Publisher Health

 Staying well-hydrated throughout life could reduce the risk of developing heart failure, according to research presented at ESC Congress 2021.
“Our study suggests that maintaining good hydration can prevent or at least slow down the changes within the heart that lead to heart failure,” said study author Dr. Natalia Dmitrieva of the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, Bethesda, US. “The findings indicate that we need to pay attention to the amount of fluid we consume every day and take action if we find that we drink too little.”
Recommendations on daily fluid intake vary from 1.6 to 2.1 litres for women and 2 to 3 litres for men. However, worldwide surveys have shown that many people do not meet even the lower ends of these ranges. Serum sodium is a precise measure of hydration status: when people drink less fluid, the concentration of serum sodium increases. The body then attempts to conserve water, activating processes known to contribute to the development of heart failure.
Dr. Dmitrieva said: “It is natural to think that hydration and serum sodium should change day to day depending on how much we drink on each day. However, serum sodium concentration remains within a narrow range over long periods,3 which is likely related to habitual fluid consumption.”
This study examined whether serum sodium concentration in middle age, as a measure of hydration habits, predicts the development of heart failure 25 years later. The researchers also examined the connection between hydration and thickening of the walls of the heart’s main pumping chamber (left ventricle) – called left ventricular hypertrophy – which is a precursor to heart failure diagnosis.
The analysis was performed in 15,792 adults in the Atherosclerosis Risk in Communities (ARIC) study. Participants were 44 to 66 years old at recruitment and were evaluated over five visits until age 70 to 90.
Participants were divided into four groups based on their average serum sodium concentration at study visits one and two (conducted in the first three years): 135–139.5, 140–141.5, 142–143.5, and 144–146 mmol/l. For each sodium group, the researchers then analysed the proportion of people who developed heart failure and left ventricular hypertrophy at visit five (25 years later).
Higher serum sodium concentration in midlife was associated with both heart failure and left ventricular hypertrophy 25 years later. Serum sodium remained significantly associated with heart failure and left ventricular hypertrophy after adjusting for other factors related to the development of heart failure: age, blood pressure, kidney function, blood cholesterol, blood glucose, body mass index, sex and smoking status. Every 1 mmol/l increase in serum sodium concentration in midlife was associated with 1.20 and 1.11 increased odds of developing left ventricular hypertrophy and heart failure, respectively, 25 years later.
The risks of both left ventricular hypertrophy and heart failure at age 70 to 90 began to increase when serum sodium exceeded 142 mmol/l in midlife.
Dr. Dmitrieva said: “The results suggest that good hydration throughout life may decrease the risk of developing left ventricular hypertrophy and heart failure. In addition, our finding that serum sodium exceeding 142mmol/l increases the risk of adverse effects in the heart may help to identify people who could benefit from an evaluation of their hydration level. This sodium level is within the normal range and would not be labelled as abnormal in lab test results but could be used by physicians during regular physical exams to identify people whose usual fluid intake should be assessed.”-
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A new study found that incidence rates for malignant brain and other central nervous system (CNS) tumors declined by 0.8% annually during 2008 through 2017 in the United States for all ages combined. The decline was driven by trends in adults, whereas rates have slightly increased by 0.5% to 0.7% annually among children and adolescents over the same time period. The report, appearing in CA: A Cancer Journal for Clinicians,assessed contemporary patterns in brain tumor occurrence in the context of incidence, mortality, and survival trends in the U.S.
This collaborative study with Central Brain Tumor Registry of the United States researchers, led by Kimberly D. Miller, MPH, American Cancer Society, also found that although malignant brain and other CNS tumors are rare in the U.S., they account for a substantial burden of cancer mortality because of their high fatality rate. In 2021, an estimated 83,570 individuals will be diagnosed with brain and other CNS tumors in the U.S. (24,530 malignant tumors and 59,040 nonmalignant tumors), and 18,000 people will die from the disease.
While incidence rates for malignant tumors are declining overall, survival remains low — only 36% of patients survive more than 5 years after diagnosis, up from 26% for patients diagnosed in the mid-1970s. The slow progress largely reflects a lack of advancement in the early detection and treatment of glioblastoma, for which 5-year survival only increased from 4% to 7% during this time period. Glioblastoma accounts for 49% of all malignant brain cancers in the U.S.
