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The therapeutic decision whether or not to systematically supplement vitamin D in all children aged 0 to 5 years is a question that remains difficult to answer. In France, a multicenter epidemiological study shows that rickets is not very prevalent even though compliance with vitamin D intake is not known and can be considered imperfect because it is restrictive. Children under 5 with pigmented skin, immigrants or adopted children, as well as those exclusively breastfed are at risk of deficiency rickets. A better knowledge of the risk factors could make it possible to define a priority target population for supplementation. [ABSTRACT FROM AUTHOR]

Otorrhea is a common symptom of acute otitis media (AOM). It is sometimes the first and only symptom of a perforated AOM (absence of fever or pain). National and international recommendations consider it as a noisy symptom or a sign of seriousness of an AOM, justifying systematic oral antibiotic therapy, whatever the age of the child and whatever the symptomatic character (fever or pain). What randomized clinical trials (RCTs) or meta-analyses of RCTs support these recommendations? What is the effectiveness of oral or topical antibiotics in children with isolated otorrhea on AOM? A systematic review of RCTs and meta-analyses of RCTs (MA) concerning the antibiotic treatment of otorrhea isolated on AOM in children was conducted. The Medline and Cochrane databases were consulted until 30/07/2019. Results: No RCT or MA of RCT evaluated the effect of oral or topical antibiotic therapy in children with asymptomatic otorrhea following a perforated AOM. Conclusion: Current recommendations to systematically treat children with isolated otorrhea on AOM with antibiotics are not justified by an RCT. [ABSTRACT FROM AUTHOR]

Résumé Le neurofeedback par la création d’une boucle psychophysiologique rétroactive présente des avantages, en comparaison des autres techniques de remédiation cognitive utilisées dans la prise en charge des enfants souffrant de trouble déficit de l’attention/hyperactivité (TDA/H). Pourtant, bien que cette technique soit utilisée depuis près de 20 ans dans le TDA/H, son niveau de preuve d’efficacité reste débattu. L’évolution du nombre de publications recensées par la base de données électroniques PubMed par les termes medical subject headings (Mesh) « Neurofeedback » et « Attention-Deficit Disorder with Hyperactivity » permet de proposer une analyse de l’évolution de la littérature sur le neurofeedback et le TDA/H suivant deux périodes : avant 2011 et après 2011. Les premières études avant 2011, sur neurofeedback et TDA/H, ont mis essentiellement l’accent sur la qualité du protocole de neurofeedback et de l’effet d’apprentissage au cours des séances, aux dépens de la construction méthodologique du protocole en lui-même (absence de randomisation et de groupe témoin). Cette attention semble avoir diminué dans les études plus récentes, qui se concentrent sur la construction de protocoles plus rigoureux (avec groupes témoins de meilleure qualité et évaluations en aveugle). Cependant, les conditions de bonne pratique du neurofeedback lui-même sont le pendant indispensable aux études de preuve d’efficacité bien conduites. Ainsi les futures études d’efficacité du neurofeedback dans le TDA/H devront allier la qualité méthodologique des études randomisées contrôlées en aveugle à la qualité de la conduite des séances de neurofeedback. Background Neurofeedback, based on the concept of creating a retroactive psychophysiological loop, has advantages compared with other cognitive therapeutic techniques in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). However, although this technique has been used for almost 20 years in ADHD, the level of evidence for its efficacy remains debated. This debate has recently been brought into focus in the literature following a published meta-analysis. Aims This article aims to review and classify existing literature on the efficacy of neurofeedback in ADHD. Methods Publications were identified through a literature search of the electronic database PubMed using the Medical Subject Headings (Mesh) terms “Neurofeedback” and “Attention-Deficit/Hyperactivity Disorder”. All relevant papers published in English or French were reviewed by the authors. These were separated into 2 groups: published before and after 2011. Results Prior to 2011, studies are characterized by low sample size and are often non-randomized and uncontrolled. In addition these are most often performed by practitioners who participated in the development of the first neurofeedback equipment and who have electrophysiological expertise, essential for effective training during sessions. In 2009 Arns et al. published the first meta-analysis on the efficacy of neurofeedback in ADHD. They found a large effect size, 1.02 (0.84 to 1.21) and 0.94 (0.76 to 1.12) respectively for the inattention and impulsivity dimensions, and a moderate effect size of 0.71 (0.54 to 0.87) on the hyperactivity dimension. Improved inattention dimension was proportional to the number of sessions and maintained in randomized trials, which was not the case for the hyperactivity dimension. After 2011, studies are characterized by larger samples, and methodology including randomized, controlled trials and blinded assessments. In 2013, Sonuga-Barke et al. published the second meta-analysis on the efficacy of neurofeedback in ADHD ( Am J Psych ). They found a smaller effect size of 0.59 (0.31 to 0.87) compared to the first meta-analysis of 2009. The effectiveness of neurofeedback was not confirmed in studies with blinded assessment. The effect size was 0.29 (−0.02 to 0.61) ( P = 0.07; NS). However the effectiveness of the training during neurofeedback sessions in some of the included studies has been called into question. Conclusion Methodological issues are likely to have a large impact on results obtained in studies of neurofeedback. Thus, it is critical that future trials implement adequately randomized, controlled, blinded designs that do not compromise the quality of neurofeedback session itself. [ABSTRACT FROM AUTHOR]

