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Substantial evidence exists that personality traits may impact the onset, course, symptom presentation, treatment outcome, and maintenance of eating disorders (Cassin & Vonranson, 2005). Despite a strong link between personality traits and eating disorders, research to understand the mediators of this relationship is lacking to date. Both disordered eating and personality dysfunction are thought to be perpetuated by a cycle of maladaptive beliefs (Cooper & Hunt, 1998; Dweck 2008). We believe that personality pathology may lead to disordered eating because personality pathology comes with maladaptive beliefs that promote pathological eating behaviors. Additionally, maladaptive beliefs may be responsible for the link between personality and eating disorders, and it follows that holistic eating disorder treatment encompasses both factors. Therefore, we aimed to evaluate general maladaptive beliefs as mediators for the relationship between personality dysfunction and disordered eating within a sample of 304 college students. Results showed that maladaptive beliefs may partially mediate the relationship between personality dysfunction and disordered eating; using the Baron and Kenny method of mediation, we found the indirect effect of maladaptive beliefs on disordered eating was significant, β = .22 (p < .001). These findings suggest that maladaptive beliefs may constitute a common risk factor or experience in both disordered eating and personality pathology. We conclude that treatment for eating disorders should address maladaptive beliefs and personality dysfunction.

Molecular testing; Ovarian cancer Proves moleculars; Càncer d'ovaris Pruebas moleculares; Cáncer de ovarios Background The detection of homologous recombination deficiency (HRD) can identify patients who are more responsive to platinum and poly ADP ribose polymerase inhibitors (PARPi). MyChoice CDx (Myriad) is the most used HRD test in ovarian cancer (OC). However, some limitations of commercial tests exist, because of the high rate of inconclusive results, costs, and the impossibility of evaluating functional resistance mechanisms. Patients and methods Two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. One hundred patients with high-grade OC enrolled in the MITO16A/MaNGO-OV2 trial and treated with first-line therapy with carboplatin, paclitaxel, and bevacizumab were analyzed. Results The failure rate of the two genomic assays was 2%. The sensitivity in detecting HRD when compared with Myriad was 98.1% and 90.6%, respectively. The agreement rate with Myriad was 0.92 and 0.87, with a Cohen’s κ coefficient corresponding to 0.84 and 0.74, respectively. For the RAD51 foci assay, the failure rate was 30%. When the test was successful, discordant results for deficient and proficient tumors were observed, and additional HRD patients were identified compared to Myriad; sensitivity was 82.9%, agreement rate was 0.65, and Cohen’s κ coefficient was 0.18. The HRD detected by genomic assays and residual tumor at primary surgery and stage was correlated with progression-free survival at multivariate analysis. Conclusions Results suggest the feasibility of academic tests for assessing HRD status that show robust concordance with Myriad and correlation with clinical outcome. The contribution of the functional information related to the RAD51 foci test to the genomic data needs further investigation. This work was supported by funding from the AIRC [grant numbers IG 2016 – ID. 18921 and IG 2021 – ID. 25932 projects – P.I. SP and CO-2018-12367051 (Ministero della Salute) P.I SP]; Ricerca Corrente grant M2/7 from Ministero della Salute to DC, Ricerca Corrente from Ministero della Salute to SP. SM is supported by the Italian Association for Cancer Research [grant number IG-2017 n: IG19997]. MITO16A/MaNGO-OV2 trial was partially supported by Roche. AL is a recipient of a grant from the Asociación Española contra el Cáncer (AECC) [grant number INVES20095LLOP]. VS is a recipient of a grant from the Instituto de Salud Carlos III [grant number CPII19/00033] and a European grant for personalized medicine [grant number ERAPERMED 2019-215]. BP is a recipient of a grant from GOIRC. BP was supported by ESMO with a Clinical Translational Fellowship aid supported by Roche. Any views, opinions, findings, conclusions, or recommendations expressed in this material are those solely of the authors and do not necessarily reflect those of ESMO or Roche. NC has received funding from AstraZeneca (to the institution). FP has received funding from Roche, AstraZeneca, Pfizer, Merck Sharp & Dome, Bayer, Incyte, Taiho Oncology, Janssen Cilag, Exelixis, Aileron, and Daiichi Sankyo (grants to the institution for clinical trial activities).

