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In recent years, cannabinoids--the active chemicals in medical marijuana-- have been increasingly touted as a potential treatment for a range of neurological and psychiatric disorders. In a Developmental Medicine & Child Neurology review, investigators compare their efficacy with antiepileptic drugs for children with epilepsy.

One cannabinoid, called cannabidiol (CBD), has the most evidence of antiepileptic efficacy and does not have psychoactive effects. There has been little evidence for its use apart from anecdotal reports, until the last year.

The review notes that in three randomized, placebo-controlled, double-blind trials in Dravet syndrome and Lennox-Gastaut syndrome (two forms of childhood epilepsy), CBD produced a 38 percent to 41 percent median reduction in all seizures compared with 13 percent to 19 percent with placebo. Similarly, CBD resulted in a 39 percent to 46 percent responder rate (50 percent convulsive or drop-seizure reduction) compared with 14 percent to 27 percent with placebo. CBD was well tolerated, however sedation, diarrhoea, and decreased appetite were frequent.

"Community debate about the use of CBD and access to this antiepileptic therapy has been heated," the authors wrote. "With further trials and greater understanding of its role, the place of CBD in our antiepileptic armamentarium and its impact on comorbidities will become clearer."

WASHINGTON-(Nov. 6, 2018)-The majority of patients with cystic fibrosis may not achieve blood concentrations of antibiotics sufficiently high enough to effectively fight bacteria responsible for pulmonary exacerbations, leading to worsening pulmonary function, indicates a study led by researchers at Children's National Health System. Additionally, the study findings show that it's impossible to predict solely from dosing regimens which patients will achieve therapeutically meaningful antibiotic concentrations in their blood.

The findings, published online in the Journal of Pediatric Pharmacology and Therapeutics, suggest that closely monitoring blood antibiotic concentrations could prove key to improving clinical outcomes.

Cystic fibrosis, a genetic condition that affects about 70,000 people worldwide, is characterized by a buildup of thick, sticky mucus in patients' lungs. There, the mucus traps bacteria, causing patients to develop frequent lung infections that progressively damage these vital organs and impair patients' ability to breathe.

These infections, which cause a host of symptoms collectively known as pulmonary exacerbations, are typically treated with a combination of at least two antibiotics with unique mechanisms. One of these drugs is typically a Beta-lactam antibiotic, a member of a family of antibiotics that includes penicillin derivatives, cephalosporins, monobactams and carbapenems.

Although all antibiotics have a minimum concentration threshold necessary to treat infections, Beta-lactam antibiotics are time-dependent in their bactericidal activity. Their concentrations must exceed a minimum inhibitory concentration for a certain period. However, explains study lead author Andrea Hahn, M.D., MS, an infectious disease specialist at Children's National, blood concentrations of Beta-lactam antibiotics aren't typically tracked while patients receive them.

Since antibiotic dosing often doesn't correlate with cystic fibrosis patients' clinical outcomes, Dr. Hahn and colleagues examined whether patients actually achieved serum antibiotic concentrations that are therapeutically effective.

The researchers collected data from 19 patients seen at Children's Cystic Fibrosis Center. For each patient, the researchers collected respiratory secretions on four different occasions:

When they were at the clinic for a well-visit

At the beginning of an acute pulmonary exacerbation that required intravenous antibiotic therapy

After treating that acute pulmonary exacerbation and

More than 30 days after the patient completed the treatment course.

The researchers also checked plasma drug concentrations of Beta-lactam antibiotics during each patient's treatment course. They collected samples at a minimum of four time points:

A trough of fewer than 30 minutes before a dose

A peak one hour after a dose was infused

A sample three to four hours after the dose was infused and

A repeat trough fewer than 30 minutes before another dose.

In addition, all the patients underwent pulmonary function tests at the start of their exacerbations and about once weekly until their antibiotic therapy ended.

Using these data points, the researchers constructed a model to determine which patients had achieved therapeutic concentrations for the bacteria found in their respiratory secretions. They then correlated these findings with the results of patients' pulmonary function tests. Just 47 percent of patients had achieved therapeutic concentrations. Those who achieved significantly high antibiotic exposure had more improvement on their pulmonary function tests compared with patients who didn't.

Paradoxically, they discovered that although each patient received recommended antibiotic doses, some patients had adequately high serum antibiotic concentrations while others did not.

Dr. Hahn notes that real-time monitoring of antibiotic blood concentrations could help doctors stay on top of whether patients are being adequately dosed. The research team is investigating this in a new study.

Another way to ensure patients receive therapeutically meaningful levels of antibiotics is to develop new models that incorporate variables such as age, gender and creatinine clearance--a measure of kidney function that can be a valuable predictor of metabolism--to predict drug pharmacokinetics. Using findings from this research, Dr. Hahn adds, Children's National already has implemented an algorithm using different variables to determine antibiotic dosing for patients treated at the hospital.

