Carolin Ligges

Zusammenfassung: Fragestellung: Die Unterdrückung der physiologischen Pubertät mittels sog. pubertätsblockierender Präparate (PB) und die Gabe gegengeschlechtlicher Hormone (sog. Cross-Sex-Hormone [CSH]) bei Minderjährigen mit Geschlechtsdysphorie (GD) wird als Intervention für ebendiese Personen diskutiert und teilweise in der klinischen Praxis bei dieser Population auch angewendet. Zwei Übersichtsarbeiten (eine zur PB-, eine zur CSH-Gabe) des britischen National Institute for Clinical Excellence (NICE) aus dem Jahr 2020 zeigten keinen eindeutigen klinischen Nutzen in Bezug auf kritische Zielvariablen sowie andere wichtige Variablen, insbesondere keine eindeutige Verbesserung der GD-Symptomatik. Weiterhin wurde die klinisch-wissenschaftliche Qualität der bis dahin vorliegenden Befunde gemäß Modified-GRADE-Kriterien als „sehr gering“ eingestuft. Methodik: Die vorliegende systematische Übersichtsarbeit umfasst eine aktualisierte Literatursuche gemäß NICE-Vorgehensweise für die seit Erscheinen der zuvor genannten beiden NICE-Übersichtsarbeiten neu erschienenen Arbeiten bezüglich der PB- und der CSH-Gabe bei GD (Suchzeitraum Juli 2020 bis August 2023). Ergebnisse: Die neue Literatursuche ergab keinerlei neue Originalarbeiten zur PB-Gabe entsprechend den vordefinierten PICO-Kriterien mit Blick auf kritische oder wichtige Zielvariablen gemäß NICE. Für die CSH-Gabe fanden sich zwei neue Originalarbeiten mit geringer Teilnehmendenzahl, welche die PICO-Kriterien erfüllten, jedoch gemäß Modified-GRADE-Kriterien mit geringer klinisch-wissenschaftlicher Sicherheit bzw. Qualität eingestuft wurden und keine neuen belastbaren Befunde zeigten. Derzeit vorliegende Studien zur PB- und CSH-Gabe haben signifikante konzeptionelle und auch methodische Mängel. Schlussfolgerungen: Die Studienlage zur PB- und CSH-Gabe bei Minderjährigen mit GD ist weiterhin sehr begrenzt und basiert auf wenigen Studien mit unzureichender Methodik und Qualität. Aussagekräftige Langzeitstudien fehlen bisher. Die aktuelle Studienlage deutet derzeit nicht darauf hin, dass sich die GD im Speziellen und die psychische Gesundheit im Allgemeinen im Verlauf der weiteren Entwicklung nach Gabe von PB oder CSH bedeutsam verbessern. Begleitende psychotherapeutische Interventionen bei Kindern und Jugendlichen mit GD zur Unterstützung bzw. zur Minderung der erlebten Belastungen können je nach individueller Situation der Betroffenen ggfs. notwendig werden. Sofern PB- und CSH-Gaben bei Minderjährigen mit GD nach sorgfältiger Risiko-Nutzen-Analyse, abgeschlossener kinder- und jugendpsychiatrischer Diagnostik und ggfs. folgender Behandlung auch begleitender psychischer Symptome oder Störungen bzw. Belastungsfaktoren zum Einsatz kommen sollten, so kann ein solches Vorgehen im Rahmen von Forschungsprojekten bzw. klinischen Studien – wie aktuell in England praktiziert – zum weiteren Erkenntnisgewinn beitragen und wichtige Daten liefern. Das elektronische Supplement (ESM) 1 ist eine adaptierte und gekürzte englische Version dieser Arbeit.

Background: The underlying mechanisms of dyslexia are still debated. The question remains as to whether there is evidence of a predominant type of deficit or whether it is a multideficit disorder with individual profiles. The assumptions of which mechanism causes the disorder influences the selection of the training approach. Methods: A sample of German neurotypical reading children (NT) and children with dyslexia (DYSL) was investigated with a comprehensive behavioral test battery assessing phonological, auditory, visual, and cerebellar performance, thus addressing performance described in three major theories in dyslexia. Results: In the present sample using the test battery of the present study, DYSL had the strongest impairment in phonological and auditory processing, accompanied by individual processing deficits in cerebellar performance, but only a few in the investigated visual domains. Phonological awareness and auditory performance were the only significant predictors for reading ability. Conclusion: These findings point out that those reading difficulties were associated with phonological as well as auditory processing deficits in the present sample. Future research should investigate individual deficit profiles longitudinally, with studies starting before literacy acquisition at as many processing domains as possible. These individual deficit profiles should then be used to select appropriate interventions to promote reading and spelling.

