Digital inhalers may detect early warning signs of COPD flare-ups: Study

Digital inhalers may help predict impending acute exacerbations of chronic obstructive pulmonary disease (COPD), according to a new study. The study is published in the May 2025 issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, a peer-reviewed, open-access journal.

COPD is an inflammatory lung disease, comprising several conditions, including chronic bronchitis and emphysema, and can be caused by genetics and irritants like smoke or pollution. The disease affects more than 30 million Americans and is the fourth leading cause of death worldwide.

Exacerbations, or flare-ups, can cause accelerated loss of lung function, a decrease in quality of life, and reduce a person’s physical function and activity. More than 50% of people with COPD experience at least one acute COPD exacerbation within four years of an initial COPD diagnosis. Increased respiratory rates and decreased lung volumes are early signs of an exacerbation.

This new study examines how digital inhalers using remote monitoring data can help predict and identify early or impending COPD exacerbations. The digital inhaler used in this study measured peak inspiratory flow, inhalation volume, inhalation duration, time to peak inhalation, and inhaler use. The study examined whether the data collected by the digital inhaler could identify a possible early-stage exacerbation.

“While this study examined a small group of participants, the remote monitoring data showed people experienced significant decreases in the amount of air they inhaled and how long that inhalation lasted in the approximately two weeks prior to experiencing an exacerbation,” said M. Bradley Drummond, M.D., MHS, professor of medicine in the Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina, Chapel Hill School of Medicine and lead author of the study. “As these remote monitoring technologies get more advanced, we can help both patients and health care providers identify exacerbations earlier, which allows us to provide better exacerbation management and improve health outcomes.”

Reference:

Drummond MB, Hemphill CC, Hill T, Boe A, Yu D, Ohar JA. Use of a digital inhaler to assess COPD disease variability and identify impending acute COPD exacerbations: a pilot study. Chronic Obstr Pulm Dis. 2025; 12(3): 250-259. doi: http://doi.org/10.15326/jcopdf.2024.0555

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Antibiotic Exposure Linked to Higher Risk of Childhood Atopic Dermatitis: Study

According to a recent meta-analysis published in eClinicalMedicine, antibiotic use during pregnancy or in early childhood significantly increases the risk of developing atopic dermatitis (AD) in children. The study analyzed 39 cohort studies involving pregnant women and children under 5, highlighting a strong association between early antibiotic exposure and this chronic inflammatory skin condition. The study was conducted by Huawei Zhao and colleagues.

Atopic dermatitis occurs in about 2% of adults but is seen in as many as 4% of children, making it a significant atopic condition in children. Antibiotics, one of the most frequently prescribed medications in early life, are frequently used in the first years of life or even prenatally. This broad exposure has raised questions about its effect on immune system development, gut microbiota, and the potential for the development of allergic conditions such as eczema. Although previous studies implied a connection, conclusive results have been out of reach until this latest research.

To examine the possible relationship between antibiotic use and AD in children, researchers undertook a systematic review and meta-analysis. The research examined 39 articles in both English (Scopus, PubMed, Web of Science, Cochrane Library) and Chinese (VIP, CNKI, Wanfang) databases, until the data cut date of May 1, 2025. A random-effects model meta-analysis was utilized to evaluate aggregated data. The review covered 7,487,925 children, making the study one of the largest of its nature. Registration for the study in the PROSPERO database (CRD42024535141) was done.

Key Findings

• Overall Risk: Children exposed to antibiotics at the time of pregnancy or early life had a 22% higher risk of acquiring AD (OR = 1.22, 95% CI: 1.17–1.28) with high heterogeneity (I² = 98.06%)

• Timing of Exposure: Children exposed post-birth were at greater risk of eczema than those exposed during pregnancy.

Influencing Factors: AD risk differed according to:

• Diagnostic criteria employed for AD.

• Race of the child.

• Type and frequency of antibiotic exposure.

• Age at measurement of outcome (but not age at exposure).

• Geographic Location: Residence location did not influence the association between antibiotic use and AD risk significantly.

These findings reflect the need for cautious use of antibiotics in pregnant women and young children. The link between antibiotics and AD can be mediated by their actions on emerging immune responses and gut microbiota in those phases of early life that are particularly formative. Pediatricians and obstetricians will be required to review prescribing habits and consider very carefully the use of antibiotic therapy, particularly where there are alternative treatments available.

