Health policies promote educational activities during the care pathways for children and adolescents hospitalized in pediatric oncology services. However, the development of these activities is still ...limited and particularly in the physical education area. The aim of this article is to describe the implementation of a new life plan through a project of adapted physical activity in the university hospital complex of Bordeaux. It leads to broaden the educational life plan including health education for young people and teenagers affected by chronic disease.
Résumé: Les pouvoirs publics promeuvent les activités éducatives dans le parcours de soins des enfants et des adolescents hospitalisés en oncopédiatrie. Leur développement reste toutefois limité particulièrement sur l’éducation corporelle et physique. L’article propose de montrer comment se réalise l’approche du projet de vie à travers la mise en oeuvre d’un projet d’activité physique adaptée au sein du CHU de Bordeaux. Il conduit à élargir la perspective éducative du projet de vie à une approche plus globale de l’éducation pour la santé chez des jeunes touchés par la maladie chronique.
Autoimmune hemolytic anemia is a rare condition in children. Little is known about its initial presentation and the subsequent progression of the disease.
Since 2004, a national observational study ...has been aiming to thoroughly describe cases and identify prognostic factors. Patients from all French hematologic pediatric units have been included if they had a hemoglobin concentration less than 11 g/dL, a positive direct antiglobulin test and hemolysis. Evans' syndrome was defined by the association of autoimmune hemolytic anemia and immunological thrombocytopenic purpura. Data from patients' medical records were registered from birth to last follow-up. Autoimmune hemolytic anemia was classified as primary or secondary. Remission criteria, qualifying the status of anemia at last follow-up, were used with the aim of identifying a subgroup with a favorable prognosis in continuous complete remission.
The first 265 patients had a median age of 3.8 years at diagnosis. In 74% of cases the direct antiglobulin test was IgG/IgG+C3d. Consanguinity was reported in 8% of cases and first degree familial immunological diseases in 15% of cases. Evans' syndrome was diagnosed in 37% of cases. Autoimmune hemolytic anemia was post-infectious in 10%, immunological in 53% and primary in 37% of cases. After a median follow-up of 3 years, 4% of children had died, 28% were still treatment-dependent and 39% were in continuous complete remission. In multivariate analysis, IgG and IgG+C3d direct antiglobulin tests were associated with a lower rate of survival with continuous complete remission (adjusted hazard ratio, 0.43; 95% confidence interval, 0.21-0.86).
This nationwide French cohort is the largest reported study of childhood autoimmune hemolytic anemia. The rarity of this condition is confirmed. Subgroups with genetic predisposition and underlying immune disorders were identified.
•Biaxial fatigue crack growth behavior of aluminum alloy 7075-T6 was characterized.•Two biaxiality ratios, λ (=1 and 1.5) were investigated as well as axial fatigue (λ=0).•Crack growth rate was ...practically same for λ=0 and 1 and it was faster for biaxial λ=1.5.•However, fatigue damage mechanisms were quite different in each case.
Crack growth behavior of aluminum alloy 7075-T6 was investigated under in-plane biaxial tension–tension fatigue with stress ratio of 0.5. Two biaxiality ratios, λ (=1 and 1.5) were used. Cruciform specimens with a center hole, having a notch at 45° to the specimen’s arms, were tested in a biaxial fatigue test machine. Crack initiated and propagated coplanar with the notch for λ=1 in L–T orientation, while it was non-coplanar for λ=1.5 between L–T and T–L orientations. Uniaxial fatigue crack growth tests in L–T and T–L orientations were also conducted. Crack growth rate in region II was practically the same for biaxial fatigue with λ=1 in L–T orientation and for the uniaxial fatigue in L–T or T–L orientations, while it was faster for biaxial fatigue with λ=1.5 at a given crack driving force. However, fatigue damage mechanisms were quite different in each case. In region I, crack driving force at a given crack growth rate was smallest for biaxial fatigue with λ=1.5 and for uniaxial fatigue in T–L orientation, followed by biaxial fatigue with λ=1 and uniaxial fatigue in L–T orientation in ascending order at a given crack growth rate.
