Exploring the genetic link between RLS and ADHD

Attention deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder of childhood onset. Clinical and biological evidence points to shared common central nervous system (CNS) pathology of ADHD and restless legs syndrome (RLS). It was hypothesized that variants previously found to be associated with RLS in two large genome-wide association studies (GWA), will also be associated with ADHD. SNPs located in MEIS1 (rs2300478), BTBD9 (rs9296249, rs3923809, rs6923737), and MAP2K5 (rs12593813, rs4489954) as well as three SNPs tagging the identified haplotype in MEIS1 (rs6710341, rs12469063, rs4544423) were genotyped in a well characterized German sample of 224 families comprising one or more affected sibs (386 children) and both parents. We found no evidence for preferential transmission of the hypothesized variants to ADHD. Subsequent analyses elicited nominal significant association with haplotypes consisting of the three SNPs in BTBD9 (chi2 = 14.8, df = 7, nominal p = 0.039). According to exploratory post hoc analyses, the major contribution to this finding came from the A-A-A-haplotype with a haplotype-wise nominal p-value of 0.009. However, this result did not withstand correction for multiple testing. In view of our results, RLS risk alleles may have a lower effect on ADHD than on RLS or may not be involved in ADHD. The negative findings may additionally result from genetic heterogeneity of ADHD, i.e. risk alleles for RLS may only be relevant for certain subtypes of ADHD. Genes relevant to RLS remain interesting candidates for ADHD; particularly BTBD9 needs further study, as it has been related to iron storage, a potential pathophysiological link between RLS and certain subtypes of ADHD.

Extratumoral spiral fixed wire marking of small pulmonary nodules for thoracoscopic resection

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) for pulmonary nodules close to the visceral pleura is an established procedure. Different methods have been developed to mark these nodules when resecting small nodules distant to the pleural surface. The possibility of tumor cell spread due to nodule penetration is a major drawback. Furthermore, guide wire-based marking systems have revealed the problem of accidental wire dislocation prior to resection.

METHODS

In this study, a new marker system for computed tomography-guided extranodular spiral fixed wire marking (ESFWM) was evaluated in an attempt to maintain tumor integrity while reducing the risk of wire dislocation.

RESULTS

Our study included 42 patients with 44 marked nodules. 40 nodules were resected by VATS in 38 of these patients. The remaining 4 patients required conversion to thoracotomy due to adhesions and a non-deflated lung. Wire dislocation and nodule penetration occurred only once.

CONCLUSION

The new lung marker system revealed a very low risk of wire dislocation. Peritumoral marking allows the safe resection of subpleural nodules without a risk of tumor cell spread.

Association and linkage of allelic variants of the dopamine transporter gene in ADHD

Previously, we had reported a genome-wide scan for attention-deficit/hyperactivity disorder (ADHD) in 102 families with affected sibs of German ancestry; the highest multipoint LOD score of 4.75 was obtained on chromosome 5p13 (parametric HLOD analysis under a dominant model) near the dopamine transporter gene (DAT1). We genotyped 30 single nucleotide polymorphisms (SNPs) in this candidate gene and its 5' region in 329 families (including the 102 initial families) with 523 affected offspring. We found that (1) SNP rs463379 was significantly associated with ADHD upon correction for multiple testing (P=0.0046); (2) the global P-value for association of haplotypes was significant for block two upon correction for all (n=3) tested blocks (P=0.0048); (3) within block two we detected a nominal P=0.000034 for one specific marker combination. This CGC haplotype showed relative risks of 1.95 and 2.43 for heterozygous and homozygous carriers, respectively; and (4) finally, our linkage data and the genotype-IBD sharing test (GIST) suggest that genetic variation at the DAT1 locus explains our linkage peak and that rs463379 (P<0.05) is the only SNP of the above haplotype that contributed to the linkage signal. In sum, we have accumulated evidence that genetic variation at the DAT1 locus underlies our ADHD linkage peak on chromosome 5; additionally solid association for a single SNP and a haplotype were shown. Future studies are required to assess if variation at this locus also explains other positive linkage results obtained for chromosome 5p.

