Culture

Peptide receptor radionuclide therapy (PRRT) has been shown to be safe and effective for patients with grade 3 (G3) neuroendocrine neoplasms (NENs), according to research presented at the Society of Nuclear Medicine and Molecular Imaging's (SNMMI) 66th Annual Meeting.

"While numerous studies have demonstrated the effectiveness of PRRT in well-differentiated grade 1 and 2 neuroendocrine neoplasms, limited data has been reported on PRRT in G3 NENs," noted Richard P. Baum, MD, PhD, chairman and clinical director at THERANOSTICS Center for Molecular Radiotherapy and Precision Oncology in Bad Berka, Germany. "Our study--which followed the largest cohort of G3 NEN patients for the longest period of time--aimed to assess the safety and efficacy of PRRT in terms of survival analysis. In addition, we evaluated the utility of positron emission tomography (PET)/computed tomography (CT) in predicting long-term prognosis."

In the study, 69 patients with various types of metastatic, progressive G3 NENs received PRRT with 177Lu- and/or 90Y-labeled DOTATATE or DOTATOC. For some patients this therapy was a first-line treatment, but for the majority, PRRT was a second- or third-line treatment. Patients were followed for a median of 94.3 months, and progression-free survival and overall survival rates were calculated.

The median progression-free survival rate for patients with G3 NENs was 9.6 months, and the overall survival rate was 19.9 months. When taking into account the Ki-67 index, which measures a key protein associated with cell proliferation, researchers found a significant difference between survival rates. Patients with a Ki-67 index less than or equal to 55 percent responded more favorably to the PRRT than others, with a median progression-free survival rate of 11 months and an overall survival rate of 22 months.

"Compared to studies evaluating the efficacy of chemotherapy for NEN patients with a Ki-67 index less than or equal to 55 percent, PRRT has a longer overall survival rate--22 months versus 14 months," the researchers pointed out. "These results suggest that PRRT, rather than chemotherapy, may be a superior first-line therapeutic option in selected patients with a high level of SSTR expression and a Ki-67 index of less than or equal to 55%."

In addition to tracking survival rates, researchers also performed response assessments with 68Ga-SSTR PET/CT and 18F-FDG PET/CT. Patients with a good response and favorable outcome after PRRT were observed to have a relatively higher SUVmax with 68Ga-SSTR PET/CT imaging. Patients with no or minor 18F-FDG uptake responded well to PRRT, and the survival rates were significantly longer than for those with avid 18F-FDG uptake. In terms of stratifying patients, the mismatch pattern of low 18F-FDG uptake and high 68Ga-SSTR uptake was associated with a better long-term prognosis.

Jingjing Zhang and Richard P. Baum of Zentralklinik Bad Berka noted, "Overall, our findings demonstrated that PRRT was tolerated well, without any significant adverse effects, and was effective in patients with G3 NENs, even those for whom chemotherapy had failed. These findings provide the basis for the expansion of clinical indications of PRRT in the future."

Enhancing cancer treatment is a "major priority" for the UK public, which also thinks that the NHS needs more resources to provide "excellent cancer care", finds a new national survey led by UCL.

The study, British Public Attitudes towards Cancer Research and Treatment in 2019, found that half (49%) the population believe cancer is the disease group for which they most want better treatments for themselves and their families. In addition, 59% believe that stopping the suffering caused by cancer is one of the most important things society could achieve by 2050.

The survey also found that public support for a tax funded NHS available to all remains strong. While 77% support the concept of universal publicly funded health care, only 7% oppose it. However, 82% of British adults believe NHS professionals need more resources to provide excellent cancer care.

With the UK due to leave the EU on October 31st this year, the survey found only 14% think cancer research and care will improve after Brexit: 26% actively disagree and the remainder are uncertain.

The research is part of the UCL School of Pharmacy Cancer Policy Project. It was conducted online among a sample of 2,077 people aged 18 and over during April 2019.

Launching the report, lead author Professor David Taylor (UCL School of Pharmacy) said: "Further improving cancer related health-outcomes is a major priority for people in every age group.

"Despite the costs of some interventions, cancer care presently accounts for only 5-7% of the NHS budget and NHS anti-cancer medicine spending currently represents no more than 0.2% of GDP.

"At UCL and across the UK, scientists are leading pioneering research that will transform the outlook for adults here and around the world who are living with conditions like lung cancer and for both children and adults with diseases such as leukaemias and lymphomas.

"If we can work together across the public, private and charity sectors and keep good European and wider research links, the UK will be able to go on playing a global role in creating cost-effective anti-cancer treatments and ending the suffering caused by cancer in people of all ages, and in doing so help earn its living in a post-Brexit environment."

Despite majority confidence in specialist NHS cancer care, the survey found just under a third of adults were concerned that the NHS would not consistently provide the most effective treatments if they, or members of their family, were to develop cancer, or fear that the NHS would provide poor care compared to the world's best health care providers

Cancer presently remains a threat to children and young adults. But two in every three cancer deaths now occur amongst people aged 70 and over, 95% of whom believe they have as much right to good NHS cancer treatment as anyone else.

Professor Taylor added: "Problems with providing optimally effective cancer treatment and care for NHS patients in later life will intensify if the UK economy falters and skilled professionals leave."

Other key findings include:

There is strong support for increasing rates of early cancer diagnosis. Despite past (now no longer accepted) fears that low NHS early cancer diagnosis rates were due to poor UK public awareness of cancer risks four people in five (80%) want better early cancer detection services even if this increases the risk of 'false alarms'.