"Getting adequate treatment is crucial for getting better," she says. "At Children's National, we are implementing policies to make sure that happens for our patients with cystic fibrosis, infusing new research insights into patients' ongoing clinical care."

Nowadays, overweight or obese patients, particularly those with metabolic syndrome, are recommended to lose weight by changing their lifestyle. The aim of these recommendations is to reduce their cardiovascular risk; however, there is no scientific evidence that this beneficial effect can be maintained in the long-term. Although low fat and low carbohydrate diets have proven effective in losing weight and improving cardiovascular risk, the benefits tend to diminish after a year.

With this investigation, the researchers from the Human Nutrition Unit at the Universitat Rovira i Virgili, in collaboration with 23 other research groups in the PREDIMED-Plus study, have evaluated the changes in body weight, fat accumulation and different cardiovascular risk factors after one year in 626 patients. The results have shown that the lifestyle changes included in the study are effective in maintain clinically significant weight loss. Indeed, after 12 months of intervention, 33.7% of the patients following the hypocaloric Mediterranean diet and daily exercise showed a minimum of 5% weight loss. These patients also showed improvements in those parameters related with glucose metabolism and certain inflammatory markers, in contrast with those patients who did not follow the diet. Furthermore, for those patients with diabetes or at risk of diabetes, the benefits from these lifestyle changes were particularly high in terms of glucose control.

The researchers highlight that, in this study, the greatest weight loss has been found after 12 months, which illustrates that weight loss was maintained over time. In the light of these results, the researchers expect that this weight-loss maintenance in response to the PREDIMED-Plus lifestyle programme can provide the same or more benefits for cardiovascular disease (myocardial infarction, stroke or mortality from these causes) in the long term. In fact, this is the main objective of the PREDIMED-PLUS trial.

A new high-tech bracelet, developed by scientists from the Netherlands detects 85 percent of all severe night-time epilepsy seizures. That is a much better score than any other technology currently available. The researchers involved think that this bracelet, called Nightwatch, can reduce the worldwide number of unexpected night-time fatalities in epilepsy patients. They published the results of a prospective trial in the scientific journal Neurology.

SUDEP, sudden unexpected death in epilepsy, is a major cause of mortality in epilepsy patients. People with an intellectual disability and severe therapy resistant epilepsy, may even have a 20% lifetime risk of dying from epilepsy. Although there are several techniques for monitoring patients at night, many attacks are still being missed.

Consortium researchers have therefore developed a bracelet that recognizes two essential characteristics of severe attacks: an abnormally fast heartbeat, and rhythmic jolting movements. In such cases, the bracelet will send a wireless alert to carers or nurses.

Watch the video here: https://youtu.be/0G_BQK4LK88

The research team prospectively tested the bracelet, known as Nightwatch, in 28 intellectually handicapped epilepsy patients over an average of 65 nights per patient. The bracelet was restricted to sounding an alarm in the event of a severe seizure. The patients were also filmed to check if there were any false alarms or attacks that the Nightwatch might have missed. This comparison shows that the bracelet detected 85 percent of all serious attacks and 96% of the most severe ones (tonic-clonic seizures), which is a particularly high score.

For the sake of comparison, the current detection standard, a bed sensor that reacts to vibrations due to rhythmic jerks, was tested at the same time. This signalled only 21% of serious attacks. On average, the bed sensor therefore remained unduly silent once every 4 nights per patient. The Nightwatch, on the other hand, only missed a serious attack per patient once every 25 nights on average. Furthermore, the patients did not experience much discomfort from the bracelet and the care staff were also positive about the use of the bracelet.

These results show that the bracelet works well, says neurologist and research leader Prof. Dr. Johan Arends. The Nightwatch can now be widely used among adults, both in institutions and at home. Arends expects that this may reduce the number of cases of SUDEP by two-thirds, although this also depends on how quickly and adequately care providers or informal carers respond to the alerts. If applied globally, it can save thousands of lives.

Delayed care is a crtically important factor in the survival of patients with head and neck cancer, and the patients who most often experience these delays are African American, according to two new studies at the Medical University of South Carolina (MUSC) and Hollings Cancer Center.

These findings are reported in an article published online October 18 and by a systemic review published online October 11 - both in JAMA Otolarynology - Head & Neck Surgery (Doi: 10.1001/jamaoto.2018.2225 and 10.1001/jamaoto.2018.2716).

MUSC Hollings Cancer Center researcher, MUSC Health otolaryngologist-head and neck surgeon and lead author Evan Graboyes, M.D., said this is a critical area of research.

"Just as some scientists work to understand cancer genetics or tumor biology in the hope of finding targets that can be modified with a new drug, we see care delivery pathways in the same light," said Graboyes. "Even just changing a few things can result in a higher survival rate of patients and decreased racial disparities in care around the country."

