Malnutrition in healthcare settings and the role of gastrostomy feeding

Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes

Modification of Cantor High Entropy Alloy by the Addition of Mo and Nb: Microstructure Evaluation, Nanoindentation-Based Mechanical Properties, and Sliding Wear Response Assessment

The classic Cantor (FeCoCrMnNi) isoatomic high entropy alloy was modified by separate additions of Mo and Nb in an effort to optimize its mechanical properties and sliding wear response. It was found that the introduction of Mo and Nb modified the single phase FCC solid solution structure of the original alloy and led to the formation of new phases such as the BCC solid solution, σ-phase, and Laves, along with the possible existence of intermetallic phases. The overall phase formation sequence was approached by parametric model assessment and solidification considerations. Nanoindentation-based mechanical property evaluation showed that due to the introduction of Mo and Nb; the modulus of elasticity and microhardness were increased. Creep nanoindentation assessment revealed the beneficial action of Mo and Nb in increasing the creep resistance based on the stress sensitivity exponent, strain rate sensitivity, and critical volume for the dislocation nucleation considerations. The power law and power law breakdown were identified as the main creep deformation mechanisms. Finally, the sliding wear response was increased by the addition of Mo and Nb with this behavior obeying Archard’s law. A correlation between microstructure, wear track morphologies, and debris characteristics was also attempted

ESPEN guideline on nutritional support for polymorbid medical inpatients.

BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. RESULTS From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes

The effect of malnutrition on patients undergoing elective joint arthroplasty.

Malnutrition has been linked to serious complications in patients undergoing elective total joint arthroplasty (TJA). This study prospectively evaluated 2,161 patients undergoing elective TJA for malnutrition as defined by either an abnormal serum albumin or transferrin. The overall incidence of malnutrition was 8.5% (184 of 2,161) and the rate of overall complications in the malnourished group was 12% as compared to 2.9% in patients with normal parameters (P55years-old undergoing TJA and is associated with a significant increase in post-operative complications

Economy matters to fight against malnutrition: results from a multicenter survey

Background and Aim: Malnutrition represents a serious health care threat, as it increases morbidity, mortality and health care cost. The effective screening and treatment with enteral (EN) or parenteral (PN) nutrition are the key elements of the policy called Optimal Nutrition Care for All (ONCA). The study tried to analyze the impact of the state’s economy on the implementation of EN and PN to define its role in ONCA. Material and Methods: an international survey in twenty two European countries was performed between January and December 2014. An electronic questionnaire was distributed to 22 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Return rate was 90.1% (n=20) Results: EN and PN were used in all countries surveyed (100%), but to different extent. The country’s income significantly influenced the reimbursement for EN and PN (p0.05). Education was actively carried out in all countries, however the teaching at the pre-graduate level was the least widespread, and also correlated with the country income (p=0.042). Conclusions: Results indicated that economic situation influences all aspects of ONCA, including education and treatment. The reimbursement for EN and PN seemed to be the key factor of effective campaign against malnutrition

Development and characterization of refractory high entropy alloys - evaluation of their mechanical properties and surface degradation behavior

The present dissertation focuses on the development, characterization and evaluation of refractory high entropy alloys. These alloys are innovative materials which are targeted on applications of specialized requirements. The aim of the effort is to prepare single-phase and/or double phase structures and connect their microstructural features with their properties and degradation phenomena. More specifically, for each individual system produced, the microstructural characteristics were studied and the theoretical prediction models of solid solution formation, were checked. The corresponding solidification mechanisms were also studied, while their morphological characteristics were further analyzed. On the properties side, selected structures were studied as far as their mechanical properties (micro- and macro-hardness and compression tests) are concerned, while their strengthening mechanisms or failure modes were clarified. With regard to the alloys surface properties, the systems were examined in sliding wear tests under various experimental conditions. Through the recording of the numerical data and the study of the worn surfaces and debris, the corresponding wear mechanisms were formulated. Finally, the study of the corrosion behavior (solutions of 3.5 wt% NaCl and Hank) took place where, by analyzing the numerical data and the examination of the corroded surfaces / sections, the respective degradation mechanisms were interpreted.Η παρούσα διατριβή αφορά την ανάπτυξη, το χαρακτηρισμό και την αξιολόγηση της συμπεριφοράς πυρίμαχων κραμάτων υψηλής εντροπίας. Τα κράματα αυτά αποτελούν καινοτόμα υλικά και στοχεύουν σε εφαρμογές εξειδικευμένων απαιτήσεων. Στόχος της προσπάθειας ήταν να παρασκευαστούν μονοφασικές ή/και διφασικές δομές και να συνδεθούν τα μικροδομικά χαρακτηριστικά τους με τις ιδιότητες και τη συμπεριφορά σε φαινόμενα υποβάθμισης. Αναλυτικότερα, για κάθε επιμέρους σύστημα μελετήθηκαν τα μικροδομικά χαρακτηριστικά και έγινε έλεγχος των βιβλιογραφικών μοντέλων πρόβλεψης φάσεων στερεών διαλυμάτων. Προτάθηκαν οι αντίστοιχοι μηχανισμοί στερεοποίησης και αναλύθηκαν τα μορφολογικά χαρακτηριστικά αυτών. Στο σκέλος των ιδιοτήτων, επιλεγμένες δομές μελετήθηκαν ως προς τις μηχανικές τους ιδιότητες (μικρο- και μακρο-σκληρότητα και δοκιμές θλίψης), ενώ προτάθηκαν οι μηχανισμοί ενίσχυσης και αστοχίας τους. Σε ότι αφορά τις επιφανειακές ιδιότητες, τα συστήματα εξετάστηκαν σε δοκιμές φθοράς ολίσθησης υπό διάφορες πειραματικές συνθήκες. Μέσω της καταγραφής των αριθμητικών δεδομένων και της μελέτης των επιφανειών και ψηγμάτων της φθοράς, διατυπωθήκαν οι αντίστοιχοι μηχανισμοί υποβάθμισης. Τέλος, έλαβε χώρα η μελέτη της συμπεριφοράς τους σε διάβρωση (διαλύματα 3.5 κ.β% NaCl και Hank), όπου, μέσω της ανάλυσης των αριθμητικών δεδομένων και της εξέτασης των διαβρωμένων επιφανειών/τομών, ερμηνεύτηκαν οι αντίστοιχοι μηχανισμοί υποβάθμισης

