The Czech Home Parenteral Nutrition Registry REDNUP: Comprehensive Analysis of Adult Patients' Data.

INTRODUCTION: Home parenteral nutrition (HPN) is the primary treatment modality for patients with chronic intestinal failure, one of the least common organ failures. This article provides a retrospective analysis of the data collected on HPN patients in the Czech Republic over the past 30 years. METHODS: National registry data were collected using a standardised online form based on the OASIS registry (Oley - A.S.P.E.N. Information System) across all centres providing HPN in the Czech Republic. Data collected prospectively from adult patients in the HPN program were analysed in the following categories: epidemiology, demographics, underlying syndrome, diagnosis, complications, and teduglutide therapy prevalence. RESULTS: The registry identified a total of 1,838 adult patient records, reflecting almost 1.5 million individual catheter days. The prevalence of HPN has risen considerably over the last few decades, currently reaching 5.5 per 100,000 population. The majority of patients have short bowel syndrome and GI obstruction, with cancer being the most prevalent underlying disease. Catheter-related bloodstream infections have been the most prevalent acute complication. However, the incidence in 2022 was only 0.15 per 1,000 catheter days. The study also observed an increase in the prevalence of patients on palliative HPN over the last decade. CONCLUSION: This study presents a thorough analysis of data from the Czech REgistr Domaci NUtricni Podpory (REDNUP) registry. It shows an increasing prevalence of HPN, namely, in the palliative patient group. The sharing of national data can improve understanding of this rare condition and facilitate the development of international guidelines.

Quality of Life after Reconstructive Surgery for Intestinal Fistulas.

BACKGROUND: This retrospective clinical study would like to objectively denote a quality of life of persons afflicted by an abdominal catastrophe and managed by an extensive surgery can be almost as well conformable as those of healthy people in a similar age group. METHODS: A set of eighteen patients who were successfully surgically treated and cured enjoyed a relatively good convalescence after their surgery and returned to a satisfactory standard of life from the point of view of organ function and psychosomatic state. Statistical analysis of the data collected over a period of 1 to 6 years after this complex therapy using special questionnaire for QOL assessment SF-36 was performed. RESULTS: Almost half of the patients evaluated their state similarly to the rest of the population of comparable age and general health status. The remainder of the patients declared significantly worse evaluations in the majority of the observed domains of the questionnaire. CONCLUSION: Therapy of these patients was and must be complex: it included preparation for surgery at a special metabolic internal site, careful diagnostics of the digestive tract state, suitable surgery and good quality care after the surgery.

[Diffuse alveolar hemorrhage - acute, life-threatening situation in rheumatology]. / Difuzní alveolární hemoragie - akutní, zivot ohrozující stav v revmatologii.

Diffuse alveolar hemorrhage (DAH) is a life-threatening acute manifestation of systemic diseases, the most commonly of systemic vasculitis. Clinically DAH manifests by a rapidly progressive respiratory and renal failure. The decisive for diagnose is immediate bronchoscopic examination with the bronchoalveolar lavage examination. CT mostly show bilateral pulmonary infiltrates, in blood picture rapidly come to anemia. In the majority of patients it can be found positive ANCA antibodies. DAH should be suspected in the case of acute respiratory failure also in patients without history of systemic disease. On the set of 33 patients with acute DAH episode, we demonstrate the importance of rapid diagnosis and aggressive therapy. In a third of our patients was DAH the first manifestation of systemic disease. Immunomodulatory treatment must be initiated immediately after diagnose. Hospital mortality in our group was 27 %, although 42 % of the patients were required ventilation support and one-third of patients had acute renal failure. After handling of acute episode of DAH is the prognosis quoad vitam promising.Key words: bronchoalveolar fluid - diffuse alveolar haemorrhage - granulomatosis with polyangiitis - intensive care in rheumatology - vasculitis.

Trace Element Status (Zinc, Copper, Selenium, Iron, Manganese) in Patients with Long-Term Home Parenteral Nutrition.

BACKGROUND: The objective of the present study was to determine concentrations of zinc (Zn), copper (Cu), iron (Fe), selenium (Se) in blood plasma and manganese (Mn) in the whole blood in patients with long-term home parenteral nutrition (HPN) in comparison to the control group. PATIENTS AND METHODS: We examined 68 patients (16 men and 52 women) aged from 28 to 68 years on a long-term HPN lasting from 4 to 96 months. The short bowel syndrome was an indication for HPN. The daily doses of Zn, Cu, Fe, Se and Mn in the last 3 months were determined. RESULTS: No significant differences in blood plasma were found for Zn, Cu and Fe in patients with HPN and in the control group (p > 0.05). The concentration of Mn in whole blood was significantly increased in HPN patients (p < 0.0001), while Se concentration in these patients was significantly decreased (p < 0.005). The concentration of Mn in the whole blood of 16 patients with cholestasis was significantly increased compared to the patients without cholestasis (p < 0.001). The Cu concentration was increased with no statistical significance. CONCLUSION: In long-term HPN, the status of trace elements in the patients has to be continually monitored and the daily substitution doses of these elements have to be flexibly adjusted. Dosing schedule needs to be adjusted especially in cases of cholestatic hepatopathy. A discussion about the optimal daily dose of Mn in patients on HPN is appropriate. For clinical practice, the availability of a substitution mixture of trace elements lacking Mn would be advantageous.

