Body

New York, NY (June 2, 2021) - A phase 3 clinical trial co-led by Mount Sinai researchers is the first to show that immunotherapy after surgery to remove bladder cancer can reduce the risk of relapse for patients who are at high risk of their cancer returning in a deadly metastatic form, according to results published in The New England Journal of Medicine. The immunotherapy nivolumab was used as an adjuvant therapy, which is given after surgery in the hopes of maximizing its effectiveness.

The randomized trial, named "Checkmate 274," showed that using nivolumab increased these patients' chance of staying cancer free after surgery compared to patients who received a placebo. The average length of time before relapse nearly doubled in patients who received nivolumab, which is a monoclonal antibody immune checkpoint inhibitor that harnesses the immune system to fight cancer.

Surgery that removes the bladder or kidney and ureter is currently the standard of care for patients with urothelial cancer that has entered surrounding muscle or lymph nodes, though half of these patients later relapse with lethal metastatic cancer. Unfortunately for these patients, no consensus has emerged regarding treatments after surgery that might reduce the risk of cancer recurrence.

"These clinical trial results promise to impact standard treatment of patients with urothelial cancer of the kidney, ureter, or bladder by reducing the risk of metastatic recurrence after surgery," said Matthew Galsky, MD, senior author of the study and Director of Genitourinary Medical Oncology, Co-Director of the Center of Excellence for Bladder Cancer, Associate Director of Translational Research, and Co-Leader of the Cancer Clinical Investigation Program at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai. "Almost 200,000 people die each year of urothelial cancer worldwide, so advances like immunotherapy being used in this manner bring hope."

OAKLAND, Calif. -- In patients with insulin-treated type 2 diabetes, the use of continuous glucose monitors is associated with better blood sugar control and fewer visits to the emergency room for hypoglycemia, a Kaiser Permanente study published June 2 in the journal JAMA found.

The monitors have previously been shown to improve glucose control for patients with type 1 diabetes. Continuous glucose monitors are now the standard of care for these patients.

"The improvement in blood sugar control was comparable to what a patient might experience after starting a new diabetes medication," said the study's lead author Andrew J. Karter, PhD, a senior research scientist with the Kaiser Permanente Northern California Division of Research.

The retrospective, comparative effectiveness study included 5,673 patients with type 1 diabetes and 36,080 patients with type 2 diabetes treated with insulin who were self-monitoring their blood glucose. Between January 2015 and December 2019, on the recommendation of their doctors, 3,462 patients with type 1 diabetes and 344 with type 2 diabetes began using continuous glucose monitors.

Using statistical techniques that mimicked randomization in a clinical trial, the researchers evaluated before-and-after results among patients who initiated use of a continuous glucose monitor compared to the results among patients who did not. These analyses showed that continuous glucose monitors were associated with a decline in levels of HbA1c, a laboratory test used in the diagnosis and treatment of diabetes that measures blood sugar levels. The monitors also reduced emergency department visits and hospitalizations for hypoglycemia, or very low blood sugar. Hypoglycemia increases the risk for falls, cardiovascular disease, dementia, and death.

"Blood sugar levels that go too low can be dangerous," said the study's senior author Richard Dlott, MD, an endocrinologist and the medical director of population care for The Permanente Medical Group. "This study shows that continuous glucose monitors helped people stay close to their glucose targets without going too low."

For decades, people with diabetes have used finger sticks to test their blood sugar levels. Since 2017, Medicare has covered the cost of continuous glucose monitors for patients with diabetes who met certain qualifications. (Today, almost all people with type 1 diabetes qualify.) Continuous glucose monitors use a thin metallic sensor to detect blood sugar levels just under the skin. The sensor transmits blood sugar readings every 5 minutes to a receiver or smartphone. Continuous glucose monitors are available only with a prescription.

The study looked at patients with diabetes who started using continuous glucose monitors as prescribed by their doctor. To qualify under Medicare guidelines, a patient generally must give themselves 3 or more shots of insulin daily or use an insulin pump, perform blood glucose testing 4 or more times a day, and consistently communicate with a diabetes team every 3 to 6 months.

"Selective prescribing of continuous glucose monitors may partially explain the benefits we saw in these patients with type 2 diabetes," said Karter, who is also the associate director for the Health Delivery Systems Center for Diabetes Translational Research, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. "Doctors appeared to have preferentially prescribed monitors to patients with a history of hypoglycemia or at high risk of hypoglycemia."

The next step, the researchers say, is to determine if there are other patients with type 2 diabetes whose blood sugar would be better and more safely controlled with continuous glucose monitors. "This study found that patients who used continuous glucose monitors had very good results compared to those who continued only with intermittent testing using finger sticks," said Dr. Dlott. "We now need to determine whether there are other patients who might also benefit, even if they don't meet all of the Medicare criteria. The newest technology isn't always better for everybody. We need to identify the people who are most likely to benefit."

A new analysis of crime rates in 27 cities across 23 countries in Europe, the Americas, Asia and the Middle East has found that stay-at-home policies during the pandemic led to an overall drop in police-recorded crime of 37% across all the sites in the study.

