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Friday, October 28, 2016

Morning Rounds by Megan Thielking

Happy Friday! Before you kick off for the weekend, get ahead of the day's science and medicine news. For more STAT stories, check out our Facebook

States weigh legalizing marijuana on Election Day

record number of states are voting on marijuana use come November 8, including five that are considering legalizing the drug for recreational use. Those states — Arizona, California, Maine, Massachusetts and Nevada — would join the other four states that've already done the same. And another four states — Arkansas, Florida, Montana, and North Dakota —  are considering giving marijuana the green light for medical use. Currently, 25 states have legalized medical marijuana. Advocates for legalization say it'll create millions in tax revenue, relieve the criminal justice system, and offer a new treatment for some sick patients. But there's also concern about what it'll mean for large corporations to get involved in marijuana — and that legalization will encourage more potent products onto the market. For more on the legislation, read this

Concussion experts convene to talk sideline screening

Experts across the world have converged in Berlin for an international meeting on concussions in sports. The meeting kicked off yesterday with a special focus on sideline screening of athletes who’ve taken hits to the head. Specifically, the group — made up of doctors and academic researchers — debated what could be done to enhance the reliability of sideline screening to accurately diagnose concussions. Today they’ll be talking risk reduction, pediatric brain injuries, and the prevalence of CTE, or chronic traumatic encephalopathy, in concussion patients. The conference meets every four years to go over what’s changed in the field of concussion research. Back in 2012, the group produced a consensus statement that’s widely cited in the field. That statement laid out what a concussion is, how it should be evaluated, and best practices for managing concussions once they happen. 

Lab Chat: Exhausted T cells complicate cancer therapy

The body’s immune T cells fight off foreign invaders, but in patients with cancer and chronic diseases, they get tired from that constant battle. And it’s not just the body’s natural T cells that get exhausted. Engineered cells known as CAR-T cells — which aim to identify tumor cells and are being tested as cancer treatments — can get worn out, too. Now, scientists have a clearer picture of what's happening inside those tired T cells. Here’s what researcher Dr. Nick Haining of Dana-Farber told me about the research, published in Science.  

What’s the importance of studying T cell exhaustion?

These so-called exhausted T cells seem to be one of the main reasons patients can’t get rid of their cancer or clear their infection. T cell exhaustion seems to be a problem not only in natural T cells but also engineered CAR-T cells. Therapeutic CAR-T cells seem to work really well in blood cancers, but not so well in solid cancer or brain tumors. That’s because the CAR-T cells themselves become exhausted like natural ones.

What did you discover about those exhausted T cells? 

We’ve known [that] exhausted T cells have a different pattern of gene expression — including high levels of PD-1 — than their functional counterparts. We set out to address whether those two cells are actually functionally different. So we used a new technique to map all the regulatory regions across the genome of T cells. Those regions are like thermostats — each one can be turned up or down. When we compared functional T cells and their exhausted counterparts, we found the molecular circuitry was fundamentally different in exhausted cells. And if the wiring is completely different, that opens up a whole new way to engineer CAR-T cells so they don’t become exhausted. Rather than destroy a gene like PD-1 that you don’t like, you can destroy the thermostat that controls it. 

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At 60, Sal Ragusa overcame heart failure to take on his biggest coaching role yet

In recent years, Sal had become increasingly tired — too tired to do routine activities such as walking up the stairs in his house, carrying a gallon of milk a few feet, or even playing with his young grandson. After an advanced heart failure diagnosis, Sal received a left ventricular assist device (LVAD) to help his heart pump blood and, today, he’s helping his grandson hit a “home run.” Sal was recently named a winner of Mended Hearts’ “Thanks to an LVAD …” Video Contest. Click here to see other winning videos and to see Sal’s pitching skills in action.

Inside STAT: The science of fear

(hyacinth empinado / stat)

It feels like your body reacts a million different ways when you get scared — the blood rushes out of your face, your muscles tense up, your heart starts racing. But what’s happening inside your body that makes you feel afraid? It all comes down to a tiny, almond-shaped structure in the brain that’s called the amygdala. It’s responsible for kickstarting your “startle response.” That sends out a distress signal to the hypothalamus, and from there, your brain makes the call between fight and flight. We’ve got more about the science of fear in the new episode of Boddities — watch here

New study revives the cranberry juice for UTIs debate

A new study is giving some fresh juice to the debate over whether cranberries can treat urinary tract infections. UTIs are one of the most commonly diagnosed infections among nursing home residents. Cranberry capsules — supplements chock full of some of the chemicals found in cranberries — have been touted as an alternative to antibiotics to treat those infections. But there hasn’t much research on whether they actually work. In the latest study, researchers randomly assigned 185 women in nursing homes to either receive two oral cranberry capsules or a placebo every day. They found no significant difference in the presence of the bacteria blamed for UTIs between the two groups, nor was there a significant difference in the rate of symptomatic UTIs.

The biggest hurdles on World Stroke Day

More than 75 percent of the 795,000 strokes suffered annually in the US occur in people over age 65 — and that’s posing a particularly tricky problem for the American Stroke Association. "The American Stroke Association is in the midst of an ambitious 10-year impact goal to reduce stroke mortality by 20 percent by 2020," says Stephanie Mohl, vice president of the ASA. But Mohl says the aging population is a significant challenge to reducing stroke prevalence. Another obstacle: high rates of hypertension, Mohl says. As World Stroke Day approaches tomorrow, the American Stroke Association is also doubling down on its efforts to help the public recognize signs of a stroke as early as possible. They’ve come up with a simple acronym, FAST, to make that happen: If there’s face drooping, arm weakness, and speech difficulty, it’s time to call 911. 

What to read around the web today

  • EpiPen price hikes add millions to Pentagon costs. Reuters
  • The US is standing in the way of cheaper drugs for the poor. New York Times
  • What counts as science? Nautilus

More reads from STAT

Thanks for reading! Back bright and early on Monday morning, 

Megan

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