Heart failure, atrial fibrillation & coronary heart disease linked to cognitive impairment, reveals study

Three common cardiovascular diseases in adults-heart failure, atrial fibrillation and coronary heart disease-are linked to cognitive impairment and increased risk of dementia, according to “Cardiac Contributions to Brain Health,” a new scientific statement from the American Heart Association published today in the Association’s journal, Stroke.

The scientific statement reviews the latest research examining the relationship between cardiovascular health and brain health, including cognitive impairment or neuropsychological dysfunction. The statement emphasizes the interconnectivity between the brain and heart and how crucial this relationship is for overall health.

“Stroke and cognitive decline, both major determinants of brain health, are chronic and disabling conditions that have a dramatic impact at the individual and societal level,” said Chair of the statement writing group Fernando D. Testai, M.D., Ph.D., FAHA, professor of neurology and rehabilitation and vascular neurology fellowship director at the University of Illinois College of Medicine and stroke medical director at the University of Illinois Hospital in Chicago. “Managing heart health from an early age is important to prevent cardiovascular disease and cardiac events, protect brain health and reduce the risk of cognitive decline in later life.”

Testai added, “Dementia is commonly seen as an incurable and relentless disease that cannot be prevented. Evidence shows, however, that adopting a healthy lifestyle and identifying and treating vascular risk factors early may help preserve normal brain function and reduce the burden of Alzheimer’s disease and other related dementias.”

Heart Failure

Heart failure is a major public health issue with underlying causes that include high blood pressure, obesity and Type 2 diabetes. Heart failure is linked to cognitive impairment, affecting tasks like self-care and medication management, especially in older adults. A meta-analysis of previous studies found that almost 50% of people with heart failure experience some kind of cognitive impairment that may impact language, memory and/or executive function. The rate of cognitive problems tends to be higher in those with more severe types of heart failure.

Heart failure may lead to brain injury in a number of ways. Reduced blood flow can cause mini-strokes or silent brain injuries. Chronic inflammation and neurohormonal activation, which work to maintain the brain’s environment, may also contribute to brain damage. Obesity and sleep-disordered breathing are common conditions among people with heart failure and are also associated with cognitive dysfunction. Brain changes, such as gray matter volume reduction and/or white matter damage, are common in heart failure and contribute to reduced brain function. Emerging evidence also indicates that people with heart failure and people with neurodegenerative diseases such as Alzheimer’s may share genetic variations.

For patients with severe heart failure, cognitive screening is advised before surgical interventions due to the elevated risk of stroke; stroke is known to be one of the most common causes of cognitive decline.

Atrial Fibrillation

Atrial fibrillation is the most common heart rhythm disorder in adults, with the overall prevalence in the U.S. projected to increase from 2.7 million in 2020 to nearly 16 million by 2050. The link between atrial fibrillation and stroke is well-known, however, the connection between atrial fibrillation and cognitive decline requires more research. A large meta-analysis found that atrial fibrillation increases the risk of cognitive impairment by 39%.

Shared risk factors between atrial fibrillation and dementia include high blood pressure, Type 2 diabetes, heart failure, smoking, vascular disease, sleep-disordered breathing and advanced age. These factors cause structural and functional brain changes leading to cognitive decline. Stroke, a major predictor of cognitive impairment, has a direct link to atrial fibrillation. Small brain bleeds, or microhemorrhages, are also more common in people with atrial fibrillation and linked to cognitive decline.

Reduced cardiac output associated with atrial fibrillation (similar to heart failure) may compromise blood flow to key areas of the brain that are responsible for cognitive function. Both atrial fibrillation and Alzheimer’s disease are associated with systemic inflammation, and inflammatory biomarkers are associated with increased risk of blood clots and brain injury. While more research is needed to explore this connection, the observation illustrates the complex interaction between the nervous and cardiovascular systems.

Effective treatment of atrial fibrillation, including the use of anti-clotting medications, rhythm control or catheter ablation procedures, may reduce the risk of cognitive decline. Ongoing studies are investigating whether restoring regular heart rhythm through catheter ablation may reduce cognitive dysfunction compared to medication alone.

