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Could a wayward breath mint have caused his symptoms?The young woman was awakened by the screams of her 39-year-old husband. “Please make it stop!” he shouted, leaping from the bed. “It hurts!” He paced back and forth across the room, arms crossed over his chest as if to protect himself. Two days earlier, he had inhaled a breath mint when his wife startled him. He felt it move slowly down his throat as he swallowed repeatedly. His chest had hurt ever since. But not like this.The man squirmed miserably throughout the short drive to the emergency room at Westerly Hospital, near the Rhode Island and Connecticut border. No position was comfortable. Everything hurt. Even breathing was hard. Although the doctors in the E.R. immediately determined that the young man wasn’t having a heart attack, it was clear something was very wrong. His blood pressure was so low that it was hard to measure. A normal blood pressure may be 120/80. On arrival, his was 63/32. With a pressure this low, blood couldn’t get everywhere it was needed — a condition known as shock. His lips, hands and feet had a dusky hue from this lack of well-​oxygenated blood. He was given intravenous fluids to bring up his pressure, and when that didn’t work, he was started on medications for it. Three hours later, he was on two of these medicines and his fourth liter of fluid. Despite that, his pressure remained in the 70s. He had to be put on a breathing machine to help him keep up with his body’s demand for more oxygen.The most common cause of shock is infection. But this man, as sick as he was, had no signs of infection. The medical team started him on antibiotics anyway. Could the painful mint have torn his esophagus? Up to 50 percent of patients with that injury will die. A CT scan showed no evidence of perforation or of fluid in his chest. What else could this be? There was no sign of a clot keeping blood from entering the lungs, another cause of deadly low blood pressure. An ultrasound of the heart showed that he had some fluid in the sac called the pericardium, which contains and protects the heart, but not enough to interfere with how well it was beating. He was tested for Covid and for recreational drugs — both negative.The doctors in the small community hospital began to worry that they wouldn’t figure out what was going on with this young man in time to save his life. They reached out to Yale New Haven Hospital an hour and a half away, which was better equipped to handle tough cases. Dr. Laura Glick, a resident finishing her second year of training at Yale New Haven, heard about this pending transfer and looked him up in the electronic medical record shared by the two hospitals. The patient was getting a CT of his abdomen and pelvis. Could there be a hidden infection there? As she read through his chart, an event note popped up. The patient’s heart had stopped while he was in the scanner. Was he going to die before he even got to Yale?His rapid deterioration — from a previously healthy young man who had walked into the E.R. complaining of severe pain a few hours earlier to someone who had “coded” while being scanned — was terrifying. More notes appeared. CPR was started, and after about seven minutes, the man’s heart began to beat on its own. More notes: He was awake. He was able to answer yes-or-no questions, though the breathing tube kept him from speaking. He was loaded into the transport helicopter and flown to Yale New Haven.Photo illustration by Ina JangThree PossibilitiesGlick estimated she had 20 minutes, maybe a little more, to figure out how to save this dying man. She reached out to the I.C.U. specialist in training, Dr. Stella Savarimuthu. There are only a few things that can kill you this fast, Glick acknowledged, and at Westerly they’d done a good job of ruling out most of them. She listed other possibilities she was considering. One: If the man had a perforated esophagus, he would need to go to the operating room, so she would alert surgery. Two: Maybe he didn’t have enough cortisol, one of the “fight or flight” hormones, which could cause persistent and dangerously low blood pressure. They would need to check that right away. Three: The only