Functional abdominal pain disorders and patient- and parent- reported outcomes in children with inflammatory bowel disease in remission

BACKGROUND: Chronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission. AIMS: To assess the prevalence and factors associated with Functional Abdominal Pain Disorders among IBD children in remission (IBD-FAPD). METHODS: Patients with IBD for > 1 year, in clinical remission for ≥ 3 months were recruited from a National IBD network. IBD-FAPDs were assessed using the Rome III questionnaire criteria. Patient- or parent- reported outcomes were assessed. RESULTS: Among 102 included patients, 57 (56%) were boys, mean age (DS) was 15.0 (± 2.0) years and 75 (74%) had Crohn's disease. Twenty-two patients (22%) had at least one Functional Gastrointestinal Disorder among which 17 had at least one IBD-FAPD. Past severity of disease or treatments received and level of remission were not significantly associated with IBD-FAPD. Patients with IBD-FAPD reported more fatigue (peds-FACIT-F: 35.9 ± 9.8 vs. 43.0 ± 6.9, p = 0.01) and a lower HR-QoL (IMPACT III: 76.5 ± 9.6 vs. 81.6 ± 9.2, p = 0.04) than patients without FAPD, and their parents had higher levels of State and Trait anxiety than the other parents. CONCLUSIONS: Prevalence of IBD-FAPD was 17%. IBD-FAPD was not associated with past severity of disease, but with fatigue and lower HR-QoL

[email protected]: Using the Tech Start-Up Concept to Train, Engage, and Inform Students

Undergraduate and graduate students were enrolled in an upper-division online experiential learning course organized as a technology company start up at a public university in the US. Students participated in an academic department’s social media team, publishing a weekly newsletter and producing and curating content for multiple social media outlets designed for public and university audiences, a website for the department’s students, and a career portal. Responses to survey questions provided support for Experiential Learning Theory’s cyclical learning model. In addition, students viewed the entrepreneurial approach to the team as both liberating and challenging as they engaged with each other and the communities in which they were embedded. Although communication with their student supervisors, faculty supervisor, and other team members contributed to their positive evaluation of their learning experience, the tech start-up approach of task autonomy was the most important factor. Students came to recognize and embrace the multifaceted nature and ubiquity of learning opportunities. In addition, they developed key transferable skills, including effective writing, social media literacy, critical thinking, teamwork, problem solving, decision making, self-management, and leadershi

A critical examination of Blackboard’s e-learning environment

Blackboard’s e-learning system dominates the online learning software market. In this essay I critically examine the structure of Blackboard’s two online learning delivery systems, Blackboard 8.0 and Blackboard CE6. I identify ways in which the platforms both constrain and facilitate instructor-student and student-student interaction. I addition, I delineate features that sustain and challenge traditional power relationships in the classroom. I conclude with implications for online pedagogy and practical applications for instructors and students

Parenteral nutrition with fish oil supplements is safe and seems to be effective in severe preterm neonates with respiratory distress syndrome

International audienc

Managing Privacy Boundaries

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Comparison and validation of accelerometer wear time and non-wear time algorithms for assessing physical activity levels in children and adolescents

International audienceBACKGROUND:Accelerometers are widely used to measure sedentary time and daily physical activity (PA). However, data collection and processing criteria, such as non-wear time rules might affect the assessment of total PA and sedentary time and the associations with health variables. The study aimed to investigate whether the choice of different non-wear time definitions would affect the outcomes of PA levels in youth.METHODS:Seventy-seven healthy youngsters (44 boys), aged 10-17 years, wore an accelerometer and kept a non-wear log diary during 4 consecutives days. We compared 7 published algorithms (10, 15, 20, 30, 60 min of continuous zeros, Choi, and Troiano algorithms). Agreements of each algorithm with the log diary method were assessed using Bland-Altmans plots and by calculating the concordance correlation coefficient for repeated measures.RESULTS:Variations in time spent in sedentary and moderate to vigorous PA (MVPA) were 30 and 3.7%. Compared with the log diary method, greater discrepancies were found for the algorithm 10 min (p < 0.001). For the time assessed in sedentary, the agreement with diary was excellent for the 4 algorithms (Choi, r = 0.79; Troiano, r = 0.81; 30 min, r = 0.79; 60 min, r = 0.81). Concordance for each method was excellent for the assessment of time spent in MVPA (> 0.86). The agreement for the wear time assessment was excellent for 5 algorithms (Choi r = 0.79; Troiano r = 0.79; 20 min r = 0.77; 30 min r = 0.80; 60 min r = 0.80).CONCLUSIONS:The choice of non-wear time rules may considerably affect the sedentary time assessment in youth. Using of appropriate data reduction decision in youth is needed to limit differences in associations between health outcomes and sedentary behaviors and may improve comparability for future studies. Based on our results, we recommend the use of the algorithm of 30 min of continuous zeros for defining non-wear time to improve the accuracy in assessing PA levels in youth.TRIAL REGISTRATION:NCT02844101 (retrospectively registered at July 13th 2016)

Factors associated with success and failure of weaning children from prolonged enteral nutrition: a retrospective cohort study

International audienceThe aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure.This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for ≥6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis.Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 ± 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio = 5.7, 95% confidence interval [1.2-27.0], P = 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio = 6.2, 95% confidence interval [0.05-0.5], P = 0.005).Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered

