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Credit: Christina M. Caragine and Alexandra Zidovska, New York University. Human cell nuclei with fluorescently labeled chromatin (green) and nucleoli (red). Newswise — The health of cells is maintained, in part, by two types of movement of their nucleoli, a team of scientists has found. This dual motion within surrounding fluid, it reports, adds to our understanding of what contributes to healthy cellular function and points to how its disruption could affect human health.  “Nucleolar malfunction can lead to disease, including cancer,” explains Alexandra Zidovska, an assistant professor in New York University’s Department of Physics and the senior author of the study, which appears in the journal eLife. “Thus, understanding the processes responsible for the maintenance of nucleolar shape and motion might help in the creation of new diagnostics and therapies for certain human afflictions.”  Recent discoveries have shown that some cellular compartments don’t have membranes, which were previously seen as necessary to hold a cell together. Researchers have since sought to understand the forces that maintain the integrity of these building blocks of life absent these membranes. What has been observed is the nature of this behavior. Specifically, these compartments act as liquid droplets made of a material that does not mix with the fluid around them—similar to oil and water. This process, known as liquid-liquid phase separation, has now been established as one of the key cellular organizing principles.  In their study, the researchers focused on the best known example of such cellular liquid droplet: the nucleolus, which resides inside the cell nucleus and is vital to cell’s protein synthesis. “While the liquid-like nature of the nucleolus has been studied before, its relationship with the surrounding liquid is not known,” explains Zidovska, who co-authored the study with Christina Caragine, an NYU doctoral student, and Shannon Haley, an undergraduate in NYU’s College of Arts and Science at the time of the work and now a doctoral student at the University of California at Berkeley. “This relationship is particularly intriguing considering the surrounding liquid—the nucleoplasm—contains the entire human genome.”  Yet, unclear is how the two fluids interact with each other. To better understand this dynamic, the scientists examined the motion and fusion of human nucleoli in live human cells, while monitoring their shape, size, and smoothness of their surface. The method for studying the fusion of the nucleolar droplets was created by the team in 2018 and reported in the journal Physical Review Letters.  Their latest study showed two types of nucleolar pair movements or “dances”: an unexpected correlated motion prior to their fusion and separate independent motion. Moreover, they found that the smoothness of the nucleolar interface is susceptible to both changes in gene expression and the packing state of the genome, which surrounds the nucleoli.  “Nucleolus, the biggest droplet found inside the cell nucleus, serves a very important role in human aging, stress response, and general protein synthesis while existing in this special state,” observes Zidovska. “Because nucleoli are surrounded by fluid that contains our genome, their movement stirs genes around them. Consequently, because the genome in the surrounding fluid and nucleoli exist in a sensitive balance, a change in one can influence the other. Disrupting this state can potentially lead to disease.”  This research was supported by grants from the National Institutes of Health (R00-GM104152) and the National Science Foundation (CAREER PHY-1554880, CMMI-1762506).
Can nutraceuticals help combat diabetes?   Newswise — Every five minutes, someone in Australia is diagnosed with diabetes. It’s Australia’s fastest growing chronic condition, but as its prevalence grows more people are adding dietary supplements to their diets in the hope of reducing their risk of the disease. But how effective are dietary supplements? In a new study from the University of South Australia, researchers have examined the efficacy of some of the most commonly used supplements (‘nutraceuticals’) to manage diabetes and its risk factors. The review found that the nutraceuticals resveratrol (a compound from grapes), curcumin (from turmeric) and cinnamon were all effective in combatting various elements of diabetes, including regulating glucose, improving insulin resistance and reducing cholesterol. Diabetes is a chronic condition marked by high levels of glucose in the blood. While Type 1 diabetes cannot be prevented, Type 2 diabetes is most common and preventable in up to nearly 60 per cent of cases by maintaining a healthy weight, being physically active and following a healthy eating plan. The World Health Organization estimates that 422 million people (or one in 11) have diabetes, costing $986 billion in global health expenditure each year. In Australia, approximately 1.7 million people have diabetes, costing the economy an estimated $14.6 billion a year. With complications causing blindness, heart disease and amputations, it’s the biggest challenge confronting Australia’s health system. UniSA researcher, Dr Evangeline Mantzioris says it’s important to recognise the role nutraceuticals have in modern society, especially given their popularity among consumers. “More than 40 per cent of Australian adults regularly use dietary supplements to enhance and improve their diets,” Dr Mantzioris