Body

Researchers at the University of Maryland, Baltimore County (UMBC) have developed tools to improve the analysis of functional magnetic resonance imaging (fMRI) data. Tülay Adali, professor of computer science and electrical engineering and director of UMBC's Machine Learning for Signal Processing Lab, and Qunfang Long, a Ph.D. candidate at UMBC in electrical engineering, have spearheaded groundbreaking work identifying key patterns in brain imaging for those with particular mental illnesses, such as schizophrenia. This new research is published in NeuroImage Volume 216. Their work can assist in diagnosis and treatment of patients with mental illnesses that can be difficult to identify. It can also show medical practitioners whether the current treatments have or have not been working based on image groupings.

The image analysis method developed by Adali and Long is called independent vector analysis (IVA) for common subspace extraction (CS). Through this method, they were able to categorize subgroups of fMRI data based solely on brain activity, proving that there is a connection between brain activity and certain mental illnesses. In particular, they were able to identify subgroups of schizophrenia patients using the fMRI data that they analyzed.

Previously, there was not a clear way to group schizophrenia in patients based on brain imaging alone, but the methods developed by Adali and Long show that there is a significant connection between a patient's brain activity and their diagnoses. "The most exciting part is that we found out the identified subgroups possess clinical significance by looking at their diagnostic symptoms," explains Long. "This finding encouraged us to put more effort into the study of subtypes of patients with schizophrenia using neuroimaging data."

Importantly, the IVA-CS method used to identify these subgroups also preserves nuances in the data, but still renders statistically significant groupings. "Now that data-driven methods have gained popularity, a big challenge has been capturing the variability for each subject while simultaneously performing analysis on fMRI datasets from a large number of subjects. Now we can perform this analysis effectively, and can identify meaningful groupings of subjects," says Adali.

Diagnosing and treating mental illness is incredibly complex. The same illness will present differently in different patients, and there is often no singular treatment that will be effective for all patients. Once a treatment is in place, determining if it is successful can also vary by patient. Adali and Long's research along with their long-time collaborator Vince Calhoun at the Tri-institutional Center for Translational Research in Neuroimaging and Data Science in Georgia, U.S. responds to this variability by giving medical practitioners an objective way to analyze the fMRI results for patients within relatively homogenous diagnostic subgroups, and then compare fMRI results over time for the same patient. Consider a schizophrenic patient who receives treatment and returns in six months to be evaluated again. If their fMRI data resembles that of the control group of mentally healthy patients more than that of other patients with schizophrenia, that is objective evidence that the treatment is working. On a larger scale, this data provides a better look at patients' medical outcomes as a result of treatment.

To further improve upon this groundbreaking analysis of fMRI data, Adali's team will work with longitudinal data to determine which treatments work best for subgroups of patients with specific mental illnesses. This method will also be used in a longitudinal study of adolescents to see whether there are links between fMRI images and the addiction and substance use patterns of those adolescents over time.

LOS ANGELES -- The United States military has a constant need for service members who can serve in elite and specialized military units, such as the Marine Corps. However, because the training courses for these forces is so rigorous, the dropout rate is high.

To help determine predictors of success or failure in elite military training, Leslie Saxon, MD, executive director of the USC Center for Body Computing, and fellow Center for Body Computing researchers monitored the physical and psychological activity of three consecutive classes of Marines and sailors enrolled in a 25-day specialized training course.

The results were published in the Journal of Medical Internet Research mHealth and uHealth.

A total of 121 trainees participated. Only slightly more than half (64) successfully completed the course.

Researchers found there was no correlation between finishing and performance on physical training standards, such as hikes or aquatic training. Physical markers such as heart rate or sleep status also did not play a role.

Rather, the biggest determinant was mental. Trainees who identified themselves as extroverted and having a positive affect -- the ability to cultivate a joyful, confident attitude -- were most likely to complete the course.

"These findings are novel because they identify traits not typically associated with military performance, showing that psychological factors mattered more than physical performance outcomes," says Saxon, who is also a cardiologist with Keck Medicine of USC and a professor of medicine (clinical scholar) at the Keck School of Medicine of USC.

Researchers were also able to pinpoint psychological stressors that triggered dropping out of the course. Trainees typically quit before a stressful aquatic training exercise or after reporting an increase in emotional or physical pain and a decrease in confidence. This led researchers to be able to predict who would drop out of the course one to two days in advance.

While Saxon has been studying human performance in elite athletes for 15 years, this was her first study involving the military. She partnered with the USC Institute for Creative Technologies, which has established military research programs, to run the study with a training company in Camp Pendleton, Calif. that trains Marines in amphibious reconnaissance. Typically, only around half of the participants finish the training.

The study authors collected baseline personality assessments of the trainees before the recruits began the course, assessing personality type, emotional processing, outlook on life and mindfulness. Researchers next provided subjects with an iPhone and Apple Watch, and a specially designed mobile application to collect continuous daily measures of trainees' mental status, physical pain, heart rate, activity, sleep, hydration and nutrition during training.

The mobile application also prompted trainees to answer daily surveys on emotional and physical pain, well-being and confidence in course completion and instructor support.

"This study, the first to collect continuous data from individuals throughout a training, suggests that there may be interventions the military can take to reduce the number of dropouts," says Saxon. "This data could be helpful in designing future training courses for Marines and other military units to increase the number of elite service members, as well as provide insights on how to help athletes and other high performers handle challenges."

Saxon is already testing whether or not various psychological interventions or coaching might encourage more trainees to stay the course.

CORVALLIS, Ore. -- A recent study evaluating the effectiveness of Oregon's occupational health monitoring system concludes that the state needs to collect and share data about workplace dangers in a more timely, relevant fashion to allow for rapid intervention.