A team of researchers led by the University of Cambridge and University of Utrecht examined trends in daily crime counts before and after COVID-19 restrictions were implemented in major metropolitan areas such as Barcelona, Chicago, Sao Paulo, Tel Aviv, Brisbane and London.

While both stringency of lockdowns and the resulting crime reductions varied considerably from city to city, the researchers found that most types of crime - with the key exception of homicide - fell significantly in the study sites.

Across all 27 cities, daily assaults fell by an average of 35%, and robberies (theft using violence or intimidation, such as muggings) almost halved: falling an average of 46%. Other types of theft, from pick-pocketing to shop-lifting, fell an average of 47%.

"City living has been dramatically curtailed by COVID-19, and crime is a big part of city life," said Prof Manuel Eisner, Director of the Violence Research Centre at the University of Cambridge and senior author of the study published in the journal Nature Human Behaviour.

"No drinkers spilling into the streets after nights out at bars and pubs. No days spent in shops and cafés or at the racetrack or football match. Some cities even introduced curfews. It choked the opportunism that fuels so much urban crime."

"We found the largest reductions in crimes where motivated offenders and suitable victims converge in a public space. There would be far fewer potential targets in the usual crime hotspots such as streets with lots of nightclubs," said Eisner.

Falls in crime resulting from COVID-19 stay-at-home orders tended to be sharp but short-lived, with a maximum drop occurring around two to five weeks after implementation, followed by a gradual return to previous levels.

Overall, the team found that stricter lockdowns led to greater declines in crime - although even cities with voluntary "recommendations" instead of restrictions, such as Malmo and Stockholm in Sweden, saw drops in daily rates of theft.

Theft of vehicles fell an average of 39% over the study sites. Researchers found that tougher restrictions on use of buses and trains during lockdowns was linked to greater falls in vehicle theft - suggesting that negotiating cities via public transport is often a prerequisite for stealing a set of wheels.

Burglary also fell an average of 28% across all cities. However, lockdowns affected burglary numbers in markedly different ways from city to city. While Lima in Peru saw rates plunge by 84%, San Francisco actually saw a 38% increase in break-ins as a result of COVID restrictions.

Data from many cities didn't distinguish between commercial and residential. Where it did, burglaries of private premises - rather than shops or warehouses - was more likely to decline, with more people stuck in-doors around the clock.

Reduction was lowest for crimes of homicide: down just 14% on average across all cities in the study. Dr Amy Nivette from the University of Utrecht, the study's first author, said: "In many societies, a significant proportion of murders are committed in the home. The restrictions on urban mobility may have little effect on domestic murders.

"In addition, organised crime - such as drug trafficking gangs - is responsible for a varying percentage of murders. The behaviour of these gangs is likely to be less sensitive to the changes enforced by a lockdown," said Nivette.

However, three cities where gang crime drives violence, all in South America, did see major falls in daily homicide as a result of COVID-19 policies. In Rio de Janeiro in Brazil, homicide dropped 24%. In Cali, Columbia, the drop was 29%, and in Lima, Peru, it plummeted 76%.

Rates of reported assaults also saw striking falls in Rio de Janeiro (56% drop) and Lima (75% drop). "It may be that criminal groups used the crisis to strengthen their power by imposing curfews and restricting movement in territories they control, resulting in a respite to the violence that plagues these cities," said Eisner.

Researchers found Barcelona to be something of an "outlier", with massive falls in assault (84% drop) and robbery (80% drop). Police-recorded thefts in the Spanish city declined from an average of 385 per day to just 38 per day under lockdown.

London saw less pronounced but still significant falls in some crime, with daily robberies dropping by 60%, theft by 44% and burglaries by 29%. The two US cities in the study, Chicago and San Francisco, had their best results in the category of assault, falling by 34% and 36% respectively.

The research team found no overall relationship between measures such as school closures or economic support and crime rates during lockdowns.

Added Eisner: "The measures taken by governments across the world to control COVID-19 provided a series of natural experiments, with major changes in routines, daily encounters and use of public space over entire populations.

"The pandemic has been devastating, but there are also opportunities to better understand social processes, including those involved in causing city-wide crime levels."

June 5, 2021 marks the 40th anniversary of the first report of AIDS cases and the onset of the American AIDS epidemic. In a new, thought-provoking paper in the New England Journal of Medicine, Professor Ronald Bayer and co-author Gerald Oppenheiner capture the experiences of the physicians who were central to the AIDS epidemic. In the words of the doctors, they relay what it meant to look back after 40 years and how they "aged together."

The doctors called their experiences extraordinary and the conditions demanding, under which they performed their duties and treated their patients. They speak of their work as "in the trenches," giving their careers immediate meaning and value that they never expected. As several physicians expressed, "The epidemic changed me in about every considerable way possible." And for some, their lives in medicine were bookended by another extraordinary moment in global health - the COVID-19 epidemic.

