Body

New Haven, Conn. -- In-school nutrition policies and programs that promote healthier eating habits among middle school students limit increases in body mass index (BMI), a new study led by the Yale School of Public Health finds.

The five-year trial, conducted in conjunction with the Rudd Center for Food Policy and Obesity at the University of Connecticut, followed nearly 600 students from 12 schools in New Haven.

In schools with enhanced nutrition policies and programs, students had healthier body mass index trajectories (a measure of obesity) over time, and by the end of the study they reported healthier behaviors than their peers in schools without the nutrition policies and programs. Students in schools with enhanced support to implement nutrition policies had an increase in BMI percentile of less than 1%, compared with students in schools without enhanced support for these policies and programs who demonstrated increases of 3% to 4%. The study is published in the American Journal of Preventive Medicine.

"These findings can guide future school and community interventions. Childhood obesity is a serious health threat, and schools are a vital way to reach children and their families to reduce risks and promote health," said lead author Jeannette Ickovics, the Samuel and Liselotte Herman Professor of Social and Behavioral Sciences at the Yale School of Public Health. "These findings strongly support previous administration policies that provided healthier food for all children in public schools." These policies were rolled back last week by the U.S. Department of Agriculture.

The study is one of the first school-based policy intervention studies that followed students through middle school. The researchers analyzed both behavioral and biological indicators. Results are among the most compelling to date, said the researchers, perhaps because of the strong community-university partnership, and the recognition that health and academic achievement often go hand-in-hand.

"This is some of the strongest evidence we have to date that nutrition education and promoting healthy eating behaviors in the classroom and cafeteria can have a meaningful impact on children's health," said Marlene Schwartz, director of the Rudd Center and senior study author. "These findings can inform how we approach federal wellness policy requirements and implementation in schools to help mitigate childhood obesity."

The nutritional interventions in the schools studied included ensuring that all school-based meals met federal nutritional criteria; providing nutritional newsletters for students and their families; school-wide campaigns to limit sugary drinks and encourage the use of water; and limiting the use of food or beverages as rewards for academic performance or good behavior.

Researchers also tested whether a series of policies to promote physical activity would impact adolescent body mass index. They determined that the physical activity policies alone had little or no impact on body mass index.

In the study authors said that more than one in five American teenagers are currently obese, and as many as one in two are overweight or obese. Being overweight or obese early in life affects health across the lifespan, contributing to a range of chronic diseases such as hypertension, diabetes, and depression that reduce productivity and shorten life expectancy.

A new study reveals that during stressful moments in the operating room, surgeons make up to 66 percent more mistakes on patients. Using a technology that captured the electrical activity of a surgeon's heart, researchers found that during intervals of short-term stress, which can be triggered by a negative thought or a loud noise in the operating room, surgeons are much more prone to make mistakes that can cause bleeding, torn tissue, or burns.

The results of the study, published in the open branch of the British Journal of Surgery, could lead to the development of protocol aiming to reduce acute or short-term stress on surgeons working in the operating room. Medical errors cause between 250,000-440,000 deaths annually in the U.S., with a proportion of those mistakes occurring in operating rooms. Any change in common practice that reduces the number mistakes made by surgeons due to stress would also reduce the number deaths.

It's an important study published in a prestigious journal, and even more impressive is that its lead author, Peter Dupont Grantcharov, is a master's student at the Data Science Institute at Columbia University. A year and a half ago, Grantcharov had the idea to ask Dr. Homero Rivas, Associate Professor of Surgery at Stanford Medical Center, to wear a Hexoskin Smart Shirt under his scrubs while he did surgeries. The shirt, designed to give athletes precise physiological data during workouts, measures the electrical impulses that trigger heartbeats. From this data, Grantcharov derived heart-rate variability statistics ? the variation in times between heartbeats, to determine Rivas's momentary stress levels.

Grantcharov was also allowed in the operating room, where he collected laparoscopic video recordings of Rivas as he worked. Another researcher later reviewed the recordings and documented Rivas's mistakes using validated frameworks for assessing surgical performance. Both his stress levels and surgical errors were time stamped so that Grantcharov could correlate the two. This data yielded the somewhat alarming finding that the effect of short-term stress on surgical error is as high as a 66 percent increase.

"I was surprised by that, as well as by the amount of distractions in the operating room," says Grantcharov, who did the study while working as a research assistant at the Stanford Medical Center before enrolling at DSI. "Many machines have alarms that go off periodically, equipment malfunctions, side conversations take place, people walk in and out of the OR - I could go on. My hope is that other researchers will build upon our work to make further strides in learning about the causes of stress on surgical personnel. If our study helps make the OR a safer place for patients, I'd be thrilled."

Grantcharov was involved in designing the study, collecting and analyzing the stress and surgical performance data as well as writing the manuscript. It was his first experience with data science, and he loved it. In point of fact, this research is what prompted him to enroll in the master's program at DSI, where he just completed his first semester.

New Rochelle, NY, December 14, 2018--Breastfeeding for more than 6 months was found to be independently associated with smaller waist circumference in the decade after delivery among women in the POUCHmoms Study. Pregnancy contributes to an accumulation of abdominal adiposity, which is an indicator of cardiometabolic dysfunction in later life. The complete findings regarding the relationship between breastfeeding duration and maternal central adiposity are reported in an article published in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Journal of Women's Health website until January 14, 2019.

