Man found slumped dead at hospital coffee shop

The Sunday Times reports that the man is found slumped over a table in the hospital’s cafe.

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Alopecia: New NHS drug ‘could make life so much easier’

The autoimmune condition affects people differently – some think the drug could be life-changing.

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What the outdoor smoking ban in Australia could tell us about UK’s future

In Australia, smoking outdoors in pubs is heavily regulated – could the UK follow suit?

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Ozempic could delay ageing, researchers suggest

New studies suggest the weight loss drug could be used to treat a range of issues, including heart failure.

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Use suncream you know, warns mum after boy’s surgery

A family say they want to warn others about the risks of buying unfamiliar suncream abroad.

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Genomic dark matter solves butterfly evolutionary riddle

A team of international researchers has uncovered a surprising genetic mechanism that influences the vibrant and complex patterns on butterfly wings. In a study published in the Proceedings of the National Academy of Sciences, the team, led by Luca Livraghi at the George Washington University and the University of Cambridge, discovered that an RNA molecule, rather than a protein as previously thought, plays a pivotal role in determining the distribution of black pigment on butterfly wings.

Precisely howbutterflies are able to generate the vibrant patterns and colors on their wings has fascinated biologists for centuries. The genetic code contained within the cells of developing butterfly wings dictates the specific arrangement of the color on the wing’s scales — the microscopic tiles that form wing patterns — similar to the arrangement of colored pixels to form a digital image. Cracking this code is fundamental to understanding how our own genes build our anatomy. In the lab, researchers can manipulate that code in butterflies with gene-editing tools and observe the effect on visible traits, such as coloration on a wing.

Scientists have long known that protein-coding genes are crucial to these processes. These types of genes create proteins that can dictate when and where a specific scale should generate a particular pigment. When it comes to black pigments, researchers thought this process would be no different, and initially implicated a protein-coding gene. The new research, however, paints a different picture.

The team discovered a gene that produces an RNA molecule — not a protein — controls where dark pigments are made during butterfly metamorphosis. Using the genome-editing technique CRISPR, the researchers demonstrated that when you remove the gene that produces the RNA molecule, butterflies completely lose their black pigmented scales, showing a clear link between RNA activity and dark pigment development.

“What we found was astonishing,” said Livraghi, a postdoctoral scientist at GW. “This RNA molecule directly influences where the black pigment appears on the wings, shaping the butterfly’s color patterns in a way we hadn’t anticipated.”

The researchers further explored how the RNA molecule functions during wing development. By examining its activity, they observed a perfect correlation between where the RNA is expressed and where black scales form.

“We were amazed that this gene is turned on where the black scales will eventually develop on the wing, with exquisite precision” said Arnaud Martin, associate professor of biology at GW. “It is truly an evolutionary paintbrush in this sense, and a creative one, judging by its effects in several species.”

The researchers examined the newly discovered RNA in several other butterflies whose evolutionary history diverged around 80 million years ago. They found that in each of these species, the RNA had evolved to control new placements in the patterns of dark pigments.

“The consistent result obtained from CRISPR mutants in several species really demonstrate that this RNA gene is not a recent invention, but a key ancestral mechanism to control wing pattern diversity,” said Riccardo Papa, professor of biology at the University of Puerto Rico — Río Piedras.

“We and others have now looked at this genetic trait in many different butterfly species, and remarkably we are finding that this same RNA is used again and again, from longwing butterflies, to monarchs and painted lady butterflies,” said Joe Hanly, a postdoctoral scientist and visiting fellow at GW. “It’s clearly a crucial gene for the evolution of wing patterns. I wonder what other, similar phenomena biologists might have been missing because they weren’t paying attention to the dark matter of the genome.”

The findings not only challenge long-standing assumptions about genetic regulation but also open up new avenues for studying how visible traits evolve in animals.

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Is long-term beta-blocker therapy needed after a heart attack?

The cardiovascular safety of interrupting beta-blocker could not be shown in comparison to continuation in patients with a history of myocardial infarction (MI) and there was no benefit to the patients’ quality of life, according to late-breaking research presented August 30 at ESC Congress 2024.1

“Improvements in MI management and data from observational studies have led physicians to question whether continuing beta-blockers after 1 year post-MI is needed since unnecessary treatment may result in side effects.2-5 We conducted the ABYSS trial to provide conclusive randomised data on the effects of beta-blocker interruption vs. continuation on cardiovascular events and quality of life, but we were unable to show safety preservation in terms of clinical events nor any benefit on quality of life with beta-blocker interruption,” said Principal Investigator, Professor Johanne Silvain of the Sorbonne University, Paris, France.

