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Contrary to some claims, people in the U.S may not be substituting cannabis for opioids, according to new research at Columbia University Mailman School of Public Health. The study examined the direction and strength of association between cannabis and opioid use over 90 consecutive days among adults who used non-medical opioids. The findings showed that opioid use was at least as prevalent on days when cannabis was used as on days when it was not, and that this was irrespective whether participants were experiencing pain or not. The study, published in the scientific journal Addiction, is among the first to test opioid substitution directly.

The study, which compared the probability of non-medical opioid use on days when cannabis was used with days when cannabis was not used, included 13,271 days of observation among 211 participants from the greater New York area. The participants were predominantly male, urban, unemployed, unmarried, and had a high prevalence of substance misuse and pain.

"Our results suggest that cannabis seldom serves as a substitute for non-medical opioids among opioid-using adults, even among those who report experiencing moderate or more severe pain," said Deborah Hasin, professor of epidemiology at Columbia Mailman School and a professor in the Department of Psychiatry at Columbia University Irving Medical Center. "In other words, our study suggests that cannabis is not an effective way to limit non-medical opioid use."

In 2017, there were over 2 million people with opioid use disorder and over 70,000 opioid-related deaths in the US. Illicit opioid use, including non-medical use of prescription opioids, synthetic opioids and heroin, are the primary cause of overdose deaths among U.S. adults. Understanding how cannabis may change non-medical opioid use is critical to informing discussions around cannabis-based interventions for addressing the opioid crisis.

In a nationwide study, UCLA researchers have found that health inequities can be measured in children as young as 5 years old. The research, published in Health Affairs, contributes to a growing body of literature finding that children of color who are also poor face greater health inequities than their white counterparts.

Researchers trained kindergarten teachers in 98 school districts across the United States to administer the Early Development Instrument (EDI), a measure of children's physical, social, emotional and language development.

The assessment was administered to more than 185,000 kindergarteners from 2010 to 2017. After analyzing and correlating the results according to where the children lived, the investigators found that 30 percent of children in the lowest-income neighborhoods were vulnerable in one or more domains of health development, compared to 17 percent of children in higher-income settings.

The researchers also found that income-related differences in developmental vulnerability varied substantially among children from different ethnic and racial groups. Black children, for example, were at highest risk, followed by Latina/o children. Asian children were at lowest risk. The differences in developmental vulnerability between Black children and white children were most pronounced at the higher socioeconomic levels and tended to narrow for Black and white children from lower-income neighborhoods. Such early disparities can have a profound influence on children's long-term development, leading to higher rates of chronic conditions such as diabetes, heart disease, drug use, mental health disorders and dementia as adults.

"Our findings underscore the pronounced racialized disparities for young children," says lead study author Neal Halfon, MD, director of the Center for Healthier Children, Families and Communities at UCLA. "Many other studies have highlighted patterns of income and racial inequality in health and educational outcomes. What this study shows is that these patterns of inequality are clearly evident and measurable before kids start school." Halfon also is a professor of pediatrics, public health and public policy in the David Geffen School of Medicine at UCLA, the Fielding School of Public Health and the Luskin School of Public Affairs.

The report also underscores the value of understanding child-developmental inequities at the most micro levels. "Because the EDI is reported at and linked to Census-tract-level indices of neighborhood risk, this measurement tool helps cities and local grassroots efforts develop targeted supports and services to address racialized disparities," adds co-author Lisa Stanley, project director for Transforming Early Childhood Community Systems at the UCLA Center for Healthier Children, Families, and Communities.

The EDI tool was developed by Dr. Dan Offord and Dr. Magdalena Janus at the Offord Centre for Child Studies at McMaster University in Ontario, Canada, and has been internationally validated, and used widely in Canada, Australia and other nations. The EDI was first piloted in 2009 by UCLA in Santa Ana, in partnership with First Five Orange County. Over the past 10 years, UCLA had enabled city and school district leaders in over 85 communities, spanning 18 states, to assess the health, development and well-being of more than 350,000 kindergartners across the U.S.

UCLA researchers make this data accessible to local communities to help them develop their own initiatives to address the root causes of inequalities. "These findings not only highlight the equity challenges we face but also reveal the truly inequitable design of all the systems responsible for ensuring that children thrive," says co-author Efren Aguilar, geographic information systems lead at the Center for Healthier Children, Families, and Communities at UCLA. "Only by addressing the historical exploitation and exclusion of marginalized communities, can we begin to repair the pains and exploitative practices of the past and redesign our community systems so that all children thrive."

Pregnant women with severe or critical COVID-19 and their unborn infants face increased health risks before and after delivery, a Rutgers study finds.

Meanwhile, the study, published in the American Journal of Obstetrics and Gynecology, also found that pregnant women with mild cases of coronavirus disease 2019 had similar outcomes compared to those who were uninfected.

