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Vagus nerve stimulation (VNS), sometimes referred to as a “pacemaker for the brain,” involves a stimulator device that is implanted under the skin in the chest, with a wire that is wound around the vagus nerve in the neck. It helps prevent seizures by sending regular, mild electrical pulses to the brain. Typically, the patient is not aware the device is operating.
A new study from Ann & Robert H. Lurie Children’s Hospital of Chicago published in the journal Epilepsiaexamined a population of pediatric patients with drug-resistant epilepsy. For these patients, the study found that the patients who received VNS, when used with anti-seizure medications (ASM), had lower hospital costs compared to the use of ASM alone. The study found that the patients treated with ASM plus VNS had savings of over $3,000 of epilepsy-related annual costs per year, compared to treatment with ASM only. These findings mirror the team’s previous report of children with drug-resistant epilepsy having significantly decreased inpatient healthcare utilization following VNS plus ASM compared to those treated with ASM alone. The study on healthcare utilization was published in Epilepsy & Behavior.
“We take a health services research perspective on the patients’ journey with a challenging disease process of drug-resistant epilepsy that has not been met with a cure. For patients with drug-resistant epilepsy, reducing seizure burden and addressing quality of life are important goals. We quantify aspects of outcomes of surgical therapies and medical therapies, and we assess the impact on health care costs and utilization. To the patients, families, health care systems, health care advocates, and policymakers, these are important results,” said senior author Sandi Lam, MD, MBA, Division Head of Neurosurgery at Lurie Children’s and Professor of Neurological Surgery at Northwestern University Feinberg School of Medicine. “While we show lower costs to the health care system following VNS surgery, from a practical standpoint it means fewer hospital admissions because of seizures. Patients spend their days at home instead of in the hospital.”
The study is unique in multiple ways. There has been no previous research focusing on children with drug-resistant epilepsy and comparing the outcomes of those who had VNS and ASMs and those who only received ASMs. The study also provides a breakdown of costs by site of care (inpatient, outpatient, and Emergency Department). The study researchers found that emergency department costs decreased more for children treated with VNS and ASM, compared to ASM alone. While average annual total costs were higher in the ASM-only cohort, the researchers also observed that outpatient care costs for VNS with ASM were higher than ASM alone. The study authors note that it is not surprising that children required more outpatient care shortly after VNS implantation, since device adjustment for each patient is necessary in this time period. Outpatient costs for children with VNS decreased dramatically in the second year. Future studies warrant additional focus on costs and patterns of care in longer term follow-up.
Research with national data do not substitute for clinical research. Each patient with epilepsy presents a unique case requiring tailored clinical care that should be managed at a comprehensive Level 4 NAEC pediatric epilepsy center like Lurie Children’s. Large studies with health services research can inform future research as well as gaps and opportunities in health care delivery. The study shows that surgical options should be a part of the epilepsy treatment armamentarium. While future studies will look at cranial epilepsy surgery outcomes, this study was limited to VNS and did not include epilepsy surgery on the brain, which is an important way of epilepsy treatment.
The study included children (0-17 years of age) who were diagnosed with refractory epilepsy, with 1113 patients treated with ASM plus VNS and 3471 patients treated with ASM only. Data were sourced from the Children’s Hospital Association’s Pediatric Health Information System (PHIS) database, which contains inpatient, emergency department, ambulatory, and observation encounter level data from more than 44 children’s hospitals in the United States. Patients in the study were followed one year prior and two years after meeting pre-determined criteria for refractory epilepsy.
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine.
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Hitachi, Ltd., University of Utah Health, and Regenstrief Institute, Inc. today announced the development of an AI method to improve care for patients with type 2 diabetes mellitus who need complex treatment. One in 10 adults worldwide have been diagnosed with type 2 diabetes, but a smaller number require multiple medications to control blood glucose levels and avoid serious complications, such as loss of vision and kidney disease.
For this smaller group of patients, physicians may have limited clinical decision-making experience or evidence-based guidance for choosing drug combinations. The solution is to expand the number of patients to support development of general principles to guide decision-making. Combining patient data from multiple healthcare institutions, however, requires deep expertise in artificial intelligence (AI) and wide-ranging experience in developing machine learning models using sensitive and complex healthcare data.
