Search Results (401)

Leigh syndrome is a rare, progressive mitochondrial disorder of childhood. Early diagnosis is often challenging due to nonspecific clinical manifestations. We report a 1-month-old male infant initially referred for suspected congenital muscular torticollis who ultimately received a diagnosis of Leigh syndrome. Despite unremarkable perinatal history, he subsequently developed persistent feeding difficulties, recurrent vomiting, failure to thrive, and global developmental delay. Early neurological assessment revealed poor repertoire patterns on General Movement Assessment. The Neonatal Oral-Motor Assessment Scale (NOMAS) demonstrated dysfunctional oral-motor control, whereas the video fluoroscopic swallowing study (VFSS) revealed aspiration during swallowing. Brain MRI revealed symmetric basal ganglia lesions. Expanded whole-exome sequencing identified a pathogenic MT-ATP6 m.8993T>G variant with high heteroplasmy level (>90% in blood), confirming the diagnosis of Leigh syndrome. The variant was maternally inherited, although neither the mother nor the older sibling exhibited clinical features of mitochondrial disease. Leigh syndrome can initially manifest with subtle systemic features rather than overt neurological features. Persistent feeding difficulties and growth delay in infancy warrant thorough evaluation, including neuroimaging and comprehensive genomic testing, to enable timely diagnosis and optimize clinical management. Full article

Background: Crisponi/cold-induced sweating syndrome (CS/CISS) is a rare autosomal recessive disorder characterized by severe neonatal manifestations including paroxysmal muscle contractions, tendency for hyperthermia, and feeding and swallowing difficulties with high neonatal mortality. Pathogenic variants in the Cytokine Receptor-Like Factor 1 (CRLF1) gene have been associated with CS/CISS. These variants result in a loss of function of the encoded protein, which disrupts the formation of a functional heterodimer with Cardiotrophin-Like Cytokine Factor 1 (CLCF1). This complex is essential for the development of autonomic and sensory nervous systems, as well as for bone remodeling. We report two patients affected by CS harboring pathogenic variants in the CRLF1 gene. Methods—case reports: The first patient was diagnosed postnatally, presenting with non-epileptic paroxysmal events characterized by opisthotonus and orofacial contractions. He survived beyond infancy, later developing scoliosis and persistent episodes of hyperthermia. In the second patient, a prenatal ultrasound at 20 weeks of gestation revealed bilateral camptodactyly, also referred to as the ‘horn’s sign’, raising early suspicion of CS. The diagnosis was subsequently confirmed both clinically and genetically. After birth, the infant developed severe dysphagia, apnea, and paroxysmal events not associated with epileptiform activity on EEG. Sanger sequencing identified a homozygous c.708_709delinsT frameshift variant in the CRLF1 gene. The patient died at 30 days of age due to respiratory failure. Results and conclusions: With this manuscript, we aim to further delineate the phenotypic spectrum of this rare condition and propose the ‘horn’s sign’ as a targeted prenatal marker for early diagnosis in populations with known founder mutations or familial risk factors. Full article

Background and Objectives: Infantile colic affects 15–40% of infants ≤ 5 months, burdening families and health systems. While the effects of intrapartum oxytocin on neonatal outcomes have been widely investigated, its potential link with infantile colic remains poorly understood. We evaluated whether synthetic oxytocin is associated with infantile colic during the first five months of life and explored neonatal head circumference, feeding type and epidural anesthesia as additional factors. Materials and Methods: Prospective 1:1 matched case–control study in three Spanish pediatric outpatient clinics. Parents of 76 term infants aged 0–5 months (38 cases, 38 controls) completed face-to-face structured interviews documenting synthetic oxytocin and epidural use, infant anthropometry and feeding pattern. Infantile colic was diagnosed by Rome IV criteria. Associations were estimated with conditional logistic regression, producing adjusted odds ratios and 95% confidence intervals. Results: Synthetic oxytocin was used in 57.9% of deliveries and epidural anesthesia in 81.6%. Synthetic oxytocin showed no association with infantile colic (aOR 1.24; 95% CI 0.50–3.09). Epidural strongly predicted synthetic oxytocin exposure (aOR 4.55; 95% CI 1.28–16.20) but had no independent link to infantile colic. Infants with colic had a smaller mean head circumference at birth, although this difference did not remain significant after adjusting for gestational age, likely reflecting limited sample size. Synthetic oxytocin was not associated with breastfeeding status. Conclusions: In this cohort, intrapartum synthetic oxytocin was not related to infantile colic or to feeding difficulties. Smaller head circumference among colic cases may warrant further investigation as a potential risk marker. The high co-use of synthetic oxytocin and epidural underscores the need for larger longitudinal studies to clarify their peripartum–neonatal interactions. Full article

