Monthly Archives: May 2024

The type of surgery and its associated risk level exert a considerable influence on the occurrence of complications and mortality rates among elderly patients

Frailty stands as a well-established predictor concerning the likelihood of complications and mortality following surgery. Nonetheless, a recent study, as published in the Journal of the American College of Surgeons (JACS), reveals a significant escalation in postoperative complications and death among patients aged over 65 who undergo high-risk emergency surgeries compared to those evaluated solely based on frailty levels.

In the foreseeable future, the elderly demographic in the United States is expected to undergo a doubling, compelling surgeons to confront numerous considerations in decision-making processes, particularly concerning postoperative recuperation. Dr. Raul Coimbra, the study’s co-author and a prominent figure in the surgical field, underscores the deteriorating outcomes observed among elderly patients in emergency settings undergoing significant surgeries, urging for transparent communication with patients and their families regarding the associated risks and potential consequences.

The researchers postulated that, for the elderly cohort, the degree of procedural risk, whether high or low, holds greater significance in determining adverse outcomes when juxtaposed with frailty status alone. Utilising the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the researchers scrutinised records of elderly patients over 65 who underwent emergency surgeries between 2018 and 2020. This program is a benchmark for nationally evaluating and enhancing surgical care quality across hospitals.

Patients were categorised based on frailty levels — non-frail, frail, and severely frail — and then further grouped according to procedural risk, distinguishing between low-risk and high-risk operations. High-risk procedures included open cholecystectomy, open colectomy, laparoscopic colectomy, small bowel resection, and perforated ulcer repair, while low-risk procedures encompassed appendectomies and cholecystectomies.

The evaluation encompassed five key outcomes: 30-day mortality, 30-day postoperative complications, failure to rescue, hospital readmission, and 30-day reoperation. The aim was to delineate the impact of surgical procedure types on outcomes among elderly patients.

Among the study’s sample of 59,633 elderly patients, 29.3% were classified as non-frail, 66.4% as frail, and 4.3% as severely frail. Within these groups, 25,157 underwent low-risk procedures, whereas 34,476 underwent high-risk procedures. Both frailty and procedural risk correlated with elevated risks of mortality, postoperative complications, failure to rescue, and readmissions. However, when comparing the impact of procedural risk against frailty alone, the former emerged as a more robust predictor of adverse outcomes.

For instance, non-frail patients subjected to high-risk emergency surgeries exhibited a mortality rate of 7.1%, contrasting with a mere 0.2% mortality rate associated with low-risk procedures. Conversely, frail and severely frail patients undergoing high-risk procedures demonstrated mortality rates of 11.5% and 25.8%, respectively, compared to 1.0% and 4.1% following low-risk procedures.

High-risk procedures were associated with a fourfold increase in surgical complications among non-frail patients and similarly among frail and severely frail patients. The disparity between high-risk and low-risk procedures was consistently at least four times greater across all outcome measures compared to frailty status alone, with high-risk procedures magnifying the risk of 30-day mortality by eightfold.

Dr Coimbra underscores the urgent nature of many surgeries among elderly patients, attributing it to the delayed seeking of surgical care and surgeons’ reluctance to address issues electively. Delaying minor surgeries could significantly compromise long-term health and quality of life in elderly patients. Consequently, the study authors advocate for a shift in approach, emphasising the importance of early surgical intervention to mitigate the need for emergency surgeries and their associated risks.

The findings underscore the imperative of timely surgical intervention for elderly patients, aiming to circumvent the heightened risks associated with emergency surgeries. Transparent communication and informed decision-making are pivotal in guiding treatment strategies and managing expectations regarding postoperative outcomes in this vulnerable demographic.

More information: Zakhary, Bishoy et al, Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis, Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001079

Journal information: Journal of the American College of Surgeons Provided by American College of Surgeons

Intelligent skin bacteria can produce and secrete molecules to combat acne

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An international research project, spearheaded by the Translational Synthetic Biology Laboratory within the Department of Medicine and Life Sciences (MELIS) at Pompeu Fabra University, has successfully engineered a strain of Cutibacterium acnes, a common skin bacterium, to produce and secrete a molecule aimed at alleviating acne symptoms. This engineered bacterium has been tested on skin cell lines, and experiments with mice have confirmed its effectiveness. This breakthrough paves the way for synthetic biology to transform non-engineerable bacteria into agents that can manage skin conditions and other diseases through biotherapeutic methods.

The research consortium includes eminent scientists from prestigious institutions such as the Bellvitge Biomedical Research Institute (Idibell), the University of Barcelona, the Protein Technologies Facility of the Centre for Genomic Regulation, Phenocell SAS, Medizinische Hochschule Brandenburg Theodor Fontane, Lund University, and Aarhus University.

