Background and Aims: Skin aging is associated with dry skin and a decrease of the strength of the dermoepidermal adhesion, which increases the risk for lacerations (skin tears). Application of leave-on products improves dry skin and seems to reduce skin tear incidence. The aim of this study was to measure the effects of a humectant containing leave-on product on the strength of the dermoepidermal junction in older adult participants with dry skin. Methods: A randomized controlled trial using a split body design was conducted. One forearm was randomly selected and treated with a lipophilic leave-on product containing 5% urea for 8 weeks. The other forearm was the control. The parameters stratum corneum hydration (SCH), transepidermal water loss, pH, roughness, epidermal thickness and skin stiffness were measured at the baseline, Weeks 4 and 8. At Week 8, suction blisters were created and time to blistering was measured. Blister roofs and interstitial fluid were analyzed for Interleukin-1 alpha, 6 and 8. Results: Twelve participants were included. After 8 weeks treatment, SCH was higher (median difference 11.6 AU), and the overall dry skin score (median difference -1) and median roughness (Rz difference -12.2 mu m) were lower compared to the control arms. The median group difference for Interleukin-1 alpha was -452 fg/mu g total protein (TP) in the blister roofs and -2.2 fg/mu g TP in the blister fluids. The median time to blister formation was 7.7 min higher compared to the control arms. Conclusion: The regular application of humectant containing leave-on products improves dry skin and seems to lower inflammation and contribute to the strengthening of the dermoepidermal adhesion. This partly explains how the use of topical leave-on products helps to prevent skin tears.

We examine the consequences of compressing secondary schooling on university enrollment. An unusual education reform in Germany reduced the length of academic high school while simultaneously increasing the instruction hours in the remaining years. Accordingly, students receive the same amount of schooling but over a shorter period of time, constituting an efficiency gain from an individual’s perspective. Based on a differencein- differences approach and using administrative data on all students in Germany, we find that this reform decreased university enrollment rates. Moreover, students are more likely to delay their enrollment, to drop out of university, and to change their major. We discuss supply side restrictions, age differences, and increased workload during school as potential mechanisms and present back-of-the-envelope cost-benefit considerations showing that the earnings gain from an extended

Excessive alcohol consumption among young people is a major public health concern. On March 1, 2010, the German state of Baden-Württemberg banned the sale of alcoholic beverages between 10pm and 5am at off-premise outlets (e.g., gas stations, kiosks, supermarkets). We use rich monthly administrative data from a 70 percent random sample of all hospitalizations during the years 2007-2011 in Germany in order to evaluate the short-term impact of this policy on alcohol-related hospitalizations. Applying difference-in-differences methods, we find that the policy change reduces alcohol-related hospitalizations among adolescents and young adults by about seven percent. There is also evidence of a decrease in the number of hospitalizations due to violent assault as a result of the ban.

Patient-reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person-centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK-air (R) (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut-offs and responsiveness. Then, a multicentric, multinational, double-blind, placebo-controlled, randomised control trial (DB-PC-RCT) using an electronic VAS form was carried out. Finally, with the development of MASK-air (R) in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ-5D are included in the app. Additionally, two control-medication scores for allergic symptoms of asthma (e-DASTHMA) were validated for their criterion validity, cut-offs and responsiveness.

Background: Although there have been significant advances in the treatment of chronic spontaneous urticaria (CSU) in recent years, there remains a lack of clear guidance on when and how to step down treatment in responders. This study aims to investigate stepping down approaches of different steps of CSU treatment from a global perspective. Methods: "Stepping down chronic spontaneous urticaria treatment" (SDown-CSU) is an international, multicenter, observational, cross-sectional, survey-based study of the Urticaria Centers of Reference and Excellence (UCARE) network. The questionnaire included 48 questions completed by physicians in the UCARE network. Results: Surveys completed by 103 physicians from 81 UCAREs and 34 countries were analyzed. Seventy-eight percent of the participants responded that they had a national urticaria management guideline written by their professional societies and 28% responded that they had to operate under a regulatory guideline proposed by central health funding organizations. Seventy-two and 58.7% of these national recommendations do not contain any detailed information on when and/or how CSU treatment should be discontinued. There was a lack of detailed information on antihistamines and cyclosporine in particular. A predefined maximum duration was generally not applicable to omalizumab and cyclosporine (81% and 82%, respectively). Nearly all UCAREs step down omalizumab within 6 months from the first controlled status and 42% discontinue cyclosporine after 6 months regardless of the control status. Conclusions: The findings from the SDown-CSU study clearly highlight a global need for guidance on the process of stepping down treatment in CSU. Additionally, the study offers a step-down algorithm applicable to all stages of CSU treatment.

