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D'un point de vue statistique, un enfant siffleur chronique est a priori asthmatique. Cette réalité écrasante ne devrait pas masquer d'autres diagnostics dont le retard de prise en charge peut avoir des conséquences néfastes : corps étranger méconnu, syndrome médiastinal, maladie parenchymateuse. Pour le praticien, un débrouillage clinique et radiologique permet généralement d'identifier des points d'appel atypiques qui doivent orienter l'enfant vers une consultation spécialisée. Le diagnostic final peut être différentiel, mais aussi celui d'une comorbidité dont la prise en charge permettra de stabiliser un asthme avéré répondant mal au traitement de fond. Statistically speaking, a child with chronic wheeze is likely to have asthma. This overwhelming fact should not obliterate alternate diagnoses and the potential for serious consequences: unrecognized foreign body, mediastinal syndrome, chronic lung disease. Detecting unusual features – clinical or radiological – must make the child referred to a specialised consultation. The ultimate diagnosis is either differential or the one of a comorbidity, the management of the latter allowing better asthma control. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL) is a parasitic disease that is endemic in more than 80 countries, and leads to high fatality rates when left untreated. We investigate the relationship of VL cases in dogs and human cases, specifically for evidence of VL in dogs leading to excess cases in humans. We use surveillance data for dogs and humans for the years 2007–2011 to conduct both spatial and spatio-temporal analyses. Several models are evaluated incorporating varying levels of dependency between dog and human data. Models including dog data show marginal improvement over models without; however, for a subset of spatial units with ample data, models provide concordant risk classification for dogs and humans at high rates (∼70%). Limited reported dog case surveillance data may contribute to the results suggesting little explanatory value in the dog data, as excess human risk was only explained by dog risk in 5% of regions in the spatial analysis. [ABSTRACT FROM AUTHOR]

Résumé L'endoscopie des voies respiratoires n'apporte rien dans le bilan d'un asthme standard. Chez le jeune enfant elle est cependant parfois utile au titre du diagnostic différentiel, particulièrement lorsqu'existent des symptômes atypiques. Son apport est incontestable dans le cadre de l'asthme difficile à traiter, mettant en évidence une gamme variée de comorbidités dont la prise en charge spécifique permet d'améliorer la réponse au traitement de fond: hypertrophie des végétations adénoïdes, anomalies fonctionnelles du larynx et des cordes vocales, colonisation bactérienne des voies respiratoires inférieures. Abstract Airways endoscopy is of no interest in standard asthma testing. However, it may occasionally be useful in young children for establishing differential diagnoses, particularly where atypical symptoms exist. It is extremely valuable in cases of asthma that are difficult to treat, since it can demonstrate a wide range of comorbidities whose specific management improves response to background treatment, for instance, adenoid tonsils hypertrophy, functional anomalies of the larynx and vocal cords, and bacterial colonisation of the lower airways. [ABSTRACT FROM AUTHOR]

Abstract: Kinetic properties of tyrosinase immobilized on a polymeric membrane for the production of l-3,4-dihydroxyphenylalanine (l-DOPA) were investigated. A comparison with the properties shown by the free enzyme used in a stirred tank reactor was also carried out. The values of the Michaelis–Menten constant indicated that the immobilized tyrosinase exhibited better affinity for the substrate (K m=1.56mM and 2.10mM for the immobilized and free enzyme, respectively). The stability (pH, thermal, storage and operational) of both free and immobilized tyrosinase was also evaluated. Results showed that the immobilization enhanced the enzyme stability. The optimum pH and temperature for the activity of both free and immobilized enzyme were found at pH 7.0 and 35°C, respectively. However, the immobilized tyrosinase was more stable in the whole range of pH and temperature. These advantages of the immobilized enzyme make it a good candidate for its use in different industrial processes. [Copyright &y& Elsevier]