Head and neck squamous cell carcinoma (HNSCC) affects the areas around the throat, voice box, nose, sinuses and mouth. The disease begins when healthy cells in the head and neck start to grow rapidly and out of control to form a tumor, according to the American Society of Clinical Oncology. Squamous cell carcinoma refers to the origin of the tumor: flat cells that form the lining of both the mouth and the throat.

While HNSCC is considered rare, consisting of only 4 percent of all cancer cases each year, it has a high mortality rate. The American Cancer Society estimates that almost 14,000 patients will die from this disease in the U.S. in 2018, and African Americans are even more likely to die from it.

Treatment for HNSCC varies depending on the stage at which the patient is diagnosed, but best practices have been tested and agreed upon by a team of doctors from across the United States. These findings, which form the basis for the National Comprehensive Cancer Network (NCCN) guidelines for treating this form of cancer, shaped the parameters of these two studies.

According to the NCCN treatment guidelines, patients undergoing surgery for HNSCC need to receive postoperative radiotherapy (PORT) within six weeks of their surgical procedure to maximize their chances of remission.

Graboyes' study found that delays starting PORT are common and occurred in 45 percent of the patients involved in his research. While examining these findings, the team also determined that 56 percent of African American patients received delayed care while only 43 percent of white patients did.

Graboyes and his team investigated the processes of care that caused delays and found many factors contribute. Patients who received their pathology report within seven days of surgery were four times more likely to follow treatment guidelines by starting PORT within six weeks.

Patients who had care in two different hospitals rather than continuous care at one hospital or academic medical center were more likely to experience delays as well. Those who met with radiation oncology before surgery had an 8.9-fold increase in timely PORT.

"We know that African Americans with this disease have a significantly higher rate of mortality than white patients, but we aren't sure why," said Graboyes. "This research showed us that delays in treatment disproportionately affected African Americans, which could be one of the factors contributing to their lower survival rates."

More research is still needed to determine the specific barriers to timely and equitable HNSCC care, and racial differences as well as treatment delays in other aspects of cancer care continue.

Barriers to cancer treatment in general often relate to a patient's insurance status, the cost of the procedure, fear or distrust of the medical system, lack of knowledge of the disease and a lack of perceived importance.

Graboyes aims to enact real change that will benefit future patients in South Carolina and across the country. "We hope that these data will be helpful for head neck cancer providers and healthcare policy makers to understand the magnitude of the problem and spur coordinated action to address its root causes," he said.

"We can't always control the inner workings of a disease," said Graboyes. "But we can change the way in which cancer care is delivered to patients, and that's exciting to me."

CHAMPAIGN, Ill. -- Single mothers, those with less education and mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children - better known as the WIC Program - may receive less information and support with breastfeeding, a new study found.

Led by University of Illinois postdoctoral research associate Carolyn Sutter, the study suggests that mothers who are at greatest risk of breastfeeding cessation may have access to fewer resources that provide helpful information and support.

More than 440 new mothers responded to an online survey about their breastfeeding practices, breast pump use and infant feeding methods at six weeks postpartum. All of the women were participants in the Synergistic Theory and Research on Obesity and Nutrition Group 2, better known as STRONG Kids 2, an ongoing child-obesity prevention program administered by the U. of I.'s Family Resiliency Center.

"The STRONG Kids 2 program collects a lot of data around breastfeeding and different feeding practices that mothers are using, especially during their infants' first year of life," Sutter said. "Within that initiative, I was interested in finding out where mothers get their information and support for engaging in the often-challenging task of breastfeeding, and how we can bolster those resources or eliminate some of the barriers that mothers face."

Despite the many documented benefits of breastfeeding, such as breastfed infants receiving antibodies that resist bacteria and viruses and reduced risks of asthma and allergies, only about half of U.S. mothers breastfeed their infants through their first six months of life, according to the Centers for Disease Control and Prevention's Breastfeeding Report Card.

Barriers that discourage mothers from breastfeeding or expressing breast milk to feed their infants include physical complications such as insufficient milk supply, and structural barriers such as mothers' need to return to work.

Slightly more than 70 percent of the mothers in the current study were breastfeeding exclusively, while another 18 percent of them were feeding their child a combination of breast milk and infant formula.

Women were asked whether they had received information on breastfeeding and breast pumping or support for these practices from professional sources such as clinicians and WIC; educational and informational media; relatives, friends and peers; their workplaces; and their child care providers.

The majority of the women in the study were first-time mothers, and 97 percent of these women reported that they received support from their health care providers or other professionals to help them with breastfeeding. Nonetheless, Sutter found that these mothers, along with women participating in WIC, were less likely to breastfeed their infants, even though WIC provides educational materials and assistance to mothers who do so.

"Despite receiving information and support at higher rates, being a first-time parent was associated with decreased odds of breastfeeding, as was WIC participation," Sutter said. "It's unclear whether the information and support is completely absent or if it's not resonating with them in a meaningful way that supports breastfeeding practices due to ineffective delivery methods or to some mothers' heightened stress levels."

