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Tag: Trauma

  • Novel genetic mechanisms of tetracycline resistance in gut bacteria discovered

    Novel genetic mechanisms of tetracycline resistance in gut bacteria discovered

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    Antibiotic resistance is a significant and growing medical problem worldwide. Researchers at the Marine Biological Laboratory (MBL) and collaborators have found a novel genetic arrangement that may help a common bacterium in the human gut, Bacteroides fragilis, protect itself from tetracycline, a widely used antibiotic.

    While these findings will not lead directly to new ways of combating tetracycline-resistant bacteria, the researchers have discovered previously unseen genetic arrangements that confer antibiotic resistance. Such understanding might help in developing new ways to limit the spread of antibiotic resistance genes, through genetic manipulation or other means.

    The findings were reported in the journal mBio by MBL scientists Joseph Vineis, Mitchell Sogin and Blair Paul, along with colleagues from MBL, Argonne National Laboratory, and the University of Chicago.

    The bacteria they studied, Bacteroides fragilis, was recovered from a patient with ulcerative colitis, where it was found to be abundant during periods of inflammation. The team had a large set of samples to analyze from patients with inflammatory bowel disease that had been surgically treated to alleviate the inflammation.

    These samples were studied at MBL using shotgun metagenomics, which produces sequences for all the genetic material in an entire community of microbial cells. It also facilitates cultivation of bacterial strains from the community, providing the data required to observe the activity of the tetracycline-resistance genes while growing in the presence of tetracycline. (At the time they started this work, Vineis says, “to be able to reconstruct genomes from metagenomic data was just getting started in the field. It was a novel approach, but now it’s common.”)

    “When we looked at the data,” Vineis says, “there was a very strong signal” showing high numbers of copies of particular regions of the bacterial genomes. One of these regions, encompassing many genes, “was very abundant” in the sample, and later they were able to determine “that this particular high-copy region contained tetracycline resistance… So we kept digging.”

    These high-copy sections of the genome contained DNA fragments that can move around in the genome or even jump into a different genome. Called transposons, these mobile genetic elements are “important ways for bacteria to develop adaptations to the environment without having to reinvent them themselves completely,” Vineis says. And in the human intestines, where vast numbers of species of gut bacteria are constantly in close proximity, “the potential for exchange is really high,” he says, and the rate increases when there is inflammation.

    Such exchange of genetic material between different species is called horizontal transfer. Blair Paul, an assistant scientist at MBL, says that “we think these transposons are actually a key vehicle for horizontal gene transfer.”

    In this case, the bacteria apparently sense when there is tetracycline in the environment and begin “a whole cascade” of production of a transposon containing the resistance gene, Vineis says.

    The part of the transposon containing the resistance gene, they found, occurred in two different forms within the same genome: Sometimes it is in its normal linear form, and sometimes rolled into a circle. Both forms occur at once in the Bacteroides fragilis genome, but the linear form contains a unique genomic insert in the region of DNA that encodes the machinery for mobilization into other cells.

    This hasn’t been seen before, to our knowledge, this particular type of transposon having a subregion amplified. And it’s occurring in bacteria that coincide with inflammation.”


    Blair Paul, MBL Scientist

    The increased expression of this group of genes is potentially associated with the success of Bacteroides fragilis during inflammation, although the connection is not yet proven and requires further research. But Paul says the findings “raise new questions about the role of gene transfer in human health, but also in terms of just how these transposons are controlled and how they may be changing evolutionarily over time.”

    “This finding is not going to change our understanding about the world of antibiotic resistance, but it’s a novel kind of mechanism that at least we can start looking for,” Vineis says. “There’s a lot of offense and defense happening within the microbial world that we’re not even fully aware of.”

    Source:

    Marine Biological Laboratory

    Journal reference:

    Vineis, J. H., et al. (2024). A novel conjugative transposon carrying an autonomously amplified plasmid. mBio. doi.org/10.1128/mbio.02787-23.

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  • Collaborative analysis of disease and death drivers in Gaza conflict

    Collaborative analysis of disease and death drivers in Gaza conflict

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    The analysis was conducted to help better address the humanitarian crisis in Gaza both during and after the war. The war has disrupted health services and resulted in overcrowding, inadequate water, sanitation and hygiene conditions, and insufficient food intake in Gaza. It is important to understand how the conflict is contributing to disease and death there.

    The report is a collaborative effort between researchers from the London School of Hygiene & Tropical Medicine (LSHTM) and the Johns Hopkins Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health and is funded by the UK Humanitarian Innovation Hub.

    Visit the Gaza projections website for the complete report.

