Influenza poses a perennial threat in part because of its ability to jump from species to species. Birds and pigs have been known to harbor viruses that cross over to humans, and even dogs and cats have carried nonhuman-infecting varieties of influenza. Now, man’s best friend is closer to joining the list of potential vectors, Science News reports. Researchers in southern China found a surprising variety of flu viruses in dogs, including three new variants of influenza A that evolved after being passed on by pigs, researchers reported this week in mBio. The new finding doesn’t mean you’ll have to put a surgical mask on your beagle any time soon, but it does mean scientists are going to be closely monitoring the evolution of canine influenza.
Friday, June 8, 2018
Carbon dioxide reduces belly fat
The first randomized, controlled trial testing carbon dioxide gas injections (carboxytherapy) to reduce belly fat found the new technique eliminates fat around the stomach. However, the changes were modest and did not result in long-term fat reduction, according to the Northwestern Medicine study.
“Carboxytherapy could potentially be a new and effective means of fat reduction,” said lead author Dr. Murad Alam, vice chair of dermatology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “It still needs to be optimized, though, so it’s long lasting.”
The paper was published this week in the Journal of the American Academy of Dermatology.
The new technique‘s benefits are that it is a “safe, inexpensive gas, and injecting it into fat pockets may be preferred by patients who like natural treatments,” Alam said. “Non-invasive fat reduction has become increasingly sought-after by patients.”
Benefits of a non-invasive approach are diminished downtime, avoidance of scarring and perceived safety.
Current technologies routinely used for non-invasive fat reduction include cryolipolysis, high intensity ultrasound, radiofrequency, chemical adipocytolysis and laser-assisted fat reduction.
Carboxytherapy has been performed primarily outside the U.S., with a few clinical studies suggesting it may provide a lasting improvement in abdominal contours. The way carboxytherapy works is not well understood. It is believed that injection of carbon dioxide causes changes in the microcirculation, and damages fat cells.
No randomized controlled trials for carboxytherapy efficacy and benefit over time have been previously conducted. The purpose of this study was to assess the effectiveness of carboxytherapy for fat reduction in a randomized, controlled trial, and to determine if any observed benefits persisted for six months.
The Northwestern study consisted of 16 adults who were not overweight (body mass of 22 to 29) and were randomized to get weekly carbon dioxide gas injection to one side of their abdomens and a sham treatment on the other side once a week for five weeks. A high-resolution ultrasound detected a reduction in superficial fat after five weeks but not at 28 weeks. The patients’ body weight did not change over the course of the study.
That the difference was not maintained at six months suggests the treatment stimulated a temporary metabolic process that reduced the size of fat cells without inducing cell death, Alam said.
“If carboxytherapy can provide prolonged benefits, it offers patients yet another noninvasive option for fat reduction,” Alam said. “But we don’t feel it’s ready for prime time.”
Children with autism more likely to suffer from food allergy
A new study from the University of Iowa finds that children with autism spectrum disorder (ASD) are more than twice as likely to suffer from a food allergy than children who do not have ASD.
Wei Bao, assistant professor of epidemiology at the UI College of Public Health and the study’s corresponding author, says the finding adds to a growing body of research that suggests immunological dysfunction as a possible risk factor for the development of ASD.
“It is possible that the immunologic disruptions may have processes beginning early in life, which then influence brain development and social functioning, leading to the development of ASD,” says Bao.
The study is published in the Journal of the American Medical Association’s JAMA Network Open. It analyzed the health information of nearly 200,000 children gathered by the U.S. National Health Interview Survey (NHIS), an annual survey of American households conducted by the U.S. Centers for Disease Control and Prevention. The children were between the ages of 3 and 17 and the data were gathered between 1997 and 2016.
The study found that 11.25 percent of children reportedly diagnosed with ASD have a food allergy, significantly higher than the 4.25 percent of children who are not diagnosed with ASD and have a food allergy.
Bao says his study could not determine the causality of this relationship given its observational nature. But previous studies have suggested possible links–increased production of antibodies, immune system overreactions causing impaired brain function, neurodevelopmental abnormalities, and alterations in the gut biome. He says those connections warrant further investigation.
“We don’t know which comes first, food allergy or ASD,” says Bao, adding that another longitudinal follow-up study of children since birth would be needed to establish temporality.
