Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy ...being the most common underlying risk factor. Surgical removal of enlarged adenoids or tonsils is the currently recommended first-line treatment for OSA due to adenotonsillar hypertrophy. Given the perioperative risk and an estimated recurrence rate of up to 20% following surgery, there has recently been an increased interest in less invasive alternatives to adenotonsillectomy. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory drugs have been proposed as a potential non-surgical treatment option in children with OSA.
To assess the efficacy and safety of anti-inflammatory drugs for the treatment of OSA in children.
We identified trials from searches of the Cochrane Airways Group Specialised Register, CENTRAL and MEDLINE (1950 to 2019). For identification of ongoing clinical trials, we searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal.
Randomised controlled trials (RCTs) comparing anti-inflammatory drugs against placebo in children between one and 16 years with objectively diagnosed OSA (apnoea/hypopnoea index (AHI) ≥ 1 per hour).
Two authors independently performed screening, data extraction, and quality assessment. We separately pooled results for the comparisons 'intranasal steroids' and 'montelukast' against placebo using random-effects models. The primary outcomes for this review were AHI and serious adverse events. Secondary outcomes included the respiratory disturbance index, desaturation index, respiratory arousal index, nadir arterial oxygen saturation, mean arterial oxygen saturation, avoidance of surgical treatment for OSA, clinical symptom score, tonsillar size, and adverse events.
We included five trials with a total of 240 children aged one to 18 years with mild to moderate OSA (AHI 1 to 30 per hour). All trials were performed in specialised sleep medicine clinics at tertiary care centres. Follow-up time ranged from six weeks to four months. Three RCTs (n = 137) compared intranasal steroids against placebo; two RCTs compared oral montelukast against placebo (n = 103). We excluded one trial from the meta-analysis since the patients were not analysed as randomised. We also had concerns about selective reporting in another trial. We are uncertain about the difference in AHI (MD -3.18, 95% CI -8.70 to 2.35) between children receiving intranasal corticosteroids compared to placebo (2 studies, 75 participants; low-certainty evidence). In contrast, children receiving oral montelukast had a lower AHI (MD -3.41, 95% CI -5.36 to -1.45) compared to those in the placebo group (2 studies, 103 participants; moderate-certainty evidence). We are uncertain whether the secondary outcomes are different between children receiving intranasal corticosteroids compared to placebo: desaturation index (MD -2.12, 95% CI -4.27 to 0.04; 2 studies, 75 participants; moderate-certainty evidence), respiratory arousal index (MD -0.71, 95% CI -6.25 to 4.83; 2 studies, 75 participants; low-certainty evidence), and nadir oxygen saturation (MD 0.59%, 95% CI -1.09 to 2.27; 2 studies, 75 participants; moderate-certainty evidence). Children receiving oral montelukast had a lower respiratory arousal index (MD -2.89, 95% CI -4.68 to -1.10; 2 studies, 103 participants; moderate-certainty evidence) and nadir of oxygen saturation (MD 4.07, 95% CI 2.27 to 5.88; 2 studies, 103 participants; high-certainty evidence) compared to those in the placebo group. We are uncertain, however, about the difference in desaturation index (MD -2.50, 95% CI -5.53 to 0.54; 2 studies, 103 participants; low-certainty evidence) between the montelukast and placebo group. Adverse events were assessed and reported in all trials and were rare, of minor nature (e.g. nasal bleeding), and evenly distributed between study groups. No study examined the avoidance of surgical treatment for OSA as an outcome.
There is insufficient evidence for the efficacy of intranasal corticosteroids for the treatment of OSA in children; they may have short-term beneficial effects on the desaturation index and oxygen saturation in children with mild to moderate OSA but the certainty of the benefit on the primary outcome AHI, as well as the respiratory arousal index, was low due to imprecision of the estimates and heterogeneity between studies. Montelukast has short-term beneficial treatment effects for OSA in otherwise healthy, non-obese, surgically untreated children (moderate certainty for primary outcome and moderate and high certainty, respectively, for two secondary outcomes) by significantly reducing the number of apnoeas, hypopnoeas, and respiratory arousals during sleep. In addition, montelukast was well tolerated in the children studied. The clinical relevance of the observed treatment effects remains unclear, however, because minimal clinically important differences are not yet established for polysomnography-based outcomes in children. Long-term efficacy and safety data on the use of anti-inflammatory medications for the treatment of OSA in childhood are still not available. In addition, patient-centred outcomes like concentration ability, vigilance, or school performance have not been investigated yet. There are currently no RCTs on the use of other kinds of anti-inflammatory medications for the treatment of OSA in children. Future RCTs should investigate sustainability of treatment effects, avoidance of surgical treatment for OSA, and long-term safety of anti-inflammatory medications for the treatment of OSA in children and include patient-centred outcomes.
