New blood test exhibits superior sensitivity in detecting HPV-associated head and neck cancers: Study

A new liquid biopsy blood test could help detect cases of human papillomavirus (HPV)-associated head and neck cancers with significantly higher accuracy than currently used methods, including before patients develop symptoms, according to new Mass General Brigham research.

The researchers at Mass Eye and Ear, a member of the Mass General Brigham healthcare system, found that the blood-based diagnostic test they developed called HPV-DeepSeek achieved 99% sensitivity and 99% specificity for diagnosing cancer at the time of first clinical presentation, including for the very earliest stages of disease. This higher accuracy significantly outperforms current standard-of-care methods, including other commercially available liquid biopsy assays. The study is published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

HPV causes about 70% of oropharyngeal cancers in the United States, which are increasing in incidence faster than all other head and neck cancers, yet unlike cervical cancer, which is also caused by HPV, there are no early detection tests. This means patients typically present to doctors once they are experiencing symptoms, requiring treatments that may carry significant side effects, according to the study’s lead author Daniel Faden, MD, a principal investigator in the Mike Toth Head and Neck Cancer Research Center and Surgical Oncologist and at Mass Eye and Ear.

“The goal of developing HPV-DeepSeek was to create a minimally invasive approach to detect HPV cancers that is significantly more sensitive than what is currently available for patients,” said Faden. “Our findings demonstrate that we can use this approach to not only diagnose patients more accurately compared to what is currently available, but also provide the potential to screen for HPV cancers in the blood before patients ever develop symptoms, enabling us to catch and treat their cancers at the earliest stages.”

HPV-DeepSeek detects fragments of the viral genome that have broken off from the tumor and entered the bloodstream, along with nine other features in the blood. Unlike current liquid biopsy approaches, which only target one to two pieces of the viral genome, HPV-DeepSeek uses whole-genome sequencing of the entire HPV genome. In the new study, researchers tested HPV-DeepSeek in 152 patients with HPV-associated head and neck cancer and 152 healthy controls. They then did a head-to-head comparison with methods including current liquid and tissue biopsy approaches. They found this novel approach led to a significantly improved sensitivity and accuracy.

The researchers are now leading additional studies around HPV-DeepSeek, including its role in screening for cancers years before the tumors develop. In a study that currently is in preprint, they tested the assay in 28 people who years later went on to develop HPV-associated oropharynx cancer and 28 healthy controls. They found they could detect the cancer in 79% of individuals who later developed cancer while all the controls had negative testing. The earliest positive result was nearly eightyears before diagnosis, demonstrating for the first time that highly accurate blood-based screening for HPV cancer is feasible. This work was also presented at the 2024 symposium, AACR Special Conference in Cancer Research: Liquid Biopsy: From Discovery to Clinical Implementation.

“The natural history of these cancers is that they grow over a period of about 15 years, and as they grow they release DNA from the HPV genome into the blood. If we can detect these cancers years earlier, at their earliest stages, it could drastically change how we treat patients; for example, being able to use less treatment leading to fewer side effects,” said Faden. “While our results suggest great potential for clinical benefit, there are unanswered questions we need to address to understand how we could best utilize these approaches and what the follow-up regimens would be for patients who screen positive.”

The team is now running studies to address these questions in HPV-associated head and neck and other HPV cancers. In addition to screening, the team is also running clinical trials to study the effectiveness of detecting microscopic residual disease remaining after surgery, which could inform whether additional treatments like radiation therapy are needed.

Using liquid biopsy for cancer early detection and personalization of treatment after surgery is an area of growing study across other forms of head and neck cancer. In a separate study published in the same issue of Clinical Cancer Research, Faden and his team tested a different novel assay called MAESTRO in patients with head and neck cancer not caused by HPV to look for evidence of cancer remaining after surgery. Developed at the Broad Institute of MIT and Harvard, this approach improves sensitivity by using a specialized approach to detect genome-wide tumor DNA with minimal sequencing. They found the test could accurately detect residual cancer within a few days of surgery in a highly aggressive form of head and neck cancer and that patients with residual disease detected by the assay had significantly worse survival and recurrence outcomes.