Hitachi, U of U Health, and Regenstrief researchers partnered to develop and test a new AI method that analyzed electronic health record data across Utah and Indiana and learned generalizable treatment patterns of type 2 diabetes patients with similar characteristics. Those patterns can now be used to help determine an optimal drug regimen for a specific patient.
Some of the results of this study are published in the peer-reviewed medical journal, Journal of Biomedical Informatics, in the article, “Predicting pharmacotherapeutic outcomes for type 2 diabetes: An evaluation of three approaches to leveraging electronic health record data from multiple sources.”
Hitachi had been working with U of U Health for several years on development of a pharmacotherapy selection system for diabetes treatment. However, the system was not always able to accurately predict more complex and less prevalent treatment patterns because it did not have enough data. In addition, it was not easy to use data from multiple facilities, as it was necessary to account for differences in patient disease states and therapeutic drugs prescribed among facilities and regions. To address these challenges, the project partnered with Regenstrief to enrich the data it was working with.
The new AI method initially groups patients with similar disease states and then analyzes their treatment patterns and clinical outcomes. It then matches the patient of interest to the disease state groups and predicts the range of potential outcomes for the patient depending on various treatment options. The researchers evaluated how well the method worked in predicting successful outcomes given drug regimens administered to patient with diabetes in Utah and Indiana. The algorithm was able to support medication selection for more than 83 percent of patients, even when two or more medications were used together.
In the future, the research team expects to help patients with diabetes who require complex treatment in checking the efficacy of various drug combinations and then, with their doctors, deciding on a treatment plan that is right for them. This will lead not only to better management of diabetes but increased patient engagement, compliance, and quality of life.
The three parties will continue to evaluate and improve the effectiveness of the new AI method and contribute to future patient care through further research in healthcare informatics.
Hitachi will accelerate efforts, including the practical application of this technology through collaboration between its healthcare and IT business divisions and R&D group. GlobalLogic Inc., a Hitachi Group Company and leader in Digital Engineering, is promoting healthcare-related projects in the U.S., will also deepen the collaboration in this field. Through these efforts, the entire Hitachi group will contribute to the health and safety of people.
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A novel class of bed net that kills mosquitoes resistant to traditional insecticides by making them unable to move or fly, significantly reduces malaria infection in children, according to new research published in The Lancet.
Unlike other insecticides which kill the mosquito via the nervous system, the effects of the new bed net mean the mosquito dies from starvation or being unable to fend for itself.
The two-year community randomised trial involved more than 39,000 households and followed over 4,500 children aged 6 months to 14 years in Tanzania. It found that a long-lasting insecticidal net treated with two insecticides, chlorfenapyr and pyrethroid (chlorfenapyr LLIN), reduced the prevalence of malaria by 43% and 37% in the first and second year respectively, compared to the standard pyrethroid only long-lasting insecticidal net (LLIN).
Chlorfenapyr LLIN also reduced clinical episodes of malaria by 44% over the two years and the number of malaria-infected mosquitoes captured by 85%.
The study was conducted by the London School of Hygiene & Tropical Medicine (LSHTM), National Institute for Medical Research, Kilimanjaro Christian Medical University College in Tanzania, and the University of Ottawa, Canada.
Long-lasting insecticidal nets are the cornerstones of malaria control in sub-Saharan Africa. However, in the past few years the decline in malaria has stalled and even reversed in some countries. In 2020, there were 627,000deaths from malaria, mainly in Africa and occurring mostly in children.

Antithrombotic therapy is prescribed to prevent thrombotic (blood clotting inside a blood vessel) events but the treatment also increases the likelihood of experiencing a bleeding event, which can be extremely serious if it occurs in a vital organ. Ageing societies tend to have an increased number of patients undergoing antithrombotic therapy, and the drugs used in this treatment can affect kidney function. In particular, reduced kidney function caused by antithrombotic medications can significantly influence bleeding events. It is highly recommended that patients, especially those with decreased kidney function, have a detailed discussion with their doctor about the possible risks and benefits of proceeding with antithrombotic therapy.