Cannabinoid treatment during development and evaluation of behavioral and neurobiological indices in adulthood

Objective: The study of escalating low-dose Δ9-tetrahydrocannabinol (Δ9-THC) administration – the main psychoactive component of the plant cannabis - during adolescence focusing on behavioral, neurochemical and neurobiological indices of adult rats.Methodology: In the present study escalating low-dose adolescent Δ9-THC was used (between post-natal days 35-45) in male rats (0.3 mg/kg, 1 mg/kg, 3 mg/kg) in order to better simulate the human adolescent cannabis abuse and its effects on adulthood. Behavioral studies aimed to pattern an endophenotype providing information on spontaneous motor activity of adult rats, their habituation profile in the open field, their object location discrimination ability and the spatial memory and learning through the evaluation of the Morris Water Maze test, and their higher-order cognitive functions through the attentional set-shift test. In parallel, we assessed the filtering of the sensorimotor information through the pre-pulse inhibition test and the impact of acute d-amphetamine (1 mg/kg) hyperlocomotion on the motor response of adult rats. The neurochemical–neurobiological studies aimed to evaluate Δ9-THC effects concerning dopaminergic and serotonergic activity in specific brain regions (prefrontal cortex, hippocampus, dorsal striatum, nucleus accumbens) using High Performance Liquid Chromatography, while in the aforementioned regions DAT and SERT protein expression levels were measured. Further neurobiological evaluation aimed to study protein expression levels of specific markers and to correlate them with the observed behavioral and neurochemical changes (BDNF pathway and evaluation of cannabinoid receptors CB1 and CB2).Results: The escalating low-dose Δ9-ΤΗC treatment during adolescence induced major changes in behavioral parameters. In particular, our pharmacological model led to increased spontaneous horizontal and vertical activity and affected the pattern of behavioral habituation of adult rats in the open-field test. Moreover, escalating low-dose Δ9-ΤΗC treatment led to impairment in adult short-term spatial recognition memory and learning. On the contrary, our protocol did not affect either the execution of higher-order cognitive tasks or the filtering of sensorimotor gating during adulthood. Moreover, we observed a reduction in motor parameters of adult Δ9-ΤΗC-treated rats that received an acute dose of d-amphetamine. Regarding the neurochemical evaluation of dopaminergic and serotonergic activity in specific brain regions of adult rats, an opposing pattern of changes between the two neurotransmitter systems was found in adult rats treated with Δ9-THC. These changes were accompanied with increased protein expression levels of serotonin transporter in the hippocampus, while unaffected DAT protein expression levels were observed. Finally, we observed decreased expression levels of the neuroplasticity marker BDNF in the hippocampus as well as in the prefrontal cortex of Δ9-THC-treated rats in adulthood, while increased CB1 receptor levels were measured in the prefrontal cortex.Conclusions: Adolescent low-dose Δ9-THC treatment induced a «cognitive deranged» phenotype regarding alterations in specific indices that could be related to psychotic-like symptomatology.