Body

AUSTIN, Texas -- Mexican women born and educated in Mexico who now live in Texas breastfeed longer than those born and educated in the United States. That's the finding from new research from the Texas Policy Evaluation Project (TxPEP) at The University of Texas at Austin, which points to a "breastfeeding gap" among some Mexican-origin women living in Texas.

The study, published in Pediatrics, compared 1,235 women of Mexican origin living in Texas who were: 1) both born and educated in Mexico, 2) born in Mexico and but finished their last year of education in the United States, and 3) both born and educated in the United States.

Of the women who started breastfeeding, there was no difference among the groups in how long the women intended to breastfeed: 85% intended to breastfeed for at least 6 months and 41% intended to breastfeed for a year or longer. Differences came in the actual duration of breastfeeding: Over half of women born and educated in Mexico breastfed for at least 6 months, compared with 38% of women born in Mexico and educated in the U.S. and just 23% of women who were born and educated in the U.S.

In line with previous research, this study also showed that for all women, early formula use, returning to work and smoking were all risk factors for discontinuing breastfeeding earlier than intended.

"There is plenty that can be done to help all women meet their breastfeeding goals -- discussing breastfeeding plans at prenatal visits, providing support at pediatric appointments, postponing early formula supplementation, and more," said Michelle Eilers, a doctoral student in sociology and graduate research associate at the Texas Policy Evaluation Project at UT Austin. "Our study shows a breastfeeding gap that can help physicians, nurses and lactation consultants be aware that additional support may be needed for Mexican American women who were born in the United States so that they can meet their breastfeeding goals."

Breastfeeding confers health benefits for mothers and their newborns. The American Academy of Pediatrics recommends that all mothers breastfeed one year or longer and exclusively breastfeed for about six months after delivery.

"We all want to see healthy mothers and healthy babies, and breastfeeding is one of the most cost-effective ways to promote health and child development in early life," said study co-author Rafael Pérez-Escamilla, a professor of public health and the director of the Office of Public Health Practice at the Yale School of Public Health. "The more we can tailor breastfeeding protection, promotion and support programs to the needs of immigrant populations with different acculturation trajectories, the more effective interventions at maternity facilities, the WIC program and worksites will be."

A nationwide study of nearly 7,500 people who are obese or severely obese has found that bariatric surgery is linked to significantly fewer heart attacks and strokes.

The study, which is published in the European Heart Journal [1] today (Thursday), found there were 60% fewer fatal and non-fatal heart attacks and stroke among 3,701 men and women who received bariatric surgery compared to the same number of patients who did not, during an average of 11 years following the surgery.

In addition, patients who had bariatric surgery lost significantly more weight (an average of over 10 kg more), and type 2 diabetes was more likely to improve to the point where the patients no longer required medication to maintain normal blood sugar levels.

Bariatric surgery involves restricting how much food the stomach can hold, usually by means of a gastric band that is placed around the stomach, or a gastric bypass that links the top part of the stomach to the small intestine. Both methods mean the patient does not need to eat so much to feel full, and the gastric bypass reduces the number of calories absorbed from food. [2]

Researchers at Imperial College London (UK) analysed data from the Clinical Practice Research Datalink (CPRD) database, which holds information on over 11 million patients from 674 general practice surgeries in the UK, dating from 1987 to the present. They extracted data on 3,701 patients who had a body mass index (BMI) of 35 kg/m2 or more, who had not suffered a heart attack or stroke when the study started and who had undergone bariatric surgery. They also looked at a control group of 3,701 patients who matched the first group in age, BMI and gender but who had not had bariatric surgery.

They adjusted for factors that could affect the results, such as high levels of cholesterol in the blood, smoking, alcohol and cocaine use, exercise and use of medications, such as statins, beta blockers and hormone replacement therapy. The average (median) age was 36 years in both groups; the average (median) BMI before surgery was 40.5 kg/m2 in the group that had bariatric surgery and 40.3 kg/m2 in the group that did not.

During follow-up, there were 37 fatal or non-fatal heart attacks or strokes in the bariatric surgery group and 93 in the non-surgery group.

Dr Maddalena Ardissino, academic foundation trainee at Imperial and joint first author of the EHJ paper, said: "The results of our study indicated that the rates of heart attacks and strokes were significantly lower in those who underwent bariatric surgery; specifically, we observed lower rates of heart attacks. This means that bariatric surgery was associated with a 1.5% reduction in the absolute risk of heart attacks or strokes; 62 patients would need to have bariatric surgery to prevent one heart attack or stroke. As this was a young group of patients, in whom we would expect to see fewer such events than in older patients, the reduction in the absolute risk has important clinical implications.

"Rates of acute ischaemic stroke were similar across the two groups, though very few events were recorded."

There was a 60% reduction in new diagnoses of heart failure during follow-up, 22 in the bariatric surgery group and 46 in the control group, and death from any cause was 80% lower among patients who had bariatric surgery compared to those who did not: 45 versus 182 deaths respectively.

Co-author, Peter Collins, Professor of Clinical Cardiology at the National Heart and Lung Institute at Imperial, said: "It's important to emphasise that this is a retrospective study and can only show there is an association between bariatric surgery and a reduced risk of heart attacks and strokes, not that the surgery causes the reduction in risk. Large, prospective trials are required to show causation. Nonetheless, the difference observed in cardiovascular events is striking, and it indicates that if a causative effect does indeed exist, its size has the potential to be very large and important.

"These findings call for increased awareness and increased uptake of bariatric surgery as a treatment step for patients with obesity who do not achieve significant weight loss on lifestyle and pharmacological therapy alone. This is important, as only a small minority of patients are offered the surgery and, among these, a minority actually undergo it. The rate has been estimated to be as low as 1%." [3]

Senior author, Mr Sanjay Purkayastha, a senior lecturer at Imperial and also a consultant bariatric surgeon at Imperial College Healthcare NHS Trust, said: "The results of this study, taken together with the wealth of emerging evidence on the benefits of bariatric surgery, not only on weight loss but also on the management and prevention of obesity-related health problems, call for a definitive shift in the perception of bariatric surgery, from what used to be seen as a 'bonus' or 'extra', almost as an aesthetic procedure undergone by only a minority of the eligible population, to a truly disease-preventing and standard of care procedure that should at least be offered sooner rather than later to eligible patients.

