Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients:An international survey

Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care

A new damping modelling approach and its application in thin wall machining

In this paper, a new approach to modelling the damping parameters and its application in thin wall machining is presented. The approach to predicting the damping parameters proposed in this paper eliminates the need for experiments otherwise used to acquire these parameters. The damping model proposed was compared with available damping models and experimental results. A finite element analysis and Fourier transform approach has been used to obtain frequency response function (FRF) needed for stability lobes prediction. Several predicted stable regions using both experimental and numerical FRF’s for various examples gave a good comparison.Engineering and Physical Sciences Research Counci

The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

BACKGROUND: Short bowel syndrome (SBS) is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition (TPN). Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A (S-IgA), impairs intestinal immunity, and changes mucosal architecture in children with SBS. METHODS: The databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity. RESULTS: A total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1) sepsis, 2) impaired immune functions: In vitro studies, 3) mortality, 4) villous atrophy, 5) duration of dependency on TPN after bowel resection. CONCLUSION: Based on this exhaustive literature review, there is no direct evidence suggesting that TPN promotes bacterial overgrowth, impairs neutrophil functions, inhibits blood's bactericidal effect, causes villous atrophy, or causes to death in human model. The hypothesis relating negative effects of TPN on gut immunity remains attractive, but unproven. Enteral nutrition is cheaper, but no safer than TPN. Based on the current evidence, TPN seems to be safe and a life saving solution

J Fr Ophtalmol

Introduction : Les implants corticoïdes à libération prolongée sont injectés dans la cavité vitréenne à l’aide de stylos préchargés. L’implant de fluocinolone (FAc) se caractérise par une taille environ deux fois inférieure à celle de celui de dexaméthasone (Dex-I). Il est également simplement « déposé » dans la base du vitré et non propulsé dans la cavité vitréenne comme le Dex-I. Le contrôle de son bon positionnement après injection est de ce fait très difficile en ophtalmoscopie indirecte. Notre étude a pour objectif de comparer les performances des différents examens disponibles pour confirmer la présence dans la cavité vitréenne du FAc après injection. Méthodes : Douze yeux de 12 patients consécutifs ont été inclus dans une étude rétrospective monocentrique, observationnelle, réalisée au CHU de Bordeaux. Les patients ont tous bénéficié de l’injection du FAc après dilatation pupillaire, puis d’un fond d’œil, d’une rétinographie grand-champ (Clarus®, Carl-Zeiss-Meditec, Dublin, CA, USA) et d’une rétinographie ultra-grand-champ (California®, Optos, Edinbourg, Royaume-Uni). Sept jours après, une échographie en mode-B (10 MHz, AVISO, Quantel-medical, France) et une échographie UBM (50 MHz, AVISO, Quantel-medical, France) ont été réalisées. Résultats : Le fond d’œil et la rétinographie grand-champ ont permis d’observer 4/12 implants (33,3 %). La rétinophotographie ultra-grand-champ a permis de détecter 6/12 implants (50 %). Tous les implants vus au fond d’œil et en rétinographie grand-champ ont été également visualisés avec l’ultra-grand-champ. L’échographie en mode-B a mis en évidence 5/12 implants (41,6 %) et l’UBM 9/12 implants (75 %). Enfin, un implant a migré en chambre antérieure et a pu être mis en évidence dans l’angle irido-cornéen en gonioscopie. Conclusion : La confirmation objective du bon positionnement de l’implant FAc est essentielle. S’il n’est pas visible au simple FO et à l’examen du segment antérieur, la rétinographie ultra-grand-champ puis l’échographie UBM apparaissent comme étant les deux meilleures modalités d’imagerie.INTRODUCTION: Sustained-release corticosteroid implants are injected into the vitreous cavity using preloaded pens. The fluocinolone (FAc) implant is approximately half the size of the dexamethasone implant (Dex-I). It is simply introduced in the vitreous base rather than propelled into the vitreous cavity as is Dex-I. Verification of its positioning after injection is thus difficult by indirect ophthalmoscopy. The goal of our study is to compare the performance of available clinical and imaging tools to confirm the presence of the FAc in the vitreous cavity following injection. METHODS: Twelve eyes of 12 consecutive patients were included in a retrospective, single-center, observational study carried out at the Bordeaux University Hospital, France. All patients were injected with the FAc after pupil dilation, and presence of the implant was immediately checked by indirect biomicroscopy, wide-field retinography (Clarus®, Carl-Zeiss-Meditec, Dublin, CA, USA) and ultra-wide-field retinography (California®, Optos, Edinburgh, United-Kingdom). Seven days later, a B-mode ultrasonography (10MHz, AVISO, Quantel-medical, France) and an UBM ultrasonography (50MHz, AVISO, Quantel-medical, France) were performed. RESULTS: Indirect biomicroscopy and wide-field retinography detected 4/12 implants (33.3%). Ultra-wide-field retinophotography detected 6/12 implants (50%). All the implants seen using indirect biomicroscopy and wide-field retinography were also visualized with ultra-wide-field. B-mode ultrasonography showed 5/12 implants (41.6%) and UBM 9/12 implants (75%). Finally, one implant dislocated into the anterior chamber and was seen in the iridocorneal angle on gonioscopy. CONCLUSION: Objective confirmation of the proper positioning of the FAc implant in the vitreous cavity is mandatory. If both indirect ophthalmoscopy and anterior examination fail to detect it, ultra-wide field retinography along with UBM ultrasonography, if necessary, appear to be the two best imaging modalities to use