Food fussiness is associated with family environmental factors in 1-3-year-old children: A large-scale cross-sectional study.

The effects of environmental factors on eating behavior and food intake are not well-known during toddlerhood. This is a cross-sectional study exploring the association between family environmental factors, food fussiness and poorly diversified diet. N = 1679 healthy children aged 1-3 years were recruited by general practitioners and pediatricians. Two validated questionnaires were used: the Children's Eating Behavior Questionnaire (CEBQ), which includes a food fussiness (FF) dimension, and the Infant and Child Feeding Index (ICFI) which assesses diet diversification. Factors associated with FF and diet diversification were identified by multivariate logistic regression. Of the 1356 analyzed children, 19.5% were fussy (CEBQ-FF subscore >3). Food fussiness was significantly more common in older children (25.1% of 2-3-year-olds, versus 15.2% of 1-2-year-olds; OR = 1.7) and those conceived with medical assistance (OR = 3.2). Food fussiness was also observed more often in children exposed to distractions during meals (OR = 1.8), rewarded by parents to finish meals (OR = 3.9), free to eat at will (OR = 3.7), or who ate only occasionally with the whole family (OR = 2.0). Unsatisfactory dietary diversification (ICFI≤13.8) was observed in 21.8% of children and was not significantly associated with any variable. No association was found between eating behavior and dietary diversification level. This study showed that food mistrust tends to increase with age in 1-3-year-old children. It highlighted the influence of environmental factors on FF, including family habits during meals. Assisting parents with child food fussiness may help reduce later unhealthy dietary patterns.

Pomalidomide and dexamethasone until progression after first salvage therapy in multiple myeloma.

Lenalidomide maintenance in myeloma is well established. Nevertheless, pomalidomide could provide an alternative. Myeloma patients in first relapse, initially treated in the Intergroupe Francophone du Myélome (IFM) 2009 trial, and subsequently in the IFM 2013-01 phase 2 trial, received four cycles of salvage therapy with pomalidomide plus cyclophosphamide plus dexamethasone (PCD) with transplantation plus 2 PCD consolidation or without transplantation but with 5 PCD and for all patients pomalidomide plus dexamethasone maintenance therapy. This consisted of 28-day cycles of pomalidomide 4 mg daily on days 1-21 and dexamethasone 20 mg weekly until progression. The primary endpoint was an improved response to treatment. A total of 75/100 patients reached therapy. The median follow-up time was 73 months. The median duration of treatment was 23.7 months. One third of patients improved their response from the initiation of treatment: 11%, 19% and 4% to a very good partial response, complete response or stringent complete response respectively. The median progression-free survival time was 33.2 months and the median overall survival time was not reached. Among the 75 patients, the reasons for pomalidomide discontinuation were progressive disease (54%), adverse events (AEs) (30%), investigator discretion (11%) and consent withdrawal (5%). Grade (G) 3/4 haematological AEs included neutropenia (51%) and lymphopenia (35%); G3/4 drug-related non-haematological AEs (>5%) comprised 13% infections. Long-term administration of pomalidomide and dexamethasone is feasible and one third of the patients improved their response.

Pomalidomide, cyclophosphamide, and dexamethasone for relapsed multiple myeloma.

It is important to have an effective therapy for patients with multiple myeloma (MM) at first relapse, particularly if an autologous stem cell transplant (ASCT) is considered at this stage. This multicenter, phase 2 trial evaluated the efficacy and safety of weekly oral pomalidomide-cyclophosphamide-dexamethasone (PCD) in patients with MM in first relapse after treatment with lenalidomide-bortezomib-dexamethasone (RVD). All patients had received RVD as induction and consolidation therapy, plus lenalidomide maintenance for 1 year (arm A). Half had also received an ASCT after induction (arm B). At MM relapse, all patients received 4 oral cycles of pomalidomide 4 mg (days 1-21), cyclophosphamide 300 mg (days 1, 8, 15, and 22), and dexamethasone 40 mg (days 1-4 and days 15-18 of a 28-day cycle; PCD). Responding patients in arm A underwent ASCT and received 2 additional cycles of PCD, whereas those in arm B received 5 cycles of PCD. All patients received pomalidomide-dexamethasone maintenance until disease progression. Primary end point was partial remission or better after the initial 4 cycles of PCD. Responses were obtained in 82/97 (85%) patients evaluated: complete remission (n = 1; 1%), very good partial remission (n = 32; 33%), and partial remission (n = 49; 51%). Three patients (3%) had stable disease, and 6 (6%) had disease progression (6 response failures). Forty-five (94%) of the 48 patients in arm A underwent planned ASCT. PCD was effective therapy after first relapse with RVD. After 4 cycles, the rate of partial remission or better was 85%, and 94% of planned ASCTs were performed. Toxicity was mostly hematologic and manageable. This trial was registered at www.clinicaltrials.gov as #NCT02244125.