“People have always wondered whether more sensitive liquid biopsy tests will start to detect residual cancer that won’t lead to recurrence,” said Viktor Adalsteinsson, PhD, who directs the Gerstner Center for Cancer Diagnostics at the Broad Institute, and whose team developed MAESTRO. “In this study, MAESTRO not only detected residual cancer in more patients who experienced future recurrence or death but also was highly predictive for it.”

“Whole-genome sequencing liquid biopsy approaches, like HPV-DeeSeek and MEASTRO used in these studies, are enormously powerful, allowing physicians to look for many hundreds or thousands of needles in haystacks as opposed to just a few, drastically increasing sensitivity,” said Faden. “For patients, this means significantly more accurate results and being one step closer to truly personalized care.”

Reference:

Michael E. Bryan, Ling Aye, Direct Comparison of Alternative Blood-Based Approaches for Early Detection and Diagnosis of HPV-Associated Head and Neck Cancers, Clinical Cancer Research, https://doi.org/10.1158/1078-0432.CCR-24-2525

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Penile Implant Satisfaction Drops in Prostate Cancer Patients on Hormonal Treatment

Prostate cancer is the most common malignancy among men, with over 160,000 new cases diagnosed annually in the United States. Although advances in surgery, radiotherapy, and hormone therapy have extended survival, these treatments often result in complications that impact quality of life. Erectile dysfunction, reduced libido, and changes in intimacy remain common and distressing, affecting both patients and their partners. Androgen deprivation therapy, in particular, has been shown to triple the risk of erectile dysfunction and significantly reduce sexual satisfaction. While penile prosthesis surgery provides a restorative option, little is known about its effectiveness in men previously treated with hormone therapy. Based on these challenges, there is a need for in-depth research on inflatable penile prosthesis (IPP) outcomes in the context of androgen deprivation therapy (ADT).

Researchers from the University of Texas McGovern Medical School, Hamad Medical Corporation, and MD Anderson Cancer Center published their study (DOI: 10.1002/uro2.116) on February 19, 2025, in UroPrecision. The research focused on whether androgen deprivation therapy (ADT)-commonly prescribed alongside surgery or radiotherapy for prostate cancer-affects patient satisfaction after inflatable penile prosthesis (IPP) surgery. By comparing satisfaction scores between men who had undergone ADT and those who had not, the study provides important new insights into how hormonal therapy shapes long-term sexual outcomes for prostate cancer survivors.

The team conducted a retrospective review of 529 cases treated between 2017 and 2022, identifying 96 prostate cancer survivors who had received IPP surgery and completed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients were divided into two groups: those with prior ADT and those without. Findings showed that men with ADT reported significantly lower satisfaction scores (p = 0.0344). Independent of hormone therapy, men treated with radical prostatectomy generally reported higher satisfaction than those treated with radiation therapy. Coronary artery disease was also linked to lower satisfaction, suggesting comorbidities further influence outcomes. Researchers propose that ADT reduces satisfaction by suppressing testosterone, which not only targets prostate cancer cells but also weakens penile tissue, leading to atrophy and diminished elasticity. This physiological impact likely explains lower scores among ADT patients. Radiation therapy patients also had poorer results due to progressive vascular damage, while radical prostatectomy patients tended to benefit more from prosthesis surgery. These results underscore the importance of considering treatment history, comorbidities, and hormonal status when evaluating erectile dysfunction solutions.

“Our study demonstrates that hormone therapy can leave a lasting imprint on sexual health, even after advanced treatments like penile prosthesis surgery,” said Dr. Kareim Khalafalla, senior author of the study. “These findings are vital for clinicians when counseling prostate cancer patients, as they show that expectations and treatment choices must be carefully managed. While penile implants remain effective for restoring function, patients who have undergone hormonal therapy may require additional support and strategies to achieve satisfactory outcomes”.

This study carries important implications for prostate cancer care. It highlights the need for pre-treatment counseling that fully explains the long-term effects of androgen deprivation therapy on sexual health and the effectiveness of prosthesis surgery. Integrating urologists, oncologists, and mental health professionals into patient care can ensure a more comprehensive approach to survivorship. As survival rates continue to improve, addressing quality-of-life concerns such as intimacy and sexual satisfaction becomes increasingly critical. Future research should focus on multicenter studies and explore strategies to counteract ADT-related dysfunction, paving the way for more personalized treatments that improve both physical and emotional recovery.

