Culture

DENVER, CO - A new editorial accompanying a study published in the Journal of the American College of Cardiology is bringing attention to the underappreciated and often overlooked issue of malnutrition among those who are obese. Malnutrition is defined as faulty nutrition due to inadequate or unbalanced intake of nutrients. It is often incorrectly perceived as an illness that primarily affects those who are underweight, yet a recent study examining acute coronary disease (ACD) found malnourishment is an important underlying factor in the disease. In fact, about half of those found to be malnourished were overweight or obese.

"Malnutrition is a largely under-recognized and undertreated condition in patients with increased body mass index, as increased abdominal girth is too often mistaken for overnutrition rather than undernutrition," said Andrew Freeman, MD, director of cardiovascular prevention and wellness at National Jewish Health and co-author of the editorial. "It's important to dispel the thought that weight is correlated with food quality and that obese patients are not at risk of malnutrition."

The ACD study is just the latest evidence that underscores the prevalence of malnutrition among obese individuals and how it contributes to serious health complications. In fact, the World Health Organization reports that malnutrition affects more than four times more overweight or obese individuals than those who are underweight.

"It is imperative that individuals undergo nutritional assessments and are offered counseling and resources to ensure they are taking in the right nutrients to adequately fuel their body," Dr. Freeman said. "If left untreated, malnutrition leads to serious health conditions including diabetes, hypertension and heart disease."

While it is well-documented in the scientific community that malnutrition causes these health concerns, obese patients who are seen for these conditions often do not undergo nutritional screening, especially in cardiology. Recognizing that overweight patients often have poor diet quality can help shift the conversation in the patient-physician visit toward improving nutritional status.

"Paying lip service with the usual phrases, such as 'Be sure to exercise and eat right,' simply doesn't cut it. It behooves us as a profession to ensure adequate training and competency in the delivery of care in the lifestyle space," Dr. Freeman said. "Clinicians should be well-versed in the dietary patterns known to reduce or even reverse cardiovascular disease, as well as physical activity guidelines and self-care practices such as stress relief, mindfulness and good, quality sleep."

Monitoring each of these lifestyle components can lead to marked improvements in many chronic diseases. This new paper highlights an urgent call to action: it is time for the medical community to arm itself with the most cost effective and powerful tool in the battle against heart disease and other common health conditions: nutrition and lifestyle medicine.

Studies have previously shown that eating whole grains, legumes, fruits, vegetables, nuts, and seeds are beneficial in reducing blood pressure, blood glucose, cholesterol and inflammatory markers. Treatment of at-risk patients must include counseling on how to shift toward a diet that is rich in these healthier food options. In fact, many hospitalizations for life-threatening events can be valuable teaching moments to truly affect care and change treatment trajectories.

Long after a COVID-19 vaccination is developed and years after the coronavirus death toll is tallied, the impact on mental health will linger, continuing to inflict damage if not addressed, according to new research. Michael Zvolensky, University of Houston Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of Psychology and director of the Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, has published two papers discussing the psychological, addictive and health behavior issues related to the COVID-19 pandemic from a behavioral science perspective.

"The impact of COVID-19 on psychological symptoms and disorders, addiction and health behavior is substantial and ongoing and will negatively impact people's mental health and put them at greater risk for chronic illness and drug addiction," reports Zvolensky in Behaviour Research and Therapy. "It will not equally impact all of society. Those at greater risk are those that have mental health vulnerabilities or disorders."

For instance, those who 'catastrophize' the pandemic amplify the actual stress impact, increasing their symptoms and creating the possibility for substance abuse.

"That sets in motion a future wave of mental health, addiction and worsening health problems in our society. It's not going to go away, even with a vaccination, because the damage is already done. That's why we're going to see people with greater health problems struggling for generations," said Zvolensky

Zvolensky offers a model of how the COVID-19 stress burden may be associated with addictive problems and health behaviors, and how these may be associated with later chronic illness and psychological problems.

In Psychiatry Research, Zvolensky presents findings linking worry and fear about the pandemic to drug use and abuse.

Zvolensky evaluated a group of 160 participants to find if COVID-19-related worry and fear differed between substance abstainers, pre-COVID-19 users and those who initiated drug use for the first time during the pandemic.