Computerized static posturography and laterality in children. Influence of age.

PURPOSE: The present study aims to explore relationships between footedness and posturographic assessment in children aged from 4 to 10. A real-time computerised device was used on a force plate for movement analysis. It requires a static posturography to assess postural control of children with the same handedness and footedness. METHODS: Thirty eight right-handed and right-footed children organized in three age groups of 4 to 6 years old, 6 to 8 years old and 8 to 10 years old participated in the study. Two statical tests, the Unilateral Stance (US) and the Weight Bearing Squat (WBS) were performed, jointly with a dynamic balance examination (Limits of Stability (LOS)). All these tests were executed to explore the body capability of the right/left side. RESULTS: The study demonstrated significant differences involving the right/left side among the three age groups. Better performance on the youngest children's right part and on the oldest children's left part was observed. Differences between the left and right sides of the body were noticeably revealed by posturographic assessments in right-handed and right-footed children. CONCLUSIONS: Age seemed to be a determinant for these outcomes. Maturation of the vestibular at the ages of 6 or 7 years might explain the observed differences between the youngest children and olderchildren.

Disruptions of ultradian and circadian organization of core temperature in a rat model of African trypanosomiasis using periodogram techniques on detrended data.

Periodogram techniques on detrended data were used to determine the incidence of Trypanosoma brucei brucei infection on the distribution of the core temperature of rats and the expression of temperature rhythms. In such an animal model, sudden episodic hypothermic bouts were described. These episodes of hypothermia are used here as temporal marks for the purpose of performing punctual comparisons on temperature organization. The experiment was conducted on 10 infected and 3 control Sprague-Dawley rats reared under a 24 h light-dark cycle. Core temperature was recorded continuously throughout the experiment, until the animals' death. Temperature distributions, analyzed longitudinally across the full duration of the experiment, exhibited a progressive shift from a bimodal to unimodal pattern, suggesting a weakening of the day/night core temperature differences. After hypothermic events, the robustness of the circadian rhythm substantially weakened, also affecting the ultradian components. The ultradian periods were reduced, suggesting fragmentation of temperature generation. Moreover, differences between daytime and nighttime ultradian patterns decreased during illness, confirming the weakening of the circadian component. The results of the experiments show that both core temperature distribution and temperature rhythm were disrupted during the infection. These disruptions worsened after each episode of hypothermia, suggesting an alteration of the temperature regulatory system.

Reasons for prescribing second generation antihistamines to treat allergic rhinitis in real-life conditions and patient response.

BACKGROUND: Second generation H1 antihistamines (H1A) are currently recommended as first choice medications for allergic rhinitis and rhinoconjunctivitis. However, little is known about what influences the choice of prescription of one second generation (H1A) as opposed to another in real-life conditions. OBJECTIVE: The aim of the study was to identify the main criteria determining the choice of a second generation H1A by allergy specialists in mainland France. METHODS: Consecutive patients suffering from allergic rhinitis or rhinoconjunctivitis were included and followed prospectively for 30 days from the prescription of a second generation H1A in monotherapy. Patients were asked to fill in auto-questionnaires at baseline, daily during the first 10 days of the new treatment, and at the end of follow-up. Data on efficacy, tolerance, safety, rate and type of response to treatment, as well as patient satisfaction were recorded and analyzed. RESULTS: 1,080 patients were included between March 2011 and October 2012, mostly suffering from moderate to severe rhinitis (82.0%). The most frequently cited reason for choosing a specific H1A was the expected efficacy (85.3%). The mean time to nasal and ocular recovery was 6 days and 78.2% of patients responded to treatment within this interval. The presence of conjunctivitis was significantly associated with a more rapid response. At the end of follow-up, the satisfaction rate was higher for patients who were switched from a previous treatment (87.5%), compared to those receiving their first treatment (78.8%). CONCLUSION AND CLINICAL RELEVANCE: The main reason for choosing a specific second generation H1A was its expected efficacy. Concomitant conjunctivitis is associated with a more rapid response to treatment. Symptom recovery necessitates a mean of 6 days.

