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Almost a quarter of people with severe sight loss in the UK are going without the treatment they need, according to a new study being presented at the World Congress on Public Health today (Friday 16 October).

Researchers examined data from a survey of more than 300,000 people aged 15 and over in 28 countries in Europe for the study, published in the journal Acta Ophthalmologica.

The study found that 26% of people across Europe reporting either blindness or severe vision loss had an unmet need for eye care - with this figure at approximately 23% for the UK.

The paper reports significant differences among EU countries in terms of the prevalence of overall severe sight loss amongst the general pop. These range from 0.86% experiencing vision loss in Ireland and Malta, to 6.48% in Belgium.

There was a generally higher prevalence of severe vision problems in Eastern Europe, with around 2.43% of the general population experiencing issues when compared to 1.25% in Northern Europe, which includes the UK. The discrepancy widens when examining figures for the over 60s, where 6.34% of people in Eastern Europe reported severe vision loss, compared to 2.50% of the Western European population.

A total of 1.11% of the UK's general population self-reported severe vision loss issues, rising to 2.15% among the over 60s.

Poor health, social isolation, smoking and poverty were associated with higher levels of self-reported severe vision loss.

Lead author, Professor Rupert Bourne of Anglia Ruskin University (ARU) said: "We found self-reported severe vision problems in Europe were more frequently observed in the elderly, women, smokers and in those reporting greater social isolation.

"The higher prevalence in Eastern European countries could be partially explained by economic restrictions limiting access to eye care.

"Given that this study reports 26% of people with an unmet need for optical correction in Europe, efforts should be increased to address this requirement.

"While we had access to Europe-wide data, it is crucial that countries survey their population thoroughly to establish where the problems lie, and ensure people have access to the right care."

AURORA, Colo. (Oct. 16, 2020) - A study of Catholic obstetrician-gynecologists shows that many face moral dilemmas when dealing with issues of family planning and abortion due to their religious faith, according researchers at the University of Colorado Anschutz Medical Campus.

The study, published this week in JAMA Network Open, revealed that some Catholic Ob/Gyn practitioners lean toward natural methods of birth control and do not perform abortions due to their faith, while others believe providing a full range of services to those in need is intrinsic to their religious teachings.

"The primary outcome was understanding how participants describe integration of Catholic values with family planning service provision," the study said.

The intersection of family planning and Catholicism highlights a complex relationship between religion and medicine. The US Conference of Catholic Bishops provides medical guidelines called the Ethical and Religious Directives for Catholic Health Care Services, known as the Directives. They are intended for all practitioners in Catholic health care settings and for Catholic physicians in non-Catholic settings. The Directives only allow for natural family planning counseling for heterosexual married couples.

The researchers interviewed 34 Catholic obstetrician-gynecologists - 27 or 79.4% were women - from 19 states. `Low' practitioners were described as those who provided natural family planning only. `Moderate' practitioners provided additional contraceptive methods. `High' practitioners offered a full range of family planning services including abortions. In this study, there were 10 low, 15 moderate and 9 high practitioners.

Researchers found a complex web of reasons and rationale for how practitioners decided what services to provide.

Those who only offered natural family planning, or `low' practitioners, focused on the patient's broader circumstances and sought to avoid interfering with natural conception.

"...in the realm of family planning I have never really felt that I could justify introducing harm if the only thing I'm getting from it is the disruption of something that's working normally to begin with..." said one such doctor.

Physicians dubbed as `moderate' worked hard to prevent abortion by providing contraception. If pregnancy occurred, they would often refer the patient to an abortion provider.

A `moderate' practitioner put it this way:

"I have no problems prescribing birth control or doing tubal ligations. I know the Catholic church frowns upon birth control as well as tubals, but it's something I feel like I'm doing less harm than more harm. If it were an ideal world I wouldn't have to prescribe birth control to teenagers, or people who are single, but unfortunately, it's not. So I see it as the lesser of two evils. The other evil would be getting pregnant and then ending up with going to terminate the pregnancy."

Those called `high' practitioners tended to believe patient needs trumped their own personal beliefs. Providing family planning services, some said, was a way of achieving social justice.

"What Jesus taught, washing the feet of people who are beggars. You take the lowest person and you treat them with compassion. Not that women getting abortions are low, I don't mean that, but I mean in the sense that other people will reject them and treat them poorly, and we do the opposite. We try to mentor them and treat them well, which it's a reversal, and I think it's completely in line with the Catholic faith. Just looking out for the poor and the people who are rejected by others," said one such doctor.

The paper's lead author, Angela Marchin, MD, who did the research while a fellow at the University of Colorado School of Medicine, said the study showed that `just like we know each patient is different, healthcare provision is not a one-size-fits-all for Catholic providers.'

"Catholic Ob/Gyns provide a range of reproductive health services, including abortion, and they're all consistent with different Catholic values and medical ethics," said Marchin. "Our study shows how moral and ethical values are integrated in the context of Catholicism and medical practice."

The findings could lead to better guidance for exercises and workshops tailored to the inherent conflicts and sensitive nature of this intersection of medicine and religion.

"Understanding the dilemmas faced by Catholic obstetrician-gynecologists and their moral and ethical decision-making can improve discourse on this topic and help destigmatize the varying choices Catholic patients and health professionals make," Marchin said. "Physician concerns may provide insight to church leaders charged with providing guidance for modern medical issues."