The open-label, non-inferiority, randomised ABYSS trial, conducted by the ACTION Group, included patients with a prior MI taking long-term beta-blockers, with a left ventricular ejection fraction of at least 40% and no cardiovascular events in the previous 6 months. Participants were randomised (1:1) to interrupting or continuing their β-blocker medication.

The primary endpoint was a composite of death, non-fatal MI, non-fatal stroke or hospitalisation for cardiovascular reasons at the longest follow-up (minimum, 1 year), according to an analysis of non-inferiority (defined as a between-group absolute difference of <3 percentage points for the upper boundary of the two-sided 95% confidence interval [CI]). The main secondary endpoint was the change in quality of life as measured by the European Quality of Life-5 Dimensions questionnaire.

In total 3,698 patients were randomised from 49 sites in France. The mean age was 64 years and 17% were female. The median time between last MI and randomisation was 2.9 years (interquartile range 1.2-6.4 years).

Over median follow-up of 3 years, interruption of long-term beta-blocker treatment was not shown to be non-inferior to beta-blocker continuation. A primary-outcome event occurred in 23.8% of patients in the interruption group and in 21.1% in the continuation group (risk difference 2.8 percentage points; 95% CI <0.1-5.5), with a hazard ratio of 1.16 (95% CI 1.01-1.33; p=0.44 for non-inferiority).

Death occurred in 4.1% in the interruption group and 4.0% in the continuation group, while MI occurred in 2.5% and 2.4%, respectively. Of note, hospitalisation for cardiovascular causes occurred in 18.9% in the interruption group and 16.6% in the continuation group. Beta-blocker interruption was also associated with increases in systolic and diastolic blood pressure and heart rate at 6 months (all p<0.001 vs. beta-blocker continuation) and during the study follow up. Beta-blocker interruption did not improve the patients’ quality of life.

Summing up the evidence from the ABYSS trial, Professor Silvain concluded: “Differences between the groups with respect to hospitalisation for cardiovascular reasons and the negative effect on blood pressure levels, together with the absence of quality-of-life improvement do not support interruption of a chronic beta-blocker treatment in post-MI patients. These results must be put into context with recent findings from the open-label REDUCE-MI6 trial and ongoing trials to provide additional evidence on the optimal use of beta-blockers after MI.”

1 ‘Beta blocker interruption in patients with prior myocardial infarction: results of the ABYSS trial and effect on blood pressure and heart rate control’ will be discussed during Hot Line 1 on Friday 30 August in room London.

2 Holt A, Blanche P, Zareini B, et al. Effect of long-term beta-blocker treatment following myocardial infarction among stable, optimally treated patients without heart failure in the reperfusion era: a Danish, nationwide cohort study. Eur Heart J. 2021;42:907-914.

3 Park CS, Yang H-M, Ki Y-J, et al. Left ventricular ejection fraction 1 year after acute myocardial infarction identifies the benefits of the long-term use of beta-blockers: analysis of data from the KAMIR-NIH Registry. Circ Cardiovasc Interv. 2021;14:e010159.

4 Puymirat E, Riant E, Aissaoui N, et al. β Blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ. 2016;354:i4801.

5 Kim J, Kang D, Park H, et al. Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study. Eur Heart J. 2020;41:3521-3529.

6 Yndigegn T, Lindahl B, Mars K, et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 2024;390:1372-1381.

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How hope beats mindfulness when times are tough

A recent study finds that hope appears to be more beneficial than mindfulness at helping people manage stress and stay professionally engaged during periods of prolonged stress at work. The study underscores the importance of looking ahead, rather than living “in the moment,” during hard times.

Mindfulness refers to the ability of an individual to focus attention on the present, in a way that is open, curious and not judgmental. Essentially, the ability to be fully in the moment.

“There’s a lot of discussion about the benefits of mindfulness, but it poses two challenges when you’re going through periods of stress,” says Tom Zagenczyk, co-author of a paper on the work and a professor of management in North Carolina State University’s Poole College of Management. “First, it’s hard to be mindful when you’re experiencing stress. Second, if it’s a truly difficult time, you don’t necessarily want to dwell too much on the experience you’re going through.

“Because hope is inherently forward looking, while mindfulness is about appreciating your current circumstances, we wanted to see how each of these two mindsets influenced people’s well-being and professional attitudes during difficult times,” Zagenczyk says. “The COVID pandemic presented us with an unfortunate, but useful, opportunity to explore this topic. And we chose to focus on the performing arts since that sector was particularly hard hit by the pandemic.”

For the study, researchers recruited 247 professional musicians from the organization MusiCares to take two surveys, one month apart. The first survey was given in September 2021. In addition to collecting broad demographic data, study participants were asked about their thoughts and experiences at the beginning of the pandemic — March to August 2020. They were also asked questions aimed at capturing how hopeful and mindful they were from September 2020 through March 2021.

