Archive for category: News

A recent study published in The Annals of Thoracic Surgery suggests that despite strong clinical guidelines, the use of surgical ablation during coronary artery bypass grafting (CABG) in patients with atrial fibrillation (AF) remains low and potentially life-shortening.

The study reviewed data from over 87,000 Medicare beneficiaries who had preexisting atrial fibrillation and underwent CABG between 2008 and 2019. This revealed that only 22.2% received concomitant surgical ablation. This technique targets the abnormal electrical signals causing AF and was associated with significantly improved long-term survival.

This study found that patients who received surgical ablation during CABG lived a median of 4.4 months longer than those who did not. Also, risk-adjusted median survival was 7.82 years in the ablation group when compared to 7.46 years in the non-ablation group (P < .001).

The survival benefit was even more pronounced when looked at the surgeon practice patterns. The patients operated on by surgeons who frequently perform ablation (defined as doing so in ≥40% of their CABG cases) had a median survival advantage of nearly 5 months (4.96 months) when compared to the patients treated by infrequent ablation surgeons (<5% of cases). Median survival in this analysis was 7.03 years versus 6.62 years, respectively (P < .001).

While the survival gains may appear modest on paper, the public health impact is substantial, given the high volume of CABG procedures and the prevalence of atrial fibrillation in older adults. This study argues that the findings support current guideline recommendations advocating for surgical ablation in AF patients undergoing CABG and spotlight a significant gap between evidence-based guidance and real-world practice.

In a detail examination, 652 surgeons (frequent ablation) performed the procedure in ≥40% of their CABG patients, 1834 surgeons (occasional ablation) performed it in 5–40% of cases and 1193 surgeons (infrequent ablation) did so in <5% of cases. These numbers suggest that a large proportion of cardiac surgeons either rarely or inconsistently offer this beneficial procedure.

As the study brought out, improving adherence to surgical ablation guidelines could meaningfully enhance long-term outcomes for tens of thousands of cardiac surgery patients every year. Overall, while surgical ablation during CABG clearly offers survival advantages, it remains underutilized, which calls for an urgent need for practice alignment with current evidence and guidelines.

Reference:

Schaffer, J. M., Kluis, A., Squiers, J. J., George, T. J., Shih, E., Banwait, J. K., Mack, M. J., & DiMaio, J. M. (2025). Survival after surgical ablation of atrial fibrillation during coronary artery bypass in Medicare beneficiaries. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2025.03.044

New Delhi: In a move to curb potential misuse of critical tuberculosis medications, the Drugs Consultative Committee (DCC) has recommended that licenses for Bedaquiline, Delamanid, Pretomanid, and Rifapentine be issued with strict usage conditions, restricting their use to the National TB Elimination Programme (NTEP) and in accordance with the Standards of TB Care in India (STCI). Additionally, the DCC proposed mandatory red-box warnings on drug labels indicating their restricted use.

For the first time, researchers have found that lung cancer patients who have a combination of high levels of depression and inflammation at diagnosis are later found with continuing depressive symptoms in the next several months, even as they receive new, promising therapies.

The study found that having both maladies at diagnosis predicted higher, continuing levels of depression during the next eight months. Those who had only high levels of depression or only high levels of inflammation, or neither of them, showed no changes in depression over time.

In the analyses, the researchers took into account a wide variety of other factors that could affect the results, including age, race, partner status, education, employment status, lifetime smoking, and any cancer treatments the patients received.

“What this suggests is that there may be an additive effect or perhaps a synergy between inflammation and depression that can lead to worse outcomes with depression,” said Barbara L. Andersen, corresponding author of the study and professor of psychology at The Ohio State University.

The results are important because high depression levels have been linked to poorer outcomes in lung cancer patients, suggesting that patients with high inflammation and depression may be at particular risk, Andersen said.

The study was published online recently in the journal Biopsychosocial Science and Medicine.

Andersen and colleagues at Ohio State’s College of Medicine and The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute studied 182 patients who were newly diagnosed with advanced lung cancer (Stage IV). The patients were followed with monthly depression assessments for eight months.

A previous study with the same participants found that depression was linked to higher levels of inflammation in lung cancer patients at diagnosis. This study was designed to see how that combination affected future levels of depression, which had not been studied before, Andersen said.