He says previous studies on the association of allergic conditions with ASD have focused mainly on respiratory allergy and skin allergy, and those studies have yielded inconsistent and inconclusive results. The new study found 18.73 percent of children with ASD suffered from respiratory allergies, while 12.08 percent of children without ASD had such allergies; and 16.81 percent of children with ASD had skin allergies, well above the 9.84 percent of children without ASD.
“This indicates there could be a shared mechanism linking different types of allergic conditions to ASD,” says Bao.
Bao says the study is limited in that the NHIS depends on respondents to voluntarily self-report health conditions, so the number of children with ASD or allergies may be misreported by those taking the survey. But he says the large number of respondents and ethnic and gender cross-representation of the survey are major strengths.
Probing role of glutamate in age-associated cognitive disorders
As people around the world live longer, the prevalence of age-associated cognitive disorders is growing. Alzheimer’s disease (AD), for which advanced age is the most significant risk factor, currently defies all therapeutic efforts. Experts argue that identifying the onset of this progressive disease as early as possible will advance the fight against its devastating effects.
A research team at Wayne State University hopes to give clinicians tools for identifying the early signs of impending disease by measuring subtle deviations in the way the brain modulates its chemistry during the formation of new memories. Their research project, “Task-related modulation of hippocampal glutamate, subfield volumes and associative memory in younger and older adults: a longitudinal ¹H FMRS study,” was recently awarded a two-year, $423,500 grant from the National Institute on Aging of the National Institutes of Health.
The study, led by Jeffrey Stanley, Ph.D., professor of psychiatry and behavioral neurosciences in Wayne State’s School of Medicine, and by Naftali Raz, Ph.D., professor of psychology in Wayne State’s College of Liberal Arts and Sciences and director of the Lifespan Cognitive Neuroscience Program in the Institute of Gerontology at Wayne State, will use a noninvasive technique called functional magnetic resonance spectroscopy (fMRS) to characterize memory function based on the modulation of the brain’s most common neurotransmitter, glutamate, in real time, as study participants engage in a memory task.
Stanley and Raz will examine changes in glutamate within the hippocampus -; one of the brain regions that is critical for memory -; during creation of new associations between pictorial stimuli and their location.
“Studying glutamate, sometimes called the brain’s light switch, will help us better understand the brain chemistry behind basic memory processes,” said Raz. “Most of what we know about glutamate changes with age, and its relations to memory comes from animal models and measurements of stationary levels of glutamate in humans. The fMRS technique perfected by Dr. Stanley will allow us to examine age difference and age-related changes over time in task-related glutamate modulation, in intact human participants.”
The research team will acquire a structural MRI of the whole brain, a high-resolution scan of the hippocampal body, and a ¹H fMRS of the hippocampus during formation of associations between common objects and locations in healthy, young and older participants. An important feature of this study is a one-year follow-up that will help gauge the rate of change and individual differences in change over time in a fundamental memory-related brain process, while avoiding potentially misleading conclusions based on cross-sectional comparisons of age groups.
The investigators believe that the results of this study will lay the foundation for intervention aimed at mitigating cognitive decline.
Computerized brain shows how depressive episodes affect memory
It was already known that people who suffer an acute depressive episode are less likely to remember current events, but the new model suggests that older memories are also affected.
During a depressive episode, the brain’s ability to produce new brain cells is reduced. In major depressive disorder, patients can suffer from cognitive impairment so severe that it is sometimes referred to as pseudodementia.
Pseudodementia differs from the classic form of dementia in that the memory recovers once the depressive episode has ended.
Computational neuroscientists Professor Sen Cheng and colleagues investigated this process by developing a computational model that captures the characteristic features of the brain in patients with depression.
As occurs in patients with depression, the model alternated between depressive episodes and periods that were symptom-free.
As reported in the journal Plos One, the model showed that during a depressive episode, the brain formed fewer new brain cells.
Unlike previous simulations, memories were represented as a sequence of neural activity patterns rather than as static neural activity patterns.
“This allows us not only to store events in memory but also their temporal order,” explains Cheng.
The authors report that the model was able to recall memories more accurately if the brain region involved was able to form many new neurones, but if the region formed fewer new neurones, it was more difficult to distinguish similar memories and to recall them separately.
The model also showed that the impact of depressive episodes was stronger than previously thought.