Background The European Society for Medical Oncology (ESMO) 2021 conference provided a high number of randomized phase III trial reports, many of which were claimed to be practice changing. Given the short time available for conference presentations, results and conclusions tend to have greatest priority with less time remaining for study background and study methodology. Purpose On behalf of the ESMO Practicing Oncologists Working Group, 11 potentially practice-changing reports were selected and screened for three main questions: (i) Did the investigators provide sufficient details with regard to Patients and Methods to make the results comprehensible? (ii) Were there any reasons to consider bias? (iii) To which extent did the results presented translate to clinical benefit? Results In 2 out of 11 trials, the study design presented differed considerably from the study design described at ClinicalTrials.gov. Allocation concealment was not carried out in 6 out of 11 trials. In none of the trials reporting progression-free survival was informative censoring considered an issue. In none of the trials reporting overall survival was desirable crossover considered an issue. Defined trial outcome measures depicted at ClinicalTrials.gov, which could boost or weaken the ESMO-Magnitude of Clinical Benefit Scale score, were often lacking in the presentation. Study success was claimed in a heterogeneous manner, which was often not clearly linked to overall clinical benefit. Conclusion ESMO conference presentations can inform the scientific community and catalyze further research but cannot replace the full papers in peer-reviewed journals, which are needed to estimate the thoroughness of the results, the overall impact on clinical benefit and the consequences for future treatment guidelines., Highlights • An oncological peer-reviewed paper is lengthy and well structured. • An oncological conference presentation is short and less structured, but its impact can be high. • ESMO 2021 conference encompassed many possibly practice-shaping phase III trial reports. • A survey of 11 selected reports to ascertain if the conclusions made were adequately underlined by the provided information.

Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3–10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8–11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3–15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.

Resume Propos L’objectif est de decrire les modalites et les besoins de soins palliatifs durant les 3 derniers mois de vie des enfants decedes d’un cancer ou d’une pathologie hematologique en 2010 en Ile-de-France. Methodes Il s’agit d’une etude retrospective, multicentrique de 68 dossiers identifies. Ce travail a ete mene par le Reseau d’Ile-de-France d’hematologie et oncologie pediatrique (RIFHOP) et l’Equipe regionale ressource en soins palliatifs pediatriques en Ile-de-France (PALIPED). Resultats La decision de prise en charge palliative a ete prise en reunion de concertation pluridisciplinaire dans 70 % des cas. On retrouve une decision de non-reanimation dans 40 % des dossiers. Pres de 80 % des patients sont decedes a l’hopital. La demande initiale d’un deces a domicile a pu etre respectee dans 10 cas sur 17. Au cours de derniere semaine de vie, 80 % des enfants ont recu de la morphine, 91 % des steroides, 21 % de la chimiotherapie, et 53 % des antibiotiques ; 47 % ont eu une transfusion sanguine et 57 % ont ete mis sous sedation. Conclusion Cette etude retrospective sur dossiers offre une description detaillee du parcours de soins des enfants en situation palliative suivis en cancerologie en Ile-de-France pendant les trois derniers mois de vie. Le developpement de moyens de confort non medicamenteux, la poursuite de certains gestes invasifs ou de certains traitements dans la derniere semaine de vie, le lieu de fin de vie ou la coordination ville-hopital sont autant d’axes de travail mis en lumiere par cette etude.

Resume Le reseau d’Ile-de-France d’hematologie et d’oncologie pediatrique (RIFHOP) a pour principal objectif d’aider les familles lors de leur premier retour au domicile apres le diagnostic d’un cancer pediatrique, mais intervient aussi aupres des professionnels de soins autour de formations specifiques et de l’harmonisation des soins aux enfants. Apres 8 annees d’exercice sur le terrain, l’equipe de coordination fait le point sur ces differentes actions. Partant de ses objectifs initiaux, elle s’interroge sur ce qu’il lui a ete possible de realiser avec les familles et les professionnels de sante. Entre les visites a domicile aupres des familles, les formations des professionnels et la creation de nombreux outils, c’est, au-dela de l’equipe de coordination, tout un reseau de professionnels qui s’impliquent au quotidien pour ameliorer la qualite de vie et faciliter les soins des enfants soignes pour cancer a travers les nombreux groupes de travail et dans l’administration du reseau. Depuis la mise en place de ce reseau regional, de reelles avancees sont visibles meme si des actions complementaires restent a finaliser.

Resume Propos Evaluer la mise en application des recommandations de prise en charge therapeutique des neutropenies febriles au sein du Reseau d’Ile-de-France d’hemato-oncologie pediatrique (RIFHOP) et l’incidence des infections documentees au cours des neutropenies febriles. Methodes Etude observationnelle multicentrique prospective chez les enfants traites pour une tumeur solide ou une hemopathie maligne presentant une neutropenie febrile au decours d’une cure de chimiotherapie conventionnelle prise en charge dans un service de pediatrie du RIFHOP sur une periode de 6 mois. Resultats Cent soixante-seize episodes de neutropenie febrile sont survenus chez 144 enfants (77 hemopathies malignes – 67 tumeurs solides). Les recommandations d’antibiotherapie de premiere ligne ont ete suivies dans 91 % des cas. L’antibiotherapie a ete adaptee selon les recommandations du RIFHOP dans 88 % des cas et les modalites de sorties ont ete respectees dans 87 % des neutropenies febriles. Une documentation microbiologique a ete retrouvee dans 33,5 % avec une predominance d’infections urinaires a Escherichia coli. Conclusions Cette adhesion aux recommandations semble etre le reflet du souhait d’homogeneisation des pratiques au sein de l’Ile-de-France. La faisabilite et l’efficacite de ces recommandations semblent etre excellentes avec une incidence d’infection documentee comparable a celle de la litterature.