Dr. Ronald Bayer, professor of Sociomedical Sciences and co-director of the Center for the History and Ethics of Public Health at Columbia University Mailman School of Public Health, focuses his research on issues of social justice and ethical matters related to AIDS, tuberculosis, illicit drugs, and tobacco. An elected member of the Institute of Medicine of the U.S. National Academy of Sciences, he has served on its committees dealing with the social impact of these issues in addition to vaccine safety and the Ryan White Care Act. Dr. Bayer has been a consultant to the World Health Organization on ethical issues related to public health surveillance, HIV and tuberculosis.

MINNEAPOLIS - Older people with type 1 diabetes who have been to the hospital at some point for both low and high blood sugar levels may be at six times greater risk for developing dementia years later. The research is published in the June 2, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study also found that people with type 1 diabetes who visit the hospital for just one of the blood sugar extremes may also be at greater risk for developing dementia.

Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin.

Hypoglycemia is low blood glucose, or the main sugar in blood, that may result in loss of consciousness. Hyperglycemia results from insulin deficiency or extremely high blood sugar and dehydration. This study looked at severe glycemic events, which were defined as episodes of high or low blood sugar that resulted in an emergency room visit or hospital stay.

"For people with diabetes, both severely high and low blood sugar levels are emergencies and both extremes can largely be avoided. However, when they do occur, they can lead to coma, increased hospitalization and even death," said study author Rachel A. Whitmer, PhD, of the University of California Davis School of Medicine in Sacramento, Calif. "People with type 1 diabetes are living longer than before, which may place them at risk of conditions such as dementia. If we can potentially decrease their risk of dementia by controlling their blood sugar levels, that could have beneficial effects for individuals and public health overall."

The study looked at 2,821 people with an average age of 56 who had type 1 diabetes. Of those, 398, or 14%, had a history of severe low blood sugar; 335, or 12%, had a history of severe high blood sugar and 87, or 3%, had both. Researchers followed up with the people for an average of seven years to determine who had been diagnosed with dementia.

Researchers found that 153 people, or about 5%, developed dementia. After adjusting for age, sex and ethnicity, the people with low blood sugar events had a 75% greater risk of developing dementia than those without one. People with high blood sugar events had more than twice the risk of developing dementia than those without one.

However, the people who experienced both types of events had more than six times the risk of developing dementia than people who had neither event.

Researchers also looked at dementia incidence rates. After adjusting for age, the incidence rate of dementia in people with low blood sugar events was 26.5 cases for every 1,000 person-years compared to 13.2 for people without. Person-years take into account the number of people in a study as well as the amount of time spent in the study. The incidence rate of dementia in people with high blood sugar events was 79.6 cases for every 1,000 person-years, compared to 13.4 for people without.

For people who had both high and low blood sugar events at various times, the incidence rate of dementia was 98.5 for every 1,000 person-years, compared to 12.8 for those who had neither.

"Our findings suggest that exposure to severe glycemic events may have long-term consequences on brain health and should be considered additional motivation for people with diabetes to avoid severe glycemic events throughout their lifetime," Whitmer said.

A limitation of the study is that people had to be diagnosed with dementia by a health care provider to be counted as having dementia. Since many dementia cases go undiagnosed, this may have resulted in underreporting the number of dementia cases. Whitmer noted that the study was not designed to determine whether high and low blood sugar events caused dementia. It only showed an association.

ITHACA, N.Y. - Influencing millions of people on social media and being paid handsomely is not as easy as it looks, according to new Cornell University research.

Algorithm vagaries are just one of several challenges social media content creators face, according to study author Brooke Erin Duffy, associate professor of communication at Cornell.

"I think [our research] is a cautionary tale for aspiring creators as well as the broader public," Duffy said. "The people hoping to work as full-time YouTubers, Instagrammers, and TikTokers are led to believe it's easy and democratic. I disagree: if you look at who makes it as an influencer, for instance, they are not all that dissimilar to traditional celebrity exemplars, with a few exceptions. Social media celebrity remains lopsided."

Duffy and her collaborators interviewed 30 aspiring and professional content creators on a range of social media platforms - including Instagram YouTube, TikTok, Pinterest and Twitter - to learn about their experiences within and across platforms, including their pursuit of visibility and their understanding of the forces at play in their quest for metrics success.

In general, study participants all spoke the same language: They wished to have their content "seen," to "build an audience" and "get attention," to craft "posts that get more traction" and, in terms of metrics, "do well."

Relying on public sentiment and its taste for the flavor of the week is by no means a 21st century phenomenon. Content creators have for decades relied on opinion research - be it Nielsen ratings or newspaper subscription figures from the Audit Bureau of Circulation - to help guide creative decision making.

But nowadays, Duffy said, the science of determining what an audience likes and wants comes with a new twist: The tenuous nature of the platforms themselves.

"These [influencers and creators], they don't know if Instagram is going to be there when they wake up," she said. "And they don't know if TikTok is going to be banned the next day in the U.S. It's a much more accelerated, intensified form of precarity in the era of Google and Facebook."

Duffy and her collaborators view the "nested" precarities akin to a Russian matryoshka doll, with the outermost doll being capitalism itself, followed by the markets, the platform ecology and algorithms as the innermost doll. The promise of being seen, and talked about, is what drives many to the world of social media influencing. But it's not all that it appears, Duffy said.

