Emmanuelle Rochette

L'arthrite juvénile idiopathique (AJI) est une maladie rare chronique caractérisée par une inflammation persistante qui se manifeste par des douleurs articulaires, le gonflement des articulations et la limitation des mouvements articulaires. La fatigue et les douleurs entraînent une diminution de l'activité physique et une sédentarité accrue. Ce manque d'activité physique a pour conséquence une altération de la qualité de vie et une aggravation de la fatigue chronique, des troubles de l'humeur et des troubles métaboliques chez ces enfants. Les études sur les programmes d'exercices physiques montrent que l'exercice physique est bénéfique pour cette population. Mais les mécanismes d’action permettant de comprendre comment elle améliore la qualité de vie et la santé de l'enfant atteint d'arthrite juvénile idiopathique sont encore mal connus. Notre objectif était d’explorer la réponse physiologique à l’exercice des enfants et adolescents atteints d’arthrites juvéniles idiopathiques. Nous nous sommes intéressés principalement au métabolisme énergétique à l’exercice et à la fonction musculaire chez ces enfants. Nous avons étudié l’impact de la pathologie, des traitements par anti-TNF-α et de l’activité de la maladie sur ce métabolisme. Ensuite, nous avons étudié la sécrétion induite par l’exercice des myokines telles que l’IL-6 et les calgranulines en post exercice immédiat et dans les 24h suivant l’exercice.

Background and aims In adolescents with obesity, a left atrial (LA) enlargement has been reported. However, data regarding its function and its stiffness are missing. The aim of this study was to describe LA morphology and function, using speckle-tracking echocardiography (STE) and to explore their potential determinants in adolescents with obesity. Methods Twenty-eight adolescent women with obesity (13.2 ± 1.4 yr) with an illness duration of 130 ± 27 months and 33 controls (14.1 ± 2.0 yr) underwent a resting echocardiography including an analysis of left ventricular (LV) and LA morphologies and strains. A fasting venous blood sample was performed to biochemical determinations including inflammation markers. Results LA volume and stiffness index were increased in adolescents with obesity compared to controls. LA reservoir, conduit and booster pump functions were not different between groups. By stepwise forward multivariate regression analyses, systolic blood pressures, cardiac output and sedimentation rate were the independent determinants of LA volume (p < 0.0001, β-coefficient = 0.460) whereas only the body mass index was an independent determinant of LA stiffness (p = 0.003, β-coefficient = 0.413). Conclusion In adolescents with obesity, we observed a specific LA remodeling, including higher volume and lower stiffness, which could constitute early signs of an altered LV diastolic function.

Sleep is bi-directionally linked to energy balance. This crossover study design will evaluate the acute effect of a moderate energy deficit (500 kcal) induced by diet, exercise, or mixed (−250 kcal by diet and 250 kcal by exercise) on sleep and the next morning’s appetitive responses. The study sample comprises 24 healthy young adults. The experimental measurements will be conducted in a naturalistic, momentary manner and partly assessed by the participants. The participants will undergo a run-in period in order to stabilize their sleep schedules and provide them with training on the study protocol and measurements. Indirect calorimetry will be used to determine their resting metabolic rate and peak oxygen consumption (VO₂ peak). Then, they will take part in a control session (CTL), followed by three energy deficit sessions in random order: a diet-induced energy deficit session (DED), an exercise-induced energy deficit session (EED), and a mixed energy deficit session (MED). All experimental sessions will be separated by a one-week washout. The participants’ sleep will be monitored by ambulatory polysomnography, and the next morning’s appetitive response will be evaluated via ad libitum food intake, appetite sensations, and food reward, measured by a food liking and wanting computerized test.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in young people. Although biologics now enable most children and adolescents with JIA to enjoy clinical remission, patients present lower physical activity and spend more time in sedentary behavior than their healthy counterparts. This impairment probably results from a physical deconditioning spiral initiated by joint pain, sustained by apprehension on the part of both the child and the child’s parents, and entrenched by lowered physical capacities. This in turn may exacerbate disease activity and lead to unfavorable health outcomes including increased risks of metabolic and mental comorbidities. Over the past few decades, there has been growing interest in the health benefits of increased overall physical activity as well as exercise interventions in young people with JIA. However, we are still far from evidence-based physical activity and / or exercise prescription for this population. In this review, we give an overview of the available data supporting physical activity and / or exercise as a behavioral, non-pharmacological alternative to attenuate inflammation while also improving metabolism, disease symptoms, poor sleep, synchronization of circadian rhythms, mental health, and quality of life in JIA. Finally, we discuss clinical implications, identify gaps in knowledge, and outline a future research agenda.