Background: Swallowing difficulties (dysphagia) are highly prevalent among older adults and significantly contribute to malnutrition, dehydration, and poor health outcomes. Healthcare aides (HCAs), as frontline caregivers in long-term care, play a pivotal role in supporting residents’ nutritional intake. However, validated tools to evaluate their competencies in nutrition-related eating support are lacking. Methods: A cross-sectional study was conducted to develop and validate a competency-based questionnaire assessing healthcare aides’ knowledge, attitudes, and behaviors toward nutrition-focused eating support. Core domains, including oral function care, safe feeding practices, food texture modification, and nutrition safety, were identified through a systematic literature review and refined using a two-round modified Delphi process involving 26 experts. A 47-item questionnaire was then administered to 202 HCAs in Taiwan. Psychometric testing included item analysis, KR-20, Cronbach’s α, confirmatory factor analysis (CFA), composite reliability (CR), and average variance extracted (AVE). Results: The final instrument demonstrated strong content validity. The knowledge domain achieved acceptable reliability (KR-20 = 0.61), while the attitude and behavior domains showed excellent internal consistency (Cronbach’s α = 0.98). CFA confirmed good structural validity (χ²/df = 3.86, CFI = 0.93). CR and AVE values further supported construct validity. Conclusions: This nutrition-centered questionnaire is a valid and reliable tool to assess HCAs’ competencies in providing eating support. It offers a foundation for identifying training needs and designing educational programs aimed at preventing malnutrition and enhancing person-centered mealtime care in long-term care facilities. Full article

Background: Schizophrenia (SCZ) is a psychiatric disorder that negatively impacts patients’ quality of life, frequently inducing difficulties in managing day-to-day tasks. Current research is persistently working on finding therapeutic methods to alleviate the positive and negative symptoms, as well as the associated cognitive dysfunctions. Since the main therapeutic approach in SCZ is antipsychotics, the current study aimed to explore the effects of typical (haloperidol, HAL) vs. atypical (risperidone, RIS) antipsychotics on the cognitive functions in an animal model (Danio rerio) of SCZ, obtained by ketamine (KET) administration. Methods: The cognitive evaluation of the zebrafish was performed using memory and learning tests based on two stimuli: food and colours (i.e., T memory test and novel object recognition (NOR) test, respectively). Results: According to the behavioural analyses, HAL significantly enhanced the cognitive performances of the SCZ model, as compared to RIS. Nonetheless, HAL and RIS exhibited comparable effects on social behaviour in the SCZ model. Interestingly, both HAL and RIS enhanced the interest for the novel object in the NOR test in control individuals, but significantly decreased it in the SCZ model. The interaction between KET and RIS could exhibit sedative properties. Conclusions: Both typical (HAL) and atypical (RIS) antipsychotics alleviated cognitive, socio-affective, and decision-making impairments in a ketamine-based adult zebrafish model of schizophrenia. HAL was more effective, particularly in food-stimulated decision-making compared to novel object or social stimuli. Colour influenced behavioural responses, with silver linked to prey/feeding effects and red perceived as aversive. The KET–RIS combination induced exploratory impairments, possibly due to sedative effects. These findings highlight differential pharmacological and ethological modulation of schizophrenia-like behaviours. Full article

