Body

WEST LAFAYETTE, Ind. -- No woman's breast tissue is the same, so MRIs detecting and monitoring cancer shouldn't treat them all the same.

Without a way to prove that a new MRI technique is safe for all women, clinical MRIs haven't been able to keep pace with the latest advances in MRI research. More informative cancer detection is possible with stronger magnetic fields that also, unfortunately, increase the risk of tissue heating during a screening.

Purdue University researchers have simulated how over 20 different breast tissue ratios respond to heat given off by MRIs at higher field strengths than available in hospitals today.

The simulations would allow cutting-edge MRI techniques to finally show that they meet safety limits, as defined by entities like the U.S. Food and Drug Administration, and start clinical trials for real-life use.

On the flip side, using knowledge about how much radiofrequency energy each breast tissue ratio can handle, new techniques could one day target the heat produced from an MRI at tumors to kill them.

Published findings are featured in the journal Magnetic Resonance in Medicine, and software code for the simulations is available open-access to the scientific community via Github.

The work aligns with Purdue's giant leaps celebration, acknowledging the university's global advancements made in health, space, artificial intelligence and sustainability as part of Purdue's 150th anniversary. Those are the four themes of the yearlong celebration's Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues.

Despite the limitations of clinical field strengths, a yearly MRI screening is still recommended for women with higher than average risk of breast cancer because it's more sensitive than a standard mammogram.

"We're starting to develop techniques at high field strengths that could immediately monitor how tumors respond to treatment. So we don't want tissue heating concerns to stand in the way of improving such a powerful tool," said Joseph Rispoli, Purdue assistant professor of biomedical engineering and electrical and computer engineering.

How dense a woman's breast is determines how much radiofrequency energy from an MRI the breast will absorb in the form of heat, defined as the specific absorption rate (SAR). The more fibroglandular tissue in the breast compared with fat tissue, the higher the breast density and SAR.

But not all women have the same ratio of fibroglandular to fat tissue. This makes it harder for researchers to show that a potentially life-saving MRI technique is safe for every woman, even though the risk of overheated tissue is generally low.

"In hospitals, MRI field strengths are currently up to 3 tesla, tesla being the unit we use for measuring magnetic field strength," Rispoli said. "Many techniques would be far superior at 7 tesla. This would come at a fivefold increase in SAR, but also double the MRI sensitivity."

The researchers demonstrated through their simulations that a fivefold increase could still stay within FDA limits for most breast tissue ratios, even at 7 tesla.

To make these simulations, the team had to jump several public health hurdles, the first being that there are far fewer computer models, or "phantoms," of the female body than the male body. Researchers can test their techniques on computational phantoms, typically generated from MRI or CT image sets, before the techniques are clinically approved for using on real humans.

Japan's National Institute of Information and Communications Technology, for example, developed the "Hanako" model to represent the average Japanese woman, and the Swiss Foundation for Research on Information Technologies in Society developed "Ella" for a typical Caucasian woman.

Other existing phantoms lie behind a paywall; all were developed in a standing or upward position even though a woman would be lying downward for an MRI, and none have been successfully combined with breast phantoms to accurately predict SAR.

Purdue researchers fused 36 breast phantoms at various densities, as classified by the American College of Radiology Breast Imaging Reporting and Data System Atlas, with the full body Hanako and Ella models. They then simulated the behavior of each fused phantom in response to MRI coils at 7 tesla.

The simulations help other researchers to tailor their techniques to each woman's unique breast tissue ratio. Power should be limited somewhat, for example, for those with more fibroglandular tissue.

"We want to facilitate the most cutting-edge of breast MRI techniques at any site in the world," Rispoli said. "Ultimately, a woman will be able to go in, have a fast low-power anatomical MRI scan, and then the computer could quickly simulate on-the-fly what the SAR would be in that patient."

Rispoli is part of a working group with the International Society for Magnetic Resonance in Medicine that will use the simulations to inform best practices for safety testing of experimental radiofrequency hardware. The effort will also facilitate these investigations across hospitals and research sites.

Encouraging young people to do strength-based exercises - such as squats, push ups and lunges - could play a key role in tackling child obesity, research suggests.

Taking part in exercises that cause muscles to contract, and strengthen muscles and bones, was found to reduce children's body fat percentage.

The findings also suggests an increase in muscle mass - gained from strength-based exercises - could help boost children's metabolism and energy levels.

The effects were small but meaningful, prompting calls for further research to investigate how resistance training could treat and prevent the growing issue of child obesity.

Researchers at the Universities of Edinburgh and Dundee examined the findings from a number of studies that explored effects of resistance training on body weight for children aged eight to 16 years.

They found that resistance training decreased body fat, but had no overall effect on other measures, including lean muscle mass, body mass index and waist circumference.

This is the most extensive review so far of resistance training's impact on young people.

Research from 18 studies across eight countries was examined, including the US, Australia, and Japan.

Helen Collins, a PhD student at the University of Edinburgh and Sport and Exercise Scientist at the University of Dundee, said the results show the positive effect resistance training can have on maintaining a healthy weight and reducing body fat for young people.

"Treatment, and more importantly, prevention, of child obesity is a growing concern. Our findings highlight the need for more robust research into the role strength-based exercises can play in helping everyone make healthy life choices and be more physically active."

A third of people who undergo ACL reconstruction surgery will have osteoarthritis in their injured knee within 10 years. Within two decades, nearly 50 percent will -- terrible odds for getting a debilitating condition with no known cure.

While no one yet knows exactly why this is the case, researchers have explored two related theories:

The knee injury itself may cause persistent and chronic inflammation resulting in underlying joint tissue changes.

People who sustain an ACL injury end up moving differently during activities like running, jumping and walking, which causes damage to cartilage over time.

Keying on those theories, researchers from the University of North Carolina and Brigham Young University conducted a study to observe walking biomechanics of 130 subjects who have had ACL reconstruction surgery. The study, which included people who had the surgery anywhere from 6 months to 13 years previously, collected data describing ground reaction forces on the injured leg during walking.

