Carbon Chemist

Tag: CT

  • Treatment for anxiety and depression associated with improved heart disease outcomes

    Treatment for anxiety and depression associated with improved heart disease outcomes

    [ad_1]

    Treating anxiety and depression reduced emergency room visits and rehospitalizations among people with heart disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death.”


    Philip Binkley, M.D., M.P.H., lead study author, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University in Columbus, Ohio

    Binkley noted that anxiety and depression are common in people with heart failure, and mental health can have a significant impact on an individual’s risk of other health conditions, disability and death.

    In this study, Binkley and colleagues examined the association of mental health treatment with antidepressant medication or psychotherapy, also known as talk therapy or a combination of the two in relation to, emergency room visits, hospitalizations and death in people with blocked arteries or heart failure and with a formal diagnosis of anxiety or depression before hospitalization.

    The analysis found using three different statistical models that adjusted for different variables and compared to patients not receiving treatment for anxiety or depression:

    • For people who received both medication and talk therapy for anxiety or depression the risk of hospitalization was reduced by 68% to 75% the risk of being seen in the emergency department was reduced by 67% to 74%, and the risk of death from any cause was reduced by 65% to 67%.

    • Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits.

    • Medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%.

    • Follow-up time was variable based on the needs of each patient.

    “Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”

    Binkley considers the large number of people with heart disease and the marked reduction in hospitalizations and emergency room visits and the drop in death to be the strength of the study.

    “I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” he said.

    Study details and background:

    • 1,563 adults ages 22 to 64 over a three-year period were included, and all participants had a first hospital admission for blocked arteries or heart failure and had two or more health insurance claims for an anxiety disorder or depression.

    • Sixty-eight percent of participants were women, and 81% were noted as white race. All were enrolled in Ohio’s Medicaid program during the six months prior to the hospital admission. Health data was from two sources: Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012.

    • Participants were followed through the end of 2014 or until death or the end of Medicaid enrollment.

    • About 23% of participants received both antidepressant medications and psychotherapy; nearly 15 percent received psychotherapy alone; 29% took antidepressants alone; and 33% received no mental health treatment.

    • About 92% of participants in the study were diagnosed with anxiety and 55.5% with depression prior to hospitalization.

    The study was limited to people enrolled in Medicaid, therefore, it may not be representative of people covered by commercial health insurance plans. In addition, the majority of participants were noted as white race, therefore, these finding are not applicable to people of other races, ethnicities or communities.

    Source:

    American Heart Association

    Journal reference:

    Carmin, C. N., et al. (2024) Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.031117.

    [ad_2]

    Source link

  • Regular intake of sugary drinks, fruit juices tied to higher Type 2 diabetes risk in boys

    Regular intake of sugary drinks, fruit juices tied to higher Type 2 diabetes risk in boys

    [ad_1]

    A small, long-term study of almost 500 children in Massachusetts has found that regularly drinking sugary drinks and 100% fruit juices during childhood and adolescence may be linked to a higher risk of developing Type 2 diabetes among boys than girls, according to preliminary research to be presented at the American Heart Association’s Epidemiology and Prevention│Lifestyle and Cardiometabolic Scientific Sessions 2024, March 18- 21, in Chicago. The meeting offers the latest science on population-based health and wellness and implications for lifestyle.

    While these findings are preliminary, they support the existing evidence about the potential relationship between beverages with added sugar and long-term risk of Type 2 diabetes in children. Pediatricians and other health care professionals should caution young patients and their parents about sugary drinks and fruit juices when discussing healthy eating habits.”


    Soren Harnois-Leblanc, Ph.D., lead investigator, registered dietitian and postdoctoral researcher in the department of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School

    According to a 2022 American Heart Association fact sheet about sugary drinks, nearly two-thirds of children and adolescents in the U.S. consume at least one sugary drink, such as soda, lemonade or an energy drink, each day. It also notes that in addition to weight gain, eating too many foods with added sugars, especially from sugary drinks, raises the risk of developing heart disease, high blood pressure, Type 2 diabetes and tooth decay.

    Using data from Project Viva, an ongoing long-term study of women and their children in eastern Massachusetts that began in 1999, researchers explored whether drinking sugary drinks, 100% fruit juices and eating fresh fruits were associated with markers for developing Type 2 diabetes. Researchers calculated the average consumption of sugary drinks, 100% fruit juices, and fresh fruits over childhood and adolescence based on dietary records and assessed their potential associations to three markers of Type 2 diabetes: insulin resistance, fasting blood glucose level and HbA1c levels. These markers were measured by a single blood test while fasting in late adolescence (approximately age 17).

    The analysis found:

    • Each daily serving of sugary drinks (approx. 8 ounces) during childhood and adolescence among boys was associated with a 34% increase in insulin resistance; a 5.6 milligrams per deciliter (mg/dl) increase in fasting glucose levels; and a 0.12% increase in HbA1c levels in late adolescence.

    • Drinking 100% fruit juice throughout childhood and adolescence was linked to a 0.07% increase in HbA1c levels in late adolescence per daily serving of 100% fruit juice among the boys in the study, with only a slight increase in girls of 0.02%.

    • Eating fresh fruit during childhood and adolescence did not appear to have a positive or negative effect on the risk of developing Type 2 diabetes among the boys or girls in the study, according to Harnois-Leblanc.

    The associations between regularly drinking sugar-sweetened beverage and insulin resistance, fasting blood glucose levels and elevated HbA1c levels among boys persisted when other health, family and social factors were considered. These factors included socioeconomic status; child’s and mother’s body mass index; mother’s age at time of child’s birth; maternal and paternal history of Type 1 or Type 2 diabetes; overall diet quality and other lifestyle behaviors.

    “Although several aspects of biology and behaviors differ between boys and girls, I would have expected to also find an association between sugar-sweetened beverages and fruit juice intake and the increases in insulin resistance, glycemia and HbA1c levels in late-adolescent girls. I was also surprised that eating whole fruits did not reduce the levels of these markers of Type 2 diabetes,” Harnois-Leblanc said.

    “The next steps are to use more advanced statistical tools to enable us to better understand the potential causal role of sugary drinks and fruit juices, and to examine whether the relationships may also differ among children by race and/or ethnicity.”

    Study background and details:

    • Researchers analyzed data of children of the 2,128 pregnant women who had children while enrolled in Project Viva. 972 of the children met criteria for inclusion in this study (parent-completed questionnaires at the child’s age-3 examination and no personal or parental history of Type 1 or Type 2 diabetes, assessed separately from parental history of Type 2 diabetes). Of the 972 children, 455 had a fasting blood sample collected at a research visit in late adolescence, Harnois-Leblanc noted.

    • 240 of the children in the study were girls and 215 were boys.

