This artificial sweetener could make cancer treatment less effective: Study

Sucralose is a popular sugar substitute for people who are cutting calories or managing blood sugar levels, but new research by the University of Pittsburgh and UPMC Hillman Cancer Center suggests that the artificial sweetener may not be the best choice for patients undergoing cancer immunotherapy.

Publishing today in Cancer Discovery, a publication of the American Association for Cancer Research, the study found that patients with melanoma and non-small cell lung cancer who consumed high levels of sucralose had worse response to immunotherapy and poorer survival than those with diets low in the artificial sweetener.

Strikingly, supplements that boosted levels of the amino acid arginine mitigated the negative effects of sucralose on immunotherapy in mice, an approach that could now be tested in clinical trials.

“It’s easy to say, ‘Stop drinking diet soda,’ but when patients are being treated for cancer, they are already dealing with enough, so asking them to drastically alter their diet may not be realistic,” said lead author Abby Overacre, Ph.D., assistant professor in the Department of Immunology at Pitt and UPMC Hillman. “We need to meet patients where they are. That’s why it’s so exciting that arginine supplementation could be a simple approach to counteract the negative effects of sucralose on immunotherapy.”

Senior author Diwakar Davar, M.D., associate professor of medicine at Pitt and a medical oncologist and hematologist at UPMC Hillman, collaborating with Overacre and their team, used mouse models to show that the negative impacts of sucralose are driven by disruption to gut bacteria.

Sucralose shifted the composition of the mouse gut microbiome, increasing bacterial species that degrade arginine, which reduced levels of this amino acid in the blood, tumor fluid and stool.

Immune checkpoint inhibitor immunotherapies such as anti-PD1 work by ramping up T cell activity so that they can more effectively kill cancer cells. Arginine is essential for T cell function, especially in cancer.

“When arginine levels were depleted due to sucralose-driven shifts in the microbiome, T cells couldn’t function properly,” said Overacre. “As a result, immunotherapy wasn’t as effective in mice that were fed sucralose.”

In mouse models of adenocarcinoma and melanoma, adding sucralose to the diet inhibited anti-PD1 therapy, leading to larger tumors and poorer survival. But when the researchers gave sucralose-fed mice arginine or citrulline, which is metabolized into arginine in the body, the effectiveness of immunotherapy was restored.

To assess the relevance of these findings for humans, the researchers looked at 132 patients with advanced melanoma or non-small cell lung cancer who received anti-PD1 therapy alone or in combination with chemotherapy. Patients filled out detailed diet history questionnaires that included questions about how often they consumed artificial sweeteners in coffee, tea and diet soda.

“We found that sucralose impeded the effectiveness of immunotherapies across a range of cancer types, stages and treatment modalities,” said Davar. “These observations raise the possibility of designing prebiotics, such as targeted nutrient supplementation for patients who consume high levels of sucralose.”

The researchers hope to launch a clinical trial investigating whether citrulline supplements — which boost arginine levels more than arginine itself — affect the gut microbiome and anti-tumor immune response in patients.

They are also interested in looking at how other sugar substitutes, such as aspartame, saccharin, xylitol and stevia, impact the immune system and response to immunotherapy.

Reference:

Kristin M. Morder, Madison Nguyen, Sucralose consumption ablates cancer immunotherapy response through microbiome disruption, Cancer Discovery, https://doi.org/10.1158/2159-8290.CD-25-0247.

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Plastic pollution is an underrecognized threat to health, experts warn

Ahead of the expected finalization of a UN global plastics treaty, a group of international experts calls for a greater focus on health impacts when considering plastic pollution. The Health Policy published in The Lancet reviews the current evidence on how plastics—including microplastics and plastic chemicals—impact health and announces the launch of a new project tracking these impacts: the Lancet Countdown on Health and Plastics.

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How leukemia virus stays hidden in the body—and a key to future treatments

A research team from Kumamoto University has made a new discovery that reveals how the human T-cell leukemia virus type 1 (HTLV-1) silently persists in the body. Their finding potentially lays the foundation for new therapeutic approaches. Their study, published in Nature Microbiology, identifies a previously unknown genetic “silencer” element that keeps the virus in a dormant, undetectable state.

