New research from Michigan State University finds that microbes play an important role in shaping early brain development, specifically in a key brain region that controls stress, social behaviour, and vital body functions.
The study, published in Hormones and Behavior, used a mouse model to highlight how natural microbial exposure not only impacts brain structure immediately after birth but may even begin influencing development while still in the womb. A mouse model was chosen because mice share significant biological and behavioural similarities with humans and there are no other alternatives to study the role of microbes on brain development.
This work is of significance because modern obstetric practices, like peripartum antibiotic use and Cesarean delivery, disrupt maternal microbes. In the United States alone, 40% of women receive antibiotics around childbirth and one-third of all births occur via Cesarean section.
“At birth, a newborn body is colonised by microbes as it travels through the birth canal. Birth also coincides with important developmental events that shape the brain. We wanted to further explore how the arrival of these microbes may affect brain development,” said Alexandra Castillo Ruiz, lead author of the study and assistant professor in the MSU Department of Psychology.
The research team focused on a brain region called the paraventricular nucleus of the hypothalamus (PVN), which plays a central role in regulating stress, blood pressure, water balance, and even social behaviour. Their previous work had shown that mice raised without microbes, or germ-free mice, had more dying neurons in the PVN during early development. The new study set out to determine whether this increased cell death translated to changes in neuron number in the long run, and if any effects could be caused by the arrival of microbes at birth or if they began in the womb via signals from maternal microbes.
To find out, the researchers used a cross-fostering approach. Germ-free newborn mice were placed with mothers that had microbes and compared them to control groups. When the brains of these mice were examined just three days after birth, results were striking: All mice gestated by germ-free mothers had fewer neurons in the PVN, regardless of whether they received microbes after birth. They also found that germ-free adult mice had fewer neurons in the PVN.
“Our study shows that microbes play an important role in sculpting a brain region that is paramount for body functions and social behaviour. In addition, our study indicates that microbial effects start in the womb via signaling from maternal microbes,” said Castillo-Ruiz.
Rather than shunning our microbes, we should recognise them as partners in early life development,” said Castillo-Ruiz. “They’re helping build our brains from the very beginning.”
Not all acute myocardial infarction patients should be offered routine screening for the stomach ulcer bacterium Helicobacter pylori. However, it is possible that some patient groups with an elevated risk of post-infarction gastrointestinal bleeding benefit from such a test, concludes a large-scale study from Karolinska Institutet and Södersjukhuset published in the journal JAMA.
Upper gastrointestinal bleeding is a serious complication that affects approximately two per cent of patients within a year of a myocardial infarction.
“It’s associated with increased mortality and the risk of recurring cardiovascular events,” says the study’s lead author Robin Hofmann, senior consultant at the Department of Cardiology, Södersjukhuset, and associate professor at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet. “We therefore wanted to examine if screening for the common Helicobacter pylori bacterium, which causes gastritis and gastric ulcers, can reduce the risk of bleeding. This is currently not routine practice.”
The randomised study included almost 18 500 myocardial infarction patients at 35 hospitals in Sweden. Half the group was tested for the bacterium and treated with antibiotics and protein pump inhibitors by their doctors if testing positive, while the other half received routine care without an extra test or treatment.
Effective in anaemic patients
After almost two years’ follow-up, the researchers found that there were slightly fewer individuals in the screening programme who had suffered gastrointestinal bleeding, but not enough to make the difference statistically significant. However, they found a positive effect of the screening when studying specific sub-groups of patients, such as those with anaemia or kidney failure. A particularly positive effect was observed in patients with moderate to severe anaemia, who suffered gastrointestinal bleeding at roughly half the rate if they underwent screening.
“Our results suggest that screening for Helicobacter pylori does not need to be done routinely for all individuals following a heart attack,” says Dr Hofmann. “On the other hand, testing and treatment could be a meaningful complement for selected patient groups with an elevated risk of bleeding.”
The researchers will now go on to study the long-term effects and try to identify which groups will benefit most from screening.