"Despite the romanticism of social media creative careers, they are structured by various levels of precarity," she said. "Some of these precarities well predate the rise of social media, but one of the most novel forms is the precarity of these algorithmic systems."

The pollution of the world's oceans with plastic waste is one of the major environmental problems of our time. However, very little is known about how much plastic is distributed globally in the ocean. Models based on ocean currents have so far suggested that the plastic mainly collects in large ocean gyres. Now, researchers at the University of Bern have calculated the distribution of plastic waste on a global scale while taking into account the fact that plastic can get beached. In their study, which has just been published in the "Environmental Research Letters" scientific journal, they come to the conclusion that most of the plastic does not end up in the open sea. Far more of it than previously thought remains near the coast or ends up on beaches. "In all the scenarios we've calculated," says Victor Onink, the study's lead author, "about 80 percent of floating plastic waste drifts no more than 10 kilometers from the coast five years after it entered the ocean."

Much of this plastic also washes ashore. The study's authors conclude that between a third to virtually all of the buoyant plastic washed into the sea is stranded. This has serious consequences for the environment, as coastal ecosystems are particularly sensitive to plastic pollution. Polluted coasts also dramatically lose their value for tourism.

The Nile pollutes the Mediterranean Sea

The proportion of stranded plastic is highest in the regions of the world with the largest sources of plastic waste. These include areas such as Southeast Asia and the Mediterranean. Concentrations are lowest in sparsely populated regions such as the polar regions, the coast of Chile and parts of the coast of Australia. For physics doctoral student Victor Onink, there are two reasons why there is so much plastic waste in the Mediterranean: On the one hand, a lot of plastic enters the Mediterranean Sea, particularly through the Nile. On the other hand, this sea is relatively small and closed. These factors also contribute to the high concentration of plastic.

Plastic waste must not be allowed to enter the sea in the first place

The Bernese ocean modellers also investigated the question of what proportion of the stranded plastic waste comes from where. Their answer: a lot of beached plastic is from local sources, especially when the local sources are large. Ocean currents also play a major role in the distribution of waste. Regions with a high proportion of plastic originating locally include the coasts of China, Indonesia and Brazil. Conversely, regions were also identified where an above-average proportion of plastic escapes to the open sea. These include the eastern United States, eastern Japan and Indonesia. "In these places, it would be particularly effective to collect plastic waste before it can escape into the open ocean," Victor Onink points out.

The Bernese researcher takes a more skeptical view of initiatives to collect plastic from the ocean itself, which receive a great deal of media attention. "The concentration of plastic appears relatively low in the open ocean," Victor Onink points out. "It makes you wonder if resources are really being used most efficiently with these kinds of projects." Instead, it might be more effective to prevent plastic from reaching the open ocean in the first place, such as by fishing plastic out of large rivers or removing plastic from coastlines.

Rapidly reducing waste volumes

The new research results show where in the world such measures are particularly needed. "With our modelling, we present solid estimates of where the biggest problems with plastic waste in the sea are in the world," says Victor Onink. Now it is first and foremost a matter of finding political solutions to rapidly reduce the amount of waste. A reminder: Depending on the calculations, 1 to 13 million tons of plastic end up in the ocean every year.

Nano-sized particles have been engineered in a new way to improve detection of tumors within the body and in biopsy tissue, a research team in Sweden reports. The advance could enable identifying early stage tumors with lower doses of radiation.

In order to enhance visual contrast of living tissues, state-of-the-art imaging relies on agents such as fluorescent dyes and biomolecules. Advances in nanoparticle research have expanded the array of promising contrast agents for more targeted diagnostics, and now a research team from KTH Royal Institute of Technology has raised the bar further yet. They are combining optical and X-ray fluorescence contrast agents into a single enhancer for both modes.

Muhammet Toprak, Professor of Materials Chemistry at KTH, says the synthesis of contrast agents introduces a new dimension in the field of X-ray bio-imaging. The research was reported in the American Chemical Society journal, ACS Nano.

"This unique design of nanoparticles paves the way for in vivo tumor diagnostics, using X-ray fluorescence computed tomography (XFCT)," Toprak says.

He says the new "core-shell nanoparticles" may have a role to play in the development of theranostics, a portmanteau for therapy and diagnostics, in which for example single drug-loaded particles could both detect and treat malignant tissues.

The core-shell contrast agent gets its name from its architecture: it consists of a core combination of nanoparticles with previously-established potential in X-ray fluorescence imaging, such as ruthenium and molybdenum (IV) oxide. This core is encased in a shell comprised of silica and Cy5.5, a near-infrared fluorescence-emitting dye for optical imaging techniques such as optical microscopy and spectroscopy.

Toprak says that encapsulating the Cy5.5 dye within the silica shell improves the agent's brightness and extends its photo-stability--enabling the dual optical/X-Ray imaging approach. In addition, silica provides the benefit of tempering the toxic effects of the core nanoparticles.

