PURPOSE OF REVIEW:To examine in the light of recent data whether diets low in FODMAPs (a now classic exclusion diet for treatment for IBS: irritable bowel syndrome) have shown interest/efficacy in diseases of the digestive tract (beyond IBS) manifesting as diarrhea. RECENT FINDINGS:Very little good quality data or publications are available in recent medical literature. It is therefore difficult to estimate that the low FODMAP diet can be considered with a good level of confidence outside of IBS except in borderline symptomatic forms or with associated pathophysiology (e.g. IBD: inflammatory bowel disease). SUMMARY:There is a lack of quality data on the benefits, safety and value of LFD, outside of IBS. This is particularly the case in the majority of organic digestive diseases, notably with diarrhea, unless accompanied by dysregulation of the intestine-brain axis (and so with IBS symptoms), for example in post-inflammatory situations. When effective, which is currently highly unpredictable, the mechanism of action remains poorly understood.

The impact ionization process of target is a crucial issue in the study of Heavy Ion Beam (HIB)-driven Magnetized Inertial Fusion (MIF). The collision systems between heavy projectile ions (Xeq+, Biq+, Uq+) and light target atoms/ions (H, D, T, 3He, 3He+, 11B) are promising candidate reactions for fusion power. In this study, the impact ionization process in medium-energy (ranges 1–100 MeV/u) is studied numerically based on the extended Classical-trajectory Monte Carlo (CTMC) method, where the effects of projectile charge state, external magnetic field and plasma screening on the single ionization process are considered. The results show that the existed external magnetic field results in a decrease of the yield of ionized high-energy electrons, whereas the yield of backward emitted electrons is increased. The effect of plasma screening on the ionization process is shown to be determined by the competition between the screening charge of projectile ion and the target nucleus. Thus, a significant decrease of ionization cross section is found in the low energy region since the screening charge of projectile ion is dominant. However, the screening effect of target nucleus charge is dominant in high energy region, where a significant increase of ionization cross sections is found.

Apraglutide (FE 203799) is a glucagon-like peptide-2 (GLP-2) analog under development for the treatment of intestinal failure associated with short bowel syndrome (SBS-IF) and graft-versus-host disease (GvHD). Compared with native GLP-2, apraglutide has slower ab-sorption, reduced clearance, and higher protein binding, enabling once-weekly dosing. This study evaluated the pharmacokinetic (PK) and pharmacodynamic (PD) profile of apraglutide in healthy adults. Healthy volunteers were randomized to receive 6 weekly subcutane-ous administrations of 1, 5, or 10 mg apraglutide or placebo. PK and citrulline (an enterocyte mass PD marker) samples were collected at multiple time points. Kinetic parameters of apraglutide and citrulline were calculated using noncompartmental analysis; repeated PD measures were analyzed with a mixed model of covariance. A popu-lation PK/PD model was developed that also included data from a previous phase 1 study in healthy volunteers. Twenty-four subjects were randomized; 23 received all study drug administrations. Mean estimated apraglutide clearance was 16.5-20.7 l/day, and mean vol-ume of distribution was 55.4-105.0 liters. A dose-dependent in-crease in citrulline plasma concentration was observed, with 5-mg and 10-mg doses inducing higher citrulline levels than 1-mg doses and placebo. PK/PD analysis showed that weekly 5-mg apraglutide induced the maximal citrulline response. Increased plasma citrulline levels were sustained for 10-17 days after the final apraglutide ad-ministration. Apraglutide displays predictable dose-dependent PK and PD profiles, with a 5-mg dose showing significant PD effects. Results suggest that apraglutide has early and enduring effects on enterocyte mass and supports the continued development of weekly subcutaneous apraglutide for SBS-IF and GvHD patient populations.SIGNIFICANCE STATEMENT Once-weekly subcutaneous apraglutide results in dose-dependent elevations of plasma citrulline (an enterocyte mass pharmacody-namic marker) with parameters suggesting that apraglutide has lasting effects on enterocyte mass and the potential to provide therapeutic benefits. This is the first report of a model relating glucagon-like peptide-2 (GLP-2) agonism and its effects in intestinal mucosa, affording not only the ability to predict pharmacologic ef-fects of GLP-2 analogs but also the exploration of optimal dosing regimens for this drug class across populations with different body weights.

