Panax ginseng (i.e., ginseng) root is extensively used in traditional oriental medicine. It is a modern pharmaceutical reagent for preventing various human diseases such as cancer. Ginsenosides—the major active components of ginseng—exhibit immunomodulatory effects. However, the mechanism and function underlying such effects are not fully elucidated, especially in human monocytes and dendritic cells (DCs).We investigated the immunomodulatory effect of ginsenosides from Panax ginseng root on CD14+ monocytes purified from human adult peripheral blood mononuclear cells (PBMCs) and on their differentiation into DCs that affect CD4+ T cell activity.After treatment with ginsenoside fractions, monocyte levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 increased through phosphorylation of extracellular signal-regulated kinase (ERK)1/2 and c-Jun N-terminal kinase (JNK), but not p38 mitogen-activated protein kinase (MAPK). After treatment with ginsenoside fractions, TNF-α production and phosphorylation of ERK1/2 and JNK decreased in lipopolysaccharide (LPS)-sensitized monocytes. We confirmed that DCs derived from CD14+ monocytes in the presence of ginsenoside fractions (Gin-DCs) contained decreased levels of the costimulatory molecules CD80 and CD86. The expression of these costimulatory molecules decreased in LPS-treated DCs exposed to ginsenoside fractions, compared to their expression in LPS-treated DCs in the absence of ginsenoside fractions. Furthermore, LPS-treated Gin-DCs could not induce proliferation and interferon gamma (IFN-γ) production by CD4+ T cells with the coculture of Gin-DCs with CD4+ T cells.These results suggest that ginsenoside fractions from the ginseng root suppress cytokine production and maturation of LPS-treated DCs and downregulate CD4+ T cells.

Pour les professionnels de santé, il est important de connaître les motivations et les comportements des adolescents face au tabagisme actif. La dépendance au tabac est différente des adultes. Cette population représente un enjeu considérable pour les acteurs de la prévention mais aussi économique pour l’industrie du tabac.

All asthma consensus statements recommend the use of a written action plan. Patients tend to have a positive perception regarding the use of action plans for asthma. They find that action plans are useful for the managernent of their asthma. Nevertheless, an action plan should not be viewed as the only element in self-management strategy. It is usually part of a multifaceted intervention, including therapeutic education sessions, medical review and prescription of medications. A recent meta-analysis reported a positive effect of the use of written action plans. It is agreed that a written action plan should be tailored to each individual patient and to the type and severity of his asthma. Still, the precise elements of action plans that are responsible for their benefit have not yet been clearly identified. However, considering the different action plans that have been published, it would appear reasonable to build on prior experience and adopt a three-step approach, such as a sequence of stoplight colours, as a means to compare one action plan with others. (C) 2008 Elsevier Masson SAS. Tons droits reserves.

Établir un protocole interrégional actualisé de prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an.Un groupe de travail composé de pédiatres et d’urgentistes des hôpitaux universitaires du Grand Ouest (HUGO) s’est réuni autour de l’analyse des données récentes de la littérature. Les recommandations issues de ce travail ont ensuite été soumises et validées par les pédiatres des HUGO.Après avoir établi des critères permettant de distinguer un asthme débutant du nourrisson d’une bronchiolite aiguë virale, les indications d’examens complémentaires ainsi que les prescriptions d’antibiotiques et de kinésithérapie respiratoire ont été précisées et réservées à des situations très limitées. De même, des modalités de prescription de l’oxygénothérapie et du support nutritionnel ont été proposées. Enfin, d’autres thérapeutiques comme les nébulisations de sérum salé hypertonique ont été jugées prometteuses mais leur place dans la prise en charge de la bronchiolite aiguë du nourrisson reste encore à préciser.Alors que la prise en charge de la bronchiolite aiguë du nourrisson en France est actuellement guidée par la conférence de consensus de la Haute Autorité de santé (HAS) qui date de 2000 et que nos confrères européens et nord-américains ont récemment mis à jour leurs recommandations, ce travail a permis d’actualiser les modalités de prise en charge de cette affection et d’homogénéiser les pratiques au sein des HUGO.While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants.Pediatricians, pediatric pulmonologists, and emergency physicians of the Grand Ouest University Hospitals (France) gathered to analyze the recent data from the literature.Criteria to distinguish childhood asthma from acute viral bronchiolitis were established, then prescriptions of diagnostic tests, antibiotics, and chest physiotherapy were defined and reserved for very limited situations. Similarly, the modalities of oxygen therapy prescription and nutritional support were proposed. Finally, other therapeutics such as nebulized hypertonic saline seem promising, but their place in the treatment of acute bronchiolitis in infants remains unclear.This work has provided new proposals for management of acute viral bronchiolitis and helped standardize practices within the Grand Ouest University Hospitals. This local organization could lay the keystone for working toward guidelines initiated by learned societies at the national level.

