Scientists ‘Clear’ Alzheimer’s Plaque From Mice Using Only Light And Sound


Clumps of harmful proteins that interfere with brain functions have been partially cleared in mice using nothing but light and sound.

Research led by MIT has found strobe lights and a low pitched buzz can be used to recreate brain waves lost in the disease, which in turn remove plaque and improve cognitive function in mice engineered to display Alzheimer’s-like behaviour.

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It’s a little like using light and sound to trigger their own brain waves to help fight the disease.

This technique hasn’t been clinically trialled in humans as yet, so it’s too soon to get excited – brain waves are known to work differently in humans and mice.

But, if replicated, these early results hint at a possible cheap and drug-free way to treat the common form of dementia.

So how does it work?

Advancing a previous study that showed flashing light 40 times a second into the eyes of engineered mice treated their version of Alzheimer’s disease, researchers added sound of a similar frequency and found it dramatically improved their results.

“When we combine visual and auditory stimulation for a week, we see the engagement of the prefrontal cortex and a very dramatic reduction of amyloid,” says Li-Huei Tsai, one of the researchers from MIT’s Picower Institute for Learning and Memory.

It’s not the first study to investigate the role sound can play in clearing the brain of the tangles and clumps of tau and amyloid proteins at least partially responsible for the disease.

Previous studies showed bursts of ultrasound make blood vessels leaky enough to allow powerful treatments to slip into the brain, while also encouraging the nervous system’s waste-removal experts, microglia, to pick up the pace.

Several years ago, Tsai discovered light flickering at a frequency of about 40 flashes a second had similar benefits in mice engineered to build up amyloid in their brain’s nerve cells.

“The result was so mind-boggling and so robust, it took a while for the idea to sink in, but we knew we needed to work out a way of trying out the same thing in humans,” Tsai told Helen Thomson at Nature at the time.

The only problem was this effect was confined to visual parts of the brain, missing key areas that contribute to the formation and retrieval of memory.

While the method’s practical applications looked a little limited, the results pointed to a way oscillations could help the brain recover from the grip of Alzheimer’s disease.

As our brain’s neurons transmit signals they also generate electromagnetic waves that help keep remote regions in sync – so-called ‘brain waves’.

One such set of oscillations are defined as gamma-frequencies, rippling across the brain at around 30 to 90 waves per second. These brain waves are most active when we’re paying close attention, searching our memories in order to make sense of what’s going on.

Tsai’s previous study had suggested these gamma waves are impeded in individuals with Alzheimer’s, and might play a pivotal role in the pathology itself.

Light was just one way to trick the parts of the brain into humming in the key of gamma. Sounds can also manage this in other areas.

Instead of the high pitched scream of ultrasound, Tsui used a much lower droning noise of just 40 Hertz, a sound only just high enough for humans to hear.

Exposing their mouse subjects to just one hour of this monotonous buzz every day for a week led to a significant drop in the amount of amyloid build up in the auditory regions, while also stimulating those microglial cells and blood vessels.

“What we have demonstrated here is that we can use a totally different sensory modality to induce gamma oscillations in the brain,” says Tsai.

As an added bonus, it also helped clear the nearby hippocampus – an important section associated with memory.

The effects weren’t just evident in the test subjects’ brain chemistry. Functionally, mice exposed to the treatment performed better in a range of cognitive tasks.

Adding the light therapy from the previous study saw an even more dramatic effect, clearing plaques in a number of areas across the brain, including in the prefrontal cortex. Those trash-clearing microglia also went to town.

“These microglia just pile on top of one another around the plaques,” says Tsai.

Discovering new mechanisms in the way nervous systems clear waste and synchronise activity is a huge step forward in the development of treatments for all kinds of neurological disorders.

Translating discoveries like this to human brains will take more work, especially when there are potential contrasts in how gamma waves appear in mice and human Alzheimer’s brains.

So far early testing for safety has shown the process seems to have no clear side effects.

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Americans now more likely to die from opioids than car crashes


​It marks a first for the U.S., where some 49,000 people died from opioids in 2018.

  • Each American has about a 1 in 7,569 chance of dying from an opioid overdose, according to a National Safety Council report. The probability of dying in a motor vehicle accident is 1 in 8,096.
  • The death rate for opioids is now six times higher than it was in 1999, with about 130 Americans dying every day from the drugs.
  • Narcan is a life-saving drug that can stop opioid overdoses in their tracks, however factors like stigma and cost are preventing this antidote from becoming more accessible.

For the first time in U.S. history, Americans are more likely to die from opioid overdoses than car accidents, according to a new report from the nonprofit National Safety Council.

Americans have a 1 in 7,569 chance of dying from an opioid overdose, while the probability of dying in a motor vehicle accident is 1 in 8,096. Those odds were calculated by dividing the total U.S. population by the total number of deaths for each cause in 2017, using data on preventable deaths from the National Center for Health Statistics.

“We’ve made significant strides in overall longevity in the United States, but we are dying from things typically called accidents at rates we haven’t seen in half a century,” Ken Kolosh, manager of statistics at the National Safety Council, said in a press release. “We cannot be complacent about 466 lives lost every day. This new analysis reinforces that we must consistently prioritize safety at work, at home and on the road to prevent these dire outcomes.”

The figures on opioid deaths are even more startling when presented in terms of lifetime odds, which are approximated by dividing the one-year odds of dying from a particular cause by the life expectancy of a person born in 2017 (78.6 years). Measured this way, Americans have a 1 in 96 probability of dying from an opioid overdose.

The lifetime odds of dying in a plane crash? 1 in 188,364.

“As human beings, we’re terrible at assessing our own risk,” Kolosh told National Public Radio. “We typically focus on the unusual or scary events … and assume that those are the riskiest.”

Opioids abuse and overdoses have been on the rise for years. In 2017, more than 49,000 people died of opioid overdoses, according to the National Institute on Drug Abuse. That’s about six times higher than the rate for 1999. Now, an average of 130 Americans die every day from an opioid overdose.