A total of 678 women from the Pregnancy Outcomes and Community Health (POUCH) cohort participated in the POUCHmoms Study 7-15 years after delivery. The researchers assessed the relationship between waist circumference measured at follow-up and self-reported history of breastfeeding duration. Propensity score approaches were incorporated into the study to account for systematic differences between women who did and did not breastfeed. The article, entitled "Breastfeeding Greater than Six Months is Associated with Smaller Maternal Waist Circumference Up to One Decade After Delivery" is co-authored by Gabrielle G. Snyder, MPH and colleagues from the Departments of Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh (Pennsylvania) and the Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University (East Lansing).

"This study provides important new information about the potential benefits of breastfeeding for more than 6 months for maternal health, specifically less central adiposity as measured by waist circumference," states Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health and Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA. "The novel use of propensity score methods enabled the researchers to minimize the possibility of bias in the likelihood of breastfeeding due to overall healthier lifestyles. Additional analyses that consider lifetime duration of breastfeeding are proposed in order to advance understanding of the cumulative effect of breastfeeding on maternal central adiposity."

Hope has emerged for patients with a serious type of bone marrow cancer as new research into a therapeutic drug has revealed improved outcomes and survival rates.

In the largest study of its kind, researchers at Newcastle University, UK, have led national research into the treatment of patients with newly diagnosed myeloma.

The results, published online today by The Lancet Oncology, show an improvement for those who received ongoing therapy with a drug called lenalidomide, compared to those not receiving it.

Improved outcomes

Findings of the study identified that long-term therapy with lenalidomide (also known as Revlimid®) doubles remission duration and also improves survival in younger patients by almost 8%.

Myeloma is a cancer of the plasma cells and it can affect several areas of the body, such as the spine, skull, pelvis and ribs. Current treatment usually involves chemotherapy and a stem-cell transplant.

Professor Graham Jackson, from the Northern Institute for Cancer Research at Newcastle University, and a Consultant Haematologist at Newcastle's Freeman Hospital, led the UK-wide study.

He said: "This is a major breakthrough as it shows that the long-term use of lenalidomide significantly improves the time myeloma patients stay in remission after initial therapy.

"It is a huge step and, importantly, identifies that for younger patients lenalidomide improves their overall survival for this difficult-to-treat bone marrow cancer.

"Our research highlights that lenalidomide should be considered for newly diagnosed patients following stem-cell transplantation."

Study's findings

The Myeloma XI seven-year study involved more than 4,000 patients in 110 hospitals in the UK and was funded primarily by Cancer Research UK, with support from Myeloma UK and a number of educational grants.

As part of the study, a total of 1,137 newly diagnosed patients were randomly assigned to lenalidomide maintenance therapy and 834 patients to observation - this was after they completed their initial treatment.

The results show that lenalidomide can prolong the average remission time by more than two years in younger patients and by well over a year in older, less fit patients. It reduced the risk of progression or death by more than 50% in both groups.

The trial was run through the Clinical Trials Research Unit at the University of Leeds and the research involved experts from hospitals around the UK.

Professor Gordon Cook, Clinical Director at the Leeds Institute of Clinical Trials Research at the University of Leeds, was a co-author of the paper and believes lenalidomide should be available on the NHS.

He said: "Our results confirm lenalidomide can significantly prolong the lives of people living with myeloma in the largest trial to date.

"This treatment is not yet available on the NHS for this group of patients and this represents an unmet need."

The results confirm the findings of three much smaller studies which showed that after stem-cell transplantation, lenalidomide reduces the risk of disease progression or death by 50% compared with placebo or no treatment.

Patient's story

Mother-of-one Sarah Williamson was given a shock diagnosis of myeloma three years ago.

The 41-year-old had suffered from back and shoulder pain for almost a year but believed it was a running injury and could never have imagined how her life would be turned upside down.

She had attended her doctors' surgery multiple times, but it was not until a birthday hug from her husband fractured a rib, and she was unable to get out of bed one morning, that the seriousness of her condition became clear.

Hospital scans and tests revealed that she had myeloma and Sarah was put under the care of Professor Graham Jackson at the Freeman Hospital.

She joined the Myeloma XI study and was randomly selected to receive lenalidomide following chemotherapy and a stem-cell transplant.

Sarah, who is married to Richard, 39, and has daughter, Annecy, six, is currently in remission and has no sign of the bone marrow cancer in her body.

The communications executive, from Darlington, said: "It was devastating to be diagnosed with myeloma. I had a young child, my health was in a bad way and I couldn't imagine feeling well again.

"When I was asked if I wanted to be part of the clinical trial I didn't hesitate to say 'yes' and I was delighted that I was randomly selected to get lenalidomide as I've responded very well to the drug.

"For patients to get an extra two years remission is fantastic and it's what every person with the condition hopes for as it means they can get their life back to as normal as possible.

"I have hardly any side effects of the treatment and all my pain is gone. I feel lenalidomide should be available on the NHS.

"When I meet people who have the condition and are not on the trial I feel a sense of injustice on their behalf as taking this drug has helped me get my life back and I am enjoying it to the full."

Sarah continues to be monitored by experts and gets regular check-ups and medical tests.

Mental health patients who have difficulty performing daily living tasks are four times more likely to experience discharge delays than someone who can perform those tasks independently.

In a recent study, researchers from the University of Waterloo found patients who had not been able to maintain or learn skills such as taking medication, preparing meals, or arranging transportation experienced discharge delays of more than 30 days.

"We found that impairment in functional, social or cognitive abilities often means that patients experience a delay in being discharged, suggesting their needs are not being served in the mental health care setting," said Jerrica Little, lead author of the study and PhD candidate at Waterloo's School of Public Health.

