Research news tip sheet: story ideas from Johns Hopkins Medicine

UTERINE FIBROIDS CAN TAKE A HEAVY EMOTIONAL TOLL ON WOMEN, STUDY SHOWS

Media Contact:
Marisol Martinez,
mmart150@jhmi.edu

In a comprehensive review of 57 research studies looking at the quality of life of women with uterine fibroids compared with that of people with other chronic diseases, Johns Hopkins Medicine researchers found that the psychological and social burden of the condition is comparable with those for heart disease, diabetes or breast cancer.

The findings, published in the Nov. 1, 2020, issue of the American Journal of Obstetrics & Gynecology, suggest that fibroids affect a woman's quality of life both physically and emotionally. Furthermore, the condition may become a disability in terms of bodily pain, mental health, social functioning and satisfaction with sex life.

Uterine fibroids are the most prevalent benign gynecologic tumors, affecting up to 80% of women of reproductive age. They are made of smooth muscle cells and fibrous connective tissue, and their cause is unknown. One in four women with fibroids may experience heavy menstrual bleeding, anemia, abdominal pain or pressure, increased urinary frequency, and infertility or recurrent miscarriages.

"Over half of the women in the United States will have fibroids, so their overall impact is substantial and yet, this fact does not receive enough attention," says James Segars Jr., M.D., director of the Division of Reproductive Science and Women's Health Research, and professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.

Women with fibroids, the study states, may experience debilitating feelings of worry, fear, anxiety, insecurity and helplessness, as well as issues with self-image and depression. Moreover, the findings show that lack of control over the condition is a leading cause of distress.

"For some women, the unpredictability and intensity of the heavy bleeding and related symptoms associated with the condition go beyond an inconvenience," says Segars. "Many women suffer in silence, and feel they can't go out or be social because they may start bleeding at any time."

Treatment for uterine fibroids depends on the condition's severity. Medication may be used to help shrink the size of the fibroids or they may be surgically removed. With fibroids resulting in approximately 600,000 hysterectomies per year, the tumors are the second most common reason for surgery among pre-menopausal women.

Segars is available for interviews.

FOR BLACKS WITH RESPIRATORY ILLS, INDIVIDUAL AND NEIGHBORHOOD POVERTY YIELD WORSE OUTCOMES

Media Contact:
Helen Jones,
hjones49@jhmi.edu

Research has shown that African Americans have worse health outcomes than non-Hispanic whites regarding respiratory illnesses such as chronic obstructive pulmonary disease (COPD). Now, a new study by Johns Hopkins Medicine researchers reveals that much of this racial disparity can be explained by differences in the socioeconomic status of individuals and neighborhoods.

The findings were published Oct. 2, 2020, in the American Journal of Respiratory and Critical Care Medicine.

In their study, the researchers looked at 2,649 current and former smokers, with or without COPD. They assessed racial differences for different COPD characteristics, including symptoms; results of functional and imaging tests, including scores on a COPD Assessment Test (the questionnaire that measures COPD's impact on a person's life); the ability to perform a six-minute walk test; and the risk for severe worsening of symptoms.

Then, they compared the Black participants with the white participants regarding the socioeconomic status reported by each person and federal data on neighborhood poverty levels. The researchers adjusted for several known risk factors influencing respiratory health outcomes, including smoking status and pack-years (calculated by multiplying the number of packs of cigarettes smoked per day by the number of years a person has smoked).

"We found that Black study participants fared worse than their non-Hispanic white counterparts in a number of areas, including respiratory symptoms, quality of life measures, functional status and imaging findings, as well as having higher rates of severe exacerbations," says study lead author Chinedu Ejike, M.D., M.P.H., a postdoctoral research and clinical fellow at the Johns Hopkins University School of Medicine. "However, several but not all of these racial differences could be explained by lower socioeconomic status and living in poor neighborhoods."

The researchers say that low individual socioeconomic status has previously been associated with higher odds of having COPD, and according to their recent study's findings, residing in lower-income neighborhoods also has detrimental associations with respiratory morbidity. Several factors, they explain, associated with living in disadvantaged neighborhoods -- such as higher stress, poor access to health care, lower quality of care, lack of access to healthy food, exposure to environmental contamination, poor neighborhood walkability and diminished physical activity -- may affect COPD outcomes.

"Thus, to fully understand racial disparities with COPD, one must take into consideration where people live," says Ejike.

"Our work adds to the understanding of the complex relationship among race, socioeconomic status -- both at the individual and neighborhood levels -- and respiratory health outcomes," says study co-author Han Woo, Ph.D., a biostatistician at the Johns Hopkins University School of Medicine.

Ejike and Woo hope their study will encourage health care providers to develop strategies that can break the current link between socioeconomic disadvantage and poor health outcomes.

In further research, they plan to (1) identify more risk factors leading to increased respiratory morbidity among Blacks with COPD, (2) understand why neighborhood context plays a role in COPD health and (3) examine constructs of a neighborhood, such as residential segregation, that contribute to the racial gap in COPD health.

Ejike and Woo are available for interviews.