Background A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. Methods This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. Results Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH(2)0 (P = 0.035) and 3.12 [0.5; 5.73] cm(3)/kg (P = 0.022), respectively). Conclusions Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016.

Background: Apraglutide, a novel long-acting glucagon-like peptide-2 (GLP-2) analogue that promotes intestinal growth in animals and increases intestinal absorption, is in Phase III development for the treatment of short bowel syndrome with intestinal failure (SBS-IF). Pharmacokinetic (PK) and pharmacodynamic (PD) characterization revealed a predictable linear PK distribution and elimination kinetics and a dose-dependent PD relationship. A model was created to enable characterization of PK and PD relationships at the population level using plasma citrulline, a biomarker of small intestine functional enterocytic mass. Methods: A population PK/PD model was created by combining PK and citrulline data from two randomized, placebo-controlled, Phase I studies of apraglutide in healthy adult volunteers. In Study 1, 64 volunteers received either a single ascending dose of apraglutide (2.8, 5.7, 11.4, 28.4, or 56 mg), 3 weekly doses of apraglutide (11.4, 28.4, or 56 mg) or placebo by subcutaneous (SC) injection. In Study 2, 24 volunteers received 6 weekly SC administrations of apraglutide (1, 5 or 10 mg) or placebo. A one-compartmental structural model with zero-order absorption and linear clearance was used to describe apraglutide PK. Plasma citrulline levels were described by a turnover model with a synthesis and degradation rate. The effect of apraglutide on citrulline synthesis was modeled with a stimulatory effect on the citrulline synthesis rate using an Emax relationship. Population PK and PD parameters were estimated using the stochastic approximation of expectation-maximization algorithm (Monolix Suite 2019 R1). Inter-subject variability was modelled using log-normal distributions. Simulations included the impact of covariates. Results: Actual PK observations were best matched by a population PK/PD model with a dose covariate on absorption duration and body weight covariates on V1/F and Cl/F. The parameter estimates for a 70-kg individual receiving apraglutide 5 mg SC were an apparent volume of distribution of 31.3 L and time to maximal concentration (T) of 1.39 days. Simulated PK and PD profiles with weekly apraglutide 2.5, 5, or 10 mg sc are shown in Figure 1. The PK/PD model did not indicate any accumulation of apraglutide over time for a weekly administration. Although accumulation of citrulline was apparent during the first 3 weeks of treatment, a steady state concentration was subsequently reached. Conclusions: This population PK/PD model enables prediction of the effect of different apraglutide doses on plasma citrulline levels as well as the impact of covariates, such as body weight, at the population level. This further demonstrates apraglutide’s predictable PK profile with no accumulation during once weekly sc dosing and its ability to induce a dose-dependent citrulline increase.

Malnutrition and swallowing disorders are common in Duchenne muscular dystrophy (DMD) patients. We assessed, in adult DMD with home mechanical ventilation (HMV) and cough assist device, its prevalence and the relationships with respiratory muscle strength and long‐term respiratory prognosis. We reviewed the patients (n = 117, age 18–39 years [median 24]), followed in a reference center, from 2006 to 2015, to obtain clinical baseline, nutritional status, vital capacity (VC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). The median body mass index (BMI) was low (15.6 kg/m²). Included patients had severe restrictive respiratory function with a median VC of 10.5% [7–17] of the predicted value. All patients were on HMV. Prevalence of malnutrition, swallowing disorders, and gastrostomy were respectively 62%, 34%, and 11%. BMI and serum albumin level were significantly associated with MIP, MEP, and VC. The 1‐year/5‐years cumulative incidences of respiratory events (pulmonary sepsis and acute respiratory distress) were, respectively, 20.7%/44.5%. Using univariate analysis, predictive factors for respiratory events were swallowing disorders (p = .001), transthyretinemia (p = .034), MIP (p = .039), and MEP (p = .03) but not BMI or albuminemia. Using multivariate analysis, only swallowing disorders remained significantly associated with respiratory events (OR = 4.2, IC 95% 1.31–12.2, p = .01). In conclusion, this study highlights the interrelationships between nutritional intake, swallowing function, airway clearance, and respiratory function in adult DMD. A multidisciplinary approach focusing on these previous factors is essential to optimize DMD patient health.

