Culture

A new study has shown that gentle, controlled stimulation of the ear canal can help reduce symptoms of Parkinson's disease.

The randomised, controlled study, led by the University of Kent, UK, showed that twice daily stimulation for two months was associated with a significant reduction in both motor and non-motor features of Parkinson's disease.

Participants reported greater movement and mobility, and also showed improvements in decision-making, attention, memory, mood, and sleep. Participants also said that by the end of the study they found it easier to perform everyday activities by themselves.

Most of the therapeutic gains were greatest five weeks after the end of treatment suggesting that the treatment may have long lasting effects.

The stimulation therapy was performed at home using a portable headset produced exclusively for clinical investigations by Scion Neurostim, a US-based device company. Participants continued to take their regular dopamine replacement therapy while using the 'easy to use' device.

The study, led by Professor David Wilkinson at Kent's School of Psychology, was conducted on 46 individuals with Parkinson's disease. The research was supported by Dr Mohamed Sakel, Director of the East Kent NHS Neuro-rehabilitation Service and Dr Mayur Bodani, consultant neuropsychiatrist, Kent & Medway NHS and Social Care Partnership Trust, UK. Additional help with participant recruitment was given by the national charity Parkinson's UK.

Professor Wilkinson said: 'This study raises the intriguing possibility that some aspects of Parkinson's disease may be better managed if traditional drug-therapies are combined with gentle, non-invasive stimulation of the balance organs'.

Dr Beckie Port, Research Manager at Parkinson's UK, said: 'The results from this small scale study are very exciting. While more research is needed to better understand how delivering this kind of non-invasive stimulation to the nerve in the ear works, it holds a lot of promise to relieve troublesome symptoms that many with Parkinson's experience'.

Professor Ray Chaudhuri, Director of the National Parkinson Foundation Centre of Excellence at King's College Hospital, said: 'The results are very encouraging. Achieving both widespread efficacy and durable gains in motor and specifically non-motor aspects of Parkinson's disease would be quite novel, and improvements in non-motor symptoms would be especially notable. Those symptoms are often untreated or poorly treated and have a particularly detrimental impact on quality of life, and their treatment is a key unmet need. I am intrigued and want to see where this device technology might go.'

The results build on other work conducted by Professor Wilkinson's research group at Kent's School of Psychology, which has shown that gentle stimulation of the inner ear can also improve neurological symptoms associated with stroke and traumatic brain injury.

Miami Beach, FL--A new study presented today at the Society of NeuroInterventional Surgery's (SNIS) 16th Annual Meeting found significant differences in decision-making for endovascular treatment (EVT) when the physician's experience with EVT use and practice area were taken into consideration.

The web-based, global study of 607 clinicians and interventionalists had participants respond to randomly selected acute stroke case scenarios and state how they would treat the patient. Participants also indicated how they would treat patients both within the constraints of their practice and in ideal settings. The study was conducted through an unrestricted research grant from Stryker to University of Calgary.

Factors Associated with the Decision-making on Endovascular Thrombectomy for the Management of Acute Ischemic Stroke found that EVT decisions differed significantly between regions and specialties under current local resources, but not under assumed ideal conditions. It also found that the NIH Stroke Scale score (34.9%), level of evidence (30.2%), ASPECTS or ischemic core volume (22.4%), patient's age (21.6%), and clinicians' experience in EVT use (19.3%) are the most important factors for EVT decisions.

"Physicians of different specialties and practicing in different geographic regions make decisions based on different external variables," said Mayank Goyal, MD, lead author of the study, a professor of radiology and clinical neurosciences, and the director of imaging and endovascular treatment at the University of Calgary. "While it is promising to see acceptance of EVT as the standard of care for patients with acute ischemic stroke, it is clear that more work needs to be done to standardize decision-making for the benefit of all patients."

A team led by Johns Hopkins Kimmel Cancer Center investigators reports that a new laboratory test they developed to identify chemical changes to a group of cancer-related genes can accurately detect which breast tumors are cancerous or benign, and do it in far less time than gold-standard tests on biopsied breast tissue.

Although the findings are preliminary and need further validation in larger groups of people, the investigators say the test has the potential to dramatically reduce the time (minimum by one month, maximum by 15 months) generally needed to make a definitive breast cancer diagnosis in poorer countries. A quick diagnosis has already been definitively proven to boost survival for all cancers by reducing wait times to surgical and other treatments. A report on the test, which exploits the tendency of some cancer-related genes to undergo the attachment of a chemical group, by a process known as methylation, is published online in the July issue of Clinical Cancer Research.

"Diagnosis is a huge bottleneck to starting treatment, especially in developing countries that have a small number of pathologists available to review breast cancer biopsies who serve a huge population," says study leader Saraswati Sukumar, Ph.D., professor of oncology and pathology at the Johns Hopkins Kimmel Cancer Center. "That means a test like ours could be especially useful in places with fewer resources and where mortality rates from breast cancer are much higher compared to the developed world."

Breast cancer cases are rising around the world, Sukumar notes. Globally, breast cancer incidence is steadily increasing. In 1980, GLOBOCAN reported 641,000 new cases of breast cancer worldwide. In 2018, the estimated incidence of breast cancer worldwide rose to 2.1 million cases (a 3.2% annual rate of increase) with 626,000 deaths due to this cancer.

