Body

What The Study Did: This randomized clinical trial looked at changes in levels of the hormone estradiol in men with hormone receptor-positive breast cancer after three months of treatment with endocrine therapies.

Authors: Sibylle Loibl, M.D., Ph.D., of the German Breast Group in Neu-Isenburg, Germany, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamaoncol.2020.7442)

Editor's Note: The article includes conflicts of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Ultrasound is not only used as an imaging technique but targeted pulses of ultrasound can be used as a highly accurate treatment for a range of brain diseases, for which there were previously only limited treatment options. Over the last few years, several revolutionary techniques of this kind have been developed, primarily in Toronto but also at MedUni Vienna. The Viennese technique improves brain functions by externally activating neurons that are still functional. Improvements can be expected in various neuropsychiatric brain diseases such as Alzheimer's, Parkinson's, stroke, Multiple Sclerosis, and neuralgia. A review jointly written by MedUni Vienna and the University of Toronto and published in the specialist journal "Advanced Science" shows that the new treatments are already on the brink of broad clinical application.

Over the last few years, new concepts for ultrasound brain therapy have been developed. Highly focused ultrasonic waves can now be used for non-invasive surgery, focal delivery of therapeutics or genes to selected areas of the brain and therapeutic modulation of neural networks in various brain diseases. According to Roland Beisteiner, who oversaw the development of the new method of transcranial pulsed stimulation with ultrasound (TPS) at the Department of Neurology of MedUni Vienna and Vienna General Hospital, the new ultrasound techniques are not just a "take-it-or-leave-it" choice but a genuine advantage for clinical practice. "The techniques developed in Vienna and Toronto represent innovative additional options we can use to supplement the existing established treatments. The patient data that has now been published show that the transcranial ultrasound innovations are safe and ready for broad clinical application." The huge extra advantage of the Viennese technique is that it is virtually free from any side-effects.

Viennese TPS: broad clinical roll-out in sight

The TPS neural stimulation technique developed by an international consortium led by Vienna was presented as the cover article in a top scientific journal at the beginning of 2020. Alzheimer's patients in this pilot study displayed sustained improvements over a period of three months. The broad clinical roll-out has already started but, according to Beisteiner, requires special expertise: "The new treatment is an ongoing scientific development and requires clinicians to have specific neurological and methodological expertise, as well as knowledge of brain function," explains Beisteiner. As well as diseases such as Alzheimer's, Parkinson's, stroke, Multiple Sclerosis, and neuralgia, which have previously also been investigated with older, less accurate brain stimulation techniques, there are probably completely new applications for TPS as well. TPS is the only technique that can also activate deep regions of the brain in a targeted and non-invasive way. Therefore, all diseases where it is possible to restore disrupted brain functions by activating still-functional neurons, are candidates for the new Viennese therapy. TPS is already licensed for the treatment of Alzheimer's (CE certification).

Ultrasound techniques from Toronto: different technique, different targets

The two other techniques developed at the University of Toronto under the clinical lead of study co-author Andres Lozano likewise use ultrasonic waves. Targeted, non-invasive ultrasound surgery is already licensed for essential tremor and tremor-dominant Parkinson's disease.

For the first time, it is now possible to treat brain malfunctions by targeted deactivation of overactive neurons without the need to open the skull, making this a technique that could be relevant in the future for many neurological movement disorders. The third innovative ultrasound technique, targeted drug, antibody or gene therapy, solves one of the main challenges in neurology, in that it facilitates non-invasive local opening of the blood-brain barrier. Although many highly effective therapeutics are essentially available, it is not always possible to deliver them to the necessary site in the brain. "By overcoming this barrier, it is now possible to deliver therapeutics and genes to the affected brain areas for the first time. This can potentially be used to treat all brain diseases where local drug therapy is effective, such as tumours and motor system diseases, for example," says Beisteiner.

Requests to participate in studies

The new ultrasound treatments are being offered in the context of studies and at various treatment centres. However, since these are highly complex techniques, they require extensive briefing of patients and proven neuroscientific expertise to carry out the treatment.

Researchers at NUI Galway have identified genomic signatures in women developing the most common type of breast cancer that can be associated with long-term survival. The NUI Galway team analysed the genomes of breast cancer patients to look for associations with survival rates using advanced statistical techniques.

Carried out by Lydia King during her studies in NUI Galway's MSc in Biomedical Genomics programme, the research has been published in the international journal PLOS ONE.

