Body

A mutated gene found in people with intellectual disabilities that could be targeted for treatment has been identified by an international team including University of Queensland researchers.

The gene, USP9X, regulates a network of genes underlying Intellectual Disability (ID) and Autism Spectrum Disorder (ASD).

UQ School of Biomedical Sciences Associate Professor Michael Piper said focussing on the network, rather than individual genes, could lead to therapy developments for a range of neurological disorders.

"Treating ID and ASD one gene at a time is not feasible, as more than 1000 genes have been implicated in the conditions," Dr Piper said.

"Research is switching to identifying networks in which multiple genes function in common pathways, such as USP9X.

"USP9X regulates a family of proteins that control how nerves communicate and share information.

"By targeting this network, there is a possibility that treatments could be developed that will help a wide range of patients."

Mice lacking the USP9X gene were used to study the function of this factor, as well as its interacting partners.

Mutations in USP9X have also been implicated in Parkinson's and Alzheimer's diseases.

The research showed a critical two-week period following birth where development of USP9X is crucial to normal brain function.

"This represents a window of opportunity for therapeutical intervention," Dr Piper said.

"It is possible that this model will help test interventions in mice as a step towards developing new therapeutic approaches for patients."

Only 8% of Americans survive cardiac arrest outside a hospital, but that percentage could increase significantly if bystanders recognize cardiac arrest and perform simple lifesaving tasks, a UVA Health physician says.

UVA emergency medicine physician William J. Brady, MD, co-authored an article in the New England Journal of Medicine that highlights a few steps anyone without extensive medical training can do to help:

Recognize quickly the signs of cardiac arrest and call 911

Begin cardiopulmonary resuscitation (CPR) using chest compressions

Use an automated external defibrillator (AED), when appropriate, to deliver an electric current to restart a victim's heart

"Early emergency care by the bystander, long before emergency medical providers arrive, can save a life. This care is referred to as 'pre-arrival care,'" said Brady. "This pre-arrival care is as important as more advanced care by EMTs, nurses, and doctors once trained providers are available."

Calling 911, Beginning CPR

The first step is simply noting that someone may be in cardiac arrest.

The article notes that the American Heart Association and other medical groups "recommend that bystanders should suspect cardiac arrest and begin CPR whenever a person is unresponsive and not breathing normally." Faster recognition of cardiac arrest will also lead to a quicker 911 call, speeding the arrival of trained emergency medical providers.

But research has shown that bystanders can help cardiac arrest victims by beginning CPR themselves (major groups like the American Heart Association now endorse compression-only CPR, which is performed using chest compressions only and not breathing into the victim's mouth). A 2010 review of more than 10,000 out-of-hospital cardiac arrest cases found that 22.1% of patients receiving pre-arrival care, including bystander CPR, survived, compared with 7.8% of patients that did not.

How AEDs Can Help

Bystanders can further help a cardiac arrest victim's chances of survival by also using an AED. Brady helped spearhead an effort to install more than 300 AEDs across Grounds, helping UVA earn a HEARTSafe Campus award from the National Collegiate EMS Foundation twice in recent years.

Multiple research papers have shown the benefits of having AEDs accessible for use by members of the public. For example, a 2018 study of more than 50,000 out-of-hospital cardiac arrests found that 66.5% of patients who were treated with an AED by a bystander survived, compared with 43% of patients who were shocked only after fire rescue crews arrived. This highlights the benefits of quick action from bystanders. As Brady's article notes, "for every minute that a person with out-of-hospital cardiac arrest goes without CPR and defibrillation, the chance of survival decreases by 7 to 10%."

The Need for Education

One major barrier to bystanders providing lifesaving care for cardiac arrest victims is a lack of training, especially in how to perform CPR. Brady's article points to a study that estimates only 2.4% of Americans receive CPR training each year.

One potential way to boost the number of people getting trained, Brady and his co-authors write, is to offer shorter training sessions. Potential options include 4-minute training sessions at CPR kiosks in public locations, as well as video training sessions ranging from 60 seconds to 8 minutes.

Another option to boost bystander care is one Brady hopes will soon be available in Central Virginia: a smartphone app that notifies volunteer users of a cardiac arrest occurring near them in a public location. This would enable people close to the scene to start CPR and use an AED, if available, before emergency medical providers arrive. Albemarle County Fire Rescue, Charlottesville Fire Department, the Charlottesville-Albemarle-UVA Emergency Communications Center and UVA Health are working together to launch this tool.

"The next major advance in cardiac arrest management is not a new hospital-based treatment nor fire-rescue intervention. It is this pre-arrival care performed by a bystander, before fire-rescue personnel arrive and long before a patient is transported to the hospital. This care can allow victims of cardiac arrest to return to their lives and families," Brady said.