More than 95 percent of breastfeeding mothers and 78 percent of the mothers who used breast pumps reported that they received information and support from professional sources. However, Sutter found that mothers' sources of information and support were linked with demographic differences.

For example, first-time mothers reported receiving greater levels of support from professionals and from friends and relatives than did their counterparts who had given birth previously, Sutter found. Accordingly, women who had college or postgraduate degrees, who were white and not enrolled in WIC were more likely to seek information from books, websites or other media.

While receiving advice from a trusted friend or relative may be beneficial, Sutter noted that interpersonal factors may become impediments, especially when family and community members provide incorrect information to the new mother or when negative subjective norms in the community discourage breastfeeding.

To be effective, educational and informational materials about infant feeding practices must be culturally sensitive and be sensitive to women's differing lifestyles, Sutter said. For example, mothers who must return to work shortly after giving birth may find information on using breast pumps more useful to them than information on breastfeeding alone.

Sutter will present her findings at the National Council on Family Relations annual conference Nov. 7 in San Diego. The paper was published recently in the journal Breastfeeding Medicine.

Glasgow, UK: Men who have been newly diagnosed with prostate cancer say they would trade some improvement in their odds of survival for improvements in side effects and quality of life, according to research presented at the 2018 NCRI Cancer Conference.

Prostate cancer is one of the most common forms of the disease in men but in many cases it is a slow growing disease with relatively good survival, even if left untreated. Treatment can include surgery or radiotherapy, but both can cause urinary incontinence and a loss of sexual function. Some patients will spend weeks or months recovering from treatments and some may need a second round of treatment.

The new study suggests that, while patients value a longer life, they also value quality of life and may be willing to choose less treatment on that basis.

The study was presented by Hashim Ahmed, Chair and Professor of Urology, Imperial College London and Chair of NCRI's Prostate Cancer Clinical Studies Group. He explained: "Men with early prostate cancer have to choose between active surveillance, with regular check-ups, and more invasive therapy, such as removal of the prostate gland or radiotherapy. Previous research suggests that men with low-risk prostate cancer do not gain improvements in survival at ten years following treatment. Men with high-risk prostate cancer gain a five per cent improvement in ten-year survival with treatment. In men with medium-risk disease there is uncertainty over whether treatment affects survival.

"Men who have treatment do suffer side effects including urine incontinence, requiring daily use of pads, loss of erectile function, despite medication like Viagra, and some will require further treatment.

"We know men wish to live longer, but many men get depressed following treatment and their quality of life and personal relationships are affected."

Professor Ahmed and his colleagues worked with 634 men who had been newly diagnosed with prostate cancer at UK hospitals. The men had only been told their diagnosis and given general information. They had not yet discussed any specific treatment with their clinicians.

In all cases, the cancer had not yet spread. Seventy-four per cent had low or medium risk cancer and 26 per cent had high risk cancer.

Men were presented with two different hypothetical treatments that were different in terms of their likely impact on survival, incontinence, impotence, recovery time and the chance of needing further treatment. The men were asked to say which of the two hypothetical treatments they would pick and this was repeated several times with varying impacts on survival and side effects.

Based on the men's choices, researchers were able to quantify how important each factor was for the men, on average.

The results showed that survival was the most important factor, followed by avoiding incontinence, not needing further treatment and finally, maintaining an erection.

However, they also suggested that patients were willing to make trade-offs between side-effects and survival. The choices the men made suggest that, on average, they were willing to give up a 0.68% chance of improved survival if that meant they could gain a one per cent improvement in the chance of keeping urinary function. They were also willing to give up a 0.41% chance of improved survival in return for a one per cent improvement in the chance of not needing more treatment. For a one per cent chance of being able to achieve erections, they were willing to trade a 0.28% chance of improved survival.

Professor Ahmed said: "It's easy to assume that patients' key motivation is survival, but this research shows the situation is more nuanced. Men do want long life but they highly value treatments that have low side-effects, so much so that, on average, they were willing to accept lower survival if it meant the risk of side-effects was low. The amount of lower survival they were willing to accept is about the same as the small benefit they might expect from radical surgery or radiotherapy instead of active surveillance.

"Each patient differs as to what treatment they prefer but it may help them to know that many men think about the balance between the quantity and the quality of life, and they should not feel it is wrong to have similar thoughts."

He added: "I am interested in strategies that reduce patient harm and limit the impact of treatments on side-effects and quality of life. For many patients that means opting for active surveillance or less invasive treatments such as focal therapy."

Focal therapy uses heat or cold to target the cancer, as opposed to the whole prostate, in order to reduce side-effects, but it is not available in all hospitals. The researchers did not gather information on which treatments the patients ultimately chose, partly because the real options available varied between hospitals.