Coronary Heart Disease

Coronary heart disease significantly increases the risk of dementia and cognitive impairment. A large systematic review of more than 1 million adults indicates that those with heart disease have a 27% higher risk of developing dementia compared to people without heart disease. Up to 50% of people experience loss of brain function after a heart attack. Data from multiple, large-scale studies show a heart attack is linked to a steeper decline in cognitive function, including memory and executive function. Elevated levels of calcium buildup in the arteries are also linked to a greater risk of developing dementia.

Coronary heart disease can harm brain function through various mechanisms. Common risk factors like high blood pressure and Type 2 diabetes cause inflammation that affects the blood-brain barrier and reduces blood flow to the brain, leading to cognitive decline and dementia. Heart disease is also linked to small vessel disease in the brain and reduced brain blood flow, resulting in cognitive impairment. These issues are also seen in patients with Alzheimer’s, indicating a close link between blood vessel damage and brain degeneration. Additionally, genetic factors that increase heart disease risk may also contribute to brain shrinkage and cognitive decline.

Improving vascular risk factors may preserve cognitive performance, though specific effects in patients with coronary heart disease are not fully established. Intensive blood pressure treatment has shown promise in reducing mild cognitive impairment but not dementia. Other studies suggest managing cardiovascular risk factors with lifestyle interventions such as diet and exercise may help maintain cognitive health.

Testai said, “Although new medications with the potential to treat Alzheimer’s disease are being developed, the medical community is well aware that prevention is better than a cure. More research is needed to confirm and outline how cardiovascular care can improve brain health. In addition, more research is needed to understand the ways gender, race and ethnicity may influence the connection between the brain and the heart.”

“Health care professionals should approach their patients in a holistic manner with an approach to improved heart health throughout their lives. Promoting heart health earlier in life with resources that encourage healthy lifestyles is crucial, and monitoring and managing heart health through resources like the Association’s Life’s Essential 8 are important to reduce the risk of cognitive impairment.”

Reference:

Fernando D. Testai, Philip B. Gorelick, Cardiac Contributions to Brain Health: A Scientific Statement From the American Heart Association, Stroke, https://doi.org/10.1161/STR.0000000000000476.

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Autoantibodies fail to influence reproductive parameters in patients with Hashimoto thyroiditis, reports research

A new study published in the journal of Endocrine Research found that autoantibodies had no effect on reproductive characteristics, despite a mild correlation observed among thyroid volume, preterm deliveries and the quantity of antithyroid peroxidase (TPOAb).

Among autoimmune diseases, Hashimoto’s thyroiditis (HT) is the most common where the thyroid stimulating hormone (TSH) levels are up, serum free thyroxine (FT4) levels are low, anti-thyroid autoantibodies like TPOAb and anti-thyroglobulin (TGAb) are present, and there is local parenchymal lymphocytic infiltrate. According to studies, eutrophic women with thyroid autoimmunity (TAI) have a greater risk of pregnancy morbidity and loss. Also, inflammatory processes of viral/bacterial origin and autoimmune have been identified as influencing cellular structures at the maternal-fetal interface and determining various abnormalities in the product of conception. Research of the role of TAI in infertility and assisted reproduction results in women without dysfunction found that TAI had no effect on the number of oocytes retrieved, the chance of fertilization, implantation or clinical pregnancy.

In order to assess the presence as well as concentration of antithyroglobulin (TGAb) antibodies and antithyroid peroxidase at the onset of Hashimoto’s thyroiditis (HT) as well as their correlation with disease attributes and reproductive parameters both before and after diagnosis, Rafaela and colleagues conducted this study.

A total of 65 women with HT were included in this cross-sectional research, which was conducted in an outpatient clinic. Medical records were reviewed and interviews were conducted to gather data. The factors included illness features, TPOAb and TGAb levels, live births, preterm births, infertility and pregnancy losses. This research employed Spearman correlation, Mann-Whitney test, and chi-square or Fisher’s exact tests. 

The average age upon diagnosis was 38 (SD ± 11.1) years, and the disease lasted for 7.5 (SD ± 5.3) years. Of the women, 46% had spells of infertility. Also, 42 women (64.6%) had TGAb antibodies and 59/65 (90.7%) had TPOAb antibodies. Comparison between the groups with and without TPOAb or TGAb revealed no variations in any of the examined variables. TPOAb concentration was strongly connected with thyroid volume and preterm deliveries, whereas TGAb concentration was correlated with age.