Résumé: Les infections respiratoires sont un problème de santé publique. Leur cause en est majoritairement virale chez le jeune enfant. La mise au point de techniques de détection par biologie moléculaire a permis d’en élargir le spectre virologique. L’objectif de notre travail est d’évaluer la corrélation entre les résultats des prélèvements effectués par aspiration rhinopharyngée et par lavage bronchoalvéolaire. Trente enfants présentant une symptomatologie d’infection respiratoire basse ont ainsi été prélevés aux deux sites au cours d’une même séance. Les échantillons ont été analysés par Polymerase chain reaction (PCR) virale multiplex (xTAG™RVP). Une corrélation forte est retrouvée entre la positivité de la PCR virale dans les voies respiratoires hautes et basses (p =0,0002). Le virus le plus fréquemment isolé est l’entéro-rhinovirus. Ces résultats confirment que l’infection virale touche l’appareil respiratoire de façon diffuse, et suggèrent que le prélèvement par aspiration rhinopharyngée suffit au diagnostic virologique d’une infection respiratoire virale basse chez l’enfant immunocompétent. [ABSTRACT FROM AUTHOR]

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Abstract: Whey proteins (WP) today offer an extremely high potential for innovative development of functional and nutritious food products. Acid cold-set gels present an interesting approach of gelation at low temperature upon acidification of preformed whey protein (WP) aggregates. In the present work, we aimed to demonstrate how structure and rheological properties of acid gels can be controlled by combining two types of WP aggregates with different structural and chemical properties. Whey protein microgels (WPM) and soluble aggregates (WPSA) were generated upon heating WP isolate in specific pH conditions and temperature, leading to Z-average hydrodynamic diameters close to 270 nm for WPM and 100 nm for WPSA. Mixtures of WPM and WPSA were prepared at different weight ratios ranging from 100% WPM to 100% WPSA. The total protein concentration was set to 4 or 8%wt. Acidification was performed at 40 °C by addition of 1%wt glucono-δ-lactone (GDL). Gelation was followed using turbidimetry and small deformation rheology as function of pH. Microstructures of the gel were investigated at different length scales using various microscopy techniques (CLSM, SEM, AFM). When the WPM/WPSA ratio decreased, the pH of gelation and the gel strength increased because of the different structure and chemical reactivity of the two types of WP aggregates. The final pH had a strong impact on the structure of the gels. When final pH decreased below pH 4.3, a structure change was suggested by turbidimetry measurements. This resulted in a non self-supporting gel or in a decrease of gel strength. For pH above 4.3, self supporting gel were obtained. The rheological properties of the gel could therefore be modulated depending on the properties of the building blocks used (WPM versus WPSA). Interestingly, the gel microstructures observed for WPM/WPSA mixtures or WPM were comparable to those of acidified skimmed milk gels ranging from coarse structures with clumps of aggregates or to homogeneous fine networks (WPSA only) that have been described for WP gels obtained upon direct heating at various pH. [Copyright &y& Elsevier]

Abstract: Tracheomalacia (TM) or bronchomalacia (BM) refers to softness or weakness of the trachea or the bronchi. Its management is not evidenced-based. Conservative therapy is preferred in milder cases, since the outcome is usually favourable within the first 2 years of life. The clinical utility of non-specific treatments (anti-inflammatory agents, bronchodilators, antibiotics, physiotherapy) has not been proven by clinical trials. Treatment of symptomatic cases should be discussed on an individual basis. Airway surgery should be avoided, and non-invasive ventilation may be proposed as a temporary measure. In case of very severe cases, aortopexy, trachostomy or stent placement are the preferred treatments. Regular respiratory monitoring until remission is mandatory. [Copyright &y& Elsevier]

