New findings from McGill University researchers could help clinicians understand the course of delusions in youth and young adults that signal the need for a timely intervention to prevent a full relapse of psychosis.
Delusions – strong beliefs that don’t align with commonly accepted reality – are a defining symptom of psychosis but are not sufficiently understood.
For the first time, researchers studied whether delusion themes, such as paranoia or grandiosity, stay the same or shift between psychotic episodes in youth and young adults undergoing early intervention treatment.
The importance of timely treatment
Notably, most patients did not relapse at all following their first episode, showing the efficacy of early intervention and highlighting the need for improved access, said the researchers. An estimated 75% of children with mental disorders do not use specialised treatment services, according to Youth Mental Health Canada.
“Early intervention is essential if we want to give young people the best chance at lasting recovery,” said lead author Gil Grunfeld, a recent master’s graduate from McGill’s Department of Psychiatry and a current doctoral student at Boston University.
Detecting patterns in delusions
The study, published in JAMA Psychiatry, found that in the less likely instances of relapse, patients almost always had the same type of delusion as their first episode.
“The return of similar narratives potentially suggests the mind may be reflecting the same patterns seen in earlier episodes,” said Grunfeld.
“Recognizing this pattern of delusions in those who go on to relapse could help clinicians understand the experience of their patients and adjust the care they provide,” said Dr Jai Shah, an Associate Professor in McGill’s Department of Psychiatry and a researcher at the Douglas Hospital Research Centre.
Delusions often persisted even as other symptoms improved, suggesting delusions may require different treatment strategies, he added.
“Delusions are often highly distressing and difficult to define, which makes closing the gap in research all the more crucial. There is a great deal of future work to be done,” said Grunfeld.
The researchers followed about 600 patients ages 14 to 35 for up to two years. All were receiving treatment at an early-intervention service for psychosis in Montreal.
Bioactive glasses, a filling material which can bond to tissue and improve the strength of bones and teeth, has been combined with gallium to create a potential treatment for bone cancer. Tests in labs have found that bioactive glasses doped with the metal have a 99% success rate of eliminating cancerous cells and can even regenerate diseased bones.
In laboratory tests 99% of osteosarcoma (bone cancer) cells were killed off without destroying non-cancerous normal human bone cells. The researchers also incubated the bioactive glasses in a simulated body fluid and after seven days they detected the early stages of bone formation.
Gallium is highly toxic, and the researchers found that the ‘greedy’ cancer cells soak it up and self-kill, which prevented the healthy cells from being affected. Their research appears in the journal Biomedical Materials.
Osteosarcoma is the mostly commonly occurring primary bone cancer and despite the use of chemotherapy and surgery to remove tumours survival rates have not improved much since the 1970s. Survival rates are dramatically reduced for patients who have a recurrence and primary bone cancer patients are more susceptible to bone fractures.
Despite extensive research on different types of bioactive glass or ceramics for bone tissue engineering, there is limited research on targeted and controlled release of anti-cancer agents to treat bone cancers.
Professor Martin said: “There is an urgent need for improved treatment options and our experiments show significant potential for use in bone cancer applications as part of a multimodal treatment.
“We believe that our findings could lead to a treatment that is more effective and localised, reducing side effects, and can even regenerate diseased bones.
“When we observed the glasses, we could see the formation of a layer of amorphous calcium phosphate/ hydroxy apatite layer on the surface of the bioactive glass particulates, which indicates bone growth.” The glasses were created in the Aston University labs by rapidly cooling very high temperature molten liquids (1450°C) to form glass. The glasses were then ground and sieved into tiny particles which can then be used for treatment.
In previous research the team achieved a 50% success rate but although impressive, this was not enough to be a potential treatment. The team are now hoping to attract more research funding to conduct trials using gallium.
Dr Lucas Souza, research laboratory manager for the Dubrowsky Regenerative Medicine Laboratory at the Royal Orthopaedic Hospital, Birmingham worked on the research with Professor Martin. He added: “The safety and effectiveness of these biomaterials will need to be tested further, but the initial results are really promising.
