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Background: An association of different autoimmune diseases is suspected. In juvenile idiopathic arthritis (JIA), only few and partially conflicting data on the co-existence of other autoimmune disorders are available. The prevalence of autoantibodies in patients with JIA in Germany is not known., Methods: Samples from 499 patients (median age at time of blood collection 11 years, median disease duration 4.4 years) in the prospective, multicenter inception cohort of children newly diagnosed with JIA (ICON-JIA) were analysed for the presence of anti-thyroid antibodies, celiac disease-specific antibodies (anti-tTG IgA, anti-tTG IgG), and connective tissue disease-associated antibodies (CTD-screen)., Results: A total of 76 (15.2%) patients had either clinically diagnosed autoimmune comorbidity or elevated autoantibodies. Of 21 patients with clinical autoimmune comorbidity, only 8 were also serologically positive at the time of testing, while 55 patients had autoantibodies without clinical diagnosis. Thus, 63 patients (12.6%) had at least one elevated autoantibody. Antibodies against thyroglobulin were found in 3% and against thyreoperoxidase in 4% of the samples. TSH receptor antibodies could not be detected in any of the 499 patients. Tissue transglutaminase antibodies were elevated in 0.4% of the patients. A positive screen for CTD-specific antinuclear antibodies was found in 7%, but only rarely specific antibodies (anti-dsDNA 1.4%, anti-SS-A and -SS-B 0.2% each, anti-CENP-B 0.4%) were confirmed., Conclusions: In our study, a specific correlation between JIA and other autoimmune phenomena could not be confirmed. The lack of well-matched control groups makes interpretation challenging. Further data need to corroborate the suspected increased risk of developing other autoimmune phenomena in JIA patients., (© 2022. The Author(s).)

Objective: Due to the increasing degree of internationalization and migration movements, German universities must increasingly pay attention to the cultural diversity of their students. Numerous studies have shown that there is still considerable room for improvement at German universities with regard to the integration of foreign students. Therefore, the University of Cologne aims at improving study conditions for students from third countries (especially non-EU) by introducing a compulsory study entry semester Studienstart International . In this study, we ask if effects on the dropout rates of international students before the introduction of Studienstart International can be observed after the introduction of the study entry semester. In addition, results of a survey of foreign students about familiarizing themselves with the German university educational system and on social contacts with fellow students are presented. Methods: After a one-year voluntary pilot phase in summer semester 2009 and winter semester 2009/10, Studienstart International was made compulsory for Non-EU students in preparation for the study of human medicine. 113 students of the human medicine degree program have taken part in this program since the beginning of winter semester 2016/17. The comparison of dropout rates before and after the introduction of Studienstart International as well as the results from a survey of foreign students are presented descriptively. Statistical significance of the difference in dropout rates between the two groups of students is tested using a Chi 2 -test. Results: The dropout rates of foreign students fell slightly from 19% to 14% following the introduction of the mandatory study entry semester, but this difference is not statistically significant (Chi 2 =0.785, df=1, p=0.376). According to the survey, almost three-quarters of foreign students have contact with German fellow students at the university, 55% of whom report daily contact. 68% of respondents have contact with German fellow students outside the university. 97% feel they are well prepared for the degree course and 91% say they know where to go with questions and problems during their studies. Conclusion: With the introduction of the compulsory study entry semester Studienstart International , the University of Cologne aims at improving integration of foreign students. Although dropout rates could not be significantly reduced, survey results suggest that Studienstart International can certainly support international students. Reliable statements on the success of the study cannot yet be made due to the small number of cases. A follow-up study will deal with this question.

Objectives: Associations of interleukin-10 (IL-10) promoter single nucleotide polymorphisms (SNPs) and their haplotypes with systemic lupus erythematosus (SLE) are unclear. We extended the analysis of established proximal IL-10 promoter haplotypes to a more distal SNP with functional capacity., Methods: Two hundred and ten German caucasian SLE patients fulfilling the ACR criteria and 160 ethnically, age and sex matched controls were genotyped for IL-10 -2849 G > A, -1082 A > G, -819 T > C and -592 C > A. Haplotypes were reconstructed via a mathematical model, then allele and haplotype distributions were compared between patients and controls and patients with different disease manifestations., Results: We detected at -2849, -1082, -819 and -592 the four predominant haplotypes GGCC (22% in patients vs. 29% in controls), AGCC (24% vs. 21%), GACC (30% vs. 25%) and GATA (24% vs. 24%). GGCC was underrepresented in SLE patients, suggesting a protective effect (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.48-0.94). AGCC was found significantly more frequently in patients with pathognomonic anti-dsDNA antibodies (26% vs. 15%; OR 1.98, 95% CI 1.04-3.75). As compared to patients with glomerulonephritis type V (WHO classification), the presumptive IL-10 high producer allele -2849 G was found significantly more often in patients with GN type III/IV (93% vs. 60%; OR 8.7, 95% CI 1.59-47.15)., Conclusion: Our data confirm that the complexity of the IL-10 promoter evokes the need for a meticulous analysis of its haplotypic structure in order to specify disease associations, particularly under functional aspects, thereby shedding light on the pathophysiology of SLE.

