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Acute chest syndrome (ACS) is a life-threatening complication of sickle cell anemia (SCA). Most often, ACS occurs during the progression of a painful vaso-occlusive crisis (VOC) in vulnerable patients. The present study aimed to identify early risk factors for ACS progression, focusing on patient assessments in a pediatric Emergency Department. In this study (2016–2022) concerning exclusively the SS and Sβ 0 sickle cell disease genotypes, severe VOC encounters progressing to ACS were compared to uncomplicated severe VOCs. Medical history, clinical and laboratory data were collected for both groups. Out of 280 severe VOC encounters without initial respiratory symptoms, 40 progressed to life-threatening acute chest syndrome. The forty ACS (age 8.5 ± 4.3 years, 37% females) were compared with 240 severe VOCs (9.3 ± 4.4 years, 46% females). ACS was positively correlated with the occurrence of VOC at night, diffuse (multifocal) pain and increased C-Reactive protein (p < 0.05). The multivariable modelling, using generalized linear mixed-effects models, defined three risk factors for ACS occurrence: diffuse pain, night-time pain occurrence, and increased C-Reactive protein (p < 0.01). Increased use of opiates in the Emergency Department, elevated total leucocyte count, breath rate, and decreased red blood cell count were not significantly associated with ACS occurrence (p > 0.05). The initial evaluation of SCA patients’ acute pain in the Emergency Department is crucial for subsequent management during hospitalization.

Falmein et al examine the impact of COVID-19 on pediatric clinical research in France. Temptations to use unproven medications and strategies instead of relying on scientific evidence are high when facing the frightening pandemic. Most medical and scientific communities have reacted promptly to better fight the disease. This is a particular challenge in pediatric clinical research. PEDSTART is the national network of French pediatric clinical research centers. A task force has been created to gather all national research initiatives and anticipate the consequences of COVID-19 on pediatric clinical research. At present, no fewer than 15 projects were identified at different stages of maturity involving pediatric patients. Overlap between studies is frequent, and multiplicity of trials may jeopardize a relevant approach. Each pediatric clinical investigation center had to reorganize itself rapidly. Yet, this period may be a chance to merge projects and join forces to deal with the resumption of usual activity, which will be a challenging task in itself. The merging of risk mitigation activities is encouraged at an international level to better anticipate and respond to the impact of COVID-19 on ongoing and future pediatric clinical research.

Exclusively breastfed infants born to obese mothers have previously been shown to gain less weight by 1-month postpartum than infants of normal-weight mothers. Our hypothesis is that human milk composition and volume may differ between obese and normal-weight mothers. To compare human milk leptin, macronutrient concentration, and volume in obese and normal-weight mothers. Mother and infant characteristics were studied as secondary aims. This cross-sectional observational study compared 50 obese mothers matched for age, parity, ethnic origin, and educational level with 50 normal-weight mothers. Leptin, macronutrient human milk concentration, and milk volume were determined at 1 month in exclusively breastfed infants. Mother characteristics and infant growth were recorded. Human milk leptin concentration was higher in obese mothers than normal-weight mothers (4.8±2.7 vs. 2.5±1.5 ng.mL-1, p<0.001). No difference was observed between obese and normal-weight mothers in protein, lipid, carbohydrate content, and volume, nor in infant weight gain. Leptin concentration was higher in the milk of obese mothers than that of normal-weight mothers, but macronutrient concentration was not. It remains to be established whether the higher leptin content impacts on infant growth beyond the 1-month of the study period.

