Study shows early preterm births can be decreased with DHA supplementation

birth

Early preterm births may be dramatically decreased with docosahexaenoic acid (DHA) supplements, with a dose of 1000 mg more effective for pregnant women with low DHA levels than the 200 mg found in some prenatal supplements, according to a study led by researchers from the University of Kansas and the University of Cincinnati and published today in EClinicalMedicine, a clinical journal of The Lancet. Early preterm birth, defined as birth before 34 weeks gestation, is a serious public health issue because these births result in the highest risk of infant mortality and child disability.

“This study tells us that pregnant women should be taking DHA,” said Susan E. Carlson, Ph.D., professor of nutrition in the Department of Dietetics and Nutrition in the KU School of Health Professions, co-principal investigator and first author on the study. “And many would benefit from a higher amount than in some prenatal supplements, particularly if they are not already taking a prenatal vitamin with at least 200 mg DHA or eating seafood or eggs regularly,” Carlson said. “Many pregnant women take DHA, but we wanted to see if the amount in most prenatal supplements was enough to prevent early preterm birth.”

Overall, women who received the higher dose had fewer early preterm birth, however, participants with low DHA levels at enrollment had half the rate of early preterm birth (2.0% compared to 4.1%) when they were given a supplement of 1000 mg compared with those given a 200 mg supplement during the last half of pregnancy. For women who began the study with high DHA levels, many of whom were already taking prenatal DHA, the rate of early preterm birth was 1.3%, and there was no benefit of the higher dose.

“We knew from our previous work that women in the United States eat very little food sources of DHA, and we thought a higher dose might be needed to boost intake,” said Christina J. Valentine, M.D., a neonatologist and registered dietitian at the University of Cincinnati and one of three principal investigators for the study.

Because preterm birth is associated with such negative outcomes and high health care costs, having an option for women to prevent preterm birth reliably and inexpensively is significant.

“This study is a potential game changer for obstetricians and their patients,” said co-author Carl P. Weiner, M.D., professor of obstetrics and gynecology and professor of integrative and molecular physiology at the University of Kansas School of Medicine and professor of pharmaceutical sciences at the University of Kansas School of Pharmacy. “The dramatic decrease in early preterm birth with DHA supplementation will improve short- and long -term outcomes for children, families and society in a cost-effective fashion.”

Carlson notes that this information should be widely shared with women who are pregnant and those planning to become pregnant. “Women should be consulting with their doctor and getting their DHA levels tested to ensure they are taking the proper dose to prevent preterm birth,” she said.

The multi-center, double-blind, randomized, superiority trial recruited participants at three large academic medical centers in the United States (the University of Kansas Medical Center, Ohio State University and the University of Cincinnati).

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Mental health treatment rate rose early in pandemic

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A detailed analysis of mental health treatment trends during the COVID-19 pandemic found a 7% increase in visits during the initial shelter-in-place period in 2020, compared with the same three-month period in 2019.

The study, published in The Journal of Clinical Psychiatry on March 3, examined patient visits for psychiatric diagnoses among members of Kaiser Permanente in Northern California.

The greatest increases in visits were for substance use (up 51%), adjustment disorder (up 15%), anxiety (up 12%), bipolar disorder (up 9%), and psychotic disorder (up 6%). Adjustment disorder is diagnosed when someone responds to a stressful life event with symptoms such as sadness and hopelessness.

“The increases we found in patients seeking care for substance use and anxiety are consistent with other data showing the pandemic and shelter-in-place orders were difficult for many people,” said lead author Kathryn Erickson-Ridout, MD, a psychiatrist with Kaiser Permanente in Northern California and a member of the Physician Researcher Program with the Kaiser Permanente Northern California Division of Research. “These findings reflect what I experienced with my patients who sought out care.”

