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Published1 hour agoShareclose panelShare pageCopy linkAbout sharingThis video can not be playedTo play this video you need to enable JavaScript in your browser.By Catriona MacPhee & Rachel CoburnBBC DisclosureA Turkish doctor selling weight-loss “holidays” abroad told an undercover BBC reporter to gain weight so she could have gastric sleeve surgery.Dr Ogün Erşen told the reporter to “eat some snacks” so she could increase her body mass index (BMI) to qualify for his weight loss surgery.The BBC reporter had a BMI of 24.4, which is within the healthy weight range.”You must eat, eat. Eat something and reach 30,” Dr Ersen said.The reporter gave the weight-loss clinic information which would have meant her BMI was 29 but she was not weighed and no medical checks were carried out during her consultation.Instead, Dr Erşen offered to book her in for surgery in three months’ time and told her to try to put on weight.Seven UK patients died after Turkey weight loss surgeryA health expert told the BBC it was completely unethical to push a patient to gain weight to hit the threshold for surgery.He stressed the risks of this irreversible surgery and said it should not be done if it is not needed.Image source, CosmedacareReferrals to weight management services in Scotland are up 96% compared to pre-pandemic levels and waiting lists for bariatric surgery on the NHS can exceed four years in some areas.The price to have it done privately in the UK is between £10,000 and £15,000 but it can cost as little as £2,000 to book weight-loss surgery in Turkey. However, a BBC Disclosure investigation has uncovered the unethical practices used by some companies offering cheap weight-loss “holidays” abroad.Ekol Hospitals is one of the many Turkish companies targeting British customers. It regularly holds sales days in cities across the UK. Undercover filming at a sales day in Glasgow revealed Ekol accepting patients whose BMI did not meet the criteria for bariatric surgery. BMI is based on a person’s height and weight and it is one of the main factors when assessing for bariatric surgery. A patient with a BMI of less than 40, and no severe co-morbidities relating to obesity, would typically be rejected for weight-loss surgery in the UK. Under the international IFSO guidelines the threshold is lower, at 35. What is bariatric surgery?Bariatric surgery, also known as weight-loss surgery, is used by the NHS as a last resort to treat people who are dangerously obese (having a body mass index of 40 or above or 35 plus other obesity-related health conditions).Patients must have tried and failed to achieve clinically-beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery.The two most common types of weight loss surgery are:Sleeve gastrectomy or gastric bypass, where some of the stomach is removed or the digestive system is re-routed past most of the stomach Gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make someone feel full At the Ekol sales day, two undercover journalists falsely presented medical information which should have ruled them outThey said their BMIs were 29 and 33 – and one cited depression, all of which should have raised red flags with the consultant.An Ekol sales rep also encouraged the reporter to eat more and return for surgery at a later date.The sales rep said: “I yo-yo dieted my whole life, for 30 years, and I got my sleeve two years ago.” She added: “Do you look into more traditional ways, and risk that yo-yo? Or do you just let it go for a few months and eat like a pig? High fat, high calorie, high everything.”In a statement, Ekol Hospitals said: “We completely refute the suggestion that our hospital accepts patients for surgeries who do not meet international guidelines or criteria. “Whilst at the hospital, a full and extensive health check is completed.”When later asked for a response, the sales rep said: “It is unfortunate that our health care, NHS or private, is unable to cope with the obesity epidemic in our country, ideally every person would have access to the health care they need but that is not the case.”Dr Erşen denied he made the comments encouraging a patient to gain weight.Omar Khan, a consultant bariatric surgeon and chair of the National Bariatric Surgery Registry, described the consultation as “utterly indefensible”.He said: “I have major concerns. It seems that he’s almost pushing the patient to hit the target so that they can do the surgery and that’s completely unethical.”There’s no surgery which is risk free. What we have to do is balance those risks against potential benefits of weight loss surgery. “If you take someone who is thin, there’s no point in giving them weight loss surgery, because they’ll take all of the risks of surgery, but none of the benefits.”Gill Baird, who runs a cosmetic surgery business in Glasgow, says she regularly turns people away for weight-loss surgery because they do not meet the criteria. She said: “We check for stones in your pockets when you come to the scales. “We’ve had patients come in with anoraks on and you’ll find that they’ve got weights in their pockets trying to make themselves heavier. It happens quite a lot.”They do it because they’re desperate, and I can understand that. But they’re not understanding the risks that they’re taking with their health.”For some British patients the consequences of going abroad have been fatal. “Unfortunately, we recently had a situation with a patient from the UK who had inquired with us about a particular procedure,” Ms Baird said. “She didn’t meet the criteria. We had advised her of that and she told me on the phone that she was going to see a provider who was based abroad the very next day. “Unfortunately a few weeks later it was in the headlines that she’d sadly passed away as a result of that surgery abroad, which was difficult to process.”Getting Thin Quick is on BBC One Scotland on Monday 15 January at 20:00 and on the iPlayer.If you’ve been affected by issues raised in this report, details of organisations offering information and support about emotional distress are available via BBC Action lineMore on this storyScots woman dies in Turkey during gastric band opPublished3 April 2023Women regret cut-price weight loss surgery abroadPublished23 October 2022

