Search This Blog

Friday, July 6, 2018

Candidate AIDS vaccine passes key early test


 The near 40-year quest for an AIDS vaccine received a hopeful boost Saturday when scientists announced that a trial drug triggered an immune response in humans and shielded monkeys from infection.
Shown to be safe in humans, the candidate vaccine has now advanced to the next phase of the pre-approval trial process, and will be tested in 2,600 women in southern Africa to see whether it prevents HIV infection.
While the results so far have been encouraging, the research team and outside experts warn there are no guarantees it will actually work in the next trial phase dubbed HVTN705 or “Imbokodo” — the isiZulu word for “rock”.
“Although these data are promising, we need to remain cautious,” study leader Dan Barouch, a Harvard Medical School professor, told AFP.
Just because it protected two-thirds of monkeys in a lab trial doesn’t mean the drug will protect humans, “and thus we need to await the results of the… study before we know whether or not this vaccine will protect humans against HIV infection,” he said.
The results of the Imbokodo trial are expected in 2021/22.
“This is only the fifth HIV vaccine concept that will be tested for efficacy in humans in the 35+ year history of the global HIV epidemic,” added Barouch.
Only one so far, RV144, yielded some protection. RV144 was reported in 2009 to reduce the risk of HIV infection among 16,000 Thai volunteers by 31.2 percent — deemed insufficient for the drug to be pursued.
For the latest study, published in The Lancet medical journal, Barouch and a team tested the candidate drug on 393 healthy, HIV-free adults aged 18 to 50 in east Africa, South Africa, Thailand, and the United States.
The participants were randomly given one of seven vaccine combinations or a placebo “dummy” alternative. They received four shots each over 48 weeks.
– Needed ‘badly’ –
The study used so-called “mosaic” vaccine combinations.
These combine pieces of different HIV virus types to elicit an immune response — when the body attacks intruder germs — against virus strains from different regions of the world.
The vaccine “induced robust (high levels of) immune responses in humans,” said Barouch.
The tests also showed the vaccine was safe. Five participants reported side-effects such as stomach pain and diarrhoea, dizziness, or back pain.
In a separate study, the same vaccine offered complete protection from infection in two-thirds of 72 trial monkeys each given six injections with an HIV-like virus.
“I cannot emphasise how badly we need to have a vaccine… to get rid of HIV in the next generation altogether,” said Francois Venter of the University of the Witwatersrand Reproductive Health and HIV Institute in South Africa.
Approached for comment on the study, which he was not involved in, Venter urged caution.
“We have been here before, with promising candidate vaccines that haven’t panned out,” he told AFP.
“This one is novel in many ways so it is exciting, but we have a long way to go.”
– Could be ‘phenomenal’ –
Jean-Daniel Lelievre of France’s Vaccine Research Institute said the vaccine was likely not the “definitive” version, but may represent “a phenomenal advance.”
An estimated 37 million people live with HIV/AIDS, according to the World Health Organization.
There are about 1.8 million new infections and a million deaths every year.
Almost 80 million people are estimated to have been infected since the virus was first diagnosed in the early 1980s.
About 35 million have died.
A vaccine has proven elusive as the human immunodeficiency virus (HIV) mutates easily and can hide away in cells, evading the immune system, only to reemerge and spread years later.
For now, people infected with HIV rely on lifelong virus-suppressing anti-retroviral treatment (ART) to stay healthy.
Condoms are still at the frontline of efforts to prevent infection — mainly through sex and blood contact — though more and more people use ART as prophylaxis.
The latest results come ahead of the International Aids Conference to be held in Amsterdam from July 23 to 27.