abnormality seen at Westerly was the small amount of fluid around his heart. In medicine, when it really matters, the rule is “Trust but verify.” With a patient this sick, things can change rapidly. When he arrived, she would have cardiologists ready to examine his heart.A couple of hours later, Glick stood watching the ultrasound monitor. The pixelated gray-and-white image of the patient’s rapidly beating heart muscle was surrounded by an unnatural black halo, indicating the presence of excess fluid in the pericardial sac. The pump was hard at work, but there wasn’t enough room for blood to even enter his heart. No wonder his blood pressure was so low.The patient was moved to the O.R., and a cardiologist inserted a thick needle into the fluid-filled sac. Just under a cup of pale yellow liquid poured out. On the screen, the halo shrank until it disappeared. His doctors would still need to figure out why he had this fluid in the first place, but now that it was gone, his blood pressure should return to normal.Back in the I.C.U., Glick followed the patient closely. Hours passed, then days, and though his blood pressure was better, it remained too low. Why? Glick sent test tube after test tube to the lab, looking for signs of infection, inflammation, autoimmune disorders — everything she could think of. After the man’s near-death experience, Glick knew that many of his lab results would be abnormal. His liver was damaged, his kidneys, his heart. Her job was to identify which abnormalities were a result of his rapid deterioration and which were the cause.Aberrant results streamed in, but only one surprised the resident. The man’s thyroid wasn’t making its essential hormone. The thyroid is like the carburetor in an old internal-combustion engine. It tells the body when to rev up and when to slow down. Right now the man’s body needed to be fully revved up, but without this hormone, it couldn’t do it. Before giving the man replacement hormones, Savarimuthu reminded Glick they had to recheck his cortisol level. They had checked it when he arrived, and it was high — as expected, given the physiological stress he was under. But administering thyroid hormone to someone who is cortisol-deficient is like jump-starting a car that has no oil in the engine. You could ruin the whole machine. So Glick sent off a second cortisol-level test. This time, the level was undetectable. She checked again: undetectable.The Steroid TestA different test revealed the cause: His adrenal glands, where cortisol is made, weren’t working at all, just like his thyroid gland. She started the man on steroids — an artificial form of cortisol — along with thyroid hormone, and consulted the endocrine team. She then reviewed the records from Westerly, where she saw, buried deep in his chart, that he had been given steroids there. Because he wasn’t deficient when he arrived, and they hadn’t mentioned the steroids in their notes, Glick hadn’t administered them at Yale New Haven. She now turned to the medical literature to figure out just what might have caused these devastating twin hormone deficiencies.It didn’t take long to determine that he must have autoimmune polyglandular syndrome Type 2. In this rare disorder, the immune system suddenly and mistakenly starts to attack parts of the patient’s own body — in this case, the thyroid gland and the adrenal glands. Why this happens is not well understood. A few hours after getting both replacement hormones, the young man was well enough to begin tapering the medications sustaining his blood pressure. A couple of days later, he was well enough to leave the I.C.U. Ten days later, he was able to go home.Once the patient understood what he had and started to feel the benefit of the treatment, he realized he’d been sick long before that mint went down wrong. He will have to take these hormones for the rest of his life, but he feels better than he has for years. No one can be certain exactly when his glands were destroyed; it was probably long ago. “I’m not a guy who goes to the doctor,” he admitted. He thought he was just getting old: “You know what they say — after 30, it’s all downhill.” But not anymore. Not for him, anyway.Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.

