[German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children-perioperative management]. / S1-Leitlinie: Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern ­ perioperatives Management.

Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.

[Management of diagnostic procedures and treatment of sleep related breathing disorders in the context of the coronavirus pandemic]. / Diagnostik und Therapie schlafbezogener Atmungsstörungen im Zusammenhang mit der Corona­Pandemie: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM).

When providing sleep medical services special aspects must be taken into account in the context of the coronavirus pandemic. Despite all prevention, due to the high number of unrecognized cases, SARS-CoV2 contacts in the sleep laboratory must be expected and appropriate precautions are necessary. Nevertheless, the continuation or resumption of sleep medical services under the appropriate hygiene measures is strongly recommended to avoid medical and psychosocial complications. There is no evidence for a deterioration of COVID-19 through CPAP therapy. In principle, the application of positive pressure therapy via various mask systems can be accompanied by the formation of infectious aerosols. In the case of confirmed infection with SARS-CoV2, a pre-existing PAP therapy should be continued in an outpatient setting in accordance with the local guidelines for home isolation, since discontinuation of PAP therapy is associated with additional cardiopulmonary complications due to the untreated sleep-related breathing disorder. According to the current state of knowledge inhalation therapy, nasal high-flow (NHF), and PAP therapy can be carried out without increased risk of infection for health care workers (HCW) as long as appropriate personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) is being used.This position paper of the German Society for Pneumology and Respiratory Medicine (DGP) and the German Society for Sleep Medicine (DGSM) offers detailed recommendations for the implementation of sleep medicine diagnostics and therapy in the context of the coronavirus pandemic.

[Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders]. / Positionspapier zum Telemonitoring bei schlafbezogenen Atmungsstörungen.

The use of telemonitoring in the care of patients with Sleep-related Breathing Disorders (SBD) can enhance medical support significantly. Telemonitoring aims at helping physicians to detect therapy problems early and thus improve patients' therapy adherence. Diagnostics and therapy decisions in the telemonitoring process nevertheless remain the responsibility of sleep specialists. The selection of data monitored, their evaluation and resulting consequences fall to the physician, who makes decisions and prescribes therapy in consultation with the patient. In light of professional legal and ethical requirements, it must be ensured that the extensive changes to the process flow in sleep medicine are designed in a way to guarantee high-quality patient care. In this position paper, the German Sleep Society, the German Respiratory Society, the Association of Pneumological Hospitals and the Federal Association of German Pneumologists comment on important aspects for implementation of telemonitoring for SRBD and describe the basic conditions required for its use.

[Cologne Statement for Medical Care of Refugees]. / Kölner Statement zur medizinischen Versorgung von Flüchtlingen.

The Cologne statement resulted from both regional and nationwide controversial discussions about meaning and purpose of an initial examination for infectious diseases of refugees with respect to limited time, personnel and financial resources. Refugees per se are no increased infection risk factors for the general population as well as aiders, when the aiders comply with general hygiene rules and are vaccinated according to the recommendations of the German Standing Committee on Vaccination (STIKO). This is supported by our own data. Based on individual medical history, refugees need medical care, which is offered purposeful, economic, humanitarian and ethical. In addition to medical confidentiality, the reporting obligation according § 34 Infection Protection Act (IPA) and the examination concerning infectious pulmonary tuberculosis according to § 36 (4) IPA must be considered.

[Snoring in children. Algorithm for diagnostic approach]. / Schnarchen bei Kindern. Algorithmus zum diagnostischen Vorgehen.

BACKGROUND: Snoring in children is a prevalent symptom and may be an indicator of obstructive sleep apnoea. Despite its importance, there is no national guideline on its appropriate management. OBJECTIVE: To provide recommendations for the management of snoring in children and adolescents treated in a primary care setting. METHODS: A total of 16 national paediatric sleep experts were included in a Delphi process and formulated recommendations in the form of a step-wise work-up procedure. RESULTS: The following 8 steps were developed: (1) Identification of true cases of habitual snoring. (2) Identification of high-risk patients who should undergo polysomnography in a sleep laboratory. (3) Identification of mild cases that may be treated with anti-inflammatory medication. (4) Identification of cases that should be referred to an otorhinolaryngologist for potential surgery. (5) Performance of polysomnography in cases that remain unclear despite steps 3 and 4 to rule out obstructive sleep apnoea. (6) Reconsideration of surgery in cases with moderate to severe obstructive sleep apnoea. (7) Identification of severe sleep apnoea cases requiring continuous positive airway pressure therapy. (8) Identification of cases suitable for orthodontic treatment, craniofacial surgery or speech therapy. CONCLUSION: This guideline should help to improve the management of snoring children and adolescents in Germany.

[Medicinal treatment of breathing disorders in adenotonsillar hyperplasia]. / Medikamentöse Behandlung von Atmungsstörungen bei adenotonsillärer Hyperplasie.

