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Cardiovascular calcification is a major health concern in patients with kidney failure undergoing haemodialysis. A first-time-in-human clinical trial of an investigational calcification inhibitor has generated promising results in terms of safety, tolerability, and pharmacokinetics. The findings are published in the British Journal of Clinical Pharmacology.

The drug, called SNF472, is being studied in additional clinical trials, using various doses and dosing schedules. A phase 1b study was completed in 2016, evaluating the safety, tolerability, and pharmacokinetic and pharmacodynamic activity of SNF472 at repeated dosing in haemodialysis patients. A phase 2 proof of concept study in calciphylaxis patients undergoing haemodialysis was successfully finalized in early 2018, suggesting a positive effect of SNF472 on wound healing and pain in this very ill patient population. A 270-patient, phase 2b, randomized, placebo-controlled study is evaluating the effect of SNF472 in attenuating cardiovascular calcification over 1 year in haemodialysis patients.

"We are very proud of this first-in-human trial, which reveals a linear and predictable pharmacokinetic behavior and strengthens the excellent safety profile of SNF472", said senior author Dr. Carolina Salcedo, of Laboratoris Sanifit, in Spain.

"This study is just the first step of an ambitious clinical development program with SNF472 to address severe unmet medical needs in patients who suffer from the devastating consequences of accelerated cardiovascular calcification. We are hopeful that in the near future this experimental drug will be available to calciphylaxis and haemodialysis patients", added senior author Dr. Joan Perelló, also of Laboratoris Sanifit.

Researchers have discovered a new use for an old drug as a potential treatment for prostate cancer. The findings are published in the journal The Prostate.

Since the 1940s, androgens have been linked to prostate cancer, and decades of work since have focused on androgen receptor (AR), a nuclear receptor transcription factor. Although AR drives prostate cancer, inhibiting it induces remission for only a short time. Investigators have found that a drug approved for the treatment of amyotrophic lateral sclerosis--called riluzole--promotes the degradation of AR through a distinct pathway.

The findings suggest that riluzole should be investigated clinically for prostate cancer and predict that it may be effective for both early stage and advanced disease," said senior author Dr. Shahriar Koochekpour, of Roswell Park Comprehensive Cancer Center.

Previous studies on the association between blood levels of vitamin D and survival have come from high-income countries. A new Geriatrics & Gerontology International study has now found that vitamin D insufficiency is linked with earlier death in community-dwelling Thai older men.

The study included 1268 adults with a median age of 74 years from the Thai 4th National Health Examination Survey carried out in 2008. Participants were followed and linked to a vital registry in 2015.

Vitamin D insufficiency was associated with a 77% higher risk of dying during follow-up among men, but there was no increased risk in women.

Also, the risk in men was only significant in those who were diabetic. "Cardiovascular disease may be the link between vitamin D insufficiency and risk of death in diabetic older male," said co-author Dr. Chalermsri Chalobol, of Mahidol University, in Bangkok.

New findings suggest that diet is a major contributor for the increased risk of hypertension in black compared to white Americans. The results, published in the Journal of the American Medical Association, are part of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which looks at the incidence of stroke in approximately 30,000 individuals. The study is funded by the National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health.

"This study addresses a lead cause of racial disparity in mortality and identifies potential lifestyle changes that could reduce racial disparities in both stroke and heart disease," said Claudia Moy, Ph.D., NINDS program director and one of the study authors.

In the study, led by George Howard, Dr.P.H., a biostatistics professor at the University of Alabama at Birmingham, researchers studied individuals over the age of 45 over a period of 10 years and looked to identify risk factors associated with the higher likelihood of developing high blood pressure in the study participants.

"The majority of disparities we see in the health of black versus white Americans are cardiovascular in nature," said Dr. Howard, "and of these, all are tied to an increase in high blood pressure."

For both men and women, a diet composed of high amounts of fried and processed foods and sweetened beverages was the greatest factor associated with why blacks are at a greater risk of developing high blood pressure compared to whites. For both men and women, other important factors included salt intake and education level. For women, additional factors contributing to the racial difference in high blood pressure included obesity and waist size.