Acne is a prevalent skin ailment caused by the clogging or inflammation of pilosebaceous follicles. Manifestations range from whiteheads and blackheads to more severe forms like pustules and nodules, predominantly affecting areas such as the face, forehead, chest, upper back, and shoulders. While acne commonly appears during adolescence, it does not discriminate by age.

For more severe acne cases, traditional treatments have included antibiotics to eradicate bacteria within the follicles or isotretinoin (also known as Accutane), a vitamin A derivative that promotes the death of sebocytes—epithelial cells producing sebum. Nevertheless, these treatments can disrupt the balance of skin microbiota due to their non-selective bacterial eradication or cause severe side effects like photosensitivity and congenital disabilities.

The study, published today in Nature Biotechnology, describes how the researchers modified the genome of Cutibacterium acnes to enable the secretion of the NGAL protein, which mimics the action of isotretinoin. This protein effectively reduces sebum production by promoting the apoptosis of sebocytes.

Nastassia Knödlseder, the study’s lead author and a postdoctoral researcher at the UPF Translational Synthetic Biology Laboratory, commented on the innovation: “We have devised a topical treatment that leverages what nature already provides. By engineering a naturally occurring skin bacterium to produce therapeutic agents, we have opened the door to treating not only acne but potentially other conditions as well.”

Engineering C. acnes, previously deemed intractable for genetic modification, was overcome by improving methods for DNA delivery, enhancing the stability of DNA within the cell, and optimizing gene expression. The research team, led by Marc Güell, employed regulatory strategies to develop a biocontainment approach that eliminates concerns related to mobile genetic elements, plasmids, or antibiotic resistance markers, ensuring the safety of the synthetic bacterium for potential therapeutic applications.

The synthetic C. acnes wereld secreted NGAL in tests, regulating sebum production in cell cultures. Although initially tested in mice, whose skin differs significantly from human skin, the researchers underscore the need for alternative models that more closely resemble human skin, such as 3D skin models, to validate these findings further.

Looking ahead, Güell highlights the broader implications of their work: “Our technology platform is not limited to treating acne. It can potentially be used to engineer any bacterium to treat a wide range of diseases, from skin conditions to immune system disorders, by delivering genetic modifications that enable bacteria to sense and respond to bodily changes.”

The ongoing research under the European ‘SkinDev’ project aims to extend this technology to tackle atopic dermatitis, a chronic inflammatory skin condition prevalent among young children, by engineering C. acnes to address this and potentially other dermatological disorders.

This innovative approach to creating living therapeutics holds promise for transforming the treatment of skin conditions and other diseases, offering a new realm of possibilities in medical science. Given the safe and effective history of non-engineered C. acnes in clinical settings, the researchers remain optimistic about the potential application of these engineered microbes in human patients.

More information: Nastassia Knödlseder et al, Delivery of a sebum modulator by an engineered skin microbe in mice, Nature Biotechnology. DOI: 10.1038/s41587-023-02072-4

Journal information: Nature Biotechnology Provided by Universitat Pompeu Fabra

Medicare is covering message-based e-visits. Are older adults utilising this service?

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At the onset of the pandemic, Medicare made a pivotal move, announcing its intention to reimburse healthcare providers for the time spent managing patients’ digital messages. This landmark initiative, which primarily focused on messages involving at least five minutes of medical decision-making, marked a significant shift in healthcare policy. While these asynchronous “e-visits” conducted through secure patient portals may have received less attention compared to video and phone telehealth visits, recent research indicates that they have become a routine aspect of healthcare for some of the 30 million older Americans under traditional Medicare. Approximately 1% of this demographic engaged in patient portal messaging, prompting their healthcare providers to bill Medicare for their time. However, these billed e-visits represented only a minuscule fraction (0.05%) of all visits aimed at evaluating or managing health conditions in this population.

The study, led by researchers from the University of Michigan and published in Health Affairs Scholar, revealed that nearly half of the billed e-visits involved primary care providers, primarily assisting patients with hypertension or diabetes. Following a surge at the pandemic’s onset, the rate of billed e-visits in traditional Medicare stabilised consistently until the end of 2022. Nonetheless, it’s important to note that a considerable volume of patient portal messages circulate daily without generating a bill, such as requests for prescription refills or updates on the patient’s well-being, which were not part of the study due to the unavailability of data without billing information.

The transformation in care delivery, particularly the increasing use of patient portal messaging, has significantly impacted the workflow of primary care clinicians. Dr Terrence Liu, the study’s lead author and a National Clinician Scholar at U-M’s Institute for Healthcare Policy and Innovation, emphasises the need for a deeper understanding of how such care modalities can be optimally utilised by both patients and providers. He highlights the potential implications on clinic operations, provider burnout, and patient outcomes. For instance, while e-visits offer a convenient tool for chronic disease management, they also pose challenges for clinicians, especially those managing large patient panels, as even a few lengthy e-visits can consume significant time not accounted for in their schedules.

