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Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder
(2021)
Konrad, Kerstin ; Kohls, Gregor ; Baumann, Sarah ; Bernhard, Anka ; Martinelli, Anne ; Ackermann, Katharina ; Smaragdi, Areti ; Gonzalez-Madruga, Karen ; Wells, Amy ; Rogers, Jack C. ; Pauli, Ruth ; Clanton, Roberta ; Baker, Rosalind ; Kersten, Linda ; Prätzlich, Martin ; Oldenhof, Helena ; Jansen, Lucres ; Kleeven, Anneke ; Bigorra, Aitana ; Hervás, Amaia ; Kerexeta-Lizeaga, Iñaki ; Sesma-Pardo, Eva ; Gonzalez-Torres, Miguel Angel ; Siklósi, Réka ; Dochnal, Roberta ; Kalogerakis, Zacharias ; Pirlympou, Mara ; Papadakos, Leonidas ; Cornwell, Harriet ; Scharke, Wolfgang ; Dikeos, Dimitris ; Fernández-Rivas, Aranzazu ; Popma, Arne ; Stadler, Christina ; Herpertz-Dahlmann, Beate ; De Brito, Stephane A. ; Fairchild, Graeme ; Freitag, Christine M.
Background: Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses of female CD.
Methods: As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9–18 years), compared to 864 sex- and age-matched typically developing controls.
Results: Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the ‘gender paradox’ hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the ‘delayed-onset pathway’ hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology.
Conclusions: Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.
Koll, Florestan ; Meisenzahl, Eva ; Haller, Bernhard ; Maisch, Philipp ; Kirchhoff, Florian ; Horn, Thomas ; Gschwend, Jürgen E. ; Schmid, Sebastian C.
Purpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect of adjuvant chemotherapy on survival and oncologic outcome in UTUC.
Methods: We analyzed records of patients receiving surgical treatment for UTUC. Pathology of pre-operative biopsy was compared to surgical specimen. We used Kaplan-Meier method to estimate survival probabilities and Cox's proportional hazards models to estimate the association between covariates and event times. Primary endpoint was overall survival (OS). A matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy.
Results: 151 patients underwent surgical treatment (28% open, 36% laparoscopic, 17% robotic radical nephroureterectomy; 14% segmental ureteral resections and 5% palliative nephrectomy) for UTUC and were included in the analysis. Upstaging from <pT1 in endoscopic biopsy to ≥pT1 in final pathology occurred in 61% of patients and upgrading from low-grade to high-grade occurred in 30% of patients. Five-year OS was 59.5%. In the univariate Cox-regression model pathological stage, grade, lymphovascular invasion and positive surgical margins were associated with OS. Matched pair analysis for stage (<pT3; ≥pT3; pN+) and age revealed a significant survival benefit for adjuvant chemotherapy (HR 0.40, 0.14–0.77, p < 0.018) in this cohort.
Conclusion: UTUC is often underestimated in pre-operative biopsy, and it is associated with significant mortality. Pathological stage and grade, lymphovascular invasion and lymph node metastases are predictors of oncologic outcome and survival.
Trebicka, Jonel ; Gu, Wenyi ; De Ledinghen, Victor ; Aubé, Christophe ; Krag, Aleksander ; Praktiknjo, Michael ; Castera, Laurent ; Dumortier, Jerome ; Bauer, David Josef Maria ; Friedrich-Rust, Mireen ; Pol, Stanislas ; Grgurevic, Ivica ; Zheng, Rongqin ; Francque, Sven ; Gottfriedovà, Halima ; Mustapic, Sanda ; Sporea, Ioan ; Berzigotti, Annalisa ; Uschner, Frank Erhard ; Simbrunner, Benedikt Michael ; Ronot, Maxime ; Cassinotto, Christophe ; Kjaergaard, Maria ; Andrade, Filipe ; Schulz, Martin ; Semmler, Georg ; Tjesic Drinkovic, Ida ; Chang, Johannes ; Brol, Maximilian ; Rautou, Pierre Emmanuel ; Vanwolleghem, Thomas ; Straßburg, Christian P. ; Boursier, Jerome ; Ferstl, Philip ; Rasmussen, Ditlev Nytoft ; Reiberger, Thomas ; Vilgrain, Valerie ; Guibal, Aymeric ; Guillaud, Olivier ; Zeuzem, Stefan ; Vassord, Camille ; Lu, Xue ; Vonghia, Luisa ; Senkerikova, Renata ; Popescu, Alina ; Margini, Cristina ; Wang, Wenping ; Thiele, Maja ; Jansen, Chrisitan
Objective: Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.
