ariz.: Dandelion Books, 1997); Richard C. Hoagland and David Wilcock, “The Bees’ Needs: It’s the Physics, Stupid!,” http://www.enterprisemission.com/Bees/thebeesneeds.htm.
  9. P. Gariaev and M. Pitkanen, “Model for the Findings about Halogram Generating Properties,” unpublished manuscript, http://tgd.wippiespace.com/public.html.
  10. Swanson, Claude. Life Force: The Scientific Basis. (Tucson, AZ: Poseidia Press, 2011).
  11. “The Torsion Field and the Aura.” Subtle Energies and Energy Medicine 19, no. 3 (2008): 43–89.
  12. Carl W. Hall, The Age of Synthesis (New York: Peter Lang, 1995).

About the author:

Melissa Joy Jonsson is the founder of M-Joy, a unifying “we” movement that provides a new language to experience self-love as integrity. She is best known for her ability to engage people to embrace their true authentic power by playing in the field of the heart. Melissa has been teaching popular life-transformational seminars around the world since 2008. As an intuitive coach and holistic practitioner, Melissa has a diverse client base in more than 25 countries. Melissa spent more than a decade as an executive in the pharmaceutical industry. She is the author of “The Art of Limitless Living”, “Little Book of Big Potentials”, “Practical Play the Heart-Centered Way”, and “M-Joy Practically Speaking”. Melissa has a bachelor’s degree in psychology from the University of California at Santa Barbara. She resides in San Diego, California.

This article is excerpted and adapted from ‘The Art of Limitless Living’, available in Print, E-book and AudioBook.

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

For Some Hard-To-Find Tumors, Doctors See Promise In Artificial Intelligence


A team at Johns Hopkins Medicine in Baltimore is developing a tumor-detecting algorithm for detecting pancreatic cancer. But first, they have to train computers to distinguish between organs.

 

Artificial intelligence, which is bringing us everything from self-driving cars to personalized ads on the web, is also invading the world of medicine.

In radiology, this technology is increasingly helping doctors in their jobs. A computer program that assists doctors in diagnosing strokes garnered approval from the U.S. Food and Drug Administration earlier this year. Another that helps doctors diagnose broken wrists in X-ray images won FDA approval on May 24.

One particularly intriguing line of research seeks to train computers to diagnose one of the deadliest of all malignancies, pancreatic cancer, when the disease is still readily treatable.

That’s the vision of Dr. Elliot Fishman, a professor of radiology at Johns Hopkins Medicine in Baltimore. Artificial intelligence and radiology seem like a natural match, since so much of the task of reading images involves pattern recognition. It’s a dream that’s been decades in the making, Fishman says.

“When I started in radiology, they said, ‘OK, don’t worry about reading the chest X-rays because the computers will read them,’ ” Fishman says. “That was 35 years ago!”

Elliot Fishman says the goal of developing an artificial intelligence program is to spot pancreatic tumors early.

 

Computers still can’t perform the seemingly simple task of reading a chest X-ray, despite sky-high expectations and more than a little hype around the role of artificial intelligence. Fishman is undaunted as he turns this technology on pancreatic cancer.

And that disease is a huge challenge. Only 7 percent of patients given a pancreatic cancer diagnosis are alive five years later. One reason the disease is so deadly is that doctors usually diagnose it when it’s too late to remove the tumors with surgery. Fishman and his team want to change that, by training computers to recognize pancreatic cancer early. Working with Johns Hopkins computer science students and faculty, they are helping develop a tumor-detecting algorithm that could be built into CT scanner software.

Americans get 40 million CT scans of the abdomen every year, for everything from car accidents to back pain. Imagine if a computer program with expert abilities could look for pancreas tumors in all those scans.

“That’s the ultimate opportunity — to be able to diagnose it before you have any symptoms and at a stage where it’s even maybe too subtle for a radiologist to be able to detect it,” says Dr. Karen Horton, chair of the Johns Hopkins radiology department and Fishman’s collaborator on the project.