To effectively handle the influx of patient portal messages, some clinics have implemented triage systems, assigning dedicated staff members to screen and allocate messages to appropriate responders. This strategic approach helps preserve physician and advanced-practice provider time for addressing inquiries that require their expertise the most. However, variations exist in how different clinics triage portal messages, underscoring the need for standardised protocols to ensure consistency and efficiency across healthcare settings. This discussion on managing patient portal messages presents an intriguing area for further research and development in healthcare delivery.

Despite the potential benefits of e-visits, concerns linger regarding the financial implications for patients. At the same time, Medicare covers e-visits and insurance coverage for such services varies, leading some providers to hesitate to bill portal exchanges to avoid passing costs onto patients. Dr Liu underscores the importance of further research to assess the impact of e-visits on overall healthcare utilisation and explore the content and outcomes of these interactions, particularly regarding chronic disease management. Additionally, it’s crucial to evaluate whether adopting patient portal e-visits exacerbates healthcare disparities, potentially widening the gap among patients with differential access to and proficiency in communication technologies.

More information: Terrence Liu et al, National trends in billing patient portal messages as e-visit services in traditional Medicare, Health Affairs Scholar. DOI: 10.1093/haschl/qxae040

Journal information: Health Affairs Scholar Provided by University of Michigan Health

Research review highlights the gut-skin connection as a key factor in atopic dermatitis

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Atopic dermatitis (AD), a chronic inflammatory skin condition, primarily manifests through symptoms such as redness, swelling, and itchy rashes. It predominantly affects individuals genetically predisposed to the condition. The presentation of symptoms is influenced by a complex interplay among the immune system, environmental factors, and gut microbiota, with many aspects of this intricate relationship yet to be fully uncovered. Recent studies have shed light on critical elements contributing to AD severity. For instance, changes in gut microbiota composition have been linked to exacerbated disease symptoms, while environmental triggers like allergens and pollution can aggravate the condition. Genetic predispositions also play a critical role in susceptibility to AD, and emerging treatments such as dietary adjustments and faecal transplantation show promise in managing the disease.

The understanding of these interconnected factors is crucial for advancing our comprehension of AD and serves as a foundation for developing new therapeutic approaches, as discussed in a collaborative review article from the International Journal of Molecular Sciences. This research, conducted by teams from the University of São Paulo (USP) and Federal University de São Paulo (UNIFESP) in Brazil, delves into these dynamics, showcasing the global effort in tackling this complex condition.

Often referred to as atopic eczema, AD impacts approximately 7%-10% of adults and 20%-25% of children, with no clear consensus on its prevalence between genders. The frequency of AD has significantly risen in the 21st century, a trend attributed to various factors, including genetic and autoimmune influences, compromised skin barrier function, viral infections, changes in gut microbiome composition, dietary habits, and lifestyle alterations.

A notable hypothesis posits that the surge in AD cases in developing regions might stem from reduced exposure to beneficial bacteria, potentially affecting immune system maturation. In this critical process, the immune system evolves its response following initial microbial contact.

The review underscores the pivotal role of gut microbiota in recent AD research. According to Sabri Saeed Sanabani, a researcher at the Institute of Tropical Medicine (IMT-USP) and the article’s senior author, the gut microbiome is integral not only for regulating 70% of the immune system but also for maintaining the integrity of the skin barrier and gastrointestinal tract structure. It is crucial in nutrient absorption and energy balance and is directly connected to the skin through the gut axis.

Recent findings suggest that disturbances in gut microbiome composition can lead to AD pathogenesis. Research indicates an increased presence of pathogenic bacteria like Clostridium difficile, Escherichia coli, and Staphylococcus aureus, alongside a reduced abundance of beneficial bacteria such as Bifidobacteria and Bacteroides, which produce short-chain fatty acids (SCFAs). A decrease in SCFA levels is often linked with intestinal inflammation in otherwise healthy individuals.

Genetic research, particularly genome-wide association studies (GWAS), continues to identify genetic variants associated with AD susceptibility and progression. Notably, mutations in the filaggrin gene (FLG), vital for maintaining skin barrier integrity, have been identified as a significant risk factor for AD. However, it remains unclear whether alterations in the gut microbiome are genetically determined.

Although not fully understood, the role of environmental factors in AD is acknowledged in the context of how allergens, irritants, pollution, and microbial exposure can undermine skin barrier function and disrupt gut microbiome balance.

The review discusses promising therapeutic approaches targeting epigenetic changes and modulating gut microbiome diversity through dietary interventions, probiotics, prebiotics, and faecal transplants. These innovative treatments hold the potential to revolutionize the management of atopic dermatitis, offering new hope for patients and healthcare professionals alike.