Reference:

Zhao, H., Luo, Y., Li, W., Jiang, C., Jin, E., & Xu, Z. (2025). Association between antibiotic exposure and childhood atopic dermatitis: a systematic review and meta-analysis. EClinicalMedicine, 84(103296), 103296.https://doi.org/10.1016/j.eclinm.2025.103296

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Isolated CBD Dilation on Ultrasound Not Linked to Increased Choledocholithiasis Risk: Study

Researchers have found in a new study that pre-operative ultrasound showing isolated common bile duct (CBD) dilation does not increase the risk of choledocholithiasis (CD) compared to normal CBD diameter. Therefore, such findings should not influence the decision to perform an intraoperative cholangiogram during cholecystectomy. The study was published in the American Journal of Surgery by Benjamin R. and fellow researchers.

Asymptomatic choledocholithiasis symptomless stones in the common bile duct has been detected in about 5–15% of patients who undergo cholecystectomy for gallstones. Traditionally, a dilated CBD on pre-operative imaging, particularly ultrasound, has been a finding to indicate IOC during laparoscopic cholecystectomy to identify these occult stones. But the clinical significance of isolated CBD dilation dilation without other pathology has not been studied extensively. The purpose of this study was to evaluate if such isolated dilation does predict choledocholithiasis.

This was a retrospective observational study involving 341 patients who underwent laparoscopic cholecystectomy (LC) with intraoperative cholangiogram during the study period. Among these, 46 patients (13.5%) were identified as having isolated CBD dilation on pre-operative ultrasound.

CBD dilation was also termed as a diameter of ≥0.6 cm, with an additional 1 mm for each decade in patients aged more than 60 years to compensate for the changes due to aging. The researchers contrasted these 46 patients with the remaining cohort who presented with normal CBD diameter. Information gathered included demographic factors, laboratory investigations, severity of cholecystitis, complications, and readmission.

Key Findings

• Solitary CBD dilation did not significantly predict a greater risk of choledocholithiasis on IOC.

• The specificity of ultrasound-detected CBD dilation in the prediction of stones was 80.00%, but low at 25.49%.

• The PPV was 17.39% only, reflecting that a majority of patients with dilation did not have bile duct stones.

• NPV was 86.67%, i.e., patients without dilation were very unlikely to have choledocholithiasis.

• There is no difference in patient demographics, cholecystitis severity, complications, or readmission from the hospital between the dilated and non-dilated patients.

This research concludes isolated pre-operative ultrasound common bile duct dilation is not a risk factor for choledocholithiasis and should not in itself dictate the intraoperative cholangiogram’s use. These results support more individualized decision-making during intraoperative procedures and question the necessity of routine IOC based solely on CBD diameter.

Reference:

Ramser, B., Samuel, K., Pieracci, F. M., Morton, A., & Yeh, D. D. (2025). Isolated common bile duct dilation on pre-operative ultrasound is not a predictor of choledocholithiasis on intra-operative cholangiogram. American Journal of Surgery, 116478, 116478. https://doi.org/10.1016/j.amjsurg.2025.116478

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Exposure to pollution during pregnancy linked with changes in fetal brain structures: Study

Fetuses more exposed to certain air pollutants show changes in the size of specific brain structures, particularly during the second and third trimesters of pregnancy. This is the main finding of a new study led by the Barcelona Institute for Global Health (ISGlobal), a center supported by the ”la Caixa” Foundation, in collaboration with the BCNatal center (Hospital Sant Joan de Déu, Hospital Clínic, and University of Barcelona) and the Hospital de la Santa Creu i Sant Pau. It is the first study to specifically examine the association of air pollution on fetal brain development during pregnancy.

The study, published in The Lancet Planetary Health, analyzed data collected between 2018 and 2021 from 754 mother-fetus pairs participating in the BiSC (Barcelona Life Study Cohort) project in Barcelona. This study aimed to understand the association of air pollution on child health and brain development, and is considered one of the most comprehensive studies in this field.

