PCOM Library / Hot Topics in Research / Archive for "Internal Medicine"

Category: Internal Medicine

Hot Topics: Hearing Aids Could Delay Cognitive Decline

Jackie Werner Hot Topics in Research, Neurology, Otolaryngology

The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?

Sarant J, Harris D, Busby P, et al. The effect of hearing aid use on cognition in older adults: Can we delay decline or even improve cognitive function? J Clin Med. 2020;9(1). https://doi.org/10.3390/jcm9010254

Hearing loss is a modifiable risk factor for dementia in older adults. Whether hearing aid use can delay the onset of cognitive decline is unknown. Participants in this study (aged 62-82 years) were assessed before and 18 months after hearing aid fitting on hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, isolation, mood, and medical health. At baseline, multiple linear regression showed hearing loss and age predicted significantly poorer executive function performance, while tertiary education predicted significantly higher executive function and visual learning performance. At 18 months after hearing aid fitting, speech perception in quiet, self-reported listening disability and quality of life had significantly improved. Group mean scores across the cognitive test battery showed no significant decline, and executive function significantly improved. Reliable Change Index scores also showed either clinically significant improvement or stability in executive function for 97.3% of participants, and for females for working memory, visual attention and visual learning. Relative stability and clinically and statistically significant improvement in cognition were seen in this participant group after 18 months of hearing aid use, suggesting that treatment of hearing loss with hearing aids may delay cognitive decline. Given the small sample size, further follow up is required.

Hot Topics: Existing Drugs May Fight Coronavirus

Jackie Werner Hot Topics in Research, Infectious Disease

Discovery and development of safe-in-man broad-spectrum antiviral agents

Andersen PI, Ianevski A, Lysvand H, et al. Discovery and development of safe-in-man broad-spectrum antiviral agents. Int J Infect Dis. 2020. https://doi.org/10.1016/j.ijid.2020.02.018

Viral diseases are one of the leading causes of morbidity and mortality in the world. Virus-specific vaccines and antiviral drugs are the most powerful tools to combat viral diseases. However, broad-spectrum antiviral agents (BSAAs, i.e. compounds targeting viruses belonging to two or more viral families) could provide additional protection of general population from emerging and re-emerging viral diseases reinforcing the arsenal of available antiviral options. Here, we reviewed discovery and development of BSAAs and summarized the information on 119 safe-in-man agents in freely accessible database (https://drugvirus.info/). Future and ongoing pre-clinical and clinical studies will increase the number of BSAAs, expand spectrum of their indications, and identify drug combinations for treatment of emerging and re-emerging viral infections as well as co-infections.

Hot Topics: Color-Changing Bandages Treat Infection

Jackie Werner Hot Topics in Research, Infectious Disease

Colorimetric Band-aids for Point-of-Care Sensing and Treating Bacterial Infection

Sun Y, Zhao C, Niu J, Ren J, Qu X. Colorimetric band-aids for point-of-care sensing and treating bacterial infection. ACS Cent Sci. 2020. https://doi.org/10.1021/acscentsci.9b01104.

Sensing bacterial infections and monitoring drug resistance are very important for the selection of treatment options. However, the common methods of sensing resistance are limited by time-consuming, the requirement for professional personnel, and expensive instruments. Moreover, the abuse of antibiotics causes the accelerated process of bacterial resistance. Herein, we construct a portable paper-based band-aid (PBA) which implements a selective antibacterial strategy after sensing of drug resistance. The colors of PBA indicate bacterial infection (yellow) and drug resistance (red), just like a bacterial resistance colorimetric card. On the basis of color, antibiotic-based chemotherapy and Zr-MOF PCN-224-based photodynamic therapy (PDT) are used on site to treat sensitive and resistant strains, respectively. Eventually, it takes 4 h to sense, and the limit of detection is 104 CFU/mL for drug-resistant E. coli. Compared with traditional PDT-based antibacterial strategies, our design can alleviate off-target side effects, maximize therapeutic efficacy, and track the drug resistance in real time with the naked eye. This work develops a new way for the rational use of antibiotics. Given the low cost and easy operation of this point-of-care device, it can be developed for practical applications.