"One of the main factors affecting the difference between the black and white population is cardiovascular disease, and the increased risk of high blood pressure among black Americans could help explain why their life expectancy is four years shorter than that of whites," said Dr. Howard. "Understanding how we can prevent this increased risk of hypertension in blacks is critical for reducing health disparities among the black population."

The researchers hope that these findings could be applied to reduce the prevalence of hypertension and thus the risk of stroke and heart attack in the black American population. This study suggests that lifestyle changes, particularly changes in diet, could help reduce the disparities seen in black versus white Americans.

"The best way to treat high blood pressure is to prevent it from occurring in the first place," said Dr. Howard.

The REGARDS study includes more than 30,000 black and white Americans, approximately half of whom live in the Stroke Belt, an area in the southeastern United States where the rate of stroke mortality is higher than the rest of the country. Of these, 6,897 participants, 1,807 black and 5,090 white, were analyzed for this study.

In 2016, the NINDS launched a stroke prevention campaign called Mind Your Risks, which is designed to educate people aged 45-65 about the link between uncontrolled high blood pressure and the risk of having a stroke or developing dementia later in life.

New research presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) in Berlin looks into the rising prevalence of both obesity and type 2 diabetes (T2D) around the world and estimates the population that will likely be affected by both conditions over the coming decades.

The research conducted by University College London, Steno Diabetes Centre Copenhagen and Novo Nordisk, studied past trends as a guide to predicting the regional prevalence of obesity and T2D from 2017 to 2045. The study was commissioned by Cities Changing Diabetes, a partnership programme established to improve the understanding of diabetes in urban settings.

Around the world, obesity and T2D are rising at an alarming rate, and while T2D is a complex condition influenced by multiple diverse factors, the one that is most significant, and also modifiable, is excess bodyweight.

There are currently around 650 million obese people around the world, and more than 400 million individuals living with diabetes. In support of the World Health Organization (WHO) Global Target 7* "Halt the rise in diabetes and obesity", the authors have previously demonstrated that stabilising the number of people living with diabetes at 10% of the world's population will require a 25% reduction in the prevalence of obesity. Should this be achieved, a staggering 111 million cases of diabetes would be prevented.

In this study, the team have produced two sets of predictions, one based on a past trend scenario in which rates of obesity and T2D follow existing trends and continue to rise, and another target scenario which assumes that the goal of reducing obesity prevalence by 25% by 2045 is achieved.

The authors obtained BMI data for all the countries in the world covering the years 2000 to 2014 from the Non-communicable Disease Risk Factor Collaboration. The adult population of each country was then split into groups by age and body mass index (BMI), and a projection of the share of people in each BMI class was calculated based on the past trend and the target scenario of reduced obesity. The risk of developing T2D at different ages and BMIs were then applied to the data to estimate diabetes prevalence for each country and scenario in 2045. (for individual country info, please contact the authors details below)

The study found that the North America and Caribbean region has the highest current rates of obesity and T2D (35.7% and 13.2% respectively), and will continue to do so in 2045 in both past trend (51.5% and 16.8%) and target scenario (26.8% and 13.1%) outcomes. If the target scenario can be achieved, it will result in 15.3 million fewer people in the region developing diabetes than if the past trend continues.

Currently the lowest rates of T2D are found in Africa with just 3.3% of the population having the disease, despite a moderate obesity rate of 9.0%. This pattern is projected to continue to 2045 in both past trend (16.4% obesity rate, 4.2% T2D rate), and target (6.4% and 3.5% respectively) scenarios. The authors estimate that 7.2 million people in Africa could avoid acquiring T2D if obesity prevalence can be reduced by 25% by 2045.