Doubling diet fat on sugar ratio in children with mitochondrial OXPHOS disorders: Effects of a randomized trial on resting energy expenditure, diet induced thermogenesis and body composition

International audienceBackground & aims: Mitochondrial OXPHOS disorders (MODs) affect one or several complexes of respiratory chain oxidative phosphorylation. An increased fat/low-carbohydrate ratio of the diet was recommended for treating MODs without, however, evaluating its potential benefits through changes in the respective contributions of cell pathways (glycolysis, fatty acid oxidation) initiating energy production. Therefore, the objective of the present work was to compare Resting Energy Expenditure (REE) under basal diet (BD) and challenging diet (CD) in which fat on sugar content ratio was doubled. Diet-induced thermogenesis (DIT) and body compositions were also compared. Energetic vs regulatory aspects of increasing fat contribution to total nutritional energy input were essentially addressed through measures primarily aiming at modifying total fat amounts and not the types of fats in designed diets.Methods: In this randomized cross-over study, BD contained 10% proteins/30% lipids/60% carbohydrates (fat on sugar ratio = 0.5) and was the imposed diet at baseline. CD contained 10% proteins/45% lipids/45% carbohydrates (fat on sugar ratio = 1). Main and second evaluation criteria measured by indirect calorimetry (QUARK RMR®, Cosmed, Pavona; Italy) were REE and DIT, respectively. Thirty four MOD patients were included; 22 (mean age 13.2 ± 4.7 years, 50% female; BMI 16.9 ± 4.2 kg/m2) were evaluated for REE, and 12 (mean age 13.8 ± 4.8 years, 60% female; BMI 17.4 ± 4.6 kg/m2) also for DIT. OXPHOS complex deficiency repartition in 22 analysed patients was 55% for complex I, 9% for complex III, 27% for complex IV and 9% for other proteins.Results: Neither carry-over nor period effects were detected (p = 0.878; ANOVA for repeated measures). REE was similar between BD vs CD (1148.8 ± 301.7 vs 1156.1 ± 278.8 kcal/day; p = 0.942) as well as DIT (peak DIT 260 vs 265 kcal/day; p = 0.842) and body composition (21.9 ± 13.0 vs 21.6 ± 13.3% of fat mass; p = 0.810).Conclusion: Doubling diet fat on sugar ratio does not appear to improve, per se, energetic status and body composition of patients with MODs

Frequency of abnormal glucose tolerance test suggestive of dumping syndrome following oesophageal atresia repair

International audienceDumping syndrome (DS) is mostly described as a complication of antireflux surgery in oesophageal atresia (OA) but we previously reported 2 cases of DS before any other surgery in infants operated at birth for OA. The objectives of the present study were to assess the prevalence of abnormal oral glucose tolerance test (OGTT) at 3 months of age in infants operated at birth with type C OA, to describe symptoms and clinical features, and to assess risk factors in infants presenting with abnormal OGTT suggestive of DS.A prospective case series study including infants with type C OA without fundoplication, born between 2013 and 2016 in 8 centres was conducted. An OGTT was performed between 2.5 and 3.5 months. Abnormal OGTT was defined as early hyperglycaemia (>1.8 g/L until 30 minutes; >1.7 g/L between 30 minutes and 2 hours; and >1.4 g/L between 2 and 3 hours) and/or late hypoglycaemia (<0.6 g/L after 2 hours).Eleven of the 38 OGTT (29%) showed abnormalities. None of the patients' demographics (birth weight, sex, prematurity, associated malformation, use of enteral nutrition) or conditions of the surgery tested was associated with abnormal OGTT. No clinical sign was specific for it.DS should be considered in every infant operated at birth for OA presenting with digestive symptoms. No risk factor was predictive for abnormal OGTT. An OGTT to screen for potential DS around 3 months of age should be considered in infants born with EA.DUMPING NCT02525705

Alteration of cathepsin D trafficking induced by hypoxia and extracellular acidification in MCF-7 breast cancer cells

International audienceThe microenvironment that surrounds tumor cells is characterized by hypoxic conditions and extracellular acidity. These hostile conditions induce crucial changes in cell behavior and can promote the secretion of many soluble factors such as growth factors, cytokines and enzymes. The lysosomal aspartyl-endopeptidase cathepsin D (CD) is a marker of poor prognosis in breast cancer and is associated with a metastatic risk. In this study, the transport of CD was investigated in a model of breast cancer cells line (MCF-7) cultivated under hypoxia and acidification of media. CD secretion was assessed using Western blot analysis and protease activity was measured in conditioned culture media. We demonstrate that cultured MCF-7 cells secrete an active 52 kDa pCD precursor and report that under hypoxia there was an increased amount of pCD secreted. More surprisingly, extracellular acidification (pH 6 and 5.6) induced the secretion of the fully-mature and active (34 kDa + 14 kDa) double chain CD. Our findings reflect the fact that chemical anomalies influence the secretion path of CD in a breast cancer cell model, resulting in altered trafficking of the mature form. This important result may provide new arguments in favor of the role of extracellular CD in the degradation of the matrix proteins that constitute the breast tumor microenvironment