Intravascular Insights: Study evaluates Overlooked Challenge of Volume Depletion in Colonoscopy Preparation

Fasting and bowel preparation before colonoscopy can lead to intravascular volume depletion, but rigorous assessment of its clinical implications is limited. Recent prospective cohort study was conducted to evaluate the relationship between intravascular volume status and hypotension during propofol sedation for elective colonoscopy. The cohort included adult patients undergoing colonoscopy following polyethylene glycol (PEG) bowel preparation. Using a combination of transthoracic echocardiography (TTE) and ClearSight noninvasive monitoring, the study aimed to assess pre-procedural volume status and monitor intraprocedural hemodynamics.

Patient Analysis

Among the 99 patients analyzed, 32% exhibited signs of intravascular volume depletion based on TTE assessments following a passive leg-raising test. The study observed inadequate agreement between TTE and ClearSight measurements of stroke volume at baseline and post-leg raising, casting doubt on the reliability of the noninvasive monitor alone in determining volume status. Notably, significant intraprocedural hypotension, defined as a mean arterial pressure below 60 mm Hg, was more prevalent in patients identified as fluid-responsive compared to those who were normovolemic (48% vs. 21%, respectively).

Demographic Insights

The lack of significant association between demographic variables (age, ASA status, antihypertensive therapy) and fluid responsiveness suggests that other factors may be influencing intravascular depletion. Fasting durations for fluids and food averaged 9 hours and 25 hours, respectively, which aligns with established guidelines, yet the risks associated with fasting and required bowel preparation persist.

Monitoring Implications

The study emphasizes that while individuals undergoing colonoscopy may frequently display signs of fluid responsiveness, their hemodynamic stability remains questionable, especially under sedation’s influence. Propofol’s vasodilatory effects amplify this concern, suggesting a need for vigilant monitoring during procedures. Though current recommendations encourage intravenous fluid administration as a preventive strategy against hypotension, its efficacy continues to be debated.

Conclusions and Future Directions

Overall, the findings underscore a critical gap in understanding the clinical impacts of bowel preparation-induced volume depletion during colonoscopy. The study suggests a need for further investigation into the optimal management of intravascular volume status pre-procedurally and the overall necessity of advanced monitoring approaches in outpatient endoscopic settings to mitigate adverse outcomes.

Key Points

– A prospective cohort study assessed the impact of fasting and bowel preparation on intravascular volume status and hypotension during propofol sedation in elective colonoscopy, revealing that volume depletion may lead to significant hemodynamic instability.

– Transthoracic echocardiography (TTE) indicated that 32% of the 99 patients studied exhibited signs of intravascular volume depletion after a passive leg-raising test; however, there was a notable lack of agreement between TTE and ClearSight noninvasive monitoring regarding stroke volume measurements, raising concerns about the latter’s reliability.

– Patients identified as fluid-responsive experienced a higher incidence of significant intraprocedural hypotension compared to those classified as normovolemic (48% vs. 21%), demonstrating the potential risks associated with inadequate volume status during sedation.

– Demographic factors such as age, ASA status, and antihypertensive medication use did not correlate with fluid responsiveness, indicating the involvement of other unidentified elements in intravascular depletion.

– The study highlighted the necessity of ongoing monitoring during colonoscopies, particularly under propofol sedation, due to the anesthetic’s vasodilatory effects which can exacerbate hypotensive episodes, despite existing guidelines recommending preventive intravenous fluid administration.

– Findings point to an urgent need for enhanced understanding and management strategies for intravascular volume status prior to procedures, advocating for the exploration of advanced monitoring techniques in outpatient endoscopic environments to minimize the risk of adverse events.

Reference –

Allen, M.L., Kluger, M., Schneider, F. et al. Fluid responsiveness and hypotension in patients undergoing propofol-based sedation for colonoscopy following bowel preparation: a prospective cohort study. Can J Anesth/J Can Anesth 72, 529–539 (2025). https://doi.org/10.1007/s12630-025-02939-x

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First oral drug shows promise for Barth syndrome heart and muscle symptoms

Researchers at Tohoku University have discovered that an oral drug called MA-5 can improve both heart and muscle problems in Barth syndrome, a rare genetic disorder affecting 1 in 300,000 births worldwide with no current cure.