Abstract: Food quality is not only a function of nutritional values but also of the presence of bioactive compounds exerting a positive effects on human health. This research was undertaken to study the influence of the ultrafiltration (UF) on the composition of some bioactive compounds of the kiwifruit juice in order to develop a natural product which can be used to fortify foods and beverages. At the same time the effect of transmembrane pressure (TMP) and temperature on the permeate flux was also investigated in order to identify the optimal operating conditions for the processing of the juice. An optimal TMP value occurred at 0.6–0.65 bar in different conditions of cross flow velocities. Steady-state permeate fluxes increased linearly with temperature in the range 20–30 °C. The kiwifruit juice was clarified in optimal operating conditions, according to the batch concentration mode, up to a final volume reduction factor (VRF) of 2.76. The analyses of flux decay according to fouling models reported in the literature revealed that the formation of a cake layer covering the entire surface of the membrane is the main cause of the membrane fouling. Most bioactive compounds of the depectinised kiwifruit juice were recovered in the clarified fraction of the UF process. The rejection of the UF membrane towards total phenolics was 13.5%. The recovery of glutamic, folic, ascorbic and citric acids, in the clarified juice, with respect to the initial feed, was dependent on the final VRF of the UF process: an increase of the VRF determines an increase of these compounds in the clarified juice. The rejections of the UF membrane towards these compounds were in the range 0–4.3%. Industrial relevance: Among different substances contained in the kiwifruit a primary role, in the safeguard of the human health, is carried out by some bioactive compounds such as ascorbic, folic, citric, glutamic acids and polyphenols. This research was undertaken to study the influence of ultrafiltration on the composition of these compounds in order to develop a natural product which can be used to fortify foods and beverages. [Copyright &y& Elsevier]

Abstract: There is a wide range of indications for therapeutic bronchoscopy in children today: foreign body removal, bronchoaspiration, endoscopy-assisted tracheal intubation, selective intubation and airway management during thoracic surgery or in children undergoing mechanical ventilation. Some adult-derived methods may find potential indications in pediatric patients: airway stenosis dilation, laser photoresection, tracheobronchial stenting. There are no rules regarding such procedures in children, and supposed benefits have to be weighted against those of more conventional therapies. [Copyright &y& Elsevier]

Abstract: Fresh depectinised kiwifruit juice has been clarified by ultrafiltration (UF) process on laboratory scale. In experimental tests performed according to the total recycle mode the effect of transmembrane pressure (TMP), axial flow-rate and temperature on permeation flux has been studied. The results showed that flux increased with temperatures from 20 to 30°C and with axial feed flow rate from 300 to 700l/h. The flux-pressure curves showed no increase in permeate fluxes for TMP values higher than 90kPa (TMPlim). Clarified kiwifruit juice has been produced in experimental tests carried out according to the batch concentration mode working in optimal operating and fluid dynamic conditions. The quality of clarified juice has been analysed in terms of total antioxidant activity (TAA), content of ascorbic acid, suspended solids, turbidity and viscosity. The UF process permitted a good level of clarification reducing totally the suspended solids and the turbidity of the fresh juice. In the permeate a 16% reduction of ascorbic acid was observed with respect to the fresh juice; however, the reduction of the TAA was lower than 8%. Cake layer and irreversible fouling resistances gave a minimum contribution to the total resistance (2.23% and 2.75%, respectively) while the contribution of the reversible fouling was more significant (29.4%). A good restore of the hydraulic permeability of the membrane (about 96% of the initial one) was observed after a cleaning treatment performed by using alkaline and acid detergents. Thus, the flux decline during UF could be ascribed to fouling layers formed by a combination of suspended particles and adsorbed macromolecular impurities. [Copyright &y& Elsevier]

Abstract: The present investigation aimed at understanding how the type of cations (Na+ and/or Ca2+) influences heat-induced gelation of globular protein/LM pectin mixtures in comparison to the globular protein only. Two globular proteins (β-lactoglobulin or bovine serum albumin) were compared. On the basis of viscoelastic and microscopic observations (CLSM), it has been shown that the two cations play a major role in gelation of the individual biopolymers and, therefore, influence strongly the properties of the mixture. These differences are related to a competition between gelation of the protein (in absence of Ca2+) or of both biopolymers (if Ca2+ is added) and phase separation processes taking place before the mixed system is entirely gelled. [Copyright &y& Elsevier]

