An old fellow came into the hospital truly on death's door due to an infected gallbladder. The surgeon who removed the gallbladder was adamant that his patients be up and walking in the hall the day after surgery, to help prevent blood clots forming in the leg veins. The nurses walked the patient in the hall as ordered, and after the third day the nurse told how he complained bitterly each time they did. The surgeon told them to keep walking him.

After a week, the patient was ready to go. His family came to pick him up and thanked the surgeon profusely for what he had done for their father. The surgeon was pleased and appreciated the thanks, but told them that it was really a simple operation and we had been lucky to get him in time. "But doctor, you don't understand," they said, "Dad hasn't walked in over a year!"

If it is dry - add moist; if it is moisten - add dryness. Congratulations, now you are a dermatologist

Patient to the eye doctor: "Whenever I drink coffee, I have this sharp, excruciating pain."

"Try to remember to remove the spoon from the cup before drinking."

A man goes to the eye doctor. The receptionist asks him why he is there. The man complains, "I keep seeing spots in front of my eyes."
The receptionist asks, "Have you ever seen a doctor?" and the man replies, "No, just spots."

Patient: I always see spots before my eyes.
Doctor: Didn't the new glasses help?
Patient: Sure, now I see the spots much clearer

A veterinarian was feeling ill and went to see her doctor. The doctor asked her all the usual questions, about symptoms, how long had they been occurring, etc., when she interrupted him: "Hey look, I'm a vet -- I don't need to ask my patients these kind of questions: I can tell what's wrong just by looking. Why can't you?"

The doctor nodded, looked her up and down, wrote out a prescription, and handed it to her and said, "There you are. Of course, if that doesn't work, we'll have to have you put down."

A chemist walks into a pharmacy and asks the pharmacist, "Do you have any acetylsalicylic acid?"
"You mean aspirin?" asked the pharmacist.
"That's it, I can never remember that word."

A physicist, biologist and a chemist were going to the ocean for the first time.
The physicist saw the ocean and was fascinated by the waves. He said he wanted to do some research on the fluid dynamics of the waves and walked into the ocean. Obviously he was drowned and never returned.

The biologist said he wanted to do research on the flora and fauna inside the ocean and walked inside the ocean. He too, never returned.

The chemist waited for a long time and afterwards, wrote the observation, "The physicist and the biologist are soluble in ocean water".

Researchers explore augmented ACL reconstruction procedure


Marshall University Joan C. Edwards School of Medicine


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IMAGE: Viewing outside the knee, the tibial passing sutures, InternalBrace passing sutures, and femoral passing sutures can all be seen docked. view more 

Credit: Chad Lavender, M.D., Marshall University

HUNTINGTON, W.Va. - An innovative procedure that explores the use of amnion, bone marrow concentrate and suture tape in anterior cruciate ligament (ACL) reconstruction may result in earlier return to play protocols for athletes, suggests a new Marshall University study published in the May 6, 2019, edition of Arthroscopy Techniques, a companion to Arthroscopy: The Journal of Arthroscopic and Related Surgery.

The ACL is one of four major ligaments that stabilize the knee. An ACL tear is one of the most common types of knee injuries, most often occurring during high-demand sports such as soccer or football. Traditional ACL reconstruction requires a graft to replace the ligament. Small tunnels are drilled into the bone above and below the knee for screws to keep the graft in place. Small buttons may also be used along the bone's edge to secure the graft.

In the Arthroscopy Techniques article, Chad D. Lavender, M.D., lead author and assistant professor of orthopaedic surgery at the Marshall University Joan C. Edwards School of Medicine, and Charles Bishop, M.D., a fifth-year orthopaedic resident at Marshall's School of Medicine, outline a new process that fills, or "fertilizes," these tunnels with a mixture of amnion, bone marrow concentrate and suture tape to speed up recovery and stabilize the knee. Amnion is used due to its potential to decrease adhesions, possibly protect ACL grafts and increase vascularization by acting as a scaffold. Bone marrow concentrate containing the patient's mesenchymal stem cells combined with Allosync has the potential to increase the speed and quality of graft bone incorporation, especially when used in the setting of a soft-tissue allograft. Using suture tape augmentation with the reconstruction has been thought to increase the early strength of the reconstruction.

"There are early advantages to fertilized ACL reconstruction such as decreased pain, and when this is combined with biologics, we may be able to accelerate rehabilitation and return to play more than previously anticipated," Lavender said.

The study builds off Lavender's previous approach using bone marrow concentrate and a suture tape, as published in the November 19, 2018, edition of Arthroscopy Techniques.

To date, Lavender has successfully completed more than 30 procedures using some form of the fertilized ACL. Patients have reported the same results as the standard ACL reconstruction with shorter recovery times, significantly less pain and no known additional risks. Future research will determine whether using this technique could shorten the return to play for athletes and reduce the use of opioids post-surgery

News Release 3-Jun-2019

Climate action urgently required to protect human health in Europe

New EASAC report 'The imperative of climate action to protect human health in Europe' highlights an alarming range of health risks due to climate change and the benefits of rapid phase out of fossil fuels

European Academies' Science Advisory Council, Leopoldina - Nationale Akademie der Wissenschaften


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EASAC is the voice of independent science advice, mobilising Europe's leading scientists from 27 national science academies to guide EU policy for the benefit of society. By considering a large body of independent studies on the effects of climate change on health, and on strategies to address the risks to health, EASAC has identified key messages and drawn important new conclusions. The evidence shows that climate change is adversely affecting human health and that health risks are projected to increase. Solutions are within reach and much can be done by acting on present knowledge, but this requires political will. With current trends in greenhouse gas emissions, a global average temperature increase of over 3°C above pre-industrial levels is projected by the end of the century. The increase will be higher over land than the oceans, exposing the world population to unprecedented rates of climate change and contributing to the burden of disease and premature mortality. Health risks will increase as climate change intensifies through a range of pathways including:

•Increased exposure to high temperatures and extreme events such as floods and droughts, air pollution and allergens;
•Weakening of food and nutrition security;
•Increased incidence and changing distribution of some infectious diseases (including mosquito-borne, food-borne and water-borne diseases);
•Growing risk of forced migration.


EASAC emphasises that the top priority is to stabilise climate and accelerate efforts to limit greenhouse gas emissions. The economic benefits of action to address the current and prospective health effects of climate change are likely to be substantial.

Working Group co-chair, Professor Sir Andy Haines (London School of Hygiene & Tropical Medicine), comments, "If urgent action is not taken to reduce emissions in order to keep temperatures below the 2°C (or less) limit enshrined in the Paris Climate Agreement, we face potentially irreversible changes that will have wide ranging impacts on many aspects of health. The scientific community has an important role in generating knowledge and countering misinformation. We hope that this comprehensive report will act as a wake-up call and draw attention to the need for action, particularly by pursuing policies to decarbonise the economy. The protection of health must have a higher profile in policies aimed at mitigating or adapting to the effects of climate change". Key messages addressed in the report include:

•Several hundred thousand premature deaths annually in the EU could be averted by a 'zero-carbon' economy through reduced air pollution
Pollution endangers planetary health, damages ecosystems and is intimately linked to global climate change. Fine particulate and ozone air pollution arise from many of the same sources as emissions of greenhouse gases and short-lived climate pollutants. For the EU overall, fossil-fuel-related emissions account for more than half of the excess mortality attributed to ambient (outdoor) air pollution. A recent estimate suggests that about 350,000 excess deaths annually in the EU can be attributed to ambient air pollution from burning fossil fuels and a total of about 500,000 from all human-related activities.

Understanding of the range of health effects of air pollution on the health of children and adults is growing. Seven million babies in Europe are living in areas where air pollution exceeds WHO recommended limits and such exposure may affect brain development and cognitive function. Action to reduce pollution through decarbonisation of the economy must be viewed as a priority to address both climate change and public health imperatives.



•Promotion of healthier, more sustainable diets with increased consumption of fruit, vegetables and legumes and reduced red meat intake will lower the burden of non-communicable diseases and reduce greenhouse gas emissions.
Promoting dietary change could have major health and environmental benefits, resulting in significant reductions of up to about 40% in greenhouse gas emissions from food systems as well as reducing water and land use demands. Such diets can also lead to major reductions on non-communicable disease burden through reduced risk of heart disease, stroke and other conditions.

If food and nutrition security declines because of climate change, the EU can probably still satisfy its requirements by importing food. But this will have increasing consequences for the rest of the world; for example, by importing fodder for livestock from arable land that has been created through deforestation. It is therefore vital to develop climate-smart food systems to ensure more resilient agricultural production and to promote food and nutrition security, for the benefit of human health.


•Climate action could avert a significant increase in the spread of infectious diseases
The spread of infectious diseases in Europe could increase through climate change. These diseases include those that are spread by vectors (particularly mosquitos) and food- and water-borne infections. There is also an increased risk to animal health across Europe from conditions such as Blue tongue virus.

Distribution of the mosquito species Aedes albopictus, known to be a vector for diseases such as dengue, is already expanding in Europe and may extend to much of Western Europe within the next decade.

Water-borne infections such as diarrhoea may increase following heavy rainfall and flooding and higher temperatures may be associated with increased antibiotic resistance for pathogens such as E. coli. In the case of Salmonella species, an increase in temperature will increase multiplication and spread in food and increase the risks of food poisoning. There could also be an increase in Norovirus infections related to heavy rainfall and flooding. Strengthening communicable disease surveillance and response systems should be a priority for improving adaptation to climate change.


•Providing evidence of the health benefits of action on climate change may be instrumental in achieving rapid reductions in greenhouse gas emissions
Although the EU is actively engaged in efforts to reduce greenhouse gas emissions and to identify suitable adaptation measures, the impacts of climate change on health have been relatively neglected in EU policy. Recognising the serious challenges that climate change poses to the global health gains made in recent decades is key to promoting public engagement.

Furthermore, the impact of climate change in other regions can have tangible consequences in Europe and the EU has responsibilities in addressing problems outside its area.

The EU must do more to ensure that health impact assessment is part of all proposed initiatives, and that climate and health policy is integrated with other policy priorities including coordinating strategies at EU and national level. It is also vital that the steps are taken to counter misinformation about the causes and consequences of climate change which threaten to undermine the political will to act.

News Release 3-Jun-2019

A little formula in first days of life may not impact breastfeeding at 6 months

But it might alter moms' attitudes to longer-term feeding, UCSF-led study shows

University of California - San Francisco


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A study has lodged a new kink in the breastfeeding dilemma that adds to the angst of exhausted new parents: While most newborns lose weight in the first days of life, do you or don't you offer a little formula after breastfeeding if the weight loss is more than usual?

For years, the answer has been "no," as infant formula was seen as a deterrent to breastfeeding. The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age, and continuing breastfeeding until 12 months while transitioning to solids. But according to the Centers of Disease Control and Prevention, just over one-third of infants in the United States are breastfeeding at 12 months.

The answer is no longer clear-cut, say researchers of the UCSF Benioff Children's Hospitals - led study, publishing in JAMA Pediatrics on June 3, 2019. It depends on breastfeeding duration goals and attitudes, and needs to be balanced against the risks that newborns face in the first days of life when their weight is dropping.

In the study, the researchers tracked the long-term feeding habits of 164 babies born at UCSF Benioff Children's Hospitals and Penn State Children's Hospital. The infants had been breastfed between 1-to-3 days old, and their weight loss had been in the 75th percentile or above for age. Half of the mothers added syringe-fed formula after each breastfeeding, which stopped when the mother's milk came in at two-to-five days after delivery. The other half had continued to breastfeed exclusively.

Marital Status, Breastfeeding Goals Are Factors in Weaning

The researchers found that at 6 months of age, the infants in the supplemented group were as likely to breastfeed as those who had exclusively breastfed. But by 12 months of age, that had changed. In the supplemented group, 21 of the 12-month-olds (30 percent) were still breastfeeding, versus 37 of the infants (48 percent) in the non-supplemented group. The disparity between the two groups was less marked when the researchers accounted for married status and longer breastfeeding duration goals, both of which are associated with longer-term breastfeeding.

"The results suggest that using early, limited formula may not have a negative impact on infants, but it may alter maternal attitudes toward breastfeeding," said first author Valerie Flaherman, MD, a pediatrician at UCSF Benioff Children's Hospitals and associate professor in the UCSF departments of pediatrics, and epidemiology and biostatistics.

While limited formula in the first days of life did not seem to change feeding habits among newborns that were exclusively breastfed, "it's possible that supplementation reduced commitment, by the mother or other family members, to avoid it later in infancy," she said.

An earlier study of the same 164 infants, also led by Flaherman, found that the supplemented newborns may have been at lower risk for hyperbilirubinemia, a condition that leads to jaundice and may be caused by inadequate nutrition. Of the five infants readmitted to the hospital by 1 month of age, four were in the non-supplemented group.

