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Milan, Italy - 4 May 2019: Two-thirds of patients with heart failure have cognitive problems, according to research presented today at EuroHeartCare 2019, a scientific congress of the European Society of Cardiology (ESC).1

Heart failure patients who walked further in a six-minute test, which shows better fitness, as well as those who were younger and more highly educated, were significantly less likely to have cognitive impairment. The results suggest that fitter patients have healthier brain function.

Study author Professor Ercole Vellone, of the University of Rome "Tor Vergata", Italy, said: "The message for patients with heart failure is to exercise. We don't have direct evidence yet that physical activity improves cognition in heart failure patients, but we know it improves their quality and length of life. In addition, studies in older adults have shown that exercise is associated with improved cognition - we hope to show the same for heart failure patients in future studies."

The cognitive abilities that are particularly damaged in heart failure patients are memory, processing speed (time it takes to understand and react to information), and executive functions (paying attention, planning, setting goals, making decisions, starting tasks).

"These areas are important for memorising healthcare information and having the correct understanding and response to the disease process," said Professor Vellone. "For example, heart failure patients with mild cognitive impairment may forget to take medicines and may not comprehend that weight gain is an alarming situation that requires prompt intervention."

The study highlights that cognitive dysfunction is a common problem in patients with heart failure - 67% had at least mild impairment. "Clinicians might need to adapt their educational approach with heart failure patients - for example involving a family caregiver to oversee patient adherence to the prescribed treatment," said Professor Vellone.

The study used data from the HF-Wii study, which enrolled 605 patients with heart failure from six countries. The average age was 67 and 71% were male. The Montreal Cognitive Assessment test was used to measure cognitive function and exercise capacity was measured with the six-minute walk test.

Professor Vellone said: "There is a misconception that patients with heart failure should not exercise. That is clearly not the case. Find an activity you enjoy that you can do regularly. It could be walking, swimming, or any number of activities. There is good evidence that it will improve your health and your memory, and make you feel better."

The HF-Wii study was led by Professor Tiny Jaarsma and Professor Anna Stromberg from Linkoping University, Sweden.

Milan, Italy - 4 May 2019: Many physicians are not telling cancer patients about the cardiotoxicity risks of treatments and may not be fully aware of the dangers themselves. A new study reveals an urgent need to look after the hearts of these patients. The research is presented today at EuroHeartCare 2019, a scientific congress of the European Society of Cardiology (ESC).1

"There was no mention that it could lead to heart disease. Would have been nice to know."

The growing number of cancer survivors and increasing number of over-65s needing chronic cancer therapy mean that the need for cardio-oncology services is rising. Heart failure caused by cancer therapy can occur up to 20 years after treatment. In 2012 over 32 million people worldwide were living with cancer.2

"Depending on the type of chemotherapy and radiotherapy, between 1% and 25% cancer patients may develop heart failure due to cancer treatment," said study author Professor Robyn Clark, of Flinders University, Adelaide, Australia. "Risk also depends on cardiovascular risk factors such as smoking and obesity. Better monitoring of the heart and intervention before, during and after treatment can prevent or lessen the impact of this cardiotoxicity."

The researchers reviewed medical records of 46 randomly selected cancer patients with cardiotoxicity who attended one of three hospitals between 1979 and 2015. Just 11% were referred to a cardiologist before chemotherapy and less than half (48%) were referred to a heart failure clinic after cancer treatment. Almost 40% were overweight or obese, 41% were current or ex-smokers, 24% were regular consumers of alcohol, 48% had hypertension, and 26% had diabetes.

In a subset of patients, practice was compared before (1994-2011) and after (2012-2015) the 2012 European Society for Medical Oncology guidelines were published.3 Referral to a cardiologist before chemotherapy rose from 0 to 23% and conducting a baseline echocardiogram of the heart increased from 57% to 77%.

Eleven patients were interviewed, of whom seven were involved in the medical records analysis. No patient could articulate their heart health needs. More than half said they started eating healthily after their cancer diagnosis yet appeared to lack understanding of a balanced diet.

The ESC published recommendations in 20164 and in 2018 launched the ESC Council of Cardio-Oncology to promote the prevention, early diagnosis, and management of cancer therapy-related cardiovascular diseases. Patients should be told the risks to their heart before starting cancer therapy, given help to quit smoking, eat healthily, exercise, and control their weight, and told to report signs and symptoms of cardiovascular disease.

Cardiotoxicity is detected using electrocardiogram (ECG), cardiac imaging, and biomarkers. The frequency of assessment depends on a number of factors - for example, evaluation for coronary artery disease, ischaemia and vascular disease is recommended in patients with a history of mediastinal radiation starting five years post-treatment and then at least every five years thereafter, even if they have no symptoms.

Angiotensin-converting enzyme (ACE) inhibitors or beta-blockers may be given to prevent or treat heart failure. And cancer therapy can be modified - for example reducing the dose or having a gap between two agents which raise heart failure risk when taken together (e.g. anthracyclines and trastuzumab).

"Monitoring the heart throughout the cancer journey can ensure it is protected," said Professor Clark. "Cardiotoxicity can occur even in people without cardiovascular risk factors since drugs like anthracyclines and trastuzumab are toxic to the heart, so it is an innocent bystander."

"For cancer patients who do develop heart failure, there are clinics that will improve their quality of life but our study shows many are not referred," she added. "Telephone calls to support and monitor those with cancer and heart failure would reduce the burden of hospital appointments, which patients said was a priority."