"We know that women are more susceptible to some viral respiratory infections during pregnancy, but needed to understand how the severity of this novel coronavirus might affect maternal and neonatal health," said lead author Justin Brandt, an assistant professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine at Rutgers Robert Wood Johnson Medical School. "A major advantage of our study was the matched case-control design that allowed comparisons of pregnant women with COVID-19 to uninfected pregnant controls," he said.

The researchers looked at 183 pregnant women who delivered between 16 and 41 weeks of gestation between March to June 2020, comparing 61 who were diagnosed with COVID-19 and 122 who were uninfected. Among the positive cases, 54 were mild, six were severe and one was critical.

They found that Black and Hispanic women, women who were obese, women over 35 and those with medical conditions such as diabetes and high blood pressure were at greatest risk of having severe or critical COVID-19. These women were at risk of delivering early, having preeclampsia, requiring supplemental oxygen or mechanical ventilation, and extended hospital stays.

Neonatal risks, which were largely driven by premature births, included respiratory distress, bleeding in the brain, bowel inflammation, low Apgar scores, an abnormal fetal heart rate despite interventions to increase oxygen and blood flow to the placenta, and higher admissions to the NICU.

More than 60 percent of the women with a mild case of COVID-19 were asymptomatic; the rest had a cough, fever and muscle aches.

All the women with severe and critical COVID-19 required supplemental oxygen, and some received other interventions such as hydroxychloroquine in the early stages and steroids toward the end of the study.

In a clinical trial testing two different forms of "nudging," statin prescriptions at the right dosages increased significantly among patients with heart disease when doctors had to actively choose whether or not to prescribe the medications, which are used to lower cholesterol. However, for patients who were just deemed at-risk for heart disease, neither an active choice nudge nor a more passive one affected prescribing rates. The results were published today in JAMA Cardiology.

Researchers in the Perelman School of Medicine at the University of Pennsylvania (Penn Medicine) randomly embedded one of two different types of nudges into patients' electronic health records (EHR) a "passive choice" notification that doctors needed to navigate to, or an "active choice" pop-up prompting a prescription for a certain dose of statins that doctors needed to accept or dismiss. Each prompt was tailored to flag patients with atherosclerotic cardiovascular disease or those who were at-risk for it based on a clinical score. Each nudge also called for an optimal dosage based on the patients' information.

"Active choice prompts are used commonly in electronic health records, but they often are not rigorously tested head-to-head against other approaches," said the study's senior author, Mitesh Patel, MD, the director of Penn Medicine's Nudge Unit. "By systematically testing these interventions we can build upon the approaches that do work and turn off the ones that don't."

The clinical trial included 82 cardiologists and more than 11,000 of their patients. Doctors and their patients were randomly split into three groups: one using the active choice, one with the passive choice, and one without either nudge. The last served as the control group for the study, which lasted for six months.

Upon examining the data, the researchers saw a 4 percentage point increase in optimal statin prescribing in patients already diagnosed with atherosclerotic cardiovascular disease, if their doctors were in the active choice arm of the study.

"Active choice prompts led to small increases in prescribing the right dose of statins for patients at highest risk - those who already had atherosclerotic heart disease," said first author Srinath Adusumalli, MD, an assistant professor of Cardiovascular Medicine. "These are the types of patients who stand to benefit the most from statin therapy with regard to reduction in major adverse cardiovascular events, like a heart attack, and mortality."

When it came to patients judged to be at-risk for atherosclerotic heart disease but who did not yet have it, there were no significant differences in prescription rates, no matter what arm of the study patients were in. Analysis showed that 42.6 percent of patients in the control group, 40.6 percent in the passive choice group, and 44.5 in the active choice group received statin prescriptions in the optimal amount. Similarly, when examining whether the patients with heart disease received any statin prescriptions at all, at an optimal level or not, there was little difference there as well: 71.6 percent of the control group, 70.9 percent in passive choice, and 73.1 in active choice.

Built into the study was a survey for the cardiologists to give a clearer picture for why the data turned out the way it did. Tellingly, only about a quarter of the doctors from the passive choice arm even remembered seeing a statin prescribing alert, while every single responding doctor from the active choice group remembered seeing theirs. But even then, the cardiologists expressed some misgivings. Some wanted ready access to the information that factored into the prompt for statin prescription, while others knew their patients were already on statins and felt they were getting a message in error--when, in reality, their message was prompting them to prescribe a different dosage.

"Feedback from clinicians revealed that small design changes could have improved the impact of the alerts by making clear why a statin, and a specific statin dose, was indicated within the context of the alert," said Adusumalli.

Moving forward, the researchers hope to build upon the result of this research.

"We learned a significant amount about the way settings in EHR alerts behave, which will allow us to more finely tune decision support interventions going forward," Adusumalli said. "Additionally, we developed a framework for measuring the impact of these alerts using EHR data, which can be used for future studies."