In developing countries, women present with late-stage breast lesions due to lack of breast cancer screening/pathology programs. Even after the biopsy of palpable lumps, diagnosis is delayed since most countries in Sub-Saharan Africa average less than one pathologist per million population. Pathology and treatment services are available only at regional hospitals. This, combined with limited access to effective treatments, leads to high case-fatality rates. For the few and drastically overworked pathologists, an accurate, fast and resource-efficient test for use in screening clinics that can detect malignancies would greatly assist in prioritizing patients who need accelerated pathological and clinical evaluation, while reducing the burden on overtaxed health systems, Sukumar explains.

The reasons for higher death rates in the developing world include social stigmas that prevents many women from seeking timely treatment and a lack of health care resources. However, a major factor is time between biopsies and delivery of a diagnosis, which can be as long as 15 months in places with fewer resources compared to a few days or weeks in the United States.

With current challenges in pathology services in most low to middle income countries, the turnaround time for pathology results is several weeks and often several months in some countries. A retrospective review of turn-around time from Butaro Cancer Center in Rwanda reported that it took an average of 32 days from specimen receipt to reporting. Another study reported delays of 15 months following biopsy. A retrospective analysis from Malawi, a country in southeastern Africa, identified a median turn around time of 43 days for cancer specimens paid out-of-pocket and 101 days for nonpaid-for specimens, which rely on state funds. A study from Mexico reported delays of six to 10 months for a pathology diagnosis.

Seeking to shrink the time from biopsy to diagnosis, Sukumar and her colleagues in the Johns Hopkins Kimmel Cancer Center, Johns Hopkins University School of Medicine's departments of pathology, surgery, and radiology, and the Johns Hopkins Bloomberg School of Public Health and collaborators from Cepheid developed a novel technology platform. Here, a patient's biopsy sample is loaded into cartridges and inserted in a machine that tests levels of gene methylation--a chemical addition to genes that results in changes in gene activity. This platform returns methylation marker results within five hours.

To develop the test, the researchers gathered 226 samples of breast tissue. These samples came from women in the U.S., China, and South Africa. Their ages ranged from 25 years old to 85 years old and represented all subtypes of breast cancer: estrogen receptor positive, HER2 positive, triple negative breast cancer, ductal and lobular cancers, and ductal carcinoma in situ (DCIS). Four different kinds of benign lesions and normal breast were also sampled. A genetically diverse collection helped assure that results would be widely applicable. Sampling both malignant and benign lesions allowed the researchers to distinguish methylation differences between the two groups.

Using these samples, Sukumar and collaborators Bradley Downs, Ph.D., and Mary Jo Fackler, Ph.D., evaluated the utility of 25 genes that previous studies have shown are often--although not always--methylated differently in breast cancer and benign lesions. Eventually, they narrowed their candidate genes to a panel of 10 with methylation characteristics that were more likely able to distinguish between a majority of the malignant and benign training samples.

The researchers evaluated this 10-gene panel using 246 more breast tissue samples, showing similar success in the panel's ability to distinguish cancer from non-cancer.

They then ran a pilot study using 73 samples from Portugal and Hong Kong of fine needle aspirates obtained from breast lesions first deemed suspicious through mammography. The test differentiated the 49 benign lesions from the 24 cancerous ones with 96% accuracy.

These results suggest that the test holds promise as a "first pass" to distinguish between malignant and benign breast tumors, Sukumar says. With the 5-hour-long return on results, low skill required to run the test, and relatively low expense, it could offer hope of speeding diagnosis for thousands of women worldwide.

Sukumar cautions that the team's molecular test cannot replace expert analysis by a pathologist, whose skill will be necessary to review core biopsies of the breast lesion for a definitive diagnosis and optimal therapy recommendations.

"The hope is that if further studies confirm its value, it could push women who test positive for these methylation markers to the front of the line to have their biopsies reviewed rapidly by the few pathologists in developing countries," Sukumar says. "Instead of languishing for months while they wait for a diagnosis, patients can start potentially lifesaving treatments right away."

While the number of babies who die from sudden infant death syndrome (SIDS) has been on the decline, a study by researchers at Florida Atlantic University's Schmidt College of Medicine and collaborators shows that infant deaths from accidental suffocation and strangulation in bed have more than tripled between 1999 and 2016 in the United States with increases in racial inequalities.

Findings from the study, published in the Maternal and Child Health Journal, reveal similar risk factor profiles for non-Hispanic black infants and non-Hispanic white infants, though in every instance, non-Hispanic black rates were higher than those for non-Hispanic whites. Data from the study generate new theories about the occurrence of infant deaths in bed and racial inequalities by identifying factors that may be associated with increased as well as decreased risks.

For the study, researchers examined race, ethnicity, and sex-specific infant mortality rates by state. Findings reveal that infant mortality rates increased from 10.4 per 100,000 live births in 1999 to 45.8 per 100,000 live births in 2016 among non-Hispanic black female infants; from 15.4 to 53.8 for non-Hispanic black male infants; from 5.9 to 15.8 for non-Hispanic white female infants, and from 6.5 to 25.9 for non-Hispanic white male infants (1999 to 2016). All increases over time were statistically significant.

Between 2007 and 2016, 83 percent of all U.S. deaths in bed among non-Hispanic black and non-Hispanic white infants occurred to mothers who lived in the Midwest and the South at the time of delivery.