During the third trimester of pregnancy, participants underwent transvaginal neurosonography, a specialized ultrasound that allows the analysis of fetal brain shape and structures. Exposure to nitrogen dioxide (NO₂), particulate matter (PM2.5), and black carbon was estimated with hybrid models that combine data from real measurements with advanced statistical methods. The research considered three “microenvironments”: the participants’ homes, workplaces, and commuting routes. Data on activity patterns were collected via a geolocation app installed on the participants’ mobile phones.

The research team observed that prenatal exposure to NO₂, PM2.5, and black carbon in all aforementioned microenvironments combined was associated with an increase in the volume of various brain cavities that contain cerebrospinal fluid. Specifically, direct associations were identified between exposure to these pollutants and increased volume of the lateral ventricles, located in each brain hemisphere, as well as an enlargement of the cisterna magna, a cavity located at the lower part of the brain. An increase in the width of the cerebellar vermis-the central part of the cerebellum, essential for balance and motor coordination— was also detected.

The study results also showed an association between higher exposure to black carbon and a reduction in the depth of the lateral sulcus (also known as the Sylvian fissure), a deep groove that runs through the brain, which might suggest less maturation of the brain.

The associations between exposure to air pollution and changes in the morphology of these brain structures were stronger during the second and third trimesters of pregnancy. “During mid to late gestation, the fetal brain enters a key phase of its development, making it particularly vulnerable to external factors such as pollution,” explains Payam Dadvand, ISGlobal researcher and a senior author of the study.

“As clinicians, we are now seeing compelling evidence that even in pregnancies that appear healthy by all conventional measures, factors such as air pollution can subtly affect fetal brain development. These findings underline the importance of increased awareness and education, both within the health community and across society,” say Elisa Llurba and Lola Gómez-Roig, clinicians at the Hospital de Sant Pau and BCNatal-Hospital Sant Joan de Déu, respectively, and co-authors of the study.

Significant Differences at the Population Level

The observed effects do not imply that the children participating in the BiSC project have pathological brain alterations. In fact, all measurements of the participants’ brain structures are within the range considered normal. “The point is that these differences, although small at the individual level, are indeed relevant from a population perspective, as they inform us about how pollution affects the fetal brain and its vulnerability to environmental exposures,” says Laura Gómez-Herrera, ISGlobal researcher and co-lead author of the study.

The research team emphasizes the need for further studies to confirm these findings and track their potential consequences over time. “At this stage, we can only report having observed differences in the brains of fetuses with higher exposure to pollution compared to those with lower exposure. Additional research is needed to determine whether these effects are reversible after birth or if they persist, and whether they have any implications for neurodevelopmental outcomes in later stages,” emphasizes Jordi Sunyer, a senior author of the study.

Despite the uncertainties that remain, this study could have significant implications for public health policy. “Our findings strengthen the evidence supporting the need to reduce pregnant women’s exposure to air pollution, particularly in urban settings,” says Yu Zhao, ISGlobal researcher and co-lead author of the study.

Reference:

Gómez-Herrera, Laura et al., Air pollution and fetal brain morphological development: a prospective cohort study, The Lancet Planetary Health, DOI:10.1016/S2542-5196(25)00093-2 

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MetALD, ALD Linked to Higher Liver Risks and Mortality in Steatotic Liver Disease: Study Shows

USA: A large cohort study published in JAMA Internal Medicine has revealed that adults with alcohol-associated forms of steatotic liver disease face significantly higher risks of liver complications and mortality compared to those with metabolic-associated steatotic liver disease (MASLD). The study, led by Dr. Pedro Ochoa-Allemant and colleagues from the University of Pennsylvania, sheds light on how different subtypes of liver steatosis influence long-term health outcomes.

“MetALD and ALD subtypes of steatotic liver disease showed higher liver complications (HR 1.56 and 2.33) and mortality (HR 1.42) vs MASLD, while cardiovascular risks were similar. Advanced fibrosis raised liver risks over 10-fold across all subtypes,” the researchers reported.

Steatotic liver disease, a growing global contributor to advanced liver disease, encompasses several subtypes, including MASLD, alcohol-associated liver disease (ALD), and a combined category termed MetALD (metabolic dysfunction and alcohol-associated liver disease). While prior studies have generally grouped these patients, the new analysis provides a clearer understanding of subtype-specific risks.

