Emerging Roles of Small Extracellular Vesicles in Gastrointestinal Cancer Research and Therapy

Discovered in the late eighties, sEVs are small extracellular nanovesicles (30-150 nm diameter) that gained increasing attention due to their profound roles in cancer, immunology, and therapeutic approaches. They were initially described as cellular waste bins; however, in recent years, sEVs have become known as important mediators of intercellular communication. They are secreted from cells in substantial amounts and exert their influence on recipient cells by signaling through cell surface receptors or transferring cargos, such as proteins, RNAs, miRNAs, or lipids. A key role of sEVs in cancer is immune modulation, as well as pro-invasive signaling and formation of pre-metastatic niches. sEVs are ideal biomarker platforms, and can be engineered as drug carriers or anti-cancer vaccines. Thus, sEVs further provide novel avenues for cancer diagnosis and treatment. This review will focus on the role of sEVs in GI-oncology and delineate their functions in cancer progression, diagnosis, and therapeutic use.

The Role of Human Milk Oligosaccharides in Myelination, Socio-Emotional and Language Development: Observational Data from Breast-Fed Infants in the United States of America

Infancy is a critical period for neurodevelopment, which includes myelination, synaptogenesis, synaptic pruning, and the development of motor, social-emotional, and cognitive functions. Human milk provides essential nutrients to the infant's developing brain, especially during the first postnatal months. Human milk oligosaccharides (HMOs) are a major component of human milk, and there is growing evidence of the association of individual HMOs with cognitive development in early life. However, to our knowledge, no study has explained these associations with a mechanism of action. Here, we investigated possible mediating associations between HMOs in human milk, brain myelination (measured via myelin water fraction), and measures of motor, language (collected via the Bayley Scales of Infant and Toddler Development (Bayley-III)), and socioemotional development (collected via the Ages and Stages Questionnaire: Social-Emotional Version (ASQ-SE)) in healthy term-born breast-fed infants. The results revealed an association between 6'Sialyllactose and social skills that was mediated by myelination. Furthermore, associations of fucosylated HMOs with language outcomes were observed that were not mediated by myelination. These observations indicate the roles of specific HMOs in neurodevelopment and associated functional outcomes, such as social-emotional function and language development.

Impact of a Nutrient Formulation on Longitudinal Myelination, Cognition, and Behavior from Birth to 2 Years: A Randomized Clinical Trial

Observation studies suggest differences in myelination in relation to differences in early life nutrition. This two-center randomized controlled trial investigates the effect of a 12-month nutritional intervention on longitudinal changes in myelination, cognition, and behavior. Eighty-one full-term, neurotypical infants were randomized into an investigational (N = 42) or a control group (N = 39), receiving higher versus lower levels of a blend of nutrients. Non-randomized breastfed infants (N = 108) served as a reference group. Main outcomes were myelination (MRI), neurodevelopment (Bayley-III), social-emotional development (ASQ:SE-2), infant and toddler behavior (IBQ-R and TBAQ), and infant sleep (BISQ) during the first 2 years of life. The full analysis set comprised N = 67 infants from the randomized groups, with 81 myelin-sensitive MRI sequences. Significantly higher myelination was observed in the investigational compared to the control group at 6, 12, 18, and 24 months of life, as well as significantly higher gray matter volume at 24 months, a reduced number of night awakenings at 6 months, increased day sleep at 12 months, and reduced social fearfulness at 24 months. The results suggest that brain development may be modifiable with brain- and age-relevant nutritional approaches in healthy infants and young children, which may be foundational for later learning outcomes.

Human milk oligosaccharide composition and associations with growth: results from an observational study in the US

Background

Breast milk is the recommended source of nutrients for newborns and infants. Human milk oligosaccharides (HMO) are the third most abundant solid component in human milk and their composition varies during lactation.

Objectives

Our objective was to investigate longitudinal and cross-sectional changes in HMO composition and whether these changes were associated with infant growth up to 24 months of age. Associations with maternal characteristics were also investigated.

Methods

24 HMOs were quantified in samples taken at 2 weeks (n = 107), 6 weeks (n = 97) and 3 months (n = 76), using high performance liquid chromatography. Body length, weight, and head circumference were measured at 8 timepoints, until 24 months. Clusters of breast milk samples, reflecting different HMO profiles, were found through a data-driven approach. Longitudinal associations were investigated using functional principal component analysis (FPCA) and used to characterize patterns in the growth trajectories.

Results

Four clusters of samples with similar HMO composition were derived. Two patterns of growth were identified for length, body weight and head circumference via the FPCA approach, explaining more than 90% of the variance. The first pattern measured general growth while the second corresponded to an initial reduced velocity followed by an increased velocity ("higher velocity"). Higher velocity for weight and height was significantly associated with negative Lewis status. Concentrations of 3'GL, 3FL, 6'GL, DSNLT, LNFP-II, LNFP-III, LNT, LSTb were negatively associated with higher velocity for length.

Conclusion

We introduced novel statistical approaches to establish longitudinal associations between HMOs evolution and growth. Based on our approach we propose that HMOs may act synergistically on children growth. A possible causal relationship should be further tested in pre-clinical and clinical setting.

Internal fixation of canine coccygeal vertebral fractures: four cases (2018-2022)

OBJECTIVES

To describe the surgical technique and evaluate the outcome and complications after coccygeal vertebral fracture repair in dogs using internal fixation.

MATERIALS AND METHODS

Medical records and radiography of client-owned dogs were reviewed retrospectively. A lateral approach to the vertebral body was used, and a 1.5 or 1.0 mm plate was applied laterally. Initial follow-up included clinical and radiographic assessment at 6 to 8 weeks postoperatively. Short-term follow-up was assessed by the completion of an adapted functional questionnaire by owners.

RESULTS

Four dogs presented with mid-vertebral body fractures. The neurological function of the tail was preserved, and fracture repair was performed in all cases. One dog developed a surgical site infection, which was successfully treated with antimicrobial therapy. One dog experienced prolonged postoperative pain and delayed union. Fracture healing occurred in all patients at the final follow-up. Neither discomfort nor reduced function or mobility of the tails was noticed during the postoperative patient assessment. The questionnaire was completed by all owners with a mean follow-up time of 40 weeks. Excellent outcomes were established from subsequent clinical reviews and owner questionnaires, related to their dog's activity and comfort levels.

CLINICAL SIGNIFICANCE

Excellent outcomes can be achieved following the repair of coccygeal vertebral fractures in dogs using internal fixation, including a return to normal function of the tail.

Dynamic Interplay between Social Brain Development and Nutrient Intake in Young Children

Myelination of the brain structures underlying social behavior in humans is a dynamic process that parallels the emergence of social-emotional development and social skills in early life. Of the many genetic and environmental factors regulating the myelination processes, nutrition is considered as a critical and modifiable early-life factor for establishing healthy social brain networks. However, the impact of nutrition on the longitudinal development of social brain myelination remains to be fully understood. This study examined the interplay between childhood nutrient intake and social brain development across the first 5 years of life. Myelin-sensitive neuroimaging and food-intake data were analyzed in 293 children, 0.5 to 5 years of age, and explored for dynamic patterns of nutrient-social brain myelin associations. We found three data-driven age windows with specific nutrient correlation patterns, 63 individual nutrient-myelin correlations, and six nutrient combinations with a statistically significant predictive value for social brain myelination. These results provide novel insights into the impact of specific nutrient intakes on early brain development, in particular social brain regions, and suggest a critical age-sensitive opportunity to impact these brain regions for potential longer-term improvements in socio-emotional development and related executive-function and critical-thinking skills.

