Latest news with #MarkWorthington
Medscape
10 hours ago
- Health
- Medscape
Sclerosing Mesenteritis: Update on Rare GI Disease
The American Gastroenterological Association (AGA) has issued an updated pragmatic review on sclerosing mesenteritis (SM). Published in Clinical Gastroenterology and Hepatology, the update evaluates available evidence for diagnosis and treatment and examines opportunities for future research in SM, previously known by such names as misty mesentery, mesenteric panniculitis, and inflammatory pseudotumor. Led by Mark T. Worthington, MD, a professor of medicine in the Division of Gastroenterology and Hepatology at the University of Virginia in Charlottesville, Virginia, an expert AGA panel described SM as an uncommon benign idiopathic autoimmune disease of the mesenteric fat. Although of poorly understood etiology, gastroenterologists need to be prepared to diagnose it. 'CT radiologists increasingly are reporting SM and related lesions, such as misty mesentery,' Worthington told Medscape Medical News . 'We are also seeing new SM cases caused by immune checkpoint inhibitors in cancer treatment, and the oncologists ask us to manage this because it interferes with the treatment of the underlying malignancy. Those are often readily treated because we catch them so early.' Metabolic syndrome and associated conditions increase the risk for SM, as does aging. The recent changes are intended to help clinicians predict disease activity and the need for other testing or treatment. 'For instance, most cases are indolent and do not require aggressive treatment — often no treatment at all — but for those that are aggressive, we want the clinician to be able to identify those and make sure the treatment is appropriate. The aggressive cases may warrant tertiary referral,' Worthington said. 'A secondary cancer is a possibility in this condition, so drawing from the SM radiology studies, we try to help the clinician decide who needs other testing, such as PET-CT or biopsy, and who can be monitored.' As many as 60% of cases are asymptomatic, requiring no treatment. Abdominal pain is the most frequent symptom and its location on clinical examination should correspond to the SM lesion on imaging. Treatment involves anti-inflammatory medications tailored to disease severity and clinical response. No biopsy is not necessary if the lesion meets three of the five CT criteria reported by B. Coulier and has no features of more aggressive disease or malignancy. Although some have suggested that SM may be a paraneoplastic syndrome, current evidence does not support this. SM needs to be differentiated from other diagnoses such as non-Hodgkin's lymphoma, peritoneal carcinomatosis, and mesenteric fibromatosis. 'There are now CT guidelines for who actually has SM, who needs a biopsy or a PET-CT to rule-out malignancy, and who doesn't,' said Worthington. 'Radiologists do not always use the Coulier criteria for diagnosis, but often they will with encouragement. From this review, a GI clinician should be able to identify SM on CT.' Epidemiologically, retrospective CT studies have reported a frequency of 0.6%-1.1%, the panelists noted. And while demographic data are limited, a large early case series reported that SM patients had a mean age of 55 years and more likely to be men and of White race. Patients with SM do not have a higher prevalence of autoimmunity in general, but may have increased rates of metabolic syndrome, obesity, coronary artery disease, and urolithiasis, the panelists noted. The update allows room for differences in clinical judgment. 