Karen Horton is chair of the Johns Hopkins radiology department and is collaborating with Fishman on The Felix Project.

The challenge lies in teaching a computer to detect what a well-trained doctor knows to look for.

“Elliot and I are very subspecialized so we’re really, really good,” Horton says matter-of-factly. “We see more pancreatic cancer than probably anyone in the world.”

She says if the computer algorithm could capture their collective knowledge about how to diagnose pancreatic cancer and give that expertise to the typical doctor, “you could be, I would argue, better than us, but certainly as good as us — which would mean better than most of the practicing radiologists.”

Even a program perfectly attuned to finding patterns can’t reliably recognize cancer if it hasn’t been trained on reliable starting material.

When it comes to developing AI, “sometimes people say, ‘oh just take a bunch of cases and put them in a computer and the computer will figure out what to do’,” Fishman says. “That’s nonsensical.”

The Felix Project at Johns Hopkins, as the pancreas effort is called, pours a huge amount of human time, labor and intellect into training computers to recognize the difference between a normal pancreas and one with a tumor.

Of all the internal organs to deal with, “the pancreas is the hardest,” Fishman says. “The kidney looks like a kidney, the liver’s a big thing.” On the other hand, he says, “The pancreas is a very soft organ, it sits way in the middle and the shape varies from patient to patient. Just finding the pancreas, even for radiologists, is at times a challenge.”

Eva Zinreich, a medical researcher, digitally paints a CT scan to help train the computer program. The process can take almost four hours for a single scan.

 

Eva Zinreich, a retired oncologist, is up for that challenge. She is one of a team of medical experts who spend their days poring over CT scans and teaching the computer how to recognize the pancreas, other organs, and then, tumors within the pancreas.

She sits at a computer workstation, wielding a digital paintbrush.

“I’ll show you in 3D because that’s the fun stuff, ok?” she says as she sets about coloring in the aorta and other blood vessels on a scan.

Next, she colors the pancreas yellow.

“You see that shaded area?” she asks. “That’s the tumor,” and she proceeds to color it red.

Zinreich digitally paints the pancreas (yellow) and a tumor (red) in a CT scan.

 

It will take her almost four hours just to mark up this single scan. Four medical experts have been working full-time for well over a year on this project. They’ve done this painstaking work on scans from about 1,000 healthy people, and their tally of pancreatic cancer images is now approaching 1,000 as well, Fishman says.

They are feeding their annotated scans into the project’s computer program and gradually teaching it to recognize the same signs of a tumor that radiologists now pick out of the scans.

At another workstation in the lab, radiologist Linda Chu is trying to make the computer system even more adept than Elliot Fishman and Karen Horton are at recognizing pancreas cancers. She’s developing ways for the computer to look for patterns in the scan that the human eye can’t pick out. It’s interpreting textures in the images, rather than shapes and shading.

Chu says she’s making tentative progress. For example, she’s been training the software to identify subtle clues that distinguish between a benign cyst and cancer.

“We don’t truly understand what the computer is seeing, but clearly the computer is able to see something in the images that us humans cannot comprehend at this point,” Chu says.

But this is also part of the challenge of AI — if the computer highlights something that a human expert can’t see, and it’s not clear how it arrived at that conclusion, can you trust it?

“That’s what makes the research interesting!” Chu says.

Computer science students from the Johns Hopkins University main campus are key to developing the software that’s learning how to read and interpret the images that flow from Fishman’s lab.

The Lustgarten Foundation, which is focused on pancreatic cancer, has provided nearly $4 million over two years to fund the Felix Project. Horton says if it’s successful, all the information they collected on healthy people can be used as a starting point to study tumors elsewhere in the body.

“You could have Felix kidney, Felix liver, Felix lung, Felix, heart,” she says. And they could all go together into the scanner software.

The project is named after the “Felix Felicis” good-luck potion, from the Harry Potter books. And, absent an effective magic spell, the laborious process is a reminder that success in bringing artificial intelligence to medicine will not be as simple as dumping piles of data into a computer and trusting that an algorithm will sort it all out.

