News

Switching continuous positive airway pressure–treated patients to autotitrating positive airway pressure (APAP) systems resulted in reduced severity of patient-reported aerophagia symptoms, according to results from a double-blind, randomized study.

Aerophagia, the swallowing of air leading to gastrointestinal distress, is a frequently reported adverse effect among people treated for obstructive sleep apnea with continuous positive airway pressure (CPAP).

The APAP-treated group saw significantly reduced median therapeutic pressure levels compared with the CPAP-treated patients (9.8 vs. 14.0 cm H₂O, P less than .001) and slight but statistically significant reductions in self-reported symptoms of bloating, flatulence, and belching. No significant difference was seen in compliance with therapy between the two treatment groups in this study, published in the August 2017 issue of Journal of Clinical Sleep Medicine (J Clin Sleep Med. 2017;13[7]:881-8).

For their research, Teresa Shirlaw and her colleagues in the sleep clinic at Princess Alexandra Hospital in Woolloongabba, Queensland, Australia, analyzed results from 56 adult patients with sleep apnea who had been recently treated with CPAP and reported bloating, flatulence, or belching following therapy.

Patients were randomized 1:1 to in-clinic nighttime CPAP or APAP for 2 weeks and blinded to treatment assignment, while investigators recorded therapy usage hours, pressure, leak, and residual apnea-hypopnea index across the study period. Most of the subjects (n = 39) used full face masks, while others used nasal-only systems.

The researchers considered differences in PAP therapy usage of at least 30 minutes per night to be statistically significant. The APAP group used the assigned therapy a mean 7 hours per night, vs. 6.8 for the CPAP group. Daytime sleepiness outcomes were also similar for the two treatment groups.

Ms. Shirlaw and her colleagues described the compliance findings as a surprise, noting that an earlier meta-analysis had shown slight improvements in compliance associated with APAP (Syst Rev. 2012;1[1]:20). In clinical practice, patients complaining of aerophagia associated with CPAP are frequently switched to APAP based on the belief that doing so “will lead to improved therapy acceptance and … improved compliance,” they wrote.

The investigators described the self-reporting of aerophagia symptoms as one of the study’s limitations. They surmised that the lack of difference seen for compliance measures might be explained in part by the 30-minute usage increments in the study design (compared with 10-minute increments used in some other studies), and the fact that the cohort had relatively high compliance with CPAP at baseline (5.5 hours/night), suggesting a motivated patient population at entry.

The study received some funding from the government of Queensland, and the authors disclosed no conflicts of interest related to their findings.

Switching continuous positive airway pressure–treated patients to autotitrating positive airway pressure (APAP) systems resulted in reduced severity of patient-reported aerophagia symptoms, according to results from a double-blind, randomized study.

Aerophagia, the swallowing of air leading to gastrointestinal distress, is a frequently reported adverse effect among people treated for obstructive sleep apnea with continuous positive airway pressure (CPAP).

The APAP-treated group saw significantly reduced median therapeutic pressure levels compared with the CPAP-treated patients (9.8 vs. 14.0 cm H₂O, P less than .001) and slight but statistically significant reductions in self-reported symptoms of bloating, flatulence, and belching. No significant difference was seen in compliance with therapy between the two treatment groups in this study, published in the August 2017 issue of Journal of Clinical Sleep Medicine (J Clin Sleep Med. 2017;13[7]:881-8).

For their research, Teresa Shirlaw and her colleagues in the sleep clinic at Princess Alexandra Hospital in Woolloongabba, Queensland, Australia, analyzed results from 56 adult patients with sleep apnea who had been recently treated with CPAP and reported bloating, flatulence, or belching following therapy.

Patients were randomized 1:1 to in-clinic nighttime CPAP or APAP for 2 weeks and blinded to treatment assignment, while investigators recorded therapy usage hours, pressure, leak, and residual apnea-hypopnea index across the study period. Most of the subjects (n = 39) used full face masks, while others used nasal-only systems.

The researchers considered differences in PAP therapy usage of at least 30 minutes per night to be statistically significant. The APAP group used the assigned therapy a mean 7 hours per night, vs. 6.8 for the CPAP group. Daytime sleepiness outcomes were also similar for the two treatment groups.