A high intake of fast food is associated with increased obesity risk. This study assessed recent changes in caloric content and macronutrient composition in large U.S. fast food restaurants.Data from the MenuStat project included 11,737 menu items in 37 fast food restaurants from 2012 to 2014. Generalized linear models were used to examine changes in the caloric content and corresponding changes in the macronutrient composition (non-sugar carbohydrates, sugar, unsaturated fat, saturated fat, and protein) of menu items over time. Additionally, macronutrient composition was compared in menu items newly introduced in 2013 and 2014, relative to 2012. Analyses, conducted in January 2016, controlled for restaurant and were stratified by menu categories.Overall, there was a 22-calorie reduction in food items from 2012 to 2014. Beverages had a 46-calorie increase, explained by an increase in calories from sugar (12 calories) and saturated fat (16 calories). Newly introduced main courses in 2014 had 59 calories fewer than those on 2012 menus, explained by a 54-calorie reduction in unsaturated fat, while other macronutrient content remained fairly constant. Newly introduced dessert items in 2014 had 90 calories more than those on 2012 menus, explained primarily by an increase of 57 calories of sugar.Overall, there were relatively minor changes in menu items’ caloric and macronutrient composition. Although declines in caloric content among newly introduced fast food main courses may improve the public’s caloric intake, it appears that the macronutrient composition of newly introduced items did not shift to a healthier profile.

Normal school life is an essential aim of the modem management of asthmatic children. The integration of asthmatic children into normal school activities leads to much better acceptance of the condition by both the patient's family and society as a whole. The keystone to good scholastic performance rests on good compliance to the treatment regime by both child and parents. In general, with good compliance the scholastic performance of asthmatic children should be equivalent to that of non-asthmatic children. Poor socioeconomic status remains the principal barrier to good scholastic performance. (c) 2005 Elsevier SAS. Tous droits reserves.

Les maladies allergiques sont une des causes majeures de morbidité dans les pays développés et leur incidence augmente rapidement. Parmi les maladies allergiques l’asthme et l’allergie à l’arachide tiennent une place à part en pédiatrie en raison de la fréquence de l’asthme et de la gravité de l’allergie à l’arachide. Des progrès indiscutables ont été effectué lors de l’année écoulée tant en ce qui concerne l’épidémiologie que le traitement. Un consensus est établi d’une part pour le dépistage et d’autre part pour la prévention des maladies allergiques, et enfin pour la prescription d’adrénaline. Une nouvelle circulaire interministérielle permet d’étendre le projet d’accueil individualisé aux enfants en maternelle, en crèche collective et pour le temps périscolaire. De plus en plus d’écoles de l’asthme s’ouvrent à l’éducation de l’allergie alimentaire. Le choix des références qui suivent reflète les préoccupations des patients et de nos collègues mais il s’agit d’une sélection personnelle, donc partiale, et partielle. Allergic diseases are a major cause of morbidity in developed countries, and their incidence is increasing rapidly. Among these allergic conditions, asthma and peanut allergy are particularly important in paediatrics because of the prevalence of asthma and the seriousness of peanut allergy. Considerable progress has been made in the past year in both the epidemiology and treatment of these problems. A concensus has been established for the detection and prevention of allergic diseases and, in addition, for the prescription of epinephrine. A new interministerial circular IIe provides for greater availability of individualized attention for children in kindergarten and day-care centers and in their extracurricular time. More and more asthma groups are becoming knowledgeable about food allergy. The choice of references that follows reflects the preoccupations of patients and our physician colleagues, but it also reflects my personal interests, so it is therefore biased and incomplete.