“Treatments for a bone cancer diagnosis remain very limited and there’s still much we don’t understand. Research like this is vital to support in the development of new drugs and new methodologies for treatment options.”
Four plants eaten by gorillas, also used in Gabonese traditional medicine, have antibacterial effects
Four plants consumed by wild gorillas in Gabon and used by local communities in traditional medicine show antibacterial and antioxidant properties, find Leresche Even Doneilly Oyaba Yinda from the Interdisciplinary Medical Research Center of Franceville in Gabon and colleagues in a new study publishing September 11 in the open-access journal PLOS ONE.
Wild great apes often consume medicinal plants that can treat their ailments. The same plants are often used by local people in traditional medicine.
To investigate, researchers observed the behavior of western lowland gorillas (Gorilla gorilla gorilla) in Moukalaba-Doudou National Park in Gabon and recorded the plants they ate. Next, they interviewed 27 people living in the nearby village of Doussala, including traditional healers and herbalists, about the plants that were used in local traditional medicine. The team identified four native plant species that are both consumed by gorillas and used in traditional medicine: the fromager tree (Ceiba pentandra), giant yellow mulberry (Myrianthus arboreus), African teak (Milicia excelsa) and fig trees (Ficus). They tested bark samples of each plant for antibacterial and antioxidant properties and investigated their chemical composition.
The researchers found that the bark of all four plants had antibacterial activity against at least one multidrug-resistant strain of the bacterium Escherichia coli. The fromager tree showed “remarkable activity” against all tested E. coli strains. All four plants contained compounds that have medicinal effects, including phenols, alkaloids, flavonoids, and proanthocyanidins. However, it’s not clear if gorillas consume these plants for medicinal or other reasons.
Biodiverse regions, such as central Africa, are home to a huge reservoir of unexplored and potentially medicinal plants. This research provides preliminary insights about plants with antibacterial and antimicrobial properties, and the four plants investigated in this study might be promising targets for further drug discovery research – particularly with the aim of treating multidrug-resistant bacterial infections.
The authors add: “Alternative medicines and therapies offer definite hope for the resolution of many present and future public health problems. Zoopharmacognosy is one of these new approaches, aimed at discovering new drugs.”
Patients with throat problems were less able to regulate their blood pressure in a new study published in JAMA Otolaryngology. The baroreflex is a crucial part of the autonomic nervous system which detects changes in blood pressure, adjusting heart rate and blood vessel tone accordingly to maintain stable blood pressure. It is what prevents fainting when standing up.
Researchers from the University of Southampton and University Hospitals of Dorset Foundation Trust believe the findings could be explained by the Vagas nerve (which controls the autonomic nervous system) prioritising protection of the airways over less urgent functions, such as blood pressure regulation.
“Our immediate survival depends on the throat being able to separate air and food passages each time we swallow,” says the lead author of the study Reza Nouraei, Professor of Laryngology and Clinical Informatics at the University of Southampton.
“The throat does this using delicate reflexes, but when these reflexes are disturbed, for example, due to a viral infection like Covid or exposure to reflux affecting nerves in this region, the control of this critical junction becomes compromised, giving rise to symptoms like the feeling of a lump in the throat, throat clearing and coughing.
“To compensate for a faulty throat, the autonomic control system must expend significant amounts of energy to maintain a safe airway. We found that in patients with a faulty throat, the heart, specifically a function called baroreflex, is less well controlled. This is one of the Peters that has been robbed to pay Paul.
“The problem with robbing this Peter is that it likely impacts long-term survival, as patients with reduced baroreflex function are more likely to die of a heart attack or stroke in years to come.”
The researchers compared the heart rates, blood pressure and baroreflex sensitivity of 23 patients admitted to Ear, Nose and Throat (ENT) surgery with aerodigestive (laryngopharyngeal) symptoms and 30 patients admitted to Gastroenterology with digestive (oesophagogastric) symptoms at University Hospitals of Dorset NHS Foundation Trust.
