The primary objective was to compare the efficacy of a single-dose misoprostol for abortion before 7 weeks of gestation and between 7 and 9 weeks of gestation. The secondary objectives were to ...compare the amount of misoprostol required for complete expulsion, the need for endo-uterine aspiration, and to assess pain and patient experience in these two groups.
This was a single-centre prospective observational study conducted at the University Hospitals of Strasbourg from 1st October 2019 to 31st December 2020.
A total of 306 patients were included, 150 in the group before 7 weeks of gestation and 156 in the group between 7 and 9 weeks of gestation. There was no significant difference in the success rate of the single dose of misoprostol between the two groups with 34.7 and 37.8% respectively (P=0.63). After taking painkillers, there is no difference in terms of pain relief (EN ≤ 4 for 92 et 95% of patients P=0.37).
The single dose of misoprostol for in-hospital abortion is as effective between 7 and 9 weeks of gestation as it is before 7. By extension, therefore, we would suggest that there should be no difference in efficacy between home abortions before 7 weeks of gestation and between 7 and 9 weeks of gestation and therefore suggest that home abortions can be performed up to 9 weeks of gestation without fear of a decrease in the rate of complete expulsion and the efficacy of analgesia, with potentially less use of misoprostol compared with the hospital setting.
Identifying rare genetic forms of infantile cholestasis is challenging due to their similar clinical presentation and their diverse etiology. After exclusion of common non-genetic causes a huge list ...of rare differential diagnosis remains to be solved. More than 90 genes are associated with monogenic forms of infantile cholestasis, thus preventing routine genetic workup by Sanger sequencing.
Here we demonstrate a next generation sequencing approach to discover the underlying cause in clinically well characterized patients in whom common causes of infantile cholestasis have been excluded. After validation of the analytical sensitivity massive parallel sequencing was performed for 93 genes in six prospectively studied patients. Six novel mutations (PKHD1: p.Thr777Met, p.Tyr2260Cys; ABCB11: p.Val1112Phe, c.611+1G > A, p.Gly628Trpfs*3 and NPC1: p.Glu391Lys) and two known pathogenic mutations were detected proving our multi gene panel for infantile cholestasis to be a sensitive and specific method overcoming the complexity of the phenotype-based, candidate gene approach.
Three exemplary clinical cases of infants with cholestasis are presented and discussed in the context of their genetic and histopathological findings (autosomal recessive polycystic kidney disease, atypical PFIC and Niemann–Pick syndrome type C1). These case reports highlight the critical impact of integrating clinical, histopathological and genetic data during the process of multi gene panel testing to ultimately pinpoint rare genetic diagnoses.
Patients with detrusor-sphincter dysynergia (DSD) who are unable to perform self-catheterisation can benefit from an endoscopic treatment. We chose regular urethral stent changes as an alternative to ...sphincterotomy in this kind of patients. The purpose of this study is to show that temporary urethral stents changes represent a treatment option with a reasonable morbidity for patients with DSD.
We retrospectively reviewed patients in our center who had been treated with urethral stents from April 2005 to September 2017. The stent changes were performed every 12 to 18 months depending on urethrovesical fibroscopy findings. The primary endpoint was treatment continuation.
A total of 44 patients were enrolled in our study and the average follow-up duration was 46 months 18.5-53.25. Primary treatment failure was seen in 14 (32%) patients mainly due to problems related to equipment (n=3) and urinary retention (n=2). Four patients died before their first stent change. The treatment was successful in 30 (68%) patients, of whom 10 (33%) subsequently adopted a voiding mode change. We lost sight of 5 patients (11%) during follow-up. The main complications were urinary retention (29%), urinary tract infections (27%) and stent migration (18%). Fifteen (34%) experienced grade III-IV complications.
Regular urethral stent changes represent an alternative treatment option for patients with DSD but with a significant morbidity.
4.