They found people who report lingering symptoms post-surgery either underload their injured leg (6-12 months after surgery) or overload the injured leg (after the 24-month mark), as compared to those who have had the surgery but no longer report symptoms.

"ACL reconstruction is fairly effective, but some people don't ever fully recover," said study co-author Matt Seeley, associate professor of exercise sciences at BYU. "The way you move is related to the outcome of your ACL surgery."

For the study, published in Medicine and Science in Sports and Exercise, each subject was placed in either a symptomatic or asymptomatic category, based on self-reports of knee pain and other symptoms, and then asked to walk barefoot at a self-selected speed over a force plate embedded in a walkway. Participants were told to walk as if they were "comfortably walking over a sidewalk" while maintaining a constant speed.

Lead author Brian Pietrosimone of UNC and BYU's Seeley measured ground reaction forces for the subjects at three time periods: less than 12 months post-surgery, between 12 and 24 months, and more than 24 months. Participants were outfitted with retroreflective markers on their legs and researchers then used a 10-camera 3D motion capture system to track the positions of the markers.

They found the symptomatic group was overloading or underloading their injured leg 4 to 5 percent more than the asymptomatic group.

"At first look, these changes are relatively small," Pietrosimone said. "Yet when you think about a 5 percent difference every step you take every day, over the course of a month, year, or lifetime, you can extrapolate why a seemingly small change could lead to a progressive and chronic disease like posttraumatic osteoarthritis."

The findings support the notion that mechanical loading of the lower extremity is associated with clinically relevant knee symptoms after ACL surgery and, surprisingly, that association is influenced by time post-surgery.

The implication is that people who have had ACL reconstruction surgery need to restore movement mechanics in a way to improve chances of avoiding osteoarthritis. According to the authors, this may include closer adherence to a physical therapy program or increased strength training.

"These data indicate overloading and underloading are likely deleterious to cartilage," Seeley said. "This study sets the table for a longitudinal study to determine the precise causes of altered leg biomechanics post-surgery."

Washington, DC - September 18, 2018 - An international team of researchers has successfully deployed a Zika virus vaccine to target and kill human glioblastoma brain cancer stem cells, which had been transplanted into mice. In a study published this week in mBio®, an open-access journal of the American Society for Microbiology, the team shows that a live, attenuated version of the Zika virus could form the basis of a new treatment option for this fatal brain cancer.

Glioblastoma kills about 15,000 adults in the US each year and is currently incurable because patients experience a high recurrence rate of their cancer even after the standard treatments of surgery, radiation and chemotherapy. Scientists suspect this recurrence is due to cancer stem cells, called glioblastoma stem cells (GSCs), which hide out in nearby brain tissue even after the combination of therapies.

"During the Zika epidemic, we learned that the virus preferentially infects neural progenitor cells in the fetus, and causes the devastating microcephaly seen in babies born to infected mothers," says Pei-Yong Shi, a virologist at University of Texas Medical Branch in Galveston. He co-led the current study with tumor biologist Jianghong Man of the National Center of Biomedical Analysis in Beijing and virologist Cheng-Feng Qin of the Chinese Academy of Military Medical Sciences in Beijing.

"We made the connection that perhaps Zika virus could also specifically infect the GSCs," because these cells have similar properties to neural stem cells, says Man. In previous work, Shi and his collaborators at Washington University in St. Louis showed that Zika virus did indeed attack and kill GSCs grown in the lab dish and in a mouse model of glioblastoma. In addition, the Zika virus was much less efficient at attacking the differentiated, healthy brain cells. (image: transmission electron micrograph of Zika virus, NIAID)

"If we could find a way to specifically target those GSCs that are the source of recurrence, then that might provide an option to prevent recurrence or even a cure," says Qin.

The team's first objective was to determine if there was a safe way to use Zika virus in patients to attack the cancer cells. Shi's lab has developed a promising live-attenuated Zika vaccine candidate called ZIKV-LAV that had been shown to be safe, non-virulent, and effective in protecting against infection in mice and non-human primates. The ZIKV-LAV has a small deletion from the viral genome that prevents it from replicating itself efficiently.

When the team injected this ZIKV-LAV into the brains of mice, they saw no health effects on the mice, no weight loss, and no behavioral abnormalities such as loss of appetite, depression, lethargy, or self-injury. The mice also functioned normally in tests for anxiety and motor function.

Next, the team wanted to show whether the ZIKA-LAV could work to infect and kill human patient-derived GSCs in a mouse model. So they mixed GSCs from two different human patient donors with the ZIKA-LAV and injected the mixture into the brains of mice. Mice that got the injection of the GSCs only rapidly developed tumors. Mice that got the ZIKV-LAV injected as well saw a significant delay in tumor development. Co-implanting the virus along with the GSCs also prolonged the median survival time of the treated mice to around 50 days, compared to around 30 days for the untreated mice who received GSCs alone.

Qin says that perhaps in the future patients would be given the Zika vaccine at the same time as surgery to "let the viruses hunt down the GSCs and eliminate them."

Finally, the team investigated the cellular mechanisms that the modified Zika virus used to kill the GSCs. They took GSCs treated with the ZIKV-LAV and those GSCs not treated and sequenced all the RNA messages being expressed in these two cell populations. Comparing those profiles, the team found that in the treated cells, the virus triggered a strong antiviral response in the cells, which induced inflammation and eventually cell death.

Next, the team will work with clinicians to develop safety tests of the ZIKV-LAV in glioblastoma patients. They may also modify the Zika virus further to make it an even more potent cancer cell killing machine. For example, Man explains, the researchers could add an immune modulator as a 'cargo' in the viral genome. Then, once such a virus infects a cancer cell and kills it, the immune modulator would be released to alert and activate the patient's systemic immune system against the remaining cancer cells.

"As a virologist, I see that we should take advantage of the 'bad' side of viruses," says Shi. "They should have a role to play in cancer treatment."

