Our study confirmed that clinical symptoms and radiological findings before bronchoscopy have a low diagnostic value in children with a history of FBA.

Objective: Prevalence of non-alcoholic fatty liver disease (NAFLD) among children is increasing dramatically. It is unclear why some patients develop steatohepatitis (NASH), fibrosis and cirrhosis from steatosis, and others do not. A role for leptin has been claimed. This study aims to evaluate the relationship between leptin, insulin resistance (IR) and NAFLD in children. Design and methods: In 72 biopsy-proven NAFLD children (aged 9-18 years; 51M/21F), fasting leptin and its soluble receptor (sOB-R) were measured; free leptin index (FLI) was calculated as leptin/sOB-R; IR was estimated by homeostasis model assessment (HOMA-IR) and insulin sensitivity index (ISIcomp); glucose tolerance by oral glucose tolerance test (OGTT). Percentage of total body fat (TBF) by dual-energy X-ray absorptiometry (DXA) was available in 65 patients. Results: Prevalence of diabetes, impaired fasting and/or after load glucose tolerance was 11%. HOMA-IR and ISI-comp values were 2.55G1.39 and 4.4G2. NASH was diagnosed in 38 and simple steatosis in 25 children; diagnosis was indeterminate in 29 children. Increased fibrosis, mostly of mild severity, was observed in 41 patients. Median NAFLD activity (NAS) score was 3.42G1.60. According to histology, levels of leptin and FLI increased as steatosis (leptin from 11.9G6.3 in score 1 to 17.4G6.9 in score 2 (PZ0.01) and 22.2G6.8 ng/ml in score 3 (P!0.001); FLI 2.56G1.40, 3.57G0.34, 4.45G0.64 respectively (PZ0.05)); ballooning (from 13.7G6.7 in score 1 to 17G7.5 in score 2 (PZ0.001) and 22.1G7.1 ng/ml in score 3 (PZ0.01); FLI 2.81G1.50, 3.40G1.65, 4.57G1.67 (PZ0.01 between 0 and 2)); fibrosis (from 14.3G7 to18.3G6.9; PZ0.03; FLI 3.03G1.57 vs 3.92G077; P!0.05) and NAS score (score 1-2: 12.9G6.9; score 3-4: 17G6.9 (PZ0.01); score 5-7: 22.9G7.5 ng/ml (PZ0.03); FLI 2.70G1.53, 3.12G1.53, 4.58G1.57 PZ0.01 and PZ0.05 between 1-2 vs 3-4 and 3-4 vs 5-7 respectively) worsened. Higher leptin correlated with more severe steatosis, ballooning and NAS score (r 0 Z0.6, 0.4 and 0.6 respectively; for all P!0.001); FLI with ballooning (r 0 Z0.4, P!0.0001), steatosis (r 0 Z0.5, P!0.0001) and NAS score (r 0 Z0.5, P!0.0001). Conclusions: Leptin and liver injury correlated independently of age, BMI and gender in the present study. Nevertheless, any causative role of leptin in NAFLD progression could be established. Thus, studies are needed to define whether the hormone plays a major role in the disease. 155 735-743 European Journal of Endocrinology

Background: Dog bites are a major cause of traumatic injury in children. The aim of this study was to determine the experience, management, and outcome of dog bite injuries in our department. Methods: We retrospectively reviewed the clinical records for 127 patients (mean age 7.15 AE 4.24 years, range 1 to 17 years; 68 males) affected by dog-related injuries, from 2012 to 2018. Characteristics of patients and dogs, type and severity of injuries, circumstances of the accidents, treatment and outcome were analyzed. Results: Of 141 wounds, 73 (51.8%) affected the head and neck, 62 (44%) the limbs, and six (4.2%) affected the trunk. According to the Mcheik classification, 107 lesions (75.9%) were stage 1, 26 (18.4%) stage 2, and eight (5.7%) stage 3. Seventy-eight percent of the cases involved known dogs. The breed of the dog was recorded in 62/ 127 cases (48.8%) and the most common were mongrels (23/62, 37.1%). Seventy-five percent of the attacks occurred during spring and summer. All patients underwent antibiotic prophylaxis and immediate surgical repair. Wound infection was observed in two patients. Three unsightly scars required rectification, with good cosmetic results in all cases. Conclusions: Our results are consistent with previous data showing that the typical dog-related injury occurs from a known dog, during spring and summer, and in younger boys, who are frequently exposed to head and neck wounds. Our experience showed the feasibility and safety of primary repair and antibiotic prophylaxis in all patients, with very low incidence of infection and good cosmetic results.

A wide range of outcome measures or endpoints has been used in clinical trials to assess the effects of treatments in paediatric respiratory diseases. This can make it difficult to compare treatment outcomes from different trials and also to understand whether new treatments offer a real clinical benefit for patients. Clinical trials in respiratory diseases evaluate three types of endpoints: subjective, objective and health-related outcomes. The ideal endpoint in a clinical trial needs to be accurate, precise and reliable. Ideally, the endpoint would also be measured with minimal risk and across all ages, easy to perform, and be inexpensive. As for any other disease, endpoints for respiratory diseases must be viewed in the context of the important distinction between clinical endpoints and surrogate endpoints. The association between surrogate endpoints and clinical endpoints must be clearly defined for any disease in order for them to be meaningful as outcome measures. The most common endpoints which are used in paediatric trials in respiratory diseases are discussed. For practical purposes, diseases have been separated into acute (bronchiolitis, acute viral-wheeze, acute asthma and croup) and chronic (asthma and cystic fibrosis). Further development of endpoints will enable clinical trials in children with respiratory diseases with the main objective of improving prognosis and safety.

Infants with laryngomalacia may have episodes of microaspiration. BAL performed during FFB to evaluate stridor may add helpful therapeutic information without increasing the risks of the procedure.