People in the UK are optimistic about the ability of researchers in institutions like universities to develop more effective cancer treatments by 2050, and want to see closer partnerships between the public and private sectors. Two thirds (66%) expect most cancers to be curable by 2050, or to be treatable in ways that stop them taking lives.

The UK public is more divided and uncertain about funding cancer research and paying for new treatments. For example, 43% say the NHS should purchase cancer treatments as cheaply as possible regardless of impacts on research and UK investment while 53% say the NHS should pay prices that encourage research and investment. Similar divisions between those in favour of granting patents for new anti-cancer medicines in order to fund research for the future and a smaller percentage who oppose patenting anti-cancer treatments because it increases prices in countries like Britain or in developing nations.

Despite growing concerns about the global impacts of cancer, 49% of the British population opposes the use of tax payers' money to improve cancer care in poor countries. Only 18% agree with giving such aid. Regarding NHS drug costs, just over 1 person in 5 thinks that 'the costs of anti-cancer drugs are bankrupting the NHS'. A similar proportion disagrees, while 3 adults in 5 do not feel able to say.

At a UCL Cancer Policy Project organised meeting in the House of Lords this week, sponsored by peers from all three main parties, Professor Mark Emberton, Dean of the UCL Faculty of Medical Sciences and Professor of Interventional Oncology at UCL, confirmed that the UK public should expect improved cancer care across the spectrum from prevention and early diagnosis through to surgery, radiography, immunotherapy and cell based treatment provision.

Following the report's launch he said: "The future of cancer therapy will be defined by a quest for and refinement of treatment selectivity on the one hand and attempts to counter treatment resistance on the other."

Cancer and dementia - balancing different fears

The proportion of the UK public (49%) who say cancer is the disease group from which they most want better protection for themselves and their families is twice the proportion naming Alzheimer's disease and other dementias as their top priority for improved treatment. However, when asked about the serious disease consequences they as individuals most want to avoid half said 'living in a confused state for years with little control over what happens to me', three times the proportions saying that they most want to avoid either death or having to live with chronic pain.

In explaining this apparent conflict the report notes that as people age many do not want to burden relatives and exhaust their families' resources by having to pay for long term 'social' care. At the same time they also want their children's and grandchildren's lives to be protected by better cancer care.

Commenting on the report, Emlyn Samuel, Head of Policy at Cancer Research UK, said: "Despite progress, UK cancer survival lags behind other countries and the number of people getting cancer is growing - by 2035 one person will be diagnosed with cancer every minute.

"Early diagnosis is crucial to improving patients' chances of survival, but NHS staff shortages are impeding our ability to meet demand and introduce new technologies effectively.

"The Government must invest to resolve staff shortages now and in the long term, or it will be impossible to meet its ambition to diagnose three in four cancers at an early stage by 2028.

"Research and innovation has been at the heart of improvements for patients. As the UK prepares to leave the European Union, it is essential that patients and our world-leading life sciences environment are not harmed."

Professor Sean Duffy, former National Clinical Director for Cancer at NHS England, said: 'Curing more cancers means diagnosing them early, this remains our challenge today and for the foreseeable future. Having the ability to act swiftly to diagnose people with symptoms should be our greatest priority.'

BIRMINGHAM, Ala. - Despite medical and surgical advances to treat epilepsy, between 15 and 40 percent of patients continue to suffer from seizures. A significant service gap exists to bring new therapies -- called neuromodulation -- that could help many of these patients.

To fill this gap and improve seizure control for drug-resistant epilepsy, the University of Alabama at Birmingham created an epilepsy neuromodulation clinic. Now Sandipan Pati, M.D., assistant professor in the UAB Department of Neurology, and colleagues report on the outcomes provided by this specialized clinic during 19 months of operation, in a short research article published in Epilepsia Open.

Overall, Pati says, they found improved access for patients, good communication with referring physicians, achievement of expected outcomes for reducing or eliminating seizures, and the ability to train future providers in programming neuromodulation devices. This met their benchmark goals for the clinic of rapid accessibility for patients and referring physicians, despite the challenges of running a special clinic in a busy tertiary academic center like UAB Hospital.

In the study, UAB researchers report on two Food and Drug Administration-approved neuromodulation therapies -- vagal nerve stimulation, or VNS, and responsive neurostimulation, or RNS. Both use implantable stimulators that deliver electrical pulses to the brain or to the vagus nerve in the neck.

"There is a significant challenge in integrating these neuromodulation therapies in clinical practice," Pati said, "including appropriate patient selection, education for informed decision-making, availability of trained physicians to implant the device safely, and programming or troubleshooting the device to optimize therapy."

The neuromodulation devices need to be adjusted a number of times after implantation, a process called titration, to determine the most effective stimulation for each patient.

For patients receiving VNS at the UAB clinic, 12 out of 27 self?reported a more than 60 percent reduction in seizures at follow-ups, eight months or more after implantation; none were seizure-free. All of the VNS patients were from Alabama, many traveling considerable distances, up to 250 miles.

For the RNS, 11 of 16 patients self?reported a more than 60 percent reduction in seizures, and four were seizure?free. Most of the RNS patients were from Alabama, with many traveling considerable distances. Four were from the states of Arkansas, Mississippi and Florida.