A new study from the University of Iowa finds that type 2 diabetes remains overwhelmingly the most common type of diabetes diagnosed in American adults who have the disease.

The study found that 8.5 percent of American adults have been diagnosed with type 2 diabetes and .5 percent with type 1 diabetes. Among those who are diagnosed with diabetes, 91.2 percent have type 2 diabetes and 5.6 percent have type 1 diabetes. The study was published this month in the prestigious British Medical Journal.

Although previous survey studies have reported the rate of diabetes in the United States, the rates by diabetes subtypes--type 1 , type 2, or other type--were virtually unknown. Study lead author Wei Bao, assistant professor of epidemiology in the College of Public Health, says the results are important because it allows health care professionals and policy makers to better allocate resources to treat each type of the disease.

"These two types of diabetes differ not only by their causes, but also by their clinical manifestations and treatment strategies," he says. Type 1 diabetes is an auto-immune disease that typically develops in childhood. Patients with type 1 diabetes also have problems in producing insulin, and therefore they require insulin treatment for survival.

Type 2 diabetes mostly develops in adulthood and is caused by a complex interplay between genetic and environmental factors such as obesity, unhealthy diet and physical inactivity. Type 2 diabetes is treated with lifestyle change, medication, and/or insulin.

"Type 2 diabetes can be prevented through lifestyle changes, but so far, there is no established method for preventing type 1 diabetes", Bao says.

The study is based on data gathered by the CDC's National Health Interview Survey (NHIS), which is conducted annually by survey-takers who visit peoples' homes and ask them about their health. Bao says the NHIS is the first and only national health survey that attempts to determine how many adults have each type of diabetes. Since 2016, survey takers started to ask respondents who had been diagnosed with diabetes if they had type 1, type 2, or other type.

Bao acknowledges that the present study has a limitation in that it relies on self-reported data from respondents, so it could be subject to reporting errors. However, he says the results provide a benchmark for future surveys to better determine the prevalence of type 1 diabetes and type 2 diabetes in adults. In addition, this study only has data on diagnosed diabetes and could not determine the rate of undiagnosed diabetes.

Bao emphasizes the need to continue monitoring the dynamic changes of these two types of diabetes in American population. He expects more Americans to report type 2 diabetes as a result of the ongoing obesity epidemic. But he also wouldn't be surprised if more adults have type 1 diabetes because of improved treatments that keep patients alive longer.

"Type 1 diabetes used to be lethal for children years ago and so children who had the disease had shorter lifespans," he says. "Now, treatment has been improved to be so effective that a lot of children will survive well into adulthood."

Paris, France: First results from a clinical trial of a procedure to open obstructed airways in patients with chronic obstructive pulmonary disease (COPD) have shown that it significantly reduces problems associated with the disease and is safe.

Presenting findings from the AIRFLOW 2 phase II clinical trial, the principal investigator, Dr Dirk-Jan Slebos, from the University Medical Centre Groningen (The Netherlands), told the European Respiratory Society International Congress today (Tuesday) that a technique called Targeted Lung Denervation (TLD) had reduced COPD problems by more than 50% in patients who received the active treatment compared to patients who received the sham treatment.

"We have been able to significantly reduce chronic respiratory symptoms such as shortness of breath, exacerbations of the disease, infections and hospitalisations in a group of COPD patients who are already on aggressive medical therapy. There was also a trend towards improved quality of life and better lung function in the treated patients. This has important implications for patient quality of life, and also healthcare costs, as these are events that have a significant impact on the cost of caring for these patients," he said.

TLD involves passing a special catheter through an instrument called a bronchoscope into the lungs. The bronchoscope allows doctors to see the inside of a patient's airways and to use the catheter to deliver a type of electrical charge called radiofrequency energy to the nerves on the outside of the airways, interrupting their normal function. This causes the airways to relax and widen, decreases mucus production and decreases airway wall inflammation. Then the catheter and bronchoscope are removed.

The AIRFLOW 2 clinical trial is taking place in several centres in six European countries [2]. Patients are randomised to receive either TLD or a sham procedure under general anaesthetic. The sham procedure still involves inserting the bronchoscope and catheter, but the radiofrequency electrical change is not delivered. This is performed under "double-blind" conditions, in which the treatment team that is carrying out the procedure knows whether the patient is assigned to the active treatment or the sham, but the follow-up team who sees the patient for post-procedure visits and tests does not, and nor does the patient.

TLD targets a well-known pathway involved in the development of COPD, called the cholinergic pathway, which regulates the body's inflammatory responses to injury and promotes smooth muscle constriction of the airways. Anti-cholinergic drugs, which are often used to treat COPD, also target this pathway, but when they are combined with TLD there appears to be an additional, beneficial effect, even in patients who are being heavily treated with other drugs. Patients in both parts of the trial received tiotropium, an anti-cholinergic bronchodilator.

Dr Slebos presented results from 82 patients in the trial at the ERS Congress today. Half of them were male and they had an average age of nearly 64 years. Three to six months after the treatment, 71% of patients who had received the sham treatment had an adverse respiratory event related to COPD compared to 32% of patients who received the TLD treatment.

"Furthermore, the positive benefit has continued in those receiving TLD treatment, with the number of patients hospitalised for respiratory complications in the first year reduced by more than half in the treatment arm versus the sham arm," said Dr Slebos.

None of the patients died and there were no TLD-related adverse side effects that needed to be treated. Five patients (12%) who received the TLD treatment experienced stomach problems such as nausea, abdominal bloating and digestion discomfort, but these were temporary symptoms that had gone after six months.

"These occurred because of the radiofrequency energy affecting the nerves lining the nearby gullet," said Dr Slebos. "We are improving our process and imaging in order to better understand where these gastric nerves are, and we have implemented additional measures to improve our ability to avoid them in future procedures."

A larger, phase III trial, AIRFLOW 3, is now being planned. It is likely to be launched in carefully chosen centres of excellence in Europe, beginning some time next year.

