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Based on the latest gnomAD dataset, the prevalence of symptomatic hereditary cerebral cavernous malformations (CCMs) prone to cause epileptic seizures and stroke-like symptoms was re-evaluated in this review and calculated to be 1:5,400-1:6,200. Furthermore, state-of-the-art molecular genetic analyses of the known CCM loci are described which reach an almost 100% mutation detection rate for familial CCMs if whole genome sequencing is performed for seemingly mutation-negative families. An update on the spectrum of CCM1, CCM2, and CCM3 mutations demonstrates that deep-intronic mutations and submicroscopic copy-number neutral genomic rearrangements are rare. Finally, this review points to current guidelines on genetic counselling, neuroimaging, medical as well as neurosurgical treatment and highlights the formation of active patient organizations in various countries.
Streptococcus pneumoniae (pneumococci) and Staphylococcus aureus (S. aureus) are human-specific commensals of the upper respiratory tract. Every individual is asymptomatically colonized with both bacteria at least once in their life-time. The opportunistic pathogens can affect further organs and invade into deeper tissue. The occupation of normally sterile niches of the human body with the bacteria can lead to local infections such as sinusitis, otitis media and abscesses, or to life-threatening diseases like pneumonia, meningitis or sepsis. A strong interaction between the bacterium and the respiratory epithelial cells is a prerequisite for a successful colonization. This interaction is ensured by bacterial surface proteins, so called adhesins. The binding of the adhesins to the epithelial lineage occurs predominantly indirectly via components of the extracellular matrix (ECM), but also directly to cellular receptors. Pneumococci and S. aureus bind to various ECM glycoproteins, amongst others: fibronectin, fibrinogen, vitronectin, and collagen. Also binding of both pathogens to human thrombospondin-1 has been described. Thrombospondin-1 is mainly stored in the α-granula of thrombocytes (platelets) and released into the circulation upon activation. However, thrombospondin-1 is also produced and secreted by other cell types like endothelial cells, macrophages, and fibroblasts, which gets subsequently incorporated as component into the ECM. So far, no thrombosponin-1-binding adhesins of pneumococci were identified. PspC, Hic, and PavB are important surface-localized virulence factors, which were shown to interact with human ECM and plasma proteins. PspC and Hic bind to vitronectin and factor H, which inhibits the complement cascade of the human immune system. PavB interacts with fibronectin and plasminogen, and a pavB-deficient mutant of S. pneumoniae showed diminished capacity in colonization in a mouse model. Among the surface proteins of S. aureus, only Eap was identified as thrombospondin-1-binding adhesin. Beyond colonization, pneumococci and S. aureus can enter the blood circulation, interact with platelets, and cause their activation. The aggregation of platelets, especially initiated by S. aureus, plays an important role in the clinic, because most of the septic patients develop thrombocytopenia. Surface localized factors of
S. pneumoniae triggering platelet activation are unknown to date. In contrast, few proteins of S. aureus with potential to activate platelets, including Eap, were identified previously.
This study identified the surface proteins PavB, PspC, and Hic of S. pneumoniae as specific ligands of the human thrombospondin-1. Flow cytometric, surface plasmon resonance spectroscopic and immunological analyses revealed interactions between the pneumococcal proteins and soluble as well as immobilized thrombospondin-1. The use of specific pneumococcal deletion mutants verified the importance of the three virulence factors as binding partners of soluble thrombospondin-1. The results suggest that pneumococci are capable of acquiring soluble thrombospondin-1 from blood as well as utilizing immobilized glycoprotein of the ECM as substrate for adhesion. Furthermore, the thrombospondin-1-binding domain within the pneumococcal proteins was analyzed by use of recombinant fragments of PavB, PspC, and Hic. The binding capacity of thrombospondin-1 increased proportionally with the amount of repetitive sequences in PavB and PspC, and the length of the α-helical region within the Hic molecule. The binding behavior of thrombospondin-1 towards PavB and PspC is comparable with that of the ECM proteins vitronectin and fibronectin, but is unique towards Hic.
The localization of the binding domain of the adhesins within the thrompospondin-1 molecule occurred via use of glycosaminoglycans as competitive inhibitors for the interaction. The results suggest that the pneumococcal proteins Hic and PspC target the identical binding region within thrombospondin-1, which differs from the binding domain for PavB. However, all three virulence factors seem to bind in the N-terminal part of thrombospondin-1.
Two-dimensional gel electrophoresis, thrombospondin-1 overlay assay and subsequent mass spectrometric analysis identified AtlA of S. aureus as a surface localized interaction partner of human thrombospondin-1. Moreover, a vitronectin binding activity for AtlA was determined. Immunological and surface plasmon resonance binding studies with recombinant AtlA fragments revealed that interactions with both matrix proteins is mediated via the C-terminal located repeats R1R2 of the AtlA amidase domain. Binding of thrombospondin-1 and vitronectin occurred not simultaneously, due to a competitive inhibition.
The second part of the study focused on the activation of human platelets by recombinant pneumococcal and staphylococcal proteins. In total, 28 proteins of S. pneumoniae and 52 proteins of S. aureus were incubated with human platelets. The activation of the cells was detected by flow cytometry using the activation markers P-selectin and the dimerization of the integrin αIIbβIII. The proteins CbpL, PsaA, PavA, and SP_0899 of S. pneumoniae induced platelet activation, however, the detailed mechanism has to be deciphered in further studies. Furthermore, the secreted proteins CHIPS, FLIPr, and AtlA of S. aureus were discovered as inductors for the activation of platelets. In addition, the domains of AtlA and Eap, crucial for platelet activation, were narrowed down. Interestingly, CHIPS, FLIPr, and Eap were described as inhibitors of neutrophil recruitment. Platelets are recently recognized as immune cells, due to the expression of immune receptors. The data obtained in this study highlight a comprehensive spectrum of effects of the S. aureus proteins towards different type of immune cells. Besides the activation of platelets in suspension buffer and plasma, the aggregation of platelets in whole blood was triggered by the proteins CHIPS, AtlA, and Eap. These results suggest a contribution of the proteins during the S. aureus-induced infectious endocarditis. Secretion of the platelet activating virulence factors, which were identified within this study, might represent a pathogenic strategy during S. aureus infection in which a direct contact between S. aureus and platelets is not required or even avoided.
In conclusion, PavB, PspC, and Hic of S. pneumoniae and AtlA of S. aureus were identified as interaction partners of human thrombospondin-1. Furthermore, CHIPS, FLIPr, AtlA, and Eap were characterized as platelet activators. This study provides candidates for the development of protein-based vaccines, to prevent bacterial colonization and to neutralize secreted pathogenic factors.
Chemosymbiosis in marine bivalves – unravelling host-symbiont interactions and symbiotic adaptions
(2018)
Symbiosis essentially forms the cornerstone of complex life on earth. Spearheading
symbiosis research in the last few decades include the exploration of diverse mutualistic
animal-bacterial associations from marine habitats. Yet, many facets of symbiotic
associations remain under-examined. Here we investigated marine bivalves of the genera
Bathymodiolus and Codakia, inhabiting hydrothermal vents and shallow water
ecosystems, respectively, and their bacterial symbionts. The symbionts reside
intracellularly within gill epithelia and supply their host with chemoautotrophically fixed
carbon. They oxidize reduced substrates like sulfide (thiotrophic symbionts) and methane
(methanotrophic symbionts) from surrounding fluids for energy generation. The nature of
interactions between host and symbiont at the metabolic and physical level, as well as
between the holobiont and its environment remain poorly understood. In vitro cultivations
of both symbiont and host are difficult till date, hampering the feasibility of targeted
molecular investigations.
We bypassed culture-based experiments by proteogenomically investigating physically
separated fractions of host and symbiont cell components for the bivalves Bathymodiolus
azoricus, Bathymodiolus thermophilus and Codakia orbicularis. Using these
enrichments, we sequenced the symbionts’ genomes and established semi-quantitative
host-symbiont (meta-) proteomic profiles. This combined approach enabled us to resolve
symbiosis-relevant metabolic pathways and adaptations, detect molecular factors
mediating physical interactions amongst partners and to understand the association of
symbiotic traits with the environmental factors prevailing within habitats of the respective
bivalve.
Our results revealed intricate metabolic interdependence between the symbiotic partners.