The retrospective study included over 341,000 adults with imaging-confirmed hepatic steatosis, all receiving outpatient care through the US Veterans Health Administration between 2010 and 2021. Patients were followed for a median of 5.5 years to track adverse liver outcomes—such as cirrhosis, liver failure, hepatocellular carcinoma, liver transplants, or liver-related deaths—as well as major adverse cardiovascular events (MACE) and all-cause mortality.

The study revealed the following findings:

  • 77.3% of patients had MASLD, 17.9% had MetALD, and 4.8% had ALD.
  • Liver-related complication rates were higher in MetALD (1.12 per 100 person-years) and ALD (1.78 per 100 person-years) compared to MASLD (0.61 per 100 person-years).
  • All-cause mortality was elevated in MetALD (HR 1.08) and ALD (HR 1.42) groups compared to MASLD.
  • Cardiovascular event rates were similar across MASLD, MetALD, and ALD subtypes.
  • Advanced liver fibrosis, reflected by higher Fibrosis-4 (FIB-4) scores, was linked to a tenfold increase in liver-related complications across all subtypes.
  • ALD patients with high FIB-4 scores had a liver event rate of 5.05 per 100 person-years.
  • Severe alcohol use, alcohol use disorder, and diabetes were the strongest risk factors for adverse liver outcomes.

The study’s results emphasize the clinical value of assessing alcohol use and liver fibrosis in patients with hepatic steatosis. “Recognizing the nuanced risks associated with different subtypes of steatotic liver disease is critical,” the authors note, as it can help target those patients who may benefit most from closer monitoring and early interventions.

The authors concluded, “Overall, this study highlights the need for more personalized approaches in managing patients with fatty liver disease, particularly those with coexisting metabolic and alcohol-related risk factors.”

Reference:

Ochoa-Allemant P, Hubbard RA, Kaplan DE, Serper M. Adverse Liver Outcomes, Cardiovascular Events, and Mortality in Steatotic Liver Disease. JAMA Intern Med. Published online June 16, 2025. doi:10.1001/jamainternmed.2025.1809

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Aloe Vera useful and Viable Pre-Treatment in Endodontics, suggests research

Researchers have found in a new research that Aloe vera solution can serve as an effective alternative pre-treatment before cementing fiberglass posts using conventional dual-cure resin cement in endodontically treated dentin.

This study evaluated the effects of mechanical agitation of Aloe vera Barbadensis Miller solution at different concentrations using passive ultrasonic irrigation (PUI), XP Endo Finisher (XPF), XP Clean (XPC), and Easy Clean (ECL), compared to conventional endodontic irrigation (CIE), on bond strength and adhesive failure patterns in the cervical, middle, and apical thirds of the root canal. Aloe vera solutions at 1%, 3%, and 5% were tested to reverse collagen fiber collapse induced by hypochlorous acid, a free radical released by 2.5% sodium hypochlorite, which impairs dentin hybridization and the light curing of resin cement. Fiberglass posts were cemented using an etch-and-rinse adhesive system (Ambar; FGM) and conventional dual resin cement (Allcem Core) in root dentin across all thirds. Human teeth underwent chemical–mechanical preparation, and the Aloe vera solution was agitated using the CIE, PUI, XPF, XPC, or ECL protocols. Slices from each root third were evaluated under a stereomicroscope at 10× magnification and subjected to the push-out test. Cytotoxicity was assessed by applying various Aloe vera concentrations to stem cells from the apical papilla (SCAPs) for 24 h, followed by analysis of cell metabolism (Alamar Blue), viability (Live/Dead), and proliferation (F-actin). Aloe vera demonstrated significant biological activity and enhanced bond strength, particularly at 3% and 5%, irrespective of the agitation method or root third. Thus, it can be concluded that using Aloe vera solution is an alternative for pre-treatment before the cementation of fiberglass posts with conventional dual-cure resin cement in endodontically treated dentin.

