SNMMI Image of the Year: Ultra-high-resolution PET provides never before seen images of the brain

SOCIETY OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

 

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FIGURE 1. A. 18F-SYNVEST-1 IMAGES AT EARLY (0-10) AND LATE (90-120 MINUTE) TIMES POSTINJECTION. THERE IS CLEAR IDENTIFICATION OF HIGH FLOW REGIONS IN THE EARLY IMAGES. THE LATE IMAGES SHOW THE SYNAPTIC (SV2A) PATTERN WHICH DIFFERS FROM THE FLOW PATTERN, E.G., IN THE THALAMUS. B. 11C-PHNO BINDING POTENTIAL (BPND) IMAGES SHOWN IN TRANSVERSE, CORONAL, AND SAGITTAL ORIENTATIONS OF PET ALONE AND PET OVERLAID WITH MRI. LEFT: REGION OF SUBSTANTIA NIGRA (GREEN ARROW, MAX DISPLAY: 4.0). RIGHT: THALAMIC REGION (MAX: 2.5) SHOWING FOCAL BILATERAL BINDING IN A SPECIFIC THALAMIC NUCLEUS (BLUE ARROW, LIKELY ANTEROVENTRAL NUCLEUS). C. SAGITTAL IMAGES OF 11C-LSN3172176 M1 MUSCARINIC CHOLINERGIC BPND (MAX DISPLAY: 10). D. R1 IMAGES OF THE SAME TRACER (MAX: 2). CEREBELLUM (BLUE ARROW) SHOWS NO SPECIFIC BINDING (C) AND HIGH TRACER DELIVERY (D). E. 18F-FE-PE2I DOPAMINE TRANSPORTER BPND IMAGES (ZOOMED, MAX DISPLAY: 6) SHOWING STRIATUM AND SUBSTANTIA NIGRA (GREEN ARROW). F. R1 IMAGES OF THE SAME TRACER (MAX: 2) WITH INSET SHOWING ZOOMED REGION IN E.

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CREDIT: IMAGES CREATED BY RICHARD E. CARSON, ET AL., YALE UNIVERSITY, NEW HAVEN, CT.

Toronto, Ontario—A new ultra-high-performance brain PET system allows for the direct measurement of brain nuclei as never before seen or quantified. With its ultra-high sensitivity and resolution, the NeuroEXPLORER provides exceptional brain PET images and has the potential to spur advances in the treatment of many brain diseases. This research was presented at the 2024 Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting, and the grouping of images highlighting targeted tracer uptake in specific brain nuclei has been selected as the 2024 SNMMI Henry N. Wagner, Jr., Image of the Year.

Each year, SNMMI chooses an image that best exemplifies the most promising advances in the field of nuclear medicine and molecular imaging. The state-of-the-art technologies captured in these images demonstrate the capacity to improve patient care by detecting disease, aiding diagnosis, improving clinical confidence, and providing a means of selecting appropriate treatments. This year, the SNMMI Image of the Year was chosen from more than 1,500 abstracts submitted for the meeting.

The image quality of PET systems has improved in recent years, mostly by increases in sensitivity, including enhanced time-of-flight capabilities. However, these systems have shown only minimal improvement in intrinsic resolution. To address these issues, researchers designed the NeuroEXPLORER PET scanner with a focus on ultra-high sensitivity and resolution, as well as continuous head motion correction.

In the study, researchers conducted human brain imaging with both the NeuroEXPLORER and the High Resolution Research Tomograph, or HRRT (the previous state-of-the-art imaging tool). Multiple targeted radiopharmaceuticals were administered to observe synaptic density, dopamine receptors and transporters, muscarinic cholinergic receptors, and glutamate receptors. Images from both scanners were then compared.

A striking improvement in image contrast and quality of the NeuroEXPLORER compared to the HRRT was evident. NeuroEXPLORER images demonstrated low noise and exquisite resolution, showing focal uptake in specific brain nuclei.

“The high resolution of NeuroEXPLORER images is due to the system’s unique detector design and exceptional sensitivity produced by its long axial field-of-view,” said Richard E. Carson, PhD, professor of Biomedical Engineering and of Radiology and Biomedical Imaging and Emeritus director of the PET Center at Yale University in New Haven, Connecticut. “This technology will provide the opportunity for advanced research on all types of neuronal molecular and functional activity.”

