Emotionale aversive Anspannung bei Anorexia nervosa: Implikationen des Emotionsdysregulations-Störungsmodells

In den letzten Jahren rückte zunehmend die emotionale Dysregulation als auslösender und aufrechterhaltender Faktor der Anorexia nervosa (AN) in den Fokus der Forschung. Neben überdauernden Emotionen wurde hierbei auch die Wichtigkeit von kurzfristigen affektiven Zuständen untersucht, allerdings zumeist bei erwachsenen Betroffenen. Aversive Anspannung ist eine kurzzeitige Form hoher emotionaler Dysregulation, die bei Patientinnen mit Borderline-Persönlichkeitsstörungen bereits gut untersucht ist. Bei der Borderline-Persönlichkeitsstörung zeigte sich zudem, dass Zustände hoher Anspannung mit einer schlechteren Identifikation von Emotionen assoziiert waren. Bisher gab es jedoch keine Untersuchungen hierzu an Patientinnen mit Essstörungen. Als eine mögliche Ursache der emotionalen Dysregulation bei AN wird eine Invalidierung des emotionalen Erlebens und des Körpers diskutiert, wie sie durch das Schönheitsideal der westlichen Gesellschaft verursacht wird. Möglicherweise stellt hier die lateinamerikanische Kultur einen protektiven Faktor dar. In dieser publikationsbasierten Dissertation werden daher drei Studien vorgestellt, die das Auftreten von aversiver Anspannung bei Jugendlichen mit AN untersuchen, den Zusammenhang dieser Zustände mit der Emotionsidentifikation betrachten und zuletzt die Prävalenz der AN in westlichen Ländern mit Lateinamerika vergleichen. In der ersten Publikation wurde mit Hilfe einer Smartphone-basierten Echtzeiterhebung überprüft, ob weibliche Jugendliche mit AN häufiger hohe aversive Anspannung im Alltag erleben als gesunde weibliche Jugendliche. Des Weiteren wurden mögliche auslösende Ereignisse identifiziert. Es zeigte sich, dass Jugendliche mit AN Zustände hoher Anspannung häufiger erlebten als gesunde Jugendliche. Essensbezogene Ereignisse führten in der Gruppe der Jugendlichen mit AN zu einem zusätzlichen Anstieg der Anspannung, nicht jedoch in der gesunden Kontrollgruppe. Sport- oder schulbezogene Ereignisse hatten keinen Einfluss auf die Anspannung. Die Ergebnisse weisen darauf hin, dass aversive Anspannung als eine Facette der emotionalen Dysregulation eine Rolle bei AN spielt. Aufgrund der Verknüpfung von hoher Anspannung mit Mahlzeiten könnte die Regulation von Anspannung in der Therapie die Gewichtsrestitution von Jugendlichen mit AN verbessern. In der zweiten Publikation wurde anhand der gleichen Stichprobe untersucht, ob sich gesunde Jugendliche und solche mit AN hinsichtlich ihrer selbstberichteten momentanen Emotionsidentifikation unterscheiden. Jugendliche mit AN gaben eine signifikant schlechtere Emotionsidentifikation als die Kontrollgruppe an. Eine Verbesserung der Emotionsidentifikation fand nur in der Kontrollgruppe statt. Weder in der Kontroll- noch in der AN-Gruppe wurde ein Einfluss der aversiven Anspannung auf die Emotionsidentifikation nachgewiesen. Im Gegensatz zur Borderline-Persönlichkeitsstörung scheinen bei AN aversive Anspannung und niedrige Emotionsidentifikation zwei unabhängige Formen der emotionalen Dysregulation darzustellen. Es gilt zukünftig zu klären, warum sich Jugendliche mit AN im Verlauf des Tages nicht in ihrer Emotionsidentifikation verbessern. In der dritten Publikation wurden mit Hilfe einer Meta-Analyse die mittleren Punkt-Prävalenzen für AN, Bulimia nervosa und Binge-Eating-Störung in Lateinamerika berechnet. Es zeigte sich eine niedrigere Prävalenz der AN im Vergleich zu westlichen Ländern, jedoch höhere Prävalenzen für Bulimia nervosa und Binge-Eating-Störung. Dies ist ein erster Hinweis darauf, dass die lateinamerikanische Kultur möglicherweise weniger invalidierend zu sein scheint und damit einen Schutzfaktor hinsichtlich der AN darstellt. Ein direkter Zusammenhang muss jedoch noch in kulturvergleichenden Studien überprüft werden. Zusammenfassend konnten in dieser Dissertation bisher nicht berücksichtige Aspekte der emotionalen Dysregulation bei AN untersucht werden. Zukünftige Studien sollten zum einen den Einfluss von aversiver Anspannung und selbstberichteter Emotionsidentifikation auf störungsbedingtes Verhalten wie Restriktion oder kompensierende Maßnahmen erfassen, zum anderen den protektiven Einfluss der lateinamerikanischen Kultur auf die AN weitergehend untersuchen