Background/Objectives: This study aimed to evaluate diet diversity and feeding practices in toddlers with food allergy (FA) compared to healthy peers. Methods: This cross-sectional survey was conducted in Polish nurseries and included children aged 13–36 months with and without FA. Parents completed a questionnaire assessing feeding practices, anthropometric measurements, diet diversity using the Food Frequency Questionnaire, and feeding difficulties using the Montreal Children’s Hospital Feeding Scale. Results: Data from 388 children (predominantly from Warsaw and from families with high socioeconomic status) were analyzed. Among them, 61 (16%) had FA confirmed by a physician (however, an oral food challenge was performed only in one-third of cases). The proportion of underweight children (≤third percentile) was similar between the FA and non-FA groups (3.4 vs. 0.9%, respectively). Compared with the non-FA group, children with FA had significantly lower median overall diet diversity, food group diversity (≥nine food groups), food item diversity, and mean food allergen diversity. We found no difference in the proportion of children with feeding difficulties between the FA and non-FA groups (median = 18% vs. 13.5%). Although a lower proportion of children with FA had introduced cow’s milk, hen’s egg, tree nuts, nuts, and sesame compared with the non-FA group, only a minority had confirmed allergies to nuts, peanuts, and sesame. Most children with cow’s milk and hen’s egg allergy reintroduced baked milk (48.9%) and egg (40%). Conclusions: Children aged 13–36 months with FA are at risk of reduced overall diet diversity and over-restriction of potentially allergenic foods. Full article

Background/Objectives: Feeding and swallowing difficulties are common in young children with cerebral palsy (CP), yet no validated tool has been available in Korea for those under 3 years. The Mini-Eating and Drinking Ability Classification System (Mini-EDACS) was designed for children aged 18–36 months. This study aimed to translate the Mini-EDACS into Korean and evaluate its reliability and validity. Methods: Translation followed international guidelines, including forward–backward translation and Delphi consensus with experts in pediatric dysphagia. Forty-eight children with CP (mean age 27.1 ± 5.0 months) were assessed. Caregivers and speech–language pathologists (SLPs) independently rated Mini-EDACS and assistance levels. Inter-rater reliability was examined using Cohen’s κ. Construct validity was tested by Spearman’s correlations with the Gross Motor Function Classification System (GMFCS), Mini-MACS, the Communication Function Classification System (CFCS), the Visual Function Classification System (VFCS), and the Functional Oral Intake Scale for Children (FOIS-C). Results: Agreement between caregivers and SLPs was excellent (κ = 0.90; weighted κ = 0.98). Assistance-level ratings also showed almost perfect concordance (κ = 0.97). Mini-EDACS correlated strongly with FOIS-C (ρ = −0.86, p < 0.001) and with assistance levels (ρ = 0.81, p < 0.001). Moderate-to-strong positive correlations were observed with GMFCS (ρ = 0.56), Mini-MACS (ρ = 0.64), CFCS (ρ = 0.61), and VFCS (ρ = 0.61), supporting construct validity. Conclusions: The Korean Mini-EDACS is a reliable and valid tool for classifying eating and drinking abilities in children with CP under 3 years. It enables standardized communication between caregivers and clinicians, complements existing functional classification systems, and may facilitate earlier identification and intervention for feeding difficulties. Full article

The green macroalgae Ulva Linnaeus, 1753, also known as sea lettuce, is one of the most ecologically and economically significant algal genera. Its representatives occur in marine, brackish, and freshwater environments worldwide and show high adaptability, rapid growth, and marked biochemical diversity. These traits support their ecological roles in nutrient cycling, primary productivity, and habitat provision, and they also explain their growing relevance to the blue bioeconomy. This review summarizes current knowledge of Ulva biodiversity, taxonomy, and physiology, and evaluates applications in food, feed, bioremediation, biofuel, pharmaceuticals, and biomaterials. Particular attention is given to molecular approaches that resolve taxonomic difficulties and to biochemical profiles that determine nutritional value and industrial potential. This review also considers risks and limitations. Ulva species can act as hyperaccumulators of heavy metals, microplastics, and organic pollutants, which creates safety concerns for food and feed uses and highlights the necessity of strict monitoring and quality control. Technical and economic barriers restrict large-scale use in energy and material production. By presenting both opportunities and constraints, this review stresses the dual role of Ulva as a promising bioresource and a potential ecological risk. Future research must integrate molecular genetics, physiology, and applied studies to support sustainable utilization and ensure safe contributions of Ulva to biodiversity assessment, environmental management, and bioeconomic development. Full article