The increased availability of fentanyl, a powerful synthetic opioid, is partly responsible for the recent spike in opioid overdoses, the council said in the press release.

“The nation’s opioid crisis is fueling the Council’s grim probabilities, and that crisis is worsening with an influx of illicit fentanyl.”

​Can Narcan curb the opioid crisis?

There’s one life-saving drug that, if administered quickly and properly, can stop nearly all opioid overdoses in their tracks: naloxone, commonly known as Narcan. Patented in 1961, the drug works by preventing the brain’s receptors from bonding with opioids, eliminating their effects on the body. Narcan can’t stop the addiction, but it can stop an overdose.

In 2018, U.S. Surgeon General Jerome Adams issued an advisory calling for more people to carry and learn how to administer Narcan, which is already carried by many EMTs and police officers.

“The call to action is to recognize if you’re at risk,” Adams told NPR. “And if you or a loved one are at risk, keep within reach, know how to use naloxone … We should think of naloxone like an EpiPen or CPR. Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond.”

Some believe making Narcan more accessible is the key to curbing the opioid crisis. That’s why most U.S. states have recently implemented a so-called standing order that allows people to get Narcan from a pharmacist without having to visit a doctor. Still, several factors seem to be preventing Narcan from being as ubiquitous as advocates like Adams might hope.

One problem is stigma. A 2017 study published in the Journal of the American Pharmacists’ Association showed how both pharmacists and addicts report being uncomfortable engaging in face-to-face discussions about the need for Narcan. The researchers argued that this stigma might be reduced through policies that call for pharmacies to universally offer Narcan to patients obtaining opioid prescriptions.

Another component of the stigma surrounding Narcan is an argument that says increasing the drug’s accessibility actually enables addicts. The idea is that addicts are more willing to take risks, and take increasingly dangerous drugs like fentanyl, when they know they have a life-saving drug in their pocket. Proponents of this idea might argue that Narcan “subsidizes recklessness,” but others say denying medical patients a lifesaving drug isn’t the answer.

“I understand the frustration,” Police Chief Thomas Synan Jr. of Newtown, Ohio, told The Associated Press. “I understand the feeling that someone is doing something to themselves, so why do the rest of us have to pay? But our job is to save lives, period.”

But perhaps the biggest obstacle to increasing the accessibility of Narcan is the price. As STAT points out, a life-saving dose of Narcan cost just $1 a decade ago, but now “costs $150 for the nasal spray, a 150-fold increase,” while a “naloxone auto-injector, approved in 2016, costs $4,500.”

As Stephen Wood wrote for Harvard Law School’s Bill of Health, these price increases came “when the opioid epidemic was at its peak, and they came without any explanation.” If the prices don’t drop, it’s unlikely that efforts like standing orders and community distribution programs will be effective.

Ultimately, Wood argued, it’s all about the money for pharmaceutical companies.

“Naloxone has gone from a $21 million dollar a year industry prior to 2014, to a booming $274 million dollar take per year since 2015. There is no doubt: pharmaceutical companies are making money off the opioid epidemic. Additionally, those who need this drug the most, often don’t have access to it. They are the under- or uninsured, so waving a co-pay is moot.

There are plenty of opportunities to reduce costs. Several authorities have asked for induction of federal law 28 U.S.C. section 1498, which would allow the United States to contract with a manufacturer to act on their behalf to create a less costly product. However, this still puts the onus of the cost on the tax payer. The pharmaceutical industry brought us the opioids that sparked this epidemic, heavily marketing oxycontin and oxycodone, which retail at around $1.25 a pill. What could possibly justify the antidote costing upwards of 3,600 percent more? There is no justification for this and policy makers need to draw their attention to this scamming of the general public in a time of crisis.”

Cannabis Could Increase Men’s Sperm Count


Cannabis Could Increase Men's Sperm Count

 

Men who have smoked marijuana at some point in their life had significantly higher concentrations of sperm when compared with men who have never smoked marijuana, according to new research led by Harvard T.H. Chan School of Public Health. The study, conducted in the Fertility Clinic at Massachusetts General Hospital, also found that there was no significant difference in sperm concentrations between current and former marijuana smokers.

“These unexpected findings highlight how little we know about the reproductive health effects of marijuana, and in fact of the health effects of marijuana in general,” said Jorge Chavarro, associate professor of nutrition and epidemiology at Harvard Chan School. “Our results need to be interpreted with caution and they highlight the need to further study the health effects of marijuana use.”

The study will be published on February 5, 2019 in Human Reproduction.

It is estimated that 16.5 percent of adults in the US use marijuana, and support for legal recreational use of marijuana has increased dramatically in recent years. Understanding the health effects associated with marijuana use is important given the growing perception that it poses few health hazards.

The researchers hypothesized that marijuana smoking would be associated with worse semen quality. Previous studies on marijuana have suggested that it is associated with negative effects on male reproductive health, but most of those studies had focused on animal models or on men with histories of drug abuse.

For this study, researchers collected 1,143 semen samples from 662 men between 2000 and 2017. On average, the men were 36 years old, and most were white and college educated. Additionally, 317 of the participants provided blood samples that were analyzed for reproductive hormones. To gather information on marijuana use among study participants, researchers used a self-reported questionnaire that asked the men a number of questions about their usage, including if they had ever smoked more than two joints or the equivalent amount of marijuana in their life and if they were current marijuana smokers.

Among the participants, 365, or 55 percent, reported having smoked marijuana at some point. Of those, 44 percent said they were past marijuana smokers and 11 percent classified themselves as current smokers.

Analysis of the semen samples showed that men who had smoked marijuana had average sperm concentrations of 62.7 million sperm per milliliter of ejaculate while men who had never smoked marijuana had average concentrations of 45.4 million sperm per milliliter of ejaculate. Only 5 percent of marijuana smokers had sperm concentrations below 15 million/mL (the World Health Organization’s threshold for “normal” levels) compared with 12 percent of men who had never smoked marijuana.

