Early administration of initial IM adrenaline dose may improve survival rates and neurological outcomes for OHCA patients: Study

The prompt administration of adrenaline is linked to better survival rates following out-of-hospital cardiac arrest (OHCA). However, delays in gaining vascular access can hinder the timely administration of adrenaline. Innovative approaches for delivering adrenaline prior to establishing vascular access might improve survival outcomes. Recent study evaluated the impact of administering an initial intramuscular (IM) adrenaline dose on survival outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA). The objective was to compare the outcomes of patients who received IM adrenaline against those receiving standard intravenous (IV) or intraosseous (IO) adrenaline administration. The research was designed as a before-and-after implementation study, with the pre-intervention phase occurring from January 2010 to October 2019 and the post-intervention period spanning from November 2019 to May 2024, conducted in an urban single-center EMS agency.

Patient Demographics

The study included a total of 1,405 adult patients who underwent EMS treatment for non-traumatic OHCA. Out of these, 420 patients received IM adrenaline, while 985 patients received conventional IV/IO care. The IM group showed a younger demographic and a higher incidence of bystander CPR when compared to the standard care group. Notably, the median time from EMS arrival to the first adrenaline dose was significantly shorter in the IM group (4.3 minutes) compared to the IV/IO group (7.8 minutes), indicating faster intervention.

Major Outcomes

Key outcomes measured included survival rates to hospital admission, survival to hospital discharge, and favorable neurologic function at discharge assessed via the cerebral performance category (CPC) scale. The results indicated that IM adrenaline correlates with improved survival outcomes: the survival to hospital admission was 37.1% in the IM group compared to 31.6% in the standard care group (adjusted odds ratio [aOR] of 1.37), while survival to hospital discharge was 11.0% versus 7.0% (aOR 1.73). Furthermore, favorable neurologic function at discharge was observed in 9.8% of IM-treated patients compared to 6.2% of those receiving IV/IO adrenaline (aOR 1.72).

Conclusions and Future Directions

The study concludes that the early administration of an initial IM adrenaline dose, as a supplemental strategy to established advanced cardiac life support protocols, is associated with improved survival rates and neurological outcomes for OHCA patients. However, the authors emphasize the need for future randomized controlled trials to further validate these findings and to explore the potential benefits more comprehensively, particularly in relation to timing and appropriate dosing strategies of IM adrenaline. The implications of this research suggest a potential paradigm shift in the management of OHCA to enhance patient outcomes effectively.

Key Points

– The research was a before-and-after implementation study aiming to evaluate the effects of initial intramuscular (IM) adrenaline versus standard intravenous (IV) or intraosseous (IO) administration on survival outcomes in adults experiencing out-of-hospital cardiac arrest (OHCA). The pre-intervention phase was from January 2010 to October 2019, and the post-intervention phase lasted from November 2019 to May 2024 within a single urban EMS agency.

– A total of 1,405 adult patients treated for non-traumatic OHCA were included. Of these, 420 received IM adrenaline and 985 received conventional IV/IO treatment. The IM group was generally younger and had a higher rate of bystander CPR, and notably, the time from EMS arrival to the administration of adrenaline was significantly shorter for the IM group (4.3 minutes) than for the IV/IO group (7.8 minutes).

– The primary outcomes analyzed were survival rates to hospital admission, survival to hospital discharge, and favorable neurological function at discharge, assessed using the cerebral performance category (CPC) scale.

-Survival Rate Improvements: The study found that administering IM adrenaline was associated with improved survival rates: 37.1% of patients receiving IM adrenaline survived to hospital admission compared to 31.6% in the IV/IO cohort (adjusted odds ratio [aOR] of 1.37). Additionally, the IM group showed higher survival to hospital discharge rates (11.0% vs. 7.0%; aOR 1.73).

-Neurological Outcomes- The analysis indicated that favorable neurological function at discharge was more prevalent among IM adrenaline-treated patients (9.8%) compared to those receiving standard treatment (6.2%), with an aOR of 1.72 reflecting this improved outcome.