"GPs should consider earlier referral to derive greater benefits in their patients. Especially for patients with type 2 diabetes, as several prospective randomised studies have shown that bariatric surgery is significantly better, currently, compared to best medical management. Similar studies should be designed to further investigate the impact on heart attacks and strokes."

This is the largest study of bariatric patients so far, and the findings are likely to be generalisable to the whole of the UK and most Western countries because of the diverse nature of the UK population within the CPRD database. However, limitations include that because the average age of the patients was relatively low, there were few heart attacks and strokes, so the effect of surgery may be underestimated. In addition, other factors that could affect the results may be unknown or unmeasurable.

Experiencing the symptoms of opioid withdrawal increases the odds that a person who injects drugs will share needles or have a non-fatal overdose, according to new USC study published in the journal Drug and Alcohol Dependence.

The study has implications for others with opioid use disorder, even if they don't inject opioids, since they are also likely to experience withdrawal, putting them at higher risk for an overdose.

Opioid withdrawal symptoms can include severe pain, abdominal cramps, diarrhea, nausea and vomiting, as well as agitation and anxiety.

The study says medication-assisted treatment for opioid withdrawal is urgently needed and recommends that the drug buprenorphine be made available to those at risk. Typically prescribed by primary care physicians, buprenorphine tightly binds to opiate receptors in the brain, preventing a person from feeling the effects of the opioid, including the symptoms of withdrawal.

"Withdrawal is one of the main chronic health challenges for this population, and we need to be intervening on it," said Ricky Bluthenthal, PhD, associate dean for social justice at the Keck School of Medicine of USC and the study's lead author. "I suspect if we're successful at that, then a lot of other things that can improve health in this population will be more readily achieved."

Millions of Americans misuse opioids each year and the Centers for Disease Control and Prevention (CDC) estimates that an average of 130 people die each day from an opioid overdose. According to the CDC, needle sharing increases a person's risk of blood borne viruses such as HIV and hepatitis as well as other serious health problems.

This is the first study to report on the attributes and frequency of opioid withdrawal symptoms in a large sample of people who inject drugs. People were recruited at public places where people who use drugs congregate in San Francisco and Los Angeles.

Vast majority of study participants experienced opioid withdrawal

Of the more than 800 study participants, 85 percent reported experiencing at least one episode of opioid withdrawal in the previous six months. More than a third reported having withdrawal symptoms on a weekly basis or more. Most described their symptoms as very or extremely painful.

Researchers found any opioid withdrawal was associated with needle sharing and non-fatal overdose. People who reported having withdrawal symptoms weekly or more had even higher odds of sharing needles or overdosing than those who reported less. People who reported very severe pain from withdrawal also had higher odds of overdosing, though the severity of pain was not associated with needle sharing.

"Opioid withdrawal is a common public health issue and it is rarely treated," said Bluthenthal. "Knowing that 85% or so of the people who are chronic opiate users are going to experience withdrawal at some point in the near future and that we have medication to treat it, we should make it available for that purpose."

Combining a therapeutic vaccine for human papilloma virus (HPV) with two standard chemotherapy drugs may extend survival in patients with advanced, recurrent cervical cancer, according to a phase 1/2 trial involving 77 patients. The trial results suggest that integrating therapeutic cancer vaccines with traditional drug regimens could invigorate anticancer immunity and improve outcomes in patients with end-stage cervical cancer, who currently have few treatment options. Therapeutic cancer vaccines work by expanding the population of tumor-specific T cells, resulting in more robust antitumor immunity. These vaccines have shown promise in treating pre-cancerous lesions caused by HPV, a virus that plays a key role in the development of cervical cancer. However, other cell types such as myeloid cells pose a major obstacle because they can suppress the expansion of T cells, counteracting the stimulation provided by the vaccine. Building on previous work, Cornelis Melief and colleagues administered the therapeutic HPV vaccine ISA101 to 77 HPV-positive cervical cancer patients receiving the chemotherapy drugs carboplatin and paclitaxel. Although the patients experienced chemotherapy-related side effects, the vaccine was well-tolerated and did not cause any additional adverse reactions. Melief et al. observed that the drugs reduced the amount of suppressive myeloid cells, allowing ISA101 to better stimulate T cells. Ultimately, 43% of the patients achieved tumor regression and another 43% showed stable disease. Furthermore, patients who showed stronger responses to the vaccine had a longer median overall survival of 16.8 months compared with patients who displayed weaker responses (11.2 months). The scientists plan to conduct further studies to compare the benefits of adding ISA101 to chemotherapy regimens versus receiving chemotherapy alone.

For researchers investigating Alzheimer's Disease (AD), a devastating neurodegenerative illness afflicting close to 6 million Americans, it is the best and worst of times.

Scientists have made exponential advances in understanding many aspects of the mysterious disease since it was first diagnosed over 100 years ago. Nevertheless, every effort to find a cure for AD or even slow its relentless advance has met with dispiriting failure.

The next chapter in the fight against the disease will require dynamic insights and adventurous new approaches.

In a lively discussion appearing in the Viewpoint section of the journal Nature Reviews Neurology, Ben Readhead, a researcher in the ASU-Banner Neurodegenerative Disease Research Center at the Biodesign Institute joins several distinguished colleagues to discuss the idea that bacteria, viruses or other infectious pathogens may play a role in Alzheimer's disease.

