As Americans are managing life with the Coronavirus, the travel industry is continuing to come back. Hotels and travel destinations in many parts of the country are open in anticipation of travelers ready to throw off their cabin fever and venture out. Your plans may be for a weekend get away to a cozy bed and breakfast, or perhaps a fishing trip to catch that “big one” that won’t get away this time. Maybe it’s a camping trip full of hiking adventures with stunning vistas, or possibly you would rather walk through America’s glorious past by taking in all the amenities offered in any of hundreds of museums. How about a week’s stay at a ranch out west? Whatever your travel desires are, your options are plentiful and, more importantly, clean, safe and following all CDC guidelines for Coronavirus. Each week we will list state by state travel options we recommend to help make your vacation choices easy. ALASKA: MV Discovery Alaska & Canada Yacht Tours – Juneau/Vancouver. ARIZONA: Southern Mesa RV Park – Yuma/Mesa. CALIFORNIA: The Eagle Inn – Santa Barbara. Cupertino Hotel – Cupertino. The Grand Hotel – Sunnyvale. COLORADO: Cliffhouse Lodge – Morrison. FLORIDA: Road Runner Travel Resort – Yuma/Mesa. IDAHO: Pend Oreille Shores Resort – Hope. Vacation IOWA: Squier’s Manor Bed & Breakfast – Maquoketa. MAINE: Penobscot Bay Guide Service – Searsport. MASSACHUSETTS: Gull Cottage – Wellfleet/Cape Cod. MISSOURI: Branson Treehouse Adventures & RV –Branson West. OREGON: Honey Bear by the Sea Campground – Gold Beach. RHODE ISLAND: Block Island Fishworks – Block Island. SOUTH DAKOTA: Spearfish Canyon Lodge – Lead. Skiing and weddings as well as hunting & fishing Terry Peak Chalets – Lead. Ski resort. TEXAS: American Undersea Warfare Center – Galveston. UTAH: The Iron Gate Inn – Cedar City. VIRGINIA: Historic Smithfield – Blacksburg. Museum and weddings. WISCONSIN: Slammin Salmon II Charters – Sheboygan. Iron Ridge Motel – Iron Ridge. WYOMING: Butte Creek Outfitters – Cody. 5K Outfitters – Thayne. When you are ready to travel, we are here to help! Keep checking back every week for more featured locations. Our travel hosts are eager to see you and work with you to provide safe and clean facilities.
Researchers conclude that regularly speaking two languages contributes to cognitive reserve and delays the onset of the symptoms associated with cognitive decline and dementia. Newswise — In addition to enabling us to communicate with others, languages are our instrument for conveying our thoughts, identity, knowledge, and how we see and understand the world. Having a command of more than one enriches us and offers a doorway to other cultures, as discovered by a team of researchers led by scientists at the Open University of Catalonia (UOC) and Pompeu Fabra University (UPF). Using languages actively provides neurological benefits and protects us against cognitive decline associated with ageing. In a study published in the journal Neuropsychologia, the researchers conclude that regularly speaking two languages -and having done so throughout one's life- contributes to cognitive reserve and delays the onset of the symptoms associated with cognitive decline and dementia. "We have seen that the prevalence of dementia in countries where more than one language is spoken is 50% lower than in regions where the population uses only language to communicate", asserts researcher Marco Calabria, a member of the Speech Production and Bilingualism research group at UPF and of the Cognitive NeuroLab at the UOC, and professor of Health Sciences Studies, also at the UOC. Previous work had already found that the use of two or more languages throughout life could be a key factor in increasing cognitive reserve and delaying the onset of dementia; also, that it entailed advantages of memory and executive functions. "We wanted to find out about the mechanism whereby bilingualism contributes to cognitive reserve with regard to mild cognitive impairment and Alzheimer's, and if there were differences regarding the benefit it confers between the varying degrees of bilingualism, not only between monolingual and bilingual speakers", points out Calabria, who led the study. Thus, and unlike other studies, the researchers defined a scale of bilingualism: from people who speak one language but are exposed, passively, to another, to individuals who have an excellent command of both and use them interchangeably in their daily lives. To construct this scale, they took several variables into account such as the age of acquisition of the second language, the use made of each, or whether they were used alternatively in the same context, among others. The researchers focused on the population of Barcelona, where there is strong variability in the use of Catalan and Spanish, with some districts that are predominantly Catalan-speaking and others where Spanish is mainly spoken. "We wanted to make use of this variability and, instead of comparing monolingual and bilingual speakers, we looked at whether within Barcelona, where everyone is bilingual to varying degrees, there was a degree of bilingualism that presented neuroprotective benefits", Calabria explains. Bilingualism and Alzheimer's At four hospitals in the Barcelona and metropolitan area, they recruited 63 healthy