Body

Latest U.S. estimates indicate that since 1989, hundreds of thousands of women's lives have been saved by mammography and improvements in breast cancer treatment. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings point to progress made in early detection and management of breast cancer.

Screening mammography for the detection of breast cancer became widely available in the mid-1980s, and various effective therapies have been developed since that time. To estimate the number of breast cancer deaths averted since 1989 due to the collective effects of both screening mammography and improved treatment, R. Edward Hendrick, PhD, of the University of Colorado School of Medicine, Jay Baker, MD, of Duke University Medical Center, and Mark Helvie, MD, of the University of Michigan Health System, analyzed breast cancer mortality data and female population data for U.S. women aged 40 to 84 years over the past three decades.

Cumulative breast cancer deaths averted from 1990 to 2015 ranged from more than 305,000 women to more than 483,000 women depending on different background mortality assumptions. When extrapolating results to 2018, cumulative breast cancer deaths averted since 1989 ranged from 384,000 to 614,500. When considering 2018 alone, an estimated 27,083 to 45,726 breast cancer deaths were averted. The investigators calculated that mammography and improved treatment decreased the expected mortality rate of breast cancer in 2018 by 45.3 to 58.3 percent.

"Recent reviews of mammography screening have focused media attention on some of the risks of mammography screening, such as call-backs for additional imaging and breast biopsies, downplaying the most important aspect of screening--that finding and treating breast cancer early saves women's lives. Our study provides evidence of just how effective the combination of early detection and modern breast cancer treatment have been in averting breast cancer deaths," said Dr. Hendrick.

He noted that currently, only about half of U.S. women over 40 years of age receive regular screening mammography. "The best possible long-term effect of our findings would be to help women recognize that early detection and modern, personalized breast cancer treatment saves lives and to encourage more women to get screened annually starting at age 40."

Dr. Helvie added that additional benefits will likely be realized as research continues. "While we anticipate new scientific advances that will further reduce breast cancer deaths and morbidity, it is important that women continue to comply with existing screening and treatment recommendations," he said.

An unexpected finding in pre-clinical platelet studies by Baker Institute researchers could provide a novel approach to targeting and destroying difficult-to-treat cancer cells, providing new therapeutic options for a range of cancers.

This latest finding, published in the journal Theranostics, was discovered while studying activated platelets in the setting of heart disease and may now prove useful for delivering targeted treatment to cancer cells without major side effects.

Early detection of cancer is crucial for successful therapy. However, some cancer types do not have specific cancer surface markers that can be used to detect them and even the same cancer type can exhibit different properties in different patients.

Professor Karlheinz Peter, Deputy Director, Basic and Translational Science at the Baker Heart and Diabetes Institute has been working for many years with platelets, which are small blood cells in the circulation that mainly promote blood clotting (for example, platelets are the main perpetrator of a heart attack) and prevent us from bleeding when we are injured. In his recent experiments, he observed that platelets and more specifically, "activated platelets" accumulate in the area surrounding a wide range at tumour types.

Based on this observation, Prof Peter's team has now developed a new imaging and platelet targeting chemotherapy agent for the early detection and treatment of cancers. "We have shown that we can image activated platelets to detect tumours with clinically available imaging technologies such as ultrasound and PET/CT," he said.

"This unique approach holds great promise both for the diagnosis and therapy of a broad range of tumors. It provides a new treatment option particularly for difficult to treat cancer types that lack specific markers for therapy with conventional chemotherapy such as breast cancer etc...," said Prof Karlheinz.

"This activated platelet targeted chemotherapy approach also provides the means to deliver high concentrations of chemotherapy specifically to tumour cells whilst minimising side effects and preventing tumour growth.

"This highly promising and unexpected discovery with immense importance for cancer diagnosis and therapy emerged from years of research on the function of platelets in heart disease. It is a good example of the importance of funding in basic research which often produces unexpected but highly relevant discoveries that ultimately will provide benefit for patients."

His team has now patented the drug and is looking for funding to test in large-scale clinical studies.

Women's hormonal cycles may not only make them more prone to drug addiction but also more affected by triggers that lead to relapse, a new Vanderbilt University study revealed. The findings are especially significant since there are virtually no addiction studies in women that account for these cycles.