Incidence rates for nonmalignant tumors, which disproportionately affect women and Black people, are slowly increasing, likely due to improvements in case finding and increased awareness. For example, incidence rates for meningioma, which accounts for 54% of all nonmalignant cases in the U.S., increased by 0.9% annually among adults from 2008 to 2017. Though 5-year relative survival for all nonmalignant tumors remains high (92%), patients often experience debilitating long-term effects from their tumor and/or its treatment.
The report also found persisting disparities among children. For example, mortality rates are the same in White and Black children despite lower incidence in Black children, reflecting lower 5-year survival (70% versus 79%, respectively). The largest Black-White disparities for children diagnosed during 2009 to 2015 were for diffuse astrocytomas (75% versus 86%, respectively) and embryonal tumors (59% versus 67%).
“Although the molecular understanding of how brain cancers differ from each other is advancing rapidly, we continue to know little about why these tumors develop in the first place. To facilitate greater understanding, it critical to have access to timely, comprehensive data on occurrence,” said Miller. “This is particularly important to understand the causes of sex, age, and racial/ethnic differences, especially for rarer subtypes and among understudied populations.”
The report also noted differences in incidence by sex: Malignant brain tumor incidence rates were higher in males (8.3 cases per 100,000) compared to females (6.0). Conversely, incidence rates for nonmalignant tumors were higher in females (20.3) compared to males (12.8). For malignant tumors, sex differences were largest among ages 45 years or older, among whom rates in females were 30% lower than those in males. For nonmalignant tumors, sex differences peaked in ages 25-29 years, among whom rates in females were >2-fold those in males (10.2 versus 4.7 per 100,000), a pattern driven by high pituitary adenoma rates in females in this age group.
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The advent of the COVID-19 pandemic, which began in earnest in the United States in early 2020, affected different demographic groups in different ways. According to a new study, among adolescents ages 10 to 14 in the United State, the overall rate of drug use remained relatively stable in the first six months of the COVID-19 pandemic. However, one change was a decreased use of alcohol, but an increased use of nicotine and misuse of prescription drugs.
The findings, publishing in the August 24, 2021 issue of the Journal of Adolescent Health, are derived from the ongoing Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health ever conducted in the United States.
“The COVID-19 pandemic has produced sustained disruptions to several domains of adolescents’ lives, including alcohol and drug use,” said first author William Pelham III, PhD, a postdoctoral scholar in the Center for Human Development at UC San Diego. “Thus, surveillance of adolescent substance use is an important public health priority.”
The ABCD study, which began in 2015 with central components and leadership from UC San Diego, is following almost 12,000 children for at least 10 years, starting at ages 9 to 10. Researchers will track the children’s biological and behavioral development through adolescence into young adulthood.
In the current paper, researchers monitored 7,842 adolescents and their families at 21 sites across the United States for six months following the first issuing of stay-at-home orders. In multiple surveys, the participants were asked to describe their substance use, including alcohol, tobacco and un-prescribed drugs.
Surveys also assessed youth’s intensity of worry about COVID-19 and measured related stressors, such as educational disruptions, loss of jobs or hardships within their families.
Survey responses were adjusted so that ABCD participants reflected the demographics of same-age youth across the United States. Substance use among surveyed adolescents was stable during the first six months of the pandemic: 8 percent reported using a substance in the past 30 days; 3.4 percent reported using alcohol; 3.6 percent reported using nicotine.
Compared to pre-pandemic behavior, use of alcohol declined, but use of nicotine or misuse of prescription drugs increased, perhaps, suggested researchers, because the latter are easier to hide when families were locked down together.
In families that experienced loss of income or material hardship during the pandemic, substance use among youth was higher. Heightened stress, depression and anxiety were all robustly associated with youth substance abuse.
“Taken together, these findings underscore the disproportionate burden of the pandemic on youth and families with pre-existing disadvantages,” said Pelham. “Providing material support to distressed families and linking emotionally distressed youth to support may serve as important risk-mitigation strategies, both today and during similar events in the future.”
“Continued surveillance of adolescents’ alcohol and drug use as many adolescents return to their pre-pandemic routines will comprise an important public health priority and goal of the ABCD Study.”