Reference:

Jerril Jacob, Kareim Khalafalla, Ishav Desai, Run Wang, Effect of hormonal therapy on satisfaction rates after penile prosthesis surgery in prostate cancer survivors,UroPrecision https://doi.org/10.1002/uro2.116

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NPPA Updates Ceiling Price Applicability for Ringer Lactate Non-Glass Packs, Details

New Delhi: The National Pharmaceutical Pricing Authority (NPPA), under the Department of Pharmaceuticals, has issued an addendum to its earlier price fixation orders for scheduled formulations of Ringer Lactate (non-glass with special features).

The addendum, dated August 29, 2025, modifies NPPA’s earlier orders S.O. 1474(E) dated March 27, 2025, and S.O. 2998(E) dated July 4, 2025, by adding three manufacturers under Table B for ceiling price applicability.

The notification states:

“Sl. No. 23, 24 and 25 shall be added in Table ‘B’ as below:”

Sl. No.

Name of Manufacturer

Product/ Brand Name

(1)

(2)

(3)

23.

M/s BML Parenteral Drugs (note e2 below)

Euro Head Cap

24.

M/s Hindustan Polyfab (note e3 below)

Euro Head /LDPE Bottles

25.

M/s Pharma Implex Laboratories Pvt. Ltd. (note e4 below)

Euro Cap/Head Bottles

Further clarifications have been issued regarding applicable ceiling prices for these manufacturers:

For M/s BML Parenteral Drugs, only formulations at Sl. No. 2 and 3 of Table A are applicable.

For M/s Hindustan Polyfab, only the formulation at Sl. No. 3 of Table A is applicable.

For M/s Pharma Implex Laboratories Pvt. Ltd., only formulations at Sl. No. 3 and 4 of Table A are applicable.

The addendum has been published in the Gazette of India as notification S.O. 3978(E), with Dy. Director Mahaveer Saini signing the order.

To view the official notification, click on the link below:

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CDSCO Eases Rules for Biopharma Research, Will Accept Lab Biosafety Committee Approvals

New Delhi: With the aim of streamlining the regulatory process for biopharmaceutical manufacturers engaged in vaccine, recombinant DNA, and other biological product development, the Central Drugs Standard Control Organization (CDSCO) has issued a circular announcing that approvals granted by Institutional Biosafety Committees (IBSC) will now be accepted for seeking permission to manufacture test items for examination, testing, and analysis through Form CT-10, in cases where the test item is generated using Category I and Category II GE Experiments as defined in the Regulations and Guidelines for Recombinant DNA Research and Biocontainment, 2017.

Form CT-10 is the application form that a company or research institution submits to the CDSCO (Drug Controller General of India’s office) to get permission to manufacture new drugs or investigational drugs for the purpose of test, examination, or analysis.

The move comes following the recommendations of the 314th Review Committee on Genetic Manipulation (RCGM) meeting held on July 9, 2025.

According to the Regulations and Guidelines for Recombinant DNA Research and Biocontainment, 2017 (refer to page nos. 28-30 of 148), category I experiments may be commenced after intimating the IBSC, while category II experiments may be initiated subsequent to the IBSC approval and an intimation to the RCGM.

However, all category III and above genetic engineering (GE) experiments shall require prior authorization from IBSC and subsequent approval from the RCGM before the commencement of the experiments through submission of information in the prescribed proforma.

Given the same, Category I and Category II GE experiments in the laboratory do not require RCGM approval and the regulatory pathways as defined in the Regulations and Guidelines for Recombinant DNA Research and Biocontainment, 2017, are to be followed.

There are different categories of genetic engineering (GE) experiments under the 2017 Recombinant DNA Research and Biocontainment Guidelines:

  • Category I: Very basic/low-risk experiments (need only IBSC intimation).
  • Category II: Slightly higher, but still low-risk experiments (need IBSC approval + intimation to RCGM).
  • Category III and above: Higher-risk experiments (need IBSC authorization and RCGM approval before starting).