Leishmaniasis is caused by the protozoan Leishmania parasites which are transmitted by the bite of an infected sandfly. Although in rich countries this disease mainly affects dogs, in other countries it can wreak havoc on the health of humans, causing anything from ulcers to damage to the bone marrow, liver or spleen, all which could be fatal. The WHO estimates that there are currently over one billion people living in areas in which leichmaniasis is endemic and that there are over one million new cases each year. There is therefore an urgent need to find new, efficient and selective alternatives to leishmaniasis chemotherapy which can reduce the adverse side effects of existing drugs such as paromomycin and miltefosine.

Lecturers Rosa Maria Ortuño and Ona Illa from the UAB Department of Chemistry were in charge of coordinating a multidisciplinary research into finding new anti-Leishmania therapies. Also involved in the study were the groups of lecturer Jean-Didier Maréchal, from the same department, and of lecturer Carme Nogués, from the UAB Department of Cell Biology, Phyisology and Immunology, as well as researchers Luis Rivas from the CIB Margarita Salas - CSIC (Madrid) and Míriam Royo from the IQAC - CSIC (Barcelona).

The study consisted in the preparation and biological evaluation of new cell-penetrating peptides (CPPs) which, with an antibiotic conjugation, serve as a vehicle or vector for the drug, enabling it to enter the parasite's cell membrane and be released inside, thus causing its death. The result is greater effectiveness, while at the same time a lower number of oral doses of the drug are needed. In addition, the synthesised CPPs are not toxic for mammal cells, but are for the Leishmania. "Although the idea of using CPPs in the treatment of leishmaniasis is not unknown, the importance of this study lies in its high cell-penetrating capacity and the selectivity (mammal vs parasite cells) of the new synthesised and studied peptides", explains Rosa Maria Ortuño.

In particular, the research has served to study peptides made up of non-protein amino acids with a covalent conjugate of doxorubicin (Dox), a drug which is also used in cancer treatments. While Dox in its free form is not active when incubated with Leishmania because it is not capable of penetrating its interior, the Dox-PPC conjugate has demonstrated to be toxic in very low concentrations. Its cell-penetrating capacity has been rationalised through molecular modelling studies. The results are highly promising, and "a great deal of research is still needed before thinking about new drugs, but we are now a little bit closer of our objective", concludes Ortuño.

INDIANAPOLIS -- Research scientists from Regenstrief Institute and Indiana University have further improved the performance of Uppstroms, a machine learning application that identifies patients who may need referrals to wraparound services, by incorporating additional personal and population-level data sources and advanced analytical approaches.

Research team affiliations include Regenstrief, IU Fairbanks School of Public Health at IUPUI, IU School of Medicine and Eskenazi Health.

Uppstroms has been in use at nine clinics associated with a safety net hospital in Indianapolis. The algorithm identifies primary care patients with social risks such as behavioral health or struggles with food or housing. This allows clinicians to offer these patients referrals to specialized services such as a dietician, behavioral health or a social worker, with the goal of addressing the need before it turns into a crisis.

Evidence suggests that at least one in four adults, and possibly as many as one in two, have a need driven by social determinants of health.

"These wraparound services can enhance primary care delivery by addressing socioeconomic, behavioral and financial needs that cannot be addressed by primary care providers," said Suranga Kasthurirathne, PhD, first author on the paper, Regenstrief research scientist and assistant professor of pediatrics at IU School of Medicine. "To make it more useful in the clinical setting, we incorporated a wide spectrum of patient-level data and more granular population health data to improve the precision of the app, leading to fewer false positives."

Innovations to prior approaches

Additional data added to the algorithm included patient-level social determinants of health, insurance, medication history and behavioral health history. These data came from Eskenazi Health's electronic health record system and the Indiana Network for Patient Care, which is managed by the Indiana Health Information Exchange. Population-level social determinants of health measured at census-tract area, which is smaller than the area encompassed by a zip code, were derived from the U.S. Census Bureau, the Marion County Public Health Department and community health surveys.

The research team assessed the new decision models and found that they outperformed previous models. The new patient-level data and advanced analytical approaches played a key role in improving the precision.

"So much of what affects health happens outside of a doctor's office," said senior author Joshua R. Vest, PhD, MPH, Regenstrief research scientist and professor and director of the Center for Health Policy at IU Fairbanks School of Public Health at IUPUI. "Health systems are working to integrate those social determinants of health into the EHR. This study shows the benefit of capturing social factors in the EHR during clinical visits and leveraging them for clinical decision making."

In addition to the added data elements, the study team adapted the application to be vendor neutral, meaning it can be implemented into any electronic health record system.

The next steps for the researchers are to develop a way to harness unstructured data in the EHR and include it in the algorithm.

The VIBRA project, "Very fast Imaging by Broadband coherent Raman", has just ended at the Politecnico di Milano. Funded by the prestigious European Research Council of the European Community and lasted 5 years (2015-2020), it led to the development of a new revolutionary optical microscope in the biological and biomedical fields. "Today, the identification of tumors and other diseases is largely based on the subjective judgment of a pathologist who visually inspects the tissue under a microscope. Our optical microscope, based on coherent Raman spectroscopy, is able to quickly visualize the chemical content of a biological sample to identify diseased cells in human biopsy - an accurate, reliable and non-invasive tool that can guide the surgeon's work in real time", explains Dario Polli, Professor of Physics at the Politecnico di Milano and scientific director of the project.

