Habituation durch repetitive elektrische Stimulation bei einem neuen Modell zur Testung der konditionierten Schmerzmodulation

Conditioned Pain Modulation (CPM) ist ein etabliertes Testparadigma zur Untersuchung der Fähigkeit zur körpereigenen Schmerzhemmung. Bei einem neuen Paradigma wird CPM durch repetitive elektrische Hautstimulation (painful cutaneous electrical stimulation = PCES) als Teststimulus und einen Kaltwasserreiz als konditionierenden Stimulus ausgelöst. Diese Studie untersucht den Anteil der Habituation an der Reduktion der Schmerzintensität und der Amplitudenhöhe zeitgleich abgeleiteter evozierter Potenziale bei gesunden Probanden. Bei repetitiver elektrischer Reizung über einen längeren Zeitraum mit PCES-Elektroden bei konstanter Stromintensität tritt eine signifikante Reduktion der Schmerzintensität sowie der N1P1-Amplitudenhöhe der evozierten Potentiale ein. Quantitativ sind die Effekte jedoch deutlich geringer als die durch CPM mit einem Kälteschmerz erzielbare Reduktion von Schmerzintensität und N1P1-Amplitudenhöhe, sodass diese sich allein durch Habituation nicht erklärt

To Mask or Not to Mask—Evaluation of Cognitive Performance in Children Wearing Face Masks during School Lessons (MasKids)

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

Evaluation of an automated analysis for pain-related evoked potentials

This paper presents initial steps towards an auto-mated analysis for pain-related evoked potentials (PREP) to achieve a higher objectivity and non-biased examination as well as a reduction in the time expended during clinical daily routines. While manually examining, each epoch of an en-semble of stimulus-locked EEG signals, elicited by electrical stimulation of predominantly intra-epidermal small nerve fibers and recorded over the central electrode (Cz), is in-spected for artifacts before calculating the PREP by averag-ing the artifact-free epochs. Afterwards, specific peak-latencies (like the P0-, N1 and P1-latency) are identified as certain extrema in the PREP’s waveform. The proposed automated analysis uses Pearson’s correlation and low-pass differentiation to perform these tasks. To evaluate the auto-mated analysis’ accuracy its results of 232 datasets were compared to the results of the manually performed examina-tion. Results of the automated artifact rejection were compa-rable to the manual examination. Detection of peak-latencies was more heterogeneous, indicating some sensitivity of the detected events upon the criteria used during data examina-tion

Generation and validation of a PREP sample response

PREP are typical signal courses in the EEG, which are used to investigate the influence of neuropathologies or, for example, post-traumatic headaches on pain processing. The medically meaningful peaks are detected manually for further analysis. To develop a more time-efficient method, an automatic, latency-independent way of detection was created using the cross-correlation function, which generates a sample response for each data set. The comparison of automatic and manual methods shows advantages and disadvantages of both methods, but no significant deviation of the automatic method can be found

Longitudinal Rise in Seroprevalence of SARS-CoV-2 Infections in Children in Western Germany—A Blind Spot in Epidemiology?

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

Longitudinal Rise in Seroprevalence of SARS-CoV-2 Infections in Children in Western Germany—A Blind Spot in Epidemiology?

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

Pulmonary function and long-term respiratory symptoms in children and adolescents after COVID-19

$\bf Background:$ Persistent 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. $\bf Methods:$ Participants 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. $\bf Findings:$ In 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 ($\it p$ = 0.012) in patients with severe SARS-CoV-2 infection. $\bf Interpretation:$ Pulmonary 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

Painful cutaneous electrical stimulation vs. heat pain as test stimuli in conditioned pain modulation

Different paradigms can assess the effect of conditioned pain modulation (CPM). The aim of the present study was to compare heat pain, as an often used test stimulus (TS), to painful cutaneous electrical stimulation (PCES), having the advantage of the additional recording of PCES-related evoked potentials. In 28 healthy subjects we applied heat and PCES at the dominant hand as test stimulus (TS) to compare the CPM-effect elicited by hand immersion into cold water (10 °C) as conditioning stimulus (CS). Subjects rated the pain intensity of TS at baseline, during and 5 min after CS application and additionally of CS, on a numerical rating scale (NRS) (0–100). The "early" (during CS–before CS) and 'late' (after CS–before CS) CPM-effects were analyzed. Parallel to the PCES, the related evoked potentials were recorded via Cz to evaluate any changes in PCES-amplitudes. CS reduced significantly the pain intensity of both PCES and heat pain as TS. On a group level, the CPM-effect did not differ significantly between both paradigms. Both early and late CPM-effect based on PCES correlated significantly with the CS pain intensity ($\it r$ = −0.630 and −0.503, respectively), whereas using heat pain the correlation was not significant. We found a significant reduction of PCES-amplitudes during CS, but this did not correlate with the PCES-induced pain intensity. Correlation with the CS painfulness $\it r$ = −0.464) did not achieve the significance level after Bonferroni correction. The extent of the CPM effects was similar in both testing paradigms at group level, despite intraindividual differences. Future studies should further elicit the exact mechanisms explaining the modality of these specific differences

Somatosensory abnormalities after infection with SARS-CoV-2

$\bf Background:$ Long-term neurological complaints after SARS-CoV-2 infection occur in 4–66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals. $\textbf {Materials and Methods:}$ Eighty-one subjects after SARS-CoV-2 infection ($\it n$ = 44 female, 11.4 $\pm$ 3.5 years, $\it n$ = 75 SARS-CoV-2 seropositive, $\it n$ = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, $\it n$ = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 $\pm$ 3.4 years, $\it n$ = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with $\it z$-value 0 $\pm$ 1), as well as with each other, as previously described. Statistical analyses: $\it t$-test, Chi-squared test, and binominal test. $\bf Findings:$ None of the controls, but 27 of the 81 patients (33%, $\it p$ < 0.001) reported persistent complaints 2.7 $\pm$ 1.9 (0.8–8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter ($\it p$ < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2–4 months. $\bf Interpretation:$ This study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired