Daily Archives: 9 July 2024

Surgical Intervention Enhances Quality of Life in Patients with Acoustic Neuroma: Study Findings

Researchers at the University of California, San Diego School of Medicine have discovered that employing an innovative surgical technique to remove acoustic neuromas and slow-growing benign brain tumours enhances hearing preservation and quality of life for patients, alongside excellent facial nerve outcomes.

Published in the May 21, 2024, online edition of Otology & Neurotology, the study highlights significant improvements in patient outcomes following the surgical removal of acoustic neuromas using the middle fossa craniotomy approach. This method involves accessing the area above the inner ear and internal auditory canal, which is crucial for preserving hearing and overall well-being.

Key findings from the research, involving 71 participants, indicate that 68% of patients retained their hearing, with 94% achieving excellent facial nerve function at the one-year post-operative mark. Dr. Rick Friedman, MD, PhD, a professor at UC San Diego School of Medicine and neurotologist at UC San Diego Health, emphasised the transformative impact of preserving hearing, which directly influences patients’ quality of life.

Acoustic neuromas, or vestibular schwannomas, are tumours that develop on the nerve connecting the ear to the brain. Symptoms include tinnitus, hearing loss, dizziness, and balance issues, and if untreated, they can potentially lead to severe complications.

The middle fossa craniotomy approach is specifically tailored for smaller tumours, up to approximately 1.7 centimetres in size, confined to the internal auditory canal. This precise surgical technique involves meticulous tumour dissection while safeguarding surrounding brain structures and the inner ear to preserve hearing.

Julie Sifford, a patient from Las Vegas, highlighted the emotional and physical toll of living with an acoustic neuroma. After experiencing symptoms such as numbness, memory loss, and tinnitus, she sought medical attention and was diagnosed with the tumour in early 2023. Following extensive research and consultation with specialists at UC San Diego Health, she opted for the middle fossa craniotomy, prioritising the preservation of her hearing despite the inherent risks.

Dr. Marc Schwartz, MD, co-director of the acoustic neuroma program at UC San Diego Health, underscored the institution’s status as a Centre of Excellence for treating these tumours. The centre offers advanced surgical techniques and achieves superior patient outcomes. The centre’s multidisciplinary approach ensures comprehensive care, with many patients travelling internationally for treatment.

The study’s outcomes reinforce the importance of tailored treatment approaches and informed decision-making in managing acoustic neuromas. By prioritising patient-centric care and advancing surgical techniques, researchers aim to improve outcomes further and enhance the quality of life for patients globally.

More information: Jiramongkolchai, Pawina et al, Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy, Otology & Neurotology. DOI: 10.1097/MAO.0000000000004202

Journal information: Otology & Neurotology Provided by University of California San Diego

Projected Population Shifts and Risk Factors Expected to Triple U.S. Cardiovascular Disease Costs by 2050

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Driven by an increasingly diverse and ageing population, coupled with a significant rise in risk factors such as hypertension and obesity, the projected costs associated with cardiovascular diseases (CVD) are set to triple by 2050, according to forecasts by the American Heart Association. This prediction highlights a potentially monumental health and economic burden, with an estimated 61% of US adults—more than 184 million people—expected to suffer from some form of CVD over the next three decades. This prevalence is anticipated to incur direct and indirect costs of $1.8 trillion.

The new projections, detailed in two presidential advisories published in the Association’s journal Circulation, build upon previous research to assess future CVD prevalence and economic impact trends. Over its century-long history, the American Heart Association has significantly reduced death rates from heart disease and stroke, achievements acknowledged as the organisation marks its centennial milestone. Despite these advancements, heart-related conditions remain the leading causes of death and disability in the US.

Karen E. Joynt Maddox, M.D., M.P.H., FAHA, chair of the advisory writing groups, emphasised the ongoing challenges CVD poses and the critical need to address future projections. The advisories aim to anticipate trends over the next 30 years and identify key areas requiring intervention to sustain progress. This proactive approach is essential in mitigating the forecasted increase in CVD cases and associated costs.