Early detection by national screening programmes and timely treatment for patients diagnosed with "luminal" types of breast cancer have resulted in excellent prognoses with survival rates of over 80% within five years of treatment. The challenge of long-term survival however is not as well understood and studies have shown that more than half of all recurrences for luminal breast cancers takes place after this time point. Identifying patients most likely to suffer relapses would therefore be invaluable to patient monitoring and choice of therapies.

Genomes are the collection of all DNA in the chromosomes of cells containing all of our inherited genetic information. Cancer is often described as a disease of the genome because it is a consequence of alterations in the instructions encoded within some of our cell's DNA that lead to them proliferating without restraint. These alterations are a hallmark of a tumour and can range from single base-pair errors in the DNA code to the duplication or deletion of entire chromosome arms. The level of alterations in the genome of a cancer cell is known as 'genome instability'.

The NUI Galway team focused on whether an overall measurement of genome instability in cancer cells from luminal breast cancer patients, observed at diagnosis and before treatment started, could provide additional information in predicting their long-term survival. To test this hypothesis, they analysed data from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) led by Cambridge University.

METABRIC is one of the first multi-centre studies aimed at uncovering links between the clinical and genomic properties of biopsies taken from over 2000 patients suffering from primary breast carcinoma enrolled between 1977 and 2005. The richness of having both high quality genomic data and the up-to-date clinical data makes the METABRIC database a very powerful resource for researching breast cancer.

Lydia and her colleagues calculated the level of genome instability across all 2,000 patient genomes, then used multivariable statistical modelling to identify distinct long term survival outcomes for luminal subtype breast cancer patients. This enabled them to confirm the significantly worse prognoses for luminal A patients suffering from the most extreme levels of genome instability in their tumour biopsies.

Importantly, the NUI Galway researchers were able to stratify the patients into groups and link the genome instability score with clinical classifications. This provided clear evidence that patients diagnosed with Luminal A breast cancer that had high levels of genome instability exhibited similar patterns of reduced survival commonly seen in patients suffering from the more aggressive Luminal B subtype. Since patients identified as either Luminal A or B subtypes normally receive different treatments, the result suggests that incorporating genomic analysis into clinical care could improve diagnosis and allow oncologists to tailor treatments for individual patients. This approach of using genomic analysis is known as "precision (or genomic) medicine" and is helping to define a new standard of care in many areas of clinical practice.

Senior author of the paper, Dr Aaron Golden of NUI Galway's School of Mathematics, Statistics and Applied Mathematics, said: "This is an excellent example of how interdisciplinary research is supposed to work in the genomics data sciences. This started out as a speculative idea between myself, a physicist, and my colleague Dr Andrew Flaus, who is a biochemist from the School of Natural Sciences, and was taken by Lydia for her MSc dissertation project. We then received the invaluable assistance of our statistician colleague Dr Emma Holian and through Lydia's phenomenally hard work we could demonstrate the promise of precision genomics in cancer treatment."

Commenting on this result, Dr Pilib Ó Broin, Programme Director of NUI Galway's MSc in Biomedical Genomics, added: "This is a fantastic result for Lydia and her supervisors and highlights the enormous benefits of training interdisciplinary scientists like Lydia who possess both the statistical and computational skills as well as the domain knowledge necessary to generate new biological insights from genomics data with the potential to improve patient care."

FOOD SCIENCE Sweden takes first, Denmark second and Norway lags at the bottom when it comes to how much organic food is served in canteens, kindergartens and other public sector workplaces across the three Nordic nations. This, according to the results of a new report by the University of Copenhagen. The report details plenty of potential for expanding the conversion to organic food service in the Danish public sector--a topic of discussion across the EU at the moment.

Plate with potatoes and beef

The governments of Denmark, Norway and Sweden are all keen on ramping up the amount of organic food being served in their hospital kitchens, kindergartens, canteens and other institutions. Doing so benefits the environment, biodiversity and animal welfare, not to mention that consumers are demanding organic. A new report by the University of Copenhagen's Department of Food and Resource Economics compares the performance of these three countries in introducing more organic food to their public sectors.

The study reports Sweden as Scandinavia's top performer, with a 39 percent share of organic food in their public sector. Denmark comes in at 22 percent and Norway, at just 1 percent. The Swedish experience demonstrates that large volumes of organic food procurement can be achieved nationally within the public sector and that there remains plenty of potential for expansion in Denmark.

"Sweden in particular, but also Denmark in part, should to be regarded as countries with successful track records in introducing organic meals into the public sector, while Norway's efforts seem to have failed," states Professor Carsten Daugbjerg, who is behind the report.

In Sweden, organic equates with health

According to the study, the Swedish strategy has been to establish concrete targets for how much organic food should be procured by public kitchens, which municipalities then should live up to.