– Conclusions and Future Research Directions: The study concludes that early initial administration of IM adrenaline as an adjunct to established advanced cardiac life support protocols enhances survival and neurological outcomes in OHCA patients. The authors call for future randomized controlled trials to confirm these findings and investigate optimal timing and dosing strategies for IM adrenaline to further improve patient care.

Reference –

H. Palatinus et al. (2024). Early Intramuscular Adrenaline Administration Is Associated With Improved Survival From Out-Of-Hospital Cardiac Arrest.. *Resuscitation*, 110266 . https://doi.org/10.1016/j.resuscitation.2024.110266.

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Mixed histology protective factor impacting overall survival and progression free survival in Neuroendocrine Carcinoma of Cervix: Study

Neuroendocrine carcinoma of the cervix (NECC) , a rare type of cervical cancer, has a poor prognosis and is more aggressive compared to more common types, with a 5-year survival rate ranging from 0% to 30%. Recent research paper focused on evaluating the prognostic factors and survival outcomes of patients who underwent surgery for high-grade neuroendocrine carcinoma of the cervix (NECC). The study was a multicenter retrospective analysis involving 98 patients with high-grade NECC at different stages. Patients were divided into pure and mixed histology groups, with 60 patients in the pure group and 38 in the mixed group. The study identified various prognostic factors affecting overall survival (OS) and progression-free survival (PFS) in surgically treated high-grade NECC.

Impact of Histology on Survival Outcomes

The findings revealed that mixed histology was a protective factor impacting OS and PFS, while factors like ovarian preservation, age over 45 years, tumor size over 4 cm, parity over 3, and perineural invasion were associated with negative survival outcomes. Kaplan–Meier survival curves showed significant differences in histologic type, chemotherapy, ovarian preservation, uterine invasion, and depth of stromal invasion, affecting OS and PFS.

Prognosis and Treatment Recommendations

Patients with mixed histologic types had a better prognosis, while those with high-risk factors should receive more attention in clinical practice. The study emphasized the importance of accurate pathologic diagnosis and the need for continued research in understanding and treating high-grade NECC. The results also suggested that patients with high-grade NECC may benefit from specific treatments like adjuvant EP chemotherapy and avoiding ovarian preservation.

Significance of Clinicopathologic Factors

The study highlighted the significance of clinicopathologic factors such as tumor size, staging, surgical margins, and uterine invasion in evaluating cervical cancer prognosis. Limitations of the study included a small sample size and the rarity of high-grade NECC, which necessitates further research with larger sample sizes and extended follow-up periods to strengthen the evidence. Overall, the research findings contribute to enhancing the understanding and management of high-grade NECC patients.

Key Points

1. The research evaluated prognostic factors and survival outcomes of patients who underwent surgery for high-grade neuroendocrine carcinoma of the cervix (NECC) through a multicenter retrospective analysis involving 98 patients at various stages, with 60 in the pure histology group and 38 in the mixed histology group.

2. Mixed histology was identified as a protective factor impacting overall survival (OS) and progression-free survival (PFS), while factors like ovarian preservation, age over 45 years, tumor size over 4 cm, parity over 3, and perineural invasion were associated with negative survival outcomes. Kaplan–Meier survival curves showed significant differences in histologic type, chemotherapy, ovarian preservation, uterine invasion, and depth of stromal invasion affecting OS and PFS.

3. Patients with mixed histologic types demonstrated a better prognosis, emphasizing the need for attention to high-risk factors in clinical practice. The study underscored the importance of accurate pathologic diagnosis and called for further research in understanding and treating high-grade NECC. Specific treatments like adjuvant EP chemotherapy were suggested, and avoiding ovarian preservation was recommended for patients with high-grade NECC.

4. Clinicopathologic factors such as tumor size, staging, surgical margins, and uterine invasion were deemed significant in evaluating cervical cancer prognosis. The study acknowledged limitations, including a small sample size and rarity of high-grade NECC, prompting the call for larger sample sizes and extended follow-up periods to strengthen the evidence and insight into managing high-grade NECC patients.

