Body

COLUMBIA, Mo. -- Independence has always been a driving force in Nancy Cheak-Zamora's life. Now an associate professor at the University of Missouri School of Health Professions, she grew up undiagnosed with dyslexia, a learning disorder that can lead to difficulty reading.

"Although I wasn't receiving all the assistance or services I probably needed because I was undiagnosed, I always had supportive people in my life who encouraged me and gave me opportunities to be successful," Cheak-Zamora said. "That encouragement fundamentally allowed me to take on more independence and work through challenges in a way that has helped me succeed in both academia and in life."

Eager to offer the same encouragement she received growing up, Cheak-Zamora's research is rooted in a desire to improve the independence of young adults with developmental disabilities, particularly autism. One of her previous studies found young adults with autism were half as likely to receive health care transition services, such as learning how to schedule a doctor's appointment or fill a prescription, compared to other young adults with special health care needs.

To help solve this disparity, she recently developed the world's first health care "transition readiness assessment" specifically for adolescents with autism. A transition readiness assessment identifies skills adolescents need to transition from pediatric care to adult care and be able to manage their health appropriately. By partnering with five autism clinics across the United States, including the MU Thompson Center for Autism & Neurodevelopmental Disorders, Cheak-Zamora had 500 caregivers of young adults with autism in her study.

She found young adults with autism could benefit by better understanding medication management, insurance policies and health care finances; developing skills like scheduling a doctor's appointment or filling a prescription; and receiving education on other areas like interactions with law enforcement and understanding their sexual health and relationship needs.

"Building their autonomy and independence in a health care setting is important because once they can meet the challenges in front of them in one aspect of their life, the research shows that confidence will carry over into other areas of their life as well," Cheak-Zamora said. "Successfully scheduling a doctor's appointment can translate into more autonomous behavior in school or taking more ownership of chores at home."

Cheak-Zamora added that health care providers can use her transition readiness assessment to better identify gaps in education and areas for improvement when caring for young adults with autism, which will take the pressure off already overburdened caregivers.

"The goal is to provide more services for young adults with autism while at the same time allowing them to meet challenges on their own and not always be protected by mom and dad," Cheak-Zamora said. "I want them to know a support system is there for them when they need it, but I also want them to believe in their ability to be independent and do whatever it takes to be successful in life."

Taking into account two common kidney disease tests may greatly enhance doctors' abilities to estimate patients' cardiovascular disease risks, enabling millions of patients to have better preventive cardiovascular care, according to a large international study co-led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The researchers used data from more than nine million individuals around the world to develop and validate a risk-scoring calculation that adds blood and urine measures of kidney disease to the current standard method in the United States for assessing cardiovascular disease risk. The two measures--estimated glomerular filtration rate and urine albumin--are commonly used to reveal chronic kidney disease. CKD, as it's called, has long been considered a risk factor for cardiovascular disease, although until now CKD-related measures have not been included in standard algorithms for quantifying cardiovascular disease risk.

The researchers showed that the use of their "CKD patch"--a computer-program update--can result in large increases in cardiovascular disease-risk estimates among patients with severe CKD.

The investigators also developed a similar patch to enhance the standard risk-assessment tool used in Europe.

The study appears October 14 in EClinicalMedicine, a new online open-access journal published by The Lancet.

"Adding these two measures of kidney disease, which are frequently available from blood and urine tests at checkups, allows potentially big improvements in the accuracy of a patient's risk estimates--improvements that should in turn enable doctors to optimize patient care," says study co-first author Kunihiro Matsushita, MD, an associate professor in the Bloomberg School's Department of Epidemiology.

"This is a big deal--an estimated ten percent of the United States adult population has kidney disease and potentially would benefit from improved care if this new tool is adopted," says co-last author Josef Coresh, MD, George W. Comstock Professor in the Department of Epidemiology at the Bloomberg School.

The other co-first author was Simerjot Jassal, MD, of the University of California, San Diego, and the other co-last author was Elke Schaeffner, MD, of Charité University Hospital Berlin. Shoshana Ballew, PhD, assistant scientist in the Bloomberg School's Department of Epidemiology, helped coordinate the data-gathering. In all, the study included more than 50 researchers.

The reduction of kidney function in CKD can lead to higher blood pressure as well as hormonal and other chemical imbalances, and these in turn promote the narrowing of arteries that supply the heart muscle--conditions known as atherosclerosis and arteriolosclerosis. The American Heart Association and the American College of Cardiology, in their guidelines for physicians, already list CKD as a "risk enhancer" for atherosclerotic cardiovascular disease, but without a specific tool that quantifies the added risk as part of the standard risk calculator.

Since 2009, Coresh, Matsushita, and colleagues have been assembling a large, international database of CKD patients and healthy adults, under a collaboration known as the CKD Prognosis Consortium. For the new study, they analyzed a portion of this database, covering 4.1 million adults around the world, to develop algorithms that estimate cardiovascular disease risk using standard measures plus the two kidney-disease measures. They then validated the accuracy of their algorithms using further samples covering 4.9 million adults.

The two kidney disease measures, estimated glomerular filtration rate and urine albumin, respectively, indicate the kidneys' blood-filtering efficiency and the level of an essential protein called albumin that the kidneys normally would filter out of the urine.

The researchers incorporated these measures in a "CKD patch" to the standard cardiovascular disease-risk estimation algorithm developed by the American Heart Association and the American College of Cardiology. They found that for adults who had results on these kidney- disease tests indicating CKD, the addition of these measures via the CKD patch significantly improved the estimated 10-year risks of atherosclerotic cardiovascular disease.

For example, for patients with "very high-risk" CKD, the estimated 10-year chances of developing atherosclerotic cardiovascular disease were a median of 1.55 times higher than estimates without the CKD patch, while the figures were a median of 1.24 times higher for "high-risk" CKD patients.

The researchers' CKD patch for the standard European 10-year cardiovascular disease mortality risk estimator also boosted estimated risks, by a median of 2.64 times in very high-risk CKD patients, and 1.86 times in high-risk CKD patients.

"These results suggest that doctors have tended to underestimate cardiovascular disease risks in kidney disease patients," Matsushita says.

The researchers hope that their CKD patches will be adopted widely, enabling more accurate assessments of cardiovascular disease and related mortality risks--which in turn should result in better preventive care including the use of statins and other interventions to ward off cardiovascular disease.

