Fluid intake and changes in limb volumes in male ultra-marathoners: does fluid overload lead to peripheral oedema?

An increase in body mass due to oedema has been previously described. The aim of this study was to investigate a potential association between both fluid and electrolyte intake and the formation of peripheral oedemas. Fluid and electrolyte intakes and the changes in limb volumes in 50 male 100-km ultra-marathoners were measured. Pre- and post-race serum sodium concentration ([Na+]), serum aldosterone concentration, serum copeptin concentration, serum and urine osmolality and body mass were determined. Fluid intake, renal function parameters and urinary output, as well as the changes of volume in the extremities, were measured. The changes of volume in the limbs were measured using plethysmography. Serum [Na+] increased by 1.6%; body mass decreased by 1.9kg. Serum copeptin and aldosterone concentrations were increased. The change in serum copeptin concentration and the change in serum [Na+] correlated positively; the change in serum [Na+] and body mass correlated negatively. A mean fluid intake of 0.58L/h was positively related to running speed and negatively to post-race serum [Na+]. Total fluid intake was positively related to the changes in both arm and lower leg volumes. Running speed was positively associated with the changes in arm and lower leg volumes; race time was related to the changes in serum copeptin or aldosterone concentrations. To conclude, fluid intake was related to the changes in limb volumes, where athletes with an increased fluid intake developed an increase in limb volume

Frailty as a Predictor of Poor Rehabilitation Outcomes among Older Patients Attending a Geriatric Day Hospital Program: An Observational Study.

BACKGROUND The Geriatric Day Hospital (GDH) is an important outpatient geriatric service, but there are few data on the role of frailty as a potential predictor of poor outcomes in this setting. METHODS Data were analyzed from 499 patients aged ≥ 60 years attending a 12-week GDH program between 2018 and 2021. Frailty status was defined as non-frail (68, 13.6%), mild/moderate frailty (351, 70.3%), and severe frailty (80, 16.0%) based on the Clinical Frailty Scale (CFS). Outcomes were defined as (1) poor outcome (hospital readmission, death, or medical deterioration) during the program and (2) admission to permanent nursing home care upon completion of the program. Multivariate logistic models were used for predictive analyses. RESULTS The mean age was 80.3 (standard deviation 7.0); 58.3% were women. Overall, 77 patients (15.4%) had a poor outcome, and 48 (9.6%) were admitted to permanent nursing home care. Poor outcome was experienced by none of the non-frail patients (0%), by 49 (14.0%) patients with mild/moderate frailty, and 22 (27.5%) patients with severe frailty (adjusted OR, 2.0; 95% CI 1.3, 3.2; p < 0.01). Admission to a permanent nursing home care was experienced by none of the non-frail patients (0%), 20 (5.7%) of those with mild/moderate frailty, and 28 (35.0%) with severe frailty (adjusted OR, 2.9; 95% CI 1.3, 6.3; p < 0.01). CONCLUSIONS The CFS is a promising risk predictor of poor outcome and admission to permanent nursing home discharge among older patients attending a GDH program

Decision support for the selection of reference sites using 137Cs as a soil erosion tracer

The classical approach of using 137Cs as a soil erosion tracer is based on the comparison between stable reference sites and sites affected by soil redistribution processes; it enables the derivation of soil erosion and deposition rates. The method is associated with potentially large sources of uncertainty with major parts of this uncertainty being associated with the selection of the reference sites. We propose a decision support tool to Check the Suitability of reference Sites (CheSS). Commonly, the variation among 137Cs inventories of spatial replicate reference samples is taken as the sole criterion to decide on the suitability of a reference inventory. Here we propose an extension of this procedure using a repeated sampling approach, in which the reference sites are resampled after a certain time period. Suitable reference sites are expected to present no significant temporal variation in their decay-corrected 137Cs depth profiles. Possible causes of variation are assessed by a decision tree. More specifically, the decision tree tests for (i) uncertainty connected to small-scale variability in 137Cs due to its heterogeneous initial fallout (such as in areas affected by the Chernobyl fallout), (ii) signs of erosion or deposition processes and (iii) artefacts due to the collection, preparation and measurement of the samples; (iv) finally, if none of the above can be assigned, this variation might be attributed to "turbation" processes (e.g. bioturbation, cryoturbation and mechanical turbation, such as avalanches or rockfalls). CheSS was exemplarily applied in one Swiss alpine valley where the apparent temporal variability called into question the suitability of the selected reference sites. In general we suggest the application of CheSS as a first step towards a comprehensible approach to test for the suitability of reference sites

Simplified Bioprinting-Based 3D Cell Culture Infection Models for Virus Detection

Studies of virus–host interactions in vitro may be hindered by biological characteristics of conventional monolayer cell cultures that differ from in vivo infection. Three-dimensional (3D) cell cultures show more in vivo-like characteristics and may represent a promising alternative for characterisation of infections. In this study, we established easy-to-handle cell culture platforms based on bioprinted 3D matrices for virus detection and characterisation. Different cell types were cultivated on these matrices and characterised for tissue-like growth characteristics regarding cell morphology and polarisation. Cells developed an in vivo-like morphology and long-term cultivation was possible on the matrices. Cell cultures were infected with viruses which differed in host range, tissue tropism, cytopathogenicity, and genomic organisation and virus morphology. Infections were characterised on molecular and imaging level. The transparent matrix substance allowed easy optical monitoring of cells and infection even via live-cell microscopy. In conclusion, we established an enhanced, standardised, easy-to-handle bioprinted 3D-cell culture system. The infection models are suitable for sensitive monitoring and characterisation of virus–host interactions and replication of different viruses under physiologically relevant conditions. Individual cell culture models can further be combined to a multicellular array. This generates a potent diagnostic tool for propagation and characterisation of viruses from diagnostic samples.Peer Reviewe

Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

BACKGROUND General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction. METHODS This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia. RESULTS In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11 %) were demented. If SST or PMR were abnormal, sensitivity was 71 % (95 % CI 44-90 %), and specificity 64 % (95 % CI 55-72 %) for detecting dementia. If both tests were abnormal, sensitivity was 24 % (95 % CI 7-50 %), but specificity increased to 93 % (95 % CI 88-97 %). CONCLUSION Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results

Biomarqueurs des pathologies neurodégénératives dans le diagnostic des troubles cognitifs. Revue et recommandations de Swiss Memory Clinics

Established cerebrospinal fluid (CSF) biomarkers allow for earlier and more accurate etiological diagnosis of cognitive impairment. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published consensus recommendations. The results must be interpreted in the context of the other available history information and assessments. Blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice soon. Consequently, a broader usage of biomarkers is expected and may accelerate the development of individually tailored prevention and treatment approaches. This article provides the recommendations of the Swiss Memory Clinics for the use of biomarkers in clinical practice. = Les marqueurs du liquide céphalorachidien établis permettent un diagnostic des troubles cognitifs plus précoce et précis. Il est nécessaire de conseiller les patients avant et après un examen des biomarqueurs. Les procédures de la ponction lombaire et de traitement préanalytique des échantillons doivent suivre des recommandations publiées. L’interprétation des résultats prendra en compte les antécédents médicaux et les autres résultats d’examen disponibles. Des marqueurs sanguins pourraient être disponibles dans un avenir proche. Cela pourrait conduire à une utilisation plus large des biomarqueurs et accélérer le développement d’approches personnalisées de prévention et de traitement. Cet article présente les recommandations de Swiss Memory Clinics concernant l’utilisation des biomarqueurs en pratique clinique

Biomarker in der Diagnostik kognitiver Störungen – Empfehlungen der Swiss Memory Clinics

Zusammenfassung. Molekulare Liquormarker der Alzheimer-Kernpathologie (Amyloidpathologie, Tau-Hyperphosphorylierung und neuronaler Zelluntergang) sind Bestandteil des diagnostischen Instrumentariums zur Abklärung kognitiver Störungen im Alter. Sie erlauben eine frühere und präzisere Diagnose und werden von Swiss Memory Clinics als Zusatzdiagnostik nach individuell gestellter Indikation empfohlen. Aufklärung und Beratung sind sowohl vor als auch nach der Biomarker-Diagnostik erforderlich. Die Durchführung der diagnostischen Lumbalpunktion und der präanalytische Umgang mit den Proben richtet sich nach publizierten Standards. Die Interpretation der Resultate muss sorgfältig und im Gesamtkontext aller anderen Befunde erfolgen. Dank bedeutender Fortschritte ist zu erwarten, dass Blutbiomarker und andere kostengünstige und leicht zugängliche Marker sowie spezifische Biomarker für weitere Demenzursachen in wenigen Jahren zur Verfügung stehen werden. Dieser Trend dürfte zu einem deutlich breiteren Einsatz von Biomarkern führen und die Entwicklung wirksamer und personalisiert anwendbarer Präventions- und Behandlungsansätze beschleunigen. Unser Beitrag bietet einen Überblick über den Stand der Entwicklung und beinhaltet Empfehlungen der Swiss Memory Clinics zum Einsatz von Liquormarkern im diagnostischen Prozess. Biomarkers for the diagnosis of cognitive impairment – Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice. Les biomarqueurs dans le diagnostic des troubles cognitifs – Recommandation de Swiss Memory Clinics Résumé. Les biomarqueurs moléculaires du liquide céphalorachidien (LCR) de la pathologie de la maladie d’Alzheimer font désormais partie des outils diagnostiques établis pour l’investigation clinique des troubles cognitifs chez les personnes âgées. Les biomarqueurs permettent un diagnostic différentiel plus précoce et plus précis et sont recommandés par Swiss Memory Clinics en tant qu’examen complémentaire sur la base d’une indication individuelle. Il est indispensable que la situation soit éclaircie et soigneusement discutée avant et après un examen des biomarqueurs. Les procédures de ponction lombaire diagnostique et de manipulation pré-analytique des échantillons doivent en outre suivre les recommandations publiées. L’interprétation des résultats doit prendre en compte les antécédents médicaux et les autres résultats d’examens disponibles. Grâce aux progrès récents, des biomarqueurs sanguins et d’autres marqueurs non-invasifs pourraient être disponibles pour la pratique clinique dans un avenir proche. Cela pourrait conduire à une utilisation beaucoup plus large des biomarqueurs et devrait accélérer le développement d’approches de prévention et de traitement efficaces et personnalisées. Cet article de synthèse offre un aperçu de l’état des lieux des biomarqueurs et présente les recommandations de Swiss Memory Clinics concernant leur utilisation en pratique clinique