5. The research contributes to enhancing knowledge and management strategies for high-grade NECC patients, emphasizing the impact of histology, prognostic factors, and treatment recommendations on survival outcomes. Understanding the clinicopathologic factors affecting cervical cancer prognosis is crucial for improving patient care and outcomes.

6. Overall, the study provides valuable insights into prognostic factors, survival outcomes, and treatment considerations for high-grade NECC patients, highlighting the significance of histology, clinicopathologic factors, and the need for continued research to optimize the management of this rare and challenging cancer type.

Reference –

Lyu YH, Liu HX, Han X, Yuan P, Wang MY, He YY, Ge JL, Zou W, Jing R, Xin CS, Yang H, Chen BL, Chen GW, Li J. Clinicopathologic characteristics and prognostic factors of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix: A multicenter retrospective study. Int J Gynaecol Obstet. 2024 Dec;167(3):1055-1065. doi: 10.1002/ijgo.15771. Epub 2024 Jul 19. PMID: 39031110.

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AI model used with one-inhale CT helps diagnose COPD: Study

AI model used with one-inhale CT may help diagnose COPD suggests a study published in the Radiology: Cardiothoracic Imaging.

A study measured the benefit of single-phase CT, inspiratory-expiratory CT, and clinical data for convolutional neural network (CNN)–based chronic obstructive pulmonary disease (COPD) staging. This retrospective study included inspiratory and expiratory lung CT images and spirometry measurements acquired between November 2007 and April 2011 from 8893 participants (mean age, 59.6 years ± 9.0 [SD]; 53.3% [4738 of 8893] male) in the COPDGene phase I cohort (ClinicalTrials.gov: NCT00608764). CNNs were trained to predict spirometry measurements (forced expiratory volume in 1 second [FEV1], FEV1 percent predicted, and ratio of FEV1 to forced vital capacity [FEV1/FVC]) using clinical data and either single-phase or multiphase CT. Spirometry predictions were then used to predict Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Agreement between CNN-predicted and reference standard spirometry measurements and GOLD stage was assessed using intraclass correlation coefficient (ICC) and compared using bootstrapping. Accuracy for predicting GOLD stage, within-one GOLD stage, and GOLD 0 versus 1–4 was calculated. Results: CNN-predicted and reference standard spirometry measurements showed moderate to good agreement (ICC, 0.66–0.79), which improved by inclusion of clinical data (ICC, 0.70–0.85; P ≤ .04), except for FEV1/FVC in the inspiratory-phase CNN model with clinical data (P = .35) and FEV1 in the expiratory-phase CNN model with clinical data (P = .33). Single-phase CNN accuracies for GOLD stage, within-one stage, and diagnosis ranged from 59.8% to 84.1% (682–959 of 1140), with moderate to good agreement (ICC, 0.68–0.70). Accuracies of CNN models using inspiratory and expiratory images ranged from 60.0% to 86.3% (684–984 of 1140), with moderate to good agreement (ICC, 0.72). Inclusion of clinical data improved agreement and accuracy for both the single-phase CNNs (ICC, 0.72; P ≤ .001; accuracy, 65.2%–85.8% [743–978 of 1140]) and inspiratory-expiratory CNNs (ICC, 0.77–0.78; P ≤ .001; accuracy, 67.6%–88.0% [771–1003 of 1140]), except expiratory CNN with clinical data (no change in GOLD stage ICC; P = .08). CNN-based COPD diagnosis and staging using single-phase CT provides comparable accuracy with inspiratory-expiratory CT when provided clinical data relevant to staging.

Reference:

Evaluating the Cumulative Benefit of Inspiratory CT, Expiratory CT, and Clinical Data for COPD Diagnosis and Staging through Deep Learning, Amanda N. Lee, Albert Hsiao, Kyle A. Hasenstab. Author Affiliations. Published Online:Dec 12 2024https://doi.org/10.1148/ryct.240005

Keywords:

Convolutional Neural Network, Chronic Obstructive Pulmonary Disease, CT, Severity Staging, Attention Map, CT, Expiratory CT, Radiology: Cardiothoracic Imaging

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Study explores whether CBD can reduce scan-related anxiety in patients with advanced breast cancer

