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The U.S female viagra for sale. House of Representatives on Thursday passed two bills that call for increased funding and access to mental health resources for emergency department patients and healthcare professionals.The Improving Access to Mental Health Act, sponsored by Rep. Raul Ruiz (D-Calif.) will award grants to emergency departments female viagra for sale looking to expand mental health programs for those experiencing an acute mental health episode. This includes increasing the supply of in-patient beds and coordination with regional service providers, who may be better suited to provide follow-up care than crowded emergency departments.

Some of the funding will also go toward more experimental approaches to care such as telehealth consultations and creating emergency psychiatric service units."As an emergency physician, I know the barriers to getting female viagra for sale mental health patients the follow-up care they need," Ruiz said in a statement Thursday.One in eight emergency department visits involve an adult struggling with either mental health or substance abuse, according to the National Alliance on Mental Illness. Many patients turn to the emergency department because there aren't beds available in local in-patient facilities, with some spending days waiting for the appropriate care. This adds to the burden emergency medical professionals have taken female viagra for sale on over the last year, according to Rep. Ami Bera (D-Calif.).

Bera sponsored another bill passed Thursday, the HERO Act, which would develop tactics for targeted interventions to prevent suicide among emergency personnel."Our first responders already experience higher mental health stress and higher risk of suicide than many other professions," Bera said in a statement. "It's our obligation to be there for them in their time of need by ensuring they have access to life-saving mental healthcare." The HERO Act, would allow the female viagra for sale U.S. Centers for Disease Control and Prevention to set up a database tracking suicide incidence among public safety officials and emergency healthcare providers. The database would track the total number of female viagra for sale suicides by public safety agency, state, gender, age and career status.

The data would be used to analyze more effective intervention strategies to prevent these deaths, but privacy mechanisms would be set up to keep parts of the registry confidential. Additional funding will go toward training peer support specialists, who are counselors with similar mental health challenges able to assist in providing care, within hospitals and public safety departments female viagra for sale. CMS data from March through October 2020 show beneficiaries under age 19 had 14 million fewer mental health visits, a 34% decline from the year prior, and adults on Medicaid had 12 million fewer visits or a 22% decline.Both bills will now go to the Senate for committee consideration.The finances of several not-for-profit health systems perked up in the first three months of 2021 compared to the prior-year period—which mostly preceded the erectile dysfunction treatment viagra—although executives say they still face a number of challenges. Large providers like Henry Ford Health System, Mass General Brigham and RWJBarnabas Health had either moved into the black or strengthened operating profit in the female viagra for sale quarter ended March 31.

Finances are generally still weaker than they were pre-viagra. On top of that, executives said the unpredictability of erectile dysfunction treatment surges since March 2020 has made planning difficult. "Everything has been disrupted," said Mike Allen, chief financial officer female viagra for sale of OSF HealthCare, a 14-hospital system based in Peoria, Ill. "All the normal patterns of life have been disrupted, and that includes healthcare."OSF's Allen said it's hard to compare the two periods because circumstances were so different, although he noted that patients are now returning for care they put off during the worst of the crisis.

OSF's outpatient female viagra for sale visits were up 12.5% year-over-year. Other big systems, like CommonSpirit Health and ProMedica Health, lost money in the recently ended quarter excluding grants as both organizations struggle to fully regain volumes in their hospitals and senior care facilities. The first three months of 2020, by contrast, were mostly unaffected by the viagra, except female viagra for sale for the final two weeks of March. At that point, cases spiked and many of the country's healthcare providers suspended elective procedures, sending revenue over a cliff.

The 2020 quarter does not female viagra for sale include aid from federal relief grants, which some systems recorded in the first quarter of 2021. Robin Damschroder, chief financial officer of Detroit-based Henry Ford Health System, said the economy had already been cooling off before the viagra, so Henry Ford's volumes had already been down in the first quarter of 2020. She agreed with Allen that it's difficult to compare the first quarters of 2020 and 2021, as the mix of services Henry Ford provided in the recently ended quarter are different, with fewer orthopedic surgeries and more erectile dysfunction treatment patients. Looking forward, Henry female viagra for sale Ford is "cautiously optimistic," Damschroder said.

