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7 July 2020: Fifteen years ago a large population study from Denmark found a significantly increased risk of cerebral palsy in infants born as a result of assisted reproduction.(1) Although the absolute risk was small, such studies at this time made cerebral palsy the greatest developmental birth defect risk associated with IVF, and a concern in its overall safety profile.

Now, another large-scale population study, using data from birth cohorts in Denmark, Finland and Sweden, has found that the risk of cerebral palsy in IVF children has declined by more than 50% over the past two decades, largely, say the researchers, because of the reduction in the rate of twin births in IVF. The results of the study are presented today by Dr Anne Lærke Spangmose from Rigshospitalet, Copenhagen University Hospital at the online Annual Meeting of ESHRE.

The study included three national IVF birth cohorts, the first born in the years 1990 to 2010 in Denmark, the second from 1990 to 2010 in Finland, and the third from 1990 to 2014 in Sweden, in total 111,844 children. These births were then stratified into six groups: those born 1990-1993, 1994-1998, 1999-2002, 2003-2006, 2007-2010 and 2011-2014. The national health records of these children were followed up until 2014 for Denmark and Finland and until 2018 for Sweden, and compared with the records of almost 5 million naturally conceived children.

The risk of cerebral palsy was still evident in the results of the study, but the overall prevalence was found to decline consistently over the six time-periods - from 12.5 cases per 1000 live born in 1990-1993 to 3.4 per 1000 in 2011-2014. By contrast, throughout the study period the prevalence dropped only slightly in the children conceived naturally - from 4.3 o 2.1 per 1000. However, among the singletons born from IVF, the prevalence of cerebral palsy decreased from 8.5 per 1000 (1990-1993) to the background population rate of 2.8 (2011-2014), but remained stable for IVF twins at 10.9 per 1000.

The results, says Dr Spangmose, provide strong evidence that reducing the number of twins born after IVF treatment has lowered the risk of cerebral palsy in the IVF population - indeed to a level comparable with those naturally conceived. "Multiple embryo transfer is still standard care in many countries," she warns. "Our findings emphasise that single embryo transfer and singleton births should be encouraged worldwide."(2)

She notes that over the past two decades there has been considerable reduction in twin birth rates after IVF treatment, particularly in Europe and especially the Nordic countries, where IVF twin rates have declined from almost 25% in the 1990s to less than 5% today, not much different from the 2% twin rate seen in the background population of naturally conceived pregnancies.

This reduction in the rate of multiple deliveries in IVF has also brought about a reduction in rates of preterm birth (the greatest obstetric risk of multiplicity), which is also known to increases the risk of cerebral palsy. Thus, while the precise cause of cerebral palsy is largely unknown, preterm birth, low birth weight and twin births are known to be major risk factors. The prevalence of cerebral palsy increases exponentially with the number of fetuses in a pregnancy, thought primarily as a result of an increased risk of preterm birth and low birth weight.

Large registry studies have now shown that the risk of cerebral palsy has virtually disappeared in IVF children born in the Nordic countries after a policy of single embryo transfer was introduced in the early 2000s.

The strength of this study, says Dr Spangmose, lies in its large sample size - with almost 112,000 IVF children born over 24 years in Denmark, Finland, and Sweden. "The inclusion of complete IVF and naturally conceived birth cohorts makes our data robust," she adds, "and has allowed assessment of the true risk of cerebral palsy in IVF and its decline over time."

No matter how close parks are to home, perceptions of park-centered crime may keep New Yorkers from using them.

Researchers at NYU Grossman School of Medicine found that New Yorkers are more likely to exercise in a park if they believe they live very close to it. In turn, they feel less anxious and less depressed the more often they exercise there -- but only if they are not concerned about being safe.

"Living near a park may not be enough to improve your physical and mental well-being through exercise," says study lead author Stephanie Orstad, PhD, a research assistant professor in the Department of Medicine at NYU Langone Health. "If we want to make the most of the abundant health benefits parks offer, then we need to make them not only accessible, but also safe for everyone."

Many past studies have linked the availability of urban green spaces to lower stress levels, weight, and risk of heart disease, the study authors say. Other work has shown that living closer to a park leads to fewer days of anxiety and depression.

The new study, publishing online July 7 in the International Journal of Environmental Research and Public Health, is the latest to suggest that safety concerns could interfere with mental health advantages that park proximity offers New Yorkers, Orstad says.

For the investigation, the researchers analyzed responses from more than 3,800 New Yorkers who completed the city's 2010-2011 Physical Activity and Transit Survey. The assessment tracked the participants' mental health, as well as how long they estimated it would take them to walk from home to the nearest park. The survey also asked participants to estimate how often they used the park to exercise or play sports.

Nearly twice as many people said they exercised in the nearest park "sometimes," or "often" if they lived less than a five-minute walk away, compared with people who estimated living more than 30 minutes away, the researchers say. In addition, people who described themselves as "frequent" park exercisers reported having one fewer day of mental health issues a month compared to people who said they "rarely" or "never" were active in their local park.