Sources of magnetic fields-magnetic monopoles-have so far proven elusive as elementary particles. Condensed-matter physicists have recently proposed several scenarios of emergent quasiparticles ...resembling monopoles. A particularly simple proposition pertains to spin ice on the highly frustrated pyrochlore lattice. The spin-ice state is argued to be well described by networks of aligned dipoles resembling solenoidal tubes-classical, and observable, versions of a Dirac string. Where these tubes end, the resulting defects look like magnetic monopoles. We demonstrated, by diffuse neutron scattering, the presence of such strings in the spin ice dysprosium titanate (Dy2Ti2O7). This is achieved by applying a symmetry-breaking magnetic field with which we can manipulate the density and orientation of the strings. In turn, heat capacity is described by a gas of magnetic monopoles interacting via a magnetic Coulomb interaction.
Aims/hypothesis
The anatomic location of excess body fat has an impact on associated cardiometabolic morbidity, and visceral adipose tissue (VAT) is more pathogenic than subcutaneous adipose tissue ...(SAT). However, VAT or SAT alone provides little information regarding the relative distribution of body fat. We hypothesised that the propensity to store energy in VAT relative to SAT depots may be a correlate of cardiometabolic risk, and tested this hypothesis using the VAT/SAT ratio as a metric of fat distribution.
Methods
We investigated associations of the VAT/SAT ratio with cardiometabolic traits in 3,223 participants (48% women) from the Framingham Heart Study. Fat depots were quantified by multidetector computed tomography (CT) scanning.
Results
In women and men, higher VAT/SAT ratio was associated (
p
< 0.05) with most assessed cardiovascular risk factors reflecting blood pressure, dyslipidaemia and insulin resistance. Additional adjustment for BMI did not materially change the findings in women, and generally strengthened associations in men. Further adjustment for VAT attenuated some associations in women, but those with lower HDL-cholesterol, higher triacylglycerol (both
p
< 0.0001) and higher prevalence of hypertension (
p
= 0.02), diabetes (
p
= 0.01) and the metabolic syndrome (
p
= 0.005) remained significant. Similarly, in men, associations with higher systolic (
p
= 0.006) and diastolic blood pressure (
p
= 0.03), higher fasting glucose (
p
= 0.0005), lower HDL-cholesterol and higher triacylglycerol (both
p
< 0.0001) and higher prevalence of diabetes (
p
= 0.006) remained significant.
Conclusions/interpretation
VAT/SAT ratio is a correlate of cardiometabolic risk, above and beyond BMI and VAT. The propensity to store fat viscerally versus subcutaneously may be a unique risk factor independent of absolute fat volumes.
Introduction
Professionals in the inpatient care of burdened children and adolescents are confronted with high demands in their daily work. The job satisfaction can be affected negatively, if these ...professionals do not have the necessary resources to carry out their work.
Objectives
In a study as part of the accompanying research of an online course called “Trauma informed Care”, the connection between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction were investigated on a sample of N = 543 professionals working in the (inpatient) care of children and adolescents.
Methods
In order to quantify the connections between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction, correlations and a multiple regression were calculated.
Results
Moderate to strong correlations were identified between personal resources and job satisfaction among the professionals. The regression model revealed self-efficacy to be the most important predictor of job satisfaction. Self-care was also identified as an important predictor. Less importance could be ascribed to emotional competence. Action competence showed no effects in the regression model.
Conclusions
The results indicate the importance of personal resources for job satisfaction an their targeted promotion in order to increase job satisfaction and thus counteract the tendency of fluctuation and shortage of professionals in the area of child and youth welfare.