“The dramatic improvement in resolution and overall quality of the NeuroEXPLORER images compared to the HRRT images is clear,” noted SNMMI Scientific Program Committee chair Heather Jacene, MD. “The NeuroEXPLORER has the potential to be a gamechanger in research for conditions such as Alzheimer’s disease, Parkinson’s disease, epilepsy, and mental illnesses.”

The NeuroEXPLORER scanner was built as a collaboration with Yale University, University of California, Davis, and United Imaging Healthcare of America, and was funded by a National Institutes of Health Brain Initiative grant. While the NeuroEXPLORER is currently used for research purposes, Carson and colleagues hope that once the excellent image quality is recognized by physicians it will become available for clinical use.

Abstract 241473. “Exceptional Brain PET Images from the NeuroEXPLORER: Scans with Targeted Radiopharmaceuticals and Comparison to HRRT.” Richard Carson, Jean-Dominique Gallezot, Takuya Toyonaga, Tommaso Volpi, Nikkita Khattar, Mika Naganawa, Praveen Honhar, Tianyi Zeng, Kathryn Fontaine, Tim Mulnix, Shannan Henry, David Matuskey, Rajiv Radhakrishnan, Nabeel Nabulsi, Yiyun Huang, Ramsey Badawi, Simon Cherry, Ansel Hillmer, Terry Jones, Chi Liu, Evan Morris, Jinyi Qi, Hongdi Li, Yale University, New Haven, Connecticut.

Link to Session

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All 2024 SNMMI Annual Meeting abstracts can be found online.

About the Society of Nuclear Medicine and Molecular Imaging

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and medical organization dedicated to advancing nuclear medicine and molecular imaging—vital elements of precision medicine that allow diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes.

SNMMI’s members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snmmi.org.

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JOURNAL

Journal of Nuclear Medicine

ARTICLE TITLE

Exceptional Brain PET Images from the NeuroEXPLORER: Scans with Targeted Radiopharmaceuticals and Comparison to HRRT

ARTICLE PUBLICATION DATE

10-Jun-2024

 

Imposing cost-efficient trade sanctions

SINGAPORE MANAGEMENT UNIVERSITY

 

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A NEW PAPER, CO-AUTHORED BY SMU ASSISTANT PROFESSOR YUAN MEI, COMPUTES THE MOST COST-EFFICIENT WAY TO IMPOSE TRADE SANCTIONS AGAINST RUSSIA IN RESPONSE TO ITS WAR IN UKRAINE.

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CREDIT: SINGAPORE MANAGEMENT UNIVERSITY

By Alistair Jones

SMU Office of Research – Global condemnation of Russia over its invasion of Ukraine has prompted the imposition of trade sanctions. Such measures are a form of economic coercion, commonly used for reasons of foreign policy. 

Trade sanctions can be put in place in an attempt to alter objectionable behaviour – in Russia's case, waging a war – or to punish an offending state through the disruption of economic exchange. 

"Sanctions can be in many forms and raising tariffs is one of them," says Yuan Mei, an Assistant Professor of Economics at Singapore Management University (SMU). Professor Mei is the co-author of a new paper, '(Trade) War and Peace: How to Impose International Trade Sanctions', that was published in the Journal of Monetary Economics. 

The researchers have built a quantitative model of international trade with input-output connections, and the aim of the paper is to "compute the most cost-efficient way to impose trade sanctions against Russia in the context of the Russia-Ukraine war", Professor Mei says.

Willingness to pay

Trade sanctions are meant to hurt the sanctioned country’s economy, but if they severely restrict trade, they can also hurt the sanctioning countries.

"Raising tariffs on Russian goods can hurt the Russian economy. In the meanwhile, this action could also hurt the sanctioning country by making imports more costly," Professor Mei says.

Under import restrictions, consumers in the imposing country may have limited choices of goods, which affects their welfare. And if export restrictions are imposed, or if sanctions prohibit companies in the imposing country from trading with the target country, the imposing country may lose markets and investment opportunities to competing countries.

To make sense of this apparent juggling act, the researchers offer the concept of ‘Willingness to pay’ – the amount of economic burden an imposing country is prepared to incur to exact damage on the target country.

"We find that for countries with a low willingness to pay for sanctions, the optimal strategy is to impose a moderate and similar tariff across all products," Professor Mei says. 

