Publisher Health

Chemical peels are a common treatment for acne scars, but a Rutgers study finds that microneedling is significantly more effective for patients with dark skin.
Babar Rao, a professor of dermatology and pathology at Robert Wood Johnson Medical School, and fellow researchers randomly assigned 60 patients with acne scars and dark skin — Fitzpatrick Skin Phototype IV to VI — to treatment with either 35 percent glycolic acid chemical peels or microneedling, both administered every two weeks for 12 weeks.
Microneedling is a cosmetic procedure involving tiny, sterilized needles that pierce the skin to stimulate collagen production and reduce scarring. Chemical peels involve applying a solution to the skin that removes the top layers.
Treatment produced an improvement of two points or more on the Goodman and Baron Scarring Grading System in 33 percent of patients who received chemical peels and 73 percent of patients who underwent microneedling.
“Based on the results of this study, patients whose darker skin precludes the use of stronger chemical peels, which can permanently discolor darker skin, should treat acne scars with microneedling,” said Rao, the senior author of the study. “For patients with lighter skin who can use stronger peels without risk of discoloration, chemical peels might still be the best option for some.”
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Materials provided by Rutgers University. Note: Content may be edited for style and length.

Kidney cancer is not always confined to the kidney. In advanced cases, this cancer invades the body’s biggest vein, the inferior vena cava (IVC), which carries blood out of the kidneys back to the heart. Via the IVC, cancer may infiltrate the liver and heart. The Mays Cancer Center at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) is one of the high-volume centers in the U.S. with surgical expertise in treating this serious problem. The Mays Cancer Center is San Antonio’s National Cancer Institute-designated Cancer Center.
In a study featured on the cover of the Journal of Urology (Official Journal of the American Urological Association), researchers from the Mays Cancer Center and Department of Urology at UT Health San Antonio show that robotic IVC thrombectomy (removal of cancer from the inferior vena cava) is not inferior to standard open IVC thrombectomy and is a highly safe and effective alternative approach. The affected kidney is removed along with the tumor during surgery, which is performed at UT Health San Antonio’s clinical partner, University Hospital.
Harshit Garg, MD, urologic oncology fellow in the Department of Urology, is first author of the study, and Dharam Kaushik, MD, urologic oncology fellowship program director, is the senior author. Kaushik is an associate professor and the Stanley and Sandra Rosenberg Endowed Chair in Urologic Research at UT Health San Antonio.
The open surgery requires an incision that begins 2 inches below the ribcage and extends downward on both sides of the ribcage. “It looks like an inverted V,” Kaushik said. Next, organs that surround the IVC, such as the liver, are mobilized, and the IVC is clamped above and below the cancer. In this way, surgeons gain control of the inferior vena cava for cancer resection.
“Open surgery has an excellent success rate, and most cases are performed in this manner,” Kaushik said. “But now, with the robotic approach, we can achieve similar results with smaller incisions. Therefore, we need to study the implications of utilizing this newer approach.”
The study is a systematic review and meta-analysis of data from 28 studies that enrolled 1,375 patients at different medical centers. Of these patients, 439 had robotic IVC thrombectomy and 936 had open surgery. Kaushik and his team collaborated with Memorial Sloan Kettering Cancer Center, New York; Cedars-Sinai Medical Center, Los Angeles; and the University of Washington, Seattle, to perform this study.
“We pulled the data together to make conclusions because, before this, only small studies from single institutions had been conducted to compare the IVC thrombectomy approaches,” Kaushik said.
Findings
The results are encouraging and indicate further study of robotic IVC thrombectomy is warranted. The robotic approach in comparison with open was associated with: Fewer blood transfusions: 18% of robotic patients required transfusions compared to 64% of open patients. Fewer complications: 5% of robotic patients experienced complications such as bleeding compared to 36.7% of open thrombectomy patients.These large, technically challenging surgeries last eight to 10 hours and involve a multidisciplinary team of vascular surgeons, cardiac surgeons, transplant surgeons and urologic oncology surgeons, Kaushik said.