Dr Slebos said: "The results I am presenting today suggest that TLD can be an additional treatment option for COPD patients who are already receiving the optimum drug treatment for their symptoms. It offers the ability to significantly reduce symptoms and exacerbations even in patients already on aggressive medical therapy.

"With the addition of AIRFLOW-3, which will have a similar design but will include many more patients, there will be a profound amount of evidence for the procedure, gathered in a highly scientifically rigorous manner."

Over 300 million people worldwide suffer from COPD, including 4-10% of adults in European countries. TLD is a relatively new approach to treating the disease, which has been under investigation since 2008, with four clinical trials in the last six years (IPS-I, IPS-II, AIRFLOW-1 and AIRFLOW-2). "The clinical need for more effective therapies is great," said Dr Slebos.

"After proving safety and feasibility in earlier trials, we felt a double-blind, randomised, sham-controlled trial would be an important scientific control to demonstrate the effectiveness of the treatment."

Professor Daiana Stolz, from University Hospital Basel, Switzerland, is Chair of the European Respiratory Society Education Council and was not involved in the study. She said: "These are really exciting and important results. COPD is a difficult disease to treat successfully and the results from this well-conducted trial of Targeted Lung Denervation show that it can make a significant difference to the health of patients. Better treatments for COPD patients, particularly those with severe disease, are desperately needed and we look forward to the results from the AIRFLOW-3 trial, which we hope will confirm this as an effective and safe treatment."

Among patients with cardiovascular disease, it's a common complaint: a sudden, piercing pain, stiffness or tenderness in a joint that lasts for days at a time with all signs pointing to a gout attack. Gout and cardiovascular disease (CVD) appear to be intimately linked - they are frequently seen together although the underlying connection between the two remains unclear. When rheumatologist Daniel Solomon, MD, MPH, heard about a large, clinical study to determine if targeting inflammation among patients with a history of heart attacks could lower future risk of cardiovascular events, he immediately wondered if the new approach might help prevent gout attacks among these patients as well. Solomon and colleagues found a significant reduction in risk of gout attacks among patients who received the drug that targets a key inflammatory molecule, suggesting a new target for therapeutic strategies to prevent gout attacks. Their findings are published online today in Annals of Internal Medicine.

"By looking across diseases, we're trying to put together a picture of the relationship between gout, cardiovascular disease and inflammation," said Solomon. "There's a long-held understanding that gout and cardiovascular disease travel together. We're using data from the CANTOS trial to understand why."

CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study), sponsored by Novartis, was designed to test whether canakinumab, which targets interleukin-1β, could reduce risk of a future cardiovascular event. The study recruited people who had had a prior heart attack and who, despite aggressive care, had persistently elevated levels of the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP).

CANTOS, which met its primary endpoints, also offers a treasure trove of data on 10,000 patients with a history of heart attacks. As part of the study, information on gout attacks and levels of baseline serum urate concentrations (a measure associated with the production of monosodium urate crystals that form in joints, tendons, kidneys and elsewhere) was collected.

Solomon et al. report that, over the course of the trial, 3 percent of participants taking the placebo had a gout attack. This percentage was reduced by half among participants taking the IL-1β blocker. Serum urate levels remained unchanged over time, suggesting that, importantly, the drug was acting on an independent mechanism to reduce risk of a gout attack.

"Our results suggest that targeting IL-1β could open up new therapeutic avenues for not only treating heart disease but also crystal diseases like gout," said Solomon.

Canakinumab, manufactured by Novartis, has been shown in previous research studies to shorten the length of gout attacks but has not been approved by the FDA for gout treatment. Additional studies are ongoing to test the effectiveness of less expensive drugs, including generics, that target inflammation.

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) shows that if a woman gains either too much or too little weight during pregnancy, there are adverse effects in children at 7 years of age. The study is by Professor Wing Hung Tam and Professor Ronald C.W. Ma, at The Chinese University of Hong Kong, Shatin, Hong Kong, and colleagues.

There have been various studies on the effects of weight gain during pregnancy (gestational weight gain or GWG), however data on the metabolic effects in the children subsequently born have not been comprehensively studied. This study aims to evaluate the relationship between GWG and cardiometabolic risk in offspring aged 7 years.

The study included a total of 905 mother-child pairs who were enrolled in the follow-up visit of the multicentre Hyperglycemia and Adverse Pregnancy Outcome study, at the study centre in Hong Kong. Women were classified as having gained weight below, within or exceeding the 2009 Institute of Medicine (IOM) guidelines. Also factored in the study were standardised GWG values based on pre-pregnancy body-mass index (BMI).

Among the 905 women, the mean pre-pregnancy BMI was 21 kg/m2, the total prevalence of overweight and/or obese participants was 8.3%. The weight change from pre-pregnancy to delivery was 15kg on average, with 17% having gained weight below, 42% having gained weight within and 41% having gained weight exceeding the IOM recommendation.

Independent of pre-pregnancy BMI, gestational hyperglycaemia and other confounders, women who gained more weight than the IOM recommendation had offspring with larger body size at age 7 years, and increased odds of higher body fat, high blood pressure and poor blood sugar control, while women who gained less than the recommendation had offspring with increased risks of high blood pressure and poor blood sugar control at 7 years of age, compared with those who gained weight within the recommended range.

The authors say: "We found evidence of linkage between GWG and several cardiometabolic risk factors in the offspring aged 7 years, independently of maternal BMI prior to pregnancy and glucose level during pregnancy. These findings have important implications for both prevention and treatment. There is a need for greater awareness and monitoring of weight gain during pregnancy. Pregnancy might be a potential window of opportunity for intervention through modifiable behaviours, including maternal nutrition and physical activity."

However, they add: "Although limiting excessive GWG may help minimise the intergenerational cycle of obesity, the benefits of lower weight gain must be balanced against other cardiometabolic risks -- such as high blood pressure and poorer blood sugar control --and risk of stunted growth in the offspring if GWG is inadequate."

They conclude: "Long-term follow-up of these children is necessary to evaluate the effect of maternal GWG on cardiometabolic risk in adolescence and adulthood."