    The projections, which are not predictions, cover the period from February 7 to August 6, 2024 (six months). The projections cover three different scenarios: ceasefire; status quo; and escalation. Over the next six months the report estimates that:

    With no epidemics occurring, the projection for the ceasefire scenario would be 6,550 excess deaths, for the status quo scenario 58,260 excess deaths, and for the escalation scenario 74,290 excess deaths.

    With epidemics occurring, the projection for the ceasefire scenario would be 11,580 excess deaths, for the status quo scenario 66,720 excess deaths, and for the escalation scenario 85,750 excess deaths.

    Under the ceasefire scenario the projections suggest that infectious diseases, would be the main cause of excess deaths. Traumatic injuries followed by infectious diseases would be the main causes of excess deaths in both the status quo and escalation scenarios.

    Even in the best-case scenario of an immediate ceasefire there would continue to be thousands of excess deaths after a ceasefire was agreed. These would only be mitigated by rapid action to improve the provision of water, sanitation and shelter, and restore functioning healthcare services in Gaza.

    The breakdown of water and sanitation, inadequate shelter and insufficient food intake leads to a projected high risk of excess deaths from endemic infectious diseases, particularly respiratory tract infections. If infectious disease epidemics occur, cholera, measles, meningococcal meningitis, and polio are epidemics projected to potentially cause the most excess deaths.

    While a ceasefire may reduce trauma-related deaths, our projections show excess deaths due to wounds and complications from traumatic injuries would continue to occur, highlighting the critical importance of providing secure and operational healthcare facilities that can offer trauma care and rehabilitation services.

    Even though the total numbers of estimated excess deaths from maternal and neonatal causes are relatively small compared to other health areas, every loss of a mother has severe consequences for family health and wellbeing. It could see progress made in maternal and neonatal survival put back over a decade.

    The researchers are undertaking this work as Gaza’s health infrastructure is no longer adequately functioning. The impact of the crisis on Israel is better understood and there is not a lack of capacity to respond.

    We wanted to develop and share evidence for decision-makers, to show how this crisis could play out in terms of lives.”


    Professor Francesco Checchi of LSHTM, co-leader of the project team

    Professor Paul Spiegel of the Johns Hopkins Center for Humanitarian Health, co-leader of the project team, said: “Even if a ceasefire were declared tomorrow, thousands more people would likely die as a result of the conflict. Our analysis can help humanitarian organizations, governments, and others plan more effectively and save lives.”

    Source:

    London School of Hygiene & Tropical Medicine (LSHTM)

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  • Study reveals gaps in emergency medical services performance, suggests room for improvement

    Study reveals gaps in emergency medical services performance, suggests room for improvement

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    A recent study published in the journal Prehospital Emergency Care assesses current approaches to measure the performance of emergency medical services (EMS) throughout the United States and identifies novel strategies that can improve the quality of care provided by EMS.

    Study: A National assessment of EMS performance at the response and agency level. Image Credit: blurAZ / Shutterstock.com​​​​​​​ Study: A National assessment of EMS performance at the response and agency level. Image Credit: blurAZ / Shutterstock.com

    The evolution of EMS care guidelines

    Throughout the U.S., a wide range of quality measures are used to measure the quality of care provided by EMS. Nevertheless, compared to hospital-based or ambulatory medicine, there remains a lack of specific, nationally accepted, and evidence-based protocols to monitor EMS and determine how these services can be improved.

    An earlier statement from the 2007 Consortium of U.S. Metropolitan Municipalities’ EMS Medical Directors suggested the implementation of multiple quality control measures in the treatment of ST-elevated myocardial infarctions (STEMI), convulsions, pulmonary edema, cardiac arrest, and trauma. These quality control measures guided the appropriate management of these conditions before hospital arrival and how to choose the appropriate hospital destination.

    In 2015, the EMS Compass initiative published a set of quality measures authored jointly by the National Highway Traffic Safety Administration Office of EMS and the National Association of State EMS Officials. By 2018, the National EMS Quality Alliance (NEMSQA) increased the array of stakeholders for this initiative, which ultimately led to the development of an evidence-based suite of EMS quality measures that can be applied at scale to the EMS currently being operated in the United States.

    These NEMSQA guidelines, released in 2019, include 11 quality measures covering eight areas of clinical management required in EMS.

    The current study uses national data on EMS to determine the use of these measures to appraise the quality of EMS responses at the individual and agency levels. The dataset included 26.5 million responses that were executed by nearly 10,000 EMS agencies.

    Importantly, the current study is the first to determine how EMS agencies met quality measures applied nationwide.

    What did the study show?

    Performance varied by agency type, size, and category of response. In the case of using lights and sirens, either when responding or transporting patients to the hospital, only 12% of EMS did not use lights and sirens as compared to over 53% during patient transport. With children, over 80% of cases diagnosed with respiratory distress by EMS were evaluated for breathing difficulty, and the results were documented.