    • Project Viva is a long-term study of women and their children in eastern Massachusetts that began enrollment in 1999. The study is focused on improving maternal and child health by examining the potential impact of various life and health factors during and after pregnancy on the mother’s health and their children’s health, including a review of diet and nutrition. Children were followed from birth to late adolescence, up to age 20 at most recent follow-up.

    • Researchers evaluated the frequency of drinking sugary drinks, fruit juices and eating fresh fruit (based on standard serving sizes) from questionnaires completed by the parent at the child’s age of approximately 3, 8 and 13 years old; and measured fasting blood glucose, insulin and HbA1c levels in late adolescence (average age of 17.4 years).

    The study had several limitations. Although it found an association between regularly drinking sugary drinks and fruit juices and the development of markers for Type 2 diabetes, it could not prove that the drinks caused Type 2 diabetes. Additionally, the relatively small number of study participants may have affected the strength of the association found between sugary drinks and fruit juices and the increased risk of developing Type 2 diabetes.

    “Diet and cardiometabolic health are complex, with many factors varying over time and interacting in different ways, and this study represents one small piece of this puzzle,” Harnois-Leblanc said.

    American Heart Association nutrition committee member Penny M. Kris-Etherton, Ph.D., R.D., FAHA, said, “This study has shown that greater sugar sweetened beverage intake, including fruit juice, throughout childhood and adolescents is associated with higher markers of diabetes risk in late adolescents in boys but not girls. It is striking that many measures of Type 2 diabetes risk were increased in boys at such an early age.”

    Kris-Etherton, an emeritus professor of nutritional sciences at Penn State University, was also a co-author of the Association’s 2018 science advisory on low-calorie sweetened beverages and cardiometabolic health.

    “Importantly, although fruit intake did not appear to be protective, it nonetheless was not associated with increased Type 2 diabetes risk,” she said. “These findings support the current dietary recommendations of the Association, and many organizations, to limit or eliminate drinking sugar sweetened beverages and instead consume whole fruits, which are high in so many nutrients especially the shortfall nutrients in the average American diet.” (Shortfall nutrients are the vitamins and nutrients that people are missing each day from the foods they eat; long-term deficiencies in some vitamins and nutrients have been linked to adverse health outcomes.)

    The health care resource called Know Diabetes by Heart, developed by the American Heart Association and the American Diabetes Association, provides information about preventing heart disease and stroke while living with Type 2 diabetes. The initiative aims to raise awareness and understanding of the link between Type 2 diabetes and cardiovascular disease, provide resources and support to help people better manage their risk for heart disease and stroke, support health care professionals by sharing the latest clinical guidelines and science and engage health systems to improve quality of care for people with Type 2 diabetes.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • AI assistance in radiology shows mixed results for performance

    AI assistance in radiology shows mixed results for performance

    [ad_1]

    One of the most touted promises of medical artificial intelligence tools is their ability to augment human clinicians’ performance by helping them interpret images such as X-rays and CT scans with greater precision to make more accurate diagnoses.

    But the benefits of using AI tools on image interpretation appear to vary from clinician to clinician, according to new research led by investigators at Harvard Medical School, working with colleagues at MIT and Stanford. 

    The study findings suggest that individual clinician differences shape the interaction between human and machine in critical ways that researchers do not yet fully understand. The analysis, published March 19 in Nature Medicine, is based on data from an earlier working paper by the same research group released by the National Bureau of Economic Research.

    In some instances, the research showed, use of AI can interfere with a radiologist’s performance and interfere with the accuracy of their interpretation. 

    We find that different radiologists, indeed, react differently to AI assistance -; some are helped while others are hurt by it.”


    Pranav Rajpurkar, co-senior author, assistant professor of biomedical informatics, Blavatnik Institute at HMS

    “What this means is that we should not look at radiologists as a uniform population and consider just the ‘average’ effect of AI on their performance,” he said. “To maximize benefits and minimize harm, we need to personalize assistive AI systems.”

    The findings underscore the importance of carefully calibrated implementation of AI into clinical practice, but they should in no way discourage the adoption of AI in radiologists’ offices and clinics, the researchers said. 

    Instead, the results should signal the need to better understand how humans and AI interact and to design carefully calibrated approaches that boost human performance rather than hurt it.

    “Clinicians have different levels of expertise, experience, and decision-making styles, so ensuring that AI reflects this diversity is critical for targeted implementation,” said Feiyang “Kathy” Yu, who conducted the work while at the Rajpurkar lab with co-first author on the paper with Alex Moehring at the MIT Sloan School of Management. 

    “Individual factors and variation would be key in ensuring that AI advances rather than interferes with performance and, ultimately, with diagnosis,” Yu said.

    AI tools affected different radiologists differently

    While previous research has shown that AI assistants can, indeed, boost radiologists’ diagnostic performance,these studies have looked at radiologists as a whole without accounting for variability from radiologist to radiologist. 

    In contrast, the new study looks at how individual clinician factors -; area of specialty, years of practice, prior use of AI tools -; come into play in human-AI collaboration. 

    The researchers examined how AI tools affected the performance of 140 radiologists on 15 X-ray diagnostic tasks -; how reliably the radiologists were able to spot telltale features on an image and make an accurate diagnosis. The analysis involved 324 patient cases with 15 pathologies -; abnormal conditions captured on X-rays of the chest.

    To determine how AI affected doctors’ ability to spot and correctly identify problems, the researchers used advanced computational methods that captured the magnitude of change in performance when using AI and when not using it.

    The effect of AI assistance was inconsistent and varied across radiologists, with the performance of some radiologists improving with AI and worsening in others. 

    AI tools influenced human performance unpredictably

    AI’s effects on human radiologists’ performance varied in often surprising ways. 

    For instance, contrary to what the researchers expected, factors such how many years of experience a radiologist had, whether they specialized in thoracic, or chest, radiology, and whether they’d used AI readers before, did not reliably predict how an AI tool would affect a doctor’s performance. 

    Another finding that challenged the prevailing wisdom: Clinicians who had low performance at baseline did not benefit consistently from AI assistance. Some benefited more, some less, and some none at all. Overall, however, lower-performing radiologists at baseline had lower performance with or without AI. The same was true among radiologists who performed better at baseline. They performed consistently well, overall, with or without AI. 

    Then came a not-so-surprising finding: More accurate AI tools boosted radiologists’ performance, while poorly performing AI tools diminished the diagnostic accuracy of human clinicians. 

    While the analysis was not done in a way that allowed researchers to determine why this happened, the finding points to the importance of testing and validating AI tool performance before clinical deployment, the researchers said. Such pre-testing could ensure that inferior AI doesn’t interfere with human clinicians’ performance and, therefore, patient care.

    What do these findings mean for the future of AI in the clinic?