"We also hope that the availability and value of these new algorithms will encourage doctors to order estimated glomerular filtration rate and urine albumin tests for their patients more often," Coresh says.

A team of doctors from RUDN University with their Italian colleagues had studied the data of existing studies on the effect of endometriosis on pregnancy and childbirth and suggested ways to reduce obstetrical complications in women with this condition. The results of the work were published in The Journal of Maternal-Fetal&Neonatal Medicine.

Endometriosis is a pathological process accompanied by growth of benign of tissues (that are morphologically and functionally similar to endometrium) outside the uterine cavity. In the premenstrual phase, the endometrium becomes thicker, and if the ovum is not fertilized, it sheds and is removed from the uterine cavity with the menstruations. This process is almost painless in healthy women but in patients with endometriosis, it is accompanied by the inflammation of surrounding tissues. Such patients suffer from chronic pelvic pain, menstrual cramps, painful intercourse, and often infertility. 10% to 15% of women of reproductive age have endometriosis and 30% to 40% experience birth complications. Despite such prevalence of endometriosis, the patterns of obstetrical complications haven't been properly studied yet. A team of doctors from RUDN University with their Italian colleagues was had studied the data of earlier works and proposed the ways for preventing obstetrical complications in women with this condition.

"Earlier studies focused on the biological factors that affect the gestation course in women with endometriosis. We know that patients with endometriosis may experience miscarriages, preterm birth, or other complications due to immunological and endocrinal disorders in the endometrium. However, the mechanism of obstetrical complications is still a not well-clarified issue. That is why we conducted a systematic review of the literature and studied the effects of endometriosis on pregnancy taking into account such factors as treatment and conception methods, as well as stage and localization of the pathological process. We also suggested ways for preventing obstetrical complications in patients with a history of endometriosis," said Doctor Anna V. Borisova, PhD, assistant at the Department of Obstetrics and Gynecology with the Course of Perinatology, RUDN University.

The team analyzed the results of earlier studies taking into account each possible complication: preterm birth, hypertensive complications in pregnancy, placental abnormalities, risk of cesarean section, underweight of the fetus, and stillbirth. Based on the results of the study, the team suggested several methods to improve pregnancy prognosis. Namely, laparoscopy was mentioned as the main treatment option in case of adhesions. Laparoscopy is a modern surgical method that allows doctors to destroy the adhesions between peritoneal and pelvic organs using special endoscopic devices. This helps combat infertility and reduces discomfort and pain in patients with endometriosis. According to the team, the conception's methods should be chosen based on the stages of the disease. Patients with advanced stages of endometriosis are recommended to undergo hormone therapy and women after surgery -- in vitro fertilization with embryo transfer (IVF/ET). The team had suggested that all patients with diagnosed endometriosis should start taking 400 micrograms of folic acid in advance before conception to reduce the risks of preterm birth and spina bifida in the fetus leading to anencephaly (a lethal developmental defect in which a fetus has no cerebral hemispheres and calvarial bones).

"The results of different studies are controversial: some of them did not take concomitant hormone therapy into account; and some had methodological limitations. However, we managed to develop a rather clear picture of all possible obstetrical complications in patients with endometriosis, establish causal relations, and identify issues for further discussion," added Romeo Konnon, PhD, assistant professor at the Department of Obstetrics and Gynecology with the Course of Perinatology, RUDN University.

The probability that an obese person will develop severe COVID-19 is high regardless of age, sex, ethnicity, and the presence of co-morbidities such as diabetes, high blood pressure, and heart or lung disease, according to a study by Brazilian researchers published in Obesity Research & Clinical Practice.

The systematic review and meta-analysis of relevant data in the scientific literature focus on nine clinical studies, which in aggregate reported the evolution of 6,577 COVID-19 patients in five countries. The authors conclude that obesity is itself a factor that favors rapid progression to critical illness requiring intensive care and significantly increases the risk of death. The associated research project was supported by São Paulo Research Foundation - FAPESP .

"Several factors contribute to the progression to critical illness in the obese organism. One is the limited capacity to produce interferons [a class of proteins secreted by defense cells and essential to inhibit viral replication] and antibodies. In addition, adipose tissue functions as a reservoir for the virus, maintaining it in the organism for longer," said Silvia Sales-Peres , a professor at the University of São Paulo (USP) in Bauru and principal investigator for the project.

This potentially higher viral load, she explained, is not the only problem faced by patients with a high body mass index (BMI). Recent research shows that the chronic low-grade inflammation typical of obesity - caused by excessive expansion of adipose cells - makes the inflammatory cytokine storm triggered by SARS-CoV-2 even more damaging to the lungs.

"Obese patients usually present with impaired respiratory function, as abdominal adipose tissue compresses the diaphragm and prevents it from moving normally," Sales-Peres said. "In sum, various concurrent factors make these patients more predisposed to dependency on mechanical ventilation and other kinds of intensive care if they contract COVID-19. In the studies we analyzed, 9.4% of the obese patients treated in intensive care units died."

Risk scale

BMI is a measure of body fat proportional to height and weight that applies to adult men and women and is considered the international standard for diagnosing malnutrition and obesity. It is calculated by dividing weight in kilograms by height in meters squared. Generally speaking, overweight corresponds to a BMI of 25 or more, while 30 or more indicates obesity. Almost 60% of Brazilians are overweight and some 20% are obese, according to the Health Ministry's telephone surveillance survey on risk factors for chronic diseases (Vigitel).

"A higher degree of susceptibility to the novel coronavirus when a person reaches a certain number on the BMI scale is no accident. Impaired antibody production and chronic inflammation favor progression of COVID-19 in overweight subjects," Sales-Peres said. "Our analysis also showed that the risk associated with obesity is even greater for smokers or subjects with co-morbidities such as diabetes, hypertension, and lung disease."

She went on to argue that studies like this are important both to alert patients to the need to protect themselves against the virus and to help health services prepare for the potential demand for intensive care.

"We embarked on the study in April when it wasn't so clear that obesity would be considered a major risk factor for COVID-19," she said.

For the systematic review, the authors first searched Medline, Embase, Web of Science, BVS/Lilacs, SciELO, Scopus, and Google Scholar to select studies published on or before April 27 using key terms such as obesity and COVID-19. They identified 40 and ended up with eight that matched the inclusion criteria and were considered worthy of meta-analysis because they contained scientific evidence at the highest level to orient clinical practice.