Introduction L’augmentation de l’anaphylaxie ces dernieres annees, nous obligent a reflechir sur nos pratiques. L’objectif de l’etude est de preciser le profil des patients atteints d’anaphylaxie et d’evaluer les pratiques dans un service d’urgence pediatrique d’un hopital d’Ile-de-France, a Poissy. Methodes Il s’agit d’une etude descriptive retrospective a partir des dossiers de patients admis entre le 1re janvier 2014 et le 31 decembre 2016 aux urgences pediatriques de Poissy. Les sujets ayant presente une anaphylaxie etaient inclus apres analyse des diagnostics selon 7 codes diagnostiques CIM-10. L’ensemble des dossiers ont reinterprete selon les criteres cliniques d’anaphylaxie de Sampson. Resultats Nous rapportons une serie de 53 enfants, âges de 3 mois a 18 ans, atteints d’anaphylaxie selon Sampson. L’âge moyen est de 8 ans. Majoritairement, l’allergie est d’origine alimentaire. Plus de 70 % des patients presentent un terrain atopique. Un traitement par adrenaline est administre dans 47 % des cas. Les patients grade 3 selon Ring et Messmer sont identifies comme etant plus severe, avec un taux d’hospitalisation et une prescription d’adrenaline plus frequents. La surveillance hospitaliere n’est pas optimale, plus du tiers des patients est surveille moins de 6 heures. On retrouve peu de dossiers avec dosage de tryptase. A la sortie des urgences, moins du tiers de nos patients beneficient d’une prescription d’un stylo auto-injecteur ; un plan d’action individualise n’est mentionne dans aucun dossier. En revanche, les patients sont orientes vers un allergologue dans plus de 70 % des cas. Discussion Notre etude montre la frequence des antecedents d’atopie. Lorsque le patient reste symptomatique a l’arrivee aux urgences, 8 fois sur 10, une prescription d’adrenaline est realisee. Il reste a ameliorer la surveillance hospitaliere, minimum de 6 heures pour toute forme d’anaphylaxie. Par ailleurs, l’accompagnement du patient a la sortie, avec la prescription de stylos auto-injectable d’adrenaline, associee a un plan d’action est insuffisamment prescrit. Conclusion Une etude portant sur l’impact des nouvelles recommandations dans la prise en charge de l’anaphylaxie serait pertinente.

Resume Nous rapportons la mise en place et l’experience de l’equipe ressource en soins palliatifs pediatriques (ERRSPP) en Ile-de-France, PALIPED. Les projets menes depuis 2010 sont decrits, en particulier les actions d’acculturation des equipes a la demarche palliative pediatrique, la contribution a la recherche clinique en soins palliatifs et le soutien a l’entourage des patients sans oublier les actions de formation/information et de communication. Ce travail qui s’est accompagne d’un maillage territorial doit se poursuivre afin d’ameliorer le parcours des enfants en soins palliatifs mais aussi de leurs parents, leur fratrie et des soignants qui les accompagnent.

Background andobjectivesThecalcimimeticcinacalcet reduced therisk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older ($65 years, n=1005) and younger (,65 years, n=2878) patients. Design, setting, participants, & measurements Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified. ResultsOlderpatients hadhigher baselineprevalenceof diabetesmellitusandCV comorbidity. Annualizedrates of kidney transplantation and parathyroidectomy were .3-fold higher in younger relative to older patients and were more frequent in patients randomized to placebo. In older patients, the adjusted relative hazard (95% confidence interval) for the primary composite (CV) end point (cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients, the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to 1.13). Reduction in the risk of severe unremitting HPT was similar in both groups. Conclusions In the EVOLVE trial, cinacalcet decreased the risk of death and of major CV events in older, but not younger, patients with moderate to severe HPT who were receiving hemodialysis. Effect modification by age may be partly explained by differences in underlying CV risk and differential application of cointerventions that reduce parathyroid hormone. Clin J Am Soc Nephrol 10: ccc–ccc, 2015. doi: 10.2215/CJN.07730814