Professor Ahmed says that more research is needed into less invasive treatments such as focal therapy and into how active surveillance can be improved by using imaging instead of repeat biopsies.

Robert Jones is Chair of the NCRI's Advanced Disease Prostate Cancer Clinical Studies Subgroup, Professor of Clinical Cancer Research at the University of Glasgow, and was not involved in the research. He said: "This research shows that patients are willing and able to make trade-offs between different aspects of treatment and they may wish to choose treatments or strategies that have fewer side effects, even if survival is not as good. Clinicians should ensure they give non-biased information about the different options for prostate cancer to help patients decide what is right for them."

Glasgow, UK: Thyroid cancer patients whose disease is at low risk of returning can be treated safely with a smaller amount of radiation following surgery, according to results from the world's longest running trial to investigate this.

Dr Jonathan Wadsley, a consultant clinical oncologist at the Weston Park Hospital, Sheffield, UK, and chair of the National Cancer Research Institute (NCRI) Thyroid Cancer Subgroup, told the 2018 NCRI Cancer Conference today (Monday) that the latest results from the HiLo trial showed there was no significant difference in the recurrence rate between patients given a low radiation dose compared to the standard, higher dose. He said this meant that international guidelines could be updated to recommend the lower dose in low risk patients and these patients would benefit from fewer side effects and long-term complications, and a more convenient treatment.

He reported results from 434 patients with low risk thyroid cancer in the HiLo trial with a median (average) follow-up time of 6.5 years. The patients were randomised to receive low administered radioactive iodine activity (RAI) of 1.1GBq, or the standard high RAI of 3.7GBq [1]. They also received either Thyrogen (a genetically-engineered thyroid stimulating hormone, TSH), which stimulates thyroid cancer cells to absorb as much radioactive iodine as possible, making it more effective, or they were asked to stop taking their thyroid hormone tablets, which achieves the same effect by allowing levels of their natural TSH to rise.

Dr Wadsley explained: "Activity is a measure of the amount of radiation that is administered to the patient in the form of a radioactive isotope of iodine. The aim of the treatment is to destroy any residual normal thyroid tissue and thyroid cancer cells following surgery to remove the thyroid gland. The treatment is most commonly given as a capsule to swallow. As a general principle, we would always wish to give the lowest quantity of radiation possible to prevent the recurrence of thyroid cancer. This is to reduce the risk of longer-term side effects from the treatment, most importantly reducing the risk of the treatment causing another cancer in the future. In our study the low activity 1.1GBq dose was less than a third of the higher activity 3.7GBq dose, but has been proven to be as effective."

During the nearly seven years of follow-up, there were 21 recurrences of cancer (11 and 10 with 1.1GBq and 3.7GBq respectively). The recurrence rates were similar between the two doses, and also between patients using Thyrogen or thyroid hormone withdrawal.

"The study showed that patients receiving a lower activity experienced fewer side effects, in particular less risk of feeling sick or suffering damage to the salivary glands, which can potentially lead to a permanently dry mouth. The use of a lower activity also raises the possibility of giving the treatment in one day rather than having to admit patients to be nursed in isolation for two to three nights. This is required for the higher activity due to radiation protection regulations to avoid exposing the general public to unnecessary radiation, but can be particularly distressing for patients as they can only have very limited contact with other people during this time, which is particularly hard for someone with a recent cancer diagnosis. Therefore, not only is lower activity preferable for patients, it can also result in cost savings to the health service," said Dr Wadsley.

"The study also showed that quality of life and ability to continue normal activities was much better for patients receiving Thyrogen than those using thyroid hormone withdrawal. If thyroid hormone withdrawal is used, patients have to come off their regular medication for at least two weeks. This leaves them feeling extremely tired and in some cases quite depressed."

He said that the HiLo trial had the longest follow-up time of any other randomised study worldwide. Until now, there had not been enough evidence for international guidelines to do more than make weak recommendations about using 1.1GBq in low risk patients, due to the limited data and only short-term follow-up.

"Now that we have confirmation that there is no difference in recurrence rates over a longer follow-up period, these recommendations can be strengthened and clinicians and patients can be confident that use of the lower activity is acceptable and in fact preferable," he concluded.

The HiLo trial has finished and now the researchers are investigating whether a group of patients can be identified that have such a low risk of recurrence of their thyroid cancer that they do not require radioiodine therapy at all. The IoN trial (Iodine or Not) is allocating patients with very low risk thyroid cancer to have radioiodine therapy or careful observation alone to determine whether there is any difference in recurrence rates and whether or not these patients could avoid iodine treatment altogether.