Reference:

Galvani, L. D., Bordini, E. A. F., Soares, D. G., Costa, J. L. d. S. G., Verbicário, J. R., Guastaldi, F. P. S., Kuga, M. C., & Vaz, L. G. (2025). Aloe Vera as an Adjunct in Endodontic Irrigation: Impact on Dentin Bond Strength and Cytotoxicity. Materials, 18(12), 2874. https://doi.org/10.3390/ma18122874

Keywords:

Aloe Vera , useful, Viable, Pre-Treatment, Endodontics, suggests research, adhesion; fiber post; aloe vera; bond strength; biocompatible materials; cell survival, Galvani, L. D., Bordini, E. A. F., Soares, D. G., Costa, J. L. d. S. G., Verbicário, J. R., Guastaldi, F. P. S., Kuga, M. C., & Vaz, L. G.

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PCKP has less risk of cement leakage than UPKP in treatment of vertebral compression fractures: study

Osteoporotic vertebral compression fractures (OVCFs) have become a significant public health concern due to the high morbidity and limited efficacy of conservative treatment. Conventional unilateral percutaneous vertebral kyphoplasty (UPKP) is beset by technical limitations, including the uneven distribution of cement and the inherent risk of leakage. Conversely, percutaneous curved kyphoplasty (PCKP) involves the creation of an accessible contralateral bone tunnel through a curved bone auger, a technique that, in theory, optimizes cement distribution. However, the clinical benefits of PCKP remain a subject of debate.

Yang Fuguo et al conducted a study to prospectively compare the difference in near- and midterm efficacy between PCKP and UPKP for the treatment of single-segment OVCFs, and to clarify the clinical value of PCKP.

A total of 89 patients with single-segment OVCFs were divided into two groups: the PCKP group (n = 43) and the UPKP group (n = 46). At the 12-month follow-up, pain visual analog scores (VAS, Oswestry Dysfunction Index (ODI)) and cement distribution were assessed preoperatively, at 2 days, 3 months, and 12 months postoperatively. The duration of surgery was recorded, as were the number of fluoroscopy, bone cement dose, and complications. Compare the two sets of parameters.

Key findings of the study:

(1) Functional improvement: the VAS score and ODI of patients in PCKP group was better than that of UPKP group at 2 days postoperatively (P < 0.05), and there was no statistically significant difference between the VAS score and ODI of the two groups at the rest of the follow-up points (P > 0.05).

(2) Bone cement: the amount of cement used in the PCKP group was significantly more than that in the UPKP group (P < 0.05), and the rate of excellent distribution and leakage rate were better (P < 0.05).

(3) Vertebral recovery: the degree of recovery of the height of the anterior margin of the vertebral body was similar between the two groups (P > 0.05).

(4) Complications: there was no difference in the rate of re-fracture (P > 0.05), and the risk of leakage was lower in the PCKP.

The authors concluded – “Both PCKP and UPKP can effectively treat single-segment OVCFs, but PCKP achieves better control of spatial distribution of cement through curved bone drilling technique and significantly reduces the risk of leakage, especially for patients with moderate and severe fractures, and PCKP has more advantages in early pain relief, but near- and intermediate term follow-up shows that the efficacy of the two converge.”

Further reading:

Comparison of near‑ and midterm outcomes of two unilateral percutaneous translaminar vertebral kyphoplasty procedures for the treatment of single‑segment OVCF: a single‑center randomized controlled study

Yang Fuguo et al

European Journal of Orthopaedic Surgery & Traumatology (2025) 35:142

https://doi.org/10.1007/s00590-025-04241-4

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Study finds that common bacteria in the mouth can help predict the progression of head and neck cancer

For decades, oral healthcare has mainly focused on preventing cavities and gum disease. However, scientific research has increasingly highlighted the importance of the oral microbiome – a set of microorganisms that naturally inhabit the oral cavity. Recent studies have shown links between imbalances in this microbial ecosystem and the development of head and neck cancers, as well as a growing body of evidence associating it with colorectal cancer.

Fusobacterium nucleatum is one of the microbial species that has attracted the most attention from the scientific community. It is a bacterium that is normally found at low levels in the oral flora of healthy individuals. However, its uncontrolled proliferation has been associated with inflammatory diseases, such as periodontitis, and other oral health issues. More recently, it has been linked to an increased risk of developing malignant tumors in other parts of the body.