However, the closeness of a local park made no difference in park use for those who worried about crime in the area. According to Orstad, improving cleanliness and lighting along paths, offering more park-based programs, and fostering a sense of community could help make parks feel safer. She emphasized that the coronavirus pandemic has highlighted the importance of such communal programs because parks are one of the few remaining places where people can get out of their homes, be active, and connect (from a distance) with their neighbors.

"Investing in park safety offers a practical way of improving physical and mental health in different communities in the city, especially in areas where there are stigmas associated with seeking help," says senior study author Melanie Jay, MD, MS, an associate professor in the Department of Medicine and Population Health at NYU Langone. "It takes advantage of resources that may already exist in the neighborhood."

Next, the research team plans to investigate ways to improve a community's perceptions of its neighborhood park to increase opportunities for exercise and mental health.

Gene coding regions constitute 2% of the human genome. St. Jude Children's Research Hospital scientists have developed a computational tool to identify alterations that drive tumor formation in the remaining 98% of the genome. The method will aid discovery of oncogenes and advances in precision medicine for children and adults with cancer.

The approach, detailed today in the journal Nature Genetics, is called cis-expression or cis-X. Researchers developed the innovative analytic method to identify novel pathogenic variants and oncogenes activated by such variants in regulatory noncoding DNA of patient tumors. Cis-X works by identifying abnormal expression of tumor RNA. Investigators analyzed leukemia and solid tumors and demonstrated the power of the approach.

Noncoding DNA, which does not encode genes, makes up 98% of the human genome. However, growing evidence suggests that more than 80% of the noncoding genome is functional and may regulate gene expression. Population studies have identified variants in noncoding DNA that are associated with an elevated cancer risk. But only a small number of noncoding variants in tumor genomes that contribute to tumor initiation have been discovered. Finding these variants required whole genome sequencing analysis of a large number of tumor samples.

"Cis-X is a fundamental change from existing approaches that require thousands of tumor samples and only identify noncoding variants that happen recurrently," said Jinghui Zhang, Ph.D., St. Jude Department of Computational Biology chair. She and Yu Liu, Ph.D., previously of St. Jude and now of Shanghai Children's Medical Center, are the corresponding authors. Liu is also a first author.

"By using aberrant gene transcription to reveal the function of noncoding variants, we developed cis-X to enable discovery of noncoding variants driving cancer in individual tumor genomes," Zhang said. "Identifying variants that lead to dysregulation of oncogenes can expand the scope of the precision medicine to noncoding regions for identifying therapeutic options to suppress aberrantly activated oncogenes in tumors."

Inspiration

Cis-X was inspired by a 2014 Science paper from Thomas Look, M.D., of Dana-Farber Cancer Institute and his colleagues. Look is a co-author of the current paper. Working in cell lines, Look's team identified noncoding DNA variants responsible for abnormal activation of an oncogene (TAL1) that led to T-cell acute lymphoblastic leukemia (T-ALL). The research prompted Zhang to pursue her long-standing interest in examining variations in expression of each copy of a gene.

Cis-X works by searching for genes with altered expression in two ways. Researchers used whole genome and RNA sequencing to find genes that are expressed on just one chromosome and expressed at aberrantly high levels.

"It can be noisy when analyzing the imbalance of gene expression between alleles," Liu said. "This analysis used a novel mathematical model that makes cis-X a robust tool for discovery."

Cis-X then searches for the cause of the abnormal expression by looking for alterations in regulatory regions of noncoding DNA within a 3D genome architecture. "The approach mimics the way the variants work in living cells," Liu said. The alterations include changes such as chromosomal rearrangements and point mutations.

"Few functional noncoding variations happen at high recurrence, but they are important drivers of tumor initiation and progression," Zhang said. "Without identifying the noncoding variant, we may not have the full picture of what caused the cancer."

Confirmation

Researchers used cis-X to analyze the cancer genomes of 13 T-ALL patients with the data generated as a collaboration between St. Jude and Shanghai Children's Medical Center. The algorithm identified known and novel oncogene-activating noncoding variants as well as a possible new T-ALL oncogene, PRLR.

Investigators also showed the method worked in adult and pediatric solid tumors, including neuroblastoma, a childhood cancer of immature nerve cells. Solid tumors posed a greater analytic challenge. Unlike leukemia, solid tumors often have an abnormal number of chromosomes that are not uniformly distributed in the tumor.

"Cis-X offers a powerful new approach for investigating the functional role of noncoding variants in cancer, which may expand the scope of precision medicine to treat cancer caused by such variants," Zhang said.

Cis-X software is publicly available at no cost to researchers through GitHub software repository, St. Jude Cloud and Zhang's laboratory page.