The concept, sometimes referred to as the infectious theory of Alzheimer's disease, was first proposed some 30 years ago. Since then, the idea has encountered considerable resistance in the research community. Until recently, it had been largely displaced in favor of approaches based on the amyloid hypothesis, the leading theory of Alzheimer's, which identifies plaques of amyloid beta and tangles of tau protein as underlying drivers of the disease.

The research landscape for AD, however, may be changing. The repeated failures of amyloid-targeting drugs along with recent discoveries supporting a microbial link to AD have generated fresh interest in this unorthodox approach.

The Viewpoint article continues a discussion that took place last year at the Alzheimer's Association International Conference in Los Angeles, including a panel titled "Emerging Concepts in Basic Science Series: Is There a Causative Role for Infectious Organisms in Alzheimer's Disease?"

"The acceleration of technology and methods for profiling biological systems has really opened up new approaches for understanding whether microbes might play a role in AD," says Readhead. The AAIC debate, and this Viewpoint article were an opportunity for scientists with diverse opinions to discuss key evidence, discordant findings, and opportunities for new investigations that might help advance the field to a more sophisticated understand of the role of microbes in AD."

Plaques and tangles

Since the first diagnosis of Alzheimer's disease in 1906, research into the deadly affliction has focused on two hallmarks appearing consistently in brains damaged by Alzheimer's: sticky accumulations of plaque occupying the extracellular spaces, caused by the protein amyloid- beta, and twisted forms of the protein tau, known as neurofibrillary tangles, which crowd the interiors of affected neurons.

Although plaques and tangles are regarded as diagnostic signposts of Alzheimer's disease, many believe they are late arrivals in the pitiless course of the ailment, rather than primary instigators of the illness. Recently, a pair or promising experimental drugs, gantenerumab, made by Roche, and solanezumab, made by Eli Lilly, were tested on a unique group of participants. Still young and healthy at the time of the drug trials, each carried a rare mutation that guaranteed they would develop dementia over time, making them ideal candidates to test if amyloid-fighting drugs, given well in advance of AD symptoms, could prove beneficial.

The results, reported a month ago, confirmed the drugs failed to prevent or slow mental decline associated with dementia. It was the latest stunning blow to the amyloid hypothesis--the reigning theory describing the mechanisms of Alzheimer's onset and progression.

Another path to AD

Even before the amyloid hypothesis came under attack as a potential blind alley, alternate theories of the disease had been proposed. One of the more intriguing is described in the Viewpoint discussion. Perhaps Alzheimer's is caused not by accumulations of inanimate protein but rather by microorganisms, the way so many infectious diseases are.

Readhead and others have tracked the presence of various infectious agents that appear to be associated with Alzheimer's disease. The Viewpoint discussion highlights much of the circumstantial evidence suggesting that microbes may indeed be crucial players in Alzheimer's pathology, while emphasizing a number of confounding factors and the serious challenges involved in proving a pathogen link to the disease.

In earlier research, Readhead and his colleagues at the Icahn School of Medicine at Mount Sinai used large data sets in order to explore the prevalence of two common herpesviruses sometimes found in Alzheimer's brain tissue. The study demonstrated that three viral strains, HSV-1, HHV-6A and 7 appeared in greater abundance in brain samples derived from Alzheimer's patients, compared with normal brains.

The viruses also seem to be implicated in the AD-related genetic networks associated with classic Alzheimer's pathology, including cell death, accumulation of amyloid-β and production of neurofibrillary tangles.

In the current article, Readhead is joined by Ruth Itzhaki, Emeritus Professor at Manchester University and a Visiting Professor at Oxford University, UK; Todd E. Golde, Professor of Neuroscience and Director of the Evelyn F. and William L. McKnight Brain Institute at the University of Florida, and director of the NIH-funded Florida Alzheimer's Disease Research Center; and Michael T. Heneka, currently the Director of the Department of Neurodegenerative Disease and Geriatric Psychiatry at the University of Bonn Medical Center.

All were participants in the 2019 AAIC debate.

Brain bugs

The Viewpoint discussion explores some of the leading evidence both for and against the infectious theory of Alzheimer's, highlighting both viral and bacterial correlates. It also offers suggestions for future research and drug development.

The panelists cite a number of reasons the pathogen theory has met with some hostility. Researchers may have insufficient background in microbiology or may inaccurately associate infectious agents solely with acute rather than chronic afflictions, though a number of microbial infections can indeed linger in the body asymptomatically for decades.

Perhaps the greatest resistance to the pathogen theory comes from proponents of the amyloid hypothesis, some of whom believe that it will diminish research into amyloid plaques and tau tangles. The Viewpoint article stresses that a microbial link with AD and the amyloid hypothesis may be complementary rather than exclusionary. It is still possible that deposition of amyloid instigates a process of neurological decline, followed by opportunistic infections, or that the reverse is the case, with amyloid deposits representing a defense response to infection, trapping invasive microbes in sticky concentrations of amyloid like insects entombed in tree resin.

Are microbes really causative agents of AD or do they perhaps act to accelerate disease processes set in motion by plaques and tangles or as-yet-undiscovered mechanisms? Could antiviral drugs protect the brain from infections that may be linked to cognitive decline? While much work remains in making the case for the infectious theory of AD pathology, the field has matured considerably. Based on encouraging advances, the NIH has decided to provide significant research funding for the topic and the American Society for Infectious Diseases is offering several grants to pursue new avenues of discovery.

The initiatives offer new hope in the fight against Alzheimer's, which remains the only leading killer without treatment or cure and one that exacts an extraordinary emotional and financial toll on patients, medical resources and families of those afflicted. Without a significant break in the case, the crisis is projected to explode by 2050, with more than 152 million patients worldwide suffering from Alzheimer's disease and other forms of dementia.

"This is an exciting time to be engaged in AD research. More than ever before, we're poised to be able to see into the basis of this devastating affliction," says Readhead. "It's energizing to see increased activity and attention being paid to the relatively underexplored idea of whether microbes play a causative role in AD. Regardless of how the eventual answer emerges, there is true value for the field in resolving this old, largely unanswered question."