Ms. Shirlaw and her colleagues described the compliance findings as a surprise, noting that an earlier meta-analysis had shown slight improvements in compliance associated with APAP (Syst Rev. 2012;1[1]:20). In clinical practice, patients complaining of aerophagia associated with CPAP are frequently switched to APAP based on the belief that doing so “will lead to improved therapy acceptance and … improved compliance,” they wrote.

The investigators described the self-reporting of aerophagia symptoms as one of the study’s limitations. They surmised that the lack of difference seen for compliance measures might be explained in part by the 30-minute usage increments in the study design (compared with 10-minute increments used in some other studies), and the fact that the cohort had relatively high compliance with CPAP at baseline (5.5 hours/night), suggesting a motivated patient population at entry.

The study received some funding from the government of Queensland, and the authors disclosed no conflicts of interest related to their findings.

Switching continuous positive airway pressure–treated patients to autotitrating positive airway pressure (APAP) systems resulted in reduced severity of patient-reported aerophagia symptoms, according to results from a double-blind, randomized study.

Aerophagia, the swallowing of air leading to gastrointestinal distress, is a frequently reported adverse effect among people treated for obstructive sleep apnea with continuous positive airway pressure (CPAP).

The APAP-treated group saw significantly reduced median therapeutic pressure levels compared with the CPAP-treated patients (9.8 vs. 14.0 cm H₂O, P less than .001) and slight but statistically significant reductions in self-reported symptoms of bloating, flatulence, and belching. No significant difference was seen in compliance with therapy between the two treatment groups in this study, published in the August 2017 issue of Journal of Clinical Sleep Medicine (J Clin Sleep Med. 2017;13[7]:881-8).

For their research, Teresa Shirlaw and her colleagues in the sleep clinic at Princess Alexandra Hospital in Woolloongabba, Queensland, Australia, analyzed results from 56 adult patients with sleep apnea who had been recently treated with CPAP and reported bloating, flatulence, or belching following therapy.

Patients were randomized 1:1 to in-clinic nighttime CPAP or APAP for 2 weeks and blinded to treatment assignment, while investigators recorded therapy usage hours, pressure, leak, and residual apnea-hypopnea index across the study period. Most of the subjects (n = 39) used full face masks, while others used nasal-only systems.

The researchers considered differences in PAP therapy usage of at least 30 minutes per night to be statistically significant. The APAP group used the assigned therapy a mean 7 hours per night, vs. 6.8 for the CPAP group. Daytime sleepiness outcomes were also similar for the two treatment groups.

Ms. Shirlaw and her colleagues described the compliance findings as a surprise, noting that an earlier meta-analysis had shown slight improvements in compliance associated with APAP (Syst Rev. 2012;1[1]:20). In clinical practice, patients complaining of aerophagia associated with CPAP are frequently switched to APAP based on the belief that doing so “will lead to improved therapy acceptance and … improved compliance,” they wrote.

The investigators described the self-reporting of aerophagia symptoms as one of the study’s limitations. They surmised that the lack of difference seen for compliance measures might be explained in part by the 30-minute usage increments in the study design (compared with 10-minute increments used in some other studies), and the fact that the cohort had relatively high compliance with CPAP at baseline (5.5 hours/night), suggesting a motivated patient population at entry.

The study received some funding from the government of Queensland, and the authors disclosed no conflicts of interest related to their findings.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

DENVER – Can e-cigarettes help smokers quit?

“So far, the evidence regarding e-cigarettes’ effectiveness for smoking cessation is equivocal at best,” Alison Breland, PhD, said at the annual meeting of the Teratology Society.

But Dr. Breland noted that there is significant controversy around this topic. “I can tell you that, at the conferences I go to, where there are lots of people studying nicotine and tobacco, scientists are fighting with each other over this question,” said Dr. Breland, a psychologist and project director at the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond.

mauro grigollo/Thinkstock

How e-cigarettes work

What are e-cigarettes? They are basically nicotine delivery devices. They use electricity to power a heating element that aerosolizes a liquid containing varying concentrations of nicotine; solvents, such as propylene glycol and vegetable glycerins; and flavorants. As a class, e-cigarettes are rapidly evolving. A vast array of devices are marketed with wide differences in design, materials, construction, amount of nicotine delivered, and electrical power – which, along with puff duration, is a key factor in how much nicotine gets into a user’s blood.