“This study is the largest meta-analysis analyzing the outcomes of robotic versus open IVC thrombectomy,” Kaushik said. “In more than 1,300 patients, we found that overall complications were lower with the robotic approach and the blood transfusion rate was lower with this approach.
“That tells us there is more room for us to grow and refine this robotic procedure and to offer it to patients who are optimal candidates for it,” Kaushik said. “Optimal candidacy for a robotic surgery should be based on a surgeon’s robotic expertise, the extent and burden of the tumor, and the patient’s comorbid conditions. The open surgical approach remains the gold standard for achieving excellent surgical control.”

Adults self-report their pain on a one to 10 numerical score, while children can point to an equivalent face scale — from a green smiling face to a red crying face — to indicate their pain. Newborns, however, cannot say a number or point to a face, leaving it up to their caregivers to identify and evaluate any pain they may be in. Until the turn of this century, a significant number of clinicians did not recognize that neonates could even experience pain, resulting in infrequent, nonstandard training for medical workers. Now, researchers are reporting that a flexible e-learning program improves neonate pain management knowledge and skills for nurses.
They published the results of their randomized, controlled study on July 30 in Pain Management Nursing.
“Continuing education is essential to maintain and increase nurses’ proficiency in neonatal pain assessment and treatment,” said corresponding author Mio Ozawa, associate professor in the Graduate School of Biomedical and Health Science at Hiroshima University. “Our results showed that e-learning programs were more effective as compared to no training.”
The researchers randomly divided recruited certified neonatal intensive care nurses from across Japan into two groups. One group received four weeks of online training in pain measurement, using structured scales designed for pre-term newborns, called the e-Pain Management of Neonates program. The other group did not receive training. Participants in both groups took a pre- and post-test. While there were no differences in knowledge or skill in the pre-test scores between the two groups, the e-learning group scored higher for both knowledge and skill.
The research builds on a prior pilot study, in which 52 nurses completed the e-learning program and improved their test scores. However, without a control group for comparison, the evidence was not sufficient to illustrate the intervention’s effectiveness, according to Ozawa.
“In the current study, we tested the e-learning program with a randomized control trial, a more powerful research design than used with the pilot study,” Ozawa said. “To the best of our knowledge, this is the first such trial that investigates the effects of e-learning on the knowledge and skill in neonatal pain measurement for certified nurses across NICUs across multiple hospitals.”
The e-learning program consists of four modules, each of which takes about 15 minutes to complete. Participants could save their progress and return at any point, as well as review as many times as they wanted. While more nurses were more likely to access the program in the middle of the day or late at night on a weekday, participants still accessed the program at odd hours and over the weekend.

Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle (MFB), which is linked to reward and motivation, revealed metabolic brain changes over 12 months post-DBS implantation, making it a strong potential therapy for treatment-resistant depression according to researchers at UTHealth Houston.
The results of the study, which included 10 patients, were published today in Molecular Psychiatry.
“This is something that people have been trying to do for a long time, but we have not always been very successful with using DBS for psychiatric illnesses,” said first author Christopher Conner, MD, PhD, a former neurosurgery resident in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth Houston. “But this PET study shows that we’re altering how the brain is functioning long term and we are starting to change the way brain starts to organize itself and starts to process information and data.” Conner is currently a fellow with the University of Toronto.
For years, DBS has been used to treat patients suffering from movement disorders such as Parkinson’s disease, tremor, and dystonia, and studied as a possible treatment for patients with treatment-resistant depression. In DBS, electrodes are implanted into certain brain areas, where they generate electrical impulses to affect brain activity.
However, finding what part of the brain needs to be targeted to treat depression long term has been challenging.
“We targeted a bundle of fibers that leave this small area in the brainstem to travel to other areas throughout the brain,” Conner said. “The PET scans indicated that this small target area has very diffuse downstream effects. It’s not one single effect because there’s not one single area of the brain linked to depression. The whole brain needs to be changed and through this one small target, that’s what we were able to do.”