Allergic diseases are a major cause of morbidity in developed countries, and their incidence is increasing rapidly. Among these allergic conditions, asthma and peanut allergy are particularly important in paediatrics because of the prevalence of asthma and the seriousness of peanut allergy. Considerable progress has been made in the past year in both the epidemiology and treatment of these problems. A concensus has been established for the detection and prevention of allergic diseases and, in addition, for the prescription of epinephrine. A new interministerial circular He provides for greater availability of individualized attention for children in kindergarten and day-care centers and in their extracurricular time. More and more asthma groups are becoming knowledgeable about food allergy. The choice of references that follows reflects the preoccupations of patients and our physician colleagues, but it also reflects my personal interests, so it is therefore biased and incomplete. (C) 2003 Elsevier SAS. Tous droits reserves.

Therapeutic education is becoming essential in the management of asthmatic children. The objective of this type of education is to modify in a durable manner the knowledge and behaviour of parents so as to decrease the morbidity of the disease.Objectives. - To describe the population of patients whose parents attend the asthma school at Necker-Enfants-Malades Hospital and to evaluate the impact of this educational activity.Methods. - We included the 54 children whose parents attended the asthma school from September 27th to December 31st, 2000. Two educational sessions were offered. Socio-demographic and medical data were collected and markers of this educational activity were assessed by means of three questionnaires. The parents first answered questions immediately after the educational session. The second questionnaire was completed 3 to 6 months later.Results. - The mean age of the patients was 8 years and 3 months, The patients were of French origin, living in traditional family structures in the Ile-de France region. All had symptomatic asthma, affecting their quality of life and requiring active treatment. During the immediate evaluation, the knowledge and behaviour of the parents were judged to be correct. Some parents changed attitudes or behaviour later, particularly with respect to the means of managing asthma episodes or their beliefs concerning possible secondary effects of the treatment or the origins of the child's asthma. The follow-up period was too short, and the sample too small to draw any firm conclusions on the impact of this educational action on morbidity.Conclusion. - The structured educational action is effective. It should be adapted to patients and reinforced later because its effects may be transient. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

Asthma training programmes for parents and children have been developed to increase both selfmanagement skills of asthmatic children and compliance with medical regimens. There has been ample evidence that health education programmes can reduce morbidity, health costs and improve the quality of life of children with asthma, as well as that of their parents. It is now widely recommended that all patients with asthma be provided with training enabling them to either monitor the situation, recognize signs of deterioration, initiate treatment of an attack, adjust their maintenance therapy, or comply with action plans. However, the majority of physicians has not adopted asthma education programmes as a regular part of routine asthma care. A key reason is that undertaking asthma education programmes or obtaining agreement from the national center for health for a disability allowance to help support medical cost is time-consuming. However, these issues are the responsibility of politicians rather than physicians. The longer they are neglected, the more distant effective and efficient health care in the field of asthma will be. (C) 2000 Editions scientifiques et medicales Elsevier SAS.