The highest mortality rate occurred among non-Hispanic blacks in Michigan (126.4 per 100,000 live births) compared to 11.8 per 100,000 live births for non-Hispanic blacks in California. The highest corresponding rate for non-Hispanic whites occurred in Mississippi (45 per 100,000 live births) and the lowest rate occurred in California (6.5 per 100,000 live births).

Notably, two adjacent, low-income southern states had significantly different outcomes. Alabama had 41 deaths per 185,549 live births for non-Hispanic black infants and 46 deaths per 362,404 live births for non-Hispanic white infants. Mississippi, however, had 115 deaths per 176,825 live births for non-Hispanic black infants and 93 deaths per 206,819 live births for non-Hispanic white infants.

"Despite increased public health efforts for education about safe sleep practices, we have seen significant surges in infant deaths from accidental strangulation and suffocation," said Joanna Drowos, D.O., M.P.H., M.B.A, lead author, associate dean for faculty affairs, and associate chair, Department of Integrated Medical Science, FAU's Schmidt College of Medicine. "By gaining a deeper understanding of the epidemiology, including both risk and protective factors, public health professionals can tailor messages and programs to reach a diverse group of mothers to help reduce deaths related to this preventable tragedy."

The study also shows that mortality rates increased as live birth order increased, especially among young mothers. Non-Hispanic black infants who were the fourth live births for mothers 15 to 24 years old had the highest rate of all of the sub-groups analysed (116.7 per 100,000 live births), followed by non-Hispanic black infants from the same maternal age group who were the fifth or sixth live-born infant. Among non-Hispanic white mothers 15 to 24 years old, the death rate for infants who were the fifth or sixth live birth was 87.1 per 100,000 live births.

In Michigan, non-Hispanic black infants who were the fourth to sixth live births for mothers 15 to 29 years old had an infant mortality rate of 259 per 100,000 live births and 78.9 per 100,000 live births for non-Hispanic white infants (2007-2016 inclusive). For non-Hispanic black infants who were the fifth or sixth live births occurring to such mothers, the rate was 301 per 100,000 live births.

According to the Centers for Disease Control and Prevention (CDC), in 2016, accidental suffocation and strangulation in bed accounted for 25 percent (900) of the approximately 3,600 sudden unexpected infant deaths in the U.S.

"We must conduct the rigorous studies to curb these alarming increases in overall deaths and racial inequalities," said Charles H. Hennekens, M.D., Dr.P.H., co-author, first Sir Richard Doll Professor and senior academic advisor in FAU's Schmidt College of Medicine. "Future areas of research might include examining family and cultural differences around sleep, local pediatrician practices, available social services, and policies to combat these alarming increases."

SILVER SPRING, Md.--The use of intensive lifestyle interventions focused on altering dietary and physical activity habits using behavioral strategies can produce sustained weight loss among African Americans and Hispanics who have type 2 diabetes (T2D), according to a new study published online today in Obesity, the flagship journal of The Obesity Society.

Researchers explain that rates of obesity and T2D are particularly high among African American and Hispanic adults, and underlie substantial health disparities observed in these populations. Limited published data are available on the specific components of effective lifestyle interventions for minority men and women with T2D or the individual behavioral weight control practices associated with successful weight control, leaving gaps in the scientific literature and a lack of guidance about how to tailor intervention approaches for these high-risk populations.

"The current research points to key lifestyle intervention program elements that are associated with successful, long-term, weight control in minority men and women, as well as specific behavioral strategies that could be emphasized within individual sub-groups to optimize weight loss outcomes," said one of the study's authors Delia West, PhD, of the University of South Carolina Arnold School of Public Health in Columbia.

To expand previous findings, West and colleagues examined information collected as part of the Action for Health in Diabetes (Look AHEAD) Trial. Researchers studied 2,361 African American, Hispanic, and non-Hispanic white men and women, who had obesity and T2D, and were randomized to receive the Intensive Lifestyle Intervention (ILI). Participants were given a weight loss goal of 10 percent to be achieved through decreased calorie and fat intake; and increased physical activity. Changes in weight were measured at one, four and eight years.

Study participants were provided weekly group and individual counseling sessions for the first six months (three group and one individual session), followed by three sessions per month (two group and one individual session) for the second six months. Structured meal plans and meal replacements were provided at no cost to facilitate weight loss goals. Participants were to engage in at least 175 min./week of unsupervised, moderate-intensity, physical activity such as brisk walking. Researchers instructed participants to record dietary intake, calculate calorie and fat consumption, log weight and monitor physical activity on a daily basis using a paper-based journal. Behavioral strategies included goal setting, problem solving, social support and relapse prevention.

Results revealed high attendance at individual and group intervention counseling sessions. According to West and colleagues, individual session attendance appeared to be particularly important for successful weight loss among Hispanic and African American men, while group attendance was strongly associated with weight loss for Hispanic and African American women.

The study's authors also found meal replacement use was high during the first year of intervention. Researchers said, however, that meal replacements were not an independent predictor of weight loss in Hispanics or African American men, but were strongly associated with poorer weight loss outcomes among African American women.

Researchers found daily monitoring of body weight associated with successful weight loss in the first year of the lifestyle intervention among African American men and women with T2D and it continued to be important for weight maintenance among African American women, but was not as strongly associated with weight loss outcomes among Hispanic men and women with T2D.