[Characteristics of risk groups with an insufficient demand for dental services - results of the study of health in Pomerania (SHIP)]

AIM

The purpose of this study was to identify risk groups for low dental care utilisation and to highlight adequate determinants for necessary action.

METHODS

The database was the "Study of Health in Pomerania" (SHIP), a cross-sectional sample drawn from the adult population (20 - 79 years) in a northeast region of Germany. 4310 of 7008 randomly selected inhabitants participated in the examinations (response rate 68.8 %). The use of dental care in the last year was analysed using logistic regression according to the conceptual model by Andersen and Newman.

RESULTS

Multivariate analysis revealed that participation in the bonus scheme system of the statutory sickness funds (OR = 8.2) and participation in the bonus system of the private health insurance companies (OR = 2.6) as "enabling resources" predicted dental care use in the last year. "Objektive need" (OR = 1.02) is weaker associated with dental care utilisation than "subjective need", for instance the attitude towards need of regular dental checkups. Presence of own teeth is a significant predictor for dental care utilization (OR = 3.3), whereas edentulous persons, those with complete denture prosthesis, don't think about possible oral problems and don't visit the dentist at least once a year. Among "predisposing factors" only gender and education were significant determinats for dental care utilization.

CONCLUSIONS

The conclusions concerning the significant influence of subjective need and promotional impact of the bonus scheme are important for health care. Financial incentives and motivation for regular prevention should be continued and upgraded. Measures to improve preventive dental care utilization should focus on persons with low educational levels and on men with inadequate dental care utilisation. The mental anchorage of the term "oral health" rather than the conventional term "dental health" is important, so that edentulous persons become conscious of regular prevention pointers to maintain a high quality of life.

Zubereitungen zur Anwendung am Auge unter Berücksichtigung der Therapie des Sicca-Syndroms

Da das Auge ein empfindliches Körperorgan ist, stellt die Behandlung von Augenerkrankungen hohe Ansprüche an die applizierten Zubereitungen. So darf die Zubereitung weder chemisch noch physikalisch reizen und muss zu jeder Zeit steril sein. Zudem sollte sie den physiologischen Gegebenheiten des Auges wenn möglich angepasst werden, um Reizungen zu vermeiden. Mit der Wahl der Applikationsform können z.B. Wirkintensität und Wirkdauer bestimmt werden. Vom so genannten Sicca-Syndrom ist ein Großteil der Bevölkerung betroffen. Die Therapie umfasst sowohl nichtmedikamentöse als auch medikamentöse Maßnahmen. Dabei kommen unter anderem künstliche Tränen zum Einsatz. Die Auswahl eines geeigneten Präparates richtet sich nach dem Schweregrad der Erkrankung und auch nach der Viskosität der Zubereitung. In schwerwiegenderen Fällen werden Substanzen wie Hyaluronsäure oder Formulierungen, die Lipide enthalten, hinzugezogen.

Non-associative defensive responses of rats to ferret odor

Predators and their odors offer an ethologically valid model to study learning processes. The present series of experiments assessed the ability of ferret odor to serve as an unconditioned stimulus and examined behavioral and endocrine changes in male Sprague-Dawley rats with single or repeated exposures in a defensive withdrawal paradigm or in their home cages. Rats exposed to ferret odor avoided the ferret odor stimulus more, exhibited greater risk assessment and displayed higher adrenocorticotropin hormone (ACTH) and corticosterone release compared with control odor exposed rats and these measures did not significantly habituate over repeated exposures. Ferret odor exposure did not show associative conditioning effects during extinction trials. However, rats that were pre-exposed to ferret odor only once, as compared to control and repeatedly exposed rats, displayed a sensitized ACTH and corticosterone response to an additional ferret odor exposure in small cages. These experiments suggest that ferret odor is a highly potent unconditioned stimulus that has long lasting effects on behavior and endocrine responses, and further suggests the independence of habituation and sensitization processes.

Late-onset neurologic disease in glutaryl-CoA dehydrogenase deficiency

Neurologic disease in glutaryl-CoA dehydrogenase (GCDH) deficiency usually presents with acute encephalopathic crises before 2 years of age. The authors report two previously asymptomatic patients with macrocephaly presenting with progressive neurologic deterioration and a severe leukoencephalopathy during adolescence or adulthood.

