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Borderline personality disorder (BPD) is characterized by intense mood swings, impulsivity, self-injurious behavior, poor anger control, fear of abandonment, and unstable interpersonal relationships. BPD is also associated with a heightened risk of cardiovascular disease, whereby the underlying mechanisms are insufficiently understood. Accordingly, the present study set out to examine whether individuals with BPD would show abnormal myocardial deformation and to explore the role of potential risk factors, including maladaptive stress responsivity, childhood trauma, and current stress exposure.Fifty female patients diagnosed with BPD and 50 controls matched for sex and age underwent echocardiography to determine the global longitudinal strain (GLS) of the left ventricle. In addition, childhood trauma, chronic stress, and "allostatic load" were determined, as well as borderline symptom severity and common risk factors for cardiovascular disease.Aside from a significantly greater GLS in BPD patients, a multivariable regression analysis revealed that allostatic load (β = 0.225, p = .048) was significantly associated with GLS, with childhood trauma (β = 0.279, p = .062) approaching significance. Conversely, smoking (p = .867), chronic stress (p = .193), and borderline symptom severity (p = .342) were not associated with GLS, even though bivariate correlations were significant.Somatically healthy women with BPD display subtle signs of increased GLS, which is associated with allostatic load as an indicator of the "wear-and-tear" of the body. The association between childhood trauma with GLS was of similar strength but did not reach the threshold for statistical significance. This finding may support the need for primary prevention of somatic consequences of maladaptive stress responsivity in psychiatric patients.

Background: Given the crucial role of vaccination in managing and halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. However, data on this topic are currently limited. This study aimed to characterize the adolescent population willing to receive COVID-19 vaccination in mid-2021 in an urban region in Germany and to identify the factors that motivated those who accepted vaccination with the mRNA vaccine Comirnaty, which was not yet nationally recommended. Methods: We surveyed adolescents and their accompanying guardians who were scheduled to receive COVID-19 vaccination and collected data on sociodemographic characteristics, the adolescent's medical history, the family's vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic and reasons for vaccinating the adolescents. Results: Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were to protect against SARS-CoV-2-related illness and to gain access to leisure facilities. The adolescents' motivation for vaccination was not influenced by gender, health status, migration background, or presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Conclusions: Adolescents are especially willing to be vaccinated if they have a better-educated environment and a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of population and removing barriers to vaccines, may lead to an ameliorated acceptance of COVID-19 vaccines.

BackgroundAvailable data on aerosol emissions among children and adolescents during spontaneous breathing are limited. Our aim was to gain insight into the role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and whether aerosol measurements among children can be used to help detect so-called superspreaders—infected individuals with extremely high numbers of exhaled aerosol particles.MethodsIn this prospective study, the aerosol concentrations of SARS-CoV-2 PCR-positive and SARS-CoV-2 PCR-negative children and adolescents (2–17 years) were investigated. All subjects were asked about their current health status and medical history. The exhaled aerosol particle counts of PCR-negative and PCR-positive subjects were measured using the Resp-Aer-Meter (Palas GmbH, Karlsruhe, Germany) and compared using linear regression.ResultsA total of 250 children and adolescents were included in this study, 105 of whom were SARS-CoV-2 positive and 145 of whom were SARS-CoV-2 negative. The median age in both groups was 9 years (IQR 7–11 years). A total of 124 (49.6%) participants were female, and 126 (50.4%) participants were male. A total of 81.9% of the SARS-CoV-2-positive group had symptoms of viral infection. The median particle count of all individuals was 79.55 particles/liter (IQR 44.55–141.15). There was a tendency for older children to exhale more particles (1–5 years: 79.54 p/L; 6–11 years: 77.96 p/L; 12–17 years: 98.63 p/L). SARS-CoV-2 PCR status was not a bivariate predictor (t = 0.82, p = 0.415) of exhaled aerosol particle count; however, SARS-CoV-2 status was shown to be a significant predictor in a multiple regression model together with age, body mass index (BMI), COVID-19 vaccination, and past SARS-CoV-2 infection (t = 2.81, p = 0.005). COVID-19 vaccination status was a highly significant predictor of exhaled aerosol particles (p ConclusionDuring SARS-CoV-2 infection, children and adolescents did not have elevated aerosol levels. In addition, no superspreaders were found.

Background The serotonergic and the endocannabinoid system are involved in the etiology of depression. Depressive patients exhibit low serotonergic activity and decreased level of the endocannabinoids anandamide (AEA) and 2-arachidonylglycerol (2AG). Since the cannabinoid (CB) 1 receptor is activated by endogenous ligands such as AEA and 2AG, whose concentration are controlled by the fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase, respectively, we investigated the effects on serotonergic utilization. In this study, we investigated the impact of the rs1049353 single-nucleotide polymorphism (SNP) of the cannabinoid receptor 1 (CNR1) gene, which codes the endocannabinoid CB1 receptor, and the rs324420 SNP of the FAAH gene on the serotonergic and endocannabinoid system in 59 healthy volunteers. Methods Serotonergic activity was measured by loudness dependence of auditory-evoked potentials (LDAEP). Plasma concentrations of AEA, 2AG and its inactive isomer 1AG were determined by mass spectrometry. Genotyping of two SNPs (rs1049353, rs344420) was conducted by polymerase chain reaction (PCR) and differential enzymatic analysis with the PCR restriction fragment length polymorphism method. Results Genotype distributions by serotonergic activity or endocannabinoid concentration showed no differences. However, after detailed consideration of the CNR1-A-allele-carriers, a reduced AEA (A-allele-carrier M = 0.66, SD = 0.24; GG genotype M = 0.72, SD = 0.24) and 2AG (A-allele-carriers M = 0.70, SD = 0.33; GG genotype M = 1.03, SD = 0.83) plasma concentration and an association between the serotonergic activity and the concentrations of AEA and 2AG has been observed. Conclusions Our results suggest that carriers of the CNR1-A allele may be more susceptible to developing depression.