Occupational safety and health surveillance is a type of public health surveillance that collects data on work-related fatality, injury and illness and the presence of workplace hazards. In disseminating this data, occupational health agencies aim to help workplaces implement policies and procedures to keep workers safe.

"More timely, complete and sustainable surveillance is going to benefit Oregon workers," said study author Liu Yang, a recent Ph.D. graduate in Oregon State University's College of Public Health and Human Sciences. "The whole purpose for surveillance is to generate quality data that can be used for research and guiding practice. So if the system can provide more timely, complete data in a stable and systematic way, this is going to help improve work safety and health for Oregon workers."

One of the ways to accomplish this is to develop state-centric health indicators. When something like the COVID-19 pandemic arises, for example, focusing on more local and timely indicators would allow Oregon agencies to quickly provide safety guidance for industries throughout the state.

Yang's evaluation study, published this month in the American Journal of Industrial Medicine, is a collaboration with the Oregon Occupational Public Health Program, which is currently funded by the National Institute for Occupational Safety and Health (NIOSH) to expand state-level surveillance.

The state occupational safety and health surveillance system is based on a national set of occupational health indicators covering work-related injuries, illnesses, and safety-related risk factors. This standardization allows states to report comparable data to national occupational health agencies.

But some of the sources of data have a much slower turnaround than others, so it's difficult to gather all the necessary information at the same time. In Oregon, this has resulted in a 2- to 3-year lag between when a workplace hazard or accident occurs, and when a new indicator is generated and disseminated. Oregon's 2015 health indicator report was not published until 2018.

For the study, Yang, co-author Laurel Kincl, an associate professor in Public Health at OSU, and researchers from the Oregon Health Authority collected data via onsite observations, interviews, focus groups and surveys among stakeholders, along with reviews of existing literature.

They found that Oregon's occupational safety and health surveillance system is easy to operate, regularly updated and flexible in adopting changes, and ranked as highly relevant to users. However, it is not timely; its funding source is not sustainable; and while the quality of data is good overall, there is room for improvement in its sensitivity and representativeness. Because of these shortcomings, most users ranked the system as "moderately" or "somewhat" useful.

To solve the timeliness issue, Yang said, Oregon should adopt state-specific occupational health indicators, using state agency data that can be compiled more quickly. In addition to disseminating safety information to workplaces faster, state-level indicators would produce data that better reflects specific local needs.

State surveillance leaders are already moving in this direction, and have started using emergency department visits and other real-time clinical health sources to track occupational health incidents.

While other types of public health surveillance, such as infectious disease monitoring, are funded as ongoing practice-oriented systems, occupational safety and health surveillance is paid for based on research projects. Program leadership has to come up with new research projects to secure money every five years, which leaves the surveillance system on unstable footing.

Surveillance is more important than ever during the COVID-19 pandemic, as public health agencies need more time-sensitive methods for gathering data on viral outbreaks in workplaces across the state, Yang said. She hopes Oregon will continue to evaluate its surveillance system on a more regular basis going forward.

"Without evaluation, without taking a step back to reflect, you just keep doing things but you don't know whether you're doing right or wrong," she said.

Whole genome duplication followed by massive gene loss has shaped many genomes, including the human genome. Why some gene duplicates are retained while most perish has puzzled scientists for decades.

A study, published today in Science, has found that gene retention depends on the degree of "functional and structural entanglement", which measures interdependency between gene structure and function. In other words, while most duplicates either become obsolete or they evolve new roles, some are retained forever because, evolutionarily speaking, they're simply stuck.

"When we scan genomes there are some gene pairs that remain from whole genome duplication events that occurred millions of years ago," says Elena Kuzmin, a co-lead author of the study and former graduate student who trained with Charles Boone, professor of molecular genetics in the Donnelly Centre for Cellular and Biomolecular Research, at the University of Toronto, who co-led the study.

"Why are some duplicates retained while most are eliminated? We tried to find some of the reasons for this retention to help us understand evolutionary forces that shape genomes," says Kuzmin, who is now postdoctoral fellow at the Goodman Cancer Research Centre at McGill University.

The study was also led by Brenda Andrews, University Professor and Director of the Donnelly Centre, and Chad Myers, a professor of computer science at the University of Minnesota-Twin Cities.

Whole genome duplication is seen as a major source of raw genetic material for evolution to act on. Duplicated gene copies, also known as paralogs, can be found across eukaryotes, organisms that include single-celled yeasts and all multicellular forms of life.

Over extensive evolutionary time, through random mutation, the DNA code of one gene copy diverges from another until they are no longer recognized as duplicates. They either evolve new roles or decay into the non-coding part of the genome.

But some duplicates are retained, suggesting there may be evolutionary advantage to the organism in keeping both. There is little agreement among scientists about why this might be the case, however. Many evolutionary biologists think that all paralog pairs will eventually revert to single copy genes.

Genome evolution is not easy to study. "None of us were there to see what really happened with these genes," says Boone. But he believes clues can be gained from studying functional relationships between paralogs and other genes in the genome.

The researchers turned to Saccharomyces cerevisiae, or baker's yeast, whose relatively small genome makes such studies feasible. Most of its 6,000 genes exist as single copies, but 551 paralog pairs have remained from a duplication event some 100 million years ago.

Because paralogs started as identical gene copies, their function should to some extent be overlapping, or redundant. This indeed is the case for some yeast paralogs. In their 2016 Science paper, the team showed that 331 paralog pairs are redundant so that deleting either gene had no effect on the cells, whereas deleting both reduced their survival. This suggested that some paralogs are retained as essential backup in case either gene copy is lost.

