Body

Since the dawn of the 21st century, there has been a rapid rise in the number of human immunodeficiency virus (HIV) infections in China, and today, the epidemic continues to grow. Several populations are victims of this virus, including injection drug users, sex workers, and men who have sex with men (MSM). In the various decades since HIV has gripped China, these groups and others have variously been at the forefront or background of national efforts to tackle the epidemic.

In the recent past, the prevalence of HIV has been high among the MSM population, particularly, MSM students. According to China CDC's national data on newly reported HIV/AIDS cases, there was a 35% annual increase in cases among student MSM from 2011 to 2015. Between 2005 and 2007, the HIV prevalence among this population was 3%. This increased to 6% between 2008 and 2010.

Dr. Jing Zhang, researcher at the NHC Key Laboratory of AIDS Immunology (China Medical University) and lead scientist on a recent study on HIV incidence among MSM youth in China, says, "This increasing HIV prevalence could be because of expanding HIV testing in China in the recent years, or it could be that the number of recent infected cases has truly been growing." Explaining her rationale for the study, she continues, "To clarify why this increase is happening and its proportions, we need data on the 'incidence'. The incidence is one of the most crucial indicators of the trend of the epidemic and is key to understanding the impact of prevention measures. Because unlike 'prevalence', which accounts both recent and established cases, 'incidence' more specifically records only the recent cases. Data on incidence is what is lacking among the MSM student population."

In their study, which has been published in Chinese Medical Journal, Dr. Zhang and her colleagues conducted a multi-center study, measuring not only the incidence but also the rate of transmitted drug resistance (TDR) among MSM college students in seven cities across China during 2012 and 2013. The TDR negatively impacts the prognosis of HIV-infected individuals when receiving antiretroviral therapy, the main measure China has taken to combat the epidemic over the years.

"For an epidemiologist and public health provider, concrete data on these trends of recent incidence and TDR is valuable evidence for understanding the epidemic and evaluating the outcomes of the prevention measures employed thus far," Dr. Zhang says.

In the study, a total of 4496 candidates--565 MSM college students, 1094 non-student MSM youth

The scientists found 436 HIV-positive participants, 186 of whom were recent infections. Among MSM college students, the proportion of HIV recent infections was 70.3%, among non-student MSM youth it was 50.8%, and among non-youth MSM it was 35.1%. The TDR prevalence rates were ~7%, 2%, and ~5%, respectively, for these groups. In short, in the recent past, more MSM college students had become infected than the other groups, and they were more likely to be resistant to antiretroviral therapy.

Drawing on previous studies about behavioral changes among young MSM, Dr. Zhang explains, "The median age of first anal intercourse for these men in China has significantly decreased from 33 years for those born during 1940-1959 to 18 years for those born during 1990-1996. This could be indicative of the gap in current sexual health education in China. China has taken many actions to mitigate the HIV epidemic among students in higher education institutions, including comprehensive education on sexual health and more accessible HIV testing. According to our findings, and given these changing trends, this education should be provided as early as possible during college, or preferably in high school, as soon as youth become sexually active."

Further highlighting and underlining the importance of her team's study, Dr. Zhang remarks, "This study unravels the high proportion of recent HIV infections among college student MSM in 2012-2013. This is expected to facilitate an understanding of the growing HIV epidemic among MSM college students in China today. The study also addresses the importance of regular HIV testing among students and young MSM, emphasizing to this population the importance of early diagnoses. It further brings to the fore the need for TDR testing among this population before initiation of antiretroviral therapy for better response and prognosis."

With such meticulous data collection and proactive measures, perhaps the HIV epidemic in China will soon see an end.

Decades of research show that depression, stress, loneliness, and poor health behaviors can weaken the body's immune system and lower the effectiveness of certain vaccines. A new report accepted for publication in Perspectives on Psychological Science suggests that the same may be true for the new COVID-19 vaccines that are in development and the early stages of global distribution. Fortunately, it may be possible to reduce these negative effects with simple steps like exercise and sleep.

Vaccines are among the safest and most effective advances in medical history, protecting society from a wide range of otherwise devastating diseases, including smallpox and polio. The key to their success, however, is ensuring that a critical percentage of the population is effectively vaccinated to achieve so-called herd immunity.

Even though rigorous testing has shown that the COVID-19 vaccines approved for distribution in the United States are highly effective at producing a robust immune response, not everyone will immediately gain their full benefit. Environmental factors, as well as an individual's genetics and physical and mental health, can weaken the body's immune system, slowing the response to a vaccine.

This is particularly troubling as the novel coronavirus continues to rage across the world, trigging a concurrent mental health crisis as people deal with isolation, economic stressors, and uncertainty about the future. These challenges are the same factors that have been previously shown to weaken vaccine efficacy, particularly among the elderly.

"In addition to the physical toll of COVID-19, the pandemic has an equally troubling mental health component, causing anxiety and depression, among many other related problems. Emotional stressors like these can affect a person's immune system, impairing their ability to ward off infections," said Annelise Madison, a researcher at The Ohio State University and lead author on the paper. "Our new study sheds light on vaccine efficacy and how health behaviors and emotional stressors can alter the body's ability to develop an immune response. The trouble is that the pandemic in and of itself could be amplifying these risk factors."

Vaccines work by challenging the immune system. Within hours of a vaccination, there is an innate, general immune response on the cellular level as the body begins to recognize a potential biological threat. This frontline response by the immune system is eventually aided by the production of antibodies, which target specific pathogens. It is the continued production of antibodies that helps to determine how effective a vaccine is at conferring long-term protection.

"In our research, we focus most heavily on the antibody response, though it is just one facet of the adaptive immune system's response," said Janice Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at The Ohio State University and senior author on the paper.