Στόχος: Η μελέτη της χορήγησης χαμηλών, κλιμακούμενων δόσεων Δ9-τετραϋδροκανναβινόλης (Δ9-THC) - του κύριου ψυχοδραστικού συστατικού της κάνναβης - κατά την εφηβεία στο συμπεριφορικό, νευροχημικό και νευροβιολογικό προφίλ ενήλικων επιμύων. Μεθοδολογία: Χρησιμοποιήθηκαν χαμηλές κλιμακούμενες δόσεις Δ9-THC κατά την εφηβεία (μεταγεννητική ημέρα 35-45) σε αρσενικούς επιίμυες (0.3 mg/kg, 1 mg/kg, 3 mg/kg), σε μια προσπάθεια προσομοίωσης της χρήσης κάνναβης στους έφηβους και της επίδρασή της κατά την ενηλικίωση. Οι συμπεριφορικές μελέτες εστιάστηκαν στον έλεγχο της αυθόρμητης κινητικής δραστηριότητας των επιμύων και της ικανότητας εξοικείωσής τους στο ανοικτό πεδίο, της ικανότητα διάκρισης νέας θέσης αντικειμένου, της έκφρασης της χωρικής μάθησης και μνήμης μέσω της δοκιμασίας υδάτινου λαβύρινθου κατά Morris και στις ανώτερες εκτελεστικές ικανότητες μέσω της δοκιμασίας μετατόπισης της προσοχής. Ελέγχθηκε η ροή αισθητικοκινητικής πληροφορία χρησιμοποιώντας τη δοκιμασία προ-παλμικής αναστολής, και κατά πόσο επηρεάζεται η αυξημένη κινητική δραστηριότητα μετά από οξεία χορήγηση d-αμφεταμίνης (1 mg/kg) στην ενηλικίωση. Οι νευροχημικές-νευροβιολογικές μελέτες έγιναν με στόχο τη διερεύνηση των επιδράσεων της Δ9-THC όσον αφορά τη ντοπαμινεργική και σεροτονεργική δραστηριότητα σε συγκεκριμένες εγκεφαλικές περιοχές μέσω Υγρής Χρωματογραφίας Υψηλής Απόδοσης, ενώ στις περιοχές αυτές αξιολογήθηκαν τα επίπεδα έκφρασης των μεταφορέων ντοπαμίνης και σεροτονίνης. Επιπλέον, μετρήθηκαν τα επίπεδα έκφρασης συγκεκριμένων δεικτών και ελέγχθηκε η συσχέτισή τους με τις παρατηρούμενες συμπεροφορικές/νευροχημικές αλλαγές (πχ το μονοπάτι του νευροπαράγοντα BDNF και η έκφραση των υποδοχέων των κανναβινοειδών τύπου 1 και 2).Αποτελέσματα: Το φαρμακολογικό μας μοντέλο οδήγησε σε αύξηση της αυθόρμητης κινητικότητας και επηρέασε το προφίλ εξοικείωσης των ενήλικων επιμύων στο ανοικτό πεδίο. Επιπλέον, η χορήγηση χαμηλών δόσεων Δ9-THC οδήγησε σε βλάβη στη βραχύχρονη αναγνωριστική χωρική μνήμη και μάθηση κατά την ενηλικίωση. Αντίθετα, δεν παρατηρήθηκαν αρνητικές επιδράσεις κατά την εκτέλεση δοκιμασιών που ελέγχουν ανώτερες εκτελεστικές λειτουργίες και τη ροή της αισθητικοκινητικής πληροφορίας στην ενηλικιωση. Επίσης, παρατηρήθηκε μείωση των κινητικών παραμέτρων στους επίμυες που έλαβαν Δ9-THC κατά την εφηβεία μετά από οξεία χορήγηση d-αμφεταμίνης στην ενηλικίωση. Αναφορικά με το νευροχημικό έλεγχο της ντοπαμινεργικής και σεροτονεργικής δραστηριότητας σε συγκεκριμένες περιοχές των ενήλικων εγκεφάλων, παρατηρήθηκε ένα αντίθετο πρότυπο μεταβολών μεταξύ των δυο νευροδιαβιβαστικών συστημάτων για τους ενήλικες επίμυες που έλαβαν Δ9-THC. Οι αλλαγές αυτές συνοδεύτηκαν από αυξημένα επίπεδα έκφρασης του μεταφορέα της σεροτονίνης στον ιππόκαμπο, αφήνοντας αμετάβλητα τα επίπεδα έκφρασης του μεταφορέα της ντοπαμίνης. Τέλος, παρατηρήθηκαν μειωμένα επίπεδα έκφρασης του νευροπλαστικού δείκτη BDNF στον ιππόκαμπο και τον προμετωπιαίο φλοιό για τους Δ9-THC επίμυες κατά την ενηλικίωση, ενώ αυξημένα επίπεδα έκφρασης του υποδοχέα CB1 καταγράφηκαν στον προμετωπιαίο φλοιό.Συμπεράσματα: Η χορήγηση χαμηλών, αυξανόμενων δόσεων Δ9-THC κατά την εφηβεία δεν οδήγησε στην εμφάνιση αμιγούς τύπου ψυχωτικής συμπτωματολογίας, αλλά συνδέθηκε με την εμφάνιση ενός «αποδιοργανωμένου γνωστικά» φαινοτύπου συνοδευόμενου από συγκεκριμένες αλλαγές σε δείκτες, ορισμένοι από τους οποίους μπορούν να συσχετιστούν με την εμφάνιση ψυχοπαθολογίας