    About 60% of patients with trauma were evaluated for pain, only 16% of whom reported pain relief during the response process. Over 25% of patients with status epilepticus received benzodiazepines, the drug of choice, during the EMS response.

    Performance measures at the agency level also varied widely. For pediatric cases, agency performance ranked high at over 90%, whereas the safety ranking for these cases was 2%.

    There were 22 agencies that had over 100,000 patient calls, which accounted for one in seven of all 911 responses by EMS throughout the study period. The agency size also influenced performance, with the smallest agencies performing at 60% for hypoglycemia as compared to nearly 85% for larger agencies with 25,000 to 100,000 runs.

    There was no significant difference between urban and rural agencies in responding to pediatric emergencies for six measures, including safety and trauma. Some differences were observed regarding the performance of rural agencies; however, these observations may not reflect clinical outcomes.

    What are the implications?

    The quality of EMS care can vary significantly in some measures related to clinical and safety outcomes. Importantly, there is no official standard by which performance may be classified as good or bad in this field; however, the current study found that over 50% of the agencies performed below 35% for three of the six assessed measures. Conversely, some performed at almost 100%.

    These findings offer a baseline from which to measure performance in aggregate and track the progress of the national picture.”

    While it may not be ideal to achieve 100% performance in all measures, the study findings provide the basis for further research to establish benchmarks in these areas. Moreover, the study findings can be reassessed by comparing performance measures based on outcomes as compared to process, thereby supporting the development of an evolving standardized set of measures that will improve EMS delivery.

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  • Associations between childhood trauma and emotion recognition

    Associations between childhood trauma and emotion recognition

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    In a recent study published in Scientific Reports, researchers evaluated the associations of childhood trauma with emotion recognition accuracy (ERA).

    Study: The association between childhood trauma and emotion recognition is reduced or eliminated when controlling for alexithymia and psychopathy traits. Image Credit: Suzanne Tucker/Shutterstock.comStudy: The association between childhood trauma and emotion recognition is reduced or eliminated when controlling for alexithymia and psychopathy traits. Image Credit: Suzanne Tucker/Shutterstock.com

    Background

    Emotion recognition is crucial in daily interactions and relationships. Expressing emotions forms the core of social interactions, facilitating appropriate responses in social situations.

    Accurate recognition of emotions is advantageous, and people with greater accuracy are more likable. Further, the classification and perception of emotional expressions can influence behavior.

    Therefore, accurate recognition of emotions is pivotal, as misclassifications may result in inappropriate responses. Experiences of childhood trauma are linked to poor emotion recognition. Nevertheless, the breadth of these effects and their relationship with individual differences remain unclear.

    About the study

    In the present study, researchers explored the effects of childhood trauma on the ERA and whether they vary by emotion, intensity of stimuli, or modality (audiovisual, face, or voice).

    Participants aged 18 or older, with normal or corrected-to-normal vision and without significant hearing loss, were recruited from an online site and an undergraduate course. Experimental task variables included emotion, modality, and intensity level.

    Variables of individual differences were childhood trauma, psychopathy, and alexithymia. Participants completed the 28-item childhood trauma questionnaire short-form (CTQ-SF), 29-item self-reported psychopathy scale short-form (SRP-SF), and 20-item Toronto alexithymia questionnaire (TAS-20). Total scores from these questionnaires were standardized and used for analyses.

    For emotional tasks, stimuli were selected from a database containing clips of actors expressing six emotions (happy, angry, sad, surprise, disgust, and fear) and a neutral condition across three modalities (audiovisual, face, and voice).

    Emotional stimuli were presented at normal or strong intensity. A silent video of actors expressing a neutral or emotional expression was presented in the face modality.

    Participants listened to an audio clip in the voice condition, while in the audiovisual condition, a clip with both video and audio was presented. They specified the emotion expressed in the clips.

    The experiment was run online in four blocks – 1) personality questionnaire, 2) TAS-20 and face task, 3) SRP-SF and voice task, and 4) CTQ-SF and audiovisual task.

    The effect of childhood trauma alone on ERA was examined using generalized mixed models and additionally controlled for psychopathy and alexithymia.

    Results

    The analytic sample comprised 122 participants. In the model with childhood trauma and modality as fixed factors, there was a significant main effect of childhood trauma and modality. However, the effect size was small. The team found that higher childhood trauma was associated with poorer ERA.

    Accuracy was significantly better for audiovisual emotions than vocal and facial emotions.

    However, childhood trauma was no longer significant when controlled for psychopathy and alexithymia, albeit modality remained significant.

    There was no significant interaction between childhood trauma and modality, suggesting the effects of trauma were not significantly different across modalities. Further, a significant main effect of childhood trauma and emotion portrayed was evident in the model with these as fixed factors.