Hepatitis C is a serious disease, but the biggest threat to someone's health is not the virus itself. Rather, it is the diseases that can result from it such as reduced liver functioning, scar tissue in the liver and potentially cirrhosis. A new study shows that the antiviral treatment which has been used to fight the disease over the last five years, also helps improve the complications which follow.

"It's really good news, because the treatment is effective on almost all patients with hepatitis C, but the fact that it also works against complications is new to us. And this is absolutely crucial for this group of patients, because they don't die from the hepatitis C virus, but in worst case scenarios, from the diseases that chronic liver damage can lead to," says Tea Lund Laursen, PhD student at the Department of Clinical Medicine at Aarhus University.

The results have just been published in the scientific journal Journal of Viral Hepatitis.

Less scar tissue and improved cognitive function

It can often take 20-30 years from being infected with hepatitis C until a person experiences the symptoms. During that period the liver inflammation becomes chronic for the majority of patients and serious damage develops.

"With the study, we now know that even though the patients discover the disease late, the new treatment gives them good chances of a more positive prognosis. Simply because the liver is on the mend when they become free of the virus," says Tea Lund Laursen.

The researchers followed 71 patients with chronic liver inflammation before, during and after treatment. The studies showed that the inflammation in their liver diminished, that there was less scar tissue, and that the liver improved its ability to break down various substances. At the same time, the researchers could measure that the patients reacted quicker to sounds than before they began the treatment.

"Chronic liver inflammation can also lead to cognitive problems where patients become tired, have poorer memory and also reduced response times. But we could also see an improvement in reaction times one year after the 12 week course of treatment. We therefore expect this to also be the case for the other cognitive functions," says Tea Lund Laursen.

Major perspectives in antiviral treatment

The Danish Health and Medicines Authority estimates that approx. 17,000 people are infected with hepatitis C in Denmark and that around half of them are not known in the healthcare system. The vast majority have been infected by sharing syringes. They include both former and current drug abusers and people who demonstrated high-risk behaviour in their youth 30-40 years ago - with many of them unaware that they are infected.

"If the people in the risk category contacted the healthcare system, we would be able to save or improve the lives of a great many people, and also more or less eradicate hepatitis C in Denmark in the long term," says Tea Lund Laursen.

While the number of people with the infection is relatively limited in Denmark, hepatitis C is a major problem globally with approx. 160 million people infected. The disease is particularly widespread in several West African countries, Russia and Greenland.

The research results - more information

Type of study: Prospective treatment cohort study

Partners: Medical departments in the Central Denmark Region and at Aalborg University Hospital

The study is not externally funded.

The scientific article "Time?dependent improvement of liver inflammation, fibrosis and metabolic liver function after successful direct?acting antiviral therapy of chronic hepatitis C" has been published in the Journal of Viral Hepatitis.

Colorectal cancer is the second most common type of cancer worldwide, with about 90% of cases occurring in people 50 or older. Arising from the inner surface, or muscosal layer, of the colon, cancerous cells can penetrate through the deeper layers of the colon and spread to other organs. Left untreated, the disease is fatal.

Current colon cancer screening is performed by flexible colonoscopy. The procedure involves visual inspection of the mucosal lining of the colon and rectum with a camera mounted on an endoscope. Abnormal appearing areas are then biopsied for analysis. Although this is the current standard of care, it does have its shortcomings. First, this technique relies on visual detection, but small lesions are hard to detect with the naked eye, and early malignancies are often missed. Second, visual endoscopy can only detect changes in the surface of the bowel wall, not in its deeper layers.

Quing Zhu, professor of biomedical engineering in the McKelvey School of Engineering at Washington University in St. Louis, and Yifeng Zeng, a biomedical engineering doctoral student, are developing a new imaging technique that can provide accurate, real-time, computer-aided diagnosis of colorectal cancer.

Using deep learning, a type of machine learning, researchers used the technique on more than 26,000 individual frames of imaging data from colorectal tissue samples to determine the method's accuracy. Compared with pathology reports, they were able to identify tumors with 100% accuracy in this pilot study.

This is the first report using this type of imaging combined with machine learning to distinguish healthy colorectal tissue from precancerous polyps and cancerous tissue. Results appear in advance online publication in the journal Theranostics.

The investigational technique is based on optical coherence tomography (OCT), an optical imaging technology that has been used for two decades in ophthalmology to take images of the retina. However, engineers in the McKelvey School and elsewhere have been advancing the technology for other uses since it provides high spatial and depth resolution for up to 1- to 2-millimeter imaging depth. OCT detects the differences in the way health and diseased tissue refract light and is highly sensitive to precancerous and early cancer morphological changes. When further developed, the technique could be used as a real-time, noninvasive imaging tool alongside traditional colonoscopy to assist with screening deeply seated precancerous polyps and early-stage colon cancers.