The study also found that among marijuana smokers, greater use was associated with higher serum testosterone levels.

The researchers cautioned that there are several potential limitations to the findings, including that participants may have underreported marijuana use given its status as an illegal drug for most of the study period. The researchers emphasized that they do not know to what extent these findings may apply to men in the general population as the study population consisted of subfertile men in couples seeking treatment at a fertility center. Additionally, they noted that there are few similar studies to compare their results against.

“Our findings were contrary to what we initially hypothesized. However, they are consistent with two different interpretations, the first being that low levels of marijuana use could benefit sperm production because of its effect on the endocannabinoid system, which is known to play a role in fertility, but those benefits are lost with higher levels of marijuana consumption,” said Feiby Nassan, lead author of the study and a postdoctoral research fellow at Harvard Chan School. “An equally plausible interpretation is that our findings could reflect the fact that men with higher testosterone levels are more likely to engage in risk-seeking behaviors, including smoking marijuana.”

Italy bans unvaccinated children from school


  A generic photograph of a vaccine being drawn from a vial into a needle
The new law demands 10 compulsory vaccinations – and has proved controversial

Italian children have been told not to turn up to school unless they can prove they have been properly vaccinated.

The deadline follows months of national debate over compulsory vaccination.

Parents risk being fined up to €500 (£425; $560) if they send their unvaccinated children to school. Children under six can be turned away.

The new law came amid a surge in measles cases – but Italian officials say vaccination rates have improved since it was introduced.

Under Italy’s so-called Lorenzin law – named after the former health minister who introduced it – children must receive a range of mandatory immunisations before attending school. They include vaccinations for chickenpox, polio, measles, mumps, and rubella.

Children up to the age of six years will be excluded from nursery and kindergarten without proof of vaccination under the new rules.

Those aged between six and 16 cannot be banned from attending school, but their parents face fines if they do not complete the mandatory course of immunisations.

The deadline for certification was due to be 10 March after a previous delay – but as it fell on a weekend, it was extended to Monday.

“Now everyone has had time to catch up,” Health Minister Giulia Grillo told La Repubblica newspaper.

She had reportedly resisted political pressure from deputy prime minister Matteo Salvini to extend the deadline even further.

Ms Grillo said the rules were now simple: “No vaccine, no school”.

Italian media report that regional authorities are handling the situation in a number of different ways.

In Bologna, the local authority has sent letters of suspension to the parents of some 300 children, and a total of 5,000 children do not have their vaccine documentation up to date.

In other areas there have been no reported cases, while still others have been given a grace period of a few days beyond the deadline.

Is the law having an effect?

The new law was passed to raise Italy’s plummeting vaccination rates from below 80% to the World Health Organisation’s 95% target.

On Monday – the last day for parents to provide documentation proving their children had been properly vaccinated – the Italian health authority released figures claiming a national immunisation rate at or very close to 95% for children born in 2015, depending on which vaccine was being discussed.

The 95% threshold is the point at which “herd immunity” kicks in – when enough of the population is vaccinated for the spread of the disease to become unlikely, thereby protecting those who cannot be vaccinated.

That includes babies too young to be vaccinated themselves, or those with medical conditions such as a compromised immune system.

Last month, an eight-year-old recovering from cancer was unable to attend school in Rome due to his weak immune system.

The child had spent months receiving treatment for leukaemia, but was at risk of infection because a proportion of pupils in the school had not been vaccinated – including several in the same class.

Image copyright Getty Images
Image caption Demonstrations against compulsory vaccination were held in Rome, 2017

The Lorenzin law, drafted by the previous government, had a tumultuous birth. When the current coalition came to power, it said it would drop mandatory immunisations although it later reversed its position.

The two populist parties in power had faced accusations that they were pursuing anti-vaccination policies.

Writing in a Facebook post on Monday, Ms Grillo admitted it “is a law that, at the time of approval, we criticised for several reasons” – and said that the law would be changed to include only those vaccinations that were necessary based on scientific data.

Why do parents not immunise their children?

The anti-vaccination movement has been growing globally in recent years, sparking alarm from the World Health Organization.

A long-discredited paper by Andrew Wakefield was behind much of the scare, but rumours around immunisation have continued to spread, leading to public health risks as not enough people are immune to such diseases.

Mr Wakefield was struck off the UK medical register after fraudulently claiming there was a link between the measles, mumps and rubella vaccine (MMR) and autism and bowel disease in children.

He made the claim based on the experiences of just 12 children, and no other study since has been able to replicate his results.

Digital Technology Is Transforming Care Delivery


Jim was an elderly patient suffering from emphysema. He lived some distance from the nearest hospital and couldn’t easily see a doctor, and he was rushed to the hospital once or twice a month when symptoms of his chronic lung condition flared up, putting a heavy strain on him and his family. Then Jim’s life was transformed: He became the beneficiary of a revolutionary approach to healthcare, and he could be tested and his condition monitored without ever having to go to a hospital.

American health provider Mercy Health put Jim on a new “virtual care” program, and care was brought directly to his bedside at home. Mercy used remote technology to carry out tests, monitor Jim and make sure any worrying signs were responded to before they became an emergency.

This example shows how care delivery is being transformed by modern digital technology. Jim’s care was managed by the Mercy Virtual Care Center, a “hospital without beds” that uses digital technology to enable remote care of patients at home.

Randy Moore, former president of Mercy Virtual, speaking at the Siemens Healthineers Executive Summit in Frankfurt, Germany in October 2018, recalled how Jim’s wife summed up the benefits of remote care. “She told us, ‘Our family had two years where I could leave the house, go shopping and not be afraid. Jim got to be at home. You gave us the best gift we could have,’” Moore said. Hospitals can be stressful for the families of patients as they are an unusual and often inconvenient setting. Relatives may prefer home-based care.

The Value-Based Approach

Modern healthcare is about more than simply caring for the sick, he added. “We have to be excellent if Jim shows up, but we also have to be in the business of health optimization. We can unleash that power and give 10 times the value we have in the past,” said Moore.