The good news, according to the researchers, is that the COVID-19 vaccines already in circulation are approximately 95% effective. Even so, these psychological and behavioral factors can lengthen the amount of time it takes to develop immunity and can shorten the duration of immunity.

"The thing that excites me is that some of these factors are modifiable," said Kiecolt-Glaser. "It's possible to do some simple things to maximize the vaccine's initial effectiveness."

Based on prior research, one strategy the researchers suggest is to engage in vigorous exercise and get a good night's sleep in the 24 hours before vaccination so that your immune system is operating at peak performance. This may help ensure that the best and strongest immune response happens as quickly as possible.

"Prior research suggests that psychological and behavioral interventions can improve vaccine responsiveness. Even shorter-term interventions can be effective," said Madison. "Therefore, now is the time to identify those at risk for a poor immune response and intervene on these risk factors."

A detailed description of how ovarian cancer cells adapt to survive and proliferate in the peritoneal cavity has been published in Frontiers in Oncology. Researchers show that structures inside the cells change as the disease progresses from benign to malignant, helping the cells to grow in an otherwise hostile environment of low nutrients and oxygen. Understanding how these cellular adaptations are regulated could herald new targeted treatment options against the fifth-leading cause of cancer-related deaths in women.

"Our study compared the structures inside cells representing different stages of ovarian cancer, including after aggregation, which enhances their survival," says Eva Schmelz, a Professor and Scientific Director at Virginia Tech University, USA, who led this research. "We found that one of these structures, the mitochondria, known as the 'battery pack' of the cell, changed shape and function to adapt to the hostile conditions in the peritoneal cavity, allowing aggressive cancerous cells to grow and take hold."

Fatal spread of cells

Ovarian cancer can often originate from cancerous cells in the fallopian tubes. Cells exfoliating from this cancerous mass can then spread onwards throughout the peritoneal cavity via the fluid in the abdomen. At this stage, a patient's survival rates are just 30%, even if the original tumor is removed. Chances are greatly increased to over 90% if it is caught in the initial stages, but this cancer is hard to detect because there are very few reliable early biomarkers or symptoms.

"If we understand how ovarian cancer cells survive in the fluid of the abdomen as they spread around the peritoneal cavity, we may be able to develop specific therapeutics and interventions to suppress cancerous outgrowths of cells from the original tumor," explains Schmelz.

"Our previous work has shown the metabolism of cells changed as ovarian cancer progressed. We wanted to build on this by looking inside the cells to see if any structural differences could be seen. By examining cells developed from the ovaries of mice, any changes could be attributed to the progression of the disease rather than any differences between individuals."

The researchers used a wide variety of microscopy techniques to obtain 2D images and 3D models of the mitochondria, to identify and measure their structure at different stages of the cancer.

Adapt to survive

"As the ovarian cancer progressed, the mitochondria changed from a filamentous network to that of a highly fragmented form," reports Schmelz. "This fragmentation and known changes in the way mitochondria function in this state, are how the cells adapt to an environment that is low in nutrients and oxygen. It also allows the cells to escape treatments commonly used in ovarian cancer patients, so they can continue to proliferate."

Schmelz's team at Virginia Tech hope these findings will form the basis of research to bring new treatments for this devastating disease.

"Future studies will identify how the changes we have identified inside the cells are regulated by isolating specific cell signaling pathways to create targets for therapies that limit the viability and spread of ovarian cancer cells."

Researchers from University of Hawaii and University of Florida published a new paper in the Journal of Marketing that argues that a biological account of human behavior, especially undesirable behavior, will benefit human welfare. This biological perspective can complement traditional psychological, anthropological, and economic perspectives on consumption, particularly with respect to the vital topic of self-control.

The study, forthcoming in the Journal of Marketing, is titled "Consumer Self-Control and the Biological Sciences: Implications for Marketing Stakeholders" and is authored by Yanmei Zheng and Joe Alba.

Society's understanding of human ills is constantly evolving. Many ill-advised consumer behaviors are conventionally viewed through a non-biological lens, with the underlying biological causation of such behaviors often neglected. This research considers two biological domains that have produced a tsunami of findings in very recent years: neuroscience and genetics. A review of the biological literature shows that many undesirable consumer behaviors are biologically rooted in the brain and the genes. These biological insights bear important implications for public policy, marketing practice, and consumer well-being.

The researchers argue, however, that biological insights will not translate directly into improved welfare if those insights fail to make an impression on marketing's many stakeholders. They further argue that the road to welfare-enhancing policies will be rocky if the lay public is resistant to the implications of biology. They sought to understand laypeople's existing beliefs about biological causation and gauge how those beliefs can be shaped by findings from the biological sciences.

To do so, the researchers conducted 10 studies to examine lay beliefs about--and lay reactions to--biological causation. Zheng explains that "Overall, we find a sizable amount of resistance to biological causation, in part due to the entrenched lay belief in mind-body dualism. Moreover, the studies show that acceptance of biology as a causal explanation of human behavior varies as a function of the portrayal of biological causation, the nature of the behavior, the amount of deliberation by the actor, and individual differences of the external observer. On an optimistic note, the studies also suggest that acceptance of biological causation can be influenced by marketing scholarship and marketing practice."

Biological causation has multiple implications. First, if biological causation becomes more widely accepted by the general public, policymakers' effort to regulate certain products and protect certain consumers will garner more public support. Moreover, policies that focus on prevention (e.g., investment in high-quality childhood education, social and family support programs, etc.) will gain more traction. Second, biological causation may raise more public scrutiny for some firms (e.g., unhealthy food and weight-loss programs) and alter the business models for others (e.g., healthcare and insurance industries). Biological causation may also open new opportunities for companies that provide welfare services and self-enhancement offerings. Third, biological causation will enhance consumers' self-understanding, which can translate into an improved state of well-being; it will also enhance understanding of others, which can translate into greater empathy and mutual respect.

