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In psychiatry, there has been a growing focus on identifying at-risk populations. For schizophrenia, these efforts have led to the development of early recognition and intervention measures. Despite a similar disease burden, the populations at risk of bipolar disorder have not been sufficiently characterized. Within the BipoLife consortium, we used magnetic resonance imaging (MRI) data from a multicenter study to assess structural gray matter alterations in N = 263 help-seeking individuals from seven study sites. We defined the risk using the EPIbipolar assessment tool as no-risk, low-risk, and high-risk and used a region-of-interest approach (ROI) based on the results of two large-scale multicenter studies of bipolar disorder by the ENIGMA working group. We detected significant differences in the thickness of the left pars opercularis (Cohen’s d = 0.47, p = 0.024) between groups. The cortex was significantly thinner in high-risk individuals compared to those in the no-risk group (p = 0.011). We detected no differences in the hippocampal volume. Exploratory analyses revealed no significant differences in other cortical or subcortical regions. The thinner cortex in help-seeking individuals at risk of bipolar disorder is in line with previous findings in patients with the established disorder and corresponds to the region of the highest effect size in the ENIGMA study of cortical alterations. Structural alterations in prefrontal cortex might be a trait marker of bipolar risk. This is the largest structural MRI study of help-seeking individuals at increased risk of bipolar disorder.
Es wurde für Protonen- und Deuteronenbeschleuniger unter Extrembedingungen (hoher Ionenstrom, Dauerstrichbetrieb, Niedrigenergieabschnitt) ein Vergleich zwischen der konventionellen RFQ-Alvarez-DTL-Kombination und einer erstmals am IAP für diese Zwecke entwickelten RFQ-H-DTL-kombination durchgeführt. Insbesondere die Auslegung der Teilchendynamik von HF-Driftröhrenlinearbeschleunigern und RFQ's für leichte Ionen unter Miteinbeziehung der Raumladung und der Forderung nach Dauerstrichbetrieb sind Thema der vorliegenden Arbeit. Die vorgestellten Beschleuniger müssen extrem hohen Anforderungen an Transmission (Stromverlustrate << 3 µ A/m nach dem RFQ), Stabilität (stetige Strahldynamik bei Strahlfehlanpassung und Berücksichtigung von mechanischen und optischen Toleranzen), Anlagensicherheit ("Hands-on-Kriterium") und -zuverlässigkeit (Anlagenverfügbarkeit > 80 %) bei hoher HF-Effizienz (optimierte Shuntimpedanzen, Laufzeitfaktoren und Oberflächenstromdichten) genügen. Es wurden exemplarisch im Rahmen von zwei aktuellen Hochstromprojekten mit Dauerstrichbetrieb teilchendynamische DTL-Entwürfe für den mittleren Energiebereich (0.1 = ß = 0.34) durchgeführt: einmal für das ADS/XADS Projekt (Hier: 40 mA, 350/700 MHz 24 MW, Protonen, CW) und als extremes Beispiel das IFMIF Projekt (125 mA, 175 MHz, 5 MW, Deuteronen, CW). Da IFMIF hinsichtlich Transmissionseffizienz und Strahlstrom in Verbindung mit einem 100 %-Tastverhältnis wohl einzigartig ist, mussten besonders intensive Anstrengungen für den Test der Robustheit des teilchendynamische Entwurfs der DTL-Strukturen unternommen werden. Hierzu wurde der gesamte Injektorpart vom Eingang des Referenz Four-Vane-RFQ bei 0.1 MeV bis zum Ausgang des DTL bei 40 MeV als ganzes simuliert, unter Einbeziehung von optischen, HF- und mechanischen Toleranzen. Diese Rechnungen machten deutlich, dass die Einbringung einer kompakten Strahltransportstrecke (MEBT) zwischen RFQ und DTL notwendig ist, um den Strahl transversal und longitudinal ohne Teilchenverluste an den nachfolgenden DTL anzupassen. Man gewinnt dadurch auch zusätzliche Möglichkeiten für Strahljustierung und -diagnose. Infolgedessen gehört ein MEBT mittlerweile zum Referenz-Design, welches einen 175 MHz Four-Vane-RFQ als Vorbeschleuniger vorsieht und nach dem MEBT einen 175 MHz Alvarez-DTL mit FoDo-Fokussierschema. Die Designkriterien