By exploiting sophisticated laser techniques that generate ultra-short light pulses (lasting millionths of millionths of a second, among the shortest events ever made by man), it was possible to record the fingerprint of the molecules that make up matter. Each molecule, in fact, is recognizable by the "sound" it emits when it vibrates. Hence the name of the project. The laser pulses have the double function of hitting molecules like a hammer to make them vibrate and then recording their vibration, at frequencies billions of times higher than the sounds we can perceive with our ears. All this in a non-invasive way, that is, without adding any contrast agent or destroying or disturbing the sample. It was therefore possible to map the concentration of the various constituents of matter and create detailed three-dimensional maps of cells and tissues. "The results obtained will have a great impact in biology and medicine. In the future, they will allow researchers to visualize the properties of organic samples with great bio-chemical specificity. The aim will be to study the cellular mechanisms underlying various pathologies and to automatically identify tumors in biopsies, with a degree of accuracy and reproducibility better than we can do today", comments Professor Dario Polli.

It's generally accepted health advice that adults of all ages should sit less, move more, and engage in regular exercise to feel better and reduce the risk of chronic diseases. However, when it comes to the brain and cognition, a new study of older adults from Colorado State University suggests that some sedentariness isn't all bad, so long as basic physical activity benchmarks are being met.

The research, from Assistant Professor Aga Burzynska in the CSU Department of Human Development and Family Studies, examined the association between sensor-measured physical activity and cognitive performance in a sample of 228 healthy older adults, aged 60 to 80.

Published in Psychology and Aging, the results showed that, as expected, adults who engaged in more moderate-to-vigorous activity had better speed, memory, and reasoning abilities. However, the data also revealed that adults who spent more time sedentary performed better on vocabulary and reasoning tasks.

The study could be a bit of good news for a population of Americans who spend a significant amount of time sitting for work and for leisure.

SENSITIVE MEASUREMENTS

The association between increased physical activity and improved cardiovascular and metabolic health is one that's well documented, according to Burzynska. But the link between different intensities of daily physical activity and cognitive health is less understood, especially in older adults.

"We know that as we grow older, even if we do not have any cognitive impairments, people aged 60 and up already show some decreases in speed, executive functioning, and memory. Those decreases are totally within a normal range, but this study was looking to understand how our behaviors and habits may correlate with cognitive outcomes in older age," Burzynska said.

What differentiates this study from others is the way the researchers measured daily physical activity, using scientifically validated sensors that are more accurate than your average, consumer-based activity tracker. Other studies rely on self-reported data to measure physical activity, "and we already know that people like to overestimate their daily movement and underestimate the time they spend sitting," Burzynska said.

"If you ask, 'How long did you sit today?' people will perhaps say 2 to 3 hours when the reality is more like 6 to 8 hours," she added.

Further, where other studies might use only one or two measures of cognition and a general definition of physical activity, Burzynska's study employed a broad assessment that tested 16 cognitive tasks. In addition, they measured and controlled for socioeconomic and health factors, such as employment status, income level, aerobic fitness, blood pressure, and mobility issues.

"Our study has pretty high-quality measures that cannot be done 'quick and dirty'," Burzynska said.

Older adults who participated in the study wore the sensor on their hip for a span of seven days, during which the sensor captured the daily time they spent sitting or in light versus moderate-to-vigorous physical activity.

FLUID VS. CRYSTALLIZED COGNITION

The cognitive assessment prompted participants to select patterns, fill-in-the-blanks, and identify shapes, among other tasks -- the results of which helped researchers gauge if there was a correlation between physical activity and fluid vs. crystallized cognition.

So-called "fluid" abilities, such as speed and memory, problem solving, and reasoning skills, tend to decline throughout adulthood; yet, participants in the study who engaged in moderate-to-vigorous physical activity performed better on fluid tasks, suggesting that exercise might stave off some of the typical effects of brain aging.

However, most participants in the study did not spend a significant amount of time in physical activity; in fact, data showed that, on average, most participants spent less than 2.7% of their time engaged in moderate-to-vigorous activities. Those older adults who instead sat more hours each day performed better on knowledge-based activities, like vocabulary tests or reading comprehension. These "crystallized" abilities tend to strengthen with age as adults acquire more knowledge and experience.

Interestingly, the researchers observed no associations between light physical activities -- such as doing laundry, cooking, or other household chores -- and cognition. Although replacing sedentariness with light physical activity has been recommended for better metabolic health, there is no evidence of such a relationship at the cognitive level.

While the results are purely correlations and have no clear causes, the researchers speculate that when people are sedentary, they're likely to be engaging in educational, stimulating activities, like reading, playing games or puzzles, or attending plays, which might serve to boost crystallized cognition.

"There's this big push within health and wellness that sitting is always bad for your body, that being a couch potato is not good," Burzynska said, "and although our earlier studies indicated that the brains of those who spend more time sitting may age faster, it seems that on the cognitive level, sitting time may also be meaningful."

WAYS TO SPEND OUR SITTING TIME

However, future studies are needed to determine how exactly the participants spent their time sitting before any definitive conclusions can be made about sedentary activity and cognitive health.

Burzynska says the study reinforces the recommendation that regular exercise is good for general health, but for those older adults who might not be able to be physically active, engaging in more cognitively demanding activities may also be an option.

"I don't think I would in any way suggest that we should engage in more sitting, but I think trying to be as physically active as possible and making sure that you get stimulated in your sedentary time -- that it's not just spent staring at the TV -- that this combination might be the best way to take care of your brain," she said. "I hope it sends some positive message for those of us who have had limited opportunities to exercise during the pandemic."

In the quest for long-term brain health, it seems balance is the answer.

"When you exercise, enjoy your exercise. Maybe sometimes think, 'Yeah I'm going to go sit now and enjoy a really good book," Burzynska added.

A new study by UBC researchers is set to change international treatment recommendations for people who are newly diagnosed with HIV--an update that could affect nearly two million people per year worldwide.