"Our study's results show that early, limited formula may have significant benefits as well as risks for subsequent breastfeeding duration," said Flaherman.

"Counseling that implies all formula is harmful would be inaccurate and may be detrimental to long-term breastfeeding success," she said. However, if formula is used in the first few days after birth to prevent hyperbilirubinemia or dehydration, "it should be discontinued as soon as possible, since ongoing use at 1 week of age indicates a mother is at high risk of early breastfeeding cessation."

Senior author Ian M. Paul, MD, of Penn State College of Medicine, emphasized that a "rigid, one-size-fits-all approach" was inappropriate. "Guidelines for care and standards set by hospital accreditation agencies should consider these data and how best to support babies and their mothers," he said.

Fathers aid development of larger brains




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IMAGE: Callitrichids, like these common marmosets, usually give birth to two infants. The father and the other group members help the female rear her young. view more 

Credit: Judith Burkart


The bigger the brain in relation to body size, the more intelligent a living organism is. This means that mammalian species with large brains are smarter than small-brained mammals. However, developing a large brain comes at a price: An infant expends around two-thirds of its energy alone on supplying nourishment to its brain. That huge amount of energy must be continually available in the form of milk and, later on, through the intake of food. The females of many large-brained animal species cannot bear the energetic costs of rearing offspring on their own - they are reliant on additional help.

Fathers help dependably

Previously, it was generally assumed that it is immaterial whether it is the father or other members of the group who assist the mother in caring for offspring. However, evolutionary biologist Sandra Heldstab and her colleagues Karin Isler, Judith Burkart and Carel van Schaik from the University of Zurich's Department of Anthropology have now demonstrated for the first time that it very well does matter who helps the mother. Animal species with paternal care of offspring are particularly able to energetically afford bigger brains. Help from other group members is far less essential to the evolution of a large brain. In their study, the researchers compared brain sizes and the extent and frequency of paternal and alloparental care in around 480 mammalian species.

"Fathers help consistently and dependably with the rearing of offspring, whereas assistance from other group members, such as elder siblings for instance, is far less reliable," Sandra Heldstab explains. For example, in the case of wolves and African wild dogs - two mammal species with large brains -, elder siblings often help out less, and they look out for themselves first when food is scarce. Sometimes they even steal the prey that parents bring for the infants. The father, in contrast, actually steps up his willingness to help his young offspring when environmental conditions worsen.

Bigger brains or bigger litters

In the case of other species like meerkats and prairie voles, for instance, elder siblings often defect to a different group when they reach puberty and, unlike the father, are no longer available to help the mother. Moreover, the quality of the paternal help is usually superior to help provided by other group members, who are often young and inexperienced. "A female cannot energetically afford offspring with large brains unless she can rely on help, and such dependable help only comes from the father," Heldstab says.

If the assistance that the female receives for rearing her young is inconsistent, evolution takes an alternative path. In mammalian species that fit this bill - such as lions and red-ruffed lemurs for example -, mothers do not give birth to few offspring with large brains, but to many with small brains. If there is plenty of help in caring for the young, the entire litter survives. If the female receives little support, some of the young die. This is evolution's way of making certain that at least some of the young survive even in the event of scant help and ensuring that the female doesn't needlessly invest energy in an offspring with a large brain that will die in the absence of dependable helpers. The study demonstrates once more that only a stable and dependable supply of energy - procured through paternal help, for instance - enables a large brain to develop in the course of evolution.

Humans are the exception

Humans are unique in this respect: Paternal assistance in child rearing is very reliable, but so is childcare help from other relatives and non-relatives. This circumstance enabled humans to develop the largest brain relative to body size in the animal kingdom and nonetheless to considerably shorten the time span between births compared to that for our closest relatives, apes. "In the world of mammals, only help from fathers is dependable. We humans, though, fortunately can also count on help from others," Sandra Heldstab says.

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News Release 3-Jun-2019

Immunotherapy drug found safe in treating cancer patients with HIV

Researchers seek to break down HIV exclusions in cancer clinical trials

Fred Hutchinson Cancer Research Center


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IMAGE: Dr. Tom Uldrick of Fred Hutchinson Cancer Research Center led the study. view more 

Credit: Robert Hood / Fred Hutch

SEATTLE -- June 2, 2019 --The results of a study led by physicians at Fred Hutchinson Cancer Research Center showed that patients living with HIV and one of a variety of potentially deadly cancers could be safely treated with the immunotherapy drug pembrolizumab, also known by its brand name, KEYTRUDA®.

During an ASCO presentation concurrent with release of a study in JAMA Oncology, Fred Hutch researcher and lead author Dr. Tom Uldrick said that in nearly all cases it was safe to use the drug in patients with cancer and HIV. The "adverse events profile," a measure of the safety of the drug in the study, was not substantially different from prior studies that excluded such patients. The results, study authors said, are likely applicable to five similar drugs that block receptors known as PD-1 or PD-L1 on the surface T cells.

"Our conclusion is that anti-PD-1 therapy is appropriate for cancer patients with well-controlled HIV, and that patients with HIV and cancer can be treated with the drug and should be included in future immunotherapy studies," Uldrick said.

The 30-patient trial studied only pembrolizumab, the anti-PD-1 therapy manufactured by Merck. Merck provided the study drug to the National Cancer Institute (NCI). The NCI sponsored the trial. HIV-positive patients with different cancers that might respond to the drug were included in the trial. Among the cancers treated were lung cancer; Kaposi sarcoma, or KS; non-Hodgkin lymphoma; liver cancer; anal cancer and advanced squamous cell skin cancer.

Fred Hutch immunotherapy researcher Dr. Mac Cheever is director of the NCI-funded Cancer Immunotherapy Trials Network, which carried out the trial, and he is senior author of the JAMA Oncology paper. The study was conducted at seven different cancer centers across the United States, including the HIV and AIDS Malignancy Branch of the National Cancer Institute, in Bethesda, Maryland.

Overall, the safety profile of pembrolizumab in people with HIV and cancer was similar to that noted in clinical trials in the general population. Although the primary purpose of the study was to evaluate safety, it also provided a snapshot of the anti-cancer activity of the drug on these patients. One patient with lung cancer had a complete response to treatment, and activity was also noted in important HIV-associated cancers, including non-Hodgkin lymphoma, Kaposi sarcoma and liver cancer.

An unexpected death on study from a rare KSHV-associated B-cell lymphoproliferation was noted in one patient and while the association with therapy is still unclear, it has led to recommendations to use substantial caution if anti-PD-1 therapy is considered in the setting of KSHV-associated multicentric Castleman disease. The researchers concluded that anti-PD-1 therapy may be considered for FDA approved indications in patients with HIV who are on antiretroviral therapy and have a CD4 count above a certain threshold (100 cells per microliter of blood). However, more research is needed as to its effectiveness in the setting of HIV infection.

The FDA, Friends of Cancer Research, and the American Society of Clinical Oncology have all recommended that HIV patients should be included in more clinical trials. The NCI has generally allowed patients with HIV to enroll on the immuno-oncology studies that it sponsors with PD-1 and PD-L1 inhibitors. However, this trial was one of only two trials sponsored by the NCI to focus exclusively on patients living with HIV, and it has been the first prospective trial to report its results.

"Exclusion of people with HIV in clinical trials is a longstanding problem that grew out of the poor outcomes of AIDS patients with cancer, before there were effective antiviral therapies for HIV," Uldrick said. In prior research, Uldrick surveyed 46 recent clinical trials that led to approval of cancer drugs, and found 30 contained explicit exclusions for patients with HIV, and nine others where an exclusion was implied.

This study was sponsored by the National Cancer Institute Cancer Therapy Evaluation Program (CTEP). Study drug was provided to the NCI by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., via a collaborative research and development agreement. It was supported by U.S. federal funds from the National Cancer Institute (NCI), National Institutes of Health (NIH), under Contract No.HHSN261200800001E , NIH Intramural Research Program Support ZIA BC011700 to Dr. Uldrick and ZIA BC010885 to Dr. Robert Yarchoan, and 1U01CA154967 to Dr. Cheever for the Cancer Immunotherapy Trials Network.

Dr. Uldrick reported the following disclosures: Merck & Co. during the conduct of the study, and Celgene and Roche outside the submitted work. In addition, Dr. Uldrick had a patent to the NCI and Celgene issued. Dr. Cheever reported the following disclosures: grants from NIH, NCI during the conduct of the study; as well as others from Merck, Horizon, Dendreon and Celldex outside the submitted work.

News Release 2-Jun-2019

Using facial recognition technology to continuously monitor patient safety in the ICU


ESA (European Society of Anaesthesiology)


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A team of Japanese scientists has used facial recognition technology to develop an automated system that can predict when patients in the intensive care unit (ICU) are at high risk of unsafe behaviour such as accidentally removing their breathing tube, with moderate (75%) accuracy.

The new research, being presented at this year's Euroanaesthesia congress (the annual meeting of the European Society of Anaesthesiology) in Vienna, Austria (1-3 June), suggests that the automated risk detection tool has the potential as a continuous monitor of patient's safety and could remove some of the limitations associated with limited staff capacity that make it difficult to continuously observe critically-ill patients at the bedside.

"Using images we had taken of a patient's face and eyes we were able to train computer systems to recognise high-risk arm movement", says Dr Akane Sato from Yokohama City University Hospital, Japan who led the research.

"We were surprised about the high degree of accuracy that we achieved, which shows that this new technology has the potential to be a useful tool for improving patient safety, and is the first step for a smart ICU which is planned in our hospital."

Critically ill patients are routinely sedated in the ICU to prevent pain and anxiety, permit invasive procedures, and improve patient safety. Nevertheless, providing patients with an optimal level of sedation is challenging. Patients who are inadequately sedated are more likely to display high-risk behaviour such as accidentally removing invasive devices.

The study included 24 postoperative patients (average age 67 years) who were admitted to ICU in Yokohama City University Hospital between June and October 2018.

The proof-of-concept model was created using pictures taken by a camera mounted on the ceiling above patients' beds. Around 300 hours of data were analysed to find daytime images of patients facing the camera in a good body position that showed their face and eyes clearly.

In total, 99 images were subject to machine learning--an algorithm that can analyse specific images based on input data, in a process that resembles the way a human brain learns new information. Ultimately, the model was able to alert against high-risk behaviour, especially around the subject's face with high accuracy.

"Various situations can put patients at risk, so our next step is to include additional high-risk situations in our analysis, and to develop an alert function to warn healthcare professionals of risky behaviour. Our end goal is to combine various sensing data such as vital signs with our images to develop a fully automated risk prediction system", says Dr Sato.

The authors note several limitations including that more images of patients in different positions are needed to improve the generalisability of the tool in real life. They also note that monitoring of the patient's consciousness may improve the accuracy in distinguishing between high-risk behaviour and voluntary movement

News Release 3-Jun-2019

Six fingers per hand


University of Freiburg


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IMAGE: Congenital six-fingered hand with additional muscles to move the extra finger which yield augmented manipulation abilities. The muscles controlling the additional finger (in green) are distinct from the thumb muscles... view more 

Credit: Source: compare „Original Publication ", license: Creative Commons, https://creativecommons.org/licenses/by/4.0

Polydactyly is the extraordinary condition of someone being born with more than five fingers or toes. In a case study published in Nature Communications, researchers from the University of Freiburg, Imperial College London, the University Hospital of Lausanne, and EPFL have for the first time examined the motor skills and sensorimotor brain areas in people with polydactyly. The results show that an extra finger can significantly extend the manipulation abilities and skill. It enables people with six fingers to perform movements with one hand where people with only five fingers would need two hands. The augmented motor abilities observed in the polydactyly subjects are made possible by dedicated areas in the sensorimotor brain areas. These findings may serve as blueprint for the development of additional artificial limbs extending motor abilities.

The case study of the researchers from Freiburg, London and Lausanne investigates for the first time the movement abilities of people with six fingers per hand. In the case of the two examined subjects, an additional finger between thumb and forefinger is fully formed on each hand. "We wanted to know if the subjects have motor skills that go beyond people with five fingers and how the brain is able to control the additional degrees of freedom," explains Prof. Dr. Carsten Mehring from the University of Freiburg and the Bernstein Center Freiburg.

To find out the extent of their abilities, the researchers had the subjects perform several behavioural experiments, and their brain activity was monitored using functional magnetic resonance imaging (fMRI). The results show that the subjects' extra fingers are moved by own muscles. This allows the subjects to move their extra fingers as far as possible independently of all other fingers. "Our subjects can use their extra fingers independently, similar to an additional thumb, either alone or together with the other five fingers, which makes manipulation extraordinary versatile and skilful. For instance, in our experiments subjects can carry out a task with one hand, for which we normally need two hands," summarises Professor Mehring. "Despite the extra finger increasing the number of degrees of freedom that the brain has to control, we found no disadvantages relative to five-finger people. In a nutshell, it is amazing that the brain has enough capacity to do it without sacrificing elsewhere. That's exactly what our subjects do," says Prof. Dr. Etienne Burdet of Imperial College London.

