Prediction of alcohol drinking in adolescents: Personality-traits, behavior, brain responses, and genetic variations in the context of reward sensitivity

Adolescence is a time that can set the course of alcohol abuse later in life. Sensitivity to reward on multiple levels is a major factor in this development. We examined 736 adolescents from the IMAGEN longitudinal study for alcohol drinking during early (mean age = 14.37) and again later (mean age = 16.45) adolescence. Conducting structural equation modeling we evaluated the contribution of reward-related personality traits, behavior, brain responses and candidate genes. Personality seems to be most important in explaining alcohol drinking in early adolescence. However, genetic variations in ANKK1 (rs1800497) and HOMER1 (rs7713917) play an equal role in predicting alcohol drinking two years later and are most important in predicting the increase in alcohol consumption. We hypothesize that the initiation of alcohol use may be driven more strongly by personality while the transition to increased alcohol use is more genetically influenced

Anaphylaxis in Elderly Patients-Data From the European Anaphylaxis Registry

Background: Elicitors and symptoms of anaphylaxis are age dependent. However, little is known about typical features of anaphylaxis in patients aged 65 years or more. Methods: The data from the Network for Online Registration of Anaphylaxis (NORA) considering patients aged ≥65 (elderly) in comparison to data from adults (18–64 years) regarding elicitors, symptoms, comorbidities, and treatment measures were analyzed. Results: We identified 1,123 elderly anaphylactic patients. Insect venoms were the most frequent elicitor in this group (p < 0.001), followed by drugs like analgesics and antibiotics. Food allergens elicited less frequently anaphylaxis (p < 0.001). Skin symptoms occurred less frequently in elderly patients (77%, p < 0.001). The clinical symptoms were more severe in the elderly (51% experiencing grade III/IV reactions), in particular when skin symptoms (p < 0.001) were absent. Most strikingly, a loss of consciousness (33%, p < 0.001) and preexisting cardiovascular comorbidity (59%, p < 0.001) were more prevalent in the elderly. Finally, adrenaline was used in 30% of the elderly (vs. 26% in the comparator group, p < 0.001) and hospitalization was more often required (60 vs. 50%, p < 0.001). Discussion and Conclusion: Anaphylaxis in the elderly is often caused by insect venoms and drugs. These patients suffer more often from cardiovascular symptoms, receive more frequently adrenaline and require more often hospitalization. The data indicate that anaphylaxis in the elderly tends to be more frequently life threatening and patients require intensified medical intervention. The data support the need to recognize anaphylaxis in this patient group, which is prone to be at a higher risk for a fatal outcome

Peanut‐induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

Background Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition

Broadband Multi-wavelength Properties of M87 during the 2017 Event Horizon Telescope Campaign

Abstract: In 2017, the Event Horizon Telescope (EHT) Collaboration succeeded in capturing the first direct image of the center of the M87 galaxy. The asymmetric ring morphology and size are consistent with theoretical expectations for a weakly accreting supermassive black hole of mass ∼6.5 × 109 M ⊙. The EHTC also partnered with several international facilities in space and on the ground, to arrange an extensive, quasi-simultaneous multi-wavelength campaign. This Letter presents the results and analysis of this campaign, as well as the multi-wavelength data as a legacy data repository. We captured M87 in a historically low state, and the core flux dominates over HST-1 at high energies, making it possible to combine core flux constraints with the more spatially precise very long baseline interferometry data. We present the most complete simultaneous multi-wavelength spectrum of the active nucleus to date, and discuss the complexity and caveats of combining data from different spatial scales into one broadband spectrum. We apply two heuristic, isotropic leptonic single-zone models to provide insight into the basic source properties, but conclude that a structured jet is necessary to explain M87’s spectrum. We can exclude that the simultaneous γ-ray emission is produced via inverse Compton emission in the same region producing the EHT mm-band emission, and further conclude that the γ-rays can only be produced in the inner jets (inward of HST-1) if there are strongly particle-dominated regions. Direct synchrotron emission from accelerated protons and secondaries cannot yet be excluded