As with all comprehensive reviews, the primary aim is to analyze existing scientific literature, confirm what is known, and identify gaps that require further investigation, as explained by Sanabani. This ongoing research is pivotal for paving the way towards more effective and targeted treatments for atopic dermatitis.

More information: Rodrigo Pessôa et al, The Interaction between the Host Genome, Epigenome, and the Gut–Skin Axis Microbiome in Atopic Dermatitis, International Journal of Molecular Sciences. DOI: 10.3390/ijms241814322

Journal information: International Journal of Molecular Sciences Provided by Fundação de Amparo à Pesquisa do Estado de São Paulo

A spiral-shaped lens offers clear vision across distances and lighting conditions

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Researchers have developed a groundbreaking spiral-shaped lens capable of maintaining sharp focus across different distances and lighting conditions, akin to progressive lenses but without their typical distortions. Dubbed the “spiral diopter,” this innovative lens has the potential to significantly advance various fields, including contact lens technology, intraocular implants for cataracts, and miniaturised imaging systems.

Unlike existing multifocal lenses, the spiral diopter performs exceptionally well under a wide range of lighting conditions and maintains its multifocality regardless of pupil size. This unique characteristic could revolutionise the field of ophthalmology by providing consistently clear vision for individuals, particularly those with age-related farsightedness or needing intraocular implants.

Published in Optica, the journal for high-impact research by Optica Publishing Group, the research team unveils the innovative design of the spiral diopter. Its spiralling features create multiple points of focus, akin to having multiple lenses in one. This design offers wearers the ability to see clearly at various distances, presenting a versatile solution for vision correction across different visual tasks and environments. The novelty of this design is sure to pique the interest of the scientific community.

The inspiration behind the spiral lens design originated from analysing severe corneal deformations in patients, leading to the conceptualisation of a lens with a unique spiral design. This design induces a phenomenon known as an optical vortex, where light spins like water going down a drain, creating multiple clear focus points. Integrating these elements directly into the lens’s surface simplifies the creation of optical vortices, marking a significant advancement in optics.

By combining an intuitively crafted design with advanced fabrication techniques, the researchers have harnessed the potential of the spiral diopter. Validation studies using the lens to image a digital ‘E’ demonstrated satisfactory image quality regardless of aperture size. Volunteers reported noticeable improvements in visual acuity across various distances and lighting conditions. The researchers are now poised to conduct systematic trials to comprehensively establish the lens’s real-world performance and advantages in correcting vision. Moreover, they are exploring the potential application of the concept to prescription eyeglasses, promising clear vision across multiple distances for users. This breakthrough technology enhances depth perception in changing lighting conditions. It holds promise for advancing compact imaging technologies, wearable devices, and remote sensing systems for drones or self-driving cars, contributing to their reliability and efficiency. The potential of the spiral diopter lens is vast, sparking excitement for its future applications.

More information: Laurent Galinier et al, Spiral diopter: freeform lenses with enhanced multifocal behavior, Optica. DOI: 10.1364/OPTICA.507066

Journal information: Optica

New research reveals that ageing adults have withdrawn from civic life since the onset of the pandemic

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Several years after the United States started to gradually recover from the enforced COVID-19 lockdowns, new findings from the University of Colorado Boulder indicate that a significant number of older adults continue to spend more time at home and less time engaging socially in public areas compared to their pre-pandemic habits. This research highlights that over half of the older adult population still avoids the social scene, driven by fears of infection and a social atmosphere they find increasingly uncomfortable and hostile.

Jessica Finlay, an assistant professor of geography, shared insights from her recent research through a series of papers. She pointed out that for many, the pandemic still significantly impacts their lives. “The pandemic is not over for a lot of folks,” she remarked, acknowledging that some individuals feel neglected in the current recovery phase.

This study is particularly relevant in the context of what the U.S. Surgeon General has described as an ‘epidemic of loneliness,’ with older adults, especially those who are immunocompromised or have disabilities, being acutely vulnerable. Finlay elaborated on how the pandemic has profoundly transformed ageing Americans’ community dynamics and daily routines, posing long-lasting effects on their physical, mental, social, and cognitive well-being.

As a health geographer and environmental gerontologist, Finlay is particularly interested in how social and physical environments influence health outcomes as people age. Her curiosity about the long-term effects of the pandemic was piqued in March 2020 when restaurants, gyms, grocery stores, and other communal spaces were suddenly closed under shelter-in-place directives. This prompted her to initiate the COVID-19 Coping Study in collaboration with Lindsay Kobayashi, an epidemiologist at the University of Michigan. Their ongoing study began with a baseline survey followed by monthly updates, gathering responses from nearly 7,000 individuals aged 55 and over across the United States.

The research has been particularly attentive to the evolving social landscape, surveying participants at critical moments, including shortly after the murder of George Floyd in May 2020 and following the attack on the U.S. Capitol in January 2021. The findings collectively depict a concerning scenario where a large segment of the older population remains isolated while the rest of society moves forward.