The study, published today by The Lancet in the journal EClinicalMedicine, was commissioned by the World Health Organization (WHO) as part of a planned update to its guidelines for HIV antiretroviral treatment (ART). The study found that dolutegravir is the optimal medication for first-line treatment for people newly diagnosed with HIV, a choice that has not been clear over the past several years.

"Research supporting the 2016 WHO guidelines suggested that dolutegravir was effective and well tolerated, but its efficacy and safety among key populations, such as pregnant women and people living with both HIV and tuberculosis (TB), remained unclear," said the study's lead author, Dr. Steve Kanters, who completed the research as a PhD candidate in UBC's School of Population and Public Health (SPPH). "In 2018, new research warned of a potentially serious increase in risk of neural tube defects in the children of women who became pregnant while taking this treatment."

The risk of adverse reaction meant that, although dolutegravir was found to be favourable compared to other options, it was only recommended as an alternative, with an antiretroviral called efavirenz recommended as the primary treatment.

The study team, which included Dr. Nick Bansback, associate professor at SPPH, Dr. Aslam Anis, professor at SPPH and director of the Centre for Health Evaluation and Outcome Sciences (CHÉOS), and Dr. Ehsan Karim, assistant professor at SPPH, completed a network meta-analysis of research stemming from 68 available antiretroviral therapy (ART) clinical trials.

They found dolutegravir was superior to efavirenz in most outcomes, including viral suppression, tolerability, and safety. According to Kanters, the increased odds of viral suppression with dolutegravir could have a significant impact on achieving international goals for HIV treatment.

"We found about a five per cent increase in the probability of viral suppression, which means that more people who start treatment will be able to successfully control their HIV," he said.

Another key attribute of dolutegravir is that it is effective in people who are resistant to NNRTI-class antiretrovirals, like efavirenz, a problem that is becoming increasingly common.

The analysis also showed that dolutegravir and efavirenz had similar rates of adverse events for pregnant women -- the increased risk of neural tube defects for dolutegravir was estimated to be less than 0.3 per cent.

"The new evidence on neural tube defects show that the risk with dolutegravir is much more tolerable than previously thought and should quell the initial worry about this drug," said Kanters.

"Dolutegravir appears to be here to stay as the preferred treatment for people newly diagnosed with HIV," he said. "However, it is important to recognize the good that efavirenz has done over the past two decades, as it helped lead the ART scale-up around the world."

Despite the many benefits of dolutegravir, dolutegravir use was associated with increased weight gain, a side effect that could increase the risk of aging-associated comorbidities, like heart attack or stroke.

"In many places, well-treated HIV has become a chronic condition and we are now seeing people living long lives with HIV," said Kanters. "The research community will continue to monitor the effects dolutegravir may have on the healthy aging process."

While this study is specifically focused on the optimal treatment for people newly diagnosed with HIV, an upcoming publication will review the evidence in support of switching to dolutegravir for people whose first treatment choice has been unsuccessful in controlling their infection. This recommendation could mean improved treatment for the many people living with HIV around the world who are unable to achieve viral suppression despite being on treatment.

NEW YORK - October 16, 2020 - In the FORECAST randomized clinical trial, the use of fractional flow reserve management derived from computed tomography (FFRCT) did not significantly reduce costs but did reduce the use of invasive coronary angiography (ICA).

Findings were reported today at TCT Connect, the 32nd annual scientific symposium of the Cardiovascular Research Foundation (CRF). TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine.

FFRCT is a novel, validated, non-invasive method for describing both the amount of coronary atheroma from a CT coronary angiogram (CTCA), but also vessel-specific ischemia derived from the CTCA and other clinical parameters using a fluid dynamics computer model. Previous studies have indicated that FFRCT reduces the uptake of invasive angiography that shows no significant CAD, without compromising patient safety. The clinical effectiveness and economic impact of using FFRCT instead of other tests in the evaluation of patients with stable chest pain has not yet been tested in a randomized trial, although based upon cost models on observational data, FFRCT is already recommended in routine clinical practice by National Institute for Health and Care Excellence (NICE) in the UK, because it appeared cost dominant.

The primary endpoint of the FORECAST trial was resource utilization derived from non-invasive cardiac tests, invasive angiography, coronary revascularization, hospitalization for a cardiac event, and cardiac medications at nine months. Prespecified secondary endpoints included major adverse cardiac and cerebrovascular events, revascularization, angina severity, and quality of life (QOL).

In the trial, 1,400 patients with stable chest pain at 11 UK centers were randomized to receive either CCTA with FFRCT of lesions with stenosis severity of 40% or greater (test arm, n=699) or routine assessment as directed by the NICE Guideline for Chest Pain of Recent Onset (reference arm, n=700). The routine assessment arm included a mixture of non-invasive tests, including CCTA (without FFRCT) in 61.4% of subjects. The mean age of the overall population was 60 (25-89) years and 52% were male. Baseline demographics, angina status, and QOL/health status were similar between the groups.

In patients presenting with new onset stable chest pain, a strategy of CTCA with FFRCT, when compared with a strategy of routine care, did not significantly reduce average total costs in the NHS system (£1,605.50 vs. £1,491.46, p=0.962). At nine months, the number of patients in the test arm who underwent the following non-invasive tests were: CTCA (674), FFRCT (220), stress echo (13), perfusion scan (4), stress MRI (15), exercise ECG (27). The number of patients in the reference arm who underwent these tests were: CTCA (460), FFRCT (9), stress echo (124), perfusion scan (34), stress MRI (20), and exercise ECG (99). A total of 22% fewer patients in the test group had invasive coronary angiography (ICA) compared to the reference group (136 vs. 175, p=0.01). There was no significant difference in the rates of MACCE or revascularization.