Cardiovascular disease encompasses a range of conditions, including coronary heart disease, stroke, hypertension, and heart failure. The prevalence of these conditions is expected to rise significantly, driven mainly by increases in high blood pressure, diabetes, and obesity across all age groups. Despite these concerning projections, positive shifts in health behaviours, such as a decline in smoking rates and improvements in physical activity levels, are noted, suggesting a growing awareness and commitment to healthier lifestyles.

Looking ahead, the demographic landscape of the US will play a pivotal role in shaping CVD trends. The ageing population, alongside demographic shifts towards more diverse racial and ethnic groups, underscores the need for targeted health strategies. Disparities in CVD prevalence and risk factors persist among different demographic groups, influenced by systemic factors, including socioeconomic status and access to healthcare.

The economic impact of CVD is projected to escalate dramatically, primarily due to soaring healthcare costs and lost productivity. Direct healthcare expenditures related to CVD are forecasted to quadruple, reflecting both inflationary pressures and the increasing prevalence of these conditions. Stroke, in particular, is anticipated to drive a significant portion of these costs, given its association with an ageing population and rising hypertension rates.

Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA, vice-chair of the advisory writing groups, highlighted the urgency of strategic interventions to curb these rising costs and prevalence rates. Modelling scenarios suggest that targeted reductions in risk factors could yield substantial benefits, potentially averting millions of CVD events and deaths annually by 2050. These scenarios underscore the importance of early intervention and comprehensive healthcare policies aimed at prevention and treatment.

Looking towards the future, advancements in medical research and public health initiatives offer hope for reversing current trends in CVD. The development of innovative treatments and continued support for scientific discovery are crucial in tackling these challenges. Moreover, addressing broader social determinants of health, including poverty and structural racism, is essential to ensuring equitable access to healthcare and reducing disparities in CVD outcomes across diverse populations.

Nancy Brown, Chief Executive Officer of the American Heart Association, emphasised the organisation’s commitment to advancing cardiovascular health into its second century. She called for collaborative efforts across communities, industries, and policy-makers to implement practical solutions and improve health outcomes nationwide. This collective approach, bolstered by ongoing research and public engagement, aims to transform the trajectory of cardiovascular health in the US and beyond.

As the American Heart Association prepares to navigate the complexities of an evolving healthcare landscape, the focus remains on equipping individuals and communities with the tools needed to lead healthier lives. By addressing the root causes of CVD and investing in preventive strategies, there is potential to mitigate the projected burden and foster a future where cardiovascular health is optimised for all.

More information: Karen E. Joynt Maddox et al, Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association, Circulation. DOI: 10.1161/CIR.0000000000001256

Journal information: Circulation Provided by American Heart Association

A Roadmap Towards Achieving Health Equity in American Diets

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Poor diet remains a significant burden on American adults, posing major risks such as obesity, type 2 diabetes, cardiovascular disease, and certain cancers. According to the Food and Drug Administration, more than one million Americans die annually from diet-related diseases. The economic toll is staggering, too, with poor diet and food insecurity contributing an estimated $1.1 trillion to healthcare costs and lost productivity. These issues exacerbate health disparities across income levels, education, geographical locations, and racial and ethnic backgrounds.

Recent research from the Food is Medicine Institute at Tufts University’s Friedman School of Nutrition Science and Policy, published in the Annals of Internal Medicine, highlights some improvements in diet quality among U.S. adults from 1999 to 2020. Despite these gains, many Americans still have poor diet quality, and disparities persist or worsen over time.

Lead researcher Dariush Mozaffarian, director of the Food is Medicine Institute, notes that modest improvements in American diets have yet to be equitable across the population. Many Americans continue to experience barriers in accessing and consuming nourishing foods, hindering progress towards nutritional and health equity.

The study analysed data from 51,703 adults over ten National Health and Nutrition Examination Survey cycles, using the American Heart Association diet score to measure diet quality. It found a decrease in the proportion of adults with poor diet quality from 48.8% to 36.7% over the two decades studied, with a corresponding increase in those with intermediate diet quality. However, the percentage of adults with an ideal diet remained strikingly low, showing minimal improvement.