SINGAPORE, September 18, 2018--New four-year study data shows the significant impact of a pioneering contact lens management approach to slowing the progression of myopia (nearsightedness) in children, including those whose treatment begins later. CooperVision is presenting the multi-year study's latest outcomes during the BCLA Asia conference in Singapore this week, at which the globally increasing prevalence of myopia is among the most widely discussed issues.

The ongoing clinical trial is assessing a specially-designed, dual-focus myopia control 1-day soft contact lens in reducing the rate of progression of juvenile-onset myopia. The lens is commercially available as CooperVision MiSight® in select countries.1

"Four-year results on the efficacy of our innovative myopia control lens represent a landmark in slowing myopia progression. The treatment is continuing to work for children who have been wearing MiSight® contact lenses for the entire study, and their axial length progression in this last year has slowed further. This illustrates the benefits of beginning myopia management as early as possible to maximize the benefit," said Paul Chamberlain, BSc (Hons), MCOptom, Director of Research Programs for CooperVision.

After year three, myopia progression slowed in children wearing the MiSight® contact lens: 59% as measured by mean cycloplegic spherical equivalent (SE) and 52% as measured by mean axial elongation of the eye when compared to the children in the control group wearing a single vision 1-day contact lens.

In year four, children in the original control group were refit with the myopia control lens, and then continued to be tracked separately. Use of the dual-focus contact lens -- which has alternating visual correction and treatment zones -- was effective in slowing myopia progression in both groups:

There was a significant reduction in myopic progression for the previous single vision 1-day wearers, indicating that MiSight® contact lenses are also effective when beginning myopia management at an older age.

There were no significant differences between groups for change in Spherical Equivalent Refractive Error and Axial Length over 12 months.

Axial length growth of 0.07mm in the MiSight® group and 0.06mm in the previous control group, compared to 0.10mm seen in the MiSight® group in year three, represents further myopia slowing as the children age.

There were no significant differences in myopia progression rates for two demographically matched populations in their first versus fourth years of MiSight® contact lens wear.

No other prospective randomized controlled study has offered conclusive data for such a high degree of continued efficacy in myopia management using a 1-day soft contact lens over four years. The contact lens-based approach does not induce common side effects exhibited by some alternative pharmacological therapies.

The prevalence of myopia is projected to increase from approximately two billion people worldwide in 2010 to almost five billion people in 20502, bringing with it near- and long-term health challenge Not only does it create blurred vision, but also increases the likelihood of conditions later in life such as glaucoma, cataract, retinal detachment and myopic maculopathy if not addressed.

"The four-year results are another great learning for CooperVision and the entire optical industry on the capability to slow the progression of myopia in children. Though children benefit at whatever age the treatment is started, the sooner their myopia is managed with MiSight® contact lenses, the more effect and benefit they receive in reducing final levels and the future risk of related vision impairment issues," said Stuart Cockerill, Senior Director, Myopia Management.

Physiological changes among 100 myopic children from Singapore, Canada, England, and Portugal were evaluated during the fourth year.

Sept. 17, 2018--A new guideline focused on the role of weight management in treating adult obstructive sleep apnea (OSA) has been published online by the American Thoracic Society in the Sept. 15 American Journal of Respiratory and Critical Care Medicine.

OSA is a common disease that occurs when the upper airway becomes blocked repeatedly during sleep, reducing or stopping airflow. Being overweight or obese is a strong risk factor for OSA, and weight loss can often reduce the severity of OSA.

"This guideline expands the content of previous clinical practice guidelines addressing the care of OSA patients who are overweight or obese by offering specific recommendations for weight loss and discussing the evidence for each recommendation," said David W. Hudgel, MD, panel chair and a specialist and investigator in sleep-disordered breathing. "In addition to these scientifically derived recommendations, the guideline reviews and discusses successful methods for practitioners to discuss weight issues and ways to interact with patients who are overweight or obese."

The 20-member guideline panel - which included sleep, pulmonary, weight management and behavioral experts, as well as three patients - reviewed scores of studies and rated the strength of study findings, along with the certainty of the panel's recommendations, using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.

For patients with OSA who are overweight or obese (body mass index - BMI ? 25 kg/m2 ) the panel:

Recommended participation in a comprehensive lifestyle intervention program that includes a reduced calorie diet, exercise/increased physical activity and behavioral counseling (strong recommendation, very low certainty in the estimated effects).

Suggested that in the absence of a comprehensive program, participation in a diet and exercise program is recommended, together or individually (conditional recommendation, very low certainty in the estimated effects).

For patients with OSA who have a BMI ?27 kg/m2 and whose weight has not improved despite participating in a comprehensive program--and who have no contraindications to pharmacotherapy such as active cardiovascular disease--the panel:

Suggested an evaluation for anti-obesity pharmacotherapy (conditional recommendation, very low certainty in the estimated effects).

The panel defined active cardiovascular diseases as "myocardial infarction or cerebrovascular accident within the past six months, uncontrolled hypertension, life-threatening arrhythmias or decompensated congestive heart failure."

For patients with OSA who have a BMI ? 35 kg/m2 and whose weight has not improved despite participating in a comprehensive weight loss lifestyle intervention program--and who have no contraindications--the panel:

Suggested referral for bariatric surgery evaluation (conditional recommendation, very low certainty in the estimated effects). ,/li>

The panel found that the only available well-controlled trials of bariatric surgery in patients with OSA examined the effect of gastric banding. Gastric banding was not found to be more effective in reducing OSA severity than lifestyle interventions that result in weight loss.

The panel also noted that weight loss, either through lifestyle changes or bariatric surgery, has benefits beyond reducing OSA severity. Among those benefits are prevention of type 2 diabetes, improved glycemic control in those with type 2 diabetes, lower blood pressure and improved quality of life.

In formulating its recommendations, the panel reviewed studies that found patients are often unaware that they are overweight or obese and that clinicians are often reluctant to give patients a diagnosis of obesity. Even when the need for weight loss is discussed, the panel said, an effective weight loss program is often not initiated.

