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Taba G, Ceccato V, Fernandes O, Michel S, Darrigues L, Girard N, Gauroy E, Pauly L, Gaillard T, Reyal F, Hotton J. Impact of ERAS in breast reconstruction with a latissimus dorsi flap, compared to conventional management. J Plast Reconstr Aesthet Surg 2023; 85:202-209. [PMID: 37524032 DOI: 10.1016/j.bjps.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs are associated with improved management, reduced hospital stays, and lower complication rates. OBJECTIVE To evaluate the impact of ERAS on mean length of stay (LOS) and postoperative morbidity in breast reconstruction with latissimus dorsi flap (LDF) compared with conventional recovery program. PATIENTS AND METHOD All patients operated by LDF between December 2014 and October 2020: those managed before April 2018, when the ERAS protocol was introduced, were included in the "no ERAS" group, and beyond in the "ERAS" group. RESULTS Out of 193 patients, 129 were included in the "ERAS" group and 64 in the "no ERAS" group. There was a significant difference between the two groups in LOS (4.2 ± 1.5 days in the "ERAS" group vs. 5.4 ± 1.9 days in the "no ERAS" group; p < 0.001), high-grade complications at 30 days (9.3% in the "ERAS" group vs. 25% in the "no ERAS" group; p = 0.01), reintervention rate (13.9% vs. 26.6%, respectively; p = 0.02), and 30-day rehospitalization rate (6.2% in the "ERAS" group vs. 15.6% in the "no ERAS" group; p = 0.03). CONCLUSION The ERAS protocol has a positive impact on breast reconstruction with LDF without generating additional adverse effects. These results support the democratization of these programs for breast reconstruction surgery.
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Affiliation(s)
- G Taba
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - V Ceccato
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - O Fernandes
- Department of Anesthesia, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - S Michel
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - L Darrigues
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - N Girard
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - E Gauroy
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - L Pauly
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - T Gaillard
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - F Reyal
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France
| | - J Hotton
- Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France.
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Tuil A, Fourchotte V, Binder JP, Pauly L, Gaillard T, Girard N, Gauroy E, Darrigues L. [How I do… a TUG Flap after vulvo-vaginal excision surgery]. Gynecol Obstet Fertil Senol 2023; 51:289-293. [PMID: 36754121 DOI: 10.1016/j.gofs.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Affiliation(s)
- A Tuil
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France.
| | - V Fourchotte
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - J-P Binder
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - L Pauly
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - T Gaillard
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - N Girard
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - E Gauroy
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
| | - L Darrigues
- Institut Curie, service de chirurgie sénologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
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Pieber TR, Svehlikova E, Mursic I, Esterl T, Wargenau M, Sartorius T, Pauly L, Schwejda-Guettes S, Neumann A, Faerber V, Stover JF, Gaigg B, Kuchinka-Koch A. Blood glucose response after oral lactulose intake in type 2 diabetic individuals. World J Diabetes 2021; 12:893-907. [PMID: 34168736 PMCID: PMC8192256 DOI: 10.4239/wjd.v12.i6.893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lactulose is approved for the symptomatic treatment of constipation, a gastrointestinal (GI) complication common in individuals with diabetes. Lactulose products contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose for the treatment of mild constipation. A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.
AIM To evaluate the blood glucose profile after oral lactulose intake in mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.
METHODS This prospective, double-blind, randomized, controlled, single-center trial was conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects with T2DM. Eligible subjects were randomized and assigned to one of six treatment sequences, each consisting of four treatments stratified by sex using an incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose (crystal and liquid formulation), water as negative control or 30 g glucose as positive control. Capillary blood glucose concentrations were measured over a period of 180 min post dose. The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period [AUCbaseline_c (0-180 min)]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters included GI tolerability, which was assessed at 180 min and 24 h post dose, and adverse events occurring up to 24 h post dose.