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

Canola Oil Impairs Brain and Memory


Canola Oil Increases Memory Loss

Think your cooking oil is safe and healthy? Canola oil producers claim that it’s the healthiest oil you can use, but science begs to differ. Unless significant weight gain and diminished memory are your idea of good health!

Canola oil has been heralded as a modern healthy alternative to olive oil, and ‘saturated fats’ like coconut and palm oil, backed by a big promotional push from North American growers. The Canola Council of Canada pulls no punches, calling it “the healthiest of all commonly used cooking oils.”[1] The marketing campaign appears to be working: canola oil consumption in the United States has nearly tripled since 2000, up to almost 3 million metric tons in 2017.[2]

When asked if canola oil is the same as rapeseed oil, the answer is both “yes” and “no.” Canola oil comes from the rapeseed plant, and was called rapeseed oil until the early 1970s, when a promotional campaign to rebrand the oil was devised in conjunction with genetic-modification to remove two of the plant’s undesirable elements, erucic acid and glucosinolates.

The Rapeseed Association of Canada took the opportunity to rename the plant, and “Can” for Canada, plus “ola” for oil, was born.[3] Producers are still keen to leave the rapeseed designation behind, hence their claim that this GM-version is a distinct type of plant. Essentially, it is a very comprehensive marketing campaign designed to confuse and lead the public to a foregone conclusion.

With more than 90% of U.S. crops and upwards of 80% of Canadian canola derived from genetically-engineered seeds, it’s almost certain that your bottle of canola oil comes from plants contaminated with chemical herbicides. Because processing removes the genetically-modified protein from the finished oils, producers consider it the same as conventional oil,[4] believing this production process removes all potential for harm. It is therefore marketed as being 100% safe for unlimited human consumption. But as the latest medical science points out, this oil is far from being a healthy choice for human brains and bodies.

Canola oil is often promoted as a low-cost alternative to olive oil, possessing the same health benefits. It’s even promoted as having a mere 7% saturated fat, compared to olive oil’s 15%. But what does science say about the healthfulness of canola? Until recent years, no data were available on the effect of canola oil intake in relation to increasingly common diseases, like Alzheimer’s disease. Canola oil had never been examined as a causal factor in the sixteen-fold increase in deaths from Alzheimer’s reported in 1991: a total of 14,112, up from just 857 deaths reported in 1979.[5]

In December 2017, researchers from Alzheimer’s Center at Temple University investigated the effect of daily consumption of canola oil on mice whose brains had developed both plaques and tangles, common brain characteristics for Alzheimer’s patients.[6] Mice in the control group received a typical diet, while mice in the experimental group were fed a diet supplemented with canola oil for a period of 6 months. At the beginning of the study, mice had the same body weight. They were put through three different tests involving memory functions and conditioning, such as mazes. Ability to navigate these environments demonstrated measurable brain function and emotional stimulation.

Their findings debunked the claims of Canola oil marketers, demonstrating negative impacts to bodies and brains. 

Mice who were chronically exposed to canola oil experienced a significant increase in body weight; a gain of nearly one-fifth of total weight recorded just six months earlier. Effects on the brain were equally undesirable. Mice showed impairments in their working memory, demonstrated by decreased problem-solving abilities. Together with reduced levels of beneficial brain proteins that mark synaptic integrity, or how well neurons are firing, the mice performed significantly worse on all tests as compared to control mice. Synaptic integrity can affect whether or not critical connections are made in the brain, something that is vital to a functional memory and enjoying a high quality of life. Canola oil impairs synaptic integrity, which greatly exacerbates the debilitating symptoms of Alzheimer’s disease.

Researchers concluded that their findings do not support the beneficial effect of regular canola oil consumption, nor does their data justify the current trend aimed at replacing olive oil with canola oil in your diet. Not when research has consistently shown that olive oil reduces the same brain plaques and unhealthy proteins that canola oil increases.[7] The same way that Big Pharma selectively publishes only favorable scientific research on drugs,[8] canola oil producers have cherry-picked data that is both contradictory and inconclusive when viewed in its entirety.[9] Meanwhile, consumption of extra virgin olive oil continues to deliver on its promise of being a true superfood.