Finding more effective ways of caring for patients is essential to overcome the challenges facing modern healthcare. Aging populations have created a spike in chronic illnesses even as healthcare budgets are spiraling downward and costs spiral upward, and new treatments are ever more expensive.

Many healthcare systems were put in place a hundred years ago primarily to treat acute medical problems, at a time when most people didn’t live long enough to develop chronic conditions. Today’s health systems are often ill-equipped to cope with the rise in long-term care. Hospitals are paid for the number of operations they perform—the “fee for service” model—not for the long-term well-being of patients. Yet hospitals are an expensive way of caring for patients. This disparity is forcing the transformation of healthcare systems to achieve the most patient value for money spent by keeping hospitalizations to a minimum.

The new value-based healthcare approach is turning the care model on its head. It rewards health providers for prevention and long-term results, rather than one-off operations, often providing a fixed fee or “capitation fee” for each patient every year. This incentivizes care providers to prevent illnesses by educating as well as diagnosing and intervening early.

Value-based healthcare is also leading a sea change in the way care is provided.

Improving Access to Care

Expanding access to care is an important step to reduce the incidence and severity of illness and to treat conditions before they lead to hospitalization. This means greater use of ambulatory services to diagnose, observe and treat patients outside hospitals. Many chronic conditions such as diabetes and lung disease, including emphysema, lend themselves to this approach.

Oak Street Health is one U.S. organization that has pioneered ways of improving access to healthcare for ordinary Americans, primarily working with older Medicare patients and focusing on prevention and treatment in the community. Chief Medical Officer Dr. Griffin Myers, told the Executive summit that 80 percent of illnesses are related to social and environmental factors, such as poor access to healthy food and clean water, a lack of stable housing and neighborhood violence. Doctors tend to think such factors are not part of their job, but Myers disagrees.

“It is time for us as leaders in this space to take responsibility for those social factors because those are the things that determine how well our patients do,” he said.

Oak Street charges insurers a set fee for patients, and pays all their medical bills as well as costs related to social and other factors, such as transportation. “The value-based model is not theoretical. Our goal is to keep people happy, healthy and out of hospitals,” said Myers.

Oak Street has achieved a 40 percent reduction in hospitalizations largely by addressing social determinants. However, a drawback in today’s reimbursement systems for hospitals is that this approach may lead to a decline in hospitals’ income as they treat fewer patients.

Increasing Workforce Productivity

While demand for care is rising, the medical professionals needed to provide this care are in limited supply. To address this imbalance, health providers are looking for ways to improve workforce productivity.

In a value-based healthcare system, productivity is increased by organizing care around a patient’s medical condition with integrated teams collaborating to help the patient through all stages of care.

A good example of this is the Martini-Klinik in Hamburg, Germany which was established in 2005 to focus on delivering care for a single condition – prostate cancer. The clinic handles over 2,200 prostate cancer cases a year and claims better outcomes than any other organization. But the clinic doesn’t simply “cure” patients and send them on their way. The Martini-Klinik uses research and patient surveys to measure the long-term outcomes of its care and find ways of improving them.

The clinic has focused on boosting productivity through training and supporting staff. This has led to greater job satisfaction and staff loyalty with a low employee turnover.

The clinic uses a system where all physicians involved in treating prostate cancer are given joint incentives. This encourages them to work together, reducing difficulties with handing over information and losing data.

As Dr. Ghada Trotabas, Senior Vice President of Marketing and Sales at Siemens Healthineers, told the summit: “The complexities of medicine have by far exceeded the ability of the single individual. Today’s medicine needs to be practiced in teams.” She compared these teams to “pit crews,” the integrated group of mechanics who service race cars.

Today’s value-based  care teams help the patient before, during and after treatment, and deal with side effects, complications and care throughout the process.

Like Oak Street Health, provider Kaiser Permanente, based in California, also uses a capitation model with a set fee per patient which creates incentive to improve the health of each patient and prevent illness. Kaiser promotes benchmarking of staff across the organization so everyone can see who the top, middle and lowest performers are in every area of care. Dr. John Mattison, Kaiser’s Chief Health Information Officer, told the summit that a workflow specialist regularly analyzes the company’s benchmarking data and helps recommend how clinics can achieve the best results. “We replicate that across the program, which requires integrated care and an ethos and culture, so you can transfer those processes and the system configurations from site to site very easily,” he said.

Mattison noted that too much emphasis has been placed on giving health providers incentives based on procedures, rather than outcomes. “The only way to change that is to change the cultural model—changing leadership, inspiration and motivation—as well as aligning the kinds of outcomes you want with pay.”

Managing Population Health

Value-based healthcare is also about managing health across entire populations. This includes public health information campaigns that promoted disease prevention and screening, as well as programs to identify chronic patients who will benefit from intensive programs and treatments.

Globally, managing population health will require a massive expansion of healthcare systems in developing countries. India has launched one of the biggest projects globally to put healthcare within reach of hundreds of millions of underserved people: Ayushman Bharat – also known as “Modicare,” launched in early 2018 by Prime Minister Narendra Modi, will bring health insurance and medical care to 500 million Indian citizens, cover healthcare costs of up to $7,800 for 100 million impoverished families and spend $188 million to create “health and wellness” centers.

“Healthcare was not on the political agenda of India like it has been in the USA,” Dr. Girdhar Gyani, Director General of India’s Association of Health Providers, told the summit. “Half of the money has been driven by the state government directly. But in the new scheme, we are pushing the insurance companies to drive it; the insurers will learn to make sure they put emphasis on preventive healthcare, and that is where technology will play a leading role.”

Modern advances in healthcare are designed to keep hospitalization to a minimum. As Kaiser Permanente’s John Mattison said, “An unplanned hospitalization for someone with a chronic disease is a system failure.”

Patients and their families are welcoming the transformation in care delivery, as illnesses are prevented, hospitalizations are reduced and the care workflow is improved. Hospitals may find that traditional income streams decline as a result of more efficient and remote care, but the clear aim is to keep patients out of expensive hospital beds and improve their quality of life.