The analysis focused on a period when Kaiser Permanente pivoted to virtual visits by video and telephone to ensure that patients continued to have access to care when shelter-in-place orders were implemented. “COVID-19 has created huge psychosocial disruption,” Dr. Erickson-Ridout said. “It’s impacting people’s ability to work, socialize, and have relationships, and that is having mental health consequences. We were able to respond to that with a robust telehealth system, to reach those patients and give them good care.”

The study was a retrospective observational analysis comparing 165,696 psychiatric outpatient contacts between March 9 and May 31, 2019, with 181,015 during the same period in 2020, an increase of 7%. The researchers also confirmed the shift away from in-person visits, tallying a 264% increase in telephone and video visits from the year before. Kaiser Permanente clinicians also offer mental health support by secure email message, but this study did not count those.

The study found 42% more addiction clinic visits than the same period in 2019. This could be related to patients having more difficulty coping with the pandemic, but it could also reflect existing patients having good connections with their addiction medicine providers, said study senior author Esti Iturralde, Ph.D., a research scientist with the Division of Research. “They may have been able to seek care more easily from the health system because of the strong connections and supports Kaiser Permanente provides, including case management,” she said.

The results also suggest some people did not immediately adjust to the new virtual visit format. Visits with new patients declined by 42%, as did visits by children and adolescents (down 23%), and older adults (down more than 5%).

The authors said these results may reflect which patients were most comfortable reaching out for telehealth care, at least during the first few months of the pandemic. Reliance on caregivers to facilitate visits, or healthcare avoidance during this time, may be behind these changes. Future research may reflect how patients adjusted to virtual visits past May 2020.

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Blood biomarker detects COVID-19 severity and enables early triage

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Dr. Kulasinghe, from QUT Centre for Genomics and Personalised Health and School of Biomedical Sciences, delivered the findings to a special virtual meeting of the American Association of Cancer Research (AACR) on “COVID-19 and Cancer” earlier this month.

He said results of the test could inform doctors those patients that were likely to develop a severe infection and require a ventilator when they first present and thus differentiate them from patients likely to experience a milder case and who could go home and self-isolate.

“This is extremely important for the triage of patients when hospitals are running near or beyond capacity,” Dr. Kulasinghe said.

“We used spatial transcriptomic profiling (a technique which enables researchers to map cell-to-cell interactions and genes) to study lung samples from COVID-19 patients who had died.

“These spatial profiling biology approaches to understand complex tissues were voted the method of the year in 2020 Nature Methods.

“We drew upon our previous experience in spatial profiling of lung cancer to study COVID-19 in the lungs.

“Using high-resolution imaging and genomic profiling, we were able to map the presence of the virus in the lungs down to the single cells present in the lung tissue.

“We discovered a handful of pro-inflammatory genes which were upregulated (higher expression) in COVID-19 cases when compared with the closest pandemic virus, swine flu or H1N1, and the lungs of healthy people.

“The pro-inflammatory genes, including one called ifi27, are involved in type 1 interferon response—an inflammatory response to defend the body from viruses and other pathogens.

“The value of measuring this biomarker, ifi27, in a nasal swab or blood sample is in triaging patients because it can tell us how severe the COVID-19 disease is as soon as the patient seeks medical help with COVID symptoms.”

Dr. Kulasinghe said the researchers had measured ifi27 in asymptomatic, mild, moderate and severe COVID-19 cases.

“We saw that ifi27 is elevated in a step-wise manner with severe cases having high ifi27 levels.”

Dr. Kulasinghe said researchers knew that ifi27 was elevated in the blood of COVID-19 patients.

“But there had not been any evidence of where the signal for the high ifi27 levels was coming from.

“By spatial profiling lung tissue of COVID-19 patients who had died we got a much deeper picture of the cellular changes driven by viral infection and that the lungs were a source of the raised ifi27.

“This technique also allowed us to identify which cells in the lungs the virus was binding to.”

This collaborative research project with University of Queensland Diamantina Institute and the Walter and Eliza Hall Institute of Medical Research was awarded the Ausbiotech Johnson & Johnson Industry Excellence Collaboration Award and Industry Choice Award in 2020.