“Most of the devices have a battery, but it’s important to know that some of them can be plugged directly into a USB port on a computer,” Dr. Breland said.

E-cigarettes don’t generate a vapor, as is widely believed. It’s an aerosol, and it contains toxic byproducts. On the plus side, unlike combustible cigarettes, e-cigarettes don’t deliver carbon monoxide.

A vast array of flavorant mixtures are sold, including some that are clearly designed to be attractive to children, with names like “blue cotton candy” and “Apple Jacks.”
 

User demographics

Who is using e-cigarettes? Primarily adolescents and young adults in prime reproductive age. National surveys indicate e-cigarettes are now the most widely used tobacco product among U.S. high school students, well ahead of combustible cigarettes.

Of particular concern, data from the Centers for Disease Control and Prevention’s National Health Interview Survey indicate that, among 18- to 24-year-olds who use e-cigarettes, about 40% also currently use conventional cigarettes, about 20% are former cigarette smokers, and about 40% are never smokers – that is, have never smoked combustible cigarettes (MMWR Morb Mortal Wkly Rep. 2016;65:1177. doi: 10.15585/mmwr.mm6542a7).

“We don’t know what’s going to happen to these never smokers who are currently using e-cigarettes. Are they starting on a lifetime of nicotine dependence via e-cigarettes, or perhaps even worse, are they going to transition to combustible cigarettes? There’s more and more evidence showing that’s happening,” Dr. Breland said.

The CDC survey also showed that 59% of adult users of e-cigarettes are what Dr. Breland called “dualies,” individuals who also smoke conventional cigarettes.

“That really diminishes any potential benefit of e-cigarettes,” she said.
 

Impact on pregnancy

What is known about the impact of e-cigarettes on pregnancy and birth outcomes? Almost nothing at this point. E-cigarettes deliver nicotine to the bloodstream, and nicotine is known to cause unwelcome, long-term changes in fetal brain development and in that of adolescents as well. The other aerosolized toxicants have not been well studied. A few small surveys conducted in obstetric practices indicate some pregnant women perceive e-cigarettes as posing only minor health risks and safer than combustible cigarettes. And some pregnant women are using e-cigarettes.

Regulation

One audience member asked what the point of allowing e-cigarettes is since, under a best-case scenario, their effectiveness as a smoking cessation tool is similar to a nicotine patch, and smokers already have access to the patch as well as nicotine gum.

Dr. Breland replied that the patch and gum deliver nicotine very slowly, so they are not as satisfying as smoking.

“The hope with e-cigarettes is that, since they get nicotine into your blood pretty fast – similar to a cigarette – they can more effectively suppress your withdrawal,” she said. “Whether or not that’s true isn’t known yet.”

The Food and Drug Administration has the authority to regulate e-cigarettes through several different mechanisms but, in late July 2017, announced a delay in issuing new regulations that would likely have removed many of the devices and flavorings from the marketplace.

Dr. Breland’s research is supported by the National Institute on Drug Abuse and the Food and Drug Administration. She reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

DENVER – Can e-cigarettes help smokers quit?

“So far, the evidence regarding e-cigarettes’ effectiveness for smoking cessation is equivocal at best,” Alison Breland, PhD, said at the annual meeting of the Teratology Society.

But Dr. Breland noted that there is significant controversy around this topic. “I can tell you that, at the conferences I go to, where there are lots of people studying nicotine and tobacco, scientists are fighting with each other over this question,” said Dr. Breland, a psychologist and project director at the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond.

mauro grigollo/Thinkstock

How e-cigarettes work

What are e-cigarettes? They are basically nicotine delivery devices. They use electricity to power a heating element that aerosolizes a liquid containing varying concentrations of nicotine; solvents, such as propylene glycol and vegetable glycerins; and flavorants. As a class, e-cigarettes are rapidly evolving. A vast array of devices are marketed with wide differences in design, materials, construction, amount of nicotine delivered, and electrical power – which, along with puff duration, is a key factor in how much nicotine gets into a user’s blood.

