Body

Researchers at the University of Illinois at Chicago have found that some preterm babies born without haptoglobin, a protein in blood cells, have higher odds of brain bleeding, cerebral palsy and death. Their findings suggest that the absence of the protein could serve as a potential biomarker indicating a need for increased monitoring or other preventive interventions.

Their study, which is published in the Lancet's EClinicalMedicine, was a translational analysis of data and newborn cord blood samples stored at the National Institutes of Health from a previous clinical trial.

UIC's Dr. Catalin Buhimschi and Dr. Irina Buhimschi led the research and analyzed cord blood samples from 921 newborns to see if haptoglobin was associated with poor outcomes in babies who had been exposed to in utero inflammation, which causes about 30 percent of preterm births.

By calculating odds ratios -- a statistic indicating the strength or weakness of an association -- they found that preterm babies who had been exposed to inflammation and who lacked haptoglobin were more likely to die before 1 year or develop cerebral palsy by 2 years when compared to preterm babies who had the protein or had not been exposed to inflammation. Odds of intraventricular hemorrhage, known as bleeding in the brain, were also higher in this group.

These findings persisted even when potentially confounding factors, like birth weight, gestational age, fetal sex or other treatments, such as magnesium sulfate given for neuroprotection, were evaluated.

"Our study provides strong evidence that an absence of haptoglobin in preterm babies who have been exposed to inflammation is an indicator of increased risk for complications like brain bleeding, cerebral palsy and even death," said Dr. Catalin Buhimschi, professor of obstetrics and gynecology at the UIC College of Medicine and corresponding author. "This underscores the potential protective role of haptoglobin against short- and long-term poor neonatal outcomes and suggests that the protein may be a valuable marker of neurologic damage and the need for clinical interventions."

Catalin Buhimschi and Irina Buhimschi, who are married, have conducted multiple studies on haptoglobin in preterm babies but this is the first to include a large, representative sample of participants.

Irina Buhimschi, professor of obstetrics and gynecology and study co-author, says that this individualized approach to understanding risk among a specific group of newborns is needed in the maternal-fetal medicine specialty.

"New mothers and babies are particularly complex and we cannot put all preterm deliveries under the same umbrella," Irina Buhimschi said. "This study is also particularly fascinating because haptoglobin is a known protein. It's one that researchers have seen time and again but, until now, has not been applied in this way."

For their studies, Catalin Buhimschi and Irina Buhimschi developed a new method of testing haptoglobin at very low levels, as the protein does not reach adult levels until babies are about one year old.

"The takeaway message of this study is that a simple test of cord blood after delivery could help doctors develop an individualized care plan for some at-risk newborns," said Catalin Buhimschi.

Some diseases which are fatal in one species can cause only mild discomfort in another--but it's hard for scientists to predict how lethal a disease will be if it leaps across species.

However, a new paper published this week in the Proceedings of the National Academy of Sciences indicates that the evolutionary relationship between infected hosts can predict the impact of diseases.

Canadian researchers used data from the World Organisation for Animal Health to track diseases in domesticated mammals, tracing their paths and outcomes across the world.

"The bigger the evolutionary jump between species, the more likely the disease could be lethal in its new host," says Jonathan Davies, a University of British Columbia biologist and senior researcher on the paper.

A disease jumping from a buffalo to a cow is making a short evolutionary jump, and is less likely to be fatal. A disease jumping from a buffalo to a cat involves a larger evolutionary jump and a higher chance of death. Luckily, this lethality may cause the disease to spread poorly amongst its new hosts.

Nevertheless, such infections are a concern. Many diseases are transmitted between domesticated animals, wildlife and humans. A disease that is less lethal, but easy to spread, could be even more problematic than one with a high mortality rate.

"With the world's ecosystems undergoing rapid transformations and climate change altering species' ranges, different animals are coming in contact for the first time. This may promote the emergence of diseases in new hosts," says Maxwell Farrell, the lead author of the study who conducted the research while at McGill University. "Predicting the outcome of these interactions will pose a major challenge."

The biologists hope to expand their research, looking at more species, including humans, to create a database of infection outcomes.

"We shouldn't worry about the number of diseases we have, we should be worried about how virulent they are--whether they are in wildlife, domesticated animals or humans," concludes Davies.

Preterm infants must establish regular breathing patterns at delivery. For extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving two sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of bronchopulmonary dysplasia (BPD) or death at 36 weeks postmenstrual age.

Researchers compared the two methods in a large, multicenter trial led by Children's Hospital of Philadelphia. The findings were published in the March 26, 2019 edition of the Journal of the American Medical Association.

Studies comparing the two methods have been limited thus far. Pooled data from smaller randomized trials were conflicting: one showed that sustained inflations reduced the need for mechanical ventilation. However, another found no benefit in mortality. In infants younger than 30 weeks gestational age, sustained inflations are commonly used in delivery rooms in Europe, but not in the United States.

"Preterm infants with weak respiratory muscles and liquid-filled lungs struggle to aerate their lungs, leaving them at risk of complications, including Bronchopulmonary Dysplasia (BPD), which is associated with a lot of long-term problems," said Haresh Kirpalani, MD, MSc, neonatologist at Children's Hospital of Philadelphia and the study's lead author. "We hypothesized that establishing adequate lung volume quickly in these infants could reduce the risk of BPD. This was possible using sustained inflations at delivery, as these appeared beneficial in animal models, and in smaller prior human studies. However, in our larger randomized trial, in the smallest and most vulnerable preterm infants, this proved not to be the case."