A new study at Intermountain Primary Children's Hospital in Salt Lake City has found that follow-up appointments for hospitalized children treated for childhood bronchitis are often not necessary, and that switching from mandatory to "as-needed" follow-up care can save families from unnecessary medical care and expense - and may help guide treatment during the COVID-19 pandemic.

The study is published in Monday's issue of JAMA Pediatrics.

Typically, when children leave the hospital after treatment for bronchiolitis (including from RSV), parents are advised to follow up with their pediatrician or family physician within a few days. Researchers asked a simple question: why - especially when most children make a full and quick recovery?

"The majority of children who come into the hospital with bronchiolitis are otherwise healthy. They often don't have underlying, chronic conditions, like adults do," said the study's lead author Eric Coon, MD, MS, from University of Utah Health and Intermountain Primary Children's Hospital. "When they leave the hospital, they are expected to rapidly and completely recover. If we can save these children and their parents from the time and expense of coming in for another medical visit - especially during a pandemic - we should do so."

In the study, researchers randomly assigned 304 children less than two years of age and hospitalized for bronchiolitis to either a scheduled post-hospitalization follow-up visit or an as-needed follow-up visit. Parents in the as-needed follow-up group were told that they did not necessarily need to have a follow-up visit, but should do so if the child was not getting better at home.

Results from the study demonstrated that families in the as-needed follow-up group chose to attend substantially fewer clinic visits, but otherwise experienced equivalent outcomes to families in the scheduled follow-up group.

Specifically, researchers found the two groups were equivalent in terms of parent anxiety, duration of the child's symptoms, parent satisfaction with care, and risk of readmission to the hospital.

"Our findings suggest that we may be inefficiently using our limited healthcare resources for these patients," said Dr. Coon, who is an associate professor of pediatrics at the University of Utah School of Medicine. "This is especially true for families where a follow-up appointment could be another financial stressor on top of a child already being in the hospital."

"We know from prior research that the burden of attending outpatient visits like this disproportionally affects lower income families," he added. "This one follow-up appointment may take more time away from work for parents. Plus, transportation may not be readily accessible. If we can spare families that trip and expense, we want to do that."

Researchers also found that children with scheduled follow-up appointments were more likely to be prescribed antibiotics at that appointment. Antibiotics are not a standard course of treatment for bronchiolitis, which is a viral disease, said Dr. Coon.

"The fact that more kids are getting antibiotics in the scheduled follow-up group suggests that healthcare is begetting healthcare," Dr. Coon said. "Switching to 'as-needed' follow-up visits means fewer opportunities for patients to receive treatments they may not need."

Dr. Coon added that this rationale could potentially apply to other common reasons for children's hospitalizations, like pneumonia, urinary tract infections and gastroenteritis, especially during the COVID-19 pandemic.

One of the consequences of diabetes mellitus, particularly if accompanied by high blood pressure (hypertension), can be a chronic kidney disease (diabetic nephropathy), which can lead to permanent failure of the kidneys (end-stage renal disease). The German Institute for Quality and Efficiency in Health Care (IQWiG) now produced a rapid report to investigate the advantages or disadvantages of a diagnostic-therapeutic strategy using a proteomic analysis of the urine in comparison with a conventional diagnostic-therapeutic strategy to prevent renal disorders by early diagnosis and therapy.

This investigation was prompted by the results of the first randomized trial on an early therapy of patients who, according to the proteomic analysis, had a high risk of a kidney disease. These patients received either treatment with spironolactone or placebo. However, the study results did not suggest any advantages or disadvantages of an early proteomic analysis in combination with the administration of spironolactone for any of the patient-relevant outcomes.

This conclusion is the update of an earlier benefit assessment of proteomic analysis conducted by IQWiG in 2015 (D13-01).

Proteomic analysis aims to detect impending diabetic nephropathy earlier

When clear symptoms occur, diabetic nephropathy (DN) is already far progressed. Proteomic analysis determines the concentration of several biomarkers in the urine by means of mass spectrometry. The values calculated in this analysis are supposed to allow earlier and more precise clinical conclusions on the development of DN than conventional diagnostic methods.

However, the PRIORITY study provided no hint of a benefit or harm of spironolactone administration based on a proteomic analysis regarding the following patient-relevant outcomes: all-cause mortality, chronic kidney disease, cardiovascular morbidity (ischaemic heart disease, stroke, cardiac failure, etc.), damage to the retina of the eyes in need of treatment (retinopathy), and serious adverse events. There were no data on health-related quality of life.

With the results of the PRIORITY study, it is therefore still unknown which therapeutic consequence from the test result of the proteomic analysis could offer a benefit for patients. Further ongoing or planned studies on proteomic analysis in people with diabetes and hypertension were not identified.

Process of report production

IQWiG had sent the first benefit assessment on proteomic analysis as final report D13-01 in September 2015 to the commissioning agency, the Federal Joint Committee (G-BA). The G-BA then suspended its decision on proteomic analysis in patients with diabetes mellitus and arterial hypertension with the provision that the hitherto unanswered questions had to be answered on the basis of informative scientific documents.