Participants completed a depression measure. In addition, levels of neutrophils and lymphocytes from patients’ blood samples were used to calculate a measure of systemic inflammation, called the Advanced Lung Cancer Inflammation Index (ALI). A previous study by Andersen showed ALI from these patients predicted their survival. That study also found that overall, 35% of the patients had moderate to severe depressive symptoms. That study was the first to show that, among these patients with higher levels of depression, upwards of 70% also had high inflammation.

“We found that this is a particularly alarming combination. None of the three other groups in our study – those with just high inflammation, those with just high depression, or those with neither – had increasing levels of depression over the eight months,” Andersen said.

Scientists don’t know for sure how inflammation and depression interact to increase depression, she said.

One hypothesis is that inflammation in the body, as seen in this study, can be transmitted to the brain, where it settles into the microglia. During inflammation, the microglia can release harmful substances associated with the development of depression.

These findings are important because of all cancer patients, those with lung cancer are among those with the highest rates of depression, Andersen explained. And the fact that depression is already linked to systemic inflammation suggests the risk is compounded.

“Our findings suggest the need to screen for depression and determine inflammation biomarkers at diagnosis of lung cancer,” she said.

“This can help identify vulnerable patients who need psychological therapies to reduce depressive symptoms with a possibility of impacting inflammation as some studies have found.”

Reference:

Park, Kylie R. MS; Shields, Peter G. MD; Myers, John PhD; Reisinger, Sarah A. PhD; Andersen, Barbara L. PhD. Depression and Inflammation Predict Depression Trajectory of Non-Small Cell Lung Cancer Patients. Biopsychosocial Science and Medicine ():10.1097/PSY.0000000000001379, June 11, 2025. | DOI: 10.1097/PSY.0000000000001379

Psychosis often begins not with characteristic disturbances of the mind – delusions like paranoia or hallucinations – but with disturbances in the way we move our body. For researchers like Indiana University Assistant Professor Alexandra Moussa-Tooks in the Department of Psychological and Brain Sciences, these motor disturbances offer critical insights into the condition of psychosis itself.

In a new study published on June 25 in the American Journal of Psychiatry, senior-author Moussa-Tooks and first-author Heather Burrell Ward, assistant professor of psychiatry and behavioral sciences at Vanderbilt University Medical Center, explore one such motor ability – grip strength – to uncover the mechanisms linking motor disturbances to psychosis.

As Moussa-Tooks explains: “Poor grip strength has been associated with many negative outcomes in a variety of people: lower well-being, higher risk of mortality, poor day-to-day functioning, poor quality of life. Grip strength seems to capture that things are not going well. But it hasn’t been well studied in relation to brain function or early psychosis. Our study looks at how grip strength may be an important sign of brain and psychological health in early psychosis.”

The study is the first to suggest that grip strength and overall well-being share common patterns of brain connectivity. It shows that impairment in grip strength and well-being may reflect alterations in what researchers call “resting-state functional connectivity,” a measure of brain network function that may be key to understanding psychosis.

Through a novel neuroimaging analysis, Moussa-Tooks and her collaborators demonstrate that brain networks with important roles in both motor and cognitive function play key roles in gripping ability and mental well-being. Their findings lay the groundwork for interventions aimed at improving functioning and wellness in early psychosis.

A unifying brain circuit explanation

The study’s data came from the Human Connectome Project for Early Psychosis, a large initiative conducted from 2016 to 2020 across multiple sites, among them the IU School of Medicine. It included 89 individuals in the first five years of psychotic illness and 51 healthy controls for whom age- or medication-related motor decline could be ruled out.

The analysis confirmed that participants with early psychosis had lower grip strength and well-being scores than healthy controls. These metrics related to three key brain regions -the anterior cingulate cortex, sensorimotor cortex, and cerebellum-each of which were shown to be connected to the default mode network. Higher grip strength and greater well-being correlated with greater connectivity between these regions and the default mode network.

