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Medicated drops may help close small macular holes over a two- to eight-week period, allowing some people to avoid surgery to fix the vision problem, a new study suggests.

The findings, based on a retrospective multicenter case series published Dec. 15, 2020, in Ophthalmology Retina, could lead to a better understanding of which patients may benefit from the treatment, as well as the timeline of the treatment's effectiveness.

"For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina," said ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, senior author of the study. Skondra is an associate professor of ophthalmology and visual science and director of the J. Terry Ernest Ocular Imaging Center at the University of Chicago Medicine.

Macular holes are age-related and usually affect people over 60 years old. An area located in the retina on the inside back of the eyeball, the macula allows us to have sharp, central vision. Depending on the size and location of the break in a person's macula, the holes can cause distorted, blurred or a dark patch in central vision.

Between 4% and 11.5% of macular holes end up closing on their own, but for those that do not, the traditional treatment is a vitrectomy. This surgical procedure involves removing most of the gel-like fluid that fills the space between the retina and lens, repairing the macula at the back of the eye, then adding a gas bubble to the eye cavity. Much like a temporary bandage, the gas bubble helps the edges of the hole come together and eventually close.

Unfortunately, patients must remain face down for several days and nights after the procedure while the gas bubble floats to the back of their eye. Even then, a small percentage of holes do not close; others may reopen later or the patient may develop complications, such as a cataract, retinal detachment, scar tissue or peripheral vision loss.

All 14 of the study's patients had some swelling around the hole, which is common, and half had previously undergone retinal surgery.

As an alternative to surgery, the researchers prescribed a daily three-drug regimen -- medications that are FDA-approved and routinely used for other eye conditions -- consisting of prednisolone or difluprenate, ketorolac or bromfenac and brinzolamide or dorzolamide. The goal was to dehydrate patients' retinas, decrease the swelling and allow the edges of the macular holes to creep back together.

Using this topical medicated treatment, twelve of the fourteen patients had holes that closed within two to eight weeks - two to four times faster than spontaneous closure rates of macular holes. The two patients that did not have closure within this time period had multiple missed follow-up appointments. The treatment was most effective for patients whose macular holes were less than 200 micrometers in diameter. The length of time the drops were administered then tapered off, ranged from 3 1/2 to 20 months.

"Adding a nonsurgical approach to even a small subset of patients is refreshing not only to retina surgeons, but especially for patients with small macular holes," said Ronald Gentile, MD, a professor of ophthalmology at the Icahn School of Medicine at Mount Sinai in New York and contributing author of the study.

The researchers now hope to conduct a prospective randomized trial. "In the future, we want to definitively determine the benefits of a drop regimen for treating macular holes compared to the natural history of macular holes closing on their own without any drop treatment," said Skondra.

Researchers at Vanderbilt University Medical Center and colleagues have identified genetic factors that increase the risk for developing pneumonia and its severe, life-threatening consequences.

Their findings, published recently in the American Journal of Human Genetics, may aid efforts to identify patients with COVID-19 at greatest risk for pneumonia, and enable earlier interventions to prevent severe illness and death.

Despite the increasing availability of COVID-19 vaccines, it will take months to inoculate enough people to bring the pandemic under control, experts predict. In the meantime, thousands of Americans are hospitalized and die from COVID-19 each day.

"This study is so important because we performed analyses separately in participants of Caucasian ancestry as well as African ancestry to identify genetic risk factors contributing to pneumonia susceptibility and severity," said Jennifer "Piper" Below, PhD, associate professor of Medicine and the paper's corresponding author.

"Combined with systemic racism and socioeconomic factors that have been reported by others, these genetic risk differences may contribute to some of the disparities we observe in COVID-19 outcomes," Below said.

The researchers conducted genome-wide association studies (GWAS) of more than 85,000 patients whose genetic information is stored in VUMC's BioVU biobank and which has been linked to "de-identified" electronic health records stripped of personal identifying information. GWAS can identify associations between genetic variations and disease.

With colleagues from the University of North Carolina at Chapel Hill, the University of Texas MD Anderson Cancer Center in Houston, and the Icahn School of Medicine at Mount Sinai in New York, the VUMC researchers identified nearly 9,000 cases of pneumonia in patients of European ancestry, and 1,710 cases in patients of African ancestry.

The strongest pneumonia association in patients of European ancestry was the gene that causes cystic fibrosis (CF). This disease produces abnormally thick mucus leading to chronic infections and progressive respiratory failure.