Cancer diagnosis tied to increased risk of diabetes


People who get diagnosed with cancer may be more likely to develop diabetes, a Korean study suggests.
The study included 524,089 men and women, ages 20 to 70, who didn’t have cancer or diabetes at the start. By the time half the participants had been in the study for at least seven years, 15,130 people had developed cancer and 26,610 had developed diabetes.
Cancer patients were 35 percent more likely to develop diabetes than people without malignancies, the study found. The excess diabetes associated with tumors persisted even after accounting for other diabetes risk factors like obesity, smoking and drinking.
“The reasons why patients with cancer may be at increased risk of diabetes are unclear,” said senior study author Juhee Cho of Sungkyunkwan University in Seoul, South Korea.
In some cases, the cancer itself or treatments used to eradicate tumors might cause diabetes, Cho said by email.
Also, Cho said, “cancer is a highly stressful experience, associated with multiple high-stress episodes such as infections, bleeding episodes, and surgery, that may also increase the risk of diabetes.”
Worldwide, about one in 10 adults have diabetes.
Most have type 2 diabetes, which is associated with obesity and aging and happens when the pancreas can’t properly use or make enough of the hormone insulin to convert blood sugar into energy. Left untreated, diabetes can lead to nerve damage, amputations, blindness, heart disease and strokes.
In the current study, the risk of diabetes varied by cancer type.
With pancreatic cancer, the increased risk of diabetes was more than five-fold, while it was roughly doubled for liver and kidney malignancies.
Gallbladder and lung tumors were associated with at least a 70 percent greater risk of diabetes. Breast, thyroid and stomach malignancies were also tied to an increased risk of diabetes.
Time also played a role, with a 47 percent greater risk of diabetes in the first year or two after a cancer diagnosis. Six to ten years after the cancer diagnosis, the increased diabetes risk was 19 percent.
The study wasn’t a controlled experiment designed to prove whether or how cancer itself or tumor treatments might directly cause diabetes. It’s also possible that some people in the study had undiagnosed diabetes before they developed cancer, researchers note in JAMA Oncology.
“A significant number of people are living with diabetes, but do not know about it as they have no symptoms,” said Tahseen Chowdhury, a researcher at Royal London Hospital in the U.K. who wasn’t involved in the study.
Even so, the findings add to a growing body of evidence linking cancer to diabetes, Chowdhury said by email.
“Cancer therapies such as steroids, and many chemotherapy and radiotherapy regimes can increase glucose (or blood sugar) levels,” Chowdhury said. “This may in part explain the link.”
“A further important factor might be that many of these patients are being seen (by doctors) frequently and having lots of blood tests, which might mean their diabetes is picked up quicker than people who do not have lots of blood tests,” Chowdhury added.
SOURCE: bit.ly/2uagWsI JAMA Oncology, online June 7, 2018.

Predictive Modeling Highlights Value of Late-Life Healthcare Spending


End-of-life healthcare spending in the United States may not be the low-hanging fruit it’s often thought to be, according to a predictive modeling study recently published in Science.
As it turns out, death is “highly unpredictable,” and less than 5% of spending is accounted for by individuals with predicted mortality above 50%.
The findings offer new insight into the oft-quoted statistic that 25% of Medicare spending occurs in the last year of life, a fact seized upon by those looking for ways to eliminate waste and lower healthcare spending.
“I think we need to be more careful in drawing the distinction between a fact and its implications,” said economist Amy Finkelstein, PhD, from the National Bureau of Economic Research and Massachusetts Institute of Technology, both in Cambridge, Massachusetts.
“That one quarter of all Medicare spending occurs in the last 12 months of life is correct, but the implication that is commonly drawn from that —  that clearly this money is waste —  is incorrect because it presumes implicitly that at the time we are spending the money, we know with high probability that the recipient of the spending is going to die.”
Finkelstein and colleagues used Medicare claims data from a random sample of 20% of enrollees to build a machine-learning model of annual mortality risk. Machine learning extends traditional regression analysis to account for not just the independent effect of multiple variables but also for the interaction effect of multiple variables.
Their main analysis focused on enrollees alive on January 1, 2008, while a second analysis focused on the moment of admission to the hospital, “which is a more decision-relevant vantage because you’re admitting someone and you have to diagnose them and start spending a lot of money,” Finkelstein said.
Even from the vantage point of admission to hospital, where annual mortality was about 20%, the 95th percentile of annual death probabilities was still only 67%, and less than 4% of those who ended up dying in the subsequent year had a predicted mortality above 80% at the time of admission.
“What the study shows is that it’s not correct to look at people who died and compute their spending, but rather you need to look at people who are at high predicted risk of death and see how much spending happened on them and whether it affected outcomes,” Anupam Bapu Jena, MD, PhD, the Ruth L Newhouse associate professor of health care policy at Harvard Medical School, Boston, Massachusetts, told theheart.org | Medscape Cardiology. Jena was not involved in the study.
“You also need to ask how often it is that we really know a person is at death’s door, where a lot of money is spent. It turns out that the proportion of healthcare spending going to those people, where we might think spending is wasteful, is really low,” he explained.
“We have to recognize that our ability to predict isn’t that good, so even if there’s a 10% chance we could be wrong, that means that 1 out of 10 patients you see in the ICU [intensive care unit] and think isn’t going to make it and where you recommend to the family that they withdraw care, could have made it. For some doctors, that kind of error could occur once a week,” said Jena, who is also a hospitalist at Massachusetts General Hospital in Boston.
“Maybe 90% sounds good, but it’s not for a life-or-death situation.”