Results from one of the papers published in February in the journal Wellbeing, Space and Society show that 60% of respondents now spend more time at home, 75% dine out less frequently, and over half report decreased attendance at cultural, artistic, and religious gatherings compared to their life before the pandemic. Despite the survey being two years old, more recent data from spring 2023 continues to reflect similar trends, indicating persistent changes in these individuals’ social and entertainment routines.

Another study, “I just can’t go back,” reveals that 80% of participants hesitate to revisit certain public places. The research presents personal accounts, like that of a 72-year-old man who cannot envision returning to a gym, highlighting the deep-seated apprehensions about public gatherings in enclosed spaces.

Respondents who still venture into public places like grocery stores do so with minimal interaction, quickly moving in and out to avoid prolonged contact. This shift in behaviour is a stark departure from the pre-pandemic norms, where casual conversations were commonplace. Many participants expressed concerns about contracting or transmitting the virus to vulnerable family members, and the social stigma associated with mask-wearing and social distancing only reinforces their reluctance to engage publicly.

However, it’s not all grim. Finlay points out some positive shifts, such as a 10% increase in older adults exercising outdoors more frequently and a small subset who have embraced the digital expansion of meetings, concerts, and classes. Yet, she remains concerned about the broader health implications of reduced spontaneous social interactions, often called ‘third places’ in sociological terms. The absence of these interactions, she warns, can heighten the risk of premature death, mental illness, and dementia, comparable to the health risks of smoking 15 cigarettes a day.

Finlay advocates for societal adaptations that could reintegrate older adults into public life, suggesting enhancements like outdoor dining, ventilated cultural spaces, and accommodations for masked or hybrid events. She also calls for a more understanding approach towards those who continue to practice caution in their social interactions, emphasizing that for many, overcoming the pandemic is not merely a matter of choice but a complex challenge shaped by various personal factors. Her work aims to foster a more inclusive environment that acknowledges and addresses these continued disparities in the post-pandemic landscape.

More information: Jessica Finlay et al, Altered place engagement since COVID-19: A multi-method study of community participation and health among older americans, Wellbeing Space and Society. DOI: 10.1016/j.wss.2024.100184

Journal information: Wellbeing Space and Society Provided by University of Colorado Boulder

Researchers demonstrate the impact of insomnia and depression on asthma management

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Researchers from National Jewish Health have illuminated the adverse effects of underlying mood and sleep disorders on asthma control. Data unveiled a significant interplay between insomnia, depression, and obstructive sleep apnea in individuals managing asthma. Recently published in the Journal of Asthma, this study sheds crucial light on the intricate relationship between these conditions.

Dr. Michael Wechsler, a pulmonologist, Professor of Medicine, and Director of The Cohen Family Asthma Institute at National Jewish Health, and the paper’s senior author, emphasized the importance of collectively considering asthma control, sleep quality, and mood. He highlighted the strong correlation among these factors, stating that individuals with asthma should undergo regular screening for both sleep quality and co-existing mood disorders.

In their investigation, researchers conducted a retrospective chart review of 659 adult patients participating in a long-term study at National Jewish Health. The evaluation of asthma patients encompassed factors such as concurrent obstructive sleep disorder, mood disorders, frequency of asthma exacerbations, and asthma control test scores (ACT). The findings underscored a notable increase in mood disorders among asthma patients experiencing insomnia compared to those without sleep disturbances.

The association between poor sleep quality and asthma, especially in those with inadequate asthma control, is well-established. Moreover, insomnia frequently overlaps with depression. While previous research has explored the link between sleep issues and asthma management, the interaction between these conditions and mood disorders has not been extensively examined.

Upon scrutinizing the data, researchers observed that individuals with insomnia were more likely to receive concurrent diagnoses of obstructive sleep apnea, depression, or anxiety compared to those without sleep disturbances. Moreover, among patients with insomnia, there was a higher average frequency of asthma exacerbations per year compared to those without insomnia.

Dr. Wechsler underscored the importance of addressing asthma comorbidities, such as sleep and mood disorders, akin to other conditions impacting asthma management, including reflux, sinus disease, and vocal cord dysfunction.

Further research is imperative to elucidate the mechanisms underlying the intricate interactions between asthma, sleep, and depression. Such understanding may pave the way for developing guidelines for screening and managing sleep and mental health disorders in individuals with asthma.

More information: Sarah L. Rhoads et al, The impact of insomnia and depression on asthma control, Journal of Asthma. DOI: 10.1080/02770903.2024.2335367

Journal information: Journal of Asthma Provided by National Jewish Health

Scientists identify skin biomarkers in infants that forecast the early onset of food allergies

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Food allergies are prevalent during childhood and pose severe or even life-threatening risks. Researchers at National Jewish Health are actively developing strategies to prevent these allergies and have made significant strides in identifying early indicators of the condition.