"The 2018 Vigitel survey pointed to 30% growth in the overall prevalence of overweight in Brazil compared with 2006. Considering only the 18-24 group, the increase was 55.7%. This makes discussing the risk of severe COVID-19 associated with obesity extremely important," Sales-Peres said.

Public health policy should promote an integrated and intersectoral approach to obesity, she argued, and should have regulatory and enforcement authority. "There should be a transformational mobilization to encourage outdoor physical exercise and healthy dietary habits from early childhood," she said. "This should be a coordinated initiative across all three tiers of government so as to enable integrated planning, funding, and strategy to promote wellness and prevent obesity."

DALLAS, Oct. 14, 2020 -- Results of a retrospective analysis suggest that people born with a heart defect who developed COVID-19 symptoms had a low risk of moderate or severe COVID-19 infection, according to a new article published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

In what may be the largest study of its kind to date, researchers at Columbia University Vagelos College of Physicians and Surgeons in New York City explored the impact of COVID-19 infection on patients with congenital heart disease (CHD). The specialty center follows more than 7,000 adult and pediatric patients born with a heart defect. Fifty-three CHD patients (median age 34) with COVID-19 infection were reported at their center between March and July 2020.

"At the beginning of the pandemic, many feared that congenital heart disease would be

as big a risk factor for COVID-19 as adult-onset cardiovascular disease" the researchers wrote. However, they are "reassured by the low number of patients treated at their center and the patients' outcomes."

Among the 43 adults and 10 children with a congenital heart defect infected with COVID-19 , additional characteristics included: 58% had complex congenital anatomy; 15% had a genetic syndrome; 11% had pulmonary hypertension; and 17% had obesity. Additional analysis found:

The presence of a concurrent genetic syndrome in all patients and advanced physiologic stage in adult patients were each associated with an increased risk of symptom severity.

Five patients had trisomy 21 (an extra chromosome at position 21); four patients had Eisenmenger's syndrome (abnormal blood circulation caused by structural defects in the heart); and two patients had DiGeorge syndrome (a condition caused by the deletion of a segment of chromosome 22). Nearly all patients with trisomy 21 and DiGeorge syndrome had moderate/severe COVID-19 symptoms.

As for outcomes among all 53 patients with CHD: nine patients (17%) had a moderate/severe infection, and three patients (6%) died.

In addition, the researchers note several limitations to their analysis:

"While our sample size is small, these results imply that specific congenital heart lesions may not be sufficient cause alone for severe COVID-19 infection."

"While it is possible that our patient population exercised stricter adherence to social distancing given early publicized concerns about cardiac risk, these early results appear reassuring."

"...the median age and the frequency of acquired cardiac risk factors were lower in hospitalized patients in our cohort compared to published reports of hospitalized patients from COVID-19 in NYC at large. This may be because the CHD community, at large, is younger than the general population or because individuals with CHD may have distinct risk factors for severe COVID-19 infection when compared to the general population. It is possible that a cohort of elderly CHD patients might have a different risk profile than the general population."

The researchers concluded, "Despite evidence that adult-onset cardiovascular disease is a risk factor for worse outcomes among patients with COVID-19, patients with CHD without concomitant genetic syndrome, and adults who are not at advanced physiological stage, do not appear to be disproportionately impacted."

RENO, Nev. - Rapid detection of the SARS-CoV-2 virus, in about 30 seconds following the test, has had successful preliminary results in Mano Misra's lab at the University of Nevada, Reno. The test uses a nanotube-based electrochemical biosensor, a similar technology that Misra has used in the past for detecting tuberculosis and colorectal cancer as well as detection of biomarkers for food safety.

Professor Misra, in the University's College of Engineering Chemical and Materials Department, has been working on nano-sensors for 10 years. He has expertise in detecting a specific biomarker in tuberculosis patients' breath using a metal functionalized nano sensor.

"I thought that similar technology can be used to detect the SARS-CoV-2 virus, which is a folded protein," Misra said. "This is Point of Care testing to assess the exposure to COVID-19. We do not need a laboratory setting or trained health care workers to administer the test. Electrochemical biosensors are advantageous for sensing purposes as they are sensitive, accurate and simple."

The test does not require a blood sample, it is run using a nasal swab or even exhaled breath, which has biomarkers of COVID-19. Misra and his team have successfully demonstrated a simple, inexpensive, rapid and non-invasive diagnostic platform that has the potential to effectively detect the SARS-CoV-2 virus.

The team includes Associate Professor Subhash Verma, virologist, and Research Scientist Timsy Uppal at the University's School of Medicine, and Misra's post-doctoral researcher Bhaskar Vadlamani.

"Our role on this project is to provide viral material to be used for detection by the nanomaterial sensor developed by Mano," Verma said. "Mano contacted me back in April or May and asked whether we can collaborate to develop a test to detect SARS-CoV-2 infection by analyzing patients' breath. That's where we came in, to provide biological material and started with providing the surface protein of the virus, which can be used for detecting the presence of the virus."

Verma, an expert on SARS-CoV-2, synthesized and prepared the antigenic protein of COVID-19 virus in his laboratory, SARS-CoV-2 receptor binding domain protein, for the preliminary testing and determining the sensitivity of our nano sensor. Synthesizing and purification of viral proteins is usual and routine work in a virology laboratory.

"Our lab is a virology laboratory, which works on different viruses, and we have been working on SARS-CoV-2 from the beginning of the outbreak," he said. "Our genomics and diagnostic group have been sequencing the SARS-CoV-2 from the nasal swabs of COVID-19 patients of the state of Nevada to determine mutational changes in the virus while SARS-CoV-2 circulates in our population."

The team developed co-metal functionalized nanotubes as a sensing material for electrochemical detection of the protein. They confirmed the biosensor's potential for clinical application by directly analyzing the RBD of the Spike glycoprotein on the sensor.

The team plans to move to the next step of sensor validation on the actual COVID-19 patients swabs stored in the Viral Transport Medium and have applied for funding to develop a specific and inexpensive point-of-care sensor for a rapid detection of COVID-19 virus in saliva or breath of infected individuals.