individuals, 135 patients with mild cognitive impairment, such as memory loss, and 68 people with Alzheimer's, the most prevalent form of dementia. They recorded their proficiency in Catalan and Spanish using a questionnaire and established the degree of bilingualism of each subject. They then correlated this degree with the age at which the subjects' neurological diagnosis was made and the onset of symptoms. To better understand the origin of the cognitive advantage, they asked the participants to perform various cognitive tasks, focusing primarily on the executive control system, since the previous studies had suggested that this was the source of the advantage. In all, participants performed five tasks over two sessions, including memory and cognitive control tests. "We saw that people with a higher degree of bilingualism were given a diagnosis of mild cognitive impairment later than people who were passively bilingual", states Calabria, for whom, probably, speaking two languages and often changing from one to the other is life-long brain training. According to the researcher, this linguistic gymnastics is related to other cognitive functions such as executive control, which is triggered when we perform several actions simultaneously, such as when driving, to help filter relevant information. The brain's executive control system is related with the control system of the two languages: it must alternate them, make the brain focus on one and then on the other so as not to cause one language to intrude in the other when speaking. "This system, in the context of neurodegenerative diseases, might offset the symptoms. So, when something does not work properly as a result of the disease, the brain has efficient alternative systems to solve it thanks to being bilingual", Calabria states, who then continues: "we have seen that the more you use two languages and the better language skills you have, the greater the neuroprotective advantage. Active bilingualism is, in fact, an important predictor of the delay in the onset of the symptoms of mild cognitive impairment, a preclinical phase of Alzheimer's disease, because it contributes to cognitive reserve". Now, the researchers wish to verify whether bilingualism is also beneficial for other diseases, such as Parkinson's or Huntington's disease.
Newswise — DALLAS, November 16, 2020 -- Adults with the healthiest sleep patterns had a 42% lower risk of heart failure regardless of other risk factors compared to adults with unhealthy sleep patterns, according to new research published today in the American Heart Association's flagship journal Circulation. Healthy sleep patterns are rising in the morning, sleeping 7-8 hours a day and having no frequent insomnia, snoring or excessive daytime sleepiness. Heart failure affects more than 26 million people, and emerging evidence indicates sleep problems may play a role in the development of heart failure. This observational study examined the relationship between healthy sleep patterns and heart failure and included data on 408,802 UK Biobank participants, ages 37 to 73 at the time of recruitment (2006-2010). Incidence of heart failure was collected until April 1, 2019. Researchers recorded 5,221 cases of heart failure during a median follow-up of 10 years. Researchers analyzed sleep quality as well as overall sleep patterns. The measures of sleep quality included sleep duration, insomnia and snoring and other sleep-related features, such as whether the participant was an early bird or night owl and if they had any daytime sleepiness (likely to unintentionally doze off or fall asleep during the daytime). "The healthy sleep score we created was based on the scoring of these five sleep behaviors," said Lu Qi, M.D., Ph.D., corresponding author and professor of epidemiology and director of the Obesity Research Center at Tulane University in New Orleans. "Our findings highlight the importance of improving overall sleep patterns to help prevent heart failure." Sleep behaviors were collected through touchscreen questionnaires. Sleep duration was defined into three groups: short, or less than 7 hours a day; recommended, or 7 to 8 hours a day; and prolonged, or 9 hours or more a day. After adjusting for diabetes, hypertension, medication use, genetic variations and other covariates, participants with the healthiest sleep pattern had a 42% reduction in the risk of heart failure compared to people with an unhealthy sleep pattern. They also found the risk of heart failure was independently associated and: 8% lower in early risers; 12% lower in those who slept 7 to 8 hours daily; 17% lower in those who did not have frequent insomnia; and 34% lower in those reporting no daytime sleepiness. Participant sleep behaviors were self-reported, and the information on changes in sleep behaviors during follow-up were not available. The researchers noted other unmeasured or unknown adjustments may have also influenced the findings. Qi also noted that the study's strengths include its novelty, prospective study design and large sample size. First-author is Xiang Li, Ph.D.; other co-authors are Qiaochu Xue, M.P.H.; Mengying Wang, M.P.H.; Tao Zhou, Ph.D.; Hao Ma, Ph.D.; and Yoriko Heianza, Ph.D. Author disclosures are detailed in the manuscript.