Erin Calipari, an assistant professor of pharmacology in the Vanderbilt Center for Addiction Research, points out that women represent a particularly vulnerable population, with higher rates of addiction following exposure to drugs, but addiction studies have primarily focused on the mechanisms underlying these effects in men. Her study found that, when fertility-related hormone levels are high, females learn faster, make stronger associations to cues in their environment and are more prone to seek rewards.

"Women becoming addicted to drugs may be a fundamentally different process than men," Calipari said. "It's important to understand this, because it's the first step in developing treatments that are actually effective."

The next step, she said, would be to figure out specifics of how hormonal shifts affect women's brains and, ultimately, develop medications that could help override those. But long before those future medications are available, treatment centers could use the information in this study to educate women about their stronger mental connections to places and objects. That may mean a higher chance of relapse just by, for example, visiting a place where they used drugs or holding the kind of spoon they used in the process.

Researchers historically have avoided using female animals in medical studies specifically so they don't have to account for influences from hormonal cycles. As a result, medication development has often focused on correcting dysfunctions in men, which may explain why women often don't respond to available medications or treatments in the same way as men do, Calipari said.

Her work was published recently in the Nature-affiliated journal Neuropsychopharmacology in a paper titled "Cues play a critical role in estrous cycle-dependent enhancement of cocaine reinforcement."

In this study, male and female rats were allowed to dose themselves with cocaine by pushing a lever, with a light set up to come on during dosing. That's similar to the environmental cues, such as drug paraphernalia, present when humans are taking drugs. When their circulating hormone levels were high, female rats made stronger associations with the light and were more likely to keep pushing the lever as much as it took to get any amount of cocaine.

Ultimately, females were willing to "pay" more in the presence of these cues to get cocaine. The results are transferable to humans through behavioral economic analysis, which uses a complicated mathematical equation with values for the most and least a subject will do to get a payoff. It's one of the few ways that comparisons can be made across species.

"We found that the animals will press a lever just to get the light - that environmental stimuli," Calipari said. "That has value to them.

"There's epidemiological data that says women are more vulnerable, but it's unclear what the factors are. We know they transition to addiction faster and have more problems with craving and relapse. Now, with research like this, we're beginning to isolate environmental and physiological causes."

This new research builds on earlier work Calipari published at the Icahn School of Medicine at Mount Sinai that showed estrogen intensifies the brain's dopamine reward for cocaine use.

Feb. 8, 2019-- Compared to Mexican American children, Puerto Rican children were more likely to have poor or decreasing use of inhaled medication needed to control their asthma, according to new research published online in the Annals of the American Thoracic Society.

The study also found that girls of both ethnic groups were more likely than boys to have poor or decreasing use of the asthma control medications.

In "Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Utilization," Kimberly J. Arcoleo, PhD, MPH, and co-authors report on what is believed to be the first study of adherence over time to inhaled corticosteroids (ICS) for asthma within Latino populations. To control asthma and prevent exacerbations, ICS need to be taken by those with persistent asthma even when their symptoms are not apparent.

The study followed 123 children, ages 5-12, with persistent asthma living in Phoenix, Arizona, and Bronx, New York, for one year. A device attached to their inhalers monitored their inhaler use, and the researchers categorized use as poor, moderate, declining adherence or increasing adherence. All of the children received their medication for free.

The study found:

Between 23 percent and 32 percent of all children had poor adherence (less than 50 percent of prescribed doses taken) at each three-month follow-up after enrollment.

Less than 15 percent had good adherence (more than 80 percent of prescribed doses taken) at each three-month follow-up after enrollment.

Puerto Rican children were more than five times as likely as Mexican American children to have their ICS use described as poor, and nearly three times as likely to have their ICS use described as decreasing.

Girls were five times as likely as boys to have their ICS use described as poor or decreasing.

Children with poor adherence were more likely to go to the ER or be hospitalized for an asthma attack throughout the study period.

Study limitations include the fact that the devices only stored data on ICS use for the most recent 30 days, so adherence was not continuous across the 12 months the children were followed.

Still, the authors believe their study may help focus intervention efforts on those who are least compliant with ICS use and those who are decreasing their use of the controller medications.

Dr. Arcoleo, who is an associate professor at the University of Rochester School of Nursing in New York, said that the study shows that there are naturally changing patterns of children's ICS adherence over time.

"As clinicians and researchers, we cannot assume that a child who demonstrates good adherence at one visit will remain adherent," she explained. "We need easy-to-use, validated methods of assessing adherence during the clinical visit, which is something our team is working on developing."