Dietary tryptophan-rich protein hydrolysate can acutely impact physiological and psychological measures of mood and stress in healthy adults

BACKGROUND

Tryptophan is the precursor to the mood regulating neurotransmitter serotonin. Its brain bioavailability from food can be dependent on the dietary source. Egg protein hydrolysate (EPH), a dietary supplement rich in tryptophan, has previously shown to acutely impact cognition, mood and stress benefits at 2 g dose. No data exist on the acute effects of lower doses in a food matrix.

METHODS

This exploratory study tested the acute effects of low-doses EPH (0.5, 1 g) in a food matrix on cognition, mood and stress. The study employed a double-blinded randomized controlled parallel design in 45 participants with three arms. The effects of the interventions were measured after a multi-task cognitive stressor on blood biomarkers, self-reported mood states, performances of attention, autonomic parameters and, emotional reactivity responses from electroencephalographic recording.

RESULTS

As compared to the reference, the 1 g EPH dose increased tryptophan bioavailability from baseline, and, both doses improved heart rate variability parameters related to parasympathetic activation while showing differences in the late neural response to negative versus neutral emotions. Post-hoc analyses indicated a gender difference in the baseline tryptophan bioavailability and further examination suggested the change in mood rating depends on the interaction between gender and change from baseline of tryptophan bioavailability.

CONCLUSIONS

Overall, this study suggests that low levels of tryptophan rich EPH in a food matrix positively impact mood or stress in acute settings and adds to the body of evidence linking tryptophan and dietary sources thereof with these benefits. Confirmatory randomized controlled trials are needed to confirm these findings.Trial registration number: CER-VD N°2019-00218.

Associations between sleep trajectories up to 54 months and cognitive school readiness in 4 year old preschool children

Purpose

This study explores the association between the duration and variation of infant sleep trajectories and subsequent cognitive school readiness at 48–50 months.

Methods

Participants were 288 multi-ethnic children, within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Caregiver-reported total, night and day sleep durations were obtained at 3, 6, 9, 12, 18, 24 using the Brief Infant Sleep Questionnaire and 54 months using the Child Sleep Habits Questionnaire. Total, night and day sleep trajectories with varying durations (short, moderate, or long) and variability (consistent or variable; defined by standard errors) were identified. The cognitive school readiness test battery was administered when the children were between 48 and 50 months old. Both unadjusted adjusted analysis of variance models and adjusted analysis of covariance models (for confounders) were performed to assess associations between sleep trajectories and individual school readiness tests in the domains of language, numeracy, general cognition and memory.

Results

In the unadjusted models, children with short variable total sleep trajectories had poorer performance on language tests compared to those with longer and more consistent trajectories. In both unadjusted and adjusted models, children with short variable night sleep trajectories had poorer numeracy knowledge compared to their counterparts with long consistent night sleep trajectories. There were no equivalent associations between sleep trajectories and school readiness performance for tests in the general cognition or memory domains. There were no significant findings for day sleep trajectories.

Conclusion

Findings suggest that individual differences in longitudinal sleep duration patterns from as early as 3 months of age may be associated with language and numeracy aspects of school readiness at 48–50 months of age. This is important, as early school readiness, particularly the domains of language and mathematics, is a key predictor of subsequent academic achievement.

Associations between Early Life Nutrient Intakes and Brain Maturation Show Developmental Dynamics from Infancy to Toddlerhood: A Neuroimaging Observation Study

BACKGROUND

Myelin imaging has increasingly been applied to study the impact of nutrition on brain development in recent years. Although individual dynamics for nutrient intakes and myelin trajectories previously have been investigated across childhood, the longitudinal interaction between both remains unclear in typically developed children.

OBJECTIVES

The objective of this work was to explore the developmental dynamics of nutrient-myelin interactions from infancy to early childhood using myelin imaging as a marker for brain maturation.

METHODS

Brain neuroimaging (1 scan per child) and dietary nutrient intake data were analyzed for 88 nutrients from 293 children (127 female, 62% White) from a longitudinal cohort study in the United States. A sliding window approach was used to investigate correlations between nutrient intakes and brain myelination over a continuous set of age windows. Image processing techniques (Sobel-filter vertical edge detection) were applied to determine age windows with unique association profiles, providing novel insight into how these relationships change with child age.

RESULTS

We identified 3 nutrient-myelin windows covering the age range of 1-5 y: window 1 from 6 to 20 mo with 60% positive nutrient correlations, window 2 from 20 to 30 mo with 20% positive correlations, and window 3 from 30 to 60 mo with 37% positive correlations. The windows are aligned with reported myelin and white matter dynamics that change in the first 5 y from fast and steep (window 1) to continued but slower growth (window 3), with window 2 possibly representing the inflection period.

CONCLUSIONS

To our knowledge, this is the first study in typically developing children demonstrating the developmental dynamics between early life nutrient intakes and brain maturation in toddlerhood. The knowledge can be applied for identifying targeted and brain-stage-appropriate nutritional interventions for this critical stage of brain development.

Trajectories of reported sleep duration associate with early childhood cognitive development

STUDY OBJECTIVES

Examine how different trajectories of reported sleep duration associate with early childhood cognition.

METHODS

Caregiver-reported sleep duration data (n = 330) were collected using the Brief Infant Sleep Questionnaire at 3, 6, 9, 12, 18, and 24 months and Children's Sleep Habits Questionnaire at 54 months. Multiple group-based day-, night-, and/or total sleep trajectories were derived-each differing in duration and variability. Bayley Scales of Infant and Toddler Development-III (Bayley-III) and the Kaufman Brief Intelligence Test- 2 (KBIT-2) were used to assess cognition at 24 and 54 months, respectively.

RESULTS

Compared to short variable night sleep trajectory, long consistent night sleep trajectory was associated with higher scores on Bayley-III (cognition and language), while moderate/long consistent night sleep trajectories were associated with higher KBIT-2 (verbal and composite) scores. Children with a long consistent total sleep trajectory had higher Bayley-III (cognition and expressive language) and KBIT-2 (verbal and composite) scores compared to children with a short variable total sleep trajectory. Moderate consistent total sleep trajectory was associated with higher Bayley-III language and KBIT-2 verbal scores relative to the short variable total trajectory. Children with a long variable day sleep had lower Bayley-III (cognition and fine motor) and KBIT-2 (verbal and composite) scores compared to children with a short consistent day sleep trajectory.

CONCLUSIONS

Longer and more consistent night- and total sleep trajectories, and a short day sleep trajectory in early childhood were associated with better cognition at 2 and 4.5 years.