Abstract: Bronchoscopy can be helpful for microbiological diagnosis in children with primary tuberculosis and its yield is clearly enhanced by PCR detection. However perendoscopic sampling has a lower sensitivity rate than repeated gastric whashings and probably sputum induction. Bronchoscopy is indicated in case of clinically and/or radiologically suspected endobronchial involvement, helps for restoration of normal airway diameter and bronchial wall injury follow-up. A few series on endoscopic findings according to the mode of presentation have been published in pediatric patients. In these studies endobronchial tuberculosis occurrence is described irrespective of clinical or radiological symptoms. [Copyright &y& Elsevier]

Asthma is one of the most frequent disease in childhood. The objectives of this survey were to study asthma and asthma related symptoms epidemiology in preschool children and to analyse their medical management.Methods. – A cross-sectional survey was conducted in 1998 in Alsace-France by school doctors, on a randomized sample of 2 765 pupils attending third year kindergarten. The first questionnaire accessed diagnosed asthma and asthma related symptoms history, and school absenteeism. The cumulative prevalence was estimated for diagnosed asthma on the period since birth and for asthma related symptoms unassociated with diagnosed asthma for the past 12 months. Parents who reported diagnosed asthma or asthma related symptoms unassociated with diagnosed asthma of their children were interviewed with a supplemental questionnaire examining clinical patterns, health care and asthma-related hospitalization.Results. – Prevalence of asthma was 6,5%. Prevalence of asthma related symptoms unassociated with a diagnosis of asthma was 7,2%. The “chesty” pupils school absenteeism was important. Most of the patients (91,3%) had a mild disease form. One third of them were not getting specific treatment. The drugs mostly prescribed were inhaled bronchodilators for acute episodes of asthma and antihistamines in prophylactic treatment. The rate of asthma-related hospitalization was 11,9%. Severe clinical pattern was statisticaly related to treatment and asthma-related hospitalization.Conclusion. – Asthma prevalence is high in children attending nursery school in Alsace. This disease is still nowadays undiagnosed, underinvestigated and undertreated. [Copyright &y& Elsevier]

This study sought to investigate whether encapsulation of lipids in core-shell hydrogel structures of tailored shell porosity could create a delayed burst release of encapsulated lipids, and examined the underpinning mechanisms. We demonstrated that gastrointestinal digestion of core-shell structures resulted in a delay in the onset of lipid digestion, without affecting lipid digestion kinetics. Systematic increase in hydrogel protein content above 65 g/L lead to an exponential increase in digestive delay (250 min). Whilst an increase in xanthan content between 5 and 9 g/L lead to a modest decrease in digestive delay (40 min). Rheological investigations revealed a linear relationship between hydrogel storage modulus G′ and digestive breakdown delay (T 1/2). Given that G' is directly related to hydrogel mesh size, this result suggests that the main factor controlling the timing of digestive release is the average mesh size of the outer protein hydrogel. A kinetic model was created to describe the delayed burst release behaviour of encapsulated lipids and successfully predicted the influence of shell thickness, shell protein density on the timing of gastro-intestinal release (in vitro). By combining microstructural/rheological experiments with in vitro digestive studies we have understood the main factors controlling the digestive breakdown of hierarchical biopolymer hydrogels. We could successfully miniaturise these core-shell structures so they would easily empty from the stomach whilst maintaining programmable delayed burst release. We have created a novel family of core-shell hydrogel oral dosage forms for the delivery of poorly soluble drugs and the programmed delivery of lipids within the gut. Image 1 • Encapsulation of lipids in core-shell hydrogels creates a delayed burst release. • Core-shell structures delay the start of lipid digestion, without affecting the speed. • A kinetic model was created to describe the delayed burst release behaviour. • These new hydrogels can be used for programmed delivery within the gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La loi dite ű Léonetti Ƈ prévoit le recours aux soins palliatifs (SP). Très peu de données françaises sont disponibles sur cette pratique nouvelle en néonatologie. Objectif: Décrire et évaluer la pratique des SP au nouveau-né (motifs d’entrée, modalités) et son évolution dans le temps. Patients et méthodes: Étude observationnelle ambispective avec inclusion de toutes situations de SP en néonatologie. Analyses, quantitative et qualitative, des données recueillies systématiquement. Comparaison entre deux périodes P1 (2006–2007) et P2 (2008–2010). Résultats: Inclusion de 93 nouveau-nés en SP pour complications de la prématurité (36/93–39 %), encéphalopathie anoxo-ischémique (19/93–20,5 %), syndromes polymalformatifs (8/93–8,5 %), cardiopathies sévères (8/93–8,5 %), causes diverses (22/93–23,5 %). Le nombre d’entrée en SP/nombre de naissance et le nombre de décès après SP/nombre de décès en néonatologie sont restés stables. En cas de diagnostic prénatal (n =31), une augmentation des ű projets de naissance en SP Ƈ (13/22 en P2 vs 1/9 en P1 ; p =0,02) a été observée. Un arrêt des thérapeutiques actives et une limitation des gestes de soins/surveillance ont été plus fréquents en P2 vs P1, respectivement 37/59 vs 12/34 (p =0,02) et 39/59 vs 14/34 (p =0,03). La titration des antalgiques de palier III était élevée et stable sur les 2 périodes, mais l’évaluation systématique de la douleur semblait plus fréquente en P2 (81,6 % vs 64,5 %, p =0,085). Conclusion: Un nombre non négligeable de nouveau-nés atteints d’affections diverses est concerné par les SP. Malgré son introduction récente en néonatologie, la pratique des SP évolue notablement, majoritairement dans le cadre de la loi. [ABSTRACT FROM AUTHOR]