All patients, Pati says, were scheduled in the clinic within two to four weeks, and stimulations were rapidly optimized. About 40 percent of patients participated in research, and 28 percent were referred for additional diagnostic studies. Additionally, 19 students and fellows were trained in programming the neurostimulators.

"Here, we have demonstrated the value of organizing a specialized clinic with a focus on rapid accessibility," Pati said. "Having a specialized neuromodulation clinic allows efficient management of resources, like scheduling field engineers to attend the clinic and avoiding multiple visits within a week. Also, one important aspect of titrating stimulation is patient tolerability, and the clinic provided rapid access within three weeks to manage stimulation?related side effects."

Poor seizure control, Pati notes, has been associated with poor quality of life, depression, anxiety and adverse side effects from medications.

CORVALLIS, Ore. - Broader monitoring of patients is needed to reduce the number of people who develop a urinary tract infection after being discharged from the hospital, new research by Oregon State University suggests.

Findings were published in the journal Infection Control & Hospital Epidemiology. The exploratory study of more than 3,000 at-risk patients showed that infection was nearly three times as likely to begin after they went home compared to when they were in the hospital.

"Every healthcare-associated infection represents an undesirable patient outcome," said Jessina McGregor, associate professor in the OSU College of Pharmacy and the study's corresponding author. "If people are still at risk for those types of infections after they leave the hospital, then healthcare-associated infection research should focus more broadly than the current definitions of surveillance definitions. We need more data to stimulate innovation for better informing patient care and preventing these types of infections."

Urinary tract infections, or UTIs, are the most common type of healthcare-associated infection, according to the National Institutes of Health. Seventy-five percent of UTIs acquired in a hospital trace to the use of a urinary catheter, a tube inserted into the bladder through the urethra to drain urine. About 20% of hospitalized patients need a catheter.

"UTI surveillance has largely focused on catheter-associated infections, and also has not focused very much on infections that onset post-discharge from the hospital," McGregor said. "But recently discharged patients are still at risk for hospital-associated UTIs, and as hospitals continue to encourage shorter hospital stays, symptoms of these infections may be more likely to show up after the patient goes home. However, data to describe the incidence of these infections is lacking, which is a barrier to better identifying which patients are most at risk."

In the group studied by Oregon State researchers, 10.6 patients per 1,000 developed a UTI while in the hospital; 29.8 per 1,000 did so within 30 days of going home. In addition to catheterization, other risk factors for healthcare-associated "community onset" UTIs - those that develop outside a hospital setting - are quadriplegia and paraplegia, prior use of certain antibiotics, and whether a patient has private insurance; those with private insurance are less likely to become infected.

"Patients who got sick after discharge had similar pathogens and antibiotic sensitivities to those who got sick while still in the hospital, which suggests that patients developing a UTI following discharge may need different treatment strategies than patients who develop UTIs that aren't associated with hospital stays," McGregor said.

The results don't say with certainty that the post-discharge infections were acquired in the hospital, but the evidence is strong enough to warrant further study, she added.

ANAHEIM, CA (Embargoed until 10:30 a.m. PDT, Tuesday, June 25, 2019) - Research presented at the 2019 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNM MI) shows preliminary evidence that tobacco smokers may have reduced neuroimmune function compared with nonsmokers.

Tobacco, a leading cause of preventable death, has complex effects on immune signaling. While nicotine suppresses the immune system, other compounds in tobacco smoke cause inflammation. Since impaired neuroimmune signaling may contribute to compulsive drug use, this study compared neuroimmune responses in tobacco smokers and nonsmokers using a new [11C]PBR28 positron emission tomography (PET) brain imaging paradigm.

"This work has important implications for tobacco smokers," explains Ansel T. Hillmer, PhD, assistant professor of radiology and biomedical imaging and of psychiatry at Yale University in New Haven, Connecticut. "There is broad interest in targeting neuroimmune mechanisms with therapeutics for substance use disorders, but most of the interest is in suppressing the brain's immune system. Our preliminary work suggests that restoring the immune system may benefit tobacco smokers. Immune dysfunction is linked to cognitive dysfunction, which is also a typical complaint in smokers trying to quit."

For the study, baseline scans were acquired in 16 smokers and 19 nonsmokers. A subset of eight smokers and nine nonsmokers also participated in a second scan three hours after administration of the pro-inflammatory stimulus lipopolysaccharide (LPS).

No significant differences in baseline scans were observed between smokers and nonsmokers. However, the response to LPS was significantly lower in smokers vs. nonsmokers in certain regions of the brain, including the striatum and cortex. The preliminary results of this ongoing study provide initial evidence for impaired neuroimmune function in tobacco smokers compared to nonsmokers.

Hillmer points out, "This is the first demonstration of group differences with this imaging paradigm. Our findings indicate an important new role for molecular imaging in clinical research studying the brain's immune system." He adds, "We hope to explore in future research how restoration of the immune system may help smokers quit by improving cognitive function."

The Affordable Care Act (ACA) expanded health insurance coverage, including eligibility for Medicaid, the public insurance program for low-income Americans. Under the ACA, states can decide whether to expand eligibility for Medicaid coverage. As of earlier this year, 36 states and the District of Columbia had adopted Medicaid expansion, and other states are still debating whether to do so.