Modes and Mechanisms of Pacific Decadal-Scale Variability

The modes of Pacific decadal-scale variability (PDV), traditionally defined as statistical patterns of variance, reflect to first order the ocean's integration (i.e., reddening) of atmospheric forcing that arises from both a shift and a change in strength of the climatological (time-mean) atmospheric circulation. While these patterns concisely describe PDV, they do not distinguish among the key dynamical processes driving the evolution of PDV anomalies, including atmospheric and ocean teleconnections and coupled feedbacks with similar spatial structures that operate on different timescales. In this review, we synthesize past analysis using an empirical dynamical model constructed from monthly ocean surface anomalies drawn from several reanalysis products, showing that the PDV modes of variance result from two fundamental low-frequency dynamical eigenmodes: the North Pacific-central Pacific (NP-CP) and Kuroshio-Oyashio Extension (KOE) modes. Both eigenmodes highlight how two-way tropical-extratropical teleconnection dynamics are the primary mechanisms energizing and synchronizing the basin-scale footprint of PDV. While the NP-CP mode captures interannual- to decadal-scale variability, the KOE mode is linked to the basin-scale expression of PDV on decadal to multidecadal timescales, including contributions from the South Pacific.

Endothelial Protein kinase D1 is a major regulator of post-traumatic hyperinflammation

Trauma is a major cause of death worldwide. The post-traumatic immune response culminates in the release of pro-inflammatory mediators, translating in the infiltration of neutrophils (PMNs) at injury sites. The extent of this inflammation is determined by multiple factors, such as PMN adhesion to the endothelium, transendothelial migration, endothelial barrier integrity as well as PMN swarming, mass infiltration and activation. This process is initiated by secondary lipid mediators, such as leukotriene B₄ (LTB₄). We here provide evidence that Protein kinase D1 (PRKD1) in endothelial cells is implicated in all these processes. Endothelial PRKD1 is activated by pro-inflammatory stimuli and amplifies PMN-mediated inflammation by upregulation of cytokine and chemokines as well as adhesion molecules, such as ICAM-1, VCAM-1 and E-selectin. This induces enhanced PMN adhesion and trans-migration. PRKD1 activation also destabilizes endothelial VE-cadherin adhesion complexes and thus the endothelial barrier, fostering PMN infiltration. We even describe a yet unrecognized PRKD1-dependant mechanism to induce biosynthesis of the PMN-swarming mediator LTB₄ directed via intercellular communication through small extracellular vesicles (sEVs) and enhanced CXCL8 secretion from activated endothelial cells. These endothelial sEVs transfer the LTB₄ biosynthesis enzyme LTA₄ hydrolase (LTA₄H) to prime PMNs, while initiating biosynthesis also requires additional signals, like CXCL8. We further demonstrate the respective LTA₄H-positive sEVs in the serum of polytrauma patients, peaking 12 h post injury. Therefore, PRKD1 is a key regulator in the coordinated communication of the endothelium with PMNs and a vital signaling node during post-traumatic inflammation.

Early Life to Adult Brain Lipidome Dynamic: A Temporospatial Study Investigating Dietary Polar Lipid Supplementation Efficacy

The lipid composition of the brain is well regulated during development, and the specific temporospatial distribution of various lipid species is essential for the development of optimal neural functions. Dietary lipids are the main source of brain lipids and thus contribute to the brain lipidome. Human milk is the only source of a dietary lipids for exclusively breastfed infant. Notably, it contains milk fat globule membrane (MFGM) enriched in polar lipids (PL). While early life is a key for early brain development, the interplay between dietary intake of polar lipids and spatial dynamics of lipid distribution during brain development is poorly understood. Here, we carried out an exploratory study to assess the early postnatal temporal profiling of brain lipidome between postnatal day (PND) 7 and PND 50 using matrix-assisted laser desorption ionization as a mass spectrometry imaging (MALDI-MSI) in an in vivo preclinical model. We also assessed the effect of chronic supplementation with PL extracted from alpha-lactalbumin-enriched whey protein concentrate (WPC) containing 10% lipids, including major lipid classes found in the brain (37% phospholipids and 15% sphingomyelin). MALDI-MSI of the spatial and temporal accretion of lipid species during brain development showed that the brain lipidome is changing heterogeneously along time during brain development. In addition, increases in 400+ PL supplement-dependent lipids were observed. PL supplementation had significant spatial and temporal effect on specific fatty esters, glycerophosphocholines, glycerophosphoethanolamines, and phosphosphingolipids. Interestingly, the average levels of these lipids per brain area tended to be constant in various brain structures across the age groups, paralleling the general brain growth. In contrast, other lipids, such as cytidine diphosphate diacylglycerol, diacylglycerophosphates, phosphocholines, specific ether-phosphoethanolamines, phosphosphingolipids, glycerophosphoinositols, and glycerophosphoserines showed clear age-dependent changes uncoupled from the general brain growth. These results suggest that the dietary PL supplementation may preferentially provide the building blocks for the general brain growth during development. Our findings add to the understanding of brain-nutrient relations, their temporospatial dynamics, and potential impact on neurodevelopment.

The interplay of chronic stress and genetic traits discriminates between patients suffering from multisomatoform disorder with pain as the leading symptom and matched controls

OBJECTIVE

Somatoform disorders and functional somatic syndromes (FSS) with symptoms that are not sufficiently explained by physical or technical examination are among the most challenging underlying causes. Many different somatoform disorders and FSS have overlapping symptoms, often with pain as the most prevalent one, leading to a high burden of disease. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We analyzed a group of 151 patients and 149 matched controls to identify interactions of genetic and environmental factors with a possible influence on the development of MSD.

DESIGN

In a retrospective case-control study, we performed a statistical analysis on 151 patients and 149 matched controls using logistic regression and a Classification and Regression Tree (CART) analysis.

RESULTS

The logistic regression analysis of genes and environmental factors demonstrated significant differences in the results of the Trier Inventory of Chronic Stress (TICS) questionnaire, the single nucleotide polymorphism rs1800955 of the dopamine receptor D4 and the single nucleotide polymorphism rs4818 of the enzyme catechol-O-methyltransferase between patients with MSD and healthy controls. The resulting decision tree of the CART analysis determined that the TICS questionnaire was able to differentiate patients and controls most accurately, followed by certain genotypes of the 5-hydroxytryptamine receptor 2A and a single nucleotide polymorphism of the enzyme catechol-O-methyltransferase.

CONCLUSIONS

The results of the statistical analysis identified a gene-environmental interaction possibly leading to MSD. The resulting identifiers could be used as a reference to inform diagnostic algorithms to easier identify patients suffering from MSD.

Electroanatomic visualization of coronary arteries: a case series to elicit safety, feasibility and diagnostic value in complex ablation procedures

Funding Acknowledgements

Type of funding sources: None.

Background

Although three dimensional (3D) electroanatomic mapping systems allow detailed assessment of anatomy and substrates, ablation still carries substantial risk when close proximity to coronary arteries is suspected. 3D integration of coronary anatomy in mapping systems is still cumbersome, highlighting the need for an option of ad hoc acquirement of coronary artery anatomy. The goal of this case series was to evaluate the feasibility of a wire-based approach to the live visualization of coronary arteries and to assess its diagnostic information regarding procedure guiding.