Among those future studies is one launching later this month which also focuses on statin prescribing, this time in a primary care setting. Patel and his team are designing that study to focus both on clinician and patient nudges to motivate statin prescribing.

Several predictions made by experts ahead of the UK-wide lockdown in March are confirmed in a detailed re-analysis of the data published by The BMJ today.

A report produced by researchers from Imperial College London was reported to be the main evidence behind lockdown decisions taken by the UK government in March 2020.

The Imperial College report was based on a detailed model of interactions between people in the UK. The model predicted how the virus would spread, how the NHS would be affected, and how many would die in different scenarios.

Now researchers at the University of Edinburgh have re-analysed the results from this report using updated data in a detailed simulation model ("CovidSim").

The new analysis confirms that information used by the SAGE advisory committee to advise on lockdown showed that school closures would result in more overall covid-19 deaths than no school closures, and that social distancing in the over 70s only would be more effective in reducing covid-19 deaths than general social distancing.

It also confirms that none of the proposed mitigation strategies modelled in the original report, apart from effective implementation of a vaccine, would reduce the predicted total number of covid-19 deaths in the UK below 200,000, more than three times the current number.

Their analysis suggests that the interventions implemented in March gave the best possible outcome in terms of reducing peak demand for intensive care unit (ICU) beds, but were also known to prolong the epidemic, resulting in more long-term covid-19 deaths unless an effective vaccination programme is implemented.

It confirms that adding school and university closures to other measures (case isolation, household quarantine, and social distancing in people older than 70) would increase the overall total number of covid-19 deaths compared with no closures.

It supports the projection that while general social distancing would reduce the number of covid-19 cases, it would increase the total number of deaths compared with social distancing of over 70s only. This is because covid-19 related deaths are highly skewed towards older age groups.

Over 97% of covid deaths occur in over 65s, compared with 5% for Spanish 'flu. As such, they conclude that mitigating a covid-19 epidemic "requires a different strategy from an influenza epidemic, with more focus on shielding elderly and vulnerable people."

The model clearly predicts a second wave, initially growing more slowly, but becoming larger than the first unless interventions are reimplemented. The researchers stress that currently available data are insufficient to reliably predict exactly where localised spikes will occur.

Nevertheless, they point out that UK policy advice has concentrated on reducing the total number of covid-19 cases, not the number of deaths. Strategies which minimise deaths "involve focusing stricter social distancing measures on care homes where people are likely to die rather than schools where they are not."

In all mitigation scenarios, epidemics modelled using CovidSim eventually finish with widespread infection and immunity, and the final death toll depends primarily on the age distribution of those infected and not the total number, they write.

Reston, VA--A new intraoperative imaging technique, Cerenkov luminescence imaging (CLI), can accurately assess surgical margins during radical prostatectomy, according to a first-in-human research published in the October issue of the Journal of Nuclear Medicine. The feasibility study showed that 68Ga-PSMA CLI can image the entire excised prostate specimen's surface to detect prostate cancer tissue at the resection margin.

Radical prostatectomy is one of the primary treatment options for men with localized prostate cancer. The goal of a radical prostatectomy is to completely resect the prostate without positive surgical margins. Incomplete removal of the cancer tissue during radical prostatectomy is often associated with poorer patient outcomes, including increased likelihood of recurrence and prostate cancer-related mortality.

Prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET) has emerged as an accurate tool to detect prostate cancer both in primary staging and at time of biochemical recurrence. As PET imaging agents also emit optical photons via a phenomenon called Cerenkov luminescence, researchers sought to evaluate the feasibility and diagnostic accuracy of CLI in detecting prostate cancer.

"Intraoperative radioguidance with CLI may help surgeons in the detection of extracapsular extension, positive surgical margins and lymph node metastases with the aim of increasing surgical precision," stated Christopher Darr, PhD, resident at the Department of Urology of the University Medical Center Essen in Essen, Germany. "The intraoperative use of CLI would allow the examination of the entire prostate surface and provide the surgeon with real-time feedback on the resection margins."

The single-center study included 10 patients with high-risk primary prostate cancer. 68Ga-PSMA PET scans were performed followed by radical prostatectomy and intraoperative CLI of the excised prostate. CLI images were analyzed postoperatively to determine regions of interest based on signal intensity, and tumor-to-background ratios were calculated. CLI tumor margin assessment was performed by analyzing elevated signals at the surface of the intact prostate images. To determine accuracy, tumor margin status as detected by CLI was compared to postoperative histopathology.

Tumor cells were successfully detected on the incised prostate CLI images and confirmed by histopathology. Three patients had positive surgical margins, and in two of the patients, elevated signal levels enabled correct identification on CLI. Overall, 25 out of 35 CLI regions of interest proved to visualize tumor signaling according to standard histopathology.