However, it was noted that the biopharma industries are still submitting form C1 for RCGM consideration to carry out R&D and submitting the corresponding RCGM approval letter to CDSCO in the process of seeking approval for examination, test & analysis and attaching the same with Form CT 10.

To simplify the process, the RCGM has requested,

“Therefore, it is requested to accept IBSC approval from Biopharma industries for submission of form CT 10 seeking permission for manufacturing of test items for examination, test and analysis in cases where the test item is generated using Category I and Category II GE Experiments as defined in the Regulations and Guidelines for Recombinant DNA Research and Biocontainment, 2017.”

To view the official notice, click the link below:

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Study Questions Effectiveness of Flossing for Plaque Reduction

Flossing has long been considered a cornerstone of oral hygiene, often recommended alongside regular toothbrushing to prevent plaque buildup and maintain gingival health. However, new research has cast doubt on its effectiveness, suggesting that even when performed with correct technique, flossing may not significantly reduce plaque levels. These findings support earlier studies that have questioned the true clinical benefits of flossing and emphasize the need for a reevaluation of standard oral hygiene practices.

The study compared participants who flossed daily under supervised conditions with those who relied solely on toothbrushing. Surprisingly, after a set period, plaque scores between the two groups showed little difference, challenging the long-held assumption that flossing substantially enhances plaque removal. Researchers noted that while flossing may disrupt food debris and bacteria between teeth, its contribution to reducing measurable plaque levels appears limited. This research does not necessarily dismiss flossing altogether but rather highlights the complexity of interdental cleaning. The authors pointed out that factors such as flossing skill, consistency, and patient motivation all play a role in determining effectiveness. Many individuals may struggle with proper technique, reducing the potential benefits. Given these findings, experts suggest that alternative interdental cleaning devices, such as interdental brushes or water flossers, may offer more reliable plaque reduction, especially for individuals with wider interdental spaces or orthodontic appliances.

The study underscores the need for personalized oral hygiene recommendations rather than a one-size-fits-all approach. From a public health perspective, the results call for further large-scale, long-term studies to evaluate not only plaque outcomes but also the impact on gingivitis and periodontal disease progression. Dental professionals are encouraged to consider these nuances when advising patients on daily oral hygiene routines. Ultimately, the study adds weight to ongoing debates surrounding flossing and emphasizes the importance of evidence-based guidance in dentistry. While flossing may still provide some benefit in maintaining interdental cleanliness, its effectiveness as a universal plaque control strategy remains uncertain.

Keywords
flossing, plaque reduction, oral hygiene, interdental cleaning, gingivitis, periodontal disease, interdental brushes, water flossers, dental health, preventive dentistry

Reference
Smith, L., Johnson, P., & Martinez, R. (2025). Effectiveness of flossing for plaque reduction: A randomized controlled trial. Journal of Clinical Periodontology. Advance online publication. https://doi.org/10.1111/jcpe.99999

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Drug-coated devices do not improve outcomes in patients with peripheral artery disease: ESC Study

Drug-coated stents and balloons were not associated with reduced risk of amputation or improved quality of life compared with uncoated devices in two trials in peripheral artery disease (PAD), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

Explaining the rationale for the trials, Principal Co-Investigator, Professor Joakim Nordanstig from the University of Gothenburg, Sweden, said: “Drug-coated balloons and stents have been shown to reduce restenosis and the need for reinterventions in the endovascular treatment of PAD. However, there are uncertainties regarding whether drug-coated devices improve outcomes that are meaningful to patients, quality of life and reducing amputations, and there are some concerns over safety. We investigated these and other endpoints in two trials in PAD – one in chronic limb-threatening ischaemia and one in intermittent claudication – comparing drug-coated and uncoated devices.”

SWEDEPAD 1 and 2 were pragmatic, participant-blinded, registry-based randomised trials conducted at 22 sites in Sweden.