says. “They’re easily available, accessible and affordable, and unlike pharmaceuticals, they don’t need a prescription, making them extraordinarily popular. “The challenge is, however, knowing which nutraceuticals will deliver on their promises. “Our research sought to establish the effectiveness of the most popular types of nutraceuticals, and for diabetes, nutraceuticals that used the active ingredients cinnamon, curcumin or resveratrol were all effective, but in different ways. “We found cinnamon can reduce fasting blood glucose levels in type 2 diabetes; curcumin can improve insulin resistance in pre-diabetic and Type 2 diabetes, and resveratrol can reduce glucose levels and improve insulin resistance. “We also tested the efficacy of nutraceuticals on obesity, a key risk factor for diabetes, and, despite all the hype, none had any significant impact for weight loss.” Dr Mantzioris says while nutraceuticals have their place, a healthy diet and lifestyle is the most important factor influencing health. “People should invest in a diet filled with whole foods – vegetables and fruits, cereals, lean meats, fish, eggs, nuts and seeds, as well as dairy foods – as recommended by the Australian Guide to Healthy Eating. This should provide them with enough of the nutrients essential for good health. “However, if you are considering nutraceuticals to manage or prevent diabetes, we always recommend speaking with your doctor. “Nutraceuticals may have a place in healthcare, but there is still a lot we need to learn about them.”
Newswise — November 19, 2019 – Three models of off-site integrated care can help to meet the growing need for mental health services in children and adolescents, according to a report in the November/December issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer. Led by Andrea E. Spencer, MD, of Boston University School of Medicine and Rheanna E. Platt, MD, MPH, of Johns Hopkins University School of Medicine, the researchers analyzed available evidence on direct and remote approaches to integrating mental health care services with primary care for children. "Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication," the researchers write. Off-Site Approaches to Pediatric Mental Health Care – What's the Evidence? Up to 20 percent of children have a psychiatric disorder, highlighting a "large and growing gap" between the need for and availability of pediatric mental health care. Integrating mental health services with primary care is a promising strategy for increasing access to pediatric mental health care. But for several reasons, it's difficult to "co-locate" qualified metal health providers (MHPs) at primary care practices or clinics. Off-site integration – referring to various types of partnerships between primary care practices and specialty MHPs – may offer advantages over on-site integration. The new report provides an overview of available evidence on emerging approaches to off-site integration of mental health care services for children and adolescents. In a scoping review of the evidence, Drs. Spencer and Platt and colleagues identified 39 papers reporting on 24 off-site integrated pediatric mental health and behavioral care programs. The researchers analyzed three categories of programs: Direct in-person models – In-person evaluations performed at specialty agencies, coordinated through primary care. Most of these programs involved partnerships between primary care sites and existing mental health agencies. Direct remote models – Remote evaluations of children with mental health or behavioral issues using technology: telepsychiatry approaches using videoconferencing or telephone calls. Indirect remote models – Real-time telephone consultations between primary care practitioners and MHPs – usually child and adolescent psychiatrists. On analysis of implementation outcomes, all three models were well used and well accepted by providers and families. Programs with strong communication, timely and reliable specialty services, additional support after the initial evaluation, standardized care approaches, and ongoing support were better accepted by primary care practitioners. Programs with adequate planning and ongoing administrative support had better feasibility, adoption, and penetration. Off-site integrated care seemed more appropriate for some groups of patients, such as those with less-complicated attention-deficit/hyperactivity disorder, depression, or anxiety; but less so for others, including preschool-aged children and those with conduct disorders. "Funding and adequate reimbursement were barriers to sustainability in all models." the researchers add. "[O]ff-site pediatric integrated behavioral health programs...have the potential to expand integrated care without substantial infrastructure changes and to reach a broader population of patients than on-site programs," Drs. Spencer and Platt and coauthors conclude. They emphasize that further studies testing guidelines, protocols, and application of integrated care models in specific groups of patients will be needed for successful future expansion of these programs. Click here to read "Implementation of Off-Site Integrated Care for Children" DOI: 10.1097/HRP.0000000000000239 ### About the Harvard Review of Psychiatry The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics. About Wolters Kluwer Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services. Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth. For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.
