Category: 8. Health

Spinal cord injuries can cut off communication between the brain and neurons that control leg movements, causing paralysis. Despite decades of research, there are very few therapies that can restore the ability to walk afterwards.

For work identifying a novel therapeutic target to improve walking after SCI, Newton Cho is the 2025 winner of the Science & PINS Prize for Neuromodulation. The prize rewards innovative research that modulates neural activity to advance our understanding of human health or to guide therapeutic interventions.

Cho discovered a circuit in the brain that could accelerate recovery after SCI. In his prize-winning essay in Science, he describes how electrical stimulation of this circuit led to long-term improvements in walking in two people with partial SCI.

“The winning essay written by Dr. Cho succinctly and beautifully showcases the potential of neurostimulation for ameliorating spinal cord injury,” said Mattia Maroso, senior editor at Science. “The judges were particularly impressed by the quality of the research, suggesting it could represent an unconventional, paradigm-shifting approach for treating this condition.”

More than just scientific curiosity

For Cho, the drive to find improved therapies for SCI stems from a very personal connection. 

“When I was much younger, one of my family members actually suffered a spinal cord injury,” he said. “We as a family saw first-hand the devastating effects of that kind of injury in terms of emotional stress, physical stress, and the economic consequences of it.”

Attempts to treat SCI with neuroprotective drugs or by regenerating parts of the spinal cord have produced mixed outcomes. More recently, combining rehabilitation with electrical stimulation of the lower spine — to activate remaining neural circuits that orchestrate movement — has had some success in restoring walking. Despite these advances, recovery is not always guaranteed or complete. 

Looking beyond the spine

Cho wondered if a different approach might be warranted to address this challenge. In his essay, he argues that to improve walking after an injury, scientists must first understand how the brain controls the process.

“Even though the injury is directly to the spinal cord, there are circuits in the brain that are suboptimally activated afterwards,” explained Cho, a surgeon and scientist at the University of British Columbia as part of the International Collaboration on Repair Discoveries . “The ‘normal’ brain as it’s directing walking isn’t necessarily the same brain that’s directing walking after spinal cord injury.”

To trigger walking, the brain sends instructions to neural circuits within the spinal cord, which then activate leg muscles. When the spinal cord is damaged, circuits near the injury site and in the brain undergo reorganization. In less severe cases of SCI —involving partial, or incomplete, severance of circuits — this reorganization can prompt the spontaneous (but limited) recovery of walking.

Cho and his colleagues surmised that an unbiased examination of the entire brain could reveal these pathways and thereby uncover new therapeutic targets to aid recovery. In a 2024 study in Nature Medicine, they tested this theory by performing whole-brain imaging on mice recuperating after SCI. 

Unexpectedly, this analysis revealed increased connectivity and activity in a region known as the lateral hypothalamus. Although prior studies have targeted this region to treat other disorders in humans, it had not been previously linked to SCI.

The researchers then stimulated the lateral hypothalamus in different rodent models of SCI. They found that activating a subset of excitatory neurons led to an immediate improvement in walking. Finally, Cho and his team enrolled two people with incomplete SCI in a preliminary clinical trial and observed that deep brain stimulation of the lateral hypothalamus produced long-lasting walking enhancements without causing any serious side effects. 

“These achievements have expanded the therapeutic spectrum of neuromodulation. Such progress offers new prospects for neuroscientific research and clinical practice,” said PINS Medical CEO Hao Hongwei. 

Being recognized for his work feels like validation for his somewhat unconventional focus on brain circuits in relation to SCI, Cho said.

“It’s good to know that other people feel just as strongly and passionately about what I’m doing, and that I’m on the right path,” he added.

A step in the right direction

Cho is optimistic about what his findings portend for the future of SCI therapies, and notes that larger trials will be necessary to determine efficacy.

He hopes to combine deep brain stimulation with spinal cord stimulation to test whether the two treatments produce complementary effects to restore walking. Cho is also interested in applying lateral hypothalamus stimulation to treat patients with cervical injuries, which occur higher in the spine and impact hand function.

Finalist

Huiliang Wang is a 2025 finalist for his essay, “Rapid deep brain chemogenetics.” Wang received an undergraduate degree from the University of Oxford and completed his Ph.D. and postdoctoral fellowship at Stanford University. In 2021, he started his laboratory at the University of Texas at Austin. His research group focuses on the development of nanomaterials, electronics and genetic approaches for advanced neurotechnology.

A new study conducted by scientists at the University of California San Francisco (UCSF) has made significant strides in understanding the connections between endometriosis and a range of other health conditions. Using big data from patient records across six health centers within the University of California system, the researchers uncovered over 600 correlations between endometriosis and other diseases. The findings, which were published on July 31, 2025, in Cell Reports Medicine, reveal that this common yet often underdiagnosed condition frequently occurs alongside a variety of other disorders, including some unexpected ones like cancer and asthma.