Vaping Linked to a Noisy, Foreboding Consequence of Poor Lung Health


“The take-home message is that electronic cigarettes are not safe when it comes to lung health.”

vaping

Electronic cigarettes are marketed as less harmful alternatives to cigarette smoking, but researchers are increasingly concerned about the potential long-term health consequences of vaping. A study released Thursday in the journal Tobacco Control adds to the growing number of reasons the phenomenon is more risky than it might appear.

According to scientists from the University of Rochester and the Roswell Park Comprehensive Cancer Center, people who vape are nearly twice as likely to experience wheezing compared to people who don’t regularly use tobacco products. Wheezing — which is typically caused by inflammation and narrowing of the airway between the throat and lungs — is often seen as a precursor to serious health conditions, including lung cancer and heart failure.

“The take-home message is that electronic cigarettes are not safe when it comes to lung health,” study author Deborah Ossip, Ph.D., announced Thursday. “The changes we’re seeing with vaping, both in laboratory experiments and studies of people who vape, are consistent with early signs of lung damage, which is very worrisome.”

vapes
Scientists are concerned about the long-term health consequences of vaping.

Importantly, this study doesn’t prove that vaping causes wheezing. Instead, it identifies an association between the two. This association has been found in previous studies as well, including a 2017 paper in PLOS One that found a link between e-cigarette use and greater odds of wheezing and shortness of breath.

Here the researchers analyzed self-reported data collected from 28,000 Americans who participated in the Population Assessment of Tobacco and Health (PATH) study. The study participants including current vapers who used e-cigarettes exclusively, people who only smoked traditional cigarettes, dual users, and non-users who avoided tobacco products.

When they compared non-users to those who exclusively vape, they found that the risk of wheezing and related respiratory symptoms significantly increased: Adult vapers were 1.7 times more likely to experience difficulty breathing. Meanwhile, vapers had lower odds of wheezing compared to those who only smoked cigarettes and those who used both tobacco products.

“Promoting complete cessation of both smoking and vaping will be beneficial to maximize the risk reduction of wheezing and other related respiratory symptoms,” the study authors recommend. “Importantly, we reported that ex-smokers who did not vape, although they had already quit smoking, still have significantly elevated risk of wheezing and other related respiratory symptoms, compared with never smokers, suggesting long-term impact of prior smoking.”

A video released as part of the FDA’s anti-vaping campaign, “The Real Cost.” 

The authors note these results are particularly concerning because of the mass use of e-cigarettes by both adults and juveniles alike. They write statistics indicate that close to 13 percent of American adults have tried vaping, and four percent currently do so. Meanwhile, Centers for Disease Control and Prevention data show that in 2018, vaping increased by 78 percent among ninth- to twelfth-graders and 48 percent in sixth- to eighth-graders. In 2017, more than 2 million middle and high school students were regular users of e-cigarettes.

It’s a rise that caused Food and Drug Administration Commissioner Scott Gottlieb, M.D., to announce in September that the use of e-cigarettes by teenagers has now reached “nothing short of an epidemic proportion of growth.” According to Gottlieb, the “FDA won’t tolerate a whole generation of young people becoming addicted to nicotine,” and is putting pressure on e-cigarette makers to cease marketing to teenagers.

In turn, the scientists behind this study are concerned that their research indicates that if young people continue to vape, they will develop serious health consequences. Vaping might be healthier than smoking cigarettes, but that doesn’t mean the act itself is healthy.

Abstract:

Background: Wheezing is a symptom of potential respiratory disease and known to be associated with smoking. Electronic cigarette use (‘vaping’) has increased exponentially in recent years. This study examined the cross-sectional association of vaping with wheezing and related respiratory symptoms and compare this association with smokers and dual users.

Methods: The Population Assessment of Tobacco and Health study wave 2 data collected from October 2014 to October 2015 with 28 171 adults were used. The cross-sectional association of vaping with self-reported wheezing and related respiratory symptoms relative to smokers and dual users of tobacco and electronic cigarettes were studied using multivariable logistic and cumulative logistic regression models with consideration of complex sampling design.

Results: Among the 28 171 adult participants, 641 (1.2%) were current vapers who used e-cigarettes exclusively, 8525 (16.6%) were current exclusive smokers, 1106 (2.0%) were dual users and 17 899 (80.2%) were non-users. Compared with non-users, risks of wheezing and related respiratory symptoms were significantly increased in current vapers (adjusted OR (aOR)=1.67, 95% CI: 1.23 to 2.15). Current vapers had significantly lower risk in wheezing and related respiratory symptoms compared with current smokers (aOR=0.68, 95% CI: 0.53 to 0.87). No significant differences were found between dual users and current smokers in risk of wheezing and related respiratory symptoms (aOR=1.06, 95% CI: 0.91 to 1.24).

Conclusions: Vaping was associated with increased risk of wheezing and related respiratory symptoms. Current vapers had lower risk in wheezing and related respiratory symptoms than current smokers or dual users but higher than non-users. Both dual-use and smoking significantly increased the risk of wheezing and related respiratory symptoms.

AIDS success ‘unworkable’ for vast majority


Graphic representation of the AIDS virus.

Graphic representation of the AIDS virus. Copyright: Preshkova,

Speed read

  • For the second time, a bone marrow transplant eliminates the AIDS virus from the blood of a patient
  • Given its complexity and cost, this method is not likely to be used on a large scale
  • Pending ongoing research, ARVs remain the recommended treatment
Medical experts hailed the news this week that a second HIV-positive man appears to have eliminated the virus from his body, but warned the treatment used is completely unviable for the vast majority of the 37 million people living with the disease.

AIDS, caused by infection with the human immunodeficiency virus (HIV) virus, is one of the three big diseases affecting people in the developing world along with tuberculosis and malaria. Around a million people died from AIDS-related illnesses in 2017.