For example, if a sanctioning country is willing to sacrifice US$0.10 per US$1 loss incurred by the Russian economy, the cost-efficient trade sanction would be a uniform tariff of 20 percent.

 The effect would be that "Russia’s export to the sanctioning countries will decrease, which eventually leads to less national income. In this scenario, the eventual welfare (real GDP) loss of Russia is 1.2 percent based on our calculation," he says.

Key exports

"For countries with a high willingness to pay for sanctions, sanctioning countries should target what Russia exports the most – mining and energy products," Professor Mei says.

In fact, the U.S., the European Union (EU), the G7 and sanctioning allies such as Australia have recently prohibited the import of seaborne crude oil and refined petroleum products from Russia. Is this a step in the right direction?

"Yes. Our simulation results show that countries with high willingness to pay should impose an embargo on Russia’s oil and energy exports, and these countries do appear to have a high willingness to pay." Professor Mei says.

But Russia has found alternative markets, notably in India, which is happy to buy discounted crude oil, reportedly in huge quantities. And China, Russia's largest trading partner, has supported what Russia calls its "special military operation" in Ukraine. Can trade sanctions be effective without unified global support?

"That depends on the definition of effective sanction," Professor Mei says. "In the paper, we consider an alternative scenario in which the non-sanctioning countries join the U.S., EU and their allies to sanction Russia. In this case, the maximum welfare loss on Russia increases from two percent to six percent, which we consider a significant increase."

But the economic effect of the existing sanctions regime on non-sanctioning countries does not seem like an incentive to change position.

"The rest of the world (ROW) boosts its exports in reaction to sanctions placed on Russia. As sanctioning countries raise tariffs against Russia, sanctioning countries substitute imports from Russia with those from the ROW. This pattern, referred to as the trade diversion effect, leads to an increase in ROW exports to the sanctioning countries," Professor Mei says.

Carrying the burden

The researchers note that Russia exports much more to the EU – the world's largest trading bloc – than to the U.S. or other sanctioning allies (OSA). Accordingly, tariffs imposed by the U.S. or OSA can, at most, reduce Russian real income by only 0.07 percent or 0.22 percent, respectively. By contrast, the EU alone can reduce real income in Russia by as much as 0.8 percent. Therefore, the burden of trade sanctions against Russia would seem to fall on the EU.

"We are not saying that the EU has to carry the burden. To be more accurate, our message is the EU is the group of countries that can hurt the Russian economy the most – not the U.S. or other sanctioning allies," Professor Mei says.

Sanctions, of course, can go both ways. Russia could retaliate by levying tariffs on the U.S. and Europe, but Professor Mei’s research suggests it would hurt Russia even more.

“If Russia also chooses tariffs to punish the sanctioning countries, the economic consequence of tariff sanctions on Russia would more than double,” he explains. “The EU is an important importing origin for Russia but Russia is not an important exporting destination for the EU. Therefore, Russia imposing retaliatory tariffs on EU would result in a large decline in its own welfare, but it does not decrease EU welfare much.”

 

Bartonella DNA Found in Blood of Patients With Psychosis

NORTH CAROLINA STATE UNIVERSITY

A new study has found that patients diagnosed with schizophrenia or another psychotic disorder are three times more likely to have Bartonella DNA in their blood than adults without these disorders. The work further supports the idea that pathogens – particularly vector-borne pathogens – could play a role in mental illness.

Bartonella are a group of vector-borne bacteria transmitted primarily via arthropods like fleas, lice and potentially ticks, but also by the animals that harbor them. For example, the species Bartonella henselae is associated with cat scratch disease, which until recently was thought to be a short-lived (or self-limiting) infection. There are at least 45 different known Bartonella species, of which 18 have been found to infect humans.

Improved methods for detecting Bartonella infection in animals and humans have led to the diagnosis of bartonelloses in patients with a host of chronic illnesses, as well as in some patients with psychiatric symptoms.

In this latest study, researchers at North Carolina State University analyzed the blood of 116 people for evidence of Bartonella DNA and Bartonella specific antibodies. The samples were collected during a biomarker research study conducted by Dr. Shannon Delaney and colleagues at the Columbia University Irving Medical Center (CUIMC).

Of the 116 people, 29 were in the control group; 16 were prodromal, meaning they had symptoms but no formal diagnosis; 51 were children, adolescents or adults with psychosis; and 20 were close relatives of those diagnosed with psychosis.