A similar study was conducted by the same Temple University research group in June 2017,[10] but this time the focus was on olive oil and its effects on Alzheimer’s brain plaques and tangles. Mice were fed a diet of normal food, or food supplemented with extra virgin olive oil for six months. Compared with controls, the group fed olive oil demonstrated improvements in their prior behavioral deficits. Synaptic integrity also improved, thanks to a significant increase in steady-state levels of synaptophysin, a protein marker of synaptic integrity. In addition, brain plaque deposition decreased, thanks to reductions in insoluble peptides and specific proteins associated with the disease. Overall, their findings supported the beneficial effect of olive oil consumption on all major features of Alzheimer’s disease.

GreenMedInfo has over 70 abstracts on olive oil, demonstrating its healthful effects on over 150 different disease conditions, including Alzheimer’s disease and breast cancer. Start enjoying these benefits immediately by swapping out your canola oil today!

References:

About the author:

Sayer Ji is the founder of Greenmedinfo.com, a reviewer at the International Journal of Human Nutrition and Functional Medicine, Co-founder and CEO of Systome Biomed, Vice Chairman of the Board of the National Health Federation, and Steering Committee Member of the Global Non-GMO Foundation.

 

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Age related BP targets for chronic kidney disease patients work better


A cautious approach to lowering blood pressure (BP) in elderly patients with chronic kidney disease (CKD) is recommended, said US-based researchers. Treatment of hypertension in younger patients with CKD can follow current clinical guidelines, they added.

“Hypertension affects almost all patients with CKD, and is one of the few conditions that is treatable with a wide array of medications,” said lead author Professor Casaba P. Kovesdy, from the Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, US.

Kovesdy and team examined systolic BP (SBP) and diastolic BP (DBP) with all-cause mortality, together with the incidence of chronic heart disease (CHD), ischaemic stroke, and end stage renal disease (ESRD) in 339,887 patients with CKD. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.08660815]

During the 4.8 year median follow-up 100,763 patients died (95 percent confidence interval [CI], 62.6- 63.4). Mortality rates were high in older SBP patients. SBP ≥ 140mmHg and <120 mmHg was associated with higher mortality rates across all age groups. Lowest mortality was seen in SBP 120-139 mmHg for patients <80 years, and SBP 120-159 mmHg for patients ≥80 years.

Compared to SBP of 130-139 mmHg, SBP ≥170mmHg in patients aged <50, 50-59, 60-69, 70-79, and ≥80 years were adjusted hazard ratio [aHR], 1.95, 95 percent CI, 1.34-2.84; aHR, 2.01, 95 percent CI, 1.75-2.30; aHR, 1.68, 95 percent CI, 1.49-1.89; aHR, 1.39, 95 percent CI, 1.25-1.54; and aHR, 1.30, 95 percent CI, 1.17-1.44, respectively.

Lower DBP was associated with high mortality. DBP of 70-79 mmHg in patients <50 years and 80-89 mmHg in patients ≥50 years had the lowest mortality.

CHD was experienced in 9,450 patients during the study period (95 percent CI, 9.6-10.0). Higher SBP was associated with higher CHD rates in patients <80 years. However, lowest CHD rates were associated with SBP<110 mmHg in patients <70 years and SBP<140 mmHg in patients ≥70 years. DBP on the other hand had no association with CHD.

Ischaemic stroke was experienced by 14,557 patients (95 percent CI, 10.2-10.6). While higher SPB was associated with higher stroke rates across all age groups, DBP showed no association. Lowest stroke risk was seen in patients with SBP <100mmHg.

ESRD rates were found to be lower in older individuals compared to younger patients. ESRD was seen in 5,161 patients (95 percent CI, 3.2-3.3). DBP was found to have no association with ESRD, but high SBP was associated with high ESRD incidence. Patients <80 years with SBP ≥170mmHg had high ESRD risk, but SBP <170mmHg in this age group had no associated risk.