A few years ago, researchers from the Hospital de Amor (formerly the Barretos Cancer Hospital) in the state of São Paulo became interested in the association of F. nucleatum with tumors and began studying its role in colorectal cancer. Recently, with support from FAPESP and other funding agencies, the group expanded its research to investigate its potential role in head and neck tumors. They discovered that the presence of the bacteria is associated with a better prognosis and longer survival in these cases. The results were published in the Journal of Oral Microbiology.

The study, led by Rui Manuel Reis, scientific director of the Teaching and Research Institute at Hospital de Amor, used an ultrasensitive methodology (digital PCR) to detect the presence of F. nucleatum in tumor tissue. The researchers analyzed 94 samples from patients with different types of head and neck cancer who were treated at the institution.

“We performed the intratumoral analysis using paraffin-embedded archival material that was initially used for the diagnosis of these patients,” Reis explains. “Using more traditional methodologies, it’d be difficult to identify the presence of this bacterium with the same precision in degraded material such as paraffin. However, the ultra-sensitive PCR technique offers high reliability and sensitivity – even minimal traces of bacterial DNA can be detected,” he points out.

According to the researcher, the difference was detecting the bacteria inside the tumor cells, a surprising finding. “If we analyze a person’s saliva, we’re likely to find this bacterium since it’s normally present in the oral cavity and makes up the dental biofilm. What we didn’t expect, however, was for it to be located within the tumor microenvironment,” Reis points out.

Better prognosis

Over the course of approximately five years, the researchers monitored the patients’ clinical data and found that the presence of F. nucleatum in the tumors was associated with a more favorable prognosis. The bacterium was identified in 59.6% of cases, with a higher prevalence in oropharyngeal tumors (62.1%) than in tumors of the oral cavity (53.6%).

Patients whose tumors contained the bacteria had an average survival rate of 60 months, while those without the bacteria lived an average of 36 months – a significant difference. “We didn’t expect this result because, in other types of cancer such as colorectal cancer, the presence of these bacteria is usually associated with greater aggressiveness and lower survival,” says Reis.

Despite this promising finding, researchers still do not fully understand why the presence of F. nucleatum is associated with a better prognosis in head and neck cancer cases. One hypothesis is that the bacterium regulates immune factors, boosting the immune system’s response and making the tumor less aggressive. “We don’t have this answer yet, but we’re going to investigate further. That’ll be the next step,” says the researcher.

Another line of study will seek to understand whether the presence of F. nucleatum in tumors influences the response to therapies. This could pave the way for more personalized approaches to treating these patients. If confirmed, F. nucleatum could become an important biomarker for head and neck cancer prognosis.

“We showed that even using old material and in small quantities, we were able to detect this bacterium. In other words, if it’s validated as a biomarker in the future, we already have an effective technique for identifying it in tumor tissue,” Reis points out.

A possible oncobacterium?

According to Reis, analyzing the oral microbiome is becoming essential to understanding modern oncology. “Rather than presenting a definitive result, this pioneering study draws attention to the relevance of this bacterium in tumor development, not just oral disease,” Reis said.

This is just the beginning of a new line of research. “This bacterium is emerging as an important modulator in the context of cancer and could solidify the use of the term ‘oncobacterium,’” Reis says. “If proven to be involved in the origin of cancer, antibiotics could be considered a complementary therapy to chemotherapy and radiotherapy.”

Future research could reveal whether the presence of F. nucleatum is related to different treatment responses, paving the way for more personalized strategies. With this knowledge, we will be able to more precisely identify which therapies are potentially most effective for each type of cancer based on the presence or absence of the bacterium.

The disease in Brazil

Head and neck cancer is a group of malignant tumors that can appear in the mouth, oropharynx, larynx, nose, sinuses, nasopharynx, eye socket, neck, and thyroid. According to the National Cancer Institute (INCA), the main risk factors are smoking, alcoholism, HPV infection, poor oral hygiene, and malnutrition.

INCA data shows that approximately 80% of cases diagnosed in Brazil between 2000 and 2017 were identified in advanced stages, significantly reducing the chances of successful treatment. These figures underscore the importance of strategies for early diagnosis and the development of new prognostic tools, as discussed in this study.