"We think this technology, combined with the colonoscopy endoscope, will be very helpful to surgeons in diagnosing colorectal cancer," said Zhu, the paper's senior author who also is a professor of radiology at the Mallinckrodt Institute of Radiology at Washington University School of Medicine. "More research is necessary, but the idea is that when the surgeons use colonoscopy to examine the colon surface, this technology could be zoomed in locally to help make a more accurate diagnosis of deeper precancerous polyps and early-stage cancers versus normal tissue."

Zhu and her team collaborated with Matthew Mutch, MD, chief of colon and rectal surgery; William C. Chapman Jr., MD, a resident in colon and rectal surgery; and Deyali Chatterjee, MD, assistant professor of pathology & immunology, all at the School of Medicine.

Two years ago, Zeng, the paper's lead author, began using OCT as a research tool to image samples of colorectal tissue removed from patients at the School of Medicine. He observed that the healthy colorectal tissue had a pattern that looked similar to teeth. However, the precancerous and cancerous tissues rarely showed this pattern. The teeth pattern was caused by light attenuation of the healthy mucosa microstructures of the colorectal tissue.

Zeng began working with another graduate student, Shiqi Xu, who earned a master's in electrical engineering from McKelvey Engineering in 2019 and is co-first author on the paper, to train RetinaNet, a neural network model of the brain where neurons are connected in complex patterns to process data, to recognize and learn the patterns in the tissue samples. They trained and tested the network using about 26,000 OCT images acquired from 20 tumor areas, 16 benign areas and six other abnormal areas in patient tissue samples. The diagnoses predicted by this system were compared with evaluation of the tissue specimens using standard histology. Pathology residents Zahra Alipour and Heba Abdelal assisted with the comparison. The team found a sensitivity of 100% and a specificity of 99.7%.

"The unique part of our system is that we could detect a structural pattern within the image," Zeng said. "Using OCT, we are imaging something that we can find a pattern across all normal tissues. Then we can use this pattern to classify abnormal and cancerous tissue for accurate diagnosis."

Zhu, Zeng and the team, in collaboration with Chao Zhou, associate professor of biomedical engineering, are now developing a catheter that could be used simultaneously with the colonoscopy endoscope to analyze the teeth-like pattern on the surface of the colon tissue and to provide a score of probability of cancer from RetinaNet to the surgeons.

"Right now, we can obtain the feedback in 4 seconds," Zeng said. "With further development of computation speed and the catheter, we can provide the feedback to surgeons in real-time," Zeng said.

Canadians spend a lot of money around this time of year, on gifts, food, entertainment and travel. In its annual study of holiday season spending habits, the accounting firm PwC estimates that the average Canadian consumer will drop close to $1,600 in 2019.

And while the holidays are associated almost as much with stress as they are with shopping, a new paper out of Concordia's John Molson School of Business suggests that spending some of that money on green products might make consumers feel quite a bit better about their purchases.

The study looks at the so-called "greenconsumption effect" -- how using a green product creates a "warm glow" feeling in users -- and what it means for retailers in an increasingly eco-conscious marketplace. Onur Bodur, professor of marketing, and his now-former PhD student Ali Tezer, currently an assistant professor at HEC Montréal, published the paper in the Journal of Consumer Research.

"The warm glow is a good overall feeling," Bodur says. "It is found in other literature relating to pro-social behaviour. You get the feeling when you help others and have a sense of accomplishment that gives you satisfaction."

Bodur says Tezer approached him with the idea after watching a 3D movie and learning that the disposable glasses were made of recycled plastic. That knowledge led to a heightened sense of enjoyment while watching the movie, even though he had no say in choosing to use the product.

Feel green, feel good

To conduct their research, Bodur and Tezer set up five experiments using a variety of products. They were looking to test the conditions under which participants say they experienced a warm glow feeling.

They looked at how green options affect product enjoyment, their perceived quality, the consumer's sense of social worth, how social exclusion affects green product enjoyment and whether the product's environmental impact mitigates the warm glow feeling.

They found that green products do generally affect consumers in a positive way. Participants who listened to music on a set of green-labelled headphones reported enjoying the music more than listeners using conventional headphones and added that they would be more likely to purchase them.

Participants also reported overcoming inherent, long-standing biases against the quality of certain green products, in this case cleaning fluids. Bodur notes that, fairly or not, green dish and laundry detergents are widely believed to be less efficient than their conventional counterparts. After using them, respondents felt that belief no longer applied.

They also reported a higher sense of self-worth and lower perception of social exclusion. Green product users said they experienced warm glow feelings and people who felt isolated from their communities reported feeling less so after using a green product.