While breast milk appears to be superior to formula for the development of very low birthweight (VLBW) infants, it is supplemented to meet the metabolic demands of the rapidly growing premature ...infant. To estimate the nutritional variability of breast milk from mothers of VLBW infants, protein (bicinchoninic acid method) and fat content (creamatocrit) were measured in breast‐milk spot samples from mothers of 20 VLBW infants, collected 4 times a day during the first 4 wk of lactation Protein content (median 1.9 g dl−1, range 1.1–3.5 g dl−1) and fat content (3.8/1.0–14.6 g dl−1) were highly variable and lacked a normal distribution over all samples and in individual women's milk. There was only a weak correlation between fat and protein (rs= 0.416, p < 0.001). Fat but not protein was lower in morning samples than in samples collected later in the day (p < 0.001). Protein but not fat content decreased during the weeks of lactation (rs=−0.446, p < 0.001). No impact of the baby's gestational age was observed.
Conclusion: The fat and protein content of breast milk from mothers of VLBW infants is highly variable, calling into question the clinical feasibility of individualized supplementation of breast milk for VLBW infants based on spot sample measurements.
Four different series of polyacrylamides containing different amounts of azobenzene moieties have been synthesized via a polymer analogous reaction of poly(pentafluorophenylacrylate) (PPFPA). All ...copolymers were designed to exhibit a lower critical solution temperature (LCST) in aqueous solution, which was dependent on (i) the amount of incorporated chromophoric azobenzene groups and (ii) the isomerization state of the respective azobenzene group. Higher LCST values were measured for UV-irradiated solutions of the copolymers in comparison to the non-irradiated copolymer solutions. A maximum difference in the LCST of up to 7°C was found for the copolymer poly(N,N-dimethylacrylamide) containing 8.5mol% of azobenzene groups. Within this temperature range, a reversible solubility change of the copolymer could be induced by irradiation with light.
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Background: Previous guidelines on Paediatric Parenteral Nutrition (PN) were published in 2010, by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the ...European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR) were published. The aim of the present paper was to provide up-to-date evidence for health professionals working with infants, children and adolescents receiving PN. Methods: The current document is a revision of the 2005 guidelines produced by the same 3 organizations (ESPEN, ESPGHAN, ESPR) together with the Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Experts participating in the guideline updating process were all professionals with extensive experience in managing PN from a wide range of European countries, Israel and China. The guideline development process was coordinated by a guideline steering committee. Each chapter of the guideline was prepared by a separate author group. These author groups were responsible for screening titles and abstracts identified by a systematic literature search for inclusion, for conducting additional expert searches (including secondary sources such as other published valid guidelines), for evaluating the quality of studies included in the given chapter and assigning evidence levels to the literature. Based on the evidence level of included studies experts formulated and graded recommendations. A consensus conference was held in February 2015. All chapter manuscripts were revised following the recommendations of the consensus conference and then reviewed and edited by the project steering committee. Final consensus on each individual guideline and its individual recommendations was achieved and assessed by online voting. This process lasted until January 2018. Funding for the consensus conference (including travel expenses for participants) was provided by all participating societies. No other funding was received for the guideline updating process and participants received no payment. Support was provided by the Hungarian Cochrane organization. Results/conclusions: The present document provides guideline for the use of PN across the wide range of pediatric patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg 1. It covers their individual macro- and micronutrient needs 2, 3, 4, 5, 6, 7, 8, fluid requirements 9, venous access 10, organizational aspects 11, home parenteral nutrition 12, standardized vs. individualized PN 13, and last but not least a wide range of safety considerations for prevention and management of complications such central line associated bloodstream infections (CLABSI)
Zusammenfassung
Trotz des häufigen Auftretens von krankheitsassoziierter Unterernährung (KaU) bei Kindern und Jugendlichen – auch in Deutschland – steht diese Problematik (im Gegensatz zum Thema ...Übergewicht und Adipositas) kaum im Fokus der Beschäftigten rund um die Kinder- und Jugendgesundheit. Die Prävalenz von KaU beträgt in Deutschland bis zu 23 % bei pädiatrischen Patienten. Mit KaU sind, z. T. schwerwiegende, gesundheitliche Folgen (z. B. Infektionen und andere Komplikationen, beeinträchtigte Lebensqualität, negative epigenetische Effekte, erhöhte Mortalität) verbunden. Die ökonomische Belastung für das Gesundheitssystem durch längere Krankenhausverweildauer und gehäufte Komplikationen ist hoch. Daher besteht die Notwendigkeit, für diese Thematik zu sensibilisieren und die wissenschaftliche Diskussion dazu anzuregen. Das gilt umso mehr, da erfolgreiche Behandlungsoptionen bestehen.
