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Background: Addressing the high prevalence of disease-related malnutrition (DRM) requires political will. The aim of this study is to define DRM as a health public policy issue from the point of view of the stakeholders. Methods: We conducted a qualitative phenomenological study consisting of grey data search and individual semi-structured in-depth interviews with stakeholders (policy-makers, academics, and civil society organization representatives) from 17 Latin American countries. The analyzed themes reflected ideas repeatedly found across the interviews. Results: 26 respondents were interviewed (5 policy-makers, 18 academics, 3 civil society organizations representatives). The grey data research and interviews showed that Brazil and Costa Rica were the only countries in the Region that had developed a specific public health policy addressing DRM and nutrition care issues. The rest of the Latin American countries had a nutrition policy which neither addressed DRM specifically nor included nutrition care, with important heterogeneity existing in terms of national regulation of selected nutritional care categories. Stakeholder opinions allowed to identify heterogeneity in the understanding of the nature and causes of DRM, confusing DRM with malnutrition caused by food insecurity and lack of food availability. Policy in the field of clinical nutrition can be addresses from two approaches: interdisciplinarity and a human rights-based approach. Conclusion: DRM is an unaddressed problem by health policy. Due to internal and external factor related to the health systems DRM has not been able to become a public policy issue. The study highlights the need for the development of public policy in clinical nutrition aimed at improving access to nutrition care. © 2021 European Society for Clinical Nutrition and Metabolism Background: Addressing the high prevalence of disease-related malnutrition (DRM) requires political will. The aim of this study is to define DRM as a health public policy issue from the point of view of the stakeholders. Methods: We conducted a qualitative phenomenological study consisting of grey data search and individual semi-structured in-depth interviews with stakeholders (policy-makers, academics, and civil society organization representatives) from 17 Latin American countries. The analyzed themes reflected ideas repeatedly found across the interviews. Results: 26 respondents were interviewed (5 policy-makers, 18 academics, 3 civil society organizations representatives). The grey data research and interviews showed that Brazil and Costa Rica were the only countries in the Region that had developed a specific public health policy addressing DRM and nutrition care issues. The rest of the Latin American countries had a nutrition policy which neither addressed DRM specifically nor included nutrition care, with important heterogeneity existing in terms of national regulation of selected nutritional care categories. Stakeholder opinions allowed to identify heterogeneity in the understanding of the nature and causes of DRM, confusing DRM with malnutrition caused by food insecurity and lack of food availability. Policy in the field of clinical nutrition can be addresses from two approaches: interdisciplinarity and a human rights-based approach. Conclusion: DRM is an unaddressed problem by health policy. Due to internal and external factor related to the health systems DRM has not been able to become a public policy issue. The study highlights the need for the development of public policy in clinical nutrition aimed at improving access to nutrition care. © 2021 European Society for Clinical Nutrition and Metabolism

La desnutrición es una enfermedad común en pacientes con enfermedades incurables que se benefician de cuidados paliativos. El cuidado nutricional, parte integral del tratamiento de estos pacientes, permite la administración adecuada de la terapia nutricional oral, enteral o parenteral. En este contexto, la terapia nutricional está indicada con el objetivo de aumentar la supervivencia y la calidad de vida en algunos pacientes, como aquellos con problemas neurológicos o cáncer. Sin embargo, existe gran controversia sobre sus indicaciones y los beneficios potenciales, en particular, los de la nutrición parenteral a domicilio. Por tanto, el objetivo de esta revisión es responder a dos preguntas: ¿Cuándo se debe iniciar y detener la terapia nutricional? ¿La terapia nutricional mejora la calidad de vida y prolonga la sobrevida de los pacientes en cuidados paliativos? Las sociedades científicas no recomiendan la introducción de la terapia nutricional en todos los casos de desnutrición, especialmente en pacientes hipofágicos, si su esperanza de vida es inferior a 2 meses. La nutrición parenteral puede beneficiar a algunos pacientes bien identifica-dos, al aumentar el tiempo de supervivencia, sin embargo, el impacto en la calidad de vida sigue siendo incierto. Las decisiones deben tomarse de manera individualizada y respetando la autonomía del paciente, evitando el encarnizamiento terapéutico. La investigación en este campo debe avanzar para poder determinar, con mayor certitud, la relación riesgo-beneficio de la terapia nutricional.