Methods

For this single center case series, we included procedures in which close proximity of an ablation site to an epicardial vessel had to be suspected. An uninsulated-tip wire was then introduced into the relevant coronaries via diagnostic catheters after exclusion of critical stenosis by coronary angiography. The wire was connected to an impedance based 3D mapping system using a clamp and standard pin connection. Integrating this setup in the mapping system allows for live visualization of the wire tip, as well as the assessment of local electrograms within the respective vessel.

Results

We included a total of 9 procedures (4 ventricular tachycardia (VT) ablation procedures and 5 procedures for the ablation of premature ventricular contractions (PVCs)). The left coronary arteries were mapped in 8 cases, the right coronary artery was mapped in one case. In the majority of cases, the arrhythmogenic substrate was found in the left ventricle (5/9) or left ventricular summit area and the distal coronary sinus respectively (3/9). In two cases, epicardial mapping was performed combined with visualization of the right or left coronary arteries, respectively. There were no complications attributed to coronary wiring and mapping in this case series.

In two cases, the diagnostic information from mapping of the coronary arteries could be used to rule out an epicardial origin of arrhythmia. In the majority of cases, coronary visualization was used to ascertain a proper distance between the ablation site and the vessel.

Discussion

In this case series, we could demonstrate the feasibility and safety of coronary artery visualization and its integration in a 3D mapping system. The data obtained was used for diagnostic, as well as safety aspects. The electrograms from the wire were used to quickly assess relative timing of arrhythmias, thus allowing for an estimation of possible epicardial origin.

Conclusion

Applying the same caveats as for any other wiring of coronary arteries, their electroanatomic visualization is achieved in a safe and straightforward manner, with minimal technical requirements. Mapping of the coronary arteries adds critical diagnostic information and their real-time visualization is feasible without exceeding costs or risks

A Nutrient Formulation Affects Developmental Myelination in Term Infants: A Randomized Clinical Trial

Background and Objectives

Observational studies suggest differences between breast-fed and formula-fed infants in developmental myelination, a key brain process for learning. The study aims to investigate the efficacy of a blend of docosahexaenoic acid (DHA), arachidonic acid (ARA), iron, vitamin B12, folic acid, and sphingomyelin (SM) from a uniquely processed whey protein concentrate enriched in alpha-lactalbumin and phospholipids compared with a control formulation on myelination, cognitive, and behavioral development in the first 6 months of life.

Methods

These are 6-month results from an ongoing two-center, randomized controlled trial with a 12-month intervention period (completed for all participants). In this study, full term, neurotypical infants of both sexes (N = 81) were randomized into investigational (N = 42) or control groups (N = 39). In addition, non-randomized breast-fed children (N = 108) serve as a natural reference group. Main outcomes are myelination (MRI), cognitive (Bayley Scales of Infant and Toddler Development, 3rd edition [Bayley-III]), social-emotional development (Ages and Stages Questionnaires: Social-Emotional, 2nd edition [ASQ:SE-2]), sleep (Brief Infant Sleep Questionnaire [BISQ]), and safety (growth and adverse events [AEs]).

Results

The full analyses set comprises N = 66 infants. Significant differences in myelin structure, volume, and rate of myelination were observed in favor of the investigational myelin blend at 3 and 6 months of life. Effects were demonstrated for whole brain myelin and for cerebellar, parietal, occipital, and temporal regions, known to be functionally involved in sensory, motor, and language skills. No statistically significant differences were found for early behavior and cognition scores.

Conclusions

This is the first study demonstrating the efficacy of a myelin nutrient blend in well-nourished, term infants on developmental myelination, which may be foundational for later cognitive and learning outcomes.

Clinical Trial Registration

ClinicalTrials.gov, identifier: NCT03111927.

National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project

Background

In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).

Methods

Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.

Discussion

For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00898-w.

Effects of Post-natal Dietary Milk Fat Globule Membrane Polar Lipid Supplementation on Motor Skills, Anxiety, and Long-Term Memory in Adulthood

Early life nutrition critically impacts post-natal brain maturation and cognitive development. Post-natal dietary deficits in specific nutrients, such as lipids, minerals or vitamins are associated with brain maturation and cognitive impairments. Specifically, polar lipids (PL), such as sphingolipids and phospholipids, are important cellular membrane building blocks and are critical for brain connectivity due to their role in neurite outgrowth, synaptic formation, and myelination. In this preclinical study, we assessed the effects of a chronic supplementation with a source of PL extracted from an alpha-lactalbumin enriched whey protein containing 10% lipids from early life (post-natal day (PND) 7) to adulthood (PND 72) on adult motor skills, anxiety, and long-term memory. The motor skills were assessed using open field and rotarod test. Anxiety was assessed using elevated plus maze (EPM). Long-term object and spatial memory were assessed using novel object recognition (NOR) and Morris water maze (MWM). Our results suggest that chronic PL supplementation improved measures of spatial long-term memory accuracy and cognitive flexibility in the MWM in adulthood, with no change in general mobility, anxiety and exploratory behavior. Our results indicate memory specific functional benefits of long-term dietary PL during post-natal brain development.

Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age

Background

Irritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated.

Materials and methods

In this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests.

Results

Parents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect.

Conclusion

The pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product.

Trial registration

Swiss registry of clinical trial: CER-VD 2019-02155.

How to cite this article

Lerond C, Hudry J, Zahar S, et al. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021;14(4):525–530.

Nutrients for executive function development and related brain connectivity in school-aged children

Executive functions refer to a set of higher-order cognitive processes involved in the control and organization of information to serve goal-directed behaviors. Skills in executive functioning are developed throughout childhood and adolescence and have been shown to be predictive of academic achievement. The coordination of these complex processes is critically dependent on brain maturation and connectivity, including key neurodevelopmental processes like myelination and synaptogenesis. Among other factors, research highlights the influential effect of nutrition and diet on these neurodevelopmental processes, which may impact executive function performance in healthy and deficient populations. This review considers the research to date on the role of key nutrients that have been identified for executive function development and their underlying neurophysiological processes in school-aged children.

Evolving Business Models in Orthotics

This submission provides an important historical context for understanding the current challenge facing the Orthotic and Prosthetic community in Alberta including Alberta Aids to Daily Living (AADL), Suppliers, and Providers: maintaining sustainable access to Orthotic care for people with mobility disorders in the face of declining real rates of reimbursement combined with increasing costs and a shortage of skilled Clinicians. Under the Canada Health Act, the federal government delegates responsibility for providing health care to the provinces. This delegation of responsibility to the provinces results in a degree of variability of funding of Orthotics and Prosthetics between provinces across the country. Funding of Orthotics and Prosthetics in Alberta is characterized by structural inequities that favour Prosthetics at the expense of Orthotics. To the extent that the structural inequities that exist in Alberta are related to governance by volunteer-run, non-profit organizations, they may be generalized to the Canadian experience. Finally, in a Call to Action a number of recommendations are made to address the challenge of sustainable access to Orthotic care in Alberta serving as a model for other provinces across Canada.