Inkosi Albert Luthuli Central Hospital is KwaZulu-Natal’s only public hospital with a functioning cardiac unit. Photo by Hush Naidoo Jade Photography on Unsplash
By Chris Bateman
Doctors have blown the whistle about a crisis at one of KwaZulu-Natal’s most important public hospitals, saying it is functioning far under capacity due to a series of crippling cuts.
The Inkosi Albert Luthuli Central Hospital in Durban’s Cato Manor is operating at around 40% below surgical capacity, according to senior doctors there. As one of a small number of central hospitals in South Africa, it provides specialist services unavailable elsewhere in KwaZulu-Natal and serves as a critical hub for training healthcare workers.
Several doctors who work at Albert Luthuli, who asked to remain anonymous for fear of reprisals, told Spotlight that frozen posts, severely understaffed ICUs, shortages of surgical consumables, and delays in diagnostic tests have combined to drive an austerity-fuelled collapse they say is costing lives.
One doctor said theatre slates – daily surgery schedules – have been cut by as much as 60% compared to pre-pandemic levels. Some described the situation as worse than during COVID-19, when all elective surgeries were cancelled.
“Patients have to wait or be sent home when they can’t get on a theatre list. Then they’re either lost to follow-up or they present ‘in extremis’ later,” said one senior doctor. “Paediatric cases are among the worst. They should be referred on day one, but because of ICU nursing shortages they only get admitted on day four or five – if at all. Often, they’re too ill for our care to be effective.”
Spotlight put these allegations to the KwaZulu-Natal Department of Health, but the department had not responded by deadline despite several follow-ups.
Collapsing specialist services
Albert Luthuli is KwaZulu-Natal’s only public hospital with a functioning cardiac unit, according to one of the doctors who spoke to Spotlight. The doctor said the province has just one adult cardiologist in the public sector who sees over 60 patients per day and that cardiac surgeries have dropped from 600 per year to under 300 projected for 2025. By contrast, there are over 30 adult cardiologists working in the private sector in the province.
Anaesthesiology is among the hardest hit areas. According to Spotlight’s sources, eight anaesthetic consultants resigned in the past year, citing burnout and workload. Where nine or ten theatre slates once ran daily, there are now only four or five. Eleven anaesthetists remain to cover 19 theatres.
“I never thought I’d see the day when I wouldn’t want to come in. We are four ICU consultants covering nine beds. ICU needs one nurse per bed, but we’re usually staffed with six or seven nurses in total. Across six ICUs, we’ve got 25 nurses. We pull in ward staff or rely on overtime. You can’t have one nurse running between beds – it spreads infection, mistakes happen. It’s impossible,” one ICU doctor told Spotlight.
Doctors estimate a 45% shortage of qualified ICU nurses. “It’s like airplanes circling, running out of fuel, and crashing before they can land,” one senior doctor said. “Patients deteriorate while waiting for beds or for a theatre list to open.”
Specialist theatre nursing posts have also been cut, compounding the strain.
Registrars squeezed, training undermined
The hospital is meant to offer advanced procedures, experimental treatments, innovative research, and specialist training. Instead, registrars – these are doctors in specialist training – say they are losing out on irreplaceable experience.
Junior registrars are allegedly blocked from logging procedures they need to qualify, because seniors are prioritised to assist with the shrinking pool of operations.
Spotlight has seen a grievance letter from the Anaesthetics Department’s Registrar Representative, addressed to the hospital CEO, medical manager, the SA Society of Anaesthesiologists, and training stakeholders. It warns that the consultant exodus has left registrars running high-risk cases with inadequate supervision, “directly compromising both patient safety and registrar training.”
One senior doctor said theatre usage had more than halved in recent months compared to historical averages. With no new registrar intake and no appointments of departed registrars to consultant posts, it is projected only 10 or 12 permanent consultants will remain for the hospital’s 846 beds – there should be at least 21 consultants. (A registrar becomes a consultant, or qualified specialist, once their training is complete.)
“This is no longer a looming concern, but an active crisis,” the letter warned, threatening patient safety, staff wellbeing, and the integrity of training in KwaZulu-Natal.