Barth syndrome is caused by mutations in the TAZ gene that leave patients-mostly young boys-with weakened hearts, muscle fatigue, and increased rates of infection. Many require heart transplants, and current treatments only manage symptoms without addressing the underlying cause.

The research team, led by Professors Takaaki Abe, and Takafumi Toyohara, and first author Yoshiyasu Tongu, tested MA-5 on cells from four Barth syndrome patients and in fruit fly (Drosophila) models of the disease. Published in The FASEB Journal on June 21, 2025, their findings reveal that MA-5 boosted cellular energy (ATP) production by up to 50% and protected cells from oxidative stress-induced death.

“What excites us most is that MA-5 works by targeting the fundamental problem in Barth syndrome-defective energy production in mitochondria,” explains Abe. “Unlike current treatments that only manage symptoms, MA-5 actually improves the root cause of how cells generate energy.”

MA-5 was chosen as a treatment because it enhances interactions between two crucial mitochondrial proteins-mitofilin and ATP synthase-leading to more efficient energy production. As such, this mechanism directly addresses the cause of cellular dysfunction in Barth syndrome.

In human muscle cells derived from Barth syndrome iPS cell models, MA-5 corrected abnormal mitochondrial structures and reduced cellular stress markers. When tested in Drosophila with Barth syndrome, the drug dramatically improved their climbing ability (capacity for physical exertion) and normalized their elevated heart rates-two key symptoms that mirror how the disease affects humans. Furthermore, MA-5 restored normal mitochondrial structure in the Drosophila muscle tissue.

These promising results suggest that MA-5 addresses the largest challenges faced by patients with Barth syndrome, which would significantly improve their quality of life. Phase I clinical trials in Japan have been completed successfully, and the research team is preparing to start Phase II trials soon.

“We’ve validated MA-5 using patient cells, iPS cell models and a Drosophila model of Barth syndrome,” remarks Abe. “The evidence from all of these studies supports its potential effectiveness in patients with Barth syndrome, which we hope to examine more in the next clinical trial.”

Considering the limited options for treatment currently available, this research provides hope for a better future for patients and their families. Critically, MA-5 can be taken orally, which makes administration significantly easier for pediatric patients. It is the first oral medication for Barth syndrome to progress to the clinical trial stage.

The team’s findings suggest that MA-5 could become the first disease-modifying treatment for Barth syndrome, offering new therapeutic options beyond current symptomatic management.

Reference:

Yoshiyasu Tongu, Tomoko Kasahara, Tetsuro Matsuhashi, Yoshitsugu Oikawa, Ryota Akimoto, Yuhan Luo, Sayaka Sekine, Momoka Suzuki, Hitomi Kashiwagi, Shinichiro Kanno, Mitochondria-Homing Drug Mitochonic Acid 5 Improves Barth Syndrome Myopathy in a Human-Induced Pluripotent Stem Cell Model and Barth Syndrome Drosophila Model,  The FASEB Journal, https://doi.org/10.1096/fj.202401856RRR.

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Good Blood Sugar Control May Lower Risk of Eye Diseases in Older Adults, Study Finds

UK: A 14-year observational study published in BMJ Open has revealed a strong link between blood sugar control and the risk of developing several eye diseases in older adults. The research, conducted by Caitlin Lin and Stephen Jivraj from the UCL Global Business School for Health, examined how diabetes status and blood sugar levels influence the likelihood of being diagnosed with glaucoma, diabetic eye disease, macular degeneration, and cataracts over time.

Using data from the English Longitudinal Study of Ageing (ELSA), the study followed over 5,600 participants aged 50 and above across eight waves of data collection from 2004 to 2019. Researchers analyzed nearly 29,000 observations, using logistic regression models to assess the relationship between baseline blood sugar status and the later development of eye conditions.

Participants were grouped based on their diabetic status and glycated hemoglobin (HbA1c) levels: non-diabetic (HbA1c <6.5%, no diabetes diagnosis), controlled diabetes (diagnosed with diabetes, HbA1c <6.5%), uncontrolled diabetes (diagnosed, HbA1c ≥6.5%), and undiagnosed diabetes (no diagnosis, HbA1c ≥6.5%). Adjustments were made for various factors, including age, gender, physical activity, BMI, and smoking.