"These facilities don't usually provide rehabilitation interventions for social engagement and life skills training, so providing these services - and coordinating with community partners at the time of admission - could be key to reducing the rate of delayed discharges."

Other factors resulting in delayed discharges included moderate-to-severe cognitive impairment (almost twice as likely), middle and older age (2-3 times as likely), and being male or speaking a non-official language (1.4 times more likely).

"Delays in discharge can reduce the flow through the hospital and restrict access to mental health beds for persons with more acute needs," said co-author John Hirdes, professor in Waterloo's School of Public Health and Health Systems. "However, it also can have negative consequences that make it more difficult for those patients to return to the community. For that reason, we regard improvements in these functional indicators to be important markers of the quality of in-patient mental health care."

According to the Ministry of Health and Long-Term Care, it costs an average of $930 per day to stay in one of Ontario's four specialty psychiatric hospitals.

The researchers obtained and examined data from the Resident Assessment Instrument-Mental Health (RAI-MH), a comprehensive standardized mental health assessment tool, at the request of the Ontario Hospital Association, which had noticed a high rate of delayed discharges. A total of 76,184 inpatient cases from 68 psychiatric facilities between 2011 and 2013 were examined, and researchers found delays of more than 30 days in 2,074 cases.

Oral spray containing two compounds derived from the cannabis plant reduced spasticity compared with placebo in patients already taking anti-spasticity drugs.

Chemical compounds derived from the cannabis sativa plant given as an add-on treatment may help ease symptoms of spasticity (tight or stiff muscles), a major cause of disability and reduced quality of life in people with motor neuron disease, according to a phase 2 trial of 60 adults published in The Lancet Neurology journal.

The findings show for the first time that adults with motor neuron disease taking first-line anti-spasticity drugs who were then treated with an oral spray (nabiximols) containing equal parts delta-9 tetrahydrocannabinol THC and cannabidiol (THC-CBD) experienced less spasticity and pain at 6-week follow-up compared with those given placebo.

While there are several drugs to relieve spasticity, evidence for their effectiveness is scant and they do not sufficiently improve symptoms in all patients. Moreover, they can have undesirable side effects, such as increasing muscle weakness and fatigue. In the study, participants continued taking other medications throughout the trial.

"There is no cure for motor neuron disease, so improved symptom control and quality of life are important for patients," says Dr Nilo Riva from the San Raffaele Scientific Institute in Milan, Italy, who led the research. "Our proof-of-concept trial showed a beneficial effect of THC-CBD spray in people on treatment-resistant spasticity and pain. Despite these encouraging findings, we must first confirm that THC-CBD spray is effective and safe in larger, longer term phase 3 trials." [1]

Spasticity is a common symptom in motor neuron disease, a rapidly progressive, fatal neurodegenerative disorder affecting the nerve cells that control muscle movement (motor neurons). It occurs to a variable degree in people with amyotrophic lateral sclerosis (ALS), the most common and severe form of motor neuron disease, and is a defining characteristic of primary lateral sclerosis (PLS), that is rarer and progresses more slowly.

Previous research has found possible therapeutic benefits of cannabinoids (components of the cannabis plant) to include muscle relaxation, appetite stimulation, and pain-relieving, anticonvulsant, and anti-inflammatory effects in patients with other neurological conditions. Cannabinoids have been licensed in several countries for symptomatic treatment of spasticity in multiple sclerosis, and are increasingly recognised as a valuable option for the management of pain.

To investigate whether cannabinoids might also reduce spasticity in motor neuron disease, Italian researchers recruited 60 adults (aged 18-80 years) with ALS or PLS from four tertiary motor neuron disease centres in Italy. To participate in the study, patients had to have experienced spasticity symptoms for at least 3 months and be taking a stable dose of any anti-spasticity medication for 30 days before enrolment and throughout the study.

Participants were randomised to receive THC-CBD mouth spray (29 participants) or placebo (30) for 6 weeks. The number of sprays was gradually increased for the first 2 weeks of treatment until the optimum dose was reached, and then that dose was maintained for 4 weeks.

Change in spasticity was assessed by a physician who rated the spasticity of each participant's joints on the Modified Ashworth Scale (MAS)--an objective tool to evaluate intensity of muscle tone. Participants were also asked to keep a daily symptom diary on spasticity levels, pain, spasm frequency, and sleep disruption.

At the end of treatment (6 weeks), spasticity was significantly improved in the THC-CBD spray group compared with the placebo group (mean MAS-scores improved by an average 0.11 vs deteriorated by an average 0.16). Additionally, the number of participants treated with THC-CBD spray reporting an improvement was significantly higher compared with participants receiving placebo (55%; 16/29 participants vs 13%; 4/30). Finally, pain scores were significantly improved in the THC-CBD spray group compared with placebo on a 0-10 scale (-0.97 vs -0.06).

Overall, THC-CBD spray was well tolerated and adverse events were mild to moderate and typical of cannabinoids--asthenia (loss of energy and fatigue), somnolence (sleepiness), vertigo, and nausea. Twenty-one (72%) participants in the THC-CBD spray group and four (13%) in the placebo group reported at least one potentially treatment-related adverse event. There were no serious adverse events and no participants permanently discontinued treatment. However, three patients temporarily discontinued treatment in the THC-CBD spray group, two because of adverse events (one had nausea and anxiety and the other influenza), and one because of disease progression.

The authors note that an important limitation of the study was that the Modified Ashworth Scale has lacked sensitivity in studies assessing cannabinoids efficacy in multiple-sclerosis-related spasticity.