Philadelphia, March 18, 2020 - Hyponatremia is a condition of low sodium concentration in the blood. Prolonged overhydration during exercise is the primary cause of all forms of exercise-associated hyponatremia (EAH) and should be avoided. The updated EAH clinical practice guidelines issued by the Wilderness Medical Society stress that individuals engaged in physical and endurance activities should drink to satisfy their thirst (known as "drink to thirst") to avoid overhydration. The guidelines appear in Wilderness & Environmental Medicine, published by Elsevier.

Review articles and international consensus statements have mainly focused on the incidence of EAH in organized endurance events that are conducted in the frontcountry, where medical tents and local emergency medical services are typically available on site and transport to a local hospital is readily available. However, many prolonged individual exertional activities such as backpacking, ultramarathons, and multiple-day endurance events take place in the backcountry with limited or no medical support and expectations of delayed medical evacuation.

Appropriated management of EAH depends first on correctly diagnosing the condition. The guidelines address the assessment of patients with overlapping or nonspecific signs that can make differential diagnosis challenging, for example, with heat exhaustion or exertional heat stroke.

"Even after 40 years of worldwide documentation of EAH in both frontcountry and backcountry physical activities there is still an ongoing need for education of the public, event directors, EMS personal, and clinicians for prevention strategies and medical management caused by overhydration of fluids that can result in rare, but life threatening medical outcomes," explained lead author Brad L. Bennett, PhD, Adjunct Professor, Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. "The typical field response for heat-related illness or when someone is dehydrated is to encourage oral hypotonic fluid intake or administer rapid isotonic IV fluids to endurance activity participants. However, such universal treatment may result in increased morbidity and mortality in the EAH patient."

The guidelines recommend that:

Appropriate education and coordination among participants, event directors, support crews, park rangers, first responders, and EMS transport personnel are essential in both prevention and management of EAH.

Prolonged overhydration during exercise, which is the primary risk factor in the development of all forms of EAH, should be avoided.

Sodium and/or salty snacks should be freely available for consumption along with the appropriate fluids, particularly in long, hot events in non-heat acclimatized persons.

Participants should drink enough to satisfy their thirst but avoid overdrinking.

Point-of-care testing should be done on at-risk, symptomatic patients, when available.

Oral fluids should be restricted if EAH from fluid overload is associated with mild symptoms.

Hypotonic fluids are contraindicated with suspected EAH.

The use of oral salt or hypertonic fluids may be effective in reversing moderate to severe symptoms of EAH when no IV hypertonic saline (3 percent) is available.

Patients should be observed for at least 60 minutes after exercise to ensure no decompensation from delayed symptomatic EAH.

Receiving caregivers should be alerted to the potential diagnosis of EAH and fluid management restrictions when transferring care.

"It is important to note that no single recommendation for fluid hydration will work in the range of physical activities in different humidity and ambient temperatures with varied sweat rate, body mass, exercise intensity, and duration. However, for the majority of individuals, drinking according to thirst can help prevent EAH and the potential for life threatening outcomes," commented Dr Bennett.

EAH is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe EAH being below 120 mEq/L. Symptoms may include nausea and vomiting, headache, short-term memory loss, confusion, and lethargy, altered mental status, coma, seizures, and/or respiratory distress, some of which can be confused with other medical conditions.

Danon disease is a very rare, life-threatening condition where the fundamental biological process of removing and recycling proteins does not work. This impairment results in dysfunction of the heart, skeletal muscle, neurologic system, eyes, and liver. Most patients die or require heart transplants by the third decade of life.

In a new study published online March 18, 2020 in Science Translational Medicine, researchers at University of California San Diego School of Medicine identified a novel way to treat Danon disease using gene therapy.

"Heart transplant is not always available for patients, and does not treat the other organs affected in Danon disease," said Eric Adler, MD, principal investigator of the study. Adler is a cardiologist at UC San Diego Health and director of cardiac transplant and mechanical circulatory support. "We knew we needed to find therapies specifically designed to address the underlying cause."

Danon disease is a result of mutations in the gene LAMP2. For nearly a decade, Adler and a team of researchers at UC San Diego Health have been working to determine whether gene therapy could provide a new treatment approach. Gene therapy involves either replacing or repairing a gene that causes a medical problem or adding genes to help the body treat disease. In this case, Adler and the team focused on adding a specially designed gene that restores LAMP2 function, resulting in improved cardiac and liver function.

"We utilized mice that were a model for Danon disease and missing this specific LAMP gene. We applied gene therapy to a group of these mice and compared to mice that did not receive treatment," said Adler. "The mice that received gene therapy expressed positive results in heart, liver and muscle function. The heart's overall function of ejecting blood and relaxing improved, as did the body's ability to degrade proteins and metabolism."

Danon disease is more common in males, and symptoms begin in early childhood or adolescence. "In many cases, the condition is inherited by a parent, typically the mother. We believe Danon disease is actually more common than we think, but it is often misdiagnosed," said Adler. "By utilizing gene therapy, we were able to identify a possible new treatment approach other than a heart transplant. This study is a significant step for patients with Danon disease."

Prior studies in Adler's lab have focused on using a patient's skin cells to create stem cells. These stem cells were used to create a heart model, allowing researchers to study Danon disease at the cellular level. The approach has provided new insight into the disease's pathology and led to the idea of using gene therapy. "Our work is also proof that using stem cells to model diseases has great potential for helping develop new medicines," said Adler.

The next step, said Adler, is testing in patients with Danon disease. A Phase I clinical trial for safety and efficacy has begun. "This is the first trial using gene therapy to treat a genetic cardiac disorder and three patients are currently being treated, which means we're that much closer to finding a cure for this terrible disease, and may be able to use similar methods to treat other diseases.

The American Journal of Gastroenterology published today a new study that reveals digestive symptoms, including diarrhea, are common in COVID-19 patients. The study comes from the Wuhan Medical Treatment Expert Group for COVID-19 in China.