"The ILI is noteworthy in that it successfully produced weight loss over eight years in a diverse sample of individuals with diabetes, with more than a third of individuals self-identifying as a member of a racial or ethnic minority group. Furthermore, 40 percent of participants were male, which contrasts with most previous weight control studies that enrolled few men," West and colleagues write in the report.

Jamy Ard, MD, FTOS, professor of epidemiology and prevention at Wake Forest University School of Medicine in Winston-Salem, NC, who was not associated with the research, said the study has two important implications.

"First, it demonstrates that people respond differently to various treatments, and as a result, we should continue seeking personalized treatment approaches, using different tools in the behavioral toolbox based on individual characteristics. Secondly, this work shows that behavioral treatment can be effective for a diverse population, especially when treatment engagement is frequent and continues long term. If we want to address disparities and engage diverse populations in effective obesity treatment, it will likely depend on providing access to care and insurance coverage for these treatments," said Ard.

WASHINGTON--High blood sugar may increase the risk of pancreatic cancer, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

An 45,750 deaths (23,800 men and 21,950 women) will occur this year from pancreatic cancer, a disease in which healthy cells in the pancreas stop working correctly and grow out of control. The five-year survival rate for people with pancreatic cancer is only nine percent because the disease is so difficult to diagnose and is often not found until later stages when the cancer has spread from the pancreas to other parts of the body.

"Diabetes is one of the established risk factors for pancreatic cancer," said the study's corresponding author, Cheol-Young Park, M.D., Ph.D., of Kangbuk Samsung Hospital in Seoul, Korea. "When we evaluated the pancreatic cancer incidence according to fasting glucose levels using a national cohort database, we found the number of pancreatic cancer cases rose as fasting glucose levels increased. This was true in people who had diabetes as well as those who did not."

In this nationwide study, researchers evaluated pancreatic cancer incidence in Korea according to blood sugar levels using a national cohort database of more than 25 million patients. They found that as blood sugar levels rose, the rate of pancreatic cancer significantly increased not only in diabetic populations, but also in those with prediabetes or normal range of blood sugar levels.

"Our research implies that early detection of hyperglycemia in health checkups and lifestyle modification to improve glucose profile might offer a critical opportunity for lowering the risk of pancreatic cancer," Park said.

Scientists can turn proteins into never-ending patterns that look like flowers, trees or snowflakes, a technique that could help engineer a filter for tainted water and human tissues.

Their study, led by researchers at Rutgers University-New Brunswick, appears in the journal Nature Chemistry.

"Biomolecular engineers have been working on modifying the building blocks of life - proteins, DNA and lipids - to mimic nature and form interesting and useful shapes and structures," said senior author Sagar D. Khare, an associate professor in the Department of Chemistry and Chemical Biology in the School of Arts and Sciences at Rutgers-New Brunswick. "Our team developed a framework for engineering existing proteins into fractal shapes."

In nature, building blocks such as protein molecules are assembled into larger structures for specific purposes. A classic example is collagen, which forms connective tissue in our bodies and is strong and flexible because of how it is organized. Tiny protein molecules assemble to form structures that are scaled up and can be as long as tendons. Assemblies of natural proteins are also dynamic, forming and dissolving in response to stimuli.

The research team developed a technique for assembling proteins into fractal, or geometric, shapes that are repeated over and over. Examples include trees, leaves and pineapples. The team used protein engineering software to design proteins that bind to each other, so they form a fractal, tree-like shape in response to a biological stimulus, such as in a cell, tissue or organism. They can also manipulate the dimensions of the shapes, so they resemble flowers, trees or snowflakes, which are visualized using special microscopy techniques.

These techniques could lead to new technologies such as a filter for bioremediation, which uses biological molecules to remove herbicides from tainted water, or synthetic matrices to help study human disease or aid tissue engineering to restore, improve or preserve damaged tissues or organs.

The next steps are to further develop the technology and expand the range of proteins that form fractal shapes as well as use different stimuli, such as chemicals and light. The scientists also want to study how fractal shapes form in greater detail, so they could gain greater control over the process and the shapes and sizes of designer biomaterials.

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Atrial fibrillation is a common abnormal heart rhythm. It is treated either with medications or by applying heat or extreme cold to destroy small specific tissue areas in the atrium. This inevitably causes small wounds. A team at the Cardiac and Vascular Surgery Unit of the German Heart Center Munich (DHM) of the Technical University of Munich (TUM) has now discovered a blood-borne marker that quickly reveals the extent of such wounds, allowing healing and the success of the intervention to be monitored precisely.

Atrial fibrillation leads to a persistent irregular - often accelerated - heartbeat. While the condition is not life-threatening, if left untreated it can lead to serious complications such as stroke or heart failure. It is caused by areas of the heart that hinder the normal conduction of electrical impulses so that the atrium no longer contracts rhythmically," explains Professor Rüdiger Lange, Director of the Cardiac and Vascular Surgery Unit of the German Heart Center Munich.

Ablation is a procedure in which specific regions of the atrium are destroyed by applying heat or extreme cold to reroute the paths of electrical conduction and correct the abnormality.