The second survey was given in October 2021 and asked study participants questions aimed at capturing work engagement, work tensions, how positive their emotions were, and the extent to which they were experiencing distress.

The researchers then used statistical techniques to identify relationships between hope, mindfulness, and outcomes related to their personal well-being and attitudes toward work.

“Fundamentally, our findings tell us that hope was associated with people being happy, and mindfulness was not,” says Kristin Scott, study co-author and a professor of management at Clemson University. “And when people are hopeful — and happy — they experience less distress, are more engaged with their work, and feel less tension related to their professional lives.”

“Being mindful can be tremendously valuable — there are certainly advantages to living in the moment,” says Sharon Sheridan, study co-author and an assistant professor of management at Clemson. “But it’s important to maintain a hopeful outlook — particularly during periods of prolonged stress. People should be hopeful while being mindful — hold on to the idea that there’s a light at the end of the tunnel.”

While the study focused on musicians during an extreme set of circumstances, the researchers think there is a takeaway message that is relevant across industry sectors.

“Whenever we have high levels of job stress, it’s important to be hopeful and forward looking,” says Emily Ferrise, study co-author and a Ph.D. student at Clemson. “And to the extent possible, there is real value for any organization to incorporate hope and forward thinking into their corporate culture — through job conditions, organizational communications, etc.”

“Every work sector experiences periods of high stress,” says Zagenczyk. “And every company should be invested in having happy employees who are engaged with their work.”

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New findings on TB could change how we treat inflammatory disorders

Tuberculosis is a confounding scourge. It’s the leading cause of death from infectious disease in the world, and yet it’s estimated that those deaths represent perhaps 5% of infections with Mycobacterium tuberculosis (Mtb). Antibiotics can take credit for saving the lives of some of those with Mtb, but a chasm nevertheless persists between the prevalence of infection and the targeted severity of its impact. A growing body of evidence suggests genetic vulnerabilities to TB account for that gap.

Now researchers from The Rockefeller University have found another rare mutation that leaves its carriers much more likely to become ill with TB — but, curiously, not with other infectious diseases. This finding, recently published in Nature, may upend long held assumptions about the immune system.

It’s long been known that an acquired deficiency of a pro-inflammatory cytokine called TNF is linked to an increased risk of developing TB. The current study, led by Rockefeller’s Stéphanie Boisson-Dupuis and Jean-Laurent Casanova, revealed a genetic cause of TNF deficiency, as well as the underlying mechanism: a lack of TNF incapacitates a specific immune process in the lungs, leading to severe — but surprisingly targeted — illness.

The findings suggest that TNF, long considered a key galvanizer of the immune response, might actually play a much narrower role — a discovery with far-reaching clinical implications.

“The past 40 years of scientific literature have attributed a wide variety of pro-inflammatory functions to TNF,” says Casanova, head of the St. Giles Laboratory of Human Genetics of Infectious Diseases. “But beyond protecting the lungs against TB, it may have a limited role in inflammation and immunity.”

Rare risk

Casanova’s lab has been studying the genetic causes of TB for more than two decades through field work in several countries and a wide network of collaborating physicians across the world. They maintain an ever-growing database of whole-exome sequences from a global pool of patients — more than 25,000 people to date. Of those, some 2,000 have had TB.

Over the years they’ve identified several rare genetic mutations that render some people vulnerable to TB. For example, mutations in a gene called CYBB can disable an immune mechanism called the respiratory burst, which produces chemicals called reactive oxygen species (ROS). Despite its pulmonary-sounding name, the respiratory burst takes place in immune cells throughout the body.

ROS help pathogen-consuming white blood cells called phagocytes (from the Greek for “eating”) to destroy the invaders they’ve devoured. If ROS aren’t produced, those pathogens can thrive unchecked, leading to debilitating complications. As a result, carriers of this CYBB mutation become vulnerable to not just TB but to a wide variety of infectious diseases.

For the current study, the team suspected that a similar inborn error of immunity may lay behind the severe, recurring TB infections experienced by two people in Colombia — a 28-year-old woman and her 32-year-old cousin — who had been repeatedly hospitalized with significant lung conditions. In each cycle, they initially responded well to anti-TB antibiotics, but within a year, they were sick again.

Puzzlingly, however, their long-term health records showed that their immune systems functioned normally, and that they were otherwise healthy.

A telling deficiency

To find out why they were particularly prone to getting TB, the researchers performed whole-exome sequencing on the two, as well as a genetic analysis of their respective parents and relatives.