    The researchers cautioned that their findings do not provide an explanation for why and how AI tools seem to affect performance across human clinicians differently, but note that understanding why would be critical to ensuring that AI radiology tools augment human performance rather than hurt it. 

    To that end, the team noted, AI developers should work with physicians who use their tools to understand and define the precise factors that come into play in the human-AI interaction. 

    And, the researchers added, the radiologist-AI interaction should be tested in experimental settings that mimic real-world scenarios and reflect the actual patient population for which the tools are designed.

    Apart from improving the accuracy of the AI tools, it’s also important to train radiologists to detect inaccurate AI predictions and to question an AI tool’s diagnostic call, the research team said. To achieve that, AI developers should ensure that they design AI models that can “explain” their decisions.

    “Our research reveals the nuanced and complex nature of machine-human interaction,” said study co-senior author Nikhil Agarwal, professor of economics at MIT. “It highlights the need to understand the multitude of factors involved in this interplay and how they influence the ultimate diagnosis and care of patients.”

    Authorship, funding, disclosures

    Additional authors included Oishi Banerjee at HMS and Tobias Salz at MIT, who was co-senior author on the paper.

    The work was funded in part by the Alfred P. Sloan Foundation (2022-17182), the J-PAL Health Care Delivery Initiative, and MIT School of Humanities, Arts, and Social Sciences. 

    Source:

    Journal reference:

    Yu, F., et al. (2024). Heterogeneity and predictors of the effects of AI assistance on radiologists. Nature Medicine. doi.org/10.1038/s41591-024-02850-w.

    [ad_2]

    Source link

  • 99mTc-maraciclatide holds potential as a non-invasive test for early-stage endometriosis

    99mTc-maraciclatide holds potential as a non-invasive test for early-stage endometriosis

    [ad_1]

    The presentation summarized the preliminary findings from patients with known or suspected endometriosis who were imaged with a SPECT-CT camera and subsequently underwent planned laparoscopic surgery, a key-hole surgical procedure to establish the presence, absence and location of endometriotic lesions. The imaging findings were compared to the surgical and histology reports and indicate that 99mTc-maraciclatide holds potential as a non-invasive test for early-stage endometriosis.

    Specifically these preliminary findings demonstrate that 99mTc-maraciclatide has the potential to:

    • Visualize superficial peritoneal endometriosis which is found in the thin peritoneum lining which covers the abdomen and pelvis, and currently can only be identified accurately by surgery. This subtype accounts for c. 80% of all endometriosis diagnoses. In the patients in this study 99mTc-maraciclatide correctly identified superficial peritoneal endometriosis in those who went on to have this early-stage endometriosis confirmed by laparoscopy.

    • Highlight areas of activity in patients with deep endometriosis (often found on the organs e.g., bladder, bowel, rectum, ovaries) and endometrioma (cysts which are commonly found in the ovaries)

    The presentation also outlined a case study on one patient with superficial peritoneal endometriosis which had not been identified by ultrasound, but which had been visualized with 99mTc-maraciclatide, and later confirmed by laparoscopic surgery.

    The ongoing study which will recruit 20-25 patients in total is being led by Professor Christian Becker, Co-Director of the Endometriosis CaRe Centre in Oxford, together with Professor Krina Zondervan, Head of Department at the Nuffield Department of Women’s and Reproductive Health, University of Oxford. It is anticipated that the study will complete later this year.

    99mTc-maraciclatide is a radio-labeled tracer which binds with high affinity to the cell adhesion protein αvβ3 integrin and images angiogenesis (new blood vessel formation) which is known to be critical to the establishment and growth of endometriotic lesions.

    David Hail, Chief Executive Officer of Serac Healthcare, said:

    “These promising initial findings indicate that there is real potential for maraciclatide as a novel non-invasive method of diagnosing early-stage endometriosis. The ability to visualize the early-stage of this disease is particularly significant as it cannot be seen by other imaging modalities, which contributes to the almost nine year average delay to secure a diagnosis. We are hugely encouraged by these results and look forward to continuing this work with the world-leading specialists from Oxford University.”

    Endometriosis is a common disease affecting many millions of women worldwide with pain and infertility. The current delay in diagnosis results in prolonged suffering and uncertainty. Therefore, a novel imaging tool to assist healthcare professionals in identifying or ruling out the disease is urgently needed.”


    Professor Christian Becker, Co-Director of the Endometriosis CaRe Centre in Oxford

    Professor Krina Zondervan, Head of Department at the Nuffield Department of Women’s and Reproductive Health, University of Oxford added:

    “Superficial peritoneal endometriosis is the most prevalent form of the disease. It often affects younger women for whom earlier diagnosis could enable intervention at an earlier stage, with the potential to significantly change outcomes and improve prospects. At the Endometriosis CaRe Centre at the University of Oxford our studies focus on identifying novel genetic, diagnostic and therapeutic targets for endometriosis. We are delighted about the early results of the DETECT study and are looking forward to recruiting more patients to consolidate the data.”

    [ad_2]

    Source link

  • Biocompatible, bioresorbable sticker detects anastomotic leaks

    Biocompatible, bioresorbable sticker detects anastomotic leaks

    [ad_1]

    Researchers led by Northwestern University and Washington University School of Medicine in St. Louis have developed a new, first-of-its-kind sticker that enables clinicians to monitor the health of patients’ organs and deep tissues with a simple ultrasound device.

    When attached to an organ, the soft, tiny sticker changes in shape in response to the body’s changing pH levels, which can serve as an early warning sign for post-surgery complications such as anastomotic leaks. Clinicians then can view these shape changes in real time through ultrasound imaging.

    Currently, no existing methods can reliably and non-invasively detect anastomotic leaks -; a life-threatening condition that occurs when gastrointestinal fluids escape the digestive system. By revealing the leakage of these fluids with high sensitivity and high specificity, the non-invasive sticker can enable earlier interventions than previously possible. Then, when the patient has fully recovered, the biocompatible, bioresorbable sticker simply dissolves away -; bypassing the need for surgical extraction.

    The study will be published on Friday (March 8) in the journal Science. The paper outlines evaluations across small and large animal models to validate three different types of stickers made of hydrogel materials tailored for the ability to detect anastomotic leaks from the stomach, the small intestine and the pancreas.

    “These leaks can arise from subtle perforations in the tissue, often as imperceptible gaps between two sides of a surgical incision,” said Northwestern’s John A. Rogers, who led device development with postdoctoral fellow Jiaqi Liu. “These types of defects cannot be seen directly with ultrasound imaging tools. They also escape detection by even the most sophisticated CT and MRI scans. We developed an engineering approach and a set of advanced materials to address this unmet need in patient monitoring. The technology has the potential to eliminate risks, reduce costs and expand accessibility to rapid, non-invasive assessments for improved patient outcomes.”