Disclosure
No significant relationships.
Foxp3 (forkhead box P3 transcription factor)-expressing regulatory T cells (Tregs) are essential for immunological tolerance, best illustrated by uncontrolled effector T-cell responses and ...autoimmunity upon loss of Foxp3 expression. Tregs can adopt specific effector phenotypes upon activation, reflecting the diversity of functional demands in the different tissues of the body. Here, we report that Foxp3(+)CD4(+) T cells coexpressing retinoic acid-related orphan receptor-γt (RORγt), the master transcription factor for T helper type 17 (Th17) cells, represent a stable effector Treg lineage. Transcriptomic and epigenetic profiling revealed that Foxp3(+)RORγt(+) T cells display signatures of both Tregs and Th17 cells, although the degree of similarity was higher to Foxp3(+)RORγt(-) Tregs than to Foxp3(-)RORγt(+) T cells. Importantly, Foxp3(+)RORγt(+) T cells were significantly demethylated at Treg-specific epigenetic signature genes such as Foxp3, Ctla-4, Gitr, Eos, and Helios, suggesting that these cells have a stable regulatory rather than inflammatory function. Indeed, adoptive transfer of Foxp3(+)RORγt(+) T cells in the T-cell transfer colitis model confirmed their Treg function and lineage stability in vivo, and revealed an enhanced suppressive capacity as compared with Foxp3(+)RORγt(-) Tregs. Thus, our data suggest that RORγt expression in Tregs contributes to an optimal suppressive capacity during gut-specific immune responses, rendering Foxp3(+)RORγt(+) T cells as an important effector Treg subset in the intestinal system.
Sodium cobaltate (NaxCoO2) has emerged as a material of exceptional scientific interest due to the potential for thermoelectric applications, and because the strong interplay between the magnetic and ...superconducting properties has led to close comparisons with the physics of the superconducting copper oxides. The density x of the sodium in the intercalation layers can be altered electrochemically, directly changing the number of conduction electrons on the triangular Co layers. Recent electron diffraction measurements reveal a kaleidoscope of Na+ ion patterns as a function of concentration. Here we use single-crystal neutron diffraction supported by numerical simulations to determine the long-range three-dimensional superstructures of these ions. We show that the sodium ordering and its associated distortion field are governed by pure electrostatics, and that the organizational principle is the stabilization of charge droplets that order long range at some simple fractional fillings. Our results provide a good starting point to understand the electronic properties in terms of a Hubbard hamiltonian that takes into account the electrostatic potential from the Na superstructures. The resulting depth of potential wells in the Co layer is greater than the single-particle hopping kinetic energy and as a consequence, holes preferentially occupy the lowest potential regions. Thus we conclude that the Na+ ion patterning has a decisive role in the transport and magnetic properties.
Introduction
Adolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the ...transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should give greater consideration to the transition phase.
Objectives
An online-course addressing health care professionals was developed to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize for the special challenges and needs of young adults with mental illness. Evaluation focuses on the gain of competences, benefit for practical work and user satisfaction.
Methods
Participants´ estimations and opinions on quality of the online-course, on impact of course participation to their practical work and on their competences regarding transition psychiatry are assessed with an online-survey before starting (t1) and after finishing (t2) the online-course. T1-assessment is already completed with 1924 datasets, t2-assessmend will take place 02/2022.
Results
Analyses of t1-assessment show a high heterogeneity of participants regarding their work background and setting. Special knowledge about mental illnesses during transition and about transition psychiatry, as well as feeling confident in accompanying transition processes is on a medium level. Results of t2-assessment and comparing analyses are expected in March 2022 and will be presented.
Conclusions
There was high interest of the target group in participating in the online-course. Evaluation will show if the online-course is a helpful measure in delievering the necessary education of professionals in transition psychiatry.
Disclosure
No significant relationships.
Background
Data on the long‐term impact of hydrolyzed formulas on allergies are scarce.
Objective
To assess the association between early intervention with hydrolyzed formulas in high‐risk children ...and allergic outcomes in adolescence.