Space GlucoseControl system for blood glucose control in intensive care patients--a European multicentre observational study.

BACKGROUND: Glycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B.Braun Space GlucoseControl system (SGC), which allows direct data communication between pumps and microprocessor. The present study was undertaken to assess the clinical performance and safety of the SGC for glycaemia control in critically ill patients under routine conditions in different ICU settings and with various nutritional protocols. METHODS: The study endpoints were the percentage of time the BG was within the target range 4.4 - 8.3 mmol.l(-1), the frequency of hypoglycaemic episodes, adherence to the advice of the SGC and BG measurement intervals. BG was monitored, and insulin was given as a continuous infusion according to the advice of the SGC. Nutritional management (enteral, parenteral or both) was carried out at the discretion of each centre. RESULTS: 17 centres from 9 European countries included a total of 508 patients, the median study time was 2.9 (1.9-6.1) days. The median (IQR) time-in-target was 83.0 (68.7-93.1) % of time with the mean proposed measurement interval 2.0 ± 0.5 hours. 99.6% of the SGC advices on insulin infusion rate were accepted by the user. Only 4 episodes (0.01% of all BG measurements) of severe hypoglycaemia <2.2 mmol.l(-1) in 4 patients occurred (0.8%; 95% CI 0.02-1.6%). CONCLUSION: Under routine conditions and under different nutritional protocols the Space GlucoseControl system with integrated eMPC algorithm has exhibited its suitability for glycaemia control in critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01523665.

A distinct influenza infection signature in the blood transcriptome of patients with severe community-acquired pneumonia.

INTRODUCTION: Diagnosis of severe influenza pneumonia remains challenging because of a lack of correlation between the presence of influenza virus and clinical status. We conducted gene-expression profiling in the whole blood of critically ill patients to identify a gene signature that would allow clinicians to distinguish influenza infection from other causes of severe respiratory failure, such as bacterial pneumonia, and noninfective systemic inflammatory response syndrome. METHODS: Whole-blood samples were collected from critically ill individuals and assayed on Illumina HT-12 gene-expression beadarrays. Differentially expressed genes were determined by linear mixed-model analysis and overrepresented biological pathways determined by using GeneGo MetaCore. RESULTS: The gene-expression profile of H1N1 influenza A pneumonia was distinctly different from those of bacterial pneumonia and systemic inflammatory response syndrome. The influenza gene-expression profile is characterized by upregulation of genes from cell-cycle regulation, apoptosis, and DNA-damage-response pathways. In contrast, no distinctive gene-expression signature was found in patients with bacterial pneumonia or systemic inflammatory response syndrome. The gene-expression profile of influenza infection persisted through 5 days of follow-up. Furthermore, in patients with primary H1N1 influenza A infection in whom bacterial co-infection subsequently developed, the influenza gene-expression signature remained unaltered, despite the presence of a superimposed bacterial infection. CONCLUSIONS: The whole-blood expression-profiling data indicate that the host response to influenza pneumonia is distinctly different from that caused by bacterial pathogens. This information may speed the identification of the cause of infection in patients presenting with severe respiratory failure, allowing appropriate patient care to be undertaken more rapidly.

Characterization of Newly Developed Zinc Composite with the Content of 8 wt.% of Hydroxyapatite Particles Processed by Extrusion.

Zinc and its alloys belong to a group of biodegradable materials, which can be potentially used for the preparation of temporary orthopedic implants. The research of biodegradable zinc materials revealed a lot of limitations; however, the new processing approaches of those materials can enhance their properties, which are insufficient for now. In this study, the zinc composite with 8 wt.% of hydroxyapatite (Zn/HA8) prepared for the first time by extrusion process was characterized from the point of view of the structural, mechanical and corrosion properties. The extrusion process led to good integrity of the interfaces between the zinc and hydroxyapatite particles. Mechanical behavior confirmed the role of hydroxyapatite as a defect in the material structure, which led to a decrease of the Zn/HA8 mechanical properties by approximately 30% (compressive yield strength (CYS) = 154 MPa Zn, 113 MPa Zn/HA8). Despite that, the Zn/HA8 composite showed sufficient mechanical properties for cancellous bone replacement and reached the lower limit for cortical bone. Additionally, the presence of hydroxyapatite caused the preferential precipitation of hydroxyapatite (HA) from the solution and can lead to a significant enhancement of the tissue/implant interface interactions.