Reflux was a common cause of symptoms in both groups – making up the majority of digestive group cases. Other causes like thinning of the vocal cord were present in the aerodigestive group.
The team found patients in the aerodigestive group had a higher resting heart rate, lower resting blood pressure, and lower baroreflex sensitivity, than those in the digestive group.
“Now, and especially since Covid which damages nerves, we are seeing more patients with throat symptoms,” says Professor Nouraei.
“Reduced baroreflex sensitivity impacts survival independent of other cardiovascular risks, so if the association we’ve discovered is confirmed by future studies, the need to make timely and accurate diagnoses and provide early and definitive treatments will become more pressing.”
The study adds to the increasing interest in the Vaus nerve and holistic health. As well as regulating blood pressure through the baroreflex, the Vagus nerve controls our heart rate, digestion, respiration, mood and a host of other bodily functions which affect our health and wellbeing.
Professor Nouraei says: “This study helps us to think about patients more holistically. As a clinician, if you can fix a problem in the throat that is potentially taking away bandwidth from the Vagus, then it frees up the nerve to give to the rest of the body.
“If there is a chance that throat problems can affect functions like the baroreflex, or have a wider impact on overall wellbeing, then they need more consideration.”
The researchers will now look at the long-term impacts of throat conditions on autonomic health and the effects of treatment.
Tubal sterilisation rates in states that banned, limited, or protected abortion access after Dobbs v Jackson Women’s Health decision, both before and after the decision. Source: Columbia University Irving Medical Center
Surgical sterilisation rates among women increased in the United States after a 2022 Supreme Court ruling (Dobbs vs Jackson Women’s Health) overturned the constitutional right to abortion, found researchers at Columbia University Vagelos College of Physicians and Surgeons. The study was published September 11 in JAMA.
Surgical sterilisation – tying, cutting, or removing the fallopian tubes – is a highly effective but essentially irreversible method of preventing pregnancy.
Before the Supreme Court decision, the rate of surgical sterilisation in the United States had declined from a peak in the mid-1970s as effective reversible contraceptive methods became more accessible.
The study looked at the use of surgical sterilisation before and after the Dobbs decision among roughly 4.8 million women in 36 states and Washington, DC.
In the first month after the ruling, sterilisation rates in all states included in the study increased from stable rates in the prior year and a half.
In the six months after the ruling, surgical sterilizations continued to rise by 3% per month in states where abortion was banned after Dobbs. A similar but not statistically significant trend was seen in states that limited access to abortion after Dobbs; no further increase was seen in states that protected abortion access.
“Our study suggests that the Dobbs ruling and subsequent state laws banning or limiting access to abortion may affect a woman’s choice of contraception,” says Xiao Xu, a health outcomes researcher who led the study. “The findings also warrant attention because tubal sterilisation is an irreversible method of contraception.”
The impact of concussion while playing sport is different in those who don’t play professionally, says new research.
Sports-related concussions (SRC) may not be associated with long-term cognitive risks for non-professional athletes, a study led by a UNSW medical researcher suggests. In fact, study participants who had experienced an SRC had better cognitive performance in some areas than those who had never suffered a concussion, pointing to potential protective effects of sports participation.
Published in the Journal of Neurology, Neurosurgery and Psychiatry, the research reveals that individuals who reported experiencing any SRC during their lifetime had a marginally better cognitive performance than those who reported no concussions.
The study, a collaboration between researchers at UNSW Sydney, the University of Oxford, the University of Exeter and Harvard University, analysed data from more than 15 000 participants from the UK-based PROTECT study of 50- to 90-year-olds. This ongoing research aims to understand brain ageing and cognitive decline.
“Our findings suggest that there is something about playing sport, even though a person may experience concussion, that may be beneficial for long-term cognitive outcomes,” says lead author Dr Matt Lennon MD, PhD, at UNSW Medicine & Health.