Climbing stairs, doing jumping jacks or even taking as few as 15 steps during mini-breaks improved blood sugar control among office workers. Sitting for hours at a desk can play havoc with our metabolic health, contributing over time to high blood sugar and high cholesterol, even in people who otherwise seem mostly healthy. But a practical though small new study shows that standing up and moving every 30 minutes for about three minutes may lessen the health impacts of over-sitting. The study found that climbing several flights of stairs, bopping through some jumping jacks or squats or even taking as few as 15 steps during these mini-breaks improved aspects of blood sugar control among office workers, without noticeably interrupting their work flow.But the study, which involved 16 middle-aged, white-collar workers at high risk for Type 2 diabetes, also indicates that these bi-hourly, three-minute breaks likely represent the minimum amount of movement needed to protect metabolic health. While 15 steps twice an hour may be a good start, they should not be the only steps we take toward reducing how much we sit.For most of us, sitting is not just commonplace but constant. According to epidemiological studies, adults in the United States typically sit for about six and a half hours a day, with most of that time uninterrupted by standing or strolling. This postural lassitude likely accelerated during the pandemic. Preliminary data suggests that many of us are more inactive now than in 2019, especially if we have children and jobs. Such relentless sitting squashes metabolic health. Or, as the new study’s authors write, “Every waking hour spent in sedentary postures (that is, sitting or lying) increases risk for metabolic syndrome and Type 2 diabetes.” Blame flaccid muscles. When we sit, the muscles in our legs, which are the largest in our body and are usually active and hungry, barely contract, so, require minimal fuel and slurp little sugar from our bloodstreams. They also do not release biochemical substances that would normally help break down fatty acids in the blood. So, when we hunch over our desks, blood sugar and cholesterol build up in our bloodstreams.Helpfully, frequent breaks from sitting improve blood sugar control and cholesterol levels, past studies show. But much of that research took place in university labs and lasted only a day or two, conditions that do not reflect real life.So, for the new study, which was published last month in The American Journal of Physiology: Endocrinology and Metabolism, an international consortium of scientists, led by researchers at the Karolinska Institute in Stockholm, Sweden, decided to see what would happen if office workers agreed to break up their sitting time, over three weeks, in their normal workplace.They began by recruiting 16 middle-aged men and women in Stockholm with sedentary desk jobs and a history of obesity, putting them at high risk for metabolic problems like diabetes. They checked the volunteers’ current metabolic health and asked them to wear activity monitors for a week, to get baseline numbers.Then, half of the volunteers continued with their normal lives, as a control, and the rest downloaded a smartphone app that alerted them every 30 minutes during the workday to rise and be active for three minutes. They ambled halls, strolled stairs, marched in place, squatted, hopped or otherwise moseyed about in whatever way they found convenient, tolerable and not overly distracting or amusing to their co-workers. But they had to take a minimum of 15 steps before the app recorded their movement as an activity break.The experiment continued for three weeks, after which everyone returned to the lab for another round of metabolic tests. The researchers found that the two groups’ results subtly diverged. The control group displayed ongoing problems with insulin resistance, blood sugar control and cholesterol levels. But the other volunteers, who had stood and moved while at work, showed lower fasting blood sugar levels in the morning, meaning their bodies better controlled blood sugar during the night, a potentially important indicator of metabolic health. Their blood sugar also stabilized during the day, with fewer spikes and dips than in the control group, and the amount of beneficial HDL cholesterol in their bloodstreams rose. These improvements were slight, but might mean the difference, over time, between progressing to full-blown Type 2 diabetes or not.Interestingly, the gains also ranged, depending on how often and how rigorously workers complied with their app alerts. Those who rose regularly and were the most active — generally managing 75 steps or more during the three minutes — improved their metabolisms the most. Others, accumulating fewer steps, or frequently ignoring their beeping alerts, benefited less.But their metabolic health did improve somewhat, said Dr. Erik Näslund, a professor at the Karolinska Institute who oversaw the new study. The findings suggest that aiming to get up twice an hour is worthwhile, even if we do not always succeed. He offered two pieces of advice to anyone concerned about over-sitting and their metabolic health.Download an app or set an alarm on your computer or phone to remind you to rise every half-hour. Walk for a few minutes. Jog in place. “Going to the bathroom or getting a coffee” also count, Dr. Naslund said, with the second potentially contributing to the first.Be sure to keep moving, outside of work hours. “In general, it is important to introduce more physical activity into our lives,” he said. “Walk stairs rather than take the elevator. Get off one bus stop earlier on the way home. There are so many minor changes we can make that are beneficial for metabolic health.”

