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The historical view of the renin-angiotensin system (RAS) is that of an endocrine hypertensive system that is controlled by renin and mediated via the action of angiotensin II on its type 1 receptor. Numerous new angiotensins (Ang) and receptors have been described, the majority being hypotensive and natriuretic, namely Ang-(1-7) and its receptor rMas. Renin and its precursor (pro-renin) can bind their common receptor. In addition to the production of Ang II, this receptor triggers intracellular effects. Given the control of renin production by intracellular calcium, calcium homeostasis is of particular importance. Ang-(1-12), which is not controlled by renin, is converted to several different angiotensin peptides and is a new pathway of the RAS. Local RAS enzymes produce or transform the different hyper- or hypotensive angiotensin within vessels and organs, but also in blood through circulating forms of the enzymes. In the kidney, a powerful local vascular RAS allows for the independence of renal vascularization from systemic control. Moreover, the kidney also contains an independent urinary RAS, which counterbalances the systemic RAS and coordinates proximal and distal sodium reabsorption. The systemic and local effects of renal RAS cannot be analyzed without taking into account the antagonistic effect of renalase. Our concept of RAS needs to evolve to take into account its dual potentiality (hyper- or hypotensive). Keywords Blood arterial pressure * Kidney * Renin * Prorenin * Angiotensin II * Angiotensin-(1-7) Natriuresis * Vascular tone, Introduction At the end of the 19th century, Tigerstedt and Bergman observed that an extract of a rabbit kidney injected into another animal led to increased arterial blood pressure. They [...]

Aim: This study examined the influence of different human milk fortifiers on biomarkers of gastrointestinal immaturity and inflammation in preterm infants.Methods: We report secondary outcomes from a controlled, double-blind, randomised, parallel group study conducted from 2011 to 2014 in neonatal intensive care units at 11 metropolitan hospitals in France, Belgium, Germany, Switzerland and Italy. Preterm infants born at up to 32 weeks or weighing up to 1500 g were randomised to a new powdered human milk fortifier (n = 77) or a control fortifier (n = 76) for a minimum of 21 days. We analysed faecal markers of gut inflammation, namely alpha-1 antitrypsin and calprotectin, and maturity, namely elastase-1.Results: Faecal alpha-1 antitrypsin was slightly lower in the new than control fortifier group after 21 days of full enteral feeding, with a geometric mean and standard deviation of 1.52 ± 1.32 vs 1.82 ± 1.44 mg/g stools (P = .01). There was no significant difference in faecal calprotectin (median [Q1-Q3] of 296 [136-565] μg/g stools in both groups combined at study day 21). Faecal elastase-1 was lower in the new fortifier than control fortifier group (202.5 ± 1.6 vs 257.7 ± 1.5 μg/g stools, P = .016).Conclusion: Mean values for each parameter were within the ranges in healthy term infants, indicating favourable markers of gastrointestinal status in both groups. In addition, for faecal calprotectin, the relatively high concentration observed in preterm infants fed fortified human milk suggests that the threshold level for detecting necrotising enterocolitis should be revised. [ABSTRACT FROM AUTHOR]

Background: Transcutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy., Objectives: To evaluate TcB diagnostic accuracy for very preterm neonates., Methods: Total serum bilirubin (TSB) and TcB measurements were performed prospectively in a multicenter sample of newborns <30 weeks of gestational age (GA). TcB sensitivity, specificity, predictive values, and likelihood ratios for the detection of neonates requiring phototherapy were calculated over the first 15 days of life, with or without phototherapy, with the expectation of achieving a detection rate of hyperbilirubinemia of over 95%. The potential influence of neonatal characteristics on the discordance between TcB and TSB in very preterm newborns was analyzed using multivariate multilevel logistic regression analyses., Results: Altogether, 481 measurements were analyzed in 167 preterm patients. Mean GA was 27.6 ± 1.6 weeks. The rates of newborns requiring phototherapy were 52% in the first 3 days, 16% from the 4th to the 7th day, and 2% during the second week. Diagnostic performance was similar among babies with or without phototherapy. TcB sensitivity decreased over time from 100% (93.9-100.0) to 50% (1.3-98.7). Specificity showed an inverse evolution from 14.8% (7.0-26.2) to 80.7% (72.2-89.2). The best performance was that of negative predictive values which varied from 95.5 to 100.0. False negatives were rare throughout the study (0.8% of measurements). In a multivariate analysis, the only factor significantly influencing discordance between TcB and TSB was postnatal age. We did not find any impact of GA and skin color., Conclusion: Among very preterm babies, TcB measurements might be useful for screening for neonatal jaundice in the first 2 weeks of life. In case of a TcB value below the phototherapy threshold, invasive TSB quantification could be unnecessary, with potential avoidance of blood drawing., (© 2016 S. Karger AG, Basel.)

A too-long anterior process of the calcaneus is one of the causes of repeated sprained ankles or painful feet in the child or adolescent that is often ignored and misdiagnosed. Among 31 cases of adolescents having consulted for these symptoms, a too-long anterior process of the calcaneus was discovered on radiographs, and explored in detail with a computed tomography scan or an MRI. The decision for surgical resection was taken considering the discomfort expressed by these children. The intraoperative observation corroborated the radiological findings and permitted a better understanding of the mechanisms responsible for the pain, the repeated sprained ankles and other instabilities. The surgical resection, which is a simple procedure, gave very good results. One must nevertheless be aware of the possible secondary lesions because of repeated sprained ankles: breakage of the lateral ligaments of the ankle and external malleolus nonunion or talus osteochondritis, which can compromise the operation's result, if they are not treated simultaneously.

Screwing of slipped capital femoral epiphysis must prevent its further slipping by prematurely fusing the physis. Whichever material is used, persistent femoral growth has been described, thereby increasing the risk of bone deformation. The objective of this study is to evaluate the residual growth after screwing of slipped capital femoral epiphysis. This study concerned 26 children, among which 13 children have been included, and 13 children excluded because of an incomplete clinical or radiological follow-up, or treatment by another technique. The pathological hip was treated with one screw (in eight cases) or two screws (in five cases). The controlateral hip was fixed with one screw. The different measures were taken on anteroposterior radiographs done the days after surgery, and on the first radiograph on which the growth plate had fused. Growth plate fusion was obtained after an average of 20 months. Each patient had presented a residual growth of at least one hip, thus 85% of the 26 fixed screws. Among the four hips, which did not grow, three were pathological, and were fixed by one screw (in one case) or two screws (in two cases), in a central or medial position. There was not any statistical relationship between the growth persistence and the other studied criteria. These results, proving the growth persistency, suggest that the follow-up must be extremely careful, as the number of threads crossing the growth plate will decrease, with the risk of loss of mechanical stability and reappearance of the femoral epiphysis slippage.