Novel bidirectional universal 1-phase/3-phase-input unity power factor differential AC/DC converter

A common 400 V dc bus for industrial motor drives advantageously allows the use of high-performance 600 V power semiconductor technology in the inverter drive converter stages and to lower the rated power of the supplying rectifier system. Ideally, this supplying rectifier system features unity power factor operation, bidirectional power flow and nominal power operation in the three-phase and the single-phase grid. This paper introduces a novel bidirectional universal single-/three-phase-input unity power factor differential ac-dc converter suitable for the above mentioned requirements. The basic operating principle and conduction states of the proposed topology are derived and discussed in detail. Then, the main power component voltage and current stresses are determined and simulation results in PLECS are provided. The concept is verified by means of experimental measurements conducted in both three-phase and single-phase operation with a 6 kW prototype system employing a switching frequency of 100 kHz and 1200 V SiC power semiconductor

Meeting report of the 2nd German dialectical behavior therapy for adolescents network meeting

Over the past 30 years, dialectical behavior therapy has been shown to be an effective treatment for adult borderline personality disorder. The adaptation of DBT for adolescents (DBT-A) in different patient groups has also led to some promising improvements of the respective psychopathology. During the second German DBT-A network meeting in 2015 in Mainz, Germany, a need for further research and innovative approaches in treatment of adolescents became apparent and resulted in controversial discussions. Main issues were enlarging evidence of effectiveness of DBT-A strategies with regard to family interaction, i.e. involving caregivers in treatment. In general, there seems to be a dire need for disentangling different therapeutic strategies and resulting treatment outcomes, especially concerning the needs of different patient groups. Additionally, the implementation of smartphone-based real life assessment and intervention into DBT-A was discussed extensively. Providing time congruent skills within an application, decreasing aversive tension and reducing dysfunctional behavior could lead to an enhanced therapist-patient interaction. This meeting report presents the core issues raised during the network meeting and discusses their implications for further research

Aversive tension in female adolescents with Anorexia Nervosa : a controlled ecological momentary assessment using smartphones

BACKGROUND: Current models of Anorexia Nervosa (AN) emphasize the role of emotion regulation. Aversive tension, described as a state of intense arousal and negative valence, is considered to be a link between emotional events and disordered eating. Recent research focused only on adult patients, and mainly general emotion regulation traits were studied. However, the momentary occurrence of aversive tension, particularly in adolescents with AN, has not been previously studied. METHOD: 20 female adolescents with AN in outpatient treatment and 20 healthy adolescents aged 12 to 19years participated in an ecological momentary assessment using their smartphones. Current states of aversive tension and events were assessed hourly for two consecutive weekdays. Mean and maximum values of aversive tension were compared. Multilevel analyses were computed to test the influence of time and reported events on aversive tension. The effect of reported events on subsequent changes of aversive tension in patients with AN were additionally tested in a multilevel model. RESULTS: AN patients showed higher mean and maximum levels of aversive tension. In a multilevel model, reported food intake was associated with higher levels of aversive tension in the AN group, whereas reported school or sport-related events were not linked to specific states of aversive tension. After food intake, subsequent increases of aversive tension were diminished and decreases of aversive tension were induced in adolescents with AN. CONCLUSIONS: Aversive tension may play a substantial role in the psychopathology of AN, particular in relation with food intake. Therefore, treatment should consider aversive tension as a possible intervening variable during refeeding. Our findings encourage further research on aversive tension and its link to disordered eating. TRIAL REGISTRATION: German register of clinical trials (DRKS): DRKS00005228 (Date of registration: September 2, 2013)