Endometriosis is a chronic condition affecting about 10% of women globally, often leading to debilitating symptoms such as chronic pelvic pain, painful menstruation, and infertility. The research sheds new light on the disease’s complexity and suggests that understanding these links could help improve both diagnosis and treatment strategies for endometriosis.

Uncovering unexpected correlations through data

Endometriosis develops when tissue similar to the lining of the uterus grows outside the uterus. This ectopic tissue leads to inflammation, pain, and scarring, and may cause complications with fertility. Traditionally, the gold standard for diagnosing endometriosis is surgery, which can confirm the presence of this ectopic tissue. Treatment options typically include hormone therapy to manage symptoms or surgery to remove excess tissue. However, not all women respond well to these treatments, and some may continue to experience symptoms even after surgery or hysterectomy.

The UCSF researchers set out to explore how endometriosis might relate to other diseases using the vast amount of patient data available in the UC health system. The researchers, led by Dr. Marina Sirota, PhD, interim director of the UCSF Bakar Computational Health Sciences Institute (BCHSI), used computational methods to analyze electronic health records (EHRs) from UC health centers, focusing on correlations between endometriosis and other medical conditions.

They discovered that, in addition to commonly recognized associations like infertility, autoimmune diseases, and gastrointestinal disorders, endometriosis was also linked to other, more unexpected conditions, such as certain types of cancer, asthma, and eye diseases. The findings indicate that the effects of endometriosis may extend beyond the reproductive system and could impact multiple areas of health.

Analyzing data at scale

The research team employed advanced computational algorithms to sift through the health records and identify these correlations. Lead author Umair Khan, a bioinformatics graduate student in Dr. Sirota’s lab, played a key role in analyzing the data. He compared patients diagnosed with endometriosis to those without it, categorizing them based on shared health histories and searching for recurring patterns in the data.

Through this approach, the team identified hundreds of correlations that had not been fully explored in previous studies. Some of these associations were known or suspected, like infertility, autoimmune disorders, and acid reflux. However, others were more surprising, such as links to asthma, various cancers, and even eye-related diseases. These findings offer a broader view of how endometriosis may affect women’s overall health.

For instance, the study revealed that some patients with endometriosis also experienced migraines, supporting earlier research that suggested that migraine medications could potentially be used as a treatment for the chronic pain associated with endometriosis. This data-driven insight could open doors for new treatment options that are more targeted to specific symptoms or comorbidities of the disease.

Endometriosis as a multisystem disorder

This study also contributes to the growing understanding of endometriosis as a multisystem disorder. The disease, once thought to mainly affect the reproductive system, is now recognized as a condition that may influence other bodily systems, potentially explaining why some patients experience symptoms beyond the typical pelvic pain.

Dr. Linda Giudice, MD, PhD, MSc, a physician-scientist at UCSF and co-author of the study, emphasized the profound impact that endometriosis has on women’s lives. She described the condition as debilitating, with effects that extend to patients’ ability to maintain relationships, hold jobs, have families, and preserve psychological wellbeing. The findings from this study reinforce the importance of considering the broader health implications of endometriosis, beyond just its reproductive aspects.

The researchers believe that these insights could ultimately lead to faster and more accurate diagnosis of endometriosis. In particular, the use of large-scale patient data could provide a more comprehensive picture of how the disease presents across different individuals, improving physicians’ ability to identify it earlier. Moreover, understanding the complex relationships between endometriosis and other health conditions could allow for more personalized treatment options tailored to each patient’s unique health profile.

The role of electronic health records in advancing research

The study also highlights the growing potential of electronic health records (EHRs) in advancing medical research. The large-scale analysis of EHR data has only become feasible in recent years, with patient data being de-identified and made available for research purposes. As Dr. Tomiko Oskotsky, MD, a co-author of the study, pointed out, just over a decade ago, the availability of such data on this scale was unimaginable. Today, it is a powerful tool for uncovering patterns that might otherwise go unnoticed.

By integrating data from multiple UC health centers, the researchers were able to ensure the robustness and generalizability of their findings. The fact that these associations held true across different hospitals and patient populations further strengthens the validity of the results.

The research team is optimistic that this approach could revolutionize how endometriosis is diagnosed and treated, as well as how other complex diseases are understood. By utilizing big data, the medical community can gain deeper insights into the intricate ways diseases affect the body, leading to better outcomes for patients.

Reference: Khan U, Oskotsky TT, Yilmaz BD, et al. Comorbidity analysis and clustering of endometriosis patients using electronic health records. Cell Rep Med. 2025. doi: 10.1016/j.xcrm.2025.102245

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Caffeine may help some bacteria keep antibiotics out of their cells, potentially reducing the therapeutic effects of the drugs, a new laboratory study hints.

However, experts caution that it’s not yet clear how this effect might play out in humans, so caffeine drinkers needn’t panic yet.