The developed approach also has the potential for diagnosis of other respiratory viral diseases by identifying appropriate metallic elements to functionalize nanotubes.

A new U.S. study of waterbirths found that hospital-based births involving water immersion had no higher risk of neonatal intensive care unit (NICU) or special care nursery admission than comparable deliveries in the control group without water immersion. The primary purpose of the study is to address the lack of methodologically sound research regarding maternal and neonatal outcomes for waterbirths. The study has been published in the journal, Obstetrics and Gynecology.

The American College of Obstetricians and Gynecologists (ACOG), the professional organization that sets standards for obstetric practice, previously concluded that water immersion during the first stage of labor (when a woman is in labor but is not fully dilated) is safe for women with full-term, uncomplicated pregnancies. In fact, water immersion during labor provides benefits of pain relief, reduced analgesic need, shorter labor, and increased patient satisfaction. However, ACOG also identified an absence of well-designed studies to aid in the determination of the risks and benefits of water immersion during the second stage of labor (when a woman is fully dilated and can actively push during contractions).

"This study demonstrates that the system we put in place provides waterbirth in the context of a strong clinical program that ensures safety," said Dr. Lisa Saul, a perinatologist, president of Allina Health's Mother Baby service line and study coauthor. "As a health system, we want to offer women as many choices as possible to help them manage pain during labor. Our primary focus is always on the safety of mothers and newborns so we need to ensure we are basing our practices on the best evidence available"

In order to address the lack of quality research on waterbirth outcomes during the second stage, Allina Health led a multi-site study. The study includes data from 583 births over 4-years (2014-2018) from eight hospitals in the Allina Health and HealthPartners systems and a matched comparison group of 583 births to women who met the criteria for waterbirth but did not have water immersion during labor. As waterbirth has become more popular in the United States, it is important for practitioners to be able to inform their practices and guidelines in the context of US clinical standards. Prior to this study, there were only a few studies examining waterbirth outcomes in the US, and those mostly focused on deliveries outside of a hospital setting (such as home births or birth centers).

Prior studies on waterbirths, conducted primarily in Europe, had varied clinical protocols that were often not described making it hard to understand how outcomes might be affected by clinical protocols. Additionally, prior studies often lacked strong study designs and thus were subject to potential sources of bias. The current study brings new methodological strengths not found in many prior studies, such as a large sample size and matching techniques used to ensure comparability between the women delivering in water and the comparison group. In alignment with ACOG recommendations, Allina and HealthPartners, established rigorous protocols for candidate selection, tub maintenance and cleaning, monitoring of women and fetuses, and moving women from tubs if maternal or fetal concerns or complications develop. The sites also developed rigorous training program to credential providers for water immersion deliveries, and a quality assurance process.

"Women and families deserve safe and evidence based care regardless of their birth preferences," said Kathrine Simon, study coauthor, a certified nurse midwife and Midwifery Lead for Allina Health who conducts provider training for water immersion deliveries. "This study demonstrates that waterbirth is a safe option for women during labor in addition to supporting provider and nursing training and support."

The study found that the proportion of deliveries with NICU or special care nursery admission was significantly lower for women with second-stage immersion (2.9%) than the control group (8.3%). There was no difference in NICU or special care nursery admissions for deliveries with first-stage immersion only. Of the secondary neonatal outcomes examined (i.e., respiratory distress, anemia, sepsis, asphyxia, or death), there were no significant differences between the water immersion groups and matched deliveries in the control group.

A possible benefit identified in the study for women was reduced likelihood of lacerations during delivery. Women in the second stage water immersion group were half as likely as women in the comparison group to experience any perineal lacerations. This measure did not differ for women who had first-stage only immersion cases.

"Women are often grateful for the opportunity for labor and birth in the water. Many are surprised by the lack of pelvic pressure and a sense of the baby gliding out," said Simon. "This study confirms that waterbirths, conducted in alignment with a strong clinical protocol, are at least as safe as traditional birthing methods."

(MEMPHIS, TENNESSEE - October 14, 2020) Researchers have used insight from a comprehensive genomic analysis of neuroblastoma to learn about the process driving one of the most common childhood solid tumors. The findings revealed possible approaches for developing precision medicines to improve patient outcomes. St. Jude Children's Research Hospital scientists led the study, which appears today in the journal Nature Communications.

The analysis involved whole genome, whole exome and whole transcriptome sequencing of 702 neuroblastoma samples. The tumors included 23 samples from patients who relapsed. The work identified associations among common mutational traits that researchers hope to exploit therapeutically.

"This combined analysis of a large cohort of tumors provided insight into previously unrecognized correlations at work in neuroblastoma as well as the discovery of less common driver mutations," said corresponding author Jinghui Zhang, Ph.D., chair of the St. Jude Department of Computational Biology.

The co-corresponding authors are Michael Dyer, Ph.D., chair of the St. Jude Department of Developmental Neurobiology and a Howard Hughes Medical Institute investigator, and Michael Hogarty, M.D., of the Children's Hospital of Philadelphia.

Connecting the dots between common mutations and oxidative stress

Researchers used a common mutational pattern almost like a fingerprint to identify internal processes fueling the tumor's growth and spread. Investigators knew DNA-damaging molecules called reactive oxygen species and oxidative stress are elevated in neuroblastoma. Reactive oxygen species are generated in the mitochondria of cells. The analysis found an association between a chromosomal mutation in 65% of neuroblastomas and the DNA-damaging molecules. These tumors have an extra piece of chromosome 17. That piece includes genes expressed in the mitochondria. The results suggest that mitochondrial gene defects may lead to increased production of reactive oxygen species, fueling tumor growth and drug resistance.

A St. Jude Cloud search of more than 1,000 pediatric tumor genomes from 39 cancer types found the association was not unique. Researchers reported that more than 20% of samples from another cancer, rhabdomyosarcoma, had increased expression of mitochondrial genes and a pattern of increased oxidative stress. The finding strengthened the newly identified connection between mitochondrial gene defects and the mutational process.

"Thanks to this analysis, we have a deeper understanding of the alterations driving neuroblastoma, including how tumors form, progress and respond to therapy," Dyer said. "That is the foundation for translational research going forward."