Writing in a linked Comment, Dr Marinne de Visser from Amsterdam University Medical Centre, University of Amsterdam, the Netherlands, says: "Before asking for approval of cannabinoids for symptomatic treatment of spasticity in patients with amyotrophic lateral sclerosis, further studies are needed to establish the frequency of spasticity in the various presentations of motor neuron disease, and also whether reductions in spasticity improve quality of life. Natural history studies including all subtypes of motor neuron disease and better outcome measures aimed at assessment of spasticity are required. Riva and colleagues' data are encouraging, and larger multicentre randomised controlled trials should be done to identify which subgroups of patients derive clinically significant benefits from nabiximols."

EVANSTON, Ill. --- Exercise has been called a double-edged sword for women when it comes to body image as some types of exercise seem to improve body esteem, whereas others have the potential to lower it.

In other words, from a psychological perspective, not all fitness approaches are created equal.

A new Northwestern University study found that while exercise, in this case, a 16-minute conditioning class, generally improved women's mood and body satisfaction, women felt even better if the instructor made motivational comments that focused on strength and health instead of on losing weight or changing the appearance of one's body.

"Our goal was to determine whether the psychological outcomes of a fitness class might vary based on whether the instructor made motivational comments based on health verses appearance," said Renee Engeln, lead author of the study and professor of instruction in psychology in the Weinberg College of Arts and Sciences at Northwestern.

After taking the class, women reported more positive emotions and felt more satisfied with the shape of their body if the instructor said things like, "This exercise is crucial to developing strength in the legs; these are the muscles that truly help you run, jump, sprint like a super hero!" Those randomly assigned to the class in which the instructor made appearance-focused comments like, "This exercise blasts fat in the legs, no more thunder thighs for us! Get rid of that cellulite!" didn't show those same improvements.

"We also asked the women to list three words that described how they felt at the end of class," said Engeln, author of "Beauty Sick" (HarperCollins, 2017). "Those who heard appearance-focused comments were much more likely to write things like 'ashamed' and 'disgusted with myself.' Those in the health-focused classes were more likely to write things like 'accomplished' and 'strong.'"

Engeln said the study is one more reminder that words really matter.

"The women in this study all did the same exercises, in the same room, with the same music playing," Engeln added. "Yet just modifying the script the fitness instructor used had a meaningful impact on the way they felt about themselves afterward.

"If we want people to stick with exercise, we need to remove shame from the equation. This study points to an easy and cost-free step that fitness instructors can take to make their classrooms healthier, more inclusive and more inspiring."

Philadelphia, December 12, 2018 - For men newly diagnosed with prostate cancer or patients previously treated, the risk of metastasis is a crucial determinant of whether to choose conservative management or undergo further treatment. For prostate as well as other cancers, primary tumor growth or spread is driven by amplifications or deletions of portions of the genome known as copy number alterations (CNAs). A report in The Journal of Molecular Diagnostics describes a new assay to assess CNAs that is cheaper, faster, reproducible, and requires less tissue than other diagnostic techniques and has the potential to significantly enhance prostate cancer evaluation.

Metastases occur in approximately 16 percent of prostate cancers and account for 8 percent of all male cancer deaths. Accurate prediction at the time of diagnosis can identify men at risk for metastasis who would benefit from aggressive therapy. Detection of CNAs in prostate tissue or blood can provide an indication whether previously diagnosed disease has progressed. The amplified and deleted genes represent novel targets for treating aggressive prostate cancer.

"We have demonstrated that CNAs can be detected rapidly and accurately with the new Next-Generation Copy Number Alteration (NG-CNA) assay. The impact of this information is two-fold: to assure aggressive therapy at the time of diagnosis for men with metastasis-prone disease and provide a rationale for active surveillance (and not overtreatment) for men with indolent disease," explained lead investigator Harry Ostrer, MD, of the Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA.

The NG-CNA assay is a targeted amplification sequencing technique that is able to analyze 902 genomic sites belonging to 194 genomic regions. Compared to array comparative genomic hybridization array (CGH), NG-CNA can process samples faster and decrease the cost per sample. "For example, with NG-CNA the cost of DNA extraction, library preparation, and sequencing reagents can be $20 to $40 per sample, compared to nearly $1000 for whole genome sequencing," said Dr. Ostrer.

In fact, "massively multiplexed assays, like the NG-CNA assay, provide an entry into personalized medicine applications at a fraction of the cost of traditional whole genome sequencing approaches," added first author Viacheslav Fofanov, PhD, of the School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, USA.

Another practical advantage of NG-CNA is that the results are easier to decipher than whole genome sequencing. The new assay allows hundreds to thousands of samples to be processed in a single run, with a typical turn-around time of 36 hours. Samples evaluated with the NG-CNA assay also require less data storage than whole genome sequencing. "This allows our approach to move from large reference laboratories to smaller, more resource-constrained independent laboratories as needed," added Dr. Ostrer.

A further benefit of the NG-CNA assay is that it can process smaller amounts of material (as low as 12.5 ng) than required by other techniques, allowing cell lines, surgical samples, and biopsies to be analyzed. The CNA approach also provides a single platform onto which other sequencing tests, such as companion diagnostic tests, can be incorporated.

In previous work, the researchers developed the metastatic potential score (MPS) as an indicator of metastatic potential, using data from other measurement techniques. They found the MPS to be highly predictive of prostate cancer, triple negative breast cancer, and lung adenocarcinoma metastases. In the current investigation, NG-CNA assay data were used to compute the MPS in 70 prostate cancer surgical research samples with known clinical outcomes, and the results were highly correlated with that of the Oncoscan CNV assay. In a separate group, clinical and analytical validity was found between surgical samples and matched biopsies run exclusively on the NG-CNA platform. An MPS threshold of 0.99 delineated high risk from low risk tumors.