Employees of the technology transfer centre ANAXAM and researchers from the Paul Scherrer Institute PSI used the unique analytical methods available at PSI to look inside pre-filled syringes. They found that, in rare cases, zinc from the needle shield can leach into the drug solution to be injected and possibly contribute to syringe clogging.

The task which the employees of the technology transfer centre ANAXAM set themselves, together with colleagues at the Paul Scherrer Institute PSI, can be likened to looking for a needle in a haystack. They were asked by the pharmaceutical company MSD (a trade name of Merck & Co., Inc., Rahway, N.J., USA) to find out whether tiny amounts of the element zinc can get inside the needles of pre-filled syringes and, if so, where it lodges in the needles.

The background is the observation that, in rare cases, the needles of pre-filled syringes (PFS) can become blocked, for example if the syringes are not stored in a cool enough environment. This phenomenon has been known for some time and has already been studied by ANAXAM. However, what has remained unclear is exactly what triggers the blockage. One suggestion was that zinc from the needle shield – the rubber cap into which the needle is inserted when the syringe is manufactured – could leach into the drug solution to be injected, making it more viscous, which would ultimately lead to blockages.

To investigate this theory, the team led by ANAXAM has now resorted to sophisticated methods of detection. These allowed them to look inside the blocked hypodermic needles and check whether and where zinc was present. The results have now been published in the journal Pharmaceutical Research.

Convenient pre-filled syringes

Pre-filled syringes are widely available, practical and easy to use, both for healthcare professionals and for patients. The amount of solution to be injected is precisely measured, which virtually rules out dosing errors, for example. The fact that their needles can become clogged, especially when the solution to be injected is highly concentrated, is a well-known issue in the pharmaceutical industry and has also been raised during licensing applications. There have also been cases of clogged needles which have led to products being recalled. “So Merck was very interested in knowing whether zinc could in fact find its way into the needles and cause the blockage,” says Vlad Novak, project manager at ANAXAM.

This meant that several questions had to be answered. Is there zinc inside the needle? And if so, where do they come from? What does the inside of a clogged needle look like? And is the zinc also present in the solution being injected, which could ultimately lead to the blockage?

Tracking the zinc

MSD was able to answer the first question in-house using mass spectroscopy. Yes, the dried solution in the needle contained zinc, and this had to come from the needle shield. This followed from the fact that no zinc was detected in a control experiment in which the needle shield was omitted. However, to carry out these analyses MSD first had to extract the material from the needle and then feed it into the mass spectrometer. This meant that the MSD researchers could not determine exactly where the zinc was located in the blockage. To answer this, they needed analytical methods that went beyond the scope of a conventional laboratory. They found these at ANAXAM.

As a technology transfer centre, ANAXAM offers its customers unique imaging and spectroscopic methods that can be achieved using the large research facilities at PSI. “PSI’s strength lies in the fact that we operate several highly complex instruments at a single site, which we can combine with each other and make available to industry under the direction of ANAXAM,” says Margie Olbinado. The PSI physicist used synchrotron radiation from the Swiss Light Source SLS to look inside the needles and locate the blockage.

Olbinado did this at SLS’s TOMCAT beamline. This facility can be used to produce computed tomograms. The system works much like a CT scan in a hospital, but uses synchrotron radiation, special X-rays which are partially coherent and can therefore interfere with each other. This property allows researchers to visually record even the tiniest amounts of material in an ultra-thin hypodermic needle made of stainless steel – with an internal diameter of less than 200 micrometres. In this particular case, the result was a clear image of the dried solution inside the clogged needle.

X-ray fingerprint

Finally, to answer the last question – Is there really zinc inside the clogged needles? – they used a technique known as SR-XRF (synchrotron-based X-ray fluorescence), for which PSI’s Dario Ferreira Sanchez was responsible. “This tool allows us to produce a visual record of the characteristic ‘fingerprint’ of certain chemical elements inside the hypodermic needle with high spatial resolution,” says Ferreira Sanchez.

Sanchez achieves this by using X-rays of a very specific wavelength, which remove one of the inner electrons from the atom. The electrons of an atom are arranged in a series of shells, whereby the electrons in the inner shells are most tightly bound to the nucleus. However, even such an electron can be torn away from the atom by high-energy X-rays. When this happens, an electron from one of the higher shells takes its place, in turn emitting X-rays. Ferreira Sanchez was able to record these X-rays and determine which element had produced them.

The X-ray fingerprint revealed that there was indeed zinc in the solution blocking the needle. Putting all this together, the ANAXAM team was able to conclude that zinc leaches from the needle shield into the drug solution when the syringe is stored at temperature of 40 degrees. Zinc can promote protein gelation and viscosity increase of the formulation contributing to syringe clogging. When stored correctly (5 degrees) no zinc was detected.