“Most of the devices have a battery, but it’s important to know that some of them can be plugged directly into a USB port on a computer,” Dr. Breland said.

E-cigarettes don’t generate a vapor, as is widely believed. It’s an aerosol, and it contains toxic byproducts. On the plus side, unlike combustible cigarettes, e-cigarettes don’t deliver carbon monoxide.

A vast array of flavorant mixtures are sold, including some that are clearly designed to be attractive to children, with names like “blue cotton candy” and “Apple Jacks.”
 

User demographics

Who is using e-cigarettes? Primarily adolescents and young adults in prime reproductive age. National surveys indicate e-cigarettes are now the most widely used tobacco product among U.S. high school students, well ahead of combustible cigarettes.

Of particular concern, data from the Centers for Disease Control and Prevention’s National Health Interview Survey indicate that, among 18- to 24-year-olds who use e-cigarettes, about 40% also currently use conventional cigarettes, about 20% are former cigarette smokers, and about 40% are never smokers – that is, have never smoked combustible cigarettes (MMWR Morb Mortal Wkly Rep. 2016;65:1177. doi: 10.15585/mmwr.mm6542a7).

“We don’t know what’s going to happen to these never smokers who are currently using e-cigarettes. Are they starting on a lifetime of nicotine dependence via e-cigarettes, or perhaps even worse, are they going to transition to combustible cigarettes? There’s more and more evidence showing that’s happening,” Dr. Breland said.

The CDC survey also showed that 59% of adult users of e-cigarettes are what Dr. Breland called “dualies,” individuals who also smoke conventional cigarettes.

“That really diminishes any potential benefit of e-cigarettes,” she said.
 

Impact on pregnancy

What is known about the impact of e-cigarettes on pregnancy and birth outcomes? Almost nothing at this point. E-cigarettes deliver nicotine to the bloodstream, and nicotine is known to cause unwelcome, long-term changes in fetal brain development and in that of adolescents as well. The other aerosolized toxicants have not been well studied. A few small surveys conducted in obstetric practices indicate some pregnant women perceive e-cigarettes as posing only minor health risks and safer than combustible cigarettes. And some pregnant women are using e-cigarettes.

Regulation

One audience member asked what the point of allowing e-cigarettes is since, under a best-case scenario, their effectiveness as a smoking cessation tool is similar to a nicotine patch, and smokers already have access to the patch as well as nicotine gum.

Dr. Breland replied that the patch and gum deliver nicotine very slowly, so they are not as satisfying as smoking.

“The hope with e-cigarettes is that, since they get nicotine into your blood pretty fast – similar to a cigarette – they can more effectively suppress your withdrawal,” she said. “Whether or not that’s true isn’t known yet.”

The Food and Drug Administration has the authority to regulate e-cigarettes through several different mechanisms but, in late July 2017, announced a delay in issuing new regulations that would likely have removed many of the devices and flavorings from the marketplace.

Dr. Breland’s research is supported by the National Institute on Drug Abuse and the Food and Drug Administration. She reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

DENVER – Can e-cigarettes help smokers quit?

“So far, the evidence regarding e-cigarettes’ effectiveness for smoking cessation is equivocal at best,” Alison Breland, PhD, said at the annual meeting of the Teratology Society.

But Dr. Breland noted that there is significant controversy around this topic. “I can tell you that, at the conferences I go to, where there are lots of people studying nicotine and tobacco, scientists are fighting with each other over this question,” said Dr. Breland, a psychologist and project director at the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond.

mauro grigollo/Thinkstock

How e-cigarettes work

What are e-cigarettes? They are basically nicotine delivery devices. They use electricity to power a heating element that aerosolizes a liquid containing varying concentrations of nicotine; solvents, such as propylene glycol and vegetable glycerins; and flavorants. As a class, e-cigarettes are rapidly evolving. A vast array of devices are marketed with wide differences in design, materials, construction, amount of nicotine delivered, and electrical power – which, along with puff duration, is a key factor in how much nicotine gets into a user’s blood.

“Most of the devices have a battery, but it’s important to know that some of them can be plugged directly into a USB port on a computer,” Dr. Breland said.