Against this background, a new study sought to determine how the nature of visits to emergency departments (EDs) changed for previously uninsured patients who gained Medicaid insurance expansion under the ACA in 2014 and who went to the ED at least once before and once after expansion. The study found that compared with patients who remained uninsured in states where Medicaid was not expanded, these patients shifted their use of the ED toward conditions that required subsequent hospitalization and predominantly for illnesses that were not easily avoided by robust outpatient care.

The study, by researchers at Carnegie Mellon University and US Acute Care Solutions, appears in Medical Care Research and Review.

"This is the first study to follow individual patients across multiple states who gained Medicaid insurance under the expansion of the ACA, and we found that they shifted their ED use toward visits for more severe conditions," explains Rahul Ladhania, a recent Ph. D. graduate from Carnegie Mellon University's Heinz College, who led the study. "The findings suggest that newly insured patients may have greater access to outpatient care for less severe conditions that had previously been addressed by visits to the ED."

The researchers sought to identify the average effect of enrollment in Medicaid after the ACA expansion went into effect on the nature of subsequent ED use by patients who had previously been uninsured and who visited EDs at least once before and once after expansion. To do so, they looked at data on patient visits from 30 EDs in seven states (Illinois, Nevada, North Carolina, Ohio, Oklahoma, Rhode Island, and West Virginia) from April 2013 through September 2015. Of these seven states, 19 EDs were in five states (Illinois, Nevada, Ohio, Rhode Island, West Virginia) that expanded Medicaid in January 2014, and 11 were in two states (North Carolina and Oklahoma) that did not expand Medicaid before the end of 2015. ED visits in the facilities the researchers examined are comparable to ED visits nationally.

Specifically, the researchers examined changes in use of EDs by previously uninsured 18- to 64-year-old patients who were identified as repeat ED users in states that expanded Medicaid eligibility and were subsequently Medicaid-insured in the period after expansion. The authors compared these patients' change in ED use with that of patients who were similar in their use of EDs but remained uninsured because they lived in states that did not expand Medicaid. The study linked individual patients' ED visits to the same facility over time, which allowed researchers to track changes in individual patients' behavior as they went from being uninsured to having Medicaid or as they remained uninsured, depending on the state.

The study found that visits to the ED were nearly 29% more likely to result in hospital admission for the newly insured patients in expansion states, compared with those visiting the ED who remained uninsured in non-expansion states. Additionally, they found a similar (31%) increase for conditions for which hospital admissions may not be avoided by robust treatment in an outpatient setting. The authors point to these findings as important for the patients studied because using the ED for less severe conditions is of particular concern.

"We find that Medicaid expansion led the newly insured to use EDs for more severe, acute conditions than they did when they were uninsured. This suggests that ending Medicaid expansion may increase the use of hospital EDs for less severe cases, reducing the efficiency of EDs in taking care of critically ill and injured patients - exactly what policymakers and clinicians wish to avoid," says Amelia Haviland, associate professor of statistics and health policy at Carnegie Mellon University, who co-authored the study.

The researchers acknowledge that the group targeted in their work--patients who use the EDs at least twice in a two-and-a-half-year period --is a selective cohort. This is a group of particular interest to policymakers.

CLEVELAND -- Common antidepressants interact with the opioid pain medication tramadol to make it less effective for pain relief, according to a study from University Hospitals (UH). These findings have important implications for the opioid epidemic, suggesting that some patients suspected of drug-seeking may in fact be under-medicated and just are seeking more effective pain relief. They also could help explain why some people exceed the prescribed dose of tramadol, increasing their risk of addiction.

The study was published in the journal Pharmacotherapy.

Researchers reviewed the medication records of 152 patients at UH Cleveland Medical Center and UH Geauga Medical Center who received scheduled tramadol for at least 24 hours. All participants in the study were admitted as inpatients or observation status. Those patients who also were taking the antidepressants Prozac (fluoxetine), Paxil (paroxetine) or Wellbutrin (bupropion) required three times more pain medication per day to control "breakthrough" pain throughout the day, when compared with patients not taking those antidepressants.

"As we looked at in secondary analysis, it ended up being four times as much over their entire hospital stay," said Derek Frost, a pharmacist at UH and lead author of the study.

Previous studies with healthy volunteers have shown effects on blood levels when combining tramadol with these particular antidepressants. However, this is the first study to document the effects of this interaction in a real-world setting with patients.

"We knew that there was a theoretical problem, but we didn't know what it meant as far as what's happening to pain control for patients," Frost said.

What explains the interaction between tramadol and these antidepressants?

"Tramadol relies on activation of the CYP2D6 enzyme to give you that pain control," Frost said. "This enzyme can be inhibited by medications that are strong CYP2D6 inhibitors, such as fluoxetine, paroxetine and bupropion."

According to Frost, it's likely that millions of Americans may be suffering the ill effects of this drug-to-drug interaction.

"These drugs are super-common," he said. "They're all in the top 200 prescription drugs. In addition, chronic pain and depression and anxiety go hand in hand. Many chronic pain patients are taking antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), which many of these CYP2D6 inhibitors fit into. There are a lot of patients who experience both, unfortunately. The likelihood that somebody on one of these offending agents and tramadol is relatively high."

Fortunately, Frost said, this problem has a relatively easy fix.

"We have a lot of other antidepressants available that are in the same class of medication that don't inhibit this particular enzyme, such as Zoloft (sertraline), (Celexa) citalopram and Lexapro (escitalopram)," he said. "You also have other options for pain control - non-opioid medications such as NSAIDs. If we need to use opioids, a scheduled morphine or a scheduled oxycodone would avoid this interaction."