Newswise — Microglia -- the brain's immune cells -- play a primary role in removing cellular debris from the brain. According to a recent study by a Nagoya University-led research team in Japan, another kind of brain cell, called astrocyte, is also involved in removing debris as a backup to microglia. The finding, published recently in The EMBO Journal, could lead to new therapies that accelerate the removal of cellular debris from the brain and thereby reduce detrimental effects of the debris on surrounding cells. Even in a healthy brain, neurons die at a certain rate, which increases with age. As dead cells and cellular debris accumulate, they harm surrounding cells, which in turn accelerates neuron death and causes neurodegenerative diseases such as Alzheimer's disease. Microglia -- brain "phagocytes" (a type of cell that engulfs and absorbs bacteria and cellular debris) -- act to clear the danger, but the debris sometimes overwhelms the microglia. This has led to suggestions that another mechanism that helps remove cellular debris is also at work. To clarify the nature of the alternative debris-clearing mechanism, a research team led by Dr. Hiroshi Kiyama and Dr. Hiroyuki Konishi of the Graduate School of Medicine at Nagoya University first investigated what would happen to microglial debris in the brains of mouse models in which microglial death was induced. As expected, the team observed that dead microglia were cleared, indicating that indeed another phagocyte was at work. The researchers next analyzed the expression of molecules in the brains of the mouse models and identified astrocytes that play a role in the removal of microglial debris. Then, using mutant mice with phagocytosis-impaired microglia, they examined how astrocytes work when microglia don't function properly. The results showed that almost half of the cellular debris was engulfed by astrocytes, not by microglia. This indicates that astrocytes have the potential to compensate for microglial dysfunction. The team concluded that not only are astrocytes capable of engulfing cellular debris, but also that they are likely to actually do this when microglia don't function properly. The team next plans to clarify how astrocytes recognize microglial dysfunction and deploy their phagocytic function. Drs. Kiyama and Konishi say, "Further investigation of how to control astrocytic phagocytosis may lead to new therapies that accelerate efficient debris clearance from aged or injured brains." Photo credit: Hiroyuki Konishi Microglial ablation or microglial dysfunction actuates phagocytic activity of astrocytes. Astrocytes possess phagocytic machinery and have the potential to compensate for microglia with dysfunctional phagocytic activity.
Newswise — COVID-19 has significantly increased public use of face masks to protect others from the wearer’s respiratory droplets as well as the wearer from airborne contaminants. After each wear however, bacteria from even a healthy wearer’s own respiratory droplets collect on the inside of a mask as well as the outside, which could contain airborne pathogens capable of living on its surface. Although proper sanitization is imperative, many people reuse masks and other face coverings many times without sanitizing them. That is likely because current sanitization methods can be cumbersome. To address the many pitfalls of sanitizing all types of face masks from N-95s to cloth and surgical masks, a scientist from Florida Atlantic University’s Schmidt College of Medicine has come up with an innovative solution. Patrick Grant, Ph.D., associate professor of biomedical science, has designed a compact and portable sanitizing device for masks and other items that can be used at home or at work. The “portable hanging rack device” has been designed as an enclosed chamber that comes in two forms – a plastic container with a handle and a stainless steel compartment. The hanging rack and an ultraviolet-C (UV-C) light source is placed within either of these enclosed chambers and is capable of sterilizing up to six masks simultaneously and quickly, killing bacteria, yeasts, mold spores, and viruses. The masks are positioned vertically on the internal rack. To prevent the UV light from harming a user’s skin and eyes, the light source is shielded within the housing enclosure. When UV-C radiation contacts the mask, the surface of the mask is subsequently sanitized as the radiation deactivates the biological components of pathogens. The UV-C light source delivers uninterrupted UV-C radiation to the mask surfaces and uses a UV-C bulb that produces limited ozone. Grant has tested a number of micro-organisms using this device and has shown its efficacy against pathogens including the highly-contagious E-coli, which was eradicated within the device in about one minute. FAU recently filed a provisional patent application for Grant’s novel invention with the United States Patent & Trademark Office. “People only have access to a limited supply of masks and often don’t have the option of disposing of them after a single use,” said Grant. “Those who wear cloth masks may sanitize them by washing them, but the washing and drying process is often too time-consuming to sustain washing after each wear. Moreover, washing is not an option for those who wear medical-grade masks, and using disinfectant sprays can cause skin irritation or damage the fibers of the mask designed to catch particulates. That’s why I created this device as a time-efficient way to sanitize facial coverings without damaging their effectiveness and enable wearers to safely reuse them in their daily lives.” Although there are commercially-available UV-C treatment devices, many