Researchers from University College London (UCL) reported 5 March in the journal Nature the case of an HIV-positive man who, after receiving a bone marrow transplant, no longer showed any sign of the AIDS virus, 18 months after he had stopped taking antiretroviral therapy.

Presenting their work on the same day at the annual conference on retroviruses and opportunistic infections in Seattle, USA, the researchers said they used largely the same method which had been used in 2007 in Berlin on Timothy Ray Brown.

“Even reaching a very limited number of people to achieve ‘near-cure’ of HIV infection is a welcome achievement. It still seemed utopian a decade ago.”

Avelin Aghokeng

The so-called “Berlin patient” is considered the first person in the world to have been cured of HIV/AIDS, as the virus has not been detected in his body since then.
The method involves finding a compatible donor who additionally has a mutation in a gene called CCR5.
It is this gene that causes the AIDS virus to penetrate the immune cells and multiply. But the mutation prevents the virus from entering and taking hold.

As a stem cell, the transplanted bone marrow will produce new immune cells containing the mutated CCR5 gene which will gradually replace the old cells, blocking the virus, which can no longer replicate.

“Continuing our research, we need to understand if we could knock out this receptor in people with HIV, which may be possible with gene therapy,” said Ravindra Gupta, lead author of the study in a statement published by UCL.

There are strong reservations about this method, however, among parts of the scientific community.

Eric Delaporte, head of the laboratory for translational research on HIV and infectious diseases at the Institute of Research for Development (IRD), in France, says the rare genetic mutation is only found in one per cent of the population.

“As is often the case with AIDS, we are dealing with an overrepresentation of a result where we speak of ‘healing’, when in practice, for the millions of people living with HIV, this is not the solution,” he tells SciDev.Net.

‘False hope’

Delaporte also finds the process “complicated and dangerous”.

“You have to put the patient in aplasia, that is, destroy the cells with chemotherapy and then transplant the marrow of a compatible donor,” he says.

“During the aplasia phase when cells are destroyed, the slightest infection can kill, because the patient has no defence. It must therefore take place in a specialist unit with a sterile room, so with an advanced, sophisticated and expensive medical infrastructure.”
For Delaporte, the excitement around the story gives “false hope”.
But Michel Sidibé, executive director of UNAIDS, gives a more nuanced view.
“Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure,” he wrote in a press release issued by the organisation.
“However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.

Sidibé’s optimism is shared by Avelin Aghokeng, researcher at the International Centre for Medical Research in Franceville, Gabon.

“Even reaching a very limited number of people to achieve ‘near-cure’ of HIV infection is a welcome achievement. It still seemed utopian a decade ago,” he says.
“Advances in research are enriched by such proofs of concept and open up new avenues for research and intervention.”

‘Proof of concept’

“Although it is not a viable large-scale strategy. these new findings reaffirm our belief that there exists a proof of concept that HIV is curable,” says Anton Pozniak, president of the International AIDS Society (ISA).

The British infectious disease specialist said he hoped “that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.

The authors of the work prefer to focus on the potential for the scientific community.

“If it is too early to say for sure that our patient is now cured of HIV, the apparent success of stem cells gives hope that new strategies can be developed to combat the disease,” says research team member Eduardo Olavarria.

Commenting on the findings in relation to the 2007 case, Aghokeng says the question of reproducibility of a procedure, experiment or intervention is “crucial””It is difficult,” he says, “to draw important conclusions from a single case. A second success, realized by another research team and in a different patient, allows scientists to confirm the first result and consider the experiment reproducible,” he tells SciDev.Net.

“It also helps to better control the approach, its benefits and also its limitations and dangers. It should be noted that behind this success are also many failures of this approach.”
Meanwhile, everyone in the scientific community agrees that the only way to treat this disease, which affects 37 million people worldwide, according to UNAIDS, is to take antiretrovirals for life.

Tetanus Remains a Threat to Unvaccinated


A recent case of tetanus in an unvaccinated child highlights the continued threat of this rare but dangerous disease among the unvaccinated individuals in the United States.

“Unvaccinated or inadequately vaccinated persons are at risk for tetanus, irrespective of age, and recovery from tetanus disease does not confer immunity,” write Judith A. Guzman-Cottrill, DO, from the Oregon Health and Science University, Portland, and colleagues. The case report was published online March 7 in Morbidity and Mortality Weekly Report.

The case involved a 6-year-old boy who suffered a scalp laceration while playing outdoors. Although his wound was cleaned and sutured at home, the boy was unvaccinated.

After 6 days, he developed symptoms of jaw clenching, involuntary upper extremity muscle spasms, opisthotonus, generalized spasms, and breathing difficulty. He was airlifted to a hospital, where a clinical diagnosis of tetanus was made.

He underwent 8 weeks of inpatient care, including administration of tetanus immune globulin, as well as diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). His wound was irrigated and debrided, and he received intravenous metronidazole.

He required neuromuscular blockade to manage his muscle spasms, continuous intravenous medication infusions to control his pain and blood pressure, and a tracheostomy for ventilator support.

After 8 weeks, his condition improved enough for transfer to an inpatient rehabilitation center, where he remained for 17 days. One month later, he was able to resume his normal active lifestyle. His family refused the second dose of DTaP and other vaccinations recommended by clinicians.

Because of continued use of tetanus immune globulin for wound management and widespread vaccination with tetanus toxoid, tetanus cases have dropped in the United States by 95% since the 1940s, and the number of tetanus-related deaths have dropped by 99%.

In this case, the boys inpatient care alone cost $811,929, which is about 72 times the mean cost of $11,143 for a child’s hospital stay, according to a 2012 study.

This is the first case of tetanus in a child in Oregon in more than 30 years, the authors emphasize, but it highlights the importance of vaccination for this preventable disease.

The Advisory Committee on Immunization Practices recommends a five-dose DTaP series for all eligible children at 2, 4, and 6 months of age, followed by a fourth dose at 15 to 18 months of age, and a fifth at 4 to 6 years of age.