The randomized trial was conducted from August 2014 to September 2017, in 18 neonatal intensive care units in nine countries. Preterm infants from 23 to 26 weeks gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. The primary outcome was the rate of BPD or death at 36 weeks postmenstrual age. There were 27 prespecified secondary efficacy outcomes and seven safety outcomes, including death at less than 48 hours.

Among 460 infants randomized (mean gestational age, 25.30 weeks; 50.2 percent female), 426 infants (92.6 percent) completed the trial. In the sustained inflation group, 137 infants (63.7 percent) died or survived with BPD as compared to 125 infants (59.2 percent) in the standard resuscitation group. Death at less than 48 hours of age occurred in 16 infants (7.4 percent) in the sustained inflation group compared with 3 infants (1.4 percent) in the standard resuscitation group. Of 27 secondary efficacy outcomes assessed by 36 weeks' postmenstrual age, 26 showed no significant difference between groups.

"Because we had been worried about complications, the external data safety monitoring board was looking for early adverse events. Unfortunately, this promising therapy seemed to have higher mortality, especially in the smallest, most vulnerable infants," added Kirpalani. "Additional research is needed to address how best to treat these infants at delivery, to reduce their risk of extreme side effects of a very early birth."

Newton, Mass. (March 26, 2019) - Being a gymnast has its risks--the countless jumps, twists, and landings can take a toll on the body. But there's another, invisible risk: the equipment used in training contains hazardous flame retardant chemicals that accumulate in air and dust, and eventually end up in the athletes' bodies. A new study, however, shows that replacing the foam cubes in the landing pits with flame retardant-free alternatives can significantly lower their exposures.

Previous studies have found high levels of flame retardants in dust at gym facilities, at levels an order of magnitude higher than in other indoor spaces. Studies have also shown high levels in the bodies of U.S. collegiate gymnasts, up to six times higher compared with the general population. One important source is the soft foam pits gymnasts use for practicing dismounts and other aerial work. The pits are filled with cubes made of polyurethane foam that are typically treated with flame retardant chemicals.

Rather than staying put in the foam, the flame retardants migrate into air and dust where they can be ingested and inhaled; they can also be absorbed through the skin. Scientists are concerned about exposure to flame retardants because the chemicals have been associated with health effects including thyroid problems, attention-deficit/hyperactivity disorder (ADHD), weight gain, infertility, and cancers.

"Gymnasts are particularly at risk because so much of their training happens during childhood and adolescence, when their bodies are developing and are vulnerable to chemical exposures," says lead author Courtney Carignan, an epidemiologist at Michigan State University and a former gymnast herself. "And competitive athletes and coaches may have higher levels of these chemicals in their bodies than recreational gymnasts because they spend more time in the gym," she says.

Given the health risks and the frequency of exposures, she and her colleagues decided to conduct an intervention study in which they partnered with a gym in Massachusetts and worked with the facility's owner to replace the standard foam pit cubes with flame retardant free alternatives.

Prior to the switch, the researchers collected hand wipe samples from 10 gymnasts before and after a two-hour training session and then tested the wipes for more than a dozen different flame retardant chemicals. After the gym replaced their pit cubes with flame retardant free substitutes, the researchers repeated the experiment, collecting another set of hand wipe samples from the gymnasts and analyzing them for flame retardants.

Reporting March 26 in the journal Environment International, the researchers observed a 5.4-fold decrease in levels of flame retardants that had accumulated on the gymnasts' hands during practice, suggesting that replacing the pit cubes with flame retardant free alternatives is an effective strategy for reducing exposures. The researchers say the findings could have implications for other recreational facilities as well, including trampoline parks and climbing gyms that also have foam pits.

Even though the reduction in exposures was significant, the study did not entirely eliminate exposures, since there were still some residual amounts of flame retardants on the athletes' hands. "This tells us there are likely other sources of chemicals in the gym, such as the landing mats, which could be opportunities for future interventions," says Carignan.

To ensure the replacement of the pit cubes would not compromise fire safety, the team had an independent fire protection engineer inspect the gym facility before the flame retardant free cubes were brought in. The inspector determined the gym was safe since the building had sprinklers and smoke detectors, and other safety measures in place. As a result, the local fire and building departments approved the replacement of the pit cubes.

According to study co-author Robin Dodson, an environmental exposure scientist at Silent Spring Institute, not only do flame retardants pose a health risk, their use in products has shown to have little benefit in terms of improving fire safety. "Given the health risks, and the fact that these chemicals are not necessary, we should not be exposing young gymnasts to these harmful substances, especially when safer alternatives are available."

Carignan and her colleagues have created a guidance document to help gyms make the transition, with information on purchasing flame retardant free equipment. Gyms can also limit exposures by requiring athletes and coaches to wash their hands with soap and water after practice and before eating.

Some gyms have already started taking steps to make their facilities healthier in response to the study's findings. "This research provides the science to help gyms and other facilities have confidence in their decision to reduce their use of toxics," says co-author Joy Onasch, Small Business and Industry Program Manager at the Toxics Use Reduction Institute at University of Massachusetts Lowell, which provided funding for the intervention study.

Gym owner Janine Walsh, who runs Walker's Gymnastics & Dance in Lowell, Mass., recently made the switch to flame retardant free pit cubes. "Gymnastics is a physically demanding sport that requires the development of healthy habits early on," she says. "Those habits should include reducing exposures to harmful chemicals that could harm our health, especially the health of our children."