Prevention and treatment fell in poor countries last year as access to health care declined, according to a new report.The Covid-19 pandemic has severely set back the fight against other global scourges like H.I.V., tuberculosis and malaria, according to a sobering new report released on Tuesday.Before the pandemic, the world had been making strides against these illnesses. Overall, deaths from those diseases have dropped by about half since 2004.“The advent of a fourth pandemic, in Covid, puts these hard-fought gains in great jeopardy,” said Mitchell Warren, executive director of AVAC, a nonprofit organization promoting H.I.V. treatment worldwide.The pandemic has flooded hospitals and disrupted supply chains for tests and treatments. In many poor countries, the coronavirus diverted limited public health resources away from treatment and prevention of these diseases.Many fewer people sought diagnosis or medication, because they were afraid of becoming infected with the coronavirus at clinics. And some patients were denied care because their symptoms of a cough or fever resembled those of Covid-19.Unless comprehensive efforts to beat back the illnesses resume, “we’ll continue to play emergency response and global health whack-a-mole,” Mr. Warren said.The report was compiled by the Global Fund, an advocacy group that funds campaigns against H.I.V., malaria and tuberculosis.Before the arrival of the coronavirus, TB was the biggest infectious-disease killer worldwide, claiming more than one million lives each year. The pandemic has exacerbated the damage.In 2020, about one million fewer people were tested and treated for TB, compared with 2019 — a drop of about 18 percent, according to the new report.The number of people treated for drug-resistant TB declined by 19 percent, and for extensively drug-resistant TB, by 37 percent. Nearly 500,000 people were diagnosed with drug-resistant TB in 2019.“We’ve been hit really hard on TB,” said Peter Sands, executive director of the Global Fund. “I’m afraid that inevitably means hundreds of thousands of extra deaths.”India, which has the highest TB burden in the world, had resumed its pre-Covid rate of TB diagnoses by late 2020, but the outbreak this spring is likely to have reversed that progress, Mr. Sands said.A drop in TB diagnoses can have far-reaching consequences for a community. One person with untreated TB can spread the bacteria to as many as 15 people each year.Compared with 2019, the number of people who sought testing for H.I.V. declined by 22 percent, and those who opted for H.I.V. prevention services by 12 percent. Medical male circumcision, thought to slow the spread of the virus, decreased by 27 percent.“Because there isn’t a cure for H.I.V., every single person who gets infected is a long-term impact,” Mr. Sands said.Diagnoses of malaria fell by a small amount, according to the report. Most countries were able to implement measures that limited the impact on diagnosis and treatment.As many as 115 million people have been driven into extreme poverty because of Covid-19, further limiting their access to treatment and support. In some countries, school closures and lockdowns made it particularly difficult for adolescent girls and young women to receive health services.There were a few glimmers of hope amid the bleak news: The crisis forced health agencies and ministries in many poor countries to adopt innovations that may outlast the pandemic. Among them: dispensing to patients multi-month supplies of TB and H.I.V. drugs, or of condoms, lubricants and needles; using digital tools to monitor TB treatment; and testing simultaneously for H.I.V., TB and Covid-19.For example, in Nigeria, community health workers who tested people for Covid also looked for cases of H.I.V. and TB. As a result, the country became one of the few to see a rise in H.I.V. diagnoses compared with 2019.In Ouagadougou, Burkina Faso, community health workers on motorbikes delivered insecticide-treated bed nets door to door, rather than distributing them from trucks in village squares, allowing them to reach more households than before, and cutting down the number of malaria infections.“It’s a bit more expensive” to deliver nets to individual households, but “that was an investment that was clearly worth doing,” Mr. Sands said.To minimize the impact of the pandemic, the Global Fund has spent about $1 billion more than its usual budget, Mr. Sands said. In March 2020, the organization released $500 million to help countries cope; as of August 2021, it has raised $3.3 billion for use in 107 countries.The funds have been used to shore up health systems, provide tests, treatments and oxygen, and to give personal protective equipment to health care workers.Donors have committed to provide another $6 billion for H.I.V. and $2 billion for TB over the next three years, Mr. Sands said.