Boris A. Hadaschik, PhD, director of the Clinic for Urology of the University Medical Center Essen, added, "Radical prostatectomy could achieve significantly higher accuracy and oncological safety, especially in patients with high-risk prostate cancer, through the intraoperative use of radioligands that specifically detect prostate cancer cells. In the future, a targeted resection of lymph node metastases could also be performed in this way. This new imaging combines urologists and nuclear medicine specialists in the local treatment of patients with prostate cancer."

The authors of "Intraoperative 68Gallium-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy - A Feasibility Study" include Christopher Darr, Nina N. Harke, Jan Philipp Radtke, Leubet Yirga, Claudia Kesch and Boris A. Hadaschik, Department of Urology, University Hospital Essen, Essen, Germany; Maarten R. Grootendorst, Clinical Research, Lightpoint Medical Ltd., Chesham, United Kingdom; Wolfgang P. Fendler, Peter Fragoso Costa, Christopher Rischpler, Christine Praus, Ken Herrmann and Ina Binse; Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Johannes Haubold, Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany; and Henning Reis and Thomas Hager, Institute of Pathology, University of Duisburg-Essen, Essen, Germany.

This study was made available online in February 2020 ahead of final publication in print in October 2020.

Kanazawa, Japan - The compound thymoquinone (TQ) selectively kills prostate cancer cells at advanced stages, according to a new study published in Oncogene. Led by researchers at Kanazawa University, the study reports that prostate cancer cells with a deletion of the SUCLA2 gene can be therapeutically targeted. SUCLA2-deficient prostate cancers represent a significant fraction of those resistant to hormone therapy or metastatic, and a new therapeutic option for this disease would have immense benefits for patients.

Hormone therapy is often chosen for the treatment of metastatic prostate cancer but nearly half of patients develop resistance to the treatment in as little as 2 years. A mutation in RB1, a tumor suppressor gene that keeps cell growth under control, has been pegged as a particularly strong driver of treatment resistance and predicts poor outcome in patients.

"Mutations in tumor suppressor genes are enough to induce initiation and malignant progression of prostate cancer, but so far we haven't been able to directly target these mutations with drugs to treat prostate cancer," says the lead author Susumu Kohno. "We wanted to find a genetic aberration associated with that of a tumor suppressor gene which we could target therapeutically."

In the genome, SUCLA2 neighbors RB1. An analysis of prostate cancer cells showed that cells with a RB1 deletion were also missing SUCLA2, pairing up the SUCLA2 deletion with the RB1 deletion present in advanced stage prostate cancer. Kohno and colleagues analyzed prostate cancer tissue and found that 11% of cases were missing both SUCLA2 and RB1.

The researchers screened compounds to identify drugs that would selectively kill cells with a SUCLA2 deletion. Out of around 2,000 compounds, TQ emerged as a hit compound. TQ already has known anti-cancer effects and was shown to be safe in a phase I clinical trial. Kohno and colleagues applied the TQ treatment to a mouse model of SUCLA2-deficient prostate cancer and TQ selectively suppressed tumor growth.

"These findings show that TQ treatment could be an effective therapy for treating prostate cancer cells that harbor SUCLA2 deficiency" says the senior author Chiaki Takahashi.

In a search of genetic databases from patients with prostate cancer, the researchers found that the frequency of SUCLA2 loss was almost perfectly aligned with RB1 loss at every disease stage--meaning the SUCLA2 deletion could identify people with prostate cancer needing advanced therapy.

Finding this drug-targetable vulnerability opens a crack in the barrier of treatment resistance for prostate cancer. More work needs to be done to improve efficacy of TQ and identify patients that would benefit from this type of treatment, but the compound provides a promising route for new treatment options for advanced prostate cancer.

(Jena, Germany) At the latest since the Nobel Prize in Physics was awarded for research on graphene in 2010, 2D materials - nanosheets with atomic thickness - have been a hot topic in science.

This significant interest is due to their outstanding properties, which have enormous potential for a wide variety of applications. For instance, combined with optical fibres, 2D materials can enable novel applications in the areas of sensors, non-linear optics, and quantum technologies. However, combining these two components has so far been very laborious. Typically, the atomically thin layers had to be produced separately before being transferred by hand onto the optical fibre. Together with Australian colleagues, Jena researchers have now succeeded for the first time in growing 2D materials directly on optical fibres. This approach significantly facilitates manufacturing of such hybrids. The results of the study were reported recently in the renowned journal on materials science Advanced Materials.

Growth through a technologically relevant procedure

"We integrated transition metal dichalcogenides - a 2D material with excellent optical and photonic properties, which, for example, interacts strongly with light - into specially developed glass fibres," explains Dr Falk Eilenberger of the University of Jena and the Fraunhofer Institute for Applied Optics and Precision Engineering (IOF) in Germany. "Unlike in the past, we did not apply the half-nanometre-thick sheet manually, but grew it directly on the fibre," says Eilenberger, a specialist in the field of nanophotonics. "This improvement means that the 2D material can be integrated into the fibre more easily and on a large scale. We were also able to show that the light in the glass fibre strongly interacts with its coating." The step to a practical application for the intelligent nanomaterial thus created is no longer very far away.