The study led to the following findings:

  • Well-controlled diabetes was associated with a lower risk of developing glaucoma, diabetic eye disease, and macular degeneration in older adults.
  • Individuals with undiagnosed diabetes had a 1.38 times higher risk of developing macular degeneration compared to those with controlled diabetes.
  • Those with uncontrolled diabetes were 1.20 times more likely to develop diabetic eye disease than those with controlled diabetes.
  • Even individuals without diabetes had a 1.29 times higher risk of glaucoma compared to those managing diabetes effectively.
  • There was no significant association between blood sugar control and the risk of developing cataracts.

According to the researchers, “Our findings suggest that maintaining good blood sugar control in older age not only helps in diabetes management but may also play a crucial role in preventing vision-related complications.”

The study is notable for its use of a large, nationally representative cohort with detailed biomarker and lifestyle data, offering valuable insights into the long-term effects of metabolic health on eye disease. However, the authors acknowledged limitations, such as reduced sample size over time due to participant attrition and the use of subjective physical activity data without duration metrics.

Overall, the study supports routine screening for eye diseases in older adults, particularly those with diabetes or elevated blood sugar levels. It also reinforces the need for early detection and proper glycemic control to help reduce the burden of preventable vision loss in aging populations.

Reference:

Lin C, Jivraj SAre diabetes and blood sugar control associated with the diagnosis of eye diseases? An English prospective observational study of glaucoma, diabetic eye disease, macular degeneration and cataract diagnosis trajectories in older ageBMJ Open 2025;15:e091816. doi: 10.1136/bmjopen-2024-091816

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Screen time and emotional problems in kids: A vicious circle?

Spending too much time on screens may cause emotional and behavioral problems in children-and those problems can lead to even more screen use, according to research published by the American Psychological Association.

Conducted by an international team of researchers, the study systematically reviewed and meta-analyzed 117 studies, encompassing data from over 292,000 children worldwide. The findings were published in the journal Psychological Bulletin.

“Children are spending more and more time on screens, for everything from entertainment to homework to messaging friends,” said Michael Noetel, PhD, an associate professor in the School of Psychology at Queensland University and one of the authors of the study. “We found that increased screen time can lead to emotional and behavioral problems, and kids with those problems often turn to screens to cope.”

Noetel and his colleagues conducted a meta-analysis to better understand the relationship between screen time and socio-emotional problems, like aggression, anxiety, or low self-confidence. They included any study with participants under 10 years of age that measured screen use and socio-emotional problems, where children were followed-up for at least six months. Screen-based activities included social media, video games, TV watching and online homework.

Most of the studies were conducted in the United States (41 studies), followed by Canada (13), Australia (11), and Germany and the Netherlands (7 each).

The study revealed that the more children engaged with electronic screens the more likely they were to develop socio-emotional problems. This included both internalizing problems, such as anxiety and depression, and externalizing problems, such as aggression and hyperactivity. Conversely, children experiencing socio-emotional problems were found to be more likely to turn to screens as a coping mechanism.

The researchers identified several factors that may moderate these relationships. Compared with younger children (ages 0-5), older children (ages 6-10) were more likely to develop socio-emotional problems with greater screen use. Girls were generally more susceptible to developing socio-emotional problems with greater screen use, while boys were more likely to increase screen use when facing socio-emotional challenges.

The type of screen content and purpose of screen use also played a role, according to Noetel. Gaming was associated with higher risks compared with educational or recreational screen use. Children experiencing socio-emotional problems were also more likely to turn to games to cope.

The findings suggest parents might want to be cautious about what screens they allow and use parental controls to manage time, said Noetel. He also noted that kids who use screens heavily might need emotional support, not just restrictions. Parents could benefit from programs helping them handle both screen use and emotional problems.

“This comprehensive study highlights the need for a nuanced approach to managing children’s screen time,” said lead author Roberta Vasconcellos, PhD, a lecturer at the University of New South Wales who conducted the research while a doctoral student at Australian Catholic University. “By understanding the bidirectional relationship between screen use and socio-emotional problems, parents, educators and policymakers can better support children’s healthy development in an increasingly digital world.”