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, David Perella/BBCBy Alice Bhandhukravi and Alex PopeBBC News, HertfordshireA woman has said her cervical cancer was not caught early enough because a hospital falsely assumed she was from a travelling community.Angelina Devlin, from Hertfordshire, says she was not offered a follow-up after giving birth despite a midwife detecting a growth in her cervix.A letter from the hospital admitted it mistakenly assumed she would not have an address.The hospital said it would not comment on individual cases.Image source, Angelina DevlinIn October 2017, Ms Devlin, who lives in a house in St Albans, gave birth aged 20 at Watford General Hospital – part of the West Hertfordshire Teaching Hospitals NHS Trust (WHTH).She said a midwife detected a growth in her cervix at the time, but claimed necessary referrals did not take place.After months of extreme pain and complaining to her GP, she said she was seen by a bladder specialist, who discovered a tumour in her cervix the “size of a large cooking apple”.Same address”I lost fertility, and if I was diagnosed two weeks later, it probably would have been too late for me,” she said.Ms Devlin received intensive chemotherapy and radiotherapy, but her cancer returned.She was told she had “three months to live” and to prepare for the worst, but said it was “miraculous” she was still alive.”[The hospital trust] have admitted they didn’t send a letter as they thought I was from the Gypsy-Traveller community and I wouldn’t have an address, although the address is the same address I’ve had all the time – I’m a settled person.”‘Missed opportunity’The BBC has seen evidence that the 26-year-old has lived at the same address since 2017.A letter sent to her by the WHTH in June 2018, and seen by the BBC, said: “Patient says she was told there was something wrong with her cervix and that it would be checked at a post natal check six weeks after the baby had delivered but no post natal check was offered and this girl comes from the travelling community and was lost to follow up.”Clearly we have missed an opportunity to diagnose and treat this girl at a much earlier stage of her cancer.”She may have had chance to preserve her fertility going forward and her chance of survival would have been significantly improved.”She said she was offered £5,000 from the trust, but she refused the money. Ms Devlin said she was not currently taking legal action.Image source, Angelina DevlinMs Devlin said: “Worthless, that’s how it made me feel, like my life is really worth nothing.”The people who were supposed to be taking care of me and my son didn’t.”She said her cancer was in remission, and that her bladder and most of her bowel had been removed. Ms Devlin has learnt to walk again and is living with an organism in her pelvis that makes her susceptible to sepsis. “My doctor told me they’re going to do their best to get me to 30,” said Ms Devlin, whose son is aged six.”I’ve been living in hell for six years.”Smear tests: ‘Five minutes could save your life’NHS promises to eliminate cervical cancer by 2040Study to look at ways to increase cervical screeningThe hospital trust said: “We are sorry Miss Devlin has not been satisfied with her experience. “However, we do not believe it is right to comment on individual cases or claims against the trust. “If representatives for Miss Devlin contact us, we can discuss how to progress her claim.”Follow East of England news on Facebook, Instagram and X. Got a story? Email eastofenglandnews@bbc.co.uk or WhatsApp 0800 169 1830More on this storySmear tests: ‘Five minutes could save your life’Published10 August 2023Study to look at ways to increase cervical screeningPublished20 July 2023NHS calls 13,000 women for smear tests after errorPublished17 April 2023Cervical cancer: ‘A smear test saved my life’Published27 January 2023Related Internet LinksWatford General HospitalDepartment of Health and Social CareThe BBC is not responsible for the content of external sites.