Fundamental dietary changes contributing to these trends included increased consumption of nuts, seeds, whole grains, poultry, cheese, and eggs, alongside decreased intake of refined grains, sugary beverages, and fruit juice. Consumption of fruits, vegetables, fish, shellfish, processed meats, potassium, and sodium remained relatively stable.

Despite these overall trends, disparities in diet quality improvement were evident across different demographic groups. Younger adults, women, Hispanic adults, and those with higher education, income levels, food security, and private health insurance showed more significant gains in dietary quality. Conversely, older adults, men, Black adults, and individuals with lower socioeconomic status or non-private health insurance saw less improvement or even worsening diet quality.

Junxiu Liu, the study’s first author, emphasised that while some progress is visible, particularly in reducing consumption of added sugars and fruit drinks, significant challenges remain, especially for marginalised communities. These groups continue to face higher rates of obesity and type 2 diabetes, underscoring the urgent need to address nutrition security and broader social determinants of health such as housing, transportation, fair wages, and structural racism.

Mozaffarian reiterated the urgency of addressing these issues comprehensively, advocating for policies and interventions that tackle not only dietary habits but also the underlying social and economic factors perpetuating poor health outcomes. He highlighted the importance of addressing nutrition security alongside other social determinants of health to mitigate the human and financial costs associated with inadequate diets.

While there have been some improvements in diet quality among Americans over the past two decades, these gains have been unevenly distributed across different demographic groups. Achieving nutritional and health equity requires concerted efforts to remove barriers to accessing nutritious foods and address the broader social determinants contributing to disparities in diet quality and related health outcomes.

More information: Junxiu Liu et al, Trends in Diet Quality Among U.S. Adults From 1999 to 2020 by Race, Ethnicity, and Socioeconomic Disadvantage, Annals of Internal Medicine. DOI: 10.7326/M24-0190

Journal information: Annals of Internal Medicine Provided by Tufts University

Exploring Brain Wave Functions through Precise Sound Stimulation

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A recent study reveals promising findings on using sound to improve sleep quality in individuals with dementia or cognitive decline, a group often plagued by sleep disturbances. These disruptions, affecting up to half of dementia patients, prompted researchers from the University of Surrey and the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London to investigate alpha rhythms, a brainwave associated with memory and perception.

The study, led by Senior Lecturer Dr Ines Violante, employed sound stimulation targeted at alpha rhythms, delivered at precise phases. This approach, known as Alpha Closed-Loop Auditory Stimulation (aCLAS), explores how the brain responds to such interventions in real-time. The team monitored participants’ brain electrical activity, synchronising sound bursts (pink noise) with specific alpha wave phases to observe varied effects on rhythm speed and brain region-specific responses.

Dr Henry Hebron, the study’s first author, highlighted the unexpected discovery that sound administered during certain alpha phases hindered deeper sleep stages without causing awakenings, contrasting with phases without disruption. This intriguing finding challenges our current understanding of sleep and cognition and opens up new avenues for research. He noted that this closed-loop method allowed for direct manipulation of alpha oscillations, suggesting potential applications in understanding neural behaviour linked to cognition and sleep.

The findings underscored the critical role of alpha rhythms in brain function, particularly in diseases like Alzheimer’s, where these rhythms are often slowed. Professor Derk-Jan Dijk, Director of the Surrey Sleep Research Centre, emphasised the implications for future research, particularly in exploring how manipulating alpha waves might enhance cognitive functions and sleep quality in dementia patients. Further investigations are now focusing on applying this technique to REM sleep, where alpha rhythms are present, but their precise role still needs to be clarified.

The study signifies a significant step towards leveraging non-invasive sound-based techniques to modulate brain oscillations effectively. The potential to enhance cognitive abilities and sleep patterns holds promise for improving the quality of life for individuals with dementia. These findings pave the way for future research and the development of innovative interventions that could significantly improve the lives of dementia patients.

More information: Henry Hebron et al, A closed-loop auditory stimulation approach selectively modulates alpha oscillations and sleep onset dynamics in humans, PLoS Biology. DOI: 10.1371/journal.pbio.3002651

Journal information: PLoS Biology Provided by University Of Surrey