Die richtige Ernährung von Kindern und Jugendlichen ist eine wichtige Grundlage für deren Entwicklung und trägt zur Prävention vieler Krankheiten bei. Im Rahmen dessen spielt auch das Ess- und Gesundheitsverhalten in der Familie eine essentielle Rolle.

Zusammenfassung Hintergrund Zystische Fibrose (CF) ist eine der häufigsten vererbbaren Stoffwechselerkrankungen in Deutschland. Sie betrifft verschiedene Organsysteme und führt häufig zu Schmerzen, die meist unterschätzt werden. Im deutschsprachigen Raum existieren bis dato keinerlei Leitlinien zu diesem relevanten Thema. Methoden Es erfolgte eine systematische Literaturrecherche in PubMed sowie der deutschsprachigen Leitlinien und Fachliteratur zum Thema CF und Schmerzen. Als relevant wurden Arbeiten gewertet, die Daten zu CF, zu Schmerzen oder deren Behandlung bei der CF enthielten. Insgesamt fanden sich 1690 Artikel, von denen 41 Arbeiten unsererseits aufgenommen wurden. Ergebnisse Die Recherche ergab, dass Schmerzen unterschiedlichster Art aufgrund der diversen Organbeteiligungen weit verbreitet sind. Zur Diagnostik und Therapie von Schmerzen bei CF existieren aber keine deutschsprachigen Leitlinien oder Konsenspapiere. In europäischen und amerikanischen Studien spiegelt sich die klinische Relevanz und Bandbreite des Themas wider, Daten zur Effektivität der Schmerztherapie enthalten diese jedoch nicht. Neben einer klassischen Schmerzmedikation mit Analgetika setzen viele Patienten auch auf alternative Heilversuche wie physikalische Therapien, Akupunktur oder Tetrahydrocannabinol (THC). Angesichts der multiplen Organdysfunktionen ist der Einsatz von Analgetika mit besonderen Risiken verbunden. Diskussion Eine Schmerztherapie ist bei Patienten mit zystischer Fibrose und Multiorganbeteiligung häufig erforderlich und muss der Progression der Erkrankung angepasst werden. Kontraindikationen und Nebenwirkungen der Analgetika sollten individuell ermittelt werden. Die Aufnahme der Behandlung von Schmerzen in deutschsprachige CF-Leitlinien ist dringend erforderlich.

Zusammenfassung Hintergrund Die zystische Fibrose (CF) ist eine multisystemische progrediente Stoffwechselerkrankung mit vorwiegend abdomineller und pulmonaler Beteiligung. Schmerzen sind für Betroffene ein weiteres komplexes und von den Behandlern unterschätztes Problem. Methoden Eine Literaturrecherche deutschsprachiger Leitlinien und englischsprachiger Studien zum Thema CF und Schmerzen wurde durchgeführt, zusätzlich die Beobachtungen zur Diagnostik und Therapie eines CF-Patienten mit progredienten thorakalen Schmerzen ausgewertet. Ergebnisse Die Recherche ergab, dass zur Diagnostik und Therapie thorakaler Schmerzen bei CF keine deutschsprachigen Leitlinien oder Konsenspapiere existieren. Die europäischen und amerikanischen Erhebungen zeigen aber die große Relevanz des Themas und postulieren einen Zusammenhang von Schmerzintensität mit einer erhöhten Mortalität. Sie enthalten jedoch keine Daten zur Effektivität der Schmerztherapie. Anhand dieser Daten und des Fallberichts eines jungen CF-Patienten mit stärksten Thoraxschmerzen bei pulmonalen Exazerbationen lassen sich die CF-spezifischen Herausforderungen der Schmerztherapie illustrieren. Neben den Schmerzen an sich sind auch Analgetika angesichts der multiplen Organdysfunktionen mit besonderen Risiken wie gastrointestinalen Blutungen, opioidinduzierter Atemdepression oder opioidinduzierter Obstipation verbunden. Diskussion Schmerztherapie bei Patienten mit zystischer Fibrose und Multiorganbeteiligung erfordert ein sorgfältiges Monitoring und interdisziplinäres Handeln. Empfehlungen zum Schmerzmanagement sollten in die deutschsprachigen CF-Leitlinien aufgenommen werden.

Recently, the European Food Safety Authority (EFSA) issued a tolerable daily intake (TDI) for erucic acid, which is mainly found in rapeseed oil. Infants may be exposed to erucic acid from rapeseed oil indirectly through maternal consumption via breastmilk or the fat component in formula, and directly as a part of complementary feeding (CF). To check the safety of infant nutrition, scenarios for erucic acid exposure were calculated based on the daily food amounts of the German dietary guidelines. Information on erucic acid concentrations in foods was obtained from European studies for breastmilk, from EFSA samples for formula powder, and from a representative analysis of rapeseed oil samples in the German retail market. 6 scenarios were calculated for the early milk feeding phase (4 formula feeding, 2 breastfeeding) and 8 scenarios for the later CF phase (5 CF +formula feeding, 3 CF +breastfeeding). Out of the 14 scenarios, only 3 resulted in exposures that were definitively below the TDI (range 4.4.–6.0 mg/kg bodyweight; BW). Assuming either high consumption or high concentration led to high exceedances (range 7.5–26.2 mg/kg BW), especially in case of the new EU limits for formula or vegetable oils (33.6 and 43.2 mg/kg BW, respectively). In our scenarios, high erucic acid exposures occurred during a particularly sensitive developmental period. To definitively weigh the potential risks from erucic acid in infants against nutritional benefits of the dietary recommendations, reliable, timely data on erucic acid in breast milk and formula are needed, similar to those from rapeseed oil in Germany., In infancy, the diet requires both, an especially high nutritional quality and toxicological safety. In view of the recent TDI for erucic acid issued by EFSA, our scenarios show that the nutritionally safe food‐based dietary guidelines for infancy in Germany may no longer be safe with regard to potential exposure to erucic acid that originates mainly from rapeseed oil. In addition to the strong data base on erucic acid in rapeseed oil in Germany, timely data bases for human milk and formula are needed to definitely decide on the toxicological safety of infant nutrition.

