Deep learning-based algorithm accurately classifies sleep stages in preadolescent children with sleep-disordered breathing symptoms and age-matched controls.

Introduction: Visual sleep scoring has several shortcomings, including inter-scorer inconsistency, which may adversely affect diagnostic decision-making. Although automatic sleep staging in adults has been extensively studied, it is uncertain whether such sophisticated algorithms generalize well to different pediatric age groups due to distinctive EEG characteristics. The preadolescent age group (10-13-year-olds) is relatively understudied, and thus, we aimed to develop an automatic deep learning-based sleep stage classifier specifically targeting this cohort. Methods: A dataset (n = 115) containing polysomnographic recordings of Icelandic preadolescent children with sleep-disordered breathing (SDB) symptoms, and age and sex-matched controls was utilized. We developed a combined convolutional and long short-term memory neural network architecture relying on electroencephalography (F4-M1), electrooculography (E1-M2), and chin electromyography signals. Performance relative to human scoring was further evaluated by analyzing intra- and inter-rater agreements in a subset (n = 10) of data with repeat scoring from two manual scorers. Results: The deep learning-based model achieved an overall cross-validated accuracy of 84.1% (Cohen's kappa κ = 0.78). There was no meaningful performance difference between SDB-symptomatic (n = 53) and control subgroups (n = 52) [83.9% (κ = 0.78) vs. 84.2% (κ = 0.78)]. The inter-rater reliability between manual scorers was 84.6% (κ = 0.78), and the automatic method reached similar agreements with scorers, 83.4% (κ = 0.76) and 82.7% (κ = 0.75). Conclusion: The developed algorithm achieved high classification accuracy and substantial agreements with two manual scorers; the performance metrics compared favorably with typical inter-rater reliability between manual scorers and performance reported in previous studies. These suggest that our algorithm may facilitate less labor-intensive and reliable automatic sleep scoring in preadolescent children.

[Autoimmune/inflammatory syndrome induced by aduvants].

For decades, breast implants have been available for breast reconstructions and breast augmentations to improve the patients' health-related quality of life. Silicone implants (SI) have been used since the middle of the last century for breast reconstruction, for example after breast cancer, for birth defects, gender confirmation procedures, or for breast augmentation. Every year, several hundred SI are performed in Iceland for these purposes, but no central register is maintained. It can be estimated that at least 1000 - 3000 women have SI in Iceland and that around 300 Icelandic patients get SI every year. This informal review article discusses the so-called ASIA syndrome, the immunological effects of silicone and the possible relationship of SI to autoimmune diseases, symptoms, and diagnosis. In the methodology, this paper does not rely on the strict conditions of systematic reviews, but the authors relied only on peer-reviewed sources through PubMed, UpToDate and Scopus. The keywords used are silicon, silicon implant, silicon particles, immune response, autoimmunity, autoinflammation, Autoimmune/inflammatory syndrome induced by aduvants, ASIA, ASIA syndrome, breast implant illness. The paper reviews known facts about the disease, its characteristics, and statistical aspects.

Risk Factors for Hen's Egg Allergy in Europe: EuroPrevall Birth Cohort.

BACKGROUND: Hen's egg is one of the commonest causes of food allergy, but there are little data on its risk factors. OBJECTIVE: To assess the risk factors, particularly eczema, for hen's egg allergy in the EuroPrevall birth cohort. METHODS: In the pan-European EuroPrevall birth cohort, questionnaires were undertaken at 12 and 24 months or when parents reported symptoms. Children with suspected egg allergy were invited for skin prick testing, specific IgE assessment, and double-blind, placebo-controlled food challenge (DBPCFC) as indicated. Each egg allergy case (positive DBPCFC or egg-induced anaphylaxis) was allocated up to 2 age- and country-matched controls. RESULTS: A total of 12,049 infants were recruited into the EuroPrevall birth cohort, and 9,336 (77.5%) were followed until 2 years. A total of 86 infants had egg allergy (84 by DBPCFC) and were matched with 140 controls. Independently associated with egg allergy were past/current eczema (adjusted odds ratio, 9.21; 95% CI, 2.65-32.04), Scoring Atopic Dermatitis (1.54 per 5 units; 1.28-1.86), antibiotics in the first week of life (6.17; 1.42-26.89), and current rhinitis (3.02; 1.04-8.78). Increasing eczema severity was associated with an increasing likelihood of egg allergy. Eczema was reported to have started 3.6 (SE, 0.5) months before egg allergy. Age of introduction of egg into the diet was not associated with egg allergy. CONCLUSIONS: Similar to peanut allergy, eczema was strongly associated with egg allergy development and the association increased with increasing eczema severity. The age of introduction of dietary egg was not a risk factor. The potential role of antibiotics in early life as a risk factor for egg allergy needs further examination.