What Works and for Whom?

Rather than focusing on impressive-sounding statistics and rough averages, “we need to roll up our sleeves and do the hard work,” said Finkelstein.
“It would be easier if there was some global solution like cutting end-of-life spending, but it turns out it’s not so easy as to just say we’re spending a lot of money on people who die and maybe we should stop,” she said. “But rather, we actually need to do the important and challenging work that is, in essence, the work of health economists and medical researchers, of looking policy by policy and medical intervention by medical intervention at what kind of spending is actually generating value, saving lives, and improving quality of life, and what is not.”
To Jena, a follow-on trial to this study might be one that either randomly assigns patients — “which might be difficult for a variety of reasons” — or quasi-randomly assigns different individuals to different hospitals that vary in terms of intensity of the care they provide.
“Then you can stratify the analysis by these various risk groups that these researchers and others have studied and see what happens to patients who happen to be treated in a hospital or healthcare system that tends to be more intensive compared to one that is less intensive,” he said.
Jena added, however, that just looking at hospital care is “a bit of a red herring” because the costs explored in this analysis and reflected in the 25%-of-spending-in-the-last-year-of-life statistic represent both “inpatient and outpatient care, multiple hospitalizations and consultant visits, imaging, et cetera. So it would really be best to look at people exposed to two different healthcare systems that vary in their care intensity.”
Finkelstein and Jena declared no conflicts of interest related to this study.  
Science. 2018;360:1462-1465. Abstract