"Results generally suggest the persons using substance experience the highest levels of COVID-19-related worry and fear," said Zvolensky. "Additionally, worry about COVID-19 is related to coping motives for substance use."

These results provide preliminary evidence that COVID-19-related worry and fear may be putative risk factors for substance use initiation in the face of COVID-19, and these results may provide critical clinical information for helping individuals cope with this pandemic," he said.

A team of researchers in the United States and Japan reports that spinal cord stimulation (SCS) measurably decreased pain and reduced motor symptoms of Parkinson's disease, both as a singular therapy and as a "salvage therapy" after deep brain stimulation (DBS) therapies were ineffective.

Writing in the September 28, 2020 issue of Bioelectronic Medicine, first author Krishnan Chakravarthy, MD, PhD, assistant professor of anesthesiology at University of California San Diego School of Medicine, and colleagues recruited 15 patients with Parkinson's disease, a neurodegenerative disorder that is commonly characterized by physical symptoms, such as tremors and progressive difficulty walking and talking, and non-motor symptoms, such as pain and mental or behavioral changes.

The mean age of the patients was 74, with an average disease duration of 17 years. All of the patients were experiencing pain not alleviated by previous treatments. Eight had undergone earlier DBS, a non-invasive, pain therapy in which electrical currents are used to stimulate specific parts of the brain. Seven patients had received only drug treatments previously.

Researchers implanted percutaneous (through the skin) electrodes near the patients' spines, who then chose one of three types of electrical stimulation: continuous, on-off bursts or continuous bursts of varying intensity.

Following continuous programmed treatment post-implantation, the researchers said all patients reported significant improvement, based on the Visual Analogue Scale, a measurement of pain intensity, with a mean reduction of 59 percent across all patients and stimulation modes.

Seventy-three percent of patients showed improvement in the 10-meter walk, a test that measures walking speed to assess functional mobility and gait, with an average improvement of 12 percent.

And 64 percent of patients experienced improvements in the Timed Up and Go (TUG) test, which measures how long it takes a person to rise from a chair, walk three meters, turn around, walk back to the chair and sit down. TUG assesses physical balance and stability, both standing and in motion. Average TUG improvement was 21 percent.

The authors said the findings suggest SCS may have therapeutic benefit for patients with Parkinson's in terms of treatment for pain and motor symptoms, though they noted further studies are needed to determine whether improved motor function is due to neurological changes caused by SCS or simply decreased pain.

"We are seeing growing data on novel uses of spinal cord stimulation and specific waveforms on applications outside of chronic pain management, specifically Parkinson's disease," said Chakravarthy, pain management specialist at UC San Diego Health. "The potential ease of access and implantation of stimulators in the spinal cord compared to the brain suggests that this is a very exciting area for future exploration."

Irvine and Pasadena, CA - Sept. 28, 2020 - Early results of an experimental vaping study have shown significant lung injury from E-cigarette (eC) devices with nickel-chromium alloy heating elements. The findings were consistent, with or without the use of nicotine, vitamin E oil or tetrahydrocannabinol (THC), which have previously been thought to contribute to the life-threatening respiratory problem.

The early results, published in the Journal of the American Heart Association by researchers from the University of California, Irvine (UCI) School of Medicine and the Huntington Medical Research Institutes (HMRI), were observed during a larger study designed to explore the effect of e-cigarette and other vaping product use on the cardiovascular system. While conducting experiments, researchers observed eC or vaping product use-associated lung injury (EVALI) immediately after switching from a vaping device with a stainless steel heating element, to one that used nickel-chromium alloy (NC).

"The results were so impactful, we felt it imperative to release the initial findings early so that electronic cigarette users could be cautioned sooner, especially considering E-cigarette users are at increased risk of COVID-19," stated senior author Robert A. Kloner, MD, PhD, chief science officer for HMRI and professor of medicine at USC.

The switch in devices occurred in September 2019, when the eC device the team was using went off market and a substitute device was offered as an alternative. The new device was physically compatible with the original exposure system, but the heating element changed from stainless steel (SS) to a nickel?chromium alloy (NC).