The G-BA resumed the assessment procedure in 2019, and commissioned IQWiG in December 2019 with the assessment of the benefit of proteomic analysis in patients with diabetes mellitus and arterial hypertension, particularly under consideration of the results of the PRIORITY study, which had been completed in the meantime. IQWiG was to prepare the report in an accelerated process, known as a "rapid report". Interim products were therefore not published and were not the subject of a hearing.

TAMPA, Fla. (July 6, 2020)- For decades, people diagnosed with familial hypercholesterolemia have been instructed to minimize their consumption of saturated fats to lower cholesterol and reduce their risks of heart disease. But a new study published in the prestigious journal "BMJ Evidence-Based Medicine" found no evidence to support those claims.

Familial hypercholesterolemia is a genetic disorder that causes people to have cholesterol levels 2-4 times higher than the average person. Organizations, including the American Heart Association, have suggested they avoid eating food from animal sources, such as meat, eggs and cheese, and to avoid coconut oil. An international team of experts on heart disease and diet, including five cardiologists, reviewed dietary guidelines for people with familial hypercholesterolemia. They say they couldn't find any justification for health experts to recommend a low saturated fat diet.

"For the past 80 years, people with familial hypercholesterolemia have been told to lower their cholesterol with a low saturated fat diet," said lead author David Diamond, professor and heart disease researcher at the University of South Florida. "Our study showed that a more 'heart healthy' diet is one low in sugar, not saturated fat."

Diamond and his co-authors say following a low-carb diet is most effective for people at increased risk of heart disease, such as those who are overweight, hypertensive and diabetic. Their findings are consistent with another paper recently published in the "Journal of the American College of Cardiology," which provided strong evidence that food that raises blood sugar, such as bread, potatoes and sweets, should be minimized, rather than tropical oils and animal-based food.

Erythropoietin (Epo) is actually a medication for anaemia. According to researchers at the Max Planck Institute of Experimental Medicine in Göttingen, the doping agent Epo could also be effective against Covid-19. The growth factor could mitigate severe disease progression and protect patients from long-term neurological effects when the Sars-CoV-2 virus attacks the brain. Initial case studies indicate a positive effect of Epo. The researchers are now planning a randomized clinical trial to systematically investigate the effects of Epo treatment in Covid-19 patients.

At the end of March, a patient with severe Covid-19 symptoms was admitted to an Iranian hospital. Because the patient also had poor blood values, the doctors prescribed the haematopoietic growth factor Epo. Seven days after the start of treatment, the patient was able to leave the hospital.

Another indication of the protective role of Epo in the case of Covid-19 comes from South America, where severe illness is rarer in higher-lying regions than in the lowlands. This may be because people living at higher altitudes form more Epo and are better adapted to oxygen deficiency because they have more red blood cells. Could Epo have contributed to the rapid healing of the Iranian patient and could it also explain the differing frequency of the disease in South America?

Milder disease progression thanks to Epo?

Hannelore Ehrenreich thinks this is possible. She is a scientist at the Max Planck Institute of Experimental Medicine and has been researching the effect of the endogenous growth factor for over 30 years and suspects a connection between the administration of Epo and the mild illness progression. "For example, we have observed that dialysis patients withstand Covid-19 remarkably well - and it is precisely these patients who regularly receive erythropoietin", says Ehrenreich.

Epo is released as a natural reaction to oxygen deficiency. The molecule stimulates the formation of red blood cells and thus improves the supply of oxygen to the brain and muscles. This effect is also exploited by athletes who take synthetic Epo as a doping agent. Epo stimulates not only blood cells but also many other tissues.

Epo improves breathing in case of oxygen deficiency

Ehrenreich and her colleagues have now summarized the various studies on the effects of Epo. Animal experiments suggest that Epo acts on areas of the brain stem and spinal cord that control breathing. As a result, breathing improves when there is an oxygen deficiency. Epo also has an anti-inflammatory effect on immune cells and could thus attenuate the frequently exaggerated immune response in Covid-19 patients. It could also protect against neurological symptoms and long-term effects of the disease such as headaches, dizziness, loss of smell and taste, and seizures.

The protective effects of Epo have been shown in animals as well as in numerous studies in humans with various brain disorders. Unfortunately, pharmaceutical companies have only limited interest in financing further studies on approved active ingredients such as erythropoietin for which patent protection has expired. "Because Covid-19 can have such severe health-related consequences, we must investigate any evidence of a protective effect of Epo. After all, there is currently neither a vaccine nor a medication for the disease. We are therefore preparing a 'proof-of-concept study' to investigate the effect of Epo on Covid-19 in humans", says Ehrenreich. In this clinical trial, severely ill Covid-19 patients will also receive Epo. The researchers will then investigate whether the growth factor can alleviate severe disease progression.

