A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease

In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18-24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if "non-drug" treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children

Associations between weight change and biomarkers of cardiometabolic risk in South Asians:secondary analyses of the PODOSA trial

Background/Objectives: The association of weight changes with cardiometabolic biomarkers in South Asians has been sparsely studied. Subjects/Methods: We measured cardiometabolic biomarkers at baseline and after 3 years in the Prevention of Diabetes and Obesity in South Asians Trial. We investigated the effect of a lifestyle intervention on biomarkers in the randomized groups. In addition, treating the population as a single cohort, we estimated the association between change in weight and change in biomarkers. Results: Complete data were available at baseline and after 3 years in 151 participants. At 3 years, there was an adjusted mean reduction of 1·44 kg (95% confidence interval (95% CI): 0.18–2.71) in weight and 1.59 cm (95% CI: 0.08–3.09) in waist circumference in the intervention arm as compared with the control arm. There was no clear evidence of difference between the intervention and control arms in change of mean value of any biomarker. As a single cohort, every 1 kg weight reduction during follow-up was associated with a reduction in triglycerides (−1.3%, P=0.048), alanine aminotransferase (−2.5%, P=0.032), gamma-glutamyl transferase (−2.2%, P=0.040), leptin (−6.5%, P<0.0001), insulin (−3.7%, P=0.0005), fasting glucose (−0.8%, P=0.0071), 2-h glucose (−2.3%, P=0.0002) and Homeostatic Model Assessment of insulin resistance (HOMA-IR: −4.5%, P=0.0002). There was no evidence of associations with other lipid measures, tissue plasminogen activator, markers of inflammation or blood pressure. Conclusions: We demonstrate that modest weight decrease in SAs is associated with improvements in markers of total and ectopic fat as well as insulin resistance and glycaemia in South Asians at risk of diabetes. Future trials with more intensive weight change are needed to extend these findings

Effets de la réalimentation après le jeûne sur la morphologie et l'activité disaccharidasique de la muqueuse de l'intestin chez le rat adulte

International audienc

Steel thixoforming, influence of forming parameters on the microstructure

Forming of parts in the semi-solid state is quite a complex process, especially for high melting point alloys such as steel. A reason for this complexity is the amount of parameters involved in the process. Among these we could quote liquid fraction, shear rate, shape factor, contiguity, tool temperature, agglomeration level, heating rate, protecting gas, temperature distribution, lubricant. Of course all of these parameters don’t have the same order of importance. In this paper we show the influence of a set of chosen parameters and we highlight their effects on the microstructure and so, on the deformation behavior. The studied parameters are the heating conditions, the tool temperature, the part temperature, the thermal exchanges between the part and the dies and the forming rate

Metallurgical and mechanical analysis from thixoforging steel shape

Since always, Industry minimizes manufacturing process plan and increases mechanical behaviour. In this topic, the thixoforging process offers important perspectives especially steel thixoforging. It is on the way of industrial development between casting and forging process. Previous works have illustrated the importance many parameters such as steel grade, slide speed, slug and tool temperature on the geometry from thixoforging part and of the forming load. This paper completes the previous results. It presents an analysis from mechanical resistance of samples extracted of from thixo-extrusion parts on a high speed hydraulic press. This strength investigation is correlated with metallurgical analysis. Macrograph analyses allow identifying the material yield during the process and the different phases

Diagnostic colonoscopy

Les indications d'une coloscopie diagnostique demeurent limitées par les contraintes liées à l'exécution d'une coloscopie totale chez l'enfant: nécessité de matériel adapté, préparation colique, sédation anesthésique. Schématiquement, deux situations justifient une coloscopie: 1) les rectorragies dont les étiologies sont analysées en fonction de l'âge des enfants, 2) les maladies inflammatoires cryptogénétiques de l'intestin (MICI). Sont successivement décrits ou analysés, les lésions endoscopiques de la maladie de Crohn et de la rectocolite hémorragique, leurs traits distinctifs, les règles de dépistage des lésions dysplasiques dans les pancolites ulcéreuses, la place de l'endoscopie dans la surveillance du traitement des MICI en particulier après traitement chirurgical, les contre-indication