Overall, the findings of this study found that among women with HT, infertility was highly prevalent. This was greater than the whole population, but there was no indication that the concentration or existence of the autoantibodies TGAb and TPOAb had any bearing on it.

Source:

de Souza, R. S. X., Quintino-Moro, A., Engelbrecht Zantut-Wittmann, D., & Fernandes, A. (2024). Antithyroid Antibodies and Reproductive Parameters of Women with Hashimoto’s Thyroiditis. In Endocrine Research (pp. 1–8). Informa UK Limited. https://doi.org/10.1080/07435800.2024.2405147

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Chronic stress accelerates colorectal cancer progression by disrupting the balance of gut microbiota, new study shows

Cutting-edge research has uncovered how chronic stress disrupts the balance of gut microbiota to speed up the progression of colorectal cancer (CRC), opening new avenues for CRC prevention and treatment.

By eliminating certain gut bacteria and inducing stress, researchers were able to conclude a relationship between stress and gut microbiota in the progression of CRC, identifying a particular bacterial species as a potential therapeutic target.

Presenting the study at UEG Week 2024, lead researcher Dr Qing Li explained, “In our study, we used an antibiotic cocktail (vancomycin, ampicillin, neomycin, and metronidazole) to eradicate gut microbiota, followed by faecal microbiota transplantation to investigate whether gut microbiota was necessary for chronic stress to accelerate CRC progression.”

The findings showed that chronic stress not only increased tumour growth but also reduced beneficial gut bacteria, particularly Lactobacillus genus, which are essential for a healthy immune response against cancer. Dr Li noted, “Stress-related CRC progression can be attributed to a reduction in beneficial gut bacteria, as this weakens the body’s immune response against cancer. Lactobacillus, being sensitive to vancomycin and ampicillin, was depleted in both the control and stress groups by the antibiotic cocktail. This depletion highlights its crucial role in maintaining gut health and its potential association with CRC progression under chronic stress.”

To further explore how Lactobacillus influences CD8+ T cell levels – which play a crucial role in the body’s anti-tumour immunity – and CRC progression, the researchers supplemented mice with Lactobacillus during chronic stress and observed reduced tumour formation. Dr Li stated, “Through faecal analysis, we found that Lactobacillus plantarum (L. plantarum) specifically regulated bile acid metabolism and enhanced the function of CD8+ T cells. This indicates how Lactobacillus may enhance anti-tumour immunity.”

Unexpected findings also emerged during the research, explained Dr Li. “Initially, we thought that L. plantarum might enhance the anti-tumour immune function of CD8+ T cells by initiating metabolite production, as previous findings suggest. However, our in vitro tests revealed that the conditioned medium from L. plantarum did not significantly stimulate CD8+ T cells to produce such key metabolites. This indicates that L. plantarum may require substances in the gut environment to enhance anti-tumour of CD8+ T cells.”

The potential for Lactobacillus-based therapies in treating patients, particularly those affected by chronic stress, is promising. “Combining traditional anti-tumour drugs with L. plantarum supplementation could be a viable therapeutic strategy for patients with stress-related CRC,” Dr Li said.

CRC is a significant health concern across Europe and is the second most prevalent cancer and second leading cause of cancer-related death.

Its incidence is predicted to rise significantly in the next decade, due to an aging population, unhealthy diets, physical inactivity and obesity.3Moving forward, the research team plans to collect faecal and tumour samples from CRC patients to analyse changes in gut microbiota among individuals with and without chronic stress. “Our aim is to verify if L. plantarum is significantly reduced in stressed CRC patients and to explore its relationship with anti-tumour immune cells,” Dr Li shared.

This study highlights the intricate relationship between stress, gut microbiota, and CRC, suggesting that strategies to restore gut health may play a critical role in cancer care, particularly for patients facing chronic stress. “Restoring beneficial bacteria in the gut, such as Lactobacillus, could strengthen the body’s natural defences against colorectal cancer,” concluded Dr Li.

Reference:

Chronic stress accelerates colorectal cancer progression by disrupting the balance of gut microbiota, new study shows, Beyond, Meeting: UEG Week 2024.