Marijuana odor seeps into Mojave towns as area becomes pot-growing mecca


Along a dusty dirt road in this Mojave Desert outpost 20 miles east of Barstow, U.S. postal worker Jessica Garcia stopped at the few houses dotting Morgan Lane and unloaded packages from the back of her 4-wheel-drive Jeep Wrangler.
On this day, the pungent odor of marijuana was not wafting in the air, at least not on Morgan Lane. But it certainly was elsewhere — at the all-too-familiar marijuana compounds with padlocked front gates and pot grows concealed by chain-link and plywood fencing and black or green mesh fabric screening.
“I have been working for the post office for a year now. Driving the route, you smell it while you’re driving by,” said Garcia, 39, delivering mail at a home that just a week before had been raided by San Bernardino County sheriff’s deputies. More than 1,000 pot plants and 16 pounds of processed marijuana were seized from the residence. Four people were arrested.
Although California law now allows the use of both recreational and medical marijuana, cultivation and sales of the drug can be strictly regulated by cities and counties. And in San Bernardino County, marijuana cultivation for commercial purposes is prohibited.
In the past five years, the San Bernardino County Sheriff’s Department’s Marijuana Enforcement Team has seized nearly half a million marijuana plants and nearly 17,000 pounds of processed marijuana from across the High Desert region, mostly in the areas of Newberry Springs, Phelan and Lucerne Valley — all pot-growing meccas for people seeking fortune in the booming industry.
“The High Desert area is definitely our busiest area for marijuana grows. They are spread throughout the county, but the highest concentration is the High Desert,” said Sgt. Rich Debevec, who heads the Marijuana Enforcement Team.
Remote location ideal for illegal pot farms
Since 2012, marijuana cultivation has ramped up in Newberry Springs, an alfalfa and pistachio farming community off Highway 40 known for the Bagdad Cafe, of the cult classic German film namesake. Debevec said the community’s remote location and cheap property make it ideal for illegal pot growing.
“They hear you can go to Newberry Springs and live and make some money,” Debevec said. “When you’re going to grow that many marijuana plants, it’s pretty easily detected, so the farther out, the better for them.”
Many locals appear indifferent to the increasing number of marijuana farms popping up in their community and are becoming immune to the presence of law enforcement, which shows up for raids in SUVs, pickups with trailers hitched behind and, sometimes, helicopters hovering overhead.
“They come in caravans,” said Bagdad Cafe employee Michael Wright, a 42-year resident of Newberry Springs. He said there is no escaping the strong odor of fresh-cut marijuana piled in trailers as law enforcement hauls it away for destruction after a raid.
“You can smell it as they drive by. Some of it’s flying out the top,” Wright said. Locals, he said, often scavenge for any trace of marijuana left behind at the raided properties.
In Phelan, about 16 miles west of Hesperia, a sheriff’s MET raid on June 21 netted more than 3,100 plants from four domed greenhouses, an outbuilding and an outdoor garden at a home on Pacific Road and 932 pounds of processed marijuana from three residences. Fifteen people were arrested by MET deputies assisted by the California National Guard Counterdrug Task Force.
Chinese immigrants arrested
Many of the growers arrested in recent years have been Chinese nationals, raising questions about why they are here, how they are recruited and who is financing their operations. During the raid in Phelan, deputies arrested Zhixue Fan, a 62-year-old Chinese citizen; Guoxo Yang, 48, of San Gabriel; and Jia Zhi Shi, 39, a Canadian citizen.
From August 2015 to June 6, sheriff’s deputies arrested dozens of Chinese immigrants during raids in Newberry Springs, where hundreds of pounds of processed marijuana were being packaged and shipped out across the country, mainly to the East Coast. Those arrested came from all over California and the rest of the country — Tennessee, Las Vegas, Porterville, Fresno and New York, among other cities.
Debevec could not say whether the growers are involved in a Chinese crime ring, but he has reached out to federal authorities. He would not elaborate.
In Northern California — Sacramento, Placer, Yolo and Yuba counties, specifically — Chinese marijuana cultivation operations at suburban homes have led to five indictments in the past five years and the seizure of more than 100 properties believed to have been purchased by a Chinese crime syndicate, court records show.
One indictment, filed in August 2017 in U.S. District Court in Sacramento, alleges that over a four-month period in 2016 one of 10 defendants received three wire transfers totaling $146,955 from China Construction Bank in Fujian, China. The money was used for down payments on homes to be used for marijuana cultivation.
“They were making large cash down payments on homes, usually 50 percent down, and the rest was financed by hard money lenders,” said Michael Anderson, supervising assistant U.S. attorney and head of the white collar crime division for the U.S. Department of Justice’sEastern District in Sacramento. “It’s a fairly interesting and direct link back to China. An unusual method of financing.”
Federal prosecutors allege that at least $6.3 million has been wired from Chinese banks to the U.S. in the past five years to purchase properties for commercial marijuana cultivation. Each wire transfer was for less than $50,000, the threshold at which financial institutions would have to report the transactions.
Human trafficking at play
Anderson said some of the Chinese nationals identified in the Northern California cases may have been working the marijuana grows to pay off a debt for their safe passage to the U.S.
“Indoor marijuana grows associated with criminal organizations raise significant concerns about human trafficking,” Anderson said. “Investigators pay particular attention to the individuals found at the grows, some of whom may be working to pay off debts to the criminal groups.”
The elusive culprits in all this are the “dragonheads” — those who fund and organize the marijuana growing operations, said Thomas Yu, a retired Los Angeles County sheriff’s detective who investigated Asian gangs for years. He said federal prosecutors have only scratched the surface, and to really make a dent they need to take down the ringleaders, or “dragonheads.”
“Those cases, for lack of a better word, they’re being prosecuted in a vacuum. They’re not prosecuting the guys who are the dragonheads at the top of the food chain,” Yu said.
He said the Chinese crime syndicates recruit skilled farmers from Fujian, China, to cultivate marijuana in the U.S., as well as electricians to bypass electricity needed to power the hydroponic equipment used for indoor cultivation. “They steal (electricity) from the power poles,” Yu said.
Unlike hard drugs such as cocaine and heroin, penalties for marijuana cultivation and distribution are particularly lenient in the U.S., especially in states like California, Washington and Colorado, where the drug is now legal for both medical and recreational use. Most offenders get off with probation and fines, which may be why Chinese crime syndicates are exploiting opportunities to cash in on the expanding and lucrative marijuana industry in the U.S., Yu said.
Debevec said another trend has emerged among marijuana growers in recent years that could explain the proliferation of pot farms in the High Desert: an exodus of growers from the San Bernardino Mountains, once a hot spot for large-scale marijuana cultivation.
“Our National Forest grows were huge. We’d get thousands of plants in a forest grow,” Debevec said. “That’s a federal crime and a 10-year mandatory minimum. They realize they can come down here into the valley and do it in smaller plots and face less charges if they get caught. It definitely wouldn’t be a federal charge, and, in a lot of cases it would be a misdemeanor.”
And so the marijuana growers continue flocking to the High Desert to harvest their crops, which has some, like Newberry Springs postal worker and resident Jessica Garcia, somewhat perturbed. She’s tired of the stink marijuana brings to her community, literally.
“I wish they’d go away,” she said.