Ferret odor as a processive stress model in rats: neurochemical, behavioral, and endocrine evidence

Predator odors have been shown to elicit stress responses in rats. The present studies assessed the use of domestic ferret odor as a processive stress model. Plasma corticosterone and adrenocorticotropin hormone levels were higher after 30 min of exposure to ferret odor (fur/skin) but not control odors, ferret feces, urine, or anal gland secretions. Behavioral differences were also found between ferret and the control odors as tested in a defensive withdrawal paradigm. In addition, c-fos messenger RNA expression in several brain areas previously associated with processive stress was significantly higher in ferret odor-exposed rat brains than in control odor-exposed brains. These results suggest that ferret odor produces a reliable unconditioned stress response and may be useful as a processive stress model.

[The problem of response in epidemiologic studies in Germany (Part II)]

The first part of this paper introduced various definitions of response and discussed their significance in the context of different study types. This second part addresses incentives as a method to increase response and evaluates the impact of non response or delayed response on the validity of the study results. Recruitment aims at minimising the proportion of refusal. To achieve this, incentives can be used and potential participants can be contacted in a sequence of increasing intensity. The effectiveness of different incentives was investigated within the pretest of the German survey on children and adolescents by the Robert Koch Institute. A low response is often interpreted in terms of non-response bias. This assumption, however, is as incorrect as would be opposite conclusion, that a high response guarantees valid results. Any study of the influence of nonresponse requires information on non-responders. The comparison between early and late responders as an indirect method to evaluate systematic differences between participants and non-participants by wave analysis is demonstrated within the Northern Germany Leukaemia and Lymphoma study (NLL). The German guidelines for Good Epidemiologic Practice recommend to solicit a minimum of information on the principal hypotheses of a study from non-participants. The example of a population-based health survey (Cooperative Health Research in the Region of Augsburg, KORA) illustrates how information on non-responders within a quantitative non-responder analysis can be achieved and used for the estimation of prevalences. Recommendations how to deal with the response in epidemiological studies in Germany are suggested.

The fixed combination of valerian and hops (Ze91019) acts via a central adenosine mechanism

The aim of the study was to demonstrate competition between caffeine and a fixed valerian/hop extract combination (Ze91019) by the central adenosine mechanism. EEG was used to describe the action of caffeine on the central nervous system after oral administration (200 mg) in healthy volunteers. In addition to caffeine, the volunteers (16 in each group) received either placebo or verum (2 and 6 tablets containing the valerian/hop extract). The EEG responses were recorded every 30 min thereafter. The verum medication was capable of reducing (2 tablets) or inhibiting (6 tablets) the arousal induced by caffeine. This pharmacodynamic action was observed 60 minutes after oral administration, indicating not only competition between the antagonist caffeine and the partial agonist, i. e., the valerian/hop extract but also bio-availability of the compound(s) responsible for the agonistic action. In conclusion, the valerian/hop extract acts via a central adenosine mechanism which is possibly the reason for its sleep-inducing and -maintaining activity.

Comparative regression analysis of concurrent elimination-phase blood and breath alcohol concentration measurements to determine hourly degradation rates

Following the introduction of limit values for blood alcohol and breath alcohol concentrations of 0.5 g/kg and 0.25 mg/L, respectively, as provided under s. 24 a of the German Road Traffic Act the question is whether also breath alcohol concentrations can be back calculated to the time of the traffic offence in cases where it is definite that the person to be examined is in the period of alcohol elimination. To this end, a study was performed in which 56 healthy volunteers consumed 0.5, 0.8 and 1.0 g of ethanol mixed with fruit juice per kilogram of body weight over a period of 10-20 min. Calculations included all 391 pairs of concurrent blood alcohol and breath alcohol concentration values obtained after 2 h following the end of drinking. All volunteers exceeded the peak value of the alcohol curve. The measured values included were above 0.1 g/kg and 0.05 mg/L. For an average intake of alcohol of 0.88 g/kg the following regression lines were calculated for the period starting 2 h after the end of drinking: blood alcohol concentration [g/kg] = 1.318 - 0.172 h and breath alcohol concentration [mg/L] = 0.589 - 0.079 h. Subtracting the simple standard deviation from the mean value yielded hourly degradation rates above 0.1 g/kg and above 0.05 mg/L, respectively. Subtracting two standard deviations, the values fell below this level in both cases. In fact, back calculation of breath alcohol concentrations based on 0.05 mg/h seems to be possible for traffic offences if certain conditions are complied with, such as the use of Evidential 7110, a calibrated breath alcohol analyser approved by the Federal Physical-Technical Laboratory for measuring the breath alcohol concentration.