Background Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. Methods We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. Results A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). Conclusions This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.

The aim of the study was to determine the prevalence of cancer cachexia according to the clinical stage and determine differences in body composition, usual energy intake, and proinflammatory profile between cachectic and non-cachectic patients newly diagnosed with head and neck squamous cell carcinoma (HNSCC). A cross-sectional study was conducted in adult patients diagnosed with HNSCC admitted to the oncology unit before starting cáncer treatment. Cancer cachexia was assessed according to Fearon criteria, and patients were divided into two groups: cachectic and non-cachectic patients. Body composition measured by bioelectrical impedance, energy intake, and biochemical and inflammatory markers were assessed. Comparative analyses were performed Student’s-T test, using one-way ANOVA, chi-square and Mann Whitney-U test. Of the 79 consecutive patients included in the analysis, 72% (n¼57; 61 ± 15 years) were classified as cachectic and 28% (n¼22;59 ± 10 years) as non-cachectic. According to clinical stage, the prevalence of cachexia was stage I¼8.8%, stage II ¼ 15.8%, stage III ¼ 33.3% and stage IV ¼ 42.1% (P¼0.564) and phase angle showed to be different between these groups (P

The World Health Orga-nization declared the disease COVID-19 caused by the SARS-CoV-2 virus as a pandemic on March 11, 2020. In Colombia, the first case was registered on March 6, 2020. Unprecedented, this pandemic presents challenges for patients and healthcare systems worldwide. The objective of this document is to offer recommendations on nutrition interventions in hospitalized patients with SARS-CoV-2 infection with special emphasis on the critically ill patient.

Justificación: La brecha entre la educación nutricional proporcionada a los estudiantes de medicina y las competencias y actitudes nutricionales necesarias para que los médicos brinden una atención nutricional eficaz es una preocupación mundial. El objetivo de este estudio fue investigar el contenido curricular sobre educación nutricional en las facultades de medicina de América Latina y evaluar los conocimientos, las actitudes y las barreras autopercibidas para la práctica de la nutrición de los estudiantes de último año de medicina. Métodos: Se invitó a participar en el estudio a 85 facultades de medicina públicas y privadas de 17 países de América Latina. Se enviaron dos cuestionarios en línea cerrados que constaban de 25 y 43 preguntas a los directores de las facultades de medicina. Las variables cuantitativas se expresaron como frecuencias, porcentajes, media ± desviación estándar, medianas y rangos. Resultados: Respondieron un total de 22 (26%) directores de escuelas de medicina, de los cuales 11 escuelas (50%) ofrecían cursos de nutrición obligatorios independientes en años preclínicos y 8 (36%) en años clínicos. La media de horas dedicadas a la educación nutricional fue de 47 (rango: 0-150). Respondieron un total de 1530 de 1630 (94%) estudiantes de 12 países. La edad promedio de los estudiantes fue de 25 ± 3 años y el 59% eran mujeres. La mayoría de los estudiantes estuvo de acuerdo en que mejorar la salud de los pacientes a través de la nutrición (91 %) es importante y que el asesoramiento y la evaluación nutricional deben ser parte de la atención de rutina brindada por todos los médicos (89 %), pero carecen del nivel de educación y capacitación necesarios para abordar la nutrición. -asuntos relacionados. Conclusiones: La actitud positiva y el interés por la nutrición entre los estudiantes de último año de medicina es alto, pero la educación en nutrición no se percibe como suficiente para preparar adecuadamente a los médicos en el campo de la nutrición. Rationale: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. Methods: Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0–150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students’ average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients’ health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Conclusions: Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

