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Recent clinical trials have indicated that immune checkpoint blockade (ICB) therapy, which is designed to unleash a patient's immune system to attack cancer, has been revolutionary in its implications for breast cancer treatment, especially for its potential to treat patients with triple negative breast cancer (TNBC). Despite the fact that most breast cancer patients are over the age of 60, most clinical trials enroll patients under the age of 60. Age may be an important consideration with respect to ICB, given that aging is associated with profound changes to the immune system, so whether ICB will benefit patients of all age groups is still unknown. In order to understand the influence of aging on the effectiveness of ICB therapy, researchers from Brigham and Women's Hospital, the Dana Farber Cancer Institute, and Harvard Medical School conducted preclinical studies using younger and older mice with TNBC, finding that age affects the efficacy of ICB therapy. The results of this study are published in Cancer Discovery.

"Your immune system changes dramatically as you age, but no one has looked at how age affects the efficacy of this new class of drugs in breast cancer," said co-first author Greg Goreczny, PhD, a postdoctoral fellow in the Brigham's Hematology Division. "Because there are so few older patients enrolled in clinical trials, not enough is known about the effect of age on ICB therapy. Our initial question was whether ICB therapy would benefit all ages equally or have a greater benefit to some ages than others."

The team injected TNBC cell lines into young mice, aged 8 to 12 weeks, and old mice, aged 12 to 15 months. Once the mice formed palpable tumors, the researchers gave them four doses of one of two ICB drugs -- anti-PD-L1 or anti-CTLA-4 antibodies. They also injected a group with control antibodies. They then measured the tumor growth over time.

The study revealed that age had a huge effect on response to immunotherapy. The young mice experienced significant reduction in tumor growth and better overall survival rates in response to treatment than those who did not receive the treatment. Immunotherapy treatment did not significantly benefit the aged mice compared to those injected with the control.

The investigators also interrogated the METABRIC database, which includes data on tumor samples from patients with TNBC. Gene markers that predicted responsiveness to ICB in the young mice were prevalent in younger patients, but not in older ones. They also found signs indicative of failure of the innate immune system in the tumors of both aged mice and in samples from older patients with TNBC, implying that this study could be relevant to the treatment of people as well. Those findings led the authors to test a new combination therapy. By combining ICB with a STING agonist, a drug that has immune activation properties, they found that tumors in aged mice now responded to ICB and the mice had improved survival.

"Assessing the immune changes that occur with age could be a new way to think about immunotherapy," said corresponding author Sandra McAllister, PhD, an associate scientist in the Brigham's Hematology Division. "Immunological age might not be the same as chronological age. We're beginning to understand the markers of immunological age, and this opens up the possibility of using it to guide treatment decisions in the clinic."

A new national study done by researchers at Boston University School of Medicine (BUSM) and Boston Medical Center showed large differences in the emergency department (ED) and hospital destinations of minority (Black and Hispanic) patients who are transported by emergency medical services (EMS) when compared with their non-Hispanic white counterparts. The study appears in JAMA Network Open.

National guidelines require EMS transportation to the nearest suitable hospital. To what extent this occurs and whether this varies by the race and ethnicity of the patient is unknown since there is little to no prior research on destination patterns of EMS-transported patients to hospitals.

Using the national Medicare claims data, the study divided patients based on the zip code they lived in, and compared which EDs and hospitals non-Hispanic white, black and Hispanic patients living in the same zip code were brought to. The study also looked at how often the most frequently used destinations for white patients were also the destination for black and Hispanic patients.

The results of the study showed there were sizable differences by race and ethnicity in which emergency rooms and hospitals patients were brought to. The largest differences were seen in larger urban areas with multiple emergency rooms and hospitals within the vicinity. In addition, the study found that black and Hispanic patients were more likely to be transported to a safety-net hospital compared to their white counterparts living in the same zip code.

According to the researchers, these findings suggest EMS transports are often not transported to the nearest suitable hospital, as recommended by national guidelines. The difference in these transportation destinations may be motivated by factors other than proximity or time.