“Booster doses of diphtheria and tetanus toxoids are recommended every 10 years throughout life,” the authors stress.

How The Microbiome Undermines the Ego, Vaccine Policy, and Patriarchy


How The Microbiome Destroyed the Ego, Vaccine Policy, and Patriarchy

The relatively recent discovery of the microbiome is not only completely redefining what it means to be human, to have a body, to live on this earth, but is overturning belief systems and institutions that have enjoyed global penetrance for centuries.

A paradigm shift has occurred, so immense in implication, that the entire frame of reference for our species’ self-definition, as well as how we relate fundamentally to concepts like “germs,” have been transformed beyond recognition. This shift is underway and yet, despite popular interest in our gut ecology, the true implications remain unacknowledged.

It started with the discovery of the microbiome, a deceptively diminutive term, referring to an unfathomably complex array of microscopic microorganisms together weighing only 3-4 lbs. in the average human, represents a Copernican revolution when it comes to forming the new center, genetically and epigenetically, of what it means in biological terms to be human.

Considering the sheer density of genetic information contained within these commensals, as well as their immense contribution towards sustaining basic functions like digestion, immunity, and brain function, the “microbiome” could just as well be relabeled the “macrobiome”; that is, if we are focusing on the size of its importance rather than physical dimensionality.

For instance, if you take away the trillions of viruses, bacteria and fungi that coexist with our human cells (the so-called holobiont), only 1% of the genetic material that keeps us ticking, and has for hundreds of millions of years, remains. One percent isn’t that much for the ego to work with, especially considering it now has to thank what were formerly believed to be mostly “infectious agents” for the fact that it exists. Even more perplexing, the remaining 1% of our contributed DNA to the collective gene pool of the holobiont is at least 8% retroviral (yes, the same category as HIV) in origin!

Us Against Them?

Once the object of modern medicine’s fundamental responsibility – the human body – is redefined and/or perceived with greater veracity, and “germs” become less other and more self, a challenge is created for germ theory which seeks to differentiate between the “good” germs we are versus the “bad” ones out there that we must fight with antibiotics and vaccines. Nowhere is this more apparent than what we learned in our conventional schooling about viruses like influenza, most of which was wrong. The rabbit hole goes extremely deep when it comes to the virome, owing to the fact that many of the viruses we once identified as “other” are actually required for the body’s natural immunological homeostasis. The NIH lecture on the virome below will bring this amazing discovery into high relieve and promises to change your perspective on viruses forever:

As many readers are already poignantly aware, today’s political climate and agenda is unilaterally pro-vaccination on both sides of the aisle (conveniently funded by the same industry lobbyists), with a tidal wave of bills across the U.S. set to eliminate exemptions against mandatory vaccination. The rationale, of course, is that deadly germs can only be prevented from killing the presumably germ-free host through injecting dead, weakened or genetically modified germ components to “prevent” theoretical future exposures and infection. This concept is of course intellectually unsophisticated, and if you do some investigating you’ll find it was never quite grounded in compelling evidence or science.

But the intellectual implications of the microbiome go even deeper than undermining germ theory, vaccine policy, and the culture of medical monotheism that upholds these constructs…

Maternal Origins of Health and Ultimately our Species Identity

Deep within the substratum of humanity’s largely unquestioned assumptions of what it means to be human, the microbiome has also fundamentally displaced a latent patriarchal prejudice concerning the relative importance and contribution of the man and woman towards the health and ultimately the continuation of our species.

It has been known for some time that only women pass down mitochondrial DNA, already tipping the scales in favor of her dominant position in contributing genetic information (the seat of our humanity or species identity, no?) to offspring. The microbiome, however, changes everything in favor of amplifying this asymmetry of hereditary influence. Since we are all designed to gestate in the womb and come through the birth canal, and since the neonate’s microbiome is therein derived and established thereof, it follows that most of our genetic information as holobionts is maternal in origin. Even when the original colonization eventually changes and is displaced through environmentally-acquired microbial strains as the infant, child, adolescent, and then adult, develops, the original terrain and subsequent trajectory of changes was established through the mother (unless of course we were C-sectioned into the world).

Put in simpler terms: if 99% of what it means to be human is microbiome-based, and if the mother contributes most, if not all, of the original starting material, or at least the baseline and trajectory of future changes in the inner terrain, then her contribution becomes vastly more important than that of the father.

Moreover, the conditions surrounding gestation (important because of maternal-to-fetal microbiome trafficking in utero), her general health, and the way in which she gives birth (home, birth center, or hospital) now take on vastly greater importance than previously imagined. In other words, being born in a hospital via C-section and vaccination, will produce, genetically and epigenetically, a human that is so different – qualitatively – from one born at home, naturally, that they could almost be classified as different species, despite sharing nearly identical eukaryotic DNA (remember, only 1% of the holobiont’s total).

The Scientific Inevitability of Birth Feminism

Given this perspective, obstetric interventions are the archetypal expression of a male-dominated paradigm that seeks to manage a woman’s birth experience with largely unacknowledged consequences for the health of our species. Protecting health and preventing disease has now been traced back to the origins of the microbiome, best expressed through natural birth in the home, which has been estimated to be as much as 1,000 times safer than a hospital birth despite propaganda to the contrary.

Birth

In light of the new, microbiome-based view, the male role in protecting the health of women and children will be irrevocably downgraded in importance, not just professionally and medically, but biologically.  First, it is interesting to look at the ancient roots of the biology-based psychospiritual disparities that exist between men and women, and which still influence today’s practice of medicine.