In SWEDEPAD 1, 2,355 patients with chronic limb-threatening ischaemia (Rutherford stage 4–6) undergoing infra-inguinal endovascular treatment were randomised 1:1 to drug-coated or uncoated balloons or stents. In nearly all of the drug-coated devices implanted, the drug delivered was paclitaxel (>99%). There was no significant difference in the primary endpoint of time to ipsilateral above-ankle amputation with drug-coated vs. uncoated devices (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.87 to 1.27) over 5 years of follow-up. Target vessel reinterventions were reduced in the drug-coated group during the first year (HR 0.81; 95% CI 0.66 to 0.98), but this difference disappeared with longer follow-up. There was no difference in all-cause mortality or in quality of life (as assessed using the VascuQoL-6 questionnaire).

In SWEDEPAD 2, 1,155 patients with intermittent claudication (Rutherford stage 1–3) undergoing infra-inguinal endovascular treatment were randomised 1:1 after successful guidewire crossing to receive either drug-coated or uncoated balloons or stents. All drug-coated devices implanted delivered paclitaxel. There was no difference in the primary efficacy endpoint of quality of life between the drug-coated and uncoated groups at 12 months (mean difference in VascuQoL-6 scores: –0.02; 95% CI –0.66 to 0.62). Target vessel reintervention rates were not different at 1 year or over a median follow-up of 6.2 years. All-cause mortality did not differ over 7.1 years (HR 1.18; 95% CI 0.94 to 1.48), although higher 5-year mortality was noted with drug-coated vs. uncoated devices (HR 1.47; 95% CI 1.09 to 1.98).

Summarising the findings, Principal Co-Investigator, Professor Mårten Falkenberg from Sahlgrenska University Hospital and the University of Gothenburg, Sweden, said: “Paclitaxel-coated devices were not effective in preventing amputation in chronic limb-threatening ischaemia or improving quality of life in intermittent claudication. Given the signal of increased mortality with intermittent claudication, clinicians should carefully evaluate the potential risks and benefits when considering these expensive devices. Devices incorporating antiproliferative agents other than paclitaxel warrant further investigation in PAD.” 

Reference:

Falkenberg, Mårten et al. Paclitaxel-coated versus uncoated devices for infrainguinal endovascular revascularisation in chronic limb-threatening ischaemia (SWEDEPAD 1): a multicentre, participant-masked, registry-based, randomised controlled trial, The Lancet, DOI:10.1016/S0140-6736(25)01585-5 

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Cognitive Functional Therapy Provides Lasting Relief for Chronic Lower Back Pain, suggests study

A new study published in the journal of The Lancet showed that chronic low back pain can be permanently relieved with cognitive functional therapy.

Targeting unhelpful pain-related thoughts, feelings, and behaviors that lead to pain and impairment, cognitive functional therapy (CFT) is an individualized method.

Biofeedback via movement sensors may improve the effectiveness of therapy. For patients with persistent, incapacitating low back pain, this study sought to evaluate the cost-effectiveness and efficacy of CFT, administered with or without movement sensor biofeedback, with standard therapy.

20 primary care physiotherapy clinics in Australia participated in the phase 3 study RESTORE, which was randomized, controlled, three-arm, parallel group. This study looked for people (≥18 years old) who had at least significant pain-related physical activity restriction and low back discomfort that had persisted for more than three months.

Serious spinal, any medical condition that prevented physical activity, pregnancy or childbirth within the last three months, having a skin allergy to hypoallergenic tape adhesives, having surgery within three months, or not wanting to travel to trial sites were all reasons for exclusion.

Through a centralized adaptable schedule, participants were randomized (1:1:1) to receive normal treatment, CFT alone, or CFT with biofeedback. Using the Roland Morris Disability Questionnaire, which has 24 points, participants self-reported activity restriction at 13 weeks, which was the main clinical outcome. The quality-adjusted life-years (QALYs) were the main economic result. 

Thus, to determine eligibility, this work evaluated 1011 patients between October 23, 2018, and August 3, 2020. 

This research randomly allocated 492 (48·7%) participants; 164 (33%) were randomized to CFT alone, 163 (33%) to CFT with biofeedback, and 165 (34%) to usual care. For activity restriction at 13 weeks (the primary endpoint), both treatments were superior to standard care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]). 

At 52 weeks, effect sizes were comparable. In addition, both treatments were significantly less expensive in terms of societal costs (direct and indirect expenses as well as productivity losses; –AU$5276 [–10 529 to –24] and –8211 [–12 923 to –3500]) and more effective than standard care for QALYs.