The success has been achieved thanks to a growth process developed at the Institute of Physical Chemistry of the University of Jena, which overcomes previous hurdles. "By analysing and controlling the growth parameters, we identified the conditions at which the 2D material can directly grow in the fibres," says Jena 2D materials expert Prof. Andrey Turchanin, explaining the method based on chemical vapour deposition (CVD) techniques. Among other things, a temperature of over 700 degrees Celsius is necessary for the 2D material growth.

Hybrid material platform

Despite this high temperature, the optical fibres can be used for the direct CVD growth: "The pure quartz glass that serves as the substrate withstands the high temperatures extremely well. It is heat-resistant up to 2,000 degrees Celsius," says Prof. Markus A. Schmidt of the Leibniz Institute of Photonic Technology, who developed the fibres. "Their small diameter and flexibility enable a variety of applications," adds Schmidt, who also holds an endowed professorship for fibre optics at the University of Jena.

The combination of 2D material and glass fibre has thus created an intelligent material platform that combines the best of both worlds. "Due to the functionalisation of the glass fibre with the 2D material, the interaction length between light and material has now been significantly increased," says Dr Antony George, who is developing the manufacturing method for the novel 2D materials together with Turchanin.

Sensors and non-linear light converters

The team envisages potential applications for the newly developed materials system in two particular areas. Firstly, the materials combination is very promising for sensor technology. It could be used, for example, to detect low concentrations of gases. To this end, a green light sent through the fibre picks up information from the environment at the fibre areas functionalised with the 2D material. As external influences change the fluorescent properties of the 2D material, the light changes colour and returns to a measuring device as red light. Since the fibres are very fine, sensors based on this technology might also be suitable for applications in biotechnology or medicine.

Secondly, such a system could also be used as a non-linear light converter. Due to its non-linear properties, the hybrid optical fibre can be employed to convert a monochromatic laser light into white light for spectroscopy applications in biology and chemistry. The Jena researchers also envisage applications in the areas of quantum electronics and quantum communication.

Exceptional interdisciplinary cooperation

The scientists involved in this development emphasise that the success of the project was primarily due to the exceptional interdisciplinary cooperation between various research institutes in Jena. Based on the Thuringian research group "2D-Sens" and the Collaborative Research Centre "Nonlinear Optics down to Atomic Scales" of Friedrich Schiller University, experts from the Institute of Applied Physics and Institute of Physical Chemistry of the University of Jena; the University's Abbe Center of Photonics; the Fraunhofer Institute for Applied Optics and Precision Engineering IOF; and the Leibniz Institute of Photonic Technology are collaborating on this research, together with colleagues in Australia.

"We have brought diverse expertise to this project and we are delighted with the results achieved," says Eilenberger. "We are convinced that the technology we have developed will further strengthen the state of Thuringia as an industrial centre with its focus on photonics and optoelectronics," adds Turchanin. A patent application for the interdisciplinary team's invention has recently been filed.

86% of UK residents who tested positive for COVID-19 during lockdown did not have the specific virus symptoms (cough, and/or fever, and/or loss of taste/smell), finds a new study by UCL researchers. The authors say a more widespread testing programme is needed to catch 'silent' transmission and reduce future outbreaks.

The paper, which is published today in Clinical Epidemiology, used data from the Office for National Statistics Coronavirus (COVID-19) Infection Survey pilot study - a large population based survey looking at the association between Covid-19 symptoms and Covid-19 test results.

The research included data from a representative population sample of 36,061 people who were tested between 26 April and the 27 June 2020 and provided information of whether they had any symptoms.

The data showed 115 (0.32%) people out of the total 36,061 people in the pilot study had a positive test result. Focusing on those with COVID-19 specific symptoms (cough, and/or fever, and/or loss of taste/smell), there were 158 (0.43%) with such symptoms on the day of the test.

Of the 115 with a positive result, there were 16 (13.9%) reporting symptoms and in contrast, 99 (86.1%) did not report any specific symptoms on the day of the test.

The study also includes data on people reporting a wider range of symptoms such as fatigue and shortness of breath. Of the sample who tested positive, 27 (23.5%) were symptomatic and 88 (76.5%) were asymptomatic on the day of the test.

The authors say the findings have significant implications for ongoing and future testing programmes.

Professor Irene Petersen (UCL Epidemiology & Health Care) explained: "The fact that so many people who tested positive were asymptomatic on the day of a positive test result calls for a change to future testing strategies. More widespread testing will help to capture "silent" transmission and potentially prevent future outbreaks.