In South-East Asia, the pattern is reversed, with the lowest current regional obesity rate of just 4.0% despite a relatively high prevalence of T2D (8.7%). The study suggests that this trend will also continue through to 2045 resulting in past trend (7.9% obesity rate, 12.0% T2D rate) and target (3.1% and 10.7% respectively) scenarios in which achieving the goal of a reduced obesity rate would result in 17.1 million fewer cases of T2D.

The authors note that the proportion of people with T2D who are also obese differs substantially among regions. In North America and the Caribbean 60% of individuals with T2D are obese, while the figure in South-East Asia is just 10%.

The authors say: "North America and the Caribbean and Europe where obesity has been on the rise for decades have the highest T2D prevalence but also the slowest future increases."

They add: "In regions with lower T2D prevalence like Africa, the number of people with T2D will increase up to three-fold in the coming three decades unless obesity prevalence is reduced."

They conclude: "To realise the target scenario, health should be integrated into all policies in order to contribute to reduce the obesity and T2D burden. Not doing so represents a lost opportunity to improve people's health, well-being and economic productivity."

Exercising at least three times a week for six months reduced stress in a group of family caregivers and even appeared to lengthen a small section of their chromosomes that is believed to slow cellular aging, new UBC research has found.

"I am hoping that a new focus on the family caregiver will emerge out of this research," said Eli Puterman, a professor in the University of British Columbia's school of kinesiology and lead author of the study. "We need to design interventions that help caregivers take care of their bodies and their minds, and provide the type of support that's needed to maintain that long-term."

The population of seniors in the U.S., where Puterman and colleagues from the University of California conducted the study, is expected to nearly double by 2050. Younger family members will increasingly be providing this type of care and it can take a toll on their health.

"What caregivers need is support for healthy behaviours, because that is one of the first things to drop when you become a family caregiver," said Puterman. "The time to take care of yourself just goes out the window."

The researchers recruited physically inactive people who care for family members with Alzheimer's disease and dementia, and who reported feeling high levels of stress. The 68 participants were divided randomly into two groups. One group undertook 40 minutes of aerobic exercise three to five times per week, while the others were asked not to alter their level of activity. Those in the exercise group had free access to a gym, and a fitness coach for weekly conversations. Eighty-one per cent of them adhered to at least 120 minutes of exercise per week for the duration of the study.

At the end of the study, not only had the caregivers improved their cardiorespiratory fitness, reduced their body mass index and trimmed their waistlines, they also reported lower levels of perceived stress.

At the cellular level, the researchers observed longer telomeres in the participants' white blood cells after the program. Telomeres protect the ends of chromosomes, much like the aglets that protect the ends of shoelaces. Without them, chromosomes shorten to the point where they either die or enter a state called "senescence," in which they stop replicating. Senescent cells have been shown to be predictive of future health problems such as cardiovascular disease.

The study's findings suggest that in addition to reducing stress, exercise can slow or even reverse telomeric aging in a highly stressed, at-risk group.

The research will be published in an upcoming issue of Psychoneuroendocrinology.

LOS ANGELES - Oct. 2, 2018 - Heart experts have long believed that weekday mornings - and especially Mondays - were the danger zones for unexpected deaths from sudden cardiac arrests. But a new Cedars-Sinai study shows those peak times have disappeared and now, sudden cardiac arrests are more likely to happen on any day at any time.

"While there are likely several reasons to explain why more cardiac arrests happen outside of previously identified peak times, stress is likely a major factor," said Sumeet Chugh, MD, professor of medicine and associate director of the Smidt Heart Institute at Cedars-Sinai. "We now live in a fast-paced, 'always on' era that causes increased psycho-social stress and possibly, an increase in the likelihood of sudden cardiac arrest," said Chugh, the primary investigator on the study, published in the peer-reviewed journal Heart Rhythm.

Chugh's team of investigators analyzed data from the community-based Oregon Sudden Unexpected Death Study between 2004 to 2014. All reported cases were based on emergency medical service reports containing detailed information regarding the cause of the cardiac arrest.

Key findings include:

Of the 1,535 patients who died from sudden cardiac arrest, only 13.9 percent died in the early morning hours between 6 - 10 a.m.