Every day, 78 Canadians receive a diagnosis of lung cancer, the most deadly form of cancer in the country. Some of them will have one of the lobes of a lung removed by thoracotomy, a common, but risky surgical procedure that requires months of recovery. However, a less invasive and safer surgical technique exists and could be used more widely.

In a large international clinical study presented at the 99th Annual Meeting of the American Association for Thoracic Surgery, Dr. Moishe Liberman, a thoracic surgeon and researcher at the University of Montreal Hospital Research Centre (CRCHUM), and his team showed that thoracoscopic lobectomy--video-assisted thoracoscopic surgery (VATS)--combined with pulmonary artery sealing using an ultrasonic energy device reduced the risk of post-operative bleeding, complications and pain.

Unlike surgery with thoracotomy, which involves making a 25 cm incision in the patient's chest and cutting the ribs, a VATS procedure requires small incisions. A miniature video camera is inserted through one of the incisions. In both types of surgical interventions, there is a risk of bleeding because the branches of the pulmonary artery are very thin, fragile and are attached directly to the heart.

"Thanks to this clinical trial conducted in Canadian, American and British hospitals, we have shown that it is possible to safely seal pulmonary blood vessels through ultrasonic sealing and effectively control possible bleeding during a VATS procedure," explained Dr. Liberman, an Associate Professor of Surgery at the University of Montréal.

Currently, only 15% of lobectomies around the world are performed by VATS, mainly because of the actual risks of major bleeding or surgeons' perception of these risks.

"I truly hope that the results of our clinical trial will reassure surgeons about the technical feasibility and safety of this operation and will encourage them to adopt it. A large number of patients could benefit from it and would be on their feet faster, with less pain," indicated Dr. Liberman.

Next-generation device

After five years of preclinical research at the CRCHUM, trials conducted on animals, phase 1 and phase 2 clinical trials showing the safety of the surgical intervention, Dr. Liberman's team has recently completed their large international phase 2 clinical trial launched in 2016.

It was able to evaluate the effectiveness of this new technique on 150 patients in eight hospitals across Canada, the United States and the United Kingdom. 139 of them underwent a lobectomy, while the remaining 11 underwent a segmentectomy (removal of a small part of the lung).

A total of 424 pulmonary artery branches were sealed during the study: 181 using surgical staplers, 4 with endoscopic clips and 239 using the HARMONIC ACE® +7 Shears, designed by the company Ethicon (Johnson & Johnson). With a 3-millimetre jaw at its tip, this high-tech "pistol" allows a surgeon to seal blood vessels by delivering ultrasonic energy.
According to the World Health Organization, lung cancer kills nearly 1.69 million people around the world every year.

OKLAHOMA CITY - A gynecologic oncologist at the Stephenson Cancer Center at OU Medicine was a national leader of a newly published research study that reveals good news for women with ovarian cancer - longer survival times plus a treatment option that causes fewer difficult side effects.

Joan Walker, M.D., was the senior author of the large clinical trial, which enrolled 1,560 patients from around the nation, including 38 Oklahomans. The research was recently published in the Journal of Clinical Oncology, a leading peer-reviewed journal.

The clinical trial compared three different treatments for ovarian cancer, as well as the way they were administered - either through an IV or through a port in the abdomen. All patients in the study underwent surgery to remove their tumors. Among patients whose surgeries removed all but 1 centimeter or less of cancer, the results were heartening -- about 75 months of survival compared to 68 months of survival for patients in a similar previous study. For patients who had no residual cancer left after surgery, their survival increased to 100 months. In addition, the treatment regimen with the fewest side effects was just as effective as the ones with more side effects.

"To have our patients live for more than five years is pretty remarkable," said Walker, who holds the Louise and Clay Bennett Endowed Chair in Cancer at the Stephenson Cancer Center. "This clinical trial gives our patients with ovarian cancer more hope that long-term survival is possible, and with a treatment that is much more tolerable."

The foundation for the current clinical trial was laid years ago. In 2006, Walker was the author for a similar study that compared chemotherapy given either through an IV or through an abdominal port. The results of that study were very promising at the time - 68 months' survival - but side effects like nausea, vomiting and neuropathy were so significant that less than half of eligible women opted for the treatment. That's when Walker and her colleagues set out to discover a treatment that was at least as effective but with fewer side effects.

Their work led them to the recently published study. Eligible patients enrolled on the study had been diagnosed with stage two, three or four ovarian cancer. After surgery, they were randomized into three treatment regimens. One delivered two types of chemotherapy - paclitaxel and carboplatin - through an IV. The second regimen featured the same types of chemotherapy, but with one given through an abdominal port. The third regimen added a third type of chemotherapy, cisplatin, that was given through an abdominal port. In addition, patients on each regimen received the drug bevacizumab through an IV.

After receiving their treatments, patients were followed for 84.8 months. In addition to the improved survival rate, several other findings bring reason for new hope. Because the outcomes were the same for each regimen, patients can most likely choose the route with fewer side effects, Walker said. Giving chemotherapy through an abdominal port is often difficult for patients. A catheter delivers the drug through the port, which is painful, and the site sometimes becomes infected.

In addition, the IV therapies can be delivered in an outpatient setting, whereas patients previously had to be hospitalized. Medical oncologists can also administer the drugs in addition to gynecologic oncologists, which makes the treatments accessible to more people.