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Gates says coronavirus could still be risk through early 2022

California restaurant owner on staying open despite coronavirus shutdown order: ‘I really have no choice’

Cronie’s Sports Grill co-owner Dave Foldes discusses his decision to keep his business open despite shutdown orders on ‘America’s News HQ.’

Bill Gates, the founder of Microsoft, struck a sobering tone during an interview on Sunday and while he expressed optimism about coronavirus vaccines, he mentioned that a lot of parts need to move correctly in order for the U.S. to reach some level of normalcy.

Gates is an influential voice on the pandemic and co-founded the Bill & Melinda Gates Medical Research Institute.

Jake Tapper, the CNN host, mentioned the lockdown orders in states like California and the hardships that many businesses face across the country. Health officials insist that these lockdowns are needed due to the risk of hospitals potentially being inundated with patients.

“Bars and restaurants—in most of the country—will be closed as we go into this wave, and I think, sadly, that’s appropriate,” Gates said.

He said the next four to six months “really call on us to do our best, because we can see that this will end and you don’t want somebody that you love to be the last to die from coronavirus.”

Gates was asked when he believes the U.S. will regain some sense of pre-coronavirus life, and he said by late summer, the U.S. will be closer to normal than at the moment.

“But even through early 2022, unless we help other countries get rid of this disease, and we get high vaccination rates in our country, the risk of reintroduction will be there and, of course, the global economy will be slowed down, which hurts America economically in a pretty dramatic way,” he said.

Some on social media said Gates seemed out of touch when it came to the severity of the crisis when it came to the dire financial stress faced by restaurants. 

Richard Grenell, President Trump's former acting director of National Intelligence, tweeted, "Both have large paychecks."

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Early birth linked to greater risk of hospital visits during childhood

Being born early (before 37 weeks’ gestation) is associated with a higher risk of hospital admission throughout childhood than being born at full term (40 weeks’ gestation), finds a study published by The BMJ today.

Although the risk declined as the children grew up, particularly after age 2, an excess risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation, representing many potentially vulnerable children, say the researchers.

Preterm birth is a major contributor to childhood ill health. Existing evidence suggests that the risk of illness associated with preterm birth declines as children grow up, but it remains unclear at what age this begins to happen and how these changes vary by week of gestational age at birth.

To explore this further, a team of UK researchers set out to examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.

Their findings are based on data from more than 1 million children born in NHS hospitals in England between 1 January 2005 and 31 December 2006. Children were monitored from birth until 31 March 2015 (an average of 9.2 years per child), during which time the researchers analysed numbers of hospital admissions.

Gestational age at birth was analysed in weeks, from less than 28 up to 42 weeks.

Over 1.3 million hospital admissions occurred during the study period, of which 831,729 (63%) were emergency admissions. Just over half (525,039) of children were admitted to hospital at least once during the study period.

After taking account of other potentially influential risk factors, such as mother’s age, marital status and level of social deprivation, and child’s sex, ethnicity and month of birth, the researchers found that hospital admissions during childhood were strongly associated with gestational age at birth.

The hospital admission rate during infancy in babies born at 40 weeks was 28 per 100 person years—this figure was about six times higher in babies born extremely prematurely (less than 28 weeks). By the time the children were aged 7-10 years, the hospital admission rate in children born at 40 weeks was 7 per 100 person years—this figure was about three times higher in those born at less than 28 weeks.

But even children born a few weeks early had higher admission rates. Being born at 37, 38, and 39 weeks’ gestation was associated with a difference in the rate of admission of 19, 9, and 3 admissions per 100 person years during infancy, respectively, compared with those born at 40 weeks.

The risk of hospital admission associated with gestational age decreased over time, particularly after age 2. However, an excess risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation.

Although this excess risk at 38 and 39 weeks was relatively small, the large number of babies born globally at these gestational ages suggests that they are likely to have a large impact on hospital services, say the researchers.

Infections were the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.

