Strong Eczema Response to JAK Inhibitor

Patients with moderate or severe atopic dermatitis (AD) had as much as 74% improvement in disease status with the oral Janus kinase (JAK) inhibitor upadacitinib, a randomized trial showed.

After 16 weeks, patients randomized to one of three doses of upadacitinib had a mean improvement of 39.4% to 74.4% in the Eczema Area and Severity Index (EASI), as compared with 23% in the placebo group. Half of the patients had 90% improvement in the index (EASI 90) after 16 weeks. The same proportion met the criteria for almost/completely clear by investigator global assessment criteria (IGA 0/1).

Upadacitinib is a once-daily, oral JAK1-selective inhibitor under evaluation for several inflammatory diseases, Guttman-Yassky noted. The FDA recently granted breakthrough therapy status for the drug.

Adverse events, serious adverse events, and severe adverse events occurred in a similar proportion of placebo- and upadacitinib-treated patients. Rates of discontinuation because of adverse events were 5.0% with placebo and 2.4-9.5% with upadacitinib. The most common adverse events in all groups (including placebo) were upper respiratory tract infection, worsening of AD, and acne.

Those scented products you love? NOAA study finds they can cause air pollution

Emissions from volatile chemical products like perfumes, paints and other scented consumer items now rival vehicles as a pollution source in greater Los Angeles, according to a surprising new NOAA-led study.

Even though 15 times more petroleum is consumed as fuel than is used as ingredients in industrial and consumer products, the amount of chemical vapors emitted to the atmosphere in scented products is roughly the same, said lead author Brian McDonald, a CIRESoffsite link scientist working at NOAA.

A paper presenting these study findings was published today in Science.offsite link

The chemical  vapors, known as volatile organic compounds or VOCs, react with sunlight to form ozone pollution, and, as this study finds, also react with other chemicals in the atmosphere to form fine particulates in the air.

“As the transportation sector gets cleaner, these other sources of VOCs become more and more important,” McDonald said. “A lot of stuff we use in our everyday lives can impact air pollution.”

New and Proposed Changes to Medicare Part D

Late last week, Congress passed and the President signed a sweeping spending bill that will fund the government through March 23 and raise the spending caps imposed by the Budget Control Act of 2011 for two years, paving the way for a longer-term spending agreement. The legislation – the Bipartisan Budget Act of 2018 (BBA of 2018) – also contains a number of health care provisions important to people with Medicare and their families, including changes to Medicare Part D prescription drug coverage that will close the donut hole in 2019.

Just days later, on February 12, the White House released President Trump’s fiscal year (FY) 2019 budget request to Congress, which also includes several proposals related to Medicare, including changes to Part D drug coverage and Part B drug reimbursement.

The BBA of 2018 also addressed critical “extenders” – creating permanent fixes for the therapy cap and extending for two years funding for critical Medicare outreach and assistance activities. But the bill also included increases in premiums for some higher-income beneficiaries, further means testing the program. Both the legislation and the budget request allow for more flexibility for private Medicare Advantage plans and target Medicare Part D for a number of changes.

new brief from the Kaiser Family Foundations focuses on the Part D related changes and their potential impact – including, in the President’s request, the imposition of an out-of-pocket cap on Part D, changes to how the donut hole is calculated that will increase the amount of time people spend in it, and allowing the administration to shift medications from Part B to Part D.

Aging area near Traverse City joins “village movement” to stay at home

Decades ago, before “aging in place” became a movement, a small group of residents in rural Leelanau County began a conversation.

That led to a plan: a grassroots network of volunteers and basic services for the elderly so they could remain in their homes as long as possible.

More than 20 years later, Pauline McClure, 91, is still in her home in Northport, a pretty beachfront town popular with retirees north of Traverse City. That’s in no small part due to ShareCare of Leelanau Inc., the nonprofit that grew from those discussions.

“It’s almost a lifesaver,” McClure said.

McClure was a ShareCare charter member in 1994. She’s served on its board, as board vice president and has given her time driving members to dental or medical appointments, visiting the lonely or taking meals to those in need.

Now she’s on the receiving end.

A couple years ago, she fell and bruised her left leg, which led to infection and surgery. After her release from the hospital, ShareCare’s nurse came to her home to change her dressing. Members brought meals. McClure now depends on a volunteer driver from the organization to take her to doctor appointments in Traverse City 30 miles away.

“When we were younger, we said, ‘We’ll never need that.’ Well, now I’m the one having to ask for help once in a while,” McClure said.

There’s another name for what ShareCare does ‒ what’s become known nationally as the “village movement” that now counts 230 like-minded programs across the United States, with another 130 in development. Officially the Village to Village Network, it traces its origins to a Boston nonprofit called Beacon Hill Village that opened in 2002 – eight years after network member ShareCare was founded on similar principles.

Other Michigan nonprofits are exploring establishing something similar, though none has taken it as far as ShareCare.

Ice Age Mammoth Footprints Show How Juveniles Took Care Of The Elderly In Ancient Times

As explained in a report from the Daily Mail, a team of researchers from the University of Oregon examined a total of 117 mammoth prints dating back to approximately 43,000 years ago, with these fossilized footprints first spotted in 2014, and excavated some time later. In 2017, the Oregon Bureau of Land Management gave study lead author and University of Oregon professor Greg Retallack and his colleagues permission to return to the area. This was when the researchers’ interest was piqued by a collection of about 20 Ice Age mammoth footprints that hinted at some interesting behavior from the prehistoric elephants.

After analyzing the footprints, the researchers concluded that they might have belonged to Columbian mammoths that were, during those times, quite plentiful in certain parts of the present-day United States. A look at the 20 recently spotted footprints suggested that some of the prints came from a wounded, possibly elderly mammoth, with the other prints coming from younger mammoths.