"The cause for this observed pattern is unknown and needs to be further studied to really understand the impact on patient clinical outcomes and if such outcomes vary by race and ethnicity," explained corresponding author Amresh Hanchate, PhD, associate professor of medicine at BUSM. "We need more research to understand the role that patient choice, usual source of care and clinical condition play in guiding EMS transportation decisions in diverse systems across the United States."

The research will also inform future studies on the impact of ambulance diversion, a practice where hospitals temporarily close emergency departments to new ambulance transports. Massachusetts banned ambulance diversion 10 years ago.

"Ambulance diversion is unfortunately a practice that remains common throughout the country," said co-author James Feldman, MD, MPH, FACEP, professor of emergency medicine at BUSM and Vice Chair of Research for the Department of Emergency Medicine at Boston Medical Center. "This research is a necessary first step in order to examine the effects ambulance diversion has on patient care and understanding the relationship between emergency utilization and health care disparities."

A Finnish study found that the more allergic diseases an individual has, the higher the asthma risk.

The number of allergic diseases increases the risk of adult-onset asthma especially in individuals born after 1940, according to a study published in the Allergy journal.

Approximately one in ten Finns suffers from asthma. It is one of the most common chronic illnesses in Western countries. Allergy is a risk factor in childhood asthma but its significance to adult-onset asthma is not precisely known.

A collaborative population-based study of the universities of Helsinki and Tampere interviewed 1,205 recently diagnosed asthmatics and 2,050 matched controls. The subjects were between 31 and 71 years of age. They were questioned about the occurrence of allergic rhinitis and conjunctivitis as well as atopic dermatitis.

Individuals with asthma had significantly more symptoms of allergic diseases than those in the control group. The number of allergic diseases was an independent risk factor for adult-onset asthma. One allergic disease approximately doubled the asthma risk. Correspondingly, two diseases tripled and three diseases quadrupled the asthma risk.

At least one allergic disease resulted in a 3.5-fold risk of adult-onset asthma in the under-50s age group, while for 50-62-year-olds the risk was 2.4-fold and in over 62-year-olds only 1.7-fold.

"The link between allergic diseases and asthma has strengthened in our population born after 1940. The cause for this phenomenon may be the radical decrease of microbial diversity in our living environment," says Sanna Toppila-Salmi, docent at the University of Helsinki.

The research result may also be partly due to asthma with an onset later in life being less associated with allergy. Discovering precise mechanisms is challenging, since data relating to the early living environment of the adult population is incomplete.

"According to another recent Finnish study, adult-onset asthma is more likely among women and family background is a major risk factor," says Toppila-Salmi.

GALVESTON, Texas - Long-term opioid use previously has been linked with low testosterone in men. What has been unclear is how many men taking opioids had been screened or treated for low testosterone.

A new study by researchers from The University of Texas Medical Branch at Galveston has found a very low rate of screening for low testosterone, a surprising finding given that a link is known.

UTMB researchers conducted the first large-scale, nationally representative investigation of how many of the men with extended opioid prescriptions were screened and, if needed, treated for low testosterone. Although more men taking long-term opioids were screened for low testosterone than men who only took opioids for a short period, these rates were surprisingly lower than expected, based on previous, smaller studies. The findings are currently available in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

Earlier studies have shown that low testosterone, which is associated with muscle wasting, weight gain, osteoporosis, low libido and infertility, has been linked with opioid use in 35 to 90 percent of cases. Opiates inhibit the release of chemicals in the brain that trigger testosterone production in the testis.

"Given the dramatic increase in opioid use over the past 20 years, it's likely that opioid-induced low testosterone is becoming increasingly common," said senior author Jacques Baillargeon, UTMB professor in the department of preventive medicine and community health. "This situation can have a profound effect on men's health and quality of life."

Using one of the nation's largest commercial insurance databases, the researchers identified 53,888 men aged 20 years or older who had 90 or more days of opioid prescriptions in a single 12-month period between January 1, 2010 and December 21, 2017 with no history of low testosterone or testosterone therapy in the year before. The researchers compared this group of men with 53,888 men who received 14 or fewer days of opioid prescriptions that were otherwise familiar.

Although the rate of low testosterone screening, diagnosis and treatment was higher among men with prolonged opioid prescriptions than those only taking opioids for a brief period, these numbers were lower than expected.