SharecloseShare pageCopy linkAbout sharingimage sourceReutersMexico’s Supreme Court has ruled that criminal penalties for terminating pregnancies are unconstitutional. The ruling, for the northern state of Coahuila, prevents women from being prosecuted for getting an abortion.Abortion is currently severely restricted in all but four of the country’s states.Supreme Court Justice Luis Maria Aguilar described the move as a “historic step for the rights of women”. On Tuesday, the court ordered the state of Coahuila to remove sanctions for abortion from its criminal code. The decision could pave the way for the decriminalisation of abortions across the country. Currently, abortion is only legal in a handful of states, except in cases of rape or where the mother’s life is in danger. A judicial source said the ruling will affect the whole of Mexico, allowing women in states where abortion is criminalised to undergo the procedure with a judge’s order. The Information Group on Reproductive Choice (GIRE), which campaigns for abortion rights, described the decision as “historic”.”We hope that throughout the country women and people with the ability to carry a child have the conditions and freedom to determine their reproductive destiny,” it said.Coahuila borders the US state of Texas, where the Supreme Court allowed a state law banning all abortions after six weeks of pregnancy. The ruling could open up avenues for people from Texas seeking legal abortions.The decision to decriminalise abortion in what is Latin America’s second largest Catholic nation might appear surprising. However, the debate in Mexico has been gradually moving towards removing the illegality for some time. High profile protests by feminist and women’s rights campaigners have underlined the need for greater reproductive rights in Mexico. Specifically, the Supreme Court was asked to rule on a law in the northern state of Coahuila which punishes women who have illegal abortions with jail terms of up to three years. The 11 Supreme Court judges unanimously voted to decriminalise abortion in that state, and under Mexican law, it will now apply to all the other states in the country.It is likely to take some time to be applied across the nation, but in effect the decision provides each state with a roadmap towards new legislation. Furthermore, it should mean that women who were jailed for having abortions will be immediately released. The decision is likely to anger more conservative politicians in Mexico and the Catholic Church. However, the church’s influence has been waning in recent years and the government considers itself staunchly secular.

Throughout the COVID-19 pandemic, clinicians have noted that certain patients are at especially high risk of developing severe illness or dying from coronavirus infection. Type 2 diabetes — a condition affecting more than 10 percent of the U.S. population — is one of the main risk factors for severe COVID-19 illness. New research from U-M uncovers why this might be and offers hope for a potential therapy.
The culprit appears to be an enzyme called SETDB2. This same enzyme has been implicated in the non-healing, inflammatory wounds found in people with diabetes. Working in the lab of Katherine Gallagher, M.D. of the Michigan Medicine Departments of Surgery and Microbiology and Immunology, researcher W. James Melvin, M.D., and his colleagues decided to probe a possible link between the enzyme and the runaway inflammation they witnessed first-hand in COVID patients in the ICU.
Starting with a mouse model of coronavirus infection, they found that SETDB2 was decreased in immune cells involved in the inflammatory response, called macrophages, of infected mice with diabetes. They later saw the same thing in monocyte-macrophages in the blood from people with diabetes and severe COVID-19.
“We think we have a reason for why these patients are developing a cytokine storm,” said Melvin.
In the mouse and human models, noted Melvin and Gallagher, as SETDB2 went down, inflammation went up. In addition, they revealed that a pathway known as JAK1/STAT3 regulates SETDB2 in macrophages during coronavirus infection.
Taken together, the results point to a potential therapeutic pathway. Previous findings from the lab demonstrated that interferon, a cytokine important for viral immunity, increased SETDB2 in response to wound healing. In their new study, they found blood serum from patients in the ICU with diabetes and severe COVID-19 had reduced levels of interferon-beta compared to patients without diabetes.

Emoji, that universal lexicon of colorful and clever symbols meant to replace the written and spoken word, could be a valuable tool in the field of medicine, allowing patients to better communicate symptoms, concerns, and other clinically relevant information, argue a Massachusetts General Hospital (MGH) physician and others. In a commentary in the Journal of the American Medical Association, senior author Shuhan He, MD, an emergency department attending, suggests that each medical discipline begin discussions around the creation of its own unique set of iconography for official adoption and incorporation into everyday practice.