Background: Blood tryptase and fecal calprotectin levels may serve as biomarkers of necrotizing enterocolitis. However, their interpretation may be hindered by the little-known effects of perinatal factors. The aim of this study was to compare the tryptase and calprotectin levels in newborns according to their term, trophicity, and sex. Method: One hundred and fifty-seven premature newborns and 157 full-term newborns were included. Blood tryptase and fecal calprotectin were assayed. Results: Blood tryptase levels were higher in premature than in full-term newborns (6.4 vs. 5.2 µg/L; p < 0.001). In situations of antenatal use of corticosteroids (p = 0.007) and non-exclusive use of human milk (p = 0.02), these levels were also higher. However, in multiple linear regression analyses, only prematurity significantly influenced tryptase levels. Fecal calprotectin levels were extremely wide-ranging and were much higher in female than in male newborns (300.5 vs. 110.5 µg/g; p < 0.001). Conclusions: The differences in tryptase levels according to term could be linked to early aggression of the still-immature digestive wall in premature newborns, in particular, by enteral feeding started early. The unexpected influence of sex on fecal calprotectin levels remains unexplained.

This study aimed to determine the short-term effect of two isocaloric diets differing in the ratio of protein–carbohydrate on melatonin levels, sleep, and subsequent dietary intake and physical activity in healthy young men. Twenty-four healthy men took part in a crossover design including two sessions of three days on isocaloric diets whether high-protein, low-carbohydrate (HPLC) or low-protein, high-carbohydrate (LPHC) followed by 24-h free living assessments. Sleep was measured by ambulatory polysomnography pre-post-intervention. Melatonin levels were assessed on the third night of each session on eight-point salivary sampling. Physical activity was monitored by accelerometry. On day 4, participants reported their 24-h ad-libitum dietary intake. LPHC resulted in better sleep quality and increased secretion of melatonin compared to HPLC. A significant difference was noted in sleep efficiency (p < 0.05) between the two sessions. This was mainly explained by a difference in sleep onset latency (p < 0.01) which was decreased during LPHC (PRE: 15.8 ± 7.8 min, POST: 11.4 ± 4.5 min, p < 0.001). Differences were also noted in sleep staging including time spent on REM (p < 0.05) and N1 (p < 0.05). More importantly, REM latency (PRE: 97.2 ± 19.9 min, POST 112.0 ± 20.7 min, p < 0.001) and cortical arousals (PRE: 7.2 ± 3.9 event/h, POST 8.5 ± 3.3 event/h) increased in response to HPLC diet but not LPHC. On day 4, 24-h ad-libitum energy intake was higher following HPLC compared to LPHC (+64 kcal, p < 0.05) and explained by increased snacking behavior (p < 0.01) especially from carbohydrates (p < 0.05). Increased carbohydrates intake was associated with increased cortical arousals.

Overcrowding in paediatric emergencies departments is a worldwide issue, where improving the quality of care is a priority. The main objective of this study was to determine the effect of triage nurse-initiated X-ray radiography on length of stay in paediatric emergency admissions. This retrospective, monocentric, descriptive study was performed in two successive 3-month periods: a pre-protocol (“before”) period from February 03, 2020 to May 03, 2020, and a protocol (“after”) period from May 04, 2020 to August 02, 2020, when patients underwent nurse-initiated X-ray radiography. The study involved all patients aged 3 years and over, valid, non-hyperalgic, accompanied by their parents, consulting for a simple closed distal trauma, involving a single limb segment or joint, in the paediatric emergency department. 695 patients were included, 298 in the first period and 397 in the second period. Median length of stay in the paediatric emergency department was significantly shorter during the second period (119 min [80; 165] vs. 80 min [60; 105], p < 0.001), i.e. a median reduction time of 39 minutes or 33% (effect size = −0.68, 95% CI [−0.84; −0.53]). Triage nurse requests were judged “adequate and sufficient” in 95.2% of cases with only 2.0% of instances deemed “unnecessary” by the medical team. In 2.8% of cases, “another X-ray” was required to support diagnosis. The application of a triage nurse X-ray protocol significantly reduced length of stay in a paediatric emergency department. The quality of patient management remained unchanged and nurse requests were relevant.

Background: Asthma is a chronic inflammatory disease of the airways common in children. Soluble advanced glycation end-product receptor (sRAGE) is a blood biomarker of lung damage and inflammation. We sought to determine whether it could also be a biomarker in childhood asthma. Methods: We conducted a prospective, observational, analytical study at Clermont-Ferrand University Hospital. We measured plasma sRAGE levels in asthmatic and healthy children aged 7 years. Results: Of the 68 children assessed, 15 (22.05%) presented asthma. All presented normal respiratory function. The mean plasma sRAGE level was 1875 pg/mL in the children with asthma and 1794 pg/mL in the healthy children (p = 0.525). The mean plasma sRAGE level was significantly decreased with tobacco exposure during pregnancy: 1478 pg/mL versus 1870 pg/mL without (p = 0.007). Lower levels were observed in children living in apartments (1557 pg/mL) than in those living in houses (1863 pg/mL) (p = 0.031). Conclusions: No difference was observed in plasma sRAGE levels in children with asthma in our well-treated and controlled population. Environmental exposure may affect these levels. Further studies are required to better characterize the role of sRAGE.