Co-authors of this study include: Susan F. Tapert, Marybel R. Gonzalez, Connor J. McCabe, Wesley K. Thompson, Natasha Wade and Sandra A. Brown, UC San Diego; Krista M. Lisdahl, University of Wisconsin at Milwaukee; Elisabet R. Alzueta and Fiona C. Baker, SRI International; Forence J. Breslin, Laureate Institute for Brain Research; Anthony Steven Dick, Florida International University; Gayathri J. Dowling and Elizabeth A. Hoffman, National Institute on Drug Abuse; Mathieu Guillaume, Bruce D. McCandliss and Amandine M. Van Rinsveld, Stanford University; Andrew T. Marshall and Elizabeth R. Sowell, University of Southern California; Chandni S. Sheth, University of Utah.

A predicted population drop at the end of the century could be explained by stress from meaningless social interactions, according to a review article published in the Endocrine Society’s journal, Endocrinology.
Researchers predict a peak in population numbers in 2064 followed by a 50% drop by the end of the century from changes in human reproductive behavior and function. There has been a 50% decrease in sperm counts over the last 50 years. People are stressed out from more frequent but less quality social interactions, and stress can suppress sperm count, ovulation and sexual activity.
“Rising population numbers contribute to less meaningful social interactions, social withdrawal and chronic stress, which subsequently suppresses reproduction,” said the manuscript’s author Alexander Suvorov, Ph.D., of the University of Massachusetts Amherst in Amherst, Mass. “Changes in reproductive behavior that contribute to the population drop include more young couples choosing to be ‘child-free,’ people having fewer children and couples waiting longer to start families.”
Suvorov found a connection between population numbers, stress and reproduction by reviewing several studies and asking the following questions: Why do people refuse to have children when access to all vital resources is becoming better than humankind ever had? Why has there been a 50% decrease in sperm counts over the last 50 years? He hypothesized declining reproduction may be due to stress from less quality social interactions and changes in reproductive behavior such an increase in “child-free” couples and delayed parenthood.
“Numerous wildlife and laboratory studies demonstrated that population peaks are always followed by increased stress and suppressed reproduction,” said Suvorov. “This review provides evidence from multiple disciplines that the same mechanisms previously observed in wildlife species may work in humans as well.”
The manuscript received no external funding.
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Scottish comedian Sir Billy Connolly has said the medical challenges he faces while filming for television are “getting worse”.He was speaking during a session at the Edinburgh TV Festival honouring the 78-year-old with a lifetime achievement award for his contribution to the industry.Sir Billy was diagnosed with Parkinson’s disease in 2013 and retired from live performances five years later.The comedian has continued to make TV programmes but, interviewed by his wife, Dr Pamela Stephenson Connolly, he said: “The challenges lately have been medical. They are getting worse.””I will have to weigh it up and see how bad it gets. Play it by ear.”

Chronically high cholesterol levels are known to be associated with increased risks of breast cancer and worse outcomes in most cancers, but the link has not been fully understood.
In a study appearing online Aug. 24 in the journal Nature Communications, a research team led by the Duke Cancer Institute has identified the mechanisms at work, describing how breast cancer cells use cholesterol to develop tolerance to stress, making them impervious to death as they migrate from the original tumor site.
“Most cancer cells die as they try to metastasize — it’s a very stressful process,” said senior author Donald P. McDonnell, Ph.D., professor in the departments of Pharmacology and Cancer Biology and Medicine at Duke University School of Medicine. “The few that don’t die have this ability to overcome the cell’s stress-induced death mechanism. We found that cholesterol was integral in fueling this ability.”
McDonnell and colleagues built on earlier research in their lab focusing on the link between high cholesterol and estrogen-positive breast and gynecological cancers. Those studies found that cancers fueled by the estrogen hormone benefitted from derivatives of cholesterol that act like estrogen, stoking cancer growth.
But a paradox emerged for estrogen-negative breast cancers. These cancers are not dependent on estrogens, but high cholesterol is still associated with worse disease, suggesting a different mechanism might be at work.
In the current study using cancer cell lines and mouse models, the Duke researchers found that migrating cancer cells gobble cholesterol in response to stress. Most die.
But in the what-doesn’t-kill-you-makes-you-stronger motif, those that live emerge with a super-power that makes them able to withstand ferroptosis, a natural process in which cells succumb to stress. These stress-impervious cancer cells then proliferate and readily metastasize.