As with most clinical trials, the results serve as a jumping off point for subsequent studies. Walker plans to analyze the genetics of each participant's tumor to see if their mutations might make a subset of them respond better to one treatment regimen over another. The trial also underscores the importance of surgery for ovarian cancer.

"Surgery is a very important part of patient's outcome," she said. "Earlier diagnosis of ovarian cancer, by recognizing the symptoms, will make surgery more successful. Identifying people with genetic mutations putting them at risk of cancer is also very important. Patients with ovarian cancer and anyone with a strong family history of breast, ovarian and pancreatic cancers should see a genetic counselor and get testing for known cancer-causing genes."

Walker also will be among many people continuing to study the effectiveness of bevacizumab for ovarian cancer, as well as which types of chemo pairings might make it more effective. Bevacizumab was approved for ovarian cancer treatment in June 2018 by the Food and Drug Administration. When the clinical trial began, it had not been approved but was provided by the National Cancer Institute. It essentially starves the tumor by blocking the production of blood vessels that feed it.

Although establishing new treatments through clinical trials takes time, the resulting increases in survival demonstrate amazing progress, something Walker has witnessed during her long career, she said.

"When I was a resident, we were giving one drug for ovarian cancer, and the survival was about 15 months," she said. "Then we would find another drug or another combination, and the survival time kept increasing. To reach our current survival times is pretty profound."

A radar system developed at the University of Waterloo can wirelessly monitor the vital signs of patients, eliminating the need to hook them up to any machines.

Housed in a device smaller than a cellphone, the new technology records heart and breathing rates using sensitive radar waves that are analyzed by sophisticated algorithms embedded in an onboard digital signal processing unit.

Researchers developed the system to monitor sleep apnea patients by detecting subtle chest movements instead of connecting them to equipment in labs via numerous cumbersome wires.

"We take the whole complex process and make it completely wireless," said George Shaker, an engineering professor at Waterloo. "And instead of a clinic, it could be done in the comfort of your own bed and run daily for continuous monitoring."

In a study at the Research Institute for Aging, a unique facility affiliated with the university, the radar unit was mounted to the ceiling over the bed of more than 50 volunteers as they slept normally in a model long-term care apartment.

The system, which collects and analyzes data from radar waves that are reflected back to the unit from the bodies of patients, achieved results over 90 per cent as accurate as standard hard-wired equipment.

"This is the first time radar has been used for heart sensing with this degree of accuracy and in such an uncontrolled environment," said Mostafa Alizadeh, a research associate who led the study. "Our subjects slept unobstructed, in any position, for up to eight hours."

Researchers are also exploring use of the technology to monitor activity levels and falls by residents of long-term care homes, and in hospitals for routine monitoring of heart and breathing rates of all kinds of patients.

Advantages of the system for apnea monitoring include complete privacy since no cameras are used, much improved comfort and potential use in homes rather than special sleep clinics.

"With traditional systems involving wires and appointments booked weeks in advance, you can't sleep as you normally do in your own bed at home, making the common sleep study an unpleasant experience," said Shaker, a cross-appointed professor of electrical and computer engineering, and mechanical and mechatronics engineering.

In addition to sleep apnea, which involves breathing that repeatedly stops and starts, the system can monitor conditions such as periodic limb movement disorder, restless leg syndrome and seizures.

Bottom Line: Elderly survivors of breast cancer, lung cancer, and melanoma face risk of brain metastasis later in life, and may require extra surveillance in the years following initial cancer treatment.

Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Authors: Jill S. Barnholtz-Sloan, PhD, Sally S. Morley Designated Professor in Brain Tumor Research, Cleveland Institute for Computational Biology and Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine in Cleveland, and Mustafa S. Ascha, MS, a PhD candidate in the Center for Clinical Investigation, Department of Population and Quantitative Health Sciences at Case Western.

Background: "As cancer treatments have gotten better and more people are surviving a primary cancer diagnosis, it's important to study secondary cancers, including metastasis to the brain," Barnholtz-Sloan said. "With an aging U.S. population, the number of people with brain metastasis is increasing, although sometimes that metastasis does not occur until many years after the initial cancer diagnosis."

"As people are living longer after an initial cancer diagnosis, their 'time at risk' for metastasis is going up. In addition, the majority of primary cancer diagnoses have no standard of care for brain metastasis screening," Ascha added.

How the Study Was Conducted: In this study, researchers analyzed rates of synchronous brain metastases (SBM), those diagnosed during the staging workup for the primary cancer, and lifetime brain metastases (LBM), those diagnosed later in life. Primary cancers in this study were lung cancer, breast cancer, and melanoma, which are more likely to metastasize to the brain than many other cancer types.

The researchers linked data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to Medicare claims data on brain metastases to investigate rates of brain metastasis in elderly patients. Because Medicare is the primary insurer for most patients age 65 or older, the results of SEER-Medicare studies are generalizable to the elderly population, Barnholtz-Sloan explained. Final data included patients diagnosed in 2010 through 2012, with 70,974 lung cancer cases, 67,362 breast cancer cases, and 21,860 melanoma cases.

The researchers calculated incidence proportion, the ratio of brain metastases counts to the total number of cases, for each primary cancer.

Results: For primary lung cancer, the incidence proportion of SBM was 9.6 percent and for LBM, 13.5 percent. The highest rates of metastasis were in small-cell and non-small-cell lung carcinoma, compared with adenocarcinoma, a more common type of lung cancer.