WASHINGTON -- The immunotherapy that has revolutionized treatment of many cancers appears to offer similar benefit to cancer patients living with HIV, say researchers at Georgetown Lombardi Comprehensive Cancer Center.

Their study, published in JAMA Oncology, focused on whether a relatively new class of drugs called checkpoint inhibitors is both safe and effective in patients with advanced cancer who also live with HIV. Because checkpoint inhibitors manipulate the immune system, the concern has been that these therapies might have adverse effects such as virus reactivation in patients with HIV infection.

Investigators searched the medical literature to find 73 HIV patients whose cancer had been treated with checkpoint inhibitors. Only a fraction of patients came from a clinical trial; the rest were mostly case reports and case series from oncologists who chose to treat their patients with cancer and HIV infection with the new cancer drugs.

"Cancer patients with HIV and their oncologists have found themselves in a real conundrum," says the study's lead investigator, Chul Kim, MD, MPH, an assistant professor at Georgetown Lombardi, and an attending physician at MedStar Georgetown University Hospital and MedStar Washington Hospital Center. "Because of their HIV infection, they are at higher risk of developing cancer than people who are not infected. In fact, cancer has become one of the leading causes of death in patients with HIV. But conventional chemotherapies can reverse HIV suppression, and on top of that, these patients are widely excluded from clinical studies that test the next generation of cancer treatments.

"We hope our finding will lead to increased study of checkpoint inhibitors in patients with HIV and cancer," says Kim. He adds that the checkpoint inhibitors might not just keep cancer in check. "There are signals in this analysis and other studies that suggest these new cancer drugs may restore an immune response against HIV in patients whose immune system is exhausted by its long fight with HIV."

Checkpoint inhibitors work by removing the "brakes" that cancer puts on a natural immune response against tumors. Antiretroviral drugs target and block different stages of the virus' life cycle, preventing it from replicating.

Kim and his co-author, Michael Cook, MD, an internal medicine resident at MedStar Georgetown University Hospital, specifically found that checkpoint inhibitors offered similar objective response rates in treating non-small cell lung cancer (30 percent) and melanoma (27 percent) as has been found in non-infected cancer patients. Additionally, the inhibitor offered benefit in treatment of Kaposi's sarcoma, a cancer strongly linked to HIV infection for which there are not many effective treatment options. The objective response in this patient population was 67 percent.

Additionally, HIV patients did not experience increased side effects, compared to the norm, and HIV remained undetectable in 93 percent of patients (26 of 28) known to have undetectable viral load before treatment.

"And we found something that is really intriguing," Kim adds. "In six patients who had a detectable load of HIV in the blood before treatment, five had a decrease in their viral load after treatment. It could be that checkpoint inhibitors are helping to suppress HIV, though this finding needs to be verified in future studies."

To further investigate these findings, Georgetown will soon launch a clinical trial to test checkpoint inhibitor therapy as first-line therapy in lung cancer patients with HIV or viral hepatitis. "We will be able to look at what effects checkpoint inhibitor therapy has on both the cancer and the infection," Kim says.

Las Vegas, NV (Feb. 7, 2019) -- It is estimated that 3 million Americans live with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Currently, there are no cures for these diseases. For many patients, their disease impacts other areas of their health and well-being, including aspects of their reproductive and mental health.

Studies being presented at the Crohn's & Colitis Congress -- a partnership of the Crohn's & Colitis Foundation and the American Gastroenterological Association, in Las Vegas, NV, from Feb. 7-9 - highlights the need to treat the entire patient and reinforces the role of patient-provider communication.

UC patients and GI physicians disconnected on communication priorities

Study Titles:

* Discordance of Communication Priorities Between Healthcare Professionals and Patients with Ulcerative Colitis: Results of a Global Ulcerative Colitis Narrative Survey.
o J. Colombel, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, et al.

* Patient and Healthcare Professional Views on Emotional Health and Intimacy in Ulcerative Colitis: Results of Global Ulcerative Colitis Narrative Survey.
o D.T. Rubin, The University of Chicago Medicine, Inflammatory Bowel Disease Center, et al.

Significance: The Ulcerative Colitis (UC) Narrative is a global survey of patients and gastroenterology physicians aimed at identifying the impact of the disease and comparing and contrasting perceptions of UC burden and management approaches. Key findings:

- Among patients and physicians, symptom control is a high priority. However, patients are more likely than physicians to prioritize cancer risk, fatigue management and emotional impact. This disconnect reveals opportunity for physicians to be mindful of topics that are of greatest concern to the patient.