Published3 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Catriona MacPheeBBC DisclosurePeople who go abroad for weight-loss surgery, and then need urgent medical care back in the UK, cost the NHS more than it costs to carry out the operation itself, according to new research.A study featuring five London hospitals recorded the details of 35 people who had suffered complications after travelling abroad for gastric surgery during 2022.The data, shared with the BBC’s Disclosure programme, shows the patients suffered from a range of symptoms including severe malnutrition, vomiting, sepsis, hernias and haemorrhaging. Five of them needed feeding tubes inserted, while the average stay in hospital was 22 days. The interventions at the five hospitals for the 35 patients cost the NHS a total of £560,234, or £16,006 per patient, in 2022.The equivalent amount would have covered the cost of about 110 bariatric surgeries in UK hospitals. The paper featured cases at St George’s Hospital, University College Hospital, The Whittington Hospital, Imperial College Healthcare NHS Trust and Homerton Hospital, and was carried out on behalf of the patient safety committee of the Bariatric and Obesity Metabolic Surgery Society (BOMSS).Consultant bariatric surgeon Omar Khan, one of the lead authors of the study, said the paper was intended “to try and quantify” the effect on the NHS of increasing numbers of people going abroad for weight-loss surgery – sometimes known as bariatric tourism.”We know that the waiting lists in the NHS are unfortunately long. We also know that there are new units, particularly in Turkey, which have been set up to cater for an international market,” he explained.”We focused on patients with major complications, patients who were severely ill. They had leaks from the stomach, they had bleeding, they had infections. A significant portion required further surgery and some required revisional surgery.”Seven UK patients died after Turkey weight loss surgeryTurkey weight-loss op plea after mum-of-four’s deathWomen regret cut-price weight loss surgery abroadMost of the patients (60%) had returned from hospitals in Turkey and 90% of them were women. The most common operation was gastric sleeve followed by gastric balloon, both of which are intended to make patients feel full more quickly, meaning they eat less.The study also revealed that more than half of the 35 patients would likely have been rejected for surgery on the NHS, while almost 60% did not meet the National Institute for Care and Excellent (NICE) criteria for surgery. The NICE guidelines are used by the NHS to assess a patient’s suitability for bariatric surgery. One of the main criteria is a patient’s body mass index (BMI), a measurement based on height and weight. A patient with a BMI of less than 40, and no severe co-morbidities relating to obesity, would typically be rejected for bariatric surgery in the UK. What is bariatric surgery?Bariatric surgery, also known as weight-loss surgery, is used as a last resort to treat people who are dangerously obese (having a body mass index of 40 or above, or 35 plus other obesity-related health conditions).Patients must have tried and failed to achieve clinically-beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery.The two most common types of weight loss surgery are:Sleeve gastrectomy or gastric bypass, where some of the stomach is removed or the digestive system is re-routed past most of the stomach Gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make someone feel full It can cost as little as £2,000 to book weight-loss surgery in Turkey. The price to have it done privately in the UK is between £10,000 and £15,000. The rise in complications as a result of bariatric tourism prompted BOMSS to issue a public warning in October last year. It said: “As a professional society we are increasingly concerned by the number of patients presenting with the complications of surgical procedures performed outside the UK. “There is often an assumption that the NHS will sort out any issues once the patient returns home, but this is not always straightforward and has resulted in severely ill patients being repatriated to the UK and presenting themselves to their local A&E department.”Private hospitals in the UK have formal agreements in place with the NHS to recoup the costs of medical interventions.The study of the cases in London hospitals, titled The London Experience, is currently being peer-reviewed and will be published in full later this year. Mr Khan said the findings raised questions around NHS policy on bariatric tourism. “Obviously if someone is in extremis, is unwell, we need to treat them. We have a duty to do that,” he said.”A broader question, though, is more a public policy question. For example, if an NHS hospital deems a patient not suitable for bariatric surgery and they then go abroad to have that surgery, and then have, effectively a predictable complication… is the NHS obligated from a public policy perspective to effectively incentivise that behaviour, by giving a safety net? “That’s not to say we shouldn’t be treating people, but it is more a general question at a higher level as to how we should be approaching this.”‘Working on advice’On its website, the NHS states that people who consider travelling abroad for bariatric surgery should “make sure you weigh up any potential savings against the potential risks.”Standards may not be as strict in clinics outside the UK, and aftercare is not always straightforward. Clinics in other countries may not provide follow-up care, or it may not be the same standard as in the UK.”The Department of Health (DoH) recently said in a statement there were risks associated with travelling abroad for surgery “which people should consider carefully and fully understand before making their decision.The department said it was working to develop advice to help people understand the associated challenges and risks, including the need to arrange appropriate follow up care with the private provider.The public, the department added, could refer to UK-wide information and guidance on medical tourism.For details of organisations in the UK which offer advice and support with body image and mental health, go to bbc.co.uk/actionlineYou can watch BBC Disclosure’s Getting Thin Quick on BBC iPlayerListen to the best of BBC Radio London on Sounds and follow BBC London on Facebook, X and Instagram. Send your story ideas to hello.bbclondon@bbc.co.ukMore on this storySeven UK patients died after Turkey weight loss surgeryPublished21 March 2023Turkey weight-loss op plea after mum-of-four’s deathPublished6 September 2023Women regret cut-price weight loss surgery abroadPublished23 October 2022Doctors warning about weight loss surgery overseasPublished26 May 2022Related Internet LinksNHSBritish Obesity & Metabolic Surgery SocietyThe BBC is not responsible for the content of external sites.

Using artificial intelligence to scan surgery patients’ medical records for signs of risky drinking might help spot those whose alcohol use raises their risk of problems during and after an operation, a new study suggests.
The AI record scan tested in the study could help surgery teams know in advance which patients might need more education about such risks, or treatment to help them reduce their drinking or stop drinking for a period of time before and after surgery.
The findings, published in Alcohol: Clinical and Experimental Research by a team from the University of Michigan, show that using a form of AI called natural language processing to analyze a patient’s entire medical record can spot signs of risky drinking documented in their charts, such as in doctor’s notes, even when they don’t have a diagnosis of an alcohol problem.
Past research has shown that having more than a couple of drinks a day on average is associated with a higher risk of infections, wound complications, pulmonary complications and prolonged hospital stays in people having surgery.
Many people who drink regularly don’t have a problem with alcohol, and when they do they may never receive a formal diagnosis for alcohol use disorder or addiction, which would be easy for a surgical team to spot in their chart.
Scouring records and notes
The researchers, from Michigan Medicine, U-M’s academic medical center, trained their AI model by letting it review 100 anonymous surgical patients’ records to look for risky drinking signs, and comparing its classifications with those of expert human reviewers.