Background/Objectives: Congenital laryngomalacia (LM) is the most common cause of stridor in infants, presenting with a clinical spectrum that ranges from benign, self-limiting symptoms to severe airway obstruction. This study aimed to objectively characterize the type and severity of sleep-disordered breathing in infants with LM using polysomnography (PSG) and to correlate findings with LM subtypes, clinical presentation, and type of surgical intervention. Methods: A cohort of 42 infants diagnosed with LM (Type I: n = 14, Type II: n = 18, Type III: n = 10) underwent overnight PSG before surgical treatment. The Apnea–Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), minimum and mean SpO₂, and heart rate were recorded. Clinical features (stridor, feeding difficulties, respiratory effort) and type of surgery (supraglottoplasty [S] or supraglottoplasty with epiglottopexy [S + E]) were analyzed across LM subtypes. Results: Baseline AHI was significantly higher in LM Type III (25.41 ± 6.95 events/h) compared with Type II (12.50 ± 5.05) and Type I (2.84 ± 1.96; p < 0.001). After surgery, AHI decreased to 1.76 ± 1.56 in Type III and 0.97 ± 0.70 in Type II. ODI showed a similar trend (Type III: 9.87 ± 5.99 before vs. 0.78 ± 0.69 after surgery; p < 0.001). Minimum SpO₂ increased from 69.50 ± 7.76% to 93.60 ± 1.82% in Type III (p < 0.001). Feeding difficulties were observed in 100% of Type III patients, compared with 83.3% of Type II and 42.9% of Type I patients. The distribution of apnea type differed significantly across groups (p < 0.001), with mixed obstructive–central apnea predominating in Type III. Conclusions: Polysomnography is an effective and objective tool for assessing LM severity and guiding surgical qualification. Increasing LM severity is associated with more pronounced PSG abnormalities, greater clinical burden, and a higher likelihood of requiring advanced surgical correction. Full article

Fodder maize constitutes a key economic crop in Thailand, particularly in the northeastern region, where it significantly contributes to livestock feed production and local economic development. Nevertheless, the planning and management of cultivation areas remain a major challenge, especially in urban and peri-urban agricultural zones, due to the limited availability of spatial data and suitable analytical frameworks. These difficulties are exacerbated in urban settings, where the complexity of land use patterns and high spectral similarity among land cover types hinder accurate classification. The Google Earth Engine (GEE) platform provides an efficient and scalable solution for geospatial data processing, enabling rapid land use classification and spatiotemporal analysis. This study aims to enhance the classification accuracy of fodder maize cultivation areas in Mueang District, Nakhon Ratchasima Province, Thailand—an area characterized by a heterogeneous mix of urban development and agricultural land use. The research integrates GEE with four machine learning algorithms: Random Forest (RF), Support Vector Machine (SVM), Naïve Bayes (NB), and Classification and Regression Trees (CART). Eleven datasets were developed using Sentinel-2 imagery and a combination of biophysical variables, including elevation, slope, Normalized Difference Vegetation Index (NDVI), Normalized Difference Built-up Index (NDBI), and Modified Normalized Difference Water Index (MNDWI), to classify land use into six categories: fodder maize cultivation, urban and built-up areas, forest, water bodies, paddy fields, and other field crops. Among the 44 classification scenarios evaluated, the highest performance was achieved using Dataset 11—which integrated all spectral and biophysical variables—with the SVM classifier. This model attained an overall accuracy of 97.41% and a Kappa coefficient of 96.97%. Specifically, fodder maize was classified with 100% accuracy in both Producer’s and User’s metrics, as well as a Conditional Kappa of 100%. These findings demonstrate the effectiveness of integrating GEE with machine learning techniques for precise agricultural land classification. This approach also facilitates timely monitoring of land use changes and supports sustainable land management through informed planning, optimized resource allocation, and mitigation of land degradation in urban and peri-urban agricultural landscapes. Full article