"Within an hour of beginning an experiment, we observed evidence of severe respiratory distress, including labored breathing, wheezing and panting," said Michael Kleinman, PhD, professor of occupational and environmental medicine at UCI School of Medicine and member of the UCI Center for Occupational and Environmental Health. "After analyzing lung tissue from subjects in the study, we found them to be severely compromised and observed other serious changes such as lung lesions, red blood cell congestion, obliteration of alveolar spaces, and pneumonitis in some cases."

The current research aimed to study the impacts of breathing in E-cigarette vapors on heart function in a well- established pre-clinical experimental model. Over the course of nearly a year, none of the subjects exposed to vapors from the stainless steel devices, both with and without additives, contracted respiratory distress and only one showed a less than 10% area of inflammation in the lungs. Once the new eC device was introduced, affected subjects showed severe respiratory distress, with labored breathing, wheezing and panting. The lung injury occurred without nicotine, THC, or Vitamin E additives; and may also have been related to higher wattage of power settings on the E-cigarette devices. These preliminary studies will be followed up with additional future studies to systematically try to determine the cause of the lung problem.

"While further research is needed, these results indicate that specific devices and power settings may play a key role in the development of EVALI as much as the additives do," said Kloner. "The harms associated with E-cigarettes and vaping simply cannot be overstated."

Vaping has been proven to cause increased blood pressure, endothelial dysfunction, and the risk of myocardial infarction and stroke. Heating elements in commercially available eC are usually made of stainless steel, nickel?chromium or nichrome, Kanthal nickel, or titanium.

A condition, which was dubbed "E?cigarette or vaping product use-associated lung injury" (EVALI) was recognized in the United States in June 2019 and peaked in September 2019. In March 2020, there were 2,800 US cases of EVALI and 68 deaths reported. Patients were typically found to be young males and users of E-cigarettes or vaping products whose CT scans revealed lung inflammation and injury. Of note, EVALI can mimic many of the features of COVID-19 pneumonia.

WOODS HOLE, Mass. -- The dialogue between neurons is of critical importance for all nervous system activities, from breathing to sensing, thinking to running. Yet neuronal communication is so fast, and at such a small scale, that it is exceedingly difficult to explain precisely how it occurs. A preliminary observation in the Neurobiology course at the Marine Biological Laboratory (MBL), enabled by a custom imaging system, has led to a clear understanding of how neurons communicate with each other by modulating the "tone" of their signal, which previously had eluded the field. The report, led by Grant F. Kusick and Shigeki Watanabe of Johns Hopkins University School of Medicine, is published this week in Nature Neuroscience.

In 2016 Watanabe, then on the Neurobiology course faculty, introduced students to the debate over how many synaptic vesicles can fuse in response to one action potential (see this 2-minute video for a quick brush-up on neurotransmission). To probe this controversy, they used a "zap-and-freeze" imaging technology conceived by co-authors M. Wayne Davis, Watanabe and Erik Jorgensen, and built by Leica for testing in the Neurobiology course. They zapped a neuron with electricity to induce an action potential, then quickly froze the neuron and took an image. They saw multiple vesicles fusing at once at many synapses, the first novel finding of this Nature Neuroscience report.

But there was more. Back at Johns Hopkins, Kusick and Watanabe decided to walk through the neurotransmission process with zap-and-freeze, taking images every 3 milliseconds after the action potential. That's when they found an answer to an even larger question - how do neurons change the tone of their neurotransmission signal?

At any given time, only a few synaptic vesicles are in "docked" position, meaning loaded and ready to release neurotransmitter. Immediately after an action potential, the number of docked vesicles decreases by 40 percent, so after 2 to 3 action potentials, the docked vesicles would be depleted. (That is, their signal or "voice" would become weaker and weaker, as more action potentials are induced.) But they found that, within 14 milliseconds following an action potential, new vesicles are swiftly recruited to the docked pool that can fuse and release neurotransmitter, and this recruitment is transient such that neurotransmission can be strong or weak on a millisecond time scale. This is the first close-up look at neural communication that adds up from a temporal perspective.