Because every study in the meta-analysis followed kids over time, the research is a big step closer to cause‑and‑effect (as opposed to correlation) than the usual snapshots done at a single point in time, according to Noetel.

“It’s about as close as we can get to causal evidence without randomly cutting screens for thousands of kids,” he said. “But still, we can’t completely rule out other factors—like parenting style-that could influence both screen use and emotional problems.”

Reference:

Roberta Pires Vasconcellos, Taren Sanders, Chris Lonsdale, Philip Parker, James Conigrave, Samantha Tang, Borja del Pozo Cruz, Electronic Screen Use and Children’s Socioemotional Problems: A Systematic Review and Meta-Analysis of Longitudinal Studies, Psychological Bulletin, DOI: 10.1037/bul0000468 

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NLR Shows Promise in Asthma Detection and Severity Stratification: Meta-Analysis

China: A recent systematic review and meta-analysis published in Frontiers in Medicine highlights the potential role of the neutrophil-to-lymphocyte ratio (NLR) as a valuable biomarker for asthma diagnosis and severity stratification. Led by Lei Jin and colleagues from the Department of Cardiothoracic Surgery at The First Affiliated Hospital of Xi’an Medical University, the study aimed to clarify the diagnostic relevance of NLR amid previous uncertainties.

The researchers analyzed data from 19 studies, which included over 43,000 patients with asthma and more than 8,000 healthy controls. Using pooled statistical methods, they evaluated NLR values across different asthma severity groups and assessed how well NLR could distinguish asthma patients from healthy individuals through receiver operating characteristic (ROC) curve analysis.

The latest findings from this meta-analysis spotlighted the diagnostic utility of NLR. The results showed that NLR levels were significantly higher in individuals with asthma compared to healthy controls, with an area under the curve (AUC) of 0.92. Furthermore, NLR effectively differentiated between severe and non-severe asthma cases (AUC 0.91), making it a potentially useful tool for severity assessment. However, its ability to differentiate between moderate and severe asthma was limited, indicating the need for additional or complementary biomarkers to capture more nuanced stages of the disease.

The following were the key findings of the study:

  • Individuals with asthma had significantly higher neutrophil-to-lymphocyte ratio (NLR) values compared to healthy controls.
  • NLR levels increased progressively with worsening asthma severity.
  • The meta-analysis showed a strong ability of NLR to differentiate asthma patients from healthy individuals (AUC = 0.929).
  • NLR effectively distinguished severe asthma from non-severe cases (AUC = 0.914).
  • Statistically significant differences in NLR were observed between mild and moderate asthma, and between severe and non-severe asthma.
  • The ability of NLR to distinguish between moderate and severe asthma was limited.
  • There were strongest NLR differences in pediatric populations.
  • Studies conducted in developed countries reported greater variation in NLR levels.
  • These findings suggest that demographic and regional factors may influence inflammatory responses in asthma.

Despite these promising insights, the study acknowledged key limitations. Considerable heterogeneity across the included studies may affect the consistency and broader applicability of the results. Additionally, since most studies were retrospective, they could be subject to selection and reporting biases. Moreover, while NLR shows strong potential, it may not sufficiently capture all aspects of disease progression on its own.

The authors concluded that the study supports the neutrophil-to-lymphocyte ratio (NLR) as an accessible and cost-effective biomarker for the identification and severity assessment of asthma. They highlighted the importance of conducting future prospective studies to validate these findings, establish standardized NLR cut-off values, and explore the potential of combining NLR with other clinical indicators to enhance the accuracy and precision of asthma management.

Reference:

Jin, L., Guo, J., Deng, K., & Yao, Y. (2025). Neutrophil-to-lymphocyte ratio as a biomarker for asthma identification and severity stratification: A systematic review and meta-analysis. Frontiers in Medicine, 12, 1620695. https://doi.org/10.3389/fmed.2025.1620695

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CKC exercises more effective than conventional therapy in improving function in DRF rehabilitation: study

Distal radius fractures (DRFs) are common upper extremity injuries that often result in pain, limited mobility, and impaired proprioception. While conventional rehabilitation typically targets range of motion (ROM) and strength, closed kinetic chain (CKC) exercises may offer additional benefits by enhancing neuromuscular control and proprioception. Menek and Dansuk conducted a study to investigate the effects of CKC exercises on pain, function, proprioception, and ROM in individuals recovering from conservatively treated DRFs.