"We believe the addition of the NG-CNA assay onto a standard cancer gene testing platform will augment personalized medicine by identifying aggressive tumors and genetic mutations that are predictors of response to targeted therapies," said Dr. Ostrer.

Researchers at Stanford University, Palo Alto, California, have created a noninvasive technology that detects when nerve cells fire based on changes in shape. The method could be used to observe nerve activity in light-accessible parts of the body, such as the eye, which would allow physicians to quantitatively monitor visual function at the cellular level. The study was published in the journal Light: Science and Applications. The work was funded by the National Eye Institute, part of the National Institutes of Health.

When nerves fire, there's a change in the electrical potential (trans-membrane voltage) in the cell. Current techniques for monitoring nerve activity are invasive - requiring either electrodes placed near the nerves or fluorescent markers inserted into the cell. But a new technique, developed by the Stanford team, instead takes advantage of a side-effect of that change in voltage. As the nerve cell fires, the cell's membrane temporarily becomes slightly stiffer, leading to a rounding of the cell's shape. These cell shape changes can be picked up by interferometric (phase) imaging, which senses alterations in the the light passing through the cell or being reflected from its surface.

Tong Ling, Ph.D., and colleagues in the lab of Daniel Palanker, Ph.D., at Stanford constructed an interferometric microscope equipped with a high-speed camera that collects 50,000 frames per second. This speed is important because the changes in cell shape are subtle, so there's very little signal compared to noise in the images. With high-speed imaging, the researchers can combine 50 frames together in chunks, averaging out the noise and increasing the strength of the signal. They also designed a novel algorithm that would detect informative regions (i.e. the parts of the cells that move the most) and boost the signal further.

"This nanometer-scale shape change is very difficult to see," said Palanker, "but with ultrafast quantitative phase imaging, it actually turns out to be visible."

Using a dish of cells that had been engineered to fire like neurons, the researchers compared their method to classic, electrode-based measurements of neurons firing. The recordings from their microscope precisely matched the electrical signals sensed by the electrodes.

The project is part of a larger collaboration funded through the NEI Audacious Goals Initiative for Regenerative Medicine, a program that aims to restore vision lost due to retinal injury or disease. The eventual goal of the project is to use this technology to detect signals passing through the optic nerve, or even signals from individual nerve cells in the retina. Direct monitoring of nerves in the eye will help researchers design and test new therapies to restore visual function.

"Our task in this joint grant was establishment of the basic facts--how fast and how much the cells move during action potential--and to devise the best technical strategies for the system to be then used in humans," said Palanker. "I think this paper will be a solid reference regarding mechanical effects in cells when they fire."

Moving forward, team members, including the grant's principal investigator, Austin Roorda, Ph.D., University of California, Berkeley, will determine how to use this technique with optical coherence tomography, a type of imaging technology commonly used to visualize the back of the eye.

"Non-invasive, all-optical, neural recording techniques like those being pioneered by Dr. Palanker and his team are very exciting because, unlike other methods, these can potentially be used in human eyes," said Roorda. "These developments give promise for a day when we can study retinal diseases in human on a cellular scale and evaluate the treatments to cure them."

New research on prostate cancer staging shows that PSMA-targeted PET/MRI performs equally as well as currently used predictive tools to determine the risk for advanced disease. The first-of-its-kind study, published in the December issue of The Journal of Nuclear Medicine, purports that whole-body imaging with 68Ga-PSMA-11 PET/MRI could be advantageous for physicians, as it offers information to guide treatment options for prostate cancer patients.

Accurate primary staging is imperative to develop individualized treatment strategies for those with prostate cancer. Currently, prediction tools--or nomograms--assess a variety of factors to determine risk of advanced disease: prostate-speci?c antigen value at diagnosis, Gleason score, and others. While these nomograms offer an estimate of probability, they do not specifically indicate the extent of disease, which can be obtained using molecular imaging.

To compare the performance 68Ga-PSMA-11 PET/MRI with clinical nomograms, researchers conducted a retrospective study including 73 patients. Each patient's risk for advanced disease was predicted using the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, the Partin tables and 68Ga-PSMA-11 PET/MRI. The staging predictions were then compared with histopathologic results, specifically, the prevalence of lymph node metastases (LNM), extracapsular extension (ECE) and seminal vesicle invasion (SVI).

In each of the three advanced disease types analyzed (LNM, ECE and SVI), 68Ga-PSMA-11 PET/MRI resulted in an equivalent positivity rate compared with the MSKCC nomogram and the Partin tables. On a patient base, the sensitivity and specificity for 68Ga-PSMA-11 PET/MRI were also comparable to that of the other methodologies for the three disease types. Overall, a trend towards higher prediction of the final T and N stages on a patient base was noticed for PSMA-targeted molecular imaging.

"Our results showed that PSMA-targeted PET/MRI performed equally well to established clinical nomograms for preoperative staging in high-risk prostate cancer patients and provided additional information on tumor location" noted Andrei Gafita, MD. "Translated into a clinical setting, the use of this imaging technique for preoperative staging might support treatment planning that may lead to improved patient outcomes."

INDIANAPOLIS - Sleep, pain, anxiety, depression, and low energy/fatigue (known collectively as SPADE for short) symptoms are extremely common, but often unrecognized and undertreated by primary care physicians. A new Regenstrief Institute study has found that patients want to tell their doctors about their symptoms and would be willing to do so via a formal reporting system, but patients are reluctant to report symptoms if they perceive busy clinicians will not use that information to improve care.