"What this means is that we have identified a mechanism that neurons use to communicate through intonations," Watanabe says. "Each docked vesicle is like a word that neurons can use for communication at any given moment. It has been known for decades that neurons can speak more than a few words at a time, and they can also change the tone of these words. The question was how. We've shown that neurons continuously bring in more words, but by simply changing the number of vesicles, they can raise or lower the voice. If you are asking a question, you will raise the intonation at the end of a sentence - neurons do so by changing the number of docked vesicles ready to go."

The "zap and freeze" electron microscopy technology is the 21st-century version of the "freeze slammer" developed by John Heuser, Tom Reese et al., and used at MBL nearly 50 years ago to demonstrate how neurons communicate with each other.

The emergence of jaws in primitive fish allowed vertebrates to become top predators. What is less appreciated is another evolutionary innovation that may have been just as important for the success of early vertebrates: the formation of covers to protect and pump water over the gills. In a new study published in the Proceedings of the National Academy of the Sciences (PNAS), USC Stem Cell scientists and their collaborators have identified a key modification to the genome that led to the evolution of gill covers more than 430 million years ago.

The scientists started by creating zebrafish with mutations in a gene called Pou3f3. Strikingly, fish lacking this gene, or the DNA element controlling its activity in the gills, failed to form gill covers. Conversely, zebrafish producing too much Pou3f3 developed extra rudimentary gill covers.

Intrigued by these findings, co-corresponding authors Gage Crump and Lindsey Barske collaborated with scientists from several universities to explore whether changes in Pou3f3 might account for the wide variation in gill covers across vertebrates. Crump is a professor of stem cell biology and regenerative medicine at the Keck School of Medicine of USC. Barske initiated the study in the Crump Lab, and is now an assistant professor at Cincinnati Children's Hospital Medical Center.

In jawless fish such as sea lampreys, which lack gill covers, the scientists found that the control element to produce Pou3f3 in the gill region is missing.

In contrast, in cartilaginous fish such as sharks and skates, the control element for Pou3f3 is active in all gills. Correspondingly, nearly all cartilaginous fish have a separate cover over each gill. In bony fish, including zebrafish, the control element produces Pou3f3 in one particular region, leading to a single cover for all gills.

"Remarkably, we have identified not only a gene responsible for gill cover formation," said Crump, "but also the ancient control element that allowed Pou3f3 to first make gill covers and then diversify them in cartilaginous versus bony fish."

Barske and Crump even showed that humans retain this control element, reflecting the presence of gill cover-like structures in human embryos that are inherited from our distant fish ancestors.

Newly released study results present a strong case for lung cancer screening in New Zealand - particularly for Māori whose mortality rates are between three and four times higher than other ethnic groups.

Around 450 Māori are diagnosed with lung cancer each year and approximately 300 die from it.

Waitematā and Auckland DHBs have collaborated with University of Otago researchers on a study to assess whether low dose computerised tomography (LDCT) might be a cost-effective way to catch the disease in its early stages and improve health outcomes for Māori and, ultimately, other ethnic groups.

LDCT is a computerised x-ray that produces very clear three dimensional images by using only a small amount of radiation.

The study, led by Associate Professor Sue Crengle (Kāi Tahu, Kāti Mamoe, Waitaha) from the University of Otago and just published online by medical journal BMJ Open, used scientific modelling to estimate the benefits and costs of LDCT screening in a high-risk population.

Multiple factors need to be considered before any kind of screening programme goes ahead but an answer to the question of cost-effectiveness is a significant step forward.

"Having clarity about the cost-effectiveness of lung cancer screening provides further impetus to get this work started," Associate Professor Crengle says. "If this works for Māori, then it will work for everyone else as well."

Study findings show that:

a national biennial lung cancer screening programme is likely to be cost-effective for Māori and the total population in New Zealand.

screening is likely to reduce population inequities relating to lung cancer among Māori.

Screening trials have been completed overseas where they have resulted in a 20-26 per cent reduction in lung cancer deaths.

The DHBs and University of Otago are now planning to trial an invitation process with up to 50 general practices across the Auckland and Waitematā catchments. The trial will be aimed at Māori patients and the results will help shape any future screening roll-out across New Zealand.