“The need to listen to patients is at the core of our mission as physicians, and the use of emoji is a great opportunity to take communication to another level,” says He, who is director of growth for the MGH Center for Innovation in Digital HealthCare and a member of MGH’s Lab of Computer Science. “Emoji could be particularly important in treating children with still-developing language skills, people with disabilities that impair their ability to communicate, and the many patients who speak a different language.”
Emoji (which means “picture character”) originated in Japan over a decade ago and today an estimated five billion are used daily on Facebook and Facebook Messenger alone. While around 3,500 emoji are currently within the domain of the Unicode Consortium — the nonprofit organization that maintains text standards across computers and which must approve every emoji before it can be digitally used — only about 45 emoji can be considered relevant to medicine. The first, introduced in 2015, were the syringe and the pill. In 2017, Apple added emoji to represent people with disabilities, followed by symbols of the stethoscope, bone, tooth and microbe in 2019. He was co-creator of the anatomical heart and the lung emoji introduced globally in 2020 and is now working with co-authors Debbie Lai and Jennifer 8. Lee, who are active in the field, as well as with a wide range of medical societies and organizations to advocate for an additional 15 medically related emoji.
“It’s tempting to dismiss emoji as a millennial fad, but they possess the power of standardization, universality and familiarity, and in the hands of physicians and other health care providers could represent a new and highly effective way to communicate pictorially with patients,” says He. In emergency medical settings where time is critical, emoji could lead to a point-and-tap form of communication that could facilitate important clinical decisions, he adds. The tiny graphic symbols which now span all digital platforms — from mobile to tablet to desktop — could also have utility as annotations to hospital discharge instructions, which are often confusing if not incomprehensible to some patients.
In addition, the recent growth of telemedicine could be a rich opportunity for emoji to make medical inroads. The interactive platform is seen as particularly well suited for patients to transmit to health care providers visual information that charts the intensity of pain they have experienced over a period of days, weeks or months, and for those providers to make it part of the patient’s digital health record for ongoing treatment.
He is continuing his research to better understand how emoji could help patients and doctors communicate common symptoms — such as mobility, mood, and duration and quality of pain – that are associated with various diseases and conditions. “It’s clear that emoji have become part of the global, mainstream conversation, and that medical societies and physician committees and organizations need to take them seriously,” says He. “Which means they should be determining now which emoji would best serve the interests of their patients, building consensus around the medical accuracy of these emoji, then working to get them approved through the global standard-setting body and working through the long adaptation and implementation process.”
Co-author Jennifer 8. Lee is founder of Emojination, a grassroots group that has led successful campaigns for over 100 new emoji over the past five years. Co-author Debbie Lai is chief operating officer of the Act Now Coalition, a nonprofit that provides visualizations of data on COVID-19 and climate change.
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A collection of leading health and medical journals called this week for swift action to combat climate change, calling on governments to cooperate and invest in the environmental crisis with the degree of funding and urgency they used to confront the coronavirus pandemic.In an editorial published in more than 200 medical and health journals worldwide, the authors declared a 1.5-degree-Celsius rise in global temperatures the “greatest threat to global public health.” The world is on track to warm by around 3 degrees Celsius above preindustrial levels by 2100, based on current policies.“The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse,” the authors wrote. “Indeed, no temperature rise is ‘safe.’”Although medical journals have copublished editorials in the past, this marked the first time that publication has been coordinated at this scale. In total more than 200 journals representing every continent and a wide range of medical and health disciplines from ophthalmology to veterinary medicine published the statement. The authors are editors of leading journals including The Lancet and the New England Journal of Medicine.In the editorial, they raised concerns not only about the direct health consequences of rising temperatures, including heat-related mortality, pregnancy complications and cardiovascular disease, but also the indirect costs, including the effects that soil depletion could have on malnutrition and the possibility that widespread destruction of habitats could increase the likelihood of future pandemics.The editorial urged wealthy countries to go beyond their targets and commit to emissions reductions that are commensurate with their cumulative, historic emissions. It also called on them to go beyond their stated goals of $100 billion for climate resiliency plans in developing nations, including funding for improving health systems.