Summary: Background & aims: The high prevalence of disease-related malnutrition is a major public health issue worldwide despite the fact that the efficacy of nutritional care has been extensively documented. Therefore, it is needed to move forward on stronger public health policies. The aim of our article is to analyze the link between nutritional care and human rights. We wonder whether it is possible to consider nutritional care as a human right. Methods: We examine the relationship between nutritional care and human rights by using the human rights-based approach. It allows us to determine the grounding of the nutritional care as a human right, the duty-bearers and its content or scope. Results: The difficulties in the conception and realization of the right to food in the clinical context and the possibility to define a specific scope for nutritional care within the care-giving context shows that the right to nutritional care can be considered as a human right by itself and closely related to the right to food and the right to health. The human right to nutritional care implies that the patient has the right to beneficiate from the right to be screened for malnutrition and receive a malnutrition diagnosis, to receive regular hospital diet, therapeutic diet and medical nutrition therapy administrated by a team of experts, and the government has the duty to guarantee it. Conclusion: The right to nutritional care can be considered as a human right by itself. Violating the right to nutritional care may often impair the enjoyment of other human rights, such as the rights to health or food and vice versa. The main impact of this recognition is attended to be at the national and international policies level. Knowing that the relation between human rights and nutritional care is a new issue, more research is warranted to ascertain its precise nature. Keywords: The human right to food, The human right to health, Malnutrition, Nutritional care

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Background The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education. Methods We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5). Results A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process. Conclusion The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.

When the natural oral intake of food and liquids is disturbed the role of caregivers is to assist the patient in order to cover the individual's need for nutrition by nutrition therapy. Nutrition therapy is a medical intervention, which requires an indication for achieving a treatment goal and the informed consent of the competent patient. Withholding and withdrawing nutrition therapy and artificial hydration must be evaluated in specific situations (terminally ill, palliative care, dementia, aged patients) and always case by case according to the patients' cultural and spiritual needs. In the case of ethical issues or dilemmas, application of the four principles of autonomy, beneficence, non-maleficence, and justice is recommended. These principles assist the caregiver in the decision as whether to feed or not to feed. Caregivers must emphasize the right to self-determination and thus to respect the autonomy of the patient, and also the particular vulnerability of the patient suffering from or at risk of malnutrition. Caregivers must be ethically capable of responding to the nutritional needs according to the patient's will and desires even if the patient is not capable of self-determination, always looking for the best benefit to the patient and avoiding harm.

The COVID‐19 pandemic has reached worldwide and until a vaccine is found it will continue to cause significant morbidity and mortality. The clinical presentation of COVID‐19 ranges from that of being asymptomatic to developing a fatal illness characterized by multiple organ involvement. Approximately 20% of the patients will require hospitalization; one quarter of hospitalized patients will develop severe COVID‐19 requiring admission to the intensive care unit, most frequently, with acute respiratory failure.An ongoing effort is being made at identifying the patients that will develop severe COVID‐19. Grossly, patients present with three different nutritional risk phenotypes: 1) the frail older patient, 2) the patient with severe ongoing chronic illness, and 3) the patient with severe and morbid obesity. These three phenotypes represent different nutritional risks, and diverse nutrition interventions. This article explores the different potential approaches to nutrition intervention in patients with COVID‐19 evaluating, in this process, the challenges faced for the implementation of guidelines written by different societies. This article is protected by copyright. All rights reserved

The Sustainable Development Goals (SDGs) seek to end all forms of hunger and malnutrition by 2030 and ensure the access of all people, especially children, to sufficient and nutritious food throughout the year. However, the goals of SDG 2 “Zero Hunger,” and the other 16 SDGs do not include the problem of malnutrition associated with disease. Malnutrition (low weight, overweight and obesity, micronutrient deficiencies) associated with socio-economic factors (poor diet, hunger and poverty) and malnutrition associated with disease have different pathophysiological origins and mechanisms and therefore need different approaches. The Cartagena Declaration is an instrument where nutritional care is defined for the first time as a human right and can be considered as a strategy to give visibility and draw the attention of public policy makers on the need to advance in this field. By including this type of malnutrition within the global approach to the problem of population malnutrition, we would be contributing to achieving the SDG targets and, in particular, to the sustainable development of countries.