Children’s cognitive performance can be influenced by behaviors such as eating breakfast in the morning. The aim of this analysis was to investigate the mediating effects of breakfast behavior and other lifestyle habits on eye-hand coordination and attention. In a secondary analysis of the CogniDROP study, children from the 5th and 6th grade of a comprehensive school in Germany (n  =  223) performed a simple computerized Visual Attention Task and answered a questionnaire about behavioral patterns, i.e., skipping breakfast on a school day, frequency of physical activity (PA) outside school, and nighttime sleep. An association matrix was constructed to show the relationship between the variables. Almost 11% of children left home in the morning without breakfast, more than 9.5% of children reported poor sleep quality, 24.9% slept less than the recommended 9 h, and girls were insufficiently physically active. Sleep duration, bedtime, and PA correlated with skipping breakfast. Better sleep quality was positively related to reaction time in the Visual Attention Task. Overall, the data suggest that unfavorable behaviors in children tend to run in packs, just as skipping breakfast in the morning seems to be associated with other unfavorable habits, which impairs children’s eye-hand coordination and attention.

Desmin mutations cause familial and sporadic cardiomyopathies. In addition to perturbing the contractile apparatus, both desmin deficiency and mutated desmin negatively impact mitochondria. Impaired myocardial metabolism secondary to mitochondrial defects could conceivably exacerbate cardiac contractile dysfunction. We performed metabolic myocardial phenotyping in left ventricular cardiac muscle tissue in desmin knock-out mice. Our analyses revealed decreased mitochondrial number, ultrastructural mitochondrial defects, and impaired mitochondria-related metabolic pathways including fatty acid transport, activation, and catabolism. Glucose transporter 1 and hexokinase-1 expression and hexokinase activity were increased. While mitochondrial creatine kinase expression was reduced, fetal creatine kinase expression was increased. Proteomic analysis revealed reduced expression of proteins involved in electron transport mainly of complexes I and II, oxidative phosphorylation, citrate cycle, beta-oxidation including auxiliary pathways, amino acid catabolism, and redox reactions and oxidative stress. Thus, desmin deficiency elicits a secondary cardiac mitochondriopathy with severely impaired oxidative phosphorylation and fatty and amino acid metabolism. Increased glucose utilization and fetal creatine kinase upregulation likely portray attempts to maintain myocardial energy supply. It may be prudent to avoid medications worsening mitochondrial function and other metabolic stressors. Therapeutic interventions for mitochondriopathies might also improve the metabolic condition in desmin deficient hearts.

Introduction Socio-economic and ethnic background have been discussed as possible risk factors for SARS-CoV-2 infections in children. Improved knowledge could lead to tailored prevention strategies and help improve infection control. Aim We aimed to identify risk factors for SARS-CoV-2 infections in children in the first and second wave of the pandemic. Methods We performed an observational population-based cohort study in children (6 months–18 years) scheduled for legally required preventive examination and their parents in a metropolitan region in Germany. Primary endpoint was the SARS-CoV-2 seroconversion rate during the study period. Risk factors assessed included age, pre-existing medical conditions, socio-economic factors and ethnicity. Results We included 2,124 children and their parents. Seroconversion rates among children in all age groups increased 3–4-fold from June 2020 to February 2021. Only 24 of 58 (41%) seropositive children reported symptoms. In 51% of infected children, at least one parent was also SARS-CoV-2-positive. Low level of parental education (OR = 3.13; 95% CI: 0.72–13.69) non-significantly increased the risk of infection. Of the total cohort, 38.5% had a migration background, 9% of Turkish and 5% of Middle Eastern origin, and had the highest risk for SARS-CoV-2 infections (OR = 6.24; 95% CI: 1.38–28.12 and OR = 6.44 (95% CI: 1.14–36.45) after adjustment for other risk factors. Conclusion In the second half of 2020, seroprevalence for SARS-CoV-2 in children increased especially in families with lower-socioeconomic status. Culture-sensitive approaches are essential to limit transmission and could serve as a blueprint for vaccination strategies.

ObjectivesTo show by the example of the Optimized Mixed Diet (OMD) for children and adolescents in Germany, how the different food and nutrient profiles of the traditional daily meals complement each other to achieve daily nutrient intakes that meet the Dietary References V.MethodsThe 7-day menu plan of the OMD with the usual 5 daily meals in Germany was used. The total nutrient intake from all meals was compared with the nutrient references. Then the composition of the meals was optimized.ResultsAlthough the cooked meal (lunch) provides only 25% of the daily energy intake, it is relatively rich (>25% of the daily intake) in most vitamins and minerals, which distinguishes it from the other meals. The cold main meals (breakfast, dinner) are rich in calcium and vitamin B2, due to the preferential use of milk in these meals. The two snacks each provide 12.5% of the daily energy intake.Discussion and conclusionPeople eat foods but not nutrients and they eat foods as meals; this holds especially true for children and adolescents. A well-calculated menu plan can assure the nutrient adequacy of an OMD where the different food and nutrient profiles of the meals complement each other in a modular system. Guidelines for meals could facilitate flexible coordination of family meals and meals in childcare centers and schools. Different meal types set varied stimulus patterns at different levels (neurocognition, emotion, digestion), which may open up long-term health benefits.

Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of the present study was to assess problematic internet use (PIU) in adolescents after the third wave (nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools and universities were offered a prioritized vaccination in August 2021 with an approved vaccine against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use Scale (SCIUS) and two additional items to capture a possible change in digital media usage time and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis was performed to identify predictors of PIU. The original sample consisted of 1477 participants, and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12–17 (x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to be significant predictors of PIU: female gender, increasing age, longer digital media usage time and higher intensity of negative emotions during the COVID-19 pandemic were associated with higher SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the period after the third wave of the COVID-19 pandemic, which has increased significantly compared to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion regulation have an impact on PIU, which provides starting points for preventive interventions.

Installing an energy saving device such as a pre-swirl duct (PSD) is a major investment for a ship owner and prior to an order a reliable prediction of the energy savings is required. Currently there is no standard for how such a prediction is to be carried out, possible alternatives are both model-scale tests in towing tanks with associated scaling procedures, as well as methods based on computational fluid dynamics (CFD). This paper summarizes a CFD benchmark study comparing industrial state-of-the-art ship-scale CFD predictions of the power reduction through installation of a PSD, where the objective was to both obtain an indication on the reliability in this kind of prediction and to gain insight into how the computational procedure affects the results. It is a blind study, the KVLCC2, which the PSD is mounted on, has never been built and hence there is no ship-scale data available. The 10 participants conducted in total 22 different predictions of the power reduction with respect to a baseline case without PSD. The predicted power reductions are both positive and negative, on average 0.4%, with a standard deviation of 1.6%-units, when not considering two predictions based on model-scale CFD and two outliers associated with large uncertainties in the results. Among the variations present in computational procedure, two were found to significantly influence the predictions. First, a geometrically resolved propeller model applying sliding mesh interfaces is in average predicting a higher power reduction with the PSD compared to simplified propeller models. The second factor with notable influence on the power reduction prediction is the wake field prediction, which, besides numerical configuration, is affected by how hull roughness is considered.

Vegetarianism is a common diet worldwide. For a large proportion of people, meat or fish is not available at all or not regularly as a meal. But also in the industrialised countries, vegetarian nutrition is becoming more and more popular for various reasons. Many vegetarian parents also want a suitable diet for their children. But are restrictive diets beneficial or potentially harmful in certain situations, such as a predisposition to severe atopy? Are vegetarian diets equally suitable for pregnant women, nursing mothers, infants, children, and adolescents? What critical nutrients should parents, children, pediatricians, and nutritionists pay particular attention to? This article is focused on questions like these and discusses scientifically based concepts of nutrition. Main findings are that exposure to a variety of food antigens during early life may play a role in the development of healthy eating habits and that restrictive diets have not been found in studies to prevent allergic disease.

ZusammenfassungDie Huntington-Erkrankung (HD) ist eine autosomal-dominante neurodegenerative Erkrankung, die vornehmlich zwischen dem 30. und 50. Lebensjahr auftritt. Verursacht wird sie durch eine Genmutation auf dem Chromosom 4, welche zu einer Tripletexpansion (CAG) führt. Weniger als 10% der Betroffenen erkranken vor dem 20. Lebensjahr. Die beim Erwachsenen typischen choreatiformen Bewegungsmuster tauchen beim Jugendlichen erst im späteren Verlauf auf, können aber auch ganz fehlen. Etwa ein Drittel der Jugendlichen entwickelt eine Epilepsie.Wir präsentieren sechs Fälle kindlicher/juveniler HD und beschreiben vergleichend zur adulten HD Erstsymptome, genetische Befunde und weitere Besonderheiten.Die klinische Präsentation und auch der Erkrankungsverlauf der jugendlichen HD-Patienten unterscheiden sich mitunter deutlich von der adulten Form. Es imponieren initial vor allem Teilleistungsstörungen bei den Kindern sowie psychiatrische Symptome wie Depression und Aufmerksamkeitsstörungen bei den Jugendlichen.Aufgrund der niedrigen Prävalenz juveniler HD sowie der variablen klinischen Symptomatik ist eine Diagnosestellung im Kindes- und Jugendalter schwierig und gelingt oftmals erst mit einer zeitlichen Latenz. Die frühe Diagnosestellung kann allerdings wichtig sein, insbesondere, um soziale und schulische Probleme zu entschärfen.

Background Intervention studies suggest an influence of breakfast dietary glycemic index (GI) on children’s cognition. The Cognition Intervention Study Dortmund-GI-I study examined whether lunch dietary GI might have short-term effects on selected cognitive parameters. Methods A randomized crossover study was performed at a comprehensive school on 2 test days. One hundred and eighty-nine participants (5th and 6th grade) were randomly assigned to one of the two sequences, medium-high GI (m-hGI) or high-medium GI (h-mGI), following block randomization. In the first period, one group received a dish containing hGI rice (GI: 86) ad libitum, the other mGI rice (GI: 62)—1 week later, in the second period, vice versa. Tonic alertness, task switching, and working memory updating were tested with a computerized test battery 45 min after beginning of lunch break. Treatment effects were estimated using the t test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data. Results The crossover approach revealed no effects of lunch dietary GI on the tested cognitive parameters in the early afternoon. However, we determined carryover effects for two parameters, and therefore analyzed only data of the first period. The reaction time of the two-back task (working memory updating) was faster (p = 0.001) and the count of commission errors in the alertness task was lower (p = 0.04) in the hGI group. Conclusion No evidence of short-term effects of lunch dietary GI on cognition of schoolchildren was found. Potential positive effects on single parameters of working memory updating and tonic alertness favoring hGI rice need to be verified.