In patients of African ancestry, the strongest pneumonia association was the mutation that causes sickle cell disease (SCD), a red blood cell disorder that increases the risk for pneumonia, influenza and acute respiratory infections.

Children with CF and SCD are at particular risk for severe disease if they contract COVID-19.

The researchers found that "carriers" who are unaffected by CF yet carry a copy of the CF gene had a heightened susceptibility to pneumonia, and those who are unaffected by SCD yet carry a copy of the SCD mutation were at increased risk for severe pneumonia.

Further studies will be needed to determine whether these carriers also bear "a silent, heightened risk for poor outcomes from COVID-19," the researchers said.

To identify other genetic variations that increase pneumonia risk, they removed patients with CF and SCD from their analysis, repeated the GWAS, and used another technique called PrediXcan, which correlates gene expression data with traits and diseases in the electronic health record.

This time they found a pneumonia-associated variation in a gene called R3HCC1L in patients of European ancestry, and one near a gene called UQCRFS1 in patients of African ancestry. The molecular function of R3HCC1L is unclear, but deletion of the UQCRFS1 in mice disrupts part of their infection-fighting immune response.

"Although our understanding about the genetic mechanism of pneumonia is still limited, this study identified the novel candidate genes, R3HCC1L and UQCRFS1, and offered an insight for further host genetic studies of COVID-19," said the paper's first author, Hung-Hsin Chen, PhD, MS, a postdoctoral fellow in Below's lab.

"Our findings may be applied to identify the individuals with high risk of severe pneumonia and develop a precise treatment for them," Chen said.

CHAPEL HILL, N.C. - Many organizations are looking at effective ways to communicate the importance of wearing a mask, especially as highly transmissible new strains of coronavirus threaten to cause a surge in infections.

Experts at the University of North Carolina at Chapel Hill suggest positive messages are critical to supporting the effort.

Their findings, described in a study published in December in the International Journal of Environmental Research and Public Health, give public health experts, leaders and communicators critical insight to craft messaging that could potentially increase mask usage during the pandemic.

"As science evolved during the pandemic, it became clear wearing masks was going to be a critical step," said Allison Lazard, associate professor at the UNC Hussman School of Journalism and Media. "But there just isn't much out there for evidence-based messaging, especially not for what might motivate people to wear face coverings."

Lazard led the study with Victoria Shelus, doctoral student in health behavior at the UNC Gillings School of Global Public Health and the Carolina Population Center. Researchers conducted six virtual focus groups with residents in North Carolina to gain a better understanding of when and why they are using face coverings, as well as potential insights for messaging that might improve rates of usage.

Focus group diversity, perspectives on mask wearing

The six focus groups featured participants from many demographics, including Latinx (English- and Spanish-speaking); Black, Indigenous and people of color (BIPOC); white and living in a rural area; and young adults aged 18-25.

Focus group participants reported that they wore face coverings frequently when in public, indoor settings - including grocery stores, health care facilities and religious services - but did not wear them when outside and able to practice physical distancing. Participants also reported forgoing masks while home alone or with household members, as well as in indoor office settings with co-workers.

Study participants were primarily motivated to wear masks to protect and respect the safety of fellow community members, especially family who are at higher risk of complications from infection. Focus groups commonly believed that masks were effective and that wearing one was a matter of personal responsibility. The authority of mask mandates and public health guidance also played a motivating role.

Conversely, participants did not use masks in situations where they did not feel their use was necessary, such as around family and trusted friends or colleagues. The study reported that "these interactions were not perceived as occurring in public. These perceptions are problematic, as cluster infections among family, friends and colleagues remain a common pattern for COVID-19 transmission."

Social challenges prevented some from wearing masks or asking others to wear them out of fear of causing offense. Some cited barriers related to physical challenges and low perception of susceptibility. In addition to confusion about whether masks protected the wearer or only others around them, some participants were confused by guidance at the beginning of the pandemic that called for masks to be reserved only for health care personnel. And while infrequent, myths and conspiracy theories surrounding facial coverings caused concern.

Issues related to identity - such as political affiliation, or the perception that masks were "uncool," "not masculine" or an infringement on individual rights - also created challenges. According to the study, "even participants who consistently wore face coverings disliked being told what to do."

Communications solutions

In discussion of potential communication strategies with the focus groups, concise and positive messages about togetherness and unity were more appealing than messages of fear or instructiveness. Stories that conveyed the personal effects of COVID-19 were particularly impactful, such as accounts from health care workers or those who had lost a loved one to the virus.