Nearly half of COVID-19 patients enrolled in the study conducted in the Hubei province of China presented digestive symptoms, such as diarrhea and anorexia, and cited it as their chief complaint. The study also reveals that patients with digestive symptoms had a longer gap between the onset of symptoms and hospital admission than patients presenting only respiratory symptoms and were less likely to be cured and discharged than those without digestive symptoms.

The authors recommend that "the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge."

People with a history of cancer have an over two-fold risk of developing atrial fibrillation (AFib), the most common heart rhythm disorder, compared to the general population, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC). In particular, people who had prostate cancer had the highest burden of AFib, followed by those with colon, lung and breast cancers.

While earlier studies have shown that people with cancer are at greater risk for developing AFib at the time of cancer diagnosis, prior to any treatment and after therapy is initiated, researchers said this is the first study to examine AFib's association with specific cancer types. With AFib, the heart doesn't always beat or keep pace the way it should, which can lead to palpitations, dizziness and fatigue. If untreated, it can lead to blood clots, stroke and heart failure. People with AFib are five times more likely to have a stroke than people without the condition.

"When we looked at everyone with some form of AFib, those with certain types of cancer were more likely to have heart rhythm abnormalities, and this trend persisted even after accounting for other cardiovascular risk factors and disease," said Muhammad Khan, MD, a resident at St. Mary Medical Center in Langhorne, Pennsylvania, and the study's lead author. "We found 2.3-fold increased odds of having AFib with all cancers studied. There was a greater than 50% increased risk of AFib in prostate, colon and lung cancer patients. Of these three, those with prostate cancer had the highest risk of AFib."

The findings suggest that other factors related to the specific type of cancer itself may be contributing to AFib in these patients, Khan said.

"For example, these cancers may be associated with higher mortality due to circulating pro-coagulants and greater systemic inflammation, but this relationship has yet to be studied," he said. "Based on our findings, certain patients should be considered at higher risk of AFib and may benefit from cardiac evaluation and appropriate treatments, whether it be with medication or ablative techniques, to help improve the survival rates in the long-term."

Drawing on a data set known as the National Inpatient Sample, researchers analyzed the records of more than 143 million adult patients who visited a hospital in the United States between 2012 and 2015. Of these, 10% (roughly 14.5 million people) were found to have some form of AFib. Researchers then examined medical records for these patients to determine how often AFib and cancer coexisted and to determine whether people with certain cancer types were more likely to have this heart rhythm abnormality.

After adjusting for known cardiovascular risk factors and other heart conditions that could lead to AFib (for example, hypertension, diabetes, coronary artery disease, cardiomyopathy and valvular disorder), the odds of having AFib with any cancer was more than twice what would be expected. Prostate cancer ranked highest in association with AFib, followed by breast, lung, colon and non-Hodgkin's lymphoma. Death rates were also more likely among AFib patients who had prostate cancer, compared to those without AFib (3.28 vs. 2.31%); similar comparisons show the chance of dying was higher in non-Hodgkin's lymphoma (1.64 vs. 1.61%) and colon cancer (2.46 vs. 2.2%).

Khan said that he was surprised about the higher incidence of AFib with prostate cancer when compared with other cancers studied. While the researchers do not know why this might be, they have some ideas.

"The mean age of prostate cancer diagnosis and AFib is around the same--generally 66 years--so there may be a correlation between the two due to the similar age of onset. Given the older age of onset, these patients tend to have more comorbidities that may contribute to them developing AFib," Khan said.

Researchers were unable to distinguish whether AFib cases were new, chronic or paroxysmal (AFib that comes and goes and generally stops on its own). They were also unable to track which cancer treatments patients received. Many lifesaving cancer treatments, including certain chemotherapies and targeted drugs, are known to cause heart damage.

Future studies are needed to clarify what is behind the development of AFib in cancer patients, Khan said. Researchers need to investigate which inflammatory markers may have a greater association with the development of AFib and better understand how to treat AFib more effectively and possibly prevent its onset in cancer patients.

It's normal for expectant parents to worry about how well their baby is developing and growing. But could a newborn's birthweight serve as a red flag for risks to mom's future health, too? A new study, presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC), suggests that giving birth to a baby under 5.5 pounds may be an independent risk factor for developing changes in heart function that can lead to heart failure, a condition in which the heart is unable to pump enough blood and oxygen to meet the body's needs.

Recent data suggest adverse pregnancy outcomes, such as preeclampsia, high blood pressure during pregnancy, pre-term birth (

Researchers said their findings are the first to examine early changes in heart function prior to a woman developing symptomatic heart failure and should raise concerns about the cardiovascular impact of adverse pregnancy complications.

"There is emerging evidence that what happens during pregnancy may be a window into a woman's future cardiovascular health, but there are still important knowledge gaps about the early trajectory following pregnancy complications and structural changes that happen before someone has an event, which may ultimately help us to identify targets for prevention," said Priya Mehta, MD, a cardiology fellow at Northwestern University in Chicago and the study's lead author. "At 30 years of follow up, the women who had an adverse pregnancy outcome in our study had a lower absolute global longitudinal strain on their echocardiograms, which is an early marker of increased risk for heart failure. Clearly, the risk for heart disease doesn't go away when pregnancy ends, and these complications are a critical piece of a woman's past medical history that is not always routinely reported or asked about."

The study included 936 women from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a national, longitudinal cohort study that has followed people from a young age to examine the development of, and risk factors for, cardiovascular disease. Mehta said that, unlike previous studies that focused on a first or specific pregnancy, their study included women who had been followed for three decades after recruitment in 1985-86 and, therefore, was able to capture the woman's entire reproductive life course. Participants were 24 years old, on average, at the start of the study, and about half were black. Women who already had diabetes, high blood pressure or heart failure were excluded. Researchers collected and analyzed the number of pregnancies, pregnancy complications (preeclampsia,

gestational hypertension, pre-term birth of

Of the women in the study, 330 (35%) reported at least one adverse pregnancy outcome over an average of two births during the study period. At their 30-year follow-up, women who had experienced an adverse pregnancy outcome had a nearly 1% lower (worse) absolute global longitudinal strain--a magnitude of difference that has been shown in other studies to be associated with an increased risk for incident heart failure.