“What they broke in six months will take years to fix,” said one registrar.
But some are more positive. Professor Dean Gopalan, Head of Anaesthesiology, Pain Medicine & Critical Care at UKZN’s School of Medicine, said austerity cuts had dented efforts to achieve excellence, but “we remain above required training norms”. He said he was awaiting feedback from the Health Professions Council (HPCSA), which inspected the hospital in July and raised concerns about specialist and nurse shortages. Spotlight followed up with the HPCSA, but had not received a response by the time of publication.
Not all departments are as fortunate. One doctor said it would be “almost impossible” to meet training accreditation standards for cardiology given the patient workload.
Human cost
Doctors say the crisis is most visible in paediatric congenital heart disease cases.
“These children could live normal lives if operated on early. Instead, they wait until they are drastically sick before making the theatre slate – often six months later,” said one doctor. “People forget surgery is also a primary healthcare intervention. Breadwinners sit at home unable to work, while their families suffer.”
In orthopaedics, doctors say the waiting list exceeds 1 300 patients, with the first elective surgery dates only available in March 2028. Before COVID-19, they say the waiting period was seven months.
“Many patients are unable to work due to their conditions and would be able to get back to work if they had their operations,” said one source. “We try prioritising them, but then you put them ahead of others also in severe pain. Complications are already coming in from other hospitals due to unavailable implants and delayed treatments.”
Procurement freeze
Several doctors trace the crisis to a “G77 notice” issued by the KZN Department of Health on 14 November 2024, freezing new purchase orders until April 2025 to “manage accruals” and reduce overspending. Exceptions required approval from head office.
While a less prescriptive circular has since replaced it, procurement remains “extremely difficult”, sources said.
Doctors said the freeze caused months-long delays in acquiring consumables, drugs, and equipment. “We’re almost at the point where we’re only doing emergencies,” said one doctor. “We prioritise cancer patients for chemo or radiation instead of urgently needed surgery. But in cardiac surgery, there’s definite mortality. You can’t avoid it when you can’t do bypasses or valve replacements. Waiting lists are years long.”
One anaesthetist recalled a patient being “closed” mid-operation because a critical consumable was unavailable.
A national problem?
The situation at Albert Luthuli hospital partly reflects a wider national crisis in specialist care. A 2019 government strategy paper noted only 16.5 specialists per 100 000 people overall, with just seven per 100 000 in the public sector, compared to 69 per 100 000 in private.
Professor Eric Buch, CEO of the Colleges of Medicine of SA, said austerity has worsened matters by reducing registrar posts and constricting the pipeline. “Specialist posts are being frozen, impeding access to specialist care and reducing the number of specialists available to train registrars. Even before austerity we had far too few specialists. Some registrars waited up to two years for a post.”
The Albert Luthuli hospital crisis is “not unique”, said Dr Reno Morar, COO of Nelson Mandela University’s Faculty of Health Sciences.
“Equity of access to specialised services simply does not exist,” he said. “Despite the mess, there are pockets of excellence, but there’s no strategic national vision for highly specialised services.”
Health Ombud Professor Taole Mokoena told Spotlight his office had not specifically investigated Albert Luthuli, but said that, “sadly, there are reports not dissimilar from many hospitals in the country,” citing Helen Joseph Hospital in Johannesburg and Robert Mangaliso Sobukwe Hospital in Kimberley.
Doctors at Albert Luthuli hospital have indicated to Spotlight they will lodge a formal complaint with the health Ombud.
Posts advertised
While the KZN Department of Health did not respond to Spotlight’s questions, there are signs of movement. Two days after we requested comment, a circular went out advertising dozens of specialist posts across provincial referral hospitals, including 12 anaesthetics posts, five of them at Albert Luthuli, plus 100 staff nurse and 50 registered nurse posts.
We also understand that an internal briefing of department heads was called for 27 August, 36 hours after Spotlight’s first request for comment.
Doctors, however, remain sceptical.