RESULTS In 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The primary endpoint [AUCbaseline_c (0-180 min)] was not significantly different between lactulose and water regardless of lactulose dose and formulation. Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level. A minor increase in maximum blood glucose was observed after the 30 g dose, liquid lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, respectively (all P < 0.0001). No differences in blood glucose response were observed between the different lactulose formulations. As expected, lactulose increased the number of bowel movements and was generally well tolerated. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.
CONCLUSION Blood glucose AUCbaseline_c (0-180 min) levels in mildly constipated, non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations.
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Affiliation(s)
- Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Eva Svehlikova
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Ines Mursic
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Tamara Esterl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Manfred Wargenau
- Department of Statistic, M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Düsseldorf 40211, Germany
| | - Tina Sartorius
- Department of Nutritional CRO, BioTeSys GmbH, Esslingen 73728, Germany
| | - Lioba Pauly
- Department of Medical & Clinical Affairs, Market Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany
| | - Susann Schwejda-Guettes
- Department of Medical & Clinical Affairs, Market Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany
| | - Annalena Neumann
- Department of Medical, Clinical & Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi Deutschland GmbH, Bad Homburg 61352, Germany
| | - Valentin Faerber
- Department of Medical, Clinical & Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi Deutschland GmbH, Bad Homburg 61352, Germany
| | | | - Barbara Gaigg
- Market Unit Lactulose, Fresenius Kabi Austria GmbH, Linz 4020, Austria
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Steudle J, Schön C, Wargenau M, Pauly L, Schwejda-Güttes S, Gaigg B, Kuchinka-Koch A, Stover JF. Blood glucose response after oral intake of lactulose in healthy volunteers: A randomized, controlled, cross-over study. World J Gastrointest Pharmacol Ther 2018; 9:22-30. [PMID: 30090645 PMCID: PMC6081387 DOI: 10.4292/wjgpt.v9.i3.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/03/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate possible changes of blood glucose levels after oral intake of lactulose in healthy subjects.
METHODS The study was performed as prospective, randomized, two-part study with 4-way cross-over design with n = 12 in each study arm. Capillary blood glucose levels were determined over a time period of 180 min after intake of a single dose of 10 g or 20 g lactulose provided as crystal or liquid formulation. During the manufacturing process of lactulose, impurities with sugars (e.g., lactose, fructose, galactose) occur. Water and 20 g glucose were used as control and reference. Because lactulose is used as a functional food ingredient, it may also be consumed by people with impaired glucose tolerance, including diabetics. Therefore, it is of interest to determine whether the described carbohydrate impurities may increase blood glucose levels after ingestion.
RESULTS The blood glucose concentration-time curves after intake of 10 g lactulose, 20 g lactulose, and water were almost identical. None of the three applications showed any changes in blood glucose levels. After intake of 20 g glucose, blood glucose concentration increased by approximately 3 mmol/L (mean Cmax = 8.3 mmol/L), reaching maximum levels after approximately 30 min and returning to baseline within approximately 90 min, which was significantly different to the corresponding 20 g lactulose formulations (P < 0.0001). Comparing the two lactulose formulations, crystals and liquid, in the dosage of 10 g and 20 g, there was no difference in the blood glucose profile and calculated pharmacokinetic parameters despite the different amounts of carbohydrate impurities (1.5% for crystals and 26.45% for liquid). Anyhow, the absolute amount of single sugars was low with 0.3 g in crystals and 5.29 g in liquid formulation in the 20 g dosages. Lactulose was well tolerated by most volunteers, and only some reported mild to moderate mainly gastrointestinal side effects.
CONCLUSION The unchanged blood glucose levels after lactulose intake in healthy subjects suggest its safe use in subjects with impaired glucose tolerance.