“Our results reinforce the significant association of elevated SBP with all the studied outcomes but suggest weak association in the elderly, especially in patients aged ≥80years,” said Kovesdy. “The best outcomes were seen with SBP of 120-130 mmHg in patients <80 years and of 120-159 mmHg in those ≥80years.”

In a separate editorial, Assistant Professor Jessica W. Weiss from the Division of Nephrology and Hypertension, Oregon Health and Science University, Portland, Oregon, US said that the study by Kovesdy and team added to the collective understanding of the relationship between BP and a wide range of various clinical outcomes in older adults with CKD, a group rarely studied. This, she said, may be useful in guiding the design of future studies in this area. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.03100316]

“These results may also add a note of caution to newfound enthusiasm for lower BP targets after the release of the SPRINT* via the suggestion that harm may persist at upper and lower extremes of BP among populations more comorbid and complex than those evaluated in the setting of a clinical trial,” said Weiss.

 

Evolocumab plus statin potentially reduces atherosclerosis progression in GLAGOV study


The addition of evolocumab to statin therapy in individuals with angiographic coronary disease appeared to encourage coronary atherosclerosis regression, as demonstrated in the GLAGOV* trial presented at the Scientific Sessions of the American Heart Association (AHA 2016) held in New Orleans, Louisiana, US.

In comparison with patients on statin alone who experienced a nonsignificant 0.05 percent increase in percent atheroma volume (PAV), those on combined therapy of statin and evolocumab had a 0.95 percent reduction in PAV (difference, -1.0 percent, 95 percent confidence interval [CI], -1.8 to -0.64 percent; p<0.001). Normalized total atheroma volume (TAV) decreased by 0.9 mm3 (nonsignificant) in those on statin alone compared with 5.8 mm3 in those on statin and evolocumab (difference, -4.9 mm3, 95 percent CI, -7.3 to -2.5; p<0.001). [AHA 2016, LBCT 03; JAMA 2016;doi:10.1001/jama.2016.16951]

Plaque regression occurred in a greater number of patients on evolocumab and statin compared with those on statin alone (64.3 percent vs 47.3 percent; difference, 17.0 percent, 95 percent CI, 10.4 to 23.6 percent; p<0.001 for PAV and 61.5 percent vs 48.9 percent; difference, 12.5 percent, 95 percent CI, 5.9 to 19.2 percent; p<0.001 for TAV).

“We are really reducing plaque burden in the coronaries if we can get [low-density lipoprotein cholesterol (LDL-C)] down to these very low levels,” said study chair Dr Steven Nissen from the Department of Cardiovascular Medicine at the Cleveland Clinic, Cleveland, Ohio, US, who presented the findings. “It turns out that a little bit of change in plaque volume translates into a very big change in plaque behaviour.”

“[These findings] suggest a new era in lipid management,” said discussant Dr Raul Santos from the University of São Paulo, Brazil.

Evolocumab appeared to be well tolerated with comparable incidences of injection site reactions (0.4 percent vs 0 percent), myalgia (7.0 percent vs 5.8 percent), neurocognitive events (1.4 percent vs 1.2 percent), and new onset diabetes (3.6 percent vs 3.7 percent) for evolocumab plus statin vs statin monotherapy, respectively.

In this double-blind, placebo-controlled, multicentre trial, participants (n=968, mean age 59.8 years; 72 percent male) with angiographic coronary disease, LDL-C levels ≥80 mg/dL or 60–80 mg/dL with additional high-risk features, and on stable statin therapy were randomized to receive monthly subcutaneous injections of the proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor, evolocumab (420 mg) or placebo for 76 weeks. After angiography, participants underwent intravascular ultrasound (IVUS) of the same artery at baseline and at week 78.