“Nothing will change for six months as we go through the interview, verification, and induction processes. Why did they take so long to listen? The damage is done. Relief is 18 to 24 months too late,” said one doctor.
Another senior doctor said that with each resignation over the past year, he lined up replacements and pleaded in vain for permission to advertise. “Since posts reopened this week, I know of just one applicant. Do they expect specialists to suddenly appear out of the woodwork?”
The job advertisements are for “far less than what has been lost and needed. And it’s far more than just numbers – it’s skills and experience”, noted another doctor. “It will take years to get back to where we were.”
Despair among staff
Several doctors expressed despair at what they see as a lack of urgency from government.
“It makes me wonder how resources are managed. Local cuts feel disproportionate compared to national ones. It’s disheartening. Some of us are here to make a difference, but we’re starting to lose hope,” one said.
Another added: “If you know there’s light at the end of the tunnel, you can keep going. But when it feels endless, it’s damn hard. We try to hide our disenchantment, but it’s becoming impossible.”
A team of researchers at Washington University in St. Louis is in pursuit of translating induced, or synthetic, torpor into potential solutions for humans, such as when there is reduced blood flow to tissues or organs, to preserve organs for transplantation or to protect from radiation during space travel. (Credit: Chen lab)
Nature is often the best model for science. For nearly a century, scientists have been trying to recreate the ability of some mammals and birds to survive extreme environmental conditions for brief or extended periods by going into torpor, when their body temperature and metabolic rate drop, allowing them to preserve energy and heat.
Taking inspiration from nature, Hong Chen, professor of biomedical engineering in the McKelvey School of Engineering and of neurosurgery at WashU Medicine, and an interdisciplinary team induced a reversible torpor-like state in mice by using focused ultrasound to stimulate the hypothalamus preoptic area in the brain, which helps to regulate body temperature and metabolism. In addition to the mouse, which naturally goes into torpor, Chen and her team induced torpor in a rat, which does not. Their findings, published in 2023 in Nature Metabolism, showed the first noninvasive and safe method to induce a torpor-like state by targeting the central nervous system.
Now, the team is in pursuit of translating induced, or synthetic, torpor into potential solutions for humans, such as when there is reduced blood flow to tissues or organs, to preserve organs for transplantation or to protect from radiation during space travel.
Conventional medical interventions focus on increasing energy supply, such as restoring blood flow to the brain after a stroke. Synthetic torpor seeks to do the opposite by reducing energy demand.
“The capability of synthetic torpor to regulate whole-body metabolism promises to transform medicine by offering novel strategies for medical interventions,” said Chen in a Perspectives paper published in Nature Metabolism July 31, 2025.
Synthetic torpor has been used successfully in preclinical models with medications and specialised targeting of the neural circuit, but there are challenges to adapting these methods for humans. Previous human trials with hydrogen sulfide were terminated early due to safety concerns.
“Our challenges include overcoming metabolic differences among animals and humans, choosing the correct dose of medication and creating ways to allow a reversible torpor-like state,” said Wenbo Wu, a biomedical engineering doctoral student in Chen’s lab and first author of the Perspectives paper, a collaboration between Chen’s team and Genshiro Sunagawa from the RIKEN Center for Biosystems Dynamics Research in Japan. “Collaboration among scientists, clinicians and ethicists will be critical to develop safe, effective and scalable solutions for synthetic torpor to become a practical solution in medicine.”
Chen’s team, including Yaoheng (Mack) Yang, who was a postdoctoral research associate in her lab and is now assistant professor of biomedical engineering at the University of Southern California, targeted the neural circuit with their induced torpor solution in mice. They created a wearable ultrasound transducer to stimulate the neurons in the hypothalamus preoptic area. When stimulated, the mice showed a drop in body temperature of about 3 degrees C for about one hour. In addition, the mice’s metabolism showed a change from using both carbohydrates and fat for energy to only fat, a key feature of torpor, and their heart rates fell by about 47%, all while at room temperature.
