Body

PHILADELPHIA - More than 750,000 people in the United States have dilated cardiomyopathy, a potentially life-threatening condition in which the heart's main pumping chamber, the left ventricle, enlarges and grows increasingly weak. Research has shown that one in 10 people with this condition were born with a mutation in the TTN (titin) gene, but - until now - it has been unclear whether everyone with these mutations will inevitably develop dilated cardiomyopathy. In a new study published today in Circulation, researchers at Penn Medicine and Geisinger reviewed gene sequences of more than 70,000 people, and found that 95 percent of patients who had the genetic mutations did not have heart disease or signs of cardiac decline. However, they did find subtle differences in the hearts ability to pump efficiently, compared to those without the mutation.

"It's clear that these gene mutations have a real effect on one's heart, and yet, there are a lot of people carrying the deleterious mutations right now who are fine," said the study's corresponding author Zoltan Arany, MD, PhD, a professor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania. "While our study moves us one step closer to being able to predict, based on one's genes, who will get this disease, there is still a difference between these two populations that we don't yet understand. The next step will be to identify the specific variable causing some of these patients to get heart disease."

The TTN gene, which codes the body's largest protein, acts as a spring inside the heart muscle and helps limit how much it can be stretched. Mutations in this gene - which affect about 1 percent of the global population - are commonly found in people with dilated cardiomyopathy, when cardiologists order a genetic test to determine if the disease stems from a genetic variant.

In this study, researchers sought to reverse the process, and determine if pinpointing the mutations could predict whether people carrying the faulty genes would develop the disease. To do so, researchers reviewed the exome sequence data of 61,040 from the Geisinger MyCode Community Health Initiative and 10,273 from the Penn Medicine BioBank to identify individuals with the gene mutations. From there, they examined corresponding information, including diagnoses, imaging and test results - available via linked electronic health records - to determine whether the patients had heart disease or showed signs of declined cardiac function.

Researchers found that patients with cardiomyopathy who have the mutations fare worse, even on treatment, than patients with the condition who don't have a mutation. The finding, researchers say, underscores the value of ordering a genetic test for patients who have been diagnosed with cardiomyopathy. That said, Arany cautions against patients who don't have heart disease undergoing genetic tests for titin variants.

"For now, I would not recommend people get genetic testing for the titin variants because that will just make them anxious for something that's highly unlikely," Arany said. "That may change, for example, if we were to find that the combination of a TTN gene mutation and a mutation in another gene causes people to get the disease, then we'd recommend genetic testing for both of the variants. But right now we still don't know enough."

AUGUSTA, Ga. (July 2, 2019) -A program with clear rules, routines and activities, attentive adults and a chance to interact with peers appears to work as well at improving the quality of life, mood and self-worth of a child who is overweight or obese as a regular exercise program, researchers report.

While regular exercise is clearly beneficial to children -- and adults -- the psychosocial health of children may benefit as much from other kinds of adult-led after school programs, Medical College of Georgia researchers report in the journal Translational Behavioral Medicine.

"For me the take-home message is yes, exercise has many wonderful benefits but some of that is because you are in a program run by caring adults," says Dr. Catherine Davis, clinical health psychologist at MCG's Georgia Prevention Institute and the study's corresponding author.

They looked at 175 predominantly black children ages 8-11 who had overweight or obesity and were previously inactive. Children participated in either a fun-driven aerobic exercise program or a sedentary after-school program where they played board games and did artistic activities.

The investigators hypothesized that they would find that the exercise intervention would be more effective at improving quality of life, mood and self-worth than the sedentary program.

They found instead that, while the exercise program had the additional benefits of reducing body fat, improving fitness, and even improved brain health, there was no mood advantage from the exercise program. Fatness and fitness did not change as much in the sedentary group.

In fact, in the case of the boys, those in the sedentary group reported depressive symptoms actually decreased more over time than their peers in the exercise group.

About 10 percent of children in both groups had symptoms indicating depression at the start of the study. Depressive symptoms in children include things like a sad mood, interpersonal problems and inability to feel pleasure.

Among participating girls, depressive symptoms yielded similar improvements whether in the exercise or sedentary group, says Celestine F. Williams, senior research associate at the Georgia Prevention Institute and first author on the study.