Alba says "We believe that a biological account of human behavior can benefit human welfare. In addition, we believe marketing can play a critical role in facilitating public understanding and acceptance of biological causation. A truer understanding of the biological underpinnings of behavior should reduce moral scolding and enhance empathy toward those who exhibit poor self-control and other "failings"--including depression, irresoluteness, social awkwardness, infidelity, and even a lack of empathy--for which the biological and psychological causes are mistakenly dissociated. As the understanding of biological causation increases, so too should comity, mutual understanding, and societal well-being."

WASHINGTON, January 12, 2021 -- The risk of infection of COVID-19 is high for medical specialists who come in contact with symptomatic or asymptomatic patients. Dentists and otolaryngologists are at particular risk, since they need direct access to the mouth, nose, and throat of patients.

The current solutions, which include wearing N95 masks and face shields, clinic room evacuation, negative pressure rooms, and special air filtration systems, are expensive, not highly effective, and not very accessible.

In Physics of Fluids, by AIP Publishing, researchers at Cornell University discuss their design of an open-faced helmet for patient use that is connected to a medical-grade air filtration pump from the top that creates a reverse flow of air to prevent cough droplets from exiting the helmet.

In a computer simulation using computational fluid dynamics, they showed the helmet design can contain 99.6% of droplets emitted from coughing within 0.1 seconds.

"To put this into context, if we use the same air pump to create a negative pressure isolation room, it will take about 45 minutes to remove 99.0% of the airborne contaminants from the room," said author Mahdi Esmaily.

Currently available personal protective equipment does not provide open face access while maintaining high effectiveness in containing contaminants. The proposed helmet has a shell that is 1 millimeter thick and fully encloses the head with access and vacuum ports.

A nozzle is attached to the access port to extend the distance droplets must travel against the flow and minimize their chance of escape through the opening, allowing for a smoother flow transition that reduces patient discomfort generated by flow turbulence.

The proposed helmet design could also greatly reduce cost by replacing current practices. For example, building a negative pressure room with air filtration can cost tens of thousands of dollars. The cost of each helmet could be as cheap as couple of dollars if made disposable, said the researchers. Medical-grade HEPA filter negative air machines designed to power the helmets are readily available and cost around $1,000.

"Our next step is to refine the helmet design to have higher efficiency and broader application," said author Dongjie Jia. "After that, we plan to build prototypes of the helmet and perform experiments to verify our simulation predictions."

The simulation framework could be used as a fast and accurate way to study other particle-related phenomena and designs.

ATLANTA - JANUARY 12, 2021 - Overall cancer death rates in the United States dropped continuously from 1991 through 2018 for a total decrease of 31%, including a 2.4% decline from 2017 to 2018. The news comes from the American Cancer Society's annual Cancer Statistics, 2021 article, appearing in CA: A Cancer Journal for Clinicians, and its consumer version, Cancer Facts & Figures 2021. This year marks the American Cancer Society's 70th anniversary of reporting this data to inform the nation's fight against cancer.

The report estimates that in the U.S. in 2021, almost 1.9 million (1,898,160) new cancer cases will be diagnosed and 608,570 Americans will die from cancer. These projections are based on currently available incidence and mortality data through 2017 and 2018, respectively, and thus do not account for the impact of the COVID-19 pandemic on cancer diagnoses or deaths.

"The impact of COVID-19 on cancer diagnoses and outcomes at the population level will be unknown for several years because of the time necessary for data collection, compilation, quality control, and dissemination," said Rebecca Siegel, MPH, lead author of the report. "We anticipate that disruptions in access to cancer care in 2020 will lead to downstream increases in advanced stage diagnoses that may impede progress in reducing cancer mortality rates in the years to come."

Progress in reducing mortality has slowed for other leading causes of death in the U.S., but accelerated for cancer, which is the second-leading cause. An estimated 3.2 million cancer deaths have been averted from 1991 through 2018 due to reductions in smoking, earlier detection, and improvements in treatment, which are reflected in long-term declines in mortality for the four leading cancers: lung, breast, colorectal, and prostate.

Lung cancer is the most common cause of cancer death, accounting for more deaths than breast, prostate, and colorectal cancers combined. Sluggish progress against these latter cancers in recent years contrasts with accelerating reductions in the death rate for lung cancer, from 2.4% annually during 2009 to 2013 to 5% annually during 2014 to 2018. As a result, lung cancer accounted for almost half (46%) of the overall decline in cancer mortality in the past 5 years and spurred a record single-year drop (2.4% from 2017 to 2018) for the second year in a row.

Recent rapid reductions in lung cancer mortality reflect better treatment for the most common subtype - non-small cell lung cancer (NSCLC). Two-year relative survival for NSCLC has increased from 34% for patients diagnosed during 2009 through 2010 to 42% for those diagnosed during 2015 through 2016, including absolute gains of 5% to 6% for every stage of diagnosis. Two-year survival for small cell lung cancer remained at 14% to 15% during this time period.

Cervical cancer is almost 100% preventable through screening and, in recent years, the HPV vaccine, but continues to cause thousands of deaths in the U.S. annually. Approximately 11 women per day died from cervical cancer in 2018, half of whom were in their 50s or younger. It is the second-leading cause of cancer death among women in their 20s and 30s. Although the HPV vaccine holds promise to nearly eliminate cervical cancer with complete population coverage, U.S. vaccination rates remain far below those in other high-income countries: 57% of U.S. adolescent females are up-to-date vs >80% in Australia and >90% in the U.K. Per ACS guidelines HPV vaccinations are recommended in children starting between the ages of 9 to 12, and cervical cancer testing (screening) in young women should begin at age 25.

Other highlights from Cancer Statistics 2021/Cancer Facts & Figures 2021 include:

Cancer is the leading cause of death in Hispanic, Asian American, and Alaska Native persons.

