Design and manufacture of a reinforced fuselage structure through automatic laying-up and in-situ consolidation with co-consolidation of skin and stringers using thermoplastic composite materials

Thermoplastic composites can be used to construct safer and more efficient aircraft fuselage structures. They provide significant weight reduction compared to conventional metallic materials, reducing the fuel consumption of the aircraft and increasing its performance and profitability. In this study, we designed and manufactured a level 2* flat fuselage specimen. The specimen comprises 2 Ω-shaped stringers and one Z-shaped frame that were manufactured using a carbon fibre-reinforced thermoplastic material. The skin was laminated on top of the stiffeners and co-consolidated to them, eliminating the need for rivets or adhesives. The manufacturing processes of the stiffeners (press-forming) and skin (in-situ consolidation) are described herein. The quality of the manufactured specimens was evaluated through non-destructive and physical-chemical testing. The test results will serve as a reference for designing and manufacturing a level 3* curved fuselage in a future study. *Level 2: "Element tests according to the Building Block approach (MIL-HDBK-17, 2002) [18]"; Level 3: "Detail tests according to the Building Block approach (MIL-HDBK-17, 2002) [18]".

Co-created training program to promote active ageing in people with Down syndrome

Background

Population ageing is a current challenge for the European society. Specifically, People with Down Syndrome (PDS) are living longer than before, reaching some of them around 60 years old. However, it is known that they show premature ageing that in some cases may be misled with Alzheimer first signs. Hence, it is crucial to promote an Active Ageing (AA) and healthy living in this specific population by keeping their cognitive, physical and emotional functions, and also promoting social activities such as community participation. In such way, their Quality of Life (QoL) will be increased.

Objectives

The main objective of this study was to co-design a Training Program (TP) to promote AA in PDS, professionals, relatives and/or caregivers, on the framework of the DS-AGEING project (2018-1-ES01-KA204-050733).

Results

Co-creation sessions with PDS, professionals and relatives/informal caregivers from Spain, Portugal, Slovenia, Rumania and Greece were carried out to determine contents, methodology and materials of the TP. This methodology allows meeting their real needs but also it promotes inclusion. The resulting TP is formed by the next topics (and its subtopics): active ageing, cognitive functioning (attention, memory, executive functions, praxis, gnosis, etc.), facing transition events, physical health (healthy habits & postural control). Training will be performed by 3 types of activities: face-to-face, practical and e-training. Co-validation sessions with end-users were conducted to validate the TP. Also, an e-training platform to support the TP implementation will be designed.

Conclusions

An easy, practical and flexible TP was co-created to be adjusted to each PDS and to be used by any person with/without experience in training. In such way, this study has a holistic perspective as cover all end-users needs: PDS will be able to train in the affected areas and professionals and relatives will have tools to assist them in the training.

Key messages

This co-created TP will be a tool for professionals and relatives/caregivers to foster AA and increase QoL of PDS. This study will promote an early detection of deterioration symptoms and the preservation of abilities in PDS.

[Comorbidity, anemia and response to erythropoiesis stimulating agents in chronic hemodialysis]

INTRODUCTION

Patients treated with haemodialysis have a high prevalence of co-morbidity that induces a elevate mortality risk. On the other hand, these patients have anaemia whose treatment is based in erythropoiesis stimulating agents. To date there are not enough studies to determine if co-morbidity alters erythropoietin response and the relationship between co-morbidity, response to treatment of anaemia and resistance to erythropoiesis-stimulating agents.

OBJECTIVES

We have the following objectives: i) to study the prevalence of associated diseases in patients treated with haemodialysis in our Hospital Unit and to evaluate the co-morbidity Charlson Index, ii) to know the degree of anaemia control, dose and response to erythropoiesis-stimulating agents, and iii) to determine the relationship with co-morbidity and anaemia treatment.

PATIENTS AND METHODS

We designed a retrospective study in stable haemodialysis treated patients. We calculated the Charlson co-morbidity index adjusted to age and we analysed levels of haemoglobin in the 6 months before study, dose of erythropoiesis-stimulating agents and its resistance index defined as doses of erythropoiesis-stimulating agents/weight (kg)/week/haemoglobin (g/dL). The different variables included in Charlson index were considered as independent variables and the index to repose to erythropoiesis-stimulating agents as a dependent variable, using bivariant and multivariate statistical analysis.