"Future testing programmes should involve frequent testing of a wider group of individuals, not just symptomatic cases, especially in high-risk settings or places where many people work or live close together such as meat factories or university halls. In the case of university halls, it may be particularly relevant to test all students before they go home for Christmas.

"Pooled testing could be one way to help implement a widespread testing strategy where several tests are pooled together in one analysis to save time and resources on individual testing. This strategy would be an efficient way to test when the overall prevalence is low as negative pooled samples can quickly show a large group of people are not infectious."

The authors did note that several studies have highlighted a lower proportion of individuals testing positive for Covid-19 are asymptomatic, however, the prevalence of asymptomatic cases varies substantially, possibly due to the sampling and the settings of the study. For example, the study references how among 262 confirmed cases admitted to hospitals in Beijing 13 (5%) were asymptomatic. In contrast, reports from a small village in Italy suggest that up to 40-75% were asymptomatic. A study of 13,000 residents in Iceland found 43 out of 100 with a positive Covid-19 test were asymptomatic.

*** Reposted with permission of UCL ***

PLYMOUTH MEETING, PA [October 7, 2020] -- New research in the October 2020 issue of JNCCN--Journal of the National Comprehensive Cancer Network finds the rate of bone mineral density (BMD) testing in people with prostate cancer undergoing androgen deprivation therapy (ADT) has improved in recent years, but remains low. ADT is considered a cornerstone of treatment for high-risk or advanced prostate cancer and is used in nearly half of all prostate cancer patients. However, it can result in preventable side effects like osteoporosis and bone fractures. Despite clinical recommendations that call for BMD testing in ADT recipients, only 23.4% of the patients studied received testing in 2015. That is up from just 4.1% in 2000.

"Although we expected BMD testing rates to be fairly low given the prior literature, we were somewhat surprised that they didn't go up more in recent years," said senior author Alice Dragomir, MSc, PhD, McGill University in Montreal, Quebec who worked with Armen G. Aprikian, MD, Marie Vanhuyse, MD, MSc, and Jason Hu, MSc, also from McGill. "Bone density testing helps doctors evaluate fracture risk and identify which patients would benefit from additional monitoring and interventions like lifestyle changes and/or medications. Perhaps the low rate of testing will change in the coming years thanks to renewed attention on bone health issues in the clinical oncology community. It may be interesting to re-examine BMD testing rates in a few years."

The researchers used the Régie de l'assurance maladie du Québec (RAMQ)--a Canadian public healthcare administrative database--to review patient demographic and billing information for 22,033 people with prostate cancer who began receiving ADT between January 2000 and December 2015. Of those, 3,910 (17.8%) received a BMD test at any point during the study period. The largest increase in testing rates occurred around 2003 and 2004, coinciding with the publication of several articles and guidelines recommending BMD screening in this set of patients. People age 80 and older, with metastatic disease, or living in rural areas were less likely to be screened.

"While we have known for many years that the androgen deprivation therapies used to treat prostate cancer carry an increased risk of osteoporosis, this study identifies specific populations that might not undergo recommended screening prior to hormone-based therapies," commented Joshua M. Lang, MD MS, Associate Professor of Medicine, Carbone Cancer Center, University of Wisconsin. "These populations are especially vulnerable, including our older patients located in rural areas of the country."

Dr. Lang, a Member NCCN Guidelines® Panel for Prostate Cancer, who was not involved in this research, continued: "The importance of screening is even more critical given the availability of medications that can slow or reverse osteoporosis. The NCCN Guidelines for Prostate Cancer specifically recommend screening for these patients and this report demonstrates that more work is needed to advocate for and implement screening of vulnerable patient populations."

Oral cancer is more likely to spread in patients experiencing high levels of pain, according to a team of researchers at New York University (NYU) College of Dentistry that found genetic and cellular clues as to why metastatic oral cancers are so painful.

The findings--which appear in Scientific Reports, a journal published by Nature--may ultimately be used to alleviate oral cancer pain and refine surgical decision making when treating oral cancer.

Oral cancer can cause severe pain during everyday activities, including talking and eating. Previous research by Brian L. Schmidt, DDS, MD, PhD, director of the NYU Oral Cancer Center and one of the study's authors, suggests that patients with metastatic oral cancer--cancer that spreads beyond the mouth--experience more pain than those whose cancer has not spread. The new study helps researchers understand why.

When oral cancer metastasizes, spreading to lymph nodes in the neck, a patient's chance of survival is cut by half. However, it's often unclear through imaging and physical assessment if oral cancer has spread, leaving surgeons struggling with whether to preemptively remove lymph nodes--an invasive procedure termed prophylactic neck dissection--during surgery to remove the oral cancer. While most oral cancer surgeries include a prophylactic neck dissection, research shows that up to 70 percent are unnecessary.