The two were the only members of their extended family with a mutation in the TNF gene, which encodes for proteins linked to the regulation of a variety of biological processes. Short for “tumor necrosis factor,” increased TNF production is also associated with a variety of conditions, including septic shock, cancer, rheumatoid arthritis, and cachexia, which causes dangerous weight loss.

The protein is largely secreted by a type of phagocyte called a macrophage, which relies on the ROS molecules generated by the respiratory burst to finish off pathogens they’ve consumed.

In these two patients, the TNF gene failed to function, preventing the respiratory burst from occurring, and thus the creation of ROS molecules. As a result, the patients’ alveolar macrophages, located in their lungs, were overrun with Mtb.

“We knew that the respiratory burst was important for protecting people against various types of mycobacteria, but now we know that TNF is actually regulating the process,” says Boisson-Dupuis. “And when it’s missing in alveolar macrophages, people will be susceptible to airborne TB.”

She adds, “It’s very surprising that the people we studied are adults who have never been sick with other infectious diseases, despite being repeatedly exposed to their microbes. They are apparently selectively at risk for TB.”

Treatment potential

The discovery also solves a long-standing mystery about why TNF inhibitors, which are used to treat autoimmune and inflammatory diseases, raise the chances of contracting TB. Without TNF, a key part of the defense against it is defunct.

The findings may lead to a radical reassessment of TNF’s role in immune function — and new treatment possibilities. “TNF is required for immunity against Mtb, but it seems to be redundant for immunity against many other pathogens,” Casanova says. “So the question is, what other pro-inflammatory cytokines are doing the jobs we thought TNF was doing? If we can discover that, we may be able to block these cytokines rather than TNF to treat diseases where inflammation plays a role.”

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Doughnut-shaped region found inside Earth’s core deepens understanding of planet’s magnetic field

A doughnut-shaped region thousands of kilometres beneath our feet within Earth’s liquid core has been discovered by scientists from The Australian National University (ANU), providing new clues about the dynamics of our planet’s magnetic field.

The structure within Earth’s liquid core is found only at low latitudes and sits parallel to the equator. According to ANU seismologists, it has remained undetected until now.

The Earth has two core layers: the inner core, a solid layer, and the outer core, a liquid layer. Surrounding the Earth’s core is the mantle. The newly discovered doughnut-shaped region is at the top of Earth’s outer core, where the liquid core meets the mantle.

Study co-author and ANU geophysicist, Professor Hrvoje Tkalčić, said the seismic waves detected are slower in the newly discovered region than in the rest of the liquid outer core.

“The region sits parallel to the equatorial plane, is confined to the low latitudes and has a doughnut shape,” he said.

“We don’t know the exact thickness of the doughnut, but we inferred that it reaches a few hundred kilometres beneath the core-mantle boundary.”

Rather than using traditional seismic wave observation techniques and observing signals generated by earthquakes within the first hour, the ANU scientists analysed the similarities between waveforms many hours after the earthquake origin times, leading them to make the unique discovery.

“By understanding the geometry of the paths of the waves and how they traverse the outer core’s volume, we reconstructed their travel times through the Earth, demonstrating that the newly discovered region has low seismic speeds,” Professor Tkal?i? said.

“The peculiar structure remained hidden until now as previous studies collected data with less volumetric coverage of the outer core by observing waves that were typically confined within one hour after the origin times of large earthquakes.

“We were able to achieve much better volumetric coverage because we studied the reverberating waves for many hours after large earthquakes.”

Study co-author, Dr Xiaolong Ma, said that the discovery uncovers some mysteries of the dynamics of Earth’s magnetic field.

“There are still mysteries about the Earth’s outer core that are yet to be solved, which requires multidisciplinary efforts from seismology, mineral physics, geomagnetism and geodynamics,” Dr Ma said.

The outer core is predominantly made of liquid iron and nickel, and the vigorous movement of the electrically conductive liquid creates Earth’s magnetic field, which shields around Earth and helps to sustain all life, protecting it from damaging solar winds and harmful radiation.

The scientists believe that knowing more about the Earth’s outer core’s composition, including light chemical elements, is fundamental to understanding the magnetic field and predicting when it could potentially cease or weaken.

“Our findings are interesting because this low velocity within the liquid core implies that we have a high concentration of light chemical elements in these regions that would cause the seismic waves to slow down. These light elements, alongside temperature differences, help stir liquid in the outer core,” Professor Tkalčić said.

“The magnetic field is a fundamental ingredient that we need for life to be sustained on the surface of our planet.

“The dynamics of Earth’s magnetic field is an area of strong interest in the scientific community, so our results could promote more research about the magnetic field on both Earth and other planets.”

The research is published in Science Advances.

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