"As COVID-19 cases continue to rise in North Carolina and across the United States, there is an urgent need for effective messaging to encourage the use of face coverings," said Shelus. "Among our recommendations is a need for public health messaging to normalize the use of masks in social settings. We're seeing a rise in COVID-19 cases from unmasked indoor interactions with family and friends over the holidays, and this may continue over the winter months."

Following the focus groups, the study team launched a broader survey to ask more individuals in North Carolina about what might help to motivate them to wear a face mask.

The insights from this survey were similar to those gained in the study -- residents want to protect others and themselves, and they want positive messages to encourage them to do so.

"We are pleased to see our insights incorporated in the 'Whatever Your Reason' campaign that the North Carolina Department of Health and Human Services has launched statewide to encourage everyone to 'get behind the mask,'" said Lazard.

A recent study published in Acta Obstetricia et Gynecologica Scandinavica found that questions typically asked to new mothers to screen for depression after giving birth can also help to detect depressive symptoms and other mental disorders during early pregnancy.

The questions are part of what's called the Edinburgh Postnatal Depression Scale. In the study of 2,271 women, 85% of women with a score of 13 or higher had one or more mental disorders or risk factors for mental disorders during early pregnancy.

"The Edinburgh Postnatal Depression Scale seems to be a valuable screening tool to detect depressive symptoms as well as other mental disorders during early pregnancy," the authors wrote.

The US prevalence of the autoimmune disease lupus is 72.8 cases per 100,000 individuals, according to an analysis of population-based registries. The analysis, which is published in Arthritis & Rheumatology, found that the rate is 9 times higher for females than males (128.7 vs. 14.6 per 100,000), and it's highest among American Indians/Alaska Natives and Black females.

The study's investigators estimate that in 2018, a total of 204,295 persons in the United States had lupus.

"This meta-analysis is a culmination of almost two decades of work from a network of five Centers of Disease Control and Prevention-funded population-based registries and provides prevalence estimates for systemic lupus erythematosus among the major racial/ethnic demographics in the United States," said lead author Peter M. Izmirly, MD, of the NYU School of Medicine. "These detailed estimates on how many Americans are affected by lupus may have implications for the various stakeholders who study and treat the disease."

Where people die can affect the quality of their deaths and the end-of-life care that they receive. A study published in the Journal of the American Geriatrics Society found that satisfaction with end-of-life care was rated highest when individuals died at home.

Analyzing data from the National Health and Aging Trends Study of community-dwelling Medicare beneficiaries who died at age 65 years or older, investigators found that the most frequent place of death for persons with cognitive impairment was in the home, but cognitively healthy persons were equally as likely to die at home or in the hospital. Regardless of their cognitive health, individuals who received hospice care were more likely to die at home.

"Our findings suggest that older adults' preference for place of death should be a central component of advance care planning, and the receipt of hospice care may be a key to achieving that preference," said lead author Natalie G. Regier, PhD, of the Johns Hopkins University School of Nursing.

MINNEAPOLIS - A new study has found a brain pressure disorder called idiopathic intracranial hypertension is on the rise, and the increase corresponds with rising obesity rates. The study is published in the January 20, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study also found that for women, socioeconomic factors like income, education and housing may play a role in their risk.

Idiopathic intracranial hypertension is when the pressure in the fluid surrounding the brain rises. It can mimic the symptoms of a brain tumor, causing chronic, disabling headaches, vision problems and in rare cases, vision loss. It is most often diagnosed in women of childbearing age. Treatment is often weight loss. In some cases, surgery may be required.

"The considerable increase in idiopathic intracranial hypertension we found may be due to many factors but likely mostly due to rising obesity rates," said study author William Owen Pickrell, Ph.D., M.R.C.P., of Swansea University in Wales in the United Kingdom and a member of the American Academy of Neurology. "What is more surprising from our research is that women who experience poverty or other socioeconomic disadvantages may also have an increased risk independent of obesity."

For the study, researchers used a national healthcare database in Wales to analyze 35 million patient years of data over a 15-year period, between 2003 and 2017. They identified 1,765 people with idiopathic intracranial hypertension during that time. Of the group, 85% were women. Researchers recorded body mass index measurements for study participants. Body mass index is calculated by dividing weight by height. For every one person with the disorder, researchers compared three people without it who were matched for gender, age and socioeconomic status.