Forty individuals with conservatively treated DRF were randomly assigned to either the CKC group (n = 20) or the conventional group (CP) (n = 20). Both groups participated in a six-week rehabilitation program after cast removal. Outcome measures included Visual Analog Scale for activity-related pain (VAS-Activity), active ROM (flexion/ extension), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and joint position sense (JPS).

Key findings of the study were:

• Both groups demonstrated significant improvements in all outcomes after six weeks (p < 0.05). However, the CKC group showed greater improvements across all domains.

• Specifically, JPS improved by 6.75° ± 3.21° in the CKC group compared to 4.95° ± 2.88° in the CP (Cohen d = 2.05), exceeding the minimal clinically important difference (MCID) of 5°.

• DASH scores decreased by 37.11 ± 10.27 points in the CKC group and 18.15 ± 9.61 in the CP (Cohen d = 3.46 vs. 1.77), both surpassing the 10-point MCID.

• Wrist extension increased by 44.00° ± 13.01 (CKC) versus 30.10° ± 11.42 (CP) (p < 0.001), and flexion by 52.50° ± 14.81 (CKC) vs. 39.20° ± 14.21 (CP) (p < 0.001).

• VAS-Activity scores improved by 5.35 ± 2.04 (CKC) and 3.40 ± 1.52 (CP) (Cohen d = 2.60 vs. 1.72), both exceeding the 2-point MCID threshold.

The authors concluded – “This study demonstrated that CKC exercises were more effective than conventional physiotherapy in improving JPS, upper extremity function (as measured by the DASH questionnaire), wrist ROM, and activity-related pain (assessed via the VAS) in individuals recovering from DRFs. These findings suggest that CKC exercises enhance proprioceptive input and neuromuscular control, thereby improving JPS and functional performance. Moreover, the increased joint loading and co-contraction during CKC exercises may contribute to reductions in pain and improvements in ROM, supporting their clinical utility. While the integration of CKC exercises into rehabilitation protocols appears to yield measurable improvements in proprioceptive function, pain management, and upper extremity functionality in individuals with DRF, further long-term follow-up studies are essential to validate the sustainability and external validity of these outcomes.”

Further reading:

Investigating the effects of closed kinetic chain exercises on joint position sense, functionality, range of motion, and pain in individuals with distal radius fracture: a randomized controlled trial Menek and Dansuk BMC Sports Science, Medicine and Rehabilitation (2025) 17:137 https://doi.org/10.1186/s13102-025-01195-2

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Lichen Planopilaris Linked to Elevated Risk of Autoimmune, Skin, and Heart Conditions: Meta-Analysis

USA: A comprehensive review and meta-analysis published in the International Journal of Dermatology has revealed that lichen planopilaris (LPP)-a rare, scarring form of alopecia—is significantly linked to a range of comorbid medical conditions, especially autoimmune, dermatologic, and cardiometabolic disorders.

Dr. Maryanne M. Senna and colleagues from the Department of Dermatology at Harvard Medical School, Boston, USA, conducted the study. Their goal was to clarify the associations between LPP and various systemic illnesses, an area previously marked by inconsistent findings.

To provide a clearer understanding, the team performed a systematic review and meta-analysis adhering to PRISMA guidelines. Researchers examined data from multiple databases, including PubMed/MEDLINE, EMBASE, the Cochrane Library, and Web of Science, up until December 25, 2023. Of the 2,535 studies initially screened, 59 met the inclusion criteria, covering a total of 15,178 patients diagnosed with LPP and over 64 million non-LPP controls.

The researchers reported the following findings:

  • Individuals with LPP had significantly higher odds of developing lichen planus (OR 15.78).
  • The risk of psoriasis is elevated among LPP patients (OR 3.55).
  • Rosacea was more common in those with LPP (OR 3.15).
  • LPP was associated with a higher risk of melanoma (OR 3.11).
  • There was an increased risk of cutaneous squamous cell carcinoma in LPP patients (OR 3.04).
  • Systemic lupus erythematosus was more frequently seen in individuals with LPP (OR 3.06).
  • The odds of having vitiligo were higher in LPP patients (OR 2.89).
  • Rheumatoid arthritis was more common among those with LPP (OR 1.50).
  • Hypothyroidism showed a significant association with LPP (OR 1.48).
  • Thyroiditis was also more prevalent in LPP patients (OR 1.26).
  • LPP patients were more likely to have coronary artery disease (OR 1.66).
  • Iron deficiency anemia was slightly more common among LPP patients (OR 1.18).