A study recently published online in the March 2024 edition of the Journal of Allergy & Clinical Immunology revealed groundbreaking findings from skin tape strips collected from the forearms of two-month-old infants, an age before any observable signs of food allergies. The researchers at National Jewish Health pioneered this non-invasive and gentle skin tape sampling technique specifically for young patients. The process involves applying tape to the skin to collect superficial proteins and lipids, which are then analysed to examine the constituents of the skin. Following the initial testing, the children were closely monitored until age two to determine if any allergies would manifest.

Dr. Evgeny Berdyshev, a distinguished researcher at National Jewish Health and the first author of the study, provided insightful explanations. He stated, “The immune system’s interaction with the skin barrier alters its composition. With our gentle skin tapes, we can detect whether the proteins on the surface are abnormal.” He further noted that the presence of abnormal lipids and proteins is an early indicator of potential future conditions such as atopic dermatitis and food allergies.

Dr. Donald Leung, the head of the Division of Pediatric Allergy & Immunology in the Department of Pediatrics at National Jewish Health and senior author of the study, highlighted the broader aims of the research. “Our goal is to identify individuals at risk of developing food allergies and intervene early by addressing abnormalities in the skin barrier, thus preventing these conditions,” he said.

Dr. Leung, the head of the Division of Pediatric Allergy & Immunology in the Department of Pediatrics at National Jewish Health and senior author of the study, shared insights on the ongoing efforts. He stated, “This study marks just the beginning. We have now identified a biomarker for atopic dermatitis and food allergies, characterised by abnormal lipids, microbes, and proteins. Our current trials involve administering a lipid cream to newborns to see if it can correct these abnormalities by penetrating and enriching the skin with fatty acids.” The researchers are also developing an anti-inflammatory cream based on their findings.

National Jewish Health is recruiting. It is one of four global sites participating in the study known as SEAL—an acronym for ‘Stop Eczema and Allergy.’ The study is looking for expectant mothers and babies aged between 0 and 12 weeks to participate in this pivotal research.

More information: Evgeny Berdyshev et al, Skin biomarkers predict the development of food allergy in early life, Journal of Allergy and Clinical Immunology. DOI: 10.1016/j.jaci.2024.02.014

Journal information: Journal of Allergy and Clinical Immunology Provided by National Jewish Health

Opting for sugary beverages instead of fruit juice during infancy has been associated with an increased likelihood of developing obesity in adulthood

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Consuming sugar-sweetened beverages during childhood has been associated with the development of unhealthy dietary patterns, which can elevate the risk of obesity in later stages of life, as indicated by a recent investigation conducted by the School of Psychology at Swansea University.

Published in the European Journal of Clinical Nutrition, this research tracked the dietary influences on a cohort of 14,000 British children from infancy to adulthood, marking it as one of the most extensive studies of its nature to date.

Utilising the Avon Longitudinal Study of Parents and Children, the team of researchers uncovered several noteworthy findings:

Firstly, it was observed that children who consumed carbonated drinks like cola or sugar-laden fruit cordials before reaching the age of two tended to exhibit increased weight gain by the time they reached 24. Interestingly, girls who consumed pure fruit juice exhibited lesser weight gain, while boys did not display significant weight changes.

Furthermore, toddlers who consumed cola at three demonstrated higher calorie, fat, protein, and sugar intake but lower fibre consumption. Conversely, those given pure apple juice exhibited reduced fat and sugar intake but consumed higher levels of fibre.

The study also shed light on the differing dietary preferences associated with these beverage choices. Children who consumed pure apple juice tended to follow diets comprising more fish, fruits, green vegetables, and salads. In contrast, those consuming cola preferred burgers, sausages, pizza, french fries, meat, chocolate, and sweets.

Moreover, the research team identified a correlation between sugar-sweetened beverage consumption and social deprivation, noting that children from more affluent backgrounds were more likely to have access to pure fruit juice.

Lead researcher Professor David Benton remarked, “Early dietary habits establish patterns that have enduring effects on weight regulation throughout life. It is imperative to encourage the development of healthy dietary habits from infancy, promoting lower fat and sugar consumption. However, it’s important to note that pure fruit juice, as part of one’s recommended daily intake of fruits and vegetables, contributes essential nutrients such as vitamin C, potassium, folate, and plant polyphenols.”

Dr Hayley Young added, “Obesity poses significant health risks and can predispose individuals to various other medical conditions. Our findings underscore the critical role of early childhood diet in shaping the trajectory towards adult obesity. To effectively address this issue, greater emphasis must be placed on promoting healthy dietary practices during the formative years of life.”