Partial deficiency of HIF-1α stimulates pathological cardiac changes in streptozotocin-induced diabetic mice

BACKGROUND: Diabetic cardiomyopathy is associated with a number of functional and structural pathological changes such as left ventricular dysfunction, cardiac remodeling, and apoptosis. The primary cause of diabetic cardiomyopathy is hyperglycemia, the metabolic hallmark of diabetes. Recent studies have shown that a diabetic environment suppresses hypoxia-inducible factor (HIF)-1α protein stability and function. The aim of this study was to analyze the functional role of HIF-1α in the development of diabetic cardiomyopathy. We have hypothesized that the partial deficiency of HIF-1α may compromise cardiac responses under diabetic conditions and increase susceptibility to diabetic cardiomyopathy. METHODS: Diabetes was induced by streptozotocin in wild type (Wt) and heterozygous Hif1a knock-out (Hif1a( +/- )) mice. Echocardiographic evaluations of left ventricular functional parameters, expression analyses by qPCR and Western blot, and cardiac histopathology assessments were performed in age-matched groups, diabetic, and non-diabetic Wt and Hif1a( +/- ) mice. RESULTS: Five weeks after diabetes was established, a significant decrease in left ventricle fractional shortening was detected in diabetic Hif1a( +/- ) but not in diabetic Wt mice. The combination effects of the partial deficiency of Hif1a and diabetes affected the gene expression profile of the heart, including reduced vascular endothelial growth factor A (Vegfa) expression. Adverse cardiac remodeling in the diabetic Hif1a( +/- ) heart was shown by molecular changes in the expression of structural molecules and components of the extracellular matrix. CONCLUSIONS: We have shown a correlation between heterozygosity for Hif1α and adverse functional, molecular, and cellular changes associated with diabetic cardiomyopathy. Our results provide evidence that HIF-1α regulates early cardiac responses to diabetes, and that HIF-1α deregulation may influence the increased risk for diabetic cardiomyopathy

Cardioprotective Regimen of Adaptation to Chronic Hypoxia Diversely Alters Myocardial Gene Expression in SHR and SHR-mtBN Conplastic Rat Strains

Adaptation to continuous normobaric hypoxia (CNH) protects the heart against acute ischemia/reperfusion injury. Recently, we have demonstrated the infarct size-limiting effect of CNH also in hearts of spontaneously hypertensive rats (SHR) and in conplastic SHR-mtBN strain characterized by the selective replacement of the mitochondrial genome of SHR with that of more ischemia-resistant Brown Norway rats. Importantly, cardioprotective effect of CNH was more pronounced in SHR-mtBN than in SHR. Thus, here we aimed to identify candidate genes which may contribute to this difference between the strains. Rats were adapted to CNH (FiO2 0.1) for 3 weeks or kept at room air as normoxic controls. Screening of 45 transcripts was performed in left ventricles using Biomark Chip. Significant differences between the groups were analyzed by univariate analysis (ANOVA) and the genes contributing to the differences between the strains unmasked by CNH were identified by multivariate analyses (PCA, SOM). ANOVA with Bonferroni correction revealed that transcripts differently affected by CNH in SHR and SHR-mtBN belong predominantly to lipid metabolism and antioxidant defense. PCA divided four experimental groups into two main clusters corresponding to chronically hypoxic and normoxic groups, and differences between the strains were more pronounced after CNH. Subsequently, the following 14 candidate transcripts were selected by PCA, and confirmed by SOM analyses, that can contribute to the strain differences in cardioprotective phenotype afforded by CNH: Alkaline ceramidase 2 (Acer2), Fatty acid translocase (Cd36), Aconitase 1 (Aco1), Peroxisome proliferator activated receptor gamma (Pparg), Hemoxygenase 2 (Hmox2), Phospholipase A2 group IIA (Ppla2g2a), Dynamin-related protein (Drp), Protein kinase C epsilon (Pkce), Hexokinase 2 (Hk2), Sphingomyelin synthase 2 (Sgms2), Caspase 3 (Casp3), Mitofussin 1 (Mfn1), Phospholipase A2 group V (Pla2g5), and Catalase (Cat). Our data suggest that the stronger cardioprotective phenotype of conplastic SHR-mtBN strain afforded by CNH is associated with either preventing the drop or increasing the expression of transcripts related to energy metabolism, antioxidant response and mitochondrial dynamics