Credit: Vanderbilt University Medical Center Myrick “Ricky” Shinall Jr., MD, PhD, an assistant professor and general surgeon at Vanderbilt University Medical Center   Newswise — Even a minor surgery such as a laparoscopic gallbladder removal can prove to be a high-risk and even fatal procedure for frail patients, according to new research published in JAMA Surgery.  A team of researchers from leading U.S. academic medical centers and VA medical centers examined the records of 432,828 patients who underwent a non-cardiac surgical procedure. They found that patients who were classified as frail or very frail had substantially higher mortality rates after surgeries with low and moderate operative stress, with up to 43% dying after moderate stress procedures such as laparoscopic cholecystectomy (minimally invasive gallbladder removal).  “It’s been established that frailty is a strong predictor of complications and death related to surgery, but what we learned in this study is that frail patients have alarmingly high rates of postoperative death, no matter how minor the surgical procedure,” said lead author Myrick “Ricky” Shinall Jr., MD, PhD, an assistant professor and general surgeon at Vanderbilt University Medical Center (VUMC). “A laparoscopic cholecystectomy is one of the most common operations I do as a general surgeon, and this has really given me pause to think that for frail to very frail patients — about 10% of our sample — this is a big deal. Our data indicate that there are no ‘low-risk’ procedures among frail patients.”  In layman’s terms, frailty is a vulnerability to becoming sick from even minor stress when the body has lost the ability to recover, said Shinall. It is typically measured before surgery by a clinical tool known as the Risk Analysis Index (RAI). With the RAI, several symptoms are assessed such as unintentional weight loss, shortness of breath, weakness, and difficulties with daily activities like walking, eating or bathing.  The study’s investigators pulled patient medical records for a four-year period from the VA Surgical Quality Improvement Program (VASQIP) database, a representative sample of all surgeries conducted across the country in the Veterans Health Administration. Data included patient information for a minimum of one year following surgery, and the patients’ postoperative mortality was noted at 30, 90 and 180 days. Past research related to frail patients and surgery has largely focused on small groups undergoing high-risk procedures, but the current study had a large sample size and included a range of procedures grouped according to how much operative stress they cause. Because no tool to consistently measure operative stress existed, an Operative Stress Score (OSS) was created by the study investigators. Surgeries from the patients’ cases were then sorted into five categories of physiologic stress, ranging from the lowest (OSS1) to the highest (OSS5).  Of the study’s patient sample, 8.5% were classified as frail, and 2.1% were very frail. The 30-day mortality rates for frail patients undergoing the lowest stress operations and moderate stress operations were 1.55% and 5.13%, both exceeding the 1% mortality rate often used to define high-risk surgery. For very frail patients, 30-day mortality rates after the lowest and moderate-stress procedures was even higher at 10.34% and 18.74%. For frail and very frail patients, mortality continued to rise at 90 days and 180 days after surgery, reaching as high as 43% for very frail patients 180 days after moderate-stress operations.  “This leads us to recommend that pre-surgical frailty screenings should be done universally, even for procedures known to cause low to moderate physiological stress, and frail patients and their families should be counseled about the greater risk of undergoing even minor surgery,” said corresponding author Daniel Hall, MD, associate professor at the University of Pittsburgh, staff surgeon at the Veterans Affairs Pittsburgh Healthcare System, and core investigator at the VA Center for Health Equity Research and Promotion.  “The greatest volume of surgeries performed at hospitals are those that cause moderate operative stress, and it is expected that all procedures at ambulatory surgical centers are considered to be those with a low mortality risk, but clinicians spend little time considering whether or not their patients can actually endure the stress of surgery,” said Shinall. “It is worth pausing to assess every patient to determine whether they are frail, and if they are, taking steps to mitigate the factors contributing to their frailty before a procedure is ever scheduled or re-evaluating whether they should even undergo a procedure at all.”  The study was supported by the US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (I21 HX-002345 and XVA 72-909 [Hall] and CIN 13-413 [Massarweh]. Additional support was provided by NIH/NIA 5R03AG050930 [Arya], NIH/NCI K12CA090625 [Shinall] and U01 TR002393 [Hall and Shireman].