Not only was there a reduced ability to recall current events, but there were also deficits in recalling memories that were collected prior to the depressive episode. The longer the duration of the depressive episode, the further the memory deficits reached back.
So far it was assumed that memory deficits only occur during a depressive episode,” says Cheng. “If our model is right, major depressive disorder could have consequences that are more far reaching. Once remote memories have been damaged, they do not recover, even after the depression has subsided.”Professor Sen Cheng, Ruhr-Univesität Bochum
NYU Langone Health tests out Amazon Business programs
NYU Langone Health is a “strategic development partner” with Amazon Business, the online marketplace for institutions, said Chris Holt, leader of global health care at Amazon.
Holt spoke Thursday on the NYU Langone campus in Manhattan for the health system’s Health Tech Summit. He described how hospitals must adapt for the digital age and, of course, how Amazon could help them do it.
NYU Langone held the event in part to promote its health-tech hub, which conducts outreach to early stage companies that might partner with the system, said Dr. Christopher Morris, NYU Langone’s associate director for digital health innovation.
An NYU Langone spokeswoman said the health system was “in talks about partnership and participating in some pilot opportunities” with Amazon but declined to elaborate beyond that description.
One of Amazon Business’s major entries into health care has been as a supplier. Holt said that large organizations often spend 80% of their procurement budget with 20% of their suppliers, and the remaining 20% of spending is split between 80% of vendors. Amazon is looking to consolidate that share.
He said that NYU Langone is in “pilot mode” with Amazon Business, which allows organizations’ procurement offices to select certain products for employees to reorder.
Amazon Business said in July 2017 that its platform selling supplies to customers in health care, education, government and other business categories had more than 1 million U.S. customers.
Not all area health systems have jumped at the opportunity to work with Amazon. Northwell Health CEO Michael Dowling told Crain’s in April that Northwell had discussions with the company about its medical-supply business. It ultimately decided to continue using its internal group-purchasing organization and Acurity, the purchasing organization of the Greater New York Hospital Association.
Holt said Amazon’s interest in hospitals goes beyond medical and office supplies. He noted that Amazon’s Alexa device can help patients perform tasks such as adjusting the lights and lowering the shades. NYU Langone has begun using Alexa in some of its recovery rooms, he said. The company is also interested in remaking hospital cafeterias through its Amazon Fresh and Whole Foods brands.
Hospitals need to improve the patient experience if they are going to attract customers as more care moves online, Holt said.
He cited the example of his daughter’s emergency hospital visit. Several months afterward, Holt began receiving bills totaling $130,000. After his insurance company’s share, he was left to pay only about $2,600. But it was the billing experience, not the quality of care his daughter received, that lingered in his memory.
“This experience is unacceptable in any other industry on Earth except for health care,” Holt said.
With the rise in telehealth, proximity and a family’s history with a hospital won’t be enough to attract patients, he said.
“Probably in the next 10 years, I’m only going to interact with a person for the most acute care issues in my life. Everything else will be done digitally,” Holt said. “You’re going to have reinvent your brand in a digital setting with a new type of customer.”
Uncertainty could spook insurance markets as DOJ decides not to defend ACA
The Trump administration’s request Thursday that a Texas federal court invalidate three key Obamacare mandates for insurance coverage has jolted the healthcare industry as all eyes home in on a case that until now has drawn little national attention or interest.
The U.S. Justice Department on Thursday not only refused to defend the Affordable Care Act against a lawsuit filed by 20 Republican state attorneys general, but echoed the state litigators’ arguments that Congress rendered major provisions of the law invalid when it zeroed out the individual mandate penalty in the 2017 tax bill.
In particular, the Justice Department said the court should overturn the ACA’s individual mandate along with provisions requiring insurers to cover people with pre-existing conditions and to use a community rating to set premiums instead of basing rates on a person’s health condition because they were specifically tied to the mandate’s implementation.
The move shifts the defense of the law to Democratic state attorneys general who have already intervened.
The Justice Department pushed back on the plaintiffs’ request to immediately invalidate the ACA, since the tax penalty is still in effect until January 2019. Instead, the administration asked the court to nix the provisions when the tax cut begins. Paul Larkin of the conservative Heritage Foundation said he believes this request was made to set up the case for a Supreme Court hearing.
Legal scholars largely panned the Justice Department’s argument for lacking merit, but the industry and some analysts are already on alert for what the administration’s stated position on the Affordable Care Act’s most popular aspects could mean.