Design: This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.
Results: After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.
Conclusion: The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.
Thill, Marc ; Friedrich, Michael ; Kolberg-Liedtke, Cornelia ; Albert, Ute-Susann ; Banys-Paluchowski, Maggie ; Bauerfeind, Ingo ; Blohmer, Jens-Uwe ; Budach, Wilfried ; Dall, Peter ; Fallenberg, Eva Maria ; Fasching, Peter Andreas ; Fehm, Tanja ; Gerber, Bernd ; Gluz, Oleg ; Harbeck, Nadia ; Heil, Jörg ; Huober, Jens ; Jackisch, Christian ; Kreipe, Hans-H. ; Krug, David ; Kühn, Thorsten ; Kümmel, Sherko ; Loibl, Sibylle ; Lüftner, Diana ; Lux, Michael Patrick ; Maass, Nicolai ; Mundhenke, Christoph ; Nitz, Ulrike ; Park-Simon, Tjoung-Won ; Reimer, Toralf ; Rhiem, Kerstin ; Rody, Achim ; Schmidt, Marcus ; Schneeweiss, Andreas ; Schütz, Florian ; Sinn, Peter ; Solbach, Christine ; Solomayer, Erich-Franz ; Stickeler, Elmar ; Thomssen, Christoph ; Untch, Michael ; Witzel, Isabell ; Wöckel, Achim ; Müller, Volkmar ; Janni, Wolfgang ; Ditsch, Nina
Klinker, Hartwig ; Naumann, Uwe ; Rössle, Martin ; Berg, Thomas ; Bondin, Mark ; Lohmann, Kristina ; Koenig, Bettina ; Zeuzem, Stefan ; Cornberg, Markus
Glecaprevir/pibrentasvir, a pangenotypic, direct-acting antiviral combination approved for chronic hepatitis C virus treatment, has limited real-world evidence supporting 8-week therapy in compensated cirrhosis. We investigated effectiveness and safety of 187 hepatitis C virus-infected, treatment-naïve, patients with compensated cirrhosis receiving 8-week glecaprevir/pibrentasvir therapy in the German Hepatitis C-Registry between 2 August 2017 and 1 January 2020. Sustained virologic response was 98.4% (127/129) in the per-protocol analysis (excluding patients lost to follow-up or who discontinued treatment due to compliance) and was 85.8% (127/148) in patients with data available in an intention-to-treat analysis. Nineteen patients were lost to follow-up; nine genotype 3 patients, nine nongenotype 3 patients and one mixed genotype patient. One patient relapsed, and one died, unrelated to treatment. Adverse events (>5%) were fatigue and headache. Two serious adverse events occurred; no adverse events resulted in drug discontinuation. An 8-week glecaprevir/pibrentasvir therapy was effective and well-tolerated in this real-world analysis.
Schmidt, Florian ; Marx, Alexander ; Baumgarten, Nina ; Hebel, Marie ; Wegner, Martin ; Kaulich, Manuel ; Leisegang, Matthias ; Brandes, Ralf ; Göke, Jonathan ; Vreeken, Jilles ; Schulz, Marcel Holger
Understanding how epigenetic variation in non-coding regions is involved in distal gene-expression regulation is an important problem. Regulatory regions can be associated to genes using large-scale datasets of epigenetic and expression data. However, for regions of complex epigenomic signals and enhancers that regulate many genes, it is difficult to understand these associations. We present StitchIt, an approach to dissect epigenetic variation in a gene-specific manner for the detection of regulatory elements (REMs) without relying on peak calls in individual samples. StitchIt segments epigenetic signal tracks over many samples to generate the location and the target genes of a REM simultaneously. We show that this approach leads to a more accurate and refined REM detection compared to standard methods even on heterogeneous datasets, which are challenging to model. Also, StitchIt REMs are highly enriched in experimentally determined chromatin interactions and expression quantitative trait loci. We validated several newly predicted REMs using CRISPR-Cas9 experiments, thereby demonstrating the reliability of StitchIt. StitchIt is able to dissect regulation in superenhancers and predicts thousands of putative REMs that go unnoticed using peak-based approaches suggesting that a large part of the regulome might be uncharted water.
