A new report by University of Sydney and Bond University scholars weighs the risks and benefits of a recent change to blood pressure guidelines in the US.
Recommendations from the American College of Cardiology and American Heart Association to lower thresholds defining hypertension and the treatment of higher risk patients are sparking debate, the report reveals.
The recommendations from American College of Cardiology and the American Heart Association are as follows:

• lowering the threshold for diagnosing hypertension in adults from 140/80 mmHg to 130/80 mmHg
• lowering the threshold for drug treatment of ‘high risk’ adults with hypertension who have existing CVD from 140/80 mmHg to 130/80 mmHg
• lowering the threshold for drug treatment of adults with a calculated 10-year CVD risk ≥10 percent, or otherwise high risk, for example, people with diabetes or renal disease, from 140/80 mmHg to 130/80 mmHg.

Changing the diagnostic and treatment thresholds for hypertension could put people at risk in three ways, say the University of Sydney and Bond University authors of the report.
“First, wider disease definitions mean more people are labelled as unwell, even if they have low risk of a disease,” said the report’s lead author, Dr Katy Bell of the University of Sydney. “Labelling a person as having hypertension increases their risk of anxiety and depression, as compared to the risk for people with the same blood pressure who aren’t labelled as hypertensive.
“Second, it means more people may experience serious adverse effects from treatments.
“Third, in countries without universal health coverage, such as the United States, people newly diagnosed with hypertension may face difficulties gaining insurance coverage for a ‘pre-existing’ condition.”
Report co-author, Bond University Professor Paul Glasziou said: “The ACC/AHA guideline follow an established pattern in the medical specialties, where disease definitions are more often widened than narrowed.
“Systolic blood pressure has poor reproducibility, with a 10mmHg standard deviation for repeat measurements between clinics,” he added.
“Since a large proportion of all adults have a ‘true’ systolic blood pressure near the threshold of 130 mm Hg, the inherent variability of blood pressure increases the potential that hypertension will be diagnosed.”
The report says 80 percent of people with newly diagnosed hypertension under the ACC/AHA guideline would get no expected benefit in terms of cardiovascular disease risk reduction by lowering their blood pressure. Eleven per cent would get a marginal benefit and nine per cent would get a larger benefit.
However, the 2017 ACC/AHA guideline would classify an additional 13.7 percent of all adults as having hypertension – 31 million additional people in the United States as having hypertension, and around 2.4 million additional Australians.
For the majority of these people, who are at low risk and not recommended for drug treatment (about 25 million), the authors say doctors should not label them as having hypertension.
“Doctors should continue to support healthy choices with regard to diet and physical activity regardless of whether a patient’s systolic blood pressure is above or below 130 mmHg,” said Bond University co-author, Professor Jenny Doust. “When there is a question of starting blood pressure medication, the risk of cardiovascular disease should be estimated using a reliable risk calculator and the potential benefits and harms discussed with the patient”.

University of Sydneyhttps://tinyurl.com/yb6benfj

Using light-emitting nanoparticles, Rutgers University-New Brunswick scientists have invented a highly effective method to detect tiny tumours and track their spread, potentially leading to earlier cancer detection and more precise treatment.
The technology could improve patient cure rates and survival times.
“We’ve always had this dream that we can track the progression of cancer in real time, and that’s what we’ve done here,” said Prabhas V. Moghe, a corresponding author of the study and distinguished professor of biomedical engineering and chemical and biochemical engineering at Rutgers-New Brunswick. “We’ve tracked the disease in its very incipient stages.”
The study shows that the new method is better than magnetic resonance imaging (MRI) and other cancer surveillance technologies. The research team included Rutgers’ flagship research institution (Rutgers University-New Brunswick) and its academic health centre (Rutgers Biomedical and Health Sciences, or RBHS).
“The Achilles’ heel of surgical management for cancer is the presence of micro metastases. This is also a problem for proper staging or treatment planning. The nanoprobes described in this paper will go a long way to solving these problems,” said Steven K. Libutti, director of Rutgers Cancer Institute of New Jersey. He is senior vice president of oncology services for RWJBarnabas Health and vice chancellor for cancer programmes for Rutgers Biomedical and Health Sciences.
The ability to spot early tumours that are starting to spread remains a major challenge in cancer diagnosis and treatment, as most imaging methods fail to detect small cancerous lesions. But the Rutgers study shows that tiny tumours in mice can be detected with the injection of nanoprobes, which are microscopic optical devices, that emit short-wave infrared light as they travel through the bloodstream – even tracking tiny tumours in multiple organs.
The nanoprobes were significantly faster than MRIs at detecting the minute spread of tiny lesions and tumours in the adrenal glands and bones in mice. That would likely translate to detection months earlier in people, potentially resulting in saved lives, said Vidya Ganapathy, a corresponding author and assistant research professor in the Department of Biomedical Engineering.
“Cancer cells can lodge in different niches in the body, and the probe follows the spreading cells wherever they go,” she said. “You can treat the tumours intelligently because now you know the address of the cancer.”
The technology could be used to detect and track the 100-plus types of cancer, and could be available within five years, Moghe said. Real-time surveillance of lesions in multiple organs should lead to more accurate pre- and post-therapy monitoring of cancer.
“You can potentially determine the stage of the cancer and then figure out what’s the right approach for a particular patient,” he said.
In the future, nanoprobes could be used in any surgeries to mark tissues that surgeons want to remove, the researchers said. The probes could also be used to track the effectiveness of immunotherapy, which includes stimulating the immune system to fight cancer cells.
Rutgers Universityhttps://tinyurl.com/yblku22y