But 240 paralog pairs are non-essential, that is, both can be deleted with no effect on cell survival. To unpick their functional requirement, the researchers looked for a context in which removing both genes is detrimental to cell fitness. They found it in triple mutant yeast lacking three genes--a paralog pair plus another gene.

Fitness analysis of 550,000 double and 260,000 triple mutant strains revealed that the non-essential paralogs fall into two basic classes--those with overlapping roles, and those that diverged and acquired new functions.

A closer look at the genes' DNA code revealed that the ability of non-essential paralogs to evolve new roles is determined by the molecular structure of the proteins they encode. The authors coined the term "functional and structural entanglement" to describe how much a gene's cellular function is constrained by the intrinsic physical forces acting on its protein product.

Membrane proteins, such as ion channels and receptors, are an example of this. These proteins typically contain multiple hydrophobic, or water-repelling, segments, which allow them to mix with hydrophobic lipid molecules that make up the cell membrane. Mutations to the underlying genes are likely to alter the proteins' hydrophobic nature, impairing their ability to be inserted into the membrane and rendering them nonfunctional as a result.

"Somehow these paralogs retain this functional overlap because they can't get rid of their basic structure or they lose everything," says Boone.

"Our study is an extensive experimental analysis of the functional redundancy associated with retained paralogs. We can see different features associated with the genes in the two groups that suggest that functional and structural entanglement model is valid," he says.

Computational modelling performed by the study's other co-lead author, Benjamin VanderSluis, a former postdoctoral fellow with Myers, aligned with experimental findings.

The greater the structural entanglement, the modelling showed, the greater the chance that a random mutation will harm protein function. Consequently, one paralog will be under strong evolutionary pressure to remain intact, while the other will become nonfunctional over time.

At the other end of the spectrum, paralogs that are least structurally entangled have more freedom to evolve new roles and divide up the ancestral functions between them. At the middle level of entanglement, paralogs retain overlapping functions and coexist in a steady state.

The functional and structural entanglement model predicts that some paralog pairs will be maintained indefinitely. It challenges the widely accepted view that all paralog pairs will eventually revert to a single gene state.

"We show that functional redundancy between paralogs is evolutionarily stable and can exist at steady state", says Kuzmin.

What The Study Did: This case series describes 20 children and adolescents who presented with new-onset acral inflammatory lesions during the COVID-19 pandemic.

Authors: Ignacio Torres-Navarro, of the Hospital Universitario y Politécnico la Fe in Valencia, Spain, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamadermatol.2020.2340)

Editor's Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

A group of Lithuanian and Kurdish scientists have raised a hypothesis that the measles, mumps, and rubella (MMR) vaccine could protect children from COVID-19. The hypothesis is based on the discovered sequence similarity of the 30 amino acid residues between glycoproteins of SARS-CoV-2, measles and rubella viruses. An experimental analysis is required in order to support the hypothesis.

An ongoing global pandemic of coronavirus disease 2019 (COVID?19) has claimed more than 450 thousand lives already; globally, more than 9 million cases of COVID?19 infection have been confirmed.

According to detailed data of COVID-19-infected patients from China, Italy, and South Korea, the disease is less common and milder in children younger than 10 years of age.

The reasons why children are less susceptible to COVID-19 remain unclear. However, the research carried out at Charmo University in Iraq and at Kaunas University of Technology (KTU) in Lithuania, provided evidence that MMR vaccination might be a reason why children have protection against the disease.

The hypothesis is backed up by the sequence similarity data between the SARS-CoV-2 with both measles and rubella viruses.

"The antibodies produced in children due to the MMR vaccine could recognize some protein parts (epitopes) on the SARS-CoV-2 spike proteins. These antibodies, particularly in the epithelial layer of respiratory airways, block binding, and entering the virus into the cells", explains Prof Rimantas Kodzius from KTU Panevezys Faculty of Technology and Business.

SARS-CoV-2 is a single- strand, positive-sense RNA virus. S protein is a key immunogenic protein of SARS-CoV-2 that induces the host immune system; the latter fights off the foreign particles that enter the human body by producing antibodies. Humans are routinely immunized against several viral diseases in early childhood, which usually induces broad immunity against the viral particles.

Immunological principle based on the antibody cross-reaction recognizing antigens in two different microbes inspired the group of scientists lead by Prof Kodzius of KTU, to look for homology sequence searching in SARS-CoV-2 and the viruses that commonly are prevented by vaccination during childhood. It was discovered that 30 amino acid residues share similarities between the Spike (S) glycoprotein of the SARS-CoV-2 virus and the Fusion glycoprotein of Measles virus as well as with the envelope glycoprotein of the Rubella virus.

"We are the first group to propose children protection through MMR vaccine and to support the claim by sequence homology between SARS-CoV-2 with measles and rubella viruses", says Prof Kodzius.

According to scientists, recent studies show that the levels of antibodies against MMR vaccination may persist for 15-20 years. Therefore, the protection against COVID-19 could last up to 15-20 years. However, experimental research including testing purified spike protein of SARS-CoV-2 against the polyclonal and monoclonal antibodies of measles and rubella viruses in vivo and in vitro is required in order to support the hypothesis.

Prof Rimantas Kodzius spent a year teaching and researching at The American University of Iraq Sulaimani (AUIS) in Iraq, Kurdistan region, Sulaimani city. That is how his cooperation with the local researchers began.

"In uncertain times like the COVID-19 pandemic, the collaboration yields results. The phone connection, the internet is available, and the work is possible even without travel", says Prof Kodzius, who has joined KTU in 2018.

Today Cochrane, a global independent organization that reviews evidence from research to inform health decision-making, publishes a review of studies looking at the accuracy of COVID-19 antibody tests.