"For patients who have the combination of chronic pain and depression or anxiety, keep in mind that this interaction does exist," Frost said. "And for health care providers, if you have a patient approaching you saying this medication isn't working for me, is there an interaction at play?"

CORVALLIS, Ore. - Private prisons play a political role in immigration and incarceration issues in the United States and the industry may face obstacles as well as opportunities in the current political landscape, a new paper from an Oregon State University researcher suggests.

"The big picture view of this industry shows that companies operating private prisons are political actors who shape politics and policies but also are affected by ongoing political battles," said the paper's author, Brett Burkhardt, an associate professor of sociology in the School of Public Policy at OSU. "That leaves them in a somewhat precarious position moving forward."

The findings were published recently in a special issue of the journal Criminology & Public Policy that focuses on private prisons.

The modern private prison system in the United States has been around since the 1980s. Today, the industry is a multi-faceted, multi-billion dollar market. Private prisons hold more than 120,000 inmates, about 8% of all prisoners, for 29 states and the federal government. The two largest private prison companies also operate more than 13,000 beds for immigrant detention.

Burkhardt's paper reviews existing research on private prisons and the politics of the industry in an effort to identify broad themes. He found that privatizing corrections is not uniformly accepted by politicians and the public.

"There is no evidence to suggest that private prisons are any better, or worse, than public correctional facilities, which raises questions about what their role is," Burkhardt said. "Private prisons tend to take on different responsibilities, generally working with lower risk offenders."

He also found that private prisons face both challenges and opportunities in the current climate. Among the obstacles facing the industry is the volatility around immigration detention, which provides a growing market but also may present moral or ethical challenges for investors and the public.

While the current U.S. government administration has adopted tough immigration policies that have led to increased detention, some private companies are refusing to participate in activities related to detention of migrant children, or publicly distancing themselves from government policies around child detention, Burkhardt found.

The private prison industry also faces declining incarceration rates nationally - in part due to political decisions around criminal justice reform and decriminalization of drugs like marijuana in many places.

But as the corrections industry changes in the U.S. private prison companies also could explore new opportunities that emerge, such as overseeing drug testing and treatment programs or community supervision programs.

"The issues the private corrections industry are facing are not going away anytime soon. That presents a dilemma for the industry," Burkhardt said. "Political decisions will help determine how the industry develops from here."

A recent study conducted at The Westmead Institute for Medical Research has shed light on the role of vitamin D in muscle cells. The study looked at the role of vitamin D in muscles in mice, and showed that vitamin D signaling (how cells communicate with one another) is needed for normal muscle size and strength.

Researchers found that mice missing the vitamin D receptor only in myocytes (muscle cells) had smaller muscles, and they were less strong. They also had significantly decreased running speed and didn't run as far as mice with normal vitamin D action.

Lead researcher, Professor Jenny Gunton says, "For a long time, we have known that vitamin D deficiency is associated with muscle weakness and greater risk of falls and fractures. However, whether vitamin D played a direct role in muscle wasn't known.

"We show that vitamin D receptor is present in low levels in normal muscle, and our study found that deleting muscle cell vitamin D receptors had important effects on muscle function."

Professor Gunton says that, compared to a previous study she conducted that looked at mice missing vitamin D receptors across their whole body, this new study has highlighted some important differences.

"We found that mice missing muscle cell vitamin D receptors had normal body size but less muscle mass and more fat mass.

"In terms of choosing to run on a wheel in their cage, the mice had shorter running distance and slower speed. These might contribute to the lower muscle mass and increase in fat.

In terms of muscle strength, these mice also had a significantly decreased grip strength from a very early age."

While more research is needed, Professor Gunton says that these results suggest that maintaining normal vitamin D signaling in muscle is important for preserving muscle bulk and function.

"These findings also have the potential to open up avenues to pursue new therapies that target muscle cell vitamin D receptors. These therapies could help to address or prevent age-related sarcopenia (degenerative loss of skeletal muscle mass) and other disorders related to muscle function."

The research paper was published in the Journal of Cachexia, Sarcopenia and Muscle.

Researchers at the University of Washington in Seattle, Washington, are developing a user-friendly (worn at home) vest with technology that collects data to tailor personalized therapy for patients with metastatic, somatostatin-receptor-2 positive neuroendocrine tumors (NETs). The study was presented at the 2019 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

Targeted therapy using lutetium-177 (177Lu)-DOTATATE greatly increases progression-free survival for NETs patients. While approved by the United States Food and Drug Administration (FDA), the FDA package instructions call for patients to receive a standardized protocol, regardless of size or weight. Traditionally, targeted radionuclide therapies are personalized based on dose to the main organs at risk (OAR, e.g., kidneys, liver, spleen).

"Organ specific dosimetry for the 177Lu-DOTATATE (Lutathera) is the norm at many medical centers outside of the United States," explains Robert Miyaoka at the University of Washington. "Longitudinal imaging studies are conducted after each therapy treatment to determine the cumulative dose to the OAR for each patient. The standardized 177Lu-DOTATATE treatment protocol in the United States consists of four 200 mCi doses spaced two months apart. Although this is safe for a vast majority of patients, it is less than optimal for most. Studies out of Europe are revealing that tailoring the number of treatment doses based upon the dose-limiting toxicity to the patient's OAR can more than double the progression-free and overall survival for NET patients undergoing 177Lu-DOTATATE therapy."

