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OBJECTIVE The effect of advanced carbohydrate counting (ACC) on metabolic and quality of life (QOL) outcomes is uncertain in children with type 1 diabetes. Our aim was to determine whether ACC would improve HbA1c and QOL scores as compared with standard nutrition in this population. METHODS We randomized 87 patients using pump and rapid-acting analogs in a 1 year randomized multicenter study (age 9.6 ± 3.5 years, diabetes duration 4.6 ± 2.7 years, HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]). The ACC group received CC education and the control group received traditional dietary education. HbA1c was measured every 3 months. At 0 and 1 year, general, diabetes-specific, and diet-related QOL were respectively assessed by the KIDSCREEN and WHO-5 questionnaires, the diabetes-specific module of the DISABKIDS, and the diet restriction items of the DSQOLS. RESULTS Mean HbA1c was lower in the ACC than the control group at 3 months (P

AIM To assess the safety and efficacy of hybrid closed-loop (HCL) insulin delivery 24/7 versus only evening and night (E/N), and on extended 24/7 use, in free-living children with type 1 diabetes. MATERIALS AND METHODS Prepubertal children (n = 122; 49 females/73 males; age, 8.6 ± 1.6 years; diabetes duration, 5.2 ± 2.3 years; insulin pump use, 4.6 ± 2.5 years; HbA1c 7.7% ± 0.7%/61 ± 5 mmol/mol) from four centres were randomized for 24/7 versus E/N activation of the Tandem Control-IQ system for 18 weeks. Afterwards, all children used the activated system 24/7 for 18 more weeks. The primary outcome was the percentage of time spent in the 70-180 mg/dL glucose range (TIR). RESULTS HCL was active 94.1% and 51.1% of the time in the 24/7 and E/N modes, respectively. TIR from baseline increased more in the 24/7 versus the E/N mode (52.9% ± 9.5% to 67.3% ± 5.6% [+14.4%, 95% CI 12.4%-16.7%] vs. 55.1% ± 10.8% to 64.7% ± 7.0% [+9.6%, 95% CI 7.4%-11.6%]; P = .001). Mean percentage time below range was similarly reduced, from 4.2% and 4.6% to 2.7%, and the mean percentage time above range decreased more in the 24/7 mode (41.9% to 30.0% [-11.9%, 95% CI 9.7%-14.6%] vs. 39.8% to 32.6% [-7.2%, 95% CI 5.0%-9.9%]; P = .007). TIR increased through the whole range of baseline levels and always more with 24/7 use. The results were maintained during the extension phase in those initially on 24/7 use and improved in those with initial E/N use up to those with 24/7 use. Neither ketoacidosis nor severe hypoglycaemia occurred. CONCLUSIONS The current study shows the safety and efficacy of the Tandem Control-IQ system in free-living children with type 1 diabetes for both E/N and 24/7 use; 24/7 use shows better outcomes, sustained for up to 36 weeks with no safety issues.

Background The impact of 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unknown in youths with suboptimal control by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence in real-life conditions. Methods This French multicenter longitudinal observational study included T1D youths with HbA1c > 7.5% or a history of severe hypoglycemia (SH) or recurrent documented hypoglycemia. A sensor was inserted at the study-inclusion visit, and one of three predefined treatment changes was proposed by the investigator within 7–15 days: INT = MDI intensification, CSII = switch to continuous insulin infusion, or ER = educational reinforcement with no change in insulin regimen and a 4-month follow-up visit (M4) was scheduled. Results A total of 229 children (12.2 ± 3.5 years old) were recruited by 74 pediatricians; 12.8% had a history of SH, 22.2% had recurrent hypoglycemia. Baseline HbA1c was 8.7 ± 1.5% (> 7.5% in 82.8%). Overall, 139 (79.4%), 19 (10.9%), and 17 patients (9.7%) were, respectively, included in the INT, CSII, and ER subgroups. At M4, the global incidence of SH and recurrent hypoglycemia dropped (3.4% vs. 12.8% and 6.0% vs. 22.2%, respectively) as well as the incidence of ketoacidosis (2.1% vs. 8.1%) or ketosis (6.9% vs. 11.4%). The HbA1c decrease was significant overall and in the INT subgroup (adjusted difference −0.29%, P = 0.009). The satisfaction rate was ≥ 93.0% among children. Conclusion In a real-life setting, a 1-week RT-CGM can promote treatment optimization in youths with uncontrolled T1D resulting mostly in less acute events. CGM acceptance may improve with new-generation sensors.

Summary Primary endobronchial tumors are rare in children and they include a broad spectrum of lesions. The aim of this study was to determine the characteristic features, treatments and outcomes of these tumors. We report a retrospective analysis of all patients treated for endobronchial tumor in nine French hospitals between 1990 and 2010 and a comparison of the results with those reported in the medical literature. Twelve tumors were reported: five low grade muco epidermoid carcinomas, two inflammatory myofibroblastic tumors, two hemangiomas, one anaplastic large cell lymphoma, one carcinoid tumor, and one juvenile xanthogranuloma. The mean age of the patients was 7.5 ± 3.5 years. The most common sign revealing the disease was persistent atelectasis or recurrent pneumonia (eight cases). The other revealing signs were a persistent bronchospasm (three cases) and hemoptysis (one case). The clinical presentation, biology, serum tumor markers, and chest X-ray abnormalities were not specific to a particular histological diagnosis. Chest CT scan revealed the presence of an endobronchial tumor in 11 cases. Nine tumors could be diagnosed from a biopsy obtained by video endoscopy. Complete surgical resection was performed in seven patients. Bronchoscopic removal was performed in five cases and was successful in three. There were no deaths. Endobronchial tumors are rare in childhood and their histology is diverse. Chest CT scan and per-endoscopic endobronchial biopsies are required for diagnosis, when possible. Surgical or endoscopic treatment should be discussed by a multidisciplinary team. Despite the multiple etiologies, the prognosis of these tumors is good if diagnosis is early and if resection is complete. Long-term recurrences have been described, so long-term follow-up of these children is recommended. Pediatr Pulmonol. 2014; 49:E121–E125. © 2014 Wiley Periodicals, Inc.