'For instance, a longer or more frequent CT surveillance interval can be justified depending on the patient's findings, and no one should feel locked in by these recommendations,' Worthington said. Medical Therapy Although there is no surgical cure, pharmacologic options are many. These include prednisone, tamoxifen, colchicine, azathioprine, thalidomide, cyclophosphamide, and methotrexate, as well as the biologics rituximab, infliximab and ustekinumab. Current corticosteroid-based therapies often require months to achieve a clinical response, however. Bowel obstruction is managed nonoperatively when feasible, but medically refractory disease may require surgical bypass. Offering his perspective on the guidance but not involved in its formulation, Gastroenterologist Stephen B. Hanauer, MD, a professor of medicine at Northwestern Medicine in Chicago, said, 'The most useful component of the practical review is the algorithm for diagnosis and determination when biopsy or follow-up imaging is reasonable in the absence of evidence.' He stressed that the recommendations are pragmatic rather than evidence-based 'as there are no controlled trials and the presentation is heterogeneous.' Hanauer added that none of the recommended treatments have been shown to impact reduction on imaging. 'Hence, all of the treatments are empiric without biological or imaging endpoints.' In his experience, patients with inflammatory features are the best candidates for immune-directed therapies as reduction in inflammatory markers is a potential endpoint, although no therapies have demonstrated an effect on imaging or progression. 'As an IBD doctor, I favor steroids and azathioprine or anti-TNF directed therapy, but again, there is no evidence beyond reports of symptomatic improvement.' Worthington and colleagues agreed that treatment protocols have developed empirically. 'Future investigation for symptomatic SM should focus on the nature of the inflammatory response, including causative cytokines and other proinflammatory mediators, the goal being targeted therapy with fewer side effects and a more rapid clinical response,' they wrote. Currently, said Worthington, the biggest gaps remain in treatment. 'Even the best studies are small and anecdotal, and we do not know the cytokine or other proinflammatory mediators.' In other comments, Gastroenterologist Eli D. Ehrenpreis, MD, research director, Internal Medicine Residency, at Advocate Lutheran General Hospital in Park Ridge, Illinois, and not involved in the update, found it fell short in several ways, including nomenclature. 'The appropriate term for this condition is mesenteric panniculitis, meaning inflammation of the mesenteric fat, seen histologically on biopsy. The term sclerosing mesenteritis introduces the idea of fibrosis, which is seen in a smaller number of patients, not all,' he told Medscape Medical News . Ehrenpreis also took issue with the inclusion of the cancer drug tamoxifen as the most common treatment used. 'Mesenteric panniculitis, when it does not represent a malignancy, is a benign disease,' he said. 'However, many patients on tamoxifen will experience hormone-related adverse effects such as breast tenderness and hot flashes.' He noted the drug has an FDA Black Box warning for uterine malignancies, pulmonary embolism, and other thromboembolic events, including stroke. Another significant gap, in his view, is the lack of recognition of the psychological effects on patients of the diagnosis. According to Ehrenpreis, more prospective analyses of treatments are needed with objective measures of success including symptom scoring and laboratory testing with erythrocyte sedimentation rate and C-reactive protein. 'And as with many rare diseases, a better understanding of the psychological effects of having a poorly understood disease and management of this challenge is vital to the comprehensive care of the patient with mesenteric panniculitis.' This guidance was supported by the AGA. Worthington reported renumeration from TriCity Surgery Center, Prescott, Ariz. The coauthor Wolf has received renumeration from AbbVie, Align Technology, Alnylam Pharmaceuticals, CVS Health ORP, Dexcom, Exact Sciences, HCA Healthcare, Johnson & Johnson, Eli Lilly, McKesson, Moderna, Regeneron Pharmaceuticals, Sarepta Therapeutics, Seagen, Stryker, and Thermo Fisher Scientific. Crockett has served as a consultant for IngenioRx. Pardi has served as a consultant for Boehringer Ingelheim and received research support from Atlantic, ExeGI Pharma, Rise Therapeutics, Janssen, Pfizer, Seres, Applied Molecular Transport, Takeda Pharmaceuticals, and Vedanta Biosciences. Hanauer and Ehrenpreis had no conflicts of interest relevant to their comments.