Another factor the researchers sought to address is the fact that traditional imaging-based methods for organ dosimetry estimation for 177Lu require three-to-four longitudinal imaging sessions spread over seven days. This is expensive, uses a lot of clinic resources and is burdensome to the patient.

"We propose to create a lightweight, low-cost, wearable, patient-specific technology that will allow organ-specific measurement recordings to be made within the comfort of the patient's home," Miyaoka says. "The garment [called a multi-detector personalized home dosimetry (MD PHD) vest] will house 15-20 small radiation detectors, strategically placed within the vest based upon the patient's own anatomy. In addition to the radiation detectors the vest will be coupled to a compact electronics pack that will acquire the data and send it via WiFi or cellular services to a secure website where medical personnel/software can check the data for quality control in near real-time."

He further explains, "The patient will be asked to wear the vest for a two-minute data acquisition once a day for seven (and up to 21) days. Based upon these at-home measurements and a single SPECT/CT image taken 24 hours after the therapy administration, organ specific dosimetry will be determined for all of the patient's OAR." With the information collected via the vest, physicians would be able to tailor the number of treatments based upon personalized organ dosimetry information.

Miyaoka reports, "Preliminary vest results from simulations are showing that at-home vest measurements made over 7-21 days can provide organ-specific washout rates with precision as good or better than the current accepted gold standard of three-four quantitative SPECT/CT images acquired over seven days. The initial goal of this technology is to enable personalized 177Lu-DOTATATE therapies in the United States and to lower the cost for treatment personalization throughout the world."

A new technology discovered by a team including UConn School of Dental Medicine researchers records cellular communication in real time – providing a closer look into the dynamics of cell secretion and a greater understanding of how cells repair tissue.

Kshitiz, an assistant professor (who goes by just his first name), and Yasir Suhail, a postdoctoral fellow, in the Dental School’s Department of Biomedical Engineering, along with Andre Levchenko and Onur Kilic, Yale University; David D. Ellison and Laura Woo, The Johns Hopkins School of Medicine; Junaid Afzal, University of California, San Francisco; and Jeffrey Spees, University of Vermont, collaborated on the study, which is published online in the Proceedings of the National Academy of Sciences.

Now for the first time, scientists can record cells communicating in real time, opening the floodgates for new developments in cell therapy and other areas within cell biology.

Cells - like humans - are in constant communication with each other. Whereas humans exchange words, cells deliver and receive messages through secreting proteins and changing their behavior accordingly. When we listen to humans speak to each other, we can understand how words are placed into sentences and how the conversation moves back and forth. When it comes to recording communication between cells, however, the key characteristics of the conversation have been largely unknown until now.

Communication between cells is necessary to maintain most functions in the body and can also help the body properly respond to an external cue - such as an ailment or injury. Current technology only allows broad snapshots of these protein secretions.

"This is akin to detecting what words were spoken in a sentence, but not really knowing their placement, the inflection, and tone of the message," says Kshitiz. Prior to the current findings, he adds, understanding of the language of communication between cells has been very limited, and did not capture the complexity of messaging involved.

Using a combination of microfluidics and computer modeling, researchers created a platform to record cell messages in depth, uncovering the precise ways in which the words and messages are arranged in these intercellular conversations.

In the study, which was funded by the American Heart Association and the National Cancer Institute, Kshitiz and fellow researchers Suhail at UConn and Levchenko at Yale looked at stem cells from bone marrow that can be used to treat myocardial infarction, commonly known as a heart attack. Using the platform, the researchers recorded the proteins that were secreted by these stem cells, and how these secretions changed with time.

The information was used to create a protein cocktail that led to a second discovery - the possibility of aiding an injury without the use of stem cells. Since the researchers recorded in depth the conversations between the stem cells, they were able to copy the stem cells' exact behavior.

Stem cells - the researchers witnessed - are flexible enough to change their behavior depending on the injury present. These cells only act as "Good Samaritans," the researchers discovered, when they see injured tissue.

This information created a way to make a "cell-less" therapy by copying what stem cells do when they see a tissue injury and creating a new protein cocktail that aided in repairing cardiac tissue. The discovery of cell-less therapy can potentially reduce many complications associated with stem cell transplantation in the future.

"The findings solve a fundamental problem afflicting systems biology: measuring how cells communicate with each other," says Suhail. "The platform technology will open new lines of inquiry into research, by providing a unique way to detect how cells talk to each other at a deeper level than what is possible today."

BINGHAMTON, N.Y. - The Woodstock Music Festival celebrates its 50th anniversary this summer, and new archaeological research from Binghamton University, State University of New York shows that the iconic event took on a life of its own.

Binghamton University's Public Archaeology Facility have worked closely with The Museum at Bethel Woods and Bethel Woods Center for the Arts to dig at the site of the original Woodstock Music and Art Fair. In 2018 they determined the exact location of the stage. More recently, they worked to locate and identify cultural features to help the museum construct a trail system based on plans from the Woodstock archives. By analyzing the rocks and vegetation surrounding the area, the team successfully identified 24 vendor booths and 13 other potential cultural features in an area known as the Bindy Bazaar.

Maria O'Donovan, project director, said the Bindy Bazaar is an important cultural landmark that reflects the spirit of the festival.

"The Bindy Bazaar was a meeting place where transactions -- which included trading and bartering, in addition to selling -- and cultural interactions took place," said O'Donovan. "It exemplifies the informal, free-wheeling spirit of the counterculture."

