-A new role for the pediatrician: the prevention of social violence-.

Social violence is a kind of violence which is applied by one individual to another. It is a stake in the field of public health because of an increasing number of children with such behaviors. In addition to environmental factors, the occurrence of abnormal social behavior before 9 years of age seems to precede social violence for the subsequent 20 years of life. One must therefore identify an inadequate attitude towards the parents and/or the teachers, or a poor child's self-esteem and self-respect. These phenomena are based on parental authority, on the ethical development of the child, on his verbalization capacity, on his socialization and his affective development. It is therefore important to stimulate ethical capacities and feelings in the child not only to provide autonomy but also to allow reflexive distinction of language, behavior and judgment, which enable him to understand, consider and respect other individuals.     

Problèmes éthiques du dépistage prénatal non invasif (DPNI)

The antenatal noninvasive testing represents a new progress with many possible benefits for the pregnant woman. However, it also raises three types of ethical problems: 1) those linked to the technical conditions of this test in respect of the exactitude of the results and its relevant use in clinical situations; 2) those raised by the stakes of nonmaleficience (to reassure the women, to avoid many invasive diagnosis, and miscarriage with their psychological consequences, useless antenatal treatments, and the facilitation of antenatal decisions) and the stakes of information, autonomy, and justice are also mentioned; 3) the new challenges of this new testing are also discussed with special concern for the quality of life, the risks of stigmas and discrimination of the disabled persons and the extension of this test to sex selection, paternity determination, consumerism, and the concern of eugenics. These analyses conclude that new responsibilities are raised by these tests and for the reproductive choices to come.     

Univalve Split Plaster Cast for Postoperative Immobilization in Foot and Ankle Surgery

Casting is an important part of the postoperative treatment in foot and ankle surgery. Applying a split plaster cast allows for swelling while maintaining surgical correction and alignment. Resecting approximately a 1-in. portion of the plaster cast dorsally and anteriorly maintains stable structural support of the cast while relieving the pressure caused by swelling. We describe a technique for applying a plaster below the knee cast, with a univalve dorsal split, to provide support, while allowing for edema and access to anterior postoperative dressings.     

Effect of oral administration of lipids with 67% medium chain triglycerides on glucose homeostasis in preterm neonates

Since hypoglycemic responses to medium chain triglycerides (MCT) have been reported in adults we studied the effect of an acute oral load of lipids (2,8 g/kg) with 67% MCT on glucose homeostasis in 21 preterm infants in comparison to 14 age-matched control preterm infants. A hyperglycemic response from (mean ± SEM) 57 ± 1.1 to 74 ± 2.5 at 30 min (p < 0.01) and to 80.5 ± 2.5 mg/dl at 60 min (p < 0.01) was observed after administration of the lipids whereas no change in plasma glucose concentration was observed in the control group. After administration of the lipids there was no change in the concentration of insulin and glucagon in plasma. An intravenous glucose tolerance test (1 g/kg) was similar in the control group and 60 min after administration of the lipids. After administration of the lipids free fatty acid concentration remained unchanged while a significant decrease from 304 ± 56 to 199 ± 28 μEq/l was observed in 60 min in the control group. At 60 min β-hydroxybutyrate concentration was higher after lipid administration (630 ± 86 μmol/l) than in the control group (436 ± 66 μmole/l) (p < 0.05). A more rapid decrease in blood lactate concentration was found after lipid administration than in the control group while no change in plasma alanine concentration was observed in either groups. In five additional preterm infants, plasma glucose concentration increased from 56 ± 0.6 to 75 ± 0.9 mg/dl (p < 0.01) 60 minutes after gastric administration of glycerol (0.3 g/kg). These data show that in preterm infants, a lipid load with 67% TCM produces a hyperglycemic response through gluconeogenesis without changing the peripheral rate of glucose disappearance.     

Chemoradiation-induced changes in systemic inflammatory markers and their prognostic significance in oesophageal squamous cell carcinoma

Objective:Chemoradiation (CRT) may induce a change in systemic inflammatory state which could affect clinical outcomes in oesophageal cancer. We aimed to evaluate the changes and prognostic significance of systemic inflammatory markers following definitive CRT in oesophageal squamous cell carcinoma.Methods:A total of 53 patients treated with concurrent CRT were included in this retrospective analysis. We compared neutrophils, lymphocytes, platelets, neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) before and after CRT using Wilcoxon signed-rank test. Overall survival (OS) and progression-free survival (PFS) were calculated. Univariable and multivariable survival analysis were performed using Cox regression analysis. Clinical univariable survival prognostic factors with p < 0.1 were included in a multivariable cox regression analysis for backward stepwise model selection.Results:Both NLR (median ∆+2.8 [IQR −0.11, 8.62], p < 001) and PLR (median ∆+227 [81.3–523.5], p < 0.001) increased significantly after CRT. Higher levels of pre-CRT, post-CRT and change (∆) in NLR and PLR were associated with inferior OS and PFS. Post-CRT NLR (HR 1.04, 95% CI 1.02–1.07, p < 0.001), post-CRT platelets (HR 1.03, 95% CI 1.01–1.05, p = 0.005), cT-stage (HR 3.83, 95% CI 1.39–10.60, p = 0.01) and RT dose (HR 0.41, 95% CI 0.21–0.81, p = 0.01) were independent prognostic factors for OS in multivariable analysis. Change in NLR (HR 1.04, 95% CI 1.01–1.06, p = 0.001), post-CRT platelets (HR 1.03, 95% CI 1.01–1.05, p = 0.002), cT-stage (HR 3.98, 95% CI 1.55–10.25, p = 0.004) and RT dose (HR 0.41, 95% CI 0.21–0.80, p = 0.009) were independent prognostic factors for PFS.Conclusion:Both NLR and PLR increased following definitive CRT. Post-CRT NLR and ∆NLR were associated with adverse survival in oesophageal SCC.Advances in knowledge:We showed that CRT increased PLR and NLR, possibly reflecting a systemic inflammatory state which were associated with poor clinical outcomes in oesophageal SCC.     