The socioeconomic status of each person with the disorder was determined by where they live, using a national scoring system that considers factors like income, employment, health, education and access to services. People in the study were then divided into five groups ranging from those with the fewest socioeconomic advantages to those with the most.

Overall, researchers found a six-fold increase in the number of cases of the disorder over the course of the study. In 2003, for every 100,000 people, 12 were living with the disorder, compared to 76 people in 2017. Also, in 2013, for every 100,000 people, two were diagnosed during that year, compared to eight people in 2017.

Researchers found that the increasing number of people living with the disorder corresponded to rising obesity rates in Wales during the study, with 29% of the population being obese in 2003 compared to 40% in 2017.

"The worldwide prevalence of obesity nearly tripled between 1975 and 2016, so while our research looked specifically at people in Wales, our results may also have global relevance," said Pickrell.

There were strong links for both men and women between body mass index and risk of the disorder. For women, there were 180 cases per 100,000 people during the study for those with high body mass index compared to 13 women with a body mass index considered to be ideal. For men, there were 21 cases per 100,000 among those with a high body mass index compared to eight cases for those with an ideal body mass index.

Researchers also found that for women only, socioeconomic factors were linked to risk. There were 452 women in the group with the fewest socioeconomic advantages compared to 197 in the group with the most. The women in the group with the fewest had a 1.5 times greater risk of developing the disorder than women in the group with the most, even after adjusting for body mass index.

"Of the five socioeconomic groups of our study participants, women in the lowest two groups made up more than half of the female participants in the study," said Pickrell. "More research is needed to determine which socioeconomic factors such as diet, pollution, smoking or stress may play a role in increasing a woman's risk of developing this disorder."

A limitation of the study was that researchers identified the socioeconomic status of participants by the regions in which they lived instead of obtaining individual socioeconomic information for each participant.

Antidepressants are commonly used worldwide to treat pain, however new research from the University of Sydney shows they offer little to no help for people suffering chronic back pain and osteoarthritis and may even cause harm.

Back pain and knee osteoarthritis affect millions of people globally and are leading causes of disability. When first-line pain medications such as paracetamol and ibuprofen fail to improve symptoms, many people are prescribed antidepressants for their pain. Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain and hip and knee osteoarthritis, yet evidence supporting their use is uncertain.

Published today in the BMJ the study investigated the efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis compared with placebo.
The authors hope this study could help clinicians and patients make more informed decisions about whether to treat chronic back pain and osteoarthritis pain with antidepressants.

"The use of antidepressants to treat people with chronic back pain and osteoarthritis is increasing worldwide, but prior to our work, it was not clear whether antidepressants relieved pain or were safe," said lead author Dr Giovanni Ferreira, postdoctoral research fellow at the Institute for Musculoskeletal Health at the University of Sydney and Sydney Local Health District and the University's Faculty of Medicine and Health.

"We conducted a review of all randomised clinical trials evaluating the efficacy of antidepressants for people with back pain or knee osteoarthritis and found that for back pain the antidepressants were either ineffective or provided a very small effect, which was unlikely to be perceived as worthwhile by most patients. For people with osteoarthritis, effects were still small, but could be potentially perceived as worthwhile by some patients," he said.

"It is concerning as some antidepressants significantly increase the risk of a person to experience adverse events. Many people are being treated with these medications that may not be helping their pain and may be doing them harm."

About the study:

The study was a systematic review and meta-analysis that included 33 randomised controlled trials with more than 5,000 participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.

The trials tested six classes of antidepressants including serotonin-noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants.

The study set a difference of 10 points on a 0-100 scale for pain as the smallest worthwhile difference between groups, which is a common threshold in studies of chronic pain.

Most clinical trials included in the review did not include patients with pain and depression. The results apply to patients treated with these drugs for their pain condition, not depression in people living with pain.

Key findings:

- SNRIs had a trivially small effect on back pain, reducing pain by just 5.3 points out of 100 on the pain scale compared with placebo after three months. This amount is unlikely to be considered clinically important by most patients.

- SNRIs had a slighter stronger effect on osteoarthritis pain after three months, with an average difference of 9.7 points on the pain scale compared with placebo. This amount is still small, but close to the 10 point difference needed for antidepressants to be considered worthwhile by some patients.

- Tricyclic antidepressants were ineffective for back pain and related disability

- Tricyclic antidepressants and SNRIs might reduce pain in people with sciatica (pain down the leg associated with back pain), but the evidence was not certain enough to draw any firm conclusions.