Bariatric surgery is associated with significant weight loss and improvement in comorbid conditions but in rare cases can expose to complications requiring intensive nutritional care (INC). INC in this context is poorly described and no data are available concerning long-term impact. We retrospectively reviewed charts of bariatric patients who were hospitalized in our institution between 2013 and 2018. We identified patients with a postoperative complication requiring INC and we described their nutritional management (INC group). These patients were compared with controls matched to age, gender, preoperative BMI, and type of surgery selected from our database (control group). The primary endpoint was the percentage of total weight loss (%TWL) at 2.5 years. Secondary endpoints were improvement of co-morbidities, vitamin deficiencies, and depression/anxiety scores. The INC group consisted of 18 patients among which 77.8% had sleeve gastrectomy (SG). Half of these patients underwent revisional surgery. The most common complication was fistula formation (66.7%). Patients in the INC group, compared to the control group, showed a significantly higher %TWL at 2.5 years (33.6% vs 26.1%, P = 0.03). There was no significant difference in either reduction of preoperative comorbidities or depression/anxiety scores between the two groups. The number of patients with more than three nutritional deficiencies was similar in both groups. Thiamine deficiency was only observed in the INC group. Complications requiring INC after bariatric surgery occur mainly after revisional surgery and may increase long-term %TWL but have no impact on nutritional deficiencies or symptoms of anxiety/depression.

BACKGROUND & AIMS:Plasma citrulline, a non-protein amino acid, is a biochemical marker of small intestine enterocyte mass in humans. Indeed, citrulline is highly correlated with residual bowel length in patients with short bowel syndrome. It is known to be synthesised in epithelial cells of the small intestine from other amino acids (precursors). Citrulline is then released into systemic circulation and interconverted into arginine in kidneys. If plasma citrulline concentration depends on abundance of intestinal amino acid transporters is not known. The aim of the present study was to explore whether plasma citrulline concentration correlates with the expression of intestinal amino acid transporters. Furthermore, we assessed if arginine in urine correlates with plasma citrulline.METHODS:Duodenal samples, blood plasma and urine were collected from 43 subjects undergoing routine gastroduodenoscopy. mRNA expression of seven basolateral membrane amino acid transporters/transporter subunits were assessed by real-time PCR. Plasma and urine amino acid concentrations of citrulline, its precursors and other amino acids were analysed using High Performance Liquid Chromatography measurements. Amino acid transporter mRNA expression was correlated with blood plasma and urine levels of citrulline and its precursors using Spearman's rank correlation. Likewise, urine arginine was correlated with plasma citrulline.RESULTS:Plasma citrulline correlated with the mRNA expression of basolateral amino acid transporter LAT4 (Spearman's r = 0.467, p = 0.028) in small intestine. None of the other basolateral membrane transporters/transporter subunits assessed correlated with plasma citrulline. Plasma citrulline correlated with urinary arginine, (Spearman's r = 0.419, p = 0.017), but not with urinary citrulline or other proteinogenic amino acids in the urine.CONCLUSIONS:In this study, we showed for the first time that small intestinal basolateral LAT4 expression correlates with plasma citrulline concentration. This finding indicates that LAT4 has an important function in mediating citrulline efflux from enterocytes. Furthermore, urine arginine correlated with plasma citrulline, indicating arginine in the urine as possible additional marker for small intestine enterocyte mass. Finally, basolateral LAT4 expression along the human small intestine was shown for the first time.

L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.