Those sex differences might be attributable to males in the sedentary group not being under the pressure they may feel to participate and succeed in physical activities, and finding instead an opportunity to pursue more artistic and social endeavors, which children of this age tend to prefer, the investigators write.

Countless studies, including some led by Davis, have shown that regular physical activity in children who are overweight or obese and inactive can yield a variety of benefits, including reducing fatness, improving fitness and insulin sensitivity -- which reduces the risk of diabetes and other maladies -- as well as perhaps less obvious benefits, like improved cognition and improved brain health, and reduced anger and depression.

This time Davis and her colleagues wanted to more directly compare the impact of an exercise program versus a similar sedentary program on the psychosocial wellbeing of these children. While there are often control groups in this type of study, most compare the exercise program to either no program, or a less interactive and fun program. Davis and Williams agree that likely was a big part of the differences they found this time.

All the children were evaluated for depressive symptoms, anger expression, self-worth and quality of life right before starting and after finishing either arm of the study. Depressive symptoms and quality of life were measured again about a year later.

In the exercise program, the instructor led fun aerobic activity for 40 minutes daily based on the interests and abilities of the children. Rather than time on a treadmill, for example, there were more entertaining strategies to get and keep the heart rate up like a version of the age-old game tag. Children wore heart rate monitors and were rewarded for an average heart rate above 150 beats per minute during the exercise -- the average resting heart rate for an 8-year-old is 70 to 110 beats per minute -- and they got more points for a higher average.

In the other group, children participated in instructor-led activities like board games, puzzles, arts and music, and were rewarded for participation and good behavior. There were arts and crafts, challenging games like the strategy board game Connect 4, guitar music and singing popular songs, and the children were rewarded with points for being nice and cleaning up behind themselves. The children were free to talk with each other as long as it was not disruptive, which was probably a highlight for the boys, Williams says.

Relationships the children built with each other over the course of both programs likely were beneficial in elevating their mood and quality of life, Williams says. The sedentary program may have given children more time to talk with each other and develop friendships with little competitive pressure.

Other investigators have shown that children in the 8-11 age range may actually prefer just talking or socializing with their friends as a fun activity, rather than some form of exercise, while younger children may think it's more fun to run around, Williams says.

The fact that both programs provided psychosocial benefit to the children led the investigators to conclude that some benefits of exercise found in previous studies, including Davis', resulted from the regular opportunity to be with attentive adults who provide behavioral structure. It also resulted from the children enjoying interacting with each other, sharing snacks and other activities, while spending less time watching television.

Rates of obesity among children and the adolescents in this country have more than tripled since the 1970s, according to the Centers for Disease Control and Prevention, and currently about 1 in 5 school-age children and young people has obesity. Young blacks are disproportionately affected in this country.

There is plenty of evidence that obesity and overweight can impact overall quality of life and that children with these conditions can have increased problems with anxiety, bullying, fatigue, anger and general behavior problems, and that generally higher BMI, or body mass index, a ratio of weight to height, is associated with a lower self-worth in children.

"Exercise is very well demonstrated to improve mood. However, I think you have to consider exercise in the context that it occurs, so the social context counts too," says Davis.

Feeling safe and being able to get to sleep at night are the things that matter most to sick kids in hospital, according to world-first research from Edith Cowan University.

Researchers at ECU's School of Nursing developed the 'Needs of Children Questionnaire' (NCQ), the first of its kind to measure children's self-reported psychosocial, physical and emotional needs in paediatric wards.

They assessed 193 school-aged children in paediatric settings in Australia and New Zealand.

More than 1.7 million Australian children were admitted to hospital in 2016-17, according to the most recently available figures, some for a short visit and some for lengthy and regular stays.

Lead researcher Dr Mandie Foster said the study fills a gap in our understanding of how children are feeling in hospital settings.

"Historically the literature on children's needs and experiences within healthcare settings have been largely limited to surveys completed by adults answering for children," Dr Foster said.

"To our knowledge, no instrument has been available to assess the perception of the needs of school-aged children during a hospital stay.

"Development of the NCQ is part of an international movement to place children as central to care delivery, which honours the United Nations Convention on the Rights of the Child."

The most important needs

The children surveyed identified their most important needs as:

1. "To know I am safe and will be looked after."

2. "To get enough sleep at night."

3. "That staff listen to me."

4. "To have places my parents can go to for food and drinks."

