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The COVID-19 pandemic was associated with a marked decline in respiratory infections and asthma exacerbations in children. Following the easing of restrictions, a rebound in respiratory morbidity was observed. However, the long-term impact on paediatric asthma remains unclear. We conducted a retrospective study using data from the largest healthcare provider in Israel. Children aged 2-18 years with recurrent wheezing or clinician-diagnosed asthma were included. Healthcare utilisation between January 2019 and July 2023 was analysed. A total of 209 954 children, mean age 6.8 years (56.9% male), were included. During winter 2020-2021, compared with winter 2019-2020, healthcare utilisation declined significantly for chest radiographs (CXR) (RR = 0.69), asthma medication dispensing (RR = 0.67), and emergency department (ED) visits (RR = 0.61). After restrictions were lifted, all outcomes rose sharply, peaking in summer 2021. By winter 2022-2023, rates of CXR (RR = 1.30), asthma medication dispensing (RR = 1.03), ED visits (RR = 1.04), and hospitalisations (RR = 1.30) remained significantly higher than pre-pandemic levels across all age groups. Paediatric respiratory-related healthcare utilisation exceeded pre-pandemic levels during the first and second post-pandemic winters. These findings highlight the unpredictable, long-lasting, and indirect consequences of pandemic-era interventions on respiratory health.

Background: Non-pharmaceutical interventions during the COVID-19 pandemic altered respiratory pathogen circulation, and a bacterial rebound followed once restrictions were lifted. We describe pediatric pneumococcal respiratory infections and their bacterial co-detections in the immediate post-pandemic period. Methods: We retrospectively analyzed respiratory specimens from children aged 0-18 years tested with a multiplex real-time PCR panel (Allplex Respiratory Panel, Seegene, Seoul, South Korea; seven bacterial pathogens) restricted to this predefined bacterial spectrum at a tertiary pediatric hospital in Galați, Romania, during 2022 and 2023. A total of 2546 panels were performed in 2022 and 3250 in 2023, allowing pneumococcal positivity rates to be calculated. Proportions are reported with Wilson 95% confidence intervals; associations were tested with Pearson chi-square and Fisher exact tests in SPSS v.23. Results: Children with detected Streptococcus pneumoniae rose from 100 to 415, corresponding to a rise in pneumococcal positivity from 3.9% (100/2546) to 12.8% (415/3250). Among the positive children, pneumococcus-Haemophilus influenzae co-detection increased from 33.0% to 45.1% (odds ratio 1.63, 95% CI 1.02-2.61; p = 0.029), while pneumococcus alone fell from 60.0% to 50.1%. Boys, urban residence, and early childhood predominated, and community-acquired pneumonia diagnoses rose from 61 to 214. No profile-demographic association reached significance (panel-residence 2023, p = 0.063). Conclusions: A post-pandemic rise in pediatric pneumococcal detections and increasing H. influenzae co-detection were observed, supporting syndromic multiplex PCR in rapid pediatric diagnostics and antimicrobial stewardship.

Microorganisms living in nutrient- and energy-limited environments must finely coordinate anabolic and catabolic pathways. However, the molecular mechanisms underlying this balance remain poorly understood. Here, we report a mechanism cross-regulating amino acid biosynthesis and anaerobic respiration in bacterial cells. Using the model bacterium Shewanella oneidensis MR-1, we demonstrated that methionine activates extracellular electron transfer activity at submillimolar concentrations. This regulation is mediated by the transcription factor MetR, a canonical regulator of methionine biosynthesis. Under methionine-limited conditions, MR-1 upregulates methionine biosynthesis genes while repressing genes involved in extracellular electron transfer (metal reduction) and other anaerobic respiratory processes. Conversely, methionine availability relieves this repression, enhancing extracellular electron transfer. Furthermore, the MetR-mediated regulation of extracellular electron transfer was observed in Aeromonas hydrophila. These findings reveal a novel physiological role for MetR, suggesting its involvement in the coordinated energy distribution between anabolic and catabolic pathways.IMPORTANCEThis study identifies a novel regulatory link between methionine metabolism and anaerobic respiration. We show that Shewanella oneidensis MR-1 uses MetR to repress anaerobic respiratory pathways while activating methionine synthesis. This suggests a resource allocation strategy where bacterial cells prioritize the synthesis of "expensive" amino acids like methionine over the synthesis of respiratory machinery in amino acid-limited environments. Upon methionine availability, this suppression is lifted, boosting anaerobic electron transfer and energy production. Understanding this cross-regulation provides new insights into bacterial survival strategies and offers genetic targets for optimizing microbial electrochemical technologies, such as microbial fuel cells, where maximizing the extracellular electron transfer rate is critical.