"This finding suggests a wide underscreening of opioid-induced low-testosterone, but it's not clear what factors drove this low rate," said Baillargeon. "It may reflect a lack of awareness among some clinicians or a reluctance to screen for conditions that would require additional medications in patients who already have complex conditions and treatment plans.

"From a patient's perspective, it's possible that men who are struggling with chronic pain and related conditions are less concerned than their peers about low testosterone symptoms and are therefore less likely to bring these symptoms to the attention to their physician."

A Rutgers New Jersey Medical School study has found a genetically tractable cause of drug tolerant tuberculosis, paving the way for researchers to develop new drugs to combat the global TB epidemic and cure the disease.

The study, led by Drs. Hassan Safi, assistant professor of medicine, and David Alland, professor and chief of infectious disease in the department of medicine at Rutgers New Jersey Medical School, (NJMS) was published on September 5, 2019 in the scientific journal, the Proceedings of the National Academy of Sciences (PNAS).

Tuberculosis is the leading cause of death from an infectious disease worldwide. One fourth of the world's population is currently infected with TB, and at least 1.3 million people died from the disease in 2017 alone, according to data from the CDC.

This new research study reveals that reversible mutations in the M.tuberculosis glpK gene, a gene responsible for an important metabolic pathway, produce a reversible form of tolerance to most of the first-line drugs used to treat TB.

"By discovering these mutants, we have pin-pointed a genetically tractable cause of drug tolerance, and as a result, we now have a unique opportunity to develop and test new treatments that are effective against drug tolerant organisms, which could lead to more rapid and effective therapies for tuberculosis," said Dr. Alland.

The study also shows that drug tolerant organisms accumulate during TB infection and accumulate even more rapidly with TB treatment. This form of drug tolerance can explain the high rates of treatment failure and relapse which occur in this disease unless it is treated for at least 6 months.

The surprising rapidly reversible nature of these mutations produce a transient form of drug tolerance that appears to disappear after the pressure of drug treatment is withdrawn. This unusual behavior likely explains why this drug tolerance mechanism has not been discovered previously.

Despite decades of efforts to stem the tide of contagion, the length and complexity of TB therapy continue to present major barriers to global control efforts.

For example, most cases of TB must be treated for 6 months and relapses are fairly common. In fact, about 20% of patients with drug susceptible TB will experience a relapse if treated for less than 6 months and approximately 5% will relapse even when treated for a full 6 months.

Drug resistance is fixed within the TB bacterium's genetic code, but any case of TB - even cases that were previously deemed "drug susceptible" - can become drug tolerant by reversible mutations in the glpK gene.

Researchers believe drug tolerance stems from TB's ability to lie dormant in the host's immune system. This biological change allows the disease to adapt to its environment and ultimately becomes transiently resistant to traditional therapies.

Dr. Alland and his research team set out to study this phenomenon and in doing so, they discovered a new mechanism of drug tolerance caused by genetically coded, but rapidly reversable mutations in the Mycobacterium tuberculosis bacteria that could be used to develop drugs that can quickly and effectively cure drug-resistant TB.

According to this research, drugs that are effective against phase-variant M.tuberculosis can hasten TB treatment and improve cure rates.

"Because of this study, we now have the ability to track and manipulate genetic mutations so that they have the same characteristics as drug tolerant cases of tuberculosis. That's never been done before," said Dr. Alland. "If we are going to defeat this disease, we need to find effective treatments for drug tolerant TB, and we need to do it now."

Liver cancer affects hundreds of thousands of people annually, and there are few viable therapies for the advanced stages of its most common form--hepatocellular carcinoma. A drug called sorafenib improves overall survival in patients with advanced hepatocellular carcinoma and is considered a standard treatment, but questions remain regarding how we can increase its effectiveness. Right now, the two available clinical trials show that sorafenib treatment increased overall survival by 6.5 to 10.7 months.