Identifying brain targets for new treatments

“Our findings are particularly exciting because they identify potential brain targets for new treatments for psychosis,” Ward said. For example, both researchers see enormous potential in transcranial magnetic stimulation. If in psychosis there is poor communication within the default mode network, TMS is a non-invasive tool that can be used to directly increase that connectivity. Motor training, like exercise, to strengthen brain networks indirectly can offer another promising strategy.

“Grip strength and other motor functions,” Moussa-Tooks explains, “are easily assessed and more readily interpretable than complex tasks often used to study psychosis. Our work is showing that these seemingly simple metrics can help us understanding disturbances not only in the motor system, but across complex brain systems that give rise to the complex symptoms we see in psychosis.”

Consider the following analogy, she suggests: “If psychosis is a house on fire, symptoms such as delusions and hallucinations are the smoke. In a fire you don’t target the smoke, you target the fire and its source. And yet, currently that’s not how we approach treatment for psychosis. Motor disturbances help us get closer to identifying where the fire may have started and spread. They are more fundamental in the sense that they’re easier to link to different disturbances in the brain.”

With this new study researchers are getting closer to the fire. By drawing a line between motor function and mental health – from grip strength and well-being to patterns of brain connectivity with a key role in psychosis – they are mapping out new paths for understanding and treating an elusive disorder. 

Reference:

Heather Burrell Ward, Adam Beermann, Karlos Manzanarez Felix, Grip Strength as a Marker of Resting-State Network Integrity and Well-Being in Early Psychosis, American Journal of Psychiatry, https://doi.org/10.1176/appi.ajp.20240780

The American Academy of Neurology (AAN) has issued a position statement on therapies for neurological conditions that have limited evidence or no approved use by the Food and Drug Administration (FDA). The statement is published June 25, 2025, in Neurology®, the medical journal of the American Academy of Neurology. The statement includes guiding principles for discussions with patients and policymakers about these therapies. Although the statement includes illustrative examples, it does not provide clinical recommendations regarding the use of specific therapies.

“As the experts in brain health, neurologists and neuroscience professionals are continually working toward achieving scientific breakthroughs through rigorous research,” said American Academy of Neurology President Natalia S. Rost, MD, MPH, FAAN, FAHA. “Still, people often ask about emerging therapies not yet supported by science. In our efforts to provide brain health resources for all, the American Academy of Neurology has issued this position statement to help facilitate conversations between patients and their doctors about emerging therapies.”

The position statement says the AAN recommends that a patient and their neurologist carefully review all available evidence and discuss the potential risks and benefits of the therapy, including when patients are considering using their “Right to Try.” The Right to Try Act allows people with life-threatening diseases who have tried all other approved treatments, and who cannot participate in a clinical trial, to try an experimental treatment.

“There is a growing and unmet need for effective treatments for a variety of neurological disorders,” said author Larry B. Goldstein, MD, FAAN, FAHA, of the University of Kentucky, and who serves on the AAN Board of Directors. “Whenever considering a potential treatment that has not been thoroughly researched, a person and their neurologist need to have a discussion about the available data supporting effectiveness and what is known about any risks to their health.”

The statement says the AAN supports the “off-label” use of FDA-approved therapies when high-quality evidence indicates that the benefit of the therapy outweighs the risks, with shared decision making between the patient and physician.

When discussing such therapies more broadly, including with policymakers, the statement says for those that have FDA approval but a high risk or incomplete data on side effects, or newly recognized and potentially serious side effects, the AAN supports waiting to take a definitive position until after further FDA review. If a suspended therapy is reintroduced, or as the data otherwise warrants, the AAN supports FDA required post-approval monitoring. The AAN supports neurologists and patients incorporating data about side effects in their shared decision making about the relative risks and benefits of a possible therapy.

The statement notes the proliferation of unproven treatments for neurological diseases that people may want to use to self-treat their conditions, yet those treatments may have limited or no supporting data and can have the potential to cause harm. These may be of interest especially to people with rare neurologic conditions with no approved therapies.

The statement says that rigorous investigation of any treatment is necessary to determine its efficacy and ensure safety and recommends patients discuss any potential treatment with their neurologist.

Reference:

Larry B. Goldstein, Principles for Novel Neurologic Therapeutics An AAN Position Statement, Neurology, https://doi.org/10.1212/WNL.0000000000213850