The results of this tricky detective work will give the pharmaceutical company MSD a better understanding of the complex causes of blockages in pre-filled syringes, so that they can be better prevented. This will make these syringes, which are already very safe and reliable, even safer in the future.

Should physicians use conventional medicine or lifestyle medicine to treat their patients? Those treatment protocols go hand-in-hand, so the best doctors will combine elements of both. School of Medicine Greenville Professor Jennifer L. Trilk, PhD, FACSM, DipACLM, explains why it is not a question of either-or.

Trilk is a co-author of “Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement,” published in JAMA Network Open. The authors’ goal was to recommend nutrition competencies in medical education to improve patient and population health. She is the co-founder of the Lifestyle Medicine Education Collaborative, which has published free medical education curriculum materials on lifestyle medicine.

Jennifer L. Trilk, PhD, FACSM, DipACLM: I always say to the medical students, it’s not an either-or. It’s not either you put a patient on medication or you utilize lifestyle — they go very much hand in hand. So we don’t want to demonize one or the other. You really want to use them as partners, as adjunct. If a patient comes in and has uncontrolled hypertension, you need to utilize the pharmaceuticals and the medications to bring that high blood pressure down so that the high blood pressure doesn’t cause a stroke or myocardial infarction, which is called a heart attack, and yes, absolutely utilize those medications to help the patient. And then over time, because we know that lifestyle behaviors take time, over time, use the lifestyle modifications with the patient talking with them, so that they can eventually reduce the dosage of the medication, or maybe even reduce medication altogether. So we want to make sure that we utilize those hand-in-hand. But if a patient is newly diagnosed with Type 2 diabetes, and, you know, has a has an A1c that’s maybe in that 6.5 to 7.5 range to where they just have started that, we highly recommend, hey, let’s talk with your patient about the changes that they may be able to make to not need to get on medication in the first place and put Type 2 diabetes in remission. Because there’s evidence around that Type 2 diabetes absolutely can go into remission without medications if proper lifestyle is managed. There’s definitely a place for both. The one thing I say with this, with our students and our future doctors, is, if you’re going to utilize a medication, be a very responsible physician, and don’t just send out a medication or prescribe a medication with your with your patient, without talking to them about their lifestyle and how they got that disease in the first place. That is being a responsible doctor. So utilizing both and making sure you’re being responsible in your management of your patient.

ST. PAUL, Minn., July 31 (UPI) — Doctors are routinely “underdosing” statins for patients at risk for heart attacks and strokes due to elevated levels of “bad” cholesterol, even though the drugs have proven safe and effective, a top U.S. researcher maintains.

At a time when an estimated 40% of U.S. adults have metabolic syndrome — a combination of heart risk factors including obesity, hypertension, dyslipidemia and insulin resistance — doctors usually don’t start them off with the maximum dosage of statins, even though they can quickly lower levels of LDL cholesterol, according to an opinion published this month in the medical journal Trends in Cardiovascular Medicine.

Co-author Dr. Charles Hennekens, the Sir Richard Doll Professor of Medicine and Preventive Medicine at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, says his analysis of several major clinical studies of the new generation of highly potent statins, such as rosuvastatin and atorvastatin, shows that maximal doses are safe and sorely needed, but aren’t being prescribed.

Those with metabolic syndrome have cardiovascular risks equivalent to those with prior heart attacks or strokes, yet many are “undertreated” by starting their statin regimens at low or moderate dosages, Hennekens told UPI.

“The data indicate that over half of people who were put on a statin remain on the initial dose they’re given, so even though the intent may be to titrate it up, it’s not done in the majority of instances,” he said. “So, you get on a low dose of statin and you stay on it.”

But this “flies at the face of the data” showing that statins “have the strongest and most consistent body of evidence supporting their prescription in treatment and prevention in both men and women including older adults,” he said. “There’s no threshold for LDL below which you don’t see incremental benefits.”

The studies demonstrate newer statins can lower LDL, or bad cholesterol, in as quickly as a month and can provide related benefits, such as stabilizing the build-up of harmful plaque on the cells that line the interior surface of blood vessels, Hennekens said.

Therefore, he urges cardiologists who initiate drug therapies for those with metabolic syndrome to start statins at maximal tolerated levels.

“Everything points to getting on the highest dose of evidence-based statin,” he noted. “The goal of LDL in the high-risk secondary patients is less than 50 [milligrams per deciliter], and we have a lot to do to achieve that goal because there are lots of forces in society, especially in American society, that are making that more difficult.

“For example, in the United States today, in middle-age people gain 7 to 10 pounds of body weight every 10 years, so we have a society that’s fatter, but only about 21% of Americans reach the daily minimum recommendation for daily physical activity, Hennekens said.

“We have a nation that would benefit enormously from therapeutic lifestyle changes, but in the end, we have such high absolute risk that many are going to require adjunctive therapy.”

