Trials

BACKGROUND: Postoperative upper gastrointestinal fistula (PUGIF) is a devastating complication, leading to high mortality (reaching up to 80%), increased length of hospital stay, reduced health-related quality of life and increased health costs. Nutritional support is a key component of therapy in such cases, which is related to the high prevalence of malnutrition. In the prophylactic setting, enteral nutrition (EN) is associated with a shorter hospital stay, a lower incidence of severe infectious complications, lower severity of complications and decreased cost compared to total parenteral nutrition (TPN) following major upper gastrointestinal (GI) surgery. There is little evidence available for the curative setting after fistula occurrence. We hypothesize that EN increases the 30-day fistula closure rate in PUGIF, allowing better health-related quality of life without increasing the morbidity or mortality. METHODS/DESIGN: The NUTRILEAK trial is a multicenter, randomized, parallel-group, open-label phase III trial to assess the efficacy of EN (the experimental group) compared with TPN (the control group) in patients with PUGIF. The primary objective of the study is to compare EN versus TPN in the treatment of PUGIF (after esophagogastric resection including bariatric surgery, duodenojejunal resection or pancreatic resection with digestive tract violation) in terms of the 30-day fistula closure rate. Secondary objectives are to evaluate the 6-month postrandomization fistula closure rate, time of first fistula closure (in days), the medical- and surgical treatment-related complication rate at 6 months after randomization, the fistula-related complication rate at 6 months after randomization, the type and severity of early (30 days after randomization) and late fistula-related complications (over 30 days after randomization), 30-day and 6-month postrandomization mortality rate, nutritional status at day 30, day 60, day 90 and day 180 postrandomization, the mean length of hospital stay, the patient's health-related quality of life (by self-assessment questionnaire), oral feeding time and direct costs of treatment. A total of 321 patients will be enrolled. DISCUSSION: The two nutritional supports are already used in daily practice, but most surgeons are reluctant to use the enteral route in case of PUGIF. This study will be the first randomized trial testing the role of EN versus TPN in PUGIF. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03742752. Registered on 14 November 2018.This research program is funded by the French Ministry of Health through Programme Hospitalier de Recherche Clinique 2016

Characterization of sea water ageing effects on mechanical properties of carbon/epoxy composites for tidal turbine blades

In recent years, many tidal turbine projects have been developed using composites blades. Tidal turbine blades are subject to ocean forces and sea water aggressions, and the reliability of these components is crucial to the profitability of ocean energy recovery systems. The majority of tidal turbine developers have preferred carbon/epoxy blades, so there is a need to understand how prolonged immersion in the ocean affects these composites. In this study the long term behaviour of different carbon/epoxy composites has been studied using accelerated ageing tests. A significant reduction of composite strengths has been observed after saturation of water in the material. For longer immersions only small further changes in these properties occur. No significant changes have been observed for moduli nor for composite toughness. The effect of sea water ageing on damage thresholds and kinetics has been studied and modelled. After saturation, the damage threshold is modified while kinetics of damage development remain the same

Enhancement of mode I fracture toughness of adhesively bonded secondary joints using layup patterning of CFRP

International audienceThis work aims to analyse the influence of the CFRP layup patterning on the crack path of composite bonded joints and evaluate its effect on the mode I fracture toughness. An experimental program has been performed using Double Cantilever Beam tests with three different CFRP layup patterning and two adhesives. In addition, a finite element analysis was also implemented to further identify different damage mechanisms during the tests. The outcome shows that different substrate CFRP layup patterning results in distinct crack onsets and propagation paths during the tests, also influenced by the type of adhesive used. Furthermore, an enhancement of around 25% in the joint's onset fracture toughness was observed with the layup patterning compared to a reference joint (with unidirectional layup). Thus, the substrate's patterning morphology seems to be a promising method to increase the mode I fracture toughness of the studied secondary joints

Enhancement of mode I fracture toughness of adhesively bonded secondary joints using different layup patterning of CFRP