“While low and middle income countries have historically contributed less to climate change, they bear an inordinate burden of the adverse effects, including on health,” said Dr. Lukoye Atwoli, the editor in chief of the East African Medical Journal and one of the co-authors of the editorial, in a statement. “We therefore call for equitable contributions whereby the world’s wealthier countries do more to offset the impact of their actions on the climate.”Sue Turale, the editor in chief of the International Nursing Review and a co-author of the editorial, said in a statement, “As our planet faces disasters from climate change and rising global temperature, health professionals everywhere have a moral responsibility to act to avoid this.”The publication comes ahead of a busy few months of climate and environmental conferences. The U.N. General Assembly is scheduled to meet this month in New York City, the U.N.’s biodiversity summit will meet in October in Kunming, China, and the U.N. Climate Change Conference, known as COP, in Glasgow in November.A growing body of research has shown that extreme weather events worsened by climate change are contributing to a wide range of adverse health outcomes. Earlier this year a study found that around a third of heat-related deaths worldwide could be attributed to the extra warming associated with climate change. And this summer, hundreds of Americans have died in extreme weather events, including more than 600 during the weeklong record-breaking heat wave in the Pacific Northwest that climate scientists say would have been “virtually impossible without climate change.”

Neuroblastoma is a type of childhood cancer that develops in infants and young children. Whilst it is a relatively rare form of cancer, it is still responsible for approximately 15 percent of all cancer deaths in children. In a new study published today in Nature Communications, researchers at Karolinska Institutet in Sweden have discovered that low-risk and high-risk neuroblastoma have different cell identities, which can affect the survival rate.
Neuroblastoma often starts in the sympathetic nervous system or the adrenal glands. This cancer has a high variability in outcome, ranging from spontaneous regression and complete disappearance to relentless disease progression with very few treatment options.
The child’s age at the time of diagnosis is one of the most important prognostic factors for a favourable outcome. However, the importance of age is a question that has previously been left unanswered.
“In our research we have studied single cell sequencing in healthy adrenal tissues from fetuses, babies and older children, and compared this to tumor tissue from different neuroblastoma risk groups,” says Susanne Schlisio, associate professor at the Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet in Solna, and co-corresponding author of the study.
Different cell types with different malignancy potentials
Tumor tissue samples have been collected from children where the age at diagnosis ranged from less than a month to 6,5 years. Approximately 50 percent of the tumors were classified as high-risk and 50 percent as low-risk.

Psychiatric and cognitive symptoms emerge at an early stage in Huntington’s disease. However, research so far has mainly focused on movement impairment, a symptom associated with the more advanced stages of the disease. A new study from Lund University in Sweden now shows that the emotional brain — the limbic system – is affected earlier in the course of the disease, and should therefore be given more attention in the development of new treatments.
Huntington’s is a fatal illness with no treatment to slow its course. The new research findings provide knowledge about where the early changes take place in the brain. This is important for the development of new treatments which, according to the researchers, should target the earliest disease-related changes.
“Our results show that the emotional brain is affected at an early stage, and that this can contribute to the development of psychiatric and cognitive symptoms, which are the most difficult for the patients and their relatives. It is not only nerve cells that are affected, but also other cells, oligodendrocytes, which enable communication between different parts of the brain, that are affected early in the course of the disease,” explains Åsa Petersén, professor of neuroscience at Lunds University and senior consultant in psychiatry at the Huntington Centre in Lund.
Huntington’s disease is caused by a known genetic mutation that results in the production of a protein known as mutant huntingtin in all the cells of the body. However, only certain cells are very sensitive to the protein mutation and these are in specific areas of the brain.
“It is still a mystery why certain cells are sensitive to the protein mutation and why the disease starts to break out at a certain time, even though it was there all along. However, our study shows for the first time that changes in the oligodendrocytes in the emotional brain are expressed in the brains of individuals suffering from Huntington’s disease,” says researcher and first author of the study, Sanaz Gabery.