However, the researchers did note that the warm glow feeling was absent when consumers felt the environmental impact of the product was low. This was the case when participants were told the ink in a disposable Bic pen was supposedly environmentally friendly, but with negligible impact.

Live the green feeling

To someone who, like Bodur, studies marketing for a living, this greenconsumption effect has serious implications for retailers. Consumers obviously prefer using high-quality sustainable products -- but service providers can benefit by providing greener experiences.

"Imagine that the chair you are sitting on is certified bamboo, or the tablecloth at a restaurant is made of recycled materials and the utensils are made of wood," he says. "You can opt to use sustainable, green products that are more likely to improve your customer's experience."

He is also aware of the risk that unscrupulous businesses may see his research and decide to exaggerate or outright falsify their environmental credentials. Doing so, he believes, would be at their own peril.

"I believe consumers are becoming a lot more conscious of green attributes, despite all the confusion with regard to certifications of sustainability," he says. "The risk will only be eliminated when there is some sort of regulation or standardization of certification."

Scientists from 22 institutions, including UCLA, are recommending early diagnosis, prevention and treatment of severe chronic inflammation to reduce the risk of chronic disease and death worldwide.

The group of international experts, which also includes scientists from the National Institutes of Health, Stanford University, Harvard Medical School, Columbia University Medical Center and University College London, point to inflammation-related diseases as the cause of 50 percent of all deaths worldwide.

Inflammation is a naturally occurring response by the body's immune system that helps fight illness and infection. When inflammation is chronic, however, it increases the risk of developing potentially deadly diseases.

In a perspective article, published in the journal Nature Medicine, the authors describe how persistent and severe inflammation in the body plays a key role in heart disease, cancer, diabetes, kidney disease, non-alcoholic fatty liver disease, and autoimmune and neurodegenerative disorders.

Future research should focus on identifying ways to better diagnose and treat severe chronic inflammation, according to the authors. Doing so may not only extend life, but also help reduce chronic disease worldwide and improve health, they said.

Senior author George Slavich, director of the UCLA Laboratory for Stress Assessment and Research, said it is important to make people aware of the risk factors for chronic inflammation, which include obesity, physical inactivity, social isolation, chronic stress and inadequate or poor sleep.

"Chronic inflammation is influenced by many social, environmental and lifestyle factors," said Slavich, who is also a research scientist at the Norman Cousins Center for Psychoneuroimmunology at UCLA. "If we make people aware of these risk factors, our hope is that individuals will reduce the factors that apply to them."

Slavich said research should focus on identifying new biomarkers or substances in the body that will enable doctors to screen for and better diagnose and treat severe chronic inflammation. Currently, just a few biomarkers are known to indicate inflammation, such as elevated levels of C-reactive protein, a protein found in blood plasma. Slavich said there are potentially hundreds of other substances in the body's immune system that may indicate chronic inflammation, but they have yet to be identified.

"It's also important to recognize that inflammation is a contributor not just to physical health problems, but also mental health problems such as anxiety disorders, depression, PTSD, schizophrenia, self-harm and suicide," Slavich said. "This is a substantial public health crisis."

Can more be done besides diet and exercise to better recover from a heart attack, a stroke, or to prevent one? Scientists from Columbia University Irving Medical Center and the Institute for Prevention Research conducted a study, with and without meditation, to find out.

The study, published in the Journal of Nuclear Cardiology, reported that patients with coronary heart disease who included Transcendental Meditation (TM) with their cardiac rehabilitation regime increased blood flow to the heart by more than 20%.

Titled “Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography”, the pilot study was funded by the National Institutes of Health and conducted at Columbia University Irving Medical Center, in collaboration with the Institute for Prevention Research. The research involved 56 patients who had coronary heart disease, including recent heart attack, coronary artery bypass, or angina.

First study of its kind

The project was a groundbreaking proof-of-concept study, in that it was the first to combine Transcendental Meditation with other lifestyle treatment modalities, and the first to use positron emission tomography (PET) to measure the effect of mind-body lifestyle modificaiton on cardiac function.

“This was the first study to show that the cardiovascular benefits of lifestyle modification such as structured exercise and dietary counseling may be enhanced by adding Transcendental Meditation in patients with heart disease,” said Robert Schneider, MD, FACC, co-director of the study and medical director of the Institute for Prevention Research. “It also found that the Transcendental Meditation technique alone was able to reverse the effects of coronary heart disease assessed by PET imaging.”

Considered a gold standard for measuring myocardial flow reserve non-invasively, cardiac PET has diagnostic and prognostic significance in coronary heart disease.

Randomized, controlled pilot study

The researchers randomly divided the subjects into four groups: cardiac rehabilitation, Transcendental Meditation, Transcendental Meditation plus cardiac rehabilitation, or usual care.