"We expect volatility on volume."Some highlights from the first quarter of 2021. CommonSpirit Health female viagra for sale. The 140-hospital, Chicago-based system posted an operating loss of $117 million in the three months ended March 31, 2021 excluding federal grants and a pre-tax gain on the sale of joint venture shares. Including those items, the system generated $539 million in female viagra for sale operating income in the quarter ended March 31, 2020.

That's compared with a $145 million loss in the prior-year period, a 2% loss margin. CommonSpirit said it continues to struggle with patient volumes female viagra for sale and the ongoing impact of the viagra. ProMedica. The Toledo, Ohio-based health system had a rocky start to 2021, posting a 4.2% operating loss margin in the first three months.

The health system was weighed down by its senior female viagra for sale care division, which posted an 11% loss margin. Nursing homes have been particularly hard hit during the viagra, and continue to see occupancy declines and job losses. At ProMedica, skilled nursing occupancy was 68% in the first quarter of 2021, down from female viagra for sale 84% in the first quarter of 2020. ProMedica's assisted living occupancy was down to 61% in the recently ended quarter, compared with 81% in the 2020 period.

ProMedica's provider female viagra for sale division, which includes 12 hospitals, posted a 1.2% loss margin. The bright spot in ProMedica's financials was its insurance division, Paramount, which posted a 4.1% operating margin. RWJBarnabas Health female viagra for sale. The New Jersey system posted a very slim 0.1% operating margin in the first three months of 2021, compared with a 3.8% loss margin in the prior-year period.

About half of the $54 million positive operating income swing was federal grant money. RWJ's outpatient volumes increased about 1.9% year-over-year, primarily due female viagra for sale to hospital same-day surgeries growing 6.9%. The system admitted 6,111 erectile dysfunction treatment patients during the first quarter of 2021, compared with 1,952 in the prior-year period. Ochsner Health female viagra for sale.

Louisiana's Ochsner experienced a modest rebound in the first quarter of 2021, posting $15.1 million in operating income—a 1% margin—compared with a $32.8 million loss in the comparable 2020 period, a 3.4% loss margin. Ochsner said its erectile dysfunction treatment patients peaked female viagra for sale at 973 on April 7, 2020, and ultimately dropped to a low of about 100 patients in April 2021 after a third peak in January 2021. By the end of June 2020, Ochsner said clinic visits and outpatient surgeries were close to pre-viagra levels. BJC HealthCare female viagra for sale.

St. Louis-based BJC generated $35 million in operating income in the first quarter, a 2.4% margin, compared with just $4.5 million in the 2020 period, a 0.3% margin. BJC's admissions, inpatient surgeries and emergency room visits were still down year-over-year, but female viagra for sale outpatient surgeries grew by almost 5% in that time. Mass General Brigham.

If the Boston-based system hadn't taken in any federal grants in the quarter ended March 31, 2021, it female viagra for sale would have posted $18 million in operating income, a 0.5% margin. That's compared to a $178 million operating loss in the comparable 2020 period, during which the system weathered the initial shutdown in elective procedures and expenses related to preparing for the viagra. Including federal grants, the system posted female viagra for sale $250 million in operating income in the recently ended quarter. Mass General Brigham has treated almost 19,000 erectile dysfunction treatment patients, including a peak of 925 in April 2020 and a second surge of more than 400 in January 2021.

Henry Ford female viagra for sale Health System. The Detroit system lost $16 million on operations in the first quarter of 2021—a 1% loss margin—which was narrower than its $36.2 million loss in the comparable 2020 period, a 2.4% loss margin. The number of erectile dysfunction treatment patients the system was treating had declined to just over 100 at the end of February 2021. However, beginning female viagra for sale in March through the middle of April, erectile dysfunction treatment cases jumped across the state.

Henry Ford hit a peak of over 600 patients admitted by mid-April 2021 before declining to 300 patients by early May. Henry Ford saw some volume female viagra for sale recovering in the 2021 period, with outpatient surgeries up 12.8% year-over-year. Inpatient surgeries grew 3.9% in that time.Today, I call on my fellow U.S. Healthcare CEOs to do two things—acknowledge female viagra for sale our collective failures and embrace the fight for justice.