Waitematā DHB and Auckland DHB Director of Health Outcomes Dr Karen Bartholomew says deaths from lung cancer are the single-greatest contributor to the higher mortality rate for Māori compared with NZ Europeans / other ethnicities.

"Around 75 per cent of early-stage lung cancer may be curable." Dr Bartholomew says. "If lung cancer is caught early enough, the impact of screening could go a long way towards helping us save lives and eliminate the unacceptable inequities we currently see in mortality between Māori and non-Māori."

First described in the 13th century in Russia, clubroot has been affecting worldwide brassica production, including canola, broccoli, and black mustard, since. Clubroot is so tenacious because the casual pathogen produces resting spores that can survive in infected soil for decades, surviving harsh environments like cold winters and hot summers. It is also easily transferable from field to field when farmers share equipment.

In Canada, clubroot is a very serious threat to the $27 billion dollar canola industry. In the last ten years, clubroot has led to $500 million in losses. And while some Canadian provinces do a great job trying to trace the pathogen in canola fields, other fields, growing mainly Brassicas vegetables, have been overlooked, resulting in a growing clubroot infection.

"As a plant pathologist, my philosophy has always been to listen to the farmers. They know the problems that the scientists should try to tackle," Edel Pérez-López, author of a paper recently published in Plant Health Progress, said. This attitude inspired him and his colleagues at the University of Calgary and the University of Saskatchewan to develop a new tool that will curtail the devastating effects of clubroot.

"ClubrootTracker is an interactive tool that will help farmers locate clubroot-infected areas and can be used by farmers, researchers, and industry and government representatives to share the clubroot status of their land," explained Edel Pérez-López, one of the plant pathologists involved in the development of this tool. "We believe that the ClubrootTracker will be a gamechanger on the management of clubroot disease both in Canada and worldwide."

The ClubrootTracker is the first tool that groups in one place the distribution of clubroot disease and while the team had the support of Saskatchewan Agriculture Development Fund and the Saskatchewan Canola Development Commission, Pérez-López pointed out that his team really didn't need more than a computer and ideas to develop this new technology.

"There has been a widely positive response to the ClubrootTracker and many farmers and industry partners have showed interest in using it."

New research is revealing how genetic differences in the fat in men's and women's bodies affect the diseases each sex is likely to get.

University of Virginia researchers Mete Civelek, PhD, Warren Anderson, PhD, and their collaborators have determined that differences in fat storage and formation in men and women strongly affect the activity of 162 different genes found in fat tissue. Further, 13 of the genes come in variants that have different effects in men and women.

Some of those genes identified have already been connected with conditions such as type 2 diabetes and cardiovascular disease. The findings help explain the differing health risks men and women face, and they set the stage for better, more targeted treatments.

"Obesity is associated with a number of health risks, and how men and women store excess calories as fat makes a difference in how they have different susceptibilities to common diseases," said Civelek, of UVA's Department of Biomedical Engineering, a joint program of UVA's School of Medicine and School of Engineering. "We studied people of different ethnicities and health conditions, and we found a group of genes that are different in their abundance between men and women independent of ethnicity or health status."

Fat Genes

One of the great challenges of genetic research is the tremendous volume of information it produces. Previous studies had identified thousands of genes found in fat that appeared to behave differently based on sex, but Civelek and his collaborators found "robust" differences in only 162. This was based on the researchers' analysis of approximately 3,000 human samples collected from geographically and ethnically diverse populations.

"By combining a variety of data resources, we were able to identify specific genes that could be targeted to elicit distinct therapeutic outcomes in men and women." said Anderson, a member of Civelek's lab.

Digging deeper, the researchers identified six specific genes that were particularly influential in terms of regulating the activity of fat tissue. "We can now focus on these six genes as potential therapeutic targets," Civelek said.

The findings are particularly notable because there has been much research into sex differences in fat tissue in terms of its distribution (pear shaped vs. apple shaped bodies, for example) and other aspects, but the important genetic contributions have remained relatively unexplored.