    The accuracy was significantly different between fear and neutral expressions; expressions of fear had significantly poorer accuracy. Notably, childhood trauma remained significant after controlling for psychopathy and alexithymia, with a significant main effect of emotion portrayed.

    No significant interaction was observed between childhood trauma and the emotion portrayed, suggesting no variations in the effect of trauma across emotions.

    In the model with childhood trauma and stimulus intensity as fixed factors, there was a significant main effect of childhood trauma only. Greater childhood trauma was associated with poorer ERA. Notably, ERA was comparable for stimuli with normal and strong intensity.

    Childhood trauma was no longer significant after controlling for psychopathy and alexithymia, but alexithymia was significant. Consistently, the effect of childhood trauma was not different by the intensity of stimuli.

    Conclusions

    In sum, the researchers investigated the associations between childhood trauma and ERA with multiple modalities and varying stimuli intensities.

    Childhood trauma alone was significantly associated with ERA when exploring stimuli intensity, modality, and emotion. Further, when controlling for psychopathy and alexithymia, childhood trauma was significant only when exploring the emotion portrayed.

    Notably, the effect sizes were small overall. Together, the findings suggest the significance of controlling for interrelated individual differences.

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  • Blocking artery plus surgery offers hope for reducing reoperations in brain hematoma patients

    Blocking artery plus surgery offers hope for reducing reoperations in brain hematoma patients

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    Injection of a substance to block an artery feeding the dura (protective sack around the brain) along with surgery to remove pooled blood reduced the risk that patients will require repeat surgery compared to surgical drainage alone, according to preliminary late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2024. The meeting, held in person in Phoenix Feb. 7 – 9, 2024, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    A subdural hematoma occurs when there is a tear in one of the thin blood vessels that stretch between the surface of the brain and the overlying membranes that protect the brain. A subdural hematoma can occur because of physical trauma such as a car accident, however, it may also develop slowly in the days or weeks after the injury. This study explored treatment for subacute or chronic subdural hematoma. Subacute subdural hematoma occurs following less severe trauma, such as a concussion – with symptoms such as weakness, numbness, tingling, seizure, headache, confusion or dizziness that develops over hours or days after the event. Chronic subdural hematoma can result from slow bleeding after minimal trauma that the patient may not even remember – symptoms may be subtle and/or may take weeks to be noticeable enough to seek treatment.

    Chronic subdural hematoma is one of the most common neurosurgical conditions and is likely to increase in the future since we have a sizeable aging population, with many taking blood thinners to manage various medical conditions. These hematomas often form in the elderly because as we age, the brain shrinks and pulls away from the inside of the skull, stretching the veins that form a bridge between the dura and the brain, which makes them more likely to tear after a small trauma and leak blood into the protective space between the brain and skull, the dura.”


    Jason Davies, M.D., Ph.D., study co-author, associate professor in the departments of neurosurgery and biomedical informatics at the State University of New York, Buffalo

    Treatment for subacute or chronic subdural hematoma may involve a surgical procedure to drain pooled blood from the area or closely monitoring symptoms to determine if and when intervention may be necessary. The challenge is that even with surgery, repeat surgery may be needed in up to 20% of cases of subdural hematomas.

    The EMBOLISE clinical trial tested whether a subacute or chronic subdural hematoma is less likely to require additional surgery if, in addition to surgical drainage, a substance is injected to block, or embolize, one of the arteries supplying blood to the dura. The OnyxTM liquid embolic system, tested in this trial, is already used prior to surgery to reduce bleeding in people having an operation to correct an abnormal connection between arteries and veins in the brain.

    Between December 2020 and August 2023, researchers enrolled 400 adults (average age of 72; 27% women) at 39 centers (including both community and academic hospitals). All were about to undergo surgery for subacute or chronic subdural hematoma and were considered able to care for themselves and likely to survive at least one year. Patients were randomly assigned to receive either surgery alone or surgery plus embolization using the liquid embolic system to help reduce the progression or recurrence of subdural hematoma.

    The primary outcome was how frequently there was reaccumulation of blood (a recurrence) that required surgical drainage within 90 days.

    The analysis found:

    • Subsequent subdural hematoma within 90 days and need for surgical drainage occurred in 4.1% of patients who had surgery plus embolization and 11.3% of those who had surgery alone.

    • At 90 days after surgery, increasing disability and neurological dysfunction was found to be comparable (statistically the same) in both groups, with 11.9% of patients who had surgery plus embolization and 9.8% of patients who had surgery alone.

    • Serious adverse events attributed to embolization occurred in 2% of patients who received it.

    “The EMBOLISE trial showed that there was a nearly 3-fold reduction in re-operation for patients that were treated with surgery plus embolization,” Davies said. “Fewer trips to the operating room mean less potential for pain, complications, recovery and expense for the patient. Furthermore, we see that the complications related to the embolization procedure were low and that there was no increase in neurological problems.” 