And if so, “we make a strong case that the first one you should consider is a statin, and that every other adjunctive therapy should be viewed in the context of residual risk after the statin is given with maximal doses,” Hennekens added.

Other experts on the use of statins to control LDL cholesterol contacted by UPI generally agreed with the premise that dosages should start at maximum levels for those at high risk of heart disease.

Dr. Laurence Sperling, the Katz Professor in Preventive Cardiology at the Emory University School of Medicine in Atlanta, noted it’s already on a list of guidelines developed in 2018 by an American College of Cardiology/American Heart Association joint task force.

“In patients with clinical atherosclerotic cardiovascular disease, [the guidelines say] reduce LDL cholesterol with high-intensity statin therapy or maximally tolerated statin therapy,” he said. “The more LDL cholesterol is reduced on statin therapy, the greater will be subsequent risk reduction.”

Sperling said he agreed with the recommendation to use “a maximally tolerated statin to lower LDL-C levels by 50%.”

Joseph Saseen, a researcher and professor of clinical pharmacy at the University of Colorado’s Skaggs School of Pharmacy and Pharmaceutical Sciences in Boulder, told UPI one reason for the low-dosage prescriptions is that cardiologists overestimate the chances of possible side effects, such as muscle aches and digestive problems.

“While dose-related side effects can occur, they do not justify the routine underdosing of statins in high-risk populations,” Saseen said. “Clinicians too often initiate therapy at suboptimal doses, particularly in patients with elevated [cardiovascular] risk. Evidence-based guidelines recommend starting high-intensity statin therapy, especially very high-risk secondary prevention patients.”

Clinical data have shown, for instance, that initiating atorvastatin at as much as 80 mg. daily “is both safe and effective in reducing cardiovascular events among secondary prevention patients,” Saseen said. “Similarly, rosuvastatin at 20 mg. has been shown to be a safe and effective starting dose in primary prevention patients with elevated [high-sensitivity C-reactive protein].”

Also agreeing with Hennekens’ conclusion is Dr. Paul Heidenreich, a practicing cardiologist, professor at the Stanford University School of Medicine and chief of medicine at the Palo Alto, Calif., Veterans Affairs clinic.

“When high intensity statins are indicated, one can recommend starting with the high intensity or beginning with moderate intensity followed by up-titration,” he said.

He noted some cardiologists are concerned that if patients can’t tolerate a high-intensity statin, they may subsequently refuse all statins, in which case it may be better to start off with a moderate dose.

“However, I feel it is rare that the patient will refuse to try a lower dose,” Heidenreich said. “As the authors note, titration to a higher intensity is not as frequent as it should be, with patients staying on the initial intensity. Thus, patients are likely better off starting with the recommended high-intensity statin.”

The clinical data also showed that the rate of intolerance with a placebo “was surprisingly high, suggesting that patients are on the lookout for any new symptom that occurs following initiation of a new medication. It is important to stress that the vast majority of patients tolerate statins medications without side effects,” he said.

A new study reveals that some men who are diagnosed with “Grade Group one” (GG1) prostate cancer may actually be at higher risk than biopsy results suggest, according to research led by Weill Cornell Medicine, University Hospitals Cleveland and Case Western University. The researchers conclude that relying on biopsy grade alone can lead to underestimating disease risk and misclassifying individuals who may benefit from definitive treatment with either surgery or radiation. Biopsies test only small areas of the prostate, so they can miss more advanced or aggressive cancer cells, providing an incomplete picture.

The study, published July 31 in the journal JAMA Oncology, found that one in six men with GG1 category cancer turns out to have intermediate- or high-risk cancer when other clinical features are considered in addition to biopsy results. “We don’t want to miss aggressive cancers that initially present as Grade Group one on biopsy,” said co-senior author Dr. Bashir Al Hussein, an assistant professor of urology and population health sciences at Weill Cornell Medicine. “Such underestimation of risk could lead to undertreatment and poor outcomes.”

The study results could also inform recent discussions on whether to drop the cancer label completely for GG1 tumors. “There is a misunderstanding that ‘low grade’ and ‘low risk’ are the same. Here, we show clearly that they are not,” said co-senior author Dr. Jonathan Shoag, associate professor of urology at Case Western Reserve University and an urologist at University Hospitals Cleveland. “Attempts to rename GG1 are misguided as many patients with GG1 cancers on biopsy have substantial risks of their cancers causing pain and suffering over their lifetime if untreated.”

Accurately Categorizing Tumors Guides Treatment

The team drew on data collected between 2010 and 2020 by the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. “This is real-world, contemporary data representing all men diagnosed with prostate cancer across the United States,” said Dr. Al Hussein, who is also a urologist at NewYork-Presbyterian/Weill Cornell Medical Center and a member of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine. The data included about 300,000 men who were diagnosed with cancer that was localized to the prostate.