Patients with heart arrythmia (atrial fibrillation) have a high risk for thrombotic events in blood vessels that could lead to permanent organ damage — such as cerebral infarction — and are prescribed antithrombotic therapy to lower their risk of developing blood clots. However, the risk of bleeding events simultaneously increases due to the nature of these medications. The severity of these bleeding events is highly variable, ranging from epistaxis (nosebleeds) to fatal brain hemorrhage.
While kidney function is known to be related to bleeding event risk, researchers at Kumamoto, Miyazaki, and Tohoku Universities in Japan conducted a post-hoc subgroup analysis of the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial to determine the impact of kidney function on the risk of recurrent bleeding events during antithrombotic therapy. Their analysis revealed that the effect of kidney function on recurrent bleeding risk events was quite large for patients undergoing this treatment. They also found that the bleeding risk decreased with time for patients with healthy kidney function but remained high for patients with decreased kidney function. Clearly, the decision to use such a therapy should be balanced between the expected antithrombotic effects and bleeding risks.
In most cases, it is considered better to continue antithrombotic therapies even after bleeding events as long as the event was not severe. However, it is not surprising that both patients and physicians hesitate to continue the therapy after any bleeding event. To assess for drug safety and efficacy, these drugs are usually measured by the numbers of bleeding and thrombotic events. Unfortunately, in the assessment of antithrombotic therapy, most studies only consider the first event in their analyses even though patients could experience multiple events throughout their lifetime. This study revealed that the impact of kidney function on bleeding risk during antithrombotic therapy is larger than estimated in previous studies. Furthermore, patients with healthy kidney function appear to have a decreased risk of experiencing a bleeding event over time, but the risk for patients with reduced kidney function remains high as time continues.
“A detailed discussion between patients and physicians based on all current scientific evidence about the risks and benefits of antithrombotic therapy is highly recommended,” said study leader Dr. Kunihiko Matsui of Kumamoto University Hospital’s Department of General Medicine and Primary Care. “Our analysis should be quite useful in facilitating this type of discussion.”
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Liver disease negatively impacted by lifestyle changes during the first year of the pandemic, according to a new study in the journal Liver International.
The retrospective study used health checkup data of 973 participants between 2018 and 2020 from MedCity21, an advanced medical center for preventive medicine established by Osaka City University Hospital in 2014, and found that new diagnoses of metabolic dysfunction-associated fatty liver disease (MAFLD) rose from 22 before the COVID pandemic to 44 during the pandemic.
“Before the pandemic, we found routine late-night meals, or dinner 2 hours before bedtime, as an independent lifestyle predictor of developing MAFLD,” states Hideki Fujii, first author of the study, “however, analysis showed higher daily alcohol intake as an independent predictor of the disease during the pandemic.”
Pre-pandemic
Researchers analyzed the lifestyle habits of the 22 patients who developed MAFLD between July 2018 and December 2019, which included alcohol intake, exercise, sleep duration, meals per day, and late-night meals. Through a univariate and multivariate analysis of the data to control for potential risk factors like age, sex, etc., they found only the proportion of late-night meals as significantly higher, marking this as an independent predictor of developing MAFLD.
During pandemic
Between December 2019 and December 2020, in the additional 44 patients who developed MAFLD, researchers found a jump in alcohol intake mainly among patients less than 60 years of age. “This represents a major proportion of the working-age population,” says Dr. Fujii, “suggesting a need to more closely monitor and address this life-style change as the pandemic continues.” Also, the proportion of smokers and those who ate 2 meals a day instead of 3 were higher in those who developed MAFLD during the pandemic.
“Our data is drawn from individuals who, after undergoing abdominal ultrasonography in 2018, returned for routine follow-ups until 2020,” explains Dr. Fujii. While the research team is aware that this suggests most participants were healthy enough to engage in work and were sufficiently health conscious to voluntarily undergo health checkups, “we were curious about the impact COVID-19, and its associated “new normal” lifestyles, had on incidences of MAFLD,” continues Dr. Fujii — something that has remained until now, unknown.