Although the problem of whether foetuses are able to feel pain or not is still controversial, experts at the University Hospital Virgen del Rocío in Seville have recently published a study in which they confirm that from the second trimester of pregnancy, the future baby already shows signs of pain when given a harmful stimulus or as a response to stress. In response to this confirmation, the researchers indicate the need to anaesthetise the foetus during open foetal surgery, OFS.
There is a school of thought that believes that in the case of foetal interventions, it is sufficient to administer anaesthesia to the mother as this passes through the foetus through the umbilical cord. Now, the experts have shown that this might not be sufficient and that from 21 weeks, the foetus can feel pain, so it also needs to be anaesthetised.
"At the Hospital Virgen del Rocío, we have spent a decade doing open foetal surgery. In 2007, we did the first intrauterine spina bifida operation in Europe, and in only one case was the foetus unable to receive intravenously administered anaesthesia from the start of the operation. It was at that moment that our monitoring teams detected anomalies in the behaviour of the foetus, which led us to believe that this was effectively a reaction to the stress caused by the pain. We quickly put in place the anaesthesia protocol and the spinal reconstruction was possible and the post-op period passed without any problems", explains Doctor Javier Márquez Rivas, Heat of the Infant Neurosurgery Unit and the Neurosurgery Service at the hospital.
For her part, Doctor María J. Mayorga Buiza, paediatric anaesthetist and first signatory of the article, adds that one of the key aspects of anaesthesia in open foetal surgery is to help uterine relaxation, to keep foetal circulation stable and, once surgery is complete, to offer adequate management of the patient to avoid contractions among other complications, which helps to reduce the incidence of premature birth in these cases.
Open foetal surgery (OFS) is still a serious procedure for the mother and the foetus. In such cases, anaesthesia given directly to the foetus can be provided by different means, but in the opinion of these experts, direct administration is "obligatory" for reduce foetal stress and also release the incidence of foetal mortality.
Even though current models do not prove the perception of foetal pain before the third trimester and there is little evidence of the effectiveness of direct foetal analgesic and anaesthetic techniques, it is a confirmed fact that foetal mortality is higher than 20% in the case of non-anaesthetised foetuses. This rate drops to 0% in operations carried out until now at the University Hospital Virgen del Rocío in Seville.
"The response of foetal stress to harmful stimulation that our monitoring teams observed in this case, does not completely prove that the foetus can feel pain. However, it is very improbable that there can be a perception of pain without a response to stress, and so these signals are often used as a substitute pain indicator", explains the University of Seville researcher and co-author of this study, The Applied Physics professor Emilio Gómez González.
University of Seville (in Spanish)comunicacion.us.es/centro-de-prensa/personal-docente-e-investigador/la-anestesia-disminuye-el-indice-de-mortalidad 