After adjusting for other known risk factors for heart disease, only low birthweight remained significantly associated with echocardiogram changes suggestive of increased risk for heart failure. For women with hypertensive disorders of pregnancy (preeclampsia or gestational hypertension) or pre-term birth, the risk for heart failure seemed to be explained, in part, by higher rates of high blood pressure, diabetes and obesity that developed in these women. Although more research is needed, Mehta said the findings underscore the need to be more intensive about managing the cardiovascular risks seen with these adverse pregnancy outcomes.

"Women who experience adverse pregnancy outcomes have more risk factors for heart disease at younger ages and, ultimately, have a higher rate of [early] heart disease," Mehta said. "Even though pregnancy complications have been included in some cardiovascular disease prevention recommendations and are named as a risk enhancer in the ACC/AHA primary prevention guideline, there needs to be more intensive surveillance and screening. We are missing women at high cardiovascular risk if we don't make it routine practice to take adverse pregnancy outcomes into account when we inquire about patients' cardiovascular history."

The other challenge, she said, is that clinicians must try to engage women at a time when they are focusing their energy on motherhood and their newborn, rather than remembering to prioritize self-care.

This study is limited by its reliance on self-reported information about pregnancy history; future studies should validate with medical records and determine whether an echocardiogram could help identify women who need strategies to lower heart risks.

Mehta plans to extend this research by exploring the mechanisms that lead to these women developing heart disease in order to identify strategies for prevention before, during and after pregnancy. Her future research will be supported through the ACC/Merck Research Fellowship Award, as one of two national recipients starting in July 2020.

Whether you like to burn the midnight oil to check emails or binge watch your favorite series, toss and turn or sleep until mid-morning, it seems the amount of sleep you get matters when it comes to your future vascular and heart health. Compared with people who slept for longer or shorter periods of time, those who reported sleeping seven or eight hours a night had significantly less evidence of stiffness in their arteries, indicating a lower chance of developing heart disease or suffering a stroke, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Even after accounting for other known risk factors for heart disease or stroke, people who slept less than six hours or more than eight hours a night had significantly greater odds of having plaque buildup in the walls of their carotid arteries--a 54% and 39% increase, respectively--compared with those who got seven or eight hours of shut eye. The study adds to mounting evidence that sleep patterns, similar to diet and exercise, may play a defining role in someone's cardiovascular risk.

"The message, based on our findings, is 'sleep well, but not too well.' Getting too little sleep appears bad for your health but too much seems to be harmful as well," said Evangelos Oikonomou, MD, consultant cardiologist and the study's lead author. "Unlike other heart disease risk factors such as age or genetics, sleep habits can be adjusted, and even after taking into consideration the impact of established risk factors for atherosclerosis and cardiovascular diseases--for example age, gender, obesity, smoking, hypertension, diabetes, high blood pressure and even a history of coronary artery disease--both short and long sleeping duration may act as additional risk factors."

For this analysis, researchers assessed sleep patterns in 1,752 people living in the Corinthia region of Greece using a standard questionnaire that was fielded by a trained cardiologist, primary care provider or nurse. Participants were then divided into one of four groups based on self-reported sleep duration: normal (seven to eight hours a night), short sleep duration (six to seven hours a night), very short sleep duration (less than six hours a night) or long sleep duration (greater than eight hours a night). Participants represented a broad spectrum of the general public, including healthy people as well as those with cardiovascular risk factors and established heart disease, and most were from rural areas with less than 1,000-2,000 inhabitants. They ranged in age from 40 to 98 years, with a mean age of 64 years old.

At the time of the study, each participant also underwent ultrasound imaging to measure the thickness of the inner part of the arterial wall. Thickening of the arterial walls reflects plaque buildup and is associated with an increased risk of stroke and other cardiovascular events. Intima media thickness of >1.5 mm or protrusion >50% compared to nearby segments of the artery wall was defined as atherosclerotic plaque.

Researchers uncovered a U-shaped pattern between sleep duration and early indicators of atherosclerosis, which underscores the need for a balanced sleep pattern, Oikonomou said. Intima media thickness and plaque build-up in the artery walls was greater in both the shorter and longer sleep duration groups as compared to normal sleep duration.

"We don't fully understand the relationship between sleep and cardiovascular health. It could be that sympathetic nervous system withdrawal or a slowing [of this system] that occurs during sleep may act as a recovery phase for [usual] vascular and cardiac strain," Oikonomou said. "Moreover, short sleep duration may be associated with increased cardiovascular risk factors--for example, unhealthy diet, stress, being overweight or greater alcohol consumption--whereas longer sleep duration may be associated with a less active lifestyle pattern and lower physical activity."

Researchers said that adopting a balanced sleep pattern of six to eight hours nightly may be just what the doctor ordered.

"It seems that this amount of sleep may act as an additive cardioprotective factor among people living in modern western societies, and there can be other health benefits to getting sufficient and quality sleep," Oikonomou added.

The amount of sleep someone needs depends on several factors, especially one's age. In the U.S., most guidelines recommend that adults sleep between seven and nine hours each night. Yet, one out of every three American adults do not get enough sleep, according to the Centers for Disease Control and Prevention. Poor sleep has also been linked to a higher risk of obesity, diabetes, high blood pressure, heart disease, poor mental health and even dying early.

This study is limited in that it relies on self-reported sleep patterns and is cross sectional in nature, so the relationship between sleep patterns and atherosclerotic activity is based on a single point in time. Further research is needed, especially to look at whether too much sleep is harmful, which hasn't been studied as well as getting too little.