Delamination growth in fibre reinforced polymer composites is generally evaluated with experiments that have been standardized for quasi-static load conditions. These tests characterize unidirectional delamination growth in mode I (DCB), mode II (ELS or ENF) of mixed mode conditions (MMB). However, little attention is paid in literature to the applicability of these tests to in-service delamination problems that are generally characterized by planar delamination growth. In this study, the relation between planar delamination growth, induced by transverse quasi-static indentation loading, and these unidirectional delamination tests was investigated. To that aim, prior planar delamination growth tests reported in literature, performed at EPFL, were analysed to identify up to what extent this planar growth could be correlated to the concepts of strain energy release and strain energy density. Once this appeared to successful, an experimental setup was designed to measure the delamination boundary during the transverse indentation loading of planar delamination specimens made of nontransparent carbon fibre reinforced polymer composites. With that set-up, quasi-static and fatigue planar delamination growth experiments were performed, and delamination contours could be successfully captured. While the quasi-static tests revealed limited growth, evaluation with numerical simulations revealed that the indentation force required to extend the delamination quasi-statically would cause damage to the specimen. This is attributed to the increasing length of the delamination contour when delaminations expand, which is not the case with standard unidirectional specimen. With the fatigue tests, however, delamination growth was achieved, but interestingly enough two phases were observed; first the delamination propagated in a planar fashion, while at some point in time work did not exceed an apparent threshold. Instead of no growth, however, the delamination still increased but then in a transverse manner. What makes this study of particular interest, is that the strain energy density as criterion could capture the strain energy offered (work) along the entire delamination contour, while the strain energy release rate described the resistance to delamination growth. This latter observation is in agreement with the original concept employed by Griffith when he formulated the basis of linear elastic fracture mechanics. This presentation present the experiments performed, the analysis of results, and will conclude with a proposal how to relate standard unidirectional tests to planar growth, considering that these standard tests contain little to no information on transverse phenomena with respect to strain energy density (work) and strain energy release (dissipation)

Enhancement of mode I fracture toughness of adhesively bonded secondary joints using different layup patterning of CFRP

Delamination growth in fibre reinforced polymer composites is generally evaluated with experiments that have been standardized for quasi-static load conditions. These tests characterize unidirectional delamination growth in mode I (DCB), mode II (ELS or ENF) of mixed mode conditions (MMB). However, little attention is paid in literature to the applicability of these tests to in-service delamination problems that are generally characterized by planar delamination growth. In this study, the relation between planar delamination growth, induced by transverse quasi-static indentation loading, and these unidirectional delamination tests was investigated. To that aim, prior planar delamination growth tests reported in literature, performed at EPFL, were analysed to identify up to what extent this planar growth could be correlated to the concepts of strain energy release and strain energy density. Once this appeared to successful, an experimental setup was designed to measure the delamination boundary during the transverse indentation loading of planar delamination specimens made of nontransparent carbon fibre reinforced polymer composites. With that set-up, quasi-static and fatigue planar delamination growth experiments were performed, and delamination contours could be successfully captured. While the quasi-static tests revealed limited growth, evaluation with numerical simulations revealed that the indentation force required to extend the delamination quasi-statically would cause damage to the specimen. This is attributed to the increasing length of the delamination contour when delaminations expand, which is not the case with standard unidirectional specimen. With the fatigue tests, however, delamination growth was achieved, but interestingly enough two phases were observed; first the delamination propagated in a planar fashion, while at some point in time work did not exceed an apparent threshold. Instead of no growth, however, the delamination still increased but then in a transverse manner. What makes this study of particular interest, is that the strain energy density as criterion could capture the strain energy offered (work) along the entire delamination contour, while the strain energy release rate described the resistance to delamination growth. This latter observation is in agreement with the original concept employed by Griffith when he formulated the basis of linear elastic fracture mechanics. This presentation present the experiments performed, the analysis of results, and will conclude with a proposal how to relate standard unidirectional tests to planar growth, considering that these standard tests contain little to no information on transverse phenomena with respect to strain energy density (work) and strain energy release (dissipation).Structural Integrity & Composite

Practice patterns in complex ventral hernia repair and place of biological grafts: a national survey among French digestive academic surgeons

International audienceBACKGROUND: Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications.METHODS: A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals.RESULTS: Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%).CONCLUSIONS: Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications.</p