In a previous study conducted at Columbia, these same patients had been tested for increased inflammatory mediators – in other words, evidence of inflammation. That study found that patients with psychosis were more likely to have increased inflammatory markers in the blood.

“As an infectious disease researcher, I believe that infection should be critically examined as a potential cause of diseases for which the cause is unclear or unknown,” says Dr. Edward Breitschwerdt, Melanie S. Steele Distinguished Professor of Internal Medicine at NC State’s College of Veterinary Medicine. “We wanted to explore potential drivers of inflammation in patients with neuropsychiatric illnesses. Based on the associations I’ve seen between Bartonella and symptoms of mental illness in my prior work, Bartonella infection could be one possible candidate.”

In a blinded study, the NC State team used immunofluorescence assays and digital droplet PCR testing to detect and amplify DNA in the blood samples. As the blood samples had been frozen and stored, the researchers did not attempt to culture bacteria from them. Culturing the bacteria can further enhance DNA detection.

Forty-three percent of participants diagnosed with psychosis had Bartonella DNA in their blood compared to 14% in the control population. Additionally, using DNA sequencing, the team was able to identify the Bartonella species for 18 of the 31 participants with Bartonella in their blood, including infection or co-infection with Bartonella henselae (11/18), Bartonella vinsonii subsp. berkhoffii (6/18), Bartonella quintana (2/18), Bartonella alsatica (1/18), and Bartonella rochalimae (1/18)

This is the second study to identify Bartonella in the blood of psychiatric patients. A 2020 study, interrupted by the COVID pandemic, found Bartonella species DNA in 11 of 17 (65%) University of North Carolina School of Medicine patients with schizophrenia versus one of 13 (8%) in healthy volunteer controls.

“We’ve now demonstrated the presence of Bartonella species in the blood of two separate cohorts of patients with neuropsychiatric symptoms, which indicates that these bacteria are worth studying further as a potential driver of these symptoms,” Breitschwerdt says. “At the very least, we need to continue to see if these findings are replicated in other patient populations.”

“This study provides further support for an association between Bartonella species infection and psychosis and may have important clinical implications,” notes Dr. Brian Fallon of CUIMC. “However, it is worth emphasizing that association does not prove causality; other factors may account for the association.

“The other significant finding was that the frequency of positive antibody tests for Bartonella infection was not significantly different for the controls versus the individuals with psychosis; this suggests that exposure to Bartonella is common in the general population and that reliance on serologic test results alone can be misleading.”

The study appears in Frontiers in Psychiatry and was supported in part by the Steven & Alexandra Cohen Foundation, the Lyme & Tick-borne Diseases Research Center at CUIMC, and the American Academy of Child and Adolescent Psychiatry. Dr. Delaney is first author. Cynthia Robveille, assistant research professor at NC State, is co-first author. Drs. Breitschwerdt and Fallon are co-corresponding authors. Other NC State co-authors include Research Professor Ricardo Maggi, former Ph. D. student Dr. Erin Lashnits, junior research scientist Emily Kingston, and graduate research assistant Chance Liedig. Research RN Lilly Murray from Columbia University also contributed to the work.

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Note to editors: An abstract follows.

“Bartonella species bacteremia in association with adult psychosis”

DOI: 10.3389/fpsyt.2024.1388442

Authors: Cynthia Robeville, Ricardo Maggi, Erin Lashnits, Emily Kingston, Chance Liedig, Edward Breitschwerdt, North Carolina State University; Shannon Delaney, Lily Murray, Brian Fallon, Columbia University
Published: June 6, 2024 in Frontiers in Psychiatry