Background: Structural disconnectivity was found to precede dementia. Global white matter abnormalities might also be associated with postoperative delirium (POD). Methos: We recruited older patients (>= 65 years) without dementia that were scheduled for major surgery. Diffusion kurtosis imaging metrics were obtained preoperatively, after 3 and 12 months postoperatively. We calculated fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and free water (FW). A structured and validated delirium assessment was performed twice daily. Results: Of 325 patients, 53 patients developed POD (16.3%). Preoperative global MD (standardized beta 0.27 [95% confidence interval [CI] 0.21-0.32] p < 0.001) was higher in patients with POD. Preoperative globalMK (-0.07 [95% CI -0.11 to (-0.04)] p < 0.001) and FA (0.07 [95% CI -0.10 to (-0.04)] p < 0.001) were lower. When correcting for baseline diffusion, postoperative MD was lower after 3 months (0.05 [95% CI -0.08 to (-0.03)] p < 0.001; n = 183) and higher after 12 months (0.28 [95% CI 0.20-0.35] p < 0.001; n = 45) among patients with POD. Discussion: Preoperative structural disconnectivity was associated with POD. POD might lead to white matter depletion 3 and 12 months after surgery.

Genetic variants in relevant genes coexisting with MRI lesions in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. Still, presurgical evaluation does not include genetic diagnostics routinely. Here, we report our presurgical evaluation algorithm that includes routine genetic testing. We analyzed retrospectively the data of 68 children with DRE operated at a mean age of 7.8 years (IQR: 8.1 years) at our center. In 49 children, genetic test results were available. We identified 21 gene variants (ACMG III: n = 7, ACMG IV: n = 2, ACMG V: n = 12) in 19 patients (45.2%) in the genes TSC1, TSC2, MECP2, DEPDC5, HUWE1, GRIN1, ASH1I, TRIO, KIF5C, CDON, ANKD11, TGFBR2, ATN1, COL4A1, JAK2, KCNQ2, ATP1A2, and GLI3 by whole-exome sequencing as well as deletions and duplications by array CGH in six patients. While the results did not change the surgery indication, they supported counseling with respect to postoperative chance of seizure freedom and weaning of antiseizure medication (ASM). The presence of genetic findings leads to the postoperative retention of at least one ASM. In our cohort, the International League against Epilepsy (ILAE) seizure outcome did not differ between patients with and without abnormal genetic findings. However, in the 7/68 patients with an unsatisfactory ILAE seizure outcome IV or V 12 months postsurgery, 2 had an abnormal or suspicious genetic finding as a putative explanation for persisting seizures postsurgery, and 3 had received palliative surgery including one TSC patient. This study highlights the importance of genetic testing in children with DRE to address putative underlying germline variants as genetic epilepsy causes or predisposing factors that guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning. Plain Language Summary Genetic variants in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. However, presurgical evaluation does not include genetic diagnostics routinely. This retrospective study analyzed the genetic testing results of the 68 pediatric patients who received epilepsy surgery in our center. We identified 21 gene variants by whole-exome sequencing as well as deletions and duplications by array CGH in 6 patients. These results highlight the importance of genetic testing in children with DRE to guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning.

The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient's length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas (R) Liat (R) (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients' LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly (p<0.01) shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.