"We believe our findings will be beneficial in precision medicine efforts to find drug targets that can help with specific problems that men and women face," Civelek said. "For example, men are more prone to cardiovascular disorders and women to obesity. The fat genes we identified could contribute to the severity of those illnesses and how men and women respond to treatment differently."

CORVALLIS, Ore. - An Oregon State University study has identified four new species of parasitic, cockroach-killing ensign wasps that became encased in tree resin 25 million years ago and were preserved as the resin fossilized into amber.

"Some species of ensign wasps have even been used to control cockroaches in buildings," OSU researcher George Poinar Jr. said. "The wasps sometimes are called the harbingers of cockroaches - if you see ensign wasps you know there are at least a few cockroaches around. Our study shows these wasps were around some 20 or 30 million years ago, with probably the same behavioral patterns regarding cockroaches."

Ensign wasps, of the Hymenoptera order and scientifically known as Evaniidae, earned their common name because their abdomen resembles a flag; an ensign is a large flag on a ship, usually flown at the stern or rear of the vessel, that indicates the ship's nationality.

"As the wasps move about, their 'ensign' is constantly moving up and down as if they are flag waving," said Poinar, professor emeritus in the OSU College of Science and an international expert in using plant and animal life forms trapped in amber to learn more about the biology and ecology of the distant past.

About 400 species of ensign wasps exist today, distributed across 20 genera. The wasps live everywhere except polar regions. They typically measure 5 to 7 millimeters in length and don't sting or bite but are lethal for unhatched cockroaches.

A female ensign wasp will look for cockroach egg cases, known as ootheca, and lay an egg on or in one of the cockroach eggs inside the case. When the wasp egg hatches, the larva eats the cockroach egg where it was laid.

Successive instars of the larva then consume the other dozen or so eggs inside the cockroach egg case. Mature wasp larvae pupate within the cockroach egg case en route to coming out as adults, and no cockroach offspring emerge from an egg case infiltrated by an ensign wasp.

Analyzing Tertiary period specimens from Dominican amber, Poinar was able to describe three new species of ensign wasps: Evaniella setifera, Evaniella dominicana and Semaeomyia hispaniola. He described a fourth, Hyptia mexicana, from Mexican amber. The Tertiary period began 65 million years ago and lasted for more than 63 million years.

No cockroaches accompanied the wasps in the amber, but three flying termites were found along with an ensign wasp in one of the Dominican amber pieces. It's likely the termites were sharing a nest with the cockroaches and this attracted the wasp, Poinar said.

What causes quasiparticle death?

In large systems of interacting particles in quantum mechanics, an intriguing phenomenon often emerges: groups of particles begin to behave like single particles. Physicists refer to such groups of particles as quasiparticles.

Understanding the properties of quasiparticles may be key to comprehending, and eventually controlling, technologically important quantum effects like superconductivity and superfluidity.

Unfortunately, quasiparticles are only useful while they live. It is thus particularly unfortunate that many quasiparticles die young, lasting far, far less than a second.

The authors of a new Monash University-led study published today in Physical Review Letters investigate the crucial question: how do quasiparticles die?

Beyond the usual suspect—quasiparticle decay into lower energy states—the authors identify a new culprit: many-body dephasing.

MANY BODY DEPHASING

Many-body dephasing is the disordering of the constituent particles in the quasiparticle that occurs naturally over time.

As the disorder increases, the quasiparticle’s resemblance to a single particle fades. Eventually, the inescapable effect of many-body dephasing kills the quasiparticle.

Far from a negligible effect, the authors demonstrate that many-body dephasing can even dominate over other forms of quasiparticle death.

This is shown through investigations of a particularly ‘clean’ quasiparticle—an impurity in an ultracold atomic gas—where the authors find strong evidence of many-body dephasing in past experimental results.

The authors focus on the case where the ultracold atomic gas is a Fermi sea. An impurity in a Fermi sea gives rise to a quasiparticle known as the repulsive Fermi polaron.

The repulsive Fermi polaron is a highly complicated quasiparticle and has a history of eluding both experimental and theoretical studies.

Through extensive simulations and new theory, the authors show that an established experimental protocol—Rabi oscillations between impurity spin states—exhibits the effects of many-body dephasing in the repulsive Fermi polaron.