AUSTIN, TEXAS (March 25, 2019)-- Uterine fibroid embolization (UFE) effectively treats uterine fibroids with fewer post-procedure complications compared to myomectomy, according to new research presented today at the Society of Interventional Radiology's 2019 Annual Scientific Meeting. Women who received this minimally-invasive treatment also had a slightly lower need for additional treatment than those who underwent surgery.

UFE is a minimally-invasive treatment for uterine fibroids that is less painful, preserves the uterus and allows women to get back to their lives sooner than surgical options. However, past research suggests U.S. women, a majority of whom will experience uterine fibroids by age 50, are largely unaware of UFE despite more than 30 years as an evidence-based treatment.

"Women have options for treating their uterine fibroids. UFE and myomectomy are procedures with similar efficacy and durability for treating fibroids, but UFE has fewer complications and shorter hospital stays," said Jemianne Bautista-Jia, MD, radiology resident at Kaiser Permanente and lead author of the study. "There are important factors women should consider when choosing between the procedures. These factors include risk of bleeding, possibility of infections, and recovery time."

In the retrospective cohort study, researchers analyzed treatment outcomes of 950 uterine fibroid patients from Jan. 1, 2008 through Dec. 31, 2014. Half of the patients underwent UFE, a non-surgical treatment that eliminates the blood supply to fibroids, causing them to shrink or disappear. The other half were treated surgically through myomectomy, a procedure that removes existing fibroids.

After an average seven-year follow up, the study found that women who underwent myomectomy had a higher rate of postprocedural complications, including a 2.9 percent rate of blood transfusion, which was significantly higher than the 1.1 percent rate for those who were treated using UFE. Patients in both treatment groups demonstrated a significant increase in hemoglobin one year after the initial procedure due to reduced bleeding. The two methods were comparably effective based on the rate at which secondary interventions--including UFE, myomectomy, and hysterectomy--were needed. Second interventions were completed in 8.6 percent of women who received an initial UFE compared to 9.9 percent for women who initially underwent a myomectomy.

This study also showed similar rates of miscarriage for women who underwent either UFE or myomectomy. Future research should explore the impact of all uterine-sparing fibroid procedures on pregnancy, which remains still poorly understood.

A uterine fibroid (leiomyoma) is a noncancerous tumor that occurs in the muscle cells of the uterus. These growths do not spread to other regions of the body and are typically not dangerous. While some women do not experience symptoms, others have very heavy and prolonged bleeding that can be debilitating, as well as pelvic pain and abdominal enlargement.

Treatments for uterine fibroids can range from monitoring the fibroids or administering medications to relieve the symptoms, to more invasive approaches, such as myomectomy and hysterectomy. UFE falls in the middle of the spectrum of treatment options and is performed through a tiny incision. Using real-time imaging, an interventional radiologist guides a catheter into the uterine arteries and then releases tiny particles to block the blood flow to the fibroid tumors. Learn more about UFE and fibroids at sirweb.org/fibroidfix.

AUSTIN, TEXAS (March 24, 2019)--Tennis elbow, the painful chronic condition that affects up to 3 percent of the U.S. adult population, can be effectively treated through transcatheter arterial embolization (TAE), an image-guided, non-surgical treatment that decreases abnormal blood flow to the injured area to reduce inflammation and pain, according to research presented today at the Society of Interventional Radiology's 2019 Annual Scientific Meeting. The condition, also known as lateral epicondylitis, stems from repetitive stress injuries that occur in activities such as sports, typing and knitting, and the injury is common in carpenters, cooks and assembly line workers impacting basic tasks that affect job performance and quality of life.

"Tennis elbow can be difficult to treat, leaving many patients unable to perform the simplest tasks, such as picking up their children, cooking dinner, or even working on a computer. With this frustration, many patients turn to invasive major surgery after years of failed physical therapy and medication use," said Yuji Okuno, MD, PhD, founder of the Okuno Clinic in Japan and lead author of the study. "We were interested to see if this technique, already in use in other areas of the body, would be effective for this common, debilitating condition and help people immediately regain a range of motion that many of us take for granted in our everyday tasks."

Dr. Okuno's team conducted a prospective study in 52 patients with tennis elbow who did not find relief from other forms of treatment. The patients received TAE between March 2013 and October 2017 and were followed for up to four years after the treatment. The researchers said they found statistically significant reductions in pain-rating scores, using methods including the Quick Disability of the Arm, Shoulder and Hand scores; visual analog scale pain rating scores; Patient-rated Tennis Elbow Evaluation scores; and pain-free grip strength. Additionally, images taken in 32 patients two years after undergoing TAE showed an improvement in tendinosis and tear scores.

The treatment can be completed in approximately one hour and requires only a needle hole to access the radial artery in the wrist under local anesthesia. A catheter is moved through the wrist to the elbow where the inflamed blood vessels are embolized, preventing excessive blood flow to the affected part of the elbow. The treatment is safe and effective and doesn't require physical therapy, researchers said. No adverse events were observed and no patients experienced negative effects to the surrounding bones, cartilage or muscles.

Tennis elbow is caused by overuse and repetitive stress to the tendons and muscles around the elbow. It typically affects people who play sports with repetitive swinging motions, such as tennis or golf, but it can also affect job performance of carpenters, cooks, assembly-line workers and others. While pain is a hallmark symptom, chronic tennis elbow can cause loss of grip and arm strength, limited use of the arm, and burning sensations on the outer portion of the arm.