Beyond SARS-CoV2 vaccines, mRNA drugs are being explored to overcome today's greatest healthcare burdens, including cancer and cardiovascular disease. Synthetic mRNA triggers immune responses in transfected cells, which can be reduced by chemically modified nucleotides. However, the side effects of mRNA-triggered immune activation on cell function and how different nucleotides, such as the N1-methylpseudouridine (m1 psi) used in SARS-CoV2 vaccines, can modulate cellular responses is not fully understood. Here, cellular responses toward a library of uridine-modified mRNAs are investigated in primary human cells. Targeted proteomics analyses reveal that unmodified mRNA induces a pro-inflammatory paracrine pattern marked by the secretion of chemokines, which recruit T and B lymphocytes toward transfected cells. Importantly, the magnitude of mRNA-induced changes in cell function varies quantitatively between unmodified, psi-, m1 psi-, and 5moU-modified mRNA and can be gradually tailored, with implications for deliberately exploiting this effect in mRNA drug design. Indeed, both the immunosuppressive effect of stromal cells on T-cell proliferation, and the anti-inflammatory effect of IL-10 mRNA are enhanced by appropriate uridine modification. The results provide new insights into the effects of mRNA drugs on cell function and cell-cell communication and open new possibilities to tailor mRNA-triggered immune activation to the desired pro- or anti-inflammatory application.

Introduction: Childhood obesity is increasing worldwide and presents as a global health issue due to multiple metabolic comorbidities. About 1% of adolescents with obesity develop type 2 diabetes (T2D); however, little is known about the genetic and pathophysiological background at young age. The objective of this study was to assess the prevalence of impaired glucose regulation (IGR) in a large cohort of children and adolescents with obesity and to characterize insulin sensitivity and insulin secretion. We also wanted to investigate adolescents with insulin secretion disorder more closely and analyze possible candidate genes of diabetes in a subcohort. Methods: We included children and adolescents with obesity who completed an oral glucose tolerance test (OGTT, glucose+insulin) in the outpatient clinic. We calculated Matsuda index, the area under the curve (AUC (Ins/Glu)), and an oral disposition index (ISSI-2) to estimate insulin resistance and beta-cell function. We identified patients with IGR and low insulin secretion (maximum insulin during OGTT<200 mU/l) and tested a subgroup using next generation sequencing to identify possible mutations in 103 candidate genes. Results: The total group consisted of 903 children and adolescents with obesity. 4.5% showed impaired fasting glucose, 9.4% impaired glucose tolerance, and 1.2% T2D. Matsuda index and Total AUC (Ins/Glu) showed a hyperbolic relationship. Out of 39 patients with low insulin secretion, we performed genetic testing on 12 patients. We found five monogenetic defects (ABCC8 (n=3), GCK (n=1), and GLI2/PTF1A (n=1)). Conclusion: Using surrogate parameters of beta-cell function and insulin resistance can help identify patients with insulin secretion disorder. A prevalence of 40% mutations of known diabetes genes in the subgroup with low insulin secretion suggests that at least 1.7% of patients with adolescent obesity have monogenic diabetes. A successful molecular genetic diagnosis can help to improve individual therapy.

Background: Subclinical myocardial injury in form of hs-cTn (high-sensitivity cardiac troponin) levels has been associated with cognitive impairment and imaging markers of cerebral small vessel disease (SVD) in population-based and cardiovascular cohorts. Whether hs-cTn is associated with domain-specific cognitive decline and SVD burden in patients with stroke remains unknown. Methods and results: We analyzed patients with acute stroke without premorbid dementia from the prospective multicenter DEMDAS (DZNE [German Center for Neurodegenerative Disease]-Mechanisms of Dementia after Stroke) study. Patients underwent neuropsychological testing 6 and 12 months after the index event. Test results were classified into 5 cognitive domains (language, memory, executive function, attention, and visuospatial function). SVD markers (lacunes, cerebral microbleeds, white matter hyperintensities, and enlarged perivascular spaces) were assessed on cranial magnetic resonance imaging to constitute a global SVD score. We examined the association between hs-cTnT (hs-cTn T levels) and cognitive domains as well as the global SVD score and individual SVD markers, respectively. Measurement of cognitive and SVD-marker analyses were performed in 385 and 466 patients with available hs-cTnT levels, respectively. In analyses adjusted for demographic characteristics, cardiovascular risk factors, and cognitive status at baseline, higher hs-cTnT was negatively associated with the cognitive domains "attention" up to 12 months of follow-up (beta-coefficient, -0.273 [95% CI, -0.436 to -0.109]) and "executive function" after 12 months. Higher hs-cTnT was associated with the global SVD score (adjusted odds ratio, 1.95 [95% CI, 1.27-3.00]) and the white matter hyperintensities and lacune subscores. Conclusions: In patients with stroke, hs-cTnT is associated with a higher burden of SVD markers and cognitive function in domains linked to vascular cognitive impairment. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01334749.