"At the same time, the Swedes have framed organic within a broader context, linking organic food with public health. This is as an important explanation for Sweden's success in bringing organic foods into the public sector. However, it is probably also related to Swedish municipalities being more receptive to the authority and objectives coming from Stockholm," explains Professor Daugbjerg.

According to Daugbjerg, the effort to get organic foodstuffs into public sector kitchens in Denmark has been greater than in Sweden, an effort that has succeeded in linking organic food and sustainability, for example. However, the effort to link organic foods to health has been weaker in Denmark than in Sweden.

"Within the Danish public sector, there hasn't been the same type of effort to connect public health with organic food, as there has in Sweden. In Sweden, they have a concept for healthy diets in the public sector called SMART, which links organic food to public health. There, municipalities actually use this concept in their menu planning and meal delivery," says Carsten Daugbjerg.

Demand must follow production

Within the EU, there is currently discussions on converting more farmland to organic farming. In fact, the EU would like 25 percent of its agricultural area to be organic, which would help protect the environment, among other things. To kickstart this development, there are proposals for special assistance schemes for farmers who switch from conventional to organic farming. However, according to Daugbjerg, this cannot stand on its own if the EU wants to reach its goal.

"In Denmark, there has been a great deal of focus on increasing demand as production expands. This strategy has been successful. By focusing on increasing supply through farmer incentives, there is a risk of oversupply and falling prices," he explains.

According to Carsten Daugbjerg, the Danish strategy has been successful in engaging market actors to grow the market for organic products. The collaboration between the Ministry of Environment and Food and the organic sector, in particular Organic Denmark, has played a major role here.

"Over time, efforts to stimulate demand have ranged from motivating and assisting supermarket chains in their marketing of organic products, to engaging public sector kitchen staff. This occurred while production grew. And, I think the EU can learn a lot from this," states the Professor Daugbjerg.

Alongside Sweden, Austria and Switzerland, Denmark leads within the EU when it comes to sales of organic products. Nationally these products account for just under 12 percent of Denmark's total food sales.

People undergoing long-term dialysis are almost 4 times more likely to die from COVID-19 and should be prioritized for vaccination, found a new Ontario study published in CMAJ (Canadian Medical Association Journal).

"As the COVID-19 pandemic proceeds, focused efforts should be made to protect this population from infection including prioritizing patients on long-term dialysis and the staff treating them for SARS-CoV-2 vaccination," writes Dr. Peter Blake, provincial director, Ontario Renal Network, Ontario Health, and professor, Schulich School of Medicine and Dentistry, Western University, London, Ontario, with coauthors.

The study looked at data on 12 501 patients undergoing long-term dialysis in Ontario between March 12 and August 20, 2020, of whom 187 (1.5%) were diagnosed with SARS-CoV-2 infection. Of these, 53 people (28.3%) died and 117 (62.6%) were admitted to hospital. By contrast, uninfected people who were receiving dialysis during that period had a death rate of 5.8% and a hospitalization rate of 27%. Since this analysis and particularly in the last two months, the number of people on dialysis infected with the virus has risen to over 570 and the number of deaths has increased to 120.

Risk factors for SARS-CoV-2 infection in people on dialysis include hemodialysis at a hospital facility as compared to home dialysis; living in long-term care; living in the Greater Toronto Area; Black, Indian subcontinent and other non-White ethnicity; and lower income.

In addition to vaccination and infection precautions, the authors recommend educating patients about their increased risk of infection and higher mortality, including risks associated with social activities. Paid sick leave should be available for those in high-risk occupations. Other strategies should include a low symptom threshold for testing, more space between treatment stations in dialysis units, and regular testing of high-risk groups, such as those living in long-term care.

The unmet HIV prevention and treatment needs of female sex workers and especially their male clients could contribute substantially to ongoing HIV transmission in South Africa, according to a new study led by researchers at the University of Bristol, UK.

The researchers used mathematical modelling to look at the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa.

They found that, over a ten-year period (2010-19), sex between female sex workers and their paying clients contributed 6.9 per cent of new HIV infections, while sex between clients with their non-paying partners contributed 41.9 per cent. Sex between men contributed 5.3 per cent and sex between men who have sex with men and their female partners contributed 3.7 per cent.

The study, published in Journal of the International AIDS Society, also looked at the potential impact and efficiency of increasing HIV treatment among each risk group. Increasing treatment among female sex workers, their paying clients and men who have sex with men would be up to five times more efficient for reducing HIV transmission than increasing treatment among the general population.