The findings showed that CBD did not significantly change scan-related anxiety when compared to a placebo, but researchers did find that CBD was safe and resulted in significantly lower overall anxiety levels

Anxiety is extremely common among adults receiving cancer care, with as many as one out of every four patients meeting the clinical criteria for anxiety. Many patients with cancer also experience scan-related anxiety (scanxiety), a condition in which individuals develop anxiety related to getting imaging studies to assess the potential spread of cancer, evaluate response to treatment, or investigate cancer-related symptoms. There are not many good options for managing anxiety outside of benzodiazepines (medications like lorazepam or alprazolam). While benzodiazepines work, they can cause significant complications including falls and oversedation.

A new study conducted as a collaboration between researchers from Dana-Farber Cancer Institute and Mass General Brigham explores whether cannabidiol (CBD), a component of marijuana, can reduce anxiety levels, specifically among patients with advanced breast cancer before a scan assessing tumor burden. The randomized clinical trial compared patients who received 400 mg of CBD compared to patients who received a placebo. While the study did not meet its primary endpoint of significant difference between groups in anxiety change scores, the researchers did find that anxiety levels were significantly lower 2-to-4 hours after ingesting CBD and that CBD was safe as a treatment for anxiety among patients with breast cancer. Their results are published in JAMA Network Open.

“Our results lay the groundwork for larger, more definitive trials testing CBD in patients with breast cancer and other cancers as a way of reducing anxiety,” said co-first author Peter Chai, MD, of the Department of Emergency Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. Chai is also a member of the Department of Psychosocial Oncology at Dana-Farber Cancer Institute.

“Our study also demonstrates high levels of interest in clinical trials to test treating anxiety with CBD and highlights the need to conduct follow-up studies to understand how CBD integrates into the armament of therapies to address cancer related anxiety,” said corresponding author Ilana Braun, MD, of the Department of Psychiatry at the Brigham and Department of Supportive Oncology at Dana-Farber Cancer Institute. “We recruited patients at the height of the pandemic when clinical trials generally stagnated, but nearly three-quarters of potential participants expressed interest and many referred others to the study.”

The team, led by Braun with co-first author Chai and co-first author Manan M. Nayak, PhD, MA, of the Dana-Farber Cancer Institute, measured whether administering one oral dose of 400mg FDA-approved CBD would decrease the anxiety levels of patients with advanced breast cancer. Participants at the Dana-Farber Cancer Institute’s Breast Oncology Center were randomized into two groups: a control group (25 women receiving no treatment) and a treatment group (25 women receiving CBD). Anxiety levels among participants were assessed using the Visual Analog Mood Scale (VAMS) prior to and 2-to-4 hours following the treatment drug ingestion. Participants who were randomly assigned to take CBD did not have a significantly greater reduction in anxiety after ingestion compared to patients who did not take CBD. However, though the study did not achieve its primary endpoint, it did demonstrate that participants who consumed CBD experienced lower anxiety levels 2-to-4 hours after drug ingestion, suggesting that CBD does have anxiety-reducing properties.

According to the researchers, this finding suggests CBD’s potential as an anxiety treatment for women with advanced breast cancer and clinical anxiety, necessitating further investigation.

Reference:

Nayak MM, Chai P, Catalano PJ, et al. Cannabidiol for Scan-Related Anxiety in Women With Advanced Breast Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2450391. doi:10.1001/jamanetworkopen.2024.50391

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Herpes Simplex Virus Infection Linked to Increased Risk of Vitiligo, Study Suggests

Taiwan: A nationwide retrospective cohort study has revealed a significant association between herpes simplex virus (HSV) infection and an increased risk of developing vitiligo, a chronic skin condition characterized by the loss of pigment in patches of the skin. This population-based study, published in Archives of Dermatological Research, offers new insights into the potential role of viral infections in the pathogenesis of autoimmune diseases like vitiligo.

Results indicated that individuals with a history of HSV infection were more likely to develop vitiligo over time, suggesting a potential link between the two conditions. The findings emphasize the importance of considering viral infections as a possible contributing factor in the onset of autoimmune and inflammatory skin disorders.