5. "To have my mum, dad or family help care for me."

Dr Foster said it was important to let children in hospital communicate for themselves.

"As adults, we often make assumptions about children's needs and wants, but hospitals can be a scary and unfamiliar environment for many children and we shouldn't assume we know how they are feeling.

"Being listened to and understood can give children an added sense of confidence about the situation they find themselves in.

"And from a medical point of view, child self-reports are essential to inform healthcare delivery, policy, research and theory development."

Dr Foster said children's needs are often interconnected to those of their parents, so if parents feel informed, valued and cared for, then their children are more likely to feel relaxed.

"From a child's perspective, feeling safe means having mum and dad here to help care for me, smiling nurses, special time spent with me just talking, not treats, just time to get better," she said.

Dr Mandie Foster is a nursing lecturer, research scholar and experienced paediatric nurse. 'Development and validation of the Needs of Children Questionnaire (NCQ): An instrument to measure children's self-reported needs in hospital' is published in the Journal of Advanced Nursing.

Dr Foster will present her findings at the AUT Child & Youth Health Research Centre's Research Presentation Series at AUT University, New Zealand, on Thursday 4 July.

Search engines and social media organizations must do more to prevent the spread of inaccurate information on childhood vaccination, and governments must better support mandatory immunization programs, says an international group of leading public health scientists in a statement published in the Journal of Health Communication.

The Salzburg Statement on Vaccination Acceptance lays down several recommendations to combat the global fall in vaccination rates fuelled by a powerful worldwide 'anti-vax' movement. The statement, which pledges to "support the development of new, effective and fact-based communications programs" to help parents, community and government leaders make appropriate decisions on childhood immunization, has already been endorsed by more than 60 public health leaders from the Americas, Europe, Asia, Africa and Australia.

It calls upon major search engines and social media organisations to better monitor the vaccine information they provide so that they can improve the identification of disproven or inaccurate false claims about vaccine safety - just as they do for sexually explicit, violent and threatening messages.

At the same time, advocacy groups, educators and health professionals should join forces to correct misleading vaccine information and disseminate reliable, accurate information via mass and social media and through trusted sources at all levels of society, including celebrities, faith-based leaders and parents.

Governments and policymakers should support laws that limit exemptions from mandatory vaccinations and treat childhood vaccination like other essential services such as police, firefighters and public sanitation, the statement also says.

"We are alarmed that the WHO this year declared vaccine hesitancy a top-ten international public health problem. This is a man-made, dangerous and wholly unnecessary crisis. We intend to keep up a steady drumbeat of accurate vaccine communications until the traditional public consensus in support of childhood immunization is restored," said Dr. Scott Ratzan, founding editor of the Journal of Health Communication and founder of the International Working Group (IWG) on Vaccination and Public Health Solutions.

Vaccines have prevented hundreds of millions of infectious diseases, including polio, measles, hepatitis B and meningitis, saving up to 3 million lives yearly. Every US dollar spent on childhood immunization returns up to $44 in benefits . However, immunization rates globally are threatened by misinformation spread by the 'anti-vax' movement. Vaccine coverage has waned in many populations, and the US and 34 countries in the WHO's European region no longer have the 95% immunization rate that provides the 'herd immunity' necessary to protect against highly contagious diseases such as measles.

Prof. Lawrence Gostin, Director of the WHO Collaborating Center on National and Global Health Law and co-director of the IWG, said: "The resurgence of potentially life-threatening diseases like measles, which the US Centers for Disease Control declared eliminated in the United States in 2000, undermines the integrity of childhood protections that thousands of dedicated scientists, doctors, and public health officials spent the better part of the last century putting in place. Parents do have rights to make informed decisions about vaccinating their children, but they do not have the right to place their children, or other children, at risk of a serious infectious disease. We need to do a far better job of reaching out to vaccine-hesitant parents."

WASHINGTON--Antidepressants reduce deaths by more than a third in patients with diabetes and depression, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

People with diabetes are two to three times more likely to have depression than people without diabetes, according to the U.S. Centers for Disease Control and Prevention. Half to three-quarters of people with diabetes and depression go undiagnosed, despite therapy and medicine being very effective.

"The incidence of major depressive disorder amongst individuals with diabetes is significantly greater than the general population," said the study's corresponding author, Vincent Chin-Hung Chen, Professor, of Chiayi Chang Gung Memorial Hospital and Chang Gung University in Puzi, Taiwan. "Diabetes and depression each independently contribute to increasing total mortality."