Brain tumours are the most frequent solid tumours in children and the most frequent radiotherapy indications in paediatrics, with frequent late effects: cognitive, osseous, visual, auditory and ...hormonal. A better protection of healthy tissues by improved beam ballistics, with particle therapy, is expected to decrease significantly late effects without decreasing local control and survival. This article reviews the scientific literature to advocate indications of protontherapy and carbon ion therapy for childhood central nervous system cancer, and estimate the expected therapeutic benefits.
A systematic review was performed on paediatric brain tumour treatments using Medline (from 1966 to March of 2014). To be included, clinical trials had to meet the following criteria: age of patients 18 years or younger, treated with radiation, and report of survival. Studies were also selected according to the evidence level. A secondary search of cited references found other studies about cognitive functions, quality of life, the comparison of photon and proton dosimetry showing potential dose escalation and/or sparing of organs at risk with protontherapy; and studies on dosimetric and technical issues related to protontherapy.
A total of 7051 primary references published were retrieved, among which 40 clinical studies and 60 papers about quality of life, dose distribution and dosimetry were analysed, as well as the ongoing clinical trials. These papers have been summarized and reported in a specific document made available to the participants of a final 1-day workshop. Tumours of the meningeal envelop and bony cranial structures were excluded from the analysis. Protontherapy allows outstanding ballistics to target the tumour area, while substantially decreasing radiation dose to the normal tissues. There are many indications of protontherapy for paediatric brain tumours in curative intent, either for localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, low-grade gliomas; or panventricular irradiation of pure non-secreting germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure germinomas. Carbon ion therapy is just emerging and may be studied for highly aggressive and radioresistant tumours, as an initial treatment for diffuse brainstem gliomas, and for relapse of high-grade gliomas.
Both protontherapy and carbon ion therapy are promising for paediatric brain tumours. The benefit of decreasing late effects without altering survival has been described for most paediatric brain tumours with protontherapy and is currently assessed in ongoing clinical trials with up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric patients in France can receive protontherapy due to the lack of equipment.
Les tumeurs cérébrales sont l’indication de radiothérapie pédiatrique la plus fréquente, avec des effets tardifs fréquents : cognitifs, osseux, visuels, auditifs et hormonaux. En raison de leur balistique exceptionnelle, les faisceaux de particules pourraient apporter une meilleure protection des tissus sains sans diminuer le contrôle local et la survie. Cet article est une revue de la littérature scientifique ayant pour but de proposer les indications de protonthérapie et de thérapie par ions carbone pour les tumeurs cérébrales pédiatriques et d’estimer les bénéfices thérapeutiques escomptés.
Une revue systématique a été réalisée sur les essais cliniques de radiothérapie des tumeurs pédiatriques en utilisant Medline (de 1966 à mars 2014), selon les critères suivants : patients âgés de 18ans ou moins, ayant reçu une radiothérapie et comportant des données de survie. Les études sur les fonctions cognitives, la qualité de vie, la comparaison dosimétrique photons–protons ont également été incluses.
Sur 7051 références primaires publiées, 40 études cliniques et 60 articles de qualité de la vie et dosimétrie ont été analysés, ainsi que les essais cliniques en cours. Ces documents ont été condensés et présentés dans un document spécifique mis à la disposition des experts participant à un atelier final d’une journée. Il existe de nombreuses indications de protonthérapie pour les tumeurs cérébrales pédiatriques à visée curative : pour le traitement localisé des épendymomes, tumeurs germinales, craniopharyngiomes, gliomes de bas grade, pour l’irradiation pan-ventriculaire des germinomes purs non-sécrétant et pour l’irradiation crâniospinale des médulloblastomes et germinomes purs métastatiques. La thérapie par ions carbone est en train d’émerger et pourrait être étudiée pour les tumeurs très agressives et radiorésistantes, tels les gliomes du tronc cérébral diffus, et les rechutes des gliomes de haut grade.