für IFMIF gelten uneingeschränkt auch für das ADS/XADS Projekt und infolgedessen wurde ebenfalls erstmals eine Auslegung des Mittelenergieabschnitts des ADS/XADS-Beschleunigers, der unmittelbar nach dem 350 MHz RFQ bei 5 MeV anfängt und bis ~ 100 MeV reicht, mit der neuen supraleitende CH-Struktur unternommen. Der Hochenergiebereich von 100 MeV bis 600 MeV wird im Referenzentwurf mit den bereits bewährten supraleitenden elliptischen Kavitäten mit einer Resonanzfrequenz von 700 MHz abgedeckt [ADS]. Die umfangreichen Untersuchungen inklusive Toleranzabschätzungen ergaben, dass eine Kette von zehn supraleitenden CH-Resonatoren mit Zwischentankfokussierung (Ausnahme das Modul 1) für diese Anwendung bestens geeignet ist. Des weiteren ergab sich, dass ein Frequenzsprung auf 700 MHz nach dem 6-ten CH-Modul bei einer Energie von ~ 56 MeV die Beschleunigungs- und HF-Effizienz erhöht. Außerdem wird dadurch der Strahl ideal an den Hochenergieabschnitt angepasst. Im Rahmen dieser Arbeit wurden neue Driftröhrenlinearbeschleunigerstrukturen vorgestellt (normal leitender IH-DTL, supraleitender CH-DTL), die für bis zu 10 MW Strahlleistung, 125 mA Strahlstrom und höchsten Tastverhältnissen geeignet sind. Ferner konnte durch geschickte Wahl der Strukturparameter und Arbeitspunkte eine gute Teilchendynamik mit einem moderaten Emittanzwachstum erzielt werden: Strahltransport und -beschleunigung ohne Teilchenverluste, starke transversale und longitudinale Fokussierung, große Aperturfaktoren und höchste HF-Effizienz sind gleichzeitig erreichbar. Somit stellen die neuen H-Moden Driftföhrenbeschleuniger vor allen Dingen in der supraleitenden Ausführung (CH-DTL) eine tragfähige Basis für alle weiteren geplanten Hochintensitätsbeschleunigeranlagen dar.
Hypofunction of the N-methyl-D-aspartate receptor (NMDAR) has been implicated as a possible mechanism underlying cognitive deficits and aberrant neuronal dynamics in schizophrenia. To test this hypothesis, we first administered a sub-anaesthetic dose of S-ketamine (0.006 mg/kg/min) or saline in a single-blind crossover design in 14 participants while magnetoencephalographic data were recorded during a visual task. In addition, magnetoencephalographic data were obtained in a sample of unmedicated first-episode psychosis patients (n = 10) and in patients with chronic schizophrenia (n = 16) to allow for comparisons of neuronal dynamics in clinical populations versus NMDAR hypofunctioning. Magnetoencephalographic data were analysed at source-level in the 1–90 Hz frequency range in occipital and thalamic regions of interest. In addition, directed functional connectivity analysis was performed using Granger causality and feedback and feedforward activity was investigated using a directed asymmetry index. Psychopathology was assessed with the Positive and Negative Syndrome Scale. Acute ketamine administration in healthy volunteers led to similar effects on cognition and psychopathology as observed in first-episode and chronic schizophrenia patients. However, the effects of ketamine on high-frequency oscillations and their connectivity profile were not consistent with these observations. Ketamine increased amplitude and frequency of gamma-power (63–80 Hz) in occipital regions and upregulated low frequency (5–28 Hz) activity. Moreover, ketamine disrupted feedforward and feedback signalling at high and low frequencies leading to hypo- and hyper-connectivity in thalamo-cortical networks. In contrast, first-episode and chronic schizophrenia patients showed a different pattern of magnetoencephalographic activity, characterized by decreased task-induced high-gamma band oscillations and predominantly increased feedforward/feedback-mediated Granger causality connectivity. Accordingly, the current data have implications for theories of cognitive dysfunctions and circuit impairments in the disorder, suggesting that acute NMDAR hypofunction does not recreate alterations in neural oscillations during visual processing observed in schizophrenia.