The 5-year survival rate for all cancers combined diagnosed during 2010 through 2016 was 68% in White patients versus 63% in Black patients.

For all stages combined, survival is the highest for prostate cancer (98%), melanoma of the skin (93%), and female breast cancer (90%), and lowest for cancers of the pancreas (10%), liver (20%), esophagus (20%), and lung (21%).

Survival rates are lower for Black patients than for White patients for every cancer type except pancreas.

Prostate, lung and bronchus, and colorectal cancers account for 46% of all incident cases in men, with prostate cancer alone accounting for 26% of diagnoses.

For women, breast, lung, and colorectal cancers account for 50% of all new diagnoses, with breast cancer alone accounting for 30% of female cancers.

In contrast to declining trends for lung and colorectal cancers, female breast cancer incidence rates increased by about 0.5% per year from 2008 to 2017, which is attributed at least in part to continued declines in the fertility rate and increased body weight.

Colorectal cancer overtook leukemia in 2018 as the second leading cause of cancer death in men aged 20 to 39 years, reflecting increasing trends in colorectal cancer in this age group, coinciding with declining rates for leukemia.

The Black-White disparity in overall cancer mortality among men and women combined has declined from a peak of 33% in 1993 (279 vs 211 per 100,000, respectively) to 13% in 2018 (174 vs 154).

Geographic disparities are widest for the most preventable cancers, such as lung and cervical cancers, for which incidence and mortality rates vary up to 5- and 3-fold, respectively, across states.

"While recent advances in treatment for lung cancer and several other cancers are reason to celebrate, it is concerning to see the persistent racial, socioeconomic, and geographic disparities for highly preventable cancers," said William G. Cance, M.D., chief medical and scientific officer, American Cancer Society. "There is a continued need for increased investment in equitable cancer control interventions and clinical research to create more advanced treatment options to help accelerate progress in the fight against cancer."

WASHINGTON--The Endocrine Society is calling on policymakers to include government negotiation as part of an overall strategy to reduce insulin prices in its updated position statement published today in The Journal of Clinical Endocrinology & Metabolism.

More than 34 million Americans have diabetes, and another 88 million are at risk for developing the disease. The cost of insulin has nearly tripled in the past 15 years, and a lack of transparency in the drug supply chain has made it challenging to identify and address the causes of soaring costs.

Federal law currently prohibits Medicare, which accounts for a third of all drug spending, from negotiating directly with pharmaceutical companies over drug prices. Legislation empowering the government to negotiate lower insulin prices could save billions and provide more benefits to Medicare beneficiaries.

"Inventors Frederick Banting and Charles Best sold the insulin patent for a mere $1 in the 1920's because they wanted their discovery to save lives and for insulin to be affordable and accessible to everyone who needed it," said Endocrine Society President-Elect Carol Wysham, M.D., of the Rockwood/MultiCare Health Systems in Spokane, Wash. "People with diabetes without full insurance are often paying increasing out-of-pocket costs for insulin resulting in many rationing their medication or skipping lifesaving doses altogether."

Rising costs have limited access to affordable insulin for many people with diabetes, especially low-income individuals, those on high deductible health plans, Medicare beneficiaries, and those who turn 26 and must transition from their parents' insurance.

All stakeholders across the supply chain from manufacturers to employers have a role to play in addressing the high cost of insulin. Patient Assistance Programs need to be more inclusive and accessible, and rebate programs, another effort to reduce costs, should be used by employers to reduce patients' out-of-pocket costs and health insurance premiums.

The Society recommends the following policy changes to increase access to affordable insulin:

Allowing government negotiation of drug prices

Creating greater transparency across the supply chain to understand rising insulin costs

Limiting future list price increases to the rate of inflation

Limiting out-of-pocket costs through one, or more, of the following policies without increasing premiums or deductibles:

Limiting cost-sharing to a co-pay of no more than $35

Providing first-dollar coverage

Capping costs at no more than $100 per month

Eliminating rebates, or passing savings from rebates along to consumers without increasing premiums or deductibles

Expediting the approval of insulin biosimilars to create competition in the marketplace

Including real-time benefit information on medication costs in electronic medical records

Developing a payment model for Medicare Part B beneficiaries in addition to Part D that lowers their out-of-pocket co-pay

"Addressing Insulin Access and Affordability: An Endocrine Society Position Statement," and other insulin related resources can be found on the Society's 100 Years of Insulin website. The Endocrine Society is celebrating the discovery of insulin with this collection of resources and different activities throughout the year.

Highlights:

Severe cases of COVID-19 often include GI symptoms

Chronic diseases associated with severe COVID-19 are also associated with altered gut microbiota

A growing body of evidence suggests poor gut health adversely affects prognosis

If studies do empirically demonstrate a connection between the gut microbiota and COVID-19 severity, then interventions like probiotics or fecal transplants may help patients

Washington, D.C. - January 12, 2021 - People infected with COVID-19 experience a wide range of symptoms and severities, the most commonly reported including high fevers and respiratory problems. However, autopsy and other studies have also revealed that the infection can affect the liver, kidney, heart, spleen--and even the gastrointestinal tract. A sizeable fraction of patients hospitalized with breathing problems also have diarrhea, nausea and vomiting, suggesting that when the virus does get involved in the GI tract it increases the severity of the disease.

In a review published this week in?mBio,?microbiologist Heenam Stanley Kim, Ph.D, from Korea University's Laboratory for Human-Microbial Interactions, in Seoul, examined emerging evidence suggesting that poor gut health adversely affects COVID-19 prognosis. Based on his analysis, Kim proposed that gut dysfunction--and its associated leaky gut--may exacerbate the severity of infection by enabling the virus to access the surface of the digestive tract and internal organs. These organs are vulnerable to infection because they have widespread ACE2--a protein target of SARS-CoV-2--on the surface.