It would appear that men have from the beginning of time envied the creative role of women in conception, pregnancy, birth and caretaking. Erich Fromm also described the pyschospiritual implications for men of this biologically-based existential disparity in terms of the phenomena of womb-envy, exemplified by the biblical passage where God takes a rib from Adam to “create” Eve – an obvious reversal of the natural order of things, reflecting the inherent impotence men feel knowing their creative potency is secondary importance. It has been said, rightly, that the most powerful thing in the universe is to create life (is this not why we attribute this to “God”), and the second most powerful thing to take it. It is no coincidence that history, since it’s inception as recorded, is largely a documentation of the history of wars, of men “creating meaning” by killing men, and establishing symbol systems intended to capture by proxy the creative power latent within every woman’s body and experience.  And so, 10,000 years later, the world ruled by monotheistic, male-principled religious and cultural systems, both in secular and religious form, it seems that the facts of our biology are now intervening to shake up these largely subconscious belief systems in favor of an ancient truth: women are superior to men, fundamentally. (Though it is not a type of superiority to be used against the “weaker sex”: men, rather but to denote a higher responsibility, and perhaps greater need to be supported by men to get the job done, together, as inscribed in the natural order of things and its inherent design.)

The birth process, also, has been described as the closest thing to death without dying (it is ironic that anesthesiology, which could also be described in the same way, makes obstetrical interventions like C-section and epidural possible, at the same moment that it negates the spiritual experience of natural birth/women’s empowerment we are describing), offering women a window into the ‘in between’ and a direct experience of Source that men, less likely to experience it naturally would later emulate and access through the various technologies of shamanism.

Clearly, protecting the microbiome is of utmost importance if we are making the health of our future generations a priority. Indeed, ensuring the health of our offspring is perhaps the most fundamental evolutionary imperative we have.  How do we accomplish this? What is the microbiome but ultimately a selective array of commensal microorganisms that ultimately originated from the environment: in the air we breath, the soil we interact with, and the water and food, of course, we ingest. This means we can’t simply live in a hermetically sealed bubble of shopping for organic, non-GMO certified foods at Whole Foods, while the entire planet continues to go to post-industrial hell in a hand basket.  Our responsibility becomes distributed across everything in the world, and every impactful choice then becomes relevant to the fundamental issue and imperative at hand. With the microbial biodiversity in Big Ag, GM-based agricultural zones fire-bombed with biocides, by the very same corporations that either own or distribute the “organic brands” we all love to think will save our bodies, if not the planet, we need to step deeper into our activism by stepping out of the diversions and palliative measures that don’t result in lasting change.

When we work with the natural world, when we honor and acknowledge what is unknown about the complex web that we all share, we will bring back a vital health that now seems so far out of reach. When we engage technologies positioned in the war against germs and organisms, however, we are doomed to fail and to cripple not only our species but our home.

Bone Marrow Transplant Renders Second Patient Free Of HIV


A color-enhanced scanning electron micrograph shows HIV particles (orange) infecting a T cell, one of the white blood cells that play a central role in the immune system.

Doctors in London say they have apparently eradicated HIV from a patient’s body. It’s only the second time this has been accomplished, despite many attempts over more than a decade.

While some commentators are calling this a “cure” for HIV, the scientists who performed the experiment say it’s too soon to say that. Instead, they say the patient is in remission.

Both cases involved a risky procedure called a stem-cell transplant (otherwise known as a bone marrow transplant). The first recipient, Timothy Brown, gained fame as the so-called Berlin patient after transplants in 2007 and 2008 rid him of HIV. He remains free of HIV today.

That result raised hopes that HIV could be eradicated through a medical procedure and cure people of HIV infection. Yet Brown’s case remained the lone success since then. Other attempts had failed.

Now, researchers at University College London report in a paper being published Tuesday in Nature that they have apparently eliminated HIV in a second person.

That man had been diagnosed with HIV in 2003. Then, in 2012 the unidentified patient was diagnosed with a cancer, Hodgkin lymphoma. After standard treatments failed, they gave the patient a stem-cell transplant — essentially killing off his old immune system and giving him a new one.

The doctors selected a donor who had two copies of a particular mutation in the CCR5 gene that prevents HIV from infecting T-cells, a part of the immune system where the virus takes hold and does its damage. As a result, the man ended up with an immune system that was naturally resistant to HIV.

Sixteen months after the man’s transplant, doctors found no sign of HIV in his body. They decided to stop treating him with antiviral drugs after he volunteered to stop taking them. It has now been more than 18 months and the infection hasn’t reappeared, the scientists say.

Ravindra Gupta and his colleagues write, “it is premature to conclude that this patient has been cured,” but they are hopeful that will prove to be the case.

“This is a highly significant study,” Aine McKnight, a professor of viral pathology at Queen Mary University of London, said in a statement. “After a ten year gap it provides important confirmation that the ‘Berlin patient’ was not simply an anomaly.”

But McKnight cautioned that this won’t necessarily lead to a treatment for anyone with HIV. For one thing, the rare mutation in this case, a variant of a receptor called CCR5, only blocks one variety of HIV. A second, less common form of HIV could still cause infection despite a transplant like this.

This receptor was recently in the news after Chinese scientist He Jiankui claimed he had edited the genes of embryos to include a protective version of CCR5. This experiment raised an ethical furor.

AIDS researchers have known about this CCR5 mutation for years and have tried to think of ways to exploit it as a treatment for HIV.

“Although it is not a viable large-scale strategy for a cure, it does represent a critical moment in the search for an HIV cure,” Anton Pozniak, president of the International AIDS Society, said in a statement. “These new findings reaffirm our belief that there exists a proof of concept that HIV is curable.”

Stem-cell transplants are expensive and risky, because they involve wiping out a patient’s immune system with powerful drugs or radiation and then reconstituting it.

The benefits of this treatment outweigh the risk for cancer patients, which is where it is most commonly used. But HIV drugs have become so effective that many people carrying this infection have a normal lifespan if they take these medications for a lifetime.

The scientists note in their study that the treatment for the second patient was less harsh than the one used for the Berlin patient, raising the possibility that they could develop a less risky procedure for stem-cell transplants for HIV-positive patients.

They say this procedure could be useful now for those rare people with HIV who have also been diagnosed with cancer and are in need of a stem-cell transplant to reconstitute their immune systems. Those patients could benefit if they can find a donor with the rare mutation in CCR5 that protects them from HIV reinfection.

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