More information: David Benton et al, Early exposure to sugar sweetened beverages or fruit juice differentially influences adult adiposity, European Journal of Clinical Nutrition. DOI: 10.1038/s41430-024-01430-y

Journal information: European Journal of Clinical Nutrition Provided by Swansea University

NUS researchers reveal a connection between unhealthy diets and increased cancer risk

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A team of researchers from the National University of Singapore (NUS) has made a significant breakthrough in understanding how poor diets contribute to an increased risk of cancer and other common diseases, such as diabetes. The findings of this study promise to enhance strategies for cancer prevention and promote healthier ageing.

Professor Ashok Venkitaraman spearheaded the research at the Cancer Science Institute of Singapore (CSI Singapore) and the NUS Centre for Cancer Research (N2CR) at the Yong Loo Lin School of Medicine. The team collaborated closely with colleagues from the Agency for Science, Technology and Research (A*STAR).

Professor Venkitaraman, the Director of CSI Singapore, highlighted the complexity of cancer’s causation, which involves genetic factors and environmental influences like diet, physical activity, and pollution. He stressed the importance of clarifying these interactions to devise effective preventative measures contributing to sustained health.

Central to their research was the study of methylglyoxal, a byproduct of glucose breakdown in cells, implicated in diabetes, obesity, and poor dietary habits. This chemical was found to be particularly damaging to the DNA of patients with an inherited risk of breast or ovarian cancers linked to a defective BRCA2 gene. Such damage serves as an early indicator of potential cancer development.

Further investigations revealed that individuals without the genetic defect but with elevated methylglyoxal levels—such as those suffering from diabetes or pre-diabetes associated with poor diet—also showed signs of increased cancer risk. Professor Venkataraman explained that detecting high methylglyoxal levels through a simple blood test, like the HbA1C, could be a marker for cancer risk, paving the way for preventative treatments through medication and dietary adjustments.

Dr Li Ren Kong, a Lee Kuan Yew Fellow at N2CR and the study’s first author mentioned that their initial goal was to explore risk factors in genetically predisposed families. Still, they uncovered a crucial link between energy metabolism and cancer development. This underscores the importance of diet and weight management in cancer risk reduction.

The research also challenged a long-standing theory in cancer genetics, known as Knudson’s ‘two-hit’ hypothesis, which posits that cancer-preventing genes need to be permanently disabled for cancer to emerge. The team’s findings suggest that temporary inactivation of these genes by compounds like methylglyoxal, mainly through repeated poor dietary choices or unmanaged diabetes, could cumulatively heighten cancer risk over time. These insights could significantly redirect future cancer research.

Their groundbreaking work, published in the prestigious journal Cell on 11 April 2024, has set the stage for subsequent studies. The team plans to explore further how metabolic disorders affect cancer risks in different populations, particularly in Singapore and other Asian contexts.

Looking ahead, the researchers are eager to delve deeper into the mechanisms they’ve uncovered between metabolism, diet, and cancer. Their goal is to develop more effective strategies to prevent or delay the onset of cancer, potentially transforming the landscape of cancer research and prevention.

More information: Li Ren Kong et al, A glycolytic metabolite bypasses “two-hit” tumor suppression by BRCA2, Cell. DOI: 10.1016/j.cell.2024.03.006

Journal information: Cell Provided by National University of Singapore

The Canadian Cardiovascular Society has recently released updated guidelines for evaluating the fitness of private and commercial drivers to operate vehicles

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The latest update from the Canadian Cardiovascular Society (CCS) brings forth refreshed guidelines to evaluate the suitability of private and commercial drivers to operate vehicles safely. These guidelines, encapsulated in the CCS Fitness to Drive Guidelines, reflect the most recent insights into driving restrictions, particularly concerning the risk of sudden cardiac incapacitation. Employing the CCS Risk of Harm formula alongside available empirical evidence, these guidelines delineate the probability of such incapacitation and acceptable risk thresholds, thereby furnishing essential direction on when it is prudent to allow individuals to resume driving activities.

The recommendations outlined in the Fitness to Drive Guidelines are strategically crafted to assist physicians and healthcare practitioners in advising individuals grappling with heart-related ailments about the associated risks and appropriate durations for driving abstinence. Spearheaded by a panel of national experts, these updated, evidence-based guidelines have found their place in the esteemed Canadian Journal of Cardiology under the auspices of Elsevier.

Dr. Peter G. Guerra, the lead co-chair of the revamped guidelines from the Montréal Heart Institute, University of Montréal, underscores the pivotal role cardiovascular conditions play in compromising driving capability. Such conditions, owing to their potential to impede blood circulation to the brain, can precipitate alterations in mental acuity through various mechanisms like myocardial infarction, cardiac arrhythmias, and heart failure. Consequently, healthcare providers frequently find themselves tasked with evaluating the fitness of individuals with cardiac ailments to operate vehicles.