As healthcare providers, we know our mission is sacred. But we also know the actual medical care we provide accounts for only 10%-20% of a person's female viagra for sale overall wellness. Our communities also need food and clean water, employment opportunities, affordable housing and transportation, the right to vote, and the right to feel safe walking down the sidewalk. It's hard to believe almost a year has passed since George Floyd was murdered on a Minneapolis street, his death triggering a national reckoning with systemic racism and police violence—erupting in protests across our nation.

The range of emotions we felt earlier this year as we watched former police officer Derek Chauvin being quietly led away in handcuffs were complex—confidence that justice was served, sadness for lives lost and female viagra for sale forever changed, and hope that the outcome of the trial will be a catalyst for authentic change. But hope is not enough.At the same time, while leading Michigan's response to erectile dysfunction treatment, we saw how the viagra severely impacted our communities of color, forcing a reckoning of another kind. African Americans account for 14% of Michigan's female viagra for sale population, yet represented 40% of our erectile dysfunction treatment-related deaths during the first surge in 2020. After feeling left behind by Detroit's economic resurgence, many are feeling that the healthcare and public health system let them down, as well.

Additionally, clinicians of color have faced racial bias for decades, a recent report finding that more than 30% of African-American, Asian-American, and Hispanic clinicians and female viagra for sale front-line teams have experienced intolerable conduct and remarks while courageously doing their jobs. To say our hearts are broken by both would be an understatement. As CEO of a Detroit-based female viagra for sale health system, and an African-American man, I can attest to this brokenness. It is a sobering reminder of the painful irony in which we live in America—the world's most diverse melting pot plagued by pervasive intolerance and a failure to act on behalf of those who need us most.I didn't experience Detroit during the 1967 uprising, but I did grow up in the segregated South, in the small, yet infamous town of Tuskegee, Ala.

Raised in the hotbed of the Civil Rights movement, I was too young to fully comprehend the events swirling around me—the passing of the Civil Rights Act of 1964, my parents' participation in the 1965 Selma March, civil rights activist Myrlie Evers-Williams sitting in our living room chatting about race-stoked violence sweeping the country. More than five female viagra for sale decades later, we still cannot shake the inescapable gravitational force of our troubled beginnings. Systemic racism and other inherent structural barriers have sadly become embedded in our society—and I am not about to pretend that the healthcare industry is immune. There are many who remain hopeful that we are at an inflection point and encouraged that authentic conversations are taking place, both female viagra for sale in our healthcare institutions and our broader societies.

But dialogue is not enough. We must act on behalf of every life we serve, female viagra for sale partnering to earnestly and courageously lift up our communities. If we fail to do this, we dare not call ourselves successful stewards of health and wellness. It is only through the actions we take that this moment truly becomes the inflection point that leads to a better America for our children and grandchildren..

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Latest data from the World Health Organization (WHO) and check my source UN Children’s Fund (UNICEF) reveals that three in 10 people viagra de mujer worldwide could not wash their hands with soap and water at home during the erectile dysfunction treatment viagra. €œHandwashing is one of the most effective ways to prevent the spread of erectile dysfunction treatment and other infectious diseases, yet millions of people across the world lack access to a reliable, safe supply of water”, said WHO Director-General Tedros Adhanom Ghebreyesus. Latest estimates reveal that 3 viagra de mujer in 10 people worldwide could not wash their hands with soap and water at home during the erectile dysfunction treatment viagra.

@WHO https://t.co/favuo4F5L5— UNICEF (@UNICEF) July 1, 2021 Progress made The Joint Monitoring Programme report, Progress on household drinking water, sanitation and hygiene 2000 – 2020, did, however, offer some good news on universal access to water, sanitation and hygiene services (or WASH for short). Between 2016 and 2020, it showed that access to safely managed drinking water at home, increased from 70 to 74 per cent. Sanitation services viagra de mujer went from 47 to 54 per cent.

And handwashing facilities with soap and water, rose from 67 to 71 per cent. And rather than sewer connections, last year for the first time, more people used pit latrines, septic tanks and other improved on-site sanitation to effectively contain and treat waste viagra de mujer. “Despite our impressive progress to date, to scale-up these lifesaving services, the alarming and growing needs continue to outstrip our ability to respond”, said UNICEF Executive Director Henrietta Fore.