"This guideline demonstrates that weight loss provides a distinct benefit to OSA patients, but many patients may not know about how to achieve these benefits because their health care provider has not had an in-depth discussion about proven methods to achieve weight loss with them," said panel co-chair Sanjay R. Patel, MD, professor of medicine and medical director of the sleep laboratory at the University of Pittsburgh Medical Center.

"Overweight or obese patients with OSA who are encouraged to participate in a comprehensive weight-loss program that includes calorie reduction, increased physical activity, behavioral counseling and close follow-up, will most likely be grateful to their health care provider for discussing the issue and recommending effective strategies for weight management."

In a new analysis of data submitted to Maryland's state trauma registry from 2005 to 2017, Johns Hopkins Medicine researchers found that gunshot victims are approximately five times more likely to require blood transfusions, they require 10 times more blood units and are 14 times more likely to die than people seriously injured by motor vehicles, non-gun assaults, falls or stabs.

A report of the findings of the study, designed to better understand demands for and shortages of blood transfusion products, was published Sept. 13 in Transfusion.

"Blood products cost a lot, come with a lot of risks for those transfused, and are scarce, so understanding what kinds of trauma are most likely to require more of them can help hospitals improve outcomes for trauma victims," says Steven Frank, M.D., professor of anesthesiology and critical care medicine at The Johns Hopkins University and the study's corresponding author.

To better understand the extent of blood use and associated costs for gunshot wound (GSW) victims, Frank and colleagues analyzed data from 23,422 Johns Hopkins Hospital trauma patients entered into the Maryland trauma registry from 2005 to 2017.

The average age for GSW patients was 27 and the average for non-GSW patients was 38. Males made up the majority of both types of patients -- 2,497 of 2,672 (93.45 percent) GSW patients and 13,954 of 20,750 (67.3 percent) of non-GSW patients were male.

Of all patients in the trauma registry, 2,672 (11.4 percent) had GSW injuries and 20,750 (88.6 percent) had non-GSW trauma injuries resulting from motor vehicle, nongun assaults, falls or stabs. GSW patients were five times more likely to require a blood transfusion (538 of 2,672, or 20.1 percent) compared to non-GSW patients (798 of 20,750, or 3.9 percent).

When comparing all patients, the researchers found that GSW patients needed 10 times more units of blood than non-GSW patients (3.3 units versus 0.31 units for non-GSW patients).

Frank and colleagues also found that GSW patients were more likely to die in the emergency department (69 of 2,672, or 2.6 percent) than non-GSW patients (17 of 20,750, or 0.08 percent). Overall, GSW patients were about 14 times more likely to die (653 of 2,672, or 24.4 percent) than non-GSW patients (352 of 20,750, or 1.7 percent).

"The most likely explanation for these findings is the dramatic degree of injury severity in gunshot victims compared to all other types of trauma, including stab wounds," says Frank.

In their analysis of cost for blood transfusions, the research team compared two types of costs: acquisition costs, or the cost of the unit itself ($200 per unit of red blood cells, $500 per unit of platelets, $50 per unit of plasma and $250 per dose of cryoprecipitate), and activity based costs, which are acquisition costs plus a fourfold increase for overhead that includes storage, viral testing, transport, compatibility testing and the cost of giving the blood to the patient.

Although overall, only 11.4 percent of all trauma patients had GSW injuries, more money was spent on blood for these patients than for all non-GSW trauma patients combined: $1,523,450 for GSW patients versus $1,140,250 for non-GSW patients in acquisition costs, and $6,093,800 versus $4,561,000 for non-GSW activity costs.

"For emergency preparedness purposes, hospitals that treat trauma need to have a sufficient amount of blood in the bank in order to treat patients coming in with gunshot wounds," says Frank.

In the United States each year, over 116,000 people are injured and over 38,000 people die from gun-related injuries.

Paris, France: A quick and easy test for viral infections can reduce unnecessary antibiotic use and hospital admissions, according to new research presented to the European Respiratory Society International Congress today (Monday). [1]

The test, which takes just 50 minutes to obtain results, could save hospitals around €2,500 per patient not admitted to hospital, would help to relieve winter pressures on available beds, and may help to reduce the development of antibiotic resistance.

Dr Kay Roy, consultant physician in respiratory and general internal medicine at West Hertfordshire Hospitals NHS Trust, Watford, and honorary senior lecturer at the University of Hertfordshire, Hatfield (UK), told the congress: "Initial results on the first 1,075 patients, show the potential of this service. We were able to identify 121 patients who had viral infections, lacked any evidence of bacterial infection, had a normal chest x-ray and only modest indicators of inflammation. Of these, hospital admission was subsequently avoided in 25% and unnecessary antibiotics were avoided in 50%. None of the 30 patients who avoided hospital admission and who were not prescribed antibiotics experienced adverse clinical outcomes, which is reassuring." [2]

Point of care respiratory viral testing (POCT) is a new service that was launched at Watford General Hospital (UK) on 15 January 2018. It is quick and simple to perform; it involves inserting a swab into the patient's nostril to collect a sample of secretions from the back of the nose (1 minute); the sample is prepared and inserted into a compact machine called a FilmArray® [3] (3-5 minutes), which analyses the sample and then generates a printout within 43 minutes.

"The whole process from obtaining a sample from the patient's nose to getting a result should take under 50 minutes, which has a potentially enormous impact on quality of care, improving the patient journey by allowing earlier, informed decision-making about patient management," said Dr Roy. "This is the same test and technology as used in our microbiology laboratory, but we have brought the equipment to the patient's bedside. Results from samples sent to the microbiology lab can take more than two days."

Dr Roy presented data from the first 1075 patients between 15 January and 1 May 2018 to the congress. Of these, 61% showed the patients had one or more viruses, of which 56% were influenza and 54% were other viruses, such as rhinovirus, coronavirus, metapneumovirus and adenovirus, which can cause just as many respiratory and other problems as 'flu or a bacterial infection, particularly in patients with chronic obstructive pulmonary disease (COPD).