Several studies have suggested a potential link between herpes simplex virus infection and the development of vitiligo. Jing-Xing Li, Department of Internal Medicine, China Medical University Hospital, Number 2, Yude Road, North District, Taichung, Taiwan, and colleagues aimed to investigate the association between HSV infection and the risk of vitiligo.

For this purpose, the researchers utilized the National Health Insurance Research Database of Taiwan to conduct a comparative analysis between individuals with and without a diagnosis of HSV infection. The study covered the period from January 1, 2008, to December 31, 2019. The primary outcome included the date of the first vitiligo diagnosis, death, withdrawal from the National Health Insurance Program, or the conclusion of the study period.

The study led to the following findings:

  • A 1:1 propensity score matching was performed based on age, sex, and comorbidities, resulting in 1,009,445 matched pairs of patients with and without HSV infections.
  • The adjusted hazard ratio for developing vitiligo in the HSV-infected group was 1.71.
  • An age-dependent pattern was observed among HSV-infected patients with vitiligo.
  • Both males and females showed a significantly higher risk of developing vitiligo in the presence of HSV infection.
  • The HSV-infected group demonstrated a significantly increased cumulative risk of vitiligo over a 12-year follow-up compared to the non-HSV group.
  • Sensitivity analysis confirmed results consistent with the primary analysis.
  • The risk of vitiligo was notably higher within the first year of follow-up among HSV-infected patients compared to the non-HSV group (adjusted hazard ratio, 4.83).

“The study establishes a notable link between HSV infection and an elevated risk of vitiligo, marking a significant step toward unraveling the complex interplay between viral infections and autoimmune disorders. However, further research, including molecular studies of affected skin regions, is essential to confirm causality and explore the underlying mechanisms of this association,” the researchers concluded.

Reference:

Li, JX., Yu, TS., Hsu, SB. et al. Association of herpes simplex virus infection and vitiligo: a nationwide retrospective cohort study. Arch Dermatol Res 317, 90 (2025). https://doi.org/10.1007/s00403-024-03612-x

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Ultra-processed foods may drive colorectal cancer risk, USF-TGH study finds

Colorectal cancer, the second leading cause of cancer-related deaths in the United States, may be fueled by the food on our plates. Researchers at the University of South Florida and Tampa General Hospital Cancer Institute have uncovered a potential link between the Western diet-dominated by ultra-processed foods and unhealthy oils – and the chronic inflammation that drives tumor growth.

The researchers, through a five-year, $3.1 million grant from the National Institutes of Health, have already made major advancements in the understanding of colorectal cancer. The project’s first study examines how processed foods are likely hindering the body’s natural healing processes. Their findings will publish online in Gut, a leading international journal in gastroenterology and hepatology, on Tuesday, Dec. 10, at 10 a.m. ET, and the embargo will lift at that time.

“It is well known that patients with unhealthy diets have increased inflammation in their bodies,” said Dr. Timothy Yeatman, a renowned physician-scientist and professor of surgery in the USF Health Morsani College of Medicine and associate center director for Translational Research and Innovation at the TGH Cancer Institute. “We now see this inflammation in the colon tumors themselves, and cancer is like a chronic wound that won’t heal – if your body is living off of daily ultra-processed foods, its ability to heal that wound decreases due to the inflammation and suppression of the immune system that ultimately allows the cancer to grow.”

According to Yeatman, the findings emphasize the urgent need to reevaluate the components of the Western diet, which typically consists of excessive consumption of added sugars, saturated fats, ultra-processed foods, chemicals and inflammatory seed oils. In previous studies, the USF Health Heart Institute found an imbalanced diet not only impacts colorectal cancer, but also plays a role in other diseases, including Alzheimer’s, diabetes and cardiovascular conditions.

“Our bodies are designed to actively resolve inflammation through bioactive lipid compounds derived from the healthy fats, like avocados, that we consume,” said Ganesh Halade, associate professor in the USF Health Heart Institute and a member of the Cancer Biology Program at TGH Cancer Institute. “Bioactive lipids are very small molecules derived from the foods that we eat and, if the molecules are coming from processed food products, they directly imbalance the immune system and drive chronic inflammation.”