Sophia Antipolis, 24 March 2019: Fathers-to-be who smoke may increase the risk of congenital heart defects in their offspring, according to a study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC). For mothers-to-be, both smoking and exposure to secondhand smoke were detrimental.

"Fathers-to-be should quit smoking." said study author Dr Jiabi Qin, of Xiangya School of Public Health, Central South University, Changsha, China. "Fathers are a large source of secondhand smoke for pregnant women, which appears to be even more harmful to unborn children than women smoking themselves."

Congenital heart defects are the leading cause of stillbirth and affect 8 in 1,000 babies born worldwide. Prognosis and quality of life continues to improve with innovative surgeries, but the effects are still lifelong.

"Smoking is teratogenic, meaning it can cause developmental malformations. The association between prospective parents smoking and the risk of congenital heart defects has attracted more and more attention with the increasing number of smokers of childbearing age." said Dr Qin.

This was the first meta-analysis to examine the relationships between paternal smoking and maternal passive smoking and risk of congenital heart defects in offspring. Previous analyses have focused on women smokers. Yet, as Dr Qin points out: "In fact, smoking in fathers-to-be and exposure to passive smoking in pregnant women are more common than smoking in pregnant women."

The researchers compiled the best available evidence up to June 2018. This amounted to 125 studies involving 137,574 babies with congenital heart defects and 8.8 million prospective parents.

All types of parental smoking were associated with the risk of congenital heart defects, with an increase of 74% for men smoking, 124% for passive smoking in women, and 25% for women smoking, compared to no smoking exposure.

This was also the first review to examine smoking at different stages of pregnancy and risk of congenital heart defects. Women's exposure to secondhand smoke was risky for their offspring during all stages of pregnancy and even prior to becoming pregnant. Women who smoked during pregnancy had a raised likelihood of bearing a child with a congenital heart defect, but smoking before pregnancy did not affect risk.

"Women should stop smoking before trying to become pregnant to ensure they are smokefree when they conceive." said Dr Qin. "Staying away from people who are smoking is also important. Employers can help by ensuring that workplaces are smokefree."

"Doctors and primary healthcare professionals need to do more to publicise and educate prospective parents about the potential hazards of smoking for their unborn child." added Dr Qin.

Regarding specific types of congenital heart defects, the analysis showed that maternal smoking was significantly associated with a 27% greater risk of atrial septal defect and a 43% greater risk of right ventricular outflow tract obstruction compared to no smoking. The overall risk of congenital heart defects with all types of parental smoking was greater when the analysis was restricted to Asian populations.

NEW ORLEANS--In recent years, women who start taking bisphosphonates (BPs) to treat osteoporosis and prevent fracture have trended from younger to older and from having osteopenia to having osteoporosis, researchers report. The results of the study will be presented on Saturday at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, La.

"Bisphosphonate drugs have been first-line therapy for osteoporosis and fracture prevention for more than 20 years; however, osteoporosis care has changed over the past decade. Instead of treating younger, healthier women at low risk for fracture, the medical community now focuses on treating older women and those with bone density and other factors that indicate high risk for future fracture," said senior study author Joan Lo, M.D., of Kaiser Permanente Northern California Division of Research in Oakland, Calif.

"These findings reflect the success of regional initiatives targeting these potent therapies to those who will benefit the most. In response to national guidelines and quality metrics introduced in 2008, we are doing a better job of giving more appropriate drug treatment to women who are most likely to benefit while avoiding excess treatment of women at low risk for fracture," she said.

To investigate whether the characteristics of women who began BP therapy changed over a recent 12-year period, Lo and her colleagues at Kaiser Permanente reviewed the records of women in the integrated Northern California health care system, which serves 4.3 million members.

The research team included 28,495 female members in their study: the women ranged in age from 50 to 79 years, initiated oral BP therapy between 2002 and 2013, underwent a bone mineral density (BMD) test within the past two years, had no fracture history (except for head, fingers, or toes), and did not have advanced kidney disease or metastatic cancer.

For each of the 12 years, the percentage of younger women fell while the percentage of older women increased; over the years, the percentage of women initiating BP treatment who were between 50 and 59 years of age dropped (31 percent to 12 percent), while the percentage of women between 60 and 69 (39 percent to 54 percent) and 70 and 79 (29 percent to 34 percent) rose.

Among women starting BP treatment, the percentage with osteopenia fell, while the percentage with osteoporosis at the time of starting treatment expanded from 62 percent in 2002 to 79 percent in 2013.

The overall percentage of osteoporosis among white women was 65 percent, increasing from 58 percent in 2002 to 71 percent in 2013. Among Asian women, the overall percentage of osteoporosis was 82 percent, increasing from 74 percent to 95 percent over the same period.

"Approximately 13 percent to 15 percent of older women in the health plan were Asian compared to 27 percent of our study population, which suggests that Asians may be more likely to begin bisphosphonate treatment for primary prevention," Lo said.

NEW ORLEANS--Eating later in the day may contribute to weight gain, according to a new study to be presented Saturday at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, La.

Previous studies have suggested that later timing of eating and sleeping are related to obesity, said lead author Adnin Zaman, M.D., of the University of Colorado in Denver, Colo. "However, few studies have assessed both meal and sleep timing in adults with obesity, and it is not clear whether eating later in the day is associated with shorter sleep duration or higher body fat," she said.