Malnutrition is a public health problem in the world. Malnutrition associated with socioeconomic factors falls within the scope of the right to adequate food. The approach to this type of malnutrition is achieved through the two aspects of this right: the right to be protected against hunger and the right to adequate food, wich implies the need to constitute an economic, political and social environment that allows people to achieve food security by their own means. However, malnutrition associated with the disease cannot be defined within the scope of the right to food. In this context, a human right to nutritional care should be considered where the person at risk or in a state of malnutrition can receive nutritional care including nutritional therapy in an optimal and timely manner. This new emerging human right must be studied and defined from the human rights approach to be recognized before international and national human rights institutions.

Considering the high prevalence of malnutrition associated with disease and the need to advance education and research in clinical nutrition, the Cartagena Declaration was signed in May 2019. This is the International Declaration on the right to nutritional care which is addressed to societies, colleges and associations affiliated with FELANPE, and to any organization or institution that promotes the fight against malnutrition. The Declaration provides a coherent framework of 13 Principles which can serve as a guide in the development of action plans. In addition, it will serve as an instrument for states to formulate policies and legislate in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raising awareness about the magnitude of this problem and forging cooperation networks between the countries of the region, and why not, the world. It will be, then, contributing to achieving the United Nations Sustainable Development Goals that seek, by 2030, to end all forms of malnutrition.

Purpose To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. Methods Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure 4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. Results Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n = 150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a non-decrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5–6.2). Conclusions Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4 mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.

Nutritional care through interdisciplinary nutritional support groups and under standards and clinical guidelines has been shown to improve patient outcomes and safety with a positive financial impact on health institutions. However, the world tendency is to the diminution of these groups. The objective of this article is to present the information about the status and evolution of the nutritional support groups in Colombia obtained in the nutritionDay in the period 2011 to 2016.

Background: Surgical interventions such as posterior lumbar interbody fusion (PLIF) with and without posterior instrumentation are often employed in patients with degenerative spinal conditions that fail to respond to conservative medical management. The VariLift ® Interbody Fusion System was developed as a stand-alone solution to provide the benefits of an intervertebral fusion device without the requirement of supplemental pedicle screw fixation. Methods: In this retrospective case series, 25 patients underwent PLIF with a stand-alone VariLift ® expandable interbody fusion device without adjunctive pedicle screw fixation. There were 12 men and 13 women, with a mean age of 57.2 years (range, 33–83 years); single level in 18 patients, 2 levels in 7 patients. Back pain severity was reported as none, mild, moderate, severe and worst imaginable at baseline, 6 and 12 months. Preoperatively, 88% (22 of 25) of patients reported severe back pain. Results: All patients experienced symptomatic improvement and, by 12 months postoperatively, 71% (15 of 21) of patients reported only mild residual pain. Overall, pain scores improved significantly from baseline to 12 months (P=0.0002). There were no revision surgeries and fusion was achieved 12 of 13 patients (92%) who returned for a 12-month radiographic follow-up. There were three cases of intractable postsurgical pain which required extended hospitalization or pain management, one wound infection and one case of surgical site dehiscence, both treated and resolved during inpatient hospitalization. Conclusions: In this single-physician case series, the VariLift ® device used in single or two-level PLIF provided effective symptom relief and produced a high fusion rate without the need for supplemental fixation.