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Dupilumab therapy reduced atopic dermatitis symptoms in pediatric population, finds study

A new study published in the Journal of American Academy of Dermatology found that Dupilumab improved atopic dermatitis (AD) symptoms as well as quality of life (QoL) in pediatric patients and caregivers/families.

The effects of moderate-to-severe atopic dermatitis on kids and caregivers are significant. Assessing several symptoms (such as pruritus and sleep disruption) is challenging for professionals. In addition to clinician-reported outcomes, patient-reported outcomes (PROs) offer valuable support. When young patients cannot offer meaningful, trustworthy self-reports on their experiences, the US Food and Drug Administration and the International Society for Pharmacoeconomics and Outcomes Research Task Force recommend the use of observer-reported outcomes. Thus, this study by Amy Paller and colleagues was to assess how dupilumab medication affected young children’s quality of life and symptoms of AD as reported by patients and caregivers.

Children with moderate-to-severe AD who were 6 months to 5 years old were enrolled in the randomized, placebo-controlled LIBERTY AD PRESCHOOL trial. They were given low-potency topical corticosteroids along with either dupilumab or a placebo for 16 weeks. The change in caregiver-reported outcomes of AD symptoms (such as itching and sleep) and QoL of patients as well as their caregivers/families was evaluated in this post-hoc study between baseline and week 16.

The participants who received dupilumab showed substantial improvements in caregiver-reported AD symptoms and quality of life when compared to the ones who received a placebo. When compared to the placebo group, the dupilumab group showed a least square mean (LSM) drop of -3.6 from baseline on the Worst Scratch/Itch Numerical Rating Scale (WSI-NRS) in week 1 and maintained it through week 16.

Also, 48% of the dupilumab group satisfied the criterion for a clinically relevant change in WSI-MRS, against 9% in the placebo group. The dupilumab group improved their sleep quality numerical rating scale (NRS) by 2.0 points from baseline to week 16 when compared to a 0.3 point change in the placebo group for both individuals and caregivers. The number of patients declaring no days or 1-2 days of itching in the previous 7 days differed more in the dupilumab group from baseline than in the placebo group.

Similarly, the proportion of patients stating no days and 1-2 days of sleep disturbances in the previous 7 days differed more between week 16 and baseline. Overall, Dupilumab helped individuals with AD symptoms and their families/caregivers’ quality of life.

Source:

Paller, A. S., Silverberg, J. I., Simpson, E. L., Cork, M. J., Arkwright, P. D., Chen, Z., Bansal, A., Prescilla, R., Wang, Z., & Marco, A. R. (2024). The effect of dupilumab on caregiver- and patient-reported outcomes in young children with moderate-to-severe atopic dermatitis: results from a placebo-controlled, phase 3 study. In Journal of the American Academy of Dermatology. Elsevier BV. https://doi.org/10.1016/j.jaad.2024.09.039

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Use of OdonAssist device tied to higher rate of successful assisted vaginal deliveries, finds study

Recent research paper “Safety and efficacy of the OdonAssist inflatable device for assisted vaginal birth: the BESANCON ASSIST study” aimed to investigate the safety and efficacy of the OdonAssist inflatable device before conducting a randomized controlled trial. The study was an open-label, nonrandomized investigation of 104 women with clinically indicated assisted vaginal delivery using the OdonAssist at the Besancon University Hospital, France. The primary outcome measure was the proportion of successful assisted vaginal births using the OdonAssist, and the secondary outcomes included neonatal and maternal data, ease of use of the device, and maternal perception ratings of the birth experience.

Safety and Efficacy Results

The study reported a success rate of 88.5% for assisted vaginal births using the OdonAssist, with no emergency cesarean deliveries performed in the OdonAssist group, and no serious adverse maternal or neonatal reactions related to the use of the device. The rate of third- and fourth-degree perineal tears with the OdonAssist was 3.8%, and maternal perception ratings of the birth experience with the OdonAssist were high. The paper also highlighted the safety and efficacy of the OdonAssist as an alternative to other current devices for assisted vaginal births, with high acceptance rates among pregnant women and the high rate of successful assisted vaginal births using the OdonAssist confirming the feasibility of a future randomized controlled trial.