The review shows that antibody tests could have a useful role in detecting if someone has had COVID-19, but that timing is important. The tests were better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started. We do not know if this is true for people who have milder disease or no symptoms, because the studies in the review were mainly done in people who were in hospital. In time, we will learn whether having previously had COVID-19 provides individuals with immunity to future infection.

Antibody tests are an important public health tool to identify individuals with previous COVID-19 disease. This enables assessment of the spread of infection and the need for public health interventions. The review summarizes research evidence available up until the end of April 2020 to see whether antibody tests:

- are accurate enough to diagnose disease in people with or without symptoms of COVID-19, and

- can be used to find out if someone has already had COVID-19.

The immune system of people who have COVID-19 responds by developing proteins in the blood called antibodies that attack the virus. Detecting antibodies in people's blood may indicate whether they currently have COVID-19 or have had it previously. Whilst detecting current infection is usually done using swab tests within the first 5 days of illness, they may miss infection and are not available to all.

Cochrane researchers from universities across the world led by experts from the University of Birmingham searched through the 11,000 publications on COVID-19 available at the end of April to find studies that reported results of antibody tests in groups of people known to have (or have had) COVID-19 and others known not to have had COVID-19 based. They found a total of 54 relevant studies reporting test results for nearly 16,000 samples. The majority of studies were from China and were carried out in people who had been admitted to hospital and likely to have had severe disease.

The studies looked at three types of antibody, IgA, IgG and IgM. Most tests measured both IgG and IgM, but some measured a single antibody or combinations of the three antibodies. Data were only available for 27 tests, a small fraction of the over 200 tests on the market. Data were available on both laboratory based tests, which require blood samples taken from the veins, and point-of-care tests, which can use finger-prick blood samples. There were not enough data to compare the accuracy of different tests. The authors will continue to update this review over the next few months to provide a more complete summary of the research evidence as it accumulates.

The researchers found that the sensitivity (the proportion of the people who have had COVID-19 that the test can detect) of antibody testing is very closely related to when the test is performed. Tests of the IgG and IgM antibodies at 8 to 14 days after onset of symptoms correctly identified only 70% of people who had COVID-19. However, when the researchers looked at data reported at between 15 and 35 days after symptoms first began, antibody tests accurately detected over 90% of people with COVID-19. There are insufficient studies to estimate the sensitivity of antibody tests beyond 35 days after the beginning of symptoms. The tests only wrongly diagnosed COVID-19 in 1% to 2% of people without COVID-19.

To illustrate what these accuracy figures mean, in a sample of 1000 people where 200 people (20%) really have COVID-19, typical of workers in a hospital setting where COVID-19 patients have been treated:

- 193 people would receive a positive test result but 10 (5%) of those people would not have COVID-19 (known as a false positive result);

- 807 people would receive a negative test result but 17 (2%) of those people would have COVID-19 (known as false negative result).

In a population where COVID-19 was more common there would be more false negatives and fewer false positives.

Studies showed that antibody tests may have a role in diagnosing COVID-19 in patients who have had COVID-19 symptoms for two or more weeks but who have not had a swab (PCR) test or tested negative despite COVID-19-like symptoms.

Professor Jon Deeks, Professor of Biostatistics and head of the Test Evaluation Research Group at the University of Birmingham, explains: "We've analyzed all available data from around the globe - discovering clear patterns telling us that timing is vital in using these tests. Use them at the wrong time and they don't work. While these first COVID-19 antibody tests show potential, particularly when used two or three weeks after the onset of symptoms, the data are nearly all from hospitalized patients, so we don't really know how accurately they identify COVID-19 in people with mild or no symptoms, or tested more than five weeks after symptoms started.

The researchers also had several concerns about the quality of the studies they found. Studies were small and did not report their results fully. Many papers included multiple samples from the same patients. More than half of the studies were made available before they had been through peer review (publications known as 'preprints'). In one important UK study the biomarker manufacturers did not approve the identification of the tests that had been evaluated.

Dr Jac Dinnes, who worked on the review with the University of Birmingham team commented, "The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data broken down by time since onset of symptoms. Action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan to update this review regularly as more studies are published."

ARLINGTON HEIGHTS, IL (June 25, 2020) - As the COVID-19 pandemic has changed how plastic surgeons will care for patients and how they operate their practices, the American Society of Plastic Surgeons (ASPS) recently conducted a member survey to understand what procedures were top of mind among patients to gauge whether the public's mindset on preferred treatments has shifted.

2020 Top 5 Plastic Surgery Trend Predictions from Telemedicine Visits During Pandemic

While practices were closed, plastic surgeons continued to stay in touch with patients via virtual visits. ASPS measured the performance of telemedicine and found that most members sought technology to connect with clients.

64% of respondents had seen an increase in their telemedicine consultations since before COVID-19 began

68% of respondents started seeing patients virtually because of COVID-19.

ASPS member surgeons formulated the following early predictions on top 2020 procedure trends as in-office visits safely resume for patients, doctors and staff. Insights were gathered from more than 350 members and were based on what members learned from patients via telemedicine appointments.

Injectables were the most asked-for treatments, followed by more invasive procedures.

1. Botulinum Toxin Type A - 65%
2. Breast Augmentation - 44%
3. Soft Tissue Fillers - 37%
4. Liposuction - 30%
5. Abdominoplasty - 24%

The continued interest in plastic surgery procedures during the COVID-19 pandemic suggest patient confidence in the specialty and its board-certified plastic surgeons to reopen and resume procedures safely. This aligns with findings from an ASPS national consumer survey released in May, which revealed an overall positive attitude towards plastic surgery procedures even among those who are interested but have not undergone procedures before.