This is an observational study, so can’t establish cause, and the researchers point to some limitations, such as being unable to take account of several factors that can impact child health like maternal smoking and breastfeeding.

However, they say this was a large study using routinely collected data over a 10 year period, and the findings remained relatively stable after further analyses, suggesting that the results withstand scrutiny.

As such, the researchers say their findings indicate that gestational age at birth “is a strong predictor of childhood illness, with those born extremely preterm being at the greatest risk of hospital admission throughout childhood.”

And the finding that infections were the main cause of excess hospital admissions at all ages prompt the researchers to call for targeted strategies to help prevent and better manage childhood infections.

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Italy closes gyms, shuts eateries early to fight COVID-19

Italy’s leader imposed at least a month of new restrictions across the country Sunday to fight rising coronavirus infections, shutting down gyms, pools and movie theaters, putting an early curfew on cafes and restaurants and mandating that people keep wearing masks outdoors.

Worried about crippling Italy’s stagnant economy, especially after 10 weeks of a severe lockdown earlier in the pandemic, Italian Premier Giuseppe Conte opted against another heavy nationwide lockdown. The new decree goes into effect Monday and lasts until Nov. 24.

“Our aim is to protect health and the economy,” Conte said.

A day earlier, Italy surpassed a half million confirmed coronavirus cases since February, when it became the first country in Europe stricken by the pandemic. On Sunday, Italy registered 21,273 new confirmed cases and 128 deaths since the day before. Italy has reported a total of 37,338 virus deaths, Europe’s second-highest pandemic death toll after Britain.

Restaurant and bar owners had lobbied hard against the new measures, which orders them to close at 6 p.m. Most restaurants in Italy usually don’t even start to serve dinner before 8 p.m. Cafes and restaurants were allowed in recent months to re-open for outdoor dining or limited indoor seating. But many are struggling to pay their bills and some have already failed after tourists were banned from the United States and many other countries.

Conte promised financial aid from his center-left government as soon as November to the food sector and noted that cafes and restaurants can do delivery and takeout orders until midnight. But before the curfew, no more than four diners will be allowed per restaurant table, unless they are from the same family.

Under the new rules, ski slopes are off-limits to all but competitive skiers and all spectators are banned from stadiums during professional sports matches, including soccer. Receptions after religious or civil ceremonies like weddings are forbidden. The decree continues to exempt children younger than six and those exercising outdoors from wearing masks.

“We all have to do small sacrifices,” Conte said. “If we can’t go to the gym, we can exercise outdoors.”

Conte kept elementary and middle schools open but said 75% of high school students must have remote classes. Crowding on public transit, especially since schools reopened last month, has concerned health authorities.

By early summer, after Italy’s lockdown was all but lifted, new virus caseloads had dropped as low as 200 a day.

“These are difficult days,” Health Minister Roberto Speranza said after Conte explained the aim of the latest limits. “The curve of contagion is growing in the world. And in all Europe the wave is very high. We must react immediately and with determination if we want to avoid unsustainable numbers.”

Several Italian regions and cities recently slapped on overnight curfews to cut down on young people congregating outdoors, especially to drink. But Conte said given the approaching cold weather, people would prefer to socialize inside at bars and restaurants instead, so that’s why he ordered them to close early.

On Friday, demonstrators in Naples protested a 11 p.m. to 5 a.m. curfew and clashed with police. On Saturday night, far-right and neo-fascist political groups led a similar protest in Rome against that city’s curfew.















Conte said he understood the frustration of citizens, whose incomes and way of life are being heavily hit by pandemic limitations.

“I’d feel anger, too, toward the government,” he said, but noted that authorities had determined that the protests were also fueled by agitators.

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Interim data from early US COVID-19 hotspot show mortality of disease were not associated with race/ethnicity

A study of interim data from two hospitals in an early US COVID-19 hotspot, to be presented at the ESCMID Conference on Coronavirus Disease (ECCVID, held online 23-25 September), shows that race and ethnicity were not significantly associated with higher in-hospital COVID-19 mortality, and that rates of moderate, severe, and critical forms of COVID-19 were similar between racial and ethnic groups.