Resume Introduction L’equilibre metabolique est un objectif primordial du traitement du diabete de type 1 afin de prevenir ou de retarder l’apparition des complications. Chez l’enfant, les recommandations internationales sont de maintenir une hemoglobine glycosylee (HbA1c) inferieure a 7,5 %. L’objectif de ce travail etait de comparer l’equilibre metabolique d’enfants diabetiques de type 1 traites par pompe a insuline externe (PIE) ou par schema multi-injections (SMI). Patients et methodes Trente-huit enfants traites par PIE ont ete compares a 38 autres traites par SMI, apparies pour l’âge, le sexe et l’anciennete du diabete. Les donnees suivantes ont ete relevees de maniere retrospective sur une duree de 3 ans : dose quotidienne d’insuline, valeur de l’HbA1c, indice de masse corporelle, nombre d’hypoglycemies severes et d’hospitalisations liees au diabete. Resultats A l’inclusion, les 2 groupes avaient des caracteristiques similaires. Durant les 3 annees d’observation, les sujets traites par PIE ont eu une consommation quotidienne d’insuline diminuee (0,78 ± 0,19 vs. 0,87 ± 0,22 UI/kg/j, p p p Conclusion Cette etude suggere que le traitement par PIE permet un meilleur equilibre glycemique a long terme chez les enfants traites pour un diabete de type 1.

Resume Objectifs Le metapneumovirus humain (hMPV) est responsable d’infections respiratoires hivernales de l’enfant. Le but de notre etude etait de decrire l’epidemiologie et la semiologie clinique des infections a hMPV du jeune enfant. Patients et methodes Une etude prospective a ete menee de novembre 2007 a avril 2008 chez les enfants de moins de 2 ans hospitalises au CHU de Tours et ayant beneficie d’un prelevement nasopharynge pour recherche virale. Les donnees epidemiologiques et cliniques des infections a hMPV ont ete comparees a celles des infections respiratoires a virus respiratoire syncytial (VRS) ou negatives pour ces 2 virus (groupe NEG). Resultats Nous avons inclus 374 enfants, dont 22 (6 %) infectes par le hMPV, 177 (47 %) par le VRS et 175 (47 %) NEG. L’infection a hMPV avait 1 pic epidemique au mois de decembre, semblable a celui du VRS, et etait rare a partir du mois de fevrier. La majorite des enfants hMPV avait moins d’1 an. Un diagnostic de bronchiolite etait pose chez plus de 90 % d’entre eux ; les signes cliniques respiratoires etant au premier plan. La severite de l’infection, estimee par la necessite d’une assistance nutritionnelle ou respiratoire, etait similaire a celle de l’infection a VRS et superieure a celle du groupe NEG. L’existence d’une maladie chronique sous-jacente ou d’1 antecedent de bronchiolite etait 1 facteur de risque d’infection a hMPV. Conclusion Ces resultats confirment la place importante du hMPV dans les infections respiratoires hivernales du jeune enfant, avec une severite similaire a celle du VRS.

Resume La neurofibromatose de type 1 (NF1) est une maladie genetique frequente. Le diagnostic repose sur des criteres cliniques precis. La NF1 expose a des complications variees et imprevisibles. Objectifs Realiser un suivi clinique prospectif pluridisciplinaire de ces patients afin d'affiner les donnees de la litterature sur la variete des complications et leurs frequences reelles. Population et methodes Nous presentons une serie de 100 enfants atteints de NF1, etudies sur 4 ans au sein du reseau NF1-Tours region centre. Trois bilans (2–5, 6–7, 14–15 ans) ont ete realises ainsi qu'une visite annuelle. Resultats Dans notre serie, l'âge moyen des patients etait de 7,8 ans avec un sex-ratio de 1. L'âge moyen au moment du diagnostic etait de 3,8 ans et les signes d'appel principaux etaient les taches cafe au lait et les cas familiaux pour 80 % des cas. Aucun gliome des voies optiques retrouve n'etait asymptomatique. Les troubles d'apprentissage representaient la principale complication (46 % des cas). Conclusion Le depistage de ces difficultes frequentes dans la NF1 est une priorite de la prise en charge pediatrique.

Objectives Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia. Study design Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤50mg/dl) episodes per patient detected by CGMS. Results Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2±0.4 vs 0.4±0.2 episode/patient, p

RESIDENCY TRAINING programs are unique parts of the medical educational system of the US, although they somewhat resemble German assistantships. The institution of the first residency programs depended on the initiative of Osler and Halsted, of Johns Hopkins University, in the last years of the 19th century. At that time. North American physicians traveled to Europe for advanced training, just as doctors today come to this country. Today the US offers, in general, more and better opportunities for postgraduate medical training than any other country. Nevertheless, there are a few points, in relation to orthopedic training programs in particular, that should be looked at through the eyes of a foreign doctor. I believe that many foreign physicians look up to North American training as their highest educational goal. There are valid reasons for such an attitude, but sometimes they return to their countries disappointed, convinced that they made the