ORI, FAU Study First to Show Statistically Significant Links between Regular Use of Pain and/or Sleep Prescriptions and Frailty Risk in Older Adults 14-Nov-2019 9:00 AM EST   Credit: Oregon Research Institute   Newswise — Researchers from the Oregon Research Institute (ORI) and Florida Atlantic University (FAU) are the first to demonstrate statistically significant links between self-reported regular use of prescription drugs for pain and/or sleep, and longitudinal risk of frailty in adults ages 65 and older. Frailty consists of deficits in a variety of functional measures, and is a reliable predictor of loss of independence, increased use of health care resources, and mortality. The possible implications of current research findings are especially serious given that it is common for older Americans to use two or more prescription drugs at the same time and many of these prescription drugs are for pain and sleep, including analgesics and sedatives. Results, published online in the Journal of the American Geriatric Society, estimate long-term frailty risks and rank the long-term risks of two classes of prescription drugs. Researchers found over eight years of follow-up, those who self-reported regular use of prescription drugs for pain and sleep had a 95 percent increased risk of frailty compared to those who did not report regular use of these drugs. For regular prescription drug use for pain only or for sleep only, the increased risks were 58 percent and 35 percent, respectively. Co-authors Gulcan Cil, Ph.D., associate scientist, ORI, Juyoung Park, Ph.D., associate professor in FAU’s Phyllis and Harvey Sandler School of Social Work within the College for Design and Social Inquiry, and senior scientist Andrew Bergen, Ph.D., ORI, analyzed data from the Health & Retirement Study (HRS), a nationally representative longitudinal cohort of older Americans. For their analysis, they selected a large cohort (N=7,201) of community-living non-frail older adults (age 65 to 104, mean 72, median 70) from the HRS. Analyses were adjusted for demographics and other drug use. “Co-use of multiple prescription medications is a growing phenomenon, especially among older adults,” said Park.  “Geriatric medicine societies, including the American Geriatric Society, have developed guidelines to help prescribers avoid potentially inappropriate prescribing or PIP, which requires assessment of several types of PIP, including the benefits and risks associated with certain drug classes.”  “Our study shows that regular self-reported use and co‐use of prescription drugs for pain and for sleep are significantly associated with increased incidence of frailty,” said Bergen. “We recommend further research to estimate the frailty risk of pain and sleep measures and of prescription pain and sleep drugs.” The HRS dataset used by the researchers is sponsored by the National Institute on Aging (NIA) of the National Institutes of Health and the Social Security Administration (SSA) and is conducted by the University of Michigan. RAND HRS data products used in this study are produced by RAND Center for the Study of Aging with funding from the NIA and SSA. Park will present this work at the Gerontological Society of America Annual Scientific Meeting (geron.org/2019) on Nov. 16 in Austin, Texas.   About the Oregon Research Institute Founded in 1960, Oregon Research Institute (ORI) is a charitable 501(c) 3 research center, dedicated entirely to understanding human behavior and improving the quality of human life. Funded by research grants from the National Institutes of Health and by the United States Department of Education, ORI scientists study such topics as childhood obesity and behavioral problems, promoting health across the age span, preventing and treating teen substance use and abuse, and understanding and preventing eating disorders. Emerging areas include genetics, opioid addiction, Alzheimer's disease, and health economics. See www.ori.org.   About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit www.fau.edu.
Newswise — LOS ANGELES (Nov. 11, 2019) -- A new study from researchers at the Smidt Heart Institute at Cedars-Sinai shows that electronic nicotine delivery systems, including devices such as e-cigarettes, may be just as harmful to the heart, if not more, than traditional cigarettes. The findings were presented today at the annual American Heart Association Scientific Sessions 2019.  "What makes e-cigarettes so harmful to the heart and lungs is not just nicotine," said senior author Florian Rader, MD, MSc, medical director of the Human Physiology Laboratory and assistant director of the Non-Invasive Laboratory at the Smidt Heart Institute. "It's the completely unknown bucket of manufactured products used to form vapors that is likely causing the most harm. This is what we believe is underlying the current public health problem."  These findings come at a crucial time, as reports of lung-related e-cigarette injuries are increasing, even while many distributors continue to claim that using e-cigarettes are safe and can help tobacco cigarette smokers kick the habit. A recent study by the Food and Drug Administration found that 27.5% of high school students used e-cigarettes in 2019, compared to 20.8% in 2018. The same study also estimates 3.62 million middle and high school students were e-cigarette users in 2018. In the Smidt Heart Institute study, the team of researchers compared healthy, young-adult smokers aged 18 to 38 who were regular users of e-cigarettes or tobacco cigarettes. The researchers then measured participants' blood flow to the heart muscle-focusing on a measure of coronary vascular function-before and after sessions of either e-cigarette use or cigarette smoking, while participants were at rest and also after they performed a handgrip exercise which simulates physiologic stress.  