As the pandemic continues into 2022, these results are ever more relevant for patient lifestyle counseling to prevent the increasing number of individuals with MAFLD.
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The amygdala is a small structure deep in the brain important for interpreting the social and emotional meaning of sensory input — from recognizing emotion in faces to interpreting fearful images that inform us about potential dangers in our surroundings. Historically the amygdala has been thought to play a prominent role in the difficulties with social behavior that are central to autism.
Researchers have long known the amygdala is abnormally large in school-age children with autism, but it was unknown precisely when that enlargement occurs. Now, for the first time, researchers from the Infant Brain Imaging Study (IBIS) Network, used magnetic resonance imaging (MRI) to demonstrate that the amygdala grows too rapidly in infancy. Overgrowth begins between six and 12 months of age, prior to the age when the hallmark behaviors of autism fully emerge, enabling the earliest diagnosis of this condition. Increased growth of the amygdala in infants who were later diagnosed with autism differed markedly from brain-growth patterns in babies with another neurodevelopmental disorder, fragile X syndrome, where no differences in amygdala growth were observed.
Published in the American Journal of Psychiatry, the official journal of the American Psychiatric Association, this research demonstrated that infants with fragile X syndrome already exhibit cognitive delays at six months of age, whereas infants who will later be diagnosed with autism do not show any deficits in cognitive ability at six months of age, but have a gradual decline in cognitive ability between six and 24 months of age, the age when they were diagnosed with Autism Spectrum Disorder in this study. Babies who go on to develop autism show no difference in the size of their amygdala at six months. However, their amygdala begins growing faster than other babies (including those with fragile X syndrome and those who do not develop autism), between six and 12 months of age, and is significantly enlarged by 12 months. This amygdala enlargement continues through 24 months, an age when behaviors are often sufficiently evident to warrant a diagnosis of autism.
“We also found that the rate of amygdala overgrowth in the first year is linked to the child’s social deficits at age two,” said first author Mark Shen, PhD, Assistant Professor of Psychiatry and Neuroscience at UNC Chapel Hill and faculty of the Carolina Institute for Developmental Disabilities (CIDD). “The faster the amygdala grew in infancy, the more social difficulties the child showed when diagnosed with autism a year later.”
This research — the first to document amygdala overgrowth before symptoms of autism appear — was conducted through The Infant Brain Imaging Study (IBIS) Network, a consortium of 10 universities in the United States and Canada funded through a National
Institutes of Health Autism Center of Excellence Network grant.
The researchers enrolled a total of 408 infants, including 58 infants at increased likelihood of developing autism (due to having an older sibling with autism) who were later diagnosed with autism, 212 infants at increased likelihood of autism but who did not develop autism, 109 typically developing controls, and 29 infants with fragile X syndrome. More than 1,000 MRI scans were obtained during natural sleep at six, 12, and 24 months of age.
So, what might be happening in the brains of these children to trigger this overgrowth and then the later development of autism? Scientists are starting to fit the pieces of that puzzle together.
Earlier studies by the IBIS team and others have revealed that while the social deficits that are a hallmark of autism are not present at six months of age, infants who go on to develop autism have problems as babies with how they attend to visual stimuli in their surroundings. The authors hypothesize that these early problems with processing visual and sensory information may place increased stress on the amygdala, leading to overgrowth of the amygdala.
Amygdala overgrowth has been linked to chronic stress in studies of other psychiatric conditions (e.g., depression and anxiety) and may provide a clue to understanding this observation in infants who later develop autism.
Senior author Joseph Piven, MD, Professor of Psychiatry and Pediatrics at the University of North Carolina at Chapel Hill added, “Our research suggests an optimal time to start interventions and support children who are at highest likelihood of developing autism may be during the first year of life. The focus of a pre-symptomatic intervention might be to improve visual and other sensory processing in babies before social symptoms even appear.”