To compare the effects of high- versus low-load isotonic resistance training performed to task failure on skeletal muscle growth and distal biceps brachii tendon thickness, while incorporating a time-matched non-exercise control group. 201 non-resistance trained individuals [20.9 (3.0) years] were randomly assigned to one of four groups: High-Load (n=45), Low-Load (n=48), Mid-Point (n=54), or Control (n=54). High- and Low-Load completed 4 sets of unilateral elbow flexions to task failure 3x/week for 6-weeks (8-12RM and 20-30RM, respectively). Mid-Point completed pre- and post-testing, plus a 1RM test at 3-weeks, whereas Control performed pre- and post-testing only. Muscle thickness of the elbow flexors and distal biceps brachii tendon thickness (short- and long-head regions) were assessed via B-mode ultrasound before and after the intervention. Group differences in pre- to post-intervention changes were evaluated using Bayesian ANCOVA with informative hypotheses, supplemented by Bayesian regression models to estimate adjusted between-group differences. Low-Load produced greater increases in muscle thickness than High-Load (~0.30 cm versus ~0.20 cm), with both exceeding changes observed in Mid-Point and Control. In contrast, distal biceps brachii tendon thickness demonstrated small increases at the short-head across all training groups (High-Load, Low-Load, and Mid-Point; ~0.02-0.03 cm) relative to Control, whereas no detectable changes occurred at the long-head. When resistance exercise is performed to task failure, skeletal muscle and tendon tissues demonstrate distinct adaptation patterns; muscle growth may be augmented by low-load failure training, whereas tendon morphological adaptations may be driven more by localized strain exposure rather than the external load lifted per repetition.

Andersen, V, Petushek, EJ, Saeterbakken, AH, Paulsen, G, and Krosshaug, T. Squat performance in elite powerlifters: biomechanical analyses of maximal and near maximal lifts. J Strength Cond Res XX(X): 000-000, 2026-The aim of this study was to investigate lifting technique and joint loading near maximal and maximal loads in elite powerlifters and to investigate their strategies to maximize performance. Eight elite national powerlifters volunteered to participate in the study. The subjects lifted single repetitions at 3 different loads (90, 95, and 100% of 1-RM). The ascending movement was divided into presticking, sticking, and poststicking regions and analyzed for hip torque, knee torque, and hip/knee torque ratio in addition to barbell displacement, barbell velocity, lifting time, and joint angles. The results indicated a significantly higher hip torque than knee torque across all phases, particularly during the sticking region, where a hip-to-knee torque ratio exceeding 3:1 was observed. This ratio indicates a much larger contribution from the hip extensors in powerlifters than what has previously been reported in recreational lifters. Based on ANOVA and equivalence testing (equivalence bounds: d = ±0.51), the increased barbell loading increased the knee joint torque in the presticking region (8% between 90 and 95% of 1-RM), increased the forward lean toward the end of the sticking region and reduced lifting velocity in the sticking and poststicking region. In conclusion, top-level powerlifters were able to maintain their load distribution across the knee and hip when increasing the loading in the barbell back squat, while increasing the initial thrust from the bottom position with higher knee torques during the heaviest lifts. The high proportion of the load distributed to the hip joint indicates that a powerlifting squat requires substantial hip extensor strength.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often require long-acting or pro-drug stimulants, but telehealth prescribing is constrained by the Ryan Haight Act's in-person requirements. While pandemic-era waivers temporarily lifted these mandates, their permanent status remains uncertain. Assess long-acting or pro-drug stimulant medication adherence using proportion of days covered (PDC) in adolescents with ADHD (12-17) receiving telehealth or hybrid care (2022-2024), comparing rates to post-pandemic (April 2020-June 2022) adherence rates in urban pediatric populations. Examine symptom scores on the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screening (GAD-2), and ADHD Symptom and Side Effect Tracking (ASSET). Compare visit attendance between telehealth and hybrid care. Program evaluation consisting of retrospective chart reviews, pre-visit surveys, and prescription data on 49 adolescents (21 telehealth and 28 hybrid) in a psychiatric clinic were evaluated. The total sample mean PDC was .381. Hybrid group adherence was .448 and .313 for the telehealth group. PDC was the same as the post-pandemic adherence rate (.310-.440). Paired t-tests comparing GAD-2 scores were (p < .001), PHQ-9 (p < .001), and ASSET (p = .010). Telehealth attendance was lower than hybrid attendance. The hybrid care model showed better adherence and attendance than telehealth for adolescents with ADHD. PDC from this program evaluation was statistically similar to national trends in pediatric ADHD management. Future research must prioritize geographic and digital determinants, understand the impact of polypharmacy, and establish evidence-based strategies to enhance long-term adherence in telehealth care models.