Connecting inside out: Development of the social brain in infants and toddlers with a focus on myelination as a marker of brain maturation

Early childhood is a sensitive period for learning and social skill development. The maturation of cerebral regions underlying social processing lays the foundation for later social‐emotional competence. This study explored myelin changes in social brain regions and their association with changes in parent‐rated social‐emotional development in a cohort of 129 children (64 females, 0–36 months, 77 White). Results reveal a steep increase in myelination throughout the social brain in the first 3 years of life that is significantly associated with social‐emotional development scores. These findings add knowledge to the emerging picture of social brain development by describing neural underpinnings of human social behavior. They can contribute to identifying age‐/stage‐appropriate early life factors in this developmental domain.

Electroconvulsive therapy practice in a general hospital in chile

Introduction

Electroconvulsive therapy (ECT) is a current, relevant treatment for severe mental illness. In this article we describe our experience on ECT in a public hospital in Chile.

Objectives

Describe a 34 patients’ cohort who received ECT and their outcomes.

Methods

Data was extracted from ECT records between 2018-2020, patients’ evaluations before and after ECT, and case files. Data was then analyzed and described.

Results

ECT was received by 18 males and 16 females. Age ranged from 19 to 73 years (41 average). More than 75% had 12 or more years of education. Patients’ diagnoses and indications for ECT are shown in Figures 1-2

The CGI-SI scale was applied to subjects before treatment, and 85% had a score of 5 or more. On average, patients received 8.7 ECT sessions. Right unilateral electrode placement (RUL) was preferred initially for 94% of patients. Brief pulse width (0.3ms) was most commonly used (76%). Seizure duration averaged in 29 seconds. Adverse reactions presented on 32%, most being mild. One treatment had to be stopped due to confusional symptoms post ECT. After ECT, 91% of patients improved according to CGI-GI scale. 55% were assessed CGI-GI 1 “very much improved”. MoCA scale was also evaluated, showing a 2,1 point gain.

Conclusions

Schizophrenia and psychosis were the most frequent diagnosis and indication for ECT. RUL and brief pulse width were the preferred settings. This cohort suggests that ECT had an impact on markedly ill patients, based on CGI and MoCA scales.

Sialylated human milk oligosaccharides program cognitive development through a non-genomic transmission mode

Breastmilk contains bioactive molecules essential for brain and cognitive development. While sialylated human milk oligosaccharides (HMOs) have been implicated in phenotypic programming, their selective role and underlying mechanisms remained elusive. Here, we investigated the long-term consequences of a selective lactational deprivation of a specific sialylated HMO in mice. We capitalized on a knock-out (KO) mouse model (B6.129-St6gal1^tm2Jxm/J) lacking the gene responsible for the synthesis of sialyl(alpha2,6)lactose (6'SL), one of the two sources of sialic acid (Neu5Ac) to the lactating offspring. Neu5Ac is involved in the formation of brain structures sustaining cognition. To deprive lactating offspring of 6'SL, we cross-fostered newborn wild-type (WT) pups to KO dams, which provide 6'SL-deficient milk. To test whether lactational 6'SL deprivation affects cognitive capabilities in adulthood, we assessed attention, perseveration, and memory. To detail the associated endophenotypes, we investigated hippocampal electrophysiology, plasma metabolomics, and gut microbiota composition. To investigate the underlying molecular mechanisms, we assessed gene expression (at eye-opening and in adulthood) in two brain regions mediating executive functions and memory (hippocampus and prefrontal cortex, PFC). Compared to control mice, WT offspring deprived of 6'SL during lactation exhibited consistent alterations in all cognitive functions addressed, hippocampal electrophysiology, and in pathways regulating the serotonergic system (identified through gut microbiota and plasma metabolomics). These were associated with a site- (PFC) and time-specific (eye-opening) reduced expression of genes involved in central nervous system development. Our data suggest that 6'SL in maternal milk adjusts cognitive development through a short-term upregulation of genes modulating neuronal patterning in the PFC.

Body mass index and self-reported body image in German adolescents

BACKGROUND

Despite knowledge about eating disorder symptoms in children and adolescents in the general population, relatively little is known about self-reported and sex-specific eating-disorder-related psychopathology, as well as its specific correlates.

METHODS

880 German school-attending adolescents (15.4 ± 2.2 years) and 30 female patients with AN (16.2 ± 1.6 years) were studied. All participants completed the Eating Disorder Inventory-2 and a Body Image Questionnaire.

RESULTS

There were more overweight males than females (15.2% vs 10.1%, p < 0.001), but more females with underweight than males (6.2% vs. 2.5%, p < .001). Negative body evaluations (p < .001) and dissatisfaction (p < .001) were significantly more frequent in females. Compared to underweight female patients with AN, underweight school-attending females had less negative body evaluations (p < .001) and lower scores on 5 of the 11 EDI-2 subscales (p < .001; p < .05).

CONCLUSIONS

Males were more overweight than females, females more underweight. Body image was more important to female than to male youth, yet without reaching pathological values when compared to female patients with AN. Complex emotional and cognitive challenges seem to be a representative factor for eating pathology rather than simply being underweight. These aspects may be relevant for the shift from a thinness-related focus in girls in the general population to the development of an eating disorder.

[Emergency and intensive care medicine aspects of COVID-19 infections]

CLINICAL ISSUE

The COVID 19 pandemic led to a profound adaptation of the German healthcare system in preparation of a massive increase of SARS-CoV-2-associated diseases. While general practitioners care for COVID patients who are less severely ill, hospitals are focused on the care of severely ill COVID-19 patients.

STANDARD TREATMENT

The role of emergency medicine (EM) is to rapidly detect the virus, to classify disease severity, and to initiate therapy. In addition, the flow of patients into the hospital must be directed in such a way that optimal care is provided without risk of infecting health care personnel and patients. Despite optimal intensive care treatment, the mortality of patients remains high if organ failure develops, especially in patients who are older or have pre-existing conditions.

TREATMENT INNOVATIONS

Rapid diagnosis of patients with SARS-CoV‑2 infection together with assessment of disease severity and awareness of organ failure are the mainstays of emergency care. Intensive care is needed for the treatment of SARS-CoV-2-induced organ failure, whereby lung failure in these patients requires differentiated ventilation therapies.

DIAGNOSTIC WORK-UP

The polymerase chain reaction (PCR) test is performed to diagnose SARS-CoV‑2 infection. Adjunctive diagnostic measures which enhance diagnostic specificity are lung ultrasound, x‑ray, and computed tomography of the lungs. This also allows categorization of the type of COVID-19 pneumonia.

PRACTICAL RECOMMENDATIONS

For early detection and appropriate treatment of SARS-CoV‑2 infection, PCR is needed. Adjunctive sonographic and radiological examinations allow the treatment of COVID-19 patients to be tailored according to the specific type of pneumonia.

Variations in longitudinal sleep duration trajectories from infancy to early childhood

OBJECTIVE

This study investigates variations in night, day, and total sleep trajectories across infancy and childhood in Asian children.