The Impact of Glucose-Based or Lipid-Based Total Parenteral Nutrition on the Free Fatty Acids Profile in Critically Ill Patients.

INTRODUCTION: Our study aim was to assess how the macronutrient intake during total parenteral nutrition (TPN) modulates plasma total free fatty acids (FFAs) levels and individual fatty acids in critically ill patients. METHOD: Adult patients aged 18-80, admitted to the intensive care unit (ICU), who were indicated for TPN, with an expected duration of more than three days, were included in the study. Isoenergetic and isonitrogenous TPN solutions were given with a major non-protein energy source, which was glucose (group G) or glucose and lipid emulsions (Smof lipid; group L). Blood samples were collected on days 0, 1, 3, 6, 9, 14, and 28. RESULTS: A significant decrease (p < 0.001) in total FFAs occurred in both groups with a bigger decrease in group G (p < 0.001) from day 0 (0.41 ± 0.19 mmol∙L-1) to day 28 (0.10 ± 0.07 mmol∙L-1). Increased palmitooleic acid and decreased linoleic and docosahexaenoic acids, with a trend of increased mead acid to arachidonic acid ratio, on day 28 were observed in group G in comparison with group L. Group G had an insignificant increase in leptin with no differences in the concentrations of vitamin E, triacylglycerides, and plasminogen activator inhibitor-1. CONCLUSION: Decreased plasma FFA in critically ill patients who receive TPN may result from increased insulin sensitivity with a better effect in group G, owing to higher insulin and glucose dosing and no lipid emulsions. It is advisable to include a lipid emulsion at the latest from three weeks of TPN to prevent essential fatty acid deficiency.

Photonic crystal cavity-enhanced emission from silicon vacancy centers in polycrystalline diamond achieved without postfabrication fine-tuning.

Diamond optical centers have recently emerged as promising single-photon sources for quantum photonics. Particularly, negatively charged silicon vacancy (SiV-) centers show great promise due to their narrow zero-phonon emission line present also at room temperature. However, due to fabrication tolerances it is challenging to prepare directly photonic structures with optical modes spectrally matching the emission of SiV- centers. To reach the spectral overlap, photonic structures must typically undergo complicated post-processing treatment. In this work, suspended photonic crystal cavities made of polycrystalline diamond are engineered and more than 2.5-fold enhancement of the SiV- center zero-phonon line intensity via coupling to the cavity photonic mode is demonstrated. The intrinsic non-homogeneous thickness of the diamond thin layer within the sample is taken as an advantage that enables reaching the spectral overlap between the emission from SiV- centers and the cavity modes without any post-processing. Even with lower optical quality compared to monocrystalline diamond, the fabricated photonic structures show comparable efficiency for intensity enhancement. Therefore, the results of this work may open up a promising route for the application of polycrystalline diamond in photonics.

Microbending Experiments on Pure Magnesium with Nonbasal Slip Orientation.

In the present study, in situ microbending experiments on magnesium single crystalline microcantilevers are presented. Microcantilevers with pentagonal cross-section were fabricated by focus ion beam. Two basic crystallographic orientations of the microcantilevers were investigated: {0001} and {10-10}, i.e., the c-axis perpendicular to and parallel with the cantilever top surface, respectively. After bending, the longitudinal sections of the microcantilevers were analyzed using electron backscatter diffraction to investigate the crystal lattice rotations and accumulated deformations. The stress levels in the loaded cantilevers are strongly dependent on the crystal orientation. Extension twins were found in the {10-10} cantilevers.

Effect of Nitrogen Doping and Temperature on Mechanical Durability of Silicon Carbide Thin Films.