Disease-related malnutrition is a known factor for poor outcomes. However, there is a lack of knowledge about the prevalence and the impact of nutritional risk on outcomes in Colombia. The aim of the present study was to determine the prevalence of nutritional risk, to know how nutrition screening is routinely performed and to determine the impact of nutritional risk on the outcomes of in-hospital mortality and being discharged home outcomes.We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples (2009-2015) including a total of 7,994 adult patients in 248 units in Colombia. Data is contrasted with the Latin American and worldwide results. The prevalence of nutritional risk was determined according to the malnutrition screening tool (MST). The impact of nutritional risk in Colombian patients regarding outcomes was assessed by a Fine and Gray competing risk regression model controlling for PANDORA score (age, BMI, length of stay before nutritionDay, cancer diagnosis, and mobility).The prevalence of nutritional risk (MST score ≥ 2) in Colombia was 38%, 41% in Latin America, and 32% worldwide. Half of the Colombian units screened patients for malnutrition or nutritional risk on admission to hospital, compared to 80% in Latin America and 62% worldwide. Only 23% of the Colombian patients identified as being at nutritional risk in the nutritionDay survey received any nutritional therapy. The hospital mortality hazard ratio of Colombian patients at nutritional risk defined by MST was 1.94 (95% CI, 1.53,2.46; p 0.001) and 0.82 of being discharged home (95% CI, 0.76,0.88, p 0.001).This is the first large-scale study in Colombia evaluating the impact of nutritional risk on clinical outcomes showing an increase of in-hospital mortality and a reduction of being discharged home. Moreover, the study shows that nutritional risk is still highly prevalent worldwide implying the need to promote an optimal nutritional care. The participation of Latin American countries in the nutritionDay survey is an opportunity to increase knowledge and awareness of these issues.

investigación en nutrición clínica, las sociedades que constituyen la FELANPE firmaron la Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición, “Declaración de Cartagena”, el 3 de mayo del presente año en la ciudad de Cartagena, en el marco del 33º Congreso de la Asociación Colombiana de Nutrición Clínica. La Declaración proporciona un marco coherente de 13 principios, los cuales podrán servir de guía a las sociedades afiliadas a la FELANPE en el desarrollo de los planes de acción. Además, servirá como un instrumento para que promuevan, a través de los gobiernos, la formulación de políticas y legislaciones en el campo de la nutrición clínica. Consideramos que el marco general de principios propuesto por la Declaración puede contribuir a crear conciencia acerca de la magnitud de este problema y a forjar redes de cooperación entre los países de la región. Aunque esta Declaración no tiene un efecto jurídico vinculante (obligatorio), tiene una fuerza moral innegable y puede proporcionar orientación práctica a los estados. Un plan de implementación permitirá desarrollar la caja de herramientas necesaria para transformar los principios en acciones. The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE’s societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, “Declaration of Cartagena”. The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raise awareness about the magnitude of this problem and to promote cooperation networks among Latin-American countries. Although this Declaration does not have a binding legal effect, it has an undeniable moral strength and it can provide practical guidance to States. An implementation program will allow developing a toolkit to transform principles into actions.

[No abstract available]

Background: Adjacent Segment Disease (ASD) is a notable complication following lumbar fusion surgery. Clinicians use various surgical techniques to correct the progression of spine deterioration and reduce the risk of continued ASD. The aim of this retrospective case series is to describe patient outcomes following posterior lumbar interbody fusion (PLIF) using the VariLift® standalone interbody device (without supplemental fixation) for the treatment of ASD. Methods: Nine consecutive patients who underwent a single-level PLIF for the treatment of ASD were reviewed. Outcome measures included patient demographics, comorbidities, surgical complications, time to fusion, Visual Analog Scales for Pain (VAS), and overall patient reported recovery of symptoms. Nine patients (8 males, 1 female) with a mean age of 62.3 (42 to 72) years underwent a single-level procedure. The standalone VariLift interbody fusion system was used in all 9 sequential patients, regardless of the type of fusion/fixation instrumentation previously used. Surgical technique consisted of discectomy and generous bilateral laminotomies with medial facetectomies preserving midline ligamentous structures. Results: Radiographic ASD was confirmed in all cases. Each patient had a history of a lumbar fusion. Preoperatively, 89% of patients reported 9-10 VAS back pain levels. All patients experienced symptomatic improvement. By 12 months postoperatively, average VAS back pain score was 2, a significant improvement from baseline (p