Reference:

Datorre, J. G., dos Reis, M. B., Sorroche, B. P., Teixeira, G. R., Hatano, S. S., de Carvalho, A. C., … Reis, R. M. (2025). Intratumoral Fusobacterium nucleatum is associated with better cancer-specific survival in head and neck cancer patients. Journal of Oral Microbiology, 17(1). https://doi.org/10.1080/20002297.2025.2487644

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New USC study links wildfire smoke exposure and heat stress to adverse birth outcomes

Exposure to wildfire smoke and heat stress can negatively affect birth outcomes for women, especially in climate-vulnerable neighborhoods, according to a recent study led by USC postdoctoral researcher Roxana Khalili, PhD. The investigation, just published in Environmental Science & Technology, is one of the first to show that living in areas more susceptible to the harmful effects of climate-related exposures can significantly alter the effects of heat stress on adverse birth outcomes, even among women exposed to these conditions in the month before becoming pregnant.

“We already know that poor air quality is associated with adverse health outcomes and that pregnant women and fetuses are especially vulnerable,” said Khalili, a researcher in the department of population and public health sciences at the Keck School of Medicine of USC and lead author of the study. “Our knowledge about the specific effects of wildfire smoke during pregnancy has been limited. We know even less about the impact of these hazards right around or before conception.”

Khalili worked alongside Rima Habre, director of USC’s CLIMA Center to explore the associations between exposure to wildfire smoke and heat stress on infant health. They used data from the MADRES cohort (Maternal and Developmental Risks from Environmental and Social Stressors), an ongoing study of pregnant women in Los Angeles.

“Where you live makes a difference in your health,” said Khalili. “So does the timing of your exposure during or immediately before pregnancy. We wanted to better understand how these risks might differ for women who lived in neighborhoods that experience more climate related stressors and have fewer resources to deal with them.”

Measuring exposure

The research team examined 713 births among MADRES participants between 2016 and 2020. They used data from CalFIRE (California Department of Forestry and Fire Protection) to identify the location, size, and duration of every wildland fire in southern California during the study period. They used the NOAA hazard mapping system to calculate the smoke density from each fire and applied sophisticated modeling methods to calculate ground-level smoke concentrations, estimating how much particle pollution—tiny droplets of black carbon, soot, and burned vegetation—the women in the cohort were exposed to during these events based on their daily residential location histories.

Heat stress is another risk factor for pregnant women and fetuses, partly because pregnancy impedes a woman’s ability to regulate body temperature. To measure heat stress exposures in study participants, Khalili and her colleagues used meteorological data documenting the daily temperature, relative humidity, and wind speed. They also factored in a separate measurement that takes into account sun angle and cloud cover to gauge heat stress in direct sunlight, providing a better measure of how hot a given day feels when outdoors.

Next, the team pinpointed those LA neighborhoods that are most vulnerable to climate risks with mapping data from the California Urban Heat Island Index and the US Climate Vulnerability Index, two geospatial tools that analyze and map layers of data. These tools allow researchers to conduct deeper, more nuanced analyses that better assess the cumulative impacts of factors ranging from excessive heat and wildfire smoke to socioeconomic conditions.

Where there’s smoke…

The researchers found that greater exposure to wildfire smoke and excessive heat during the month before conception and the first trimester of pregnancy was associated with greater odds of having a small-for-gestational-age (SGA) baby. An infant is considered SGA if their birth weight is below the 10th percentile of their expected weight based on their gestational age. SGA places an infant at greater risk of health problems, from immediate complications at birth such as low oxygen levels to long-term challenges, including potential metabolic, cognitive and neurodevelopmental impairments. The team also found an association between pregnant women exposed to moderate smoke-density days in the first trimester and having a low-birth-weight baby, or an infant weighing less than five pounds, eight ounces. Like SGA, low birth weight is linked to an array of potential health problems, both short and long term.

“Overall, we found consistent associations between increased exposure to wildfire smoke and heat stress during preconception and the first trimester with the odds of having an SGA infant,” Khalili said.

The study also suggested that living in a climate-vulnerable neighborhood could increase the odds of an SGA birth, particularly for women exposed to heat stress during preconception. For women living in the most climate-vulnerable neighborhoods, the study showed the effect of heat stress during preconception on the likelihood of an SGA birth almost doubled.