Yahoo
14-02-2025
- Entertainment
- Yahoo
Too quiet on set? Hollywood pushes for more LA productions post wildfires
Hollywood may be known as Tinseltown, a dream factory at the heart of the global entertainment industry. But nowadays crews are more likely to film in Atlanta, London, Toronto or Sydney than in Los Angeles. Cheaper labour and better tax breaks have lured producers away from the City of Angels for years. The wildfires, which killed at least 29 people and destroyed thousands of homes, have only added to this existential crisis. Now, many here are calling on the state - and studios and streaming services - to boost local production. "The best thing the studios could do for fire relief is to bring work back for the rank and file LA film workers," says Mark Worthington, a production designer whose home burned down in Altadena. "That's what we want." Mr Worthington had already been struggling to cope with the city's downturn, noting he hadn't set foot on an LA set in two years. Covid, labour strikes, and the inevitable end of the streaming boom had led many producers to try and save costs by skipping town - sometimes leaving the country altogether. Why Hollywood's big boom has gone bust Productions in the US decreased 26% last year compared to pre-strike levels in 2022, according to ProdPro, which tracks global production. In Australia and New Zealand, production was up 14% and in the UK it was up nearly 1%, with Canada up 2.8%. The loss clearly stings. The Red Hot Chili Peppers are a band synonymous with Los Angeles, with many love songs to the City of Angels. But a biopic about the band is being filmed in Atlanta, Georgia - which has become a major production hub due to its lucrative tax breaks - not LA. Before the fires, "Survive until '25" had become a kind of mantra for Mr Worthington and other filmmakers who hoped for a turnaround of fortune. Instead, their city went up in flames. "It's crushing in terms of how you see yourself as a creative individual and just as a person, and then on top of that to have these fires," Mr Worthington says. "This is adding a horrible other thing to pile on top of all the other difficulties and our own work situation over the last couple years." Even before the LA fires, Californians fled for 'climate havens' Power lines, hikers, arson: What might have sparked LA's devastating fires? Mel Gibson, Jeff Bridges and other LA celebrities lose homes to wildfires 'I have nothing to go back to' - LA fires heartbreak Hollywood's studios and streaming services have donated more than $70m (£56m) to fire relief efforts and have turned the glitzy awards season parties and red carpets typical this time of year into major fundraisers. Many say these efforts are not enough and that Hollywood's biggest companies need to commit to filming in LA. But studios don't often make business decisions based on the greater good of workers in one city - ultimately, they care about the bottom line. The reality is LA is expensive and the vast majority of industry jobs here are union protected – so they come with high salaries and expensive health care and pensions. Studios are, however, very responsive to A-list actors. Megastar Vin Diesel helped ensure Universal Pictures would finish filming the latest Fast and Furious movie in Los Angeles. "LA really, really, really needs production to help rebuild," Diesel said in an Instagram post. "Los Angeles is where Fast and Furious started filming 25 years ago… and now Fast will finally return home." Nearly 20,000 people – including actors Keanu Reeves, Zooey Deschanel and Kevin Bacon – have signed a "Stay in LA" petition urging the state's leaders to temporarily remove caps on production tax incentives for LA County. It's part of a grassroots campaign started by director Sarah Adina Smith and other filmmakers who want California to use its emergency powers to boost tax incentives for the next three years to make filming in LA more affordable and help heal Los Angeles. They also want studios to commit to making 10% more productions in Los Angeles. "We need to bring production back to LA and get LA working again if we want to rebuild," says Ms Smith. Before the fires, California Gov Newsom had already proposed to more than double the tax credit the state offers to producers of films and TV shows that shoot in California – changing the annual credit from $330m to $750m, but that must be approved by the state legislature and might not come into effect until the summer. He says the incentives are good for the economy and that California's programme has generated more than $26bn in economic activity and supported more than 197,000 cast and crew jobs across the state. If passed, the subsidy would be the most generous offered by any US state except Georgia, which doesn't have a cap on the amount it gives to productions per year. Stay in LA wants the cap lifted now. President Donald Trump has also said he plans to make Hollywood great again with the help of actors Jon Voight, Mel Gibson, and Sylvester Stallone, who have been tapped to be "special ambassadors" for "troubled Hollywood". It's not yet clear what they have in mind - they did not agree to an interview - but several executives said the instability caused by the Trump administration's trade wars make risk-averse Hollywood studios nervous. The Canadian dollar recently hit 22-year lows making Canada even more attractive to Hollywood. On a