Environmental influences on childhood allergies and asthma - The Farm effect.

Asthma and allergies are major health problems and exert an enormous socioeconomic burden. Besides genetic predisposition, environmental factors play a crucial role in the development of these diseases in childhood. Multiple worldwide epidemiological studies have shown that children growing up on farms are immune to allergic diseases and asthma. Farm-related exposures shape children's immune homeostasis, via mediators such as N-glycolylneuraminic acid or arabinogalactan, or by diverse environmental microbes. Moreover, nutritional factors, such as breastfeeding or farm milk and food diversity, inducing short-chain fatty acids-producing bacteria in the intestine, contribute to farm-related effects. All farm-related exposures induce an anti-inflammatory response of the innate immunity and increase the differentiation of regulatory T cells and T helper cell type 1. A better understanding of the components of the farm environment, that are protective to the development of allergy and asthma, and their underlying mechanisms, will help to develop new strategies for the prevention of allergy and asthma

Non-invasive optical measurement of cerebral critical closing pressure in pediatric hydrocephalus

Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology that results in elevated intracranial pressure (ICP) and progressive expansion of cerebral ventricles.1 It affects 1-2 of every 1000 live births, making it the most common disease treated by pediatric neurosurgeons in the US.1 In roughly half of infants with hydrocephalus, ventricular expansion requires surgical intervention whereby a shunt is placed in the ventricles to divert CSF and relieve elevated ICP. Although timely treatment of elevated ICP is important for brain tissue viability, its implementation is hindered by the lack of tools for non-invasive ICP measurement. This study aims to validate non-invasive intracranial pressure (ICP) assessment with the near-infrared diffuse correlation spectroscopy (DCS) technique in infants with hydrocephalus. DCS employs near-infrared light to measure local, microvascular cerebral blood flow (CBF) continuously at the bedside. In addition to CBF, a novel approach for measurement of cerebral critical closing pressure (CrCP) based on DCS measurements of pulsatile CBF in arterioles was recently demonstrated.2-4 CrCP, which depends on ICP, defines the arterial blood pressure at which CBF approaches zero. Intraoperative non-invasive CrCP measurements with DCS on the prefrontal cortex were performed concurrently with invasive ICP measurements in 9 infants with hydrocephalus at the Children’s Hospital of Philadelphia. Invasive ICP was measured during surgical shunt placement. Please click Additional Files below to see the full abstract

Electrical impedance spectroscopy detects skin barrier dysfunction in childhood atopic dermatitis

Background Skin barrier dysfunction is associated with the development of atopic dermatitis (AD), however methods to assess skin barrier function are limited. We investigated the use of electrical impedance spectroscopy (EIS) to detect skin barrier dysfunction in children with AD of the CARE (Childhood AlleRgy, nutrition, and Environment) cohort. Methods EIS measurements taken at multiple time points from 4 months to 3‐year‐old children, who developed AD (n = 66) and those who did not (n = 49) were investigated. Using only the EIS measurement and the AD status, we developed a machine learning algorithm that produces a score (EIS/AD score) which reflects the probability that a given measurement is from a child with active AD. We investigated the diagnostic ability of this score and its association with clinical characteristics and age. Results Based on the EIS/AD score, the EIS algorithm was able to clearly discriminate between healthy skin and clinically unaffected skin of children with active AD (area under the curve 0.92, 95% CI 0.85–0.99). It was also able to detect a difference between healthy skin and AD skin when the child did not have active AD. There was no clear association between the EIS/AD score and the severity of AD or sensitisation to the tested allergens. The performance of the algorithm was not affected by age. Conclusions This study shows that EIS can detect skin barrier dysfunction and differentiate skin of children with AD from healthy skin and suggests that EIS may have the ability to predict future AD development

Systematic review of the association between short chain fatty acids and allergic diseases.

We performed a systematic review to investigate the current evidence on the association between allergic diseases and short chain fatty acids (SCFAs), which are microbially produced and suggested as one mechanism on how gut microbiome affects the risk of allergic diseases. Medline, Embase and Web of Science were searched from data inception until September 2022. We identified 37 papers, of which 17 investigated prenatal or early childhood SCFAs and the development of allergic diseases in childhood, and 20 assessed SCFAs in patients with pre-existing allergic diseases. Study design, study populations, outcome definition, analysis method and reporting of the results varied between papers. Overall, there was some evidence showing that the three main SCFAs (acetate, propionate and butyrate) in the first few years of life had a protective effect against allergic diseases, especially for atopic dermatitis, wheeze or asthma and IgE-mediated food allergy in childhood. The association between each SCFA and allergic disease appeared to be different by disease and the age of assessment. Further research that can determine the potentially timing specific effect of each SCFA will be useful to investigate how SCFAs can be used in treatment or in prevention against allergic diseases

Electrical impedance spectroscopy detects skin barrier dysfunction in childhood atopic dermatitis.