PARTICIPANTS

Participants consisted of a subset of 901 children, within the Growing Up in Singapore Towards healthy Outcomes cohort, which recruited 1247 pregnant women between June 2009 and September 2010.

DESIGN

We used a novel conditional probabilistic trajectory model: a probabilistic model for mixture distribution, allowing different trajectory curves and model variances among groups to cluster longitudinal observations. Longitudinal sleep duration data for the trajectory analyses were collected from caregiver-reported questionnaires at 3, 6, 9, 12, 18, 24, and 54 months.

RESULTS

We found 3 patterns of night sleep trajectories (n = 356): long consistent (31%), moderate consistent (41%), and short variable (28%); and 4 patterns of day sleep trajectories (n = 347): long variable (21%), long consistent (20%), moderate consistent (34%), and short consistent (25%). We also identified 4 patterns of total sleep trajectories (n = 345): long variable (19%), long consistent (26%), moderate consistent (28%), and short variable (27%). Short, moderate, and long trajectories differed significantly in duration. Children with consistent trajectories also displayed sleep patterns that were significantly more representative of typical developmental sleep patterns than children with variable trajectories.

CONCLUSIONS

This is the first study to describe multiple sleep trajectories in Singaporean children and identify between-individual variability within the trajectory groups. Compared to predominantly Caucasian samples, night/total sleep trajectories were generally shorter, while day sleep trajectories were longer. Future studies should investigate how these variations are linked to different developmental outcomes.

Functional connectivity correlates of infant and early childhood cognitive development

Childhood is defined by the development of cognitive abilities as well as brain growth and function. While prior neuroimaging studies have investigated early development fragmentally, we studied the typical development of functional network connectivity continuously from infancy to childhood (average of 24 months) in 196 singleton term born children, as well as their emergence with age and visual, motor, and language abilities as assessed using the Mullen Scales of Early Learning. We demonstrate a cross-age shift to networks linked to higher-order cognitive processes, paralleling previous findings about developmental courses of functional connectivity networks. When investigating skill associations with functional connectivity independent of age, we revealed distinct network connectivity patterns for visual, motor, and language skills as each of them become more and more refined along childhood development. Specifically, the amount of functional networks recruited increases with skill complexity, with an exceeding involvement of higher order networks enabling daily maintenance and coordination of cognitive functions. Further, both motor and language network connectivity patterns overlapped in network connectivity patterns for the default mode, visual, salience, and dorsal attention networks, possibly implicating their overarching contribution to each other’s and higher cognitive development.

Postpartal Affective and Endocrine Differences Between Parents of Preterm and Full-Term Infants

BACKGROUND

During the postpartum period, new parents frequently experience emotional stress and exhibit symptoms of depression and anxiety, accompanied by substantial endocrine changes. However, evidence predominantly exists from parents of full-term infants, while data on parents of preterm infants are scarce. In this exploratory, cross-sectional study, we compared psychological well-being and endocrine parameters in parents of very preterm and term born infants.

METHODS

Mothers (N = 28) and fathers (N = 30) of full-term infants as well as mothers (N = 18) and fathers (N = 21) of very or extreme preterm infants (< 32^nd gestational week) were recruited in the days following birth. Anxiety, depression, and perceived stress were assessed with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Perceived Stress Questionnaire (PSQ), respectively. Physiological measures included serum levels of estradiol, progesterone, prolactin, and thyroid-stimulating hormone (mothers only), as well as the salivary cortisol awakening response (mothers and fathers).

RESULTS

New mothers and fathers of very preterm infants exhibited higher scores of depression, anxiety and stress than parents of term infants. Besides, mothers of very preterm infants showed lower levels of estradiol, progesterone, and prolactin, as well as a heightened post-awakening cortisol response compared to mothers of term infants. Furthermore, in mothers of preterm infants we found significant negative associations between serum prolactin levels and BDI and STAI scores, respectively.

CONCLUSIONS

Parents of very preterm infants suffered from a higher burden of psychological distress than parents of full-term infants. The affective symptoms in preterm mothers were accompanied by altered endocrine profiles that, at least to some extent, may contribute to the psychological changes. The profound psychological and physiological disturbances in mothers of preterm infants may have an impact on long-term mental health and early pharmacological and psychological interventions may help to ameliorate postpartum affective symptoms.

Dietary Polar Lipids and Cognitive Development: A Narrative Review

Polar lipids are amphiphilic lipids with a hydrophilic head and a hydrophobic tail. Polar lipids mainly include phospholipids and sphingolipids. They are structural components of neural tissues, with the peak rate of accretion overlapping with neurodevelopmental milestones. The critical role of polar lipids in cognitive development is thought to be mediated through the regulation of signal transduction, myelination, and synaptic plasticity. Animal products (egg, meat, and dairy) are the major dietary sources of polar lipids for children and adults, whereas human milk and infant formula provide polar lipids to infants. Due to the differences observed in both concentration and proportion of polar lipids in human milk, the estimated daily intake in infants encompasses a wide range. In addition, health authorities define neither intake recommendations nor guidelines for polar lipid intake. However, adequate intake is defined for 2 nutrients that are elements of these polar lipids, namely choline and DHA. To date, limited studies exist on the brain bioavailability of dietary polar lipids via either placental transfer or the blood-brain barrier. Nevertheless, due to their role in pre- and postnatal development of the brain, there is a growing interest for the use of gangliosides, which are sphingolipids, as a dietary supplement for pregnant/lactating mothers or infants. In line with this, supplementing gangliosides and phospholipids in wild-type animals and healthy infants does suggest some positive effects on cognitive performance. Whether there is indeed added benefit of supplementing polar lipids in pregnant/lactating mothers or infants requires more clinical research. In this article, we report findings of a review of the state-of-the-art evidence on polar lipid supplementation and cognitive development. Dietary sources, recommended intake, and brain bioavailability of polar lipids are also discussed.

The nephrology eHealth-system of the metropolitan region of Hannover for digitalization of care, establishment of decision support systems and analysis of health care quality

Background

Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany. This leads to insufficient communication between medical providers and therefore suboptimal nephrologic care. In addition, Clinical Decision Support Systems have not been used in Nephrology until now.

Methods

The aim of NEPHRO-DIGITAL is to create a eHealth platform in the Hannover region that facilitates integrated, cross-sectoral data exchange and includes teleconsultation between outpatient nephrology, primary care, pediatricians and nephrology clinics to reduce communication deficits and prevent data loss, and to enable the creation and implementation of an interoperable clinical decision support system. This system will be based on input data from multiple sources for early identification of patients with cardiovascular comorbidity and progression of renal insufficiency. Especially patients will be able to enter and access their own data. A transfer to a second nephrology center (metropolitan region of Erlangen-Nuremburg) is included in the study to prove feasibility and scalability of the approach.

Discussion

A decision support system should lead to earlier therapeutic interventions and thereby improve the prognosis of patients as well as their treatment satisfaction and quality of life. The system will be integrated in the data integration centres of two large German university medicine consortia (HiGHmed (highmed.org) and MIRACUM (miracum.org)).

Trial registration

ISRCTN16755335 (09.07.2019).