Neuroblastoma predictors

Neuroblastoma develops in fetal nerve cells called neuroblasts that fail to mature normally. While 7 to 10% of childhood cancers are neuroblastoma, the tumor accounts for half of all cancers in infants. This cancer generally begins in the adrenal glands, but it can also start in the chest, the spine or spinal cord regions, abdomen and other areas.

Treatment and outcomes vary widely based on patient age. Survival rates for the youngest patients (younger than 18 months old) are about 95%. For older, high-risk patients, survival rates are only about 50%.

This study reinforced the association between patient age and the mutations driving the disease. For example, the genes MYCN and TERT were commonly altered in patients 3.8 years of age or younger while mutations in ATRX were more frequent in children with a median age of 5.6 years.

MYCN, ATRX and a "beautiful convergence"

The analysis offered insight into previous research from Dyer and his colleagues. The researchers noted that while MYCN or ATRX were potent drivers of neuroblastoma, the mutations did not occur together.

"In most cancers, you would expect to find patients with both mutations who did even worse," Dyer said. "But we never found this combination, which was a surprise."

Dyer said this analysis suggests why. MYCN and ATRX mutations induce oxidative stress. Dyer hypothesized that, when combined, the mutations may be lethal to tumor cells.

"This was a beautiful convergence of two different approaches to understanding the mutational processes underway inside cells," he said.

Recurring, but less common gene alterations The analysis included data from St. Jude, including the St. Jude-Washington University Pediatric Cancer Genome Project; the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative, managed by the National Cancer Institute; and the Children's Oncology Group, a clinical cooperative trials group.

The large number of samples aided efforts to find recurring, but less common neuroblastoma alterations that may be candidates for precision medicines. The newly identified mutations were in the genes FGFR1 and ALK.

ARLINGTON, Va., October 14, 2020 -- The American Society for Radiation Oncology (ASTRO) announced today the studies that will be highlighted in the 2020 ASTRO Annual Meeting press program. The press program will feature studies on cancer treatment advances and discussions of topical issues including COVID-19 and racial representation in radiation therapy clinical trials. Researchers will present their findings in three news briefings to be held via live webcasts on October 26 and 27. Reporters can register for the briefings and embargoed access to news releases at http://www.astro.org/annualmeetingpress.

The news briefing schedule is as follows:

Monday, October 26, 12:00 - 1:00 p.m. ET

* "CCTG SC.24/TROG 17.06: A randomized phase II/III study comparing 24Gy in 2 stereotactic body radiotherapy (SBRT) fractions versus 20Gy in 5 conventional palliative radiotherapy (CRT) fractions for patients with painful spinal metastases," presented by Dr. Arjun Sahgal, University of Toronto (Abstract LBA-2)

* "Initial report of a randomized trial comparing conventional- vs conventional plus fluciclovine (18F) PET/CT imaging-guided post-prostatectomy radiotherapy for prostate cancer," presented by Dr. Ashesh Jani, Winship Cancer Institute of Emory University (Abstract LBA-1)

* "Phase III randomized trial of postoperative adjuvant conventional radiation (3DCRT) versus image guided intensity modulated radiotherapy (IG-IMRT) in cervical cancer (PARCER): Final analysis," presented by Dr. Supriya Chopra, Tata Memorial Centre (Abstract 2)

* "Stereotactic ablative fractionated radiotherapy versus radiosurgery for oligometastatic neoplasia to the lung: A randomised phase II trial," presented by Dr. Shankar Siva, Peter MacCallum Cancer Centre (Abstract 5)

* "Stereotactic radiosurgery versus whole-brain radiation therapy for patients with 4-15 brain metastases: A phase III randomized controlled trial," presented by Dr. Jing Li, The University of Texas MD Anderson Cancer Center (Abstract 41)

Tuesday, October 27, 12:00 - 12:30 p.m. ET

* "Characterization of underrepresented populations in modern era radiation therapy clinical trials," presented by Emily Hughes Bero, Medical College of Wisconsin (Abstract 204)

* "Geographic access to radiation therapy in the United States," presented by Dr. Sean Maroongroge, The University of Texas MD Anderson Cancer Center (Abstract 203)

* "Sexual health toxicity in cancer survivors: Is there a gender disparity in physician evaluation and intervention?" presented by Dr. James Taylor, Sidney Kimmel Cancer Center (Abstract 1042)

Tuesday, October 27, 2:00 - 3:00 p.m. ET - Special COVID-19 Session

* Update from the ASTRO COVID-19 Impact Survey

* Panel Discussion: "Low-Dose Radiation Therapy and COVID-19-related Pneumonia"

Originally planned as an on-site meeting in Miami, the 2020 ASTRO Annual Meeting was moved to a web-based platform due to safety concerns associated with the COVID-19 pandemic. The meeting, Global Oncology: Radiation Therapy in a Changing World, will feature more than 2,500 accepted abstracts including reports from the latest clinical trials; more than 120 expert panels on topics including global oncology, health disparities and the novel coronavirus; and an immersive attendee experience in a virtual convention center.

Press registration and other media resources are available in the online press kit, and ASTRO's media relations team is available at press@astro.org or 703-286-1600 to answer questions related to the press program. General information about the meeting is available at the ASTRO Annual Meeting webpage and session/presentation details are available in the Online Conference Planner.

DALLAS, October 13, 2020 -- More than half of older patients hospitalized for heart failure, a progressive condition in which the heart doesn't pump blood as well as it should, are discharged from the hospital with prescriptions for 10 or more medications, according to new research published today in Circulation: Heart Failure, an American Heart Association journal.

"High medication burden, also known as polypharmacy, is commonly associated with adverse events and reactions," said Parag Goyal, M.D., M.Sc., senior study author and assistant professor of medicine at Weill Cornell Medicine and a geriatric cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center in New York City. "As the treatment options for various conditions including heart failure expand and the population ages, it is becoming increasingly important to weigh the risks and possible benefits of multiple medications."

To explore the medication burden of older adults with heart failure, researchers examined the medical charts of 558 adults, aged 65 and older, covered by Medicare and hospitalized for heart failure between 2003 and 2014 at one of 380 hospitals in the U.S. All were participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a large nationwide prospective observational cohort of over 30,000 participants that began in 2003 and continues with ongoing follow-up.