- The majority of patients consider their UC mentally exhausting. Thirty percent of patients wished their GIs better understood the effect of UC on their mental health and only 52 percent of patients felt comfortable discussing emotional concerns with their GI. The study shows that impact of UC on emotional health should not be underestimated.

Pre-conception counseling needed for IBD patients

Study Title: Infrequent Counseling by Physicians on IBD and Reproductive Health Issues Reported by Patients in Conjunction with Low CCPKNOW Knowledge Scores in an Educated Cohort.

* A. Rao, Gastroenterology and Hepatology, Stanford, Palo Alto, California, et al.

Significance: Male and female IBD patients, ages 18-45, were surveyed about their reproductive health and education experiences. Results show that both male and female patients considered not having a child due to IBD; the majority among them did not receive prior reproductive health counseling. The study also shows the majority of patients pregnant after diagnosis did not seek GI care pre-conception and many stopped or changed medications during pregnancy without consulting a physician. The study shows patients want to receive more education on pregnancy-related topics and the need for proactive counseling by gastroenterologists on IBD and reproductive health issues.

- Featured resource: IBD Parenthood Project (http://www.IBDParenthoodProject.org) and care pathway (https://www.gastrojournal.org/article/S0016-5085(18)35437-4/fulltext?utm_source=aga&utm_medium=hub&utm_campaign=ibd_parenthood_project&utm_term=ibd_pregnancy&utm_content=organic).

All abstracts accepted to the Crohn's & Colitis Congress will be published in Inflammatory Bowel Diseases® (the official journal of the Crohn's & Colitis Foundation) and Gastroenterology (the official journal of the American Gastroenterological Association) on Feb. 7.

Attribution to the Crohn's & Colitis Congress® is requested in all coverage.

WHAT:

Hyperglycemia, or increased glucose, is common in patients with acute ischemic stroke and is associated with worse outcomes compared to normal glucose levels. Doctors all over the world have debated whether intensive glucose management, which requires the use of IV insulin to bring blood sugar levels down to 80-130 mg/dL, or standard glucose control using insulin shots, which aims to get glucose below 180 mg/dL, lead to better outcomes after stroke. Primary results from the Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study provide a clear answer to that question.

The primary results show that intensive glucose management did not improve functional outcomes at 90 days after stroke compared to standard glucose therapy. In addition, intense glucose therapy increased the risk of very low blood glucose (hypoglycemia) and required a higher level of care such as increased supervision from nursing staff, compared to standard treatment. The findings will be presented at a plenary session at the International Stroke Conference in Honolulu on February 6, 2019 at 11:23 am HT/4:23 pm ET.

ANN ARBOR--It's long been known that couples HIV testing and counseling is an effective way to mutually disclose HIV status and link to health care--unfortunately, couples don't use it even though it's widely available.

Lynae Darbes, associate professor in the School of Nursing at the University of Michigan, wanted to change that, so she and her team developed an intervention designed to improve the likelihood that couples will decide to engage in HIV testing together.

The intervention, called Uthando Lwethu --"our love" in Zulu--took place in a rural area of South Africa in a province with the highest prevalence of HIV in the country. It worked, and of the 334 couples enrolled in their study, 42 percent of the experimental group chose to participate in couples HIV testing, compared to 12 percent of couples in the control group.

The idea was that providing relationship skills to couples would improve their communication and their relationship in general, and this would in turn improve their ability to talk about sex and HIV--as well as HIV testing.

The idea came about from Darbes' earlier work, in which she asked couples why they didn't do HIV testing together. Darbes conducted the research while at the University of California, San Francisco, and it was a partnership with the Human Sciences Research Council in Durban, South Africa.

"Many people talked about the importance of communication, but didn't know how to talk about HIV," she said. "It seemed like if we taught them more effective communication, they could discuss HIV and testing, and then they might be able to actually do it.

"What people haven't acknowledged is that we haven't factored in relationship dynamics as much as we should with HIV couples testing. HIV is a complicated conversation to have."

All couples received a group counseling session together, then were randomly placed into the experimental or control groups. The experimental group received an additional couples-based group session, in single-gender groups, followed by four single-couple counseling sessions. Topics included communication skills, intimate partner violence and HIV prevention. The control group only received the first group counseling, but after the study they were offered a condensed version of the couples counseling sessions.