Das Auswahlverfahren für Studierende der Tiermedizin in Deutschland wurde 2020 umgestellt, indem u. a. die Wartezeitquote und andere Assessmentverfahren abgebaut und der Test für medizinische Studiengänge (TMS) wieder eingeführt wurde. Im Rahmen einer deutschlandweiten Online-Umfrage wurde untersucht, ob sich dadurch Veränderungen hinsichtlich des Bildungshintergrunds der erfolgreichen Bewerbenden ergaben. Es wurden Antworten von 1.525 Studierenden der Tiermedizin ausgewertet, was einer Antwortrate von 24 % entspricht. Sowohl vor als auch nach der Umstellung hatten fast alle Teilnehmenden (97 %) die Allgemeine Hochschulreife. Auch gab es keine Unterschiede zwischen den beiden Kohorten hinsichtlich der Abiturnote oder dem Anteil an Arbeiterkindern (Personen, deren Eltern nicht studiert haben). Ab 2020 nahmen 64 % der Umfrageteilnehmenden am freiwilligen TMS teil. Diejenigen, welche nicht am TMS teilnahmen, fanden ihn aufgrund der Abiturbestnote unnötig oder wussten nichts bzw. zu spät davon. Studierende, die nach dem alten Verfahren zugelassen worden waren, hatten tendenziell etwas seltener bereits vor Studienbeginn eine Berufsausbildung abgeschlossen als Studierende, die ab 2020 ihr Studium begannen (34,1 % bzw. 38,7 %; p = 0,094). In der Kohorte ab 2020 wurde signifikant häufiger eine Berufsausbildung zum Tiermedizinischen Fachangestellten (TFA) und seltener eine Berufsausbildung im nicht-tiermedizinischen Bereich abgeschlossen (p < 0,001). Gründe für die Berufsausbildung waren vielfach eine für das Tiermedizinstudium nicht hinreichende Abiturnote oder der Wunsch, Berufserfahrung zu sammeln. Die meisten Teilnehmenden sprachen sich für eine stärkere Bepunktung von bereits absolvierten Praktika bei der Zulassung aus. Die Ergebnisse zeigen, dass sich durch das veränderte Zulassungsverfahren, abgesehen von mehr absolvierten Berufsausbildungen zum TFA, keine deutlichen Unterschiede in der Bildungsbiografie der zugelassenen Studierenden im Untersuchungszeitraum ergeben haben.

Students' diverse levels of knowledge and competence—shaped by individual interests and educational debts, including structural, systemic, and institutional barriers—create substantial cognitive heterogeneity in instructional settings. Adequately addressing this heterogeneity is challenging. Emerging studies applying artificial intelligence (AI) in education claim that advanced AI techniques like machine learning (ML) can mitigate educational debts by providing adaptive support. However, previous research offers limited clarity on how learning outcomes vary following AI-based adaptive instruction and which students improve their learning outcomes. To address these issues, this article quantitatively examines the extent to which ML-based adaptivity influences students' learning outcomes over time and identifies which students, considering their intersectional identities, benefit most from this adaptive support. Specifically, we illustrate a semester-long study conducted within an undergraduate organic chemistry course, where an ML model adaptively supported 266 students across four interventions on mechanistic reasoning. We identified five learning trajectories throughout these adaptive interventions. Our findings show that students with higher prior knowledge made greater progress than their peers. Additionally, men without an underrepresented minority (URM) status majoring in chemistry benefited more than URM women who are not chemistry majors. This indicates that the adaptive support maintained and partly exacerbated educational debts. Our study contributes to the literature by analyzing how ML-based adaptivity affects educational debts in undergraduate organic chemistry. In doing so, it adopts a theoretical framework—the enhanced educational debt framework—to assess when different aims of adaptive support are most appropriate in undergraduate education, informing an equity-centered design of adaptive support.