Design and Innovation

The study used an innovative design combining mechanical principles that favor the progression of the fetal head, including propulsion, flexion, and traction. The device was reported to be safer, easier to use, and more acceptable to women and obstetricians than currently available instruments. The success rate was higher than previously reported in a feasibility study, and the results confirmed the feasibility of conducting randomized controlled trials to evaluate the efficacy of OdonAssist in comparison with other assisted vaginal delivery devices.

Conclusion

Overall, the study concluded that the OdonAssist is a safe and effective alternative to other current devices for assisted vaginal births, with the high acceptance rate among pregnant women and the high rate of successful assisted vaginal births using the OdonAssist confirming the feasibility of a future randomized controlled trial. The detailed findings and safety and efficacy data from this study contribute to the existing knowledge on the OdonAssist device and support the feasibility of future randomized controlled trials to further evaluate its performance and safety in comparison with other assisted vaginal delivery devices.

Key Points

1. The study aimed to investigate the safety and efficacy of the OdonAssist inflatable device for assisted vaginal birth before conducting a randomized controlled trial.

2. Safety and efficacy results revealed a success rate of 88.5% for assisted vaginal births using the OdonAssist, with no emergency cesarean deliveries performed in the OdonAssist group and no serious adverse maternal or neonatal reactions related to the use of the device. The rate of third- and fourth-degree perineal tears with the OdonAssist was 3.8%, and maternal perception ratings of the birth experience with the OdonAssist were high.

3. The study used an innovative design combining mechanical principles favoring fetal head progression, including propulsion, flexion, and traction. The OdonAssist was reported to be safer, easier to use, and more acceptable to women and obstetricians than currently available instruments. The high success rate confirmed the feasibility of conducting randomized controlled trials to evaluate the efficacy of OdonAssist in comparison with other assisted vaginal delivery devices.

4. The OdonAssist was highlighted as a safe and effective alternative to other current devices for assisted vaginal births, with high acceptance rates among pregnant women. The detailed findings and safety and efficacy data from this study contribute to the existing knowledge on the OdonAssist device, supporting the feasibility of future randomized controlled trials to further evaluate its performance and safety in comparison with other assisted vaginal delivery devices.

5. The primary outcome measure was the proportion of successful assisted vaginal births using the OdonAssist, and the secondary outcomes included neonatal and maternal data, ease of use of the device, and maternal perception ratings of the birth experience.

6. Overall, the study concluded that the OdonAssist is a safe and effective alternative to other current devices for assisted vaginal births, with the high acceptance rate among pregnant women and the high rate of successful assisted vaginal births using the OdonAssist confirming the feasibility of a future randomized controlled trial.

Reference 

Mottet N, Hotton E, Eckman-Lacroix A, Bourtembourg A, Metz JP, Cot S, Poitrey E, Delhomme L, Languerrand E, Nallet C, Lallemant M, Draycott T, Riethmuller D. Safety and efficacy of the OdonAssist inflatable device for assisted vaginal birth: the BESANCON ASSIST study. Am J Obstet Gynecol. 2024 Mar;230(3S):S947-S958. doi: 10.1016/j.ajog.2023.05.016. Epub 2023 Aug 1. PMID: 38462265.

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Coffee during pregnancy safe for baby’s brain development, reveals research

A University of Queensland-led study has failed to find any strong links between drinking coffee during pregnancy and neurodevelopmental difficulties in children, but researchers are advising expectant mothers to continue following medical guidelines on caffeine consumption.

Dr Gunn-Helen Moen and PhD student Shannon D’Urso from UQ’s Institute for Molecular Bioscience (IMB) led an in-depth genetic analysis of data from tens of thousands of families in Norway.

“Scandinavians are some of the biggest coffee consumers in the world, drinking at least 4 cups a day, with little stigma about drinking coffee during pregnancy,” Dr Moen said.

“Our study used genetic data from mothers, fathers and babies as well as questionnaires about the parents’ coffee consumption before and during pregnancy.

“The participants also answered questions about their child’s development until the age of 8, including their social, motor, and language skills.”

“Our analysis found no link between coffee consumption during pregnancy and children’s neurodevelopmental difficulties.”

The researchers said physiological changes during pregnancy prevent caffeine breaking down easily and it can cross the placenta and reach the foetus, where there are no enzymes to metabolise it.

Caffeine accumulation was thought to impact the developing foetal brain, but Dr Moen said previous observational studies couldn’t account for other environmental factors such as alcohol, cigarette smoke or poor diet.