In order to make testing and counseling easily available in the rural area, where health services are often hundreds of miles away, researchers took a mobile testing van to the study participants instead of asking them to travel. Since the area lacks health professionals and therapists, the study team trained laypeople to counsel the couples.

In addition to the higher couples HIV-testing rate, the experimental group also chose to test significantly sooner than those in the control group who tested together. At baseline, nearly 40 percent of the participants (both men and women) had never been tested for HIV, which surprised Darbes, considering the high rate of HIV in the area. Additionally, most couples had not disclosed prior HIV test results to partners.

The model could work well in any area with a dearth of health care clinics and clinicians, Darbes said. It could also be tailored to other health conditions like diabetes, weight control, etc.

"I think that general relationship conversations can cascade out into other health outcomes, and you can talk about issues and behaviors more easily if you improve your overall communication," Darbes said.

The next step is to apply for a grant to investigate ways to feasibly implement the counseling in a real-life community setting.

A smaller portion of fish and chips has been embraced by takeaway owners and customers, research has found and may well be healthier for us.

Experts led by Newcastle University worked with independent fish and chip supplier, Henry Colbeck to see whether people could be encouraged to eat a healthier size portion which led to the development of the Lite-BITE® box. Its smaller dimensions ensures a smaller portion of fish and chips coming close to 600 calories compared to an average fish and chip meal containing over 1,600 calories.

Henry Colbeck supplies fish and chip shops with Frozen-at-Sea fish, frozen foods, frying oils and packaging to over 2,500 fish and chip shops in the North of England and Scotland. Together with the academic team, they wanted to reduce obesity levels in the UK but decided they needed to tackle it in a different way by offering their customers a smaller portion size to consumers.

The work is published today in BMJ Open by researchers from Fuse, The Centre for Translational Research in Public Health involving Newcastle, Durham, Cambridge and Teesside Universities. It is funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR).

The research describes how takeaway owners were supported with a three hour session which highlighted the problem of excessive portion sizes, customers' desire to be more health conscious and have smaller meals. They were also supplied with promotional posters and business incentives of free packaging and customer loyalty points.

Encouraged by the findings, Henry Colbeck came up with the Lite-BITE® box to ensure a smaller portion meal that's closer to 600 kcal.

Lead author Louis Goffe, Research Associate at Newcastle University and member of Fuse, The Centre for Translational Research said: "I love fish and chips and this research aims to find a way that we can have our fish and chip treat - but less of it.

"We focussed on coming up with a solution which provides a healthier meal option but equally importantly works for the fish and chip shop owners. The sales show that there is a demand for smaller portion meals and we hope this will act as a template for others in the fast-food sector to follow."

Jackie Pearson, Head of Marketing at Henry Colbeck Limited said: "The Lite-BITE® boxes have been hugely popular and sales have continued to grow with over 250 shops now using the boxes and buying over 700,000 in the last year.

"We have national coverage to the UK fish and chip market through our two sister companies, Friar's Pride and VA Whitley. Combined, we have sold 12,000 cases of Lite-BITE boxes in 2018 which equates to 12,000,000 boxes."

A 600 calorie meal fits within Government nutritional guidelines for meal sizes and a meal of 5oz fish and 5oz of chips, fried in vegetable oil, is around 650 calories.

The research describes through sales, secret-shopper, customer surveys and interviews completed with 12 participating fish and chip shops that customers happily purchased the smaller portions and takeaway owners were happy to sell them.

Louis Goffe added: "The independent takeaway sector is one of the most challenging food sectors to work with to make changes. This research emphasises the importance of working with wholesale suppliers, who have a strong relationship with traders, to improve the health benefits of hot food takeaways - and Henry Colbeck have taken a lead in that, understanding the changing market and giving customers what they want, a lighter meal."

Fish and chip shop owner's perspective

David Pascoe, is director and co-owner of Green Lane Fisheries in South Shields. He said: "The Lite-BITE® box has been really popular, especially with older customers.

"A lot of customers don't like a full portion so we can put a smaller one in the box and it's really flexible.

"Some people can't eat a full portion or prefer a smaller one - and we've found they like the smaller size and then come back another time."

Researchers at the University of Waterloo have developed a new way to prevent and treat Chlamydia, the most common sexually transmitted bacterial infection in the world.

The new treatment differs from the traditional anti-biotic treatment as it is a type of gene therapy that is delivered via nanotechnology and is showing a 65 per cent success rate in preventing chlamydia infection on a single dose.