Background/Objectives: Children with Down syndrome (DS) present unique and multifaceted nutritional challenges arising from genetic, metabolic, and developmental factors. Despite growing interest in the health of individuals with DS, dedicated nutritional guidelines tailored to their specific needs remain lacking. This narrative review aims to summarize current scientific evidence on nutritional status, challenges, and therapeutic strategies in children with DS, with an emphasis on clinical implications and practical recommendations for healthcare professionals. Methods: A literature search was conducted across four databases (PubMed, Scopus, Web of Science, and Google Scholar) for English-language publications from 1993 to June 2025. Thirty-five peer-reviewed articles were included, comprising original studies, narrative reviews, and expert guidelines (e.g., the American Academy of Pediatrics [AAP], the European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN], and the European Federation of Associations of Dietitians [EFAD]). The selection process followed the PRISMA protocol. Studies were categorized according to key themes: energy requirements, comorbidities, feeding difficulties, nutrient needs, and therapeutic interventions. Results: Children with DS typically exhibit lower basal metabolic rates and altered body composition (i.e., higher fat mass and reduced lean mass), which increase their risk of both obesity and nutrient deficiencies. Common comorbidities—such as hypothyroidism, celiac disease, and gastrointestinal or immune disorders—further complicate dietary management. Feeding difficulties, including sucking/swallowing impairments, food selectivity, neophobia, and delayed independence in eating, are prevalent and significantly affect diet quality. Key nutrients of concern include protein, omega-3 fatty acids, fiber, vitamins B12 and D, iron, and antioxidants. Although no official nutrition guidelines currently exist for this population, existing recommendations from pediatric and dietetic organizations provide partial guidance that can be adapted to clinical practice. Conclusions: There is an urgent need to develop evidence-based, population-specific dietary guidelines for children with Down syndrome. Clinical nutrition care should be individualized, multidisciplinary, and proactive, integrating regular assessments of growth, feeding abilities, and biochemical markers. Dietitians must play a central role in both early intervention and long-term management. Further research, particularly interventional studies, is essential to optimize dietary strategies and improve health outcomes in this vulnerable population. Full article

Motor insurance can use telematics data not only to understand individual driving style but also to implement innovative coaching strategies that feed back to the drivers, through an app, the aggregated information extracted from the data. The purpose is to encourage an improvement in their driving style. A precondition for this improvement is that drivers are digitally engaged, that is, they interact with the app. This paper proposes a narrow understanding of the term engagement, referring to users’ interactions with the app. This interaction is also a behavior producing specific data that can be tracked and used by insurance companies. Based on the empirical investigation of the dataset of a company selling a telematics motor insurance policy, our research investigates if there is a correlation between engagement with the app and improvement of driving style. The analysis distinguishes different groups of users with different driving abilities, and takes into account time differences. Our findings contribute to clarifying the methodological challenges that must be addressed when exploring engagement and coaching effectiveness in proactive insurance policies. We conclude by discussing the possibility and difficulties of tracking and using second-order behavioral data related to policyholder engagement with the app. Full article

Introduction: Children and adolescents with autism spectrum disorder (ASD) often present sleep and eating problems. However, the relationship between these two factors has seldom been studied. Objective: This paper aimed to examine the association between sleep disturbances and feeding problems in children and adolescents with ASD. Methods: This cross-sectional observational study assessed feeding behaviors using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and assessed sleep problems with the Sleep Disturbance Scale for Children (Bruni scale). Bivariate analyses and multivariate logistic and linear regression analyses were performed. Results: Sleep disturbances were significantly associated with autism severity (p = 0.003), but not with BPFAS subscale scores. Multivariate logistic regression indicated that sleep disturbances were independently associated with autism severity (p = 0.01; OR = 0.23; 95% CI: 0.06–0.77) and the BPFAS frequency subscale score (p = 0.01; OR = 1.04; 95% CI: 1.01–1.07). A secondary logistic regression identified five BPFAS items significantly associated with sleep disturbances: difficulty chewing (p = 0.02, OR = 0.12, 95% CI 0.02–0.74), voluntary attendance at meals (p = 0.01, OR = 0.60, 95% CI 0.39–0.90), tantrums during meals (p < 0.001; OR = 2.08, 95% CI 1.21–3.56), poor appetite (p < 0.001; OR = 2.63, 95% CI 1.43–4.82), and the caregiver’s perception that the child’s eating habits negatively affected their health (p = 0.03; OR = 1.53, 95% CI 1.03–2.40). No significant associations were found with age, sex, medical comorbidities, behavioral disorders or genetic factors. Conclusions: The findings suggest that greater autism severity and more pronounced feeding behaviors are independently associated with an increased risk of sleep disturbances in children and adolescents with ASD. Specific maladaptive mealtime behaviors, such as poor appetite, tantrums, and chewing difficulties, may serve as predictors of sleep problems, highlighting the need for integrated screening and early intervention strategies. Full article

