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Most of biomarker panels, extracted from single omics traits, still need improvement since they display a gray zone where prediction is uncertain. Here we verified whether a combination of omics traits, fetal urinary metabolites and peptides analyzed in the same sample, improved prediction of postnatal renal function in fetuses with posterior urethral valves (PUV) compared to individual omics traits. Using CE-MS, we explored the urinary metabolome of 13 PUV fetuses with end stage renal disease (ESRD) and 12 PUV fetuses without postnatal ESRD at 2 years postnatally. This allowed the selection of 24 differentially abundant metabolite features which were modelled into predictive classifiers, alone or in combination with 12 peptides previously identified as predictive of ESRD. Validation in 35 new fetuses showed that the combination of peptides and metabolites significantly outperformed the 24 metabolite features with increased AUC (0.987 vs 0.905), net reclassification improvement (36%) and better sensitivity accuracy (86% vs 60%). In addition, the two trait combination tended to improve, but without reaching statistical significance, the already high performances of the 12 peptide biomarkers (AUC 0.967, accuracy 80%). In conclusion, this study demonstrates the potential of cumulating different omics traits in biomarker research where single omics traits fall short., Significance: Although increasingly proposed in disease-diagnosis and -prognosis because of their improved efficacy over single markers, panels of body fluid biomarkers based on single omics analysis still fail to display perfect accuracy, probably due to biological variability. Here, we hypothesized that combination of different omics traits allowed to better capture this biological variability. As proof of concept, we studied the added value of fetal urine metabolites and peptides using CE-MS, starting from the same urine sample, to predict postnatal renal outcome in fetuses with posterior urethral valves. We observed that the prognostic power of combined metabolite and peptide markers was clearly higher than that of metabolites alone and slightly, but non-significantly, improved compared to the peptides alone. To our knowledge, this report is the first to demonstrate that combining multiomics traits extracted from (fetal) urine samples displays clear promise for kidney disease stratification., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This research studied the effects of additional fiber in the rearing phase diets on egg production, gastrointestinal tract (GIT) traits, and body measurements of brown egg-laying hens fed diets varying in energy concentration from 17 to 46 wk of age. The experiment was completely randomized with 10 treatments arranged as a 5 × 2 factorial with 5 rearing phase diets and 2 laying phase diets. During the rearing phase, treatments consisted of a control diet based on cereals and soybean meal and 4 additional diets with a combination of 2 fiber sources (cereal straw and sugar beet pulp, SBP) at 2 levels (2 and 4%). During the laying phase, diets differed in energy content (2,650 vs. 2,750 kcal AMEn/kg) but had the same amino acid content per unit of energy. The rearing diet did not affect any production trait except egg production that was lower in birds fed SBP than in birds fed straw (91.6 and 94.1%, respectively; P < 0.05). Laying hens fed the high energy diet had lower feed intake (P < 0.001), better feed conversion (P < 0.01), and greater BW gain (P < 0.05) than hens fed the low energy diet but egg production and egg weight were not affected. At 46 wk of age, none of the GIT traits was affected by previous dietary treatment. At this age, hen BW was positively related with body length (r = 0.500; P < 0.01), tarsus length (r = 0.758; P < 0.001), and body mass index (r = 0.762; P < 0.001) but no effects of type of diet on these traits were detected. In summary, the inclusion of up to 4% of a fiber source in the rearing diets did not affect GIT development of the hens but SBP reduced egg production. An increase in the energy content of the laying phase diet reduced ADFI and improved feed efficiency but did not affect any of the other traits studied., (© 2016 Poultry Science Association Inc.)