Abstract:
Introduction: The potential role of pathogens, particularly vector-transmitted infectious agents, as a cause of psychosis has not been intensively investigated. We have reported a potential link between Bartonella spp. bacteremia and neuropsychiatric symptoms, including pediatric acute onset neuropsychiatric syndrome and schizophrenia. The purpose of this study was to further assess whether Bartonella spp. exposure or infection are associated with psychosis. Methods: In a blind manner, we assessed the presence of anti-Bartonella antibodies by indirect immunofluorescence assays (IFA), and infection by amplification of bacterial DNA from blood by quantitative polymerase chain reaction (qPCR), digital PCR (dPCR), and droplet digital PCR (ddPCR) in 116 participants. Participants were categorized into one of five groups: 1) controls unaffected by psychosis (n = 29); 2) prodromal participants (n = 16); 3) children or adolescents with psychosis (n = 7); 4) adults with psychosis (n = 44); and 5) relatives of a participant with psychosis (n = 20). Results: There was no significant difference in Bartonella spp. IFA seroreactivity between adults with psychosis and adult controls unaffected by psychosis. There was a higher proportion of adults with psychosis who had Bartonella spp. DNA in the bloodstream (43.2%) compared to adult controls unaffected by psychosis (14.3%, p = 0.021). The Bartonella species was determined for 18 of the 31 bacteremic participants, including infection or co-infection with Bartonella henselae (11/18), Bartonella vinsonii subsp. berkhoffii (6/18), Bartonella quintana (2/18), Bartonella alsatica (1/18), and Bartonella rochalimae (1/18). Discussion: In conjunction with other recent research, the results of this study provide justification for a large national or international multi-center study to determine if Bartonella spp. bacteremia is more prevalent in adults with psychosis compared to adults unaffected by psychosis. Expanding the investigation to include a range of vector-borne and other microbial infections with potential CNS effects would enhance knowledge on the relationship between psychosis and infection.

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JOURNAL

Frontiers in Psychiatry

DOI

10.3389/fpsyt.2024.1388442 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

Bartonella species bacteremia in association with adult psychosis

ARTICLE PUBLICATION DATE

6-Jun-2024

COI STATEMENT

In conjunction with Dr. S. Sontakke and North Carolina State University, EB holds US Patent No. 7,115,385 Media and Methods for Cultivation of Microorganisms, which was issued on October 3rd, 2006. He is a co-founder, shareholder and Chief Scientific Officer for Galaxy Diagnostics, a company that provides advanced diagnostic testing for the detection of Bartonella spp. infections. RM is a co-founder and the Chief Technical Officer for Galaxy Diagnostics Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 

Pesticides impair mobility and immune system of Brazilian native stingless bees, study shows

After 48 hours of exposure to the pesticides imidacloprid, pyraclostrobin and glyphosate, stingless bees of the species Melipona scutellaris exhibited morphological and behavioral alterations that could weaken colonies and aimpair pollination

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

 

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BEES FED A SOLUTION CONTAINING ONE OR MORE OF THE PESTICIDES WALKED LESS, MOVED MORE SLOWLY, AND DISPLAYED FAT BODY MORPHOLOGICAL CHANGES

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CREDIT: GRAZIELE LUNA

A study conducted by Brazilian researchers affiliated with São Paulo State University (UNESP), the Federal University of São Carlos (UFSCar) and the Federal University of Viçosa (UFV) has shown how three pesticides widely used by farmers in Brazil – imidacloprid, pyraclostrobin and glyphosate – affect native stingless bees of the species Melipona scutellaris. Whether they are used singly or combined, the pesticides impaired the bees’ ability to move about and weakened their defenses. An article describing the results of the study is published in the journal Environmental Pollution.

Indiscriminate use of pesticides and their adverse effects on the survival of bees are under discussion worldwide, and a great deal of research is being done on the subject, yet most of the findings published to date focus on European and North American bee species. In Brazil, native stingless bees like M. scutellaris are the priority because of their vital role in pollinating many wild plants and economically important crops.

In the study, which was conducted under the aegis of the FAPESP Research Program on Biodiversity Characterization, Conservation, Restoration and Sustainable Use (BIOTA-FAPESP) and supported via two projects (17/21097-3 and 21/09996-8), the researchers assessed the sublethal effects of the three pesticides on the bees’ behavior, morphology and physiology by orally exposing them to the substances singly and in combination for 48 hours. The results were compared with those of a control group.

The harm done by the pesticides was clear. Bees fed a solution containing one or more of the pesticides in solution walked less and moved more slowly. In addition, their fat body, a vital organ for energy storage, metabolism and immune response regulation, underwent morphological change.

“We found that the pesticides, both singly and combined, interfered severely with the bees’ behavior, damaging their fat body and impairing the activity of important proteins for the immune system and cell survival,” said Cliver Fernandes Farder-Gomes, first author of the article and a researcher at UFSCar’s Center for Agrarian Sciences (CCA).

According to Farder-Gomes, the results show that even if the bees survive exposure to the pesticides, their immune system is weakened and cannot adequately combat pathogenic bacteria, so they become more prone to infections.