Dynamics of cluster-forming hub-filament systems: The case of the high-mass star-forming complex Monoceros R2

CONTEXT

High-mass stars and star clusters commonly form within hub-filament systems. Monoceros R2 (hereafter Mon R2), at a distance of 830 pc, harbors one of the closest such systems, making it an excellent target for case studies.

AIMS

We investigate the morphology, stability and dynamical properties of the Mon R2 hub-filament system.

METHODS

We employ observations of the 13CO and C18O 1→0 and 2→1 lines obtained with the IRAM-30m telescope. We also use H2 column density maps derived from Herschel dust emission observations.

RESULTS

We identified the filamentary network in Mon R2 with the DisPerSE algorithm and characterized the individual filaments as either main (converging into the hub) or secondary (converging to a main filament) filaments. The main filaments have line masses of 30-100 M ⊙ pc-1 and show signs of fragmentation, while the secondary filaments have line masses of 12-60 M ⊙ pc-1 and show fragmentation only sporadically. In the context of Ostriker's hydrostatic filament model, the main filaments are thermally supercritical. If non-thermal motions are included, most of them are trans-critical. Most of the secondary filaments are roughly transcritical regardless of whether non-thermal motions are included or not. From the morphology and kinematics of the main filaments, we estimate a mass accretion rate of 10-4-10-3 M ⊙ yr-1 into the central hub. The secondary filaments accrete into the main filaments with a rate of 0.1-0.4×10-4 M ⊙ yr-1. The main filaments extend into the central hub. Their velocity gradients increase towards the hub, suggesting acceleration of the gas.We estimate that with the observed infall velocity, the mass-doubling time of the hub is ~ 2:5 Myr, ten times larger than the free-fall time, suggesting a dynamically old region. These timescales are comparable with the chemical age of the Hii region. Inside the hub, the main filaments show a ring- or a spiral-like morphology that exhibits rotation and infall motions. One possible explanation for the morphology is that gas is falling into the central cluster following a spiral-like pattern.

A blend containing docosahexaenoic acid, arachidonic acid, vitamin B12, vitamin B9, iron and sphingomyelin promotes myelination in an in vitro model

During the development of the central nervous system, oligodendrocytes (OLs) are responsible for myelination, the formation of the myelin sheath around axons. This process enhances neuronal connectivity and supports the maturation of emerging cognitive functions. In humans, recent evidence suggests that early life nutrition may affect myelination. In the present study, we investigated the impact of a blend containing docosahexaenoic acid, arachidonic acid, vitamin B12, vitamin B9, iron and sphingomyelin, or each of these nutrients individually, on oligodendrocyte precursor cells (OPCs) proliferation and maturation into OLs as well as their myelinating properties. By using an in vitro model, developed to study each step of myelination, we found that the nutrient blend increased the number of OPCs and promoted their differentiation and maturation into OLs, as measured by quantifying A2B5 positive cells, myelin-associated glycoprotein (MAG) positive cells and area, myelin binding protein (MBP) positive cells and area, respectively. Moreover, measuring myelination by quantifying the overlapping signal between neurofilament and either MAG or MBP revealed a positive effect of the blend on OLs myelinating properties. In contrast, treatment with each individual nutrient resulted in differential effects on the various readouts. This work suggests that dietary intake of these nutrients during early life, might be beneficial for myelination.

Collective Thomson scattering diagnostic at Wendelstein 7-X

A Collective Thomson Scattering (CTS) diagnostic is installed at Wendelstein 7-X for ion temperature measurements in the plasma core. The diagnostic utilizes 140 GHz gyrotrons usually used for electron cyclotron resonance heating (ECRH) as a source of probing radiation. The CTS diagnostic uses a quasi-optical transmission line covering a distance of over 40 m. The transmission line is shared between the ECRH system and the CTS diagnostic. Here we elaborate on the design, installation, and alignment of the CTS diagnostic and present the first measurements at Wendelstein 7-X.

Concurrent operation of 10 gyrotrons at W7-X experience and improvement opportunities

At the stellarator Wendelstein 7-X (W7-X) Electron Cyclotron Resonance Heating (ECRH) is the main heating system for steady-state operation and was the only available heating system during the operation phase OP1.2a in 2017. The ECRH, equipped with 10 operational 140 GHz gyrotrons [1], was used for different tasks at W7-X such as wall conditioning, controlled plasma start-up from the neutral gas up to steady state plasma control and different heating scenarios such as X2-mode and O2-mode heating as well as current drive (ECCD). The operational experiences and improvement opportunities of the ECRH plant will be discussed.

Early nutrition influences developmental myelination and cognition in infants and young children

Throughout early neurodevelopment, myelination helps provide the foundation for brain connectivity and supports the emergence of cognitive and behavioral functioning. Early life nutrition is an important and modifiable factor that can shape myelination and, consequently, cognitive outcomes. Differences in the nutritional composition between human breast and formula milk may help explain the functional and cognitive disparity often observed between exclusively breast versus formula-fed children. However, past cognitive and brain imaging studies comparing breast and formula feeding are often: cross-sectional; performed in older children and adolescents relying on parental recall of infant feeding; and generally treat formula-fed children as a single group despite the variability between formula compositions. Here we address some of these weakness by examining longitudinal trajectories of brain and neurocognitive development in children who were exclusively breastfed versus formula-fed for at least 3 months. We further examine development between children who received different formula compositions. Results reveal significantly improved overall myelination in breastfed children accompanied by increased general, verbal, and non-verbal cognitive abilities compared to children who were exclusively formula-fed. These differences were found to persist into childhood even with groups matched for important socioeconomic and demographic factors. We also find significant developmental differences depending on formula composition received and that, in particular, long-chain fatty acids, iron, choline, sphingomyelin and folic acid are significantly associated with early myelination trajectories. These results add to the consensus that prolonged and exclusive breastfeeding plays an important role in early neurodevelopment and childhood cognitive outcomes.

Far-infrared observations of a massive cluster forming in the Monoceros R2 filament hub⋆

We present far-infrared observations of Monoceros R2 (a giant molecular cloud at approximately 830 pc distance, containing several sites of active star formation), as observed at 70 μm, 160 μm, 250 μm, 350 μm, and 500 μm by the Photodetector Array Camera and Spectrometer (PACS) and Spectral and Photometric Imaging Receiver (SPIRE) instruments on the Herschel Space Observatory as part of the Herschel imaging survey of OB young stellar objects (HOBYS) Key programme. The Herschel data are complemented by SCUBA-2 data in the submillimetre range, and WISE and Spitzer data in the mid-infrared. In addition, C18O data from the IRAM 30-m Telescope are presented, and used for kinematic information. Sources were extracted from the maps with getsources, and from the fluxes measured, spectral energy distributions were constructed, allowing measurements of source mass and dust temperature. Of 177 Herschel sources robustly detected in the region (a detection with high signal-to-noise and low axis ratio at multiple wavelengths), including protostars and starless cores, 29 are found in a filamentary hub at the centre of the region (a little over 1% of the observed area). These objects are on average smaller, more massive, and more luminous than those in the surrounding regions (which together suggest that they are at a later stage of evolution), a result that cannot be explained entirely by selection effects. These results suggest a picture in which the hub may have begun star formation at a point significantly earlier than the outer regions, possibly forming as a result of feedback from earlier star formation. Furthermore, the hub may be sustaining its star formation by accreting material from the surrounding filaments.