In Bathymodiolus, these metabolic interactions included (1) the concentration of essential
substrates like CO2 and thiosulfate by the host for the thiotrophic symbiont, and (2) the
host’s replenishment of essential TCA cycle intermediates for the thiotroph that lacks
biosynthetic enzymes for these metabolites. In exchange (3), the thiotroph compensates
the host’s putative deficiency in amino acid and cofactor biosynthesis by cycling aminoacids
derived from imported precursors back to the host. In case of Codakia orbicularis,
the symbionts may metabolically supplement their host with N-compounds derived from
fixation of molecular nitrogen, a trait that was hitherto unknown in chemosynthetic
thiotrophic symbionts.
Individual proteogenomic investigations of the bivalves Bathymodiolus azoricus and
Bathymodiolus thermophilus showed that their symbionts are able to exploit a multitude
of energy sources like sulfide, thiosulfate, methane and hydrogen to fuel chemosynthesis.
The bivalves and their thiotrophic symbionts, however, are particularly adapted to
thiosulfate-utilization, as indicated by mitochondrial production and concentration of
thiosulfate by host and dominant expression of thiosulfate oxidation enzymes in the
symbiont. This may be advantageous, because thiosulfate is less toxic to the host than
sulfide. The central metabolic pathways for energy generation, carbon and nitrogen
assimilation and amino acid biosynthesis in thiotrophic symbionts of both Bathymodiolus
host species are highly conserved. Expression levels of these pathways do, however, vary
between symbionts of both species, indicating differential regulation of enzyme synthesis,
possibly to accommodate differences in host morphology and environmental factors.
Systematic comparison of symbiont-containing and symbiont-free sample types within
and between B. azoricus and B. thermophilus revealed the presence of ‘symbiosisspecific’
features allowing direct host-symbiont physical interactions. Host proteins
engaged in symbiosis-specific functions include 1) a large repertoire of host digestive
enzymes predominant in the gill, possibly facilitating symbiont population control and
carbon acquisition via direct enzymatic digestion of symbiont cells and 2) a set of host
pattern-recognition receptors, which may enable the host to selectively recognize
pathogens or even symbionts “ripe” for consumption. Symbiont proteins engaged in
symbiosis-specific interactions included 3) an enormous set of adhesins and toxins,
putatively involved in symbiont colonization, persistence and host-feeding.
Bathymodiolus symbionts also possess repertoires of CRISPR-Cas and restrictionmodification
genes for phage defense that are unusually large for intracellular symbionts.
Genomic and proteomic comparisons of thiotrophic symbionts of distinct Bathymodiolus
host species from different vent sites revealed a conserved core genome but divergent
accessory genomes. The B. thermophilus thiotroph’s accessory genome was notably more
enriched in genes encoding adhesins, toxins and phage defense proteins than that of other
Bathymodiolus symbionts. Phylogenetic analyses suggest that this enrichment possibly
resulted from horizontal gene acquisition followed by multiple internal gene duplication
events. In others symbionts, these gene functions may be substituted by alternate
mechanisms or may not be required at all: The methanotrophic symbionts of B. azoricus,
for example, has the genetic potential to supplement phage defense functions. Thus, the
accessory genomes of Bathymodiolus symbionts are species- or habitat-associated,
possibly facilitating adaptation of the bivalves to their respective micro- and macroenvironments.
In support of this, we show that symbiont biomass in B. thermophilus,
which hosts only one thiotrophic symbiont phylotype, is considerably higher than in B.
azoricus that hosts thiotrophic and methanotrophic symbionts. This suggests that different
symbiont compositions in each species produce distinct microenvironments within the
holobiont.
Our study presents an exhaustive assessment of the genes and proteins involved in this
bivalve-microbe interaction, hinting at intimate host-symbiont interdependencies and
symbiotic crosstalk between partners. The findings open novel prospects for
microbiologists with regard to mechanisms of host-symbiont interplay within highly
specialized niches, origin and distribution of prokaryote-eukaryote interaction factors
across both mutualistic and pathogenic associations.