Atrial protein as a potential biomarker

Two years ago, Privatdozent Dr. Markus Krane, Deputy Director of the Cardiac and Vascular Surgery Unit at the DHM und Professor Matthias Mann of the Max Planck Institute of Biochemistry compiled an Atlas of the Heart. In the process, they discovered the protein myosin binding protein H-like (MYBPHL), which exists in two forms and exhibits an important characteristic: in humans, one of the forms, isoform 2, occurs only in the atria of the heart. Most other proteins in the heart, by contrast, are just as likely to occur in other cardiac regions as well.

The researchers therefore wondered whether MYBPHL might serve as a blood-borne marker for atrial tissue damage. "Markers are particularly important in cardiac medicine for predicting and assessing progress, because early recognition of problems in such a vital organ as the heart can save many lives," says Markus Krane.

Elevated blood levels following injury

The scientists tested over a hundred blood samples from patients with atrial fibrillation in whom ablation had been performed. They found that levels of MYBPHL in the blood were highest immediately after ablation when the patients arrived at the intensive care unit and then gradually declined over the next 24 hours. Patients who underwent cardiac valve surgery without atrial intervention, for example, did not show increased levels of the protein, which remained at the same levels as in the healthy control group.

"In this way we're able to assess the extent of atrial damage and predict the patient's progress by means of a simple blood test. This is only possible because the new marker has the considerable advantage that it is highly specific to atrial tissue. If levels of the new marker decrease while other markers for myocardial damage remain high, it can be assumed that other problems are at play, which we can then target early with additional tests and therapeutic measures," says Krane.

Development of a rapid blood test planned

In the next step, Krane and his team plan to produce antibodies that only recognize isoform 2, which can then be used in a rapid blood test. Such a standardized test would be suitable for widespread routine use following surgical or interventional procedures that specifically target atrial tissue.

Autism and other neurodevelopmental disorders often aren't diagnosed until a child is a few years of age, when behavioral interventions and speech/occupational therapy become less effective. But new research this week in PNAS suggests that two simple, quantifiable measures -- spontaneous fluctuations in pupil dilation or heart rate-- could enable much earlier diagnosis of Rett syndrome and possibly other disorders with autism-like features.

The study, led by Boston Children's Hospital neuroscientist Michela Fagiolini, PhD, and postdoctoral fellow Pietro Artoni, PhD, unveils a machine-learning algorithm that can spot abnormalities in pupil dilation that are predictive of autism spectrum disorder (ASD) in mouse models. It further shows that the algorithm can accurately detect if a girl has Rett syndrome, a genetic disorder that impairs cognitive, sensory, motor, and autonomic function starting at 6 to 18 months of age, as well as autism-like behaviors.

Fagiolini and colleagues hope this system could provide an early warning signal not just for Rett syndrome but for ASD in general. In the future, they believe it could also be used to monitor patients' responses to treatments; currently, a clinical trial is testing the drug ketamine for Rett syndrome, and a gene therapy trial is planned.

"We want to have some readout of what's going on in the brain that is quantitative, objective, and sensitive to subtle changes," says Fagiolini. "More broadly, we are lacking biomarkers that are reflective of brain activity, easy to quantify, and not biased. A machine could measure a biomarker and not be affected by subjective interpretations of how a patient is doing."

Altered arousal in autism

Fagiolini and Artoni, in close collaboration with Takao Hensch, PhD, and Charles Nelson, PhD, at Boston Children's, began with the idea that people on the autism spectrum have altered behavioral states. Prior evidence indicates that the brain's cholinergic circuits, which are involved in arousal, are especially perturbed, and that altered arousal affects both spontaneous pupil dilation/constriction and heart rate.

Fagiolini's team, supported by the IRCN at Boston Children's F.M. Kirby Neurobiology Center, set out to measure pupil fluctuations in several mouse models of ASD, including mice with the mutations causing Rett syndrome or CDKL5 disorder, as well as BTBR mice. Spontaneous pupil dilation and constriction were altered even before the animals began showing ASD-like symptoms, the team found.

Moreover, in mice lacking MeCP2, the gene mutated in Rett syndrome, restoring a normal copy of the gene, in cholinergic brain circuits only, prevented the onset of pupillary abnormalities as well as behavioral symptoms.

Predicting Rett syndrome in girls

To systematically link the observed arousal changes to the cholinergic system, the team took advantage of an earlier discovery by Hensch: mice lacking the LYNX1 protein exhibit enhanced cholinergic signaling. Based on about 60 hours of observation of these mice, the investigators "trained" a deep learning algorithm to recognize abnormal pupillary patterns. The same algorithm accurately estimated cholinergic dysfunction in the BTBR, CDKL5, and MeCP2-deficient mice.

The team then brought this algorithm to 35 young girls with Rett syndrome and 40 typically developing controls. Instead of measuring the girls' pupils (as patients may fidget), they used heart rate fluctuations as the measure of arousal. The algorithm nonetheless successfully identified the girls with Rett, with an accuracy of 80 percent in the first and second year of life.

"These two biomarkers fluctuate in a similar way because they are proxies of the activity of autonomic arousal," says Artoni. "It is the so-called 'fight or flight response."

Autonomic arousal, a property of the brain that is strongly preserved across different species, is a robust indicator of an altered developmental trajectory, Fagiolini and Artoni found.

Biomarkers for babies?