Summary: In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006–2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006–2007 season (13.9% for the 2005–2006 season and 10.9% for the 2004–2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p <0.001). In France, in 2006–2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children. [Copyright &y& Elsevier]

Objectives. – This work was splitted in two parts: the first one was the study of retinopathy incidence in premature infants less than 33 weeks gestation, born between 1988 and 1997; the second one is the identification of severe retinopathy different risk factors.Patients and methods. – Our study was retrospective over ten years. All premature infants less than 33 weeks gestation born between January 1, 1988 and December 31 1997, admitted to the Strasbourg neonatal intensive care unit with retinopathy, were included (164 children). First we studied the incidence evolution of retinopathy over these ten years; then by a statistical study (univaried and multivaried) we looked for a significant difference for several factors between the infants with mild retinopathy and the group with severe ocular disease.Results. – Retinopathy incidence decreased in ten years from 13.7 to 6.7% for the moderate forms (P<0.001) and from 3.7 to 1.7% for severe stage (non significant). A significant difference was found for various factors after comparison between both groups. The birth weight (P=5.10–4), the gestational age (P=4.10–6), were weaker in the group with severe retinopathy. A maternofetal or nosocomial infection (P=0.009 ; P=0.002), hemodynamic shock (P=10–6), patent ductus arteriosus (P=10–6), bronchopulmonary dysplasia (P=3.10–6), postnatal steroid treatment (P=0.007), respiratory distress syndrome (P=0.01), were all more frequent in the severe retinopathy sample. The number of days with oxygenotherapy (P=10–6) and mechanical ventilation (P=10–6) the number of blood transfusion (P=10–5) were higher in this group than in the other. The logistic regression analysis showed that the hemodynamic parameters influence mostly on the risk of severe ocular disease, like an hemodynamic shock syndrome (OR=16.94; CI=2.12–135.77) or a patent ductus arteriosus (OR=5.36; CI=1.53–18.74).Conclusion. – A decrease of the retinopathy incidence in premature infants was observed in ten years, probably due to better care in the neonatal period. An unstable hemodynamic state would be one prominent risk factor in the genesis of severe retinopathy of prematurity. [Copyright &y& Elsevier]