In this large population-based study, researchers used the National Health Insurance Research Database in Taiwan to identify 53,412 patients diagnosed with diabetes and depression since 2000. The researchers followed this population until 2013 to see if antidepressants reduced the death rate. They found that antidepressants significantly reduced mortality by 35 percent.

"This data provides further rationale for the screening and treating of depression in persons who have diabetes," Chen said.

New York, NY -- July 2, 2019 -- Carefully designed, integrated multi-"omic" studies could accelerate the use of precision medicine for asthma patients, according to researchers from the Icahn School of Medicine at Mount Sinai. In an invited review article published today in the Journal of Allergy and Clinical Immunology, Scott R. Tyler, PhD, and Supinda Bunyavanich, MD, MPH report that numerous studies have shown the value of applying transcriptomics and other "omic" approaches (the study of the role, relationships, and actions of a system-wide measure of a given molecular type) for defining asthma subtypes--but they also cite the need for more studies aimed at pulling together these disparate data streams for a more comprehensive view of the disease.

Asthma is a highly heterogeneous disease, presenting with a broad range of symptoms. According to the American Lung Association, more than 26 million Americans have asthma. It is the third most common cause for hospitalization among children. Much effort has gone toward establishing clinical and molecular subtypes--known as endotypes--of asthma in order to better understand the disease and hone treatment recommendations for patients in each group.

"Endotypes are important for physicians and biomedical researchers because they organize the way we think about asthma, which manifests in many different ways across patient populations," said Dr. Bunyavanich, faculty allergist/immunologist and Associate Professor of Pediatrics and of Genetics and Genomic Sciences, at the Icahn School of Medicine at Mount Sinai. "By strategically integrating clinical and molecular data, it should be possible to identify meaningful endotypes that both enhance our mechanistic understanding of asthma and guide our clinical care of asthma toward the best treatments for each subtype. This is important for optimizing patient outcomes."

The review covers several types of omic studies that have been applied to asthma already, including transcriptomics, epigenomics, metabolomics, proteomics, and microbiome analysis. But, as the authors note, each approach captures only one dimension of the disease biology. More complex studies that integrate multiple layers of data have begun, but additional work is needed.

"We are in the early stages of these more sophisticated and comprehensive analyses of asthma, but the growth in available patient cohorts, data repositories, technology, and analytical tools gives us confidence that this kind of approach is rapidly becoming more feasible," said Dr. Tyler, a postdoctoral fellow in the Bunyavanich Lab at Mount Sinai. "As this concept gains traction, it will be essential for researchers to ensure careful study design and implement rigorous methodology for the most reliable results for future use in precision medicine."

Adolescents exposed to elevated levels of pesticides are at an increased risk of depression, according to a new study led by Jose R. Suarez-Lopez, MD, PhD, assistant professor in the Department of Family Medicine and Public Health at University of California San Diego School of Medicine. The study was published online (ahead of print) in June 2019 in the journal International Journal of Hygiene and Environmental Health.

Suarez-Lopez and colleagues have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008. In this latest study, they examined 529 adolescents between the ages of 11 and 17. Ecuador is the world's third-largest exporter of roses, with much of the flower production located near the homes of participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system.

To test exposure levels of children, the research team measured levels of the enzyme acetylcholinesterase (AChE) in the blood. Pesticides such as organophosphates and carbamates exert their toxicity by inhibiting AChE activity. Past studies have shown that cholinesterase inhibition is linked to behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link; however, pesticide exposure assessment in past studies had been only established by self-report of exposure and not using biological measures.

The results confirmed their hypothesis: teens who had lower AChE activity, suggesting greater exposure to cholinesterase inhibitors, showed more symptoms of depression assessed using a standardized depression assessment tool. Notably, the association was stronger for girls (who comprised half of all participants) and for teens younger than 14 years.

"Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies," said Suarez-Lopez. "This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study."

DENVER/July 2, 2019 – The last, large, isolated, healthy chlamydia-free population of koalas in Australia may have been identified on Kangaroo Island, said Morris Animal Foundation-funded researchers at the University of Adelaide.