Hot Topics: Stroke Care Affected by Traffic

Jackie Werner Hot Topics in Research, Neurology, Public Health

Rubber Meeting the Road: Access to Comprehensive Stroke Care in the Face of Traffic

Dworkis DA, Axeen S, Arora S. Rubber meeting the road: Access to comprehensive stroke care in the face of traffic. Acad Emerg Med. 2020. https://doi.org/10.1111/acem.13909.

Acute stroke is one of the leading causes of death in the United States, with an estimated annual cost of $34 billion and a death from stroke occurring approximately every 4 minutes. Early access to specialized stroke care is critically important in the treatment of suspected acute stroke, but access to dedicated stroke centers is unequal and varies geographically. Among the different levels of hospitals providing stroke care, the comprehensive stroke center (CSC) is the highest designation: CSCs utilize multidisciplinary stroke teams to provide the most advanced stroke care, including therapies like endovascular clot retrieval that are not available at most non‐CSC hospitals.

Hot Topics: Novel Target for Addiction Treatment

Jackie Werner Hot Topics in Research, Neurology, Pharmaceutical Sciences, Substance Use Disorders

Dopamine-Evoked Synaptic Regulation in the Nucleus Accumbens Requires Astrocyte Activity

Corkrum M, Covelo A, Lines J, et al. Dopamine-evoked synaptic regulation in the nucleus accumbens requires astrocyte activity. Neuron. 2020. https://doi.org/10.1016/j.neuron.2019.12.026.

Dopamine is involved in physiological processes like learning and memory, motor control and reward, and pathological conditions such as Parkinson’s disease and addiction. In contrast to the extensive studies on neurons, astrocyte involvement in dopaminergic signaling remains largely unknown. Using transgenic mice, optogenetics, and pharmacogenetics, we studied the role of astrocytes on the dopaminergic system. We show that in freely behaving mice, astrocytes in the nucleus accumbens (NAc), a key reward center in the brain, respond with Ca2+ elevations to synaptically released dopamine, a phenomenon enhanced by amphetamine. In brain slices, synaptically released dopamine increases astrocyte Ca2+, stimulates ATP/adenosine release, and depresses excitatory synaptic transmission through activation of presynaptic A1 receptors. Amphetamine depresses neurotransmission through stimulation of astrocytes and the consequent A1 receptor activation. Furthermore, astrocytes modulate the acute behavioral psychomotor effects of amphetamine. Therefore, astrocytes mediate the dopamine- and amphetamine-induced synaptic regulation, revealing a novel cellular pathway in the brain reward system.

Hot Topics: Stroke Increases Risk of Heart Complications

Jackie Werner Cardiology, Hot Topics in Research, Neurology

First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93,627 Older Women and Men

Sposato Luciano A, Melody L, Britney A, Shariff Salimah Z, Gustavo S. First-ever ischemic stroke and incident major adverse cardiovascular events in 93 627 older women and men. Stroke. https://doi.org/10.1161/STROKEAHA.119.028066.

Background and Purpose

Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke.

Methods

We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk.

Results

We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3–32.6]; men: aHR, 23.4 [95% CI, 17.2–31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8–6.0]; men: aHR, 4.2 [95% CI, 3.3–5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8–2.3]; men: aHR, 2.0 [95% CI, 1.7–2.3]).

Conclusions

In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

Hot Topics: US Cancer Survivors Suffer Financial Hardship

Jackie Werner Hot Topics in Research, Oncology, Public Health

Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States

Han X, Zhao J, Zheng Z, de Moor JS, Virgo KS, Yabroff KR. Medical financial hardship intensity and financial sacrifice associated with cancer in the united states. Cancer Epidemiol Biomarkers Prev. 2020. https://dx.doi.org/10.1158/1055-9965.EPI-19-0460.

Background: With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States.

Methods: We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey – Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18–64 or 65+ years).

Results: Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices.

Conclusions: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors.

Impact: Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.