Infant sleep and its relation with cognition and growth: a narrative review

OBJECTIVE

Infant sleep development is a highly dynamic process occurring in parallel to and in interaction with cognitive and physical growth. This narrative review aims to summarize and discuss recent literature and provide an overview of the relation between infant sleep and cognitive development as well as physical growth.

METHODS

We conducted online literature search using MEDLINE, Embase, and Cochrane Library databases. We considered original research on humans published in the English language from January 2005 to December 2015. Search terms included "sleep" AND "infant" AND "cognition" OR "memory" OR "executive functioning", OR "growth" OR "obesity" OR "growth hormone" OR "stunting", and combinations thereof.

RESULTS

Ten studies on infant sleep and cognition were included in this review. Overall, findings indicated a positive association between sleep, memory, language, executive function, and overall cognitive development in typically developing infants and young children. An additional 20 studies support the positive role of infant sleep in physical growth, with the current literature focusing largely on weight gain and obesity rather than healthy growth. Existing evidence in both the domains is mainly based on cross-sectional designs, on association studies, and on parental reports. In contrast, there were limited studies on longitudinal sleep trajectories and intervention effects, or studies have not used more objective sleep measures such as actigraphy and polysomnography.

CONCLUSION

The reviewed studies support a critical and positive role of infant sleep in cognition and physical growth. Future studies should consider key environmental and parental confounders, include a combination of more objective (actigraphy) and subjective measures (sleep diaries and questionnaires), and move towards longitudinal trajectory designs of infant sleep and development.

Multigene expression profile testing in breast cancer: is there a role for family physicians?

BACKGROUND

Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing.

METHODS

We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing.

RESULTS

The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy.

CONCLUSIONS

Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.

Early Nutritional Interventions for Brain and Cognitive Development in Preterm Infants: A Review of the Literature

Adequate nutrition is important for neurodevelopmental outcomes in preterm-born infants. In this review, we aim to summarize the current knowledge on nutritional interventions initiated during the hospital stay targeting brain and cognitive development benefits in preterm human infants. Studies can broadly be split in general dietary intervention studies and studies investigating specific nutrients or nutritional supplements. In general, mother's breast milk was reported to be better for preterm infants' neurodevelopment compared to infant formula. The differences in methodologies make it difficult to conclude any effects of interventions with individual nutrients. Only protein and iron level studies showed some consistent findings regarding optimal doses; however, confirmatory studies are needed. This review does not support some widely accepted associations, such as that between long-chain polyunsaturated fatty acid supplementation and visual development. Clear nutritional recommendations cannot be made based on this review. However, the type of infant nutrition (i.e., breast milk versus formula or donor milk), the timing of the nutritional intervention, and the dose of the nutrient/supplement have been found to be relevant factors in determining the success of nutritional intervention studies in preterm infants.

Diet and nutrients in the modulation of infant sleep: A review of the literature

OBJECTIVES

The establishment of organized sleep patterns is an important developmental process during infancy. Little is known about the role of nutrition in sleep maturation. This review focuses on exploring the link between infant sleep and nutrition with the aim to provide an overview of existing literature on the impact of diet and specific nutrients on sleep modulation in infants.

METHODS

An exploratory literature search was performed on the topic in Medline, Scopus and Cochrane Library databases, with a focus on publications in English.

RESULTS

Both the type of nutrients consumed and the timing at which they were consumed, relative to sleeping time, have been reported to influence infant sleep. Some nutrients have been shown to naturally fluctuate in maternal breast milk with circadian rhythm, and nutrients such as tryptophan, nucleotides, essential fatty acids and Omega-3 long-chain fatty acids have been suggested to impact infant sleep.

DISCUSSION

In summary, little is known about the nutritional impact on infant sleep and sleep maturation, particularly with regard to specific nutrients. While nutrients like tryptophan and nucleotides seem to impact sleep at the level of brain activity, some fatty acids may affect sleep as a result of their role in supporting the maturity of the central nervous system. In our view, the existing literature indicates that the link between nutrition and infant sleep may be a promising concept to support this crucial phase of early development.

Psychiatric Disorders and Personality Styles in Mothers of Female Adolescent Patients with Eating Disorders

OBJECTIVE

To provide further insight into the presently poorly understood role of familial psychopathology in the development of eating disorders (ED).

METHOD

The present study assesses psychiatric and personality disorders listed on Axis I and II of the DSM-IV in 27 mothers of adolescent patients with anorexia (AN mothers) and 14 bulimia nervosa (BN mothers) as well as 22 mentally healthy girls (CG mothers) on a categorical level. Furthermore, we conducted a dimensional diagnostic regarding personality styles and personality traits.

RESULTS

AN and BN mothers showed increased rates of Axis I disorders, especially affective, substance use, and anxiety disorders. Differences on Axis II did not reach statistical significance. However, BN mothers showed higher occurrences of paranoid, negativistic, and schizotypal personality styles compared to the other groups. BN mothers further showed higher occurrences than CG mothers of the personality traits excitability, aggressiveness, physical complaints, openness, and emotionality. AN mothers differed significantly from CG mothers on the scale demands.

CONCLUSIONS

Increased occurrence of psychopathology on both categorical and dimensional levels in mothers of patients with AN and BN supports the assumption of a familial accumulation of psychopathology in ED. Longitudinal studies and genetic analyses should clarify a possible cause-effect relationship and interactions between familial dynamics and adolescent ED.

Illness behaviour of general practitioners-a cross-sectional survey

Background

International guidelines recommend that physicians should be registered with a general practitioner (GP) and should avoid self-treatment. Adherence to these recommendations is mixed.

Aims

To describe illness behaviour and chronic medical conditions of GPs in Germany.

Methods

Cross-sectional, observational questionnaire study. We contacted 1000 GPs by mail in April 2014. We asked about registration with a GP, chronic conditions and self-treatment. We undertook descriptive statistical analysis and analysed associations using t-tests and chi-square test.

Results

Two hundred and eighty-five responses (29%) were eligible for analysis. Nineteen per cent of GPs were registered as patients of a GP, 58% reported at least one chronic condition, 68% disclosed self-diagnosis and 60% self-treatment. Self-therapy for chronic conditions was inversely correlated with subjective severity of the disease (r = −0.159; P < 0.05).

Conclusions

The high rates of self-treatment and the low rate of registration with a GP of German GPs are in contrast to international guideline recommendations. Further research is needed to analyse specific reasons.

[Integration and utilization of physiotherapy in hospice and palliative care : A survey on clinical practice in Germany]

BACKGROUND

Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role.

AIM

This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany.

METHODS

A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out.

RESULTS

The response rate was 43.5 % (n = 296). Physiotherapy is predominantly applied in palliative care units (79 %) but rarely in hospices (38 %) and outpatient palliative care teams (30 %). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26 %). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea.

CONCLUSION

Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.