Women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have significantly more chest pain caused by plaque build-up, yet less extensive disease as compared with men, according to new research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The study, which included a subset of women and men from the ISCHEMIA trial who received abnormal stress test results indicative of moderate to severe ischemia, is the first to look at sex differences within this patient population. Those with open arteries, or no obstructive coronary artery disease, on further testing were excluded from this analysis. Because women were more than three times as likely as men to have non-obstructive disease (34% vs. 11%), women only comprised 23% of study participants, with 4,011 men and 1,168 women ultimately being enrolled. Women in the study had 38% higher odds of having more chest pain than men, even after considering other factors such as age, race, stress test findings, medication use, smoking, diabetes, high blood pressure, prior heart attack, kidney function and overall heart function.

"Women are having more chest pain even though they have less plaque on imaging, and yet they have very abnormal stress test results," said Harmony Reynolds, MD, director of the Sarah Ross Soter Center for Women's Cardiovascular Disease at NYU Langone Health and the study's lead author.

The results beg the question of why and what might be different about the biology of how plaque forms in men and women, Reynolds said, especially as more severe angina is typically associated with higher rates of events like heart attack or death.

"The heart has nerves that can sense when there isn't enough blood flow, but we can't always tell if those nerves have been activated by a large amount of heart muscle or a smaller amount," she said. "Just like a small cut on your finger can really sting and hurt and yet it may hardly look like anything. So when it comes to the burden of chest pain in these women, is it because the activation of nerve endings in a relatively smaller amount of heart muscle will raise the red flag in a woman's brain differently, or is it because there are other factors going on in women, like small vessel disease, that we aren't assessing with the tests that we are using?"

The results underscore the need for more research and for clinicians to adopt a dual focus to prevent cardiovascular events and worsening disease, as well as to better control symptoms to improve patients' quality of life.

For this study, patients from the ISCHEMIA trial were included based on very abnormal stress test findings and presence of some degree of narrowed coronary arteries. Women were found to have less ischemia on stress tests than men even though they had more angina. Those tests included stress nuclear tests, stress echocardiograms and stress MRI tests. Chest pain symptoms were assessed using the validated Seattle Angina Questionnaire, which asked questions about how often patients experience chest pain and whether it affects daily activities, such as walking briskly, lifting, cooking, vacuuming, bathing and more.

"Even when women have very abnormal stress tests--more characteristic of what we think of as typical 'male type' coronary heart disease--they have less extensive atherosclerosis and yet they are still having more symptoms as compared to men," Reynolds said. "These findings suggest that just because there may not be as much plaque, many women may have chest pain that limits their daily activities, and we have medicines that can improve chest pain from heart disease."

This analysis is limited in that it only includes people with very abnormal stress tests. In addition, people whose symptoms were uncontrollable with medication could not be enrolled in the study.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Hamilton, ON (March 17, 2020) - An independent investigative as well as an international offender database are needed to tackle allegations of abuse in elite youth sport properly, urges a McMaster University expert, in an editorial published online in the British Journal of Sports Medicine.

Much is being done to protect young athletes, but "there are still significant gaps," says Margo Mountjoy, associate clinical professor of family medicine, member of the International Olympic Committee Working Group on the Prevention of Harassment and Abuse in Sport and a sports medicine clinician scientist. She is also the regional assistant dean of the Waterloo Regional Campus of McMaster's Michael G DeGroote School of Medicine.

She cites the case of Mary Cain as an exemplar of unhealthy practices in elite youth sport. Cain was a star performer at the age of 17 when she joined Nike's Oregon Project, which was set up to promote long distance running.

But Cain was constantly harried to lose more and more weight to boost her performance and ended up with an eating disorder. She went public last year with allegations of physical and psychological abuse at the hands of her coach, Alberto Salazar.

"Mary Cain's story demonstrates a culture where the sport leadership of Nike's Oregon Project failed to protect their female athletes," says Mountjoy. "Cain reported that there was no qualified sport-specific physician, physiologist, dietician or psychologist available, nor an independent safeguarding officer to hear her concerns."

Salazar has subsequently apologized and Nike has stated that it has investigated the allegations and stepped up support for women athletes.

But abuse in elite youth sport isn't just an issue for Nike leadership, says Mountjoy. It's an issue for the media, society in general, and women's sport, she says, referring to the widespread sexual abuse of U.S. female gymnasts by team physician Larry Nassar, which came to light in 2018.

"Abuse is nurtured in a sport culture where athletes are commodified in an environment that pursues 'winning at all costs': one in which athletes have no power, and where abuse is either accepted as being normal or is ignored," Mountjoy says in the editorial.

She lists a commendable array of international programs, initiatives, and policies, designed to protect athletes from abuse. But she adds: "While much is being done in the field of athlete safeguarding, there are still significant gaps."

She calls for the establishment of an independent international safeguarding agency for sports to handle athlete disclosures, investigate and process allegations, and to support victims of abuse. The expertise developed could then be used for preventive efforts, she says. But this agency would have to have sufficient cash and clout to be effective, she insists.

An international database of offenders should also be set up, she says. This would stop "perpetrator migration" to new sport organizations, and athletes charged with misconduct from competing elsewhere.

This has happened in the National Collegiate Athletes Association (NCAA), where 33 athletes, charged with sexual offences since 2014, have managed to transfer to other colleges, she explains.

"Together we must act to stop the victimization of youth elite athletes from abusive coaching practices. From Mary Cain's story, we know what the problem is. We should strive to achieve a safe sporting environment for all," she concludes.

Scientists from the Skoltech Center for Energy Science and Technology (CEST) and the Institute for Problems of Chemical Physics of Russian Academy of Sciences in collaboration with researchers from the Catholic University of Leuven (Belgium) developed a single-step method to obtain water-soluble fullerene compounds with remarkable biological properties, such as the ability to effectively suppress the human immunodeficiency virus (HIV).