Blutdruckmedikationskosten bei Patienten mit obstruktiver Schlafapnoe

Die obstruktive Schlafapnoe stellt eine der häufigsten Schlafstörun-gen dar und führt zu exzessiver Tagesmüdigkeit. In der erwachsenen Bevölkerung wird eine Prävalenz von ca. 3-7% bei Männern und 2-5% bei Frauen angenommen. Neben der Reduktion der Lebensquali-tät der betroffenen Patienten wird der Körper durch die gestörte Schlafstruktur einem andauernden Stress ausgesetzt. Über einen längeren Zeitraum gesehen kommt es zu Bluthochdruck und erhöh-ter Herzfrequenz. Somit stellt das Syndrom der obstruktiven Schlafapnoe einen relevanten kardiovaskulären Risikofaktor dar. Die Therapie erfolgt seit beinahe dreißig Jahren mittels CPAP-Therapie und gilt mittlerweile als Goldstandard zur Behandlung des obstrukti-ven Schlafapnoesyndroms. Der therapeutische Effekt einer CPAP-Therapie auf den Blutdruck ist inzwischen gut untersucht und doku-mentiert, eine erfolgreiche CPAP-Therapie führt zu einer signifikan-ten Senkung des Blutdrucks und auch der kardiovaskulären Ereig-nisse. Daten über Auswirkungen auf die medikamentöse antihyper-tensive Therapie und mögliche kostensparende Effekte wurde bisher noch nicht untersucht und fehlen bis jetzt. In der vorliegenden Arbeit wurden die Daten von 726 Patienten mit obstruktiver Schlafapnoe und dem Beginn einer CPAP-Therapie aus dem Schlafmedizinischen Zentrum des Universitätsklinikums Mar-burg ausgewertet. Zu Beginn erfolgte eine Diagnostiknacht mit Poly-somnographie, angeschlossen wurden 2 Therapienächte zur Einstel-lung einer CPAP-Therapie. In der Nachbeobachtung nach 3 Monaten stellten sich von diesen Patienten 527 erneut zur polysomnographi-schen Kontrolle unter CPAP-Therapie vor. Zu den genannten Zeit-punkten erfolgte jeweils eine komplette polysomnographische Aus-wertung des Schlafs sowie eine Messung des Blutdrucks. Die Ta-gesschläfrigkeit wurde mittels Epworth Sleepiness Scale erfasst. Die 54 zu den jeweiligen Zeitpunkten bestehende antihypertensive Therapie wurde erfasst und die Tagestherapiekosten wurden errechnet. Bei den beobachteten Patienten ließ sich nach 3 Monaten eine deut-liche Verbesserung der Schlafqualität zeigen, tiefere Schlafphasen und REM-Schlaf wurden signifikant häufiger erreicht, die Zeit in NREM-Stadien 1 und 2 nahm signifikant ab. Der RDI sank von 35 in der ersten Diagnostiknacht auf 4 (p<0,001), die Tagesschläfrigkeit reduzierte sich hoch signifikant von 10,91 Punkten auf 6,52 Punkte in der Epworth Sleepiness Scale (p< 0,001). 56% der Patienten erhielten vor Therapiebeginn eine medikamentö-se antihypertensive Therapie, meist eine Kombination aus 2 oder mehr Wirkstoffen. Zum Einsatz kamen vor allem ACE-Hemmer, AT2-Antagonisten, Beta-Blocker, Calcium-Antagonisten und Diuretika. Die ermittelten Tagestherapiekosten lagen bei ca. 0,37 Euro. In der Nachbeobachtung unter CPAP-Therapie zeigten sich signifikant niedrigere Blutdruckwerte, aber keine signifikante Veränderung der medikamentösen Therapie. Ein kostensparender Effekt ließ sich nicht nachweisen, die Tagestherapiekosten stiegen sogar unter nun verbesserter Einstellung der Hypertonie hochsignifikant an (von 0,37 Euro auf 0,42 Euro, p<0,001). Der Aspekt der verbesserten Blutdruckeinstellung ist abschließend noch einmal hervorzuheben, da in Studien belegt werden konnte, dass durch eine Blutdrucksenkung von ungefähr 10 mmHg das Risi-ko für ein akutes Krankheitsereignis einer KHK um 37% und das Ri-siko, einen Schlaganfall zu erleiden um insgesamt 56% gesenkt wer-den konnte [35]. Dies ist eine aus gesundheitsökonomischer Sicht extrem bedeutende Tatsache, bedenkt man die Kosten, welche durch stationäre Aufenthalte und Rehabilitationsmaßnahmen nach einem Schlaganfall oder Myokardinfarkt entstehen

Interindividual Differences in Mid-Adolescents in Error Monitoring and Post-Error Adjustment

A number of studies have concluded that cognitive control is not fully established until late adolescence. The precise differences in brain function between adults and adolescents with respect to cognitive control, however, remain unclear. To address this issue, we conducted a study in which 185 adolescents (mean age (SD) 14.6 (0.3) years) and 28 adults (mean age (SD) 25.2 (6.3) years) performed a single task that included both a stimulus-response (S-R) interference component and a task-switching component. Behavioural responses (i.e. reaction time, RT; error rate, ER) and brain activity during correct, error and post-error trials, detected by functional magnetic resonance imaging (fMRI), were measured. Behaviourally, RT and ER were significantly higher in incongruent than in congruent trials and in switch than in repeat trials. The two groups did not differ in RT during correct trials, but adolescents had a significantly higher ER than adults. In line with similar RTs, brain responses during correct trials did not differ between groups, indicating that adolescents and adults engage the same cognitive control network to successfully overcome S-R interference or task switches. Interestingly, adolescents with stronger brain activation in the bilateral insulae during error trials and in fronto-parietal regions of the cognitive control network during post-error trials did have lower ERs. This indicates that those mid-adolescents who commit fewer errors are better at monitoring their performance, and after detecting errors are more capable of flexibly allocating further cognitive control resources. Although we did not detect a convincing neural correlate of the observed behavioural differences between adolescents and adults, the revealed interindividual differences in adolescents might at least in part be due to brain development

Procedure of the interference and switch task with two out of 16 possible stimuli.

<p>Procedure of the interference and switch task with two out of 16 possible stimuli.</p