The process appears to be used not only by ER-negative breast cancer cells, but other types of tumors, including melanoma. And the mechanisms identified could be targeted by therapies.
“Unraveling this pathway has highlighted new approaches that may be useful for the treatment of advanced disease,” McDonnell said. “There are contemporary therapies under development that inhibit the pathway we’ve described. Importantly, these findings yet again highlight why lowering cholesterol — either using drugs or by dietary modification — is a good idea for better health.”
In addition to McDonnell, study authors include Wen Liu, Rachid Safi, Dmitri Kazmi, Binita Chakraborty and Ching-yi Chang.
The study received funding support from The Department of Defense Breast Cancer Research Program and the National Institutes of Health.
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Materials provided by Duke University Medical Center. Note: Content may be edited for style and length.

The majority of patients who contracted COVID-19 while in hospital did so from other patients rather than from healthcare workers, concludes a new study from researchers at the University of Cambridge and Addenbrooke’s Hospital.
The study provides previously unprecedented detail on how infections might spread in a hospital context, showing that a minority of individuals can cause most of the transmission.
The researchers analysed data from the first wave of the pandemic, between March and June 2020. While a great deal of effort is made to prevent the spread of viruses within hospital by keeping infected and non-infected individuals apart, this task is made more difficult during times when the number of infections is high. The high level of transmissibility of the virus and the potential for infected individuals to be asymptomatic both make this task particularly challenging.
Looking back at data from the first wave, researchers identified five wards at Addenbrooke’s Hospital, part of Cambridge University Hospitals (CUH) NHS Foundation Trust, where multiple individuals, including patients and healthcare workers, tested positive for COVID-19 within a short space of time, suggesting that a local outbreak might have occurred.
Using new statistical methods that combine viral genome sequence data with clinical information about the locations of individuals, the researchers identified cases where the data were consistent with transmission occurring between individuals in the hospital. Looking in detail at these transmission events highlighted patterns in the data.
The results of the study, published today in eLife, showed that patients who were infected in the hospital were mostly infected by other patients, rather than by hospital staff. Out of 22 cases where patients were infected in hospital, 20 of these were the result of the virus spreading from patients to other patients
Dr Chris Illingworth, a lead author on the study, who carried out his research while at Cambridge’s MRC Biostatistics Unit, said: “The fact that the vast majority of infections were between patients suggests that measures taken by hospital staff to prevent staff transmitting the virus to patients, such as the wearing of masks, were likely to have been effective.
“But it also highlights why it is important that patients themselves are screened for COVID-19 regularly, even if asymptomatic, and wear face masks where possible.”
The study found contrasting results among healthcare workers, who were almost as likely to be infected by patients as they were by other healthcare workers. This was one piece of evidence that motivated the decision to upgrade the respiratory protection worn by healthcare workers in COVID-19 wards at CUH. A recent Cambridge study indicated that this resulted in staff being better protected against catching COVID-19.
The researchers also found a trend towards individuals either infecting no one else, or infecting multiple other people — just over a fifth of patients (21%) caused 80% of the infections. This phenomenon is sometimes called ‘superspreading’ and can make infection control very challenging. Whether or not an individual can be identified in advance as being more or less likely to pass on the virus is an ongoing topic of research.
Dr William Hamilton, an infectious diseases clinician at CUH and co-lead author on the study said: “Preventing new cases of hospital-based infection is a critical part of our work. Here we have shown that analysing clinical and viral genome sequence data can produce insights that inform infection control measures, which are so important for protecting patients and healthcare workers alike.”
The research was funded by COG-UK, Wellcome, the Academy of Medical Sciences, the Health Foundation and the NIHR Cambridge Biomedical Research Centre.
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Materials provided by University of Cambridge. The original text of this story is licensed under a Creative Commons License. Note: Content may be edited for style and length.

Researchers are bringing the use of acoustic waves to target and destroy cancerous tumours closer to reality.
While doctors have used low-intensity ultrasound as a medical imaging tool since the 1950s, experts at the University of Waterloo are using and extending models that helpcapture how high-intensity focused ultrasound (HIFU) can work on a cellular level.
Led by Siv Sivaloganathan, an applied mathematician and researcher with the Centre for Math Medicine at the Fields Institute, the study found by running mathematical models in computer simulations that fundamental problems in the technology can be solved without any risk to actual patients.