Losing an arm doesn’t have to mean losing all sense of touch, thanks to prosthetic arms that stimulate nerves with mild electrical feedback.
University of Illinois researchers have developed a control algorithm that regulates the current so a prosthetics user feels steady sensation, even when the electrodes begin to peel off or when sweat builds up.
“We’re giving sensation back to someone who’s lost their hand. The idea is that we no longer want the prosthetic hand to feel like a tool, we want it to feel like an extension of the body,” said Aadeel Akhtar, an M.D./Ph.D. student in the neuroscience program and the medical scholars program at the University of Illinois. Akhtar is the lead author of a paper describing the sensory control module, published in Science Robotics, and the founder and CEO of PSYONIC, a startup company that develops low-cost bionic arms.
“Commercial prosthetics don’t have good sensory feedback. This is a step toward getting reliable sensory feedback to users of prosthetics,” he said.
Prosthetic arms that offer nerve stimulation have sensors in the fingertips, so that when the user comes in contact with something, an electrical signal on the skin corresponds to the amount of pressure the arm exerts. For example, a light touch would generate a light sensation, but a hard push would have a stronger signal.
However, there have been many problems with giving users reliable feedback, said aerospace engineering professor Timothy Bretl, the principal investigator of the study. During ordinary wear over time, the electrodes connected to the skin can begin to peel off, causing a buildup of electrical current on the area that remains attached, which can give the user painful shocks. Alternately, sweat can impede the connection between the electrode and the skin, so that the user feels less or even no feedback at all.
“A steady, reliable sensory experience could significantly improve a prosthetic user’s quality of life,” Bretl said.
The controller monitors the feedback the patient is experiencing and automatically adjusts the current level so that the user feels steady feedback, even when sweating or when the electrodes are 75 percent peeled off.
The researchers tested the controller on two patient volunteers. They performed a test where the electrodes were progressively peeled back and found that the control module reduced the electrical current so that the users reported steady feedback without shocks. They also had the patients perform a series of everyday tasks that could cause loss of sensation due to sweat: climbing stairs, hammering a nail into a board and running on an elliptical machine.
“What we found is that when we didn’t use our controller, the users couldn’t feel the sensation anymore by the end of the activity. However, when we had the control algorithm on, after the activity they said they could still feel the sensation just fine,” Akhtar said.
Adding the controlled stimulation module would cost much less than the prosthetic itself, Akhtar said. "Although we don’t know yet the exact breakdown of costs, our goal is to have it be completely covered by insurance at no out-of-pocket costs to users."
The group is working on miniaturizing the module that provides the electrical feedback, so that it fits inside a prosthetic arm rather than attaching to the outside. They also plan to do more extensive patient testing with a larger group of participants.

University of Illinois Urbana-Champaignnews.illinois.edu/view/6367/643862

A drug already used to treat certain forms of cancer may also be an effective therapy for Huntington’s disease, according to a new study. The same study also increases our understanding of how this drug, and other medications like it, may offer hope for other neurodegenerative diseases like Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease.
Huntington’s disease is a devastating, inevitably fatal disease, with no medications that slow or stop disease progression. In this study, mice with the equivalent of Huntington’s disease became more mobile, recovered from neurodegeneration, and lived longer after being treated with bexarotene. The same research builds on a 2016 study where La Spada and his team showed that the drug KD3010 is an effective treatment for Huntington’s disease in mice and in human patient neurons made from stem cells.
Senior author Al La Spada, MD, PhD, said the study results are exciting not just because these drugs worked, but because of how they worked. “It’s not just the response from the drugs, but the mechanistic pathways these drugs are targeting,” said La Spada, director of the forthcoming Duke Center for Neurodegeneration and Neurotherapeutics. “These pathways are relevant to other neurodegenerative disorders and potentially the aging process, itself in addition to Huntington’s disease.”
Bexarotene and KD3010 function by activating PPARδ, a transcription factor that keeps neurons functional in two ways: by keeping mitochondria healthy and active, and by helping neurons remove dysfunctional proteins. Mice–and humans–with Huntington’s disease have problems activating PPARδ. When La Spada and colleagues treated Huntington’s mice with bexarotene or KD3010, they observed improved mitochondrial health in neurons, as well as increased removal of damaging misfolded proteins.
The same factors of impaired mitochondrial function and protein misfolding are recognized as increasingly important in diseases like Alzheimer’s disease, Parkinson’s disease, and ALS.
The study doesn’t mean that patients with Huntington’s disease or other conditions should rush to get bexarotene or KD3010. Further research needs to determine how to use these drugs in human patients. Bexarotene can have difficult side effects at high dosages, and optimal doses aren’t known, while KD3010 has only been tested in human subjects for type II diabetes.
Instead, future therapies for Huntington’s disease and other neurodegenerative conditions may take a cue from HIV treatments and involve a “cocktail” approach of combined medications. Lead author Audrey Dickey, PhD, found that, taken together, bexarotene and KD3010 produced better results in cells even when given at lower doses.
“With this approach, we could minimize side effects with lower doses of each compound, even when together the treatments provide a higher effect than either one alone,” said Dickey. “We are carrying out further research on the underlying mechanisms of neuroprotection and applying this research to other diseases with similar issues of mitochondrial dysfunction and protein quality control, such as Parkinson’s disease, Alzheimer’s disease, and ALS.”
Duke University School Of Medicinehttps://tinyurl.com/y73s5wfd