Background: Biliary rhabdomyosarcoma (RMS) is the most common biliary tumor in children. The management of affected patients contains unique challenges because of the rarity of this tumor entity and its critical location at the porta hepatis, which can make achievement of a radical resection very difficult.
Methods: In a retrospective chart analysis we analysed children suffering from biliary RMS who were registered in three different CWS trials (CWS-96, CWS-2002P, and SoTiSaR registry).
Results: Seventeen patients (12 female, 5 male) with a median age of 4.3 years were assessed. The median follow-up was 42.2 months (10.7–202.5). The 5-year overall (OS) and event free survival (EFS) rates were 58% (45–71) and 47% (34–50), respectively. Patients > 10 years of age and those with alveolar histology had the worst prognosis (OS 0%). Patients with botryoid histology had an excellent survival (OS 100%) compared to those with non-botryoid histology (OS 38%, 22–54, p = 0.047). Microscopic complete tumor resection was achieved in almost all patients who received initial tumor biopsy followed by chemotherapy and delayed surgery.
Conclusion: Positive predictive factors for survival of children with biliary RMS are age ≤ 10 years and botryoid tumor histology. Primary surgery with intention of tumor resection should be avoided.
Individual differences in perception are widespread. Considering inter-individual variability, synesthetes experience stable additional sensations; schizophrenia patients suffer perceptual deficits in, eg, perceptual organization (alongside hallucinations and delusions). Is there a unifying principle explaining inter-individual variability in perception? There is good reason to believe perceptual experience results from inferential processes whereby sensory evidence is weighted by prior knowledge about the world. Perceptual variability may result from different precision weighting of sensory evidence and prior knowledge. We tested this hypothesis by comparing visibility thresholds in a perceptual hysteresis task across medicated schizophrenia patients (N = 20), synesthetes (N = 20), and controls (N = 26). Participants rated the subjective visibility of stimuli embedded in noise while we parametrically manipulated the availability of sensory evidence. Additionally, precise long-term priors in synesthetes were leveraged by presenting either synesthesia-inducing or neutral stimuli. Schizophrenia patients showed increased visibility thresholds, consistent with overreliance on sensory evidence. In contrast, synesthetes exhibited lowered thresholds exclusively for synesthesia-inducing stimuli suggesting high-precision long-term priors. Additionally, in both synesthetes and schizophrenia patients explicit, short-term priors—introduced during the hysteresis experiment—lowered thresholds but did not normalize perception. Our results imply that perceptual variability might result from differences in the precision afforded to prior beliefs and sensory evidence, respectively.
Individual differences in perception are widespread. Considering inter-individual variability, synesthetes experience stable additional sensations; schizophrenia patients suffer perceptual deficits in e.g. perceptual organization (alongside hallucinations and delusions). Is there a unifying principle explaining inter-individual variability in perception? There is good reason to believe perceptual experience results from inferential processes whereby sensory evidence is weighted by prior knowledge about the world. Different perceptual phenotypes may result from different precision weighting of sensory evidence and prior knowledge. We tested this hypothesis by comparing visibility thresholds in a perceptual hysteresis task across medicated schizophrenia patients, synesthetes, and controls. Participants rated the subjective visibility of stimuli embedded in noise while we parametrically manipulated the availability of sensory evidence. Additionally, precise long-term priors in synesthetes were leveraged by presenting either synesthesia-inducing or neutral stimuli. Schizophrenia patients showed increased visibility thresholds, consistent with overreliance on sensory evidence. In contrast, synesthetes exhibited lowered thresholds exclusively for synesthesia-inducing stimuli suggesting high-precision long-term priors. Additionally, in both synesthetes and schizophrenia patients explicit, short-term priors – introduced during the hysteresis experiment – lowered thresholds but did not normalize perception. Our results imply that distinct perceptual phenotypes might result from differences in the precision afforded to prior beliefs and sensory evidence, respectively.