BackgroundPersistent respiratory symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults are frequent, and there can be long-term impairment of pulmonary function. To date, only preliminary evidence is available on persistent respiratory sequelae of SARS-CoV-2 in children and adolescents. Our objective was to examine the long-term effects of symptomatic and asymptomatic SARS-CoV-2 infections on pulmonary function in this age group in a single-center, controlled, prospective study.MethodsParticipants with serological or polymerase chain reaction-based evidence of SARS-CoV-2 infection were recruited from a population-based study of seroconversion rates. Multiple-breath washout (MBW), body plethysmography, and diffusion capacity testing were performed for children and adolescents. Participants were interviewed about their symptoms during the acute phase of infection and long-lasting symptoms. Cases were compared with SARS-CoV-2 seronegative controls from the same population-based study with and without history of respiratory infection within 6 months prior to assessment. Primary endpoints were differences in pulmonary function, including diffusion capacity and MBW, between participants with and without evidence of SARS-CoV-2 infection. Secondary endpoints included correlation between lung function and long-lasting symptoms as well as disease severity.FindingsIn total, 73 seropositive children and adolescents (5–18 years) were recruited after an average of 2.6 months (range 0.4–6.0) following SARS-CoV-2 infection. Among 19 patients (27.1%) who complained of persistent or newly emerged symptoms since SARS-CoV-2, 8 (11.4%) reported respiratory symptoms. No significant differences were detected in frequency of abnormal pulmonary function when comparing cases with 45 controls, including 14 (31.1%) with a history of previous infection (SARS-CoV-2: 12, 16.4%; controls: 12, 27.7%; odds ratio 0.54, 95% confidence interval 0.22–1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p = 0.012) in patients with severe SARS-CoV-2 infection.InterpretationPulmonary function is rarely impaired in children and adolescents after SARS-CoV-2 infection, except from those with severe infection, and did not differ between SARS-CoV-2 and other previous infections, suggesting that SARS-CoV-2 is not more likely to cause pulmonary sequelae than other infections. The discrepancy between persisting respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

Background: From March – June 2021, the third wave of the COVID-19 pandemic occurred in Germany. First and second wave evaluations showed an increase in mental health problems and a reduction of quality of life in adolescents. In August 2021, two vaccines against COVID-19 were approved for adolescents aged 12-17 years in Germany. Aim of the study was to assess mental health and health-related quality of life (HRQoL) after 1.5 years of COVID-19 pandemic in adolescents who decided to receive a vaccination. Methods: In the German region of Siegen-Wittgenstein, all students from 12-17 years from secondary level schools, vocational schools and universities were offered a prioritized vaccination against COVID-19. Mental health and HRQoL were assessed at the first vaccination appointment by self- and parental report. Adolescents and their parents completed the Strength and Difficulties Questionnaire (SDQ) and the KIDSCREEN-10. Results: Data from 1412 adolescents (49.2% female, 47.7% male; mean age 14.3 years, SD=1.64) and 908 parents were collected. Mean self-reported HRQoL was T=53.7 (SD=11.2), in boys significantly higher than in girls (56.0 vs. 51.3), and significantly higher in younger (12-14 years) than in older (15-17 years) adolescents (56.2 vs. 51.5). Parental-reported HRQoL was T=51.8 (SD=12.8). In total, 18.5% of adolescents reported clinically relevant psychological symptoms, especially peer problems (23.7%), emotional problems (16.7%) and hyperactivity (17.2%). Girls reported significantly higher scores on emotional, peer and total problems than boys, whereas younger adolescents reported more hyperactivity and less emotional and peer problems than older ones. Comparing the present data to evaluations after the first and second wave of COVID-19 in Germany, adolescents facing vaccination after the third wave rated a higher HRQoL and reported less mental health problems. The data from the present study are comparable to those from pre-COVID evaluations. Conclusion: After 1.5 years of living with the pandemic, adolescents may have adapted to the changes in everyday life which has lowered the anticipated stress. Further, the relaxation of restrictions, better school organization and the prospect of the vaccination may have increased optimism, wellbeing and contentment, leading to declining but still alarming rates of psychological symptoms.

In the current SARS-CoV-2 pandemic, wearing a face mask is mandatory again during school lessons. There are no controlled studies in children to date indicating an effect on cognitive performance from wearing face masks. In a randomized controlled trial, we analysed the influence of face masks on cognitive performance of pupils during regular school lessons. Pupils (n = 133, fifth to seventh grade) were randomized by alternating allocation into control (with masks, n = 65) and intervention groups (without mask, n = 68). After two school lessons with (control) and without (intervention) face masks in class, all pupils performed digital tests for cognitive performance regarding attention and executive functions (switch, Corsi block-tapping, 2-back and flanker task). Overall, there were no significant differences in cognitive performance between both groups, masks vs. no masks. Wearing face masks has no significant influence on attention and executive functions of pupils and can still be recommended during school lessons.

Background There is increasing evidence suggesting that patients with Borderline Personality Disorder (BPD) are at greater risk of developing cardiovascular diseases (CVD) compared to the general population. Homocysteine (Hcy) has been discussed as a serum marker for endothelial dysfunction as a mechanism involved in CVD and has been shown to be associated with numerous psychiatric conditions. Pathophysiologically, there seems to be a link between Hcy and psychological stress mediated by abnormal activity of the autonomic nervous system. Accordingly, the present study sought to examine Hcy in BPD and to explore possible associations with clinical parameters. Methods Plasma Hcy levels as well as conventional cardiovascular risk factors, such as blood pressure, BMI, smoking habits, HbA1c, HDL, LDL, and cholesterol, were examined in 49 young female in-patients diagnosed with BPD and 50 psychologically healthy control subjects matched for age and sex. Assessment of borderline symptom severity, childhood trauma, exposure to chronic stress, and quality of sleep was performed using self-reported questionnaires. Results BPD patients showed significantly higher mean plasma Hcy concentrations compared to controls, though below ranges considered pathological. Moreover, Hcy correlated significantly with the severity of childhood trauma, chronic stress, and subjective sleep disturbances. In a regression model BPD diagnosis was found to predict Hcy levels best. Conclusion In conclusion, young female BPD patients with no history of CVD show higher, though non-pathological, Hcy levels compared to healthy controls. Our findings seem to support the assumption that BPD is associated with increased risk of CVD, and that Hcy could serve as potential marker for risk evaluation of midlife CVD in BPD patients.