Dr Jack Stone, from Bristol Medical School and lead author of the study, said: "South Africa has made considerable investment in scaling up interventions for preventing and treating HIV and are close to achieving the UNAIDS HIV treatment targets. However, the rate of new HIV infections remains over twice the UNAIDS 2020 target. To close this gap, and to regain momentum, the HIV response must adapt to focus on those communities where the risks and disease burden are greatest, which for South Africa are the paying clients of female sex workers."

Professor Peter Vickerman, from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, who supervised the study, said: "The HIV response in South Africa has traditionally focused on the general population. This is based on the assumption that key populations such as female sex workers and men who have sex with men play a small role in HIV transmission in countries where HIV is endemic. Our findings show this is not the case and suggest that South Africa, and indeed other countries, may not be focusing new initiatives on those who most need them, which, in South Africa, are the paying clients of female sex workers."

Dr Jenny Coetzee, CEO of the African Potential Foundation and Principal Researcher at the Perinatal HIV Research Unit, who contributed data from a study on male clients, commented that: "The response to HIV in South Africa places the burden of responsibility for prevention and behavioural change upon women. It is vital that we begin to draw men into the solution. This study highlights the importance of a criminalised and often marginalised group of men who have clearly been overlooked in our national response".

A global team of researchers has developed a new strategy for fast and reliable antibody tests, which can quantify the immune response induced by vaccination and reveal the timeline and stage of pathogen infection.

Led by Professor Martin Hegner, Principal Investigator in CRANN and Trinity College Dublin's School of Physics, the team's one-step quantitative antibody tests are conducted using (blood) serum and are on a par with the gold-standard, enzyme-linked immunosorbent assay (ELISA) technique.

The major advantage of the newly developed nano technique with respect to ELISA tests is that it is equally sensitive and able to simultaneously detect multiple target molecules - but in a fraction of the time.

As a global multidisciplinary research consortium from Europe, Africa and the US, Professor Hegner and his co-workers focused on malaria vaccines and their generated humoral immune response for case study analysis. Malaria is a life-threatening epidemic disease with 228 million estimated annual cases occurring worldwide. It caused over 400,000 deaths last year.

The team's findings have been published in the interdisciplinary journal, Nanoscale, which is a high-impact, peer-reviewed journal of the Royal Society of Chemistry.

Professor Hegner said:

"The current worldwide situation caused by the spread of SARS-CoV-2 cannot leave us blind towards the ongoing malaria plague that our technology directly addresses. While malaria is our published test case, we believe that this new technology will improve antibody testing in a broad range of diseases and infections."

"The direct technique greatly simplifies the preparation protocol that in ELISA includes many washings and waiting steps, hence reducing the amount of consumables needed and thus the relative cost. It will therefore be well suited to use in emergency situations."

"Due to the COVID-19 pandemic, it has been increasingly emphasised during such a tough year that a novel diagnostic tool must be added to our arsenal. Our technology is capable of directly quantifying immune responses with potential application across a range of diseases. We are currently investigating its applicability to COVID-19 antigen responses."

Laparoscopic surgery, a less invasive alternative to conventional open surgery, involves inserting thin tubes with a tiny camera and surgical instruments into the abdomen. To visualize specific surgical targets, ultrasound imaging is used in conjunction with the surgery. However, ultrasound images are viewed on a separate screen, requiring the surgeon to mentally combine the camera and ultrasound data.

Modern augmented reality (AR)-based methods have overcome this issue by embedding ultrasound images into the video taken by the laparoscopic camera. These AR methods precisely map the ultrasound data coordinates to the coordinates of the images seen through the camera. Although the process is mathematically straightforward, it can only be done if the pose (position and orientation) of the ultrasound probe (transducer) is known by the camera coordinate system. This has proven to be challenging, despite many strategies for tracking the laparoscopic transducer. Hardware-based tracking by attaching electromagnetic (EM) sensors to the probe is a feasible approach, but it is prone to errors due to calibration and hardware limitations. Camera vision (CV) systems can also be used to process the images acquired by the camera and determine the probe's pose. However, because they rely entirely on camera data, such methods fail if the probe is defocused or if the camera's view is occluded. Thus, such CV systems are not yet ready for clinical settings.

To this end, in a recent study published in the Journal of Medical Imaging, a team of scientists from the US have come up with a creative solution. Instead of relying entirely on either hardware- or CV-based tracking, they propose a hybrid approach that combines both methods. Michael Miga, Associate Editor of the journal, explains, "In the context of interventional imaging with laparoscopic ultrasound, tracking the flexible ultrasound probe for correlation with preoperative images is a challenging task. The team led by Dr. Shekhar has demonstrated an impressive tracking ability with the proposed hybrid approach; these types of capabilities will be needed to advance the field of image-guided surgery."