E-cigarettes don’t generate a vapor, as is widely believed. It’s an aerosol, and it contains toxic byproducts. On the plus side, unlike combustible cigarettes, e-cigarettes don’t deliver carbon monoxide.

A vast array of flavorant mixtures are sold, including some that are clearly designed to be attractive to children, with names like “blue cotton candy” and “Apple Jacks.”
 

User demographics

Who is using e-cigarettes? Primarily adolescents and young adults in prime reproductive age. National surveys indicate e-cigarettes are now the most widely used tobacco product among U.S. high school students, well ahead of combustible cigarettes.

Of particular concern, data from the Centers for Disease Control and Prevention’s National Health Interview Survey indicate that, among 18- to 24-year-olds who use e-cigarettes, about 40% also currently use conventional cigarettes, about 20% are former cigarette smokers, and about 40% are never smokers – that is, have never smoked combustible cigarettes (MMWR Morb Mortal Wkly Rep. 2016;65:1177. doi: 10.15585/mmwr.mm6542a7).

“We don’t know what’s going to happen to these never smokers who are currently using e-cigarettes. Are they starting on a lifetime of nicotine dependence via e-cigarettes, or perhaps even worse, are they going to transition to combustible cigarettes? There’s more and more evidence showing that’s happening,” Dr. Breland said.

The CDC survey also showed that 59% of adult users of e-cigarettes are what Dr. Breland called “dualies,” individuals who also smoke conventional cigarettes.

“That really diminishes any potential benefit of e-cigarettes,” she said.
 

Impact on pregnancy

What is known about the impact of e-cigarettes on pregnancy and birth outcomes? Almost nothing at this point. E-cigarettes deliver nicotine to the bloodstream, and nicotine is known to cause unwelcome, long-term changes in fetal brain development and in that of adolescents as well. The other aerosolized toxicants have not been well studied. A few small surveys conducted in obstetric practices indicate some pregnant women perceive e-cigarettes as posing only minor health risks and safer than combustible cigarettes. And some pregnant women are using e-cigarettes.

Regulation

One audience member asked what the point of allowing e-cigarettes is since, under a best-case scenario, their effectiveness as a smoking cessation tool is similar to a nicotine patch, and smokers already have access to the patch as well as nicotine gum.

Dr. Breland replied that the patch and gum deliver nicotine very slowly, so they are not as satisfying as smoking.

“The hope with e-cigarettes is that, since they get nicotine into your blood pretty fast – similar to a cigarette – they can more effectively suppress your withdrawal,” she said. “Whether or not that’s true isn’t known yet.”

The Food and Drug Administration has the authority to regulate e-cigarettes through several different mechanisms but, in late July 2017, announced a delay in issuing new regulations that would likely have removed many of the devices and flavorings from the marketplace.

Dr. Breland’s research is supported by the National Institute on Drug Abuse and the Food and Drug Administration. She reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

COLORADO SPRINGS – Significant variability exists between hospitals in Washington state in their rates of invasive mediastinal staging for lung cancer, Farhood Farjah, MD, reported at the annual meeting of the Western Thoracic Surgical Association.

“We found evidence of a fivefold variation in hospital-level rates of invasive mediastinal staging not explained by chance or case mix,” according to Dr. Farjah of the University of Washington, Seattle.

bjancin@frontlinemedcom.com

COLORADO SPRINGS – Significant variability exists between hospitals in Washington state in their rates of invasive mediastinal staging for lung cancer, Farhood Farjah, MD, reported at the annual meeting of the Western Thoracic Surgical Association.

“We found evidence of a fivefold variation in hospital-level rates of invasive mediastinal staging not explained by chance or case mix,” according to Dr. Farjah of the University of Washington, Seattle.

bjancin@frontlinemedcom.com

COLORADO SPRINGS – Significant variability exists between hospitals in Washington state in their rates of invasive mediastinal staging for lung cancer, Farhood Farjah, MD, reported at the annual meeting of the Western Thoracic Surgical Association.

“We found evidence of a fivefold variation in hospital-level rates of invasive mediastinal staging not explained by chance or case mix,” according to Dr. Farjah of the University of Washington, Seattle.

bjancin@frontlinemedcom.com

Solid organ transplant recipients contribute a disproportionate fraction of pediatric non-Hodgkin lymphoma (NHL) cases, especially diffuse large B-cell lymphoma cases (DLBCL), according to an analysis of data drawn from transplant and cancer registries.