Durch Sensibilisierung für das Thema und die Anwendung von Screeningalgorithmen (z. B. mithilfe eines verbindlichen Eingangsscreenings, wenn notwendig, gefolgt von einer Intervention durch ein multidisziplinäres Ernährungsteam) lässt sich das Behandlungsergebnis von Kindern und Jugendlichen mit KaU signifikant verbessern. Das belegen auch evidenzbasierte Daten aus der „Erwachsenenmedizin“ mit gleichgerichteten Ergebnissen, wie sie an pädiatrischen Patienten erhoben wurden. Durch das rechtzeitige Erkennen und Behandeln von KaU lassen sich sowohl die negativen gesundheitlichen Auswirkungen, die Gesundheitssystemkosten als auch das persönliche Leid der betroffenen nachweisbar reduzieren.
Krankheitsassoziierte Unterernährung zu erkennen und zu behandeln, ist einfach und lohnt sich.
Recently, new commercial infant formulas have been composed considering novel fat blends and oligosaccharides to better resemble the fatty acid (FA) composition and stereospecific distribution (e.g., ...increased amount of ß-palmitate) as well as probiotics content of human breast milk. We hypothesized that these newly composed infant formulas may decrease fecal FA soap excretion and may positively affect erythrocyte FA profiles compared with regular formulas.
Healthy infants were randomly assigned to receive a high-sn-2-palmitate formula (>25% of the PA is esterified to the sn-2 position of the glycerol backbone, verum: n = 30) or a "standard" formula containing <10% of PA in sn-2 position and no oligosaccharides (control: n = 27); a non-randomized group of breast-fed infants served as control. Anthropometric data of the infants (body weight, recumbent length, and head circumference) were recorded at inclusion (visit 1) and 6 and 12 weeks after onset of intervention (visits 2 and 3). Blood samples for erythrocyte FA analysis (gas chromatography) were taken at visits 1 and 2; stool samples were collected at visit 2.
Quantitative formula intake (mL/kg body weight × day) at visit 2 (verum: 155 ± 30, control: 164 ± 30) and visit 3 (verum: 134 ± 26, control: 134 ± 21) was comparable. Six weeks after onset of intervention, stool total FA soaps, palmitate soaps, and total FAs were similar in both formula-fed groups but significantly higher than in breast-fed infants. During the 6-week intervention, erythrocyte palmitate decreased significantly from baseline in all 3 groups with no group differences (verum: 29.20 ± 1.17 to 27.12 ± 0.66, control: 29.88 ± 2.00 to 27.01 ± 0.94, breast-fed: 30.20 ± 0.86 to 26.84 ± 0.98). For selected FAs, significant changes over time in verum and control group were obvious but without formula effects. Some variations in the FA profile of breast-fed infants compared to both verum and control groups were observed.
In contrast to our hypothesis, feeding a newly composed infant formula based on a fat blend with 25% of PA in the sn-2 position of triacylglycerols and supplemented with a prebiotic could not decrease insoluble FA soap excretion compared with a standard product; in this respect, breastfeeding is obviously the best choice. Surprisingly, erythrocyte FA profiles were comparable in formula-fed and breast-fed infants; obvious alterations in FA composition of the respective fat sources and structure did not affect FA incorporation into membranes. Caution should be, however, exercised in drawing robust conclusions in the absence of larger, adequately powered intervention studies.
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