For primary breast cancer, the incidence proportion of SBM was 0.3 percent and for LBM, 1.8 percent. The rates of brain metastasis were lowest among patients who had localized breast tumors and highest among those whose cancer had already spread to another part of the body. The rates also varied by molecular subtype, with the highest rates for triple-negative breast cancer.

For melanoma, the incidence proportion of SBM was 1.1 percent and for LBM, 3.6 percent. Rates rose dramatically for patients whose melanoma had already spread at the time of diagnosis; 30.4 percent of those who had distant disease at diagnosis would later develop brain metastasis, compared with 15.2 percent of those who had regional and lymph node involvement, 13.2 percent who had lymph node involvement only, 7.8 percent who had regional tissue involvement, and 2.5 percent among those who had localized disease.

Author's Comments: Barnholtz-Sloan and Ascha said that the results of the study could help clinicians better understand patients' risk for brain metastasis and could potentially influence screening and surveillance practices.

"Brain metastases are detected with MRI, which is very expensive," Barnholtz-Sloan said. "An improved understanding of who is likely to develop a brain metastasis could help determine who should get an MRI."

Ascha added that more targeted surveillance could potentially help physicians detect metastases at early stages. "If we can identify brain metastases earlier in their progression, that could allow for earlier treatment and improved outcomes for these patients," he said.

Study Limitations: The authors said the study's primary limitation is that Medicare data, while providing a comprehensive view of the elderly population, cannot always be generalized to younger patients. Also, the study encompassed four to five years of follow-up, whereas in some cancers, such as breast cancer, brain metastasis can occur decades after the initial cancer, Barnholtz-Sloan said.

Funding & Disclosures: This study was supported in part through support to the Central Brain Tumor Registry of the United States, which receives funding from the American Brain Tumor Association, The Sontag Foundation, Novocure, AbbVie, the Musella Foundation, and the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

May 3, 2019--The antibiotic azithromycin may reduce treatment failure in patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD), according to a randomized, controlled trial published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Azithromycin during Acute COPD Exacerbations Requiring Hospitalization (BACE): a Multicenter, Randomized, Double-blind, Placebo-controlled Trial," researchers in Belgium report that adding a low dose of azithromycin to the medicines prescribed while in the hospital and continuing a low dose of the antibiotic for three months after hospitalization reduced treatment failure compared to standard of care alone. The researchers defined treatment failure as the need to intensify treatment with systemic corticosteroids and/or antibiotics, transfer the patient to the intensive care unit or readmit the patient to the hospital after discharge, and death from any cause.

Previous studies have shown that azithromycin prevents acute COPD exacerbations, but whether the antibiotic could reduce the need to intensify care of patients hospitalized for an exacerbation or improve their chances of not having another exacerbation once they left the hospital was unclear.

Wim Jannssens, MD, PhD, senior study author, professor of medicine at KU Leuven and a pulmonologist at University Hospitals Leuven, said that the goal of the study was to test whether targeting the highest risk patients for a limited period of time, rather than using azithromycin widely as a chronic preventive treatment for COPD exacerbations, was beneficial to patients.

"We wanted to establish a new treatment option for acute exacerbations with hospitalization as current treatments are clearly insufficient," he added. "Equally important, we wanted to see whether continuing azithromycin for a relatively short time after leaving the hospital could interrupt the vicious cycle of relapse, even after treatment withdrawal."

The study enrolled 301 patients at 20 Belgian hospitals. Half the patients were given azithromycin, the other half a placebo, in addition to the medicines their physicians would normally prescribe to resolve the exacerbation. Patients in the azithromycin arm of the study received 500 mg/day for three days while hospitalized, and then received 250 mg twice weekly for three months once they left the hospital.

The study found that the rates of treatment failure were 49 percent for those in the azithromycin group vs. 60 percent in the placebo arm. Because the researchers did not reach their goal of 500 participants, the trial was underpowered to demonstrate statistical significance of its primary endpoint: time to treatment failure.

Those receiving the antibiotic spent 24 percent fewer days in the hospital and 74 percent fewer days in the ICU than those taking the placebo. Mortality among those in the azithromycin group was half of the placebo group: 2 percent vs. 4 percent.

These benefits appeared more pronounced among non-smokers. Current smokers experienced little or no benefit from low-dose azithromycin.

The researchers also studied the effects of withdrawing azithromycin at the end of three months and found that six months later the clinical benefits of the antibiotic were lost.

Although the study could not prove statistical significance of its primary endpoint, "a positive message of the trial is that our strategy reduced hospital time, days in the ICU and recurrent exacerbations in the most severe COPD group," Dr. Janssens said, adding that a large phase 4 study with hospital readmission as the primary endpoint would be necessary before broad implementation of the current study's findings.

Milan, Italy - 3 May 2019: If a room or car is smoky, stay away until it has cleared. That's the main message of research presented today at EuroHeartCare 2019, a scientific congress of the European Society of Cardiology (ESC). (1)

"Avoid exposure to secondhand smoke regardless of whether the smoker is still in the room," said study author Professor Byung Jin Kim, of Sungkyunkwan University, Seoul, Republic of Korea. "Our study in non-smokers shows that the risk of high blood pressure (hypertension) is higher with longer duration of passive smoking - but even the lowest amounts are dangerous."

