Publisher Health

Approximately one in four patients hospitalized for the acute respiratory distress syndrome (ARDS) associated with severe COVID-19 infections may have a distinct phenotype (disease presentation) or biochemical profile associated with organ dysfunction, blood-clotting abnormalities and greater risk of death than patients with other, seemingly similar forms of the disease, researchers at Massachusetts General Hospital (MGH) have found.
Among 263 patients admitted to intensive care units (ICUs) at MGH for respiratory failure due to severe COVID-19 infection, 70 (26.6%) had increased levels of biomarkers in the bloodstream indicating disordered blood clotting, higher inflammation, and organ dysfunction compared with the other patients, report Sylvia Ranjeva MD, PhD, and Lorenzo Berra, MD, investigators in the Department of Anesthesia, Critical Care and Pain Medicine, and their colleagues in that department and Pulmonary and Critical Care Medicine and Respiratory Care at MGH.
Patients with this more severe phenotype had twice the risk of death, despite minimal differences in respiratory mechanics or in the severity of ARDS between the two phenotypes.
Their findings are published in EClinicalMedicine, an open-access journal of The Lancet group.
ARDS is a catch-all term for lung injury that can arise from many different conditions such as pneumonia, severe influenza, trauma, blood infections or inflammation of the pancreas.
The syndrome can be life-threatening and may require patients to be put on mechanical ventilation, but it has been difficult for clinicians to develop effective therapies because of the wide spectrum of causes associated with it.

Young adults must step up their exercise routines to reduce their chances of developing high blood pressure or hypertension — a condition that may lead to heart attack and stroke, as well as dementia in later life.
Current guidelines indicate that adults should have a minimum of two-and-a-half hours of moderate intensity exercise each week, but a new study led by UCSF Benioff Children’s Hospitals reveals that boosting exercise to as much as five hours a week may protect against hypertension in midlife — particularly if it is sustained in one’s thirties, forties and fifties.
In the study publishing in American Journal of Preventive Medicine on April 15, researchers followed approximately 5,000 adults ages 18 to 30 for 30 years. The participants were asked about their exercise habits, medical history, smoking status and alcohol use. Blood pressure and weight were monitored, together with cholesterol and triglycerides.
Hypertension was noted if blood pressure was 130 over 80 mmHg, the threshold established in 2017 by the American College of Cardiology/American Heart Association.
The 5,115 participants had been enrolled by the Coronary Artery Risk Development in Young Adults (CARDIA) study and came from urban sites in Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Approximately half the participants were Black (51.6 percent) and the remainder were White. Just under half (45.5 percent) were men.
Fitness Levels Fall Fast for Black Men Leading to More Hypertension
Among the four groups, who were categorized by race and gender, Black men were found to be the most active in early adulthood, exercising slightly more than White men and significantly more than Black women and White women. But by the time Black men reached age 60, exercise intake had slumped from a peak of approximately 560 exercise units to around 300 units, the equivalent to the minimum of two-and-a-half hours a week of moderate intensity exercise recommended by the U.S. Department of Health and Human Services. This was substantially less exercise than White men (approximately 430 units) and slightly more than White women (approximately 320 units). Of the four groups, Black women had the least exercise throughout the study period and saw declines over time to approximately 200 units.

An observational study in nearly 20,000 individuals has found that greater intake of red and processed meat is associated with worse heart function. The research is presented at ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).
“Previous studies have shown links between greater red meat consumption and increased risk of heart attacks or dying from heart disease,” said study author Dr. Zahra Raisi-Estabragh of Queen Mary University of London, UK. “For the first time, we examined the relationships between meat consumption and imaging measures of heart health. This may help us to understand the mechanisms underlying the previously observed connections with cardiovascular disease.”
The study included 19,408 participants of the UK Biobank. The researchers examined associations of self-reported intake of red and processed meat with heart anatomy and function.
Three types of heart measures were analysed. First, cardiovascular magnetic resonance (CMR) assessments of heart function used in clinical practice such as volume of the ventricles and measures of the pumping function of the ventricles. Second, novel CMR radiomics used in research to extract detailed information from heart images such as shape and texture (which indicates health of the heart muscle). Third, elasticity of the blood vessels (stretchy arteries are healthier).