Researchers performed an initial PET scan before the DBS procedure on the 10 patients in the study for a baseline image. They performed additional PET scans at six and 12 months to assess changes after treatment. Scans of 8 of the 10 patients showed a response.
“A responder to the treatment means that your depression potentially decreases at least 50%; you’re feeling much better,” said co-author João de Quevedo, MD, PhD, professor in the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School. “So, for patients with severe chronic treatment-resistant depression, decreasing our symptoms by half is a lot. It’s the difference between being disabled to being able to do something. Correlating with the PET image changes, our patients reported that their depression lessened after the treatment.” De Quevedo also serves as director of the Translational Psychiatry Program and the Treatment-Resistant Depression Program, part of the Center of Excellence on Mood Disorders.
Jair Soares, MD, PhD, professor and the Pat R. Rutherford, Jr. Chair in Psychiatry in the Faillace Department of Psychiatry and Behavioral Sciences, was a co-author. Albert J. Fenoy, MD, former associate professor of neurosurgery with McGovern Medical School, was senior and corresponding author.
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Materials provided by University of Texas Health Science Center at Houston. Original written by Halle Jones. Note: Content may be edited for style and length.

Since the late 1800s non-nutritive sweeteners have promised to deliver all the sweetness of sugar with none of the calories. They have long been believed to have no effect on the human body, but researchers publishing in the journal Cell on August 19 challenge this notion by finding that these sugar substitutes are not inert, and, in fact, some can alter human consumers’ microbiomes in a way that can change their blood sugar levels.
In 2014, senior author Eran Elinav an immunologist and microbiome researcher at the Weizmann Institute of Science and the German National Cancer Center (DKFZ) and his team found that non-nutritive sweeteners affected the microbiomes of mice in ways that could impact their glycemic responses. The team was interested in whether these results would also be found in humans.
To address this important question, the research team carefully screened over 1300 individuals for those who strictly avoid non-nutritive sweeteners in their day-to-day lives, and identified a cohort of 120 individuals. These participants were broken into six groups: two controls and four who ingested well below the FDA daily allowances of either aspartame, saccharin, stevia, or sucralose.
“In subjects consuming the non-nutritive sweeteners, we could identify very distinct changes in the composition and function of gut microbes, and the molecules they secret into peripheral blood. This seemed to suggest that gut microbes in the human body are rather responsive to each of these sweeteners,” says Elinav. “When we looked at consumers of non-nutritive sweeteners as groups, we found that two of the non-nutritive sweeteners, saccharin and sucralose, significantly impacted glucose tolerance in healthy adults. Interestingly, changes in the microbes were highly correlated with the alterations noted in people’s glycemic responses.”
To establish causation, the researchers transferred microbial samples from the study subjects to germ-free mice — mice that have been raised in completely sterile conditions and have no microbiome of their own.
“The results were quite striking,” says Elinav. “In all of the non-nutritive sweetener groups, but in none of the controls, when we transferred into these sterile mice the microbiome of the top responder individuals collected at a time point in which they were consuming the respective non-nutritive sweeteners, the recipient mice developed glycemic alterations that very significantly mirrored those of the donor individuals. In contrast, the bottom responders’ microbiomes were mostly unable to elicit such glycemic responses,” he adds. “These results suggest that the microbiome changes in response to human consumption of non-nutritive sweetener may, at times, induce glycemic changes in consumers in a highly personalized manner.”
Elinav says that he expects the effects of the sweeteners will vary person to person because of the incredibly unique composition of our microbiome. “We need to raise awareness of the fact that non-nutritive sweeteners are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies.”
“In the meantime, we need to continue searching for solutions to our sweet tooth craving, while avoiding sugar, which is clearly most harmful to our metabolic health,” says Elinav. “In my personal view, drinking only water seems to be the best solution.”
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A new MIT study finds that Alzheimer’s disease disrupts at least one form of visual memory by degrading a newly identified circuit that connects the vision processing centers of each brain hemisphere.