Methods
GINI trial participants (n = 2252) received one of four formulas in the first four months of life as breastmilk substitute if necessary: partial or extensive whey hydrolyzate (pHF‐W, eHF‐W), extensive casein hydrolyzate (eHF‐C) or standard cow′s milk formula (CMF) as reference. Associations between these formulas and the cumulative incidence and prevalence of parent‐reported physician‐diagnosed asthma, allergic rhinitis (AR) and eczema, as well as spirometric indices and sensitization, were examined using generalized linear models.
Results
Between 11 and 15 years, the prevalence of asthma was reduced in the eHF‐C group compared to CMF (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.26–0.89), which is consistent with the spirometric results. The cumulative incidence of AR was lower in eHF‐C (risk ratio (RR) 0.77, 95% CI 0.59–0.99) and the AR prevalence in pHF‐W (OR 0.67, 95% CI 0.47–0.95) and eHF‐C (OR 0.59, 95% CI 0.41–0.84). The cumulative incidence of eczema was reduced in pHF‐W (RR 0.75, 95% CI 0.59–0.96) and eHF‐C (RR 0.60, 95% CI 0.46–0.77), as was the eczema prevalence between 11 and 15 years in eHF‐C (OR 0.42, 95% CI 0.23–0.79). No significant effects were found in the eHF‐W group on any manifestation,nor was there an effect on sensitization with any formula.
Conclusion
In high‐risk children, early intervention using different hydrolyzed formulas has variable preventative effects on asthma, allergic rhinitis and eczema up to adolescence.
Mountain environments represent heterogeneous environments with shallow soils that are sensitive to human impact and climate change. Despite the thin soil cover, high soil organic carbon content of ...mountain soils may provide a major source of atmospheric CO2, if released. However, the importance of mountain soils remains controversial, largely due to insufficient information on the spatial variability of mountain SOC stocks. Here, we study the spatial variability of soil properties and SOC stocks in a changing mountain environment in the Bernese Alps (Switzerland) and the methodologies to assess them. We use different interpolation techniques (averaging, inverse distance, ordinary-, block- and regression-kriging) and sampling densities and analyze the sources of uncertainty using a nested sampling approach and the Gaussian and Taylor error propagation.
We found a low sensitivity of the median SOC stocks of the study area (ranging between 8.1 and 8.6kgCm−2 in the upper 30cm), the general patterns of the predicted stocks and the explanatory power with respect to the utilized interpolation techniques. In contrast the small-scale SOC pattern fluctuates strongly between different interpolation techniques. All interpolation techniques, except regression kriging, show a low variability of the calculated root mean square errors of the predicted SOC stocks in terms of variable sampling densities. To improve spatial prediction using regression kriging, which combines the kriging approach with multiple linear regression based on factors controlling the SOC variability (e.g. soil type, land use and topography), large sampling density (>35 samples per km2) is required in alpine environments. This is especially true for the coarse mineral fraction, which introduces the largest source of uncertainty. Nested sampling designs seem to provide an efficient tool to study SOC inventories and their associated sources of uncertainties in mountain environments.
•SOC inventories in alpine environments are characterized by large uncertainty.•Nested sampling allows estimation of spatial uncertainty of SOC inventories.•Analytical uncertainty is smaller than uncertainty related to spatial variability.•Uncertainty related to vertical variability is smaller than horizontal uncertainty.
Introduction
Adolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the ...transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should be given greater consideration to the transition phase.
Objectives
The aim of the project ProTransition is the development of an online course for health care professionals to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize them for the special challenges and needs of young adults with mental illness.
Methods
The online-course is being developed at the Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm and is expected to start in May 2021. It comprises e.g. special psychopathology of emerging adulthood, clinical interventions for adolescents with mental illness or legal aspects. An innovative and multi-didactical approach with specialized texts, case-studies, online-chats and interviews with experts and young people is applied. Additionally, user satisfaction with the online course will be evaluated.
Results
On the basis of the gained experiences, ideas for new transition-psychiatric treatment models will be derived. The accompanying research will point out the status quo and the course-related increasing knowledge of health care professionals regarding transition psychiatry. First results are expected in November 2021.
Conclusions
As transition psychiatry is facing great difficulties and challenges, professionals should be adequately educated. E-Learning offers a flexible and low-level approach to reach a broad target group.
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