Decreased immune response to pneumococcal conjugate vaccine after 23-valent pneumococcal polysaccharide vaccine in children.

BACKGROUND: Pneumococcal polysaccharide vaccine (PPV) is used in children at high risk of IPD. PPV is generally not considered to induce immunologic memory, whereas pneumococcal conjugate vaccines (PCVs) elicit protective antibody responses in infants and induce immunologic memory. Little is known about the characteristics of immune responses to PCV in children who previously received PCV and PPV in series. OBJECTIVE: To characterize immune responses to 13-valent pneumococcal CRM197 conjugate vaccine (PCV13; serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) in children vaccinated in infancy with 9-valent pneumococcal-meningococcal C-CRM197 conjugate combination vaccine (PCV9-MnCC), followed by a toddler dose of PCV9-MnCC or 23-valent pneumococcal polysaccharide vaccine (PPV23). METHODS: Children (n=89) who received PCV9-MnCC in infancy and PPV23 or PCV9-MnCC at age 12 months in a previous (2002-2003) study were vaccinated at age 7.5 years with PCV13; groups PPV23/PCV13 (n=50) and PCV9/PCV13 (n=39). Immunoglobulin (Ig)G antibodies, avidity, and opsonophagocytic activity (OPA) were measured before and at 1 and 4 weeks postvaccination. RESULTS: One week postvaccination, IgG levels increased significantly for all serotypes in both groups, and >97% of vaccinees achieved IgG ≥0.35µg/ml 4 weeks after PCV13 vaccination. The PCV9/PCV13 group had higher IgG responses compared with the PPV23/PCV13 group. The upper limits of the 95% confidence intervals of the PPV23/PCV13:PCV9/PCV13 IgG geometric mean concentration ratios were <1.0 for serotypes 1, 4, 5, 9V, 18C, and 23F at 1 week. OPA and avidity results supported these findings. CONCLUSIONS: PPV23 vaccination of toddlers may compromise subsequent responses to pneumococcal conjugate vaccines. The clinical relevance of this finding is unclear.

[Prevalence of food allergy in Icelandic infants during first year of life]. / Algengi fæduofnæmis hjá íslenskum börnum á fyrsta ári.

OBJECTIVE: This study is a part of EuroPrevall, an EU-funded European food allergy project. The aim was to evaluate the prevalence of food allergy in Icelandic infants during their first year of life. MATERIAL AND METHODS: Infants (n=1,341) were followed prospectively from birth to 12 months of age. Questionnaires were obtained at birth and 12 months. Children with symptoms of possible food allergy were assessed with a skin-prick test (SPT) and specific IgE. Food allergy was confirmed with a double-blind placebo-controlled food challenge (DBPCFC). RESULTS: Out of 170 symptomatic children 44 infants (3.27%) had either positive SPT (n=21; 1.57%) or specific IgE (n=40; 2.98%). Food allergy was confirmed in 25 (1.86%); egg allergy 1.42%, milk 0.52%, fish 0.22%, wheat 0.15%, peanuts 0.15%, and soy 0.07%. Atopic dermatitis was diagnosed in 7.90% (n=106) and according to questionnaires 8.80% had asthma (n=118). Positive family history was the strongest risk factor for asthma (OR=2.12; p<0.001) and atopic dermatitis (OR=1.90; p=0.004). Family history influenced the relationship between predisposing factors and allergy symptoms. CONCLUSION: Our results show lower prevalence of food allergy than previously reported in a study of Icelandic children at two years of age. The prevalence was also lower than reported in some other European countries and could be explained by different genetic and environmental factors.

Meningococcal serogroup C polysaccharide specific memory B cells, directly enumerated by labeled polysaccharide, are not affected by age at vaccination.

The influence of age on the generation and persistence of specific memory B cells after vaccination with Neisseria meningitidis type C polysaccharide (MenC-PS) conjugate is unknown. MenC-PS-specific B cells could be directly enumerated by fluorochrome-labeled MenC-PS and flow cytometry in blood up to at least 4 years after vaccination, ranging from 0.01% to 0.78% of total B cells and did not correlate with age at vaccination. The percentage of MenC-specific memory B cells out of total memory B cells correlated with total MenC-specific B-cells and with frequencies of IgA(+) plus IgG(+) MenC-specific AbSC, but not with MenC-specific Ab.