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Affiliation(s)
| | | | - Manfred Wargenau
- M.A.R.C.O. GmbH and Co. KG, Institute for Clinical Research and Statistics, Düsseldorf 40211, Germany
| | - Lioba Pauly
- Fresenius Kabi Deutschland GmbH, Oberursel 61440, Germany
| | | | | | | | - John F Stover
- Fresenius Kabi Deutschland GmbH, Oberursel 61440, Germany
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Koch C, Dax A, Schug B, Pauly L, Reichart S, Stover J, Pestana E, Lekkos K. MON-P245: New High Protein and High Energy Oral Nutritional Supplement for Compliance and Tolerance in Elderly Care. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koch C, Dax A, Warnke A, Pauly L, Reichart S, Pestana E, Stover J, Lekkos K. MON-P244: Dispensing a High Caloric, High Protein Oral Nutritional Supplement 3 Times Daily is Well Tolerated and Increase Compliance in Elderly. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lesser S, Pauly L, Volkert D, Stehle P. Nutritional situation of the elderly in Eastern/Baltic and Central/Western Europe - the AgeingNutrition project. Ann Nutr Metab 2008; 52 Suppl 1:62-71. [PMID: 18382083 DOI: 10.1159/000115353] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS In the AgeingNutrition project, funded by the European Commission, partners from 10 'Eastern/Baltic' (new) European (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Poland, Romania, Slovak Republic, Slovenia, and Turkey) and 5 'Central/Western' (old) European countries (Austria, Belgium, Germany, Greece, and Spain) performed a comparative analysis of existing data on nutritional status, food intake, nutrient intake, dietary habits and lifestyle of the aging population in Europe. METHODS Using predefined inclusion criteria, 36 studies (22 from Eastern/Baltic, 14 from Central/Western countries) were chosen for evaluation. The studies varied in general design, data assessment and parameters and methods applied (especially regarding assessment of nutritional situation, comprising anthropometry, blood lipid profile, dietary nutrient and food intake). Thus, data evaluation by recalculation of raw data had to be restricted to a few distinct, common parameters. RESULTS AND CONCLUSION Energy intake is too high in both regions, especially in some of the 'younger old' and seems not to be adjusted to energy expenditure. Simultaneously, energy intake was considerably lower than recommended in some very old seniors in Eastern/Baltic countries. Interestingly, quantity and quality of available information is similar in 'new' and 'old' member states. Immense variations in methodology hampered performing reliable comparative evaluation. It is, thus, mandatory to standardize methods for assessment of nutrition and health status for future international multicenter studies.
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Abstract
Malnutrition in institutionalized elderly is of individual and public concern since it negatively affects health outcome and quality of life and is often preventable. Over the past years several studies have examined the prevalence of malnutrition in institutionalized elderly and reported greatly diverse results. The purpose of the present literature review is to give an overview of the current knowledge about the nutritional situation of institutionalized elderly having specific regard to the prevalence of protein-energy malnutrition and nutrition-related problems. Based on a literature search and additional articles from the files of the authors, observational studies with relatively unselected populations reporting figures for the prevalence of malnutrition and/or the prevalence of nutrition-related problems (e. g. poor appetite, chewing or swallowing problems, eating dependency or poor intake) and published between 1990 and 2006 were considered. Relevant information was extracted and compiled. A total of 42 eligible studies with 41 to 6832 participants were found. BMI was the most frequently used parameter for nutritional assessment with mean values mostly between 21 and 24 kg/m(2). Eight studies applied a cut-off value of 20 kg/m(2) and reported between 10% and 50% low values. Weight loss was reported in 7 studies with prevalence rates between 5 and 41%, reduced serum albumin (< 35 g/L) in 10 studies with prevalence rates between 0 and 50%. According to the MNA (12 studies) malnutrition was observed in 2 to 38% and a risk of malnutrition in 37 to 62%. Nutritional problems were reported in 17 studies, again with great variability between the studies. In physically and mentally capable study populations malnutrition was relatively unfrequent. Prevalence rates were highest in studies with great proportions of disabled and severely impaired residents. It can be concluded that malnutrition is generally widespread in institutionalized elderly. Prevalence rates vary according to the parameters and cut-off values used for nutritional assessment and according to the population under study. Future studies should carefully characterize their participants and use standardized nutritional assessment tools in order to achieve better comparability of study results as up to now.
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Affiliation(s)
- L Pauly
- Department of Food and Nutrition Sciences, Nutritional Physiology, University of Bonn, Endenicher Allee 11-13, 53115 Bonn, Germany
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