- SNRI antidepressants significantly increased the risk of patients experiencing an adverse event; about two-thirds of patients taking this class of antidepressant had at least one adverse event such as nausea.

Professor Andrew McLachlan, Head of School and Dean of Pharmacy at the University of Sydney and co-author on the study, strongly advises those currently taking antidepressants for treating back pain and osteoarthritis not to abruptly cease treatment with antidepressant medicines but to consult with their doctor.

"This can lead to withdrawal effects which can be distressing and sometimes present as serious health issues. These withdrawal effects include dizziness, nausea, anxiety, agitation, tremor, sweating, confusion and sleep disturbance."

Dr Ferreira added: "More research is needed to resolve uncertainties about the efficacy of antidepressants for sciatica and osteoarthritis highlighted by this review."

BOSTON -- While deaths related to heart disease have declined among older people, studies suggest that death rates among younger patients have remained stagnant or increased slightly. To understand what factors put younger individuals at higher risk of premature coronary heart disease (CHD), researchers from Brigham and Women's Hospital and the Mayo Clinic analyzed more than 50 risk factors in 28,024 women who participated in the decades-long Women's Health Study. Notably, women under 55 with type-2 diabetes had a tenfold greater risk of having CHD over the next two decades, with lipoprotein insulin resistance (LPIR) proving to be a strong, predictive biomarker as well. Findings are published in JAMA Cardiology.

"We're going to see, unfortunately, younger and younger people having heart attacks," said corresponding author Samia Mora, MD, MHS, of the Brigham's Center for Lipid Metabolomics in the Division of Preventive Medicine and an associate professor at Harvard Medical School. "When a younger individual has a cardiovascular event, it will affect their quality of life going forward, their productivity, and their contribution to society."

"Prevention is better than cure, and many risk factors for heart disease are preventable. This study shows the impact that lifestyle has on heart health in women of all ages, and younger women in particular," said Sagar Dugani, MD, PhD, a hospital internal medicine practitioner at Mayo Clinic in Rochester, MN. Dr. Dugani is a co-first author of the study.

The researchers analyzed approximately 50 biomarkers associated with cardiovascular health. Commonly used metrics like low-density lipoprotein (LDL) cholesterol (or "bad" cholesterol) and hemoglobin A1C (a measure of blood sugar levels) had much weaker associations with CHD onset in women younger than 55 years than LPIR, a newer metric for insulin resistance. LPIR uses a weighted combination of six lipoprotein measures and is analyzed through specialized laboratory testing. Whereas LDL cholesterol was only associated with a 40 percent increase in risk of CHD onset in women under 55, LPIR demonstrated a sixfold (600 percent) increase.

"In otherwise healthy women, insulin resistance, type-2 diabetes, and its sister diagnosis, metabolic syndrome, were major contributors to premature coronary events," said Mora. "Women under 55 who have obesity had about a fourfold-increased risk for coronary events, as did women in that age group who smoked or had hypertension. Physical inactivity and family history are all part of the picture as well."

The researchers acknowledged the study is limited in its generalizability -- beyond its focus on women, who have been shown to have worse outcomes after premature cardiac events than men, its participants were over 95 percent white. According to Mora, findings could be even more dramatic in ethnic and racial groups that have a greater prevalence of metabolic syndrome, insulin resistance and diabetes, among other risk factors.

"Diabetes is mostly preventable, but it's a systems-wide problem, and we urgently need further research into new strategies to address it," Mora said. "These could be innovative lifestyle-based strategies, like community efforts, greater public health efforts, ways to medically target metabolic pathways, or new surgical approaches."

With the prevalence of diabetes and its associated risk factors increasing dramatically, and affecting more women than men, the researchers emphasize the urgency of developing effective interventions.

We need new strategies to improve outcomes in these younger individuals and address the risk of diabetes, because we're only seeing the beginning of this epidemic now," said Mora.

Antidepressant drugs are largely ineffective for back and osteoarthritis pain, despite being widely used for these conditions, suggests a review of the evidence published by The BMJ today.

The findings, based on moderate certainty evidence, show that for people with back pain the effects were too small to be worthwhile, but for osteoarthritis a small beneficial effect cannot be ruled out.

Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain and hip and knee osteoarthritis, yet evidence supporting their use is uncertain.

To address this knowledge gap, researchers led by Giovanni Ferreira at the University of Sydney set out to investigate the effectiveness and safety of antidepressants for back and osteoarthritis pain compared with placebo.