Khalili and her colleagues also found that Fenton Z-scores, which measure how much an infant’s size deviates from the average for their age, significantly decreased with more days of wildfires experienced during pregnancy. These findings are particularly relevant given the longer-lasting fire events that Los Angeles experienced in January 2025 and that many cities across the US are currently facing.

“Understanding what’s happening to women during wildfires and excessively hot days could help us identify protective measures, develop guidance, and plan interventions,” said Khalili.

Given how frequent and long California’s wildfire seasons are expected to become, such interventions are urgently needed. But these need to go beyond simple measures an individual can take – like staying indoors, running air filters or air conditioners-to truly understanding and addressing what makes a community more resilient to these impacts.

Habre, who developed and oversaw the project, agrees that the study breaks new ground-and also that more holistic, actionable research is needed.

“As the recent Los Angeles fires have demonstrated, infrastructure, socioeconomic, and health vulnerabilities can combine with excessive climate and environmental factors to magnify health risks,” said Habre. “It is only by looking at the cumulative impacts of burdens communities are facing, now and into the future, that we can start to truly quantify health risks of climate hazards and target interventions to strengthen community resilience.”  

Reference:

Roxana Khalili, Yisi Liu, Yan Xu, Adverse Birth Outcomes Associated with Heat Stress and Wildfire Smoke Exposure During Preconception and Pregnancy, Environmental Science & Technology, DOI: 10.1021/acs.est.4c10194.

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Botox mitigates debilitating dry mouth in prostate cancer patients receiving radiopharmaceutical therapy: Study

A dual-protective approach using botulinum toxin (Botox) alongside an anti-nausea patch significantly reduces salivary gland toxicity in patients with metastatic prostate cancer undergoing PSMA-targeted radiopharmaceutical therapy.

The strategy led to a 30 percent decrease in PSMA uptake by the salivary glands without affecting the treatment’s cancer-fighting efficacy. This reduction may enhance treatment adherence and improve overall patient outcomes. The findings were presented at the Society of Nuclear Medicine and Molecular Imaging 2025 Annual Meeting.

Salivary gland toxicity from radiopharmaceutical therapy—particularly from alpha-emitting therapies like 225Ac-PSMA—is a critical dose-limiting side effect, often leading to debilitating dry mouth. Prior attempts to alleviate dry mouth using cold packs, single anticholinergics, or external cooling have shown minimal protective benefit.

“In order for patients to maintain a good quality of life and continue with their treatments, it’s essential to address these serious dry mouth issues,” said Tianzhi Zhao, research assistant at the Theranostics Centre of Excellence in the Yong Loo Lin School of Medicine at the National University of Singapore. “Our study explored the use of Botox paired with a nausea patch on reducing radiation uptake to the salivary glands.”

Fourteen patients were enrolled in the study and received Botox injections in the parotid and submandibular glands on opposite sides of the body three to four weeks prior to their combined 225Ac- and 177Lu-PSMA radiopharmaceutical therapy. Three days before treatment, nausea patches were applied behind the ears where they remained until two hours after the treatment. Molecular imaging was performed pre- and post-treatment to measure salivary gland uptake.

A significant reduction in PSMA radioligand uptake in the salivary glands was observed. Botox-treated parotid glands showed a mean 30 percent reduction in PSMA uptake compared to the opposite parotid gland. A mean 17 percent reduction in PSMA uptake was observed in injected submandibular glands compared to the opposite submandibular glands. The injections were well tolerated, with patients reporting mild injection pain but no serious or systemic side effects. No patient discontinued PSMA therapy due to dry mouth.

“This study demonstrates that Botox, administered at recommended doses in combination with a nausea patch, offers a promising therapeutic strategy for reducing radiation-induced salivary gland toxicity without compromising PSMA tumor uptake,” stated Jingjing Zhang, MD, PhD, assistant professor at the Theranostics Centre of Excellence in the Yong Loo Lin School of Medicine at the National University of Singapore. “The significance of this work lies in its direct patient benefit and its potential to expand the therapeutic utility of PSMA radiopharmaceutical therapy, particularly with alpha-emitting radionuclides like 225Ac.”

Both Botox and nausea patches are FDA-approved medications, already available in clinical practice for other indications. As this approach leverages approved medications with established safety profiles, this strategy could be immediately applied in experienced centers offering PSMA radioligand therapy.

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