Le syndrome du Cimeterre associe un retour veineux pulmonaire anormal partiel droit dans la veine cave inférieure, une hypoplasie du parenchyme et de l’artère pulmonaires droits, et parfois une séquestration basale droite vascularisée par des artères venant de l’aorte abdominale. L’expression clinique est très variable, allant d’une intolérance dès les premiers jours de vie à une découverte fortuite chez l’adulte ; elle dépend de l’importance de l’hypoplasie pulmonaire et de la fistule artério-veineuse à travers la séquestration. Nous rapportons le cas d’une enfant de 4 mois hospitalisée pour dyspnée aiguë sifflante en période d’endémie. Le traitement symptomatique d’une bronchiolite est instauré, sans succès, avec persistance de la détresse respiratoire et des difficultés alimentaires. Une première échocardiographie retrouve alors une dilatation des cavités droites et une petite CIA. La radiographie du thorax montre une distension parenchymateuse et un aspect de pneumopathie interstitielle diffuse ainsi qu’une cardiomégalie. Une seconde échocardiographie met alors en évidence un retour veineux anormal partiel se jetant dans la veine cave inférieure ; le syndrome du Cimeterre est évoqué. L’angioscanner confirme l’existence d’une artère partant de l’aorte abdominale et vascularisant un séquestre pulmonaire inférieur droit avec retour veineux pulmonaire anormal dans la veine cave inférieure. Après échec d’embolisation percutanée, l’artère aberrante irriguant le séquestre est ligaturée en urgence par laparotomie, permettant l’occlusion de la fistule artério-veineuse et la disparition rapide des signes cardio-respiratoires. Le syndrome du Cimeterre est une pathologie rare, méconnue, dont l’expression clinique est insidieuse et non spécifique. Sa forme la plus sévère avec séquestration pulmonaire conduit rapidement à un tableau d’insuffisance cardiaque à haut débit dont la prise en charge est une urgence thérapeutique. [Copyright &y& Elsevier]

Objectif: L’objectif est d’évaluer le taux de couverture vaccinale (CV) contre la grippe chez les enfants asthmatiques pour la saison 2006-2007. La vaccination annuelle contre la grippe est recommandée en France pour les patients asthmatiques. Un bon de prise en charge gratuite du vaccin grippe est adressé par la Caisse Nationale d’Assurance Maladie (CNAM) aux patients atteints de certaines affections de longue durée, dont l’asthme sévère. En novembre 2006, cette mesure a été étendue à l’asthme quel que soit son degré de sévérité. En 2008, l’objectif national de la loi de santé publique est d’atteindre pour les populations à risque, incluant les patients asthmatiques, un taux de CV contre la grippe d’au moins 75 %. Méthodes: Etude multicentrique, observationnelle, réalisée de mars à septembre 2007 dans huit hôpitaux répartis sur l’ensemble du territoire français. Critères d’inclusion : enfants âgés de 6 à 17 ans révolus, consultant un pneumo-pédiatre à l’hôpital, dont le diagnostic d’asthme datait de plus de 6 mois et disposant d’un carnet de santé ou d’un dossier médical. Le médecin remplissait un questionnaire pour chaque enfant inclus. Résultats: Les données de 433 enfants ont été analysées (moyenne : 9,5 ans, 61 % de sexe masculin). Le taux global de CV contre la grippe était de 15,7 % en 2006-2007. Parmi ces enfants, 39,6 % avaient reçu un bon CNAM. La réception du bon CNAM augmentait la CV (31 % de vaccinés parmi les enfants ayant reçu le bon, versus 5,9 % de vaccinés parmi les enfants n’ayant pas reçu le bon, p < 0.001). La vaccination était effectuée principalement par le médecin généraliste (72,1 %). La principale raison de non-vaccination était le manque d’information des patients (42 %). Pour ces mêmes enfants, les taux de CV en 2004-2005 et 2005-2006 étaient respectivement de 10,9 % et 13,9 %. Conclusions: En France, en 2006-2007, le taux de CV grippe chez les enfants asthmatiques (15,7 %) est très inférieur à l’objectif national d’au moins 75 % en 2008. L’extension récente de la prise en charge gratuite du vaccin grippe à tous les patients asthmatiques pourrait améliorer ce taux. Une information plus importante des patients sur les risques de la grippe en cas de maladie asthmatique et sur les bénéfices de la vaccination devrait aussi contribuer à l’amélioration de ce taux. [Copyright &y& Elsevier]