There was no evidence that more sudden cardiac arrests occurred on Mondays.

Aside from stress, other contributing factors may be a shift in how high-risk patients are being treated, as well as inadequacies in how past studies have measured time of death caused by sudden cardiac arrest (such as using time of death found on a death certificate versus time of death when sudden cardiac arrest actually occurred).

Although "sudden cardiac arrest" and "heart attack" often are used interchangeably, the terms are not synonymous. Unlike heart attacks (myocardial infarctions), which are typically caused by clogged coronary arteries reducing blood flow to the heart muscle, sudden cardiac arrest is the result of defective electrical activity of the heart. Patients may have little or no warning, and the disorder usually causes instantaneous death. Sudden cardiac arrest accounts for approximately 300,000 deaths each year in the U.S.

The Oregon Sudden Unexpected Death Study is a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the 1 million population Portland, Oregon, metropolitan area. Led by Chugh, the project - now ongoing for more than 15 years - provides researchers with unique, community-based information to help determine the causes of sudden cardiac arrest.

"Because sudden cardiac arrest is usually fatal, we have to prevent it before it strikes," said Chugh, the Pauline and Harold Price Professor of Cardiac Electrophysiology Research. "This is just another piece to the puzzle. Our next steps are to conclusively determine the underlying reasons behind this shift, then identify public health implications as a result."

In North America, 20 to 25 percent of women and 18 to 21 percent of men of reproductive age report daily psychological stress. Although previous research has suggested that stress can decrease the odds of conception, few studies have examined this association among couples from the general population.

Now, a new study led by Boston University School of Public Health (BUSPH) researchers finds higher levels of stress are associated with lower odds of conception for women, but not for men.

The study was published in the American Journal of Epidemiology.

"Although this study does not definitely prove that stress causes infertility, it does provide evidence supporting the integration of mental health care in preconception guidance and care," says BUSPH doctoral student Amelia Wesselink, the study's lead author.

The researchers used data from the Pregnancy Study Online (PRESTO), an ongoing preconception cohort of North American pregnancy planners that follows couples for 12 months or until pregnancy, whichever comes first. For the new study, the researchers followed 4,769 women and 1,272 men who did not have a history of infertility and had not been trying to conceive for more than six menstrual cycles.

The researchers measured perceived stress using the 10-item version of the perceived stress scale (PSS), which is designed to assess how unpredictable, uncontrollable, and overwhelming an individual finds their life circumstances. The items referred to the past month, with five response choices ranging from 0 (never) to 4 (very often), up to a total of 40, with a higher total score indicating a higher level of perceived stress. Both partners completed the PSS at baseline, and women also completed the PSS at each bi-monthly PRESTO follow-up. The baseline questionnaires also included a range of demographic and behavioral factors, including race/ethnicity, household income, diet, sleep, and frequency of intercourse.

On average, baseline PSS scores were about 1 point higher among women than men, and the average follow-up PSS scores among women remained fairly constant over the 12 months that they participated in the study.

The researchers found women with PSS scores of at least 25 were 13 percent less likely to conceive than women with PSS scores under 10. This association was stronger among women who had been trying to conceive for no more than two menstrual cycles before joining PRESTO than among women who had been trying for three or more cycles before enrolling. The association was also stronger among women under 35 years old.

The researchers found that, if the link between higher levels of stress and lower odds of conception is a causal association, a small proportion of that association could be due to decreased intercourse frequency and increased menstrual cycle irregularity.

The researchers did not find an association between men's PSS score and the likelihood of conceiving. However, couples in the study were about 25 percent less likely to conceive when the man's PSS score was under 10 and the women's was 20 or higher. The authors wrote that this is the first study to suggest that "partner stress discordance" may affect the likelihood of conception, although the finding was imprecise and speculative.

New research presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) in Berlin, Germany, reveals that the use of diuretic drugs in individuals with type 2 diabetes (T2D) is associated with a significantly increased risk of serious problems in their lower limbs which can lead to amputation.