The results showed that of the 37 patients who completed posttesting, myocardial blood flow increased by 20.7% in the group that did both Transcendental Meditation and cardiac rehabilitation. Blood flow in the group that practiced Transcendental Meditation alone increased 12.8%. Cardiac rehabilitation by itself showed an improvement of 5.8%. And patients who received the usual treatment showed a decrease in blood flow of -10.3%.

Stress reduction therapies in cardiac rehabilitation

“Although this is a preliminary study, it suggests that managing one’s mind-body connection with Transcendental Meditation can improve the function of the heart in cardiovascular patients,” said Dr. Schneider, who is also dean of Maharishi University of Management’s College of Integrative Medicine.

He said that psychosocial stress is known to be a risk factor for coronary heart disease but that stress reduction therapies aren’t usually included in cardiac rehabilitation.

“More research needs to be done, but this study and previous research strongly suggest that medical professionals should consider utilizing this simple yet effective mind-body intervention in their heart health treatment and prevention programs,” Dr. Schneider said.

Possible mechanism

While it’s not known precisely how Transcendental Meditation would increase blood flow, the researchers speculate that it’s a result of improved endothelial-mediated coronary and arteriolar vasomotor function. That is, reduced levels of stress hormones and possibly inflammation may result in improved function of the endothelial cells that line the coronary arteries. They cite research, which has found that modifying risk factors for cardiovascular disease improves blood flow in the heart.

Limitations of the study

While the study suggests that the Transcendental Meditation technique can increase blood flow in cardiovascular patients, carefully conducted clinical trials with larger sample sizes are needed to confirm the benefit.

“This was a first pilot study designed to determine the size of the effect and feasibility,” Dr. Schneider said. “Of the 56 original subjects, only 37 were available for the final posttesting of blood flow after the 12-week study period. In addition, compliance with cardiac rehabilitation was average, with attendance at exercise sessions about 60%. Also, the subjects practicing Transcendental Meditation may have received more attention than the rehabilitation group. This initial study paves the way for full scale clinical trials that will more rigorously evaluate these effects.”

Transcendental Meditation also reduces risk factors for heart disease

Earlier studies have shown that the Transcendental Meditation technique reduces risk factors for cardiovascular disease, such as blood pressure, atherosclerosis, and insulin resistance. A 2012 study found a 48% reduction in heart attack, stroke, and death.

In the United States, apart from some forms of skin cancer, breast cancer is the most common cancer in women. It is also the most common cause of death from cancer among Hispanic women and the second most common among all other women, after lung cancer. There are different types of breast cancer, and for this reason there are multiple alternative treatments. Determining a patient's specific cancer type helps physicians decide which of these therapies are most appropriate.

At Baylor College of Medicine, Dr. Meenakshi Anurag and her colleagues apply precision data science to improve breast cancer diagnosis, treatment and survival. In a recent study, the researchers studied estrogen receptor positive (ER+) breast cancer, a type that represents nearly 75 percent of breast cancer cases.

"Endocrine therapy has dramatically improved outcomes for ER+ breast cancer patients; however, about one-third of cases do not respond to this therapy," said Anurag, assistant professor of medicine at Baylor and first and co-corresponding author of this work. ""Here we focus on ER+ breast cancers that are resistant to endocrine drugs such as aromatase inhibitors."

ER+ breast cancer can be divided into two subtypes: luminal A and luminal B. The latter type is more aggressive, showing greater tumor proliferation rates and worse patient survival, when compared with luminal A type.

"In clinical trials, almost 50 percent of women with luminal B respond poorly to endocrine therapy," Anurag said. "This result motivated us to search for tumor characteristics that could be modified in order to make the cancer more susceptible to therapy."

Searching the genome

To search what could make these cancers more susceptible to therapy, the researchers conducted an unbiased genome-wide profiling analysis. With this type of analysis they looked to identify genes, among the 20,000 in the genome, that were more active in tumors resistant to endocrine therapy, when compared to tumors susceptible to the treatment.

"At the outset, we didn't know what we were going to discover in this process. The transcriptome-wide profiling analysis allowed us to identify any gene that could potentially be involved in poor outcome," Anurag said.

Anurag and her colleagues studied 66 luminal B cases, half of which were resistant to endocrine therapy. They found that genes that were most commonly actively expressed in resistant tumors were immune checkpoint genes, which are regulators of the immune system. These genes produce proteins that normally keep the immune system in check, preventing T-cells, a type of immune cell, from indiscriminately attacking other cells.

In some cancers, activation of immune checkpoint genes can also keep the T-cells from killing cancer cells. The gene IDO1, an immune checkpoint component, was the gene that associated the most with luminal B, endocrine therapy-resistant cancers.

"This finding is important because we know that immune checkpoint pathways can be manipulated with drugs called immune checkpoint inhibitors," Anurag said. "Inhibiting immune checkpoints in cancer is like removing the 'brake' that is keeping the immune system from attacking the tumor."