Passive smoking at home or work was linked with a 13% increased risk of hypertension. Living with a smoker after age 20 was associated with a 15% greater risk. Exposure to passive smoking for ten years or more was related to a 17% increased risk of hypertension. Men and women were equally affected.

Participants with hypertension were significantly more likely to be exposed to secondhand smoke at home or work (27.9%) than those with normal blood pressure (22.6%). Hypertension was significantly more common in people exposed to passive smoke at home or work (7.2%) compared to no exposure (5.5%).

High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015, and those affected are advised to quit smoking.(2) Previous research has suggested a link between passive smoking and hypertension in non-smokers. But most studies were small, restricted to women, and used self-reported questionnaires in which respondents typically over-report never-smoking.

This is the first large study to assess the association between secondhand smoke and hypertension in never-smokers verified by urinary levels of cotinine, the principal metabolite of nicotine. It included 131,739 never-smokers, one-third men, and an average age of 35 years.

"The results suggest that it is necessary to keep completely away from secondhand smoke, not just reduce exposure, to protect against hypertension," said Professor Kim.

"While efforts have been made around the world to minimise the dangers of passive smoking by expanding no smoking areas in public places, our study shows that more than one in five never-smokers are still exposed to secondhand smoke. Stricter smoking bans are needed, together with more help for smokers to kick the habit. Knowing that family members suffer should be extra motivation for smokers to quit," he said.

DALLAS, May 3, 2019 - Prolonged exposure to low doses of ionizing radiation increased the risk of hypertension, according to a study of workers at a nuclear plant in Russia published in the American Heart Association's journal Hypertension.

Uncontrolled hypertension, also known as high blood pressure, can to lead to heart attack, stroke, heart failure and other serious health problems.

Earlier studies linked exposure to high doses of radiation to increased risk of cardiovascular diseases and death from those diseases. This study is the first to find an increased risk of hypertension to low doses of ionizing radiation among a large group of workers who were chronically exposed over many years.

The study included more than 22,000 workers at the first large-scale nuclear enterprise in Russia known as the Mayak Production Association. The workers were hired between 1948 and 1982, with an average length of time on the job of 18 years. Half had worked there for more than 10 years. All of the workers had comprehensive health check-ups and screening tests at least once a year with advanced evaluations every five years.

The researchers evaluated the workers' health records up to 2013. More than 8,400 workers (38 percent of the group) were diagnosed with hypertension, as defined in this study as a systolic blood pressure reading of ?140 mm Hg, and a diastolic reading ? 90 mm Hg. Hypertension incidence was found to be significantly associated with the cumulative dose.

To put it in perspective, the hypertension incidence among the workers in the study was higher than that among Japanese survivors of the atomic bomb at the end of World War II, but lower than the risk estimated for clean-up workers following the Chernobyl nuclear accident.

The differences may be explained by variations in exposure among the three groups, according to the researchers. Following the atomic bombing, the Japanese experienced a single, high-dose exposure of radiation, the Chernobyl workers were exposed to radiation for a short time period (days and months), while the Mayak workers were chronically exposed to low doses of radiation over many years.

While the development of cancer is commonly associated with radiation exposure, "we believe that an estimate of the detrimental health consequences of radiation exposure should also include non-cancer health outcomes. We now have evidence suggesting that radiation exposure may also lead to increased risks of hypertension, cardiovascular disease and cerebrovascular disease, as well," said Tamara Azizova, M.D., lead author of the study at the Southern Urals Biophysics Institute in Russia.

Azizova pointed out that in recent years, the number of people exposed to radiation in everyday life, such as during diagnostic procedures, has increased. "It is necessary to inform the public that not only high doses of radiation, but low to moderate doses also increase the risk of hypertension and other circulatory system diseases, which today contribute significantly to death and disability. As a result, all radiological protection principles and dose limits should be strictly followed for workers and the general public."

How radiation exposure may increase the risk of hypertension is still a question, according to Azizova. "So far, the mechanisms remain unclear, not only for certain cohorts but also for the general population. One of the main tasks for the coming decade is to study the mechanisms of hypertension and heart and brain atherosclerosis occurring in people who are - and who were exposed - to radiation."

The authors note that their study is a retrospective one, and while many health conditions and behaviors were documented in the medical records of the workers (such as age, smoking, alcohol consumption and body mass index), other factors, such as stress and nutrition, were unavailable for researchers to be taken into account in this study.

AMES, Iowa - A recently published study from Iowa State University medical entomologists found transmission of West Nile virus most often occurs in Iowa's western counties, where the data also found the heaviest concentrations of the mosquito species most often identified as the vector of disease transmission.

The study, published this week in the academic journal Scientific Reports, drew on 15 years of data collected by mosquito surveillance efforts led by the ISU Medical Entomology Laboratory. The research found the species Culex tarsalis, which is most often associated with transmission of West Nile, is more abundant in Iowa's western-most counties. These findings correlate with human cases of West Nile virus, which also occur at higher rates in western Iowa than in other parts of the state, said Ryan Smith, assistant professor of entomology and director of the medical entomology laboratory. The study also examined the intensity of West Nile virus infection in humans and mosquitoes in Iowa over the last 15 years, which peaks in early September.

An ongoing concern

Smith said the study should reinforce for Iowans that West Nile remains a real concern in the state, with transmission of the disease occurring every year.