RESULTS

We included 58 patients (31 males and 27 females), median age of 69.5 years (range 24-88), mean haemodialysis 83.7 months. Mean Charlson index was 7.4 +/- 2.8 (range 2-13). Comorbidity-age Charlson index was 2 in 3.4% of patients; 10.3% had 3 or 4 points; 43.2% between 5 and 7 and 43,1% 8 or more. Mean haemoglobin levels was 11,7+/-1,2 g/dL. Mean erythropoiesis-stimulating agents dose was 163.7+/-114.5 IU/kg/week and resistance index 14.1+/-9.7. Most of patients (57%) had a IRE value higher than 10. Fourteen patients (24%) had haemoglobin less than 11 g/dL, and 3 of them (5.1%) received erythropoiesis-stimulating agents more than 300 IU/kg/week. Nine subjects (15.5%) was treated with high dose of erythropoiesis-stimulating agents (>300 IU/kg/week): 3 of them had Hb>or=11 g/dL and 6 had Hb<11 g/dL. We did not found that the intensity of Charlson index is related with the degree of anaemia control or response to erythropoiesis-stimulating agents.

CONCLUSIONS

Although the co-morbidity index is high and the response to erythropoiesis-stimulating agents is inadequate. In our study there is not relationship between these conditions.

[Preliminary results of the Spanish Society of Nephrology multicenter study of quality performance measures: hemodialysis outcomes can be improved]

INTRODUCTION

The Spanish Society of Nephrology "Quality in Nephrology Working Group" (QNWG) was created in 2002. The aims of this group are the identification, diffusion, implementation and consolidation of a systematic, objective and comprehensive set of quality performance measures (QPMs) to help along the improvement of patient care and outcomes on hemodialysis, by means of strategies of feedback and benchmarking, and the design of quality improvement projects. The objective of this study is to present the preliminary results of a set of quality performance measures obtained in a group of Spanish hemodialysis centers, as well as to evaluate the repercussion of the application of the aforementioned thecniques on the observed results.

METHODS

During 2007 a total of 28 hemodialysis units participated in the study; 2516 patients were evaluated. A specific software was designed and used to facilitate the calculation of CPMs in each unit. The clinical indicators used refered to dialysis adequacy; anemia; mineral metabolisme; nutrition; viral infections; vascular access; mortality, morbidity (number and days of hospital admissions); and renal transplant. Every three months each center received its own data and its comparison with the rest of the group.

RESULTS

Except for hemoglobin levels we observed a global improvement. The percentage of centers reaching the stablished standards defined by the QNWG passed from 65% to 90,9% for Kt/V Daugirdas II (> 1,3 in > that 80% of the patients); from 71,4 % to 77,2 % for PTH (> 30 % of patients with serum PTH between 150 and 300 pg/ml); and from 42,8 % to 63,5 % for phosphate (> 75 % of patients with a serum phsphate < 5,5 mg/dl). More than 50% of centers showed an improvement in their final results as compared with their own initial results in all analyzed CPMs. Those centers that did not obtained an improvement in their results started the study with better percentages of acomplishment than those that showed a significant improvement in QPMs. (80,6+/-15,4 versus 71,8+/-16,6 respectively; p<0,001)

CONCLUSIONS

We are starting to make progresses in our knowledge of clinical results in our hemodialysis units, although there is still a long way to go over. To monitor and share CPMs results within hemodialysis centers might help to improve their results as well as to reduce intecenters variability.

Preemptive Kidney Transplant From Deceased Donors: An Advantage in Relation to Reduced Waiting List

BACKGROUND

Preemptive living donor kidney transplantation is associated with better allograft and recipient survival. However, it remains unclear whether preemptive transplantation from deceased donors is beneficial too. An increased number of deceased donors has reduced the waiting list in our hospital in the last years allowing preemptive deceased donor kidney transplantation (PDDKT).

AIM

We compared our experience with preemptive transplantation with patients who underwent dialysis before transplantation.