BACKGROUND: Adenotonsillar hyperplasia (ATH) can lead to severe breathing disorders, such as impaired nasal breathing, mouth breathing, snoring and obstructive sleep apnea. In such cases ATH should be treated mostly by performing adenoidectomy and/or adenotonsillectomy. There is increasing evidence that anti-inflammatory medication (AIM) is effective in treating ATH-related breathing disorders. OBJECTIVES: The aim of this study was to provide evidence and recommendations for the use of AIM in the treatment of ATH-related breathing disorders. METHODS: In this study 12 national pediatric sleep experts were included into a Delphi process and formulated indications and recommendations. RESULTS: The use of AIM in the treatment of ATH-related breathing disorders is sufficiently supported by the results of randomized controlled trials and systematic reviews. Nasal beclometason and nasal mometason have been studied for the treatment of enlarged adenoids and nasal fluticason and oral montelukast for the treatment of obstructive sleep apnea. The use of AIM for first-line treatment should be restricted to selected indications, such as a characteristic patient age and exclusion of an acute upper respiratory tract infection. Evidence-based recommendations are given concerning indications, dosage, treatment duration and correct administration of AIM. CONCLUSIONS: Anti-inflammatory medications are simple and effective alternatives for the treatment of ATH-related breathing disorders. These guidelines are intended to promote the use of AIM by pediatricians in ambulatory care settings.

[Sleep disorders during infancy and childhood]. / Schlafstörungen im Kindesalter.

Several different systems are used to classify sleep disorders. The International Classification of Sleep Disorders (ICSD-2), established in 2005 by the American Academy of Sleep Medicine (AASM), utilizes eight different categories [1]: insomnias, sleep-related breathing disorders, hypersomnias, circadian rhythm disorders, parasomnias, sleep-related movement disorders, isolated symptoms/normal variants/unresolved issues, as well as other sleep disorders. Sleep disorders are a frequent problem during infancy and childhood, and at least 20% of children in elementary school describe having sleep problems, which are often accompanied by abnormal behavior, hyperactivity, and lack of concentration and result in problems at school. Several sleep disorders, for example, obstructive sleep apnea, have been observed to cause physical diseases as well as growth and developmental problems [2, 3]. Thus, it is essential to detect the problem early, to obtain a differentiated diagnosis, and initiate appropriate therapeutic measures.

α-(1 → 3)-D-glucans from fruiting bodies of selected macromycetes fungi and the biological activity of their carboxymethylated products.

PURPOSE OF WORK: To show biological activity of carboxymethylated α-(1 → 3)-D-glucans isolated from the selected macromycetes fungi on human tumor and normal cells. Water-insoluble, alkali-soluble polysaccharides (WIP) were isolated from fruiting bodies of four macromycetes fungi: Lentinus edodes, Pleurotus ostreatus, Piptoporus betulinus and Laetiporus sulphureus. The structure of the polysaccharides was determined using composition analysis, methylation analysis, fourier transform infrared spectroscopy, and nuclear magnetic resonance spectroscopy. The chemical and spectroscopic investigations indicated that the polysaccharides were an α-(1 → 3)-D-glucans. A biological activity analysis of the carboxymethylated (CM) α-(1 → 3)-D-glucans was based on an assessment of their cytotoxic, mitochondrial metabolism-modulating, and free radical scavenging effects. The cytotoxic activity of the CM-glucans was concentration- and cell-type-dependent. The tested CM-glucans, generally, did not have a free radical scavenging effect. The CM-α-(1 → 3)-D-glucans isolated from the selected macromycetes fungi are biologically active and may therefore be used as diet or therapy supplements.

Mutanase from Paenibacillus sp. MP-1 produced inductively by fungal α-1,3-glucan and its potential for the degradation of mutan and Streptococcus mutans biofilm.

Laetiporus sulphureus is a source of α-1,3-glucan that can substitute for the commercially-unavailable streptococcal mutan used to induce microbial mutanases. The water-insoluble fraction of its fruiting bodies from 0.15 to 0.2% (w/v) induced mutanase activity in Paenibacillus sp. MP-1 at 0.35 µ ml(-1). The mutanase extensively hydrolyzed streptococcal mutan, giving 23% of saccharification, and 83% of solubilization of glucan after 6 h. It also degraded α-1,3-polymers of biofilms, formed in vitro by Streptococcus mutans, even after only 3 min of contact.

Self-reported sleep patterns, sleep problems, and behavioral problems among school children aged 8-11 years.