    Study details and background:

    • The EMBOLISE (Embolization of the Middle Meningeal Artery With OnyxTM Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) study was conducted at multiple hospitals and health centers in the United States.

    • The liquid embolic system treatment starts as an injectable soft solid, flows as a liquid when force is applied, and then returns to a soft solid state to stop the leaking blood vessel.

    • Other arms of the EMBOLISE study, which included patients not undergoing surgery and randomized to either receive the liquid embolic system or not, are ongoing and not being presented at ISC 2024.

    • Additional measures to gauge success of the liquid embolic system treatment included the number of hospital readmissions; change in hematoma (pooling of blood) volume or thickness; and change in midline shift (when a hematoma pushes brain tissue out of alignment), all assessed at 90 days after treatment.

    • Safety endpoints included the incidence of neurological death or serious adverse events occurring within 30, 90 and 180 days after treatment.

    The main limitation was a relatively high loss to follow up. “One of the challenges of conducting this trial was dealing with a frail elderly population, especially in the middle of the pandemic. Tracking patients down for follow up is always a challenge, and these were compounded by the various COVID-era restrictions that many of our sites faced,” Davies said.

    Source:

    American Heart Association

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  • Machine learning tool reads brain scans for early signs of psychosis

    Machine learning tool reads brain scans for early signs of psychosis

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    The onset of psychosis can be predicted before it occurs, using a machine-learning tool which can classify MRI brain scans into those who are healthy and those at risk of a psychotic episode. An international consortium including researchers from the University of Tokyo, used the classifier to compare scans from over 2,000 people from 21 global locations. About half of the participants had been identified as being clinically at high risk of developing psychosis. Using training data, the classifier was 85% accurate at differentiating between people who were not at risk and those who later experienced overt psychotic symptoms. Using new data, it was 73% accurate. This tool could be helpful in future clinical settings, as while most people who experience psychosis make a full recovery, earlier intervention typically leads to better outcomes with less negative impact on people’s lives.

    Anyone might experience a psychotic episode, which commonly involves delusions, hallucinations or disorganized thinking. There is no single cause, but it can be triggered by illness or injury, trauma, drug or alcohol use, medication, or a genetic predisposition. Although it can be scary or unsettling, psychosis is treatable and most people recover. As the most common age for a first episode is during adolescence or early adulthood, when the brain and body are undergoing a lot of change, it can be difficult to identify young people in need of help. 

    At most only 30% of clinical high-risk individuals later have overt psychotic symptoms, while the remaining 70% do not. Therefore, clinicians need help to identify those who will go on to have psychotic symptoms using not only subclinical signs, such as changes in thinking, behavior and emotions, but also some biological markers.”

    Shinsuke Koike, Associate Professor, Graduate School of Arts and Sciences, University of Tokyo

    The consortium of researchers have worked together to create a machine-learning tool which uses brain MRI scans to identify people at risk of psychosis before it starts. Previous studies using brain MRI have suggested that structural differences occur in the brain after the onset of psychosis. However, this is reportedly the first time that differences in the brains of those who are at very high risk but have not yet experienced psychosis have been identified.

    The team from 21 different institutions in 15 different countries gathered a large and diverse group of adolescent and young adult participants. According to Koike, MRI research into psychotic disorders can be challenging because variations in brain development and in MRI machines make it difficult to get very accurate, comparable results. Also, with young people, it can be difficult to differentiate between changes that are taking place because of typical development and those due to mental illness. 

    “Different MRI models have different parameters which also influence the results,” explained Koike. “Just like with cameras, varied instruments and shooting specifications create different images of the same scene, in this case the participant’s brain. However, we were able to correct for these differences and create a classifier which is well tuned to predicting psychosis onset.”

    The participants were divided into three groups of people at clinical high risk: those who later developed psychosis; those who didn’t develop psychosis; and people with uncertain follow-up status (1,165 people in total for all three groups), and a fourth group of healthy controls for comparison (1,029 people). Using the scans, the researchers trained a machine-learning algorithm to identify patterns in the brain anatomy of the participants. From these four groups, the researchers used the algorithm to classify participants into two main groups of interest: healthy controls and those at high risk who later developed overt psychotic symptoms.

    In training, the tool was 85% accurate at classifying the results, while in the final test using new data it was 73% accurate at predicting which participants were at high risk of psychosis onset. Based on the results, the team considers that providing brain MRI scans for people identified as being at clinically high risk may be helpful for predicting future psychosis onset. 

    “We still have to test whether the classifier will work well for new sets of data. Since some of the software we used is best for a fixed data set, we need to build a classifier that can robustly classify MRIs from new sites and machines, a challenge which a national brain science project in Japan, called Brain/MINDS Beyond, is now taking on,” said Koike. “If we can do this successfully, we can create more robust classifiers for new data sets, which can then be applied to real-life and routine clinical settings.”