of the devices permitting sanitization of multiple objects are of a commercial size that is too large for household use. Furthermore, these devices frequently utilize larger UV bulbs, which are not only costly, but also produce ozone, resulting in an unpleasant odor. In addition, current portable devices are not suitably adapted to sanitize the entire surface of multiple masks at once – a concern for families using multiple face coverings on a daily basis. While handheld-UV wands exist, these wands increase exposure to UV rays and often require the user to hold the wand for a lengthy period of time to properly sanitize the desired surface, increasing the user’s risk of skin burns and damage to the corneas of the eyes. Studies also have shown users of hand-held devices are unable to hold the devices at the angle and for the length of time necessary to generate a stable UV directional output and effectively sanitize a surface. Moreover, open-air UV devices risk UV exposure to commonly found household surfaces such as plastics, which may damage the integrity and appearance of these materials. When fully developed, this apparatus will effectively sanitize masks as well as other objects such as keys and smart phones in a way that is safe, affordable, odor-free, and suitable for household use. Grant anticipates the cost of the plastic portable container and the steel container to be under $100 and to provide cost savings from an extended life of masks and from potential savings from reducing preventable infections. Photo Credit: Patrick Grant, Ph.D., Florida Atlantic University Video shows two versions of the “portable hanging rack device” and the researcher swabbing a face mask and placing it onto a Petri dish. The cover image is a side-by-side view of bacteria from a face mask before and after using the sanitization device. When UV-C radiation contacts the mask, the surface of the mask is subsequently sanitized as the radiation deactivates the biological components of pathogens.
Newswise — ARLINGTON, Va., October 21, 2020 — A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides guidance for physicians who use radiation therapy to treat patients with locally advanced rectal cancer. Recommendations outline indications and best practices for pelvic radiation treatments, as well as the integration of radiation with chemotherapy and surgery for stage II-III disease. The guideline, which replaces ASTRO's 2016 guidance for rectal cancer, is published in Practical Radiation Oncology. Colorectal cancer is the second most common cause of cancer death in the U.S., and half of new colorectal cancer diagnoses are in people age 66 or younger. Rectal cancer diagnoses account for nearly one-third of colorectal cancers; an estimated 43,340 adults will be diagnosed with rectal cancer in 2020. While rectal cancer incidence and mortality rates have dropped among older adults in recent years, they have increased for those younger than age 55. "As rectal cancer becomes more of a disease of younger adults, long-term survivorship and quality of life considerations become even more important. Part of our motivation was to create guidelines that provide options for different treatments that could potentially improve survival rates and also help preserve patients' quality of life," said Prajnan Das, MD, MPH, chair of the rectal guideline task force, and professor and chief of gastrointestinal radiation oncology at The University of Texas MD Anderson Cancer Center in Houston. Standard treatment for locally advanced rectal cancer generally involves chemoradiation therapy or short-course radiation without chemotherapy, followed by tumor removal surgery and additional chemotherapy. More recently, several trials have shown potential for emerging paradigms, such as changing the sequencing of treatments or omitting portions of treatments for select patients. "Different treatments are appropriate for different patients, and the oncology field at large is moving toward personalized care," explained Jennifer Y. Wo, MD, vice chair of the rectal guideline task force and associate professor of radiation oncology at Harvard Medical School and Massachusetts General Hospital in Boston. "Some patients may need less than what is considered a typical course of treatment, while some patients may need more. This guideline focuses on providing options that can be tailored to patients' characteristics and their wishes." Recommendations in the guideline address patient selection for radiation therapy, delivery of pelvic radiation treatments, options for non-operative management of locally advanced rectal cancer and guidance for follow-up care. Key recommendations include: Neoadjuvant radiation therapy is strongly recommended for patients with clinical stage II-III rectal cancer to reduce their risk of locoregional recurrence. Radiation therapy for locally advanced rectal cancer should be performed before rather than after surgery. Radiation may be omitted in favor of upfront surgery for some patients at low risk of recurrence, after discussion by a multidisciplinary care team. Clinical staging involving a physical exam and pelvic MRI is critical to determine which patients should receive neoadjuvant radiation therapy. For patients who require neoadjuvant radiation therapy, both conventionally fractionated radiation and short-course radiation are recommended equally, given high-quality evidence for similar efficacy and patient-reported quality of life outcomes with each treatment. The guideline specifies optimal dosing, fractionation and delivery techniques for radiation therapy Recommendations address how to incorporate chemotherapy into the