Peripheral arterial disease (PAD) is an increasing cause of morbidity and its severity is graded based on clinical manifestation. To investigate the influence of the different stages on myopathy of ischemic muscle we analysed severity-dependent effects of mitochondrial respiration in PAD. Eighteen patients with severe PAD, defined as chronic limb-threatening ischemia, 47 patients with intermittent claudication (IC) and 22 non-ischemic controls were analysed. High-resolution respirometry (HRR) was performed on muscle biopsies of gastrocnemius and vastus lateralis muscle of patients in different PAD stages to investigate different respiratory states. Results from HRR are given as median and interquartile range and were normalized to citrate synthase activity (CSA), a marker for mitochondrial content. In order to account for inter-individual differences between patients and controls, we calculated the ratio of O-2-flux in gastrocnemius muscle over vastus muscle ('GV ratio'). CSA of the gastrocnemius muscle as a proxy for mitochondrial content was significantly lower in critical ischemia compared to controls. Mitochondrial respiration normalized to CSA was higher in IC compared to controls. Likewise, the GV ratio was significantly higher in IC compared to control. Mitochondrial respiration and CSA of PAD patients showed stage-dependent modifications with greater changes in the mild PAD stage group (IC).

The magnitude and understanding of the Kingdom Fungi are expanding with the application of DNA-based molecular approaches. Non-Dikarya fungi (sometimes referred to as 'basal fungi', 'early divergent fungi' or 'lower fungi'), a large group of fungi that are included in 16 different phyla, comprise approximately 5000 species to date. This paper compiles all existing information on the families of the non-Dikarya fungal phyla. Two phylogenomic analyses are provided separately to show the relationships of the phyla of non-Dikarya and families of Mucoromycota, respectively. A phylogenetic tree based on partial 45S or partial 28S sequences is provided to show the placements of families in Glomeromycota. We provide the descriptions of each family and its type genus, including an illustration of the type species or a well-established other genus in the family. All the genera included in the family are listed with their type species. Bulbosporaceae fam. nov. is introduced to accommodate Bulbospora in Gigasporales (Glomeromycetes, Glomeromycota). Densosporales Tedersoo, Densosporaceae Desiro et al., and Jimgerdemanniaceae Tedersoo are validated. Taxa in Rozellomycota (including Microsporidia) and Aphelidiomycota are currently accepted as groups of fungi. Still, most species names require further revision following the International Code of Nomenclature for algae, fungi, and plants. Caudosporina Y.S. Tokarev & I.V. Issi nom. nov. and Mesnilivella Frolova & Nassonova nom. nov. are provided to accommodate Caudospora J. Weiser (nom. illegit.) and Mesnilia Frolova et al. 2023 (nom. illegit.), respectively. Taxa introduced based on eDNA (by Tedersoo et al. 2024) are listed separately, as currently these taxa are treated as invalid. Fossil non-Dikarya taxa are also provided separately.

We present the characterisation of the TOI-6041 system, a bright (V = 9.84 ± 0.03) G7-type star hosting at least two planets. The inner planet, TOI-6041 b, is a warm Neptune with a radius of 4.55−0.17+0.18 R⊕, initially identified as a single-transit event in TESS photometry. Subsequent observations with TESS and CHEOPS revealed additional transits, enabling the determination of its 26.04945−0.00034+0.00033 orbital period and the detection of significant transit-timing variations (TTVs), exhibiting a peak-to-peak amplitude of about 1 hour. Radial-velocity (RV) measurements obtained with the APF spectrographs allowed us to place a 3σ upper mass limit of 28.9 M⊕ on TOI-6041 b. In addition, the RV data reveal a second companion, TOI-6041 c, on an 88 d orbit, with a minimum mass of 0.25 MJup. A preliminary TTV analysis suggested that the observed variations could be caused by gravitational perturbations from planet c; however, reproducing the observed amplitudes requires a relatively high eccentricity of about 0.3 for that planet. Our dynamical stability analysis indicates that such a configuration is dynamically viable and places a 1σ upper limit on the mass of TOI-6041 c at 0.8 MJup. An alternative is the presence of a third, low-mass planet located between planets b and c, or on an inner orbit relative to planet b – particularly near a mean-motion resonance with planet b – which could account for the observed variations. These findings remain tentative, and further RV and photometric observations are essential in to better constrain the mass of planet b and to refine the TTV modeling, thereby improving our understanding of the system’s dynamical architecture.