To begin with, the team designed and 3D-printed a custom tracking mount to be placed on the tip of the transducer. This mount contained a sensor for EM-based tracking and several flat surfaces on which black-and-white markers can be attached for CV-based tracking. These markers, which resemble QR codes, are detected in the images recorded by the camera using an open-source AR algorithm called ArUco. Once two or more markers were detected in a frame, the scientists could immediately calculate the pose of the transducer.

Because CV-based tracking is more accurate than EM-based, the system defaults to using the former to track the transducer. And whenever markers are undetectable in a frame, the system adaptively switches to EM-based tracking. Moreover, to enhance their approach beyond the simple combination of both techniques, the scientists developed an algorithm that can perform corrections to the EM-based tracking results based on previous camera frames. This greatly reduces the errors associated with the EM sensor, especially those due to rotations of the laparoscopic probe.

The team demonstrated the effectiveness of their strategy through experiments on both a realistic tissue phantom and live animals. Excited about the results, Raj Shekhar, who led the study, concludes, "Our hybrid method is more reliable than using CV-based tracking alone and more accurate and practical than using EM-based tracking alone. It has the potential to significantly improve tracking performance for AR applications based on laparoscopic ultrasound."

As this hybrid strategy undergoes further improvements, it can pave the way for laparoscopic surgery to be more effective and safer, leading to faster recoveries and better patient outcomes overall.

Researchers at Baylor College of Medicine found that while most individuals responded to respiratory syncytial virus (RSV) natural reinfection with a typical sustained antibody response associated with protection, a few individuals surprisingly responded atypically, not being able to sustain the antibody response, which declined to levels that made the individuals susceptible to RSV reinfection.

The researchers highlight in their study, published in the journal Vaccine, that their findings point at a subpopulation of people who also may not maintain an antibody response to vaccines and suggest the need to characterize patient-specific responses to respiratory viral infections, such as COVID-19.

"RSV is the leading cause of childhood acute lower respiratory illness worldwide and a significant cause of morbidity and mortality in older adults," said corresponding author Dr. Pedro A. Piedra, professor of molecular virology and microbiology, pediatrics and of pharmacology and chemical biology at Baylor. He also is the director of Baylor's Clinical Laboratory Improvement Amendments (CLIA)-Certified Respiratory Virus Diagnostic Laboratory. Piedra also is a leader in the fight against COVID-19.

In response to RSV infection, the body produces specific antibodies that have been correlated with protection from infection and reduction of severe disease, but reinfection is still frequent.

"To understand RSV reinfection, we studied the levels of the natural RSV-specific antibody response on an adult population during an RVS season in Houston," said first author Brittani N. Blunck, graduate student in the Piedra lab.

The researchers found that the 19 individuals they studied could be placed in one of three categories according to their antibody profiles: A) those whose RSV antibody profile did not change, an indication that they did not get reinfected during the study period. B) those who showed an increase in RSV antibodies, a typical response showing that they had a reinfection that boosted the antibody response, and C) a surprising, small group that showed good antibody levels at the beginning of the study followed by a quick decline in antibodies to levels that made them susceptible to reinfection.

The 'original antigenic sin'

"The other important finding was what we call the 'original antigenic sin,'" Piedra said. "This phenomenon, which has been demonstrated for the influenza virus and others, refers to the immune system responding more to older infections than to recent infections."

In this original antigenic sin case, the immune system produced a stronger antibody response to RSV strains it had encountered long ago than to other strains of the same virus it encountered more recently.

"That was surprising but not totally unexpected because we see that with other viruses. However, we had not seen that for RSV before," Piedra said.

"We think that our main findings, the existence of a small portion of a human population that does not sustain an RSV antibody response after reinfection and the original antigenic sin, have important implications for vaccine development and deserve further study," Blunck said.

"Understanding natural reinfection is essential for vaccine development because it helps us design more effective vaccines," said co-author Dr. E. Lynn Zechiedrich, Kyle and Josephine Morrow Chair in Molecular Virology and Microbiology at Baylor.

"This study is also relevant to the current COVID-19 epidemic, as in some ways RSV and SASRS-Cov-2 are similar," said co-author Dr. Brian Gilbert, associate professor of molecular virology and microbiology at Baylor. "We need more detailed studies on the immune responses to SARS-CoV-2, the virus that causes COVID-19."

The researchers are continuing their studies by investigating the responses of other branches of the immune system, such as the cellular immune response, to RSV reinfection, as well as the mechanism that mediates the atypical antibody response observed in this work.