An unforeseen possibility

This study is significant because it's been thought that ER+ breast tumors will not respond to immunotherapy, Anurag explained. "But we have shown that a subset of endocrine therapy-resistant luminal B breast cancers activate immune responses that could be amenable to manipulation with immunotherapy," Anurag said.

"This paper identifies an important missed opportunity - the treatment of aggressive ER+ breast cancer with immune checkpoint therapy. While the current emphasis for immunotherapy is almost entirely on triple-negative breast cancer, we think that this focus excludes as many as half of the patients who could benefit, because endocrine therapy-resistant luminal B disease is as common as triple-negative breast cancer," said co-corresponding author, Dr. Matthew Ellis, professor and director of the Lester and Sue Smith Breast Center, associate director of precision medicine at the Dan L Duncan Comprehensive Cancer Center and McNair Scholar at Baylor.

"Our findings highlight the importance of personalized medicine. Proper stratification of patients before treatment would help identify individuals who are likely to respond to treatments targeting immune checkpoints," Anurag said.

Researchers at UT have developed a free open source computer program that can be used to create visual and quantitative representations of brain electrical activity in laboratory animals in hopes of developing countermeasures for opioid use disorder.

The program is described in a paper published in JoVE. Lead author Christopher O'Brien is a UT graduate who manages the research laboratory of Helen Baghdoyan and Ralph Lydic, both co-authors on the paper and professors in UT's Department of Psychology and the Graduate School of Medicine's Department of Anesthesiology.

In the paper, the researchers describe the steps they took to create a multitapered spectrogram for electroencephalogram (EEG) analyses with an accessible and user-friendly code. They validated the program through analyses of EEG spectrograms of mice that had received different opioid treatments.

"There is a misconception that opioids promote sleep, but in quantitative studies of states of sleep and wakefulness using electroencephalographic recordings of brain waves, opiates are shown to disrupt sleep," Lydic said. "Additionally, drug addiction studies show that abnormal sleep is associated with increased likelihood of addiction relapse."

Long-term results from the NRG Oncology clinical trial NSABP B-39/RTOG 0413 comparing whole-breast irradiation (WBI) to accelerated partial-breast irradiation (APBI) indicated that, although the absolute difference between treatment was less than 1%, APBI did not meet the criteria for equivalence to WBI in controlling ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy. The trial provided the longest follow-up reported to date in the largest and most diverse group of patients treated with APBI; it is also the first study to include all forms of APBI. These results were published in The Lancet.

Trial participants on NSABP B-39/RTOG 0413 were randomly assigned to receive either WBI in 25 daily fractions of 2 Gy (50 Gy over five weeks) +/- a tumor bed boost (to 60 Gy) or APBI in 34 Gy of brachytherapy or 38.5 Gy of external-beam radiotherapy delivered in 10 fractions over 5 treatment days. The goal of the trial was to determine if treatment with APBI could shorten the treatment duration for patients while being equally as effective as WBI treatment.

Between March 2005 and April 2013, the trial enrolled 4,216 women and, of that group, 2,036 patients in the WBI group and 2,089 in the APBI group were available for survival analysis. At the 10-year follow-up, the cumulative incidence of IBTR was 4.6% (95% CI 3.7-5.7) in the APBI treatment group versus 3.9% (3.1-5.0) in the WBI treatment group. Treatment related toxicities and second cancers were similar between treatment groups.

"The value of our trial is that it has a large, diverse population of patients and sufficient power to demonstrate that APBI should not replace WBI in all types of patients who undergo lumpectomy. However, with an absolute difference of less than 1% in the 10-year cumulative incidence of IBTR, APBI might be chosen as an acceptable alternative for some women." said Frank Vicini, MD, principal investigator at the MHP Radiation Oncology Institute/21st Century Oncology in Pontiac, Michigan and Julia White MD, co-principal investigator at The Ohio State University. Dr. White added, "Differences in outcomes among the various forms of APBI, as well as quality of life (including patient-reported outcomes and cosmetic results), and quality assurance analyses will be reported separately"

Metabolic syndrome is the name for a group of risk factors, such as high blood pressure and cholesterol levels, that increase the risk for adverse health issues, from heart disease and diabetes to stroke. Eating healthier, getting more exercise and taking prescribed medications when needed are common remedies but often prove insufficient to fully managing risks.

In a recent collaborative effort, researchers from University of California San Diego School of Medicine and the Salk Institute for Biological Studies reported a form of intermittent fasting, called time-restricted eating, improved the health of study participants who had been diagnosed with metabolic syndrome.