"There seems to be a clear connection between the altered gut microbiome and severe COVID-19," Kim said.

Studies have demonstrated that people with underlying medical conditions including high blood pressure, diabetes and obesity face a higher risk of severe COVID-19. Risk also increases with age, with older adults most vulnerable to the most serious complications and likelihood of hospitalization. But both of these factors--advanced age and chronic conditions--have a well-known association with an altered gut microbiota. This imbalance can affect gut barrier integrity, Kim noted, which can allow pathogens and pathobionts easier access to cells in the intestinal lining.

So far, the link between gut health and COVID-19 prognosis hasn't been empirically demonstrated, Kim noted. Some researchers have argued, he said, that unhealthy gut microbiomes may be an underlying reason for why some people have such severe infections.

What studies have been done hint at a complicated relationship. A study on symptomatic COVID-19 patients in Singapore, for example, found that about half had a detectable level of the coronavirus in fecal tests--but only about half of those experienced GI symptoms. That study suggests that even if SARS-CoV-2 reaches the GI tract, it may not cause problems. Kim also noted that a person's gut health at the time of infection may be critical for symptom development.

Many recent studies have found reduced bacterial diversity in gut samples collected from COVID-19 patients, compared to samples from healthy people. The disease has also been linked to a depletion of beneficial bacterial species - and the enrichment of pathogenic ones. A similar imbalance has been associated with influenza A infection, though the 2 viruses differ in how they change the overall microbial composition.

The depleted bacterial species associated with COVID-19 infection include some families that are responsible for producing butyrate, a short-chain fatty acid, which plays a pivotal role in gut health by reinforcing gut-barrier function.

Kim said he started analyzing the studies after realizing that wealthy countries with a good medical infrastructure--including the United States and nations in Western Europe--were among the hardest hit by the virus. The "western diet" that's common in these countries is low in fiber, and "a fiber-deficient diet is one of the main causes of altered gut microbiomes," he said, "and such gut microbiome dysbiosis leads to chronic diseases."

The pathogenesis of COVID-19 is still not fully understood. If future studies do show that gut health affects COVID-19 prognosis, Kim argued, then clinicians and researchers should exploit that connection for better strategies aimed at preventing and managing the disease. Eating more fiber, he said, may lower a person's risk of serious disease. And fecal microbiota transplantation might be a treatment worth considering for patients with the worst cases of COVID-19.

The problem with gut health goes beyond COVID-19, though, he said. Once the pandemic passes, the world will still have to reckon with chronic diseases and other problems associated with poor gut health.

"The whole world is suffering from this COVID-19 pandemic," Kim said, "but what people do not realize is that the pandemic of damaged gut microbiomes is far more serious now."

A major risk of being hospitalised is catching a bacterial infection.

Hospitals, especially areas including intensive care units and surgical wards, are teeming with bacteria, some of which are resistant to antibiotics - they are infamously known as 'superbugs'.

Superbug infections are difficult and expensive to treat, and can often lead to dire consequences for the patient.

Now, new research published today in the prestigious journal Nature Microbiology has discovered how to revert antibiotic-resistance in one of the most dangerous superbugs.

The strategy involves the use of bacteriophages (also known as 'phages').

"Phages are viruses, but they cannot harm humans," said lead study author Dr Fernando Gordillo Altamirano, from the Monash University School of Biological Sciences.

"They only kill bacteria."

The research team investigated phages that can kill the world's leading superbug, Acinetobacter baumannii, which is responsible for up to 20 per cent of infections in intensive care units.

"We have a large panel of phages that are able to kill antibiotic-resistant A. baumannii," said Dr Jeremy Barr, senior author of the study and Group Leader at the School of Biological Sciences and part of the Centre to Impact AMR.

"But this superbug is smart, and in the same way it becomes resistant to antibiotics, it also quickly becomes resistant to our phages," Dr Barr said.

The study pinpoints how the superbug becomes resistant to attack from phages, and in doing so, the superbug loses its resistance to antibiotics.

"A. baumannii produces a capsule, a viscous and sticky outer layer that protects it and stops the entry of antibiotics," said Dr Gordillo Altamirano.

"Our phages use that same capsule as their port of entry to infect the bacterial cell.

"In an effort to escape from the phages, A. baumannii stops producing its capsule; and that's when we can hit it with the antibiotics it used to resist."

The study showed resensitisation to at least seven different antibiotics.

"This greatly expands the resources to treat A. baumannii infections," Dr Barr said.

"We're making this superbug a lot less scary."

Even though more research is needed before this therapeutic strategy can be applied in the clinic, the prospects are encouraging.

"The phages had excellent effects in experiments using mice, so we're excited to keep working on this approach," said Dr Gordillo Altamirano.

"We're showing that phages and antibiotics can work great as a team."

Thanks to major progress in the understanding and management of rare congenital diseases and syndromes, many patients with these rare disorders are now living longer lives. With this progress it has become apparent that many non-skeletal rare diseases have an impact on bone mass, bone quality and/or bone metabolism, with potentially severe repercussions for quality of life in adults.

The new paper 'Bone fragility in patients affected by congenital diseases non skeletal in origin', published in Orphanet Journal of Rare Diseases by the International Osteoporosis Foundation (IOF) Skeletal Rare Diseases Working Group (SRDWG), provides a first taxonomic classification of selected non-skeletal rare congenital disorders with an impact on bone physiology on the basis of phenotypes. The diseases have been described according to the systemic disease; genetic defect; pathophysiology of bone phenotype; and therapy, where available.