“Both the primary and secondary IVUS efficacy measures showed atherosclerosis regression … in patients treated with the combination of evolocumab and statins and absence of regression in patients treated with a statin alone,” said study lead investigator Dr Steven Nicholls, also from the Cleveland Clinic. “These findings provide evidence that PCSK9 inhibition produces incremental benefits on coronary disease progression in statin-treated patients.”

“Over the last 4 decades, evidence has accumulated suggesting that optimal LDL levels for patients with coronary disease may be much lower than commonly achieved. While we await large outcome trials for PCSK9 inhibitors, the GLAGOV trial provides intriguing evidence that clinical benefits may extend to LDL-C levels as low as 20 mg/dL,” said Nissen, who acknowledged the limitations of the trial such as the small number of patients and short treatment period. “IVUS is a useful measure of disease activity, but the critical determination of benefit and risk will require completion of large outcome trials currently underway,” he said.

Other factors that could potentially influence disease progression in the setting of very low LDL-C levels also need to be investigated, said Nicholls.

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Managing hypertension may prevent chronic kidney disease


Health education combined with general practitioner (GP) training in managing blood pressure delayed decline of kidney function and lowered the risk of death from kidney failure in individuals with hypertension, according to an extended analysis of the COBRA* study.

“Our findings indicate that public health interventions using effective lifestyle modification approaches and training of providers in a primary care setting can yield long-term benefits for preserving kidney function,” said lead author Dr. Tazeen Jafar, a professor of Health Services and Systems Research at the Duke-NUS Graduate Medical School in Singapore, Singapore.

The study included 1,271 hypertensive individuals aged ≥40 years from low-income communities in Pakistan. The participants were randomly assigned to a control group, which received standard care, or an intervention group, which received health education emphasising healthy lifestyle and adherence to antihypertensive medication, and/or care from GP trained in hypertension management for 2 years. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.05300515]

The participants were evaluated for changes in kidney function from baseline to 7 years after the start of intervention.

Kidney function, measured as the estimated glomerular filtration rate (eGFR), of the intervention group did not changed significantly (-0.3 ml/min per 1.73m2, 95 percent confidence interval [CI], -3.5 to 2.9 ml/min per 1.73m2) after 7 years, compared with the control group, which saw a -3.6 ml/min per 1.73m2 decline in eGFR (95 percent CI, -5.7 to -2.0 ml/min per 1.73m2) (p=0.01).

Participants receiving intervention were half as likely as participants on standard care to experience a >20 percent decline in kidney function (adjusted risk ratio [adjRR], 0.53, 95 percent CI, 0.29-0.96; p=0.04).

Also, the risk of death from kidney failure or >20 percent kidney function decline was significantly lower in the intervention group compared with control group (adjRR, 0.47, 95 percent CI, 0.25-0.89).

“Blood pressure control is a cornerstone of management to both prevent the onset and delay the progression of CKD,” said Drs. Min Jun and Brenda Hemmelgarn from the Department of Medicine at the University of Calgary in Alberta, Canada in a separate editorial. [Clin J Am Soc Nephrol 2016;11:932–934]

“Current clinical guidelines widely advocate blood pressure reduction strategies, including both pharmacologic and lifestyle interventions.”

Previous studies showed that improvement in diet and exercise had beneficial effects on cardiometabolic parameters and preserving kidney function. [Cochrane Database Syst Rev 2011;(10): CD003236, Nephrology (Carlton) 2015;20:61–67]

These simple interventions could be implemented in low- and middle-income countries to help prevent chronic kidney diseases (CKD), suggested Jafar.

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Malay ethnicity, smoking, hyperlipidaemia predict risk of coronary calcification


Malay ethnicity, male gender, smoking and having hyperlipidaemia are associated with an increased risk of coronary calcification, according to a study presented at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taipei, Taiwan.

“Coronary artery calcium (CAC) is highly associated with the presence of coronary atherosclerotic plaque that has prognostic value towards cardiovascular events,” lead author Shu Yun Heng said. “It has shown that CAC varies among different ethnic groups in the same age and gender.”