To understand how the brain of polydactyly subjects controls the additional fingers, the scientist used high-resolution functional magnetic resonance imaging (fMRI). "We found dedicated neural resources that control the sixth finger, and the somatosensory and motor cortex are organized exactly to allow for the additional motor skills observed," comment Prof. Dr. Andrea Serino and Dr. Michael Akselrod, who carried out the neuroimaging studies at EPFL and Lausanne University Hospital.

The study of these polydactyly hands could advance the development of additional artificial limbs to expand people's motor skills. For example, an extra arm to help working alone in a narrow environment, or to enable a surgeon carrying out operations without an assistant. However, the scientists note, "The additional extremities have been trained in the subjects since birth. This does not necessarily mean that similar functionality can be achieved when artificial limbs are supplemented later in life. Yet, people with polydactyly provide a unique opportunity to analyse the neuronal control of extra limbs and the possibilities of sensorimotor skills."

News Release 3-Jun-2019

Large national study tracks veterans' health, highlights areas of unmet needs

Brief survey allows identification of health disparities in veterans relative to the general population

Northwestern University


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•Novel data describes use of instrument that encourages vets to report on their health using a brief survey
•PROMIS self-reported outcomes matched physician diagnoses documented in medical records
•This tool may serve as a motivator for some veterans who are hesitant to seek medical care
•Findings provide fuller picture of national health, allow health professionals to see how everyone, including veterans, is doing


CHICAGO --- For the first time, a large national population of United States veterans used the same standardized tool that the general population uses for tracking health.

More than 3,000 veterans from across the country used the tool to self-report their health in the study led by a researcher from Northwestern Medicine and the U.S. Department of Veterans Affairs. Findings showed that veterans scored worse in several areas, including feeling more anxiety, depression, fatigue, sleep disturbance and pain compared to people in the general population.

These self-reported outcomes were valid because they matched physician diagnoses documented in medical records, the study found.

The study's scientists believe patient self-reporting will be a successful way to track the health of veterans, who may be hesitant to seek medical care.

The self-reporting tool - a survey called PROMIS-29 - is commonly used in the general population but not widely or systematically offered to veterans. The scientists mailed the survey to veterans for this study, which is the first to report PROMIS-29's use in a large national cohort of veterans.

"These are our nation's veterans. They served our country, and they deserve access to things made available to everyone," said lead author Sherri LaVela, a research associate professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine and a department of veterans affairs scientist. "The PROMIS instrument is being used more and more for health care, and we hope to see it integrated into veteran care as well."

The instrument used in the study may be a useful tool for health care providers to assess veteran patient's physical and mental health, as indicated by the positive associations between scores and clinical documentation which suggests clinical validity for targeted measures, LaVela said.

The study was published last week in the Journal of General Internal Medicine.

The VA serves more than 8.3 million veterans in the U.S. annually.

"Seeing how veterans fare relative to population norms is important because it gives us a fuller picture of their health and allows us a cursory glance at how they are doing in general," LaVela said. "Estimates like this are important because they provide normal ranges for health measures across cohorts.

"Veterans have enhanced options of seeking care outside the VA, which makes it crucial to have an accurate measurement of health status and symptoms among population-based samples. Being able to simply, yet effectively, collect these data will identify unmet needs in which to intervene."

Patients using PROMIS-29 answered a short series of questions about their health and quality of life. The survey is scored to indicate if they are experiencing disturbed sleep, anxiety, depression or pain, for instance. Given the responses, the patient and their health care team can follow up and schedule a doctor's appointment.

"If a veteran has poor scores, we want to get them in and take a look," LaVela said.

Veterans in the study also scored lower for physical function than civilians and lower for satisfaction with social role, such as being satisfied with their ability to work, do regular personal and household responsibilities, and perform daily routines.

Patient-reported data can be used to inform health care providers about symptoms, perceived state of health and are especially important to understand patient experiences among people with chronic diseases.

The ability to quickly and easily identify health disparities in veterans is important because it can prompt health care providers to intervene. For example, the study found that relative to general population norms, veterans reported worse scores for pain interference. The VA has been integrating innovative, patient-centric approaches ways into treatment options. Using pain as an example, the VA has a stepped-care pain management approach that can be used for intervention, and recently the VA implemented mindfulness types of interventions to help veterans with pain, post-traumatic stress disorder, and other conditions that may afflict veterans, LaVela said.

Former Marine Dustin Lange said seeing how a veteran's health stacks up against the general population can serve as much-needed motivation for a veteran to go see the doctor.

"A lot of times, veterans might be hesitant to go to the hospital or not get proper checkups," said Lange, a U.S. Veteran who spent eight years in the Marines and is now the associate director of the Chez Center for Wounded Veterans in Higher Education at University of Illinois, Urbana-Champaign.

Lange has taken the PROMIS-29 survey, though not for this study. His score indicated some disturbances in his sleep, which prompted him to schedule a doctor's appointment. His clinical checkup validated his PROMIS-29 results. Lange said he hopes PROMIS-29 becomes more widely available for veterans, because he thinks it could motivate veterans to see a doctor.

"As a vet, you're able to see, 'Am I having similar problems to the general population? Do I have higher sleep or pain problems?" Lange said. "Seeing that difference from the general population could prompt a vet to visit the VA and get help

3-Jun-2019

Hormone produced during pregnancy repurposed to treat painful joint condition

Multiple injections of ligament-loosening relaxin restored range of motion in animal model of "frozen shoulder" syndrome

Beth Israel Deaconess Medical Center


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BOSTON - Beginning in the first trimester of pregnancy, the body begins to produce the hormone relaxin, which loosens the expectant mother's muscles, joints and ligaments to help her body accommodate a growing baby and prepare for birth. When Edward Rodriguez, MD, PhD, Chief of Orthopedic Trauma in the Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center (BIMDC) observed that patients with a common and painful joint condition called arthrofibrosis experienced long-lasting relief during and after pregnancy, he reached out to his colleagues in the lab to confirm his suspicion that relaxin could explain the phenomenon.

In a first-of-its-kind study, Rodriguez collaborated with Ara Nazarian, PhD, a principal investigator in the Center for Advanced Orthopaedic Studies at BIDMC, and Mark Grinstaff, PhD, Professor of Chemistry at Boston University, to investigate whether relaxin's joint-loosening properties could be applied to alleviate symptoms of arthrofibrosis. The team found that multiple injections of human relaxin directly into the afflicted joint restored range of motion and improved tissue health in an animal model of frozen shoulder, a painful and debilitating form of arthrofibrosis particularly common among middle aged, often diabetic women. The findings are published in the journal Proceedings of the National Academies of Sciences.

"Current treatment options for arthrofibrosis, such as physical therapy and medication provide only marginal or temporary relief and do not address the source of the pain and stiffness," said Nazarian, who is also Associate Professor of Orthopaedic Surgery at Harvard Medical School. "While more research is needed, repurposing this pregnancy hormone as a treatment for arthrofibrosis could provide an unprecedented opportunity."

Most common in the shoulders, knees, hips, wrists and ankles, arthrofibrosis affects more than five percent of the general population. Characterized by pain accompanied by a reduction in range of motion, arthrofibrosis is caused by an excessive build-up of scar tissue in the joint, triggered by injury, trauma, long-term immobility, or surgery. Up to a third of patients who have undergone ACL reconstruction surgery can end up with arthrofibrosis.

In the new study, using human cells in vitro, Nazarian and colleagues showed that a specific version of the hormone, human relaxin-2, inhibits cells' production of scar tissue and by indirectly downregulating production of collagen - the strong protein that supports joints and other tissues throughout the body, but is overproduced in scarring. Next they showed in an animal model of frozen shoulder that multiple injections to the joint resulted in significant and lasting improvements in range of motion, while a single injection to the joint, or systemic treatment did not. Similarly, when the scientists looked at the joint tissues, the animals that received multiple injections of relaxin to the joint appeared to undergo changes indicating restorative healing.

More studies will be necessary before investigating relaxin's efficacy for treatment of arthrofibrosis in humans, but the team is optimistic that the naturally-occurring and well-tolerated hormone could offer relief for millions of people.

"Arthrofibrosis is a widespread disease, occurring in all joints, and its high incidence, limited treatment options and poor patient outcomes call for alternative and effective non-surgical solutions," said Rodriguez, who is also an Associate Professor of Orthopaedic Surgery at Harvard Medical School. "The local delivery of relaxin-2 offers a potential paradigm shift in the treatment for the millions of individuals who are affected by arthrofibrosis every year."

Trap-and-release accelerates study of swimming ciliated cells

Researchers use ultrasound to streamline measurement of movement

Washington University in St. Louis
Researchers at Washington University in St. Louis have been studying cilia for years to determine how their dysfunction leads to infertility and other conditions associated with cilia-related diseases. Now, they will be able to perform these studies more rapidly through a new method that uses sound waves to momentarily trap cells propelled by cilia, then releases them to measure their movement as they swim away.

An interdisciplinary team led by J. Mark Meacham, assistant professor of mechanical engineering & materials science in the McKelvey School of Engineering, and students in his lab used an acoustic microfluidic approach that uses ultrasonic standing waves within a small fluid-filled chamber to collect groups of the single-cell green algae cells Chlamydomonas reinhardtii, a model organism for studying human cilia. The so-called acoustic trap takes advantage of material properties of the cell bodies to hold them in place without damaging them. By first collecting the cells, the team can efficiently analyze hundreds of cells in minutes. Results were published in and featured on the inside back cover of the journal Soft Matter in the June 12, 2019, print edition.

"Think of it as a tiny cage made by the ultrasound field," Meacham said. "The cells are trying to find a way to escape but are pushed back by the waves that make up the cage walls. When the walls are removed, they are free to run."

Cilia are tiny hair-like structures in cells that line our lungs, nose, brain and reproductive systems. They are designed to sweep out fluids and microbes to keep people healthy. When they malfunction, infertility, chronic middle-ear infections, water on the brain and other conditions can develop.

Susan Dutcher, professor of genetics and of cell biology and physiology at the School of Medicine and a co-author on the paper, works with C. reinhardtii and hundreds of its genetic variants, or mutants, to study ciliary behavior and dysfunction. Analyzing so many variants using current methods, which manually trace individual cells, would take a very long time, Meacham said.

"It is useful for Dr. Dutcher to rapidly classify her cells based on swimming effectiveness and to choose those that are of most interest for the more laborious and tedious, detailed analysis," Meacham said. "That's what this type of population-based method really helps with, allowing us to analyze a large number of given mutants in a short time."

For this work, the team used three genetic variants of C. reinhardtii cells from Dutcher's lab as models.

Meacham and a doctoral student, Minji Kim, first author on the paper, developed the microfluidic chip, which is small enough that two of them fit on a 1- by 3-inch glass slide. Cells entered and exited through inlet and outlet channels connected to a circular chamber at the center of the device -- which is like a large, open holding pen for the cells -- before the ultrasound is turned on. Kim and Meacham inserted fluid containing the cells into the device, then activated the ultrasound via a piezoelectric transducer. The ultrasonic waves reflect off of the chamber walls to create pressure wells within the circular chamber, which trap the cells into a group at the chamber's center.

After imaging the cells, the researchers turn off the ultrasound, effectively opening the cage door and allowing the cells to swim off.

"This acoustic trap allows us to do this interesting type of analysis that we couldn't do any other way," Meacham said. "We can trap and release a cell population, analyze it, load up the next population, trap, release, analyze, and load up the next one in a matter of tens of seconds to a minute per sample to get a graded measure of swimming capability for the different cell types."

Analysis of spreading cells is easily automated because swimming starts from a single location, Meacham said. Cells appear as black pixels in successive images of the released cells. The change in shape of the cells is then related to swimming speed.

"We observe them swimming for one to three seconds, then once we have those images, the process of analyzing them is automated," Kim said. "We can get the motility measurement from about 50 cells in an automated way considerably faster than by having to track individual cells."

Ultimately, the team seeks to provide researchers with a tool that categorizes cells based on their movement capability, whether for cataloging C. reinhardtii mutants or for assessing sperm cell motility, Meacham said

Ngày Ăn 3 Bữa Là Đang Giết Chết Cơ Thể?









Bạn có biết thói quen ăn 3 bữa một ngày tiềm ẩn nhiều nguy cơ gây hại tới sức khỏe, hãy điều chỉnh ngay một cách khoa học nhất!






Ăn uống cần khoa học để đảm bảo sức khỏe




Theo nhà nghiên cứu lịch sử Abigail Carroll, những bữa ăn ngày nay xuất phát từ ảnh hưởng cấu trúc văn hóa của người di cư châu Âu tác động đến người Mỹ bản địa.