rainy day more than a month after the fires, Mr Worthington, the production designer, and his partner Mindy Elliott, a film editor, inspected the remains of their home, wishing they'd taken some of their art when they evacuated. They marvelled that a cactus was regrowing next to where their SUV had melted. "If only we'd had this rain in January," says Ms Elliott. Although he is critical that the tax breaks amount to "corporate welfare" for behemoth companies, Mr Worthington says they are a necessary evil if LA wants to compete - both Australia and the UK now have more lucrative tax breaks than California. Ms Smith, the co-founder of Stay in LA, likens the decline of Hollywood productions to the fall of Detroit, whose once formidable automotive industry collapsed, leaving much of the city desolate and impoverished. "Once you ruin that infrastructure and that legacy, it's not so easy to build it back again," she says. "If we let Hollywood die, it could be for good." Others think it's naïve to think that any incentives will usher in a new Golden Age of Hollywood. Pointing out the melted remains of what used to be his piano and his drum set in the music studio of his incinerated Topanga Canyon home, composer Matthew Ferraro wipes away tears for what he and his wife have lost. His once spectacular hilltop home is now rubble and ash and Ferraro says he's still in shock, consumed with thoughts of where he will sleep on Tuesday, rather than his future in LA. "I think it's wishful thinking for people who are still in love with, like yesteryear's dream of Hollywood, but that's just not how it works anymore," says Ferraro, who composed music for The Incredibles and The Minority Report among others. About a mile away, Jamie Morse's home also burned. Topanga Canyon has always attracted artists, musicians and dreamers - and Morse had just quit her sensible day job to devote 2025 to making it in Hollywood, working fulltime on her comedic writing and performing. She laughs when asked about the terrible timing - and says she's grieving along with everyone else in LA, but remains hopeful. "Whether they're performers or studio execs - people love this city," says Ms Morse, who now sleeps at friends' homes or in her car with her dog between comedy gigs or classes with her improv troupe, The Groundlings. Ms Morse wishes she'd taken more sentimental things when she evacuated with her dog, like a Toronto Blue Jays T-shirt which reminded her of her grandfather and her native Canada. But she's astonished that some of her notebooks and journals survived with some of her comedy writing intact. "Where an entire stone table is, is in pieces, is like, absolutely decimated, melted," she said. "But pieces of paper survived… It's truly unbelievable." Does she think it's fate? A sign that she is meant to make it in Hollywood? "I'm choosing to believe that this is a sign," she says, adding that there will be "beautiful, creative things to come out of this very, very crappy time."
BBC News
14-02-2025
- Entertainment
- BBC News
Hollywood pushes for more LA productions post wildfires
Hollywood may be known as Tinseltown, a dream factory at the heart of the global entertainment industry. But nowadays crews are more likely to film in Atlanta, London, Toronto or Sydney than in Los labour and better tax breaks have lured producers away from the City of Angels for years. The wildfires, which killed at least 29 people and destroyed thousands of homes, have only added to this existential many here are calling on the state - and studios and streaming services - to boost local production."The best thing the studios could do for fire relief is to bring work back for the rank and file LA film workers," says Mark Worthington, a production designer whose home burned down in Altadena."That's what we want." Mr Worthington had already been struggling to cope with the city's downturn, noting he hadn't set foot on an LA set in two years. Covid, labour strikes, and the inevitable end of the streaming boom had led many producers to try and save costs by skipping town - sometimes leaving the country Hollywood's big boom has gone bustProductions in the US decreased 26% last year compared to pre-strike levels in 2022, according to ProdPro, which tracks global production. In Australia and New Zealand, production was up 14% and in the UK it was up nearly 1%, with Canada up 2.8%.The loss clearly stings. The Red Hot Chili Peppers are a band synonymous with Los Angeles, with many love songs to the City of Angels. But a biopic about the band is being filmed in Atlanta, Georgia - which has become a major production hub due to its lucrative tax breaks - not the fires, "Survive until '25" had become a kind of mantra for Mr Worthington and other filmmakers who hoped for a turnaround of fortune. Instead, their city went up in flames."It's crushing in terms of how you see yourself as a creative individual and just as a person, and then on top of that to have these fires," Mr Worthington says. "This is adding a horrible other thing to pile on top of all the other difficulties and our own work situation over the last couple years." Hollywood's studios and streaming services have donated more than $70m (£56m) to fire relief efforts and have turned the glitzy awards season parties and red carpets typical this time of year into major say these efforts are not enough and that Hollywood's biggest companies need to commit to