Tests with laboratory mice have shown that the XFCT contrast agents enable location of early stage tumors of only a few millimetres in size.

Toprak says the technology opens the possibility to identify early stage tumors in living tissue. That's because the presence of multiple contrast agents increases the odds that diseased areas will show up in scans, even as the distribution of the nanoparticles becomes obscured by their interaction with proteins or other biological molecules.

"Nanoparticles of different size, originating from the same material, don't appear to be distributed in the blood in the same concentrations," Toprak says. "That's because when they come into contact with your body, they're quickly wrapped in various biological molecules--which gives them a new identity."

A multitude of contrast agents for XFCT would enable studying the biodistribution of nanoparticles in-vivo using low-dose X-rays, he says. That would allow identifying the best size and surface chemistry of the nanoparticles for the desired targeting and imaging of the diseased region.

Oncotarget published "Molecular characterization of lung squamous cell carcinoma tumors reveals therapeutically relevant alterations" which reported that unlike lung adenocarcinoma patients, there is no FDA-approved targeted-therapy likely to benefit lung squamous cell carcinoma patients.

The authors performed survival analyses of lung squamous cell carcinoma patients harboring therapeutically relevant alterations identified by whole exome sequencing and mass spectrometry-based validation across 430 lung squamous tumors.

They report a mean of 11.6 mutations/Mb with a characteristic smoking signature along with mutations in TP53, CDKN2A, NFE2L2, FAT1, KMT2C, LRP1B, FGFR1, PTEN and PREX2 among lung squamous cell carcinoma patients of Indian descent.

In overall, the data suggests 13.5% lung squamous patients harboring druggable mutations have lower median overall survival, and 19% patients with a mutation in at least one gene, known to be associated with cancer, result in significantly shorter median overall survival compared to those without mutations.

They present the first comprehensive landscape of genetic alterations underlying Indian lung squamous cell carcinoma patients and identify EGFR, PIK3CA, KRAS and FGFR1 as potentially important therapeutic and prognostic target.

Dr. Amit Dutt and Dr. Kumar Prabhash said, "Lung cancer is the leading cause of cancer-related deaths across the globe with more than 1.7 million deaths annually."

"Lung cancer is the leading cause of cancer-related deaths across the globe with more than 1.7 million deaths annually."

Non-small cell lung cancer, a more common type of lung cancer, accounts for 85% of all lung cancers comprising two major histological subtypes, adenocarcinoma and squamous cell carcinoma.

The adenocarcinoma of the lung arises mostly in patients with no previous significant tobacco exposure, while the squamous subtype is found almost exclusively in former or current smokers with relatively higher overall mutational load.

However, no approved targeted therapy regimens are available for lung squamous patients in spite of distinct genetic alterations identified in the tumor type, including alterations in TP53, PIK3CA, CDKN2A, MLL2, PTEN, KEAP1, NFE2L2,DDR2, FGFR1, PDGFRA, SOX2, and CCND1.

Moreover, most of the reported studies describe Caucasian, Chinese, Korean and Japanese population, with sparse information on the molecular profile of lung squamous patients of Indian origin that accounts for about 30% of Indian lung cancer disease.

In this study, the authors sought to describe the first genetic landscape of alterations underlying 430 Indian lung squamous genomes and uncover the prevalence of known targetable somatic alterations using next generation sequencing followed by validation using mass spectrometry.

The Dutt/Prabhash Research Team concluded in their Oncotarget Research Output, "we present a striking variation of genetic heterogeneity among lung squamous cell carcinoma patients of Indian descent. The findings from this study extend the scope of the ongoing umbrella clinical trials such as the Lung-MAP master protocol that aims to evaluate multiple targeted therapeutic strategies in lung squamous cell carcinoma patients and the AACR Project GENIE database collaborative project [29, 39]. A systematic exploration of these target genes in lung squamous cell carcinoma patients and variability across ethnicity could further extend our insights into the etiology of lung squamous cancer."

A new study reveals that B cells can produce antibodies against the H1N1 influenza virus that also neutralize various other influenza strains, marking a development that could inform research into potential universal flu vaccines. The findings showed that the antibodies targeted two conserved regions of the virus - the cause of the 2009 swine flu pandemic - and that transfers of the antibodies protected mice from lethal infection. The work suggests that vaccines that target the two sites might be able to protect against a broader array of flu strains. Influenza is one of humanity's greatest microbial foes, being responsible for both seasonal flu and more severe flu pandemics that pose major threats to global health. Current vaccines for seasonal flu induce antibodies against the "head" region of hemagglutinin, the major surface antigen on influenza viruses. However, this strategy only protects against a few strains of influenza, and these antigen sites mutate frequently enough that a new vaccine is needed each year. Searching for better vaccine targets, Jenna Guthmiller and colleagues studied the properties of antibodies from memory B cells exposed to the 2009 pandemic H1N1 influenza virus. They saw that the B cells produced antibodies that targeted the receptor-binding site or lateral patch epitopes, two regions of the hemagglutinin head that are conserved across many strains of influenza. As a result, these antibodies neutralized most H1 influenza viruses the researchers tested, and antibodies against the lateral patch also reacted to the H3N2 strain and to influenza B viruses. Furthermore, transfers of the antibodies protected mice from lethal doses of H1N1 influenza, and some of the lateral patch antibodies also neutralized a natural, recent flu strain with mutations in a major antigen site.