Thói quen ăn ba bữa một ngày bắt nguồn từ sự áp đặt của người di cư Châu Âu khi họ đến Mỹ định cư.

Những người bản địa Mỹ thường ăn bất cứ khi nào họ đói chứ không phải lúc đồng hồ chỉ giờ sáng, trưa hay tối.




Sau cuộc cách mạng công nghiệp, con người bắt đầu biến bữa giữa ngày thành bữa trưa chính và bữa sau giờ làm thành bữa tối, rồi dành chỗ cho bữa ăn sau giấc ngủ vào buổi sáng.

Trong cuốn sách mới của mình tên là "Three Squares: The Invention of the American Meal", bà Carroll nói rằng người châu Âu định cư trên đất Mỹ ăn vào những giờ quy củ.

Họ xem điều này là văn minh hơn người bản địa - những người ăn uống theo ý thích, dùng thực phẩm theo mùa và thi thoảng còn nhịn đói.

Đến nay chưa có bằng chứng nào cho thấy việc ăn uống đúng giờ, đủ bữa đảm bảo cho sức khỏe.

Chẳng hạn, theo bà Carroll, bữa sáng được coi là bữa ăn quan trọng trong ngày có thể là hệ quả từ các chiến dịch quảng cáo của các công ty ngũ cốc và nước trái cây.






Hãy ăn uống một cách khoa học nhất để đảm bảo sức khỏe.




Chúng ta nên ăn mỗi ngày bao nhiêu bữa ăn?

Nếu như một số người phụ nữ đang tìm kiếm biện pháp giảm cân , dựa trên chiều cao/ trọng lượng, mức độ hoạt động hiện tại và di truyền học, nó có thể là lượng calo của bạn sẽ cần phải có khoảng 1200 - 2000 calo mỗi ngày.




Để tìm cách xây dựng cơ bắp dựa trên chiều cao/ trọng lượng, mức độ hoạt động hiện tại và di truyền học, thì có thể lượng calo của bạn sẽ cần phải được giữa 3000 - 4000 calo mỗi ngày.








Đừng quên bổ sung sữa protein vào một trong các bữa ăn trong ngày của mình.




Thực tế, một nghiên cứu năm 2014 do Đại học Bath (Anh) cho thấy, một người dù ăn sáng hay không cũng chẳng ảnh hưởng đến tổng lượng calo họ tiêu thụ trong ngày.

Những người ăn sáng nạp nhiều calo hơn người bỏ bữa nhưng lại loại bỏ lượng calo thừa vào cuối ngày, nghĩa là tổng lượng tiêu thụ calo như nhau.




Nghiên cứu mới cho thấy bỏ bữa và nhịn đói có thể thực sự có lợi cho sức khỏe, giúp giảm cân và củng cố hệ thống miễn dịch.

Nghiên cứu tương tự của Đại học Alabama (Anh) cho thấy ăn sáng hay không chẳng tạo sự khác biệt nào đến người ăn kiêng đang cố gắng giảm cân.

Nghiên cứu mới cho thấy, việc nhịn ăn có thể thực sự tốt cho sức khỏe.

Phe ủng hộ chế độ ăn theo tỷ lệ 5:2, tức giới hạn thực phẩm chỉ 500 calo vào hai ngày trong một tuần, nói rằng việc hạn chế thức ăn này giúp giảm cân, tăng tuổi thọ và làm huyết áp thấp hơn.

Một nghiên cứu cho thấy nhịn đói hai ngày hay hơn nữa có thể giúp khởi động lại hệ thống miễn dịch, đặc biệt nếu nó đã bị hư hỏng do tuổi tác hay điều trị ung thư.




theo Khỏe & Đẹp

WVU study: Diabetics exposed to common household chemicals have lower heart disease rates

MORGANTOWN, W.Va.--Chemicals found in nonstick cookware, cleaning products and paint may help lead to new treatments for heart disease in diabetic adults, according to a West Virginia University epidemiologist's research.

Kim Innes, of the WVU School of Public Health, and her colleagues recently discovered that greater exposure to perfluoroalkyl substances was associated with lower rates of existing coronary heart disease in adults with diabetes. PFAS, considered a public health threat by the Centers for Disease Control and Prevention, are manufactured chemicals that were popularized by various industries in the 1940s because of their ability to repel oil and water.

In this study, researchers investigated the association of blood PFAS levels to coronary heart disease using data gathered as part of the C8 Health Project. A large, community-based study launched in 2005, the C8 Health Project was created to address the potential health effects stemming from contamination of West Virginia and Ohio drinking water with the PFAS perfluorooctanoic acid (also called C8) between 1950 and 2004.

Of the 5,270 adults with diabetes in this study--led by Baqiyyah Conway, University of Texas Health Science Center at Tyler--1,489 had been diagnosed with coronary heart disease previously, and 3,781 had not. The researchers investigated the relation between blood levels of four PFAS and coronary heart disease, considering the participants' age, sex, race, BMI, smoking history, duration of diabetes, kidney function, chronic kidney disease and other traits.

"In this cross-sectional study of adults with diabetes, the likelihood of reporting a diagnosis of coronary heart disease declined with increasing blood levels of four PFAS after adjustment for demographics, BMI and other factors," Innes said.

The four PFAS were also inversely related to the likelihood of coronary heart disease in adults without diabetes, but these associations were far less pronounced than in people with the condition.

It remains unknown exactly how PFAS might lower heart disease risk, but as Innes pointed out, "several factors could explain the inverse association." For example, PFAS may reduce inflammation. It's also possible that PFAS increases the body's sensitivity to insulin or ability to transport oxygen. All of these effects might promote heart health.

Because the study used data collected at a single point in time--rather than multiple times, over several years--it could not determine whether exposure to PFAS caused heart disease rates to drop. It could only establish an association between PFAS exposure and lower heart disease rates. But the research team is planning studies to fill this knowledge gap.

"The next step will be to conduct additional longitudinal studies in the C8 and other cohorts in order to assess the relation of baseline PFAS blood levels to subsequent risk for incident coronary heart disease in those with and without diabetes," Innes said. "Such research will help determine if the inverse association observed in this study might reflect a causal association between PFAS and the development of coronary heart disease."

If longitudinal studies bear out the current findings, they may inform new therapies for preventing coronary heart disease in people with diabetes.

"The findings of this paper in no way suggest that PFAS should be released into drinking water or the environment," Innes said. "With few exceptions, you wouldn't want any substance--including those with certain established health benefits, such as coffee and aspirin--contaminating the water. It is important to remember that PFAS are complex compounds that may have both positive and negative effects on health."

4-Jun-2019

For Latinos with diabetes, new study looks at ways to improve medication adherence

Certain lifestyle changes and low-cost interventions may improve how patients manage their medication regimen

University of Southern California - Health Sciences


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IMAGE: Keck School of Medicine of USC, Los Angeles. view more 

Credit: Ricardo Carrasco III

LOS ANGELES -- Latino adults have higher diabetes rates than non-Latinos, yet research shows they are less likely to correctly follow medication instructions provided by their doctors. Furthermore, diabetes can set off a cascade of medical complications, requiring multiple medications that often create a challenging daily regimen. In a new study coming out of the Keck School of Medicine of USC, student researchers have identified several potential approaches for improving medication adherence among Latinos.

Simple measures such as giving patients pillboxes for their medications, helping patients' family members understand their medication regimen and having patients attend weekly education sessions about managing the disease through lifestyle changes are all ways that patients could improve medication adherence.

The study also points toward specific challenges that underserved Latinos may be facing. Such challenges include having difficulty understanding what their medications are for, keeping track of their medications and feeling that they may take too many medications. Cohorts in this study took an average of 6.5 prescribed medications daily.

"Obtaining patients' perspectives is key to finding solutions that help improve their medication adherence and health outcomes," says Andrea Bañuelos Mota, the study's first and corresponding author. "Not only do our findings suggest several potential approaches to intervention for Latinos with diabetes, but they could also pave the way for the development of future evidence-based guidelines." Bañuelos Mota is currently enrolled in the Keck School's Doctor of Medicine/Master of Public Health (MDMPH) degree program.

Published in the Journal of General Internal Medicine (JGIM) on June 4, the cross-sectional study involved conducting surveys of 120 patients from across four safety net clinics in Los Angeles. Patients were at least 18 years old, self-identified as Latino/Hispanic/Chicano, were diagnosed with diabetes for more than six months, and were taking multiple diabetes medications. Furthermore, the study's dependent variable was patients with "controlled diabetes" (i.e., having a hemoglobin A1c level of less than 7.5%) versus patients with "uncontrolled diabetes" (i.e., having a hemoglobin A1c level equal to or greater than 7.5%).

"This study is exemplary of excellent primary care research and brings awareness to the language and literacy barriers faced by our immigrant communities, which health care providers must address to deliver quality medical care," says Jo Marie Reilly, MD, MPH, professor of clinical family medicine (educational scholar). Reilly leads the Keck School's Primary Care Initiative, a program created to promote careers in primary care and the one through which this study was established.

Conceived and led entirely by a team of five medical students -- including Andrea Bañuelos Mota, Emilio Ernesto Feliz Sala, Jennifer M. Perdomo, Joel Alejandro Solis and Walter M. Solorzano -- the study also marks an achievement for the Keck School initiative. "JGIM is one of the highest ranked general internal medicine journals, so it is particularly impressive that a student group got a paper accepted," says Michael Hochman, MD, MPH, a faculty mentor on the project with Reilly. Hochman is an associate professor of clinical medicine and serves as director of the USC Gehr Family Center for Health Systems Science.

Native Hawaiians at far greater risk for pancreatic cancer

Twenty years of data reveal surprising disparities

University of Southern California


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Native Hawaiians are at highest risk for pancreatic cancer, according to a USC study that provides a surprising look at disparities surrounding the deadly disease.

The findings -- published May 8 in the journal Cancer Medicine -- could help focus efforts to prevent pancreatic cancer, which will kill an estimated 45,750 people in the United States this year.

The study shows:

•Native Hawaiians have a 60% increased risk for pancreatic cancer, compared to European Americans.
•Japanese Americans have a 33% increased risk for pancreatic cancer, compared to European Americans.
•African Americans have a 20% increased risk for pancreatic cancer, compared to European Americans.


"The greater risks in Native Hawaiians and Japanese Americans, compared to whites -- in addition to the already reported increased risk in African Americans -- are new, important findings," said senior author Veronica Wendy Setiawan, associate professor of preventive medicine at the Keck School of Medicine of USC. "This study underscores the importance of studying diverse populations in cancer research."

For the research, scientists turned to the Multiethnic Cohort Study, established in 1993-1996 by USC and the University of Hawaii to investigate patterns in cancer incidence. The study includes more than 215,000 people recruited from Los Angeles County and Hawaii. The main ethnic groups represented are European American, African American, Latino American, Japanese American and Native Hawaiian.

Participants completed self-administered questionnaires, which included information on demographics, medical conditions, family history of cancer and lifestyle factors. Individuals were excluded if they had a prior pancreatic cancer diagnosis or were missing information integral to the study.

The resulting group numbered 184,559 individuals: 100,969 females and 83,590 males. The largest racial/ethnic group was Japanese Americans (29%), followed by European Americans (25.1%), Latino Americans (22%), African Americans (16.7%) and Native Hawaiians (7.3%).

There were 1,532 cases of pancreatic cancer over an average follow-up period of 16.9 years. The researchers took into account family history of pancreatic cancer, diabetes, smoking, body mass index, alcohol and red meat consumption. They said 20% of the cases could be attributed to smoking, obesity and red meat intake.

The study doesn't answer why certain groups are more at risk but it did make a number of observations about risk factors, including:

•Family history of pancreatic cancer was slightly more prevalent in Japanese Americans.
•Native Hawaiians and African Americans were more likely to be current smokers.
•Diabetes mellitus was more common in African Americans, Latino Americans and Native Hawaiians.
•Red meat intake was highest among African Americans, Latino Americans and Native Hawaiians.


"Our results show that African Americans are not the only minority populations with increased risk of pancreatic cancer," Setiawan said. She added that Latinos and whites are at similar risk.

Approximately 56,770 people -- roughly 12.9 per 100,000 people -- will be diagnosed with pancreatic cancer in the United States in 2019, according to the National Cancer Institute. There are no symptoms in the early stages; it is often detected late and has a poor prognosis.

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Diabetes drug alleviates anxiety in mice

Findings could have implications for patients with metabolic and mental disorders

Society for Neuroscience


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IMAGE: This is a model underpinning the effects of metformin on depressive symptoms in mice fed a HFD. view more 

Credit: Zemdegs et al., JNeurosci (2019)

The antidiabetic medication metformin reduces anxiety-like behaviors in male mice by increasing serotonin availability in the brain, according to a study published in JNeurosci. These findings could have implications for the treatment of patients with both metabolic and mental disorders.