In smokers who used traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation and then decreased with subsequent stress. However, in smokers who used e-cigarettes, blood flow decreased after both inhalation at rest and also after handgrip stress.  "Our results suggest that e-cigarette use is associated with coronary vascular dysfunction at rest, even in the absence of physiologic stress," said Susan Cheng, MD, MPH, MMsc, director of Public Health Research at the Smidt Heart Institute and director of Cardiovascular Population Sciences at the Barbra Streisand Women's Heart Center. "These findings indicate the opposite of what e-cigarette and vaping marketing is saying about their safety profile." The original concept and design of this study was initiated by the late Ronald G. Victor, MD, a foundational pioneer in cardiovascular physiology studies. "We have known for decades that smoking increases your risk for heart attack and dying from heart disease," said Christine Albert, MD, MPH, founding chair of the newly established Department of Cardiology at the Smidt Heart Institute. "Now, with this study, we have compelling evidence suggesting that newer methods of electronic nicotine delivery may be equally, or potentially more, harmful to your heart as traditional cigarettes." Given that e-cigarettes represent a relatively new product on the market, Albert cautions users that there may be a number of unforeseen health effects. To better understand the potentially dangerous consequences of e-cigarettes, Rader, Cheng and investigators in the Human Physiology Laboratory at the Smidt Heart Institute plan on studying the mechanisms underlying changes in heart and blood vessel flow seen in their work to-date, as well as the effects of e-cigarette use across a more diverse population of study participants including those with existing cardiovascular risk. "What we are learning from our own research, along with the work of others, is that use of any electronic nicotine delivery system should be considered with a high degree of caution until more data can be gathered," said Rader. URL : http://www.cedars-sinai.org/newsroom/study-e-cigarettes-may-be-more-harmful-to-heart-health-than-tobacco/
UNC School of Medicine researchers are the first to show in animal models that components of marijuana, including its cannabinoids THC and CBD, can cause brain and facial birth defects if used during the first trimester of pregnancy. Credit: UNC School of Medicine (Left) The brain of a control mouse. (Right) The brain of a mouse exposed to alcohol and a cannabinoid on the 8th day of pregnancy. Note the enlarged cerebral ventricle caused by the loss of the midline septal region (black arrow).     Newswise — CHAPEL HILL, NC – A new study published in Scientific Reports, a Nature Research journal, shows how a one-time exposure during early pregnancy to cannabinoids (CBs) – both synthetic and natural – can cause growth issues in a developing embryo. This is the first research to show such a connection in mammals.  The study was performed in mice, which are very accurate models for the development that occurs during early pregnancy, according to the study’s senior author, Scott Parnell, PhD, assistant professor of cell biology and physiology in the UNC School of Medicine. “The development of the embryo in this time period is very similar across all vertebrates,” said Parnell, a member of the UNC Bowles Center for Alcohol Studies. “In this study we also test a synthetic cannabinoid in zebrafish that yielded similar growth deformations as the natural CBs. Having the same results across animal models reinforces our findings.” In this study, the brain and facial developmental effects caused by one-time exposure to CBs – CBD and THC (the primary ingredients of marijuana) – are very similar to what is seen in fetal alcohol syndrome (FAS). Parnell and colleagues also found that when CBs and alcohol were used together, the likelihood of these birth defects more than doubled. They went on to show that these drugs may be causing defects by interacting on a basic cellular level and disrupting signaling between molecules and cells that control growth and development. “The interaction between alcohol and CBs we witnessed is very concerning,” said the study’s first author, Eric Fish, PhD, research associate in the UNC School of Medicine Bowles Center for Alcohol Studies. “Previous studies have shown that CBs and alcohol are frequently used together, and for pregnant women we’re learning that could be very dangerous to a developing child.” In the study CBs, and CBs with alcohol, were given in varying amounts on day eight of pregnancy, which is comparable to the third and fourth weeks of pregnancy in humans. This time period is when alcohol and CB exposure is especially damaging to a developing embryo, and is before some women know they are pregnant. The CBD amounts administered were within what is considered a therapeutic range for humans. The THC concentration administered was similar to levels reached by a person smoking marijuana. “It is concerning how little we know about the use of marijuana, its CBs, and products like CBD oil during pregnancy,” Parnell said. “We know that there is no safe period to drink alcohol during a pregnancy, and I think this research shows the same is likely true of marijuana use.” With the results of these one-time exposures, Parnell and Fish are planning to now test smaller, multiple exposures throughout a pregnancy that better mimics real-life usage in human pregnancy. This research was supported by grants U01-AA021651 and U54-AA019765 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health. This work was done, in part, with the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), which is funded by grants from NIAAA.