Their findings are based on analysis of published data from 33 randomised controlled trials involving more than 5,000 adults with low back or neck pain, sciatica, or hip or knee osteoarthritis.

The trials were designed differently, and were of varying quality, but the researchers were able to allow for this in their analysis. Most of the data came from industry sponsored trials.

The researchers set a difference of 10 points on a 0 to 100 point scale for pain or disability as the smallest worthwhile difference between groups - a threshold commonly used in other studies of chronic pain.

Results showed that serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced back pain after three months. But the effect was small - an average difference of 5.3 points on the pain scale compared with placebo - and unlikely to be considered clinically important by most patients.

For osteoarthritis, they found a slightly stronger effect of SNRIs on pain after three months - an average difference of 9.7 points on the pain scale compared with placebo - meaning that a worthwhile effect could not be excluded.

Low certainty evidence showed that tricyclic antidepressants (TCAs) were ineffective for back pain and related disability.

Tricyclic antidepressants and SNRIs might reduce pain in people with sciatica, but the evidence was not certain enough to draw any firm conclusions.

The researchers acknowledge several limitations, including the possibility of missing trials and being unable to explore a dose-response relation for most antidepressants because of the low number of studies spread across six different classes of antidepressants.

Nevertheless, the review was based on a thorough literature search with a prespecified threshold for clinical importance used in other reviews of treatments for back and osteoarthritis pain.

As such, they say their review updates the evidence for back pain, sciatica, and osteoarthritis, and could help clinicians and their patients decide whether to take antidepressants for chronic pain.

But they conclude: "Large, definitive randomised trials that are free of industry ties are urgently needed to resolve uncertainties about the efficacy of antidepressants for sciatica and osteoarthritis highlighted by this review."

In a linked editorial, researchers at the University of Warwick call for clearer guidance to inform a consistent approach to use of antidepressants for people with painful disorders.

They acknowledge that some patients might choose to try antidepressants for a small chance of a worthwhile reduction in pain after three months.

Overall, however, they argue that drug treatments "are largely ineffective for back pain and osteoarthritis and have the potential for serious harm. We need to work harder to help people with these disorders to live better with their pain without recourse to the prescription pad."

DANVILLE, Pa. - An analysis of data collected from patients treated for ischemic stroke at Geisinger shows no disparity in outcomes based solely on sex.

Various studies have suggested that women are disproportionately affected by stroke and may have poorer stroke outcomes. Women have a longer life expectancy than men and, therefore, likely have an increased lifetime risk of stroke. Women tend to be older than men at the time of stroke and have a higher pre-stroke degree of disability or dependence in their daily activities, which may contribute to worse outcomes. Rural populations may also have a higher risk of stroke based on a greater incidence of conditions like hypertension and poorly controlled diabetes.

Researchers at Geisinger analyzed electronic health record data for 8,900 patients who had an ischemic stroke between 2004 and 2019. Overall, female patients had a higher rate of all-cause mortality following stroke. However, after controlling for comorbidities, such as atrial fibrillation, diabetes, heart failure, and chronic lung or kidney diseases, survival rates for men and women were equal.

"Our study results indicate that women may have higher crude mortality after stroke; however, sex is not an independent risk factor for all-cause mortality in the rural communities that Geisinger serves," said Vida Abedi, Ph.D., a scientist in the department of molecular and functional genomics at Geisinger and a co-author of the study. "Ischemic stroke recurrence and the composite outcome of stroke recurrence or death also did not demonstrate evidence of a sex disparity."

The results were published in Therapeutic Advances in Neurological Disorders.

ATLANTA - JANUARY 19, 2021 - A new study finds that alcohol consumption accounts for a considerable portion of cancer incidence and mortality in all 50 states and the District of Columbia. The article, which appears in Cancer Epidemiology, states that the proportion of cancer cases attributable to alcohol consumption ranged from a high of 6.7% in Delaware to a low of 2.9% in Utah. Similarly, Delaware had the highest proportion of alcohol-related cancer deaths (4.5%) and Utah had the lowest (1.9%).

This study conducted by Farhad Islami, MD, PhD, and colleagues at the American Cancer Society is the first to estimate contemporary proportions and counts of alcohol-attributable cancer cases and deaths for all states. Data shows the proportions were generally higher in New England and Western states and lower in Midwestern and Southern states.

"This information is important for prioritizing state-level cancer prevention and control efforts to reduce alcohol consumption and the burden of alcohol-related cancers," said Dr. Islami.