    “Right now, there is no good way whatsoever to detect these kinds of leaks,” said gastrointestinal surgeon Dr. Chet Hammill, who led the clinical evaluation and animal model studies at Washington University with collaborator Dr. Matthew MacEwan, an assistant professor of neurosurgery. “The majority of operations in the abdomen -; when you have to remove something and sew it back together -; carry a risk of leaking. We can’t fully prevent those complications, but maybe we can catch them earlier to minimize harm. Even if we could detect a leak 24- or 48-hours earlier, we could catch complications before the patient becomes really sick. This new technology has potential to completely change the way we monitor patients after surgery.”

    A bioelectronics pioneer, Rogers is the Louis Simpson and Kimberly Querrey Professor of Materials Science and Engineering, Biomedical Engineering and Neurological Surgery, with appointments at the McCormick School of Engineering and Northwestern University Feinberg School of Medicine. He also directs the Querrey Simpson Institute for Bioelectronics. At the time of the research, Hammill was an associate professor of surgery at Washington University. Rogers, Hammill and MacEwan co-led the research with Heling Wang, an associate professor at Tsinghua University in Beijing.

    The importance of being early

    All gastrointestinal surgeries carry the risk of anastomotic leaks. If the leak is not detected early enough, the patient has a 30% chance of spending up to six months in the hospital and a 20% chance of dying, according to Hammill. For patients recovering from pancreatic surgery, the risks are even higher. Hammill says a staggering 40-60% of patients suffer complications after pancreas-related surgeries.

    The biggest problem is there’s no way to predict who will develop such complications. And, by the time the patient is experiencing symptoms, they already are incredibly ill.

    “Patients might have some vague symptoms associated with the leak,” Hammill said. “But they have just gone through big surgery, so it’s hard to know if the symptoms are abnormal. If we can catch it early, then we can drain the fluid. If we catch it later, the patient can get sepsis and end up in the ICU. For patients with pancreatic cancer, they might only have six months to live as it is. Now, they are spending half that time in the hospital.”

    In search of improved outcomes for his patients, Hammill contacted Rogers, whose laboratory specializes in developing engineering solutions to address health challenges. Rogers’ team had already developed a suite of bioresorbable electronic devices to serve as temporary implants, including dissolving pacemakers, nerve stimulators and implantable painkillers.

    The bioresorbable systems piqued Hammill’s interest. The greatest odds of developing an anastomotic leak occur either three days or two weeks after surgery.

    “We like to monitor patients for complications for about 30 days,” Hammill said. “Having a device that lasts a month and then disappears sounded ideal.”

    Enhancing ultrasound

    Instead of developing new imaging systems, Rogers speculated that his team might be able to enhance current imaging methods -; allowing them to “see” features that otherwise would be invisible. Ultrasound technology already has many advantages: it’s inexpensive, readily available, does not require cumbersome equipment and does not expose patients to radiation or other risks.

    But, of course, there is a major drawback. Ultrasound technology -; which uses sound waves to determine the position, shape and structure of organs -; cannot reliably differentiate between various bodily fluids. Blood and gastric fluid, for example, appear the same.

    “The acoustic properties of the leaking fluids are very similar to those of naturally occurring biofluids and surrounding tissues,” Rogers said. “The clinical need, however, demands chemical specificity, beyond the scope of fundamental mechanisms that create contrast in ultrasound images.”

    Ultimately, Rogers’ team devised an approach to overcome this limitation by using tiny sensor devices designed to be readable by ultrasound imaging. Specifically, they created a small, tissue-adhesive sticker out of a flexible, chemically responsive, soft hydrogel material. Then, they embedded tiny, paper-thin metal disks into the thin layers of this hydrogel. When the sticker encounters acidic fluids, such as stomach acid, it swells. When the sticker encounters caustic fluids, such as pancreatic fluids, it contracts.

    Making the invisible visible

    As the hydrogel swells or shrinks in response to changing pH, the metal disks either move apart or closer together, respectively. Then, the ultrasound can view these subtle changes in placement.

    “Because the acoustic properties of the metal disks are much different than those of the surrounding tissue, they provide very strong contrast in ultrasound images,” Rogers said. “In this way, we can essentially ‘tag’ an organ for monitoring.” Because the need for monitoring extends only during a postsurgical recovery, Rogers team designed these stickers with bioresorbable materials. They simply disappear naturally and harmlessly in the body after they are no longer needed.

    Computational collaborator Yonggang Huang, the Jan and Marcia Achenbach Professorship in Mechanical Engineering and professor of civil and environmental engineering at McCormick, used acoustic and mechanical simulation techniques to help guide optimized choices in materials and device layouts to ensure high visibility in ultrasound images, even for stickers located at deep positions within the body.

    “CT and MRI scans just take a picture,” Hammill added. “The fluid might show up in a CT image, but there’s always fluid collections after surgery. We don’t know if it’s actually a leak or normal abdominal fluid. The information that we get from the new patch is much, much more valuable. If we can see that the pH is altered, then we know that something isn’t right.”

    Rogers team constructed stickers of varying sizes. The largest measures 12 millimeters in diameter, while the smallest is just 4 millimeters in diameter. Considering that the metal disks are each 1 millimeter or smaller, Rogers realized that it might be difficult for radiologists to assess the images manually. To overcome this challenge, his team also developed software that can automatically analyze the images to detect with high accuracy any relative movement of the disks.

    Improving quality of life

    To evaluate the efficacy of the new sticker, Hammill’s team tested it in both small and large animal models. In the studies, ultrasound imaging consistently detected changes in the shape-shifting sticker -; even when it was 10 centimeters deep inside of tissues. When exposed to fluids with abnormally high or low pH levels, the sticker altered its shape within minutes.

    Rogers and Hammill imagine that the device could be implanted at the end of a surgical procedure. Or, because it’s small and flexible, the device also fits (rolled up) inside a syringe, which clinicians can use to inject the tag into the body.

    “These tags are so small and thin and soft that surgeons can easily place collections of them at different locations,” Rogers said. “For example, if an incision extends by a few centimeters in length, an array of these tags can be placed along the length of the site to develop a map of pH for precisely locating the position of the leak.”

    “It’s obviously an early prototype, but I can envision the final product where, at the end of surgery, you just place these little patches for monitoring,” Hammill said. “It does its job and then completely disappears. This could have a huge impact on patients, their recovery time and, ultimately, their quality of life.”

    Next, Rogers and his team are exploring similar tags that could detect internal bleeding or temperature changes. “Detecting changes in pH is a good starting point,” Rogers said. “But this platform can extend to other types of applications by use of hydrogels that respond to other changes in local chemistry, or to temperature or other properties of clinical relevance.”