OBJECTIVES: Investigation of sleep patterns, sleep problems, and behavioral problems in 8- to 11-year-old children. METHODS: A total of 330 children (age: M=9.52; SD=0.56; range=8-11 years; 47.3% girls) in the 4th grade of elementary school in Salzburg (Austria) completed a self-report questionnaire (80 items) to survey sleep patterns, sleep problems, and behavioral problems. RESULTS: Children aged 8-11 years slept approximately 10 h and 13 min on school days (SD=47 min) as well as on weekends (SD=81 min); girls slept significantly longer on weekends than boys. Most common self-reported sleep problems were dryness of the mouth (26.6%), sleep onset delay (21.9%), bedtime resistance (20.3%), and restless legs (19.4%). There was a significant association between watching TV as well as playing computer games prior to sleep with frightful dreams. Daytime sleepiness indicated by difficulty waking up (33.4%) and having a hard time getting out of bed (28.5%) was also very prominent. However, children in Salzburg seemed to be less tired during school (6.6%) or when doing homework (4.8%) compared to other nationalities. Behavioral problems (e.g., emotional symptoms, hyperactivity and inattention, conduct problems, peer problems) and daytime sleepiness were both significantly associated with sleep problems: the more sleep problems reported, the worse behavioral problems and daytime sleepiness were. Moreover, we could show that sharing the bed with a pet was also related to sleep problems. CONCLUSIONS: Self-reported sleep problems among 8- to 11-year-old children are very common. There is a strong relationship between sleep disorders and behavioral problems. Routine screening and diagnosis as well as treatment of sleep disorders in school children should, therefore, be established in the future.

Paenibacillus strain MP-1: a new source of mutanase.

A mutan-degrading bacterium, closely related to Paenibacillus curdlanolyticus, was isolated from soil. It produced 0.4 U mutanase ml(-1 )in 2 days in shake-flask cultures when bacterial mutan was the sole carbon source. Mutanase activity was optimal at pH 6.2 and 45 degrees C over 1 h and was stable between pH 5.8 and 12 at 4 degrees C for 24 h and up to 40 degrees C for 1 h. Mutan produced by Streptococcus mutans was rapidly hydrolyzed by this enzyme. The hydrolysis of mutan (1 g l(-1)) resulted in 17% saccharification over 2 h and, at the same time, glucan was entirely solubilized.

Enhancement of mutanase production in Trichoderma harzianumby mutagenesis.

Conidia of Trichoderma harzianum F-340, an active producer of fungal mutanase, were mutagenized with physical and chemical mutagens used separately or in combination. After mutagenesis, the drop in conidia viability ranged from 0.004% to 71%. Among the applied mutagens, nitrosoguanidine gave the highest frequency of cultures with enhanced mutanase activity (98%). In total, 400 clones were isolated, and preliminarily evaluated for mutanase activity in flask microcultures. Eight most productive mutants were then quantified for mutanase production in shake flask cultures. The obtained results fully confirmed a great propensity of all the tested mutants to synthesize mutanase, the activity of which increased from 59 to 107% in relation to the parental T. harzianum culture. The best mutanase-overproducing mutant (T. harzianumn F-340-48), obtained with nitrosoguanidine, produced the enzyme activity of 1.36 U/ml (4.5 U/mg protein) after 4 days of incubation in shake flask culture. This productivity was almost twices higher than that achieved by the initial strain F-340, and, at present, is the best reported in the literature. The potential application of mutanase in dentistry is also discussed.

Optimization of conditions for the efficient production of mutan in streptococcal cultures and post-culture liquids.

The strain Streptococcus sobrinus CCUG 21020 was found to produce water-insoluble and adhesive mutan. The factors influencing both stages of the mutan production, i.e. streptococcal cultures and glucan synthesis in post-culture supernatants were standardized. The application of optimized process parameters for mutan production on a larger scale made it possible to obtain approximately 2.2 g of water-insoluble glucan per 11 of culture supernate--this productivity was higher than the best reported in the literature. It was shown that some of the tested beet sugars might be successfully utilized as substitutes for pure sucrose in the process of mutan synthesis. Nuclear magnetic resonance analyses confirmed that the insoluble biopolymer synthesized by a mixture of crude glucosyltransferases was a mixed-linkage (1-->3), (1-->6)-alpha-D-glucan (the so-called mutan) with a greater proportion of 1,3 to 1,6 linkages.

[Sleep disorders in hyperkinetic children--correlation with arousal disorders, differential diagnosis and comorbidity]. / Schlafstörungen bei hyperkinetischen Kindern--Zusammenhänge zu Arousalstörungen, differential diagnostische Abgrenzungen und Komorbiditäten.

OBJECTIVES: Sleep disorders are frequently observed in Attention Deficit-Hyperactivity Disorder (ADHD). At the same time, however, there is little evidence of their prevalence and their specific characteristics. Also unclear is a possible pathogenetic relationship between disturbed sleep and the core symptoms of ADHD. There are still very few findings on the role of comorbid internal and neurological disorders like sleep apnea and restless legs syndrome in the differential diagnosis of ADHD. METHODS: We present an overview of the current literature, describing the most important results concerning sleep disorders in ADHD. RESULTS: A principal goal of future assessments is to ascertain whether sleep problems in children with ADHD represent unspecific concurrent symptoms or whether they play a substantial role in the pathogenesis of ADHD. CONCLUSIONS: Moreover a possibly increased risk of comorbid sleep-disordered breathing disorder might be an important issue in the differential diagnostic considerations with regard to ADHD.