The proportion of alcohol-related cancers was far greater for some individual cancer types. For oral cavity/pharyngeal cancer cases, for example, it ranged from 36% in Utah to 62.5% in Delaware and was 45% or more in 45 states and the District of Columbia. By sex, alcohol-related cancer cases and deaths for most evaluated cancer types were higher among men, in part reflecting higher levels of alcohol consumption among men.

In the U.S. on average, alcohol consumption accounted for 4.8% of cancer cases and 3.2% of cancer deaths, or about 75,200 cancer cases and 18,950 cancer deaths annually, during 2013 to 2016.

In addition, the authors say, "healthcare providers and public health practitioners can educate the community to expand the currently limited awareness of the cancer-related risks of alcohol consumption." The American Cancer Society's guideline for Diet and Physical Activity for Cancer Prevention states that it is best not to consume alcohol; for those who do drink, consumption should be limited to no more than 1 drink per day for women and 2 drinks per day for men.

Psoriasis is a chronic inflammatory skin disease characterized by erythematous (red) patches and plaques. In some patients, psoriasis may be associated with comorbidities such as arthritis, obesity, diabetes, cardiovascular diseases, hyperlipidemia, or depression. Psoriasis lesions can occur on the scalp and face, in addition to all other areas of the body, causing considerable physical discomfort and psychosocial trauma from the stigma surrounding appearance defects.

More than 90% of patients with psoriasis have what is called psoriasis vulgaris, which is characterized by plaques, and less than 5% have the other varieties: arthritic psoriasis, pustular psoriasis, and erythrodermic psoriasis. The most common treatments for mild to moderate plaque psoriasis are topical corticosteroids and vitamin D3 analogs.

However, the long-term use of these topical steroids often causes various side-effects such as skin atrophy, hypo- or hyper-pigmentation, telangiectasia, and skin infections. And the long-term use of vitamin D3 analogs may add the requirement of interventions to regulate calcium and phosphate metabolism. These effects on the body are significant and there is a need for novel topical and systemic treatments for psoriasis.

In a study recently published in Chinese Medical Journal, scientists from renowned research institutes and hospitals across China, led by Prof. Jian-Zhong Zhang from Peking University People's Hospital, have met this need in part. They have reported that benvitimod, a novel non-steroid topical drug, is effective and safe for treating plaque psoriasis.

Speaking of their research journey, Prof. Zhang says, "Benvitimod (also known as tapinarof) is a small molecule that was first isolated from the bacterium Photorhabdus luminescens and was synthesized by late Genhui Chen and his team from Beijing Wenfeng Tianji Pharma. It took more than 20 years to study the mechanism of action, come up with the formulation, and evaluate the efficacy and safety of this compound in patients with psoriasis. It was hard work indeed."

In their study, Prof. Zhang and his colleagues carried out a double blinded, placebo controlled, phase III clinical trial in twenty-three dermatological centers in China to evaluate the safety and efficacy of topical benvitimod cream in patients with mild-to-moderate plaque psoriasis.

Six hundred and eighty-six adult patients with mild to moderate plaque psoriasis were included in this study. Patients were randomized to receive 1% benvitimod cream, 0.005% calcipotriol ointment--a standard treatment for plaque psoriasis--or a similar-looking "placebo." They were treated for 12 weeks. The efficacy of benvitimod was assessed at the end of the treatment period.

Of the patients receiving treatment with benvitimod cream, 50.4% achieved a psoriasis area and severity index (PASI) score of 75 at 12 weeks, which indicates a 75% or greater decrease in psoriasis size and severity compared to pre-treatment levels. In contrast, PASI 75 was achieved in only 38.5% and 13.9% of patients receiving calcipotriol ointment and placebo, respectively. Similarly, a significantly higher proportion of patients who received benvitimod cream (66.3%) achieved a static physicians' global assessment (sPGA) score of 0 or 1 (which indicate very low disease severity) compared to those who were put on placebo (33.5%).

This phase III trial also showed that the benvitimod cream was well tolerated. The most common side-effects were only mild irritation and itching at the site of application and these symptoms resolved spontaneously in most patients. No serious systemic side-effects were found.

Prof. Zhang remarks, "The results of this phase III trial are encouraging. The benvitimod cream can soon be a new treatment option for Chinese patients with plaque psoriasis. Given that most patients with psoriasis have plaque psoriasis, this will have a significant impact in terms of reducing the psoriasis disease burden in the country."

