Messung des renalen Sauerstoffmetabolismus und der renalen Hämodynamik mittels Gewebephotospektrometrie und Dopplersonographie zur Detektion einer akuten Nierenschädigung bei Säuglingen nach Herzoperation mit kardiopulmonalem Bypass

Neugeborene und Säuglinge mit angeborenem Herzfehler müssen sich früh komplexen Operationen mit Einsatz der Herz-Lungen-Maschine (CPB) unter-ziehen. Postoperativ erschwert eine akute Nierenschädigung (AKI) als häufige Komplikation den intensivmedizinischen Verlauf und bedingt eine erhöhte Morbidität und Mortalität. Die nicht invasive Messmethode „Oxygen to see“ (O2C) ermöglicht durch Kombination zweier optischer Techniken (Weißlichtspektrometrie und Laser-Doppler-Spektroskopie) sowohl die Messung der absoluten Sauerstoffsättigung im Nierengewebe als auch die des relativen Blutflusses und evaluiert die lokale Mikrozirkulation in Echtzeit. Die dopplersonographische Bestimmung des renalen Resistive Index (RRI), eine etablierte Methode zur Beurteilung der renalen Perfusion, wurde als Vergleichsmethode herangezogen und wie die O2C-Methode hinsichtlich ihrer diagnostischen Qualität in Bezug auf die frühe Detektion einer postoperativen AKI überprüft. In der vorgestellten Studie wurden 50 Neonaten und Säuglinge präoperativ und in den ersten 48 h nach Herzoperation mit CPB untersucht. Bei den Patienten erfolgte entweder eine Korrekturoperation (Repairkategorie, n=31) oder eine palliative Versorgung des Herzfehlers (Palliativkategorie, n=19). 40 % der Patienten entwickelten eine postoperative AKI definiert nach den pRIFLE-Kriterien. Die renale Sauerstoff-sättigung (rSO2) und der annähernde renale Sauerstoffmetabolismus (aRMRO2) eigneten sich in beiden Kategorien für die AKI-Detektion. Bei Kindern mit AKI war die rSO2 signifikant niedriger und der aRMRO2 signifikant höher als bei Kindern ohne AKI. Bei Patienten der Repairkategorie erlangten rSO2 und aRMRO2 eine AUC von 0,75 und 0,68, während die Patienten der palliativen Kategorie für rSO2 und aRMRO2 eine AUC von 0,73 und 0,83 aufwiesen. Mithilfe des rrFlow als Korrelat für den renalen Blutfluss konnte nur bei palliativ operierten Kindern eine AKI diagnostiziert werden, während der RRI aufgrund des diastolischen Run-offs über einen aortopulmonalen Shunt bei palliativ operierten Patienten nur in der Repairkategorie einen diagnostischen Benefit zeigte. Die erhobenen Daten sprachen für einen gesteigerten Sauerstoffmetabolismus im Nierengewebe bei Vorliegen einer AKI, welcher als Teil des Pathomechanismus einen Ansatzpunkt für die Erforschung präventiver und therapeutischer Strategien bietet. Bekannte Risikofaktoren für eine AKI wie geringeres Alter, längere CPB-Zeit oder höherer Bedarf an positiv inotroper Medikation konnten in der untersuchten Studienpopulation bestätigt werden. Das Monitoring des renalen Sauerstoffmetabolismus mithilfe der O2C-Methode erlaubt die frühe Detektion einer AKI bei Neugeborenen und Säuglingen nach Herzoperation mit CPB und liefert neue Erkenntnisse zur Pathogenese dieser AKI-Form. Dies bildet die mögliche Grundlage für eine zukünftig frühere Therapieeinleitung und Therapieoptimierung, um eine AKI zu verhindern bzw. deren Progression mit irreversiblen Endorganschäden zu unterbinden

Resting-state perfusion in motor and fronto-limbic areas is linked to diminished expression of emotion and speech in schizophrenia.

Negative symptoms (NS) are a core component of schizophrenia affecting community functioning and quality of life. We tested neural correlates of NS considering NS factors and consensus subdomains. We assessed NS using the Clinical Assessment Interview for Negative Symptoms and the Scale for Assessment of Negative Symptoms. Arterial spin labeling was applied to measure resting-state cerebral blood flow (rCBF) in 47 schizophrenia patients and 44 healthy controls. Multiple regression analyses calculated the relationship between rCBF and NS severity. We found an association between diminished expression (DE) and brain perfusion within the cerebellar anterior lobe and vermis, and the pre-, and supplementary motor area. Blunted affect was linked to fusiform gyrus and alogia to fronto-striatal rCBF. In contrast, motivation and pleasure was not associated with rCBF. These results highlight the key role of motor areas for DE. Considering NS factors and consensus subdomains may help identifying specific pathophysiological pathways of NS

Associations of resting-state perfusion and auditory verbal hallucinations with and without emotional content in schizophrenia.