Selection of strain and optimization of mutanase production in submerged cultures of Trichoderma harzianum.

Nineteen fungal strains belonging to different genera were tested for extracellular mutanase production in shaken flasks. The optimal enzymatic activity was achieved by Trichoderma harzianum F-470, a strain for which the mutanase productivity has not yet been published. Some of factors affecting the enzyme production in shaken flasks and aerated fermenter cultures have been standardized. Mandels mineral medium with initial pH 5.3, containing 0.25% mutan and inoculated with 10% of the 48-h mycelium, was the best for enzyme production. A slight mutanolytic activity was also found when sucrose, raffinose, lactose and melibiose were carbon sources. Application of optimized medium and cultural conditions, as well as use of a fermenter with automatic pH control set at pH 6.0 enabled to obtain a high mutanase yield (0.33 U/ml, 2.5 U/mg protein) in a short time (2-3 days). The enzyme in crude state was stable over a pH range of 4.5-6.0, and at temperatures up to 35 degrees C; its maximum activity was at 40 degrees C and at pH 5.5.

Telemetry as a new concept in long term monitoring of SIDS-risk infant.

Sudden Infant Death Syndrome (SIDS) is the most frequent cause of infant death within the period of 2 to 12 months in western countries. It has been found that a suit similar to that worn by the astronauts during the execution of experiments on the Spacelab Mission D-2 is a very simple and useful means to carry the sensors required to monitor vital signs of babies at risk. A small baby-suit has been developed with the same technology used for the Spacelab Mission. The baby s suit is equipped with similar sensors to record thoracic and abdominal respiratory movements as its big -space travel brother-. This is a typical example of a successful technology transfer from medical aerospace activities into fields of daily clinical routine. In addition to the above described sensors, ECG-electrodes were integrated, as well as sensors to record vascular oxygen saturation and the corresponding pulse curve, and the baby s movements. All these vital signs are registered by a medical monitor, and permanently stored and automatically analysed online. In case of a life-threatening situation the system alerts simultaneously the personal at hospital and the parents at home. The requisite software algorithms have been developed by DLR in Cooperation with the pediatricians of the Pediatric Hospital in Köln-Porz, Cologne. When the system registers an alteration of the parameters above described -as a signal of a change in the baby s health condition- all vital signs are transfered in real-time to the supervising hospital via radio data transmission devices, mobile phone or a fixed network phone. The parents are also alerted by the device, and they can carry out the necessary reanimation procedures in case of an emergency. Parents will be trained in such actions when newborns must to be monitored. But nevertheless, they are guided and tele-assisted by an expert via telephone during the action. A clinical field trial, that will start in December 1999 at the Pediatric Hospital in Köln-Porz, Cologne, will evaluate the benefits of teleprotection by home monitoring of SIDS risk-babies.

Insoluble glucans synthesized by cariogenic streptococci: a structural study.

Of the three cariogenic streptococci grown in four various culture media, the strain Streptococcus mutans 20,381 was found to produce large amounts of extracellular glucosyltransferase and water-insoluble, adhesive exopolysaccharide when grown in batch culture on brain-heart infusion broth. Methylation and nuclear magnetic resonance analyses revealed that the insoluble polymers synthesized by the crude glucosyltransferase preparations were mixed-linkage (1-->3), (1-->6)-alpha-D-glucans (so-called mutans) with a greater proportion of 1,3 to 1,6 linkages and major branch points of 3,6-linked glucose. The percentage content of different types of linkages in glucans varied widely and depended on the strain of cariogenic bacteria used to produce glucosyltransferase, and on the kind of medium utilized to cultivate mutans streptococci. The potential application of insoluble glucan produced by mutans streptococci is discussed.

The preparation of specific sorbents with polyclonal antibodies as a ligand for purification of human antithrombin III.

Antithrombin III (AT III) is a serine protease inhibitor active against thrombin, factor X and factor VII. Major hematolytic abnormalities such as disseminated intravascular closing, coagulative vein inflammation, embolism in lungs or brain etc. frequently occur when the level of AT III is low. As a drug AT III is separated from blood preparations by bioselective sorption on sorbents containing heparine as a complementary ligand interacting with AT III molecules. The present paper describes the preparation procedures and the properties of sorbents with chemically bonded AT III antigen. The chromatographic ability of the prepared sorbents to separate AT III from human plasma are discussed in relation to the bonding procedure which was used for AT III antigen immobilization.