The legal questions boil down to the point of “severability,” an argument brought in Obama-era litigation against the ACA.
The Justice Department argued in its brief that most of the ACA could stand except the individual mandate, pre-existing conditions and community rating provisions. The Obama administration had said these measures go hand-in-hand and cannot survive without each other and the tax penalty.
“It’s pretty bad,” libertarian law professor Jonathan Adler said of the underlying case merits. “It reflects poor understanding of severability doctrine, you see that in the state’s brief, and you see it implicitly in the DOJ brief insofar as they accept those arguments.”
Abbe Gluck, a Yale University law professor, noted that the doctrine of severability is based on congressional intent, but the legal question in this case shouldn’t focus on Congress’ intent in 2010 when lawmakers passed the ACA. Instead, the court should focus on 2017 when Congress zeroed out the individual mandate penalty but did not touch the pre-existing condition and community rating provisions.
“A court doesn’t now have to guess whether Congress wanted the rest of the statute to remain standing,” Gluck said. “Congress told us that by leaving it intact. The intervening and dispositive action of the 2017 Congress itself is why the whole severability argument has no basis in law and also why the 2012 litigating position isn’t relevant any more.”
Melinda Hutton, general counsel for American Hospital Association, also weighed in on the severability issue, arguing that “as it stands today, the individual mandate is clearly severable from the rest of the (ACA).”
Hatton warned that a legal ruling otherwise “would devastate this nation’s hospitals and health systems and the patients they serve.”
“Nothing requires that catastrophic result,” Hatton said.
America’s Health Insurance Plans, the trade group representing a swath of carriers who offer plans on the exchanges, is planning to file an amicus brief against the plaintiffs’ request for a preliminary injunction—the first signal of stakeholder involvement in the lawsuit.
AHIP also issued a forceful statement against the Justice Department’s petition to invalidate the consumer protection clauses.
“Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions,” AHIP said Friday in a statement. “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019.”
Ceci Connolly, president of the Alliance of Community Health Plans, called the legal position “troubling” and warned it could spark fresh market instability.
“At the very least it adds uncertainty at exactly the moment when plans are trying to set rates for next year,” Connolly said in a statement. “At the worst, it could strip away guaranteed coverage for those with pre-existing conditions. We don’t want to return to the days when people who needed the care the most could be turned away because of their health status.”
Insurers in Virginia and Maryland have already proposed 2019 rates showing high double-digit spikes, while insurers in Pennsylvania and Maine are showing minimal increases so far.
Jost also worried that as the case gets tangled in court, the Trump administration’s position could reverberate in HHS’ decisions as some states seek greater authority to skirt some ACA regulations.
Although he conceded it is unlikely, Jost wondered whether the Justice Department’s stated belief that the consumer protections are unconstitutional means the executive branch will stop enforcing them. He pointed to at least one outstanding case: HHS’ so-far delayed decision over Idaho’s request to offer exchange plans that don’t comply with the Obamacare requirements. The state is in discussions with the department over its proposal, with a decision expected later this month. Other states, including North Dakota, are watching how HHS responds before proposing their own coverage mandate changes.
For Jost, that leads to more complications for such major issues as setting tax credits that subsidize coverage for people with lower incomes.
“Once you start to invalidate those provisions, the problem is how does the rest of the statute work?” Jost said. “How do you set tax credits if everyone has different rate based on status?”
Gluck said, however, that the Justice Department brief shouldn’t affect HHS’ action.
“The guaranteed issue and community rating provisions are the law of the land until a court or Congress says otherwise,” Gluck said. “And in fact it was Congress that left those provisions on the books. For HHS to try to undermine those provisions before a court rules, which I wouldn’t expect it to do, would be unconstitutional sabotage.”
The case is being heard in a north Texas federal court by U.S. District Judge Reed O’Connor, who was appointed by President George W. Bush. Historically, O’Connor has been an outspoken opponent of Obamacare and observers expect him to skew in favor of the plaintiffs.
If O’Connor rules in Republicans’ favor, the case could move forward to the 5th U.S. Circuit Court of Appeals. Adler predicted the appellate judges won’t accept the merits of the plaintiffs’ case and that the litigation will end there rather than heading to the Supreme Court.
But Larkin, who has not yet studied the Justice Department’s severability argument, said he believes the case will get to the Supreme Court.
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