Résumé Les concentrés érythrocytaires sont conservés jusqu’à 42 jours après le prélèvement sanguin. Les banques de sang fournissent le concentré le plus vieux afin de réduire les pertes. De nombreux professionnels de la communauté médicale sont convaincus qu’il serait avantageux de transfuser du sang frais. L’objectif de l’étude ABLE était de vérifier si l’administration de concentrés érythrocytaires entreposés moins d’une semaine (sang frais) améliore le sort d’adultes transfusés en réanimation comparé au sort d’adultes recevant du sang distribué en fonction de la politique standard actuelle des banques de sang. Entre mars 2009 et mai 2014, 1211 patients ont été randomisés dans le groupe « sang frais », 1219 dans le groupe standard (durée de conservation de 6,1 ± 4,9 et 22,0 ± 8,4 jours respectivement, p < 0,001). La mortalité observée 90 jours après la randomisation (critère de jugement principal) fut de 448 (37,0 %) dans le groupe « sang frais » et de 430 (35,3 %) dans le groupe témoin (différence absolue du risque : 1,7 % ; intervalle de confiance à 95 %, −2,1 % à 5,5 %). Une analyse de survie a démontré un risque accru de mortalité du côté du groupe « sang frais » : le rapport de risque instantané ( hazard ratio ) était de 1,1 avec un intervalle de confiance à 95 % de 0,9 à 1,2 ( p = 0,38). Les mêmes tendances en défaveur du sang frais ont été observées pour tous les critères de jugement secondaires à une exception près. En conclusion, des concentrés érythrocytaires conservés moins de 7 jours n’améliorent pas le sort des adultes transfusés en réanimation comparativement à des concentrés conservés pendant 3 semaines en moyenne. Red blood cell units are stored up to 42 days post-collection. The standard policy of blood banks is to deliver the oldest units in order to limit blood wastage. Many caregivers believe that giving fresh rather than old units can improve the outcome of their transfused patients. The ABLE study aims to check if the transfusion of red blood cell units stored seven days or less (fresh arm) improve the outcome of transfused critically ill adults compared to patients who received units delivered according to the standard delivery policy (control arm). From March 2009 to May 2014, 1211 patients were allocated to the fresh arm, 1219 to the control arm (length of storage: 6.1 ± 4.9 and 22.0 ± 8.4 days respectively, P < 0.001). The primary outcome measure was 90-day all-cause mortality post-randomisation: there were 448 deaths (37.0%) in the fresh arm and 430 (35.3%) in the control arm (absolute risk difference: 1.7%; 95% confidence interval: −2.1% to 5.5%). In a survival analysis, the risk of death was higher in the fresh arm (hazard ratio: 1.1; 95%CI: 0.9 to 1.2), but the difference was not statistically significant ( P = 0.38). The same trend against the fresh arm was observed with all but one secondary outcome measures. The conclusion is that the transfusion of red blood cell units stored seven days or less does not improve the outcome of critically ill adults compared to the transfusion of units stored about three weeks (22.0 ± 8.4 days). [ABSTRACT FROM AUTHOR]