Auditory Verbal Hallucinations (AVH) are highly prevalent in patients with schizophrenia. AVH with high emotional content lead to particularly poor functional outcome. Increasing evidence shows that AVH are associated with alterations in structure and function in language and memory related brain regions. However, neural correlates of AVH with emotional content remain unclear. In our study (n = 91), we related resting-state cerebral perfusion to AVH and emotional content, comparing four groups: patients with AVH with emotional content (n = 13), without emotional content (n = 14), without hallucinations (n = 20) and healthy controls (n = 44). Patients with AVH and emotional content presented with increased perfusion within the amygdala and the ventromedial and dorsomedial prefrontal cortex (vmPFC/ dmPFC) compared to patients with AVH without emotional content. In addition, patients with any AVH showed hyperperfusion within the anterior cingulate gyrus, the vmPFC/dmPFC, the right hippocampus, and the left pre- and postcentral gyrus compared to patients without AVH. Our results indicate metabolic alterations in brain areas critical for the processing of emotions as key for the pathophysiology of AVH with emotional content. Particularly, hyperperfusion of the amygdala may reflect and even trigger emotional content of AVH, while hyperperfusion of the vmPFC/dmPFC cluster may indicate insufficient top-down amygdala regulation in patients with schizophrenia

Larger capacity for unconscious versus conscious episodic memory

Episodic memory is the memory for experienced events. A peak competence of episodic memory is the mental combination of events to infer commonalities. Inferring commonalities may proceed with and without consciousness of events. Yet what distinguishes conscious from unconscious inference? This question inspired nine experiments that featured strongly and weakly masked cartoon clips presented for unconscious and conscious inference. Each clip featured a scene with a visually impenetrable hiding place. Five animals crossed the scene one-by-one consecutively. One animal trajectory represented one event. The animals moved through the hiding place, where they might linger or not. The participants' task was to observe the animals' entrances and exits to maintain a mental record of which animals hid simultaneously. We manipulated information load to explore capacity limits. Memory of inferences was tested immediately, 3.5 or 6 min following encoding. The participants retrieved inferences well when encoding was conscious. When encoding was unconscious, the participants needed to respond intuitively. Only habitually intuitive decision makers exhibited a significant delayed retrieval of inferences drawn unconsciously. Their unconscious retrieval performance did not drop significantly with increasing information load, while conscious retrieval performance dropped significantly. A working memory network, including hippocampus, was activated during both conscious and unconscious inference and correlated with retrieval success. An episodic retrieval network, including hippocampus, was activated during both conscious and unconscious retrieval of inferences and correlated with retrieval success. Only conscious encoding/retrieval recruited additional brain regions outside these networks. Hence, levels of consciousness influenced the memories' behavioral impact, memory capacity, and the neural representational code

Effect of Season of Birth on Hippocampus Volume in a Transdiagnostic Sample of Patients With Depression and Schizophrenia.

Psychiatric disorders share an excess of seasonal birth in winter and spring, suggesting an increase of neurodevelopmental risks. Evidence suggests season of birth can serve as a proxy of harmful environmental factors. Given that prenatal exposure of these factors may trigger pathologic processes in the neurodevelopment, they may consequently lead to brain volume alterations. Here we tested the effects of season of birth on gray matter volume in a transdiagnostic sample of patients with schizophrenia and depression compared to healthy controls (n = 192). We found a significant effect of season of birth on gray matter volume with reduced right hippocampal volume in summer-born compared to winter-born patients with depression. In addition, the volume of the right hippocampus was reduced independent from season of birth in schizophrenia. Our results support the potential impact of season of birth on hippocampal volume in depression

German Ageing Survey (DEAS) - the second half of life: research instruments of the third wave

Contents: 1. Introduction; 2. Main research areas; 3. Sampling; 4. Survey methods; 5. Project management and staff; 6. Data access; 7. Survey documents

German Ageing Survey (DEAS) - the second half of life: research instruments of the third wave

Contents: 1. Introduction; 2. Main research areas; 3. Sampling; 4. Survey methods; 5. Project management and staff; 6. Data access; 7. Survey documents

Limbic links to paranoia: increased resting-state functional connectivity between amygdala, hippocampus and orbitofrontal cortex in schizophrenia patients with paranoia.

Paranoia is a frequent and highly distressing experience in psychosis. Models of paranoia suggest limbic circuit pathology. Here, we tested whether resting-state functional connectivity (rs-fc) in the limbic circuit was altered in schizophrenia patients with current paranoia. We collected MRI scans in 165 subjects including 89 patients with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, brief psychotic disorder, schizophreniform disorder) and 76 healthy controls. Paranoia was assessed using a Positive And Negative Syndrome Scale composite score. We tested rs-fc between bilateral nucleus accumbens, hippocampus, amygdala and orbitofrontal cortex between groups and as a function of paranoia severity. Patients with paranoia had increased connectivity between hippocampus and amygdala compared to patients without paranoia. Likewise, paranoia severity was linked to increased connectivity between hippocampus and amygdala. Furthermore, paranoia was associated with increased connectivity between orbitofrontal and medial prefrontal cortex. In addition, patients with paranoia had increased functional connectivity within the frontal hubs of the default mode network compared to healthy controls. These results demonstrate that current paranoia is linked to aberrant connectivity within the core limbic circuit and prefrontal cortex reflecting amplified threat processing and impaired emotion regulation. Future studies will need to explore the association between limbic hyperactivity, paranoid ideation and perceived stress