Safety and immunogenicity of CRM197-conjugated pneumococcal-meningococcal C combination vaccine (9vPnC-MnCC) whether given in two or three primary doses.

This randomized trial compares safety and immunogenicity when vaccinating infants with a pneumococcal-meningococcal conjugate vaccine in two doses vs. three doses. Infants (N=223) received 9vPnC-MnCC (CRM197-conjugated pneumococcal serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F and meningococcal C polysaccharides) either at 3 and 5 or 3, 4 and 5 months and a booster with either 9vPnC-MnCC or 23-valent pneumococcal-polysaccharide vaccine (23vPPS) and CRM197-MnCC, at 12 months. Safety was monitored and IgG measured at 3, 6, 12 and 13 months in all subjects and serum bactericidal activity (SBA) in half. The 9vPnC-MnCC vaccine was safe and induced significant IgG to all components. Three doses induced higher antibody GMCs (geometric mean concentrations) at 6 months to seven of nine pneumococcal serotypes. This was most significant for 6B and 23F (p<0.001), that also showed lower rate of responders>0.35 (6B, 23F) and >0.5 microg/mL (6B). Antibody GMCs remained lower following 9vPnC-MnCC booster in subjects primed with two doses although only significant for serotype 18C. Significant memory responses were observed 1 week after the 23vPPS toddler dose. MnCC-IgG GMC was lower after two doses, however with comparable SBA. This study shows that the 9vPnC-MnCC vaccine is safe and induces successful immunological memory, whether given in two or three primary doses.

[Beta-lactam allergy with special reference to Iceland]. / Ofnaemi fyrir beta-lactam lyfjum og greining pess Yfirlitsgrein.

Allergies to antibiotics are reported by 8-14% of the adult population out of which half is thought to be due to penicillins. Women are two thirds of those. It is estimated that 20.000 Icelanders believe they are allergic to beta-lactam drugs. Less than 10% of suspected penicillin allergy can be proved by allergy testing and challenge tests. The allergy to beta-lactam drugs can be of all types of allergy reactions, leading to clinical symptoms from mild to life threatening. The beta-lactam allergy is diagnosed by a precise history, measuring drug specific IgE, by prick- and intradermal skin tests and challenge tests with the drug in question. The purpose of this article is to draw the attention of Icelandic doctors to the importance of drug allergy with specific emphasis on beta-lactam drugs and the value of accurate recording of symptoms and signs in the patient's records. We also describe the diagnostic methods used and propose an algorithmic approach to diagnose beta-lactam allergy in Icelandic children and adults.

What characterizes house dust mite sensitive individuals in a house dust mite free community in Reykjavik, Iceland?

BACKGROUND: Previous studies show that 6-9% of young adults in Reykjavik are sensitised to the house dust mite (HDM) Dermatophagoides pteronyssinus (D. pteronyssinus). However, only negligible amounts of HDM and HDM allergens were detected in their homes. The study investigates what characterizes these individuals. METHODS: We investigated all participants in the European Community Respiratory Health Surveys I and II (ECRHS I and II) with D. pteronyssinus specific IgE, in the years 1991-92. A grass positive but D. pteronyssinus negative control group was recruited from the same cohort. A detailed questionnaire was administered and the specific IgE (Pharmacia CAP system) against six D. pteronyssinus cross-reactive allergens was measured. RESULTS: Of 601 ECRHS I participants with available IgE results, 88% returned for ECRHS II, 8.4 years later. Of 49 individuals with D. pteronyssinus specific IgE in ECRHS I, 24 had become negative in ECRHS II. Compared with controls, HDM sensitive subjects were more often men who had lived on farms or kept aquaria fish in childhood. Of those with specific IgE against D. pteronyssinus in ECRHS I and II, 75% had detectable IgE antibodies (>or=0.35 kU/l) to cross-reactive allergens compared with none in the control group (p<0.0001): Lepidoglyphus destructor (L. destructor) (67%), shrimp (58%), cockroach (33%), mosquito (17%), tropomyosin (17%) and blood worm (4%). CONCLUSIONS: Icelanders with specific IgE to D. pteronyssinus are more often men who spent time on farms in childhood and today have high prevalence of IgE antibodies cross-reactive to D. pteronyssinus.