INDIANANAPOLIS--A 2020 report from the Centers for Disease Control estimates that 1 in 54 children in the United States is identified each year with autism spectrum disorder (ASD). While children can be diagnosed with ASD as early as 2 years old, most children are still being diagnosed after the age of 4.

Led by Nancy Swigonski, MD and Mary Ciccarelli, MD, a team of faculty at Indiana University School of Medicine have developed a statewide early ASD screening and evaluation system in the primary care setting showing success in improving access to evaluations and lowering the age of diagnosis. This study, published July 6 in Pediatrics, is the first of its kind in the U.S. to include health care systems across an entire state.

"One of the unique aspects of this effort is its scale. While similar innovative diagnostic approaches have previously been tested across the country, our primary-care based Early Autism Evaluation hubs provide data representing much of the state of Indiana," said Rebecca McNally Keehn, PhD, HSPP, lead author on the Pediatrics study. "By improving access to earlier high-quality diagnostic evaluations in children's local communities, our hope is that children will be enrolled in evidence-based interventions that can improve developmental outcomes here in Indiana."

Of over 2,000 patients evaluated at the Early Autism Evaluation (EAE) hubs across Indiana from 2012 to 2018, 33 percent have received an ASD diagnosis. The mean age of diagnosis in the hubs is 30 months, while the national average hovers around 48-plus months. The study also found that the average wait-time to be seen for evaluation at an EAE hub was 62 days, compared to previous estimates of 9 to 12 months in specialty diagnostic centers.

"This system empowers communities to be able to provide life-changing diagnostic services locally, drastically altering the trajectory of development in children who previously remained without diagnoses until age 5 or older," said Naseer Syed, MD, pediatrician at Meridian Health Services in Muncie, Indiana. "To actively be a part of something that life-changing is a reward in and of itself. To witness the impact this has on the child and their family makes it all worthwhile."

A critical component of the EAE hubs is the partnership of organizations and professionals across the state of Indiana working together to get needed care to families potentially facing this diagnosis. Syed is one of more than 30 primary care physicians and nurse practitioners statewide who have been trained by EAE hub leadership to provide this specialized ASD evaluation. This training allows physicians to be able to identify children who are at risk for ASD in a 90-minute primary care visit and then to collaborate with the referring primary care physician to access interventions and community resources.

The development and evaluation of the EAE hub system has been made possible by the generous support of Riley Children's Foundation and Kiwanis Indiana Three Wishes Campaign. Additional funding was provided by Project LAUNCH, Indiana State Department of Health, and ECCS CoIIN.

TROY, N.Y. -- Consider this scenario: A vaccine for the novel coronavirus has been developed that is 91.27% effective. If public health officials present this information using the specific number, people are likely to think the vaccine is actually less effective than if it is presented as being 90% effective.

This concept is a real-life application of recent findings from Gaurav Jain, an assistant professor of marketing in the Lally School of Management at Rensselaer Polytechnic Institute, published recently in Organizational Behavior and Human Decision Process.

The paper, titled "Revisiting Attribute Framing: The Impact of Number Roundedness on Framing," explores an area of behavioral economics research pertaining to attribute framing, which evaluates how people make decisions based on the manner in which information is presented.

Watch this video to learn more.

For decades, researchers in this field have been focused on the attributes, the adjectives, and other words that describe what is being measured. In this paper, Jain looked at the numbers that are used in the frames themselves.

Using six sets of data with more than 1,500 participants, Jain and his co-authors considered what would happen to peoples' perception of information when specific, or non-round, numbers were used instead of round numbers.

The research showed that people find non-round numbers unique and jarring. Jain and his team determined that people pause to think about the specific number due to its uniqueness. Because it isn't easy to comprehend, people tend to compare the non-round number to an easily understood ideal standard -- like 100%. Then, because the specific number doesn't live up to the ideal, people perceive it negatively.

"Numbers have a language and give non-numerical perceptions," Jain said. "When we use specific numbers, the evaluations decrease. There was no apparent reason for this kind of behavior, and this was incredibly surprising."

While Jain and his team explored this question using standard behavioral economic research scenarios and not a specific question, such as communications regarding a potential coronavirus vaccine, this research has direct and critical impact in marketing and public health messaging.

"The extensive use of attribute framing in marketing, organizational behavior, and public policy communication and the robustness of the effects in experimental settings make it one of the most important and frequently studied phenomena in the field," Jain said. "Managers and public health officials should be careful when using non-round numbers, because the use of this approach in communication messages may decrease the subjective evaluations of the target on the associated attributes."

According to Jain, the paper also helps to add to the theoretical understanding of attribute framing. "Our studies lend support and offer an elaborated process account for the attention-association-based reasoning for framing effects in general, which adds to the scarce literature on processes underlying framing effects," Jain said.