Ziemann, Malte ; Suwelack, Barbara ; Banas, Bernhard ; Einecke, Gunilla ; Hauser, Ingeborg A. ; Heinemann, Falko ; Kauke, Teresa ; Kelsch, Reinhard ; Koch, Martina ; Lachmann, Nils ; Reuter, Stefan ; Seidl, Christian ; Sester, Urban ; Zecher, Daniel ; Budde, Klemens
With the introduction of the virtual allocation crossmatch in the Eurotransplant (ET) region in 2023, the determination of unacceptable antigen mismatches (UAM) in kidney transplant recipients is of utmost importance for histocompatibility laboratories and transplant centers. Therefore, a joined working group of members from the German Society for Immunogenetics (Deutsche Gesellschaft für Immungenetik, DGI) and the German Transplantation Society (Deutsche Transplantationsgesellschaft, DTG) revised and updated the previous recommendations from 2015 in light of recently published evidence. Like in the previous version, a wide range of topics is covered from technical issues to clinical risk factors. This review summarizes the evidence about the prognostic value of contemporary methods for HLA antibody detection and identification, as well as the impact of UAM on waiting time, on which these recommendations are based. As no clear criteria could be determined to differentiate potentially harmful from harmless HLA antibodies, the general recommendation is to assign all HLA against which plausible antibodies are found as UAM. There is, however, a need for individualized solutions for highly immunized patients. These revised recommendations provide a list of aspects that need to be considered when assigning UAM to enable a fair and comprehensible procedure and to harmonize risk stratification prior to kidney transplantation between transplant centers.
Görgülü, Esra ; Gu, Wenyi ; Trebicka, Jonel ; Therese Mücke, Victoria ; Mücke, Marcus Maximilian ; Friedrich-Rust, Mireen ; Bojunga, Jörg ; Zeuzem, Stefan ; Finkelmeier, Fabian ; Peiffer, Kai-Henrik
Dongen, Jenny van ; Hagenbeek, Fiona A. ; Suderman, Matthew ; Roetman, Peter J. ; Sugden, Karen ; Geburtig-Chiocchetti, Andreas ; Ismail, Khadeeja ; Mulder, Rosa H. ; Hafferty, Jonathan D. ; Adams, Mark J. ; Walker, Rosie M. ; Morris, Stewart W. ; Lahti, Jari ; Küpers, Leanne K. ; Escaramis, Georgia ; Alemany, Silvia ; Bonder, Marc Jan ; Meijer, Mandy ; Ip, Hill F. ; Jansen, Rick ; Baselmans, Bart M. L. ; Parmar, Priyanka ; Lowry, Estelle ; Streit, Fabian ; Sirignano, Lea ; Send, Tabea S. ; Frank, Josef ; Jylhävä, Juulia ; Wang, Yunzhang ; Mishra, Pashupati Prasad ; Colins, Olivier F. ; Corcoran, David L. ; Poulton, Richie ; Mill, Jonathan ; Hannon, Eilis ; Arseneault, Louise ; Korhonen, Tellervo ; Vuoksimaa, Eero ; Felix, Janine F. ; Bakermans-Kranenburg, Marian J. ; Campbell, Archie ; Czamara, Darina ; Binder, Elisabeth ; Corpeleijn, Eva ; González Ruiz, Juan Ramon ; Grazuleviciene, Regina ; Gutzkow, Kristine B. ; Evandt, Jorunn ; Vafeiadi, Marina ; Klein, Marieke ; Meer, Dennis van der ; Ligthart, Lannie ; Heijmans, Bastiaan Theodoor ; Hoen, Peter A. C. 