Researchers from Nanyang Technological University, Singapore (NTU Singapore), Singapore University of Technology and Design (SUTD) and Khoo Teck Puat Hospital (KTPH) have developed a new way to create "food inks" from fresh and frozen vegetables, that preserves their nutrition and flavour better than existing methods.

Food inks are usually made from pureed foods in liquid or semi-solid form, then 3D-printed by extrusion from a nozzle, and assembled layer by layer.

Pureed foods are usually served to patients suffering from swallowing difficulties known as dysphagia. To present the food in a more visually appetising way, healthcare professionals have used silicone moulds to shape pureed foods, which is labour and time intensive, and requires storage.

While 3D food printing means food can be easily produced in a desired shape and texture in a shorter time, the dehydrated food and freeze-dried powders used as food inks usually contain a high percentage of food additives such as hydrocolloids (HCs) to stabilise the ink and enable a smoother printing process. High concentration of HCs usually changes the taste, texture and aroma of the printed food, making it unappetising to patients with dysphagia. This may lead to reduced food consumption and malnutrition among patients.

To overcome this challenge, the research team explored various combinations of fresh and frozen vegetables to make the food inks stable.

Not only were they able to better preserve the nutrition of the printed food, they also made it more palatable. This new method of making food inks should lead to increased meal consumption by patients, contributing positively to their physical health and mental state of mind.

Additionally, the team discovered that vegetables could be broadly classified into three categories with each requiring a different hydrocolloid treatment in order to become printable. For instance, garden pea, carrot and bok choy were chosen as representatives in each category, requiring no HCs, one type of HC and two types of HCs, respectively (refer to images).

Prof Yi Zhang, the principal investigator from the NTU team said, "Our technology helps to provide dysphagic patients with adequate nutrient-rich and safe diets. Their feeding is more dignified, enabling them to socialise and consume meals that look, feel and taste like regular food. Our method of 3D printing fresh vegetables can be used easily in hospitals, nursing homes, day care centres for the ageing population with dysphagia and other swallowing disorders. Our research is also another step forward in digital gastronomy, where we can cater to specific requirements prescribed by dieticians, such as nutrition customisation and visual appeal."

Prof Chua Chee Kai, corresponding author and the Head of Pillar, Engineering Product Development at SUTD, added: "The next frontier of additive manufacturing is 3D food printing. As the 3D food printing landscape is increasingly evolving, we are excited to continue pushing the boundaries of this industry to find innovative solutions for global issues such as food security and sustainability."

Gladys Wong, co-principal investigator and Senior Principal Dietitian from KTPH said: "3D Food Printing is more than a novelty. I believe it will be a viable approach in the near future in providing sustenance and nourishment to our increasing ageing population. Our frail, elderly patients as well as those with swallowing difficulties will be able to enjoy a visually presentable and pleasurable dining experience even with a restrictive diet of smooth pureed dishes."

Tsukuba, Japan - Although exercise is known to enhance cognitive function and improve mental health, the neurological mechanisms of this link are unknown. Now, researchers from Japan have found evidence of the missing link between aerobic fitness and cognitive function.

In a study published in Medicine & Science in Sports & Exercise, researchers from the University of Tsukuba revealed that spontaneous eye blink rate (sEBR), which reflects activity of the dopamine system, could be used to understand the connection between cognitive function and aerobic fitness.

The dopaminergic system is known to be involved in physical activity and exercise, and previous researchers have proposed that exercise-induced changes in cognitive function might be mediated by activity in the dopaminergic system. However, a marker of activity in this system was needed to test this hypothesis, something the researchers at the University of Tsukuba aimed to address.

"The dopaminergic system is associated with both executive function and motivated behavior, including physical activity," says first author of the study Ryuta Kuwamizu. "We used sEBR as a non-invasive measure of dopaminergic system function to test whether it could be the missing link between aerobic fitness and cognitive function."

To do this, the researchers asked healthy participants to undergo a measure of sEBR, a test of cognitive function, and an aerobic fitness test. They also measured brain activity during the cognitive task using functional near-infrared spectroscopy.

"As expected, we found significant correlations between aerobic fitness, cognitive function, and sEBR," explains Professor Hideaki Soya, senior author. "When we examined these relationships further, we found that the connection between higher aerobic fitness and enhanced cognitive function was mediated in part by dopaminergic regulation."

Furthermore, activity in the left dorsolateral prefrontal cortex (l-DLPFC) during the cognitive task was the same or lower in participants with higher sEBR compared with lower sEBR, even though those with higher sEBR appeared to have greater executive function, and thus higher neural efficiency.