La dystrophie musculaire de Duchenne (DMD), myopathie héréditaire sévère liée à l’X avec mutations du gène de la dystrophine, a vu son pronostic amélioré grâce aux techniques ventilatoires, VAD (ventilation à domicile) et toux assistée. Les troubles respiratoires restrictifs et de la déglutition restreignant les apports alimentaires y sont fréquents. De plus, la dénutrition peut affecter la fonction respiratoire et la morbidité. Évaluer chez les patients adultes atteints de DMD : – la prévalence de la dénutrition et des troubles de la déglutition, – le pronostic respiratoire à long terme. Cohorte régionale de patients DMD génotypés suivis dans un centre de référence neuro-musculaire avec pôle VAD de 2006 à 2018. Evaluation du statut nutritionnel clinique et biologique, de la capacité vitale (CV), des pressions inspiratoire (MIP) et expiratoire (MEP) maximales, et de leur liens avec les événements respiratoires (ER). Analyses statistiques par modèles logistiques et actuariels. À l’inclusion (n = 117 adultes masculins) en VAD (ventilation mécanique et trachéotomie n = 56, ventilation non invasive -VNI- nocturne n = 61), l’âge était de 24(21–28) (med.(IQR)) ans, IMC 15,6(12,1–20,6), CRP 4(2–7)mg/L ; prévalence de la dénutrition 63 %, pour 42 % sévère. La prévalence des troubles de la déglutition (évaluée par vidéo-endoscopie) et de la gastrostomie était respectivement à 34 et 11 %. La CV était à 10,5[7–17] %, les MIP et MEP étaient très abaissées. La survie à 5 ans a été de 82 % (IC95 % 74–89). Durant le suivi 8(7 %) patients supplémentaires ont dus avoir recours à une gastrostomie motivée par une dénutrition sévère et/ou des troubles de la déglutition. L’albuminémie était associée à MIP (r = 0,43, p = 0,0005), MEP (r = 0,36, p = 0,0005) et CV (r = 0,29, p = 0,003). Les incidences cumulées d’ER(sepsis pulmonaire, détresse respiratoire aiguë et/ou nécessité de ventilation invasive) à 1 et 5 ans, étaient respectivement de 20,7 et 44,5 %. En analyse univariée les facteurs prédictifs d’ER étaient les troubles de la déglutition (p = 0,001), la transthyrétinémie (p = 0,03), l’albuminémie (p = 0,05), MIP (p = 0,04) et MEP (p = 0,03), mais pas la dénutrition clinique ou le type de VAD. En analyse multivariée seuls les troubles de la déglutition étaient associés aux ER(OR 4,2, IC95 % 1,8–10,1, p = 0,01). Une détérioration de l’état nutritionnel au cours du suivi était observée chez les patients sous VNI sans gastrostomie. La prévalence de la dénutrition (63 %) et des troubles de la déglutition (34 %) sont élevées chez les DMD adultes en début de VAD. La force des muscles respiratoires est associée à l’albuminémie. Le pronostic respiratoire est affecté principalement par les troubles de la déglutition mais pas directement par l’état nutritionnel qui cependant se dégrade chez les patients en VNI non gastrostomisés.

Several studies have raised possible associations between high selenium exposure and type 2 diabetes. Here we investigate the association between dietary selenium intake and the risk of type 2 diabetes in a female population from western Algeria. The analytical study included a total sample of 290 women, 140 type 2 diabetics and 150 controls. The dietary selenium intake has been measured by a 72-hour dietary recall. The odds ratio (OR) and the corresponding 95% confidence interval (CI) were used to determine the relationship between dietary selenium intake and diabetes through logistic regression. The quartile in the range of recommended dietary selenium intake was considered as a reference. The average level of dietary selenium intake was 72.40 μg/day in diabetics and 70.30 μg/day in controls (P > 0.05). The odds ratio for diabetes, comparing the highest quartile of dietary selenium intake to the reference quartile was 2.21 (95% CI 1.06–4.38; P = 0.036). While the lowest quartile had an odds ratio of 2.52 (95% CI 1.25–5.09; P = 0.010). In conclusion, this study indicates that there is a significant association between the risk of type 2 diabetes and both high and low dietary selenium intake.Plusieurs études soulèvent des inquiétudes concernant de possibles associations entre une exposition élevée au sélénium et le diabète de type 2. Dans ce travail, nous avons examiné l’association entre l’apport alimentaire en sélénium et le risque de diabète de type 2, chez une population féminine de l’ouest algérien. L’étude analytique a inclus un échantillon total de 290 femmes, dont 140 diabétiques de type 2 et 150 témoins ne souffrant d’aucune pathologie. L’apport alimentaire journalier en sélénium a été mesuré par un rappel de 72 heures. L’odds ratio (OR) et l’intervalle de confiance (IC) à 95 %, correspondant ont été utilisés pour déterminer la relation entre l’apport alimentaire en sélénium et le diabète par la régression logistique. Le quartile se trouvant dans la zone de l’apport alimentaire recommandé est considéré comme référence. La moyenne de l’apport alimentaire en sélénium était de 72,40 μg/jour chez les diabétiques et de 70,30 μg/jour chez les témoins (p > 0,05). L’odds ratio pour le diabète, comparant le quartile le plus élevé de l’apport alimentaire en sélénium par rapport au quartile de référence était de 2,21 (CI 95 % 1,06–4,38; p = 0,036). Alors que le quartile le plus faible présentait un odds ratio de 2,52 (CI 95 % 1,25–5,09; p = 0,010). En conclusion, cette étude indique qu’il existe une association significative entre le risque de diabète de type 2 et un apport alimentaire en sélénium aussi bien élevé que faible.