“While it may be that those who play sports have had access to better education and more resources, we controlled for these factors in the analysis, so that doesn’t explain the result. We hypothesise that there may be physical, social and long-term behavioural effects of sport that may make for healthier adults in late-life,” said Dr Lennon.
Largest study of long-term effects of sports concussions
The study is the largest to date examining the long-term cognitive effects of SRC. Researchers collected lifetime concussion histories from 15 214 participants using the Brain Injury Screening Questionnaire.Among them, 6227 (39.5%) reported at least one concussion and 510 (3.2%) at least one moderate-severe concussion. On average, participants reported suffering their last head injury an average of 29 years prior to the study and their first head injury an average of 39 years earlier.
Researchers then compared cognitive function among individuals with 0, 1, 2 and 3+ SRCs and 0, 1, 2 and 3+ non-sports-related concussions (nSRCs) (i.e. from falls, car accidents, assaults and other causes). The SRC group showed 4.5 percentile rank better working memory than those who hadn’t experienced an SRC, and 7.9% better reasoning capacity than those without concussions.
Those with one SRC also had better verbal reasoning and attention compared to those with no SRC.
Conversely, participants with 3+ nSRCs – so things like accident and assaults – had worse processing speed and attention, and a declining trajectory of verbal reasoning with age.
“This study suggests that there could be long term benefits from sport which could outweigh any negative effects of concussions, which could have important implications for policy decisions around contact sport participation. It may also be that non-sports related head injuries lead to greater brain damage than sports-related concussions,” said senior author Professor Vanessa Raymont from the University of Oxford and Oxford Health NHS Foundation Trust.
The researchers say the study had some limitations.
“The retrospective design of the study, with elderly participants often recalling details of events over three decades in the past, may have affected the reporting of head injuries, even though we used a well-validated head injury screening tool,” said Prof. Raymont.
Study implications
The study looked at mid-to-late-life people who experienced SRC years earlier, whereas most other studies on SRC focus on younger athletes in the immediate period after their head injuries, where cognitive effects are most salient.
“While these results do not indicate the safety of any sport in particular, they do indicate that overall sports may have greater beneficial effects for long-term cognitive health than the damage it causes, even in those who have experienced concussion,” said Dr Lennon.
“This finding should not be overstated – the beneficial effects were small and in people who had two or more sports-related concussions there was no longer any benefit to concussion. Additionally, this study does not apply to concussions in professional athletes whose head injuries tend to be more frequent, debilitating and severe.”
Anne Corbett, Professor at Exeter University and the lead investigator of the PROTECT study, said: “What we see emerging is a completely different profile of brain health outcomes for people who have concussions as a result of sport compared to those that are not related to sport. Concussions that occur during sport do not lead to brain health concerns whereas other concussion types do, especially when people experience multiple concussions. In fact, people who take part in sport seem to have better brain health regardless of whether they have had a concussion whilst taking part or not.”
A common skin fungus, Malassezia globosa may invade deep tissues through the skin or by other means, then cause tumour growth, according to a new study. The study results appear in mBio, an open access journal of the American Society for Microbiology.
“It is important to take care of skin not only for beauty, but also for health,” said corresponding study author Qi-Ming Wang, PhD, a professor in the School of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Hebei, China. “As a factor promoting tumour growth, intertumoural microorganisms need to be paid more attention.”
Recently, an increasing number of studies have shown a relationship between fungus and cancer. In the new study, Wang and colleagues subjected mouse breast cancer cells to tumour transplantation and then injected the M. globosa into the mammary gland fat pad. At the end of the experiment, they collected the tumour tissue to measure the tumour size and observe the content of intertumoral M. globosa. The researchers discovered that M. globosa colonises in breast fat pads leading to tumour growth. As a lipophilic yeast, the breast fat pad may provide an external source of lipids for the development of M. globosa, said the researchers. They also found that the pro-inflammatory cytokine interleukin (IL)-17a/macrophage axis plays a key role in mechanisms involved in M. globosa-induced breast cancer acceleration from the tumour immune microenvironment perspective.