“The death of bees is always shocking, but it should be borne in mind that it can often be even more hazardous if they survive exposure to pesticides because colonies are weakened and made smaller, with adverse effects on honey production and pollination, which in turn means losses to fruit and vegetable production,” said Roberta Cornélio Ferreira Nocelli, last author of the article. She is a professor at CCA-UFSCar and chairs an International Commission for Plant-Pollinator Relationships (ICCPR) working group that is developing methods to test for toxicity in Brazilian native bees,

Public policy

To complement these results and provide a more comprehensive picture of the adverse effects of the three pesticides, the researchers plan to analyze their influence on the expression of other proteins and find out how they are affecting other native bee species.

According to Osmar Malaspina, penultimate author of the article and a professor at the Institute of Biosciences of UNESP’s campus in Rio Claro, the study led by Farder-Gomes reveals impacts with long-term consequences for biodiversity and food security and should be used by public policymakers as a rationale for tighter restrictions. He cites as examples the contributions made in recent decades by the Ecotoxicology and Bee Conservation Laboratory (LECA-UNESP) and the Research Group on Bees and Environmental Services (ASAs-UFSCar), led by himself and Nocelli.

“Our 80-plus articles and books, among other works, have been used over the years, above all by IBAMA [Brazil’s main environmental law enforcement agency], to restrict the use of agrochemicals such as fipronil, the insecticide that has been most associated with the global decline of bees,” Malaspina said.

Nocelli stressed that he and his colleagues have no interest in hindering Brazilian agriculture. On the contrary, the point of scientific research is to improve it. “We want agriculture to be more sustainable and to go hand in hand with conservation. This is the only way to assure future food security,” he said.

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.

 

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JOURNAL

Environmental Pollution

DOI

10.1016/j.envpol.2024.123783 

ARTICLE TITLE

Exposure of the stingless bee Melipona scutellaris to imidacloprid, pyraclostrobin, and glyphosate, alone and in combination, impair its walking activity and fat body morphology and physiology

 

Analyzing the benefits of transboundary cooperation in the Lancang-Mekong River Basin

INTERNATIONAL INSTITUTE FOR APPLIED SYSTEMS ANALYSIS

A new study conducted by IIASA researchers and their colleagues highlights that cooperation in infrastructure operation between countries surrounding the Lancang-Mekong River Basin could bring major economic and environmental co-benefits.

The Lancang-Mekong River Basin is one of the largest rivers in the world, passing through Cambodia, China, Laos, Myanmar, Thailand, and Vietnam before emptying into the South China Sea. The national economies of those countries are in various ways reliant on the basin’s forest, agricultural, freshwater, coastal, and marine ecosystems, which provide crucial goods and services for the livelihoods of around 75 million people.

The basin is currently undergoing extensive water resource infrastructure development; however, it also faces severe climate change impacts, long-term transboundary conflicts, and trade-offs between economic goals and ecosystem services provision. To address these challenges and minimize the trade-offs, IIASA scientists Taher Kahil, Yoshihide Wada, and colleagues from other institutions conducted a new study, published in Nature Water, seeking to identify sustainable infrastructure operation pathways, which could also be replicated in similar contexts.

The study includes a new holistic modeling framework that simulates the multisectoral impacts of different policies and operational measures to evaluate the overall economic and environmental effects of various water resource development modes (e.g., non-cooperation, partial cooperation, and full cooperation). The framework integrates the physical infrastructure operation processes associated with water, energy, food, the environment, and their interconnectedness with the decision-making behaviors of national governments.

Applying the framework to the Lancang-Mekong River Basin allowed the researchers to draw several important conclusions. Most importantly, the findings of this study provide additional incentive for riparian countries (located on the banks of a natural watercourse) adjacent to transboundary river basins to choose full cooperation, as more incremental benefits from cooperation could be achieved by minimizing adverse environmental impacts from the existing and planned infrastructures, especially under changing climate conditions.

“We found that full cooperation in the operation of existing and proposed infrastructure outweighs non-cooperation or partial-cooperation modes by maximizing economic benefits while also minimizing the losses in fishery and sediment transport,” explains Taher Kahil, Research Group Leader and Senior Research Scholar in the Water Security Research Group of the IIASA Biodiversity and Natural Resources Program and a coauthor of the study. “Full cooperation becomes more beneficial and stable alongside infrastructure expansion, intensification of climate change, and the degree of satisfying hydrological needs for river ecosystems.”