For this analysis, the number of medications for each patient was tallied at hospital admission and discharge. Medicines were categorized by the primary condition they treat: heart failure; other types of heart disease (such as aspirin and statin drugs for coronary heart disease); or non-heart-related (such as medications for lung, kidney disease or Type 2 diabetes).

Researchers found:

Upon admission to the hospital, 84% of the study participants took five or more medications, and 42% took 10 or more.

Participants were discharged from the hospital with prescriptions for more medications than when they were admitted: 95% were prescribed five or more medications; and 55% were prescribed 10 or more at hospital discharge.

Polypharmacy has become increasingly common, with 10 or more medications prescribed at discharge for 41% of participants hospitalized between 2003-2006, and 68% for those hospitalized between 2011 and 2014.

Most of the medications taken by participants with heart failure were not to treat heart failure or a heart condition.

"The medication burden for older adults with heart failure was higher following a heart failure hospitalization. Some of these drugs may be appropriate. However, our prior work has shown that many patients are discharged with prescriptions for medications that can worsen heart failure. This supports the ongoing need for improved and routine medication review processes prior to hospital discharge, and particularly in the immediate post-discharge period where the risk of hospital readmission is particularly high," said Goyal, who also directs the Heart Failure with Preserved Ejection Fraction Program at Weill Cornell Medicine and at NewYork-Presbyterian/Weill Cornell Medical Center.

According to researchers, this study was conducted prior to the approvals of several new heart failure medications, so the number of people with heart failure prescribed 10 or more medications may be even higher today.

"Advances in medicine have provided patients with an increasing number of treatment options. This is a good thing. However, it is important to also consider the negative consequences of more medications prescribed for each patient," Goyal said.

While all adults with heart failure can experience adverse effects from their medication, the researchers suggest that people with heart failure taking 10 or more medications may be especially vulnerable to negative interactions due to possible medication use.

"Our findings support the need to tailor decisions related to medication prescribing for each patient while considering their overall health status," Goyal said "The key to managing polypharmacy is medication review during each appointment. With regular review, the hope is that the right medications - where the possible benefit outweighs the risks - will be started or continued, and if the risks outweigh possible benefits, those medications are discontinued."

Researchers noted because their study focused on older adults with Medicare coverage, these findings may not be generalizable to younger adults, or anyone not enrolled/eligible for Medicare or without health insurance.

Ann Arbor, October 13, 2020 - American women living in states with less restrictive reproductive rights policies are less likely to give birth to low-birth weight babies, according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The findings show that women, particularly US-born Black women, giving birth in states with less restrictive reproductive rights policies have a seven percent lower low-birth weight risk, compared to women in states with more restrictive policies.

"Our study provides evidence that reproductive rights policies play a critical role in advancing maternal and child health equity," said lead investigator May Sudhinaraset, PhD, of the Department of Community Health Sciences in the UCLA Fielding School of Public Health, Los Angeles, CA, USA.

Compared to infants of normal weight, low birth weight babies may be more at risk for many health problems. Some infants may become sick in the first six days of life or develop infections. Others may even suffer from long-term problems, including delayed motor and social development or learning disabilities.

This research contributes to understanding how broader social policies affect birth outcomes measured by examining race and nativity status. The events of 2020 sharpened national focus on structural racism, which historically and culturally reinforces racial inequities through discriminatory practices and unequal distribution of resources, such as wealth, healthcare, and housing. This dynamic may be an important factor in producing reproductive disadvantages via stress-induced physiological pathways that are exacerbated by racism and tied to poor health outcomes.

The study analyzed birth record data for the nearly four million births that occurred in the 50 states and the District of Columbia in 2016 to assess the associations between reproductive rights policies and adverse birth outcomes. The investigators further evaluated if the associations were different for women of color and immigrants. Compared with women living in states with the most restrictive reproductive rights policies, women living in the least restrictive states had a 7 percent lower low-birth weight risk. Low-birth weight risk was 8 percent lower among Black women living in states with the least restrictive reproductive rights policies compared with their counterparts living in the most restrictive states.

The study indicates that expanding reproductive rights may decrease the risk of low-birth weight, particularly for US-born Black women. Specifically, the findings showed significant associations between low-birth weight and states' reproductive rights climate among US-born, but not foreign-born, Black women. This finding is in line with the growing literature on the context-dependent nature of race as a determinant of population health. It may be that US-born Black women's reproductive health is affected by the cumulative impact of lifetimes and generations within a systematically racist society.

The national reckoning on racial injustice and the Black Lives Matter movement underscore the critical importance and urgency of addressing longstanding systemic racism and its adverse effects on the health and well-being of black, Indigenous and people of color (BIPOC) women and families, in particular. Black women are more likely to die in pregnancy and childbirth than any other race group, experience more maternal health complications than White women, and experience lower quality maternity care, including disrespectful care during childbirth. Moreover, adverse birth outcomes constitute a major public health priority; yet significant inequities exist across race and nativity status.

Dr. Sudhinaraset concluded, "Addressing the adverse consequences of structural racism requires examination of the historical and present-day policies that negatively affect women of color. Future studies should assess specific evidence-based policies, particularly highlighting women's lived experiences of policy exclusion or inclusion, and the effects on women and newborn health. Important policy levers can and should be implemented to improve women's reproductive health overall, including increasing abortion access and mandatory sex education in schools."

Five years ago, the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) and National Cancer Institute (NCI), part of the National Institutes of Health, jointly launched a very different kind of cancer study. NCI-Molecular Analysis for Therapy Choice (NCI-MATCH or EAY131), the largest precision medicine cancer trial to date, sought to match genetic abnormalities driving patients' tumors with approved or experimental drugs targeting those defects. The type of cancer did not matter. Nearly 6000 cancer patients quickly joined the trial and contributed their tumor specimens for genomic testing. Now, the Journal of Clinical Oncology is publishing an in-depth look into the tumor gene make-up of these patients. It is the largest data set ever compiled on patients with tumors that have progressed on one or more standard treatments, or with rare cancers for which there is no standard treatment. The information contains significant discoveries that tell physicians and patients more about how to use genomic testing to select the best treatments.

"Our exhaustive efforts to enlist all of the promising agents in NCI-MATCH established a new benchmark for the utility of next-generation sequencing in the conduct of clinical trials," said Keith T. Flaherty, MD, a medical oncologist at Massachusetts General Hospital Cancer Center in Boston and ECOG-ACRIN study chair for the overall NCI-MATCH trial.