In all, the AI model matched the human expert classification most of the time. The AI model found signs of risky drinking in the notes of 87% of the patients who experts had identified as risky drinkers.
Meanwhile, only 29% of these patients had a diagnosis code related to alcohol in their list of diagnoses. So, many patients with higher risk for complications would have slipped under the radar for their surgical team.
The researchers then allowed the AI model to review more than 53,000 anonymous patient medical records compiled through the Michigan Genomics Initiative. The AI model identified three times more patients with risky alcohol use through this full-text search than the researchers found using diagnosis codes. In all, 15% of patients met criteria via the AI model, compared to 5% via diagnosis codes.
“This evaluation of natural language processing to identify risky drinking in the records of surgical patients could lay the groundwork for efforts to identify other risks in primary care and beyond, with appropriate validation,” said V. G. Vinod Vydiswaran, Ph.D., lead author of the new paper and an associate professor of learning health sciences at the U-M Medical School. “Essentially, this is a way of highlighting for a provider what is already contained in the notes made by other providers, without them having to read the entire record.”
“Given the excess surgical risk that can arise from even a moderate amount of daily alcohol use, and the challenges of implementing robust screening and treatment in the pre-op period, it’s vital that we explore other options for identifying patients who could most benefit from reducing use by themselves or with help, beyond those with a recorded diagnosis,” said senior author Anne Fernandez, Ph.D., an addiction psychologist at the U-M Addiction Center and Addiction Treatment Services and an associate professor of psychiatry.
The new data suggest that surgical clinics that simply review the diagnosis codes listed in their incoming patients’ charts, and flag ones such as alcohol use disorder, alcohol dependence or alcohol-related liver conditions, would be missing many patients with elevated risk.

Alcohol + surgery = added risk
In addition to known risks of surgical complications, Fernandez and colleagues recently published data from a massive Michigan surgical database showing that people who both smoke and have two or more drinks a day were more likely to end up back in the hospital, or back in the operating room, than others. Those with risky drinking who didn’t smoke also were more likely to need a second operation.
She and colleagues also found that 19% of people having surgery may have risky levels of alcohol use, in a review of detailed questionnaire data from people participating in two different studies that enroll people from Michigan Medicine surgery clinics.
The new study used the NLP form of AI not to generate new information, but to look for clues in the pages and pages of provider notes and data that make up a person’s entire medical record.
After validation, Vydiswaran said, the tool could potentially be run on a patient’s record before they are seen in a pre-operative appointment and identify their risk level.
Just knowing that a person has a potentially risky level of drinking isn’t enough, of course.
Fernandez is leading an effort to test a virtual coaching approach to help people scheduled for surgery understand the risks related to their level of drinking and support them in reducing their intake.
“Our goal is to identify people who may be in need of more treatment services, including medication for alcohol use disorder and support during their surgical recovery when alcohol abstinence is necessary,” she said. “We are not aiming to replace the due diligence every provider must do, but to prompt them to talk with patients and get more information to act upon.”
The risks of combining alcohol with the opioid pain medications often used to treat post-surgical pain are very high, she noted.
In addition to current work to validate the model, the team hopes to make their model publicly available, though it would have to be trained on the electronic records system of any health system that seeks to use it.
“These AI tools can do amazing things, but it’s important we use them to do things that could save time for busy clinicians, whether that’s related to alcohol or to drug use, disordered eating, or other chronic conditions,” said Fernandez. “And if we are going to use them to spot potential issues, we need to be ready to offer treatment options too.”
In addition to Fernandez and Vydiswaran, who are members of the U-M Institute for Healthcare Policy and Innovation, the study’s authors are Asher Strayhorn and Katherine Weber of Learning Health Sciences, and Haley Stevens, Jessica Mellinger and G. Scott Winder of Psychiatry.
The study was funded by the National Institute on Alcoholism and Alcohol Abuse, part of the National Institutes of Health (AA026333, AA028315) and by U-M Precision Health, which also runs the Michigan Genomics Initiative. The study used the U-M Data Office for Clinical and Translational Research.