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Bacterial cellulose-based dressing offers rapid bleeding control for burn wound care

In a study published in Advanced Materials, a research team developed an innovative bacterial cellulose (BC)-based hemostatic dressing that enables rapid and sustained bleeding control.

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Two-Thirds of Indian Children With Lupus Develop Nephritis Early, Registry Finds

India: A recent study from India has revealed that kidney involvement is highly prevalent among children diagnosed with systemic lupus erythematosus (SLE), with nearly two-thirds developing lupus nephritis (LN) either at diagnosis or within five years. These findings are part of the first report from the Indian Pediatric Lupus Nephritis (pLN) Registry and were published in Clinical Rheumatology by Dr. Sanjukta Poddar and colleagues from the Institute of Child Health, Kolkata.

The Indian pLN Registry, which began in 2020, is the first prospective initiative of its kind in a low- and middle-income country (LMIC). It collects data from multiple centers across India to better understand the clinical characteristics, laboratory parameters, and renal biopsy findings in children (≤18 years) diagnosed with lupus and nephritis. The present report captures the initial clinical presentation of these children and highlights some stark patterns.

The following were the key findings of the study:

  • Of the 154 children enrolled in the registry by July 2024, 75% were female. The median age at diagnosis was 12 years.
  • Most children had kidney involvement at the time of lupus diagnosis, while others developed nephritis within five years.
  • Edema was present in 75% of the children.
  • Hypertension was in 54% of cases.
  • Proteinuria was detected in 98% of children, with nearly 70% exhibiting nephrotic-range protein loss.
  • Acute kidney injury (AKI) occurred in 43% of patients, with 20% having stage 3 AKI.
  • Low complement levels (C3, C4, or both) were in 94% of the cohort.
  • Anti-nuclear antibody positivity was seen in 96% of children.
  • Class IV lupus nephritis was the most common renal biopsy finding, affecting 45% of patients.
  • Class IV lupus nephritis was associated with significantly lower kidney function compared to Class V, indicating a more severe disease course.

The researchers noted that AKI, often overlooked in earlier studies due to retrospective data limitations, was found to be far more common when assessed prospectively. Given its independent link with increased morbidity and mortality, early identification and management of AKI in pediatric lupus is critical.

The report highlights the urgent need for better awareness, early diagnosis, and robust follow-up in managing pediatric lupus nephritis, particularly in resource-constrained settings. As children enrolled in the registry continue to be followed up, researchers hope to gain deeper insights into treatment responses and long-term outcomes, which could ultimately help refine care protocols and improve prognosis for affected children in LMICs.

The authors concluded, “The study emphasizes the value of prospective data collection in understanding disease burden more accurately and shaping more effective, evidence-based strategies for managing pediatric lupus nephritis.”

Reference:

Poddar, S., Dasgupta, D., Pradhan, S. et al. Clinical presentation of children with lupus nephritis from a low- and middle-income country (LMIC): an initial report from the Indian pSLE Nephritis Registry. Clin Rheumatol (2025). https://doi.org/10.1007/s10067-025-07576-9

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What are Key Predictors and Management Factors for Orthokeratology Effectiveness in Myopic Children? Study Finds Out

China: A new study published in BMC Ophthalmology has identified key factors influencing the success of orthokeratology (Ortho-K) in slowing axial elongation among children with myopia. Researchers found that age, spherical equivalent refraction (SER), and parental high myopia significantly affect treatment outcomes. Additionally, maintaining proper lens decentration without visual disturbances and adhering to regular follow-ups were shown to enhance the efficacy of myopia control.    

The retrospective analysis, conducted by Kai Wang and colleagues at the Institute of Medical Technology, Peking University Health Science Center, Beijing, reviewed 542 eyes from 300 myopic children fitted with Ortho-K lenses between January 2022 and December 2023. They evaluated Baseline ocular measurements, such as corneal parameters, anterior chamber depth, pupil size, and treatment zone characteristics. Researchers also incorporated genetic factors, parental myopia status, and lifestyle habits—including near-work duration, outdoor activity, diet, and follow-up compliance—collected through detailed questionnaires.