Amorphous silicon carbide (a-SiC) films are promising solution for functional coatings intended for harsh environment due to their superior combination of physical and chemical properties and high temperature stability. However, the structural applications are limited by its brittleness. The possible solution may be an introduction of nitrogen atoms into the SiC structure. The effect of structure and composition on tribo-mechanical properties of magnetron-sputtered a-SiCxNy thin films with various nitrogen content (0-40 at.%) and C/Si close to one deposited on silicon substrates were evaluated before and after exposure to high temperatures up to 1100 °C in air and vacuum. IR transmission spectroscopy revealed formation of multiple C-N bonds for the films with N content higher than 30 at.%. Improvement of the organization in the carbon phase with the increase of nitrogen content in the a-SiCN films was detected by Raman spectroscopy. Nanoindentation and scratch test point out on the beneficial effect of the nitrogen doping on the tribo-mechanical performance of a-SiCxNy coatings, especially for the annealed coatings. The improved fracture resistance of the SiCN films stems from the formation of triple C≡N bonds for the as deposited films and also by suppression of SiC clusters crystallization by incorporation of nitrogen atoms for annealed films. This together with higher susceptibility to oxidation of a-SiCN films impart them higher scratch and wear resistance in comparison to SiC films before as well as after the thermal exposure. The best tribo-mechanical performance in term of high hardness and sufficient level of ductility were observed for the a-Si0.32C0.32N0.36 film. The enhanced performance is preserved after the thermal exposure in air (up to 1100 °C) and vacuum (up to 900 °C) atmosphere. Annealing in oxidizing atmosphere has a beneficial effect in terms of tribological properties. Harder films with lower nitrogen content suffer from higher brittleness. FIB-SEM identified film-confined cracking as the initial failure event in SiC, while it was through-interface cracking for SiCN at higher loads. This points out on the higher fracture resistance of the SiCN films where higher strains are necessary for crack formation.

Dynamics of antioxidants in patients with acute pancreatitis and in patients operated for colorectal cancer: a clinical study.

OBJECTIVES: This clinical study compared the dynamics of antioxidants levels in patients with acute pancreatitis (AP), patients operated for colorectal cancer (CA), and healthy control subjects. METHODS: This prospective descriptive study enrolled 21 AP and 14 CA patients and 17 healthy controls. Blood was collected from AP patients on days 1, 5, and 9 and from CA patients before surgery and on days 1, 5, and 9 after surgery. We measured concentrations of selenium in plasma, red blood cells (RBCs), and big-toe nails, vitamin A (retinol) in serum, alpha-tocopherol in serum and in RBCs, vitamin C in serum, concentration ratio of 9,11- and 10,12-octadecanoic acids to linoleic acid in RBC membrane, activity of superoxide dismutase, and glutathione peroxidase in RBCs. RESULTS: Plasma concentrations of selenium, vitamin A, and vitamin C were significantly lower in AP and CA patients than in healthy controls over the monitored period (P < 0.05). Patients with severe AP had a significantly lower concentration of selenium in RBCs than did healthy controls and CA patients (P < 0.05). The concentration of selenium in toe nails of AP patients was significantly lower than that in CA patients and healthy controls (P < 0.001). The marker of increased reactive oxygen species activity the ratio of 9,11- and 10,12-octadecanoic acids to linoleic acid in RBCs was significantly higher in AP and CA patients than in healthy controls (P < 0.05). CONCLUSIONS: Low levels of measured antioxidants and increased activity of reactive oxygen species occurred during the course of AP. These findings applied in particular to patients who had severe AP. Levels of measured antioxidants seemed to be similar in AP and CA patients except for lower levels of selenium in toe nails in AP patients and lower selenium concentrations in RBCs in patients with severe AP.

Incidence of intravenous drug incompatibilities in intensive care units.

AIMS: Drug incompatibilities are relatively common in inpatients and this may result in increased morbidity/mortality as well as add to costs. The aim of this 12 month study was to identify real incidences of drug incompatibilities in intravenous lines in critically ill patients in two intensive care units (ICUs). METHODS: A prospective cross sectional study of 82 patients in 2 ICUs, one medical and one surgical in a 1500-bed university hospital. One monitor carried out observations during busy hours with frequent drug administration. Patients included in both ICUs were those receiving at least two different intravenous drugs. RESULTS: 6.82% and 2.16% of drug pairs were found to be incompatible in the two ICUs respectively. Among the most frequent incompatible drugs found were insulin, ranitidine and furosemide. CONCLUSIONS: The study showed that a significant number of drug incompatibilities occur in both medical and surgical ICUs. It follows that the incidence of incompatibilities could be diminished by adhering to a few simple rules for medication administration, following by recommendations for multiple lumen catheter use. Future prospective studies should demonstrate the effect of applying these policies in practice.

Hyaluronate-iodine complex: a new adjunct for the management of complex sternal wounds after a cardiac operation.

A wound-healing agent developed in the European Union is based on the combination of organic hyaluronan with inorganic iodine. The aim of this pilot study was to assess the efficacy and safety of hyaluronate-iodine in the treatment of sternal wounds. Eight patients with sternal wound dehiscence were entered into the study. After debridement, wounds were dressed with gauze soaked in hyaluronate-iodine. In one patient with an epipleural abscess, hyaluronate-iodine was instilled directly into the abscess cavity daily. Complete healing was achieved in 7 patients, and 1 patient underwent a reconstructive operation for wound closure. The mean (SD) length of treatment was 136 (114.2) days. No adverse effects or complications were apparent in this group. Hyaluronate-iodine is safe and effective in healing sternal wound dehiscence. Randomized controlled trials are needed for further validation.