While the molecules are difficult to detect, Halade used a highly sensitive analytical technique to identify trace amounts of lipids in 162 tumor samples from patients at Tampa General Hospital. The tumors were frozen within 30 minutes of removal and transported to his lab via USF and TGH Cancer Institute’s Biobank, in collaboration with USF Health Colorectal Surgery and the Gastrointestinal Oncology Program at TGH Cancer Institute.

Inside the tumors, the team observed an excess number of molecules that promote inflammation and a shortage of those that help resolve it and promote healing. These findings pave the way for a new, natural approach — resolution medicine — which focuses on restoring balance in the patient’s diet to treat colorectal cancer more effectively.

“A human’s immune system can be extremely powerful and drastically impact the tumor microenvironment, which is great if harnessed correctly for health and wellness,” Yeatman said. “But not if it’s suppressed by inflammatory lipids from processed foods.”

Resolution medicine would focus on reversing inflammation using healthy, unprocessed foods rich with omega-3 fatty acids and derivatives of fish oil called “specialized pro-resolving mediators,” to restore the body’s healing mechanisms along with balanced sleep and exercise.

“This has the potential to revolutionize cancer treatment, moving beyond drugs to harness natural healing processes,” Yeatman said. “It’s a vital step toward addressing chronic inflammation and preventing diseases before they start.”

Early trials using specialized derivatives of fish oil have shown promise in addressing inflammation at its root cause. The trials are underway at TGH Cancer Institute and the team will continue studying resolution medicine and its impact on patient treatment and disease prevention.

Examples of healthy, unprocessed foods: crab, salmon, halibut, spinach, brussels sprouts, seaweed, algae and grass-fed, pasture-raised meats, etc.

Examples of ultra-processed foods: ice cream, sausages, chips, mass-produced bread, breakfast cereals, doughnuts, carbonated drinks, instant soups, some alcoholic drinks, etc.

Reference:

Soundararajan R, Maurin MM, Rodriguez-Silva J, et alIntegration of lipidomics with targeted, single cell, and spatial transcriptomics defines an unresolved pro-inflammatory state in colon cancerGut Published Online First: 10 December 2024. doi: 10.1136/gutjnl-2024-332535.

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Hemodiafiltration reduces all-cause mortality in people with kidney failure: Lancet

A new study published in The Lancet journal showed that hemodiafiltration lowers mortality associated with kidney failure compared to hemodialysis, with dose-dependent advantages. Within 5 years of the first dialysis demand, kidney failure is linked to a death risk of almost 50%. Estimates of survival may increase with convection-based hemodialysis therapies, which eliminate a wider range of uremic chemicals than diffusive therapy.

According to randomized clinical research, individuals with kidney failure who get high-dose hemodiafiltration instead of traditional high-flux hemodialysis have a 23% decreased chance of dying. However, it is yet unknown if treatment effects vary among subgroups, if there is a dose-response connection with convection volume, and how it affects cause-specific mortality.

Thus, Robin Vernooij and colleagues presented an overview of the available data from randomized controlled studies comparing hemodiafiltration and hemodialysis that were intended to evaluate all-cause mortality in patients with renal failure is the goal of this individual patient data meta-analysis. This study wanted to offer more exact estimates of the impact of hemodiafiltration vs hemodialysis across multiple subgroups, to measure cause-specific mortality, and to provide light on the ongoing link between attained convection volume and mortality risks.

This research looked for randomized controlled trials that compared online hemodialysis vs hemodiafiltration intended to quantify mortality outcomes in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials published since the creation of database on July 17, 2024. All-cause mortality was the main result. Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. 

This analysis included 5 studies with a total of 4153 patients (2070 undergoing hemodialysis and 2083 receiving hemodiafiltration). When compared to 559 patients (27·0%) treated with hemodialysis, 477 patients (23·3%) had all-cause death after a median follow-up of 30 months (IQR 24–36) (hazard ratio 0·84 [95% CI 0·74–0·95]).