Dr. Flaherty continued: "With time, the efficiency of using tumor genetic testing for broad-based clinical investigation will only increase."

Major Findings

1. Four in 10 patients had tumor gene abnormalities that matched to targeted drugs studied in the trial.

The gene abnormalities studied in the trial were already known to drive cancer growth. The chosen treatments were either new drugs in development that had shown promise in other clinical trials or ones that were FDA-approved in at least one cancer type. What was not known before this trial was how often the tumor gene defects happen across cancer types. Based on the NCI-MATCH data, the individual patient has a high likelihood (a 40% chance) that there is a defect in their tumor for which there is a drug available or in development.

This discovery tells patients and their physicians that there is value in having tumor gene testing. The 40% match rate was for a limited number of targeted treatments--between 10 and 30 in the trial at that time. The rate may increase as more drugs become available, especially ones that target common gene defects.

"The 6000-patient analysis from NCI-MATCH describes the genetic complexity that is characteristic of relapsed, refractory cancers," said Peter J. O'Dwyer, MD, a medical oncologist at the University of Pennsylvania and Group Co-Chair of ECOG-ACRIN.

"This publication represents an important milestone in the oncology field's efforts to translate a genetic understanding of cancer into improved treatments," said Dr. O'Dwyer.

2. While the overall match rate was 40%, it varied widely across cancer types.

Surprisingly, uncommon cancers had some of the highest match rates. Over 25% of patients with either melanoma, bile duct, prostate, uterine, gastroesophageal junction, urinary tract, central nervous system, or cervix cancer, had tumor gene defects that matched to trial treatments. By contrast, only 6% of those with pancreas cancer did. The average match rate was 17% for the four most common cancers -- breast, colorectal, non-small cell lung, and prostate.

3. Cancer genetic defects may not change much over time and treatment.

NCI-MATCH researchers compared the tumor gene make-up of patients with seven cancer types against The Cancer Genome Atlas (TCGA). TCGA is a database of patients with mostly untreated primary tumors. The seven cancer types were breast, bile duct, cervix, colorectal, lung, pancreas, and prostate. The researchers were surprised to see that there was not much difference between the primary and metastatic databases. Until NCI-MATCH, the research community did not have a database of metastatic tumors to compare to TCGA. However, NCI-MATCH researchers cannot make any conclusions yet. To learn more, they plan to compare the NCI-MATCH patients' primary and metastatic tumors.

4. It was common for patients to have not just one but several tumor gene abnormalities that drive cancer growth.

This discovery should encourage cancer researchers to shift their thinking and explore combinations of targeted and other therapies that address multiple defects at the same time.

The NCI-MATCH research does not end with this analysis. Through broad engagement with the pharmaceutical industry and a rigorous process for vetting therapies, ECOG-ACRIN and the NCI opened multiple treatment arms in NCI-MATCH. The trial currently has 38 arms, and each one will tell its own story. Each arm is contributing valuable information on responsive vs. unresponsive cancer types, especially in rare cancers where there are little or no data available. NCI-MATCH is a signal-finding trial. Treatments that show promise can advance to larger, more definitive trials.

"NCI-MATCH is a unique and ground-breaking trial that will continue to make major contributions in years to come as genomic findings from individual treatment arms, correlated with outcomes, are released," said Lyndsay Harris, MD, Translational Co-chair of NCI-MATCH and Associate Director of the Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, NCI.

Facts about NCI-MATCH

NCI-MATCH is the first trial to establish the likelihood of identifying targeted treatments for patients with relapsed, refractory cancers--both common and rare.

The trial proved that it is feasible to conduct a national precision medicine cancer trial. First, there was broad interest in the trial, which was open in every state, the District of Columbia, and Puerto Rico. Together, approximately 1100 clinical sites enrolled nearly 6000 patients in 15 months--completing enrollment two years early. Second, the trial demonstrated a high rate of success with the central testing of biopsies from local facilities. Third, the trial showed a high rate of technical success with a specific next-generation sequencing platform that included most of the relevant molecular alterations found in cancers with the timely return of results, and, if eligible, treatment assignment.

NCI-MATCH differs from other recent clinical trials that used next-generation sequencing for treatment selection. Some focused on only one cancer type. Others focused on only one tumor defect across multiple cancer types. A few trials used a group of physicians (tumor board) to assign treatments. NCI-MATCH is the only trial to use uniform, central tumor gene testing and to pre-set objective rules for treatment assignments. Unlike other studies that evaluate the use of next-generation sequencing, NCI-MATCH is investigating both approved and experimental drugs broadly across cancer types and beyond what we currently know about these biomarkers.

A new study of beliefs and attitudes toward COVID-19 in five different countries - UK, US, Ireland, Mexico and Spain - has identified how much traction some prominent conspiracy theories have within these populations.

The research reveals "key predictors" for susceptibility to fake pandemic news, and finds that a small increase in the perceived reliability of conspiracies equates to a larger drop in the intention to get vaccinated.

Scientists from the University of Cambridge gathered data from national samples in each country, and asked participants to rate the reliability of several statements, including six popular myths about COVID-19.

While a large majority of people in all five nations judged the misinformation to be unreliable, researchers found that certain conspiracy theories have taken root in significant portions of the population.

The conspiracy deemed most valid across the board was the claim that COVID-19 was engineered in a Wuhan laboratory. Between 22-23% of respondents in the UK and United States rated this assertion as "reliable". In Ireland this rose to 26%, while in Mexico and Spain it jumped to 33% and 37% respectively.

This was followed by the idea that the pandemic is "part of a plot to enforce global vaccination", with 22% of the Mexican population rating this as reliable, along with 18% in Ireland, Spain and the US, and 13% in the UK.

The notorious 5G conspiracy - that some telecommunication towers are worsening COVID-19 symptoms - holds sway over smaller but still significant segments: 16% in Mexico, 16% in Spain, 12% in Ireland, and 8% in both the UK and US. The study is published today in the journal Royal Society Open Science.

"Certain misinformation claims are consistently seen as reliable by substantial sections of the public. We find a clear link between believing coronavirus conspiracies and hesitancy around any future vaccine," said Dr Sander van der Linden, co-author and Director of the Cambridge Social Decision-Making Lab.