Chlamydia is a serious threat to the species, contributing to dramatic population declines, and the team hopes the Kangaroo Island koalas can provide a safeguard against further losses and even extinction. The team published their findings in the Nature journal Scientific Reports.

“This is a very important finding because chlamydial disease is so prevalent and efforts to fight it have so far been unsuccessful,” said Dr. Natasha Speight, koala researcher and lecturer at the University of Adelaide’s School of Animal and Veterinary Sciences. “These koalas could potentially be used as a disease-free breeding colony in the future.”

Chlamydia pecorum is a bacterial infection of koalas that is mainly transmitted sexually, but also can be spread by close contact, including from mothers to joeys. It develops as conjunctivitis, which can lead to blindness, and urinary tract infections that can ascend to the kidneys and reproductive tract, causing infertility. Chlamydia is common in koalas and ultimately fatal.

“The impact of Chlamydia on populations of koalas in parts of Australia is devastating, with high levels of severe disease and death, and common infertility,” says lead author Jessica Fabijan, from the University of Adelaide. “This last Chlamydia-free population holds significant importance as insurance for the future of the species. We may need our Kangaroo Island koalas to re-populate other declining populations.”

The Morris Animal Foundation-funded study sought to determine the prevalence of C. pecorum in wild-ranging koalas. Based on previous evidence that found low or no infection rates, the study focused on wild koalas in the Mount Lofty Ranges, a mountain range just east of Adelaide, and Kangaroo Island (KI), Australia’s third largest island, 70 miles southwest of Adelaide.

The team worked in conjunction with the South Australian Government Department for Environment and Water (DEW) and the University of the Sunshine Coast. They captured and released 75 koalas from the Mount Lofty Ranges and 170 koalas from KI. Veterinarians checked each koala and collected swab samples to test for C. pecorum DNA. Researchers also examined more than 13,000 historical veterinary records of KI koalas from over a 22-year period for accounts of the disease.

They found that nearly half of the Mount Lofty Ranges koalas were positive for C. pecorum DNA, but showed no signs of disease, except for three koalas. The koalas at KI, however, were all C. pecorum negative and no disease was observed. There were also no definitive records of the disease in the island’s historical records. The team used the results in a statistical model that showed, with 95% confidence, that Kangaroo Island is C. pecorum-free.

“This could be the break we need to finally turn the tide on this infection and improve conservation efforts,” said Dr. Janet Patterson-Kane, Morris Animal Foundation Chief Scientific Officer. “We’re proud to support this work to save one of the world’s most unique and beloved animals.”

Morris Animal Foundation is one of the largest nonprofit animal health research organizations in the world, funding more than $126 million in studies across a broad range of species since 1948. The Foundation is one of the only organizations funding health research particularly for endangered and at-risk wildlife species, including the koala. The Foundation has funded numerous studies in koalas, including another devastating infection, koala retrovirus.

Chlamydia was first discovered in koalas in northern Australia in the 1970s. Populations there are declining, due to the disease and other threats, such as habitat destruction and road deaths. Koalas are classified as vulnerable by the International Union for Conservation of Nature’s Red List of threatened species. Their populations in southern Australia are considered stable, thought to be partly due to a lower prevalence and severity of the disease.

University of Houston associate professor of chemistry, Vassiliy Lubchenko, is reporting a new finding in Nature Communications on how sickle cells are formed. Lubchenko reports that droplets of liquid, enriched in hemoglobin, form clusters inside some red blood cells when two hemoglobin molecules form a bond - but only briefly, for one thousandth of a second or so.

The mystery of how the clusters form has long puzzled scientists. In patients with the inherited blood disorder known as sickle cell disease, or anemia, abnormal hemoglobin molecules line up into stiff filaments inside red blood cells, distorting their shapes and making it difficult for the blood cells to flow through narrow blood vessels. For the filaments to grow, the protein first congregates into tiny liquid droplets that are bigger than an atom, but so small their measurements are counted in increments between microscopic and macroscopic, called mesoscopic.

"Though relatively small in number, the mesoscopic clusters pack a punch," said Lubchenko. "They serve as essential nucleation, or growth, centers for things like sickle cell anemia fibers or protein crystals. The sickle cell fibers are the cause of a debilitating and painful disease, while making protein crystals remains to this day the most important tool for structural biologists."