Building upon that trust, following stay-at-home orders and CDC guidelines, ASPS convened plastic surgeon working groups to issue guidance regarding COVID restrictions, elective surgery, and safe resumption of surgery. "The early signs of patients' confidence in resuming procedures with our trusted members is a testament to why we do what we do," said ASPS President Lynn Jeffers, MD, MBA, FACS.

From this survey, results show patients continue to be interested in pursuing major surgeries and that the general interest has not changed in the type of procedures and operations from the Society's pre-pandemic statistics.

ASPS 2019 Top Procedures

Top 10 Cosmetic Surgical Procedures

While ASPS anticipates a decrease in total number of cosmetic procedures in 2020 due to the COVID-19 pandemic, the Society forecasts a strong demand for treatments as practices reopen for in-office procedures. The number of cosmetic surgical procedures remained steady in 2019 vs. 2018 with 1.8 million surgical procedures performed, and six of the top 10 procedures focused from the neck down.

The Top 10 cosmetic surgical procedures performed in 2019 were:

1. Breast augmentation (299,715 procedures)
2. Liposuction (265,209 procedures)
3. Eyelid surgery (211,005 procedures)
4. Nose reshaping (207,284 procedures)
5. Facelift (123,685 procedures)
6. Tummy tuck (123,427 procedures)
7. Breast lift (113,188 procedures)
8. Dermabrasion (77,366 procedures)
9. Neck lift (54,852 procedures)
10. Breast reduction (46,340 procedures)

Top 5 Cosmetic Minimally Invasive Procedures

In 2019, minimally invasive cosmetic procedures grew at a slightly higher rate than surgical procedures, and the total number of procedures increased for the third year in a row. 2019 marked the highest number of Botulinum toxin type A injections to date with over 7.69 million injections, and facial rejuvenation procedures are not showing signs of slowing down in 2020.

Among the 16.3 million cosmetic minimally invasive procedure performed in 2019, up 2 percent compared to 2018 data, the top 5 were:

1. Botulinum toxin type A (7.69 million procedures)
2. Soft tissue fillers (2.72 million procedures)
3. Chemical peel (1.38 million procedures)
4. Laser hair removal (1.0 million procedures)
5. Intense Pulsed Light (IPL) treatment (685,755 procedures)

"Injectable use is now a part of our cultural conversation, thanks to the average patient seeing the benefits of natural results from the advancements in technique and products that allow plastic surgeons to individualize their recommended treatments to what each patient needs," Dr. Jeffers commented.

Top 5 Reconstructive Procedures

Nearly 6 million reconstructive procedures were performed in 2019. Tumor removal is by far the most common reconstructive procedure with approximately 4.4 million procedures performed.

The Top 5 Reconstructive Procedures that were performed in 2019 were:

1. Tumor removal (4.4 million procedures)
2. Laceration repair (249,171 procedures)
3. Maxillofacial surgery (207,862 procedures)
4. Scar revision (181,132 procedures)
5. Hand surgery (141,139 procedures)

Although not within the top five, breast reconstruction saw a significant 5 percent year-over-year jump, a greater increase than any of the top five reconstructive procedures. "Some of the newer techniques have encouraged women to have breast reconstruction who might not have chosen it previously or may not have been good candidates for the procedure in the past," Dr. Jeffers said.

June 25, 2020 - Only about 1 out 7 American women have heard about breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) - an immune system cancer occurring in a small percentage of women with breast implants, according to a new survey.

Awareness increases to just over half among women who have breast implants, according to the new research by Justin M. Sacks, MD, MBA, and colleagues. Dr. Sacks is Chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri, and a member of the American Society of Plastic Surgeons.

"Our findings can help surgeons navigate the risks of BIA-ALCL with current and prospective patients and can guide future public education efforts on BIA-ALCL," Dr. Sacks and coauthors write. The study appears in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Five hundred American women responded to a crowdsourced survey assessing their knowledge and concerns about BIA-ALCL: a form of lymphoma that can develop around breast implants. Individual risk of BIA-ALCL is very low, estimated to occur in 1 in 3,000 to 12,000 women with textured breast implants (associated with a higher BIA-ALCL rate than smooth-surfaced implants). Yet more than 620 cases and at least 17 deaths from BIA-ALCL have been reported worldwide.

Particularly since a US Food and Drug Administration (FDA) update in 2019, several high-profile media outlets have reported on evolving knowledge of BIA-ALCL. Dr. Sacks and colleagues designed their survey to assess women's knowledge and perceptions regarding BIA-ALCL and cosmetic/reconstructive breast implants.

Overall, just 13.6 percent of the women surveyed said they had heard of BIA-ALCL. Twelve percent of respondents had received breast implants - in this group, awareness of BIA-ALCL increased to 51.7 percent.

After receiving information about the risk of BIA-ALCL, about 58 percent of women said they would still be willing to receive a reconstructive breast implant, while 46 percent said they would be willing to undergo cosmetic breast implant placement. In contrast, about 36 percent of women reported they would be less likely to receive an implant.

Two-thirds of the women with breast implants "expressed some degree of concern" regarding BIA-ALCL. Thirty-five percent were "strongly considering removing their implants." Currently, there is no recommendation to remove breast implants in women with no implant-related symptoms. (Symptoms of BIA-ALCL include swelling, a mass, or pain in the area of the breast implant, often many years after implant placement.)

Most women who had heard of BIA-ALCL got their information through the media and healthcare blogs. "Our findings suggest that professional healthcare blogs and media outlets may be the most effective way to spread knowledge, particularly to those who are not in direct contact with healthcare professionals," Dr. Sacks and colleagues write.