The researchers believe that previous research focused too much on the typical movement impairments associated with Huntington’s disease and the link to effects on the movement control centre.
“The emotional brain and cells other than just nerve cells are affected by the development of Huntington’s disease. The nerve-fibre system in the emotional brain is already reduced before the typical movement impairments emerge. The changes consist of damage to myelin, i.e. the insulation system in the white matter of the brain, which is important for information transfer, and an effect on genes that are important for oligodendrocytes’ identity and function,” explains Åsa Petersén.
“Today, many researchers are focused on reducing the levels, and thereby the effect, of the disease-inducing mutant huntingtin in the nerves cells and in the brain’s movement control centre. But our findings indicate that there is also a need to examine the white matter in the emotional brain. Why are oligodendrocytes sensitive to mutant huntingtin? Is it possible to slow down Huntington’s disease by affecting the changes that we have identified?”
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When dental implants are inserted, saliva or blood plasma immediately coat them. The implants adsorb a thin layer of proteins from these fluids that help gum tissue attach, but also allow microorganisms — including potentially harmful bacteria — to grow on the implant surface.
The surface of implants, as well as other medical devices, plays a significant role in the adsorption of oral proteins and the colonization by unwanted microorganisms (a process known as biofouling), according to a new study led by the University at Buffalo and the University of Regensburg.
The research, published in the Journal of Dental Research, sought to increase scientists’ understanding of this complex biological process by examining the makeup of the oral protein layer and how it can be controlled by chemically modifying the biomaterial surface. The findings lay the groundwork for improving the success of medical and dental implants, says co-lead investigator Stefan Ruhl, DDS, PhD, professor of oral biology in the UB School of Dental Medicine.
“It is often this protein layer, rather than the biomaterial surface, that is encountered by colonizing bacteria or attaching tissue cells. These proteins help determine the biological or pathological consequences that result in either long-term survival of the implant or its failure along with irreversible damage to the surrounding tissues from infection,” says Ruhl. “Therefore, it is important to determine how adsorption might be controlled through chemical modification of the biomaterial surface to achieve a desired outcome.”
The study was also co-led by Rainer Müller, PhD, professor at the Institute of Physical and Theoretical Chemistry at the University of Regensburg.
Using silica beads designed in Müller’s lab with various chemically modified surfaces, the researchers found that the adsorption of proteins from blood plasma is more influenced by the amount of protein adsorbed than by the composition of the protein layer.
However, the adsorption of proteins from saliva was directly impacted by the biomaterial’s surface. Adsorption was lower on surfaces that had a negative electric charge or that repelled water, countering the findings of previous studies.
When examining complex biofluids such as saliva and blood, adsorption became unpredictable for the majority of proteins, says Ruhl.
“The interaction between the proteins contained in the biofluids may play an important, but still little understood, role in adsorption processes,” says Müller. “The ultimate goal to connect surface properties to protein adsorption so that optimal tissue compatibility will be achieved but microbial adhesion will be prevented, will likely not be as straightforward as expected.”
The model system of chemically modified silica surfaces developed by the researchers may serve as a platform to study the basic principles of protein adsorption from complex biofluids.
“To improve the design of implant surface coatings, future research should examine the adsorption of proteins that are known to either foster the attachment of tissue cells or colonizing bacteria, as well as explore the molecular structure of complex mixtures of blood plasma and saliva proteins,” says Ruhl.
Jutta Lehnfeld, doctoral candidate at the University of Regensburg, is the first author. Additional UB School of Dental Medicine investigators include alumnus Yegor Dukashin, DDS; alumna Janet Mark, DDS; Gregory White, DDS, volunteer clinical assistant professor; and alumna Stephanie Wu, DDS. University of Regensburg alumna Verena Katzur, PhD, is also an investigator.
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Materials provided by University at Buffalo. Original written by Marcene Robinson. Note: Content may be edited for style and length.