Systemic lupus erythematosus (SLE) is an autoimmune disease, in which the immune system that normally protects the body from invading microbes, turns against the body´s own cells. This autoimmune attack can affect any organ and patients commonly develop skin rashes, joint inflammation, blood clots, kidney failure, heart disease, fatigue and psychiatric problems. Until to date, there is no cure for SLE and patients are treated with immunosuppressing drugs with considerable side effects.
A group of researchers lead by Min Ae Lee-Kirsch from the Department of Pediatrics, Medical Faculty, TUD Dresden University of Technology (Germany), studied four patients from two families who developed symptoms of SLE in the first years of life. As familial occurrence of SLE in young children is highly unusual, her team searched for a primary genetic cause and found a mutation in the UNC93B1 gene in all affected family members. UNC93B1 is a membrane-spanning structural protein required for maturation and trafficking of a group of receptors that play an important role in the defense against viral infections. These receptors recognize the nucleic acid component of the virus and activate type I interferons, which instruct cells to fight a viral infection. However, nucleic acids, such as DNA and RNA, are not only found in viruses, but are also present in every cell of the human body. This means that the immune system must be capable of discriminating foreign from self nucleic acids.
The identified UNC93B1 mutations lead to selective overactivation of TLR7, one of the UNC93B1-regulated receptors that specifically recognizes RNA, leading to erroneous recognition of self RNA with uncontrolled overproduction of type I interferon. This results in an immune attack on normal cells which then triggers inflammation. Moreover, this also stimulates the survival of self-reactive B cells that produce autoantibodies directed against the body´s own cells, fueling the autoimmune attack. These findings demonstrate that UNC93B1 controls the activity of specific nucleic acid receptors, such as TLR7, thereby preventing autoimmunity.
Remarkably, people lacking functional UNC93B1 are prone to viral infections with a severe course, such as herpes simplex virus encephalitis and severe COVID-19, highlighting the essential role of UNC93B1 for a healthy immune system.
The findings of this study are also of clinical relevance regarding the development of novel targeted therapies for patients with common forms of SLE, who often show signs of overactivation of the TLR7 pathway. Professor Lee-Kirsch says: “Our study demonstrates a direct causal link between an overactive UNC93B1/TLR7 axis and lupus pathogenesis and indicates that blocking overactive TLR7 might be therapeutically effective. As such, our findings are expected to accelerate further development of TLR7 inhibitors for patients with SLE and related autoimmune diseases.”
The study was funded in part by the German Research Foundation (Deutsche Forschungsgemeinschaft; DFG) and the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung; BMBF).
Results were published in Science Immunology as early release on January 11, 2024.

Global fungal infections, which affect one billion people and cause 1.5 million deaths each year, are on the rise due to the increasing number of medical treatments that heighten vulnerability. Patients undergoing chemotherapy or immunosuppressive treatments after organ transplant often present compromised immune systems. Given the emergence of resistant strains, the limited variety of current antifungal drugs as well as their cost and side effects, the treatment of these infections is challenging and brings about an urgent need for more effective treatments.
In this context, a team from the Institute for Research in Biomedicine (IRB Barcelona) and the Barcelona Supercomputing Center — Centro Nacional de Supercomputación (BSC-CNS), led by the ICREA researcher Dr. Toni Gabaldón, has identified hundreds of genes subject to recent, clinically-relevant selection in six species of the fungal pathogen Candida.
“This work highlights how thesepathogens adapted to humans and antifungal drugs and provides valuable knowledge that could lead to better treatments for Candida infections,” explains Dr. Gabaldón, head of the Comparative Genomics lab at IRB Barcelona and the BSC.
More than 2,000 genomes from 6 different species
The study delves into the evolutionary landscape of Candida pathogens by analysing approximately 2,000 genomes from clinical samples of six major Candida species. These genomes are stored in public databases. The researchers compared these genomes to a reference, creating a comprehensive catalogue of genetic variants.
Building on previous work addressing drug-resistant strains, the researchers conducted a Genome-Wide Association Study (GWAS) to identify genetic variants linked to antifungal drug resistance in clinical isolates. This approach provided insights into both known and novel mechanisms of resistance towards seven antifungal drugs in three Candida species. “Additionally, a concerning finding has arisen from the study: the potential spread of resistance through mating between susceptible and resistant strains, contributing to the prevalence of drug-resistant Candida pathogens,” explains Dr. Miquel Àngel Schikora-Tamarit, a postdoctoral researcher in the same lab and first author of the study.
In addition, by focusing on variants acquired recently among clinical strains, the researches detected shared and species-specific genetic signatures of recent selection that inform on which adaptations might be needed to thrive and spread in human-related environments.
Beyond the novel insights into the adaptation of Candida, the study provides a valuable resource, namely a comprehensive catalogue of variants, selection signatures, and drivers of drug resistance. This knowledge not only contributes to our understanding of these infections but also lays the groundwork for future experiments and potential advancements in the development of more effective treatments for Candida infections.
This work was funded by the Spanish Ministry of Science, Innovation and Universities, The European Research Council, and “la Caixa” Foundation.