The authors urge a proactive approach to communicating accurate information about this potentially serious, yet highly treatable cancer - especially to women who have undergone cosmetic or reconstructive surgery using breast implants. Patients should be directed to up-to-date and authoritative sources of information: the ASPS maintains an information page about BIA-ALCL. The US Food and Drug Administration also has a "question and answer page" about BIA-ALCL.

June 25, 2020 - Replacing guidelines for managing women with abnormal results on cervical cancer screening test from 2012, new recommendations from ASCCP emphasize more precise management based on estimates of the patient's risk - enabling more personalized recommendations for diagnosis, treatment, and follow-up. The revised guidelines with updated recommendations are now available in the Journal of Lower Genital Tract Disease (JLGTD), official journal of ASCCP. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors were published in JLGTD on April 2, 2020. The recommendations reflect advances in understanding of the multiple factors affecting a woman's risk of developing cervical cancer or precancer. Rebecca Perkins, MD, of Boston University School of Medicine and Richard Guido, MD, of University of Pittsburgh are lead authors of the revised Guideline documents.

Focus on 'More Complete and Precise' Management Based on Risk Estimates in Women with Cervical Screening Abnormalities

The three available strategies for cervical cancer screening are primary HPV screening, co-testing with HPV testing and cervical cytology (Papanicolaou test), and cervical cytology alone. The 2012 Guidelines were an important step forward, based on the principle of "equal management for equal risk."

Developed by a consensus of 19 professional societies, federal agencies, and patient advocacy groups, convened by ASCCP, the new update "further aligns management recommendations with current understanding of HPV natural history and cervical carcinogenesis [cancer development]." Objectives of the 2019 ASCCP Risk-Based Management Consensus Guidelines include:

Allowing for immediate and five-year personal risk estimation for the patient. Drs. Perkins and Guido and coauthors write, "New data indicate that a patient's risk of developing cervical precancer or cancer can be estimated using current screening test results and prior screening test and biopsy results," along with data on age and other personal factors. The revised recommendations incorporate recent evidence showing that patients with previous abnormal cervical screening results require more frequent screening.

Providing more appropriate intervention for high-risk individuals. The new 2019 risk-based guidelines call for more frequent follow-up, colposcopy/biopsy, and treatment for patients with higher individualized risk estimates of developing more advanced precancers or cervical cancer.

Recommending less intervention for low-risk individuals in order to decrease testing and treatment that won't prevent cancer and may cause reproductive harm. The new 2019 risk-based guidelines build on recent evidence showing that patients with lower-risk characteristic need less frequent-follow-up, and in some cases can take a 'wait-and-see' approach rather than undergoing immediate colposcopy/biopsy in some cases.

Allowing for the future addition of new screening and management technologies, and risk modifiers (such as HPV vaccination status). These changes reflect the rapidly evolving field of cervical cancer prevention and changes in population risk as more HPV-vaccinated women reaching screening age.

Recognizing that the new guidelines bring together an abundance of data, ASCCP has launched a brand new app, and soon a website, to streamline the navigation of the new 2019 risk-based guidelines. These computer resources greatly simplify what would otherwise be a very complex system. More information on this technology can be found at http://www.asccp.org.

"The revised Guidelines provide a framework for incorporating new data and technologies as ongoing incremental recommendation revisions, minimizing time to implement changes that are beneficial to patient care," Drs. Perkins and Guido and colleagues conclude. They plan future studies to assess the costs, benefits, and effectiveness of the updated recommendations, along with a guideline dissemination strategy "to create a new national standard-of-care for management of abnormal cervical cancer screening test results."

There's some good news in New Jersey about a potentially deadly tick-borne bacterium. Rutgers researchers examined more than 3,000 ticks in the Garden State and found only one carrying Rickettsia rickettsii, the bacterium that causes Rocky Mountain spotted fever.

But cases of tick-borne spotted fevers have increased east of the Mississippi River, and more research is needed to understand why, according to a study in The American Journal of Tropical Medicine and Hygiene.

Rocky Mountain spotted fever from infection with Rickettsia rickettsii can involve blood vessel damage, gangrene and organ failure. It was rare in the United States and limited to the Mountain states until the beginning of this century. Since then, the mid-Atlantic states have seen a steep increase in spotted fever cases that are associated with a lower risk of severe illness and death - a puzzling and unexplained phenomenon.

In the past decade, New Jersey has reported between 42 and 144 cases of spotted fever a year, but it is unclear which, if any, involved the dangerous Rickettsia rickettsii since current blood tests for spotted fever do not distinguish between different kinds of Rickettsia bacteria.

"CDC researchers recently found that the invasive Asian longhorned tick, like the American dog tick and lone star tick, is an efficient vector of Rickettsia rickettsii in the lab," said senior author Dina M. Fonseca, a professor and director of the Center for Vector Biology in the Department of Entomology in the School of Environmental and Biological Sciences at Rutgers University-New Brunswick. "The Asian longhorned tick, which was first detected in the U.S. by Rutgers Center for Vector Biology researchers, is now very abundant in some New Jersey counties. And while this tick species has not been found infected with any human pathogens in the U.S. so far, this raised concerns. Our finding of the rarity of Rickettsia rickettsii in New Jersey is good news, but we can't let our guard down."

Rutgers researchers looked for the pathogen in two separate studies. The latest one, published this week, included 805 ticks collected statewide during a 2018 Tick Blitz and 394 ticks collected from 2013 to 2018. It found no evidence of the pathogen. The other study, published this year, involved 1,858 ticks collected in Monmouth County in 2018 and found Rickettsia rickettsii in one.

"We do not rule out that cases of Rocky Mountain spotted fever may occur in New Jersey since the deadly bacteria have been detected in New Jersey ticks. However, our results indicate that most cases of spotted fevers in New Jersey are likely caused by other Rickettsia bacteria," said Jim Occi, a Rutgers doctoral student who was the lead author of the statewide study.