Zum Problem der Response in epidemiologischen Studien in Deutschland (Teil I)

To achieve high response rates in German epidemiological studies is growing more difficult. Low response in epidemiological studies may decrease the acceptance of the results. Response, however, is not identical with the quality of a study. In the first part of this paper various definitions of response (contact, cooperation, response, recruitment proportions) are introduced and discussed in the context of different study designs with reference to practical examples. A population-based survey such as the Study of Health in Pomerania (SHIP) investigates the distribution of risk factors and health-related endpoints. Surveys should yield representative results which can be generalised to apply to the entire population (external validity). This study design usually requires large participitation proportions. In a prospective cohort study such as the European Investigation into Cancer and Nutrition (EPIC) the emphasis is on internal validity. A stable study population willing to participate in regular follow-ups is a primary recruitment goal. If the response in a case-control study such as the Northern Germany Leukaemia and Lymphoma Study (NLL) is low, the priority is to achieve approximately equal response proportions for cases and controls. Simultaneous public relation and media activities can improve participitation in a study. Multidimensional strategies combining public communications, cooperation with local and regional officials and frequent press and media coverage are emphasised. The second part of this paper will discuss methods to quantify the effects of the response proportions on the validity of the study results.

Animal models for glutaryl-CoA dehydrogenase deficiency

In vitro studies suggest that excitotoxic cell damage is an underlying mechanism for the acute striatal damage in glutaryl-CoA dehydrogenase (GCDH) deficiency. It is believed to result from an imbalance of glutamatergic and GABAergic neurotransmission induced by the accumulating organic acids 3-hydroxyglutaric acid (3-OH-GA) and to a lesser extent glutaric acid (GA). Stereotaxic administration of 3-OH-GA and GA into the rat striatum have confirmed these results, but may not truly represent the effect of chronic exposure to these compounds. In an attempt to better understand the pathophysiology of GCDH deficiency in vivo , two animal models have been utilized. A mouse that lacks GCDH activity in all tissues was generated by gene targeting in embryonic stem cells. These animals develop the characteristic biochemical phenotype of the human disease. Pathologically, these mice have a diffuse spongiform myelinopathy similar to that in human patients; however, there is no evidence for acute striatal damage or sensitivity to acute encephalopathy induced by catabolism or inflammatory cytokines. A naturally occurring animal model, the fruit-eating bat Rousettus aegypticus, lacks hepatic and renal GCDH activity, but retains cerebral enzyme activity. Like the mouse, these bats develop the characteristic biochemical phenotype of glutaryl-CoA dehydrogenase deficiency, but lack overt neurological symptoms such as dystonia. It is not known whether they also develop the spongiform myelinopathy seen in the Gcdh-deficient mice. Otherwise, these constellations would suggest that cerebral GCDH deficiency is responsible for the development of neuronal damage. The lack of striatal damage in these two rodent models may also be related to species differences. However, they also highlight our lack of a comprehensive understanding of additional factors that might modulate the susceptibiliy of neurons to accumulating 3-OH-GA and GA in GCDH deficiency. Unravelling these mechanisms may be the key to understanding the pathophysiology of this unique disease and to the development of neuroprotective strategies.