    Source:

     Northwestern University

    Journal reference:

    Liu, J., et al. (2024) Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis. Science. doi.org/10.1126/science.adk9880.

    [ad_2]

    Source link

  • Cardiovascular health variances in women’s lifespan

    Cardiovascular health variances in women’s lifespan

    [ad_1]

    Women’s cardiovascular disease risks and outcomes differ throughout the lifespan from those of men, according to a collection of studies devoted to cardiovascular medicine research focused on women of all ages, published today in a special “spotlight” issue of the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    Cardiovascular disease kills more women than all forms of cancer combined. Among females 20 years and older, nearly 45% are living with some form of cardiovascular disease, and less than 50% of women entering pregnancy in the U.S. have good heart health. In addition, more than half of deaths from high blood pressure are in women. Yet, women make up only 38% of participants in cardiovascular disease clinical trials, according to the American Heart Association.

    The special Go Red for Women issue of the Journal, in recognition of American Heart Month, features studies that reveal insights such as: how diet may affect the high preeclampsia risk in pregnant Hispanic/Latina women; how women were less likely than men to receive bystander CPR and automated external defibrillator (AED) treatment, as well as survive the first 30 days post-hospitalization after out-of-hospital cardiac arrest; and how rehospitalization rates differ in women with heart failure and obstructive sleep apnea. In yet another study featured, researchers report that while the incidence of intracerebral hemorrhage (bleeding within the brain), the second most common stroke type, was lower in women, women were more likely to die one year after a stroke than men.

    Below are highlights of some of the manuscripts in this issue,

    • Prospective Associations of Accelerometer-measured Machine-learned Sedentary Behavior with Mortality among Older Women: The OPACH Study

    Steve Nguyen, Ph.D., et al.; University of California, San Diego, La Jolla, California

    This team studied sedentary behavior patterns in nearly 6,000 older women (average age 79 years) to determine the impact of sitting time on death from cardiovascular disease and all causes. Using a measurement tool powered by machine learning to accurately classify sitting time, researchers found those who sat more than 11.6 total hours a day and had longer bouts of uninterrupted sitting had a 57% higher risk of death from all causes and a 78% increased risk of death from cardiovascular disease. This was compared to women who sat less than 9.3 hours a day. The increased risk of death was consistent regardless of age, body mass index, physical functioning, cardiovascular disease risk factors, physical activity intensity and race/ethnicity. Reducing overall sedentary behavior and uninterrupted sitting time would likely have large public health benefits in an aging society, according to researchers.

    • Sex Differences in the Relationship between Schizophrenia and the Development of Cardiovascular Disease

    Hidehiro Kaneko, M.D., Ph.D., et al.; University of Tokyo, Tokyo, Japan

    Researchers studied cardiovascular disease risk in people with schizophrenia, a serious psychotic disorder and one of the top 15 leading causes of disability worldwide. Schizophrenia results in severe, chronic mental illness characterized by disturbances in perception, thought and behavior. The study found a strong association between schizophrenia and risk of developing cardiovascular disease in adults, but particularly in women. This higher risk in women may be related to hormonal changes during pregnancy and menopause, or reports that women are more sedentary than men. Nevertheless, the findings point to the need for health care professionals to take a thorough and gender-focused approach to cardiovascular disease prevention due to the notable role schizophrenia seems to play in cardiovascular disease. The researchers suggest that it’s crucial to promote physical activity, especially among women with schizophrenia, as inactivity may have increased the risk in female participants in this study. Healthcare providers should routinely screen and treat schizophrenia as part of standard clinical practice, with special attention to women, authors wrote.

    • Maternal Dietary Patterns During Pregnancy Are Linked to Hypertensive Disorders of Pregnancy Among a Predominantly Low-Income US Hispanic/Latina Pregnancy Cohort

    Luis E. Maldonado, Ph.D., M.P.H., et al.; Keck School of Medicine, University of Southern California

    In a study of more than 400 predominantly low-income, pregnant Hispanic/Latina women in Los Angeles, researchers found that a diet characterized by higher intakes of solid fats, refined grains and cheese was strongly associated with greater odds of having had a hypertensive disorder of pregnancy including preeclampsia during pregnancy.

    Other papers in the spotlight issue include:

    • Association of Sex With Cardiovascular Outcomes in Heart Failure Patients With Obstructive or Central Sleep Apnea -; Jian Zhang, M.D., Ph.D., et al.; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    • Pregnancy History at 40 Years of Age as a Marker of Cardiovascular Risk -; Liv G. Kvalvik, M.D., Ph.D., et al.; University of Bergen, Bergen, Norway

    • Sex Differences in the Epidemiology of Intracerebral Hemorrhage Over 10 Years in a Population-Based Stroke Registry -; Simona Sacco, M.D., et al.; University of L’Aquila, L’Aquila, Italy

    • Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial -; Harmony R. Reynolds, M.D., FAHA, et al.; NYU Grossman School of Medicine, New York City

    • Sex Differences in Receipt of Bystander CPR Considering Neighborhood Racial and Ethnic Composition -; Audrey L. Blewer, Ph.D., M.P.H., et al.; Duke University, Durham, North Carolina

    • Hypertension in Pregnancy among Immigrant and Swedish Women – A Cohort Study of All Pregnant Women in Sweden -; Axel C. Carlsson, Ph.D., et al.; Karolinska Institutet, Huddinge, Sweden

    • Sex Differences In Out-of-Hospital Cardiac Arrest Survival Trends -; R. L. A. Smits, et al.; Amsterdam University Medical Center, Amsterdam, The Netherlands;

    • Posttraumatic Stress Disorder is Associated With Elevated Risk of Incident Stroke and Transient Ischemic Attack in Women Veterans -; Ramin Ebrahimi, M.D., et al.; University of California, Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; and

    • Sex differences in Outcomes of Acute Myocardial Injury After Stroke -; Michela Rosso, M.D., et al.; University of Pennsylvania, Philadelphia.

    Source:

    American Heart Association

    Journal reference:

    Mujahid, M. S. & Peterson, P. N., (2024) JAHA Go Red for Women Spotlight on Women and Cardiovascular Disease and Stroke. Journal of the American Heart Association. doi.org/10.1161/JAHA.124.035104.

    [ad_2]

    Source link

  • Ultrahigh-spatial-resolution PCD-CT improves assessment of coronary artery disease

    Ultrahigh-spatial-resolution PCD-CT improves assessment of coronary artery disease

    [ad_1]

    Ultrahigh-spatial-resolution photon-counting detector CT improved assessment of coronary artery disease (CAD), allowing for reclassification to a lower disease category in 54% of patients, according to a new study published today in Radiology, a journal of the Radiological Society of North America (RSNA). The technology has the potential to improve patient management and reduce unnecessary interventions.