The study, by Dr. Daniel Chastain (University Of Georgia College Of Pharmacy, Albany, GA, U.S.) and colleagues included data from adult patients hospitalised between March 10 and and May 22 with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia.

The authors compared severity of illness categories on presentation to the hospital between patients from different racial and ethnic groups based on criteria from the US National Institutes of Health (NIH) COVID-19 treatment guidelines. They also studied outcomes including comorbidities, laboratory values, vital signs, and in-hospital mortality.

A total of 164 randomly selected non-consecutive patients were included with a median age of 61.5 years. These consisted of 119 African American patients, 36 Caucasian patients, and 9 Latinx patients. Thus the majority were African American (73%) and 51% were female. Rates of moderate, severe, and critical COVID-19 did not significantly differ between African American (9%, 56%, and 35%), Caucasian (0%, 69%, and 31%), and Latinx patients (0%, 56%, and 44%). In-hospital mortality was not statistically significantly different between groups but was highest among Caucasians (31%) followed by Latinx (22%) and African Americans (16%).

Caucasian patients had significantly higher Charlson comorbidity index scores (meaning more underlying conditions) (4.5) compared to African American (4) and Latinx (2) patients, while median BMI was significantly higher in African Americans (33.7 kg/m2) than in Caucasians (26.9) or Latinx patients (25.9).

Duration of time from symptom onset to admission was similar between groups, whereas median temperature on admission was significantly higher in African Americans (38.3C) than in Caucasians (37.9) or Latinx patients (37.8)

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Risk gene for Alzheimer’s has early effects on the brain

A genetic predisposition to late-onset Alzheimer’s disease affects how the brains of young adults cope with certain memory tasks. Researchers from the German Center for Neurodegenerative Diseases (DZNE) and the Ruhr-Universität Bochum report on this in the scientific journal Current Biology. Their findings are based on studies with magnetic resonance imaging in individuals at the age of about 20 years. The scientists suspect that the observed effects could be related to very early disease processes.

The causes for Alzheimer’s in old age are only poorly understood. It is believed that the disease is caused by an unfavorable interaction of lifestyle, external factors and genetic risks. The greatest genetic risk factor for late-onset Alzheimer’s disease stems from inherited mutations affecting “Apolipoprotein E” (ApoE), a protein relevant for fat metabolism and neurons. Three variants of the ApoE gene are known. The most common form is associated with an average risk for Alzheimer’s. One of the two rarer variants stands for an increased risk, and the other for a reduced risk.

“We were interested in finding out whether and how the different gene variants affect brain function. That is why we examined the brains of young adults in the scanner while they had to solve a task that challenged their memory,” explained Dr. Hweeling Lee, who led the current study at the DZNE in Bonn.

Distinguishing similar events

The group of study participants comprised of 82 young men and women. They were on average 20 years old, and all of them were university students considered to be cognitively healthy. According to their genotype for ApoE, 33 of them had an average, 34 an increased and 15 a reduced risk of developing Alzheimer’s disease at a late age. During the study in the brain scanner, all individuals were presented with more than 150 successive images displayed on a monitor. These were everyday objects such as a hammer, a pineapple or a cat. Some pictures were repeated after a while, but sometimes the position of the displayed objects on the screen had changed. The study participants had to identify whether an object was “new” or had been shown before—and if so, whether its position had shifted.

“We tested the ability to distinguish similar events from one another. This is called pattern separation,” said Hweeling Lee. “In everyday life, for example, it’s a matter of remembering whether a key has been placed in the left or right drawer of a dresser, or where the car was parked in a parking garage. We simulated such situations in a simplified way by changing the position of the depicted objects.”

High-resolution through modern technology

Simultaneously to this experiment, the brain activity of the volunteers was recorded using a technique called “functional magnetic resonance imaging”. Focus was on the hippocampus, an area only a few cubic centimeters in size, which can be found once in each brain hemisphere. The hippocampus is considered the switchboard of memory. It also belongs to those sections of the brain in which first damages occur in Alzheimer’s disease.