An original map and photos of the Bindy Bazaar indicate that there were about 25 vendor booths in the area that appear to have been ad hoc arrangements of natural rock, trees, wood and other materials. However, the mapped-out booths were not in the same spatial configuration as those defined by the current archaeological research.

O'Donovan said this discovery reveals the exciting spontaneity of Woodstock.

"Our research demonstrated that the reality of what occurred at Woodstock was not captured by the preliminary plans," she said. "Archaeologists located 24 potential vendor booths concentrated on one side of the Bindy Bazaar area and not distributed as on the 1969 plans. This is more evidence that the festival took on a life of its own that organizers could not control. We also identified more recent usage of the area, which could be related to later anniversary events or causal use of the site before it was acquired and preserved by Bethel Woods."

Based on photos, the Bindy Bazaar seemed to be located between two campgrounds, with trails that funneled foot traffic between venues. At first glance, the location appears to be unchanged over the last 50 years, but new trees and vegetation produced debris that reduced the area's visibility. Despite these challenges, archaeologists determined that potential vendor booths could be distinguished through well-defined examples of stacked stone and other features that clearly indicated human intervention. Other elements were labeled as cultural features if they had no clear function and if the arrangements seemed unnatural.

The results from this research will help The Museum at Bethel Woods develop a cultural interpretation program that includes interpretive walking routes for the concert's 50th anniversary this summer. O'Donovan said the Museum at Bethel Woods aims to use this research to preserve and honor the Bindy Bazaar and surrounding area.

"The Museum at Bethel Woods has long-term preservation and interpretive goals for the site," she said. "Their immediate concerns were to prevent further impact to the area and to open the Bindy Bazaar to visitors with a reconstructed trail network and with interpretive signage. The Museum at Bethel Woods is considering special displays in the Bindy Bazaar for the 50th anniversary and I am sure the anniversary influenced the timing of our research."

The trails opened to the public on May 4 in a ribbon cutting ceremony, Assistant Curator at Bethel Woods Center for the Arts Julia Fell welcomed guests in saying "...[Bindy Bazaar] was a whimsical place where all manner of vendors and other attendees bartered for goods, met up with lost friends, made new friends, and attempted to stay out of the rain. With all this in mind, The Museum at Bethel Woods set out to bring the Bindy Bazaar back into its former glory."

If a man is handy with the vacuum cleaner, isn't averse to rustling up a lush family meal most nights after he's put on the washing machine having popped into the supermarket on his way home then it's more than likely his partner will have her own bank account.

A new study by Lancaster University reveals the way in which couples manage their money tells 'a tale of two marriages' in the UK today.

The research shows the management of household finances and control of financial decisions are linked to the time spent by women and men on routine housework such as cooking, cleaning, laundry and grocery shopping.

'What about money? Earnings, household financial organization, and housework' conducted by Lancaster Lecturer in Sociology, Dr Yang Hu, is published today in the Journal of Marriage and Family.

The study analysed data from more than 6,000 heterosexual couples, aged 20 to 59, from the UK Household Longitudinal Survey (Understanding Society).

This is the first study to examine how the organisation of household finances intervenes between couples getting their pay packets and housework at home. It takes previous studies on housework a step further.

"Housework provides a window into the 'checks and balances' of power and gender in couple relationships," said Dr Hu.

To negotiate their housework participation, men either hand over their income to their partners, who manage the money, so they use money to 'exchange' their way out of housework, or they hold on to their income to 'bargain' their way out of housework.

"Men get away with not doing housework through both channels," explains Dr Hu. "It puts women in a very compromising position as they are left to do the lion's share of housework."

Given wage penalties and a glass ceiling in the labour market, women are unlikely to win the 'war' over housework by 'exchanging' and 'bargaining' with men.

They are seen to negotiate in a different way. Going 'solo', some working women are seen to opt out of housework by taking control of their own earnings and developing a sense of autonomy.

Indeed, women's income only reduces their housework time when they can access their own earnings and have a say in household financial decisions. But the study finds that in the UK, less than 12% of working-age women kept separate purses, another 23% managed household finances, and only around 15% controlled financial decisions.

"Our research provides further evidence to show that despite women's participation in education and the labour market, this still has not yet translated into gender equality in housework at home," said Dr Hu.

"If men still monopolise the management of household finances and financial decisions, then things are unlikely to change," said Dr Hu. "It's therefore important for everyone to be able to access their own earnings.

"Educating and employing more women and settling the gender pay gap with gender equality flowing neatly into place at home as a result is certainly not the story this analysis is revealing."

Selecting the best possible embryo to implant in a woman undergoing in vitro fertilization (IVF) is a complicated task. As success rates for IVF have improved, many clinics now implant a single embryo during an IVF cycle -- with the goal of avoiding a multiple pregnancy -- and the responsibility of selecting the embryo falls to the embryologist. To determine the quality and viability of an embryo, embryologists typically examine specific features of the embryos using a light microscope. In addition, specialists can use data from preimplantation genetic testing for aneuploidy (PGT-A), a test of whether cells from the embryo at the blastocyst stage have a normal or abnormal number of chromosomes. However, this crucial test carries the risk of false positives (which could lead to discarding a normal embryo) and false negatives (which could lead to transferring an embryo with a chromosomal abnormality). A team of researchers from Brigham and Women's Hospital, in collaboration with colleagues at Peking University and Yikon Genomics in China, have evaluated a new way to conduct preimplantation genetic testing and present results showing that this new method may improve the reliability of the test. Their findings are published in Proceedings of the National Academy of Sciences.