The classifications are provided in separate tables for these rare disorders as follows:

Metabolic rare diseases: lysosomal storage diseases, disorders of sulphur metabolism, disorders of tyrosine pathway

Liver rare diseases: disorders of copper pathway (Menkes and Wilson disease)

Respiratory rare disease: cystic fibrosis

Hematological rare diseases: mastocytosis, beta-thalassemia, hemophilia, sickle cell disease, Ghosal hemato-diaphyseal dysplasia, severe congenital neutropenia, Histiocytosis

Neurological Rare Disease: Rett Syndrome

Malformation: Tricho-rhino-phalangeal syndrome, type I

Professor Maria-Luisa Brandi, chair of the past IOF SRD Working Group and convener of the IOF Skeletal Rare Disease Academy, stated:

"With this work, we have established the first classification of systemic rare diseases which alter bone metabolism and which may be amenable to different therapeutic approaches to maintain bone health. We look forward to updating the classification as new knowledge and new therapeutic options become available."

Professor Nicholas Harvey, chair of the IOF Committee of Scientific Advisors (CSA) and the IOF Skeletal Rare Disease Academy, added:

"This new publication, documenting a novel approach to the classification of these rare diseases, demonstrates the enormous value in bringing together global leaders in this field through the International Osteoporosis Foundation's science programme, continuing through the IOF Skeletal Rare Diseases Academy, to generate state-of-the-art reports that will inform clinical practice worldwide."

Most people experience turbulence primarily from the experience of flying in an airplane. However, turbulence is a key feature of nature and is found everywhere, from rivers to galaxies.

Turbulent-like dynamics are difficult to capture in a still image. However, Leonardo da Vinci did everything possible to identify the underlying order of the phenomenon, which he observed in eddy currents forming randomly in water. In fact, he was fascinated by trying to understand and describe the generating principles governing such complicated dynamics. This is so much so that he coined the phrase "turbolenza", which comes from the Latin word for crowds: "torba". This same idea was the beginning of centuries of research into turbulence. Through the work of the giants of modern physics and mathematics like Andrey Kolmogorov, Yosihiki Kuramoto and Werner Heisenberg, some of the main organizing principles of turbulence have been established. Heisenberg said: "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe God will have an answer to the first".

The article: "Turbulent-like dynamics in the human brain" published by the main open access journal Cell Reports on Monday 8 December 2020, focuses on characterizing and identifying the turbulence that occurs in the human brain.

This work is the result of international collaboration between the Center for Brain and Cognition (CBC) at Pompeu Fabra University, the Department of Psychiatry at the University of Oxford (UK), and the Center for Music in the Brain at Aarhus University (Denmark), conducted by the researchers Gustavo Deco (ICREA-DTIC) and Morten L. Kringelbach, who have discovered turbulent-like dynamics in the human brain by means of functional magnetic resonance imaging (fMRI) in a sample of over 1,000 participants.

Turbulence as a fundamental organizing principle of physical systems

Gustavo Deco stated: "Previous research has shown that turbulence is the optimal way to make energy cascade through space-time on many scales, which is not just a visually pleasing phenomenon but also a fundamental organizing principle of physical systems".

The new approach suggested by this work proposes the existence of turbulent-like dynamics as the backbone of the communication of large-scale neural networks

Deco continues: "We have also shown that the physics of turbulence has important practical applications ranging, for example, from improved chemical plants to aircraft and windmills. Our results reveal a new way of analysing and modelling whole-brain dynamics. This new approach suggests the existence of turbulent-like dynamics as the backbone of the communication of large-scale neural networks. This new knowledge could revolutionize our understanding of brain function".

Morten L. Kringelbach, co-author of the research, adds: "Our findings provide a solid, innovative framework for use as novel biomarkers for neuropsychiatric diseases. In the coming years, this theoretical framework could lead to new interventions that might improve the mental health of many people, especially after this turbulent pandemic".

New Orleans, LA - Catherine O'Neal, MD, Assistant Professor of Clinical Medicine at LSU Health New Orleans School of Medicine's branch campus in Baton Rouge, is a co-author of a paper reporting that shortening the length of quarantine due to COVID exposure when supported by mid-quarantine testing may increase compliance among college athletes without increasing risk. The findings are published in the Centers for Disease Control and Prevention's January 8, 2021 Morbidity and Mortality Weekly Report (MMWR), available here.

CDC partnered with representatives of the NCAA conferences to analyze retrospective data collected by participating colleges and universities. De-identified data from a total of 620 athletes with positive SARS-CoV-2 test results during quarantine were included in a time-to-event analysis.

The analysis showed that nearly 49% of the positive test results occurred by day 2 of quarantine and by day 5 for 73% of the athletes. The positivity rate for all of the SARS-CoV-2 RT-PCR tests administered decreased over the quarantine period. Among those whose test results remained negative at day 5, the estimated probability of having a positive test result was 26.9% after day 5, 14.2% after day 7, and 4.7% after day 10. Among the 29 athletes who received positive test results during days 11-14, 89.7% had not been tested previously during their quarantine period.

The researchers noted that despite the potential risk for transmission from frequent, close contact associated with athletic activities, more athletes reported exposure to COVID-19 at social gatherings (40.7%) and from roommates (31.7%) than they did from exposures associated with athletic activities (12.7%).

"The revised quarantine guidance from CDC is an important step in reducing the hardship of a 14-day quarantine while maintaining public safety," notes Dr. O'Neal, who is an infectious diseases specialist and also serves as Chief Medical Officer at Our Lady of the Lake Medical Center. "Routine surveillance for COVID-19 in athletes participating in NCAA college athletics provided the opportunity for a critical evaluation of the quarantine period in the 20-year-old population."

The authors wrote that new shortened quarantine options (after day 10 without testing or after day 7 with negative test result) were based on decreasing transmission risk over the duration of quarantine (5). Findings from this investigation support shortened quarantine options for collegiate athletes, given the low proportion of athletes who had positive test results after day 10.