Ileocolic intussusception in infants and children requires emergency treatment and has a very good prognosis. Abdominal ultrasonography imaging has a high sensitivity and specificity in its detection. Management of ileocolic intussusceptions now requires fewer surgical procedures because interventional radiology is usually efficient. Surgery (laparoscopy or laparotomy) is reserved for failed radiological reductions and advanced or immediately complicated intussusceptions (pneumoperitoneum, acute peritonitis, shock). Radiology teams have two reduction techniques: hydrostatic barium enema under fluoroscopic or sonographic guidance and air enema under fluoroscopic guidance. The superiority of one radiological reduction technique over the other cannot be asserted, and the choice depends on experience and available equipment. Current management of intussusceptions should be performed by pediatric radiology, anesthesiology and surgery teams., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Choledochal cysts are rare congenital malformations of the biliary tract. Traumatic rupture of a choledochal cyst can be misleading. An 11-year-old boy was admitted for peritonitis and intestinal occlusion after blunt abdominal trauma, evolving over 48 h. Laparotomy revealed bile ascites and a suspected duodenal perforation. After referral to our center, a CT scan showed a perforated choledochal cyst. Six months later, a complete excision of the cyst was successfully performed. This treatment is mandatory because of the risk of further complications such as lithiasis, pancreatitis, cholangitis, biliary cirrhosis, and malignant transformation (cholangiocarcinoma)., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Intussusceptions in infants and children are a medical and surgical emergency. A seasonal pattern, with fall and winter predominance, is usually taught in medical schools, but in France the epidemiological characteristics of intussusceptions are not clearly described., Methods: We conducted a retrospective study concerning children with idiopathic ileocolic intussusceptions admitted and treated at our institution (Emergency Department and Pediatric Surgery Department, Toulouse University Hospital) between January 2002 and December 2011. The main purpose was to evaluate the seasonality of intussusceptions. We describe the sex ratio, age of occurrence, rate of recurrence, and rate of failed enema reduction., Results: A total of 306 idiopathic ileocolic intussusceptions (280 patients) were included over a 10-year period with an average of 31 cases per year [21-42]. No seasonal pattern of intussusceptions or fall/winter predominance was shown (P=0.6) in the cumulative number of monthly cases: 24% of the intussusceptions occurred during fall, 21% during winter, 29% during spring, and 27% during summer. There were two peaks: April (35 cases over 10 years) and June (34 cases). The mean age was 18.7 months [2.3-159.4]: 19.5 months [3-159.4] in boys and 14.8 months [2.3-77.5] for girls (P=0.02). Two peaks were shown: one between six and nine months, the other one between 18 and 21 months. Male children had a higher incidence than female children: the sex ratio was 2:1, with 65.4% boys and 34.6% girls (P=0.0003), with an increasing sex ratio for older children. The recurrence rate was 8.2% among all (26 recurrences): 10.1% in boys and 4.9% in girls (P=0.08). The rate of surgery after failed enema reduction was 7.5% (21/280 children). There was no case of recurrence after operation., Conclusion: These results were consistent with previous reports. We did not show any seasonal pattern of idiopathic ileocolic intussusceptions in our patients. A new survey of childhood intussusceptions would be relevant to confirm these results and would make it possible to modify academic teachings about seasonality in intussusceptions., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Acute scrotal pain is a true surgical emergency as patients presenting with acute scrotal pain may suffer from spermatic cord torsion and gonadal loss. We assessed whether the type of consultation (first consultation in our center or secondary transfer from a peripheral hospital or primary care practice), distance from home to hospital, and duration of pain had an impact on the orchiectomy rate., Patients and Methods: We retrospectively reviewed the medical records of all patients under 15years of age suffering from acute scrotal pain who had surgical exploration between January 2007 and January 2010 in our center. Patient demographics, transfer status, time to consultation in our center, time to surgery, operative findings and clinical outcome were reviewed., Results: Of the 76 patients with acute scrotal pain in whom surgical exploration was performed, 59 had acute spermatic cord torsion, 16 had torsion of the testicular appendage, and 1 had orchitis. In patients with acute spermatic cord torsion, the median age was 13 years (range: 0.18-14.97). In patients with acute spermatic cord torsion, 32 came straight to our center (direct admission group, 54.2%), and 27 (45.8%) came after a prior consultation out of side the center (transfer group). The median journey was 19km (range: 2.5-113) in the direct admission group and 44km (range: 2.5-393) in the transfer group (P=0.0072). The median time between pain onset and consultation at our center was 4.3h (range: 0.5-48) in the direct admission group, and 11h (range: 2-48) in the transfer group (P=0.6139). The median time between admission at our center and surgery was 2.5h, with no difference between the 2 