“Ultrasound is the only noninvasive energy modality capable of safely penetrating the skull and precisely targeting deep brain structures,” Chen said. “While ultrasound neuromodulation lacks cell-type specificity compared with genetic-based neuromodulation, it provides a noninvasive alternative for inducing synthetic torpor without the need for genetic modifications.”
Chen and her team indicate that synthetic torpor offers a promising therapeutic strategy with additional applications, including inhibiting tumour growth and potential development of new therapies for tau protein related diseases, such as Alzheimer’s disease. However, much remains unknown about how brain regions, peripheral organs and cellular pathways coordinate metabolic suppression and arousal. Researchers also need to study the long-term risks and potential side effects and call for more preclinical studies and technological innovations that will facilitate a dual approach, which would include modulating neural circuits associated with hypometabolism and influencing peripheral metabolic pathways through systemic interventions, such as with drugs or peripheral neuromodulation.
“Synthetic torpor is no longer just a theoretical concept – it is an emerging field with the potential to redefine medicine,” Chen said. “Bridging fundamental neuroscience, bioengineering and translational medicine will be key to overcoming current challenges and advancing synthetic torpor toward real-world applications. Synthetic torpor could transition from a scientific curiosity to a human reality through interdisciplinary collaborations.”
Photo by cottonbro studio: https://www.pexels.com/photo/close-up-shot-of-a-person-holding-a-scalpel-5721557/
Chronic rhinosinusitis (CRS), or sinusitis, is a long-term condition affecting one in 10 UK adults. Symptoms include a blocked and runny nose, loss of smell, facial pain, tiredness and worsening of breathing problems, such as asthma. It’s often similar to the symptoms of a bad cold, but it can last for months or even years.
The team carried out a randomised controlled patient trial comparing sinus surgery with long-term use of antibiotics, and a placebo.
More than 500 patients took part from around the UK, and all of them used nasal steroids and saline rinses as part of their usual care – both of which have been shown to help the condition.
The researchers found that surgery was effective at relieving sinusitis symptoms, and trial participants who underwent surgery were still feeling better six months later, according to the findings published in The Lancet. Of those who underwent surgery, 87% said their quality of life had improved six months on.
A three-month course of low dose antibiotics was not found to be helpful as there was no significant difference in outcomes between those on antibiotics and those in the placebo arm of the trial.
The study is part of the MACRO programme, involving a collaborative group of researchers from UCL (the trial’s sponsor), the University of East Anglia (UEA), Guy’s and St Thomas’ NHS Foundation Trust, the University of Southampton, the University of Oxford, UCLH, and Imperial College London. The programme is funded by the National Institute for Health and Care Research.
Lead author Professor Carl Philpott, from UEA’s Norwich Medical School, one of the Chief Investigators of the MACRO trial, said: “What we found is that surgery was effective at reducing symptoms six months on, while taking the course of antibiotics seemed to make little difference. Until now, there was no evidence in the form of a trial that showed sinus surgery works better than medical treatment and access to sinus surgery has been restricted in some parts of the UK in recent years. This could be a real game-changer for sufferers worldwide.
“We hope our findings will help reduce the length of time for patients to get treatment. Streamlining clinical pathways will help reduce unnecessary visits and consultations, and save on healthcare resources.”
For the trial, all participants received nasal steroids and saline rinses as standard care, alongside their randomly allocated treatment option of either sinus surgery, antibiotics or placebo tablets. They were followed up after three and six months, where researchers examined their nose and sinuses, took airflow readings and conducted smell tests, to gauge the success of each treatment in terms of improvement of symptoms, quality of life and possible side effects.
Jim Boardman, MACRO patient representative, said: “I’ve lived under a cloud for years with CRS, as have many others I’ve met with the same condition. There’s a persistent headache and blocked nose along with the loss of sense of smell, which removes a whole dimension of everyday experience and enjoyment. A clear path to successful treatment will be welcomed by all CRS sufferers.”
The researchers are now continuing their research to assess the cost-effectiveness of sinus surgery, while also continuing to follow up trial participants over longer periods of time to see how long the benefits last.