pre-operative setting for patients who are at high risk of recurrence and who would likely benefit from the additional treatment using a total neoadjuvant therapy (TNT) approach. Recommendations also address other sequencing and timing issues for radiation, chemotherapy and surgery, with specific attention to treatment tolerability and potential downstaging. Organ preservation approaches (i.e., non-operative management and local excision) may present an alternative to radical surgery for select patients, especially those who would have a permanent colostomy or inadequate bowel continence after surgery. The guideline outlines specific criteria for situations where surgery can be avoided, as well as long-term surveillance and care for these patients. COVID-19 and Rectal Cancer While the guideline was completed before the COVID-19 pandemic, recommendations can guide clinics as they continue to care for patients. To reduce how frequently patients needed to come into the clinic for treatment, many institutions across the country moved toward short-course radiation in the early months of the pandemic, which aligns with the guideline's recommendations. "Patients usually complete short-course radiation therapy in one week, compared to five-and-a-half weeks for standard radiation treatment. That is particularly important in the COVID era, when you want to minimize patient time in the hospital and issues like financial toxicity are especially salient," said Dr. Das. "We have yet to see the true impact of COVID-19, but we know that interruptions in screening likely will lead to fewer patients receiving treatment when their disease is more manageable," said Dr. Wo. "And if that does happen and we start seeing patients with more advanced disease, then the parts of the guidelines that specifically address treatment for high-risk patients will become even more important." About the Guideline The guideline was based on a systematic literature review of articles published from January 1999 through April 2019. The multidisciplinary task force included radiation, medical and surgical oncologists, a radiation oncology resident, medical physicists and a patient representative. The guideline was developed in collaboration with the American Society of Clinical Oncology and the Society of Surgical Oncology, and endorsed by the American College of Radiology, Canadian Association of Radiation Oncology, European Society for Radiotherapy and Oncology, the Royal Australian and New Zealand College of Radiologists and the Society of Surgical Oncology. ASTRO's clinical guidelines are intended as tools to promote appropriately individualized, shared decision-making between physicians and patients. None should be construed as strict or superseding the appropriately informed and considered judgments of individual physicians and patients. Additional Resources on Colorectal Cancers Video: Radiation Therapy for Colon, Rectum and Anus Cancers; An Introduction to Radiation Therapy (Spanish) Brochure: Radiation Therapy for Colon, Rectum and Anus Cancers Chart: Side Effects of Colorectal Cancer Radiation Treatment ABOUT ASTRO The American Society for Radiation Oncology (ASTRO) is the world’s largest radiation oncology society, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. The Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics, Practical Radiation Oncology and Advances in Radiation Oncology; developed and maintains an extensive patient website, RT Answers; and created the nonprofit foundation Radiation Oncology Institute. To learn more about ASTRO, visit our website, sign up to receive our news and follow us on our blog, Facebook, Twitter and LinkedIn.
Newswise — Rutgers researchers have discovered human gene markers that work together to cause metastatic prostate cancer – cancer that spreads beyond the prostate. The study, published in the journal Nature Cancer, explored prostate cancer cells from people and mice and found a wide collaboration among 16 genes that leads to metastasis, which often leads to treatment challenges. The gene markers identified can predict if a prostate cancer patient has a high probability of developing metastasis, including bone. Prostate cancer is the second leading cause of cancer-related deaths among men in the United States with a five-year relative survival rate of near 100 percent when diagnosed early. Metastatic prostate cancer has a five-year survival rate of 30 percent. Current therapeutics like first- and next- generation anti-androgens that target male sex hormones alongside radiation, chemotherapy and others are not always effective, and it’s impossible to predict which patients are at risk of developing the advanced late stage of the disease. “People diagnosed with prostate cancer should now be screened for the protein markers discovered to help determine their risk of developing metastatic prostate cancer, which can help inform more personalized therapy,” said Antonina Mitrofanova, an assistant professor at the Rutgers School of Health Professions and research member at Rutgers Cancer Institute of New Jersey. “Our results show that molecular profiling at the time of diagnosis can help inform more personalized therapy leading to better outcomes for those with this advanced form of disease.” Researchers say testing for these gene markers can also predict which patients will fail to respond to normally used androgen targeting therapies in metastatic disease and can decrease multiple treatment rounds for patients. Researchers, in collaboration with Cory Abate-Shen’s lab at Columbia University, have obtained a patent for their discovery and are looking to develop therapeutics and diagnostic tools.