Introduction: L-Arginine (Arg) is a semi-essential amino acid. Constitutive and inducible nitric oxide synthase (NOS) isoforms convert Arg to nitric oxide (NO), a potent vaso- and bronchodilator with multiple biological functions. Atopic dermatitis (AD) and bronchial asthma (BA) are atopic diseases affecting many children globally. Several studies analyzed NO in airways, yet the systemic synthesis of NO in AD and BA in children with BA, AD or both is elusive. Methods: In a multicenter study, blood and urine were obtained from 130 of 302 participating children for the measurement of metabolites of the Arg/NO pathway (BA 31.5%; AD 5.4%; AD + BA 36.1%; attention deficit hyperactivity disorder (ADHD) 12.3%). In plasma and urine amino acids Arg and homoarginine (hArg), both substrates of NOS, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), both inhibitors of NOS, dimethylamine (DMA), and nitrite and nitrate, were measured by gas chromatography–mass spectrometry. Malondialdehyde (MDA) was measured in plasma and urine samples to evaluate possible effects of oxidative stress. Results: There were no differences in the Arg/NO pathway between the groups of children with different atopic diseases. In comparison to children with ADHD, children with AD, BA or AD and BA had higher plasma nitrite (p < 0.001) and nitrate (p < 0.001) concentrations, suggesting higher systemic NO synthesis in AD and BA. Urinary excretion of DMA was also higher (p = 0.028) in AD and BA compared to patients with ADHD, suggesting elevated ADMA metabolization. Discussion/Conclusion: The Arg/NO pathway is activated in atopic diseases independent of severity. Systemic NO synthesis is increased in children with an atopic disease. Plasma and urinary MDA levels did not differ between the groups, suggesting no effect of oxidative stress on the Arg/NO pathway in atopic diseases.

The article Short-term effects of carbohydrates differing in glycemic index (GI) consumed at lunch on children’s cognitive function in a randomized crossover study, written by Kathrin Jansen, Jana Tempes, Alina Drozdowska, Maike Gutmann, Michael Falkenstein, Anette E. Buyken, Lars Libuda, Henrik Rudolf, Thomas Lücke, Mathilde Kersting was originally published Online First without Open Access. After publication in volume 74, issue 5, page 757 - 764 the author decided to opt for Open Choice and to make the article an Open Access publication. Therefore, the copyright of the article has been changed to © The Author(s) 2020 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

This current consensus paper for long COVID complements the existing AWMF S1 guidelines for long COVID with a detailed overview on the various clinical aspects of long COVID in children and adolescents. Members of 19 different pediatric societies of the DGKJ convent and collaborating societies together provide expert-based recommendations for the clinical management of long COVID based on the currently available but limited academic evidence for long COVID in children and adolescents. It contains screening questions for long COVID and suggestions for a structured, standardized pediatric medical history and diagnostic evaluation for patients with suspected long COVID. A time and resource-saving questionnaire, which takes the clinical complexity of long COVID into account, is offered via the DGKJ and DGPI websites as well as additional questionnaires suggested for an advanced screening of specific neurocognitive and/or psychiatric symptoms including post-exertional malaise (PEM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). According to the individual medical history as well as clinical signs and symptoms a step by step diagnostic procedure and a multidisciplinary therapeutic approach are recommended.

In the current Sars-CoV-2 pandemic, wearing a face mask was mandatory and is still desired during school lessons. There are no controlled studies in children to date indicating an effect on cognitive performance wearing face masks. In a randomized controlled trial, we analysed the influence of face masks on cognitive performance of pupils during regular school lessons. Pupils (n=133, 5th to 7th grade) were randomized by alternating allocation into control (with masks, n=65) and intervention groups (without mask, n=68). After two school lessons with (control) and without (intervention) face masks in class all pupils performed digital tests for cognitive performance regarding attention and executive functions (Switch, CORSI block tapping, 2-back and flanker task). Overall, there were no significant differences in cognitive performance between both groups, masks vs. no masks. Wearing face masks has no significant influence on attention and executive functions of pupils and can still be recommended during school lessons.

SARS-CoV-2 infection rates in children and adolescents are often underestimated due to asymptomatic or oligosymptomatic infections. Seroprevalence studies can reveal the magnitude of “silent” infections in this age group and help to assess the risk of infection for children but also their role in spreading the disease. In total, 2045 children and their parents from the Ruhr region were finally included after the exclusion of drop-outs. Seroconversion rates among children of all age groups increased from 0.5% to 8% during the study period and were about three to fourfold higher than the officially registered PCR-based infection rates. Only 41% recalled symptoms of infection, 59% were asymptomatic. In 51% of the infected children, at least one parent also developed SARS-CoV-2 antibodies. Depending on local incidences, the rates of seroconversion rose to different levels during the study period. Although the dynamics of infection within the study cohort mirrors local incidence, the figure of SARS-CoV-2 infections in children and adolescents appears to be high. Reported contact with SARS-CoV-2-infected individuals in the same household carries a high risk of infection.