The study used three types of technology to record participants' sleep, physical activity and eating patterns. "It has been challenging to apply sleep and circadian science to medicine due to a lack of methods for measuring daily patterns of human behavior," Zaman said. "We used a novel set of methods for simultaneous measurement of daily sleep, physical activity, and meal timing patterns that could be used to identify persons at risk for increased weight gain."

The week-long study included 31 overweight and obese adults, average age 36. Ninety percent were women. They were enrolled in an ongoing weight-loss trial comparing daily caloric restrictions to time-restricted feeding, meaning they could only eat during certain hours of the day.

Participants wore an activPAL electronic device on their thigh. This device measured how much time they spent in physical and sedentary activities. They also wore an Actiwatch, which assesses sleep/wake patterns. Participants were asked to use a phone app called MealLogger to photograph and time stamp all meals and snacks throughout the day.

The researchers found that on average, participants consumed food throughout an 11-hour timeframe during the day and slept for about 7 hours a night. People who ate later in the day slept at a later time, but they slept for about the same amount of time as those who finished eating earlier. Later meal timing was associated with a higher body mass index as well as greater body fat.

"We used a novel set of methods to show that individuals with overweight or obesity may be eating later into the day," Zaman said. "These findings support our overall study, which will look at whether restricting the eating window to earlier on in the day will lower obesity risk."

"Given that wearable activity monitors and smartphones are now ubiquitous in our modern society, it may soon be possible to consider the timing of behaviors across 24 hours in how we approach the prevention and treatment of obesity," Zaman said.

NEW ORLEANS--Obesity may play a role in reproductive problems in women with type 1 diabetes, according to a new study to be presented Saturday, March 23 at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, La.

Earlier studies have shown that type 1 diabetes is associated with menstrual irregularities and lower rates of fertility.

"Women with type 1 diabetes remain at risk of significant reproductive problems despite improvements in current therapies, and this may be partly explained by the high prevalence of obesity in this group," said lead researcher Eleanor Thong, M.B.B.S., of the Monash Centre for Health Research and Implementation in Clayton, Australia.

The researchers analyzed data from the large community-based Australian Longitudinal Study in Women's Health (ALSWH), a national study funded by the Australian Department of Health. A total of 23,752 women aged 18-23 and 34-39 were included in the study. Of these women, 162 had type 1 diabetes. The researchers found 24 percent of women with type 1 diabetes were obese, compared with 16 percent of those without diabetes. Another notable finding was that one in four women with type 1 diabetes were current smokers, compared to one in six controls.

Menstrual irregularities were seen in 47 percent of those with type 1 diabetes, compared with 35 percent of those without the disease. Polycystic ovary syndrome (PCOS) was found in 14 percent of those with diabetes, compared with 5 percent in those without the disease. Women with PCOS produce higher-than-normal amounts of male-type hormones. This hormone imbalance causes them to skip menstrual periods and makes it harder for them to get pregnant.

Menstrual irregularity was associated with increased body mass index (BMI), high blood pressure, smoking and PCOS in this cohort.

In women with prior pregnancies, those with type 1 diabetes experienced significantly more miscarriages (46 percent compared with 33 percent of those without diabetes) and stillbirths (7 percent versus 1 percent). There was no difference in pregnancy rates.

"Despite universal healthcare and improved diabetes management, the risk of miscarriages and stillbirths remain elevated in women with type 1 diabetes. Increased BMI may play a role in the development of PCOS, menstrual and reproductive problems. Furthermore, smoking is associated with an increased risk of menstrual disorders and miscarriage in this cohort," said co-author Professor Helena Teede, M.B.B.S. Ph.D., of the Monash Centre for Health Research and Implementation. "Pre-conception care and counseling in reproductive-aged women with type 1 diabetes, including weight management and smoking cessation, is imperative to minimize complications in pregnancy."

NEW ORLEANS--Treating women who have thyroid antibodies, but normal thyroid function, with a medicine called Levothyroxine does not make them more likely to deliver a live baby, new research from the United Kingdom suggests. The research will be presented Saturday, March 23 at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, La., and published in The New England Journal of Medicine.

"Levothyroxine treatment, started before pregnancy, in women with normal thyroid function and thyroid peroxidase antibodies who have a history of miscarriage or infertility, does not improve the chances of live birth," said lead author Rima Dhillon-Smith, Ph.D., M.R.C.O.G., M.B.Ch.B., an academic clinical lecturer at the University of Birmingham in the United Kingdom. "We were surprised because previous small studies suggested there could be a benefit with levothyroxine treatment in women with thyroid antibodies."

The authors conducted a double-blind study of women with normal thyroid function between 16 and 41 years of age who were positive for thyroid peroxidase antibodies, had a history of miscarriage or infertility, and were trying to conceive naturally or with assisted conception. Between 2011 and 2016, the researchers randomized and followed-up 470 women who received 50 mcg daily levothyroxine and 470 who received daily placebo, through 34 or more weeks of gestation in 49 hospitals throughout the U.K. The participants began taking the medication before they conceived and continued until the end of their pregnancy.

Outcomes in both groups were similar: 266 of the 470 (56.6 percent) women who received levothyroxine, and 274 of 470 (58.3 percent) who received placebo, became pregnant; 176 women (37.4 percent) taking levothyroxine, and 178 (37.9 percent) taking placebo, had live births (relative risk 0.97, p=0.74; absolute risk difference, -0.4 percent).

