Efficacy and cost-effectiveness of nutritional intervention in elderly after hip fracture: design of a randomized controlled trial

Background: Hip fracture patients often have an impaired nutritional status at the time of fracture, which can result in a higher complication rate, prolonged rehabilitation time and increased mortality. A study was designed to evaluate the effect of nutritional intervention on nutritional status, functional status, total length of stay, postoperative complications and cost-effectiveness. Methods: Open-labelled, multi-centre, randomized controlled trial in hip fracture patients aged 55 years and above. The intervention group receives dietetic counselling (by regular home visits and telephone calls) and oral nutritional supplementation for three months after surgery. The control group receives usual dietetic care as provided by the hospital. Outcome assessment is performed at three and six months after hip fracture. Discussion: Patient recruitment has started in July 2007 and has ended in December 2009. First results are expected in 2011. Trial registration: ClinicalTrials.gov NCT00523575Mechanical, Maritime and Materials Engineerin

A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

<p>Abstract</p> <p>Background</p> <p>Proximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery.</p> <p>Methods/Design</p> <p>This randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention), or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control).</p> <p>Discussion</p> <p>The ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in the development of effective and alternative treatment methods post proximal femoral fracture surgery which may ultimately result in a reduction in systemic inflammation, loss of weight and lean muscle and improvements in nutritional status, mobility, independence and quality of life among elderly patients.</p> <p>Trial Registration</p> <p>ACTRN12609000241235</p

Epidémiologie et traitement des lymphomes non hodgkiniens chez la personne âgée

L'incidence des lymphomes non hodgkiniens (LNH) chez les patients de plus de 60 ans est en nette augmentation depuis une vingtaine d'années. La survie globale à 5 ans de ces patients est environ de 50% pour les lymphomes de bas degré de malignité et de 30% ou moins pour les lymphomes de haut degré de malignité. Les facteurs pronostiques sont les mêmes que chez les adultes, en dehors de l'âge qui est un facteur indépendant. En ce qui concerne les LNH de bas degré de malignité, il n'y a pas de bénéfice à traiter précocement les malades asymptomatiques. Les agents alkylants restent le traitement de choix pour les patients symptomatiques, mais les analogues des purines sont des agents prometteurs. Le CHOP reste le traitement standard des LNH de haut degré de malignité. Il est important de recruter ces patients dans des études cliniques prospectives

Blunted glucose-induced thermogenesis in 'overweight' patients: a factor contributing to relapse of obesity.

Glucose-induced thermogenesis was studied in 12 overweight patients (9F and 3M) before (mean body weight +/- s.e.m. 83 +/- 2 kg) and after weight loss (68 +/- 2 kg), and in eight of the same patients following relapse of body weight gain (84 +/- 5 kg). Expressed as a percentage of the energy content of the 100 g oral glucose load, glucose-induced thermogenesis was lower in the overweight before weight loss (6.5 +/- 0.5 per cent, P less than 0.05), after weight loss (3.9 +/- 0.6 per cent, P less than 0.01) and after weight regain (6.3 +/- 0.9 per cent, P less than 0.05) than in a group of lean control subjects, matched for sex and age (8.3 +/- 0.5 per cent). Basal energy expenditure was lower after weight reduction than before (1.16 +/- 0.04 vs 1.41 +/- 0.08 kcal/min, P less than 0.01). In the formerly overweight patients, the combined effect of a decreased basal energy expenditure and an attenuation of glucose induced thermogenesis resulted in a postprandial energy expenditure which was markedly lower than in the overweight state (P less than 0.001). Following relapse of obesity, glucose-induced thermogenesis remained attenuated compared to control subjects. These results suggest that a lowered basal energy expenditure and a reduced glucose-induced thermogenesis contribute to the positive energy balance which results in relapse of body weight gain after cessation of a hypocaloric diet

Representation of a Continuous Settling Tank by Hybrid Partial Differential Non Linear Equations for Control Design

International audienceThe representation of the main physical phenomena of continuous sedimentation within a settling tank (hydrodynamics of two-phase suspensions) is essential for the further control design of the quality of the solid-liquid separation. The model is still made of non-linear partial differential equations after simplifying assumptions and considering a one dimensional settler. It comes from both mass and momentum balance equations and includes effective solid stress appearing when the solid particles concentration is above a given threshold which depends on the quality of the sludge. Then a mobile interface appears between two different behaviours. The settler is divided into two zones to represent this discrete phenomenon. Our goal is to develop a model that can be used for a further control design of the water quality at the top outlet of the settling tank. A hybrid state space representation is provided with the different dynamics in each of the two zones, the constitutive equations and the boundary conditions. The steady state profile is calculated. A simplified version of a settling tank model is simulated