Concludes Dr. O'Neal, who is LSU's representative on the NCAA Southeastern Conference Committee on Return to Activity and Medical Guidance Task Force, "This data supports the CDC's new recommendation and highlights the importance of mid-quarantine testing as an effective way to detect asymptomatic infection in this population."

A detailed analysis of the burden of osteoporosis in eight Eurasian countries has found that osteoporosis is a significant and growing health problem in the region that will escalate in the future due to expected demographic changes.

The authors of the Audit report [1] carried out a review of the available literature and a survey of the representatives of the national osteoporosis societies in eight Eurasian countries. The Audit reviews both the burden and the differences between Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan with regard to the prevalence of osteoporosis and incidence of osteoporotic fractures, future demographic changes, diagnostic resources, and treatment availability.

The findings reveal:

The expected number of osteoporosis patients varies from 240,000 in Armenia to 16 million in the Russian Federation.

Fragility fractures represent a serious health problem in all countries, with the highest incidence in Kazakhstan and the Russia Federation.

In all the countries audited, according to a systematic review of hip fracture incidence worldwide, women are at moderate risk (200-300/100,000 persons per year) of hip fracture while men are at moderate (100-150/100,000) to high (150/100,000) risk in the Russian Federation, Uzbekistan and Kazakhstan.

The rate of hospitalization following hip fracture in the majority of countries is low (33-80%), considerably below international standards.

In the coming decades the populations, in particular of Uzbekistan, Kazakhstan, and Kyrgyzstan, will continue to see increases in life expectancy with a corresponding increase in the number of fractures in older people. Thus, in 2050, the number of hip fractures in these countries is expected to increase by 2.5-3.5 times.

The availability of DXA devices in the region is low (0.2-1.3 per million), and DXA scans are expensive.

Almost all current treatments are available, but in countries which do not provide coverage, the costs of even the most commonly prescribed bisphosphonate is prohibitively high for the majority of people with osteoporosis.

Professor Olga Lesnyak, lead author of the Audit, stated:

"We were pleased to see that in the 10 years since the previous International Osteoporosis Foundation (IOF) Audit2, some progress has been made in the region. However, the Audit clearly shows that there are enormous gaps and a great need for improvement in the fight against osteoporosis and related fractures, particularly in the face of expected demographic changes. We have identified an unacceptable absence of organized, specialized trauma care for hip fracture patients and continued poor accessibility to diagnosis, preventive treatments and post-fracture care in most countries of region."

IOF CEO, Dr Philippe Halbout added:

"With the expected demographic changes in the Eurasian region there will be a significant increase in the number of people with osteoporosis. To stem the tide of disability and loss of independence due to fragility fractures, urgent action is needed now at the national level in each country. This must begin with the recognition of osteoporosis as a priority health issue. We very much hope that this Audit will provide valuable insights and recommendations for health policy advances that will lead to fewer fractures and better patient outcomes in the region."

The authors and the national osteoporosis societies which contributed to the regional Audit have been commended by Professor Jean-Yves Reginster, Chair of the IOF Committee of National Societies (CNS):

"IOF is honoured to count 14 societies from the Eurasian region in its network of 260 member organizations from across the world. We congratulate the member societies and lead authors on this important initiative which highlights the burden of osteoporosis and identifies the key areas that must be addressed now and in the future."

The American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), National Hemophilia Foundation (NHF), and World Federation of Hemophilia (WFH) have developed joint clinical practice guidelines on the diagnosis and management of von Willebrand Disease (VWD), the world's most common inherited bleeding disorder. The guidelines were published today in Blood Advances.

VWD affects approximately 1% of the world's population, and it is the most common bleeding disorder. Although VWD occurs among men and women equally, women are more likely to notice the symptoms because of heavy or abnormal bleeding during their menstrual periods and after childbirth. This inherited condition results in the decreased production, absence, or abnormal function of the clotting protein von Willebrand factor.

VWD can cause unusual bleeding from small wounds or minor procedures, frequent nosebleeds, bruising, bleeding in joints, and heavy menstrual periods and post-partum bleeding in women. Symptoms may vary from patient to patient or in a single patient over the course of his or her life. Primary care providers, pediatricians, obstetricians, and gynecologists who observe unusual bleeding often refer their patients to a hematologist for further testing and management. Many individuals with mild symptoms do not receive a diagnosis right away and live for many years with untreated bleeding or do not realize they have VWD until they experience a severe bleed that could have been prevented.

"While VWD is a common bleeding disorder, it is also complex, presenting challenges in the timely diagnosis and appropriate management of bleeding for patients," said 2021 ASH President Martin S. Tallman, MD, of Memorial Sloan Kettering Cancer Center. "Because diagnosis is not straightforward and symptoms range in severity, there is a need for trustworthy guidelines to help improve the quality of care for patients. There are no better partners for ASH in this effort than ISTH, NHF, and WFH, whose collective expertise in VWD from the scientific and patient perspectives around the world enhanced this effort."

Notably, the guidelines make key statements on thresholds of laboratory testing to classify VWD to be more inclusive of patients who experience bleeding, but whose blood work does not meet currently accepted thresholds for diagnosis. In addition, the guidelines for the first time recommend that VWD patients who suffer from frequent, severe bleeding that decreases quality of life should receive routine VWD prophylaxis - an injectable concentrate of clotting protein - several times a week. Together, the guidelines on diagnosis and management include a combined 19 recommendations.

The guidelines were developed by two expert panels made up of 32 individuals, including U.S.-based and international hematologists, individuals living with VWD, and scientists with expertise in evidence synthesis and appraisal and guideline development methodology. Clinical questions were developed by the panels and prioritized, and an international survey was completed to identify the most important clinical questions. A systematic review of available evidence was conducted by the University of Kansas Medical Center and the panel referred to this evidence to make recommendations. This process shed light on the lack of strong evidence on which to base recommendations, and therefore the report calls for more research.