"Although previous studies have indicated that aerobic fitness and cognitive function are correlated, this is the first to provide a neuromodulatory basis for this connection in humans. Our data indicate that dopamine has an essential role in linking aerobic fitness and cognition," says first author Kuwamizu.

Given that neural efficiency in the l-DLPFC is a known characteristic of the dopaminergic system that has been observed in individuals with higher fitness and executive function, it is possible that neural efficiency in this region partially mediates the association between aerobic fitness and executive function. Furthermore, physical inactivity may be related to dopaminergic dysfunction. This information provides new directions for research regarding how fitness affects the brain, which may lead to improved exercise regimens. For instance, exercise that specifically focuses on improving dopaminergic function may particularly boost motivation, mood, and mental function.

The COVID-19 pandemic has had a profound effect on higher education -- shifting classes online, canceling events, and putting financial strain on institutions.

One area of academia that has actually shown positive increases, however, is the submission of research papers. A study conducted by Michelle Bell, Mary E. Pinchot Professor of Environmental Health at the Yale School of the Environment (YSE), and postdoctoral associate Kelvin C. Fong found the rate of manuscript submission to a major peer-reviewed journal (American Journal of Public Health) were higher during the pandemic -- but also revealed a concerning imbalance in submissions by gender.

Using data provided from January 1, 2020 to May 12, 2020, the researchers found that increases were higher for submissions from men compared with women: 41.9 percent vs. 10.9 percent for corresponding author. In the United States, submissions increased 23.8 percent for men, but only 7.9 percent for women.

"This is an example of remaining inequities that exist broadly in academia," Bell says. "While we would like to believe gender roles have changed, disparities remain. They are often just minimized."
Bell says she believes much of the imbalance is due to women taking on household tasks while working from home during the pandemic, particularly childcare. She cited anecdotal evidence from colleagues and peers, as well as editors of scientific journals, but also leaned on her own experience during the pandemic. Bell, a mother of two school-aged children, said she noticed her "own productivity was plummeting" while working from home and conducted the study, in part, to see how women in public health research were being affected.

"The fact that I have tenure and yet still felt it made me concerned for what others were going through," she says, adding that the disparity could have long-lasting effects on women becoming full-time faculty members, women leading research projects and, ultimately, women's voices being adequately represented in critical conversations surrounding public health.

"Many researchers have shifted their research focus to COVID, yet only 25 percent of COVID-related articles have been authored by women," she says. "The longer these disparities go on, they longer we'll see inequity -- with or without COVID."

Bell, who has a secondary faculty appointment at the Yale School of Public Health, focuses her research on how human health is affected by environmental conditions, including air pollution, weather, and climate change, and also examines environmental justice. Her work, which is largely based in epidemiology, biostatistics, and environmental engineering, is designed to be policy relevant and contribute to decision making that better protects human health and benefits society.

Last year, Bell was elected to the National Academy of Medicine, one of the highest honors in the fields of health and medicine, recognizing individuals who have demonstrated outstanding professional achievement and commitment to service.

Amsterdam, NL, February 3, 2021 - Patients with Parkinson's disease (PD) and healthcare professionals caring for them have expressed concerns about the COVID-19 vaccine's efficacy and safety in the specific context of PD and its symptomatic treatment. In a commentary just published in the Journal of Parkinson's Disease, a set of experts addresses these concerns from an evidence-based perspective. Their conclusion is that COVID-19 vaccination with approved vaccines should be recommended to persons with PD, unless there is a specific contraindication.

"The arrival of these vaccines has created hope for people with PD, as this can help to mitigate their risk of becoming infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can lead to serious, life-threatening disease, at least among those with more advanced PD," explains lead author Bastiaan R. Bloem, MD, PhD, Radboud University Nijmegen Medical Center; Donders Institute for Brain, Cognition and Behavior; Department of Neurology, Nijmegen, the Netherlands, and co-Editor-in-Chief of the Journal of Parkinson's Disease.

Based on the authors' interpretation of the scientific literature, the unfolding experience with widespread vaccination in the population at large, and input from the International Parkinson and Movement Disorder Society Scientific Issues Committee (IPMDS-SIC), the take home messages with respect to COVID-19 vaccination for persons with PD are:

Compared to the general population, the risk of SARS-CoV-2 infection causing serious, life-threatening disease seems higher for people living with PD, at least among those with more advanced disease.

The approved mRNA-based vaccines and viral vector vaccines under development are not known or expected to interact with the neurodegenerative process in PD.

The types or incidence of side effects of these vaccines in persons with PD seem no different than in the general population.