Fibers don't grow just anywhere. Special, mesoscopically-sized droplets of the protein hemoglobin inside blood cells initiate their formation. "It turns out that inside your blood cell, there are little droplets of hemoglobin that are even more crowded with the protein than the rest of the cell," said Lubchenko. In an unexpected twist, these crowded areas are also expected to have more molecules bound together into 'dimers' or duos, the kind that last only a millisecond.

"The dimers are key to the formation of the mesoscopic clusters," reports Lubchenko, who suggests that one way to prevent sickle cell disease, which affects about 100,000 Americans, mostly African American and Hispanics, is to prevent the formation of the clusters so fibers are unable to grow out of them.

Same mechanism, different substances

Lubchenko suspects that the "dimer mechanism" applies to many other types of protein and soluble chemicals. The ability to make large numbers of tiny droplets of dense liquids or gels, that are all the same size, may have applications in nanotechnology and industrial synthesis of highly textured materials. Lubchenko and researcher Ho Yin Chan's work implies that deliberately inducing the formation of similar-sized clusters in liquids and in solids may provide a separate avenue for making uniformly-sized nanoparticles for industry.

He also speculates the formation of the clusters suggests "a tantalizing possibility that the precursors to living cells were not encased in membranes but, instead, were more like the so called membrane-less organelles," which Lubchenko thinks have much in common with the mesoscopic clusters.

In other words, his work touches on nothing less than the mystery of life.

WASHINGTON--Nutrition knowledge is essential for today's physicians, according to a JAMA Internal Medicine commentary published July 1. The commentary--authored by Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine--points out that overweight, diabetes, heart disease, and many forms of cancer are driven by unhealthful diets, and that most doctors do not have the knowledge to turn this problem around. In a 2018 survey, 61 percent of internal medicine residents reported having little or no training in nutrition.

In the commentary, Dr. Barnard recalls a patient who was hospitalized with a foot infection that was a complication of longstanding diabetes. Although Dr. Barnard notes that with sufficient change in the diet, insulin resistance and diabetes itself can improve and sometimes even disappear, the patient's doctors recommended amputation.

"Although the roots of type 2 diabetes are in the everyday food choices that lead to obesity and insulin resistance, we were ready to amputate, but never started a discussion about improving her diet," writes Dr. Barnard. While 94 percent of resident physicians recognize the importance of diet and feel that nutrition counseling should be part of patient visits, only 14 percent feel trained to offer it.

Research shows that a diet rich in fruits, vegetables, grains, and beans, can help fight heart disease, hypertension, diabetes, and cancer. But just 9.3 percent of U.S. adults meet the daily vegetable intake recommendation, while only 12.2 percent of adults get enough fruit.

Dr. Barnard recommends five steps the medical community can take to address this lack of knowledge about nutrition: (1) Nutrition should be a required part of continuing medical education for physicians everywhere; (2) Doctors should work with registered dietitians; (3) Electronic medical record services should include customizable nutrition questions and handouts; (4) Doctors are role models and should embrace that fact by modeling healthy eating habits; (5) The medical community should support healthier food environments, including in hospitals and schools.

Legislators throughout the U.S. are also calling for nutrition education for physicians. Last month, Washington, D.C., Councilmember Mary Cheh introduced a bill recommending continuing education on nutrition for physicians, nurses, and physician assistants. In New York, lawmakers have introduced similar legislation: A7695/S5887.

Two professors' joint research team discovered how to synthesize new materials to deliver nitric oxide, which controls cell activation signal. The cell signaling control is expected to contribute positively to the development of treatment for cardiovascular diseases.

DGIST announced on June 24 that Professor Jaeheung Cho and Professor Daeha Seo's research teams in the Department of Emerging Materials Science developed a stable cobalt(III)-nitrosyl complex and confirmed the changes of signal transmission path of nitric oxide inside the cells.

Nitric oxide controls cell activities by delivering various biochemical information including vasodilation, immunity system control, and signal transmission. However, scientists haven't been able to clarify the detail in nitric oxide delivery to cells due to difficulties in controlling and regulating its movement, although they have assumed nitric oxide movement to cells.

