A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.</p> <p>Methods</p> <p>Children aged 2–18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm³). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.</p> <p>Results</p> <p>124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).</p> <p>Conclusion</p> <p>Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.</p> <p>Trial Registration</p> <p>The trial was registered with Clinical Trials.gov (number NCT00775112).</p

Evolution of urine metabolomic profiles in newborns

International audienceMetabolomics provides untargeted identification of all detectable low molecular-weight molecules by profiling without a priori the metabolic signatures of biological samples in connection to pathophysiological events. The goal of metabolomic studies is to identify relevant biomarkers or composite metabolic patterns associated with particular disease status. Urine is particularly suited for metabolomic analysis in newborns and children, due to its simple and non-invasive method of collection. Its biochemical composition is correlated to a number of factors such as genotype, gender, disease, nutritional state and age. The number of metabolomic studies in pediatrics is rising, but little is known concerning age-related changes in urine metabolic profiles and newborn metabolic maturation over time. The aim of this study was to investigate changes in urine metabolic profiles during the first four months of life using 1H-nuclear magneticresonance (NMR) spectroscopy combined with multivariate statistical analysis. Urine samples were collected from 91 newborns under 4 months old without nephrologic or urologic disease. The mean age was 68 days ± 24. The1H-NMR spectra were analyzed using Principal Component Analysis (PCA) and the effect of age on the urinary metabolite profile was observed even from this unsupervised analysis. Further analysis using Orthogonal Partial Least Squares (OPLS) methodology was performed and a model with good predictive power was calculated, allowing the identification of an age-related metabolic profile. We observed the most significant evolution between 2 and 3 months of life. Our results allow a deeper understanding of newborn metabolic maturation. They contribute to identifying potential confounding factors in the application of metabolomics in newborns

Evolution of urine metabolomic profiles in newborns

International audienceMetabolomics provides untargeted identification of all detectable low molecular-weight molecules by profiling without a priori the metabolic signatures of biological samples in connection to pathophysiological events. The goal of metabolomic studies is to identify relevant biomarkers or composite metabolic patterns associated with particular disease status. Urine is particularly suited for metabolomic analysis in newborns and children, due to its simple and non-invasive method of collection. Its biochemical composition is correlated to a number of factors such as genotype, gender, disease, nutritional state and age. The number of metabolomic studies in pediatrics is rising, but little is known concerning age-related changes in urine metabolic profiles and newborn metabolic maturation over time. The aim of this study was to investigate changes in urine metabolic profiles during the first four months of life using 1H-nuclear magneticresonance (NMR) spectroscopy combined with multivariate statistical analysis. Urine samples were collected from 91 newborns under 4 months old without nephrologic or urologic disease. The mean age was 68 days ± 24. The1H-NMR spectra were analyzed using Principal Component Analysis (PCA) and the effect of age on the urinary metabolite profile was observed even from this unsupervised analysis. Further analysis using Orthogonal Partial Least Squares (OPLS) methodology was performed and a model with good predictive power was calculated, allowing the identification of an age-related metabolic profile. We observed the most significant evolution between 2 and 3 months of life. Our results allow a deeper understanding of newborn metabolic maturation. They contribute to identifying potential confounding factors in the application of metabolomics in newborns

The specific salivary composition of children affected by oral disorders

The specific salivary composition of children affected by oral disorders. 10. european symposium on Saliv

Bone disease in nephropathic cystinosis is related to cystinosin-induced osteoclastic dysfunction

International audienc

Inhibition of Osteoclast Differentiation by 1.25-D and the Calcimimetic KP2326 Reveals 1.25-D Resistance in Advanced CKD

International audienceActive vitamin D analogs and calcimimetics are the main therapies used for treating secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD). Peripheral blood mononuclear cells of 19 pediatric patients with CKD1-5D and 6 healthy donors (HD) were differentiated into mature osteoclasts with receptor activator of NF-κB ligand (RANKL) and macrophage colony-stimulating factor (M-CSF). The effects of single or combined treatment with active vitamin D (1.25-D) and/or calcimimetic KP2326 were evaluated on osteoclastic differentiation and osteoclastic-mediated bone resorption. Although 1.25-D inhibited osteoclastic differentiation, a significant resistance to 1.25-D was observed when glomerular filtration rate decreased. A significant albeit less important inhibitory effect of KP2326 on osteoclastic differentiation was also found both in cells derived from HD and CKD patients, through a putative activation of the Erk pathway. This inhibitory effect was not modified by CKD stage. Combinatorial treatment with 1.25-D and KP2326 did not result in synergistic effects. Last, KP2326 significantly inhibited osteoclast-mediated bone resorption. Both 1.25-D and KP2326 inhibit osteoclastic differentiation, however, to a different extent. There is a progressive resistance to 1.25-D in advanced CKD that is not found with KP2326. KP2326 also inhibits bone resorption. Given that 1.25-D has no effect on osteoclastic resorption activity and that calcimimetics also have direct anabolic effects on osteoblasts, there is an experimental rationale that could favor the use of decreased doses of 1.25-D with low doses of calcimimetics in SHPT in dialysis to improve the underlying osteodystrophy. However, this last point deserves confirmatory clinical studies. © 2020 American Society for Bone and Mineral Research

The atypical diet of children affected by oral disorders is associated to specific salivary patterns

The atypical diet of children affected by oral disorders is associated to specific salivary patterns. 3. international conference on Food oral processing: physics, physiology and psychology of eatin

The atypical diet of children affected by oral disorders is associated to specific salivary patterns

The atypical diet of children affected by oral disorders is associated to specific salivary patterns. 3. international conference on Food oral processing: physics, physiology and psychology of eatin

Bone Disease in Nephropathic Cystinosis: Beyond Renal Osteodystrophy

International audiencePatients with chronic kidney disease (CKD) display significant mineral and bone disorders (CKD-MBD) that induce significant cardiovascular, growth and bone comorbidities. Nephropathic cystinosis is an inherited metabolic disorder caused by the lysosomal accumulation of cystine due to mutations in the CTNS gene encoding cystinosin, and leads to end-stage renal disease within the second decade. The cornerstone of management relies on cysteamine therapy to decrease lysosomal cystine accumulation in target organs. However, despite cysteamine therapy, patients display severe bone symptoms, and the concept of "cystinosis metabolic bone disease" is currently emerging. Even though its exact pathophysiology remains unclear, at least five distinct but complementary entities can explain bone impairment in addition to CKD-MBD: long-term consequences of renal Fanconi syndrome, malnutrition and copper deficiency, hormonal disturbances, myopathy, and intrinsic/iatrogenic bone defects. Direct effects of both CTNS mutation and cysteamine on osteoblasts and osteoclasts are described. Thus, the main objective of this manuscript is not only to provide a clinical update on bone disease in cystinosis, but also to summarize the current experimental evidence demonstrating a functional impairment of bone cells in this disease and to discuss new working hypotheses that deserve future research in the field