“We used a method called Mendelian randomisation which uses genetic variants that predict coffee drinking behaviour and can separate out the effect of different factors during pregnancy,” she said.

“It mimics a randomised controlled trial without subjecting pregnant mothers and their babies to any ill effects.

“The benefit of this method is the effects of caffeine, alcohol, cigarettes and diet can be separated in the data, so we can look solely at the impact of caffeine on the pregnancy.”

The researchers use genetic analysis to understand complex traits and diseases especially in early life, with a previous study by Dr Moen showing that drinking coffee in pregnancy did not affect birth weight, risk of miscarriage or stillbirth.

They emphasise the importance of following advice from healthcare providers to limit caffeine consumption during pregnancy, as caffeine may influence other pregnancy outcomes.

The researchers are now looking to apply similar analyses to understand more about genetic and environmental causes of neurodiversity, and the effect of it from other factors on brain development during pregnancy.

Reference:

D’Urso S, Wootton RE, Ask H, et al. Mendelian randomization analysis of maternal coffee consumption during pregnancy on offspring neurodevelopmental difficulties in the Norwegian Mother, Father and Child Cohort Study (MoBa). Psychological Medicine. Published online 2024:1-14. doi:10.1017/S0033291724002216.

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Innovative nanoparticle therapy targets fat absorption to combat obesity: Study

Researchers have unveiled a novel approach to tackle obesity by targeting fat absorption in the small intestine. The cutting-edge nanoparticle system, engineered to deliver therapeutic molecules directly to the digestive tract, has shown significant potential to prevent diet-induced obesity.

Presented today at UEG Week 2024, the study focuses on an enzyme called Sterol O-acyltransferase 2 (SOAT2), which plays a critical role in fat absorpsion in the small intestine. By inhibiting this enzyme in the small intestine, the study offers a promising therapeutic approach to reduce fat absorption and potentially prevent obesity.

Despite extensive research into fat metabolism, effective inhibitors of intestinal fatty acid uptake have until now remained elusive. “For years, researchers have studied fat metabolism, but finding an effective way to block fat absorption has been difficult,” explained lead researcher Dr Wentao Shao. “While most strategies focus on reducing dietary fat intake, our approach targets the body’s fat absorption process directly.”

The research team developed an innovative delivery system using nanoparticles – a tiny capsule made from a polymer core, coated in a protective shell. The system was designed to efficiently carry small interfering RNAs (siRNAs) to the small intestine, where they can reduce SOAT2 expression, inhibiting fat absorption. In mouse models, the animals treated with the nanoparticle therapy absorbed less fat and avoided obesity, even on a high-fat diet.

“This oral treatment offers several advantages”, said Dr Shao. “It’s non-invasive, has low toxicity, and it has high potential for better patient compliance compared to current obesity treatments, which are often invasive or difficult to maintain. This makes it a promising alternative.”

The study also uncovered the underlying mechanism by which SOAT2 regulates fat absorption. Inhibition of SOAT2 in the small intestine triggers degradation of CD36, a protein reponsible for transporting fat. This process involves both cellular stress and the recruitment of E3 ligase RNF5, an enzyme that enhances CD36 degradation.

Previous studies have shown that blocking hepatic SOAT2 leads to fat accumulation in the liver, whereas this intestine-specific approach circumvents that risk, offering a safer and more focused treatment for obesity.

Professor Zhaoyan Jiang, study supervisor, explained, “One of the most exciting aspects of this therapy is its ability to target fat absorption in the intestines without affecting the liver. This is important because previous studies showed that blocking SOAT2 in the liver can lead to fat buildup there – a risk our treatment avoids by focusing only on intestinal SOAT2.”

Looking ahead, the research team plans to test the nanoparticle system in larger animal models to confirm its effectiveness and safety for potential use in humans.

“We believe that this nanoparticle system represents a breakthrough in obesity management, offering a new solution that tackles both fat metabolism and diet-related weight gain, potentially ushering in a new era of more effective treatments”, Professor Jiang concluded.

Reference:

Innovative nanoparticle therapy targets fat absorption to combat obesity, Beyond, Meeting: UEG Week 2024.