"This is the most comprehensive study of West Nile virus transmission in the state since the virus was first introduced here," Smith said. "It's a reminder to Iowans that this virus is here and probably isn't going away anytime soon."

West Nile virus is the leading cause of mosquito-borne disease in the United States, according to the Centers for Disease Control. Infected mosquitos transmit the disease to humans through their bite, and one in five infected humans develop symptoms, such as a fever. About one in 150 cases become serious and potentially fatal, according to the CDC.

The number of human cases in Iowa fluctuates every year , Smith said. While this study is an important step in understanding when and where West Nile virus is transmitted, researchers are still working to determine the factors that influence yearly transmission rates, he said.

The study analyzed data collected by the mosquito surveillance program led by the ISU Medical Entomology Laboratory between 2002 and 2016. The laboratory conducts yearly surveillance of mosquito populations, using a network of traps across the state. Each trap is regularly emptied and the mosquitoes inside are catalogued. Some are tested for the presence of the virus.

Smith said nuisance species, such as Aedes vexans, are the most common mosquitoes in Iowa. But the species most likely to carry the virus are Culex pipiens and Culex tarsalis. These species are most active around dusk and dawn during the summer and early fall months. Smith said the lab's research showed Culex tarsalis tends to feed on humans more often than other Culex species, making it a prime suspect in West Nile transmission.

Counties along Missouri River at higher risk

The study shows counties in western Iowa, particularly those along the Missouri River, are at a higher risk of West Nile virus infections due to the increased abundance of Culex tarsalis populations in this region of the state. The findings mirror similar surveillance studies in Nebraska and South Dakota, which also implicate Culex tarsalis in the majority of West Nile virus cases. Smith said Iowa is positioned along a transition zone for North American mosquito populations, with Culex tarsalis more abundant in Nebraska, South Dakota and western Iowa and becoming less abundant in central and eastern Iowa.

"The research gives a strong indication that this particular mosquito species, Culex tarsalis, is likely most often responsible for the West Nile transmission in the state," he said. "However, other regions of the state are still at risk of transmission from other Culex species."

Smith recommended Iowans use insect repellent with DEET if they intend to be outside for an extended period of time during the summer months. He also recommended Iowans stay indoors at dusk and dawn, when Culex mosquitos are most likely to feed.

The recurrent vibrations caused by snoring can lead to injuries in the upper airways of people who snore heavily. This in turn, can cause swallowing dysfunction and render individuals more vulnerable for developing the severe condition obstructive sleep apnea. These findings are reported by researchers at Umeå University, Sweden. Their on-going research focuses on the processes behind vibratory damage and healing of the upper airway tract. The data generated will help identify people at high risk of developing sleep apnea and to find novel treatment strategies.

"Besides the disturbing effects, constant snoring can be a significant health risk. Nonetheless, there are indications that our research will guide towards early preventive measures and in the long term also enhance healing of damaged tissue caused by snoring," says Associate Professor Per Stål, research leader at the Department of Integrative Medical Biology at Umeå University.

Researchers in Umeå have shown that snorers and sleep apnea patients have neuromuscular injuries in the upper respiratory tract. The injuries can be seen at both the structural and molecular level. Researchers could also observe a correlation between snoring and swallowing dysfunction as well as a relation between nerve damage and obstructive sleep apnea. Sleep apnea is characterized by repeated collapse of the upper respiratory tract leading to respiratory arrest during sleep, which increases the risk of cardiovascular disease.

The studies show that people who constantly snore heavily and have sleep apnea displayed a loss of nerves and muscle mass in the soft palate. Furthermore, the attempts by the body to heal damaged tissue were disturbed resulting in an abnormal muscle structure. Another interesting finding was that muscle fibres in the soft palate lacked or had a disturbed organization of certain structural proteins. These proteins stabilize the organelles of the muscle cell and support cellular structures related to energy production and muscle fibre contraction.

The researchers also found that a neurotransmitter that is normally associated with healing and regeneration of neurons was present in the muscle cells. This finding suggests that the body is trying to heal the injuries, but the recurrent snoring vibrations prevent proper healing. It becomes a vicious circle where snoring causes damage and at the same time disturb healing of injuries, which can lead to swallowing dysfunction and sleep apnea.

"Present findings have given us a clearer picture of the effects of snoring vibrations, which in turn increase the possibilities of finding ways to prevent damage and enhance the body's healing processes," says Farhan Shah, one of the researchers in the group.

The research group has now begun to experimentally grow muscles and nerve cells at the Laboratory of muscle biology. The cultured cells will be exposed to harmful vibrations and oxygen desaturation, and the process of damage will be assessed. Thereafter, the cells will be treated with substances previously known for their role in repair and regenerations. Researchers are hopeful that the experiments will generate extensive data that can contribute to new treatment strategies for vibration damage.

A vaccine that combines a fentanyl antigen with a tetanus toxoid has been shown to reduce fentanyl choices and increase food choices with effects lasting several months in rats. These results suggest that the vaccine may not only decrease dangerous drug-taking behavior, but can also increase behaviors maintained by healthier non-drug alternatives. The findings are presented in the journal Neuropsychopharmacology.

The fentanyl-tetanus toxoid vaccine tested in this study was developed by Kim D. Janda at Scripps Research. Fentanyl on its own is unable to stimulate the production of antibodies. The Scripps researchers produced a vaccine cocktail to elicit an immune response against the fentanyl family of synthetic opioids. Researchers at Virginia Commonwealth University School of Medicine then investigated the effectiveness of this vaccine to decrease fentanyl self-administration and increase food self-administration in male and female rats.