The findings revealed the following:

  • Children who started orthokeratology treatment at a younger age showed greater axial length elongation (ALE).
  • Patients with less baseline myopia experienced faster ALE progression.
  • High myopia in both parents was associated with increased ALE.
  • Larger treatment zone decentration, when without visual disturbances or complications, was linked to slower axial elongation.
  • Regular and consistent follow-up examinations were crucial for better control of myopia progression.

Researchers emphasized that the study’s strength lies in its comprehensive approach, integrating a wide range of ocular, genetic, and behavioral factors in a relatively large cohort. This holistic evaluation highlights the importance of combining precise clinical assessments with parental involvement and lifestyle management to optimize myopia control strategies.

Despite its robust design, the study acknowledged several limitations. Being retrospective, it relied partly on parental recall for lifestyle factors, which may have introduced memory bias. Approximately 10% of cases were excluded due to incomplete data or low-quality questionnaires, and the absence of a prospective design limits causal inference. Additionally, the complex etiology of myopia, influenced by environmental and behavioral factors, suggests that further research with prospective, multi-time-point data collection is necessary to validate these findings.

The authors concluded that understanding these predictive factors can help clinicians better tailor Ortho-K treatment plans. “Younger children, those with lower baseline myopia, and with both parents highly myopic require closer monitoring and possibly additional interventions to maximize treatment effectiveness,” they noted. Encouraging regular follow-ups and educating families on healthy visual habits were highlighted as essential steps to enhance myopia management and reduce trial-and-error in clinical practice.

By integrating personalized lens fitting, maintaining optimal decentration, and addressing genetic and lifestyle influences, the study suggests that orthokeratology can be a powerful tool in combating progressive myopia and its associated long-term visual complications in children.

Reference:

Deng, Y., Li, X., Zhao, M. et al. Critical factors to predict efficacy of orthokeratology in inhibiting axial elongation in myopic children. BMC Ophthalmol 25, 433 (2025). https://doi.org/10.1186/s12886-025-04265-8

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Efinaconazole 10% Proven Safe and Effective for Toenail Fungus in Older Adults: Study

A post hoc study published in Mycoses has confirmed that efinaconazole 10% solution is both effective and safe for treating toenail onychomycosis in adults aged 65 and older. Despite age-related nail changes, the treatment showed comparable results in older adults and the general population, supporting its use in elderly patients. The study was conducted by Shari R. and colleagues.

Onychomycosis, a fungal toenail infection, is particularly common in the elderly. Thicker nails and slower growth, both associated with aging, as well as comorbid medical conditions, contribute to making the infection more difficult to treat. Oral antifungals, while effective, carry risks including liver injury and drug–drug interactions that are particularly problematic in this age category. Topical treatments such as efinaconazole 10% solution, which can be applied locally to the nail with minimal absorption into the body, provide a safer option. Hitherto, there have been sparse data on their efficacy particularly among elderly populations.

This analysis employed data from two multicenter, randomized, double-blind, vehicle-controlled phase 3 trials (NCT01008033 and NCT01007708), involving once-daily use of efinaconazole 10% solution or vehicle for 48 weeks with a post-treatment follow-up period of 4 weeks. The analysis was applied to a subgroup of patients 65 years of age or older, with mild to moderate toenail onychomycosis, consisting of 162 patients who received efinaconazole and 56 patients treated with vehicle. The main outcome was 52-week complete cure, which was taken as 0% clinical involvement of the target toenail and mycologic cure (negative potassium hydroxide [KOH] microscopy and fungal culture). Secondary outcomes were mycologic cure and complete or near complete cure (≤5% nail involvement + mycologic cure). Safety was evaluated through treatment-emergent adverse events (TEAEs).

Results

• At week 52, 13.6% of the subjects between the ages of 65 and 71 years receiving efinaconazole had a complete cure, whereas only 3.6% in the vehicle group a statistically significant difference (p < 0.05).

• Complete or near-complete cure rate was significantly greater in the efinaconazole group as well at 19.1%, compared with 5.4% with vehicle (p = 0.01).

• Most significantly, 59.2% of the patients had a mycologic cure on efinaconazole, as compared to a mere 12.5% in the placebo group (p < 0.001).