Resume But de l’etude. – Afin d’optimiser l’utilisation des nouvelles formes d’Amphotericine B (Ampho B), un arbre decisionnel a ete mis en place fin 2001 dans le service d’hemato-oncologie pediatrique pour le traitement empirique antifongique chez les enfants neutropeniques febriles : le medicament de reference restait l’Ampho B conventionnelle et Abelcet ® etait prevu en cas d’antecedent ou de survenue d’une alteration de la fonction renale (AFR). Afin de valider la place d’Abelcet ® , nous avons realise une evaluation retrospective sur l’annee 2002. Resultats. – Vingt et un traitements ont ete instaures chez 14 enfants avec une duree mediane de traitement de huit jours (1–48 jours). Trois types d’indications ont ete retrouvees : antecedent d’AFR (10 episodes : groupe A), survenue d’une AFR sous Ampho B conventionnelle (7 episodes : groupe B), âge inferieur a un an (3 episodes). 81 % des episodes etaient donc traites selon l’arbre decisionnel. La tolerance clinique a ete bonne dans 90 % des cas, avec une premedication dans la moitie des cas. L’etude de la fonction renale a permis d’observer une bonne tolerance renale pour 6/9 episodes evaluables dans le groupe A, trois resolutions et deux stabilisations de l’atteinte renale pour les cinq episodes evaluables du groupe B. Un delai de sept a dix jours de traitement par Abelcet ® etait necessaire pour obtenir la normalisation de la fonction renale. Conclusion. – Cette etude confirme l’interet d’Abelcet ® dans le traitement empirique des infections fongiques chez les enfants neutropeniques febriles en particulier chez les enfants ayant des antecedents d’AFR lies ou non a l’Ampho B conventionnelle.

Vanadium complexes have been encapsulated in inorganic (based on hydrolysis/condensation of tetramethylorthosilicate - TMOS) and hybrid matrices (TMOS plus a co-condensation agent) using the sol-gel method. The resulting solids were tested in the epoxidation of allylic alcohols in the presence of tert-butyl hydroperoxide (TBHP) as the oxidant agent at 70 ºC. When the catalyst was based on [VO(salen)], the hybrid matrix led to higher initial turnover frequencies than the inorganic one for all tested alcohols (trans-3-phenyl-2-methyl-2-propen-1-ol, trans-2-hexen-1-ol, cis-2-hexen-1-ol, 1-octen-3-ol), which might be related to its higher pore diameter. Although no vanadium leaching was observed during the catalytic reactions, recycling experiments with the hybrid catalyst and trans-2-hexen-1-ol showed that some loss of vanadium took place at every Soxhlet washing (performed after every run, using CH2Cl2): a total of 1.5 wt.% after three reactions. In four successive runs, keeping the initial molar ratios, conversions decreased from 100% to 85%, 65% and 40% (in 5h). Complexos de vanádio foram encapsulados em matrizes inorgânicas (baseadas na hidrólise/condensação de tetrametilortossilicato - TMOS) e híbridas (TMOS e um agente de co-condensação) pelo método sol-gel. Os sólidos resultantes foram testados na epoxidação de álcoois alílicos na presença de hidroperóxido de terc-butila (TBHP) como agente oxidante, a 70 ºC. Para o catalisador baseado em [VO(salen)], a matriz híbrida levou a maiores freqüências de turnover iniciais do que a matriz inorgânica para todos os álcoois testados (trans-3-fenil-2-metil-2-propen-1-ol, trans-2-hexen-1-ol, cis-2-hexen-1-ol, 1-octen-3-ol), o que pode estar relacionado com seu maior diâmetro de poros. Embora não tenha sido observada lixiviação de vanádio nas reações catalíticas, os experimentos de reciclagem com o catalisador híbrido e trans-2-hexen-1-ol mostraram perda de vanádio em cada lavagem com Soxhlet (efetuada após cada corrida, usando CH2Cl2), totalizando 1,5% em massa após 3 reações. Em 4 corridas sucessivas, mantendo as relações molares iniciais, as conversões decresceram de 100% a 85%, 65% e 40% (em 5h).

Resume But. – Evaluer l’efficacite d’un traitement par vincristine d’hemangiomes graves, compliques et corticoresistants. Patients et methodes. – Neuf nourrissons, huit filles et un garcon, atteints d’hemangiomes compliques ont recu un traitement par vincristine (VCR). Six enfants avaient une atteinte cervicofaciale segmentaire, severe et diffuse (3/6 avec atteinte laryngee et 2/6 tracheale obstructive, et 5/6 avec envahissement palpebral et orbitaire) ; un enfant avait des hemangiomes miliaires cutanes tres necrotiques et hemorragiques et une atteinte hepatique et renale ; deux autres avaient une hemangiomatose hepatique avec defaillance cardiaque. La resistance a des doses elevees de corticosteroides donnees au prealable durant des semaines ou mois etait notee sept fois, dont une fois avec un echappement a un traitement par corticoides puis par interferon α 2b pendant cinq mois. Deux enfants ont recu d’emblee la VCR. La dose etait de 1 mg/m 2 par voie intraveineuse pour chaque injection. Resultats. – Les injections, hebdomadaires au debut, etaient ensuite espacees selon la reponse : cinq a 25 injections (moyenne = 16) ont ete administrees, durant un mois et demi a huit mois (moyenne = 5 1/2 mois). L’efficacite a ete nette apres un mois de traitement dans sept cas, reelle mais plus lente et progressive dans les deux autres cas. Des effets secondaires transitoires moderes ont ete notes chez quatre patients. Discussion. – Les corticosteroides sont consideres comme le traitement de premiere intention. Mais la reponse therapeutique est tres inconstante ou transitoire avec rebond dans les formes graves. En cas d’echec des corticoides, le traitement par interferon α 2a ou 2b a donne un taux de reponse favorable de 90 %, mais la survenue de paraplegie spastique de pathogenie inconnue, a conduit a rechercher d’autres traitements pharmacologiques. La vincristine apparait dans notre etude comme un traitement efficace des hemangiomes compliques corticoresistants.