"Results from FORECAST indicate that CTCA and FFRCT as a frontline strategy may not be associated with the financial savings projected from observational data by NICE," said Nick Curzen, BM (Hons), PhD, Professor of Interventional Cardiology, University of Southampton, United Kingdom. "However, the reduction in invasive coronary angiography is important and will be very attractive to patients. More data is needed to determine the optimal use for FFRCT in clinical practice."

A new study has found that Vietnamese-American adults who were not obese were 60% more likely to have diabetes than non-obese, non-Hispanic, White Americans, after accounting for age, sex, sociodemographic factors, smoking history and exercise level.

Overall, only 9% of Vietnamese Americans with diabetes in the study were obese -- defined as having a body mass index (BMI) of 30 or higher. In comparison, half of all non-Hispanic White Americans with diabetes were obese.

"While obesity is commonly associated with diabetes risk, the study's findings indicate that this is not necessarily the case for Vietnamese Americans," says the study's first author Leanne R. De Souza, Assistant Professor, Human Biology and Health Studies Programs, University College, University of Toronto. "As a result, health care professionals may miss screening for preventing and treating this potentially life-threatening disease in the Vietnamese-American population. Screening of Vietnamese adults who have normal weight would be helpful."

The data set used in this study did not provide information on why non-obese Vietnamese Americans have higher odds of diabetes than White Americans, but previous research provides potential answers.

Other studies have found that accumulation of excess fat in the abdomen is higher among Asian Americans than White Americans of a similar weight.

"A growing body of literature suggests that measurement of excess weight around the liver and in the abdomen may be a better way to assess diabetes risk than merely taking into account weight and height," says co-author Keith Tsz-Kit Chan, Assistant Professor, Silberman School of Social Work at Hunter College, City University of New York.

Past research has also shown that Asian Americans are less likely to be screened and are therefore more likely to be living with undiagnosed diabetes and pre-diabetes. Untreated diabetes can result in many serious complications including nerve damage, preventable amputation, blindness, heart attacks, strokes, chronic kidney disease and kidney failure.

The authors of the present study found that among non-obese Vietnamese Americans, those aged 45 and older had at least 40-fold the odds of diabetes compared to young adults.

"These findings suggest that screening for diabetes in Vietnamese Americans starting at age 45 might be warranted," says co-author Alexis Karasiuk, a research assistant at the University of Toronto.

In the subsample of non-obese Vietnamese Americans, men and those living in poverty had a much higher prevalence of diabetes compared to women and those with higher incomes, respectively. Adults who had never smoked and those with a post-secondary degree were less likely to have diabetes.

The authors hope to examine the role of diet in future studies.

"Previous research has found that each additional portion of white rice consumed daily raises the risk of diabetes by 11%. Substituting other whole grains such as brown rice instead of white rice may be a promising strategy for decreasing this risk," noted co-author Karen Kobayashi, professor in the department of Sociology and a research fellow at the Institute on Aging & Lifelong Health at the University of Victoria.

Given that non-obese Vietnamese Americans, including those as young as 45, have a relatively high prevalence of diabetes, the authors say that routine screening of this population is needed.

"Better identification of those in the 'pre-diabetes' stage may increase awareness of personal risk and interventions to promote lifestyle changes. Such interventions may substantially decrease the risk of progression to full diabetes," says senior author, Esme Fuller-Thomson, Director of the Institute for Life Course & Aging and professor at the University of Toronto's Factor-Inwentash Faculty of Social Work and Department of Family & Community Medicine.

The author's study was based upon a representative sample of community-dwelling Californians aged 18 and older from seven combined waves of the California Health Interview Survey (CHIS) conducted between 2007 and 2016. The study sample was restricted to Vietnamese Americans (n = 3,969) and non-Hispanic whites (n = 119,651) who were non-obese, defined as having a body mass index (BMI) of less than 30.

A study published in the journal Science and coordinated by researchers of IDIBAPS, the UB and teh Spanish National Center of Cardiovascular Research (CNIC) describes a new immune defence mechanism unknown until now. It is a mechanism orchestrated by lipid droplets (LDs), the cellular organelles capable of attracting and eliminating invading pathogens.

Researchers from Spain, the United States, Australia and Brazil have participated in the international project, financed by the Human Frontier Science Program, with the collaboration of scientists from the CNIC and IIBB-CSIC. Albert Pol, ICREA professor at IDIBAPS, where he leads the Lipid Trafficking and Diseases team and associate professor at the UB School of Medicine and Health Sciences, and Robert G. Parton, from the Institute of Molecular Biosciences at the University of Queensland, are the study coordinators. The first authors of the work are Marta Bosch, a researcher from the IDIBAPS group, and Miguel Sánchez-Álvarez, from the CNIC Mechanoadaptation and Caveolas Biology group.

LDs are the organelles where our cells accumulate nutrients that, in the form of fat, provide the necessary energy for them to develop their function. For example, LDs provide the energy for the heart to beat, the liver to do its metabolic function, or the muscle to move. "The lipid droplet is like the pantry of our cells, where we accumulate the food that we will use later. This happens in all eukaryotic cells, from yeasts or insects to plants or mammals," says Albert Pol.

When viruses or bacteria infect the host cell, they need great amounts of nutrients to multiply and to get them to reach the LD. In the study published in Science the researchers have shown that, in response to infection, DLs organize complexes of antibiotic and antiviral proteins that act cooperatively to fight the pathogen and eliminate it. It is a mechanism that would work in all cells of the body, not just professional cells of the immune system such as macrophages. This defence strategy has also been observed in insects, suggesting its importance during the evolution of our innate immunity.