Climate Change-Induced Shift of Tree Growth Sensitivity at a Central Himalayan Treeline Ecotone
(2018)
Tree growth at northern boreal treelines is generally limited by summer temperature, hence tree rings serve as natural archives of past climatic conditions. However, there is increasing evidence that a changing summer climate as well as certain micro-site conditions can lead to a weakening or loss of the summer temperature signal in trees growing in treeline environments. This phenomenon poses a challenge to all applications relying on stable temperature-growth relationships such as temperature reconstructions and dynamic vegetation models. We tested the effect of differing ecological and climatological conditions on the summer temperature signal of Scots pine at its northern distribution limits by analyzing twelve sites distributed along a 2200 km gradient from Finland to Western Siberia (Russia). Two frequently used proxies in dendroclimatology, ring width and maximum latewood density, were correlated with summer temperature for the period 1901–2013 separately for (i) dry vs. wet micro-sites and (ii) years with dry/warm vs. wet/cold climate regimes prevailing during the growing season. Differing climate regimes significantly affected the temperature signal of Scots pine at about half of our sites: While correlations were stronger in wet/cold than in dry/warm years at most sites located in Russia, differing climate regimes had only little effect at Finnish sites. Both tree-ring proxies were affected in a similar way. Interestingly, micro-site differences significantly affected absolute tree growth, but had only minor effects on the climatic signal at our sites. We conclude that, despite the treeline-proximal location, growth-limiting conditions seem to be exceeded in dry/warm years at most Russian sites, leading to a weakening or loss of the summer temperature signal in Scots pine here. With projected temperature increase, unstable summer temperature signals in Scots pine tree rings might become more frequent, possibly affecting dendroclimatological applications and related fields.
Introduction
We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean dose optimized stereotactic body radiation therapy (SBRT) for primary and secondary lung tumors with and without robotic real-time motion compensation.
Materials and methods
Between 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc). Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED)10 was 162.0 Gy10 (34.2–253.6 Gy10) and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10). Motion compensation was realized through direct tracking (44.9%), fiducial tracking (4.4%), and internal target volume (ITV) concepts with small (≤5 mm, 33.2%) or large (>5 mm, 17.5%) motion. The local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity were analyzed.
Results
Median follow-up was 14.5 months (1–72 months). The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR) 0.18, confidence interval (CI) 0.05–0.63, p = 0.01), GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02), and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01) were predictive for LC while the tracking method was not (p = 0.97). For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01) and tumor stage (p ≤ 0.02) to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur.
Conclusion
Robotic SBRT is a safe and effective treatment for lung tumors. Reducing the PTV prescription and keeping high GTV mean doses allowed the reduction of toxicity while maintaining high local tumor control. The use of real-time motion compensation is strongly advised, however, well-performed ITV motion compensation may be used alternatively when direct tracking is not feasible.
Mendelian randomization (MR) is a framework for assessing causal inference using cross-sectional data in combination with genetic information. This paper summarizes statistical methods commonly applied and strait forward to use for conducting MR analyses including those taking advantage of the rich dataset of SNP-trait associations that were revealed in the last decade through large-scale genome-wide association studies. Using these data, powerful MR studies are possible. However, the causal estimate may be biased in case the assumptions of MR are violated. The source and the type of this bias are described while providing a summary of the mathematical formulas that should help estimating the magnitude and direction of the potential bias depending on the specific research setting. Finally, methods for relaxing the assumptions and for conducting sensitivity analyses are discussed. Future researches in the field of MR include the assessment of non-linear causal effects, and automatic detection of invalid instruments.
Mendelian randomization (MR) is a framework for assessing causal inference using cross-sectional data in combination with genetic information. This paper summarizes statistical methods commonly applied and strait forward to use for conducting MR analyses including those taking advantage of the rich dataset of SNP-trait associations that were revealed in the last decade through large-scale genome-wide association studies. Using these data, powerful MR studies are possible. However, the causal estimate may be biased in case the assumptions of MR are violated. The source and the type of this bias are described while providing a summary of the mathematical formulas that should help estimating the magnitude and direction of the potential bias depending on the specific research setting. Finally, methods for relaxing the assumptions and for conducting sensitivity analyses are discussed. Future researches in the field of MR include the assessment of non-linear causal effects, and automatic detection of invalid instruments.