The authors emphasized that these associations emphasize the need for heightened clinical awareness when managing individuals with LPP. “Our findings suggest that LPP is not merely a localized scalp disorder but may reflect broader systemic immune dysfunction,” the authors noted. They advocated for clinicians to consider comorbidity screening as part of routine care for LPP patients.

Despite the robust methodology, the authors acknowledged the variability in study designs and populations across the included research as a limitation. They called for future studies to better understand the biological mechanisms driving these associations and to help define guidelines for screening and long-term monitoring.

The authors concluded, “The meta-analysis positions LPP as a dermatological condition with important systemic implications, highlighting the importance of multidisciplinary care and early comorbidity detection to improve patient outcomes.”

Reference:

Chen, C., Ogbutor, C., Bae, S., Spencer, C., Kelley, K. J., & Senna, M. M. Comorbidities Associated With Lichen Planopilaris: A Systematic Review and Meta-Analysis. International Journal of Dermatology. https://doi.org/10.1111/ijd.17925

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New urine-based tumor DNA test may help personalize bladder cancer treatment: Study

In a multi-institutional study published in Science Direct, researchers revealed that testing urine-based tumor DNA (utDNA) can help predict which bladder cancer patients are at higher risk for recurrence after treatment.

This study analyzed utDNA from patients in the SWOG S1605 trial, who were treated with atezolizumab, an immunotherapy drug. Researchers used the UroAmp test to examine urine samples from 89 patients at the start of treatment and from 77 patients three months later. The goal was to see if utDNA could help identify which bladder cancer patients are most likely to respond to immunotherapy.

“This approach could help improve patient care by guiding more effective treatments and supporting more personalized plans,” said Robert Svatek, MD, MSCI, professor and chair of urology at the Joe R. and Teresa Lozano Long School of Medicine at The University of Texas Health Science Center at San Antonio (UT Health San Antonio). “It means we may be able to tailor therapy sooner, reduce unnecessary delays and help patients avoid major surgery without compromising the quality of their care.”

A nationally recognized urologic oncologist with the Mays Cancer Center at UT Health San Antonio, Svatek is the leading expert in bladder cancer and a member of SWOG, also known as Southwest Oncology Group. SWOG is part of the National Cancer Institute’s (NCI) National Clinical Trials Network (NCTN) and one of the five leading cancer clinical trial groups in the United States.

The SWOG S1605 study was a phase 2 clinical trial testing atezolizumab in patients with high-risk bladder cancer that didn’t respond to BCG (Bacillus Calmette-Guérin) treatment, the main immunotherapy to treat early-stage bladder cancer.

Samples were collected from participants before treatment and again three months later. Researchers used the UroAmp assay, a non-invasive urine test that detects bladder cancer–related mutations, to analyze utDNA and generate a genomic profile for each patient.

They found that utDNA levels were linked to how well patients responded after six months and how long they stayed cancer-free over 18 months. Patients with positive utDNA results were less likely to respond and more likely to have their cancer return.

According to the American Cancer Society, bladder cancer is the sixth most common cancer in the United States, with more than 83,000 new cases diagnosed annually. Of these cases, approximately 75% are non–muscle invasive, meaning the cancer has not yet invaded the bladder muscle.

Patients who don’t respond to immunotherapy may face the difficult decision of either continuing therapies that spare the bladder but carry high risks of recurrence or undergo major surgery that removes the bladder and profoundly impacts one’s quality of life.

This study offers new hope for patients with high-risk bladder cancer by showing that a urine-based DNA test can help predict who is more likely to benefit from immunotherapy. By identifying treatment response early, this approach could guide more personalized, bladder-preserving care and reduce the need for major surgery.