This research could not be possible without all the families and children who have participated in the IBIS study. Research sites included UNC-Chapel Hill, Washington University in St. Louis, Children’s Hospital of Philadelphia, McGill University, and University of Washington. This research was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, and National Institute of Mental Health (R01-HD055741, R01-HD059854, R01-MH118362-01, R01-MH118362-02S1, T32-HD040127, U54-HD079124, K12-HD001441, R01-EB021391, U54-HD086984; NIH P50 HD103573), along with Autism Speaks and the Simons Foundation.

Scientists at Nanyang Technological University, Singapore (NTU Singapore) have developed probiotics with a unique edible coating that ensures the beneficial bacteria successfully reach the intestine once they are ingested.
Probiotics are defined by the World Health Organisation as live microorganisms, which when administered in adequate amounts, confer a health benefit on the host[1]. They have been shown to help prevent infections of the urinary and digestive tracts, and to maintain a healthy gut flora, which is linked to reducing the risk of obesity and promoting overall well-being[2].
However, several modes of delivering probiotics, including supplements and dairy products, have not been effective in ensuring they survive conditions in the human stomach to be delivered in quantities that would be sufficient to benefit one’s health. Many studies show that the bulk of probiotics delivered in commercial supplements and yogurts die off within the first 30 minutes of exposure to the acidic environment of the stomach[3].
In the NTU-study, the probiotics, gut-friendly Lacticaseibacillus bacteria, are spray-coated with alginate, a carbohydrate derived from brown algae, protecting them from the harsh acidic conditions in the stomach.
Through experiments simulating a journey along the human digestive tract, only the probiotics with the NTU-developed coating survived. The bacteria are released only when they reach the small intestine, as the coating breaks down by reacting with phosphate ions, which are present in higher amounts in the small intestine.
Development of the alginate coating technology reflects NTU’s commitment to the needs and challenges of healthy living and ageing, which is one of four humanity’s grand challenges that the University seeks to address through its NTU 2025 strategic plan.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesUK officials say they have found a confirmed case of a viral illness called Crimean-Congo haemorrhagic fever in England. The woman, who is being treated at the Royal Free Hospital in London, had recently travelled to Central Asia, where this tick bite infection is endemic.The disease does not spread easily between people, meaning the risk to the public is very low, say experts. It is not carried by ticks in the UK. It is the third known case of the fever in the UK, with prior cases reported in 2012 and 2014.The disease can be caught from contact with infected blood or tissues from a person or animal. Symptoms then develop quite quickly – after a few days – and include fever, aches, nausea and vomiting, and a rash caused by bleeding into the skin. Patients can become severely ill with organ damage, which can be fatal. Chief Medical Advisor at the UK Health Security Agency, Dr Susan Hopkins, said robust infection control measures were being followed at the hospital that is caring for the patient. “We are working to contact the individuals who have had close contact with the case prior to confirmation of their infection, to assess them as necessary and provide advice,” she added. The woman was diagnosed at Cambridge University Hospitals NHS Foundation before being transferred to The Royal Free Hospital. Dr Sir Michael Jacobs, consultant in infectious diseases at the Royal Free London, said: “The Royal Free Hospital is a specialist centre for treating patients with viral infections such as Crimean-Congo haemorrhagic fever. “Our high-level isolation unit is run by an expert team of doctors, nurses, therapists and laboratory staff, and is designed to ensure we can safely treat patients with these kind of infections.”People living in or visiting endemic areas should use personal protective measures to avoid contact with ticks, including:avoiding areas where ticks are abundant at times when they are activeusing tick repellentschecking clothing and skin carefully for ticksRelated Internet LinksWHO – Crimean-Congo haemorrhagic feverThe BBC is not responsible for the content of external sites.