During the past decade, scientists began to test whether a radiological procedure called transarterial chemoembolization (TACE) can raise patient survival even further. This therapy involves blocking blood vessels leading to a tumor, depriving it of blood and thereby killing the malignant cells. When performed alone, TACE could stop tumors from spreading. However, only a few experiments have directly tested how addition of TACE to a sorafenib drug treatment would fare in improving survival compared with sorafenib alone. These experiments do not agree, with the only major clinical trial finding no increase in patient survival after combining TACE with sorafenib. However, adding sorafenib after TACE seems to increase indicators of therapeutic effectiveness.

To untangle these different outcomes, scientists from Taiwan and Japan, led by Dr Victor Kok from Kuang Tien General Hospital Cancer Center and Asia University Taiwan, performed the first large, national-level, population-based cohort study (published in the journal Cancers) examining the influence of TACE on the effectiveness of sorafenib against liver cancer. A cohort study involves following a group of people that share a characteristic (in this case, liver cancer) over a set period and periodically measuring relevant data from them (e.g., response to treatment). The scientists also used a statistical method called propensity matching to eliminate confounding factors (e.g., patient age, sex, socioeconomic status) that could affect between-group differences in survival beyond the effects of sorafenib and TACE. They obtained data on liver-cancer patients from the Taiwan National Health Insurance Research Database, which is very representative of Taiwan's population (99.9% of the island's population is enrolled in national health insurance).

Dr Victor Kok comments, "real-world data for this treatment combination is long overdue, and here we aimed to provide empirical evidence on whether sorafenib+TACE is actually more effective than sorafenib alone. Our work can fuel further research aimed at understanding the molecular mechanisms underlying any synergistic effects of sorafenib and TACE."

After tracking the data of 2112 Taiwanese patients until their death or the end of the study, Dr Kok and colleagues identified a 26% decrease in mortality when TACE was added to sorafenib treatment, compared with sorafenib treatment alone. More specifically, six months and one year after treatment, median overall survival was 80.3% and 53.5%, respectively, in the patients treated with sorafenib+TACE, whereas it was 54.4% and 32.4% in patients treated with sorafenib alone. The improvement was present regardless of whether patients received only one session of TACE or more. Additionally, median overall survival among the sorafenib-only patients was similar to what other researchers found in the only other clinical trial that had a comparable population, suggesting that sorafenib's anti-cancer effects are consistent. What's more encouraging--patients appeared to tolerate the combination treatment, because negative side-effects were similar between patients treated with sorafenib alone or with sorafenib+TACE.

This real-world study provided important confirmation that sorafenib interacts with TACE to control the spread of malignant liver tumors. Dr Kok explains, "Right now, oncologists aren't necessarily offering TACE as a treatment option because the evidence for its effectiveness isn't fully developed. But here, we've used a very large dataset to show that TACE can be added to a sorafenib-based treatment and improve its outcome. We're hoping that this will signal an advancement in liver cancer therapy, while also encouraging more research on the molecular mechanisms of exactly how sorafenib synergizes with TACE to control liver tumors. A better understanding of the underlying processes responsible for this additive, positive effect could help us identify further treatments."

The American Society for Gastrointestinal Endoscopy (ASGE) has released its updated "ASGE guideline on screening and surveillance of Barrett's esophagus," published in the September issue of GIE: Gastrointestinal Endoscopy.

The guideline aims to help clinicians understand the published literature and quality of available data on screening and surveillance in patients with Barrett's esophagus; a precancerous condition for esophageal adenocarcinoma. This document addresses several key clinical issues in this field, including the role and impact of screening and surveillance of Barrett's esophagus. As with other types of cancer, identifying this precancerous condition and early changes of cancer provides the best chance of successful treatment and, ultimately, improves patient outcomes.

Several endoscopic procedures and related technologies are used to screen and monitor patients with known or suspected Barrett's esophagus. If changes are found in the cells lining the esophagus, various endoscopic treatment approaches are available.

This guideline addresses the utility of advanced imaging and sampling modalities used during screening and surveillance endoscopic procedures and includes chromoendoscopy, confocal laser endomicroscopy, endoscopic ultrasound, wide-area transepithelial sampling (WATS) and others. Table 4 contains a summary of the recommendations.

The document complies with the standards of guideline development set forth by the Institute of Medicine for the creation of trustworthy guidelines and provides recommendations based on the GRADE framework.