New research from Oregon Health & Science University for the first time reveals the function of a little-understood junction between cells in the brain that could have important treatment implications for conditions ranging from multiple sclerosis to Alzheimer’s disease, to a type of brain cancer known as glioma.
The study published today in the journal Nature Neuroscience.
Neuroscientists focused on the junction, or synapse, connecting neurons to a non-neuronal cell, known as oligodendrocyte precursor cells, or OPCs. OPCs can differentiate into oligodendrocytes, which produce a sheath around nerves known as myelin. Myelin is the protective sheath covering each nerve cell’s axon — the threadlike portion of a cell that transmits electrical signals between cells.
The study found that these synapses play a pivotal role in producing that myelin.
“This is the first investigation of these synapses in live tissue,” said senior author Kelly Monk, Ph.D., professor and co-director of the Vollum Institute at OHSU. “This gives an understanding of the basic, fundamental properties of how these cells work in normal development. In the future, we might look at how they function differently in the context of MS patients.”
The fact that these synapses exist at all was the subject of a landmark discovery by OHSU researchers at the Vollum that was published in the journal Nature in May of 2000. Until that point, synapses in the brain had been known only to carry neurotransmitters between neurons, so the discovery of a synapse between neurons and OPCs came as a revelation.
“After two decades, we still didn’t know what these synapses do,” Monk said.

Scientists tackled the problem by using single-cell imaging of live tissue in zebrafish, whose transparent bodies enable researchers to see the inner workings of their central nervous system in real time. Using powerful new tools in imaging, pharmacology and gene editing, researchers were able to use neuron-OPC synapses to predict the timing and location of the formation of myelin.
The findings are likely the tip of the iceberg in terms of understanding the importance of these synapses, said lead author Jiaxing Li, Ph.D., a postdoctoral fellow in Monk’s lab.
Oligodendrocyte precursor cells comprise about 5% of all cells in the brain — meaning the synapses they form with neurons could be relevant to many disease conditions, including the formation of cancerous tumors.
Li noted that previous studies have suggested a role for OPCs in a range of neurodegenerative conditions, including demyelinating disorders such as MS, neurodegenerative diseases such as Alzheimer’s and even psychiatric disorders like schizophrenia.
By demonstrating the basic function of the synapse between neurons and OPCs, Li said the study may lead to new methods of regulating OPC function to alter disease progression. For example, these synapses could be the key to promoting remyelination in conditions such MS, where myelin has been degraded. In MS, this degradation can slow or block electric signals required for people to see, move their muscles, feel sensations and think.
“There may be a way to intervene so that you can increase the myelin sheath,” he said.

Monk said the discovery may be most immediately relevant to cancer.
“In glioma, these synapses are hijacked to drive tumor progression,” she said. “It may be possible to modulate the synaptic input involved in tumor formation, while still allowing for normal synaptic signaling.”
Even though these precursor cells comprise roughly 5% of all human brain cells, only a fraction go on to form oligodendrocytes.
“It’s becoming pretty clear that these OPCs have other functions aside from forming oligodendrocytes,” Monk said. “From an evolutionary perspective, it doesn’t make sense to have so many of these precursor cells in your brain if they’re not doing something.”
Their synaptic connection to neurons therefore likely plays a fundamental role in the brain, and is worthy of future exploration, she said.
In addition to Monk and Li, co-authors include Tania Miramontes of OHSU and Tim Czopka, Ph.D., of the Centre for Clinical Brain Sciences at the University of Edinburgh in the U.K.

If you are one of the 30% to 50% of women experiencing urinary incontinence, new research suggests that it could turn into a bigger health issue.
Having more frequent urinary incontinence and leakage amounts is associated with higher odds of disability, according to RUSH researchers in a study published in the January issue of Menopause.
“Often symptoms from urinary incontinence are ignored until they become bothersome or limit physical or social activities,” said Sheila Dugan, MD, chair of the Department of Physical Medicine and Rehabilitation at RUSH. “Because this study suggests that urinary incontinence is associated with disability, exploring treatment options in the early stages may help decrease this outcome in midlife women.”
Urinary incontinence affects many women at some point during their lifetime, she said. Some women will leak urine when they sneeze or cough, which is called stress incontinence.
“When you sneeze or cough, there is a mechanical pressure from your belly that overwhelms the sphincter and you leak,” she said.
Others suffer from urge incontinence, which is an overwhelming urge to urinate, such as when they get close to a restroom. Women who experience both have what’s called mixed urinary incontinence, Dugan said.
Researchers considered the amount and frequency of the incontinence and whether the study participant had stress incontinence, urge incontinence, or both.