PATIENTS AND METHODS

Thirty-three PDDKT, including 77.5% male patients of overall mean age of 48 +/- 14 years, were performed in our hospital between January 1999 and December 2004 (8% of transplantations). We compared the outcomes of these patients with those of renal transplants in subjects who had undergone dialysis. The donors for both groups had similar characteristic; they were paired donor kidneys in most cases.

RESULTS

The types of donors in both groups were: non-heart-beating (49%), heart-beating deceased (27%) or en bloc pediatric (24%). The serum creatinine of the recipients was 6.9 +/- 1.8 mg/dL prior to transplantation, and the creatinine clearance was 14.6 +/- 3.6 mL/min (estimated by the Cockroft-Gault formula). The Charlson comorbidity index adapted for patients with advanced chronic kidney disease (ACKD) was 0.8 +/- 0.2 in the preemptive group versus 1.7 +/- 0.4 in the dialysis group (P < .05). Delayed graft function rates were 0% versus 25% in preemptive vs dialysis groups, respectively. No differences in 1-month or 1-year renal function as determined by serum creatinine were observed between the groups. We did not observe differences in the incidence of acute rejection or 1- and 2-year graft and patient survivals.

CONCLUSION

PDDKT is the treatment of choice for ACKD. It is associated with less delayed graft function and similar 2-year graft and patient survivals than kidney transplantation after dialysis. The Charlson index reflected less comorbidity among patients with PDDKT, a finding that must influence long-term outcomes.

[Lupus nephritis and hypothyroidism]

Thyroid diseases could be associated with several renal alterations. In the present report we describe a patient with SLE with inactive renal involvement and symptomatic hypothyroidism that developed a clinical picture similar to lupus flare.

[CA-P control in haemodialysis and K/DOQI guidelines]

BACKGROUND

The publication in 2003 of the K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease recommended targets levels for serum iPTH, Ca, P, and CaxP product. However, many patients do not achieved these target ranges. It is necessary to known the percentage of patients out of range in order to prevent the development of bone disease and to reduce mortality and morbidity.

OBJECTIVES

To know the degree of control of Ca-P metabolism in haemodialysis patients in our haemodilalysis facilities and the achievement of target levels recommended by K/DOQI Guidelines.

PATIENTS AND METHODS

We have retrospectively investigated in 190 prevalent haemodialysis patients (males 58.2%, ratio M/F 1.4, mean age 70 years, range 17-87 years, at least 3 months in haemodialysis) the serum levels of Ca, albumin-corrected serum Ca, P, CaxP product and iPTH in all analitycal determinations performed in 2004. In each patient we have obtained the average (and median) of these serum markers. Cut-off levels were carried out following the recommendations of the K/DOQI Guidelines.

RESULTS

The average of serum Ca and albumin-corrected serum Ca is normal (means +/- SD = 8.9 +/- 0.6 mg/dL and 9.2 +/- 0.7 mg/dL, respectively); however, 53.7% has normal values, 9.1% hypocalcemia and 37.1% hypercalcemia. The average of serum P is also normal (mean +/- SD = 5.0 +/- 1.3 mg/dL); however, only 57.2% has normal values, and 11.7% has hypophosphoremia and the remaining 31, 1% hyperphosphoremia. The CaxP product is normal (mean +/- SD = 46.3 +/- 13.3 mg2/mL2), 4.9% with low values and 23.4% with high values. The median of serum iPTH is 253 pg/mL, but only 31.1% of them have normal values, 25.1% low range values and 43.7% has hyperparathyroidism; 9.3% with iPTH higher than 800 pg/mL. The percentage of patients with hyperphosphoremia is higher in the group with iPTH higher than 300 pg/mL (23.3% vs. 40%, chi2, p= 0.006). In patients with PTHi in normal range, 3.6% have low CaxP product and the remaining 17.8% high CaxP product. Overall, only 25% of patients falls within recommended ranges for all indicators of mineral metabolism and 17% has all serum markers outside these recommendations.

CONCLUSIONS

The degree of control of mineral metabolism in haemodyalisis patients if clearly insufficient and a large percentage of them do not achieved the recommended serum targets recommended by K/DOQI Guidelines. This groups of patients are exposed to a increased risk for oseous and cardiovascular morbimortality. The analysis of adequacy must be performed with percentage of patients out of range in order to apply new therapeutical strategies.