The spanish body image state scale: factor structure, reliability and validity in a colombian population

Objective: Body image is a construct highly dependent on culture and ethnicity. Furthermore, recent studies reveal that body image is not only a trait, but also a momentary state subject to change in diverse situational contexts. However, cultural influences on momentary body image have not been sufficiently investigated. To assess the influence of Latin American culture on momentary body image and to enable its comparison to Western countries, the Spanish translation of an existing state body image scale such as the Body Image States Scale (BISS) is needed. In addition, the factor structure, reliability and general validity of the Spanish BISS (S-BISS) should be evaluated prior to its application in diverse situational contexts. Method: We conducted a cross-sectional study evaluating 1137 individuals between the ages of 18 and 28 years from Barranquilla, Colombia, South America. The original BISS, which assesses body satisfaction, was translated from English to Spanish. Factorial structure, scale score reliability and convergent/divergent validity were assessed. Results: Exploratory and confirmatory factor analyses revealed that a one-factor model with correlated items best described the factorial structure present in the BISS questionnaire. The coefficient of scale score reliability was a = 0.92 (McDonalds & = 0.93), with similar results for men and women. Significant differences between males and females were found with lesser body satisfaction in females (W = 163260, p = 0.016). Lower S-BISS scores indicating less body satisfaction were associated with higher BMI (r = −0.287, p < 0.001) and obtained in participants who were currently on a diet (t1135 = −3.98, p < 0.001). The S-BISS was negatively correlated with a trait body image measurement assessing body dissatisfaction (Body Shape Questionnaire, r = −0.577, p < 0.001) and a psychopathology questionnaire (Brief Symptom Inventory 53, r = −0.331, p < 0.001). Conclusion: The S-BISS is a valid and reliable instrument to assess body image in the Colombian population, and exhibits similar psychometric properties to those of the original version. Future studies should examine whether the S-BISS captures change in state body image when applied in diverse situational contexts

Proteomic and transcriptomic analysis of heart failure due to volume overload in a rat aorto-caval fistula model provides support for new potential therapeutic targets - monoamine oxidase A and transglutaminase 2

<p>Abstract</p> <p>Background</p> <p>Chronic hemodynamic overloading leads to heart failure (HF) due to incompletely understood mechanisms. To gain deeper insight into the molecular pathophysiology of volume overload-induced HF and to identify potential markers and targets for novel therapies, we performed proteomic and mRNA expression analysis comparing myocardium from Wistar rats with HF induced by a chronic aorto-caval fistula (ACF) and sham-operated rats harvested at the advanced, decompensated stage of HF.</p> <p>Methods</p> <p>We analyzed control and failing myocardium employing iTRAQ labeling, two-dimensional peptide separation combining peptide IEF and nano-HPLC with MALDI-MS/MS. For the transcriptomic analysis we employed Illumina RatRef-12v1 Expression BeadChip.</p> <p>Results</p> <p>In the proteomic analysis we identified 2030 myocardial proteins, of which 66 proteins were differentially expressed. The mRNA expression analysis identified 851 differentially expressed mRNAs.</p> <p>Conclusions</p> <p>The differentially expressed proteins confirm a switch in the substrate preference from fatty acids to other sources in the failing heart. Failing hearts showed downregulation of the major calcium transporters SERCA2 and ryanodine receptor 2 and altered expression of creatine kinases. Decreased expression of two NADPH producing proteins suggests a decreased redox reserve. Overexpression of annexins supports their possible potential as HF biomarkers. Most importantly, among the most up-regulated proteins in ACF hearts were monoamine oxidase A and transglutaminase 2 that are both potential attractive targets of low molecular weight inhibitors in future HF therapy.</p