People with diabetes have an increased risk for mood disorders such as depression. Although the mechanisms underlying the relationship between insulin resistance -- the precursor to diabetes -- and depression are not known, studies suggest the neurotransmitter serotonin may be the culprit.

In mice raised on a high fat diet, Bruno Guiard and colleagues demonstrate that the insulin-sensitizing drug metformin reduces levels of amino acids that impair the entry of tryptophan in the brain and thereby limit its conversion into serotonin. The drug's antidepressant-like effects were accompanied by improved neurotransmission in the hippocampus. The researchers achieved similar effects by reducing the amount of so-called branched chained amino acids in the diet.

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Manuscript title: Metformin promotes anxiolytic and antidepressant-like responses in insulin-resistant mice by decreasing circulating branched-chain amino acids

Please contact media@sfn.org for full-text PDF and to join SfN's journals media list.

About JNeurosci

JNeurosci, the Society for Neuroscience's first journal, was launched in 1981 as a means to communicate the findings of the highest quality neuroscience research to the growing field. Today, the journal remains committed to publishing cutting-edge neuroscience that will have an immediate and lasting scientific impact, while responding to authors' changing publishing needs, representing breadth of the field and diversity in authorship.

About The Society for Neuroscience

The Society for Neuroscience is the world's largest organization of scientists and physicians devoted to understanding the brain and nervous system. The nonprofit organization, founded in 1969, now has nearly 37,000 members in more than 90 countries and over 130 chapters worldwide.

Researchers restore beta-cell function by deleting old cells

Acceleration of beta-cell aging determines diabetes -- senolysis improves disease outcomes

Joslin Diabetes Center


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VIDEO: Cristina Aguayo-Mazzucato, MD, PhD, explains her research into the application of senolysis to the rejuvenation of beta-cell function in type 2 diabetes. view more 

Credit: Joslin Communications Office


BOSTON - (May 30, 2019) --Research from Joslin Diabetes Center has shown in mice that insulin resistance increases the proportion of aged beta-cells which are dysfunction. Such an increase in aged beta-cells could lead to type 2 diabetes. These researchers confirmed similarly increased proportion of aged beta-cells in islets recovered from humans with type 2 diabetes. The study also showed that beta cell function can be recovered by removing these aged populations either via genetic modification or oral medication.

"Our hypothesis was that there was an important component in the development of diabetes which consisted of accelerated aging of beta-cells and that this population could be targeted therapeutically," says Cristina Aguayo-Mazzucato, MD, PhD, Assistant Investigator in the Section on Islet Cell and Regenerative Biology, first author on the paper, recently published in Cell Metabolism.

This research falls into a broader field of the study of senescence. Senescence is the slow decline of proliferation and function of a specific cell population. These cells accumulate as organisms grow older, but certain circumstances can cause some cells in an organism to age faster than the whole.

The research team, led by Dr. Aguayo-Mazzucato, generated animal models of insulin resistance and tracked the proportion of senescent beta-cells.

"What we found is that indeed, insulin resistance was increasing the amount of senescent or old beta-cells," she says.

Next, they deleted the aged cells through either genetic manipulation or medications that are known to remove senescent cells. The results were striking.

"We were able to recover beta cell function, we were able to restore glucose tolerance," says Dr. Aguayo-Mazzucato

The ability to restore beta cell function with minimal intervention could be a game changer in the care of type 2 diabetes. For many people with the disease, beta cell function declines to the point where they need injectable insulin. Should this research be borne out in clinic trials, the implications for treatment could be huge.

"When you look at the absolute percentage or quantity of the senescent beta-cells, they rarely exceed 20 percent of the whole beta cell population and yet targeting this relatively minor population had a huge effect on function and glucose metabolism and cellular identity," she says.

Medications to delete senescent cells , termed senolytics, are still under investigation. Dr. Aguayo-Mazzucato and her team hope to bring a potential treatment closer to the clinic by partnering with companies that are already working on senolytics, to test if their medications would work for people with diabetes.

"This opens a new target to treat diabetes which is basically to target populations of old or senescent cells that are really contributing to the local disfunction," she says.

Senolysis, or the removal of aged or dysfunctional cells, is a growing field in the treatment of age-related diseases. This new research fits into the larger picture of how senolytics could help combat many different diseases of aging, leading to better quality of life.

"In fact, it's a very exciting and rapidly growing field in medicine, which is called Senolytics or Senolysis," says Dr. Aguayo-Mazzucato. "It has promises, as shown by other laboratories, in osteoarthritis, muscle frailty or degeneration, renal function, some brain function."

While the work was completed in models of type 2 diabetes, the findings could also be relevant in type 1 diabetes.

"What we're seeing is that senescence is, in reality, a response to stress. In the case of type two diabetes, this stress is insulin resistance. In the case of type one diabetes, it is the immune attack on beta-cells," she says. "But in both models, beta-cells are responding to these stresses by becoming senescent. So, we think that the potential of this new vision of preventing diabetes will be valid for both type one and type two."

Intelligent algorithms for genome research

New repository 'Kipoi' improves access to machine learning models

Technical University of Munich (TUM)


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Although the importance of machine learning methods in genome research has grown steadily in recent years, researchers have often had to resort to using obsolete software. Scientists in clinical research often did not have access to the most recent models. This will change with the new free open access repository: Kipoi enables an easy exchange of machine learning models in the field of genome research. The repository was created by Julien Gagneur, Assistant Professor of Computational Biology at the TUM, in collaboration with researchers from the University of Cambridge, Stanford University, the European Bioinformatics Institute (EMBL-EBI) and the European Molecular Biology Laboratory (EMBL).

Trained models freely available

"What makes Kipoi special is that it provides free access to machine learning models that have already been trained," says Julien Gagneur. "What we are doing with Kipoi is not just sharing data and software, but sharing models and algorithms that are already trained on the most relevant data. These models are ready to use, because all the cumbersome work of applying them to data has already been done," says Anshul Kundaje, Assistant Professor at Stanford. More than 2,000 trained models are currently freely accessible on Kipoi. In a recent study published in Nature Biotechnology, the researchers show that the new repository will accelerate exchange in the genomics community and thereby advance genome research.

Fast algorithms and easy operation

Because Kipoi simplifies access to already trained models, researchers can perform transfer learning. This means that a model that has already been trained with a particular dataset is capable of learning a similar task faster. Kipoi also simplifies the process of feeding data into the models stored there: Standardized file formats and software frameworks reduce the installation and execution of a model to three simple commands. Those who previously had no experience in machine learning can thus also easily use the repository.

Understanding individual genomes

As Kipoi is oriented towards models that link genotype and phenotype, the new platform will make it easier to identify genetic causes of disease: "Kipoi puts the latest deep learning models trained on massive genomics data at the fingertips of clinical researchers," says Julien Gagneur. "This provides very exciting opportunities to understand individual genomes, for instance to pinpoint genetic variants causing diseases or to interpret mutations occurring in tumors."

However, the extent of the platform's contribution to genomic research will also depend on the genomics community. "We hope that in the future more researchers will bring their models to our repository," says Oliver Stegle, team leader at the EMBL-EBI. "That is the only way we can make genomics analysis accessible and ultimalely make a wider range of predictive machine learning tools available to the genomics community

Bariatric surgery can be safe and effective for adolescents


Pediatricians are often reluctant to recommend bariatric surgery for teen-agers, but a Rutgers-led study concludes it is a justifiable treatment for adolescents with persistent extreme obesity if they can maintain a healthy lifestyle afterward.

The researchers reviewed studies on bariatric surgery in adolescents and adults in their report in The Journal of Pediatrics.

"If we look at obesity as a disease with the real possibility of eventual organ system failure and special health concerns for adolescents, we need to ask whether health care practitioners are doing enough to manage it," said lead author Ahmed Khattab, a physician at Rutgers Robert Wood Johnson Medical School's Division of Pediatric Endocrinology. "The objective evidence shows that, under the right circumstances and with the right patients, bariatric surgery is an effective treatment for adolescents with obesity."

The findings are consistent with those of a separate study, published May 16 in the New England Journal of Medicine.

Obesity and its related conditions, including hypertension, cardiovascular disease and type 2 diabetes, are increasing worldwide in adults and children, according to the study. Excess weight and obesity in adolescents cost more than $14 billion per year. Meanwhile, type 2 diabetes causes more severe insulin deficiency and other complications in youths than in adults and the steps being taken to avoid obesity or prevent its complications are often ineffective.

Although bariatric surgery requires lifelong follow-up and monitoring of nutritional deficiencies, it is considered effective for severe obesity in adults, leading to long-term improvement or remission in obesity-related diabetes and other disorders, sustained weight loss and an improved quality of life.

Studies of bariatric surgery in adolescents, although scarce, show it is associated with remission of type 2 diabetes, abnormal kidney function and other complications of obesity, and that resulting nutritional deficiencies can be corrected with dietary supplements.

When considering bariatric surgery for teenagers, the researchers recommend pediatricians follow the guidelines published by the Endocrine Society. They recommend the procedure only for patients who have neared the end of puberty and are close to their final adult height; who have extreme obesity and related complications that persist despite the patient's compliance with a formal program of lifestyle modification; and who demonstrate the ability to follow a regimen of healthy eating and living habits.

The researchers also follow the Endocrine Society in saying bariatric surgery is not recommended for patients who have not mastered healthy eating and living habits or who have unresolved substance abuse, eating or psychiatric disorders

Stiffening arteries in teenagers with persistent obesity


University of Gothenburg


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IMAGE: Frida Dangardt, first author, Associate Professor in Clinical Physiology at Sahlgrenska Academy, University of Gothenburg, and a doctor at Queen Silvia Children's Hospital, part of Sahlgrenska University Hospital in Gothenburg,... view more 

Credit: Photo by Johan Wingborg

Children and adolescents with long-term obesity have increased arterial stiffness by their late teens, a study of more than 3,000 children followed from age 9 to 17 shows. These results, in the researchers' view, call for more initiatives to reduce teenage obesity.

"The teens are a key period for measures to tackle obesity, since doing so then brings better health in the long term," states Frida Dangardt, the first author of the article. She is Associate Professor in Clinical Physiology at Sahlgrenska Academy, University of Gothenburg, and a doctor at Queen Silvia Children's Hospital, part of Sahlgrenska University Hospital in Gothenburg, Sweden.

The study, published in The Lancet Child & Adolescent Health, covers 3,423 children whose body composition was measured at ages 9, 11, 13, 15 and 17. The method used was DEXA (dual energy X-ray absorptiometry) scanning for whole-body measurement with weak X-rays. DEXA scans yield clear figures on fat, muscle and bone proportions in the body.

Assessing obesity in a population of children and adolescents through puberty is otherwise difficult. Using Body Mass Index (BMI) as a measuring method is complicated by children's increasing muscle mass and rapid growth spurts.

In the study, the scientists investigated whether blood vessels, too, were affected by other risk factors for cardiovascular disease, such as high blood pressure, high blood lipid (fat) levels and high blood sugar. These factors were associated to some extent with increased arterial stiffness at age 17, but mainly for those who had obesity.

"We've been able to demonstrate that fat mass as such is what is most strongly associated with arterial stiffness, but that inferior metabolic health boosts this effect," says Frida Dangardt.

Stiffness in the arteries, which is gauged by measuring pulse-wave velocity, is a clear sign of atherosclerosis. In adults, it entails elevated risks of heart attack, stroke and death from cardiovascular disease.

However, the study showed that it is possible to influence arterial stiffness. The children and adolescents who normalized their fat mass also attained normal arterial resilience -- a key result for future research on weight-loss programs.

"The fact that we can see, already in the teenage years, that a decrease in fat mass brings about a normalization of the arterial stiffness is positive, since it shows we can do something about this risk," says Frida Dangardt.

The DEXA scanning measurement method is emphasized as a key factor in the context. The study makes it clear that this method is considerably more reliable than BMI for studying obesity trends in childhood and adolescence.

High sugar levels during pregnancy could lead to childhood obesity

Audio interviews available

University of Tennessee at Knoxville


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AUDIO: Samantha Ehrlich, professor of public health at the University of Tennessee, explains how gestational diabetes can increase the risk of early childhood obesity. view more 

Credit: University of Tennessee

The children of women who have high glucose blood levels during pregnancy, even if their mothers are not diagnosed with gestational diabetes, are at an increased risk of developing obesity in childhood, according to a new study published in PLOS One.

The study was coauthored by Samantha Ehrlich, professor of public health at the University of Tennessee, Knoxville and fellow researchers at Kaiser Permanente Northern California.

For the research, scientists analyzed the data of more than 40,000 pregnant women who delivered babies between 1995 and 2004 in the Kaiser Permanente Northern California health care system. They also considered the data of the children, whom they followed until 5 to 7 years of age.