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesA simple blood test can help spot pre-eclampsia, a potentially dangerous condition in pregnancy, and should be offered to women on the NHS, new draft guidelines for England say. Early diagnosis of this disorder, which affects up to 6% of pregnancies, can save lives, the National Institute for Health and Care Excellence (NICE) says.The test checks the health of the placenta, which provides nutrients and oxygen to the baby in the womb. And it can warn early of any problem. Many hospitals have already started using the placental growth factor (PLGF) test.Fast reassurancePLGF is a protein that helps the development of new blood vessels in the placenta. Abnormally low levels could be an indicator the placenta is not developing properly.The new guidelines say midwives caring for pregnant women can use it, alongside other checks, to quickly identify pre-eclampsia. It can give a result the same day, providing fast reassurance and allowing closer monitoring and extra care to swiftly begin for those who need it.If the test is normal, pre-eclampsia is unlikely to develop over the next week or so. Jeanette Kusel, from NICE, said: “These tests represent a step change in the management and treatment of pre-eclampsia.”This is extremely valuable to doctors and expectant mothers as now they can have increased confidence in their treatment plans and preparing for a safe birth.”Tina Prendeville from Tommy’s, a charity funding research into miscarriage, stillbirth and premature birth, said: “Tens of thousands of women have already been helped as this testing has been used across the country. With three quarters of maternity units now using it, NICE’s consultation is very welcome.”Pre-eclampsiaWhen it happens, it is usually in the second half of pregnancy or soon after the baby is bornEarly signs include headaches, high blood pressure and protein in the urine of the mother-to-beThose who have it should be carefully monitored and their baby may need to be delivered earlyMost cases improve soon after the baby is deliveredIn a small number, it can develop into a more serious, life-threatening illnessMore on this storyNHS to offer mums-to-be new blood testSome mums-to-be in Wales to get pre-eclampsia testRelated Internet LinksPre-eclampsia – NHSThe BBC is not responsible for the content of external sites.

Receiving psychosocial and behavioral therapy alongside medications for opioid use disorder leads to better treatment engagement and continuity, according to Rutgers researchers.
To better understand the role of psychosocial and behavioral therapy, the study, published in the Journal of Substance Abuse Treatment, examined services received by people in the first six months after beginning buprenorphine, a medication used to treat opioid use disorder.
Researchers found that the majority patients initiating buprenorphine medication to treat opioid use disorder had little to no psychosocial and behavioral therapy, with less than 1 in 5 receiving low-intensity therapy, about twice a month, and less than 1 in 10 receiving higher-intensity therapy.
In analyses of buprenorphine use among patients with at least seven days of treatment, receiving opioid use disorder-related therapy was associated with lower risk of medication discontinuation in the first 180 days after treatment, raising the possibility that therapy may help to reduce high attrition rates commonly observed early during treatment.
“We focused on the first 180 days of treatment because this is a particularly high-risk period for discontinuing medication,” said Hillary Samples, study author and an assistant professor in the Department of Health Behavior, Society, and Policy at the Rutgers School of Public Health.
While fewer patients with minimal or no therapy services reached the benchmark for minimum duration of pharmacotherapy, a substantial proportion had 180 days or more of buprenorphine treatment, indicating that many patients persist in treatment with medication alone.
“This finding indicates that insurance policies requiring referral or receipt of psychosocial services to receive buprenorphine or other medications for opioid use disorder treatment may create overly restrictive barriers to highly effective medication treatment,” said Samples. “Still, efforts to ensure adequate availability of psychosocial support services are important to facilitate access for patients who could benefit from therapy, such as recent expansions in telehealth that could address current barriers to care.”
The researchers note ?that patterns of therapy use corresponded to indicators of treatment need, which may signal appropriate alignment between patient characteristics and current clinical practices. Patients who received psychosocial and behavioral therapy had higher rates of co-occurring mental health and substance use diagnoses, including cannabis and stimulant use disorders.
“Patients who have comorbid substance use disorders that lack effective medication options, such as cocaine and amphetamines, could represent a priority group for psychosocial services,” adds Samples. “Further research to understand the relationship between clinical profiles and therapy services is critical to align patient needs with evidence-based treatment to improve medication retention and patient outcomes.”
The study was the first to characterize trends in psychosocial and behavioral therapy received alongside buprenorphine in the treatment of adults with opioid use disorder.
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Materials provided by Rutgers University. Original written by Michelle Edelstein. Note: Content may be edited for style and length.