"Clinicians and researchers are keen to define a biomarker that accurately predicts metastasis," said Aditi Bhattacharya, PhD, an assistant professor in the Department of Oral and Maxillofacial Surgery at NYU College of Dentistry, an investigator at NYU Bluestone Center for Clinical Research, and the study's lead author. "Given that patients with metastatic oral cancer experience more pain, we thought that a patient's level of pain might help predict metastasis. A surgeon could then use this knowledge to only remove lymph nodes in patients with cancers that are most likely to metastasize."

In their study in Scientific Reports, the researchers first documented the pain experienced by 72 oral cancer patients before surgery, using an oral cancer pain questionnaire developed by the investigators. While most patients reported some pain, those who suffered with the most pain were more likely to have cancer that spread to lymph nodes in the neck. This observation suggests that patients with less pain are at low risk of metastasis, and will rarely benefit from a neck dissection.

To begin to understand why metastatic cancers are more painful, the investigators looked for differences in gene expression between metastatic cancers from patients with high levels of pain compared to non-metastatic cancers from patients not experiencing pain. Cancer pain is attributed to the release of mediators from cancers that sensitize nerves near the cancer. Forty genes were identified that were more highly expressed in painful metastatic cancers, suggesting that they promote metastasis and mediate cancer pain. Many of these genes are found in exosomes, small vesicles that break away from a cell and can be taken up by other cells--revealing a potential mechanism for how cancers communicate with nerves.

"I have been investigating the underlying cause of oral cancer pain for two decades. This is the first time that we have demonstrated a correlation between a patient's pain and the clinical behavior of the cancer," said Schmidt, who is also the director of the NYU Bluestone Center for Clinical Research and professor in the Department of Oral and Maxillofacial Surgery at NYU College of Dentistry.

Next, the team undertook laboratory experiments to study exosomes found in the extracellular fluid of oral cancer cells grown in the lab. When this extracellular fluid was injected into animal models, it produced pain, but when the cancer-derived exosomes in the fluid were removed, it did not cause pain. This suggests that exosomes from cancer may be responsible for oral cancer pain.

Now, with a deeper understanding of why metastatic oral cancers are painful, the researchers point to several potential clinical applications for their research, including a biomarker for oral cancer metastasis to help with surgical decision making and future testing options.

"While we need to undertake a follow-up study, our current data reveal that a patient's pain intensity score works as well as the current method--depth of invasion, or how deeply a tumor has invaded nearby tissue--as an index to predict metastasis," said Bhattacharya.

"The identified genes are targets for therapy aimed at stopping pain and cancer. In addition, exosomes shed from cancers can be detected in saliva, blood, and urine, offering the potential for an objective molecular test to diagnose risk of metastasis," said Donna Albertson, PhD, professor in the Department of Oral and Maxillofacial Surgery at NYU College of Dentistry, an investigator at NYU Bluestone Center for Clinical Research, and the study's corresponding author.

From Covid-19- to COVID-20 - the evolution of COVID-19 in terms of its overall medical and socio-economic impacts is examine through a comparison of cases and deaths in the two successive waves we have experienced. Peak comparisons show that although the number of cases has doubled the number of deaths has decreased by 50 percent with case mortality decreasing by a factor of four. In addition, where at the beginning of the pandemic interventions were aimed at containment and mitigation of a single disease entity, today we are addressing concurrent co-morbidities which are largely attributable to social determinants of health and the collateral morbidities resulting from our interventions. Overall, we are currently dealing more with a "syndemic" and a name change should be considered for many reasons.

A brief commentary on how the above needs to be considered as we draw closer to having a vaccine for which an equitable allocation plan must be developed. This is a pressing need as projections indicate that initially only a limited supply will be available.

WINSTON-SALEM, N.C. - Oct. 7, 2020 - Is this person with chest pain having a heart attack? That's a question EMTs frequently confront when responding to 911 calls.

A study conducted at Wake Forest Baptist Health shows that on-scene use of a new protocol and advanced diagnostic equipment can help paramedics better identify patients at high risk for adverse cardiac events. This approach could help paramedics determine the hospital best equipped to treat those people.

The study is published in the Oct. 7 edition of the journal PLOS One.

"While only 7% of people who make 911 calls due to chest pain are having a heart attack, paramedics must be able to make the correct decisions using objective measurements to identify another 20% that need specific cardiac care," said principal investigator Jason Stopyra, M.D., associate professor of emergency medicine at Wake Forest Baptist. "High-risk patients are often transported to facilities that don't have interventional cardiology capabilities, and later have to be transferred to another hospital for urgent procedures."

Currently, pre-hospital assessment of patients with chest pain focuses on looking for signs of a heart attack with a portable electrocardiogram (EKG). For the 93% of people who aren't having a discernible heart attack, paramedics rely on their experience and patient preference to decide what hospital to go to rather than on an objective risk assessment of the level of cardiac care needed, Stopyra said.

In the prospective study that took place from December 2016 to January 2018, the Wake Forest Baptist team worked with EMS agencies in three rural and urban counties in North Carolina to evaluate the use of a pre-hospital modified HEART Pathway (PHMP) to identify both high- and low-risk patients who called 911 with chest pains.