The research was conducted by Dr Louis Potier, Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France, and colleagues. The aim of the study was to analyse the association between diuretic use and the risk of what are known as lower limb events (LLE) in patients with T2D. These events include lower extremity amputations (LEA), and lower limb revascularisations (LLR) such as angioplasty or the bypassing of blocked or damaged blood vessels to prevent amputations.

Recently, it has been observed that individuals with T2D who take canagliflozin, a member of a relatively new type of diabetes drug called an SGLT2 inhibitor, to reduce their blood glucose are at an increased risk of undergoing limb amputations. The authors suggest that this side effect may be caused by drug-induced hypovolaemia (decreased blood volume), and that if this is the case, then diuretics should also increase amputation risk as they have a similar effect.

The team drew their data from SURDIAGENE; a French observational cohort which includes T2D patients enrolled from 2002 until 2012. Participating subjects were followed up until whichever came first out of the onset of LLE, death, or 31 December 2015. There were 1459 studied participants of whom 670 were taking diuretics. During a follow-up period which averaged 7 years, LLE occurred in 85 (13%) of diuretic users and 57 (7%) of non-users.

To better account for difference in characteristics of patients taking or not diuretics, the authors used a propensity score matching approach by matching each patient using diuretics to a comparable non-user patient. Among the 1074 patients included in the matched cohort, those using diuretics had an almost doubled risk (75% higher) of LLE than non-users. These data were analysed further and revealed that there was a large increase in the risk of LEA (2.3 times greater in diuretic users than non-users), and while LLR showed a small increase (1.3 times greater in users), this result was not statistically significant.

The authors conclude: "Among patients with type 2 diabetes treated with diuretics, there was a significant and independent increase in the risk of lower limb events, coming predominantly from a rise in lower extremity amputations. Diuretics should be used cautiously in patients with type 2 diabetes at risk of amputations."

They add: "Further studies are needed to explore the role of drug-induced hypovolaemia in the association between the use of diuretics and LLE. The hypovolaemia hypothesis could provide an explanation for the increased risk of LEA observed with SGLT2 inhibitors."

Attendance at a nursery/crèche staffed by professionals may be linked to better psychological development than being looked after by family/friends or a childminder in early childhood, suggests research published online in the Journal of Epidemiology & Community Health.

It may be associated with lower odds of poor social skills, difficult relationships with peers, and behavioural issues, particularly if attendance lasts a year or more, the findings indicate.

Previous evidence suggests that early childcare may boost a child's language and thinking skills, and possibly academic prowess. But the jury is still out on its potential impact on behaviour.

To explore this further, the researchers drew on data for 1428 children taking part in a French study(EDEN) looking at the factors involved in childhood health and development.

In France, formal childcare provision is widespread, of good quality, and open to all. Most children (97%) start school by the age of 3, making it a good setting to look at the potential impact of different types of early childcare on development, say the researchers.

They tracked children's emotional development from birth up to the age of 8, using responses to a validated questionnaire (Strengths and Difficulties Questionnaire), completed by parents when the children were 3, 5.5, and 8 years old.

The questionnaire includes 25 items, focusing on behavioural and emotional problems, including difficulties making friends, hyperactivity/inattention, conduct, and social skills.

When their children were 4, 8, and 12 months old, and again when they were 2 and 3 years old, parents were also asked what type of childcare had been provided up to the age of 3: formal (nursery, day care centre, crèche staffed by professionals); informal (provided by family/friends); or childminder.

Some 636 (44.5%) children had been in the care of a childminder; nearly one in four (just under 26%, 367) had attended formal care; while nearly a third (just under 30%, 425) had been cared for by family/friends.

Overall, 15.5 per cent of the children had persistently high levels of conduct problems; just over 15 per cent were hyperactive/had low attention spans; 16 per cent had emotional issues; just under 7 per cent found it difficult to make friends with their peers; and just over 13 per cent had poor social skills.