    Source:

    Journal reference:

    Zhu, Y., et al. (2024). Using brain structural neuroimaging measures to predict psychosis onset for individuals at clinical high-risk. Molecular Psychiatry. doi.org/10.1038/s41380-024-02426-7.

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  • Burn injury disrupts the intestinal mucus barrier and alters gut microbiota, study reveals

    Burn injury disrupts the intestinal mucus barrier and alters gut microbiota, study reveals

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    On a study (doi:10.1093/burnst/tkad056) published in the journal Burns & Trauma, researchers employed a combination of techniques to analyze the effects of burn injury on the gut microbiota and mucus barrier in mice. A modified histopathological grading system assessed colon tissue and mucus barrier integrity. 16S rRNA sequencing revealed changes in gut microbial composition over 10 days post-burn. Metagenomic sequencing provided deeper insights into mucus-related bacteria and potential underlying mechanisms.

    This study provides compelling evidence that burn injury disrupts the intestinal mucus barrier and alters the gut microbiota composition. Mucus-degrading bacteria appear to play a role in mucus breakdown, while probiotics may promote repair through short-chain fatty acids production.

    Professor Xi Peng, the leading researcher of this study, emphasizes, “This study is a breakthrough in understanding the intricate relationship between gut microbiota and intestinal health post-burn injuries. It highlights the dual role of microbiota in both exacerbating and healing intestinal damage, offering a new perspective for targeted therapeutic strategies.”

    This research holds significant promise for improving burn treatment outcomes. By targeting specific gut bacteria or their metabolites, it may be possible to protect the intestinal mucus barrier, prevent bacterial translocation, and ultimately improve patient survival and recovery. Further research is warranted to translate these findings into clinical applications.

    Source:

    Journal reference:

    Zha, X., et al. (2023). The impact of gut microbiota changes on the intestinal mucus barrier in burned mice: a study using 16S rRNA and metagenomic sequencing. Burns & Trauma. doi.org/10.1093/burnst/tkad056.

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  • Genetic link found to emotional sensitivity in stressful situations

    Genetic link found to emotional sensitivity in stressful situations

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    In a recent study published in Scientific Reports, researchers assess how genetic variation in a cluster of differentiation 38 (CD38) is associated with increased personal distress in an emotionally evocative situation. 

    Study: CD38 genetic variation is associated with increased personal distress to an emotional stimulus. Image Credit: Dragana Gordic / Shutterstock.com Study: CD38 genetic variation is associated with increased personal distress to an emotional stimulus. Image Credit: Dragana Gordic / Shutterstock.com

    CD38 and oxytocin

    Oxytocin is a peptide neurohormone that is actively involved in social behavior, including parent-infant bonding, particularly in the immediate period following childbirth, romantic relationships, and group dynamics. Oxytocin-related genetic variants have been associated with various effects on empathy, brain activation during emotion recognition tasks, responses to trauma, and the risk of autism.

    Recently, researchers have identified that A allele carriers of the CD38 single nucleotide polymorphism (SNP) rs3796863 had higher plasma oxytocin levels, a more sensitive approach to parenting, and stronger empathic responses. However, other studies have reported that students with the AA genotype of the CD38 SNP reported higher levels of suicide ideation, depressive symptoms, and greater alienation from parents and peers.

    These conflicting findings have led some researchers to theorize that A carriers may be more socially sensitive, which, as a result, could lead to a stronger negative emotional response during stressful situations. Despite this concept, no study to date has assessed the impact of the CD38 genotype on negative reactivity to an emotionally stressful situation.

    About the study

    For the present study, researchers recruited Canadian university students 18 years of age and older with no health issues expected to influence hormone levels. All study participants were shown a three-minute video depicting a father narrating the story of his child’s terminal cancer.

    After the video, study participants completed a questionnaire seeking to assess their emotional response to 12 emotions, six of which involved feelings of empathic concern, whereas the remaining six included feelings of personal distress. These responses were rated on a scale from one to five, with higher scores indicating higher endorsement of the emotional response. 

    Two Interpersonal Reactivity Index (IRI) subscales, including the personal distress and empathic concern subscales, were used to explore whether the CD38 genotype related to dispositional measures of emotional responses. Participants completed the IRI approximately 10 minutes after watching the emotional video, during which they rated their responses on a five-point Likert scale, with a higher score indicating increased empathy.

    Study findings

    A total of 171 students participated in the current study, 24, 77, and 70 of whom had the AA, AC, and CC genotypes of the CD38 SNP, respectively. 