To maintain progress, the two UN agencies underscored the need for governments to adequately support safely managed on-site sanitation, including faecal sludge. The study also made clear that if current trends persist, by 2030 billions of children and families would be viagra de mujer left without life-saving WASH services. It notes that still only 81 per cent of the world’s population would have access to safe drinking water at home, leaving 1.6 billion without.

Just 67 per cent would have safe sanitation services, leaving 2.8 billion in the lurch. And only 78 per cent would have basic handwashing facilities, leaving viagra de mujer 1.9 billion adrift. €œInvestment in water, sanitation and hygiene must be a global priority if we are to end this viagra and build more resilient health systems”, Tedros stressed.

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Rich countries fair better While the overall mitigation impact was strong, the study also uncovered that it was largely confined to high and upper middle-income States. Rich countries spent up to 212 times per capita more than poor nations, on social assistance. UNDP Administrator Achim Steiner pointed out that their ability to spend more on social protection viagra de mujer measures, “played a critical role in keeping people out of poverty”.

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Massive differences The authors estimated that between 117 million and 168 million people became poor during the viagra. Although $2.9 trillion were invested in social protection policies globally, only viagra de mujer $379 billion were spent by developing countries. Meanwhile, on average, high-income countries allocated $847 per capita on social protection measures, including assistance and insurance, while low and middle-income counterparts spent an average of just $124 per head.

At the same time, total per capita social protection in low-income countries alone, was as little as $4. €˜Two-track recovery’ “The report provides some thoughts on how the viagra impacted poor and vulnerable viagra de mujer households in developing countries but also how important policy choices were to mitigate poverty increases”, said UNDP Chief Economist George Gray Molina. It estimated that if applied to all poor and vulnerable households in the developing world, a temporary basic income – championed by UNDP - could have prevented the number of new extreme poor, globally.  Projections in the study illustrated that this could have been achieved by dedicating just 0.5 per cent of developing countries’ gross domestic product (GDP), spread over six months for income support-related measures.

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Latest data from the World Health Organization (WHO) and UN Children’s Fund (UNICEF) reveals that three in 10 people worldwide could not wash their hands with soap and female viagra for sale water at home during the erectile dysfunction treatment viagra. €œHandwashing is one of the most effective ways to prevent the spread of erectile dysfunction treatment and other infectious diseases, yet millions of people across the world lack access to a reliable, safe supply of water”, said WHO Director-General Tedros Adhanom Ghebreyesus. Latest estimates reveal that 3 in 10 people worldwide could not wash their hands with soap and water at home during the erectile dysfunction treatment female viagra for sale viagra. @WHO https://t.co/favuo4F5L5— UNICEF (@UNICEF) July 1, 2021 Progress made The Joint Monitoring Programme report, Progress on household drinking water, sanitation and hygiene 2000 – 2020, did, however, offer some good news on universal access to water, sanitation and hygiene services (or WASH for short). Between 2016 and 2020, it showed that access to safely managed drinking water at home, increased from 70 to 74 per cent.

Sanitation services went from 47 to 54 per female viagra for sale cent. And handwashing facilities with soap and water, rose from 67 to 71 per cent. And rather than sewer connections, female viagra for sale last year for the first time, more people used pit latrines, septic tanks and other improved on-site sanitation to effectively contain and treat waste. “Despite our impressive progress to date, to scale-up these lifesaving services, the alarming and growing needs continue to outstrip our ability to respond”, said UNICEF Executive Director Henrietta Fore. To maintain progress, the two UN agencies underscored the need for governments to adequately support safely managed on-site sanitation, including faecal sludge.

The study also made clear that if current trends persist, by 2030 billions of children and families would be left female viagra for sale without life-saving WASH services. It notes that still only 81 per cent of the world’s population would have access to safe drinking water at home, leaving 1.6 billion without. Just 67 per cent would have safe sanitation services, leaving 2.8 billion in the lurch. And only 78 per cent would have basic handwashing facilities, leaving 1.9 billion adrift female viagra for sale. €œInvestment in water, sanitation and hygiene must be a global priority if we are to end this viagra and build more resilient health systems”, Tedros stressed.