Investigators calculated that the incidence of NHL for the pediatric transplant population was 257 times higher than the general population, after analysis from the U.S. transplant registry and 16 cancer registries from around the country between 1990 and 2012. The incidence of NHL for the pediatric transplant population was 306 cases per 100,000 person-years (95% CI, 271-344), compared to 1.19 cases per 100,000 person-years (95% CI, 1.12-1.27) in the general population. Furthermore, transplant recipients made up a much larger proportion of general population DLBCL cases (7.62%; 95% CI, 6.35%-8.88%).

In the general population, the most common subtypes were DLBCL (25% of cases), Burkitt lymphoma (24%), and precursor cell lymphoblastic lymphoma (20%). Among NHLs diagnosed in transplant recipients, 65% were DLBCL, and 9% were Burkitt lymphoma, whereas there were no cases of precursor cell lymphoblastic lymphoma, reported Elizabeth L. Yanik, PhD, of Washington University, St. Louis, and her associates (Cancer. 2017 Jul 31. doi: 10.1002/cncr.30923).

The increased risk of NHL and other cancers for organ transplant recipients is primarily the result of the immunosuppressant medications administered after transplantation, leading to an increased risk of infection-related cancers, the authors said.

“NHL cases are largely attributable to EBV [Epstein-Barr virus] infections that occur while recipients are immunosuppressed, as evidenced by the high prevalence of EBV detectable in NHL tumors and particularly in cases diagnosed during the heavily immunosuppressed period early after transplantation,” wrote Dr. Yanik and her colleagues. “Patients who experience a primary EBV infection after transplantation are particularly susceptible because transplant recipients have a higher NHL risk if they are seronegative for EBV before transplantation.”

Among those at risk, Dr. Yanik and fellow investigators found transplant patients younger than 5 years were the most susceptible to NHL, making up 19.79% of those diagnosed with DLBCL.

The proportion of NHL in solid organ transplant recipients within the entire pediatric NHL population has risen over time, from 1.66% of the NHL population during 1990-1994 to 3.73% during 2010-2012.

“This trend is driven by the rising prevalence of transplant recipients in the general population and not by increases in NHL risk among transplant recipients,” noted Dr. Yanik and her coauthors. “The proportion of NHL diagnoses attributable to transplant recipients has grown over time, and it is likely that this population will be an important source of pediatric NHL cases in the future.”

This study was partially funded by the National Cancer Institute. One coauthor reported being an employee at GRAIL Inc. No other relevant financial disclosures were reported.

ezimmerman@fronlinemedcom.com

On Twitter @eaztweets

Solid organ transplant recipients contribute a disproportionate fraction of pediatric non-Hodgkin lymphoma (NHL) cases, especially diffuse large B-cell lymphoma cases (DLBCL), according to an analysis of data drawn from transplant and cancer registries.

Investigators calculated that the incidence of NHL for the pediatric transplant population was 257 times higher than the general population, after analysis from the U.S. transplant registry and 16 cancer registries from around the country between 1990 and 2012. The incidence of NHL for the pediatric transplant population was 306 cases per 100,000 person-years (95% CI, 271-344), compared to 1.19 cases per 100,000 person-years (95% CI, 1.12-1.27) in the general population. Furthermore, transplant recipients made up a much larger proportion of general population DLBCL cases (7.62%; 95% CI, 6.35%-8.88%).

In the general population, the most common subtypes were DLBCL (25% of cases), Burkitt lymphoma (24%), and precursor cell lymphoblastic lymphoma (20%). Among NHLs diagnosed in transplant recipients, 65% were DLBCL, and 9% were Burkitt lymphoma, whereas there were no cases of precursor cell lymphoblastic lymphoma, reported Elizabeth L. Yanik, PhD, of Washington University, St. Louis, and her associates (Cancer. 2017 Jul 31. doi: 10.1002/cncr.30923).

The increased risk of NHL and other cancers for organ transplant recipients is primarily the result of the immunosuppressant medications administered after transplantation, leading to an increased risk of infection-related cancers, the authors said.