Perhaps, in time, it can become a standard method of psoriasis management all over the world.

DANVILLE, Pa. - A team of Geisinger researchers has identified a common genetic variant as a risk factor for stroke, especially in patients older than 65.

Cerebral small vessel disease (SVD) causes about a quarter of ischemic strokes worldwide and is the most common cause of vascular dementia. SVD can manifest as lesions on the brain, which typically appear on brain scan images. SVD is commonly associated with aging and hypertension, but a minority of cases are caused by cysteine altering variants in the NOTCH3 gene. Approximately 1 in 300 people have this type of gene variant. A rare hereditary condition known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL, which is caused by this gene variant, has been associated with SVD and an increased risk of stroke.

In their study, published in Stroke, researchers evaluated a set of health records, including imaging and genomic sequencing data, of more than 300 Geisinger patients, of which 118 exhibited a NOTCH3 variant. Of this group, 12.6% had a history of stroke, compared with 4.9% of those in a control group. The risk of stroke was significantly higher in those older than 65, and patients exhibited a higher number of white matter lesions on the brain. Although all 118 patients in the study group had a NOTCH3 genetic variant, the specific variant that causes CADASIL was rarely seen.

Given the high population frequency of NOTCH3 variants, the number of individuals who may be at higher risk of SVD and stroke as a result of a NOTCH3 variant is significant, the research team wrote. The study indicates that most individuals with a NOTCH3 variant will develop NOTCH3-associated SVD after the age of 65.

"Stroke is a complex multifactorial condition," said Vida Abedi, Ph.D., a scientist in the department of molecular and functional genomics at Geisinger and a co-author of the study. "Dissecting its risk factors and identifying ways to improve patient outcomes is a crucial part of improving patient care."

"This study represents a novel and powerful approach to studying the genetic basis of neurologic disease," said Ramin Zand, M.D., a vascular neurologist and clinician-scientist at Geisinger and co-author of the study. "Geisinger's unique resources, its electronic health records and focus on precision medicine allows us to leverage this data to provide better care for all of our patients."

DENVER--A study in the Journal of Thoracic Oncology (JTO) comparing surgeries performed at one Chinese hospital in 2019 with a similar date range during the COVID-19 pandemic found that routine thoracic surgery and invasive examinations were performed safely. The JTO is the official journal of the International Association for the Study of Lung Cancer.

Wentao Fang, MD, chief director of the Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China and his colleagues analyzed the number of elective procedures by a single surgeon team between 2019 and 2020 and compared the clinicopathological characteristics, surgical procedures and perioperative results of this year with the corresponding period last year.

After the first case of COVID-19 was reported in Wuhan, China in December 2019, the confirmed local cases in Shanghai reached its peak level between late January and early February 2020 and then rapidly decreased by late February after stringent mitigation policies were taken by the Shanghai municipal government.

To prevent potential COVID-19 infection among patients and hospital staff, multiple measures were undertaken and adjusted according to policies and procedures put in place during the pandemic in Shanghai.

In terms of surgical volume, the number of cases declined 14.1%, from 263 in 2019, to 226 in 2020, representing a significant impact of COVID-19 on shifited medical care from cancer patients.

"Importantly, neither medical staffs nor patients were diagnosed of COVID-19 infection during this time," Fang said.

All 226 patients received spirometry examinations and 7 patients received esophagoscopy and 16 patients received bronchoscopy before operations. All the surgical procedures were safely performed under the general anesthesia with double-lumen tube intubations.

More than a quarter (27.7%, n=65) of the patients were current or former smokers. There were 26 patients (11.5%) who received surgical operations after neoadjuvant therapy in 2020, which was similar to those in 2019 (34 patients, 12.9%).

Fang reported that the number of surgical procedures began to bounce back from its lowest point in February 2020 as the local situation of COVID-19 showed signs of improvement, and then surpassed the sum of the same period last year in April 2020 when full work resumption was upcoming.

"We noticed that postoperative complication rate decreased in the first two months of 2020 during the peak of the COVID-19 pandemic, when surgical indication was strictly reconsidered, and surgical volume was largely decreased. And complication rates in each month of 2020 was all lower than the same month of last year," Fang said.

"The COVID-19 pandemic had a significant impact on the elective operations for thoracic diseases for a delay of almost two months. However, routine thoracic surgery as well as invasive examinations could be performed safely if careful screening and examinations of patients and effective protection of medical staffs are well completed during the full work resumption in low-risk areas of COVID-19," Fang said.