Les compléments alimentaires (CA) sont à la mode. Cependant, la régulation de ce marché florissant porté par Internet est, à ce jour, imparfaite. Pour ce qui concerne la France, d’après l’étude INCA3, près de 30 % des adultes et près de 20 % des enfants en consomment. Cependant, en dehors des carences avérées, la preuve rigoureuse d’efficacité en est le plus souvent faible ou nulle. Ceci est notamment le cas de la plupart des CA proposés comme prévention ou « adjuvant » en oncologie. Ceci est également le cas des huiles de poissons ou des omégas 3 dans le cadre du risque cardiovasculaire et de la plupart des probiotiques. Par contre, des effets indésirables et des risques sont possibles et avérés. En France, ces derniers sont colligés depuis 2009 par l’ANSES, dans le cadre de la mission « Nutrivigilance ». Des avis et mises en garde sont régulièrement publiés à destination des autorités publiques, des professionnels de santé et des consommateurs. Outre, des toxicités spécifiques (notamment hépatiques) ou allergies, liées notamment à des plantes ou à des ingrédients biochimiques, des problèmes d’allégations non autorisées, d’adultération (fraude) de la composition, de mésusages, etc. ne sont pas exceptionnelles. Il est important que les consommateurs et les patients : (a) soient informés de l’importance d’un approvisionnement via un circuit bien authentifié ; (b) indiquent aux professionnels de santé la consommation de ces produits, notamment en cas d’apparition d’effets indésirables. Les populations spécifiques, fragiles (sujets âgés, pathologies chroniques, femmes enceintes, enfants), doivent également être mises en garde.

A l’instar des autres systemes de vigilance francais et compte tenu de l’importance des consequences en matiere de sante et des decisions industrielles qui en decoulent, l’analyse de la relation de causalite entre un produit vise par le dispositif national de nutrivigilance et l’effet indesirable declare doit etre realisee avec une methode d’analyse appropriee et objective. Cette methode dite « methode d’imputabilite de nutrivigilance » estime le degre de causalite, d’un ou de plusieurs produits dans la survenue de l’effet indesirable declare, de maniere standardisee, permettant d’eliminer les divergences d’opinion pouvant exister entre plusieurs observateurs. De telles methodes sont couramment mises en oeuvre en France pour les medicaments (Arimone et al. 2011, Begaud et al. 1985, Montastruc et al. 2005), les produits cosmetiques (Afssaps 2009) ou les xenobiotiques en cas d’intoxication (CCTv 2015). En raison de differences notables avec les medicaments (absence de benefice demontre et d’etude d’innocuite), l’Anses s’etait auto-saisie le 25 aout 2010 pour construire une methode d’imputabilite specifique aux signalements d’effets indesirables susceptibles d’etre lies a la consommation de produits concernes par le dispositif national de nutrivigilance. Cette methode d’imputabilite a ete publiee le 11 mai 2011 (Anses 2011). Depuis 2011, cette methode a ete completee et precisee au fur et a mesure de son application par le groupe de travail « Nutrivigilance ». Ces precisions ont ete enregistrees dans un « manuel de decisions » non publie. Dans ce contexte, l’Anses s’est auto-saisie le 12 fevrier 2018 afin d’actualiser la methode d’imputabilite des signalements d’effets indesirables de nutrivigilance en prenant en compte les evolutions proposees par le groupe de travail depuis 2011.