Les thérapeutiques inhalées ont l'intérêt majeur de permettre à la quasi totalité des enfants asthmatiques de mener une vie normale avec des traitements à la fois efficaces et parfaitement tolérés. Toutefois, lorsqu'on demande aux enfants de faire une démonstration de leur technique d'inhalation on constate souvent que l'inhalation est imparfaite ou qu'ils ne sont pas capables de savoir quand leur dispositif est vide ou de l'entretenir. Les systèmes d'inhalation pour l'enfant, de plus en plus nombreux sur le marché, sont disponibles sous trois formes: les aérosols doseurs (avec ou sans chambre d'inhalation, autodéclenchants ou non), les inhalateurs de poudres (multidose ou unidose), les solutions et les suspensions pour les nébulisations. Quel que soit le mode d'inhalation, l'utilisation correcte d'un traitement inhalé nécessite l'apprentissage de la technique d'inhalation, mais également que l'enfant soit capable de reconnaître quand son dispositif est vide et comment entretenir son matériel (en particulier pour les chambres d'inhalation et les nébuliseurs).

Respiratory viral infections, particularly rhinoviruses, are very important triggers of asthma exacerbation. The precise mechanisms of virus-induced exacerbations remain poorly understood, although human and animal studies suggest that local production of cytokines (IL-6, IL-8, IL-11, Rantes, MIP1 alpha...) and the increased expression of intercellular adhesion molecule 1 (ICAM1) in asthmatic individuals, play an important role in recruitment and activation of inflammatory cells in the airways. One hypothesis, that remains to be demonstrated, would be that, in the presence of Th2 predominance, as occurs in asthma, an excess of IL4 could inhibit the development of cytotoxic CD8, NK and Th1 activity, thereby resulting in decreased IFN production, more severe allergic inflammation and less efficient viral clearance.

Les therapeutiques inhalees ont l'interet majeur de permettre a la quasi-totalite des enfants asthmatiques de mener une vie normale avec des traitements a la fois efficaces et parfaitement toleres. Plusieurs systemes d'inhalation sont actuellement disponibles. Les chambres d'inhalations constituent la methode de choix pour les enfants d'âge prescolaire (les aerosols doseurs sont, de toute facon, rarement utilises sans chambre d'inhalation en pediatrie). Des etudes recentes soulignent l'importance capitale de l'entretien des chambres d'inhalation. Les inhalateurs de poudre peuvent etre prescrits a partir de 5-6 ans. Ils ont l'avantage d'etre peu encombrants et simples d'utilisation. Les nebulisations sont reservees au traitement des crises d'asthme et au traitement continu des nourrissons atteints d'asthme severe. Les performances d'une nebulisation dependent essentiellement de celles du nebuliseur. Chaque nebuliseur prescrit devrait donc avoir ete valide pour le medicament a nebuliser. Quel que soit le mode d'inhalation choisi, le medecin doit effectuer une demonstration complete de la technique d'inhalation a l'enfant et a sa famille (eventuellement completee dans une ecole de l'asthme) et verifier a chaque consultation que cette technique reste correcte. Enfin, il faut toujours tenir compte des souhaits de l'enfant car si le medecin prescrit un systeme d'inhalation peu ou pas apprecie par l'enfant, l'observance therapeutique sera probablement mauvaise, cause «injustifiee» d'echec therapeutique.

Inhaled drugs have the significant advantage of allowing virtually all asthmatic children to lead normal lives under effective and safe therapy. Several inhalation systems are currently available. Spacers are the method of choice in preschoolers, and metered-dose inhalers are rarely used without a spacer in pediatrics. Recent studies have emphasized the need for appropriately maintaining spacers Powder inhalers can be used starting at five to sir years of age and have the advantages of small bulk and simplicity of use. Nebulizers are used only for asthma attacks and for the continuous treatment of infants with severe asthma. The benefits derived from nebulization depends critically on the performance of the nebulizer. Each nebulizer model should be validated for each drug solution to be nebulized. Whatever the inhalation device selected, the physician should demonstrate the inhalation technique to the child and family, who can also attend an asthma school if they need further training. The child's or parent's inhalation technique should be evaluated at each follow-up visit. The wishes of the child should be taken into account since poor compliance responsible for treatment failure can be expected whenever a child is asked to use a device that he or she dislikes.