Early withdrawal of aspirin following successful percutaneous coronary intervention (PCI) for acute coronary syndrome and in low-risk patients following an acute myocardial infarction (MI) was the focus of two separate hot line trials presented at ESC Congress 2025. A third trial provided insights into early escalation and late de-escalation of antiplatelet therapy after complex PCI.
In the NEO-MINDSET trial, simultaneously published in NEJM, researchers in Brazil randomised approximately 3400 patients within the first four days of hospitalisation following a successful PCI to either stop treatment with aspirin and receive potent P2Y12 inhibitor monotherapy (ticagrelor or prasugrel) or to receive dual antiplatelet therapy (DAPT) that included aspirin and a potent P2Y12 inhibitor for 12 months.
At 12 months, the primary endpoint of death from any cause, MI, stroke or urgent revascularisation had occurred in 119 patients in the monotherapy group and in 93 patients in the DAPT group (p = 0.11 for noninferiority). Researchers also noted that major or clinically relevant nonmajor bleeding occurred in 33 patients assigned to monotherapy vs 82 patients assigned to DAPT. Stent thrombosis occurred in 12 patients in the monotherapy group and in 4 in the dual antiplatelet therapy group.
“We failed to demonstrate the noninferiority of aspirin-free monotherapy initiated immediately after PCI with regard to the ischaemic primary endpoint over 12 months,” said Principal Investigator Pedro Lemos, MD. “Results from the landmark analysis suggest that the excess ischaemic risk with monotherapy occurred in the first 30 days, with comparable outcomes thereafter. Bleeding appeared to be lower at both 30 days and 12 months with monotherapy versus DAPT.”
In TARGET-FIRST, also simultaneously published inNEJM, P2Y12-inhibitor monotherapy was noninferior to continued DAPT with respect to the occurrence of adverse cardiovascular and cerebrovascular events among low-risk patients with acute MI who had undergone early complete revascularisation and had completed one month of DAPT without complications. It also resulted in lower incidence of bleeding events.
Nearly 2000 patients from 40 centres in Europe were randomised to receive P2Y12-inhibitor monotherapy or to continue DAPT for 11 months. A primary-outcome event occurred in 20 patients (2.1%) in the P2Y12-inhibitor monotherapy group and in 21 patients (2.2%) in the dual antiplatelet therapy group (p = 0.02 for noninferiority). Major bleeding occurred in 2.6% of the patients assigned to P2Y12-inhibitor monotherapy group compared with 5.6% of those assigned to DAPT (p = 0.002 for superiority). The incidence of stent thrombosis and serious adverse events appeared to be similar in the two groups, researchers said.
Principal Investigator Giuseppe Tarantini, MD, noted that no previous randomised trials have assessed early aspirin discontinuation in acute MI patients who achieve early, complete revascularisation with modern stents. “These results reflect the benefits of modern stents, high procedural success and optimal medical therapy, making early aspirin discontinuation feasible in this selected population,” he said.
The TAILORED-CHIP trial found early escalation and late de-escalation of antiplatelet therapy is not beneficial in patients with high-risk anatomical or clinical characteristics undergoing complex PCI.
Researchers in South Korea randomised approximately 2000 patients to standard DAPT (clopidogrel plus aspirin for 12 months) or a tailored antiplatelet strategy consisting of early escalation (low-dose ticagrelor at 60mg twice daily plus aspirin for 6 months) followed by late de-escalation (clopidogrel monotherapy for 6 months).
Overall findings showed no significant difference in the incidence of major ischemic events at 12 months with tailored therapy compared with standard DAPT. However, the incidence of clinically relevant bleeding was significantly higher with tailored therapy, according to study investigators.
“Our results suggest that a tailored strategy in patients undergoing complex high-risk PCI does not provide a net clinical benefit,” said Principal Investigator Duk-Woo Park, MD, PhD, FACC. “We observed an increase in bleeding complications without a significant reduction in ischaemic events. This challenges the notion that ‘more is better’ even in carefully selected patients at high ischaemic risk.”