Inequalities prevail The report also noted vast inequalities female viagra for sale – with vulnerable children and families suffering the most. At the current rate of progress, for least developed countries (LDCs) to access safely managed drinking water by 2030, the study spelled out that there would need to be a ten-fold increase. €œEven before the viagra, millions of children and families were suffering without clean water, safe sanitation, and a place to wash their hands”, said the UNICEF chief. €œThe time has come to dramatically accelerate our efforts to provide every child and family with the most basic needs for their health and well-being, including fighting off infectious female viagra for sale diseases like erectile dysfunction treatment.” Spotlighting women For the first time, the report also presented emerging national data on menstrual health. In many countries, it showed a significant proportion of women and girls are unable to meet their menstrual health needs.

And disparities are significant among vulnerable groups, such as the poor and those with disabilities.Offering fresh data on how social assistance spending has cushioned the unparalleled economic shock triggered by the viagra, the UN Development Fund’s (UNDP) Mitigating Poverty assessment, revealed that in the 41 countries for which data was available, female viagra for sale around 12 million people were prevented from falling below the poverty line, out of 15 million in danger. Rich countries fair better While the overall mitigation impact was strong, the study also uncovered that it was largely confined to high and upper middle-income States. Rich countries spent up to 212 times per capita more than poor nations, on social assistance. UNDP Administrator Achim Steiner pointed out that their female viagra for sale ability to spend more on social protection measures, “played a critical role in keeping people out of poverty”. For low middle-income countries, the report showed that social assistance spending was insufficient to avert a surge of people becoming newly-poor, and in low-income countries it was unable to prevent any income losses at all.

€œThis lifeline depends on where you live”, observed the UNDP chief. €œThe challenge now is female viagra for sale to expand the fiscal space to allow all countries to implement and sustain social assistance spending measures, which is proven to be a highly cost-efficient and effective way to keep people from falling into poverty”. Massive differences The authors estimated that between 117 million and 168 million people became poor during the viagra. Although $2.9 trillion were invested in social protection policies globally, only $379 billion were spent female viagra for sale by developing countries. Meanwhile, on average, high-income countries allocated $847 per capita on social protection measures, including assistance and insurance, while low and middle-income counterparts spent an average of just $124 per head.

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The Shape of Training review1 and the Future Hospital Commission2 identified the need for How to get viagra without a doctor a reform of postgraduate medical training in natural viagra for men the UK for doctors to adapt to changing population and service needs. The focus of postgraduate training needed to move from a ‘time-served’ approach to a competency-based one with doctors developing high-level learning outcomes, capabilities in practice (CiPs). The General Medical Council (GMC) also recommended that all revised curricula from 2020 should include generic professional capabilities (GPCs), including communication, leadership, multidisciplinary teamwork and patient safety, which are crucial to safe and effective patient care.Genitourinary medicine (GUM), along with many other physicianly specialities, will adopt a dual training model from August 2022, leading to accreditation in both GUM and general internal medicine (GIM). The GUM curriculum will continue to offer training in the diagnosis, investigation and management of sexually transmitted s and related conditions, contraception, HIV inpatient and outpatient care, management of ….

The Shape http://www.securityresources.com/how-to-get-viagra-without-a-doctor/ of Training review1 and the Future Hospital Commission2 identified the need for a reform of postgraduate medical training in female viagra for sale the UK for doctors to adapt to changing population and service needs. The focus of postgraduate training needed to move from a ‘time-served’ approach to a competency-based one with doctors developing high-level learning outcomes, capabilities in practice (CiPs). The General Medical Council (GMC) also recommended that all revised curricula from 2020 should include generic professional capabilities (GPCs), including communication, leadership, multidisciplinary teamwork and patient safety, which are crucial to safe and effective patient care.Genitourinary medicine (GUM), along with many other physicianly specialities, will adopt a dual training model from August 2022, leading to accreditation in both GUM and general internal medicine (GIM). The GUM curriculum will continue to offer training in the diagnosis, investigation and management of sexually transmitted s and related conditions, contraception, HIV inpatient and outpatient care, management of ….

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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a viagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a viagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..