The analysis was adjusted for other factors that might influence the relationship including age, sex, deprivation, education, smoking, alcohol, exercise, high blood pressure, high cholesterol, diabetes, and body mass index (BMI) as a measure of obesity.
The researchers found that greater intake of red and processed meat was associated with worse imaging measures of heart health, across all measures studied. Specifically, individuals with higher meat intake had smaller ventricles, poorer heart function, and stiffer arteries — all markers of worse cardiovascular health.
As a comparison, the researchers also tested the relationships between heart imaging measures and intake of oily fish, which has previously been linked with better heart health. They found that as the amount of oily fish consumption rose, heart function improved, and arteries were stretchier.
Dr. Raisi-Estabragh said: “The findings support prior observations linking red and processed meat consumption with heart disease and provide unique insights into links with heart and vascular structure and function.”
The associations between imaging measures of heart health and meat intake were only partially explained by high blood pressure, high cholesterol, diabetes, and obesity.
“It has been suggested that these factors could be the reason for the observed relationship between meat and heart disease,” said Dr. Raisi-Estabragh. “For example, it is possible that greater red meat intake leads to raised blood cholesterol and this in turn causes heart disease. Our study suggests that these four factors do play a role in the links between meat intake and heart health, but they are not the full story.”
She noted that the study did not look into alternative mechanisms. But she said: “There is some evidence that red meat alters the gut microbiome, leading to higher levels of certain metabolites in the blood, which have in turn been linked to greater risk of heart disease.”
Dr. Raisi-Estabragh said: “This was an observational study and causation cannot be assumed. But in general, it seems sensible to limit intake of red and processed meat for heart health reasons.”
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Researchers at the University of Zurich show that increased sensitivity in a specific region of the brain contributes to the development of anxiety and depression in response to real-life stress. Their study establishes an objective neurobiological measure for stress resilience in humans.
Some people don’t seem to be too bothered when it comes to handling stress. For others, however, prolonged exposure to stress can lead to symptoms of anxiety and depression. While stress resilience is a widely discussed concept, it is still very challenging to predict people’s individual response to increased levels of stress. Lab experiments can only go so far in replicating the chronic stress many people experience in their day-to-day lives, as stress simulated in the lab is always limited in exposure time and intensity.
It is possible, however, to observe a group of medical students who are all about to face real-life stress for an extended period — during their six-month internship in the emergency room. This is precisely the real-life situation on which a team of researchers involving Marcus Grueschow and Christian Ruff from the UZH Zurich Center for Neuroeconomics and Birgit Kleim from the Department of Psychology and the University Hospital of Psychiatry Zurich based their study.
Stress as a response to cognitive conflict and loss of control
Before starting their internship, the subjects were given a task that required them to process conflicting information. This conflict task activates the locus coeruleus-norepinephrine (LC-NE) system, a region of the brain associated with regulating our response to stress and resolving conflict. However, the intensity of LC-NE activation — often referred to as the “firing rate” — varies from one person to the next.
Subjects with a higher LC-NE responsivity showed more symptoms of anxiety and depression following their emergency room internships. “The more responsive the LC-NE system, the more likely a person will develop symptoms of anxiety and depression when they’re exposed to prolonged stress,” Marcus Grueschow summarizes their findings.
Objective measure predicting stress resilience
With their study, the scientists have identified an objective neurobiological measure that can predict a person’s stress response. This is the first demonstration that in humans, differences in LC-NE responsivity can be used as an indicator for stress resilience. “Having an objective measure of a person’s ability to cope with stress can be very helpful, for example when it comes to choosing a profession. Or it could be applied in stress resilience training with neuro-feedback,” Marcus Grueschow explains.
This does not mean that aspiring doctors or future police officers will all have to have their brain scanned. “There might be an even more accessible indicator for stress resilience,” Christian Ruff says. Research with animals suggests that stimulation of the LC-NE system correlates with pupil dilation. “If we could establish the same causal link between pupil dilation and the LC-NE system in humans, it would open up another avenue,” he adds.