There is an increasingly urgent need to understand and predict how organisms will cope with the environmental consequences of global climate change. Adaptation in any form can be mediated by genetic adaptation and/or by phenotypic plasticity. Disentangling these two adaptive processes is critical in understanding and predicting adaptive responses to environmental change. Usually, disentangling genetic adaptation from phenotypic plasticity requires common garden experiments conducted under controlled laboratory conditions. While these experiments are powerful, it is often difficult to translate the results into natural populations and extrapolate to naturally occurring phenotypic variation. One solution to this problem is provided by the many examples of invasive species that exhibit wide phenotypic variation and that reproduce asexually. Besides selecting the appropriate in situ model, one must carefully choose a relevant trait to investigate. Ecomorphology has been a central theme in evolutionary biology because it reflects how organisms can adapt to their environment through their morphology. Intraspecific ecomorphological studies are especially well suited to identify adaptive pressures and provide insights into the microevolutionary mechanisms leading to the phenotypic differentiation.
One excellent candidate for an intraspecific ecomorphological study aiming to understand adaptation through genetic adaptation and phenotypic plasticity is the invasive New Zealand mudsnail Potamopyrgus antipodarum Gray (1853). This ovoviviparous snail features high variability in shell morphology and has successfully invaded a wide range of fresh- and brackish water habitats around the world. The evolutionary and ecological situations in this species’ native and invasive ranges is drastically different. In New Zealand, P. antipodarum’s native range, sexual and asexual individuals coexist and experience selective pressure by sterilizing endoparasites. By contrast, only a few asexual lineages have been established in invaded regions around the globe, where parasite infection is extremely rare. Here, we took advantage of the low genetic diversity among asexually reproducing European individuals in an attempt to characterize the relative contribution of genetic variation and phenotypic plasticity to the wide variation in shell morphology of this snail.
Analysing the ecomorphology of 425 European P. antipodarum in a geometric-morphometric framework, using brood size as proxy for fecundity, and mtDNA and nuclear SNPs to account for relatedness and identify reproductive mode, we hypothesized that 1) shell variation in the invasive range should be adaptive with respect to colonization of novel habitats, and 2) at least some of the variation might be caused by phenotypic plasticity. We then expanded our ecomorphological scope by analysing 996 native specimens, expecting 1) genetic and morphological diversity to be higher in the native range compared to invaded regions; 2) morphological diversity to be higher in sexual compared to asexual individuals according to the frozen niche hypothesis; and 3) shell morphology to be habitat specific, hence adaptative. In a last part, we used computational fluid dynamics simulations to calculate relative drag and lift forces of three shell morphologies (globular, intermediate, and slender). Here, we tested the overall hypothesis that shell morphology in gastropods is an adaptation against dislodgement through lift rather than drag forces, which would explain the counterintuitive presence of wider shells with shorter spires in lotic environments. With a final flow tank experiment, we tested the specific hypothesis that the dislocation velocity of living snails is positively linked to foot size, and that the latter can be predicted by shell morphology, in particular the aperture area as assumed by several authors.
As expected, we found genetic and morphological diversity to be higher in native than in invasive snails, but surprisingly no higher morphological diversity in sexual versus asexual individuals. The relationships between shell morphology, habitat, and fecundity were complex. Shape variation was primarily linked to genetic relatedness, but specific environmental factors including flow rate induced similar shell shapes. By contrast, shell size was largely explained by environmental factors. Fecundity was correlated with size, but showed trade-offs with shape in increasingly extreme conditions. With increasing flow and in smaller habitats such as springs, the trend of shell shape becoming wider was reversed, i.e. snails with slender shells were brooding more embryos. This increase in fitness was explained by our CFD simulations: in lotic habitats, slender shells experience less drag and lift forces compared to globular shells. We found no correlation between foot size and shell shape or aperture area showing that the assumed aperture/foot area correlation should be used with caution and cannot be generalized for all aquatic gastropod species. Finally, shell morphology and foot size were not related to dislodgement speed in our flow tank experiment. We concluded that the relationship of shell morphology and flow velocity is more complex than assumed. Hence, other traits must play a major role in decreasing dislodgement risk in stream gastropods, e.g. specific behaviours or pedal mucus stickiness. Although we did not find that globular shells are adaptations decreasing dislodgement risk, we cannot rule out that they are still flow related adaptations. For instance, globular shells are more crush-resistant and might therefore represent a flow adaptation in terms of diminishing damage caused by tumbling after dislodgement or against lotic specific crush-type predators.