Summary: Through their personal experience, the authors want to relate the problems a surgeon has to face to make an idea accepted, either on the intellectual or the technical or the material point of view. A surgeon''s everyday life, his university cursus and his psychological profile does not prepare him to a very different world, the world of administration, of files, of categories, of laws, of initials, of acronyms. Yes, the surgeon has to deal with this universe if he wants to develop his new concept. The authors relate the great efforts, which are similar sometimes to mythological works, to achieve their aim with a little humour just to survive. [Copyright &y& Elsevier]

Résumé: Objectif: Évaluer l’effet des exercices de renforcement musculaire pratiqués pendant neuf mois sur la densité minérale osseuse (DMO, g/cm2) corps entier et régionale chez 58 femmes âgées de 30 à 50 ans en période de préménopause. Méthodes: Les sujets ont été randomisés en un groupe intervention pratiquant des exercices supervisés de renforcement musculaire deux fois par semaine pendant 15 semaines puis non supervisés pendant 24 semaines, et en un groupe témoin. Les caractéristiques recueillies à l’inclusion étaient le poids, la taille, la force musculaire maximale, les apports caloriques et l’activité physique. L’analyse des résultats d’absorptiométrie biphotonique à rayons×corps entier (DXA, Lunar Prodigy) a porté sur la composition corporelle (masses grasses et maigres) et la DMO corps entier et régionale (rachis, hanche, bras et jambes). Toutes les mesures ont été réalisées à l’inclusion, aux 15e et 39e semaines. Les différences entre les groupes en termes de DMO, poids et apports énergétiques et calciques ont été évaluées par analyse de covariance. Résultats: À l’inclusion, les deux groupes avaient une DMO et des caractéristiques physiques comparables, à l’exception d’un poids plus faible (−7,1kg) et d’apports énergétiques (+259kilojoules par jour) et calciques (+232mg par jour) plus élevés dans le groupe intervention (p <0,05). Aucune différence significative n’était observée entre les groupes témoin et l’intervention pour le pourcentage ajusté de changement de la DMO aux 15e (0,5 % versus 0.4 %) et 39e semaines (0,9 % versus 1,2 %). Dans le groupe intervention, on notait une augmentation non significative de la DMO au rachis et aux jambes (1–2,2 %), tandis qu’aucun changement n’était observé dans le groupe témoin. Conclusion: Les exercices de renforcement musculaire pratiqués pendant neuf mois n’entraînent pas de variations significatives de la DMO corps entier ou régionale dans une population de femmes en période de préménopause. [Copyright &y& Elsevier]

The rational of the surgical treatment of female stress urinary incontinence has changed over the past few years. The techniques of colposuspension have been replaced by the suburethral slings, retropubic initially with the TVT, recreating a backboard between the urethra and the vaginal anterior wall. Nevertheless with overall cure rates of 69% to 88%, in periods beyond 5 years, the colposuspension still remains the reference (high-grade scientific evidence). Based on observational studies (low quality scientific evidence), with generally a short follow-up, the results of the TVT appear similar. More recently, the suburethral transobturator tape (TOT) was introduced to reduce the complications of the TVT. It is thus difficult to currently have an objective idea of the effectiveness of the TOT compared to the TVT, even if the first impressions, with respect to the TOT, are rather favourable. Furthermore the TOT technique itself and the biomaterials used, have continued to evolve. In fact, if the complications of these two kinds of suburethral slings are different: bladder perforation for the TVT, prosthetic erosion for the TOT, in contrast, in the future, their indications could be different. Therefore the TVT appears more effective in presence of intrinsic sphincter deficiency with urethral hypermobility. [Copyright &y& Elsevier]