"As antibiotic resistance continues to develop, people may experience Chlamydia infections that cannot be treated through conventional means, which is causing increasing public health challenges," said Emmanuel Ho, a professor at Waterloo's School of Pharmacy. "If left untreated or if treatment takes an extended period of time it can lead to infertility and other reproductive issues so finding new ways to treat this common infection is important.

"As the Food and Drug Administration in the United States has recently approved the first siRNA-based drug for market, we're hopeful this kind of research will be able to be widely available in the future."

The new treatment created in Ho's lab targets Chlamydia infection by preventing the majority of bacteria from entering cells in the genital tract and destroying any bacteria that is able to penetrate a cell wall. The team was able to achieve this by using a small interfering ribonucleic acid (siRNA) to target a specific gene called PDGFR-beta in the female reproductive tract, which creates a protein that binds to Chlamydia bacteria.

"By targeting PDGFR-beta we're able to stop the creation of the protein that Chlamydia will use to enter genital tract skin cells," said Ho. "As a result, an incoming infection has fewer targets to latch onto and infection is less likely to occur."

If Chlamydia bacteria can bind to cells and enter them the nanomedicine treatment is designed to activate autophagy, a cellular process where infected skin cells are able to form a bubble around that bacteria and destroy it.

On its own, siRNA cannot enter skin cells to reduce PDGFR-beta expression and prevent Chlamydia binding. The new gene therapy uses a unique nanoparticle that enables siRNA to enter the cells, reduce Chlamydia's ability to bind and destroy invasive bacteria and prevent the disease from spreading.

Vitamin D has been found to speed up the clearance of tuberculosis (TB) bacteria from the lungs of people with multi-drug resistant TB, according to a study of 1,850 patients receiving antibiotic treatment, led by Queen Mary University of London.

Lead researcher Professor Adrian Martineau from Queen Mary University of London said: "Multi-drug resistant TB is on the rise globally. It's notoriously difficult to treat, and it carries a much worse prognosis than standard TB.

"Our study raises the possibility that vitamin D - which is very safe and inexpensive - could benefit this hard-to-treat group of patients by taking a novel approach to their treatment. By adding vitamin D to antibiotic treatment, we can boost the immune system to help the body to clear TB bugs, rather than relying on antibiotics on their own to kill the bacteria directly.

"This is a novel approach, as it contrasts with the conventional tactic of developing new antibiotics in an attempt to 'keep up' with the emergence of drug-resistant bacteria - an arms race that is proving hard for us to win."

The World Health Organisation estimates that 10.0 million people developed active tuberculosis in 2017, and that 1.6 million people died of this disease. Multi-drug resistant (MDR) TB is caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs, causing around 500,000 cases and 150,000 deaths per year worldwide. Existing antibiotic treatments for MDR TB are lengthy, costly and often toxic due to their serious side effects.

Vitamin D has shown potential in boosting the immune system, but randomised controlled trials of vitamin D in TB treatment have yielded conflicting results.

In the new study, published in European Respiratory Journal, the research team pooled data from 1,850 TB patients who took part in clinical trials of vitamin D in eight countries (the UK, Pakistan, Bangladesh, India, Indonesia, Mongolia, Republic of Georgia and Guinea Bissau). They then ran an analysis to see whether there were particular groups of patients who responded better to vitamin D than others.

When added to antibiotic treatment, vitamin D was found to accelerate TB clearance specifically in patients with MDR TB, even though no acceleration of TB clearance was seen when looking at the entire study population as a whole.

The vitamin D supplementation was also found to be safe at the doses administered, with no links to serious adverse events.

The researchers say these results illustrate the potential for so-called 'host-directed therapies' - treatments that boost the immune system - to improve outcomes in patients with drug-resistant bacterial infections.

The researchers caution that the analysis is not sufficient on its own to justify a clinical recommendation of the use of vitamin D in the treatment of MDR TB, as it is based on a relatively small number of participants. However, they say these results now provide a rationale to carry out new clinical trials to see if vitamin D really can benefit patients who are taking standard antibiotics for MDR TB.

The findings add to a growing list of health benefits for the 'sunshine vitamin'. While vitamin D is best known for its effects on bone health, previous studies by Queen Mary researchers have revealed its role in protecting against colds, flu, asthma attacks, and last month, that it can protect COPD patients from deadly lung attacks.