Background In patients with neuromuscular disorders, assessment of respiratory function relies on forced vital capacity (FVC) measurements. Providing complementary respiratory outcomes may be useful for clinical trials. Diaphragm sniff ultrasound (US) is a noninvasive technique that can assess diaphragm function that may be affected in patients with neuromuscular disorders. Purpose We aimed to provide normal values of sniff diaphragm ultrasound, to assess the relationship between sniff diaphragm US, vital capacity (VC) and sniff nasal pressure. Additionally, we aimed to evaluate the diagnostic accuracy of sniff diaphragm US for predicting restrictive pulmonary insufficiency. Materials and methods We included patients with neuromuscular disorders that had been tested with a sniff diaphragm US and functional respiratory tests. Healthy subjects were also included to obtain normal diaphragm sniff ultrasound. We performed diaphragm tissue Doppler imaging (TDI) and time movement (TM) diaphragm echography combined with sniff maneuver. Results A total of 89 patients with neuromuscular diseases and 27 healthy subjects were included in our study. In patients, the median age was 32 years [25; 50] and the median FVC was 34% of predicted [18; 55]. Sniff diaphragm motion using TM ultrasound was significantly associated with sniff nasal pressure, both for the right hemidiaphragm (r = 0.6 p <0.0001) and the left hemidiaphragm (r = 0.63 p = 0.0008). Right sniff peak TDI velocity was also significantly associated with FVC (r = 0.72, p<0.0001) and with sniff nasal pressure (r = 0.66 p<0.0001). Sniff diaphragm ultrasound using either TM mode or TDI displayed significant accuracy for predicting FVC<60% with an area under curve (AUC) reaching 0.93 (p<0.0001) for the right sniff diaphragm ultrasound in TM mode and 0.86 (p<0.001) for right peak diaphragm TDI velocity. Conclusion Sniff diaphragm TM and TDI measures were significantly associated with sniff nasal pressure. Sniff diaphragm TM and TDI had a high level of accuracy to reveal respiratory involvement in patients with neuromuscular disorders. This technique is useful to assess and follow up diaphragm function in patients with neuromuscular disorders. It may be used as a respiratory outcome for clinical trials.

Background:Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic muscle disorder. Respiratory muscle function is classically affected in this disease. Ultrasound recently emerged as a non-invasive tool to assess diaphragm function. However, there are only a few studies using diaphragm ultrasound (US) in DMD. Purpose:We aimed to assess diaphragm ultrasound patterns in DMD, their relationship with age and their association with home mechanical ventilation (HMV). Methods:We included DMD patients followed at Raymond Poincaré Hospital who benefited from diaphragm ultrasound and pulmonary function tests. Results:There were 110 DMD patients and 17 male sex-matched healthy subjects included. In all, 94% of patients were permanent wheelchair users. Median body mass index (BMI) was 18 kg/m2. DMD patients disclosed a reduced forced vital capacity (VC) (12% of predicted value), and 78% of patients were on HMV. In patients, right and left diaphragmatic motions on deep inspiration were reduced and end expiratory diaphragm thickness was borderline normal. In patients, right and left diaphragmatic thickening fractions (TF) were reduced 12.7% and 15.5%, respectively. Age and end expiratory thickness were significantly inversely associated (p = 0.005 for the right diaphragm, p = 0.018 for the left diaphragm). Diaphragm TF was significantly inversely associated with age (p = 0.001 for the right side, p < 0.0001 for the left side). Right and left inspiratory diaphragm motions were significantly inversely associated with age (p < 0.0001). Conclusion:This study describes the severity of diaphragm dysfunction in patients with DMD. Diaphragm US may be a non-invasive outcome measure for DMD.