Approximately 117,000 of those men had a biopsy that was categorized as GG1. This grade is often used synonymously with a low risk for progression to metastasis, or cancer spreading to other parts of the body. They are usually followed through active surveillance—blood tests to monitor a protein produced by the prostate, additional biopsies and MRI scans. Increasing prostate-specific antigen (PSA) levels in the blood can indicate cancer progression. 

But what if some of these men harbored more aggressive prostate cancers than suggested by their biopsy grade alone? Dr. Al Hussein and his colleagues further analyzed the individuals in the GG1 group with their clinical data such as PSA levels and tumor sizes. When all the data were factored in, the researchers discovered that more than 18,000 of these men had higher risk cancers that are often treated with radiation therapy or removal of the prostate (radical prostatectomy).

“Our data show that up to 30 percent of patients who were diagnosed with GG1 but were in the higher risk category underwent active surveillance, which means they were potentially undertreated,” Dr. Al Hussein said.

What’s in a Name

Understanding how cancer classification correlates with clinical outcomes is particularly critical, as some physicians advocate removing the “cancer” label from GG1 prostate cancer, which could reduce anxiety and unnecessary treatment. They argue that most tumors categorized as GG1 grow slowly and rarely spread or cause harm. However, the paper advises that a one-size-fits-all approach is risky.

“There has been an unfortunate conflation of several different terms by some of my colleagues who are trying to rename GG1 cancer,” explained Dr. Shoag. “One is that biopsy GG1 and prostatectomy GG1 are similar, but they are not. As clinicians, we must make decisions based on each patient and his biopsy results in that context.” The data suggesting that GG1 cancers do not spread is based largely on previous studies of prostatectomy specimens, which examined the whole prostate once it was removed.

“A subset of men with low-grade tumors has adverse clinical features that are associated with worse cancer outcomes. We need to better understand this biology, which could help clinicians improve prognosis,” said first author Dr. Neal Arvind Patel, assistant professor of clinical urology, an urologist at NewYork-Presbyterian/Weill Cornell Medical Center and a member of the Meyer Cancer Center.

Dr. Al Hussein also sees room for improving how patients are counseled. “We need to find a better way to inform patients about their prognosis when they have GG1 prostate cancer with adverse clinical features,” he said. “As physicians, the responsibility falls on us to educate patients and provide them with the information they need to understand their diagnosis and decide on the best approach for treatment, while continuing to advocate for active surveillance for those who are indeed low risk.”

This research is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.

How’s the weather inside your head? If it’s foggy, you are not alone. You may have what people with a variety of health conditions call brain fog — a common term for thinking problems that can make getting through the day a mental slog.

While there’s no official list of symptoms, people with brain fog often say that “their thinking is not clear, it’s cloudy,” says Lynne Shinto, a naturopathic doctor and professor of neurology at Oregon Health & Science University. “They might say, ‘I have problems concentrating.… I feel like I don’t have clarity of thought, and sometimes I forget things.’ ”

Unlike people with dementia or other, more severe cognitive challenges, they often can do what they need to do in a day, but “their thought processes are just slower,” she says.

Cognitive psychologist Julie Dumas, a professor of psychiatry at the University of Vermont, says brain fog can be like “thinking through mud or molasses.”

Brain fog is not a disease or disorder itself, so it’s important to figure out the underlying cause, Dumas says.

A recent research review published in Trends in Neurosciences found that brain fog has been linked with more than a dozen chronic conditions, and exact symptoms and cognitive test results can vary, depending on the apparent cause. That suggests that there’s no one underlying pathway, the researchers said.

Here are some of the most common possible causes of brain fog:

1. Sleep problems

Not getting enough sleep is a major cause of brain fog. If you have chronic insomnia, which can include problems falling or staying asleep, improving your sleep can clear the fog, says Leslie Swanson, a clinical associate professor of psychiatry at Michigan Medicine.

Another sleep disorder strongly tied to daytime sleepiness and foggy thinking is obstructive sleep apnea, a disorder in which people stop breathing repeatedly during sleep. Many people go undiagnosed and untreated for this condition, Swanson says. “Snoring is a red alert” and a good reason to see a doctor.

2. Perimenopause

Women going through the hormonal shifts of perimenopause, the years before periods end, often report brain fog, with problems like forgetting names or having trouble focusing at work, Swanson says. Studies back them up, she says, finding “small declines” in learning and verbal memory.

Part of the explanation is that perimenopause often comes with sleep disturbances, especially unwanted awakenings during the night, Swanson says. Hot flashes cause some, but not all, of those disturbances, she says.

Hormonal shifts may affect sleep and brain functioning even in women who don’t have a lot of hot flashes, she says. The good news, she says, is that the fog tends to lift after menopause.