    The average distress-related response ratings were higher for females than males and AA/AC than CC genotypes, thus suggesting that sex and CD38 genotype affected these responses but not their interaction. Females also scored higher than males on empathy-related responses; however, these scores were not significantly different among the different genotypes.

    On both IRI subscales, sex had a significant effect, with females scoring higher than males. However, the IRI subscale results were not significantly different between the CD38 genotypes.

    When seeing someone in distress, people with the A allele reported insignificant levels of empathy, a well-recognized response of care, but markedly higher levels of personal distress, a self-focused emotional reaction. 

    An empathy-inducing situation may elicit these two responses simultaneously; however, they can have different consequences. For example, while empathy promotes helping behavior to relieve the distress of the individual in need, a person in distress may have the urge to alleviate their own distress rather than offer help to the other person in need of help.

    Conclusions

    The current study provides preliminary evidence that genetic variation in CD38 influences social-emotional sensitivity. To this end, A allele carriers were more vulnerable to distress-related emotions in response to a negative social stressor. 

    The study findings may reconcile paradoxical findings that CD38 A allele carriers are more empathetic despite exhibiting worse interpersonal outcomes. Despite having greater empathy, their high levels of personal distress may prevent appropriate social support from being provided when involved in social conflict. 

    This data on oxytocin-related genetic variants could be used to predict individuals for whom the buffer against stress and anxiety in response to challenging interpersonal situations is weaker. Given their inability to regulate their negative emotions, these individuals should receive adequate and timely support.

    Future studies, especially in interpersonal contexts, need to use more natural empathy paradigms to assess the role of CD38 in emotional regulation.

    Journal reference:

    • Procyshyn, T. L., Leclerc Bédard, L., Crespi, B. J., & Bartz, J. A. (2024). CD38 genetic variation is associated with increased personal distress to an emotional stimulus. Scientific Reports 14(1); 1-7. doi:10.1038/s41598-024-53081-5

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  • Stroke and neck artery tear increase heart attack risk in the first year

    Stroke and neck artery tear increase heart attack risk in the first year

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    Heart attack risk almost doubles in the first year after a stroke or when combined with a tear in a neck artery wall, however, a tear without a stroke does not seem to raise heart attack risk, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Our findings may aid physicians in assessing and managing cardiovascular risk after these events.”

    Liqi Shu, M.D., clinical fellow in neurology, Warren Alpert Medical School of Brown University in Providence, Rhode Island

    Aortic dissection is a tear in the wall of the aorta, the large artery that receives blood directly from the heart, and is known to increase heart attack risk. Tears in the walls of the carotid or vertebral arteries, which extend out from the aorta and carry blood through the neck to the brain, are called carotid or vertebral artery dissections. These dissections can result in stroke, and stroke is known to be associated with heart attack. It was unclear whether carotid or vertebral artery dissection itself increases heart attack risk prior to this study.

    The researchers analyzed health information for more than 800,000 adults (average age of 63 years; 62% women) hospitalized in New York (between 2011 and 2017) or Florida (between 2011-2019). The patients with no history of recent major head or neck trauma were separated into four groups based on diagnoses: acute ischemic stroke; cervical artery dissection; both; or a reference group of patients with transient ischemic attack known as a “warning stroke,” temporary loss of short-term memory (transient global amnesia) or migraine.

    After adjusting for heart attack risk factors, the study found:

    • Patients who had carotid or vertebral artery dissection without stroke had the same risk of having a heart attack within a year as those in the reference group.
    • Patients with stroke, either with or without carotid or vertebral artery dissection, were almost twice as likely to have a heart attack within a year, in comparison to patients in the reference group.

    “Before, it was just a guess, but now we know that carotid or vertebral artery dissection not causing a stroke does not raise the risk of a heart attack, and it makes sense that clinicians should focus predominantly on stroke prevention in this subgroup of patients,” Shu said.

    Study background:

    • Participants with a recent history of major head or neck trauma were excluded. Head or neck trauma may lead to traumatic carotid dissection, which is different from this study’s focus on spontaneous dissection.
    • The analysis controlled for several heart attack risk factors, including age, Type 1 or Type 2 diabetes, heart failure, coronary artery disease, high cholesterol and high blood pressure.
    • Almost 20,000 of the participants experienced a heart attack within one year of their initial hospitalization, and the risk of heart attack was compared among the diagnostic groups.
    • Among the study group of 823,634 participants, 65.4% were white, 16.2% were Black or African American, and 12.2% were Hispanic or Latino adults. 

    While this study is based on hospitalization data only in New York and Florida, it’s important to note that these states collectively represent a substantial portion of the U.S. population, accounting for over 10% of the total. These two states also provide a good representation of diverse demographic groups, adding strength to the findings. However, caution should still be exercised when generalizing these results to people living in other geographic areas. In addition, this retrospective analysis (looks back in time to analyze data) might not have accounted for all factors influencing heart attack risk such as medication usage, which was not included in the databases.