The key to the innate immunity of cells

Researchers have shown that to protect themselves from infection, cells place large amounts of antibiotics and antiviral proteins on LDs. In total, comparing the surface area of DL in normal cells and infected cells, the study has identified 400 candidates that would perform the protective function of LDs when they are in contact with the pathogen. "In this study, we have focused on six of these proteins and we have shown that they protect the cell during the infection of different types of bacteria" explains Marta Bosch.

"The concentration of these antibiotic and antiviral proteins in a single compartment inside the cell allows creating synergies while reducing their toxicity and allowing the rest of the cellular machinery to function normally," says Miguel Sánchez-Álvarez.

Furthermore, the study shows that this strategy allows a broad-spectrum response, that is, there are many antibiotics and antivirals with different mechanisms of action. It also allows the generation of cooperative mechanisms to attack the infection. "There are synergies between proteins, and, for example, one breaks the membrane of the pathogen and the other destroys its genomic material," authors explain.

"This study represents a paradigm shift since until now it was thought that LDs were at the service of viruses or bacteria during infection," says Albert Pol. "Given the widespread resistance to current antibiotics, this study has deciphered an important defence mechanism that could be used for the development of new therapeutic strategies to stop infections," he concludes.

Peer reviewed / Randomised clinical trial / People

The Lancet Infectious Diseases: Preliminary results find vaccine candidate based on inactivated SARS-CoV-2 virus is safe and induces an immune response in healthy volunteers

Phase 1/2 randomised controlled trial of an inactivated SARS-CoV-2 vaccine candidate was carried out in China between 29 April and 30 July 2020 and involved more than 600 healthy volunteers.

Study detected antibody responses in all recipients by day 42 after vaccination, and provides some data for participants aged over 60 years.

The vaccine was safe and well tolerated at all tested doses, with no severe adverse reactions reported. The most common reported side effect was pain at the injection site.

The primary objective was to evaluate the immune response and safety of the vaccine, and the study was not designed to assess how effective it is at preventing infection with SARS-CoV-2.

A Chinese COVID-19 vaccine candidate based on the inactivated whole SARS-CoV-2 virus (BBIBP-CorV) is safe and elicits an antibody response, findings from a small early-phase randomised clinical trial published today in The Lancet Infectious Diseases journal have found.

A previous clinical trial reported similar results for a different vaccine that is also based on inactivated whole SARS-CoV-2 virus, but in that study the vaccine was only tested in people aged under 60 years.

The latest study included participants aged between 18 and 80 years, and found that antibody responses were induced in all recipients. Participants aged 60 and over were slower to respond, taking 42 days before antibodies were detected in all recipients compared with 28 days for participants aged 18-59. Antibody levels were also lower in those aged 60-80 years compared with those aged 18-59 (Mean neutralising antibody titre 42 days after receiving a 8μg vaccine dose was 228.7 for people aged 18-59, and 170.9 for those aged 60-80) [1].

The trial was not designed to assess efficacy of the vaccine, so it is not possible to say whether the antibody responses induced by the vaccine, called BBIBP-CorV, are sufficient to protect from SARS-CoV-2 infection.

Professor Xiaoming Yang, one of the authors of the study, from the Beijing Institute of Biological Products Company Limited, Beijing, China, said: "Protecting older people is a key aim of a successful COVID-19 vaccine as this age group is at greater risk of severe illness from the disease. However, vaccines are sometimes less effective in this group because the immune system weakens with age. It is therefore encouraging to see that BBIBP-CorV induces antibody responses in people aged 60 and older, and we believe this justifies further investigation." [2]

There are currently 42 vaccines for COVID-19 in clinical trials [3]. These vary in type and include DNA plasmid vaccines, inactivated virus vaccines, adenovirus-vectored vaccines, RNA vaccines, protein subunit vaccines and virus-like particle vaccines. Some of these have already been shown to be safe and to elicit immune responses in early phase clinical trials.

The BBIBP-CorV vaccine used in the study reported here is based on a sample of the virus that was isolated from a patient in China. Stocks of the virus were grown in the lab using cell lines and then inactivated using a chemical called beta-proprionolactone. BBIBP-CorV includes the killed virus mixed with another component, aluminium hydroxide, which is called an adjuvant because it is known to boost immune responses.

The first phase of the study was designed to find the optimal safe dose for BBIBP-CorV. It involved 96 healthy volunteers aged between 18 and 59 years and a second group of 96 participants aged between 60 years and 80 years. Within each group, the vaccine was tested at three different dose levels (2?g, 4?g and 8?g, 24 participants per group), with two vaccinations administered on day 0 and 28. A fourth group within each age group (24 participants in each age group) were given two doses of a placebo vaccine. In total, in phase 1 of the study, 144 participants received the vaccine and 48 received the placebo.

The second phase of the study was designed to identify the optimal timing schedule for vaccination. 448 participants aged between 18 and 59 years were randomly assigned to receive either one 8?g shot of vaccine or placebo, or two shots of 4?g vaccine or placebo (at 0 and 14 days, 0 and 21 days or 0 and 28 days). In this second phase, there were 112 participants per group, with 336 receiving the vaccine, and 112 receiving the placebo.

Participants were asked to report any adverse events for the first seven days after each vaccination and these were verified by the research team. Thereafter, participants recorded any adverse events using paper cards for the following 4 weeks. During phase 1, laboratory tests were carried out after the first and second vaccinations to assess kidney function, liver function and other organ functions. Blood samples were taken to test antibody levels for SARS-CoV-2 before and after vaccination.