To update the data on food consumption and practices in children under 3 years of age in metropolitan France. The Nutri-Bébé 2013 cross-sectional study selected a random sample, according to the quota sampling method. After giving their informed consent, parents had to record the food consumption during three non-consecutive days framed by two face-to-face interviews, using for quantitative information different portion size measurement aids. One thousand one hundred and eighty-four children were enrolled. Mothers' mean age was 30·8 (sd 5·4) years; 38 % were primiparous; 89 % lived with a partner; 60 % had an occupation. Of the infants younger than 4 months, 31 % were breast-fed. One thousand and thirty-five children consumed infant formula followed by growing-up milk in 63 % of them; solid foods were introduced at a mean age of 5·4 (sd 2·13) months. From 8 months onwards, 25 % of children consumed the same foods as their parents on a more or less regular basis; 29 % ate in front of a screen, with a daily average screen time of 43·0 (sd 40·4) min. This robust survey highlights the low prevalence and duration of breast-feeding in France and shows a modest improvement since the previous survey of 2005 in the observance of recommendations concerning other feeding practices. The frequent consumption of adult foods and the screen time are of concern.

Nutrition during fetal life and early childhood is thought to play a crucial role in the risk for developing metabolic syndrome and cardiovascular diseases in the future adult and branched-chain amino acids (BCAA) intake may play a role in the development of obesity. The aim of this study was to compare the breast milk amino acid profiles of obese and normal weight (control) breast-feeding mothers. Fifty obese and 50 control breast-feeding mothers were enrolled. Age and parity were similar in both groups. Breast milk samples were collected at the end of the first month of lactation. Free amino acid (FAA) concentrations in breast milk were determined by ultra-performance liquid chromatography tandem mass spectrometry. Comparisons between groups were performed using a two-tailed paired t test. We analyzed 45 breast milk samples from each group. Body mass index was 34.3 ± 3.9 kg/m2 in the obese group and 21.6 ± 1.4 kg/m2 in the control group (P < 10−4). BCAA concentrations were higher in breast milk of obese mothers (95.5 ± 38.2 μM versus 79.8 ± 30.9 μM; P = 0.037), as was tyrosine concentration (13.8 ± 7.1 μM versus 10.6 ± 5.2 μM; P = 0.016). The mature breast milk of obese mothers contained 20% more BCAA and 30% more tyrosine than breast milk of control mothers. Whether altered breast milk FAA profile affects metabolic risk in the breast-fed child remains to be explored. •Obesity affects the composition of free amino acids in breast milk.•The concentration of branched-chain amino acids is higher in the breast milk of obese women.•Amino acid pattern in the milk of obese mothers is similar to that reported in plasma.

While clinical evidence remains limited, an extensive amount of research suggests a beneficial role of n-3 polyunsaturated fatty acid supplementation in cancer treatment. One potential benefit is an improvement of protein homeostasis, but how protein metabolism depends on proinflammatory cytokines in this context remains unclear. Here, using the natural abundance of the stable isotopes of nitrogen as a marker of changes in protein metabolism during a randomized, double-blind, controlled clinical trial, we show that protein homeostasis is affected way faster than proinflammatory cytokines in metastatic breast cancer patients supplemented with n-3 polyunsaturated fatty acids. We provide some evidence that this response is unrelated to major changes in whole-body substrate oxidation. In addition, we demonstrate that more fatty acids were impacted by metabolic regulations than by differences in their intake levels during the supplementation. This study documents that the percentage of patients that complied with the supplementation decreased with time, making compliance assessment crucial for the kinetic analysis of the metabolic and inflammatory responses. Our results highlight the time-dependent nature of metabolic and inflammatory changes during long-chain n-3 fatty acid supplementation.