    Coronary CT angiography is a first-line test in the assessment of coronary artery disease. However, its diagnostic value is limited in patients with severe calcifications, or calcium buildup in the plaque of the coronary arteries.

    Ultrahigh-spatial-resolution photon-counting detector CT (PCD-CT) improves image quality compared to conventional CT. Additionally, it provides better spatial resolution, or the ability to differentiate two adjacent structures as being distinct from one another.

    Our study provides a glimpse into the potential impact of performing coronary CT angiography using ultrahigh spatial resolution technology on risk reclassification and recommended downstream testing.” 

    Tilman Emrich, M.D., study co-author, attending radiologist at the University Medical Center Mainz in Germany, and assistant professor of radiology at the Medical University of South Carolina in Charleston

    For the study, researchers evaluated coronary stenoses, or narrowing in the coronary arteries, in a vessel phantom (in-vitro) containing two different stenosis grades (25%, 50%), and retrospectively in 114 patients (in-vivo) who underwent ultrahigh-spatial-resolution cardiac PCD-CT for the evaluation of coronary artery disease. In-vitro values were compared to the phantom’s manufacturer specifications, and patient results were assessed regarding effects on coronary artery disease reporting and data system reclassification (CAD-RADS).

    “The study used a combination of artificial vessel models and real-world patient data,” Dr. Emrich said. “It simulated three types of reconstructions from a single PCD-CT scan, resembling conventional CT, high-resolution, and ultrahigh-spatial-resolution scans. Observers evaluated the severity of stenosis and generated CAD-RADS classifications, guiding further patient management decisions.”

    In-vitro results demonstrated a reduced overestimation of the stenosis by ultrahigh-spatial-resolution scans by reducing the adverse effects of the calcifications on the image.

    Results from the patients with suspected or diagnosed coronary artery disease confirmed a lower median degree of stenosis for calcified plaques (29% vs. 42%) with ultrahigh-spatial-resolution PCD-CT compared to standard CT. Ultrahigh-spatial-resolution often led to patients being reclassified to a lower CAD-RADS category. Of the 114 patients, 54% were given a lower CAD-RADS classification than they were originally assigned. The researchers found in-vitro quantification of the 193 coronary CT angiography-based stenoses was also more accurate using ultrahigh-spatial-resolution than standard resolution.

    “We found that ultrahigh-spatial-resolution reconstructions resulted in significant changes in recommendations for over 50% of patients,” Dr. Emrich said. “The impact was particularly notable in cases with calcified plaques, where ultrahigh-spatial-resolution reduced the overestimation of stenosis.”

    Dr. Emrich explained that ultrahigh-spatial-resolution may address the current limitations of conventional cardiac CT angiography by reducing the overestimation of stenosis due to calcium blooming, an effect which can cause small, high-density structures-;such as calcifications-;to appear larger than their true size.

    “This could significantly alter recommendations for downstream testing, potentially leading to a reduction of unnecessary procedures (and their potential complications) and reduced healthcare costs,” he said.

    No substantial benefits of ultrahigh-spatial-resolution were observed for mixed and non-calcified plaques.

    “It is important to note that these findings are from a simulation study, and further validation is needed in real-world comparisons,” Dr. Emrich said.

    “Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment.” Collaborating with Dr. Emrich were Moritz C. Halfmann, M.D., Stefanie Bockius, M.D., Michaela Hell, M.D., U. Joseph Schoepf, M.D., Gerald S. Laux, M.D., Larissa Kavermann, M.D., Dirk Graafen, M.D., Tomasso Gori, M.D., Ph.D., Yang Yang, M.D., Roman Klöckner, M.D., Pál Maurovich-Horvat, M.D., Ph.D., Jens Ricke, M.D., Lukas Müller, M.D., Akos Varga-Szemes, M.D., Ph.D., and Nicola Fink, M.D.

    Source:

     Radiological Society of North America

    Journal reference:

    Halfmann, M. C., et al. (2024) Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment. Radiology. doi.org/10.1148/radiol.231956.

    [ad_2]

    Source link

  • Study suggests CT imaging with automated AI system predicts EGFR genotype, identifying mutation status cost-effectively and non-invasively

    Study suggests CT imaging with automated AI system predicts EGFR genotype, identifying mutation status cost-effectively and non-invasively

    [ad_1]

    In a recent study published in The Lancet Regional Health-Southeast Asia, researchers developed an artificial intelligence (AI)-based predictive system (AIPS) model for the early detection of lung cancer by combining radiological, clinical, and genetic data.

    Study: AI-based pipeline for early screening of lung cancer: integrating radiology, clinical, and genomics data. Image Credit: create jobs 51/Shutterstock.com
    Study: AI-based pipeline for early screening of lung cancer: integrating radiology, clinical, and genomics data. Image Credit: create jobs 51/Shutterstock.com

    Background

    Lung cancer prognosis has improved due to molecular targets and targeted treatments, including therapy for somatic epidermal growth factor receptor (EGFR) mutations. However, next-generation sequencing (NGS) is unavailable in resource-constrained nations like India. An AI-based pipeline is required to recognize lung nodule characteristics in computed tomography (CT) scans and predict EGFR mutation probability, allowing for near-optimal care and therapy.

    About the study

    In the present study, researchers demonstrated the APIS pipeline for identifying and predicting the presence of EGFR-mutant lung nodules from CT scans in resource-constrained situations such as India.

    Using EGFR sequencing and CT imaging data from 2,277 lung cancer patients, the researchers created an automated lung nodule identification and characterization algorithm. They concentrated on Indians (Cohorts 1, 2, and 3), contrary to prior research, which mainly focused on individuals of white and Chinese descent.

    The team collected data on the Indian population from the Rajiv Gandhi Cancer Institute and Research Centre, India, and the white population (Cohort 4) data from The Cancer Imaging Archive (TCIA). They created the AI prediction system-Nodule model (AIPS-N) by obtaining the Lung Image Database Consortium image collection (LIDC-IDRI) computed tomography imaging data (Cohort 5), which included 1,010 patients (denoted by 244,527 images).

    The researchers pre-processed CT scans with windowing techniques to improve lung visibility, then interpreted picture annotations and used automatic lung segmentations to detect and segregate the lung region in the image. They trained the faster region-based convolutional neural network (R-CNN) model with the parsed image annotations and the corresponding pre-processed images.

    The team preprocessed LIDC-IDRI images to assess the anatomy and identify pathologies. They normalized the DICOM intensity values to a specified range before using windowing techniques to achieve a consistent intensity range across images from various cohorts. They passed the training dataset, which included masks, image annotations, and slices, into the pre-trained basic model, which extracted features from input images and generated high-level multi-scale convolutional-type feature maps.