Dr Martin Forster from University College London, who is chair of the NCRI Head and Neck Clinical Studies Group and was not involved with this research said: "Nearly seven years of follow-up data from the HiLo trial provides us with confidence that the lower 1.1GBq radiation dose for patients with low risk thyroid cancer is a safe and effective treatment, and that international guidelines can be updated to reflect this. For many patients, the treatment and how it is delivered, as well as the short and long-term side effects, can have a big impact on their lives. The HiLo trial is a good example of a well-conducted clinical trial that can make a real difference to the quality of life for these patients. We look forward to the results of the IoN trial, which could determine whether some patients have such a low risk of their cancer returning that they could be spared radioiodine treatment completely."

Thyroid cancer is rare, with approximately 3,500 cases in the UK each year, less than 1% of the total annual number of cancers. Low risk thyroid cancers have a good survival rate with approximately 99% patients surviving for ten years or more.

A clinical trial led by La Trobe University has shown eating fish such as salmon, trout and sardines as part of a healthy diet can reduce asthma symptoms in children.

The international study found children with asthma who followed a healthy Mediterranean diet enriched with fatty fish had improved lung function after six months.

Lead researcher Maria Papamichael from La Trobe said the findings added to a growing body of evidence that a healthy diet could be a potential therapy for childhood asthma.

"We already know that a diet high in fat, sugar and salt can influence the development and progression of asthma in children and now we have evidence that it's also possible to manage asthma symptoms through healthy eating," Ms Papamichael said.

"Fatty fish is high in omega-3 fatty acids which have anti-inflammatory properties. Our study shows eating fish just twice a week can significantly decrease lung inflammation in children with asthma."

Co-researcher and Head of La Trobe's School of Allied Health, Professor Catherine Itsiopoulos, said the results were promising.

"Following a traditional Mediterranean diet that is high in plant-based foods and oily fish could be an easy, safe and effective way to reduce asthma symptoms in children," Professor Itsiopoulos said.

Associate Professor Bircan Erbas, from La Trobe's School of Psychology and Public Health, is an expert in asthma and allergies, who co-supervised the trial.

"Asthma is the most common respiratory disease in young people and one of the leading reasons for hospitalisations and trips to emergency for children," Associate Professor Erbas said.

"Unfortunately, the rate of asthma worldwide remains high. It is imperative that we identify new therapies that we can use alongside conventional asthma medications."

The clinical trial involved 64 children from Athens in Greece, aged 5 to 12 who had mild asthma. Researchers from Australia and Greece divided the children into two groups and instructed around half to eat two meals of cooked fatty fish (of at least 150 grams) as part of the Greek Mediterranean diet every week for six months. The remaining children followed their normal diet.

At the end of the trial, they found the group who ate fish had reduced their bronchial inflammation by 14 units. Above 10 units is significant under international guidelines.

Data presented at Neuroscience 2018 demonstrates genetic deletion of SARM1 protects axons in the central and peripheral nervous systems with a corresponding reduction of blood neurofilament-light (NF-L), a clinically-validated biomarker of axonal degeneration.

CAMBRIDGE, Mass., Nov. 3, 2018 - Disarm Therapeutics, a biotechnology company creating a new class of disease-modifying therapeutics for patients with axonal degeneration, a central driver of neurological disease, today announced data demonstrating that genetic inhibition of SARM1 prevents axonal degeneration in the central, ocular and peripheral nervous systems. Disarm also discovered that SARM1 inhibition lowers two biomarkers - blood NF-L and cADPR - providing critical insight into the development of small-molecule inhibitors of SARM1, identified by Disarm's scientific founders as the central driver of axonal degeneration. These data are presented today as a scientific poster at the Neuroscience 2018 conference in San Diego.

Axonal degeneration is a common yet unaddressed pathology in a broad range of neurological diseases. It causes disability and disease progression in chronic and acute diseases of the central, ocular, and peripheral nervous systems such as multiple sclerosis, amyotrophic lateral sclerosis, glaucoma, and peripheral neuropathies. Disarm Therapeutics is developing disease-modifying SARM1 inhibitors to treat axonal degeneration.

Highlights from the data presented at Neuroscience 2018 include:

SARM1 genetic deletion protects axons in vitro and in vivo

cADPR, a metabolite of SARM1, was identified, for the first time, as a proximal biomarker of SARM1 enzymatic activity in vitro and in vivo

NF-L, a prognostic biomarker of neurodegeneration increasingly used in the clinic, is released in blood following CNS, ocular, and PNS axonal degeneration in a SARM1-dependent manner

"The data presented at Neuroscience 2018 are important milestones in Disarm's work as we develop small-molecule inhibitors that prevent axonal degeneration in diseases such as multiple sclerosis and peripheral neuropathies," said Rajesh Devraj, PhD, founder and chief scientific officer of Disarm Therapeutics. "We now have validated biomarkers that measure SARM1 activity and axonal degeneration. These are important tools for translating our therapies rapidly into human clinical trials and, ultimately, to patients."

NEW ORLEANS -- An evaluation of breast cancer patients enrolled in Medicaid showed that states that expanded Medicaid during 2011 to 2017 had a 27 percent increase in prescriptions for hormonal therapy medications compared to states that did not expand Medicaid during the same period, according to results of a study presented at the 11th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held here Nov. 2-5.