groups (P=0.8789). The orchiectomy rate was 25% in the direct admission group and 14.8% in the transfer group (P=0.5177). In children who underwent orchiectomy, the duration of pain was consistently over 6h. The duration of pain was greater in patients with orchiectomy (12h [range: 1-72]) than in patients without orchiectomy (12h [range: 6-48]; P=0.0001)., Conclusion: In this study, the orchiectomy rate depended on the duration of pain but not on transfer status. Acute scrotal pain must lead to surgical exploration as soon as possible, requiring close collaboration between peripheral hospitals, primary care physicians, and referral centers., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Lactobezoar is a compact mass of undigested milk concretions and mucous secretions in the gastrointestinal tract. It is usually located in the stomach, resulting in various degrees of gastric outlet obstruction. Lactobezoar is the most common type of bezoar in infancy. We report the case of rare and complicated gastric outlet obstruction secondary to lactobezoar. A female infant, 35weeks and 4days' gestation, one of dichorionic, diamniotic twins (birth weight, 1.890kg), was referred to our center at 5days of life for shock and food intolerance. She was on discontinuous oral feedings with a maltodextrin-enriched infant formula. On examination on day 4, there was a tender mass palpable in the left hypochondrium and on day 5, there was abdominal distension with signs of hemodynamic instability and sepsis. Plain abdominal X-ray showed a pneumoperitoneum associated with a heterogeneous mass in a distended stomach, consistent with a bezoar. An emergency laparotomy revealed a gastric perforation secondary to a large lactobezoar, with necrosis of the greater curvature and anterior wall of the stomach. Surgical treatment consisted of extraction of the lactobezoar, partial gastrectomy (resection of necrotic areas), and gastrostomy. Pathological examination confirmed the necrosis of the gastric mucosa. The postoperative course was complicated by prolonged sepsis. The child was kept NPO for 21days. On day 21 postsurgery, an upper gastrointestinal contrast study showed a well-dimensioned stomach, with a good pyloric passage. Gastrostomy and oral feedings were then initiated with good outcome at 6months. Etiopathogenic factors of lactobezoar are prematurity, low birth weight, altered gastric secretions and disturbed gastric emptying, hypercaloric and predominantly casein-based formulas, and inadequate milk composition. Lactobezoar should be considered in infants with symptoms of gastrointestinal obstruction with evocative images. Conservative management with nil per os, parenteral nutrition, and regular saline gastric washes has a good prognosis with rapid resolution of symptoms. Surgical indications are rare, and early and appropriate diagnosis should help limit and reduce the morbidity of lactobezoar., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Malignant melanoma in children is a rare and poorly understood pathology. We report a case of nodular melanoma that developed on congenital naevus in a 6-month-old infant. The histological results revealed a nodular melanoma on a congenital naevus measuring 6.625 mm in tumour thickness according to Breslow. The infant was treated by broad resection without adjuvant treatment. Follow up is 43 months without metastasis. Malignant melanoma is a rare pathology: 1-4% of all melanomas occur before the age of 20 and 0.3-0.4% of those are before puberty. The risk of degeneration of a congenital naevus into a melanoma is approximately 0.7%. Surgical exeresis must be broad. Up to now, no complementary treatment has proven to be effective. Pre-operative examination for sentinel lymph nodes by lymphography can be of interest although such an examination is difficult in children. The prognosis would appear to be similar to that of malignant melanoma in adults with a high mortality. This is therefore an argument in favour of early treatment and prolonged follow up of children with malignant melanoma.

Arteriovenous malformations are seldom in children but raise important therapeutic problems. Apart from intracranial arteriovenous malformations, few observations have been described in the literature. We report the case of a superficial perineal arteriovenous malformation in a 5-year-old child. Tailored embolization followed shortly by thorough surgery is the best attitude. Surgery must totally eradicate the lesion to allow hope for a cure. Surgery should be reserved for forms that are extensive or a source of complications. Even total resection does not ensure non-recurrence.

Abnormal persistence of the processus vaginalis in children predisposes to a complication that is strangulated inguinal hernia. The inguinal hernia is a frequent pathology because global incidence varies from 0,8 to 4,4% for children of any age and reaches about 30% in premature children. Strangulated inguinal hernia is rare (from 1,5 to 8%) and constitutes a surgical emergency. More frequently, reduction following sedation is possible (from 25 to 33%), and normally leads to delayed surgery. Current practice is to operate early in these children, including preterm infants, before any complication arises. This early surgery requires use of regional anaesthetic techniques such as spinal anaesthesia, ileo-inguinal ileohypogastric nerve blocks and caudal anaesthesia. However, although this pathology may appear to be routine commonplace it requires a specialized surgical and anaesthetic approach and specialized environment.