To identify this, the research team synthesized cobalt(III)-nitrosyl complex on their own, enabling an additional research on nitric oxide by shedding light on it and moving nitric oxide to a desired place at a desired time. As a result, the research team confirmed differences in the delivery kinetics of nitric oxide to various paths in and outside the cells. The difference of delivery speed observed by the research team is expected to greatly impact the development of treatment in the future. If used well, a desired chemical reaction can occur at a desired time in a certain cell, enabling necessary treatment. This can be applied to various areas since it is related to the development of 'Prodrug ,' which becomes effective in a specific area that needs treatment.

Professor Jaeheung Cho said "We highly look forward to developing a prodrug that effectively supplies nitric oxide to a necessary area or time. By expanding our research to animal behavior and human body, we plan to develop treatment for cardiovascular diseases related to vasodilation and enhancement of nueroplasticity.

New figures from Cancer Research UK show that people who are obese now outnumber people who smoke two to one in the UK*, and excess weight causes more cases of certain cancers than smoking, as the charity urges Government action to tackle obesity.

Almost a third of UK adults are obese** and, while smoking is still the nation's biggest preventable cause of cancer and carries a much higher risk of the disease than obesity, Cancer Research UK's analysis revealed that being overweight or obese trumps smoking as the leading cause of four different types of cancer***.

Excess weight causes around 1,900 more cases of bowel cancer than smoking in the UK each year. The same worrying pattern is true of cancer in the kidneys (1,400 more cases caused by excess weight than by smoking each year in the UK), ovaries (460) and liver (180).

Cancer Research UK launched a nationwide campaign this week to increase awareness of the link between obesity and cancer. Extra body fat sends out signals that can tell cells to divide more often and can cause damage that builds up over time and raises the risk of cancer****.

The campaign compares smoking and obesity to show how policy change can help people form healthier habits, not to compare tobacco with food.

Michelle Mitchell, Cancer Research UK's chief executive, said: "As smoking rates fall and obesity rates rise, we can clearly see the impact on a national health crisis when the Government puts policies in place - and when it puts its head in the sand.

"Our children could be a smoke-free generation, but we've hit a devastating record high for childhood obesity*****, and now we need urgent Government intervention to end the epidemic. They still have a chance to save lives.

"Scientists have so far identified that obesity causes 13 types of cancer but the mechanisms aren't fully understood. So further research is needed to find out more about the ways extra body fat can lead to cancer."

The charity wants the Government to act on its ambition to halve childhood obesity rates by 2030 and introduce a 9pm watershed for junk food adverts on TV and online, alongside other measures such as restricting promotional offers on unhealthy food and drinks.

Professor Linda Bauld, Cancer Research UK's prevention expert, commented: "There isn't a silver bullet to reduce obesity, but the huge fall in smoking over the years - partly thanks to advertising and environmental bans - shows that Government-led change works. It was needed to tackle sky-high smoking rates, and now the same is true for obesity.

"The world we live in doesn't make it easy to be healthy and we need Government action to fix that, but people can also make changes themselves; small things like swapping junk food for healthier options and keeping active can all add up to help reduce cancer risk."

About 30 percent of nursing home residents are obese. That can complicate their care. The facility may need to buy them special wheelchairs or motorized lifts. Nursing aides may struggle to help them shower. And doctors may grapple with how--or even whether--to restrict their diets.

West Virginia University researcher Nicholas Castle is part of a team investigating how nursing homes can best meet obese residents' healthcare needs. The Agency for Healthcare Research and Quality--a division of the Department of Health and Human Services--has awarded them nearly $2 million for the project.

"It's a five-year initiative to tease out if nursing homes are prepared or not," said Castle, who chairs the School of Public Health's Department of Health Policy, Management and Leadership. "The practical part of it is, we're trying to get best practices from those nursing homes that seem to know what they're doing with obese residents. If we can find out what they're doing, we can disseminate that to those that haven't had as much experience."

The five-year project also involves John Engberg, of the RAND Corporation, and is led by John Harris, of the University of Pittsburgh.

In a previous study, Castle, Engberg and Harris evaluated national- and county-level data to see if staffing levels at nursing homes across the United States are associated with residents' obesity rates. Their findings, published in the Journal of Applied Gerontology, suggest that high concentrations of obese residents correlate to lower staffing levels.

"We would have thought the opposite," Castle said. "With residents who are obese, you would expect more intense amounts of labor to be used with them, such as moving them, getting them in and out of rooms and toileting. You would think that more nurse aides would be needed to help--not fewer." This may be one indication that some nursing homes need best practices in this area, he added.