Multivariate analysis of 16,546 individuals revealed that CAC increased with increasing age (adjusted odds ratio [AOR], 1.13; 95 percent CI, 1.13–1.14). Compared with women, men had higher CAC score across all ages (AOR, 3.70; 3.41–4.02).

Individuals of Malay ethnicity generally had higher CAC compared with those of Chinese ethnicity (AOR, 1.37; 1.16–1.63), after adjusting for confounding variables. In addition, CAC was also higher in smokers than nonsmokers (AOR, 13.29; 1.43–123.87) and among individuals with hyperlipidaemia (AOR, 1.62; 1.02–2.58).

These results are consistent with those of the Multi-Ethnic Study of Atherosclerosis (MESA), which found that men had greater calcium levels than women, and calcium amount and prevalence were steadily higher with increasing age. Researchers also found significant differences in calcium by race, and these associations differed across age and gender. [Circulation 2006;113:30-73]

A prospective cohort study, MESA is designed to assess subclinical cardiovascular disease (CVD) in a multiethnic cohort free of clinical CVD. A total of 6,110 patients (mean age 62 years; 53 percent women) participated in the study. [Circulation 2006;113:30-73]

The MESA public website (http://www.mesa-nhlbi.org) provides an interactive form that allows one to enter an age, gender, race/ethnicity, and CAC score to obtain a corresponding estimated percentile.

Bild and colleagues, in one publication of the MESA results, also found ethnic differences in the presence and quantity of coronary calcification that were not explained by coronary risk factors. [Circulation 2005;111:1313-1320]

“Identification of the mechanism underlying these differences would further our understanding of the pathophysiology of coronary calcification and its clinical significance,” said Bild, adding that “[d]ata on the predictive value of coronary calcium in different ethnic groups are needed.”

Furthermore, data from another study focusing on the prognostic value of CAC in a large, ethnically diverse cohort for the prediction of all-cause mortality support a growing body of evidence noting substantial differences in cardiovascular risk by ethnicity. [J Am Coll Cardiol 2018;doi:10.1016/j.jacc.2007.03.066]

In this present retrospective study, Heng and colleagues assessed the distribution of CAC in a multiethnic cohort between ages 35–84 years from a single tertiary institution, National Heart Centre Singapore, between 2007 and 2017. Participants were 64 percent men and had a mean age of 55 years. CAC was determined by 320 Multi-Detector Row CT.

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What, how, when of using NOACs in practice


Dr Chan Yi-Hsin

When making practical decision on using non-vitamin K antagonist oral anticoagulants (NOACs), several factors should be considered such as age, renal function, and risk of bleeding, according to a presentation at the APSC Congress 2018.

The Asia Pacific Heart Rhythm Society (APHRS) 2017 consensus paper states that “for Asian patients with nonvalvular atrial fibrillation (AF), standard-dose NOACs are the default doses of choice for stroke prevention unless label guidance recommends low-dose regimens.” [J Arrhythm 2017;33:345-367]

“Aspirin is not recommended solely for stroke prevention in AF,” said Dr Chan Yi-Hsin of Chang Gung Memorial Hospital, Linkou, Taiwan.

The recommendations from APHRS are generally aligned with the ACC* and ESC** guidelines, he noted, which indicate that low-risk patients (defined by a CHAD2DS2-VASc=0 for male and =1 for female) do not require antithrombotics. On the other hand, higher-risk patients (CHAD2DS2-VASc ≥2 for all or =1 for male) were recommended to be further assessed with the SAMeTT2R2 score to guide the choice of anticoagulants — NOACs are preferred if the final score is ≥3. [J Arrhythm 2017;33:345-367]

How and what to select?