Newswise — Taking into account two common kidney disease tests may greatly enhance doctors’ abilities to estimate patients’ cardiovascular disease risks, enabling millions of patients to have better preventive cardiovascular care, according to a large international study co-led by researchers at the Johns Hopkins Bloomberg School of Public Health. The researchers used data from more than nine million individuals around the world to develop and validate a risk-scoring calculation that adds blood and urine measures of kidney disease to the current standard method in the United States for assessing cardiovascular disease risk. The two measures—estimated glomerular filtration rate and urine albumin—are commonly used to reveal chronic kidney disease. CKD, as it’s called, has long been considered a risk factor for cardiovascular disease, although until now CKD-related measures have not been included in standard algorithms for quantifying cardiovascular disease risk. The researchers showed that the use of their “CKD patch”—a computer-program update—can result in large increases in cardiovascular disease-risk estimates among patients with severe CKD. The investigators also developed a similar patch to enhance the standard risk-assessment tool used in Europe. The study appears October 14 in EClinicalMedicine, a new online open-access journal published by The Lancet. “Adding these two measures of kidney disease, which are frequently available from blood and urine tests at checkups, allows potentially big improvements in the accuracy of a patient’s risk estimates—improvements that should in turn enable doctors to optimize patient care,” says study co-first author Kunihiro Matsushita, MD, an associate professor in the Bloomberg School’s Department of Epidemiology. “This is a big deal—an estimated ten percent of the United States adult population has kidney disease and potentially would benefit from improved care if this new tool is adopted,” says co-last author Josef Coresh, MD, George W. Comstock Professor in the Department of Epidemiology at the Bloomberg School. The other co-first author was Simerjot Jassal, MD, of the University of California, San Diego, and the other co-last author was Elke Schaeffner, MD, of Charité University Hospital Berlin. Shoshana Ballew, PhD, assistant scientist in the Bloomberg School’s Department of Epidemiology, helped coordinate the data-gathering. In all, the study included more than 50 researchers. The reduction of kidney function in CKD can lead to higher blood pressure as well as hormonal and other chemical imbalances, and these in turn promote the narrowing of arteries that supply the heart muscle—conditions known as atherosclerosis and arteriolosclerosis. The American Heart Association and the American College of Cardiology, in their guidelines for physicians, already list CKD as a “risk enhancer” for atherosclerotic cardiovascular disease, but without a specific tool that quantifies the added risk as part of the standard risk calculator. Since 2009, Coresh, Matsushita, and colleagues have been assembling a large, international database of CKD patients and healthy adults, under a collaboration known as the CKD Prognosis Consortium. For the new study, they analyzed a portion of this database, covering 4.1 million adults around the world, to develop algorithms that estimate cardiovascular disease risk using standard measures plus the two kidney-disease measures. They then validated the accuracy of their algorithms using further samples covering 4.9 million adults. The two kidney disease measures, estimated glomerular filtration rate and urine albumin, respectively, indicate the kidneys’ blood-filtering efficiency and the level of an essential protein called albumin that the kidneys normally would filter out of the urine. The researchers incorporated these measures in a “CKD patch” to the standard cardiovascular disease-risk estimation algorithm developed by the American Heart Association and the American College of Cardiology. They found that for adults who had results on these kidney- disease tests indicating CKD, the addition of these measures via the CKD patch significantly improved the estimated 10-year risks of atherosclerotic cardiovascular disease. For example, for patients with “very high-risk” CKD, the estimated 10-year chances of developing atherosclerotic cardiovascular disease were a median of 1.55 times higher than estimates without the CKD patch, while the figures were a median of 1.24 times higher for “high-risk” CKD patients. The researchers’ CKD patch for the standard European 10-year cardiovascular disease mortality risk estimator also boosted estimated risks, by a median of 2.64 times in very high-risk CKD patients, and 1.86 times in high-risk CKD patients. “These results suggest that doctors have tended to underestimate cardiovascular disease risks in kidney disease patients,” Matsushita says. The researchers hope that their CKD patches will be adopted widely, enabling more accurate assessments of cardiovascular disease and related mortality risks—which in turn should result in better preventive care including the use of statins and other interventions to ward off cardiovascular disease. “We also hope that the availability and value of these new algorithms will encourage doctors to order estimated glomerular filtration rate and urine albumin tests for their patients more often,” Coresh says. The CKD patches are available online at: http://ckdpcrisk.org/ckdpatchscore/ and http://www.ckdpcrisk.org/ckdpatchpce/ The study, “Incorporating kidney disease measures into cardiovascular risk prediction: Development and validation in 9 million adults from 72 datasets,” was funded by the National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases.