LYME DISEASE BACTERIA ALTER IMMUNE SYSTEM AND MAY CAUSE IT TO ATTACK HEALTHY CELLS

Media Contact:
Waun'Shae Blount,
wblount1@jhmi.edu

With the incidence of Lyme disease rising to over 300,000 new U.S. cases annually, more people are suffering with the debilitating and persistent symptoms associated with what clinicians call post-treatment Lyme disease syndrome. Now, researchers at the Johns Hopkins Lyme Disease Research Center have found that the bacterium behind the disease, Borrelia burgdorferi, causes significant changes in how the human body responds to its presence.

In a recent study, the researchers showed that Borrelia burgdorferi alters dendritic cells, which normally present antigens -- proteins from pathogens such as bacteria and viruses -- to immune system T-cells, signaling an immune response against the foreign invaders. However, Borrelia burgdorferi stops this communication, which may then lead to the immune system mistakenly attacking healthy cells.

A report on the findings were published in the September 2020 issue of Frontiers in Medicine.

"We believe these observations are relevant not only to how Borrelia burgdorferi disrupts the immune system but other infections as well," says senior author Mark Soloski, Ph.D., co-director for basic research at the Johns Hopkins Lyme Disease Clinical Research Center, and professor of medicine at the Johns Hopkins University School of Medicine. "Antibodies that react with a person's own tissues or organs have been reported in patients with infections, including COVID-19."

In an attempt to better understand how a Lyme disease infection contributes to weakening the immune system, the Johns Hopkins Medicine researchers isolated dendritic cells from healthy study participants and exposed them to Borrelia burgdorferi. They found that bacterial infection causes receptor sites on the surface of dendritic cells, known as HLA-DRs, to mature and become active. HLA-DRs normally present antigens to killer T-cells, the immune system agents that remove invaders from the body.

However, the researchers believe that when the HLA-DRs interact with Borrelia burgdorferi, they are structurally changed and keep the dendritic cells from "marking" the bacterial proteins as foreign. As a result, the dendritic cells attract T-cells but in response to healthy cells in the area rather than the Lyme disease microbes.

The researchers further surmise that if a person has a genetic predisposition to autoimmune diseases such as lupus or rheumatoid arthritis, infection by Borrelia burgdorferi may trigger their development.

Future research on HLA-DR and dendritic cell response to Borrelia burgdorferi, the researchers say, could contribute to new treatments for Lyme disease and a better understanding of how autoimmune diseases may arise.

Soloski is available for interviews.

BRAIN IMPLANTS ENABLE MAN TO SIMULTANEOUSLY CONTROL TWO PROSTHETIC LIMBS WITH 'THOUGHTS'

Media Contact:
Brian Waters,
bwaters3@jhmi.edu

In what is believed to be a medical first, researchers from Johns Hopkins Medicine (JHM) and the Johns Hopkins University Applied Physics Laboratory (APL) have enabled a quadriplegic man to control a pair of prosthetic arms with his mind.

In January 2019, surgeons implanted six electrodes into the brain of Robert "Buz" Chmielewski, during a 10-hour operation. The goal was to improve the sensation in his hands and enable him to mentally operate his prostheses. For more than three decades after a surfing accident while in his teens, Chmielewski has been paralyzed with only minimal movement in his arms and hands.

Now, almost two years into the joint JHM/APL research study following the surgery, Chmielewski has reached an important milestone -- he can now use both of his robotic appendages to perform simple tasks such as feeding himself.

"This type of research, known as brain-computer interface [BCI], has for the most part focused on only one arm, controlled from only one side of the brain," says Pablo Celnik, M.D., professor and director of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and a member of the research team. "Thus, being able to control two robotic arms performing a basic activity of daily living -- in this case, cutting a pastry and bringing it to the mouth using signals detected from both sides of the brain via implanted electrodes -- is a clear step forward to achieve more complex task control directly fed from the brain."

"Simultaneous brain-machine interface control of two limbs is a particular challenge because it's not a simple 1+1 summation of what the left arm is doing plus what the right arm is doing in the brain, but more like trying to calculate the sum of the two arms as 1 plus 1 equals 3.8," adds Gabriela Cantarero, Ph.D., assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and a member of the research team.

The technology uses a system of devices that automates a portion of the robotic control with artificial intelligence.

"Our goal is to make activities, such as eating, easy to accomplish by having the robot do one part of the work and leaving the user in charge of the details: which food to eat, where to cut, how big the cut piece should be, and so on," says David Handelman, Ph.D., a senior roboticist at APL and a member of the research team. "By combining brain-computer interface signals with robotics and artificial intelligence, we allow the user to focus on the parts of the task that matter most."

"Our next steps for this work include expanding the number and types of activities of daily living that we can demonstrate with this form of human-machine teaming, as well as providing users with additional sensory feedback as tasks are conducted," says Francesco Tenore, Ph.D., an electrical engineer at APL and a member of the research team. "This means that the user won't have to rely entirely on vision to know if he's succeeding, in the same way that uninjured people can 'feel' how they're tying their shoelaces without having to look."

A recent video shows Chmielewski cutting food with his left hand and feeding himself with the right, at times simultaneously controlling both robot arms.

All of the researchers are available for interviews.

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