The goal of the study was to determine whether dyslexia is associated with differences in local brain volume, and whether these local brain volume differences show cross-sectional age-effects. We investigated the local volume of gray and white brain matter with voxel-based morphometry (VBM) as well as reading performance in three age groups of dyslexic and neurotypical normal reading subjects (children, teenagers and adults). Performance data demonstrate a steady improvement of reading skills in both neurotypical as well as dyslexic readers. However, the pattern of gray matter volumes tell a different story: the children are the only group with significant differences between neurotypical and dyslexic readers in local gray matter brain volume. These differences are localized in brain areas associated with the reading network (angular, middle temporal and inferior temporal gyrus as well as the cerebellum). Yet the comparison of neurotypical and normal readers over the age groups shows that the steady increase in performance in neurotypical readers is accompanied by a steady decrease of gray matter volume, whereas the brain volumes of dyslexic readers do not show this linear correlation between brain volume and performance. This is further evidence that dyslexia is a disorder with a neuroanatomical basis in the form of a lower volume of gray matter in parts of the reading network in early dyslexic readers. The present data point out that network shaping processes in gray matter volume in the reading network does take place over age in dyslexia. Yet this neural foundation does not seem to be sufficient to allow normal reading performances even in adults with dyslexia. Thus dyslexia is a disorder with lifelong consequences, which is why consistent support for affected individuals in their educational and professional careers is of great importance. Longitudinal studies are needed to verify whether this holds as a valid pattern or whether there is evidence of greater interindividual variance in the neuroanatomy of dyslexia.

The following are the aims of the study: assessment of oral health status, oral health-related quality of life (OHRQoL) and the effect of oral health care training over OHRQoL in children and adolescents hospitalized with mental disorders.

Quantification of functional connectivity in physiological networks is frequently performed by means of time-variant partial directed coherence (tvPDC), based on time-variant multivariate autoregressive models. The principle advantage of tvPDC lies in the combination of directionality, time variance and frequency selectivity simultaneously, offering a more differentiated view into complex brain networks. Yet the advantages specific to tvPDC also cause a large number of results, leading to serious problems in interpretability. To counter this issue, we propose the decomposition of multi-dimensional tvPDC results into a sum of rank-1 outer products. This leads to a data condensation which enables an advanced interpretation of results. Furthermore it is thereby possible to uncover inherent interaction patterns of induced neuronal subsystems by limiting the decomposition to several relevant channels, while retaining the global influence determined by the preceding multivariate AR estimation and tvPDC calculation of the entire scalp. Finally a comparison between several subjects is considerably easier, as individual tvPDC results are summarized within a comprehensive model equipped with subject-specific loading coefficients. A proof-of-principle of the approach is provided by means of simulated data; EEG data of an experiment concerning visual evoked potentials are used to demonstrate the applicability to real data.

A coupled system of nonlinear neural oscillators with an individual resonance frequency is assumed to form the neuronal substrate for the photic driving phenomenon. The aim was to investigate the spatiotemporal stability of these oscillators and quantify the spatiotemporal process of engagement and disengagement of the neuronal oscillators in both multitrial and single-trial data. White light-emitting diode flicker stimulation was used at 15 frequencies, which were set relative to the individual α frequency of each of the 10 healthy participants. Simultaneously, the electroencephalogram (EEG) and the magnetoencephalogram (MEG) were recorded. Subsequently, spatiotemporal matching pursuit (MP) algorithms were used to analyze the EEG and MEG topographies. Intraindividually similar topographies were found at stimulation frequencies close to (1) the individual α frequency and (2) half the individual α frequency in the multitrial and the single-trial cases. In both stimulation frequency ranges, the authors observed stable topographies 5 to 10 stimuli after the beginning of the stimulation and lasting three nonexisting periods after the end of the stimulation. This was interpreted as the engaging/disengaging effect of the observed oscillations, because especially the frequency parameter adopted before and after stable topographies were observed. Topographic entrainment was slightly more pronounced in MEG as compared with that in EEG. The results support the hypothesis of nonlinear information processing in human visual system, which can be described by nonlinear neural oscillators.