In the United States, pregnant women get a blood glucose screening test between weeks 24 and 28. If the test shows elevated blood glucose levels, an additional test is then done to determine whether the woman has gestational diabetes mellitus, or GDM.

However, Ehrlich and team found that once elevated levels of blood glucose are found on the screening test, even if the blood glucose is not elevated enough for a diagnosis of gestational diabetes, the children are at higher risk of developing obesity between 5 to 7 years of age. In this scenario, the risk increases by 13 percent when compared to women with normal blood glucose levels on the screening test.

"And if the woman is indeed diagnosed with gestational diabetes, the risk of the child developing obesity increases by 52 percent," according to Ehrlich.

Additionally, researchers also found that if the mother has a normal body mass index (BMI), elevated blood glucose levels during pregnancy were no longer associated with the development of childhood obesity.

"This information is important because it suggests that we may be able to prevent childhood obesity in two ways: by helping mothers to achieve a normal BMI before they become pregnant, and by reducing hyperglycemia during the pregnancy," Ehrlich said.

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News Release 3-Jun-2019

Brush your teeth -- postpone Alzheimer's

You don't only avoid holes in your teeth by keeping good oral hygiene, Norwegian researchers have discovered a clear connection between gum disease and Alzheimer's disease

The University of Bergen


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IMAGE: For several years, Piotr Mydel has done research investigating how different bacteria are implicated in Alzheimer's disease. view more 

Credit: Kim E. Andreassen

The researchers have determined that gum disease (gingivitis) plays a decisive role in whether a person developes Alzheimer´s or not.

"We discovered DNA-based proof that the bacteria causing gingivitis can move from the mouth to the brain," says researcher Piotr Mydel at Broegelmanns Research Laboratory, Department of Clinical Science, University of Bergen (UiB).

The bacteria produces a protein that destroys nerve cells in the brain, which in turn leads to loss of memory and ultimately, Alzheimer´s.

Brush your teeth for better memory

Mydel points out that the bacteria is not causing Alzheimer´s alone, but the presence of these bacteria raise the risk for developing the disease substantially and are also implicated in a more rapid progression of the disease. However, the good news is that this study shows that there are some things you can do yourself to slow down Alzheimer´s.

"Brush your teeth and use floss". Mydel adds that it is important, if you have established gingivitis and have Alzheimer´s in your family, to go to your dentist regularly and clean your teeth properly.

New medicine being developed

Researchers have previously discovered that the bacteria causing gingivitis can move from the mouth to the brain where theharmful enzymes they excrete can destroy the nerve cells in the brain. Now, for the first time, Mydel has DNA-evidence for this process from human brains. Mydel and his colleagues examined 53 persons with Alzheimer´s and discovered the enzyme in 96 per cent of the cases.According to Mydel, this knowledge gives researchers a possible new approach for attacking Alzheimer´s disease.

"We have managed to develop a drug that blocks the harmful enzymes from the bacteria, postponing the development of Alzheimer´s. We are planning to test this drug later this year, says Piotr Mydel.

Facts: Gingivitis

•The bacteria Porphyromonas gingivalis (P.gingivalis) is one of the main causes to infection in the gums.
•The bacteria causes chronic infection in the gums, but can move to the brain where it can damage nerve cells in the brain.
•Circa 50 per cent of the population have this bacteria in one or another form.
•Circa 10 per cent of the ones having this bacteria will develop serious gum disease, loose teeth, and have an increased risk of developing Alzheimer´s disease.
•In addition to Alzheimers, the bacteria is linked to rheumatism, COPD and esophageal cancer.

Dartmouth study reveals how ACOs use home visits to improve care and reduce hospital use


The Dartmouth Institute for Health Policy & Clinical Practice


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A new Dartmouth-led study, published this week in the June issue of Health Affairs, offers new details about how one key approach--home visits--is helping many ACOs improve care management and identify patient needs while aiming to reduce hospital use. The study was part of a broader set of research based at Dartmouth focused on how ACOs care for patients with complex clinical and social needs.

ACOs--groups of physicians, hospitals, and other healthcare providers who voluntarily form partnerships and agree to take responsibility for meeting certain quality and total costs of care measures--may employ a variety of strategies, approaches, and processes to meet their goals. Over the past decade, they have played an increasingly prominent role in efforts to reform the American healthcare system.

"We focused on ACOs because we felt that their responsibility for total costs of care might motivate them to implement care delivery innovations that otherwise might be too resource-intensive," explains lead author Taressa Fraze, PhD, a research scientist at The Dartmouth Institute for Health Policy and Clinical Practice.

The researchers used national survey data from physician practices and ACOs, paired with qualitative interviews with 18 ACOs across the country to learn more about home-visiting programs.

They found that the majority of ACOs believed that home visits were valuable--80 percent reported using home visits within 72 hours of post-discharge for at least some of their patients. These ACOs were more likely to be larger and part of a system, including a hospital, and to participate in risk-bearing contracts or other payment reforms. They also found that physician practices with ACO contracts were more likely to report using home visits for care transition than non-ACO practices.

Home visits were typically embedded as part of a larger care management, care transition, or disease management program. "ACOs used home visits much more broadly than we might have expected, and they were usually conducted by a care management team member rather than a clinician," says Fraze, who is presenting the study's findings this week in Washington, DC, as part of a national panel discussion on community care for high-needs patients.

"These visits were not focused on providing clinical care," she emphasizes. "At their heart, they were essentially a fact-finding mission--described by several ACOs as providing 'eyes in the home.'"

The three most commonly reported activities during home visits were: needs assessments, which included inspecting the patient's home; medication reconciliation; and identifying patient barriers to managing their health. These activities provided staff members with an opportunity to coach patients on how to manage their health needs.

Interestingly, the researchers also found that home visits functioned similarly across different patient cohorts--patients who were post-discharge, for example, had similar home visits as those with social risks or specific chronic conditions.

"One of the things that was quite unique about ACOs, and that we really didn't expect, was that several used home visits as a way to locate patients, such as those who might have missed their primary care appointment, were unresponsive, or if the ACO was concerned that the patient might be at especially high risk for costly utilization," Fraze says.

However, despite the value perceived in home visits, ACOs continued to face challenges such as reimbursement, staffing capacity, and the inability to address observed patient needs.

"Our findings that larger and system-based ACOs were more likely to implement resource-intensive home visits creates concerns about the ability of smaller, independent practices and organizations to use home visits as a tool to engage patients and discover barriers to improved care," she says. "These organizations may need further financial or logistical support to implement home visits."

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Facial bones of black adults age differently than other races, Rutgers study finds

Study has implications for cosmetic surgery, which black individuals seek twice as often as white


Facial bones in black adults maintain higher mineral density as they age than other races, resulting in fewer changes to their facial structure, a Rutgers study finds.

The study, published in JAMA Facial Plastic Surgery, is the first to document how facial bones change as black adults age. The findings suggest significant differences in how facial bones age across races, which can affect how plastic surgeons approach facial rejuvenation. About 16 percent of black adults seek cosmetic procedures -- double that of whites.

"It is important for plastic surgeons to understand how the facial aging process differs among racial and ethnic groups to provide the best treatment," said study lead author Boris Paskhover, an assistant professor at Rutgers New Jersey Medical School's Department of Otolaryngology, who specializes in facial plastic and reconstructive surgery.

How a face ages is determined by a combination of changes to the skin, muscle, fat and bones that naturally occur as people grow older. However, most facial rejuvenation procedures historically have focused on the soft tissue, using treatments like face-lifts and injectable fillers.

"As bones change, they affect the soft tissue around them, resulting in perceived decreases in facial volume," Paskhover said. "Treatment should consider the underlying bone structure."

As people grow older, they can lose bone mineral density, which results in bone loss. In the face, this loss can affect the shape of the nose, lower jowl area, cheekbones and middle and lower areas of the eye sockets.

To understand how facial bones age in black adults, researchers analyzed medical records from 1973 and 2017 of 20 black patients -- 14 women and six men between ages 40 and 55 -- who had at least two facial computed tomographic (CT) images taken on average a decade apart without any surgical intervention and self-reported as being black. While the comparative images showed a significant change in the facial bones over time in the black patients, these changes were minor compared to similar studies on the aging white population.

"This finding reflects other studies that show black adults have higher bone mineral density, decreased rates of bone loss and lower rates of osteoporosis as compared to the general population," Paskhover said.

Previous studies on how facial bones age have ignored race or were limited to whites, and studies on ethnic groups focused on the differences in skin composition rather than bone changes, he said.

"These other studies have shown that the Caucasian population saw more significant bone changes over a decade, especially in the lower forehead and upper jawbone, than the black group in this study, Paskhover said. "Since this population may experience less mid-facial bone loss than whites, it suggests that bony volume loss may not contribute as much to the aging face appearance."

Researchers identify link between more frequent, intense heat events and deaths in Las Vegas


Desert Research Institute


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IMAGE: Heat Index (HI) and Excess Heat Factor (EHF) are metrics that go beyond just temperature to also account for the human body's response to heat. This study found that rising... view more 

Credit: DRI

Over the last several decades, extreme heat events around the world--particularly in the American Southwest--have gotten hotter, occurred more frequently, and lasted longer. These trends pose significant health risks to the growing number of people making cities like Las Vegas home.

A new study by scientists at the Desert Research Institute (DRI), Nevada State College, Universidad de Las Americas Puebla, and several undergraduates from Nevada State College traces the relationship between extreme heat and mortality rates, identifying a clear correlation between heat wave episodes and heat-related deaths in Las Vegas over the last ten years.

"Current climate change projections show an increased likelihood of extreme temperature events in the Las Vegas area over the next several years," explained Erick Bandala, Ph.D., an assistant research professor at DRI and lead author on the study. "Understanding recent extreme heat trends and their relationship to health hazards is essential to protecting vulnerable populations from risk in the future."

Urban areas of the Southwest are of particular concern because several factors compound the health-related risks of extreme heat events. The heat-absorbing properties of common materials like asphalt exacerbate already high temperatures in cities (called the urban heat island effect), particularly at night. What's more, populations in cities like Las Vegas are growing rapidly, especially among those 55 and older, which means that more and more people are exposed to risk.

In this study, the research team analyzed two measures of extreme heat--heat index and excess heat factor--for the Las Vegas metropolitan area in the June, July, and August months from 2007 to 2016. Heat index (HI) accounts for how the human body reacts to surface temperature and relative humidity. Excess heat factor measures (EHF) heat wave intensity in relation to historic temperature trends to account for how acclimated the public is to a given temperature threshold. Because both HI and EHF incorporate the human body's response to extreme heat, they are ideal metrics for assessing public health impacts, and both were shown to rise over the study period.

The annual average of severe heat events per year in Las Vegas also showed significant increases in this study, from an average of 3.3 events per year from 2007-2009 to 4.7 per year in the 2010-2016 period. These findings match historic trends, which show a steady increase in the severity and frequency of excess heat in Las Vegas since 1980.

Strikingly, the number of heat-related deaths in Las Vegas map onto these trends: as heat wave intensity increases, the number of heat-related deaths does, too.

"From 2007 to 2016, there have been 437 heat-related deaths in Las Vegas, with the greatest number of those deaths occurring in 2016," explained Bandala. "Interestingly, 2016 also shows one of the highest heat index measures over the last 35 years. This shows a clear relationship between increasingly intense heat events in our area and public health effects."

Bandala's team found that the subpopulation, particularly at risk of heat-related deaths, is adults over 50 years old--76% of the heat-related deaths in the study period were individuals in this subpopulation. Of the deaths in this group, almost all individuals also showed evidence of pre-existing heart disease. Researchers note that these findings are highly significant given that the population of adults over 50 in Las Vegas is increasing, with more retirees choosing Clark County as a retirement destination.

Only 23% of heat-related deaths occurred in the subpopulation of adults aged 20 to 50 years; interestingly, the most common pre-existing condition for this group was drug and alcohol use. More research is needed to understand how heat is impacting this segment of the population, Bandala noted, because though the number of deaths in this group is comparatively smaller, it is still nearly one-quarter of heat-related deaths in the Las Vegas Valley. Additionally, this subpopulation includes economically active adults.

With more intense, more frequent, and longer lasting heat events projected in the coming years, the research team hopes that the trends identified in this study can assist local decision-makers in taking steps to protect the most vulnerable groups in Las Vegas.

"This research helps us better understand the connection between the climate changes we've experienced in Las Vegas and their impact to public health over the last 35 years," Bandala said. "Ideally, this data analysis will help our community adapt to the changes yet to come."