The article is available free with open access from the Journal of the American Geriatrics Society at https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15731

As we age, we become more likely to experience symptoms of depression. Research shows that depression's symptoms can be linked to a higher risk for death. Yet often, older adults' symptoms of depression may be missed by healthcare professionals.

What's more, symptoms of depression have been linked to heart disease and stroke in middle-aged and older adults. Researchers suggest that the depression-heart disease link could play a role in the increased risk of death among older adults who have symptoms of depression. There's also a known link between depression and deaths from cancer and falls in older adults. These connections might contribute to an increased risk of death for older adults, researchers suggest.

Since depression symptoms change over time, it's possible that studying those symptoms during an older adult's doctor visits could provide more information. To learn more, a research team designed a study to investigate the role depression symptoms play in an increased risk of death over time. The team also examined the role heart disease and stroke play in the link between depression symptoms and increased risk of death. Their study was published in the Journal of the American Geriatrics Society.

The researchers used information from the Three-City Study, a French study that investigated dementia, heart disease, and stroke in people aged 65 and older during five healthcare visits the participants made over 10 years.

At the start of the study, 16 percent of 9,294 participants had a history of heart disease. Most participants were around 73 years old; 37 percent were men.

About 23 percent of participants had symptoms of depression when the study began (28 percent of women and 13 percent of men). Almost 7 percent were taking medication for their depression. At three follow-up visits, the participants were tested again for symptoms of depression.

When the participants were monitored for depression symptoms at several visits over time, symptoms of depression were linked to an increased risk for death, including death from heart disease and stroke. However, those diseases explained only a small percentage of the deaths associated with depression symptoms over time.

The researchers said their study suggested that, for older adults living with depression, preventing heart disease may not be the only factor that will help prevent or delay death. Interestingly, antidepressants were not associated with an increased risk of death in this study.

Highlight

Certain practices in dialysis facilities related to managing fluid volume and low blood pressure during dialysis are important to patients' health and survival.

Washington, DC (February 5, 2019) -- A new study highlights the importance of regular and careful assessment of dry or target weight and fluid balance in patients undergoing hemodialysis. The study appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

In patients with kidney failure, dialysis helps remove excess fluid and waste products from the blood. This is important because too much fluid, or volume overload, can cause peripheral edema (swelling of legs) and breathlessness in the short-term, and hypertension (high blood pressure), left ventricular hypertrophy (enlargement of heart), and heart failure in the long-term. Removal of too much fluid, however, can cause cramps, abdominal pain, vomiting, and dizziness; and it can lead to intradialytic hypotension (acute drop in blood pressure during dialysis) which can cause damage to heart muscles and is associated with a higher risk of death.

Indranil Dasgupta, DM, FRCP (Heartlands Hospital, UK) and his colleagues compared the way patients' fluid volume was managed in different dialysis facilities and the effects this had on patient health.

Data were analyzed from 10,250 patients and 270 facilities across 12 countries in the DOPPS (Dialysis Outcomes and Practice Pattern Study). Medical directors of the dialysis centers were sent a questionnaire on fluid volume management of patients on hemodialysis, and the responses to 10 of the 29 questions, deemed most important by the researchers, were analyzed.

The researchers found that having a protocol that specifies how often to assess dry weight was associated with lower rates of all-cause and cardiovascular deaths. Routine postural (lying or sitting and standing) blood pressure measurement was associated with lower all-cause hospitalization and cardiovascular events. Routine use of lower dialysis temperature to prevent or limit intradialytic hypotension was associated with lower cardiovascular death.

The findings emphasize the importance of regular and careful clinical assessment of target weight and fluid balance in patients on hemodialysis.

"Dialysis units should consider how they can make sure every patient has their target weight assessed regularly, ideally before every treatment. This can be done by a doctor or nurse and should include careful measurement of blood pressure," said Dr. Dasgupta.

In an accompanying editorial, Andrew Davenport, MD, FRCP (Royal Free Hospital, UK) noted that the study raises numerous questions. "Answers to some of the subsidiary questions remain to be analyzed, and the responses analyzed so far open up further avenues that require greater exploration," he wrote.

How have stars and planets developed from the clouds of dust and gas that once filled the cosmos? A novel experiment at the U.S. Department of Energy's (DOE) Princeton Plasma Physics Laboratory (PPPL) has demonstrated the validity of a widespread theory known as "magnetorotational instability," or MRI, that seeks to explain the formation of heavenly bodies.