Canavan disease (CD; MIM 271,900) or spongy degeneration of the central nervous system (CNS) is a lethal, rare autosomal recessive leukodystrophy, first described in 1931 (Canavan in Arch Neurol Psychiatry 25: 299–308, 1931). The clinical presentation includes severe neurologic impairment and macrocephaly with onset of symptoms at the age of 3–5 months. Biochemical and genetic fundamentals of the disease are elucidated. Imaging diagnosis is principally based on MRI with important role of MR spectroscopy. We report the cerebral sonographic findings in a severely affected infant with CD: Diffuse hyperechogenicity and small multicystic changes of white matter as well as an inverted pattern of echogenicity between cortical gray and subcortical white matter. These findings are compared to to the few cases found in literature and to normal ultrasound examples. Finally, ultrasound and MRI imaging findings are correlated.

Inherited disorders of neurotransmitter metabolism are a group of rare diseases, which are caused by impaired synthesis, transport, or degradation of neurotransmitters or cofactors and result in various degrees of delayed or impaired psychomotor development. To assess the effect of neurotransmitter deficiencies on intelligence, quality of life, and behavior, the data of 148 patients in the registry of the International Working Group on Neurotransmitter Related Disorders (iNTD) was evaluated using results from standardized age-adjusted tests and questionnaires. Patients with a primary disorder of monoamine metabolism had lower IQ scores (mean IQ 58, range 40-100) within the range of cognitive impairment (, Dietmar Hopp Stiftung (DE); Medical Faculty of the University of Heidelberg.

Orphanet journal of rare diseases : OJRD 17(1), 47 (2022). doi:10.1186/s13023-022-02176-1, Published by BioMed Central, London

Background Hyperprolinemia type 2 (HPII) is a rare autosomal recessive disorder of the proline metabolism, that affects the ALDH4A1 gene. So far only four different pathogenic mutations are known. The manifestation is mostly in neonatal age, in early infancy or early childhood. Case presentation The 64-years female patient had a long history of abdominal pain, and episode of an acute neuritis. Ten years later she was admitted into the neurological intensive-care-unit with acute abdominal pain, multiple generalized epileptic seizures, a vertical gaze palsy accompanied by extensive lactic acidosis in serum 26.0 mmol/l (reference: 0.55–2.2 mmol/l) and CSF 12.01 mmol/l (reference: 1.12–2.47 mmol/l). Due to repeated epileptic seizures and secondary complications a long-term sedation with a ventilation therapy over 20 days was administered. A diagnostic work-up revealed up to 400-times increased prolin-level in urine CSF and blood. Furthermore, a low vitamin-B6 serum value was found, consistent with a HPII causing secondary pyridoxine deficiency and seizures. The ALDH4A1 gene sequencing confirmed two previously unknown compound heterozygous variants (ALDH4A1 gene (NM_003748.3) Intron 1: c.62 + 1G > A - heterozygous and ALDH4A1 gene (NM_003748.3) Exon 5 c.349G > C, p.(Asp117His) - heterozygous). Under high-dose vitamin-B6 therapy no further seizures occurred. Conclusion We describe two novel ALDH4A1-variants in an adult patient with hyperprolinemia type II causing secondary pyridoxine deficiency and seizures. Severe and potentially life-threatening course of this treatable disease emphasizes the importance of diagnostic vigilance and thorough laboratory work-up including gene analysis even in cases with atypical late manifestation.

Wie wirkt sich die Ernahrung auf den Aufbau und die Funktion unseres Gehirnes aus? Und welche Ernahrung konnte die Entwicklung moglicherweise auch langfristig unterstutzen? Die Zusammenhange zwischen Ernahrung und Hirngesundheit rucken in den letzten Jahren zunehmend in den Blickpunkt von Padiatrie und Ernahrungswissenschaft.

In der Beratung und Betreuung von Familien und Kindern mit vegetarischen Kostformen stellen sich insbesondere die Fragen, welche Nahrstoffe unter der gewahlten Kost kritisch knapp sein konnten, und ob die Kost im Einzelfall moglicherweise mit einem gesundheitlichen Risiko fur Sauglinge, Kinder und Jugendliche einhergeht. Stellungnahmen von Fachgesellschaften und Institutionen geben meist lediglich nahrstoffbasierte Empfehlungen, die bei vegetarischen Kostformen (insbesondere fur Kinder) zu beachten sind. Die vorliegende Arbeit bietet fur die familiar oft individuell gestalteten vegetarischen Kostformen spezifische lebensmittelbasierte Hinweise zur Verminderung bekannter Risiken, die sich an der jeweiligen Auspragung der anamnestisch erhobenen Kostform in der Familie orientieren. Ausgangsbasis sind die in der padiatrischen Beratung bewahrten und durchkalkulierten lebensmittelbasierten Praventionskonzepte fur die Ernahrung von Sauglingen, Kindern und Jugendlichen in Deutschland.

This systematic review aims to evaluate previous findings on the dose-related effects of short- and long-term physical activities (PA) on executive functions (EF) using a new approach by considering the success of experimental manipulation. Eight electronic databases were searched between May 2021 and September 2021. Randomized control trials among healthy children (6–12 years) were screened. Data extraction included the measurement of experimental manipulations and pre–post measurements of physical fitness. After identifying 1774 records, 17 studies were included (nine short-term PA and eight long-term PA). The overall results suggest that a single 20-min PA may be overwhelming for short-term EF in children up to 9 years of age but may be beneficial for children 9 years and older. A dose-related relationship between PA and EF could not be verified in long-term studies, which is possibly due to insufficient fitness gains and participation in the intervention. Short- and long-term endurance and coordination training could improve children’s executive functions, but so far, there is no specific evidence on the duration, frequency, and intensity of PA. Not quantity but quality of intervention seems to be important in this context. Further intervention studies are needed that control for the characteristics of the experimental manipulation.