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Limiting warming to 2 degrees C will require emission cuts across entire food system

Feeding 10 billion people and keeping Earth from overheating this century require not only major changes to agriculture, but transformation of the entire food system, according to a new review

International Center for Tropical Agriculture (CIAT)


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IMAGE: A food market in Nicaragua. view more 

Credit: Adriana Varón / CIAT


Agriculture and the food system have long been challenging subjects for climate negotiators at the United Nations' annual gathering to advance the global agenda on climate change. Issues related to mitigation, fiscal responsibility, subsidies, food sovereignty, cultural identity and national agriculture-based economies have long made the topics taboo, says Ana María Loboguerrero, the head of Global Policy Research of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), led by the International Center for Tropical Agriculture (CIAT).

Better understanding agriculture and the food system's unique place in climate change - as both drivers of climate change and victims of it - is helping to increase support for climate action. Unfortunately, progress across the food system is lagging, according to a new analysis published in Sustainability by Loboguerrero and CCAFS colleagues. To change this, the researchers are calling for climate change adaptation and mitigation strategies for agriculture to extend to the entire food system.

"If you think about the two-degree increase, efforts need to go beyond the agricultural sector," said Loboguerrero. "This means reducing emissions by stopping deforestation, decreasing food loss and waste, reducing supply chain emissions, and rethinking human diets, if we really want to get on track to that target."

Agriculture is typically lumped together with forestry and land-use to account for about 25 percent of global greenhouse gas emissions. On its own, agriculture accounts for about 10-12 percent of all emissions. But up to one-third of food produced is wasted between the farm and the table. This accounts for another 8 percent of global emissions, and if just 25 percent of this waste could be saved, it would be enough to feed 870 million people a year.

The review found that adoption of emission-reducing practices in agriculture is slow. Even under the most optimistic uptake scenarios, studies have shown that by 2030 these practices will only contribute 21-40 percent of a one-gigaton reduction in carbon dioxide (CO2) emissions, which would be about 1 percent of current annual CO2 emissions. On the other hand, food waste reduction presents such an important opportunity for reducing emissions intensity. Across regions, agricultural production wastes about one-third of food in the production stage. In rich countries, most of the loss comes in the consumption stage.

"Food loss and waste is a big opportunity," Loboguerrero said. "Addressing this issue can reduce emissions intensity, potentially improve global nutrition and boost the bottom line for smallholders, who are hardest hit by losses on the farm."

Another challenge in bringing down emissions from agriculture is the projected growth of meat and dairy production. By 2000, the sector contributed an estimated 18 percent of all human-caused greenhouse gas emissions, when accounting for related deforestation and land-use change as well. Given current trends in population growth and meat consumption, the sector could account for about a quarter of all emissions by 2050.

"Reducing meat and dairy emissions needs to be a priority," said Lini Wollenberg, Flagship Leader of CCAFS' low-emissions development research. "And the good news is that we have lots of options in the pipeline, ranging from low-emissions cattle to meat alternatives. We need more research and development to make some of these options a reality."

Planned migration and other hard discussions

The review analyzes some 160 papers across global agriculture and food systems, but focuses primarily on smallholder farming and food supply chains, which sustain as many as 2.5 billion people. Small holders contribute about one-third of global agriculture emissions (or about 3-4 percent of the global total) but smallholders are disproportionately exposed to climate risk.

Many farmers can adapt, provided access to the proper tools. These include technology that can help increase smallholders' access to climate information and markets, insurance schemes that can reduce risk of crop loss, government support including social safety nets, and the implementation of climate-smart agriculture (which seeks to increase smallholder productivity, help farms adapt to climate change and reduce their contribution to climate change).

But desertification, sea-level rise, soil degradation, and other inevitable changes have placed hundreds of millions of people on an irreversible track to migration, even if rapid global action is taken on climate.

"There are some farmers that shouldn't do agriculture at all due to already precarious conditions that do not allow them to ensure a meaningful livelihood, and with climate change, it is going to make it worse," Loboguerrero said. "If that migration is going to happen anyway, then policymakers and planners need to really start thinking about this and how they can work with these migrants to help them find better livelihoods where they migrate."

Back at the negotiation table, Loboguerrero says adaptation - learning to cope with the problem - is a far easier sell than mitigation - reducing emissions - which is often seen as constraining farming options and increasing costs. This is the case for some economies that depend heavily on agriculture. In the long term however, the costs of adaptation will possibly be larger, and reducing emissions now will help reduce the need to adapt.

"There is a lot of tension and you can see it when you go into the negotiations. Some countries don't even want to begin discussions on the mitigation side of things," Loboguerrero said. "Adaptation is something that everyone, however, agrees is necessary. Everyone is keen on discussing adaptation. Some adaptation measures have the co-benefit for mitigation. It's like an entrance to discussing some things at some points that are a little bit taboo in the negotiations."

A combination of insecticides and mite weakens honeybees


University of Bern


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IMAGE: A Varroa destructor mite on the thorax of an experimental Western honeybee, Apis mellifera. view more 

Credit: Geoffrey R. Williams


The Western honeybee is the most important managed pollinator globally and has recently experienced unsustainably high colony losses in many regions of the world. Synergistic interactions among stressors are believed to be primarily responsible. Despite the clear negative impact of certain neonicotinoids and the ubiquitous ectoparasitic mite Varroa destructor on exposed honeybees, no data existed to show synergistic effects between these two stressors.

Current data that was collected at the University of Bern and Agroscope, in cooperation with the Auburn University (USA) and Chiang Mai University (Thailand), suggest a novel possible previously overlooked mechanism for recent unsustainably high losses of managed honeybee colonies. The results were published in "Scientific Reports", an Open-Access Journal of "Nature". According to the authors, the study underlines the importance of developing sustainable agro-ecosystem management schemes that incorporate reduced used of neonicotinoids and sustainable solutions for V. destructor mites.

A negative combination

Two stressors having a clear negative impact on the health of honeybees are insecticides and the ubiquitous ectoparasitic mite Varroa destructor. These mites originated from Asia, and have switched hosts from Eastern honeybees Apis cerana to Western honeybees Apis mellifera to become the most serious biotic threat to Western honeybees globally. Similarly, there is evidence for negative impact of widely used neonicotinoid insecticides. However, no data existed so far to show synergistic effects between these two stressors.

In the present work, honeybee colonies exposed to two neonicotinoids (thiamethoxam and clothianidin) via pollen paste feeding, did not affect honeybee worker mass or longevity. However, when in combination with V. destructor infestation, a synergistic negative effect was observed. Whilst a negative synergism was observed for body mass in both summer and autumn, it was only observed for survival 16 weeks post neonicotinoid colony exposure. The revealed results suggest a previously overlooked time-lag effect of neonicotinoid exposure. Because honeybee colonies in temperate regions must produce significant quantities of long-living winter bees to survive, the observed negative synergistic effects on individual winter honeybee longevity are most likely compromising colony survivorship.

Sustainable solutions required

"Beekeepers in many regions of the world face losses of their colonies, which are far too high", says Prof. Peter Neumann of the Institute of Bee Health at the University of Bern, co-author and president of COLOSS. Due to the present evidence for interactions between insecticides and mites, the authors stress the importance of developing sustainable agro-ecosystem management and varroa-management schemes. "Reduced usage of insecticides and sustainable solutions for V. destructor mites in agriculture and beekeeping are urgently required", adds Dr. Lars Straub, first author and Post-Doc at the Institute of Bee Health

Should STEMI patients recover in the ICU?


Michigan Medicine - University of Michigan


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IMAGE: Providers need more clear guidance on whether a patient who has suffered from STEMI heart attack should recover in the intensive care unit, a new University of Michigan study in... view more 

Credit: Michigan Medicine

A trip to an intensive care unit can be more than twice as costly as a stay in a non-ICU hospital room, but a new study finds intensive care is still the right option for some vulnerable patients after a severe heart attack.

The difficulty lies in determining which people are best served in the ICU while they recover.

The new Michigan Medicine (University of Michigan) research, published in The BMJ, found ICU admission was associated with improved 30-day mortality rates for patients who had a STEMI heart attack and weren't clearly indicated for an ICU or non-ICU unit.

"For these patients who could reasonably be cared for in either place, ICU admission was beneficial," says lead author Thomas Valley, M.D., M.Sc., an assistant professor of internal medicine at Michigan Medicine, who cares for patients in the intensive care unit.

But Valley cautions against simply continuing to send nearly everyone to the ICU.

"ICU care is a treatment just like any medication," Valley says. "Providers need to know whether it's right for an individual person just like we try to do with a prescription drug."

The researchers analyzed Medicare data from more than 100,000 patients hospitalized with STEMI, or ST-elevation myocardial infarction, a dangerous heart attack that requires quick opening of the blocked blood vessel to restore blood flow. Those patients were hospitalized at 1,727 acute care hospitals across the U.S. in a nearly two-year period from January 2014 to October 2015, and most were sent to the ICU after treatment.

"A lot of the focus is on getting these people to the cardiac catheterization lab as soon as possible to open up the blood vessel, but less is known about what you do after that," Valley says.

Current U.S. guidelines don't address whether to send patients to the ICU, while European guidelines recommend the ICU.

Valley says providers could use more clear guidance on how to make these decisions.

In this study, the mortality rate was 6.1% lower after 30 days for those admitted to their hospital's ICU. Valley says the surprising results--in the face of other studies that show ICU overuse--demonstrate that ICU care is misdirected.

'An important debate in cardiology'

This study addresses an important issue in ICU care, says Michael Thomas, M.D., an assistant professor of internal medicine who runs the Cardiac ICU at Michigan Medicine's Cardiovascular Center.

"At Michigan Medicine, all of our STEMI patients are admitted to the Cardiac ICU," says Thomas, who was not involved with the BMJ paper. "However, knowing where to send these patients after STEMI is an important debate in cardiology right now."

"Some recent studies suggest many patients don't need ICU level of care and that it wastes resources. But before we pull back from this model, we need to understand this problem more fully," he says.

Across the nation, 75% of STEMI heart attack patients are sent to the ICU, most of the time after reperfusion treatment in the cath lab to open up the blocked vessel.

ICU vs. non-ICU care

People recovering from a STEMI are some of the very sick patients ICUs were originally designed for, so providers may not even think about disrupting the longtime status quo, Valley says.

"The historical thinking was, 'Why not send everyone to the ICU?' Now, we see that there are risks associated," Valley says. "For example, in the ICU, you're more likely to have a procedure, whether you need it more or not.

"We must also consider the risk of infection, sending someone to a unit full of really sick patients who might have C. diff or other serious infections."

The sleep quality as people are recovering from their heart attacks may also be lower in the ICU, because patients are given such close nursing care, Valley says.

That's necessary for the sickest patients, but it might be disruptive to those people on the bubble who could be getting better rest on a regular floor, he says.

Medicare has requirements for what constitutes ICU care, such as high nurse staffing levels and access to lifesaving care.

"Because of Medicare requirements, ICUs tend to be more similar across hospitals than non-ICUs," Valley says.

"Perhaps some hospitals can take care of patients anywhere, while others really need to use the ICU at high rates in order to provide safe care."

A clear benefit for some, increased cost for others

Valley says these data show a clear benefit of ICU care for vulnerable patients, as opposed to non-STEMI patients studied who did not have a significant difference in mortality rates with or without ICU admission.

"Physicians might look at STEMI patients and wonder, 'Do they really need the ICU? Could it harm them? Is it a good use of resources?'" Valley says.

Valley, a member of U-M's Institute for Healthcare Policy and Innovation, has previously found ICU overuse occurred for less critical patients hospitalized for a flare-up of chronic obstructive pulmonary disease (COPD) or heart failure. In that study, ICU admission dramatically increased cost of care without an increased survival benefit.

The next step, according to Valley, is to determine what is beneficial about the ICU for those patients who benefit from it. He says that could lead to hospitals adopting some ICU care practices on non-ICU floors.

Valley hopes making non-ICU floors more similar to the ICU in some ways could improve outcomes while reducing cost of care and infection risk

Home exercise program reduces rate of falling in at-risk seniors


University of British Columbia


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An in-home exercise program reduced subsequent falls in high-risk seniors by 36 per cent, according the results of a 12-month clinical trial published today in the Journal of the American Medical Association.

The study, conducted by UBC faculty of medicine researchers in partnership with the clinical team at the Falls Prevention Clinic at Vancouver General Hospital, found a reduction in fall rate and a small improvement in cognitive function in seniors who received strength and balance training through the clinical trial.

"When we think about falls we often think about loss of muscle strength and poor balance," said Dr. Teresa Liu-Ambrose, principal investigator at the Vancouver Coastal Health Research Institute and professor in the department of physical therapy at the University of British Columbia. "However, the ability to remain upright and not fall is also dependent on cognitive abilities--calculating how far to lift your foot to get over a curb, making a decision as to when to cross the road, and paying attention to your physical environment while you are having a conversation."

Falls increase risk of injury and loss of independence for older adults. Exercise is a widely recommended fall prevention strategy, but whether it can reduce subsequent falls in those who have previously fallen is not well established.