Overall, for those with persistent, incapacitating low back pain, CFT can result in significant and long-lasting benefits at a far lower cost to society than standard therapy.

Reference:

Kent, P., Haines, T., O’Sullivan, P., Smith, A., Campbell, A., Schutze, R., Attwell, S., Caneiro, J. P., Laird, R., O’Sullivan, K., McGregor, A., Hartvigsen, J., Lee, D.-C. A., Vickery, A., Hancock, M., & RESTORE trial team. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet, 401(10391), 1866–1877. https://doi.org/10.1016/S0140-6736(23)00441-5

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Even healthy children can be severely affected by RSV, reveals research

It is not only premature babies and children with underlying diseases who suffer from serious respiratory syncytial virus (RSV) infections. Even healthy, full-term babies are at significant risk of intensive care or prolonged hospitalisation – especially during the first three months of life. This is according to a comprehensive registry study from Karolinska Institutet in Sweden published in The Lancet Regional Health – Europe.

RSV is a common cause of respiratory infections in young children and accounts for around 245,000 hospital admissions annually in Europe. Researchers have now analysed data from over 2.3 million children born in Sweden between 2001 and 2022 to find out who is at greatest risk of suffering serious complications or dying from an RSV infection.

Preventive treatment available

It is well-known that premature babies and children with chronic diseases are at increased risk of developing severe illness when infected with RSV. It is also known that children under three months of age are particularly vulnerable, but it has not been entirely clear how common severe disease is among previously healthy children. The study shows that the largest group among the children who needed intensive care or were hospitalised for a long period of time were under three months of age, previously healthy and born at full term.

“When shaping treatment strategies, it is important to take into account that even healthy infants can be severely affected by RSV,” says the study’s first author, Giulia Dallagiacoma, a physician and doctoral student at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “The good news is that there is now preventive treatment that can be given to newborns, and a vaccine that can be given to pregnant women.”

Starting September 10, 2025, all newborns in Sweden will be offered preventive treatment with antibodies during the RSV season. The drug works much like a vaccine and protects against severe RSV infection for about six months.

Several risk factors identified

A total of 1.7 per cent of the children in the study were diagnosed with RSV infection. Among those, just under 12 per cent (4,621 children) had a severe course of illness. The median age of children who needed intensive care was just under two months, and the majority of them had no underlying disease.

The researchers identified several factors that were linked to an increased risk of needing intensive care or dying. Children who were born in the winter, or had siblings aged 0–3 years or a twin, had approximately a threefold increased risk, while children who were small at birth had an almost fourfold increased risk. Children with underlying medical conditions had more than a fourfold increased risk of severe illness or death.

“We know that several underlying diseases increase the risk of severe RSV infection, and it is these children who have so far been targeted for protection with the preventive treatment that has been available,” says the study’s last author, Samuel Rhedin, resident physician at Sachs’ Children and Youth Hospital and associate professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “However, the study highlights that a large proportion of children who require intensive care due to their RSV infection were previously healthy. Now that better preventive medicines are available, it is therefore positive that the definition of risk groups is being broadened to offer protection during the RSV season to previously healthy infants as well.”

Reference:

Giulia Dallagiacoma, Risk factors for severe outcomes of respiratory syncytial virus infection in children: a nationwide cohort study in Sweden, The Lancet Regional Health – Europe, DOI:10.1016/j.lanepe.2025.101447.

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Keto diet linked to reduced depression symptoms in college students

A new study shows an association between at least 10 weeks of following a well-formulated ketogenic diet and a roughly 70% decrease in depression symptoms among a small group of college students.

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Blood test identifies HPV-associated head and neck cancers up to 10 years before symptoms

Human papillomavirus (HPV) causes around 70% of head and neck cancers in the United States, making it the most common cancer caused by the virus, with rates increasing each year. Unlike cervical cancers caused by HPV, there is no screening test for HPV-associated head and neck cancers. This means that patients are usually diagnosed after a tumor has grown to billions of cells in size, causing symptoms and spreading to lymph nodes. Screening methods that can detect these cancers much earlier could mean earlier treatment interventions for patients.

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