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Age-Related Macular Degeneration Increases Rheumatoid Arthritis Risk, Study Finds

Researchers report that the prevalence of rheumatoid arthritis (RA) is greatly higher in patients with age-related macular degeneration (AMD), regardless of the presence of visual disability. A recent study was published in the journal Scientific Reports by Jee Moon Yoon and colleagues..

Age-related macular degeneration is a leading cause of blindness among older adults. Rheumatoid arthritis is an autoimmune disease, characteristically involving the joints. They investigated this in a risk study of RA in individuals with AMD, with and without visual disability, using data on over 2 million South Koreans.

This was a large cohort study, with 3,537,293 people who underwent health checkup in 2009 and were followed for 10 years until 2019. Patients were stratified into three groups: patients suffering from AMD without VD, patients with AMD with VD, and controls without AMD. Loss of vision or defects in the visual field according to certified criteria by the Ministry of Health and Welfare of Korea was used as the condition for diagnosing visual disability. The incidence of RA diagnoses was tracked during the study period, and the analysis used multivariable-adjusted Cox regression to estimate RA risk in the exposed relative to the control groups. Lifestyle factors and other possible confounders were controlled for in the hazard ratios (HRs).

Results

  • A total of 43,772 people (1.24% of the study population) were diagnosed with RA during the follow-up period.

  • The risk of RA was higher in the AMD group than in controls regardless of visual disability status (aHR 1.11; 95% CI, 1.02–1.21).

  • The additional analysis in the AMD group shows that patients with AMD without visual disability had a higher risk of RA (aHR 1.13; 95% CI, 1.03–1.21), while those with AMD and visual disability had a non-significant lower risk of RA (aHR 0.90; 95% CI, 0.64–1.27).

  • There is also a significantly associated risk of RA with AMD even after accounting for lifestyle factors such as smoking and alcohol consumption, and comorbid conditions such as hypertension and diabetes.

This study found that there is a modestly increased risk of rheumatoid arthritis (RA) with age-related macular degeneration (AMD). Even after adjusting for lifestyle and comorbid factors, this association remained, which potentially brings to the fore a common pathway existing between the two diseases. This discrepancy could reflect differences in mechanisms between the two conditions operated with or without visual impairment or the effects of chronic inflammatory processes in both diseases.

Reference:

Yoon, J. M., Eun, Y., Han, K., Kim, B. S., Jung, W., Kim, H., Shin, D. W., & Lim, D. H. (2024). Association of rheumatoid arthritis with age-related macular degeneration in nationwide longitudinal cohort study. Scientific Reports, 14(1), 1–8. https://doi.org/10.1038/s41598-024-71524-x

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Flow within radial artery remains unchanged after cannulation among patients undergoing abdominal surgery, finds study

The radial artery is commonly cannulated during the perioperative period and in critical care situations. Despite being invasive, this procedure offers real-time monitoring of arterial blood pressure, enabling clinicians and anesthesiologists to promptly assess and treat patients, as well as to obtain arterial blood samples for various diagnostic purposes such as blood chemistry, blood gas analysis, and coagulation management. Recent study evaluated the impact of arterial cannulation on flow in the radial artery and the ulnar artery in patients undergoing abdominal surgery. The primary outcome was to measure the resistive indices (RIs) before cannula insertion and 6 hours after decannulation, while the secondary outcomes included measuring the artery size by anteroposterior (AP) diameter at the insertion site and at a point 4 cm proximal to the insertion site in both the radial and ulnar arteries. The study included 96 patients and used peak systolic velocity (PSV) and end‑diastolic velocity (EDV) to derive RI using a linear ultrasound transducer.

Study Results

The results showed that the flow in the radial artery did not change following cannulation, and the resistive index (RI) and AP diameter at the insertion site and proximal to the insertion site were similar before and after cannulation. However, the peak systolic velocity (PSV) and anteroposterior (AP) diameter in the ulnar artery increased significantly after decannulation, indicating a compensatory increase in flow following radial artery decannulation. Subgroup analysis revealed that patients with cannulas retained for less than 24 hours showed increased end‑diastolic velocity (EDV) of the radial artery following decannulation, while those with cannulas retained for more than 24 hours showed an increase in PSV and AP diameter of the ulnar artery after decannulation. The study also considered other research findings and discussed the impact of different techniques of radial arterial cannulation on complications. The study acknowledged limitations, such as the inability to document decreased pulsatility of the radial pulse on ultrasound Doppler due to study design constraints and the lack of follow-up beyond 6 hours of decannulation. In conclusion, the study found that resistive indices and artery size in the radial artery did not change significantly following cannulation, while there was a compensatory increase in flow in the ulnar artery after decannulation. The study emphasized the need for further research to evaluate flow patterns at decannulation and extend the measurement period beyond immediate decannulation. Overall, the study provided insight into the impact of arterial cannulation on arterial flow in patients undergoing abdominal surgery and highlighted the need for further research in this area.