In selecting which NOAC to use, clinicians need to consider the CHAD2DS2-VASc score, age, renal and liver function, risk of bleeding, and concurrent medications a patient is receiving, Chan pointed out. [APSC 2018, session S047-04]

If CHAD2DS2-VASc=0/1, dabigatran or apixaban can be considered, based on findings from the RELY and ARISTOTLE trials which involved 30–34 percent of lower-risk patients in the overall study population. [N Engl J Med 2009;361:1139-1151; N Engl J Med 2010;363:1875-1876; N Engl J Med 2011;365:981-992] In higher-risk patients, the ENGAGE AF-TIMI 48 trial involving 77.4 percent of patients with CHAD2DS2-VASc=2 suggests the use of edoxaban in such patients, while the ROCKET AF study comprising 87 percent of patients with CHAD2DS2-VASc ≥3 indicates that rivaroxaban be used in these patients. [N Engl J Med 2011;365:883-891; N Engl J Med 2013;369:2093-2104]

Nonetheless, Chan was quick to point out that there are no head-to-head trials comparing the different NOACs so far, and the above suggestions are based on review of the various randomized controlled trials comparing each NOAC with warfarin.

When selecting NOAC in elderly patients (aged ≥75 years), a review study on phase III randomized clinical trials (RCTs) suggests that the risk of bleeding was reduced with apixaban 5 mg BID vs warfarin but the converse was seen (ie, warfarin was favoured) when compared with rivaroxaban 20 mg QD or dabigatran 110/150 mg BID in elderly patients. [Best Pract Res Clin Haematol 2013;26:215-224]

As different NOAC has different renal excretion rate, AF patients with impaired renal function (eGFR*** <50 mL) can consider dabigatran up to 150 mg with regards to efficacy (in terms of reduction in stroke rates), said Chan. [N Engl J Med 2009;361:1139-1151] However, in terms of safety outcome, apixaban can be considered in these patients as previous finding has shown a greater extent of reduction in major bleeding risk with apixaban vs warfarin. [N Engl J Med 2011;365:981-992]

“NOACs can [also] be used in patients with mild or moderate liver impairment (Child-Pugh categories A and B), with no dose reduction required for any of the NOAC in AF patients with Child-Pugh category A impairment,” said Chan. “NOACs are not recommended for those in Child-Pugh category C.” [Eur Heart J 2018;39:1330-1393]

One should also consider drug-drug interactions of NOACs with other medications a patient is taking, advised Chan. For example, in AF patients who are also taking HIV protease inhibitor or anti-epileptic drugs (such as carbamazepine, phenobarbital, phenytoin), all NOACs are contraindicated. [J Formos Med Assoc 2016;115:893-952; J Arrhythm 2017;33:345-367]

When to stop and restart?

“Renal function and surgical factors [ie, bleeding risk for surgery] help to determine when to discontinue and restart a NOAC for elective surgery,” said Chan.

According to the APHRS, TSOC, and THRS# guidelines, AF patients with normal renal function can stop any of the NOAC ≥24 hours before an elective surgical intervention classified to be of low bleeding risk and ≥48 hours for high bleeding risk. However, in AF patients with renal impairment, a longer duration of NOAC discontinuation before an elective surgery needs to be considered for those on dabigatran. [J Formos Med Assoc 2016;115:893-952; J Arrhythm 2017;33:345-367]

“Heparin/LMWH## bridging is generally not necessary for NOACs. NOAC is uninterrupted when performing AF catheter ablation,” said Chan.

“Generally, NOACs can be restarted 24 hours post-procedure with low-bleeding risk, and 48–72 hours post-procedure with high-bleeding risk. For procedure in which immediate and complete haemostasis can be achieved (eg, pacemaker implantations and skin surgery), NOACs can be resumed 6–8 hours after the interventions,” he added, citing recommendations from the ESC, APHRS, TSOC, and THRS guidelines. [Eur Heart J 2018;39:1330-1393; J Formos Med Assoc 2016;115:893-952; J Arrhythm 2017;33:345-367]

Bleeding management

“For non-life-threatening major bleeding, reversal agent is generally not necessary … these can be managed with supporting care,” said Chan. [Eur Heart J 2018;39:1330-1393]

For life-threatening major bleeding, idarucizumab is the specific reversal agent for dabigatran while andexanet alpha can be used to reverse factor Xa inhibitors such as apixaban, rivaroxaban, and edoxaban, he stated.

 

 

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