ITHACA, N.Y. - In a study of New York state apple orchards, Cornell University plant pathologists have identified a new fungal pathogen that causes bitter rot disease in apples. In addition, a second related fungus known to cause rot disease in other fruits was found for the first time in apples.

"We were shocked by what we found, just dumbfounded," said Srdjan Acimovic, a senior extension associate at the Hudson Valley Research Laboratory (part of Cornell AgriTech) and the paper's senior author. "We found these two species, one that has never been described before and one that has been described before but never on this host."

Both pathogens belong to the genus Colletotrichum, which contains 189 species of fungi that cause devastating rot diseases in a wide variety of fruit crops, including banana, strawberry, citrus, avocado, papaya, mango and apple.

If protective practices are not applied in a timely manner, apple losses from bitter rot in New York state can average up to 25% per year, with reports of some organic farms losing up to 100% of their crop. Bitter rot also accounts for up to 5% additional loss of marketable fruit in storage post-harvest.

This damage is costly for farmers; the farm gate value for New York apples was roughly $260 million in 2018, according to U.S. Department of Agriculture statistics.

The dominant species found in the apples was C. fioriniae, followed by C. chrysophilum, which is found in other fruits but not apples until now, and the newly discovered C. noveboracense, named after New York state in Latin.

Colletotrichum fungi that infect apple fruit can largely be divided in two main groups. One group called the C. gloeosporioides complex thrives in warmer growing regions than the other group, the C. acutatum complex, which is more frequently reported in cooler apple growing regions. And based on the group they belong to, species can react differently to fungicides, which the researchers also tested. For this reason, identifying and characterizing the fungi is important for bitter rot management.

"When we know which species are dominant in our area, we know how environmental conditions will affect them and which control method is best in an orchard," said study first author Fatemeh Khodadadi, a postdoctoral researcher in Acimovic's lab.

In the future, the researchers plan to work with other plant pathologists and apple breeders to identify possible genes that confer natural resistance to Colletotrichum fungi that may be bred into apple cultivars.

DALLAS, July 6, 2020 -- Medications commonly prescribed to treat high blood pressure may also reduce patients' colorectal cancer risk, according to new research published today in Hypertension, an American Heart Association journal.

Angiotensin converting enzyme inhibitor (ACE-i) or angiotensin II receptor blocker (ARB) medications are prescribed for conditions such as heart failure, high blood pressure or heart disease. These medications inhibit or block angiotensin, a chemical that causes arteries to become narrow. Doctors commonly prescribe these medications to people with high blood pressure to relax and open blood vessels, thereby lowering blood pressure.

Based on the findings of this large study, taking these medications may also reduce colorectal cancer risk. Colorectal cancer is the third most common cancer and is the second leading cause of cancer death worldwide.

"The roles of ACE inhibitors and ARBs on cancer development are controversial and, in some cases, study findings are conflicting. Results of previous studies have been limited by several factors including a small number of patients and data only on short-term follow-ups. Our results provide new insights on a potential role of these medications for colorectal cancer prevention," said study author Wai K. Leung, M.D., clinical professor of medicine at the University of Hong Kong in Hong Kong, China. "This is the first study to show the potential beneficial effects of ACE inhibitors and ARBs on colorectal cancer development, based on a large group of patients who were colorectal cancer-free at the beginning of the study."

Researchers reviewed health records of 187,897 adult patients in Hong Kong from 2005 to 2013, with a negative baseline colonoscopy for colorectal cancer. The analysis found that:

those who took hypertension medications such as ACE-i or ARBs had a 22% lower risk of developing colorectal cancer in the subsequent three years;

the benefits of ACE-i and ARBs were seen in patients 55 or older and those with a history of colon polyps; and

the benefit associated with the medications was limited to the first three years after the negative baseline colonoscopy.

"While ACE-i and ARBs are taken by patients with high blood pressure, heart failure and kidney diseases, the reduction in colorectal cancer risk may be an additional factor for physicians to consider when choosing anti-hypertensive medications," Leung said.

This is a retrospective study, looking back at whether patients on these medications developed colorectal cancer. Researchers note that the results should be verified with a prospective randomized controlled study, which would actively follow patients to determine the potential benefits of these medications on colorectal cancer risk.

Can antibiotic-resistant bacteria escape from sewers into waterways and cause a disease outbreak?

A new Rutgers study, published in the journal Environmental Science: Water Research & Technology, examined the microbe-laden "biofilms" that cling to sewer walls, and even built a simulated sewer to study the germs that survive within.

They found that these biofilms often contain harmful, antibiotic-resistant bacteria and can withstand standard treatment to disinfect sewers. Cleaning with bleach can reduce the density of biofilms but not entirely remove them, potentially leaving wastewater treatment workers and the public exposed to health risks.