Also, there was no indication of a difference in impact between subgroups. It was evident that the convection volume and mortality risk had a graded relationship, with the mortality risk decreasing as the volume grew. Overall, online hemodiafiltration lowers all-cause mortality in patients with renal failure when compared to hemodialysis. 

Source:

Vernooij, R. W. M., Hockham, C., Strippoli, G., Green, S., Hegbrant, J., Davenport, A., Barth, C., Canaud, B., Woodward, M., Blankestijn, P. J., Bots, M. L., Blankestijn, P. J., Vernooij, R. W., Hockham, C., Strippoli, G. F., Canaud, B., Hegbrant, J., Barth, C., Cromm, K., … Woodward, M. (2024). Haemodiafiltration versus haemodialysis for kidney failure: an individual patient data meta-analysis of randomised controlled trials. In The Lancet (Vol. 404, Issue 10464, pp. 1742–1749). Elsevier BV. https://doi.org/10.1016/s0140-6736(24)01859-2

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Older children and boys with IBD have more periodontal treatment needs, compared to controls: Study

Older children and boys with inflammatory bowel disease (IBD) have more periodontal treatment needs, compared to controls suggests a study published in the Special Care in Dentistry.

Inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), is thought to develop as a result of dysregulation οf the immune response to abnormal gut flora in a genetically susceptible host.In about 25% of the affected individuals, IBD occurs late in childhood and adolescence, peaking in the second and third decades of life.

Increased incidence of periodontal disease is described in adult patients with inflammatory bowel disease (IBD), implicating similarities in gut immunopathogenesis and periodontitis. Evaluation of periodontal status and treatment needs of children with IBD in remission, according to disease phenotype, sex, age, and oral hygiene status, and compare them to age-matched healthy population of a dental practice. Fifty-five children with IBD (mean age 12.27 ± 3.67 years) and 55 matched healthy controls of a dental practice (mean age 12.21 ± 3.96 years) were assessed with the simplified gingival index (GI-S) and the plaque control record (PCR) index and the community periodontal index of treatment needs (CPITNs). A dental questionnaire on therapy, oral hygiene, gum bleeding, and dental attendance was completed by participants.

Results: Children with inflammatory bowel disease (IBD) in remission had higher gingival inflammation and periodontal treatment needs compared to controls. In patients with IBD, the CPITN was higher in older compared to younger children (59.37% vs. 47.83%) and in boys compared to girls (65% vs. 46.67%). Among controls, CPITN was also higher in older children (21.88% vs. 4.34%) and in boys (16% vs. 13.33%). Older children and boys with IBD have more periodontal treatment needs, compared to controls, despite similar oral hygiene.

Reference:

Zellos A, Koutsochristou V, Dimakou K, et al. Periodontal treatment needs in children and adolescents with inflammatory bowel disease. Spec Care Dentist. 2025; 45:e13077. https://doi.org/10.1111/scd.13077

Keywords:

Older, children, boys, IBD, periodontal, treatment, needs, compared, controls, study, Special Care in Dentistry, Zellos A, Koutsochristou V, Dimakou Km

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Research finds New drug promising against Duchenne muscular dystrophy

A novel drug holds promise for treating Duchenne muscular dystrophy (DMD), a rare genetic disorder that causes severe muscle degeneration.

McGill University researchers have discovered that an experimental compound called K884 can boost the natural repair abilities of muscle stem cells. Current treatments can slow muscle damage, but don’t address the root problem.

DMD affects about one in 5,000 boys worldwide, often leading to wheelchair dependence by the teenage years and life-threatening complications in early adulthood.

“By strengthening muscle repair rather than just slowing degeneration, therapies that stimulate muscle stem cell function have the potential to improve quality of life for DMD patients. It may help restore muscle function and, ultimately, offer greater independence,” said senior author Natasha Chang, Assistant Professor in McGill’s Department of Biochemistry.

Building stronger muscles from stem cells

Biotechnology company Kanyr Pharma originally developed the drug for cancer and metabolic diseases, but it has not yet been approved for any specific use. This preclinical study marks the first time the drug has been tested in DMD cells.