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Despite dire predictions, the number of suicides fell by 5 percent over all. Still, smaller studies suggested the trends were much worse among nonwhite Americans.Ever since the pandemic started, mental health experts have worried that grief, financial strain and social isolation may take an unbearable toll on American psyches. Some warned that the coronavirus had created the “perfect storm” for a rise in suicides.The concern was seized on by lawmakers who were eager to reopen the economy. In March 2020, Donald J. Trump predicted a surge in suicides resulting from statewide lockdowns. A provisional tally of last year’s deaths, however, contains a surprising nugget of good news.While nearly 350,000 Americans died from Covid-19, the number of suicides dropped by 5 percent, to 44,834 deaths in 2020 from 47,511 in 2019. It is the second year in a row that the number has fallen, after cresting in 2018.The decline came even as the number of unintentional overdose deaths rose dramatically during the pandemic. Some overdoses are classified as suicides; there is debate among researchers as to how many ought to be included.But while the number of suicides may have declined over all, preliminary studies of local communities in states like Illinois, Maryland and Connecticut found a rise in suicides among Black Americans and other people of color when compared with previous years.Whether that is the case nationally is not known. Federal health officials have yet to release a detailed breakdown of the race and ethnicity of last year’s suicide victims, and some experts have cautioned against making generalizations based on trends in a few localities.“We can’t make any bold statements until we have more national data,” said Arielle Sheftall, a principal investigator at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio. “It may be that only certain areas or certain cities have experienced these increases” among people of color, she added.Suicides are comparatively rare events, and it is hard to know how to interpret changes in small numbers and whether they represent statistical hiccups or broad trends. Rates usually fall off during times of war or natural disasters, when people feel drawn together to fight for survival against a common enemy. But the effect can peter out over time, and fatigue and despair may follow, experts say.In the early days of the pandemic, families posted colorful drawings of rainbows in their windows and children stuck their heads out each day at 7 p.m. to ring bells and cheer for health care workers.“During the early phase of a natural disaster, there’s a sense of community building, a feeling that we’re all in this together,” said Dr. Christine Moutier, chief medical officer for the American Foundation for Suicide Prevention. “The survival instinct can really kick in front and center.”The initial sense of crisis and purpose may have been a source of strength for people around the world. A new study of suicide trends among residents of 10 countries and 11 states or regions with higher incomes found that the number remained largely unchanged or had even declined during the early months of the pandemic, though there were increases in suicide later in the year in some areas. (Another study that has not yet been peer reviewed reported sharp increases in suicide from July to November in Japan, with a greater increase in suicides among women during that time period.)In the United States, the pandemic has taken a starkly disproportionate toll on communities of color: Hispanic, Black and Native Americans, as well as Alaska Natives, are more likely than white Americans to be hospitalized with Covid-19 and to die from it. Two in five Black and Hispanic Americans have lost a close friend or family member to the virus, compared with one in four white adults.People of color have also been pummeled financially, particularly low-wage earners who have lost their jobs and had few resources on which to fall back. Many who remain employed hold jobs that put them at risk of contracting the virus on a daily basis.Anxiety and depression have risen across the board, and many Americans are consumed with worry about their health and that of their families. A recent study found that one in 12 adults has had thoughts of suicide; Hispanic Americans in particular said they were depressed and stressed about keeping a roof over their heads and having enough food to eat.Some Americans plunged into poverty for the first time, shattering their sense of identity and self, said Dr. Brandi Jackson, a psychiatrist who is director of integrative behavioral health at Howard Brown Health in Chicago.News reports about the killings of Black people, from Breonna Taylor and Ahmaud Arbery to the shocking death of George Floyd in May, added to the trauma for Black Americans, Dr. Jackson said.