"These guidelines are an excellent example of collaboration across multiple societies ensuring that the guidelines develop represent the most up to date and relevant advice about diagnosis and treatment of this common, but often misunderstood bleeding disorder," said ISTH Past President Claire McLintock, MD. "Working as part of the incredible team that developed the guidelines in diagnosis of VWD was hugely rewarding and inspiring."
People with VWD made up approximately one quarter of each guideline panel's composition. As full voting members they contributed their expertise to every aspect of the rigorous guideline development process, from the prioritization of clinical questions, through the evaluation of the available evidence, to the consideration of factors such as stakeholder values and preferences, equity, and feasibility. Their involvement, actively supported by the panel chairs and collaborating organizations, was critical to ensuring the development of recommendations with the greatest pertinence and in which the community will have great confidence. Collaboration with WFH and NHF was essential to engaging the broader VWD patient community.

With their extensive established functional networks with healthcare professionals in centers for comprehensive care of bleeding disorders and patient organizations throughout the US and around the world, the four collaborating organizations, ASH, ISTH, NHF, and WFH will all play important roles in the creation and dissemination of resources based on the guidelines, and their implementation in individual care and broader advocacy efforts.

"These guidelines are an extremely important step in our quest to address the difficulties individuals go through to obtain an accurate, timely diagnosis, and appropriate treatment. The challenge ahead will be for us to educate both those living with VWD and healthcare professionals on the guideline recommendations," said Leonard Valentino, MD, President and CEO of NHF. "We were excited to work with ASH, ISTH, and WFH to create these and introduce them to the community."
"In 2017 we gathered members of the global VWD community for the first WFH International Symposium on VWD. Delegates from countries around the world told us that the number one tool they needed in order to provide comprehensive care to people with VWD was clinical practice guidelines," explained WFH President Cesar Garrido. "The WFH is very proud to deliver these guidelines today, with our partners from ASH, ISTH, and NHF, to the global community. In addition to offering guidance for clinicians and individuals with VWD as they partner in personalized care decisions, they constitute the foundation for important advocacy initiatives to improve access to the recommended diagnostic techniques and treatment options in all countries."

The publication of the guideline will be accompanied by tools and educational resources to help patients, hematologists and other health care providers understand and implement the recommendations.

BOSTON -- Reprogramming the rich connective tissue microenvironment of a liver cancer known as intrahepatic cholangiocarcinoma (ICC) inhibits its progression and resistance to standard chemotherapy in animal models, researchers from Massachusetts General Hospital (MGH) have found. This new treatment for a disease with extremely poor outcomes uses antibodies to block placental growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, which has been widely studied for its role in new vessel formation in cancers. PlGF is highly expressed in ICC compared to normal liver tissue, and blocking it reduces the production of connective tissue while increasing the efficacy of chemotherapy and survival in mice with ICC. These findings were reported in Gut, the journal of the British Society of Gastroenterology.

"We were able to demonstrate that PlGF is a mediator of ICC progression, and that antibody blockade of PlGF in ICC models inhibited the activity of cancer-associated fibroblasts (CAFs), which produce connective tissue and also provide ICC cells with pro-survival and pro-invasion signals," says Dan G. Duda, DMD, PhD, director of Translational Research in GI Radiation Oncology at MGH, and senior author of the study. "Our findings suggest that PlGF inhibition is a potential therapeutic target that could have implications for other emerging combination therapies that have shown promise against ICC, a largely intractable disease with a dismal prognosis."

ICC is an aggressive cancer of the liver with a five-year survival rate of 15% for patients with early-stage disease, and 6% for those with metastases to regional lymph nodes. The cancer is characterized by vascular abnormalities, abundant connective tissue (known as desmoplasia) produced by activated CAFs, and few therapeutic options. Systemic chemotherapy using gemcitabine and cisplatin remains the standard of care for patients with advanced ICC, but the benefits are limited. "New therapies are urgently needed as incidence of ICC grows at 3% a year in the U.S. and worldwide," emphasizes Duda.

The MGH study was inspired by previous research by Duda and Rakesh K. Jain, PhD, director of the Edwin L. Steele Laboratories for Tumor Biology at MGH, and a pioneer in the fields of tumor microenvironment and cancer therapy, that identified PlGF as a potential target to inhibit the growth and spread of medulloblastoma, the most common pediatric malignant brain tumor. Their groundbreaking research demonstrated high expression of the PlGF receptor neuropilin 1 (Nrp1) in medulloblastoma and found that PlGF/Nrp1 blockade resulted in tumor regression, decreased metastasis, and increased survival in mice. PlGF blockade using antibodies has been tested in a phase 1 clinical trial (ClinicalTrials.gov Identifier: NCT02748135) with final results to be reported later this year.

"Our prior work led us to study other cancers where PlGF might play a pivotal role," notes Duda. "We found that PlGF levels were also elevated in CAFs and circulating blood plasma in ICC patients, and were associated with disease progression." Investigation in mouse models further revealed that PlGF blockade reduced desmoplasia and tissue stiffness, which are determinants of tumor aggressiveness and resistance to treatment. Consequently, the antibody blockade re-opened collapsed tumor vessels and improved blood perfusion and chemotherapy efficacy, while reducing ICC cell invasion and increasing survival in mice. "In effect, we reprogrammed the hypoxic tumor microenvironment, which could have major implications for novel combination therapies targeting ICC or other highly desmoplastic tumors, such as pancreatic cancer," explains Jain, co-author of the latest study.

Such a systemic approach could enhance the efficacy of standard chemotherapy but also radiation therapy or immune checkpoint inhibitors, including programmed cell death 1 (PD-1) blockade - all of which have shown promise against ICC. "Our results indicate that PlGF blockade can provide a clinical strategy for growing numbers of ICC patients who have failed to see any significant improvements in treatment over the years," says Duda.