Key Points

– The study aimed to assess the impact of arterial cannulation on flow in the radial and ulnar arteries in patients undergoing abdominal surgery. It included 96 patients and measured resistive indices (RIs) before cannula insertion and 6 hours after decannulation, as well as artery size by anteroposterior (AP) diameter at the insertion site and proximal to it in both arteries, using peak systolic velocity (PSV) and end‑diastolic velocity (EDV) derived from a linear ultrasound transducer.

– The analysis of the results revealed that the flow in the radial artery did not change following cannulation, and the resistive index (RI) and AP diameter at the insertion site and proximal to it were similar before and after cannulation. However, there was a significant increase in peak systolic velocity (PSV) and anteroposterior (AP) diameter in the ulnar artery after decannulation, suggesting a compensatory increase in flow following radial artery decannulation.

– Subgroup analysis indicated that patients with cannulas retained for less than 24 hours showed increased end‑diastolic velocity (EDV) of the radial artery following decannulation, while those with cannulas retained for more than 24 hours showed an increase in PSV and AP diameter of the ulnar artery after decannulation.

– The study also acknowledged limitations, including the inability to document decreased pulsatility of the radial pulse on ultrasound Doppler due to study design constraints and the lack of follow-up beyond 6 hours of decannulation. – In conclusion, the study found that resistive indices and artery size in the radial artery did not change significantly following cannulation, while there was a compensatory increase in flow in the ulnar artery after decannulation. The study emphasized the need for further research to evaluate flow patterns at decannulation and extend the measurement period beyond immediate decannulation.

– Overall, the study provided valuable insight into the impact of arterial cannulation on arterial flow in patients undergoing abdominal surgery and highlighted the need for more comprehensive research in this area.

Reference –

Kumar L, Subramaniam R, Kartha PA, Thomas DE, Patel S, Kartha N. Does the resistive index of the radial artery change after arterial cannulation in patients undergoing abdominal surgery? A prospective observational study. Indian J Anaesth 2024;68:909‑14

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Using transparent capsules in dry powder inhalers could significantly improve medication delivery, reports study

Background and Goal: 

This study examined whether patients with non-reversible chronic airway disease using a transparent capsule in single-dose dry powder inhalers affects the amount of medication delivered. The goal was to determine if patients who use transparent capsules that allow them to see if the medication has been fully inhaled have better inhalation results compared to those using opaque capsules.

Study Approach:

Researchers conducted an observational cross-sectional study between October 2020 and October 2022 at a tertiary university hospital. The study involved 91 patients using long-acting bronchodilators with single-dose dry powder inhalers for chronic airway disease. Patients used their inhalers under supervision, and the weight of the capsule was measured before and after inhalation to assess how much of the medication was delivered.

Main Results:

• Patients using transparent capsules had a significant decrease in capsule weight after inhalation, with a 30.1% reduction compared to an 8.6% reduction for opaque capsules, indicating more medication was delivered.

• The change in capsule weight was consistent regardless of the severity of the patient’s airway disease.

Why It Matters:

The findings suggest that using transparent capsules in dry powder inhalers could improve medication delivery by providing patients with visual feedback on their inhalation technique. This could lead to better management of chronic airway diseases by ensuring that patients receive their full dose of medication.

Reference:

Rocío Reinoso Arija, Rosario Ruiz-Serrano de la Espada, Mª Dolores Núñez Ollero, Laura Carrasco Hernandez, Esther Quintana Gallego and Jose Luis López-Campos, Evaluation of the Importance of Capsule Transparency in Dry Powder Inhalation Devices, The Annals of Family Medicine September 2024, 22 (5) 417-420; DOI: https://doi.org/10.1370/afm.3147.

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