These previously unrecognised results provide strong evidence that many-body dephasing is fundamental to the nature of quasiparticles.

CLEVELAND, Ohio (September 28, 2020)--Although many women manage menopause symptoms with hormone therapy, increasing numbers of women are considering nonhormone options. Dr. Susan Reed from the University of Washington School of Medicine is a featured speaker during the 2020 Pre-Meeting Symposium of The North American Menopause Society (NAMS) and will discuss the latest advances in nonhormone hot flash management. One of the more promising drug developments targets the KNDy neuron complex.

According to Dr. Reed, who serves as the vice chair of the Department of Obstetrics and Gynecology at the University of Washington School of Medicine in Seattle, successful nonhormone therapies that preceded work in the area of kisspeptin, neurokinin B, and dynorphin (KNDy) neuron targeting include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, oxybutynin, and clonidine. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors given in higher doses are primarily used for depression management. GABAergic drugs, such as gabapentin and pregabalin, are currently used for pain syndromes and seizures. Oxybutynin is FDA approved for overactive bladder. New research focused on a better understanding of the physiology of menopause hot flashes is leading to the development of new nonhormone pharmacotherapies.

In her presentation during the 2020 Pre-Meeting Symposium, Dr. Reed will summarize progress on drug development targeting the KNDy neuron complex, adverse effects of these novel drugs, and their long-term potential as nonhormone therapies for menopause symptoms.

"At menopause, diminished estrogen causes the KNDy neurons to go into hyperdrive, activating the adjacent thermoregulatory center, resulting in hot flashes," explains Dr. Reed. "To date, there are no FDA-approved products for menopause directed toward the KNDy neuron complex, but drugs first developed for pain control and for mood disorders acting via KNDy are under investigation for the treatment of vasomotor symptoms in the United States and Europe and hold great promise."

Beyond her discussion on the future of these new treatments, Dr. Reed will also present new data on the effectiveness of oxybutynin, as well as existing data on SSRIs/SNRIs, GABAergics, and clonidine.

"Hot flashes are one of the most common complaints of postmenopausal women, adversely affecting their overall quality of life," says Dr. Stephanie Faubion, NAMS medical director. "Although hormone therapy remains one of the most-proven methods of treatment, some women are unwilling or unable to take hormones. That's why this presentation on the latest innovations in the nonhormone treatment options for hot flashes is so valuable."

Drs. Reed and Faubion are available for interviews before the presentation during the virtual annual meeting which starts on September 28.

CLEVELAND, Ohio (September 28, 2020)--Hormone therapy remains the best proven method for managing menopause symptoms such as hot flashes. Research continues, however, in the area to identify novel approaches to estrogen therapy that minimize any associated risks. Dr. Hugh Taylor from Yale School of Medicine will discuss some of the latest developments, including fetal estrogens, during the 2020 Pre-Meeting Symposium of The North American Menopause Society (NAMS).

According to Dr. Taylor, a number of improvements have been introduced in the past decade. These include new selective estrogen receptor modulators (SERMs) and the use of estrogens together with SERMs to replace progestins. Fetal estrogens represent one of the newest promising developments. Their unique properties distinguish them from estradiol, although they have some SERM-like properties.

Dr. Taylor noted that estriol and estetrol have entered clinical use with new data revealing promising characteristics. Specifically, estetrol decreases hot flashes and results in favorable cardiovascular changes while counteracting estradiol stimulation of the breast. Estriol similarly acts as a weak estrogen but can counteract some negative effects of estradiol.

"In addition to the already-established benefits, there is also reason to believe that these fetal estrogens may provide added benefits that have yet to be fully explored, making them even more promising," says Dr. Taylor.

"This presentation promises to offer some great insights into the future of hormone therapy," says Dr. Stephanie Faubion, NAMS medical director. "It's important for healthcare providers to understand that these SERMS and estrogens have different biological characteristics, and some may have benefits over others, increasing opportunities for personalizing care for women."