Pour les tumeurs cérébrales pédiatriques, protonthérapie et thérapie par ions carbone sont prometteuses. L’avantage de diminuer les effets tardifs sans altérer la survie a été décrit pour la plupart des tumeurs cérébrales pédiatriques avec la protonthérapie et est en évaluation dans des essais cliniques en cours. Actuellement, en France, une minorité de patients pédiatriques reçoit une protonthérapie en raison du manque d’équipement.
•Studied fatigue crack growth behavior under biaxial fatigue with a phase difference.•A crack splits into two symmetric cracks under biaxial fatigue with phase difference.•Analytical and finite ...element analyses confirms experimental splitting observations.•Total strain energy release rate of split cracks is equal to that of initial crack.•As far the authors are aware, this is the first study in this respect.
Crack growth behavior of aluminum alloy 7075-T6 was characterized under in-plane biaxial tension–tension fatigue with phase differences of 90° or 180° between the two applied orthogonal cyclic loads. The initial single crack, created under the biaxial fatigue without any phase difference, splits into two symmetric cracks under the biaxial fatigue with the phase difference. The split cracks grow without any further branching. Directions of split cracks deviate sharply from the direction of the initial single crack. Under both phase differences of 90° and 180°, lengths of both split cracks are almost the same at a certain number of cycle. Strain energy release rate versus crack growth rate relationships of the split cracks are almost equal to each other. Further, sum of strain energy release rates at a given crack growth rate of both split cracks is equal to that of a single crack under the biaxial fatigue without phase difference. Analytical and finite element analyses are presented to explain the splitting of a crack due to the phase difference between the applied biaxial cyclic loads.
Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l'Enfant et de l'Adolescent cohort) to determine the prevalence ...and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level ⩾350 ng/mL) was 42.2% (95%CI 37.2-47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant (P<0.001), allogeneic versus autologous transplantation (P<0.001), radiation-based preparative regimen (P=0.035) and recent period of transplantation (P<0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73-15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63-10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47-7.13), allogeneic graft (OR=4.34, 95% CI: 2.07-9.12 for alternative donors and OR=2.53, 95% CI: 1.2-5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09-5.53). Graft-versus-host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft-versus-host disease.
Background: The association between acute childhood leukaemia and residing next to petrol stations and automotive repair garages was analysed in a national registry-based case–control study carried ...out in France in 2003–2004. Methods: Population controls were frequency matched with cases on age and gender. Data were collected by standardised telephone interview with the mothers. The latter were asked to report the proximity of their homes to petrol stations, automotive repair garages and other businesses from the conception of the index child to the diagnosis (for cases) or interview (for controls). Odds ratios were estimated using unconditional regression models adjusted for age, gender, number of children under 15 years of age in the household, degree of urbanisation and type of housing. Results: 765 cases of acute leukaemia and 1681 controls were included. Acute leukaemia was significantly associated with residence next to petrol stations or automotive repair garages (OR 1.6, 95% CI 1.2 to 2.2) and next to a petrol station (OR 1.9, 95% CI 1.2 to 3.0). The OR showed no tendency to increase with duration of exposure. The results were not modified by adjustment for potential confounding factors including urban/rural status and type of housing. Conclusions: The results support the findings of our previous study and suggest that living next to a petrol station may be associated with acute childhood leukaemia. The results also suggest that the role of low-level exposure to benzene in acute childhood leukaemia deserves further evaluation.
Principles of transfusion strategy have been used for neonates and children similar to adults. However, due to substantial discrepancies between physiology/pathology in children and in their adult ...counterparts, decisions, indications, and doses are different from those of adults, especially in neonates. Specific data and practice guidelines for blood product transfusion are reported owing to the experience of pediatrics and neonatology units and partners of the French Blood product bank.
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