Sivaloganathan, together with his graduate students June Murley, Kevin Jiang and postdoctoral fellow Maryam Ghasemi, creates the mathematical models used by engineers and doctors to put HIFU into practice. He said his colleagues in other fields are interested in the same problems, “but we’re coming at this from different directions.”
“My side of it is to use mathematics and computer simulations to develop a solid model that others can take and use in labs or clinical settings. And although the models are not nearly as complex as human organs and tissue, the simulations give a huge head start for clinical trials.”
One of the obstacles that Sivaloganathan is currently working to overcome is that in targeting cancers, HIFU also poses risks to healthy tissue. When HIFU is being used to destroy tumours or cancerous lesions, the hope is that good tissue won’t be destroyed. The same applies when focusing the intense acoustic waves on a tumour on the bone where lots of heat energy gets released. Sivaloganathan and his colleagues are working to understand how the heat dissipates and if it damages the bone marrow.
Other researchers working with Sivaloganathan include engineers, who are building the physical technology, and medical doctors, in particular, James Drake, chief surgeon at Hospital for Sick Children, looking at the practical application of HIFU in clinical settings.
Sivaloganathan believes HIFU will make significant changes in cancer treatments and other medical procedures and treatments. HIFU is already finding practical application in the treatment of some prostate cancers.
“It’s an area that I think is going to take center stage in clinical medicine,” he said. “It doesn’t have the negative side effects of radiation therapy or chemotherapy. There are no side effects other than the effect of heat, which we are working on right now. It also has applications as a new way to break up blood clots and even to administer drugs.”
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A study in more than 30,000 heart patients shows that becoming active later in life can be nearly as beneficial to survival as continued activity. The research is presented at ESC Congress 2021.
“These encouraging findings highlight how patients with coronary heart disease may benefit by preserving or adopting a physically active lifestyle,” said study author Dr. Nathalia Gonzalez of the University of Bern, Switzerland.
Regular physical activity is advised for patients with heart disease, but recommendations are largely based on studies that used either a single assessment or an average of activity levels assessed over time. However, patients may modify the amount of exercise they do, and it remains unclear whether these changes are related to survival.
This study investigated activity levels over time and their relationship to the risk of death in patients with heart disease.
The meta-analysis included 33,576 patients with coronary heart disease from nine longitudinal cohorts. The average age was 62.5 years and 34% were women. The median follow-up was 7.2 years. Activity was assessed at baseline and follow-up using validated questionnaires and participants were classified as active or inactive at the two time points. Definitions of active and inactive varied across the studies but were in line with recommendations for healthy people: at least 150 minutes a week of moderate intensity, or 75 minutes a week of vigorous activity, or a combination.
Patients were divided into four groups according to their activity status at baseline and follow-up: inactive over time, active over time, increased activity over time, and decreased activity over time. All the studies defined “increased activity over time” as moving from the inactive to the active category and “decreased activity over time” as moving from the active to the inactive category.
The researchers examined the risks of all-cause death and death from cardiovascular disease according to the four groups. Compared to patients who were inactive over time, the risk of all-cause death was 50% lower in those who were active over time, 45% lower in those who were inactive but became active, and 20% lower in those who had been active but became inactive.
Similar results were observed for death due to cardiovascular disease. Compared to those who remained inactive, the risk for cardiovascular mortality was 51% lower among those who remained active and 27% lower for those whose activity increased. Cardiovascular mortality was not statistically different for those whose activity decreased over time, compared to those who remained inactive.
Dr. Gonzalez said: “The results show that continuing an active lifestyle over the years is associated with the greatest longevity. However, patients with heart disease can overcome prior years of inactivity and obtain survival benefits by taking up exercise later in life. On the other hand, the benefits of activity can be weakened or even lost if activity is not maintained. The findings illustrate the benefits to heart patients of being physically active, regardless of their previous habits.”
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The UK’s largest ever study into autism hopes to answer questions such as why some autistic people have epilepsy or poor mental health outcomes and others do not.The Autism Research Centre at the University of Cambridge is looking for 10,000 autistic people and their families to take part in the research. TV presenter Paddy McGuinness, who has three children with autism, is an ambassador for the Spectrum 10K project.He spoke to BBC Breakfast about his parenting experience.