In a previous study with Nelson, Fagiolini showed that visual evoked potentials, an EEG measure of visual processing in the brain, could also serve as a potential biomarker for Rett syndrome. She believes that together, such biomarkers could offer robust yet affordable screening tools for infants and toddlers, warning of impending neurodevelopmental problems and helping to follow the progression of their development or treatment.

"If we have biomarkers that are non-invasive and easily evaluated, even a newborn baby or non-verbal patient could be monitored across multiple timepoints," Fagiolini says.

PHILADELPHIA -- Parkinson's disease often begins with small tremors. Over time symptoms worsen. Tremors become shakes and stiffness takes the body hostage. People with advanced stages of the neurodegenerative disease often have trouble with coordination, walking and maintaining their balance. Currently no cure exists for the condition and available treatments only address symptoms. No therapies are able to slow the progression of the disease yet.

Now an international team of researchers led by Jay Schneider, PhD, a professor in the department of pathology, anatomy and cell biology at Thomas Jefferson University, report new information that may in part explain how a molecule called GM1 ganglioside protects the brain against major features of Parkinson's disease. The discovery further points to GM1 as one of the first potential treatments to directly impact the degenerative processes that cause the disease.

Dr. Schneider has been investigating the therapeutic potential of GM1 in Parkinson's disease for nearly 30 years. In previous research, he and colleagues showed that Parkinson's patients have less GM1 than healthy patients in the part of the brain most affected by Parkinson's, called the substantia nigra. Other researchers followed this work to show in cell culture models that GM1 interacts with a protein called alpha-synuclein. In Parkinson's disease, alpha-synuclein can form clumps, which can become toxic to brain cells in the substantia nigra and lead to cell death. "The accumulation of alpha-synuclein aggregates has been proposed as one of the major pathological processes in Parkinson's disease," Dr. Schneider says.

In the new work, Dr. Schneider and colleagues show that giving daily GM1 doses to animals that overproduce alpha-synuclein inhibits the toxic effects of the protein.

"When we looked in the brains of these animals, not only did we find we could partially protect their dopamine neurons from the toxic effects of alpha synuclein accumulation, we had some evidence that these animals had smaller and fewer aggregates of alpha-synuclein than animals that received saline injection instead of GM1," Dr. Schneider says.

In addition to protecting brain cells from death, the treatment also reversed some early motor symptoms, the team announced June 10th in the journal Scientific Reports.

The researchers suspect that less GM1 in the brains of Parkinson's disease patients may facilitate the aggregation of alpha-synuclein and increase its toxicity.

"By increasing GM1 levels in the brains of these patients, it would make sense that we could potentially provide a slowing of that pathological process and a slowing of the disease progression, which is what we found previously in a clinical trial of GM1 in Parkinson's disease patients," Dr. Schneider says.

The team is now following up on their results to find out what other effects GM1 might have on alpha-synuclein.

"It's important to understand how GM1 is working because there might be other ways we could manipulate GM1 levels in the brain to have a beneficial effect," Dr. Schneider says.

Miami Beach, Fla.--A progressive Emergency Medical Services (EMS)-driven partnership in South Florida has expedited access to lifesaving care for stroke patients. This groundbreaking effort to optimize the likelihood of recovery from a "brain attack" was showcased this week at the Society of NeuroInterventional Surgery's (SNIS) 16th Annual Meeting.

To form the South Florida Stroke Coalition (SFSC), regional EMS agencies and neuro-interventionalists collaborated with the University of Miami's Florida Stroke Registry (UMFSR) team to establish a regional quality assurance dashboard. The novel dashboard enables area hospitals to share quality metrics and outcomes with EMS medical directors about time-sensitive treatments administered to acute stroke patients.

Acute strokes due to large vessel occlusion, a leading cause of disability in Florida and worldwide, can now be reversed in many cases when patients quickly receive endovascular thrombectomy -- an image-guided procedure for removing clots from blocked arteries that restores vital blood flow to the brain. Recognizing that not all hospitals offering this procedure are equal, the dashboard helps EMS medical directors identify the most appropriate hospital destinations for a given stroke patient with the goal of directly transporting the patient to the center that can provide appropriate treatment -- right away, even if it means having to bypass other facilities to do so.

"Over the past decade in South Florida, there has been a proliferation of stroke centers. However, the resources and capabilities that each offer have been extremely variable," said Brijesh P. Mehta, MD, lead author of the study and a neurointerventional surgeon at the Memorial Neuroscience Institute in Hollywood, Florida. "Currently, EMS transports stroke patients to the nearest hospital rather than using data to make informed triage decisions. This dashboard will be instrumental for benchmarking the quality of stroke care across the region and ushering in hospital-level accountability."

Part of a statewide effort to improve outcomes, the initiative aimed to optimize both pre-hospital (EMS) and in-hospital processes. A core tenet of the SFSC was that stroke centers could no longer simply provide thrombectomy through self-attestation; instead, they needed to apply for Joint Commission certification to verify their capabilities and performance.

"Every minute counts when brain cells are dying -- the earlier the intervention, the better the results," said Dr. Paul Pepe, a study co-author and head of the U.S. Metropolitan EMS Medical Directors Consortium. "This vanguard South Florida experience is compelling and serves as a model for progressive stroke care around the world."