"As well as flagging false claims, governments and technology companies should explore ways to increase digital media literacy in the population. Otherwise, developing a working vaccine might not be enough."

Earlier this week, the Social Decision-Making Lab launched a project with the UK Cabinet Office: Go Viral!, a short online game that helps "inoculate" players against fake news by lifting the lid on common misinformation techniques.

For the new study, the team - including Cambridge's Winton Centre for Risk and Evidence Communication - looked at correlations between certain beliefs and demographic categories and the perceived reliability of misinformation.

Scoring highly on a series of numeracy tasks given as part of the study, as well as declaring high levels of trust in scientists, are "significantly and consistently" associated with low levels of susceptibility to false information across all nations.

"Numeracy skills are the most significant predictor of resistance to misinformation that we found," said Dr Jon Roozenbeek, lead author and Postdoctoral Fellow in Cambridge's Department of Psychology.

"We all now deal with a deluge of statistics and R number interpretations. The fostering of numerical skills for sifting through online information could well be vital for curbing the 'infodemic' and promoting good public health behaviour."

Moreover, and despite 'boomer' memes, the team found that being older is actually linked to lower susceptibility to COVID-19 misinformation in all nations except Mexico (where the opposite is true).

Identifying as more right-wing or politically conservative is associated with higher likelihood of believing COVID-19 conspiracies and falsehoods in Ireland, Mexico and Spain - but less so in the UK or US.

Trusting that politicians can effectively tackle the crisis predicts higher likelihood of buying into conspiracies in Mexico, Spain and the US, but not in the UK and Ireland. Exposure to information about the virus on social media is linked to misinformation susceptibility in Ireland, the UK and US.

Researchers asked participants about their attitude to a future coronavirus vaccine. They were also asked to rate the reliability of conspiratorial COVID-19 claims on a scale of one to seven.

On average, an increase by one-seventh in someone's perceived reliability of misinformation is associated with a drop of almost a quarter - 23% - in the likelihood they will agree to get vaccinated.

Similarly, a one-point increase on the conspiracy reliability scale is linked, on average, to a 28% decrease in the odds of someone recommending vaccination to vulnerable friends and family.

Conversely, on average, a one-seventh increase in trust in scientists is associated with a 73% increase in the likelihood of getting vaccinated and a 79% increase in the odds of recommending vaccination to others.

The researchers controlled for many other factors - from age to politics - when modelling levels of "vaccine hesitancy", and found the results to be consistent across all countries except Spain.

Although uncommon, sudden permanent hearing loss seems to be linked to COVID-19 infection in some people, warn doctors, reporting the first UK case in the journal BMJ Case Reports.

Awareness of this possible side effect is important, because a prompt course of steroid treatment can reverse this disabling condition, they emphasise.

Sudden hearing loss is frequently seen by ear, nose and throat specialists, with around 5-160 cases per 100,000 people reported every year. It's not clear what the causes are, but the condition can follow a viral infection, such as flu, herpes, or cytomegalovirus.

Despite plenty of published research on sudden onset hearing loss, only a handful of other cases associated with COVID-19 have been reported, and none in the UK--until now.

The doctors describe a case of a 45 year old man with asthma who was referred to the ear nose and throat department at their hospital after suddenly experiencing hearing loss in one ear while being treated for COVID-19 infection as an inpatient.

He had been admitted to hospital with COVID-19 symptoms which had been going on for 10 days. He was transferred to intensive care as he was struggling to breathe.

He was put on a ventilator for 30 days and developed other complications as a result. He was treated with remdesivir, intravenous steroids and a blood transfusion after which he started to get better.

But a week after the breathing tube was removed and he left intensive care, he noticed ringing (tinnitus) in his left ear followed by sudden hearing loss in that ear.

He had not lost his hearing or had ear problems before. And apart from asthma, he was otherwise fit and well.

Examination of his ear canals revealed that he had no blockages or inflammation. But a hearing test showed that he had substantially lost his hearing in the left ear. He was treated with steroid tablets and injections after which his hearing partially recovered.

He tested negative for other potential causes, including rheumatoid arthritis, flu and HIV, prompting his doctors to conclude that his hearing loss was associated with COVID-19 infection.

"Despite the considerable literature on COVID-19 and the various symptoms associated with the virus, there is a lack of discussion on the relationship between COVID-19 and hearing," say the report authors.

"Hearing loss and tinnitus are symptoms that have been seen in patients with both COVID-19 and influenza virus, but have not been highlighted." The first case of hearing loss mentioning COVID-19 alone was reported in April this year.

SARS-CoV-2, the virus responsible for COVID-19, is thought to lock on to a particular type of cell lining the lungs. And the virus has also recently been found in similar cells lining the middle ear, explain the report authors.

SARS-CoV-2 also generates an inflammatory response and an increase in the chemicals that have been linked to hearing loss.

"This is the first reported case of sensorineural hearing loss following COVID-19 infection in the UK," write the report authors. "Given the widespread presence of the virus in the population and the significant morbidity of hearing loss, it is important to investigate this further."

They add: "This is especially true given the need to promptly identify and treat the hearing loss and the current difficulty in accessing medical services," they say. Doctors should ask patients in intensive care about hearing loss and refer them for urgent treatment, they advise.

People with eating disorders are 12 times more likely to be preoccupied with perceived flaws in their physical appearance than those without, according to new research published in the journal Eating and Weight Disorders.

Researchers from Anglia Ruskin University (ARU) surveyed more than 1,600 health club members recruited via social media. They found the number of people with body dysmorphic disorder - a mental condition marked by obsession with perceived flaws in appearance which are not noticed by others - was 12 times higher among people with suspected eating disorders.

Around 30% of participants had indicated eating disorders, and the researchers noted that 76% of those people also suffered from body dysmorphia.

The paper also found no significant associations between body dysmorphia, sexuality and social media use, although there was association with gender, with women being more likely to show symptoms of body dysmorphia.

Lead author Mike Trott, PhD researcher in Sports Science at ARU, said: "Body dysmorphia can result in anxiety, stress and reduced quality of life. While sufferers of eating disorders, such as anorexia and bulimia nervosa, share similar traits to those with body dysmorphia, research into any correlation between the two is sparse.

"Healthcare professionals working with people with body dysmorphia should screen them for eating disorders regularly, as this research shows a strong correlation between the two."