Still, disinfecting a sewer line may be a good idea before sewer maintenance is done, especially following events such as a disease outbreak or bioterrorism incident that might expose sewer lines to high-risk microbes. Luckily, with respect to SARS-CoV-2, the coronavirus causing COVID-19, water and wastewater are not expected to be important transmission routes.

Normally, what's flushed down a toilet goes to a wastewater treatment plant. But rainfall can cause overflows of untreated waste into bays, rivers, streams and other waterways. The researchers say a potential worst-case scenario would be an infectious disease outbreak following a sewer overflow that releases wastewater, sewer solids and biofilms to surface water.

"Given the current interest in wastewater-based epidemiology for monitoring the coronavirus, our study highlights the need to consider sewer processes and how best to combat pathogens," said senior author Nicole Fahrenfeld, an associate professor in the Department of Civil and Environmental Engineering in the School of Engineering at Rutgers University-New Brunswick. "We will work to repeat a portion of our experiments to understand how long the coronavirus may linger in sewers and if that will impact monitoring of it in wastewater."

The researchers found that sewer pipe materials (concrete or PVC plastic) did not affect the formation of biofilms but played a role in the effectiveness of bleach to disinfect them. Bleach is better at removing biofilms from PVC than from concrete, likely because PVC is smoother.

The lead author is William R. Morales Medina, a Rutgers doctoral student. Alessia Eramo, who earned a doctorate at Rutgers, and Melissa Tu, a Rutgers undergraduate student, contributed to the study.

Miami, FL--Your doctor tells you that you need a statin to lower your cholesterol and reduce your heart attack risk. You don't like taking medicine and your friend tells you that he had achy muscles after he started a statin. You wonder if you should listen to your doctor or go without the medicine. An article just published in Mayo Clinic Proceedings by Dr. Carl E Orringer of the University of Miami Miller School of Medicine and Dr. Kevin C Maki of Indiana University's School of Public Health may help your doctor to make the right decision.

The American Heart Association, American College of Cardiology and 10 other medical organizations published a Guideline in late 2018 to help doctors determine which patients are most likely to benefit from cholesterol-lowering drug treatment. Statins, the most widely prescribed cholesterol-lowering medicines, have well-established benefits for lowering heart attack and stroke risk.

For those who don't have a previous history of cardiovascular disease or other high-risk conditions, the Guideline recommends that doctors use a risk calculator to help to decide which patients have high enough cardiovascular risk to benefit from a statin. A statin is recommended for those at high risk, and not recommended for those at low risk. However, most have risk somewhere in between, where the decision about the need for statin treatment is uncertain.

An imaging test called coronary calcium scoring can help doctors to make the right recommendation about the use of statin therapy. The test is a 10-minute CT (computed tomography) scan looking for calcium deposits in the arteries supplying blood to the heart. Calcium deposits indicate the presence of coronary plaque, also known as atherosclerosis.

The test requires no injections, produces less radiation exposure than a routine mammogram, and is widely available, usually costing $99 or less. This test has been available for about 20 years, but its use to guide treatment decisions for heart attack and stroke prevention has only recently been supported by enough evidence to recommend widespread use.

Up to half (generally 40-50%) of people with a calculated heart attack and stroke risk in the middle group between the low and high categories have a calcium score of zero. These people have such low heart attack and stroke risk over the next 10 years that taking a statin provides, at most, minimal protection. On the other hand, those with evidence of significant calcium build-up are very likely to benefit from taking a statin.

Taking a statin is not a small decision, since doing so means that buying the medicine, taking it daily, and undergoing follow-up blood tests and medical appointments to be sure that the treatment is working. In addition, a small percentage of patients have side effects that may require additional testing and medical appointments. That is why Drs. Orringer and Maki make the point in this article that coronary calcium scoring in this "middle risk" group is so important. They recommend that patients in this group get the test, whenever possible, so that therapy can be more effectively targeted to those most likely to benefit. KCM: The preceeding paragraph could be omitted if we want to keep to one page.

Cardiovascular diseases such as heart attack and stroke are the leading causes of death for both men and women in the United States. An important point made in the article is that coronary calcium scoring may be particularly useful in women 50 years of age and older. There is more than a 50% chance that a woman in her 50s will eventually develop cardiovascular disease. The risk of developing breast cancer over a lifetime (about 12-13%) is much lower than for cardiovascular disease. Women who are 55 years of age or older and at average breast cancer risk are advised to have a screening mammogram annually, or every other year.

For those with calculated cardiovascular risk in the middle range (not high or low), it is reasonable to substitute a single coronary calcium test for one annual mammogram. Women with a coronary calcium score of zero will gain peace of mind about their heart attack and stroke risk, while those with significant coronary calcium can take a statin to lower their cardiovascular risk.

Asthma does not appear to increase the risk for a person contracting COVID-19 or influence its severity, according to a team of Rutgers researchers.