The results of the study, published in Neuron by a research team based at The Picower Institute for Learning and Memory, come from experiments in mice, but provide a physiological and mechanistic basis for prior observations in human patients: the degree of diminished brain rhythm synchrony between counterpart regions in each hemisphere correlates with the clinical severity of dementia.
“We demonstrate that there is a functional circuit that can explain this phenomenon,” said lead author Chinnakkaruppan Adaikkan, a former Picower Institute postdoc who is now an assistant professor in the Centre for Brain Research at the Indian Institute of Science (IISc) in Bangalore. “In a way we uncovered a fundamental biology that was not known before.”
Specifically, Adaikkan’s work identified neurons that connect the primary visual cortex (V1) of each hemisphere and showed that when the cells are disrupted, either by genetic alterations that model Alzheimer’s disease or by direct laboratory perturbations, brain rhythm synchrony becomes reduced and mice become significantly less able to notice when a new pattern appeared on a wall in their enclosures. Such recognition of novelty, which requires visual memory of what was there the prior day, is an ability commonly disrupted in Alzheimer’s.
“This study demonstrates the propagation of gamma rhythm synchrony across the brain hemispheres via the cross hemispheric connectivity,” said study senior author Li-Huei Tsai, Picower Professor and director of The Picower Institute and MIT’s Aging Brain Initiative. “It also demonstrates that the disruption of this circuit in AD mouse models is associated with specific behavioral deficits.”
Cross-hemispheric cells
In the study, Adaikkan, Tsai, Thomas McHugh and co-authors discovered and traced V1 neurons that extended their axons all the way through the corpus callosum, which connects the brain’s hemispheres, to cells in the V1 on the brain’s other side. There, they found, the cross-hemispheric (CH) neurons forged connections, or synapses, with target cells, providing them with “excitatory” stimulation to drive their activity. Adaikkan also found that CH neurons were much more likely to be activated by a novelty discrimination task than V1 neurons in general or neurons in other regions heavily involved in memory such as the hippocampus or the prefrontal cortex.

A study finds that blood tests taken the day of a traumatic brain injury can predict which patients are likely to die or survive with severe disability, allowing clinicians to make decisions earlier on possible treatment of TBI.
Researchers from Michigan Medicine, the University of California San Francisco and the University of Pennsylvania analyzed day-of-injury blood tests of nearly 1,700 patients with TBI. Results published in The Lancet Neurology reveal that higher values of two protein biomarkers, GFAP and UCH-L1, are associated with death and severe injury.
This is the first study to examine the association between biomarker levels of these two proteins and all-cause mortality following TBI, says first author Frederick Korley, M.D., Ph.D., associate professor of emergency medicine at the University of Michigan Medical School.
“Early and accurate prediction of TBI outcomes will help clinicians gauge how severe a brain injury is and inform how best to counsel family members about care for their loved ones with brain injury and what to expect with regards to their recovery,” Korley said. “It will also help researchers more precisely target promising TBI therapeutics to the right TBI patients.”
The U.S. Food and Drug Administration cleared the use of GFAP and UCH-L1 in 2018 to help clinicians decide whether to order CT scans for mild traumatic brain injury.
Researchers measured the proteins using two devices from Abbott Laboratories, the i-STAT Alinity and the ARCHITECT. Results were compared to evaluations made six months after injury using the Glasgow Outcome Scale-Extended, a system that grades the functional status of TBI patients.
Investigators found that compared to those with GFAP values in the bottom 20th percentile, those with GFAP values in the top 20th percentile had a 23 times higher risk of death during the subsequent six months. Similarly, compared to those with UCH-L1 values in the bottom 20th percentile, those with UCH-L1 values in the top 20th percentile had a 63 times higher risk of death during the subsequent 6 months.
“Modern trauma care can result in good outcomes in what we had once believed were non-survivable injuries,” said co-senior author Geoffrey Manley, M.D., Ph.D., professor and vice chair of neurosurgery at UCSF. “These blood tests are both diagnostic and prognostic, as well as easy to administer, safe and inexpensive.”