“It’s one stressor on top of another stressor on top of another stressor,” Dr. Sheftall said. “You’ve lost your job. You’ve lost people in your family. Then there’s George Floyd. At one point, I had to shut the TV off.”A makeshift memorial for George Floyd at the Cup Foods in Minneapolis last week.Joshua Rashaad McFadden for The New York TimesResearchers who study the racial trends said increases in suicide among people of color were consistent across the cities and regions that they examined — and all the more striking because suicide rates among Black and Hispanic Americans had always been comparatively low, about one-third the rate among white Americans.Rodney Moore Sr., of Anaheim, Calif., lost his 14-year-old son, Rodney Jr., to suicide in January. Mr. Moore believes that his son despaired when his school did not reopen as expected earlier this year.Mr. Moore urged parents to be on the lookout for any changes in behavior or mood in their children that could indicate hopelessness about the future. “Look out for anything that is different in their sleeping, their eating, a change in attitudes, a personality change,” he said.Public health officials in Chicago were among the first to notice that even though overall suicide numbers remained stable during the first eight months of 2020, the number of suicides among Black residents had increased.Officials were particularly concerned about a rise in suicides among young Black adults in their 20s, as well as by an increase among older people of all races, issuing a health alert in November and taking steps to beef up funding for crisis hotlines and mental health services.The state’s Department of Health in January reported a similarly lopsided trend, saying suicides in the state had dropped by 6.8 percent over all, but they had risen by 27.7 percent among Black residents and by 6 percent among Hispanic individuals.“It’s important to not just be monitoring the topline numbers, because we know that Covid has impacted different communities in disparate ways,” said Matthew Richards, the deputy commissioner for behavior health at Chicago Department of Public Health.“When we talk about Covid and the amount of trauma, grief and stress at the community level — we should not underestimate how significant a public health issue that has the potential to be.”A similar trend appeared in Maryland, where researchers analyzed suicide deaths from March 5, 2020, when a statewide emergency was declared, to May 7, when public spaces started to reopen, and then compared them with the same periods during previous years.The study found that suicides fell by almost half among white Americans — but doubled among Black residents of the state after the emergency declaration in March. (There was no change in suicide trends from Jan. 1 to March 4 of last year.)“It’s clear the pandemic has hit African-Americans a lot harder than it has whites,” said Dr. Paul Nestadt, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins who was the senior author of the study, which was published in JAMA Psychiatry in December.“The pandemic may have been a perfect storm, but we’ve all been in very different boats in that storm,” he added.He and a colleague, Michael Bray, have continued to investigate and say there is preliminary evidence that suicide rates have also increased among Hispanics in Maryland last year.In Connecticut, Yale University scientists who studied death rates during the period of strict stay-at-home measures in that state, between March 10 and May 20 of last year, were also at first surprised to find that the overall suicide rate in the state had plummeted by 20 percent, when compared with the same period in 2019.But a closer look revealed that while suicide among white residents had plunged to a six-year low, the rate among the nonwhite population had risen.Of 74 Connecticut residents who died by suicide during the lockdown period, 23 percent identified as nonwhite, nearly double the percentage of suicide deaths compared with the previous six years, the researchers found. Neither the average age of suicide death (50) nor the sex ratio (three-quarters were men) had changed.“It was deeply disturbing,” said Dr. Thomas O. Mitchell, a psychiatrist and one of the authors of the paper, which was published in the journal Psychiatry Research in December. He said that financial strain — known to be strongly linked to suicide — might have played a critical role in the deaths.“People in minority groups already face unique economic challenges, so the financial crisis from losing a job during the pandemic might be felt even more intensely by these communities,” Dr. Mitchell said, adding that those who continued to work in public-facing jobs “are putting their life on the line every day — a stressful thing to do.”Jasmin Pierre, a Black woman is now a mental health advocate, narrowly survived a suicide attempt seven years ago after a number of setbacks, including a job loss and the death of her sister.Many friends and relatives responded with disbelief. “They said, ‘Black people don’t do that,’ or, ‘Girl, go and pray,’” recalled Ms. Pierre, who has developed an educational app called The Safe Place. “But actually, we do do that. We just don’t talk about it. It’s taboo.”If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Any future attempts to reduce the spread of covid-19 should be focused on tackling close airborne transmission of the virus which is considered to be the primary route for its circulation, according to experts in an editorial published in The BMJ.