• TEAEs due to treatment were low with efinaconazole at 6.0%, which was comparable to the rates experienced by the total study population.

• These results highlight the safety and efficacy of efinaconazole even among elderly patients, who often present with more recalcitrant nail conditions.

Efinaconazole 10% solution was both safe and effective in the treatment of toenail onychomycosis among adults aged 65 years and older. With notable improvement in cure rates and minimal adverse effects, efinaconazole is a worthwhile treatment option for older adults who are not candidates for systemic antifungal treatment.

Reference:

Lipner, S. R., Gupta, A. K., Joseph, W. S., Elewski, B., Guenin, E., & Vlahovic, T. C. (2025). Efficacy and safety of efinaconazole 10% topical solution for treatment of onychomycosis in older adults: A post hoc analysis of two phase 3 randomised trials. Mycoses, 68(5), e70069. https://doi.org/10.1111/myc.70069

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Reformer Pilates Eases Pain and Boosts Well-being in Chronic Pain Patients: Study

A new study published in the journal of BMC Psychology revealed that reformer pilates significantly reduces pain intensity, fear of movement, and fatigue in patients with chronic musculoskeletal pain. The practice also promotes active living and improves both mental and physical health, with some effects reaching clinical significance.

Chronic pain is often defined as persistent or recurring pain that lasts more than 3 months. According to data from a number of studies, international treatment guidelines for the management of musculoskeletal pain recommend resistance exercise training and flexibility exercises at least twice a week in order to preserve functional status, encourage lifetime physical activity, and enhance overall quality of life.

This trial sought to determine how Reformer Pilates affects the degree of pain, coping mechanisms, pain beliefs, fear of movement, exhaustion, and sleep quality in young adults with persistent neck and low back pain.

A total of 54 women between the ages of 30 and 50 were randomized into 2 groups. A 6-week exercise regimen consisting of 45 minutes twice a week was given to the Reformer Pilates (RP) group, whereas no exercise regimen was given to the control group (CG). The following outcomes were assessed both before and after the interventions: Pittsburg Sleep Quality Index, Tampa Kinesiophobia Scale, FACIT Fatigue Scale, Pain Coping Scale, Pain Beliefs Scale, and Brief Pain Questionnaire.

At baseline, the groups were all the same. With small to large effect sizes in pain parameters (p <0.05; Cohen’s d = 0.17–1.45), big effect sizes in dread of movement, moderate effect sizes in tiredness, and medium effect sizes in sleep quality (p <0.05; Cohen’s d = 0.43–0.86), statistical differences were detected in favor of RP. Only the passive methods sub-headings of the Pain Coping Scale and the pain beliefs organic sub-heading of the Pain Beliefs Scale showed a statistically significant difference between the groups (p > 0.05).

Overall, these findings indicate that Reformer Pilates workouts assist individuals with chronic musculoskeletal pain manage their pain by fostering body-mind unification and lowering pain perception. The current study broadens the focus by assessing the neurophysiological and cognitive impacts of Reformer Pilates, especially in connection to pain beliefs and coping mechanisms, whereas earlier research has mostly concentrated on the physical advantages of Pilates.

Source:

Şahan, N., Uluğ, N., & Özeren, A. (2025). Effects of reformer pilates on pain, psychological factors, and sleep in chronic musculoskeletal pain: a randomized controlled trial. BMC Psychology, 13(1), 836. https://doi.org/10.1186/s40359-025-03207-9

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Women with PCOS more prone to Unhealthy Eating Behaviors at midlife: Study

A new study published in the journal of Fertility and Sterility showed that women with polycystic ovary syndrome (PCOS) at midlife are more prone to unfavorable eating behaviors. Therefore Weight management counseling should be sensitive and holistic, addressing psychological distress and eventually targeted support can help reduce disordered eating patterns in this population.