    The researchers used the Region Proposal Network (RPN) on multiple-scale convolutional feature maps to anticipate region proposals and probable locations in the picture that may include items of interest. Anchor deltas were prefabricated bounding boxes with varied aspect ratios and sizes placed onto the convolutional feature maps to help improve the anchor boxes and align them more closely with image objects.

    The AIPS-Nodule model used a yellow box to visually emphasize and enclose the lung region of interest in CT scans, allowing for additional investigation. The automated pulmonary segmentation and object identification models were built separately for each nodule feature, yielding five AIPS-N feature models. The researchers used basic models such as the ResNet101-Feature Pyramid Network (R101-FPN) and Faster region-based CNN to extract image features and train the model. They used 70%, 15%, and 15% of the data for model training, validation, and testing, respectively.

    Results

    The deep learning model could substitute machine learning (ML) models by adding AIPS-N results, which enhanced ML performance. The AIPS-Nodule model could automatically detect and characterize lung nodules, with a mean AP50 score of 70%. The AIPS-M system combined the AIPS-Nodule results with clinical parameters to predict EGFR genotype to yield area under the receiver-operating characteristic curve (AUC) values ranging between 0.6 and 0.9.

    Cohort 1-trained ML algorithms had a mean AUC of 0.85 in the validation subgroup. Random Forest, Randomized Search Cross-Validation, XGBoost, and AIPS-Mutation ML models trained on the Indian population and white cohort produced a mean AUC of 0.8 when tested on Cohort 4. In testing Cohort 4, the mean AUC of the ML models trained using the first cohort increased from 0.6 to 0.9, demonstrating the positive impact of integrating AIPS-N ratings on predictive capabilities.

    The research included an Indian male smoker aged 71 years diagnosed with squamous cell carcinoma and carrying the EGFR gene mutation. The AIPS-Nodule model accurately identified the features and location of the detected nodule, assigning spiculation and sphericity to class 1. AIPS-Mutation models trained on Cohort 1 were used to determine the EGFR gene status of the male patient, who was clinically determined as mutated. All six machine learning algorithms predicted EGFR status as mutated, yielding a ‘True Positive’ result.

    The study showed that CT imaging paired with AIPS automated pulmonary nodule analysis might predict EGFR gene presence and identify individuals with EGFR mutations cost-effectively and non-invasively.

    The AIPS-Nodule model could detect and describe lung nodules, whereas the AIPS-Mutation model predicted EGFR genotype by integrating AIPS-N findings with clinical variables. The study’s findings might help oncologists prioritize patients for tailored medicines, improve patient care, and enhance global healthcare standards.

    The innovative AIPS approach could benefit resource-limited situations and add to previous evidence by broadening the scope of nodule investigation to include thorough characterization and association with the EGFR mutation.

    [ad_2]

    Source link

  • Early detection may help Kentucky tamp down its lung cancer crisis

    Early detection may help Kentucky tamp down its lung cancer crisis

    [ad_1]

    Anthony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.

    “I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in eastern Kentucky near his childhood home shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”

    Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate. For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.

    The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which in 2014 launched to improve screening and prevention, to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia. But, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested, namely the fear and stigma that swirl around smoking and lung cancer.

    Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to data from the Centers for Disease Control and Prevention.

    It’s a bit early to see the impact on lung cancer deaths because people may still live for years with a malignancy, LEADS researchers said. Plus, treatment improvements and other factors may also help reduce death rates along with increased screening. Still, data already shows that more cancers in Kentucky are being detected before they become advanced, and thus more difficult to treat, they said. Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to Kentucky Cancer Registry data. By 2020, that number had declined to 72%, according to the most recent data available.

    “We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.

    Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health, a nonprofit health system that serves Kentucky and Indiana.

    “A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.

    The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, state lawmakers established a statewide lung cancer screening program based in part on the group’s work.

    Jacob Sands, a lung cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and serves as a volunteer spokesperson for the American Lung Association.

    In 2014, Kentucky expanded Medicaid, increasing the number of lower-income people who qualified for lung cancer screening and any related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.

    Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%.

    But regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.

    Some adults, like Lisa Ayers, didn’t realize lung cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at UK King’s Daughters, a hospital in far eastern Kentucky. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.

    She was diagnosed with a lung carcinoid tumor, a type of neuroendocrine cancer that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely.

    Ayers, a lifelong smoker, recalled her doctor said that her type of cancer isn’t typically linked to smoking. But she quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer. “It was a big wake-up call for me.”

    Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start. The goal is to avoid stigmatizing people and instead to build rapport, meeting them where they are that day, he said.

    “If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help,” Studts said. “You know what? You actually develop a relationship with an individual by accepting, ‘No.’”

    Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.

    That data likely doesn’t capture all California screenings, as it may not include CT scans done through large managed care organizations, said Raquel Arias, a Los Angeles-based associate director of state partnerships at the American Cancer Society. She cited other 2022 data for California, looking at lung cancer screening for eligible Medicare fee-for-service patients, which found a screening rate of 1%-2% in that population.

    But, Arias said, the state’s effort is “nowhere near what it needs to be.”

    The low smoking rate in California, along with its image as a healthy state, “seems to have come with the unintended consequence of further stigmatizing people who smoke,” said Arias, citing one of the findings from a 2022 report looking at lung cancer screening barriers. For instance, eligible patients may be reluctant to share prior smoking habits with their health provider, she said.

    Meanwhile, Kentucky screening efforts progress, scan by scan.

    At Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, a lung cancer screening champion at the health system, which includes 14 hospitals, most located in eastern Kentucky.

    The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said, “just how sad is that?”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

    [ad_2]

    Source link

  • New weight loss drug may be an effective strategy for preventing or treating high blood pressure

    New weight loss drug may be an effective strategy for preventing or treating high blood pressure

    [ad_1]

    The new weight loss medication tirzepatide significantly lowered the systolic blood pressure (the top number in a blood pressure reading) for nearly 500 adults with obesity who took the medication for about eight months, according to new research published today in Hypertension, an American Heart Association journal.

    Systolic blood pressure, or the top number in the blood pressure reading, is a stronger predictor for cardiovascular death than diastolic, or bottom number, blood pressure. According to the American Heart Association’s 2024 Heart Disease and Stroke Statistics, more than 122 million adults in the United States, or 47% of adults have hypertension, and nearly 42% of adults have obesity.

    Tirzepatide works by mimicking two metabolic hormones in the body: it acts as a glucagon-like peptide-1 (GLP-1) receptor agonist and also as a glucose dependent insulinotropic polypeptide (GIP) receptor agonist. These hormones stimulate insulin secretion and sensitivity after a person eats. Together, they have been found so far to help regulate the body’s blood sugar levels, slow down digestion and reduce appetite, which makes a person feel more full and eat less, leading to weight loss. In contrast, semaglutide has only the GLP-1 hormone; it does not contain a GIP receptor agonist.