Product review: The desk that’s also a bike


At Medical News Today, we are often asked to try out new and unusual health and fitness gizmos. We tend to turn the offers down, but this device piqued my interest.
It is now common knowledge that sitting still for hours every day is bad for our health.
But many of us work in office environments, where a sedentary position is necessary.
Standing desks have become quite common over recent years, but they don’t allow you much scope for physical exertion.
Therefore, when FlexiSpot contacted me to ask if I would like to trial their Deskcise Pro, I jumped at the chance.
In short, it’s a desk with pedals, which allows you to cycle while you work.
FlexiSpot Deskcise Pro
The FlexiSpot Deskcise Pro in all its glory.
I chose to give this particular product a go because it ticked a couple of vital boxes for me: one, I am a relatively keen cyclist; and two, it seemed like it might be amusing to get everyone in the office to have a go.
After all, watching someone furiously pump the pedals while trying to type is sure to raise a few chuckles.

Was it any good?

Before the desk arrived, I had some reservations; I couldn’t really see it working that well. My main concerns were that it would be too noisy in an office environment and that I wouldn’t be able to type as I bobbed up and down with each pedal push.
In both regards, I was pleasantly surprised. The bike is silent and, actually, typing while cycling is quite easy. Because of the range of adjustments to saddle height and desk position, it is easy to find a setting that works for you.
Over the course of a few days, I spent a few minutes to an hour testing the Deskcise Pro. However, I was careful not to work up a sweat; our office is relatively small, and I didn’t think that would be fair on my colleagues. That said, I could imagine that keeping my blood pumping and muscles working might benefit my health in the long run.
Overall, I enjoyed the experience, and I will continue to use it sporadically. However, I am but one man, so I asked my colleagues to try the contraption for themselves. Here’s what they had to say.
James, our senior editor, had the following to say:
“The FlexiSpot Deskcise Pro was surprisingly easy to use, and I soon found myself working, unconscious of the fact that I was cycling away!”
“Changing the settings was simple enough, and the desk component provided welcome wrist support.”
“My desk setup is quite busy, however, and it was tricky trying to fit everything onto the surface that the device offers.”
However, he goes on, “I would also recommend wearing cool, loose-fitting clothing when using the FlexiSpot Deskcise Pro; I got quite hot wearing jeans!”
The picture above demonstrates the rather complex desk setup that James needed to make up for the lack of desk space. It also shows his inappropriate cycling attire.
Surprisingly comfortable, the cycle desk helps to keep you focused and alert. It feels good to be moving while working rather than being slumped in a chair. It was also surprisingly easy to read and type documents while maintaining a rhythmic cycle.”
Copy editor Isy
She goes on, saying, “However, the wrist support was in the wrong place for me so hindered typing somewhat. There is also not much space on the desk for anything other than a laptop, so it would probably need to be an additional desk for someone, rather than their main place of work.”