Many first generation stand-alone fusion cages required endplate decortication and surgical impaction during the procedure resulting in segmental subsidence, implant migration and loss of lordosis postoperatively. The primary objective of this study was to evaluate radiographically, in a large series of patients, whether engineering and design modifications incorporated in a specific stand-alone, expandable interbody fusion device (VariLift(®)-L) adequately addressed previously recognized deficiencies of stand-alone interbody cages.In this retrospective chart review of 470 patients (642 treated levels), we evaluated radiographic evidence of fusion, subsidence and migration following a one- or two-level PLIF procedure utilizing this stand-alone expandable interbody fusion device. A secondary objective was to corroborate the low morbidity and symptomatic improvements achieved with previous interbody cage devices used to treat symptomatic disc degeneration.The average postoperative followup was 3.9 ± 1.8 years and a solid fusion rate of 94% was achieved among patients with ≥ 9 months of radiographic followup. Subsidence3 mm was noted at 10 levels with no cases of device migration. Composite back pain severity scores improved from 8.5 ± 1.5 preoperatively to 0.8 ± 1.5 at final followup (p0.001) and 94% of patients met or exceeded the minimal clinical important difference of 3.8 points. Eighteen patients required reoperation following the index procedure; 16 of these patients were treated for adjacent segment disease.The VariLift-L device has excellent clinical and technical performance characteristics, providing adequate stabilization of the anterior column without the need for supplemental posterior instrumentation. Level of Evidence IV. IRB Approval: Expedited Federal Register Categories 57: Methodist IRB 3/30/2011; Informed Consent statement: retrospective data collection, patients signed consent forms allowing for data to be used for research.This stand-alone expandable fusion device produced high fusion rates, a low incidence of reoperation and effective symptom relief in a "real world" setting among a large group of patients with refractory symptomatic disc degeneration.

Summary Background Although the therapeutic and economic efficacy of nutrition has been proven, optimal nutritional care is still scarce among hospital and ambulatory patients. Thus malnutrition is still highly prevalent. We identify as an underlying cause the absence of a common understanding of clinical nutrition as a discipline. The aim of this paper is to establish the epistemological foundations of clinical nutrition and to characterize it as a science. Methods and results From the standpoint of historical epistemology, we examine the historical conditions that determine i) the main object of knowledge, ii) the nature and iii) domain of this science. Our hypothesis is that clinical nutrition as a science was formed in the second half of the twentieth century as an outcome of the integration of medicine and nutrition and underpinned by a primary transformation of the “nutrient” concept. We identify malnutrition as the primary practical and research domain of knowledge. Conclusion Clinical nutrition is an autonomous empirical science that can be characterized as a basic and applied science. Its wide multi-disciplinarity guarantees its future.

Background and aim The link between food and health has been documented since Antiquity. The aim of the article is to show that the alleged Hippocratic phrase “let food be thy medicine and medicine be thy food” is a widespread misquotation, lying at the root of an entire misconception about the ancient concepts of food and medicine. Methods Examples of publications gathered from the MEDLINE ® and Google Scholar databases which cite the phrase verbatim and attribute it to Hippocrates were selected. Then, an extensive review of the works related to food and diet in the Corpus Hippocraticum was made in order to search for the phrase. Results At least for the last 30 years this phrase has mistakenly helped scientists confirm the importance of food to health and highlight new ethical challenges in medicine and dietetics. We showed that at least one biomedical journal per year has cited the phrase. Conclusion This literary creation has led to an essential misconception. For Hippocrates, even if food was closely linked to health and disease, the concept of food was not confused with that of medication.

Resume L’α-cetoglutarate d’ornithine (ACO) est un adjuvant de la nutrition artificielle utilise par voie orale, enterale ou parenterale et entrant dans la categorie des immuno-pharmaconutriments azotes. L’utilisation de modeles animaux et des etudes chez l’homme ont permis de mettre en evidence que l’administration d’ACO entraine la secretion d’hormones anaboliques (insuline, hormone de croissance) et la production de metabolites aux proprietes anti-cataboliques, anaboliques et/ou immunostimulantes : arginine, glutamine, proline et polyamines. Cliniquement, l’ACO a fait la preuve de son efficacite dans le traitement de la denutrition du sujet brule, ainsi que chez le sujet âge denutri. Ses proprietes pro-cicatrisantes permettent d’envisager son utilisation dans le traitement de la brulure, des escarres et en chirurgie plastique et reparatrice. L’apport d’ACO a ete propose chez le cancereux cachectique et dans certaines pathologies infantiles, mais les donnees restent tres limitees. L’utilisation de supplements comme l’ACO pourrait ameliorer la prise en charge des malades denutris hospitalises ou ambulatoires.

