IntroductionAcute cholangitis (AC) is a clinical condition that requires prompt medical management with IV fluids, antibiotics, and biliary drainage (BD). The optimal timing for BD remains unclear.AimTo investigate the effect of biliary drainage timing on clinical outcomes in AC.Material and methodsWe conducted a retrospective study of patients with AC admitted to the ICU using the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. Emergency department to BD time, hospital death, length of stay (LOS), and severity scores were extracted from the database. We investigated the effect of BD timing on mortality rates, persistent organ failure, and LOS.ResultsA total of 177 patients were included; 50% were males; median age was 75 years, in-hospital mortality was 9.6%, mean time-to-ERCP was 32 h (range: 0.42–229.6) with 76% meeting the Tokyo Guidelines (TG13) criteria for severe cholangitis, and median Simplified Acute Physiology Score II (SAPS II) was 42 (IQR: 33–51). Using 24 h as a cut-off, patients who underwent BD ≤ 24 h had less persistent organ failure (OR = 0.49; 95% CI: 0.26–0.96, p = 0.040), shorter ICU LOS (3.25 vs. 4.95 days, p = 0.040), shorter hospital LOS (7.71 vs. 13.57 days, p = 0.001), but no difference in either in-hospital mortality (OR = 0.47, 95% CI: 0.17–1.29, p = 0.146) or 28-day mortality (OR = 0.61, 95% CI: 0.24–1.53, p = 0.297).ConclusionsIn critically-ill patients with acute cholangitis, early biliary drainage ≤ 24 h is associated with less persistent organ failure and shorter length of stay but had no effect on patient survival.

Background: Acute kidney injury (AKI) is a significant complication of Coronavirus Disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analog, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. Methods: We implemented a quasi-experimental design with non-random, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline estimated glomerular filtration rate <15 ml/min/1.73m2 on or off dialysis, with COVID-19-related AKI by Kidney Disease Improving Global Outcomes (KDIGO) criteria, in two hospitals with identical COVID-19 care algorithms, one of which additionally implemented treatment with niacinamide for COVID-19-related AKI. Patients on the niacinamide protocol (B3 patients) were compared against patients at the same institution before protocol commencement and contemporaneous patients at the non-niacinamide hospital (collectively, non-B3 patients). The primary outcome was a composite of death or renal replacement therapy (RRT). Results: 38/90 B3 patients and 62/111 non-B3 patients died or received RRT. Using multivariable Cox proportional hazard modeling, niacinamide was associated with a lower risk of RRT or death (HR 0.64, 95% CI 0.40 to 1.00, p=0.05), an association driven by patients with KDIGO stage 2/3 AKI (HR 0.29, 95% CI 0.13 to 0.65, p=0.03; p interaction with KDIGO stage 0.03). Total mortality also followed this pattern (HR 0.17, 95% CI 0.05-0.52 in KDIGO 2/3 patients, p=0.002). Serum creatinine following AKI increased by 0.20 (SE 0.08) mg/dL/day among non-B3 patients with KDIGO 2/3 AKI but was stable among comparable B3 patients (+0.01 (SE 0.06) mg/dL/day; p interaction 0.03). Conclusions: Niacinamide was associated with lower risk of RRT/death and improved creatinine trajectory among patients with severe COVID-19-related AKI. Larger randomized studies are necessary to establish a causal relationship.

This paper provides an illustration of all stages of primary aeronautical composite structure repair by using industrial tools and scientific methodologies, as well as numerical tools to simplify the cross-over analysis of the mechanical behaviour of the repaired area. Economically and scientifically speaking, one of the main challenges of composite repair (for monolithic long fiber composite parts) consists of promoting a bonded composite patch option without additional riveted doublers. To address this challenge, size reduction of the patch could be mandatory. A patent (jointly owned by ICA, Bayab Industries and CES), entitled “Method for repairing a wall consisting of a plurality of layers”, is devoted to reducing repair patch dimensions of monolithic composite parts provided the bonding zone has a stepped-lap geometry. This patent is based on a simple idea that no overlapping length is required between composite plies for load transfer except in the fiber directions of the plies (unidirectional or biaxial long fiber reinforcements with epoxy matrix). To prove this concept, we consider on one hand, a situation unusual in the literature by studying a composite specimen without fibers aligned along the main loading axis, and on the other hand, a classical situation of where the shape of the specimen is adapted to be studied by uniaxial tension tests. After different manufacturing steps, the studied specimen contains three zones representing both the influence of the total thickness of a repair patch, the stepped-lap area assembled with an adhesive film and the parent composite part. Basically, a simple parent structure consisting of 16 plies of UD Hexply® M21/35%/268/T700GC (close to Airbus composite raw materials on board in A380) is manufactured with a stacking sequence of [+45/−45/−45/+45/+45/−45/−45/+45]s. Then, the parent structure is machined by the Airbus Abrasive Water Jet machine and the final repair area has a stepped-lap geometry by overlapping successive plies of the same nature as the parent plate and after having previously applied an adhesive film (cured at 180 °C). Furthermore, 3 values of overlap length (respectively, 6, 8 and 13 mm) are investigated to include the mean value required by Airbus in the case of the use of the studied prepreg. After abrasive water jet machining of the composite parent part, repair patch manufacturing was performed according to Airbus requirements. The studied specimens were cut from the final plate (involving the parent plate, the stepped lap zone and the zone of the patch itself) and tested in an uniaxial tensile configuration with a loading direction shifted 45° with respect to the fiber direction. Furthermore, studying uniaxial tensile tests on multilayer-pasted interface is innovative in the literature. In this paper, it is shown that the stepped-lap area assembled with an adhesive film is not the weak link of the mechanical response but rather the parent area, i.e. the unrepaired monolithic composite. Numerical calculations confirm this proof of concept by underlying that the level of shear stress in the adhesive film, for these three overlapping values, is below the chosen limit value. These results show that the patch size reduction is possible.