Newswise — Without directly invading the brain or nerves, the virus responsible for COVID-19 causes potentially damaging neurological injuries in about one in seven infected, a new study shows. These injuries range from temporary confusion due to low body-oxygen levels, to stroke and seizures in the most serious cases, say the study authors. Led by researchers at NYU Grossman School of Medicine, the study showed no cases of brain or nerve inflammation (meningitis or encephalitis), indicating no immediate invasion of these organs by the pandemic virus, SARS-CoV-2. While this should reassure patients, the neurological complications of COVID-19 should be taken seriously because they dramatically raise a patient’s risk of dying while still in hospital (by 38 percent), researchers say. Such adverse effects also raise a coronavirus patient’s likelihood (by 28 percent) of needing long-term or rehabilitation therapy immediately after their stay in hospital. “The results of our study showed no signs that the coronavirus directly attacks the nervous system,” says study lead investigator Jennifer Frontera, MD. “The neurological complications seen in COVID-19 are predominately the secondary effects of being severely ill and suffering from low oxygen levels in the body for prolonged periods of time,” says Frontera, a professor in the Department of Neurology at NYU Langone Health. Published in the journal Neurology online Oct. 5, the study closely monitored the progress of 606 COVID-19 adult patients diagnosed with brain or other nerve-related medical conditions at any of four NYU Langone hospitals in New York City and Long Island between March 10 and May 20, when coronavirus infections were at their peak in the region. Frontera says that ahead of the pandemic, dozens of NYU Langone neurologists and trainees had deployed across its medical centers to assist with the expectant surge of COVID-19 patients. Early reports from Asia and Europe, where infections had spiked before rising in the United States, she says, had also “raised the alarm” about possible brain damage from coronavirus infection. Because of this, the research team was ready to look for any signs of neurological dysfunction among the thousands of patients being admitted to hospital in the spring. Among all the hospitals, 4,491 patients tested positive for COVID-19 during that time. Among the study’s other key results was that common neurological problems, such as confusion caused by chemical electrolyte imbalances, severe infection or kidney failure, usually arose within 48 hours of developing general COVID-19 symptoms, including fever, difficulty breathing, and cough. Half of those neurologically affected were over the age of 71, which researchers say is significantly older than the other 3,885 patients with COVID-19 (at a media age of 63) who did not experience brain dysfunction. Most were men (66 percent) and white (63 percent). Frontera notes that the study results do suggest that Blacks are not at greater risk of neurological complications than other COVID-19 patients, which is “welcome news,” given that Blacks are widely known to be at greater risk of death from coronavirus infection. However, she says this potentially important observation requires further investigation. While the coronavirus is known to attack other organs, including blood vessels and the heart, researchers say its main target is the lungs, where it makes breathing difficult, starving the body of oxygen it needs to stay alive. Low levels of oxygen in the body and brain was another common neurological problem, study results showed, that could lead to confusion, coma, or permanent brain damage. “Our study results suggest that physicians need to be more aggressive in stabilizing body oxygen levels in patients with COVID-19 as a potentially key therapy for stopping, preventing and/or possibly reversing neurological problems,” says study senior investigator Steven Galetta, MD. Galetta, the Philip K. Moskowitz, MD Professor and chair of the Department of Neurology at NYU Langone, says various blood-oxygen-raising therapies that could possibly work against neurological problems in patients with COVID-19 include early intubation or use of heart-lung machines, called ECMO, which mechanically “clean” the blood and “deliver” oxygen into it. Funding support for the study was provided by National Institutes of Health grant P30 AG066512 and NYU Langone. Besides Frontera and Galetta, other NYU Langone researchers involved in this study are Sakinah Sabadia, MD; Rebecca Lalchlan, DO; Taolin Fang, MD; Brent Flusty, DO; Patricio Millar-Vernetti, MD; Thomas Snyder, MD; Stephen Berger, MD; Dixon Yang, MD; Andre Granger, MD; Nicole Morgan, MD; Palek Patel, MD; Josef Gutman, MD; Kara Melmed, MD; Shashank Agarwal, MD; Mathew Bokhari, MD; Kaitlyn Lillemoe, MD; Daniel Friedman, MD; David Friedman, MD; Manisha Holmes, MD; Joshua Huang, MSc; Sujata Thawani, MD; Jonathan Howard, MD; Nada Abou-Fayssal, MD; Penina Krieger, MPhil; Ariane Lewis, MD: Aaron Lord, MD; Ting Zhou, MD; D. Ethan Kahn, DO; Barry Czeisler, MD; Jose Torres, MD; Shadi Yaghi, MD; Koto Ishida, MD; Erica Scher, RN, MPH; Dimitris Placatonakis, MD, PhD; Mengling Liu, PhD; Thomas Wisniewski, MD; Andrea Troxel, ScD; and Laura Balcer, MD, MSCE. Other study co-investigators are Sherry Chou, MD, MSc; and Ericka Fink, MD, at the University of Pittsburgh; Molly McNett, RN; and Shraddha Mainali, MD, at Ohio State University in Columbus; Raimund Helbok, MD, PhD, at the Medical University of Innsbruck in Austria; Courtney Robinson, MD; Jose Suarez, MD; and Wendy Ziai, MD, at Johns Hopkins University in Baltimore, Md.; Michelle Schober, MD; and Adam de Havenon, MD, at the University of Utah in Salt Lake City; and David Menon, MD, PhD, at the University of Cambridge in the United Kingdom.