"We are hopeful that this current information will help guide clinicians in using the growing array of tools and technologies available to us to diagnose and manage Barrett's esophagus, which, in turn, has the potential to significantly impact patient outcomes," said Sachin Wani, MD, FASGE, Chair of the ASGE Standards of Practice Committee.

Houston - (Sept. 5, 2019) - A new study shows that many OB-GYNs are uncomfortable counseling their patients on fertility at a time when more women are delaying pregnancy and needing their doctors to be more vigilant about this education.

"We found that most OB-GYNs don't bring up fertility with every patient, often because they believe the patient would bring it up if she wanted to discuss it," said Rashmi Kudesia, M.D., reproductive endocrinology and infertility specialist at Houston Methodist and CCRM Houston and lead author on the study, published in the Journal of Reproductive Medicine. "It's a missed opportunity when OB-GYNs don't start the conversation because many women are routinely exposed to conflicting information about fertility, leading many to believe that they'll have no issues conceiving and delivering."

In fact, 82% of OB-GYNs surveyed believe women receive mixed messages about their optimal fertility window, and 68% said women seem to believe they can indefinitely postpone making childbearing plans.

"It isn't unusual for women to believe that assisted reproductive technologies like IVF are their safety net because they hear so many success stories," Kudesia said. "The reality is that IVF only has a 5% success rate for women in their mid-40s."

Kudesia and her co-authors found that OB-GYNs were more likely to provide fertility counseling to married women between the ages of 27-40. For all age groups, single and lesbian women were less likely to receive fertility counseling than married women. It was also found that the 117 physicians who participated provided more counseling on contraception than fertility in nearly all age and relationship status groups.

"The results tell me that regardless of current relationship status or future plans for pregnancy, women need to bring up fertility at their next well-woman exam or ask for a referral to a fertility specialist," Kudesia said. "Women who want to wait several years and even those who think they don't want kids at all should still talk to their doctor about fertility so that they can make an informed decision about what is best for them."

E-cigarette usage may impair fertility and pregnancy outcomes, according to a mouse study published in the Journal of the Endocrine Society.

Many young and pregnant women are using e-cigarettes as a safer alternative to smoking, but little is known about the effects on fertility and pregnancy outcomes. E-cigarettes are driving increases in tobacco product use among youth. According to the Centers for Disease Control and Prevention, the number of middle and high school students using e-cigarettes rose from 2.1 million in 2017 to 3.6 million in 2018--a difference of about 1.5 million youth.

"We found that e-cigarette usage prior to conception significantly delayed implantation of a fertilized embryo to the uterus, thus delaying and reducing fertility (in mice)," said the study's corresponding author, Kathleen Caron, Ph.D., of University of North Carolina at Chapel Hill, N.C. "We also discovered that e-cigarette usage throughout pregnancy changed the long-term health and metabolism of female offspring--imparting lifelong, second-generation effects on the growing fetus."

In this study, researchers used a mouse model to examine whether e-cigarette exposure impairs fertility and offspring health. After exposure to e-cigarette vapor, female mice showed decreased embryo implantation and a significant delay in the onset of pregnancy with the first litter. Female offspring exposed to e-cigarettes in utero also failed to gain as much weight as control mice by the 8.5 month mark.

"These findings are important because they change our views on the perceived safety of e-cigarettes as alternatives to traditional cigarettes before and during pregnancy," Caron said.

MRI's give us a picture of our body's insides--organs, bones, nerves and soft tissue. But what if MRI's could show us the molecular makeup of our body parts, and help doctors more quickly determine the onset of disease and begin treatment?

In a paper published today in Nature Communications, Dr. Aviv Mezer and his team at the Hebrew University of Jerusalem (HUJI)'s Edmond and Lily Safra Center for Brain Sciences successfully transformed an MRI from a diagnostic camera that takes into a device that can record changes in the biological makeup of brain tissue. This is especially important for doctors looking to understand whether a patient is merely getting older or developing a neurodegenerative disease, such as Alzheimer's or Parkinson's.