Researchers then measured disability by the World Health Organization disability assessment scale as the outcome of interest.
“We found that mixed incontinence was the most highly correlated with disability, along with daily incontinence and larger amounts of incontinence,” Dugan said.
Dugan helped create the Program for Abdominal and Pelvic Health at RUSH, which treats several types of conditions, including urinary incontinence. Each patient is examined to determine the causes and treatment options. For example, muscles are evaluated to uncover whether tight bands in the muscles are causing incontinence or whether weak muscles are to blame.
“In a case of tight muscles, a woman may try to tighten the muscles further with more exercise, not knowing that it may make the incontinence worse,” Dugan said. “Pelvic floor muscles support pelvic organs and organ problems can lead to muscle problems or vice versa. One patient may have incontinence due to hip arthritis, another from a difficult delivery, or it can be caused by cancer treatment, for example, radiation in the pelvic area.”
There are a number of potential causes, or even a combination of causes, of incontinence. The data used was from a larger clinical trial called SWAN (the Study of Women Across the Nation) that included more than 1,800 participants. SWAN was initiated in 1994 with seven sites across the U.S. to identify changes that occur during the menopause transition in midlife women and their effects on subsequent health and risk for age-related diseases.
“More studies are needed to show what causes this association, with a focus on prevention,” Dugan said.

Individuals with obesity are more likely to have monoclonal gammopathy of undetermined significance (MGUS), a benign blood condition that often precedes multiple myeloma, according to new research published in Blood Advances.
Multiple myeloma is a blood cancer of the plasma cells, a type of white blood cells that produce antibodies to fight infection. MGUS, characterized by an abnormal protein produced by plasma cells, is a known precursor to multiple myeloma. Most people with MGUS exhibit no significant symptoms and are not immediately ill. Rather, the presence of MGUS serves as a warning to monitor for the potential development of more critical conditions, like multiple myeloma, that MGUS can turn into.
The Centers for Disease Control and Prevention reported in 2020 that nearly 42% of the US population is classified as obese, defined by a body mass index (BMI) of 30 or higher. Yet, little research exists to suggest how obesity may impact cancer outcomes.
“While significant advancements have been made in therapeutics for multiple myeloma, it remains an incurable disease, often diagnosed after patients have already experienced end-organ damage,” explained David Lee, MD, MPH, MMSc, an internal medicine resident at Massachusetts General Hospital. “It’s preceded by premalignant conditions including MGUS. Our research group is focused on investigating risk factors and etiology of MGUS to better understand who may be at increased risk for developing MGUS and its progression to multiple myeloma.”
Investigators enrolled 2,628 individuals from across the United States who were at elevated risk of developing multiple myeloma, based on self-identified race and family history of hematologic malignancies, between February 2019 and March 2022. Participants were screened for MGUS, defined by the presence of monoclonal proteins at serum concentrations of 0.2g/L or greater. Investigators measured MGUS using mass spectrometry — a novel, highly sensitive method of identifying and quantifying monoclonal proteins in the blood.
After controlling for age, sex, race, education, and income, the team found that being obese was associated with 73% higher odds of having MGUS, compared to individuals with normal weights. This association remained unchanged when accounting for physical activity. However, highly active individuals (defined as doing the equivalent of running or jogging 45-60 minutes per day or more) were less likely to have MGUS even after adjusting for BMI class, whereas those who reported heavy smoking and short sleep were more likely to also have detectable levels of MGUS.
Limitations include that this was a cross sectional study — a snapshot of how certain variables or characteristics may relate to one another at a single point in time. While investigators found a strong correlation between MGUS, obesity, and lifestyle factors, they do not have enough evidence to assume causation.
Additionally, the American Medical Association recently voted to adopt a new policy that no longer uses BMI alone to assess whether someone is of a healthy weight, as previous research suggests the metric does not effectively distinguish between fat and lean mass and does not account for how fat is distributed throughout the body. The formula was created based on data from non-Hispanic white populations, suggesting its implications cannot accurately be generalized across Black, Asian, and Hispanic groups.
Going forward, researchers will aim to validate these findings in other study cohorts, including individuals who are followed longitudinally, to further explore the mechanisms through which obesity and other modifiable risk factors might influence the development and progression of MGUS.
“These results guide our future research in understanding the influence of modifiable risk factors, such as weight, exercise, and smoking, on cancer risk,” explained Dr. Lee. “Before we can develop effective preventative health strategies to lower the risk of serious diseases like multiple myeloma, we first need to better understand the relationship between MGUS and potentially modifiable risk factors like obesity.”

Only a small percentage of older Americans have jumped on the rising trend of getting health care services and prescriptions directly from an online-only company, rather than seeing their usual health care providers in person or via telehealth, a new poll finds.
But that could change rapidly, the University of Michigan survey suggests.
In all, 7.5% of people between the ages of 50 and 80 have used at least one direct-to-consumer health care service from an online-only provider, according to the new findings from the National Poll on Healthy Aging (https://www.healthyagingpoll.org/).
Of those who did use such a service, most said they were driven by convenience. More than 60% of them received a prescription, mostly for a one-time treatment. But only one-third of them told their regular health care provider about the prescription.
People in their pre-Medicare years of 50 to 64 were more than twice as likely as adults over 65 to have used direct-to-consumer, or DTC, online health services (10% vs. 4%). Meanwhile, 47% of those over 65 said they had never heard of such companies.
Looking to the future, nearly a third of all older adults, and more than 42% of those age 50 to 64, said they’d be interested in using such services in the future.
The poll is based at the U-M Institute for Healthcare Policy and Innovation, and supported by AARP and Michigan Medicine, U-M’s academic medical center.