Unlabelled: Population-representative data on sleep disorders in children is scarce., Background and Objective: The aim of this epidemiological study was to determine the prevalence of various sleep-related breathing disorders (SRBD) and any correlations with occlusion and jaw abnormalities in preschool children., Materials and Methods: The study material consisted of 4,318 children (5.5 years old) whose parents completed the Pediatric Sleep Questionnaire (PSQ); 60 out of 140 children (6.3 ± 0.78 years old) with a positive questionnaire score (> 0.33) were examined by an orthodontist and ENT specialist. From this cohort, 15 children who presented a dental occlusion and jaw abnormality but no indication for surgical reduction of adenotonsillar tissue underwent polysomnography in a sleep laboratory., Results: According to the PSQ, 3.3% of the 5.5-year-olds showed evidence of a SRBD. Boys were affected significantly more frequently. Lack of concentration, hyperactivity, morning fatigue, mouth breathing, loud snoring, and breathing interruptions were indicators of SRBD. The SRBD children more frequently presented with jaw abnormalities such as mandibular retrognathia, lateral cross-bite, and increased overjet. The SRBD cohort showed a higher rate of orofacial dysfunctions. Adenotonsillar hyperplasia still played a significant role in the development of SRBD., Conclusion: In contrast to previous reports in the literature, the frequency of SRBD in our group of 5- to 6-year-olds was lower (3%). Boys with adenotonsillar hyperplasia and/or mandibular retrognathia, lateral cross bite, and an enlarged overjet require special attention.

Purpose: We aimed to determine the impact of insulin resistance and hyperandrogenemia on polysomnographic variables in obese adolescents with polycystic ovarian syndrome (PCOS), as studies in adults with PCOS suggest that parameters of glucose metabolism and serum androgens are related to respiratory polysomnographic variables (RPV), and the symptoms of PCOS usually begin around menarche., Methods: We divided our study group of obese adolescents with PCOS according to HOMA-index and in a second analysis according to free androgen index (FAI). Study group A consisted of 14 girls with HOMA-index <4, study group B of 17 girls with HOMA-index >4. Study group C consisted of 19 girls with FAI <10, and study group D of 18 girls with FAI >10. The control group for both analyses consisted of 19 healthy obese adolescents without PCOS. All girls underwent overnight 12-channel polysomnography., Results: In both analyses, we found no differences between the groups concerning the RPV. Study group B demonstrated a significantly lower percentage of REM-sleep than the control group (p = 0.02). Study group D demonstrated a significantly lower percentage sleep stages 3 and 4 of non-REM-sleep than study group C and the controls (p = 0.008). Study group D demonstrated significantly lower sleep efficiency than the controls (p = 0.03)., Conclusions: Insulin resistance and hyperandrogenemia do not seem to have a significant impact on RPV in obese adolescents with PCOS. Differences in sleep architecture found between patients with PCOS and controls, however, are possibly influenced by insulin resistance and/or serum androgens.

Objective: To study the relative contribution of tumour necrosis factor (TNF) and HLA-DRB1 polymorphisms to the genetic susceptibility to systemic lupus erythematosus (SLE) via an extended haplotype analysis., Methods: We performed an association study in 205 unrelated German Caucasian patients with SLE fulfilling the 1997 revised American College of Rheumatology (ACR) criteria. Healthy age-, ethnically- and sex-matched individuals (n = 157) served as controls. HLA-DRB1 typing was performed by a sequence-specific oligonucleotide hybridisation assay. Two TNF single nucleotide polymorphisms (SNPs) and two multiallelic microsatellites were analysed by mutagenically separated polymerase chain reaction (PCR) or fragment length analysis, respectively. Extended haplotypes were reconstructed with the PHASE software., Results: Alleles for all polymorphic loci studied and the most frequent haplotypes showed a significantly different distribution between SLE patients and controls. The alleles HLA-DR2, DR3, TNFd1, TNF2, TNFB*1, and TNFa2, designated as risk alleles, and the extended haplotypes DR3-TNFd1-TNF2-TNFB*1-TNFa2 and DR2-TNFd3-TNF1-TNFB*2-TNFa11 prevailed in SLE patients. TNF risk alleles were strongly positively linked with HLA-DR3 and negatively linked with HLA-DR2. Thus, in HLA-DR3 haplotypes individual effects of TNF polymorphisms could not be resolved. By contrast, HLA-DR2 showed an association with SLE independently of TNF risk alleles, while the risk increased further when they were present. In haplotypes lacking HLA-DR2 and DR3, the alleles TNFdl and TNF2 contributed independently to SLE susceptibility., Conclusion: Extended haplotype analysis revealed HLA-DR3 independent associations of TNF polymorphisms with susceptibility to SLE. Haplotypes that have been shown to be associated with different TNF-alpha production capacity may prevail in different disease subgroups.

Background: A biallelic polymorphism (--174 G/C) within the interleukin-6 (IL-6) promoter reportedly has functional importance through the modulation of IL-6 expression in vitro and in vivo., Methods: We performed a population-based case-control study to analyse the association of the --174 G/C polymorphism with disease susceptibility and clinical manifestations in 211 German patients with systemic lupus erythematosus (SLE)., Results: There were no significant differences in allelic and genotypic frequencies between patients and healthy controls. Comparing patients with various disease manifestations, we found an association of the --174 G allele with discoid skin lesions (Pc=0.034) and anti-histone antibodies (Pc=0.009)., Conclusions: The IL-6 promoter polymorphism --174 G/C does not contribute significantly to disease susceptibility, but predisposes to distinct clinical and immunological features. A genetically determined high IL-6 response may have a pathogenic role under these conditions.

Apnea characteristics of infants, who were destined to die, were compared with control infants, matched for gestational age, sex, birth weight and age at sleep study. From 1989 to 1994 polygraphic recordings were performed in 4268 infants. In this population 7 cases of sudden infant death (SID) and 13 deaths from other causes (non-SID) occurred. Concerning all forms of apneas a higher frequency and maximal duration was found in the SID group. The number of infants with obstructive apneas and the number of obstructive apneas per infant were higher in future SID victims, as was the frequency, mean and maximal duration of central apneas of 3 to 10 s. The recordings of non-SID-infants were not different from their controls. As a group, future SID victims showed apnea characteristics different from control infants. Together with epidemiologic risk factors these polygraphic factors contribute to an identification of infants at risk for SID.