BACKGROUND Skin barrier dysfunction is associated with the development of atopic dermatitis (AD), however methods to assess skin barrier function are limited. We investigated the use of electrical impedance spectroscopy (EIS) to detect skin barrier dysfunction in children with AD of the CARE (Childhood AlleRgy, nutrition, and Environment) cohort. METHODS EIS measurements taken at multiple time points from 4 months to 3-year-old children, who developed AD (n = 66) and those who did not (n = 49) were investigated. Using only the EIS measurement and the AD status, we developed a machine learning algorithm that produces a score (EIS/AD score) which reflects the probability that a given measurement is from a child with active AD. We investigated the diagnostic ability of this score and its association with clinical characteristics and age. RESULTS Based on the EIS/AD score, the EIS algorithm was able to clearly discriminate between healthy skin and clinically unaffected skin of children with active AD (area under the curve 0.92, 95% CI 0.85-0.99). It was also able to detect a difference between healthy skin and AD skin when the child did not have active AD. There was no clear association between the EIS/AD score and the severity of AD or sensitisation to the tested allergens. The performance of the algorithm was not affected by age. CONCLUSIONS This study shows that EIS can detect skin barrier dysfunction and differentiate skin of children with AD from healthy skin and suggests that EIS may have the ability to predict future AD development

Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease

OBJECTIVE To determine growth and its relationship to IQ in children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery within the first year of life. STUDY DESIGN Prospective single-center cohort study on 143 children (91 males) with different types of CHD (29 univentricular). Children with recognized genetic disorders were excluded. Growth (weight, height, and head circumference [HC]) was assessed at birth, before surgery, and at 1, 4, and 6 years and compared with Swiss growth charts. IQ was assessed at 6 years using standardized tests. Univariate and multivariable linear regressions were performed to determine predictors of HC and IQ at 6 years. RESULTS HC at birth was in the low average range (33rd percentile, P = .03), and weight (49th percentile, P = .23) and length (47th percentile, P = .06) were normal. All growth measures declined until the first surgery, with a catch-up growth until 6 years for height (44th percentile, P = .07) but not for weight (39th percentile, P = .003) or for HC (23rd percentile, P < .001). Children undergoing univentricular palliation showed poorer height growth than other types of CHD (P = .01). Median IQ at 6 years was 95 (range 50-135). Lower IQ at 6 years was independently predicted by lower HC at birth, lower socioeconomic status, older age at first bypass surgery, and longer length of intensive care unit stay. CONCLUSIONS Smaller HC at birth and postnatal factors are predictive of impaired intellectual abilities at school age. Early identification should alert clinicians to provide early childhood interventions to optimize developmental potential

Popmusikforschung für Popmusikstudierende. Ein Erfahrungsbericht aus der Universitätslehre

Heye A, Flieger K. Popmusikforschung für Popmusikstudierende. Ein Erfahrungsbericht aus der Universitätslehre. In: Ahlers M, ed. Popmusik-Vermittlung. Zwischen Schule, Universität und Beruf. Theorie und Praxis der Musikvermittlung. Vol 14. Münster: LIT; 2015: 371-387

Smaller brain volumes at two years of age in patients with hypoplastic left heart syndrome - Impact of surgical approach

BACKGROUND Brain growth in hypoplastic left heart syndrome (HLHS) is reduced before and after birth. Little is known about further brain growth until two years of age before Fontan procedure and the potential impact of type of surgery. METHODS In a prospective, two-center study 29 patients with HLHS and variants were treated by Norwood (n = 5) or Hybrid procedure (n = 24). At two years of age a cerebral MRI was performed and brain volumes (total gray, deep gray, white matter) and cerebrospinal fluid volume were calculated using FreeSurfer image analysis suite and compared to a healthy control group (n = 8). RESULTS The total brain volumes in patients with HLHS were smaller compared to controls (HLHS: 893 ± 76 ml vs. controls: 1015 ± 148 ml, p = 0.005). This difference was found in all three brain compartments after Norwood procedure, whereas patients after Hybrid procedure had total and deep gray volumes comparable to controls. When comparing Norwood to Hybrid patients, deep gray matter volume reduction was more pronounced (Norwood: 38.4 ± 4.1 ml vs. Hybrid: 44.4 ± 3.9 ml, p = 0.005) than white matter reduction (Norwood: 255 ± 19 ml vs. Hybrid: 285 ± 31 ml, p = 0.032). CONCLUSIONS Smaller total and regional brain volumes were found two years after Norwood or Hybrid procedure in children with HLHS. The brain volume reduction was more distinct after Norwood than after Hybrid procedure. Longitudinal studies are needed to identify impact of early staged-surgeries on brain development and may become part of the decision-making process in individual patients

Neurodevelopmental Outcome and Health-related Quality of Life in Children With Single-ventricle Heart Disease Before Fontan Procedure

Neurodevelopmental impairment and impaired quality of life constitute a major source of morbidity among children with complex congenital heart disease, in particular for single-ventricle (SV) morphologies. Risk factors and quality of life determining clinical and neurodevelopmental outcome at 2 years of age are examined. In a 2-center cohort study, 48 patients with SV morphology (26 hypoplastic left heart syndrome and 22 other types of univentricular heart defect) have been examined before Fontan procedure between 2010 and 2015. Patients were assessed with the Bayley Scales of Infant and Toddler Development, Third Version (Bayley-III), and the Preschool Children Quality of Life (TAPQOL) questionnaire. A total of 44 patients underwent hybrid procedure (n = 25), Norwood procedure (n = 7), or shunt or banding procedure (n = 12) as first surgery before subsequent bidirectional cavopulmonary anastomosis (n = 48). Median cognitive, language, and motor composite scores on the Bayley-III were 100 (range 65-120), 97 (68-124), and 97 (55-124), respectively. The language composite score was significantly below the norm (P = 0.025). Risk factors for poorer neurodevelopmental outcome were prolonged mechanical ventilation, longer days of hospital stay, and more reinterventions (all P < 0.05). Parents reported a good quality of life for their children. Children undergoing Fontan procedure show a favorable development and good quality of life. More complicated postoperative course and reinterventions constitute risk factors for impaired neurodevelopment. Improving postoperative management and implementing routine follow-up assessments aremeasures to further improve the neurodevelopmental outcome of this high-risk patient population