Matthew L. Banks and Kim D. Janda, the corresponding authors suggest: "More effective and readily available treatments for opioid use disorder are needed to tackle the current crisis. One strategy includes using opioid-targeted vaccines to elicit antibody production by the host's immune system that recognize and block the passage of a specific opioid into the brain and peripheral organs/tissue."

The study relied on a behavioral procedure in which rats chose between receiving fentanyl injections or food. Before vaccine treatment, rats chose a large amount of fentanyl, but within four weeks of being vaccinated, fentanyl choices decreased, and food choices increased. The effect was similar to that observed in rats chronically treated with naltrexone, a current FDA approved treatment for opioid addiction. In response to only two vaccinations at weeks one and three, fentanyl choice was decreased for 15 weeks, after which a third vaccination renewed the vaccine's effect, suggesting a long-lasting vaccine effect. Vaccination also prevented increased choice of fentanyl over food normally observed after fentanyl withdrawal.

The findings suggest that immunopharmacotherapies, which target the drug itself, may have the potential to prevent the development of opioid dependence and subsequent withdrawal. These findings also suggest the vaccine may provide protection against unintended fentanyl overdose. Further evaluation of the present preclinical evidence in human laboratory studies and clinical trials is needed to confirm the effectiveness of the vaccine in human patients.

The authors caution that immunopharmacotherapies provide unique challenges compared to currently approved treatments. First, the vaccine relies on the individual's ability to generate a sufficient immune response to the drug, which may be difficult in some individuals, for example those with weakened immune systems. Also, all vaccines, including the fentanyl vaccine used in this study, take several weeks to achieve maximal effectiveness. This lag time may leave subjects vulnerable to the effects of the targeted opioid during this vaccine induction period.

Despite a change in the law last year, access to medical cannabis in the UK has been much slower than patients and parents had hoped, warns an expert in The BMJ today.

David Nutt, professor of neuropsychopharmacology at Imperial College London, argues that still only a tiny number of children with severe juvenile epilepsy are being treated.

In a linked article, Hannah Deacon, mother of Alfie Dingley - whose high profile case was instrumental in changing the law - asks why was the law changed if access was not to be forthcoming?

Nutt argues that cannabis is the oldest medicine in the world, and was prescribed by doctors in the UK until 1971 when the Misuse of Drugs Act declared that medical use was illegal.

The government resisted any change until June 2018 when a high-profile campaign by Hannah Deacon, on behalf of her son Alfie, led to the first UK licence for medical cannabis and prompted a review of its status.

Just a few months later, on 1 November 2018, the law was changed and cannabis products were allowed to be prescribed by specialists, or a GP acting under the instructions of one.

Yet many children continue to have multiple seizures because neurologists will not prescribe, argues Nutt, and he points to likely reasons such as a lack of training, fear of prescribing off licence, refusal by some to pay, and difficulties obtaining supplies from foreign producers.

"We must hope the situation will improve," he writes, and to tackle the dearth of evidence he suggests using the cancer research model, where small expert groups conduct open effectiveness studies to collect outcome and side effect data, similar to what is already in place to study ketamine as a potential treatment for depression.

He also points to penicillin, another natural medicine welcomed by UK doctors to fulfil a major clinical need, even though there had been no trials of its effectiveness. "If today's medical profession could embrace cannabis in the same way as it did penicillin then the true value of this plant medicine should rapidly be realised," he concludes.

"Every child with intractable epilepsy should have the right to try cannabis medicines that could save them from a life of suffering," argues Hannah Deacon.

She explains how she had to fight for doctors to prescribe medical cannabis for her son Alfie to ease his seizures, but says many other children in similar situations have not been able to access these medicines, even though they are now legal.

Reasons given by doctors included lack of evidence, money, and support from NHS managers.

She now works with the campaign group End Our Pain, currently supporting 16 families in desperate need of medical cannabis prescriptions.

Cannabis medicines are no panacea, she admits, but says "It is heartbreaking that seemingly no NHS doctor is willing or able to prescribe medicines that could help these children who have been very sick, some for many years, after having tried many other drugs."

She acknowledges that the NHS is underfunded, but says the costs of long term care far exceed those of a product that may just give children and their families a life to live.

"We became campaigners because we had no choice," she writes. "We are our child's only advocates, and we must do all we can to be heard."

Preterm and early term birth are strong risk factors for the development of chronic kidney disease (CKD) from childhood into mid-adulthood, suggests a study from Sweden published by The BMJ today.

Given the high levels of preterm birth (currently 10% in the US and 5-8% in Europe), and better survival into adulthood, these findings have important public health implications, say the researchers.

Preterm birth (before 37 weeks of pregnancy) interrupts kidney development and maturity during late stage pregnancy, resulting in fewer nephrons forming (filters that remove waste and toxins from the body).

Lower nephron number has been associated with the development of high blood pressure and progressive kidney disease later in life, butthe long-term risks for adults who were born prematurely remain unclear.

So a team led by Professor Casey Crump at the Icahn School of Medicine at Mount Sinai in New York, set out to investigate the relation between preterm birth and risk of CKD from childhood into mid-adulthood.