"Patients see both personal and clinical benefits in routinely completing questionnaires about symptoms they are experiencing," said Regenstrief Institute Research Manager Tasneem (Nina) Talib, Ph.D., lead author of the study. "While they understand that their doctors see a lot of patients, they don't want to feel like a number. They want their doctors to actually review and use the information they are providing."

"A Qualitative Study of Patients' Perceptions of the Utility of Patient-reported Outcome Measures of Symptoms in Primary Care Clinics" is published in the December issue of the peer reviewed journal Quality of Life Research.

"Patient reported symptoms are not routinely put into a patient's electronic medical record, and most EMR systems are not designed to include symptoms," said Regenstrief Institute Investigator Kurt Kroenke, M.D., senior author of the study. "The healthcare system spends a lot of money on lab and imaging test results, which we put into the patient's EMR; shouldn't we be valuing patient-reported symptoms enough to put them into that same record? Pain and other symptoms have scales assigned to them similar to measurements obtained from blood pressure cuffs which alert us to an increase or decrease.

"We -- health care systems and the doctors who work in these systems -- haven't figured out how to deal efficiently with symptoms. Some doctors want to know about symptoms but others don't see how they can work discussion and follow-up on symptoms into an already busy primary care visit," he said.

Dr. Kroenke is an internationally respected expert in symptoms. Over the past three decades, his research has focused on the management of pain and other symptoms by primary care physicians, initially examining unexplained medical symptoms. This focus has expanded to include underlying mental disorders, including depression and anxiety, that affect patient experience with symptoms. Faced with the difficulty of diagnosing these problems in primary care, he co-developed easy, valid and reliable measurement tools for depression and anxiety. These instruments, which have been translated into more than 100 languages, are used today in daily practice in most internists' offices and are the annual screening tool implemented by major healthcare institutions throughout the U.S. and Europe.

In the new study, 23 male and female patients (age 24 to 77 years) with one or more SPADE symptoms were interviewed about the use, implementation and visual display of formal, computerized patient reporting of symptoms.

Among the interview responses:

"I think they [formal surveys in which patients note their symptoms] are beneficial if they're being utilized. Every doctor should do this as a force of habit with every single patient on every single visit. But, if it's just a person checking some boxes and throwing it in my medical folder, and it's not being looked at or reviewed...sometimes I feel like a number, not an actual patient."

"I wouldn't necessarily recognize that I'm anxious, unless somebody asked me: Are you nervous? If I stop and think about it, well maybe I am. But if I don't, you know...most people are too busy to recognize what they're feeling. By looking at that [symptoms questionnaire] it does help me to stop and think. And if I did have that, then maybe I better mention this."

"In order to get them [patients] to understand the value of it, of filling out the information, the doctor needs to use it...I mean, why am I gonna fill it out if they're not gonna look at it?...I fill out the information, the doctor actually asked me a question about it. Wow! I see that as a motivating factor for filling out the information."

"Barriers exist and doctors shouldn't be blamed for not focusing on pain, depression and anxiety. They need efficient clinical strategies to deal with symptoms and reimbursement to pay for these strategies," said Dr. Kroenke, whose recent work focuses on what these optimal strategies might be and how they would function. "Extra time during the patient visit, getting nurses and other non-physicians involved, telecare, online and other self-management tools have the potential to help physicians help their patients deal with symptoms."

Researchers predict that death rates from cancer will fall in 2018 in Australasian countries and in Russia. However, a greater proportion of the population will die in Russia from the disease than in any of the other countries, mainly because of the large numbers of men who still smoke.

In a study published in the leading cancer journal Annals of Oncology [1] today (Tuesday), researchers led by Carlo La Vecchia (MD), Professor at the Faculty of Medicine, University of Milan (Italy), predict that 158,950 men and 137,810 women will die in 2018 in Russia, representing age-standardised rates of 158.5 men and 84 women per 100,000 of the population [2].

Out of the ten major cancers the researchers investigated, lung cancer accounted for the greatest number of deaths among Russian men (about 40,000), while about 9000 women are predicted to die from it - 39.7 men and 5.3 women per 100,000 of the population.

By contrast, in countries such as Australia, Israel and the Philippines 101, 95 and 84.5 men and 74.7, 76.5 and 70 women respectively per 100,000 of the population will die from any cancer in 2018. In Australia, for example, 4,970 men and 3,600 women are predicted to die from lung cancer in 2018 - 19.7 men and 13.65 women per 100,000 of the population.

Prof La Vecchia said: "There is an urgent need for further improvement in cancer prevention and treatment in Russia. Given the high lung cancer rates among Russian men, stopping smoking remains a priority there. This is particularly important among middle aged and elderly men who started smoking during the Soviet era.

"The comparatively low rates of cancer deaths in Australia are partly, but not only, due to its low lung cancer rates."

Prof La Vecchia and his colleagues from Italy, Switzerland and the USA collected data on total cancer deaths and deaths from ten major cancers (stomach, colorectum, pancreas, lung, breast, uterus and cervix, ovary, prostate, bladder and leukaemias) from the World Health Organization between 1970 and 2015 for the Russian Federation, Israel, Hong Kong, Japan, the Philippines, the Republic of Korea and Australia. They used these figures to make predictions for cancer deaths in 2018. The results of their research have public health implications, and are also relevant for the organisation of cancer management and care.