The pilot study, published online in the December 5, 2019 edition of Cell Metabolism, found that when participants restricted their eating to 10 hours or less over a period of 12 weeks, they lost weight, reduced abdominal fat, lowered blood pressure and cholesterol and enjoyed more stable blood sugar and insulin levels.

"As a cardiologist, I find it is very hard to get patients with prediabetes or metabolic syndrome to make lasting and meaningful lifestyle changes," said Pam Taub, MD, co-corresponding author and associate professor of medicine at UC San Diego School of Medicine and cardiologist at the Cardiovascular Institute at UC San Diego Health. "There is a critical window for intervention with metabolic syndrome. Once people become diabetic or are on multiple medications, such as insulin, it's very hard to reverse the disease process.

"Metabolism is closely linked with circadian rhythms, and knowing this, we were able to develop an intervention to help patients with metabolic syndrome without decreasing calories or increasing physical exercise."

Time-restricted eating (eating all calories within a consistent 10-hour window) allows individuals to eat in a manner that supports their circadian rhythms and their health. Circadian rhythms are the 24-hour cycles of biological processes that affect nearly every cell in the body. Erratic eating patterns can disrupt this system and induce symptoms of metabolic syndrome, including increased abdominal fat and abnormal cholesterol or triglycerides.

"Time-restricted eating is a simple dietary intervention to incorporate, and we found that participants were able to keep the eating schedule," said Satchin Panda, PhD, co-corresponding author and professor in Salk's Regulatory Biology Laboratory. "Eating and drinking everything (except water) during a 10-hour window allows your body to rest and restore for 14 hours at night. Your body can also anticipate when you will eat, so it can prepare the body to optimize metabolism."

The study involved 19 participants diagnosed with metabolic syndrome, with 16 taking at least one medication, like a statin. Participants used an app created by Panda called myCircadianClock to log when and what they ate during an initial two-week baseline period followed by three months of 10-hour time-restricted eating per day. They were told they could decide what time to eat and how much to eat as long as all food consumption occurred within a 10-hour window.

At the end of the 12 weeks, participants averaged a 3 percent reduction in weight and body mass index (BMI) and a 4 percent reduction in abdominal/visceral fat. Many also experienced reductions in cholesterol and blood pressure and improvements in fasting glucose. Seventy percent of participants reported an increase in sleep satisfaction or in the amount they slept. "Patients also reported that they generally had more energy, and some were able to have their medications lowered or stopped after completing the study," said Taub.

More than two-thirds of participants continued with time-restricted eating for up to a year after the study concluded -- at least part of the time. "Adapting this 10-hour time-restricted eating is also a cost-effective method for reducing symptoms of metabolic syndrome and improving health," said Panda. "By delaying the onset of diabetes by even one year in a million people with prediabetes, the intervention could save roughly $9.6 billion dollars in health care costs."

The researchers are currently conducting another clinical trial to examine the benefits of time-restricted eating in a larger group of more than 100 participants with metabolic syndrome. The study examines additional measures that will help the researchers investigate changes in body composition and muscle function.

"Knowing how to optimize circadian rhythms could lead to a new treatment option for metabolic syndrome patients with life-altering diseases," said Taub.

Obstructive Sleep Apnea (OSA) affects an estimated 22 million Americans. In addition to sleep problems, the condition can cause other health issues, including high blood pressure, chronic heart failure and stroke. Some patients with OSA are at an even higher risk of cardiovascular problems because of a phenomenon called "reverse dipping" that causes blood pressure to rise rather than lower during sleep. Most people experience lower blood pressure at night. Now, University of Missouri School of Medicine researchers have found a potential cause for reverse dipping that may help patients with OSA get the help they need before cardiovascular disease develops.

"We can now identify those with OSA at the highest risk of cardiovascular problems in order to prevent them from developing additional complications," said David Gozal, MD, the Marie M. and Harry L. Smith Endowed Chair of Child Health at the MU School of Medicine. "We can treat those patients more aggressively to ensure they adhere to therapy and use their continuous positive airway pressure device (CPAP) properly."

Gozal and fellow MU collaborator Abdelnaby Khalyfa, PhD, studied 46 patients diagnosed with OSA. They ranged in age from 18 to 70. Fifteen participants were identified to have a rise in blood pressure during sleep, while the remaining 31 participants had blood pressure readings that either remained the same or declined at night. The researchers collected blood from each participant to study the messages cells produce and send to each other through microscopic packages called exosomes.

"We found that the cell messages coming from participants with night-time elevated blood pressure were different than those transmitted in subjects with normal blood pressure," Gozal said. "The altered messages caused the cells that line the blood vessels to become dysfunctional. Those disturbed vessels allowed inflammatory cells to enter the vessels' walls, causing hardening of those vessels and leading to cardiovascular disease."

Gozal said the cell message discovery will help clinicians personalize treatment for each patient diagnosed with OSA. A simple blood test administered at the beginning of a sleep study could indicate each patient's cardiovascular risk.