"We saw a large and significant increase in the use of hormonal therapies for breast cancer treatment in states that underwent Medicaid expansion," said Michael Halpern, MD, PhD, associate professor at Temple University College of Public Health. "In contrast, states that did not participate in Medicaid expansion saw essentially no increase in these prescriptions."

For women who have received treatment for breast cancer and are recovering, hormonal therapies can reduce the chance of their breast cancer coming back, and, for best effect, they need to take these medications for three to five years, Halpern said.

"Over the course of more than a year following Medicaid expansion, the difference in the rate of hormonal therapy use between states that underwent Medicaid expansion and those that didn't continued to go up," noted Halpern. "This highlights that getting the coverage for these hormonal therapies as a one-time event isn't enough; there has to be a process where breast cancer survivors can work with their health care providers and get educated about the importance of this treatment."

Utilizing information from the Medicaid State Drug Utilization Database (SDUD) which was compiled by the Centers for Medicaid and Medicare (CMS), Halpern and colleagues evaluated outpatient prescription rates and associated payments for tamoxifen and aromatase inhibitors, two common hormonal therapeutics for the treatment of breast cancer, for individuals enrolled in Medicaid programs. Both generic and branded prescriptions were included in the study.

Following multivariable analysis, Halpern and colleagues found that prescriptions for all hormonal therapy medications and aromatase inhibitors increased by 27 percent and 29 percent, respectively, for Medicaid programs in states that expanded Medicaid, compared to Medicaid programs in non-expansion states. The study authors suggest that most of this increase was new utilization of these drugs that would not have occurred in the absence of Medicaid expansion.

"Looking at the medications funded by state Medicaid programs, it's clear that states that expanded Medicaid are funding increased access to these hormonal therapies," said Halpern. "We believe that hormonal therapy use increased among women who were previously uninsured and did not have access to these potentially life-saving drugs.

"While most women, regardless of their income or insurance status, have access to acute breast cancer treatments--initial surgery, chemotherapy, and/or radiation therapy--coverage is sometimes lacking for breast cancer survivors that may require long-term treatment with hormonal therapy," Halpern continued. "We need to be better at making sure that cancer survivors, particularly those who are in underserved populations, continue to have access to high-quality care and are able to receive the services and medications that they need to prevent their cancer from coming back."

Limitations of the study include a reliance on state level Medicaid prescription data; prescriptions for hormonal therapy could have been for conditions other than breast cancer, but this represents an extremely small cohort, noted Halpern.

A new form of therapy may halt or even reverse a form of progressive vision loss that, until now, has inevitably led to blindness. This hyper-targeted approach offers hope to individuals living with spinocerebellar ataxia type 7 (SCA7) and validates a new form of therapy with the potential to treat neurogenetic diseases effectively and with far fewer side effects than other medications. Details of this therapy appear in the latest issue of Science Translational Medicine.

Senior author Al La Spada, MD, PhD, and colleagues treated mice with SCA7, an inherited neurodegenerative disease. Humans or mice with SCA7 have repetitions of the CAG triplet in the Ataxin-7 gene. These repetitions result in the production of Ataxin-7 protein with an expanded glutamine tract; the proteins then misfold and build up in retinal neurons, leading to their demise. La Spada's team evaluated a form of therapy known as antisense oligonucleotides (ASOs) for this condition. ASOs are synthetic, single-stranded pieces of DNA that bind to specific RNA molecules--in this case the RNA formed by the excess CAG repeat in the Ataxin-7 gene. The cell can then find and destroy the bound RNA molecule before it encodes the malformed protein that leads to visual loss.

ASOs offer a promising approach because they directly target the harmful proteins produced by genetic disorders before they can be expressed. Spinraza, a therapy now in use for patients with infantile-onset spinal muscular atrophy, uses a similar technique, and has been found to be effective in preventing motor neuron loss and improving symptoms in that condition.

The research team synthesized ASOs that matched with RNA produced by mouse Ataxin-7. Then, they injected the ASOs into the vitreous humor of one eye of SCA7 mice and a saline solution into the other eye. Eyes treated with the ASOs showed improved visual function compared to controls at both 4 and 6 weeks after treatment.

In assessing the therapeutic implications of this work, Dr. La Spada noted, "SCA7 is a rare disease, but is caused by accumulation of a misfolded protein, just like in Parkinson's disease or Alzheimer's disease. By developing ASOs to treat the retinal degeneration in SCA7, we are not only creating a powerful new therapy to treat this rare disease, but also will have an opportunity to evaluate this therapeutic strategy in a system (the eye) that is easily accessible and where the treatment response can be monitored with well-defined, objective read-outs."

The team also performed ophthalmologic evaluations on two human SCA7 patients and monitored the progression of retinal degeneration to better understand how the disease develops.