No serious adverse events were reported within 28 days of the final vaccination. The most common side effect was pain at the injection site (phase 1 results: 24% [34/144] of vaccine recipients, vs 6% [3/48] of placebo recipients). A small number of participants reported experiencing a fever (phase 1 results: 4% [5/144] of vaccine recipients, vs 6% [3/48] of placebo recipients). There were no instances of clinically significant changes in organ functions detected in laboratory tests in any of the groups.

The greatest antibody responses were elicited by two 4?g doses of the vaccine at either days 0 and 21 or 0 and 28 (Mean neutralising antibody titres 28 days after second vaccination were 282.7 for two 4?g injections at day 0 and 21, and 218.0 for two 4?g injections at day 0 and 28).

Professor Xiaoming Yang said: "Our findings indicate that a booster shot is necessary to achieve the greatest antibody responses against SARS-CoV-2 and could be important for protection. This provides useful information for a phase 3 trial." [2]

The authors noted some limitations with the study, including the short duration of follow up at just 42 days. They also highlighted that the study did not include children and adolescents aged under 18. Trials with these groups will be carried out when the full analysis of data from adult groups is completed, the researchers say.

Writing in a linked Comment article, Professor Larisa Rudenko, who was not involved in the study, from the Institute of Experimental Medicine, Saint Petersburg, Russia, said: "[...] more studies are needed to establish whether the inactivated SARS-CoV-2 vaccines are capable of inducing and maintaining virus-specific T-cell responses, because CD4-positive T-cell help is important for optimal antibody responses, as well as for cytotoxic CD8-positive T-cell activation, which, in turn, are crucial for viral clearance if neutralising antibody-mediated protection is incomplete."

Silver Spring, Md.--Scientists from across the globe will present the latest research in obesity science and medicine and related topics at the 38th Annual Meeting of The Obesity Society (TOS) at ObesityWeek® Interactive. This online event will take place Nov. 2-6, 2020 at http://www.obesityweek.org. On-Demand materials and other elements of the interactive conference will remain available online through Dec. 31, 2020.

Innovative scientific research results will be presented through oral and poster abstracts. These communications provide notable exposure and recognition for studies and authors, and are likely to have a significant impact on obesity prevention and treatment.

"ObesityWeek® Interactive's program is full of cutting-edge research that includes new anti-obesity medication clinical trials, comparisons of weight loss diets and how sleep deprivation and childhood stress can impact body weight. It is a great opportunity to hear about the latest scientific developments and network with experts in obesity," said Jaime Alamdoz, MD, co-chair of the TOS Program Planning Committee.

TOS's program chairs haves selected a sampling of top abstracts from approximately 570 abstracts that will be presented at the meeting.

Samples of the science that will be presented include:

"Changes in Price and Sales of Beverage Types After Implementation of the Philadelphia Beverage Tax" - Petimar et al.

"Disordered Eating Behavior in Young Adults Following Adolescent Bariatric Surgery" - Decker et al.

"Caloric Intake Response to Repeated Sleep Restriction Bouts With Varying Intervening Recovery Nights" - Spaeth et al.

"Cumulative Social Stress in Kindergarten and Obesity Risk, ECLS-K:2011" - Quader and Suglia.

"Effects of Ad Libitum Low Carbohydrate Versus Low Fat Diets on Body Weight and Composition" - Schick et al.

"Dysregulation of a Hypothalamic Brain Aversion Network Drives Addiction-like Eating in Obesity" - O'Connor et al.

"A Randomized Trial of a Once-Weekly Formulation of Setmelanotide in Individuals With Obesity" - Gordon et al.

"Efficacy and Safety of AM833 for Weight Loss: A Dose-finding Trial in Adults With Overweight/Obesity" - Lau et al.

"Semaglutide 2.4 mg and Intensive Behavioral Therapy in Subjects With Overweight or Obesity (STEP 3)" - Wadden et al.

In the largest clinical trial of its kind, researchers show that combining sound and electrical stimulation of the tongue can significantly reduce tinnitus, commonly described as "ringing in the ears." They also found that therapeutic effects can be sustained for up to 12 months post-treatment.

The findings could potentially help millions of people since tinnitus affects about 10 to 15 percent of the population worldwide. The study was conducted by researchers from the University of Minnesota, Trinity College, St. James's Hospital, University of Regensburg, University of Nottingham, and Irish medical device company Neuromod Devices Limited.

The research was published as the cover story of Science Translational Medicine, an interdisciplinary medical journal by the American Association for the Advancement of Science (AAAS).

University of Minnesota Associate Professor Hubert Lim in the Department of Biomedical Engineering (College of Science and Engineering) and the Department of Otolaryngology (Medical School) was the senior author of the study sponsored by Neuromod Devices. Lim also serves as chief scientific officer of Neuromod Devices.

The study represents the largest and longest followed-up clinical trial ever conducted in the tinnitus field for a medical device with 326 enrolled participants, providing evidence regarding the safety, efficacy, and patient tolerability of bimodal neuromodulation for the treatment of tinnitus. About 86 percent of treatment compliant participants reported an improvement in tinnitus symptom severity when evaluated after 12 weeks of treatment, with many experiencing sustained benefit 12 months post-treatment.

"I am truly proud of our company's ability to perform such a large-scale randomized clinical trial in two countries," Lim said. "This study tracked the post-treatment therapeutic effects for 12 months, which is a first for the tinnitus field in evaluating the long-term outcomes of a medical device approach. The outcomes are very exciting and I look forward to continuing our work to develop a bimodal neuromodulation treatment to help as many tinnitus sufferers as possible."

The study was conducted at the Wellcome Trust-HRB Clinical Research Facility, St. James's Hospital, Dublin, Ireland, and the Tinnituszentrum of the University of Regensburg, Germany. There were consistent therapeutic outcomes across both clinical sites, with no serious adverse events. The Minneapolis-based branch of NAMSA, the world's only medical research organization, guided and assisted the close-out process of Neuromod Device's clinical trial.