Newswise — PITTSBURGH, Oct. 12, 2020 – Variations in a gene that regulates dopamine levels in the brain may influence the mobility of elderly and frail adults, according to new research from the University of Pittsburgh Graduate School of Public Health. These results, published today in the Journal of The American Geriatrics Society, add to a growing body of evidence hinting that lower dopamine levels could contribute to the slower, often disabling walking patterns seen in some elderly populations. “Most people think about dopamine’s role in mobility in the context of Parkinson’s disease, but not in normal aging,” said senior author Caterina Rosano, M.D., M.P.H., professor of epidemiology at Pitt Public Health. “We were curious to see if a genetic predisposition to produce more or less dopamine was related to mobility in individuals who had some level of frailty, yet did not have dementia, parkinsonism or any other neurological condition.” While several genetic elements control dopamine signaling, Rosano and her team focused on a gene called COMT, which breaks down dopamine to control its levels within the brain. They also considered the frailty status of participants, which is a common consequence of aging marked by a decline in physiological function, poor adjustment to stressors and a susceptibility toward adverse health outcomes. The researchers suspected that frail participants could be particularly vulnerable to COMT-driven differences in dopamine levels. Rosano and her collaborators examined this gene in more than 500 adults above the age of 65 in Pennsylvania, North Carolina, California and Maryland, excluding any participants taking dopamine-related medications or diagnosed with Parkinson’s disease. The researchers then looked for potential links between genotype, frailty and speed. “We found that in older, frail adults, those who have a high-dopamine genotype are more likely to maintain a faster gait and may be more resilient to mobility disablement as they age,” said Rosano. The team discovered that frail participants with a high-dopamine COMT genotype had a 10% faster walking speed compared with participants with the low-dopamine COMT genotype. “This 10% difference may seem small, but it could make a big difference for a person walking across a busy street while negotiating traffic,” said Rosano. “This difference is even more striking when you consider just how many complex genes influence walking.” Rosano and study co-author Nicolaas Bohnen, M.D., Ph.D., professor of neurology and radiology at the University of Michigan School of Medicine, are working with a team of scientists at Pitt to quantify what level of dopamine could give elders greater resilience to gait-slowing and mobility disablement. Their hope is that older adults with low dopamine levels could one day receive pharmacologic supplements of dopamine to help preserve their mobility. “There are a lot of individuals living in the community who have dopamine levels toward the lower end of normal who don't have Parkinson's disease or psychiatric conditions,” said Rosano. “If we give dopamine to these people, could we make them more resilient? That's what we don't know yet.” In the meantime, she suggests that there are actions that seniors can take today to keep moving. She recommends that elders focus on physical activities that are enjoyable and involve both the body and the brain, especially multi-sensory activities, such as dancing or walking with a loved one. “I love to see grandparents walking around holding hands with their grandchildren because they have to look where they are going, where the child is going, keep an eye on the surroundings and pay attention to what the grandchild is saying, all at the same time,” said Rosano. “They get an amazing multi-sensory rehab, and it's fantastic.” Additional authors on this research include first author Shannon Mance, B.S.N., R.N., Andrea Rosso, M.P.H., Ph.D., and Stephanie Studenski, M.D., M.P.H., all of Pitt; and Joshua Bis, Ph.D., of the University of Washington. This research was supported by the National Institutes of Health (NIH) contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086 and NIH grants U01HL080295, R01HL087652, R01HL105756, R01HL103612, R01HL120393, U01HL130114, R01AG023629, and DK063491. Additional support was provided by UCLA Clinical Translational Science Institute grant UL1TR00181. CREDIT: Ric Evans/Pitt CAPTION: Caterina Rosano, M.D., M.P.H., professor of epidemiology, University of Pittsburgh Graduate School of Public Health.