The back squat is a fundamental resistance exercise, yet technical variations such as bounce squats may substantially alter energetic demands. While previous research highlighted mechanical and neuromuscular effects of the stretch-shortening cycle, the phase-specific and muscle-specific metabolic consequences of bounce squats remain unclear. To inform training strategies aimed at improving movement economy or managing fatigue during high-volume training, this study examined how bounce influences whole-body and muscle-level metabolic energy cost across different loads using musculoskeletal simulation. Nine resistance-trained adults performed bounce and standard squats under five loading conditions (0-100% body weight) while motion capture, ground reaction forces, and surface EMG were recorded. Musculoskeletal modeling was used to estimate instantaneous metabolic power, integrated to compute phase-specific energy costs. Two-way repeated-measures ANOVA revealed that bounce squats reduced total metabolic energy cost by approximately 10.5% compared with standard squats (p&#x2009;<&#x2009;0.001), with the most pronounced effect during the eccentric phase (25.5% lower, p&#x2009;<&#x2009;0.001). Muscle-level analyses indicated that the vasti (VAS) consistently exhibited lower metabolic cost in bounce squats across loads during descent, highlighting their central role in energetic savings. In contrast, during the concentric phase, VAS and gluteus maximus costs scaled with external load, with no detectable benefit of bounce. Other lower body muscles showed statistical effects of squat type, but their absolute contributions were minimal. These findings demonstrate that the energetic benefit of bounce squats is phase- and muscle-specific, reflecting the reduced metabolic cost of eccentric VAS control and tendon recoil during rapid reversal. Bounce squats may therefore enhance movement economy without diminishing mechanical loading, offering practical value for athletic performance and rehabilitation.