Although they predict that death rates from cancer will decline in all seven countries, the actual numbers of deaths will continue to rise because of the growing population of elderly people.

By looking at the number of deaths from cancer in 1993 and projecting the number of deaths that would have been expected in 2018 if deaths had continued at the same rate, the researchers estimated that a substantial number of cancer deaths have been avoided over that period: one million in Russia, 40,000 in Israel, 63,000 in Hong Kong, about 650,000 in Japan, 330,000 in Korea and 180,000 in Australia. There was no appreciable reduction observed in the Philippines.

"The Philippines had, and still have, low rates of deaths from cancer. These are partly influenced by under-registration of causes of death, particularly in the past. Even so, the low lung cancer rates in both sexes are probably real, reflecting past low smoking prevalence. Stomach cancer rates are also low," said Prof La Vecchia.

About 17.9 men per 100,000 of the Philippine population will die from lung cancer in 2018, and 2.1 per 100,000 from stomach cancer. Death rates among women are similarly low with 6.3 per 100,000 dying from lung cancer and 1.25 from stomach cancer.

The researchers found there were persistently high rates of deaths from stomach cancer in some of the other countries, despite declines in recent years. In Russia, 13.6 men and 5.8 women per 100,000 will die from stomach cancer; in Japan, 13 men and 4.8 women per 100,000 will die; and in Korea 10 men and 4 women per 100,000 will die.

A rise in cancers of the uterus (womb) and cervix is predicted for 2018 in Russia, Israel, Hong Kong and Japan; only a slight decrease is predicted for the Philippines. "In Russia and the Philippines this is probably due to inadequacies in cervical cancer screening, as these countries have comparatively high rates - 10.2 and 7.4 per 100,000 in Russia and the Philippines respectively versus less than five per 100,000 in the European Union," said Prof La Vecchia. "The other countries that have seen an increase have relatively low rates."

Out of the seven countries considered, the lowest cancer death rates predicted in men in 2018 were in the Philippines (84.6 per 100,000), and the lowest rates among women were in Korea (52.5 per 100,000). The greatest fall in death rates between 2012 and 2018 occurred in Korean men: the researchers predicted a 20% decrease.

Prof La Vecchia concluded: "Overall, we predict falls in death rates from cancer for 2018. However, these are less pronounced and have occurred later compared to the EU and USA. Mortality from lung cancer among women is low in Russia compared to the EU and North America, reflecting the low prevalence of smoking among Russian women, in sharp contrast with figures for Russian men. However, the rise in the lung cancer death rates among women aged 25 to 44 years in Israel is particularly worrisome. This underlines the need for urgent measures on tobacco control, particularly in countries like Russia with exceedingly high lung cancer rates in men."

Editor-in-chief of Annals of Oncology, Professor Fabrice André, Professor in the Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, commented: "The predictions made in this study by Carlo La Vecchia and his colleagues are important for policy-makers and health providers to help them to make plans for the future prevention and treatment of cancers. This study shows that there is still a lot of work to be done, particularly in Russia, on encouraging people to stop smoking and to prevent them starting in the first place."

Albuminuria is a renal disease that is found to be independently associated with cardiovascular and renal problems without any links to diabetes. In latest ESC/ESH guidelines, microalbuminuria has been related to hypertension-mediated organ damages. While studying its effects and treatment, it was suggested to include albumin-to-creatinine ratio in the routine workup evaluation of the hypertensive patient. Changes in albuminuria were considered to moderate prognostic value in routine evaluations. ACEIs and ARBs were prescribed in maximum tolerated doses due to its effect on renal hemodynamic and glomerular structure.

While the ACEIs and ARBs had some effect on the results, the new CCBs generation used in addition to the RAAS blockades had promising results. T-type and N-type CCB generations were preferred for treatment when available.

Researchers have also investigated the effects of different classes of antihypertensive drugs which, regardless of having a similar antihypertensive effect in other cases, had completely different effect on albuminuria with regards to each other. Hence, it was also advised that patients should use different antihypertensive drugs if their goal is to reduce albuminuria whilst maintaining blood pressure.

If the patient is affected with resistant hypertension, the use of thiazide or thiazide like diuretic is advised along with the use of a combination of RAAS blockers and different antihypertensive drugs. A multifactorial and early antialbuminuric treatment is suggested for patients even when albuminuria values are below the cut-off value for microalbuminuria. Along with treatment, low-salt intake is also advised for all hypertensive patients, especially those with albuminuria.

A review published in Neurology® explores novel approaches beyond the common amyloid that could slow or prevent Alzheimer's

Experts say combination therapy for Alzheimer's disease likely needed for better treatment outcomes, similar to heart disease and cancer

NEW YORK, NY, December 7, 2018: A scientific strategy that explores therapeutic targets based on the biology of aging is gaining ground as an effective approach to prevent and treat Alzheimer's disease, according to research published in the December 7, 2018 online issue of Neurology®.

A comprehensive review of the clinical trial landscape, including current agents being studied for the prevention and treatment of Alzheimer's disease (and other dementias), points to the need to develop and test drugs based on an understanding of the multiple effects of aging on the brain.

"Alzheimer's is a complex disease with many different factors that contribute to its onset and progression," says Dr. Howard Fillit, founding executive director and chief science officer of the Alzheimer's Drug Discovery Foundation (ADDF), senior author of the review paper. "Decades of research have revealed common processes that are relevant to understanding why the aging brain is vulnerable to Alzheimer's disease. New therapeutics for Alzheimer's disease will come from this understanding of the effects of aging on the brain."