    According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, stroke accounted for approximately 1 of every 21 deaths in the United States in 2021.

    Source:

    American Heart Association

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  • Stroke survivors exposed to sexual assault face greater recovery challenges

    Stroke survivors exposed to sexual assault face greater recovery challenges

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    Stressors and traumatic events experienced over the course of a lifetime may negatively impact subsequent stroke recovery; specifically, stroke survivors exposed to sexual assault at any point in their life had poorer physical functioning and cognitive outcomes one year after a stroke, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    It is important to know what has happened to a patient in their life when taking care of them post-stroke. Screening for lifetime stress and trauma is important when caring for a patient who has had a stroke because those experiences often have far-reaching impact and may predict how well a person does over time.”


    E. Alison Holman, Ph.D., lead study author, professor of nursing and psychological science at the University of California, Irvine

    Researchers examined data from the STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study to investigate specific types of stressors that may contribute to adverse physical function and cognitive outcomes one year after stroke. In the STRONG study, stroke survivors were assessed four times during the year. Assessments included the Lifetime Stress and Trauma Exposure survey, completed approximately 90 days after the stroke. Participants reported their lifetime exposure to 31 different types of stressful and/or traumatic events, including witnessing a loved one being injured or killed; sexual assault; divorce; emotional and physical abuse in childhood; and poverty. Additionally, one year after the stroke, participants were assessed for physical function and cognitive abilities. The researchers evaluated the relationships among lifetime stress and trauma exposure and functional and cognitive outcomes among 763 stroke survivors, average age of 63 years.

    The analysis found:

    • Sexual assault was the traumatic event most strongly associated with a moderate decrease in the ability to perform activities of daily living and lower scores on the modified Rankin Scale (describes a person’s ability to function) and Telephone Montreal Cognitive Assessment scores one year after stroke, after controlling for age, gender, race and National Institutes of Health stroke scale score (a measure of stroke severity) three months after a stroke.

    • Other adverse experiences – witnessing a family member be injured or killed; going through a divorce; and/or suffering childhood physical abuse – were also independently associated with a moderate decrease in ability to perform daily living activities one year after stroke.

    • These associations remained even when early post-stroke acute stress levels were accounted for in the analysis.

    • In contrast, taking care of a seriously ill loved one was associated with better scores on the Telephone Montreal Cognitive Assessment. Holman noted that people taking care of others are more actively engaged in everyday life, which may keep the mind sharper. 

    • Women were significantly more likely to report being sexually assaulted and having a seriously ill loved one.

    Holman emphasized that health care professionals should be aware of the potentially lasting physical health impact of sexual assault and other traumatic events that occur over the course of a person’s life. Understanding that these prior life experiences can shape how patients respond to a subsequent stroke may encourage more compassionate communication.

    “Bad things happen to people, so the goal is to intervene in the immediate aftermath of the stroke to prevent its worst effects. We should be able to use this information to allocate resources in a targeted way to provide better support for people during post-stroke recovery,” she said. “Health care professionals can use psychological first aid strategies to support the patients’ basic needs, help them cope and refer them to resources such as a support group or community agency. Sometimes just acknowledging the experience is itself freeing.”

    “This study raises our awareness of how important it is to manage stressors and to increase our physical and mental resilience,” said Randi Foraker, Ph.D., M.A., FAHA, vice chair of the American Heart Association’s Epidemiology & Cardiovascular Stroke Nursing Prevention Science Committee, and professor of medicine, Institute for Informatics, Data Science and Biostatistics and director, Center for Population Health Informatics at Washington University in St. Louis, School of Medicine, Missouri. “Some of the ways we can bolster our resilience and our wellness is to engage in mindful meditation, social engagement and physical activity. As clinicians, researchers and caregivers, we need to make sure we are giving stroke survivors their best chance at living longer, healthier lives.” Dr. Foraker was not involved in the study.

    Study details and background:

    • The study included 763 stroke survivors (average age of 63; 41.3% female; 60.9% white adults).

    • The STRONG study was conducted at 28 stroke centers across the U.S. from 2016-2021.

    • The current study findings build on the STRONG study, led by Holman and her colleague Steven Cramer, M.D., that was previously published in the American Heart Association’s Stroke journal (Sept. 2023), which also suggested that cumulative traumatic stress exposure impairs recovery from stroke.

    The main study limitations were that patients with a severe stroke and those who did not speak English were excluded, so we do not know whether the findings would apply to those patients. Additional research is needed to investigate the potential mechanisms that link these traumatic events to worse outcomes after stroke. Holman suggests it is important to examine both psychological and physiologic processes that may explain the findings.

    Source:

    American Heart Association

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