The researchers put DMD-affected muscle stem cells from humans and mice under the microscope to see how they responded to the drug. They observed that experimental drug blocks specific enzymes, allowing muscle stem cells to develop into functional muscle tissue.

“What makes K884 particularly promising is its precision. It targets DMD-affected cells without affecting healthy muscle stem cells,” said Chang.

Unlike gene therapy, which targets specific genetic mutations and isn’t suitable for all patients, K884 works at the cellular level, restoring muscle repair regardless of the mutation causing the disease. This makes it a potential treatment option for all DMD patients, she added.

A new understanding of DMD

The findings, published in Life Science Alliance, add to a growing body of evidence that challenges previous assumptions about DMD’s root cause.

“This disease has historically been seen as a muscle problem caused by a missing protein called dystrophin,” said Chang. “But new research, including our own, shows that restoring stem cell function is just as critical for repairing muscle.”

The team plans to keep testing the drug, focusing on its safety and long-term effects, while also exploring other related compounds, some of which are already involved in early human trials.

Reference:

Yiyang Liu, Shulei Li, Rebecca Robertson, Jules A Granet, Isabelle Aubry, Romina L Filippelli, Michel L Tremblay, Natasha C Chang Life Science Alliance Oct 2024, 8 (1) e202402831; DOI: 10.26508/lsa.202402831

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In-Labour Cesarean Sections Linked to Increased Risk of Preterm Birth and Mid-Trimester Loss: Study Finds

UK: Cesarean sections performed during labor are linked to an increased risk of recurrent preterm birth and mid-trimester pregnancy loss in subsequent pregnancies, according to a new perspective by Andrew Shennan and Laura van der Krogt.

The authors from King’s College London, St Thomas’ Hospital, London, United Kingdom, emphasize that cervical damage caused by cesarean procedures during labor is a key factor contributing to these risks. The perspective was published online in PLOS Medicine on December 12, 2024.
The rate of cesarean sections has risen significantly over the past few decades, with one in five women globally now delivering by cesarean. In the UK alone, over one in three women give birth through cesarean delivery, and 24% of these are classified as emergency cesareans, with 5% being performed at full cervical dilation. Notably, in North America, cesareans performed at full dilatation have risen by 44% over the past decade. Factors such as changes in medical training, litigation fears, and cultural expectations have been identified as contributing to these trends.
Cesarean sections are often lifesaving; however, the procedure, especially when performed late in labor, has been associated with significant risks in future pregnancies. Studies suggest that women with a history of in-labour cesarean delivery face an increased likelihood of mid-trimester loss and spontaneous preterm birth (sPTB). Data from recent research show that these risks are especially elevated when cesarean delivery occurs at full cervical dilatation. In one study, women with a prior in-labor cesarean had a relative risk of 2.7 for recurrent sPTB and 5.65 for mid-trimester losses compared to women without this surgical history.
Cervical damage, specifically at the internal os during or following cesarean procedures, has been proposed as the underlying mechanism. This disruption weakens cervical integrity, impairing its ability to maintain a pregnancy in subsequent gestations. Mechanisms contributing to cervical damage include surgical trauma, healing responses, and scar positioning. Imaging studies like transvaginal ultrasound (TVUS) support these findings, showing that cesarean scars near or at the internal os can lead to a shortening cervix and subsequent preterm delivery risks.
Standard interventions such as transvaginal cerclage (TVC) have shown limited success in women with prior in-labour cesarean deliveries. This has led to increased consideration of alternative approaches like transabdominal cerclage (TAC), which involves placing a suture higher up, above the cervical damaged area. Recent studies suggest that TAC may significantly reduce the rates of sPTB compared to TVC.
The authors stress that as cesarean rates rise, healthcare professionals must address these risks through better training, imaging, and management strategies. There is an urgent need for research to explore optimal imaging protocols, risk assessments, and interventions to minimize cervical damage and improve outcomes for affected women. Recognizing cervical cesarean damage as a growing clinical issue can guide shared decision-making and improve both clinical practice and maternal health outcomes.
Reference:
van der Krogt L, Shennan A (2024) Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. PLoS Med 21(12): e1004497. https://doi.org/10.1371/journal.pmed.1004497

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