DALLAS, June 2, 2021 -- A "prescription" to sit less and move more is the optimal first treatment choice for reducing mild to moderately elevated blood pressure and blood cholesterol in otherwise healthy adults, according to the new American Heart Association scientific statement published today in the American Heart Association's journal Hypertension.

"The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks. The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity," said Bethany Barone Gibbs, Ph.D., FAHA, chair of the statement writing group and associate professor in the department of health and human development and clinical and translational sciences at the University of Pittsburgh in Pittsburgh, Pennsylvania.

An estimated 21% of U.S. adults, about 53 million, have systolic (top number) blood pressure between 120-139 mm Hg or diastolic (bottom number) blood pressure between 80-89 mm Hg; both values are abnormally high. Individuals in this range who have an otherwise low risk of heart disease or stroke meet the American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Likewise, the scientific statement authors estimate that 28% of U.S. adults, or about 71 million, have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. These people would meet the 2018 AHA/ACC Cholesterol Treatment Guidelines criteria for lifestyle-only treatment. Lifestyle changes highlighted in the blood pressure and cholesterol guidelines include increased physical activity, weight loss, improving diet, stopping smoking and moderating alcohol intake.

"Increasing physical activity can help lower blood pressure and cholesterol, along with many other health benefits." Gibbs said. Physical activity also has benefits beyond cardiovascular health, including a decreased risk of some cancers, improved bone, brain and mental health, and better sleep.

Increasing physical activity results in clinically meaningful reductions in systolic and diastolic blood pressure, typically an average reduction of 3 or 4 mm Hg. Similar improvements are seen with blood cholesterol. For example, increased physical activity typically decreases LDL cholesterol by 3 to 6 mg/dL.

The statement highlights research concluding that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

To improve health, the U.S. Department of Health and Human Services 2018 Physical Activity Guidelines for Americans suggest individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise, or 75 minutes of vigorous aerobic activity weekly plus two or more strength training sessions each week.

However, there is no minimum amount of time to receive benefits from physical activity. "Every little bit of activity is better than none," said Gibbs. "Even small initial increases of 5 to 10 minutes a day can yield health benefits."

The statement provides suggestions for clinicians to provide exercise "prescriptions" such as patient counselling, incorporating health behavior professionals (e.g., health coaches) and connecting patients to local resources like community centers to help meet their physical activity needs.

According to the statement, prescribing exercise includes:

Screening patients about physical activity at every interaction, as recommended by the American College of Sports Medicine's 'Exercise is Medicine' campaign. Clinicians can ask patients to report their physical activity with a few questions or by using a wearable device.

Providing ideas and resources for supporting patients to improve and sustain regular physical activity;

Meeting patients where they are by exploring activities that the patient enjoys and provide ideas for early success; and

Encouraging and celebrating small increases in physical activity, such as walking more or taking the stairs.

"In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit - and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus - the message that we must be relentless in our pursuit to 'sit less and move more' throughout the day is more important than ever," said Gibbs.

A healthy diet around the time of conception through the second trimester may reduce the risk of several common pregnancy complications, suggests a study by researchers at the National Institutes of Health. Expectant women in the study who scored high on any of three measures of healthy eating had lower risks for gestational diabetes, pregnancy-related blood pressure disorders and preterm birth. The study was conducted by Cuilin Zhang, M.D., Ph.D., and colleagues at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). It appears in the American Journal of Clinical Nutrition.

The researchers analyzed dietary data collected multiple times during pregnancy from the NICHD Fetal Growth Study. Nearly 1,900 women responded to questionnaires on their diets at eight to 13 weeks of pregnancy and were asked to estimate what they ate in the previous three months. At 16 to 22 weeks and 24 to 29 weeks, the women identified what they ate in the previous 24 hours. Their responses were scored according to three measures of healthy eating: the Alternate Healthy Eating Index (AHEI), Alternate Mediterranean Diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) diet. All three measures emphasize consumption of fruits, vegetables, whole grain, nuts and legumes while limiting red and processed meat.

Overall, the researchers found that following any of the diets around the time of conception through the second trimester was associated with a lower risk of gestational diabetes, hypertension, preeclampsia and preterm delivery. For example, women with a high AHEI score at 16 to 22 weeks had a 32% lower risk for gestational diabetes than women with a low AHEI score. Women with a high DASH score at eight to 12 weeks and 16 to 22 weeks had a 19% lower risk for pregnancy-related high blood pressure disorders. A high AMED score at 24 to 29 weeks or a high DASH score at 24 to 29 weeks was associated with a 50% lower risk for preterm birth.

(10 a.m. EDT, June 2, 2021--Denver) - New research published in the Journal of Thoracic Oncology (JTO) suggests the method used to calculate how obesity is measured may affect whether it is considered a risk factor for lung cancer. The JTO is an official journal of the International Association for the Study of Lung Cancer.