Gozal said additional research is needed to study the patients at highest risk of cardiovascular complications from OSA to see if CPAP compliance can actually reduce blood pressure or normalize the cell messages used to determine a patient's risk.

DALLAS, Dec. 4, 2019 -- Mobile Stroke Units (MSUs), vehicles equipped to provide stroke treatment before reaching a hospital, provided lifesaving care to stroke patients in Manhattan approximately 30 minutes faster, compared to patients transported to hospitals in traditional ambulances and who did not receive stroke treatment until arriving at the hospital, according to new research published in the Journal of the American Heart Association, the open access journal of the American Heart Association.

"This study provides further evidence suggesting a potential role for mobile stroke units in dense urban areas to increase our ability to treat stroke patients faster," said Lee H. Schwamm, M.D., executive vice chairman of neurology and director of the MGH Comprehensive Stroke Center at Massachusetts General Hospital in Boston. "This study joins a large body of efforts to improve how we swiftly recognize, triage, transport and treat patients with stroke, which is the ultimate goal."

Ischemic stroke - the most common type of stroke - occurs when a vessel supplying blood to the brain becomes blocked by a blood clot and prevents regular blood flow. Ischemic strokes are often treated with the medication alteplase, which breaks up clots. However, patients must be accurately diagnosed, and treatment with alteplase should be administered within 3 to 4.5 hours from when symptoms begin. MSUs offer the possibility of diagnosis and treatment for stroke in a specialized ambulance before patients arrive at the hospital.

In this study, the patients treated for ischemic stroke in the MSU received alteplase approximately 30 minutes sooner than patients who received treatment at the hospital.

"When it comes to stroke treatment, 30 minutes can be the difference between making a full recovery from a stroke and living independently, or becoming disabled and needing help with the activities of daily living," said the study's lead author, Matthew E. Fink, M.D., chair of neurology and the Louis and Gertrude Feil Professor in Clinical Neurology at Weill Cornell Medicine in New York, and neurologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. "The faster patients receive alteplase, the more likely they are to recover quickly and with fewer complications."

The study utilized NewYork-Presbyterian Hospital's Mobile Stroke Units (MSUs), and they were equipped with a portable CT scanner that allows neurologists on board to evaluate if a patient is having an ischemic stroke. If a stroke is diagnosed, the emergency medical technicians in the MSU can immediately administer alteplase. The New York City MSU program was launched in October 2016 by NewYork-Presbyterian, Weill Cornell Medicine, Columbia University Irving Medical Center and the Fire Department of the City of New York with one unit in Manhattan. One MSU was operated and responded to EMS calls from 9 a.m. to 5 p.m. on weekdays during the study.

For the study, researchers analyzed the treatment of 66 patients with symptoms of stroke who were taken to the hospital by an MSU, compared to 19 suspected stroke patients taken by a traditional ambulance in Manhattan, New York City's most densely populated borough, from October 2016 to September 2017. Neurologists present on the MSUs were able to diagnose ischemic stroke in 29 of the patients and treated them with alteplase immediately. Nine of the 19 patients transported by a traditional ambulance were diagnosed with ischemic stroke and received alteplase at the hospital.

This study is the first to assess whether MSUs could treat patients faster than conventional treatment in an urban area as densely populated as New York City. MSUs' ability to expedite stroke treatment has been tested in previous studies in Cleveland, Houston, and Berlin and Hamburg, Germany.

Limitations to this study included a relatively small sample size and the possibility of confounding factors such as traffic, the day of the week and the time of day when patients were transported. Researchers state that the patients treated by a traditional ambulance were identified strictly by criteria such as the type of call made to emergency medical services (EMS) and the type of care received to ensure as close of a comparison to MSU treatment as possible.

"We know that faster treatment equals better outcomes. However, further research is needed to establish if mobile stroke units improve long-term health outcomes and are a cost-effective solution in stroke systems of care for large cities, as they reflect a significant financial investment for cities and EMS agencies," said Dr. Schwamm. "While the lack of definitive evidence of benefit and of third-party reimbursement for mobile stroke unit staffing and care are barriers, additional studies are ongoing and will help address these critical issues."

In pregnant women, exposure to cooking fumes was related to an increased risk of their children having hyperactivity behaviors at the age of 3 years. The findings come from an Indoor Air study of 45,518 mothers of children who were newly enrolled in school in Shenzhen, China from 2015 to 2017.

Use of cooking fuels such as coal or gas during mothers' pregnancies was associated with higher risks of hyperactivity behaviors in young children when compared with the use of electricity for cooking. Poor ventilation during cooking was also linked with a higher risk.

The findings were relatively consistent across groups defined by social class, education, and other factors.