Reference:

Marie-Pier St-Laurent, Parminder Singh, David J. McConkey, M. Scott Lucia, Vadim S. Koshkin, Kelly L. Stratton, Trinity J. Bivalacqua, Wassim Kassouf, Sima P. Porten, Rick Bangs, Melissa Plets, Ian M. Thompson, Joshua J. Meeks, Vincent M. Caruso, Ceressa T. Ward, Brian C. Mazzarella, Kevin G. Phillips, Vincent T. Bicocca, Trevor G. Levin, Seth P. Lerner, Peter C. Black, Urine Tumor DNA to Stratify the Risk of Recurrence in Patients Treated with Atezolizumab for Bacillus Calmette-Guérin–unresponsive Non–muscle-invasive Bladder Cancer, European Urology, 2025, https://doi.org/10.1016/j.eururo.2025.03.023.

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Regular Sexual Activity May Reduce Vulvar Discomfort, pain and discomfort in perimenopausal and postmenopausal women : Study

Researchers have found in a new study that women aged 40 to 70 who engage in regular sexual activity may experience reduced vulvar pain, dryness, and irritation. Interestingly, orgasm and sexual satisfaction levels appear to remain unaffected by age, suggesting continued sexual engagement may support vaginal health without diminishing pleasure.

It’s no secret that women often become less interested in sex with age. However, orgasm and satisfaction have been shown to not decline significantly with age. A new study suggests regular sexual activity may limit vulvar pain, irritation, and dryness, which are all common reasons women have less sex as they get older. Results of the study are published online today in Menopause, the journal of The Menopause Society.

Estrogen deficiency during and after menopause may reduce the life expectancy of women and impair their quality of life through a condition called genitourinary syndrome of menopause (GSM). In 2014, GSM was defined as a collection of symptoms and signs associated with decreased estrogen and sex steroid levels. GSM includes genital, sexual and urinary symptoms-all of which can affect the frequency of sexual activity for women aged in their 40s to 70s.

In this new study involving more than 900 women aged 40 to 79 years, researchers sought to examine the association between sexual regularity and vulvovaginal-related problematic menopause symptoms. The vulva refers to the external female genitalia, and the vagina to the internal anatomy. Common problems experienced with menopause include itching, burning, pain, decreased lubrication, and changes in skin appearance.

Engaging in sexual activity in the past 3 months was defined as regular sexual activity, whereas engaging in sexual activity in the past year (but not in the past 3 months) was considered lower sexual activity. Not surprisingly, the researchers confirmed that the proportion of women having regular sexual activity decreased significantly with age, which aligns with the fact that Female Sexual Function Index scores for sexual desire, arousal, and lubrication also significantly decreased with age. The Female Sexual Function Index consists of 19 questions on female sexual function under six domains. Noteworthy, however, was that the scores for orgasm and satisfaction did not change with age.

Based on the results of the study, the researchers determined that some sexual functions and symptoms change with age but may be maintained in women who engage in more regular sexual activity. This study also revealed that women with regular sexual activity showed a low prevalence of GSM-related symptoms.

Study results are published in the article “Cross-sectional study of the association between regular sexual activity and sexual function and genitourinary syndrome of menopause-related symptoms.”

“The findings highlight the importance of diagnosing and treating GSM. Only 2.9% of the participants reported using hormone therapy. Local low-dose vaginal estrogen therapy is safe and highly effective at alleviating bothersome vulvovaginal symptoms contributing to pain and avoidance of intercourse. And although optimal sexual health is integral to overall well-being, it is also imperative to recognize the effect these symptoms can have on women who aren’t sexually active. Treatment should be offered to anyone with symptoms, whether engaging in sexual activity or not. Normalizing use of local low-dose estrogen therapy should be a thing,” says Dr. Monica Christmas, associate medical director for The Menopause Society.

Reference:

Yoshikazu Sato, Cross-sectional study of the association between regular sexual activity and sexual function and genitourinary syndrome of menopause-related symptoms, Menopause, DOI: 10.1097/GME.0000000000000002539.

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Integrating Innovation: Study explores Clinician Insights on Apps for Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) significantly contribute to maternal morbidity and mortality in the U.S., which exhibits one of the highest maternal mortality rates among high-income countries. Approximately 10% of pregnancies are affected by forms of HDP such as chronic hypertension, preeclampsia, and gestational hypertension, leading to severe health risks for mothers and neonates. Home blood pressure monitoring (HBPM) is proposed as a solution to enhance care quality, providing timely and relevant data critical for informed clinical decisions regarding hospital admissions and treatments. A recent study investigates the viewpoints of clinicians and highlights the challenges encountered in implementing an app specifically designed for hypertensive disorders of pregnancy (HDP).

