Medical Bulletin 23/ November/ 2024 - Video

Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature death, finds a large study published by The BMJ.

Growing evidence shows that both conditions are associated with a greater long term risk of chronic diseases, such as high blood pressure, heart disease, and some cancers, but their effect on risk of death before the age of 70 remains unclear. To explore this further, researchers drew on information provided by 110,091 women taking part in the Nurses’ Health Study II who were aged 25-42 years in 1989 and had no history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer.

Starting in 1993 and every two years thereafter, these women reported any diagnosis of endometriosis (confirmed by laparoscopy) and uterine fibroids (confirmed by ultrasound or hysterectomy). Other potentially influential factors including age, ethnicity, reproductive history, HRT and oral contraceptive use, regular use of aspirin or anti-inflammatory drugs, and other health-related issues were also taken into account.

During 30 years of monitoring, 4,356 premature deaths were recorded, including 1,459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. Overall, the rate of all-cause premature death for women with and without confirmed endometriosis was 2 and 1.4 per 1,000 person years, respectively.

After taking account of age and other confounding factors such as weight (BMI), diet quality, physical activity, and smoking status, endometriosis was associated with a 31% higher risk of premature death, largely driven by deaths due to gynaecological cancers. Uterine fibroids were unrelated to all-cause premature death, but were associated with a greater risk of death due to gynaecological cancers. Endometriosis was also associated with a greater risk of non-cancer mortality.

Reference: BMJ 2024;387:e078797

doi: https://doi.org/10.1136/bmj-2023-078797

Incidence of stroke and ischemic heart disease are declining around the world, except for in a handful of regions, according to research in the open access journal PLOS Global Public Health. Authors find that in East and West Sub-Saharan Africa, East and Central Asia and Oceania, ischemic heart disease is increasing, which may be attributed to eight factors that include diet, high BMI, household air pollution and more.

The team analyzed global data from 1990-2019 for incidence of ischemic heart disease and stroke and for exposure to 87 potential attributable factors. The authors describe the incidences and trends at a global, regional and national level, and find higher rates of ischemic heart disease than stroke. Over three decades ischemic heart disease reduced from 316 to 262 per 100,000 people and stroke declined from 181 to 151 per 100,000.

The increases of ischemic heart disease seen in some regions may be associated with the shifting distribution of eight factors: a diet high in trans-fatty acids; diet low in calcium; high BMI; household air pollution from solid fuels; non-exclusive breastfeeding; occupational ergonomic factors; vitamin A deficiency; and, occupational exposure to particulate matter, gases and fumes, which were determined by the World Bank income levels.

The results indicate how the potential socioeconomic development of some countries is affecting rates of cardiovascular disease and stroke, and that places experiencing rapid economic transitions – and rapidly changing lifestyle changes – may also be experiencing higher rates of disease. This study provides insight into mechanisms involved and the potential for targeted interventions.

Reference: Xia R, Cai M, Wang Z, Liu X, Pei J, Zaid M, et al. (2024) Incidence trends and specific risk factors of ischemic heart disease and stroke: An ecological analysis based on the Global Burden of Disease 2019. PLOS Glob Public Health 4(11): e0003920. https://doi.org/10.1371/journal.pgph.0003920

People with poorer mental health are more prone to browsing negative content online, which further exacerbates their symptoms, finds a study led by UCL researchers. The relationship between mental health and web-browsing is causal and bi-directional, according to the Wellcome-funded study published in Nature Human Behaviour.

The researchers have developed a plug-in tool that adds ‘content labels’ to web pages—similar to nutrition labels on food—designed to help users make healthier and more informed decisions about the content they consume. These labels emphasise the emotional impact of webpage content, along with its practicality and informativeness.

Over 1,000 study participants answered questions about their mental health and shared their web browsing history with the researchers. Using natural language processing methods, the researchers analysed the emotional tone of the webpages participants visited. They found that participants with worse moods and mental health symptoms were inclined to browse more negative content online, and after browsing, those who browsed more negative content felt worse.

Co-lead author, PhD student Christopher Kelly, said: "The results contribute to the ongoing debate regarding the relationship between mental health and online behaviour.

“Most research addressing this relationship has focused on the quantity of use, such as screen time or frequency of social media use, which has led to mixed conclusions. Here, instead, we focus on the type of content browsed and find that its emotional tone is causally and bidirectionally related to mental health and mood."

To check whether an intervention could be used to change web-browsing choices and improve mood, the researchers conducted a further study. They added content labels to the results of a Google search, which informed participants whether each search result would likely improve their mood, make it worse, or have no impact. Participants were then more likely to choose the positively-labelled sites deemed likely to improve their mood—and when asked about their mood after, those who had looked at the positive websites were indeed in better moods than other participants.

In response, the researchers have developed a free browser plug-in that adds labels to Google search results, providing three different ratings of how practical a website’s content is, how informative it is, and how it impacts mood.

Reference: Kelly, C.A., Sharot, T. Web-browsing patterns reflect and shape mood and mental health. Nat Hum Behav (2024). https://doi.org/10.1038/s41562-024-02065-6

Vagus Nerve Stimulation May Ease Inflammmatory Bowel Disease

A new study reveals how electrical stimulation of the vagus nerve—a major nerve connecting the brain and gut—may combat the stress-related inflammation that worsens inflammatory bowel disease symptoms. Published in Science Translational Medicine

, the study showed that vagus nerve stimulation in stressed mice with colitis, a form of inflammatory bowel disease, reduced inflammation, improved symptoms, and boosted survival rates. By engaging the parasympathetic nervous system, the team observed that inflammation could be eased by inhibiting SUMOylation, a cellular process that shapes immune response.

Modulating SUMOylation—either through vagal nerve stimulation or treatment with a SUMOylation inhibitor—could open the door to inflammatory bowel disease therapies that focus on managing inflammation directly, rather than alleviating symptoms.

The new study shows that targeting specific forms of SUMOylation could prevent the harmful influx of immune cells that can trigger gut inflammation. Researchers analyzed data identifying that inhibiting SUMOylation, through genetic or drug-based approaches, dramatically slowed disease progression in mouse models.

Current anti-inflammatory treatments bring relief but often fall short, as patients can lose their response to these medications over time, suffer relapses, and experience significant side effects.

Researchers have long noted that stress plays a significant role in exacerbating IBD symptoms, and some have even described ulcerative colitis as psychosomatic.

“Stimulating the vagus nerve neutralized the effects of stress and restored a balanced and healthy physiologic state,” said Ulloa, a Duke researcher, the leading and corresponding author of the study. “Many relaxation techniques, like deep breathing and meditation, are designed to enhance the parasympathetic system, with the vagus nerve playing a central role in relaxing most of our organs.

Reference: Ayman Youssef et al.,Vagal stimulation ameliorates murine colitis by regulating SUMOylation.Sci. Transl. Med.16,eadl2184(2024).DOI:10.1126/scitranslmed.adl2184