Uncommon molecular forms of carbon, C60 and C70 fullerenes are shaped as a soccer ball and a rugby ball, respectively, depending on the number of atoms in the molecule. Fullerene-based compounds have long been believed to provide a good ground for new drugs thanks to their strong antiviral, antibacterial, antitumor and antioxidant effects.

The downside is that fullerenes are totally insoluble in water, which prevents their use in medicine. The existing classical methods of synthesis of water-soluble compounds directly from fullerenes provide low product yields through several complex stages of synthesis. Therefore, these methods are inefficient and can hardly work for industrial-scale production of water-soluble fullerene compounds for pharmaceutical applications.

The team led by CEST professor, Pavel Troshin, has extensive experience in the synthesis of water-soluble fullerene derivatives. In their latest study, they proposed an effective single-step method to produce stable water-soluble fullerene derivatives displaying high anti-HIV activity. The new method enables a high yield of nearly 100% and does not require lengthy and labor-consuming chromatographic purification, which opens up new horizons for synthesizing fullerene derivatives on any scale to suit the needs of the pharmaceutical industry.

"Although high antiviral activity of fullerene derivatives was discovered over 20 years ago, these unique compounds are too difficult to obtain and for this reason have been unavailable for clinical trials. We hope that our simple single-step method of synthesizing water-soluble fullerene compounds will help to solve this issue and take us one step closer to creating effective antiviral drugs on their basis," says the first author of the paper and Skoltech PhD student, Olga Kraevaya.

The team's latest research opens up new opportunities for the directional design of water-soluble fullerene derivatives with a specified set of properties, which, in the longer term, will help bring to the market the new-generation drugs based on these compounds.

Researchers at the University of Georgia's Regenerative Bioscience Center and their colleagues have found that "natural killer" white blood cells could guard against the cascade of cellular changes that lead to Parkinson's disease and help stop its progression.

Natural killer (NK) cells are white blood cells that can kill tumors without being "told" from the body to do so. NK cells provide the first line of defense against invasion or a virus and are equipped with activating receptors that can sense cellular stress and identify cells that have been altered due to infection.

"Right now there's no available therapy to modify or stop the progression of Parkinson's," said lead author Jae-Kyung "Jamise" Lee, assistant professor in UGA's College of Veterinary Medicine. "This would be the first NK study to show the possibility of actually stopping the disease."

Appearing in the current issue of Proceedings of the National Academy of Sciences, the new study highlights that NK cells act not only as efficient scavengers that attack an intruder but may be critical for regulating and restraining inflammation of brain tissue and protein clumping--hallmarks of Parkinson's and other neurodegenerative disorders. The report also found that NK cell depletion in a mouse model significantly exaggerated the disease condition. This led to the discovery that, without NK cells, the nervous system was left vulnerable to attack.

"We believe that NK cells exert protection by their ability to reduce inflammation in the brain and clear proteins that misfold and create toxic clumps," Lee said. "In their absence, proteins were left unchecked, and we saw a substantial decrease in viral resistant cells, confirming that NK cells are a major source of signaling proteins that boost the immune system response."

Thirty years ago, when research into immunotherapies got started, a logical first step in developing such therapies--to fight cancer, for example--was to train the immune system to recognize and attack tumor cells. Today, this idea has successfully moved from lab to clinic: New immunotherapies for melanoma, lung cancer and kidney cancer were recently approved by the U.S. Food and Drug Administration.

Lee is quick to caution that her Parkinson's work was done in animal models, but she is optimistic about future immunotherapy discoveries. She cited recent human trials that tested immunotherapies against an aggressive form of brain cancer called glioblastoma, indicating that NK cells contribute to elimination of tumor cells and release messages in support of defense of the immune system.

Parkinson's is no longer considered a brain-specific disease, and researchers increasingly recognize a functional connection between the immune system and central nervous system. Lee's team found that, in conditions of chronic inflammation such as Parkinson's, the blood-brain barrier becomes disrupted, allowing immune cells to channel into the brain.

"Understanding how the periphery signals for NKs to patrol for infectious agents, even in the absence of disease, could lead to breakthrough treatments for Parkinson's disease," Lee said.

Collaborating with Lee on this study is Levi Wood, an assistant professor in Georgia Tech's School of Mechanical Engineering. The initial partnership between the researchers began with seed funding from the Regenerative Engineering and Medicine (REM) network, a joint collaboration between Emory University, Georgia Tech and UGA. As a REM awardee, Lee leveraged her seed funding into significant support from other groups, including the largest funder of Parkinson's disease in the world, the Michael J. Fox Foundation.

UGA's co-director for REM is Steven Stice, who also is director of the RBC.

"REM's support for high-risk research has provided Dr. Lee the opportunity to rapidly produce some surprising discoveries with tangible results, leveraging the capabilities of a world-renowned, private-sector partner," said Stice, a Georgia Research Alliance Eminent Scholar in the College of Agricultural and Environmental Sciences. "We are proud to continue to support early-career faculty with bold ideas and big impacts that are solving problems that save lives."

Initially, the researchers have focused on the neuroprotective effects of NK cells. The next step is to study how NK cell functions are impaired by aging.

"Our preliminary data suggest that the number and function of NK cells are decreased in aged animals, and display impaired ability to perform their normal functions," Lee said. "We would like to look deeper at age-related changes associated with NK cell biology and the wider implications for the health and well-being of older adults."

In January, Georgia Gov. Brian Kemp announced that UGA will launch a professorship in honor of former Sen. Johnny Isakson to help develop treatments for Parkinson's--the same disease that forced the senator to retire from public service. In 2017, Isakson received the Fox Foundation's Parkinson's Advocacy Award for his work to improve the lives of people living with the disease and for his advocacy in funding new treatments.

"We are excited to be part of UGA's community research interest in Parkinson's and their continued commitment to search for better treatments and a cure," said Lee.