In June, bolstered by the efforts of the national SNIS Get Ahead of Stroke campaign, Florida Governor Ron DeSantis signed "CS/CS/SB 1460: Stroke Centers," a bill that will improve first responders' identification of hospitals that can reliably provide rapid access to thrombectomy when needed. The law not only aims to reduce disability and death as a result of severe stroke but also is intended to stem the immense long-term costs for ongoing, complex health care and the unrelenting need for specialized caretakers to support daily activities of living for severely disabled stroke patients.

Private, independent firms are less likely to pollute and incur EPA penalties than public and private equity-owned firms, according to new research from the University of Notre Dame.

"Corporate governance and pollution externalities of public and private firms" is forthcoming in the Review of Financial Studies from Sophie Shive and Margaret Forster, finance professors in Notre Dame's Mendoza College of Business. They found that private, independent firms have lower carbon emissions from their operations, controlling for their size and output, than public and private equity-owned firms.

"This is a very tough question to answer in a general sample of firms," Shive says, "because one has to identify a 'normal' level of emissions, given an imperfect industry categorization and coarse measures of size, etc. For this reason, we also do a deeper dive into electric utilities, which are some of the largest emitters, and find that even controlling for things like generator age, independent privately-owned utilities (generally cooperatives or other unconventional corporate structures) emit less carbon dioxide per unit of electricity generated."

The study offers preliminary research into how finance can help mitigate climate change and sheds light on the debate about which type of corporate structure is better for reducing the "tragedy of the commons." This occurs when each entity consumes or spoils too much of a public good and harms society, rather than coordinating to use the resource wisely.

"The classic example is individual farmers who each have the incentive to let their cows eat as much grass as possible in a public field," Shive explains. "But this behavior overwhelms the grass and hurts everyone."

The study finds no differences between private, sponsor-backed firms and public firms, controlling for industry, time, location and a host of firm characteristics. Within public firms, it identified a negative association between emissions and mutual fund ownership and board size, suggesting that increased oversight may decrease pollution.

The researchers used comprehensive data on greenhouse gas emissions from 2007 to 2016, combined with EPA data. They used workhorse statistical methods to control for other potential drivers of carbon emissions.

"This should help inform the debate about whether and how business can take a leadership role in resolving these types of global problems," Shive says, "since governments often have trouble coordinating on global issues."

The future of faster, more efficient information processing may come down to light rather than electricity. Mark Lawrence, a postdoctoral scholar in materials science and engineering at Stanford, has moved a step closer to this future with a scheme to make a photon diode - a device that allows light to only flow in one direction - which, unlike other light-based diodes, is small enough for consumer electronics.

All he had to do was design smaller-than-microscopic structures and break a fundamental symmetry of physics.

"Diodes are ubiquitous in modern electronics, from LEDs (light emitting diodes) to solar cells (essentially LEDs run in reverse) to integrated circuits for computing and communications," said Jennifer Dionne, associate professor of materials science and engineering and senior author on the paper describing this work, published July 24 in Nature Communications. "Achieving compact, efficient photonic diodes is paramount to enabling next-generation computing, communication and even energy conversion technologies."

At this point, Dionne and Lawrence have designed the new photon diode and checked their design with computer simulations and calculations. They've also created the necessary nanostructures - the custom smaller-than-microscopic components - and are installing the light source that they hope will bring their theorized system to life.

"One grand vision is to have an all-optical computer where electricity is replaced completely by light and photons drive all information processing," Lawrence said. "The increased speed and bandwidth of light would enable faster solutions to some of the hardest scientific, mathematical and economic problems."

Spinning light, breaking laws

The main challenges of a light-based diode are two-fold. First, following the laws of thermodynamics, light should move forward through an object with no moving parts in the exact same way it would move backward. Making it flow in one direction requires new materials that overturn this law, breaking what's known as time-reversal symmetry. Second, light is much more difficult to manipulate than electricity because it doesn't have charge.

Other researchers have previously tackled these challenges by running light through a polarizer - which makes the light waves oscillate in a uniform direction - and then through a crystalline material within a magnetic field, which rotates the polarization of light. Finally, another polarizer matched to that polarization ushers the light out with near-perfect transmission. If light is run through the device in the opposite direction, no light gets out.

Lawrence described the one-way action of this three-part setup, known as a Faraday isolator, as similar to taking a moving sidewalk between two doors, where the sidewalk plays the role of the magnetic field. Even if you tried to go backward through the last door, the sidewalk would usually prevent you from reaching the first door.

In order to produce a strong enough rotation of the light polarization, these kinds of diodes must be relatively large - much too large to fit into consumer computers or smartphones. As an alternative, Dionne and Lawrence came up with a way of creating rotation in crystal using another light beam instead of a magnetic field. This beam is polarized so that its electrical field takes on a spiral motion which, in turn, generates rotating acoustic vibrations in the crystal that give it magnetic-like spinning abilities and enable more light to get out. To make the structure both small and efficient, the Dionne lab relied on its expertise in manipulating and amplifying light with tiny nano-antennas and nanostructured materials called metasurfaces.

The researchers designed arrays of ultra-thin silicon disks that work in pairs to trap the light and enhance its spiraling motion until it finds its way out. This results in high transmission in the forward direction. When illuminated in the backwards direction, the acoustic vibrations spin in the opposite direction and help cancel out any light trying to exit. Theoretically, there is no limit to how small this system could be. For their simulations, they imagined structures as thin as 250 nanometers. (For reference, a sheet of paper is about 100,000 nanometers thick.)