To investigate whether Salvianolic Acid B (SAB) promotes cardiomyocyte proliferation by activating the &#x3b2;3-adrenergic receptor (&#x3b2;3-AR)/microRNA-1 (miR-1) axis, thereby improving cardiac function following myocardial infarction. A rat model of myocardial infarction was established using left anterior descending artery ligation. Rats were randomly divided into 7 groups: sham surgery group, MI group, MI + SAB group, MI + &#x3b2;3-AR agonist group, MI + SAB + &#x3b2;3-AR antagonist group, MI + SAB + miR-1 mimic group, and MI + negative control RNA group. Echocardiography was used to assess cardiac function; TTC, Masson's, and H&E staining were used to evaluate infarct, fibrosis, and necrosis areas; and Ki67 immunohistochemistry was used to detect cardiomyocyte proliferation. In vitro experiments utilized a hypoxia/reoxygenation (H/R) model in neonatal rat cardiomyocytes, with interventions including SAB, &#x3b2;3-AR modulators, or miR-1 mimics/inhibitors. Cell proliferation was assessed using EdU staining, while molecular mechanisms were examined via qPCR, Western blot, and dual-luciferase reporter assays. SAB treatment significantly improved left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) in MI rats, reduced infarct and fibrosis areas, and increased the proportion of Ki67-positive cardiomyocytes. Mechanistically, SAB upregulated &#x3b2;3-AR expression, downregulated miR-1 expression, and increased the protein levels of miR-1 target genes CDK4 and Cyclin D1. &#x3b2;3-AR antagonists or miR-1 mimic could block the aforementioned protective effects of SAB. In vitro experiments confirmed that SAB promoted EdU incorporation in H/R-injured cardiomyocytes, downregulated miR-1, and upregulated Cyclin D1; &#x3b2;3-AR antagonist or miR-1 mimic could eliminate these effects. Dual luciferase reporter assays confirmed that miR-1 directly targets the 3'UTR of CDK4. SAB improves cardiac function after myocardial infarction by activating the &#x3b2;3-AR/miR-1 axis, thereby lifting miR-1's inhibition of CDK4 and Cyclin D1 and promoting cardiomyocyte proliferation. This study reveals a novel mechanism underlying the cardioprotective effects of SAB and identifies the &#x3b2;3-AR/miR-1 axis as a potential therapeutic target for cardiac regeneration following myocardial infarction.

Magnon polarons, hybrid quasiparticles embodying the intrinsic coupling between spin and lattice dynamics, bridge magnetism and phononics in quantum materials. Despite extensive studies in magnetic insulators, spectroscopic evidence for magnon polarons has been scarcely reported in metallic ferromagnets. Here, we reveal magnon polarons at the nanoscale in single crystals of Fe3GeTe2 using inelastic scanning tunneling spectroscopy (ISTS) with a milli-Kelvin scanning tunneling microscope. While ISTS of phonons or magnons has been widely explored, our study focuses on two-dimensional van der Waals (vdW) itinerant ferromagnets, where momentum selection rules normally hinder magnon excitation. We show that strong magnon-phonon interaction leads to hybridization between the magnonic and phononic bands, lifting the selection rules at their avoided band crossings. This emergent momentum selection due to magnon-phonon coupling is a hallmark of magnon polarons. Our findings establish a platform for probing and engineering magnon-phonon hybrid excitations in two-dimensional materials at the nanoscale.

Not all sleep loss is equal, and overlooking this limits progress in sleep and neurological disease research. We compared nine rodent sleep deprivation paradigms, gentle handling, multiple platform variants, disk-over-water, the Unpredictable Chronic Sleep Deprivation (UCSD) paradigm, novel object introduction, curling prevention by water, automated systems, and head-lifting, evaluating stress confounds, sleep stage specificity, chronicity, and neurobiological outcomes. Effects included hippocampal plasticity, prefrontal chemistry, glymphatic clearance, neuroinflammation, oxidative stress, neurogenesis, and circadian regulation, linked to Alzheimer's, Parkinson's, and psychiatric comorbidities. UCSD with caffeine produced antioxidant depletion, serotonin reduction, acetylcholinesterase upregulation, and synaptophysin loss, early neurodegeneration markers. We propose a disease-targeted framework with six translational priorities and reporting standards.