While the method is promising for determining poor outcomes in moderate and severe TBI, researchers say more must be done to examine its role in mild cases.
“As a next step, the TRACK-TBI team is planning a clinical trial that will examine the efficacy of promising therapeutic agents that may help traumatic brain injury patients recover quickly,” Korley said. “As part of this clinical trial, these biomarkers will be used as an objective method for selecting the right patients to enroll in this trial. We will also use these biomarkers to monitor individual patient response to these promising therapeutics.”
Korley previously consulted for Abbott Laboratories. Korley and Robertson have received research funding from Abbott Laboratories. Manley received research funding from a collaboration between Abbott Laboratories and the U.S. Department of Defense. Diaz-Arrastia consulted for MesoScale Discoveries, BrainBox Solutions, and NovaSignal. All other authors and collaborators declare no competing interests.
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Materials provided by Michigan Medicine – University of Michigan. Original written by Noah Fromson. Note: Content may be edited for style and length.

Capacitors are energy storage devices, consisting of two electrodes and an electrolyte, that are capable of rapid charging and discharging because of charge adsorption and desorption properties at the electrode-electrolyte interface. Because capacitors’ energy storage does not involve chemical reactions, their storage capacity is lower than that of lithium-ion batteries, but they are useful for power leveling for renewable energy that requires repeated charging at high currents, regenerative braking energy for trains and electric or hybrid cars, as well as instantaneous voltage drop compensation devices that prevent equipment failure due to lightning strikes. They are also expected to be used to store energy for wearable devices in the near future.
Most capacitors use a liquid electrolyte with a low boiling point, which can only be used at temperatures below 80℃. Ceramic capacitors that use solid inorganic materials as a dielectric can be used at temperatures above 80℃, but their storage capacity is much lower than liquid electrolyte capacitors, which limits their use to electronic circuits. To increase the energy storage of capacitors, it is necessary to have a large contact area at the interface between the electrode and the electrolyte. Making a large contact area is difficult using solid electrolytes; so, the creation of a capacitor with high storage capacity that can also operate at high temperatures has been desired for a long time.
A research group led by Professor Akitoshi Hayashi at the Graduate School of Engineering, Osaka Metropolitan University, has developed a solid electrolyte that is highly deformable, allowing it to have a large contact area with an electrode, which was developed to be used for an oxide-based all-solid-state battery. In this study, they fabricated a composite using the same highly deformable solid electrolyte and carbon, then used it to construct both electrodes for a bulk-type all-solid-state capacitor. This capacitor is capable of high current densities and high-capacity charging and discharging at temperatures of 200-300°C, creating the world’s first bulk-type all-solid-state capacitors. The researchers expect that their capacitor will be used to improve technology for high-temperature environments, which could not be developed previously due to these technical limitations.
“The key to realizing this capacitor was to take the solid oxide electrolytes that we have been developing for all-solid-state lithium batteries — which combine excellent deformability and lithium-ion conductivity — and apply them to capacitors,” explained Professor Hayashi.
In the future, the researchers hope to construct all-solid-state hybrid capacitors with even higher energy densities, by controlling the chemical reaction between a solid electrolyte and carbon, then combining them with positive electrode materials used in lithium-ion batteries.
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Materials provided by Osaka Metropolitan University. Note: Content may be edited for style and length.

Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding from a source that cannot be determined even after upper or lower gastrointestinal endoscopy is performed. It is an intractable disease that can cause repeated bloody stools and anemia without an identifiable cause, and may require frequent blood transfusions. Although the pathogenesis of OGIB remains largely unclear, it is assumed that in most cases, the bleeding is from the small intestine.