Hot Topics: Long-Held Perception Theory Disproven

Jackie Werner Hot Topics in Research, Otolaryngology

Rapid visual categorization is not guided by early salience-based selection

Tsotsos, J. K., Kotseruba, I., & Wloka, C. (2019). Rapid visual categorization is not guided by early salience-based selection. Plos One, 14(10), e0224306. https://doi.org/10.1371/journal.pone.0224306

The current dominant visual processing paradigm in both human and machine research is the feedforward, layered hierarchy of neural-like processing elements. Within this paradigm, visual saliency is seen by many to have a specific role, namely that of early selection. Early selection is thought to enable very fast visual performance by limiting processing to only the most salient candidate portions of an image. This strategy has led to a plethora of saliency algorithms that have indeed improved processing time efficiency in machine algorithms, which in turn have strengthened the suggestion that human vision also employs a similar early selection strategy. However, at least one set of critical tests of this idea has never been performed with respect to the role of early selection in human vision. How would the best of the current saliency models perform on the stimuli used by experimentalists who first provided evidence for this visual processing paradigm? Would the algorithms really provide correct candidate sub-images to enable fast categorization on those same images? Do humans really need this early selection for their impressive performance? Here, we report on a new series of tests of these questions whose results suggest that it is quite unlikely that such an early selection process has any role in human rapid visual categorization.

Hot Topics: New Factors Could Reverse Arterial Plaque Buildup

Jackie Werner Cardiology, Hot Topics in Research

Endothelial TGF-β signalling drives vascular inflammation and atherosclerosis

Chen, P., Qin, L., Li, G., Wang, Z., Dahlman, J. E., Malagon-Lopez, J., . . . Simons, M. (2019). Endothelial TGF-β signalling drives vascular inflammation and atherosclerosis. Nature Metabolism, http://doi.org/10.1038/s42255-019-0102-3

Atherosclerosis is a progressive vascular disease triggered by interplay between abnormal shear stress and endothelial lipid retention. A combination of these and, potentially, other factors leads to a chronic inflammatory response in the vessel wall, which is thought to be responsible for disease progression characterized by a buildup of atherosclerotic plaques. Yet molecular events responsible for maintenance of plaque inflammation and plaque growth have not been fully defined. Here we show that endothelial transforming growh factor β (TGF-β) signalling is one of the primary drivers of atherosclerosis-associated vascular inflammation. Inhibition of endothelial TGF-β signalling in hyperlipidemic mice reduces vessel wall inflammation and vascular permeability and leads to arrest of disease progression and regression of established lesions. These proinflammatory effects of endothelial TGF-β signalling are in stark contrast with its effects in other cell types and identify it as an important driver of atherosclerotic plaque growth and show the potential of cell-type-specific therapeutic intervention aimed at control of this disease.

Hot Topics: Cannabis Use in Teen Cancer Patients Increasing

Jackie Werner Hot Topics in Research, Oncology

Cannabis Use in Young Adult Cancer Patients

Donovan, K. A., Oberoi-Jassal, R., Chang, Y. D., Rajasekhara, S., Haas, M. F., Randich, A. L., & Portman, D. G. (2019). Cannabis use in young adult cancer patients. Journal of Adolescent and Young Adult Oncologyhttp://doi.org/10.1089/jayao.2019.0039

Background: The use of cannabis by young adult (YA) cancer patients is likely to increase as medical cannabis becomes more available. Clinically relevant data on cannabis use are needed to establish benchmarks for use, to identify patients who are more likely to use cannabis, and to assess outcomes associated with use.

Objective: The current study sought to determine the rate of cannabis use in YA cancer patients ages 18 to 39, identify demographic and clinical correlates of use, and examine differences in moderate-to-severe symptoms between users and nonusers.

Methods: We conducted a retrospective review of objectively measured tetrahydrocannabinol (THC), self-reported cannabis use, and cancer-related symptomatology in YA cancer patients in active treatment referred for comprehensive supportive care.

Results: Approximately 30% of YA cancer patients tested positive for THC on urine drug testing. At the univariate level, cannabis users were more likely to be male, to have a lifetime history of smoking at least 100 cigarettes, and to be more recently diagnosed. Cannabis use was associated with moderate-to-severe symptomatology, including pain, nausea, lack of appetite, constipation, difficulty sleeping, and poorer overall well-being.

Conclusions: YAs referred for comprehensive supportive care may be managing their cancer-related symptoms with cannabis. Further research is needed to better understand patients’ perceptions of cannabis’s therapeutic and adverse effects, in patients who used cannabis before diagnosis, and in patients who commenced use in response to a cancer diagnosis.