Focusing primarily on riparian countries, the proposed modeling framework can also be applied in other parts of the world where countries share transboundary basins. The extracted data can be used to identify best practices and opportunities for sustainable development concerning water resources and infrastructure operation.

“Our study provides a good starting point for analyzing similar issues in other basins, but the design of full cooperation in a specific basin will require detailed assessments of local human needs, potential conflicts, and key valued ecosystem services,” notes Kahil. “Additional research is needed to deduce how local conditions and future climate will affect the nonlinear response of basin-wide benefits to the hydrological needs of valued ecosystem services, with the ultimate goal of achieving economic-environmental sustainability in complex and contested transboundary basins.”

Reference:
Yu, Y., Bo, Y., Castelletti, A., Dumas, P., Gao, J., Cai, X., Liu, J., Kahil, T., Wada, Y., Hu, S., Liu, B., Zhou, F., & Zhao, J. (2024). Transboundary cooperation in infrastructure operation generates economic and environmental co-benefits to the Lancang-Mekong River Basin. Nature DOI: 10.1038/s44221-024-00246-1

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JOURNAL

Nature Water

DOI

10.1038/s44221-024-00246-1 

METHOD OF RESEARCH

Computational simulation/modeling

ARTICLE TITLE

Transboundary cooperation in infrastructure operation generates economic and environmental co-benefits in the Lancang-Mekong River Basin

 

Multicenter clinical study supports safety of deep general anesthesia

Minimizing anesthesia during surgery for older adults does not prevent post-op delirium

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

 

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MICHAEL S. AVIDAN, MBBCH (RIGHT), ADMINISTERS ANESTHESIA DURING A SURGERY. HE MONITORS THE ELECTRICAL ACTIVITY OF THE PATIENT'S BRAIN WITH CHIEF ANESTHESIOLOGY RESIDENT KARAM ATLI, MD, TO GUIDE ANESTHESIA DOSAGE AND ENSURE THE PATIENT DOES NOT EXPERIENCE UNINTENDED WAKING DURING SURGERY. NEW RESEARCH FROM WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS AND OTHER INSTITUTIONS SUPPORTS EARLIER FINDINGS THAT INDICATE THAT ANESTHESIA IS NO MORE HAZARDOUS FOR THE BRAIN AT HIGHER DOSES THAN AT LOWER DOSES. 

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CREDIT: WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

General anesthesia makes it possible for millions of patients each year to undergo lifesaving surgeries while unconscious and free of pain. But the 176-year-old medical staple uses powerful drugs that have stoked fears of adverse effects on the brain — particularly if used in high doses.

New findings published June 10 in the Journal of the American Medical Association (JAMA), however, support an earlier study that indicates that anesthesia is no more hazardous for the brain at higher doses than at lower doses, according to the researchers.

The new study reports results of a multicenter clinical trial of more than 1,000 older patients who underwent cardiac surgery at four hospitals in Canada. Researchers at these hospitals, in partnership with colleagues at Washington University School of Medicine in St. Louis, found that the amount of anesthesia used during surgery did not affect the risk of postoperative delirium — a state that may contribute to long-term cognitive decline.

“Concern that general anesthesia harms the brain and causes both early and lasting postoperative cognitive disorders is a major reason that older adults avoid or delay life-enhancing procedures,” said Michael S. Avidan, MBBCh, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology and head of the Department of Anesthesiology at Washington University. “Our new study contributes to other compelling evidence that higher doses of general anesthesia are not toxic to the brain. Dispelling the misleading and pervasive message that general anesthesia causes cognitive disorders will have major public health implications by helping older adults make wise choices regarding essential surgeries, which will promote and sustain healthier lives.”

The dose of administered anesthesia historically has been a carefully calculated balance between too little and too much. Administering an inadequate amount puts patients at risk of experiencing intraoperative awareness. Despite advances in anesthesia care, about 1 in 1,000 people still experience unintended waking during surgery without being able to move or indicate their pain or distress. This can lead to suffering and lifelong emotional trauma.

“The good news is that the distressing complication of intraoperative awareness can be more reliably prevented,” said Avidan, the study’s senior author. “Anesthesia clinicians can now confidently administer a sufficient dose of general anesthesia, providing a margin of safety for unconsciousness, without being concerned that this will put their patients’ brains at risk. The practice of general anesthesia should change based on mounting reassuring evidence.”