Popular all round

The desk seemed to win over some members of the team who were, initially, resolutely against the idea. For instance, despite initial hesitations, news writer Maria seems to have been wooed by the desk.
She explains, “I am not a very physically active person, and I am most definitely not into cycling. However, I decided to give the Deskcise Pro a try and see how I would fare.”
“Although, as I said, I am not the sportiest of people, I often begin to feel fidgety at work, and I have especially restless legs, so I wondered if the desk could help me deal with that and increase my focus. And it did!”
“Cycling helps me keep my restless legs occupied and my mind free to deal with the business at hand.”
“I also appreciate,” she adds, “how customizable the desk is: it’s great that I can set it to fit my (very short) height, and I also appreciate that I can customize the pedaling resistance so that I can move at the pace that I’m most comfortable with.”
“The only problem is that I fear I may soon become addicted and start fighting my colleagues for it!”
News copy editor Jasmin was similarly impressed, saying, “When I first saw the bike, I was worried that the motion of my legs while cycling would make the desk wobble around, or that the wrist support would be positioned strangely and make typing awkward.”
“How wrong I was! I knew in my first few seconds of using the bike that I would become attached to it.”
“The seat is so comfortable, the pedals move so smoothly, and the desk is the perfect size — not to mention the super useful cup holder,” Jasmin adds. “When you’re sitting at a desk all day like we in this office are, using the bike is a welcome break from shoulder ache while still being able to carry on working when we’re crunched.”
“I’ve heard that exercise can boost concentration and productivity, and this bike is proof of that! When I use it, I’m crossing things off of my to-do list faster than ever before. To summarize: an excellent addition to the MNT office.”
So, despite initial reservations in some camps, the FlexiSpot Deskcise Pro is a hit with the folks at MNT — although it might be improved with a larger desk area and an adjustable wrist support.

Your dog’s flea meds might one day protect you from Zika


Each year, thousands of people suffer from malaria, the Zika virus, and other diseases transmitted by pests such as mosquitoes. However, humans may soon be in the clear, thanks to the drugs used to protect man’s best friend from fleas and ticks. In a new study, researchers found that fluralaner and afoxolaner, sold as Bravecto and Nexgard, respectively, effectively killed infectious mosquitoes and sand fleas when they consumed human blood laced with the compounds, according to Time. Through computer modeling, these researchers also found that if enough people took the drug, 97% of infections could be prevented in Zika-prone areas, and 70% of new malaria cases could be prevented in countries that experience seasonal malaria, they reported this week in the Proceedings of the National Academy of Sciences. To test these findings, researchers are already planning clinical trials in healthy human volunteers.

‘U.S. private citizen cites mystery illness symptoms after China visit’


A U.S. private citizen who visited China has reported symptoms like those of U.S. diplomats afflicted with a mysterious illness in Havana and Guangzhou, a U.S. State Department official said on Thursday.
The person, who was not named by the department official, is the first non-official American known to have experienced the symptoms following a trip to China. Nineteen private U.S. citizens have reported similar symptoms after traveling to Cuba.
Twenty-five U.S. officials in Havana and at least one working at the U.S. consulate in Guangzhou have been sent back to the United States after exhibiting symptoms consistent with a concussion or mild traumatic brain injury.
Many of them reported the mystery illness, whose cause is unknown, following an experience of abnormal sounds or pressure.
In a March 2 travel advisory, the State Department urged U.S. citizens to reconsider travel to Cuba, saying that “numerous U.S. Embassy Havana employees appear to have been targeted in specific attacks.”
“Affected individuals have exhibited a range of physical symptoms including ear complaints and hearing loss, dizziness, headaches, fatigue, cognitive issues, visual problems, and difficulty sleeping,” it added.
News of the illness suffered by U.S. officials in Cuba first came to light last August. Reports of the illness of the American working at the U.S. consulate in Guangzhou emerged in May.
“Since the release of the first (Guangzhou-related) Health Alert on May 23, the Department of State has been contacted by one U.S. citizen who reported experiencing similar symptoms following travel to China,” said an official with the State Department’s Bureau of Consular Affairs.
Asked if the State Department had any information suggesting that the private citizens were affected by the same “attacks” as those on U.S. officials in Cuba, the official replied: “This is an evolving situation. As we state in our health alert, if you have concerns about any symptoms or medical problems, consult a medical professional as soon as possible.”
Cuban officials have denied any involvement or knowledge of what was behind the illnesses in Havana. China has said that it thoroughly investigated the initial case reported by the United States in Guangzhou and found no reasons or clues to explain it.