Background/Objectives: Food selectivity is a prevalent and challenging issue in childhood, particularly in children with autism spectrum disorder (ASD), which may result in restricted dietary patterns and nutrient deficiencies. This study aimed to identify high-risk subgroups of children by combining food selectivity, diet, BMI, gastrointestinal symptoms, sensory processing, and parental feeding practices in children with ASD and in typically developing children (TDC). Methods: To achieve this aim, we ran a cross-sectional, survey-based study, including 408 children (aged 3 to 12.11 years), with gender-matched groups. Both parents completed a survey on children’s diet, anthropometric curves, gastrointestinal symptoms, and the Brief Autism Mealtime Behavior Inventory (BAMBI), Short Sensory Profile (SSP), and Caregiver’s Feeding Style Questionnaire (CFSQ). Data analysis included comparative tests, correlations, and k-means cluster analysis. Results: Children with ASD exhibited significantly greater sensory processing difficulties, higher food refusal, limited food variety in the diet, and autism-related mealtime characteristics compared with TDC across all age groups. Caregivers of children with ASD reported higher controlling and contingency management feeding practices compared to the parents of the TDC. We found a strong correlation between sensory sensitivities and feeding issues. Notably, Body Mass Index (BMI) was not significantly associated with dietary restriction or gastrointestinal symptoms. Cluster analysis revealed a high-risk sub-phenotype in both groups of children with some differences, characterized by high food selectivity, taste, tactile, and smell sensitivity, gastrointestinal symptoms, and overactive parental practices. Conclusions: The early identification of this subgroup might foster more tailored, multidisciplinary, and effective assessment and clinical intervention. Full article

Bats are a taxa of high conservation concern and are facing numerous threats including widespread mortality due to White-Nose Syndrome (WNS) in North America. With this decline comes increasing difficulty in monitoring imperiled bat species due to lower detection probabilities of both mist-netting and acoustic surveys. Lure technology shows promise to increase detection while decreasing sampling effort; however, to date research has primarily focused on increasing physical captures during mist-net surveys using sound lures. Because much bat monitoring is now performed using acoustic detection, there is a similar need to increase detection probabilities during acoustic surveys. Ultraviolet (UV) lights anecdotally have been shown to attract insects and thereby attract foraging bats for observational studies and to experimentally provide a food source for WNS-impacted bats before and after hibernation. Therefore, we constructed a field-portable and programmable UV lure device to determine the value of lures for increasing acoustic detection of bats. We tested if the lure device increased both the echolocation passes and feeding activity (feeding buzzes) across a transect of bat detectors. There was an increase in feeding activity around the UV light, with a nuanced, species-specific and positionally dependent effect on echolocation passes received. The UV light lure increased echolocation passes for the eastern red bat (Lasiurus borealis), little brown bat (Myotis lucifugus), and evening bat (Nycticeius humeralis), but decreased passes of the North American hoary bat (Lasiurus cinereus). The northern long-eared bat (Myotis septentrionalis) showed a negative response within the illuminated area but increased echolocation activity outside the illuminated area during lure treatment and activity was elevated at all positions after the lure was deactivated. Our study demonstrates some potential utility of UV lures in increasing the feeding activity and acoustic detection of bats. Additional research and development of UV lure technology may be beneficial, including alternating on and off periods to improve detection of light-averse species, and improving echolocation call quality along with the increase in received passes. Full article