Building on those findings, the researchers will conduct a national survey of nursing homes to identify the concerns that surround caring for obese residents and determine how nursing homes are responding. Strategies may include increasing staffing levels, buying specific equipment or making architectural changes--such as widening doorways. The team will also observe care delivery at approximately 50 nursing homes, where they will interview caregivers, administrators, residents and their family members to better understand the measures nursing homes are using and what they mean for obese residents.

Using national data, Castle and his collaborators will then examine the relationship between different types of strategies and negative health outcomes--such as pressure ulcers, urinary tract infections and hospital readmissions--in obese residents.

By identifying the commonalities among nursing homes where obese residents have exceptionally good outcomes, the researchers will develop a toolkit to help nursing homes accommodate the obese. "It might be staffing, but it might be some instrumentation that they have in the rooms. It might be wider doors, but it also might be training. We don't know yet," Castle said.

Their discoveries may also help guide consumers toward nursing homes that are especially adept at caring for obese residents.

"If you were the family member of an elder who was obese," Castle said, "we might be able to tell you that if you go to a facility where 10, 15, 20 percent of the population is obese, they know how to look after someone like this."

In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) established 90-90-90 treatment targets for the treatment of HIV. These goals include 90 percent of people with HIV will know their status; 90 percent will receive appropriate treatment; and 90 percent will suppress the virus. Steven Forsythe of Avenir Health and coauthors evaluated data used by UNAIDS to calculate that in the period 1995-2015, antiretroviral therapy (ART) averted 9.5 million deaths worldwide, with global economic benefits of $1.05 trillion. The authors also found that for every $1 spent on ART, $3.50 in benefits was realized globally. Including future projections, the authors estimated that in 1995-2030, approximately 40.2 million new HIV infections could be averted (more than twice as many deaths as occurred during World War I), with economic gains reaching $4.02 trillion in 2030. With different countries achieving different results for the different targets, the authors recommend analyses of national treatment program performance to enhance overall benefits and efficiency.

Also in the issue:

Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya; Brianna Osetinsky of Brown University and coauthors

The Impact Of Price Regulation On The Availability Of New Drugs In Germany; Ariel Stern of Harvard Business School and coauthors

A new class of cancer drugs just now entering the marketplace seems promising so far, but researchers at the University of Illinois at Chicago urge doctors to take into account a patient's weight and liver status before prescribing them once they come on the market.

The drugs are known as PI3K inhibitors, and they dramatically decrease the activation of a pathway commonly used by cancer cells to survive and multiply. But in a new mouse study published in the Proceedings of the National Academy of Sciences, investigators found that in mice fed a high-fat diet, these drugs might cause an increase in the number of pre-cancerous lesions in the pancreas.

"We know that inhibiting this pathway can cause cancer cells to die and lesions to shrink, but in mice engineered to develop pancreatic cancer and fed a diet where about half the calories came from fat, inhibiting the PI3K pathway led to the development of more pancreatic lesions than the same type of mice fed a more balanced diet," said Paul Grippo, associate professor of gastroenterology and hepatology in the UIC College of Medicine and corresponding author on the paper.

Grippo and his colleagues first confirmed that the PI3K pathway is involved in the development of pre-cancerous pancreatic lesions in mice. They used mice engineered to develop pancreatic cancer. Half the mice were also engineered to lack a key signaling molecule in the PI3K pathway, effectively rendering it unable to function. In mice with a silenced PI3K pathway, 20% of the pancreas had pre-cancerous lesions. Mice with functional PI3K pathways had twice as many precancerous lesions.

"This was not surprising given that we know the role of this pathway in helping promote the growth of cancer cells in other cancers," Grippo said.

The researchers then took the same mice and fed them either a normal or a high-fat diet where 50% of calories were obtained from fat. In mice on the high-fat diet, 50% of the pancreas was covered in pre-cancerous lesions. "It seems like the high-fat diet not only obliterated the protective effect of knocking out the PI3K pathway, but it actually encouraged more precancerous lesions to form," Grippo said.

Grippo is concerned that doctors prescribing PI3K inhibitors may be doing more harm than good in patients with pancreatic cancer who are obese. "This new finding suggests that docs may want to take a personalized or precision medicine approach to using PI3K inhibitors and base part of their decision on the weight of their patients," Grippo said.