Clinician Perspectives on P-COACH

The exploration of clinicians’ perceptions regarding the integration of an HDP-specific app, P-COACH, revealed potential benefits but also highlighted significant challenges. Key insights were gathered through qualitative interviews with diverse clinicians who provided multifaceted views on the utility of such applications in managing HDP. Participants pointed out that HBPM could improve access to care, especially for underserved populations affected by socio-economic barriers and rural healthcare challenges. They recognized the unique motivation of pregnant individuals to engage in health-improving behaviors during this period, suggesting P-COACH could facilitate sustained hypertension management through empowerment and education.

Barriers to Home Blood Pressure Monitoring

However, concerns regarding affordability of BP monitoring equipment limited the accessibility of HBPM. The financial burden, coupled with the need for literacy-appropriate resources, poses barriers to successful implementation. Clinicians highlighted the need for streamlined workflows and integration of HBPM data into electronic health records (EHRs) to reduce the administrative burden on healthcare providers and focus more on patient care. The unawareness of critical BP readings could put patients at risk, emphasizing the necessity for defined protocols and clear roles among care team members to interpret and act on BP data accurately.

Considerations for P-COACH Implementation

Implementing P-COACH successfully requires addressing barriers including liability issues associated with patient-generated data oversight, as well as ensuring providers receive adequate training and resources. Participants underscored the importance of developing an understanding of individual patient risks to tailor alerts meaningfully and responsively. Despite the promising features of P-COACH in enhancing communication, continuity of care, and mitigating complications postpartum, potential limitations include the need for broader studies encompassing varied healthcare settings and patient perspectives. Engaging diverse populations and ensuring affordable access to technology remain critical for equitably addressing HDP challenges and improving maternal health outcomes.

Key Points

– -Maternal Morbidity and Mortality-: Hypertensive disorders of pregnancy (HDP) are significant contributors to maternal morbidity and mortality in the U.S., with around 10% of pregnancies affected by conditions like chronic hypertension, preeclampsia, and gestational hypertension. These disorders are associated with severe health risks for mothers and neonates, highlighting the need for effective management and intervention strategies.

– -Home Blood Pressure Monitoring (HBPM) Benefits-: Incorporating HBPM into prenatal care can enhance the quality of healthcare delivery by providing timely, relevant blood pressure data, which are crucial for informed clinical decisions regarding hospital admissions and treatments. This method addresses access disparities, particularly for underserved demographics affected by socio-economic challenges and rural healthcare limitations.

– -Clinician Insights on P-COACH-: Qualitative interviews with clinicians reveal that while there are potential advantages in using the HDP-specific app P-COACH, there are also significant hurdles. Clinicians recognize the app’s potential to motivate pregnant individuals to engage in health-improving behaviors and aid sustained management of hypertension.

– -Barriers to Effective HBPM Implementation-: Concerns regarding the affordability of blood pressure monitoring equipment, alongside the need for literacy-appropriate resources, hinder the successful implementation of HBPM. Clinical feedback indicates that streamlined workflows and incorporation of HBPM data in electronic health records (EHRs) are necessary to alleviate administrative burdens and concentrate on patient care.

– -P-COACH Implementation Considerations-: Effective implementation of P-COACH necessitates addressing various barriers, such as liability issues related to patient-generated data and ensuring healthcare providers are adequately trained. Tailoring alerts based on individual risk profiles is emphasized for responsive and meaningful patient engagement.

– -Need for Broader Studies and Engagement-: While P-COACH offers promising features for improving communication and continuity of care, limitations such as the need for more extensive studies across diverse healthcare settings and patient viewpoints persist. Ensuring affordable access to technology and engaging varied patient populations are critical to equitably confront HDP challenges and enhance maternal health outcomes.

Reference –

Shannon Canfield et al. (2025). Using RE-AIM To Inform The Adaptation Of A Clinical Decision Support Application For Hypertension Disorders Of Pregnancy: A Qualitative Study Of Provider Perspectives. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07632-x.

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