This paper discusses neck contouring prejuvenation techniques, focusing primarily on neck lift and submental liposuction to optimize neck definition. Traditional neck rejuvenation has relied on platysmaplasty, fat excision, and skin resuspension for addressing the aging neck. With growing demand for early neck rejuvenation, surgical approaches focused more on definitive sculpting such as submental liposuction and deep neck lifts have become increasingly popular. The neck consists of multiple layers and structures including skin, subcutaneous fat, platysma muscle, submandibular glands. Ideal candidates for prejuvenation surgical neck contouring procedures are patients aged 20-40 with early signs of submental fullness or a soft jawline with otherwise good skin elasticity. The senior author performs deep neck lift surgery using a small submental crease incision and sculpts prominent subplatysmal fat, anterior digastric muscle, and submandibular glands down to the level of the mandible. Following neck lift surgery, patients are instructed to follow a bland diet for 1 week and activity restriction for 2 weeks as well as appropriate wound care to the incisions. Neck lift and submental liposuction remain the cornerstones of effective surgical neck contouring procedures for younger adults. Neck Lift, Submental Liposuction.

In grid-scale energy storage applications, sodium-ion batteries have gained considerable attention due to the abundance of sodium resources, lower cost, and stable wide-temperature performance. Monoclinic bismuth vanadate, composed of Bi&#x2500;O octahedra and V&#x2500;O tetrahedra interconnected by shared vertices to form a layered structure, facilitates the reversible insertion and extraction of sodium ions. However, owing to the lack of direct atomic-level observation, the precise sodium storage mechanism remains unclear. Here, we utilized electrospinning to fabricate bamboo-jointed BiVO4 nanorods, whose segmented features effectively mitigate axial stress transfer, relieve volumetric strain, and suppress pulverization. Furthermore, we employ in situ transmission electron microscopy (TEM), combined with density functional theory (DFT) calculations, to investigate the structural evolution of bamboo-jointed BiVO4 during (de)sodiation. The anisotropic expansion of bamboo-jointed BiVO4 during initial sodium insertion is revealed for the first time, whereas its morphology becomes more isotropic in subsequent cycles. This transformation is attributed to the low stability of the alloyed Na-Bi product, which promotes particle fusion. Additionally, the detailed electrochemical performance and cycling mechanism are also comprehensively elucidated. This work not only bridges the gap in understanding the sodium storage mechanism of BiVO4 but also offers valuable insights for designing tailored morphologies for high-performance sodium-ion storage.

Since its first approval in 1981, tissue-extracted collagen injection technology has become an important method for minimally invasive facial rejuvenation, with substantial clinical experience accumulated particularly in the periorbital area. However, due to significant differences in physicochemical properties and metabolic mechanisms compared to hyaluronic acid, its clinical application still faces limitations in understanding and unique complication risks. Furthermore, no unified technical operating standards currently exist internationally. This standard is based on a synthesis of multicenter expert clinical experience. It systematically outlines the product characteristics, classification, and specifications of tissue-extracted collagen; defines clinical indications, contraindications, and operational precautions; specifies qualification requirements for medical institutions and operating physicians; establishes protocols for pre-operative assessment, regional injection design, post-operative management, and complication prevention and treatment strategies; and proposes multimodal treatment recommendations combining surgery, thread lifting, energy-based devices, and other fillers. Through standardized operating procedures and layered injection techniques, the safety and efficacy of tissue-extracted collagen injection therapy can be effectively improved, reducing the occurrence of complications such as nodules and vascular embolism. Combined treatment strategies further expand the application of collagen in facial rejuvenation, achieving complementary effects and optimizing recovery periods. This operational standard provides systematic and standardized clinical guidance for tissue-extracted collagen facial injection. It contributes to promoting the appropriate application and healthy development of this technology, enhancing overall treatment quality and patient satisfaction.