"Older age and conditions such as heart disease, high blood pressure, chronic obstructive pulmonary disease, diabetes and obesity are reported risk factors for the development and progression of COVID-19," said Reynold A. Panettieri Jr., a pulmonary critical care physician and director of the Rutgers Institute for Translational Medicine and Science and co-author of a paper published in the Journal of Allergy and Clinical Immunology. "However, people with asthma -- even those with diminished lung function who are being treated to manage asthmatic inflammation -- seem to be no worse affected by SARS-CoV-2 than a non-asthmatic person. There is limited data as to why this is the case -- if it is physiological or a result of the treatment to manage the inflammation."

Panettieri discusses what we know about asthma and inflammation and the important questions that still need to be answered.

How might awareness of SARS-CoV-2 affect the health of people with asthma?

Since the news has focused our attention on the effects of COVID-19 on people in vulnerable populations, those with asthma may become hyper-vigilant about personal hygiene and social distancing. Social distancing could improve asthma control since people who are self-quarantined are also not as exposed to seasonal triggers that include allergens or respiratory viruses. There is also evidence that people are being more attentive to taking their asthma medication during the pandemic, which can contribute to overall health.

What effect might of inhaled steroids have on COVID-19 outcomes?

Inhaled corticosteroids, which are commonly used to protect against asthma attacks, also may reduce the virus' ability to establish an infection. However, studies have shown that steroids may decrease the body's immune response and worsen the inflammatory response. Steroids also have been shown to delay the clearing of the SARS and MERS virus -- similar to SARS-CoV-2 -- from the respiratory tract and thus may worsen COVID-19 outcomes. Future studies should address whether inhaled steroids in patients with asthma or allergies increase or decrease the risks of SARS-CoV-2 infection, and whether these effects are different depending on the steroid type.

In what way does age play a role in how asthma patients react to exposure to the virus?

A person's susceptibility to and severity of COVID-19 infection increases with age. However, since asthma sufferers tend to be younger than those with reported high-risk conditions, age-adjusted studies could help us better understand if age is a factor in explaining why asthma patients may not be at greater risk for infection.

Children and young adults with asthma suffer mainly from allergic inflammation, while older adults who experience the same type of airway inflammation can also suffer from eosinophilic asthma -- a more severe form. In these cases, people experience abnormally high levels of a type of white blood cell that helps the body fight infection, which can cause inflammation in the airways, sinuses, nasal passages and lower respiratory tract, potentially making them more at risk for a serious case of COVID-19.

In addition, an enzyme attached to the cell membranes in the lungs, arteries, heart, kidney and intestines that has been shown to be an entry point for SARS-CoV-2 into cells is increased in response to the virus. This enzyme is also thought to be beneficial in clearing other respiratory viruses, especially in children. How this enzyme affects the ability of SARS-CoV-2 to infect people with asthma is still unclear.

How might conditions in addition to asthma affect a person's risk of infection?

Asthma tends to be associated with far fewer other conditions than chronic obstructive pulmonary disease or cardiovascular disease. If SARS-CoV-2 is a disease that causes dysfunction in the cells that line blood vessels throughout the body, then diabetes, heart disease, obesity and other diseases associated with this condition may make people more susceptible to the virus than those who are asthmatic. However, older people with asthma who also have high blood pressure, diabetes or heart disease may have similar instances of COVID-19 as non-asthmatics with those conditions.

In 2010, Professor Patrick Kwan from Monash University's Department of Neuroscience, led an international team researching the causes and outcomes of epilepsy patients in rural China. A decade later the results indicate that at least one million Chinese people with epilepsy could be candidates for a standard operation that may leave them seizure-free.

The study, published in Neurology, incorporated 600 epilepsy patients from across four rural provinces in China from July 2010 and December 2012, with each participant undergoing an MRI and other tests looking for abnormalities in brain imaging. Of those, 108 were found to have lesions that could potentially be cured by surgery.

"In a best-case scenario, around 70 per cent to 80 per cent of them would be seizure-free - often after enduring seizures uncontrolled by medications for 20 years or more," Professor Kwan said.

The participants were assessed by local primary care doctors trained by provincial neurologists in main hospitals to use a standardised questionnaire and take patient histories. The patients then travelled to provincial centres to have tests including MRIs and blood taken, for use in later research into genetic causes for epilepsy.

Professor Kwan said those patients identified as potential surgery candidates would need to undergo further tests including video-EEGs and neuropsychological assessments to ensure surgery would be effective, with the actual operation only taking three to four hours.

The same standard operation is carried out for suitable patients routinely around the world including Australia, UK and US.

"Extrapolating out the study results, potentially at least a million people could benefit from the operation - that's a huge surgical treatment gap," Professor Kwan said. "These findings are significant, highlighting the magnitude of the unmet needs for epilepsy surgery in China.

"Hopefully this information demonstrates a quantifiable need. By raising awareness we hope to influence policymakers to provide more resources in epilepsy care, including proper evaluation in specialist centres and proceeding to surgery if deemed appropriate."