“These prints were especially close together, and those on the right were more deeply impressed than those on the left, as if an adult mammoth had been limping,” explained Retallack.

Brain Chemical Blamed For Old Age Mental Decline Could Hold Key to Its Reversal

In both C. elegans and humans, the chemical kynurenic acid (KYNA) accumulates with age. As it builds up, KYNA interferes with the activity of glutamate, a brain chemical essential for learning and memory. In humans, it has previously been linked to neurodegenerative disorders, including Alzheimer’s and Parkinson’s disease.
In the study published Jan. 31, 2018, in Genes and Development, researchers looked at the effect of KYNA on the worms’ ability to learn an association between a neutral smell and food.

The researchers found that by keeping KYNA levels low throughout the worm’s life, they could prevent the onset of age-related decline – the worms kept learning. In older worms already impaired, lowering KYNA levels could counteract the impairments – raising hope that interventions later in life may be effective in reversing neurological decline.

The reason that KYNA increases with age is still a mystery, but the new study offers an intriguing hint, by linking KYNA buildup in aging worms to elevated levels of insulin, a hormone that controls blood sugar in both worms and humans. In contrast, earlier experiments by Ashrafi’s team had found that fasting, which has been linked to longevity, reduced levels of KYNA in worms and improved learning and memory.

Ashrafi thinks that KYNA is the linchpin through which fasting makes the brain better at learning, while aging makes it worse. “These are two sides of the same coin,” he said.

People Often Overdo it with NSAIDS

New data showed that nearly 15% of adult ibuprofen users exceeded the maximum recommended dose of ibuprofen or other NSAIDs in a 1-week period.

An online study analyzed nonsteroidal anti-inflammatory drugs (NSAID) use with a 1-week diary study in included 1,326 ibuprofen users. The vast majority (90%) of ibuprofen use was with over-the-counter (OTC) agents.

Of the participants, 37% took non-ibuprofen NSAID; the rest took ibuprofen. Those that exceeded the recommended daily NSAID limits included 11% on ibuprofen and 4% on other NSAIDs. This occurred an average of 9.1% of NSAID usage days.

Those with excessive daily use were more likely to be male, with ongoing pain, poor physical function, daily smoking, and the attitude of "choosing my own dose" and not starting with the lowest dose. They also had poor knowledge of the recommended one-time and 24-hour dose limits.

Educating consumers about OTC NSAIDs and their dosing directions could reduce excessive dosing and potential toxicity.

Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses

Among the 611 counties in this study, Medicaid expansion was associated with an increase in overall cancer diagnoses of 13.8 per 100 000 population (95% confidence interval [CI] = 0.7, 26.9), or 3.4%. Medicaid expansion was also associated with an increase in early-stage diagnoses of 15.4 per 100 000 population (95% CI = 5.4, 25.3), or 6.4%. There was no detectable impact on late-stage diagnoses.

Conclusions. In their first year, the 2014 Medicaid expansions were associated with an increase in cancer diagnosis, particularly at the early stage, in the working-age population.

Public Health Implications. Expanding public health insurance may be an avenue for improving cancer detection, which is associated with improved patient outcomes, including reduced mortality.

Vitamin B-3 could be used to treat Alzheimer's

Vitamin B-3 has previously been proposed as an alternative for treating Alzheimer's disease.

In an older study, large doses of nicotinamide — also referred to as B-3 — reversed Alzheimer's-related memory loss in mice.

A new study, however, focused on the effect of nicotinamide riboside (NR), which is a form of vitamin B-3, on Alzheimer's-related brain damage in mice.

More specifically, the researchers — who were jointly led by Dr. Vilhelm A. Bohr, the chief of the National Institute on Aging's (NIA) Laboratory of Molecular Gerontology, and Dr. Yujun Hou, a postdoctoral investigator in the laboratory — focused on how NR affects the brain's ability to repair its DNA, a function that is compromised in Alzheimer's disease.

As the scientists explain, a deficiency in the brain's ability to repair its DNA leads to dysfunction in the cells' mitochondria — the energy-creating organelles inside the cells — which, in turn, leads to neuronal dysfunction and lower neuron production.

But NR is "critical for mitochondrial health and biogenesis, stem cell self-renewal, and neuronal stress resistance." Thus, Dr. Bohr and his colleagues wanted to explore the effects of NR supplementation in a mouse model of the neurological disease.

The team added NR to the drinking water of mice that had been genetically engineered to develop the hallmarks of the neurodegenerative disorder. These included toxic buildups of the proteins tau and amyloid beta, dysfunctional synapses, and neuronal death — all of which resulted in cognitive deficits.

Compared with the controls, the NR-treated mice had less of the protein tau in the brain, less DNA damage, and more neuroplasticity — that is, the brain's ability to "rewire" itself when it learns new things, stores new memories, or becomes damaged.

Additionally — probably as a result of NR's ability to aid the self-renewal of stem cells, or cells that have the ability to transform into any other type of cell that the body needs — the mice in the intervention group produced more neurons from neuronal stem cells.

Also, fewer neurons died or were damaged in these mice. Intriguingly, however, their levels of the beta-amyloid protein stayed the same as those of the control mice.

Finally, the researchers say that in the hippocampi — a brain area involved in memory that often shrinks or is damaged in Alzheimer's — of the mice that received the treatment, NR appeared to get rid of the existing DNA damage or stop it from spreading.

All the brain changes were backed up by results from cognition and behavioral tests. All of the NR-treated mice performed better at maze tasks and object recognition tests, and they demonstrated stronger muscles and better gait.