The only approved medications for Alzheimer's disease relieve some symptoms but do not halt disease progression. New therapies that prevent, slow, or stop the disease are urgently needed to fight the growing Alzheimer's disease burden in the United States and around the world. And, aging biology provides numerous novel targets for new drug development for Alzheimer's disease, notes Dr. Fillit.

"Our success in fighting Alzheimer's disease will likely come from combination therapy - finding drugs that have positive effects on the malfunctions that happen as people age," says Dr. Fillit. "Combination therapies are the standard of care for other major diseases of aging, such as heart disease, cancer, and hypertension, and will likely be necessary in treating Alzheimer's disease and other dementias."

Increasing age is the leading risk factor for Alzheimer's disease, a progressive neurodegenerative disease that affects 5 million people in the United States and about 50 million globally. With a growing aging population, the Centers for Disease Control and Prevention projects the burden of Alzheimer's disease will nearly triple to 14 million people by 2060.

With aging, many biological processes go awry that have also been implicated in Alzheimer's disease. For example, as people age, they are more likely to have chronic systemic inflammation and neuroinflammation, which is associated with poorer cognitive function. Other aging malfunctions include impaired clearance of toxic misfolded proteins, mitochondrial and metabolic dysfunctions (associated with diabetes), vascular problems, epigenetic changes (changes in gene regulation without alterations in the DNA sequence), and loss of synapses (points of communication between neurons).

Later-phase (phase 3) trials are dominated by drugs targeting beta-amyloid and tau, the classic pathological hallmarks of Alzheimer's disease (of phase 3 trials, 52% are targeting amyloid or tau), but other strategies are gaining ground and are in phase 1 or 2 trials, according to the review paper.

Although therapeutic attempts to remove or decrease the production of beta-amyloid have been largely unsuccessful in altering the disease course of Alzheimer's disease, says Dr. Fillit, researchers learned important information from those clinical trials even if they didn't immediately result in treatments for Alzheimer's patients. And recent clinical trials suggest that problems with clearance of beta-amyloid may yet prove fruitful.

"It is currently not known if these classic pathologies (amyloid and tau) represent valid drug targets and if these targets alone are sufficient to treat Alzheimer's disease," says Dr. Fillit. "Targeting the common biological processes of aging may be an effective approach to developing therapies to prevent or delay age-related diseases, such as Alzheimer's."

Philadelphia, December 6, 2018 - A new systematic review of the literature comparing the sexual health of patients with cardiovascular disease (CVD) who attended cardiac rehabilitation (CR) with patients who did not, found that rehab attendance is associated with improved sexual function and sexual frequency. Published in the Canadian Journal of Cardiology, the study validates the benefit of exercise training and points to the need for more high quality research to better understand the role of counseling and other therapies in easing the sexual repercussions of a cardiac event. The investigators also conclude that more evidence is needed to clarify whether CR has an impact on sexual satisfaction, sexual activity resumption, and other aspects of sexual health.

"As patients live longer with chronic CVD, it is important to focus not just on clinical effectiveness of interventions, but also to understand how interventions affect patients' quality of life. We know that sexual activity is important to patients as it allows them to feel well and vital and close and connected with their partner. Evidence shows that patients with CVD suffer from decreased sexual activity due to physical limitations, medication side effects, and psychological barriers. Although CR has been shown to improve mortality and morbidity, this is the first review to explore its effects on sexual health outcomes," said lead investigator Karen L. Tang, MD, MSc, FRCPC, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

This comprehensive review of the published literature identified 341 potentially relevant published studies, of which 14 met criteria to be included in this investigation. A variety of sexual health outcomes were assessed, including sexual resumption after a cardiac event, sexual function (primarily relating to erectile dysfunction), sexual frequency, and sexual satisfaction. The results indicate that there may be potential benefits from CR on sexual outcomes. Of six studies pertaining specifically to sexual function, three showed improvement after CR, two showed mixed results, and one showed worsened sexual function. Interestingly, the effects on sexual health do not appear to depend on sex-specific counseling.

According to the investigators, CR may provide the perfect opportunity to address the sexual health of patients with CVD. Similar to assessing outcome measures, such as physical limitations and exercise capacity, it is important for physicians to ask about a patient's sexual health before and after CR attendance. In addition, the majority of CR programs in this review included lifestyle and risk factor reduction counselling components. Given their holistic nature, attendance in CR programs would also be a good time to address physical and psychological barriers to sexual activity.

The investigators also explore the question of whether exercise training in CR influences sexual health outcomes by increasing cardiovascular and muscle functioning. They identify this as a topic for further study.

"Understanding the importance of sexual health and the potential impacts that CR has on sexual outcomes are imperative in improving patient quality of life after a cardiovascular event. We need to more effectively examine how CR might be used and innovated to improve quality of life outcomes like sexual health," commented Dr. Tang.

Noting that the National Institutes of Health's Obesity-Related Health Interventions Trial (ORBIT) framework responds to well-defined needs, the investigators suggest conducting an assessment of physical and psychological barriers to sexual activity in CVD patients before and after an intervention. This view is echoed in an accompanying editorial by Claudio Gil Soares de Araújo, MD, PhD, Exercise Medicine Clinic - CLINIMEX, Rio de Janeiro, Brazil. "Whether sexual counseling should become a formal part of a comprehensive CR program, and if so, how should it be implemented, are still under debate. However, health professionals, and in particular, cardiologists, should be aware of the need to discuss and offer prompt and adequate advice regarding sexual life for patients with heart disease. This could be carried out by the CR team or, if felt appropriate, by referral to a professional specialist in sexuality."