The Monmouth County study was led by Andrea M. Egizi, a visiting professor in the Department of Entomology at Rutgers who earned a doctorate at Rutgers, and is a research scientist with the Monmouth County Tick-borne Diseases Laboratory hosted by the Rutgers Center for Vector Biology.

Rutgers Center for Vector Biology researchers reviewed studies from neighboring states and, in New Jersey, developed statewide surveillance of Rickettsia pathogens in the American dog tick and the lone star tick, the two tick species thought to be the primary vectors. The surveillance confirmed the increased distribution and abundance of lone star ticks across the Garden State.

Acknowledging health as a universal human right could galvanize people and organizations to make major improvements in health worldwide, according to new research from faculty at Binghamton University, State University of New York.

"In the U.S., few people think that everyone has a right to health or universal health care. I think that if we commit to protecting everyone's rights to health, and think creatively about how to do so, we can help a lot of people," said Nicole Hassoun, professor of philosophy at Binghamton University, State University of New York.

The human right to health is important for protecting everyone's ability to live minimally good lives, in part, because it gives rise to what Hassoun calls the virtue of creative resolve - a fundamental commitment to overcoming apparent tragedy. That is, those committed to fulfilling the right often refuse to accept that doing so is impossible, and come up with creative ways of fulfilling the right, and act to fulfill it. Those who lead efforts to improve public health often exhibit the virtue.

"Consider how human rights advocates galvanized a global effort to extend access to essential medicines for HIV around the world," said Hassoun. "Activists simply refused to accept pharmaceutical companies' claim that it was impossible to lower prices and educated patients to demand access to treatment. Mass protests shifted public opinion and generic completion brought prices down from $12,000 per patient per year to $350. Similar efforts have transformed the global health landscape helping us eliminate smallpox and reduce the prevalence of many other devastating diseases."

Hassoun believes that the human right to health could guide national and international policy.

"Committing to fulfilling everyone's human right to health can help us overcome the need to ration: it can help us find the resources we need to fulfill the right when it seems that we lack them. It can help us criticize existing policies and support proposals for positive change," said Hassoun. "People need many things for health, but that is not a reason to reject the right. By fulfilling everyone's right to health, we may also fulfill many other rights (e.g. rights to clean water, education, and food). Moreover, the human right to health can require protecting public health with things like vaccines. Doing so is important for protecting communities as well as individuals."

OAK BROOK, Ill. (June 24, 2020) - In recent weeks, a multisystem hyperinflammatory condition has emerged in children in association with prior exposure or infection to SARS-CoV-2. A new case series published in the journal Radiology examines the spectrum of imaging findings in children with the post-COVID-19 inflammatory condition known in the U.S. as Multisystem Inflammatory Syndrome in Children (MIS-C).

The array of findings includes airway inflammation and rapid development of pulmonary edema, coronary artery aneurysms, and extensive intra-abdominal inflammatory changes.

In April 2020, Evelina London Children's Hospital in London, U.K., experienced a surge of children with a multi-system hyperinflammatory syndrome. The children had a variety of symptoms, including fever, headaches, abdominal pain, rash and conjunctivitis. Clinical features and lab findings shared some similarities to those of Kawasaki disease--which causes inflammation in the walls of blood vessels--Kawasaki-disease shock syndrome or toxic-shock syndrome, although atypical and more severe.

"Our hospital saw an unprecedented cluster of children presenting with MIS-C, a new hyperinflammatory syndrome in children related to the current COVID-19 pandemic--the recognition of which led to a national alert," said the study's lead author, Shema Hameed, M.B.B.S., consultant pediatric radiologist at Evelina London Children's Hospital.

For the study, researchers performed a retrospective review of clinical, laboratory and imaging findings of the first 35 children under age 17 who were admitted to the pediatric hospital that met the case definition for MIS-C. The children were admitted from April 14 to May 9, 2020, and included 27 boys and eight girls, with a median age of 11 years old.

The most common clinical presentation was fever, found in 33 (94%) of the children, gastrointestinal symptoms including abdominal pain, vomiting and diarrhea in 30 (86%) of the children, rash (13 or 37%) and conjunctivitis (9 or 26%). Twenty-one children (60%) were in shock. Clinical status was severe enough to warrant management in the pediatric intensive care unit in 24 of 35 children (69%), of which 7 (20%) required mechanical ventilation and 20 (57%) inotropic support.

Two children required extracorporeal membrane oxygenation (ECMO) due to severe myocardial dysfunction. Lab tests revealed that all of the children had abnormal white blood cell counts.

The study identified a pattern of imaging findings in post COVID-19 MIS-C, including airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms and extensive abdominal inflammatory changes within the right iliac fossa.

All 35 children underwent chest X-ray due to fever, sepsis or features of multisystem inflammation. Nineteen X-rays were abnormal, the most common finding being that of bronchial wall thickening.

The predominant findings on chest CT were basal consolidation, or part of the lung filling with fluid; and collapsed lung with pleural effusions, or build-up of fluid in the outer membranes of the lungs.

Abdominal ultrasound findings included inflammatory changes within the right iliac fossa, with mesenteric fat stranding, lymphadenopathy and bowel wall thickening, as well as free fluid in the pelvis.

"As pediatric radiologists, we were interested in the emerging pattern of imaging findings that we observed in these children," Dr. Hameed said. "Our intention is to bring these findings to the attention of the wider radiological community."

The authors advise that future studies should include a larger group of patients, ideally utilizing multi-center databases to assess the radiological findings alongside the complex clinical course of these young patients.