“NHL cases are largely attributable to EBV [Epstein-Barr virus] infections that occur while recipients are immunosuppressed, as evidenced by the high prevalence of EBV detectable in NHL tumors and particularly in cases diagnosed during the heavily immunosuppressed period early after transplantation,” wrote Dr. Yanik and her colleagues. “Patients who experience a primary EBV infection after transplantation are particularly susceptible because transplant recipients have a higher NHL risk if they are seronegative for EBV before transplantation.”

Among those at risk, Dr. Yanik and fellow investigators found transplant patients younger than 5 years were the most susceptible to NHL, making up 19.79% of those diagnosed with DLBCL.

The proportion of NHL in solid organ transplant recipients within the entire pediatric NHL population has risen over time, from 1.66% of the NHL population during 1990-1994 to 3.73% during 2010-2012.

“This trend is driven by the rising prevalence of transplant recipients in the general population and not by increases in NHL risk among transplant recipients,” noted Dr. Yanik and her coauthors. “The proportion of NHL diagnoses attributable to transplant recipients has grown over time, and it is likely that this population will be an important source of pediatric NHL cases in the future.”

This study was partially funded by the National Cancer Institute. One coauthor reported being an employee at GRAIL Inc. No other relevant financial disclosures were reported.

ezimmerman@fronlinemedcom.com

On Twitter @eaztweets

Solid organ transplant recipients contribute a disproportionate fraction of pediatric non-Hodgkin lymphoma (NHL) cases, especially diffuse large B-cell lymphoma cases (DLBCL), according to an analysis of data drawn from transplant and cancer registries.

Investigators calculated that the incidence of NHL for the pediatric transplant population was 257 times higher than the general population, after analysis from the U.S. transplant registry and 16 cancer registries from around the country between 1990 and 2012. The incidence of NHL for the pediatric transplant population was 306 cases per 100,000 person-years (95% CI, 271-344), compared to 1.19 cases per 100,000 person-years (95% CI, 1.12-1.27) in the general population. Furthermore, transplant recipients made up a much larger proportion of general population DLBCL cases (7.62%; 95% CI, 6.35%-8.88%).

In the general population, the most common subtypes were DLBCL (25% of cases), Burkitt lymphoma (24%), and precursor cell lymphoblastic lymphoma (20%). Among NHLs diagnosed in transplant recipients, 65% were DLBCL, and 9% were Burkitt lymphoma, whereas there were no cases of precursor cell lymphoblastic lymphoma, reported Elizabeth L. Yanik, PhD, of Washington University, St. Louis, and her associates (Cancer. 2017 Jul 31. doi: 10.1002/cncr.30923).

The increased risk of NHL and other cancers for organ transplant recipients is primarily the result of the immunosuppressant medications administered after transplantation, leading to an increased risk of infection-related cancers, the authors said.

“NHL cases are largely attributable to EBV [Epstein-Barr virus] infections that occur while recipients are immunosuppressed, as evidenced by the high prevalence of EBV detectable in NHL tumors and particularly in cases diagnosed during the heavily immunosuppressed period early after transplantation,” wrote Dr. Yanik and her colleagues. “Patients who experience a primary EBV infection after transplantation are particularly susceptible because transplant recipients have a higher NHL risk if they are seronegative for EBV before transplantation.”

Among those at risk, Dr. Yanik and fellow investigators found transplant patients younger than 5 years were the most susceptible to NHL, making up 19.79% of those diagnosed with DLBCL.

The proportion of NHL in solid organ transplant recipients within the entire pediatric NHL population has risen over time, from 1.66% of the NHL population during 1990-1994 to 3.73% during 2010-2012.

“This trend is driven by the rising prevalence of transplant recipients in the general population and not by increases in NHL risk among transplant recipients,” noted Dr. Yanik and her coauthors. “The proportion of NHL diagnoses attributable to transplant recipients has grown over time, and it is likely that this population will be an important source of pediatric NHL cases in the future.”

This study was partially funded by the National Cancer Institute. One coauthor reported being an employee at GRAIL Inc. No other relevant financial disclosures were reported.

ezimmerman@fronlinemedcom.com

On Twitter @eaztweets

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.