The vaccines also seem safe for older adults, but caution is needed for the specific subgroup of very frail and terminally ill elderly persons with PD living in long-term care facilities.

COVID-19 vaccination is not known to interfere with the current therapies of PD.

Vaccinated persons with PD must continue to comply with the public health guidelines to reduce exposure and transmission of COVID-19.

Insights may change, and we must consciously monitor newly emerging data from both trials and real-life vaccination programs.

The authors strongly encourage visiting the website of the International Parkinson and Movement Disorder Society where recommendations will be updated as new data are published based on further experience, clinical trials and real-life clinical practice: https://www.movementdisorders.org/MDS-Files1/COVID-19vaccination01042021.pdf (for medical professionals) and https://www.movementdisorders.org/COVID-19-Pandemic-MDS/MDS-COVID-19-Vaccine-Statement-for-Patients.htm (for persons with PD).

"Taking all current evidence into consideration, perhaps this is the light at the end of the tunnel. We encourage our community of movement disorder specialists to recommend COVID-19 vaccination with approved vaccines to their patients with PD or their responsible caregivers, unless there is a specific contraindication," states Prof. Bloem. "Finally, even after vaccination, it is important that persons with PD continue complying with the public health guidelines to reduce exposure and transmission of COVID-19 as recommended by the World Health Organization and the Centers for Disease Control and Prevention."

WHAT:

An experimental single-dose, intranasal influenza vaccine was safe and produced a durable immune response when tested in a Phase 1 study published in the Journal of Clinical Investigation. The investigational vaccine, called Ad4-H5-VTN, is a recombinant, replicating adenovirus vaccine designed to spur antibodies to hemagglutinin, a protein found on the surface of influenza viruses that attaches to human cells.

The investigational vaccine was developed by Emergent Biosolutions Inc., (Gaithersburg, Maryland). It was administered intranasally (28 study participants), as an oral capsule (10 participants) and via a tonsillar swab (25 participants) to healthy men and non-pregnant women ages 18 to 49 years.

The participants who received the vaccine intranasally or via tonsillar swab showed significantly higher H5-specific neutralizing antibody levels compared to the group receiving the vaccine capsule orally. The participants who received the intranasal vaccine shed viral DNA for two-to-four weeks, but virus could be cultured for a median of only one day. Participants had evidence of H5-specific CD4+ and CD8+ T-cell responses. Additionally, volunteers who received the intranasal vaccine had high levels of serum neutralizing antibodies at 26 weeks after vaccination, and this level was unchanged at three to five years after a single intranasal dose of the vaccine. The duration of viral shedding correlated with a high magnitude of neutralizing antibody response at week 26. In addition, the intranasal vaccine induced a mucosal antibody response in the nose, mouth, and rectum.

The study authors speculate that replication-competent vector vaccines may have advantages over other types of vaccines because they can express viral proteins at higher levels and for longer durations. Additionally, this type of vaccine induces a mucosal immune response that is critical for limiting transmission of viruses that infect mucosal tissues.

The vaccine platform could be highly adaptable for use against other viruses including HIV and SARS-CoV-2, according to the authors.

BATON ROUGE, LOUISIANA - In patients with type 2 diabetes, big swings in blood sugar levels between doctors' visits are associated with an increased risk of heart disease.

The study, published in the journal Diabetes, Obesity & Metabolism, looked at more than 29,000 patients with type 2 diabetes over a two-year period. Patients who already had heart disease were excluded.

The American Diabetes Association recommends adults with diabetes maintain an A1c, the average blood sugar level over the past two to three months, of less than 7 percent to reduce complications from diabetes, such as heart disease. However, studies - including this one -- have shown that wide swings in blood sugar levels may be a better predictor of diabetic complications than the A1c reading at any single doctor's office visit.

"The underlying mechanism for the relationship between wide variations in blood sugar levels between doctor's appointments and high risk of heart disease in patients with type 2 diabetes is unclear," said Gang Hu, MD, PhD, Associate Professor and Director, Chronic Disease Epidemiology Lab at Pennington Biomedical Research Center. "It's possible that episodes of severely low blood sugar may be the connection."

Research has shown that wide variations in blood sugar levels are associated with poor health outcomes and even death. A 2017 Johns Hopkins study found that one-third of people with diabetes hospitalized for a severe low blood sugar episode died within three years of the incident.

"We recommend that patients and their doctors implement therapies that can reduce wide swings in blood sugar levels and the associated episodes of severe low blood sugar," Dr. Hu said. "Our findings suggest that measuring the swings in blood hemoglobin A1c levels over a specific time - six months to a year, for example - could serve as a supplemental blood sugar target," he added.