Scarless breast surgery techniques, such as radiofrequency-assisted mastopexy, transaxillary and transumbilical augmentation, and liposuction-based reductions, have gained popularity for delivering aesthetic results while minimizing visible scarring. However, evidence on outcomes and complication rates across techniques remains variable. A systematic review of 11 studies with 1,517 patients undergoing scarless aesthetic breast procedures was conducted. Data on surgical techniques, patient satisfaction, anatomical changes, and complications were extracted. Outcomes were assessed through photographic reviews, global aesthetic scales, and objective measurements of nipple and areolar position. The average patient age was 34 years. Radiofrequency-assisted mastopexy reported a mean nipple lift of 1.2 cm, while the "Compass Rose" suture technique achieved an average areolar width reduction of 11 mm. Transaxillary and transumbilical augmentations demonstrated patient satisfaction rates of &#x2265;90%. Reported complications were generally low and included hematoma (n=2), capsular contracture (n=2), implant malposition (n=1), and minor wound-related issues. Overall, complication rates were similar to or lower than those associated with traditional augmentation and mastopexy techniques. Scarless aesthetic breast procedures provide high patient satisfaction and measurable improvements in breast contour and nipple position, with complication rates comparable to conventional approaches. Future research should focus on standardized reporting and long-term outcomes to better define the efficacy and safety of these minimally invasive techniques.

This prospective case series evaluated the short-term outcomes following percutaneous cementoplasty as the sole palliative treatment for appendicular osteosarcoma in 10 dogs. Synthetic self-hardening calcium phosphate bone substitute was injected into the osseous defect under fluoroscopic guidance after curettage of the bone tumor. Clinician assessment included a numerical rating score for lameness, offloading, and ease of lifting the contralateral limb as well as the 4A-VET postoperative pain scale. Owner assessment was obtained using three descriptive questionnaires, the Helsinki Chronic Pain Index (HCPI), the Canine Brief Pain Inventory (CBPI) and the Canine Symptom Assessment Scale (CSAS). Measures were recorded preoperatively and at 2, 4, 8, and 12 weeks following surgery. Early improvement in the 4A-Vet score was noted at the 2-, 4-, 8-, and 12-week time points for all major pain and function metrics. Similarly, the CBPI pain severity and interference scores demonstrated early postoperative improvement during the 2- and 4-week time points with partial attenuation by 8 and 12 weeks. Panting, difficulty sleeping, whining/moaning, and lack of appetite were significantly reduced when assessed via the CSAS. Cementoplasty as a monotherapy, affording early pain relief and improved structural integrity, supports its role as a palliative limb-preserving option for dogs unable to undergo amputation.

Compositional data-vectors encoding relative proportions-arise across scientific domains, including ecology, geochemistry, and genomics. The features in these data often come with known hierarchical structure (e.g., taxonomies, phylogenies, ontologies), yet existing methods either ignore this structure, discard the intrinsic Aitchison geometry, are designed for binary trees, or yield incomplete coordinate systems. We describe PolyILR, a canonical orthonormal decomposition of the Aitchison tangent space aligned with any tree topology. Our construction defines a weighted local geometry at each internal node capturing full branching structure, then lifts these to a global orthonormal basis where every coordinate corresponds to a specific tree location. On microbiome and single-cell benchmarks, PolyILR yields stable, interpretable features and enables inference at multiscale tree resolution. We also establish a novel theoretical connection to softmax classifiers, suggesting possible applications to probabilistic modeling.

Bodyweight exercises and weightlifting are foundational to strength training, yet their relative public health burdens remain poorly defined in large, nationally representative samples. We analyzed data from the National Electronic Injury Surveillance System from 2014 to 2023. A standardized keyword screening protocol was utilized to identify cases of weightlifting and bodyweight injuries treated in US emergency departments. Variance estimation was performed using Taylor series linearization to account for the complex, stratified sampling design and generate nationally representative estimates. Over the 10-year study period, national estimates of 546,655 weightlifting-related injuries and 108,001 bodyweight-related injuries were identified. Weightlifting injuries primarily involved the trunk (70.1%) and phalanges (13.7%). Bodyweight injuries were significantly associated with upper and lower extremity trauma (20.7%) and joint dislocations (8.7%). After adjusting for age and sex in a cluster-robust multivariable model, exercise modality was not a significant predictor of inpatient hospitalization (adjusted odds ratio: 0.91; 95% confidence interval: 0.60-1.38; p =0.666). While weightlifting poses a higher absolute volume burden, there is no significant difference in hospitalization odds when adjusting for age and sex. Prevention should focus on a suitable technique for heavy lifts and safe joint positioning for dynamic bodyweight movements, with increased diagnostic precaution and safety monitoring recommended for older participants.