Adults with at least 2 of the following symptoms; clinical or biochemical oligomenorrhea (OA), hyperandrogenism (HA), polycystic ovarian morphology (PCOM), or increased antimüllerian hormone (AMH) levels, are diagnosed with PCOS based on the updated Rotterdam criteria. Despite variations in body weight among PCOS phenotypes, obese women are more likely than non-PCOS women to gain weight starting in childhood. Consequently, this study was set to examine the domains of eating behavior (uncontrolled, emotional, and cognitive restraint eating) in midlife women with polycystic ovarian syndrome (PCOS) who exhibited various PCOS symptoms and those who did not.

This prospective cohort study with domains of eating behavior were evaluated at 46 years of age. Variables gathered at the ages of 31 and 46 were used to assess eating behavior predictors. Using the modified Rotterdam criteria, women who were diagnosed with PCOS (n = 251) at age 31 were compared to those who did not meet any PCOS criteria (n = 935). Classic A+B-phenotype women (hyperandrogenism and oligomenorrhea, with or without elevated antimüllerian hormone, n = 60), C-phenotype women (hyperandrogenism and elevated antimüllerian hormone, n = 84), and D-phenotype women (oligomenorrhea and elevated antimüllerian hormone, n = 86) were included in the PCOS population.

At age 46, women with PCOS showed no change in cognitive restraint, but they did score higher on emotional and uncontrolled eating than those without PCOS. While uncontrolled eating ratings in the C-phenotype were greater than those in the D-phenotype and women without PCOS, emotional and uncontrolled eating scores were higher in the A+B-phenotype when compared to women without PCOS.

While a history of weight loss attempts was a predictor of uncontrolled eating, the impression of being overweight was an independent predictor of emotional eating among women with PCOS at the age of 46. A major risk factor for women with PCOS who scored in the highest quartile of emotional and uncontrolled eating at age 46 was having more psychological distress at age 31. Overall, middle aged women with PCOS had a strong propensity for unhealthy eating habits. 

Reference:

Pesonen, E., Nurkkala, M., Ollila, M.-M., Hurskainen, E., Morin-Papunen, L. C., Jämsä, T., Korpelainen, R., Niemelä, M., & Piltonen, T. T. (2024). Women with polycystic ovary syndrome are at risk of emotional and uncontrolled eating at midlife: a population-based cohort study. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2024.09.042

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Use of suction drainage in TKA associated with increased blood loss: study

Total knee arthroplasty is a commonly performed procedure with postoperative complications including blood loss, pain, and hematoma formation. The role of intra-articular drainage in reducing these complications remains controversial.

Alessandro Smimmo et al conducted a study to evaluate the effects of intra-articular drainage on hemoglobin levels, pain, hematoma formation, and the need for blood transfusion in patients undergoing knee replacement.

A prospective study was conducted on 60 patients divided into two groups: Drainage (D) and No Drainage (ND). Hemoglobin levels, pain scores, ultrasound evaluation of intra-articular hematoma, and transfusion rates were recorded on the first, third, and fifth postoperative days. The estimated blood loss was calculated using the Meunier formula. Pain was evaluated using the Visual Analog Scale, while hematoma size was measured using ultrasound.

Key findings of the study were:

• The postoperative hemoglobin drop was significantly higher in the D group (p = 0.0027), with a mean estimated blood loss of 1366 mL in the D group compared to 957 mL in the ND group.

• Four patients in the D group required blood transfusions, while none in the ND group did (p = 0.0003).

• Pain scores were lower in the D group on the first postoperative day (p = 0.0001), but no significant differences were observed on the third and fifth days.

• Ultrasound showed a larger hematoma in the ND group on the first postoperative day (p = 0.02), but no significant difference was found by the fifth day.

The authors concluded that – “The use of drainage in TKA is associated with increased blood loss and transfusion rates without providing long term clinical benefits. While it may offer temporary pain relief and reduce early hematoma formation, its routine application should be reconsidered given the potential for increased postoperative anemia and patient discomfort, along with the lack of sustained pain reduction. Surgeons should carefully weigh its short-term benefits against its risks, particularly in patients with pre-existing anemia or those at risk for significant blood loss.”

Further reading:

Clinic and Ultrasound Evaluation of Suction Drainage in Total Knee Arthroplasty Procedure: A Multicentric Prospective Trial Alessandro Smimmo et al Indian Journal of Orthopaedics https://doi.org/10.1007/s43465-025-01501-7

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