Although the association between measures of obesity and both cancer incidence and outcome are clear in some solid tumor types such as breast, esophageal, and colon cancer, the relationship between obesity and lung cancer is more nuanced.

Now, a group of researchers led by Sai Yendamuri, M,D, from Rosewell Comprehensive Cancer Cancer in Buffalo, N.Y., suggests that using traditional methods of measuring obesity, including the body mass index, might be one of the reasons why obesity is not considered a risk factor for lung cancer.

The researchers conducted an examination of patients with lung cancer before they underwent surgery and calculated their excess body weight using visceral fat index measured by CT scans.

"While BMI is easy to measure, its use has been criticized due to its inability to discriminate between fat and lean body mass," Dr. Yendamuri said. "BMI also fails to account for body fat distribution. It is becoming increasingly recognized that 'visceral' or 'central obesity' is the primary driver behind the health outcomes linked to high body fat."

A previous study demonstrated a close correlation between visceral obesity as determined by analysis of a single slice of abdominal CT and a volumetric analysis of visceral fat. This finding demonstrated the feasibility of using such image-based measurements in a large cohort of patients.

"Based on the established knowledge described above, we sought to measure central obesity in a cohort of [patients with] stage I NSCLC [who were] undergoing lobectomy at our institution and examine its association with oncologic outcomes," Joseph Barbi, PhD, first author of the manuscript, reported. Because patients with early stage disease are typically treated with surgery alone, without other treatments that may complicate analysis, the researchers believed they provide a context where the relationship between central obesity and tumor progression can be studied without additional therapy-associated confounders.

Dr. Barbi and colleagues examined 554 patients with stage I and II NSCLC undergoing lobectomy. Of these, reliable fat area measurements were obtained in 513 patients: 499 (97.3 %) at L3, 5 (0.9%) at L2, and 9 (1.8%) at L1. Similarly, 159 patients with advanced-stage NSCLC with molecular testing had reliable fat area measurements: 146 (91.8%) at L3, 10 at L2 (6.3%) and 3 at L1(1.9%). Interobserver correlation of VFI measurements were good (n = 53; R2 = 0.95). Correlation of measurements between L2 and L3 levels (n = 29; R2 = 0.92; Slope = 1.05) and between L1 and L3 levels (n = 28; R2 = 0.85; Slope = 1.05) were also good (Supplementary Figure S1). Therefore, in the few cases where measurements at L3 were not available, measurements at L2 or L1 were used. Importantly, CT scans of these patients could be used to clearly identify individuals with distinctly predominant visceral or subcutaneous adipose tissue distributions.

"These findings clarify the truly negative relationship that exists between central obesity and lung cancer outcomes, and they present a viable alternative to the use of BMI in retrospective studies of obesity rooted in biology with clear relevance to cancer outcomes," Barbi reported.

Taken together, the clinical and preclinical findings suggest a common potential mechanism for the accelerating effect of obesity on the development of tumor burden in the obese -- namely, an apparently multifaceted immune dysfunction prevalent in the tumors of obese mice and patients, the authors report.

"Our study provides much needed clarity to the relationship between adiposity and NSCLC patient survival, providing firm scientific justification for the targeting of obesity's pro-tumor effects, which include decidedly adverse effects on the antitumor immune response," Dr. Yendamuri wrote.

"Our findings also reaffirm the utility and relevance of available mouse models to study further the mechanisms of obesity's lung cancer promoting effects. Importantly, they also validate a refined approached for studying obesity in retrospective data sets [of patients with cancer]," he said.

"Visceral obesity is associated with poor overall and recurrence free survival in patients with early NSCLC, and these findings may inform continued efforts to better predict lung cancer outcomes and management, as well as apply treatments and develop novel therapeutic approaches to prevent or control early-stage lung cancers across a patient pool that is increasingly overweight and obese," according to the study.

Researchers at Linköping University in Sweden have developed an app to help women achieve a healthy weight gain and lifestyle during a pregnancy. The results from an evaluation of the app have now been published in two scientific articles. Using the app contributed to a better diet. Pregnant women with overweight or obesity who received the app also gained less weight during pregnancy.

"Pregnancy is a phase in life when many people try to do what is best for themselves and their baby. We think it's important to be able to offer a tool that has a sound base in research. Our vision is that the app will help both those working in maternity care and pregnant women, by providing support for a healthy lifestyle", says Marie Löf, professor at the Department of Health, Medicine and Caring Sciences at Linköping University, who has led the research.

Weight gain during pregnancy is normal. The definition of appropriate weight gain, or recommended weight gain, depends on the weight status prior to pregnancy. There may be negative consequences if a woman gains too much or too little weight.

"Gaining too much weight during pregnancy increases the risk of pre-eclampsia and gestational diabetes, and of subsequent overweight in both mother and child. At the same time, gaining less weight than recommended is associated with an increased risk of preterm birth and low birth weight", says Johanna Sandborg, doctoral student at Karolinska Institutet affiliated with Linköping University. She is first author for both of the articles that have been published in the journal JMIR mHealth and uHealth.