S-Acetylglutathione normalizes intracellular glutathione content in cultured fibroblasts from patients with glutathione synthetase deficiency

Glutathione synthetase deficiency is an autosomal recessive inherited metabolic defect in the gamma-glutamyl cycle. Decreased intracellular glutathione levels are one of the characteristic biochemical features. In this study we show that addition of S-acetylglutathione to the medium raised intracellular glutathione content in cultured fibroblasts from patients with glutathione synthetase deficiency. This has implications for the treatment of patients with this inborn error of metabolism.

Excitotoxicity and bioenergetics in glutaryl-CoA dehydrogenase deficiency

Glutaryl-CoA dehydrogenase deficiency is an inherited organic acid disorder with predominantly neurological presentation. The biochemical hallmark of this disease is an accumulation and enhanced urinary excretion of two key organic acids, glutaric acid and 3-hydroxyglutaric acid. If untreated, acute striatal damage is often precipitated by febrile illnesses during a vulnerable period of brain development in infancy or early childhood, resulting in a dystonic dyskinetic movement disorder. 3-hydroxyglutaric and glutaric acids are structurally similar to glutamate, the main excitatory amino acid of the human brain, and are considered to play an important role in the pathophysiology of this disease. 3-hydroxyglutaric acid induces excitotoxic cell damage specifically via activation of N-methyl-D-aspartate receptors. It has also been suggested that secondary amplification loops potentiate the neurotoxic properties of these organic acids. Probable mechanisms for this effect include cytokine-stimulated NO production, a decrease in energy metabolism, and reduction of cellular creatine phosphate levels. Finally, maturation-dependent changes in the expression of neuronal glutamate receptors may affect the vulnerability of the immature brain to excitotoxic cell damage in this disease.

The dynamics of sleep-like behaviour in honey bees

At night, honey bees pass through a physiological state that is similar to mammalian sleep. Like sleep in mammals, sleep-like behaviour in honey bees is an active process. This is expressed most clearly in these insects by spontaneous antennal movements which appear at irregular intervals throughout the night and interrupt episodes of antennal immobility. Here we present a newly developed video technique for the continuous recording of the position and movements of the bee's antennae. The same technique was used to record head inclination and ventilatory movements. Despite the constancy of the ambient temperature, the magnitudes of antennae-related parameters, as well as head inclination and ventilatory cycle duration, displayed dynamic unimodal time-courses which exhibited a high degree of temporal covariance. The similarity between these time-courses and the nightly time-course of the reaction threshold for a sensory stimulus, investigated previously, indicates that, in honey bees, deepest "sleep" and least ventilatory activity occur at the same time (in the 7th hour of the rest phase).

Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design

OBJECTIVES

The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR.

METHODS

A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Loss of the Suv39h histone methyltransferases impairs mammalian heterochromatin and genome stability

Histone H3 lysine 9 methylation has been proposed to provide a major "switch" for the functional organization of chromosomal subdomains. Here, we show that the murine Suv39h histone methyltransferases (HMTases) govern H3-K9 methylation at pericentric heterochromatin and induce a specialized histone methylation pattern that differs from the broad H3-K9 methylation present at other chromosomal regions. Suv39h-deficient mice display severely impaired viability and chromosomal instabilities that are associated with an increased tumor risk and perturbed chromosome interactions during male meiosis. These in vivo data assign a crucial role for pericentric H3-K9 methylation in protecting genome stability, and define the Suv39h HMTases as important epigenetic regulators for mammalian development.

The genomic response of the Drosophila embryo to JNK signaling

During Drosophila development, the Jun N-terminal kinase signal transduction pathway regulates morphogenetic tissue closure movements that involve cell shape changes and reorganization of the actin cytoskeleton. We analyzed the genome-wide transcriptional response to activation of the JNK pathway in the Drosophila embryo by serial analysis of gene expression (SAGE) and identified loci encoding cell adhesion molecules and cytoskeletal regulators as JNK responsive genes. The role of one of the upregulated genes, chickadee (chic), encoding a Drosophila profilin, in embryogenesis was analyzed genetically. chic-deficient embryos fail to execute the JNK-mediated cytoskeletal rearrangements during dorsal closure. This study demonstrates a transcriptional mechanism of cytoskeletal regulation and establishes SAGE as an advantageous approach for genomic experiments in the fruitfly.