Using nationwide birth records, they analysed data for over 4 million single live births in Sweden during 1973-2014. Cases of CKD were then identified from nationwide hospital and clinic records through 2015 (maximum age 43 years).

Overall, 4,305 (0.1%) of participants had a diagnosis of CKD, yielding an overall incidence rate of 4.95 per 100,000 person years across all ages (0-43 years).

After taking account of other factors that might be important, they found that preterm birth (less than 37 weeks) was associated with a nearly twofold increased risk of CKD into mid-adulthood (9.24 per 100,000 person years). Extremely preterm birth (less than 28 weeks) was associated with a threefold increased risk of CKD into mid-adulthood (13.33 per 100,000 person years).

A slightly increased risk (5.9 per 100,000 person years) was seen even among those born at early term (37-38 weeks).

The association between preterm birth and CKD was strongest up to age 9 years, then weakened but remained increased at ages 10-19 years and 20-43 years.

These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.

This is an observational study, and as such, can't establish cause, and the researchers acknowledge some limitations, such as a lack of detailed clinical data to validate CKD diagnoses and potential misclassification of CKD, especially beyond childhood.

However, the large sample size and long-term follow up prompt the researchers to conclude that preterm and early term birth "are strong risk factors for the development of CKD from childhood into mid-adulthood."

People born prematurely "need long term follow-up for monitoring and preventive actions to preserve renal function across the life course," they add.

And they call for additional studies to assess these risks in later adulthood, and to further explain the underlying causes and clinical course of CKD in those born prematurely.

A breast cancer test has been found that helps doctors make treatment decisions for some breast cancer patients, following research carried out at Queen Mary University of London and funded by Cancer Research UK.

The test was successful in predicting whether chemotherapy would be beneficial for patients with the most common type of breast cancer (oestrogen-receptor positive, HER2-negative), thereby helping to direct patients with a high-risk of metastasis to chemotherapy, while allowing lower-risk patients to opt out of the treatment and its potential side effects.

Approximately 85 per cent of breast cancer patients are now diagnosed as oestrogen receptor positive, which means that the cancer grows in response to the hormone oestrogen. Doctors treating the majority of these women increasingly use multigene tests to determine each patient's prognosis and risk of metastasis, and advise on the best suitable treatment.

The new study, published in the journal Breast Cancer Research and Treatment and carried out in the UK, Austria and Spain, has found that a multigene test called EndoPredict (Myriad Genetics) is able to predict whether chemotherapy will work for an individual patient.

Researchers at Queen Mary University of London, the Austrian Breast and Colorectal Group and the Spanish Foundation Research Group in Breast Cancer performed a combined analysis of three large clinical trials, including a total of 3,746 women, who received treatments including hormone therapy and chemotherapy.

The study results showed that patients with a high EndoPredict test result - indicating a high risk of metastasis - who received chemotherapy in addition to hormonal therapy had statistically better 10-year outcomes than those who only received hormonal therapy.

The study was therefore able to show that EndoPredict is not only a prognostic test, but for the first time was able to demonstrate that EndoPredict also has predictive abilities with regards to chemotherapy.

Traditionally clinical features such as tumour size, grade and nodal involvement are used to determine prognosis and treatment. In cases where it is unclear from these clinical features whether a woman is at high enough risk to receive chemotherapy, the EndoPredict test can give additional prognostic and indirectly predictive value in terms of chemotherapy benefit.

Multiple guidelines, as well as the National Institute for Health and Care Excellence (NICE) regulations, recommend multigene tests to be used by oncologists around the world to aid in their decision-making process about treatment for women with the most common type of breast cancer - oestrogen-receptor positive, HER2-negative.

With the added predictive benefit of EndoPredict demonstrated by this study, use of this test might become more commonly used to determine whether chemotherapy will effectively treat a patient, bringing enormous benefit to women diagnosed with breast cancer.

Lead author Dr Ivana Sestak of Queen Mary University of London commented: "Our new results give clinicians good quality data to inform specific treatment recommendations for women. Our data shows that using the EndoPredict test to assess the risk of metastasis can spare women unnecessary chemotherapy if the test results show that a woman is at low risk of recurrence by the test."

Professor Miguel Martin is the Chairman of GEICAM, the leading academic group in clinical epidemiological and translational breast cancer research in Spain. He commented: "The Spanish group GEICAM is very proud of having contributed to this analysis that can help clinicians select the best adjuvant therapy for their breast cancer patients. In the era of personalized medicine, avoiding chemotherapy when it is of little or no value is a need for the patients".

Dr Sestak added: "It is clinically important to determine which women with hormone receptor positive, HER2-negative breast cancer need chemotherapy in addition to standard 5-years of hormonal treatment. We have shown that EndoPredict has the ability to predict chemotherapy benefit, which will ultimately help clinicians in their decision-making process about adjuvant treatment."

Professor Daniel Rea, Cancer Research UK's breast cancer expert, said: "This important study is one of the few to provide not just information on the risk of a patient's breast cancer coming back, but also whether their cancer is likely to be sensitive to chemotherapy. The Endopredict test has the potential to help some women diagnosed with early hormone receptor positive, HER-2 negative breast cancer, avoid needless chemotherapy, and may reassure those where it's needed.

"This research highlights the progress being made in genetic testing and could be a valuable addition to the current tests available to doctors, helping them advise patients on the best treatment. Trials in the UK are ongoing to provide more evidence to help us make the best use of these tests."