When measuring brain activity, the scanner was able to show its full potential: It was an “ultra-high field tomograph” with a magnetic field strength of seven Tesla. Such devices can achieve a better resolution than brain scanners usually used in medical examinations. This enabled the researchers to record brain activity in various sub-fields of the hippocampus with high precision. “Up to now, there were no comparable studies with such level of detail in ApoE genotyped participants. This is a unique feature of our research,” said Hweeling Lee.

No differences in memory performance

There were no differences between the three groups of subjects with regard to their ability for pattern separation. “All study participants performed similarly well in the memory test. It did not matter whether they had an increased, reduced or average risk for Alzheimer’s disease. Such results are certainly to be expected in young healthy people,” said Nikolai Axmacher, Professor of Neuropsychology at the Ruhr-Universität Bochum, who was also involved in the current study. “However, there were differences in brain activity. The different groups of study participants activated the various subfields of the hippocampus in different ways and to varying degrees. Their brains thus reacted differently to the memory task. In fact, we saw differences in brain activation not only between people with average and increased risk, but also between individuals with average and reduced risk.”

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Genetic mutations may be linked to infertility, early menopause

A new study from Washington University School of Medicine in St. Louis identifies a specific gene’s previously unknown role in fertility. When the gene is missing in fruit flies, roundworms, zebrafish and mice, the animals are infertile or lose their fertility unusually early but appear otherwise healthy. Analyzing genetic data in people, the researchers found an association between mutations in this gene and early menopause.

The study appears Aug. 28 in the journal Science Advances.

The human gene—called nuclear envelope membrane protein 1 (NEMP1)—is not widely studied. In animals, mutations in the equivalent gene had been linked to impaired eye development in frogs.

The researchers who made the new discovery were not trying to study fertility at all. Rather, they were using genetic techniques to find genes involved with eye development in the early embryos of fruit flies.

“We blocked some gene expression in fruit flies but found that their eyes were fine,” said senior author Helen McNeill, Ph.D., the Larry J. Shapiro and Carol-Ann Uetake-Shapiro Professor and a BJC Investigator at the School of Medicine. “So, we started trying to figure out what other problems these animals might have. They appeared healthy, but to our surprise, it turned out they were completely sterile. We found they had substantially defective reproductive organs.”

Though it varied a bit by species, males and females both had fertility problems when missing this gene. And in females, the researchers found that the envelope that contains the egg’s nucleus—the vital compartment that holds half of an organism’s chromosomes—looked like a floppy balloon.

“This gene is expressed throughout the body, but we didn’t see this floppy balloon structure in the nuclei of any other cells,” said McNeill, also a professor of developmental biology. “That was a hint we’d stumbled across a gene that has a specific role in fertility. We saw the impact first in flies, but we knew the proteins are shared across species. With a group of wonderful collaborators, we also knocked this gene out in worms, zebrafish and mice. It’s so exciting to see that this protein that is present in many cells throughout the body has such a specific role in fertility. It’s not a huge leap to suspect it has a role in people as well.”

To study this floppy balloon-like nuclear envelope, the researchers used a technique called atomic force microscopy to poke a needle into the cells, first penetrating the outer membrane and then the nucleus’s membrane. The amount of force required to penetrate the membranes gives scientists a measure of their stiffness. While the outer membrane was of normal stiffness, the nucleus’s membrane was much softer.

“It’s interesting to ask whether stiffness of the nuclear envelope of the egg is also important for fertility in people,” McNeill said. “We know there are variants in this gene associated with early menopause. And when we studied this defect in mice, we see that their ovaries have lost the pool of egg cells that they’re born with, which determines fertility over the lifespan. So, this finding provides a potential explanation for why women with mutations in this gene might have early menopause. When you lose your stock of eggs, you go into menopause.”