Newswise — Tuesday, Nov. 5, 2019, CLEVELAND: Patients struggling with type 2 diabetes and obesity are faced with the decision of whether to receive usual medical care or undergo weight-loss surgery. Now, a new risk calculator developed by Cleveland Clinic researchers can show these patients their risks of developing major health complications over the next 10 years depending on which course of treatment they choose. The research was presented today as one of the Top 10 studies at the ObesityWeek 2019 international conference in Las Vegas.  Research has shown that weight-loss surgery – also known as metabolic or bariatric surgery – can help people control their diabetes and improve cardiovascular health. In 2016, the world’s leading diabetes organizations recommended in a consensus report that metabolic surgery should be a treatment option for people with type 2 diabetes and obesity.  However, few eligible patients undergo the surgery.  To help patients and their physicians better predict the health benefits of usual care versus surgical treatment, Ali Aminian, M.D., a bariatric surgeon at Cleveland Clinic, and his research team developed a risk score calculator that provides personalized evidence-based information, based on a patient’s current health status.  “The calculator can be a useful tool for physicians and patients with type 2 diabetes and obesity. It shows a patient’s risk of heart disease, stroke, heart failure, diabetic kidney disease, and death over the next 10 years with usual care. It also shows how a patient’s risk of those adverse events could change after metabolic surgery,” said Dr. Aminian, who is also lead author of the study.  The calculator — 10-year Individualized Diabetes Complications Risk Scores — was developed in two phases over the course of about two years. In the first phase, an observational study looked at nearly 2,300 patients who underwent metabolic surgery and 11,500 matched patients with similar characteristics who received usual medical care.  The phase 1 results, published in the Journal of the American Medical Association (JAMA) in September, show that weight-loss surgery performed in patients with type 2 diabetes and obesity is associated with 40 percent lower risk of death and major adverse cardiovascular events than usual medical care. Surgical patients also lost more weight, had better diabetes control, and used fewer medications for treatment of their diabetes and cardiovascular disease than those undergoing usual medical care.  In phase 2, the researchers used the same group of patients to identify predictors for different health outcomes. Evidence-based models were built and integrated into a risk calculator to estimate the likelihood of coronary heart disease, stroke, heart failure, diabetic kidney disease, and mortality over the next 10 years in patients with type 2 diabetes and obesity with and without bariatric surgery  “Based on the advice of subject matter experts, our team was able to explore 26 risk factors for the different outcomes, including risk of dying, in that large group of patients,” said Michael Kattan, Ph.D., chairman of the Department of Quantitative Health Sciences in Cleveland Clinic’s Lerner Research Institute. “We then compared machine learning and traditional statistical techniques to identify the most accurate prediction models for each outcome and built those into the calculator.” Steven Nissen, M.D., Chief Academic Officer of the Heart & Vascular Institute at Cleveland Clinic, added, “Diabetes can be a devastating disease and combined with obesity, patients are at a high risk for cardiovascular complications. Metabolic surgery is an underutilized treatment for these patients. This calculator can help both physicians and patients quantify the risks and benefits of surgery and make the best decision for treatment.”  The calculator will be accessible on the Cleveland Clinic Risk Calculator Library website and as a smartphone application (BariatricCalc). The second version of the app with additional calculators will be released during ObesityWeek 2019.  This study was partially funded by an unrestricted grant from Medtronic. Medtronic had no role in the design, conduct of the study, or reporting of the results. About Cleveland Clinic Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 66,000 employees are more than 4,200 salaried physicians and researchers and 16,600 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 11 regional hospitals in northeast Ohio, more than 180 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in southeast Florida; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2018, there were 7.9 million total outpatient visits, 238,000 hospital admissions and observations, and 220,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/CCforMedia and twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.