For the DTC survey, the poll team worked with members of U-M’s Center for Value-Based Insurance Design, who are interested in how cost and convenience influence people’s health care decisions and the continuity of care delivery.
A rapidly growing sector spurs concerns
The rise of DTC sites and subscription-based apps that promise convenient online access to providers who can evaluate symptoms, make diagnoses and prescribe medicines has received a lot of attention, especially amid a national crunch in availability of primary care providers and timely appointments.
Such companies include Amazon Clinic, Sesame, Roman, BetterHelp, Rosy, Lemonaid, Hims & Hers, and don’t require a referral or health insurance. Drug companies and membership-based organizations including Weight Watchers and Costco have also started offering access to such direct services.
But the trend has raised concern because of the potential for patients to receive care and prescriptions from providers who don’t know their full health history, don’t have access to their full medical records, and may not check for potentially dangerous interactions between medications.
One-third of those who had used a DTC service said their primary care provider wasn’t aware they had done so. If they received a new prescription through an encounter with a DTC health service, one-third said their regular primary care provider was not made aware of the new medication they were prescribed. The majority of those who received prescriptions through a DTC service said it was for a one-time treatment.

“These compelling findings have important implications for patient safety and continuity of care,” said Mark Fendrick, M.D., director of VBID and IHPI member who is a primary care physician at Michigan Medicine. “With rapid growth in this sector of health care predicted for this year and beyond, all providers, insurers and regulators need to pay more attention to how patients are using these services and why, and the impact on care quality and safety.” Fendrick is a professor of internal medicine in the Division of General Medicine at the U-M Medical School.
His colleague Nicole Hadeed, M.D., who also worked on the poll and is a clinical assistant professor, notes that while the number of poll participants who said they had used DTC services was relatively small, the analysis gives clues that should inform further research.
Types of care received
Nearly half of those who had used a DTC service said it has been for general health care such as treatment of allergies, sinus infections, pink eye or acid reflux, though again there was a clear divide between the 50-64 and 65-80 age groups.
Overall, nearly 12% said they’d used a service for mental health reasons, but the proportion was much higher (50%) among respondents who said they considered their mental health to be fair or poor and had used a DTC service of any kind.
As for other types of care, 15% had sought help from a DTC service for a sexual health issue, 9% had used it for skin care, 6% had used it for weight management, nearly 5% had used it for hair loss and a similar percentage had used it for pain management.
Convenience topped the list of reasons for choosing a DTC service, with 55% saying this drove their decision. But lack of access to their regular health care provider, not having a regular health care provider, or needing a service when their health provider was not open or available were each cited by around 20%. Discomfort discussing a sensitive health topic with a provider — often cited in marketing by such companies — was only mentioned by 10% of those who had turned to a DTC service.
“For both patients and providers, these findings drive home the importance of open dialogue and transparency about the potential uses, benefits and risks of these services — and the importance of maintaining contact for ongoing primary care,” said Jeffrey Kullgren, M.D., M.P.H., M.S., director of the poll and a primary care provider at the VA Ann Arbor Healthcare System who is also an associate professor at the Medical School.
More than 55% of the poll respondents who had used a direct-to-consumer service said the overall quality of care they get from their primary care provider is better than what they received from a DTC provider.
Fendrick and Hadeed wrote about the potential long-term change to primary care use from telehealth services in a piece published early in the COVID-19 pandemic in the American Journal of Managed Care.
And in fact, 58% of poll respondents who had used a DTC service had started doing so in 2020, 2021 or 2022.
The rapid pivot during the pandemic to vaccination in pharmacies, and not just primary care clinics, has also changed how people think about alternate ways of getting care that might be closer to home or have more flexible hours.
However, Fendrick notes, pharmacies share information about vaccination with insurance companies and statewide immunization registries that primary care providers can access.
“Patients will increasingly seek care online because of the convenience it can provide, especially for those willing to pay the cost out of pocket,” said Fendrick. “Its use will likely be boosted by the rapidly increasing number of online vendors and the national shortage of primary care clinicians. The recent launch of a telemedicine platform offering home delivery for the new highly popular weight loss drugs is a noteworthy example of this trend.”
He added, “Given a likely expansion of online care, it is critical that individuals inform their usual clinician and that we providers consistently ask our patients regarding their use. Similar to my routinely asking patients about which supplements, vitamins and over-the-counter medications they’re taking, it should become standard practice for me to inquire about prescriptions or diagnoses they’ve received online, as it might influence their care.”
The poll was a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in July and August 2023 among 2,657 adults aged 50 to 80. In all, 168 respondents reported having used a DTC health care service. The sample was subsequently weighted to reflect the U.S. population. Read past National Poll on Healthy Aging reports (https://www.healthyagingpoll.org/reports-more) and about the poll methodology (https://www.healthyagingpoll.org/survey-methods).