L’agression et les déficits (déglutition, cognitifs, moteurs) expliquent que les patients handicapés neuro-moteurs admis en rééducation post-réanimation (SRPR) soient à risque de dénutrition. De plus, de faibles niveaux d’activité physique et les modifications de la composition corporelle sont associés à des anomalies métaboliques. Dans cette étude, l’état nutritionnel et le profil métabolique des patients à l’admission et à la sortie de SRPR adulte, ainsi que les différences selon les groupes étiologiques et les modes d’assistance nutritionnelle et ventilatoire, ont été investigués en tenant compte des fortes contraintes d’exploration de ces patients fragiles. Une évaluation clinique et anthropométrique, des dosages biochimiques et hormonaux, une estimation des besoins énergétiques ainsi qu’un recueil des apports protéino-énergétiques ont étaient réalisés chez 65 patients (50H, 15F) d’âge 45(± 18)ans à l’admission et à la sortie de SRPR sur une période de 12 mois. La durée moyenne de séjour en SRPR était de 27(± 20)j. Les critères utilisés pour le diagnostic de dénutrition et de syndrome métabolique étaient ceux de la HAS et de l’OMS respectivement. La résistance à l’insuline a été calculée par l’Homeostasis Model Assessment for insulin resistance (HOMA-IR, seuil à 2,4). Les patients ont été divisés en sous-groupes selon la présence (n = 44) ou non d’une trachéotomie et/ou d’une gastrostomie (n = 32) et selon l’étiologie (traumatisme crânien [TC] [n = 22], AVC [n = 16], autres [n = 27]). Les données ont été analysées de façon descriptive et comparative. La prévalence de la dénutrition était de 33 % à l’admission et de 14 % à la sortie (p < 0,05). La majorité des patients (69 %) étaient dépendant d’une nutrition entérale (NE) stricte. Une plus forte prévalence ainsi qu’une plus forte réduction de la dénutrition ont été observées chez les patients avec gastrostomie (47 % vs 15 % à la sortie). À la sortie, un IMC significativement (p < 0,05) plus élevé avec augmentation significative de la créatininémie, de l’albuminémie et de la transthyrétinemie et une diminution de la CRP ont été observées dans tous les sous-groupes de patients. La prévalence de l’insulinorésistance à l’admission était élevée (46 %), notamment chez les femmes (60 %) et dans le groupe TC (55 %). Les patients trachéotomisés (n = 44) étaient significativement plus insulinorésistant (p = 0,01) que les non trachéotomisés. Malgré la forte prévalence de l’insulinorésistance à l’admission, celle du syndrome métabolique était relativement faible (12 %). A la sortie, un sevrage de la NE était possible dans 40 % des cas, 59 % des patients au total ayant maintenu ou retrouvé une autonomie alimentaire orale complète. Les prévalences de la dénutrition et de l’insulinorésistance des patients handicapés neuromoteur admis en SRPR sont élevés. L’état nutritionnel et l’autonomie alimentaire est amélioré à la sortie, notamment chez ceux ayant nécessité une assistance nutritionnelle par gastrostomie. Une évaluation et un contrôle périodique de l’état nutritionnel et métabolique sont donc fortement recommandés afin d’accompagner le besoin en assistance nutritionnelle.

Purpose: To assess the nutritional status and its role in the outcome of patients operated for retroperitoneal liposarcoma (RLS). Material and methods: Retrospective study on consecutive patients operated with en bloc compartment resection for primary or local recurrence of RLS between 2016 and 2017. Preoperative nutritional and laboratory assessment comprising serum albumin, serum transthyretin, orosomucoid, and CRP was systematically performed. The following preoperative parameters were analysed: weight, body mass index (BMI), significant weight loss (>5% in one month and/or >10% in 6 months), serum albumin, transthyretin, CRP, orosomucoid. PINI (prognostic inflammatory and nutritional index) was calculated. Results: There were 40 patients operated for RLS: 22 women and 18 men with a median age of 61 years (34-90). Median tumour was 280 mm (80-530). Median preoperative BMI was 24.8 (18-42) and median postoperative BMI was 23 (17.8-44). Twenty-one patients (52.5%) were considered to be malnourished: 3 with biological signs of malnutrition and 18 with weight loss. Eleven (47.6%) in the group of malnourished patients and 4 (26.3%) in the group with satisfactory nutritional status developed postoperative complications (p = 0.042). A PINI score>1 was related to significantly longer hospitalisation time 21.8 days (10-58) in comparison with 14.9 [9-30] in patients with PINI < 1, p = 0.003. Conclusions: The malnourished patients with RLS experienced more postoperative complications and longer hospitalisation. Nutritional status and biological markers contribute to the global management of RLS with improved postoperative behaviour including fewer complications and shorter hospitalisation. A prospective larger study with longer follow-up is necessary to refine these results. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.