Respiratory experts argue that it is now clear that covid-19 (SARS-CoV-2) is most likely to transmit between people at close range through inhalation rather than through contact with surfaces or longer range airborne routes, although those routes can also be responsible.
The covid-19 pandemic has helped to redefine airborne transmission of viruses, say the experts from the universities of Leicester, Edinburgh Napier and Hong Kong, Virginia Tech, and NHS Lanarkshire, Edinburgh.
There has been some confusion over precise definitions of air transmissions of infections from the last century in which the difference between “droplet” “airborne,” and “droplet nuclei” transmission have led to misunderstandings over the physical behaviour of these particles, they say.
What is important to know, they claim, is that if a person can inhale particles, regardless of their size or name, they are breathing in aerosols. And while this can happen at long range, it is more likely to happen when being close to someone because the aerosols between two people are much more concentrated at short range, similar to being close to someone who is smoking.
People infected with SARS-CoV-2 produce many small respiratory particles full of the virus as they exhale. Some of these will be inhaled almost immediately by those within a typical conversational “short range” distance of less than one metre, say the experts, while the remainder will disperse over longer distances to be inhaled by others further away — more than two metres.

UK adults who are overweight or obese retain their weight over time, which is associated with an increased risk of health complications and death, according to a study published in the open access journal BMC Public Health.
Dr Barbara Iyen, the lead author said: “We have found that despite widespread efforts to prevent and manage obesity, the majority of adults who are overweight or obese in the general population continue to remain so in the long-term. More effective policies and weight-management interventions are needed urgently to address this increasing burden and associated adverse health outcomes.”
Researchers at the University of Nottingham investigated the development of body mass index (BMI) over time. The researchers observed a stable increase in BMI scores across four groups of obese and overweight participants over an average of 10.9 years, with most retaining their degree of obesity long-term.
The authors also found that individuals in the highest BMI group had a three-fold higher risk of heart failure and cardiovascular-disease-related death compared to those in the overweight category. Those in the highest BMI category also had a three-fold higher risk of any health-related death compared to those who were overweight. Participants in the two highest BMI groups did not have an increased risk of stroke or coronary heart disease compared to those who were overweight. The authors found greater levels of socioeconomic deprivation associated with increasing severity of obesity, confirming the need for policies that include vulnerable and disadvantaged groups to tackle obesity.
The study used patient records on 264,230 individuals, collected from 790 general practices between 1999 and 2018, included in the UK Clinical Practice Research Datalink. Participants were divided into four groups, defined by the World Health Organization BMI classifications, as overweight, class-1, class-2 and class-3 obesity.
The authors caution that BMI can vary between sexes and ethnic groups, and body muscle can weigh more than fat giving an incorrect picture of ‘healthy’ weight. However, use of BMI provides routinely available data on weight and weight development that is collected by healthcare professionals. Data on the physical activity levels and dietary intake of participants was lacking in the study. Further research is needed to establish the factors that contribute to weight retention, such as diet and exercise choices, and how social and public health policies can effectively tackle obesity.
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Researchers at King’s College London Institute of Psychiatry, Psychology, & Neuroscience, in collaboration with King’s College Hospital NHS Foundation Trust, have found small clusters of cells in the brain that identify locations where tumours could become malignant.
The study, which has been published in Neuro-Oncology Advances today, analysed pieces of living human brain tissue from 20 people undergoing brain tumour surgery at King’s College Hospital, the largest neuro-oncology centre in Europe. The researchers found groups of tumour cells clustered around blood vessels and believe that these sites could be the seedbeds for malignant progression, the process by which a tumour becomes a fast growing and uncontrolled cancer.
To study the brain tissue, neurosurgeons cooled the surface of the brain. They then took a sample and placed it into a cerebrospinal fluid solution. Once it had been transported to the lab, the tissue was then placed into a miniaturised incubation chamber specially designed for this study, where it was bathed in a solution that makes the living tumour cells fluoresce and more easily studied under a microscope.
Dr Gerald Finnerty, Lead author at King’s IoPPN and Honorary Consultant Neurologist at King’s College Hospital said, “This research is hugely significant. The “hotspots” we found exhibited many of the hallmarks of cancer. The ability to pinpoint areas at high risk of malignancy gives us a much better chance of establishing why the brain tumour becomes malignant.”