McNeill and her colleagues suspect that the nuclear envelope has to find a balance between being pliant enough to allow the chromosomes to align as they should for reproductive purposes but stiff enough to protect them from the ovary’s stressful environment. With age, ovaries develop strands of collagen with potential to create mechanical stress not present in embryonic ovaries.

“If you have a softer nucleus, maybe it can’t handle that environment,” McNeill said. “This could be the cue that triggers the death of eggs. We don’t know yet, but we’re planning studies to address this question.”

Over the course of these studies, McNeill said they found only one other problem with the mice missing this specific gene: They were anemic, meaning they lacked red blood cells.

“Normal adult red blood cells lack a nucleus,” McNeill said. “There’s a stage when the nuclear envelope has to condense and get expelled from the young red blood cell as it develops in the bone marrow. The red blood cells in these mice aren’t doing this properly and die at this stage. With a floppy nuclear envelope, we think young red blood cells are not surviving in another mechanically stressful situation.”

The researchers would like to investigate whether women with fertility problems have mutations in NEMP1. To help establish whether such a link is causal, they have developed human embryonic stem cells that, using CRISPR gene-editing technology, were given specific mutations in NEMP1 listed in genetic databases as associated with infertility.

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Early government intervention is key to reducing the spread of COVID-19

Early and strict governmental intervention is a key factor in reducing the spread of COVID-19 cases. That’s the conclusion reached by a team of researchers comparing outbreaks of the novel coronavirus between the Chinese province of Hunan and Italy in a new paper published in Frontiers in Medicine.

While Hunan and Italy are similar in population size—about 60-70 million people each—the scope of the epidemic in each location has differed dramatically. At time of publication, Italy has the second-most confirmed deaths after the United States and ranks third in total confirmed infections, according to the Johns Hopkins University Coronavirus Resource Center. There are just over 1,000 confirmed cases in Hunan.

The research team, based in China, used data from the John Hopkins database through April 2 to map infection trends in both Hunan and Italy. They modified a standard mathematical model known as a susceptible-infected-removed (SIR) model to account for the effects of different epidemic prevention measures at different periods in time.

“It should be noted that in actual situations, the speed of transmission can be changed through many interventions, such as personal protective measures, community-level isolation and city blockade,” said lead author Dr. Wangping Jia with the Chinese PLA General Hospital in Beijing.

The paper’s extended SIR (eSIR) model found that under current measures there could be a total of 3,369 (the mean in a possible range of 840-8,013) infected cases in Hunan, with the endpoint of the epidemic having already occurred around March 3. In contrast, total infected cases in Italy are projected to be 182,051 (the mean in a possible range of 116,114-274,378) with an end date around August 6.

The authors speculated that the disparate trends could be due to a couple of reasons. For instance, Italy may not have implemented preventive measures soon enough, as the eSIR model demonstrated that taking action earlier in the case of Hunan drastically reduced infection rates.

The authors noted that “from China’s experience, various control measures, including the early detection and isolation of individuals with symptoms, traffic restrictions, medical tracking, and entry or exit screening, can well prevent the further spread of COVID-19.”

The paper did not specifically address mortality rates because a number of factors can affect these predictions, according to Jia, such as bed capacity of intensive care units, as well as a patient’s age, sex and any underlying health conditions such as cardiovascular disease, hypertension and diabetes.

“Accurate patient-specific data are urgent needs for the prediction of the total deaths,” he said.

The Italian government recently announced it would begin to ease lockdown measures beginning May 4—three months earlier than the eSIR model advises.

“We think it is too early to ease restrictions starting around May 4,” Jia said. “The potential second wave may come if restrictions are eased three months earlier. Italy is not in the end period of the COVID-19 epidemic.”

The authors concede that the current study has several limitations. First, due to the limited amount of testing, it’s likely the number of infected people in Italy and elsewhere is higher than the official count. The eSIR model does not incorporate the disease’s incubation period, which could make it less accurate. And there may be other factors that could throw off the estimate, such as the influence of “super spreaders” of the disease on a population.

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