A 55-year-old patient presented with persistent back pain after a lifting injury. Later, buttock pain and hypaesthesia of the left knee developed. MRI revealed a lesion at lumbar vertebral body L3, histologically confirmed as a conventional chordoma. Chordomas are rare, locally aggressive tumors of notochordal origin with a high recurrence rate and require specialized treatment. A two-stage en-bloc spondylectomy with dorsal decompression and anterior cage implantation was performed on the patient. Postoperatively, there were motor deficits in hip flexion and knee extension, while distal strength and sensation were preserved. Due to the R1 resection, an additional proton radiation therapy is actually planned. Persistierende R&#xfc;ckenschmerzen nach Hebetrauma &#x2013; von der Bagatelle bis zum seltenen Fall. Ein 55-j&#xe4;hriger Patient stellte sich nach einem Hebetrauma mit persistierenden R&#xfc;ckenschmerzen vor. Im Verlauf traten neue Ges&#xe4;ssschmerzen und eine Hyp&#xe4;sthesie am linken Knie auf. In der MRT zeigte sich dann eine Raumforderung im Lendenwirbelk&#xf6;rper 3. Histologisch wurde die Diagnose eines konventionellen Chordoms gestellt. Chordome sind seltene, lokal aggressive Tumoren notochordaler Differenzierung mit hoher Rezidivrate, die eine spezialisierte Therapie mit radikaler lokaler Resektion erfordern. Es erfolgte eine zweizeitige En-bloc-Spondylektomie mit dorsaler Dekompression und anteriorem Cage-Einsatz. Postoperativ bestanden beim Patienten motorische Einschr&#xe4;nkungen der H&#xfc;ftflexion und Knieextension, distal waren Kraft und Sensibilit&#xe4;t erhalten. Aufgrund einer R1-Resektion ist aktuell eine erg&#xe4;nzende Protonenbestrahlung geplant. Schl&#xfc;sselw&#xf6;rter: R&#xfc;ckenschmerzen, Red Flags, Tumor, Chordom.

The COVID-19 pandemic had heterogeneous effects on the mental health of children and adolescents according to individual experiences, with some consequences persisting beyond the lifting of restrictions. We aimed to examine whether the perceived impact of the COVID-19 pandemic was associated with 2022-2025 trajectories of mental health difficulties in children and adolescents, and to identify associated risk and protective factors. Data was drawn from the population-based SEROCoV-KIDS cohort study conducted in Geneva, Switzerland. The multidimensional perceived impact of the pandemic, as well as potential socio-demographic, health, family, social, and behavioral risk and protective factors were parent-reported at baseline, in 2022. Mental health difficulties were collected annually between 2022 and 2025. Generalized mixed effects models were used to estimate mental health trajectories by pandemic impact, and to assess risk and protective factors. Of 1907 children aged 2-17 years, 9.3% and 7.9% had experienced a negative and positive pandemic impact, respectively, while most of them were not or minimally affected (82.8%). Compared to their unaffected peers, negatively impacted children had more mental health difficulties in 2022 (incidence rate ratio [IRR]: 1.51; 95% confidence interval [CI] 1.34-1.70) and improving trends between 2022 and 2025 (IRR: 0.98; 95% CI 0.95-1.01). An average-to-poor financial situation was related to a milder mental health response to a negative impact in 2022 (IRR: 0.64; 95% CI 0.46-0.89). A positive pandemic impact tended to be associated with higher difficulties in 7-12 year old children in 2022 (IRR: 1.36; 95% CI 0.98-1.89), with stable trends over time. About 5 years after the onset of COVID-19, the lasting mental health difficulties presented by children with a negative perceived impact of the pandemic had largely improved. Although globally reassuring, these findings call for proactive measures to prevent such long-term consequences on youth mental health in the event of future crises.