Purpose: To clarify treatment strategy for lymphocyte-predominant Hodgkin’s lymphoma (LPHL), the French Society of Pediatric Oncology initiated a prospective, nonrandomized study in 1988. Patients received either standard treatment for Hodgkin’s lymphoma or were not treated beyond initial adenectomy. Patients and Methods: From 1988 to 1998, 27 patients were available for study. Twenty-four patients were male, and median age was 10 years (range, 4 to 16 years). Twenty-two, two, and three patients had stage I, II, and III disease, respectively. Thirteen patients (stage I, n = 11; stage III, n = 2) received no further treatment after initial surgical adenectomy (SA). Fourteen patients received combined treatment (CT; n = 10), involved-field radiotherapy alone (n = 1), or chemotherapy alone (n = 3). The two groups were comparable for clinical status, treatment, and follow-up. Results: Twenty-three of 27 patients achieved complete remission (CR). With a median follow-up time of 70 months (range, 32 to 214 months), overall survival to date is 100%, and overall event-free survival (EFS) is 69% ± 10% (SA, 42% ± 16%; CT, 90% ± 8.6%; P < .04). If we considered only the patients in CR after initial surgery (n = 12), EFS was no longer significantly different between the two groups. Patients with residual mass after initial surgery (n = 15) had worse EFS if they did not receive complementary treatment (P < .05). Conclusion: Although based on a small number of patients, our study showed that (1) no further therapy is a valid therapeutic approach in LPHL patient in CR after initial lymph node resection, and (2) complementary treatment diminishes relapse frequency but has no impact on survival.

Contexte et objectifs La base de donnees du Sniiram est un outil recemment mis a disposition des chercheurs en France. Meme si elle comporte peu de donnees medicales, cette base apporte des possibilites importantes de description des populations, des prises en charge et d’identification des parcours de soins. Elle constitue donc une opportunite de mieux identifier les parcours de fin de vie des enfants (parcours mal connus en France). L’equipe Ressources en soins palliatifs pediatriques d’Ile-de-France, PALIPED, a une mission d’integration de la demarche palliative dans la pratique de l’ensemble des professionnels de sante confrontes a la maladie grave, evolutive ou terminale en pediatrie. Pour cette equipe, la connaissance des parcours et des prises en charge est essentielle. Materiels et methodes L’analyse statistique de cette base (pour le seul Regime general, soit 85 % de la population) a ete realisee (apres obtention des accords IDS et Cnil). Elle a permis d’identifier les recours aux soins des enfants âges de 28 jours a 19 ans sur les mois precedents leur deces (a l’hopital ou a domicile), en Ile-de-France, en 2012 et 2013. Differents recodages des donnees medico-administratives ont ete necessaires. Resultats La population d’analyse est constituee de 1884 enfants. Les circonstances des deces ont ete identifiees dans 95,3 % des cas ( n = 1795) ; 36,1 % des deces non traumatiques ( n = 1709) relevaient de conditions chroniques complexes (CCC). Parmi ces CCC, les affections onco-immuno-hematologiques (37 %) et les atteintes neuromusculaires (21,7 %) etaient les plus frequentes ; 82,7 % des enfants sont decedes a l’hopital. Les enfants ont, en moyenne, passe un tiers de leur dernier trimestre de vie en hospitalisation avec des variations notables selon la pathologie sous-jacente. La duree moyenne du dernier sejour hospitalier a ete de 25,6 jours ; 41,5 % des enfants decedes de CCC sont passes au moins une fois par les urgences au cours des trois derniers mois de vie (13,8 % plusieurs fois). Conclusions Les bases de donnees de l’assurance maladie comportent des informations qui ont permis de decrire la population ciblee et de documenter les trajectoires de prise en charge des enfants susceptibles de beneficier de soins palliatifs de fin de vie, a une echelle populationnelle c’est-a-dire sur l’ensemble des enfants d’un territoire regional. L’analyse de ces bases represente une opportunite pour des equipes regionales de soins palliatifs pediatriques de mieux comprendre les prises en charge actuelles et de proposer des axes d’amelioration organisationnelle.