The results of the tests were combined with other important clinical factors, such as chest x-ray findings and lack of evidence of bacterial infection, in 387 patients. From these, 121 patients were identified who were potentially suitable for avoiding hospital admission and antibiotics.

"We found that when patients had point of care respiratory viral testing soon after they were admitted to the emergency department, bed flow improved and fewer bed closures were required due to viral infections. This is extremely valuable during winter bed pressures, especially during an influenza epidemic.

"In the first two weeks of this new service we diagnosed 50 cases of influenza: 22 by testing in the emergency department and 28 after patients were admitted. There were no bed moves in the former group but 14 in the latter, demonstrating that earlier bedside testing in the emergency department improves infection control, thereby avoiding bed and ward closures and reducing the risk of spreading infection to vulnerable groups. Infected patients with POCT-based early diagnosis of influenza can be admitted to appropriately designated beds if admission is required," she said.

The cost of POCT is offset by avoiding, for example, the cost of the microbiology laboratory testing and the cost of admitting patients to hospital beds. "The findings clearly point towards a net cost saving. Each respiratory admission can cost around £2000 (€2,500). We could make a significant saving for national health services by avoiding unnecessary admissions in patients who may have otherwise been admitted and given antibiotics while waiting up to two days for results from the lab. Patients in whom antibiotics were avoided also contribute to cost savings, as do the beds and wards which remain open," said Dr Roy.

She is about to start a randomised controlled trial in the community, in which primary care physicians (GPs) will be able to refer patients to a community hub for POCT, with respiratory physicians available to support the GPs.

"The frequent underestimation of the role of viruses in respiratory admissions, both in previously well patients and those with chronic underlying disease such as COPD, has hindered good antimicrobial stewardship," said Dr Roy. "This has sometimes led to other health problems for patients from inappropriate antibiotic use and hospital admission. We hope that quality of patient care can be improved with POCT for respiratory viruses, as well as helping to reduce the development of antibiotic resistance."

Professor Tobias Welte, from Hannover University, Germany, is President-Elect of the European Respiratory Society and was not involved in the study. He said: "As European populations age, there is increasing pressure on the availability of hospital beds. Having to close a ward because a patient has been admitted with a viral infection that could spread to other patients and is not treatable with antibiotics places even more pressure on hospitals, as well as being expensive. The innovative approach described in this presentation could make a significant difference not only to hospitals but also to patients, whose quality of life will be much improved by avoiding unnecessary antibiotic use and admittance to hospital. However, this test will have to be compared to guidelines and recommended best clinical practice to confirm its usefulness."

Paris, France: Evidence of tiny particles of carbon, typically created by burning fossil fuels, has been found in placentas for the first time, in new research presented today (Sunday) at the European Respiratory Society International Congress [1].

Previous research has indicated links between pregnant mothers' exposure to air pollution and premature birth, low birth weight, infant mortality and childhood respiratory problems.

The new study adds to existing evidence on the dangers of pollution for unborn babies and suggests that when pregnant women breathe polluted air, sooty particles are able to reach the placenta via the bloodstream.

The work was presented by Dr Norrice Liu, a paediatrician and clinical research fellow, and Dr Lisa Miyashita, a post-doctoral researcher, both members of Professor Jonathan Grigg's research group at Queen Mary University of London, UK. Dr Miyashita said: "We've known for a while that air pollution affects foetal development and can continue to affect babies after birth and throughout their lives.

"We were interested to see if these effects could be due to pollution particles moving from the mother's lungs to the placenta. Until now, there has been very little evidence that inhaled particles get into the blood from the lung."

The researchers worked with five pregnant women who were all living in London and due to have planned caesarean section deliveries at the Royal London Hospital. They were all non-smokers with an uncomplicated pregnancy and each one gave birth to a healthy baby. The women all gave permission for researchers to study their placentas after delivery.

The researchers were interested in particular cells called placental macrophages. Macrophages exist in many different parts in the body. They are part of the body's immune system and work by engulfing harmful particles, such as bacteria and pollution particles. In the placenta they also help to protect the foetus.

The team studied a total of 3,500 placental macrophage cells from the five placentas and examined them under a high-powered microscope. They found 60 cells that between them contained 72 small black areas that researchers believe were carbon particles. On average, each placenta contained around five square micrometres of this black substance.

They went on to study the placental macrophages from two placentas in greater details using an electron microscope and again found material that they believe was made up of tiny carbon particles.

In previous research, the team have used the same techniques to identify and measure these sooty particles in macrophages in people's airways. Dr Liu added: "We thought that looking at macrophages in other organs might provide direct evidence that inhaled particles move out of the lungs to other parts of the body.

"We were not sure if we were going to find any particles and if we did find them, we were only expecting to find a small number of placental macrophages that contain these sooty particles. This is because most of them should be engulfed by macrophages within the airways, particularly the bigger particles, and only a minority of small sized particles would move into the circulation.

"Our results provide the first evidence that inhaled pollution particles can move from the lungs into the circulation and then to the placenta.

"We do not know whether the particles we found could also move across into the foetus, but our evidence suggests that this is indeed possible. We also know that the particles do not need to get into the baby's body to have an adverse effect, because if they have an effect on the placenta, this will have a direct impact on the foetus."

Professor Mina Gaga is President of the European Respiratory Society, and Medical Director and Head of the Respiratory Department of Athens Chest Hospital, Greece, and was not involved in the study. She said: "Previous research shows that pregnant women living in polluted cities are more prone to pregnancy issues such as restricted foetal growth, premature birth and low birth weight babies. The evidence suggests that an increased risk of low birthweight can happen even at levels of pollution that are lower than the European Union recommended annual limit.

"This new research suggests a possible mechanism of how babies are affected by pollution while being theoretically protected in the womb. This should raise awareness amongst clinicians and the public regarding the harmful effects of air pollution in pregnant women.