Analysis of the data showed that compared with children who had been looked after by family/friends, those who received formal care were less likely to have emotional and behavioural problems, and more likely to have better social skills.

Those who had been looked after by a childminder were more likely to have behavioural issues.

Children who attended a nursery/crèche/day care centre for a year or more had even lower odds of emotional issues, difficulties making friends, and poor social skills.

Overall, children whose mothers had gone to college or university and/or whose mothers weren't depressed seemed to benefit the most from formal childcare.

And girls seemed to get more out of formal childcare than boys, possibly, suggest the researchers, because formal childcare is associated with less internalising behaviour, which is more common in girls.

Compared with boys in receipt of informal care, boys in receipt of formal care had fewer emotional problems, but those looked after by a childminder had more behavioural problems.

This is an observational study, and as such, can't establish cause, added to which the families studied were better educated and more affluent than the average for France. Nor were the researchers able to assess the quality of, or time spent in, a particular type of childcare.

Nevertheless, they suggest that, overall, the low levels of emotional symptoms, relationship issues, hyperactivity/inattention observed among children who had attended nurseries/crèches/day care centres might reflect a combination of the mental stimulus derived from play, praise, and reading, along with rules to follow, and quality child-caregiver interactions.

And they conclude: "Access to high quality childcare in the first years of life may improve children's emotional and cognitive development, prevent later emotional difficulties and promote prosocial behaviours."

But future research will be needed to find out whether these benefits translate into a lower risk of psychiatric disorders in later life, they caution.

Expanding public funding for cost-effective treatments, investing in primary care, embracing technology and engaging patients are some of the ways Canada can improve the quality of health care, according to an analysis in CMAJ (Canadian Medical Association Journal).

"The quality of health care in Canada is good, but arguably not great," write Drs. Irfan Dhalla and Joshua Tepper of Health Quality Ontario. "With thoughtful change, we could all benefit from a health care system that provides safe, timely, effective, efficient, equitable and patient-centred care at every opportunity."

The article looks at the quality of health care in Canada and outlines strategies to improve it at the system level.

"We generally focus our attention at the national level; inevitably, this obscures important differences within Canada, between provinces and territories, and also between groups (e.g., Indigenous peoples and non-Indigenous Canadians)," write the authors. "Also, although we focus here on health care, this does not diminish the importance of income, housing, education, social networks and other determinants of health."

The authors suggest the following to improve care:

Expand public funding for treatments shown to be cost-effective -- for example, funding psychotherapy for people with depression

Invest in primary care - there is still a gap in primary care, and efforts should move beyond payment reform alone to improve this important area

Use electronic information systems that help doctors work together -- growing evidence speaks to the benefits of health care records that can be accessed by patients and physicians alike

Engage patients to help determine what services should be offered -- for example, patients at a large Ontario family practice clinic suggested new ways to improve services that staff had not considered

Standardize and embed quality-improvement tools, such as guidelines -- this will help standardize practice and reduce variability based on clinical knowledge or available resources

Improve transparency

Ensure meaningful involvement of physicians -- decision-makers should involve physicians early in efforts to improve health care

Ensure health education supports high-quality care

Support wellness of health care professionals

The authors hope that decision-makers will consider these suggestions as a way forward for improving health care quality in Canada.

A large study conducted over 42 years in Shanghai -- China's largest city -- indicates that socioeconomic development most likely contributed to lower death rates for most diseases (except for cancer and diabetes, for which death rates increased), likely because of lifestyle factors. The study is published in CMAJ (Canadian Medical Association Journal).

The study looked at data on deaths among inhabitants of Yangpu, an area of Shanghai with a relatively stable population and low levels of people moving in or leaving. The study period included several key events in recent Chinese history, including the rise of polluting industries (1949 to the 1980s), the Great Chinese Famine (1959 to 1961), the Cultural Revolution (1966 to 1976) and economic reforms (1979 to present).

Out of almost 42 million person-years, there were 290 332 deaths categorized into cause groups: infectious diseases, maternal, perinatal and nutritional issues (group 1), chronic diseases (group 2) and injuries (group 3).