Elongation factor 3 (EF-3) is an ATPase essential for polypeptide chain synthesis in a variety of yeasts and fungi. We used limited proteolysis to study the organization of the subdomains of EF-3. Trypsinolysis of EF-3 at 30 °C resulted in the formation of three fragments with estimated molecular masses of 90, 70, and 50 kDa. Yeast ribosomes protected EF-3 and the large fragments from further degradation. ATP exposed a new tryptic cleavage site and stabilized the 70- and 50-kDa fragments. The conformation of EF-3 as measured by fluorescence spectroscopy did not change upon ATP binding. Poly(G) stimulated proteolysis and quenched the intrinsic fluorescence of EF-3. Using gel mobility shift, we demonstrated a direct interaction between EF-3 and tRNA. Neither tRNA nor rRNA altered the tryptic cleavage pattern. The proteolytic products were sequenced by mass spectrometric analysis. EF-3 is blocked NH2-terminally by an acetylated serine. The 90-, 70-, and 50-kDa fragments are also blocked NH2-terminally, confirming their origin. The 50-kDa fragment (Ser2-Lys443) is the most stable domain in EF-3 with no known function. The 70-kDa fragment (Ser2-Lys668) containing the first nucleotide-binding sequence motif forms the core ATP binding subdomain within the 90-kDa domain. The primary ribosome binding site is located near the loosely structured carboxyl-terminal end.

Objectifs Des offres de soins alternatives aux services d’urgences ont ete creees comme les maisons medicales de garde. Aux urgences pediatriques du CHIPS, environ 45 % des patients sont reorientes vers la MMG pediatrique (MMGP) sur les horaires de la PDS. Nous avons evalue la satisfaction des parents ayant eu recours a ce dispositif innovant, par un questionnaire distribue a l’ensemble des patients pris en charge a la MMGP. Materiels et methodes Apres evaluation par l’infirmiere d’organisation de l’accueil (IOA), l’enfant est adresse sur le site, a la consultation d’un medecin liberal participant au dispositif dans un partenariat ville-hopital efficient. L’etude s’est deroulee du 15/09 au 31/10/2014 au CHIPS. Cent quarante-six questionnaires ont pu etre analyses (27 %). Resultats principaux Il ressort que 92,9 % des parents sont satisfaits par l’organisation et 85,6 % declarent etre rassures par l’evaluation de l’IOA. Dans 98,3 % des cas, la consultation repond a leurs attentes et 97,9 % consulteraient de nouveau a la MMGP si besoin. Conclusion La satisfaction importante des parents atteste de l’efficacite du dispositif de la MMGP apportant une reponse adaptee a la demande de consultations sans rendez-vous responsables de l’engorgement des urgences pediatriques sur la PDS.

Our objective was to investigate the occurrence of sleep-related breathing disturbances in a large cohort of school-aged children in Southern Italy, and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways.A two-phase cross-sectional study was conducted with children from schools in Turi, Italy.A screening phase aimed to identify symptomatic children and clinical data from a cohort of 495 children by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders and clinical analysis of oral status were performed. According to the answers, children were classified into 3 groups: habitual snorers, occasional snorers, and non-snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with oxygen desaturation index (ODI)2 were considered for nocturnal polygraphic monitoring (NPM). Children with apnoea/ hypopnea index (AHI)3 received a diagnosis of obstructive sleep apnoea syndrome (OSAS). Moreover, a complete oral examination was performed.A total of 436 questionnaires (response rate: 88.08%) were returned and scored (202 M, 234 F; Mean age ± Standard deviation: 6.2 ± 1.8); 18 children (4%) were identified as habitual snorers, 140 children (32%) were identified as occasional snorers, and 278 children (64%) were identified as non-snorers. The percentage of female children who were habitual snorers was higher than the percentage of male children (4.7% vs 3.6%). Habitual snorers had significantly more nighttime symptoms. OSAS was diagnosed in 2 children by NPM. A statistically significant association between snoring, cross-bite, open-bite and increased over-jet was found.Habitual snoring and OSAS are significant problems for children and may be associated with diurnal symptoms. The presence of malocclusion increases the likelihood of sleep-related breathing disturbances.

In order to optimise the use of new forms of Amphotericine B (Ampho B), a decisional tree was created at the end of 2001 in the paediatric hemato-oncology unit for the empirical antifungal treatment in febrile neutropenic children: the standard remained conventional Ampho B and Abelcet was proposed in case of antecedent or occurrence of a deterioration of the renal function (DRF). In order to validate the place of Abelcet we initiated a retrospective study over year 2002.21 treatments were begun in 14 children for a median duration of 8 days (1-48 days). Three kind of indications were found: DRF antecedent (10 episodes: A group), DRF occurrence during a treatment with conventional Ampho B (7 episodes: B group), age lower than 1 year (3 episodes). 81% of the children were thus treated according to the decisional tree. The clinical tolerance was good in 90% of the cases, with a premedication in half of the cases. The study of the renal function showed a good renal tolerance for 6 episodes out of 9 evaluable in A group, 3 resolutions and 2 stabilisation of the renal failure for the 5 evaluable episodes of the B group. Seven to ten days of treatment by Abelcet were necessary to obtain the renal failure resolved.This study confirms the interest of Abelcet in the empirical antifungal treatment in febrile neutropenic children and specially in children having antecedents of DRF related or not to a treatment with conventional Ampho B.