Brain cancers are difficult to treat because they are so invasive. Even after surgery and chemoradiotherapy there is still a high risk that some cancerous cells can be left behind, increasing the likelihood that the cancer will return. This unfortunately means that many of the young adults it affects do not survive beyond a year.
Dr Alastair Kirby, First author on the study said, “It has been a privilege to work with brain tumour patients and our neurosurgical team to deliver this highly innovative research. Live human brain tissue offers great opportunities to study how a person’s brain tumour responds to treatments. This will revolutionise therapy and bring precision medicine of brain cancer one step closer.”
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Biomedical engineers at Duke University have developed a self-assembling nanomaterial that can help limit damage caused by inflammatory diseases by activating key cells in the immune system. In mouse models of psoriasis, the nanofiber-based drug has been shown to mitigate damaging inflammation as effectively as a gold-standard therapy.
One of the hallmarks of inflammatory diseases, like rheumatoid arthritis, Crohn’s disease and psoriasis, is the overproduction of signaling proteins, called cytokines, that cause inflammation. One of the most significant inflammatory cytokines is a protein called TNF. Currently, the best treatment for these diseases involves the use of manufactured antibodies, called monoclonal antibodies, which are designed to target and destroy TNF and reduce inflammation.
Although monoclonal antibodies have enabled better treatment of inflammatory diseases, the therapy is not without its drawbacks, including a high cost and the need for patients to regularly inject themselves. Most significantly, the drugs also have uneven efficacy, as they may sometimes not work at all or eventually stop working as the body learns to make antibodies that can destroy the manufactured drug.
To circumvent these issues, researchers have been exploring how immunotherapies can help teach the immune system how to generate its own therapeutic antibodies that can specifically limit inflammation.
“We’re essentially looking for ways to use nanomaterials to induce the body’s immune system to become an anti-inflammatory antibody factory,” said Joel Collier, a professor of biomedical engineering at Duke University. “If these therapies are successful, patients need fewer doses of the therapy, which would ideally improve patient compliance and tolerance. It would be a whole new way of treating inflammatory disease.”
In their new paper, which appeared online in the Proceedings of the National Academy of Sciences on April 5, Collier and Kelly Hainline, a graduate student in the Collier lab, describe how novel nanomaterials could assemble into long nanofibers that include a specialized protein, called C3dg. These fibers then were able to activate immune system B-cells to generate antibodies.

Current research on flexible electronics is paving the way for wireless sensors that can be worn on the body and collect a variety of medical data. But where do the data go? Without a similar flexible transmitting device, these sensors would require wired connections to transmit health data.
Huanyu “Larry” Cheng, Dorothy Quiggle Career Development Assistant Professor of Engineering Science and Mechanics in the Penn State College of Engineering, and two international teams of researchers are developing devices to explore the possibilities of wearable, flexible antennae. They published two papers in April in Nano-Micro Letters and Materials & Design.
Wearable antenna bends, stretches, compresses without compromising function
Like wearable sensors, a wearable transmitter needs to be safe for use on human skin, functional at room temperature and able to withstand twisting, compression and stretching. The flexibility of the transmitter, though, poses a unique challenge: When antennae are compressed or stretched, their resonance frequency (RF) changes and they transmit radio signals at wavelengths that may not match those of the antenna’s intended receivers.
“Changing the geometry of an antenna will change its performance,” Cheng said. “We wanted to target a geometric structure that would allow for movement while leaving the transmitting frequency unchanged.”
The research team created the flexible transmitter in layers. Building upon previous research, they fabricated a copper mesh with a pattern of overlapping, wavy lines. This mesh makes up the bottom layer, which touches the skin, and the top layer, which serves as the radiating element in the antenna. The top layer creates a double arch when compressed and stretches when pulled — and moves between these stages in an ordered set of steps. The structured process through which the antenna mesh arches, flattens and stretches improves the overall flexibility of the layer and reduces RF fluctuations between the antenna’s states, according to Cheng.