Previous smaller studies have suggested that too much anesthesia could be to blame for postoperative delirium, a neurological problem involving confusion, altered attention, paranoia, memory loss, hallucinations and delusions, among other symptoms. A common postoperative complication affecting about 25% of older patients after major surgeries, delirium can be distressing to patients and family members. It is typically temporary but has been linked to longer intensive care and hospital stays, other medical complications, persistent cognitive decline and higher risk of death.

To study the impact of minimizing anesthesia on postoperative delirium, Avidan and colleagues previously conducted a similar clinical study in more than 1,200 older surgical patients at Barnes-Jewish Hospital in St. Louis. The researchers used an electroencephalogram (EEG) to monitor electrical activity in the brains of patients during major surgery and adjusted anesthesia levels to prevent brain activity suppression, considered a sign of excessive anesthesia levels. They found that minimizing anesthesia administration did not prevent postoperative delirium.

To expand upon the results of their single-hospital clinical trial, Avidan collaborated with Alain Deschamps, MD, PhD, a professor of anesthesiology at Universitè de Montreal in Montreal, and a team of Canadian clinical researchers, to conduct the multicenter trial involving patients at four hospitals in Canada — in Montreal, Kingston, Winnipeg and Toronto.

This randomized clinical trial enrolled 1,140 patients undergoing cardiac surgery, high-risk procedures with a high rate of postoperative complications. Roughly half of the patients had their anesthesia adjusted based on electrical activity in the brain, and the other group of patients received the usual care without EEG monitoring. The former group was exposed to almost 20% less anesthesia than the latter group and also had 66% less time with suppressed electrical brain activity, but in both groups, 18% of the patients experienced delirium in the first five days after surgery. Additionally, the length of hospital stays, the incidence of medical complications and the risk of death up to one year postoperatively were no different between patients in the two study groups. However, almost 60% more patients in the group that received less anesthesia had undesirable movements while their surgeons were operating, which could have negatively affected the surgeries.

“The thinking has been that deep general anesthesia excessively suppresses electrical brain activity and causes postoperative delirium,” Avidan said. “Taken together, our two clinical trials, including almost 2,400 high-risk older surgical patients at five hospitals in the United States and Canada, dispel the concern that higher general anesthetic dosing incurs a neurotoxic cost. Delirium is likely to be caused by factors other than general anesthesia, such as the pain and inflammation associated with surgery. Future research should explore other avenues to prevent postoperative delirium. But we can now confidently reassure our patients that they can request and expect to be oblivious, immobile and pain-free during surgical procedures, without worrying about general anesthesia damaging their brains."

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JOURNAL

JAMA

DOI

10.1001/jama.2024.8144 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Electroencephalography-Guided Anesthesia and Delirium in Older Adults After Cardiac Surgery: the ENGAGES-Canada Randomized Clinical Trial

ARTICLE PUBLICATION DATE

10-Jun-2024

JAMA NETWORK

Global prevalence of overweight and obesity in children and adolescents

JAMA Pediatrics

About The Study: This study’s findings indicated 1 of 5 children or adolescents experienced excess weight and that rates of excess weight varied by regional income and Human Development Index. Excess weight among children and adolescents was associated with a mix of inherent, behavioral, environmental, and sociocultural influences that need the attention and committed intervention of primary care professionals, clinicians, health authorities, and the general public.

Corresponding Author: To contact the corresponding authors, email Kewei Li, Ph.D. (vivian5225133@outlook.com) and Zhihui Li, Ph.D. (rockoliver@vip.sina.com).

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamapediatrics.2024.1576)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Cancer incidence trends in successive social generations in the US

JAMA Network Open

About The Study: In this model-based cohort analysis of incident invasive cancer in the general population, decreases in lung and cervical cancers in Generation X may be offset by gains at other sites. Generation X may be experiencing larger per-capita increases in the incidence of leading cancers than any prior generation born in 1908 through 1964. On current trajectories, cancer incidence could remain high for decades.

Corresponding Author: To contact the corresponding author, Philip S. Rosenberg, Ph.D., email rosenbep@mail.nih.gov.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2024.15731)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.15731?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=061024

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

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JOURNAL

JAMA Network Open