“Although still controversial, the relationship between microbes and cancer is gaining attention. The imbalance of the microflora in the tumour may lead to disorder in the tumour microenvironment,” Wang said. “For example, Helicobacter pylori emerged as a potential cause of gastric cancer. In addition, Fusobacterium nucleatum has been identified as a potential colorectal cancer biomarker in stool and is predominantly found in the tumour microenvironment. Bacteria or fungi may play a direct (eg, toxins) or indirect (eg, inhibition of anti-tumoural immune responses) role in the tumorigenesis pathways of many of these risk factors. The imbalance of microbial homeostasis in tumours has a certain significance for cancer diagnosis, treatment and prognosis.”
According to Wang, although the researchers found that M. globosa can promote the growth of tumours, the related transmission route is still unclear.
Types of tumour cells. Credit: Scientific Animations CC4.0
A Ludwig Cancer Research study has discovered that recurrent tumours of the aggressive brain cancer glioblastoma multiforme (GBM) grow out of the fibrous scars of malignant predecessors destroyed by interventions such as radiotherapy, surgery and immunotherapy.
Led by Ludwig Lausanne’s Johanna Joyce, Spencer Watson and alumnus Anoek Zomer and published in the current issue of Cancer Cell, the study describes how these scars enable the regrowth of tumours and identifies drug targets to sabotage their malignant support. It also demonstrates the efficacy of such combination therapies in preclinical trials using mouse models of GBM.
“We’ve identified fibrotic scarring as a key source of GBM resurgence following therapy, showing how it creates a protective niche for the regrowth of the tumor,” said Joyce. “Our findings suggest that blocking the process of scarring in the brain by adding anti-fibrosis agents to current treatment strategies could help prevent glioblastoma from recurring and improve the outcomes of therapy.”
There is a great need for such interventions. GBM is the most common and aggressive form of brain cancer in adults. Despite considerable effort to develop effective therapies for the cancer, the average life expectancy of patients remains around 14 months following diagnosis.
The origins of the current study date back to 2016, when the Joyce lab reported in the journal Science its examination in mouse models of strategies to overcome resistance to a promising immunotherapy for the treatment of GBM. That experimental therapy, which inhibits signalling by the colony stimulating factor-1 receptor (CSF-1R) and currently in clinical trials, targets immune cells known as macrophages and their brain-resident versions, microglia, both of which are manipulated by GBM cells to support tumour growth and survival.
The Joyce lab has demonstrated that CSF-1R inhibition reprograms these immune cells into an anti-tumour state and so induces significant tumour regression. Yet, as the Science study showed, about half the mice show relapse following an initial response to the therapy. “What was most remarkable about that observation was that every single time a brain tumour recurred following immunotherapy, it regrew right next to a scar that had formed at the original site of a tumour,” said Joyce.
In the current study, Joyce, Watson, Zomer and their colleagues examined tumour samples obtained from patients undergoing GBM therapy and showed that fibrotic scarring occurs following therapy in humans as well – and that it is similarly associated with tumour recurrence. They also showed that the fibrotic scarring occurs in response to not only immunotherapy but also following the surgical and radiological removal of tumours.
To explore how fibrosis contributes to relapse, the researchers applied an integrated suite of advanced technologies to analyze the cellular and molecular geography of the scars and the microenvironment of resurgent tumors.
These technologies include the analysis of global gene expression in individual cells, the comprehensive analysis of proteins in the tissues as well a workflow and AI-powered suite of analytical methods for the spatial analysis of tissues named hyperplexed immunofluorescence imaging (HIFI). Recently developed by Watson and colleagues in the Joyce lab, HIFI permits the simultaneous visualisation of multiple molecular markers in and around cells across broad cross-sections of tissues, enabling the generation of granular maps of the tumour microenvironment.