3. COVID-19 and other infections

When you get the flu, COVID-19 or any infection, especially with a fever, you can get brain fog, which is likely linked to inflammation, Dumas says. But one reason more people are hearing about brain fog these days is that it’s a common part of long COVID, the symptoms that continue or develop after the initial illness, she says.

Shinto says she has seen some long COVID patients with “intense brain fog, where they have a lot of trouble concentrating [and] intense mental tasks are very draining.”

In addition, many are constantly physically exhausted. That combination, along with other symptoms, can be disabling, making it impossible for some people to manage their usual daily activities, she adds.

At least nine asylum seekers on Nauru have contracted dengue fever amid an outbreak on the island, including one man who was medically evacuated to Australia for treatment and then returned this week, according to a legal aid group and an asylum seeker there.

Cases of dengue, also known as break-bone fever, rose sharply in July amid a broader outbreak of the virus in the Pacific. The infection is transmitted through mosquito bites, and those with symptoms can experience a high fever, body aches, headache and nausea. Severe cases may require hospitalisation, and in extreme cases lead to death.

Those infected a second time are at even greater risk of severe dengue.

Nauru’s president, David Adeang, said last week he was “overwhelmed by the increased number of dengue fever cases”, including among families and children.

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Two children died of dengue in Nauru on Wednesday, the government said in a public statement on social media.

“The health of our community depends on the actions we take now,” Adeang said. “This rapid spread of dengue requires every one of us to unite.”

Heidi Abdel-Raouf, the manager of detention casework advocacy at the Asylum Seeker Resource Centre (ASRC), said the group was aware of nine men who have dengue, “but there are reports of many more”.

There are approximately 93 asylum seekers and refugees on Nauru, who mostly live in the community on a stipend of $230 a fortnight from the Australian government. They have been there between two and 22 months, and will never be settled in Australia under government policies. Those with refugee status currently have no resettlement options.

“Many of the men have pre-existing health conditions, which mean that the illness that they have with dengue is just compounding,” Abdel-Raouf said.

“We know from the history of offshore detention that … due to indefinite detention and poor living conditions and limited and inadequate healthcare services, that detention effectively makes people really unwell.”

An asylum seeker on Nauru told the Guardian he was diagnosed with dengue four or five days ago. He said through an interpreter that he still had a fever, his entire body was painful and he could not eat.

He was taken to a facility for blood tests and told to take two tablets of Panadol every six hours after his diagnosis. There is no specific treatment for dengue and doctors generally advise the use of analgesics to control pain.

“I am very concerned because I don’t think the medication, Panadol, will be helping me, especially because I cannot eat,” he said.

“It’s hard to move around, I don’t have enough strength because I cannot eat enough, so I am very concerned.”

Accessing mosquito nets, he said, was “impossible”.

“There are no mosquito nets available anywhere in Nauru.”

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The ASRC said some of the men on Nauru who were sick with dengue had reported difficulties getting enough paracetamol to deal with the pain caused by the virus, with some reporting receiving 10 tablets when they required at least 30 to help manage a few days of sickness. Abdel-Raouf also said the men had difficulty accessing Hydralyte and fruit and vegetables to aid their recovery.

The asylum seeker who spoke to the Guardian said in his case, he had been given enough Panadol to comply with his doctor’s treatment plan.

ASRC also said some of the men had requested mosquito repellant and insect netting, but authorities and case managers were not able to help them.

“Some men were particularly concerned because they live in a jungle-like area, with a higher number of mosquitoes, a higher chance of getting dengue,” Abdel-Raouf said.

Guardian Australia contacted the Australian Border Force for comment on medical supplies and insect control measures provided to those on Nauru, as well as figures on the number of people sickened with dengue. The Nauru government did not reply to a request for comment on the outbreak.

The Department of Home Affairs said it was aware cases of dengue fever were rising in Nauru, adding it is following the lead of the country’s government “to coordinate the response to the dengue outbreak”.

A spokesperson said transfer to Australia for temporary treatment “may occur on a case-by case-basis depending on individual circumstances where necessary medical treatment is not available on Nauru or to support engagement with third country migration options”.

The department added that transitory persons “do not have a settlement pathway in Australia”.

The Department of Foreign Affairs’ website notes that severe dengue fever is rare, but “a medical emergency that needs hospital treatment”.

Islands across the Pacific including Samoa, Fiji and Kiribati all reported high numbers of dengue cases in recent weeks. At least two people died in Samoa in the latest outbreak.

Abdel-Raouf said the situation on Nauru would only grow worse the longer people seeking asylum in Australia remained there.

“The health system on Nauru is already fragile and easily overwhelmed – it will struggle to cope with this outbreak,” she said. “Australia has a clear responsibility for the refugees our government has banished there.”

A UN watchdog ruled in January that Australia had violated the rights of asylum seekers detained on Nauru, finding a nation “cannot escape its human rights responsibility when outsourcing asylum processing to another state”. Australia has maintained it is not responsible for the treatment of asylum seekers of refugees there, saying it works “closely” with the country to “support the provision of health, welfare and support services”.