The JPL rover Perseverance's investigations of Jezero crater's floor reveal that the ultramafic Séítah formation and the overlying mafic Máaz formation are deformed into a broad, low-amplitude structural dome. Mastcam-Z stereo images processed into digital outcrop models, together with RIMFAX ground-penetrating radar profiles, were used to reconstruct the three-dimensional stratal geometry of both units along a SW–NE transect across a southern domain of the dome called south Séítah. Measurements from 3-D reconstructions show a progression from sub-horizontal layers in the central parts of the dome to dips <20° away from the dome on its flanks, with Máaz and underlying Séítah layers dipping concordantly. RIMFAX profiles and imaging around the dome confirm that limb dips are continuous into the subsurface and form a flat-crested composite quaquaversal fold structure. Séítah rocks in the fold core are up to 17 m higher than adjacent Máaz lava flows, despite stratigraphically underlying them, a relationship attributed to structural uplift. Fold geometry, wavelength (∼1 km), and amplitude (∼30–50 m), match models of forced folding produced by inflation of shallow igneous intrusions. The most likely cause is the emplacement of a sill or laccolith beneath the crater floor, generating elastic bending of the overlying layers. This intrusion-driven uplift explains Séítah's elevated position, constrains the deformation history of Jezero's crater floor units post-emplacement of the Séítah and Máaz formations, and supports a significant role for shallow magmatic intrusion in shaping intracrustal structures on Mars.

Scope: Secretion of the gut hormones glucagon-like peptide (GLP-1) and peptide YY (PYY) are induced by nutrients reaching the lower small intestine which regulate insulin and glucagon release, inhibit appetite, and may improve beta-cell regeneration. The aim is to test the effect of a slowly digested isomaltulose (ISO) compared to the rapidly digested saccharose (SAC) as a snack given 1 h before a standardized mixed meal test (MMT) on GLP-1, PYY, glucose-dependent insulinotropic peptide (GIP), and metabolic responses in participants with or without type 2 diabetes (T2DM). Methods and results: Fifteen healthy volunteers and 15 patients with T2DM consumed either 50 g ISO or SAC 1 h preload of MMT on nonconsecutive days. Clinical parameters and incretin hormones are measured throughout the whole course of MMT. Administration of 50 g ISO as compared to SAC induced a significant increase in GLP-1, GIP, and PYY responses over 2 h after intake of a typical lunch in healthy controls. Patients with T2DM showed reduced overall responses of GLP-1 and delayed insulin release compared to controls while ISO significantly enhanced the GIP and almost tripled the PYY response compared to SAC. Conclusion: A snack containing ISO markedly enhances the release of the metabolically advantageous gut hormones PYY and GLP-1 and enhances GIP release in response to a subsequent complex meal.

Background Suicidal ideation and self-injurious behaviors (SISIB) in children and adolescents are a major concern in clinical practice. Yet, little is known about the prevalence rates of SISIB in outpatient clinics and its response to routine psychotherapy. Therefore, the present study aims to assess the prevalence of SISIB and the changes in SISIB in a heterogeneous clinical outpatient sample of children and adolescents undergoing cognitive behavioral therapy in Germany. Methods The sample consists of N = 5730 child and adolescent outpatients, 54.05% female, mean age = 12.16 years (SD = 3.51). As metrics of SISIB, two items (Item 18 on self-injurious behavior and Item 91 on suicidal ideation) of the Youth Self Report (YSR/11–18R) and the Child Behavior Checklist (CBCL/6–18R) as caregiver report were used. Results Pretreatment, suicidal ideation was reported by 33.45% of patients and 15.39% of caregivers. Self-injurious behavior was reported pretreatment by 35.35% of patients and 20.16% of caregivers. Posttreatment, suicidal ideation was reported by 11.32% of patients and 5.25% of caregivers. Self-injurious behavior was reported posttreatment by 19.00% of patients and 9.43% of caregivers. Conclusion SISIB are very common in children and adolescents in outpatient settings. Prevalence rates are higher in self-reports than in caregiver reports, indicating the importance of assessing SISIB in children and adolescents themselves. After routine-care psychotherapy, a substantial proportion of patients report an amelioration of SISIB. These results indicate the importance of monitoring SISIB during treatment and of therapists being aware of risk assessment techniques and psychotherapy interventions targeting SISIB.