The need for information about new and existing drugs used in children was recognized in the European Union (EU) with the implementation of the Paediatric Regulation in 2007. In 2017, the 10-year review of the Paediatric Regulation identified barriers to the conduct of clinical trials, including delays in setting up and completing paediatric trials. Across Europe, the difficulties with clinical research are compounded by variation within countries and between countries. Ethics and regulatory review have national specificities. This paper describes the Collaborative Network for European Clinical Trials for Children (conect4children, c4c), which addresses selected difficulties in the design and conduct of paediatric clinical trials. c4c is a time-limited public–private consortium funded by the Innovative Medicines Initiative (IMI2). The elements of c4c are as follows: expert advice providing input on study design and/or paediatric development programmes (including patient involvement activities); a network of sites following harmonised procedures coordinated by National Hubs and a single point of contact for Europe; a facility for education and training for sites and trial teams; and support for managing data used by the network and a common paediatric data dictionary. c4c does not sponsor trials. c4c is taking a phased approach with careful piloting through industry and non-industry studies intended to demonstrate the viability of the network (proof-of-viability studies). c4c uses a co-design approach involving industry and academics within a clearly defined scope. A sustainable, successor organization open to all potential service users will be open for business before the end of IMI2 funding in 2024.

Food choices affect the isotopic composition of the body with each food item leaving its distinct isotopic imprint. The common view is that the natural abundance of the stable isotopes of nitrogen (expressed as δ15N) is higher in animals than in plants that constitute our contemporary diets. Higher δ15N is thus increasingly viewed as a biomarker for meat and fish intake. Here we show that organic compared to conventional farming increases plant δ15N to an extent that can appreciably impact the performance of δ15N as a biomarker. The error that can arise when organic plants are consumed was modelled for the entire range of proportions of plant versus animal protein intake, and accounting for various intakes of organic and conventionally grown crops. This mass balance model allows the interpretation of differences in δ15N in light of organic food consumption. Our approach shows that the relationship between δ15N and meat and fish intake is highly contextual and susceptible to variation at the population, community or group level. We recommend that fertilization practices and organic plant consumption must not be overlooked when using δ15N as a biomarker for meat and fish intake or to assess compliance to nutritional interventions.

We previously reported that exclusively breastfed infants born to mothers with pregestational obesity gain less weight during the first month after birth than those born to mothers of normal pregestational weight. This issue is potentially important since lower weight gain in breastfed infants of obese mothers might increase the risk of developing later obesity. Breast milk quality and quantity, together with breastfeeding practice, possibly influence infants’ feeding behavior, appetite control, and regulation of growth later in life. The issue of whether breast milk protein patterns from obese mothers differ in composition from those of non‐obese mothers remains largely unexplored. Here, we established a breast milk proteomic pattern that discriminates obese mothers and infants with delayed weight gain at 1 month after birth from normal‐weight mothers with infants of the same age and with normal weight gain. Obese mothers were matched to normal‐weight mothers (n = 26; body mass index 33.5 ± 3.2 vs 21.5 ± 1.5 kg·m−2). The mean weight gain of infants in the obese group at 1 month after birth was 430.8 g lower than that of the infants in the control group. Analysis of the breast milk delipidized fraction by surface‐enhanced laser desorption/ionization on CM10 and Q10 arrays was followed by MS‐assisted purification and LC‐MS/MS microsequencing of a selected biomarker. We identified 15 candidate protein biomarkers, seven of which were overexpressed in the obese group and eight in the normal‐weight group. One of the most significant candidate biomarkers, overexpressed in the obese group, was identified as a fragment of the sixth extracellular domain of the polymeric immunoglobulin receptor. Further structural identification of these candidate biomarkers and their validation in clinical assays may facilitate the development of a predictive immunoassay. A breast milk proteomic pattern of 15 candidate biomarkers, established by surface‐enhanced laser desorption/ionization, delineates a specific group of obese mothers and infants with delayed weight gain at 1 month after birth. One of these biomarkers was purified and identified by LC‐MS/MS as a 49‐amino‐acid fragment of the sixth extracellular domain of the polymeric immunoglobulin receptor.

A key point highlighted by H. Savolainen comments1 on M. Laberge's article2 is the lack of physicians trained in research and conducting interdisciplinary/ translational or clinical research. There is an urgent need to train young clinician scientists. Sharing experiences and information on measures used to attract young physicians to research programs is of special interest. This is the practice in France, particularly in pediatrics. Funding is central.