American Cancer Society nutrition and physical activity guideline for cancer survivors

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.     

Red blood cell exchange to avoid intubating a COVID-19 positive patient with sickle cell disease?

As the COVID-19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID-19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation.     

Public support for bicycling and transport policies in inner Sydney,Australia: a cross‐sectional survey

Objective : To describe the degree of community support – and factors associated with this support – for a number of potential transport policy options among an inner‐city sample of residents in Sydney, Australia. Methods : This study analysed data collected from a cross‐sectional online survey: Wave 3 of the Sydney Transport and Health Study, conducted in September–October 2015 (n=418). Results : There was a high level of overall support for policies to make public transport cheaper (85%), have more bicycle paths separated from motor vehicles (82%) and have a public bike‐share program (72%), with similar levels of support across usual commute mode, age and sex. Conclusions : Despite a natural tendency for respondents to support transport policies that were of most relevance to themselves, it appeared that, in this sample, public support for public transport and bicycling policies remained strong across all respondents. Implications for public health : Policies that support public transport and active travel and achieve positive health outcomes would be well received by inner‐Sydney residents.     

Precision medicine in chronic disease management: The multiple sclerosis BioScreen

We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine—that is, the application of information technology to medicine—has the potential to radically transform medical practice. We introduce 3 key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real‐time use of the data to assist decision making). Together, these form the stepping stones that are expected to accelerate standardization of data across platforms, promote evidence‐based medicine, support shared decision making, and ultimately lead to improved outcomes. Ann Neurol 2014;76:633–642     

Differential diagnosis of mut and cbl methylmalonic aciduria by DNA-mediated gene transfer in primary fibroblasts.

Methylmalonic aciduria can be caused by mutations in the gene encoding the methylmalonyl coenzyme A mutase apoenzyme (mut) or genes required for the provision of cofactor B12 (cbl). The mut and cbl forms are classically differentiated by somatic cell complementation. We describe a novel method for differential diagnosis of mut and cbl methylmalonic aciduria using DNA-mediated gene transfer of a methylmalonyl CoA mutase cDNA clone. Gene transfer of a functional methylmalonyl CoA mutase cDNA clone into mut fibroblasts reconstitutes holoenzyme activity measured by metabolism of [14C]-propionate in culture. Identical gene transfers into cbl fibroblasts have no effect. This method is used for the differential diagnosis of mut and cbl genotypes in cells from patients with a clinical diagnosis of methylmalonic aciduria and is shown to be a facile, sensitive, and specific method for genetic diagnosis. This work establishes the principle of using DNA-mediated gene transfer to identify the genotype of diseases which can result from mutations at several different genetic loci. This type of differential genotypic diagnosis will be particularly important for establishing the applicability of somatic gene therapy in individual patients.     

Laser refrigeration of hydrothermal nanocrystals in physiological media

Coherent laser radiation has enabled many scientific and technological breakthroughs including Bose–Einstein condensates, ultrafast spectroscopy, superresolution optical microscopy, photothermal therapy, and long-distance telecommunications. However, it has remained a challenge to refrigerate liquid media (including physiological buffers) during laser illumination due to significant background solvent absorption and the rapid (∼ps) nonradiative vibrational relaxation of molecular electronic excited states. Here we demonstrate that single-beam laser trapping can be used to induce and quantify the local refrigeration of physiological media by >10 °C following the emission of photoluminescence from upconverting yttrium lithium fluoride (YLF) nanocrystals. A simple, low-cost hydrothermal approach is used to synthesize polycrystalline particles with sizes ranging from <200 nm to >1 μm. A tunable, near-infrared continuous-wave laser is used to optically trap individual YLF crystals with an irradiance on the order of 1 MW/cm². Heat is transported out of the crystal lattice (across the solid–liquid interface) by anti-Stokes (blue-shifted) photons following upconversion of Yb³⁺ electronic excited states mediated by the absorption of optical phonons. Temperatures are quantified through analysis of the cold Brownian dynamics of individual nanocrystals in an inhomogeneous temperature field via forward light scattering in the back focal plane. The cold Brownian motion (CBM) analysis of individual YLF crystals indicates local cooling by >21 °C below ambient conditions in D₂O, suggesting a range of potential future applications including single-molecule biophysics and integrated photonic, electronic, and microfluidic devices.Advances in cryogenic sciences have enabled several observations of new low-temperature physical phenomena including superconductivity (1), superfluidity (2), and Bose–Einstein condensates (3). Heat transfer is critical in numerous fields of science and technology including thermal management within integrated microelectronics (4–6), photonic (7, 8) and microfluidic (9) circuits, and the regulation of metabolic processes (9–11). In 1929, Pringsheim (12) proposed that solid-state materials could experience refrigeration if they exhibited biased emission of anti-Stokes (blue-shifted) radiation relative to a fixed optical excitation wavelength. Epstein et al. (13) experimentally demonstrated this concept first in 1995 using rare-earth–doped fluoride glass materials. Optical refrigeration of a condensed phase with a rhodamine dye by anti-Stokes radiation has previously been reported (14–16) but the results remain controversial (17, 18). More recently, it has been shown that rare-earth–doped yttrium lithium fluoride (Yb³⁺:YLF) crystals grown in high-temperature Czochralski reactors (19) can be cooled to cryogenic temperatures ( ～ 90 K) (20) in vacuo using continuous-wave near-infrared (NIR) laser excitation. Furthermore, the laser refrigeration of doped yttrium aluminum garnet (Yb³⁺:YAG) materials has recently been reported in air at atmospheric pressure (21). Anti-Stokes photoluminescence has also been reported (22) to cool cadmium sulfide (CdS) nanoribbons in vacuo by as much as 40 °C below room temperature. In contrast with anti-Stokes processes, optomechanical laser refrigeration has also been demonstrated based on a novel mechanism of angular momentum transfer between a circularly polarized laser and a birefringent crystal (23).To date, laser refrigeration of nanocrystals in aqueous media has not been reported stemming primarily from the large NIR optical absorption coefficient of water (α_H2O|_975nm ～ 0.5/cm) (24). It has remained an open question whether these known cooling materials could act to refrigerate aqueous media and undergo hypothesized cold Brownian motion (CBM) (25, 26), or whether solvent heating from the background absorption coefficient of water would overwhelm the cooling of individual YLF crystals. Furthermore, it is not obvious a priori that YLF crystals made through hydrothermal processing would have sufficiently low background impurity levels to achieve laser cooling (27, 28). In this work, we demonstrate the local laser refrigeration of hydrothermal YLF nanocrystals dispersed within several different aqueous media including deionized water, heavy water (D₂O), and physiological electrolytes. Refrigeration  > 10 °C below ambient conditions is observed in PBS following anti-Stokes photoluminescence from optically trapped (29), rare-earth–doped YLF nanocrystals undergoing CBM.