The theory holds that MRI allows accretion disks, clouds of dust, gas, and plasma that swirl around growing stars and planets as well as black holes, to collapse into them. According to the theory, this collapse happens because turbulent swirling plasma, technically known as "Keplerian flows," gradually grows unstable within a disk. The instability causes angular momentum -- the process that keeps orbiting planets from being drawn into the sun -- to decrease in inner sections of the disk, which then fall into celestial bodies.

Unlike orbiting planets, the matter in dense and crowded accretion disks may experience forces such as friction that cause the disks to lose angular momentum and be drawn into the objects they swirl around. However, such forces cannot fully explain how quickly matter must fall into larger objects for planets and stars to form on a reasonable timescale.

MRI experiment

At PPPL, physicists have simulated the hypothesized broader process in the laboratory's MRI experiment. The unique device consists of two concentric cylinders that rotate at different speeds. In this experiment, researchers filled the cylinders with water and attached a water-filled plastic ball tethered by a spring to a post in the center of the device; the stretching and bending spring mimicked the magnetic forces in the plasma in accretion disks. Researchers then rotated the cylinders and videoed the behavior of the ball as seen from the top down.

The findings, reported in Communications Physics, compared the motions of the spring-tethered ball when rotating at different speeds. "With no stretching, nothing happens to the angular momentum," said Hantao Ji, a professor of astrophysical sciences at Princeton University and principal researcher on the MRI and a coauthor of the paper. "Nothing also happens if the spring is too strong."

However, direct measurement of the results found that when the spring-tethering was weak -- analogous to the condition of the magnetic fields in accretion disks --behavior of the angular momentum of the ball was consistent with MRI predictions of developments in a real accretion disk. The findings showed that the weakly tethered rotating ball gained angular momentum and shifted outward during the experiment. Since the angular momentum of a rotating body must be conserved, any gains in momentum must be matched by a loss of momentum in the inner section, allowing gravity to draw the disk into the object it has been orbiting.

A new study finds rates are increasing for six of 12 cancers related to obesity in younger adults in the United States, with steeper increases in progressively younger ages and successively younger generations. The study, appearing in The Lancet Public Health, also looked at rates for 18 cancers unrelated to obesity, and found rates increasing for only two.

The obesity epidemic over the past 40 years has led to younger generations experiencing an earlier and longer lasting exposure to excess adiposity over their lifetime than previous generations. Excess body weight is a known carcinogen, associated with more than a dozen cancers and suspected in several more. Exposures to carcinogens during early life may have an even more important influence on cancer risk by acting during crucial developmental periods.

Several years ago, the authors of the current study identified increases in early onset colorectal cancer in the U.S., a trend that has been observed in several high-income countries and could partly reflect the obesity epidemic. They extended that analysis by examining recent age-specific trends in 30 types of cancers, including 12 known to be associated with obesity.

For the new study, investigators led by Hyuna Sung, Ph.D., analyzed twenty years of incidence data (1995-2014) for 30 cancers in 25 states from the Cancer in North America database provided by the North American Association of Central Cancer Registries, covering 67% of the population of the U.S. The authors say theirs is the first to systematically examine incidence trends for obesity-related cancers in young adults in the USA.

Incidence increased for 6 of the 12 obesity-related cancers (colorectal, uterine corpus [endometrial], gallbladder, kidney, multiple myeloma, and pancreas) in young adults and in successively younger birth cohorts in a stepwise manner. For example, the risk of colorectal, uterine corpus [endometrial], pancreas, and gall bladder cancers in millennials is about double the rate baby boomers had at the same age. In contrast, rates in successive younger birth cohorts declined or stabilized in all but 2 of 18 other, non-obesity related cancers, including smoking-related and infection-related cancers.

"Although the absolute risk of these cancers is small in younger adults, these findings have important public health implications," said Ahmedin Jemal, DVM Ph.D., scientific vice president of surveillance & health services research and senior/corresponding author of the paper. "Given the large increase in the prevalence of overweight and obesity among young people and increasing risks of obesity-related cancers in contemporary birth cohorts, the future burden of these cancers could worsen as younger cohorts age, potentially halting or reversing the progress achieved in reducing cancer mortality over the past several decades. Cancer trends in young adults often serve as a sentinel for the future disease burden in older adults, among whom most cancer occurs."

The authors say innovative strategies are needed to mitigate morbidity and premature mortality associated with obesity-related diseases, primarily by health-care providers and policy makers.