What's possible

Big picture, the researchers are particularly interested in how their ideas might influence the development of brain-like computers, called neuromorphic computers. This goal will also require additional advances in other light-based components, such as nanoscale light sources and switches.

"Our nanophotonic devices may allow us to mimic how neurons compute - giving computing the same high interconnectivity and energy efficiency of the brain, but with much faster computing speeds," Dionne said.

"We can take these ideas in so many directions," Lawrence said. "We haven't found the limits of classical or quantum optical computing and optical information processing. Someday we could have an all-optical chip that does everything electronics do and more."

Scientists have given a fascinating new insight into the way microbes adopt a 'co-operative' approach to securing the nutrients they need to thrive.

A team of bioscientists from the University of Exeter have investigated why microorganisms spurn a "survival of the fittest" mentality to instead adopt a seemingly risky communal strategy to acquire nutrients from their environment.

A common feeding strategy involves secreting metabolic products into the surrounding environment to break down and capture required complex nutrients.

However this strategy, at first glance, appears to be flawed - not only are some nutrients lost into the environment, but they can also be exploited by neighbouring microbes that take the benefits without sharing the workload.

Now scientists have discovered a reason why microbes adopt this "public goods" approach, instead of keeping all the nutrients they need for themselves by breaking them down inside the cell.

They found that microbes that broke down nutrients internally rather than externally "took over" an otherwise stable population, leading it to become unstable and decline.

The research is published in the leading journal Nature Ecology & Evolution.

Professor Ivana Gudelj, co-author of the study and also from the University of Exeter's Living Systems Institute said: We were puzzled by the diversity of microbial feeding strategies observed in nature and created a synthetic microbial community to probe this further."

The research team examined the metabolism of Saccharomyces cerevisiae - more commonly known as Brewer's Yeast - for the study.

As well as investigating the microbes in their natural form and environment, the team also ran a series of sophisticated mathematical models, and synthetic ecological experiments, to determine why the "public goods" approach is commonly used in nature, despite its flaws.

They found that strategies that break down nutrients either internally or externally both have their own selective benefits when considered in isolation. In communities containing a mixture of these feeding strategies, microbes that broke nutrients down internally out-competed their neighbours. However, such a selfish strategy became unsustainable once the public good feeders had been out-competed.

They suggest a more co-operative approach, which can see some microbes gaining nutrients they have not worked for, can strengthen the whole population, rather than individuals selfishly keeping resources for themselves.

Dr Lindsay, co-author of the study added: "Through our interdisciplinary approach, we found that digesting resources externally is favoured in fluctuating and rapidly changing environments or in non-diverse communities where they cannot be exploited."

In pre-Columbian times, the white-tailed deer was among the most abundant and frequently consumed mammals in Panama. It was also an icon, represented on thousands of clay vessels. Through an analysis of deer remains in refuse piles at the Sitio Sierra archaeological site, researchers from the Smithsonian Tropical Research Institute (STRI) discovered signs of "feasting behavior" associated with this animal. Their findings were published in Archaeological and Anthropological Sciences.

Spanish conquistadors left some clues. They noted the abundance of deer in indigenous communities along the Pacific coast near Sitio Sierra and highlighted the existence of larders replete with dried and salted deer carcasses. These details suggest that periodic feasts may have taken place, and were likely important for enhancing social relations and strengthening alliances.

The Sitio Sierra site, a large village on the Pacific coastal plain occupied between 2,200 and 500 years ago, was excavated by STRI archaeologist Richard Cooke in the 1970s. María Fernanda Martínez-Polanco, a former pre-doctoral fellow in Cooke's lab at STRI and first author of the study, analyzed some of the evidence of feasting signs.

She found that, in certain units, remains of young white-tailed deer predominated, as well as body parts with high meat values. Most of the cut marks on the bones were due to de-fleshing, as opposed to rodent or carnivore gnawing. She also encountered the carcasses of tasty birds and mammals, a contrast from the typical food remains found around houses, consisting of marine and river fish, iguanas and small turtles.

In those units, pottery sherds were much more numerous and larger than in other contexts. A large pit with post-holes along the periphery contrasted with smaller cooking pits found in or around the structures of former houses. These findings coincide with characteristics of feasting mentioned in the scientific literature.

"This was an important tradition that could have been practiced for several generations, as we have witnessed based on the cut marks in bones, located in identical positions over different time periods," Martínez-Polanco said.

For her, the analyses of deer bone samples in conjunction with the evidence from the pottery and cooking practices, position the feasts at Sitio Sierra as part of a ritual activity. Possible motivations for feasting include ancestor worship, rites of passage, celebrations of cultural awareness and group oral-history and political gatherings designed to enhance the reputation of the provider.

Archaeologists think that Sitio Sierra was probably a low-status village, based on burials in its two cemeteries, suggesting that these feasts were likely not as sumptuous as they could have been in higher-status villages in the area, such as Sitio Conte or El Caño. Offering deer meat may have been considered a great honor for the guests and proof of the provider's status.

"Deer were more than just food for Panamanian pre-Columbian populations," Martínez-Polanco said. "Deer hunting was restricted and their consumption linked to important occasions, as we observed in the archaeological record of Sitio Sierra, allowing ancient Panamanians to share and reinforce social relations at different levels of society."