Effect of phosphate supplementation to breast fed very low birthweight infants on urinary calcium excretion, serum immunoreactive parathyroid hormone and plasma 1,25-dihydroxy-vitamin D concentration

The effect of two doses of Phosphorus (P) supplementation to pooled breast milk (BM): 0.48 and 0.800 mmol/kg/24 h given during the second month of life was evaluated in 22 very low birthweight infants. The concentration of calcium and phosphorus in serum and urine, the serum concentration of immunoreactive parathyroid hormone (iPTH) and the plasma 1,25-dihydroxy-vitamin D concentration (1,25-OH-D) were compared to the values in 19 control infants. The mean +/- SD concentrations in control infants and adults are 63 +/- 18 microliters Eq/ml for serum iPTH and 85 +/- pmol/l for plasma 1,25-OH-D. With 0.48 P supplementation, urinary Ca (UCa) excretion (median and range) 0.238 mmol/kg/24 h (0.105-0.520) was lower than in the control group 0.288 (0.205-0.679) (p less than 0.05); the reduction of UCa was larger with 0.8 P supplementation: 0.047 (0.023-0.163) (p less than 0.01). P supplementation induced no change in serum Ca concentration but a slight and significant increase in serum iPTH was observed only with the 0.8 P supplementation: 55 microliters Eq/ml (less than 25-80) (p less than 0.05). With 0.8 P supplementation there was no significant change of plasma 1,25-OH-D concentration: 173 pmol/l (106-271) vs. 255 (132-293) in the control group. These data show that with 0.8 P supplementation, the hypercalciuria in BM-fed infant disappears without secondary hyperparathyroidism, but without any change in plasma 1,25-OH-D concentration.     

Growth in extremely low birth weight infants up to three years

OBJECTIVE: To evaluate postnatal growth of extremely low birth weight infants (ELBW, <1,000 g) until 36 months of corrected age (CA), and to relate growth outcome to anthropometric parameters at birth, sex, fetal growth status (small or appropriate for gestational age--SGA/AGA), period of admission and major perinatal events. STUDY DESIGN/METHOD: Weight (Wt), height (Ht) and head circumference (HC) were assessed in 159 ELBW infants. Data were standardized with Z-scores following Usher and McLean and Sempe growth curves. Uni- and multivariate statistical analysis were performed. RESULTS: The mean birth weight was 851.2+/-116.5 g. Z-scores decreased from birth to term, at a deeper rate for AGA than for SGA infants (p<0.005 for Ht, Wt, and HC). Between term and 36 months, growth was better in SGA compared with AGA infants (p=0.003 for Ht). Multivariate analysis showed that anthropometric parameters at birth were positive determinants for Wt, Ht and HC at term, and also for Wt and Ht at 36 months CA (Z-scores). Oxygen therapy after 36 weeks of post-conceptional age was a negative determinant influencing growth at 36 months CA (Z-scores). CONCLUSIONS: Significant catch-up growth took place between birth and 36 months, which was greater for SGA than for AGA infants. Anthropometric parameters at birth and oxygen therapy at 36 weeks post-conceptional age are the main predictive factors for growth at 36 months CA.     

Metabolism of MDCK cells during cell growth and influenza virus production in large-scale microcarrier culture

The production of equine influenza in Madin-Darby canine kidney (MDCK) cells in large-scale microcarrier culture is described with detailed on- and off-line analytical data during cell growth and virus replication. Metabolite concentration profiles for glucose, glutamine, lactate and ammonium are shown. Lactate and ammonium concentrations were always below inhibiting levels. Concentration profiles for essential and non-essential amino acids of the cell culture medium are discussed. During cell growth proline was released into the medium with a significant rate while two amino acids, serine and methionine were almost depleted. After infection, virus titer increased after a delay of 10-16 h whereas first changes in amino acid metabolism could be observed within 4h post-infection. Here, glutamate and aspartate increase correlated to virus release kinetics, indicating cell disruption and apoptosis. Starting with a moi of 0.025 resulted in a maximum virus yield of 2.4 log HA/100 microl at 44 h post-infection.