SCA7 is an autosomal dominant neurodegenerative disorder affecting about one in 500,000 individuals. It is one of nine recognized polyglutamine diseases caused by excess repetitions of the CAG nucleotide; others include Huntington's disease as well as six other forms of spinocerebellar ataxia. Individuals with SCA7 develop progressive neurologic and visual symptoms that appear anywhere from childhood to middle age. No treatments currently slow or stop the course of the disease.

Ocular inflammation uveitis is a serious disease that can destroy eye tissue and cause irreversible blindness.

Fortunately, blindness and eye damage can be prevented by suppressing the immune system and treating the disease with corticosteroids, said Sai Chavala, MD, Professor of Pharmacology and Neuroscience and Director of Translational Research at the North Texas Eye Research Institute at UNT Health Science Center.

"While corticosteroids are effective in treating inflammation and preventing blindness, they often become intolerable over time," he said. "There's a risk of systemic side effects such as glucose intolerance, hypertension and osteoporosis with oral steroids."

Treating with intraocular steroids reduces the systemic adverse effects. But this treatment can cause vision loss due to the development of a cataract or steroid-induced glaucoma.

But a class of drugs known as MDM2 inhibitors could potentially be a promising new treatment for this chronic disease, which typically strikes young and middle-aged adults. MDM2 is currently being evaluated as a cancer therapy in clinical trials.

"But we have found that the same class of drugs can inhibit ocular inflammation, which was a surprising benefit," Dr. Chavala said.

The research team studied the effects of MDM2 in mice by using an agent that blocks MDM2. Inflammation was nearly abolished with systemic and ocular delivery of the MDM2 inhibitor.

"The results of this study are promising and suggest further research is warranted," said Yan Fan, PhD, a post-doctoral research fellow at UNTHSC, who is first and lead author on the study.

The findings appear in the September issue of the American Journal of Pathology.

Uveitis is estimated to account for 10 percent of all cases of blindness in the United States, including 30,000 new cases of legal blindness each year. It is affects about 200,000 people in the United States. Although it usually occurs in adults, about 5 percent to 10 percent of cases start before age 16. About 43,000 new cases are diagnosed in the United States each year.

The disease is caused by inflammatory responses inside the eye, perhaps because of an attack from the body's immune system. Infections or tumors, bruises and toxins that penetrate the eye might also lead to the disease.

Symptoms include blurred vision, eye pain and redness. Awareness of the disease has increased as celebrities such as Mila Kunis have publicly commented on the struggles uveitis patients have with vision impairment.

Highlights

In a study that compared uninsured patients starting hemodialysis with similar patients already covered by Medicare or Medicaid, patients with Medicare or Medicaid were more likely to receive dialysis through an arteriovenous fistula or graft by their fourth dialysis month.

Patients with Medicare at the start of dialysis also had fewer hospitalizations involving vascular access infection in dialysis months 4-12.

Washington, DC (November 1, 2018) -- Patients with newly diagnosed kidney failure must wait for up to 3 months before they qualify for Medicare. A new study found that this short period of time without insurance is associated with delays in the placement and use of preferred methods for gaining access to the bloodstream for dialysis. The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also found that this insurance lag time is linked with a higher risk of later dialysis-related infection.

Individuals in the United States can obtain Medicare insurance coverage no matter how old they are if they have kidney failure that requires dialysis or a kidney transplant; however, when a patient is first diagnosed with kidney failure, they must wait 3 months before they become eligible for Medicare based the kidney failure criteria.

Eugene Lin, MD, MS (Keck School of Medicine of USC) and his colleagues sought to determine whether this short delay without Medicare coverage might lead to delays in the placement and use of arteriovenous fistulas and grafts, which are preferred methods for accessing the bloodstream for dialysis. Using information from a national registry, the researchers compared uninsured patients starting hemodialysis between 2010 and 2013 with similar patients already covered by Medicare or Medicaid.

Patients with Medicare or Medicaid were much more likely to use an arteriovenous fistula or graft by their fourth dialysis month and this difference persisted through the first year of dialysis. Patients with Medicare at the start of dialysis also had fewer hospitalizations involving vascular access infection in dialysis months 4-12. (Individuals who undergo hemodialysis are at increased risk of developing infections due to the repeated need to access their blood.)

"In general, uninsured patients experience disparities in accessing healthcare. Ordinarily, Medicare pays for medical treatments for patients receiving hemodialysis; however, the uninsured must wait for 3 months before being eligible to enroll in Medicare, which makes them vulnerable to delays in medical care," said Dr. Lin. "Our study found that the uninsured were less likely than patients with Medicaid or Medicare to use an arteriovenous fistula or graft in the short-term, and these differences may have persisted even after the uninsured enrolled in Medicare. We also found that uninsured patients were more likely to have a dialysis-related infection than patients with Medicaid."