Background: Cognitive dysfunctions represent a core feature of schizophrenia and a predictor for clinical outcomes. One possible mechanism for cognitive impairments could involve an impairment in the experience-dependent modifications of cortical networks.
Methods: To address this issue, we employed magnetoencephalography (MEG) during a visual priming paradigm in a sample of chronic patients with schizophrenia (n = 14), and in a group of healthy controls (n = 14). We obtained MEG-recordings during the presentation of visual stimuli that were presented three times either consecutively or with intervening stimuli. MEG-data were analyzed for event-related fields as well as spectral power in the 1–200 Hz range to examine repetition suppression and repetition enhancement. We defined regions of interest in occipital and thalamic regions and obtained virtual-channel data.
Results: Behavioral priming did not differ between groups. However, patients with schizophrenia showed prominently reduced oscillatory response to novel stimuli in the gamma-frequency band as well as significantly reduced repetition suppression of gamma-band activity and reduced repetition enhancement of beta-band power in occipital cortex to both consecutive repetitions as well as repetitions with intervening stimuli. Moreover, schizophrenia patients were characterized by a significant deficit in suppression of the C1m component in occipital cortex and thalamus as well as of the late positive component (LPC) in occipital cortex.
Conclusions: These data provide novel evidence for impaired repetition suppression in cortical and subcortical circuits in schizophrenia. Although behavioral priming was preserved, patients with schizophrenia showed deficits in repetition suppression as well as repetition enhancement in thalamic and occipital regions, suggesting that experience-dependent modification of neural circuits is impaired in the disorder.
Introduction: Bipolar disorder (BD) is characterized by recurrent episodes of depression and mania and affects up to 2% of the population worldwide. Patients suffering from bipolar disorder have a reduced life expectancy of up to 10 years. The increased mortality might be due to a higher rate of somatic diseases, especially cardiovascular diseases. There is however also evidence for an increased rate of diabetes mellitus in BD, but the reported prevalence rates vary by large.
Material and Methods: 85 bipolar disorder patients were recruited in the framework of the BiDi study (Prevalence and clinical features of patients with Bipolar Disorder at High Risk for Type 2 Diabetes (T2D), at prediabetic state and with manifest T2D) in Dresden and Würzburg. T2D and prediabetes were diagnosed measuring HBA1c and an oral glucose tolerance test (oGTT), which at present is the gold standard in diagnosing T2D. The BD sample was compared to an age-, sex- and BMI-matched control population (n = 850) from the Study of Health in Pomerania cohort (SHIP Trend Cohort).
Results: Patients suffering from BD had a T2D prevalence of 7%, which was not significantly different from the control group (6%). Fasting glucose and impaired glucose tolerance were, contrary to our hypothesis, more often pathological in controls than in BD patients. Nondiabetic and diabetic bipolar patients significantly differed in age, BMI, number of depressive episodes, and disease duration.
Discussion: When controlled for BMI, in our study there was no significantly increased rate of T2D in BD. We thus suggest that overweight and obesity might be mediating the association between BD and diabetes. Underlying causes could be shared risk genes, medication effects, and lifestyle factors associated with depressive episodes. As the latter two can be modified, attention should be paid to weight changes in BD by monitoring and taking adequate measures to prevent the alarming loss of life years in BD patients.