Capsule endoscopy (CE) is a useful and noninvasive procedure for evaluating OGIB. Previous studies have shown that patients with severe comorbidities have a higher rate of positive CE findings — meaning that mucosal breaks, vascular lesions, tumors, or blood retention were observed — for OGIB. Additionally, for OGIB in which the initial CE fails to identify bleeding lesions, repeated CE can detect lesions at a higher rate. However, there have been no reports with a sufficiently large number of cases on the long-term outcomes of OGIB detected by CE and the risk of rebleeding.
Addressing this shortcoming, a research group led by Dr. Koji Otani from the Osaka Metropolitan University Graduate School of Medicine followed up on 389 patients who underwent CE as their initial small intestinal examination for OGIB and evaluated the risk of rebleeding over the long term. In addition, the team evaluated the risk of rebleeding in OGIB, in which no source of rebleeding was found in any part of the gastrointestinal tract, including the small intestine.
The analysis showed that the overall cumulative rebleeding rate during the five years after CE was 41.7%. In patients with positive CE findings, the cumulative rebleeding rate was 48.0%. The cumulative rebleeding rate in patients who underwent therapeutic intervention for positive CE findings was 31.8%.
Furthermore, overt OGIB, anticoagulants, positive balloon-assisted enteroscopy after CE, and iron supplements without therapeutic intervention were found to be independent predictors of rebleeding. Among the components of an index assessing the severity of complications, liver cirrhosis was an independent predictor associated with rebleeding in patients with OGIB.
“If capsule endoscopy can be used to properly diagnose and lead to therapeutic intervention, the risk of rebleeding can be reduced,” concluded Dr. Otani. “Even if the endoscopy does not detect any lesions, adequate follow-up is necessary. Here at Osaka Metropolitan University, we have been utilizing this tool clinically since its early days and have accumulated some of the world’s leading clinical data. This study revealed a high rebleeding rate in OGIB patients and clarified the effects of rebleeding predictors and therapeutic intervention. We have high expectations that this will lead to better medical care in the future.”
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Materials provided by Osaka Metropolitan University. Note: Content may be edited for style and length.

A new study of 57 people with mild COVID-19 estimates how long people are infectious for and when they can safely leave isolation.
The research, which is led by Imperial College London and published in The Lancet Respiratory Medicine journal, is the first to unveil how long infectiousness lasts for after natural COVID-19 infection in the community. The study team conducted detailed daily tests from when people were exposed to SARS-CoV-2 to look at how much infectious virus they were shedding throughout their infection.
The findings suggest that in people who develop symptoms, the majority are not infectious before symptoms develop, but two-thirds of cases are still infectious five days after their symptoms begin.
They also suggest that while lateral flow tests do not detect the start of infectiousness well, they more accurately identify when someone is no longer infectious and can safely leave isolation.
Study author, Professor Ajit Lalvani, Director of the NIHR Health Protection Research Unit in Respiratory Infections at Imperial, said: “We closely monitored people in their homes from when they were first exposed to the virus, capturing the moment when they developed infection through until they ceased being infectious. Before this study we were missing half of the picture about infectiousness, because it’s hard to know when people are first exposed to SARS-CoV-2 and when they first become infectious. By using special daily tests to measure infectious virus (not just PCR) and daily symptom records we were able to define the window in which people are infectious. This is fundamental to controlling any pandemic and has not been previously defined for any respiratory infection in the community.”
“Combining our results with what we know about the dynamics of Omicron infections, we believe that the duration of infectiousness we’ve observed is broadly generalisable to current SARS-CoV-2 variants, though their infectious window may be a bit shorter. Our evidence can be used to inform infection control policies and self-isolation guidance to help reduce the transmission of SARS-CoV-2.”
Co-author, Dr Seran Hakki also from Imperial’s National Heart and Lung Institute, said: “There is no longer a legal requirement to self-isolate if you test positive for COVID-19, but most people still want to isolate until they are not infectious. Despite this, there is lack of clarity around how to come out of self-isolation safely. Our study is the first to assess how long infectiousness lasts for, using real life evidence from naturally acquired infection. Our findings can thus inform guidance as to how to safely end self-isolation.”