The Fitness to Drive Guidelines not only build upon but also enhance the efficacy of their predecessors, which have served as stalwart pillars of guidance for over two decades. These guidelines assimilate fresh insights from therapies, interventions, and disease entities in their evolution. Among the factors considered are percutaneous therapies for valvular disease, genetic disorders, and recent research elucidating the risk of shock or incapacitation in patients with implantable defibrillators.

Dr. Christopher S. Simpson, co-chair alongside Dr. Guerra, elaborates on the methodological approach to formulating these guidelines. Given the absence of randomised trials on Fitness to Drive, observational studies were leveraged to gauge the risk of driving impairment across various scenarios. Recommendations were then moulded on the foundation of the CCS Risk of Harm formula, a validated assessment tool of paramount significance. Notably, more stringent recommendations were tailored for commercial drivers, considering their prolonged periods behind the wheel, operation of larger vehicles, and potential transportation of a more significant number of passengers.

The Fitness to Drive Guidelines offer comprehensive recommendations for individuals with a spectrum of cardiovascular conditions. These conditions, numbering seven in total, encompass active coronary artery disease, valvular heart disease, heart failure, heart transplant, left ventricular assist devices, arrhythmia syndromes, implantable devices such as pacemakers and defibrillators, syncope episodes, and congenital heart disease.

Through meticulous analysis, expert consensus, and integration of contemporary evidence, the Canadian Cardiovascular Society continues to fortify its commitment to enhancing road safety while addressing individuals with cardiovascular disorders’ unique needs and challenges. These updated guidelines stand as a testament to the society’s unwavering dedication to safeguarding public health and fostering informed decision-making within cardiology and beyond.

More information: Peter G. Guerra et al, Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive, Canadian Journal of Cardiology. DOI: 10.1016/j.cjca.2023.09.033

Journal information: Canadian Journal of Cardiology Provided by Elsevier

Biomedical researchers edge closer to understanding the causes of eczema

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Researchers at Binghamton University, State University of New York, have unveiled a study that could potentially revolutionize our understanding of eczema and pave the way for a cure. With approximately 35 million Americans and a significant global population affected by eczema, this chronic condition, also known as atopic dermatitis, is a pressing health concern. The study’s findings shed light on the underlying causes of eczema, offering a new perspective on its management and treatment.

In a collaborative effort, Associate Professor Guy German, PhD student Zachary W. Lipsky, and Associate Professor Claudia N.H. Marques has bridged two seldom-connected areas of eczema research. Their recent publication from the Thomas J. Watson School of Engineering and Applied Science’s Department of Biomedical Engineering and the Harpur College of Arts and Sciences’ Department of Biological Sciences marks a significant step forward in our understanding of this complex condition.

The study highlights that atopic dermatitis leads to reduced levels of skin oils, particularly ceramides, a group of lipids. These lipids regulate skin hydration and protect against pathogens, either by direct antimicrobial action or indirectly through immune signalling. Moreover, the research points to increased staph bacteria on the skin, which exacerbates irritation and infection.

Professor German notes the role of genetics in eczema prevalence but also identifies occupational hazards—like frequent handwashing or exposure to detergents among healthcare workers, metalworkers, hairdressers, and food processors—as factors that increase susceptibility to the condition. He poses a critical question about the consequences of reduced lipid levels on the skin due to genetic mutations or occupational exposure.

The study suggests that bacteria cannot breach the skin barrier under normal conditions. However, in conditions associated with atopic dermatitis or similar lipid deficiencies, penetration occurs within nine days. The team theorizes that staph bacteria do not merely grow around skin cells but move through them. This bacterial movement, combined with lipid depletion, compromises the skin’s barrier, increasing vulnerability to bacterial invasion and deeper skin tissue infection.

Lipsky elaborates on the protective role of skin lipids, which are traditionally associated with moisture retention. The current findings illuminate their critical function in defending against microorganisms that could cause diseases. While the study does not solve all mysteries of atopic dermatitis, it proposes that bacterial infiltration might initiate rather than result from the disease, marking a significant advancement in understanding the condition.

Further inquiries will focus on the mechanical effects of bacterial penetration on lipid-depleted skin, exploring whether it weakens the skin or enhances the likelihood of cracking and how bacteria navigate through different skin layers.

As Professor German rightly points out, every scientific answer typically raises more questions, ensuring that their research journey continues to be dynamic and exploratory. This ongoing study not only deepens the understanding of atopic dermatitis but also sets the stage for future breakthroughs in treating and managing the condition. The potential implications of this research are immense, offering hope for millions of individuals affected by eczema.

More information: Zachary W. Lipsky et al, Lipid depletion enables permeation of Staphylococcus aureus bacteria through human stratum corneum, Tissue Barriers. DOI: 10.1080/21688370.2020.1754706

Journal information: Tissue Barriers Provided by Binghamton University