The tinnitus treatment device used in the study, now branded as Lenire®, was developed by Neuromod Devices and consists of wireless (Bluetooth®) headphones that deliver sequences of audio tones layered with wideband noise to both ears, combined with electrical stimulation pulses delivered to 32 electrodes on the tip of the tongue by a proprietary device trademarked as Tonguetip®. The timing, intensity, and delivery of the stimuli are controlled by an easy-to-use handheld controller that each participant is trained to operate. Before using the treatment for the first time, the device is configured to the patient's hearing profile and optimized to the patient's sensitivity level for tongue stimulation.

For the trial, participants were instructed to use the Lenire® device for 60 minutes daily for 12 weeks. Out of 326 enrolled participants, 83.7 percent used the device at or above the minimum compliance level of 36 hours over the 12-week treatment period. For the primary endpoints, participants achieved a statistically and clinically significant reduction in tinnitus symptom severity.

When treatment was completed, participants returned their devices and were assessed at three follow-up visits for up to 12 months. Just more than 66 percent of participants who filled out the exit survey (n=272) affirmed they had benefited from using the device, and 77.8 percent (n=270) said they would recommend the treatment for other people with tinnitus.

Participants in the study were screened and selected based on a pre-defined list of inclusion and exclusion criteria to ensure the trial had a wide distribution sample of the tinnitus population.

A laboratory test developed by a research team led by Johns Hopkins University bioengineers can accurately pinpoint, capture and analyze the deadliest cells in the most common and aggressive brain cancer in adults.

The method's ability to capture the invasive proliferating and very mobile cells in the fatal condition called glioblastoma could lead to the discovery of new drugs to prevent or slow the cancer's spread. The test can also accurately predict which patients have the least or most aggressive form of glioblastoma.

The findings are described in a paper published in the most recent edition of Nature Biomedical Engineering.

"Because we have the unique ability to identify those deadly cells, we envision utilizing this platform to screen potential therapeutics in order to effectively block the invasion and/or proliferation of these cells and ultimately prolong the survival of patients by putting precision medicine in practice," said Konstantinos Konstantopoulos, the William H. Schwarz professor of chemical and biomolecular engineering, biomedical engineering and oncology, and senior author on the paper. "By subjecting these deadly cells to proteogenomic analysis, we will identify and characterize novel targets to stop these highly invasive and proliferative cells."

Current testing technologies have not been able to effectively predict glioblastoma outcomes that are specific to each patient, according to the paper. And what methods do exist for single cell analysis are too time consuming, expensive and "impractical for informing patient care given the short survival span of patients with glioblastoma," the paper states. Median survival times for the cancer ranges between nearly 6 months for the least aggressive type and about 29 months for the most aggressive.

The Johns Hopkins team, which collaborated with researchers from the Mayo Clinic and Stanford University in this glioblastoma study, demonstrated last year the ability of their test to distinguish metastatic from non-metastatic breast cancer cells, suggesting that it may be applicable to other solid cancers. The Johns Hopkins team received a U.S. patent for the test, called Microfluidic Assay for quantification of Cell Invasion (MAqCI), that requires just a small number of cells to be placed into an apparatus that resembles a fluid-filled ant farm with Y-shaped tunnels to mimic vascular conduits in the brain. The cells can be scored as the most lethal based on three key elements of metastasis: the ability to move, to compress and squeeze through tight branch channels, and to reproduce.

The method requires more testing with a larger sample of patients, but its accuracy in predicting length of survival varied from 86% in a blind retrospective study involving 28 patients to 100% in a blind prospective study with 5 patients.

New research from the International Collaboration on Repair Discoveries (ICORD) challenges the current standard for managing blood pressure in people with spinal cord injury (SCI).

The findings, published today in Nature Communications, could lead to a change in the way newly injured patients have their blood pressure managed, potentially improving their chances of retaining more function in the long term.

This study, led by ICORD principal investigators Dr. Christopher West and Dr. Brian Kwon, demonstrated that following high-thoracic SCI, the heart's ability to contract is impaired, leading to reduced spinal cord blood flow. High-thoracic SCI generally refers to injuries that affect the abdominal and lower back muscles and the legs, typically resulting in paraplegia, while arm and hand function may not be affected.

Currently, a patient being treated for acute SCI--a traumatic injury that bruises, partially or fully tears the spinal cord--has their blood pressure managed using drugs that cause their blood vessels to constrict in order to increase blood pressure.

In this study, the research team tested an experimental treatment targeting the heart to beat more powerfully, which increased the amount of blood ejected and also increased blood pressure.

"The key difference is that by targeting the heart, we increase blood pressure by increasing blood flow instead of by causing the blood vessels to narrow," said West. "This is important because by increasing blood flow we can deliver more blood and oxygen to the spinal cord which is expected to minimize the damage at the epicentre of the injury, and therefore reduce injury severity and bleeding in the cord, both of which are expected to improve the chances of people with SCI retaining more function."

This could mean in the future that an individual who is newly admitted to the hospital may receive a different drug during their initial period of post-injury management. If proven to be effective in humans with SCI, it could improve their chances of retaining more function in the long-term.

"It is important to point out that one of the only things we can currently do for acute SCI patients is to try to optimize the supply of blood and oxygen to the injured spinal cord to prevent further secondary injury," said Kwon. "We need to seek ways of delivering this care in the most effective manner possible, as any bit of spinal cord function that could be improved upon by novel approaches such as this would potentially be very impactful to a patient."