't ; Meurs, Joyce Berdina Josepha van ; Franke, Lude ; Boomsma, Dorret I. ; Pool, René ; Hottenga, Jouke J. ; Greevenbroek, Marleen M. J. van ; Stehouwer, Coen D. A. ; Kallen, Carla J. H. van der ; Schalkwijk, Casper G. ; Wijmenga, Cisca ; Zhernakova, Sasha ; Tigchelaar, Ettje F. ; Slagboom, P. Eline ; Beekman, Marian ; Deelen, Joris ; Heemst, Diana van ; Veldink, Jan H. ; Berg, Leonard H. van den ; Duijn, Cornelia M. van ; Hofman, Bert A. ; Isaacs, Aaron ; Uitterlinden, André G. ; Jhamai, P. Mila ; Verbiest, Michael ; Suchiman, H. Eka D. ; Verkerk, Marijn ; Breggen, Ruud van der ; Rooij, Jeroen van ; Lakenberg, Nico ; Mei, Hailiang ; Iterson, Maarten van ; Galen, Michiel van ; Bot, Jan ; Zhernakova, Dasha V. ; Hof, Peter van ’t ; Deelen, Patrick ; Nooren, Irene ; Moed, Matthijs ; Vermaat, Martijn ; Luijk, René ; Dijk, Freerk van ; Arindrarto, Wibowo ; Kielbasa, Szymon M. ; Swertz, Morris A. ; Zwet, Erik. W. van ; Hoen, Peter-Bram ’t ; Kluft, Cornelis ; Davies, Gareth E. ; Hakulinen, Christian ; Keltikangas-Järvinen, Liisa ; Franke, Barbara ; Freitag, Christine M. ; Konrad, Kerstin ; Hervás, Amaia ; Fernández-Rivas, Aranzazu ; Vetro, Agnes ; Raitakari, Olli ; Lehtimäki, Terho ; Vermeiren, Robert ; Strandberg, Timo ; Räikkönen, Katri ; Snieder, Harold ; Witt, Stephanie H. ; Deuschle, Michael ; Pedersen, Nancy L. ; Hägg, Sara ; Sunyer, Jordi ; Kaprio, Jaakko ; Ollikainen, Miina ; Moffitt, Terrie E. ; Tiemeier, Henning ; IJzendoorn, Marinus H. van ; Relton, Caroline ; Vrijheid, Martine ; Sebert, Sylvain ; Jarvelin, Marjo-Riitta ; Caspi, Avshalom ; Evans, Kathryn L. ; McIntosh, Andrew M. ; Bartels, Meike
DNA methylation profiles of aggressive behavior may capture lifetime cumulative effects of genetic, stochastic, and environmental influences associated with aggression. Here, we report the first large meta-analysis of epigenome-wide association studies (EWAS) of aggressive behavior (N = 15,324 participants). In peripheral blood samples of 14,434 participants from 18 cohorts with mean ages ranging from 7 to 68 years, 13 methylation sites were significantly associated with aggression (alpha = 1.2 × 10−7; Bonferroni correction). In cord blood samples of 2425 children from five cohorts with aggression assessed at mean ages ranging from 4 to 7 years, 83% of these sites showed the same direction of association with childhood aggression (r = 0.74, p = 0.006) but no epigenome-wide significant sites were found. Top-sites (48 at a false discovery rate of 5% in the peripheral blood meta-analysis or in a combined meta-analysis of peripheral blood and cord blood) have been associated with chemical exposures, smoking, cognition, metabolic traits, and genetic variation (mQTLs). Three genes whose expression levels were associated with top-sites were previously linked to schizophrenia and general risk tolerance. At six CpGs, DNA methylation variation in blood mirrors variation in the brain. On average 44% (range = 3–82%) of the aggression–methylation association was explained by current and former smoking and BMI. These findings point at loci that are sensitive to chemical exposures with potential implications for neuronal functions. We hope these results to be a starting point for studies leading to applications as peripheral biomarkers and to reveal causal relationships with aggression and related traits.