“Applied together, these advanced methods allowed us to see exactly how fibrotic scars form,” said Watson. “They revealed that the fibrosis serves as a kind of protective cocoon for residual cancer cells and pushes them into a dormant state in which they are largely resistant to therapy. We found that it also shields them from surveillance and elimination by the immune system.”
Integrated analyses of the tissue microenvironment following therapy revealed that the descendants of cells associated with tumor-feeding blood vessels become functionally altered to resemble fibroblasts—fiber-producing cells commonly involved in wound-healing. These perivascular-derived fibroblast-like (PDFL) cells fan out across the region previously occupied by the regressing tumor, where they mediate the generation of fibrotic scars. These cells, the researchers found, are especially activated by neuroinflammation and immune factors known as cytokines, most notably one called transforming growth factor-β (TGF-β).
“To see if targeting fibrotic scarring could improve therapeutic outcomes for GBM, we devised a treatment regimen using existing drugs to block TGF-β signaling and suppress neuroinflammation in combination with CSF-1R inhibition and evaluated it in preclinical trials using mouse models of GBM,” said Joyce. “We also timed these additional treatments to coincide with the period of maximal PDFL activation identified by our studies. Our results show that the drug combination inhibited fibrotic scarring, diminished the numbers of surviving tumor cells and extended the survival of treated mice compared to controls.”
The researchers suggest that approaches to limit fibrotic scarring could significantly improve outcomes for GBM patients receiving surgical, radiation or macrophage-targeting therapies. Additional research, they note, will likely yield even better drug targets for such combination therapies.
A recent analysis of all relevant published studies reveals clear benefits of Cognitive Behavioural Therapy (CBT) for improving mental health and quality of life in cancer survivors. The findings, which are published in Cancer Medicine, extend CBT’s effects beyond what has long been known in the general population.
For the analysis, investigators uncovered 132 clinical trials comparing CBT with controls, including standard therapy, waitlist control, or active/alternative therapy.
Across the trials, CBT moderately improved mental health and quality of life in people with past or current cancer, regardless of cancer type. It seemed to have stronger effects in younger individuals. In-person CBT also appeared more effective than delivering CBT through technology such as web-based videoconference platforms.
“In addition to confirming the general benefit of CBT for individuals with cancer, this study unveiled important nuances of how CBT can be most effective and for which populations. This has major clinical implications for supportive oncology providers,” said corresponding author Anao Zhang, PhD, of the University of Michigan.
Photo by Mikhail Nilov: https://www.pexels.com/photo/a-couple-doing-yoga-at-home-7500701/
Flexibility exercises are often included in the exercise regimens of athletes and exercisers. New research in the Scandinavian Journal of Medicine & Science in Sports suggests that levels of flexibility may affect survival in middle-aged individuals.
After analysing data on 3,139 people (66% men) aged 46–65 years, investigators obtained a body flexibility score, termed Flexindex. This score was derived from a combination of the passive range of motion in 20 movements (each scored 0–4) involving 7 different joints, resulting in a score range of 0–80.
Flexindex was 35% higher in women compared with men. During an average follow-up of 12.9 years, 302 individuals (9.6%) comprising 224 men and 78 women died. Flexindex exhibited an inverse relationship with mortality risk and was nearly 10% higher for survivors compared with non-survivors in both men and women.
After taking age, body mass index, and health status into account, men and women with a low Flexindex had a 1.87- and 4.78-times higher risk of dying, respectively, than those with a high Flexindex.
“Being aerobically fit and strong and having good balance have been previously associated with low mortality. We were able to show that reduced body flexibility is also related to poor survival in middle-aged men and women,” said corresponding author Claudio Gil S. Araújo, MD, PhD, of the Exercise Medicine Clinic – CLINIMEX, in Rio de Janeiro, Brazil.
He added that as flexibility tends to decrease with aging, it may be worth paying more attention to flexibility exercises and routinely including assessments of body flexibility as part of all health-related physical fitness evaluations.