Researchers found that deaths from causes in groups 1 and 3 decreased between 1974 and 2015. After 1988, age-standardized deaths in group 1 decreased because of public health and health care improvements and the removal of polluting industries in that decade. People who experienced severe starvation in utero or in infancy during the Great Chinese Famine were more likely to die from heart disease, stroke, cancer and diabetes. Deaths from chronic diseases reduced over time, except for people born after 1949, among whom deaths from cancer and diabetes increased.

Prior to 1994, Shanghai was a low-income region according to World Bank income categories, but by 2006 it had become an upper-middle income area.

"Socioeconomic development has contributed to a decrease in deaths from most diseases in China," says Dr. Guangwen Cao, Department of Epidemiology, Second Military Medical University, Shanghai, China. "However, for cancer and diabetes, the benefits from socioeconomic development appear to be overridden by new risk factors, such as changing diets and alcohol consumption, smoking, lack of physical activity, overweight and obesity."

Few studies have looked at the effect of socioeconomic events on deaths from specific causes. The authors hope their study will help with health-system planning and disease-control strategies.

The authors note that, as this is a descriptive study, it is difficult to determine if socioeconomic events and cause-specific mortality are causal or represent an association.

"Influence of socioeconomic events on cause-specific mortality in urban Shanghai, China, from 1974 to 2015: a population-based longitudinal study" is published October 1, 2018.

ROCHESTER, Minn. - Researchers at Mayo Clinic have developed a new genetics-based prognostic tool for myelodysplastic syndrome. Their findings are published in the October print issue of Mayo Clinic Proceedings.

"Myelodysplastic syndrome is one of the most frequent blood cancers affecting the elderly with annual incidence exceeding 50 cases per 100,000 in people 65 years or older," says Ayalew Tefferi, M.D., a Mayo Clinic hematologist who is the principal investigator and lead author.

Dr. Tefferi says the average survival for patients with myelodysplastic syndrome is estimated at 2½ years, and survival rates have not improved over the past several decades. "Current drug therapy for myelodysplastic syndrome is not curative and is often instituted to palliate anemia and other symptoms," says Dr. Tefferi. "The only treatment that offers a chance for cure or prolonged survival is allogeneic hematopoietic stem cell transplant. Unfortunately, this procedure is associated with substantial risk of treatment-related death and morbidity, so an accurate and reliable prognostic tool is needed to select suitable patients for transplant."

Dr. Tefferi says the current prognostic tool for myelodysplastic syndrome is based on the revised international prognostic scoring system. However, the overall value of this system is limited by its complexity and the absence of information on gene mutations.

Dr. Tefferi and collaborators from National Taiwan University Hospital in Taipei, Taiwan, examined gene mutations and their effect on survival in 685 patients with myelodysplastic syndrome. Researchers identified a favorable gene mutation, SF3B1, and unfavorable gene mutations, ASXL1 and RUNX1. They used the information to develop the Mayo Alliance Prognostic System for myelodysplastic syndrome.

In another paper, soon to be published in the American Journal of Hematology, Dr. Tefferi and his collaborators demonstrated the impact of gene mutations on treatment response in patients with myelodysplastic syndrome. They found that ASXL1 and U2AF1 mutations undermine treatment response to hypomethylating agents and the drug lenalidomide while patients with SF3B1 mutations are more likely to benefit from lenalidomide therapy.

"The Mayo Alliance Prognostic System for myelodysplastic syndrome tool provides a simpler and more contemporary prognostic system that integrates genetic and clinical information," says Dr. Tefferi. "In addition to accommodating genetic information, it offers more user-friendly cytogenetic risk stratification, accounts for gender differences in hemoglobin levels and uses a single threshold value for bone marrow blast percentages." Dr. Tefferi says, "the Mayo Alliance Prognostic System for myelodysplastic syndrome is not an enhancement of the international prognostic scoring system tool, it's a complete makeover."