Other pregnancy and neonatal outcomes were similar in both groups, including pregnancy loss and preterm birth. Serious adverse event rates were also similar: 6 percent of women in the levothyroxine group and 4 percent in the placebo group (p=0.14).

"Thyroid peroxidase antibodies are found in the blood in approximately one in 10 women who have normal thyroid function, and they have been linked to increased risk of miscarriage and preterm birth," Dhillon-Smith said.

"The American Thyroid Association and other international guidelines currently recommend the consideration of levothyroxine treatment for women with thyroid antibodies, as there is thought to be minimal chance of harm and a potential to help increase the chance of having a live birth," she said.

"As our study was large and of high quality, we can be confident that levothyroxine does not improve pregnancy success for women with thyroid antibodies and normal thyroid function and therefore should not be recommended or used in clinical practice," Dhillon-Smith said. "This will mean no longer providing unnecessary medication to women who do not need it."

Current treatments for tuberculosis (TB) are very effective in controlling TB infection caused by Mycobacterium tuberculosis (Mtb). They don't, however, always prevent reinfection. Why this happens is one of the long-standing questions in TB research.

So why are our bodies unable to generate permanent immunity to TB, - the leading infectious disease killer worldwide? A team of scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University may have found the answer... in the gut. In a study published recently in Mucosal Immunology, they showed that anti-TB drugs caused changes to gut microbiota - the diverse community of microbes living our intestines -- and increased susceptibility to Mtb infection.

Gut microbiota are critical to keeping us healthy; they help to digest food, combat pathogenic microbes and reinforce our immune system. Recent research has shown that chronic use of antibiotic leads to disruption of this community, which can in turn lead to dysregulation of the immune system. It remains unclear, however, whether changes in the composition of the microbes living in our gut have an influence on TB infection.

Impact of anti-TB drugs on microbiome

To find out, Drs. Irah King and Maziar Divangahi from the Meakins-Christie Laboratories at the RI-MUHC, with colleagues from McGill's Macdonald Campus, treated mice with the most commonly used anti-TB drugs - isoniazid, rifampicin and pyrazinamide - for a period of eight weeks. They found that while all three drugs significantly altered the composition of the mice's gut microbiome, only mice treated with isoniazid combined with pyrazinamide showed an increase in susceptibility to Mtb infection.

To make sure the vulnerability of the host to Mtb infection was due to a compromised gut microbiota, the researchers looked at. feces. Transplanting feces from healthy mice into animals treated with anti-TB drugs was sufficient to restore immunity to Mtb.

Relationship between the gut microbiome and the lungs

King and his colleagues also wanted to better understand the gut-lung axis - a bidirectional communication system between microorganisms residing in the gastrointestinal tract and the lungs - in order to how this might be involved in Mtb infection and immunity.

To do so, they evaluated a number of lung cell types known to be important for resistance to Mtb infection. Following anti-TB treatment, alveolar macrophages, a type of immune cell located in the airways of mice and humans and the first cell to encounter Mtb upon infection, were compromised in their ability to kill Mtb.

"We need to do more research in order to understand how the microbiome affects alveolar macrophages because these cells are critical for controlling early TB infection. We also need to identify the molecular pathways involved in the gut-lung axis,'' explains King.

"Anti-TB therapies have been incredibly efficient in controlling the TB epidemic by decreasing morbidity and mortality associated with Mtb,'' says King. "Now, this work provides a basis for novel therapeutic strategies exploiting the gut-lung axis in Mtb infection.''

Researchers are already thinking of monitoring patients who are being treated with these drugs to see how their gut microbiota changes over time and once treatment has stopped. The idea will be to control changes to the microbiome in combination with drugs that are effective at killing Mtb.

New research from Washington University in St. Louis explains the cellular processes that allow a sun-loving microbe to "eat" electricity -- transferring electrons to fix carbon dioxide to fuel its growth.

Led by Arpita Bose, assistant professor of biology in Arts & Sciences, and Michael Guzman, a PhD candidate in her laboratory, a Washington University team showed how a naturally occurring strain of Rhodopseudomonas palustris takes up electrons from conductive substances like metal oxides or rust. The work is described in a March 22 paper in the journal Nature Communications.

The study builds on Bose's previous discovery that R. palustris TIE-1 can consume electrons from rust proxies like poised electrodes, a process called extracellular electron uptake. R. palustris is phototrophic, which means that it uses energy from light to carry out certain metabolic processes. The new research explains the cellular sinks where this microbe dumps the electrons it eats from electricity.

"It clearly shows for the first time how this activity -- the ability for the organism to eat electricity -- is connected to carbon dioxide fixation," said Bose, a Packard Fellow who studies microbial metabolisms and their influence on biogeochemical cycling.

This mechanistic knowledge can help inform efforts to harness the microbe's natural ability for sustainable energy storage or other bioenergy applications -- a potential that has caught the attention of the Department of Energy and Department of Defense.

"R. palustris strains can be found in wild and exotic places like a rusty bridge in Woods Hole, Massachusetts where TIE-1 was isolated from," Bose said. "Really, you can find these organisms everywhere. This suggests that extracellular electron uptake might be very common."

Guzman added: "The main challenge is that it's an anaerobe, so you need to grow it in an environment that doesn't have oxygen in order for it to harvest light energy. But the flip side to that is that those challenges are met with a lot of versatility in this organism that a lot of other organisms don't have."

In their new paper, the researchers showed that the electrons from electricity enter into proteins in the membrane that are important for photosynthesis. Surprisingly, when they deleted the microbe's ability to fix carbon dioxide, they observed a 90 percent reduction in its ability to consume electricity.