    In 2022, the Food and Drug Administration approved tirzepatide for prescription as a treatment for Type 2 diabetes. In late 2023, the FDA also approved it for chronic weight management for people with obesity (body mass index of 30 kg/m2 or higher) or overweight (body mass index of 27-29 kg/m2) and at least one weight-related health condition, such as high blood pressure, Type 2 diabetes or high cholesterol.

     “Our findings indicate treating obesity with the weight loss medication tirzepatide may be an effective strategy for preventing or treating high blood pressure,” said lead study author James A. de Lemos, M.D., FAHA, the Kern Wildenthal, M.D., Ph.D., distinguished chair of cardiology and a professor of medicine at UT Southwestern Medical Center in Dallas. “Although tirzepatide has been studied as a weight loss medication, the blood pressure reduction in our patients in this study was impressive. While it is not known if the impact on blood pressure was due to the medication or the participants’ weight loss, the lower blood pressure measures seen with tirzepatide rivaled what is seen for many hypertension medications.”

    The current research was a planned sub-study including 600 of the participants from the SURMOUNT-1 weight loss study to determine if there was an effect on blood pressure. The sub-study was designed to assess the effects of tirzepatide on blood pressure levels as measured by 24-hour ambulatory blood pressure monitoring in people with obesity but without Type 2 diabetes.

    Participants received either a placebo or a dose of tirzepatide in one of three strengths (5 mg, 10 mg or 15 mg). About one-third of participants reported they had high blood pressure at the beginning of the study and were taking one or more hypertension medications. When the sub-study began, all of the participants had blood pressure levels that were less than 140/90 mm Hg, and if they used blood pressure medications, they were required to have been taking their blood pressure medications for at least three months. The sub-study included participants who had hypertension and who had normal blood pressure.

    The study was conducted from December 2019 to April 2022, and the participant results after 36 weeks of taking tirzepatide indicate:

    • For participants taking 5 mg of tirzepatide, there was an average reduction in systolic blood pressure of 7.4 mm Hg.

    • For participants taking 10 mg of tirzepatide, there was an average reduction in systolic blood pressure of 10.6 mmHg.

    • For participants taking 15 mg of tirzepatide, there was an average reduction in systolic blood pressure of 8.0 mm Hg.

    • The blood-pressure lowering effects of tirzepatide were evident in blood pressure measures taken during both the day and night. Nighttime systolic blood pressure is a stronger predictor for cardiovascular death and all-cause death than daytime blood pressure readings.

    The reductions in systolic blood pressure were consistent across subgroups of participants in the study who were categorized by additional factors, including age, sex, body mass index and hypertension-related risk factors.

    Study background and details:

    • SURMOUNT-1 was a randomized study on the effect of increasing doses of tirzepatide on weight loss. It found that in participants with overweight or obesity (body mass index (BMI) ≥27 kg/m2), once-weekly injections of 5 mg, 10 mg or 15 mg of tirzepatide led to mean weight reductions of 15%, 19.5% and 20.9%, respectively, compared to placebo.

    • The sub-study included 600 adults from SURMOUNT-1: 155 participants received placebo; 145 were taking tirzepatide 5 mg; 152 were taking tirzepatide 10 mg; and 148 were taking tirzepatide 15 mg.

    • Blood pressure measurements were available and analyzed for 494 participants who valid ambulatory blood pressure monitoring data at the beginning of the study and at week 36.

    • Only the study participants with at least 70% valid readings on ambulatory monitoring and a minimum of 20 daytime and seven nighttime readings were included in the data analyses. This was 494 out of 600 initial participants.

    • 69% of study participants self-identified as female, and 31% self-identified as male. 66.8% self-identified as white adults, 11.8% self-identified as Black adults and 25% self-identified as Hispanic ethnicity.

    • The average age of the participants was 45.5 years, and their average BMI was 37.4 kg/m2, which meets the criteria for obesity (obesity is BMI≥30). People with obesity have an increased risk of high blood pressure, heart disease, stroke and Type 2 diabetes, as well as other health conditions.

    • Ambulatory blood pressure monitoring used in this study included blood pressure measurements every 30 minutes during the day and every hour at night, providing a more comprehensive assessment of blood pressure than in office or daily home blood pressure measurements. For ambulatory blood pressure monitoring, study participants wore a blood pressure monitoring device for a 24- to 27-hour period that measured blood pressure throughout waking and sleeping hours. Ambulatory blood pressure monitoring was conducted when participants first began taking tirzepatide at the start of the study and after 36 weeks of being enrolled in the study.

    The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults classifies hypertension, or high blood pressure, as having top and bottom blood pressure measures greater than or equal to 130/80 mm Hg. 

    Study limitations include that it was only conducted in a subset of the original 2,539 SURMOUNT-1 participants; the ambulatory blood pressure monitoring was only measured at two points in the study -; baseline and at 36 weeks; and measurements were only taken once per hour at night to minimize the burden on study participants. In addition, changes in food intake and 24-hour urine sodium excretion were not assessed, meaning the contribution of dietary modifications including salt intake or other changes that may help to reduce blood pressure are unknown and cannot be estimated.

    “Overall, these data are encouraging that novel weight-loss medications are effective at reducing body weight and they are also effective at improving many of the cardiometabolic complications of obesity including hypertension, Type 2 diabetes and dyslipidemia, among others. While the impact of each of these beneficial effects is individually important, many of these obesity-related complications act synergistically to increase the risk of cardiovascular disease. Thus, strategies that mitigate multiple obesity-related complications may reduce the risk of cardiovascular events,” said Michael E. Hall, M.D., M.S., FAHA, chair of the writing group for the Association’s 2021 scientific statement on weight-loss strategies for prevention and treatment of hypertension and chair of the department of medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

    Additional studies will be necessary to determine the long-term impact on cardiovascular events such as heart attack and heart failure. Also, studies are needed to investigate what happens to blood pressure when medications like tirzepatide are discontinued – does the blood pressure rebound and go back up, or does it remain lowered?”


    Michael E. Hall, M.D., M.S., FAHA, chair of the writing group

    Co-authors and disclosures are listed in the manuscript. The study was funded by Eli Lilly and Company, the manufacturer of tirzepatide.

    Source:

    American Heart Association

    Journal reference:

    de Lemos, J. A., et al. (2024) Tirzepatide Reduces 24-Hour Ambulatory Blood Pressure in Adults With Body Mass Index ≥27 kg/m2: SURMOUNT-1 Ambulatory Blood Pressure Monitoring Substudy. Hypertension. doi.org/10.1161/HYPERTENSIONAHA.123.22022.

    [ad_2]

    Source link