The HEART Pathway, which was developed by senior author Simon Mahler, M.D., professor of emergency medicine at Wake Forest Baptist, has been used in emergency departments for 8 years, Stopyra said.

The research team trained more than 150 paramedics to use a hand-held i-STAT, a modified version of a hospital device that measures patients' blood for levels of troponin, a cardiac enzyme in the blood that can help detect heart injury. In addition, paramedics were trained to ask patients questions about their chest pain, age, risk factors and medical history to determine what's known as a HEART risk score.

The patients in the study were stratified into three groups: high risk based on elevated troponin, low risk based on a HEART score of less than 4 with negative troponin, or moderate risk based on a HEART score of 4 or higher with negative troponin. Major adverse cardiac events (MACE) were determined by reviewing records after 30 days. The sensitivity and negative predictive values for MACE at 30 days also were calculated.

The study showed that a prospective application of the prehospital modified HEART Pathway, including measurement of troponin levels completed by paramedics during ambulance transport, achieved high sensitivity, specificity and negative predictive value for 30-day MACE. A high-risk assessment resulted in a specificity of 96% and positive predictive value of 61%. A low-risk assessment was associated with a negative predictive value of 94% and a specificity of 90%.

"This teamwork between emergency medicine researchers and our local EMS agencies is so valuable," Stopyra said. "Our study showed that paramedics have the professional clinical ability to effectively assess patients' cardiac risk using this protocol before the patient ever gets to the hospital. We hope this approach will allow patients to receive faster, more focused care."

Multiparametric magnetic resonance imaging of the prostate (mpMRIp) is a promising tool for diagnosing prostate cancer, and prior to its availability, detection relied on clinical exams and prostate specific antigen screening.

In a study published in BJU International, investigators found that the availability of mpMRIp in Australia since 2012 has correlated with significantly reduced numbers of prostate biopsies by an average of 354.7 per month, with an estimated annual saving of $13.2 million.

"Our research shows publically funded prostate MRI not only represents good policy in terms of health equity, but it also makes sense from a financial perspective," said lead author Thomas Whish-Wilson, BBiomedSc, MD, of St Vincent's Hospital Melbourne and The University of Melbourne, in Australia.

A novel study shows that facemask use does not affect indicators of cognitive performance when the wearers are resting or performing moderate physical work in hot environments. However, wearing a facemask does make it more difficult to breathe when performing moderate physical work in a hot environment. The study is conducted by researchers at the Department of Nutrition, Exercise and Sports, University of Copenhagen in collaboration with the European research consortium 'HEAT-SHIELD'.

Facemasks are mandatory by law in many countries and recommended by the World Health Organization (WHO) to prevent spreading of the COVID-19 virus. However, experts and lay people alike have raised concerns that working with a facemask may aggravate heat stress, thermal discomfort and increase perceived breathlessness (dyspnea) - which eventually could impair cognitive function, concentration and jeopardize occupational safety.

The only measure worsened by wearing a mask was feelings of breathlessness

Now a study shows that facemask usage has lesser consequences on indicators of cognitive performance than expected, when the wearers are resting or performing moderate physical work in normal work-wear in hot environments. This cognitive testing battery consisted of four different math and fine motor skill tasks that were performed in a random order on a computer.

During testing, body temperature and thermal discomfort did increase in both trials, but not to a greater degree while wearing a mask. However, the study also showed that wearing a facemask does make it more difficult to breathe when performing moderate physical work in a hot environment.

Professor in human physiology at University of Copenhagen and coordinator for the HEAT-SHIELD project, Lars Nybo explains:

"We utilized an experimental set-up that mimics tasks completed in many occupations and a protocol previously used to explore how heat-stress and dehydration markedly impair performance in tasks relying on the ability to concentrate and conduct complex motor-cognitive tasks. Although prolonged exposure with facemasks while wearing normal work-wear in a thermal stressing environment elevated thermal discomfort in both trials, it did not lower scores in any of the motor-cognitive tasks that the participants completed. Indeed, the only measure worsened by wearing a mask was feelings of breathlessness."

The researchers therefore conclude that facemasks do not directly impair concentration or indicators of cognitive performance - but they may restrict physically demanding work when the restraint on respiration becomes an issue.

Facts about the study

Eight healthy, active males, aged 27 - 41, participated in the study. On two different occasions, one with a facemask and one with a bare face, participants sat in a climatic chamber regulated at 40°C and 20% humidity for 30 min to become accustomed to the testing conditions. After which they exercised for 45 minutes at an intensity that simulates occupations with manual work.

Physiological, perceptual (thermal comfort and breathlessness) and motor-cognitive measurements (consisting of four different computer tasks relying on math ability and fine motor precision) were taken immediately before and after the bout of exercise.