"It really wants to fix carbon dioxide using this system," Bose said. "If you take it away -- this innate ability -- it just doesn't want to take up electrons at all."

She said that the reaction is similar in some ways to a rechargeable battery.

"The microbe uses electricity to charge its redox pool, storing up the electrons and making it highly reduced," Bose said. "To discharge it, the cell reduces carbon dioxide. The energy for all this comes from sunlight. The whole process keeps repeating itself, allowing the cell to make biomolecules with nothing more than electricity, carbon dioxide and sunlight."

An all-Washington University team overcame a number of technical hurdles to complete this study. Mark Meacham from the McKelvey School of Engineering helped to design and fabricate the microfluidic devices that allowed the researchers to hone in on the activities that were taking place in cells as the bacteria fed from electricity sources. The team also relied on support from collaborators including David Fike in the earth and planetary sciences department, who helped Bose and Guzman to use secondary ion mass spectrometry to determine how the microbe uses carbon dioxide.

The new research answers basic science questions and provides plenty of opportunity for future bioenergy applications.

"For a long time, people have known that microbes can interact with analogues of electrodes in the environment -- that is, minerals that are also charged," Guzman said. "But no one really appreciated how this process could also be done by photoautotrophs, such as these types of organisms that fix their own carbon and use light to make energy. This research fills a poorly understood gap in the field."

Bose's lab is working on using these microbes to make bioplastics and biofuels.

"We hope that this ability to combine electricity and light to reduce carbon dioxide might be used to help find sustainable solutions to the energy crisis," Bose said.

Pain relief and end of life care is not being provided equally to people with advanced progressive diseases who were at home during their last three months of life, according to a study of 43,000 people who died across England.

The data for the study was drawn from responses to the National Bereavement Survey (VOICES) in England between 2011 and 2015, which asks families or close relatives to reflect on the quality of care provided to a person who has died.

Just 10% of patients who died of a non-cancerous disease received palliative care at home, compared to 66% of cancer patients.

Led by the University of Leeds, the findings revealed that people who did access palliative care at home were 2.7 times more likely to have experienced good pain relief compared to those who did not receive palliative care.

The association between good pain relief and palliative care at home occurred regardless of the type of disease that patients had, but access to palliative care was not provided equally.

Lead author Dr Yousuf Elmokhallalati, from the University of Leeds, said: "This research shows that palliative care is associated with significant benefits to people with every kind of progressive disease, but this is not reflected in the spread of people that are being offered palliative care.

"We need to ensure that all people, whether they have cancer, heart or lung diseases, or any other life-limiting condition, are being offered appropriate support towards the end of their lives."

Published in the journal BMC Medicine, the study is the first to suggest there are significant reductions in pain for those receiving palliative care at home. It was conducted by researchers from the St Gemma's Academic Unit of Palliative Care led by Mike Bennett, Professor of Palliative Medicine at the University of Leeds, which works in partnership with St Gemma's Hospice in Leeds.

A British Medical Association report in 2016 showed that pain is the most important concern of both the public and of doctors when considering a patient who is facing a terminal illness.

The new study also suggests that patients who had planned where they wanted to die are nearly twice as likely to experience good pain relief compared to those who had not, showing the value of planning ahead and co-ordinating the support of healthcare professionals.

Only a quarter of patients were found to have recorded a preferred place of death, and cancer patients were nearly three times more likely to have a preference recorded compared to non-cancer patients (36.6% of cancer patients vs. 13.1% of non-cancer patients).

Funded by the National Institute for Health Research (NIHR), it also found that the pain relief experienced by patients accessing palliative care in the home was approaching the levels experienced by those receiving care in a hospice.

Within the full VOICES survey, 87% of patients who died in a hospice experienced good pain relief, compared with 66% of those who received palliative care support in their home, and 37.5% of those who did not receive support in their home.

Previous research by the same group in 2018 revealed inequalities in the duration of palliative care being provided to patients across England, with cancer patients referred for care around 53 days prior to death, compared with around 27 days prior for non-cancer patients.

Professor Bennett said: "It's already been established that the home is the place where pain is least well controlled, so our findings clearly illustrate the importance of access to end of life care.

"These results, combined with our previous research, suggest that pain relief and access to palliative care is particularly poor for older patients, those with non-cancer diseases and those who live in the North of England. These inequalities must be challenged."

The study was observational and found an association between access to palliative care and pain relief, so it was unable to determine cause and effect.

In what is believed to be a first-of-its-kind systematic look at pregnancy frequency and outcomes among imprisoned U.S. women, researchers from Johns Hopkins Medicine say almost 1,400 pregnant women were admitted to 22 U.S. state and all federal prisons in a recent year. They also found that most of the prison pregnancies -- over 90 percent -- ended in live births with no maternal deaths.

Historically, say the researchers, these numbers have not been tracked by U.S. federal agencies or state prison systems, yet most of the women in American prisons are of reproductive age. And although this particular study didn't address how pregnancy care was provided, the researchers say gathering diverse, nationally representative data such as this is a much-needed first step toward developing consistent guidelines for tracking the numbers and improving maternity care in the U.S. prison system.