The study involved 344 adults aged 70 and older who had been referred to the Falls Prevention Clinic following a fall that had resulted in a visit to a medical facility, such as an emergency room. Participants had a history of falls, with an average of three prior falls per person, and generally had symptoms of frailty and limited mobility.

The study had participants perform a set of balance and resistance training exercises in the comfort of their homes, using simple equipment such as free weights, a minimum of three times per week. Over the course of six months, a physical therapist made five home visits to prescribe exercises and ensure that exercises were done properly. For those who completed the program, the results were notable. Participants were less likely to experience repeat falls, and as a secondary benefit, they improved in some markers of cognitive function.

Falls in older adults are the third-leading cause of chronic disability. According to the Public Health Agency of Canada, 20 to 30 per cent of Canadian seniors suffer falls each year, and falls are the leading cause of hospitalization for adults over age 65.

"It is well known that exercise benefits older people in general, but what was special about this study group was that they are at very high risk for losing their independence--they had both mobility and cognitive impairments and another fall may mean the inability to live in their own homes. Many already had difficulty navigating public spaces independently," said Liu-Ambrose, who holds a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience.

"Older adults who experience falls that require medical attention falls are medically complex and at high risk for both morbidity and mortality, and we demonstrated that exercise is a practical and cost-effective intervention that can improve older peoples' outcomes after a significant fall," she added.

Liu-Ambrose and her team at the Centre for Hip Health and Mobility are now looking at whether the exercise program resulted in reduced health care utilization and medical cost savings in this high-risk population.

Study: Cholesterol in eggs tied to cardiac disease, death

UMass Lowell expert stresses moderation, balance in daily diet

University of Massachusetts Lowell


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LOWELL, Mass. - The risk of heart disease and death increases with the number of eggs an individual consumes, according to a UMass Lowell nutrition expert who has studied the issue.

Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects, according to Katherine Tucker, a biomedical and nutritional sciences professor in UMass Lowell's Zuckerberg College of Health Sciences, who co-authored the analysis. The study was published in the Journal of the American Medical Association.

The study results come as egg consumption in the country continues to rise. In 2017, people ate an average of 279 eggs per year, compared with 254 eggs in 2012, according to the U.S. Department of Agriculture.

Current U.S. Dietary Guidelines for Americans do not offer advice on the number of eggs individuals should eat each day. The guidelines, which are updated every five years, do not include this because nutrition experts had begun to believe saturated fats were the driving factor behind high cholesterol levels, rather than eggs, according to Tucker. However, prior to 2015, the guidelines did recommend individuals consume no more than 300 milligrams of cholesterol a day, she said.

One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products.

While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day was associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.

Eating several eggs a week "is reasonable," said Tucker, who noted they include nutrients beneficial to eye and bone health. "But I recommend people avoid eating three-egg omelets every day. Nutrition is all about moderation and balance."

Research results also determined that study participants' exercise regimen and overall diet quality, including the amount and type of fat they consumed, did not change the link between cholesterol in one's diet and risk of cardiovascular disease and death.

"This is a strong study because the modeling adjusted for factors such as the quality of the diet," Tucker said. "Even for people on healthy diets, the harmful effect of higher intake of eggs and cholesterol was consistent."

-Jun-2019

Physical inactivity proved risky for children and pre-teens

Researchers from UNIGE have shown that children lose their motivation to participate in physical activities in PE classes at school from the age of 9

Université de Genève


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Cardio-respiratory capacity in children has dropped by 25% in 20 years, according to a study by the University of Adelaide in Australia. There are multiple reasons for this, from the social environment and the decreasing number of play areas to a more academic approach towards teaching physical education and the spread of new technologies. But at what age do children lose the desire to exercise? Researchers from the University of Geneva (UNIGE), Switzerland, followed 1,200 Geneva pupils, aged 8 to 12, for two years. The team found out that from the age of 9, the positive reasons for exercising - it's fun and good for your health - begin to be replaced by more displaced incentives: to get a good mark or improve your image with others. These results, which are published in the journal Psychology of Sport and Exercise, call for a more detailed analysis of how PE is taught in schools to counter physical inactivity leading to a sedentary lifestyle from an early age.

Society today is characterized by an increasingly sedentary way of life and a decline in physical activity, which is reflected in the growing number of overweight children (16% of children aged 6 to 12 in Switzerland). In an earlier study, UNIGE researchers noted that the recommendations issued by the World Health Organisation (WHO) for the amount of exercise undertaken by school-age children were not being met, namely: children should be active for at least 50% of the time devoted to physical education lessons in primary school. In reality, they move on average only 38% of the time. And as children grow older, the percentage drops. Why?

Positive motivations decline as the child grows older

The UNIGE researchers tracked 1,200 Geneva pupils aged 8 to 12 for two years. The children had to complete a questionnaire every six months to measure their motivation levels according to a seven-point scale based on different motivational controls related (or not) to practising the actual activity: enjoyment, learning, health, grades, satisfying other people, integration, avoiding guilt or shame, and so forth. "Our results showed for the first time that there is a sharp drop in positive motivations for physical activity (with good motivational qualities), such as pleasure or health, over a child's time at primary school from age 9 onwards", explains Julien Chanal, a researcher in the Psychology Section of UNIGE's Faculty of Psychology and Educational Sciences (FPSE). "And we've never observed this decline at such a young age!" On the other hand, motivations considered counterproductive (with poor motivational qualities) - such as undertaking the activity to get a good grade or to send a positive image to one's classmates - increase as a child gets older. "It's true that harmful motivations do also mean that a child is physically active but these motivational qualities are only positive in the short term, which is counter-productive for a child's physical development. In fact, we know that if children are motivated by good reasons when they're young, then they'll remain active when they're adults", continues Chanal. But what can be done to fight against the early decline of positive motivations?

Reforming education to increase physical activity

Given that nine years is a crucial age to establish good, healthy and long term physical activity, the way PE is taught at primary school needs to be analysed, since compulsory education is the only place where every child can be reached. "In recent decades," says Chanal, "PE teaching has changed enormously. Classes are more academic, with children learning about rules, motor functioning, mutual support, etc." But this approach has a direct cost for the child since it reduces the actual time dedicated to moderate to vigorous physical activity, which is already rare outside school.

The UNIGE researchers are now working with the Haute École Pédagogique in the canton of Vaud (HEP Vaud) on teaching physical education in primary classes. The aim is to develop autonomy and cooperation among pupils, and to work on the curriculum, course structure and teacher involvement to help them keep or boost their positive motivations for physical education. "Now that children don't move as much as before outside school, it's vital that the periods earmarked for PE maximize the time they spend moving", adds Chanal. "This is especially the case since, once again, we fall below the standards prescribed by the WHO. Their recommendation is 150 minutes of physical education per week, while students in Geneva only have 135 minutes available, or three periods of 45 minutes each." Teaching physical education has an important role to play in this new global health problem, which affects children at a younger age.

researchers caution against expecting exercise to act as a panacea for humans.

"A very important part of this research is that the mice were not forced to exercise - any physical activity was voluntary. If children are interested, they should be encouraged to do any exercise they want, but this research does not reveal how different activities might affect the brains of children with ASD," said Koyama.

Fitness for the mind

About a decade ago, small trials in children began showing that regular exercise could improve the social difficulties and repetitive behaviors common in ASD. Although many studies investigated how exercise can make large-scale changes to already healthy brains or postpone age-related neurodegeneration, there were no studies on the fine-tuned changes that exercise might make in brains with ASD.

Although the brains of healthy children naturally prune away redundant connections between neurons as they age, a defining feature of the brains of people with ASD is too many connections.

The results from the mouse model study indicate that exercise may somehow activate the brain's normal pruning processes.

"Exercise likely enhanced the contrast between active and inactive neuronal connections so that the weak ones could be more easily targeted for removal," said Koyama.

A gym for mice

ASD model mice display lifelong behaviors of neurodevelopmental difference: They interact less with new mice, they groom themselves repetitively, and they take longer to start eating when in a new environment, a sign of anxiety.

Researchers placed a running wheel in the corner of the ASD model mice's cages so they could run as much as they wished. Mice had access to the wheel from the time they were four weeks old until eight weeks old. Mice are adults at eight weeks old.

"Part of the variability of our data is that we could not give all mice the same amount of exercise. Some mice may have exercised just a little, some may have exercised very intensely," said Koyama.

Despite wide variation between individual mice, overall, ASD model mice that could exercise showed behavior that was similar to healthy mice after just 30 days of access to the running wheel.

Cellular studies for a closer look

Researchers performed additional experiments to look inside the brains of ASD model mice.

Specifically, researchers focused on a structure called mossy fibers in the hippocampus, an area of the brain thought to be important for memory and a source of new neurons (neurogenesis) in adults. Individual neurons can be connected to dozens of mossy fibers sent out by other neurons.

Immune cells called microglia change brain structure by engulfing and digesting less active synapses, which is why they are sometimes referred to as "the brain's garbage collectors."

Researchers used molecular genetics and fluorescent imaging techniques to identify which mossy fibers were most active and saw that microglia spared those active synapses, while removing the less active ones nearby.

Researchers also connected microglia to synaptic pruning in healthy mice. Juvenile mice without ASD were given medication to prevent normal microglia activity. After just five days of medication, researchers detected significant differences in the density of brain synapses between mice whose microglia were inhibited and their unmedicated peers.

Although the causes of ASD are an area of active research, Koyama's research team states that the reversible aspects of ASD and the connection between exercise and microglia should also receive continued attention.

Exercise fine-tunes brain's connections, eases autism spectrum disorder in mouse model


University of Tokyo


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Researchers at the University of Tokyo have studied how exercise can change the structure of mouse brains modeling autism spectrum disorder. Researchers specifically looked at connections between neurons in the... view more 

Credit: Photo by Ryuta Koyama, CC-BY.

A mouse model of autism has revealed how exercise changes the structure of the brain by eliminating the excess connections between neurons characteristic of autism spectrum disorder (ASD). After one month of voluntary running on a wheel, behavioral differences disappeared and structural differences in ASD model mice's brains were reduced.

"Voluntary exercise can be a safe, drug-free way to improve overall health and now we have a better understanding of how exercise can positively change brain structure in ASD," said Associate Professor Ryuta Koyama, who led the research team at the University of Tokyo.

This research study was performed in mice and researchers caution against expecting exercise to act as a panacea for humans.

"A very important part of this research is that the mice were not forced to exercise - any physical activity was voluntary. If children are interested, they should be encouraged to do any exercise they want, but this research does not reveal how different activities might affect the brains of children with ASD," said Koyama.

Fitness for the mind

About a decade ago, small trials in children began showing that regular exercise could improve the social difficulties and repetitive behaviors common in ASD. Although many studies investigated how exercise can make large-scale changes to already healthy brains or postpone age-related neurodegeneration, there were no studies on the fine-tuned changes that exercise might make in brains with ASD.

Although the brains of healthy children naturally prune away redundant connections between neurons as they age, a defining feature of the brains of people with ASD is too many connections.

The results from the mouse model study indicate that exercise may somehow activate the brain's normal pruning processes.

"Exercise likely enhanced the contrast between active and inactive neuronal connections so that the weak ones could be more easily targeted for removal," said Koyama.

A gym for mice

ASD model mice display lifelong behaviors of neurodevelopmental difference: They interact less with new mice, they groom themselves repetitively, and they take longer to start eating when in a new environment, a sign of anxiety.

Researchers placed a running wheel in the corner of the ASD model mice's cages so they could run as much as they wished. Mice had access to the wheel from the time they were four weeks old until eight weeks old. Mice are adults at eight weeks old.

"Part of the variability of our data is that we could not give all mice the same amount of exercise. Some mice may have exercised just a little, some may have exercised very intensely," said Koyama.

Despite wide variation between individual mice, overall, ASD model mice that could exercise showed behavior that was similar to healthy mice after just 30 days of access to the running wheel.

Cellular studies for a closer look

Researchers performed additional experiments to look inside the brains of ASD model mice.

Specifically, researchers focused on a structure called mossy fibers in the hippocampus, an area of the brain thought to be important for memory and a source of new neurons (neurogenesis) in adults. Individual neurons can be connected to dozens of mossy fibers sent out by other neurons.

Immune cells called microglia change brain structure by engulfing and digesting less active synapses, which is why they are sometimes referred to as "the brain's garbage collectors."

Researchers used molecular genetics and fluorescent imaging techniques to identify which mossy fibers were most active and saw that microglia spared those active synapses, while removing the less active ones nearby.

Researchers also connected microglia to synaptic pruning in healthy mice. Juvenile mice without ASD were given medication to prevent normal microglia activity. After just five days of medication, researchers detected significant differences in the density of brain synapses between mice whose microglia were inhibited and their unmedicated peers.

Although the causes of ASD are an area of active research, Koyama's research team states that the reversible aspects of ASD and the connection between exercise and microglia should also receive continued attention.