Incidence of severe candidal infections is rapidly increasing since 15 years and is becoming a major concern in onco-hematology practice, especially due to its poor prognosis in neutropenic patients. Diagnosis of candidemia is suspected in case of persistent fever resistant to a large antibiotherapy and requires to search for secondary locations as cutaneous and hepatosplenic candidal infection. Improvement of yeasts detection in blood culture bottles with specific medium is now helpful but use of specific immunoserodiagnosis or PCR methods is at this point unuseful. Fluconazole and Amphotericine B remain the recommended treatments for candidemia. Indications for "new antifongal drugs" are still limited regarding their high cost and the limited clinical studies.

To evaluate the efficacy of vincristine treatment for function- and life-threatening hemangiomas.Nine infants, eight girls and one boy, received vincristine treatment (VCR) for endangering hemangiomas. In six cases, the hemangiomas involved head and neck in a segmental unilateral or bilateral distribution (3/6 also had laryngeal and 2/6 tracheal location causing respiratory distress, 5/6 had eyelid and orbital involvement); one infant had disseminated neonatal hemangiomatosis (skin, liver, kidney); two infants had liver hemangiomas with cardiac failure. VCR was prescribed after failure of high-dosage corticosteroid treatment in six, and of both corticosteroids and interferon alpha 2b (5 months) in one; two infants received VCR as first line treatment.A dosage of 1 mg/m(2) IV injection was delivered, with weekly injections first, and then tapering, increasing the interval between injections, depending on the clinical response. The nine infants received from 5 to 25 injections (average: 16), for a length of treatment of 1.5-8 months (average: 5.5 months). In seven patients a clear clinical response was observed at the end of the first month of treatment, while a slow protracted response was noted in two. Transient mild side effects were present in four patients.Corticosteroid treatment, although a worldwide recognized treatment of problematic hemangiomas, cannot always control the growth of alarming hemangiomas. Interferon alpha 2a and 2b have proven a 90% effectiveness: treatment for cortico-resistant, function- and life-threatening, hemangiomas.

A recent increase in the incidence of beta-lactamase-producing aerobic and anaerobic bacteria in upper respiratory tract infection has been associated with an increase in the failure rate of penicillin treatment of these infections. Experimental evidence for this correlation has been reported by many investigators, who have described the sheltering of susceptible pathogens by beta-lactamase-producing organisms as 'indirect pathogenicity'. The organisms implicated in mixed infections that cooperate are Staphylococcus aureus, Haemophilus influenzae, Branhamella (Moraxella) catarrhalis and Bacteroides spp., which are pathogenic and also normal oropharyngeal inhabitants. Since these bacteria exhibit both direct and indirect pathogenicity, effective treatment requires administration of antimicrobial therapy active against all microorganisms present in mixed infection. Oral third generation cephalosporins, which are resistant to enzymatic hydrolysis, seem to be suitable initial therapy.

A storage rack system to be installed on a floor has a plurality of columns, is more flexible in a down aisle dimension than it is in a cross aisle dimension, and has at least a first column and a second column adjacent one another in the cross aisle dimension. A storage rack vibration isolator for use with this storage rack system comprises at least one seismic vibration absorption and dissipation structure constructed to be located primarily between the first and second columns to reduce the storage rack system's natural frequency in at least the cross aisle dimension. The seismic vibration absorption and dissipation structure includes a first member connectable 'to the storage rack system and a second member connectable to the floor. At least one column support assembly is mountable to at least the first and second columns to enable them to move with respect to the floor. A structure limits the movement of the first and second columns to substantially the cross aisle dimension.

Enterococci with high-level resistance to aminoglycosides have been frequently isolated from clinical specimens in the last few years. It is well known that this resistance is linked to a lack of synergism of the beta-lactam/aminoglycoside combination used in the treatment of severe infections. Many authors have reported an increasing incidence of isolation of enterococci highly resistant to gentamicin. In order to overcome the failure of the currently used antimicrobial combinations, in this work the degree of activity of ciprofloxacin plus, respectively, the glycopeptides vancomycin and teicoplanin, and also the combination teicoplanin/netilmicin, was evaluated. The results obtained with ciprofloxacin/teicoplanin and teicoplanin/netilmicin combinations show a good percentage of synergy (about 70-80%) with respect to the combination of ciprofloxacin plus vancomycin. The results are encouraging also in the highly resistant strains.