"Currently, there are no mandatory standards for prenatal and pregnancy care for women in prisons," says Carolyn Sufrin, M.D., Ph.D., lead author of the study, an assistant professor in gynecology and obstetrics at the Johns Hopkins University School of Medicine and author of Jailcare: Finding the Safety Net for Women Behind Bars. "This study gives us insight into the actual numbers, which will help us better understand the scope of care needed by pregnant people behind bars. Having this information could also help inform policies to consider alternatives to incarceration for pregnant people."

The findings of the new study, conducted by the researchers in collaboration with prison officials who reported information on a monthly basis for one year, were published online March 21 in the American Journal of Public Health.

According to the Bureau of Justice Statistics (BJS), there were more than 110,000 women in federal and state prisons in the United States at year-end 2016, with 75 percent of these women being 18-44 years old. A 2004 BJS survey found that 3 percent of women in federal prisons and 4 percent of women in state prisons reported they were pregnant at intake. Until this new study, this BJS survey from 15 years ago, which only accounted for self-reported pregnancies, was the only data on pregnancy prevalence in prisons.

Other and more current national health statistics databases exclude data from prisons, further contributing to the lack of maternal health and birth information about imprisoned populations.

To help close the information gap, the Johns Hopkins researchers gathered data on pregnant women in 22 state systems and all federal prisons, and tracked pregnancy outcomes over a period of 12 months from 2016-2017.

They did so by first contacting the prisons' custody and health care administrators via email or phone with an invitation to participate in the study. For federal prisons, approval of participation was granted by the acting director of the U.S. Department of Justice and administrators at the Federal Bureau of Prisons. The states' departments of corrections' policies allowed for participation of state prisons.

The researchers then arranged for a designated "site reporter" in each prison to use a survey form to track outcomes on a monthly basis among the pregnant patients in their prisons, reporting data on miscarriages, live births, stillbirths, maternal deaths, preterm births and abortions. Site reporters could be wardens, prison research coordinators, women's programming coordinators, medical directors or other health care personnel. At the end of each month during the survey year, site reporters sent their findings to the Johns Hopkins researchers using a secure, web-based program, Research Electronic Data Capture (REDCap).

In a bid to keep the data-gathering as accurate as possible, the Johns Hopkins researchers interviewed nearly half of the site reporters (43 percent) midway through the study to better understand how they tracked the data and to ensure accuracy. Data were also reviewed by research staff monthly to assess and correct inaccuracies. All data errors were corrected by site reporters during the study period.

From the data reported from each site, researchers determined that 1,396 already-pregnant women were admitted to the 22 state and all federal prisons in the study over the 12-month study period. These prisons house 57 percent of imprisoned women in the United States. For this study, no specific demographic information, such as race or age, was collected.

Of the pregnancies that ended while women were in custody, 753 resulted in live births. Six percent of the live births were preterm, and 30 percent were delivered by cesarean section, but these numbers varied greatly by state. The national statistic for preterm births and C-section deliveries in the general population are 10 percent and 31.9 percent, respectively.

Forty-six of the pregnancies ended in miscarriages, 11 ended in abortions, four ended in stillbirth and three newborns died. None of the mothers died. In the United States, there are more than 700 maternal deaths each year.

"We can't know for sure that these numbers come from the same women who were admitted who also had pregnancies that ended in prison," says Sufrin. "They could have gotten released."

The researchers said differences such as pre-incarceration health conditions, access to prenatal care, food, shelter and access to illegal drugs could account for the level of preterm birth rates in specific prisons that were higher or lower than the national average. In 2016, the national average for preterm births was 9.85 percent. The average for prisons in the study was 6 percent.

Access to and quality of reproductive health care varies from prison to prison, the researchers note, so the findings cannot be generalized to states that did not participate in the study. The researchers also recorded large variations in pregnancy outcomes by state.

For example, in Kansas, Vermont and Arizona, 20 or more percent of pregnancies ended in miscarriage. Additionally, Texas and Ohio had months with more than 50 pregnant women present in their prisons, while Maine and Rhode Island had some months with zero pregnant inmates.

Sufrin says that the state-by-state differences could be attributed to state sentencing laws, prison health care policies, access to public reproductive health care or other factors not measured in this study.

"We were very surprised by how willing and eager the prisons were to participate and to have better data to work with," says Sufrin. "With the collective help of the prisons, our research team was able to take the initial steps to gather more systematic and standardized information."

She added: "We know there are pregnant people in prison, and until now, it wasn't clear whether or not people wanted to pay attention to this particular population or do the adequate research needed to advance the quality of reproductive health care in prisons."

The researchers cautioned that the study had several limitations: It didn't assess how far along in pregnancy the women were at intake, the size of the prisons, the pregnancy testing policies of the prisons, the type of hospital in which imprisoned women deliver and the variability in prison living conditions. All of those factors may or may not have contributed to variations in outcomes.

They also weren't able to collect pregnancy statistics from the other 28 state prison systems, including three large systems that declined participation (California, Florida and New York).

In future studies, the researchers hope to collect more information on the individual experiences of the women by interviewing, collecting demographic data and assessing the quality of their maternity care.

"Our hope is for these findings to be used to advance national standards of care for imprisoned pregnant women," says Sufrin, "and to support those who advocate for policies and laws that guarantee acceptable and safe pregnancy care and childbirth, that consider alternatives to incarceration for pregnant people, uphold reproductive justice, and encourage more attention to the reproductive health needs of marginalized women and their families."

Sufrin has been researching reproductive health care in jails and prisons since 2005, and the pregnancy care of incarcerated women specifically, since 2009. She is also the author of Jailcare: Finding the Safety Net for Women Behind Bars.