The researchers emphasise that the app aims to support pregnant women in achieving a healthy lifestyle during pregnancy. It provides an exercise guide, help to keep track of dietary habits and physical activity, support in changing habits, recipes and information. It has been developed by a team consisting of nutritionists, dieticians, midwives, physicians, physiotherapists, behavioural scientists, and systems developers.

In order to evaluate the effectiveness of using the app, the researchers have conducted a study in which just over 300 pregnant women in Östergötland took part. Half of them received standard care within the maternity care system (the control group), and the other half also had access to the app (the intervention group). Previous similar studies of smartphone apps have most often focused on pregnant women with overweight and obesity, in other words, those with a high body mass index (BMI). In this case, however, women from all BMI categories were included. All participants registered their physical activity and food consumption (using the Riksmaten FLEX tool from the National Food Agency, Sweden) at 14 weeks of pregnancy and approximately six months later. The researchers also measured the women's weight, height and body fat percentage on both occasions.

"The diet in the group that used the HealthyMoms app was slightly better towards the end of the pregnancy than that of the control group. Another result is that the women with overweight or obesity before pregnancy in the intervention group gained on average 1.7 kg less than those in the control group. We regard it as very positive that our app can lead to an effect similar to that seen in studies evaluating interventions that require more personnel and resources", says Marie Löf.

The researchers interviewed 19 of the women who had had access to the app. In these interviews, the participants expressed that the app contained a good combination of useful tools, and that they trusted the content since the app came from a credible source.

"We now have an evidence-based, validated tool that we can use in the healthcare system, benefitting both pregnant women and personnel", says Marie Löf.

The researchers are working on how to spread the HealthyMoms app to a broader group, and to offer it in more languages than Swedish. They are working with co-workers who speak Somali and Arabic not only to translate the information, but also to adapt the app for different groups.

Sophia Antipolis - 1 June 2021: A study in 5.8 million children has found a higher incidence of stroke four decades later in those whose mother had high blood pressure or pre-eclampsia while pregnant. The research is presented at ESC Heart & Stroke 2021, an online scientific conference of the European Society of Cardiology (ESC).1

"Our findings indicate that hypertensive disorders during pregnancy are associated with increased risks of stroke and potentially heart disease in offspring up to the age of 41 years," said study author Dr. Fen Yang, PhD student, Karolinska Institutet, Stockholm, Sweden. "Studies with longer follow-up are needed to confirm the results and improve understanding of the possible underlying mechanisms."

Previous research has suggested that children exposed to maternal hypertensive disorders during gestation have increased risks of preterm birth, foetal growth restriction and cardiovascular risk factors including high blood pressure, obesity, and diabetes later in life. But evidence for a direct link with severe cardiovascular disease is limited. This study explored this link focusing on ischaemic heart disease and stroke.

This population-based cohort study linked national registers from two countries. Live singleton births in Sweden (1973 to 2014) and Finland (1987 to 2014) were followed for ischaemic heart disease and stroke until 2014. Hypertensive pregnancy disorders were identified including high blood pressure (starting before or during pregnancy), and preeclampsia (high blood pressure and organ damage).

The researchers estimated the hazards of ischaemic heart disease and stroke related to high blood pressure conditions during pregnancy. The analyses were adjusted for factors that could influence the relationships such as the child's year of birth, sex, and congenital anomalies and the mother's age, parity, marital status, education level, body mass index, smoking during early pregnancy, and family history of cardiovascular disease.

The analyses were repeated after excluding children with a preterm birth or foetal growth restriction, which have both been associated with an increased risk of cardiovascular disease.

Sibling analyses were performed to control for the potential effect of unmeasured genetic and environmental familial factors. These analyses included sibling pairs discordant for both the exposure (hypertensive pregnancy disorders) and the outcome (ischaemic heart disease/stroke).

Among more than 5.8 million singletons in the study, 218,322 (3.76%) were born to mothers with hypertensive disorders during pregnancy. During up to 41 years of follow-up, 2,340 (0.04%) offspring were diagnosed with ischaemic heart disease and 5,360 (0.09%) were diagnosed with stroke.

Offspring exposed to maternal hypertensive pregnancy disorders had 29% and 33% increased risks of ischaemic heart disease and stroke, respectively. The associations were independent of preterm birth and foetal growth restriction. In the sibling analyses, the association remained for stroke but not for ischaemic heart disease.

Dr. Yang explained: "The sibling analyses suggest that shared genetic or environmental factors were the main contributors to the association between hypertensive pregnancy disorders and the risk of ischaemic heart disease. However, the increased risk of stroke persisted, indicating the possibility of direct intrauterine effects."

She concluded: "This was one of very few studies in this area and more research is needed. It was an observational study, and we cannot make any conclusions about causality. If our findings are supported by further studies, steps could be taken to prevent cardiovascular disease in offspring exposed to hypertensive pregnancy disorders - for example by focussing on maternal health and screening children for risk factors like high blood pressure early in life."