CLEVELAND, Ohio (September 28, 2020)--As legislation relaxes regarding cannabis, it is being used to manage numerous chronic health conditions and mood symptoms. A new study indicates that a growing number of women are either using cannabis or want to use it for the management of bothersome menopause symptoms. Study results will be presented during the 2020 Virtual Annual Meeting of The North American Menopause Society (NAMS), which opens on September 28.

In a sample of 232 women (mean age, 55.95 y) in Northern California who participated in the Midlife Women Veterans Health Survey, more than half reported such bothersome symptoms as hot flashes and night sweats (54%), insomnia (27%), and genitourinary symptoms (69%). Roughly 27% of those sampled reported having used or were currently using cannabis to manage their symptoms. An additional 10% of participants expressed an interest in trying cannabis to manage menopause symptoms in the future. In contrast, only 19% reported using a more traditional type of menopause symptom management, such as hormone therapy.

Cannabis for menopause symptom management was most often used in women reporting hot flashes and night sweats. Such use did not differ by age, race/ethnicity, socioeconomic status, or mental health conditions.

"These findings suggest that cannabis use to manage menopause symptoms may be relatively common. However, we do not know whether cannabis use is safe or effective for menopause symptom management or whether women are discussing these decisions with their healthcare providers--particularly in the VA, where cannabis is considered an illegal substance under federal guidelines. This information is important for healthcare providers, and more research in this area is needed," says Carolyn Gibson, PhD, MPH, a psychologist and health services researcher at San Francisco VA Health Care System and the lead author of the study.

The study, "Cannabis use for menopause symptom management among midlife women veterans," will be one of many presentations during the 2020 NAMS Virtual Annual Meeting focused on novel approaches for treating menopause symptoms.

"This study highlights a somewhat alarming trend and the need for more research relative to the potential risks and benefits of cannabis use for the management of bothersome menopause symptoms," says Dr. Stephanie Faubion, NAMS medical director.

Drs. Gibson and Faubion are available for interviews before and after the virtual annual meeting.

CLEVELAND, Ohio (September 28, 2020)--Women often complain of being more forgetful during the transition from premenopause to perimenopause to postmenopause. Such declines in memory after menopause appear independent of chronologic age. A new study sought to identify whether mitochondrial function might be a determinant of cognition during early postmenopause. Study results will be presented during the 2020 Virtual Annual Meeting of The North American Menopause Society (NAMS), opening on September 28.

This is not the first time researchers believed that mitochondrial function played a role in memory during the menopause transition. Mitochondria are responsible for creating more than 90% of the energy needed by the human body to sustain life and support organ function. Previous, smaller-scale studies have looked at singular mitochondrial biomarkers to establish a possible link with cognitive function. These studies were based on the idea that a decline in estrogen alters the efficiency of energy production across the menopause transition, and inefficient energy production may be related to declines in cognition. In this latest study, researchers examined the association between a more extensive array of mitochondrial biomarkers and cognitive test performance in a larger sample of postmenopausal women.

They evaluated the relationship of mitochondrial functional markers to cognition while taking into account other factors that can influence cognition, including age, education, race, and body mass index. Based on the sample of 110 participants, researchers concluded that, in postmenopausal women, markers of mitochondrial function were associated with cognitive performance on measures of verbal learning, verbal memory, organizational strategies that support verbal learning and memory, verbal fluency, and spatial ability. Efficient mitochondrial function was most consistently associated with the use of executive, prefrontal-dependent strategies.

"Through this research, we confirmed that women with more efficient energy production had better cognitive performance on a range of cognitive indices, including verbal learning," says Rachel Schroeder from the University of Illinois at Chicago, lead author of the study "Bioenergetic Markers and Cognition in Peri- and Postmenopausal Women." "Interestingly, we also found indications of compensatory bioenergetic shifts that might yield less-efficient energy production but might be important to sustaining cognition as women age. These findings as a whole underscore the importance of bioenergetic processes to women's cognitive health during the postmenopause."

"Although additional research is warranted, this study provides valuable insights into a possible role of changes in mitochondrial function in reduced cognitive performance across the menopause transition," says Dr. Stephanie Faubion, NAMS medical director. "More study is needed to determine whether these changes in midlife predict future cognitive decline and whether there are actions that can be taken to prevent them."