"This technique holds the promise of a more precise test than the current method," said co-corresponding author Catherine Racowsky, PhD, director of the IVF laboratory at the Brigham, and professor in the Department of Obstetrics and Gynecology at Harvard Medical School. "It represents a new way to evaluate embryos with less risk of discarding a viable embryo."

Current PGT-A testing uses a trophectoderm (TE) biopsy. If the blastocyst was a tennis ball, then its fluffy, green outer covering would be its TE cells. Inside the blastocyst is the inner cell mass (ICM) -- cells that will give rise to the fetus. Since current PGT-A testing involves biopsy of a few TE cells, they sometimes fail to reflect the genomic profile of the ICM cells within, especially if the blastocyst contains both normal and abnormal cells -- a phenomenon known as mosaicism.

The new technique, originally developed by co-corresponding author Xiaoliang Sunney Xie, PhD, of Peking University, is known as noninvasive preimplantation genetic testing for aneuploidy (niPGT-A). Instead of extracting TE cells, niPGT-A analyzes DNA leaked from human blastocysts into the culture medium in which they are growing. The technique has several potential advantages. Since it is non-invasive, it does not interfere directly with the embryo. In addition, the technique has the potential to resolve the issue of mosaicism and is more likely to capture the genomic profile of cells from within the inner cell mass.

The team tested the accuracy of niPGT-A using 52 blastocysts donated for research by patients undergoing infertility treatment. Each blastocyst had previously undergone TE biopsy testing by an outside laboratory. The investigators compared the sequencing results of DNA from both the surrounding culture medium and TE biopsy samples with the true results obtained by sequencing the whole embryo.

The team found that the new technique of niPGT-A outperformed the current PGT-A with the TE biopsy method. The niPGT-A technique had a false positive rate of 20 percent, reporting that 3 of 15 embryos tested as abnormal when they were not; the TE method had a false positive rate of 50 percent, reporting that 9 of 18 embryos testing as abnormal were, indeed, normal.

The team notes that the sample size they used was small and that a higher percentage of the embryos were abnormal than would be traditionally seen from women of comparable age in an IVF clinic. The embryos had also been previously biopsied, frozen and then thawed, potentially increasing the amount of DNA leakage from the inner cell mass into the medium. The team is already at work on follow-up experiments to validate that DNA can be detected in the medium, even in embryos that have not been previously biopsied.

"Our ongoing work will help us to determine whether niPGT-A will translate into a paradigm shift for PGT-A in clinical IVF," said Racowsky.

If you made any plans for next week, congratulations! You've demonstrated a key feature of being human: being able to think beyond the here and now - or, think abstractly. But when babies learn different kinds of abstract thought, and how, is still hotly debated by psychologists. Now new research published in the Proceedings of the National Academy of Sciences suggests that cultural environment may play a role.

The paper, titled "Context Shapes Early Diversity in Abstract Thought," details three experiments involving nearly 400 children in the United States and China, aged 18 to 48 months old.

The children were tested on their "relational reasoning" skills. Specifically, they were tested on their ability to infer the abstract concepts "same" and "different" from pairs of blocks that either matched each other or did not.

The youngest children in the U.S. and China appear to have similar success. By age 3, however, Chinese children are outperforming their U.S. counterparts, the research shows.

The under-3 set do comparably well at recognizing the relationships between pairs of blocks - whether they're the same or different - and then figuring out whether these blocks' sameness or difference is responsible for activating a musical toy. But then the skills diverge in the two cultures for a while. Also, when given a choice between favoring an object-based solution (concrete thinking) and a relation-based solution (abstract), U.S. 3-year-olds favor the former while Chinese 3-year-olds, on the other hand, go for the latter.

Why? Why does the development curve for American kids looks like a "U," with relational reasoning skills dipping around age 3 until they pick up later - while Chinese children show no such dip in the middle, and their development seems to follow a linear trajectory?

The root reasons could be linguistic, the paper's authors suggest, or they could be cultural, environmental or some combination of these. In any case, what seems to be at work is a "learned bias," with children in the U.S. learning, for a while, to focus on objects to the detriment of relations.

The paper's first author is Alexandra Carstensen, now a postdoctoral researcher at Stanford University and a visiting scholar at the University of California San Diego. The paper's senior author is Caren Walker, assistant professor of psychology at UC San Diego and director of the university's Early Learning and Cognition Lab.

Carstensen and Walker started working on the idea when both were graduate students at UC Berkeley. Walker had shown earlier that children begin to reason abstractly much younger than had been previously believed (as well as that, in the U.S., they lose the ability for a while). That work inspired Carstensen to wonder about the possible role of language.

Both Carstensen and Walker are doing follow-up work to extend the research.

Carstensen and Walker are trying to figure out, with graduate and undergraduate students in Hungary, Germany, Italy, the United Kingdom and Pakistan, what cultural features might be most relevant to relational reasoning and the learned bias against it.

Walker and her lab, meanwhile, are also doing a series of projects to examine ways to get preschoolers in the U.S. to think more abstractly.

"It doesn't have to be something as grand as language or cultural context that makes a profound difference," Walker said. "It could be as small as changing a few features of the learning environment - or just changing a handful of simple learning cues."