Deuruxolitinib may significantly improve symptoms of anxiety and depression among adults with severe alopecia areata, recent data suggest, in addition to improving such patients’ quality of life.¹

This newly presented data was featured in a poster titled ‘Improvement in Anxiety and Depression in Adult Patients with Severe Alopecia Areata Treated with Deuruxolitinib: Pooled Data from the THRIVE-AA1 and THRIVE-AA2 Phase 3 Trials.’ The poster was presented during the Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference in Las Vegas, Nevada.

Arash Mostaghimi, MD, MBA, MPH, Associate Professor of Dermatology for Brigham and Women’s Hospital, led a team of trial investigators in authoring this data. Mostaghimi and his coauthors highlighted that alopecia areata is a persistent autoimmune condition that is characterized by non-scarring, patchy hair loss on patients’ scalps.

The hair loss condition is frequently linked with diminished quality of life as well as elevated rates of anxiety and depression compared to individuals in the general population. Notable improvements, however, have been observed with deuruxolitinib in terms of substantial scalp hair regrowth in adults with severe alopecia areata.

These findings on euruxolitinib, which is an oral inhibitor targeting Janus kinase (JAK)1 and JAK2, were previously seen in the phase 3 THRIVE-AA1 (NCT04518995) and THRIVE-AA2 (NCT04797650) clinical analyses. In this particular poster, Mostaghimi and colleagues focused their attention on any shifts in mental health outcomes.

Specifically, the investigative team looked at shifts in scores on the Hospital Anxiety and Depression Scale (HADS), pooling patient data from the THRIVE-AA1 and THRIVE-AA2 trial program. Those deemed to be eligible to take part in the trials as participants across both studies had been adults in the age range of 18 – 65 years.

These subjects were also required to have experienced at least 50% scalp hair loss as a result of alopecia areata. In order to be included, their current episode would also have had to last between 6 months – 10 years. Those who were selected were randomly assigned to be govem either deuruxolitinib 8 mg twice-per-day (BID), 12 mg BID, or placebo BID for a 24-week timeframe.

The primary aim of these studies, led by Mirimirani and colleagues, had been to determine the proportion of subjects who could attain a Severity of Alopecia Tool (SALT) score of 20 or less by the 24-week mark. Their pooled analysis also examined patient-reported satisfaction levels with scalp hair, evaluated via the 5-point Hair Satisfaction Patient Reported Outcome (SPRO) scale.

Among secondary outcomes the team assessed were the evaluation of HADS scores from baseline to the 24-week mark. The HADS instrument comprises 14 items—7 evaluating levels of anxiety (HADS-A) and 7 evaluationing depression (HADS-D)—rated on a 4-point severity scale. In this scale, higher scores indicated more severe symptoms.

Mostaghimi et al’s post hoc analysis looked at any meaningful changes in HADS scores over these 24 weeks through the use of the Cochran-Mantel-Haenszel test, stratified by baseline severity of scalp hair loss (partial versus complete/near complete) and by study. No imputation was applied for missing data.

Additional endpoints evaluated in these studies had included the proportion of trial subjects reaching a SALT score of ≤20 at the 8, 12, 16, and 20-week marks, as well as evaluations of safety, such as vital signs, adverse events, concurrent medications, lab values, and physical exams.

Overall, Mostaghimi and coauthors’ results suggested that individuals receiving deuruxolitinib 8 mg BID reported having greater average reductions in total HADS, HADS-A, and HADS-D scores as opposed to those in the placebo arm. Notably, the investigative team highlighted that 22.5% of those in the 8 mg BID cohort attained a ≥6-point dip in total HADS score between baseline and the 24-week mark, versus 11.8% in the placebo cohort—a statistically significant difference (P = .0003).

Additionally, the team found that a significantly larger proportion of their study’s participants who were on deuruxolitinib 8 mg BID had a ≥4-point dip in anxiety scores (HADS-A) and a ≥3-point dip in depression scores (HADS-D), compared with those on a placebo.

Overall, Mostaghimi et al highlighted that a significantly greater proportion of those treated with deuruxolitinib 8 mg BID compared to placebo showed clinically meaningful HADS improvements by Week 24. This, they noted, suggested deuruxolitinib’s efficacy in improving mental health-related outcomes.

For any additional information on data presented at the DERM 2025 Conference, view our latest conference coverage here.

References

1. Mostaghimi A, King B, Cassella J, et al. Improvement in Anxiety and Depression in Adult Patients with Severe Alopecia Areata Treated with Deuruxolitinib: Pooled Data from the THRIVE-AA1 and THRIVE-AA2 Phase 3 Trials. Poster presented at the DERM 2025 NP/PA CME Conference; July 23 – 26, 2025; Las Vegas, Nevada.