Breastfeeding and vitamin D supplementation reduce the risk of Kawasaki disease in a German population-based case-control study

Background

In Kawasaki disease (KD), a vasculitis of unknown etiology, the most serious complication is the development of coronary artery aneurysm (CAA). To date, the exact pathomechanism of KD is unknown. Both environmental and genetic factors seem to be associated with the development of the disease.

Methods

Data on KD patients recruited from the population-based German Pediatric Surveillance Study during 2012–2014 were used to evaluate the impact of various factors from the perinatal and infancy period on the development of KD. The study design was a matched case-control study with respect to age, sex and place of residence (n = 308 KD cases, n = 326 controls). All KD patients were individually re-evaluated; all fulfilled the international diagnostic KD criteria. A standardized questionnaire was used to review breastfeeding practices, vitamin D supplementation and birth characteristics. Logistic regression analyses were performed to obtain odds ratios (OR) for various risk factors among the case-control pairs. Simple measures of association were used to assess the impact of these factors on the clinical course.

Results

There was no difference in lengths of gestation, birth weight or parturition between KD patients and controls, but independently from each other vitamin D supplementation and breastfeeding were negatively associated with KD, even when adjusted for age, place of residence and sex. The duration of vitamin D was significantly shorter among children with KD than among children without KD (p = 0.039, OR = 0.964, 95% CI: 0.931–0.998), as was the duration of breastfeeding (p = 0.013, OR = 0.471, 95% CI: 0.260–0.853). Comparing KD patients with and without breastfeeding and/or vitamin D supplementation, there were no differences regarding developing CAA, being refractory to intravenous immunoglobulin treatment, age at onset of the disease and levels of inflammatory laboratory values.

Conclusion

Our findings indicate breastfeeding and vitamin D supplementation to have protective effects in association with KD in our study population; however, these seem not to influence the natural course of the disease. Although the overall effects were relatively small, they nevertheless underline the overall benefit of both interventions.

Trial registration

Clinical Trial Registration: German clinical trial registration, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010071. Date of registration was 26. February 2016. The trial was registered retrospectively.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1438-2) contains supplementary material, which is available to authorized users.

Eliashberg analysis of the optical conductivity in superconducting Pr2CuOx with x ≃ 4

Superconducting Pr(2)CuO(x), x ≃ 4 films with T' structure and a T(c) of 27 K have been investigated by millimeter-wave transmission and broadband (infrared-to-ultraviolet) reflectivity measurements in the normal and superconducting state. The results obtained by both experimental methods show a consistent picture of the superconducting condensate formation below T(c). An Eliashberg analysis of the data proves d-wave superconductivity and unitary-limit impurity scattering of the charge carriers below T(c). The derived electron-exchange boson interaction spectral function I(2)χ(ω) shows only marginal changes at the superconducting transition with the mass enhancement factor λ, the first inverse moment of I(2)χ(ω), being equal to 4.16 at 30 K and to 4.25 at 4 K.

Interlayer penetration depth in the pseudogap phase of cuprate superconductors

The opening of a pseudogap in the electronic structure of the underdoped high Tc cuprates has a profound effect on superconducting properties. Here we consider the c-axis penetration depth. A phenomenological model of the pseudogap due to Yang, Rice, and Zhang (YRZ) is used. It is based on the idea of a resonating valence bond spin liquid. A simplifying limit, the arc model, is also considered as it provides useful analytic formulas. The zero temperature value of the superfluid density n(s)(T = 0) is greatly reduced with increasing values of the pseudogap (Δpg). This value reflects the reconstruction of the Fermi surface from the large contour of Fermi liquid theory to ever smaller Luttinger pockets as Δpg becomes larger. Also, as temperature is increased the ratio n(s)(T)/n(s)(0) as a function of the reduced temperature t = T/T(c) decreases more rapidly than in the corresponding Fermi liquid (Δpg = 0) as states which have both superconducting and pseudogap become more significantly sampled.

Space fractional Wigner equation and its semiclassical limit

Manifestations of space fractional quantum mechanics (SFQM), as it was formulated by Laskin [Phys. Rev. E 62, 3135 (2000)], are deemed to offer a better physical interpretation of Lévy flight statistics on a quantum mechanical level. We start with the SFQM Schrödinger equation characterized by a Lévy flight index α∈ (1,2), perform a Wigner transform, and draw the limit h/Eτ → 0 (i.e., let the observed energy scale E go to infinity in comparison to the quantization given by h/τ). In order to obtain classical transport equations two possible substitutions for the terms |p|(α) and |p'|α which appear in von Neumann's equation are presented. It is demonstrated that they conform to the criteria for a successful Wigner transform. Their benefits and caveats are discussed in detail. We find, that, indeed, SFQM manifests itself in an anomalous kinetic term of the free particle's motion and, assuming an external potential diagonal in momentum space for the sake of simplicity, in corresponding anomalous terms in the resulting drift current. All our results reduce to the classical forms in the limit α = 2.