Newswise — (New York, NY – October 30, 2019) –A mother’s exposure to particulate air pollution during pregnancy is associated with reduced cardiac response to stress in six-month-old infants, according to Mount Sinai research published in Environmental Health Perspectives in October. This study is the first to find that particulate air pollution exposure in utero can affect heart rate variability, which is a known risk factor for health issues. Variability in how the heart rate responds to stressful experiences is essential for maintaining optimal functioning of the cardiovascular, respiratory, and digestive systems and also is central to emotional well-being and resilience to stress over one’s lifetime. Decreased heart rate variability, as observed in this study, is a known risk factor for mental and physical health problems in later life. Air pollution’s negative effect on heart rate variability has previously been found to lead to medical and psychological conditions such as heart disease, asthma, allergies, and mood or behavioral disorders in studies of older children, adolescents, and adults. Mount Sinai researchers studied 237 Boston-based mothers and their infants and used satellite data and air pollution monitors to determine the level of particulate air pollution the mothers were exposed to during pregnancy. The air pollution levels in this study were similar to levels experienced by the general U.S. population. By studying the babies’ heart rate and respiration at age six months, researchers found that the higher the level of the mother’s exposure to air pollution in pregnancy, the less variability in the infant’s heart rate in response to a stress challenge. “These findings, in combination with increasing worldwide exposure to particulate air pollution, highlight the importance of examining early-life exposure to air pollution in relation to negative medical, developmental, and psychological outcomes,” said senior author Rosalind Wright, MD, MPH, Dean for Translational Biomedical Research, and Professor of Pediatrics, Environmental Medicine and Public Health, and Medicine (Pulmonary, Critical Care and Sleep Medicine), at the Icahn School of Medicine at Mount Sinai. “A critical step in identifying children at risk for costly chronic disorders is identifying exposures that lead to early vulnerability.” “Identifying exposures that disrupt key processes such as heart rate response will lead to prevention strategies early in life when they can have the greatest impact. Specifically, these findings support individual-level and policy-level action to reduce exposure to particulate air pollution exposure during pregnancy,” said the study’s first author, Whitney Cowell, PhD, a postdoctoral fellow in Environmental Medicine and Public Health at the Icahn School of Medicine.    About the Mount Sinai Health System The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally. For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.
Newswise — Global warming may increase undernutrition through the effects of heat exposure on people, according to a new study published this week in PLOS Medicine by Yuming Guo of Monash University, Australia, and colleagues. It has been well documented that global warming will indirectly result in more undernourished people through threatening crop production in the long term. In the new study, researchers analyzed daily hospitalization data that covers nearly 80% of the population of Brazil, spanning the years 2000 through 2015. They studied the link between daily mean temperatures and hospitalization for undernutrition.   For every 1°C increase in daily mean temperature during the hot season, there was a 2.5% increase in undernutrition hospitalization (OR=1.025, 95% CI 1.020–1.030, p<0.001). People under age 19 years or over age 80 years with undernutrition were the most vulnerable to heat exposure. Overall, heat exposure was estimated to be responsible for 15.6% (95% CI 9.0–21.4) of undernutrition hospitalization during the study period. That fraction increased from 14.1% to 17.5% over the study period, during which time the mean temperature increased by 1.1°C. “The possible pathways of this direct impact of heat might include reducing undernourished people’s food intake, impairing their digestion and absorption function, and causing fluid and electrolyte disturbances,” the authors say. “Global strategies addressing the syndemic of climate change and undernutrition should not only focus on food supply but also the prevention of heat exposure especially among the young and elderly people.”   Funding: RX was supported by China Scholarship Council [grant number 201806010405] (https://www.csc.edu.cn/chuguo/s/1267). QZ was supported by a Monash Graduate Scholarship and Monash International Postgraduate Research Scholarship (https://www.monash.edu/graduate-research). SL was supported by the Early Career Fellowship of the Australian National Health and Medical Research Council [grant number APP1109193] (https://www.nhmrc.gov.au/). YG was supported by the Career Development Fellowship of the Australian National Health and Medical Research Council [grant number APP1107107 & APP1163693] (https://www.nhmrc.gov.au/). The funding bodies did not play any role in the study design, data collection, data analyses, results interpretation and writing of this manuscript.   Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: YG is a member of the Editorial Board of PLOS Medicine. MA holds investigator-initiated grants from Pfizer and Boehringer-Ingelheim for unrelated research and an unrelated consultancy from Sanofi. The other authors declare no actual or potential competing financial interests.   Citation: Xu R, Zhao Q, Coelho MSZS, Saldiva PHN, Abramson MJ, Li S, et al. (2019) The association between heat exposure and hospitalization for undernutrition in Brazil during 2000−2015: A nationwide case-crossover study. PLoS Med 16(10): e1002950. https://doi.org/10.1371/journal.pmed.1002950