Diurnal changes in postural control in normal children: Computerized static and dynamic assessments.

Mild traumatic brain injury (mTBI) causes postural control deficits and accordingly comparison of aberrant postural control against normal postural control may help diagnose mTBI. However, in the current literature, little is known regarding the normal pattern of postural control in young children. This study was therefore conducted as an effort to fill this knowledge gap. Eight normal school-aged children participated. Posture assessment was conducted before (7-8 a.m. in the morning) and after (4-7 p.m. in the afternoon) school on regular school days using the Balance Master® evaluation system composed of 3 static tests and 2 dynamic balance tests. A significant difference in the weight-bearing squats was detected between morning hours and afternoon hours (P < 0.05). By end of afternoon, the body weight was borne mainly on the left side with the knee fully extended and at various degrees of knee flexion. A significantly better directional control of the lateral rhythmic weight shifts was observed at the end of the afternoon than at morning hours (P < 0.05). In summary, most of our findings are inconsistent with results from previous studies in adults, suggesting age-related differences in posture control in humans. On a regular school day, the capacity of postural control and laterality or medio-lateral balance in children varies between morning and afternoon hours. We suggest that posturographic assessment in children, either in normal (e.g., physical education and sports training) or in abnormal conditions (e.g., mTBI-associated balance disorders), be better performed late in the afternoon.

Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy.

Assessment of treatments in children with cerebral palsy has been well developed, especially in the gait laboratory. However, the prerequisite for walking is adequate postural control. We hypothesize that a treatment of an equinus deformity should improve postural control. Balance control was assessed by static posturography on the Balance Master. Nine diplegic children, six girls and three boys, participated in the study. Assessment was conducted before and after treatment of the equinus deformity. Two static tests (Weight Bearing Squat and the modified Clinical Test for Sensory Interaction on Balance), and two dynamic balance tests (Limits of Stability and Rhythmic Weight Shift) were performed on the Balance Master. After treatment, mean weight-bearing asymmetry measured by the Weight Bearing Squat was significantly improved at 30 degrees of knee flexion. In the modified Clinical Test for Sensory Interaction on Balance, there was a significant improvement in two conditions (eyes closed on foam surface and the composite score). The Limits of Stability was very difficult to perform for almost all the children. In the Rhythmic Weight Shift, mean directional control improved significantly in three conditions (left/right weight shift at 1 s of transition, front/back weight shift at 2 s of transition and the composite score of the front/back direction). The Balance Master offers the opportunity for an objective and easy assessment of postural control in children with cerebral palsy.

Orthoses for mild scoliosis: a prospective study comparing traditional plaster mold manufacturing with fast, noncontact, 3-dimensional acquisition.

STUDY DESIGN: A prospective comparison of 2 different methods to make orthoses in mild scoliosis. OBJECTIVE: To evaluate the therapeutic efficiency of orthoses made by a computer-aided design procedure. SUMMARY OF BACKGROUND DATA: It is now possible to make orthoses by a computer-aided design procedure. In order to evaluate this new method, we carried out a comparative study between the traditional and computer-aided design-manufactured orthoses. METHODS: In this prospective study, we compared the 2 methods by studying the cases of 30 adolescents with mild scoliosis. For each patient requiring orthopaedic treatment, we made 2 ortheses: 1 using the traditional method and 1 using the computer-aided design method. There were 26 girls and 4 boys whose average age was 13 years and 3 months. Each body jacket was successively used in random order following the same protocol. Neither the prescriber nor the patient knew the origin of the orthosis used. The final choice of the orthosis was made using 3 criteria: first, improvement of the scoliotic curves on the frontal and lateral radiologic planes, and second, the patient's impression of comfort. RESULTS: For the 30 cases, 13 traditional and 16 computer-aided design body jackets were chosen. In 1 case, no significant difference allowed us to chose one body jacket rather than the other. For the frontal radiologic correction, the better results were obtained 3 times with the computer-aided design body jacket, 5 times with the traditional one, and in 22 cases, the results were equivalent. For the lateral radiologic correction, the better results were obtained 11 times with the computer-aided design body jacket, 3 times with the traditional one, and in 16 cases, the results were equivalent. For the comfort of the 2 body jackets for each patient, the better results were obtained 12 times with the computer-aided design body jacket, 8 times with the traditional one, and in 10 cases, the results were equivalent. CONCLUSION: Based on our results, we believe that the computer-aided design procedure is equally efficient to traditional method for mild scoliotic curves.