Arkansas Department of Health

Lung cancer remains a leading cause of cancer-related mortality worldwide, and immunotherapy has emerged as a promising treatment modality. However, its efficacy is limited to a subset of patients, necessitating predictive biomarkers for personalized treatment strategies. DNA methylation (DNAm) is increasingly recognized as a crucial regulators of gene expression and immune responses in the tumor microenvironment. This review focuses on DNAm as a key epigenetic biomarker for predicting and enhancing immunotherapy efficacy in lung cancer. We highlight DNAm changes in key immune-related genes and their association with tumor phenotype, immune cell infiltration, and response to immune checkpoint inhibitors (ICIs). The review also evaluates established and emerging genomic and non-genomic biomarkers, including tumor mutational burden (TMB), microsatellite instability (MSI), PD-L1 expression, tumor-infiltrating lymphocytes (TILs), and immunosuppressive cytokines in case of lung cancer immunotherapy. Furthermore, the potential for integrated epigenetic signatures and minimally invasive diagnostic approaches, such as liquid biopsies, is discussed. Finally, we address the challenges and future directions for translating epigenetic biomarkers into clinical practice to improve immunotherapy outcomes and reduce immune-related adverse events.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are widely used in patients with kidney disease and have been shown to increase serum magnesium levels. Case reports have described their role in correcting hypomagnesemia; however, there is limited evidence regarding their efficacy in patients with renal magnesium wasting. Furthermore, data regarding their role in acute treatment and sustained efficacy to treat hypomagnesemia are lacking. We present a multicenter retrospective, observational case series from two U.S. medical centers describing five patients with refractory hypomagnesemia who experienced significant improvement following initiation of SGLT2 inhibitors. Patients 1–4 showed marked renal magnesium wasting with severe symptomatic hypomagnesemia which responded robustly to SGLT2 inhibitor therapy. Even though Patient 5 did not have renal magnesium wasting, hypomagnesemia still improved with the addition of an SGLT2 inhibitor. Furthermore, the addition of an SGLT2 inhibitor acutely improved the hypomagnesemia of Patients 1 and 2 in an inpatient setting, and Patients 3–5 demonstrated sustained improvement of hypomagnesemia across extended outpatient follow-up. The improvement of hypomagnesemia was irrespective of the diabetic status of the patient. All cases resulted in substantial reduction or cessation of magnesium (Mg) supplementation. These findings suggest a novel therapeutic application of SGLT2 inhibitors for managing intractable hypomagnesemia, both acutely and chronically, regardless of the diabetes being the primary culprit.

This cross-sectional study examines racial and ethnic disparities associated with recently transmitted tuberculosis and reactivation of latent tuberculosis infection in Arkansas, which has low tuberculosis incidence.

The present study examined the impact of the N-type calcium channel blocker gabapentin (GBP) and the partial glycine agonist D-cycloserine (CYC) to attenuate the behavioral effects of naloxone in opioid-dependent humans responding under a naloxone discrimination procedure. Methadone-maintained participants were trained to distinguish between a low dose of naloxone (0.15 mg/70 kg, i.m.; i.e., drug A) and placebo (i.e. drug B) under an instructed novel-response drug discrimination procedure, in which participants identify the drug condition as 'A', 'B', or 'N' (neither A nor B - 'novel'). Once the discrimination was acquired, doses of CYC (0, 500, and 625 mg) and GBP (0, 100, 200, and 400 mg) each alone and in combination with the training dose of naloxone were tested. GBP alone produced only placebo-appropriate responding and did not significantly alter naloxone discrimination when coadministered with naloxone, though it modestly reduced naloxone-induced visual analog scale ratings of drug 'strength'. CYC alone also produced predominantly placebo-appropriate responding and did not modulate naloxone-appropriate responding, but increased ratings of bad effects and decreased ratings of like placebo relative to naloxone alone at the 500 mg dose. These null findings regarding the modulation of naloxone discrimination highlight the limited efficacy of GBP and CYC in this context, contributing to the understanding of pharmacological interactions with opioid antagonists and their potential implications for opioid withdrawal treatment.

The current study used a convergent mixed-methods design and identified Arkansas school professionals' perceptions about (1) their schools' tobacco use prevention needs and (2) the implementation of tobacco prevention programming at their schools. Differences in perceptions based on school-related factors and personal tobacco use history were examined. Surveys were collected from teachers, administrators, and school staff from K-12 schools in Arkansas (QUANT; N = 325) and in-depth interviews were conducted with a separate sample of school administrators (QUAL; N = 20). Logistic regressions identified the associations between dependent variables, school-related factors (school type, school position, years of education work experience, and school rurality), and school professionals' tobacco use histories. The tobacco prevention components perceived as most important were parent education, school tobacco-free policies, and up-to-date teacher training. Yet, parent education and up-to-date teacher training were perceived as being poorly integrated into schools. Quantitative and qualitative findings emphasized the importance of integrating parents into tobacco prevention. There were differences in school professionals' perceptions about important tobacco prevention components based on school level, personal tobacco use history, and work experience. There were also differences in perceptions about how well tobacco prevention was integrated into schools between teachers vs. administrators and related to school rurality, school level, and work experience. School professionals in Arkansas, a state with tobacco disparities, identified that: (1) student tobacco use is a top health priority; (2) key strategies include parent education, tobacco-free policies, and teacher training; and (3) barriers exist, particularly in implementing parent education and teacher training.

BACKGROUNDUnnecessary cesarean delivery can have negative implications for both mothers and infants. In the United States, the proportion of women undergoing cesarean delivery exceeds the acceptable World Health Organization proportion. Reducing cesarean deliveries is a national goal of Centers for Disease Control and Prevention Healthy People 2030, the American College of Obstetricians and Gynecologists, and the Alliance for Innovation on Maternal Health.OBJECTIVEThis study aimed to examine if excessive gestational weight gain is associated with increased risk of cesarean delivery across multiple body mass index categories.STUDY DESIGNAnalysis was conducted using vital records data from the National Center for Health Statistics birth records. Only low-risk births were included (singleton, term-gestation [≥37 weeks], cephalic presentation, and first birth to exclude women who had a prior cesarean delivery). We used the rate of gestational weight gain (lb/wk) measured as both a categorical and continuous variable. These results were confirmed by a sensitivity analysis using total gestational weight gain (lb).RESULTSRegardless of prepregnancy body mass index category, women with excessive gestational weight gain had a higher risk of cesarean delivery. Among women with a healthy prepregnancy body mass index, the risk of cesarean delivery decreased with appropriate weight gain, suggesting a potential protective effect of moderate weight gain for individuals with a healthy prepregnancy body mass index. However, weight gain beyond the appropriate level increased the risk of cesarean delivery. For women with overweight or obese prepregnancy body mass index, any increase in gestational weight gain was associated with a higher cesarean delivery risk.CONCLUSIONThis study found a strong association between an excessive rate of gestational weight gain and the risk of cesarean delivery, regardless of prepregnancy body mass index, suggesting the need for continued efforts to reduce excessive gestational weight gain across populations.