BOSTON - (June 25, 2020) - Historically, half or more of people with type 1 diabetes develop kidney disease, which frequently progresses to kidney failure requiring hemodialysis or a kidney transplant for survival. The high rate of this diabetic complication has dropped slightly in recent years, with the advent of better ways to control blood glucose (sugar) levels and improved blood pressure drugs, "but diabetic kidney disease is still a huge problem," says Alessandro Doria, MD, PhD, MPH, Senior Investigator in Joslin Diabetes Center's Section on Genetics and Epidemiology.

Progression of kidney disease in type 1 diabetes is correlated with increased amounts of a compound in the blood called uric acid. Hoping that a drug that reduces these uric acid levels would slow the disease, Doria and his colleagues launched a multi-institution randomized clinical trial that enrolled 530 participants with type 1 diabetes and early-to-moderate kidney disease.

Results of the Preventing Early Renal Loss in Diabetes (PERL) study were just published in the New England Journal of Medicine (NEJM), the leading clinical research journal. Unfortunately, this study did not show the desired clinical benefits. "This is not the result that we wanted," says Doria, "but it does give a very clear answer to an important scientific question."

A second trial by Australian researchers on patients with a variety of chronic kidney diseases, some with diabetes, published alongside the PERL study in the NEJM, found similar results.

The PERL trial grew out of several studies that followed a cohort of people with type 1 diabetes, including one in which Doria partnered with Andrzej Krolewski, MD, PhD, head of the Section on Genetics and Epidemiology. In a 2011 paper, the Joslin scientists demonstrated that in this cohort, people with higher levels of uric acid in their blood were more likely to display a high rate of kidney function loss. Two other research groups in Denver, Colorado and Copenhagen, Denmark obtained similar results.

"This was an actionable discovery, because allopurinol, a drug that's been on the market since the 1960s, can easily reduce uric acid," says Doria, who is also a professor of medicine at Harvard Medical School.

Allopurinol is prescribed for gout, an inflammatory condition caused by excess uric acid, he explains. It's an inexpensive generic drug with known side effects that can largely be avoided. Additionally, allopurinol produced apparent benefits in much smaller clinical trials among people with chronic kidney disease, a minority of whom had diabetes.

Doria teamed up with S. Michael Mauer, MD, of the University of Minnesota Medical School to design and carry out a clinical trial with support from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and JDRF. The PERL consortium eventually grew to 16 sites.

Participants in the three-year, placebo-controlled and double-blinded trial received the current standard of care, including a renin-angiotensin system inhibitor--an existing type of drug shown in the 1990s to slow kidney damage, albeit incompletely.

The key measurement of kidney function for PERL was glomerular filtration rate (GFR), a measure of how much blood is filtered every minute by the kidneys. GFR drops as kidney disease progresses.

Over the three years of the study, levels of uric acid dropped about 35% on average among people given allopurinol compared to those who weren't. "But despite this very nice reduction in uric acid, we could not see any effect on GFR," Doria says.

He and his colleagues will continue to follow participants through their medical records and through national databases that track people who eventually progress to dialysis or kidney transplants.

Researchers at Joslin and other institutions continue to examine other potential routes to guard against kidney disease among people with type 1 diabetes.

Despite its disappointing conclusion, "PERL was a textbook example of using epidemiology to find treatment targets, and then designing a study to translate those findings and try to find a new intervention," Doria says. "In this case, it didn't work. But this is exactly why we do epidemiological studies, and how our scientific understanding advances."

A new survey of more than 1,000 people with multiple sclerosis finds that an overwhelming majority use complementary and alternative medicine, with many using cannabis.

Researchers at Oregon Health & Science University conducted the survey of people in Oregon and Southwest Washington in 2018. The results were published recently in the journal Multiple Sclerosis and Related Disorders.

The survey found that patients are nine times more likely to talk with their neurologist about the use of alternative therapies than patients in a similar survey conducted in 2001, a sign of broader societal acceptance of treatments beyond conventional medications. In the years since the first survey, several conventional medications have become available to manage MS-related disease activity.

Even so, patients appear to be more inclined to use alternatives such as dietary supplements, despite limited evidence of their effectiveness.

"The use of these alternative supplements has remained high even though we have all these other treatment modalities," said lead author Elizabeth Silbermann, M.D., a fellow in neurology in the OHSU School of Medicine.

Key findings:

81% used dietary supplements such as vitamins, minerals and herbs, up from 65% in the same survey conducted almost two decades ago.

39% used mind-body therapies such as mindfulness and massage, up from 14% in the earlier survey.

81% used exercise to help manage their symptoms - an increase from 67% in 2001.

The use of cannabis was common among respondents in the new survey, with about 30% reporting that they've used it in a variety of forms. Although cannabis remains an illegal substance under federal law, voters in recent years legalized it in both Oregon and Washington state.

Even though traditional uses of alternative therapies such as botanical supplements dates back hundreds of years, scientific research generally has been limited. Silbermann said it's a positive sign that patients are more open to discussing their use of alternatives with their neurologist because it's important to manage interactions with conventional medications.

"There's been a change in culture between patients and providers over the past 20 years," Silbermann said. "It's less paternalistic and more of a partnership."

More research is needed so that neurologists can tell patients what does and doesn't help their MS, she said. About 85% of the respondents reported mild or moderate disability.

Senior author Rebecca Spain, M.D., M.S.P.H., associate professor of neurology in the OHSU School of Medicine, said she was gratified the survey reflected patients' comfort and openness in sharing their full experience with their doctors. She said that may be due in part to OHSU's well-established reputation as an academic health center that supports patients' use of complementary and alternative medicine, or CAM.

"Patients' openness in sharing the whole picture of what CAM they're taking has allowed us to better understand and effectively care for our patients with MS," Spain said.