SAN ANTONIO, TX (October 1, 2018)-- A study from the Thoracic Oncology Research Group (TORG), Division of Pulmonary Critical Care, Medical University of South Carolina aimed to examine the adherence to annual low-dose computed tomography (LDCT) screening after baselines LDCT within the Veteran Health Administration Lung Cancer Screening Demonstration Project (LCDSDP). The study will be presented at the CHEST Annual Meeting 2018 in San Antonio and a discussion highlighting the latest updates made the CHEST Lung Cancer Screening Guidelines will take place.

The original project was conducted from July 1, 2013 through June 30, 2015 at eight geographically diverse Veterans Affairs hospitals. Screening was performed in current and former smokers (quit within the past 15 years) ages 55-80 with at least a 30-pack year smoking history. Researchers utilized data generated from the LCSDP and 18 months following its completion stored in the BHA CorporateData Warehouse. Adherence to screening was defined as it was in the National Lung Screening Trial as having undergone a follow-up LDCT within 15 months from baseline scan.

A total of 2,106 Veterans underwent a baseline LDCT across all sites; 60% had scans negative for nodules greater than or equal to 4mm in size and repeat annual LDCT was recommended. In this group with a negative baseline scan, 149 were considered no longer eligible for screening because they had been diagnosed with lung cancer, were undergoing evaluation for cancer, no longer met the target age or years of cessation, were considered to have other life-limiting disease or were no longer interested in participating. Of the 1120 remaining eligible for repeat annual LDCT, 880 went on to undergo the follow-up scan yielding a 77.6% adherence rate from annual screening in those with a normal baseline scan.

"Our study demonstrates that even within the context of a well-designed, implemented and guideline adherent LDCT screening program, adherence is not optimal and does not reach the reported 95% of the NLST when the baseline scan is negative," says lead researcher Dr. Paul B. Brasher. "Both mortality benefit and cost-efficacy are likely to suffer without better adherence."

Further results from these two studies will be shared at CHEST Annual Meeting 2018 in San Antonio on Tuesday, October 9, 8:45 AM -9:00 AM at the Henry B. Gonzalez Convention Center, Room207A. The study abstracts can be viewed on the journal CHEST® website.

SAN ANTONIO, TX (October 1, 2018)­­-The Intensive Care Unit is a stressful place, and conflicts invariably arise. To better understand the relationships between physicians, nurses, respiratory therapists, and advanced practitioners, researchers created a conflict management education intervention. The study paid close attention to diagnosing the conflict type and cause, recognizing the internal dialogue, introducing conflict management modes used in conflict situations, and developing self and other awareness.

Utilizing quantitative analysis, researchers evaluated 56 participants using pre and post knowledge and perceptions of conflict, Thomas-Kilmann descriptive statistics to investigate the participants' chosen conflict management mode, and a qualitative analysis to evaluate open-ended questions on the post-test. Pre post-test analysis had 45 participants and the Thomas-Kilmann descriptive statistics had 49 participants participate.

The researchers found both knowledge and perception scores increased following the intervention. They found that the most frequent strategy for conflict management was avoidance (32%), followed by compromising (30%), accomodating (25%), collaborating (9%) and competing (5%). Participants indicated that the aspects of the intervention that would stay with them were the Thomas-Kilmann conflict management modes and better awareness of others. Results also showed that the more diverse the group participants were, the richer the perception and perspective dialogues during the educational sessions.

"The conflict management educational intervention improved the participants' knowledge and had an effect on perceptions," says Dr. Bobbie Ann A. White, lead researcher. "Qualitative data suggests ICU participants were interested in concrete information that will help with conflict resolution, and some participants understood that mindfulness and awareness would improve professional interactions or reduce conflict."

Further results from these two studies will be shared at CHEST Annual Meeting 2018 in San Antonio on Wednesday, October 10, 1:00 PM to 2:00PM at the Henry B. Gonzalez Convention Centre, Exhibit Hall. The study abstracts can be viewed on the journal CHEST® website.