The authors studied the in vitro antimicrobial activity of imipenem towards 355 gram-negative bacterial strains, taking into particular consideration unusual or dangerous species. The study was carried out on a comparative basis with piperacillin, cefotaxime, ceftazidime and gentamicin. Ninety percent of the fermentative gram-negative strains were inhibited at concentrations less than or equal to 2 mg/l. Imipenem inhibited 100% of strains of Alcaligenes faecalis, Alcaligenes denitrificans, Flavobacterium odoratum, Acinetobacter lwoffii, Acinetobacter anitratum, Pseudomonas fluorescens, Pseudomonas stutzeri and 90% of strains of Pseudomonas aeruginosa and Pseudomonas putida. The excellent bactericidal activity of imipenem was indicated by its minimum bactericidal concentrations equal to or slightly greater than its minimum inhibitory concentrations (MIC). As far as the other parameters were concerned (influence of the dimensions of inoculum and culture medium on MICs), imipenem confirmed its excellent in vitro microbiologic characteristics.

Ciprofloxacin's activity against 233 clinically isolated strains of both fermentative and non-fermentative bacilli was tested. In particular the authors studied the sensitivity of aminoglycoside-resistant gram-negative bacilli to ciprofloxacin. The results showed that all fermentative gram-negative bacteria were sensitive to ciprofloxacin (MICs range less than or equal to 0.02 - 1.56 mg/l). Among the non-fermentative bacilli, Pseudomonas were generally susceptible to ciprofloxacin (MIC90 less than or equal to 1.56 mg/l) except for P. cepacia and P. fluorescens (MIC90 less than or equal to 3.12 mg/l). The best antibiotic activity was shown against Moraxella, A. xylosoxidans and A. hydrophila (MICs less than or equal to 0.09 mg/l). MICs for Acinetobacter and A. faecalis were less than or equal to 1.56 mg/l while Flavobacterium were more resistant (range 1.56-3.12 mg/l). Furthermore, ciprofloxacin showed good activity against 44 aminoglycoside-resistant isolates, showing a very low (13%) incidence of resistance.

Previous electrophoretic analysis has indicated that keratins 13 and 16 (K13 and K16) are not present in normal human breast epithelium, but K16 is expressed in some ductal carcinomas (Moll et al., Cell, 31: 11-24, 1982). K16 may thus represent a marker for identifying a subset of ductal carcinomas and for distinguishing such tumor cells from normal cells. To explore this possibility further, we have used the monoclonal antibody Ks8.12, reportedly specific for K13 and K16 (Huszar et al., Differentiation, 31: 141-153, 1986), to examine keratin expression in human breast tissues. In immunocytochemistry the antibody reacted with epithelial cells of all normal samples, hyperplasias, and fibroadenomas. The staining was moderate to strong and always heterogeneous, involving most but not all luminal cells of ducts and acini. Myoepithelial cells were never stained. Of twenty-one ductal carcinomas examined, 90% gave a very weak or no reaction. The remaining 10% of cancers exhibited moderate to strong staining in about 50% of tumor cells. Cytoskeletal polypeptides extracted from the tissues and separated by polyacrylamide gel electrophoresis were analyzed by Western blotting to identify the polypeptides recognized by Ks8.12. In samples from normal tissue and a fibroadenoma, the antibody recognized a major Mr 48,000 component, a size appropriate for K16. In extracts from a hyperplasia and two of four carcinomas, the antibody detected a Mr 54,000 polypeptide, as well as a Mr 48,000 band, properties consistent with K13 and K16, respectively. Our results provide the first evidence indicating that K16 is present in normal as well as abnormal human breast epithelium. In addition, the data suggest that K13 may be expressed in some benign lesions and ductal carcinomas of the breast. Accordingly, Ks8.12 may prove to be useful for subclassifying ductal carcinomas and for discriminating between normal and certain benign and malignant disorders of human mammary epithelium.

22 Haemophilus strains, isolated from lower respiratory tract infections, were tested for their susceptibility to ampicillin and amoxicillin using both MIC and Kirby Bauer methods. Ampicillin and amoxicillin resistance tested with MIC method was not exactly correlated with Kirby Bauer standard (10 mcg ampicillin and 25 mcg amoxicillin disks) inhibition zones method (error rate: 52.6%). Yet using a 2 mcg ampicillin and 5 mcg amoxicillin handmade disk, error range decreased to 14.8%. Beta-lactamase production on whole cells were for 6 strains of the 22 tested. After breaking the cell wall, 19 on the 22 strains were beta-lactamase producers, confirming the results obtained with the MIC method.

Recent data report increasing Haemophilus influenzae ampicillin- and chloramphenicol-resistant strains. Authors report the results of one year investigation in Sicily. In 281 clinical specimens tested, Haemophilus influenzae has been isolated in 60 cases. From antibiotic susceptibility tests it can be observed that 58 strains show ampicillin-resistance.