New techniques in molecular genetic diagnostics now allow for accurate diagnosis in a large proportion of patients with muscular diseases. Nevertheless, many patients remain unsolved, although the clinical history and/or the muscle biopsy give a clear indication of the involved genes. In many cases, there is a strong suspicion that the cause must lie in unexplored gene areas, such as deep-intronic or other non-coding regions. In order to find these changes, next-generation sequencing (NGS) methods are constantly evolving, making it possible to sequence entire genomes to reveal these previously uninvestigated regions. Here, we present a young woman who was strongly suspected of having a so far genetically unsolved sarcoglycanopathy based on her clinical history and muscle biopsy. Using short read whole genome sequencing (WGS), a homozygous inversion on chromosome 13 involving SGCG and LINC00621 was detected. The breakpoint in intron 2 of SGCG led to the absence of γ-sarcoglycan, resulting in the manifestation of autosomal recessive limb-girdle muscular dystrophy 5 (LGMDR5) in the young woman.

This study investigated the relationship between different levels of physical fitness and cognitive functions in boys and girls. Schoolchildren from a comprehensive school in Germany (n = 211, 39% girls, 5th and 6th grade) attended regular or sport-focused classes with different numbers of physical education (PE) classes per week (3 vs. 5–6 h). Performance of physical fitness was tested according to endurance, strength, speed, coordination and flexibility. Four computerized instruments (switch task, 2-back task, Corsi block-tapping task and flanker task) were used to test cognitive functions. Additional predictors, sex, age, PE class, Body Mass Index and physical activity, were included in analyses. The results showed that physical fitness was associated with improved attention and memory functions in children, although the associations were mostly small. After Bonferroni correction, mainly coordination was related to improved cognition. Physical activity, i.e., step counts, PE class and sex were associated with specific cognitive outcomes. These findings may be important for effective health promotion, and supporting children’s education in the school environment. Sex-specific physical activities in school could potentially lead to greater cognitive benefits in children. Randomized trials are needed to replicate these results.

OBJECTIVES: The implementation of the “10 Step” programme of WHO/UNICEF for breastfeeding promotion (BFP) in maternity hospitals is considered as a key for long-term breastfeeding success of mothers worldwide. The objective of this work was to determine whether this expectation also holds true for Germany. METHODS: The nationwide SuSe II study (2017–19) is a combination of a cross-sectional survey in maternity hospitals and a prospective follow-up of mother-infant pairs (0.5, 2, 4, 6, 12 months postpartum (pp)) recruited in the participating hospitals. All German maternity hospitals were invited to complete an online questionnaire assessing BFP based on the 10 Steps. Mothers reported if they were breastfeeding and if the infant received any other fluid or food. Relevant factors for exclusive breastfeeding (EBF) during the first 4 months pp were determined in 5 multivariable models with variable selection through backward elimination according to the likelihood ratio. RESULTS: One hundred and three hospitals (15% out of 692) recruited 929 mothers (33% of eligible mothers) who had tried to breastfeed, with a compliance of about 90%. During hospital stay, 74% of mothers exclusively breastfed, 77% at discharge, 74% 2 weeks, 70% 2 months and 58% 4 months pp. Hospitals had implemented between 2 and 10 Steps (median 7). Until 4 months pp, the rate of EBF was higher, if mothers had given birth in hospitals with a high BFP (≥9 Steps) compared to medium (6–8 Steps) or low promotion (≤5 Steps). Even after adjusting for potential confounders, high BFP compared to medium and low promotion significantly increased the modeled odds of mothers for EBF during hospital stay (p = 0.000), at discharge (p = 0.005) and 2 months pp (p = 0.002). Maternal breastfeeding experience and absence of a pacifier significantly increased the modeled odds of mothers for EBF at all 5 time points pp. CONCLUSIONS: Implementation of at least 9 of the 10 Steps for BFP in hospitals was related to mothers' breastfeeding success in the first 2 months. It is noteworthy that this association was found even at the high level of BFP in hospitals and the high initial breastfeeding rates in the SuSe II study. FUNDING SOURCES: Funding: Federal Ministry of Food and Agriculture Client: German Society for Nutrition.

A recent study concerning the “Impact of COVID-19 on the Interrelation of Physical Activity, Screen Time and Health-Related Quality of Life in Children and Adolescents in Germany” was investigated by Wunsch et al. [...]

Juvenile Paget disease (JPD) is an ultra-rare disease, characterized by loss of function of osteoprotegerin. Osteoprotegerin inhibits osteoclast activation via the receptor activator of nuclear factor κB (RANK) pathway. Severely affected children suffer from bone deformities and pain and require long term anti-resorptive treatment. Due to the rarity of the disease, few long-term follow-up data on the clinical course in children are available. In this report, motor development during infancy and early childhood and the activity of the bone disease based on clinical, radiographic and biochemical parameters are reported in 2 children with severe forms of JPD during long term treatment (4 and 14 years) with bisphosphonates. Results of a bone biopsy in patient 1 after 10 years of treatment and video material of the motor development of patient 2 are provided. Doses per year of pamidronate ranged from 4 to 9 mg/kg bodyweight and were administered in 4–10 courses, yearly. Treatment was adjusted individually according to the presence of bone pain. Motor development was delayed in both children before treatment with bisphosphonates was commenced and improved thereafter. Bone histology revealed a significantly higher heterogeneity of mineralization which was mainly attributed to the increased percentage of low mineralized bone areas. Individualized intravenous treatment with pamidronate resulted in sufficient control of bone pain and suppression of bone turnover with few side effects over the observation period., Highlights • Long-term individualized treatment with intravenous bisphosphonates in children with JPD is safe and effective to control bone turnover and pain • Histomorphometric analyses reveal signs of high bone turnover despite long-term anti resorptive treatment. • Without curative treatment options, severe forms of JPD are a debilitating disease with high morbidity and increased mortality

Objectives:The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier.Design:In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF.Setting:Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019).Participants:In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included.Results:In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding.Conclusions:In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.