Clinical trials to identify patients at risk and to assess new therapeutic agents in the nutritional field are often single-site. The principal advantage of mounting a multicentric trial is that patient accrual is much quicker. Albumin, transthyretin, and C-reactive protein are frequently used biochemical markers of nutritional and inflammation status. However, the different techniques, reagents, and calibrators used to measure these markers introduce wide variations in values among laboratories. This study was carried out as part of a prospective multicentric study in chronic respiratory disease patients to evaluate variability and comparability of results among laboratories for these biochemical markers, and to determine whether centralization is necessary. Thirty enrolled laboratories provided their own range of reference values for those proteins a nd were then requested to process two control samples C1 and C2 blind. The results showed a broad dispersion of values for albumin and transthyretin. In 7% of laboratories, results of albumin for C2 (mean, all techniques: 39.1+/-3 g/l) were35 g/l, the threshold value indicating a potential risk of malnutrition. When only laboratories using immunonephelemetry were considered, the results were satisfactory (CV10% for all proteins). Given the possible incorrect classification of patients at risk, measurement should be made per site only if all participants use an immunonephelometric method. Otherwise, a centralizing assay of these biological markers should be considered.

Intervertebral fusion cages have been in clinical use since the 1990s. Cages offer the benefits of bone graft containment, restored intervertebral and foraminal height, and a more repeatable, stable procedure compared to interbody fusion with graft material alone. Due to concerns regarding postoperative stability, loss of lordosis, and subsidence or migration of the implant, interbody cages are commonly used with supplemental fixation such as pedicle screw systems or anterior plates. While providing additional stability, supplemental fixation techniques increase operative time, exposure, cost, and morbidity. The VariLift(®) Interbody Fusion System (VariLift(®) system) has been developed as a standalone solution to provide the benefits of intervertebral fusion cages without the requirement of supplemental fixation. The VariLift(®) system, FDA-cleared for standalone use in both the cervical and lumbar spine, is implanted in a minimal profile and then expanded in situ to provide segmental stability, restored lordosis, and a large graft chamber. Preclinical testing and analyses have found that the VariLift(®) System is durable, and reduces stresses that may contribute to subsidence and migration of other standalone interbody cages. Fifteen years of clinical development with the VariLift(®) system have demonstrated positive clinical outcomes, continued patient maintenance of segmental stability and lordosis, and no evidence of implant migration. The purpose of this report is to describe the VariLift(®) system, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The VariLift(®) System represents an improved surgical option for a stable interbody fusion without requiring supplemental fixation.

Osteomyelitis of the spine is a fairly uncommon event following an orthopedic surgical procedure. However, a solitary osteomyelitic abscess of the upper cervical spine is very rare. Surgical intervention is often the only life-saving treatment method. A 70-year-old female patient with diabetes was received from a rural community with symptoms of progressive quadraparesis and progressive respiratory failure. A CT scan of the cervical spine showed a destruction of the C1 and C2 complex, as well as the left occipital condyle, and clear evidence of craniocervical instability. She underwent surgical debridement of the abscess via an anterior microscopic transtubular approach, followed by a posterior occipital-cervical fusion. While a transoral approach is a well-established procedure for the anterior clivus/C1-2 area, it is fraught with a high degree of morbidity and mortality. The use of the transtubular anterior cervical approach in this case allowed us to access the C1-2 area with ease and minimal effort. From a technical standpoint, this type of approach for treatment of this condition has not been previously documented in the literature.