"Instead of images, our quantitative MRI model provides molecular information about the brain tissue we're studying. This could allow doctors to compare brain scans taken over time from the same patient, and to differentiate between healthy and diseased brain tissue, without resorting to invasive or dangerous procedures, such as brain tissue biopsies," explained Mezer.

External signs of aging are familiar to us: gray hair, a stooped spine, occasional memory loss. However, how do we know if a patient's brain is aging normally or developing a disease? The answer is found on the biological level. Both normal aging and neurodegenerative diseases create biological "footprints" in the brain, changing the lipid and protein content of brain tissue.

Whereas current MRI scans provide only pictures of the human brain, this new technique provides biological readouts of brain tissue--the ability to see what's going on on a molecular level, and to direct a course of treatment accordingly. "When we take a blood test, it shows us the exact number of white blood cells in our body and whether that number is higher than normal due to illness. MRI scans provide images of the brain but don't show changes in the composition of the human brain, changes that could potentially differentiate normal aging from the beginnings of Alzheimer's or Parkinson's," shared PhD student Shir Filo who worked on the study.

Looking ahead, Mezer believes that the new MRI technique will also provide a crucial understanding into how our brains age, "when we scanned young and old patients' brains, we saw that different brain areas ages differently. For example, in some white-matter areas, there is a decrease in brain tissue volume, whereas in the gray-matter, tissue volume remains constant. However, we saw major changes in the molecular makeup of the gray matter in younger versus older subjects".

All this bodes well for patients. Not only will MRI's be able to distinguish molecular signs of normal aging from the early signs of disease. Patients will more likely receive correct diagnoses earlier, speeding up when they begin treatment and maintaining an improved quality of life longer, all via a non-invasive technique.

Arrhythmogenic right ventricular cardiomyopathy type 5 (ARVC5) is a fatal genetic disease for which there is unfortunately no cure. Now, scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Puerta de Hierro Majadahonda Hospital (Spain) have discovered a possible treatment for this rare disease. The research team, whose findings are published in Circulation, show that strategies to inhibit the kinase GSK3? in mice with the disease reduce fibrosis and improve heart function.

Arrhythmogenic cardiomyopathy can cause sudden cardiac death, especially in young men. Less severely affected men and women with this disease gradually develop heart failure, explained study coordinators Dr Enrique Lara Pezzi, a group leader at the CNIC, and Dr Pablo García-Pavía, director of the Familial Cardiomyopathy Unit in the Cardiology Service at Puerta de Hierro University Hospital, Majadahonda (Madrid).

Arrhythmogenic cardiomyopathy affects an estimated 0.02% to 0.1% of the population, and is therefore classed as a rare disease. ARVC5 is the most aggressive subtype and is caused by a mutation in the TMEM43 gene. The first ARVC5 patients were identified in the island of Newfoundland, Canada, but the disease has since been detected in other regions around the world, including Spain.

The Spanish scientists said that during the early 'hidden' phase of the disease, patients generally show no symptoms, despite already being at risk of arrhythmias and sudden death. Although at early stages the disease predominantly affects the right ventricle, as fibrosis expands it can also impair left ventricular function, and patients develop symptoms and manifestations of heart failure that can require heart transplant.

"Nevertheless, the mechanisms underlying this disease are unknown, and there is currently no cure," said Dr Lara Pezzi. Current treatments are therefore palliative, and the main emphasis is on the prevention of sudden cardiac death by fitting an implantable cardioverter defibrillator (ICD), with subsequent management of heart failure, and possibly heart transplant.

In a clear example of translational research, the groups led by Dr Lara Pezzi and Dr García-Pavía joined forces to find new treatments for this devastating disease that could be used in newly diagnosed patients at Puerta de Hierro hospital. Summarizing the challenge faced by the research team, Dr García-Pavía commented, "We were confronted by a disease about which very little was known and that causes the very early death of several people from the same family."

"We realized that to identify effective treatments we needed to get a better understanding of the disease from its earliest stages. For this, we needed an animal model of the disease that we could study from birth," Dr García-Pavía continued. The two research groups together developed a transgenic mouse line that expresses the mutant version of the human protein TMEM43 and mimics the human disease. The researchers found that the mutant TMEM43 protein activates the protein kinase GSK3?. This leads to the progressive death of heart cells, which are gradually replaced by fibrotic tissue, one of the most characteristic signs of the disease. "After a few months, the hearts of these mice had too few cells to pump blood efficiently, and the heart failure resulted in the death of the animals," explained first author Laura Padrón-Barthe.