filming in LA. But studios don't often make business decisions based on the greater good of workers in one city - ultimately, they care about the bottom line. The reality is LA is expensive and the vast majority of industry jobs here are union protected – so they come with high salaries and expensive health care and are, however, very responsive to A-list Vin Diesel helped ensure Universal Pictures would finish filming the latest Fast and Furious movie in Los Angeles."LA really, really, really needs production to help rebuild," Diesel said in an Instagram post."Los Angeles is where Fast and Furious started filming 25 years ago… and now Fast will finally return home." Nearly 20,000 people – including actors Keanu Reeves, Zooey Deschanel and Kevin Bacon – have signed a "Stay in LA" petition urging the state's leaders to temporarily remove caps on production tax incentives for LA part of a grassroots campaign started by director Sarah Adina Smith and other filmmakers who want California to use its emergency powers to boost tax incentives for the next three years to make filming in LA more affordable and help heal Los Angeles. They also want studios to commit to making 10% more productions in Los Angeles."We need to bring production back to LA and get LA working again if we want to rebuild," says Ms Smith. Before the fires, California Gov Newsom had already proposed to more than double the tax credit the state offers to producers of films and TV shows that shoot in California – changing the annual credit from $330m to $750m, but that must be approved by the state legislature and might not come into effect until the says the incentives are good for the economy and that California's programme has generated more than $26bn in economic activity and supported more than 197,000 cast and crew jobs across the passed, the subsidy would be the most generous offered by any US state except Georgia, which doesn't have a cap on the amount it gives to productions per year. Stay in LA wants the cap lifted Donald Trump has also said he plans to make Hollywood great again with the help of actors Jon Voight, Mel Gibson, and Sylvester Stallone, who have been tapped to be "special ambassadors" for"troubled Hollywood".It's not yet clear what they have in mind - they did not agree to an interview - but several executives said the instability caused by the Trump administration's trade wars make risk-averse Hollywood studios nervous. The Canadian dollar recently hit 22-year lows making Canada even more attractive to Hollywood. On a rainy day more than a month after the fires, Mr Worthington, the production designer, and his partner Mindy Elliott, a film editor, inspected the remains of their home, wishing they'd taken some of their art when they evacuated. They marvelled that a cactus was regrowing next to where their SUV had melted."If only we'd had this rain in January," says Ms he is critical that the tax breaks amount to "corporate welfare" for behemoth companies, Mr Worthington says they are a necessary evil if LA wants to compete - both Australia and the UK now have more lucrative tax breaks than Smith, the co-founder of Stay in LA, likens the decline of Hollywood productions to the fall of Detroit, whose once formidable automotive industry collapsed, leaving much of the city desolate and impoverished."Once you ruin that infrastructure and that legacy, it's not so easy to build it back again," she says. "If we let Hollywood die, it could be for good."Others think it's naïve to think that any incentives will usher in a new Golden Age of out the melted remains of what used to be his piano and his drum set in the music studio of his incinerated Topanga Canyon home, composer Matthew Ferraro wipes away tears for what he and his wife have once spectacular hilltop home is now rubble and ash and Ferraro says he's still in shock, consumed with thoughts of where he will sleep on Tuesday, rather than his future in LA."I think it's wishful thinking for people who are still in love with, like yesteryear's dream of Hollywood, but that's just not how it works anymore," says Ferraro, who composed music for The Incredibles and The Minority Report among others. About a mile away, Jamie Morse's home also burned. Topanga Canyon has always attracted artists, musicians and dreamers - and Morse had just quit her sensible day job to devote 2025 to making it in Hollywood, working fulltime on her comedic writing and laughs when asked about the terrible timing - and says she's grieving along with everyone else in LA, but remains hopeful."Whether they're performers or studio execs - people love this city," says Ms Morse, who now sleeps at friends' homes or in her car with her dog between comedy gigs or classes with her improv troupe, The Morse wishes she'd taken more sentimental things when she evacuated with her dog, like a Toronto Blue Jays T-shirt which reminded her of her grandfather and her native Canada. But she's astonished that some of her notebooks and journals survived with some of her comedy writing intact."Where an entire stone table is, is in pieces, is like, absolutely decimated, melted," she said. "But pieces of paper survived… It's truly unbelievable."Does she think it's fate? A sign that she is meant to make it in Hollywood?"I'm choosing to believe that this is a sign," she says, adding that there will be "beautiful, creative things to come out of this very, very crappy time."