"We need stricter policies for cleaner air to reduce the impact of pollution on health worldwide because we are already seeing a new population of young adults with health issues."

Paris, France: Obesity is known to be a risk factor for developing asthma but a new study shows that the reverse is also true: people with asthma are more likely to go on to become obese.

The new research, presented at the European Respiratory Society International Congress [1], indicates that those who develop asthma as adults and those who have non-allergic asthma are at the greatest risk of obesity.

The team behind the research say it suggests the relationship between asthma and obesity is more complex than previously thought and more research is needed to better understand and tackle these two growing health challenges.

The research was presented by Dr Subhabrata Moitra, a European Respiratory Society research fellow at ISGlobal - the Barcelona Institute for Global Health (a centre supported by the "la Caixa" Foundation), Spain. He explained: "We already know that obesity can be a trigger for asthma, perhaps via a physiological, metabolic or inflammatory change.

"Until now there has been very little research on whether the reverse is true - whether asthma can lead to obesity. In this study, we have enough people and we have followed them for long enough to observe the relationship between these two conditions."

The research was part of the European Community Respiratory Health Survey and included 8,618 people from 12 countries who were not obese at the start of the research. This means they all had a body mass index of less than 30kg/m2.

Participants were considered to have asthma if they reported ever having asthma and had an asthma attack or were woken up by an attack of shortness of breath in the previous 12 months, or if they were currently taking asthma medication.

The study began recruiting in the 1990s, and participants were followed up after ten years and again after 20 years. The researchers examined the relationships between having asthma at the start of the study and the likelihood of being obese ten years later. They also studied people who had developed asthma after ten years in the study and their risk of obesity by 20 years. Researchers took other risk factors into consideration, including age, sex, country and physical activity.

They found that 10.2% of people with asthma at the start of the study had become obese ten years on. Among people who did not have asthma, 7.7% were obese ten years later.

The increase in the risk of obesity was even greater in people whose asthma began in adulthood. It was also greater in people who had asthma but did not suffer with allergies.

Dr Moitra added: "By following a large number of study participants over two decades, we have been able to observe how having asthma increases a person's risk of going on to become obese, especially if their asthma begins in adulthood or if they have asthma but no allergies.

"Our findings suggest the relationship between the two conditions is more complicated than we previously realised. It's important that we do more work to pick this apart. For example, we do not know why having asthma increases the risk of developing obesity or whether different asthma treatments have any effect on this risk."

Professor Guy Brusselle from Ghent University in Belgium is Chair of the European Respiratory Society Science Council and was not involved in the study. He said: "With the right medication, many people with asthma gain good control of their symptoms. However, there is no cure for asthma and there is still a lot we do not know about its causes and its effects on the rest of the body. This research is an important step in helping us untangle the relationship between obesity and asthma but it also raises new questions about why the two are linked and what can be done to help patients."

September 14, 2018 - Children who experience some type of adverse event following initial immunization have a low rate of recurrent reactions to subsequent vaccinations, reports a study in The Pediatric Infectious Disease Journal, the official journal of The European Society for Paediatric Infectious Diseases. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Most patients with a history of mild or moderate adverse events following immunization [AEFI] can be safely reimmunized," write Gaston De Serres, MD, of Laval University, Quebec, and colleagues. Although recurrent AEFIs can sometimes occur after repeat doses of vaccine, this study suggests that the risk of recurrent AEFIs after re-vaccination is relatively low, especially when the previous reaction was mild or moderate.

Safety of Repeat Vaccination after Initial Reactions - 'Passive Surveillance' Data
In Quebec, healthcare professionals are legally required to report any "unusual or severe" AEFI related to a "passive surveillance" system similar to the Vaccine Adverse Event Reporting System (VAERS) used in the United States. The analysis included 5,600 patients with AEFIs reported to Quebec's passive surveillance database from 1998 through 2016, all of whom required further doses of the vaccine to which they reacted. (The analysis excluded seasonal influenza vaccine, which changes from year to year.)

Of 1,731 patients with available follow-up data, 1,350 patients were re-vaccinated: a rate of 78 percent. Most of the re-vaccinated children were under two years old; about one-half of the AEFIs were allergic-like reactions.

Sixteen percent of patients experienced some type of recurrent AEFI after re-vaccination. In more than 80 percent of cases, the recurrent reaction was no more severe than the initial reaction. The researchers analyzed potential risk factors for recurrent reactions, including:

Patient Characteristics. Children under age 2 were more likely to be re-vaccinated and less likely to have recurrent reactions, compared to older patients. Recurrence risk was similar for males and females.
Type of AEFI. Recurrence rate was similar for patients with most types of initial AEFIs. The risk was highest (67 percent) for patients with large local reactions with "extensive limb swelling." For patients who had allergic-type reactions, the recurrence rate was 12 percent. Severe allergic events (anaphylaxis) were very rare after re-vaccination.
Severity of AEFI. Patients with more severe initial AEFIs were less likely to be re-vaccinated: only 60 percent of children with severe reactions were re-vaccinated, compared to 80 percent of those with less-severe reactions. Within this selected group, patients with severe AEFIs were less likely to have recurrences: eight versus 17 percent.
Type of Vaccine. The recurrence rate did not differ significantly for different types of vaccines. The re-vaccination rate was highest (90 percent) for children with AEFIs to diphtheria-tetanus-pertussis vaccines.

Prior to this study, there have been limited data on the safety of reimmunizing patients who had a prior AEFI. The study is one of the largest to estimate the rate of recurrent AEFIs by type of reaction and type of vaccine - key information for healthcare providers and parents/caregivers making decisions about further immunization. The results support the safety of continued vaccination especially when the previous reaction was mild or moderate.

The study provides helpful information on the risk of recurrent reactions to specific vaccines and in patients with different types of initial reactions. Dr. De Serres and coauthors suggest that vaccine adverse event passive surveillance systems could be adapted to include "systematic and standardized follow-up" to provide more complete information on recurrence risk and other outcomes for children with AEFIs .