At this point, we can conclude that shell morphology in P. antipodarum varies at least in part as an adaptation to specific environmental factors. This study shows how essential it is to reveal how plastic, genetically as well as phenotypically, adaptive traits in species can be and to identify the causal factors and how these adaptations affect the fitness in order to better predict how organisms will cope with changing environmental conditions.
The fear of somatic sensations is highly relevant in the etiology and maintenance of various disorders. Nevertheless, little is known about this fear of body symptoms and many questions are yet unanswered. Especially physiological studies on interoceptive threat are rare. Therefore, the present thesis investigated defensive mobilization, autonomic arousal, and brain activation during the anticipation of, exposure to, and recovery from unpleasant body sensations. Symptoms were provoked using a standardized hyperventilation procedure in a sample of high (and as controls: low) anxiety sensitive individuals - a population high at risk for developing a panic disorder and high in fear of internal body symptoms.
In study one, anxious apprehension was investigated during anticipation of interoceptive threat (somatic sensations evoked by hyperventilation) and exteroceptive threat (electric shock). Symptom reports, autonomic arousal, and defensive mobilization assessed by the startle eyeblink response were analyzed. Extending the knowledge on anticipation of interoceptive threat, study two investigated the neural networks activated during anxious apprehension of unpleasant body sensations. Symptom reports and startle response data were collected during a learning session after which participants high and low in fear of somatic symptoms attended a fMRI session anticipating threat (hyperventilation – learned to provoke unpleasant symptoms) or safety (normal breathing). Study three examined the actual exposure to internal body symptoms, investigating symptoms reports, autonomic arousal, and the startle eyeblink response during guided breathing (hyperventilation and, as a non-provocative comparison condition, normoventilation) and during recovery. And finally, study four addressed changes in the defensive mobilization during repeated interoceptive exposure via a hyperventilation procedure. High and low anxiety sensitive persons went through two guided hyperventilation and normoventilation procedures that were spaced one week apart while symptom reports, breathing parameters, and startle response magnitudes were measured.
In study one it was demonstrated that the anticipation of exteroceptive threat led to a defensive and autonomic mobilization in high and low anxiety sensitive individuals, while during interoceptive threat only high anxiety sensitive participants were characterized by a potentiated startle response and autonomic activation. Imaging data of study two revealed that 1) during anticipation of hyperventilation all participants were characterized by an increased activation of a fear network consisting of anterior insula/ orbitofrontal cortex and rostral parts of the dorsal anterior cingulate cortex/ dorsomedial prefrontal cortex, 2) high fear individuals showed higher anxious apprehension than low fear controls during the entire context (safe and threat conditions), indexed by an overall stronger activation of the described network, and 3) while low fear controls learned that (undisclosed to all participants) in the fMRI scanner the threat cue was not followed by an unpleasant hyperventilation task, high fear participants continued to show stronger fear network activation to this cue. In study three it was demonstrated, that the hyperventilation procedure led to a marked increase in somatic symptoms and to autonomic arousal. While high and low anxiety sensitive groups did not differ during hyperventilation, in the early recovery only high anxiety sensitive individuals showed defensive mobilization, indicated by potentiated startle response magnitudes, and increased autonomic arousal after hyperventilation as compared to after normoventilation. Substantiating these findings, in study four all participants reported more symptoms during hyperventilation than during normoventilation, in both sessions. Nevertheless, only high anxiety sensitive participants displayed a potentiation of startle response magnitudes after the first hyper- vs. normoventilation. One week later, when the exercise was repeated this potentiation was no longer present and thus both groups no longer differed in their defensive mobilization. Even more, the number of reported baseline symptoms decreased from session one to session two in the high-AS group. While high anxiety sensitive persons reported increased baseline anxiety symptoms in session one, groups did not anymore differ in session two.
These data indicate that the standardized hyperventilation procedure is a valid paradigm to induce somatic symptoms. Moreover, it induces anxious apprehension especially in persons highly fearful of internal body symptoms. The repetition of interoceptive exposure, however, reduces associated fear in highly fearful individuals. Thus, this paradigm might provide an innovative method to study anxious apprehension and also treatment effects in patients with panic disorder. The present findings are integrated and discussed in the light of the current literature.
Do We Need to Rethink the Epidemiology and Healthcare Utilization of Parkinson's Disease in Germany?
(2018)
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.