The research team tested several possible therapeutic approaches in the mouse model. While treatments directly targeting fibrosis were ineffective, positive results were obtained with two strategies for inhibiting GSK3?, one based on pharmacological inhibition and the other on overexpression of the calcineurin subunit CnAβ1. As Dr Lara Pezzi explained, "both approaches reduced the rate of cardiac cell death, improved cardiac contraction, and prolonged survival."

Nevertheless, the scientists warn that, although the transgenic mouse model mimics human ARVC5, it does not reproduce all disease characteristics. For example, male and female mice are equally affected, whereas the human disease is much more aggressive in men than in women.

Having identified a possible route for effective treatment for the disease in mice, the research team is now working to translate the results to patients. Using the mouse model, the scientists are testing drugs used to treat human heart failure to see if they are effective against ARVC5. The team is also investigating gene therapy strategies that could improve heart function or even cure the disease.

Dementia is the most common neurological disease in older adults, whereas headaches, including migraines, are the most common neurological disorder across all ages. In a recent study in the International Journal of Geriatric Psychiatry that included 679 community-dwelling adults aged 65 years and older, migraines were a significant risk factor for dementia, including Alzheimer's disease.

Identifying a mid-life risk factor for dementia, such as migraines, will allow for earlier detection of at-risk individuals. It may also help improve researchers' understanding of the biology of Alzheimer's disease and dementia.

"We don't yet have any way to cure Alzheimer's disease, so prevention is key," said senior author Suzanne L. Tyas, PhD, of the University of Waterloo, in Canada. "Identifying a link to migraines provides us with a rationale to guide new strategies to prevent Alzheimer's disease."

Elevated urate in the blood (hyperuricemia) is a precursor of gout, which is the most common form of inflammatory arthritis worldwide. A study published in Arthritis & Rheumatology that included 14,624 U.S. adults found that four modifiable risk factors--body mass index, diet, alcohol consumption, and diuretic use--each have important roles in the development of hyperuricemia.

The findings indicate that public health efforts to promote a healthy diet and prevent obesity would help reduce the frequency of hyperuricemia and eventually the risk of gout in the general population.

"These findings suggest that modifiable factors have an important place in the primary prevention of hyperuricemia and likely gout. Public health efforts should promote individual behavioral changes as well as broader policy changes targeting the obesogenic food environment," said lead author Hyon K. Choi, MD, DrPH, of Massachusetts General Hospital and Harvard Medical School. "The expected health benefits would extend well beyond hyperuricemia and gout, to impact their numerous major co-morbidities such as cardiovascular diseases and diabetes."

Anticoagulants and antiplatelet drugs, which are blood thinners such as warfarin and aspirin, are commonly taken to reduce the risk of potentially fatal blood clots, but they carry an increased risk of gastrointestinal bleeding. A study of 871 patients from Spain published in Alimentary Pharmacology and Therapeutics has shown that patients who restart their blood thinners after such a bleed have a 39% reduced risk of dying over the next 2 years even though their risk of recurrent gastrointestinal bleeding increased.

The findings indicate that the benefits of early restarting anticoagulant or antiplatelet therapy outweigh the gastrointestinal?related risks.

"Our study provides information to balance the risks and benefits of the global management of these two pharmacological groups of drugs widely associated with increased gastrointestinal bleeding risk," the authors wrote.

Addiction to social networking sites reduces nurses' performance and affects their ability to concentrate on assigned tasks, according to a study published in the Journal of Advanced Nursing. The study found that nurses can take "self-management" steps to address the issue, however.

For the study, information was collected through an online-survey taken by nurses in 53 countries across the world.

"Our study also has some important implications for hospital management, doctors and nurses," the authors wrote. They noted that hospital management should limit the use of social networking sites by nurses, devise self-management courses for nursing staff, and provide nurses with an environment where there are no distractions from mobile ringtones and beeps.