Continuous time anomalous diffusion in a composite medium

The one-dimensional continuous time anomalous diffusion in composite media consisting of a finite number of layers in immediate contact is investigated. The diffusion process itself is described with the help of two probability density functions (PDFs), one of which is an arbitrary jump-length PDF, and the other is a long-tailed waiting-time PDF characterized by the waiting-time index β∈(0,1). The former is assumed to be a function of the space coordinate x and the time coordinate t while the latter is a function of x and the time interval. For such an environment a very general form of the diffusion equation is derived which describes the continuous time anomalous diffusion in a composite medium. This result is then specialized to two particular forms of the jump-length PDF, namely the continuous time Lévy flight PDF and the continuous time truncated Lévy flight PDF. In both cases the PDFs are characterized by the Lévy index α∈(0,2) which is regarded to be a function of x and t. It is possible to demonstrate that for particular choices of the indices α and β other equations for anomalous diffusion, well known from the literature, follow immediately. This demonstrates the very general applicability of the derivation and of the resulting fractional differential equation discussed here.

Lévy-flight anomalous diffusion in a composite medium

The one-dimensional Lévy flight in a composite medium consisting of two layers in contact, with arbitrary Lévy indices, is investigated. Such systems are of much interest in the field of organic electronics, where diffusional transport between two materials profoundly influences the device performance. Using the jump-length probability density function for a particular Lévy index as a starting point, equations are derived that describe anomalous diffusion in a composite two-layer medium. Moreover, expressions for the current density are given, and the steady-state distribution for the special case of one dominating diffusion coefficient is illustrated.

An electron-boson glue function derived from electronic Raman scattering

Raman scattering cross sections depend on photon polarization. In the cuprates, nodal and antinodal directions are weighted more strongly in B(2g) and B(1g) symmetries, respectively. On the other hand, in angle-resolved photoemission spectroscopy (ARPES), electronic properties are measured along well-defined directions in momentum space rather than their weighted averages being taken. In contrast, the optical conductivity involves a momentum average over the entire Brillouin zone. Newly measured Raman response data on high-quality Bi(2)Sr(2)CaCu(2)O(8 + δ) single crystals up to high energies have been inverted using a modified maximum entropy inversion technique to extract from B(1g) and B(2g) Raman data corresponding electron-boson spectral densities (glue), and these are compared to the results obtained with known ARPES and optical inversions. We find that the B(2g) spectrum agrees qualitatively with nodal direction ARPES while the B(1g) results look more like the optical spectrum. A large peak around 30-40 meV in B(1g) and a much less prominent one in B(2g) are taken as support for the importance of (π, π) scattering at this frequency.

Exchange boson dynamics in cuprates: optical conductivity of HgBa_2CuO_4+delta

The electron-boson spectral density function I;{2}chi(Omega) responsible for carrier scattering of the high temperature superconductor HgBa_{2}CuO_{4+delta} (T_{c}=90 K) is calculated from new data on the optical scattering rate. A maximum entropy technique is used. Published data on HgBa_{2}Ca_{2}Cu_{3}O_{8+delta} (T_{c}=130 K) are also inverted and these new results are put in the context of other known cases. All spectra (with two notable exceptions) show a peak at an energy (Omega_{r}) proportional to the superconducting transition temperature Omega_{r} approximately 6.3k_{B}T_{c}. This charge channel relationship follows closely the magnetic resonance seen by polarized neutron scattering, Omega_{r};{neutron} approximately 5.4k_{B}T_{c}. The amplitudes of both peaks decrease strongly with increasing temperature. In some cases, the peak at Omega_{r} is weak and the spectrum can have additional maxima and a background extending up to several hundred meV.

Bosonic spectral density of epitaxial thin-film La1.83Sr0.17CuO4 superconductors from infrared conductivity measurements

We use optical spectroscopy to investigate the excitations responsible for the structure in the optical self-energy of thin epitaxial films of La(1.83)Sr(0.17)CuO(4). Using Eliashberg's formalism to invert the optical spectra we extract the electron-boson spectral function and find that at low temperature it has a two component structure closely matching the spin excitation spectrum recently measured by magnetic neutron scattering. We contrast the temperature evolution of the spectral density and the two-peak behavior in La(2-Sr(x)CuO(4) with another high temperature superconductor Bi(2)Sr(2)CaCu(2)O(8+delta). The bosonic spectral functions of the two materials account for the low T(c) of LSCO as compared to Bi-2212.

Coupling strength of charge carriers to spin fluctuations in high-temperature superconductors

In conventional superconductors, the most direct evidence of the mechanism responsible for superconductivity comes from tunnelling experiments, which provide a clear picture of the underlying electron-phonon interactions. As the coherence length in conventional superconductors is large, the tunnelling process probes several atomic layers into the bulk of the material; the observed structure in the current-voltage characteristics at the phonon energies gives, through inversion of the Eliashberg equations, the electron-phonon spectral density alpha2F(omega). The situation is different for the high-temperature copper oxide superconductors, where the coherence length (particularly for c-axis tunnelling) can be very short. Because of this, methods such as optical spectroscopy and neutron scattering provide a better route for investigating the underlying mechanism, as they probe bulk properties. Accurate reflection measurements at infrared wavelengths and precise polarized neutron-scattering data are now available for a variety of the copper oxides, and here we show that the conducting carriers (probed by infrared spectroscopy) are strongly coupled to a resonance structure in the spectrum of spin fluctuations (measured by neutron scattering). The coupling strength inferred from those results is sufficient to account for the high transition temperatures of the copper oxides, highlighting a prominent role for spin fluctuations in driving superconductivity in these materials.